Search

Background: Pulse wave transit time (PWTT) shows promise for monitoring intravascular fluid status intraoperatively. Presently, it is unknown how PWTT mirrors haemodynamic variables representing preload, inotropy, or afterload. Methods: PWTT was measured continuously in 24 adult volunteers. Stroke volume was assessed by transthoracic echocardiography. Volunteers underwent four randomly assigned manoeuvres: ‘Stand-up’ (decrease in preload), passive leg raise (increase in preload), a ‘step-test’ (adrenergic stimulation), and a ‘Valsalva manoeuvre’ (increase in intrathoracic pressure). Haemodynamic measurements were performed before and 1 and 5 min after completion of each manoeuvre. Correlations between PWTT and stroke volume were analysed using the Pearson correlation coefficient. Results: ‘Stand-up’ caused an immediate increase in PWTT (mean change +55.9 ms, P-value

Zum 7. April 2023 lief der rechtliche bundesweite Rahmen für die sog. Corona-Schutzmaßnahmen aus, d. h., die letzten noch verbliebenen Pflichten, vor allem das Tragen einer FFP2-Maske beim Besuch eines Krankenhauses oder Pflegeheimes, fielen weg, wie es in der „Erste[n] Verordnung zur Änderung der Schutzmaßnahmenaussetzungsverordnung“ vom 24.2.2023 durch die deutsche Bundesregierung beschlossen worden war. Spätestens jetzt sollte die (selbst-)kritische Aufarbeitung der Corona-Pandemie auf wissenschaftlicher Basis im Hinblick auf Erfolge, Folgen und Fehler bei der Pandemiebekämpfung beginnen. Nachfolgend soll daher der Versuch unternommen werden, mithilfe der Präsentation und Interpretation von Daten aus aktuellen Publikationen ein Zwischenfazit zu den möglichen Folgen und Rückwirkungen der Covid-19-Pandemie und der daraus resultierenden (gesundheits-)politischen Maßnahmen für das medizinische Personal mit dem Fokus psychisches Befinden zu ziehen.

Delta-like homolog 1 (Dlk1), an inhibitor of adipogenesis, controls the cell fate of adipocyte progenitors. Experimental data presented here identify two independent regulatory mechanisms, transcriptional and translational, by which Ifrd1 (TIS7) and its orthologue Ifrd2 (SKMc15) regulate Dlk1 levels. Mice deficient in both Ifrd1 and Ifrd2 (dKO) had severely reduced adipose tissue and were resistant to high-fat diet-induced obesity. Wnt signaling, a negative regulator of adipocyte differentiation, was significantly upregulated in dKO mice. Elevated levels of the Wnt/β-catenin target protein Dlk1 inhibited the expression of adipogenesis regulators Pparg and Cebpa, and fatty acid transporter Cd36. Although both Ifrd1 and Ifrd2 contributed to this phenotype, they utilized two different mechanisms. Ifrd1 acted by controlling Wnt signaling and thereby transcriptional regulation of Dlk1. On the other hand, distinctive experimental evidence showed that Ifrd2 acts as a general translational inhibitor significantly affecting Dlk1 protein levels. Novel mechanisms of Dlk1 regulation in adipocyte differentiation involving Ifrd1 and Ifrd2 are based on experimental data presented here.

Im Zuge der Corona-Pandemie haben sich weltweit in den verschiedenen Gesundheitssystemen in unterschiedlichem Ausmaß Fehlentwicklungen und Versäumnisse gezeigt. Aktuelle Ergebnisse der internationalen Versorgungsforschung zeigen, dass die Covid-19-Pandemie bereits bestehende gesundheitliche und sozioökonomische Ungleichheiten bei strukturell marginalisierten Zuwanderergruppen verstärkt hat. Auf der Basis einer selektiven Literaturrecherche zur möglichen Benachteiligung von Migrantinnen und Migranten im Gesundheitssystem im Zuge der Covid-19-Pandemie werden die sich daraus ergebenden Schlussfolgerungen für zukünftige pandemische Situationen, aber auch für den „postpandemischen Versorgungsalltag“ dargelegt. Die aktuelle Datenlage für Deutschland ist schlecht – hier besteht Handlungs- und Forschungsbedarf -, aber in internationalen Übersichtsarbeiten wurden eine Reihe von migrantenspezifischen Risiko- und Vulnerabilitätsfaktoren identifiziert. Zukünftige Pandemiepläne sollten Bevölkerungsgruppen mit besonderen Belastungen ausreichend und angemessen berücksichtigen.

Abstract Background The purpose of this study is to evaluate uterine artery embolization (UAE) for the management of symptomatic uterine leiomyomas regarding changes in quality of life after treatment in a large patient collective. This study retrospectively analyzed prospectively acquired standardized questionnaires of patients treated with UAE. Clinical success was evaluated before and after embolization. Patients were stratified into short- (≤ 7 months) and long-term (> 7 months) follow-up groups depending on the time of completion of the post-interventional questionnaire. Uterine leiomyomas were furthermore divided into small (

Termination of protein synthesis is triggered by the recognition of a stop codon at the ribosomal A site and is mediated by class I release factors (RFs). Whereas in bacteria, RF1 and RF2 promote termination at UAA/UAG and UAA/UGA stop codons, respectively, eukaryotes only depend on one RF (eRF1) to initiate peptide release at all three stop codons. Based on several structural as well as biochemical studies, interactions between mRNA, tRNA, and rRNA have been proposed to be required for stop codon recognition. In this study, the influence of these interactions was investigated by using chemically modified stop codons. Single functional groups within stop codon nucleotides were substituted to weaken or completely eliminate specific interactions between the respective mRNA and RFs. Our findings provide detailed insight into the recognition mode of bacterial and eukaryotic RFs, thereby revealing the chemical groups of nucleotides that define the identity of stop codons and provide the means to discriminate against noncognate stop codons or UGG sense codons.

Im Juni 2021 publizierten Schüttig und Sundmacher im „Monitor Versorgungsforschung“ Ergebnisse einer Delphi-Befragung und einer retrospektiven Datenanalyse dazu, wie sich Fehlinanspruchnahmen in Notaufnahmen potenziell vermeiden lassen. Sie identifizierten von den Autorinnen als „ambulant-sensitiv“ bezeichnete Notfälle, die sie so einstuften, dass hier eine Behandlung potenziell auch durch Vertragsärzte ambulant in der Regelversorgung erfolgen könnte. Im Ergebnis einer Regressionsanalyse zeigten die Autorinnen einen positiven Zusammenhang des Anteils an Personen mit Migrationshintergrund und der Rate der von ihnen so definierten ambulant-sensitiven Notfälle. Die Autorinnen vermuten, dass dies durch kulturelle Unterschiede in der Inanspruchnahme von Kliniknotaufnahmen, aber auch durch Sprachbarrieren erklärt werden kann (Schüttig u. Sundmacher 2021). Der nachfolgende Artikel widmet sich dem Thema, wie häufig und in welchem Ausmaß bei Menschen mit Migrationshintergrund mit einer solchen „Sprachbarriere“ zu rechnen ist und welcher Maßnahmen es bedarf, um diese im deutschen Gesundheitswesen abzubauen oder vielleicht ganz zu beseitigen. Dazu wird sowohl auf eigene Untersuchungsergebnisse der letzten 25 Jahre im Bereich Migrationsforschung/Public Health zurückgegriffen als auch auf allgemein zugängliche Daten des Statistischen Bundesamtes.

Introduction: The aim of this study was to explore a possible relation between myoma-related anxieties and general state or trait anxiety or psychological distress, to get a better understanding of the impact of anxiety on the patients. Methods: This prospective study was conducted at the myoma clinic of a large university hospital in a major European city from November 2016 to February 2017. Patients completed standardized questionnaires on myoma-related fears, the State Trait Anxiety Inventory (STAI), and the Kessler 10. Results: Eighty-five out of 88 women agreed to participate. State-anxiety on the STAI had a mean of 49.4 (11 points above the norm (p

Background Shedding of the endothelial glycocalyx can be observed regularly during sepsis. Moreover, sepsis may be associated with acute respiratory distress syndrome (ARDS), which requires lung protective ventilation with the two cornerstones of application of low tidal volume and positive end-expiratory pressure. This study investigated the effect of a lung protective ventilation on the integrity of the endothelial glycocalyx in comparison to a high tidal volume ventilation mode in a porcine model of sepsis-induced ARDS. Methods After approval by the State and Institutional Animal Care Committee, 20 male pigs were anesthetized and received a continuous infusion of lipopolysaccharide to induce septic shock. The animals were randomly assigned to either low tidal volume ventilation, high tidal volume ventilation, or no-LPS-group groups and observed for 6 h. In addition to the gas exchange parameters and hematologic analyses, the serum hyaluronic acid concentrations were determined from central venous blood and from pre- and postpulmonary and pre- and postcerebral circulation. Post-mortem analysis included histopathological evaluation and determination of the pulmonary and cerebral wet-to-dry ratios. Results Both sepsis groups developed ARDS within 6 h of the experiment and showed significantly increased serum levels of hyaluronic acid in comparison to the no-LPS-group. No significant differences in the hyaluronic acid concentrations were detected before and after pulmonary and cerebral circulation. There was also no significant difference in the serum hyaluronic acid concentrations between the two sepsis groups. Post-mortem analysis showed no significant difference between the two sepsis groups. Conclusion In a porcine model of septic shock and ARDS, the serum hyaluronic acid levels were significantly elevated in both sepsis groups in comparison to the no-LPS-group. Intergroup comparison between lung protective ventilated and high tidal ventilated animals revealed no significant differences in the serum hyaluronic acid levels.

Die derzeitige Pandemie hat schon früh eine Diskussion über den Umgang mit der befürchteten Situation nicht (mehr) ausreichender Beatmungsmöglichkeiten auf Intensivstationen ausgelöst. Um hier die Notwendigkeit von Triage-Entscheidungen zu umgehen, muss zunächst versucht werden, durch organisatorische Maßnahmen so viele intensivmedizinische Kapazitäten wie möglich zur Verfügung zu stellen. Durch das Verschieben planbarer, elektiver Operationen und anderer interventioneller Maßnahmen werden intensivmedizinische Kapazitäten frei und es wird außerdem qualifiziertes Personal freigesetzt. Bisher nicht ausreichend geklärt ist, was eigentlich „elektive Eingriffe“ genau sind und nach welchen Kriterien die Priorisierung und die sich daraus ergebende Verschiebung von Operationen erfolgen soll. Das vorliegende Arbeitspapier möchte hierzu eine Diskussionsgrundlage bieten.

Als eine Reaktion des deutschen Gesundheitssystems auf die Corona-Pandemie haben auch Kinderkliniken bzw. kinderchirurgische Abteilungen wie in der „Erwachsenenchirurgie“ elektive Operationen abgesagt und dringende Operationen priorisiert. Damit sollten zusätzliches Personal für die Betreuung von Intensivpatientinnen und -patienten freigestellt und zusätzliche intensivmedizinische Kapazitäten geschaffen werden. Für eine Situationsbeschreibung ist auf die wichtige, 2020 veröffentlichte gemeinsame Stellungnahme der Deutschen Gesellschaft für Kinderchirurgie (DGKCH), der Deutschen Gesellschaft für Kinder- und Jugendmedizin (DGKJ) und der Deutschen Gesellschaft für pädiatrische Infektiologie (DGPI) zum „Management kinderchirurgischer Patienten in der Covid-19-Pandemie“ hinzuweisen.

Abstract Background Mechanical ventilation can lead to ventilator-induced lung injury (VILI). In addition to the well-known mechanical forces of volutrauma, barotrauma, and atelectrauma, non-mechanical mechanisms have recently been discussed as contributing to the pathogenesis of VILI. One such mechanism is oscillations in partial pressure of oxygen (PO2) which originate in lung tissue in the presence of within-breath recruitment and derecruitment of alveoli. The purpose of this study was to investigate this mechanism’s possible independent effects on lung tissue and inflammation in a porcine model. Methods To separately study the impact of PO2 oscillations on the lungs, an in vivo model was set up that allowed for generating mixed-venous PO2 oscillations by the use of veno-venous extracorporeal membrane oxygenation (vvECMO) in a state of minimal mechanical stress. While applying the identical minimal-invasive ventilator settings, 16 healthy female piglets (weight 50 ± 4 kg) were either exposed for 6 h to a constant mixed-venous hemoglobin saturation (SmvO2) of 65% (which equals a PmvO2 of 41 Torr) (control group), or an oscillating SmvO2 (intervention group) of 40–90% (which equals PmvO2 oscillations of 30–68 Torr)—while systemic normoxia in both groups was maintained. The primary endpoint of histologic lung damage was assessed by ex vivo histologic lung injury scoring (LIS), the secondary endpoint of pulmonary inflammation by qRT-PCR of lung tissue. Cytokine concentration of plasma was carried out by ELISA. A bioinformatic microarray analysis of lung samples was performed to generate hypotheses about underlying pathomechanisms. Results The LIS showed significantly more severe damage of lung tissue after exposure to PO2 oscillations compared to controls (0.53 [0.51; 0.58] vs. 0.27 [0.23; 0.28]; P = 0.0025). Likewise, a higher expression of TNF-α (P = 0.0127), IL-1β (P = 0.0013), IL-6 (P = 0.0007), and iNOS (P = 0.0013) in lung tissue was determined after exposure to PO2 oscillations. Cytokines in plasma showed a similar trend between the groups, however, without significant differences. Results of the microarray analysis suggest that inflammatory (IL-6) and oxidative stress (NO/ROS) signaling pathways are involved in the pathology linked to PO2 oscillations. Conclusions Artificial mixed-venous PO2 oscillations induced lung damage and pulmonary inflammation in healthy animals during lung protective ventilation. These findings suggest that PO2 oscillations represent an independent mechanism of VILI.

Background: The role of emergency services (ES) is to provide round-the-clock acute care. In recent years, inadequate use of ES has been internationally thematised because of overcrowding and the associated cost. Evidence shows that migrant populations tend to use more ES than non-migrant but it remains to show if there is a differential in inadequacy.Method: Quantitative data from consecutive patients visiting three ES in Berlin (hospital-based outpatient clinics for internal medicine or gynecology) from July 2017 to July 2018 were obtained. Utilization was defined as adequate if the patient was admitted to hospital and/or if all of the three following criteria were fulfilled: reported to have been sent by medical staff; reported strong pain; and reported a high urgency (both ≥7, scale from 0 to 10). Differences between migrants (1st generation), their offspring (2nd generation), and non-migrants were evaluated using logistic regression.Results: Of the 2,327 patients included, 901 had a migration background. Adjusting for gender, age, gynecological hospital-based outpatient clinic, and the number of chronic diseases, 1st generation migrant patients (n = 633) had significantly lower odds than non-migrants to have an adequate utilization of services [OR 0.78, 95% confidence interval (0.62, 0.99), p-value 0.046]. For 2nd generation patients (n = 268), no statistically significant difference was found [OR 0.80, 95% confidence interval (0.56, 1.15), p-value 0.231]. Only adjusting for gynecological hospital-based outpatient clinic did weaken the association between migration status on adequacy but interactions between type of hospital-based outpatient clinic and migration were not significant.Discussion: First generation migrants show lower odds of adequate ES use compared to non-migrants. Only visiting a gynecological hospital-based outpatient clinic as opposed to internal medicine could partly explain the lower odds of adequate use among immigrants. This indicates a need for structural changes in the healthcare system: The threshold of access to general practices needs to be lowered, considering the needs of diverse subgroups of migrant patients.

Abstract Background The “Latina paradox” describes the unexpected association between immigrant status, which is often correlated to low socioeconomic status, and low prevalence of unfavourable birth outcomes. Social (e.g. culture, religion) and/or non-social factors related to country of origin are potentially responsible for this paradox. Methods Questionnaire survey of 6413 women delivering in three large obstetric hospitals in Berlin (Germany) covering socioeconomic and migration status, country of origin (Turkey, Lebanon), and acculturation. Data was linked with routine obstetric data. Logistic regressions were performed to assess the effect of acculturation, affinity to religion and country of origin on preterm birth and small-for-gestational-age (SGA). Results Immigrant women with a low level of acculturation (reference) were less likely to have a preterm birth than those who were highly acculturated (aOR: 1.62, 95%CI: 1.01–2.59), as were women from Turkey compared to non-immigrants (aOR: 0.49, 95%CI: 0.33–0.73). For SGA, we found no epidemiologic paradox; conversely, women from Lebanon had a higher chance (aOR: 1.72, 95%CI: 1.27–2.34) of SGA. Affinity to religion had no influence on birth outcomes. Conclusions There is evidence that low acculturation (but not affinity to religion) contributes towards explaining the epidemiologic paradox with regard to preterm birth, emphasising the influence of socioeconomic characteristics on birth outcomes. The influence of Turkish origin on preterm birth and Lebanese origin on SGA suggests that non-social factors relating to the country of origin are also at play in explaining birth outcome differences, and that the direction of the effect varies depending on the country of origin and the outcome.

Abstract Background Cesarean rates are higher in women admitted to labor ward during early stages rather than at later stages of labor. In a study in Germany, crude cesarean rates among Turkish and Lebanese immigrant women were low compared to non-immigrant women. We evaluated whether these immigrant women were admitted during later stages of labor, and if so, whether this explains their lower cesarean rates. Methods We enrolled 1413 nulliparous women with vertex pregnancies, singleton birth, and 37+ week of gestation, excluding elective cesarean deliveries, in three Berlin obstetric hospitals. We applied binary logistic regression to adjust for social and obstetric factors; and standardized coefficients to rank predictors derived from the regression model. Results At the time of admission to labor ward, a smaller proportion of Turkish migrant women was in the active phase of labor (cervical dilation: 4+ cm), compared to women of Lebanese origin and non-immigrant women. Rates of cesarean deliveries were lower in women of Turkish and Lebanese origin (15.8 and 13.9%) than in non-immigrant women (23.9%). In the logistic regression analysis, more advanced cervical dilatation was inversely associated with the outcome cesarean delivery (OR: 0.76, 95%CI: 0.70–0.82). In addition, higher maternal age (OR: 1.06, 95%CI: 1.04–1.09), application of oxytocic agents (OR: 0.55, 95%CI: 0.42–0.72), and obesity (OR: 2.25, 95%CI: 1.51–3.34) were associated with the outcome. Ranking of predictors indicate that cervical dilatation is the most relevant predictor derived from the regression model. Conclusions Advanced cervical dilatation at the time of admission to labor ward does not explain lower emergency cesarean delivery rates in Turkish and Lebanese migrant women, despite the fact that this is the strongest among the predictors for emergency cesarean delivery identified in this study.

The recognition of the mRNA codon by the tRNA anticodon is crucial for protein synthesis. Here the authors introduce non-standard nucleotides in bacterial and eukaryotic mRNA to reveal the minimal hydrogen bond requirement of codon-anticodon interaction for efficient and accurate translation.

Introduction: Patients usually develop subjective concepts about their illness, which then influences their further health behaviors and treatment decisions. This study aimed to evaluate several possible patient beliefs about the causal factors of illness, in a large sample of women seeking treatment for myomas. Methods: From November 2011 to October 2013, all patients at a specialized myoma clinic in a large European city were surveyed about their beliefs about the causes of myomas. We used a modified version of the Patient Theory Questionnaire from Zenz et al., which presented 16 of the most common possible beliefs about the causes of myomas, and asked patients to rate them on a five-point scale of likelihood. Retrospectively, statistical analysis was performed on their answers and sociodemographic data. Results: Data from 482 patients was included (return rate of 91.5%). The most frequent answers for possible causes were “inherited susceptibility for myomas” (67.3%), “reorganization in the body during a particular phase of life” (63.5%), “stress at work or home” (49.3%) and “an in-born tendency to react to emotional agitation with physical disorders” (41.8%). Significant differences were found for the factors of age, immigration background and self-rated knowledge about myomas. Conclusions: It is curious that two of the four most common explanations for myomas were stress and somatization, and were endorsed by nearly half of all patients. Physicians seeing women for myomas should consider that many such patients may have further hidden reasons for seeking medical care.

Abstract Background Oscillations of the arterial partial pressure of oxygen induced by varying shunt fractions occur during cyclic alveolar recruitment within the injured lung. Recently, these were proposed as a pathomechanism that may be relevant for remote organ injury following acute respiratory distress syndrome. This study examines the transmission of oxygen oscillations to the renal tissue and their tidal volume dependency. Methods Lung injury was induced by repetitive bronchoalveolar lavage in eight anaesthetized pigs. Cyclic alveolar recruitment was provoked by high tidal volume ventilation. Oscillations of the arterial partial pressure of oxygen were measured in real-time in the macrocirculation by multi-frequency phase fluorimetry and in the renal microcirculation by combined white-light spectrometry and laser-Doppler flowmetry during tidal volume down-titration. Results Significant respiratory-dependent oxygen oscillations were detected in the macrocirculation and transmitted to the renal microcirculation in a substantial extent. The amplitudes of these oscillations significantly correlate to the applied tidal volume and are minimized during down-titration. Conclusions In a porcine model oscillations of the arterial partial pressure of oxygen are induced by cyclic alveolar recruitment and transmitted to the renal microcirculation in a tidal volume-dependent fashion. They might play a role in organ crosstalk and remote organ damage following lung injury.

Abstract Background In acute respiratory respiratory distress syndrome (ARDS) a sustained mismatch of alveolar ventilation and perfusion (VA/Q) impairs the pulmonary gas exchange. Measurement of endexpiratory lung volume (EELV) by multiple breath-nitrogen washout/washin is a non-invasive, bedside technology to assess pulmonary function in mechanically ventilated patients. The present study examines the association between EELV changes and VA/Q distribution and the possibility to predict VA/Q normalization by means of EELV in a porcine model. Methods After approval of the state and institutional animal care committee 12 anesthetized pigs were randomized to ARDS either by bronchoalveolar lavage (n = 6) or oleic acid injection (n = 6). EELV, VA/Q ratios by multiple inert gas elimination and ventilation distribution by electrical impedance tomography were assessed at healthy state and at five different positive endexpiratory pressure (PEEP) steps in ARDS (0, 20, 15, 10, 5 cmH2O; each maintained for 30 min). Results VA/Q, EELV and tidal volume distribution all displayed the PEEP-induced recruitment in ARDS. We found a close correlation between VA/Q

Abstract Background Dichotomisation of continuous data has statistical drawbacks such as loss of power but may be useful in epidemiological research to define high risk individuals. Methods We extend a methodology for the presentation of comparison of proportions derived from a comparison of means for a continuous outcome to reflect the relationship between a continuous outcome and covariates in a linear (mixed) model without losing statistical power. The so called “distributional method” is described and using perinatal data for illustration, results from the distributional method are compared to those of logistic regression and to quantile regression for three different outcomes. Results Estimates obtained using the distributional method for the comparison of proportions are consistently more precise than those obtained using logistic regression. For one of the three outcomes the estimates obtained from the distributional method and from logistic regression disagreed highlighting that the relationships between outcome and covariate differ conceptually between the two models. Conclusion When an outcome follows the required condition of distribution shift between exposure groups, the results of a linear regression model can be followed by the corresponding comparison of proportions at risk. This dual approach provides more precise estimates than logistic regression thus avoiding the drawback of the usual dichotomisation of continuous outcomes.