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Hintergrund: Durch das Schluckmanöver "Chin down" (Kopfanteflexion) kann das Aspirationsrisiko gesenkt werden. Bei der medizinischen Trinkhilfe "Sippa" der Firma Iuvas wird Flüssigkeit in eine Membran, die über einer Tasse gespannt ist, gefüllt. Durch das Gewicht der Flüssigkeit dehnt sich die Membran in die Tasse aus. Je mehr Flüssigkeit, umso mehr wölbt sich die Membran in die Tasse. Dadurch verbleibt immer Flüssigkeit an der oberen Kante der Tasse. Der Patient kann in aufrechter Position trinken, ohne den Kopf nach vorne zu neigen.Im Rahmen der Studie sollte evaluiert werden, ob mit Hilfe dieses Bechers das Aspirationsrisiko im Vergleich zum Trinken aus einer herkömmlichen Tasse bzw. aus einem Schnabelbecher sinkt.Material und Methoden: Alle 44 Probanden erhielten eine endoskopische Schluckuntersuchung (FEES). 24 Probanden hatten eine strukturelle Dysphagie und 24 Patienten eine neurogene Dysphagie. Zunächst tranken sie einen Einzelschluck und im Anschluss 60 ml Wasser sukzessive jeweils aus einem herkömmlichen Trinkgefäß (Glas oder Schnabelbecher entsprechend der persönlichen Gewohnheit) und dem Sippa-Becher. Die Reihenfolge der Darreichungsform (herkömmliches Trinkgefäß oder Sippa) wurde in einem Cross-Over-Design randomisiert. Dadurch ergeben sich vier Experimentalgruppen. Die Videosequenzen wurden verblindet von zwei Ratern ausgewertet. Die Erfassung der Schlucksicherheit erfolgte mit der Penetration-Aspiration-Scale und der Schluckeffizienz mit der Yale Pharyngeal Residue Severity Rating Scale.Ergebnisse: Die Resultate der 44 Patienten werden präsentiert. Die Ergebnisse der Schlucksicherheit ermittelt durch die Penetration-Aspiriation-Scale und die Schluckeffizienz durch die Yale Pharyngeal Residue Severity Rating Scale wird für den Sippa-Becher und für die herkömmliche Tasse dargestellt. Die Schlucksicherheit der Sukzessivschlucke war signifikant besser mit einem p-Wert von 0,025. Die Schluckeffizient bei Einzelschlucken zeigte eine signifikante Besserung bei den Residuen in den Sinus piriformes (p=0.033) mit der medizinischen Trinkhilfe.Diskussion: Die medizinische Trinkhilfe (Sippa-Becher) hatte in der vorliegenden Studie sowohl signifikante Effekte auf die Schlucksicherheit als auch auf die Schluckeffizienz im Vergleich zum Trinken aus einem herkömmlichen Trinkgefäß (Glas oder Schnabelbecher).Fazit: Patienten, die von dem Schluckmanöver "Chin down" profitieren, haben durch die medizinische Trinkhilfe eine bessere Schlucksicherheit und Schluckeffizienz.

Background: Patients with synchronous clinical stage III melanoma can present with primary melanoma lesions, locally recurrent melanoma or in-transit metastases. Neoad-juvant ipilimumab plus nivolumab induces high pathologic response rates and an impressive relapse-free survival in patients with nodal macroscopic stage III melanoma. Whether primary site melanoma and in-transit metastases respond similarly to lymph node metastases with neoadjuvant immunotherapy is largely unknown. Such data would clarify whether surgical excision of these melanoma lesions should be performed before neoadjuvant therapy or whether it could be deferred and performed in conjunction with lymphadenectomy following neoadjuvant immunotherapy. Patients: Patients with synchronous clinical stage III melanoma were identified from the OpA-CIN, OpACIN-neo and PRADO neoadjuvant trials, where all patients were treated with ipi-limumab plus nivolumab. An additional case treated outside those clinical trials was included. Results: Seven patients were identified; six patients had a concordant response in primary site melanoma lesions or in-transit metastasis and the lymph node metastases. One patient had concordant progression in both the primary and nodal tumour lesions and developed stage IV disease during neoadjuvant treatment, and thus, no resection was performed. Conclusion: Pathologic response following neoadjuvant ipilimumab plus nivolumab in pri-mary site melanoma lesions or in-transit metastasis is concordant with a response in the lymph node metastases, indicating that there may be no need to perform upfront surgery to these melanoma lesions prior to neoadjuvant treatment. (c) 2021 Elsevier Ltd. All rights reserved.

The development of genetic tools allowed for the validation of the pro-aging and pro-disease functions of senescent cells in vivo. These discoveries prompted the development of senotherapies—pharmaceutical interventions aimed at interfering with the detrimental effect of senescent cells—that are now entering the clinical stage. However, unequivocal identification and examination of cellular senescence remains highly difficult because of the lack of universal and specific markers. Here, to overcome the limitation of measuring individual markers, we describe a detailed two-phase algorithmic assessment to quantify various senescence-associated parameters in the same specimen. In the first phase, we combine the measurement of lysosomal and proliferative features with the expression of general senescence-associated genes to validate the presence of senescent cells. In the second phase we measure the levels of pro-inflammatory markers for specification of the type of senescence. The protocol can help graduate-level basic scientists to improve the characterization of senescence-associated phenotypes and the identification of specific senescent subtypes. Moreover, it can serve as an important tool for the clinical validation of the role of senescent cells and the effectiveness of anti-senescence therapies. © 2021, The Author(s), under exclusive licence to Springer Nature Limited.

Background Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. Methods Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. Results 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). Conclusions The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition.