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Archives of gynecology and obstetrics 307(3), 699-708 (2023). doi:10.1007/s00404-022-06857-x, Published by Springer, Heidelberg

Pulmonary capillary haemangiomatosis (PCH) is a rare disorder of the lung, well described in adult literature. PCH is characterized by capillary proliferation, infiltrating the interstitium and alveolar walls. This leads to development of respiratory distress and to end-stage pulmonary hypertension. Mostly young adults are affected. The affection of newborn is described in less than ten cases in literature in the past forty years. PCH is a mostly deadly ending disease. We present a preterm born infant with antepartal diagnosed hydrops fetalis, who died 30 minutes after birth. Autopsy revealed PCH as lethal reason and not cardial disease as presumed before.

Altered cerebral hemodynamics are involved in changes in head biometry in fetuses with congenital heart disease (CHD). We compared head growth in different CHD groups with published normative values and investigated whether CHD groups differ from each other in terms of head circumference (HC) development over gestational age (GA). Retrospective cohort study consisting of 248 CHD fetuses. Subgroups were generated according to the expected ascending aorta oxygen saturation: Low placental blood content (BC) and therefore low oxygen delivery to the brain (group 1: n = 108), intermediate placental and systemic BC due to intracardiac mixing of blood (group 2: n = 103), high placental BC (group 3: n = 13) and low placental BC and low oxygen delivery to the brain without mixing of blood (group 4: n = 24). Furthermore, group 1 was divided into antegrade (n = 34) and retrograde (n = 74) flow through the aortic arch. Comparisons were made at a GA of 22, 30 and 38 weeks. Estimated values of zHC (z-score transformed) were not significantly different between the four CHD groups at the three time points in gestation (all p 0.05). Within group 1 fetuses with retrograde aortic arch flow showed a significant negative association between HC and GA compared to reference values (b = -0.054, p 0.001) and had significantly lower zHC values at 38 weeks (-0.836) compared to fetuses with antegrade flow (0.366, p = 0.009). Our data do not confirm that CHD fetuses in general have a significantly smaller HC. HC becomes smaller throughout gestation depending on the direction of aortic arch flow.ZIEL: Änderungen der zerebralen Hämodynamik sind von Bedeutung für die Kopfbiometrie bei Feten mit angeborenem Herzfehler (CHD). Ziel der Studie war es, das Kopfwachstum in verschiedenen CHD-Gruppen mit publizierten Normwerten zu vergleichen und zu untersuchen, ob sich die CHD-Gruppen hinsichtlich der Kopfumfang (KU) -Entwicklung über das Gestationsalter (GA) voneinander unterscheiden. Es handelt sich um eine retrospektive Kohorten-Studie, bestehend aus 248 CHD-Feten. Die CHD-Untergruppen wurden entsprechend der erwarteten Sauerstoffsättigung in der aszendierenden Aorta gebildet: Niedriges plazentares Blutvolumen (BV) und daher geringe Sauerstoffzufuhr zum Gehirn (Gruppe 1: n = 108), intermediäres plazentares und systemisches BV aufgrund einer intrakardialen Vermischung (Gruppe 2: n = 103), hohes plazentares BV (Gruppe 3: n = 13) und schließlich niedriges plazentares BV mit zudem geringer Sauerstoffzufuhr zum Gehirn ohne Vermischung (Gruppe 4: n = 24). Weiterhin wurde Gruppe 1 unterteilt in Feten mit antegradem (n = 34) und retrograden (n = 74) Fluss durch den Aortenbogen. Der Vergleich zwischen den CHD-Untergruppen erfolgte bei einem GA von 22, 30 bzw. 38 Schwangerschaftswochen (SSW). Die geschätzten Werte des zKU (z-Score transformiert) unterschieden sich nicht signifikant zwischen den 4 CHD-Gruppen (p 0,05). Gruppe-1-Feten mit retrogradem Fluss im Aortenbogen zeigten einen signifikant negativen Zusammenhang zwischen zKU und GA im Vergleich zu den Referenzwerten (b = –0,054, p 0,001). Im Alter von 38 SSW hatten Feten mit retrogradem Fluss signifikant niedrigere zKU-Werte (–0,836) im Vergleich zu solchen mit antegradem Fluss (0,366, p = 0,009). Unsere Resultate zeigen, dass CHD-Feten nicht allgemein signifikant geringere KU-Werte aufweisen. Der KU wird mit zunehmenden GA kleiner, abhängig von der Richtung des Flusses im Aortenbogen.

Objectives Cardiac remodeling due to renal dysfunction may have an impact on myocardial function (MF) of fetuses with lower urinary tract obstruction (LUTO). The aim was to identify possible differences in MF in LUTO fetuses compared with healthy controls and to look for interactions between urine biochemistry and MF indices. Methods This is a cohort study consisting of 31 LUTO fetuses and 45 healthy controls. Subgroups were generated according to intrauterine therapy (group 1: LUTO after therapy, group 2: LUTO without therapy at the time of examination, and group 3: controls). MF indices were measured using pulsed wave tissue Doppler imaging and M-mode. Furthermore, results of fetal urine biochemistry were gathered retrospectively. Results Among other findings, right ventricular (RV) e'/a' ratio was lower in group 1 compared with group 3 (p = .050). According to gestational age (GA) level-dependent analysis, RV isovolumetric relaxation time was significantly longer in group 2 compared with group 1 and group 3 at GA level 1 (19 wk of gestation). A significant positive correlation between RV e'/a' ratio and β-2-microglobulin as well as α-1-microglobulin and potassium could be observed. Conclusion We observed differences in MF and an association between ventricular filling pattern and renal protein secretion in LUTO fetuses. This can be interpreted as a sign of intrauterine cardiac remodeling.

The article discusses different kinds of depositions in their specific contexts, such as in temples, cemeteries and settlements. In the focus of this paper are depositions consisting mainly of pottery vessels which are much more common than precious objects but which are often more difficult to differentiate from mere waste. Depositions in connection to tombs are especially diverse and reflect rituals in addition to thosse otherwise known from texts and wall paintings. A case study is dedicated to depositions encountered to the south of the tomb of Djer at Abydos that most probably was arranged during the funeral and which was respected as a sacred place during the whole pharaonic history.

BACKGROUND: Salivary gland hypofunction and xerostomia are major complications to head and neck radiotherapy. This trial assessed the safety and efficacy of adipose tissue-derived mesenchymal stem cell (ASC) therapy for radiation-induced xerostomia. PATIENT AND METHODS: This randomized, placebo-controlled phase 1/2 trial included 30 patients, randomized in a 1:1 ratio to receive ultrasound-guided transplantation of ASCs or placebo to the submandibular glands. Patients had previously received radiotherapy for a T1-2, N0-2A, human papillomavirus-positive, oropharyngeal squamous cell carcinoma. The primary outcome was the change in unstimulated whole salivary flow rate, measured before and after the intervention. All assessments were performed one month prior (baseline) and one and four months following ASC or placebo administration. RESULTS: No adverse events were detected. Unstimulated whole salivary flow rates significantly increased in the ASC-arm at one (33%; P = .048) and four months (50%; P = .003), but not in the placebo-arm (P = .6 and P = .8), compared to baseline. The ASC-arm symptom scores significantly decreased on the xerostomia and VAS questionnaires, in the domains of thirst (-22%, P = .035) and difficulties in eating solid foods (-2%, P = .008) after four months compared to baseline. The ASC-arm showed significantly improved salivary gland functions of inorganic element secretion and absorption, at baseline and four months, compared to the placebo-arm. Core-needle biopsies showed increases in serous gland tissue and decreases in adipose and connective tissues in the ASC-arm compared to the placebo-arm (P = .04 and P = .02, respectively). MRIs showed no significant differences between groups in gland size or intensity (P < .05). CONCLUSIONS: ASC therapy for radiation-induced hypofunction and xerostomia was safe and significantly improved salivary gland functions and patient-reported outcomes. These results should encourage further exploratory and confirmatory trials.

The measurement of safety culture in healthcare is generally regarded as a first step towards improvement. Based on a self-assessment of safety culture, the Frankfurt Patient Safety Matrix (FraTrix) aims to enable healthcare teams to improve safety culture in their organisations. In this study we assessed the effects of FraTrix on safety culture in general practice.We conducted an open randomised controlled trial in 60 general practices. FraTrix was applied over a period of 9 months during three facilitated team sessions in intervention practices. At baseline and after 12 months, scores were allocated for safety culture as expressed in practice structure and processes (indicators), in safety climate and in patient safety incident reporting. The primary outcome was the indicator error management.During the team sessions, practice teams reflected on their safety culture and decided on about 10 actions per practice to improve it. After 12 months, no significant differences were found between intervention and control groups in terms of error management (competing probability=0.48, 95% CI 0.34 to 0.63, p=0.823), 11 further patient safety culture indicators and safety climate scales. Intervention practices showed better reporting of patient safety incidents, reflected in a higher number of incident reports (mean (SD) 4.85 (4.94) vs 3.10 (5.42), p=0.045) and incident reports of higher quality (scoring 2.27 (1.93) vs 1.49 (1.67), p=0.038) than control practices.Applied as a team-based instrument to assess safety culture, FraTrix did not lead to measurable improvements in error management. Comparable studies with more positive results had less robust study designs. In future research, validated combined methods to measure safety culture will be required. In addition, more attention should be paid to evaluation of process parameters. Implemented actions and incident reporting may be more appropriate target endpoints.German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) No. DRKS00000145.

Knapp ein Drittel der Schweizer Bevölkerung raucht. Von diesen Personen möchte jedes Jahr ein großer Anteil mit dem Rauchen aufhören. Bekanntlich werden die Erfolgschancen für einen Rauchstopp durch professionelle Beratung und medikamentöse Unterstützung erheblich verbessert. Um die zahlreichen Rauchstopp-willigen Personen adäquat beraten zu können sind genügend ausgebildete Fachpersonen notwendig. Für die Weiterbildung in Rauchstopp-Beratung gibt es für Ärzte die Möglichkeit eines Kurz- oder Langkurses in Raucherentwöhnung (Frei von Tabak Projekt), für nicht-ärztliche Fachpersonen einen Nachdiplomkurs in Tabakprävention und Raucherentwöhnung und für beide Berufsgruppen gibt es den Hospital QuitSupport workshop, welcher die Beratungsstellen an Spitälern fördert. Ärztliche Rauchstopp-Beratung kann in der Schweiz mittels ambulantem Beratungstarif abgerechnet werden. Ein entsprechender Tarifpunkt existiert noch nicht für die nicht-ärztliche Rauchstopp-Beratung. Dieser Umstand ist ein großes Hindernis für die Etablierung eines flächendeckenden Beratungsnetzwerks in der Schweiz.

Zusammenfassung Hintergrund Das Sicherheitsklima umfasst die sichtbaren Merkmale der Sicherheitskultur. Die jeweilige Auspragung ist mit speziellen Erhebungsinstrumenten wie Fragebogen messbar. Ziel des Projektes war es, das erste deutschsprachige Instrument zu erstellen, mit dem in Hausarztpraxen das Patientensicherheitsklima durch schriftliche Befragung des gesamten Praxisteams gemessen werden kann. Methoden Ausgehend von einem Fragebogen aus den USA sollte ein Instrument entwickelt werden, das in Hausarztpraxen eingesetzt werden kann, die es in dieser Organisations- und Berufsgruppenstruktur, Grose und Wirtschaftsform im Herkunftsland nicht gibt. Daher war ein Anpassungsprozess, bestehend aus folgenden Schritten, notwendig: 1) Ubersetzung des Safety Attitudes Questionnaire, ambulatory version (SAQ-A), 2) Interviews mit Experten fur Qualitatsforderung, um die Inhalte des SAQ-A auf Vollstandigkeit und Gultigkeit im neuen Kontext zu untersuchen, 3) Revision aller Items, 4) kognitives Testen der vorlaufigen Fassung mit Probanden aus der Zielgruppe (Hausarztinnen/e, Medizinische Fachangestellte) und 5) abschliesende Revision. Ergebnisse Es wurde ein 68-Item-Instrument (Fragebogen zum Sicherheitsklima in Hausarztpraxen, FraSiK) entwickelt, der in der Endfassung 36 Items des SAQ-A enthalt. Es wurden 32 Items erganzt, welche die Aspekte Patienteneinbeziehung, Kommunikation, Aus- und Fortbildung, Umgang mit Fehlern und Umgang mit Regeln erfragen. Schlussfolgerung Es waren umfangreiche Veranderungen und Erganzungen des initial ubersetzten SAQ-A notwendig, um ein Instrument zu erhalten, das im soziokulturellen Kontext deutscher Hausarztpraxen Inhalt und Bedeutung von Patientensicherheitskultur messbar macht.

Some case reports mention that Spironolactone, a mineral corticoid antagonist and aldosterone antagonist, reduces binging in patients with bulimia nervosa. Therefore, we decided to study these findings by using a randomized, double-blind, placebo controlled study design. In one study arm, patients with bulimia nervosa were treated with 150 mg Spironolactone per day; in the other arm, patients received a placebo for a total of 8 weeks. The target variables were the number of binges and the bulimia scale of the Eating Disorder Inventory. The study included 93 patients. The results show that the number of binges and the scores on the bulimia scale decreased somewhat, but this occurred in both groups. We were not able to show any significant statistical differences between the Spironolactone group and the placebo group. Additional evaluations, executed with data from the Symptom-Check-List (SCL-90R) and with other scales from the EDI-2 also showed no effect of Spironolactone. Therefore, a treatment with Spironolactone seems to have no effect on bulimia nervosa symptoms.

The experimentally determined molecular structures of 40 transition metal complexes with the tetradentate bispyridine-substituted bispidone ligand, 2,4-bis(2-pyridine)-3,7-diazabicyclo[3.3.1]nonane-9-one [M(bisp)XYZ] n + ;M=Cr I I I , Mn I I , Fe I I , Co I I , Cu I I , Cu I , Zn I I ; X, Y, Z=mono- or bidentate co-ligands; penta-, hexa- or heptacoordinate complexes) are characterized in detail, supported by force-field and DFT calculations. While the bispidine ligand is very rigid (N3...N7 distance =2.933′0.025 A), it tolerates a large range of metal-donor bond lengths (2.07 A < Σ(M-N)/4 < 2.35 A). Of particular interest is the ratio of the bond lengths between the metal center and the two tertiary amine donors (0.84 A < M-N3/M-N7 < 1.05 A) and the fact that, in terms of this ratio there seem to be two clusters with M-N3 < M-N7 and M-N3 ≥ M-N7. Calculations indicate that the two structural types are close to degenerate, and the structural form therefore depends on the metal ion, the number and type of co-ligands, as well as structural variations of the bispidine ligand backbone. Tuning of the structures is of importance since the structurally differing complexes have very different stabilities and reactivities.

Almost one third of the Swiss population smokes. Of these persons a large percentage would like to quit smoking each year. It is well known that the odds to quit successfully are improved by professional counseling and medication support. In order to counsel the numerous smokers interested in quitting a sufficient number of professionals needs to be trained in smoking cessation. For this training a short and extended course in smoking cessation for physicians is available (Frei von Tabak project). For non-physician health professionals there is a postgraduate course in tobacco prevention and smoking cessation and for both groups of professionals there is the Hospital QuitSupport workshop, which aims to support and promote hospital-based smoking cessation counseling. Smoking cessation counseling by physicians is remunerated in the outpatient setting. For non-physician smoking cessation counselling, however, there is no such tarif for remuneration. This drawback presents a considerable obstacle for the establishment of a large-scale smoking cessation counseling network in Switzerland.

Safety climate comprises shared perceptions of safety issues and is a visible feature of a safety culture. Usually self-report questionnaires are used to assess a safety climate. The aim of this project was to develop the first German questionnaire for the assessment of the patient safety climate in general practices.The development of the instrument was based on a US questionnaire. The ambulatory care setting differs considerably between the two countries in terms of organisational and economic issues as well as the number and variety of healthcare professionals. The process of adaptation therefore required the following steps: 1) translation of the Safety Attitudes Questionnaire, ambulatory version (SAQ-A), 2) interviews with experts on quality improvement in order to evaluate the comprehensiveness and relevance of the SAQ-A in the new context, 3) revision of items, 4) pretesting of the preliminary version on a sample of healthcare professionals from general practices and 5) a final revision.The "Fragebogen zum Sicherheitsklima in Hausarztpraxen" (FraSiK) is a questionnaire consisting of 68 items, 36 of which were adapted from the original. Altogether, 32 items, relating to the involvement of patients, communication, education and training, error management and dealing with regulations were added.Substantial changes were made to the original questionnaire and items added in order to obtain an appropriate instrument for the assessment of the content and relevance of patient safety culture in the socio-cultural context of German general practices.

Various DFT and ab initio methods, including B3LYP, HF, SORCI, and LF-density functional theory (DFT), are used to compute the structures, relative stabilities, spin density distributions, and spectroscopic properties (electronic and EPR) of the two possible isomers of the copper(II) complexes with derivatives of a rigid tetradentate bispidine ligand with two pyridine and two tertiary amine donors, and a chloride ion. The description of the bonding (covalency of the copper-ligand interactions) and the distribution of the unpaired electron strongly depend on the DFT functional used, specifically on the nonlocal DF correlation and the HF exchange. Various methods may be used to optimize the DFT method. Unfortunately, it appears that there is no general method for the accurate computation of copper(II) complexes, and the choice of method depends on the type of ligands and the structural type of the chromophore. Also, it appears that the choice of method strongly depends on the problem to be solved. LF-DFT and spectroscopically oriented CI methods (SORCI), provided a large enough reference space is chosen, yield accurate spectroscopic parameters; EDA may lead to a good understanding of relative stabilities; accurate spin density distributions are obtained by modification of the nuclear charge on copper; solvation models are needed for the accurate prediction of isomer distributions.

The electronic absorption spectrum of the mutant of the blue copper protein amicyanin with a pseudoazurin loop (AmiPse) shows a remarkable temperature dependence. The absorption band at approximately 460 nm increases at low temperature while the transition at approximately 600 nm is not much affected by a variation of the temperature. An approximate density functional theory (DFT) study of the active site model [Cu(II)(imidazole)(2)(SCH(3))(S(CH(3))(2))](+) (protein backbone and solvation neglected) leads to two local minimum structures (axial and rhomb) which both have a geometry close to that typical for blue copper proteins. One (rhomb) has two structurally different histidine donors, and this geometry is also found in most experimental type 1 structures. The two forms axial and rhomb are distortional isomers and are energetically almost degenerate. The temperature dependence of the spectrum of AmiPse is interpreted with a temperature-dependent change of the relative population of the two local minimum structures with slightly different energy. The 460 nm transition is believed to be due to preferential population of the structure rhomb; this is in agreement with the published assignment of the high energy transition, based on thorough spectroscopic and computational studies. Consequences of a perturbation of the "gas phase" structures axial and rhomb by the protein and solvation are also discussed on the basis of published, experimentally observed structures and spectroscopic data.

The upper Tigris river valley is located in southeastern Anatolia. Due to the planned construction of the Ilısu Dam, the region has been investigated since the late 1980’s by numerous Turkish and foreign archaeologists, detecting more than six hundred sites dated from Palaeolithic to Medieval periods. Since 2008, 30 rescue excavations have been carried out within the region. On the basis of the excavation data now available, it is possible to attempt a comparison with the initial survey data, focusing on the evolution of settlement patterns throughout the millennia.