Wirkungsabschätzung CO2-Abgabe, Synthese

Seit dem 1.1.2008 wird auf den fossilen Brennstoffen Öl und Erdgas die CO2-Abgabe erhoben. Diese Lenkungsabgabe soll einen Beitrag zur Reduktion der CO2-Emissionen im Rahmen des CO2-Gesetzes leisten. Die Abgabe verteuert die Energieträger Öl und Erdgas im Vergleich zu den nicht besteuerten Energiequellen (bspw. erneuerbare Energien). Mit dem Eingriff ins Preisgefüge sollen finanzielle Anreize geschaffen werden, um Haushalte und Unternehmen zu einem Wechsel von fossilen, CO2-intensiven Energieträgern (bspw. Heizöl) zu CO2-armen bzw. -freien Alternativen oder einem sparsameren Energieverbrauch (bspw. mit Gebäudedämmung) zu motivieren. Die mit der Abgabe erzielten Einnahmen werden zu einem grossen Teil an die Schweizer Bevölkerung und die Unternehmen zurückverteilt. Energieintensive Unternehmen können sich von der CO2-Abgabe befreien lassen. Die Bedingungen dafür sind in der CO2-Verordnung geregelt

Disease Control With Delayed Salvage Radiotherapy for Macroscopic Local Recurrence Following Radical Prostatectomy

Purpose: To retrospectively assess clinical outcomes and toxicity profile of prostate cancer patients treated with delayed dose-escalated image-guided salvage radiotherapy (SRT) for macroscopic local recurrence after radical prostatectomy (RP).Material and Methods: We report on a cohort of 69 consecutive patients with local recurrence after RP and no evidence of regional or distant metastasis who were referred for salvage radiotherapy between 2007 and 2016. SRT consisted of 64–66 Gy (2 Gy/fraction) to the prostatic bed followed by dose escalation to 72–74 Gy (2Gy/fraction) to the macroscopic disease. All patients received concurrent short-term androgen deprivation therapy (ADT). Biochemical recurrence-free survival (bRFS) and clinical progression-free-survival (cPFS) were depicted using Kaplan-Meier method. Multivariable Cox proportional hazards regression assessed predictors of survival outcomes. Baseline, acute, and late urinary and gastrointestinal (GI) toxicity rates were reported using CTCAE v4.03.Results: Median time from RP to SRT was 66 months (IQR: 32–124). Median pre-SRT prostate-specific antigen (PSA) was 2.7 ng/ml (IQR: 0.9–6.5). Median follow-up after SRT was 38 months (IQR: 24–66). The 3- and 5-year bRFS were 58 and 44%, respectively. The 3- and 5-year cPFS were 91 and 76%, respectively. Median time from SRT to clinical disease progression was 102 months (IQR 77.5–165). At baseline, 3 patients (4%) had grade 3 urinary symptoms. Six patients (9%) developed acute and six patients (9%) developed late grade 3 urinary toxicity. Five patients (7%) had acute grade 2 GI toxicity. No acute grade 3 GI toxicity was reported. Late grade 3 GI toxicity was reported in one patient (1.5%).Conclusions: Delayed dose-escalated SRT combined with short-course ADT for macroscopic LR after RP was associated with 44% bRFS and 76% cPFS at 5 years. Albeit improved patient stratification is warranted, these data suggest that delayed SRT provides inferior tumor control compared to early intervention

Identification of novel modulators towards high cell density and high-producing Chinese hamster ovary suspension cell cultures as well as their application in biopharmaceutical protein production

Thalmann B. Identification of novel modulators towards high cell density and high-producing Chinese hamster ovary suspension cell cultures as well as their application in biopharmaceutical protein production. Bielefelder Schriften zur molekularen Biotechnologie. Vol 15. Berlin: Logos; 2015

[Instillation therapies for urothelial carcinoma of the upper urinary tract].

Traditionally, urothelial carcinoma of the upper urinary tract was a clear indication for radical nephroureterectomy with bladder cuff excision. It has been shown that in well-selected patients and depending on tumor stage, a kidney-sparing approach can be pursued with good oncological outcome and equivalent to the radical approach. The prevention of local and bladder recurrences is an important factor. Instillation therapies with bacillus Calmette-Guérin and/or mitomycin C have been successfully used to this end. Due to the low incidence of upper tract urothelial cancer and due to the usually retrospective nature of existing literature, however, data is limited. In this article, we provide a review of the indication, technical execution and results of instillation therapies of the upper urinary tract

Angiotensinergic innervation of the kidney: Localization and relationship with catecholaminergic postganglionic and sensory nerve fibers

We describe an angiotensin (Ang) II-containing innervation of the kidney. Cryosections of rat, pig and human kidneys were investigated for the presence of Ang II-containing nerve fibers using a mouse monoclonal antibody against Ang II (4B3). Co-staining was performed with antibodies against synaptophysin, tyrosine 3-hydroxylase, and dopamine beta-hydroxylase to detect catecholaminergic efferent fibers and against calcitonin gene-related peptide to detect sensory fibers. Tagged secondary antibodies and confocal light or laser scanning microscopy were used for immunofluorescence detection. Ang II-containing nerve fibers were densely present in the renal pelvis, the subepithelial layer of the urothelium, the arterial nervous plexus, and the peritubular interstitium of the cortex and outer medulla. They were infrequent in central veins and the renal capsule and absent within glomeruli and the renal papilla. Ang II-positive fibers represented phenotypic subgroups of catecholaminergic postganglionic or sensory fibers with different morphology and intrarenal distribution compared to their Ang II-negative counterparts. The Ang II-positive postganglionic fibers were thicker, produced typically fusiform varicosities and preferentially innervated the outer medulla and periglomerular arterioles. Ang II-negative sensory fibers were highly varicose, prevailing in the pelvis and scarce in the renal periphery compared to the rarely varicose Ang II-positive fibers. Neurons within renal microganglia displayed angiotensinergic, cate-cholaminergic, or combined phenotypes. Our results suggest that autonomic fibers may be an independent source of intrarenal Ang II acting as a neuropeptide co-transmitter or neuromodulator. The angiotensinergic renal innervation may play a distinct role in the neuronal control of renal sodium reabsorption, vasomotion and renin secretion

Novel prototype sewing device, EndoSew ® , for minimally invasive surgery: an extracorporeal ileal conduit construction pilot study in 10 patients

What's known on the subject? and What does the study add? The EndoSew® prototype was first tested in a porcine model several years ago. The investigators found it both simple to master and reliable, its greatest advantage being a 2.4-fold time saving compared with straight laparoscopic suturing. In addition to that publication, there is a single case report describing the performance of an open EndoSew® suture to close parts (16 cm) of an ileal neobladder. The time for suturing the 16 cm ileum was 25 min, which is in line with our experience. The knowledge on this subject is limited to these two publications. We report on the first consecutive series of ileal conduits performed in humans using the novel prototype sewing device EndoSew®. The study shows that the beginning and the end of the suture process represent the critical procedural steps. It also shows that, overall, the prototype sewing machine has the potential to facilitate the intracorporeal suturing required in reconstructive urology for construction of urinary diversions. Objective To evaluate the feasibility and safety of the novel prototype sewing device EndoSew® in placing an extracorporeal resorbable running suture for ileal conduits. Patients and Methods We conducted a prospective single-centre pilot study of 10 consecutive patients undergoing ileal conduit, in whom the proximal end of the ileal conduit was closed extracorporeally using an EndoSew® running suture. The primary endpoint was the safety of the device and the feasibility of the sewing procedure which was defined as a complete watertight running suture line accomplished by EndoSew® only. Watertightness was assessed using methylene blue intraoperatively and by loopography on postoperative days 7 and 14. Secondary endpoints were the time requirements and complications ≤30 days after surgery. Results A complete EndoSew® running suture was feasible in nine patients; the suture had to be abandoned in one patient because of mechanical failure. In three patients, two additional single freehand stitches were needed to anchor the thread and to seal tiny leaks. Consequently, all suture lines in 6/10 patients were watertight with EndoSew® suturing alone and in 10/10 patients after additional freehand stitches. The median (range) sewing time was 5.5 (3–10) min and the median (range) suture length was 4.5 (2–5.5) cm. There were no suture-related complications. Conclusions The EndoSew® procedure is both feasible and safe. After additional freehand stitches in four patients all sutures were watertight. With further technical refinements, EndoSew® has the potential to facilitate the intracorporeal construction of urinary diversions

Secondary intervention due to symptomatic ureteral stones is not necessary in the majority of patients after previous stenting

Introduction and Objective Over the past 20 years, ureteroscopy (URS) has become one of the most popular treatment options for patients with ureterolithiasis. While prestenting is usually not necessary if the ureteral stones is <1 cm, some clinical situations (e.g. obstructive pyelonephritis) require stent placement for a short period. While the stent dilates the ureter, thus facilitating spontaneous stone passage, the question arises whether secondary intervention is necessary at all. We thus evaluated whether our institutional approach of removing the ureteral stent the day before secondary intervention in local anesthesia can spare the patient this intervention. Methods: Retrospective analysis of 216 patients who had previously been stented due to a symptomatic ureteral stone and who were scheduled for secondary intervention from 01/2013 to 01/2018 at our institution. The stent was removed under local anaesthesia. Patients were told to filter their urine overnight. Spontaneous stone passage or persistence of the stone was documented either by presenting the filtered stone and/or radiologically. To evaluate potential predictors for spontaneous stone passage (stone size, location, composition, stent dwell time, patient age and sex), a multivariable logistic regression was performed. Results: Median stone size was 5 mm (IQR:4-6). 26% of stones were located in the proximal, 25% in the mid-, and 49% in the distal ureter. 129/216 (60%) patients had spontaneous stone passage after a median stent dwell time of 4 weeks (IQR:3-5): 72/129 (56%) before and 57/129 (44%) within 24 hours after stent removal. In only 87/216 (40%) pre-stented patients a secondary intervention was necessary. Multivariable logistic regression analysis showed a significant association between spontaneous stone passage and stone size (OR:0.67, 95%CI: 0.55-0.83; p<0.001), distal stone location (OR:2.17, 95%CI: 1.01-4.67; p=0.049) and stent dwell time (OR:1.20; 95%CI: 1.03-1.40; p=0.02). Conclusions: The majority (60%) of ureteral stones passed spontaneously after senting, especially if they were small and located in the distal ureter; 44% of these stones passed within 24 hours after stent removal. Thus, a stent should be removed at least one day before secondary intervention in order to avoid unnecessary surgery. Characters (not including spaces): 2091 Topic: Stone disease – surgical therapy Key words: ureteral calculi, stents, ureteroscopy Source of funding: Non

An Accurate Diagnostic Pathway Helps to Correctly Distinguish Between the Possible Causes of Acute Scrotum.

Objectives We sought to identify a simplified approach for the rapid differential diagnosis of patients presenting with acute scrotum. Methods A total of 440 patients referred to the emergency department of the University Hospital of Bern, Switzerland, with acute scrotum between 2003 and 2013 were retrospectively analyzed. Simple and multiple binary logistic regression analyses were used to evaluate clinical and laboratory parameters that may help to distinguish between genital/paragenital infection and acute testicular torsion. Results Over half (58.4%; 257/440) of the patients were diagnosed with genital/paragenital infection, 11.8% (52/440) with chronic testicular pain, 9.5% (42/440) with acute testicular torsion, 4.3% (19/440) with a testicular cancer, and 2.5% (11/440) with symptomatic distal ureterolithiasis. In multivariate analysis, a positive Prehn's sign was predictive of testicular torsion, whereas fever, dysuria, high leucocyte counts in blood and/or urine, high blood C-reactive protein, and burning pain were predictive of genital/paragenital infection. Color Doppler ultrasound did not help to distinguish between torsion and infection. Conclusions An accurate diagnostic pathway helps to correctly distinguish between the possible causes of acute scrotum. However, none of the examinations performed could reliably distinguish between acute torsion and other causes of acute scrotum. Therefore, immediate surgical exploration of the testis is mandatory if torsion cannot be ruled out