Vancomycin-Resistant Enterococci Outbreak, Germany, and Calculation of Outbreak Start

On the basis of a large outbreak of vancomycin-resistant Enterococcus faecium in a German university hospital, we estimated costs (≈1 million Euros) that could have been avoided by early detection of the imminent outbreak. For this purpose, we demonstrate an easy-to-use statistical method

Inter-limb differences in upper quarter mobility/stability are not associated with performance in competitive swimmers

BackgroundThe Y Balance Test–Upper Quarter (YBT–UQ) is a cost-effective, well-established, closed kinetic chain test to assess inter-limb asymmetries in the upper quarter that could negatively affect swimming performance. Thus, the aim of the present study was to determine YBT–UQ performances and inter-limb differences as well as its association with swimming performance in athletes with diverging levels of expertise.MethodsForty female and male competitive swimmers (age range: 10–22 years) with different expertise levels (A-squad: n = 9, B-squad: n = 12, C-squad: n = 19) were tested (reach distances for the YBT–UQ) and swimming performance was calculated using the ratio of individual to world best time.ResultsYBT–UQ performances (i.e., inferolateral reach direction for the dominant arm: p = .027, ηp2 = .12 and the non-dominant arm: p = .031, ηp2 = .17) but not YBT–UQ inter-limb differences significantly differed between groups and were largest in swimmers with the lowest expertise level (i.e., C-squad). Further, YBT–UQ performances (i.e., inferolateral reach direction [r = −.68 to −.70, both p < .05] and composite score [r = −.65 to −.67, both p < .05] for both arms and medial reach direction for the non-dominant arm [r = −.64, p < .05]) but not inter-limb differences were significantly and negatively correlated with swimming performance among B-squad swimmers.ConclusionsOur results suggest that inter-limb differences in upper quarter mobility/stability are not influenced by the level of expertise and have no significant associations with swimming performance. However, greater reach distances were correlated with lower swimming performance for the B-squad swimmers indicating that a training-related increase in upper quarter mobility/stability could worsen swimming performance in those athletes

Smartglass augmented reality-assisted targeted prostate biopsy using cognitive point-of-care fusion technology

Introduction MRI-guided targeted biopsy has become standard of care for diagnosis of prostate cancer, with establishment of several biopsy techniques and platforms. Augmented reality smart glasses have emerged as novel technology to support image-guided interventions. We aimed to investigate its usage while prostate biopsy. Methods MRI with PIRADS-lesions ≥3 was uploaded to smart glasses (Vuzix BladeR) and augmented reality smart glasses-assisted targeted biopsy (SMART-TB) of the prostate was performed using cognitive fusion technology at the point of care. Detection rates were compared to systematic biopsy. Feasibility for SMART-TB was assessed (10 domains from bad [1] to excellent [10]). Results SMART-TB was performed for four patients. Prostate cancer detection was more likely for SMART-TB (46%; 13/28) than for systematic biopsy (27%; 13/48). Feasibility scores were high [8–10] for practicality, multitasking, execution speed, comfort and device weight and low [1–4] for handling, battery and image quality. Median execution time: 28 min; Investment cost smart glass: 1017 USD. Conclusion First description of SMART-TB demonstrated convenient feasibility. This novel technology might enhance diagnosis of prostate cancer in future

First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff : a step-by-step technique

Introduction While various surgical techniques have been reported for open and minimally invasive treatment of upper tract urothelial cancer (UTUC), the procedure of robot-assisted nephroureterectomy (NU) with bladder cuf has never been reported using only retroperitoneum without entering abdominal cavity. We developed a novel port placement and technique allowing to perform robot-assisted NU by a unique retroperitoneal approach. Methods Between February and June 2021 patients with history of UTUC were treated by robot-assisted NU completely restricted to retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical robot. Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed. Results The analysis included fve patients [median age: 73 years; BMI: 27.2 kg/m2 ; Charlson comorbidity index 5]. All fve patients had UTUC with a mean tumor size of 3.02 cm (range 0.9–6.0). UTUC was localized to distal ureter in two and to kidney in three cases. No positive surgical margins were noted for all patients with UTUC [1 low-grade and 4 high-grade]. Retroperitoneal lymphadenectomy in three patients did not reveal positive nodes. No intraoperative adverse events exceeding EAUiaiC classifcation≥2 were observed, while median EBL was 150 ml (IQR 100–250). No patient experienced postopera tive complications exceeding Clavien–Dindo classifcation≥3a. Median hospital stay was 5.4d without any 30-d readmission. Conclusion We demonstrate safety and feasibility of the frst entire robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuf. This surgical technique is easily reproducible, while surgical outcomes are similar to other established techniques

Disease severity in hospitalized COVID-19 patients: comparing routine surveillance with cohort data from the LEOSS study in 2020 in Germany

Introduction Studies investigating risk factors for severe COVID-19 often lack information on the representativeness of the study population. Here, we investigate factors associated with severe COVID-19 and compare the representativeness of the dataset to the general population. Methods We used data from the Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS) of hospitalized COVID-19 patients diagnosed in 2020 in Germany to identify associated factors for severe COVID-19, defined as progressing to a critical disease stage or death. To assess the representativeness, we compared the LEOSS cohort to cases of hospitalized patients in the German statutory notification data of the same time period. Descriptive methods and Poisson regression models were used. Results Overall, 6672 hospitalized patients from LEOSS and 132,943 hospitalized cases from the German statutory notification data were included. In LEOSS, patients above 76 years were less likely represented (34.3% vs. 44.1%). Moreover, mortality was lower (14.3% vs. 21.5%) especially among age groups above 66 years. Factors associated with a severe COVID-19 disease course in LEOSS included increasing age, male sex (adjusted risk ratio (aRR) 1.69, 95% confidence interval (CI) 1.53–1.86), prior stem cell transplantation (aRR 2.27, 95% CI 1.53–3.38), and an elevated C-reactive protein at day of diagnosis (aRR 2.30, 95% CI 2.03–2.62). Conclusion We identified a broad range of factors associated with severe COVID-19 progression. However, the results may be less applicable for persons above 66 years since they experienced lower mortality in the LEOSS dataset compared to the statutory notification data.Peer Reviewe

Smoking Cessation Counselling: What Makes Her or Him a Good Counsellor? Can Counselling Technique Be Deduced to Other Important Lifestyle Counselling Competencies?

Smoking is a major health concern in both developed and developing countries. Smoking cessation counselling is of major importance for health care providers such as physicians, psychologists, nurses and many further therapeutic workers. We recently have demonstrated feasibility of a 4-hour “student-to-student course” (1 hour of scientific background and 3 hours of role plays and intervision) that provided knowledge, skills and attitude to smoking cessation counselling. A key question remains whether such knowledge, skills and attitude can be further deduced to key public health or lifestyle counselling areas like body weight management in overweight persons, management of addictions like alcohol and substance or situation (e.g., Internet and shopping) abuse, management of physical activity/exercise or lifestyle modification like workaholic lifestyle. The authors try to develop such a base for enabling patients to adapt healthier behaviour and give objectives for such counselling situations including the elaboration of clear therapeutic aims for counsellors

Machine learning based prediction of COVID-19 mortality suggests repositioning of anticancer drug for treating severe cases

Despite available vaccinations COVID-19 case numbers around the world are still growing, and effective medications against severe cases are lacking. In this work, we developed a machine learning model which predicts mortality for COVID-19 patients using data from the multi-center ‘Lean European Open Survey on SARS-CoV-2-infected patients’ (LEOSS) observational study (>100 active sites in Europe, primarily in Germany), resulting into an AUC of almost 80%. We showed that molecular mechanisms related to dementia, one of the relevant predictors in our model, intersect with those associated to COVID-19. Most notably, among these molecules was tyrosine kinase 2 (TYK2), a protein that has been patented as drug target in Alzheimer's Disease but also genetically associated with severe COVID-19 outcomes. We experimentally verified that anti-cancer drugs Sorafenib and Regorafenib showed a clear anti-cytopathic effect in Caco2 and VERO-E6 cells and can thus be regarded as potential treatments against COVID-19. Altogether, our work demonstrates that interpretation of machine learning based risk models can point towards drug targets and new treatment options, which are strongly needed for COVID-19

Hospitalized patients dying with SARS-CoV-2 infection—an analysis of patient characteristics and management in ICU and general ward of the LEOSS registry

BACKGROUND: COVID-19 is a severe disease with a high need for intensive care treatment and a high mortality rate in hospitalized patients. The objective of this study was to describe and compare the clinical characteristics and the management of patients dying with SARS-CoV-2 infection in the acute medical and intensive care setting. METHODS: Descriptive analysis of dying patients enrolled in the Lean European Open Survey on SARS-CoV-2 Infected Patients (LEOSS), a non-interventional cohort study, between March 18 and November 18, 2020. Symptoms, comorbidities and management of patients, including palliative care involvement, were compared between general ward and intensive care unit (ICU) by univariate analysis. RESULTS: 580/4310 (13%) SARS-CoV-2 infected patients died. Among 580 patients 67% were treated on ICU and 33% on a general ward. The spectrum of comorbidities and symptoms was broad with more comorbidities (≥ four comorbidities: 52% versus 25%) and a higher age distribution (>65 years: 98% versus 70%) in patients on the general ward. 69% of patients were in an at least complicated phase at diagnosis of the SARS-CoV-2 infection with a higher proportion of patients in a critical phase or dying the day of diagnosis treated on ICU (36% versus 11%). While most patients admitted to ICU came from home (71%), patients treated on the general ward came likewise from home and nursing home (44% respectively) and were more frequently on palliative care before admission (29% versus 7%). A palliative care team was involved in dying patients in 15%. Personal contacts were limited but more often documented in patients treated on ICU (68% versus 47%). CONCLUSION: Patients dying with SARS-CoV-2 infection suffer from high symptom burden and often deteriorate early with a demand for ICU treatment. Therefor a demand for palliative care expertise with early involvement seems to exist

Экспериментальное исследование процесса влагоудаления из различных типов древесной хвойной биомассы при подготовке к получению тепловой энергии.

В результате эксперимента получены результаты изменения массовой скорости испарения, коэффициента аккомодации и парциального давления для хвойных пород древесины. Получены зависимости массовой скорости испарения от температуры, массовой скорости испарения от времени испарения, а также проведен расчет коэффициента аккомодации.As a result of the experiment, the results of changes in the mass evaporation rate, accommodation coefficient and partial pressure for coniferous wood species were obtained. Dependences of the mass evaporation rate on temperature, mass evaporation rate on evaporation time, and calculation of the accommodation coefficient are obtained