Lernen aus Ruanda: die Entwicklung einer wirksamen internationalen Schutzverantwortungspolitik

Im April 1994 begann der Völkermord in Ruanda. In wenigen Wochen starben mehr als 800000 Menschen. Um solche Verbrechen künftig zu verhindern, stimmten die Vereinten Nationen (UN) 2005 der Schutzverantwortung (Responsibility to Protect, R2P) zu. Damit bekräftigten sie die Verpflichtung aller Staaten, ihre Bevölkerung vor schwersten Menschenrechtsverletzungen zu schützen. Versagen die Staaten dabei, kann die internationale Gemeinschaft eingreifen. Das geschah 2011 in Libyen und der Elfenbeinküste. Der Sicherheitsrat billigte den Einsatz militärischer Gewalt, um die Bevölkerung zu schützen, da beide Staaten ihrer Verpflichtung nicht nachkamen. Ein Beschluss zum Eingreifen in Syrien ist dagegen nicht absehbar. Kritiker sehen darin bereits das Ende der Schutzverantwortung. Umstritten ist jedoch ihre Anwendung, nicht die Substanz. Die konzeptionelle und institutionelle Entwicklung deutet vielmehr darauf hin, dass die R2P sich zunehmend etabliert. Durch die Förderung präventiver Maßnahmen kann dies weiter vorangetrieben werden. Deutschland kann dazu wichtige Beiträge leisten. (Autorenreferat

Host Plant Resistance and Pest Control: A Test of the Movement Risk Hypothesis

The potato leafhopper is a major pest of alfalfa. To control this pest, farmers traditionally use pesticides that can be costly and damaging to the environment. Intercropping, in which non-host plants are incorporated into the crop, and host plant resistance, in which the plant is bred for characteristics that negatively affect the pest, are two alternative pest management strategies. Both of these strategies increase leafhopper movement behavior. We hypothesized that increased movement would lead to more pest-predator encounters and reduce leafhopper abundance. This movement risk hypothesis was tested in mesocosms consisting of three plant treatments (susceptible alfalfa, resistant alfalfa, and resistant alfalfa intercropped with orchardgrass) and two predator treatments (predator-present and predator-absent). Nabis americoferus was used as the predator. Results indicate that Nabis was more effective in the resistant and intercropped resistant alfalfa than the susceptible alfalfa, as predicted by the movement risk hypothesis

Cardiac metastasis causes paradoxical malignant embolism

Background Embolic events play an important role in clinical everyday practice. Malignant arterial embolism is a rare nevertheless often fatal entity for cardiac, cerebral or systemic ischemia, requiring immediate diagnosis and treatment. Case This is a case report of a 65 years-old female, suffering from pulmonal adenocarcinoma, who was hospitalized due to neurological deficits caused by an acute ischemic stroke, followed by anterior myocardial infarction within 3 days. Diagnostic work-up revealed metastasis of the pulmonal adenocarcinoma in the right atrium and a patent foramen ovale. Histopathological examination of the coronary embolus verified paradoxical arterial embolism of the pulmonal adenocarcinoma into a coronary vessel and consequently cerebral arteries. Conclusion The present case underlines the need for (i), consideration of malignant embolism, (ii) histopathological examination of the embolus to determine its etiology, and (iii) interdisciplinary discussion of individual therapeutic and prevention strategies in cancer patients with cerebral, cardiac or systemic embolic events

Two-sample survival tests based on control arm summary statistics.

The one-sample log-rank test is the preferred method for analysing the outcome of single-arm survival trials. It compares the survival distribution of patients with a prefixed reference survival curve that usually represents the expected outcome under standard of care. However, classical one-sample log-rank tests assume that the reference curve is known, ignoring that it is frequently estimated from historical data and therefore susceptible to sampling error. Neglecting the variability of the reference curve can lead to an inflated type I error rate, as shown in a previous paper. Here, we propose a new survival test that allows to account for the sampling error of the reference curve without knowledge of the full underlying historical survival time data. Our new test allows to perform a valid historical comparison of patient survival times when only a historical survival curve rather than the full historic data is available. It thus applies in settings where the two-sample log-rank test is not applicable as method of choice due to non-availability of historic individual patient survival time data. We develop sample size calculation formulas, give an example application and study the performance of the new test in a simulation study

BMI-Stratified Exploration of the ‘Obesity Paradox’: Heart Failure Perspectives from a Large German Insurance Database

Background: The global rise of obesity and its association with cardiovascular risk factors (CVRF) have highlighted its connection to chronic heart failure (CHF). Paradoxically, obese CHF patients often experience better outcomes, a phenomenon known as the ‘obesity paradox’. This study evaluated the ‘obesity paradox’ within a large cohort in Germany and explored how varying degrees of obesity affect HF outcome. Methods: Anonymized health claims data from the largest German insurer (AOK) for the years 2014–2015 were utilized to analyze 88,247 patients hospitalized for myocardial infarction. This analysis encompassed baseline characteristics, comorbidities, interventions, complications, and long-term outcomes, including overall survival, freedom from CHF, and CHF-related rehospitalization. Patients were categorized based on body mass index. Results: Obese patients encompassed 21.3% of our cohort (median age 68.69 years); they exhibited a higher prevalence of CVRF (p p p Conclusions: This study underscores favorable short-term outcomes among obese individuals. The ‘obesity paradox’ was confirmed, with more frequent CHF cases and rehospitalizations in the long term, alongside better overall survival for certain degrees of obesity

Acetylation and phosphorylation changes to cardiac proteins in experimental HFpEF due to metabolic risk reveal targets for treatment

Aims: Despite the high prevalence of heart failure with preserved ejection fraction (HFpEF), the pathomechan-isms remain elusive and specific therapy is lacking. Disease-causing factors include metabolic risk, notably obesity. However, proteomic changes in HFpEF are poorly understood, hampering therapeutic strategies. We sought to elucidate how metabolic syndrome affects cardiac protein expression, phosphorylation and acetylation in the Zucker diabetic fatty/Spontaneously hypertensive heart failure F1 (ZSF1) rat HFpEF model, and to evaluate changes regarding their potential for treatment.Main methods: ZSF1 obese and lean rats were fed a Purina diet up to the onset of HFpEF in the obese animals. We quantified the proteome, phosphoproteome and acetylome of ZSF1 obese versus lean heart tissues by mass spectrometry and singled out targets for site-specific evaluation.Key findings: The acetylome of ZSF1 obese versus lean hearts was more severely altered (21 % of proteins changed) than the phosphoproteome (9 %) or proteome (3 %). Proteomic alterations, confirmed by immuno-blotting, indicated low-grade systemic inflammation and endothelial remodeling in obese hearts, but low nitric oxide-dependent oxidative/nitrosative stress. Altered acetylation in ZSF1 obese hearts mainly affected pathways important for metabolism, energy production and mechanical function, including hypo-acetylation of mechan-ical proteins but hyper-acetylation of proteins regulating fatty acid metabolism. Hypo-acetylation and hypo-phosphorylation of elastic titin in ZSF1 obese hearts could explain myocardial stiffening.Significance: Cardiometabolic syndrome alters posttranslational modifications, notably acetylation, in experi-mental HFpEF. Pathway changes implicate a HFpEF signature of low-grade inflammation, endothelial dysfunction, metabolic and mechanical impairment, and suggest titin stiffness and mitochondrial metabolism as promising therapeutic targets