Vergleich der offenen und endoskopischen Therapie des Zenker-Divertikels im Zeitraum von 1977 bis 2008 an der Klinik für Hals-, Nasen- und Ohrenheilkunde der Universität Jena: Bewertung verschiedener Entzündungsparameter und deren Prädiktion für postoperative Komplikationen

Hintergrund: Die Therapie des ZD wird in offen chirurgische und endoskopische Verfahren gegliedert. Zum Vergleich werden Parameter wie Komplikationsrate oder Hospitalisierungsdauer herangezogen. Der postoperative Einsatz einer Magensonde ist ein kontrovers diskutiertes Thema nach ZD-Therapie. Während Leukozytenzahl und CRP bereits etablierte Marker für drohende oder manifeste Komplikationen darstellen, ist die Bestimmung des PCT im Zusammenhang mit Komplikation nach ZD-Therapie ein neuer und noch kritisch zu prüfender Parameter. Material und Methoden: Anhand archivierter Patientenakten erfolgte eine retrospektive Analyse von 65 Patienten mit ZD, die von 1977 bis 2008 an der HNO-Klinik Jena therapiert wurden. Ergebnisse: Die 65 Patienten gliedern sich in 22 offen und 43 endoskopisch Therapierte. Die postoperativen Komplikationen waren ausschließlich von einfachem Charakter und in keinem Fall lebensbedrohlich. Die Komplikationsrate beträgt für das transzervikale Verfahren 5 % und für das endoskopische Verfahren 28 %. Die Hospitalisierungsdauer ist nach transzervikaler Therapie 3 Tage länger als nach endoskopischen Verfahren. Der postoperative Einsatz einer Ernährungssonde korreliert mit einer erhöhten Komplikationsrate. Das PCT zeigt ein direkt proportionales Verhältnis zur Schwere drohender Komplikation. Sprunghafte CRP-Anstieg sind hinsichtlich postoperativer Komplikationen aussagekräftig. Schlussfolgerungen: Aufgrund verkürzter Hospitalisierungsdauer und marginalen postoperativen Komplikationen ist die CO2-Laser-Myotomie dem transzervikalen Verfahren bei der ZD-Therapie vorzuziehen. Im postoperativen Monitoring zeigt das PCT als Einzelwert verlässlich drohende Komplikationen an, während das CRP nur als kontinuierlich gemessener Parameter Aussagekraft besitzt

Empfehlungen für die Austrittsplanung bei Menschen mit Diabetes Mellitus, welche das Risiko einer Rehospitalisation verringern können

Darstellung des Themas: Menschen mit Diabetes Mellitus Typ 2 haben ein hohes Risiko nach einem Spitalaufenthalt rehospitalisiert zu werden. Gründe sind die Komplexität des Krankheitsbilds sowie Schwierigkeiten bei der Austrittsplanung. Pflegefachpersonen nehmen eine zentrale Rolle bei der Betreuung dieser Menschen ein. Ziel: Pflegerische Massnahmen und Angebote aufzeigen, die Menschen mit Diabetes Mellitus Typ 2 beim Austritt vom Akutspital nach Hause brauchen, um einer Rehospitalisation entgegenzuwirken. Methode: Zur Beantwortung der Fragestellung fand eine systematisierte Literaturrecherche statt. Ein- und Ausschlusskriterien sowie das Auswahlverfahren der Studien wurden in einem Flow-Chart festgehalten. Die fünf eingeschlossenen Studien wurden kritisch gewürdigt und diskutiert. Das Nursing model of transition von Schumacher, Jones und Meleis (1999) diente als theoretischer Bezugsrahmen. Ergebnisse: Folgende Pflegemassnahmen und Angebote können aus der Literatur beschrieben werden: Diabetesedukation; Besprechung von Medikamenten; Organisation von Materialien für die Blutzuckermessung und Insulininjektion; Abgabe von Kontaktinformationen; Kommunikation mit den Hausärzten/-innen; Hausbesuche sowie telefonische Kontaktaufnahme nach Spitalaustritt. Schlussfolgerung: Eine Anzahl von Massnahmen und Angeboten kann die Rehospitalisationsrate bei Menschen mit Diabetes Mellitus Typ 2 reduzieren. Pflegefachpersonen haben die Fähigkeit und das Fachwissen diese im Spitalalltag umzusetzen

Mind–body-medicine in oncology—from patient needs to tailored programs and interventions: a cross-sectional study

IntroductionNational and international guidelines recommend early integration of evidence-based multimodal interventions and programs, especially with a focus on relaxation techniques and other Mind–Body-based methods to maintain the quality of life of oncology patients, improve treatment tolerability, and promote healthy lifestyle behaviors. Consequently, we aim to understand what drives patients and how they navigate integrative medicine to best advise them. This study aimed to detect possible topics of particular interest to patients and identify the patient groups that could benefit most from further programs. Furthermore, we aimed to investigate if patients are open-minded toward integrative oncology concepts and learn about their motivational level to maintain or change behavior.MethodsBetween August 2019 and October 2020 we surveyed patients undergoing oncological therapy in a university oncological outpatient center using a custom-developed questionnaire based on established Mind–Body Medicine concepts.ResultsWe included 294 patients with various cancers. More than half reported problems sleeping through (61%) and 42% felt stressed frequently, invariably rating this as detrimental to their health. Moreover, a slight majority (52%) felt physically limited due to their disease and only 30% performed defined exercise programs. Women were significantly more likely to feel stressed and reported with alarming frequency that they often feel “everything was up to them.” The 40–65-year-olds reported significantly less restful sleep, more stress and were more dissatisfied with their situation. However, this group already used natural remedies most frequently and was most often motivated to use relaxation techniques in the next 6 months. The lower the perceived individual energy level (EL), the less frequently patients did sport, the more frequently they felt their disease impaired their activity, mostly feeling stressed and tense. We also found significant associations between negative emotions/thoughts and the variables “sleep,” “use of relaxation techniques,” “personal stress perception,” and “successful lifestyle modification.”ConclusionMind–Body programs that focus on patient’s individual resources, with tools to explore impairing patterns of self-perception and cognitive biases, can be a valuable resource for oncology patients and should therefore be part of an integrative medical treatment concept

Infection of Human Coronary Artery Endothelial Cells by Group B Streptococcus Contributes to Dysregulation of Apoptosis, Hemostasis, and Innate Immune Responses

Early onset sepsis due to group B streptococcus leads to neonatal morbidity, increased mortality, and long-term neurological deficencies. Interaction between septicemic GBS and confluent monolayers of human coronary artery endothelial cells (HCAECs) was analyzed by genome wide expression profiling. In total, 124 genes were differentially expressed (89 upregulated, 35 downregulated) based on a more than 3-fold difference to control HCAEC. Regulated genes are involved in apoptosis, hemostasis, oxidative stress response, infection, and inflammation. Regulation of selected genes and proteins identified in the gene array analysis was confirmed by Real-time RT-PCR assay (granulocyte chemotactic protein 2), ELISA (urokinase, cyclooxygenase 2, granulocyte chemotactic protein 1), and western blotting (Heme oxygenase1, BCL2 interacting protein) at various time points between 4 and 24 hours. These results indicate that GBS infection might influence signalling pathways leading to impaired function of the innate immune system and hemorrhagic and inflammatory complications during GBS sepsis

Designing a model for the global energy system—GENeSYS-MOD : an application of the Open-Source Energy Modeling System (OSeMOSYS)

This paper develops a path for the global energy system up to 2050, presenting a new application of the open-source energy modeling system (OSeMOSYS) to the community. It allows quite disaggregate energy and emission analysis: Global Energy System Model (GENeSYS-MOD) uses a system of linear equations of the energy system to search for lowest-cost solutions for a secure energy supply, given externally defined constraints, mainly in terms of CO2-emissions. The general algebraic modeling system (GAMS) version of OSeMOSYS is updated to the newest version and, in addition, extended and enhanced to include e.g., a modal split for transport, an improved trading system, and changes to storages. The model can be scaled from small-scale applications, e.g., a company, to cover the global energy system. The paper also includes an application of GENeSYS-MOD to analyze decarbonization scenarios at the global level, broken down into 10 regions. Its main focus is on interdependencies between traditionally segregated sectors: electricity, transportation, and heating; which are all included in the model. Model calculations suggests that in order to achieve the 1.5–2 C target, a combination of renewable energy sources provides the lowest-cost solution, solar photovoltaic being the dominant source. Average costs of electricity generation in 2050 are about 4 cents/kWh (excluding infrastructure and transportation costs).DFG, 325093850, Open Access Publizieren 2017 - 2018 / Technische Universität Berli

Unfolding existing Data Publication Practice in Research Data Workflows in the Biological and Environmental Sciences – First Results from a Survey

In recent years, data publication workflows get more and more attention [1,2]. In order to obtain FAIR data [3], reviewers, data curators and other stakeholders have realized that not only the submitted data matter but also the underlying process to create that data within existing research practice. A better understanding of existing data publication practices in research workflows will help service providers such as data repositories (Pangaea [4], ENA [5], GenBank [6]) to support their users with more appropriate services and tools when submitting data, and otherwise, will sustain the role of data repositories in research practice. Such improved coordination will minimize the workload of researchers and data curators and will facilitate the review process of all stakeholders with respect to reproducibility. Furthermore, well-documented data publication workflows may improve data retrieval and finally data reuse in a long run. One obstacle towards comprehensible and properly described research workflows is the fact that data publication workflows in the life sciences are hard to define. Scholars have their very individual disciplinary background, research skills and experiences. In some domains such as biodiversity, scholars work from several weeks to years to collect and analyze often heterogeneous data from various sources, such as collections, environmental or molecular data repositories. Thus, reconstructing their work process after the project is finalized is very difficult if not impossible. However, our goal is to reveal the state of the art on how scholars manage their data in their research practices. We are in the process of setting up a survey whose general structure is organized according to the GFBio Data Lifecycle [7]. The results will allow us to reveal typical data practices workflows that can be used to evaluate the suitability of existing data repository portals, such as GFBio [8]. In our talk, we present the first insights of the survey. KEYWORDS: data publication workflows, data practices, biological and environmental data, green life sciences, biodiversity REFERENCES: 1. Dallmeier-Tiessen, S., Khodiyar, V., Murphy, F., Nurnberger, A., Raymond, L., Whyte, A., 2017. Connecting Data Publication to the Research Workflow: A Preliminary Analysis, International Journal of Digital Curation, 12, https://doi.org/10.2218/ijdc.v12i1.533. 2. González-Beltrán, A., Li, P., Zhao, J., Avila-Garcia, M. S., Roos, M., Thompson, M., van der Horst, E., Kaliyaperumal, R., Luo, R., Lee, T.-L., Lam, T., Edmunds, S.C., Sansone, S.-A., Rocca-Serra, P, 2015. From Peer-Reviewed to Peer-Reproduced in Scholarly Publishing: The Complementary Roles of Data Models and Workflows in Bioinformatics, PLOS ONE 10, 7, pp. 1–20, https://doi.org/10.1371/journal.pone.0127612. 3. Mark D. Wilkinson et al., 2016. The FAIR Guiding Principles for scientific data management and stewardship, Scientific Data 3. https://doi.org/10.1038/sdata.2016.18 4. Pangaea, https://www.pangaea.org 5. ENA, https://www.ebi.ac.uk/ena 6. GenBank, https://www.ncbi.nlm.nih.gov/genbank/ 7. GFBio Data Lifecycle, https://www.gfbio.org/training/materials/data-lifecycle 8. GFBio, https://www.gfbio.or

SchussenAktivplus: reduction of micropollutants and of potentially pathogenic bacteria for further water quality improvement of the river Schussen, a tributary of Lake Constance, Germany

The project focuses on the efficiency of combined technologies to reduce the release of micropollutants and bacteria into surface waters via sewage treatment plants of different size and via stormwater overflow basins of different types. As a model river in a highly populated catchment area, the river Schussen and, as a control, the river Argen, two tributaries of Lake Constance, Southern Germany, are under investigation in this project. The efficiency of the different cleaning technologies is monitored by a wide range of exposure and effect analyses including chemical and microbiological techniques as well as effect studies ranging from molecules to communities

Interleukin-6-dependent survival of multiple myeloma cells involves the Stat3-mediated induction of micro-RNA-21 through a highly conserved enhancer

Signal transducer and activator of transcription 3 (Stat3) is implicated in the pathogenesis of many malignancies and essential for IL-6–dependent survival and growth of multiple myeloma cells. Here, we demonstrate that the gene encoding oncogenic microRNA-21 (miR-21) is controlled by an upstream enhancer containing 2 Stat3 binding sites strictly conserved since the first observed evolutionary appearance of miR-21 and Stat3. MiR-21 induction by IL-6 was strictly Stat3 dependent. Ectopically raising miR-21 expression in myeloma cells in the absence of IL-6 significantly reduced their apoptosis levels. These data provide strong evidence that miR-21 induction contributes to the oncogenic potential of Stat3

Early detection of duodenal cancer by upper gastrointestinal-endoscopy in Lynch syndrome

Small bowel cancer (SBC) is the malignancy with the highest standardized incidence ratio in Lynch syndrome (LS) patients. Of all SBCs, about 50% are duodenal cancers (DCs), therefore being accessible by esophago-gastro-duodenoscopy (EGD) for surveillance. We asked whether early detection of DC is possible for LS patients undergoing surveillance by EGD and if surveillance should be limited to specific subgroups. Data for LS patients with DC were retrieved from the registry of the German Consortium for Familial Intestinal Cancer. Patients undergoing active surveillance by EGDs (surveillance group) were compared to those who did not (nonsurveillance group) regarding tumor stage at diagnosis. Union for International Cancer Control stages I-IIA were defined as early stage disease and IIB-IV as advanced stage disease. Statistical analysis was performed using Fisher's exact test. Among 2015 patients with pathogenic variants in any mismatch-repair-gene, 47 patients with 49 DCs were identified. In 10% of cases, patients were under 35 years at diagnosis; family and personal tumor history did not correlate with DC diagnosis. Pathogenic germline variants in MSH6, PMS2 or EPCAM were present in 10% of patients. Statistical analysis could be performed on 13 DC patients in the surveillance group and 14 in the nonsurveillance group. Early detection was possible for 71% of patients in the surveillance group and 29% of patients in the nonsurveillance group (P = .021). Early detection of DC by EGD in LS patients is feasible regardless of family history, mutational status and should start no later than 25 years of age

MAPKinase inhibition after failure of immune checkpoint blockade in patients with advanced melanoma – an evaluation of the multicenter prospective skin cancer registry ADOREG

Objectives: Forty to sixty percent of patients with advanced melanoma show primary resistance to PD-1-based immunotherapy, 30-40% of initial responders also progress. Here, we evaluated the outcome of second-line targeted therapy (TT) after progression on PD-1-based immune checkpoint inhibition (ICI) in BRAFV600-mutated melanoma. In addition, we report data on the activity of re-exposure with PD-1-based regimes. Methods: Patients with advanced (non- resectable stage III or IV, AJCC 2017, 8th edition) melanoma progressing on PD-1-based ICI (nivolumab, pembrolizumab or ipilimumab plus nivolumab) and receiving second-line BRAF plus MEK inhibition were identified from the prospective multicenter skin cancer registry ADOREG. Results: We identified 108 patients with unresectable stage III or stage IV melanoma progressing on first-line ICI (nivolumab, pembrolizumab or ipilimumab plus nivolumab) and receiving second-line combined BRAF/MEK inhibition. Seventy- three percent of the cohort presented with primary PD-1 resistant disease. Median progression-free survival ( PFS) on ICI was 2.6 (95% CI 2.2-2.9) months. Median PFS on subsequent TT was 6.6 (95% CI 5.4 -7.8) months. Median OS from start of second-line TT was 16.0 (95% CI 11.2-20.8) months. The 3-year PFS and OS rates on second-line TT were 16% and 30%. The objective response rate (ORR) and disease control rate (DCR) to TT were 42.6% and 55.6%. In patients with brain metastases, the ORR and DCR were 31.4% and 43.1%. Patients without brain metastases showed an ORR and DCR of 52.6% and 66.7%, respectively. Response to first-line ICI was associated with a numerically higher ORR and DCR to second-line TT and improved OS on TT. Twenty-three patients received third-line ICI of whom two patients showed an objective response. Conclusions: BRAF plus MEK inhibition shows meaningful activity and outcome in patients with advanced melanoma resistant to anti-PD-1- based immunotherapy. Rates of long- term benefit and survival in our study were similar to those reported for treatment-naive patients receiving first-line MAPKi