Die Effekte einer Ärzte-Kurzschulung zur Raucherentwöhnung in einer pneumologischen Akutklinik eines Universitätsklinikums

Objective: The objective was to evaluate the effect of a short physician training in smoking cessation on the physicians’ performance of smoking cessation interventions. The effects on patients’ cessation rates were analyzed as well. A further aim was to identify barriers for providing cessation interventions. The study was conducted in an acute care pulmonology department of a German university hospital. Methods: 24 physicians of the pulmonology department of a German university hospital received a two-hour training in smoking cessation. 109 pre- and 89 post-training group patients were compared with regard to the frequencies of received smoking cessation interventions (Ask, Advise, Assist) and three- and six-month abstinence rates. Physicians estimated their intervention frequencies and gave reasons for not providing cessation interventions. Results: In a multivariable analysis (p<0.05), the physicians’ application of “Ask” (OR 3.28, 95% CI 1.13–9.53) and the six-month abstinence rates (OR 2.70, 95% CI 1.24–5.84) were significantly higher in the post-training group. The univariate analysis also showed a significant effect on “Assist” (OR 2.05, 95% CI 1.09–3.87). No significant effect was seen on “Advise to quit”. Physicians overestimated their intervention frequencies and reported the patients’ low motivation to stop, an oncological disease and palliative care situation as barriers to performing smoking cessation. Conclusion: A short physician training in a hospital department of pulmonology increases the use of guideline-based cessation strategies and may improve cessation rates. The findings show that hospital-based strategies such as physician trainings could be useful in the improvement of smoking cessation. Strategies for overcoming barriers for providing smoking cessation interventions are needed.Ziel: Das Ziel war die Evaluation der Effekte einer Ärzte-Kurzschulung zur Raucherentwöhnung auf die Anwendungshäufigkeit der Entwöhnungsstrategien durch die Ärzte. Ebenso wurden die Effekte auf die Abstinenzraten der Patienten untersucht. Außerdem sollten die Barrieren für die Durchführung von Raucherentwöhnungsmaßnahmen ermittelt werden. Die Studie wurde in einer pneumologischen Akutklinik eines deutschen Universitätsklinikums durchgeführt. Methoden: 24 Ärzte erhielten eine zweistündige Schulung zur Raucherentwöhnung. 109 Kontrollgruppenpatienten, die vor der Schulung in der Klinik behandelt wurden, wurden mit 89 nach der Schulung behandelten Studiengruppenpatienten hinsichtlich der Häufigkeit der ärztlichen Raucherentwöhnungsinterventionen (Ask, Advise, Assist) und ihrer Abstinenzraten drei und sechs Monate nach Klinikaufenthalt verglichen. Die Ärzte schätzten ihre Interventionshäufigkeiten und gaben Gründe an, warum sie in manchen Fällen keine Entwöhnungsinterventionen durchführten. Ergebnisse: Die Anwendung von „Ask“ (OR 3.28, 95% KI 1.13–9.53) durch die Ärzte und die Sechsmonats-Abstinenzraten (OR 2.70, 95% KI 1.24–5.84) waren in der Studiengruppe im multivariablen Modell signifikant höher (p<0.05). Bei „Assist“ zeigte nur das univariable Modell einen signifikanten Einfluss der Schulung (OR 2.05, 95% KI 1.09–3.87). Es wurde kein signifikanter Effekt der Schulung auf die Anwendung von „Advise“ festgestellt. Die Ärzte überschätzten ihre Interventionshäufigkeiten und nannten als Gründe für die Nicht-Durchführung einer Raucherentwöhnung eine wahrgenommene geringe Aufhörmotivation der Patienten und das Vorliegen einer onkologischen oder palliativen Krankheitssituation. Fazit: Eine Ärztekurzschulung zur Raucherentwöhnung in einer pneumologischen Akutklinik erhöht den Einsatz von leitlinienbasierten Raucherentwöhnungsstrategien und könnte einen positiven Effekt auf die Abstinenzraten haben. Implikationen: Die Ergebnisse zeigen, dass Krankenhaus-basierte Strategien wie Ärzteschulungen zur Verbesserung der Raucherentwöhnung nützlich sein können. Strategien zur Überwindung von Hindernissen für die Bereitstellung von Maßnahmen zur Raucherentwöhnung sind erforderlich

A structure-guided molecular chaperone approach for restoring the transcriptional activity of the p53 cancer mutant Y220C

Aim: The p53 cancer mutation Y220C creates a conformationally unstable protein with a unique elongated surface crevice that can be targeted by molecular chaperones. We report the structure-guided optimization of the carbazole-based stabilizer PK083. Materials & methods: Biophysical, cellular and x-ray crystallographic techniques have been employed to elucidate the mode of action of the carbazole scaffolds. Results: Targeting an unoccupied subsite of the surface crevice with heterocycle-substituted PK083 analogs resulted in a 70-fold affinity increase to single-digit micromolar levels, increased thermal stability and decreased rate of aggregation of the mutant protein. PK9318, one of the most potent binders, restored p53 signaling in the liver cancer cell line HUH-7 with homozygous Y220C mutation. Conclusion: The p53-Y220C mutant is an excellent paradigm for the development of mutant p53 rescue drugs via protein stabilization. Similar rescue strategies may be applicable to other cavity-creating p53 cancer mutations

Leser-Trélat syndrome in patients affected by six multiple metachronous primitive cancers

Leser-Trélat syndrome is characterized by the eruptive appearance of multiple seborrheic keratoses in association with underlying malignant disease. Usually, the sign of Leser-Trélat is associated with adenocarcinoma, most frequently of the colon, breast, or stomach, but also of the lung, kidney, liver, and pancreas. Herein, we present a case that we believe is the first report of the sign of Leser-Trélat in association with occult gastric adenocarcinoma and the anamnestic oncologic history of five other multiple primitive cancers. Epidermal growth factor receptor (EGFR) immunohistochemical expression analysis of multiple seborrheic keratoses revealed an intense membranous staining in the basal keratinocytes and in all the upper epidermal layers. Patients with the sign of Leser-Trélat should undergo a diagnostic screening programme for malignant disease along with patients with known Leser-Trélat syndrome who present with a recent acute and florid eruption of their seborrheic keratoses. We propose the importance of combining the molecular features of multiple seborrheic keratoses with EGFR immunohistochemistry analyses to determine the likelihood of Leser-Trélat syndrome and the consequent high risk of underlying multiple visceral malignancies

Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test

BACKGROUND: Faecal immunochemical test (FIT) has been recommended to assess symptomatic patients for colorectal cancer (CRC) detection. Nevertheless, some conditions could theoretically favour blood originating in proximal areas of the gastrointestinal tract passing through the colon unmetabolized. A positive FIT result could be related to other gastrointestinal cancers (GIC). AIM To assess the risk of GIC detection and related death in FIT-positive symptomatic patients (threshold 10 mu g Hb/g faeces) without CRC. METHODS: Post hoc cohort analysis performed within two prospective diagnostic test studies evaluating the diagnostic accuracy of different FIT analytical systems for CRC and significant colonic lesion detection. Ambulatory patients with gastrointestinal symptoms referred consecutively for colonoscopy from primary and secondary healthcare, underwent a quantitative FIT before undergoing a complete colonoscopy. Patients without CRC were divided into two groups (positive and negative FIT) using the threshold of 10 mu g Hb/g of faeces and data from follow-up were retrieved from electronic medical records of the public hospitals involved in the research. We determined the cumulative risk of GIC, CRC and upper GIC. Hazard rate (HR) was calculated adjusted by age, sex and presence of significant colonic lesion. RESULTS: We included 2709 patients without CRC and a complete baseline colonoscopy, 730 (26.9%) with FIT >= 10 mu gr Hb/gr. During a mean time of 45.5 +/- 20.0 mo, a GIC was detected in 57 (2.1%) patients: An upper GIC in 35 (1.3%) and a CRC in 14 (0.5%). Thirty-six patients (1.3%) died due to GIC: 22 (0.8%) due to an upper GIC and 9 (0.3%) due to CRC. FIT-positive subjects showed a higher CRC risk (HR 3.8, 95%CI: 1.2-11.9) with no differences in GIC (HR 1.5, 95%CI: 0.8-2.7) or upper GIC risk (HR 1.0, 95%CI: 0.5-2.2). Patients with a positive FIT had only an increased risk of CRC-related death (HR 10.8, 95%CI: 2.1-57.1) and GIC-related death (HR 2.2, 95%CI: 1.1-4.3), with no differences in upper GIC-related death (HR 1.4, 95%CI: 0.6-3.3). An upper GIC was detected in 22 (0.8%) patients during the first year. Two variables were independently associated: anaemia (OR 5.6, 95%CI: 2.2-13.9) and age >= 70 years (OR 2.7, 95%CI: 1.1-7.0). CONCLUSION Symptomatic patients without CRC have a moderate risk increase in upper GIC, regardless of the FIT result. Patients with a positive FIT have an increased risk of post-colonoscopy CRC

Use of IFNγ/IL10 Ratio for Stratification of Hydrocortisone Therapy in Patients With Septic Shock

Large clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may benefit of hydrocortisone treatment depending on their individual immune response. We performed an exploratory analysis of the database from the international randomized controlled clinical trial Corticosteroid Therapy of Septic Shock (CORTICUS) employing machine learning to a panel of 137 variables collected from the Berlin subcohort comprising 83 patients including demographic and clinical measures, organ failure scores, leukocyte counts and levels of circulating cytokines. The identified theranostic marker was validated against data from a cohort of the Hellenic Sepsis Study Group (HSSG) (n = 246), patients enrolled in the clinical trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT, n = 118), and another, smaller clinical trial (Crossover study, n = 20). In addition, in vitro blood culture experiments and in vivo experiments in mouse models were performed to assess biological plausibility. A low serum IFNγ/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this marker for a decision rule, we applied it to three validation sets and observed the same trend. Experimental studies in vitro revealed that IFNγ/IL10 was negatively associated with the load of (heat inactivated) pathogens in spiked human blood and in septic mouse models. Accordingly, an in silico analysis of published IFNγ and IL10 values in bacteremic and non-bacteremic patients with the Systemic Inflammatory Response Syndrome supported this association between the ratio and pathogen burden. We propose IFNγ/IL10 as a molecular marker supporting the decision to administer hydrocortisone to patients in septic shock. Prospective clinical studies are necessary and standard operating procedures need to be implemented, particularly to define a generic threshold. If confirmed, IFNγ/IL10 may become a suitable theranostic marker for an urging clinical need

Use of IFNγ/IL10 Ratio for Stratification of Hydrocortisone Therapy in Patients With Septic Shock

Large clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may benefit of hydrocortisone treatment depending on their individual immune response. We performed an exploratory analysis of the database from the international randomized controlled clinical trial Corticosteroid Therapy of Septic Shock (CORTICUS) employing machine learning to a panel of 137 variables collected from the Berlin subcohort comprising 83 patients including demographic and clinical measures, organ failure scores, leukocyte counts and levels of circulating cytokines. The identified theranostic marker was validated against data from a cohort of the Hellenic Sepsis Study Group (HSSG) (n = 246), patients enrolled in the clinical trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT, n = 118), and another, smaller clinical trial (Crossover study, n = 20). In addition, in vitro blood culture experiments and in vivo experiments in mouse models were performed to assess biological plausibility. A low serum IFNg/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this marker for a decision rule, we applied it to three validation sets and observed the same trend. Experimental studies in vitro revealed that IFNg/IL10 was negatively associated with the load of (heat inactivated) pathogens in spiked human blood and in septic mouse models. Accordingly, an in silico analysis of published IFNg and IL10 values in bacteremic and non-bacteremic patients with the Systemic Inflammatory Response Syndrome supported this association between the ratio and pathogen burden. We propose IFNg/IL10 as a molecular marker supporting the decision to administer hydrocortisone to patients in septic shock. Prospective clinical studies are necessary and standard operating procedures need to be implemented, particularly to define a generic threshold. If confirmed, IFNg/IL10 may become a suitable theranostic marker for an urging clinical need

A Transient “Changing-look” Active Galactic Nucleus Resolved on Month Timescales from First-year Sloan Digital Sky Survey V Data

We report the discovery of a new “changing-look” active galactic nucleus (CLAGN) event, in the quasar SDSS J162829.17+432948.5 at z = 0.2603, identified through repeat spectroscopy from the fifth Sloan Digital Sky Survey (SDSS-V). Optical photometry taken during 2020-2021 shows a dramatic dimming of Δg ≈ 1 mag, followed by a rapid recovery on a timescale of several months, with the ≲2 month period of rebrightening captured in new SDSS-V and Las Cumbres Observatory spectroscopy. This is one of the fastest CLAGN transitions observed to date. Archival observations suggest that the object experienced a much more gradual dimming over the period of 2011-2013. Our spectroscopy shows that the photometric changes were accompanied by dramatic variations in the quasar-like continuum and broad-line emission. The excellent agreement between the pre- and postdip photometric and spectroscopic appearances of the source, as well as the fact that the dimmest spectra can be reproduced by applying a single extinction law to the brighter spectral states, favor a variable line-of-sight obscuration as the driver of the observed transitions. Such an interpretation faces several theoretical challenges, and thus an alternative accretion-driven scenario cannot be excluded. The recent events observed in this quasar highlight the importance of spectroscopic monitoring of large active galactic nucleus samples on weeks-to-months timescales, which the SDSS-V is designed to achieve

A Transient "Changing-look'' Active Galactic Nucleus Resolved on Month Timescales from First-year Sloan Digital Sky Survey V Data

We report the discovery of a new ``changing-look'' active galactic nucleus (CLAGN) event, in the quasar SDSS J162829.17+432948.5 at z=0.2603, identified through repeat spectroscopy from the fifth Sloan Digital Sky Survey (SDSS-V). Optical photometry taken during 2020--2021 shows a dramatic dimming of ${\Delta}$g${\approx}$1 mag, followed by a rapid recovery on a timescale of several months, with the ${\lesssim}$2 month period of rebrightening captured in new SDSS-V and Las Cumbres Observatory spectroscopy. This is one of the fastest CLAGN transitions observed to date. Archival observations suggest that the object experienced a much more gradual dimming over the period of 2011--2013. Our spectroscopy shows that the photometric changes were accompanied by dramatic variations in the quasar-like continuum and broad-line emission. The excellent agreement between the pre- and postdip photometric and spectroscopic appearances of the source, as well as the fact that the dimmest spectra can be reproduced by applying a single extinction law to the brighter spectral states, favor a variable line-of-sight obscuration as the driver of the observed transitions. Such an interpretation faces several theoretical challenges, and thus an alternative accretion-driven scenario cannot be excluded. The recent events observed in this quasar highlight the importance of spectroscopic monitoring of large active galactic nucleus samples on weeks-to-months timescales, which the SDSS-V is designed to achieve.Comment: Published in ApJ

Simple to be Useful: Ecosystem Base for Coastal Management

Os processos de Gerenciamento Costeiro (GC) nas últimas décadas vêm evoluindo, apresentando diferentes métodos de gestão, sendo que uma nova fronteira se encontra na Gestão com Base Ecossistêmica (GBE). No entanto, para colocar em prática a GBE, a qual leva em consideração as funções, os processos e os serviços ecossistêmicos dos ambientes costeiros e marinhos, entendendo-os como um conjunto de ecossistemas compostos por elementos ecológicos (naturais), econômicos e sociais, se faz necessária a base de informação ecossistêmica. O presente trabalho propõe, apresentando resultados aplicados, um roteiro metodológico de seis etapas: 1. Identificar os ecossistemas como “Unidades de Gestão”; 2. Mapear, modelar e simular os ecossistemas; 3. Identificar e classificar os serviços ecossistêmicos; 4. Definir os valores e a qualidade dos serviços; 5. Identificar os espaços de gestão; e 6. Integrar com políticas e demais instrumentos de gestão e legais. As aplicações práticas apresentadas vão desde trabalhos acadêmicos de identificação e caracterização de ambientes costeiros e marinhos a aplicações nos processos de gestão ambiental portuários, passando também pelo desenvolvimento de Zoneamentos Ecológico-Econômicos (ZEEs) em nível regional, por exemplo. Na apreciação integral do conjunto de exemplos e iniciativas para todas as etapas do modelo, depreende-se que a sua aplicação é ampla, variada e consideravelmente simples. Da mesma forma, a multiplicidade de possíveis aplicações do modelo em ações voltadas ao suporte de uma GBE sugere que seu uso pode crescer e buscar iniciativas inovadoras. A expectativa dos autores é de que tal ferramenta possa, de fato, delinear e estimular pesquisas e aplicações com base ecossistêmica na busca da sustentabilidade da costa e do bem-estar de seus atores sociais.In the last decades Coastal Management (CM) processes have been evolving, presenting different management methods, and the new frontier is at the so-called Ecosystem Based Management (EBM). However, to put into practice EBM, which takes into account ecosystem functions, processes and services of coastal and marine environments, understanding them as a set of ecosystems composed of ecological (natural), economic and social elements, it is necessary an ecosystem-based information. The present work proposes, presenting practical results, a methodological path of six stages: 1. Identification of ecosystems as "Management Units"; 2. Mapping, modeling and simulating ecosystems and their connections; 3. Identification and classification of ecosystem services; 4. Definition of values and quality of services; 5. Identification of related management procedures; and 6. Integration with policies and other management and legal tools. The concrete applications range from academic studies of identification and characterization of coastal and marine environments, to port’s environmental management processes, and the development of ecological-economic zoning at regional level, for example. In the full appreciation of the set of examples and initiatives for all stages of the model, it can be concluded that its application is wide, varied and considerably simple. Likewise, the multiplicity of possible applications of the model in practical actions aimed to support of an EBM, suggests that its use can grow and pursue innovative initiatives. The authors' expectation is that such a tool may, in fact, delineate and stimulate research and applications based on ecosystems in the quest for the sustainability of the coast and the well-being of its social actors