Einstellungen zur Sterbehilfe bei unheilbar erkrankten Patienten- Eine prospektive multizentrische Untersuchung auf sächsischen Palliativstationen: Einstellungen zur Sterbehilfe bei Patienten mit inkurablem Leiden - ESPIL

Der öffentliche Diskurs um Sterbehilfe hat in den letzten Jahren eine neue Dimension erreicht. Neben der medialen Debatte melden sich verschiedene gesellschaftliche Akteure zu Wort, so die Politik, die Kirchen, Publizisten und Berufsverbände. Eine Vielzahl von plebiszitären Meinungsumfragen zeichnet das Bild einer mehrheitlichen Befürwortung von aktiver Sterbehilfe und Beihilfe zum Suizid in der Bevölkerung. Im Kontrast dazu existieren bislang kaum Daten zu den Einstellungen unter den eigentlich Betroffenen der Diskussion – zu den Haltungen unheilbar kranker Menschen zu Fragen der Euthanasie und ihrer Legitimität. Diese Promotionsarbeit umfasst die Projektierung, Koordination und Realisierung der multizentrischen ESPIL-Studie, die erstmals unheilbar kranke Patienten zu einer Vielzahl von Aspekten der Sterbehilfe befragt. Die vorliegende Dissertationsschrift beinhaltet die Auswertung der durch das Projekt generierten Daten. Im Rahmen der ESPIL-Studie wurden 100Patienten mit unheilbarer Erkrankung und begrenzter Lebenserwartung an sechs Palliativzentren in Sachsen zu diversen Aspekten von aktiver Sterbehilfe und Beihilfe zum Suizid sowie zur passiven und indirekten Sterbehilfe interviewt. Dabei wurde zwischen allgemeinen Einstellungen und Sterbehilfe als individuell denkbare Option für den jeweiligen Studienteilnehmer selbst differenziert. Weitere Fragen explorieren die Haltungen zu Therapiebegrenzung im Kontext inkurabler Erkrankung, zu Triggerfaktoren des Wunsches nach Euthanasie, zur Einbindung von Ärzten und Angehörigen wie auch zum Denken über den Suizid per se. Eine Reihe von Subgruppen- analysen stratifiziert die Ergebnisse nach demografischen Faktoren und beleuchtet damit detailliert einige weitere interessante Aspekte. Im Ergebnis zeigt sich ein differenziertes Bild: Trotz mehrheitlicher Befürwortung der aktiven Sterbehilfe unter den Studienteilnehmern liegen die Zustimmungsraten unter denen der Referenzkollektive aus dem Bevölkerungsquerschnitt. Die Majorität der in Sachsen befragten Palliativpatienten lehnt dagegen den assistierten Suizid ab. Maßnahmen der passiven und indirekten Sterbehilfe werden deutlich befürwortet. Die Daten aus ESPIL stützen die These, dass Palliativmedizin als Alternative in der Lage ist, den Wunsch nach Euthanasie zumindest partiell zu substituieren - allerdings kann dies statistisch nicht gesichert werden. Schließlich werden die Ergebnisse mit denen der Umfragen in der Bevölkerung und unter Ärzten und Pflegenden verglichen und die Situation in anderen Ländern betrachtet. Die Dissertation wirft eine Vielzahl von Fragen auf, die sich aus der täglichen medizinischen Praxis ergeben. Im Vordergrund steht hierbei, ob die Ergebnisse von ESPIL für eine Legalisierung der aktiven Formen von Sterbehilfe sprechen. Nach Analyse der hieraus resultierenden gesellschaftlichen Risiken wird dies klar verneint. Die primäre Motivation für die vorliegende Arbeit ist jedoch die Fokussierung der Euthanasie-Debatte auf die Bedürfnisse der Betroffenen - damit soll ein Beitrag zum Abbau des diesbezüglich bestehenden Defizits im öffentlichen Diskurs geleistet werden

Motion sickness, stress and the endocannabinoid system

A substantial number of individuals are at risk for the development of motion sickness induced nausea and vomiting (N&V) during road, air or sea travel. Motion sickness can be extremely stressful but the neurobiologic mechanisms leading to motion sickness are not clear. The endocannabinoid system (ECS) represents an important neuromodulator of stress and N&V. Inhibitory effects of the ECS on N&V are mediated by endocannabinoid-receptor activation

Contamination of surgical mask during aerosol-producing dental treatments

Objectives Surgical masks are usually contaminated during dental treatment. So far it has not been investigated whether a surgical mask itself can be a source of microbial transmission. The aim of this study was therefore to investigate the microbiological contamination of surgical masks during dental treatment and the transfer of microorganisms from the mask to the hands. Materials and methods Five dental treatment modalities were studied: carious cavity preparation (P-caries, n = 10), tooth substance preparation (P-tooth, n = 10), trepanation and root canal treatment (P-endo, n = 10), supragingival ultrasonic application (US-supra, n = 10), and subgingival periodontal ultrasonic instrumentation (US-sub, n = 10). Bacterial contamination of mask and gloves worn during treatment was tested by imprinting on agar plates. Additionally, before masks were tested, their outer surface was touched with a new sterile glove. This glove was also imprinted on agar. Bacteria were identified by MALDI TOF mass spectrometry. Colony-forming units (CFU) were scored: score 0: 0 CFU, score 1:  102 CFU, score 3: dense microbial growth. Results All masks and all gloves used during treatment displayed bacterial contamination (sample scores 0/1/2/3: masks 0/46/3/1 and gloves 0/31/10/9). After touching the masks with new sterile gloves, microorganisms were recovered with the following contamination scores: P-caries: 4/6/0/0, P-tooth: 2/8/0/0: P-endo: 7/3/0/0, US-supra: 0/9/1/0, US-sub: 2/8/0/0. No statistically significant differences were detected between the treatment modalities. Streptococci spp. and Staphylococci spp. representing the oral and cutaneous flora dominated. Conclusions Surgical masks are contaminated after aerosol-producing dental treatment procedures. Used masks have a potential to be a source of bacterial contamination of the hands. Clinical relevance Dental staff should avoid touching the outer surface of masks with their hands to prevent transmission of pathogens. It is recommendable to change the mask after each treated patient followed by hand disinfection

Niobium based intermetallics as a source of high-current/high-magnetic field superconductors

The article is focused on low temperature intermetallic A15 superconducting wires development for Nuclear Magnetic Resonance, NMR, and Nuclear Magnetic Imaging, MRI, magnets and also on cryogen-free magnets. There are many other applications which would benefit from new development such as future Large Hadron Collider to be built from A15 intermetallic conductors. This paper highlights the current status of development of the niobium based intermetallics with special attention to Nb 3 (Al 1-x, Ge x). Discussion is focused on the materials science aspects of conductor manufacture, such as b-phase (A15) formation, with particular emphasis on the maximisation of the superconducting parameters, such as critical current density, Jc, critical temperature, Tc, and upper critical field, Hc2 . Many successful manufacturing techniques of the potential niobium-aluminide intermetallic superconducting conductors, such as solid-state processing, liquid-solid processing, rapid heating/cooling processes, are described, compared and assessed. Special emphasis has been laid on conditions under which the Jc (B) peak effect occurs in some of the Nb3(Al,Ge) wires. A novel electrodeoxidizing method developed in Cambridge whereby the alloys and intermetallics are produced cheaply making all superconducting electromagnetic devices, using low cost LTCs, more cost effective is presented.This new technique has potential to revolutionise the existing superconducting industry enabling reduction of cost orders of magnitude.Comment: Paper presented at EUCAS'01 conference, Copenhagen, 26-30 August 200

A web-based app to provide personalized recommendations for COVID-19

Peer Reviewe

Nrf2/Keap1-Pathway Activation and Reduced Susceptibility to Chemotherapy Treatment by Acidification in Esophageal Adenocarcinoma Cells

Chronic acid reflux causes cellular damage and inflammation in the lower esophagus. Due to these irritating insults, the squamous epithelium is replaced by metaplastic epithelium, which is a risk factor for the development of esophageal adenocarcinoma (EAC). In this study, we investigated the acid susceptibility in a Barrett’s cell culture in vitro model, using six cell lines, derived from squamous epithelium (EPC1 and EPC2), metaplasia (CP-A), dysplasia (CP-B), and EAC (OE33 and OE19) cells. Cells exposed to acidic pH showed a decreased viability dependent on time, pH, and progression status in the Barrett’s sequence, with the highest acid susceptibility in the squamous epithelium (EPC1 and EPC2), and the lowest in EAC cells. Acid pulsing was accompanied with an activation of the Nrf2/Keap1- and the NFκB-pathway, resulting in an increased expression of HO1—independent of the cellular context. OE33 showed a decreased responsiveness towards 5-FU, when the cells were grown in acidic conditions (pH 6 and pH 5.5). Our findings suggest a strong damage of squamous epithelium by gastroesophageal reflux, while Barrett’s dysplasia and EAC cells apparently exert acid-protective features, which lead to a cellular resistance against acid reflux

Delay of total joint replacement is associated with a higher 90-day revision rate and increased postoperative complications

Purpose Delay of elective surgeries, such as total joint replacement (TJR), is a common procedure in the current pandemic. In trauma surgery, postponement is associated with increased complication rates. This study aimed to evaluate the impact of postponement on surgical revision rates and postoperative complications after elective TJR. Methods In a retrospective analysis of 10,140 consecutive patients undergoing primary total hip replacement (THR) or total knee replacement (TKR) between 2011 and 2020, the effect of surgical delay on 90-day surgical revision rate, as well as internal and surgical complication rates, was investigated in a university high-volume arthroplasty center using the institute’s joint registry and data of the hospital administration. Moreover, multivariate logistic regression models were used to adjust for confounding variables. Results Two thousand four hundred and eighty TJRs patients were identified with a mean delay of 13.5 ± 29.6 days. Postponed TJR revealed a higher 90-day revision rate (7.1–4.5%, p < 0.001), surgical complications (3.2–1.9%, p < 0.001), internal complications (1.8–1.2% p < 0.041) and transfusion rate (2.6–1.8%, p < 0.023) than on-time TJR. Logistic regression analysis confirmed delay of TJRs as independent risk factor for 90-day revision rate [OR 1.42; 95% CI (1.18–1.72); p < 0.001] and surgical complication rates [OR 1.51; 95% CI (1.14–2.00); p = 0.04]. Conclusion Alike trauma surgery, delay in elective primary TJR correlates with higher revision and complication rates. Therefore, scheduling should be performed under consideration of the current COVID-19 pandemic. Level of evidence Level III—retrospective cohort study

Characterization of Total RNA, CD44, FASN, and PTEN mRNAs from Extracellular Vesicles as Biomarkers in Gastric Cancer Patients

In-depth characterization has introduced new molecular subtypes of gastric cancer (GC). To identify these, new approaches and techniques are required. Liquid biopsies are trendsetting and provide an easy and feasible method to identify and to monitor GC patients. In a prospective cohort of 87 GC patients, extracellular vesicles (EVs) were isolated from 250 µL of plasma. The total RNA was isolated with TRIZOL. The total RNA amount and the relative mRNA levels of CD44, PTEN, and FASN were measured by qRT-PCR. The isolation of EVs and their contained mRNA was possible in all 87 samples investigated. The relative mRNA levels of PTEN were higher in patients already treated by chemotherapy than in chemo-naïve patients. In patients who had undergone neoadjuvant chemotherapy followed by gastrectomy, a decrease in the total RNA amount was observed after neoadjuvant chemotherapy and gastrectomy, while FASN and CD44 mRNA levels decreased only after gastrectomy. The amount of RNA and the relative mRNA levels of FASN and CD44 in EVs were affected more significantly by chemotherapy and gastrectomy than by chemotherapy alone. Therefore, they are a potential biomarker for monitoring treatment response. Future analyses are needed to identify GC-specific key RNAs in EVs, which could be used for the diagnosis of gastric cancer patients in order to determine their molecular subtype and to accompany the therapeutic response