Liver surgery in cirrhosis and portal hypertension

The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary or metastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis

Family Health Climate and Adolescents’ Physical Activity and Healthy Eating: A Cross-Sectional Study with Mother-Father-Adolescent Triads

The importance of the family environment for children’s and adolescents’ health behavior has been demonstrated, the underlying mechanisms of this influence remain unclear. Therefore, the aim of the study was to investigate the relationship between family environmental and individual determinants. It was hypothesized that the Family Health Climate (FHC) is associated with adolescents’ physical activity and dietary behavior and that intrinsic motivation mediates this association. Methods Cross-sectional data were collected from 198 families (mother, father, and child) using questionnaires. Perceptions of FHC of mothers, fathers, and their children were assessed using the FHC-scales for physical activity (FHC-PA) and nutrition (FHC-NU). The adolescents also rated their intrinsic motivation for exercise and healthy eating, their physical activity and consumption of healthful food. A structural equation model was analyzed and a bootstrapping procedure was used to test direct and indirect effects. Results The FHC-PA was related to the amount of weekly physical activity and the FHC-NU to the consumption of fruit, vegetables and salad. These effects were mediated by adolescents’ intrinsic motivation; the indirect effects were significant for both behaviors. Discussion These results emphasize the importance of the FHC in shaping adolescents’ physical activity and dietary behavior. Individual motivational factors are potential mediators of family and parental influences. Considering family-level variables and their interaction with individual factors contributes to the understanding of adolescents’ health behavior

The appreciation of nature and landscape by tourism service providers and visitors in the Ore Mountains (Germany)

The paper presents empirical studies on the appreciation of nature and landscape in the Eastern Ore Mountains (Saxony, Germany) by tourism service providers (TSP) and visitors. Attractive landscape and experience of nature are the most important reasons to visit this region and to spend leisure time there. Particularly mountain meadows, raised bogs and mixed forests are highly appreciated. Deforestation, industrial development and the decline of biodiversity would reduce attractiveness for visitors. We also assessed whether the tourism sector is prepared to contribute to the funding of nature conservation and landscape management. Use of general tax revenues is favoured, but other modes would also be accepted, e.g. a nature tax. Willingness to pay (WTP) is ranging between €0.75 and €1.36 per guest per night by TSP, or between €1.06 and €2.73 per day by visitors. With respect to landscape preference and WTP we found in some cases significant differences among visitors, depending on region of residence, age and education level. A major part of the annual costs for nature conservation and landscape could be covered by public funds (taxes), if the results of the WTP approach were understood as a sign of societal demand and a call to action

Can Exercise Enhance the Efficacy of Checkpoint Inhibition by Modulating Anti-Tumor Immunity?

Immune checkpoint inhibition (ICI) has revolutionized cancer therapy. However, response to ICI is often limited to selected subsets of patients or not durable. Tumors that are non-responsive to checkpoint inhibition are characterized by low anti-tumoral immune cell infiltration and a highly immunosuppressive tumor microenvironment. Exercise is known to promote immune cell circulation and improve immunosurveillance. Results of recent studies indicate that physical activity can induce mobilization and redistribution of immune cells towards the tumor microenvironment (TME) and therefore enhance anti-tumor immunity. This suggests a favorable impact of exercise on the efficacy of ICI. Our review delivers insight into possible molecular mechanisms of the crosstalk between muscle, tumor, and immune cells. It summarizes current data on exercise-induced effects on anti-tumor immunity and ICI in mice and men. We consider preclinical and clinical study design challenges and discuss the role of cancer type, exercise frequency, intensity, time, and type (FITT) and immune sensitivity as critical factors for exercise-induced impact on cancer immunosurveillance

Tissue Sampling Guides for Porcine Biomedical Models

This article provides guidelines for organ and tissue sampling adapted to porcine animal models in translational medical research. Detailed protocols for the determination of sampling locations and numbers as well as recommendations on the orientation, size, and trimming direction of samples from approximate to 50 different porcine organs and tissues are provided in the Supplementary Material. The proposed sampling protocols include the generation of samples suitable for subsequent qualitative and quantitative analyses, including cryohistology, paraffin, and plastic histology;immunohistochemistry;in situ hybridization;electron microscopy;and quantitative stereology as well as molecular analyses of DNA, RNA, proteins, metabolites, and electrolytes. With regard to the planned extent of sampling efforts, time, and personnel expenses, and dependent upon the scheduled analyses, different protocols are provided. These protocols are adjusted for (I) routine screenings, as used in general toxicity studies or in analyses of gene expression patterns or histopathological organ alterations, (II) advanced analyses of single organs/tissues, and (III) large-scale sampling procedures to be applied in biobank projects. Providing a robust reference for studies of porcine models, the described protocols will ensure the efficiency of sampling, the systematic recovery of high-quality samples representing the entire organ or tissue as well as the intra-/interstudy comparability and reproducibility of results

Translational research in pituitary tumours

Although effective treatment regimens (surgical resection, drug treatment with dopamine agonists or somatostatin analogues, radiotherapy) have been established for the therapy of most pituitary tumours, a considerable proportion of affected patients cannot completely cured due to incomplete resection or drug resistance. Moreover, even if hormone levels have been normalized, patients with hormone-secreting tumours still show persistent pathophysiological alterations in metabolic, cardiovascular or neuropsychiatric parameters and have an impaired quality of life. In this review reasons for the discrepancy between biochemical cure and incomplete recovery from tumour-associated comorbidities are discussed and the clinical management is delineated exemplarily for patients with acromegaly and Cushing's disease. In view of the development of additional treatment concepts for the treatment of pituitary adenomas we speculate about the relevance of RSUME as a potential target for the development of an anti-angiogenic therapy. Moreover, the role of BMP-4 which stimulates prolactinoma development through the Smad signalling cascade is described and its role as putative drug target for the treatment of prolactinomas is discussed. Regarding the well-known resistance of a part of somatotropinomas to somatostatin analogue treatment, recently identified mechanisms responsible for the drug resistance are summarized and ways to overcome them in future treatment concepts are presented. Concerning novel therapeutic options for patients with Cushing's disease the impact of retinoic acid, which is currently tested in clinical studies, is shown, and the action and putative therapeutic impact of silibinin to resolve glucocorticoid resistance in these patients is critically discussed.Fil: Stalla, Günter K. No especifíca;Fil: Dimopoulou, Christina. Technische Universitat München; AlemaniaFil: Jung Sievers, Caroline. No especifíca;Fil: Arzt, Eduardo Simon. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigación en Biomedicina de Buenos Aires - Instituto Partner de la Sociedad Max Planck; ArgentinaFil: Paez Pereda, Marcelo. Max Planck Institut Fur Psychiatrie; AlemaniaFil: Theodoropoulou, Marily. Technische Universitat München; AlemaniaFil: Ciato, Denis. Technische Universitat München; AlemaniaFil: Renner, Ulrich. Max Planck Institut Fur Psychiatrie; Alemani

Spatial-Explicit Climate Change Vulnerability Assessments Based on Impact Chains. Findings from a Case Study in Burundi

Climate change vulnerability assessments are an essential instrument to identify regions most vulnerable to adverse impacts of climate change and to determine appropriate adaptation measures. Vulnerability assessments directly support countries in developing adaptation plans and in identifying possible measures to reduce adverse consequences of changing climate conditions. Against this background, this paper describes a vulnerability assessment using an integrated and participatory approach that builds on standardized working steps of previously developed ‘Vulnerability Sourcebook’ guidelines. The backbone of this approach is impact chains as a conceptual model of cause–effect relationships as well as a structured selection of indicators according to the three main components of vulnerability, namely exposure, sensitivity and adaptive capacity. We illustrate our approach by reporting the results of a vulnerability assessment conducted in Burundi focusing on climate change impacts on water and soil resources. Our work covers two analysis scales: a national assessment with the aim to identify climate change ‘hotspot regions’ through vulnerability mapping; and a local assessment aiming at identifying local-specific drivers of vulnerability and appropriate adaptation measures. Referring to this vulnerability assessment in Burundi, we discuss the potentials and constraints of the approach. We stress the need to involve stakeholders in every step of the assessment and to communicate limitations and uncertainties of the applied methods, indicators and maps in order to increase the comprehension of the approach and the acceptance of the results by different stakeholders. The study proved the practical usability of the approach at the national level by the selection of three particularly vulnerable areas. The results at a local scale supported the identification of adaption measures through intensive engagement of local rural populations