Analyse der Komplikationen nach Sigmaresektion - Gibt es einen Unterschied in Hinblick auf den Operationszeitpunkt?

Von Januar 2011 bis einschließlich April 2013 wurden am Universitätsklinikum Tübingen 154 Sigmaresektionen aufgrund einer Divertikelkrankheit durchgeführt. Aufgrund von 5 zusätzlich notwendigen Operationen wurden insgesamt 159 Prozeduren durchgeführt. Die Prozeduren wurden anhand einer retrospektiven Studie auf ihr Outcome untersucht. Die Kohorte wurde je nach Abstand zwischen Symptombeginn und Operation sowie Eingriffsart in drei bzw. sechs Gruppen eingeteilt. Von der Kohorte der 154 Patienten wurden 112 Patienten (72,7%) laparoskopisch und 42 (27,3%) offen operiert. Sie bestand aus 80 (52,9%) Frauen und 74 (48,1%) Männern. Das durchschnittliche Alter der Gesamtkohorte betrug 59,5 Jahre. Mit 62 Fällen wurde der Großteil nach einem rezidivierenden Schub operiert (63,3%). Die meisten Patienten waren dem ASA-Stadium II zugeteilt (n=104 bzw. 67,5%). Die durchschnittliche Operationsdauer betrug 177,8 Minuten. Insgesamt führten 16 verschiedene Operateure die Eingriffe durch. Die mittlere präoperative Liegedauer betrug 2,1 Tage, postoperativ 8,7 und gesamt 10,9 Tage. Von Symptombeginn bis zur Operation vergingen im Schnitt 58 Tage. Bei den meisten Patienten wurde präoperativ das Stadium IIB nach Hansen und Stock diagnostiziert (n=42 bzw. 28%). Von der Koloskopie bis zur Operation vergingen im Mittel 246 Tage. Endoskopisch zeigten sich in 39 Fällen (36,8%) akute Entzündungszeichen. Der mittlere CRP-Wert betrug 5,89 mg/dl und der mittlere Leukozytenwert 8.421,96/l. Die Komplikationsrate der Gesamtgruppe betrug 37,74%. Die häufigsten Komplikationen waren Wundheilungsstörungen. 7 der insgesamt 60 Komplikationen konnten auf Grunderkrankungen der Patienten zurückgeführt werden. Die Arbeitshypothese besagte, dass die Patienten, bei denen der Eingriff in einem Zeitraum von 10-42 Tagen nach Symptombeginn stattfand, in einem ungünstigen Zeitintervall operiert wurden, was die Gewebefestigkeit nach einer Entzündung betrifft. Indikator hierfür wäre eine signifikant höhere Komplikationsrate der Gruppe II im Gegensatz zu den später operierten Patienten (Gruppe III) gewesen. Diese Hypothese bestätigte sich nicht, denn die besagte früher operierte Gruppe II bot entgegen der Erwartungen sogar eine niedrigere Komplikationsrate (25%) als die später operierte Gruppe III (30,91%). Diese Tatsache änderte sich auch nicht nach Herausrechnung der auf die Grunderkrankungen der Patienten zurückzuführenden Komplikationen (dann 25% vs. 29,09%). Bei der Betrachtung nach Eingriffsart war festzustellen, dass sich der Eindruck der Gesamtgruppe bei den laparoskopisch operierten Patienten nachvollziehen ließ, bei den offen operierten Patienten jedoch das Gegenteil der Fall war: Hier sank die Komplikationsrate im zeitlichen Verlauf deutlich ab. Die hohe Komplikationsrate bei den offenen Notfalleingriffen war zu einem bedeutenden Teil auf die Grunderkrankungen der Patienten zurückzuführen. Als Schlussfazit könnte man daher ziehen, dass bei laparoskopischen Eingriffen auch bei schwerkranken Patienten besonders frühzeitig mit einem guten Outcome gerechnet werden kann, während bei offenen elektiven Operationen ein möglichst später Eingriff sinnvoll zu sein scheint. Vor allem bei den offenen Notfalleingriffen sollte verstärkt auf die Grunderkrankungen der Patienten geachtet werden, um unnötige Komplikationen zu vermeiden

Interindividual variabilities in cognitive performance degradation after alcohol consuption and sleep loss are related

Introduction The sleep inducing effects of alcohol as well as the increase in sleep propensity and sleepiness after sleep loss have been linked to the adenosinergic system in the brain. While the performance impairing effects of ethanol have partly been related to the inhibitory effects of cerebral adenosine, sleep loss has been found to increase adenosine receptor density. The interindividual variability of cognitive performance impairments after alcohol intake as well as after sleep loss is extensive. Thus, we examined in humans whether performance degradations resulting from sleep loss and alcohol consumption are related. Methods Performance in a 10-min Psychomotor Vigilance Task (PVT) was tested in 47 healthy volunteers (mean age 27 ± 5 (SD) years, 21 females) at 6 pm 1) after an 8 hour control night, 2) after alcohol consumption (aiming at a blood alcohol concentration (BAC) of 0.08%), and 3) after 35 hours of total sleep deprivation. After alcohol intake, 35 of the participants reached a BAC of more than 0.06% prior to the performance testing (mean BAC 0.074%, SD 0.009%, min. 0.063%, max. 0.095%) and were included in the analyses. Two recovery nights were scheduled between conditions. Results Performance impairments due to acute alcohol intake and due to 35 hours of sustained wakefulness were calculated as differences from performance under control conditions. The degree in performance degradation correlated highly between both conditions (i.e. 10% slowest reaction times: Pearson’s r=0.73, p<0.0001; standard deviation of reaction times: r=0.75, p<0.0001; mean reaction time: r=0.59, p=0.0002). Conclusions Participants whose PVT performance proved to be vulnerable to the effects of alcohol consumption were also vulnerable to sleep loss, whereas individuals who were resilient against the effects of alcohol were also less susceptible to the impact of sleep deprivation. These results suggest that the effects of alcohol and sleep deprivation on performance are mediated – at least in part – by a common pathway that may involve the adenosinergic system in the brain

Catalyzing cooling tower efficiency : a novel energy performance indicator and functional unit including climate and cooling demand normalization

Energy and climate targets necessitate efficiency indicators to reflect resource-saving potentials. Prevailing indicators for cooling towers, however, often omit the effect of outside conditions. Hence, this study introduces an innovative indicator grounded in the energy efficiency ratio. Our proposed metric is the cost–benefit ratio between electricity demand and the thermodynamic minimum airflow. Thus, we call the novel indicator the airflow performance indicator. To validate its feasibility, we apply the indicator first to an extensive dataset encompassing 6575 cooling tower models and second to a year-long case study involving a data center’s wet cooling system. As a result, the energy performance indicator demonstrates that dry cooling requires eight times more minimum airflow at the median than evaporative cooling would, directly correlating to the fan power. Furthermore, efficiency benchmarks derived from the dataset of 6575 cooling tower models provide a comparative assessment of the case study. Defining the quantified benefit as minimum airflow additionally underscores the limitations of free cooling as the wet cooling system only partly covers the cooling demand, requiring chillers additionally. In conclusion, the indicator empowers the identification of energy-saving potentials in the selection, design, and operation of cooling towers. Moreover, the functional unit definition provides a foundation for future life cycle assessments of cooling towers, enhancing cooling tower efficiency and sustainability

Hepatic Energy Metabolism under the Local Control of the Thyroid Hormone System

The energy homeostasis of the organism is orchestrated by a complex interplay of energy substrate shuttling, breakdown, storage, and distribution. Many of these processes are interconnected via the liver. Thyroid hormones (TH) are well known to provide signals for the regulation of energy homeostasis through direct gene regulation via their nuclear receptors acting as transcription factors. In this comprehensive review, we summarize the effects of nutritional intervention like fasting and diets on the TH system. In parallel, we detail direct effects of TH in liver metabolic pathways with regards to glucose, lipid, and cholesterol metabolism. This overview on hepatic effects of TH provides the basis for understanding the complex regulatory network and its translational potential with regards to currently discussed treatment options of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) involving TH mimetics

Hepatitis B Immunoglobulin discontinuation in long‐term liver transplant patients

Background: Hepatitis B immunoglobulin (HBIG)-as a monotherapy or combined with nucleos(t)ide analogs (NUCs)-has effectively lowered Hepatitis B virus (HBV) reinfection after liver transplantation. However, it is associated with high costs and viral resistance. HBIG-free prophylaxis with novel NUCs (tenofovir, entecavir) composes a viable alternative. We evaluated reinfection rate, histological changes, and outcome associated with HBIG discontinuation. Methods: A retrospective analysis was performed of patients undergoing liver transplantation due to HBV-induced liver disease at our center since 1988. A controlled HBIG discontinuation was conducted between 2015 and 2017 in 65 patients. Recurrent infection was determined by HbsAg values. Fibrosis and inflammation were evaluated by routine biopsy. The survival of patients after HBIG discontinuation was compared to a control population on HBIG for prophylaxis. Results: From 1988 to 2013, 352 patients underwent liver transplantation due to HBV-induced liver disease. 169 patients could be included for analysis. 104 (51.5%) patients continued a prophylaxis containing HBIG. HBIG was discontinued in 65 (38.5%) patients in a controlled manner, maintaining an oral NUC. None of those patients showed HBV reinfection or graft dysfunction. No significant changes of inflammation grades (P = .067) or fibrosis stages (P = .051) were detected. The survival of patients after HBIG discontinuation was comparable to the control (P = .95). Conclusion: HBIG withdrawal under continuation of oral NUC therapy is safe and not related to graft dysfunction, based on blood tests and histology. HBIG-free prophylaxis is not associated with a worse outcome and displays a financial relief as well as a logistic simplification during long-term follow-up

A nematode-specific ribonucleoprotein complex mediates interactions between the major nematode spliced leader snRNP and its target pre-mRNAs

Acknowledgements We thank Maheshika Kurukulasuriya for her assistance with immunoprecipitations from embryo extracts. Some strains were provided by the Caenorhabditis Genetics Center, which is funded by NIH Office of Research Infrastructure Programs (P40 OD010440). Sequencing was performed by the Centre for Genome-Enabled Biology and Medicine of the University of Aberdeen, and proteomics analysis by the Aberdeen proteomics facility. We thank Kate Burgoyne and Craig Pattinson (Aberdeen Proteomics) for technical support. We thank WormBase for providing the community resource that facilitated the interrogation of C. elegans molecular genetics used in this work . Author contribution: P.E., M.A., E.S.-M., R.F., M.W., B.M. and J.P. contributed experiments. J.P. and B.M. conceived the research and managed and coordinated the research activity; J.P. and B.M. acquired funding for the project; D.S. guided the proteomics analysis, M.W., B.M. and J.P. designed and implemented the computational analysis; M.W., B.M. and J.P. wrote the manuscript and prepared figures and tables.Peer reviewe

Evaluierung des Förderungsprogramms IÖB-Toolbox

Innovationsfördernde öffentliche Beschaffung (IÖB) ist in Österreich seit 2007 Thema und in der nationalen Agenda der Innovationspolitik strategisch wie inhaltlich gut verankert. Wesentliche Meilensteine der Umsetzung des 2012 beschlossenen Leitkonzepts für eine innovationsfördernde öffentliche Beschaffung der letzten Jahre sind auf organisatorischer Ebene die Etablierung eines IÖB-Service Netzwerkes mit der IÖB-Servicestelle als Knotenpunkt und komplementären IÖB-Kompetenz- und Kontaktstellen. Die gegenständliche Evaluierung baut auf der Zwischenevaluierung des Förderungsprogramm von 2021 auf, in welcher die Genese und die Entwicklung der IÖB-Toolbox in der ersten Programmphase (2019-2020) im Vordergrund stand. Ziel der vorliegenden Untersuchung ist es, die Konzeption und die bisherige Umsetzung des Förderungsprogramms seit dessen Start im Jahr 2019, über die zweite Förderperiode (2021) bis hin zur aktuellen, dritten Förderperiode (2022-2023) gesamthaft zu beleuchten

Self‐limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30‐year liver transplant program

Background: A self-limited hepatitis B infection can reactivate in patients under immunosuppression or chemotherapy (reappearance of hepatitis B surface antigen (HBsAg) or HBV-DNA). Exact circumstances of HBV reactivation in patients undergoing liver transplantation (LT) for end-stage liver diseases (ESLD) unrelated to HBV are unknown, and recommendations on HBV prophylaxis remain unclear. Patients and methods: Among 1273 liver transplants, 168 patients with a self-limited HBV hepatitis B infection prior to LT were identified from our prospective liver transplant database. Patients with underlying chronic HBV infection and recipients of an anti-HBc-positive liver were not included in the analysis. Demographic, laboratory, serological, and virological data were analyzed retrospectively. Appearance of HBsAg or HBV-DNA was defined as reactivation. Results: The median follow-up after LT was 12.0 years (0.6-30.7 years). The rate of HBV reactivation was 0% independent of antiviral prophylaxis (n = 7; 4.2%), the etiology of ESLD, hepatitis C treatment, or the anti-HBs concentration. The overall patient survival with a history of a self-limited HBV infection before LT did not significantly differ from the rest of the cohort. Conclusion: Antiviral treatment with nucleos(t)ide analogues post-liver transplantation in order to prevent HBV reactivation in patients with a resolved self-limited hepatitis B infection prior to LT seems to be omittable since the main viral reservoir is removed by the hepatectomy. These findings may clarify the current uncertainty in the recommendations regarding the risk of HBV reactivation in patients with self-limited hepatitis B prior to LT

Tax compliance across sociodemographic categories:Meta-analyses of survey studies in 111 countries

Tax compliance varies across sociodemographic categories. However, research on the relationships between compliance and age, sex, education as well as income level shows inconsistent results, both regarding the direction of the relationship and its size. The current meta-analyses target to merge findings in survey studies on age, sex, education, and income and estimate the strength of the impact on compliance by taking into account geographical regions. In four meta-analyses, comprising 459 samples (N = 614,286) from 111 countries published between 1958 and 2012, average estimated effect sizes were small, ranging from r = 0.12 for the relationship between compliance and age, r = 0.06 for sex, r = -0.02 for education to r = -0.04 for income. These effects are more pronounced in Western countries. It thus appears sociodemographic characteristics have little impact on compliance, but nevertheless should be controlled for in tax research

Covalent Adaptable Microstructures via Combining Two‐Photon Laser Printing and Alkoxyamine Chemistry: Toward Living 3D Microstructures

Manufacturing programmable materials, whose mechanical properties can be adapted on demand, is highly desired for their application in areas ranging from robotics, to biomedicine, or microfluidics. Herein, the inclusion of dynamic and living bonds, such as alkoxyamines, in a printable formulation suitable for two-photon 3D laser printing is exploited. On one hand, taking advantage of the dynamic covalent character of alkoxyamines, the nitroxide exchange reaction is investigated. As a consequence, a reduction of the Young´s Modulus by 50%, is measured by nanoindentation. On the other hand, due to its “living” characteristic, the chain extension becomes possible via nitroxide mediated polymerization. In particular, living nitroxide mediated polymerization of styrene results not only in a dramatic increase of the volume (≈8 times) of the 3D printed microstructure but also an increase of the Young\u27s Modulus by two orders of magnitude (from 14 MPa to 2.7 GPa), while maintaining the shape including fine structural details. Thus, the approach introduces a new dimension by enabling to create microstructures with dynamically tunable size and mechanical properties