Nutzenanalyse der Blutentnahme am ersten postoperativen Tag nach Cholezystektomie

Die laparoskopische Cholezystektomie ist einer der häufigsten chirurgischen Eingriffe in Deutschland. Unter dem Wandel des Lebens- und Ernährungsstils der Bevölkerung steigen die Fallzahlen der Cholezystolithiasis weiterhin. In den vergangenen Jahrzehnten hat sich die laparoskopische Cholezystektomie zu einem hochstandardisierten Eingriff weiterentwickelt. Dadurch konnte die postoperative Komplikationsrate auf einem konstant niedrigen Niveau gehalten werden. Auf Grund dieses niedrigen Risikoprofils und den zunehmenden Bestrebungen der kosten- und zeiteffektiven Medizin, wird die ambulante Durchführung der elektiven laparoskopischen Cholezystektomie seit mehreren Jahren diskutiert. Ob-wohl eine ambulante Operation nach den S3-Leitlinien möglich wäre, hat sich dieses Verfahren in Deutschland im Vergleich zum anglo-amerikanischen Raum noch nicht etablieren können. Die routinemäßige postoperative Laborkontrolle wird flächendeckend in der chirurgischen Nachsorge und zur Detektion von möglichen postoperativen Komplikationen eingesetzt. Es handelt sich um eine breitflächig verfügbare und einfache Diagnostikmethode des postoperativen Verlaufes. Die Bestimmung der Laborparameter läuft heutzutage kostengünstig und fast voll automatisiert ab. Doch auf Grund der hohen Fallzahlen der Cholezystektomien machen die routinemäßigen Blutabnahmen ohne Indikation und therapeutische Konsequenz einen relevanten arbeitszeitlichen und ökonomischen Anteil aus. Es stellte sich die Frage, ob die routinemäßige Bestimmung der Laborparameter einen signifikanten Mehrwert für die Patienten bietet. Die Fast-Track-Chirurgie der Gallenblase mit mittleren stationären Aufenthalten von zwei Tagen, kann eine postoperative Laborkontrolle nur bis zum zweiten post-OP Tag gewährleisten. Häufig werden Patienten auf Grund von abweichenden Laborparametern am ersten postoperativen Tag länger stationär behandelt. Letztlich zeigt sich jedoch meist keine klinische oder therapeutische Konsequenz aus den Laborparametern und die Patienten werden ohne weitere Intervention verspätet entlassen. In unserer Analyse konnten wir zeigen, dass bei einem risikoarmen und standardisierten Eingriff wie der laparoskopischen Cholezystektomie die Personen mit postoperativer Komplikation mittels Laborparametern nur mit geringer bis mittlerer Sensitivität (maximal 66,67 %) ermittelt werden konnten. Bei hohen Spezifitäten bis zu 94,52 % und hohen negativ prädiktiven Werten (maximal 99,56 %) kann die postoperative Laborkontrolle allenfalls zur Ausschlussdiagnose einer Komplikation angewendet werden. Wenn man diese statistischen Ergebnisse in Bezug auf unsere Komplikationsrate von 2,6 % der laparoskopischen Cholezystektomien auswertet, ergibt sich, dass nur ein sehr geringes Patientenklientel von der postoperativen Diagnostik mittels Laborparameter profitiert. Die postoperativ routinemäßige Laborkontrolle könnte somit auf die Patientengruppe mit Risikofaktoren oder relevanten Vorerkrankungen beschränkt werden. Dadurch müsste der stationäre Aufenthalt von Patienten ohne Komplikationen nicht folgenlos verlängert werden und es kann kosten- und zeiteffizienter gearbeitet werden

Making HIV Prevention Programming Count: Identifying Predictors of Success in a Parent-Based HIV Prevention Program for Youth

Predictors of change in the number of sexual topics parents discussed and responsiveness during sex communication with their preadolescent after participating in a five-session sexual risk reduction intervention for parents were examined. Data were from 339 African American parents of preadolescents enrolled in the intervention arm of a randomized-controlled trial of the Parents’ Matter! Program (PMP). Four categories of predictors of success were examined: time and resource constraints, personal characteristics, the parent-child relationship, and parent perceptions of child readiness for sex communication. There were only sporadic associations between success and time and resource constraints for either outcome. Parent perception of child readiness for sex communication was positively associated with discussions of sex topics (b = 1.11, confidence interval [CI]: 0.24-1.97) and parental responsiveness (b = .68, CI: 0.22-1.15). Although parents face time and resource constraints, most attended at least four sessions, and demographics such as income had limited effects on program success

Exposure to repetitive head impacts is associated with corpus callosum microstructure and plasma total tau in former professional American football players

BACKGROUND: Exposure to repetitive head impacts (RHI) is associated with an increased risk of later-life neurobehavioral dysregulation and neurodegenerative disease. The underlying pathomechanisms are largely unknown. PURPOSE: To investigate whether RHI exposure is associated with later-life corpus callosum (CC) microstructure and whether CC microstructure is associated with plasma total tau and neuropsychological/neuropsychiatric functioning. STUDY TYPE: Retrospective cohort study. POPULATION: Seventy-five former professional American football players (age 55.2 ± 8.0 years) with cognitive, behavioral, and mood symptoms. FIELD STRENGTH/SEQUENCE: Diffusion-weighted echo-planar MRI at 3 T. ASSESSMENT: Subjects underwent diffusion MRI, venous puncture, neuropsychological testing, and completed self-report measures of neurobehavioral dysregulation. RHI exposure was assessed using the Cumulative Head Impact Index (CHII). Diffusion MRI measures of CC microstructure (i.e., free-water corrected fractional anisotropy (FA), trace, radial diffusivity (RD), and axial diffusivity (AD)) were extracted from seven segments of the CC (CC1-7), using a tractography clustering algorithm. Neuropsychological tests were selected: Trail Making Test Part A (TMT-A) and Part B (TMT-B), Controlled Oral Word Association Test (COWAT), Stroop Interference Test, and the Behavioral Regulation Index (BRI) from the Behavior Rating Inventory of Executive Function, Adult version (BRIEF-A). STATISTICAL TESTS: Diffusion MRI metrics were tested for associations with RHI exposure, plasma total tau, neuropsychological performance, and neurobehavioral dysregulation using generalized linear models for repeated measures. RESULTS: RHI exposure was associated with increased AD of CC1 (correlation coefficient (r) = 0.32, P < 0.05) and with increased plasma total tau (r = 0.34, P < 0.05). AD of the anterior CC1 was associated with increased plasma total tau (CC1: r = 0.30, P < 0.05; CC2: r = 0.29, P < 0.05). Higher trace, AD, and RD of CC1 were associated with better performance (P < 0.05) in TMT-A (trace, r = 0.33; AD, r = 0.31; and RD, r = 0.28) and TMT-B (trace, r = 0.31; RD, r = 0.34). Higher FA and AD of CC2 were associated with better performance (P < 0.05) in TMT-A (FA, r = 0.36; AD, r = 0.28), TMT-B (FA, r = 0.36; AD, r = 0.27), COWAT (FA, r = 0.36; AD, r = 0.32), and BRI (AD, r = 0.29). DATA CONCLUSION: These results suggest an association among RHI exposure, CC microstructure, plasma total tau, and clinical functioning in former professional American football players. LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 1

Diversity-Oriented Synthesis Yields a Novel Lead for the Treatment of Malaria

Here, we describe the discovery of a novel antimalarial agent using phenotypic screening of Plasmodium falciparum asexual blood-stage parasites. Screening a novel compound collection created using diversity-oriented synthesis (DOS) led to the initial hit. Structure–activity relationships guided the synthesis of compounds having improved potency and water solubility, yielding a subnanomolar inhibitor of parasite asexual blood-stage growth. Optimized compound 27 has an excellent off-target activity profile in erythrocyte lysis and HepG2 assays and is stable in human plasma. This compound is available via the molecular libraries probe production centers network (MLPCN) and is designated ML238.Chemistry and Chemical Biolog

Biological control in Indonesian oil palm potentially enhanced by landscape context

Oil palm plantation expansion is occurring at a rapid pace. However, substantial yield losses from pest attacks are becoming major threats to the oil palm industry, while the potential role of conservation biological control, a sustainable and environmentally friendly solution for pest control, is still largely unknown. The type of vegetation surrounding oil palm plantations is likely to influence pest predation, and we tested this in Indonesia (Sumatra), the world's largest palm oil producer. We studied six different vegetation types adjacent to oil palm plantations: another oil palm plantation (control), weedy oil palm, weedy rubber, scrub, jungle rubber, and secondary forest. Each border type was replicated eight times. We quantified predation rates and predator occurrences using dummy caterpillars and mealworms 20 m inside of the adjacent vegetation (OUT 20) as well as 20 m (IN 20) and 50 (IN 50) m inside the oil palm plantation. Ants and bush crickets were the most prominent predators in the plantations, whereas birds, bats, monkeys, beetles, and molluscs played a minor role. Mean percentage of ant and cricket predation rate in control border OUT 20 were 16.39% and 7.16% respectively, IN 20 were 16.03% and 6.1%, and IN 50 were 14.47% and 7.48%, while for other borders other than control, mean percentages OUT 20 m were 28.90% and 12.26% respectively, IN 20 m were 26.61% and 12.40%, and IN 50 m were 22.93% and 10.58%. Predation rates were ∼70% higher in non-oil palm habitat, indicating the need for improved vegetation diversification inside plantations. Overall predation rates in oil palm decreased slightly but significantly with distance to the border. Our results suggest that maintaining non-oil palm vegetation in the areas adjacent to plantations and promoting weedy strips within the plantations are potentially effective management tools for conserving and developing biological control in oil palm in the future

Clinical Presentation and Incidence of Anaerobic Bacteria in Surgically Treated Biliary Tract Infections and Cholecystitis

(1) Background: Cholecystitis and cholangitis are among the most common diseases treated by general surgery. Gallstones lead to inflammation and bacterial infection of the biliary tract. Biliary infections can lead to live threatening bacteremia and liver abscesses. The true role of anaerobes remains unclear. (2) Methods: We retrospectively analyzed bacterial cultures from biliary samples obtained from bile ducts and gallbladders at our tertiary care center. Patient characteristics and clinical outcomes were analyzed. (3) Results: In our database of 1719 patients, 365 patients had microbial testing, of which 42 grew anaerobic bacteria. Anaerobes were more frequently cultured in patients with hepatic abscesses and gallbladder perforation. These patients were older and had more comorbidities than the control group. The overall outcomes of all patients were favorable and the resistance rate to commonly used antibiotics remained low. (4) Conclusions: Anaerobes in biliary tract infections appear to be underdiagnosed and more prevalent in the elderly with advanced disease. Due to low antibiotic resistance, the combination of source control and adjunct anti-infective treatment leads to favorable outcomes

Routine postoperative blood tests fail to reliably predict procedure-related complications after laparoscopic cholecystectomy

PURPOSE: Laparoscopic cholecystectomy is a highly standardized surgical procedure with a low risk of complications. However, once complications develop, they can be life-threatening. The aim of this study was to evaluate the value of blood tests on postoperative day one regarding their potential to predict postoperative complications METHODS: A cohort study of 1706 consecutive cholecystectomies performed at a tertiary hospital and teaching facility over a 5-year period between 2014 and 2019. RESULTS: Patients that had open CCE or conversion CCE were excluded. One thousand five hundred eighty-six patients were included in the final analysis that received a laparoscopic cholecystectomy (CCE). One thousand five hundred twenty-three patients had blood tests on POD 1. Forty-one complications were detected including 14 bile leaks, 2 common bile duct injuries, 13 choledocholithiasis, 9 hematomas, and 2 active bleedings. Bilirubin was elevated in 351 patients on POD 1. A drop of more than 3 mg/dl of hemoglobin was reported in 39 patients. GPT was elevated 3 × above the upper limit in 102 patients. All three tests showed a low sensitivity and specificity in detecting postoperative complications. CONCLUSIONS: Early postoperative blood tests alone show a low specificity in detecting postoperative complications after laparoscopic CCE. Their main benefit appears to be the negative predictive value, when they are normal. Routine blood testing appears to be unnecessary and should be based on the intraoperative diagnosis and postoperative clinical findings