Increased brain lactate is central to the development of brain edema in rats with chronic liver disease

The pathogenesis of brain edema in patients with chronic liver disease (CLD) and minimal hepatic encephalopathy (HE) remains undefined. This study evaluated the role of brain lactate, glutamine and organic osmolytes, including myo-inositol and taurine, in the development of brain edema in a rat model of cirrhosis.Six-week bile-duct ligated (BDL) rats were injected with (13)C-glucose and de novo synthesis of lactate, and glutamine in the brain was quantified using (13)C nuclear magnetic resonance spectroscopy (NMR). Total brain lactate, glutamine, and osmolytes were measured using (1)H NMR or high performance liquid chromatography. To further define the interplay between lactate, glutamine and brain edema, BDL rats were treated with AST-120 (engineered activated carbon microspheres) and dichloroacetate (DCA: lactate synthesis inhibitor).Significant increases in de novo synthesis of lactate (1.6-fold, p<0.001) and glutamine (2.2-fold, p<0.01) were demonstrated in the brains of BDL rats vs. SHAM-operated controls. Moreover, a decrease in cerebral myo-inositol (p<0.001), with no change in taurine, was found in the presence of brain edema in BDL rats vs. controls. BDL rats treated with either AST-120 or DCA showed attenuation in brain edema and brain lactate. These two treatments did not lead to similar reductions in brain glutamine.Increased brain lactate, and not glutamine, is a primary player in the pathogenesis of brain edema in CLD. In addition, alterations in the osmoregulatory response may also be contributing factors. Our results suggest that inhibiting lactate synthesis is a new potential target for the treatment of HE.Canadian Institutes of Health Research. CB:Fonds de recherche du Québec – Sant

Religion und Menschenfeindlichkeit

Küpper B, Zick A. Religion und Menschenfeindlichkeit. In: Zwingmann C, Klein C, Jeserich F, eds. Religiosität: Die dunkle Seite. Beiträge zur empirischen Religionsforschung. 2017: 117-135

Religion und Menschenfeindlichkeit

Küpper B, Zick A. Religion und Menschenfeindlichkeit. In: Jeserich F, Klein C, Zwingmann C, eds. Religiösität - die dunkle Seite. Beiträge zur empirische Religionsforschung. Münster: Waxmann; 2015

Lower leg fractures in children and adolescents - comparison of conservative vs. ECMES treatment

Background: Lower leg fractures are one of the most common fractures in pediatric age. In general, treatment of lower leg fractures is predominantly non-operative, requiring clinical and radiological controls. Nevertheless, it can be observed that in recent years tibial shaft fractures have increasingly been treated surgically. The aim of the present study is to investigate treatment strategies in the context of different fracture types of the lower leg Methods: In this retrospective chart review, we analyzed 168 children with a diaphyseal fracture of the lower leg admitted to a trauma center between 2005 and 2017. The fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF). Results: The frequency of fractures based on the AO-PCCF classification was as follows: Simple oblique fracture of the tibia (43.5%, n = 73), hereof 32 toddler's fractures, multifragmentary oblique fracture of the tibia in 14.3% (n = 24) and simple oblique fracture of both, tibia and fibula in 18 patients (10.7%). Most pediatric fractures were treated conservatively by cast (n = 125). Thirty-seven patients received an ECMES, whereas 3 patients were treated with an external fixator and also 3 fractures were stabilized by plate osteosynthesis. Conservatively treated patients were significantly younger (mean age 6.0) compared to patients treated with ECMES (mean age 10.2) or plate osteosynthesis (PO)/external fixator (EF) (mean age 11.3), even if toddler's fractures (mean age 2.0) are excluded (mean age 7.4). There was no difference in time to full weight-bearing, hospitalization of patients treated with ECMES compared to conservative therapy although ECMES-treated fractures show more instability. The consolidation time was significantly higher in ECMES treated patients compared to conservative therapy. Conclusion: Pediatric patients (≤4 years) with lower leg fractures most often showed simple oblique fractures of the tibia, half of them toddler's fractures, which were treated predominantly by conservative therapy. All in all, the consolidation time was longer in intramedullary nailing (ECMES) than in conservative therapy. Nevertheless, time to full weight bearing and duration of cast was the same in both groups, even though ECMES treated fractures show more instability

Intrinsische und extrinsische religioese Orientierung Fragebogenskalen zum Einsatz in der empirisch-religionspsychologischen Forschung

SIGLEUuStB Koeln(38)-940107718 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Die GemeindeSchwester. Sehen und tun, was dran ist

Das Projekt GemeindeSchwester ist ein instruktives Beispiel für die Anknüpfung an die Tradition der Gemeindeschwester, die Theodor Fliedner in der ersten Hälfte des 19. Jahrhunderts begründet hat. In dem Modell des Wittener Mutterhauses werden Elemente dieser Tradition aufgenommen und weitergeführt, die von hoher Aktualität sind. Im Oktober 2010 begannen fünf Frauen mit der Arbeit als GemeindeSchwestern. Heute sind 38 Frauen in westfälischen Gemeinden diakonisch tätig. Es wird dargestellt, was GemeindeSchwestern bewegt und was sie tun. In den Blick kommen Faktoren, die für ihre Arbeit förderlich und erschwerend sind. Gesichtspunkte der Anstellung und der Finanzierung werden thematisiert. Gefragt wird schließlich nach den Zukunftsperspektiven für die GemeindeSchwestern. Der Darstellung liegt die Evaluation des Projekts „GemeindeSchwester“ zugrunde, die 2020/21 vom Diakoniewerk Ruhr Witten in Zusammenarbeit mit der Evangelischen Hochschule RWL in Bochum durchgeführt worden ist

Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients

Introduction: Osteoporotic posterior ring fractures of the pelvis are common injuries in the elderly, but the treatment of these fractures still remains controversial. Percutaneous iliosacral screw fixation is one surgical option if conservative treatment cannot provide sufficient pain reduction. The aim of this study is to provide short-term results of elderly patients with percutaneous screw fixation. Methods: 30 patients with posterior ring fractures were treated between 12/2009 and 01/2014 with percutaneous iliosacral screw fixation. Patients' mean age was 78.4 years. Concerning short-term outcome, we focused on initial pain level and postoperative pain reduction together with intra-and postoperative complications. Results: The average hospital stay was 23.7 days, with surgical treatment performed after an average of 9.2 days. 90% of our patients were female. All 30 patients had a lower level of pain at discharge compared with admission or immediately prior to surgery. The difference in pain level at admission compared with the pain level upon discharge showed a mean reduction from 6.8 to 1.8 with a statistically significant change (P <= 0.001). 24 of 30 patients had no registered complications, one screw malpositioning with postoperative nerve irritation occurred. Discussion: Conventional percutaneous iliosacral screw fixation is a successful operative treatment for elderly patients with persistent lower back pain after unstable posterior ring fractures of the pelvis. Intra-and postoperative complications are rare, so this treatment can be regarded as a safe procedure. Level of evidence: IV (retrospective study). (C) 2015 Elsevier Ltd. All rights reserved