RepoMed (Medizinische Hochschule Hannover)
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To defer or not to defer?: A German longitudinal multicentric assessment of clinical practice in urology during the COVID-19 pandemic
No full textINTRODUCTION:After the outbreak of COVID-19 unprecedented changes in the healthcare systems worldwide were necessary resulting in a reduction of urological capacities with postponements of consultations and surgeries. MATERIAL AND METHODS:An email was sent to 66 urological hospitals with focus on robotic surgery (RS) including a link to a questionnaire (e.g. bed/staff capacity, surgical caseload, protection measures during RS) that covered three time points: a representative baseline week prior to COVID-19, the week of March 16th-22nd and April 20th-26th 2020. The results were evaluated using descriptive analyses. RESULTS:27 out of 66 questionnaires were analyzed (response rate: 41%). We found a decrease of 11% in hospital beds and 25% in OR capacity with equal reductions for endourological, open and robotic procedures. Primary surgical treatment of urolithiasis and benign prostate syndrome (BPS) but also of testicular and penile cancer dropped by at least 50% while the decrease of surgeries for prostate, renal and urothelial cancer (TUR-B and cystectomies) ranged from 15 to 37%. The use of personal protection equipment (PPE), screening of staff and patients and protection during RS was unevenly distributed in the different centers-however, the number of COVID-19 patients and urologists did not reach double digits. CONCLUSION:The German urological landscape has changed since the outbreak of COVID-19 with a significant shift of high priority surgeries but also continuation of elective surgical treatments. While screening and staff protection is employed heterogeneously, the number of infected German urologists stays low
Hochsensitive Chimärismusanalyse zur frühzeitigen Detektion von Leukämierezidiven und Therapiesteuerung nach allogener Stammzelltransplantation
Get PDFCognitive flexibility and N2/P3 event-related brain potentials.
No full textTask switching is often considered for evaluating limitations of cognitive flexibility. Switch costs are behavioural indices of limited cognitive flexibility, and switch costs may be decomposable into stimulus- and response-related fractions, as conjectured by the domain hypothesis of cognitive flexibility. According to the domain hypothesis, there exist separable stimulus- and response-related neural networks for cognitive flexibility, which should be discernible as distinct event-related potentials (ERPs). The present card-matching study allowed isolating stimulus- and response-related switch costs, while measuring ERPs evoked by task cues and target stimuli with a focus on the target-locked N2/P3 complex. Behavioural data revealed that both stimulus-task and response-task bindings contribute to switch costs. Cue-locked ERPs yielded larger anterior negativity/posterior positivity in response to switch cues compared to repeat cues. Target-locked ERPs revealed separable ERP correlates of stimulus- and response-related switch costs. P3 waveforms with fronto-central scalp distributions emerged as a corollary of stimulus-related switch costs. Fronto-centrally distributed N2 waveforms occurred when stimulus-task and response-task bindings contributed jointly to switch costs. The reported N2/P3 ERP data are commensurate with the domain hypothesis according to which there exist separable stimulus- and response-related neural networks for cognitive flexibility
Ergebnisse der ersten 100 Patienten, die mit minimal invasiver Technik ein HeartWare Linksherzunterstützungssystem erhielten
No full textOptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section.
No full textBACKGROUND:Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. METHODS:OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates 24 weeks gestation occurred in the intervention group (0.34%) and 4/782 in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000. CONCLUSIONS:Changing clinical practice takes time. As elective repeat CS is the most common reason for CS in multiparous women, interventions that are feasible and safe and that have been shown to lead to decreasing repeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. This may best be done using an implementation science approach that can modify evidence-based interventions in response to changing clinical circumstances. TRIAL REGISTRATION:The OptiBIRTH trial was registered on 3/4/2013. Trial registration number ISRCTN10612254
Non-invasive screening for subclinical liver graft injury in adults via donor-specific anti-HLA antibodies.
No full textThe majority of liver grafts exhibit abnormal histological findings late after transplantation, even when liver enzymes are normal. Such subclinical graft injuries were associated with rejection and fibrosis progression in recent studies. The identification of non-invasive biomarkers for subclinical graft injury might help to individualize immunosuppression. Therefore, graft injury was assessed in 133 liver biopsies with normal/near normal liver enzymes from a prospective liver biopsy program. Cytokeratin-18 cell death marker (M65) and donor specific anti-HLA antibodies (DSA) were measured as non-invasive markers in paired plasma samples in addition to routine parameters. M65 was associated with subclinical graft injury but this association was too weak for reasonable clinical application. DSA positivity was associated with more graft inflammation (OR = 5.4) and more fibrosis (OR = 4.2). Absence of DSA excluded fibrosis in 87-89%, while presence of DSA excluded histological criteria for immunosuppression minimization attempts in 92-97%. While CK18 cell death marker had no diagnostic value for the detection of subclinical liver graft injury, DSA testing can help to preselect patients for immunosuppression reduction in case of DSA negativity, while DSA positivity should prompt elastography or liver biopsy for the assessment of subclinical graft injury
MicroRNA-221: A Fine Tuner and Potential Biomarker of Chronic Liver Injury
Get PDFThe last decade has witnessed significant advancements in our understanding of how small noncoding RNAs, such as microRNAs (miRNAs), regulate disease progression. One such miRNA, miR-221, has been shown to play a key role in the progression of liver fibrosis, a common feature of most liver diseases. Many reports have demonstrated the upregulation of miR-221 in liver fibrosis caused by multiple etiologies such as viral infections and nonalcoholic steatohepatitis. Inhibition of miR-221 via different strategies has shown promising results in terms of the suppression of fibrogenic gene signatures in vitro, as well as in vivo, in independent mouse models of liver fibrosis. In addition, miR-221 has also been suggested as a noninvasive serum biomarker for liver fibrosis and cirrhosis. In this review, we discuss the biology of miR-221, its significance and use as a biomarker during progression of liver fibrosis, and finally, potential and robust approaches that can be utilized to suppress liver fibrosis via inhibition of miR-221