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Impact of pre-OP independence in patients with limited brain metastases on long-term survival
No full textBackground: Brain metastasis represents a major complication with a significantly shorter overall survival of many oncological diseases, in particular of lung cancer, breast cancer and malignant melanoma patients. However, despite the poor prognosis, sometimes clinical decision-making, between on the one hand not to harm the patient and on the other hand not withholding a potential therapeutic option, is very challenging. Thus the aim of this retrospective study was to compare various scores, including scores for activities of daily living (ADL) before resection of brain metastases and to analyse their impact on survival.
Methods: Our single institution retrospective patient cohort (N = 100) with a median age of 63.6 years, which had all undergone resection of one or more brain metastases, was categorized using the original patient files. The cohort includes 52 patients with lung cancer, 27 patients with breast cancer, 8 patients with colorectal carcinoma and 13 patients with kidney cancer. To categorize, we used different score systems which were capable to evaluate the patient in relation to self-sufficiency, activity and self-determination as part of ADL. The retrospective analysis includes the ECOG-Status, Karnofsky-Index, Barthel-Index, ASA-Classification and Katz-Index. Pre-processing and the analysis of the data was implemented using KNIME, where we used the R-plugin nodes to perform the final statistical tests with R.
Results: Our analysis reveals that most of the ADL scores we tested are able to give a reliable prediction on overall survival after brain metastasis surgery. The survival rates decrease significantly with a lower score in all tested score systems, with the exception of the ASA-Risk score. In particular, the Katz Index < 6 was identified to have a significant correlation with a lower cancer specific survival (CSS) (HR 3.33, 95%-CI [2.17–5.00]; p-Value = 9.6*10^− 9), which is easy to use and has reproducible measurements.
Conclusions: Pre-operative independence assessment by indices of ADL represents a predictor for overall survival after resection of brain metastases. Especially the easily, objectively and rapidly applicable Katz-Score is a very helpful tool to assess the pre-operative status, which could be additionally included in clinical decision making in daily practice
Impact of the COVID-19 Pandemic on the Management of Staphylococcus aureus Bloodstream Infections in a Tertiary Care Hospital
No full textStaphylococcus aureus bacteremia (SAB) is associated with a high mortality rate. The clinical outcome of SAB patients highly depends on early diagnosis, adequate antibiotic therapy and source control. In the context of the COVID-19 pandemic, the health care system faced additional organizational challenges and the question arose whether structured screening and triaging for COVID-19 and shifting resources influence the management of SAB. Patients (n = 115) with SAB were enrolled in a retrospective comparative study with historical controls (March 2019–February 2021). The quality of SAB therapy was assessed with a point score, which included correct choice of antibiotic, adequate dosage of antibiotic, sufficient duration of therapy, early start of therapy after receipt of findings, focus search and taking control blood cultures 3–4 days after starting adequate antibiotic therapy. The quality of treatment before and after the onset of the COVID-19 pandemic were compared. No significant differences in the total score points were found between the pre-COVID-19 and COVID-19 cohort. All quality indicators, except the correct duration of antibiotic therapy, showed no significant differences in both cohorts. Furthermore, there were no significant differences in the outcome between both cohorts. The treatment quality of SAB therapy was comparable before and during the COVID-19 pandemic
Improvising in a crisis: an empirical study of NPD teams in the field of chemistry and chemical engineering
No full textOrganizational crises can ruin a firm’s reputation and threaten its survival. The field of chemistry and chemical engineering has experienced this from the classic example of the Tylenol scare to Deepwater Horizon. In most cases, the firm is focused on communicating outwardly with external stakeholders but what about the rest of the firm? New product development (NPD) has delivered firms successfully from such financial peril and therefore can be instrumental in being a solution to a crisis. In this study, new product development teams are investigated to see their role in delivering a firm from an organizational crisis. Using an improvisational NPD approach towards dealing with a crisis, this study looks at teams at 55 firms that are associated with the field of chemistry and chemical engineering to determine whether a perceived crisis by the NPD team can be a motivating factor on the successful outcome of the new product being developed. The results indicate that a perceived crisis by the NPD team is positively correlated with project outcomes of speed and success, brings about improvisation, but does not moderate the relationship between improvisation and NPD project outcomes
Innate Immune Cells during Machine Perfusion of Liver Grafts—The Janus Face of Hepatic Macrophages
No full textMachine perfusion is an emerging technology in the field of liver transplantation. While machine perfusion has now been implemented in clinical routine throughout transplant centers around the world, a debate has arisen regarding its concurrent effect on the complex hepatic immune system during perfusion. Currently, our understanding of the perfusion-elicited processes involving innate immune cells remains incomplete. Hepatic macrophages (Kupffer cells) represent a special subset of hepatic immune cells with a dual pro-inflammatory, as well as a pro-resolving and anti-inflammatory, role in the sequence of ischemia–reperfusion injury. The purpose of this review is to provide an overview of the current data regarding the immunomodulatory role of machine perfusion and to emphasize the importance of macrophages for hepatic ischemia–reperfusion injury
Intravenous methadone causes acute toxic and delayed inflammatory encephalopathy with persistent neurocognitive impairments
No full textBackground: The mu-opioid agonist methadone is administered orally and used in opioid detoxification and in the treatment of moderate-to-severe pain. Acute oral methadone–use and –abuse have been associated with inflammatory and toxic central nervous system (CNS) damage in some cases and cognitive deficits can develop in long-term methadone users. In contrast, reports of intravenous methadone adverse effects are rare. Case presentation: Here, we report a patient who developed acute bilateral hearing loss, ataxia and paraparesis subsequently to intravenous methadone-abuse. While the patient gradually recovered from these deficits, widespread magnetic resonance imaging changes progressed and delayed-onset encephalopathy with signs of cortical dysfunction persisted. This was associated with changes in the composition of monocyte and natural killer cell subsets in the cerebrospinal fluid. Conclusion: This case suggests a potential bi-phasic primary toxic and secondary inflammatory CNS damage induced by intravenous methadone
Evidence-based yet still challenging! Research on physical activity in old age
No full textPreserving functional health and quality-of-life in old age is a major goal and global challenge in public health. The high rate of sedentary behavior that is characteristic of the older adult population exacerbates impairments of physiological and structural systems that are typically seen in the aging process. Achieving an understanding of the profound influence of physical activity on all aspects of health in old age is the driving force behind the emergence of "physical activity in old age" as a growing area of research. Accumulated evidence implies that being physically active and exercising is far superior to other optimal aging facilitators. Yet this area of research faces numerous constraints and obstacles. This commentary addresses some of these challenges, primarily the heterogeneity of the aging process, which induces both inter- and intra-individual differences among aged individuals, heterogeneity in assessment tools, unjustified inclusion/exclusion criteria and insufficient recruitment strategies, difficulties in implementing research results in real-world conditions, and rudimentary exploitation of innovative technology. We explain the importance of establishing a network of multidisciplinary scientists and stakeholders to propose consensus-based goals and scientifically evidenced wide-ranging plans for dealing with these challenges. In addition, we suggest work directions for this network
Fehlendes Wahrheitsbemühen in literaturwissenschaftlichen Interpretationstexten
No full textBemühen sich literaturwissenschaftliche Interpret:innen in ihren Interpretationstexten um Wahrheit? Die hier vorzustellende Monografie »Wie hast Du's mit der Wahrheit?« gibt eine negative Antwort auf diese Frage
Immunoadsorption versus double-dose methylprednisolone in refractory multiple sclerosis relapses
No full textObjective: Intravenous methylprednisolone is the standard treatment for a multiple sclerosis relapse; however, this fails to improve symptoms in up to one quarter of patients. Immunoadsorption is an accepted treatment for refractory relapses, but prospective comparator-controlled studies are missing.
Methods: In this observational study, patients with steroid-refractory acute multiple sclerosis relapses receiving either six courses of tryptophan-immunoadsorption or double-dose methylprednisolone therapy were analysed. Outcomes were evaluated at discharge and three months later. Immune profiling of blood lymphocytes and proteomic analysis were performed by multi-parameter flow cytometry and Olink analysis, respectively (NCT04450030). Results: 42 patients were enrolled (methylprednisolone: 26 patients; immunoadsorption: 16 patients). For determination of the primary outcome, treatment response was stratified according to relative function system score changes (“full/best” vs. “average” vs. “worse/none”). Upon discharge, the adjusted odds ratio for any treatment response (“full/best” + ”average” vs. “worse/none”) was 10.697 favouring immunoadsorption (p = 0.005 compared to methylprednisolone). At follow-up, the adjusted odds ratio for the best treatment response (“full/best” vs. “average” + ”worse/none”) was 103.236 favouring IA patients (p = 0.001 compared to methylprednisolone). Similar results were observed regarding evoked potentials and quality of life outcomes, as well as serum neurofilament light-chain levels. Flow cytometry revealed a profound reduction of B cell subsets following immunoadsorption, which was closely correlated to clinical outcomes, whereas methylprednisolone had a minimal effect on B cell populations. Immunoadsorption treatment skewed the blood cytokine network, reduced levels of B cell-related cytokines and reduced immunoglobulin levels as well as levels of certain coagulation factors. Interpretation: Immunoadsorption demonstrated favourable outcomes compared to double-dose methylprednisolone. Outcome differences were significant at discharge and follow-up. Further analyses identified modulation of B cell function as a potential mechanism of action for immunoadsorption, as reduction of B cell subsets correlated with clinical improvement
Idee und Konflikt im modernen Konstitutionalismus – Eine Besprechung von: Linda Colley, The Gun, the Ship, and the Pen. Warfare, Constitutions and the Making of the Modern World, 2021
No full textDie Geschichte des modernen Konstitutionalismus lässt sich in zwei Dimensionen entfalten: Aufklärerische Ideen brachen sich Bahn und schlugen sich in Verfassungen nieder; gesellschaftliche Machtverhältnisse veränderten sich und machten neue soziale Pakte erforderlich. Während der erste Ansatz (Ordnungs-)Ideen in den Mittelpunkt stellt, zielt der zweite auf soziale Konflikte. Wie aber sind Idee und Konflikt miteinander verbunden? Das neue Buch von Linda Colley lässt sich als Antwort auf diese Frage lesen. Mit "The Gun, the Ship and the Pen. Warfare, Constitutions and the Making of the Modern World" legt sie eine Globalgeschichte der Verfassungsschreibung vor – durchaus im engeren Sinne: Colley schreibt über diejenigen Männer – und sehr selten Frauen –, die zur Feder griffen, um im 18. und 19. Jahrhundert Verfassungen für sich und andere zu formulieren. Anhand kunstvoll komponierter historischer Schlaglichter, die von Korsika, über St. Petersburg bis nach Tokyo reichen, zeigt Colley, dass diese Prozesse wechselseitig inspiriert und durch die globalisierte Kriegsführung der Großmächte geprägt waren. Das Buch ist eine spannende Weltreise. Freilich stellt sich beim Lesen die Frage, wie repräsentativ die ausgesuchten Fällen und Episoden für allgemeinere Trends sind.The history of modern constitutionalism can be unfolded in two dimensions: Enlightenment ideas broke through and were reflected in constitutions; social power relations changed and made new social pacts necessary. While the first approach focuses on ideas of social order, the second aims at social conflicts. But how are idea and conflict connected? Linda Colley's new book can be read as an answer to this question. With "The Gun, the Ship and the Pen. Warfare, Constitutions and the Making of the Modern World," she presents a global history of constitution writing. Colley writes about those men - and very rarely women - who took up the pen to formulate constitutions for themselves and others in the 18th and 19th centuries. Using artfully composed historical episodes ranging from Corsica to St. Petersburg to Tokyo, Colley shows that these processes were (i) mutually inspired and (ii) shaped by the globalized warfare of the great powers. The book is an exciting journey around the world. Still, the question remains how representative the selected cases and episodes are for more general trends
