Hochschulbibliothekszentrum des Landes Nordrhein-Westfalen (hbz)
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Inhaltliche und strukturelle Erwartungen an ein Tageshospiz : Ergebnisse einer interviewbasierten Studie unter Experten, Patienten und Angehörigen
No full text<jats:title>Zusammenfassung</jats:title>
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<jats:title>Hintergrund</jats:title>
<jats:p>Tageshospize stellen eine neue Form der ambulanten palliativmedizinischen Versorgung in Deutschland dar. Trotz erster Empfehlungen existieren einheitliche Leitlinien zur inhaltlichen und strukturellen Ausrichtung noch nicht.</jats:p>
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<jats:title>Ziel der Arbeit</jats:title>
<jats:p>Im Rahmen der IMPULS-Studie (Untersuchung zur Implementierung, Umsetzung und Nutzen eines Tageshospizes) wurden Patienten, Angehörige und Experten zu ihren Erwartungen bezogen auf die Institution Tageshospiz befragt, um die weitere Gestaltung und Umsetzung von Tageshospizen zu optimieren.</jats:p>
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<jats:title>Material und Methoden</jats:title>
<jats:p>Es wurde ein Leitfaden für die Interviews mit offenen Fragen zu Definition, Zielen und inhaltlichen sowie organisatorischen Aspekten eines Tageshospizes entwickelt. Die Auswertung erfolgte mittels hermeneutischer Textinterpretation.</jats:p>
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<jats:title>Ergebnisse</jats:title>
<jats:p>Elf qualitative Interviews wurden durchgeführt. Ein Tageshospiz sollte v. a. sozialer Isolation von Patienten entgegenwirken, Angehörige entlasten und die palliativ-pflegerische Versorgung sicherstellen. Bevorzugt werden Öffnungszeiten von 8 bis 16 Uhr, geschultes Personal, medizinische Betreuung, Barrierefreiheit, Einzel‑/Gruppenzimmer, ein ansprechendes Ambiente, ein Garten und ein ausgewogenes Beschäftigungsprogramm. Der Name „Tageshospiz“ wird kontrovers diskutiert. Wünschenswert wäre die Weitergabe von Informationen zum Angebot Tageshospiz über Hausärzte/Sozialdienste, digitale Öffentlichkeitsarbeit und flächendeckende Versorgung.</jats:p>
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<jats:title>Diskussion</jats:title>
<jats:p>Patienten, Angehörige und Experten erwarten von einem Tageshospiz einen positiven Nutzen für dessen Gäste und deren Angehörige. Für die genaue Umsetzung des Projekts „Tageshospiz“ wurden im Rahmen der Interviews praktische Hinweise gegeben. Der weitere Aufbau und die Entwicklung von Tageshospizen bleiben mit Spannung abzuwarten und sollten durch Studien begleitet werden.</jats:p>
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The influence of proteolytic enzymes on the change of lysozyme properties
No full textThis research examines the enzymatic modification of lysozyme, a glycosidic hydrolase that has restricted effectiveness against Gram-negative bacteria, in order to produce bioactive peptide fractions with improved antibacterial and physicochemical characteristics. Utilizing chicken egg lysozyme, modifications were performed in controlled settings with proteolytic enzymes, mainly pepsin, and experiments with a pepsin-trypsin ratio. The modification methods sought to improve the hydrophobic nature of lysozyme’s surface, create oligomeric and peptide forms, and decrease immunogenicity. Findings showed that raising pepsin concentration enhanced the creation of peptide fractions, increasing surface hydrophobicity while reducing hydrolytic and antioxidant activities. Increased hydrophobicity and reduced enzyme activity were linked to enhanced antibacterial effectiveness, particularly against Gram-negative bacteria, a characteristic absent in natural lysozyme. Additionally, the research noted a decrease in immunoreactivity as pepsin concentrations increased, achieving the lowest antibody response in optimized formulations. This enzymatic method offers an economical way to create lysozyme derivatives that hold considerable promise for wider applications, particularly in scenarios where lower immunoreactivity and a prolonged antibacterial spectrum are needed
The effect of camel milk on house dust mite allergen induced asthma model in BALB/C mice
No full textCamel milk has demonstrated robust immunomodulatory and anti-inflammatory properties in various clinical and experimental studies. However, no previous studies have characterized the cellular immunological effects of camel milk in the context of allergic asthma. Therefore, the present work aimed to evaluate the protective effects of camel milk in house dust mite induced asthma in mice, which emulate human pulmonary inflammation. Female BALB/c mice aged 8- to 10-week-old were intranasally sensitized with vehicle or HDM in 2.5 µl (5 µg) per nostril, 5 days a week for 3 weeks. On day 22, mice received an HDM challenge by a large volume but low dose into the lung (5 µg in 50µl) using intranasal inoculation. Using oral gavage technique, CM/HDM group mice received 0.5 ml of camel milk or vehicle five times a week, starting a day prior to sensitization. On day 23 following HDM challenge, mice were exposed to serial challenges with 10, 20, 40 and 100 mg/ml aerosolized methacholine to measure lung dynamics. Furthermore, BALF and whole lung samples were harvested to examine pulmonary inflammation. Camel milk effectively inhibited both HDM-induced infiltration of eosinophils and AHR. In addition to this, camel milk downregulates the number of pulmonary Th2 and Th17 cells and suppressed CCL17 expression in whole lung homogenates. Furthermore, camel milk reduced HDM-induced IL-4 and IL-13 expression following in vitro restimulation of pulmonary T cell subsets. Additionally, camel milk suppressed total concentrations of IL-5 and IL-13 in the lung. These results corroborate the asthma-preventive potential of camel milk and highlight the significance of diminished local concentrations of Th2- associated cytokines. In the present study, the observed downregulation of asthma progression by camel milk suggests its potential health benefits; however, further experimental and controlled clinical trials are needed before it can be considered a supplementary approach for allergic asthma management
The Effects of Adipose Tissue Dysregulation on Type 2 Diabetes Mellitus
No full textInternationally, the prevalence of type 2 diabetes mellitus (T2DM) and obesity rates are increasing significantly. As these epidemics continue to spread, the continuation of further research is paramount given that chronic diseases, such as T2DM, cause strain on both economies and healthcare systems. Recently, adipose tissue has been identified as an endocrine organ that produces many hormones that influence many bodily processes. Adipose tissue dysregulation (ATD)—when adipokines (adipose tissue hormones) are produced in abnormal amounts—plays an important role in T2DM development, progression, and prognosis. This narrative review focuses on mechanisms linking ATD with T2DM through adipokine actions (specifically, leptin and adiponectin) on insulin resistance and glucose metabolism. Here we show that the adipokines leptin and adiponectin are valuable in monitoring, diagnosing, and treating diseases. Further, their ratio (the leptin-to-adiponectin ratio, or LAR) may be more valuable than either adipokine individually. The LAR may give researchers the ability to utilize a primary prevention approach by utilizing LAR as a biomarker influencing early prognosis and treatment. Targeting ATD through diet, weight loss, physical activity, etc., may improve prevention and management outcomes for patients living with or at risk of T2DM
Multisite Infections Caused by Carbapenem-Resistant Klebsiella Pneumoniae: Unveiling the Clinical Characteristics and Risk Factors
No full textOBJECTIVES:
There is a scarcity of studies on multisite infections (MSIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). The primary objectives of this research were to determine the clinical characteristics of CRKP MSI, and the risk factors of infection and mortality.
METHODS:
Patients with a CRKP bloodstream infection (BSI) were enrolled retrospectively between January 2017 and December 2021 in Xijing Hospital, China. The risk factors for CRKP MSI and mortality were evaluated. The demographic data, clinical and microbiological characteristics, therapy and outcomes were analyzed.
RESULTS:
Among 101 patients, 74.3% (75/101) had a diagnosis of CRKP MSI, while 25.7% (26/101) of CRKP non-MSI. The overall case fatality rate was 42.6% (43/101). Multivariate analysis indicated that previous surgery (OR 3.971, 95% CI 1.504–10.480, p = 0.005) and ICU admission (OR 3.322, 95% CI 1.252–8.816, p = 0.016) were independent risk factors for CRKP MSI. ICU admission (OR 4.765, 95% CI 1.192–19.054, p = 0.027), a Pitt bacteremia score (PBS) > 4 (OR 3.820, 95% CI 1.218–11.983, p = 0.022) and thrombocytopenia (OR 8.650, 95% CI 2.573–29.007, p < 0.001) were independent risk factors for mortality due to CRKP MSI.
CONCLUSIONS:
Our findings confirmed that CRKP MSIs were associated with poorer outcomes. To improve prognosis, early screening of individuals at the highest risk is vital
Prognostic Factors for 28-Day Mortality in Pediatric Patients with Acute Leukemia and Candidemia Following Intensive Chemotherapy: A Retrospective Study
No full textBACKGROUND/OBJECTIVE: Candidemia is a serious complication following intensive chemotherapy and is associated with high mortality in pediatric patients. This study aimed to identify the factors associated with 28-day mortality in pediatric patients with candidemia. METHODS: We retrospectively analyzed 63 pediatric patients diagnosed with acute leukemia and candidemia following intensive chemotherapy. Clinical characteristics, laboratory findings, and epidemiological data were collected. Antifungal susceptibility data were available for 60 patients. Kaplan–Meier survival analysis was used to estimate the 28-day mortality rate, and Cox regression was performed to identify prognostic factors. RESULTS: The 28-day mortality rate among the 63 patients (57.1% male, median age 9.74 years) was 36.5%. Candida tropicalis was the predominant species (96.8%). Antifungal susceptibility rates were 100% for amphotericin B and caspofungin and 22.2% for fluconazole. The factors independently associated with reduced 28-day mortality were an absolute lymphocyte count (ALC) ≥ 0.2 G/L at the time of candidemia diagnosis (5.3% vs. 50% mortality; hazard ratio [HR] = 0.08; 95% confidence interval [CI], 0.01–0.61), the use of antifungal prophylaxis (AFP) (26.3% vs. 52%; HR 0.31; 95% CI, 0.13–0.74), and granulocyte transfusion (GTX) combined with granulocyte colony-stimulating factor (G-CSF) (20% vs. 47.4%; HR = 0.31; 95% CI, 0.11–0.85). CONCLUSIONS: Our findings suggest that an ALC ≥ 0.2 G/L, AFP, and the administration of a GTX combined with G-CSF may be considered favorable prognostic factors
Exploring the effects of gut microbiota on cholangiocarcinoma progression by patient-derived organoids
No full text<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>Recent research indicates a role of gut microbiota in development and progression of life-threatening diseases such as cancer. Carcinomas of the biliary ducts, the so-called cholangiocarcinomas, are known for their aggressive tumor biology, implying poor prognosis of affected patients. An impact of the gut microbiota on cholangiocarcinoma development and progression is plausible due to the enterohepatic circulation and is therefore the subject of scientific debate, however evidence is still lacking. This review aimed to discuss the suitability of complex cell culture models to investigate the role of gut microbiota in cholangiocarcinoma progression.</jats:p>
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<jats:title>Main body</jats:title>
<jats:p>Clinical research in this area is challenging due to poor comparability of patients and feasibility reasons, which is why translational models are needed to understand the basis of tumor progression in cholangiocarcinoma. A promising approach to investigate the influence of gut microbiota could be an organoid model. Organoids are 3D cell models cultivated in a modifiable and controlled condition, which can be grown from tumor tissue. 3D cell models are able to imitate physiological and pathological processes in the human body and thus contribute to a better understanding of health and disease.</jats:p>
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<jats:title>Conclusion</jats:title>
<jats:p>The use of complex cell cultures such as organoids and organoid co-cultures might be powerful and valuable tools to study not only the growth behavior and growth of cholangiocarcinoma cells, but also the interaction with the tumor microenvironment and with components of the gut microbiota.</jats:p>
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Long-term variability and trends in the Agulhas Leakage and its impacts on the global overturning
No full text<jats:p>Abstract. Agulhas Leakage transports relatively warm and salty Indian Ocean waters into the Atlantic Ocean and as such is an important component of the global ocean circulation. These waters are part of the upper limb of the Atlantic meridional overturning circulation (AMOC), and Agulhas Leakage variability has been linked to AMOC variability. Agulhas Leakage is expected to increase under a warming climate due to a southward shift in the Southern Hemisphere westerlies, which could further influence the AMOC dynamics. This study uses a set of high-resolution preindustrial control, historical and transient simulations with the Community Earth System Model (CESM) with a nominal horizontal resolution of 0.1° for the ocean and sea ice and 0.25° for the atmosphere and land. At these resolutions, the model represents the necessary scales to investigate Agulhas Leakage transport variability and its relation to the AMOC. The simulated Agulhas Leakage transport of 19.7 ± 3 Sv lies well within the observed range of 21.3 ± 4.7 Sv. A positive correlation between the Agulhas Current and the Agulhas Leakage is shown, meaning that an increase of the Agulhas Current transport leads to an increase in Agulhas Leakage. The Agulhas Leakage impacts the strength of the AMOC through Rossby wave dynamics that alter the cross-basin geostrophic balance with a time lag of 2–3 years. Furthermore, the salt transport associated with the Agulhas Leakage influences AMOC dynamics through the salt–advection feedback by reducing the AMOC's freshwater transport at 34° S. The Agulhas Leakage transport indeed increases under a warming climate due to strengthened and southward-shifting winds. In contrast, the Agulhas Current transport decreases due to a decrease in the Indonesian Throughflow and the strength of the wind-driven subtropical gyre. The increase in the Agulhas Leakage is accompanied by a higher salt transport into the Atlantic Ocean, which could play a role in the stability of the AMOC via the salt–advection feedback.
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Unexpected scarcity of ANME archaea in hydrocarbon seeps within Monterey Bay
No full text<jats:p>Abstract. Marine hydrocarbon seeps typically harbor a relatively predictable microbiome, including anaerobic methanotrophic (ANME) archaea. Here, we sampled two cold seeps in Monterey Bay, CA – Clam Field and Extrovert Cliff – which have been known for decades but never characterized microbiologically. Many aspects of these seeps were typical of seeps worldwide, including elevated methane and sulfide concentrations, 13C-depleted dissolved inorganic carbon, and the presence of characteristic macrofauna. However, we observed atypical microbial communities: extremely few ANME sequences were detected in either 16S rRNA or mcrA gene surveys at Clam Field (&lt; 0.1 % of total community reads), even after 6 months of incubation with methane in the laboratory, and only slightly more ANME sequences were recovered from Extrovert Cliff (&lt; 0.3 % of total community reads). At Clam Field, a lack of ANME mcrA transcription, a lack of methane-dependent sulfate reduction, and a linear porewater methane profile were consistent with low or absent methanotrophy. Although the reason for the scarcity of ANME archaea is still unclear, we postulate that non-methane hydrocarbon release excludes anaerobic methanotrophs directly or indirectly (e.g., through competitive interactions with hydrocarbon-degrading bacteria). Our findings highlight the potential for hydrocarbon seeps without this critical biofilter and therefore greater methane emissions from sediments.
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The sarcoma ring trial: a case-based analysis of inter-center agreement across 21 German-speaking sarcoma centers
No full text<jats:title>Abstract</jats:title>
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<jats:title>Purpose</jats:title>
<jats:p>The management of soft tissue sarcoma (STS) at reference centers with specialized multidisciplinary tumor boards (MTB) improves patient survival. The German Cancer Society (DKG) certifies sarcoma centers in German-speaking countries, promoting high standards of care. This study investigated the variability in treatment recommendations for localized STS across different German-speaking tertiary sarcoma centers.</jats:p>
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<jats:title>Methods</jats:title>
<jats:p>In this cross-sectional case-based survey study, 5 anonymized patient cases with imaging data of localized STS were presented to MTBs of 21 German-speaking tertiary referral hospitals. Centers provided recommendations on treatment sequence and modalities, along with the consensus level within their MTB. Agreement percentages were calculated, and consensus levels were rated on a scale of 1 to 10.</jats:p>
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<jats:title>Results</jats:title>
<jats:p>Five patient cases were discussed resulting in 105 recommendations. Agreement percentages for case 1 to 5 were 14.3%, 61.9%, 33.3%, 52.4% and 9.3%, with a median agreement percentage of 33.3%. Grouping pre- and postoperative therapies as 'perioperative' and including recommendations with and without regional hyperthermia raised the median agreement to 47.6%. The mean consensus level within each center across all 5 cases was 9.5.</jats:p>
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<jats:title>Conclusion</jats:title>
<jats:p>This first case-based analysis of inter-center agreement for STS management in German-speaking countries reveals low inter-center agreement but high intra-center consensus. Our study includes nearly all tertiary sarcoma centers in German-speaking countries, affirming its strong external validity. These findings suggest potential and clinically very relevant differences in treatment standards among sarcoma centers. Enhanced case-based exchanges and collaborative efforts are needed to reduce discrepancies and standardize the management of STS patients.</jats:p>
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