bluuebunny/crossref_metadata_2025 huggingface dataset:
Für eine gute Compliance – Therapeutisches Klettern in der Neurologie
Authors: Brünjes Jens
Published: January 2019

Mit Patienten an eine Kletterwand zu gehen erfordert Mut, kann aber effektiv sein, um etwa das Gehen bei Patienten mit Multipler Sklerose oder Parkinson zu verbessern. Denn die reziproke diagonale Bewegung ist als Urmuster in unseren basalen Gehirnebenen angelegt und kann zum Beispiel durch Bewegungsformen wie beim Klettern abgerufen werden.
Spinal fusioniert – Rehabilitation nach lumbaler Fusions-OP
Authors: Thalhamer Christoph
Published: January 2019

Die häufigsten Indikationen für spinale Fusionsoperationen sind symptomatische Spondylolisthesen, schmerzhafte degenerative Bandscheibenpathologien, stark ausgeprägte Skoliosen und instabile Frakturen. Die Basis in der postoperativen Physiotherapie sollte laut Christoph Thalhamer das Training des Positions- und Bewegungssinns der LWS sein.
Linked color imaging improves the endoscopic visibility of gastric mucosal cancers
Authors: Kitagawa Yoshiyasu , Suzuki Takuto , Hara Taro , Nankinzan Rino , Takashiro Hideyuki , Sugita Osamu , Imazeki Hiroshi , Yamaguchi Taketo
Published: January 2019

Background and study aims As a newly developed endoscopy technique, linked color imaging (LCI) provides very bright images with enhanced color tones. With the objective of improving the detection rate of gastric mucosal cancers, which are often difficult to detect, we examined the utility of LCI from the viewpoint of visibility.

Patients and methods The current study used 100 consecutive gastric mucosal cancers ≤ 20 mm in diameter. For each lesion, we selected one endoscopic image acquired by white-light imaging (WLI), blue-laser imaging (BLI) -bright, and LCI modes. Four endoscopists interpreted the images; using a previously reported scale, we scored the visibility level on a scale of 1 – 4.

Results The mean (± SD) visibility scores were 2.54 ± 1.10 for WLI, 3.02 ± 1.07 for BLI-bright, and 3.28 ± 0.97 for LCI. The score was significantly higher for BLI-bright compared with WLI (P < .001) and again higher for LCI compared with BLI-bright (P < .001). For the experts, the scores for BLI-bright and LCI were similar, but both were significantly higher than the score for WLI. For the trainees, there was no significant difference between the WLI and BLI-bright scores, but LCI score was significantly higher than those for WLI and BLI-bright scores. With regard to clinical characteristics, LCI particularly enhanced visibility of normochromic, flat and depressed lesions, which had the lowest visibility scores of all three modalities compared with those of the other lesions.

Conclusion LCI increased visibility and may contribute to early detection of gastric mucosal cancers.
Eosinophile Erkrankungen des Gastrointestinaltrakts
Authors: Hentschel Florian , Lüth Stefan
Published: January 2019

The global incidence and prevalence of eosinophilic gastrointestinal diseases is rising. Clinically, acute eosinophilic esophagitis cannot be distinguished from other causes of esophagitis. Endoscopic findings like rings, webs or furrows have a lower sensitivity than previously assumed. An improvement of symptoms by proton-pump inhibitors also doesn’t rule out the diagnosis – it has to be confirmed histologically. Early therapy will prevent later complications like strictures and motility disorders. The presentation of eosinophilic gastroenteritris/colitis is even less specific. Common cause seems to be a Th2-mediated food allergy. Successful therapies include allergen-free diets and topic steroids. Additionally, in the case of proton-pump inhibitor-responsive eosinophilic esophagitis, proton pump inhibitors do not only block gastral acid production, but may also have a direct inhibitory effect on Th2-immunity. Therefore, Th2-specific biologicals have theoretical advantages, but they could not really convince in first clinical studies.
Case report: a rare cause of a hypervascular nodule in a noncirrhotic liver
Authors: Koschny Ronald , Allgäuer Michael , Pfeiffenberger Jan , Seessle Jessica , Fuchs Juri , Longerich Thomas , Wielpütz Mark , Hoffmann Katrin
Published: January 2019

A 37-year-old male patient with Crohn’s disease and multiple liver hemangiomas was referred to our hospital for an atypical hypervascular hepatic lesion detected on an external magnetic resonance imaging (MRI) scan. The patient was otherwise well and had no history of any liver disease. Liver values and tumor markers were normal. Contrast-enhanced ultrasound confirmed multiple hemangiomas in different liver segments and a hypervascular tumor with a hypovascular rim in segment II/IV. Repeat MRI showed a strongly enhancing neoplasm of 2.6 cm with a texture distinctly different from the otherwise relatively uniform hemangiomas, without evidence of interim growth. Ultrasound-guided biopsy revealed a hepatic small vessel neoplasm. Due to the unknown malignant potential, atypical segmental surgical resection was performed. Final histopathological analysis confirmed the complete resection of the lesion. The postoperative course was uneventful.
Distale Femurfrakturen extraartikulär und intraartikulär
Authors: Graef Frank , Tsitsilonis Serafim , Märdian Sven
Published: January 2019

Distale Femurfrakturen sind komplexe Verletzungen, die zunehmend bei älteren Patienten auftreten. Trotz moderner Osteosyntheseverfahren treten nach wie vor in über 13% der Fälle Komplikationen auf. Dieser Artikel gibt einen Überblick über Diagnostik, Versorgungsstrategie und mögliche Fallstricke, die bei der Therapie zu beachten sind.
A Reliable Video-based ACL Injury Screening Tool for Female Team Sport Athletes
Authors: Weir Gillian , Alderson Jacqueline , Smailes Natalie , Elliott Bruce , Donnelly Cyril
Published: January 2019

This study aimed to develop a 2-dimensional (2D) video screening tool capable of predicting an athlete’s peak 3-dimensional (3D) knee moments during unplanned sidestepping. 2D video-based kinematic measures were simultaneously captured with 3D peak knee moments for 30 female field hockey players (15 junior, 15 senior). Intra- and intertester repeatability of 2D kinematic measures was performed. Then, linear regression models were used to model 3D knee moments from 2D kinematic variables utilizing 80% of the sample (n=24). Regression equations were then validated on the remaining 20% of the sample (n=6). Angular 2D measures had good-excellent intra- (ICC=0.936–0.998) and intertester (ICC=0.662–0.949) reliability. Displacement measures had poor-excellent intra- (ICC=0.377–0.539) and inter-tester (ICC=0.219–0.869) reliability. Significant independent predictors of peak knee moments were dynamic knee valgus, knee flexion angle at foot strike, trunk flexion range of motion (ROM), trunk lateral flexion, hip abduction and knee flexion ROM (P<0.05). Regression equations generated from these models effectively predicted peak knee extension, valgus and internal rotation moments (i. e., were not different from measured values P>0.05, ES<0.4) in the 20% subsample. 2D video-based measurements of an athlete's full body kinematics during unplanned sidestepping provide a reliable, specific, sensitive and cost-effective means for screening female team sport athletes.
Homöopathie rund um die Schwangerschaft
Authors: Boeddrich Ute
Published: January 2019

Die Homöopathie lässt sich in allen Stadien der Schwangerschaft bei gesundheitlichen Problemen hervorragend einsetzen. Sie ist eine sichere und wirksame Behandlungsmethode für das psychische und physische Wohlbefinden der Schwangeren. Bei korrekter Anwendung gibt es keine Gefährdung für Mutter und Kind. Ergänzende naturheilkundliche Maßnahmen wie eine gesunde vollwertige Ernährung, Bewegung, Entspannungstechniken, regelmäßiger Schlaf sind wertvoll und wesentlich für eine unproblematische Gravidität.
Was Naturheilkunde bei unerfülltem Kinderwunsch leisten
kann
Authors: Gerhard Ingrid
Published: January 2019

Die naturheilkundliche Behandlung einer Sterilität birgt große Chancen.
Verschiedene Studien zeigen, dass die Verbesserung der Lebensstilfaktoren die
spontane Schwangerschaftsrate mindestens verdoppeln kann. Die zuverlässigsten
Daten liegen zur Optimierung des Lebensstils, der Ernährung und
Nahrungsergänzung vor. Nach der Basisdiagnostik zu den Sterilitätsursachen
können jedoch auch weitere naturheilkundliche Methoden ergänzend genutzt werden,
um den unerfüllten Kinderwunsch zu behandeln.
Was heißt schon schwierig?
Authors: Hengeveld Elly
Published: January 2019

Welche Umstände oder Faktoren tragen dazu bei, dass Therapeuten bestimmte
Patienten oder Therapiesituationen als schwierig empfinden? Eine patienten- oder
klientenzentrierte, salutogen orientierte Kommunikation spielt eine wesentliche
Rolle dabei, mit vermeintlich schwierigen Patienten oder Therapiesituationen
umzugehen. Die Dialogbeispiele des Artikels geben Hinweise, wie eine solche
Gesprächsführung im Alltag geübt und umgesetzt werden kann.
Alcohol-free EUS-guided chemoablation of multiple pancreatic insulinomas
Authors: Gaballa Daniel , Abendroth Catherine , Moyer Matthew
Published: January 2019

Background and study aims Endoscopic ultrasound (EUS)-guided chemoablation with ethanol lavage, followed by infusion with paclitaxel, has been found to be effective for treatment of mucinous pancreatic cysts. However, there are notable adverse events (AEs) associated with ethanol and its undesirable inflammatory effects on local tissue and vessels. The recent ChARM trial demonstrated that removing ethanol from the cyst ablation process resulted in equivalent efficacy while significantly reducing associated AEs. Encouraged by these results, we speculated that alcohol-free chemoablation can be applied to treatment of solid tumors, as described in our case with a patient with severe and symptomatic recurrent hypoglycemia in the setting of multifocal insulinomas. As a result, the patient saw a significant reduction in symptoms. EUS-guided alcohol-free chemoablation may represent a new alternative to previously established therapies that will ultimately reduce risk of AEs.
Effect of cap-assisted esophagogastroduodenoscopy on examination of the major duodenal papilla: a noninferior, randomized controlled trial
Authors: Shi Xin , Luo Hui , Ning Bo , Wang Xiangping , Tao Qin , Liang Shuhui , Zhang Rongchun , Chen Jie , Luo Bing , Yao Shaowei , Pan Yanglin , Guo Xuegang , Fan Daiming
Published: January 2019

Background Cap-assisted esophagogastroduodenoscopy (CA-EGD) using a transparent cap fitted to the tip of the scope has emerged as an alternative method for examination of the major duodenal papilla (MDP). However, it remains unclear whether CA-EGD is noninferior to standard duodenoscopy for MDP examination. The aim of this study was to compare the efficacies of the two methods for complete examination of the MDP.

Methods This prospective, noninferior, randomized controlled study was conducted at two endoscopy centers. Consecutive patients who underwent endoscopic retrograde cholangiopancreatography were randomized (1:1) to undergo CA-EGD or standard duodenoscopy for MDP examination. The primary outcome was complete examination of the MDP, defined as visualization of the upper end, opening, and lower end of the papilla. Secondary outcomes included endoscopic findings and the time taken for the MDP examination.

Results The study was terminated for futility after the interim analysis. A total of 171 patients were randomly allocated to CA-EGD (n = 85) or standard duodenoscopy (n = 86). The baseline characteristics were comparable between the two groups. Complete examination of the MDP was achieved in 58/85 patients (68.2 %) in the CA-EGD group and in 74/86 (86.0 %) in standard duodenoscopy group. The difference in proportions was – 17.81 percentage points (95 % confidence interval [CI] –28.14 to –7.48) by intention-to-treat analysis and – 18.22 percentage points (95 %CI –28.34 to –8.10) by per-protocol analysis, both of which were significantly lower than the noninferiority margin of –5 %, and therefore the noninferiority of CA-EGD could not be confirmed. Examination time was significantly longer with CA-EGD (69.5 [SD 46.4] vs. 33.0 [SD 28.9] seconds; P < 0.001).

Conclusions Although complete examination of the MDP can be achieved by CA-EGD in most patients, it could not replace duodenoscopy as the standard method for examination of the MDP.
Assessment of technical parameters and skills training to inform a simulation-based training program for semi-automated robotic colonoscopy
Authors: Kopczynska Maja , Smits Stephanie , Hopps Rebecca , Ramaraj Rajeswari , Warren Neil , Goddard Stuart , Ye Xujiong , Dolwani Sunil
Published: January 2019

Background and study aims Video-colonoscopy, despite being the gold-standard for diagnosis of colorectal lesions, has limitations including patient discomfort and risk of complications. This study assessed training characteristics and acceptability in operators of a new robotic colonoscope (RC).

Materials and methods Participants (n = 9) with varying degrees of skill and background knowledge in colonoscopy performed colonoscopies with a RC on a simulation-based training model. Quantitative procedure-related and qualitative operator-related parameters were recorded.

Results Polyp detection rate was highest in the novice group (91.67 %) followed by experts (86.11 %), then equally, trainees and video gamers (79.17 %). Four participants repeated the procedure at a follow-up session. Each participant improved cecal intubation time and had the same or higher polyp detection rate. The potential role for RC was identified for an out-of-hospital environment and as a novel diagnostic tool.

Conclusions Results from this pilot suggest that operators at all skill levels found the RC acceptable and potentially useful as a diagnostic tool. Acquisition of skills with RC seems to improve rapidly to a clinically relevant level with simulation-based training
Treatment of refractory post-esophagectomy anastomotic esophageal strictures using temporary fully covered esophageal metal stenting compared to repeated bougie dilation: results of a randomized controlled trial
Authors: Kappelle W. , van Hooft J. , Spaander M. , Vleggaar F. , Bruno M. , Maluf-Filho F. , Bogte A. , van Halsema E. , Siersema P.
Published: January 2019

Background and study aims Fully covered self-expanding metal stents (FCSEMS) provide an alternative to bougie dilation (BD) for refractory benign esophageal strictures. Controlled studies comparing temporary placement of FCSES to repeated BD are not available.

Patients and methods Patients with refractory anastomotic esophageal strictures, dysphagia scores ≥ 2, and two to five prior BD were randomized to 8 weeks of FCSEMS or to repeated BD. The primary endpoint was the number of BD during the 12 months after baseline treatment.

Results Eighteen patients were included (male 67 %, median age 66.5; 9 received metal stents, 9 received BD). Technical success rate of stent placement and stent removal was 100 %. Recurrent dysphagia occurred in 13 patients (72 %) during follow-up. No significant difference was found between the stent and BD groups for mean number of BD during follow-up (5.4 vs. 2.4, P = 0.159), time to recurrent dysphagia (median 36 days vs. 33 days, Kaplan-Meier: P = 0.576) and frequency of reinterventions per month (median 0.3 vs. 0.2, P = 0.283). Improvement in quality of life score was greater in the stent group compared to the BD group at month 12 (median 26 % vs. 4 %, P = 0.011).

Conclusions The current data did not provide evidence for a statistically significant difference between the two groups in the number of BD during the 12 months after initial treatment. Metal stenting offers greater improvement in quality of life from baseline at 12 months compared to repeated BD for patients with refractory anastomotic esophageal strictures.
Die Bedeutung von Cytochrom P4502E1 bei der alkoholischen Lebererkrankung und bei der alkoholmediierten Karzinogenese
Authors: Seitz Helmut , Mueller Sebastian
Published: January 2019

Verschiedene Faktoren sind in der Pathogenese der alkoholischen Lebererkrankung (ALE) und der alkoholvermittelten Karzinogenese beteiligt. Neben genetischen, epigenetischen und immunologischen Mechanismen spielen die toxische Wirkung von Acetaldehyd, oxidativer Stress und zytokinvermittelte Entzündungen eine wesentliche Rolle. Oxidativer Stress mit der Generierung von reaktiven Sauerstoffspezies (ROS) entsteht entweder in der Entzündung (alkoholische Hepatitis) oder bei der Alkoholoxidation via Cytochrom P4502E1 (CYP2E1). CYP2E1 wird durch Alkohol induziert, oxidiert Äthanol zu Acetaldehyd und generiert dabei ROS. ROS führt unter anderem zu Proteinschädigung, Fibrogenese und DNA-Mutationen. Weiterhin resultiert die CYP2E1-Induktion in einer gesteigerten Prokarzinogenaktivierung und einem verstärkten Abbau von Retinol und Retinsäure, einem Faktor, der für eine geordnete Zelldifferenzierung und Zellproliferation verantwortlich ist. Eine Hemmung von CYP2E1 führt zu einer Verbesserung der ALE und zu einer Hemmung der chemisch induzierten Karzinogenese im Tierexperiment. Beim Menschen wird CYP2E1 bereits bei 40 Gramm Alkohol pro Tag innerhalb einer Woche induziert, jedoch gibt es signifikante interindividuelle Unterschiede. Der Mechanismus dafür ist unklar. Bei Patienten mit ALE korreliert CYP2E1 mit dem Ausmaß von hochkarzinogenen Etheno-DNA-Addukten in Leber und Ösophagus und mit der Schwere der Leberfibrose. Erste Ergebnisse zu einer Hemmung von CYP2E1 durch Chlormethiazol, einem spezifischen CYP2E1-Hemmer, bei Patienten mit ALE sind in Kürze zu erwarten.
Stand heute: Das Internet als Wissensquelle
Authors: Zehenter Christian
Published: January 2019

Eine kleine Anzahl von Lexika, Megadatenbanken und Medizinportalen stellt im Netz Millionen freier und hochwertiger Artikel zur Verfügung. Für eine erfolgreiche medizinische Recherche muss man nicht nur die richtige Suchtechnik, sondern auch die Glaubwürdigkeit, Qualität und Motivation einer Internetseite kennen. Wer den Sprung in die englischsprachige Wissenschaftsrecherche wagt, erschließt sich eine nahezu unbegrenzte Informationsgrundlage für die persönliche Fortbildung und Therapiequalität.
Vision Screening in Children in the Canton of St. Gallen
Authors: Eppenberger Leila , Züst Petra , Kunz Andrea , Scheitlin Caroline , Heckmann Jan , Sturm Veit
Published: January 2019

Background Pediatric vision screening has been shown to reduce the prevalence of amblyopia. To assess the current local situation in the Canton of St. Gallen, a survey study was performed.

Methods A standardized questionnaire was sent to 191 general practitioners and school doctors to obtain information on the currently applied vision screening protocols for children. The questionnaire included 17 questions with multiple answers possible.

Results Sixty-seven participants (35%) answered the survey. Overall, 61 (91%) of the repliers confirmed that some sort of vision screening exists. According to 45 (67%) repliers, a mandatory examination exists. As to the question about the person performing the examination, multiple answers were given; 39 (44%) answered that the secretary or the medical practical assistant performs the vision tests, 15 (17%) indicated the school doctor, and 25 (28%) indicated the general practitioner or the pediatrician. Most screening tests are performed in a general practitionerʼs practice (32; 40%), some are done in the kindergartens (17; 21%), and others are done in a pediatricianʼs practice (17; 21%). The majority of children are tested at the age of 5 – 6 years (58, 87%). Sixty-one (91%) of the repliers indicated that at least the childrenʼs visual acuity is measured. Acuity is assessed with different methods, mainly, with pictures (20; 30%), numbers (23; 34%), and Snellen optotypes (33; 49%).

Conclusions There are no consistent regulations regarding vision screening in the Canton of St. Gallen. Actually, rather different screening scenarios exist. Tests are performed by a variety of people in different locations with diverse testing procedures. A standardization of the applied screening procedures at cantonal and national levels seems reasonable.
Surgical Management of Intraocular Silicone Oil Microdroplet
Authors: Safi Antoine , Wolfensberger Thomas
Published: January 2019

Purpose Intraocular silicone oil microdroplets have been described after intravitreal injection of anti-VEGF agents packaged at a compound pharmacy. We present a case with the presence of an intraocular silicone oil microdroplet after a vitreoretinal operation using disposable instruments, and the surgical technique for its removal.

Methods A 59-year-old patient who had been operated on for vitreous opacities using a disposable 27-g vitrectomy kit complained of a small round structure floating in the eye. It appeared a few days after surgery. The bubble was not present at all times and it disappeared for days on end. Clinical examination of the vitreous and retina during these uneventful periods was normal. The bubble reappeared intermittently without a link to any specific movement for some time but was again absent once the patient was examined. The physical properties of the mobile round lesion could be identified as lighter than aqueous humor, as it was described as being in the center of the visual field if the head was tilted forward.

Results As the patient was very bothered by this bubble, a 23-g vitrectomy was performed. During deep indentation of the pars plana over 360 degrees, a tiny bubble of silicone oil could be found buried in the peripheral vitreous base, and controlled aspiration under deep indentation was performed. The patient has been without symptoms since the removal of the droplet and made an uneventful clinical recovery.

Conclusion Microdroplets of silicone oil may be present in disposable vitreoretinal instruments and stay in the eye after surgery, causing a visual disturbance. The origin of these droplets may be linked to the plastic tubing of the instruments.
Hebammenarbeit zwischen Stress, Gesundheitsfürsorge und Glückseligkeit
Authors: Esch Tobias
Published: January 2019

Prof. Dr. med. Tobias Esch vermittelte in seinem Vortrag auf dem Forum Hebammenarbeit im November 2018 in Wiesbaden Strategien zur Stressbewältigung aus der Mind-Body-Medizin. Im Mittelpunkt standen u. a. Aspekte der Positiven Psychologie, mit deren Hilfe eigene Ressourcen aufgespürt und entwickelt sowie innere und äußere Potenziale geweckt und gehoben werden können.
Polyp detection rates as quality indicator in clinical versus screening colonoscopy
Authors: Hoff G. , Botteri E. , Høie O. , Garborg K. , Wiig H. , Huppertz-Hauss G. , Moritz V. , Bretthauer M. , Holme Ø.
Published: January 2019

Background Adenoma and Polyp Detection Rates (ADR and PDR) are advocated as general performance measures for screening and clinical colonoscopy, but their evidence is largely derived from screening data. This study compares PDRs in colonoscopy for screening versus clinical indications.

Methods Consecutive patients at two Norwegian centers were examined by eight endoscopists either for colonoscopy screening in a randomized colonoscopy screening trial (Nordic-European Initiative on Colorectal Cancer, NordICC) or for clinical indications during the same time period (January 2013 to December 2014). PDR-5 mm, defined as the proportion of colonoscopies with detection of at least one polyp with diameter ≥ 5 mm, was measured prospectively. We fitted multivariable logistic regression models and calculated the adjusted odds ratios (OR) to evaluate factors for differences in PDR-5 mm between screening and clinical colonoscopies.

Results The study included 2939 clinical and 771 screening colonoscopies. The PDR-5 mm was 26 % and 31 %, respectively (P = 0.005). Among sex, age, cecum intubation, bowel cleansing, and endoscopist, only the latter explained the higher PDR-5 mm in screening compared to routine colonoscopy. In the fully adjusted logistic regression model, the detection of polyps ≥ 5 mm was not associated with indication for colonoscopy. The OR for polyp detection in screening vs. routine colonoscopy was 1.04; 95 % confidence interval 0.85 – 1.27.

Conclusion In this study, the differences in PDR-5 mm between clinical and screening colonoscopies could be explained by the endoscopist. Accordingly, PDR-5 mm benchmarks may be similar for clinical and screening colonoscopy.
Food Addiction und psychische Komorbidität
Authors: Albayrak Özgür
Published: January 2019

Food Addiction als Sondervariante impulsiven und belohnungsabhängigen Essverhaltens ist derzeitig Gegenstand wissenschaftlicher Untersuchungen. Die meisten Untersuchungen sind Zusammenhängen zwischen Food Addiction, dem Körpergewicht und essstörungspsychopathologischen Auffälligkeiten gewidmet. Nur ein kleiner Teil beleuchtet Food Addiction im Kontext psychischer Störungen. Wiederholt lassen sich Zusammenhänge zwischen Symptomen einer Food Addiction und depressiven wie auch ängstlichen Symptomen nachweisen. Die Methodik der Untersuchungen indes ist sehr uneinheitlich. Dabei kommt der Auswahl des Patientenkollektivs eine besondere Rolle zu: die meisten Untersuchungen finden an Patienten mit Essstörungen und /oder Adipositas statt. Um die Bedeutung psychischer Auffälligkeiten bei Food Addiction genau zu verstehen, eignen sich nicht-klinische Kollektive wie auch klinisch-psychiatrische Kollektive. Dieser Übersichtsartikel informiert über die aktuelle Literatur und über die Zusammenhänge zwischen Food Addiction und begleitenden psychischen Auffälligkeiten.
Perspektiven und Chancen für pflegerisch-psychotherapeutische Interventionen in der stationären psychiatrischen Behandlung
Authors: Wabnitz Pascal , Löhr Michael , Schulz Michael , Nienaber André , Oppermann Georg , Sauter Dorothea , Schreiber Wolfgang , Gouzoulis-Mayfrank Euphrosyne , Claus Sylvia , Hohl-Radke Felix , Jordan Wolfgang , Pollmächer Thomas
Published: January 2019

Hintergrund Psychotherapie ist ein essenzieller Bestandteil in der Behandlung psychisch kranker Menschen, bleibt allerdings im Bereich der stationären psychiatrischen Behandlung hinter dem Bedarf zurück. Im Rahmen des ärztlichen Gesamtbehandlungsplans ist die Anwendung psychotherapeutischer Interventionen durch andere Berufsgruppen in Deutschland nicht regelhaft üblich.

Fragestellung Welche Implikationen für die psychiatrische Pflege lassen sich aus internationalen Forschungsdaten zur Verbesserung der psychotherapeutischen Behandlung ableiten?

Methode Anhand einer Literaturrecherche werden internationale Entwicklungen analysiert und als Modell für ein deutsches Ausbildungscurriculum genutzt.

Ergebnis Ein 18 Monate dauerndes Ausbildungsprogramm für Pflegefachpersonen wird vorgestellt. Dieses Curriculum vermittelt neben störungsspezifischen Kompetenzen auch störungsübergreifende psychotherapeutische Interventionen.

Schlussfolgerung Die Zusammenarbeit unterschiedlicher Gesundheitsberufe hat sich als wirksam und hilfreich in der Behandlung psychisch kranker Menschen erwiesen. Um den wachsenden Bedarf an Psychotherapie in der stationären Behandlung besser abdecken zu können, sollten Pflegefachpersonen zukünftig stärker einbezogen werden.
Optical Imaging Technology: A Useful Tool to Identify Remission in Cushing Disease After Surgery
Authors: Afshari Ali , Keil Margaret , Lyssikatos Charalampos , Belyavskaya Elena , Valdés Nuria , Chowdhry Fatima , Parsa Kian , Ardeshirpour Yasaman , Pursley Randall , Khare Siddharth , Kainerstorfer Jana , Chittiboina Prashant , Lodish Maya , Mazzuchi Thomas , Gandjbakhche Amir , Stratakis Constantine
Published: January 2019

We recently reported the use of optical imaging technology to quantify facial plethora in endogenous Cushing syndrome (CS). In the present study, we studied a larger cohort of patients with Cushing disease (CD) and examined water content fraction as well as blood volume fraction as bio-optic markers for determining the efficacy of this methodology as a predictor of lasting remission after surgery for CS. We imaged 49 patients before and after transsphenoidal surgery (TSS) for Cushing disease (CD); 22 patients were also seen at 3–6 months, and 13 patients 12 months post-operatively. On all patients, we used multi-spectral imaging (MSI) to evaluate hemodynamic distributions as well as water content at a specific area of the face. We found a decrease in blood volume fraction after vs. before surgical treatment in the tested facial area in 37 of the 40 patients, as determined with biochemical markers (p<0.001). All patients that were followed up for up to 12 months showed the same decrease from preoperative values and they remained in remission from CD. We conclude that MSI can be used for the evaluation of remission from CD, at least in the immediate post-operative period and up to one year after surgery. The use of this technology can supplement biochemical and other testing for the evaluation of the various treatment modalities available for patients with CD.
Feasibility of the peroral endoscopic myotomy (POEM) procedure with a new small-caliber endoscope (thin-POEM) in patients with achalasia
Authors: Hernandez Mondragón Oscar , González Martínez Marina , Solórzano Pineda Omar , Blancas Valencia Juan , Hernández Reyes María
Published: January 2019

Background Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia.

Methods Naïve or previously treated patients were included between February 2016 and April 2018. A small-caliber (5.9 mm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed.

Results 45 patients were included, aged 45.5 years (interquartile range [IQR] 22 – 69); 53 % (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37 – 77) and median myotomy length was 13.5 cm (IQR 6 – 20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 (P < 0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5 mmHg (P < 0.001), and timed barium esophagram (TBE) 100 % severely delayed vs. 86 % normal (P < 0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52 – 77]). Reflux was confirmed at 3 months clinically in 17 % of patients, endoscopically in 20 %, and on pH monitoring in 53 %. At 6 months and 12 months, 40 % and 33 % of patients remained positive on pH monitoring and were medically managed.

Conclusions Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.
Phytotherapie bei Schwangeren und
Stillenden
Authors: Kraft Karin
Published: January 2019

Phytotherapie wird häufig zur Behandlung von Beschwerden in der Schwangerschaft
und Stillzeit angewendet. Die wissenschaftliche Beleglage hinsichtlich
Wirksamkeit und Unbedenklichkeit ist jedoch sehr schwach, die Anwendung erfolgt
deshalb ganz überwiegend auf empirischer Basis. In diesem Artikel wird der
aktuelle Kenntnisstand dargestellt unter besonderer Berücksichtigung von
möglichen Risiken für das ungeborene Kind und den Säugling.
Mechanistic Pathways of ATP Sensitive Potassium Channels Referring to Cardio-Protective Effects and Cellular Functions
Authors: Vishwakarma Vishal Kumar , Upadhyay Prabhat Kumar , Chaurasiya Hridaya Shanker , Srivasatav Ritesh Kumar , Ansari Tarique Mahmood , Srivastava Vivek
Published: January 2019

A study of potassium channels correlates the fundamentals of mechanistic pathways and various physiological functions. The knowledge of these pathways provides the background, how to determine unit cell functions and to affect cardio protection. ATP sensitive potassium channels adjust excitability of membrane and functions as per metabolic status of cell. A lot of energy consumption primarily occurred in skeletal muscles which also express high number of potassium channels. The increase in calcium release and high heat production is occurred due to loss of potassium channels. Such type of mediations determines metabolic changes and energy required in the dissipation. IPC reduces infarct size in anesthetized mice. In ischemic-reperfusion, pressure in left ventricle was watched while contractile power recovery did not happen. It was seen that elements of intact potassium channel are fundamental for Ischemic preconditioning (IPC). If more prominent is enactment of potassium channels and their cardiologic effects create high heart rate. All the more as of late, it has been suggested that mitochondrial ATP sensitive potassium channels are critical as closing stage effectors which trigger IPC as opposed to sarcolemmal potassium channels. Nevertheless, the importance of the potassium channels reconsidered in cardio-protection in present findings. These discoveries recommend that potassium channels in the adjusting ischemic-reperfusion damage in mice. The heart rate of the mouse occurred during ischemia; enhance watchful extrapolation applied to larger warm blooded animals.
Chirurgische Therapie des Lungenkarzinoms: Argumente für die Behandlung in großen Zentren
Authors: Hoffmann Hans , Passlick Bernward , Ukena Dieter , Wesselmann Simone
Published: January 2019

Anhand der Daten der DRG-Statistik wurde untersucht, wie sich die Versorgungssituation bei der chirurgischen Behandlung des Lungenkarzinoms in Deutschland darstellt und ob ein möglicher Zusammenhang zwischen Behandlungsvolumen und Hospitalletalität besteht. Ausgewertet wurden alle Behandlungsfälle der Jahre 2005 bis 2015 mit der Hauptdiagnose Lungenkarzinom (ICD C34) und den Prozeduren (OPS-Schlüssel 5-323 – 5-328) für anatomische Lungenresektionen. Die Behandlungsfälle wurden Krankenhausgruppen zugeordnet, definiert nach der Anzahl der durchgeführten Eingriffe pro Jahr. Die Gesamtzahl der anatomischen Lungenresektionen bei der Diagnose Lungenkarzinom stieg um 24% von 9376 Resektionen in 2005 auf 11 614 in 2015. Im Jahr 2015 wurden 57% der anatomischen Lungenresektionen bei Patienten mit Lungenkarzinom in 47 High-Volume-Kliniken (Kliniken mit ≥ 75 Resektionen/Jahr) durchgeführt, die restlichen 43% der Resektionen verteilen sich auf 271 Kliniken, die jeweils weniger als 75 Resektionen pro Jahr durchführen. In Krankenhäusern, in denen weniger als 25 dieser Eingriffe pro Jahr vorgenommen werden, ist die Krankenhausletalität mit 5,7% (Mittelwert bezogen auf die Gesamtzahl der Eingriffe 2005 – 2015) fast doppelt so hoch wie in großen Zentren mit ≥ 75 Resektionen pro Jahr (Mittelwert 2005 – 2015: 3,0%). Zusammenfassend bestätigt die vorliegende Auswertung der DRG-Statistik die traditionelle Konzentration der Lungenkrebsbehandlungen in Deutschland auf relativ wenige Kliniken mit großen Fallzahlen. Darüber hinaus konnte hier erstmals aktuell und flächendeckend für Deutschland ein Zusammenhang zwischen dem Behandlungsvolumen der Krankenhäuser und der Hospitalletalität nach chirurgischen Lungenkarzinombehandlungen belegt werden.
Ist die Geburtseinleitung bei intrauteriner Wachstumsrestriktion und small-for-gestational-age-Feten problematisch? Eine historische Kohortenstudie
Authors: Kehl Sven , Weiss Christel , Dammer Ulf , Berlit Sebastian , Große-Steffen Thomas , Faschingbauer Florian , Sütterlin Marc , Beckmann Matthias , Schneider Michael
Published: January 2019

Ziel Die Datenlage zu Geburtseinleitungen bei einem small-for-gestational-age Fetus (SGA-Fetus) oder einer intrauterinen Wachstumsrestriktion (IUGR) ist limitiert, sodass das Ziel dieser Untersuchung war, Geburtseinleitungen bei SGA-/IUGR-Feten mit Geburtseinleitungen bei Schwangerschaften mit einem fetalen Schätzgewicht oberhalb der 10. Perzentile zu vergleichen.

Material und Methodik In diese multizentrische Kohortenstudie wurden Einlingsschwangerschaften am Termin eingeschlossen. Geburtseinleitungen bei SGA-/IUGR-Feten (IUGR-Gruppe) wurden mit Geburtseinleitungen bei Feten mit einem fetalen Schätzgewicht oberhalb der 10. Perzentile (Kontrollgruppe) verglichen. Der primäre Zielparameter war die Kaiserschnitt-Rate.

Ergebnisse Es gab keinen Unterschied bezüglich der Kaiserschnitt-Rate zwischen den beiden Gruppen (27,0 vs. 26,2%, p=0,9154). In der IUGR-Gruppe lag jedoch häufiger ein pathologisches CTG (30,8  vs. 21,9%, p=0,0214) vor, und es wurden mehr Fetalblutanalysen (2,5 vs. 0,5%, p=0,0261) durchgeführt. Die Rate an kindlichen Verlegungen in die Kinderklinik war ebenfalls in der IUGR-Gruppe höher (40,0 vs. 12,8%, p<0,0001).

Schlussfolgerung Geburtseinleitungen bei wachstumsrestringierten Feten sind nicht mit einer höheren Rate an Kaiserschnitten assoziiert.
Ressourcen, Kindheitstraumata und Psychopathologie bei stationär psychiatrischen Patienten
Authors: Thörel Eberhard , Drieling Tobias , Schiele Miriam A. , Frommberger Ulrich Hermann
Published: January 2019

Kindheitstraumata können sich negativ auf die Ausbildung personaler und sozialer Ressourcen im Erwachsenenalter auswirken. Dies ist problematisch, da eine gute Ressourcenausstattung einen protektiven Faktor gegen die Entstehung psychischer Erkrankungen darstellt und teilweise auch mit besseren Therapieerfolgen einhergeht. Die vorliegende Arbeit untersuchte den Zusammenhang zwischen Ressourcen und früher Traumatisierung sowie den Einfluss dieser beiden Faktoren auf die Psychopathologie und die Reduktion der psychopathologischen Symptomatik bei stationär-psychiatrischen Patienten. Dabei gingen wir von negativen Zusammenhängen zwischen Ressourcen und psychopathologischer Symptomatik sowie früher Traumatisierung und Ressourcen aus und von positiven Zusammenhängen zwischen Traumatisierung und psychopathologischer Symptomatik. Ferner nahmen wir an, dass sich die aktuellen Ressourcen einer Person förderlich und der Grad der Traumatisierung hinderlich auf die Reduktion der Symptomatik auswirken würden. Diese Hypothesen testeten wir über Korrelations- und Regressionsanalysen an n=93 Patienten mit depressiver und posttraumatischer Symptomatik in einem psychiatrischen Krankenhaus in Offenburg. Wie erwartet konnten wir signifikante negative Zusammenhänge zwischen Ressourcen und Symptomatik sowie Traumatisierung und Ressourcen finden. Allerdings gab es entgegen unserer Vorhersage nur einen Zusammenhang zwischen Traumatisierung und posttraumatischer, jedoch nicht depressiver Symptomatik. Auch zeigten sich keine Zusammenhänge zwischen Ressourcen bzw. früher Traumatisierung und der Reduktion der psychopathologischen Symptomatik. Die beobachteten Zusammenhänge sind hinsichtlich der Prävention psychiatrischer Erkrankungen von Bedeutung und haben vielfältige Implikationen für die Entwicklung und den Einsatz präventiver und therapeutischer Interventionen.
Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling
Authors: Schegerer Alexander , Loose Reinhard , Heuser Lothar J. , Brix Gunnar
Published: January 2019

Purpose Recent developments in medical technology have broadened the spectrum of X-ray procedures and changed exposure practice in X-ray facilities. For this reason, diagnostic reference levels (DRLs) for diagnostic and interventional X-ray procedures were updated in 2016 and 2018, respectively. It is the aim of this paper to present the procedure for the update of the DRLs and to give advice on their practical application.

Materials and Methods For the determination of DRLs, data from different independent sources that collect dose-relevant data from different facilities in Germany were considered. Seven different weight intervals were specified for classifying pediatric X-ray procedures. For each X-ray procedure considered, the 25th, 50th, and 75th percentile of the respective national distribution of the dose-relevant parameters were determined. Additionally, effective doses that correspond to the DRLs were estimated.

Results In procedures with already existing DRLs before 2016, the values were lowered by circa 20 % on average. Numerous DRLs were established for the first time (9 for interventional procedures, 10 for CT examinations).

Conclusion For dose optimizations even below the new national DRLs, the BfS recommends establishing local reference levels, using dose management software (particularly in CT and interventional radiology), adapting dose-relevant parameters of X-ray protocols to the individual patient size, and establishing internal radiation protection teams responsible for optimizing X-ray procedures in clinical practice. When applying good medical practice and using modern equipment, the median dose values of the nationwide dose distributions can not only be easily achieved but can even be undercut.

Key Points:

Citation Format
Evaluation of Anti-Diarrheal Activity of Methanol Root Bark Extract of Milicia Excelsa (Welw) C. C Berg (Moraceae) in Rats
Authors: Adebayo Muritala Ayofe , Adedokun Oluwasegun Adekanmi , Akinpelu Lateef Abiola , Okafor Paul Okwudili
Published: January 2019

Milicia excelsa (Moraceae) plant is used as an antidiarrheal agent in ethnomedicine but there is no scientific rationale for its claim. Hence, this study examined the acute toxicity (LD50) and anti-diarrheal effect of methanol root bark extract of Milicia excelsa per oral in rats as well as the probable phytoconstituents responsible for this effect. The LD50 was>5000 mg/kg, suggesting its safety. The extract significantly (p<0.05) reduced the total number of feces and wet feces in castor oil-induced diarrhea with percentage inhibitions of 41.36 and 50.88% at 200 and 400 mg/kg respectively; it also significantly (p<0.05) reduced the distance travelled by charcoal in a dose dependent manner with percentage inhibitions of 33.85, 43.07 and 50.76% at 100, 200 and 400 mg/kg respectively in gastrointestinal motility test indicating anti-diarrheal potentials. The extract significantly (p<0.05) reduced the intestinal fluid accumulation with percentage inhibitions of 33.28 and 45.61% at 200 and 400 mg/kg respectively, suggesting antisecretory effect. Furthermore, the extract significantly (p<0.05) inhibited the intestinal propulsion of the charcoal meal through the gastrointestinal tract in castor oil-induced gastrointestinal transit suggesting antimotility effect. Total flavonoids and tannins are the most abundant phytoconstituents therein. This study therefore concluded that the anti-diarrhea action of the extract may at least in part be mediated via antisecretory and antimotility mechanisms, which could be due to the additive, synergy or counter interaction of the phytoconstituents therein, thus supporting its ethnomedicinal claim.
Gedächtnisambulanzstrukturen in Deutschland – Ergebnisse einer Klinikbefragung
Authors: Meiberth Dix , Rapp Michael , Jessen Frank
Published: January 2019

Ziel der Studie Erfassung der Strukturen zur Frühdiagnostik von Demenzen an Krankenhäusern in Deutschland.

Methodik Fragebogenerhebung.

Ergebnisse 14 % von 1758 kontaktierten Einrichtungen antworteten. 52 % berichteten über ein entsprechendes Angebot, zum großen Teil mit leitlinienorientierten Verfahren, wie Liquordiagnostik. Das Diagnosespektrum umfasste zu 46 % Demenzen und zu 41 % Diagnosen der leichten oder subjektiven kognitiven Störung.

Schlussfolgerung Leitlinienbasierte Diagnostik und Früherkennungskonzepte sind in Gedächtnisambulanzen weitgehend etabliert.
A Prospective Study of Efficacy of Small Fenestra Stapedotomy at a South Asian Center
Authors: Sriraam Laya , Shukla Sunita , Ramalingam Ravi , Ramalingam K.
Published: January 2019

Introduction The best surgical treatment for otosclerosis is stapedotomy. Various methods are used for creating fenestra, including manual pick, laser, and Skeeter drill. In India, despite several studies on the hearing outcomes of otosclerosis surgery, there exist few studies on small fenestra stapedotomy performed using a microdrill. Hence, we designed this study with the objectives of examining the demographic profile, hearing improvement after surgery, anatomical variations encountered at surgery, effect of microdrill use on bone conduction (BC), and postoperative complications of small fenestra stapedotomy.

Methods A prospective study was conducted for 63 patients of otosclerosis. Stapedotomy was performed by the same surgeon on all patients by a transcanal approach under local anesthesia. Small fenestra stapedotomy was performed using Skeeter microdrill. The study proforma included sociodemographic profile, clinical history, examination, audiometry, surgical details, and postoperative findings. Descriptive statistics was used to analyze the data.

Results Our study demonstrated a male preponderance (58.7%) over females (41.3%). Of the study population, 31.7% reported a family history of otosclerosis, whereas nine (14.28%) individuals had a history of measles. All four different types of footplates were identified. Most of them were either type 1 (52.4%) or 2 (34.9%). In most cases, the diameter was 0.4 mm (96.8%), a majority of the cases having either 4.25 (22.2%) or 4.5 mm (63.5%) long piston. After stapes surgery, the mean ABG reduced from 39.48 (±9.17) to 13.89 (±7.99) dB. The mean worsening in postoperative BC was only 3.035 dB. Use of microdrill caused only a slight and statistically insignificant decline in BC. Anatomical variation of a narrow oval window niche may require drilling of the bone. In practice, this drilling does not adversely affect the BC of the patient. Some facial nerve variation (partially overhanging facial nerve and exposed facial nerve) may be encountered, but it does not affect the facial nerve function or hearing improvement. On rare occasions, facial paresis may occur on the fifth to sixth postoperative day, even without facial nerve handling. This can be managed conservatively with oral steroids with favorable results. Taste alterations are seen even when the chorda handling is minimal. Complaints are most common in the first few weeks after surgery. Over a 6-month period, only 5% of the patients who underwent surgery were found to have altered taste sensation.

Conclusion Microdrill-assisted small fenestra stapedotomy, performed under local anesthesia, with placement of a 0.4-mm Teflon piston for patients with otosclerosis produces excellent results. The complication rates are low, and the surgery has a positive impact on the patient's hearing.
Additive- and Oxidant-Free Expedient Synthesis of Benzimidazoles Catalyzed by Cobalt Nanocomposites on N-Doped Carbon
Authors: Wang Zhaozhan , Song Tao , Yang Yong
Published: January 2019

A one-pot direct synthesis of a wide range of biologically active benzimidazoles through coupling of phenylenediamines and aldehydes catalyzed by a highly recyclable nonnoble cobalt nanocomposite was developed. A broad set of benzimidazoles can be efficiently synthesized in high yields and with good functional-group tolerance under additive- and oxidant-free mild conditions. The catalyst can be easily recycled for successive uses, and the process permits gram-scale syntheses of benzimidazoles.
An Asymmetric Organocatalytic Aldol Reaction of a Hydrophobic Aldehyde in Aqueous Medium Running in Flow Mode
Authors: Schober Lukas , Ratnam Shahilan , Yamashita Yasunobu , Adebar Niklas , Pieper Matthias , Berkessel Albrecht , Hessel Volker , Gröger Harald
Published: January 2019

Reaction conditions have been identified to conduct a one-pot asymmetric organocatalytic aldol reaction with a hydrophobic substrate in aqueous medium via a process running in flow mode. By employing a mixture of water and 2-propanol, a hydrophobic aldehyde and 3.6 mol% of an organocatalyst, this microreactor process affords the desired aldol adduct with a conversion of 74% and an enantioselectivity of 89% after a reaction time of 60 minutes.