[Quality of care of acute ischemic stroke in Germany 2018]. / Versorgungsqualität des akuten ischämischen Schlaganfalls in Deutschland 2018.

In this overview the current quality of acute in-hospital care of stroke patients in Germany in 2018 is described based on standardized and evidence-based quality indicators. For this purpose the reports of the regional quality assurance projects for stroke care, which collaborated within the German-speaking Stroke Registers Study Group (ADSR) were analyzed. Overall, more than 280,000 acute admissions of stroke patients were documented in the included quality assurance projects. The results regarding the defined 16 quality indicators comprising diagnostics, acute treatment, rehabilitation and secondary prevention showed a high level of acute inpatient treatment of stroke in Germany. Only a few quality indicators, such as early transfer for thrombectomy indicated a great necessity for process optimization.

Prenatal antimicrobial use and early-childhood body mass index.

BACKGROUND/OBJECTIVES: Growing evidence suggests that antibiotic use is associated with childhood body mass index (BMI), potentially via mechanisms mediated by gut microbiome alterations. Less is known on the potential role of prenatal antimicrobial use in offspring obesity risk. We examined whether prenatal antibiotic or antifungal use was associated with BMI at the age of 2 years in 527 birth cohort participants. METHODS/SUBJECTS: Antimicrobial use was obtained from the prenatal medical record. Height and weight were measured at the age of 2 years. Overweight/obesity was defined as a BMI ⩾85th percentile. RESULTS: A total of 303 (57.5%) women used antibiotics and 101 (19.2%) used antifungals during pregnancy. Prenatal antifungal use was not associated with child BMI at the age of 2 years. In the fully adjusted model, prenatal antibiotic use was associated with a 0.20±0.10 (P=0.046) higher mean BMI Z-score at the age of 2 years. Associations between prenatal antibiotic use and childhood BMI varied by trimester of exposure, with first or second-trimester exposure more strongly associated with larger BMI at the age of 2 years for both BMI Z-score (interaction P=0.032) and overweight/obesity (interaction P=0.098) after covariate adjustment. CONCLUSIONS: Prenatal antibiotic, but not antifungal, use is associated with larger BMI at the age of 2 years; associations were stronger for antibiotic exposures in earlier trimesters. Future studies examining whether these associations are due to alterations in the maternal and/or infant microbiome are necessary. Children who are overweight at the age of 2 years are at higher risk for being overweight as they age; prenatal antibiotic use is a potentially modifiable exposure that could reduce childhood obesity.

Identification and first characterization of SmEps8, a potential interaction partner of SmTK3 and SER transcribed in the gonads of Schistosoma mansoni.

In eukaryotes the roles of protein kinases (PKs) regulating important biological processes such as growth and differentiation are well known. Molecular, biochemical, and physiological analyses trying to unravel principles of schistosome development have substantiated the importance for PKs also in this parasite. Amongst others the role of SmTK3 was studied, one of the first cellular PKs characterized from Schistosoma mansoni. Its function was demonstrated in mitogenic and differentiation processes in the gonads. Furthermore, first insights were obtained for the downstream part of a signal transduction cascade SmTK3 is involved in, which includes the diaphanous homolog SmDia. Here we attempted to further unravel the SmTK3 signaling cascade by searching for upstream interaction partners. Using yeast three-hybrid (Y3H) analyses we detected the epidermal growth factor receptor (EGFR) pathway substrate 8 of S. mansoni (SmEps8) as the most interesting candidate. By detailed interaction analyses we showed a contribution of the Src homology (SH) domains SH2 and SH3 of SmTK3 to binding, with a clear bias towards SH2. Compared to full-length SmEps8, binding was enhanced when only its 5' part including the phosphotyrosine binding domain (PTB) was used for interaction analyses including the SH2 domain of SmTK3, although phosphorylation seemed not to play a decisive role for binding. RT-PCR analyses and in situ hybridization experiments demonstrated similar transcription patterns of SmTK3 and SmEPS8, which co-localize in the reproductive organs. Furthermore, first evidence was obtained for SmEps8 interaction and colocalization with SER, one of the epidermal growth factor receptor (EGFR) homologs detected in S. mansoni. The results of this study provide first evidence for a SER-SmEps8-SmTK3-SmDia signal transduction pathway controlling differentiation processes in the gonads of S. mansoni.

[Reasons for proximal femoral fracture surgery delays : Analysis of the structured dialog in Rheinland-Pfalz]. / Verzögerte Versorgung hüftgelenknaher Femurfrakturen : Analyse des Strukturierten Dialogs Rheinland-Pfalz.

BACKGROUND: For the "preoperative stay" quality indicator , which is part of the external quality assurance for proximal femoral fractures (module 17/1), a tolerance range for surgery within 48 h after admission of ≤15 % is given. MATERIALS AND METHODS: The structured dialog (2014) in Rheinland-Pfalz was analyzed with respect to reasons for delaying surgery for more than 48 h after admission. RESULTS: A total of 331 cases were analyzed. In 60.7 % patient-related reasons and in 13.3 % administrative reasons were found. In 9.1 % the statements were not feasible. Due to a lack of software-related specifications in 7.3 % a wrong preoperative length of stay was generated. Wrong coding or a computer-related problem was found in 6.6 %. The most common reason for delay was the intake of an anticoagulant (25.7 %). CONCLUSION: The significance of the quality indicator "Preoperative stay" without division into whether this was administrative or patient-related must be considered critically.

Incidence of cardiovascular and cerebrovascular events associated with sirolimus use after liver transplantation.

BACKGROUND: Sirolimus (SRL) is an immunosuppressant often used in liver transplantation (LT) to mitigate renal insufficiency associated with calcineurin inhibitors. Sirolimus can cause hyperlipidemia, but its association with coronary artery disease (CAD) and cerebrovascular accidents (CVAs) is unclear. The purpose of this study was to assess the risk of CAD and CVAs with the use of SRL in LT recipients. METHODS: We retrospectively reviewed all of our LT recipients from 2000 to 2011. Patients with multiorgan transplant, multiple liver transplants, everolimus therapy, or survival <3 months were excluded. The 803 remaining patients were divided into 3 groups: 1) 134 patients who received and tolerated SRL; 2) 604 patients who never received SRL; and 3) 65 patients who started but discontinued SRL. The primary outcome was the development of CAD or CVA beyond 4 months after transplantation with the use of time-dependent Kaplan-Meier analysis. RESULTS: In group 1, there were 6 CAD and 2 CVA events; in group 2, 27 CAD and 16 CVA events; and in group 3, 10 CAD and 2 CVA events. The event-free survival for CAD/CVA at 1, 3, and 5 years was 100%, 98.1%, and 97.2% respectively for group 1; 99.7%, 98.4%, and 96.1% for group 2; and 92.3%, 92.3%, and 85.6% for group 3. On an unadjusted basis, compared with group 2, there was no difference in CAD/CVA rates in group 1 (hazard ratio [HR] 0.92; not significant), but there was an increase in group 3 (HR 2.94; P = .0019). However, on multivariate analysis, only age at transplantation (HR 1.06; P = .001) and diabetes before transplantation (P = .011) were associated with increased CAD/CVA risk. CONCLUSIONS: Our analysis showed that patients receiving SRL after LT had no increased risk of CAD/CVA events compared with patients maintained on a calcineurin inhibitor. The risk of CAD/CVA should not be a factor in avoiding SRL.

Auger spectrum of a water molecule after single and double core ionization.

The high intensity of free electron lasers opens up the possibility to perform single-shot molecule scattering experiments. However, even for small molecules, radiation damage induced by absorption of high intense x-ray radiation is not yet fully understood. One of the striking effects which occurs under intense x-ray illumination is the creation of double core ionized molecules in considerable quantity. To provide insight into this process, we have studied the dynamics of water molecules in single and double core ionized states by means of electronic transition rate calculations and ab initio molecular dynamics (MD) simulations. From the MD trajectories, photoionization and Auger transition rates were computed based on electronic continuum wavefunctions obtained by explicit integration of the coupled radial Schrödinger equations. These rates served to solve the master equations for the populations of the relevant electronic states. To account for the nuclear dynamics during the core hole lifetime, the calculated electron emission spectra for different molecular geometries were incoherently accumulated according to the obtained time-dependent populations, thus neglecting possible interference effects between different decay pathways. We find that, in contrast to the single core ionized water molecule, the nuclear dynamics for the double core ionized water molecule during the core hole lifetime leaves a clear fingerprint in the resulting electron emission spectra. The lifetime of the double core ionized water was found to be significantly shorter than half of the single core hole lifetime.

Schistosoma mansoni: signal transduction processes during the development of the reproductive organs.

Among the topics of considerable interest concerning our understanding of the unusual biology of schistosomes is the sexual maturation of the female. The identification of genes coding for signal transduction proteins controlling essential steps of the pairing-dependent differentiation of the reproductive organs, vitellarium and ovary will help to substantiate our knowledge about this unique parasite. Furthermore, such signalling proteins could be potential targets to interfere with the development of this parasite to combat schistosomiasis since its pathology is caused by the eggs. This review summarises first post-genomic steps to elucidate the function of gonad-specific signalling molecules which were identified by homology-based cloning strategies, by in silico identification or by yeast two-hybrid interaction analyses, using a combination of novel techniques. These include the in vitro culture of adult schistosomes, their treatment with chemical inhibitors to block enzyme activity, the use of RNAi to silence gene function post-transcriptionally, and confocal laser scanning microscopy to study the morphological consequences of these experimental approaches. Finally, we propose a first model of protein networks that are active in the ovary regulating mitogenic activity and differentiation. Some of these molecules are also active in the testes of males, probably fulfilling similar roles as in the ovary.

Crystallization and preliminary X-ray diffraction studies of the glutathione S-transferase from Plasmodium falciparum.

Glutathione S-transferases (GSTs) belong to a family of detoxification enzymes that conjugate glutathione to various xenobiotics, thus facilitating their expulsion from the cells. For high-resolution crystallographic investigations, GST from the human malarial parasite Plasmodium falciparum was overexpressed in bacterial cells and crystallized using hanging-drop vapour diffusion. X-ray intensity data to 2.8 A resolution were collected from an orthorhombic crystal form with unit-cell parameters a = 62.2, b = 88.3, c = 75.3 A. A search for heavy-atom derivatives has been initiated, along with phase-determination efforts by molecular replacement.

Actividad de tirosina-proteina-quinasas en cáncer de mama: comparación con la actividad obtenida en patologías benognas y en tejidos normales / Tyrosina-protein-kinase activity in breath cancer: comparison between benign pathologies and normal tissues activity

Tyrosine protein kinase (TPK) activity is associated to malignant cellular transformation. This work compares TPK activity in 27 surgical biopsy samples of mammary carcinoma, 10 samples of normal mammary tissue. TPK activity was determined in tissue homogenates using (Val5) angiotensin II as exogenous substrate. In samples of mammary carcinoma, TPK activity was 33.86 ñ 31.98 pmol P32/mg protein/30 min. This value was significantly higher that those observed in fibrocystic disease (3.92 ñ 2.35), fibroadenomas (13.86 ñ 10.9) and normal tissue (3.56 ñ 3.02)

Visibilidad radiológica de los fibroadenomas mamarios / Radiological visibility of mammary fibroadenomas

From a clinical point of view, all mammary fibroadenomas are similar. However some of them are not visible in mammograms, phenomenom probably related to glandular density. Aiming to elucidate whether the lack of visibility is caused by the glandular density or by tumor itself, a 3 stage study was performed. In 201 cases the mammographic visibility of fibroadenomas was determined and correlated with patients' age, the presence of fibrocystic disease and tumor histological type; after surgical excision, 18 fibroadenomas were sliced into 5 mm thick samples and X rayed to determine their visibility; finally 2 visible and 2 non visible tumors were calcinated at 550ºC and their ashes subjected to X-ray diffraction analysis. Twenty two percent of fibroadenomas were not vosible on mammography, this percentage was higher for intracanicular tumors, in younger women and in the presence of fibrocystic disease. Sixteen percent of excised and sliced tumors were not visible on X rays. Also, differences were found in X-ray diffraction studies between visible and invisible tumors, probably related to NaCl and KCl tumor content

Cáncer de mama etapa I y II: resultados del tratamiento conservador / Breast cancer stage I and II: results of the conservative treatment

Con el fin de evaluar los resultados a largo plazo de nuestras políticas de tratamiento de las pacientes con cáncer de mama en etapa clínica I y II, se revisa la sobrevida total y la sobrevida libre de enfermedad en un grupo de 411 pacientes, de las cuales 213 fueron tratadas con esquema conservador entre 1980 y 1990, con un seguimiento mínimo de 2 años y un seguimiento promedio de 62,4 meses. Se encuentra que la sobrevida global a 72 meses fue de 80 por ciento, con 94,1 por ciento para el estadio I y un 75,89 por ciento para el estadio II. La sobrevida libre de enfermedad a 72 meses fue 79,89 por ciento para el grupo completo, mientras fue de 90,2 por ciento para el estadio I y 76,1 por ciento para el estadio II. No se observaron diferencias entre aquellas pacientes tratadas con esquema conservador y las tratadas con cirugía radical. La sobrevida y la sobrevida libre de enfermedad no se vieron afectadas en las pacientes con tumores de hasta 5 centímetros tratadas en forma conservadora. La falta de disección axilar en las pacientes tampoco empeoró el pronóstico

Enfermedad de Paget de la mama / Paget`s disease of the breast

Se analiza la experiencia en el manejo de la enfermedad de Paget de la mama, revisando los antecedentes de 15 casos acumulados a lo largo de 1 años. Se encuentra que el diagnóstico es demorado por la mala interpretación del eczema del pezón, el que se presentó como único signo en la mitad de los casos. La citología jugó un papel importante en el diagnóstico. El tratamiento se hizo con cirugía radical y la sobrevida estimada a 67 meses es de 80 por ciento. Se comenta la importancia de las teorías de génesis de la enfermedad en la estructuración de una política terapéutica racional

Utilidad de la termografía como predictor de pronóstico en cáncer de mama / Thermography utility as a predictor of breast cancer prognosis

Aunque existe acuerdo en que el rendimiento de la termografía como método de diagnóstico en el cáncer de mama es muy escaso, los estudios de la asociación entre ciertos cambios termográficos y el pronóstico de la paciente han obtenido resultados discrepantes. En un grupo de 436 pacientes portadoras de cáncer de mama, en diferentes estadios, estudiadas en un período de 10 años y con una mediana de seguimiento de 34 meses, se analizó la relación de una termografía con signos de crecimiento acelerado (PEV + termográfico) con la sobrevida. Se encontró que aquellas pacientes sin signos termográficos de crecimiento acelerado tenían una sobrevida a 3 años de 84,5% y a 5 años de 72%, lo que resulta significativamente mejor que la sobrevida de aquellas con termografía con signos de crecimiento acelerado en que se encontró una sobrevida a 3 años de 36,7% y a 5 años de 24,5%. Se concluye que la termografía manifestó en esta serie una poderosa capacidad de pronóstico, identificando a aquellas pacientes en que el cáncer se comportaría de manera agresiva

Factores pronósticos histológicos en cáncer de mama estadios I y II / Pronostic histological factors in breast cancer stage I and II

A 132 pacientes de sexo femenino portadoras de un cáncer de mama en estadios I y II, en quienes se practicaron diferentes tratamiento quirúrgicos, se les aplicó diferentes test de acuerdo a varios parámetros histopatológicos, para analizar su sobrevivencia de acuerdo a estos hallazgos. Se concluye que el grado de diferenciación histológica, el número de metástasis y el margen de resección son los factores pronósticos más importantes

Tumor filodes de la mama: diagnóstico y tratamiento en 26 casos / Phyllodes tumor of the breast: diagnostic and treatment in 26 cases

El tumor filodes es una patología poco frecuente de la mama. A esto se debe que los elementos útiles para el diagnóstico, así como los criterios terapéuticos permanezcan confusos. En una serie de 26 casos tratados en el curso de 10 años, se revisa el valor de los métodos de diagnóstico, se analiza la conducta seguida y la evolución de las pacientes. Se encuentra que tanto la clínica como la mamografía confunden al T. filodes con otros tumores, especialmente el fibroadenoma; que la citología es incapaz de certificar el diagnóstico y sólo permite la sospecha en algunos casos y que la termografía parece ser un buen indicador para el diagnóstico. La mayoría de las pacientes se trató de manera conservadora y se produjeron 5 recidivas locales y 4 muertes. Se destaca un caso de bilateralidad

[Diameter of coronary arteries before and after bypass grafting (author's transl)]. / Angiographische Weitenmessungen an Koronararterien vor und nach Bypassoperation.

Patients with patent coronary bypass grafts showed the followings: 1. a decrease in prestenotic coronary diameter due to a reduction in flow. 2. An increase of the poststenotic segment of the bypassed vessel due to an increase in flow via the venous graft. 3. An increase of the bypassed stenosis, mainly due to a general decrease of vessel diameter proximal to the stenosis. 4. No change in diameter in non bypassed arteries. The postoperative changes in diameter were not dependent on the time elapsed since surgery and were independent from the severity of coronary sclerosis and the number of risk factors. A correlation was found between the amount of the diameter changes and the amount of reduction in exercise induced ST-segment depression. The decrease in coronary diameter proximal to the stenosis is not due to progression of coronary sclerosis but to a functional change. A narrow poststenotic vessel does not constitute a contraindication for bypass grafting because its true diameter is flow dependent and cannot be judged with certainty from the preoperative angiogram.