[Urogeriatric thinking using the example of antiandrogen therapy for prostate cancer]. / Urogeriatrisches Denken am Beispiel der antiandrogenen Therapie des Prostatakarzinoms.

The geriatric patient is defined by an age of over 75 years and multimorbidity or by an age of over 80 years. These patients exhibit a particular vulnerability, which, in the incidence of side effects or complications, leads to a loss of autonomy. Treatment sequalae, once they have arisen, can no longer be compensated. It is important to recognize and document treatment requirements among geriatric patients with the help of screening instruments such as the Identification of Seniors at Risk (ISAR) and Geriatric 8 (G8) scores. If a treatment requirement is identified, oncologic treatment should not be commenced uncritically but rather a focus placed on identification of functional deficits relevant to treatment, ideally using a geriatric assessment but at least based on a detailed medical history. These deficits can then be presented in a structured, examiner-independent, and forensically validated manner using special assessments. A planned treatment requires not only consideration of survival gains, but also knowledge of specific side effects and, in geriatric patients in particular, their impact on everyday life. These considerations should be compared with the patient's individual risk profile in order to prevent side effects from negating the effect of the treatment, for example by worsening the patient's self-help status. With regard to androgen deprivation in prostate cancer-which often is used uncritically-it is important to consider possible side effects such as osteoporosis, sarcopenia, anemia, and cognitive impairment in terms of a possible fall risk; an increase in cardiovascular mortality and the triggering of a metabolic syndrome on the basis of preexisting cardiac diseases or risk constellations; and to carry out a careful risk-benefit analysis.

[Can the antibiotic prescription practice in a hospital be influenced by in-house guidelines? An interventional study at the University Hospital Halle (Saale), Germany]. / Lässt sich die Antibiotikaverordnungspraxis im Krankenhaus durch hausinterne Richtlinien beeinflussen? Interventionsstudie am Universitätsklinikum Halle (Saale).

BACKGROUND: In-house guidelines are an essential tool of antibiotic stewardship (ABS) programs to guide antimicrobial therapy. We studied the effect of in-house guidelines adapted to the local pathogen and resistance epidemiology on prescribing behavior. METHODS: At the University Hospital Halle (Saale) guidelines for the antimicrobial therapy and essential microbiological diagnostics were introduced. Main objectives were reducing the use of third generation cephalosporines and fluoroquinolones, decreasing selection pressure for enterococci and multidrug-resistant Gram-negative bacteria, minimizing Clostridium difficile infections (CDI), and improving microbiological diagnostics to enhance de-escalation strategies. 12 months thereafter a comparison of antibiotic consumption, pathogen and resistance statistics and use of blood cultures was performed. RESULTS: There was a decrease of third-generation cephalosporines (-18.6%) and fluoroquinolones (-9.8%), while consumption of broad- and intermediate-spectrum penicillins (+23.8% and +37%) as well as carbapenems (+11.9%) increased. The total volume of prescribed anti-infectives remained unchanged. The number of enterococcal isolates (-18.3%) and CDI (-26.3%) decreased considerably. Gram-negatives, particulary ESBL-producing Enterobacteriaceae, were detected more frequently due to an expanded screening program. The rate of blood cultures/1000 patient-days was unaffected. CONCLUSION: In-house guidelines for the empiric antiinfective therapy appear to be suitable to influence the prescribing behavior and the selection pressure on individual pathogen groups. The total volume of antibiotic prescriptions was not affected in this study.

High-power distributed Bragg reflector ridge-waveguide diode laser with very small spectral linewidth.

We manufactured and investigated distributed Bragg reflector ridge-waveguide diode lasers having sixth-order surface gratings and an emission wavelength around 974 nm. The single-mode output power of the lasers with a total length of 4 mm exceeded 1 W. A very small spectral linewidth of 1.4 MHz (3 dB) consisting of a Lorentzian part of 146 kHz and a Gaussian part of 1308 MHz was measured using a self-delayed heterodyne measurement technique.

[Phlegmon of the palm of the hand as initial manifestation of the Lemierre syndrome]. / Hohlhandphlegmone als Erstmanifestation des Lemierre-Syndroms.

Lemierre's syndrome is a rare disease in young otherwise healthy people showing septic embolism in the lungs and peripheral vessels. We report the case of a 19-year-old male patient who presented initially with a phlegmon of the right palm and beginning septic shock. During the clinical course a subcutaneous abscess of the left shoulder, multiple lesions of the lungs and a pericardial abscess were identified and Lemierre's syndrome was diagnosed. In this case, positron emission tomography (PET) was revealed to be an appropriate instrument to determine the extent of the disease in a one step procedure.

5'-upstream cis-elements and binding factor(s) potentially involved in light-regulated expression of a Brassica napus rbcS gene.

The 5'-upstream region of a Brassica napus rbcS gene contains sequence elements that resemble the cis-regulatory elements described for other species. In band shift competition assays using whole-cell extracts and sets of deletion fragments we could assign protein binding to a region located 110-130 base pairs upstream of the transcription start site. DNase I protection experiments showed that the binding region is non-contiguous and reveals symmetry. On the non-coding strand, the sequence contains 5'-CAC-3' and 5'-GTGG-3' elements which together resemble the contiguous G-box core motif, CACGTGG, of other rbcS genes. The DNA-protein interaction was more efficient with extracts from light-grown than with those from dark-grown seedlings, indicating the possible involvement of light-regulated factors(s).

Temporal and spatial pattern of plastid gene expression during crucifer seedling development and embryogenesis.

Several genes which are located close together on mustard (Sinapis alba L.) chloroplast DNA have been found to differ in their temporal mode of expression throughout seedling development. One predominant expression program, exemplified by thepsbA gene, is characterized by an early (light-independent) rise in transcript levels, followed by subsequent further accumulation to levels which are much higher in the light than in darkness (development of 'competence' for photocontrol). Other genes located next to thepsb A gene show transient or constitutive modes of expression, with no light-dark difference in transcript levels throughout seedling development. The characteristics of light-responsive expression were shown for the nuclearrbcS gene family inBrassica napus L. andSinapis alba L. cotyledons. The spatial distribution ofrbcS andpsbA transcripts across sections of crucifer cotyledons appeared to be relatively uniform, but restricted to photosynthetically active cells. Finally, assessment of these transcripts in immature seeds and embryos ofCapsella bursa-pastoris has provided in-situ evidence for tissuespecific gene expression during early development.