[Nosocomial pneumonia]. / Nosokomiale Pneumonien.

Nosocomial pneumonia is one of the leading entities of nosocomial infections in Germany and worldwide with invasive ventilation being one of the major risk factors. However nosocomial pneumonia without ventilator support is an underappreciated complication as demonstrated by prevalence studies of the European Centre for Disease Control in 2011 and 2016. Major general risk factors include old age, multi-morbidity, preexisting pulmonary disease, immunosuppression and abdominal or thoracic surgery. Evidence based prevention measures for ventilated patients include hand hygiene, aseptic handling techniques of the ventilator circuit, subglottic suctioning for patients intubated more than 72 hours, cuff pressure control, mouth and dental care, daily spontaneous breathing trials, use of sedation protocols and head of bed 30-45 degrees. For non-ventilated patients early mobilization and/or frequent position changes, correct use of feeding tubes and mouth care are key components. In preoperative patients training of a simple breathing exercise combined with mnemonic aids for its use in the postoperative period has been proven to be helpful.

Site-dependent differences in clinical, pathohistological, and molecular parameters in metastatic colon cancer.

The purpose was to develop a metastatic score specific to the hepatic and peritoneal site in colorectal cancer patients from clinical, pathohistological and molecular markers potentially reflecting oncogenic activation (OA) or epithelial-mesenchymal transition (EMT), where OA may reflect an activation and EMT the functional loss of certain genes. The primary tumour stage (OA, EMT), lymphonodal stage (OA), the presence of a lymphangiosis carcinomatosa (OA), histological grade (OA, EMT), and immunoblot extraction of E-cadherin (OA, EMT) were differentially rated with zero to one or two points due to their potential contribution to each process and the resulting scores were validated in 27 colorectal cancer patients (three patients with pre-malignant adenomas, 16 with primaries and two with local recurrencies, three of which were metastatic to the peritoneum, six metastatic to the liver and two metastatic to both, the liver and the peritoneum, and five with hepatic secondaries, one of which at histology was metastatic to the peritoneum too). As a single parameter only the N-stage significantly contributed to OA (p<0.05). Median OA and EMT scores, however, were 3.5 and 2 in the case of primaries without further spread, 5 and 4 in those nodal positive, 5 and 4 in the case of peritoneal implants, 6 and 2 in the case of liver metastases, and 6.5 and 3 in the case of a simultaneous hepatic and peritoneal spread, respectively. These differences were significant when scores from patients with and without liver metastases (OA, p<0.002) or with peritoneal implants and isolated hepatic spread (EMT, p<0.01) were compared. The results suggest a site-specific contribution of OA and EMT to tumour progression in human colon cancer.