Increasing hepatitis B vaccination coverage and decreasing hepatitis B co-infection prevalence among people with HIV-1 in Germany, 1996-2019. Results from a cohort study primarily in men who have sex with men.

OBJECTIVES: Viral hepatitis co-infection among people living with HIV is known to accelerate the progression of liver disease and AIDS. An increased prevalence and incidence of hepatitis B virus (HBV) infection among people living with HIV demands continuous monitoring to adapt targeted prevention strategies to reach the global goals of eliminating viral hepatitis as a public health threat. METHODS: We determined the prevalence and incidence of HBV for the years 1996-2019 from yearly blood sample testing and questionnaire reports among people living with HIV belonging to a nationwide, multicentre observational, prospective cohort study. RESULTS: Among this study population of 3479 participants, the majority (87%) indicated that being men who have sex with men (MSM) was their likely HIV transmission route; 51% were recruited from Berlin. HBV prevalence for acute/chronic and resolved infections decreased from 4.1% and 45% in 1996-1999 to 1.3% and 16% in 2019, respectively. Simultaneously, participants with a serological status indicating HBV vaccination increased from 25% in 1996-1999 to 69% in 2019. Among vaccinated participants with relevant information (n = 1135), 38% received their first HBV vaccination after HIV infection. The HBV incidence rate in 565 eligible participants decreased from 6.9/100 person-years in 2004-2007 to 0.45/100 person-years in 2015. CONCLUSION: Increasing vaccination coverage because of a general HBV vaccination recommendation and catch-up vaccination efforts among risk groups decreased HBV infection prevalence over time among this study population of people living with HIV, primarily MSM and from Berlin. Despite this success, the prevalence and incidence of HBV remains higher than in the general population in Germany. This emphasizes the need for continued HBV prevention by promoting HBV vaccination and HBV screening at regular intervals based on the individual risk behaviour.

[Which patients benefit from transport with ongoing cardiopulmonary resuscitation? : Retrospective analysis of 70 patients with refractory preclinical cardiac arrest]. / Welcher Patient profitiert von einem Transport unter laufender kardiopulmonaler Reanimation? : Retrospektive Analyse von 70 Patienten mit refraktärem präklinischem Herzstillstand.

BACKGROUND: Mortality in patients with out-of-hospital cardiac arrest (OHCA) remains very high despite advances in resuscitation algorithms. Most of these patients die at the scene and do not reach hospital. It is currently the subject of discussion whether transport to hospital with ongoing cardiopulmonary resuscitation (CPR) improves survival and neurological outcome in patients with OHCA. OBJECTIVE: The aim of this study was to identify predictors of survival and good neurological outcome in patients after OHCA who were transported to hospital with ongoing CPR. PATIENTS AND METHODS: A total of 70 consecutive patients with refractory OHCA (mean age 54.7 ± 15 years) transported to hospital with ongoing CPR were retrospectively analyzed. Neurological outcome was assessed after 30 days based on the Glasgow-Pittsburgh cerebral performance category (CPC). RESULTS: After 30 days 82.9% of the patients enrolled in the trial died (CPC score of 5), 8 patients (11.4%) showed a good neurological recovery with CPC scores of 1-2 and 4 patients (5.7%) had a poor neurological outcome with CPC scores of 3-4. Predictors of good neurological outcome were witnessed arrest, initial defibrillatable rhythm and serum lactate levels on admission. In all patients with good outcome, the index event for OHCA was from cardiac causes. CONCLUSION: Selected patient collectives can benefit from transport to hospital with ongoing cardiopulmonary resuscitation (CPR).

Bone marrow fat has brown adipose tissue characteristics, which are attenuated with aging and diabetes.

Fat occupies a significant portion of bone cavity however its function is largely unknown. Marrow fat expands during aging and in conditions which affect energy metabolism, indicating that fat in bone is under similar regulatory mechanisms as other fat depots. On the other hand, its location may determine specific functions in the maintenance of the environment for bone remodeling and hematopoiesis. We have demonstrated that marrow fat has a distinctive phenotype, which resembles both, white and brown adipose tissue (WAT and BAT, respectively). Marrow adipocytes express gene markers of brown adipocytes at levels characteristic for the BAT, including transcription factor Prdm16, and regulators of thermogenesis such as deiodinase 2 (Dio2) and PGC1α. The levels of expression of BAT-specific gene markers are decreased in bone of 24 mo old C57BL/6 and in diabetic yellow agouti A(vy)/a mice implicating functional changes of marrow fat occurring with aging and diabetes. Administration of antidiabetic TZD rosiglitazone, which sensitizes cells to insulin and increases adipocyte metabolic functions, significantly increased both, BAT (UCP1, PGC1α, Dio2, ß3AR, Prdm16, and FoxC2) and WAT (adiponectin and leptin) gene expression in marrow of normoglycemic C57BL/6 mice, but failed to increase the expression of BAT, but not WAT, gene markers in diabetic mice. In conclusion, the metabolic phenotype of marrow fat combines both BAT and WAT characteristics. Decrease in BAT-like characteristics with aging and diabetes may contribute to the negative changes in the marrow environment supporting bone remodeling and hematopoiesis.

Alternative shift models and the quality of patient care. An empirical study in surgical intensive care units.

UNLABELLED: On 1 January 1996, the German Arbeitszeitgesetz (working-time regulation) came into effect for hospital physicians. It states that working hours must not exceed 8 h per day, even for physician in hospitals. As a consequence, the prevalent two-shift model is legally inadmissible. The intention of this law is to protect the physician and to create better conditions for the patients. However, a systematic evaluation of the postulated benefits is still lacking. AIM: The aim of our study was to analyze the influence of the length of daily working hours on the quality of patient care by measuring the outcome of patients in intensive care units (ICUs), comparing the two-shift model (2-SM)--two 12-h shifts--with the three-shift model (3-SM)--three 8-h shifts. MATERIALS AND METHODS: In a prospective multicenter study, we compared the outcome of patients in six ICUs (organized by surgeons) with different models of working hours. The health status of each patient and the course on ICU [described by hospital mortality, number of complications, readmission to the ICU, reinterventions, duration of the stay in an ICU and hospital, the course of the Acute Physiology and Chronic Health Evaluation (APACHE) II score] were uni- and multivariately analyzed. In addition, the technical and personnel resources of the ICUs and the hospitals were documented. RESULTS: Three hundred and forty seven patients (103 2-SM, 244 3-SM) were included. The epidemiological and the health status on admission to the ICU were comparable. Patients in the 3-SM stayed 1.6 days longer on ICU and 2.3 days longer in the hospital than the 2-SM patients. The frequency of complications, reinterventions, and readmissions to ICU was higher in the 3-SM. The median of the APACHE-II score decreased more for 2-SM than for 3-SM patients. This means a significantly quicker recovery of the patients in 2-SM (P < 0.05). The multivariate analysis with individual outcome measures as dependent variables revealed a significant positive effect of the 2-SM on the physicians' assessment of postoperative course, on the relative frequency of therapeutic procedures, and to a lesser extent on the duration of stay in the ICU.