Validation of the German Classification of Diverticular Disease (VADIS)-a prospective bicentric observational study.

PURPOSE: The German Classification of Diverticular Disease was introduced a few years ago. The aim of this study was to determine whether Classification of Diverticular Disease enables an exact stratification of different types of diverticular disease in terms of course and treatment. METHODS: This was a prospective, bicentric observational trial. Patients aged ≥ 18 years with diverticular disease were prospectively included. The primary endpoint was the rate of recurrence within 2 year follow-up. Secondary outcome measures were Gastrointestinal Quality of Life Index, Quality of life measured by SF-36, frequency of gastrointestinal complaints, and postoperative complications. RESULTS: A total of 172 patients were included. After conservative management, 40% of patients required surgery for recurrence in type 1b vs. 80% in type 2a/b (p = 0.04). Sixty percent of patients with type 2a (micro-abscess) were in need of surgery for recurrence vs. 100% of patients with type 2b (macro-abscess) (p = 0.11). Patients with type 2a reached 123 ± 15 points in the Gastrointestinal Quality of Life Index compared with 111 ± 14 in type 2b (p = 0.05) and higher scores in the "Mental Component Summary" scale of SF-36 (52 ± 10 vs. 43 ± 13; p = 0.04). Patients with recurrent diverticulitis without complications (type 3b) had less often painful constipation (30% vs. 73%; p = 0.006) when they were operated compared with conservative treatment. CONCLUSION: Differentiation into type 2a and 2b based on abscess size seems reasonable as patients with type 2b required surgery while patients with type 2a may be treated conservatively. Sigmoid colectomy in patients with type 3b seems to have gastrointestinal complaints during long-term follow-up. TRIAL REGISTRATION: https://www.drks.de ID: DRKS00005576.

Operative outcome of hernia repair with synthetic mesh in immunocompromised patients.

BACKGROUND: The safety of synthetic mesh in elective hernia repair in the setting of immunosuppression lacks national and international consensus. The aim of our analysis was to explore the effects of immunosuppression on the rates of wound complications. METHODS: Comparative analysis of immunocompetent and immunocompromised patients with elective mesh repair of inguinal, femoral, primary ventral, incisional or parastomal hernia between January 2001 and December 2013. Immunosuppression included glucocorticoids, biologicals, chemotherapy and chemoradiotherapy. Primary outcome parameter was mesh infection rate. Follow-up questionnaires were completed in written form or by telephone interview. RESULTS: Questionnaire response rate was 59.5% (n = 194) with a median follow-up of 33 (interquartile range: 28-41) months. There were no differences between immunocompromised (n = 40, 20.6%) and immunocompetent patients (n = 154, 79.4%) based on hernia and patient characteristics. Immunosuppression was not associated with the rates of mesh infection (P = 1.000), surgical site infection (SSI, P = 0.330) or re-operation for SSI (P = 0.365), but with higher rates (P = 0.007) and larger odds for hernia recurrence (odds ratio 3.264, 95% confidence interval 1.304-8.172; P = 0.012). Mesh infection also increased the odds for hernia recurrence (odds ratio 11.625; 95% confidence interval 1.754-77.057; P = 0.011). Only in the subset of ventral/incisional hernias, immunocompromised (n = 8, 40%) patients had higher recurrence rates than immunocompetent patients (n = 5, 11.6%; P = 0.017). Patients with SSI reported more frequently moderate to severe dysesthesia at the surgical site (P = 0.013) and would less frequently re-consent to surgery (P = 0.006). CONCLUSION: Immunosuppression does not increase the rate of wound infections after elective hernia repair with synthetic mesh. However, immunosuppression and mesh infection are risk factors for hernia recurrence.

Sources of Support and Information During Disease: An Exploratory Study, Comparing Migrant and Nonmigrant Colorectal Cancer Patients in Germany.

Introduction: The prevalence of cancer diseases among migrants is lower relative to nonmigrants, although this equalizes with increasing duration of residence. There are differences in the health behaviors and disease coping strategies between these two groups. The aim of this analysis is to compare migrant and nonmigrant colorectal cancer (CRC) patients in Germany regarding their sources of support and information during disease. Method: Data from 522 CRC patients, collected through a survey about satisfaction with care, were analyzed by descriptive and multivariate statistics. Results: Migrants and nonmigrants differed in two aspects: Migrants reported to receive the most relevant support during disease more often by nonmedical people, compared with nonmigrants, and they favored videos explaining the therapeutic steps of CRC more than nonmigrants. Discussion: Anticipating which types of support and information sources patients will access during their disease may help guide future diversity management across the field of cancer care.

Does migrant background predict to what extent colorectal cancer patients want to be informed about their life expectancy? - a cross-sectional analysis.

BACKGROUND: Although migrant health is a topic of interest across Europe and although health care services in Germany consider migrant health issues, people with a migrant background often experience difficulties regarding health care provision. The prevalence of various cancers among migrants is lower relative to non-migrants although this equalizes with increasing duration of residence. There are documented differences in health behavior and disease-coping strategies between migrants and non-migrants, but data are scarce on this subject. This analysis investigates the extent of information migrant and non-migrant colorectal cancer (CRC) patients in Germany want about their life expectancy and the level of trust they have in their treating physician. METHOD: Data from 522 CRC patients were collected through a self-reported questionnaire. Migrant background was determined by the patients' and/or their parents' birthplace. Bivariate analyses were applied to determine the differences between migrants and non-migrants. A multivariate analysis was used to measure the effect of migration background, demographics, and cancer stage and treatment on the preferred extent of information about life expectancy and trust in their treating physician. RESULTS: There were no significant differences regarding demographics or cancer stage and treatment between migrant and non-migrant CRC patients. Having a migrant background had no influence on the level of trust in the treating physician, but migrants preferred to be less informed about their life expectancy than non-migrants (21.4% vs. 13.4%, p = 0.04). The multivariate analysis showed that men (aOR = 2.102, CI: 1.123-3.932) and patients with a non-migrant background (aOR = 5.03, CI: 1.02-24.73) preferred receiving information about the approximate value of their life expectancy, rather than receiving no information. CONCLUSION: The study found more similarities than discrepancies between migrant and non-migrant CRC patients regarding demographic factors and stage of disease and treatment, which may be a consequence of an increasingly homogeneous cross-cultural society. However, cultural differences between the minority and host population remain and should always be taken into account in daily clinical practice and in the communication skills training of health care professionals. The study also indicates that recording migration background into health registers would facilitate migrant-sensitive research.

Exploring the characteristics and potential disparities of non-migrant and migrant colorectal cancer patients regarding their satisfaction and subjective perception of care - a cross-sectional study.

BACKGROUND: Although a fifth of the German population has a migration background, health research regarding this population is scarce. The few existing studies on migrant health show that migrants are faced with restrictions regarding health care due to communication problems, a lack of information and distinct health literacy. Colorectal cancer (CRC) is the second most common tumor disease in Germany. The aim of the study is to explore the potential differences in patient characteristics between migrants and non-migrants with CRC and identify possible disparities between migrants and non-migrants regarding their satisfaction and perception with health care. METHODS: A validated questionnaire was modified for CRC, supplemented with items regarding migration background, translated additionally into Arabic, Turkish and Russian and sent out to 1.694 CRC patients. The outcome indicator was 'health care satisfaction and experience' concerning 'medical consultation', 'medical treatment (therapy)' and 'hospital stay' measured on 10-point Likert-scales; explanatory variables were migration background, age, gender, mother tongue, occupation, follow-up care, current discomfort and current treatment. Following descriptive statistics, factor analysis was conducted to compute the outcome variables. Differences between migrants and non-migrants were analyzed using Mann-Whitney-U test and regression analyses. RESULTS: A total of 522 completed questionnaires - 30.8% response rate - were used for analysis. Patients with a migration background attended less often follow up care than non-migrant patients (74.7% vs. 88.6%; p = 0.001). Mean scores regarding satisfaction and experience with consultation, medical treatment (therapy) and hospital stay were 7.86, 7.11 and 7.51 for migrants and 7.84, 7.19 and 7.33 for non-migrants, measured on a 1 to 10 scale with 10 being most satisfied. Migrants were less satisfied with their own involvement in decision making (p = 0.029) and the aspect "responsiveness to patient's questions" (p = 0.048) than non-migrants. CONCLUSIONS: Migrants showed less compliance with regard to follow-up care than non-migrants. Furthermore, migrants were more often dissatisfied with communication with the medical staff than non-migrants. This shows the importance of (cross-cultural) communication skills on the part of physicians and nurses.

Greater perceived ability to form vivid mental images in individuals with high compared to low BMI.

Obese individuals report more frequent food cravings than their lean counterparts. Since mental imagery plays a role in eliciting and maintaining craving we hypothesized that one's ability to image may be associated with body mass index (BMI) and account, at least in part, for the association between BMI and craving. Twenty-five participants (BMI range: 17.7 kg/m(2)-34.2 kg/m(2)) completed three measures of perceived mental imagery ability (The Vividness of Visual Imagery Questionnaire, The Vividness of Olfactory Imagery Questionnaire, The Vividness of Food Imagery Questionnaire), and one measure of craving (Food-Craving Inventory). As predicted, correlation analyses revealed positive associations between BMI and perceived ability to image odors and foods, but not visual objects. Olfactory imagery was singled out as the best predictor of BMI in a hierarchical regression analysis. A second experiment with 57 participants (BMI range: 19.1 kg/m(2)-38.7 kg/m(2)) then confirmed the significant positive association between BMI and perceived ability to image odors. These results raise the possibility that imagery ability may play a role in the heightened food cue reactivity observed in obese individuals.

Altered hypothalamic response to food in smokers.

BACKGROUND: Smoking cessation is often followed by weight gain. Eating behaviors and weight change have been linked to the brain response to food, but it is unknown whether smoking influences this response. OBJECTIVE: We determined the influence of smoking status (smokers compared with nonsmokers) on the brain response to food in regions associated with weight changes in nonsmokers. DESIGN: In study 1, we used functional MRI (fMRI) to identify regions of the brain associated with weight change in nonsmokers. BMI and the brain response to a milk shake, which is a palatable and energy-dense food, were measured in a group of 27 nonsmokers (5 men). Sixteen subjects (3 men) returned 1 y later for BMI reassessment. The change in BMI was regressed against the brain response to isolate regions associated with weight change. In study 2, to determine whether smokers showed altered responses in regions associated with weight change, we assessed the brain response to a milk shake in 11 smokers. The brain response to a milk shake compared with a tasteless control solution was assessed in 11 smokers (5 men) in comparison with a group of age-, sex- and body weight-matched nonsmokers selected from the pool of nonsmokers who participated in study 1. RESULTS: The response in the midbrain, hypothalamus, thalamus, and ventral striatum was positively associated with weight change at the 1-y follow-up in 16 nonsmokers. Compared with nonsmokers, smokers had a greater response to milk shakes in the hypothalamus. CONCLUSION: Smokers display an altered brain response to food in the hypothalamus, which is an area associated with long-term weight change in nonsmokers.

Comparable high rates of extended-spectrum-beta-lactamase-producing Escherichia coli in birds of prey from Germany and Mongolia.

Frequent contact with human waste and liquid manure from intensive livestock breeding, and the increased loads of antibiotic-resistant bacteria that result, are believed to be responsible for the high carriage rates of ESBL-producing E. coli found in birds of prey (raptors) in Central Europe. To test this hypothesis against the influence of avian migration, we initiated a comparative analysis of faecal samples from wild birds found in Saxony-Anhalt in Germany and the Gobi-Desert in Mongolia, regions of dissimilar human and livestock population characteristics and agricultural practices. We sampled a total of 281 wild birds, mostly raptors with primarily north-to-south migration routes. We determined antimicrobial resistance, focusing on ESBL production, and unravelled the phylogenetic and clonal relatedness of identified ESBL-producing E. coli isolates using multi-locus sequence typing (MLST) and macrorestriction analyses. Surprisingly, the overall carriage rates (approximately 5%) and the proportion of ESBL-producers among E. coli (Germany: 13.8%, Mongolia: 10.8%) were similar in both regions. Whereas bla(CTX-M-1) predominated among German isolates (100%), bla(CTX-M-9) was the most prevalent in Mongolian isolates (75%). We identified sequence types (STs) that are well known in human and veterinary clinical ESBL-producing E. coli (ST12, ST117, ST167, ST648) and observed clonal relatedness between a Mongolian avian ESBL-E. coli (ST167) and a clinical isolate of the same ST that originated in a hospitalised patient in Europe. Our data suggest the influence of avian migratory species in the transmission of ESBL-producing E. coli and challenge the prevailing assumption that reducing human influence alone invariably leads to lower rates of antimicrobial resistance.

Neurochemical architecture of the central complex related to its function in the control of grasshopper acoustic communication.

The central complex selects and coordinates the species- and situation-specific song production in acoustically communicating grasshoppers. Control of sound production is mediated by several neurotransmitters and modulators, their receptors and intracellular signaling pathways. It has previously been shown that muscarinic cholinergic excitation in the central complex promotes sound production whereas both GABA and nitric oxide/cyclic GMP signaling suppress its performance. The present immunocytochemical and pharmacological study investigates the question whether GABA and nitric oxide mediate inhibition of sound production independently. Muscarinic ACh receptors are expressed by columnar output neurons of the central complex that innervate the lower division of the central body and terminate in the lateral accessory lobes. GABAergic tangential neurons that innervate the lower division of the central body arborize in close proximity of columnar neurons and thus may directly inhibit these central complex output neurons. A subset of these GABAergic tangential neurons accumulates cyclic GMP following the release of nitric oxide from neurites in the upper division of the central body. While sound production stimulated by muscarine injection into the central complex is suppressed by co-application of sodium nitroprusside, picrotoxin-stimulated singing was not affected by co-application of this nitric oxide donor, indicating that nitric oxide mediated inhibition requires functional GABA signaling. Hence, grasshopper sound production is controlled by processing of information in the lower division of the central body which is subject to modulation by nitric oxide released from neurons in the upper division.

The anterior insular cortex represents breaches of taste identity expectation.

Despite the importance of breaches of taste identity expectation for survival, its neural correlate is unknown. We used fMRI in 16 women to examine brain response to expected and unexpected receipt of sweet taste and tasteless/odorless solutions. During expected trials (70%), subjects heard "sweet" or "tasteless" and received the liquid indicated by the cue. During unexpected trials (30%), subjects heard sweet but received tasteless or they heard tasteless but received sweet. After delivery, subjects indicated stimulus identity by pressing a button. Reaction time was faster and more accurate after valid cuing, indicating that the cues altered expectancy as intended. Tasting unexpected versus expected stimuli resulted in greater deactivation in fusiform gyri, possibly reflecting greater suppression of visual object regions when orienting to, and identifying, an unexpected taste. Significantly greater activation to unexpected versus expected stimuli occurred in areas related to taste (thalamus, anterior insula), reward [ventral striatum (VS), orbitofrontal cortex], and attention [anterior cingulate cortex, inferior frontal gyrus, intraparietal sulcus (IPS)]. We also observed an interaction between stimulus and expectation in the anterior insula (primary taste cortex). Here response was greater for unexpected versus expected sweet compared with unexpected versus expected tasteless, indicating that this region is preferentially sensitive to breaches of taste expectation. Connectivity analyses confirmed that expectation enhanced network interactions, with IPS and VS influencing insular responses. We conclude that unexpected oral stimulation results in suppression of visual cortex and upregulation of sensory, attention, and reward regions to support orientation, identification, and learning about salient stimuli.

Depression resulting from olfactory dysfunction is associated with reduced sexual appetite--a cross-sectional cohort study.

INTRODUCTION: Anecdotal reports from patients with smell loss provided the basic motivation for the present study on sexual dysfunction among patients with olfactory dysfunction. The aim of the present study was to investigate the sexual appetite and the subject's depression in regard to olfactory function. METHODS: Eighty-six patients referred to our smell and taste clinic with olfactory dysfunction were investigated. Olfactory function was assessed by means of the "Sniffin' Sticks" test battery consisting of tests for odor threshold (T), odor discrimination (D), and odor identification (I). Their results were summed up to a composite score, the so-called "TDI score." All participants completed a questionnaire including the Beck Depression Inventory (BDI) and 11 questions for evaluation of the sexual appetite in regard to the time before the onset of olfactory dysfunction and since the olfactory dysfunction. The points received for the latter questions were summed up to the so called Sexual Appetite Index (SAI). RESULTS: Olfactory testing revealed that 38 patients were functionally anosmic, 39 patients were hyposmic, and nine patients were normosmic. The average BDI score was 11.0 +/- 8.4 points. Evaluation of the SAI questionnaire revealed a significant decrease (P = 0.003) of the score from 22.7 +/- 4.5 points from the time before to 21.4 +/- 4.9 points since the onset of olfactory loss. No significant correlation was found between olfactory function and the SAI since the onset of olfactory dysfunction. However, the BDI score correlated negatively with the SAI since the onset of olfactory dysfunction (r(85) = -0.36; P = 0.001). CONCLUSION: The present study does not confirm the hypothesis that loss of olfactory function directly impacts on sexual appetite. It seems that depression caused by olfactory loss is the main cause for the self-reported decrease in sexual appetite as the onset of olfactory dysfunction.

Gustatory and olfactory sensitivity in patients with anorexia and bulimia in the course of treatment.

BACKGROUND: The majority of studies on taste and smell in eating disorders have revealed several alterations of olfactory or gustatory functions. Aim of this prospective study was to employ detailed olfactory and gustatory testing in female subjects of three homogenous groups - anorexia nervosa, bulimia nervosa and healthy controls - and to look at the effects of treatment on these measures. METHODS: Sixteen hospitalized female patients with anorexia (restricting type, mean age [M]=24.5 years), 24 female patients with bulimia (purging type, M=24.3 years) as well as 23 healthy controls (M=24.5 years) received olfactory ("Sniffin' Sticks") and gustatory testing ("Taste Strips"). Group differences in olfactory and gustatory sensitivity, body mass index (BMI), the Beck depression inventory, the eating attitudes test (EAT), and the influence of therapy on gustatory and olfactory function were investigated. RESULTS: (1) Group differences were present for odor discrimination and overall olfactory function with anorexic patients having the lowest scores. (2) Regarding taste function, controls scored higher than patients with anorexia. (3) At admission small but significant correlations were found between overall olfactory function and body weight (r(63)=0.35), BMI (r(63) = 0.37), and EAT score (r(63) = -0.27). Similarly, (4) the taste test score correlated significantly with body weight (r(63)= 0.48), and BMI (r(63) = 0.45). Finally, (5) at discharge overall olfactory and gustatory function were significantly higher compared to admission in anorexic patients. CONCLUSIONS: As compared to healthy controls and bulimic patients our results show lowered olfactory and gustatory sensitivities in anorexic patients that improved with increasing BMI and decreasing eating pathology in the course of treatment.

The influence of olfactory loss on dietary behaviors.

OBJECTIVES: To assess dietary behavior and possible changes in food selection in patients with smell loss. PATIENTS AND METHODS: A total of 176 patients (114 women and 62 men) age 17 to 86 years were classified into three diagnostic groups (normosmia, n = 12; hyposmia, n = 75; functional anosmia, n = 89) according to their olfactory test scores obtained with "Sniffin' Sticks." Group differences in food intake and dietary behaviors were investigated with a specifically designed questionnaire providing a dietary alterations score (DAS). RESULTS: Numerous dietary changes were reported, e.g., 29% of all patients reported that they eat less since the onset of olfactory dysfunction, 39% use more spices with their food, 47% go out to eat at restaurants less frequently, 37% eat less sweets, and 48% drink less sweet beverages. Subjects with weight gain or weight loss scored higher on the DAS scale than subjects who did not report changes in weight. Similarly, DAS scale changes were more pronounced in subjects with a gradual onset of olfactory loss compared to subjects with a sudden loss of olfaction. Finally, a change of taste preferences toward savory and salty foods was observed across all patients enrolled in the present study. CONCLUSIONS: Patients with olfactory loss report alterations of dietary behaviors. Numerous factors appear to impact the results of olfactory loss in terms of changes in diet.

[Psychological motives behind the wish to have children among High School and University students under consideration of female test persons with eating disorders]. / Psychische Motive für den Kinderwunsch bei Schülern und Studenten unter besonderer Betrachtung von Probandinnen mit einem gestörten Essverhalten.

OBJECTIVES: The aim was to investigate psychological motives behind the wish to have children among female and male students, with special consideration of females with eating disorders. METHODS: 736 participants (437 women and 299 men) were examined using the "Leipziger Fragebogen zu Kinderwunschmotiven und Einstellungen zum Kinderwunsch" (a questionnaire concerning the motives and attitudes for the wish to have a child). Disturbed eating behaviour was classified with the Eating Attitudes Test. RESULTS: 15.4 % of the students showed a low, 39 % a medium and 45.6 % a high wish to have children. The subscales "Desire for emotional stabilization" as well as "Social stereotypes" had the highest and "Fear of material impairment" and "Personal restriction" the lowest correlation with the wish for a child. Women with anorectic eating disorders displayed a significantly lower desire for children than students with normal eating patterns or women with a bulimic tendency. CONCLUSIONS: The psychological motives examined here contributed highly to the explanation of variance concerning the wish to have children. The results for women with eating disorders indicate that primary ambivalences concerning the wish to have children may be involved in the pre-clinical stadium of eating disorders.

[Disturbed eating behaviour among high school and university students]. / Störungen des Essverhaltens bei Gymnasiasten und Studenten.

To develop suitable preventive programs for eating disorders, it is important to examine the prevalence and severity of disturbed eating behaviour in the corresponding risk population as well as to investigate the conditions that might explain their origin and further progression. Based upon this background 736 female and male high school and university students from Eastern and Western parts of Germany were examined. Height and weight were measured objectively. In accordance with the study of Buddeberg-Fischer three groups were defined depending on the total score in the Eating Attitudes Test. 28.5 % of the women and 12.6 % of the men revealed impaired eating behaviour with female high school students being specifically affected (35.3 %). With an increasing impairment, women more often used methods to regulate their weight like diets, restrained eating, or drugs. Participants with disordered eating behaviour were also more likely to show higher scores on the subscales of the Eating Disorders Inventory and a distorted body perception. The feeling of being overweight showed a correlation with the severity of the disturbed eating. With increasing eating problems the correspondence between the real existing BMI and the subjective estimation of the weight decreased significantly. The results of this study clearly demonstrate the high prevalence of disturbed eating behaviour and concerns about weight among female adolescents and young adults. Female high school students should be a special target group for the application of preventive programs. The reported use of drugs in order to lose weight should be discussed more explicitly.