[Acute abdomen - gastrointestinal causes]

CLINICAL/METHODICAL ISSUE

Diagnostic imaging plays a crucial role in the assessment and stratification of pathologic conditions causing acute abdomen. This report provides information on etiology, clinical manifestations and therapeutic options for six common diseases resulting in acute abdomen-appendicitis, cholecystitis, bowel obstruction, diverticulitis, acute pancreatitis, and viscus perforation.

PERFORMANCE

Besides initial ultrasound, CT scans often represent the imaging gold standard for the diagnostic evaluation of acute abdomen.

PRACTICAL RECOMMENDATIONS

Depending on the underlying pathologic condition, sonography or CT is suitable for the stratification of the gastrointestinal disease causing acute abdomen.

SpraySyn-A standardized burner configuration for nanoparticle synthesis in spray flames

In many scientific communities, the definition of standardized experiments has enabled major progress in process understanding. The investigation of the spray-flame synthesis of nanoparticles at a well-defined standard burner by experiment and simulation makes it possible to produce a comprehensive data set with various established and novel measuring methods. In this work, we introduce the design of the SpraySyn burner as a new standard for a free-jet type burner that offers well-defined and simulation-friendly boundary conditions and geometries as well as accessibility for optical diagnostics. A combustible precursor solution is fed through a centrally located capillary and aerosolized with an oxygen dispersion gas flow. The spray flame is stabilized by a premixed flat methane/oxygen pilot flame fed via a porous bronze matrix surrounded by a stabilizing nitrogen coflow emanating through the same porous matrix, providing easy-to-calculate boundary conditions for simulations. This burner design enables the use of a wide choice of solvents, precursors, and precursor combinations. Best-practice operating instructions and parameters are given, and large-eddy simulations are performed demonstrating the suitability of the SpraySyn burner for computational fluid dynamics simulations. For ensuring reproducible operation across labs, we define a consumer-camera-based flame characterization scheme for the quantitative assessment of the flame geometry such as flame length, diameter, tilt angle, and photometric distribution of visible chemiluminescence along the center axis. These parameters can be used for benchmarking the pilot and spray flame by each user of the SpraySyn burner with the reference flames.

The German National Registry of Primary Immunodeficiencies (2012-2017)

Introduction: The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs. Methods: Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel. Results: The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1-25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0-88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE- syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%-subcutaneous; 29%-intravenous; 1%-unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy. Conclusion: The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment.

Neglected Hosts of Small Ruminant Morbillivirus

Eradication of small ruminant morbillivirus (PPRV) is targeted for 2030. PPRV lineage IV is found in much of Asia and Africa. We used PPRV lineage IV strain Kurdistan/2011 in transmission trials to investigate the role of pigs, wild boar, and small ruminants as PPRV reservoirs. Suids were a possible source of infection.

NIR sensor for aqueous urea solution film thickness and concentration measurement using a broadband light source

We demonstrate a multi-wavelength near-infrared (NIR) broadband absorption sensor for the simultaneous monitoring of layer thickness and urea concentration of aqueous urea solutions. Samples were prepared in thin-layer quartz transmission cells. Film thickness and urea mass fraction (at constant temperature) were determined from measured transmittance ratios in characteristic wavelength bands selected by narrowband filters in front of the detector and converted to absorbance ratios. Suitable emission bands were selected depending on the sensitivity of the NIR absorption spectrum of the solution with respect to temperature and solute concentration. For this purpose, Fourier transform IR spectra of aqueous urea solutions were recorded in the 1250-2500 nm wavelength range for urea concentrations between 0 and 40 wt.% and temperatures between 298 K and 338 K. A prototype sensor was designed using a continuous-wave fiber-coupled incoherent tungsten lamp, subsequent intensity modulation, and lock-in detection of the transmitted radiation. The sensor concept was validated with measurements using a calibration cell providing liquid layers of variable thicknesses (7-1000 μm).

Evaluation of an IGM-specific ELISA for early detection of bluetongue virus infections in domestic ruminants sera

Competitive-ELISA (c-ELISA) is the most widely used serological test for the detection of Bluetongue virus (BTV) viral protein 7 (VP7) antibodies (Ab). However, these BTV c-ELISAs cannot to distinguish between IgG and IgM. IgM Ab are generated shortly after the primary immune response against an infectious agent, indicating a recent infection or exposure to antigens, such as after vaccination. Because the BTV genome or anti-VP7 Ab can be detected in ruminant blood months after infection, BTV diagnostic tools cannot discriminate between recent and old infections. In this study, we evaluated an IgM-capture ELISA prototype to detect ruminant anti-BTV VP7 IgM on 1,650 serum samples from cattle, sheep, or goats. Animals were BTV-naive, infected, or/and vaccinated with BTV-1, -2, -4, -8, -9, -16, or -27, and we also included 30 sera from cattle infected with the Epizootic haemorrhagic disease virus (EHDV) serotype 6. Results demonstrated that this ELISA kit is specific and can detect the presence of IgM with satisfactory diagnostic specificity and sensitivity from 1 to 5 weeks after BTV infection in domestic ruminants (for goats and cattle; for sheep, at least up to 24 days). The peak of anti-VP7 IgM was reached when the level of infectious viruses and BTV RNA in blood were the highest. The possibility of detecting BTV-RNA in IgM-positive sera allows the amplification and sequencing of the partial RNA segment 2 (encoding the serotype specific to VP2) to determine the causative BTV serotype/strain. Therefore, BTV IgM ELISA can detect the introduction of BTV (or EHDV) in an area with BTV-seropositive domestic animals regardless of their serological BTV status. This approach may also be of particular interest for retrospective epidemiological studies on frozen serum samples.

Patient Characteristics as Indicator for Care Dependence after Hip Fracture: A Retrospective Cohort Study Using Health Insurance Claims Data From Germany

OBJECTIVES

Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

Statutory health insurance claims data including 122,922 insured individuals living in Germany and aged 65 years or older, who sustained a hip fracture from 2009 through 2011.

MEASURES

The association of patient characteristics with worsening care level in the quarterly period after hip fracture was investigated by means of multinomial logit regression analysis. Death constitutes a competing risk and was modeled as additional nominal outcome.

RESULTS

Among all patients, crude rates were 30.9% for worsening care level, 54.8% for unchanged care level, and 14.4% for death after hip fracture. The multivariate analysis revealed that patient factors male sex, increasing age, increasing comorbidity, increasing inpatient length of stay, and a lack of inpatient rehabilitation were significantly associated with a worsening care level.

CONCLUSIONS/IMPLICATIONS

This study uses the German standardized measurement of care dependence in terms of worsening care level after hip fracture and finds various related patient characteristics. Knowledge of these characteristics helps to identify possible risk groups for care dependence after hip fracture, for which special attention can be provided regarding treatment and prevention of hip fractures.

[Strategies to Overcome Acquired Resistance to EGFR-TKI Therapy Based on T790M Specific Substances using Osimertinib as an Example]

Tyrosine kinase inhibitors (TKIs) of the epidermal growth factor receptor (EGFR) are widely used in non-small cell lung cancer patients harboring activating EGFR mutations. However, resistance mechanisms, particularly the T790 M mutation, hamper longer-term therapeutic success of first and second generation EGFR-TKIs. To address this unmet medical need, EGFR-TKIs of the third generation are under clinical development. Relevant clinical efficacy with mainly mild to moderate class-specific side effects has been shown for third-generation EGFR-TKIs. Molecular testing is of major importance in deciding for treatment with third generation EGFR-TKIs. This article elucidates the developmental state of third generation EGFR-TKIs with its focus on Osimertinib, the first and currently the only compound in this class which is approved in Germany. Additionally, the medical importance of molecular diagnosis using tumor tissue and circulating tumor DNA is discussed.

Long-term evaluation of the implementation of a large fall and fracture prevention program in long-term care facilities

Background

Falls and fractures are extremely frequent in long-term care facilities (LTCFs). Therefore, a fall and fracture prevention program was started in nearly 1000 LTCFs in Bavaria/Germany between 2007 and 2010. The components of the program were exercise classes, the documentation of falls, environmental adaptations, medication reviews, the recommendation to use hip protectors and education of staff. The present study aimed to provide a comprehensive evaluation of the implementation process of the program regarding results of the implementation phase and the follow-up of 3–9 years after start of implementation.

Methods

Data from numerous sources were used, including data from published studies, statistical data, health insurance claims data and unpublished data from an online questionnaire. To incorporate different aspects, time periods and results, the RE-AIM framework was applied.

Results

The program was adopted by 942 of the 1150 eligible LTCFs and reached about 62,000 residents. During the implementation phase exercise classes and recommendation about environmental adaptations were offered in nearly all LTCFs. 13.5% of the residents participated in exercise classes. Hip protectors were available for 9.2% of all residents. In the first implementation wave, femoral fracture rate was significantly reduced by 18% in the first year. At follow-up nearly 90% of all LTCFs still offered exercise classes, which were attended by about 11% of residents. However, only 10% of the exercise classes completely fulfilled the requirements of an effective strength and balance training. Individual advice about environmental adaptations was provided in 74.3% of the LTCFs and nearly all LTCFs claimed to offer hip protectors to their residents. A long-term effect of the program on femoral fractures could not be detected.

Conclusions

The program did not affect the femoral fracture rate in the long run. Possible reasons could be a high turn-over of the staff, a reduced fidelity of training components or a shift in daily priorities among the staff.

Long-Range Modulations of Electric Fields in Proteins

Electrostatic interactions are essential for controlling the protein structure and function. Whereas so far experimental and theoretical efforts focused on the effect of local electrostatics, this work aims at elucidating the long-range modulation of electric fields in proteins upon binding to charged surfaces. The study is based on cytochrome c (Cytc) variants carrying nitrile reporters for the vibrational Stark effect that are incorporated into the protein via genetic engineering and chemical modification. The Cytc variants were thoroughly characterized with respect to possible structural perturbations due to labeling. For the proteins in solution, the relative hydrogen bond occupancy and the calculated electric fields, both obtained from molecular dynamics (MD) simulations, and the experimental nitrile stretching frequencies were used to develop a relationship for separating hydrogen-bonding and non-hydrogen-bonding electric field effects. This relationship provides an excellent description for the stable Cytc variants in solution. For the proteins bound to Au electrodes coated with charged self-assembled monolayers (SAMs), the underlying MD simulations can only account for the electric field changes Δ E_ads due to the formation of the electrostatic SAM-Cytc complexes but not for the additional contribution, Δ E_int, representing the consequences of the potential drops over the electrode/SAM/protein interfaces. Both Δ E_ads and Δ E_int, determined at distances between 20 and 30 Å with respect to the SAM surface, are comparable in magnitude to the non-hydrogen-bonding electric field in the unbound protein. This long-range modulation of the internal electric field may be of functional relevance for proteins in complexes with partner proteins (Δ E_ads) and attached to membranes (Δ E_ads + Δ E_int).

Methodology for the investigation of ignition near hot surfaces in a high-pressure shock tube

Autoignition of fuel/air mixtures is a determining process in internal combustion engines. Ignition can start either homogeneously in the gas phase after compression or in the vicinity of hot surfaces. While ignition properties of commercial fuels are conventionally described by a single quantity (octane number), it is known that some fuels have a varying propensity to the two processes. We present a new experimental concept that generates well-controlled temperature inhomogeneities in the shock-heated gases of a high-pressure shock tube. A shock-heated reactive mixture is brought into contact with a heated silicon nitride ceramic glow plug. The glow-plug temperature can be set up to 1200 K, higher than the post-reflected-shock gas temperatures (650-1050 K). High-repetition-rate chemiluminescence imaging is used to localize the onset of ignition in the vicinity of the hot surface. In experiments with ethanol, the results show that in most cases under shock-heated conditions, the ignition begins inhomogeneously in the vicinity of the glow plug and is favored because of the high wall temperature. Additionally, the interaction of geometry, external heating, and gas-dynamic effects was investigated by numerical simulations of the shock wave in a non-reactive flow.

Langzeitevaluation der Umsetzungstreue des Kraft- und Balancetrainings in vollstationären Pflegeeinrichtungen: Das bayerische Sturz- und Frakturpräventionsprogramm (BF2P2)

Hintergrund Stürze treten in Pflegeeinrichtungen häufig auf. Aus diesem Grund wurde in den Jahren 2007 – 2010 ein Sturz- und Frakturpräventionsprogramm in nahezu 1000 bayerischen Pflegeeinrichtungen nach den Vorgaben des „Ulmer Modells“ implementiert. Einen zentralen Bestandteil des Programms bildet ein gruppenbasiertes Kraft- und Balancetraining.

Ziel Das Ziel dieser Studie war, Verfügbarkeit und Umsetzungstreue des Trainingsprogramms nach den Vorgaben des „Ulmer Modells“ nach mehreren Jahren Laufzeit zu untersuchen.

Methode Die Querschnittserhebung fand zwischen Januar und Juni 2016 in 40 zufällig ausgewählten Pflegeeinrichtungen statt. Eine standardisierte Beobachtung des Gruppentrainings wurde durchgeführt. Die Auswertung erfolgte stratifiziert nach Trainerqualifikation.

Ergebnisse Fast alle der kontaktierten Pflegeeinrichtungen boten eine Bewegungsgruppe an (94,3 %), die häufig Komponenten eines Krafttrainings beinhaltete. Das Krafttraining der unteren Extremitäten erfolgte allerdings nur in 30 % der Gruppen mit Gewichtsmanschetten. Übungen zum Training der Balance fanden in vielen Gruppen wenig oder gar nicht statt. Das Balancetraining wurde dann häufiger umgesetzt, wenn ein Trainer mit einer therapeutischen Qualifikation die Gruppen leitete. Nur 10 % der Gruppen erfüllten vollständig die Anforderungen an ein Sturzpräventionstraining nach den Vorgaben des „Ulmer Modells“.

Schlussfolgerung Bewegungsgruppen sind mittlerweile fester Bestandteil in Pflegeeinrichtungen. Allerdings ist die Umsetzungstreue des Programms im Bereich des Balancetrainings häufig gering. Die Qualität des Trainings scheint höher zu sein, wenn ein Trainer mit einer therapeutischen Qualifikation die Gruppen leitete.