Intraprocedural gastric juice analysis as compared to rapid urease test for real-time detection of Helicobacter pylori

BACKGROUND Endofaster is an innovative technology that can be combined with upper gastrointestinal endoscopy(UGE)to perform gastric juice analysis and real-time detection of Helicobacter pylori(H.pylori).AIM To assess the diagnostic performance of this technology and its impact on the management of H.pylori in the real-life clinical setting.METHODS Patients undergoing routine UGE were prospectively recruited.Biopsies were taken to assess gastric histology according to the updated Sydney system and for rapid urease test(RUT).Gastric juice sampling and analysis was performed using the Endofaster,and the diagnosis of H.pylori was based on real-time ammonium measurements.Histological detection of H.pylori served as the diagnostic gold standard for comparing Endofaster-based H.pylori diagnosis with RUT-based H.pylori detection.RESULTS A total of 198 patients were prospectively enrolled in an H.pylori diagnostic study by Endofasterbased gastric juice analysis(EGJA)during the UGE.Biopsies for RUT and histological assessment were performed on 161 patients(82 men and 79 women,mean age 54.8±19.2 years).H.pylori infection was detected by histology in 47(29.2%)patients.Overall,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value(NPV)for H.pylori diagnosis by EGJA were 91.5%,93.0%,92.6%,84.3%,and 96.4%,respectively.In patients on treatment with proton pump inhibitors,diagnostic sensitivity was reduced by 27.3%,while specificity and NPV were unaffected.EGJA and RUT were comparable in diagnostic performance and highly concordant in H.pylori detection(κ-value=0.85).CONCLUSION Endofaster allows for rapid and highly accurate detection of H.pylori during gastroscopy.This may guide taking additional biopsies for antibiotic susceptibility testing during the same procedure and then selecting an individually tailored eradication regimen.

UGT1A1 gene polymorphism: Impact on toxicity and efficacy of irinotecan-based regimens in metastatic colorectal cancer

AIM: To investigate the correlation between uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1) gene polymorphisms and irinotecan-associated side effects and parameters of drug efficacy in patients with metastatic colorectal cancer (mCRC) receiving a low-dose weekly irinotecan chemotherapeutic regimen. METHODS: Genotypes were retrospectively evaluated by gene scan analysis on the ABI 310 sequencer of the TATAA box in the promoter region of the UGT1A1 gene in blood samples from 105 patients who had received 1st line irinotecan-based chemotherapy for mCRC. RESULTS: The distribution of the genotypes was as follows: wild type genotype (WT) (6/6 ) 39.0%, heterozygous genotype (6/7) 49.5%, and homozygous genotype (7/7) 9.5%. The overall response rate (OR) was similar between patients carrying the (6/7, 7/7) or the WT genotype (6/6) (44.3% vs 43.2%, P = 0.75). Neither time to progression [(TTP) 8.1 vs 8.2 mo, P = 0.97] nor overall survival [(OS) 21.2 vs 18.9 mo, P = 0.73] differed significantly in patients who carried the(6/6) when compared to the (6/7, 7/7) genotype. No significant differences in toxicity were observed: Grade 3 and 4 delayed diarrhoea [(6/7, 7/7) vs (6/6); 13.0% vs 6.2%, P =0.08], treatment delays [(6/7, 7/7) vs (6/6); 25.1% vs 19.3%, P = 0.24] or dose reductions [(6/7, 7/7) vs (6/6); 21.5% vs 27.2%, P = 0.07].CONCLUSION: This analysis demonstrates the non-significant influence of the UGT1A1 gene polymorphism on efficacy and rate of irinotecan-associated toxicity in mCRC patients receiving low-dose irinotecan based chemotherapy.

Battle against Aging and Folds: Benefit and Risks of the Semi-Permanent Fillers Polylactic Acid and Calcium Hydroxylapatite

Background: Semi-permanent fillers are among the most favorable fillers on the market. Through their unique mode of action and its associated lasting aesthetic effect, they take an exceptional position. Objective: To compare the two semi-permanent fillers Poly-L-Lactic Acid (PLLA) and calcium hydroxylapatite (CaHA) in reference to the aesthetic result, patient satisfaction and side effects. Methods: Studies on side effects, patient satisfaction and aesthetic results after augmentation with semi-permanent fillers were analyzed. Results: Semi-permanent fillers seem excellently suited for the augmentation of very deep wrinkles particularly in the lower half of the face. In general, high patient satisfaction can be determined with both fillers. Here, the effect from the polylactic acid can be verified for up to two years while no effect could be verified already after one year in a majority of the patients augmented with CaHA. Short-term side effects such as bleedings or erythema in the region of the augmented area have been observed in both fillers during augmentation. The incidence of nodules and granulomas seems significantly higher in augmentations with PLLA compared to CaHA. Rare side effects such as an embolization of a blood vessel caused by the implant have been described for both fillers in case reports. Conclusion: Semi-permanent fillers are superbly suited for wrinkle augmentation. Which filler is the preferred one in what case depends strongly on the individual needs of the patient and the therapist’s experience.

Visiting Patients at Home: Reasons and Efficiency of Dental House Calls

This retrospective study analyzes indications for house calls by dentists in a domiciliary setting. Its database consists in 69 visits made by a dentist office in Munich from 1998 to 2013 at the homes of 29 non-institutionalized seniors (≥62 years old, 15 females, 14 males, average age 83.7 years old). The analysis focused on the patients’ general state of health, their dental and oral health, the kinds of dental treatments administered, as well as economic aspects and the quantitative development in the frequency of house calls during the study period. The most frequent pre-existing conditions that made a house call necessary were cardiovascular illnesses (60%) and dementia diseases (36%). Multi-morbidity, dependency on care, accessibility issues, and frailty because of advanced age played a central role. The patients’ oral health was acceptable, with the exception of those with dementia diseases, who were more frequently toothless (40% versus 5.6%) and had a higher percentage of carious and decayed teeth (26.3% versus 10.3%). The most frequent procedures were treatments for denture sores and the repair of removable dentures (53.6%). The main focus was on reparative dentistry. The average house call took 37 minutes including travel time. Thus, the time needed was a multiple of the time necessary for treatment in the dental office. The lack of economic efficiency may be the reason why many dentists in Germany hesitate to make house calls. Despite the introduction of additional fees for the treatment of patients in need of long-term care on April 1, 2013, the number of house calls is low and increases only slowly. At the same time, the need for house calls will rise in the future due to an increasing proportion of elderly persons in the population and a decline in the percentage of toothless elderly.

Mycophenolic Acid Absorption Profiles in Patients with Kidney or Combined Pancreas-Kidney Transplantation

Background: Mycophenolate Mofetil (MMF) is widely used in organ transplant patients to avoid calcineurine inhibittor-associated side effects. Therapeutic monitoring of MMF is up to now perform by using trough level measurements (measurements before drug administration). The present study was designed to characterize potential differences in MMF absorption kinetics between patients with allogenic kidney transplantation [kidney Tx] and simultaneous pancreas kidney transplantation [PK Tx], which might for example occur due to diabetic gastrointestinal atony. Methods: A total of 64 pharmacokinetic profiles were prospectively studied in 44 adult kidney Tx and 20 PK Tx patients. To calculate AUC by the trapezoidal rule, mycophenolic acid (MPA) levels were measured in EDTA-plasma by an EMIT assay at 0, 0.5, 1, 2, 3, 4 6, and 12h after oral MMF administration between postoperative day 14 to 28 instable patients. Results: Substantial differences between kidney Tx and PK Tx patients were evident concerning: donor age, recipient age, number of mismatches, and kidney function (serum creatinine). Despite these dissimilarities pharmacokinetic absorption profiles did not significantly differ between patient groups as measured by AUC, C2, maximum MPA concentration (Cmax), and time until maximum absorption (Tmax). Astonishingly, concomitant cyclosporine and tacrolimus medication did not influence adsorption profiles. Only MPA concentrations 6h post administration correlated closely with AUC in both patient groups, whereas trough levels failed to be predictive for AUC. Conclusions: In our study population, MMF absorption kinetics did not differ between kidney and PK Tx patients and did not seem influenced by concomitant immunosuppressive medication. Therefore, MPA measurements during the absorption phase could be useful to better estimate AUC in patients with kidney Tx and PK Tx.

The Impact of a Pet, in This Case a Dog, on Physical Activity, Independence, Social Contacts, Health and Quality of Life of Elderly People

In a rural area near Munich, 52 persons aged 65 years and older were interviewed in person about health and social life circumstances. Findings: Dog owners take significantly longer walks than people who do not own dogs, averaging more than 120 minutes daily (p < 0.0001). On average, people who do not own a dog walked 38 minutes, cat owners 17 minutes. 94% of the dog owners were active daily compared to 14% of those who do not own a dog. Dog owners go to the doctor on average 5.3 times per year, people who do not own a dog 7.8 times. There was no difference between the two groups in regard to the use of medication. 80% would not move to a residential home for the elderly because of the dog, and 87% would want to take the dog along. 50% of the dog owners and 41% of those who do not own a dog had on average more than 3 contacts with other people, 6% of the dog owners and 23% of those who do not own a dog had less than one contact per day. 19% of the dog owners and 36% of those who do not own a dog would describe themselves as reserved in dealings with people. 71% stated that the dog had been very useful to help them overcome the loss of a person close to them. The W-5 [Wellbeing Five score] for dog owners was an average value of 75%, for those who did not own a dog 71%. Depression was uniformly distributed in both groups. The BMIs in both groups were similar. There was no correlation to the length of the daily walk.

Kaposiform hemangioendothelioma in children: a benign vascular tumor with multiple treatment options

Background Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor affecting infants and young children. Although benign, it can be associated with an aggressive locally growing tumor and/or a life-threatening Kasabach–Merritt phenomenon (KMP). To date, only reviews of limited cases have been performed. We, therefore, conducted a comprehensive literature search to collect relevant data and make recommendations for future treatment trials. Methods Review of the available literature between 1993 and 2017 revealed a total of 105 publications involving 215 patients of less than 21 years of age. To this, we added 12 from our department and 4 from the Cooperative Weichteilsarkomstudie database. Results We found that KMP was present in 79% of the infants, in 47% of the 1–5-year olds, in 43% of the 6–12-year olds, and in 10% of the 13–21-year-old patients. KMP was present in nearly all (94%) patients with retroperitoneal tumors and in all patients with extra-regional tumors. The median size of a KHE without KMP was 12 cm2 as compared to 49 cm2 when associated with a KMP. With complete (not further classifiable if R0 or R1) resection, all patients were cured. If inoperable, response regarding KMP/regression of tumor size was seen in 29/28% with steroid-, 47/39% with vincristine-, 44/43% with interferon alpha-, 65/61% with anti-platelet agents-, and in 97/100% with sirolimus-containing therapies. Conclusions Patients with progressive KHE should undergo resection whenever it is considered a safe option. If inoperable, sirolimus should be the first choice for treating KMP and reducing tumor size.

Multiculturalism or Cosmopolitanism： How Can We Describe and Understand the Diversity of the World？

Over the last decades the cultural, social and political landscapes of diversity are changing radically, but we do not even have the language through which contemporary superdiversity in the world can be described, conceptualized, understood, explained and researched. Many of the social thoughts and political actions on issues of diversity are now dominated by methodological nationalism and multiculturalism which, however, have to be called into question. As opposed to methodological nationalism, methodological cosmopolitanism is a promising lens through which to look at questions of diversity. And it is essential to draw an essential distinction between ＂cosmopolitanism＂ in a normative philosophical sense and ＂cosmopolitanization＂ as a structural phenomenon and as a social scientific research programme. Philosophical and normative cosmopolitanism can be combined with cosmopolitan social science to create a cosmopolitan realism.

Recent advances in research on tropical cyclogenesis

This review article summarizes recent(2014-2019)advances in our understanding of tropical cyclogenesis,stemming from activities at the ninth International Workshop on Tropical Cyclones.Tropical cyclogenesis involves the interaction of dynamic and thermodynamic processes at multiple spatio-temporal scales.Studies have furthered our understanding of how tropical cyclogenesis may be affected by external processes,such as intraseasonal oscillations,monsoon circulations,the intertropical convergence zone,and midlatitude troughs and cutoff lows.Additionally,studies have furthered our understanding of how tropical cyclogenesis may be affected by internal processes,such as the organization of deep convection;the evolution of the"pouch"structure;the role of friction;the development of the moist,warm core;the importance of surface fluxes;and the role of the mid-level vortex.A relatively recent class of idealized,numerical simulations of tropical cyclogenesis in radiativeconvective equilibrium have highlighted the potential importance of radiative feedbacks on tropical cyclogenesis.We also offer some recommendations to the community on future directions for tropical cyclogenesis research.

血红素铁和硝酸盐／亚硝酸盐所致的病死率增加与红肉消费量相关

国际癌症研究机构在2015年将加工肉类分类为确定致癌物。高红肉和加工肉类消费量与心血管疾病和2型糖尿病的风险以及总体病死率呈正相关。通常情况下，与未加工的红肉相比，摄入的加工红肉与疾病发生具有更强的相关性，可能与保存方法（如盐制、腌制和烟熏）相关，这些加工方法增加了肉中潜在有害物质的浓度。

Beautiful Thinking： Poetic Episteme in European Modernism

Poetic texts and poetological programs around 1900 claim a mode of thinking that exceeds the limits of rationality—beautiful thinking shallimply better thinking. In its most sophisticated utterances, poetry of Classical Modernism pretends to give better insights into the appearances and structures of the w orld than any other mode of know ledge.Moreover,it asserts a genuine aesthetic nomothesis. The paper sketches the tensions of claim and consequences with respect to some core positions of Classical Modernism( Hofmannsthal,Meyer-Graefe,Rilke).

QUASI STEADY-STATE HURRICANES REVISITED

We revisit the theoretical possibility of long-term, sustained tropical cyclone solutions using a state-of-the-art numerical model that incorporates the most recent observational guidance for subgrid scale parameters and airsea exchange coefficients of heat and momentum. Emphasis is placed on the realism of such solutions and the sources of cyclonic relative angular momentum(RAM) that are necessary to replenish that lost by friction at the surface. For simplicity, we confine our attention to strictly axisymmetric numerical experiments.We are able to replicate Hakim's long-term simulation of a quasi-steady state cyclone in a 1500 km radial domain. The structure of the wind field is found to be somewhat realistic compared to observations, but sustained by unrealistic processes. Artificial sources of cyclonic RAM are quantified and the lateral damping of the anticyclonic wind near the outer boundary is found to make the largest contribution to the source of cyclonic RAM. When the domain size is extended to 9,000 km radius and lateral damping is removed altogether, a quasi-steady vortex emerges, but the structure of this vortex has many unrealistic features. In this solution, the remaining upper-level Rayleigh damping contributes a major portion of the needed source of cyclonic RAM. In a simulation in which the upper-level damping is removed also, the solution is found to be neither quasi-steady nor realistic.These findings call into question the realism of long-term, sustained tropical cyclone simulations, which require a sufficiently large source of cyclonic RAM to facilitate the existence of a quasi-steady state.