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Ziele: Das Ziel dieser offiziellen Leitlinie, die von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) und der Deutschen Krebsgesellschaft (DKG) publiziert und koordiniert wurde, ist es, die Früherkennung, Diagnostik, Therapie und Nachsorge des Mammakarzinoms zu optimieren.
Methoden: Der Aktualisierungsprozess der S3-Leitlinie aus 2012 basierte zum einen auf der Adaptation identifizierter Quellleitlinien und zum anderen auf Evidenzübersichten, die nach Entwicklung von PICO-(Patients/Interventions/Control/Outcome-)Fragen, systematischer Recherche in Literaturdatenbanken sowie Selektion und Bewertung der gefundenen Literatur angefertigt wurden. In den interdisziplinären Arbeitsgruppen wurden auf dieser Grundlage Vorschläge für Empfehlungen und Statements erarbeitet, die im Rahmen von strukturierten Konsensusverfahren modifiziert und graduiert wurden.
Empfehlungen: Der Teil 1 dieser Kurzversion der Leitlinie zeigt Empfehlungen zur Früherkennung, Diagnostik und Nachsorge des Mammakarzinoms: Der Stellenwert des Mammografie-Screenings wird in der aktualisierten Leitlinienversion bestätigt und bildet damit die Grundlage der Früherkennung. Neben den konventionellen Methoden der Karzinomdiagnostik wird die Computertomografie (CT) zum Staging bei höherem Rückfallrisiko empfohlen. Die Nachsorgekonzepte beinhalten Untersuchungsintervalle für die körperliche Untersuchung, Ultraschall und Mammografie, während weiterführende Gerätediagnostik und Tumormarkerbestimmungen bei der metastasierten Erkrankung Anwendung finden.
Purpose: The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer.
Methods: The process of updating the S3 guideline dating from 2012 was based on the adaptation of identified source guidelines which were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and the results of a systematic search of literature databases and the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point to develop recommendations and statements which were modified and graded in a structured consensus procedure.
Recommendations: Part 1 of this short version of the guideline presents recommendations for the screening, diagnosis and follow-up care of breast cancer. The importance of mammography for screening is confirmed in this updated version of the guideline and forms the basis for all screening. In addition to the conventional methods used to diagnose breast cancer, computed tomography (CT) is recommended for staging in women with a higher risk of recurrence. The follow-up concept includes suggested intervals between physical, ultrasound and mammography examinations, additional high-tech diagnostic procedures, and the determination of tumor markers for the evaluation of metastatic disease.
In diesem Artikel und weiteren geplanten Folgen werden Ergänzungen, Nachträge, Erläuterungen und Korrekturen sowohl zum von der Taunusflora (Wittig & al. 2022) erfassten Gebiet (Vortaunus, Hoher Taunus, kammnaher Hintertaunus) als auch zum bisher nicht bearbeiteten kammfernen Bereich des Hintertaunus publiziert. Bei den bisherigen Ergänzungen und Nachträgen handelt es sich um die Ergebnisse der Nachbestimmung eines Belegs (Allium christophii), den Fund einer für das Gebiet bisher nicht genannten Art (Hylotelephium vulgare) sowie um Hinweise auf ältere Funde (Bolboschoenus maritimus, Polystichum lonchitis) und einen neueren Fund (Luronium natans). Weiterhin werden die wichtigsten Ergebnisse der Begehungen sechs kammferner Rasterfelder präsentiert (Rote-Liste- und sonstige seltene Arten). Als selten werden diejenigen Arten angesehen, die im bisherigen Kartierungsgebiet in maximal 5 % (= 26) der insgesamt 523 Rasterfelder gefunden wurden. Außerdem werden in der Taunusflora enthaltene Fehler korrigiert.
Introduction: Evidence from a number of open-label, uncontrolled studies has suggested that rituximab may benefit patients with autoimmune diseases who are refractory to standard-of-care. The objective of this study was to evaluate the safety and clinical outcomes of rituximab in several standard-of-care-refractory autoimmune diseases (within rheumatology, nephrology, dermatology and neurology) other than rheumatoid arthritis or non-Hodgkin's lymphoma in a real-life clinical setting.
Methods: Patients who received rituximab having shown an inadequate response to standard-of-care had their safety and clinical outcomes data retrospectively analysed as part of the German Registry of Autoimmune Diseases. The main outcome measures were safety and clinical response, as judged at the discretion of the investigators.
Results: A total of 370 patients (299 patient-years) with various autoimmune diseases (23.0% with systemic lupus erythematosus, 15.7% antineutrophil cytoplasmic antibody-associated granulomatous vasculitides, 15.1% multiple sclerosis and 10.0% pemphigus) from 42 centres received a mean dose of 2,440 mg of rituximab over a median (range) of 194 (180 to 1,407) days. The overall rate of serious infections was 5.3 per 100 patient-years during rituximab therapy. Opportunistic infections were infrequent across the whole study population, and mostly occurred in patients with systemic lupus erythematosus. There were 11 deaths (3.0% of patients) after rituximab treatment (mean 11.6 months after first infusion, range 0.8 to 31.3 months), with most of the deaths caused by infections. Overall (n = 293), 13.3% of patients showed no response, 45.1% showed a partial response and 41.6% showed a complete response. Responses were also reflected by reduced use of glucocorticoids and various immunosuppressives during rituximab therapy and follow-up compared with before rituximab. Rituximab generally had a positive effect on patient well-being (physician's visual analogue scale; mean improvement from baseline of 12.1 mm).
Conclusions: Data from this registry indicate that rituximab is a commonly employed, well-tolerated therapy with potential beneficial effects in standard of care-refractory autoimmune diseases, and support the results from other open-label, uncontrolled studies.
Background: Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes. Objective: To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin. Methods: A prospective, international cohort study performed between October 2018 and August 2019. Results: In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P < .001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P = .26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain. Limitations: Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline. Conclusion: This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity.
Oral presentation from 4th International Conference of cGMP Generators, Effectors and Therapeutic Implications ; Regensburg, Germany. 19–21 June 2009 Background: An exaggerated pain sensitivity is the dominant feature of inflammatory and neuropathic pain both in the clinical setting and in experimental animal models. It manifests as pain in response to normally innocuous stimuli (allodynia), increased response to noxious stimuli (hyperalgesia) or spontaneous pain, and can persist long after the initial injury is resolved. Research over the last decades has revealed that several signaling pathways in the spinal cord essentially contribute to the pain sensitization. To test the contribution of cGMP produced by NO-sensitive guanylyl cyclase (NO-GC) to pain sensitization, we investigated the localization of NO-GC in the spinal cord and in dorsal root ganglia, and we characterized the nociceptive behavior of mice deficient in NO-GC (GC-KO mice). Results: We show that NO-GC (β1 subunit) is distinctly expressed in neurons of the mouse spinal cord, while its distribution in dorsal root ganglia is restricted to non-neuronal cells. GC-KO mice exhibited a considerably reduced nociceptive behavior in models of inflammatory or neuropathic pain, but their responses to acute pain were not impaired. Moreover, GC-KO mice failed to develop pain sensitization induced by spinal administration of drugs releasing NO. Surprisingly, during spinal nociceptive processing cGMP produced by NO-GC may activate signaling pathways different from cGMP-dependent protein kinase I (cGKI), while cGKI can be activated by natriuretic peptide receptor-B (NPR-B) dependent cGMP production. Conclusion: Taken together, our results provide evidence that NO-GC has a dominant role in the development of exaggerated pain sensitivity during inflammatory and neuropathic pain. Furthermore, beside the NO-mediated cGMP synthesis, cGMP produced by NPR-B contributes to pain sensitization by activation of cGKI.
Background: The Objective Structured Clinical Examination (OSCE) is increasingly used at medical schools to assess practical competencies. To compare the outcomes of students at different medical schools, we introduced standardized OSCE stations with identical checklists.
Methods: We investigated examiner bias at standardized OSCE stations for knee- and shoulder-joint examinations, which were implemented into the surgical OSCE at five different medical schools. The checklists for the assessment consisted of part A for knowledge and performance of the skill and part B for communication and interaction with the patient. At each medical faculty, one reference examiner also scored independently to the local examiner. The scores from both examiners were compared and analysed for inter-rater reliability and correlation with the level of clinical experience. Possible gender bias was also evaluated.
Results: In part A of the checklist, local examiners graded students higher compared to the reference examiner; in part B of the checklist, there was no trend to the findings. The inter-rater reliability was weak, and the scoring correlated only weakly with the examiner’s level of experience. Female examiners rated generally higher, but male examiners scored significantly higher if the examinee was female.
Conclusions: These findings of examiner effects, even in standardized situations, may influence outcome even when students perform equally well. Examiners need to be made aware of these biases prior to examining.
The teaching of professional roles in medical education is an interdisciplinary concern. However, surgeons require specific standards of professionalism for certain context-based situations. In addition to communication, studies require collaboration, leadership, error-/conflict-management, patient-safety and decision-making as essential competencies for surgeons. Standards for corresponding competencies are defined in special chapters of the German National Competency-based Learning Objectives for Undergraduate Medical Education (NKLM; chapter 8, 10). The current study asks whether these chapters are adequately taught in surgical curricula. Eight German faculties contributed to analysing mapping data considering surgical courses of undergraduate programs. All faculties used the MERlin mapping platform and agreed on procedures for data collection and processing. Sub-competency and objective coverage, as well as the achievement of the competency level were mapped. Overall counts of explicit citations were used for analysis. Collaboration within the medical team is a strongly represented topic. In contrast, interprofessional cooperation, particularly in healthcare sector issues is less represented. Patient safety and dealing with errors and complications is most emphasized for the Manager/Leader, while time management, career planning and leadership are not addressed. Overall, the involvement of surgery in teaching the competencies of the Collaborator and Manager/Leader is currently low. However, there are indications of a curricular development towards explicit teaching of these roles in surgery. Moreover, implicitly taught roles are numerous, which indicates a beginning awareness of professional roles.
Sandra Posch, Camilo Aponte-Santamaría, Richard Schwarzl, Andreas Karner, Matthias Radtke, Frauke Gräter, Tobias Obser, Gesa König, Maria A. Brehm, Hermann J. Gruber, Roland R. Netz, Carsten Baldauf, Reinhard Schneppenheim, Robert Tampé, Peter Hinterdorfer
Mutual A domain interactions in the force sensing protein von Willebrand factor
Journal of Structural Biology, Volume 197, Issue 1, January 2017, Pages 57-64. https://doi.org/10.1016/j.jsb.2016.04.012
We here give information for a deeper understanding of single molecule force spectroscopy (SMFS) data through the example of the blood protein von Willebrand factor (VWF). It is also shown, how fitting of rupture forces versus loading rate profiles in the molecular dynamics (MD) loading-rate range can be used to demonstrate the qualitative agreement between SMFS and MD simulations. The recently developed model by Bullerjahn, Sturm, and Kroy (BSK) was used for this demonstration. Further, Brownian dynamics (BD) simulations, which can be utilized to estimate the lifetimes of intramolecular VWF interactions under physiological shear, are described. For interpretation and discussion of the methods and data presented here, we would like to directly point the reader to the related research paper, “Mutual A domain interactions in the force sensing protein von Willebrand Factor” (Posch et al., 2016).
The von Willebrand factor (VWF) is a glycoprotein in the blood that plays a central role in hemostasis. Among other functions, VWF is responsible for platelet adhesion at sites of injury via its A1 domain. Its adjacent VWF domain A2 exposes a cleavage site under shear to degrade long VWF fibers in order to prevent thrombosis. Recently, it has been shown that VWF A1/A2 interactions inhibit the binding of platelets to VWF domain A1 in a force-dependent manner prior to A2 cleavage. However, whether and how this interaction also takes place in longer VWF fragments as well as the strength of this interaction in the light of typical elongation forces imposed by the shear flow of blood remained elusive. Here, we addressed these questions by using single molecule force spectroscopy (SMFS), Brownian dynamics (BD), and molecular dynamics (MD) simulations. Our SMFS measurements demonstrate that the A2 domain has the ability to bind not only to single A1 domains but also to VWF A1A2 fragments. SMFS experiments of a mutant [A2] domain, containing a disulfide bond which stabilizes the domain against unfolding, enhanced A1 binding. This observation suggests that the mutant adopts a more stable conformation for binding to A1. We found intermolecular A1/A2 interactions to be preferred over intramolecular A1/A2 interactions. Our data are also consistent with the existence of two cooperatively acting binding sites for A2 in the A1 domain. Our SMFS measurements revealed a slip-bond behavior for the A1/A2 interaction and their lifetimes were estimated for forces acting on VWF multimers at physiological shear rates using BD simulations. Complementary fitting of AFM rupture forces in the MD simulation range adequately reproduced the force response of the A1/A2 complex spanning a wide range of loading rates. In conclusion, we here characterized the auto-inhibitory mechanism of the intramolecular A1/A2 bond as a shear dependent safeguard of VWF, which prevents the interaction of VWF with platelets.
Buchbesprechungen
(2016)
Es werden folgende Publikation rezensiert: Ackermann & Sachteleben: Identifizierung der Hotspots der Biologischen Vielfalt in Deutschland; Bellin-Harder: In der Schwebe. Vegetationsdynamik und Pflegeprognostik. Ein vegetationskundlicher Beitrag zur Gartendenkmalpflege am Beispiel der Löwenburg im Bergpark Wilhelmshöhe, Kassel; Düll & Kutzelnigg: Taschenlexikon der Pflanzen Deutschlands und angrenzender Länder. Die wichtigsten mitteleuropäischen Arten im Porträt; Nassauischer Verein für Naturkunde: Zwischen Mittelrhein und Taunus. Naturschätze in Lorch am Rhein; Parolly & Rohwer: Schmeil-Fitschen. Die Flora Deutschlands und der angrenzenden Länder; Pusch et al: Die Botaniker Thüringens.
Since 2020, the COVID-19 pandemic had an impact on education worldwide. There is increased discussion of possible negative effects on students’ learning outcomes and the need for targeted support. We examined fourth graders’ reading achievement based on a school panel study, representative on the student level, with N = 111 elementary schools in Germany (total: N = 4,290 students, age: 9–10 years). The students were tested with the Progress in International Reading Literacy Study instruments in 2016 and 2021. The analysis focused on (1) total average differences in reading achievement between 2016 and 2021, (2) average differences controlling for student composition, and (3) changes in achievement gaps between student subgroups (i.e., immigration background, socio-cultural capital, and gender). The methodological approach met international standards for the analysis of large-scale assessments (i.e., multiple multi-level imputation, plausible values, and clustered mixed-effect regression). The results showed a substantial decline in mean reading achievement. The decline corresponds to one-third of a year of learning, even after controlling for changes in student composition. We found no statistically significant changes of achievement gaps between student subgroups, despite numerical tendencies toward a widening of achievement gaps between students with and without immigration background. It is likely that this sharp achievement decline was related to the COVID-19 pandemic. The findings are discussed in terms of further research needs, practical implications for educating current student cohorts, and educational policy decisions regarding actions in crises such as the COVID-19 pandemic.
HLA-DRB1 and HLA-DQB1 genetic diversity modulates response to lithium in bipolar affective disorders
(2021)
Bipolar affective disorder (BD) is a severe psychiatric illness, for which lithium (Li) is the gold standard for acute and maintenance therapies. The therapeutic response to Li in BD is heterogeneous and reliable biomarkers allowing patients stratification are still needed. A GWAS performed by the International Consortium on Lithium Genetics (ConLiGen) has recently identified genetic markers associated with treatment responses to Li in the human leukocyte antigens (HLA) region. To better understand the molecular mechanisms underlying this association, we have genetically imputed the classical alleles of the HLA region in the European patients of the ConLiGen cohort. We found our best signal for amino-acid variants belonging to the HLA-DRB1*11:01 classical allele, associated with a better response to Li (p < 1 × 10−3; FDR < 0.09 in the recessive model). Alanine or Leucine at position 74 of the HLA-DRB1 heavy chain was associated with a good response while Arginine or Glutamic acid with a poor response. As these variants have been implicated in common inflammatory/autoimmune processes, our findings strongly suggest that HLA-mediated low inflammatory background may contribute to the efficient response to Li in BD patients, while an inflammatory status overriding Li anti-inflammatory properties would favor a weak response.
An optimized Bayesian hierarchical two-parameter logistic model for small-sample item calibration
(2019)
Accurate item calibration in models of item response theory (IRT) requires rather large samples. For instance, N > 500 respondents are typically recommended for the two-parameter logistic (2PL) model. Hence, this model is considered a large-scale application, and its use in small-sample contexts is limited. Hierarchical Bayesian approaches are frequently proposed to reduce the sample size requirements of the 2PL. This study compared the small-sample performance of an optimized Bayesian hierarchical 2PL (H2PL) model to its standard inverse Wishart specification, its nonhierarchical counterpart, and both unweighted and weighted least squares estimators (ULSMV and WLSMV) in terms of sampling efficiency and accuracy of estimation of the item parameters and their variance components. To alleviate shortcomings of hierarchical models, the optimized H2PL (a) was reparametrized to simplify the sampling process, (b) a strategy was used to separate item parameter covariances and their variance components, and (c) the variance components were given Cauchy and exponential hyperprior distributions. Results show that when combining these elements in the optimized H2PL, accurate item parameter estimates and trait scores are obtained even in sample sizes as small as N = 100. This indicates that the 2PL can also be applied to smaller sample sizes encountered in practice. The results of this study are discussed in the context of a recently proposed multiple imputation method to account for item calibration error in trait estimation.
Es wird über die Herkunft von Lysichiton americanum aus Anpflanzungen und dessen Verbreitung im Gebiet des Großen Feldbergs im Taunus (Hessen, Deutschland) berichtet, Die bekanntgewordenen Fundorte aus den Jahren 1982 bis 1992 werden beschrieben und auf einer Verbreitungskarte dargestellt. Auf Ausbreitungstendenzen von Lysichiton americanum und die dadurch mögliche Gefährdung der autochthonen Bachauenvegetation wird hingewiesen.
Folgende Publikationen werden rezensiert: Garve & al.: Verbreitungsatlas Niedersachsen, Hölzel & al.: Stromtalwiesen, Lübcke & Frede: Naturschutzgebiete in Hessen Band 4, Notizbuch 68 der Kasseler Schule, Riecken & al.: Rote Liste Biotoptypen, Schulz & Dengler: Verbreitungsatlas Moose Schleswig-Holstein, Szabo: Wandern – Erkennen – Heilen
Zweizahn-Melden-Ufergesellschaften : Bidentetea tripartitae Tüxen, Lohmeyer & Preising in Tüxen 1943
(1990)
Zweizahn-Melden-Ufergesellschaften besiedeln Standorte, die vom Winter bis in das Frühjahr hinein lange unter Wasser stehen und wo nach Rückzug des Hochwassers offene Böden zurückbleiben oder neue Sedimente abgelagert werden. Auf diesen häufig sehr nährstoffreichen (stickstoffreichen) Schlammböden, die erst spät im Jahr abzutrocknen beginnen, entwickelt sich innerhalb von nur drei bis fünf Monaten eine Pioniervegetation aus Sommerannuellen, die im August und September optimal entwickelte Aspekte zeigt und danach rasch abstirbt. Flußmelden-Gesellschaften (Verband Chenopodion rubri) besiedeln vor allem Flußufer, während Zweizahn-Gesellschaften (Verband Bidention tripartitae) häufiger an Teich- und Grabenufern, nassen Wegrändern sowie landwirtschaftlich beeinflußten Plätzen wachsen.
Es wird über die Verbreitung von Elymus elongatus (Host) Runemark subsp. ponticus (Podpera) Melderis in Hessen und benachbarten Bundesländern berichtet. Die Art wird seit 1982 beobachtet. Herkunft und Einbürgerungstendenz sowie mögliche Verwechslungen mit Elymus hispidus (Opiz) Melderis werden diskutiert. Zu den 45 Fundorten werden detaillierte Angaben gemacht, um Einbürgerung und mögliche Ausbreitung rekonstruieren zu können. Eine Punktrasterkarte ist als Verbreitungsübersicht beigefügt.