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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.
A measurement of the transverse momentum spectra of jets in Pb-Pb collisions at sNN−−−√=2.76 TeV is reported. Jets are reconstructed from charged particles using the anti-kT jet algorithm with jet resolution parameters R of 0.2 and 0.3 in pseudo-rapidity |η|<0.5. The transverse momentum pT of charged particles is measured down to 0.15 GeV/c which gives access to the low pT fragments of the jet. Jets found in heavy-ion collisions are corrected event-by-event for average background density and on an inclusive basis (via unfolding) for residual background fluctuations and detector effects. A strong suppression of jet production in central events with respect to peripheral events is observed. The suppression is found to be similar to the suppression of charged hadrons, which suggests that substantial energy is radiated at angles larger than the jet resolution parameter R=0.3 considered in the analysis. The fragmentation bias introduced by selecting jets with a high pT leading particle, which rejects jets with a soft fragmentation pattern, has a similar effect on the jet yield for central and peripheral events. The ratio of jet spectra with R=0.2 and R=0.3 is found to be similar in Pb-Pb and simulated PYTHIA pp events, indicating no strong broadening of the radial jet structure in the reconstructed jets with R<0.3.
Transverse momentum spectra of π±, K± and p(p¯) up to pT = 20 GeV/c at mid-rapidity in pp, peripheral (60–80%) and central (0–5%) Pb–Pb collisions at √sNN = 2.76 TeV have been measured using the ALICE detector at the Large Hadron Collider. The proton-to-pion and the kaon-to-pion ratios both show a distinct peak at pT ≈ 3 GeV/c in central Pb–Pb collisions. Below the peak, pT < 3 GeV/c, both ratios are in good agreement with hydrodynamical calculations, suggesting that the peak itself is dominantly the result of radial flow rather than anomalous hadronization processes. For pT > 10 GeV/c particle ratios in pp and Pb–Pb collisions are in agreement and the nuclear modification factors for π±, K± and p(p¯) indicate that, within the systematic and statistical uncertainties, the suppression is the same. This suggests that the chemical composition of leading particles from jets in the medium is similar to that of vacuum jets.
The project focuses on the efficiency of combined technologies to reduce the release of micropollutants and bacteria into surface waters via sewage treatment plants of different size and via stormwater overflow basins of different types. As a model river in a highly populated catchment area, the river Schussen and, as a control, the river Argen, two tributaries of Lake Constance, Southern Germany, are under investigation in this project. The efficiency of the different cleaning technologies is monitored by a wide range of exposure and effect analyses including chemical and microbiological techniques as well as effect studies ranging from molecules to communities.
Background: Experienced and anticipated regret influence physicians’ decision-making. In medicine, diagnostic decisions and diagnostic errors can have a severe impact on both patients and physicians. Little empirical research exists on regret experienced by physicians when they make diagnostic decisions in primary care that later prove inappropriate or incorrect. The aim of this study was to explore the experience of regret following diagnostic decisions in primary care.
Methods: In this qualitative study, we used an online questionnaire on a sample of German primary care physicians. We asked participants to report on cases in which the final diagnosis differed from their original opinion, and in which treatment was at the very least delayed, possibly resulting in harm to the patient. We asked about original and final diagnoses, illness trajectories, and the reactions of other physicians, patients and relatives. We used thematic analysis to assess the data, supported by MAXQDA 11 and Microsoft Excel 2016.
Results: 29 GPs described one case each (14 female/15 male patients, aged 1.5–80 years, response rate < 1%). In 26 of 29 cases, the final diagnosis was more serious than the original diagnosis. In two cases, the diagnoses were equally serious, and in one case less serious. Clinical trajectories and the reactions of patients and relatives differed widely. Although only one third of cases involved preventable harm to patients, the vast majority (27 of 29) of physicians expressed deep feelings of regret.
Conclusion: Even if harm to patients is unavoidable, regret following diagnostic decisions can be devastating for clinicians, making them ‘second victims’. Procedures and tools are needed to analyse cases involving undesirable diagnostic events, so that ‘true’ diagnostic errors, in which harm could have been prevented, can be distinguished from others. Further studies should also explore how physicians can be supported in dealing with such events in order to prevent them from practicing defensive medicine.
Die Bewirtschaftung von Waldökosystemen unter Berücksichtigung der natürlichen Lebensgemeinschaften ist heute anerkanntes Ziel der Mehrzahl mitteleuropäischer Forstbetriebe. Dies zeigen auch die verschiedenen forstlichen Zertifizierungssysteme (PEFC, FSC, Naturland). Dass es sich dabei immer um einen Kompromiss zwischen Nutz- und Schutzfunktionen handeln muss, beruht auf der Tatsache, dass einerseits der Rohstoff Holz auf Grund seiner günstigen Ökobilanz zu den umweltfreundlichsten gehört, andererseits entnommenes Holz im Wald immer auch einen Verlust an Nährstoff und Lebensraum darstellt (SPEIGHT 1989, GROVE 2002b). Um so wichtiger ist eine nach Artengruppen und Prozessen differenzierte Analyse zur Bedeutung der verschiedenen Totholzarten und Mengen. Erst diese kann dann in einem optimierten Kompromiss münden. Dass Totholz eine überragende Rolle im Naturnähecharakter von Wäldern spielt ist inzwischen unbestritten. Es hat sich auch gezeigt dass für Strukturspezialisten bestimmte Mengen (BÜTLER ET AL. 2004, MÜLLER 2005a) und Vernetzungen (SCHIEGG 2000), für andere wieder ein ausreichendes Angebot an seltenen Totholzhabitaten wie Mulmhöhlen (RANIUS 2002) notwendig sind. Tatsächlich dominieren im Gegensatz zu Skandinavien in den heutigen mitteleuropäischen Wäldern häufig nicht mehr die Baumarten der natürlichen Waldgesellschaften. Diese standortheimischen Arten wurden durch raschwüchsige Koniferen (meist Fichte, Kiefer oder Lärche, seltener Douglasie) ersetzt (GOßNER 2004). Für spezialisierte Insektenarten wie xylobionte Käfer, zeigt sich dabei, dass letztlich nur weit verbreitete Generalisten hier den Wirtspflanzen gefolgt sind (GOßNER 2004, MÜLLER 2005b). Spezialisten der Nadelbäume, die sich häufig in den Roten Listen wiederfinden, bedürfen aber einer Kombination aus Standortsparametern und Nadelbaumart, an die sie sich im Laufe der Evolution angepasst haben.
Urwald relict species – Saproxylic beetles indicating structural qualities and habitat tradition
(2005)
On the basis of the list of saproxylic beetles of Germany, the authors present a definition and list of “Urwald relict species”, comprising 115 beetles that are considered to be associated with primeval forest (“Urwald”) structures and features. We use the term “habitat tradition” to describe a continuity in supply of old growth dead wood and forest structures. The selection of species is made on behalf of the following criteria: relict records in Central Europe; attachment to continuity of deadwood resources and habitat tradition; continuity of old growth stand features like tree and deadwood maturity and di-versity; absence from cultivated Central European forest.
To understand the rapid rate of change in global biodiversity, it is necessary to analyse the present condition of ecosystems and to elucidate relationships of species to their environment. The BIOKLIM Project (Biodiversity and Climate Change Project) is intended to close this gap in our knowledge of montane and high montane forests of Central European low mountain ranges, one of the most threatened mixed montane systems worldwide. The Bavarian Forest National Park is characterised by its altitude range of ca. 800 m and a strongly developed gradient of forest structure. Relicts of old growth forests (areas of former local nature reserves) and dead stands, mostly killed by bark beetles, are accompanied by widely varying levels of woody debris and light. The gradients comprise a wide range of abiotic and forest structure factors, making the study area well suited for a multidisciplinary investigation of biodiversity. Unconstrained ordination (CA) of six taxa (vascular plants, wood inhabiting fungi, birds, carabids, spiders and molluscs) indicate the altitudinal gradient to be the main driver for distribution patterns of species assemblages. Objectives, structure, study design and data sampling of the BIOKLIM Project are described in detail. We set up 293 sampling plots along four main straight transects following the altitudinal gradient. All abiotic and stand structure data regarded as relevant are available for each plot. Vascular plants, wood inhabiting fungi and birds were sampled or mapped on all 293 plots. For the other 22 investigated taxa we used subsamples pre-stratified according to the sampling methods. The necessity of dealing with spatial autocorrelation, arising from sampling along linear transects, is described. Finally, study approach of our biodiversity project is compared with others involving altitudinal gradients. Worldwide, only a few multidisciplinary biodiversity studies have been previously conducted on long altitudinal gradients. However, in most cases sampling techniques were similar to ours, which allows comparison of results between continents. Keywords: Climate Change, Biodiversity, species-environment relationships
Background and objectives: Preoperative anaemia is an independent risk factor for a higher morbidity and mortality, a longer hospitalization and increased perioperative transfusion rates. Managing preoperative anaemia is the first of three pillars of Patient Blood Management (PBM), a multidisciplinary concept to improve patient safety. While various studies provide medical information on (successful) anaemia treatment pathways, knowledge of organizational details of diagnosis and management of preoperative anaemia across Europe is scarce.
Materials and methods: To gain information on various aspects of preoperative anaemia management including organization, financing, diagnostics and treatment, we conducted a survey (74 questions) in ten hospitals from seven European nations within the PaBloE (Patient Blood Management in Europe) working group covering the year 2016.
Results: Organization and activity in the field of preoperative anaemia management were heterogeneous in the participating hospitals. Almost all hospitals had pathways for managing preoperative anaemia in place, however, only two nations had national guidelines. In six of the ten participating hospitals, preoperative anaemia management was organized by anaesthetists. Diagnostics and treatment focused on iron deficiency anaemia which, in most hospitals, was corrected with intravenous iron.
Conclusion: Implementation and approaches of preoperative anaemia management vary across Europe with a primary focus on treating iron deficiency anaemia. Findings of this survey motivated the hospitals involved to critically evaluate their practice and may also help other hospitals interested in PBM to develop action plans for diagnosis and management of preoperative anaemia.
Although it has been suggested that temperature increase may alter the toxic potential of environmental pollutants, few studies have investigated the potential risk of chemical stressors for wildlife under Global Climate Change (GCC) impact. We applied a bifactorial multigeneration study in order to test if GCC conditions alter the effects of low pesticide concentrations on life history and genetic diversity of the aquatic model organism Chironomus riparius. Experimental populations of the species were chronically exposed to a low concentration of the fungicide pyrimethanil (half of the no-observed-adverse-effect concentration: NOAEC/2) under two dynamic present-day temperature simulations (11.0–22.7°C; 14.0–25.2°C) and one future scenario (16.5–28.1°C). During the 140-day multigeneration study, survival, emergence, reproduction, population growth, and genetic diversity of C. riparius were analyzed. Our results reveal that high temperature and pyrimethanil act synergistically on the midge C. riparius. In simulated present-day scenarios, a NOAEC/2 of pyrimethanil as derived from a life-cycle toxicity test provoked only slight-to-moderate beneficial or adverse effects on C. riparius. In contrast, exposure to a NOAEC/2 concentration of pyrimethanil at a thermal situation likely for a summer under GCC conditions uncovered adverse effects on mortality and population growth rate. In addition, genetic diversity was considerably reduced by pyrimethanil in the future scenario, but only slightly under current climatic conditions. Our multigeneration study under near-natural (climatic) conditions indicates that not only the impact of climate change, but also low concentrations of pesticides may pose a reasonable risk for aquatic insects in future.
Im Rahmen des BIOKLIM-Projekts wurden im Nationalpark Bayerischer Wald Daten zu verschiedenen Tier- und Pflanzenarten sowie Umweltfaktoren erhoben. Die folgende Auswertung beschränkt sich auf die Weichtiere (Gastropoda, Bivalvia). Ziel war es, herauszufinden, welche Umweltfaktoren die Arten- und Individuenanzahlen beeinflussen, was die Lebensgemeinschaften steuert und welche Parameter sich auf ausgewählte Einzelarten auswirken. In Quasi-Poisson-Modellen haben sich als Einflussgrößen für die Individuenanzahl Höhe, Alter, Magnesium und pH-Wert feststellen lassen. Auf die Artenanzahl wirkte sich der Vegetationsreichtum, die Höhe und der Managementtyp aus. Die Einzelarten werden von sehr unterschiedlichen Faktoren beeinflusst. Die Lebensgemeinschaften werden vor allem von der Höhe über dem Meeresspiegel, der Temperatur und dem Auflichtungsgrad bestimmt, was sich in verschiedenen Ordinationsverfahren gezeigt hat.
Intensive land use is a driving force for biodiversity decline in many ecosystems. In semi-natural grasslands, land-use activities such as mowing, grazing and fertilization affect the diversity of plants and arthropods, but the combined effects of different drivers and the chain of effects are largely unknown. In this study we used structural equation modelling to analyse how the arthropod communities in managed grasslands respond to land use and whether these responses are mediated through changes in resource diversity or resource quantity (biomass). Plants were considered resources for herbivores which themselves were considered resources for predators. Plant and arthropod (herbivores and predators) communities were sampled on 141 meadows, pastures and mown pastures within three regions in Germany in 2008 and 2009. Increasing land-use intensity generally increased plant biomass and decreased plant diversity, mainly through increasing fertilization. Herbivore diversity decreased together with plant diversity but showed no response to changes in plant biomass. Hence, land-use effects on herbivore diversity were mediated through resource diversity rather than quantity. Land-use effects on predator diversity were mediated by both herbivore diversity (resource diversity) and herbivore quantity (herbivore biomass), but indirect effects through resource quantity were stronger. Our findings highlight the importance of assessing both direct and indirect effects of land-use intensity and mode on different trophic levels. In addition to the overall effects, there were subtle differences between the different regions, pointing to the importance of regional land-use specificities. Our study underlines the commonly observed strong effect of grassland land use on biodiversity. It also highlights that mechanistic approaches help us to understand how different land-use modes affect biodiversity.
Flechten gehören zu den herausragenden Indikatorgruppen für Veränderungen in Wäldern. Im Rahmen des Forschungsprojektes „Biodiversität und Klima“ (BIOKLIM) wurden im Jahr 2007 im Nationalpark Bayerischer Wald entlang von 4 Forschungslinien 125 baumbewohnende Flechten, 5 lichenicole Pilze sowie 1 nicht lichenisierter Ascomycet festgestellt. Alte Wälder und Prozessschutzwälder wiesen dabei signifikant die größte Artendiversität und die höchste Anzahl an bedrohten Arten im Vergleich mit den noch gemanagten Wäldern auf. Die herausragende Bedeutung von alten Wäldern und Prozessschutzflächen für den Erhalt und die Ausbreitung gefährdeter Flechten und lichenicoler Pilze für den ostbayerischen Mittelgebirgsraum wird dargestellt. Die sehr seltenen und hochgradig gefährdeten lichenicolen Pilze Chaenothecopsis viridialba, Sphinctrina anglica und Sphinctrina turbinata und die Flechte Mycobilimbia sphaeroides werden als Neufunde für den Bayerischen Wald genannt. Der in der Bundesrepublik Deutschland als verschollen geltende Flechtenpilz Sphinctrina tubiformis wurde im „Rachelseeurwald“ wiederentdeckt. Für alte naturnahe Wälder des Bayerischen und Böhmischen Waldes werden folgende Zeigerarten beschrieben: Lecanactis abietina, Pyrenula nitida, Micarea cinerea, Microcalicium disseminatum, Loxospora cismonica und Thelotrema lepadinum. Abschließend werden für das Management montaner und hochmontaner Wälder Mitteleuropas Empfehlungen abgeleitet.
This study presents a method for adjusting long-term climate data records (CDRs) for the integrated use with near-real-time data using the example of surface incoming solar irradiance (SIS). Recently, a 23-year long (1983–2005) continuous SIS CDR has been generated based on the visible channel (0.45–1 μm) of the MVIRI radiometers onboard the geostationary Meteosat First Generation Platform. The CDR is available from the EUMETSAT Satellite Application Facility on Climate Monitoring (CM SAF). Here, it is assessed whether a homogeneous extension of the SIS CDR to the present is possible with operationally generated surface radiation data provided by CM SAF using the SEVIRI and GERB instruments onboard the Meteosat Second Generation satellites. Three extended CM SAF SIS CDR versions consisting of MVIRI-derived SIS (1983–2005) and three different SIS products derived from the SEVIRI and GERB instruments onboard the MSG satellites (2006 onwards) were tested. A procedure to detect shift inhomogeneities in the extended data record (1983–present) was applied that combines the Standard Normal Homogeneity Test (SNHT) and a penalized maximal T-test with visual inspection. Shift detection was done by comparing the SIS time series with the ground stations mean, in accordance with statistical significance. Several stations of the Baseline Surface Radiation Network (BSRN) and about 50 stations of the Global Energy Balance Archive (GEBA) over Europe were used as the ground-based reference. The analysis indicates several breaks in the data record between 1987 and 1994 probably due to artefacts in the raw data and instrument failures. After 2005 the MVIRI radiometer was replaced by the narrow-band SEVIRI and the broadband GERB radiometers and a new retrieval algorithm was applied. This induces significant challenges for the homogenisation across the satellite generations. Homogenisation is performed by applying a mean-shift correction depending on the shift size of any segment between two break points to the last segment (2006–present). Corrections are applied to the most significant breaks that can be related to satellite changes. This study focuses on the European region, but the methods can be generalized to other regions. To account for seasonal dependence of the mean-shifts the correction was performed independently for each calendar month. In comparison to the ground-based reference the homogenised data record shows an improvement over the original data record in terms of anomaly correlation and bias. In general the method can also be applied for the adjustment of satellite datasets addressing other variables to bridge the gap between CDRs and near-real-time data.
Moose spielen in Nahrungsketten meist nur eine kleine Rolle und nur wenige Tiergruppen treten bei Moosen als Herbivore auf. Im Winter 2009 konnten Pilzmücken (Mycetophilidae) bei der Aufnahme von Sporenpulver an Buxbaumia aphylla beobachtet werden. Mehrere adulte Individuen saßen an von Schnecken geöffneten Kapseln und nahmen grünes Sporenpulver auf. Während es bekannt ist, dass Schnecken als Konsument an Sporophyten auftreten, ist dies für adulte Pilzmücken neu. Möglicherweise profitieren Moosarten wie Buxbaumia durch diese Herbivorie, da hier auch eine zoochore Ausbreitung von Sporen durch Pilzmücken zu Stande kommen kann.
Die Weißtanne (Abies alba) – Symbol für naturnahe Waldwirtschaft – ist im Bayerischen Wald beheimatet. Die Tanne ist dort neben Fichte und Buche das prägende Element der Bergmischwälder auf Höhen von 600 bis 1250 m. Einstmals war sie mit etwa 20 % (ROTHE & BORCHERT 2003) am Waldaufbau beteiligt. Seit rund 150 Jahren ist jedoch ein drastischer Rückgang der Tanne - nicht nur im Bayerischen Wald – zu verzeichnen. Die Ursachen für den Rückgang der Tanne sind überwiegend anthropogen bedingt. In erster Linie ist hier die Forstwirtschaft zu erwähnen, die bestrebt ist durch waldbauliche Maßnahmen den Fichtenanteil anzuheben. An zweiter Stelle stehen die neuartigen Waldschäden, welche, bedingt durch Schadstoffimmissionen in den 70er und 80er Jahren des letzten Jahrhunderts, zu verstärktem Absterben der Tanne führten. Noch heute ist die Tanne die am stärksten geschädigte Baumart in Bayern (BAYSTMLF 2002). Ein weiterer nicht zu vergessender Faktor für den Rückgang der Tanne sind die z.T. hohen Wildbestände, durch deren Verbiss und Schälen junger Tannen das Heranwachsen einer neuen Generation verhindert wird. Mit dem Rückgang der Tanne verändert sich jedoch nicht nur die Baumartenzusammensetzung, sondern auch Tier- und Pflanzenarten sind direkt und indirekt betroffen. Die Arthropodenfauna der bisher kaum untersuchten Tanne wird als relativ artenarm beschrieben (BRÄNDLE & BRANDL 2001), jedoch gibt es wenige spezielle Untersuchungen an dieser Baumart (MÜLLER & GOßNER 2004).
Natürlicherweise war die Tanne (Abies alba) in den bayerischen Wäldern mit Anteilen von bis zu 20% vertreten (nach ROTHE & BORCHERT 2003). Seit 150 Jahren aber gehen die Tannenbestände in drastischem Ausmaß zurück, was nicht nur auf die wachsende Schadstoffbelastung der Luft, sondern auch auf hohe Wildbestände und die einseitige Waldbewirtschaftung zugunsten der Fichte (Picea abies) zurückzuführen ist. In jüngster Zeit wird seitens der Staatsforstverwaltung angestrebt, der Tanne ihren angestammten Platz in unseren Wäldern wieder einzuräumen (BAYERISCHES STAATSMINISTERIUM FÜR LANDWIRTSCHAFT UND FORSTEN 1993). Es stellt sich die Frage, welchen Beitrag die Tanne zur Biodiversität in Wäldern und speziell in Mischwäldern leistet. Frühere Untersuchungen beschrieben die Tannenfauna als artenarm im Vergleich mit anderen Baumarten (BÖHME 2001, BUCKING 1998), allerdings wurde die Kronenfauna dabei stets vernachlässigt. Da aber 90% eines Hochwaldes über der Reichhöhe eines Menschen liegt (BUßLER et al. 2004), sind Untersuchungen im Kronenraum höheren Straten für eine umfassende Aussage über die Fauna auf Bäumen von großer Bedeutung. Bis jetzt gibt es trotz des generell wachsenden Interesses an der Kronenfauna keine umfassenden Untersuchungen an Tanne (MÜLLER & GOSSNER 2004). Mit dem hier vorgestellten Projekt sollte begonnen werden, die Wissenslücke um die Insektenfauna in Tannenkronen zu schließen. Den xylobionten Käfern galt besondere Aufmerksamkeit, da sie als eine baumartengebundene Insektengruppe für vergleichendeUntersuchungen sehr gut geeignet und sowohl taxonomisch als auch ökologisch gut untersucht sind. Daneben wurden Heteroptera, Neuropterida und Hymenoptera bearbeitet .
Abstract
Rheumatoid arthritis (RA) is associated with systemic osteoporosis, which leads to severe disability and low quality of life. Current therapies target osteoclasts to reduce bone degradation, but more treatment options would be required to promote bone protection by acting directly on osteoblasts (OB). Recently, the local production of dopamine in inflamed joints of RA has been observed. Thus, in this project, we aimed to determine the implication of the neurotransmitter dopamine in the bone formation process in RA. Dopamine receptors (DR) in the human bone tissue of RA or osteoarthritis (OA) patients were examined by immunohistochemistry. DR in isolated human osteoblasts (OB) was analyzed by flow cytometry, and dopamine content was evaluated by ELISA. Osteoclasts (OC) were differentiated from the PBMCs of healthy controls (HC) and RA patients. Isolated cells were treated with specific dopamine agonists. The effect of dopamine on mineralization was evaluated by Alizarin red staining. Cytokine release in supernatants was measured by ELISA. Osteoclastogenesis was evaluated with TRAP staining. OC markers were analyzed via real-time PCR and bone resorption via staining of resorption pits with toluidine blue. All DR were observed in bone tissue, especially in the bone remodeling area. Isolated OB maintained DR expression, which allowed their study in vitro. Isolated OB expressed tyrosine hydroxylase, the rate-limiting enzyme for dopamine production, and contained dopamine. The activation of D2-like DR significantly increased bone mineralization in RA osteoblasts and increased osteoclastogenesis but did not alter the expression of OC markers nor bone resorption. DR were found in the bone remodeling area of human bone tissue and dopamine can be produced by osteoblasts themselves, thus suggesting a local autocrine/paracrine pathway of dopamine in the bone. D2-like DRs are responsible for bone mineralization in osteoblasts from RA patients without an increase in bone resorption, thus suggesting the D2-like DR pathway as a possible future therapeutic target to counteract bone resorption in arthritis
Background: Patients with head and neck cancer (HNC) are at high risk for malnutrition because of tumour localisation and therapy. Prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement is common practice to prevent malnutrition.
Objective: To investigate the benefits of prophylactic PEG tube placement for HNC patients in terms of the influence on patients’ nutritional status, utilisation rate, complications and to identify the predictors of PEG tube utilisation.
Methods: All consecutive HNC patients who underwent prophylactic PEG tube insertion between 1 January 2011 and 31 December 2012 prior to therapy were enrolled. The PEG tube utilisation rate, complications, the patients’ nutritional status and tumour therapy were evaluated with the help of electronic patient charts and telephone interviews.
Results: A total of 181 patients (48 female, median 67.5 years) were included. The PEG utilisation rate in the entire cohort was 91.7%. One hundred and forty‐nine patients (82.3%) used the PEG tube for total enteral nutrition, 17 patients (9.4%) for supplemental nutrition and 15 patients (8.3%) made no use of the PEG tube. Peristomal wound infections were the most common complications (40.3%) in this study. A high Nutritional Risk Screening (NRS) score prior to tube insertion was found to be independently associated with PEG utilisation. No significant weight changes were observed across the three patient subgroups.
Conclusions: The overall PEG tube utilisation rate was high in this study. However, given the high rate of infections, diligent patient selection is crucial in order to determine which patients benefit most from prophylactic PEG tube insertion.