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Background: Simultaneous pancreas kidney transplantation (SPK), pancreas transplantation alone (PTA) or pancreas transplantation after kidney (PAK) are the only curative treatment options for patients with type 1 (juvenile) diabetes mellitus with or without impaired renal function. Unfortunately, transplant waiting lists for this indication are increasing because the current organ acceptability criteria are restrictive; morbidity and mortality significantly increase with time on the waitlist. Currently, only pancreas organs from donors younger than 50 years of age and with a body mass index (BMI) less than 30 are allocated for transplantation in the Eurotransplant (ET) area. To address this issue we designed a study to increase the available donor pool for these patients.
Methods/Design: This study is a prospective, multicenter (20 German centers), single blinded, non-randomized, two armed trial comparing outcome after SPK, PTA or PAK between organs with the currently allowed donor criteria versus selected organs from donors with extended criteria. Extended donor criteria are defined as organs procured from donors with a BMI of 30 to 34 or a donor age between 50 and 60 years. Immunosuppression is generally standardized using induction therapy with Myfortic, tacrolimus and low dose steroids. In principle, all patients on the waitlist for primary SPK, PTA or PAK are eligible for the clinical trial when they consent to possibly receiving an extended donor criteria organ. Patients receiving an organ meeting the current standard criteria for pancreas allocation (control arm) are compared to those receiving extended criteria organ (study arm); patients are blinded for a follow-up period of one year. The combined primary endpoint is survival of the pancreas allograft and pancreas allograft function after three months, as an early relevant outcome parameter for pancreas transplantation.
Discussion: The EXPAND Study has been initiated to investigate the hypothesis that locally allocated extended criteria organs can be transplanted with similar results compared to the currently allowed standard ET organ allocation. If our study shows a favorable comparison to standard organ allocation criteria, the morbidity and mortality for patients waiting for transplantation could be reduced in the future.
Trial registered at: NCT01384006
Postoperative complications after pancreatic surgery are still a significant problem in clinical practice. The aim of this study was to characterize and compare the microbiomes of different body compartments (bile duct, duodenal mucosa, pancreatic tumor lesion, postoperative drainage fluid, and stool samples; preoperative and postoperative) in patients undergoing pancreatic surgery for suspected pancreatic cancer, and their association with relevant clinical factors (stent placement, pancreatic fistula, and gland texture). For this, solid (duodenal mucosa, pancreatic tumor tissue, stool) and liquid (bile, drainage fluid) biopsy samples of 10 patients were analyzed using 16s rRNA gene next-generation sequencing. Our analysis revealed: (i) a distinct microbiome in the different compartments, (ii) markedly higher abundance of Enterococcus in patients undergoing preoperative stent placement in the common bile duct, (iii) significant differences in the beta diversity between patients who developed a postoperative pancreatic fistula (POPF B/C), (iv) patients with POPF B/C were more likely to have bacteria belonging to the genus Enterococcus, and (v) differences in microbiome composition with regard to the pancreatic gland texture. The structure of the microbiome is distinctive in different compartments, and can be associated with the development of a postoperative pancreatic fistula.
Kriminalität und deren Bekämpfung unterliegen seit jeher permanenten Veränderungen. Durch den gesellschaftlichen Wandel und die damit einhergehende Weiterentwicklung von technischen Möglichkeiten werden fortlaufend neue Modi Operandi ermöglicht, auf welche die Polizei mit teilweise ebenfalls neuen kriminalistischen Mitteln reagiert. Entwicklungen in der Kriminalität und der Kriminalistik können somit als sich gegenseitig beeinflussende Prozesse angesehen werden. Allerdings findet dieser Wandel nicht kontinuierlich statt, sondern tritt in Schüben auf, die in der Regel auf besonders kriminalitätsrelevante Ereignisse zurückzuführen sind. In diesem Zusammenhang verändert sich die Polizei, sowohl in ihrer Organisation als auch in ihren Analysen zur Entwicklung der Kriminalität und in ihren Methoden zu deren Bekämpfung, teilweise grundlegend.
In einem ersten, konzeptionellen Teil wird anhand von ausgewählten Kriminalitätsformen und den damit verbundenen Ermittlungspraktiken ein Überblick der gegenseitigen Beeinflussung von Kriminalität und Kriminalistik gegeben. Darauf aufbauend wird im zweiten Teil der aktuelle Stand dieses 'Evolutionsprozesses' anhand der Implementierung von Predictive-Policing-Systemen in die Polizeiarbeit diskutiert. Denn darin zeigt sich nahezu idealtypisch die gegenseitige Beeinflussung von Kriminalität und Kriminalistik wie auch der digitale Wandel und die damit verbundenen Gefahren. Polizeiarbeit scheint sich im Ergebnis dieser Veränderungsprozesse von einer ursprünglich eher auf den Einzelfall bezogenen, subjektiven Sichtweise auf Kriminalität und deren Verfolgung (zum Beispiel durch kriminalistische Taktik und List in der Vernehmung) auf eine nunmehr eher allgemeine, abstraktere Betrachtung zu verschieben ('Abstract Police').