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In der vorliegenden Dissertation wurde untersucht, ob die endotracheale Intubation (ETI) der alternativen Atemwegssicherung mittels Larynxtubus (LT) bezüglich der Überlebenswahrscheinlichkeit bei außerklinisch reanimierten Patienten überlegen ist.
Das retrospektiv erfasste Kollektiv dieser monozentrischen Studie umfasst 222 Patienten, die in den Jahren 2006 bis 2014 nach nicht-traumatischem Herz-Kreislauf-Stillstand außerhalb der Klinik (engl.: Out-of-hospital cardiac arrest, OHCA) präklinisch primär mit Endotrachealtubus (ET) oder LT versorgt und anschließend auf die internistische Intensivstation des Universitätsklinikums Frankfurt am Main aufgenommen wurden. Endpunkte der Studie waren die innerklinische Gesamtmortalität während des Krankenhausaufenthaltes sowie die Überlebensrate nach 24 Stunden.
In die Analyse wurden 208 Patienten einbezogen, von denen präklinisch 48 Patienten mit LT (23 %) und 160 Patienten mit ET (77 %) intubiert wurden. Die innerklinische Sterblichkeitsrate lag insgesamt bei 85 % (n=176); darunter 23 % LT- und 77 % ET-versorgte Patienten. Zwischen den beiden Methoden zur Atemwegssicherung zeigten sich sowohl in einer univariaten Analyse (Hazard ratio [HR]=0,98; 95 % Konfidenzintervall [K.I.] 0,69-1,39; p=0,92) als auch in einer multivariaten Cox-Regressionsmodell (adjustierte HR=1,01; 95 % K.I. 0,76-1,56; p=0,62) keine Unterschiede. Die ersten 24 Stunden nach OHCA überlebten 38 % aller Patienten; auch hier unterschieden sich die beiden Patientenkollektive nicht signifikant voneinander (univariate HR=1,04; 95 % K.I. 0,71-1,52; p=0,83).
Ferner veranschaulichte eine Propensity-Score-Matching-Analyse (PSM) mit einer Subgruppe von 120 Patienten, zusammengestellt in einem 3:1 Verhältnis (ET:LT), sowohl mit Blick auf die Überlebensrate bis zur Krankenhausentlassung (Propensity-adjustierte HR=0,99; 95 % K.I. 0,65-1,51; p=0,97) als auch auf die Mortalität in den ersten 24 Stunden (Propensity-adjustierte HR=1,04; 95 % K.I. 0,44-2,36; p=0,96) vergleichbare Ergebnisse beim Atemwegsmanagement mit LT bzw. ET.
Die frühe Durchführung einer Herzkatheteruntersuchung (HR=0,47; 95 % K.I. 0,28-0,77; p=0,003) sowie der frühe Beginn einer systemischen empirischen antibiotischen Therapie (HR=0,28; 95% K.I. 0,17-0,45; p<0,001) konnten überdies als signifikant positive Prädiktoren für das Überleben in einer angepassten Cox-Regressionsanalyse herausgearbeitet werden.
Im Gesamten konnte somit demonstriert werden, dass die initiale präklinische Anwendung des LT nach OHCA der ETI hinsichtlich der Überlebenswahrscheinlichkeit nicht untergeordnet ist. Neuester Literatur zufolge ist sie womöglich sogar überlegen. Dies gilt es in weiteren Studien zu bestätigen.
This paper contributes to the clarification of the concept of “typicality” discussed in contemporary philosophy of physics by conceiving the nomological status of a typical behaviour such as that expressed in the Second Law of Thermodynamics as a “minutis rectis law”. A brief sketch of the discovery of “typicality” shows that there were ideas of typical behaviour not only in physics but also in sociology. On this basis and in analogy to the Second Law of Thermodynamics, it is shown that the nomological status of sociological laws such as Gresham’s Law can also be conceived as “minutis rectis laws”.
Die zunehmende Nutzung von Online-Kommunikationskanälen vereinfacht nicht nur den alltäglichen, zwischenmenschlichen Austausch, sondern eröffnet auch der erziehungswissenschaftlichen Forschung neue Möglichkeiten. Gleichzeitig stehen Chancen wie der Reichweitenerhöhung von Forschungsaktivitäten auch Herausforderungen bspw. im Bereich der Validität gegenüber. Vor diesem Hintergrund geht der Beitrag der Frage nach, ob sich diese Nachteile durch die methodologisch fundierte Kombination von Offline- und Online-Umgebungen kompensieren lassen. Anhand eines Forschungsszenarios werden drei verschiedene Designs konzipiert, die auf genau diese Herausforderung eingehen. Dazu wird eine Mixed Methods Perspektive eingenommen, um verschiedene Möglichkeiten aufzuzeigen, die einzelne Schwächen der Methoden adäquat ausgleichen oder sogar Synergieeffekte erzielen.
The nuclear factor kappa beta (NFκB) signaling pathway plays an important role in liver homeostasis and cancer development. Tax1-binding protein 1 (Tax1BP1) is a regulator of the NFκB signaling pathway, but its role in the liver and hepatocellular carcinoma (HCC) is presently unknown. Here we investigated the role of Tax1BP1 in liver cells and murine models of HCC and liver fibrosis. We applied the diethylnitrosamine (DEN) model of experimental hepatocarcinogenesis in Tax1BP1+/+ and Tax1BP1−/− mice. The amount and subsets of non-parenchymal liver cells in in Tax1BP1+/+ and Tax1BP1−/− mice were determined and activation of NFκB and stress induced signaling pathways were assessed. Differential expression of mRNA and miRNA was determined. Tax1BP1−/− mice showed increased numbers of inflammatory cells in the liver. Furthermore, a sustained activation of the NFκB signaling pathway was found in hepatocytes as well as increased transcription of proinflammatory cytokines in isolated Kupffer cells from Tax1BP1−/− mice. Several differentially expressed mRNAs and miRNAs in livers of Tax1BP1−/− mice were found, which are regulators of inflammation or are involved in cancer development or progression. Furthermore, Tax1BP1−/− mice developed more HCCs than their Tax1BP1+/+ littermates. We conclude that Tax1BP1 protects from liver cancer development by limiting proinflammatory signaling.
This article problematizes the assumption that national policies have a direct impact on youth participation at the local level and analyses the relationships between local forms of youth participation and local and national policies. Relying on data from a EU project funded under the HORIZON 2020 programme, the article focuses on formally institutionalized settings of youth participation and elaborates local constellations of youth participation in six European cities. These constellations may be referred to as regimes of youth participation as they reflect wider structures of power and knowledge that influence the way in which young people’s practices in public spaces and their claims of being part of society are recognized. However, the analysis reveals that rather deducing it from the model of welfare regimes, such a typology needs to be developed starting from the local level and should consider the ways in which different relationships between local youth policies and national welfare states affect youth participation.
Rationale: Bronchiolitis obliterans syndrome (BOS) is a severe, chronic inflammation of the airways leading to an obstruction of the bronchioles. So far, there are only a few studies looking at the long‐term development of pulmonary impairment in children with BOS.
Objective: The objective of this study was to investigate the incidence and long‐term outcome of BOS in children who underwent allogeneic hematopoietic stem cell transplantation (HSCT).
Methods: Medical charts of 526 children undergoing HSCT in Frankfurt/Main, Germany between 2000 and 2017 were analyzed retrospectively and as a result, 14 patients with BOS were identified. A total of 271 lung functions (spirometry and body plethysmography), 26 lung clearance indices (LCI), and 46 chest high‐resolution computed tomography (HRCT) of these 14 patients with BOS were evaluated.
Results: Fourteen patients suffered from BOS after HSCT (2.7%), whereby three distinctive patterns of lung function impairment were observed: three out of 14 patients showed a progressive lung function decline; two died and one received a lung transplant. In five out of 14 patients with BOS persisted with a severe obstructive and secondarily restrictive pattern in lung function (forced vital capacity [FVC] < 60%, forced expiratory volume in 1 second [FEV1] < 50%, and FEV1/FVC < 0.7) and increased LCI (11.67‐20.9), six out of 14 patients recovered completely after moderate lung function impairment and signs of BOS on HRCT. Long‐term FVC in absolute numbers was increased indicating that the children still have lung growth.
Conclusion: Our results showed that the incidence of BOS in children is low. BOS was associated with high mortality and may lead to persistent obstructive lung disease; although, lung growth continued to exist.
Egon Lorenz – zum Gedenken
(2020)
“Protection of the environment“ and “sustainability“ are more significant than ever. The legal system contributes an important share to the protection of the environment. However, an overview of the German private environmental liability law shows that conventional tort law is not a suitable basis for civil liability for the environmental consequences of officially approved emissions of greenhouse gases. In general, one of the main problems of private environmental liability law lies in proving the individual causality of the conduct of an emitter, as the lawsuit of a Peruvian homeowner against a German energy company pending before the Higher Regional Court of Hamm illustratively demonstrates. The outcome of this lawsuit, which may have an outstanding significance for the status and development of private environmental liability law in Germany, is awaited with great anticipation. The article also briefly examines recent developments in private environmental liability law outside Germany and the question to what extent insurance can be an instrument to protect the environment.
This paper analyses disclosure duties in insurance contract law in Germany on the basis of questions developed in preparation of the World Congress of the International Insurance Law Association (AIDA) 2018. As risk factors are within the policyholder’s sphere of knowledge, the insurer naturally depends on gaining such knowledge from its policyholder in order to calculate and evaluate premium and risk. Legal approaches as to how the insurer may obtain relevant information and the legal consequences differ in national insurance contract laws around the globe. Taking part in this legal comparison, the paper describes the key elements of such a mechanism from a German perspective and comprises both duties of the policyholder and duties of the insurer.
As for the policyholder, these issues are differences between a duty to (spontaneously) disclose and a duty not to misrepresent as a reaction to questions of the insurer, the prerequisites and remedies of such duty, the subjective standard of the disclosure duty and a duty to notify material changes during the contract term. On the other hand, the paper also addresses an insurer’s duty to investigate, a duty to ascertain the policyholder’s understanding of the policy and a duty to inform during the contract term or after the occurrence of an insured event. In doing so, the paper offers a comprehensive and critical overview on the transfer of knowledge in the insurance (pre-)contractual relationship.