Kommt die Defi-Drohne?

Die Anaesthesiologie - Der Mangel an automatischen externen Defibrillatoren (AED) und die fehlende Kenntnis von Ersthelfern im Umgang mit diesen Geräten haben in Deutschland zu einer...     

Biperiden and mepazine effectively inhibit MALT1 activity and tumor growth in pancreatic cancer

MALT1 is a key mediator of NF-κB signaling and a main driver of B-cell lymphomas. Remarkably, MALT1 is expressed in the majority of pancreatic ductal adenocarcinomas (PDACs) as well, but absent from normal exocrine pancreatic tissue. Following, MALT1 shows off to be a specific target in cancer cells of PDAC without affecting regular pancreatic cells. Therefore, we studied the impact of pharmacological MALT1 inhibition in pancreatic cancer and showed promising effects on tumor progression. Mepazine (Mep), a phenothiazine derivative, is a known potent MALT1 inhibitor. Newly, we described that biperiden (Bip) is a potent MALT1 inhibitor with even less pharmacological side effects. Thus, Bip is a promising drug leading to reduced proliferation and increased apoptosis in PDAC cells in vitro and in vivo. By compromising MALT1 activity, nuclear translocation of c-Rel is prevented. c-Rel is critical for NF-κB-dependent inhibition of apoptosis. Hence, off-label use of Bip or Mep represents a promising new therapeutic approach to PDAC treatment. Regularly, the Anticholinergicum Bip is used to treat neurological side effects of Phenothiazines, like extrapyramidal symptoms.     

(Pre)Modern sleep. New evidence from the Antwerp criminal court (1715–1795)

Lately, experts have turned to historical evidence to uncover the default mode of our sleep pattern. Even though there are some notable exceptions, most historians use a qualitative methodology based on scattered evidence in diaries, letters, novels, medical treatise and other literary sources. To provide fresh perspective in the debate, the present article develops a more quantitative approach. Drawing fresh evidence from early modern criminal records – viz the eyewitness reports of the Hoge Vierschaer or the local criminal court in Antwerp – we are able to debunk some classic stereotypes about premodern sleep patterns. Data reveal that most 18^th‐century Antwerpers slept fewer hours than we would expect, slumbered in a monophasic way and rarely if ever took a nap during the day. Moreover, the start and end of sleep were less attuned to the solar cycle than we would imagine. Last but not least, the pattern also shows some fascinating weekly and seasonal variations.     

Simultaneous dental implant placement and endoscope-guided internal sinus floor elevation: 2-year post-loading outcomes

Aims: To determine whether endoscope‐guided sinus elevation procedures can be consistently used to create sufficient bone support for stable implant placement and long‐term implant success. Material and methods: Sixty‐two implants were surgically placed into 30 patients (14 men and 16 women) following internal sinus elevation without the use of graft material. Panoramic radiographs were made pre‐, post‐operative and after 24 months in order to evaluate the peri‐implant bone and maxillary sinuses. Resonance frequency analysis (RFA) was used to evaluate implant stability immediately upon placement and just before prosthesis delivery. Results: The average pre‐operative height of the maxillary alveolar bone was 8.4±2.2 mm at the premolar and 7.3±3.1 mm at the molar regions. The average bone gain was 3.5±1.8 and 4.5±1.9 mm in the premolar and molar sites, respectively. Clinical parameters and the RFA (4 and 12 weeks post‐operative) outcomes show sufficient stability (ISQ=60) of the inserted implants. Three implants failed during the healing period of 12 weeks. The overall implant success rate was 94%. After loading, no further implant failure was observed. The overall success rate after beginning of implant loading was 100%. Conclusions: Sinus floor elevation is a well‐established procedure for augmentation of the atrophic maxillary posterior region. The minimally invasive internal sinus floor elevation procedure visually guided by an endoscope helped to prevent, diagnose and manage complications such as sinus membrane perforation. The clinical outcomes of this study show that endoscope‐controlled internal sinus floor elevation combined with implant placement results in low intra operative trauma, good implant stability upon placement, low incidence of post‐operative symptoms and high success rates after 24 months of loading.     

Is there an association between periprosthetic joint infection and low vitamin D levels?

Purpose

Vitamin D is increasingly being recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of periprosthetic joint infection. To the best of our knowledge, no other study has examined possible associations between periprosthetic joint infection and vitamin D deficiency. We investigated the rate of vitamin D deficiency in patients treated for periprosthetic joint infection and whether vitamin D deficiency is independent of other risk factors for vitamin D deficiency in patients with periprosthetic joint infection.

Methods

Serum 25-hydroxyvitamin D (25OHD) levels of every patient scheduled to receive a total prosthesis either of the hip, knee, or shoulder in the orthopaedic department of the Johannes-Guttenberg-University Hospital in Mainz, Germany (109 patients), were measured after admission. Furthermore, serum 25OHD levels were measured for every patient presenting with periprosthetic joint infection (n = 50) or aseptic loosening of the prosthesis (n = 31) scheduled to undergo revision surgery. The prevalence of normal (>30 ng/ml), insufficient (20–30 ng/ml), and deficient (<20 ng/ml) 25OHD levels was determined.

Results

All tested patient subgroups showed low vitamin D levels. Statistical analysis found no significant difference in vitamin D levels comparing patients with prosthesis and patients with aseptic prosthesis loosening (p = 0.58). Significant differences in 25OHD levels were found comparing patients with periprosthetic joint infection and patients scheduled for primary arthroplasty (p < 0.001). In addition, we found a significant difference (p < 0,001) in 25OHD levels of patients with periprosthetic joint infection compared with patients with aseptic prosthesis loosening.

Conclusion

We found a high frequency of vitamin D deficiency in patients being treated by primary arthroplasty and those with aseptic joint prosthetic loosening and periprosthetic joint infection. Vitamin D deficiency was severe in patients with periprosthetic joint infection.     

Differential impact of belatacept and cyclosporine A on central aortic blood pressure and arterial stiffness after renal transplantation

Calcineurin inhibitors (CNI) are potent vasoconstrictors and induce an acceleration of arteriosclerosis, thus contributing to the cardiovascular risk after renal transplantation. The study compares the impact of belatacept and cyclosporine A (CsA) on arterial stiffness and central aortic blood pressure. We performed a case–control study in 46 patients (23 on belatacept and 23 on CsA) matched for age, body mass index, time after transplantation, and time on dialysis prior to transplantation. Pulse wave analysis (SphygmoCor, AtCor^®) was used to assess central aortic blood pressure, aortic augmentation pressure, and pulse wave velocity (PWV) as a marker of arterial stiffness. Assessment of vascular function was performed after a minimum of 20 months and a median follow‐up of 81 months post‐transplant. Peripheral systolic and diastolic blood pressure did not significantly differ in the two groups (p > 0.05 each). The central aortic augmentation pressure was higher in the CsA group (12.7 mmHg vs. 7.3 mmHg, p = 0.048). PWV as a measure of arterial stiffness did not differ in the two groups. Thus, belatacept is not associated with a significant difference in arterial stiffness compared to CsA after a median of 81 months post‐transplant. It is associated, however, with a lower aortic augmentation pressure, a strong independent cardiovascular risk factor.