Stellenwert der Manschettenresektion am Bronchial- und Gefäßbaum der Lunge beim nichtkleinzelligen Lungenkarzinom

Background

Centrally located non-small cell lung cancer (NSCLC) can be resected by either pneumonectomy or parenchyma-sparing sleeve resection. The questions of local radicalness, significance in advanced nodal disease and the functional outcome after sleeve resection are still under discussion.

Objective

The aim of this study was an evidence-based systematic review of the current status and comparison of both resection techniques in the treatment of centrally located NSCLC.

Material and methods

A systematic literature search was performed in Pubmed, Medline, current guidelines and by manual searching. Relevant publications from the last 15 years were analyzed and the results are summarized in a structured review.

Results and discussion

Sleeve resection is performed less often than pneumonectomy. Bronchovascular sleeve resection can be performed with low morbidity and mortality. Theses methods do not have a worse prognosis compared with isolated bronchial sleeve resection. The weighted average for local recurrence is 16.1?% for sleeve resection and 27.8?% for pneumonectomy. Even in the case of multilevel N1/N2 disease the local recurrence rate is low. In nodal negative and nodal positive disease, pneumonectomy does not result in better long-term survival. Sleeve resection can safely be performed in older patients (>?70 years). Quality of life is better after sleeve resection than after pneumonectomy. Lung perfusion and forced expiratory volume per second 6 months after sleeve resection are similar to preoperative values. The loss of function after sleeve resection is comparable to lobectomy. Whenever technically and ontologically reasonable, sleeve resection should be preferred.     

Erkenntnistheorie auf der Intensivstation – Welchen Zweck erfüllt eine Definition?

The adoption of the new sepsis definition in early 2016 introduced a new paradigm for the clinical picture of sepsis. Up until now, sepsis was defined as a systemic inflammatory reaction (systemic inflammatory response syndrome, SIRS) to an infection. Based on a better understanding of the molecular mechanisms, the focus of the new definition is no longer the inflammatory response, but rather the tissue damage and impairment of organ function which this induces. The paradigm thus moves away from the infection and the systemic inflammatory response, and toward that which makes sepsis so dangerous in terms of both disease dynamics and outcome: organ failure due to a dysregulated host response to an infection. This change of perspective or paradigm enables patients with an increased risk of developing sepsis to be recognized and treated earlier in clinical routine, even outside of the intensive care unit. The new definition also promotes development of new treatment strategies with improved ability to treat sepsis causally.     

CD4+ T cells of both the naive and the memory phenotype enter rat lymph nodes and Peyer's patches via high endothelial venules: Within the tissue their migratory behavior differs

It is thought that naive T cells predominantly enter lymphoid organs such as lymph nodes (LN) and Peyer's patches (PP) via high endothelial venules (HEV), whereas memory T cells migrate mainly into non-lymphoid organs. However, direct evidence for the existence of these distinct migration pathways in vivo is incomplete, and nothing is known about their migration through the different compartments of lymphoid organs. Such knowledge would be of considerable interest for understanding T cell memory in vivo. In the present study we separated naive and memory CD4⁺ T cells from the rat thoracic duct according to the expression of the high and low molecular weight isoforms of CD45R, respectively. At various time points after injection into congenic animals, these cells were identified by quantitative immunohistology in HEV, and T and B cell areas of different LN and PP. Three major findings emerged. First, both naive and memory CD4⁺ T cells enter lymphoid organs via the HEV in comparable numbers. Second, naive and memory CD4⁺ T cells migrate into the B cell area, although in small numbers and continuously enter established germinal centers (GC) with a bias for memory CD4⁺ T cells. Third, memory CD4⁺ T cells migrate faster through the T cell area of lymphoid organs than naive CD4⁺ T cells. Thus, our study shows that memory CD4⁺ T cells are not excluded from the HEV route. In addition, “memory” might depend in part on the ability of T cells to specifically enter the B cell area and GC and to screen large quantities of lymphoid tissues in a short time.     

Recent Thymic Emigrants (CD4+) Continuously Migrate Through Lymphoid Organs: within the Tissue They Alter Surface Molecule Expression

T-cell progenitors migrate from bone marrow (BM) into the thymus. After maturation they are released as recent thymic emigrants (RTE) into the periphery ensuring the diversification of the T-cell repertoire. Both the kinetics with which RTE migrate through the periphery and the surface molecules they express are still unclear. In 1- and 18-month-old Lewis rats CD4+ RTE were identified in blood, spleen, lymph node, and thoracic duct lymph by flow cytometry (CD45RC- and CD90+), were differentiated from CD4+ naive (CD45RC+) and memory T cells (CD45RC-CD90-), and were characterized regarding the expression of surface molecules. Both in 1- and 18-month-old animals the percentage of RTE among the CD4+ population in blood was comparable to that in all other compartments. Surprisingly, RTE expressed alpha4-integrin, LFA-1, and interleukin (IL)-2 receptor at a significantly higher level than naive T cells and more comparable to memory T cells. Within lymphoid tissues RTE, naive, and memory T cells significantly upregulated the expression of CD44 and ICAM-1, and downregulated the expression of L-selectin. These changes were reversed before the cells re-entered the blood. Thus, our data indicate that CD4+ RTE travel through the periphery of young and old rats like mature T cells, continuously modulating their surface molecule expression.     

Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature

Introduction  

Systemic inflammatory response syndrome is common after surgery, and it can be difficult to discriminate between infection and inflammation. We performed a review of the literature with the aims of describing the evolution of serum procalcitonin (PCT) levels after uncomplicated cardiac surgery, characterising the role of PCT as a tool in discriminating infection, identifying the relation between PCT, organ failure, and severity of sepsis syndromes, and assessing the possible role of PCT in detection of postoperative complications and mortality.     

Impact of plasma histones in human sepsis and their contribution to cellular injury and inflammation

Introduction

Circulating histones have been identified as mediators of damage in animal models of sepsis and in patients with trauma-associated lung injury. Despite existing controversies on actual histone concentrations, clinical implications and mechanism of action in various disease conditions, histone levels in human sepsis, association with disease progression and mediated effects on endothelial and immune cells remain unreported. This study aimed to determine histone levels and its clinical implication in septic patients and to elucidate histone-mediated effects ex-vivo.

Methods

Histone levels, endogenous activated protein C (APC) levels and clinical data from two independent cohorts of septic patients were obtained. Histone levels were compared with various control groups including healthy individuals, intensive care unit (ICU) patients without sepsis, ICU patients with multiple organ failure and patients with minor or multiple trauma, all without infection. Endothelial and monocytic cells were stimulated with histones. Cellular integrity and sepsis prototypical cytokines were evaluated. The mechanism of action of histones via Toll-like receptor 4 (TLR4) was evaluated using a function blocking antibody. Histone degradation in plasma was studied by immunoblotting.

Results

Histone H4 levels were significantly elevated in patients with sepsis (cohort I; n = 15 and cohort II; n = 19) versus ICU controls (n = 12), patients with multiple organ failure (n = 12) or minor trauma (n = 7), associated with need for renal replacement therapy and decrease in platelet count during disease progression, and remarkably were significantly associated with increased mortality rates in septic patients (ICU-, 28 day- and 90 day mortality rates). There was an inverse correlation between plasma histones and endogenous APC levels. Histone stimulation induced the release of sepsis prototypic cytokines and decreased cell integrity indicated by a significant increase of lactate dehydrogenase (LDH) and propidium iodide (PI) staining. Blocking of TLR4 decreased cellular cytotoxicity on endothelial cells. The calculated half-life of histones in spiked plasma was 4.6 minutes.

Conclusions

Histone levels in septic patients are significantly increased and might mediate disease aggravation by cellular injury and inflammation via TLR4 signaling, which potentially results in multiple organ failure and fatal outcome.     

Value and significance of therapy of cutting-in in occlusally loaded incisors

With the aid of the measurements of tooth mobility the treatment success of grinding was evaluated in 208 upper incisors of 54 patients, and the results were set into correlation with different factors. The results show that decreased tooth mobility following grinding was observed both in healthy periodontium and in diseased periodontium.     

Ätiologie und Pathogenese

Ohne Zusammenfassung