Optimum versus Maximum – Eine große Herausforderung für die Pflege

Switzerland has the reputation of having one of the best healthcare systems in the world. Aims, such as a high level of patient safety, efficiency and access to a high standard of healthcare are achieved for the majority of patients. According to public surveys patient expectations and satisfaction are met to a great extent but the service is costly, making it one of the most expensive healthcare systems in the world. More than 60?% of the expense is paid by private households. Since the introduction of the new Swiss diagnosis-related groups (DRG) finance system in 2012, there have been many economic changes putting more strain on the system. This poses the question of how resources and funds can be best implemented by nursing staff, to ensure high quality care and the best possible patient outcome. Flexibility, subspecialization of healthcare professionals, patients with multiple comorbidities and electronic documentation are discussed in a clinical example. In summary, a cost-efficient provision of nursing care is possible; however, demands have risen requiring a greater flexibility of nursing staff and more patient self-motivation. A significant proportion of nursing time is consumed with administrative work and electronic data management. This reduces the time available for direct patient care. New models of nursing care need to be explored and debated.     

Early port-site metastasis during neoadjuvant chemotherapy in advanced stage ovarian cancer: report of two cases

Port-site metastases in gynecological malignancies subsequent to laparoscopy have been reported with an incidence of 1.1-16%. These metastases tend to be disappearing after primary debulking surgery and subsequent primary chemotherapy. Local resection, chemotherapy and/or radiotherapy have been defined in the management of these metastases with enhanced clinical success. However, in extremely rare cases these metastases were also defined very early during neoadjuvant chemotherapy. Herein, we present two ovarian cancer cases which are clinically diagnosed with port site metastasis during neoadjuvant chemotherapy following diagnostic laparoscopy. Although neoadjuvant chemotherapy is sometimes needed in cases of fully advanced ovarian cancers, port-site metastasis may be encountered during neoadjuvant chemotherapy. The possible poor prognosis of these patients, especially those who have ascites, should make us careful in performing diagnostic laparoscopy with preventive measures for port-site metastasis and to start the chemotherapy immediately.     

Imaging appearance of severe subcapsular hepatic steatosis: mimicking hepatic embolic infarcts

We report a case of severe subcapsular hepatic steatosis in a middle-aged woman with diabetic nephropathy requiring continuous ambulatory peritoneal dialysis (CAPD). The CT appearances of the liver were initially suspected to be due to embolic infarcts. However, an accurate diagnosis was made only after a history of intraperitoneal insulin administration was elicited, and this was confirmed on MRI with chemical shift gradient-echo pulse sequences. Haemodialysis was recommenced, and follow-up imaging 4 years later showed complete resolution of subcapsular hepatic steatosis.Subcapsular hepatic steatosis is a rare and unique form of non-alcoholic fatty liver, occurring only in individuals with diabetic nephropathy receiving continuous ambulatory peritoneal dialysis (CAPD) with intraperitoneal insulin. Imaging findings are classical, and with the appropriate history of intraperitoneal insulin administration, an accurate diagnosis can be made. Given that this disease entity has only recently been described, we hope to highlight its typical imaging appearances, which may otherwise be misinterpreted as a more insidious finding, thus averting unnecessary intervention.     

Postural instability in cerebellar ataxia: Correlations of knee,arm and trunk movements to center of mass velocity

The aim of this study was to investigate the correlations between body segment movements and center of mass (COM) velocity during pathological balance corrections of spinocerebellar ataxia (SCA) patients compared with controls, and to relate correlations indicating instability to EMG activity differences.     

Tumor treating fields in combination with gemcitabine or gemcitabine plus nab-paclitaxel in pancreatic cancer: Results of the PANOVA phase 2 study

Background

Tumor Treating Fields (TTFields), low intensity alternating electric fields with antimitotic activity, have demonstrated survival benefit in patients with glioblastoma. This phase 2 PANOVA study was conducted to examine the combination of TTFields plus chemotherapy in patients with pancreatic ductal adenocarcinoma (PDAC).

Comparative assessment of in vitro and in vivo toxicity of azinphos methyl and its commercial formulation

The toxic effects of Gusathion (GUS), which is a commercial organophosphate (OP) pesticide, and also its active ingredient, azinphos methyl (AzM), are evaluated comparatively with in vitro and in vivo studies. Initially, the 96‐h LC₅₀ values of AzM and GUS were estimated for two different life stages of Xenopus laevis, embryos, and tadpoles. The actual AzM concentrations in exposure media were monitored by high‐performance liquid chromatography. Also, the sub‐lethal effects of these compounds to tadpoles were determined 24 h later at exposure concentrations of 0.1 and 1 mg/L using selected biomarker enzymes such as acetylcholinesterase (AChE), carboxylesterase (CaE), glutathione S‐transferase (GST), glutathione reductase, lactate dehydrogenase, and aspartate aminotrasferase. Differences in AChE inhibition capacities of AzM and GUS were evaluated under in vitro conditions between frogs and fish in the second part of this study. The AChE activities in a pure electrical eel AChE solution and in brain homogenates of adult Cyprinus carpio, Pelophylax ridibundus, and X. laevis were assayed after in vitro exposure to 0.05, 0.5, 5, and 50 mg/L concentrations of AzM and GUS. According to in vivo studies AChE, CaE and GST are important biomarkers of the effect of OP exposure while CaE may be more effective in short‐term, low‐concentration exposures. The results of in vitro studies showed that amphibian brain AChEs were relatively more resistant to OP exposure than fish AChEs. The resistance may be the cause of the lower toxicity/lethality of OP compounds to amphibians than to fish. © 2014 Wiley Periodicals, Inc. Environ Toxicol 30: 1091–1101, 2015.     

Probiotics ameliorates LPS induced neuroinflammation injury on Aβ 1–42, APP, γ-β secretase and BDNF levels in maternal gut microbiota and fetal neurodevelopment processes

Metabolic Brain Disease - The gut microbiota influences brain development and functioning through the gut-brain axis. This is first study regulate maternal gut microbiota and fetal neurodevelopment...     

Is there any relationship between adverse pregnancy outcome and first trimester nuchal translucency measurements in normal karyotype fetuses?

Aim: This study aims to research whether there is a relationship between first trimester nuchal translucency (NT) measurements and pregnancy complications such as gestational diabetes mellitus (GDM), gestational hypertension (GHT), intrauterine growth restriction (IUGR) and oligohydramnios.

Method: This study included 225 singleton pregnancies attending Canakkale Onsekiz Mart University Obstetrics and Gynecology clinic for all monitoring and examinations, and gave birth at our clinic between January 2011 and December 2012. Data sources were clinical records and the hospital's automation system, and the study was planned as retrospective cohort. NT measurement was made between 10 weeks 3 days and 13 weeks 6 days gestation. For data analysis, the chi-square, Mann–Whitney U test and Spearman correlation were used.

Results: Of pregnancies, in the study, 5 (2.2%) developed GDM, 6 (2.6%) developed GHT, 2 (0.89%) developed IUGR and 10 (4.4%) developed oligohydramnios. There was no correlation identified between NT measurements and development of GDM, GHT, IUGR and oligohydramnios.

Conclusion: There was no relationship found between first trimester NT measurements and complications that could develop in pregnancy. For the first time in the literature, NT and oligohydramnios were studied and no relationship was observed.     

Aerosol‐based airway epithelial cell delivery improves airway regeneration and repair

Aerosol‐based cell therapy has emerged as a novel and promising therapeutic strategy for treating lung diseases. The goal of this study was to determine the safety and efficacy of aerosol‐based airway epithelial cell (AEC) delivery in the setting of acute lung injury induced by tracheal brushing in rabbit. Twenty‐four hours following injury, exogenous rabbit AECs were labelled with bromodeoxyuridine and aerosolized using the MicroSprayer® Aerosolizer into the injured airway. Histopathological assessments of the injury in the trachea and lungs were quantitatively scored (1 and 5 days after cell delivery). The aerosol‐based AEC delivery appeared to be a safe procedure, as cellular rejection and complications in the liver and spleen were not detected. Airway injury initiated by tracheal brushing resulted in disruption of the tracheal epithelium as well as morphological damage in the lungs that is consistent with acute lung injury. Lung injury scores were reduced following 5 days after AEC delivery (AEC‐treated, 0.25  ±  0.06 vs. untreated, 0.53  ±  0.05, P  <  0.01), and rapid clearance of haemorrhage, proteinaceous debris and hyaline membranes occurred. In the trachea, AEC delivery led to an upsurge in epithelium regeneration and repair. Re‐epithelialization was significantly increased 5 days after treatment (AEC‐treated, 91.07  ±  2.37% vs. untreated, 62.99  ±  7.39%, P  <  0.01). Our results indicate that AEC delivery helps in the regeneration and repair of the respiratory airway, including the lungs, following acute insults. These findings suggest that aerosol‐based AEC delivery can be a valuable tool for future therapy to treat acute lung injury. Copyright © 2017 John Wiley & Sons, Ltd.