Which Radiographic Parameters Are Linked to Failure of a Dynamic Spinal Implant?

Background  

Knowledge about factors leading to failure of posterior dynamic stabilization implants is essential to design future implants and establish surgical indications. Therefore, we analyzed an implant for single-level or hybrid configuration (adjacent to spondylodesis), which was recalled due to high failure rates.     

cyp51A-Based Mechanisms of Aspergillus fumigatus Azole Drug Resistance Present in Clinical Samples from Germany

Since the mid-1990s, a steady increase in the occurrence of itraconazole-resistant Aspergillus fumigatus isolates has been observed in clinical contexts, leading to therapeutic failure in the treatment of aspergillosis. This increase has been predominantly linked to a single allele of the cyp51A gene, termed TR/L98H, which is thought to have arisen through the use of agricultural azoles. Here, we investigated the current epidemiology of triazole-resistant A. fumigatus and underlying cyp51A mutations in clinical samples in Germany. From a total of 527 samples, 17 (3.2%) showed elevated MIC₀ values (the lowest concentrations with no visible growth) for at least one of the three substances (itraconazole, voriconazole, and posaconazole) tested. The highest prevalence of resistant isolates was observed in cystic fibrosis patients (5.2%). Among resistant isolates, the TR/L98H mutation in cyp51A was the most prevalent, but isolates with the G54W and M220I substitutions and the novel F219C substitution were also found. The isolate with the G54W substitution was highly resistant to both itraconazole and posaconazole, while all others showed high-level resistance only to itraconazole. For the remaining six isolates, no mutations in cyp51A were found, indicating the presence of other mechanisms. With the exception of the strains carrying the F219C and M220I substitutions, many itraconazole-resistant strains also showed cross-resistance to voriconazole and posaconazole with moderately increased MIC₀ values. In conclusion, the prevalence of azole-resistant A. fumigatus in our clinical test set is lower than that previously reported for other countries. Although the TR/L98H mutation frequently occurs among triazole-resistant strains in Germany, it is not the only resistance mechanism present.     

Best supportive care in patients with brain metastases and adverse prognostic factors: development of improved decision aids

Purpose

This study aimed to develop a survival prediction model that might aid decision making when choosing between best supportive care (BSC) and brain radiotherapy (RT) for patients with brain metastases and limited survival expectation.

Methods

A retrospective analysis of 124 patients treated with BSC, whole brain radiotherapy (WBRT), or radiosurgery was conducted. All patients had adverse prognostic features defined as 0–1.5 points according to the diagnosis-specific graded prognostic assessment score (DS-GPA) or GPA if primary tumor type was not among those represented in DS-GPA. Kaplan–Meier survival curves were compared between patients treated with BSC or RT in different scenarios, reflecting more or less rigorous definitions of poor prognosis. If survival was indistinguishable and this result could be confirmed in multivariate analysis, BSC was considered appropriate.

Results

Irrespective of point sum examined, DS-GPA by itself was not a satisfactory selection parameter. However, we defined a subgroup of 63 patients (51 %) with short survival irrespective of management approach (only 5 % of irradiated patients survived beyond 6 months; they had newly diagnosed, treatment-naïve lung cancer), i.e., patients in whom foregoing RT was unlikely to compromise survival. These were patients with 0–1.5 points and aged ≥75 years, had Karnofsky performance status ≤50, or had uncontrolled primary tumor with extracranial metastases to at least two organs.

Conclusions

BSC is a reasonable choice in patients with limited life expectancy. After successful external validation of the selection criteria developed in this analysis, identification of patients who are unlikely to benefit from WBRT might be improved.     

Die Blutversorgung des arbeitenden Muskels im O2-Mangel

Ohne ZusammenfassungAusgeführt mit Mitteln der Deutschen Forschungsgemeinschaft.     

Über Encephalitis

Ohne ZusammenfassungMit 9 Textabbildungen.Ich verzichte darauf, noch einmal eine ausführliche Literaturzusammenstellung über die Encephalitis zum Abdruck zu bringen, da aus der letzten Zeit mehrere solche Zusammenstellungen vorliegen. Selbstverständlich sind nicht nur die wenigen eigens angeführten Arbeiten berücksichtigt.     

Die Wirkung des Kampfers auf das Wühlen des Froschventrikels

Ohne ZusammenfassungMit 6 Kurven im Text.     

Klinische Beobachtungen zur Pankreaspathologie

Ohne Zusammenfassung     

Fettplastik der Lunge

Ohne Zusammenfassung (Mit I Abbildung.)     

Zur Klinik der Brocqschen Krankheit

Ohne Zusammenfassung