Summary
Background
Allergic medical care in Germany is organized on an interdisciplinary basis. An overview of the current care situation is necessary to manage and improve interdisciplinary ...cooperation.
Methods
Between January and February 2022, questionnaires were sent online and by mail to chief physicians of inpatient clinical departments to which most allergological diseases are assigned (dermatology, otorhinolaryngology ENT, pulmonology, pediatrics, environmental/occupational medicine, gastroenterology; n = 899).
Results
The response rate was 52.1%. Allergology departments of dermatology, ENT and pulmonology were predominantly located in metropolitan areas (> 100,000 inhabitants), whereas responses of pediatric departments were mostly from smaller towns. 76.8% of the respondents reported existing interdisciplinary treatment plans with other specialties. Pediatric and pulmonology clinics stated disproportionately few interdisciplinary treatment concepts with dermatology and ENT clinics, especially in smaller cities with < 100,000 inhabitants. Diagnosis and therapy of allergic rhinitis were performed in particular by the departments of ENT, asthma mainly by the pulmonology departments. Care of other allergological diseases was most frequently reported by chief physicians of dermatology and pediatrics.
Conclusions
In metropolitan areas, participating departments provide allergology care in a cooperative manner. A large spectrum of care is covered in cooperation with dermatological clinics. In more rural areas, cooperation is rarer; here, mainly pediatric departments provide allergological care, which may explain the more limited range of services compared to metropolitan areas.
Zusammenfassung Hintergrund Die Allergologie ist in Deutschland interdisziplinär organisiert. Zur Steuerung und Verbesserung fachbereichsübergreifender Kooperationen ist ein Überblick über die ...aktuelle Versorgungssituation notwendig. Methode Zwischen Januar und Februar 2022 wurden online und postalisch Fragebögen an Leitungen stationärer klinischer Fachbereiche versendet, denen die meisten allergologischen Krankheitsbilder zugeordnet werden (Dermatologie, HNO, Pneumologie, Pädiatrie, Umwelt/Arbeitsmedizin, Gastroenterologie; n = 899). Ergebnisse Die Rücklaufquote betrug 52,1%. Allergologische Abteilungen von Dermatologie, HNO und Pneumologie waren überwiegend in Ballungsgebieten verfügbar (> 100 000 Einwohner), während Antworten pädiatrischer Abteilungen größtenteils aus kleinen Städten kamen. 76,8% der befragten Kliniken gaben bestehende interdisziplinäre Behandlungskonzepte mit anderen Fachrichtungen an. Kliniken der Pädiatrie und der Pneumologie vermeldeten, insbesondere in kleineren Städten mit < 100 000 Einwohnern, unterproportional wenig interdisziplinäre Behandlungskonzepte mit Dermatologie und HNO‐Kliniken. Diagnostik und Therapie der allergischen Rhinitis wurden insbesondere durch die Abteilungen für HNO und Asthma vor allem durch die Abteilungen für Pneumologie durchgeführt. Die Betreuung der weiteren allergologischen Erkrankungen wurde am häufigsten aus der Dermatologie und Pädiatrie zurückgemeldet. Schlussfolgerungen In Ballungsgebieten übernehmen beteiligte Fachbereiche die allergologische Versorgung kooperativ. Ein großes Spektrum der Versorgung wird in Kooperationen mit dermatologischen Kliniken abgedeckt. In ländlicheren Gebieten sind Kooperationen seltener, wobei hier die Versorgung vor allem durch pädiatrische Abteilungen erfolgt, was im Vergleich zu Ballungsgebieten das eingeschränktere Leistungsangebot erklären könnte.
Zusammenfassung
Hintergrund
Die Allergologie ist in Deutschland interdisziplinär organisiert. Zur Steuerung und Verbesserung fachbereichsübergreifender Kooperationen ist ein Überblick über die ...aktuelle Versorgungssituation notwendig.
Methode
Zwischen Januar und Februar 2022 wurden online und postalisch Fragebögen an Leitungen stationärer klinischer Fachbereiche versendet, denen die meisten allergologischen Krankheitsbilder zugeordnet werden (Dermatologie, HNO, Pneumologie, Pädiatrie, Umwelt/Arbeitsmedizin, Gastroenterologie; n = 899).
Ergebnisse
Die Rücklaufquote betrug 52,1%. Allergologische Abteilungen von Dermatologie, HNO und Pneumologie waren überwiegend in Ballungsgebieten verfügbar (> 100 000 Einwohner), während Antworten pädiatrischer Abteilungen größtenteils aus kleinen Städten kamen. 76,8% der befragten Kliniken gaben bestehende interdisziplinäre Behandlungskonzepte mit anderen Fachrichtungen an. Kliniken der Pädiatrie und der Pneumologie vermeldeten, insbesondere in kleineren Städten mit < 100 000 Einwohnern, unterproportional wenig interdisziplinäre Behandlungskonzepte mit Dermatologie und HNO‐Kliniken. Diagnostik und Therapie der allergischen Rhinitis wurden insbesondere durch die Abteilungen für HNO und Asthma vor allem durch die Abteilungen für Pneumologie durchgeführt. Die Betreuung der weiteren allergologischen Erkrankungen wurde am häufigsten aus der Dermatologie und Pädiatrie zurückgemeldet.
Schlussfolgerungen
In Ballungsgebieten übernehmen beteiligte Fachbereiche die allergologische Versorgung kooperativ. Ein großes Spektrum der Versorgung wird in Kooperationen mit dermatologischen Kliniken abgedeckt. In ländlicheren Gebieten sind Kooperationen seltener, wobei hier die Versorgung vor allem durch pädiatrische Abteilungen erfolgt, was im Vergleich zu Ballungsgebieten das eingeschränktere Leistungsangebot erklären könnte.
Abstract
Motivation
Developing a robust and performant data analysis workflow that integrates all necessary components whilst still being able to scale over multiple compute nodes is a challenging ...task. We introduce a generic method based on the microservice architecture, where software tools are encapsulated as Docker containers that can be connected into scientific workflows and executed using the Kubernetes container orchestrator.
Results
We developed a Virtual Research Environment (VRE) which facilitates rapid integration of new tools and developing scalable and interoperable workflows for performing metabolomics data analysis. The environment can be launched on-demand on cloud resources and desktop computers. IT-expertise requirements on the user side are kept to a minimum, and workflows can be re-used effortlessly by any novice user. We validate our method in the field of metabolomics on two mass spectrometry, one nuclear magnetic resonance spectroscopy and one fluxomics study. We showed that the method scales dynamically with increasing availability of computational resources. We demonstrated that the method facilitates interoperability using integration of the major software suites resulting in a turn-key workflow encompassing all steps for mass-spectrometry-based metabolomics including preprocessing, statistics and identification. Microservices is a generic methodology that can serve any scientific discipline and opens up for new types of large-scale integrative science.
Availability and implementation
The PhenoMeNal consortium maintains a web portal (https://portal.phenomenal-h2020.eu) providing a GUI for launching the Virtual Research Environment. The GitHub repository https://github.com/phnmnl/ hosts the source code of all projects.
Supplementary information
Supplementary data are available at Bioinformatics online.
Severe traumatic brain injury is a leading cause of morbidity and mortality among young people around the world. Prehospital care focuses on the prevention and treatment of secondary brain injury and ...commonly includes tracheal intubation after induction of general anesthesia. The choice of induction agent in this setting is controversial. This study therefore investigated the association between the chosen induction medication etomidate versus S(+)-ketamine and the 30-day mortality in patients with severe traumatic brain injury who received prehospital airway management in the Netherlands.
This study is a retrospective analysis of the prospectively collected observational data of the Brain Injury: Prehospital Registry of Outcomes, Treatments and Epidemiology of Cerebral Trauma (BRAIN-PROTECT) cohort study. Patients with suspected severe traumatic brain injury who were transported to a participating trauma center and who received etomidate or S(+)-ketamine for prehospital induction of anesthesia for advanced airway management were included. Statistical analyses were performed with multivariable logistic regression and inverse probability of treatment weighting analysis.
In total, 1,457 patients were eligible for analysis. No significant association between the administered induction medication and 30-day mortality was observed in unadjusted analyses (32.9% mortality for etomidate versus 33.8% mortality for S(+)-ketamine; P = 0.716; odds ratio, 1.04; 95% CI, 0.83 to 1.32; P = 0.711), as well as after adjustment for potential confounders (odds ratio, 1.08; 95% CI, 0.67 to 1.73; P = 0.765; and risk difference 0.017; 95% CI, -0.051 to 0.084; P = 0.686). Likewise, in planned subgroup analyses for patients with confirmed traumatic brain injury and patients with isolated traumatic brain injury, no significant differences were found. Consistent results were found after multiple imputations of missing data.
The analysis found no evidence for an association between the use of etomidate or S(+)-ketamine as an anesthetic agent for intubation in patients with traumatic brain injury and mortality after 30 days in the prehospital setting, suggesting that the choice of induction agent may not influence the patient mortality rate in this population.
Background
Training programs directed to improve neuromuscular and musculoskeletal function of the legs are scarce with respect to older osteoporotic patients. We hypothesized that a modified step ...aerobics training program might be suitable for this purpose and performed a randomized controlled pilot study to assess the feasibility of conducting a large study. Here we report on the training-related effects on neuromuscular function of the plantar flexors.
Patients and methods
Twenty-seven patients with an age of at least 65 years were enrolled and randomized into control and intervention group. The latter received supervised modified step aerobics training (twice weekly, 1 h per session) over a period of 6 months. At baseline, and after 3 and 6 months neuromuscular function of the plantar flexors, i.e., isometric maximum voluntary torque, rate of torque development and twitch torque parameters were determined in detail in all patients of both groups.
Results
Twenty-seven patients (median age 75 years; range 66–84 years) were randomized (control group
n
= 14; intervention group
n
= 13). After 3 and 6 months of training, maximum voluntary contraction strength in the intervention group was significantly higher by 7.7 Nm (9.1%; 95% CI 3.3–12.2 Nm,
P
< 0.01) and 12.4 Nm (14.8%; 95% CI 6.4–18.5 Nm,
P
< 0.01) compared to controls. These changes were most probably due to neural and muscular adaptations.
Conclusion
It is worthwhile to investigate efficacy of this training program in a large randomized trial. However, a detailed neuromuscular assessment appears feasible only in a subset of participants.
Gastrointestinal graft-versus-host disease (GVHD) is a common and potentially life-threatening complication after allogeneic hematopoietic stem-cell transplantation (HSCT). Noninvasive tests for ...assessment of GVHD activity are desirable but lacking. In the present study, we were able to visualize intestinal GVHD-associated inflammation in an allogeneic murine transplantation model by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in vivo. A predominant localization of intestinal GVHD to the colon was verified by histology and fluorescence reflectance imaging of enhanced green fluorescent protein (EGFP)–expressing donor cells. Colonic infiltration by EGFP+ donor lymphocytes matched increased FDG uptake in PET examinations. These preclinical data were prospectively translated into 30 patients with suspected intestinal GVHD beyond 20 days after transplantation. A total of 14 of 17 patients with a diagnostic histology showed significant FDG uptake of the gut, again predominantly in the colon. No increased FDG uptake was detected in 13 patients without histologic evidence of intestinal GVHD. Our findings indicate that FDG-PET is a sensitive and specific noninvasive imaging technique to assess intestinal GVHD, map its localization, and predict and monitor treatment responsiveness. Novel targeted tracers for PET may provide new insights into the pathophysiology of GVHD and bear the potential to further improve GVHD diagnosis.
Aims Patients with atrial fibrillation (AF) present with symptoms of myocardial ischaemia despite exclusion of coronary artery disease. A small vessel disease has been suggested. We quantified ...myocardial perfusion, perfusion reserve, and coronary vascular resistance (CVR) in AF patients using positron emission tomography (PET). Methods and results Twenty-five male patients (age: 58 ± 13 years) with persistent idiopathic AF were compared with 13 age- and risk-matched male controls (age: 56 ± 8 years). Using H215O-PET, myocardial blood flow (MBF) was quantified at rest, at hyperaemia (adenosine), and during cold-pressor-testing (CPT). Scans were repeated 4.1 ± 2.3 months after cardioversion in 10 AF patients. In AF, resting MBF (0.95 ± 0.19 vs. 1.14 ± 0.22 mL/min/mL; P = 0.009), hyperaemic MBF (2.07 ± 0.80 vs. 3.33 ± 0.78 mL/min/mL; P < 0.001), and MBF under CPT (0.90 ± 0.25 vs. 1.14 ± 0.25 mL/min/mL; P < 0.014) were significantly reduced compared with matched controls. Hyperaemic CVR was increased in AF (47 ± 21 vs. 29 ± 7 mmHg × mL/min/mL; P = 0.012) but unchanged at rest and under CPT. After cardioversion, resting MBF and MBF under CPT in AF were similar to matched controls, however, hyperaemic MBF and CVR were not recovered. Conclusion In AF, MBF at baseline, at hyperaemia, and at CPT is reduced, whereas CVR under hyperaemic conditions is increased. Following electrical cardioversion, these findings are partly reversible and therefore most likely secondary to the arrhythmia.
Acute ruptures of atherosclerotic plaques with subsequent occlusion account for the vast majority of clinical events such as myocardial infarction or stroke. New imaging approaches focusing on the ...visualization of inflammation in the vessel wall could emerge as tools for individualized risk assessment and prevention of events. To this end, PET employing
18
F-fluorodeoxyglucose (FDG) has recently been introduced for the first clinical trials. Although this approach nicely visualizes plaques inflammation questions remain with respect to if and how this inflammatory signal can be employed for predicting individual plaque rupture. Molecular imaging of proteases such as matrix-metalloproteinases (MMPs) involved in several steps in plaque progression driving plaques into vulnerable, rupture-prone states seems a promising alternative approach. This review introduces and discusses the vulnerable plaque concept, animal models with human-like plaque ruptures and the potential of a FDG versus a non-FDG MMP-targeted strategy to image rupture-prone plaques.
Noninvasive imaging and quantification of matrix metalloproteinase (MMP) activity in vivo are of great (pre)clinical interest. This can potentially be realized by using radiolabeled MMP inhibitors ...(MMPIs) as positron emission tomography (PET) imaging agents. Triazole-substituted MMPIs, discovered by our group, are highly potent inhibitors of MMP-2, -8, -9, and -13. The triazole ring and its position contribute significantly to the potency of the MMP inhibitor. To evaluate structure–activity relationships (SARs) of the initially discovered triazole-substituted MMPIs, an additional CH2-group between the backbone of the molecule and the triazole core was inserted, and the triazole ring was “inversed” by switching the alkyne and azide groups. Similar to the original triazole-substituted hydroxamates, the inverse triazole MMPIs are excellent inhibitors with promising in vivo properties. Pharmacokinetic properties and metabolic stability of an 18F-labeled candidate in mice were investigated.
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