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1.
Clin Oncol (R Coll Radiol) ; 33(8): 517-526, 2021 08.
Article in English | MEDLINE | ID: mdl-33781675

ABSTRACT

AIMS: Diagnostic and post-induction 123I-meta-iodobenzylguanidine (123I-mIBG) scans have prognostic significance in the treatment of neuroblastoma, but data from low- and middle-income countries are limited due to resource constraints. The aim of this study was to determine the association between neuroblastoma-associated tumour markers (lactate dehydrogenase [LDH], ferritin and MYCN amplification) and 123I-mIBG scans (modified Curie scores and metastatic disease patterns) in predicting complete metastatic response rates (mCR) and overall survival. MATERIALS AND METHODS: Two hundred and ninety patients diagnosed with high-risk neuroblastoma in South Africa between January 2000 and May 2018 and a subanalysis of 78 patients with diagnostic 123I-mIBG scans were included. Data collection included LDH, ferritin and MYCN amplification at diagnosis. Two nuclear physicians independently determined the modified Curie scores and pattern of distribution for each diagnostic and post-induction 123I-mIBG scans with high inter-rater agreement (r = 0.952) and reliability (K = 0.805). The cut-off values for the diagnostic and post-induction modified Curie scores of ≥7.0 (P = 0.026) and 3 (P = 0.009), respectively, were generated. The association between the tumour markers and the modified Curie score of the 123I-mIBG scans was determined using post-induction mCR and 2-year overall survival. RESULTS: Diagnostic LDH (P < 0.001), ferritin (P < 0.001) and the diagnostic modified Curie scores (P = 0.019) significantly predicted mCR. Only ferritin correlated with diagnostic modified Curie scores (P = 0.003) but had a low correlation coefficient of 0.353. On multivariable analysis, the only significant covariate for 2-year overall survival at diagnosis was LDH <750 U/l (P = 0.024). A post-induction chemotherapy modified Curie score ≤3.0 had a 2-year overall survival of 46.2% compared with 30.8% for a score >3.0 (P = 0.484). CONCLUSION: LDH, ferritin and the diagnostic 123I-mIBG scans significantly predicted mCR, but only LDH predicted 2-year overall survival. Ferritin and the modified Curie scores correlated with each other. MYCN amplification neither correlated with any aspect of the 123I-mIBG scans nor significantly predicted mCR or 2-year overall survival. LDH and ferritin are therefore appropriate neuroblastoma tumour markers to be used in low- and middle-income countries with limited or no access to mIBG scans and/or MYCN amplification studies.


Subject(s)
3-Iodobenzylguanidine , Neuroblastoma , Biomarkers, Tumor/genetics , Child , Humans , Neuroblastoma/diagnostic imaging , Neuroblastoma/genetics , Radionuclide Imaging , Reproducibility of Results
2.
Ocul Immunol Inflamm ; 29(3): 530-536, 2021 Apr 03.
Article in English | MEDLINE | ID: mdl-31743044

ABSTRACT

Purpose: To determine the utility of fluorine-18 fluorodeoxyglucose Positron Emission Tomography Computed Tomography (FDG PET/CT) in patients with suspected ocular sarcoidosis (OS) or intraocular tuberculosis (IOTB) in a resource-constrained, TB endemic area.Methods: Independent review of the FDG PET/CTs, Computed Tomography (CT) scans and chest radiographs (CXRs) of patients with suspected OS or IOTB and inconclusive conventional workup.Results: Twenty-nine PET/CTs and CXRs were reviewed, with 38% of PET/CTs and CTs demonstrating evidence of TB or sarcoidosis, compared to 21% of CXRs. The sensitivity, specificity, positive and negative predictive values for PET/CT and CT were similar - 85.7%, 95.5%, 85.7% and 95.5% for OS, and 33.3%, 100%, 100% and 68% for IOTB respectively and for CXR, 57.1%, 100%, 100% and 88% for OS, and 16.7%, 100%, 100% and 63% for IOTB.Conclusion: PET/CT added no significant additional benefit over Chest CT in patients with suspected OS or IOTB.


Subject(s)
Eye Diseases/diagnostic imaging , Fluorodeoxyglucose F18/administration & dosage , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals/administration & dosage , Sarcoidosis/diagnostic imaging , Tuberculosis, Pulmonary/diagnostic imaging , Adult , Aged , False Positive Reactions , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Radiography, Thoracic , Retrospective Studies , Sensitivity and Specificity , Tuberculin Test , Young Adult
5.
Unfallchirurg ; 123(7): 507-516, 2020 Jul.
Article in German | MEDLINE | ID: mdl-32405652

ABSTRACT

BACKGROUND: The cost pressure in a competitive environment forces hospitals and physicians to optimize clinical processes. In order to secure competitive advantages, a continuous evaluation of relevant processes is necessary. OBJECTIVE: Administrative and medical processes in a university outpatient department for orthopedics and traumatology were evaluated using the lean method in order to reduce patient waiting times. MATERIAL AND METHODS: Over a period of 2 weeks all patients who were treated in the department for orthopedic and trauma surgery on an outpatient basis were included in the assessment of the process. Personnel in the policlinic were prepared and trained to record times for appointments made by telephone, arrival time at the hospital, first contact, administrative procedure, first contact with the doctor, length of stay in the radiology and anesthesiology departments and completion of treatment. In addition, potential inefficiencies were identified through patient flow analysis and personal interviews with personnel in the administration and outpatient departments as well as residents and senior physicians. RESULTS: A total of 126 patients were enrolled in the study. The average length of stay of patients in the outpatient clinic was 144 min (range 30-371 min). A necessary imaging examination increased the length of stay by an average of 53 min and a necessary premedication by an average of 78 min compared to patients with no further consultations. CONCLUSION: By analyzing the pathways and times of patients, various reasons for waiting times in the university outpatient clinic could be shown. This study shows that a structured application of lean management and a dedicated analysis create added value for patients by reducing waiting times.


Subject(s)
Orthopedics , Appointments and Schedules , Hospitals, University , Humans , Outpatients , Traumatology , Waiting Lists
6.
Unfallchirurg ; 123(7): 534-540, 2020 Jul.
Article in German | MEDLINE | ID: mdl-32405653

ABSTRACT

BACKGROUND: Geriatric patients are currently responsible for almost one third of all emergency hospital admissions. An increase of 50% is expected in the next decade. This age redistribution poses new challenges for inpatient care and discharge management. The requirements of an orthopedic trauma surgery clinic in the care of this patient group can be clarified with the help of this first collaboratively created geriatric orthopedic trauma surgery complex treatment unit of a university hospital. OBJECTIVE: What influence do age and delirium have on discharge management, length of inpatient stay and discharge destination in a geriatric cohort? MATERIAL AND METHODS: All patients who received inpatient treatment as part of the orthopedic trauma surgery geriatric complex treatment (GKB) between May 2017 and December 2019 were evaluated. An analysis of the demographics, length of inpatient stay, discharge destinations and evaluation of the Barthel index collected on admission and discharge, the mini-mental state examination (MMSE) and the geriatric depression scale (GDS) were carried out. RESULTS: Out of 312 patients, 110 men and 193 women with a median age of 81 years, 77 patients (24.6%) showed delirium when enrolled in the GKB and 39 (12.5%) dementia. Older patients presented more often with delirium than younger people (p = 0.013), especially those aged 70-79 years (p = 0.037). Dementia patients suffered more frequently from postoperative delirium (p < 0.01). The mean hospital stay was 17.79 days (±4.6 days). The GKB was regularly completed in 60.7% of all cases and 39.3% patients dropped out early. Patients with delirium were discharged significantly less often into their own home but into short-term care or nursing homes (p = 0.038). A general correlation between delirium development and the discharge destination was noticeable (p = 0.004). CONCLUSION: Patients with dementia are more likely to develop delirium postoperatively, which leads to an increase in the length of inpatient stay, an increase in treatment costs and more work for the discharge management team. In addition, the discharge to the patients' home is impaired by delirium, which means that the growing need for places in short-term care and nursing homes also creates socioeconomic burdens.


Subject(s)
Traumatology , Aged, 80 and over , Delirium , Female , Geriatric Assessment , Hospitalization , Humans , Length of Stay , Male , Patient Discharge
7.
Unfallchirurg ; 123(7): 517-525, 2020 Jul.
Article in German | MEDLINE | ID: mdl-32385538

ABSTRACT

BACKGROUND: The operating room (OR) accounts for the highest fraction of hospital costs and also has the largest proportion of revenue. Classical goals of optimizing OR efficiency are to increase the quality of treatment and economic success. As the reduction of qualified personnel as the largest cost factor was favored for many years, nowadays a shortage of nursing personnel is threatening the surgery departments in many German hospitals. OBJECTIVE: Which improvements are possible while the OR already suffers from restrictions? What are critical resources, what are the critical burdens and how can they be optimized? MATERIAL AND METHODS: An analysis of the OR organization of an orthopedic and traumatology department with reduced OR capacity due to a shortage of OR and anesthesia nursing personnel was performed. This was followed by the evaluation of possible alterations with the corresponding advantages and disadvantages. After selection and implementation, the qualitative and quantitative differences were examined before and after the alterations. RESULTS: Multifaceted problem areas could be identified. The establishment of a fast track OR with concentration of additional resources on many fast points in an OR instead of on a few complex cases was selected and implemented. The installation of a holding area for patients waiting for surgery eliminated transportation delays almost entirely. Alterations in the OR planning and capacity distribution reduced nocturnal operating times. Despite reduction of the OR capacity both the number of operations performed and the incision to suture times could be increased. CONCLUSION: Optimization of the processes in the OR is possible and necessary, despite the lack of personnel. Even only a few structural changes can eliminate bottlenecks, resulting in qualitative and quantitative improvements.


Subject(s)
Operating Rooms , Anesthesia , Hospitals , Humans , Orthopedics
8.
Unfallchirurg ; 123(7): 526-533, 2020 Jul.
Article in German | MEDLINE | ID: mdl-32399650

ABSTRACT

BACKGROUND: Due to limited financial and human resources, efficient planning of patient flows, operation preparations and perioperative diagnostics are of great importance. In the present study potential problems and solution strategies in the interdisciplinary collaboration between orthopedic surgeons, trauma surgeons and colleagues in anesthesiology and radiology departments are presented. MATERIAL AND METHODS: After implementation of a process management system, the data were collated and the number of patients, the utilization of external departments in the consultation, waiting times and patient adherence to appointments were analyzed. Patient satisfaction was determined using a questionnaire. In addition, the current literature was searched regarding the topic of process optimization and interdisciplinary cooperation. RESULTS: The waiting time for an appointment in the outpatient clinic consultation in orthopedics and trauma at the University Hospital Bonn was between 9.15 and 11.23 days. Of the patients 10-20% from the consultation presented in the premedication outpatient department. Radiological imaging was performed in 22-28% of the cases. Patient satisfaction was recorded using a questionnaire gathering information on medical treatment, organization and infrastructure as well as treatment success. The importance of an efficient and digitally organized cooperation is generally promoted in the literature; however, there is insufficient data on the subject of process organization and economic interdisciplinary cooperation. CONCLUSION: By implementing a process management, deficiencies in the workflow and interdisciplinary collaboration can be identified and optimized in a structured manner. This also improves patient and employee satisfaction and the quality of treatment.


Subject(s)
Orthopedics , Ambulatory Care Facilities , Appointments and Schedules , Humans , Patient Satisfaction , Referral and Consultation
9.
Unfallchirurg ; 122(12): 958-966, 2019 Dec.
Article in German | MEDLINE | ID: mdl-30840088

ABSTRACT

BACKGROUND: The influence of trauma-related kinematics on the injury pattern of the cervical spine is currently not considered in the available classification systems, only the force vector. Whether the strength of the trauma has an additional influence on the number and complexity of the injuries and whether this can be classified, has not yet been finally investigated. OBJECTIVE: What influence do different kinematics apart from the traumatic force vector have on injuries of the cervical spine? MATERIAL AND METHODS: Based on the AOSpine classification system for the upper and subaxial cervical spine, data from 134 trauma patients from a first level trauma center were retrospectively analyzed. Analogue to the S3 guidelines on polytrauma, patients were assigned to six trauma groups and the injuries were classified on the basis of computed tomography (CT) cross-sectional imaging. RESULTS: A higher trauma energy had a significant impact on the number of cervical spine injuries (p = 0.005). In low velocity accidents C2 was the most frequently injured vertebra (51%; p = 0.022) and high velocity accidents showed more C7 fractures (37%; p = 0.017). Furthermore, upper cervical spine injuries occurred more often in low energy trauma and older female patients (e.g. falling from a standing position). Subaxial cervical spine involvement was found significantly more often in high velocity accidents and younger male patients (p = 0.012). CONCLUSION: Exact knowledge of the trauma mechanism is helpful in the primary treatment of an injured person. Injury patterns can be better estimated and the appropriate diagnostics can be initiated. The results underline the importance of immediate cervical spine immobilization even after minor trauma. In high velocity trauma, patients more often suffer from lower cervical spine injuries, especially C7. Due to the accumulation of multilevel spinal injuries in high velocity trauma, radiographic imaging of the whole spine is advisable.


Subject(s)
Neck Injuries , Spinal Fractures , Spinal Injuries , Biomechanical Phenomena , Cervical Vertebrae , Female , Humans , Male , Neck Injuries/diagnostic imaging , Retrospective Studies , Spinal Fractures/diagnostic imaging , Spinal Injuries/diagnostic imaging , Tomography, X-Ray Computed
10.
Struct Dyn ; 5(4): 044302, 2018 Jul.
Article in English | MEDLINE | ID: mdl-30175156

ABSTRACT

We have investigated nuclear dynamics in bound and dissociating acetylene molecular ions in a time-resolved reaction microscopy experiment with a pair of few-cycle pulses. Vibrating bound acetylene cations or dissociating dications are produced by the first pulse. The second pulse probes the nuclear dynamics by ionization to higher charge states and Coulomb explosion of the molecule. For the bound cations, we observed vibrations in acetylene (HCCH) and its isomer vinylidene (CCHH) along the CC-bond with a periodicity of around 26 fs. For dissociating dication molecules, a clear indication of enhanced ionization is found to occur along the CH- and CC-bonds after 10 fs to 40 fs. The time-dependent ionization processes are simulated using semi-classical on-the-fly dynamics revealing the underling mechanisms.

11.
Oper Orthop Traumatol ; 30(5): 388, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30218132

ABSTRACT

Erratum to:Oper Orthop Traumatol 2018 https://doi.org/10.1007/s00064-018-0559-3 The article was wrongly published under the article type "Review". Please note that the article is an "Original Paper".The publisher apologizes to authors and ….

12.
Oper Orthop Traumatol ; 30(5): 369-378, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30076428

ABSTRACT

OBJECTIVE: The aim is to stabilize the thoracolumbar spine with a thoracoscopically implanted vertebral body replacement (VBR). To improve intraoperative depth perception and orientation, implantation is performed under three-dimensional (3D) thoracoscopic vision. INDICATIONS: Vertebral burst fractures at the thoracolumbar junction (A4 AOSpine classification), pseudarthrosis, and posttraumatic instability with increasing kyphosis. CONTRAINDICATIONS: Severe pulmonary dysfunctions, pulmonary or thoracic infections, previous thoracic surgery, and pulmonary adhesions. SURGICAL TECHNIQUE: The patient is lying in a right lateral decubitus position. Localization of the fractured vertebra. Minimally invasive transthoracic approach. Perform single lung ventilation and insert the 3D thoracoscope two intercostal spaces above the working portal. Utilization of special binocular glasses for 3D vision of the operation field and secure resection of the fractured vertebra. Measurement of the bony defect and insertion of the expandable cage. Control of correct cage position under fluoroscopy. Insertion of a chest tube and inflate the left lung. POSTOPERATIVE MANAGEMENT: Chestâ€¯× ray Remove chest tube when output is <500 ml/24 h Early mobilization on the ward 6 weeks no weight-bearing >5 kg RESULTS: Between 2012 and 2017, 12 patients received a VBR under 3D thoracoscopic vision. After a mean follow up of 26 months, no cage dislocation was noticed and all patients recovered from the initial back pain. Complications were notable in two cases (17%) with a small pneumothorax after removal of the chest tube and postoperative pneumonia in one patient (8%). All responded to conservative treatment. Revision surgery was not necessary.


Subject(s)
Fractures, Compression/surgery , Lumbar Vertebrae/surgery , Spinal Fractures/surgery , Thoracic Vertebrae/surgery , Thoracoscopy/methods , Female , Humans , Imaging, Three-Dimensional , Infant, Newborn , Joint Instability/etiology , Joint Instability/surgery , Kyphosis/etiology , Kyphosis/prevention & control , Kyphosis/surgery , Male , Pseudarthrosis/etiology , Pseudarthrosis/surgery , Treatment Outcome
13.
Pharmazie ; 73(3): 139-142, 2018 03 05.
Article in English | MEDLINE | ID: mdl-29544560

ABSTRACT

The aim of this study was to develop and validate a novel HPLC method for the simultaneous analysis of artemisone, clofazimine and decoquinate. Detection was obtained at two wavelengths; 284 nm (clofazimine) and 210 nm (artemisone and decoquinate). Gradient elution was used with mobile phase A (A) consisting of 0.005 M sodium octanesulphonic-acid (pH 3.5) and mobile phase B (B) of HPLC grade acetonitrile. The flow rate was set to 1.0 ml/min with (A) at 35% and (B) at 65% for 2 min, followed by a gradient shift of 10/90% ((A)/(B)) over a duration of 4 min. After 10 min, the initial gradient conditions were readjusted to 35/65% ((A)/(B)). Distinctive peaks were identified for clofazimine, artemisone and decoquinate, respectively. The proposed HPLC assay method was validated and found to be reliable, reproducible and accurate for simultaneous analysis of the three compounds.


Subject(s)
Artemisinins/analysis , Clofazimine/analysis , Decoquinate/analysis , Chromatography, High Pressure Liquid , Indicators and Reagents , Limit of Detection , Reproducibility of Results , Spectrophotometry, Ultraviolet
14.
J Dairy Sci ; 101(5): 4638-4642, 2018 May.
Article in English | MEDLINE | ID: mdl-29477513

ABSTRACT

Apocrine sweat glands in bovine skin are involved in thermoregulation. Human, horse, and sheep sweat gland epithelial cells have been isolated and grown in vitro. The present study was conducted to identify a method to isolate bovine sweat glands and culture apocrine bovine sweat gland epithelial cells in vitro. Mechanical shearing, collagenase digestion, centrifugation, and neutral red staining were used to identify and isolate the apocrine glands from skin. Bovine sweat glands in situ and after isolation comprised 2 major cell types consisting of a single layer of cuboidal epithelial cells resting on a layer of myoepithelial cells. In situ, the glands were embedded in a collagen matrix primarily comprising fibroblasts, and some of these cells were also present in the isolated material. The isolated material was transferred to complete medium (keratinocyte serum-free medium, bovine pituitary extract, and human recombinant epidermal growth factor + 2.5% fetal bovine serum) in a T 25 flask (Falcon, Franklin Lakes, NJ) with media film and then incubated at 37°C for 24 h. After sweat glands adhered to the bottom of the flask, an additional 2 mL of complete medium was added and the medium was changed every 3 d. Isolated apocrine sweat glands and bovine sweat gland epithelial cells were immunostained for cytokeratin and fibroblast specific protein, indicating fibroblast-free cultures.


Subject(s)
Cell Separation/methods , Sweat Glands/cytology , Animals , Cattle , Cell Culture Techniques , Epithelial Cells/cytology , Epithelial Cells/metabolism , Horses , Humans , Keratins/metabolism , Sheep , Skin/cytology , Skin/metabolism , Sweat Glands/metabolism
15.
Celest Mech Dyn Astron ; 130(1): 2, 2018.
Article in English | MEDLINE | ID: mdl-33184530

ABSTRACT

Collisions between large, similar-sized bodies are believed to shape the final characteristics and composition of terrestrial planets. Their inventories of volatiles such as water are either delivered or at least significantly modified by such events. Besides the transition from accretion to erosion with increasing impact velocity, similar-sized collisions can also result in hit-and-run outcomes for sufficiently oblique impact angles and large enough projectile-to-target mass ratios. We study volatile transfer and loss focusing on hit-and-run encounters by means of smooth particle hydrodynamics simulations, including all main parameters: impact velocity, impact angle, mass ratio and also the total colliding mass. We find a broad range of overall water losses, up to 75% in the most energetic hit-and-run events, and confirm the much more severe consequences for the smaller body also for stripping of volatile layers. Transfer of water between projectile and target inventories is found to be mostly rather inefficient, and final water contents are dominated by pre-collision inventories reduced by impact losses, for similar pre-collision water mass fractions. Comparison with our numerical results shows that current collision outcome models are not accurate enough to reliably predict these composition changes in hit-and-run events. To also account for non-mechanical losses, we estimate the amount of collisionally vaporized water over a broad range of masses and find that these contributions are particularly important in collisions of ∼  Mars-sized bodies, with sufficiently high impact energies, but still relatively low gravity. Our results clearly indicate that the cumulative effect of several (hit-and-run) collisions can efficiently strip protoplanets of their volatile layers, especially the smaller body, as it might be common, e.g., for Earth-mass planets in systems with Super-Earths. An accurate model for stripping of volatiles that can be included in future planet formation simulations has to account for the peculiarities of hit-and-run events and track compositional changes in both large post-collision fragments.

16.
Opt Express ; 25(25): 31130-31139, 2017 Dec 11.
Article in English | MEDLINE | ID: mdl-29245790

ABSTRACT

Intense, multi-color laser fields permit the control of the ionization of atoms and the steering of electron dynamics. Here, we present the efficient collinear creation of the second and third harmonic of a 790 nm femtosecond laser followed by a versatile field synthesizer for the three color fields' composition. Using the device, we investigate the strong-field ionization of neon by fields composed of the fundamental, and the second or third harmonic. The three-color device offers sufficient flexibility for the coherent control of strong-field processes and for time-resolved pump-probe studies.

17.
Opt Express ; 25(13): 14192-14203, 2017 Jun 26.
Article in English | MEDLINE | ID: mdl-28789005

ABSTRACT

Directional breaking of the C-H/C-D molecular bond is manipulated in acetylene (C2H2) and deuterated acetylene (C2D2) by waveform controlled few-cycle mid-infrared laser pulses with a central wavelength around 1.6 µm at an intensity of about 8 × 1013 W/cm2. The directionality of the deprotonation of acetylene is controlled by changing the carrier-envelope phase (CEP). The CEP-control can be attributed to the laser-induced superposition of vibrational modes, which is sensitive to the sub-cycle evolution of the laser waveform. Our experiments and simulations indicate that near-resonant, intense mid-infrared pulses permit a higher degree of control of the directionality of the reaction compared to those obtained in near-infrared fields, in particular for the deuterated species.

18.
Psychol Med ; 47(12): 2166-2176, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28397635

ABSTRACT

BACKGROUND: Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression. However, little is known regarding brain functional processes mediating ECT effects. METHOD: In a non-randomized prospective study, functional magnetic resonance imaging data during the automatic processing of subliminally presented emotional faces were obtained twice, about 6 weeks apart, in patients with major depressive disorder (MDD) before and after treatment with ECT (ECT, n = 24). Additionally, a control sample of MDD patients treated solely with pharmacotherapy (MED, n = 23) and a healthy control sample (HC, n = 22) were obtained. RESULTS: Before therapy, both patient groups equally showed elevated amygdala reactivity to sad faces compared with HC. After treatment, a decrease in amygdala activity to negative stimuli was discerned in both patient samples indicating a normalization of amygdala function, suggesting mechanisms potentially unspecific for ECT. Moreover, a decrease in amygdala activity to sad faces was associated with symptomatic improvements in the ECT sample (r spearman = -0.48, p = 0.044), and by tendency also for the MED sample (r spearman = -0.38, p = 0.098). However, we did not find any significant association between pre-treatment amygdala function to emotional stimuli and individual symptom improvement, neither for the ECT sample, nor for the MED sample. CONCLUSIONS: In sum, the present study provides first results regarding functional changes in emotion processing due to ECT treatment using a longitudinal design, thus validating and extending our knowledge gained from previous treatment studies. A limitation was that ECT patients received concurrent medication treatment.


Subject(s)
Amygdala/physiopathology , Depressive Disorder, Major/physiopathology , Depressive Disorder, Major/therapy , Electroconvulsive Therapy/methods , Magnetic Resonance Imaging/methods , Outcome Assessment, Health Care , Adult , Amygdala/diagnostic imaging , Depressive Disorder, Major/diagnostic imaging , Facial Expression , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies
19.
J Nutr Health Aging ; 21(4): 464-472, 2017.
Article in English | MEDLINE | ID: mdl-28346574

ABSTRACT

OBJECTIVES: The aim of this study is to comprehensively describe nutritional care in German nursing homes (NHs) and to examine if nutritional care differs between small, medium and large NHs. DESIGN: Nationwide cross-sectional postal survey. SETTING: Nursing homes. PARTICIPANTS: 541 NHs across Germany. MEASUREMENTS: Information on structural NH characteristics and nutritional care (food provision and menu planning, nursing care, and management and quality assurance) was collected by means of a questionnaire addressed to the management of a random sample of German NHs. NHs were grouped by size as small (≤ 50 beds), medium (50 - 100 beds) or large (> 100 beds) institutions. Frequencies were used to describe nutritional care, and Chi2-test to identify differences in nutritional care by NH size. RESULTS: Aspects in the domain of food provision and menu planning regarding food variety and choice were widely implemented in German NHs (77 - 100 %). Best results were achieved in the domain of nursing care, where all aspects were implemented in at least 68 % of the NHs. Aspects regarding management and quality assurance, especially those concerning staffing, i.e. the availability of an interface manager (14 %), an interdisciplinary nutrition team (12 %) and a dietician (42 %), were only rarely implemented. Differences by NH size were found between small and medium or large NHs. On the one hand, small NHs stated more often to consider individual capabilities of the residents with texture-modified food (81 % vs. 60 %, p<0.05) and produce more often hot meals at ward level on a regular base (46 % vs. 32 %, p<0.05) than large NHs. On the other hand, several aspects regarding food provision and menu planning, and management and quality assurance were significantly more often implemented in larger than smaller NHs. CONCLUSION: Whereas kitchen and nursing-related aspects of nutritional care seem to be widely implemented in German NHs, management and quality assurance demands are often not met. The differences found by NH size support the hypothesis that the number of residents living in a NH has an impact on how nutritional care is performed.


Subject(s)
Menu Planning/methods , Nursing Care/methods , Nursing Homes/standards , Nutritional Status/physiology , Nutritional Support/methods , Aged , Aged, 80 and over , Choice Behavior , Cross-Sectional Studies , Female , Germany , Hospitals , Humans , Male , Meals , State Medicine , Surveys and Questionnaires
20.
Genes Brain Behav ; 16(3): 352-360, 2017 03.
Article in English | MEDLINE | ID: mdl-27528091

ABSTRACT

Tumour necrosis factor alpha (TNFα) has been implicated in the pathophysiology of neurodegenerative and neuropsychiatric disease, with research highlighting a role for TNFα in hippocampal and striatal regulation. TNFα signals are primarily transduced by TNF receptors 1 and 2 (TNFR1 and TNFR2), encoded by TNFRSF1A and TNFRSF1B, which exert opposing effects on cell survival (TNFR1, neurodegenerative; TNFR2, neuroprotective). We therefore sought to explore the respective roles of TNFR1 and TNFR2 in the regulation of hippocampal and striatal morphology in an imaging genetics study. Voxel-based morphometry was used to analyse the associations between TNFRSF1A (rs4149576 and rs4149577) and TNFRSF1B (rs1061624) genotypes and grey matter structure. The final samples comprised a total of 505 subjects (mean age = 33.29, SD = 11.55 years; 285 females and 220 males) for morphometric analyses of rs1061624 and rs4149576, and 493 subjects for rs4149577 (mean age = 33.20, SD = 11.56 years; 281 females and 212 males). Analyses of TNFRSF1A single nucleotide polymorphisms (SNPs) rs4149576 and rs4149577 showed highly significant genotypic associations with striatal volume but not the hippocampus. Specifically, for rs4149576, G homozygotes were associated with reduced caudate nucleus volumes relative to A homozygotes and heterozygotes, whereas for rs4149577, reduced caudate volumes were observed in C homozygotes relative to T homozygotes and heterozygotes. Analysis of the TNFRSF1B SNP rs1061624 yielded a significant association with hippocampal but not with striatal volume, whereby G homozygotes were associated with increased volumes relative to A homozygotes and heterozygotes. Our findings indicate a role for TNFR1 in regulating striatal but not hippocampal morphology, as well as a complementary role for TNFR2 in hippocampal but not in striatal morphology.


Subject(s)
Corpus Striatum/physiology , Gray Matter/physiology , Hippocampus/physiology , Receptors, Tumor Necrosis Factor, Type II/genetics , Receptors, Tumor Necrosis Factor, Type I/genetics , Adult , Corpus Striatum/metabolism , Female , Gray Matter/metabolism , Hippocampus/metabolism , Humans , Male , Neostriatum/metabolism , Polymorphism, Single Nucleotide , Receptors, Tumor Necrosis Factor, Type I/metabolism , Receptors, Tumor Necrosis Factor, Type II/metabolism , Tumor Necrosis Factor-alpha/genetics , Tumor Necrosis Factor-alpha/metabolism
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