Use of LDH and autoimmune side effects to predict response to ipilimumab treatment

BACKGROUND

Ipilimumab is a cytotoxic T-lymphocyte antigen-4 antibody that enhances T-cell activity and proliferation.

METHODS

In a retrospective analysis of 86 patients the clinical benefits of ipilimumab treatment were correlated with laboratory and clinical data.

RESULTS

A lactate dehydrogenase (LDH) value within the normal range before the start of therapy was significantly correlated with better OS (p ≤ 0.009). An increase in LDH level after two cycles was indicative of a poor outcome, and was significantly negatively correlated with treatment response and overall survival and progression-free survival. 42% of all patients suffered from autoimmune toxicity (CTCAE grades 2-4). The occurrence of autoimmune toxicity clearly correlated with clinical benefit.

CONCLUSION

Changes in LDH level and side effects correlate with response to therapy and survival.

Uncertainty quantification and design-of-experiment in absorption-based aqueous film parameter measurements using Bayesian inference

Diode laser-based multi-wavelength near-infrared (NIR) absorption in aqueous films is a promising diagnostic for making temporally resolved, simultaneous measurements of film thickness, temperature, and concentration of a solute. Our previous work in aqueous urea solutions aimed at determining simultaneously two of these system parameters, while the third one must be fixed or specified by additional measurements. The current work presents a simultaneous NIR absorption-based multi-parameter measurement of thickness, temperature, and solute concentration coupled with the Bayesian methodology that is used to infer probability densities for the obtained data. The Bayesian analysis is based on a temperature- and concentration-dependent spectral database generated with a Fourier transform infrared spectrometer in the range 5500-8000  cm^-1 for water with variable temperature and urea concentration. The concept was first validated with measurements using a calibration cell. Probability densities in the measured parameters were quantified using a Markov chain Monte Carlo algorithm, which were used to derive credibility intervals. As a practical demonstration, the temporal variation of film thickness, urea concentration, and liquid temperature were recorded during evaporation of a liquid film deposited on a transparent heated quartz plate.

Pattern and Dynamics of Distant Metastases in Metastatic Colorectal Cancer

BACKGROUND

Few studies report the incidence of metastatic patterns in colorectal cancer. Furthermore, little is known about dynamic aspects of these metastases during the course of disease.

METHODS

This retrospective cohort study involved 385 patients who received anti-tumor treatment at our institution (Department of Medical Oncology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Germany) for metastatic colorectal adenocarcinoma between 2007 and 2014. We reviewed all available imaging results of these patients to document the presence and detailed localization of metastases.

RESULTS

Most of the evaluated patients were initially diagnosed with metastases in the liver (70%), followed by the lungs (24%), distant lymph nodes (16%), and peritoneum (15%), besides rare anatomical sites (<5%). Colon and rectal cancer as well as synchronous and metachronous metastases differed with regard to the pattern of individual metastatic sites. The median time to first progressive disease (PD) with new metastases was 12.6 months. The time intervals between first and second as well as second and third PD with new metastases were comparable with 10.5 and 10.8 months, respectively. At initial diagnosis, the mean number of metastatic sites was 1.4 and increased to 2.6 at the third PD with new metastases. For patients with initially one metastatic site, the mean number increased to 2.2.

CONCLUSION

The present analysis provides detailed information on the pattern and evolution of colorectal cancer metastases over time. Thus, it may establish the basis for prospective future research in this field.

Probabilistic Graph Layout for Uncertain Network Visualization

We present a novel uncertain network visualization technique based on node-link diagrams. Nodes expand spatially in our probabilistic graph layout, depending on the underlying probability distributions of edges. The visualization is created by computing a two-dimensional graph embedding that combines samples from the probabilistic graph. A Monte Carlo process is used to decompose a probabilistic graph into its possible instances and to continue with our graph layout technique. Splatting and edge bundling are used to visualize point clouds and network topology. The results provide insights into probability distributions for the entire network-not only for individual nodes and edges. We validate our approach using three data sets that represent a wide range of network types: synthetic data, protein-protein interactions from the STRING database, and travel times extracted from Google Maps. Our approach reveals general limitations of the force-directed layout and allows the user to recognize that some nodes of the graph are at a specific position just by chance.

[Near-infrared spectroscopy for the detection of traumatic intracranial hemorrhage: Feasibility study in a German army field hospital in Afghanistan]

Traumatic brain injury (TBI) is one of the most common causes of death in ordinary accidents, natural disasters, or warfare. The gold standard for diagnosis of TBI is the CT scan; a delay of diagnostics or medical care is the strongest independent predictor of mortality of TBI patients--particularly in the case of a surgically treatable intracranial hematoma. The proper classification of these patients is of major importance in situations where a CT is not accessible. A portable screening device that uses near-infrared spectroscopy (NIRS) technology allows a preliminary estimate of an intracranial hematoma. This study assessing practicability shows that the use of the device in a military medical rescue center (Kunduz, Afghanistan) is easy to learn and can be repeatedly used even under emergency room conditions. The technique can be applied in penetrating and blunt TBIs in the absence of an immediately available CT scan in rural areas, preclinically, under mass casualty conditions (e.g., in disaster situations) as well as in humanitarian crises or war zones. Nevertheless, further studies to assess the validity of this device are necessary.

Establishment of triglyceride cut-off values to detect chylous ascites and pleural effusions

OBJECTIVES

Lipoprotein electrophoresis is the gold standard for the detection of chylous ascites and pleural effusions. It is, however, not suitable as a front-line test and not widely available. Most clinicians must rely solely on the quantitative determination of lipids. The aim of this work was to establish lipid cut-off values for the presence of chylomicrons in pleural and peritoneal fluid.

DESIGN AND METHODS

Triglyceride and cholesterol levels from 113 peritoneal and 154 pleural fluid samples investigated for chylomicrons via lipoprotein electrophoresis were considered. Receiver operating characteristic analyses were performed and cut-off levels determined.

RESULTS

54 peritoneal and 59 pleural fluid samples were positive for chylomicrons. In peritoneal fluid, triglycerides and triglycerides/cholesterol ratio exhibited areas under the curve (AUC) not significantly different from each other, but significantly larger than cholesterol alone. The AUC for triglycerides in pleural fluid was significantly larger than the AUCs for cholesterol and the triglycerides/cholesterol ratio. Triglyceride cut-offs with maximum Youden-Index, sensitivity >95%, and specificity >95% were calculated to be 187, 148, and 246mg/dl (2.13, 1.69, and 2.80mmol/l) for peritoneal fluid, and 240, 94, and 240mg/dl (2.74, 1.07, and 2.74mmol/l) for pleural fluid.

CONCLUSIONS

Triglyceride levels are the best parameter to detect chylous body fluids when lipoprotein electrophoresis is not available. Single-point triglyceride cut-offs of 187 and 240mg/dl (2.13 and 2.74mmol/l) or alternatively equivocal ranges of 148-246 and 94-240mg/dl (1.69-2.80 and 1.07-2.74mmol/l) were established for peritoneal and pleural fluid, respectively.

A single-pulse shock tube coupled with high-repetition-rate time-of-flight mass spectrometry and gas chromatography for high-temperature gas-phase kinetics studies

Shock tubes are frequently used to investigate the kinetics of chemical reactions in the gas phase at high temperatures. Conventionally, two complementary arrangements are used where either time-resolved intermediate species measurements are conducted after the initiation of the reaction or where the product composition is determined after rapid initiation and quenching of the reaction through gas-dynamic processes. This paper presents a facility that combines both approaches to determine comprehensive information. A single-pulse shock tube is combined with high-sensitivity gas chromatography/mass spectrometry for product composition and concentration measurement as well as high-repetition-rate time-of-flight mass spectrometry for time-dependent intermediate concentration determination with 10 μs time resolution. Both methods can be applied simultaneously. The arrangement is validated with investigations of the well-documented thermal unimolecular decomposition of cyclohexene towards ethylene and 1,3-butadiene at temperatures between 1000 and 1500 K and pressures ranging from 0.8 to 2.4 bars. The comparison shows that the experimental results for both detections are in very good agreement with each other and with literature data.

[Large Hibernoma of the Proximal Upper Arm and the Axilla - Literature Review and Case Description of a Very Rare Benign Soft Tissue Tumor]

Hibernomas are very rare benign soft tissue tumors arising from brown fat. Malignant transformation or metastases are unknown. Males seems to be affected more often. Most patients are aged 20 to 40, but patients with intraosseous hibernomas are older. In children, hibernomas are extremely rare. The tumors grow slowly and have usually been present for a few years on presentation. Hibernomas are typically located on the thigh, neck, axilla or in the peri- und interscapular region. Diagnostic work-up in symptomatic hibernomas usually includes conventional X-ray and magnetic resonance tomography (MRI) with contrast medium. Asymptomatic hibernomas are often found accidentally in the diagnostic work-up of other diseases. Important differential diagnoses are lipomas, well differentiated liposarcomas, rhabdomyomas, granular cell tumors and sebeceous adenomas. Incisional biopsy should be performed to allow definitive histological diagnosis before definitive therapy. According to the literature, histologically preserved hibernomas can be removed with curative intention and marginal resection. After complete tumor removal, local recurrence has not been described. The following article describes the case of a large hibernoma of the proximal arm, involving the axilla, and describes the epidemiology, clinical behavior, diagnostic work-up, therapy and prognosis of this very rare benign fatty soft tissue tumor, on the basis of a review of current literature.

Mortality Risk for Acute Cholangitis (MAC): a risk prediction model for in-hospital mortality in patients with acute cholangitis

Background

Acute cholangitis is a life-threatening bacterial infection of the biliary tract. Main focus of this study was to create a useful risk prediction model that helps physicians to assign patients with acute cholangitis into different management groups.

Methods

981 cholangitis episodes from 810 patients were analysed retrospectively at a German tertiary center.

Results

Out of eleven investigated statistical models fit to 22 predictors, the Random Forest model achieved the best (cross-)validated performance to predict mortality. The receiver operating characteristics (ROC) curve revealed a mean area under the curve (AUC) of 91.5 %. Dependent on the calculated mortality risk, we propose to stratify patients with acute cholangitis into a high and low risk group. The mean sensitivity, specificity, positive and negative predictive value of the corresponding optimal cutpoint were 82.9 %, 85.1 %, 19.0 % and 99.3 %, respectively. All of these results emerge from nested (cross-)validation and are supposed to reflect the model’s performance expected for external data. An implementation of our risk prediction model including the specific treatment recommendations adopted from the Tokyo guidelines is available on http://www2.imse.med.tum.de:3838/.

Conclusion

Our risk prediction model for mortality appears promising to stratify patients with acute cholangitis into different management groups. Additional validation of its performance should be provided by further prospective trails.

Environmental impacts of various biomass supply chains for the provision of raw wood in Bavaria, Germany, with focus on climate change

Wood biomass is considered a renewable raw product, but the supply chain of wood biomass involves non-renewable energy inputs, and thus possibly entailing environmental impacts. The objective of this study was to analyze different environmental impacts (GHG emissions, without biogenic CO2; primary energy consumption, non-renewable; particulate matter) caused by the provision of forest biomass for the four main tree species in Bavaria using Life Cycle Assessment (LCA) techniques. Based on forest growth simulations, a set of realistic forest biomass supply chains for Bavarian forestry conditions were modeled for the raw wood product system from site preparation to forest road and to plant/farm gate, respectively, analyzing the four different process groups: [A1] site preparation, [A2] site tending, [A3] biomass harvesting and [T] transport of biomass to plant/farm gate. Total GHG emissions of about 383,000tCO2-eq∗year(-1) (18.95kgCO2-eq∗m(-3)) are estimated for the Bavarian forestry sector (from site preparation to plant/farm gate) in the reference year 2013 indicating a share of 0.41% in the total GHG emissions of Bavaria. 0.035MJ of non-renewable energy has to be invested in order to provide 1MJ of woody biomass to plant/farm gate (267MJ∗m(-3)). One hundred and sixty six tons of particulate matter emissions per year are calculated for the Bavarian forestry sector in 2013 (0.008kgPM2.5-eq∗m(-3)). Our LCA results reveal that there is no single GHG emission value for raw wood but a broad range of possible GHG emissions for the Bavarian forestry. Most decisive parameters are forest road maintenance, biomass harvesting, forwarding and biomass transport, and GHG emissions are also notably influenced by tree species, age class, wood assortment and site quality. We recommend that environmental impact calculations should be implemented, for example in wood certification procedures as they are important key indicators for sustainable forest management.

[Spine surgery in a combat support hospital]

BACKGROUND AND AIM

From July 2007 to October 2014, neurosurgical services have been continuously available in a multinational Role 3 combat support hospital in Mazar-e-Sharif (MeS), Afghanistan. In this paper, we analyze a 7-year operative and outpatient spinal surgery caseload experience.

MATERIALS AND METHODS

The overall annual and monthly caseloads were determined. Additionally, the surgical cases were differentiated relating to the strength of the indication, the location of the surgical site, and the origin of the patients. The outpatient caseload and spectrum of the years 2012 and 2013 were also analyzed.

RESULTS

A total of 341 surgeries were performed and 188 of them were spinal surgeries (55.1 %). The vast majority of surgeries were performed for degenerative diseases (127/188; 67.6 %). The proportion of fractures and penetrating injuries (61/188; 32.4%) increased over the observation period. Eighty percent of the immediate and urgent surgeries (within 12 h; n = 70) were performed for these indications. 19.8 % of the surgeries were done as an emergency, whereas 17.3 % had delayed urgency, and 62.9 % were elective procedures. Of the 1026 outpatient consultations documented, 82 % of them were related to spinal diseases.

CONCLUSIONS

The overall caseload in addition to the distribution of location, strength of indication, and patient origin for MeS are significantly lower than that reported by other International Security Assistance Force (ISAF) nations in eastern and southern Afghanistan. In addition, the rate of elective surgeries and those carried out in civilian Afghan patients is highest in MeS. In comparison with MeS, none of the other ISAF military hospitals shows such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future educational and material planning in comparable missions.

Preoperative serum markers for individual patient prognosis in stage I-III colon cancer

Carcinoembryonic antigen (CEA) remains the only recommended biomarker for follow-up care of colorectal cancer (CRC), but besides CEA, several other serological parameters have been proposed as prognostic markers for CRC. The present retrospective analysis investigates a comprehensive set of serum markers with regard to cancer-specific survival (CSS) and disease-free survival (DFS). A total of 472 patients with colon cancer underwent surgery for curative intent between January 1988 and June 2007. Preoperative serum was analyzed for the following parameters: albumin, alkaline phosphatase (aP), beta-human chorionic gonadotropin (βhCG), bilirubin, cancer antigen 125 (CA 125), cancer antigen 19-9 (CA 19-9), CA 72-4, CEA, C-reactive protein (CRP), cytokeratin-19 soluble fragment (CYFRA 21-1), ferritin, gamma-glutamyltransferase (γGT), glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), hemoglobin, haptoglobin, interleukin-6, interleukin-8, creatinine, lactate dehydrogenase (LDH), serum amyloid A (SAA), and 25-hydroxyvitamin D. After a median follow-up period of 5.9 years, the overall 3- and 5-year CSS was 91.7 and 84.9 % and DFS rates were 82.7 % (3 years) and 77.6 % (5 years). Multivariate analyses confirmed preoperative CEA as an independent prognostic factor with regard to CSS and DFS. CA 19-9 and γGT also provided prognostic value for CSS and DFS, respectively. Younger age was negatively associated with DFS. According to UICC stage, CEA provided significant prognostic value with regard to CSS and DFS, while CA 19-9 was only prognostic for CSS. Combined analysis is able to identify patients with favorable prognosis. In addition to tumor baseline parameters, preoperative CEA could be confirmed as prognostic marker in colon cancer. CA 19-9 and γGT also provide additional prognostic value with regard to survival and recurrence in stage III and stage I disease, respectively. The combined use of CEA together with CA 19-9 and γGT improve risk-adapted post-op surveillance.

NeoFLOT: Multicenter phase II study of perioperative chemotherapy in resectable adenocarcinoma of the gastroesophageal junction or gastric adenocarcinoma-Very good response predominantly in patients with intestinal type tumors

Perioperative treatment is a standard of care in locally advanced gastroesophageal cancer (GEC) (gastric adenocarcinoma and gastroesophageal junction (GEJ) adenocarcinoma). While preoperative treatment can be applied to the majority of patients, postoperative chemotherapy can be given only to a fraction. The NeoFLOT-study therefore investigates the application of prolonged neoadjuvant chemotherapy (NACT). Patients with T3, T4, and/or node-positive adenocarcinoma (GEC) were eligible for this multicenter phase II trial. NACT consisted of 6 cycles of oxaliplatin 85 mg/m(2) , leucovorin 200 mg/m(2) , 5-fluorouracil 2600 mg/m(2) and docetaxel 50 mg/m(2) (FLOT) applied q 2 wks. Application of adjuvant chemotherapy was explicitly not part of the protocol. R0-resection rate was evaluated as a primary endpoint. Of 59 enrolled patients, 50 patients underwent surgery and were assessable for the primary endpoint. R0-resection rate was 86.0% (43/50). Pathologic complete response (pCR) was 20.0% (10/50) and a further 20% (10/50) of patients achieved near complete histological remission (<10% residual tumor). Among these very good responders, 85% (17/20) had intestinal type tumors, 10% (2/20) had diffuse and 5% (1/20) had mixed type tumors. After 3 cycles of NACT, 6.9% (4/58) of patients developed progressive disease. Median disease-free survival was 32.9 months. The 1-year survival-rate was 79.3%. Grade 3-4 toxicities included neutropenia 29.3%, febrile neutropenia 1.7%, diarrhea 12.1% and mucositis 6.9%. This study indicates that intensified NACT with 6 cycles of FLOT is highly effective and tolerable in resectable GEC. Very good response (pCR and <10% residual tumor) was predominantly observed in patients with intestinal type tumors.

Surrogate endpoints in second-line treatment for mCRC: a systematic literature-based analysis from 23 randomised trials

PURPOSE

To evaluate progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) as potential surrogate endpoints (SEP) for overall survival (OS) in second-line treatment for metastatic colorectal cancer (mCRC).

METHODS

A systematic literature search of randomised trials of second-line chemotherapy for mCRC reported from January 2000 to July 2013 was performed. Correlation coefficients weighted by number of patients in the treatment arms between median PFS, ORR and DCR with median OS were estimated.

RESULTS

Twenty-three trials reflecting 10 800 patients met the inclusion criteria. Median PFS and OS across all trials were 4.5 months and 11.5 months and median ORR and DCR were 11.4% and 65%, respectively. PFS showed moderate correlation with OS [RPFS = 0.73; 95% confidence interval (CI) 0.61-0.82]. In contrast, ORR only weakly correlated with OS (RORR = 0.58; 95% CI 0.38-0.72, n = 22). Despite a small number of studies (n = 10) reporting on DCR, moderate correlation with OS was observed (RDCR = 0.74; 95% CI 0.56-0.86).

CONCLUSION

Based on the available trial-level data, PFS may serve as an appropriate SEP in second-line chemotherapy for mCRC. A small number of studies revealed moderate correlation of DCR with OS that justifies further investigation.

Homoleptic borates and aluminates containing the difluorophosphato ligand – [M(O2PF2)x]y− – synthesis and characterization

A new class of WCAs…? The difluoro-phosphato ligand (O₂PF₂) was used for the synthesis of borates and aluminates of the [M(O₂PF₂)_x]^y−-type in order to generate weakly coordinating anions.

Evaluation of preoperative serum markers for individual patient prognosis in stage I-III rectal cancer

Several independent serum biomarkers have been proposed as prognostic and/or predictive markers for colorectal cancer (CRC). To this date, carcinoembryonic antigen (CEA) remains the only recommended serological CRC biomarker. The present retrospective analysis investigates the prognostic value of several serum markers. A total of 256 patients with rectal cancer underwent surgery for curative intent in a university cancer center between January 1988 and June 2007. Preoperative serum was retrospectively analyzed for albumin, alkaline phosphatase (aP), beta-human chorionic gonadotropin, bilirubin, CA 125, cancer antigen 19-9, cancer antigen 72-4 (CA 72-4), CEA, CRP, CYFRA 21-1, ferritin, gamma-glutamyl transpeptidase, glutamate oxaloacetate transanunase, glutamate pyruvate transaminase, hemoglobin, haptoglobin, interleukin-6, interleukin-8, creatinine, lactate-dehydrogenase, serum amyloid A (SAA), and 25-hydroxyvitamin D. Cancer-specific survival (CSS) and disease-free survival (DFS) were estimated. Median follow-up time was 8.4 years. Overall 3- and 5-year CSS was 88.6 and 78.9 %, respectively. DFS rates were 72.8 % (3 years) and 67.5 % (5 years). Univariate analysis of CSS indicated aP, CA 72-4, CEA, and SAA as prognostic factors, while aP, CEA, and SAA were also prognostic with regard to DFS. Multivariate analysis confirmed SAA together with T and N stage as prognostic factors. According to UICC stage, CEA and SAA add prognostic value in stages II and III with regard to DFS and CSS, respectively. The combined use of CEA and SAA is able to identify patients with favorable and poor prognosis. In addition to tumor baseline parameters, routine analysis of SAA together with CEA provided markedly improved prognostic value on CSS and DFS in resected rectal cancer.

[Selective dorsal decompression of degenerative cervical canal stenosis]

BACKGROUND

Hypertrophy of the dorsal ligaments is one reason for central stenosis of the cervical spinal canal. Selective decompression techniques without stabilization and fusion could be a sufficient alternative surgical treatment option.

MATERIAL AND METHODS

This article presents the results of an observational study on 17 patients after treatment with selective decompression and undercutting of the cervical laminae and medial joint portion. The Japanese Orthopedic Association (JOA) score, the neck pain disability index (NPDI) and arm and neck pain on a visual analogue scale (VAS) were compared preoperatively and postoperatively (mean follow-up period was 14 months, minimum 12 months). The reduction of the stenosis and degree of adjacent level disease were measured using presurgical and postsurgical magnetic resonance imaging (MRI). The segmental and regional lordosis and range of motion were determined using the Cobb method on plain standing lateral radiographs.

RESULTS

There were no complications and no revision surgery was necessary. All clinical parameters improved significantly. The stenosis was significantly decompressed and no progression of myelopathy was observed on MRI. The sagittal parameters and degree of adjacent level degeneration remained unchanged.

CONCLUSION

The clinical and radiological results of this non-fusion technique are convincing. Selective decompression is therefore an alternative to laminectomy and fusion as well as laminoplasty.

Left-sided primary tumors are associated with favorable prognosis in patients with KRAS codon 12/13 wild-type metastatic colorectal cancer treated with cetuximab plus chemotherapy: an analysis of the AIO KRK-0104 trial

Purpose

AIO KRK-0104 investigated first-line therapy of metastatic colorectal cancer (mCRC) with cetuximab, capecitabine and irinotecan versus cetuximab, capecitabine and oxaliplatin. This analysis investigated the impact of primary tumor location on outcome of patients.

Patients and methods

Left-sided primary tumors were defined as tumors from rectum to left flexure, while tumors in the remaining colon were regarded right sided. Overall survival (OS), progression-free survival (PFS) and response rate were correlated with primary tumor location. A Cox regression model was used to evaluate interaction between primary tumor location and KRAS mutation.

Results

Of 146 patients of the AIO KRK-0104 trial, 100 patients presented left-sided (of those 68 KRAS codon 12/13 wild-type) and 46 patients right-sided primary tumors (of those 27 KRAS codon 12/13 wild-type). Left-sided tumors were associated with significantly longer OS (p = 0.016, HR = 0.63) and PFS (p = 0.02, HR = 0.67) as compared to right-sided tumors. These effects were present in the KRAS codon 12/13 wild-type population (HR OS: 0.42; HR PFS: 0.54), while no impact of primary tumor location was evident in patients with KRAS codon 12/13 mutant tumors (HR OS: 1.3; HR PFS: 1.01). A significant interaction of KRAS status and primary tumor location concerning OS and PFS was observed.

Conclusion

Our findings suggest that primary tumor location and KRAS codon 12/13 mutational status interact on the outcome of patients with mCRC receiving cetuximab-based first-line therapy. Left-sided primary tumor location might be a predictor of cetuximab efficacy.

[Surgical treatment of epithelial skin tumors and their precursors]

Squamous cell carcinomas of the skin and their precursors, actinic keratosis as well as basal cell carcinomas are classified as non-melanocytic skin cancer and belong to the group of epithelial skin tumors. This tumor entity is one of the most common forms of malignant cancer in western countries with an incidence of approximately 100-170 per 100,000 inhabitants per year in Europe. In German-speaking countries no exact numbers are available on the early forms of squamous cell carcinoma, actinic keratosis (carcinoma in situ); however, results from Great Britain show that at ages over 70 years old the prevalence of actinic keratosis is 34 % in men and 18 % in women. Because invasive epithelial cancer is very common and most commonly occurs in the head region, a safe but skin-sparing approach to surgical treatment is desirable. The safest procedure with respect to local recurrence is surgical excision with subsequent complete 3-dimensional histological preparation (micrographic surgery). With this method it is possible to excise tissue affected by tumor tissue in small steps. This facilitates defect coverage and leads to very good results as well as good esthetic results. The local recurrence rates are extremely low compared to alternative treatment methods, such as photodynamic therapy, topical application of imiquimod or cryosurgery and for the treatment of basal cell carcinoma, for example is 0.7 %. Dermatological operations are therefore interventions with a very high guarantee of tumor-free survival and functional and esthetic results.

An automated thermophoretic soot sampling device for laboratory-scale high-pressure flames

Studying soot particle morphology in high-pressure flames via thermophoretic sampling critically depends on sampling precision, speed, and reproducibility. This is mainly limited by the challenges of applying pneumatically driven devices for burner chamber pressures higher than the pneumatic pressure. We present a pneumatically driven device for high-pressure applications up to 90 bars. The novelty is to separate the pneumatic driver section from the high-pressure environment in the burner chamber. The device was tested by sampling soot from a laminar high-pressure flame at 20 bars.

TV news and concerns about - the EHEC-outbreak 2011 in Germany

BACKGROUND AND AIM

In the beginning of May 2011 and finally terminated on July 26th 2011 an outbreak of infections with enterohaemorrhagic Escherichia (E.) coli (EHEC) strain O104:H4 occurred in Germany. The aim of this study is to analyse whether media coverage of the outbreak influenced the number of patients presenting with diarrhoea to the emergency room of a tertiary centre and to evaluate the influence of information on perception and rating of symptoms.

METHODS

Prospectively collected data in a tertiary centre on the number of patients presenting to the emergency room with diarrhea during the EHEC outbreak was correlated with retrospectively collected data about the media coverage of the outbreak on TV and compared to the number of patients that had presented with diarrhea during a comparative period in 2010.

RESULTS

A total of 1,625 patients presented to our emergency room during the observation period in 2011 between May 31st and June 13th, including 72 patients (4.4%) presenting with the predominant symptom of diarrhoea, of whom six patients (0.4%) reported haemorrhagic diarrhoea. In the comparative period in 2010, between May 31st and June 13th, twelve patients (1.6%) presenting the symptom of diarrhea were treated in our emergency room. The analysis of the news reports in 2011 revealed a total of 1,150 reports broadcast in the ARD and a total of 173 reports broadcast in the regional news channel MDR between May 29th and June 11th. In 2010 not a single report regarding our search terms was broadcast in the corresponding time period.

CONCLUSION

Our data suggest a clear positive correlation of the frequency of TV reports dealing with the epidemic disease outbreak and the rate of outpatient consultations in emergency rooms because of diarrhoea and could make an important contribution for future discussions.