Bundesverband Glaukom-Selbsthilfe

The S2K guideline, organized by the German Respiratory Society, is aimed at physicians in Germany, Switzerland, and Austria who perform outpatient or inpatient diagnostic flexible bronchoscopy in adult patients. Its goal is to standardize the procedure, minimize complications, and improve diagnostic safety. The guideline specifically addresses specialists in pulmonology, thoracic surgery, and hospital hygiene, as well as nursing and technical staff. It provides evidence- and consensus-based recommendations on indications, preparation, execution, hygiene measures, and aftercare. Additionally, it serves as an information resource for physicians from other specialties, payers, professional societies, and can support quality management. It applies to medical care in Germany, Austria, and Switzerland and incorporates the latest scientific findings up to the date of publication.

Genetic variants in desmosomal cadherins, desmoglein 2 (DSG2) and desmocollin 2 (DSC2), cause a distinct form of arrhythmogenic right ventricular cardiomyopathy (ARVC), which remains poorly reported. In this study, we aimed to provide a comprehensive description of the phenotypic expression, natural history, and clinical outcomes of patients with this ARVC subset. Genetic and clinical data of DSG2 and DSC2 variant carriers were collected from 5 countries in Europe and Asia. We assessed the phenotypic profile of these patients and their clinical outcomes, focusing on heart failure and ventricular arrhythmia events. Overall, 271 subjects, 254 with DSG2 variants, were included in this study (median age, 38 years [interquartile range, 25-52]; 62.7% male). Of these, 165 were probands, and 200 were diagnosed with definite ARVC. A total of 181 (66.8%) individuals carried missense variants, mainly distributed in the extracellular domains. Notably, we included 78 (28.8%) individuals with multiple variants. Of the 200 cases with diagnosed ARVC, 41 (20.5%) experienced premature cardiac death before the age of 65. Among the 81 individuals for whom both left ventricular ejection fraction and right ventricular fractional area change data were available at presentation, 29 (35.8%) had isolated right ventricular dysfunction, and 16 (19.8%) had biventricular dysfunction. Single-variant carriers who engaged in intense physical exercise were younger at disease onset compared with those who did not (P=0.001). Compared with single-variant carriers, those with multiple variants were more likely to be diagnosed with ARVC (96.2% versus 64.8%; P<0.001) and exhibited more severe left ventricular dysfunction (44.4% versus 22.1%; P=0.001) and right ventricular dilation (88.9% versus 55.8%, P<0.001). Multiple-variant carriers were significantly younger at ARVC diagnosis compared with single-variant carriers (33 [18-49] years versus 42 [27-54] years; P<0.001]. During follow-up, end-stage heart failure (P<0.001) and malignant ventricular arrhythmias (P=0.004) were significantly more frequent in multiple-variant compared with single-variant carriers. Compared with PKP2 patients, DSG2/DSC2 patients exhibited a significantly higher risk of end-stage heart failure (P<0.001). ARVC attributable to variants in desmosomal cadherins mostly present with right ventricular or biventricular disease. Multiple variants are common in these patients and are associated with more frequent clinical penetrance, earlier onset of disease, and adverse clinical outcomes.

Abstract Background Arrhythmogenic cardiomyopathy (ACM) is a genetically inherited desmosome heart disease leading to life-threatening arrhythmias and sudden cardiac death. Currently, ACM treatment paradigms are merely symptom targeting. Recently, apremilast was shown to stabilize keratinocyte adhesion in the desmosomal disease pemphigus vulgaris. Therefore, this study investigated whether apremilast can be a therapeutic option for ACM. Methods Human induced pluripotent stem cells from a healthy control (hiPSC) and an ACM index patient (ACM-hiPSC) carrying a heterozygous desmoplakin (DSP) gene mutation (c.2854G&gt;T, p.Glu952Ter), confirmed by whole exome sequencing (WES), were established. Cyclic-AMP ELISA, dissociation assay, immunostaining, and Western blotting analyses were performed in human iPSC-derived cardiomyocytes (hiPSC-CMs), murine HL-1 cardiomyocytes, and cardiac slices derived from wild-type (WT) mice, plakoglobin (PG,Jup) knockout (Jup-/- ) (murine ACM model) or PG Serine 665 phosphodeficient (JUP-S665A) mice. Microelectrode array (MEA) analyses in ventricular cardiac slices and Langendorff heart perfusion were performed to analyze heart rate variability and arrhythmia. Results ACM-hiPSC derived cardiomyocytes (ACM-hiPSC-CMs) revealed a significant loss of cohesion, which was rescued by apremilast. Further, treatment with apremilast strengthened basal cardiomyocyte cohesion in HL-1 cells and WT murine cardiac slices, paralleled by phosphorylation of PG at Serine 665 in human and murine models. In HL-1 cells, apremilast in addition activated ERK1/2, inhibition of which abolished apremilast-enhanced cardiomyocyte cohesion. Further, dissociation assays in slice cultures from JUP-S665A andJup-/- mice revealed that PG is crucial for apremilast-enhanced cardiomyocyte cohesion. In parallel to enhanced cell adhesion, MEA and Langendorff measurements from WT andJup-/- mice demonstrated decreased heart rate variability and arrhythmia after apremilast treatment. Conclusions Apremilast improves loss of cardiomyocyte cohesion, enhances localization of DSG2, and reduces arrhythmia in human and murine models of ACMex vivoandin vitro, providing a novel treatment strategy for ACM by preserving desmosome function. Translational perspective The current therapeutic options for patients with arrhythmogenic cardiomyopathy (ACM) include lifestyle changes, treatment with anti-arrhythmic drugs, catheter ablation, implantable cardiac defibrillators, and ultimately, heart transplantation for patients who are having therapy refractory arrhythmia or developed heart failure. However, lifestyle changes, such as restraining from physical endurance activities and β-blocker therapy, are most used in patients carrying genetic variants coding for proteins of the desmosomal complex. Recent advancements hint that strategies enhancing intracellular cAMP could be beneficial in treating desmosomal diseases and can be effective therapeutics, which would be highly relevant for ACM patients. In this study, we show that apremilast improves loss of cardiomyocyte cohesion, enhances localization of desmosomal proteins, and reduces arrhythmia in both human and murine models of ACM ex vivo and in vitro, providing a novel treatment strategy for ACM by preserving desmosome function.

Abstract Understanding the selection of breeding sites in cities is key for the effective management of urban bird populations. We analysed 16 years of data collected within a relocation program for female mallards in Berlin (Germany), with the goal of (i) characterizing the breeding output and breeding sites in urban environments, (ii) identifying factors correlating with probabilities of individuals to return to previously used breeding sites (i.e. breeding site fidelity) and (iii) assessing the consequences of ongoing management strategies on the selection of breeding sites. Mallards using anthropogenic structures for breeding primarily chose balconies, roof terraces and courtyards. In 22.8% of cases, mallards selected the same sites in subsequent breeding events. Breeding site fidelity decreased with higher human population density at that location, and decreased as mallard families were relocated further away from the breeding site to a suitable water body. In contrast, return probabilities were higher for subsequent broods within the same breeding season than across two successive seasons. Above all, the identity of the breeding location and the identity of the female best predicted whether an individual would return to a given breeding site. We conclude that breeding site fidelity in urban mallards is strongly shaped by micro-scale location-specific properties (e.g. balcony characteristics), as well as individual variation due to an intrinsic propensity for site fidelity. We argue that adequate management for waterfowl in urban environments depends on why birds choose to breed on anthropogenic structures, on their conservation status and the availability of breeding sites around urban waters.

PurposeThe diagnosis of metastatic cancer entails an enormous psychological, physical, and social burden, whereby affected women do not feel adequately supported. To address this issue, the Women’s Self-Help Organization Cancer (Frauenselbsthilfe Krebs e.V. FSH) has implemented an innovative peer support program based on online group meetings moderated by trained peers to positively influence psychosocial distress and quality of life of affected women. This pre-post non-randomized study aims to systematically evaluate this program.MethodsParticipants were asked to evaluate the program in terms of expectations and concerns regarding the program, as well as experienced benefits and difficulties. We measured various psychosocial outcomes including psychosocial distress and quality of life at baseline (T0) before the program and after 6 months (T1) follow-up.ResultsWe included n = 97 patients (mostly metastatic breast cancer) at T0 and n = 44 patients with matching complete data sets at T1. The results showed that the program met the participants’ expectations. The online meetings were rated as helpful in terms of sharing experiences and feeling less alone. While participants initially expressed concern about confronting others’ fates (T0), this worry diminished after participation (T1). With respect to the identification of potential effects, we found a significant reduction in psychosocial stress (t (43) = 3.41, p = .001), whereas the levels of depression and anxiety remained unchanged.ConclusionThis online support program showed substantial benefits for the participants. For the next step, a controlled study should be performed to prove the effectiveness of this online program.

Deutlich steigende GKV‐Arzneimittelausgaben sind einer der Haupttreiber für ein drohendes Defizit der GKV. Für eine qualitativ hochwertige und wirtschaftliche Versorgung müssen Regelungen angepasst und die Wirtschaftlichkeitsreserven endlich gehoben werden.

Zusammenfassung Der Bundestag, dessen Abgeordnete im Ausschuss für Gesundheit, das Bundesgesundheitsministerium, die Landesgesundheitsminister und der Bundesrat setzen jährlich neben den gesundheits- auch die krankenhauspolitischen Rahmenbedingungen. Benannte Expertenbeiräte der Bundesregierung, die Gesundheitsexperten der Parteien, diverse Verbände, die (Sozial-)Gerichtsbarkeit und Bundesbehörden sowie politiknahe und wissenschaftliche Institute prägen dabei die öffentliche Diskussion um diese Regelungen. Die Selbstverwaltungspartner auf Bundesebene nutzen die ihnen übertragenen Aufgaben zur vertraglichen Gestaltung, um die medizinische und pflegerische Versorgung in den Krankenhäusern anhand der aktuellen Anforderungen weiterzuentwickeln. Die „Krankenhauspolitische Chronik“ liefert eine Übersicht über alle wesentlichen Entscheidungen der Akteure der deutschen Gesundheits- und Krankenhauspolitik und informiert über die Aktivitäten in den vergangenen zwölf Monaten.