Helios Park-Klinikum Leipzig

Zusammenfassung Hintergrund und Ziele Die medikamenteninduzierte, sarkoidoseähnliche Reaktion (drug‐induced sarcoidosis‐like reaction, DISR) ist eine zunehmend relevante Nebenwirkung bei Melanompatienten unter Immuncheckpoint‐Inhibitoren (ICI). Angaben zur Häufigkeit variieren stark. Da die Abgrenzung zum Tumorprogress schwierig ist, sind Fehldiagnosen mit möglichen negativen Therapieentscheidungen verbunden. Es besteht daher Bedarf an zuverlässigen diagnostischen Markern und einem strukturierten diagnostischen Algorithmus. Patienten und Methodik Zwischen 09/2019 und 06/2021 wurde am Universitätsklinikum Leipzig eine monozentrische retrospektive Studie durchgeführt. Ziel war die Ermittlung der DISR‐Prävalenz bei Patienten mit metastasiertem Melanom unter ICI‐Therapie. Analysiert wurden klinische Merkmale, Radiologie, Histopathologie und Serumparameter. Ergebnisse Unter 177 Patienten bestand bei 19 ein DISR‐Verdacht. In sieben Fällen wurde die Diagnose histologisch bestätigt. Bei weiteren neun Patienten war eine DISR anhand radiologischer Zeichen und deutlich erhöhtem löslichen Interleukin‐2‐Rezeptor (sIL2R) sehr wahrscheinlich . Daraus ergibt sich eine DISR‐Prävalenz von 9%. Kein Patient musste die ICI‐Therapie dauerhaft wegen der DISR beenden. Schlussfolgerungen Die DISR ist unter ICI häufig. Die Mediastinoskopie oder pulmonale Keilresektion liefert die höchste diagnostische Sicherheit. Fehlt eine Histologie, können sIL2R‐Werte hilfreich sein. Ein diagnostischer Algorithmus wird vorgeschlagen, um eine DISR von Tumorprogress besser abgrenzen zu können.

The updated S3 guideline on the "Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia", published in January 2024, provides evidence- and consensus-based recommendations aimed at improving care for this prevalent hospital-acquired infection. Replacing the 2017 version, the guideline was developed through an interdisciplinary process involving 14 professional societies. It includes 26 recommendations, covering extended diagnostic strategies (including multiplex PCR, biomarkers, and BAL) and tailored antimicrobial therapy. Key innovations include shortened treatment durations, targeted use of combination regimens, integration of viral and fungal pathogens, and a flowchart to guide empirical therapy. Emphasis is placed on antibiotic stewardship, reevaluation strategies, and resistance management. The guideline remains valid until February 2029.

BackgroundProphylactic application of a haemostatic gel to the resection field may be an easy way to prevent delayed bleeding, a frequent complication after endoscopic mucosal resection (EMR).ObjectiveWe aimed to evaluate if the prophylactic application of a haemostatic gel to the resection field directly after EMR can reduce the rate of clinically significant delayed bleeding events.DesignWe conducted a prospective randomised trial of patients undergoing hot-snare EMR of flat lesions in the duodenum (≥10 mm) and colorectum (≥20 mm) at 15 German centres. Prophylactic clip closure was not allowed, but selective clipping or coagulation could be used prior to randomisation to treat intraprocedural bleeding or for prophylactic closure of visible vessels. Patients were randomised to haemostatic gel application or no prophylaxis. The primary endpoint was delayed bleeding within 30 days.ResultsThe trial was stopped early due to futility after an interim analysis. The primary endpoint was analysed in 232 patients (208 colorectal, 26 duodenal). Both groups were comparable in age, sex, comorbidities and lesion characteristics. Preventive measures, such as selective clipping or coagulation, were applied prior to randomisation in 51.9% of cases, with no difference between groups. Delayed bleeding occurred in 14 cases (11.7%; 95% CI 7.1% to 18.6%) after Purastat and in 7 cases (6.3%; 95% CI 3.1% to 12.3%) in the control group (p=0.227), with no difference between colorectal and duodenal subgroups.ConclusionThe application of a haemostatic gel following EMR of large flat lesions in the duodenum and colorectum does not reduce the rate of delayed bleeding.

PurposeLoneliness is a pervasive phenomenon that is linked to adverse health outcomes. Unemployed individuals with mental illnesses (UMIs) constitute a high-risk group, with substantial implications for both health and vocational (re)integration. This study aims to gain deeper insights into the relationships between psychological problems and symptoms of psychopathology and loneliness in UMIs.MethodsOur research is based on a sample from LIPSY, a project that aims to maintain or restore employability. Two regression analyses were conducted on a sample of unemployed participants diagnosed with a mental illness (ICD-10: F-code) with the outcome variable loneliness (UCLA). In the first analysis, age, gender, education, cohabitation status, and social network size (LSNS-6) were used as predictors; in the second one, the nine symptom dimensions (SCL-90) - (1) Somatization, (2) Obsessive-Compulsive, (3) Interpersonal Sensitivity, (4) Depression, (5) Anxiety, (6) Anger-Hostility, (7) Phobic Anxiety, (8) Paranoid Ideation, (9) Psychoticism -were added.ResultsOur sample included 397 participants with an average age of 35.8 years, 53.1% were female. The final regression showed significant positive associations between higher levels of education, Interpersonal Sensitivity, Depression, and the outcome loneliness, and a significant negative relationship between Somatization and loneliness.ConclusionThe high scores on all SCL-90 dimensions, and the links identified between Somatization, Interpersonal Sensitivity, Depression, and loneliness highlight the importance of psychological screening and/or diagnostics in this high-risk group and offer several starting points for prevention measures as well as interventions.

Extended liver resection carries the risk of post-surgery liver failure involving thrombospondin-1-mediated aggravation of hepatic epithelial plasticity and function. Mesenchymal stromal cells (MSCs), by interfering with thrombospondin-1 (THBS1), counteract hepatic dysfunction, though the mechanisms involved remain unknown. Herein, two-thirds partial hepatectomy in mice increased hepatic THBS1, downstream transforming growth factor-β3, and perturbation of liver tissue homeostasis. All these events were ameliorated by hepatic transfusion of human bone marrow-derived MSCs. Treatment attenuated platelet and macrophage recruitment to the liver, both major sources of THBS1. By mitigating THBS1, MSCs muted surgery-induced tissue deterioration and dysfunction, and thus supported post-hepatectomy regeneration. After liver surgery, patients displayed increased tissue THBS1, which is associated with functional impairment and may indicate a higher risk of post-surgery complications. Since liver dysfunction involving THBS1 improves with MSC treatment in various animal models, it seems feasible to also modulate THBS1 in humans to impede post-surgery acute liver failure.

Correction to: S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen InsuffizienzPneumologie eFirstDOI: 10.1055/a-2148-3323

Analysis of psychiatric-psychotherapeutic crisis services in the Leipzig Psychiatry Network (LeiP#netz), assigning the services to the functional areas of the FBM according to Steinhart and Wienberg. A standardized survey of crisis care was conducted using the functions "complex outpatient treatment", "access to acute psychotherapy in crisis", and "24 h complex, intensive treatment" by means of facility-related and function-related instruments. A total of 31 measures were recorded for the three functions. All crisis care services were highly utilized; in up to one-third of cases, no services could be provided when demand was requested. Services that do not require registration or offer 24/7 care are available at very low levels. Crisis care services for severely mentally ill people are available in various constellations in the study region. Low-threshold 24/7 crisis services need to be expanded.

Background and purposePatients with neuromuscular conditions are at increased risk of suffering perioperative complications related to anaesthesia. There is currently little specific anaesthetic guidance concerning these patients. Here, we present the European Neuromuscular Centre (ENMC) consensus statement on anaesthesia in patients with neuromuscular disorders as formulated during the 259th ENMC Workshop on Anaesthesia in Neuromuscular Disorders.MethodsInternational experts in the field of (paediatric) anaesthesia, neurology, and genetics were invited to participate in the ENMC workshop. A literature search was conducted in PubMed and Embase, the main findings of which were disseminated to the participants and presented during the workshop. Depending on specific expertise, participants presented the existing evidence and their expert opinion concerning anaesthetic management in six specific groups of myopathies and neuromuscular junction disorders. The consensus statement was prepared according to the AGREE II (Appraisal of Guidelines for Research & Evaluation) reporting checklist. The level of evidence has been adapted according to the SIGN (Scottish Intercollegiate Guidelines Network) grading system. The final consensus statement was subjected to a modified Delphi process.ResultsA set of general recommendations valid for the anaesthetic management of patients with neuromuscular disorders in general have been formulated. Specific recommendations were formulated for (i) neuromuscular junction disorders, (ii) muscle channelopathies (nondystrophic myotonia and periodic paralysis), (iii) myotonic dystrophy (types 1 and 2), (iv) muscular dystrophies, (v) congenital myopathies and congenital dystrophies, and (vi) mitochondrial and metabolic myopathies.ConclusionsThis ENMC consensus statement summarizes the most important considerations for planning and performing anaesthesia in patients with neuromuscular disorders.