Nuremberg Hospital

Fatal interactions with wind turbines are a major threat to bat populations worldwide. Yet, the ultimate causes for bats colliding with wind turbines remain elusive. Using an extensive acoustic data set recorded at nacelle height in different parts of Germany, we show that feeding and social activity occur at all studied wind turbines. At least seven bat species (accounting for 95% of German bat fatalities) perform song flight at wind turbines, a behavior related to mating and courtship, indicating that males may find wind turbines attractive for establishing mating territories. Male songs broadcast over considerable distances and could function as acoustic beacons attracting females to turbine sites. Analysis of 3D thermal detection shows that bat density is higher in the rotor swept zone than in the free air space surrounding turbines. This strongly suggests that bats actively approach turbines, possibly in search of mating, roosting and/or foraging opportunities.

Mental health issues are highly prevalent in socially disadvantaged populations, impacting both mothers and children. Maternal mental health plays a crucial role in child development and well-being. This study aimed to assess the association between maternal symptoms of depression, anxiety and stress during pregnancy and child behavioral problems at age 7 in a socially disadvantaged population. Data from the German longitudinal Pro Kind study were analyzed using the Depression-Anxiety-Stress Scale (DASS-21) to assess maternal distress in pregnancy and the Child Behavior Checklist (CBCL 6-18R) to measure internalizing and externalizing problems at age 7. Logistic regression models were applied, adjusting for potential confounders, including sex-stratified analyses. The study sample included 508 socially disadvantaged mother-child dyads, with a high prevalence of maternal mental distress and a substantial proportion of children exhibiting behavioral problems. In female children, moderate to severe maternal depression, anxiety, and stress during pregnancy increased the likelihood of internalizing problems as well as the total behavior problems at age 7. In male children, only mild, but not moderate or severe symptoms of maternal stress were associated with an increased likelihood of an elevated total problem score at age 7. The results of this study highlight the importance of maternal mental health in pregnancy as a predictor for child mental health, and also point to potential sex/gender differences in susceptibility to child problem behavior associated with maternal distress. Our findings underscore the need for targeted prenatal mental health interventions, especially within socially disadvantaged populations.

Acute myeloid leukemia (AML) is the most common indication for allogeneic hematopoietic cell transplantation (alloHCT), yet graft-versus-host disease (GVHD) remains a major post-transplant complication. Conditioning regimens, particularly reduced-intensity approaches, are critical in optimizing outcomes. This subgroup analysis of the phase 3 MC-FludT.14/L trial compared treosulfan-fludarabine with reduced-intensity busulfan-fludarabine in 352 AML patients (aged 31-70) undergoing alloHCT. The primary endpoint was 24-month event-free survival (EFS); secondary endpoints included overall survival (OS), GVHD incidence, relapse/progression, and non-relapse mortality (NRM). Treosulfan compared to busulfan demonstrated superiority: 24-month EFS was 65% vs. 53% (p = 0.01), and OS was 73% vs. 65%. EFS benefits were consistent across AML risk categories and notably higher in patients with hematopoietic cell transplantation comorbidity index >2 (62% vs. 42%, p = 0.02). Treosulfan also showed lower NRM and relapse rates. GVHD outcomes favored treosulfan, with a significantly lower incidence of extensive chronic GVHD at 24 months (15.1% vs. 28.1%, p = 0.01). GVHD-free and relapse-free survival was also improved (53% vs. 40%, p = 0.02). The safety profile was more favorable with treosulfan. These findings support treosulfan-fludarabine as a more effective and safer conditioning regimen than busulfan-fludarabine for AML patients undergoing alloHCT, particularly those at higher risk.

Related to ongoing demographic, the number of patients with cardiac and non-cardiac comorbidities increases. Heart failure with mildly reduced ejection fraction (HFmrEF) represents a heterogeneous population with diverse clinical profiles. The study investigates the prevalence and prognostic impact of multimorbidity in patients hospitalized with HFmrEF. Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022 and divided into four groups based on the number of concomitant comorbidities taking into account 12 comorbidities (i.e., 0-1, 2-3, 4-5, ≥ 6 comorbidities). The prognostic impact of the number of comorbidities was investigated with regard to the primary endpoint all-cause mortality at 30months. From 2,184 patients hospitalized with HFmrEF, 37% presented with 4-5comorbidities, 17% with ≥ 6 comorbidities. Compared to patients with 4-5, 2-3, 0-1 comorbidities, patients with ≥ 6 comorbidities were more frequently discharged with beta-blockers (83.6% vs. 78.7% vs. 77.6% vs. 64.7%; p = 0.001) and mineralocorticoid receptor antagonists (MRA) (17.2% vs. 15.7% vs. 12.8% vs. 7.9%; p = 0.004). The risk of all-cause mortality at 30months was higher in patients with ≥ 6 comorbidities compared to patients with less comorbidities (i.e., 4-5, 2-3, 0-1) (59.5% vs. 38.6% vs. 17.0% vs. 7.9%, p = 0.001). Both cardiovascular (HR = 1.106; 95% CI 1.030 - 1.188; p = 0.006) and non-cardiovascular (HR = 1.564; 95% CI 1.470 - 1.664; p = 0.001) comorbidities predicted the risk of long-term all-cause mortality. In patients hospitalized with HFmrEF, more than 50% had at least 4 comorbidities. Both cardiovascular and non-cardiovascular comorbidities predicted the risk of long-term all-cause mortality in HFmrEF.

Anthracyclines are an essential component of induction therapy for acute myeloid leukemia (AML), but their optimal dosing and the associated risk for cardiotoxicity remain under debate. The DaunoDouble trial compared daunorubicin at 60 (Dauno60) versus 90 mg/m2 (Dauno90) in combination with cytarabine (100 mg/m2 for 7 days) in newly diagnosed AML patients aged 18-65 years. Cardiac function was assessed by left ventricular ejection fraction (LVEF) and cardiac biomarkers (high-sensitivity troponin T [hsTnT], NT-proBNP) before treatment and on Day 15 in 317 randomized patients. Median LVEF declined significantly from 65% [IQR 60%-68.5%] to 61% [IQR 58%-67.8%] across all patients (p < 0.01), without significant differences between treatment arms. NT-proBNP levels measured after induction therapy correlated negatively with LVEF at the same time point (ρ = -0.24, p = 0.02), but did not change significantly during induction-neither between Day 1 and 15 nor between treatment arms. HsTnT levels increased significantly from 5 [IQR 4-8] to 8 ng/L [IQR 6-14] across all patients (p < 0.01), with higher post-induction values in the Dauno90 group (9.5 ng/L [IQR 7-14]) compared to Dauno60 (7 ng/L [IQR 5-14]; p < 0.01). In exploratory subgroup analyses, post-induction hsTnT levels were also significantly higher in patients with obesity and arterial hypertension. These findings provide evidence of a dose-dependent cardiotoxic effect of daunorubicin, already apparent at standard induction doses, and underscore the importance of early cardiac monitoring. Long-term follow-up will be essential to determine the clinical significance of these early changes. Trial Registration: ClinicalTrials.gov identifier: NCT02140242.

World Health Organization (WHO) REGISTRATION: Protocol (2024): PROSPERO CRD42023468867.