St. Josef-Hospital

Zusammenfassung Hintergrund Die Prävalenz der Herzinsuffizienz mit erhaltener systolischer Ejektionsfraktion (HFpEF) nimmt kontinuierlich zu und macht einen wesentlichen Teil aller Herzinsuffizienzfälle aus. Pathophysiologisch ist diese v. a. durch eine diastolische Dysfunktion gekennzeichnet, deren Entstehungsfaktoren noch Gegenstand aktueller Forschung sind. Erfolg versprechende Therapieansätze mit nachgewiesenem klinischem Nutzen bei HFpEF sind bislang begrenzt verfügbar. Methode Es wurde eine selektive Literaturrecherche in PubMed mit den Stichworten „HFpEF“, „Herzinsuffizienz“, „HFA-PEFF“ und „kardiale Resynchronisationstherapie“ durchgeführt. Der Suchzeitraum umfasste Publikationen von 2000 bis 2025. Zur Reduzierung methodischer Verzerrung wurden vorrangig Leitlinien, randomisierte kontrollierte Studien, Metaanalysen und klinische Registerstudien berücksichtigt. Ausgeschlossen wurden Studien mit ausschließlicher Population von Patienten mit reduzierter bzw. leichtgradig reduzierter Ejektionsfraktion (HFrEF- bzw. HFmrEF) sowie Publikationen ohne definierte HFpEF-Kriterien. Ergebnisse Eine Vielzahl von randomisierten kontrollierten Studien zu unterschiedlichen pharmakologischen Therapieansätzen verfehlten bei HFpEF-Patienten ihre primären Endpunkte, insbesondere in Bezug auf Mortalität und kardiovaskuläre Ereignisse. Moderne Sodium-Glukose-Linked Transporter 2 Hemmer (SGLT-2-Inhibitoren) haben sich in Studien als ein vielversprechender Therapieansatz dargestellt und werden daher seit 2023 von der European Society of Cardiology (ESC) zur Therapie von HFpEF empfohlen (Evidenzgrad A). Weitere Studien mit Glucagon-like peptide-1 Rezeptoragonisten (GLP-1-Agonisten) und Finerenon konnten ebenfalls eine signifikante Verbesserung einiger klinischer Endpunkte, wie beispielsweise eine geringere Hospitalisierungsrate, dokumentieren. Schlussfolgerungen Die pathophysiologische Ursachenabklärung und Therapie von HFpEF bedarf einer intensiven Forschung. Zukünftige Behandlungsstrategien sollten stärker an die Komorbiditäten der Patienten angepasst werden, um den heterogenen Krankheitsmechanismen der HFpEF gerecht zu werden.

The preservation of lean mass (LM) and its restoration following catabolic loss represents a primary challenge for clinical nutrition in critically ill patients. A comprehensive review of recent literature confirms a clinical dilemma between unresponsiveness for feeding and harm of overfeeding and underfeeding. Time point-specific assessment and monitoring of body composition-via computed tomography, bioelectrical impedance analysis (BIA), and ultrasound-are recommended to become an integral part of daily care for all intensive care unit (ICU) patients. Currently, serial BIA for measuring fat-free mass appears to be the most feasible and promising method. Energy and protein supply throughout the phases of critical illness should be guided by sex-specific fat-free mass rather than total body weight, reinforcing the value of indirect calorimetry. Given the prevalence of post-intensive care syndrome, nutrition therapy and monitoring must continue into the post-ICU period. Combined strategies-rather than isolated interventions-provide the most plausible framework to support LM recovery during ICU care and throughout post-ICU rehabilitation. Future approaches, supported by machine learning, will warrant the combined use of biomarkers and clinical variables to identify anabolic resistance and determine "readiness for feeding." Further research is needed to elucidate the effects of micronutrient supplementation, ketogenic diets, and ω-3 fatty acids on muscle tissue, with a focus on mitochondrial function and anti-inflammation. The potential of orexigenic (eg, ghrelin) and anabolic (eg, nandrolone) hormones in the post-ICU phase warrants further investigation.

The present study aimed to report the early and late clinical outcomes of patients who underwent surgical repair for acute type A aortic dissection requiring concomitant coronary artery bypass grafting (CABG), and to explore potential risk factors associated with the need for this additional procedure. Data were retrieved from the multicenter European Registry of Type A Aortic Dissection (ERTAAD). Bootstrapped least absolute shrinkage and selection operator logistic regression and multilevel multivariate logistic regression were performed for variable selection to identify predictors of hospital death, and logistic regression was used for the prediction of CABG. A total of 292 (8.04%) of 3633 patients required additional CABG. The in-hospital mortality rate was 33% for patients undergoing CABG vs 16% of non-CABG recipients (P < .001; odds ratio [OR], 2.52; 95% CI, 1.93-3.35). Dissection of the aortic root involving the right coronary cusp (P < .001; OR, 7.83; 95% CI, 5.55-11.0), a tear in the aortic root (P = .002; OR, 2.08; 95% CI, 1.29-3.32), mitral valve insufficiency (P = .034; OR, 1.33; 95% CI, 1.01-1.71), and a genetic syndrome (P < .001; OR, 3.23; 95% CI, 1.66-5.99) independently predicted the need for CABG. The need for additional CABG is not a rare occurrence during repair of type A aortic dissection and is associated with an increased mortality risk. Intimal tear localization and right coronary sinus dissection should be carefully examined in the preoperative image evaluation to stratify the risk of revascularization and plan the most appropriate approach.

Background/Objectives: Endoscopic submucosal dissection (ESD) is a state-of-the-art en bloc resection for early gastro-intestinal cancers and precursors developed and validated in Japan. Western expertise with this complex technique remains limited. Tutored training might be optimal for patients and ESD learning. We established ESD tutoring courses led by experienced Japanese experts to provide (i) optimal long-term curative outcomes and low complication rates for patients and (ii) hands-on training on difficult lesions for European endoscopists under direct expert supervision. Methods: Prospective data from 2011 to 2015 (follow-up to 12/2024) were analyzed. A total of 118 neoplasms (50% HGIEN and cancer) in 101 patients (median age 68 [37-91] years; 38% with significant comorbidities) were treated with expert or tutored ESD. Japanese experts performed 28 ESDs, while 22 trained beginners conducted 90 supervised procedures on difficult lesions during 5 live and 20 tutoring events (1-4 days each). Results: Analysis of the complete data showed curative and en bloc resection rates of 88% and 95%, respectively, with no recurrence after R0 resections during a median follow-up of 9.8 [1.5-14.9] years. Long-term survival remained recurrence-free after endoscopic resection of 3 recurrent adenomas (at R1/Rx) and curative surgery/2nd ESD for 5 non-curative ESDs. Adverse events occurred in 9.3% without emergency surgery or 30-day mortality. Comparing expert-only vs. tutored ESD procedures, beginners correctly applied curative ESD indications in 94% of 118 neoplasms. Experts resected larger lesions (22 cm2) at a rate of 9.3 cm2/h in 121 min. Tutored beginners achieved a 75% [25-100] self-completion rate on 33% smaller lesions in 112 min. Conclusions: ESD tutoring courses led by Japanese experts ensure excellent patient outcomes and standardized procedural training. This model may foster professional ESD performance across European referral centers.

A virtual endoscopy simulator with a 3D-printed endoscope handle ("Endonix®") that can be used without dedicated equipment ("plug and play") to train endoscope handling has yet not been tested. We prospectively evaluated the simulator's validity, feasibility, and usability in novices, beginners, and experienced endoscopists. Delegates at two congresses (DGVS and ENDOCLUBNORD, both 2024 in Germany) were invited. 310 complete datasets (146 DGVS, 164 ENDOCLUBNORD) were analyzed. Each participant performed two different simulation modules and completed a survey comprising questions on endoscopy experience, simulator evaluation, as well as the System Usability Scale (SUS) and the National Aeronautics and Space Administration Task Load Index (NASA-TLX). The simulator demonstrated good face validity, but only merely sufficient content validity as 67.8% of all participants favored its implementation into endoscopy training. Construct validity was also favorable as experienced endoscopists completed both modules faster than novices or beginners (P < 0.001). In line, criterion validity was given as performance correlated with self-assessed experience. The SUS yielded 75 out of 100 points (corresponding to good usability) with no discernible difference between novices, beginners, and experienced endoscopists. The NASA-TLX, ranging from 0 to 600 points, reflecting level of exhaustion, exhibited a higher score in novices and beginners than experienced endoscopists (285 vs. 210 vs. 225 points, respectively, P < 0.001). Only 16.1% of participants had access to a simulator at their respective institutions, while 79.4% wished for the incorporation of simulators into endoscopy training. The first validation of a novel virtual simulator demonstrated its feasibility and usability, with mostly sufficient validity. Many participants favored its implementation in endoscopy training, particularly for novice and beginner endoscopists, who were identified as the most suitable target learners.

BackgroundGlobal climate change causes rising of the average temperature as well as an increased number of days with extreme heat, even in the temperate climate of Germany. Children are a particularly vulnerable group according to heat stress and consequentially water loss. Even small changes in the water balance can lead to functional impairments. Therefore, quantification of exact water loss as well as the knowledge of hydration status changes in children under heat stress are important and can contribute to renewing water intake recommendations in accordance with climate change. This may promote approaching public health issues.MethodsIn this study water loss, hydration status data and voluntary water intake of children are collected. Therefore, 3–6 years old children from a German kindergarten are recruited. Weight, urine osmolality and saliva osmolarity are measured twice a day on two different testing days with different temperatures (day 1: hot summer day with heat peak; day 2: fall-like day with neutral temperatures). In-between the tests on each day, the children are exposed to these climate scenarios by playing outside for 2 h just like the usual daily routine. The drinking amount as well as the activity during the observational time is recorded. Additionally, the collected data is compared to previously published data on computed estimation of body core temperature changes and water loss in heat on a theoretically modelled 3-year-old child.DiscussionThe weight difference before and after exposure (in dependence of the water intake), provides information about the water loss (thermoregulation) in the observation period. The comparison of newly collected data with modelled water loss can elaborate variations in climate and physiological responses and provide information about, whether the model calculation can be transferred to German conditions. Furthermore, hydration status changes, as reflected by the urine osmolality, are expected to be different between the two test days depending on the extent to which the higher water loss through sweating is compensated by different water intake through voluntary drinking. By means of the collected data, drinking recommendations for children may be aligned and specified in accordance to different climate scenarios.Trial registration numberGerman Clinical Trials Register (Deutsches Register Klinischer Studien), DRKS00033942,19th August 2024.

Elevated catecholamine secretion has been reported after high dietary phosphate intake in experimental studies in animals and humans.This study thus aimed to examine the prospective relationship between long-term dietary phosphorus intake during childhood and adolescence-assessed via 24-h urinary phosphate excretion-and catecholamine levels in adulthood. A total of 159 healthy participants of the DONALD Study (Dortmund, Germany) were examined, who had repeatedly provided 24-h urine samples between ages 3 and 17 years and from whom a 24-h specimen was collected again in young adulthood (ages 18-35). In the adult samples, urinary free epinephrine (EPI), norepinephrine (NE) and the O-methylated EPI- and NE-metabolites metanephrine and normetanephrine were quantified using LC-MS/MS. Phosphate was measured ion chromatographically. Individual means of standard deviation scores were calculated for urinary phosphate and further biomarker excretions as well as for anthropometric data longitudinally determined between 3 and 17 years. Multivariable linear regression was used to investigate associations between pre-adulthood phosphate and adult catecholamine excretions. After fully adjusting for growth- and adulthood-related covariates, only females' renal excretions of EPI (p=0.030) and NE (p=0.040) were associated significantly with pre-adulthood phosphate excretion. In line with a disease-free, relatively continuous adrenal-medullary production of O-methylated metabolites, no association at all was seen for metanephrine and normetanephrine. Our study provides biomarker-based evidence that habitual high dietary phosphorus intake during childhood and adolescence may be related to elevated catecholaminergic activity in adulthood, at least in females, potentially contributing in the long term to endocrine-metabolic-related neuronal and cardiovascular disorders.