Eculizumab hepatotoxicity in pediatric aHUS.

BACKGROUND Eculizumab is a humanized anti-C5 antibody approved for the treatment of atypical hemolytic uremic syndrome (aHUS). Its use is increasing in children following reports of its safety and efficacy. METHODS We reviewed biochemical and clinical data related to possible drug-induced liver injury in 11 children treated with eculizumab for aHUS in a single center. RESULTS Elevated aminotransferases were observed in 7 children aged 6 to 11 years following eculizumab treatment for aHUS. Internationally accepted liver enzyme thresholds for drug-induced liver injury were exceeded in 5 cases. In all cases, liver injury was classified as mixed hepatocellular and cholestatic. Infectious and other causes were excluded in each case. One patient with no pre-existing liver disease developed tender hepatomegaly and liver enzyme derangement exceeding 20 times the upper limit of normal following initiation of eculizumab. Recurrent liver injury following re-challenge with eculizumab necessitated its discontinuation and transition to plasma therapy. CONCLUSIONS Hepatotoxicity in association with eculizumab is a potentially important yet previously unreported adverse event. We recommend monitoring liver enzymes in all patients receiving eculizumab. Further research is required to clarify the impact of this adverse event, to characterize the mechanism of potential hepatotoxicity, and to identify which patients are most at risk.

Childhood cancer survivor cohorts in Europe.

With the advent of multimodality therapy, the overall five-year survival rate from childhood cancer has improved considerably now exceeding 80% in developed European countries. This growing cohort of survivors, with many years of life ahead of them, has raised the necessity for knowledge concerning the risks of adverse long-term sequelae of the life-saving treatments in order to provide optimal screening and care and to identify and provide adequate interventions. Childhood cancer survivor cohorts in Europe. Considerable advantages exist to study late effects in individuals treated for childhood cancer in a European context, including the complementary advantages of large population-based cancer registries and the unrivalled opportunities to study lifetime risks, together with rich and detailed hospital-based cohorts which fill many of the gaps left by the large-scale population-based studies, such as sparse treatment information. Several large national cohorts have been established within Europe to study late effects in individuals treated for childhood cancer including the Nordic Adult Life after Childhood Cancer in Scandinavia study (ALiCCS), the British Childhood Cancer Survivor Study (BCCSS), the Dutch Childhood Oncology Group (DCOG) LATER study, and the Swiss Childhood Cancer Survivor Study (SCCSS). Furthermore, there are other large cohorts, which may eventually become national in scope including the French Childhood Cancer Survivor Study (FCCSS), the French Childhood Cancer Survivor Study for Leukaemia (LEA), and the Italian Study on off-therapy Childhood Cancer Survivors (OTR). In recent years significant steps have been taken to extend these national studies into a larger pan-European context through the establishment of two large consortia - PanCareSurFup and PanCareLIFE. The purpose of this paper is to present an overview of the current large, national and pan-European studies of late effects after childhood cancer. This overview will highlight the strong cooperation across Europe, in particular the EU-funded collaborative research projects PanCareSurFup and PanCareLIFE. Overall goal. The overall goal of these large cohort studies is to provide every European childhood cancer survivor with better care and better long-term health so that they reach their full potential, and to the degree possible, enjoy the same quality of life and opportunities as their peers.

Vom Urwald zur Kulturlandschaft des Oberengadins : Vegetationsgeschichte der letzten 6200 Jahre

Aufgrund der Untersuchung von Pollen, pflanzlichen Makrofossilien und organischen Sedimentpartikeln (z. B. Holzkohle) in zwei Oberengadiner Seen wird die Vegetationsentwicklung der letzten 6200 Jahre rekonstruiert und im Licht der Entwicklung menschlicher Einflussnahme betrachtet. Der zeitliche Ablauf der Vegetationsveränderungen beruht auf 38 C-14-Datierungen terrestrischer Makroreste aus zwei Sedimentkernen. Die paläobotanischen Daten aus dem St. Moritzer See (Lej da San Murezzan) zeigen für die Zeit von 4200 bis ca. 3550 v. Chr. eine natürliche Waldvegetation bestehend aus Fichte (Picea), Wald- resp. Bergföhre (Pinus sylvestris/P. mugo), Arve (Pinus cembra) und Lärche (Larix decidua). Palynologische Kulturzeiger belegen erste Spuren neolithischer Veränderungen dieser Vegetation in der Zeit um ca. 3500 v. Chr. Eine tiefgreifende Vegetationsveränderung ist für die frühe Bronzezeit, um 2000 v.Chr. zu belegen. Die menschliche Besiedlung führte zu einer ausgeprägten Auflockerung des Waldes mit massiver Zunahme der Weide- und Kulturzeiger (z. B. Getreide, Rumex acetosella, Plantago lanceolata, Urtica, Cichorioideae) sowie einer starken Ausbreitung der Grünerle (Alnus viridis) und der Lärche (Larix decidua). Die Vegetationsentwicklung und die Verteilung von Holzkohlepartikeln in den Sedimenten weisen auf Waldbrände hin. Das Zurückdrängen des Waldes erfolgte in verschiedenen Phasen, die sich mit Besiedlungs- oder Kulturphasen erklären lassen. Der stärkste Rückgang des Waldes fällt ins Mittelalter (ab ca. 800 n. Chr.). In den letzten 200 Jahren nimmt die Baumvegetation vermutlich als Folge eines Nutzungsrückgangs wieder zu. Die ausgeprägtesten Veränderungen der Vegetation fallen mit Epochengrenzen zusammen, was sich mit technologischen Erneuerungen oder möglicherweise mit Einwanderungsphasen erklären lässt.

Die Prekarisierungsgesellschaft. Prekäre Proteste. Politik und Ökonomie im Zeichen der Prekarisierung

Gesellschaft erscheint uns heute im flackernden Licht der Verunsicherung. Nicht erst seit der Finanzkrise erweisen sich stabil geglaubte Arbeits- und Lebensverhältnisse als prekär. Der Autor stellt die wichtigsten ökonomischen und soziologischen Theorien der Prekarisierung vor und zeigt: Prekarität hat die Gesellschaft in ihrer Gesamtheit erfasst. Wir leben in der Prekarisierungsgesellschaft. Aber was ist daraus zu schließen? Marchart beschreibt die gegenwärtigen Sozialproteste und ihre Forderungen. Er untersucht ihre demokratiepolitischen Implikationen und führt hin zu einer Gesellschaftstheorie des Konflikts und der Kontingenz.

Digital goes politics: Einblick in die Schweizer ICT-Verbands und Politiklandschaft

Die Schweizer ICT-Verbands- und Politiklandschaft ist verworren. Der folgende Ueberblick ueber ICT-Verbaende, Lobbying-Organisationen, Politiker und ICT-Themen soll etwas Licht ins Dickicht bringen. Der Artikel hat weder Anspruch auf Vollstaendigkeit noch auf Neutralitaet, versucht aber dennoch einen moeglichst ausgeglichenen Einblick zu schaffen.

The importance of phrenic nerve preservation and its effect on long-term postoperative lung function after pneumonectomy

OBJECTIVES The importance of phrenic nerve preservation during pneumonectomy remains controversial. We previously demonstrated that preservation of the phrenic nerve in the immediate postoperative period preserved lung function by 3-5% but little is known about its long-term effects. We, therefore, decided to investigate the effect of temporary ipsilateral cervical phrenic nerve block on dynamic lung volumes in mid- to long-term pneumonectomy patients. METHODS We investigated 14 patients after a median of 9 years post pneumonectomy (range: 1-15 years). Lung function testing (spirometry) and fluoroscopic and/or sonographic assessment of diaphragmatic motion on the pneumonectomy side were performed before and after ultrasonographic-guided ipsilateral cervical phrenic nerve block by infiltration with lidocaine. RESULTS Ipsilateral phrenic nerve block was successfully achieved in 12 patients (86%). In the remaining 2 patients, diaphragmatic motion was already paradoxical before the nerve block. We found no significant difference on dynamic lung function values (FEV1 'before' 1.39 ± 0.44 vs FEV1 'after' 1.38 ± 0.40; P = 0.81). CONCLUSIONS Induction of a temporary diaphragmatic palsy did not significantly influence dynamic lung volumes in mid- to long-term pneumonectomy patients, suggesting that preservation of the phrenic nerve is of greater importance in the immediate postoperative period after pneumonectomy.

Gletscherarchäologie. Funde aus dem Eis [Radio-Interview]

Je mehr Gletscher zum Beispiel in den Alpen schmelzen, desto mehr Fundstücke kommen ans Licht. Charlotte Grieser im Gespräch mit Albert Hafner, Professor für prähistorische Archäologie an der Universität Bern.

[Future cardiac pacemakers – technical visions].

Cardiac pacemakers are routinely used for the treatment of bradyarrhythmias. Contemporary pacemakers are reliable and allow for a patient specific programming. However, pacemaker replacements due to battery depletion are common (~25 % of all implantation procedures) and bear the risk of complications. Batteryless pacemakers may allow overcoming this limitation. To power a batteryless pacemaker, a mechanism for intracorporeal energy harvesting is required. Such a generator may consist out of subcutaneously implanted solar cells, transforming the small amount of transcutaneously available light into electrical energy. Alternatively, intravascular turbines may harvest energy from the blood flow. Energy may also be harvested from the ventricular wall motion by a dedicated mechanical clockwork converting motion into electrical energy. All these approaches have successfully been tested in vivo. Pacemaker leads constitute another Achilles heel of contemporary pacemakers. Thus, leadless devices are desired. Miniaturized pacemaker circuits and suitable energy harvesting mechanisms (incorporated in a single device) may allow catheter-based implantation of the pacemaker in the heart. Such miniaturized battery- and leadless pacemakers would combine the advantages of both approaches and overcome major limitations of today’s systems.