Extracorporeal shock wave lithotripsy for distal ureteral calculi: what a powerful machine can achieve

PURPOSE: We assessed the efficacy of extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) for distal ureteral calculi with the HM3 (Dornier Medical Systems, Inc.) lithotriptor. MATERIALS AND METHODS: A total of 585 consecutive patients with distal ureteral calculi were treated with ESWL using an unmodified HM3 lithotriptor. Of these patients 67 referred for treatment only for whom no followup was available were excluded from further analysis. The remaining 518 cases were followed until they were radiologically documented to be stone-free or considered treatment failures. Before ESWL additional procedures were performed in 144 patients, including stone push back, ureteral catheter or Double-J (Medical Engineering Corp., New York, New York) stent placement, percutaneous nephrostomy, ureteral endoscopic maneuvers or stone basket manipulation. A total of 374 patients needed no preliminary treatment before ESWL. RESULTS: Of the 518 patients 469 (91%) were successfully treated with 1 ESWL session, while 49 (9%) needed 2 or 3. Manipulation after ESWL was performed in 22 cases, including stent placement, percutaneous nephrostomy, ureteral endoscopic stone removal and a stone basket procedure. On day 1 after ESWL 327 patients (63%) were stone-free, 158 (30%) had less than 5 mm. fragments and 33 (7%) had more than 5 mm. fragments. At 3 months the stone-free rate increased to 97%. CONCLUSIONS: These data show that ESWL for distal ureteral calculi with the powerful unmodified HM3 lithotriptor has a high success rate with a low rate of minimally traumatic manipulations before and after intervention. Results in terms of the re-treatment and stone-free rates are superior to those of any other second or third generation lithotriptor and comparable to the results of the best ureteroscopic series.

β-Glucan Antigenemia Anticipates Diagnosis of Blood Culture–Negative Intraabdominal Candidiasis

Rationale: Life-threatening intraabdominal candidiasis (IAC) occurs in 30 to 40% of high-risk surgical intensive care unit (ICU) patients. Although early IAC diagnosis is crucial, blood cultures are negative, and the role of Candida score/colonization indexes is not established. Objectives: The aim of this prospective Fungal Infection Network of Switzerland (FUNGINOS) cohort study was to assess accuracy of 1,3-β-d-glucan (BG) antigenemia for diagnosis of IAC. Methods: Four hundred thirty-four consecutive adults with abdominal surgery or acute pancreatitis and ICU stay 72 hours or longer were screened: 89 (20.5%) at high risk for IAC were studied (68 recurrent gastrointestinal tract perforation, 21 acute necrotizing pancreatitis). Diagnostic accuracy of serum BG (Fungitell), Candida score, and colonization indexes was compared. Measurements and Main Results: Fifty-eight of 89 (65%) patients were colonized by Candida; 29 of 89 (33%) presented IAC (27 of 29 with negative blood cultures). Nine hundred twenty-one sera were analyzed (9/patient): median BG was 253 pg/ml (46–9,557) in IAC versus 99 pg/ml (8–440) in colonization (P < 0.01). Sensitivity and specificity of two consecutive BG measurements greater than or equal to 80 pg/ml were 65 and 78%, respectively. In recurrent gastrointestinal tract perforation it was 75 and 77% versus 90 and 38% (Candida score ≥ 3), 79 and 34% (colonization index ≥ 0.5), and 54 and 63% (corrected colonization index ≥ 0.4), respectively. BG positivity anticipated IAC diagnosis (5 d) and antifungal therapy (6 d). Severe sepsis/septic shock and death occurred in 10 of 11 (91%) and 4 of 11 (36%) patients with BG 400 pg/ml or more versus 5 of 18 (28%, P = 0.002) and 1 of 18 (6%, P = 0.05) with BG measurement less than 400 pg/ml. β-Glucan decreased in IAC responding to therapy and increased in nonresponse. Conclusions: BG antigenemia is superior to Candida score and colonization indexes and anticipates diagnosis of blood culture–negative IAC. This proof-of-concept observation in strictly selected high-risk surgical ICU patients deserves investigation of BG-driven preemptive therapy.

Fluktuierende Kopfschmerzen und Wesensveränderung bei einem 63-jährigen Patienten

We present a 63 year old man with new onset of fluctuating headache and behavioural changes showing marked inhibition and disorientation. After non invasive and invasive diagnostics an isolated cerebral vasculitis was found. Key results have been found in cerebral MRI and cerebral digital subtraction angiography with irregularities of vessel calibre of the intracerebral arteries. During treatment with high-dose corticosteroid therapy and Cyclophosphamid pulse therapy qualitative disorders and headache rapidly regressed. We discuss differential diagnosis of secondary headache, etiology of cerebral vasculitides, diagnostic challenge and therapy in isolated cerebral vasculitis.

Selective uptake, distribution, and redistribution of Cd-109, Co-57, Zn-65, Ni-63, and Cs-134 via xylem and phloem in the heavy metal hyperaccumulator Solanum nigrum L

The focus of this article was to explore the translocation of Cd-109, Co-57, Zn-65, Ni-63, and Cs-134 via xylem and phloem in the newly found hyperaccumulator Solanum nigrum L. Two experiments with the uptake via the roots and transport of Cd-109, Co-57, and Zn-65 labeled by roots, and the redistribution of Cd-109, Zn-65, Co-57, Ni-63, and Cs-134 using flap label in S. nigrum in a hydroponic culture with a standard nutrient solution were conducted. The results showed that Cd-109 added for 24 h to the nutrient medium of young plants was rapidly taken up, transferred to the shoot, and accumulated in the cotyledons and the oldest leaves but was not efficiently redistributed within the shoot afterward leading to a rather low content in the fruits. In contrast, Co-57 was more slowly taken up and released to the shoot, but afterward, this element was redistributed from older leaves to younger leaves and maturing fruits. Zn-65 was rapidly taken up and transferred to the shoot (mainly to the youngest leaves and not to the cotyledons). Afterward, this radionuclide was redistributed within the shoot to the youngest organs and finally accumulated in the maturing fruits. After flap labeling, all five heavy metals tested (Cd-109, Co-57, Zn-65, Ni-63, Cs-134) were exported from the labeled leaf and redistributed within the plant. The accumulation in the fruits was most pronounced for Ni-63 and Zn-65, while a relatively high percentage of Co-57 was finally found in the roots. Cs-134 was roughly in the middle of them. The transport of Cd-109 differed from that previously reported for wheat or lupin and might be important for the potential of S. nigrum to hyperaccumulate cadmium.

Kompetenzen von Sport unterrichtenden Lehrpersonen der Vorschul- und Primarschulstufe: Ergebnisse einer zweistufigen Delphibefragung im Rahmen des Projektes KopS

Einleitung: Sport unterrichtende Lehrpersonen sollten in der Lage sein, Sportunterricht entsprechend seinem Bildungsauftrag (Fries, Baumberger & Egloff, 2009) zu gestalten. Dies verweist auf bestimmte Kompetenzen, welche eine Lehrperson ausweisen muss (vgl. Baumert & Kunter, 2006), um ebendiese Zielsetzungen im Unterricht anzusteuern. Aus wissenschaftlicher Perspektive herrscht jedoch Uneinigkeit darüber, was (Sport unterrichtende) Lehrpersonen wissen und können sollten oder welche Kompetenzen besonders wichtig sind (Bauer, 2002). Dieser Frage wird im Forschungsprojekt KopS (Kompetenzprofile für das Fach Sport auf Vorschul- und Primarschulstufe) nachgegangen. Methode: Im Rahmen einer zweistufigen Delphibefragung wurden in einer ersten Runde ausgewählte Lehrpersonen mit Expertenstatus der Vorschul-, Unter- und Mittelstufe in halbstrukturierten Interviews zu den aus ihrer Sicht notwendigen Fähigkeiten für unterrichtende Lehrpersonen des Faches Sport befragt (N1 = 16). Daraus wurden mittels qualitativer Inhaltsanalyse nach Mayring (2008) stufenspezifische Kompetenzen abgeleitet. In der zweiten Runde wurden die gewonnenen Kompetenzen Fachdidaktikerinnen und Fachdidaktiker verschiedener Pädagogischer Hochschulen der Deutschschweiz (N2 = 10) in einem strukturierten Interview vorgelegt und nach deren Kommentierung und Beurteilung der Kompetenzen bezüglich Wichtigkeit gefragt. Ergebnisse: Die drei schulstufenspezifischen Kompetenzraster aus der ersten Delphi-Runde weisen zwischen 30-62 Kompetenzen auf. Diese sind stufenübergreifend ähnlich, wobei sich die Kompetenzen der Vor-schule tendenziell von jener der Primarschule abgrenzen lassen: Im Bewegungs- und Sportunterricht im Kindergarten wird insbesondere das Arrangieren von motorisch herausfordernden Raum- und Materialerfahrungen als zentral erachtet. In der Schule werden dagegen sportpraktisches und organisatorisches Können von Lehrpersonen als bedeutungsvoll eingeschätzt. Allen drei Kompetenzrastern werden sportunterrichtsspezifische Kompetenzen zu den Bereichen Organisation, Unterrichtsstruktur, sport- und bewegungsbezogenes Fachwissen, Beurteilung, Interaktion, Kommunikation und Sicherheit genannt. Die von den Lehrpersonen beschriebenen Kompetenzen werden von den Fachdidaktikerinnen und Fachdidaktiker als wichtig erachtet und nur marginal ergänzt. Diskussion: Mittels des beschriebenen Verfahrens wurden erstmals Kompetenzen von Sport unterrichtenden Lehrpersonen auf Vorschul- und Primarschulstufe erfasst. Die Ergebnisse zeigen, dass die sportspezifische Tönung der Kompetenzen Unterschiede zu bisherigen Kompetenzdarstellungen für Primarlehrpersonen nahelegt und es erforderlich ist, Kompetenzen stufenspezifisch zu diskutieren. Referenzen: Bauer, K.-O. (2002). Kompetenzprofil: LehrerIn. In H.U.O.T. Rauschenbach & P. Vogel (Hrsg.), Erziehungswissenschaft: Professionalität und Kompetenz (S. 49-63). Opladen: Leske & Budrich. Baumert, J. & Kunter, M. (2006). Stichwort: Professionelle Kompetenz von Lehrkräften. Zeitschrift für Erziehungswissenschaft, 9 (4), 469-520. Fries, A.-V., Baumberger, J. & Egloff, B. (PH Zürich) (2009, 18. November). Zum Auftrag des Fachs Sport in der Volksschule. Eine Diskussionsgrundlage. Zugriff am 24. Mai 2012 unter http://www2.phzh.ch/ForschungsDB/Files/367/Auftrag_Sport_27_11_09.pdf Mayring, Ph. (2008). Qualitative Inhaltsanalyse – Grundlagen und Techniken (10., neu ausgestattete Aufl.). Weinheim: Beltz.

Fibroblast Growth Factor 23 Is an Independent and Specific Predictor of Mortality in Patients With Heart Failure and Reduced Ejection Fraction

BACKGROUND Strategies to improve risk prediction are of major importance in patients with heart failure (HF). Fibroblast growth factor 23 (FGF-23) is an endocrine regulator of phosphate and vitamin D homeostasis associated with an increased cardiovascular risk. We aimed to assess the prognostic effect of FGF-23 on mortality in HF patients with a particular focus on differences between patients with HF with preserved ejection fraction and patients with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS FGF-23 levels were measured in 980 patients with HF enrolled in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study including 511 patients with HFrEF and 469 patients with HF with preserved ejection fraction and a median follow-up time of 8.6 years. FGF-23 was additionally measured in a second cohort comprising 320 patients with advanced HFrEF. FGF-23 was independently associated with mortality with an adjusted hazard ratio per 1-SD increase of 1.30 (95% confidence interval, 1.14-1.48; P<0.001) in patients with HFrEF, whereas no such association was found in patients with HF with preserved ejection fraction (for interaction, P=0.043). External validation confirmed the significant association with mortality with an adjusted hazard ratio per 1 SD of 1.23 (95% confidence interval, 1.02-1.60; P=0.027). FGF-23 demonstrated an increased discriminatory power for mortality in addition to N-terminal pro-B-type natriuretic peptide (C-statistic: 0.59 versus 0.63) and an improvement in net reclassification index (39.6%; P<0.001). CONCLUSIONS FGF-23 is independently associated with an increased risk of mortality in patients with HFrEF but not in those with HF with preserved ejection fraction, suggesting a different pathophysiologic role for both entities.