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Endocystectomy is a conservative surgical approach to managing cystic echinococcosis. Bile leakage is the main complication of this technique. The aim of this study was to evaluate the factors associated with bile leakage and to assess the outcomes and cost efficiency of strategies used to treat bile leakage. Patients who underwent endocystectomy between 2005 and 2020 were included. The preoperative characteristics, intra- and postoperative outcomes, hospital costs, and cost efficiency (the Diagnosis-Related Group reimbursement minus the overall cost) were evaluated prospectively. A total of eighty patients with 142 cysts were included. Postoperative complications occurred in 17 patients (21%), including 11 patients with bile leakage (type A: 1, type B: 6 and type C: 4 patients, total 13%). Bile leakage was more frequent in patients with preoperative MRI signs of cysto-biliary fistulas or intraoperative visible cysto-biliary fistulas (p = 0.03 and p = 0.04, respectively) and in patients with cysts larger than 8 cm (p = 0.03). Patients with bile leakage who underwent reoperation (type C) had significantly shorter hospital stays (9 vs. 16 days, p<0.01) and better cost efficiency than those who received radiologic or endocscopic interventions (€2,072 vs. -€2,097 p = 0.01). No mortality was observed, and recurrence was seen in two patients. Endocystectomy is a safe and efficient technique. Preoperative and intraoperative cysto-biliary fistulas and a cyst diameter larger than 8 cm are correlated to postoperative bile leakage. Early operative management of bile leakage reduces hospital stay and improves cost efficiency compared with radiologic or endoscopic treatments.

In a globalized world, the threat of emerging pathogens plays an increasing role, especially if their zoonotic potential is unknown. In this study, a novel respirovirus, family Paramyxoviridae, was isolated from a Sri Lankan Giant squirrel (Ratufa macroura), which originated in Sri Lanka and deceased with severe pneumonia in a German zoo. The full-genome characterization of this novel virus, tentatively named Giant squirrel respirovirus (GSqRV), revealed similarities to murine (71%), as well as human respiroviruses (68%) with unique features, for example, a different genome length and a putative additional accessory protein. Congruently, phylogenetic analyses showed a solitary position of GSqRV between known murine and human respiroviruses, implicating a putative zoonotic potential. A tailored real-time reverse transcription-polymerase chain reaction (RT-qPCR) for specific detection of GSqRV confirmed a very high viral load in the lung, and, to a lesser extent, in the brain of the deceased animal. A pilot study on indigenous and exotic squirrels did not reveal additional cases in Germany. Therefore, further research is essential to assess the geographic distribution, host range, and zoonotic potential of this novel viral pathogen.

This study was performed to characterize the substrate specificity and mechanism of the intestinal clonidine transport. Uptake of [3H]clonidine into Caco-2 cells was investigated. Interaction with drugs was studied in competition assays. Uptake of [3H]clonidine was linear for up to 2 min, Na+-independent, and insensitive to changes in membrane potential, but strongly H+-dependent. The uptake rate of clonidine was saturable with kinetic parameters of 0.5+/-0.1 mM (Kt) and 16.6+/-1.8 nmol/2 min per mg of protein (Vmax) at an outside pH of 7.5. Many drugs such as clonidine, guanabenz, methamphetamine, imipramine, clomipramine, nortriptyline, quinine, xylazine, ephedrine, and diphenhydramine strongly inhibited the [3H]clonidine uptake with Ki values between 0.15 and 1 mM. Clonidine is transported by a carrier-mediated process. Substrate specificity and mechanism are very similar to the transport described in blood-brain barrier endothelial cells. The transport characteristics do not correspond to carriers for organic cations of the SLC22 family or the choline transporters CHT1 and CLT1. The system might be identical to the H+/tertiary amine antiporter. It interacts with a large number of both hydrophilic and lipophilic cationic drugs, and also, interestingly, with opiates.

This study was performed to characterize the mechanism of choline transport into human keratinocytes. Uptake of [3H]choline was measured both in the HaCaT cell line and in native keratinocytes. Uptake in HaCaT cells was linear with time at least up to 10 min. There was little dependence of choline transport on sodium. Choline uptake was slightly stimulated by extracellular H+ with the pH optimum being 7.5. The uptake rate was saturable and indicated participation of a single transport system (Kt = 14.8 ± 1.0 µM, Vmax = 1.0 ± 0.01 nmol per 10 min per mg protein). The choline uptake into HaCaT cells was inhibited by unlabeled choline, hemicholinium-3, and acetylcholine. The prototypical organic cation tetraethylammonium showed very little affinity for the choline uptake system in these cells. Several cationic drugs such as diphenhydramine, clonidine, and atropine also interacted with the transport system. Choline uptake in normal keratinocytes was very similar to that in HaCaT cells with respect to substrate specificity and affinity. We conclude that keratinocytes express a Na+ independent, high-affinity choline transport system. This system accepts many pharmacologically important organic cations as substrates. It is similar or identical to the choline carrier described in intestinal epithelial cells and in endothelial cells of the blood–brain barrier. The choline carrier seems to have relevance not only for the uptake of cationic drugs into the keratinocytes but also for the biosynthesis of skin lipids.

Caliciviruses (CV) were identified in the intestinal contents of five chickens and one turkey from various regions in Germany between 2009 and 2011 by degenerate reverse transcription PCR. The full 7,656-nt-long genomic sequence of the turkey CV L11043 was determined. Partial nucleotide sequences were determined for nine chicken strains. Phylogenetic analysis based on partial deduced amino acid sequences of the protease and RNA polymerase and the complete VP1 capsid sequence identified two distinct clusters of avian CVs, the first of which contained chicken CVs that were closely related to strains found in German chickens in Bavaria and that had been proposed to form a novel CV genus (proposed name: Bavovirus). In contrast, the turkey CV strain L11043 and three chicken CV strains formed a genetically distinct second cluster. Distance analysis suggested that the strains of the second cluster may represent members of two distinct genogroups of another novel CV genus (proposed name: Nacovirus). Based on the newly obtained sequence information, two real-time RT-PCR assays were developed and used to identify bavovirus and nacovirus in pooled intestinal contents from 24 chicken farms in Germany and the Netherlands. Of these, 20 (83 %) were positive for bavovirus, 11 (46 %) were positive for nacovirus, and nine (38 %) were positive for both bavovirus and nacovirus. Attempts were made to propagate chicken and turkey CVs from both the bavovirus and nacovirus clusters in primary chicken cecal cells, embryonal liver cells and fibroblast cells, but these attempts were not successful.

It is well known that microcracks generate strong higher harmonics in propagating monochromatic waves. There is a large amount of literature on modeling this phenomenon, but most of these existing papers only describe one specific mechanism. For example, Zhao et al. [36] assumes that the crack faces are either open under tension or closed under compression, and in the latter case they may slide against each other. On the other hand, the Nazarov and Sutin [23] model assumes microcracks as an elastic contact of two rough surfaces, which are never completely separated by an external load. All these mechanisms depend on the level of excitation.In this research, a micromechanical model for the acoustic nonlinearity generation of microcracks is developed by combining the bilinear stiffness model and the rough surface contact model to describe the excitation-dependent nonlinear behavior of distributed microcracks. It is shown that the first and second harmonic amplitudes have the relationship: A2 ∼ An 1 , with n dependent on the amplitude of excitation, and 2 ≥ n ≥ 1 for nonadhesive crack surfaces.Nanostructured ferritic alloys (NFA) [26] are considered as an example. These materials exhibit outstanding high-temperature properties, irradiation tolerance and thermal stability, making them a leading candidate for advanced nuclear fission and fusion applications. One characteristic property of mechanically processed NFAs is their layer-like structure, with a large number of microcracks aligned in a specific direction. Nonlinear ultrasound measurements (acoustic nonlinearity,β) with longitudinal waves are used to characterize this material. The results show that these measurement techniques are sensitive to the orientation of the cracks. The model developed in this research is then used to interpret these experimental measurements and used to characterize the microcracks in a NFA specimen.

This study explores patients' utilization of psycho-oncologic support and the effectiveness thereof. At the hospital in Munich-Harlaching, 51 patients were recruited following their first admission to the breast centre, 27 of whom utilized the psycho-oncologic service. They were compared to 24 decliners of the service. All patients completed self-rating questionnaires (Distress-Thermometer and Patient Health Questionnaire) at admission and at release. Group differences were calculated statistically by chi-square- and t-tests. We found no significant differences between users and decliners concerning socio-demographic and somatic data, but there were significant group differences in mental health. Users reported more mental distress and more depressive and anxiety symptoms. Psycho-oncologic interventions showed small to large effect sizes. Although this study corresponded more to external than to internal validity standards, it did yield provisional empirical evidence that psycho-oncologic interventions are effective in the treatment of the mental symptoms of breast cancer patients.

Objectives: This study explores patients' utilization of psycho-oncologic support and the effectiveness thereof. Methods: At the hospital in Munich-Harlaching, 51 patients were recruited following their first admission to the breast centre, 27 of whom utilized the psycho-oncologic service. They were compared to 24 decliners of the service. All patients completed self-rating questionnaires (Distress-Thermometer and Patient Health Questionnaire) at admission and at release. Group differences were calculated statistically by chi-square- and t-tests. Results: We found no significant differences between users and decliners concerning socio-demographic and somatic data, but there were significant group differences in mental health. Users reported more mental distress and more depressive and anxiety symptoms. Psycho-oncologic interventions showed small to large effect sizes. Conclusions: Although this study corresponded more to external than to internal validity standards, it did yield provisional empirical evidence that psycho-oncologic interventions are effective in the treatment of the mental symptoms of breast cancer patients. Fragestellung: Es wurden Inanspruchnahme und Effektivität von psychoonkologischen Interventionen bei Brustkrebspatientinnen untersucht. Methode: Am Brustzentrum des Klinikums München-Harlaching wurden 51 Patientinnen rekrutiert, die zur Erstbehandlung eines Mamma-Karzinoms stationär aufgenommen worden waren. Das psychoonkologische Versorgungsangebot wurde von 27 Patientinnen angenommen (Annehmer), diese wurden mit 24 Ablehnern verglichen. Alle Patientinnen füllten Selbsteinschätzungs-Fragebögen (Distress-Thermometer und Gesundheitsfragebogen PHQ-4) bei Aufnahme und Entlassung aus. Zur statistischen Analyse wurden Chi-Quadrat- und t-Tests eingesetzt. Ergebnisse: Es fanden sich keine signifikanten Unterschiede zwischen Annehmern und Ablehnern hinsichtlich soziodemographischer und somatischer Daten. Die Annehmer zeigten sich signifikant stärker psychisch belastet und litten mehr unter depressiven und ängstlichen Symptomen als die Ablehner. Die psychoonkologischen Interventionen erreichten geringe bis hohe Effektstärken. Diskussion: Wenngleich die vorliegende naturalistische Studie Kriterien der externen mehr als denen der internen Validität genügt, finden sich Hinweise, dass das Inanspruchnahmeverhalten wesentlich von psychischen Symptomen bestimmt wird und dass auch wenige psychoonkologische Interventionen psychische Symptome und psychische Belastung effektiv verbessern können.

Discusses sculptures and architectural projects planned and completed in the period 1945-68 in and near Dachau, Germany, as memorials to the victims of this Nazi concentration camp. The author identifies trends and themes in these memorials which she interprets as illustrating two distinct strategies for coming to terms with National Socialism - the one involving a Christian iconography of apology, the other involving attempts to provide a documentary record of the Holocaust. She prefaces her discussion by considering the visual records of concentration camp inmates from the Nazi period and following the liberation of Dachau, and notes that the earliest post-War records and proposals for monuments focused on the horror of the Holocaust and incorporated Jewish iconography, but that the memorials that were eventually built in the early 1950s reflected Germanic symbolism of the sort exploited by the Nazis, while commemorative art works of the same period and later Christianize and heroize the Holocaust experience, displacing any documentary function. The author observes that early buildings allude to the imagery of the watchtower; while after the 1960s the main memorial site is dominated by Christian churches. She concludes that an architectural construct - the Jewish Memorial of Dachau - and the Memorial sculpture of the Comite International de Dachau by Nandor Glid reaffirm the Jewish and the documentary aspects of the site.