Publications by authors named "Klaus Puschel"

334 Publications

Long-term Follow-up and Histological Correlation of Peripheral Nervous System Alterations in Neurofibromatosis Type 2.

Clin Neuroradiol 2021 Oct 15. Epub 2021 Oct 15.

Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.

Purpose: To examine long-term alterations of the dorsal root ganglia (DRG) and the peripheral nerve in patients with neurofibromatosis type 2 (NF2) by in vivo high-resolution magnetic resonance neurography (MRN) and their correlation to histology.

Methods: In this prospective study the lumbosacral DRG, the right sciatic, tibial, and peroneal nerves were examined in 6 patients diagnosed with NF2 and associated polyneuropathy (PNP) by a standardized MRN protocol at 3 T. Volumes of DRG L3-S2 as well as peripheral nerve lesions were assessed and compared to follow-up examinations after 14-100 months. In one patient, imaging findings were further correlated to histology.

Results: Follow-up MRN examination showed a non-significant increase of volume for the DRG L3: +0.41% (p = 0.10), L4: +22.41% (p = 0.23), L5: +3.38% (p = 0.09), S1: +10.63% (p = 0.05) and S2: +1.17% (p = 0.57). Likewise, peripheral nerve lesions were not significantly increased regarding size (2.18 mm vs. 2.15 mm, p = 0.89) and number (9.00 vs. 9.33, p = 0.36). Histological analyses identified schwannomas as the major correlate of both DRG hyperplasia and peripheral nerve lesions. For peripheral nerve microlesions additionally clusters of onion-bulb formations were identified.

Conclusion: Peripheral nervous system alterations seem to be constant or show only a minor increase in adult NF2. Thus, symptoms of PNP may not primarily attributed to the initial schwannoma growth but to secondary long-term processes, with symptoms only occurring if a certain threshold is exceeded. Histology identified grouped areas of Schwann cell proliferations as the correlate of DRG hyperplasia, while for peripheral nerve lesions different patterns could be found.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00062-021-01102-5DOI Listing
October 2021

Cardiac SARS-CoV-2 infection is associated with pro-inflammatory transcriptomic alterations within the heart.

Cardiovasc Res 2021 Oct 14. Epub 2021 Oct 14.

Department of Cardiology, University Heart and Vascular Centre Hamburg, Germany.

Aims: Cardiac involvement in COVID-19 is associated with adverse outcome. However, it is unclear whether cell specific consequences are associated with cardiac SARS-CoV-2 infection. Therefore, we investigated heart tissue utilizing in situ hybridization, immunohistochemistry and RNA-sequencing in consecutive autopsy cases to quantify virus load and characterize cardiac involvement in COVID-19.

Methods And Results: In this study, 95 SARS-CoV-2-positive autopsy cases were included. A relevant SARS-CoV-2 virus load in the cardiac tissue was detected in 41/95 deceased (43%). MACE-RNA-sequencing was performed to identify molecular pathomechanisms caused by the infection of the heart. A signature matrix was generated based on the single-cell dataset "Heart Cell Atlas" and used for digital cytometry on the MACE-RNA-sequencing data. Thus, immune cell fractions were estimated and revealed no difference in immune cell numbers in cases with and without cardiac infection. This result was confirmed by quantitative immunohistological diagnosis.MACE-RNA-sequencing revealed 19 differentially expressed genes (DEGs) with a q-value <0.05 (e.g. up: IFI44L, IFT3, TRIM25; down: NPPB, MB, MYPN). The upregulated DEGs were linked to interferon pathways and originate predominantly from endothelial cells. In contrast, the downregulated DEGs originate predominately from cardiomyocytes. Immunofluorescent staining showed viral protein in cells positive for the endothelial marker ICAM1 but rarely in cardiomyocytes. The GO term analysis revealed that downregulated GO terms were linked to cardiomyocyte structure, whereas upregulated GO terms were linked to anti-virus immune response.

Conclusion: This study reveals, that cardiac infection induced transcriptomic alterations mainly linked to immune response and destruction of cardiomyocytes. While endothelial cells are primarily targeted by the virus, we suggest cardiomyocyte-destruction by paracrine effects. Increased pro-inflammatory gene expression was detected in SARS-CoV-2-infected cardiac tissue but no increased SARS-CoV-2 associated immune cell infiltration was observed.

Translational Perspective: Cardiac injury can be documented in COVID-19, regardless the direct cardiac virus infection and is known to be associated with outcome. However, the direct virus infection of the myocardium leads to transcriptomic alterations and might therefore additionally contribute to pathophysiological processes in COVID-19. Therefore, consequences of cardiac virus infection need to be investigated in future studies, since they might also contribute to long-term effects in case of survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/cvr/cvab322DOI Listing
October 2021

Costal Cartilage Calcification: Prevalence, Amount, and Structural Pattern in the General Population and Its Association with Age: A Cadaveric Study.

Facial Plast Surg Aesthet Med 2021 Oct 4. Epub 2021 Oct 4.

Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Germany.

Costal cartilage calcification (CCC) of the cartilage graft, commonly used in reconstruction of nasal/auricular deformities, can cause poor surgical outcome, but structural and quantitative analyses are lacking. To compare the prevalence, amount, and structural pattern of CCC from individuals by gender and age, as measured by digital contact radiography. This is a cross-sectional cadaveric study ( = 92) of the seventh rib cartilage. CCC prevalence/amount/structural pattern (central [c]/peripheral [p]/diffuse [d]) was analyzed within three age groups: I (<40 years), II (40-70 years), and III (>70 years). Qualitative and quantitative CCC analyses were set in relation to gender/structural pattern/age. CCC prevalence was gender independent (96.7%) and occurred in c/p/d: 12.4%/22.4%/65.2%. Structural CCC pattern differed between age groups (I: 80%; c/p/d: 26.7%/46.6%/6.7%; II: 100%; c/p/d: 18.0%/30.8%/51.2%; III: 100%; p/d: 2.6%/97.4%). The mean CCC amount (9.1%) was gender independent and showed a significant correlation with age ( = 0.001). The mean amount showed a significant difference between the structural pattern [d/p: 3.3 times higher ( = 0.006), d/c: 7.7 times higher ( < 0.001)] and age groups (I/II/III: 6.4/8.5%/10.9%), whereby the amount was higher in groups II (factor: 7.4;  < 0.001) and III (factor: 16.5;  < 0.001) compared with group I. These data show an age-/gender-independent high CCC prevalence in the general population (96.7%). CCC already occurred in young donors (<40 years) with a not negligible amount (6.4%). CCC increased with age and structural analysis showed a gender-/age-specific pattern, whereby males were prone to peripheral/females to central CCC. Diffuse CCC was observed as an age-independent sign for high CCC levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/fpsam.2021.0063DOI Listing
October 2021

Prospective postmortem evaluation of 735 consecutive SARS-CoV-2-associated death cases.

Sci Rep 2021 09 29;11(1):19342. Epub 2021 Sep 29.

Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce. To distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts. 84.1% (n = 618) were classified as COVID-19 deaths, 6.4% (n = 47) as non-COVID-19 deaths, 9.5% (n = 70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n = 283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n = 187). Thromboses were found in 39.2% (n = 62/158 cases), pulmonary embolism in 22.1% (n = 56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n = 618) represented COVID-19 deaths. Our study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-98499-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8481286PMC
September 2021

Landscape of T-cell repertoires with public COVID-19-associated T-cell receptors in pre-pandemic risk cohorts.

Clin Transl Immunology 2021 28;10(9):e1340. Epub 2021 Aug 28.

Department of Internal Medicine IV Oncology/Hematology Martin-Luther-University Halle-Wittenberg Halle (Saale) Germany.

Objectives: T cells have an essential role in the antiviral defence. Public T-cell receptor (TCR) clonotypes are expanded in a substantial proportion of COVID-19 patients. We set out to exploit their potential use as read-out for COVID-19 T-cell immune responses.

Methods: We searched for COVID-19-associated T-cell clones with public TCRs, as defined by identical complementarity-determining region 3 (CDR3) beta chain amino acid sequence that can be reproducibly detected in the blood of COVID-19 patients. Of the different clonotype identification algorithms used in this study, deep sequencing of brain tissue of five patients with fatal COVID-19 delivered 68 TCR clonotypes with superior representation across 140 immune repertoires of unrelated COVID-19 patients.

Results: Mining of immune repertoires from subjects not previously exposed to the virus showed that these clonotypes can be found in almost 20% of pre-pandemic immune repertoires of healthy subjects, with lower representation in repertoires from risk groups like individuals above the age of 60 years or patients with cancer.

Conclusion: Together, our data show that at least a proportion of the SARS-CoV-2 T-cell response is mediated by public TCRs that are present in repertoires of unexposed individuals. The lower representation of these clones in repertoires of risk groups or failure to expand such clones may contribute to more unfavorable clinical COVID-19 courses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/cti2.1340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401425PMC
August 2021

Biomechanical Comparison of Two Double Plating Methods in a Coronal Fracture Model of Bi-condylar Tibial Plateau Fractures.

J Orthop Trauma 2021 Aug 31. Epub 2021 Aug 31.

Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik, Murnau, Germany Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik, Murnau, Germany Paracelsus Medical University, Salzburg, Austria Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany Department of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.

Objectives: Since management of bi-condylar tibial plateau fractures are complicated even for expert surgeons, with using a coronal fracture model we aimed to compare two kinds of double locked plating techniques which were consisted of the lateral locking plate and the medial locking plate inserted medial-anteriorly (MA) or medial-posteriorly (MP).

Methods: Fourteen fresh-frozen tibias stabilized with the MA or MP methods were allocated into two groups with similar BMD values. Implanted samples were tested under incremental fatigue loading conditions utilizing a customized load applicator. An optical motion tracking system was employed to assess relative displacements and rotations of fracture fragments during loading. Static and dynamic global stiffness, failure load, failure cycles, a well as movements of fracture fragments were measured.

Results: There were no significant differences between the two fixation methods regarding global stiffness, failure load, or failure cycles (p= 0.67-0.98, depending on the parameter). The kinematic evaluations, however, revealed that different positions of the medial locking plates altered the directions of movements for the medial-anterior or medial-posterior fracture segments.

Conclusions: The mechanical stability of tibia-implant constructs fixed with the double plating methods was not remarkably affected by the location of the medial locking plate. Depending on clinical conditions and surgeons' preferences, bi-condylar tibial plateau fractures can be managed with either MA or MP methods.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BOT.0000000000002257DOI Listing
August 2021

Correction to: Patient-Reported Outcomes Measures in Abdominal Cancer Surgery and Student-Led Surgical Research.

Ann Surg Oncol 2021 Aug 13. Epub 2021 Aug 13.

Resident of Surgery, University of Chile, Santiago, Chile.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1245/s10434-021-10656-0DOI Listing
August 2021

"Body stuffing" and "Body packing" - Forensic control of human excrements in police custody in Hamburg, Germany.

Leg Med (Tokyo) 2021 Nov 10;53:101940. Epub 2021 Jul 10.

Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Introduction: Different methods are used to confiscate evidence whenever suspected body packers or body stuffers are taken into custody. Among these, controlled defecation and analysis of drug toilets from suspects has proved to be safe given that no invasive or forceful procedures are applied.

Materials And Methods: All records of "drug toilet" evaluations done at the Hamburg Institute of Legal Medicine from January 1st 2018 to April 30th 2021 were descriptively analyzed for the individual's age, sex, country of origin, and whether the drug toilets contained any drug "balls", packages or containers. In case of a positive finding, the total number of balls found were recorded. Special cases are presented in detail for illustrative purposes.

Results: Drug toilets from 72 suspects were examined in the period under review. 98.6% (n = 71) of the suspects were males and relatively young with approximately two-thirds (62.5%, n = 45) aged 34 years or below (range 18-50 years). The majority of suspects originated from African countries (72.2%, n = 52). The typical drug balls or containers were found in 13 (18.1%) of the examined drug toilets.

Conclusion: Negative drug toilets might indeed indicate that the suspect had not ingested any drug packages at the time of arrest or while in custody. However, multiple excretions, voluntary delay of defecation, use of drugs to delay the excretion process or even individual differences in excretion times are possible, and therefore, a negative drug toilet should not always imply with certainty that the individual in question had not ingested any drugs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.legalmed.2021.101940DOI Listing
November 2021

[Use of Health Care by Homeless Individuals: Results of the Hamburg Survey of Homeless Individuals].

Gesundheitswesen 2021 Jul 23. Epub 2021 Jul 23.

Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Deutschland.

Objective: There is a lack of studies focusing on the use of health care facilities by homeless people. The aim of this study was to survey health care use by the homeless.

Methods: Data were taken from the Hamburg survey of homeless individuals (n=150, mean age:12,5 years; SD: 12,5 years). Assessment covered details of health insurance status, use of ambulatory and hospital care, medication use, and reasons for not accessing health services.

Results: In total, 61,2% of the homeless individuals had health insurance. About two thirds of homeless individuals (65,9%) had accessed some sort of medical services in the past 12 months. The key reason for not making use of health services was the absence of any need for treatment (74,6%). In sum, 39,8% of homeless individuals had made at least one hospital visit in the past 12 months. About one third (34,2%) had used mobile support services (mainly a mobile doctor's office). In total, 37,7% of homeless individuals took medications regularly, with 'prices too high' (63,6%) being the key reason for difficulties in access to medications. Almost one half of homeless individuals (47,0%) had not made a visit to a physician in the past three months.

Conclusion: Additional efforts are required to improve access to health care by homeless individuals. Future research in this area is therefore necessary.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1498-1581DOI Listing
July 2021

Screen-detected breast cancer is associated with better prognosis and survival compared to self-detected/symptomatic cases in a Chilean cohort of female patients.

Breast Cancer Res Treat 2021 Sep 10;189(2):561-569. Epub 2021 Jul 10.

Department of Hematology-Oncology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile.

Purpose: The implementation of national breast cancer (BC) screening programs in Latin America has been rather inconsistent. Instead, most countries have opted for "opportunistic" mammogram screenings on the population at risk. Our study assessed and compared epidemiological, clinical factors, and survival rates associated with BC detected by screening (SDBC) or self-detected/symptomatic (non-SDBC) in Chilean female patients.

Methods: Registry-based cohort study that included non-metastatic BC (stage I/II/III) patients diagnosed between 1993 and 2020, from a public hospital (PH) and a private university cancer center (PC). Epidemiological and clinical data were obtained from medical records.

Results: A total of 4559 patients were included. Most patients (55%; n = 2507) came from PH and were diagnosed by signs/symptoms (non-SDBC; n = 3132, 68.6%); these patients displayed poorer overall (OS) and invasive disease-free survival (iDFS) compared to SDBC. Importantly, the proportion of stage I and "luminal" BC (HR + /HER2 -) were significantly higher in SDBC vs. non-SDBC. Finally, using a stage/subset-stratified age/insurance-adjusted model, we found that non-SDBC cases are at a higher risk of death (HR:1.75; p < 0.001). In contrast, patients with PC health insurance have a lower risk of death (HR: 0.60; p < 0.001).

Conclusion: We confirm previous studies that report better prognosis/survival on SDBC patients. This is probably due to a higher proportion of stage I and luminal-A cases versus non-SDBC. In turn, the survival benefit observed in patients with PC health insurance might be attributed to a larger proportion of SDBC. Our data support the implementation of a systematic BC screening program in Chile to improve patient prognosis and survival rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10549-021-06317-1DOI Listing
September 2021

Allograft Chip Incorporation in Acetabular Reconstruction: Multiscale Characterization Revealing Osteoconductive Capacity.

J Bone Joint Surg Am 2021 Jul 6. Epub 2021 Jul 6.

Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background: Impacted bone-grafting with morselized allograft chips is commonly used to reconstruct acetabular bone defects in revision total hip arthroplasty (THA). While the overall clinical outcome of this procedure is described to be excellent, the microstructural basis and histological determinants of allograft incorporation remained to be further elucidated.

Methods: The acetabula of 23 individuals with documented previous use of allograft chips during revision THA were explanted post mortem. The time that the allografts were in situ averaged 10.3 ± 4.5 years (range, 1.2 to 19.8 years). The host bone (HB)-allograft bone (AB) interface was characterized using a suite of high-resolution (HR) imaging techniques including HR-peripheral quantitative computed tomography (HR-pQCT), histological analysis, cellular histomorphometry, and scanning electron microscopy.

Results: AB could be identified in 16 of the 23 cases. The HB and AB showed overlap (i.e., ingrowth) in 91.3% of the total interface. The mean ingrowth was 2.2 ± 1.0 mm with a maximum of 4.7 ± 2.1 mm. The periphery of the AB showed a tight interconnection with the HB associated with increased bone remodeling indices and increased trabecular thickness. While no association between the time in situ and the ingrowth was observed, the bone defect area was positively associated with the thickness of a fibrosis layer separating the ingrowth zone from the AB.

Conclusions: Allograft chips in revision THA form an adequate osseous foundation with successful incorporation through ingrowth of the HB (i.e., osteoconduction). While complete remodeling was not observed, larger defects were associated with fibrosis formation, which may compromise stability.

Clinical Relevance: Our study provides the first systematic, multiscale long-term evaluation of chip allograft incorporation in revision THA to underscore its successful clinical use. As larger defects were associated with fibrous ingrowth, structural allografts may be superior for larger defects in terms of long-term outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.20.01943DOI Listing
July 2021

Prevalence and Factors Associated with Fear of COVID-19 Among Homeless Individuals During the COVID-19 Pandemic: Evidence from the Hamburg Survey of Homeless Individuals.

Risk Manag Healthc Policy 2021 24;14:2689-2695. Epub 2021 Jun 24.

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany.

Purpose: To clarify the prevalence and determinants of fear of COVID-19 among homeless individuals during the COVID-19 pandemic.

Patients And Methods: Data were taken from the Hamburg survey of homeless individuals (n=150) covering homeless adults in Hamburg, Germany. Multiple linear regressions were used. Beyond sociodemographic and lifestyle-related independent variables, COVID-19-related factors were also used as independent variables.

Results: In sum, 56.2% of homeless individuals reported no fear of COVID-19, 23.8% reported a little fear of COVID-19, 9.2% reported some fear of COVID-19 and 10.8% reported severe fear of COVID-19. Regressions showed that an increased fear of COVID-19 was significantly associated with younger age (β=-.01, p<0.05), absence of chronic alcohol consume (β=-.55, p<0.01), an increased perceived own risk of getting infected with the coronavirus one day (β=0.42, p<0.001) and a higher agreement that a diagnosis of the coronavirus would ruin his/her life (β=0.13, p<0.01).

Conclusion: Given the poor hygienic conditions and their increased vulnerability, data surprisingly suggest a quite low fear of COVID-19 among homeless individuals. Efforts may be beneficial which contribute to thinking rationally about COVID-19 among homeless people, since low levels of fear of COVID-19 may contribute to careless behavior and can lead to super-spreading events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/RMHP.S317039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238066PMC
June 2021

Deep spatial profiling of human COVID-19 brains reveals neuroinflammation with distinct microanatomical microglia-T-cell interactions.

Immunity 2021 07 9;54(7):1594-1610.e11. Epub 2021 Jun 9.

Faculty of Medicine, Clinic for Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, University Medical Center Freiburg, Freiburg, Germany; Signalling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany. Electronic address:

COVID-19 can cause severe neurological symptoms, but the underlying pathophysiological mechanisms are unclear. Here, we interrogated the brain stems and olfactory bulbs in postmortem patients who had COVID-19 using imaging mass cytometry to understand the local immune response at a spatially resolved, high-dimensional, single-cell level and compared their immune map to non-COVID respiratory failure, multiple sclerosis, and control patients. We observed substantial immune activation in the central nervous system with pronounced neuropathology (astrocytosis, axonal damage, and blood-brain-barrier leakage) and detected viral antigen in ACE2-receptor-positive cells enriched in the vascular compartment. Microglial nodules and the perivascular compartment represented COVID-19-specific, microanatomic-immune niches with context-specific cellular interactions enriched for activated CD8 T cells. Altered brain T-cell-microglial interactions were linked to clinical measures of systemic inflammation and disturbed hemostasis. This study identifies profound neuroinflammation with activation of innate and adaptive immune cells as correlates of COVID-19 neuropathology, with implications for potential therapeutic strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.immuni.2021.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188302PMC
July 2021

[Infectiousness of SARS-CoV-2 positive corpses during external post mortem examination].

MMW Fortschr Med 2021 06;163(12):56-58

Institut für Rechtsmedizin, Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s15006-021-0084-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214379PMC
June 2021

The interdisciplinary and psychosocial gap in cancer survivorship: A longitudinal study in a Latin American Cancer Center.

J Surg Oncol 2021 Oct 16;124(5):876-885. Epub 2021 Jun 16.

Department of Surgery, College of Medicine, University of Nebraska, Omaha, Nebraska, USA.

Background And Objectives: There is lack of information on the quality of care provided to the rapidly increasing population of cancer survivors in Latin America. Our study attempts to address this gap and to identify areas needed to be improved.

Methods: A random sample of 210 breast and colorectal cancer survivors were selected from a hospital-based registry in Chile. Cancer registry information, electronic chart review, and personal interviews were used to assess medical and nonmedical care over a 5-year period. Survivorship care practices were compared to a standardized reference based on the US Institute of Medicine domains and the American Cancer Association guidelines.

Results: Over 80% of breast and colorectal cancer survivors received appropriate medical care, ongoing testing surveillance and risk factors assessment. Only a third of survivors were assessed for psychosocial disorders and 25% of them received interdisciplinary care. Overall, 66.1% of breast and 58.6% of colorectal cancer survivors reached the expected quality level of cancer survivorship care according to the reference standard (p < .001).

Conclusion: Medical care practices reached a high standard in a leading cancer center in Latin America. However, a much stronger psychosocial assessment and interdisciplinary care is needed to improve survivorship cancer quality care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jso.26574DOI Listing
October 2021

Impact of Screw Diameter on Pedicle Screw Fatigue Strength-A Biomechanical Evaluation.

World Neurosurg 2021 08 1;152:e369-e376. Epub 2021 Jun 1.

Department of Trauma Surgery, Orthopaedic Surgery and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany. Electronic address:

Objective: Loosening of pedicle screws is a frequently observed complication in spinal surgery. Because additional stabilization procedures such as cement augmentation or lengthening of the instrumentation involve relevant risks, optimal stability of the primarily implanted pedicle screw is of essential importance. The aim of the present study was to investigate the effect of increasing the screw diameter on pedicle screw stability.

Methods: A total of 10 human cadaveric vertebral bodies (L4) were included in the present study. The bone mineral density was evaluated using quantitative computed tomography and the pedicle diameter using computed tomography. The vertebrae underwent instrumentation using 6.0-mm × 45-mm pedicle screws on 1 side and screws with the largest possible diameter (8-10-mm × 45-mm) on the other side. Fatigue testing was performed by applying a cyclic loading (craniocaudal sinusoidal 0.5 Hz) with increasing peak force (100 N + 0.1 N/cycle) until screw head displacement of 5.4 mm was reached.

Results: The mean fatigue load was 334 N for the 6-mm diameter screws and was increased significantly to 454 N (+36%) for the largest possible diameter screws (P < 0.001). With an increase in the fatigue load by 52%, this effect was even more pronounced in vertebrae with reduced bone density (bone mineral density <120 mg/cm; n = 7; P < 0.001). The stiffness of the construct was significantly greater in the largest diameter screw group compared with the standard screw group during the entire testing period (start, P < 0.001; middle, P < 0.001; end, P = 0.009).

Conclusions: Increasing the pedicle screw diameter from a standard 6-mm screw to the largest possible diameter (8-10 mm) led to a significantly greater fatigue load.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2021.05.108DOI Listing
August 2021

The handling of SARS-CoV-2 associated deaths - infectivity of the body.

Forensic Sci Med Pathol 2021 09 2;17(3):411-418. Epub 2021 Jun 2.

Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.

The body of a deceased with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is considered infectious. In this study, we present the results of infectivity testing of the body and testing of mortuary staff for SARS-CoV-2. We performed real-time quantitative polymerase chain reaction (RT-qPCR) for SARS-CoV-2 on 33 decedents with ante mortem confirmed SARS-CoV-2 infection. Swabs of the body surface from five different body regions and from the body bag or coffin were examined. A subset of the swabs was brought into cell culture. In addition, screening of 25 Institute of Legal Medicine (ILM) personnel for ongoing or past SARS-CoV-2 infection was performed at two different time points during the pandemic. Swabs from all locations of the body surface and the body environment were negative in cases of negative post mortem nasopharyngeal testing (n=9). When the post mortem nasopharyngeal swab tested positive (n=24), between 0 and 5 of the body surface swabs were also positive, primarily the perioral region. In six of the cases, the body bag also yielded a positive result. The longest postmortem interval with positive SARS-CoV-2 RT-qPCR at the body surface was nine days. In no case viable SARS-CoV-2 was found on the skin of the bodies or the body bags. One employee (autopsy technician) had possible occupational infection with SARS-CoV-2; all other employees were tested negative for SARS-CoV-2 RNA or antibody twice. Our data indicate that with adequate management of general safety precautions, transmission of SARS-CoV-2 through autopsies and handling of bodies is unlikely.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12024-021-00379-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170863PMC
September 2021

Defective NET clearance contributes to sustained FXII activation in COVID-19-associated pulmonary thrombo-inflammation.

EBioMedicine 2021 May 14;67:103382. Epub 2021 May 14.

Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address:

Background: Coagulopathy and inflammation are hallmarks of Coronavirus disease 2019 (COVID-19) and are associated with increased mortality. Clinical and experimental data have revealed a role for neutrophil extracellular traps (NETs) in COVID-19 disease. The mechanisms that drive thrombo-inflammation in COVID-19 are poorly understood.

Methods: We performed proteomic analysis and immunostaining of postmortem lung tissues from COVID-19 patients and patients with other lung pathologies. We further compared coagulation factor XII (FXII) and DNase activities in plasma samples from COVID-19 patients and healthy control donors and determined NET-induced FXII activation using a chromogenic substrate assay.

Findings: FXII expression and activity were increased in the lung parenchyma, within the pulmonary vasculature and in fibrin-rich alveolar spaces of postmortem lung tissues from COVID-19 patients. In agreement with this, plasmaaac acafajföeFXII activation (FXIIa) was increased in samples from COVID-19 patients. Furthermore, FXIIa colocalized with NETs in COVID-19 lung tissue indicating that NETs accumulation leads to FXII contact activation in COVID-19. We further showed that an accumulation of NETs is partially due to impaired NET clearance by extracellular DNases as DNase substitution improved NET dissolution and reduced FXII activation in vitro.

Interpretation: Collectively, our study supports that the NET/FXII axis contributes to the pathogenic chain of procoagulant and proinflammatory responses in COVID-19. Targeting both NETs and FXIIa may offer a potential novel therapeutic strategy.

Funding: This study was supported by the European Union (840189), the Werner Otto Medical Foundation Hamburg (8/95) and the German Research Foundation (FR4239/1-1, A11/SFB877, B08/SFB841 and P06/KFO306).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ebiom.2021.103382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120108PMC
May 2021

[SARS-CoV‑2 incidental findings among Hamburg deaths: an epidemiological monitoring during the dynamic infection event in spring 2020].

Rechtsmedizin (Berl) 2021 Apr 20:1-7. Epub 2021 Apr 20.

Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Deutschland.

Background: In the context of the COVID-19-pandemic, mortality and incidence are key determinants to assess the transmission dynamics and the resulting potential threat. Systematic microbiological monitoring of deaths provides a fundamental basis to particularly assess underrecording of community-acquired mortality. It should be further elucidated whether a death cohort of previously unreported cases may be structurally different from the cohort of officially registered cases.

Methods: A systematic reverse transcription (RT) qPCR testing for SARS-CoV‑2 infections from nasopharyngeal swab samples was carried out. A representative sample of corpses from crematoria and the Institute of Legal Medicine of the Federal State of Hamburg were included. A comparative analysis of primarily reported and unreported fatalities in an 8‑week period after occurrence of the first pandemic-related deaths in Hamburg was performed.

Results: A total of 1231 deaths were included, all of which were previously unsuspicious for SARS-CoV‑2 infection. Thereof 29 cases of previously unknown infections were recorded. In the first phase of the pandemic, incidental findings predominantly occurred among younger people from domestic environments with unclear or unnatural manner of death at the Institute of Legal Medicine. Over time, incidental findings investigated at the crematoria increased, mostly related to nursing home residents. The overall cohort showed no significant sociodemographic differences to a comparative collective of known SARS-CoV‑2-associated deaths. Primarily unreported cases showed a significantly lower proportion of COVID-19 as the underlying cause of death.

Conclusion: A systematic PCR-based monitoring of deaths allows a more targeted detection and classification of SARS-CoV‑2 positive cases. A preventive contribution can be made by disclosing unreported pandemic-related cases of death.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00194-021-00481-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056197PMC
April 2021

Detection of SARS-CoV-2 genomic and subgenomic RNA in retina and optic nerve of patients with COVID-19.

Br J Ophthalmol 2021 Apr 9. Epub 2021 Apr 9.

Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Purpose: Presence of SARS-CoV-2 RNA in human retinal biopsies (RBs) was previously reported by us. In this consecutive study, we analysed RB and optic nerve biopsies (ONBs) in deceased patients with confirmed COVID-19 assessing viral RNA load, possible virus replication and infectivity.

Patients And Methods: In this case series, 14 eyes of 14 deceased patients with COVID-19 were enucleated during autopsy. RB and ONB were subjected to molecular detection of viral RNA, virus cultivation and immunohistochemistry. SARS-CoV-2 RNA loads were compared with RNA loads in the respective throat swabs, vitreous humour and blood samples.

Results: SARS-CoV-2 RNA was detected in 7/14 RBs and in 10/13 ONBs. While virus isolation failed and immunohistochemistry of SARS-CoV-2 spike protein was negative, subgenomic RNA (sgRNA) was detectable (40% RB; 60% ONB).

Conclusion: SARS-CoV-2 RNA is detectable in RB and ONB of patients with COVID-19. Presence of sgRNA could point to a SARS-CoV-2 infection of neuronal tissue, but as virus isolation failed and immunohistochemistry of SARS-CoV-2 spike protein was negative, an active infection seems unlikely.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjophthalmol-2020-318618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042582PMC
April 2021

Determinants of health care use among homeless individuals: evidence from the Hamburg survey of homeless individuals.

BMC Health Serv Res 2021 Apr 7;21(1):317. Epub 2021 Apr 7.

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background: To identify the determinants of health care use among homeless individuals.

Methods: Data were taken from the Hamburg survey of homeless individuals (n = 100 individuals in the here used model, mean age 44.8 years, SD 12.5) focusing on homeless individuals in Hamburg, Germany. The number of physician visits in the past 3 months and hospitalization in the preceding 12 months were used as outcome measures. Drawing on the Andersen model of health care use as a conceptual framework, predisposing characteristics, enabling resources and need factors as well as psychosocial variables were included as correlates.

Results: Negative binomial regressions showed that increased physician visits were associated with being female (IRR: 4.02 [95% CI: 1.60-10.11]), absence of chronic alcohol consume (IRR: 0.26 [95% CI: 0.12-0.57]) and lower health-related quality of life (IRR: 0.97 [95% CI: 0.96-0.98]). Furthermore, logistic regressions showed that the likelihood of hospitalization was positively associated with lower age (OR: 0.93 [95% CI: 0.89-0.98]), having health insurance (OR: 8.11 [2.11-30.80]) and lower health-related quality of life (OR: 0.97 [95% CI: 0.94-0.99]).

Conclusions: Our study showed that predisposing characteristics (both age and sex), enabling resources (i.e., health insurance) and need factors in terms of health-related quality of life are main drivers of health care use among homeless individuals. This knowledge may assist in managing health care use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12913-021-06314-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026095PMC
April 2021

Loneliness among Homeless Individuals during the First Wave of the COVID-19 Pandemic.

Int J Environ Res Public Health 2021 03 16;18(6). Epub 2021 Mar 16.

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany.

The feeling of loneliness is a major public health concern associated with multiple somatic and psychiatric illnesses. Studies have shown increasing incidence of loneliness in the general population during the first wave of the COVID-19 pandemic. Homeless individuals are a particularly vulnerable group; however, little is known about loneliness among homeless individuals. We therefore aimed to examine the prevalence of loneliness among homeless individuals during the pandemic. Furthermore, we estimated the association between loneliness and sociodemographic and lifestyle factors, as well as the self-perceived risk of contracting COVID-19. Data from the Hamburg survey of homeless individuals were used, including 151 homeless individuals that were recruited in spring of 2020. Loneliness was measured by the 3- item version of the UCLA-3 Loneliness Scale. To summarize, 48.5% of the participants experienced loneliness. Multiple linear regressions showed increased loneliness to be associated with male gender (β = 1.07, = 0.01), being single (β = 1.33, = 0.00), originating from Germany (β = 1.48, = 0.00), high frequency of sharing a sleeping space with more than three people (β = 0.42, = 0.02) and a higher self-perceived risk of contracting COVID-19 (β = 0.41, = 0.02). On the contrary, there was no association of loneliness with age, educational level, chronic alcohol consumption or frequently sharing a sleeping space. In conclusion, the magnitude of loneliness among homeless individuals during the pandemic was highlighted. Description of factors determining loneliness may help to identify homeless individuals at risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18063035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999173PMC
March 2021

Patient-Reported Outcomes Measures in Abdominal Cancer Surgery and Student-Led Surgical Research.

Ann Surg Oncol 2021 Jun 31;28(6):2941-2943. Epub 2021 Mar 31.

Resident of Surgery, University of Chile, Santiago, Chile.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1245/s10434-021-09686-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119283PMC
June 2021

Rupture Detection During Needle Insertion Using Complex OCT Data and CNNs.

IEEE Trans Biomed Eng 2021 Oct 20;68(10):3059-3067. Epub 2021 Sep 20.

Objective: Soft tissue deformation and ruptures complicate needle placement. However, ruptures at tissue interfaces also contain information which helps physicians to navigate through different layers. This navigation task can be challenging, whenever ultrasound (US) image guidance is hard to align and externally sensed forces are superimposed by friction.

Methods: We propose an experimental setup for reproducible needle insertions, applying optical coherence tomography (OCT) directly at the needle tip as well as external US and force measurements. Processing the complex OCT data is challenging as the penetration depth is limited and the data can be difficult to interpret. Using a machine learning approach, we show that ruptures can be detected in the complex OCT data without additional external guidance or measurements after training with multi-modal ground-truth from US and force.

Results: We can detect ruptures with accuracies of 0.94 and 0.91 on homogeneous and inhomogeneous phantoms, respectively, and 0.71 for ex-situ tissues.

Conclusion: We propose an experimental setup and deep learning based rupture detection for the complex OCT data in front of the needle tip, even in deeper tissue structures without the need for US or force sensor guiding.

Significance: This study promises a suitable approach to complement a robust robotic needle placement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1109/TBME.2021.3063069DOI Listing
October 2021

CT of the medial clavicular epiphysis for forensic age estimation: hands up?

Int J Legal Med 2021 Jul 24;135(4):1581-1587. Epub 2021 Feb 24.

Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.

Purpose: The aim of this study was to assess the impact of arm position in computed tomography (CT) of the clavicle performed for forensic age estimation on clavicular position, image noise, and radiation dose.

Methods And Materials: Forty-seven CT scans of the medial clavicular epiphysis performed for forensic age estimation were conducted with either hands and arms held upwards (CT 28 persons) or positioned at the body (CT, 19 persons). Presets were identical for both positions (70 mAs/140 kVp; Brilliance iCT, Philips). Each CT scan was reconstructed with an iterative algorithm (i-Dose 4) and evaluated at the middle of the sternoclavicular joint. Clavicular angle was measured on a.p. topograms in relation to a horizontal line. Quantitative image noise was measured in air at the level of medial clavicular epiphysis. Effective dose and scan length were recorded.

Results: Hands-up position compared with hands-down position resulted in a lower lateral body diameter (CT 41.1 ± 3.6 cm vs. CT 44.6 ± 3.1 cm; P = 0.03), a reduced quantitative image noise (CT: 39.5 ± 9.2; CT: 46.2 ± 8.3; P = 0.02), and lower CTDI (5.1 ± 1.4 mGy vs. 6.7 ± 1.8 mGy; P = 0.001). Scan length was longer in patients examined with hands up (HU: 8.5 ± 3.4 cm; HD: 6.2 ± 2.1 cm; P = 0.006). Mean effective dose for CT was 0.79 ± 0.32 mSv compared with 0.95 ± 0.38 mSv in CT (P = 0.12). Clavicular angle was 17° ± 6° in patients with hands down and 32° ± 7° in patients with hands up (P < 0.001).

Conclusion: By elevated arm positioning, the image quality of clavicular CT scans can be improved while maintaining radiation dose compared with hands down. Clavicular position differs according to the hand position. Thus, positioning patients with elevated hands is advisable for forensic clavicular CT examinations, but multiplanar CT reconstructions should be adjusted to clavicular position and scan length should be reduced to a minimum.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00414-021-02516-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206049PMC
July 2021

Hepatic Vasculopathy and Regenerative Responses of the Liver in Fatal Cases of COVID-19.

Clin Gastroenterol Hepatol 2021 08 29;19(8):1726-1729.e3. Epub 2021 Jan 29.

Department of General and Visceral Surgery, University Hospital OWL of the University of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany. Electronic address:

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infects the nasopharynx and lungs and causes coronavirus disease-2019 (COVID-19). It may impact the heart, brain, kidney, and liver. Although functional impairment of the liver has been correlated with worse clinical outcomes, little is known about the pathophysiology of hepatic injury and repair in COVID-19. Histologic evaluation has been limited to small numbers of COVID-19 cases with no control subjects and demonstrated largely heterogeneous patterns of pathology..
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cgh.2021.01.044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844358PMC
August 2021

Diagnostic yield of cone beam computed tomography for small foreign body detection in the hand in comparison with radiography, MSCT and MRI: an ex vivo study.

Injury 2021 Jan 15. Epub 2021 Jan 15.

Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address:

Introduction: Detection of symptomatic foreign bodies (FB) after penetrating hand injuries can be challenging. Multiplanar radiography is most frequently used for FB detection and may be complemented by multislice computed tomography (MSCT) if suspected FBs cannot be identified and clinical symptoms are persisting. Cone beam computed tomography (CBCT) is a promising imaging modality for traumatology aside from fracture detection. The aim of this study was to evaluate the diagnostic yield of CBCT for different small FBs in the hand in comparison with radiography, MSCT and magnetic resonance imaging (MRI).

Methods: In ten cadaveric hands of voluntary body donors, 20 different FBs (metal, glass, stone, wood, thorn) in predefined sizes (0.5, 1 and 2mm) were randomly placed in the central hand and the basal phalanges. All hands were imaged using radiography, 256-slice CT, CBCT, and 3T MRI. A total of 200 subcutaneous and intramuscular particles were analyzed for their visibility by two observers at two time points. The Cohens Kappa coefficient was calculated as a measure of interobserver agreement and intraobserver reliability. The particle detection rate between different imaging modalities was compared using McNemar Chi-tests.

Results: CBCT and MSCT provided a higher detection rate (94.6% and 86.3%) for detecting metal, glass and stone particles compared to standard radiography (70.0%; each p<0.001). MRI did not provide a diagnostic benefit. Wood particles and thorns were not reliably recognizable by any imaging technique. The interobserver agreement (K=0.768; p<0.001) and the intraobserver reliability for both observers (K=0.914 and K=0.907; p<0.001) were good. The dose length product (DLP) was 2-fold lower in CBCT than in MSCT (39.2 ± 2.1 vs. 81.4 ± 2.9 mGy*cm; p<0.001).

Conclusions: In this ex vivo study, CBCT provided a high detection rate for small metal, glass, and stone particles while the radiation exposure was significantly lower compared to MSCT. These results suggest that CBCT instead of MSCT seems a reasonable option in supplementary diagnostics to exclude of FBs. The primary use of CBCT instead of radiography may be considered for symptomatic patients with expected small radiopaque particles <1mm. Organic FBs can be visualized indirectly in MRI and CBCT/MSCT by entrapped surrounding air.

Level Of Evidence: Level I, diagnostic study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2021.01.017DOI Listing
January 2021

Presence of SARS-CoV-2 RNA in the Cornea of Viremic Patients With COVID-19.

JAMA Ophthalmol 2021 04;139(4):383-388

Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Importance: Current recommendations are to avoid tissue for corneal transplant from donors with coronavirus disease 2019 (COVID-19) or those who were recently exposed to COVID-19 owing to the lack of knowledge about the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in corneal tissues. Evidence of SARS-CoV-2 in corneal tissue would seem to have clinical relevance for corneal transplant.

Objectives: To investigate the presence of viral SARS-CoV-2 RNA in corneal discs of deceased patients with confirmed COVID-19 and assess viral genomic and subgenomic RNA load, possible infectivity, and histologic abnormalities.

Design, Setting, And Participants: A case series was conducted of 11 deceased patients with COVID-19 who underwent autopsy between March 20 and May 14, 2020. Eleven corneal discs (1 corneal disc per patient) were harvested for molecular detection of viral genomic and subgenomic RNA, virus isolation, and immunohistochemistry. The SARS-CoV-2 RNA loads were compared with RNA loads in the conjunctival and throat swab samples and aqueous humor, vitreous humor, and blood samples.

Main Outcomes And Measures: Evidence of SARS-CoV-2 RNA in human corneas.

Results: This study comprised 11 patients (6 women [55%]; mean [SD] age, 68.5 [18.8] years). In 6 of 11 eyes (55%), SARS-CoV-2 genomic RNA was detected in the cornea; subgenomic RNA was present in 4 of these 6 eyes (67%). Infectivity or the presence of viral structural proteins could not be confirmed in any eye. However, patients whose corneal disc was positive for SARS-CoV-2 RNA also had positive results for SARS-CoV-2 RNA in 4 of 6 conjunctival swab samples, 1 of 3 aqueous humor samples, 3 of 5 vitreous humor samples, and 4 of 5 blood samples. Overall, conjunctival swab samples had positive results for SARS-CoV-2 RNA in 5 of 11 cases. Postmortem SARS-CoV-2 viremia was detected in 5 of 9 patients.

Conclusions And Relevance: Viral genomic and subgenomic RNA of SARS-CoV-2 was detected in the cornea of patients with COVID-19 viremia. The risk of COVID-19 infection via corneal transplant is low even in donors with SARS-CoV-2 viremia, but further research is necessary to assess the rate of SARS-CoV-2 transmission via corneal transplant.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2020.6339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821081PMC
April 2021

Prevalence of alcohol consumption among seafarers and fishermen.

Int Marit Health 2020 ;71(4):265-274

Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.

Background: Over the decades, several published studies showing the relevance of alcohol use among seafarers/fishermen have highlighted the dangers of alcohol consumption during working time. The present study aims to provide an up-to-date overview of the prevalence of alcohol consumption among seafarers/fishermen. It also points out their consumption behaviour, depending on socio-demographic and job-related factors.

Materials And Methods: To detect relevant studies for this systematic review, the electronic database PubMed was searched. All identified studies published between January 2014 and September 2019 were included using the subsequent terms: (alcohol OR ethanol) AND (seafarer OR fishermen OR ship crew OR merchant ship).

Results: According to the applied search string, 18 studies were identified. Thirteen of them were selected for this review. The results of the studies about alcohol consumption among seafarers and fishermen showed a wide range of prevalence, from 11.5% to 89.5% (median 53.0%). Concerning seafarers no stratified data were available for further analyses. Among fishermen alcohol consumption has decreased over the period examined (56.9% [2010-2014] vs. 42.3% [2015-2018]). The evaluation of socio-demographic factors showed alcohol consumption was less prevalent in fishermen > 60 years (15.0%). Furthermore, a higher prevalence of alcohol intake was found in those with a lower education (63.9%). In respect of job-related data, 61.0% of the alcohol consuming fishermen reported they had been involved in an accident due to alcohol consumption.

Conclusions: The consumption of alcohol among fishermen has declined over time. Compared with the landbased European population, seafarers and fishermen show a lower prevalence of alcohol use, at least during their stay on board. Due to the limited data available - especially concerning seafarers - further studies on the prevalence of alcohol consumption among shipboard crews are recommended. In particular, these should provide more data on alcohol consumption related to socio-demographic and job-related factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/IMH.2020.0045DOI Listing
September 2021

Postmortem Stability of SARS-CoV-2 in Nasopharyngeal Mucosa.

Emerg Infect Dis 2021 01 16;27(1). Epub 2020 Dec 16.

Analyses of infection chains have demonstrated that severe acute respiratory syndrome coronavirus 2 is highly transmissive. However, data on postmortem stability and infectivity are lacking. Our finding of nasopharyngeal viral RNA stability in 79 corpses showed no time-dependent decrease. Maintained infectivity is supported by virus isolation up to 35 hours postmortem.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3201/eid2701.203112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774572PMC
January 2021
-->