University Hospital Hamburg-Eppendorf Research Articles

High incidence of periodontitis in patients with ascitic decompensated cirrhosis.

Periodontitis has been associated with various liver diseases. However, the relevance of periodontitis in the progression of decompensated cirrhosis remains inconclusive. In particular, it is unclear whether the common periodontitis pathogens, Porphyromonas gingivalis (P. gingivalis) and Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans), can be detected not only in the oral mucosa but also in ascites and stool. To investigate the significance of periodontitis, P. gingivalis, and A. actinomycetemcomitans in cirrhosis patients with ascitic decompensation. This prospective study was conducted at the University Hospital Hamburg-Eppendorf, a tertiary center in Northern Germany. A cohort of 27 patients with ascitic decompensated liver cirrhosis underwent dental examinations to assess the association between periodontitis and various clinical parameters of cirrhosis, as well as patient outcomes. PCR was used to test gingival samples, ascites, and stool for the presence of P. gingivalis and A. actinomycetemcomitans. Gingival samples were collected by probing the deepest gum pocket of a sextant and wiping them on a cotton swab. Periodontitis was diagnosed in 22 out of 27 (82%) ascite patients, which is significantly more common than in a control cohort of 100 unselected patients (59%, P = 0.04). P. gingivalis was detected in the gingiva of six patients, and one of them also had P. gingivalis in their stool. However, P. gingivalis was not found in the ascites of any patient. Five out of six patients with P. gingivalis had periodontitis (83%). A. actinomycetemcomitans was not detected in any sample. Patients without periodontitis had a significantly higher mortality rate compared to those with periodontitis, and survival (Kaplan-Meier analysis) was longer in patients with periodontitis (P = 0.02). Transplant-free survival was also more common in patients with periodontitis compared to those without (63% vs 0%, P = 0.02). Decompensated cirrhotic patients frequently suffer from periodontitis. However, there was no evidence of the translocation of P. gingivalis or A. actinomycetemcomitans into ascites. The survival of cirrhotic patients with periodontitis was not reduced.

Patients Satisfied with Care Report Better Quality of Life and Self-Rated Health—Cross-Sectional Findings Based on Hospital Quality Data

Satisfaction with care is an important indicator of health care quality. However, if this process measure is associated with patients' outcomes in real-world data is largely unknown. We, therefore, aimed to evaluate if satisfaction with physician- and nurse-related care is associated with quality of life and self-rated health among inpatients at the University Hospital Hamburg-Eppendorf in Germany. We used standard hospital quality survey data of 4925 patients treated at various departments. We used multiple linear regressions to examine an association between satisfaction with staff-related care and quality of life as well as self-rated health, adjusted for age, gender, mother tongue, and treating ward. Patients rated their satisfaction with physician- and nurse-related care from 0 "not at all" to 9 "very much". The outcomes regarding quality of life and self-rated health were evaluated on five-point Likert scales ranking from 1 "bad" to 5 "excellent". We found that satisfaction with physician-related care was positively associated with quality of life (ß = 0.16; p < 0.001) as well as with self-rated health (ß = 0.16; p < 0.001). Similar findings were observed for satisfaction with nurse-related care and the two outcomes (ß = 0.13; p < 0.001 and ß = 0.14; p < 0.001, respectively). We show that patients who are more satisfied with staff-related care report better quality of life and self-rated health than patients less satisfied with care. Thus, patient satisfaction with care, is not only a process measure indicating the quality of care but is also positively associated with patient-reported outcomes.

Use of Process Modelling for Optimization of Molecular Tumor Boards

In Molecular Tumor Boards, a team of experts discuss the individual therapy options of a cancer patient based on their individual molecular profile. The process—from recommendation request, through molecular diagnosis, to a personalized therapy recommendation—is complex and time-consuming. Therefore, process optimization is needed to decrease the workload of physicians and to standardize the process. For this purpose, we modeled the current workflow of the Molecular Tumor Board at the University Hospital Hamburg-Eppendorf on Service-Oriented Architecture using Business Process Modeling and Notation to highlight areas for improvement. This identified many manual tasks and an extensive workload for the physician. We then created a novel, simplified, more efficient workflow in which the physician is supported by additional software. In summary, we show that the use of Service-Oriented Architecture using Business Process Modeling and Notation for Molecular Tumor Board processes promotes rapid adaptability, standardization, interoperability, quality assurance, and facilitates collaboration.

Lack of Evidence for an Association between Previous HEV Genotype-3 Exposure and Glomerulonephritis in General.

Among numerous other immune-mediated diseases, glomerulonephritis has also been suspected to be an extrahepatic manifestation of HEV infection. In this prospective study, we tested 108 patients with glomerulonephritis and 108 age- and sex-matched healthy controls at the University Hospital Hamburg Eppendorf, Hamburg, Germany, for anti-HEV IgG (Wantai test) as a marker for previous HEV exposure. A total of 24 patients (22%) tested positive for anti-HEV IgG. Males tended to be more frequently anti-HEV IgG positive (29%) in comparison to females (16%). However, this does not reach statistical significance (p = 0.07). Anti-HEV IgG positive patients were older in comparison to negative patients (mean 53 vs. 45 years, p = 0.05). The kidney function seems to be slightly decreased in anti-HEV IgG positive patients in comparison to and anti-HEV IgG negative patients basing on creatinine (p = 0.04) and glomerular filtration rate (GFR) (p = 0.05). Slightly higher values of bilirubin could be found in IgG positive patients (p = 0.04). Anti-HEV-IgG seropositivity rate (22%) in glomerulonephritis patients, did not differ significantly in comparison to an age- and sex-matched control cohort of healthy blood donors (31/108 positive, 29%). A total of 2/2 patients with membranoproliferative glomerulonephritis (MPGN) tested anti-HEV IgG positive (p = 0.002 in comparison to glomerulonephritis patients with other subtypes). In conclusion, our findings indicate that previous HEV exposure in a region where GT3 is endemic is not associated with glomerulonephritis in general. However, the subgroup of MPGN patients should be investigated in future studies. Furthermore, future studies are needed to investigate whether the observed association between anti-HEV IgG positivity and reduced GFR in glomerulonephritis patients is HEV associated or is an age-related effect.

Abstract 10637: A Pooled Multi-National Validation Study of a Machine Learning, High-Sensitivity Troponin-Based Multi-Proteomic Model to Predict the Presence of Obstructive Coronary Artery Disease as Compared to High Sensitivity Troponin Alone in a Subset of Patients with Diabetes

Introduction: Diabetes Mellitus (DM) is a major risk factor for coronary artery disease (CAD) associated with a two-fold increase in mortality. We aimed to validate the performance of a machine learning based multi-biomarker diagnostic panel to predict obstructive coronary artery disease (oCAD) compared to high-sensitivity cardiac troponin-I (hs-cTnI) alone in a subset of patients with DM. Methods: A previously developed multiple biomarker scoring model was utilized. The pooled cohort included 132 patients at Inova Fairfax Hospital, 69 patients at Massachusetts General Hospital and 46 patients at the University Hospital Hamburg-Eppendorf with a mixture of acute and lesser acute presentations. Three clinical factors (sex, age, and previous coronary percutaneous intervention) and three biomarkers (hs-cTnI, Adiponectin, and Kidney Injury Molecule-1) were combined. oCAD was defined as &gt;50% coronary obstruction in at least one coronary artery (for the University Hospital Hamburg-Eppendorf cohort) or &gt;70% coronary obstruction in at least one coronary artery (for the other two cohorts). The multiple biomarker diagnostic panel’s performance to predict oCAD was also compared to hs-cTnI alone. Results: The multiple protein panel had an area under the receiver-operating characteristic curve of 0.77 (95% CI, 0.70, 0.84, p &lt;0.001) for the presence of oCAD (Figure 1). At optimal cutoff, the score had 79% sensitivity, 57% specificity, and a positive predictive value of 81% for oCAD. The multiple biomarker panel had a diagnostic odds ratio of 4.82 (95% CI 2.68, 8.67, p&lt;0.01). In comparison, in patients without an acute MI, hs-cTnI alone had an area under the receiver-operating characteristic curve of 0.53 (95% CI, 0.49, 0.57, p = 0.253) for oCAD (Figure 1). Conclusions: In this multinational pooled cohort, a previously described novel machine learning, multiple protein biomarker panel provided high accuracy to diagnose patients for oCAD in a subset of patients with DM.

A pooled multi-national validation study of a machine learning, high-sensitivity troponin-based multi-proteomic model to predict the presence of obstructive coronary artery disease

Abstract Background Undetected obstructive coronary artery disease (oCAD) is a global health problem associated with significant morbidity and mortality. A need exists for an accurate and easily accessible diagnostic test for oCAD. Using machine learning, a multi-biomarker blood diagnostic test for oCAD based on high-sensitivity cardiac troponin-I (hs-cTnI) has been developed. Purpose To validate the performance of a previously developed, algorithmically weighted, multiple protein diagnostic panel to diagnose oCAD in a pooled multi-national cohort and to compare the diagnostic panel's performance to predict oCAD to hs-cTnI alone. Methods Three clinical factors (sex, age, and previous coronary percutaneous intervention) and three biomarkers (hs-cTnI, Adiponectin, and Kidney Injury Molecule-1) were combined. hs-cTnI blood samples were assayed on the Siemens Atellica and Abbott Diagnostics ARCHITECT immunoassay platforms. Adiponectin and Kidney Injury Molecule-1 were measured with a multiplex assay on blood samples via the Luminex 100/200 xMAP platform. Individual data from a total of 924 patients with a mixture of acute and lesser acute presentations from three centers were pooled (Table 1). oCAD was defined as &amp;gt;50% coronary obstruction in at least one coronary artery (for the University Hospital Hamburg-Eppendorf cohort) or &amp;gt;70% coronary obstruction in at least one coronary artery (for the other two cohorts). The multiple biomarker diagnostic panel's performance to predict oCAD was also compared to hs-cTnI alone. Results The multiple protein panel had an area under the receiver-operating characteristic curve of 0.80 (95% CI, 0.77, 0.83, p&amp;lt;0.001) for the presence of oCAD (Figure 1). At optimal cutoff, the score had 74% sensitivity, 72% specificity, and a positive predictive value of 81% for oCAD. The multiple biomarker panel had a diagnostic odds ratio of 7.48 (95% CI 5.55, 10.09, p&amp;lt;0.001). In comparison, in patients without an acute MI, hs-cTnI alone had an area under the receiver-operating characteristic curve of 0.63 (95% CI, 0.60, 0.67, p&amp;lt;0.001)) for oCAD (Figure 1). Conclusions In this multinational pooled cohort, a previously described novel machine learning, multiple biomarker panel provided high accuracy to diagnose patients for oCAD. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Prevencio, Inc. Table 1. Pooled Variable DataFigure 1. ROC for HART CADhs and hs-cTnI

Salvage chemotherapy with cisplatin, ifosfamide, and paclitaxel in metastatic castration-resistant prostate cancer.

123 Background: Recent developments in the treatment of metastatic castration resistant prostate cancer (mCRPC) lead to a revival of platinum-based chemotherapy demonstrating increased activity in patients with aggressive variants of disease. Here, we report on the results of a combinational salvage therapy with cisplatin, ifosfamide and paclitaxel (TIP) in mCRPC. Methods: We retrospectively analyzed patients with mCRPC treated with TIP at the University Hospital Hamburg-Eppendorf between November 2013 and September 2020. Accompanying in vitro analyses were performed using human prostate carcinoma cell lines harboring different levels of drug resistance including the docetaxel-resistant sublines PC3-DR and DU45-DR. Results: In total, 17 mCRPC patients treated with TIP were eligible for efficacy analyses with a median age of 65 yrs. At baseline, liver metastases were present in 88%, metastases of other visceral sides (lung, adrenal gland, brain) in 47% and bone metastases in 76% of the patients. Median hemoglobin was 9.8mg/dl, LDH 903 U/l and AP 205 U/l. Median PSA value was 77 ng/ml covering a wide range including three patients with a PSA-value below 1ng/ml. NSE was evaluated in 83% of the patients (median 38,5 U/l). Patients were extensively pretreated with a median of three treatment lines before TIP (100% docetaxel, 82% abirateron and/or enzalutamide, 47% cabazitaxel, 41% others). A median of 3,5 cycles of TIP were applied with 29% of the patients receiving the maximum of 6 cycles. Four patients discontinued treatment due to side effects (PNP, infection, ifosfamide induced psychosis). At interim analyses, 59 % of the patients showed a radiological response or stable disease with only one patient progressing till the end of treatment. Median PFS was 2.5 months, median OS 6 months. A decrease of PSA &gt; 30% and LDH &gt; 50% was observed in 41% and 35% of the patients, respectively. In vitro experiments revealed additive effects of TIP in 22Rv1, LNCaP and DU45 cells and synergistic effects in neuroendocrine LASCPC-01 cells. In PC3 cells, TIP induced antagonistic effects at lower doses, whereas dose-independent additive effects were observed in docetaxel-resistant PC3-DR. Surprisingly, preliminary data of combined therapies with different drug pairs suggest an antagonistic effect of paclitaxel in the combination with both, cisplatin and ifosfamide. Conclusions: Combinational therapy with cisplatin, ifosfamide and paclitaxel showed promising activity in some patients with aggressive mCRPC. Preclinical data suggest that the drug combination of cisplatin and ifosfamide rule the efficacy of TIP in mCRPC.

Regional Lymph Node Metastasis on Prostate Specific Membrane Antigen Positron Emission Tomography Correlates with Decreased Biochemical Recurrence-Free and Therapy-Free Survival after Radical Prostatectomy: A Retrospective Single-Center Single-Arm Observational Study.

We sought to address the impact of preoperative prostate specific membrane antigen (PSMA) positron emission tomography (PET) findings prior to radical prostatectomy and pelvic lymph node dissection on biochemical recurrence and time to adjuvant or salvage treatment. Between 2013 and 2017, 64 intermediate and 166 high risk (230) prostate cancer patients received 68Ga-PSMA-11 PET followed by radical prostatectomy and pelvic lymph node dissection. Biochemical recurrence-free and therapy-free survivalwere determined. For all time-to-event analyses, univariable and multivariable Cox proportional hazards models and univariable Kaplan-Meier analyses were applied, with a significance threshold of p <0.05. The overall sensitivity, specificity, positive predictive value and negative predictive value of PSMA PET for pN1 disease was 48.5%, 95.7%, 82.1% and 82.2%, respectively. Median followup was 30.2 months. Biochemical recurrence occurred in 50.4% (116) of patients and adjuvant or salvage treatment was performed in 46.5% (107). Worst biochemical recurrence-free and therapy-free survival was observed in pN1 patients who also exhibited PSMA PET positive lymph node, followed by pN1 patients without PSMA PET positive lymph node and patients without evidence of lymph node metastasis on histology and PSMA PET (median biochemical recurrence-free survival 1.7 vs. 7.5 vs. >36 months, median therapy-free survival 2.6 vs. 8.9 vs. >36 months). Patients with positive lymph node on PSMA PET prior to radical prostatectomy have to expect early biochemical recurrence and adjuvant/salvage therapy, despite thorough pelvic lymph node dissection. Therefore, results from PSMA PET can be used for patients' consultation and more stringent followup as well as for planning of neoadjuvant/adjuvant therapy.

Circulating Vitamin D and Selenium Levels and Outcome in Prostate Cancer Patients: Lessons from the MARTINI-Lifestyle Cohort

BackgroundDietary agents, in particular vitamin D (Vit D) and selenium, are widely used by prostate cancer (PCa) patients to improve cancer outcomes. ObjectiveTo investigate whether plasma Vit D and selenium levels prior to radical prostatectomy (RP) are associated with worse pathologic tumor characteristics and increased risk of disease recurrence. Design, setting, and participantsA total of 3849 men with PCa scheduled for RP in the Martini-Klinik at the University Hospital Hamburg-Eppendorf, Hamburg, Germany, between January 2014 and December 2018 were included in this study. Outcome measurements and statistical analysisAge, and clinical and laboratory values were collected prior to RP. Biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) ≥0.2 μg/l and rising after RP. Kaplan-Meier plots depicted BCR-free survival. Cox regression models (adjusted for age, preoperative PSA, pT stage, pN stage, pGG, surgical margin status, and year of surgery) tested the relationship between oncologic outcomes and Vit D and selenium levels. Results and limitationsMedian plasma Vit D and selenium levels were 19.3 and 71 μg/l, respectively. Circulating Vit D and selenium levels correlated inversely with PSA values. Histologic grade, pT stage, and pN stage were not associated with Vit D and selenium levels at the time of RP. In the overall cohort, BCR-free survival at 3 yr of follow-up was 82.9%. When stratified according to median Vit D levels, BCR-free survival at 3 yr of follow-up was 82.7% and 83.0% (p ≤ 0.59). Upon stratification according to median selenium levels, BCR-free survival was 82.2% and 83.7% (p = 0.19). In a multivariable Cox regression model predicting BCR, lower Vit D and selenium levels were not independent predictors of BCR. ConclusionsPlasma Vit D and selenium levels prior to RP were not associated with BCR-free survival. Patient summaryThe results of the MARTINI-Lifestyle cohort could not show a correlation between the occurrence of biochemical recurrence of prostate cancer after radical prostatectomy and the serum levels of vitamin D and selenium. A recommendation should therefore be made to compensate for a potential deficiency and not with the expectation of a reduction in the risk of progression.

Is Standardization Transferable? Initial Experience of Urethral Surgery at the University Hospital Frankfurt.

Background: Since January 2018 performance of urethroplasties is done on regular basis at the University Hospital Frankfurt (UKF). We aimed to implement and transfer an institutional standardized perioperative algorithm for urethral surgery (established at the University Hospital Hamburg-Eppendorf—UKE) using a validated Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) in patients undergoing urethroplasty at UKF.Materials and Methods: We retrospectively analyzed all patients who underwent urethroplasty for urethral stricture disease between January 2018 and January 2020 at UKF. All patients were offered to revisit for clinical follow-up (FU) and completion of USS-PROM. Primary end point was stricture recurrence-free survival (RFS). Secondary endpoints were functional outcomes, quality of life (QoL), and patient satisfaction.Results: In total, 50 patients underwent urethroplasty and 74 and 24% had a history of previous urethrotomy or urethroplasty, respectively. A buccal mucosal graft urethroplasty was performed in 86% (n = 43). After patient's exclusion due to lost of FU, FU <3 months, and/or a pending second stage procedure, 40 patients were eligible for final analysis. At median FU of 10 months (interquartile-range 5.0–18.0), RFS was 83%. After successful voiding trial, the postoperative median Qmax significantly improved (24.0 vs. 7.0 mL/s; p < 0.01). Conversely, median residual urine decreased significantly (78 vs. 10 mL; p < 0.01). Overall, 95% of patients stated that QoL improved and 90% were satisfied by the surgical outcome.Conclusions: We demonstrated a successful implementation and transfer of an institutional standardized perioperative algorithm for urethral surgery from one location (UKE) to another (UKF). In our short-term FU, urethroplasty showed excellent RFS, low complication rates, good functional results, improvement of QoL and high patient satisfaction. PROMs allow an objective comparison between different centers.

Editorial Comment.

No AccessJournal of UrologyAdult Urology1 Feb 2021Editorial CommentThis article comments on the following:Clinical Utility of 4Kscore®, ExosomeDx™ and Magnetic Resonance Imaging for the Early Detection of High Grade Prostate Cancer Derya Tilki Derya TilkiDerya Tilki Department of Urology, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001361.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 205(2), p. 460 Reference 1. : EAU - EANM - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer. European Association of Urology 2020. Available at https://uroweb.org/guideline/prostate-cancer/. Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology8 Sep 2020Clinical Utility of 4Kscore®, ExosomeDx™ and Magnetic Resonance Imaging for the Early Detection of High Grade Prostate Cancer Volume 205Issue 2February 2021Page: 460-460 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Derya Tilki Department of Urology, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Expand All Advertisement PDF downloadLoading ...

Evaluation of the Cost of Survivorship Care After Allogeneic Hematopoeitic Stem Cell Transplantation-An Analysis of 2 German Transplantation Centers.

The aim of the presented study was to analyze the care expenditure for outpatients after allogeneic hematopoietic stem cell transplantation (alloHSCT) done in accordance with the national, European guidelines and the German Social Law. We performed an analysis of the National and European survivorship care guidelines and in parallel recorded the time expenditure and staff costs separated according to different occupational groups involved in outpatient care at two German transplantation centers [University Hospital Regensburg (UKR) and University Hospital Hamburg-Eppendorf (UKE)]. In addition, we performed a comparison of real costs vs. reimbursed costs according to the standard rating benchmark catalog (EBM), which was supplemented by a survey of German transplantation centers. The results showed that the staff costs are only covered by the EBM for patients without complications during long-term follow-up care—notably, this accounts for 15% of alloHSCT patients. Staff costs for patients requiring treatment of graft-vs.-host disease or relapse of the malignant underlying malignancy exceed to the factor 6.5 (UKR) to 12 (UKE) of the EBM revenue, caused both by the increased duration and frequency of the outpatient visits. As a result of the survey at German transplant centers, 15 out of 18 responding centers reported a lack of cost coverage for follow-up care. Two/15 centers reported that survivorship care is limited to a restricted time, independent of patient's needs, due to a lack of cost reimbursement. The results show that alloHSCT survivorship care of patients requires significant staff resources, which are not covered by the current version of the German EBM catalog. New approaches to finance labor intensive after care of transplant patients are required.

Martini-Klinik experience of prostate cancer surgery during the early phase of the COVID-19 pandemic.

Martini-Klinik experience of prostate cancer surgery during the early phase of the COVID-19 pandemic.

Reliability of Paper-Based Routine Documentation in Psychiatric Inpatient Care and Recommendations for Further Improvement.

Background: Health services research is of increasing importance in current psychiatry. Therefore, large datasets and aggregation of data generated by electronic routine documentation due to legal, financial, or administrative purposes play an important role. However, paper-based routine documentation is still of interest. It remains relevant in less developed health care systems, in emergency settings, and in long-term retrospective and historical studies. Whereas studies examining the reliability of electronic routine documentation support the application of routine data for research purposes, our knowledge regarding reliability of paper-based routine documentation is still very sparse. Methods: Basic documentation (BADO) was completed on paper forms and digitalized manually for all inpatients of the Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Germany, treated within the time period from 1998 to 2006. Four hundred twelve cases of first-episode psychosis patients were chosen for comparison with clinical data from paper-based patient files. The percentage of missing information, the percentage of correct classifications, sensitivity, and positive predictive value were calculated for all applicable variables. Results: In eight cases (1.9%), a BADO form was available, but was not filled in. In 37 cases (7.0%), the patient files were lost and could not be obtained from the centralized archive. Routine data were available for all other cases in 20 (58.8%) of the examined 34 variables, and the percentage of missing data for the remaining variables ranged between 0.3% and 22.9%, with only the variables education and suicidality during treatment having more than 5% missing data. In general, the overall rate of correct classifications was high, with a median percentage of 86.4% to 99.7% for the examined variables. Sensitivity was above 75% for eight and <75% but above 50% for six of the examined 17 variables. Values for the positive predictive value were above 75% for nine and <75% but above 50% for three variables. Conclusion: In summary, paper-based routine documentation reaches acceptable reliability, but this is dependent on the chosen documentation categories and variables. Based on the present findings, paper-based routine documentation can indeed be used for quality management, organizational development, and health services research. Its limitations, however, have to be kept in mind.

The double exclusion of the pathologist and Nazi victim Paul Kimmelstiel (1900-1970). German version

The Hamburg pathologist Paul Kimmelstiel (1900-1970) gave his name to diabetic glomerulosclerosis (Kimmelstiel-Wilson syndrome) and thus conquered aplace in the history of medicine. Far less known, however, is the fact that Kimmelstiel was one of the Jewish victims of the Third Reich. He was dismissed in 1933, saw himself forced to emigrate in 1934, and fought for "rehabilitation" ("Wiedergutmachung") after 1945.The present article focuses on Kimmelstiel's role as apolitically persecuted and disenfranchised Jew.It examines (1)the background to his dismissal and forced emigration, (2)the question of "compensation" for his deprivation in postwar Germany, but also (3)the interactions between this racially motivated exclusion and biographical uprooting on one hand and the subsequent, highly remarkable international career development on the other.The study is based on previously unknown archival sources and on areanalysis of the relevant research literature.This paper concludes that Kimmelstiel's emigration took place under traumatic circumstances. More astonishing is the fact that he quickly developed into ahighly respected and famous exile scientist. However, the political and professional treatment of Kimmelstiel in post-war Germany was much less favorable. His efforts for rehabilitation were only partially successful, taking along time and requiring considerable efforts. Only laying aStolperstein monument in front of the University Hospital Hamburg-Eppendorf in 2014 marked aprovisional, conciliatory conclusion in dealing with the victim Paul Kimmelstiel.

Poor Adherence to International Cancer Prevention Recommendations Among Patients With Prostate Cancer: First Results From the MARTINI-Lifestyle Cohort

BackgroundPromotion of a healthy lifestyle in patients with prostate cancer (PCa) has gained traction to increase patient investment in his/her health care practices, improve patient quality of life, and improve survival outcomes. ObjectiveTo investigate adherence of patients with PCa to healthy lifestyle recommendations from the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR). Design, setting, and participantsA total of 2227 men with PCa scheduled for radical prostatectomy in the Martini-Klinik at the University Hospital Hamburg-Eppendorf, Hamburg, Germany between January 2016 and December 2017. Outcome measurements and statistical analysisAge and clinical characteristics were collected at the time of the diagnosis. Assessment of diet and physical activity data were obtained via e-mail surveys using validated questionnaires developed for the European Prospective Investigation into Cancer and Nutrition (EPIC) study [food frequency questionnaire, version 2 (FFQ2), EPIC-Physical Activity Questionnaire (EPIC-PAQ)]. Baseline characteristics were calculated as means and standard deviations for continuous data or counts and percentages for categorical data. Results and limitationsPatients followed 3.3 (±1.5) of the 10 WCRF/AICR recommendations. None of the participants reached all goals; 67.3% of the patients did not fulfill the criteria of a healthy normal weight, 33.5% reported no exercise at all, and 49.6% were characterized as current or ex-smokers. As to nutritional goals, 75.4% did not meet the recommended intake of meat, 88.8% reported a low consumption of fruit and vegetables, and 86% did not achieve the recommended fiber intake. Because these analyses are based on self-reported data of diet and lifestyle, a bias toward underreporting cannot be excluded. ConclusionsFirst results of the MARTINI-Lifestyle cohort show that adherence to the AICR/WCRF recommendations for cancer prevention is poor. Patient summaryPatients with prostate cancer scheduled for surgery do not adhere to cancer prevention guidelines. Thus, improving lifestyle habits may provide significant impact on patient health and quality of life.

The Potential of Whole-Exome Sequencing (WES) in Neuropediatric Patients: Single-Center Experience at the University Hospital Hamburg Eppendorf

The Potential of Whole-Exome Sequencing (WES) in Neuropediatric Patients: Single-Center Experience at the University Hospital Hamburg Eppendorf

Non-optic glioma in adults and children with neurofibromatosis 1

BackgroundNon-optic gliomas occur in 5% of children with NF1, but little is known about these tumours in adults. We aimed to investigate progression, spontaneous regression and the natural history of non-optic gliomas in adults and compare these findings to the results found in children.ResultsOne thousand seven hundred twenty-two brain MRI scans of 562 unselected individuals with NF1 were collected at the NF outpatient department of the University Hospital Hamburg-Eppendorf between 2003 and 2015. The number of scans per patient ranged from one to 12; patients were followed for a median of 3.7 years. We identified 24 patients (4.3%) with non-optic gliomas. Median age at first scan with glioma was 21.2 years, much higher than in previous publications. Only seven of the 24 non-optic glioma patients were symptomatic. Five of 24 patients had multiple non-optic gliomas. Four individuals developed a new tumour, and 4 cases showed progression. The risk of new tumour development was 0.19% (95% confidence interval 0.06% to 0.52%) per patient year of follow-up for patients over 10 years. The rate of progressing non-optic gliomas per patient year of follow-up in the first 5 years after tumour diagnosis was 4.7% (95% confidence interval 1.5% to 12%).ConclusionsNon-optic gliomas are twice as common in an unselected cohort of NF1 patients as previously reported. This is likely due to increased frequency of diagnosis of asymptomatic tumours when routine MRIs are performed and a higher prevalence in older individuals.

Role models play the greatest role - a qualitative study on reasons for choosing postgraduate training at a university hospital.

Objective: Why physicians choose a certain specialty at a university hospital for their postgraduate training is incompletely understood. Our aim was to identify factors that led physicians from different generations to opt for postgraduate training in a specialty with high or low patient contact at a university hospital. Methods: We conducted 14 semi-structured interviews with residents and attending physicians from the departments of Internal Medicine (high patient contact) and Laboratory Medicine (low patient contact) at the University Hospital Hamburg-Eppendorf, Germany. We used template analysis to code the interview transcripts and iteratively reduced and displayed the data. Initial codes and concepts were shaped into categories until agreement on the final template was reached.Results: We identified five main categories of factors that influenced postgraduate specialty selection. Role models with a civilized code of behavior and expertise in their specialty had had the greatest influence on participants’ choice of a specialty across generations. Electives and a doctoral thesis project had also influenced participants’ decisions, mainly because of meeting a role model in their supervisor. Patient contact and intellectual challenges were identified as contributing factors in the selection of a specialty with high patient contact. As reasons for selecting a university hospital for postgraduate education four categories were identified: the possibility to participate in scientific research, a broad spectrum of activities, personal contacts and future career opportunities.Conclusions: The professional attitudes of teachers as role models were identified as having the greatest influence on postgraduate education choices. Besides other actions to attract students to certain specialties for their postgraduate education, the aspect of being perceived as a role model while teaching requires particular attention when preparing medical faculty for undergraduate medical teaching.

BCP crystals induce hypertrophic differentiation of chondrocytes by activating canonical wnt signaling

T. Kraft1, L. Godmann1, T. Hawellek2, J. Hubert2, Y. Nitschke3, F. Liote4, T. Pap1, J. Bertrand1 1 Institute for Experimental Musculoskeletal Medicine, University Hospital Munster, Germany 2 Centre for Orthopaedics and Trauma Surgery Bad Bramstedt, University Hospital Hamburg-Eppendorf, Germany 3 Department of Pedriatricts, Childrens Hospital Munster, Germany 4 University Paris Diderot, Sorbonne Paris Cite, Inserm, UMR 606, Paris, France BCP crystals induce hypertrophic differentiation of chondrocytes by activating canonical WNT signaling