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Lässt sich die verbliebene Selbstständigkeit von Pflegeheimbewohnern in kognitiver und funktioneller Hinsicht erhalten und fördern? Über die Möglichkeiten und Grenzen des Selbstständigkeitserhaltes durch geeignete therapeutische Methoden bei bereits pflegebedürftigen Bewohnern von Einrichtungen der stationären Altenhilfe ist wenig bekannt. Deshalb wurde im Rahmen des Forschungsprojektes “Rehabilitation im Altenpflegeheim” die Anwendbarkeit und Effektivität eines rehabilitativen Interventionsansatzes bei einer Pflegeheimklientel untersucht. Hierzu wurden an einer Stichprobe von 294 Bewohnern von Pflegeheimen im Alter von 70-99 Jahren psychologische, funktionelle und medizinische Variablen als Faktoren der Selbstständigkeit vor allem in den Bereichen der Aktivitäten des täglichen Lebens über einen Interventionszeitraum von 12 Monaten zu drei Zeitpunkten untersucht. Der Interventionsansatz geht aus den theoretischen und praktischen Ergebnissen der SimA-Studie (SimA = Selbstständig im Alter) (Oswald et al., seit 1991) hervor und berücksichtigt die Erkenntnisse aktueller geriatrischer und gerontopsychiatrischer Therapie- und Rehabilitationsstudien. Grundlage der Intervention stellt gemäß der Erkenntnisse der SimA-Studie eine Kombination aus kognitiver und körperlicher Aktivierung dar. Zusätzlich wurde für demenziell stärker eingeschränkte Pflegeheimbewohner ein spezifisch biographisch ausgerichtetes Aktivierungskonzept erarbeitet. Die Untersuchungsergebnisse zeigen signifikante Therapieeffekte auf kognitive und funktionelle Parameter sowie einen Transfer der Therapieinhalte auf Aktivitäten des täglichen Lebens und die Sturzhäufigkeit der Teilnehmer.

Spinal cord injury (SCI) results in lifelong paralysis due to the poor regenerative capability of the central nervous system and the hostile microenvironment that is created from processes such as inflammation, scarring, axonal dieback, and demyelination. Hydrogel scaffolds facilitate a permissive regenerative environment and overcome these barriers by reducing scarring. One important other consideration for axonal regeneration is the availability of nutrients and oxygen, making it crucial to further investigate vascularization characteristics in the regenerating spinal cord.We previously described the close relationship between blood vessel formation and axonal regeneration. In this study, we focused on identifying the vascular -axonal relationship, as well describing novel techniques to analyze their interactions after a complete T9 spinal cord transection in rats. Following implantation of positively charged oligo-polyethylene glycol fumarate (OPF+) scaffolds containing Matrigel-only (MG), Schwann cells (SCs), or SCs with rapamycin-eluting poly-lactic-co-glycolic acid (PLGA) microspheres (RAPA), stereological methods were applied to measure core area, blood vessel number, volume, diameter, inter-vessel distances, total vessel surface and cross-sectional areas, and radial diffusion distances in each group 6 weeks after implantation.Immuno-histochemical and stereological analysis demonstrated a significantly larger core area in the RAPA group and found a total of 2,494 myelinated and 4,173 unmyelinated axons at 10 micron circumferential intervals around 708 individual blood vessel profiles within scaffold channels. We found that axon number and surface density in the SC group exceeded that seen in the MG and RAPA groups and that higher axonal densities correlated with smaller vessel crosssectional areas. Generally, axons were concentrated within a concentric distance of 200 microns

Our study provides evidence that qPCR estimation for HPV infection obviously underestimates the incidence rate of infected prepuces in boys and men with phimosis. Contrary, an overestimation of the HPV infection rate with the in situ hybridization method of phimotic prepuces cannot be excluded.

1Spinal cord injury (SCI) results in lifelong paralysis due to the poor regenerative capability of the 2 central nervous system and the hostile microenvironment that is created from processes such as 3 inflammation, scarring, axonal dieback, and demyelination. Hydrogel scaffolds facilitate a 4 permissive regenerative environment and overcome these barriers by reducing scarring. One 5 important other consideration for axonal regeneration is the availability of nutrients and oxygen, 6 making it crucial to further investigate vascularization characteristics in the regenerating spinal 7 cord. 8 We previously described the close relationship between blood vessel formation and axonal 9 regeneration. In this study, we focused on identifying the vascular -axonal relationship, as well 10 describing novel techniques to analyze their interactions after a complete T9 spinal cord 11 transection in rats. Following implantation of positively charged oligo-polyethylene glycol 12 fumarate (OPF+) scaffolds containing Matrigel-only (MG), Schwann cells (SCs), or SCs with 13 rapamycin-eluting poly-lactic-co-glycolic acid (PLGA) microspheres (RAPA), stereological 14 methods were applied to measure core area, blood vessel number, volume, diameter, inter-vessel 15 distances, total vessel surface and cross-sectional areas, and radial diffusion distances in each 16 group 6 weeks after implantation.17Immuno-histochemical and stereological analysis demonstrated a significantly larger core area in 18 the RAPA group and found a total of 2,494 myelinated and 4,173 unmyelinated axons at 10 19 micron circumferential intervals around 708 individual blood vessel profiles within scaffold 20 channels. We found that axon number and surface density in the SC group exceeded that seen in 21 the MG and RAPA groups and that higher axonal densities correlated with smaller vessel cross-22 sectional areas. Generally, axons were concentrated within a concentric distance of 200 microns 23 from the blood vessel wall, but were excluded from a 25 micron zone immediately adjacent to 1 the vessel. Using a statistical spatial algorithm to generate cumulative distribution functions of 2 axons within each scaffold channel type, we demonstrated that axons located around blood 3 vessels were not randomly distributed. 4By providing methods to quantify the axonal-vessel relationship, our results refine spinal cord 5 tissue engineering strategies to optimize the regeneration of complete neurovascular bundles in 6 their relevant spatial relationships, and further provide better understanding of axon regeneration 7 in relation to revascularization in SCI.

Background: In the first and second-line therapy of metastatic urothelial carcinoma (mUC), checkpoint inhibitors (CPI) such as Pembrolizumab and Atezolizumab have been widely implemented. Little is currently known about what therapeutic options are effective after therapy with CPI. This article presents a systemic review of current treatment options in this setting. Methods: From August 2020 to 15 April 2021, a literature search was performed through the PubMed/Medline. Subsequently, a single-group meta-analysis of three studies testing Enfortumab vedotin (EV) was conducted. Results: Five therapy regimens tested in the post-CPI setting with adequate data were identified: Chemotherapy (CT), Ramucirumab plus Docetaxel, Erdafitinib (Erd), EV, and Sacituzumab govitecan (SG). In n = 74 + 125 + 288 patients, the single-group meta-analysis showed an objective response rate of 42.1% for EV compared to 17.9% for CT in a similar setting. EV was also ahead in progression free survival (5.9 months with EV vs. 3.7 months with CT) and overall survival (12.8 months with EV vs. 9.0 months with CT). Conclusion: Most data are currently available for EV. Further research is needed on the question of which patients’ subcollectives particularly benefit from which therapeutic approach.

Background: In Bacillus Calmette–Guérin (BCG) refractory non-muscle-invasive bladder cancer (NMIBC), radical cystectomy is the gold standard. The advent of immune checkpoint inhibitors (CPIs) has permanently changed the therapy landscape of bladder cancer (BC). This article presents a systematic review of immune-modulating (IM) therapies (CPIs and others) in BCG-refractory NMIBC. Methods: In total, 406 articles were identified through data bank research in PubMed/Medline, with data cutoff in October 2021. Four full-text articles and four additional congress abstracts were included in the review. Results: Durvalumab plus Oportuzumab monatox, Pembrolizumab, and Nadofaragene firadenovec (NF) show complete response (CR) rates of 41.6%, 40.6%, and 59.6% after 3 months, with a long-lasting effect, especially for NF (12-month CR rate of 30.5%). Instillations with oncolytic viruses such as NF and CG0070 show good efficacy without triggering significant immune-mediated systemic adverse events. Recombinant BCG VPM1002BC could prove to be valid as an alternative to BCG in the future. The recombinant pox-viral vector vaccine PANVAC™ is not convincing in combination with BCG. Interleukin mediating therapies, such as ALT-803, are currently being studied. Conclusion: CPIs and other IM agents now offer an increasing opportunity for bladder-preserving strategies. Studies on different substances are ongoing and will yield new findings.

ZusammenfassungDie transurethrale Resektion von Blasengewebe (TUR-B) ist für die Diagnostik und Therapie bei Blasentumoren indiziert. Diese werden fragmentiert mittels diathermaler Schlinge abgetragen. Der Wundgrund wird zur Blutstillung koaguliert. Zu achten ist auf eine ausreichende Schnitttiefe, sodass die Detrusormuskulatur erfasst ist. Postoperativ kann zur Rezidivprophylaxe eine intravesikale Single-shot-Chemotherapie verabreicht werden. Methoden zur verbesserten Tumorvisualisation (insbesondere photodynamische Diagnostik) helfen, besonders bei multilokulärem Befund oder Carcinoma in situ (CIS) bessere Detektionsraten zu erreichen sowie das Rezidiv- und Progressionsrisiko zu senken. In Abhängigkeit von der Histologie ergibt sich das weitere Vorgehen: bei nicht muskelinvasivem Blasenkarzinom Nachsorge, adjuvante Instillationstherapie mittels Chemotherapie oder Bacillus Calmette-Guérin (BCG), die Nachresektion („second look TUR-B“), die Frühzystektomie oder bei muskelinvasivem Blasenkarzinom die Zystektomie oder (onkologisch nachrangig) die trimodale Therapie mit erneuter TUR‑B, Radiotherapie und Chemotherapie. Mögliche Komplikationen im Rahmen der TUR‑B sind v. a. Nachblutung mit Blasentamponade, extra- oder intraperitoneale Blasenperforation oder Infektionen des Urogenitaltrakts.