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Journal: Deutsche medizinische Wochenschrift (1946)

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Johann Wolfgang von Goethe was one of the most renowned German poets of the late Age of Enlightenment. However, his engagement went far beyond literature especially relating to politics and natural science. Goethe, primarily trained as a lawyer, developed his own theory of colors and even challenged the concepts of Isaac Newton. His discovery of the human intermaxilary bone questioned all the dogmas of the religious-minded world of the 18th century. Together with the anatomy professor Justus Christian Loder, Goethe performed comparative anatomy and proved the conceptual uniformity of humans and animals on 27 March 1784. Even though, Félix Vicq d'Azyr described the intermaxilary bone simultaneously in Catholic France, Goethe’s findings were politically accepted due to the liberal Protestantism of the Duchy of Weimar. Nevertheless, leading anatomists of the century (Johann Friedrich Blumenbach, Petrus Camper and Samuel Thomas v. Soemmerring) mainly rejected Goethe’s postulates which led to a delayed publication in 1820; almost 36 years after writing his original manuscript. Today, Goethe’s discovery is known to be a fundamental basis for the development of Charles Darwin’s theory of phylogenetic evolution. Nowadays, the Department of Anatomy contains the Museum Anatomicum Jenense which was founded by the Duke of Weimar, Carl August and Goethe and entails Goethe’s premaxillary bones as its main attraction. The University values the cultural heritage of Goethe’s contribution to Medicine and provides access to the collection to the public and generations of medical students. Still today Goethe’s legacy is noticeable in the halls of the Alma Mater Jenensis.

Concepts: Evolution, Anatomy, Charles Darwin, Isaac Newton, Johann Wolfgang von Goethe, Age of Enlightenment, Weimar Classicism, Weimar

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Idiopathic pulmonary fibrosis (IPF), a manifestation of chronic progressive fibrosing interstitial pneumonia, is with a prevalence of 2-29 cases per 100,000 individuals a rare disease. Current treatment options are limited, and the mean survival time of the newly diagnosed (mostly elderly) patients is only about 2-3 years. As in Europe data are limited on the characteristics and management of such patients, INSIGHTS-IPF was initiated as a new registry that documents incident and prevalent patients with confirmed IPF diagnosis prospectively. Detailed data on patient characteristics, diagnostics, management, clinical outcomes, quality of life and resource utilization are recorded. It is planned to document 500 patients in 30 centers. The registry will contribute to the optimization of the management of IPF patients in the long term.

Concepts: Epidemiology, Pulmonology, Medical terms, Diagnosis, Idiopathic pulmonary fibrosis, Pulmonary fibrosis, Prevalence

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Background and objectives: To evaluate the predictive value of pre-endoscopic risk scores in patients with upper gastrointestinal bleeding (UGI-B).Patients and methods: The medical records of patients evaluated by emergency esophago-gastro-duodenoscopy (E-EGD) for suspected UGI-B outside regular working hours were retrospectively analysed.Results: During the 75 months of the study period 112 E-EGDs met the inclusion criteria. Mean age was 65.5 ± 14.7 years. 38.4 % of patients were female. Endoscopy revealed 41 gastro-duodenal ulcers, 16 Mallory-Weiss, 13 varices, 4 neoplasia. 72 patients received transfusions, 39 had endoscopic interventions. 2 patients were surgically treated, 16 had recurrent bleeding. 16 of the 110 patients died during hospitalisation. The following sensitivities were found for the Blatchford score (cut-off > 1), the clinical Rockall score (cut-off > 0) and the Adamopoulos score (cut-off > 2) in predicting need for clinical intervention (endoscopic or surgical intervention or transfusion): 100/97.7/93 %, recurrent bleeding: 100/100/93.8 %, in-hospital mortality: 100/93.8/93.8 %, respectively.Conclusions: The Blatchford score is a suitable tool in determining the need for clinical intervention and the risk of recurrent bleeding and death in patients with UGI-B. The clinical Rockall score and the Adamopoulos score (the latter had originally been developed to predict active UGI-B at endoscopy and was used with a lower cut-off in our study) are inferior alternatives.

Concepts: Surgery, Gastroenterology, Upper gastrointestinal bleeding

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History: A 59-year-old woman went into coma after she had taken a phytopharmacon from Vietnamese generally used as an antidiabetic drug to treat her skin disease.Investigations: CT-scans revealed signs of pneumonia and cerebral edema. Severe brain damage was diagnosed by MRI-investigation. By chemical-toxicological analysis of the drug glibenclamide was identified in a concentration of 1.1 mg/g.Diagnosis, treatment and course: The patient developed severe irreversible encephalopathy. By neurorehabilitative treatment her physical status slightly improved, but she died after 13 months without regaining consciousness.Conclusions: The cause of losing consciousness remained unclear, however, severe hypoglycaemia following the use of the drug may be taken into account. An urgent warning against the use of such preparations is highly recommended.

Concepts: Death, Traumatic brain injury, Hypoglycemia, Illness, Neurology, Sulfonylurea, Metformin, Brain damage

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The incidence of first stroke in Germany is about 200.000, most of which are ischemic. The benefit of stroke unit treatment and systemic thrombolysis has been shown in large randomized trials. Diagnostic work-up besides neurologic examination includes cerebral imaging by CT or MR imaging including angiography, ultrasound of brain supplying arteries, ECG and Holter ECG and - if indicated - transesophageal echocardiography. Aspirin is the cornerstone of early secondary prevention in the acute phase, thereafter secondary prevention is determined by stroke etiology. Carotid endarterectomy or stent-assisted angioplasty are indicated in patients with hemodynamic or arterio-arterial stroke etiologies due to high-grade carotid stenosis. For cardioembolism due to atrial fibrillation, oral anticoagulation with vitamin K-antagonists or new oral anticoagulants should be started after the acute phase. In patients with non-cardioembolic stroke etiologies, platelet inhibitors are used for secondary prevention.

Concepts: Myocardial infarction, Atherosclerosis, Cardiology, Stroke, Atrial fibrillation, Thrombosis, Warfarin, Anticoagulant

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On March 2, 2017, the Federal Administrative Court in Leipzig ruled: In extreme emergencies, terminally ill people have the right to acquire suicide medications.The purpose of this article is to examine the criteria used to define an “extreme emergency”. The first step is to analyze the verdict. This will show that the term “unbearable suffering” plays a crucial role in defining the “extreme emergency”. In a next step, two philosophical conceptions of the suffering are presented and analyzed with regard to their respective effects for their application in practice. Against this background, it is stated that the application of the criterion of suffering in the judgment is problematic. This leads to the conclusion that the judgment does not constitute a valid basis for practical implementation.

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 The new pandemic coronavirus SARS-CoV-2 causing coronavirus disease-2019 (COVID-19) poses immense challenges to health care systems worldwide. In the current manuscript we summarize the strategies, organisational approaches and actions of the Task-force Coronavirus at the University Medical Center Freiburg. We also report on experiences with implementation of these approaches and treatment outcomes in the first 115 COVID patients.

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Introduction | The philosophy on how to improve cardiometabolic risk factors most efficiently by endurance exercise is still controversial. To determine the effect of high-intensity (interval) training (HI[I]T) vs. moderate-intensity continuous exercise (MICE) training on cardiometabolic risk factors we conducted a 16-week crossover randomized controlled trial. Methods | 81 healthy untrained middle aged men were randomly assigned to a HI(I)T-group and a control-group that started the MICE running program after their control status. HI(I)T consisted of running exercise around or above the individual anaerobic threshold (≈ 80- 100 % HRmax); MICE focused on continuous running exercise at ≈ 65-77.5 % HRmax. Both protocols were comparable with respect to energy consumption. Study endpoints were cardiorespiratory fitness (VO2max), left ventricular mass index (LVMI), metabolic syndrome Z-score (MetS-Z-score), intima-media-thickness (IMT) and body composition. Results | VO2max-changes in this overweighed male cohort significantly (p=0.002) differ between HIIT (14.7 ± 9.3 %, p=0.001) and MICE (7.9 ± 7.4 %,p=0.001). LVMI, as determined via magnetic resonance imaging, significantly increased in both exercise groups (HIIT: 8.5 ± 5.4 %, p=0.001 vs. MICE: 5.3 ± 4.0 %, p=0.001), however the change was significantly more pronounced (p=0.005) in the HIIT-group. MetS-Z-score (HIIT: -2.06 ± 1.31, p=0.001 vs. MICE: -1.60 ± 1.77, p=0.001) and IMT (4.6 ± 5.9 % p=0.011 vs. 4.4 ± 8.1 %, p=0.019) did not show significant group-differences. Reductions of fat mass (-4.9 ± 9.0 %, p=0.010 vs. -9.5 ± 9.4, p=0.001) were significantly higher among the MICE-participants (p=0.034), however, the same was true (p=0.008) for lean body mass (0.5 ± 2.3 %, p=0.381 vs. -1.3 ± 2.0 %, p=0.003). Conclusion | In summary high-intensity interval training tends to impact cardiometabolic health more favorable compared with a moderate-intensity continuous endurance exercise protocol.

Concepts: Health, Epidemiology, Randomized controlled trial, Exercise, Magnetic resonance imaging, Body shape, High-intensity interval training, Interval training

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The ESC/ERS guidelines (published at the end of 2015) and other international recommendations defined pulmonary hypertension (PH) by an invasively measured mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg at rest. At the 6th World Symposium on Pulmonary Hypertension in Nice a modification of this hemodynamic definition in the sense of lowering the threshold to > 20 mmHg was proposed. A pulmonary vascular resistance (PVR) ≥ 3 Wood units (WU) is additionally required for the diagnosis of pre-capillary PH. This modification must be critically reviewed with regard to the underlying rationale and possible consequences. Therefore, a detailed explanation is required. In particular, it must be made clear that this change currently has no influence on the evidence-based and approval-compliant prescription of drugs for the targeted therapy of pulmonary arterial hypertension (PAH).

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The AWMF and its medical societies perceive an increasing dominance of economic targets in the hospital health care sector, leading to impairment of patient care. While resource use in health care should be appropriate, efficient and fairly allocated, “economization” creates a burdensome situation for physicians, nurses and other health care professionals.The AMWF and the medical societies studied causes and developed measures for a scientific, patient-centred and resource-conscious medical care. Disincentives due to the remuneration system, number and equipment of hospitals resp. specialist departments and their basic funding need to be overcome. Proposed actions relate to the patient-doctor-level, the management level of hospitals and the level of planning and financing hospitals including compensation of hospital care. To place patients and their health in the forefront again, joint efforts of all stakeholders in health care are needed.