Neuester Trend der Verjüngungskuren stellt das sogenannte Vampir-Lifting dar. Dabei wird Eigenblut verwendet, welches aufbereitet wieder zurück unter die Haut gespritzt wird. Die verjüngende Wirkung soll auf die Induktion der hauteigenen natürlichen Regeneration zurückzuführen sein.
Nachdem sich bereits diverse amerikanische Schauspieler und andere Berühmtheiten dieser blutigen Verjüngungskur unterzogen haben, erlangt das Vampir-Lifting immer mehr Bekanntheit und macht der herkömmlichen Botox-Behandlung starke Konkurrenz. Die Anbieter werben mit der Natürlichkeit der Behandlung. Ein zufriedenstellendes Resultat solle sich erst nach zwei Monaten nach Behandlungsabschluss einstellen und insgesamt wären bis zu vier Behandlungen notwendig.
Was halten Sie vom neuen Trend? Ist die blutige Verjüngungskur wirklich eine natürlichere Alternative zur Botox-Behandlung oder bloße Scharlatanerie?
In den letzten Jahren wurde immer wieder das Einsetzen eines Calcium-Scores zur Einschätzung des kardiovaskulären Risikos diskutiert. Derzeit wird das Risiko nach dem Framingham-Score oder anderen national adaptierten Scores wie PROCAM bestimmt.
Zur Debatte steht, ob die zusätzliche Bestimmung des Calcium-Scores die Genauigkeit der Risikoschätzung deutlich verbessern würde. Der Calcium-Score wird per Computertomographie bestimmt. Dabei wird die Verkalkung der Koronarien untersucht. Vorhandensein, Ort und Ausmaß der verkalkten Plaques werden anhand des gemessenen Calciums analysiert und schließlich ein kardiovaskuläres Risiko abgeleitet.
Derzeit kann einem Risikopatienten eine solche Untersuchung vom Arzt empfohlen werden. Sie zählt jedoch aufgrund der mangelnden Evidenz nicht zu den Standardverfahren und wird auf Eigenleistung durchgeführt.
Halten Sie das Risiko-Nutzen-Profil bei der Bestimmung des Calcium-Scores für ausgewogen? Ist eine zusätzliche Strahlenbelastung zu verantworten, wenn ein kardiales Ereignis eventuell vermieden werden kann? Sollte die Bestimmung des Calcium-Scores zu den Standardverfahren gehören?
Hier ein interessanter Auszug aus einem Abstract zu einer Studie des Massachusetts General Hospital:
Although antiviral therapy against HIV suppresses viral replication and allows infected individuals to live relatively healthy lives for many years, the virus persists in the body, and replication resumes if treatment is interrupted. Now investigators from Massachusetts General Hospital (MGH) and the Ragon Institute of MGH, MIT and Harvard may have found where the virus hides - in a small group of recently identified T cells with stem-cell-like properties.
"Most human cells are short lived, so it has been unclear how HIV manages to stick around for decades in spite of very effective antiviral treatment," says Mathias Lichterfeld, MD, of the MGH Infectious Disease Division, corresponding author of the report receiving advance online publication in Nature Medicine. "This question led to the hypothesis that HIV might infect stem cells - the most long-lasting cells in the body - but traditional organ-specific stem cells, even those that give rise to all immune and blood cells, are resistant to HIV infection. We have discovered that a new group of T cells, called T memory stem cells, are susceptible to HIV and likely represent the longest lasting cellular niche for the virus."
HIV has such a devastating impact on the human immune system because it infects the CD4-positive T cells that normally direct and support the infection-fighting activities of other immune cells. Several subtypes of CD4 T cells have different functions; and all are capable of being infected by HIV, although antiviral treatment keeps the virus in those cells from replicating. Most of these CD4 T cells are short-lived and die relatively soon. What is distinct about CD4 T memory stem cells is their ability to live for decades, while giving rise to several subgroups of T cells. Therefore, HIV-infected T memory stem cells could continuously regenerate new HIV-infected cells, fueling the fire of HIV persistence in the human body.
The MGH/Ragon team found that T memory stem cells express both CD4 and CCR5 - the receptor proteins used by HIV to enter cells - suggesting that these long-lived cells could be the long-sought HIV reservoir. They then found that these cells can be readily infected with HIV, which was unexpected since traditional stem cells resist HIV infection. Importantly, the investigators found that levels of HIV DNA in patients receiving long-term antiviral treatment were highest in T memory stem cells.
Testing blood samples that had been taken from patients soon after initial infection and several years later revealed that the viral sequences found in T memory stem cells after 6 to 10 years of treatment were similar to those found in circulating T cells soon after infection, indicating that HIV had persisted relatively unchanged in T memory stem cells. In addition, the amount of HIV DNA in these cells remained relatively stable over time, even after long-term treatment caused viral levels to drop in other T cell subsets.
"Our findings suggest that novel, specific interventions will have to be designed to target HIV-infected T memory stem cells," says Lichterfeld, an assistant professor of Medicine at Harvard Medical School. "Methods of inhibiting stem cell pathways are being studied to eliminate cancer stem cells - persistent cells that are responsible for tumor recurrence after conventional treatments kill proliferating tumor cells. We are now investigating whether any of the drugs that target cancer stem cells might be effective against HIV-infected T memory stem cells.
"Identifying the reservoirs for HIV persistence is a critical step toward developing interventions that could induce a long-term remission without the need for antiviral medication, or possibly eliminate the virus entirely," Lichterfeld adds. "Although a real cure for HIV has been elusive, it is not impossible."
###
Maria Buzon, PhD, of MGH Infectious Diseases and the Ragon Institute is lead author of the Nature Medicine paper. Additional co-authors are Hong Sun, MD, Chun Li, PhD, Amy Shaw, Katherine Seiss, Zhengyu Ouyang, PhD, Enrique Martin-Gayo, PhD, Jin Leng, PhD, Florencia Pereyra, MD, Xu Yu, MD, and Bruce Walker, MD, Ragon Institute; Eric Rosenberg, MD, MGH Infectious Disease Division; Timothy Henrich, MD, and Jonathan Li, MD, Brigham and Women's Hospital; and Ryan Zurakowski, PhD, University of Delaware. Walker, the director of the Ragon Institute, is also a Howard Hughes Medical Institute investigator. Support for the study includes American Foundation for AIDS Research grants 108302-51-RGRL and National Institutes of Health grants AI098487, AI106468, AI089339, AI098480, AI100699.
The Ragon Institute of MGH, MIT and Harvard was established in 2009 with a gift from the Philip T. and Susan M. Ragon Foundation, creating a collaborative scientific mission among these institutions to harness the immune system to combat and cure human diseases. The primary initial focus of the institute is to contribute to the development of an effective AIDS vaccine. The Ragon Institute draws scientists and engineers from diverse backgrounds and areas of expertise across the Harvard and MIT communities and throughout the world, in order to apply the full arsenal of scientific knowledge to understanding mechanisms of immune control and immune failure and to apply these advances to directly benefit patients.
LINK zum Artikel im Aerzteblatt.
Hier ein interessanter Auszug aus einem Abstract zu einer Studie des Massachusetts General Hospital:
Although antiviral therapy against HIV suppresses viral replication and allows infected individuals to live relatively healthy lives for many years, the virus persists in the body, and replication resumes if treatment is interrupted. Now investigators from Massachusetts General Hospital (MGH) and the Ragon Institute of MGH, MIT and Harvard may have found where the virus hides - in a small group of recently identified T cells with stem-cell-like properties.
"Most human cells are short lived, so it has been unclear how HIV manages to stick around for decades in spite of very effective antiviral treatment," says Mathias Lichterfeld, MD, of the MGH Infectious Disease Division, corresponding author of the report receiving advance online publication in Nature Medicine. "This question led to the hypothesis that HIV might infect stem cells - the most long-lasting cells in the body - but traditional organ-specific stem cells, even those that give rise to all immune and blood cells, are resistant to HIV infection. We have discovered that a new group of T cells, called T memory stem cells, are susceptible to HIV and likely represent the longest lasting cellular niche for the virus."
HIV has such a devastating impact on the human immune system because it infects the CD4-positive T cells that normally direct and support the infection-fighting activities of other immune cells. Several subtypes of CD4 T cells have different functions; and all are capable of being infected by HIV, although antiviral treatment keeps the virus in those cells from replicating. Most of these CD4 T cells are short-lived and die relatively soon. What is distinct about CD4 T memory stem cells is their ability to live for decades, while giving rise to several subgroups of T cells. Therefore, HIV-infected T memory stem cells could continuously regenerate new HIV-infected cells, fueling the fire of HIV persistence in the human body.
The MGH/Ragon team found that T memory stem cells express both CD4 and CCR5 - the receptor proteins used by HIV to enter cells - suggesting that these long-lived cells could be the long-sought HIV reservoir. They then found that these cells can be readily infected with HIV, which was unexpected since traditional stem cells resist HIV infection. Importantly, the investigators found that levels of HIV DNA in patients receiving long-term antiviral treatment were highest in T memory stem cells.
Testing blood samples that had been taken from patients soon after initial infection and several years later revealed that the viral sequences found in T memory stem cells after 6 to 10 years of treatment were similar to those found in circulating T cells soon after infection, indicating that HIV had persisted relatively unchanged in T memory stem cells. In addition, the amount of HIV DNA in these cells remained relatively stable over time, even after long-term treatment caused viral levels to drop in other T cell subsets.
"Our findings suggest that novel, specific interventions will have to be designed to target HIV-infected T memory stem cells," says Lichterfeld, an assistant professor of Medicine at Harvard Medical School. "Methods of inhibiting stem cell pathways are being studied to eliminate cancer stem cells - persistent cells that are responsible for tumor recurrence after conventional treatments kill proliferating tumor cells. We are now investigating whether any of the drugs that target cancer stem cells might be effective against HIV-infected T memory stem cells.
"Identifying the reservoirs for HIV persistence is a critical step toward developing interventions that could induce a long-term remission without the need for antiviral medication, or possibly eliminate the virus entirely," Lichterfeld adds. "Although a real cure for HIV has been elusive, it is not impossible."
###
Maria Buzon, PhD, of MGH Infectious Diseases and the Ragon Institute is lead author of the Nature Medicine paper. Additional co-authors are Hong Sun, MD, Chun Li, PhD, Amy Shaw, Katherine Seiss, Zhengyu Ouyang, PhD, Enrique Martin-Gayo, PhD, Jin Leng, PhD, Florencia Pereyra, MD, Xu Yu, MD, and Bruce Walker, MD, Ragon Institute; Eric Rosenberg, MD, MGH Infectious Disease Division; Timothy Henrich, MD, and Jonathan Li, MD, Brigham and Women's Hospital; and Ryan Zurakowski, PhD, University of Delaware. Walker, the director of the Ragon Institute, is also a Howard Hughes Medical Institute investigator. Support for the study includes American Foundation for AIDS Research grants 108302-51-RGRL and National Institutes of Health grants AI098487, AI106468, AI089339, AI098480, AI100699.
The Ragon Institute of MGH, MIT and Harvard was established in 2009 with a gift from the Philip T. and Susan M. Ragon Foundation, creating a collaborative scientific mission among these institutions to harness the immune system to combat and cure human diseases. The primary initial focus of the institute is to contribute to the development of an effective AIDS vaccine. The Ragon Institute draws scientists and engineers from diverse backgrounds and areas of expertise across the Harvard and MIT communities and throughout the world, in order to apply the full arsenal of scientific knowledge to understanding mechanisms of immune control and immune failure and to apply these advances to directly benefit patients.
Hier ein interessanter Auszug aus einem Abstract zu einer Studie des Massachusetts General Hospital:
Although antiviral therapy against HIV suppresses viral replication and allows infected individuals to live relatively healthy lives for many years, the virus persists in the body, and replication resumes if treatment is interrupted. Now investigators from Massachusetts General Hospital (MGH) and the Ragon Institute of MGH, MIT and Harvard may have found where the virus hides - in a small group of recently identified T cells with stem-cell-like properties.
"Most human cells are short lived, so it has been unclear how HIV manages to stick around for decades in spite of very effective antiviral treatment," says Mathias Lichterfeld, MD, of the MGH Infectious Disease Division, corresponding author of the report receiving advance online publication in Nature Medicine. "This question led to the hypothesis that HIV might infect stem cells - the most long-lasting cells in the body - but traditional organ-specific stem cells, even those that give rise to all immune and blood cells, are resistant to HIV infection. We have discovered that a new group of T cells, called T memory stem cells, are susceptible to HIV and likely represent the longest lasting cellular niche for the virus."
HIV has such a devastating impact on the human immune system because it infects the CD4-positive T cells that normally direct and support the infection-fighting activities of other immune cells. Several subtypes of CD4 T cells have different functions; and all are capable of being infected by HIV, although antiviral treatment keeps the virus in those cells from replicating. Most of these CD4 T cells are short-lived and die relatively soon. What is distinct about CD4 T memory stem cells is their ability to live for decades, while giving rise to several subgroups of T cells. Therefore, HIV-infected T memory stem cells could continuously regenerate new HIV-infected cells, fueling the fire of HIV persistence in the human body.
The MGH/Ragon team found that T memory stem cells express both CD4 and CCR5 - the receptor proteins used by HIV to enter cells - suggesting that these long-lived cells could be the long-sought HIV reservoir. They then found that these cells can be readily infected with HIV, which was unexpected since traditional stem cells resist HIV infection. Importantly, the investigators found that levels of HIV DNA in patients receiving long-term antiviral treatment were highest in T memory stem cells.
Testing blood samples that had been taken from patients soon after initial infection and several years later revealed that the viral sequences found in T memory stem cells after 6 to 10 years of treatment were similar to those found in circulating T cells soon after infection, indicating that HIV had persisted relatively unchanged in T memory stem cells. In addition, the amount of HIV DNA in these cells remained relatively stable over time, even after long-term treatment caused viral levels to drop in other T cell subsets.
"Our findings suggest that novel, specific interventions will have to be designed to target HIV-infected T memory stem cells," says Lichterfeld, an assistant professor of Medicine at Harvard Medical School. "Methods of inhibiting stem cell pathways are being studied to eliminate cancer stem cells - persistent cells that are responsible for tumor recurrence after conventional treatments kill proliferating tumor cells. We are now investigating whether any of the drugs that target cancer stem cells might be effective against HIV-infected T memory stem cells.
"Identifying the reservoirs for HIV persistence is a critical step toward developing interventions that could induce a long-term remission without the need for antiviral medication, or possibly eliminate the virus entirely," Lichterfeld adds. "Although a real cure for HIV has been elusive, it is not impossible."
###
Maria Buzon, PhD, of MGH Infectious Diseases and the Ragon Institute is lead author of the Nature Medicine paper. Additional co-authors are Hong Sun, MD, Chun Li, PhD, Amy Shaw, Katherine Seiss, Zhengyu Ouyang, PhD, Enrique Martin-Gayo, PhD, Jin Leng, PhD, Florencia Pereyra, MD, Xu Yu, MD, and Bruce Walker, MD, Ragon Institute; Eric Rosenberg, MD, MGH Infectious Disease Division; Timothy Henrich, MD, and Jonathan Li, MD, Brigham and Women's Hospital; and Ryan Zurakowski, PhD, University of Delaware. Walker, the director of the Ragon Institute, is also a Howard Hughes Medical Institute investigator. Support for the study includes American Foundation for AIDS Research grants 108302-51-RGRL and National Institutes of Health grants AI098487, AI106468, AI089339, AI098480, AI100699.
The Ragon Institute of MGH, MIT and Harvard was established in 2009 with a gift from the Philip T. and Susan M. Ragon Foundation, creating a collaborative scientific mission among these institutions to harness the immune system to combat and cure human diseases. The primary initial focus of the institute is to contribute to the development of an effective AIDS vaccine. The Ragon Institute draws scientists and engineers from diverse backgrounds and areas of expertise across the Harvard and MIT communities and throughout the world, in order to apply the full arsenal of scientific knowledge to understanding mechanisms of immune control and immune failure and to apply these advances to directly benefit patients.
LINK zum Artikel im Aerzteblatt.
Das Risiko von Blutungen ist für Patienten, die Gerinnungshemmer und Antibiotika gleichzeitig einnehmen, ist laut einer AOK-Studie mehr als doppelt so hoch (insgesamt wurden 24 Millionen versicherten verglichen). Bei bestimmten Antibiotika erhöht sich das Risiko um das Fünffache.
Laut Epidemiologe Sascha Abbas, Mitautor der Studie wurden Routinedaten der Krankenkasse verglichen. Dabei fand man 500.000 Patienten, die Medikamente mit dem Wirkstoff Phenprocoumon einnahmen – ein häufig verschriebener Gerinnungshemmer. 14.000 dieser Patienten kamen wegen einer Blutung ins Krankenhaus. Demgegenüber gestellt wurde die gleichzeitige Einnahme von Antibiotika. Ein bis zu 2,4-fach erhöhtes Risiko für Blutungen wurde festgestellt, ein Wert, der je nach Wirkstoff des antibiotikums sogar noch nach oben variieren kann (für den Wirkstoff Ofloxacin war das Risiko sogar fünfmal so hoch).
Trotzdem das Risiko bekannt ist, gibt die Studie Anlaß, etabliertes Verhalten im praxisalltag zu überdenken, gerade im Hinblick auf die Antibiotikaauswahl, bei denen es zahlreiche Alternativen gibt.
Mehr zum Thema:
http://www.aerzteblatt.de/nachrichten/57229/Gleichzeitige-Einnahme-von-Blutverduennern-und-Antibiotika-riskant
Der Arzt als Detektiv – immer auf der Spur nach der hochprisanten Diagnose? Das gibt es nur bei Dr. House? Stimmt nicht ganz. In Marburg gibt es seit kurzem im Endeffekt ein Detektivbüro für unerkannte Krankheiten. Geleitet wird es vom deutschen Dr. House – Professor Jürgen Schäfer.
Bekannt ist er auch für seine etwas ungewöhnlichen Vorlesungen. Er nutzt Schlüsselszenen aus der Serie Dr. House. Zeigt der Patient dort interessante Symptome, so stoppt er das Video und geht mit den Studenten mögliche Erkrankungen und Differentialdiagnosen durch. 2013 wurde er deswegen auch zum Arzt des Jahres gewählt. An die unterrichtenden Kollegen: Legen Sie sich auch für ihre Studenten derart ins Zeug? Was sind Ihre Tricks die Vorlesungen spannend zu gestalten?
Die DAA-Wirkstoffe Daclatasvir plus Sofosbuvir (Direct Acting Agents) konnten im Rahmen einer randomisierten klinischen Studie im New England Journal of Medicine (2014; 370: 211-221) innerhalb von 24 Wochen fast alle Hepatitis C-Infektionen beseitigen - und das mit nur einer täglichen Oralgabe.
In den USA wurde im Dezember 2013 mit Sofosbuvir (Sovaldi) der erste HCV NS5B Polymerase-Inhibitor zugelassen. Bald dürfte mit Daclatasvir von Bristol-Myers Squibb der erste HCV NS5A Replikationkomplex-Inhibitor folgen. Somit werden die Hepatitis C-Viren von unterschiedlichen Seiten in ihrem Wirkmechnismus angegriffen. Eine vollständige Eradikation ist im Gegensatz zu HIV hier möglich.
Die Studie AI444-040 hat die Kombination von Daclatasvir plus Sofosbuvir (teilweise mit Ribavirin, aber immer ohne Interferon) an 211 Patienten untersucht. Die von der Johns Hopkins University School of Medicine in Baltimore durchgeführte offene Studie untersuchte Patienten mit dem in Europa und den USA dominierenden Genotyp 1. Mit SVR-Raten von 98 Prozent und zwar sowohl bei nicht-vorbehandelten Patienten als auch bei Patienten, die bereits eine Therapie erhielten.
Die neue Kombination führte zu einem statistisch mehr als verschmerzbaren Therapieabbruch von nur zwei Probanden (einer wegen Fibromyalgie, ein anderer wegen eines Schlaganfalls). Die häufigsten Nebenwirkungen waren Abgeschlagenheit, Kopfschmerzen und Nausea.
Die Kostenfrage bleibt allerdings erst einmal im raum stehen: zwar würden erhebliche Entlastungen des Gesundheitssystems und der Wartelisten für lebertransplantationen erwartet, dennoch kostet eine Tablette Sofosbuvir 1000$, das würde für die durchschnittliche Behandlungsdauer einen stolzen Preis von 84000$ bedeuten. Und dabei wäre Daclatasvir noch nicht mit eingerechnet.
Link:
http://www.nejm.org/doi/full/10.1056/NEJMoa1306218
http://www.aerzteblatt.de/nachrichten/57234/Hepatitis-C-Orale-Therapie-mit-hoechsten-Heilungschancen
Auf dem 38. Interdisziplinären Forum der Bundesärztekammer (BÄK) wiesen Experten auf steigende Zahlen sexuell übertragbarer Infektionen hin. Zwar war es nach der großen HIV/AIDS-Welle der 80er und 90er Jahre zu einem starken Rückgang sexuell übertragbarer Erkrankungen in der westlichen Welt gekommen, jedoch werden eben dort seit Beginn des neuen Jahrtausends wieder vermehrt Infektionen bemerkt.
Deutschland weist zwar (neben Finnland und Andorra) weiterhin die geringsten HIV-Neuerkrankungsraten auf, zeigt jedoch seit einem Jahrzehnt stetig zunehmende Neuinfektionsraten für Syphilis, Gonorrhö und andere sexuell übertragbare Krankheiten. Im Jahr 2012 seien 4.500 Syphilis-Fälle registriert und 15.000 bis 16.000 Gonorrhö-Fälle geschätzt worden. Leider seien Gespräche über Sexualität und vor allem derartige Infektionen weiterhin mit großer Scham belastet, was die Kommunikation in diesem Spannungsfeld erschwert.
Liebe Kollegen, welche Erfahrungen haben Sie mit der Zurückhaltung von Patienten in Bezug auf diese Thematik gemacht? Wie gehen Sie damit um?
Liebe Kolleginnen und Kollegen,
haben Sie Fragen oder auch Antworten zur COPD & Spiroergometrie?
Besprochene Themenkomplexe bei der Fortbildung waren diesmal Lehrreiche Fälle der Spiroergometrie.
Wir, Dr. Fritsch, Dr. Kroidl, Dr. Schmidt und Dr. Kroker, freuen uns Sie hier begrüßen zu können und auf einen regen Austausch mit Ihnen!