Refine
Year of publication
- 2014 (273) (remove)
Document Type
- Article (232)
- Doctoral Thesis (15)
- Part of Periodical (12)
- Book (7)
- Conference Proceeding (3)
- Preprint (2)
- Contribution to a Periodical (1)
- Periodical (1)
Language
- English (230)
- German (41)
- Multiple languages (1)
- Romanian (1)
Is part of the Bibliography
- no (273) (remove)
Keywords
- Multimorbidity (4)
- Decorin (3)
- Depression (3)
- Primary care (3)
- ATM (2)
- Aortic valve replacement (2)
- Breast cancer (2)
- Cancer (2)
- Chronic disease (2)
- Drug hepatotoxicity (2)
Institute
- Medizin (273) (remove)
This study included 30 patients with diagnosed rheumatoid arthritis (RA) and 30 test subjects without RA (control group). The objective of the study was to examine both groups for the presence of temporomandibular disorders (TMD) and morphological changes of the temporomandibular joint (TMJ). All individuals were examined using a systematic detailed clinical TMD examination as well as magnetic resonance imaging (MRI). The clinical TMD examination yielded significant differences between the RA patients and the control group concerning crepitus of the TMJ, and palpation tenderness of the masticatory muscles as well as the unassisted mandibular opening. The evaluation of the MRI images for the RA group showed significantly more frequent deformations of the condyle, osteophyte formations and erosions in the condylar compacta, and degenerative changes in the spongiosa. Increased intra-articular accumulation of synovial liquid and signs of inflammatory changes of the spongiosa were only found in the RA group. Statistical analysis showed a significant correlation between crepitus and specific osteoarthrotic changes (MRI), respectively, and between crepitus and a complete anterior disk displacement without reduction (MRI). The duration of the RA disease correlated neither with the anamnestic and clinical dysfunction index by Helkimo nor with RA-specific MRI findings.
Background: Diabetes mellitus and thyroid diseases frequently coexist. In order to evaluate how thyroid disorders interfere with glycemic control, we analysed insulin-treated type 2 diabetes patients with thyroid disease.
Methods: Diabetes patients (n = 1.957) were retrospectively investigated. We focused on type 2 diabetes patients who had been admitted for insulin-treatment and diagnosed thyroid diseases (n = 328). Patients were divided into three groups according to thyroid disease manifestation in relation to diabetes onset: prior to (group 1), same year (group 2) and thyroid disease following diabetes (group 3).
Results: Out of all diabetes patients 27.3% had a thyroid disorder with more women (62.2%) being affected (p < 0.001). Thyroid disease was predominantly diagnosed after diabetes onset. Patients with type 2 diabetes and prior appearance of thyroid disease required insulin therapy significantly earlier (median insulin-free period: 2.5 yrs; Q1 = 0.0, Q3 = 8.25) compared to patients who had thyroid dysfunction after diabetes onset (median insulin-free period: 8.0 yrs; Q1 = 3.0, Q3 = 12.0; p < 0.001). Age at diabetes onset correlated with insulin-free period (p < 0.001).
Conclusions: Thyroid disease may be a marker of a distinct metabolic trait in type 2 diabetes potentially requiring earlier insulin treatment.
Caspase-2 represents the most conserved member of the caspase family, which exhibits features of both initiator and effector caspases. Using ribonucleoprotein (RNP)-immunoprecipitation assay, we identified the proapoptotic caspase-2L encoding mRNA as a novel target of the ubiquitous RNA-binding protein HuR in DLD-1 colon carcinoma cells. Unexpectedly, crosslinking-RNP and RNA probe pull-down experiments revealed that HuR binds exclusively to the caspase-2-5' untranslated region (UTR) despite that the 3' UTR of the mRNA bears several adenylate- and uridylate-rich elements representing the prototypical HuR binding sites. By using RNAi-mediated loss-of-function approach, we observed that HuR regulates the mRNA and in turn the protein levels of caspase-2 in a negative manner. Silencing of HuR did not affect the stability of caspase-2 mRNA but resulted in an increased redistribution of caspase-2 transcripts from RNP particles to translational active polysomes implicating that HuR exerts a direct repressive effect on caspase-2 translation. Consistently, in vitro translation of a luciferase reporter gene under the control of an upstream caspase-2-5'UTR was strongly impaired after the addition of recombinant HuR, whereas translation of caspase-2 coding region without the 5'UTR is not affected by HuR confirming the functional role of the caspase-2-5'UTR. Functionally, an elevation in caspase-2 level by HuR knockdown correlated with an increased sensitivity of cells to apoptosis induced by staurosporine- and pore-forming toxins as implicated by their significant accumulation in the sub G1 phase and an increase in caspase-2, -3 and poly ADP-ribose polymerase cleavage, respectively. Importantly, HuR knockdown cells remained insensitive toward STS-induced apoptosis if cells were additionally transfected with caspase-2-specific siRNAs. Collectively, our findings support the hypothesis that HuR by acting as an endogenous inhibitor of caspase-2-driven apoptosis may essentially contribute to the antiapoptotic program of adenocarcinoma cells by HuR.
Wassergefiltertes Infrarot A (wIRA) als spezielle Form der Wärmestrahlung mit hohem Eindringvermögen in das Gewebe bei geringer thermischer Oberflächenbelastung fördert die Heilung akuter und chronischer Wunden sowohl über thermische und temperaturabhängige als auch über nichtthermische und temperaturunabhängige Effekte. Wassergefiltertes Infrarot A steigert die Temperatur (+2,7°C in einer Gewebetiefe von 2 cm) und den Sauerstoffpartialdruck im Gewebe (+32% in einer Gewebetiefe von 2 cm) und die Gewebedurchblutung. Diese 3 Faktoren sind entscheidend für eine ausreichende Versorgung des Gewebes mit Energie und Sauerstoff und deshalb auch für Wundheilung und Infektionsabwehr. Wassergefiltertes Infrarot A hilft sowohl bei der normalen als auch bei der gestörten Wundheilung, indem es Entzündungsreaktionen und erhöhte Wundsekretion mindert, Infektionsabwehr und Regeneration fördert und Wundschmerzen lindern helfen kann. Die genannten Effekte wurden in insgesamt 7 prospektiven Studien (davon 6 randomisierten kontrollierten Studien) belegt, die meisten mit einem Evidenzgrad von Ia bzw. Ib. Die hier zusätzlich dargestellten Fallbeispiele komplizierter Wundheilungsverläufe illustrieren die belegten Wirkungen von wIRA. Nicht nur in den hier gezeigten 6 Fällen wendeten die Bestrahlungen mit wIRA komplizierte Wundheilungsverläufe zum Besseren und ermöglichten nach ganz unterschiedlich langen Gesamtdauern der Bestrahlungen (in den 6 Fällen: von 51–550 h) und nach verschieden langen Gesamtdauern der Wundpflege, meist nach Transplantation von Spalthautgittern, die Heilung der Wunden. Bei komplizierten Wundheilungsverläufen ersetzt wIRA nicht den Rat und ggf. auch die Behandlung eines erfahrenen plastischen Chirurgen und eines Chirurgen mit der Spezialisierung in septischer Chirurgie. Mit dieser Einschränkung kann wIRA als wertvolle Ergänzung der Behandlung von akuten und chronischen Wunden empfohlen werden.
Introduction: Over the last years, electronic cigarettes (ECs) have become more popular, particularly in individuals who want to give up smoking tobacco. The aim of the present study was to assess the influence of the different e-smoking liquids on the viability and proliferation of human periodontal ligament fibroblasts.
Method and materials: For this study six test solutions with components from ECs were selected: lime-, hazelnut- and menthol-flavored liquids, nicotine, propylene glycol, and PBS as control group. The fibroblasts were incubated up to 96 h with the different liquids, and cell viability was measured by using the PrestoBlue® reagent, the ATP detection and the migration assay. Fluorescence staining was carried out to visualize cell growth and morphology. Data were statistically analyzed by two-tailed one-way ANOVA.
Results: The cell viability assay showed that the proliferation rates of the cells incubated with nicotine or the various flavored liquids of the e-cigarettes were reduced in comparison to the controls, though not all reductions were statistically significant. After an incubation of 96 h with the menthol-flavored liquid the fibroblasts were statistically significant reduced (p < 0.001). Similar results were found for the detection of ATP in fibroblasts; the incubation with menthol-flavored liquids (p < 0.001) led to a statistically significant reduction. The cell visualization tests confirmed these findings.
Conclusion: Within its limits, the present in vitro study demonstrated that menthol additives of e-smoking have a harmful effect on human periodontal ligament fibroblasts. This might indicate that menthol additives should be avoided for e-cigarettes.
Objective: To analyze Mucograft (MG), a recently introduced collagen matrix, in vitro and in vivo, and compare it with BioGide (BG), a well-established collagen membrane, as control.
Material and methods: A detailed analysis of the materials surface and ultra-structure was performed. Cellular growth patterns and proliferation rates of human fibroblasts on MG and BG were analyzed in vitro. In addition, the early tissue reaction of CD-1 mouse to these materials was analyzed by means of histological and histomorphometrical analysis.
Results: MG showed a three-fold higher thickness both in dry and wet conditions, when compared to BG. The spongy surface of BG significantly differed from that of MG. Cells showed a characteristic proliferation pattern on the different materials in vitro. Fibroblasts tended to proliferate on the compact layers of both collagens, with the highest values on the compact side of BG. In vivo, at day three both materials demonstrated good tissue integration, with a mononuclear cell sheet of fibroblasts on all surfaces, however, without penetrating into the materials.
Conclusions: The findings of this study showed that MG and BG facilitate cell proliferation on both of their surfaces in vitro. In vivo, these two materials induce a comparable early tissue reaction, while serving as cell occlusive barriers.
Background: It is not well established how psychosocial factors like social support and depression affect health-related quality of life in multimorbid and elderly patients. We investigated whether depressive mood mediates the influence of social support on health-related quality of life.
Methods: Cross-sectional data of 3,189 multimorbid patients from the baseline assessment of the German MultiCare cohort study were used. Mediation was tested using the approach described by Baron and Kenny based on multiple linear regression, and controlling for socioeconomic variables and burden of multimorbidity.
Results: Mediation analyses confirmed that depressive mood mediates the influence of social support on health-related quality of life (Sobel's p < 0.001). Multiple linear regression showed that the influence of depressive mood (beta = -0.341, p < 0.01) on health-related quality of life is greater than the influence of multimorbidity (beta = -0.234, p < 0.01).
Conclusion: Social support influences health-related quality of life, but this association is strongly mediated by depressive mood. Depression should be taken into consideration in research on multimorbidity, and clinicians should be aware of its importance when caring for multimorbid patients.
Local active information storage as a tool to understand distributed neural information processing
(2014)
Every act of information processing can in principle be decomposed into the component operations of information storage, transfer, and modification. Yet, while this is easily done for today's digital computers, the application of these concepts to neural information processing was hampered by the lack of proper mathematical definitions of these operations on information. Recently, definitions were given for the dynamics of these information processing operations on a local scale in space and time in a distributed system, and the specific concept of local active information storage was successfully applied to the analysis and optimization of artificial neural systems. However, no attempt to measure the space-time dynamics of local active information storage in neural data has been made to date. Here we measure local active information storage on a local scale in time and space in voltage sensitive dye imaging data from area 18 of the cat. We show that storage reflects neural properties such as stimulus preferences and surprise upon unexpected stimulus change, and in area 18 reflects the abstract concept of an ongoing stimulus despite the locally random nature of this stimulus. We suggest that LAIS will be a useful quantity to test theories of cortical function, such as predictive coding.
Serial quantification of BCR–ABL1 mRNA is an important therapeutic indicator in chronic myeloid leukaemia, but there is a substantial variation in results reported by different laboratories. To improve comparability, an internationally accepted plasmid certified reference material (CRM) was developed according to ISO Guide 34:2009. Fragments of BCR–ABL1 (e14a2 mRNA fusion), BCR and GUSB transcripts were amplified and cloned into pUC18 to yield plasmid pIRMM0099. Six different linearised plasmid solutions were produced with the following copy number concentrations, assigned by digital PCR, and expanded uncertainties: 1.08±0.13 × 106, 1.08±0.11 × 105, 1.03±0.10 × 104, 1.02±0.09 × 103, 1.04±0.10 × 102 and 10.0±1.5 copies/μl. The certification of the material for the number of specific DNA fragments per plasmid, copy number concentration of the plasmid solutions and the assessment of inter-unit heterogeneity and stability were performed according to ISO Guide 35:2006. Two suitability studies performed by 63 BCR–ABL1 testing laboratories demonstrated that this set of 6 plasmid CRMs can help to standardise a number of measured transcripts of e14a2 BCR–ABL1 and three control genes (ABL1, BCR and GUSB). The set of six plasmid CRMs is distributed worldwide by the Institute for Reference Materials and Measurements (Belgium) and its authorised distributors (https://ec.europa.eu/jrc/en/reference-materials/catalogue/; CRM code ERM-AD623a-f).
Synaptic dysfunction and synapse loss are key features of Alzheimer's pathogenesis. Previously, we showed an essential function of APP and APLP2 for synaptic plasticity, learning and memory. Here, we used organotypic hippocampal cultures to investigate the specific role(s) of APP family members and their fragments for dendritic complexity and spine formation of principal neurons within the hippocampus. Whereas CA1 neurons from APLP1-KO or APLP2-KO mice showed normal neuronal morphology and spine density, APP-KO mice revealed a highly reduced dendritic complexity in mid-apical dendrites. Despite unaltered morphology of APLP2-KO neurons, combined APP/APLP2-DKO mutants showed an additional branching defect in proximal apical dendrites, indicating redundancy and a combined function of APP and APLP2 for dendritic architecture. Remarkably, APP-KO neurons showed a pronounced decrease in spine density and reductions in the number of mushroom spines. No further decrease in spine density, however, was detectable in APP/APLP2-DKO mice. Mechanistically, using APPsalpha-KI mice lacking transmembrane APP and expressing solely the secreted APPsalpha fragment we demonstrate that APPsalpha expression alone is sufficient to prevent the defects in spine density observed in APP-KO mice. Collectively, these studies reveal a combined role of APP and APLP2 for dendritic architecture and a unique function of secreted APPs for spine density.
Background: Hypoxia-inducible factor-1α (HIF-1α) and NF-κB play important roles in the inflammatory response after hemorrhagic shock and resuscitation (H/R). Here, the role of myeloid HIF-1α in liver hypoxia, injury, and inflammation after H/R with special regard to NF-κB activation was studied.
Methods: Mice with a conditional HIF-1α knockout (KO) in myeloid cell-line and wild-type (WT) controls were hemorrhaged for 90 min ( mm Hg) and resuscitated. Controls underwent only surgical procedures.
Results: After six hours, H/R enhanced the expression of HIF-1α-induced genes vascular endothelial growth factor (VEGF) and adrenomedullin (ADM). In KO mice, this was not observed. H/R-induced liver injury in HIF-1α KO was comparable to WT. Elevated plasma interleukin-6 (IL-6) levels after H/R were not reduced by HIF-1α KO. Local hepatic hypoxia was not significantly reduced in HIF-1α KO compared to controls after H/R. H/R-induced NF-κB phosphorylation in liver did not significantly differ between WT and KO.
Conclusions: Here, deleting HIF-1α in myeloid cells and thereby in Kupffer cells was not protective after H/R. This data indicates that other factors, such as NF-κB, due to its upregulated phosphorylation in WT and KO mice, contrary to HIF-1α, are rather key modulators of inflammation after H/R in our model.
Background: HER2 status assessment is a prerequisite for the establishment of an appropriate treatment strategy in gastric cancer. Gastric cancers are very heterogeneous and separate evaluations of gene amplification and protein expression lead to uncertainties in localizing distinct clones and are time consuming. This study evaluates the equivalence of the novel method combining both gene and protein platforms on one slide.
Methods: Immunohistochemistry (IHC) and HER2 dual-colour silver in situ hybridization (SISH) as single methods (IHC/SISH) and gene-protein platform combining both methods on one slide (gene/protein) were performed in randomly collected 100 cases of gastric adenocarcinoma. Results of IHC/SISH were compared with gene/protein staining.
Results: 96 of 100 samples were assessable. In the gene/protein staining, pathologists were able to assess gene amplification and consequent protein expression at the single cell level. In comparison trials, gene amplification was observed in 14.6% by both, conventional SISH and gene/protein platform (agreement 100%; Kappa-coefficient κ = 1.0). Protein expression scores by IHC were 70.8% (0), 10.4% (1+), 9.4% (2+), and 9.4% (3+). Protein expression by gene/protein method were: 70.8% (0), 11.5% (1+), 7.3% (2+) and 10.4% (3+) of patients. There were complete concordances in IHC assessment of cases with score 0 (100.0%; κ = 1). High concordances are shown in score 1+ (98.96%; κ = 0.947) and 3+ (96.88%; κ = 0.825) cases and good concordances in 2+ cases (95.83%; κ = 0.728).
Conclusions: This novel combined platform has the advantage of being able to evaluate both gene and the protein status in the same cancer cell and may be of particular interest for research and patient's care.
The establishment of robust HCV cell culture systems and characterization of the viral life cycle provided the molecular basis for highly innovative, successful years in HCV drug development. With the identification of direct-acting antiviral agents (DAAs), such as NS3/4A protease inhibitors, NS5A replication complex inhibitors, nucleotide and non-nucleoside polymerase inhibitors, as well as host cell targeting agents, novel therapeutic strategies were established and competitively entered clinical testing. The first-in-class NS3/4A protease inhibitors telaprevir and boceprevir, approved in 2011, were recently outpaced by the pan-genotypic nucleotide polymerase inhibitor sofosbuvir that in combination with pegylated interferon and ribavirin, further shortens therapy durations and also offers the first interferon-free HCV treatment option. In the challenging race towards the goal of interferon-free HCV therapies, however, several oral DAA regimens without nucleotide polymerase inhibitors that combine a NS3/4A protease inhibitor, a NS5A inhibitor and/or a non-nucleoside polymerase inhibitor yielded competitive results. Second generation NS3/4A protease and NS5A inhibitors promise an improved genotypic coverage and a high resistance barrier. Results of novel DAA combination therapies without the backbone of a nucleotide polymerase inhibitor, as well as treatment strategies involving host targeting agents are reviewed herein.
Sudden cardiac death (SCD) remains a daunting problem. It is a major public health issue for several reasons: from its prevalence (20% of total mortality in the industrialized world) to the devastating psycho-social impact on society and on the families of victims often still in their prime, and it represents a challenge for medicine, and especially for cardiology. This text summarizes the discussions and opinions of a group of investigators with a long-standing interest in this field. We addressed the occurrence of SCD in individuals apparently healthy, in patients with heart disease and mild or severe cardiac dysfunction, and in those with genetically based arrhythmic diseases. Recognizing the need for more accurate registries of the global and regional distribution of SCD in these different categories, we focused on the assessment of risk for SCD in these four groups, looking at the significance of alterations in cardiac function, of signs of electrical instability identified by ECG abnormalities or by autonomic tests, and of the progressive impact of genetic screening. Special attention was given to the identification of areas of research more or less likely to provide useful information, and thereby more or less suitable for the investment of time and of research funds.
Das Thoraxtrauma beim Kind
(2014)
Die vorliegende Studie soll einen Überblick geben über Epidemiologie, Unfallursachen, Verletzungsmuster, Therapie und Outcome von Kindern mit thorakalen Verletzungen und einen Vergleich zwischen kindlichen Traumapatienten mit und ohne thorakaler Beteiligung ermöglichen.
Hierfür wurden zwischen September 2002 und Juli 2006 alle Schockraumpatienten der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie der Johann Wolfgang Goethe-Universität Frankfurt am Main mittels eines standardisierten Schockraumprotokolls („TraumaWatch“) prospektiv erfasst. Die Dokumentation der Daten im Schockraum erfolgte durch einen unabhängigen Dokumentationsassistenten zeitgleich mittels Tableau-PC. Die Verlaufsdaten der Patienten wurden durch retrospektive Auswertung der Patientenakten erhoben und tabellarisch erfasst. In die Studie eingeschlossen wurden alle Patienten bis einschließlich dem 17. Lebensjahr, die lebend eingeliefert wurden und nicht direkt im Anschluss an die Schockraumdiagnostik wieder nach Hause entlassen werden konnten. Insgesamt erfüllten 256 Patienten die Einschlusskriterien. Für die Auswertung wurden zwei Gruppen gebildet: Gruppe A umfasste alle Kinder mit Thoraxtrauma (n = 46), Gruppe B alle Kinder, bei denen keine thorakale Beteiligung vorlag (n = 210).
In beiden Gruppen waren Jungen mit 69,6 % bzw. 64,8 % häufiger betroffen als Mädchen. Das Durchschnittsalter lag in Gruppe A mit 12,4 ± 4,9 Jahren signifikant höher als in Gruppe B mit 8,0 ± 5,2 Jahren. Es handelte sich fast ausschließlich um stumpfe Traumen (95,7 % bzw. 95,2 %). Verkehrsunfälle stellten in beiden Gruppen die häufigste Unfallursache dar, kamen in Gruppe A jedoch signifikant häufiger vor (65,2 % vs. 35,2 %). An zweiter Stelle lagen in beiden Gruppen Stürze, wobei in Gruppe A Stürze aus großer Höhe häufiger vorkamen. Beim Thoraxtrauma stehen demnach Unfallmechanismen mit massiverer Gewalteinwirkung im Vordergrund.
Die häufigste Thoraxverletzung war die Lungenkontusion (56,5 %), gefolgt vom Pneumothorax (34,8 %). Ein isoliertes Thoraxtrauma wurde selten beobachtet (4,3 %); die häufigste Begleitverletzung stellte das Schädel-Hirn-Trauma dar (71,7 %). Auch in Gruppe B war das Schädel-Hirn-Trauma die häufigste Verletzung (54,3 %), gefolgt von Extremitätenverletzungen (37,6 %). Verletzungen des Abdomens und Beckens wurden in Gruppe A signifikant häufiger gesehen.
Der mittlere ISS lag in Gruppe A mit 26,7 ± 15,8 signifikant höher als in Gruppe B mit 8,1 ± 6,8. Damit ist das Thoraxtrauma ein Marker für eine hohe Verletzungsschwere.
Die mittlere initiale GCS als Marker für den neurologischen Status war in Gruppe A signifikant niedriger als in Gruppe B (9,4 ± 5,1 vs. 13,0 ± 3,7). Somit treten schwere Schädel-Hirn-Traumata bei Kindern häufiger in Zusammenhang mit einem Thoraxtrauma auf.
Die Letalität war in Gruppe A höher als in Gruppe B (6,5 % vs. 1,9 %). Bei den Todesursachen stand in beiden Gruppen das Schädel-Hirn-Trauma im Vordergrund.
Sowohl die mittlere Intensivliegezeit (8,0 ± 8,1 Tage vs. 1,9 ± 5,0 Tage) als auch die Gesamtdauer des stationären Aufenthalts (13,6 ± 9,7 Tage vs. 7,9 ± 9,6 Tage) waren in Gruppe A signifikant länger als in Gruppe B. Kinder mit Thoraxtrauma mussten häufiger beatmet werden als Kinder ohne Thoraxtrauma (76,1 % vs. 26,7 %); die mittlere Beatmungsdauer war signifikant länger (5,2 ± 4,8 Tage vs. 2,7 ± 3,7 Tage). Eine präklinische Intubation war in Gruppe A ebenfalls signifikant häufiger erforderlich als in Gruppe B (56,5 % vs. 15,2 %). Kinder mit Thoraxtrauma wurden signifikant häufiger operativ versorgt (68,9 % vs. 42,9 %); unfallchirurgische Operationen standen in beiden Gruppen im Vordergrund. Komplikationen wurden in Gruppe A signifikant häufiger gesehen (52,2 % vs. 12,9 %); die häufigste Komplikation war in beiden Gruppen die respiratorische Insuffizienz (39,1 % vs. 5,2 %). In Gruppe A konnten signifikant weniger Patienten nach Hause entlassen werden als in Gruppe B (50,0 % vs. 89,0 %).
Das Thoraxtrauma stellt damit einen Marker für eine hohe Verletzungsschwere und das Vorliegen weiterer schwerer Verletzungen dar und kann somit als negativer prädiktiver Faktor angesehen werden, der die Mortalität und Morbidität bei kindlichen Traumapatienten beeinflusst.
A 48 year old patient with dilated cardiomyopathy and chronic acne inversa underwent implantation of a LVAD system (Heartmate II, Thoratec, USA) March 2011. During 2011 and 2012 the patient was repeatedly readmitted for treatment of driveline infection with MRSA. Colonization was controlled with Linezolid and Rifampicin however reoccurred after discontinuation. In August 2012 the LVAD-system was exchanged due to pump dysfunction (HVAD, HeartWare Inc., USA). Postoperatively, the patient presented with ascites which secreted through the driveline exit. Consequently, the abdominal wall was surgically corrected to prevent exit of peritoneal fluid through the driveline, and the patient was discharged with sterile wound swabs. However 6 weeks after discharge the driveline exit wound started secreting pus showing abundant growth of multi resistant staphylococcus aureus (MRSA). With clinical signs of increasing liver failure with regular need for paracentesis, and clinical signs of local infection, a CT scan of the abdomen was performed revealing an enrichment of contrast medium along the driveline and an abscess-like formation on the abdominal wall. Patient was admitted receiving regular dose Daptomycin and Rifampicin. The latter was discontinued after ten days. The abscess, surrounding driveline exit and abdominal wall cavity was excised and vacuum treatment initiated. Total duration of Daptomycin therapy was 3 weeks. While first week skin and wound swabs were still positive for MRSA, all samples were sterile after the second week. Inflammation was monitored by leucocyte count and IL6. The secretion of pus along the driveline ceased, the wound cavity was closed subsequently. After discharge and stop of antibiotics skin and driveline swabs remained negative for MRSA (10 weeks).
Predominant polarity in bipolar disorder and validation of the polarity index in a German sample
(2014)
Background: A large number of patients with bipolar disorder (BD) can be characterized by predominant polarity (PP), which has important implications for relapse prevention. Recently, Popovic et al. (EUR NEUROPSYCHOPHARM 22(5): 339¿346, 2012) proposed the Polarity Index (PI) as a helpful tool in the maintenance treatment of BD. As a numeric expression, it reflects the efficacy of drugs used in treatment of BD. In the present retrospective study, we aimed to validate this Index in a large and well characterized German bipolar sample.
Methods: We investigated 336 bipolar patients (BP) according to their PP and calculated the PI for each patient in order to prove if maintenance treatment differs according to their PP. Furthermore, we analysed whether PP is associated with demographic and clinical characteristics of BP.
Results: In our sample, 63.9% of patients fulfilled criteria of PP: 169 patients were classified as depressive predominant polarity (DPP), 46 patients as manic predominant polarity (MPP). The two groups differed significantly in their drug regime: Patients with DPP were more often medicated with lamotrigine and antidepressants, patients with MPP were more often treated with lithium, valproate, carbamazepine and first generation antipsychotics. However, patients with DPP and MPP did not differ significantly with respect to the PI, although they received evidence-based and guideline-driven treatment.
Conclusion: The reason for this negative finding might well be that for several drugs, which were used frequently, no PI value is available. Nevertheless we suggest PP as an important concept in the planning of BD maintenance treatment.
Introduction: Multimorbidity is a major concern in primary care. Nevertheless, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. The aim of this study is to systematically review studies of the prevalence, patterns and determinants of multimorbidity in primary care.
Methods: Systematic review of literature published between 1961 and 2013 and indexed in Ovid (CINAHL, PsychINFO, Medline and Embase) and Web of Knowledge. Studies were selected according to eligibility criteria of addressing prevalence, determinants, and patterns of multimorbidity and using a pretested proforma in primary care. The quality and risk of bias were assessed using STROBE criteria. Two researchers assessed the eligibility of studies for inclusion (Kappa = 0.86).
Results: We identified 39 eligible publications describing studies that included a total of 70,057,611 patients in 12 countries. The number of health conditions analysed per study ranged from 5 to 335, with multimorbidity prevalence ranging from 12.9% to 95.1%. All studies observed a significant positive association between multimorbidity and age (odds ratio [OR], 1.26 to 227.46), and lower socioeconomic status (OR, 1.20 to 1.91). Positive associations with female gender and mental disorders were also observed. The most frequent patterns of multimorbidity included osteoarthritis together with cardiovascular and/or metabolic conditions.
Conclusions: Well-established determinants of multimorbidity include age, lower socioeconomic status and gender. The most prevalent conditions shape the patterns of multimorbidity. However, the limitations of the current evidence base means that further and better designed studies are needed to inform policy, research and clinical practice, with the goal of improving health-related quality of life for patients with multimorbidity. Standardization of the definition and assessment of multimorbidity is essential in order to better understand this phenomenon, and is a necessary immediate step.
Neurons of the mammalian neocortex are produced by proliferating cells located in the ventricular zone (VZ) lining the lateral ventricles. This is a complex and sequential process, requiring precise control of cell cycle progression, fate commitment and differentiation. We have analyzed publicly available databases from mouse and human to identify candidate genes that are potentially involved in regulating early neocortical development and neurogenesis. We used a mouse in situ hybridization dataset (The Allen Institute for Brain Science) to identify 13 genes (Cdon, Celsr1, Dbi, E2f5, Eomes, Hmgn2, Neurog2, Notch1, Pcnt, Sox3, Ssrp1, Tead2, Tgif2) with high correlation of expression in the proliferating cells of the VZ of the neocortex at early stages of development (E15.5). We generated a similar human brain network using microarray and RNA-seq data (BrainSpan Atlas) and identified 407 genes with high expression in the developing human VZ and subventricular zone (SVZ) at 8–9 post-conception weeks. Seven of the human genes were also present in the mouse VZ network. The human and mouse networks were extended using available genetic and proteomic datasets through GeneMANIA. A gene ontology search of the mouse and human networks indicated that many of the genes are involved in the cell cycle, DNA replication, mitosis and transcriptional regulation. The reported involvement of Cdon, Celsr1, Dbi, Eomes, Neurog2, Notch1, Pcnt, Sox3, Tead2, and Tgif2 in neural development or diseases resulting from the disruption of neurogenesis validates these candidate genes. Taken together, our knowledge-based discovery method has validated the involvement of many genes already known to be involved in neocortical development and extended the potential number of genes by 100's, many of which are involved in functions related to cell proliferation but others of which are potential candidates for involvement in the regulation of neocortical development.
Bei Knochendefekten kritischer Größe ist es notwendig, den Knochen bei der Heilung zu unterstützen. Der derzeitige Goldstandard bei der Behandlung von critical size defects ist die Entnahme von autologem Knochen aus dem Beckenkamm, dies ist jedoch mit Nachteilen wie Entnahmemorbidität und Limitierung der entnehmbaren Menge vergesellschaftet. Das Knochen tissue engineering, bei welchem regenerative Zellen mit einem Knochenersatzmaterial kombiniert werden, könnte eine vielversprechende Alternative sein. Stromale Knochenmarkzellen, die Osteoblasten differenzieren können, und endotheliale Vorläuferzellen, die die Vaskularisierung der Defektzone unterstützen, zeigten sich effektiv in tierexperimentellen Studien; jedoch müssen diese Zellen vor Verwendung über einen längeren Zeitraum in Kultur expandiert werden. Dies kann jedoch zu einer Akkumulation genetischer Schäden und möglicherweise zu einer Entartung der transplantierten Zellen führen. Bone marrow mononuclear cells (BMC) stellen eine interessante Alternative dar, sie können innerhalb weniger Stunden isoliert und dem Patienten zurückgegeben werden. Ziel dieser Arbeit war daher, die Adhäsion und funktionelle Aspekte von BMC auf drei verschiedenen Knochenersatzmaterialien zu analysieren.
Im ersten Versuchsteil wurde untersucht, ob es möglich ist, BMC auf einem β-Tricalciumphosphat (β-TCP)-Scaffold auszusäen, und ob eine Beschichtung des Scaffolds eine positive Auswirkung auf die BMC-Adhäsion und Aktivität hat. Hierbei wurde eine Beschichtung mit humanem Plasma (FFP) und Fibronektin gegen eine Kontrolle verglichen. Es konnte gezeigt werden, dass BMC auf unbeschichtetem β-TCP adhärieren und dass eine Vorbeschichtung des Scaffolds mit Fibronektin oder mit FFP zu keiner weiteren Verbesserung der initialen Adhäsion führt. FACS-Analysen zeigten, dass der Prozentsatz der auf dem Material adhärierenden Fraktionen regenerativer Zellen dem Prozentsatz der in der Kontrolle enthaltenen regenerativen Zellen entspricht. Überdies konnte eine endotheliale Differenzierung der ausgesäten BMC beobachtet werden. Die Anzahl adhärierender BMC war zum ersten Messpunkt an Tag zwei unabhängig von der Vorbeschichtung am höchsten. Interessanterweise war die Zahl der adhärierenden BMC auf unbeschichtetem Material signifikant gegenüber den beschichteten Materialien erhöht.
Basierend auf der Beobachtung, dass eine Vorbeschichtung der Trägersubstanz nicht zu einer Verbesserung der BMC-Adhäsion auf dem Gerüststoff führt, wurden im zweiten Versuchsteil unbeschichtete Gerüststoffe miteinander verglichen. Für diese Arbeit wurden drei aus verschiedenen Klassen der Knochenersatzmaterialien stammende Scaffolds gewählt. ChronOs® als Vertreter der β-TCPs, Cerabone®, eine verarbeitete bovine Knochenmatrix, und Demineralized Bone Matrix (DBM), ein sterilisiertes humanes Knochentransplantat. Die Untersuchungen ergaben signifikante Unterschiede in der Aussaateffizienz der Zellen auf den Materialien und der Zellaktivität im Verlauf über 21 Tage. DBM zeigte hier im Materialvergleich die besten Ergebnisse. In unserem Versuch zeigte sich die Menge der absorbierten Flüssigkeit im Verhältnis zur Materialmenge bei DBM signifikant erhöht gegenüber den beiden anderen Materialien. Zudem konnte mittels HE- und Kern-Färbung (DAPI) der Nachweis erbracht werden, dass sich Zellen tief im Inneren des Materials anlagern. MTT-Tests zeigten an Tag 14 eine signifikant erhöhte metabolische Aktivität auf DBM gegenüber Cerabone® und an Tag 21 gegenüber beiden Vergleichsmatrices. Wir konnten auf allen Materialien an Tag 2 eine signifikant erhöhte VEGF-Produktion feststellen. Mittels Real-Time-PCR ließ sich eine VEGF-Genexpression in BMC auf allen Materialien bis Tag 14 und auf DBM über die kompletten 21 Tage nachweisen. Die Genexpression von vWF konnte ebenfalls auf allen Materialien über den gesamten Zeitraum nachgewiesen werden.
Zusammengefasst konnte durch diese Studie belegt werden, dass die initiale Adhärenz von BMC auf unbeschichtete Knochenersatzmaterialien generell hoch ist, aber signifikante materialspezifische Unterschiede in der Aussaateffizienz und nachfolgend der metabolischen Aktivität und der VEGFSynthese der BMC existieren. Humanes Knochenersatzmaterial zeigte sich in unserer Studie als überlegen. Daher sollte die Art des Knochenersatzmaterials für den künftigen klinischen Einsatz von BMC Berücksichtigung finden.