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CXCL16 and oxLDL are induced in the onset of diabetic nephropathy (2009)

Paul Gutwein Mohamed Sadek Abdel-Bakky Kai Doberstein Anja Schramme Janet Beckmann Liliana Schäfer Kerstin Amann Anke Doller Nicole Kämpfer-Kolb Abdel-Aziz H. Abdel-Aziz El Sayed M. El Sayed Josef Martin Pfeilschifter

Diabetic nephropathy (DN) is a major cause of end-stage renal failure worldwide. Oxidative stress has been reported to be a major culprit of the disease and increased oxidized low density lipoprotein (oxLDL) immune complexes were found in patients with DN. In this study we present evidence, that CXCL16 is the main receptor in human podocytes mediating the uptake of oxLDL. In contrast, in primary tubular cells CD36 was mainly involved in the uptake of oxLDL. We further demonstrate that oxLDL down-regulated α3-integrin expression and increased the production of fibronectin in human podocytes. In addition, oxLDL uptake induced the production of reactive oxygen species (ROS) in human podocytes. Inhibition of oxLDL uptake by CXCL16 blocking antibodies abrogated the fibronectin and ROS production and restored α3 integrin expression in human podocytes. Furthermore we present evidence that hyperglycaemic conditions increased CXCL16 and reduced ADAM10 expression in podocytes. Importantly, in streptozotocin-induced diabetic mice an early induction of CXCL16 was accompanied by higher levels of oxLDL. Finally immunofluorescence analysis in biopsies of patients with DN revealed increased glomerular CXCL16 expression, which was paralleled by high levels of oxLDL. In summary, regulation of CXCL16, ADAM10 and oxLDL expression may be an early event in the onset of DN and therefore all three proteins may represent potential new targets for diagnosis and therapeutic intervention in DN.

Current evidence for a modulation of low back pain by human genetic variants (2009)

Irmgard Tegeder Jörn Lötsch

The manifestation of chronic back pain depends on structural, psychosocial, occupational and genetic influences. Heritability estimates for back pain range from 30% to 45%. Genetic influences are caused by genes affecting intervertebral disc degeneration or the immune response and genes involved in pain perception, signalling and psychological processing. This inter-individual variability which is partly due to genetic differences would require an individualized pain management to prevent the transition from acute to chronic back pain or improve the outcome. The genetic profile may help to define patients at high risk for chronic pain. We summarize genetic factors that (i) impact on intervertebral disc stability, namely Collagen IX, COL9A3, COL11A1, COL11A2, COL1A1, aggrecan (AGAN), cartilage intermediate layer protein, vitamin D receptor, metalloproteinsase-3 (MMP3), MMP9, and thrombospondin-2, (ii) modify inflammation, namely interleukin-1 (IL-1) locus genes and IL-6 and (iii) and pain signalling namely guanine triphosphate (GTP) cyclohydrolase 1, catechol-O-methyltransferase, μ opioid receptor (OPMR1), melanocortin 1 receptor (MC1R), transient receptor potential channel A1 and fatty acid amide hydrolase and analgesic drug metabolism (cytochrome P450 [CYP]2D6, CYP2C9).

Amino acids – Guidelines on Parenteral Nutrition, Chapter 4 (2009)

Jürgen Stein Hansjosef Böhles Irina Blumenstein Christiane Goeters Ralf-Joachim Schulz

Protein catabolism should be reduced and protein synthesis promoted with parenteral nutrion (PN). Amino acid (AA) solutions should always be infused with PN. Standard AA solutions are generally used, whereas specially adapted AA solutions may be required in certain conditions such as severe disorders of AA utilisation or in inborn errors of AA metabolism. An AA intake of 0.8 g/kg/day is generally recommended for adult patients with a normal metabolism, which may be increased to 1.2–1.5 g/kg/day, or to 2.0 or 2.5 g/kg/day in exceptional cases. Sufficient non-nitrogen energy sources should be added in order to assure adequate utilisation of AA. A nitrogen calorie ratio of 1:130 to 1:170 (g N/kcal) or 1:21 to 1:27 (g AA/kcal) is recommended under normal metabolic conditions. In critically ill patients glutamine should be administered parenterally if indicated in the form of peptides, for example 0.3–0.4 g glutamine dipeptide/kg body weight/day (=0.2–0.26 g glutamine/kg body weight/day). No recommendation can be made for glutamine supplementation in PN for patients with acute pancreatitis or after bone marrow transplantation (BMT), and in newborns. The application of arginine is currently not warranted as a supplement in PN in adults. N-acetyl AA are only of limited use as alternative AA sources. There is currently no indication for use of AA solutions with an increased content of glycine, branched-chain AAs (BCAA) and ornithine-α-ketoglutarate (OKG) in all patients receiving PN. AA solutions with an increased proportion of BCAA are recommended in the treatment of hepatic encephalopathy (III–IV).

Neonatology/Paediatrics – Guidelines on Parenteral Nutrition, Chapter 13 (2009)

Christoph Fusch Karl Bauer Hansjosef Böhles Frank Jochum Berthold Koletzko Michael Krawinkel Kathrin Krohn Stefan Mühlebach

There are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.

Studienordnung für den Studiengang Medizin mit dem Abschluss "Ärztliche Prüfung" an der Johann Wolfgang Goethe-Universität Frankfurt am Main vom 06.Februar 2003 (StAnz. 43/2003, S. 4176 ff.) in der Fassung vom 04.11.2004 und 06.01.2005 (StAnz. 33/2005, S. 3210), zuletzt geändert am 04.05.2006 ; hier: Änderung (2009)

Studienordnung für den Studiengang Medizin mit dem Abschluss „Ärztliche Prüfung“ an der Johann Wolfgang Goethe-Universität Frankfurt am Main vom 06. Februar 2003 (StAnz. 43/2003, S.4176 ff.) in der Fassung vom 04.11.2004 und 06.01.2005 (StAnz. 33/2005, S.3210) zuletzt geändert am 11.12.2008 (UniReport vom 11.03.2009) : genehmigt durch das Präsidium der Johann Wolfgang Goethe-Universität vom 08.12.2009 ; Änderung (2009)

Physicians' working conditions and job satisfaction: does hospital ownership in Germany make a difference? (2009)

Stefanie Mache Karin Vitzthum Albert Nienhaus Burghard F. Klapp Jan David Alexander Groneberg

BACKGROUND: A growing number of German hospitals have been privatized with the intention of increasing cost effectiveness and improving the quality of health care. Numerous studies investigated what possible qualitative and economic consequences these changes issues might have on patient care.However, little is known about how this privatization trend relates to physicians' working conditions and job satisfaction. It was anticipated that different working conditions would be associated with different types of hospital ownership. To that end, this study's purpose is to compare how physicians, working for both public and privatized hospitals, rate their respective psychosocial working conditions and job satisfaction. METHODS: The study was designed as a cross-sectional comparison using questionnaire data from 203 physicians working at German hospitals of different ownership types (private for-profit, public and private nonprofit). RESULTS: The present study shows that several aspects of physicians' perceived working conditions differ significantly depending on hospital ownership. However, results also indicated that physicians' job satisfaction does not vary between different types of hospital ownership. Finally, it was demonstrated that job demands and resources are associated with job satisfaction, while type of ownership is not. CONCLUSION: This study represents one of a few studies that investigate the effect of hospital ownership on physicians work situation and demonstrated that the type of ownership is a potential factor accounting for differences in working conditions. The findings provide an informative basis to find solutions improving physicians' work at German hospitals.

kurz und kn@pp news : Nr. 16 [engl. Fassung] (2009)

* Cooperation between "jeder-fehlerzaehlt.de" and the Techniker statutory insurance company * "PRIoritising multiple medication in multi-morbid patients" – PRIMUM-Pilot study gets off to successful start * New work area: Quality promotion and concept development * Frankfurt Training Program in Evidence-Based Medicine * Another change in our institute is the new arrival of Sabine Pommeresch * 2nd General Practice Day in Frankfurt

kurz und kn@pp news : Nr. 15 [engl. Fassung] (2009)

* International Study on Medical Homes * Learning from mistakes * Optimizing medication for elderly, multimorbid patients * The Safety culture in German family practices * 2nd Frankfurt General Practice Day: Now online

kurz und kn@pp news : Nr. 17 (2009)

* Sachverständigenrat fordert Stärkung der Allgemeinmedizin * Evaluation von DMP * Professur für chronische Krankheiten * Fünf Jahre Jeder-Fehler-zaehlt * DEGAM-Kongress 2009

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