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Background: Patients fearing dental interventions are at risk of delaying or skipping much-needed treatments. Empathic communication could lead to a higher rate of compliance from patients within this group. Empathy, the big five personality traits, and emotion management abilities are all known to influence the quality of communication between dentists and patients. This study was conducted to analyze whether there is a correlation between these factors in dentistry students.
Methods: Dentistry students in their 2nd and 4th year of study were asked to complete questionnaires assessing empathy, emotion management, and personality traits. Out of a total of 148 eligible participants, 53 students (34%) volunteered to participate. For empathy, the Jefferson Scale of Physician Empathy (students’ version; JSPE-S) and the Interpersonal Reactivity Index (IRI) were used. Personality traits were assessed using the Short Big Five Inventory (BFI-s), and the Situational Test of Emotional Management (STEM) to measure emotional management ability.
Results: Higher scores for emotion management were significantly correlated with the female gender (p ≤ 0.005) and with higher scores in openness (p ≤ 0.05). Students with higher scores in openness also achieved higher scores on the IRI subscales: Perspective taking (p ≤ 0.05), Fantasy (p ≤ 0.01), Empathic concern (p ≤ 0.05), and Personal distress (p ≤ 0.05). For JSPE-S, no correlation with emotion management and personality traits was found.
Conclusion: Empathy and emotion management might not be significantly related in dentistry students. Regarding personality traits, students who scored higher on openness also indicated higher abilities in emotion management. These findings should be taken into consideration when planning communication courses for dentistry students, as it might be possible to independently train empathy and emotion management as part of emotional intelligence.
Resistenzen gegenüber Carbapenemen sind eine Bedrohung für die globale Gesundheit mit wenigen verbleibenden Therapieoptionen. Ceftazidim/Avibavtam (CZA) ist die Kombination aus einem Cephalosporin und einem Diazabicyclooctan, mit der Eigenschaft eine Vielzahl von Carbapenemasen der Ambler Klasse A und D zu inhibieren. Resistenzen gegenüber Carbapenemen in gramnegativen Bakterien sind in Kolumbien und anderen Ländern Lateinamerikas weit verbreitet. In den hier vorgestellten Arbeiten wurden 2.235 Enterobakterien und 492 P. aeruginosa Isolate aus fünf Lateinamerikanischen Ländern auf ihre Empfindlichkeit gegenüber CZA und anderen klinisch verfügbaren Antibiotika untersucht. Die CZA-resistenten Isolate wurden mittels PCR und Genomsequenzierung auf die zugrundeliegenden Resistenzmechanismen hin analysiert. CZA zeigte Aktivitäten gegenüber 99,2% (2.217/2.235) aller untersuchten Enterobacterales und 77,8% (383/492) aller P. aeruginosa Isolate. Als plausible Erklärung für die Resistenz gegen CZA konnte mittels qPCR bei allen Enterobakterien und bei 38,5% (42/109) der P. aeruginosa Isolate ein Metallo-β-Laktamase (MBL)-kodierendes Gen nachgewiesen werden. Die verbleibenden P. aeruginosa Isolate wurden einer Genomsequenzierung unterzogen, dabei zeigten sich Mutationen in Genen, die zuvor mit einer verringerten Empfindlichkeit gegen CZA assoziiert wurden, wie z.B. Genen die mit der Überexpression von MexAB-OprM und AmpC (PDC) in Verbindung stehen, sowie Genen, die PoxB (blaOXA-50-like), FtsI (PBP3), DacB (PBP4) und OprD kodieren. Unsere Ergebnisse unterstreichen die Notwendigkeit von Therapieoptionen gegenüber MBL-produzierenden und anderen Carbapenem-resistenten Mikroorganismen. Des Weiteren sind diese Studien eine Momentaufnahme der Empfindlichkeit gegen CZA vor dessen Verfügbarkeit in Lateinamerika und dienen deswegen als Ausgangspunkt um die Entwicklung von Resistenzen in dieser Region zu verfolgen.
The interaction of Eph receptor tyrosine kinases with their transmembrane ligands; the ephrins, is important for the regulation of cell-cell communication. Ephrin-Eph signaling is probably best known for the discrimination of arterial and venous territories by repulsion of venous endothelial cells away from those with an arterial fate. Ultimately, cell repulsion is mediated by initiating the collapse of the actin cytoskeleton in membrane protrusions. Here, we investigated the role of the Ena/VASP family of actin binding proteins in endothelial cell repulsion initiated by ephrin ligands. Human endothelial cells dynamically extended sheet-like lamellipodia over ephrin-B2 coated surfaces. While lamellipodia of control siRNA transfected cells rapidly collapsed, resulting in a pronounced cell repulsion from the ephrin-B2 surfaces, the knockdown of Ena/VASP proteins impaired the cytoskeletal collapse of membrane protrusions and the cells no longer avoided the repulsive surfaces. Mechanistically, ephrin-B2 stimulation elicited the EphB-mediated tyrosine phosphorylation of VASP, which abrogated its interaction with the focal adhesion protein Zyxin. Nck2 was identified as a novel VASP binding protein, which only interacted with the tyrosine phosphorylated VASP protein. Nck links Eph-receptors to the actin cytoskeleton. Therefore, we hypothesize that Nck-Ena/VASP complex formation is required for actin reorganization and/or Eph receptor internalization downstream of ephrin-Eph interaction in endothelial cells, with implications for endothelial navigation and pathfinding.
Unpredictable disease trajectories make early clarification of end-of-life (EoL) care preferences in older patients with multimorbidity advisable. This mixed methods systematic review synthesizes studies and assesses such preferences. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool to assess risk of bias (RoB). We synthesized findings from 22 studies (3243 patients) narratively and, where possible, quantitatively. Nineteen studies assessed willingness to receive life-sustaining treatments (LSTs), six, the preferred place of care, and eight, preferences regarding shared decision-making processes. When unspecified, 21% of patients in four studies preferred any LST option. In three studies, fewer patients chose LST when faced with death and deteriorating health, and more when treatment promised life extension. In 13 studies, 67% and 48% of patients respectively were willing to receive cardiopulmonary resuscitation and mechanical ventilation, but willingness decreased with deteriorating health. Further, 52% of patients from three studies wished to die at home. Seven studies showed that unless incapacitated, most patients prefer to decide on their EoL care themselves. High non-response rates meant RoB was high in most studies. Knowledge of EoL care preferences of older patients with multimorbidity increases the chance such care will be provided.
Introduction End-of-life care is an essential task performed by most healthcare providers and often involves decision-making about how and where patients want to receive care. To provide decision support to healthcare professionals and patients in this difficult situation, we will systematically review a knowledge cluster of the end-of-life care preferences of older patients with multimorbidity that we previously identified using an evidence map.
Methods and analysis We will systematically search for studies reporting end-of-life care preferences of older patients (mean age ≥60) with multimorbidity (≥2 chronic conditions) in MEDLINE, CINAHL, PsycINFO, Social Sciences Citation Index, Social Sciences Citation Index Expanded, PSYNDEX and The Cochrane Library from inception to September 2019. We will include all primary studies that use quantitative, qualitative and mixed methodologies, irrespective of publication date and language.
Two independent reviewers will assess eligibility, extract data and describe evidence in terms of study/population characteristics, preference assessment method and end-of-life care elements that matter to patients (eg, life-sustaining treatments). Risk of bias/applicability of results will be independently assessed by two reviewers using the Mixed-Methods Appraisal Tool. Using a convergent integrated approach on qualitative/quantitative studies, we will synthesise information narratively and, wherever possible, quantitatively.
Ethics and dissemination Due to the nature of the proposed systematic review, ethics approval is not required. Results from our research will be disseminated at relevant (inter-)national conferences and via publication in peer-reviewed journals. Synthesising evidence on end-of-life care preferences of older patients with multimorbidity will improve shared decision-making and satisfaction in this final period of life.
Background: Austria has recently been embroiled in the complex debate on the legalization of measures to end life prematurely. Empirical data on end-of-life decisions made by Austrian physicians barely exists. This study is the first in Austria aimed at finding out how physicians generally approach and make end-of-life therapy decisions.
Methods: The European end-of-life decisions (EURELD) questionnaire, translated and adapted by Schildmann et al., was used to conduct this cross-sectional postal survey. Questions on palliative care training, legal issues, and use of and satisfaction with palliative care were added. All Austrian specialists in hematology and oncology, a representative sample of doctors specialized in internal medicine, and a sample of general practitioners, were invited to participate in this anonymous postal survey.
Results: Five hundred forty-eight questionnaires (response rate: 10.4%) were evaluated. 88.3% of participants had treated a patient who had died in the previous 12 months. 23% of respondents had an additional qualification in palliative medicine. The cause of death in 53.1% of patients was cancer, and 44.8% died at home. In 86.3% of cases, pain relief and / or symptom relief had been intensified. Further treatment had been withheld by 60.0%, and an existing treatment discontinued by 49.1% of respondents. In 5 cases, the respondents had prescribed, provided or administered a drug which had resulted in death. 51.3% of physicians said they would never carry out physician-assisted suicide (PAS), while 30.3% could imagine doing so under certain conditions. 38.5% of respondents supported the current prohibition of PAS, 23.9% opposed it, and 33.2% were undecided. 52.4% of physicians felt the legal situation with respect to measures to end life prematurely was ambiguous. An additional qualification in palliative medicine had no influence on measures taken, or attitudes towards PAS.
Conclusions: The majority of doctors perform symptom control in terminally ill patients. PAS is frequently requested but rarely carried out. Attending physicians felt the legal situation was ambiguous. Physicians should therefore receive training in current legislation relating to end-of-life choices and medical decisions. The data collected in this survey will help political decision-makers provide the necessary legal framework for end-of-life medical care.
Morbus Parkinson ist die zweithäufigste neurodegenerativen Erkrankung, die durch Untergang der dopaminergen Neuronen im Mesenzephalon zu einer Störung des extrapyramidalen motorischen Systems führt. Daraus resultierende Bewegungsstörungen, zu denen Rigor, Tremor, Hypokinese und posturale Instabilität gehören, werden von nichtmotorischen Symptomen wie autonome Dysregulation, veränderte sensorische Wahrnehmung, sowie kognitive und psychische Störungen begleitet.
Mehrere Studien berichten über erhöhte Schmerzprävalenz bei Parkinson Patienten. Die genaue Pathogenese der gestörten Schmerzwahrnehmung bleibt unklar. Zusätzlich zu den zentralen Mechanismen entstehen die Schmerzen bei Morbus Parkinson wahrscheinlich durch eine Schädigung der peripheren somatosensorischen und autonomen Neuronen, die sich in sensorischen Defiziten, sowie in erhöhter Schmerzempfindlichkeit manifestieren. Als Korrelat dazu wurden abnormale somatosensorisch evozierte Potenziale, pathologische Ergebnisse in der quantitativen sensorischen Testung und eine Abnahme der Nervenfaserdichte beschrieben.
Ein Schwerpunkt unserer Untersuchungen lag auf der Erforschung von potentiellen Veränderungen von Lipidsignalmolekülen. Eine Reihe von Studien zeigen eine Schmerzlinderung durch Cannabis-Einnahme, sowie eine Tendenz zur Schmerzentwicklung bei Parkinson Patienten mit dem bekannten FAAHPolymorphismus. Die Ergebnisse deuten darauf hin, dass eine Störung im Endocannabinoid-System höchstwahrscheinlich zu erhöhter Schmerzprävalenz bei Morbus Parkinson beiträgt. Eine weitere wichtige Lipid-Gruppe sind Glycosylceramide. Ihr Abbau kann durch heterozygote Mutationen des lipidabbauenden Enzyms Glukocerebrosidase 1 (GBA1) gestört sein. GBA1 Mutationen sind mit der schnell progredienten sporadischen Verlaufsform der Parkinson-Krankheit assoziiert.
Im Rahmen der Studie wurden zwei Kohorten von Parkinson Patienten analysiert. Die 128 Patienten aus Israel wurden im ersten Teil mit 224 jungen gesunden deutschen Probanden verglichen. Im zweiten Teil wurden 50 deutschen Patienten und 50 gesunde altersgleiche Probanden untersucht. Die Schmerzevaluation erfolgte anhand der "Brief Pain Inventory“ und "Neuro Detect“ Fragebögen. Bei allen Probanden wurde quantitative sensorische Testung durchgeführt und die Plasmakonzentrationen der Lipidsignalmoleküle mittels quantitativer HPLC-Tandem-Massenspektrometrie analysiert.
Nach Auswertung der Schmerzevaluation konnte eine erhöhte Schmerzprävalenz bei Parkinson Patienten festgestellt werden. Die Prävalenz betrug 66% im ersten Teil der Studie und 74% in der deutschen Kohorte, im Vergleich zu 40% bei den altersgleichen gesunden Probanden. Ergebnisse der quantitativen sensorischen Testung zeigen einen Verlust der thermischen Empfindung (erhöhte Schwellen) bei der gleichzeitigen mechanischen Überempfindlichkeit (erniedrigte Schwellen). In der multivariaten LipidAnalyse konnten erniedrigte Konzentrationen von Anandamid und Lysophosphatidsäure 20:4 und eine Erhöhung der Glucosylceramide nachgewiesen werden. Diese Veränderungen waren bei Parkinson Patienten mit Schmerzen stärker ausgeprägt. Außerdem wurde eine lineare Korrelation zwischen Glucosylceramiden (GlcCer 18:1, GlcCer 24:1) und der Schmerzintensität, sowie sensorischem Defizit festgestellt.
Nach sorgfältiger Auswertung der Studienergebnisse kommen wir zu der Schlussfolgerung, dass eine Veränderung der Endocannabinoide und der Glucosylceramide zur Pathogenese der Schmerzen und der sensorischen Neuropathie bei Morbus Parkinson beitragen. Die Erkenntnisse könnten zukünftig zur Diagnosestellung durch frühzeitige Erkennung prämotorischer sensorischer Symptome beitragen. Darüber hinaus könnten unsere Ergebnisse zur Therapieoptimierung durch Wiederherstellung der Lipid-Homeostases beitragen.
Introduction: Arachidonoyl ethanolamide (AEA) and 2-arachidonoyl glycerol (2-AG) are central lipid mediators of the endocannabinoid system. They are highly relevant due to their involvement in a wide variety of inflammatory, metabolic or malign diseases. Further elucidation of their modes of action and use as biomarkers in an easily accessible matrix, like blood, is restricted by their susceptibility to deviations during blood sampling and physiological co-dependences, which results in high variability of reported concentrations in low ng/mL ranges.
Objectives: The objective of this review is the identification of critical parameters during the pre-analytical phase and proposal of minimum requirements for reliable determination of endocannabinoids (ECs) in blood samples.
Methods: Reported physiological processes influencing the EC concentrations were put into context with published pre-analytical research and stability data from bioanalytical method validation.
Results: The cause for variability in EC concentrations is versatile. In part, they are caused by inter-individual factors like sex, metabolic status and/or diurnal changes. Nevertheless, enzymatic activity in freshly drawn blood samples is the main reason for changing concentrations of AEA and 2-AG, besides additional non-enzymatic isomerization of the latter.
Conclusion: Blood samples for EC analyses require immediate processing at low temperatures (>0 °C) to maintain sample integrity. Standardization of the respective blood tube or anti-coagulant, sampling time point, applied centrifugal force and complete processing time can further decrease variability caused by sample handling. Nevertheless, extensive characterization of study participants is needed to reduce distortion of clinical data caused by co-variables and facilitate research on the endocannabinoid system.
Perception, particularly in the visual domain, is drastically influenced by rhythmic changes in ambient lighting conditions. Anticipation of daylight changes by the circadian system is critical for survival. However, the neural bases of time-of-day-dependent modulation in human perception are not yet understood. We used fMRI to study brain dynamics during resting-state and close-to-threshold visual perception repeatedly at six times of the day. Here we report that resting-state signal variance drops endogenously at times coinciding with dawn and dusk, notably in sensory cortices only. In parallel, perception-related signal variance in visual cortices decreases and correlates negatively with detection performance, identifying an anticipatory mechanism that compensates for the deteriorated visual signal quality at dawn and dusk. Generally, our findings imply that decreases in spontaneous neural activity improve close-to-threshold perception.
Sepsis is a serious clinical condition which can cause life-threatening organ dysfunction, and has limited therapeutic options. The paradigm of limiting excessive inflammation and promoting anti-inflammatory responses is a simplified concept. Yet, the absence of intrinsic anti-inflammatory signaling at the early stage of an infection can lead to an exaggerated activation of immune cells, including monocytes and macrophages. There is emerging evidence that endogenous molecules control those mechanisms. Here we aimed to identify and describe the dynamic changes in monocyte and macrophage subsets and lung damage in CL57BL/6N mice undergoing blunt chest trauma with subsequent cecal ligation and puncture. We showed that early an increase in systemic and activated Ly6C+CD11b+CD45+Ly6G− monocytes was paralleled by their increased emigration into lungs. The ratio of pro-inflammatory Ly6ChighCD11b+CD45+Ly6G− to patrolling Ly6ClowCD11b+CD45+Ly6G− monocytes significantly increased in blood, lungs and bronchoalveolar lavage fluid (BALF) suggesting an early transition to inflammatory phenotypes during early sepsis development. Similar to monocytes, the level of pro-inflammatory Ly6ChighCD45+F4/80+ macrophages increased in lungs and BALF, while tissue repairing Ly6ClowCD45+F4/80+ macrophages declined in BALF. Levels of inflammatory mediators TNF-α and MCP-1 in blood and RAGE in lungs and BALF were elevated, and besides their boosting of inflammation via the recruitment of cells, they may promote monocyte and macrophage polarization, respectively, toward the pro-inflammatory phenotype. Neutralization of uteroglobin increased pro-inflammatory cytokine levels, activation of inflammatory phenotypes and their recruitment to lungs; concurrent with increased pulmonary damage in septic mice. In in vitro experiments, the influence of uteroglobin on monocyte functions including migratory behavior, TGF-β1 expression, cytotoxicity and viability were proven. These results highlight an important role of endogenous uteroglobin as intrinsic anti-inflammatory signal upon sepsis-induced early lung injury, which modules the early monocyte/macrophages driven inflammation.