Effect of hospitalization on equine local intestinal immunoglobulin A (IgA) concentration measured in feces

During hospitalization horses may develop gastrointestinal conditions triggered by a stress-associated weak local immune system. The prospective, clinical trial was conducted to find out whether fecal immunoglobulin A (IgA) concentrations could be determined in hospitalized horses and how they changed during hospitalization and in response to various stressors. Samples were obtained from 110 horses and a control group (n = 14). At arrival in the hospital, horses were categorized into pain grades (1-5), and elective versus strenuous surgery (> 2 hours, traumatic and emergency procedures). Feces were collected on day 1, day 2, day 3, and day 7 in all horses. Blood samples were obtained at the same intervals, but additionally after general anaesthesia in horses undergoing surgery (day 2). IgA concentration in feces was determined by ELISA and measured in optical density at 450nm. The control group showed constant IgA concentrations on all days (mean value 0.30 OD450 ±SD 0.11, 1.26 mg/g; n = 11). After general anaesthesia fecal IgA concentrations decreased considerably independent of duration and type of surgery (P < 0.001 for elective and P = 0.043 for traumatic surgeries). High plasma cortisol concentrations were weakly correlated with low fecal IgA on the day after surgery (P = 0.012, day 3, correlation coefficient r = 0.113). Equine fecal IgA concentrations showed a decline associated with transport, surgery, and hospitalization in general, indicating that stress has an impact on the local intestinal immune function and may predispose horses for developing gastrointestinal diseases such as enterocolitis.

Unveiling microbial biomarkers of ruminant methane emission through machine learning

Background

Enteric methane from cow burps, which results from microbial fermentation of high-fiber feed in the rumen, is a significant contributor to greenhouse gas emissions. A promising strategy to address this problem is microbiome-based precision feed, which involves identifying key microorganisms for methane production. While machine learning algorithms have shown success in associating human gut microbiome with various human diseases, there have been limited efforts to employ these algorithms to establish microbial biomarkers for methane emissions in ruminants.

Methods

In this study, we aim to identify potential methane biomarkers for methane emission from ruminants by employing regression algorithms commonly used in human microbiome studies, coupled with different feature selection methods. To achieve this, we analyzed the microbiome compositions and identified possible confounding metadata variables in two large public datasets of Holstein cows. Using both the microbiome features and identified metadata variables, we trained different regressors to predict methane emission. With the optimized models, permutation tests were used to determine feature importance to find informative microbial features.

Results

Among the regression algorithms tested, random forest regression outperformed others and allowed the identification of several crucial microbial taxa for methane emission as members of the native rumen microbiome, including the genera Piromyces, Succinivibrionaceae UCG-002, and Acetobacter. Additionally, our results revealed that certain herd locations and feed composition markers, such as the lipid intake and neutral-detergent fiber intake, are also predictive features for methane emissions.

Conclusion

We demonstrated that machine learning, particularly regression algorithms, can effectively predict cow methane emissions and identify relevant rumen microorganisms. Our findings offer valuable insights for the development of microbiome-based precision feed strategies aiming at reducing methane emissions.

[DDB2-associated incidence of squamous cell carcinoma in Haflingers: risk minimization by genotyping]

INTRODUCTION

SCC (squamous cell carinomas) are among the most common eye neoplasms in horses. In recent studies Haflinger horses with a homozygous genotype for a missense variant in the DDB2 gene (damage specific DNA binding protein 2) had a significant increased risk of developing ocular SCC. The aims of this study were to determine the frequency of the SCC-associated risk allele in the DDB2 gene in Swiss and Austrian Haflinger populations and to validate the previously described phenotypic correlation. For this purpose, Haflingers presented at various horse clinics in Switzerland (n = 21, including 11 SCC cases), privately kept Haflingers (n = 52, including 1 SCC case), and Haflingers from a stud farm in the Austrian Tyrol (n = 53) were recruited. The individual DDB2 genotype of the animals was determined using a polymerase chain ceaction (PCR) test using hair follicle or whole blood samples. Of the 12 horses suffering from SCC, nine had ocular SCC and three had non-ocular SCC. Six of the nine Haflingers with ocular SCC and one of the three Haflingers with non-ocular SCC were homozygous for the DDB2 variant. Of the 113 clinically normal animals, 7/113 were homozygous (6 %) and 42/113 were heterozygous (37 %), which corresponds to an allele frequency of 24,8 % in the control cohort. The risk of ocular SCC occurring in Haflingers is significantly increased with the homozygous DDB2 genotype. However, not all animals with SCC carry this gene variant and not all DDB2 homozygous animals develop SCC, which can be explained by the multifactorial genesis of the disease. Due to the high frequency of the undesirable allele, we recommend taking the individual DDB2 genotype of breeding animals into account in order to avoid homozygous offspring with a greatly increased SCC risk by excluding high-risk matings.

Development of a workflow for the selection, identification and optimization of lactic acid bacteria with high γ-aminobutyric acid production

Lactic acid bacteria produce γ-aminobutyric acid (GABA) as an acid stress response. GABA is a neurotransmitter that may improve sleep and resilience to mental stress. This study focused on the selection, identification and optimization of a bacterial strain with high GABA production, for development as a probiotic supplement. The scientific literature and an industry database were searched for probiotics and potential GABA producers. In silico screening was conducted to identify genes involved in GABA production. Subsequently, 17 candidates were screened for in vitro GABA production using thin layer chromatography, which identified three candidate probiotic strains Levilactobacillus brevis DSM 20054, Lactococcus lactis DS75843and Bifidobacterium adolescentis DSM 24849 as producing GABA. Two biosensors capable of detecting GABA were developed: 1. a transcription factor-based biosensor characterized by the interaction with the transcriptional regulator GabR was developed in Corynebacterium glutamicum; and 2. a growth factor-based biosensor was built in Escherichia coli, which used auxotrophic complementation by expressing 4-aminobutyrate transaminase (GABA-T) that transfers the GABA amino group to pyruvate, hereby forming alanine. Consequently, the feasibility of developing a workflow based on co-culture with producer strains and a biosensor was tested. The three GABA producers were identified and the biosensors were encapsulated in nanoliter reactors (NLRs) as alginate beads in defined gut-like conditions. The E. coli growth factor-based biosensor was able to detect changes in GABA concentrations in liquid culture and under gut-like conditions. L. brevis and L. lactis were successfully encapsulated in the NLRs and showed growth under miniaturized intestinal conditions.

Metabolically defined body size and body shape phenotypes and risk of postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition

BACKGROUND

Excess body fatness and hyperinsulinemia are both associated with an increased risk of postmenopausal breast cancer. However, whether women with high body fatness but normal insulin levels or those with normal body fatness and high levels of insulin are at elevated risk of breast cancer is not known. We investigated the associations of metabolically defined body size and shape phenotypes with the risk of postmenopausal breast cancer in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition.

METHODS

Concentrations of C-peptide-a marker for insulin secretion-were measured at inclusion prior to cancer diagnosis in serum from 610 incident postmenopausal breast cancer cases and 1130 matched controls. C-peptide concentrations among the control participants were used to define metabolically healthy (MH; in first tertile) and metabolically unhealthy (MU; >1st tertile) status. We created four metabolic health/body size phenotype categories by combining the metabolic health definitions with normal weight (NW; BMI < 25 kg/m2 , or WC < 80 cm, or WHR < 0.8) and overweight or obese (OW/OB; BMI ≥ 25 kg/m2 , or WC ≥ 80 cm, or WHR ≥ 0.8) status for each of the three anthropometric measures separately: (1) MHNW, (2) MHOW/OB, (3) MUNW, and (4) MUOW/OB. Conditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Women classified as MUOW/OB were at higher risk of postmenopausal breast cancer compared to MHNW women considering BMI (OR = 1.58, 95% CI = 1.14-2.19) and WC (OR = 1.51, 95% CI = 1.09-2.08) cut points and there was also a suggestive increased risk for the WHR (OR = 1.29, 95% CI = 0.94-1.77) definition. Conversely, women with the MHOW/OB and MUNW were not at statistically significant elevated risk of postmenopausal breast cancer risk compared to MHNW women.

CONCLUSION

These findings suggest that being overweight or obese and metabolically unhealthy raises risk of postmenopausal breast cancer while overweight or obese women with normal insulin levels are not at higher risk. Additional research should consider the combined utility of anthropometric measures with metabolic parameters in predicting breast cancer risk.

Transformation of computerized electrocardiogram data into novel means to differentiate wide complex tachycardias

Background

Accurate automated wide QRS complex tachycardia (WCT) discrimination between ventricular tachycardia (VT) and supraventricular wide complex tachycardia (SWCT) can be accomplished using novel calculations derived from computerized electrocardiogram (ECG) data from paired WCT and baseline ECGs.

Purpose

Our aim was to develop and trial novel WCT discrimination approaches for WCT patients with and without a corresponding baseline ECG. Central to this analysis was the creation and use of a novel parameter (i.e., percent monophasic time-voltage area [PMonoTVA] [%]) that may be derived from computerized ECG measurements present on the WCT ECG alone.

Methods

In a two-part study, we derived and tested WCT differentiation models comprised of novel and previously established parameters formulated from computerized data of paired WCT and baseline ECGs. In Part 1, novel and established parameters generated from WCT and baseline ECG data were used to derive, validate, and compare five different binary classification models: (i) logistic regression [LR], (ii) artificial neural network [ANN], (iii) Random Forests [RF], (iv) support vector machine [SVM], and (v) ensemble learning (EL). In Part 2, two unique LR models were derived, validated, and compared using parameters generated from computerized data of the (i) WCT ECG alone (i.e., Solo Model) and (ii) paired WCT and baseline ECGs (i.e., Paired Model).

Results

In Part 1, among 103 patients with VT or SWCT diagnoses established from corroborating electrophysiology studies or intra-cardiac device recordings, favorable diagnostic performance was achieved by all modeling technique subtypes: LR (area under the receiver operating characteristic curve [AUC] 0.95), ANN (AUC 0.91), RF (AUC 0.97), SVM (AUC 0.98), and EL (AUC 0.97). In Part 2, among 235 patients with a VT or SWCT diagnosis established with (Gold Standard cohort) or without (Non-Gold Standard cohort) a corroborating electrophysiology procedure or intra-cardiac device recording, favorable diagnostic performance was achieved by the Solo Model (AUC 0.86) and Paired Model (AUC 0.95) (Table).

Conclusion

Accurate WCT discrimination may be accomplished using novel parameters derived from computerized data of the WCT ECG alone and paired WCT and baseline ECGs.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health

Magnetic charge propagation upon a 3D artificial spin-ice

Magnetic charge propagation in spin-ice materials has yielded a paradigm-shift in science, allowing the symmetry between electricity and magnetism to be studied. Recent work is now suggesting the spin-ice surface may be important in mediating the ordering and associated phase space in such materials. Here, we detail a 3D artificial spin-ice, which captures the exact geometry of bulk systems, allowing magnetic charge dynamics to be directly visualized upon the surface. Using magnetic force microscopy, we observe vastly different magnetic charge dynamics along two principal directions. For a field applied along the surface termination, local energetics force magnetic charges to nucleate over a larger characteristic distance, reducing their magnetic Coulomb interaction and producing uncorrelated monopoles. In contrast, applying a field transverse to the surface termination yields highly correlated monopole-antimonopole pairs. Detailed simulations suggest it is the difference in effective chemical potential as well as the energy landscape experienced during dynamics that yields the striking differences in monopole transport.

Multilevel Analysis of Strain Rate Effect on Visco-Damage Evolution in Short Random Fiber Reinforced Polymer Composites

In this study, the strain rate sensitivity of a discontinuous short fiber reinforced composite and the strain rate effect on the damage evolution are investigated. The studied material is a polymeric composite with a polyamide 6.6 matrix reinforced with oriented randomly short glass fibers at a 50% weigh ratio (PA6.6GF50). Tensile tests at low and high strain rate are conducted. In addition, interrupted tensile tests are carried out to quantify the damage at specific stress levels and strain rates. To perform the interrupted tensile tests, an intermediate fixture is realized via double notched mechanical fuses with different widths designed to break at suitable stress levels. The damage is estimated by the fraction of debonded fibers and matrix fractures. Based on the experimental observations, it is concluded that the ultimate stress and strain, and the damage threshold are mainly governed by the strain rate. Furthermore, it is established that the considered composite has a non-linear dynamic behavior with a viscous damage nature.

Optimal symptom combinations to aid COVID-19 case identification: Analysis from a community-based, prospective, observational cohort

Objectives

Diagnostic work-up following any COVID-19 associated symptom will lead to extensive testing, potentially overwhelming laboratory capacity whilst primarily yielding negative results. We aimed to identify optimal symptom combinations to capture most cases using fewer tests with implications for COVID-19 vaccine developers across different resource settings and public health.

Methods

UK and US users of the COVID-19 Symptom Study app who reported new-onset symptoms and an RT-PCR test within seven days of symptom onset were included. Sensitivity, specificity, and number of RT-PCR tests needed to identify one case (test per case [TPC]) were calculated for different symptom combinations. A multi-objective evolutionary algorithm was applied to generate combinations with optimal trade-offs between sensitivity and specificity.

Findings

UK and US cohorts included 122,305 (1,202 positives) and 3,162 (79 positive) individuals. Within three days of symptom onset, the COVID-19 specific symptom combination (cough, dyspnoea, fever, anosmia/ageusia) identified 69% of cases requiring 47 TPC. The combination with highest sensitivity (fatigue, anosmia/ageusia, cough, diarrhoea, headache, sore throat) identified 96% cases requiring 96 TPC.

Interpretation

We confirmed the significance of COVID-19 specific symptoms for triggering RT-PCR and identified additional symptom combinations with optimal trade-offs between sensitivity and specificity that maximize case capture given different resource settings.

Optimal symptom combinations to aid COVID-19 case identification: analysis from a community-based, prospective, observational cohort

OBJECTIVES

Diagnostic work-up following any COVID-19 associated symptom will lead to extensive testing, potentially overwhelming laboratory capacity whilst primarily yielding negative results. We aimed to identify optimal symptom combinations to capture most cases using fewer tests with implications for COVID-19 vaccine developers across different resource settings and public health.

METHODS

UK and US users of the COVID-19 Symptom Study app who reported new-onset symptoms and an RT-PCR test within seven days of symptom onset were included. Sensitivity, specificity, and number of RT-PCR tests needed to identify one case (test per case [TPC]) were calculated for different symptom combinations. A multi-objective evolutionary algorithm was applied to generate combinations with optimal trade-offs between sensitivity and specificity.

FINDINGS

UK and US cohorts included 122,305 (1,202 positives) and 3,162 (79 positive) individuals. Within three days of symptom onset, the COVID-19 specific symptom combination (cough, dyspnoea, fever, anosmia/ageusia) identified 69% of cases requiring 47 TPC. The combination with highest sensitivity (fatigue, anosmia/ageusia, cough, diarrhoea, headache, sore throat) identified 96% cases requiring 96 TPC.

INTERPRETATION

We confirmed the significance of COVID-19 specific symptoms for triggering RT-PCR and identified additional symptom combinations with optimal trade-offs between sensitivity and specificity that maximize case capture given different resource settings.

0644 An Educational and Behavioral Intervention Failed to Improve PAP Use Among Veterans With Spinal Cord Injuries and Diseases: Results of a Randomized Controlled Trial

Introduction

Sleep disordered breathing (SDB) is common among individuals with spinal cord injuries or diseases (SCI/D), many of whom are military Veterans, and physical limitations make use of positive airway pressure (PAP) therapy challenging. This study sought to test the effects of an educational and behavioral intervention to improve PAP adherence among Veterans with SCI/D over the first 3 months of use.

Methods

63 Veterans (mean age=60.7(10.2) years; 92% male) with SCI/D (33 SCI, 30 SCD; 25 cervical involvement; 38 thoracic and below) and SDB (23 with AHI 5-15; 40 with AHI&#8805;15) who received PAP treatment (CPAP or BPAP) were randomly assigned to receive a comprehensive 3-month intervention (INT) or an equal attention control (EAC). INT and EAC both included 1 face-to-face session (week 1) and 5 additional telephone sessions (weeks 2, 3, 4, 8 and 12). Main outcome measures were PAP use over the first 3 months: nights of use, nights of use &#8805;4 hours, and mean hours of use per night. Repeated measures ANCOVA models were used to test the differences between INT and EAC over the first 3 months of treatment.

Results

Number of nights with &#8805;4 hours of use in months 1-3 was 9, 7, and 6 nights in the INT and 8, 5 and 4 nights in the EAC (p’s&#8805;.37), respectively. There were no significant differences between INT and EAC for number of nights with any use (p’s&#8805;.24), or mean hours of use per night (p’s&#8805;.30). All 3 PAP use variables declined over time in both groups.

Conclusion

Sustained use of PAP therapy was difficult to achieve among those with SCI/D, and a 6-session behavioral intervention did not lead to significant improvements in use. Even when relatively high levels of initial use are achieved, this is difficult to sustain over time. Future studies should explore whether SCI/D patients experience significant symptom relief with PAP, and if so, whether home-based interventions or more intensive face-to-face PAP adherence programs will be effective.

Support

VA Rehabilitation Research and Development Service, Merit Review (1RX002116; PI: Badr); NIH/NHLBI K24 HL143055 (Martin).

Preliminary report on the safety and utility of a novel automated mechanical endoscopic tissue resection tool for endoscopic necrosectomy: a case series

Background and study aims  Endoscopic drainage of walled-off necrosis and subsequent endoscopic necrosectomy has been shown to be an effective step-up management strategy in patients with acute necrotizing pancreatitis. One of the limitations of this endoscopic approach however, is the lack of dedicated and effective instruments to remove necrotic tissue. We aimed to evaluate the technical feasibility, safety, and clinical outcome of the EndoRotor, a novel automated mechanical endoscopic tissue resection tool, in patients with necrotizing pancreatitis. Methods  Patients with infected necrotizing pancreatitis in need of endoscopic necrosectomy after initial cystogastroscopy, were treated using the EndoRotor. Procedures were performed under conscious or propofol sedation by six experienced endoscopists. Technical feasibility, safety, and clinical outcomes were evaluated and scored. Operator experience was assessed by a short questionnaire. Results  Twelve patients with a median age of 60.6 years, underwent a total of 27 procedures for removal of infected pancreatic necrosis using the EndoRotor. Of these, nine patients were treated de novo. Three patients had already undergone unsuccessful endoscopic necrosectomy procedures using conventional tools. The mean size of the walled-off cavities was 117.5 ± 51.9 mm. An average of two procedures (range 1 - 7) per patient was required to achieve complete removal of necrotic tissue with the EndoRotor. No procedure-related adverse events occurred. Endoscopists deemed the device to be easy to use and effective for safe and controlled removal of the necrosis. Conclusions  Initial experience with the EndoRotor suggests that this device can safely, rapidly, and effectively remove necrotic tissue in patients with (infected) walled-off pancreatic necrosis.

Novel sequencing technologies to support industrial biotechnology

Industrial biotechnology develops and applies microorganisms for the production of bioproducts and enzymes with applications ranging from food and feed ingredients and processing to bio-based chemicals, biofuels and pharmaceutical products. Next generation DNA sequencing technologies play an increasingly important role in improving and accelerating microbial strain development for existing and novel bio-products via screening, gene and pathway discovery, metabolic engineering and additional optimization and understanding of large-scale manufacturing. In this mini-review, we describe novel DNA sequencing and analysis technologies with a focus on applications to industrial strain development, enzyme discovery and microbial community analysis.

On the Role of Bioinformatics and Data Science in Industrial Microbiome Applications

Advances in sequencing and computational biology have drastically increased our capability to explore the taxonomic and functional compositions of microbial communities that play crucial roles in industrial processes. Correspondingly, commercial interest has risen for applications where microbial communities make important contributions. These include food production, probiotics, cosmetics, and enzyme discovery. Other commercial applications include software that takes the user's gut microbiome data as one of its inputs and outputs evidence-based, automated, and personalized diet recommendations for balanced blood sugar levels. These applications pose several bioinformatic and data science challenges that range from requiring strain-level resolution in community profiles to the integration of large datasets for predictive machine learning purposes. In this perspective, we provide our insights on such challenges by touching upon several industrial areas, and briefly discuss advances and future directions of bioinformatics and data science in microbiome research.

Current, future and potential use of mobile and wearable technologies and social media data in the ABCD study to increase understanding of contributors to child health

Mobile and wearable technologies and novel methods of data collection are innovating health-related research. These technologies and methods allow for multi-system level capture of data across environmental, physiological, behavioral, and psychological domains. In the Adolescent Brain Cognitive Development (ABCD) Study, there is great potential for harnessing the acceptability, accessibility, and functionality of mobile and social technologies for in-vivo data capture to precisely measure factors, and interactions between factors, that contribute to childhood and adolescent neurodevelopment and psychosocial and health outcomes. Here we discuss advances in mobile and wearable technologies and methods of analysis of geospatial, ecologic, social network and behavioral data. Incorporating these technologies into the ABCD study will allow for interdisciplinary research on the effects of place, social interactions, environment, and substance use on health and developmental outcomes in children and adolescents.

Therapie seltener idiopathischer Kopfschmerzerkrankungen

Die Kopfschmerzklassifikation der International Headache Society unterscheidet in ihrem Kapitel 4 verschiedene idiopathische Kopfschmerzerkrankungen, die als selten gelten, aber als eigenständige Entitäten aufgefasst werden müssen. Zu diesen gehören der primäre stechende Kopfschmerz, der primäre Hustenkopfschmerz, der primäre Kopfschmerz bei körperlicher Anstrengung, der primäre Kopfschmerz bei sexueller Aktivität, der primäre schlafgebundene Kopfschmerz, der primäre Donnerschlagkopfschmerz, die Hemicrania continua und der neu aufgetretene tägliche Kopfschmerz. Es handelt sich um harmlose Erkrankungen mit einer guten Prognose, die aber die Lebensqualität der Betroffenen erheblich einschränken können. Aufgrund einer Analyse der publizierten Fallberichte und einem Expertenkonsens werden für diese Kopfschmerzerkrankungen Therapieempfehlungen gegeben, auch wenn große randomisierte, kontrollierte Studien nicht vorliegen. Die meisten dieser Erkrankungen sprechen neben einer spezifischen Therapie unter anderem auf Indometacin an.

Einsatz neuromodulierender Verfahren bei primären Kopfschmerzen

Neuromodulierende Verfahren haben die Behandlung von Patienten mit therapierefraktären primären Kopfschmerzen im letzten Jahrzehnt revolutioniert. Unterschieden werden die invasiven (periphere Nervenstimulation, vor allem des N. okzipitalis major, Vagusnervstimulation, zervikale Rückenmarkstimulation und hypothalamische Tiefenhirnstimulation) von den nicht invasiven Verfahren (repetitive transkranielle Magnetstimulation, transkutane elektrische Nervenstimulation und transkranielle Magnetstimulation). In diesen Therapieempfehlungen werden zunächst Kriterien für therapierefraktäre Verläufe primärer Kopfschmerzen und darauf basierende Ein-und Ausschlusskriterien für eine Neuromodulation definiert. Aus dem Bereich der invasiven Verfahren ist die subkutane Stimulation des N. okzipitalis major bei chronischem Clusterkopfschmerz sowie eingeschränkt bei Hemicrania continua, Okzipitalisneuralgie und chronischer Migräne zu empfehlen. Alternativ ist bei chronischem Clusterkopfschmerz und SUNCT-Syndrom auch die hypothalamische Tiefenhirnstimulation wirksam. Für andere Kopfschmerzarten und Stimulationsverfahren fehlen derzeit überzeugende Daten. Der alleinige oder additive Einsatz nicht invasiver Verfahren ist nicht gut belegt.

Akuttherapie und Prophylaxe der Migräne

Die Deutsche Migräne- und Kopfschmerzgesellschaft und die Deutsche Gesellschaft für Neurologie legen eine revidierte Fassung ihrer gemeinsamen evidenzbasierten Leitlinie für die Therapie der Migräne vor. Zur Akuttherapie der leichten Migräneattacke wird die frühzeitige und hochdosierte Einnahme von NSAR oder von Paracetamol empfohlen. Bei schweren Migräneattacken wird die Einnahme eines Triptans empfohlen, eine generelle Präferenz für eine bestimmte Substanz wird hierbei nicht ausgesprochen. Zur medikamentösen Prophylaxe der Migräne werden als Substanzen der ersten Wahl Metoprolol, Propranolol, Flunarizin, Valproinsäure und Topiramat empfohlen. Substanzen der zweiten Wahl sind Amitriptylin, Venlafaxin, Gabapentin, Naproxen, Acetylsalicylsäure, Pestwurz, Magnesium und Vitamin B2. Im Mittelpunkt der nicht medikamentösen Behandlung der Migräne stehen neben Empfehlungen zur Lebensführung, Entspannungsverfahren (progressive Muskelrelaxation), Biofeedbackverfahren und kognitive Verhaltenstherapie. Gerade die Kombination von nicht medikamentösen Verfahren untereinander oder mit einer medikamentösen Prophylaxe ist besonders wirksam.

Therapie des Kopfschmerzes bei Medikamentenübergebrauch

Nach der zweiten Ausgabe der Internationalen Kopfschmerzklassifikation (ICHD-II, 2004) wird der Kopfschmerz bei Medikamentenübergebrauch (medication overuse headache – MOH) als chronischer Kopfschmerz definiert, induziert durch den Übergebrauch von Ergotamin, Triptanen, Analgetika, Opioiden, Kombinationspräparaten, Kombinationen einzelner Substanzen oder anderer, nicht näher spezifizierter Medikamente. Obwohl bisher keine epidemiologische Studie die tatsächliche MOH-Prävalenz (incl. erfolgreichen Entzug) untersucht hat, wird seine durchschnittliche Prävalenz auf ca. 1% der Gesamtbevölkerung geschätzt. Die genaue Pathophysiologie ist derzeit noch unklar, eine genetische Prädisposition scheint wahrscheinlich. Die Behandlung besteht in den meisten Fällen aus einem akuten Entzug der Medikation und dem Beginn einer vorbeugenden medikamentösen Therapie. Eine Ausnahme davon stellt der Übergebrauch von Opioiden und Barbituraten (in Europa sehr selten) dar, die schrittweise reduziert werden sollen. Es besteht aktuell keine klare Evidenz für die Bevorzugung einer ambulanten oder stationären Entzugstherapie. Steroide werden zur Begleitung des Entzuges eingesetzt, die Studienlage dazu ist jedoch überwiegend negativ. Topiramat und Onabotulinumtoxin können bei Patienten mit Migräne und MOH die Attackenfrequenz so reduzieren, dass die Kriterien des MOH nicht mehr erfüllt sind, ohne dass vorher ein formaler Entzug durchgeführt worden ist.

Therapie primärer chronischer Kopfschmerzen: Chronische Migräne, chronischer Kopfschmerz vom Spannungstyp und andere chronische tägliche Kopfschmerzen

Die IHS-Kriterien definieren vier primäre Kopfschmerzerkrankungen, die zu täglichen Dauerkopfschmerzen führen können: 1) chronische Migräne, 2) Kopfschmerz vom Spannungstyp, 3) Hemicrania continua, 4) neu aufgetretener Kopfschmerz. In der Praxis ist davon häufig der Kopfschmerz durch Medikamentenübergebrauch (früher: Analgetikakopfschmerz) abzugrenzen. Die jetzt von der Deutschen, Österreichischen und Schweizer Kopfschmerzgesellschaft gemeinsam vorgelegte Therapieleitlinie fasst die Literatur zur Therapie dieser Kopfschmerzformen zusammen und gibt Therapieempfehlungen, die die Literaturevidenz, aber auch die Praktikabilität berücksichtigen.

[Endoscopic and surgical treatment of early gastric and esophageal carcinoma]

BACKGROUND

The treatment of early gastric (EGC) and esophageal carcinomas (EEC) is an interdisciplinary challenge. The risk of lymph node metastasis (LNM) is the crucial point in choosing the correct treatment option.

OBJECTIVE

This article gives an overview of the current treatment options and provides help in choosing the correct therapy.

METHOD

Current concepts and therapy algorithms are presented on the basis of a literature review and data from our own center.

RESULTS

Endoscopic submucosal dissection (ESD) is recommended for mucosal gastric cancer with good or moderate differentiation (G1,2) without macroscopic ulceration, in elevated type lesions smaller than 2 cm in size or depressed lesions smaller than 1 cm in size. In additional chromoendoscopy should be carried out. The extent of surgical resection is defined by the location of the tumor. A safety margin of at least 3 cm should be applied in distal gastric resections whereas the first line goal in gastrectomy is to achieve an R0 resection. In cN0 tumors a D1 lymphadenectomy (LA) seems to be sufficient. Minimally invasive techniques currently show promising results especially for a subtotal resection. The treatment strategy in EEC differs depending on the tumor entity. Mucosal squamous cell carcinoma with high risk factors (L1,V1) and all cN0 submucosal tumors without the detection of LNM should be referred to primary surgical resection. Early stage cN+ squamous cell carcinomas should be preoperatively treated with chemoradiotherapy. Adenocarcinoma with infiltration of the deeper submucosa (sm2,3) and high-risk sm1 tumors require surgical treatment. The standard operating procedure for EEC is an Ivor Lewis esophagectomy with 2‑field LA preferably performed as a hybrid or by a completely minimally invasive procedure. The procedure of choice in endoscopic resection of EEC is resection with the suck and cut technique.

[Endoscopic therapy of esophageal diseases]

The esophagus is one of the areas of the gastrointestinal tract, for which therapeutic concepts have changed the most over the last two decades. The most decisive advance is the development of endoscopic resection techniques for early esophageal carcinomas. These methods provide excellent short- and long-term results combined with very low morbidity and negligible mortality rates in comparison with surgical esophagectomy, especially in case of mucosal Barrett's adenocarcinoma. In addition, the endoscopic myotomy techniques in Zenker's diverticulum and spastic achalasia are new, attractive endoscopic treatment modalities.

Early-stage adenocarcinoma of the esophagus with mid to deep submucosal invasion (pT1b sm2-3): the frequency of lymph-node metastasis depends on macroscopic and histological risk patterns

The rate of lymph-node (LN) metastasis in early adenocarcinoma (EAC) of the esophagus with mid to deep submucosal invasion (pT1b sm2/3) has not yet been precisely defined. The aim of the this study was to evaluate the rate of LN metastasis in pT1b sm2/3 EAC depending on macroscopic and histological risk patterns to find out whether there may also be options for endoscopic therapy as in cancers limited to the mucosa and the upper third of the submucosa. A total of 1.718 pt with suspicion of EAC were referred for endoscopic treatment (ET) to the Dept. of Internal Medicine II at HSK Wiesbaden 1996-2010. In 230/1.718 pt, the suspicion (endoscopic ultrasound, EUS) or definitive diagnosis of pT1b EAC (ER/surgery) was made. Of these, 38 pt had sm2 lesions, and 69 sm3. Rate of LN metastasis was analyzed depending on risk patterns: histologically low-risk (hisLR): G1-2, L0, V0; histologically high-risk (hisHR): ≥1 criterion not fulfilled; macroscopically low-risk (macLR): gross tumor type I-II, tumor size ≤2 cm; macroscopically high-risk (macHR): ≥1 criterion not fulfilled; combined low-risk (combLR): hisLR+macLR; combined high-risk (combHR): at least 1 risk factor. LN rate was only evaluated in pt who had proven maximum invasion depth of sm2/sm3, and who in case of ET had a follow-up (FU) by EUS of at least 24 months. 23/38 pt with pT1b sm2 lesions and 39/69 pt with sm3 lesions fulfilled our inclusion criteria. In the pT1b sm2 group, rate of LN metastasis in the hisLR, hisHR, combLR, and combHR groups were 8.3% (1/12), 36.3% (4/11), 0% (0/5), and 27.8% (5/18). In the pT1b sm3 group, rate of LN metastasis in the hisLR, hisHR, combLR and combHR groups were 28.6% (2/7), 37.5% (12/32), 25% (1/4), and 37.1% (13/35). 30-day mortality of surgery was 1.7% (1/58 pt). In EAC with pT1b sm2/3 invasion, the frequency of LN metastasis depends on macroscopic and histological risk patterns. Surgery remains the standard treatment, because the rate of LN metastasis appears to be higher than the mortality risk of surgery. Whether a highly selected group of pT1b sm2 patients with a favourable risk pattern may be candidates for endoscopic therapy cannot be decided until the results of larger case volumes are available.

Integrating Candida albicans metabolism with biofilm heterogeneity by transcriptome mapping

Candida albicans biofilm formation is an important virulence factor in the pathogenesis of disease, a characteristic which has been shown to be heterogeneous in clinical isolates. Using an unbiased computational approach we investigated the central metabolic pathways driving biofilm heterogeneity. Transcripts from high (HBF) and low (LBF) biofilm forming isolates were analysed by RNA sequencing, with 6312 genes identified to be expressed in these two phenotypes. With a dedicated computational approach we identified and validated a significantly differentially expressed subnetwork of genes associated with these biofilm phenotypes. Our analysis revealed amino acid metabolism, such as arginine, proline, aspartate and glutamate metabolism, were predominantly upregulated in the HBF phenotype. On the contrary, purine, starch and sucrose metabolism was generally upregulated in the LBF phenotype. The aspartate aminotransferase gene AAT1 was found to be a common member of these amino acid pathways and significantly upregulated in the HBF phenotype. Pharmacological inhibition of AAT1 enzyme activity significantly reduced biofilm formation in a dose-dependent manner. Collectively, these findings provide evidence that biofilm phenotype is associated with differential regulation of metabolic pathways. Understanding and targeting such pathways, such as amino acid metabolism, is potentially useful for developing diagnostics and new antifungals to treat biofilm-based infections.

A HER2 selective theranostic agent for surgical resection guidance and photodynamic therapy

In many cancers early intervention involves surgical resection of small localised tumour masses. Inadequate resection leads to recurrence whereas overzealous treatment can lead to organ damage. This work describes production of a HER2 targeting antibody Fab fragment dual conjugated to achieve both real time near-infrared fluorescent imaging and photodynamic therapy. The use of fluorescence emission from a NIR-dye could be used to guide resection of tumour bulk, for example during endoscopic diagnosis for oesophago-gastric adenocarcinoma, this would then be followed by activation of the photodynamic therapeutic agent to destroy untreated localised areas of cancer infiltration and tumour infiltrated lymph nodes. This theranostic agent was prepared from the Fab fragment of trastuzumab initially by functional disulfide re-bridging and site-specific click reaction of a NIR-dye. This was followed by further reaction with a novel pre-activated form of the photosensitiser chlorin e6 with the exposed fragments' lysine residues. Specific binding of the theranostic agent was observed in vitro with a HER2 positive cell line and cellular near-infrared fluorescence was observed with flow cytometry. Specific photo-activity of the conjugates when exposed to laser light was observed with HER2 positive but not HER2 negative cell lines in vitro, this selectivity was not seen with the unconjugated drug. This theranostic agent demonstrates that two different photo-active functions can be coupled to the same antibody fragment with little interference to their independent activities.