[Development of the Austrian Society for Child and Adolescent Psychiatry and Psychotherapeutic Medicine: results of a member survey]

Hintergrund

Die Fachgesellschaft ÖGKJP ist – bedingt durch die gesetzlichen Änderung 2015 – in einem dynamischen Entwicklungsprozess. Der Vorstand hat in den vergangenen Jahren einen Organisationsentwicklungsprozess durchlaufen und neue Strukturen und strategische Zielsetzungen entwickelt. Die Etablierung dieser Strukturen und die Erreichung dieser Ziele sollen durch verschiedene Maßnahmen und Angebote sichergestellt werden. Ziel dieser Studie war es, über eine Mitgliederbefragung in Erfahrung zu bringen, wie wichtig die Mitglieder diese Maßnahmen und Angebote erachten und wie zufrieden sie damit sind. Weiters wurden die Befragten dazu eingeladen, bereits definierte Zukunftsthemen in Bezug auf ihre Wichtigkeit zu bewerten und weitere Themen, die in Zukunft von der Fachgesellschaft (intensiver) bearbeitet werden sollen, vorzuschlagen.

Methodik

294 via E‑Mail erreichbare Mitglieder erhielten unter Heranziehung der Online-Umfrage-Applikation LimeSurvey einen von ÖGKJP-Vorstandsseite entwickelten Fragebogen. Der Fragebogen bestand aus 12 geschlossen Fragen, die entlang von 5 Themenblöcken (siehe weiter unten) sowohl die Wichtigkeit von Themen behandelten als auch die Zufriedenheit mit der bisherigen Arbeit der Fachgesellschaft. Die Bewertungen wurden entlang einer fünfteiligen Skala (1 = sehr wichtig/zufrieden, 2 = wichtig/zufrieden, 3 = moderat wichtig/zufrieden, 4 = wenig wichtig/zufrieden, 5 = gar nicht wichtig/zufrieden) erbeten. Die Auswertung erfolgte mittels deskriptiver Statistik.

Ergebnisse

101 Mitglieder (knapp 35 %) haben den Fragebogen beantwortet. 65 % der Antwortgeber*innen waren ordentliche Mitlieder, 15 % ordentliche Mitlieder in Ausbildung und 8 % außerordentliche Mitglieder. 12 % erteilen keine Angaben zu ihrem Mitgliedsstatus.

Beim Thema Forschung und Wissenschaft bewerteten die Mitglieder die Wichtigkeit im Durchschnitt zwischen 1,53–2,55 und die Zufriedenheit mit der Umsetzung zwischen 1,50 und 2,16. Hinsichtlich des Themas Veranstaltungen und Kooperationspartnerschaften liegt die Wichtigkeit zwischen 1,63 und 2,10, die Zufriedenheit mit der Umsetzung zwischen 1,55 und 2,22. Die Repräsentanz des Faches in der Öffentlichkeit wurde als höchst wichtig erachtet (1,23), die Zufriedenheit in Bezug darauf liegt bei 2,24 Punkten. Die Neuerungen im Servicebereich der Gesellschaft wurden hinsichtlich ihrer Wichtigkeit wie folgt beurteilt: Homepage 1,82, Lernplattform Moodle 2,28 und das neue Sekretariat mit 1,83. Die Zufriedenheit der Mitglieder mit diesen Neuerungen bekommt jeweils die Note 2,22; 2,50 und 1,84.

Diskussion

Bei zufriedenstellender Beteiligung wird der Fachgesellschaft eine gute, aber ausbaubare Zufriedenheit signalisiert. Die Wichtigkeit der vom Vorstand vorgenommenen Themenwahl wurde bestätigt. Zukunftsthemen, die von den Mitgliedern als besonders wichtig bewertet wurden, sind Veranstaltungen und Kooperationspartnerschaften, sowie die Repräsentanz der ÖGKJP auf politischer Ebene.

Abstract 5086: The aged tumor microenvironment promotes melanoma metabolic plasticity and therapy

“Aged” melanoma patients (>55 years old) have poorer prognosis and reduced response rates to targeted therapy relative to “young” patients (<40 years old). Here, we report an altered metabolic landscape in the aged tumor microenvironment (TME) as critical for melanoma aggressiveness. Aged fibroblasts uptake high levels of glucose compared to their young counterparts, which fuels lipid production. Melanoma cells cultured in an aged TME in vitro or in vivo display elevated intracellular lipid levels and increased metastatic potential relative to melanoma cells in a young TME. Further, lipidomics reveal an elevated lipid profile (i.e., triglycerides, ceramides, and cholesterol) preferentially secreted by aged fibroblasts relative to young. In turn, we show that melanoma cells adaptively increase extracellular fatty acid scavenging via the lipid transporter FATP2 in the lipid rich aged TME. Melanoma cells cultured in the aged TME also display an increased oxygen consumption rate (OCR) relative to those grown in young TME, which could be ablated when fatty acid transport into the mitochondria is blocked with etomixir. Notably, melanoma cells in the aged TME treated with BRAFi/MEKi in combination with a FATP2 inhibitor display decreased OCR relative to BRAFi/MEKi inhibitor alone, which paralleled the increased overall survival of aged mice treated with BRAFi/MEKi/FATP2i relative to either agent alone. To rule out off-target effects of the FATP2 inhibitor, we used a doxycycline inducible system for FATP2 knockdown in melanoma cells and reproduced the abrogation of tumor growth and extension of survival in aged immune-competent mice when combined with BRAFi/MEK therapy. Additionally, elevated FATP2 levels correlate with worse response in human patients. We hypothesize the aged TME triggers adaptive metabolic plasticity of melanoma cells critical for therapy escape.

Citation Format: Gretchen Marie Alicea, Vito W. Rebecca, Aaron Goldman, Mitchell Fane, Reeti Behera, Marie Webster, Brett Ecker, Ian Blair, David Speicher, Zachary Schug, Ashani Weeraratna. The aged tumor microenvironment promotes melanoma metabolic plasticity and therapy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5086.

Survival after surgery for metastatic small bowel compared to pancreatic neuroendocrine tumors

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Background: Surgical management of small bowel (mSBNET) and pancreatic (mPNET) neuroendocrine tumors with hepatic metastases remains controversial. Previous studies, often drawn from single institution experiences, combine outcomes mSBNET and mPNET cohorts, despite ample evidence indicating discreet biology and natural history. This study aimed to define and contrast survival outcomes after surgery in patients with mSBNET and mPNET using a large national dataset. Methods: Patients with hepatic metastases from SBNET and PNET who underwent surgical (n = 1063; n = 556, respectively) or non-surgical management (n = 456; n = 2593, respectively) were identified in the National Cancer Database (1998-2014). Surgical and non-surgical cohorts were matched (1:1) by propensity scores based on the likelihood of receiving surgery and survival hazard. Kaplan-Meier estimates of overall survival (OS) were compared. Results: After adjustment for potential cofounders (age, Charleston comorbidity index, tumor differentiation and administration of chemotherapy or radiotherapy), nonsurgical management was associated with poorer survival in SBNET (HR 2 95%CI 1.5-2.7) and in PNET (HR 3.6, 98%CI 2.8-4.5). In the propensity matched cohort, there was a significant survival advantage for patients who received surgery for both SBNET and PNET (p < 0.001). In SBNET, mean survival in the non-surgical cohort was 33.9 months (SD 1.3, 95%CI 31.5-36.4), and 39.3 months in the surgical cohort (SD 0.8, 95%CI 36.1-39.1). In PNET, mean survival in the non-surgical cohort was 32.7 months (SD 1.6, 95%CI 29.5-35.8), and 55.1 months in the surgical cohort (SD 1.4, 95%CI 52.4-57.7). Conclusions: Surgical selection or management are associated with a survival advantage in both mPNET and mSBNET; this advantage is greater in mPNET. The relative contributions of patient selection and therapeutic benefit require further elucidation.

High-harmonic generation and parametric amplification in the soft X-rays from extended electron trajectories

We report, for the first time, the generation of high-order harmonics in a spectral range between 200 eV and 1 keV with an unusual spectral property: only every 4(th) (4i + 1, i∈ℵ) harmonic line appears, whereas the usual high-harmonic spectra consist of every odd (2i + 1) harmonic. We attribute this unique property to the quantum path interference of two extended electron trajectories that experience multiple re-scattering. In the well-established theory, electrons emitted via tunnel ionisation are accelerated by a laser field, return to the ion and recombine. The acceleration typically lasts for less than one optical cycle, and the electrons radiate in the extreme ultraviolet range at recombination. In contrast, for extended trajectories, electrons are accelerated over two or more optical cycles. Here, we demonstrate that two sets of trajectories dominate and provide substantial contributions to the generated soft X-ray radiation because they fulfil the resonance condition for X-ray parametric amplification.

Overexpression and purification of a recombinant chimeric HIV type 2/HIV type 1 envelope peptide and application in an accelerated immunobased HIV type 1/2 antibody detection system (AIBS): a new rapid serological screening assay

A chimeric HIV-2/HIV-1 envelope sequence containing an immunodominant region of HIV-2 gp36 and the corresponding region of HIV-1 gp41 was constructed and overexpressed in Escherichia coli. The recombinant product (rp21/18) was purified and applied in a novel antibody-screening assay. Characteristics in the design of this new principle are as follows: (1) the overall assay time is about 30 min; (2) the assay procedure includes three manipulation steps; and (3) the test shows a reliable performance with respect to sensitivity and specificity. The diluted serum sample and the protein G-horseradish peroxidase conjugate are added simultaneously into a coated (hybrid antigen HIV-1/2) and blocked microtiter plate well. The in-batch incubation of serum sample with protein G-horseradish peroxidase saves two manipulation steps that are normally necessary in the five-step procedure of a classical ELISA. AIBS was evaluated with commercially available seroconversion panels and with random negative serum samples from a blood bank. Seroconversion results demonstrated that AIBS has equivalent sensitivity to ELISAs and the third generation assays. The specificity was determined on a total blood donor population of 5012 (Red Cross Vienna, Austria). The repeat reactive rates for donor population were 0.02%. AIBS represents a general immunometric system (not only HIV antibodies). The entire assay procedure of AIBS evaluated for HIV-1/2 screening, including result reporting, can be performed automatically by several commercially available systems. Depending on these systems AIBS is potentially useful in laboratories or blood banks that have both high- and low-volume testing.

Self- and other-directed aggression in child and adolescent psychiatric inpatients

OBJECTIVE

To examine self- and other-directed aggression in 89 children and adolescents on a psychiatric inpatient unit to determine ways in which aggressive and nonaggressive patients differ and to discover those factors associated with self-directed versus other-directed aggression.

METHOD

Three types of data were collected: ongoing observations of aggressive behavior during hospitalization, Child Behavior Checklists completed by a parent or guardian at admission, and patient and family history data gathered from a retrospective chart review.

RESULTS

Compared with nonaggressive patients, aggressive patients were more likely to have a history of antisocial behavior, to be victims of abuse or neglect, to have lived in a foster home, and to have had several primary caretakers. Both groups of aggressive patients engaged in three types of aggressive behavior with equal frequency and were strikingly similar on a host of other variables. Only the number of primary caretakers with whom a patient had lived discriminated self- from other-directed aggressive patients; patients who experienced frequent disruptions in caretaking were likely to engage in acts of self-injury during hospitalization.

CONCLUSIONS

Whether a particular patient will engage in aggressive behavior during hospitalization can be accurately predicted from preadmission characteristics; however, the manner in which a patient is likely to aggress, i.e., toward others or self, is difficult to predict because of striking similarities between types of aggressive patients. Further investigations are needed to determine how self- and other-directed aggressive patients differ and to elucidate relationships between disrupted, unstable, or inadequate caretaking and aggression, particularly self-injury, in children and adolescents.

Photostructurized electrochemical biosensors for bioreactor control and measurement in body fluids

This article details a new type of biosensor for the simultaneous analysis of glucose, glutamate and glutamine in complex biological fluids like fermentation broths and blood. Simultaneous analysis was made possible by the application of different enzyme layers onto different electrodes of one photostructurized sensor. Photostructuring was done by means of a new developed photopolymer. Preparation of the photopolymer and the enzyme layers as well as the characterization of the sensors thus constructed with respect to linearity, response time and sensitivity are described.

Interactions between parents and pediatric primary care physicians about children's mental health

Interaction patterns between parents and pediatricians were examined during 1,378 well-child visits to four public and private pediatric clinics. During 327 visits, parents listed at least one psychosocial concern related to their child's mental health. At 37 percent of these visits, parents said they did not wish to discuss the concern with the physician. Physicians failed to address concerns during approximately 35 percent of visits at which parents were willing to discuss them. Successful parent-physician interactions were three times more frequent in private practices than in a public clinic; they were more likely when fewer concerns were stated and less likely when behavior problems were the concern. Parents concerned about the parent-infant relationship were four times more likely to be referred to outside mental health services, although these cases were relatively rare. Older children and families receiving Medicaid were also more likely to be referred to such services.

Aggression and counteraggression during child psychiatric hospitalization

The article reports on a 1-year descriptive study of aggressive incidents and staff counteraggressive strategies within a child psychiatry inpatient unit. Ninety-nine child/adolescent patients produced a total of 887 reportable aggressive incidents during the 12-month study period. Seclusion, activity restriction, physical restraint, and administration of p.r.n. medication were studied in relation to patient aggression. Results of the study confirm the hypotheses that (1) much patient aggression within defined clinical contexts conforms to patterns of prediction directly related to person and environmental variables, and (2) the primary value of counteraggression strategies such as seclusion and restraint resides in the acute management of aggressive children and not in long-term therapeutic functions. The article offers some recommendations for new research in this general area as well as suggestions for clinical applications of these methods.

Acyltransferase-catalyzed cleavage of arachidonic acid from phospholipids and transfer to lysophosphatides in macrophages derived from bone marrow. Comparison of different donor- and acceptor substrate combinations

In a previous paper it was shown that in prelabeled murine thymocytes a direct CoA-mediated transfer of arachidonic acid from phosphatidylcholine to lysophosphatidylethanolamine occurs which does not involve the intermediate formation of free fatty acid. The transfer is ATP-independent and is catalyzed by the acyl-CoA: lysophosphatide acyltransferase operating in reverse. In prelabeled thymocytes phosphatidylcholine was the only arachidonoyl donor and lysophosphatidylethanolamine the only lysoacceptor. In murine bone-marrow-derived macrophages a series of CoA-mediated transfer reactions were detected leading to a redistribution of arachidonic acid between phospholipids. Using exogenous substrates a bidirectional transfer from 1-acyl-2-arachidonoylglycerophosphocholine to lysophosphatidylethanolamine occurs. An unidirectional transfer from 1-acyl-2-arachidonoylglycerophosphoinositol to lysophosphatidylcholine and from 1-acyl-2-arachidonoylglycerophosphoinositol to lysophosphatidylethanolamine was observed. Plasmalogenic lysoacceptors generally have a weaker acceptor capacity than the correspondent acyllysophospholipid. In macrophages the CoA-mediated transfer of arachidonoyl moieties is independent of ATP and Mg2+ and is totally inhibited by sodium cholate, indicating that it is catalyzed by the acyl-CoA: lysophosphatide acyltransferase.