Excellence in Acrylation - Scope and Limitation of Glucosyl Imidazolium-coated Novozym 435 Catalyzed (Meth)acryl Ester Synthesis

The incorporation of carbohydrate based ionic liquids as a support for Novozym 435 was previously studied by the authors for the acrylation of n-butanol as the target substrate, which was used as the foundation for the design of experiments. The combination of carbohydrate based ionic liquids and Novozym 435 remains a key aspect of this work. Building upon this, the reaction parameters were optimized for the Novozym catalyst. Substrate screening was performed to explore the scope and limitations of room temperature acrylation reactions. Herein, different alcohols and reaction conditions were screened extensively for the different acrylate products with yields of up to 99.9 % determined via gas chromatography (GC). Standard straight chain alcohols, 2-functionalized ethanol derivatives with electron donating and withdrawing groups, and more sterically challenging substrates were investigated over a broad concentration region. To further underline the applicability of the modified biocatalyst, two alcohols were converted with methacrylic acid. The presented method offers a greener pathway for acrylate synthesis, which eliminates the need for high reaction temperatures, strongly acidic catalysts and/or polymerization inhibitors as used in non-biocatalytic acrylate synthesis.

A Scan of Pleiotropic Immune Mediated Disease Genes Identifies Novel Determinants of Baseline FVIII Inhibitor Status in Hemophilia-A

Hemophilia-A (HA) is caused by heterogeneous loss-of-function factor (F)VIII gene (F8)-mutations and deficiencies in plasma-FVIII-activity that impair intrinsic-pathway-mediated coagulation-amplification. The standard-of-care for severe-HA-patients is regular infusions of therapeutic-FVIII-proteins (tFVIIIs) but ~30% develop neutralizing-tFVIII-antibodies called "FVIII-inhibitors (FEIs)" and become refractory. We used the PATH study and ImmunoChip to scan immune-mediated-disease (IMD)-genes for novel and/or replicated genomic-sequence-variations associated with baseline-FEI-status while accounting for non-independence of data due to genetic-relatedness and F8-mutational-heterogeneity. The baseline-FEI-status of 450 North American PATH subjects-206 with black-African-ancestry and 244 with white-European-ancestry-was the dependent variable. The F8-mutation-data and a genetic-relatedness matrix were incorporated into a binary linear-mixed model of genetic association with baseline-FEI-status. We adopted a gene-centric-association-strategy to scan, as candidates, pleiotropic-IMD-genes implicated in the development of either ³2 autoimmune-/autoinflammatory-disorders (AADs) or ³1 AAD and FEIs. Baseline-FEI-status was significantly associated with SNPs assigned to NOS2A (rs117382854; p=3.2E-6) and B3GNT2 (rs10176009; p=5.1E-6), which have functions in anti-microbial-/-tumoral-immunity. Among IMD-genes implicated in FEI-risk previously, we identified strong associations with CTLA4 assigned SNPs (p=2.2E-5). The F8-mutation-effect underlies ~15% of the total heritability for baseline-FEI-status. Additive genetic heritability and SNPs in IMD-genes account for >50% of the patient-specific variability in baseline-FEI-status. Race is a significant determinant independent of F8-mutation-effects and non-F8-genetics.

Flexomagnetism and vertically graded Néel temperature of antiferromagnetic Cr2O3 thin films

Antiferromagnetic insulators are a prospective materials platform for magnonics, spin superfluidity, THz spintronics, and non-volatile data storage. A magnetomechanical coupling in antiferromagnets offers vast advantages in the control and manipulation of the primary order parameter yet remains largely unexplored. Here, we discover a new member in the family of flexoeffects in thin films of Cr2O3. We demonstrate that a gradient of mechanical strain can impact the magnetic phase transition resulting in the distribution of the Néel temperature along the thickness of a 50-nm-thick film. The inhomogeneous reduction of the antiferromagnetic order parameter induces a flexomagnetic coefficient of about 15 μB nm−2. The antiferromagnetic ordering in the inhomogeneously strained films can persist up to 100 °C, rendering Cr2O3 relevant for industrial electronics applications. Strain gradient in Cr2O3 thin films enables fundamental research on magnetomechanics and thermodynamics of antiferromagnetic solitons, spin waves and artificial spin ice systems in magnetic materials with continuously graded parameters.

Novel Glucosylimidazolium Ionic-Liquid-Supported Novozym 435 Catalysts - A Proof of Concept for an Acrylation Reaction

Invited for the cover of this issue is the group of Stefan Jopp at the University of Rostock. The image depicts the conversion of acrylic acid and n-butanol into butyl acrylate through an engine of Novozym 435, in which the powering piston CalB (Candida antarctica lipase B) is supported by the newly developed GMIM-I (glucosyl-methyl-imidazolium iodide). The authors acknowledge Dr. Johanna Meyer (University of Hannover) for the creation of the cover image. Read the full text of the article at 10.1002/open.202200135.

Novel Glucosylimidazolium Ionic-Liquid-Supported Novozym 435 Catalysts - A Proof of Concept for an Acrylation Reaction

A series of novel ionic liquids based on glucose was synthesized in high yields in simple two or three-step reaction procedures. These carbohydrate-based ionic liquids were studied and compared to commercially available imidazolium-based ionic liquids as supports for Novozym 435 in the acrylation of n-butanol. A direct correlation between the availability of hydroxy groups and the overall activity as well as an enhanced recyclability of the biocatalyst has been found for the glucose-based ionic liquids.

Analog Nanoscale Electro-Optical Synapses for Neuromorphic Computing Applications

The typically nonlinear and asymmetric response of synaptic memristors to positive and negative electrical pulses makes the realization of accurate deep neural networks very challenging. Here, we integrate a two-terminal valence change memory (VCM) into a photonic/plasmonic circuit and show that the switching properties of this memristor become more gradual and symmetric under light irradiation. The added optical input acts on the VCM as a third, independent modulation channel. It locally heats the active area of the device, which enhances the generation of oxygen vacancies and broadens the resulting nanoscale conductive filaments. The measured conductance modulation of the VCM is then inserted into a neural network simulator. Using the MNIST data set of handwritten digits as an application, a light-enhanced recognition accuracy of 93.53% is demonstrated, similar to ideally performing memristors (94.86%) and much higher than those without light (67.37%). Notably, the optical signal does not increase the overall energy consumption by more than 3.2%. Finally, an approach to scale up our electro-optical technology is proposed, which could allow high-density, energy-efficient neuromorphic computing chips.

Making the COVID-19 crisis a real opportunity for environmental sustainability

An optimistic narrative has gained momentum during the first year of the pandemic: the COVID-19 crisis may have opened a window of opportunity to "rebuild better", to spur societal transitions towards environmental sustainability. In this comment, we review first evidence of individual and political changes made so far. Findings suggest that economies worldwide are not yet building back better. Against this background, we argue that a naïve opportunity narrative may even impair the progress of transitions towards environmental sustainability because it may render green recovery measures ineffective, costly, or infeasible. Based on these observations, we derive conditions for green recovery policies to succeed. They should consist of a policy mix combining well-targeted green subsidies with initiatives to price emissions and scrap environmentally harmful subsidies. Moreover, green recovery policies must be embedded into a narrative that avoids trading off environmental sustainability with other domains of sustainability-and rather highlights respective synergies that can be realized when recovering from the COVID-19 crisis.

Retinal Microcirculation as a Correlate of a Systemic Capillary Impairment After Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), affects the pulmonary systems via angiotensin-converting enzyme-2 (ACE-2) receptor, being an entry to systemic infection. As COVID-19 disease features ACE-2 deficiency, a link to microcirculation is proposed. Optical coherence tomography angiography (OCT-A) enables non-invasive analysis of retinal microvasculature. Thus, an impaired systemic microcirculation might be mapped on retinal capillary system. As recent OCT-A studies, analyzing microcirculation in two subdivided layers, yielded contrary results, an increased subdivision of retinal microvasculature might offer an even more fine analysis. The aim of the study was to investigate retinal microcirculation by OCT-A after COVID-19 infection in three subdivided layers (I). In addition, short-term retinal affections were monitored during COVID-19 disease (II). Considering (I), a prospective study (33 patients_post-COVID and 28 controls) was done. Macula and peripapillary vessel density (VD) were scanned with the Spectralis II. Macula VD was measured in three layers: superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). Analysis was done by the EA-Tool, including an Anatomical Positioning System and an analysis of peripapillary VD by implementing Bruch's membrane opening (BMO) landmarks. Overall, circular (c₁, c₂, and c₃) and sectorial VD (s₁-s₁₂) was analyzed. Considering (II), in a retrospective study, 29 patients with severe complications of COVID-19 infection, hospitalized at the intensive care unit, were monitored for retinal findings at bedside during hospitalization. (I) Overall (p = 0.0133) and circular (c₁, p = 0.00257; c₂, p = 0.0067; and c₃, p = 0.0345). VD of the ICP was significantly reduced between patients_post-COVID and controls, respectively. Overall (p = 0.0179) and circular (c₁, p = 0.0189) peripapillary VD was significantly reduced between both groups. Subgroup analysis of hospitalized vs. non-hospitalized patients_post-COVID yielded a significantly reduced VD of adjacent layers (DCP and SVP) with increased severity of COVID-19 disease. Clinical severity parameters showed a negative correlation with VD (ICP) and peripapillary VD. (II) Funduscopy yielded retinal hemorrhages and cotton wool spots in 17% of patients during SARS-CoV-2 infection. As VD of the ICP and peripapillary regions was significantly reduced after COVID-19 disease and showed a link to clinical severity markers, we assume that the severity of capillary impairment after COVID-19 infection is mapped on retinal microcirculation, visualized by non-invasive OCT-A.

Extended Ganglion Cell Layer Thickness Deviation Maps With OCT in Glaucoma Diagnosis

Purpose: The aim of the present study was to investigate the diagnostic power of RGCL in the macula quantitatively and qualitatively by using a conventional and extended elliptic grid with deviation maps. Subjects and Methods: Thickness of RGCL was measured using SPECTRALIS® OCT (Heidelberg Engineering, Heidelberg, Germany) in 150 eyes of 150 subjects of the Erlangen Glaucoma Registry (EGR; NTC00494923): 26 ocular hypertension (OHT), 39 pre-perimetric open-angle glaucoma (pre-OAG), 19 normal tension glaucoma (NTG), 34 primary open-angle glaucoma (POAG), 16 secondary open-angle glaucoma (SOAG), and 16 controls. Analysis of RGCL was done quantitatively (global value, GV) and qualitatively (qualitative total value, QTV) by using a color-coded point score for data of the common elliptic macular grid of deviation maps. Furthermore, qualitative analysis of RGCL was done for an extended elliptic macula grid (extended qualitative total value, eQTV). Receiver operating characteristic (ROC) curves were calculated for the conventional and the enlarged macular grid for all subjects' groups. Results: GV of RGCL thickness differed significantly between pre-OAG (p < 0.05), NTG (p < 0.001), POAG (p < 0.001), SOAG (p < 0.001), yet not OHT (p > 0.05) and controls, respectively. Quantitative ROC analysis of GV showed AUC of 0.965 (SOAG), 0.942 (POAG), 0.916 (NTG), 0.772 (pre-OAG), and 0.526 (OHT). QTV differed significantly between pre-POAG (p < 0.05), NTG (p < 0.001), POAG (p < 0.001), SOAG (p < 0.001), yet not OHT (p > 0.05) and controls, respectively. Qualitative ROC analysis of QTV showed AUCs of 0.908 (NTG) 0.914 (POAG), 0.930 (SOAG), 0.734 (pre-POAG), and 0.519 (OHT). Implementation of eQTV yielded even higher AUCs for NTG (0.919), POAG (0.969), and SOAG (0.973) compared to GV. Similar AUCs of eQTV and GV were observed for OHT (0.514) and pre-OAG (0.770). Conclusion: The results of the present study showed that quantitative and qualitative analysis of RGCL thickness yielded similar diagnostic impacts compared to RNFL. Qualitative analysis might be a quick and easy useable tool for clinical all-day life. The present data suggest that analysis of an extended macula region might improve its diagnostic impact.

Induktion einer strickleiterartigen Narbe an der Wange einer 28-jährigen Frau nach Laserung eines Naevus araneus mittels KTP-Laser

Die 28-jährige Patientin stellte sich zur Behandlung einer kosmetisch störenden Gefäßläsion an der Wange vor. Es wurde eine Lasertherapie vorgeschlagen und vereinbart. Es entstanden unmittelbar nach der Laserbehandlung Schmerzen und eine Rötung; später eine entstellende Narbe.

Die Gutachter der Gutachterkommission bei der Ärztekammer Nordrhein beurteilten die Behandlung als fehlerhaft.

Laserbehandlungen zählen insgesamt zu den risikoreicheren Therapien in der Dermatologie. Häufiger als andere Behandlungsoptionen beurteilen die Begutachter die Behandlungen als fehlerhaft.

Patientensicherheit: Die Lasertherapie gehört zu den risikoreicheren Therapieoptionen in der Dermatologie

Seit der Erstbeschreibung von Lasern und den ersten Anwendungen in der Dermatologie hat die Lasertherapie innerhalb des dermatologischen therapeutischen Armamentariums enorm an Bedeutung zugenommen.

Da sie häufig bei ästhetischen Indikationen Anwendung findet, sind hohe Sicherheitsanforderungen zu gewährleisten, ansonsten kommt es zu unangenehmen juristischen Streitigkeiten. Eine retrospektive Analyse anhand der Fälle der Gutachterkammer für ärztliche Behandlungsfehler hat gezeigt, dass Lasertherapien zu den risikoreicheren therapeutischen Optionen in der Dermatologie gehören.

Human Papillomavirus-type distribution in anogenital lesions of prepubertal children

BACKGROUND

In contrast to adults, only limited data are available on the human papillomavirus (HPV)-type spectrum in anogenital warts (AGW) of children.

OBJECTIVE

This study aimed to evaluate the HPV-type spectrum in AGW of prepubertal children.

MATERIALS & METHODS

In a retrospective German multicentre study, HPV genotyping was performed in AGW biopsies of 55 1- to 12-year-old children using HPV group-specific PCRs followed by hybridization with type-specific probes or sequence analysis.

RESULTS

Human papillomavirus-DNA was found in 53 of the 55 AGW. In 58.5% (31/53) of the HPV-positive AGW, mucosal HPV types were detected. HPV6 (27/53, 50.9%) was the predominant type. 43.4% (23/53) of the lesions were induced by cutaneous HPV types (HPV2, HPV27, HPV57). Mucosal HPV types were significantly more common in children under 5 years of age than in children 5 years of age and older (22/25, 88.0% [95% CI: 70.0-95.8] vs. 9/28, 32.1% [95% CI: 17.9-50.7], P < 0.001). In contrast, cutaneous HPV types were significantly more prevalent in the 5- to 12-year age group (4/25, 16.0% [95% CI 6.4-34.7] vs. 19/28, 67.9% [95% CI 49.3-82.1], P < 0.001).

CONCLUSION

Anogenital warts in 5- to 12-year-old children are frequently associated with cutaneous HPV types, possibly due to horizontal transmission. HPV typing, in addition to comprehensive clinical and psychosocial evaluation, can potentially help in the assessment of these cases.

[State Programs to Counter the Corona Crisis - an Option for Climate Protection?]

Public measures to combat the coronavirus pandemic have led to a severe economic crisis. In order to cope with this crisis, many expect strong state intervention. Governments across the world have pledged billions of euros for extensive recovery programs. But how 'green' should these recovery programs be? This article evaluates Germany's initial policy proposals and decisions.

Killing Two Birds with One Stone? Green Dead Ends and Ways Out of the COVID-19 Crisis

The coronavirus crisis has opened up a window of opportunity for transformation. This should be used without getting off the regulatory track. Green recovery programs must not be reduced to a mere competition for green subsidies. Abandoning barriers to green investments and imposing a carbon price are equally important. Where economically sensible, green subsidies should contribute both to stabilizing the economy and mitigating climate change. Moreover, smart green recovery programs may contribute to raising revenues for the additionally necessary public expenditures.

Sklerodermiformes Basalzellkarzinom an der Wange unter der (Fehl-)Diagnose einer Aknenarbe

Eine Patientin stellte sich 4 Mal vor etwa 10 Jahren und vor 6 Jahren bei dem beklagten Hautarzt zum Hautkrebsscreening vor. In der ärztlichen Dokumentation wurde jeweils eine Narbe aufgrund einer Akne tarda befundet. Vor 2 Jahren stellte sich die Patientin bei einem anderen Hautfacharzt vor, der eine Biopsie entnahm, die ein sklerodermiformes Basalzellkarzinom ergab. Es musste eine komplexe operative Sanierung durchgeführt werden mit entsprechenden Komplikationen wie Nervenschädigungen, Gefühlsstörungen und Formveränderungen des Gesichtes. Die Gutachterkommission hat dies als Befunderhebungsfehler dem beklagten Arzt attestiert, zumal er nach dem 4., aber spätestens nach dem 5. Vorstellungsbesuch zum Hautkrebsscreening seine Diagnose mittels einer Probebiopsie hätte überprüfen müssen. Dies entspricht dem Facharztstandard, dem das Vorgehen des Facharztes in diesem Falle nicht gerecht wurde.

Improved Cervical Cord Lesion Detection with 3D-MP2RAGE Sequence in Patients with Multiple Sclerosis

Spinal cord lesions have a real diagnostic and prognostic role in multiple sclerosis. Thus, optimizing their detection on MR imaging has become a central issue with direct therapeutic impact. In this study, we compared the 3D-MP2RAGE sequence with the conventional Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) set for cervical cord lesion detection in 28 patients with multiple sclerosis. 3D-MP2RAGE allowed better detection of cervical lesions (+62%) in this population, with better confidence, due to optimized contrast and high spatial resolution.

Auftreten des Post-Finasterid-Syndroms nach Verschreibung von Propecia 1 mg-Tablette zur Behandlung der männlichen Glatzenbildung

Ein Patient wurde im Jahre 2013 mit Propecia 1 mg aufgrund einer androgenetischen Alopezie behandelt. Es traten bei ihm eine sexuelle Dysfunktion mit Erektionsschwäche und vermindertem sexuellen Verlangen auf, die auch nach Abbrechen der Therapie anhielt. Daraufhin machte der Patient gegenüber dem Facharzt einen Behandlungsfehler geltend aufgrund mangelhafter Aufklärung mit der Konsequenz einer fehlerhaften Behandlung. Der urologische Fachgutachter bejahte den Behandlungsfehler. Er war der Meinung, dass, auch wenn nur Einzelfälle mit geringer wissenschaftlicher Basis über das Post-Finasterid-Syndrom bekannt wären, der Facharzt über diese schwerwiegende Nebenwirkung den Patienten hätte aufklären müssen, dies insbesondere bei einer rein kosmetischen Indikation männlicher Glatzenbildung.

Der dermatologische Gutachter schloss sich nicht dieser Meinung an. Im Verordnungsjahr 2013 existierten lediglich 2 Publikationen über Einzelfälle des Post-Finasterid-Syndroms. Diese Publikationen in peripheren Zeitschriften fanden noch kein allgemeines wissenschaftliches Echo und führten auch nicht zur Änderung der Fachinformation. Erst im Verlauf der Folgejahre wurde in der Postmarketing-Phase das Syndrom öfters beschrieben und fand auch Eingang in die Fachinformation. Da für die Beurteilung das im Jahre der Verordnung geltende wissenschaftliche Wissen entscheidend ist, kann dem Facharzt kein Behandlungsfehler vorgeworfen werden.

Gas-loading furnace for deuterium-charged alloy-casting

A furnace was developed and characterized to allow for safe and controlled gas-loading or degassing of alloys. This oven is able to process samples under varying atmospheres, such as high vacuum or nitrogen containing 10 vol. % deuterium, as well as for pressures up to 800 hPa. Thermal desorption spectroscopy and scanning electron microscopy demonstrate the enhancing effects of high loading-gas concentration, high pressures, high temperatures above liquidus (50-150 K above the liquidus temperature of the cast hypoeutectic aluminum-copper model-alloy), and long holding times (up to 60 min) on the amount of retained gas in the solidified sample. Lack of copper segregation in the casting is confirmed by energy dispersive x-ray diffraction and Rutherford backscattering spectroscopy. It is shown that the facility allows for the controlled generation of distinct amounts of gas pores, down to a nil amount (only shrinkage porosity appearing in the sample).

UV-B-Therapie von Hautkrankheiten: ein Update zu Indikationen, Wirksamkeit, Nebenwirkungen und Durchführung

Seit Anfang des 20. Jahrhunderts ist die UV-B-Phototherapie eine der tragenden Säulen der vielfältigen dermatologischen Therapiestrategien, die ständig weiterentwickelt wurden. Diese Weiterentwicklungen betrafen sowohl die Strahlenquellen mit effektiveren Aktionsspektren (Schmalspektrum UV-B) als auch Studien zu verschiedenen Kombinationsschemata mit externen und systemischen Pharmaka.

Die Psoriasis stellt nach wie vor die Hauptindikation für eine UV-B-Therapie dar. Im Laufe der Jahre hat sich das Indikationsspektrum deutlich erweitert.

Akute Nebenwirkungen sind Sonnenbrände durch falsche Dosierungen, wichtiger sind potenzielle chronische Nebenwirkungen wie die chronische aktinische Hautschädigung, inklusive der Photokarzinogenese. Die praktische Durchführung erfordert Erfahrung, auch wenn sie in Leitlinien sehr umfassend widergegeben ist.

Rosacea Management: Update on general measures and topical treatment options

Although there is presently no cure for rosacea, there are several recommended treatment options available to control many of the symptoms and to prevent them from getting worse. In addition to self-help measures like avoidance of trigger factors and proper skin care, rosacea management should include topical medications as one of the first-line choices for patients with erythematous and mild to severe papulopustular rosacea. Since mixed forms of characteristic rosacea symptoms are more common, medical treatment must be symptom-tailored for each individual case and will often involve a combination therapy. Approved topical agents for the major symptoms of rosacea encompass brimonidine for erythema and ivermectin, metronidazole or azelaic acid for inflammatory lesions, all of which have shown their efficacy in numerous valid, well-controlled trials. In addition, there are several other, not approved topical treatments which are possible options that require further validation in larger well-controlled studies.

Pathogenesis and clinical presentation of rosacea as a key for a symptom-oriented therapy

Rosacea is a common chronic inflammatory skin disorder that typically occurs in adults and affects the face. Synonyms of rosacea include "acne rosacea", "couperose" and "facial erythrosis", in German also "Kupferfinne" and "Rotfinne". The disorder is characterised by a chronic and flaring course and is caused by a genetically predisposed, multifactorial process. A higher incidence is seen in people with fair skin and a positive family history. The characteristic rosacea symptoms manifest primarily, but not exclusively centrofacially, with forehead, nose, chin and cheeks significantly affected. Based on the various main symptoms a classification of the individual clinical pictures can be performed. However, a classification often does not reflect the clinical reality, since the various symptoms commonly coexist. The present review provides an introduction on pathogenesis and clinical manifestations of rosacea and prefers a symptom-oriented therapy approach.

State of the art: systemic rosacea management

Based on numerous trials, oral tetracyclines and most commonly their second-generation derivative doxycycline have become the main pillar in systemic rosacea treatment. However, the only preparation that has been approved so far in this setting is 40 mg doxycycline in an anti-inflammatory dosage and with a modified release formulation. With the introduction of this once-daily, non-antibiotic dosing of doxycycline, oral therapy is more commonly prescribed as first-line treatment in moderate to severe papulopustular rosacea. In addition, topical and oral strategies are often used in combination due to the more substantial improvements compared to monotherapy. Although several other non-approved oral agents like macrolides, isotretinoin, and carvedilol have been evaluated for systemic treatment and showed promising results, yet the experience with these drugs in rosacea is limited, and thus they should be reserved for special situations.

Pathogenese und Klinik der Rosazea als Schlüssel für eine symptomorientierte Therapie

Rosazea ist eine häufige chronisch-entzündliche Hauterkrankung, die typischerweise bei Erwachsenen vorkommt und das Gesicht betrifft. Synonyme der Rosazea sind Acne rosacea, Kupferfinne, Rotfinne, Couperose und Rosacea. Die Erkrankung ist durch einen chronischen und schubartigen Verlauf gekennzeichnet und wird durch ein genetisch prädisponiertes, multifaktorielles Geschehen bedingt. Ein vermehrtes Auftreten wird bei hellem Hauttyp und positiver Familienanamnese verzeichnet. Die charakteristischen Rosazea-Symptome manifestieren sich vorwiegend, aber nicht ausschließlich zentrofazial, wobei Stirn, Nase, Kinn und die Wangen maßgeblich betroffen sind. Dabei werden unterschiedliche Hauptsymptome voneinander unterschieden, anhand derer eine Klassifikation der verschiedenen klinischen Bilder vorgenommen werden kann. Eine Klassifizierung wird oftmals jedoch nicht der klinischen Realität gerecht, da die verschiedenen Symptome häufig gemeinsam auftreten. Diese Übersichtarbeit führt in die Pathogenese und Klinik der Rosazea ein und plädiert für einen symptomorientierten Therapieansatz.

Rosazea-Management: Update über allgemeine Maßnahmen und topische Therapieoptionen

Obwohl bislang für die Rosazea keine kurative Therapie besteht, können verschiedene Optionen zur Behandlung der Symptome und zur Vorbeugung von Exazerbationen empfohlen werden. Neben Selbsthilfemaßnahme wie der Vermeidung von Triggerfaktoren und einer geeigneten Hautpflege sollte das Rosazea-Management bei Patienten mit erythematöser und leichter bis schwerer papulopustulöser Rosazea die Anwendung topischer Präparate als First-Line-Therapie umfassen. Da Überlappungen der charakteristischen Rosazea-Symptome im klinischen Alltag die Regel sind, sollte die medikamentöse Therapie auf die individuellen Symptome zugeschnitten werden; auch eine Kombinationstherapie kann erforderlich sein. Zu den für die Behandlung der Hauptsymptome der Rosazea zugelassenen Wirkstoffen gehören Brimonidin gegen das Erythem sowie Ivermectin, Metronidazol oder Azelainsäure gegen entzündliche Läsionen. Ihre Wirksamkeit wurde in zahlreichen validen, gut kontrollierten Studien belegt. Darüber hinaus existieren verschiedene nicht zugelassene topische Behandlungsmöglichkeiten, deren Wirksamkeit und Sicherheit noch in größeren, kontrollierten Studien zu untersuchen ist.

[Lymphedema as initial manifestation of malignancy]

Lymphedema may result from various benign or malignant causes. In particular rapidly progressing central or unilateral lymphedema (even in case of only discrete clinical findings) should initiate an extensive diagnostic workup to detect underlying malignancies in order to enable early therapy.

PCR analysis is superior to histology for diagnosis of Whipple's disease mimicking seronegative rheumatic diseases

OBJECTIVES

The diagnosis of Whipple's disease (WD) is commonly confirmed by histology demonstrating Periodic Acid Schiff (PAS)-positive macrophages in the duodenal mucosa. Analysis of intestinal tissue or other specimens using polymerase chain reaction (PCR) is a more sensitive method. However, the relevance of positive PCR findings is still controversial. Therefore, we evaluated the relevance of histology and PCR findings to establishing the diagnosis of WD in a series of WD patients initially presenting with suspected rheumatic diseases.

METHOD

Between 2006 and 2014, 20 patients with seronegative rheumatic diseases tested positive for Tropheryma whipplei (Tw) by PCR and/or histology and were enrolled in a retrospective analysis of the diagnostic value of both procedures.

RESULTS

Seven of the 20 cases (35%) were diagnosed with 'classic' WD as indicated by PAS-positive macrophages. In the remaining 13 patients, the presence of Tw was detected by intestinal (n = 10) or synovial PCR analysis (n = 3). Two of the 20 patients (10%) with evidence of Tw did not respond to antibiotic therapy. They were not considered to suffer from WD. Therefore, relying only on histological findings of intestinal biopsies would have missed 11 (61%) of the 18 patients with WD in our cohort. In comparison, PCR of intestinal biopsies detected Tw-DNA in 14 (93%) of the 15 WD patients evaluated. Patients with a positive histology did not differ from PCR-positive patients with regard to sex, age, or duration of disease, but more often presented with gastrointestinal symptoms.

CONCLUSIONS

A substantial number of WD patients present without typical intestinal histology findings. Additional PCR analysis of intestinal tissue or synovial fluid increased the sensitivity of the diagnostic evaluation and should be considered particularly in patients presenting with atypical seronegative rheumatic diseases and a high-risk profile for WD.

Brimonidine gel 0.33% rapidly improves patient-reported outcomes by controlling facial erythema of rosacea: a randomized, double-blind, vehicle-controlled study

Background

Facial redness contributes to impaired psychosocial functioning in rosacea patients and the only approved treatment for erythema is topical brimonidine gel 0.33%.

Objectives

To evaluate patient‐reported outcomes, as well as efficacy and safety, in subjects with self‐perceived severe erythema treated with brimonidine gel 0.33% compared to vehicle.

Methods

An 8‐day multicenter, randomized study comparing once‐daily brimonidine gel 0.33% with vehicle gel using a facial redness questionnaire, subject satisfaction questionnaire and a patient diary of facial redness control to assess patient‐reported outcomes.

Results

Of the 92 included subjects with self‐perceived severe erythema, very few were satisfied with their appearance at baseline (4.2% brimonidine group, 0 vehicle group). On Day 8, significantly more brimonidine group subjects were satisfied with their facial appearance compared to vehicle group (36.9% vs. 21.5%; P < 0.05), with the overall treatment effect (69.6% vs. 40.4%; P < 0.01), and with the improvement in their facial redness (67.4% vs. 33.3%; P < 0.001). More brimonidine group subjects were able to control their facial redness daily (e.g. 83.0% vs. 38.9% on Day 1). On Day 8, significantly more brimonidine group subjects than vehicle group had at least a one‐grade improvement from baseline in the Clinician Erythema Assessment score (71.7% vs. 35.7%; P = 0.0011) and Patient Self‐Assessment score (76.1% vs. 47.6%; P = 0.004). More subjects in the brimonidine group (29.2%) reported treatment‐related adverse events than in the vehicle group (15.9%) but most were mild and transient.

Conclusions

Once‐daily brimonidine gel 0.33% allowed patients to rapidly control their facial redness and significantly improved patient‐reported outcomes in the treatment of persistent facial erythema of rosacea.

Photoperiodic effects on diapause-associated gene expression trajectories in European Leptinotarsa decemlineata populations

Behavioural and physiological changes during diapause, an important strategy of insects for surviving harsh seasonal conditions, have been intensively studied. The genetic and molecular mechanisms underpinning diapause development are less well known. We took a candidate gene approach to study prediapause gene expression patterns in the Colorado potato beetle (Leptinotarsa decemlineata), an invasive insect that has rapidly spread northwards to high seasonality environments. Newly eclosed beetles originating from southern (Italy) and northern (Russia) Europe were reared under short- [12 h light (L):12 h dark (D)] and long-day (18L:6D) photoperiods for 10 days. This time period includes the sensitive period for the photoperiodic induction and initiation of diapause. Gene expression trajectories of 12 diapause-related genes (regulatory, metabolic and stress-resistance) were analysed from 0-, 5- and 10-day-old beetles. Gene expression differences increased with age, deviating significantly between populations and photoperiods in 10-day-old beetles. The gene expression profiles, particularly those related to energy metabolism and stress-resistance, indicate that beetles originating from Russia also prepare for diapause under the long-day photoperiod and show qualitative differences in the diapausing phenotype. Our study shows that population-dependent differences seen in behavioural and physiological traits connected with diapause in L. decemlineata are also evident in the expression trajectories of diapause-related genes.

Course and treatment of chronic hepatitis E virus infection in lung transplant recipients

OBJECTIVE

Persistent hepatitis E virus (HEV) infections have been described in various transplant cohorts. However, the frequency and the course of HEV infection in lung transplant recipients (Lu-Tr) are not well defined.

METHODS

We retrospectively analyzed serum from 95 Lu-Tr for HEV RNA and anti-HEV immunoglobulin-G (IgG) (with the MP assay). Anti-HEV seroprevalence was compared to that of 537 healthy individuals. Prospective HEV screening was subsequently initiated in Lu-Tr.

RESULTS

Elevated liver enzymes were observed in 44/95 (46.3%) patients. Anti-HEV IgG was present in 5/95 patients (5.3%), revealing a slightly higher prevalence compared to controls (2%, 11/537; P = 0.07). Chronic HEV infection with detectable viral replication was confirmed by polymerase chain reaction in 3 (3.2%) patients, all of whom demonstrated clinical and biochemical features of active liver disease (maximum alanine aminotransferase [ALTmax ] 89, 215, and 270 IU/L, respectively). One patient had died from multi-organ failure in combination with liver cirrhosis before HEV diagnosis. Two additional patients with chronic hepatitis E were identified during prospective screening (ALTmax 359 and 318 IU/L). All patients still alive commenced ribavirin therapy for 5 months, with dose adjustment (400-600 mg/day) according to renal function and hemoglobin level. Sustained resolution of HEV infection occurred in 2 patients. One patient is still under treatment, and the fourth died from graft failure considered unrelated to ribavirin therapy.

CONCLUSION

Chronic hepatitis E should be considered in the differential diagnosis of elevated liver enzymes, which are commonly seen in Lu-Tr. We observed 1 case of end-stage liver cirrhosis and death in an HEV-infected subject, who was not treated with ribavirin. Given this potentially devastating consequence, ribavirin therapy of persistent HEV infection appears to be acceptably safe and effective in Lu-Tr. However, larger prospective studies are warranted.

[Rhabdomyolysis and creatine kinase elevation]

Creatine kinase (CK) plays an important role in cellular energy metabolism in various tissues and skeletal muscle is recognized as being the largest reservoir of this enzyme. Elevated CK levels can be induced by various harmless or severe conditions implying multiple differential diagnoses for the physician. Trauma, inflammation, drug-induced toxicity, genetic disorders as well as metabolic, endocrine or rheumatic diseases might lead to cell degeneration and leakage of CK and other cellular components. Massive destruction of muscular tissue leads to rhabdomyolysis, defined as CK elevation combined with organ damage, which requires immediate diagnostic and therapeutic intervention.

Clinical validation of IFNγ/IL-10 and IFNγ/IL-2 FluoroSpot assays for the detection of Tr1 T cells and influenza vaccine monitoring in humans

The type of T cell polarization and simultaneous production of multiple cytokines have been correlated with vaccine efficacy. ELISpot is a T cell detection technique optimized for the measurement of a secreted cytokine at the single cell level. The FluoroSpot assay differs from ELISpot by the use of multiple fluorescent-labeled anticytokine detection antibodies, allowing optimal measurement of multiple cytokines. In the present study, we show that an IFNγ/IL-10 FluoroSpot assay is more sensitive than flow cytometry to detect Tr1 regulatory T cells, an immunosuppressive T cell population characterized by the production of IL-10 and IFNγ. As many tolerogenic vaccines are designed to induce these Tr1 cells, this FluoroSpot test could represent a standard method for the detection of these cells in the future. The use of an IFNγ/IL-2 FluoroSpot assay during influenza vaccine monitoring showed that the influenza-specific IL-2-producing T-cell response was the dominant response both before and after vaccine administration. This study therefore questions the rationale of using the single-color IFNγ ELISpot as the standard technique to monitor vaccine-specific T-cell response. Using this same test, a trend was also observed between baseline levels of IFNγ T cell response and T cell vaccine response. In addition, a lower IFNγ+IL-2+ T-cell response after vaccine was observed in the group of patients treated with TNFα inhibitors (P=0.08). This study therefore supports the use of the FluoroSpot assay due to its robustness, versatility and the complementary information that it provides compared with ELISpot or flow cytometry to monitor vaccine-specific T-cell responses.

Long-term (6 and 12 months) follow-up of two prospective, randomized, controlled phase III trials of photodynamic therapy with BF-200 ALA and methyl aminolaevulinate for the treatment of actinic keratosis

Background

Two phase III trials of photodynamic therapy (PDT) with BF-200 ALA, a recently approved nanoemulsion formulation of 5-aminolaevulinic acid (ALA) demonstrated high clearance rates in mild-to-moderate actinic keratosis (AK). The comparison to a registered methyl aminolaevulinate (MAL) cream demonstrated significantly superior total patient clearance rates.

Objectives

To evaluate long-term efficacy and safety of PDT for AK 6 and 12 months after the last PDT with BF-200 ALA, MAL or placebo.

Methods

The follow-up phase (FUP) was performed with patients of two phase III studies. Both studies compared BF-200 ALA with placebo, one of the studies additionally with MAL. Overall recurrence rates and various subgroups (light source, lesion severity, lesion location, complete responders after first PDT) were assessed 6 and 12 months after the last PDT.

Results

Recurrence rates were similar for BF-200 ALA and MAL, with a tendency to lower recurrence rates for BF-200 ALA. The proportion of patients who were fully cleared during PDT and remained completely clear for at least 12 months after PDT were 47% for BF-200 ALA (both studies) and 36% for MAL treatment. The subgroup that was illuminated with narrow wavelength LED lamps reached 69% and 53% for BF-200 ALA (both studies, respectively) and 41% for MAL. No safety concerns were reported.

Conclusions

The FUP data confirmed the high efficacy and safety of PDT with BF-200 ALA. The slightly lower recurrence rates after BF-200 ALA treatment compared with MAL treatment enhanced the better treatment outcome due to the significantly superior efficacy.