Ecological momentary intervention to reduce suicide risk among adolescents (EMIRA)

Suicide is among the leading causes of death among adolescents and suicide risk is particularly high after discharge from psychiatric inpatient care. Therefore, interventions to reduce suicidal thoughts and behaviours (STBs) among adolescents discharged from psychiatric inpatient care are integral for successful suicide prevention among this group. However, such interventions are scarce. EMIRA aims to close this important gap in mental health services by developing an ecological momentary intervention (i.e., intervention delivered in real-time and within one's natural setting) consisting of a personalized, automatically triggered crisis support smartphone app to reduce STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. First, we will conduct qualitative interviews with adolescents aged 14-21 years who previously experienced STBs, their parents and health care providers to identify their intervention needs and safety concerns regarding ecological momentary assessment (EMA). Next, we will investigate the short-term variability of STBs and their cognitive and physiological risk factors among adolescents aged 14-21 years using EMA (app-based self-report + wrist worn device). Based on our results and past research we will develop a personalized crisis support smartphone app (mobile safety planning) that is not only self-accessible but starts automatically based on the presence of pre-identified STB risk factors. Finally, we will conduct two consecutive studies to test the feasibility, efficacy and cost-effectiveness of the developed ecological momentary intervention in reducing STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. EMIRA has great potential to close a crucial gap in adolescent mental health services and significantly improve suicide prevention among this group.

[Discharge management in pediatric and adolescent psychiatry : Expectations and realities from the parental perspective]

BACKGROUND

Interface management after inpatient care for mentally ill children and adolescents has been proven to be a breaking point in good transition of care between child and adolescent psychiatry, social welfare services, schools, job centre and the judicial system. Criteria for successful discharge management do not exist in child and adolescent psychiatry. Aim of the study ASpeKT was to survey parents on their perception of interface management and to derive recommendations for discharge management.

METHODS

Data regarding interface management were retrieved from parents (T3, n = 124, T4, n = 81) 6 months (T3) and 12 months (T4) after discharge.

RESULTS

The parents stated that accessible help after discharge from inpatient treatment is essential for stability and requires a good coordination. Parents named that they perceived helpful for successful interface management: a case manager, early round table meetings, support in returning to school, seamless access to outpatient follow-up appointments as well as information on further treatment options and contact data.

CONCLUSION

From the perspective of affected families a proactive early individual and reliable care coordination by a constant contact person is essential for a good discharge management.

Protocol for the development and validation procedure of the managing the link and strengthening transition from child to adult mental health care (MILESTONE) suite of measures

Background

Mental health disorders in the child and adolescent population are a pressing public health concern. Despite the high prevalence of psychopathology in this vulnerable population, the transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) has many obstacles such as deficiencies in planning, organisational readiness and policy gaps. All these factors contribute to an inadequate and suboptimal transition process. A suite of measures is required that would allow young people to be assessed in a structured and standardised way to determine the on-going need for care and to improve communication across clinicians at CAMHS and AMHS. This will have the potential to reduce the overall health economic burden and could also improve the quality of life for patients travelling across the transition boundary. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Health Care) project aims to address the significant socioeconomic and societal challenge related to the transition process. This protocol paper describes the development of two MILESTONE transition-related measures: The Transition Readiness and Appropriateness Measure (TRAM), designed to be a decision-making aide for clinicians, and the Transition Related Outcome Measure (TROM), for examining the outcome of transition.

Methods

The TRAM and TROM have been developed and were validated following the US FDA Guidance for Patient-reported Outcome Measures which follows an incremental stepwise framework. The study gathers information from service users, parents, families and mental health care professionals who have experience working with young people undergoing the transition process from eight European countries.

Discussion

There is an urgent need for comprehensive measures that can assess transition across the CAMHS/AMHS boundary. This study protocol describes the process of development of two new transition measures: the TRAM and TROM. The TRAM has the potential to nurture better transitions as the findings can be summarised and provided to clinicians as a clinician-decision making support tool for identifying cases who need to transition and the TROM can be used to examine the outcomes of the transition process.

Trial registration

MILESTONE study registration: ISRCTN83240263 Registered 23-July-2015 - ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology

BACKGROUND

Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014-19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals.

METHODS

Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians.

DISCUSSION

Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers.

TRIAL REGISTRATION

"MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

Unverarbeitete Verlusterfahrungen und Angststörungen

Zielsetzung der vorliegenden Studie war es, erstmals im deutschen Sprachraum die generationsübergreifenden Zusammenhänge zwischen Angststörungen bei Müttern und möglichen Verhaltensauffälligkeiten ihrer Kinder im Kindergartenalter im Kontext der Weitergabe von Bindungsmustern zu untersuchen. Um bindungsspezifische Risikofaktoren zu identifizieren, wurden sowohl die Mütter als auch deren Kinder mit Methoden der Bindungsforschung untersucht. Entsprechend unserer Hypothese wurde bei den Müttern mit einer manifesten Angststörung ein hoher Anteil an unsicherer Bindungsrepräsentation und insbesondere unverarbeiteter Trauer klassifiziert. Die Kinder dieser Mütter zeigten ebenso zu einem hohen Prozentsatz unsicherer Bindungsmuster, jedoch nicht wie erwartet keinen erhöhten Anteil an desorganisierter Bindung. Die kinder- und jugendpsychiatrische Untersuchung führte bei den meisten Kindern zum Befund einer nachweisbar erhöhten psychosozialen Belastung und Beeinträchtigung des psychosozialen Funktionsniveaus, wenn auch nicht im psychiatrisch auffälligen Bereich. Hier liegen die Chancen für eine interdisziplinäre Zusammenarbeit mit rechtzeitigen, auch präventiven Angeboten und Hilfen, wie sie in der klinischen Versorgungslandschaft derzeit noch nicht systematisch vorgehalten werden.

Occlusion in the Flow of New Drugs for Cardiovascular Disease

There is a large misalignment between unmet need and both private and public investment activity in cardiovascular disease. In this paper, we quantify the magnitude of the gap, analyze a range of potential root causes in two main categories (issues of feasibility and valuation), and propose steps toward solutions to close the gap.

Development and psychometric properties of the Suicidality: Treatment Occurring in Paediatrics (STOP) Suicidality Assessment Scale (STOP-SAS) in children and adolescents

BACKGROUND

To create a self-reported, internet-based questionnaire for the assessment of suicide risk in children and adolescents.

METHODS

As part of the EU project 'Suicidality: Treatment Occurring in Paediatrics' (STOP project), we developed web-based Patient Reported Outcome Measures (PROMs) for children and adolescents and for proxy reports by parents and clinicians in order to assess suicidality. Based on a literature review, expert panels and focus groups of patients, we developed the items of the STOP Suicidality Assessment Scale (STOP-SAS) in Spanish and English, translated it into four more languages, and optimized it for web-based presentation using the HealthTracker^TM platform. Of the total 19 questions developed for the STOP-SAS, four questions that assess low-level suicidality were identified as screening questions (three of them for use with children, and all four for use with adolescents, parents and clinicians). A total of 395 adolescents, 110 children, 637 parents and 716 clinicians completed the questionnaire using the HealthTracker^TM, allowing us to evaluate the internal consistency and convergent validity of the STOP-SAS with the clinician-rated Columbia Suicide Severity Rating Scale (C-SSRS). Validity was also assessed with the receiver operating characteristic (ROC) area of the STOP-SAS with the C-SSRS.

RESULTS

The STOP-SAS comprises 19 items in its adolescent, parent, and clinician versions, and 14 items in its children's version. Good internal consistency was found for adolescents (Cronbach's alpha: 0.965), children (Cronbach's alpha: 0.922), parents (Cronbach's alpha: 0.951) and clinicians (Cronbach's alpha: 0.955) versions. A strong correlation was found between the STOP-SAS and the C-SSRS for adolescents (r:0.670), parents (r:0.548), clinicians (r:0.863) and children (r:0.654). The ROC area was good for clinicians' (0.917), adolescents' (0.834) and parents' (0.756) versions but only fair (0.683) for children's version.

CONCLUSIONS

The STOP-SAS is a comprehensive, web-based PROM developed on the HealthTracker^TM platform, and co-designed for use by adolescents, children, parents and clinicians. It allows the evaluation of aspects of suicidality and shows good reliability and validity.

Entwicklung eines Web-basierten Meldesystems für kongenitale Anomalien beim Rind und Übersicht über die in 15 Monaten gemeldeten Fälle

Gegenstand und Ziel: Entwicklung eines Web-basierten Meldesystems für kongenitale Anomalien beim Rind, um diese landesweit zu erfassen und deren Ursachen aufzuklären. Material und Methoden: Das Web-basierte System zur Meldung von Missbildungen beim Rind ist für alle interessierte Personen, wie Landwirte, Tierärzte und Zuchtorganisationen, unter der URL http://www.tiho-hannover.de/einricht/zucht/anomalien/rind/index.htm zugänglich. Häufig vorkommende Anomalien wurden kurz beschrieben und mit Bildmaterial veranschaulicht. Der Fragebogen enthält Angaben zur Herkunft des Tieres und zur Art der Missbildung. Das System ist unabhängig von einer Organisation oder einem auf einzelne Länder oder Bezirke begrenzten Landeskontrollverband verfügbar. Es bietet die Möglichkeit, sofort persönlichen Kontakt zu dem Untersucher herzustellen. Zudem können weitere Informationen, wie z. B. digitale Fotos oder Röntgenbilder, schnell ausgetauscht werden. Da die Meldungen häufig bereits kurz nach der Geburt der Kälber erfolgten, konnten viele Fälle weitergehenden klinischen, molekulargenetischen und pathomorphologischen Untersuchungen unterzogen werden. Ergebnisse: Von August 2004 bis November 2005 gingen insgesamt 109 Meldungen ein, wovon 46 über die Rinder-Union West und 11 über die Kliniken der Stiftung Tierärztliche Hochschule Hannover an das Institut für Tierzucht und Vererbungsforschung erfolgten. Eine detaillierte Untersuchung der missgebildeten Kälber fand in 17 Fällen statt. Am häufigsten wurden Missbildungen des Verdauungssystems (19%), des Kopfes (18%), der Wirbelsäule (17%) und der Gliedmaßen (14%) registriert. Schlussfolgerungen und klinische Relevanz: Ein weiterer Ausbau des bisherigen Systems mit einem verbesserten Rückfluss von Informationen an den Tierbesitzer und Tierarzt sowie aktuellen Informationen zu den kongenitalen Anomalien erscheint angebracht und erfolgversprechend, um das Meldesystem zu verbessern und weiter zu verbreiten. Auf diese Weise können Ursachen für kongenitale Anomalien beim Rind besser aufgeklärt werden.

[Familial occurrence of a congenital defect of the keratinisation of the skin in German Angus calves]

Congenital dysfunction of the keratinisation of the epithelium was diagnosed in two female German Angus calves born on the same farm. The relationship coefficient between the two affected Angus calves was 34.38%. The clinical findings were similar to ichthyosis congenita as the alterations of the skin were present at birth and the levels of zinc in the blood were not decreased. However, parakeratosis could not be completely excluded as skin alterations were partly parakeratotic. On account of the close relationship between the two affected calves a genetic cause is likely for the present cases.

[Aphakia in a German Holstein calf]

Aphakia and further malformations of both eyes were diagnosed in a female German Holstein calf. Besides aphakia of the left eye, the calf exhibited microphthalmia, glaucoma and a hypoplastic uveoscleral tissue. Additional findings in the right eye were buphthalmus and glaucoma. Instead of aphakia, pathohistological and investigations revealed a very small (microphakia) and luxated lens. Neither the clinical nor the pathological examination revealed further malformations of other organs. A BVD infection could be excluded as cause for the ocular malformations observed. A deficiency or excess of vitamine A was unlikely because this would have also applied to all other calves born at the same time on the farm. An inbreeding coefficient of 3.168% for the malformed calf and the exclusion of environmental causes for these malformations of the eyes let us suppose a hereditary problem.

[Case report: Ectopia cordis in a German Holstein calf]

A case of ectopia cordis pectoralis was diagnosed in a black and white coloured German Holstein calf. The heart and pericard were displaced through a fissure in the breastbone. The heart was connected with the thoracic cavity by its large vessels. Besides of the ectopia cordis no other defects of the heart were noticed. The liver was deformed and many organs showed passive hyperaemia. The calf was well developed and died under birth. The lungs were not ventilated. The malformed calf was inbred on a bull used for artificial insemination with an inbreeding coefficient of 3.125%. The ectopia cordis probably resulted from the fissure of the breastbone.

[Case report: arhinia and cyclopia in a German Fleckvieh calf]

A German Fleckvieh calf was diagnosed with cyclopia in shape of united eye sockets in one orbit. However, two fully developed eye balls were present while the nostril was not developed. The malformed calf was inbred on a bull used for artificial insemination (AI) with an inbreeding coefficient of 3.125%. Teratogenic plant alkaloids were unlikely to be responsible for the malformation of this calf. Neither in the five progeny of the dam nor in the descendants of the AI-bull with a total of 8083 calvings, calves with such anomalies were found.

[Case report: congenital myoclonus in a German Holstein calf]

A female German Holstein calf was not able to stand up after birth. Resting the animal was lying in normal position and could lift its head. Sensory stimuli like auditory or tactile impulses induced myoclonic jerking of the whole body. Afterwards it calmed down quickly. The signs observed correspond to the clinical findings of congenital myoclonus in poll Hereford calves. The pathological examination revealed no indications for changes in organs. The inbreeding coefficient of the calf was 1.56 %. The present type of congenital myoclonus in the calf examined is likely to be genetically determined, even if the point mutation in exon 2 of the glycin receptor alpha 1 gene was not confirmed.

[Case report: an exceptional case of a monozygotic thoracopagus parasiticus in a German Holstein calf]

A black and white German Holstein calf displayed a complex double malformation in shape of a thoracopagus parasiticus. By means of a molecular genetic investigation the genesis of the malformation from one zygote could be demonstrated. Both vertebral columns showed a pronounced lordosis, with the vertebral column of one animal ending in a rudimentary head. Close to this rudiment two derivates of branchial arches were found. The two thoracic cavities merged into one "thorax". In the shared thoracic cavity one heart was found. In its right atrium, a cherry-sized structure was found in which heart- and vascular smooth muscles were demonstrated histologically. The aorta split shortly after its origin to provide both animals with one aorta each. The larger pair of lungs was connected with a trachea leading to the head while the smaller pair of lungs originated from a trachea deriving from the rudimentary head. The diaphragm jejunum and split afterwards. The pedigree of the affected animal showed neither inbreeding nor any other affected animal.

Studies on platelet aggregation using the Born method in normal and uraemic dogs

Using the Born method, based on light transmission in platelet rich plasma, the minimum effective concentration (threshold values) of several platelet agonists for inducing maximum platelet aggregation was determined in healthy dogs. The final concentrations of aggregation agonists were as follows: adenosine diphosphate (ADP) (0.5-50 micromol/L; n = 75 healthy dogs), collagen (0.5-20 mg/mL; n = 75), thrombin (0.1-5 IU/mL; n = 75), ristocetin (1-10 mg/mL; n = 10), and epinephrine (5-50 micromol/L; n = 10). Reference values for maximum aggregation with a lower limit of > 80% were achieved for agonist concentrations 25 micromol/L ADP (80-98%), > or = 10 microg/mL collagen (80-96%), and > or = 1 IU/mL thrombin (80-97%). None of the concentrations of epinephrine and ristocetin used in this study induced quantitative aggregation in the whole group of healthy dogs. We also studied platelet aggregation in 14 uraemic dogs using selected concentrations of aggregation agonists. Aggregation was significantly decreased in uraemic dogs using intermediate agonist concentrations, i.e., in the region of the threshold concentration. In contrast, maximum aggregation was increased in uraemic patients compared to reference values using low concentrations of all three agonists (ADP: 1 micromol/L, collagen: 1 microg/mL, and thrombin: 0.1, 0.2 IU/mL).

[Quality management in a combined clinic - the quality management system according to DIN EN ISO 9001 of the The German Association of Spa Accommodation Resorts e. V. (VdKB)]

The implementation of a quality system in health care organizations offers huge potentials for improvement and development. But the realization of such systems necessitates high investments, which small companies and family businesses often are unable to raise. The German Association of Spa Accommodation Resorts (VdKB) commissioned two consultants to develop a reasonably priced implementation concept of a DIN EN ISO 9001 quality system specially adjusted to small companies and family businesses in medical spa and rehabilitation services, which was successfully accredited in May 2003. This paper describes fundamental requirements in combine management systems, considers the pros and cons of management combines and demonstrates the practical realization of combine requirements on the example of the VdKB-combine system.

[Children in the drive for thinness. How early anorexia nervosa modifies development]

In adolescents and young women, the prevalence of anorexia nervosa is 0.5-1%. Approximately 5% of all anorectics are younger than 12 years of age. Frequent psychiatric concomitant conditions that develop during the long-term course are depression or dysthymia (in our own patient material approximately 14%) and anxiety (some 28%). In our own studies, healing success was achieved in 54% of the cases; 18% achieved partial remission with remnant symptoms of an unspecific eating disorder, and 28% continued to exhibit anorectic and/or bulimic symptoms. Of prognostic importance were eating disorders in the child's first year and the duration of the catamnesis. The prognosis of anorexia nervosa with onset in childhood does not appear to differ significantly from that of anorexia with onset in adolescence or adulthood.

Olanzapine in children and adolescents with chronic anorexia nervosa. A study of five cases

Psychopathology in severely anorexic patients often seems to be of compulsive and delusional quality rendering therapeutic approaches extremely difficult. With conventional therapeutic regimes failing, administration of the novel antipsychotic olanzapine induced remarkable improvement in five cases reported here. Paranoid ideation concerning body image or weight gain decreased and sedative effects helped to reduce inner tensions and phobia with respect to food intake. Olanzapine, therefore, might represent an important therapeutic tool in anorexic patients who present the following characteristics: long-term history of anorexia nervosa mostly with several hospitalisations, missing perception of their severe state of illness, refusal of therapy, delusional quality of anorexic thinking, risk of discontinuation of therapy with life-threatening consequences.

Unterschiede zwischen jugendlichen Patientinnen mit Anorexia und Bulimia nervosa im Hinblick auf psychologische und psychosoziale Merkmale

Zusammenfassung: Fragestellung: Die Studie widmet sich der Frage, inwieweit sich jugendliche Patientinnen mit Anorexia und Bulimia nervosa in psychologischen Merkmalen und Lebensverhältnissen unterscheiden. Methode: Die Krankengeschichten von 140 Patientinnen (110 mit Anorexia nervosa und 30 mit Bulimia nervosa), die in den Jahren 1982 bis 1992 in der Klinik für Kinder- und Jugendpsychiatrie der Universität Würzburg stationär behandelt wurden, wurden im Rahmen einer retrospektiven Studie ausgewertet. Alle Patientinnen erfüllen die Kriterien nach ICD-10 für Anorexia- oder Bulimia nervosa. Daten aus der Basis-Dokumentation und aus der multiaxialen Klassifikation (MAS) wurden herangezogen, standardisierte Verfahren wie der Anis-32, MMPI, BDI, HAWIK-R und HAWIE kamen zur Auswertung. Die Ergebnisse zeigen signifikante Unterschiede zwischen den beiden Stichproben. Das häufigste Alter bei erster stationärer Aufnahme war bei anorektischen Patientinnen 14,5 und bei bulimischen Patientinnen 16,5 Jahre. Die störungsspezifischen Symptome betreffend unterschieden sich die beiden Stichproben hinsichtlich ihres Essverhaltens im Faktor Bulimie des Anis-32. Beim Vergleich der Persönlichkeitsmerkmale beschrieben sich die anorektischen Patientinnen im MMPI weniger psychopathisch als die Bulimia nervosa Patientinnen. Im BDI war die depressive Symptomatik bei Anorexia nervosa als klinisch relevant einzustufen. Andere Charakteristika der anorektischen Patientinnen waren ein überdurchschnittlicher IQ, Überfürsorglichkeit innerhalb der familiären Beziehungen, vermehrte Trennungsängste und Kontaktstörungen in der Schule. Im Vergleich dazu zeigten die bulimischen Patientinnen häufiger Leistungs- und Disziplinierungsschwierigkeiten in der Schule, innerhalb der Familie wurde das Kontaktverhalten und die Kommunikation beeinträchtigter als bei Familien anorektischer Patientinnen erlebt.

[Differences between adolescent patients with anorexia and bulimia nervosa with reference to psychological and psychosocial markers]

OBJECTIVES

We present a retrospective study of 140 patients (110 with anorexia nervosa, 30 with bulimia nervosa), hospitalized between 1982-1992 at the Department of Child and Adolescent Psychiatry at the University of Wuerzburg, Germany.

METHODS

All patients met the ICD-10 criteria for anorexia nervosa or bulimia nervosa. We collected data from basic documentation and the multiaxial classification (MAS), using a variety of standard instruments such as Anis 32, MMPI, BDI, HAWIK-R and HAWIE.

RESULTS

Our findings show significant differences between the two populations. At the time of their first admission anorectic patients were somewhat younger than their bulimic counterparts (14.5 years vs. 16.5 years, respectively). With regard to the typical symptoms of either disorder, the two populations differ in their eating behavior on the factor bulimia described by Anis-32. A comparison of personality features reveals that anorectic patients scored lower than bulimic patients on the MMPI scales, especially on psychopathology, but higher on depression in the BDI. Other characteristics of anorectic patients include a higher-than-average IQ, more enmeshment and overprotectiveness in family relations, more separation anxiety and insufficient communication skills at school. By contrast, bulimic patients demonstrated poorer scholastic performance and more discipline problems at school, while communication among family members was impaired.

Human dendritic cells transfected with either RNA or DNA encoding influenza matrix protein M1 differ in their ability to stimulate cytotoxic T lymphocytes

The use of tumor antigen loaded dendritic cells (DC) is one of the most promising approaches to induce a tumor specific immune response in vivo. Several strategies have been designed to load DC with tumor antigens. In this study, we investigated the delivery of in vitro transcribed RNA and plasmid DNA into monocyte-derived, ie non-proliferating human DC, using several nonviral transfection methods including electroporation and lipofection. Green fluorescent protein (GFP) was used as a reporter gene and influenza matrix protein 1 (M1) as a model antigen for HLA class I restricted antigen presentation. Using electroporation in combination with DNA or with RNA, up to 11% of DC were GFP-positive. Using liposomes as a vehicle for DNA transport up to 10% of the DC were GFP-positive. A significant increase in transfection efficacy, of up to 20%, was observed when GFP RNA was used in combination with liposomes. Importantly, the RNA transfected DC retained their typical morphological and immunophenotypical characteristics. In addition, DC transfected with M1 RNA were able to stimulate autologous peripheral M1-specific memory cytotoxic T lymphocytes (CTL), as well as M1-specific CTL clones. Furthermore, comparison of DNA-transfected DC with RNA-transfected DC revealed the latter to be far better stimulators of antigen-specific T cells. This RNA transfection technique consequently represents a very promising tool for future immunotherapy strategies.

Synthesis of novel cationic poly(ethylene glycol) containing lipids

In this paper, the synthesis of novel divalent cationic lipids with poly(ethylene glycol) segments is described. The lipids consist of an unsaturated double-chain hydrophobic moiety based on 3, 4-dihydroxy benzoic acid, attached to a hydrophilic poly(ethylene glycol) spacer which contains a divalent cationic end group. As poly(ethylene glycol) spacers monodisperse triethylene glycol and telechelic poly(ethylene glycol)s with an average degree of polymerization of 9, 23, and 45 were used. The divalent cationic end group was attached by coupling a protected dibasic amino acid to the PEG spacer and following cleavage of the protecting groups. These novel class of cationic lipids is of particular interest for nonviral gene delivery applications.

[Follow-up and treatment outcome of early anorexia nervosa]

In a two-center follow-up study on the early-onset form of anorexia nervosa, we reexamined 43 (74%) of 58 former patients who had developed anorexia nervosa at the age of 13 years or younger. In addition to make a standardized assessment of the eating disorder at follow-up we assessed psychiatric comorbidity with a structured interview based on the criteria of DSM-III-R and ICD-10. After an average follow-up period of 6.8 years, 8 (18%) of our former patients had an eating disorder not otherwise specified (EDNOS) and 4 (9%) still suffered from anorexia nervosa. 5 (11%) of the subjects had developed bulimia nervosa. In 3 cases (7%) we found both syndromes. 12 (28%) of our former patients had an additional psychiatric disorder. The results of our study indicate that the quality of outcome in patients with an early-onset form of anorexia nervosa does not differ from that in individuals with a later manifestation of the eating disorder. Factors of prognostic relevance were the existence of an eating disorder during the first year of life and the duration of the follow-up period.

Physiological effects of nitrogen starvation in an anaerobic batch culture of Saccharomyces cerevisiae

The effects of nitrogen starvation on the anaerobic physiology of Saccharomyces cerevisiae were studied in cells cultivated in a bioreactor. The composition of the mineral medium was designed such that the nitrogen source became depleted while there was still ample glucose left in the medium. The culture was characterized by acoustic gas analysis, flow injection analysis and HPLC analysis of extracellular substrates and metabolites. During the cultivation, the macromolecular composition of the cells was analysed with respect to the cellular content of RNA, protein, trehalose and glycogen. During exponential growth under anaerobic conditions, the maximum specific growth rate conditions. Depletion of ammonium in the medium led to an abrupt decrease (mumax) of S. cerevisiae CBS 8066 (0.46 h-1) was identical to the mumax determined under aerobic in the flux through glycolysis. Subsequently, a continuous decrease in the carbon dioxide evolution rate, caused by catabolite inactivation of the hexose-transport system, was observed. The apparent half-life of the transport system under nitrogen starvation was 13 h. During the exponential growth phase, the cellular content of RNA and protein was 15% (w/w) and 60% (w/w), respectively. At the end of the cultivation where the cells had been starved of nitrogen for 18 h, the cellular content of RNA and protein had decreased to 4% (w/w) and 22% (w/w), respectively. The intracellular carbohydrate content increased dramatically as trehalose and glycogen accumulated to final concentrations of 7% (w/w) and 25% (w/w), respectively. Glycerol formation during nitrogen starvation was higher than that accounted for by the formation of organic acids, suggesting a protein turnover of approximately 6% h-1. The growth energetics of S. cerevisiae CBS 8066 also changed as a result of nitrogen starvation, and YxATP was observed to increase from 80 mmol g-1 during the exponential growth phase to more than 130 mmol g-1 towards the end of the cultivation. The presented results illustrate the effect of nitrogen starvation on glycerol formation, protein turnover, catabolite inactivation of the sugar-transport system, the cellular composition, the cell cycle and growth energetics.

Dynamics of ammonia uptake in nitrogen limited anaerobic cultures of Saccharomyces cerevisiae

Dynamics of the ammonia uptake by Saccharomyces cerevisiae under anaerobic conditions was studied in ammonia limited continuous cultures. A large number of pulse additions of ammonia (25-100 mg 1(-1)) were made at different dilution rates (0.05-0.20 h-1). The response was followed by on-line monitoring of the carbon dioxide evolution rate (CER), optical density, and by frequent analysis of extra- and intracellular metabolites. The uptake of a pulse of ammonia proceeded in a qualitatively highly reproducible pattern. Initially, a rapid and growth rate dependent uptake of ammonia was observed (lasting for about 10-15 min). Next followed a phase with little uptake (approx. 5 min). Finally, the rest of the ammonia pulse was taken up at a somewhat smaller rate which also depended on the growth rate. The first phase coincided with an increase in CER caused by mobilization of the intracellular carbohydrate trehalose and subsequently of glycogen. Regardless of dilution rate and the amount of ammonia added, the initial high uptake rate of ammonia was maintained until approximately the same amount of ammonia had been taken up. Transition from the first to the second uptake phase was associated with an increased glycerol production, indicating an elevated anabolic activity.

Determination of intracellular trehalose and glycogen in Saccharomyces cerevisiae

A simple, sensitive and nonlaborious enzyme-based method has been developed for determination of both trehalose and glycogen in yeast cells. The method is based on extraction of trehalose and glycogen into a 40 mM acetate buffer (pH 4.8) by mechanical disintegration of the cells in a bead mill. Subsequently, trehalose and glycogen can be hydrolyzed to glucose by the enzymes trehalase and amyloglycosidase, respectively. The formed glucose is quantified by a flow injection analyzer based on the enzyme glucose oxidase. The method gives results comparable to traditional methods but the simplicity of the analysis results in a much lower relative standard deviation. The excellent sensitivity of the glucose analyzer means that as little as 1 microgram trehalose or glycogen can be determined which reduces the required sample volume. This makes the method ideal for physiological studies, e.g., of transients in continuous cultures of Saccharomyces cerevisiae. In addition, a consistent procedure has been derived for pretreatment and storage of samples.

[Possibilities for increasing the elimination rate of Bonnecor]

Bonnecor is excreted in rats both via urine (3/4) and bile (1/4). It was the aim of this study to find out suitable methods for detoxication of a poisoning with this antiarrhytmic drug. In vivo methods intended to enhance the renal excretion of Bonnecor (forced diuresis, changes in urinary pH-values, peritoneal dialysis) are not qualified for therapeutically relevant increase of Bonnecor elimination. Relating to this Bonnecor is quite comparable with other antiarrhythmic drugs or dibenzazepine derivatives. The hemoperfusion can be recommended for the therapy of a Bonnecor overdosage as a propping up of symptomatic methods of intensive care, which are precendentally indicated. Therefore the therapy of a Bonnecor poisoning seems to be more promising compared to intoxications with other antiarrhythmics. Among the adsorbents tested, the resin Wofatit UH91 is most suitable to remove Bonnecor from the organism. If hemoperfusion equipments are not available, hemodialysis can also be used for acceleration of Bonnecor elimination, although its effectivity is only one third of that of hemoperfusion.