Perceived Physical Health and Cognitive Behavioral Therapy vs Supportive Psychotherapy Outcomes in Adults With Late-Life Depression: A Secondary Analysis of a Randomized Clinical Trial

Importance

Physical diseases co-occur with late-life depression (LLD). The influence of physical diseases and the subjective perception of physical health (PPH) on treatment outcome in LLD, however, is not well understood.

Objective

To assess the association of physical diseases and PPH with the outcomes of 2 different types of psychotherapy in LLD.

Design, Setting, and Participants

This post hoc secondary analysis of a multicenter, observer-blinded, controlled, parallel-group randomized clinical trial assessed participants 60 years or older with moderate to severe depression recruited at 7 psychiatric-psychotherapeutic outpatient trial sites in Germany from October 1, 2018, to November 11, 2020. Data analysis was performed from April 1 to October 31, 2023.

Interventions

Patients received LLD-specific cognitive behavioral therapy (LLD-CBT) or supportive unspecific intervention (SUI).

Main Outcomes and Measures

Depression severity, response, and remission were measured during treatment and at 6-month follow-up by the change in the 30-item Geriatric Depression Scale (GDS) score. Physical health and PPH were assessed by the number of physical diseases, Charlson Comorbidity Index (CCI), and the World Health Organization Quality of Life Brief Version physical health subscale.

Results

A total of 251 patients were randomized to LLD-CBT (n = 126) or SUI (n = 125), of whom 229 (mean [SD] age, 70.2 [7.1] years; 151 [66%] female) were included in the intention-to-treat analysis. Patients with low and moderate PPH at baseline had significantly less reduction in the GDS score across both treatment groups than patients with high PPH (estimated marginal mean difference [EMMD], 2.67; 95% CI, 0.37-4.97; P = .02 for low PPH and EMMD, 1.82; 95% CI, 0.22-3.42; P = .03 for moderate vs high PPH). Higher PPH at baseline was associated with higher likelihood of response (odds ratio [OR], 1.04; 95% CI, 1.00-1.06; P = .009) and remission at the end of treatment (OR, 1.04; 95% CI, 1.02-1.08; P = .002) and response (OR, 1.05; 95% CI, 1.02-1.08; P < .001) and remission at follow-up (OR, 1.06; 95% CI, 1.03-1.10; P < .001) across both treatment groups. However, a significant interaction of PPH with treatment group was observed with low PPH at baseline being associated with significantly larger reduction in GDS scores in SUI compared with LLD-CBT at the end of treatment (EMMD, -6.48; 95% CI, -11.31 to -1.64; P = .009) and follow-up (EMMD, -6.49; 95% CI, -11.51 to -1.47; P = .01). In contrast, patients with high PPH at baseline had a significantly greater reduction in GDS scores in LLD-CBT compared with SUI at all time points (week 5: EMMD, -4.08; 95% CI, -6.49 to -1.67; P = .001; end-of-treatment: EMMD, -3.67; 95% CI, -6.72 to -0.61; P = .02; and follow-up: EMMD, -3.57; 95% CI, -6.63 to -0.51; P = .02). The number of physical diseases or CCI at baseline did not have an effect on the change in GDS score, response, or remission, neither across both groups nor within either group.

Conclusions and Relevance

In this secondary analysis of a randomized clinical trial, subjective PPH was associated with treatment outcome, response, and remission in psychotherapy of LLD. Patients with LLD responded differently to LLD-CBT and SUI, depending on their baseline PPH score. Treatment approaches for patients with LLD should address PPH in personalized interventions.

Trial Registration

ClinicalTrials.gov Identifier: NCT03735576; Deutsches Register Klinischer Studien Identifier: DRKS00013769.

Expanded nursing roles to promote person-centred care for people with cognitive impairment in acute care (ENROLE-acute): study protocol for a controlled clinical trial, process and economic evaluation

BACKGROUND

For people with cognitive impairment, hospitalisation is challenging and associated with adverse events as well as negative outcomes resulting in a prolonged hospital stay. Person-centred care can improve the quality of care and the experience of people with cognitive impairment during hospitalisation. However, current care processes in German hospitals are rarely person-centred. To enable successful implementation of person-centred care on hospital wards, change agents within the interprofessional team are key. The aim of this study is to test the feasibility and initial effects of a newly developed complex person-centred care intervention for people with cognitive impairment provided by expanded practice nurses in acute care.

METHODS

We will conduct an exploratory non-randomised controlled clinical trial with accompanying process and cost evaluation with three intervention and three control wards at one university hospital. The person-centred care intervention consists of 14 components reflecting the activities of expanded practice nurses within the interprofessional team on the intervention wards. The intervention will be implemented over a six-month period and compared with optimised care on the control wards. We will include people aged 65 years and older with existing cognitive impairment and/or at risk of delirium. The estimated sample size is 720 participants. The primary outcome is length of hospital stay. Secondary outcomes include prevalence of delirium, prevalence of agitation, sleep quality, and person-centred care. We will collect patient level data at six time points (t1 admission, t2 day 3, t3 day 7, t4 day 14, t5 discharge, t6 30 days after discharge). For secondary outcomes at staff level, we will collect data before and after the intervention period. The process evaluation will examine degree and quality of implementation, mechanisms of change, and the context of the complex intervention. The economic evaluation will focus on costs from the hospital's perspective.

DISCUSSION

The ENROLE-acute study will provide insights into the effectiveness and underlying processes of a person-centred care intervention for people with cognitive impairment provided by expanded practice nurses on acute hospitals wards. Results may contribute to intervention refinement and evidence-based decision making.

TRIAL REGISTRATION

Current controlled trials: ISRCTN81391868. Date of registration: 12/06/2023. URL: https://doi.org/10.1186/ISRCTN81391868.

Cognitive Behavioral Therapy for Late-Life Depression (CBTlate): Results of a Multicenter, Randomized, Observer-Blinded, Controlled Trial

INTRODUCTION

Different psychotherapeutic interventions for late-life depression (LLD) have been proposed, but their evaluation in large, multicenter trials is rare.

OBJECTIVE

The present study evaluated the efficacy of a specific cognitive behavioral therapy (CBT) for LLD (LLD-CBT) in comparison with a supportive unspecific intervention (SUI), both administered in a specialist psychiatric outpatient setting.

METHODS

In this randomized, controlled, parallel group trial, we recruited participants (≥60 years) with moderate to severe depression at 7 trial sites in Germany. Participants were randomly assigned to the LLD-CBT or SUI group. The primary outcome was depression severity at the end of treatment measured by change on the Geriatric Depression Scale (GDS). Secondary outcomes included change in observer-rated depression, anxiety, sleep ratings, and quality of life throughout the treatment phase and at 6-month follow-up.

RESULTS

Between October 1, 2018, and November 11, 2020, we randomly assigned 251 patients to either LLD-CBT (n = 126) or SUI (n = 125), of whom 229 provided primary-outcome data. There was no significant between-group difference in the change in GDS scores at the end of treatment (estimated marginal mean difference: -1.01 [95% CI: -2.88 to 0.86]; p = 0.287). Secondary analyses showed significant improvements in several outcomes after 8 weeks and at follow-up in both treatment arms.

CONCLUSIONS

Our data suggest that LLD-specific CBT and a supportive unspecific treatment both provide clinical benefit in patients with moderate to severe LLD without evidence for superiority of LLD-CBT.

18F-Fluorcholine-PET/CT for localizing hyperfunctioning parathyroid glands and optimizing surgical treatment in patients with hyperparathyroidism

Objective

Hyperparathyroidism (HPT) is a common endocrine disorder. Definitive cure can only be reached by surgical removal of all diseased glands. The surgical strategy and management continue to evolve. Exact preoperative localization of hyperfunctioning glands is of paramount importance to prevent unnecessary surgical exploration. Unfortunately, the number of false negative or inconclusive results in standard imaging techniques is rather high. The aim of this study is to evaluate the diagnostic accuracy of 18F-Fluorcholine-PET/CT (FCH-PET/CT) and its sensitivity in a large cohort of patients with primary as well as secondary/tertiary and familial HPT with negative and/or discordant findings in ultrasound and/or 99mTc-sestamibi scintigraphy/SPECT/CT.

Methods

Between 2015 and 2020 96 patients with HPT and negative/equivocal conventional imaging were referred for FCH-PET/CT. 69 patients who have undergone surgery and histopathologic workup were analyzed in this retrospective single institution study. 60 patients suffered from primary HPT, 4 from secondary or tertiary HPT and 5 from familial HPT. Sensitivities, positive predictive values, and accuracies were calculated.

Results

All patients showed normalized serum calcium levels in the direct postoperative period.

50 of 60 patients (8 results are awaited) with primary HPT and 4 of 4 patients with secondary/tertiary HPT showed normal calcium levels after 6 months and were cured. 4 of 5 patients with familial HPT were cured as well while 1 patient deceased before 6 month follow up. Sensitivity per lesion for primary HPT was 88%, for secondary/tertiary HPT 75% and for familial HPT 75%, respectively. Sensitivity per patient was 92% for primary HPT, 100% for secondary/tertiary HPT and 50% for familial HPT, respectively. Positive predictive value was 98% in primary HPT and 100% in secondary/tertiary HPT and 100% in familial HPT as well.

Conclusion

Diagnostic accuracy of 18F-Fluorcholine-PET/CT for patients with primary as well as secondary/tertiary and familial hyperparathyreoidism ist excellent . 18F-Fluorcholine-PET/CT is a valuable tool for endocrine surgeons to optimize the surgical treatment of patients with hyperparathyroidism.

High inter-observer reliability in standardized ultrasound measurements of subcutaneous adipose tissue in children aged three to six years

BACKGROUND

A procedure to measure subcutaneous adipose (SAT) using brightness-mode ultrasound has recently been standardized and applied to various groups of adults including underweight, overweight and obese adults. High reliability of this procedure was found in each of the examined groups. The purpose of this study was to determine inter-observer reliability of the standardized brightness-mode ultrasound measurement of uncompressed SAT in three to six-year-old children.

METHODS

Three experienced observers independently captured the ultrasound images at the eight standardized measurement sites in each of the 20 children and evaluated their images using an interactive software that detects the SAT contour and automatically measures multiple thicknesses in each image; the mean of these represents SAT thickness at a given site. The children were aged 4.9 ± 1.0 years; their body mass index ranged from 13.6-17.7 kgm- 2. Sound speed was set to 1450 ms- 1 for SAT.

RESULTS

SAT thickness sums with fibrous structures included (DI) ranged from 25.7-86.4 mm, mean DI was 48.1 ± 15.5 mm. For DI, resulting from 160 measurements by each observer, the intra-class correlation coefficient was 0.998 (95% confidence interval 0.980-0.999), standard error of the estimate was 1.1 mm, and 95% limits of agreement were within ±2.1 mm. The median difference in DI was 0.8 mm, i.e. about 1.9% of mean DI.

CONCLUSIONS

Inter-observer results in children are comparable to previously described high reliability in adults. This method, which provides a technical thickness measurement accuracy of about 0.1 to 0.2 mm, enables monitoring of subcutaneous adipose tissue in children with a similarly high reliability as was obtained in adults previously.

TRIAL REGISTRATION

German Institute of Medical Documentation and Information, German Clinical Trials Register (DRKS) ID: DRKS00010089; Date 24/02/2016.

IUPAC Collaborative Trial Study of a Method To Detect Genetically Modified Soy Beans and Maize in Dried Powder

This paper presents results of a collaborative trial study (IUPAC project No. 650/93/97) involving 29 laboratories in 13 countries applying a method for detecting genetically modified organisms (GMOs) in food. The method is based on using the polymerase chain reaction to determine the 35S promoter and the NOS terminator for detection of GMOs. Reference materials were produced that were derived from genetically modified soy beans and maize. Correct identification of samples containing 2% GMOs is achievable for both soy beans and maize. For samples containing 0.5% genetically modified soy beans, analysis of the 35S promoter resulted also in a 100% correct classification. However, 3 false-negative results (out of 105 samples analyzed) were reported for analysis of the NOS terminator, which is due to the lower sensitivity of this method. Because of the bigger genomic DNA of maize, the probability of encountering false-negative results for samples containing 0.5% GMOs is greater for maize than for soy beans. For blank samples (0% GMO), only 2 false-positive results for soy beans and one for maize were reported. These results appeared as very weak signals and were most probably due to contamination of laboratory equipment.

On-Line Hemodiafiltration with Pre- and Postdilution: A Comparison of Efficacy

Since the introduction of on-line substituate preparation, high substituate rates (Qs) in pre- and postdilution for hemodiafiltration (HDF) procedures can be realized. During postdilution HDF (POD-HDF) and additional convective removal is possible, but in vivo Qs is limited to approx. 1/3Qb (bloodflow). With predilution HDF (PRD-HDF) higher Qs and therefore high convective transport rates by ultrafiltration can be reached. On the other hand the blood concentration is diminished by predilution. Further decrease of the diffusive transport is caused by reduced dialysate flow Qd due to separation of the substituate from the dialysate (Fresenius 4008 On-Line HDF, Gambro AK100 Ultra). The theoretical description of the combined diffusive-convective transport is limited to 1-dimensional models and small UF-rates. Therefore for practical and theoretical purposes the assessment of the efficacy of on-line PRD-HDF and POD-HDF in different molecular weight ranges is desirable. By means of in vitro experiments the effective clearances Keff of hemodialysis (HD, dialyzer: Fresenius F60) for urea, creatinine, vitamin B12 and inulin were compared with measured and theoretical Keff of POD- and PRD-HDF. The theoretical expectation is confirmed that Keff for small molecular weight substances decreases slightly with PRD-HDF and increases for larger molecules. In the case of POD-HDF Keff for small molecular weight substances increases slightly and strongly for larger molecules. In vivo experiments were performed to measure the real substance removal from patient's blood and to figure out the impact of dialysate flow (collection of the used dialysate during the 1. treatment hour and concentration measurements for urea, creatinine, phosphate, ß2-MG). The results show that the substraction of Qs from Qd reduces Keff for urea, creatinine and phosphate but not for ß2-MG. PRD-HDF with Qd = 500 ml/min is significantly less effective for small molecules than HD. There is no significant difference of Keff for urea, creatinine, phosphate during HD and PRD-HDF with Qd = 800 ml/min, but a significant increase of 10-15% for POD-HDF Keff for ß2-MG increases by 75% for PRD-HDF and 95% for POD-HDF compared with HD (Qd = 500 ml/min).

High-Frequency Oscillatory Ventilation and Nitric Oxide: Alternative or Complementary to ECMO

One hundred and seventy-seven term or near-term neonates were referred to an ECMO center for severe PPHN-associated diseases. In 2 time periods from 1987 to 1991 and from 1992 to April 1995 alternative treatment modes were tried in an attempt to obviate ECMO. During the first time period patients underwent trial high-frequency oscillatory ventilation before ECMO. In the second time period patients first received inhaled NO followed by HFOV in a non-responders. If this also failed HFOV was combined with I NO. In both time periods about 40% of the patients were spared ECMO treatment by these alternative treatment modalities. I NO only benefited 15% of the ECMO candidates who apparently had fared just as well on HFOV alone in the preceding time period. While patients who were improved by I NO were spared HFOV with its potential severe complications, i.e. air leaks and cardiocirculatory instability, more extended long-term studies will have to show which of these 2 treatment modalities (INO or HFOV) should be given first priority in an attempt to avoid ECMO in neonates with severe respiratory failure.

Vorkommen von Ehrlichia canis bei Hunden in Deutschland?

Gegenstand und Ziel: Retrospektive Untersuchung von Hunden auf eine autochthone Infektion mit E. canis in Deutschland. Material und Methode: In die Studie gingen 111 Hunde ein, die sich in eine symptomatische (n = 49) und eine asymptomatische (n = 62) Gruppe unterteilten. Bei allen Hunden erfolgten eine Antikörperbestimmung gegen Ehrlichia canis mittels Immunfluoreszenztest im Serum und ein Direktnachweis von Ehrlichia und Anaplasma spp. mittels PCR aus EDTA-Vollblut. Ausschlusskriterien waren ein Auslandsaufenthalt sowie die Vorbehandlung mit Tetrazyklinen, Chloramphenicol oder Imidocarb. Ergebnisse: Niedrige IFT-Antikörpertiter gegen E. canis konnten bei sieben Hunden (6,3%) festgestellt werden. Sechs Hunde gehörten der symptomatischen und ein Hund der asymptomatischen Gruppe an. Gleichzeitig wurden bei vier dieser Hunde sehr hohe und bei einem ein moderater Antikörpertiter gegen Anaplasma phagocytophilum gefunden. Das PCR-Screening für Ehrlichia und Anaplasma war lediglich in zwei Fällen positiv. Beide Male ließ sich A. phagocytophilum nachweisen. Schlussfolgerungen: Nur bei zwei für E. canis seropositiven Hunden konnten keine Kreuzreaktionen mit A. phagocytophilum nachgewiesen werden. Da ein Direktnachweis bei diesen zwei Hunden nicht möglich war, ist eine tatsächliche Infektion mit E. canis fraglich. Die Gefahr der autochthonen Infektion von Hunden mit E. canis in Deutschland scheint somit gering zu sein, ist aber nicht ausgeschlossen. Klinische Relevanz: Bei unspezifischen Symptomen wie Apathie, Fieber und Inappetenz sowie Laborveränderungen in Form von Anämie und/oder Thrombozytopenie sollte deshalb auch bei Hunden, die Deutschland nicht verlassen haben, an eine Infektion mit E. canis gedacht werden.

Biogas purification with biomass ash

The aim of the study was to investigate the option to purify biogas from small-scale biogas plants by entrapping CO₂ and H₂S with regionally available biomass ash. Connected to the existing biogas plant Neustift (Tyrol) wood ash placed in a 1 m³ container was used as a trap for CO₂ and H₂S in the biogas. With the process conditions chosen, for a period of a few hours CO₂ was trapped resulting in pure methane. The removal of H₂S was much longer-lasting (up to 34 d). The cumulative H₂S uptake by the biomass ash ranged from 0.56 to 1.25 kg H₂S per ton of ash. The pH of the ash and the leachability of Lead and Barium were reduced by the flushing with biogas, however toxicity towards plants was increased thus reducing the potential of ash use in agriculture. It can be concluded that biomass ash may be used for removal of hydrogen sulphide from biogas in small and medium biogas plants. The economic evaluation, however, indicated that the application of this system is limited by transport distances for the ash and its potential use afterwards.

Ergebnisse nach Endoskopischer Subfaszialer Insufflations-Dissektion der Perforansvenen (ESIDP)

Ziel: Die »Endoskopische Subfasziale Insufflations- Dissektion der Perforansvenen« (ESIDP) ist eine minimal- invasive chirurgische Methode zur Behandlung der Varikosis. Wir berichten über unsere Erfahrungen mit ESIDP. Methoden: Die für die Durchtrennung der Perforansvenen notwendige Entfaltung des subfaszialen Raumes erzielten wir mittels CO2-Insufflation (Pneumocavum subfasciale). Die präoperative Diagnostik (Lokalisation insuffizienter Perforans- und oberflächlicher Venen; Beurteilung der tiefen Beinvenen) erfolgte ausschließlich mittels farbkodierter Duplexsonographie. Ergebnisse: Die ESIDP wurde 150-mal bei 125 Patienten durchgeführt und in 117 Fällen (78%) mit Segmentstripping der Vena saphena magna und Phlebektomie, in 8 Fällen (5,4%) mit komplettem Stripping der Vena saphena magna und Phlebektomie, in 20 Fällen (12,6%) nur mit Phlebektomie und in 5 Fällen (4%) mit atypischem Stripping kombiniert. Wir beobachteten keine intraoperative und 13 postoperative Komplikationen: infiziertes Hämatom (n = 1), Thrombose (n = 1), Parästhesien (n = 9) und Schmerzen bis zu 6 Wochen postoperativ (n = 2). Schlussfolgerung: Wegen ausgezeichneter Sichtverhältnisse und der Möglichkeit zur selektiven Durchtrennung aller in Frage kommenden Perforansvenen, auch unter Hautulzerationen, stellt die ESIDP eine sinnvolle, minimal-invasive Methode in der Therapie der Varikosis und der transfaszial bedingten CVI dar.

CD4+ Th2 cells are directly regulated by IL-10 during allergic airway inflammation

Interleukin-10 (IL-10) is an important regulatory cytokine required to control allergy and asthma. IL-10-mediated regulation of T cell-mediated responses was previously thought to occur indirectly via antigen-presenting cells. However, IL-10 can act directly on regulatory T cells and T helper type 17 (Th17) cells. In the context of allergy, it is therefore unclear whether IL-10 can directly regulate T helper type 2 (Th2) cells and whether this is an important regulatory axis during allergic responses. We sought to determine whether IL-10 signaling in CD4⁺ Th2 cells was an important mechanism of immune regulation during airway allergy. We demonstrate that IL-10 directly limits Th2 cell differentiation and survival in vitro and in vivo. Ablation of IL-10 signaling in Th2 cells led to enhanced Th2 cell survival and exacerbated pulmonary inflammation in a murine model of house dust mite allergy. Mechanistically, IL-10R signaling regulated the expression of several genes in Th2 cells, including granzyme B. Indeed, IL-10 increased granzyme B expression in Th2 cells and led to increased Th2 cell death, identifying an IL-10-regulated granzyme B axis in Th2 cells controlling Th2 cell survival. This study provides clear evidence that IL-10 exerts direct effects on Th2 cells, regulating the survival of Th2 cells and severity of Th2-mediated allergic airway inflammation.

Ligands with an NPNPN-framework and their application in chromium catalysed ethene tri-/tetramerization

Novel Cr(iii) catalysts supported by linear phosph(iii)azanes of the type R(1)R(2)N-P(Ph)-NR(3)-P(Ph)-NR(4)R(5) have been prepared, all of which, upon activation with MMAO-3A, are highly active for ethene tri-/tetramerization with considerable selectivity. The effect of ligand substitution as well as solvent on the catalytic performance has been examined.

North Atlantic storm track changes during the Last Glacial Maximum recorded by Alpine speleothems

The European Alps are an effective barrier for meridional moisture transport and are thus uniquely placed to record shifts in the North Atlantic storm track pattern associated with the waxing and waning of Late-Pleistocene Northern Hemisphere ice sheets. The lack of well-dated terrestrial proxy records spanning this time period, however, renders the reconstruction of past atmospheric patterns difficult. Here we present a precisely dated, continuous terrestrial record of meteoric precipitation in Europe between 30 and 14.7 ka. In contrast to present-day conditions, our speleothem data provide strong evidence for preferential advection of moisture from the South across the Alps supporting a southward shift of the storm track during the local Last Glacial Maximum (that is, 26.5–23.5 ka). Moreover, our age control indicates that this circulation pattern preceded the Northern Hemisphere precession maximum by ~3 ka, suggesting that obliquity may have played a considerable role in the Alpine ice aggradation.

Insights into Late-Pleistocene Northern Hemisphere storm track variability are hampered by a lack of well-dated proxy records. Here, the authors present a precisely dated record of meteoric precipitation between 30 and 14.7 ka, and show that obliquity may have played a vital role in Alpine glacier advance.

Notizen: Austausch von Nitrit- gegen Bromidanionen in Na3NO3 / Replacement of Nitrite by Bromide Anions in Na3NO3

Na3O(NO2) and Na3OBr are isostructural and form solid solutions with a miscibility gap χ = 0.28 to 0.62 as referred to Na3OBrx(NO2)1-x, at room temperature. Above 593 Κ formation of mixed crystals was observed for all compositions. In contrast to pure Na3O(NO2), the solid solutions do not undergo any phase transition in the investigated temperature range from 293 Κ to 130 K. These findings reveal that collective interactions between the dynamically disordered NO2 --groups are involved in the phase transitions of Na3NO3.

Constraints on spin-dependent short-range interaction between nucleons

We search for a spin-dependent P- and T-violating nucleon-nucleon interaction mediated by light pseudoscalar bosons such as axions or axionlike particles. We employ an ultrasensitive low-field magnetometer based on the detection of free precession of colocated 3He and 129Xe nuclear spins using SQUIDs as low-noise magnetic flux detectors. The precession frequency shift in the presence of an unpolarized mass was measured to determine the coupling of pseudoscalar particles to the spin of the bound neutron. For boson masses between 2 and 500  μeV (force ranges between 3×1(-4)  m and 10(-1)  m) we improved the laboratory upper bounds by up to 4 orders of magnitude.

The use of 5-aminolevulinic acid fluorescence guidance in resection of pediatric brain tumors

INTRODUCTION

Whereas in the adult population 5-Aminolevulinic acid (5-ALA) fluorescence guidance has been widely accepted for improving the extent of tumor resection, the application in children remains an off-label use. Even though most pediatric study protocols require a complete resection for improving outcome parameters, only few pediatric patients have been operated with fluorescence guidance, and it remains questionable, whether and which pediatric tumors show useful fluorescence. We present casuistic reports of application of 5-ALA in children collected from three different neurosurgical departments.

PATIENTS AND METHODS

In children with suspected malignant intracerebral tumor or recurrence, individual informed consent was obtained in each case from the parents. 5-ALA was administered according to the adult protocol, with 20 mg/kg, 2 h before induction of anesthesia. We retrospectively analyzed 18 patients (13 male, 5 female; age 3-18 years), using the intraoperative neurosurgical protocol, the postoperative MRI results, and the follow-up clinical examinations.

RESULTS

The use of 5-ALA fluorescence guidance proved to be safe in our group of pediatric patients. Fluorescence guidance was most useful for recurrent glioblastoma resection. Medulloblastoma tissue displayed fluorescence only inconsistently, and most pilocytic astrocytoma remained without staining. Ganglioglioma showed partial staining in the central tumor areas, without allowing the use for circumferent resection.

CONCLUSION

The off-label use of 5-ALA fluorescence guidance in pediatric patients appears to be most useful in recurrent high-grade gliomas. Fluorescence accumulation in other pediatric brain tumor entities is not predictable and should be evaluated in future clinical studies before being integrated into the current treatment protocols.

Site-specific immunophenotyping of keloid disease demonstrates immune upregulation and the presence of lymphoid aggregates

BACKGROUND

Keloid disease (KD) is a common fibroproliferative disorder of unknown aetiology. T cells and macrophages are increased in KD and are thought to contribute to its pathogenesis. However, while a link between inflammation and fibrotic disorders is well known for other disorders, it remains undetermined in KD.

OBJECTIVES

Systematically to immunophenotype the inflammatory infiltrate of KD in situ in a site-specific manner, and to compare this with normal skin and scar tissue.

METHODS

Sixty-eight keloid cases were screened for the presence of all three (intralesional, perilesional and extralesional) keloid-associated specific tissue sites. Subsequently, a complete set of 25 keloid biopsies (from different patients) was compared with normal skin (n = 11) and normal scar (n = 11) samples and subjected to systematic, site-specific quantitative immunohistomorphometry and histochemistry, using a range of immunological markers of B cells, T cells, macrophages, mast cells (MCs) and Langerhans cells.

RESULTS

T cells, B cells, degranulated and mature MCs (coexpressing OX40 ligand) and alternative macrophages (M2) were all significantly increased in intralesional and perilesional KD sites compared with normal skin and scar tissue (P < 0·05). Additionally, 10 of 68 KD cases (15%) showed the presence of distinctive lymphoid aggregates, which resembled mucosa-associated lymphoid tissue (MALT).

CONCLUSIONS

The increased number and activity of MCs and M2 may implicate inflammation in the fibrotic process in KD. The distinct KD-associated lymphoid aggregate resembles MALT, for which we propose the term 'keloid-associated lymphoid tissue' (KALT). It may perpetuate inflammatory stimuli that promote KD growth. KALT, MCs and M2 are promising novel targets for future KD therapy.

Effects of Alkaline Cations on Self-assembly of Cetylpyridinium Surfactants

Here we study the influence of alkaline cations on the self-assembly of cetylpyridinium chloride and cetylpyridinium nitrate. It is known that the anionic counterions have a strong influence on the solubility and self-assembly properties of cationic surfactants. However, in this paper we will show that monovalent cations have also an influence which is weaker but detectable. Scattering techniques (X-Ray, light) were used to obtain structural information about the aggregation as a function of the temperature and the ionic strength. The results are interpreted in terms of ion pair adsorption at the micellar interface, depending on the ionic strength.

Preterm twin and triplet pregnancies are at increased risk for the development of cystic periventricular leukomalacia

BACKGROUND

An increased risk of cerebral palsy in multiples has been reported.

AIMS

To determine the risk for the development of periventricular leukomalacia (PVL) of twin and triplet pregnancy.

STUDY DESIGN

Retrospective single-centre study at a tertiary care university hospital.

SUBJECTS

Infants ≤ 35 weeks gestational age born between 1988 and 2008.

OUTCOME MEASURES

Risk of twin and triplet compared to singleton pregnancy regarding development of PVL in one offspring.

RESULTS

Of 6195 infants 117 singletons and 39 multiples were diagnosed as having cystic PVL. Perinatal data did not differ as did not ultrasonographic findings and neurologic outcome. The relative risk (RR) of a twin pregnancy resulting in at least one infant with PVL when born prior to 36 weeks was 2.181 (CI 95% 1.474-3.228, p < .0001), and 6.793 (CI 95% 2.470-13.108, p < .0001) of a triplet pregnancy. In-vitro fertilisation was present in 3% of affected twins compared to 100% in triplets (p < .001).

CONCLUSION

We found an increased risk for PVL in preterm twin and triplet pregnancies.

Bedeutung der PCR in der Diagnostik der caninen Babesiose

Clinical standards to confirm babesiosis in dogs include the direct identification of the infectious agent in blood smears and serological assays for Babesia canis-specific antibodies. Here, we demonstrate in seven cases (with data on anamnesis, clinics, laboratory diagnostics, and therapeutic outcomes) that a new diagnostic procedure is required. This is the molecular-genetic identification of babesia by real time PCR allowing an unequivocal identification of the infectious agents. Indeed, all seven patients presenting severe clinical symptoms were PCR-positive, but only two of them had specific antibodies and showed babesia in their bloodstream. Six of the dogs appeared to have acquired babesiosis while travelling abroad, and one in the Swiss canton of Schaffhausen.

Rapid uptake and degradation of CXCL12 depend on CXCR7 carboxyl-terminal serine/threonine residues

CXCL12 signaling through G protein-coupled CXCR4 regulates cell migration during ontogenesis and disease states including cancer and inflammation. The second CXCL12-receptor CXCR7 modulates the CXCL12/CXCR4 pathway by acting as a CXCL12 scavenger and exerts G protein-independent functions. Given the distinct properties of CXCR4 and CXCR7, we hypothesized that the distinct C-terminal domains differently regulate receptor trafficking and stability. Here, we examined epitope-tagged wild type and C-terminal mutant receptors in human embryonic kidney cells (HEK293) with respect to trafficking, stability, (125)I-CXCL12 degradation, and G protein-coupling. The 24 CXCR7 C-terminal residues were sufficient to promote rapid spontaneous internalization. Replacement of the CXCR7 C terminus with that of CXCR4 (CXCR7-4tail mutant) abolished spontaneous internalization but permitted ligand-induced internalization and phosphorylation at the heterologous domain. The reverse tail-swap caused ligand-independent internalization of the resulting CXCR4-7tail mutant. Receptor-mediated (125)I-CXCL12 uptake and release of (125)I-CXCL12 degradation products were accelerated with receptors bearing the CXCR7 C terminus and impaired after conversion of CXCR7 C-terminal serine/threonine residues into alanines. C-terminal lysine residues were dispensable for plasma membrane targeting and the CXCL12 scavenger function but involved in constitutive degradation of CXCR7. Although the CXCR7 C terminus abolished G protein coupling in the CXCR4-7tail mutant, replacement of the CXCR7 C terminus, CXCR7 second intracellular loop, or both domains with the corresponding CXCR4 domain did not result in a G protein-coupled CXCR7 chimera. Taken together, we provide evidence that the CXCR7 C terminus influences the ligand-uptake/degradation rate, G protein coupling, and receptor stability. Regulatory pathways targeting CXCR7 C-terminal serine/threonine sites may control the CXCL12 scavenger activity of CXCR7.

Episodes of hypocarbia and early-onset sepsis are risk factors for cystic periventricular leukomalacia in the preterm infant

BACKGROUND

Septic episodes in preterm infants recently have been reported to be associated with periventricular leukomalacia (PVL). The role of hypocarbia as an independent risk factor for PVL in clinical studies raises many questions without conclusive answers.

AIMS

To evaluate risk factors for cystic PVL focussing on the influence of hypocarbia.

STUDY DESIGN

Retrospective single centre case-control study.

SUBJECTS

Preterm infants 24 to 35 weeks of gestational age and matched (1:2 for gender, birth year, gestational age and birth weight) controls.

OUTCOME MEASURES

Multivariate analysis of perinatal factors being associated with cystic PVL diagnosed by serial ultrasound examinations.

RESULTS

Univariate analysis of risk factors revealed lower 5 and 10 min Apgar scores, and higher rates of neonatal seizures, early-onset sepsis, neonatal steroids, respiratory distress syndrome with surfactant replacement therapy, and episodes of hypocarbia significantly being associated with PVL. Multivariate analysis using a logistic regression model revealed early-onset sepsis and hypocarbia being significantly associated with PVL (p=.022 and .024, respectively). Lowest PaCO(2) values did not differ as did not the duration of hypocarbia, but the onset of hypocarbia was significantly later in PVL cases compared to controls (mean 26 vs. 15 h, p=.033). Neurodevelopmental follow-up at a median time of 46 months was poor showing 88% of the cases having an adverse neurological outcome.

CONCLUSION

We found early-onset sepsis and episodes of hypocarbia within the first days of life being independently associated with PVL.

Real-time pulse length measurement of few-cycle laser pulses using above-threshold ionization

The pulse lengths of intense few-cycle (4-10 fs) laser pulses at 790 nm are determined in real-time using a stereographic above-threshold ionization (ATI) measurement of Xe, i.e. the same apparatus recently shown to provide a precise, real-time, every-single-shot, carrier-envelope phase measurement of ultrashort laser pulses. The pulse length is calibrated using spectral-phase interferometry for direct electric-field reconstruction (SPIDER) and roughly agrees with calculations done using quantitative rescattering theory (QRS). This stereo-ATI technique provides the information necessary to characterize the waveform of every pulse in a kHz pulse train, within the Gaussian pulse approximation, and relies upon no theoretical assumptions. Moreover, the real-time display is a highly effective tool for tuning and monitoring ultrashort pulse characteristics.

Transmission of cytomegalovirus via breast milk to the prematurely born infant: a systematic review

To analyse current data on transmission of human cytomegalovirus (HCMV) via breast milk with subsequent symptomatic HCMV infection of the preterm infant and to report on long-term follow-up, a systematic literature review was performed using EMBASE, MEDLINE and CINAHL (January 1966 to December 2008) Studies were included for analysis if congenital HCMV infection was excluded and transmission via breast milk was either confirmed or strongly suspected. Twenty-six studies were included for analysis. Maternal HCMV-IgG-positivity was reported to be in the range 51.6-100% (median 81.6%), HCMV-IgG detection in breast milk in the range 67-97.2% (median 80%) and HCMV-positivity of the infants in the range 5.7-58.6%. Symptomatic HCMV disease occurred in 0-34.5% (median 3.7%) and severe sepsis-like syndrome in 0-13.8% (median 0.7%). Data on long-term outcome of preterm infants with symptomatic HCMV infection revealed a low risk for mild neurological and cognitive sequelae, without hearing impairment. Recommendations for high-risk preterm infants diverged markedly. The current data report low rates of symptomatic disease after transmission of HCMV via breast milk to the preterm infant without evidence of certain long-term sequelae. The results of our review do not support a general approach, either by avoidance or pasteurization of breast milk, in high-risk preterm infants.