[Less is more in infectious diseases]. / Weniger ist mehr in der Infektiologie.

BACKGROUND: The increasing development of antimicrobial resistance has been identified as one of the greatest threats to public health and is caused to a relevant extent by falsely indicated antibiotic treatment. OBJECTIVE: The main aim of this article is to identify areas in infectious disease diagnostics and treatment where overuse occurs and to provide recommendations on how to avoid it. MATERIAL AND METHODS: The authors identified current and relevant studies on the topic of medical overuse in infectious diseases via a literature search. In particular, contributions from international "less is more" initiatives were included. The focus was on areas in which a reduction of diagnostic and therapeutic measures leads to an optimization of patient outcomes. RESULTS: In many cases overuse in the context of diagnostics and treatment of infectious diseases not only leads to an unnecessary financial burden on the healthcare system and is not beneficial but can also increase the risk of development of antimicrobial resistance and have adverse consequences for patients. CONCLUSION: Correct indications as well as focused selection and adequate application of antimicrobial agents is crucial to provide the best possible medical care. Diagnostic and antibiotic stewardship measures, which should be implemented in collaboration with infectious disease specialists, can help to identify and reduce areas of overuse and misuse.

Adipocytokines in Patients with Chronic Kidney Disease Stage 5.

BACKGROUND: Chronic kidney disease (CKD) leading to kidney failure and end stage renal disease (ESRD) is a common health problem associated with wasting syndrome characterized by inadequate nutrient intake and decrease tissue anabolism and/or catabolism. In CKD adipokines, especially leptin and adiponectin (ADPN), accumulate in serum due to reduced renal clearance. Although, rapidly growing, knowledge of adipocytokines is limited and much is still unknown of the altered adipocytokine pattern in patients with impaired renal function. The aim of this study is to assess the adipocytokines, leptin, and adiponectin in relation to weight loss in pediatric patients with CKD stage-5 treated conservatively (CT) or undergoing maintenance hemodialysis (MHD). METHODS: 41 CKD stage-5 patients and 20 healthy controls were included in this study. Serum levels of leptin and adiponectin were determined by ELISA. Leptin gene expression was analyzed using quantitative real time-polymerase chain reactions (QPCR). RESULTS: Patients had significantly elevated ADPN levels and non significantly elevated serum leptin levels as compared to controls (p < 0.001, p = 0.354, respectively). Leptin gene expression and body mass index (BMI) were highly significantly reduced in CKD stage-5 compared to controls (p < 0.001 for each). There were no significant differences between patients treated conservatively and those undergoing MHD with respect to all studied parameters. Finally, univariate logistic regression analysis revealed no association between leptin, ADPN, and weight loss in CKD stage-5 patients. CONCLUSIONS: The present study showed non significantly elevated or even normalized serum leptin levels, elevated serum adiponectin level and reduced leptin gene expression in CKD stage-5 patients as compared to healthy controls. Patients had significantly lower weight than healthy controls but there was no association between leptin, adiponectin, and weight loss in CKD stage-5 studied patients so, further studies are needed to clarify the role of the two adipokines in body weight loss in those patients.

Phenyl Saligenin Phosphate Induced Caspase-3 and c-Jun N-Terminal Kinase Activation in Cardiomyocyte-Like Cells.

At present, little is known about the effect(s) of organophosphorous compounds (OPs) on cardiomyocytes. In this study, we have investigated the effects of phenyl saligenin phosphate (PSP), two organophosphorothioate insecticides (diazinon and chlorpyrifos), and their acutely toxic metabolites (diazoxon and chlorpyrifos oxon) on mitotic and differentiated H9c2 cardiomyoblasts. OP-induced cytotoxicity was assessed by monitoring MTT reduction, LDH release, and caspase-3 activity. Cytotoxicity was not observed with diazinon, diazoxon, or chlorpyrifos oxon (48 h exposure; 200 µM). Chlorpyrifos-induced cytotoxicity was only evident at concentrations >100 µM. In marked contrast, PSP displayed pronounced cytotoxicity toward mitotic and differentiated H9c2 cells. PSP triggered the activation of JNK1/2 but not ERK1/2, p38 MAPK, or PKB, suggesting a role for this pro-apoptotic protein kinase in PSP-induced cell death. The JNK1/2 inhibitor SP 600125 attenuated PSP-induced caspase-3 and JNK1/2 activation, confirming the role of JNK1/2 in PSP-induced cytotoxicity. Fluorescently labeled PSP (dansylated PSP) was used to identify novel PSP binding proteins. Dansylated PSP displayed cytotoxicity toward differentiated H9c2 cells. 2D-gel electrophoresis profiles of cells treated with dansylated PSP (25 µM) were used to identify proteins fluorescently labeled with dansylated PSP. Proteomic analysis identified tropomyosin, heat shock protein ß-1, and nucleolar protein 58 as novel protein targets for PSP. In summary, PSP triggers cytotoxicity in differentiated H9c2 cardiomyoblasts via JNK1/2-mediated activation of caspase-3. Further studies are required to investigate whether the identified novel protein targets of PSP play a role in the cytotoxicity of this OP, which is usually associated with the development of OP-induced delayed neuropathy.

Electrical, optical, and electrochemical performances of phosphate-glasses-doped with ZnO and CuO and their composite with polyaniline.

Phosphate-based glasses (PBG) with appropriate doping agents have been used as solid electrolytes in solid-state ionic devices. Therefore, more light was shed on the electrical, optical, and electrochemical behavior of the phosphate-based glasses (PBG), containing ZnO or CuO in the absence and existence of conductive polyaniline (PANI), since no publications are available concerning this work. The glass samples were prepared by the rapid quenching method, then mixing phosphate glass and polyaniline (PANI) with metal oxide (ZnO, CuO). They were characterized by different techniques; diffuse reflectance spectrophotometer (DRS), broadband dielectric spectrometer (BDS), cyclic voltammetry (CV), and charge-discharge techniques. In the DRS study, the direct and indirect band gap were calculated from Tauc's relationship where CuO-doped glasses have higher values than ZnO-doped glasses. In the BDS study, the permittivity of all glass compositions decreased while AC conductivity increased with increasing frequency. AC conductivity of PBG doped with metal oxides and mixed with PANI exhibited semiconducting features (6.8 × 10-4 S/cm). Further, these composites exhibited lower loss tangent (0.11), and giant permittivity (186,000) compared to the pure PBG. Also, the electrochemical study exhibited that the composite with 7% CuO content has the highest specific capacitance value (82.3 F/g at 1.0 A/g) which increased to about 113% of its first cycle and then decreased to about 55% after 2500 cycles and finally increased again to 77% after 4500 cycles, indicating its good stability. The combination of optical, electrical, and electrochemical features of these composites suggests their use for energy generation and storage devices.

Effectiveness of Calcium Hydroxide and Gingerols Mixture as a Novel Obturation Material for Infected Root in Primary Teeth: A Randomized Clinical Trial.

Introduction: The tendency to use dental materials of plant origin is one of the prevailing trends in dentistry to reduce exposure to materials that could have some toxic impact in the long term. Objective: To evaluate the efficacy of calcium hydroxide combined with gingerols (Ginge-Cal) as a novel obturation material for treating infected primary teeth and decreasing the recurrence of infection. Materials and Methods: The study was conducted on 30 lower primary molars with infected pulp for children aged 4-8 years. The sample was randomly divided into two groups depending on the tested obturation material: Ginge-Cal group and the Metapex group. The evaluation was done by different parameters clinically and radiographically at various intervals up to 12 months. Results: Based on chi-squared and McNamara's test with a 5% significance level, the clinical results indicated that Ginge-Cal group was more effective than the Metapex group in reducing or eliminating pain (P=0.467) after 1 week, sensitivity to percussion (P=0.090) at 3 months of follow-up, purulent swelling (P=0.444) at 6 and 9 months of follow-up, fistula, and tooth mobility. The radiographic results, based on the periapical and furcation area radiolucency at 12 months of follow-up, favored Ginge-Cal group over the Metapex group (P=0.683), (P=0.456), respectively. There were no statistically significant differences in pathological root resorption and periodontal space. The differences within the Ginge-Cal group were directly influenced by the time intervals in a statistically significant manner, ranging from (P=0.004) to (P < 0.001). The success percentage was 87.5% for Ginge-Cal group and 64.3% for Metapex group. Conclusions: Ginge-Cal can be considered a promising material for treating the infected root canal when used as an obturation material for the infected root canal. This trial is registered with NCT05181813.

Enhanced Biocompatibility by Evaluating the Cytotoxic and Genotoxic Effects of Magnetic Iron Oxide Nanoparticles and Chitosan on Hepatocellular Carcinoma Cells (HCC).

Hepatocellular carcinoma (HCC), the fifth most prevalent cancer worldwide, is influenced by a myriad of clinic-pathological factors, including viral infections and genetic abnormalities. This study delineates the synthesis, characterization, and the biological efficacy of iron oxide nanoparticles (Fe3O4) and chitosan-coated iron oxide nanoparticles (Fe3O4-CS) against HCC. Analytical methods confirmed the successful synthesis of both nanoparticles, with Fe3O4-CS demonstrating a smaller, uniform spherical morphology and distinct surface and magnetic properties attributable to its chitosan coating. The prepared materials were analyzed using various techniques, and their potential cytotoxic effects on HepG2 cancer cells line for HCC were investigated. In biological evaluations against HepG2 cells, a notable distinction in cytotoxicity was observed. Fe3O4 showed modest anticancer activity with an IC50 of 383.71 ± 23.9 µg/mL, whereas Fe3O4 exhibited a significantly enhanced cytotoxic effect, with a much lower IC50 of 39.15 ± 39.2 µg/mL. The Comet assay further evidenced Fe3O4-CS potent DNA damaging effect, showcasing its superior ability to induce apoptosis through extensive DNA fragmentation. Biochemical analyses integrated into our results reveal that Fe3O4-CS not only induces significant DNA damage but also markedly alters oxidative stress markers. Compared to control and Fe3O4-treated cells, Fe3O4-CS exposure significantly elevated levels of oxidative stress markers: superoxide dismutase (SOD) increased to 192.07 U/ml, catalase (CAT) decreased to 0.03 U/L, glutathione peroxidase (GPx) rose dramatically to 18.76 U/gT, and malondialdehyde (MDA) levels heightened to 30.33 nmol/gT. These results underscore the potential of Fe3O4-CS nanoparticles not only in inducing significant DNA damage conducive to cancer cell apoptosis but also in altering enzymatic activities and oxidative stress markers, suggesting a dual mechanism of action that may underpin their therapeutic advantage in cancer treatment. Our findings advocate for the further exploration of Fe3O4-CS nanoparticles in the development of anticancer drugs, emphasizing their capability to trigger oxidative stress and enhance antioxidant defense mechanisms.

Evaluation of the Therapeutic Effect of Curcumin-Conjugated Zinc Oxide Nanoparticles on Reserpine-Induced Depression in Wistar Rats.

Depression, a devastating brain illness, necessitates the exploration of novel antidepressant treatments. We evaluated the antidepressant effects of free curcumin, zinc oxide nanoparticles (ZnO NPs), and curcumin-conjugated zinc oxide nanoparticles (Zn(cur)O NPs). The nanoformulations were extensively characterized using advanced techniques. An acute toxicity study ensured the safety of Zn(cur)O NPs. Rats were assigned to one of five groups: control, reserpine-induced depression model, treatment with ZnO NPs, free curcumin, or Zn(cur)O NPs. Behavioral assessments (forced swimming test [FST] and open-field test [OFT]) and neurochemical analyses were conducted. Zn(cur)O NPs exhibited superior efficacy in ameliorating reserpine-induced behavioral and neurochemical effects compared to free curcumin and ZnO NPs. The reserpine-induced model displayed reduced motor activity, swimming time, and increased immobility time in the FST and OFT. Treatment with Zn(cur)O NPs 45 mg/kg significantly improved motor activity and reduced immobility time. Furthermore, Zn(cur)O NPs decreased malondialdehyde (MDA) levels while increasing reduced glutathione (GSH) and catalase (CAT) levels. Additionally, concentrations of serotonin (5-HT) and norepinephrine (NE) increased. In conclusion, curcumin-conjugated zinc oxide nanoparticles demonstrate potent antidepressant effects, alleviating depressive-like behavior in rats. These findings support Zn(cur)O NPs as a promising therapeutic strategy for depression management, warranting further investigation and clinical validation.

Long-lasting insecticidal nets (LLINs) use among household members for protection against mosquito bite in Mogadishu districts.

Understanding long-lasting insecticidal nets (LLINs) utilization is important in monitoring and quantifying the impact of past and current prevention and control efforts of malaria. A cross-sectional study was carried out on a sample of 409 households in Mogadishu, to estimate the LLIN use and assess barriers to its utilization. A standardized questionnaire was used to collect data on demographics, malaria-related knowledge, and the use of preventive measures. LLINs use was assessed using multivariable generalized estimating equations with adjustment for clustering of study participants within the same household. Out of 409 households only 155 (37.9%) owned LLINs. Out of 237 owned LLINs, 199 (84.0%) were used. Median household size being 6.0 (3.0), intra-household net accessibility was low, with one net (42.6%) frequent. Most nets were from mass distribution (55.7%) and obtained '12 months ago'. Un-partnered respondents (unadjusted odds ratio [OR] 0.34, 95% CI 0.14, 0.82; p = 0.017) compared with partnered (married) respondents, large-sized household (adjusted OR 0.83, 96% CI 0.74-0.94; p = 0.002). There was marginal evidence of a greater odds of LLIN utilization among respondents knowledgeable of the correct cause of malaria, that is, mosquito bites (AOR 3.19, 95% CI 0.77, 13.2; p = 0.11) but was not statistically significant. Among households owning nets, most of the LLINs were hung the night prior to the survey (7.9% versus 98%) and was associated with greater marginal odds of utilization (p<0.001). Ownership of LLINs is insufficient in Mogadishu districts affecting household-level access and utilization. If this is not checked, this could weaken the progress made on malaria control efforts. LLIN utilization was modest and largely driven by recently acquired nets showing a desire to utilize them despite low coverage. These imply that mass and facility-based distribution, and awareness campaigns will remain relevant, but efforts for willingness-to-pay for LLINs should be strengthened to sustain coverage and replacements of worn-out nets.

Effectiveness of theophylline in preventing contrast-induced nephropathy after coronary angiographic procedures.

BACKGROUND: Contrast-induced nephropathy (CIN) is the third most common cause of hospital acquired acute renal failure and is associated with increased morbidity and mortality. The use of theophylline for prevention of CIN has yielded conflicting results. This study aimed at examining the effectiveness of theophylline in prevention of CIN when added to IV hydration and N-acetylcysteine (NAC). METHODS: Patients with stable serum creatinine and at least moderate risk for CIN according to Mehran's risk score were included in this parallel group, 1:1, single-blind, randomized controlled trial. All patients received IV hydration (1 mL/kg per hour for 24 hours) and NAC (600 mg bid for 2 days). Patients were randomized to placebo (group P) or theophylline (200 mg in 100 mL 0.9% saline, as IV infusion 30 minutes before contrast medium (CM) administration; group T). Patients underwent standard coronary angiography ± angioplasty. Serum creatinine (SCr) was assessed just before and 72 hours after contrast administration and estimated glomerular filtration rate (eGFR) was calculated. RESULTS: This study included 60 patients with mean SCr 1.44 ± 0.7 mg/dL and eGFR 60.2 ± 29.2 mL/min. Mean SCr among group T was 1.54 ± 0.7 mg/dL with eGFR 58.6 ± 28.6 mL/min, while group P showed mean SCr of 1.34 ± 0.7 mg/dL and eGFR of 61.8 ± 30.1 mL/min. Among group P, 6 (20%) patients developed CIN while none of the patients in group T developed CIN. In comparison to placebo, theophylline significantly decreased SCr (P = 0.0001) and increased eGFR (P = 0.001) at 72 hours. Multivariate regression analysis showed that receiving placebo instead of theophylline, anemia, congestive heart failure, chronic renal impairment, and high-contrast load are all independent predictors for deteriorating renal function after CM administration. CONCLUSION: Theophylline seems to be an effective prophylaxis against CIN for moderate- and high-risk patients undergoing coronary angiography or angioplasty. It offers additive protection when added to IV hydration and NAC.

Treatment of acute bronchitis with EPs 7630: randomized, controlled trial in children and adolescents.

BACKGROUND: The aim of this trial was to investigate the efficacy and tolerability of EPs 7630, a herbal drug preparation from Pelargonium sidoides, in children and adolescents suffering from acute bronchitis, outside the strict indication for antibiotics. METHODS: A total of 220 patients with acute bronchitis were randomized and given either verum containing EPs 7630 (1-6 years/>6-12 years/>12-18 years: 3 × 10/3 × 20/3 × 30 drops/day) or matching placebo for 7 days. The main outcome measure was the change in the total score of bronchitis-specific symptoms (BSS) from day 0 to day 7. RESULTS: The decrease in the BSS total score was significantly higher for EPs 7630 compared to placebo (change day 0-day 7: 4.4 ± 1.6 vs 2.9 ± 1.4 points; P < 0.0001). Improvements were most pronounced for 'coughing' and 'rales at auscultation'. Tolerability was similarly good in both groups. CONCLUSIONS: EPs 7630 proved to be an efficacious and well-tolerated option for the treatment of acute bronchitis in children and adolescents outside the strict indication for antibiotics.

Mutations in NR5A1 and PIN1 associated with idiopathic hypogonadotropic hypogonadism.

We tested the hypothesis that mutations in NR5A1 and PIN1 cause disorders in gonadotropin-gonadal system development and function, throught direct DNA sequencing of the coding sequence and splice-sites of NR5A1 and PIN1 in 50 subjects with sporadic idiopathic hypogonadotropic hypogonadism. These patients were recruited from the Pediatrics section of Tongji Hospital, Tongji Medical College, in Wuhan, China. None of the affected subjects had clinical signs of adrenal insufficiency. The NR5A1 and PIN1 mutations were found in 7 of the 50 cases. These 7 individuals presented severely low serum concentrations of testosterone or of estradiol and gonadotropin. Adrenal insufficiency was not diagnosed in any of these patients. Consequently, NR5A1 and PIN1 mutations should be considered in idiopathic hypogonadotropic hypogonadism patients with normal karyotypes and without adrenal insufficiency.

Structural Changes, Electrophoretic Pattern, and Quality Attributes of Camel Meat Treated with Fresh Ginger Extract and Papain Powder.

Camel is a valuable source of meat for African and Asian countries; however, the most important problem associated with camel meat is its extreme toughness. This toughness has been attributed to its contents of connective tissue, which become more crossly linked in old animals. The toughness of camel meat decreases the consumer acceptance of this meat and reduces its chances of being utilized as a raw material for further processing into meat products. Ginger and papain were used in the current study as tenderizing enzymes, and the structural changes, electrophoretic pattern, physicochemical characteristics, and sensory scores of the treated meat were examined. The treatment of camel meat with ginger and papain resulted in marked destructive changes in the connective tissue and myofibers, and a reduction in the protein bands, with a consequent improvement in its tenderness. All the enzyme-treated samples exhibited significant increases in the protein solubility, with significant decreases in the shear-force values. Moreover, an improvement in the sensory scores of the raw and cooked meat and a reduction in the bacterial counts after the treatments were recorded. Ginger and papain induced a significant improvement in the physicochemical characteristics, sensory attributes, and bacterial counts of the camel meat; therefore, these materials can be utilized by meat processors to boost the consumer acceptance of this meat, and to increase its suitability as a raw material for further meat processing.

Taking Hydroxyapatite-Coated Titanium Implants Two Steps Forward: Surface Modification Using Graphene Mesolayers and a Hydroxyapatite-Reinforced Polymeric Scaffold.

Coating with hydroxyapatite (HAP) presents a mainstream strategy for rendering bioinert titanium implants bioactive. However, the low porosity of pure HAP coatings does not allow for the infiltration of the surface of the metallic implant with the host cells. Polymeric scaffolds do enable this osseointegration effect, but their bonding onto titanium presents a challenge because of the disparity in hydrophilicity. Here, we demonstrate the inability of a composite scaffold composed of carbonated HAP (CHAP) nanoparticles interspersed within electrospun ε-polycaprolactone (PCL) nanofibers to bind onto titanium. To solve this challenge, an intermediate layer of graphene nanosheets was deposited in a pulsed laser deposition process, which facilitated the bonding of the scaffold. The duration of the deposition of graphene (0, 5, 10, 15, and 20 min) and the thickness of its mesolayer affected numerous physical and chemical properties of the material, including the surface atomic proportion of carbon bonds, the orientation and interlinking of the polymeric nanofibers, and the surface roughness, which increased in direct proportion with the thickness of the graphene mesolayer. Because the polymeric scaffold did not adhere onto the surface of pure titanium, no cells were detected growing on it in vitro. In contrast, human fibroblasts adhered, spread, and proliferated well on all the substrates sputtered with both graphene and the composite scaffold. The orientations of cytoskeletal filopodia and lamellipodia were largely determined by the topographic orientation of the nanofibers and the geometry of the surface pores, attesting to the important effects that the presence of a scaffold has on the cellular behavior. The protection of titanium from corrosion in the simulated body fluid (SBF) was enhanced by coating with graphene and the composite scaffold, with the most superior resistance to the attack of the corrosive ions being exhibited by the substrate subjected to the shortest duration of the graphene deposition because of the highest atomic ratio of C-C to C-O bonds detected in it. Overall, some properties of titanium, such as roughness and wettability, were improved monotonously with an increase in the thickness of the graphene mesolayer, while others, such as cell viability and resistance to corrosion, required optimization, given that they were diminished at higher graphene mesolayer thicknesses. Nevertheless, every physical and chemical property of titanium analyzed was significantly improved by coating with graphene and the composite scaffold. This type of multilayer design evidently holds a great promise in the design of biomaterials for implants in orthopedics and tissue engineering.

The Recombination Potential between SARS-CoV-2 and MERS-CoV from Cross-Species Spill-over Infections.

Countries in the Middle-East (ME) are tackling two corona virus outbreaks simultaneously, Middle-Eastern Respiratory Syndrome Coronavirus (MERS-CoV) and the current Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Both viruses infect the same host (humans) and the same cell (type-II alveolar cells) causing lower respiratory illnesses such as pneumonia. Molecularly, MERS-CoV and SARS-CoV-2 enter alveolar cells via spike proteins recognizing dipeptidyl peptidase-4 and angiotensin converting enzyme-II, respectively. Intracellularly, both viruses hide in organelles to generate negative RNA strands and initiate replication using very similar mechanisms. At the transcription level, both viruses utilise identical Transcription Regulatory Sequences (TRSs), which are known recombination cross-over points during replication, to transcribe genes. Using whole genome alignments of both viruses, we identify clusters of high sequence homology at ORF1a and ORF1b. Given the high recombination rates detected in SARS-CoV-2, we speculate that in co-infections recombination is feasible via TRS and/or clusters of homologies. Accordingly, here we recommend mitigation measure and testing for both MERS-CoV and SARS-CoV-2 in ME countries.

Effect of Corticosteroid Therapy in Patients With Cardiac Sarcoidosis on Frequency of Venous Thromboembolism.

Sarcoidosis is a multisystem inflammatory condition with occasional cardiac involvement (CS), which may be associated with risk of venous thromboembolism (VTE). As data on VTE in CS are sparse and corticosteroid therapy has not been previously examined, we aim to determine the association between CS, corticosteroid treatment for CS, and VTE. Patients referred to our institution with concern for sarcoidosis and underwent a positron emission tomography (PET) scan were retrospectively assessed. Chi-squared and multivariate regression analyses were conducted to determine the association between a diagnosis of sarcoidosis, CS, corticosteroid use, and VTE events. Six hundred and forty nine patients were split into 3 categories: 235 with no sarcoidosis (NS), 91 with extra-cardiac sarcoidosis only (ECS), and 323 with CS (isolated CS and/or CS with extra cardiac sarcoid). Thirty nine CS, 7 ECS, and 9 NS patients developed PE while 44 CS, 3 ECS, and 18 NS patients developed DVT. On multivariate regression, neither CS nor ECS was an independent risk factor for VTE (p >0.05) but corticosteroid use was independently associated with VTE (HR 3.06, p = 0.007 for PE, HR 6.21, p <0.0001 for DVT). On logistic regression analysis, corticosteroid dose was found to be independently associated with both PE (p = 0.001) and DVT (p = 0.007). Optimal threshold for defining VTE risk with corticosteroid therapy was a prednisone-equivalent dose of 17.5 mg. In conclusion, contrary to previous studies, this current study found that neither sarcoidosis nor CS is an independent risk factor for VTE. Rather, corticosteroid therapy was associated with an increased risk of VTE.

[Pelargonium sidoides in acute bronchitis - Health-related quality of life and patient-reported outcome in adults receiving EPs 7630 treatment]. / Pelargonium sidoides bei akuter Bronchitis - Gesundheitsbezogene Lebensqualität und Therapiebeurteilung aus Patientensicht unter Behandlung mit EPs 7630.

Health-related quality of life (HRQL) and patient-reported outcome (PRO) have become important outcome parameters for the evaluation of medical treatment within clinical trials and, furthermore, to evaluate efficiency in clinical practice. We therefore report further exploratory results of an already reported dose-finding study with EPs 7630 tablets, now focussing on HRQL and PRO. A total of 406 adults with acute bronchitis were randomly assigned to one of four parallel treatment groups (placebo, 30 mg, 60 mg or 90 mg EPs 7630 daily). HRQL and PRO were assessed by questionnaires as secondary outcome measures at each study visit or daily in the patient's diary. At day 7, the patient-reported outcome measures were significantly more improved in all the three EPs 7630 groups compared to placebo (EQ-5D and EQ VAS, SF-12: physical score, impact of patient's sickness, duration of activity limitation, patient-reported treatment outcome, satisfaction with treatment). In conclusion, a statistically significant and clinically relevant improvement of HRQL/PRO compared to placebo was shown in all the three EPs 7630 groups.

Physical, electrochemical and biological evaluations of spin-coated ε-polycaprolactone thin films containing alumina/graphene/carbonated hydroxyapatite/titania for tissue engineering applications.

Composite structures are at the frontier of materials science and engineering and polymeric/ceramic composites present one of their most prospective subsets. Prior studies have shown both improvements and deteriorations of properties of polymers upon the addition of ceramic phases to them, but not many studies have dealt with the direct comparison of chemically distinct inorganic additives. The goal of this study was to compare the properties of ε-polycaprolactone (PCL) thin films supplemented with alumina, graphene, carbonated hydroxyapatite or titania particles, individually, in identical amounts (12 wt%). The composite films were analyzed for their phase composition, grain size, morphology, surface roughness, porosity, cell response, mechanical properties and electrochemical performance. Each additive imparted one or more physical or biological properties onto PCL better than others. Thus, alumina increased the microhardness of the films better than any other additive, with the resulting values exceeding 10 MPa. It also led to the formation of a composite with the least porosity and the greatest stability to degradation in simulated body fluid based on open circuit potential (OCP) measurements and electrochemical impedance spectroscopy (EIS). Titania made the surface of PCL roughest, which in combination with its high porosity explained why it was the most conducive to the growth of human fibroblasts, alongside being most prone to degradation in wet, corrosive environments and having the highest Poisson's ratio. Graphene, in contrast, made the surface of PCL smoothest and the bulk structure most porous, but also most conductive, with the OCP of -37 mV. The OCP of PCL supplemented with carbonated hydroxyapatite had the highest OCP of -134 mV and also the highest mechanical moduli, including the longitudinal (781 MPa), the shear (106 MPa), the bulk (639 MPa), and the elastic (300 MPa). The only benefit of the deposition of multilayered PCL films supplemented with all four inorganic additives was to enable a relatively high resistance to degradation. This study demonstrates that the properties of thin PCL films could be effectively optimized through the simple choice of appropriate inorganic additives dispersed in them. There is no single additive that proves ideal for improving all the properties of interest in PCL thin films, but their choice should be adjusted to the actual application. One such method of compositional optimization could prove crucial in the effort to develop biocomposites for superior performance in tissue engineering applications.

Effects of second-hand smoking on lung functions in athlete and non-athlete school-aged children - observational study.

BACKGROUND: Second-hand smoking or environmental tobacco smoke is a critical health risk. Children are the most vulnerable to second-hand smoking because of their small bronchial ducts, less developed immunity, and low-physical activity. OBJECTIVES: The purpose of this study was to ascertain the effects of second-hand smoking on lung functions in athlete and non-athlete school-aged children. METHODS: This observational study included forty-six school-aged children, their age was 8-15 years, assigned to three groups; 2 study groups and 1 control group (n=15). The study groups comprised of 16 football players, and of 15 cyclists. Lung functions were evaluated recording forced vital capacity, forced expiratory volume in 1 sec and peak expiratory flow using digital spirometer. RESULTS: All measures were recorded in definite values and the children were also classified into second-hand smoking (SH), or non-exposed to tobacco smoking (NE). The findings presented a significant increase (p<0.05) of the study groups in forced vital capacity, forced expiratory volume in 1 sec and peak expiratory flow solely for the non-exposed children. However, there were non-significant differences between the cyclists and football players or between the passive smoking children and non-exposed children in any of the two study groups (p>0.05). CONCLUSION: The outcomes of this study suggest beneficial influences of the sports activity on the lung functions, without different influences of the cyclists and football players on the lung functions.

Patent foramen ovale and neurosurgery in sitting position: a systematic review.

We have conducted a systematic review of air embolism complications of neurosurgery in the sitting position and patent foramen ovale (PFO) closure. It assesses the risk and benefit of PFO closure before neurosurgery in the sitting position. The databases Medline, Embase, and Cochrane Controlled Trial Register were systematically searched from inception to November 2007 for keywords in both topics separately. In total, 4806 patients were considered for neurosurgery in sitting position and 5416 patients underwent percutaneous PFO closure. The overall rate of venous air embolism during neurosurgery in sitting position was 39% for posterior fossa surgery and 12% for cervical surgery. The rate of clinical and transoesophageal echocardiography detected paradoxical air embolism was reported between 0% and 14%. The overall success rate for PFO closure using new and the most common closure devices was reported 99%, whereas the average risk of major complications is <1%. On the basis of our systematic review, we recommend screening for PFO and considering closure in cases in which the sitting position is the preferred neurosurgical approach. Our proposed management including the time of PFO closure according to available data is presented. However, the conclusions from our systematic review may be limited due to the lack of level A evidence and from using data from observational cohort studies. Thus, definite evidence-based recommendations require prospective evaluation of the issue in well-designed studies.