[Psychological treatments for pain in cancer patients : A systematic review on the current state of research]. / Schmerzpsychologische Interventionen bei onkologischen Patienten : Ein systematisches Review zum aktuellen Stand der Forschung.

BACKGROUND: In cancer patients, pain is one of the main symptoms and especially in the late stages of disease, these symptoms can be associated with considerable suffering. In psycho-oncology, preliminary psychological therapies targeting cancer pain have been tested; however, a systematic review of available interventions is lacking, especially considering their dissemination, evidence base, study quality, and the comparison with established treatments. Therefore, the aim of the current study is to systematically review the current research on psychological treatments for pain in cancer patients. MATERIALS AND METHODS: During May 2014, MEDLINE, PsycINFO, PSYNDEX, and CENTRAL databases were searched. Psychological treatments for pain in adult cancer patients studied in randomized, controlled trials (RCTs) and referring to pain as primary or secondary outcome were included. After examination for inclusion, structured data extraction and assessment followed. Data were synthesized narratively. RESULTS: In the review, 32 RCTs were included. Studies mainly referred to patients with breast cancer or patients in earlier stages of the disease. The methodological quality of included studies was heterogeneous. Most commonly, short interventions were delivered by nurses in out-patient settings. Interventions including education and relaxation techniques were utilized most often, followed by interventions with behavioral or cognitive components. CONCLUSION: A need for research persists regarding efficacy of current psychotherapeutic interventions, or the role of mediator variables (e. g., coping) on pain perception in cancer patients. Studies with high methodological quality which comprehensively and transparently report on interventions and designs are lacking.

Separating two components of body image in anorexia nervosa using fMRI.

BACKGROUND: Body image distortion is a key symptom of anorexia nervosa. In behavioral research two components of body image have been defined: attitudes towards the body and body size experience. Neuroimaging studies concerning own body image distortions in anorexia nervosa have revealed an inconsistent pattern of results and are constrained by the fact that no direct distinction between the different parts of body image has been made. METHOD: The present study therefore set out to investigate the neural correlates of two parts of the own body image using functional magnetic resonance imaging (fMRI): satisfaction rating and size estimation for distorted own body photographs in patients with anorexia nervosa and controls. RESULTS: Anorectic patients were less satisfied with their current body shape than controls. Patients further demonstrated stronger activation of the insula and lateral prefrontal cortex during the satisfaction rating of thin self-images. This indicates a stronger emotional involvement when patients are presented with distorted images close to their own ideal body size. Patients also overestimated their own body size. We were able to show complex differential modulations in activation of the precuneus during body size estimation in control and anorectic subjects. It could be speculated that a deficit in the retrieval of a multimodal coded body schema in precuneus/posterior parietal cortex is related to body size overestimation. CONCLUSIONS: We were able to find specific behavioral responses and neural activation patterns for two parts of body image in anorexia nervosa and healthy controls. Thus, the present results underline the importance of developing research and therapeutic strategies that target the two different aspects of body image separately.

Alamethicin biosynthesis: acetylation of the amino terminus and attachment of phenylalaninol.

Alamethicin synthetase was extracted from the fungus Trichoderma viride at the end of its exponential growth phase. It is multienzyme complex with a molecular weight of approx. 480 000. The biosynthesis of alamethicin is initiated on the synthetase by acetylation of thiolester-bound aminoisobutyric acid, which remains enzyme bound. Acetyl-CoA serves as the acetate donor. Of the alamethicin constituents, glycine, alanine and valine are also acetylated when incubated alone. This acetylation is prevented by added aminoisobutyric acid, which indicates that the site on alamethicin synthetase catalyzing the acetylation has a preference for aminoisobutyric acid. Alamethicin formation on the synthetase is terminated by linkage of phenylalaninol to the carboxyl terminus of the peptide. It is unlikely that the amino alcohol is a degradation product of alamethicin or that it had been split off from the synthetase complex. Thus it is probably the reaction product of a separate enzyme system.

A fluorescence-based assay for quantitation of lymphokine-activated killer cell activity.

A fluorescence assay for the quantitation of tumor cell lysis by activated and non-activated killer (LAK) cells is described. The target cells are labelled with a europium chelate (Eu-diethylenetriaminopentaacetate) and after cytolysis caused by the LAK cells the Eu3+ complex is released into the culture supernatant. The addition of beta-naphthoyltrifluoroacetone to culture supernatant aliquots leads to the formation of a highly fluorescent chelate which can be measured with a time-resolved fluorometer. The influence of various assay parameters has been evaluated including incubation time, effector-to-target cell ratio, the target cell line and different concentrations of interleukin-2 during cell culture. The optimized time-resolved fluorometric assay was found to be as simple and sensitive as the commonly used cytotoxicity assay in which the release of 51Cr from the labelled target cells is measured. In addition the assay is much faster and safer since the label is not radioactive.

Peroxisome subpopulations of the rat liver. Isolation by immune free flow electrophoresis.

Peroxisomes (POs) are a heterogenous population of cell organelles which, in mammals, are most abundant in liver and kidney. Although they are usually isolated by differential and density gradient centrifugation, isolation is hampered by their high fragility, sensitivity to mechanical stress, and their sedimentation characteristics, which are close to those of other major organelles, particularly microsomes. Consequently, until now only the so-called "heavy" POs with a buoyant density of 1.22-1.24 g/cm(3) have been highly purified from rat liver, whereas the other subpopulations also present in that tissue have escaped adequate characterization. The purification of these subpopulations has become an essential task in view of the functional significance of POs in humans, and the putative importance of peroxisomal subpopulations in the biogenesis of this organelle. Here we used an alternative novel approach to density gradient centrifugation, called immune free flow electrophoresis (IFFE). IFFE combines the advantages of electrophoretic separation with the high selectivity of an immune reaction. It makes use of the fact that the electrophoretic mobility of a subcellular particle complexed to an antibody against the cytoplasmic domain of one of its integral membrane proteins is greatly diminished, provided that the pH of the electrophoresis buffer is adjusted to pH approximately 8.0, the pI of IgG molecules. Because of this reduced electrophoretic mobility, IgG-coupled particles can be separated in an electric field from those that are noncoupled and hence more mobile. The IFFE technique has been recently applied for isolation of regular POs (rho = 1.22-1.24 g/cm(3)) from a light mitochondrial fraction of rat liver. We succeeded in isolating different subpopulations of POs by applying IFFE to heavy, light, and postmitochondrial fractions separated by differential centrifugation of a rat liver homogenate. The PO subfractions obtained differed in their composition of matrix and membrane proteins, as revealed by immunoblotting. This indicates that they indeed represent distinct subpopulations of rat hepatic POs.

Calcium ionophore A 23 187 in the presence of phorbol ester PMA: a potent inducer of interleukin 2 and interferon-gamma synthesis by human blood cells.

Cultures of human blood mononuclear cells incubated with the calcium ionophore A 23 187 in the presence of the tumor promoter phorbol 12-myristate-13-acetate (PMA) produced 5-10 times more of the lymphokines interleukin 2 (IL 2) and interferon-gamma (IFN-gamma) than cultures which were stimulated with other combinations of inducing agents and PMA. Especially at low protein concentrations, the amount of ionophore which is necessary to induce maximal quantities of both lymphokines was determined by the protein content of the culture medium. The synthesis of the two lymphokines was inhibited by low doses of Mn++ which competes with Ca++ for binding to the ionophore. This suggests the importance of Ca++ in the induction process. The synthesis rates of IL 2 were maximal 10-12 h, and those of IFN-gamma 20-40 h after induction. Maximal titers of IL 2 were detected 48 h after the addition of A 23187 and PMA to the cultures, and the highest IFN-gamma levels 12-24 h later.

Co-induction of lymphokine synthesis by the antineoplastic bryostatins.

The macrocyclic lactone bryostatins, isolated from marine bryozoans, have been found to be strong inhibitors of e.g., the P 388 murine lymphocyte leukemia cell line and in vivo systems. Presently, bryostatin 1 is under preclinical development as a potential anticancer drug, although the bryostatins exhibit some of the same biological effects as the tumor promoting phorbol-12-myristate-13-acetate (PMA), especially activation of protein kinase C in certain cell types. In our experiments, we investigated the influence of bryostatin 1 on the synthesis of interleukin 2 (IL2) and interferon-gamma (IFN-gamma) by ionophore A23187 or mitogen-induced human blood lymphocytes. These results were then compared with those achieved using the two tumor promotors PMA and teleocidin. Our data indicate that bryostatin 1 is comparable to these two other drugs in increasing production of the two lymphokines 10-100-fold. The IL2 and IFN-gamma production kinetics of cultures induced with either A23187/bryostatin 1 or A23187/PMA were practically identical. The general pattern of peptides, however, released from bryostatin 1 coinduced cultures differed from that obtained when PMA was used.

Simple detection of antibodies to different viruses using rheumatoid factor and enzyme-labelled antigen (ELA).

A new one-step method was developed to detect IgG antibodies to different virus antigens. Human serum specimens were mixed with different enzyme-labelled antigen (ELA) preparations in microtitre plates coated with rheumatoid factor (RF). During the incubation in the wells of microtitre plates immune complexes form which are specifically bound to the RF on the solid phase. The test detects antibody to cytomegalovirus (CMV) and West-Nile virus with a high sensitivity and specificity.

A histomorphometric analysis of the effects of fluoride on experimental ectopic bone formation in the rat.

Ectopic bone formation was induced in 14 rats receiving 100 ppm fluoride in drinking water and in 14 control animals. Sections from ossicles removed after 14 and 20 days were sampled for stereological analysis. Bone volume density and bone volume were reduced in experimental animals on day 14 (p less than 0.05). This difference was no longer present after 20 days. On day 20, surface density and areas of formative surfaces were increased in the fluoride group (p less than 0.05). Osteoid seam thickness was higher in the fluoride group on both days (p less than 0.01). In conclusion, fluoride induced quantitative alterations in ectopic bone formation, and the presented model may prove a useful addendum to previous methods for investigation of fluoride effects on mineralization processes in vivo.

Virus inactivation of blood products by phenothiazine dyes and light.

Methylene blue (MB) and its derivatives azure A, B, C and thionine are photoactive and, in principle, are suitable for photodynamic virus inactivation of blood and blood products, such as therapeutic plasma. Methylene blue was selected for plasma decontamination because it is being clinically used and because of its known toxicological and other properties. The standard procedure for photodynamic treatment of single units of fresh plasma involves illumination with visible light at an MB concentration of 1 microM. Polymerase chain reaction analysis revealed that, in addition to model viruses, the bloodborne viruses hepatitis B virus, hepatitis C virus, human immune deficiency virus-1 and probably also the nonenveloped parvovirus B19 are sensitive to MB/light treatment. The procedure is further improved when the fluorescent tubes routinely used for illumination are replaced by more intense light sources, e.g. light-emitting diodes or low-pressure sodium lamps. Surprisingly, the improved virus kill is accompanied by reduced damage to plasma proteins.

Differences between natural and recombinant interleukin-2 revealed by gel electrophoresis and capillary electrophoresis.

High-performance capillary electrophoresis (HPCE) is shown to be useful for analysis of interleukin-2 (IL-2) in its native state under non-reducing conditions. The results obtained were compared with those from analysis of IL-2 by protein blotting after sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE) under denaturing and reducing conditions. In addition, resolution of the different glycosylated and non-glycosylated natural IL-2 species was achieved by HPCE. The HPCE electropherogram of native IL-2 could easily generate quantitative amounts of the different naturally occurring IL-2 species. For HPCE of IL-2 run times of less than 10 min are sufficient, and only extremely small amounts of IL-2 are needed. In this report, human IL-2 expressed in bacteria has been analysed by HPCE and the existence of two recombinant IL-2 forms was demonstrated.

Inactivation of viruses by chemically and photochemically generated singlet molecular oxygen.

Inactivation of viruses in blood plasma can be achieved by photodynamic procedures using methylene blue (MB) or other photoactive dyes. Singlet molecular oxygen (1O2) probably contributes to the virucidal effects of photosensitization. We report the inactivation of herpes simplex virus type 1 (HSV-1) and suid herpes virus type 1 (SHV-1) by chemically generated singlet oxygen, produced by thermal decomposition of the endoperoxide of 3,3'-(1,4-naphthylidene)dipropionate (NDPO2). We demonstrate that viruses can be inactivated by 1O2 generated by chemiexcitation in a reaction in the dark, even in the presence of human plasma. Virus inactivation in phosphate-buffered saline (PBS) was enhanced when water was replaced by deuterium oxide (D2O) and diminished when human plasma or quenchers (imidazole or histidine) were added. The singlet oxygen quenching activities of plasma, imidazole and histidine correlated with their inhibitory effects on virus inactivation. The production of 1O2 was assessed by an indicator reaction: the bleaching of p-nitrosodimethylaniline (RNO) with imidazole as 1O2 acceptor. Virus inactivation and singlet oxygen generation of NDPO2 were compared with those of MB/light-mediated photosensitization. Based on similar amounts of 1O2 generated by either procedure, virus inactivation by MB/light was more effective. Virus inactivation by MB/light was not affected by type I quenchers (e.g. mannitol), but was inhibited by human plasma or singlet oxygen quenchers. Furthermore, in D2O-based PBS, virus inactivation was more effective than that in H2O. These observations confirm that singlet oxygen is involved in virus inactivation by MB/light. Taken together, the results demonstrate that singlet oxygen produced by either procedure is virucidal. The enhanced effect of the photochemical procedure suggests that, in addition to type II, type I reactions and/or the binding affinity of the dye for the virus contribute to virus killing by MB/light.

Deoxynivalenol-contaminated wheat in swine diets.

Two studies were conducted using Fusarium graminearum-infected (scabby) wheat containing 6.8 ppm deoxynivalenol (DON), commonly called vomitoxin, substituted for normal wheat in starter pig diets to give varying levels of DON. After 3 wk on experimental treatments, one-half of the pigs in trial one were sacrificed to evaluate the effects of DON on heart, kidney, spleen and liver. Analyses for DON residues in these tissues were also performed. The remaining 16 pigs were placed on a conventional diet for 4 wk to evaluate effects of DON on subsequent animal performance. A different sample of scabby wheat containing 4.9 ppm of DON was substituted for sorghum grain in growing-finishing pig diets to give varying concentrations of DON. At the end of the 42-d feeding period, eight pigs were slaughtered to evaluate the effects of DON on selected tissues. Results of the three trials suggest that feed intake was reduced when DON concentrations in the swine diets neared or exceeded 1 ppm. No apparent signs of disease, including vomiting, were observed in experimental animals. Histological evaluation revealed no significant lesions or abnormalities related to DON ingestion in tissues examined. Traces of DON (8 to 28 ppb, wet weight) were found in kidney, liver, spleen and heart of starter pigs consuming the diets containing DON up to time of slaughter. No DON was found in tissues of growing-finishing pigs that were withdrawn from feed about 12 h before slaughter.

Functional gastrointestinal disorders among soldiers in peacetime versus out-of-area missions.

Functional gastrointestinal syndromes are chronic disorders of the abdomen with an absence of organic findings. The aim of this study was to compare the frequency and symptomatology of functional abdominal syndromes in soldiers during an out-of-area mission versus during peacetime at home. We examined 124 soldiers who sought medical care for abdominal symptoms at the German Field Hospital Trogir, Croatia. The control group consisted of 113 soldiers who were referred with abdominal symptoms to the Central Hospital of German Armed Forces Koblenz, Germany. After excluding an organic disease, the diagnosis of a functional disorder was made. Fourteen percent of the Implementation Force soldiers had symptoms of a functional syndrome. At home, the frequency of functional gastrointestinal disorders was 50%, significantly greater than the rate during the out-of-area mission (p < 0.0001). We conclude that functional gastrointestinal disorders are more rare during out-of-area missions than during peacetime. They are probably as frequent away from home as at home, but "health care seeking" is less frequent under the stressful conditions of out-of-area missions.

[Acute renal failure due to hypercalcemia and peripheral polyneuropathy--rare manifestations of sarcoidosis]. / Akutes Nierenversagen auf dem Boden einer Hyperkalzämie und periphere Polyneuropathie--seltene Manifestationen einer Sarkoidose.

BACKGROUND: Sarcoidosis can involve many organs. Whereas lung and intrathoracal lymph nodes are most often effected, there are some rare manifestations as renal failure and neuropathy. CASE REPORT: A 57-year-old male patient was referred to hospital with dyspnea on exertion, hypercalcemia and acute renal failure after holidays in Southern Europe. The diagnosis of sarcoidosis with the extraordinary manifestations of a nephropathia based on hypercalcemia and a sensitive polyneuropathy was made. CONCLUSION: These findings suggest that an asymptomatic sarcoidosis can develop hypercalcemia with renal failure by increased ultraviolet exposure. Patients with sarcoidosis should avoid marked exposure to UV light.

[Duplex ultrasound of the liver and portal vein system]. / Die Duplexsonographie der Leber und des Pfortadersystems.

Duplex ultrasound allows direct access to portal venous and hepatic vein hemodynamics. This method has been accepted as a reliable procedure to detect portal and splenic venous thrombosis, Budd-Chiari's syndrome, portosystemic collateralisation and changes in the portal venous blood flow direction with a high rate of sensitivity. Besides these qualitative findings Doppler flowmetry allows quantitative measurement of portal venous blood flow velocities. The estimation of portal hypertension and the prediction of the risk of variceal bleeding by quantitative Doppler flowmetry is of increasing clinical importance. In monitoring the efficiency of medicational prophylaxis against gastrointestinal bleeding is also helpful. Duplex ultrasound can be used to evaluate the function of portocaval shunts including the intrahepatic stent shunt as well as to detect vascular complications after liver transplantation. Furthermore the method is gaining importance in the diagnosis and monitoring of therapy of acute liver transplant rejection. In case of liver tumors duplex ultrasound is of value for tumor staging and provides information about the dignity on the basis of perfusion patterns.