National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project.

BACKGROUND: In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program 'Palliative care in Pandemics' (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON). METHODS: Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified. DISCUSSION: For a future "pandemic preparedness" national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.

Coxiella burnetii immunogenic proteins as a basis for new Q fever diagnostic and vaccine development.

Coxiella burnetii is the etiological agent of the zoonosis Q fever, which can cause an acute or a chronic, life-threatening disease in humans. It presents a highly stable cell form, which persists in the environment and is transmitted via contaminated aerosols. Ruminants are considered as the main reservoir for human infections but are usually asymptomatic. Subclinical infection in these animals and the occurrence of serologically negative shedders hamper the identification of infected animals with the currently used diagnostic techniques. This suboptimal sensitivity limits reliable identification of infected animals as well as the well-timed implementation of countermeasures. This review summarizes compounds, focusing on C. burnetii seroreactive proteins, which were discovered in recent immunoproteomic studies. We analyzed these proteins regarding their localization, function, frequency of citation, differences seen in various host species as well as sensitivity and specificity. Finally, proteins useful for the development of new diagnostic test systems as well as subunit vaccines were discussed.

[Migraine with typical aura without headache; first presentation at older age]. / Visuele verschijnselen bij migraine met typisch aura.

Transient visual phenomena in later life due to a visual aura in migraine are not uncommon and can also occur without headache. This migraine with aura is not always recognized as such. Since visual phenomena can also have a variety of other causes, they can present a diagnostic dilemma in both primary and secondary care. Visual aura phenomena have various and often complex manifestations and are usually observed binocularly. In case of transient visual phenomena, the patient's history is of utmost importance to determine whether there is a mono- or binocular cause of the complaints. Timely recognition of visual phenomena in the context of migraine can prevent unnecessary diagnostics and treatments.

Deletion of the tissue response against alginate-pll capsules by temporary release of co-encapsulated steroids.

Transplantation of encapsulated living cells is a promising approach for the treatment of a wide variety of diseases. Large-scale application of the technique, however, is hampered by inflammatory responses against the capsules. In the present study, we investigate whether tissue responses against alginate-PLL-alginate capsules can be modulated by co-encapsulation and temporary release of immunomodulating factors such as dexamethasone. Such an approach may be mandatory in order to increase the function and survival of encapsulated tissue since it has been shown that the tissue response can be caused by many, insurmountable factors. In an in vitro assay, we demonstrated an antiproliferative effect of dexamethasone-containing capsules on L929-mouse-fibroblasts. Subsequently, capsules prepared of purified alginate with or without solved dexamethasone were implanted in the peritoneal cavity of rats and retrieved one month later for histological evaluation. Most of the capsules without dexamethasone proved to be overgrown and adherent to the abdominal organs whereas with co-encapsulated dexamethasone the majority of the capsules were found freely floating in the peritoneal cavity without overgrowth. We conclude that co-encapsulation of dexamethasone has a profound effect on fibroblasts and macrophages adherence to immunoisolating capsules.

Structural similarity causes different category-effects depending on task characteristics.

It has been suggested that category-specific impairments for natural objects may reflect that natural objects are more globally visually similar than artefacts and therefore more difficult to recognize following brain damage [Aphasiology 13 (1992) 169]. This account has been challenged by the finding that the 'normal' disadvantage claimed for natural objects may be reversed when items from the categories of natural objects and artefacts are matched for visual complexity, familiarity and name frequency [Neuropsychologia 37 (1999) 1263]. In the experiments reported here it was investigated whether category effects could be found on object decision tasks (deciding whether pictures represented real objects or not), when the stimulus material was matched across categories. In experiment 1, a disadvantage for natural objects was found on difficult object decision tasks whereas no category difference was found on easy object decision tasks. In experiment 2 an advantage for natural objects was found during object decisions performed under degraded viewing conditions (lateralized stimulus presentation). It is argued that these findings can be accounted for by assuming that natural objects are more globally visually similar than artefacts, but that this difference between categories affects performance in different ways depending on task characteristics. Thus, the greater overlap between natural objects may be a disadvantage when the demand on perceptual differentiation is high (as it is in difficult object decision tasks). However, when viewing conditions are degraded and performance tends to depend on global shape information (carried by low spatial frequency components), natural objects may fare better than artefacts because the global shape of natural objects reveals more of their identity than the global shapes of artefacts.

Categorization and category effects in normal object recognition: a PET study.

To investigate the neural correlates of the structural and semantic stages of visual object recognition and to see whether any effects of category could be found at these stages, we compared the rCBF associated with two categorization tasks (subjects decided whether pictures represented artefacts or natural objects), and two object decision tasks (subjects decided whether pictures represented real objects or nonobjects). The categorization tasks differed from each other in that the items presented in the critical scan window were drawn primarily from the category of artefacts in the one task and from the category of natural objects in the other. The same was true for the object decision tasks. The experiment thus comprised a two-by-two factorial design. The factors were Task Type with two levels (object decision vs. categorization) and Category also with two levels (natural objects vs. artefacts). The object decision tasks were associated with activation of areas involved in structural processing (fusiform gyri, right inferior frontal gyrus). In contrast, the categorization tasks were associated with activation of the left inferior temporal gyrus, a structure believed to be involved in semantic processing. In addition, activation of the left premotor cortex was found during the categorization of artefacts compared with both the categorization of natural objects and object decision to artefacts. These findings suggest that the structural and semantic stages are dissociable and that the categorization of artefacts, as opposed to the categorization of natural objects, is based, in part, on action knowledge mediated by the left premotor cortex. However, because artefacts and natural objects often caused activation in the same regions within tasks, processing of these categories is not totally segregated. Rather, the categories differ in their weight on different forms of knowledge in particular tasks.

Brain activity related to integrative processes in visual object recognition: bottom-up integration and the modulatory influence of stored knowledge.

We report evidence from a PET activation study that the inferior occipital gyri (likely to include area V2) and the posterior parts of the fusiform and inferior temporal gyri are involved in the integration of visual elements into perceptual wholes (single objects). Of these areas, the fusiform and inferior temporal gyri were more activated by tasks with recognizable stimuli than by tasks with unrecognizable stimuli. We propose that the posterior parts of the fusiform and inferior temporal gyri, compared with the inferior occipital gyri, are involved in higher level integration, due to the involvement of re-entrant activation from stored structural knowledge. Evidence in favor of this interpretation comes from the additional finding that activation of the anterior part of the left fusiform gyrus and a more anterior part of the right inferior temporal gyrus, areas previously associated with access to stored structural knowledge, was found with recognizable stimuli, but not with unrecognizable stimuli. This latter finding also indicates: (i) that subjects may not refrain from (automatically) identifying objects even if they only have to attend to the objects' global shape, and (ii) that perceptual and memorial processes can be dissociated on both functional and anatomical grounds. No evidence was obtained for the involvement of the parietal lobes in the integration of single objects.

Biocompatibility and surface structure of chemically modified immunoisolating alginate-PLL capsules.

Grafting of encapsulated living cells has the potential to cure a wide variety of diseases. Large-scale application of the technique, however, is hampered by insufficient biocompatibility of the capsules. A major factor in the biocompatibility of capsules is inadequate covering of the inflammatory poly-L-lysine (PLL) on the capsules' surface. In the present study, we investigate whether tissue responses against alginate-PLL capsules can be reduced by crosslinking the surface of the capsules with heparin or polyacrylic acid. Our transplant study in rats shows a tissue response composed of fibroblasts and macrophages on alginate-PLL-alginate and alginate-PLL-heparin capsules that was completely absent on alginate-PLL-polyacrylic acid capsules. Atomic force microscopy analyses of the capsules demonstrates that the improved biocompatibility of alginate-PLL-capsules by polyacrylic acid coating should not only be explained by a more adequate binding of PLL but also by the induction of a smoother surface. This study shows for the first time that biologic responses against capsules can be successfully deleted by chemically crosslinking biocompatible molecules on the surface of alginate-PLL capsules.

Second skill educational development of personnel for a single-room maternity care system.

A modified cross-training approach was used to train nurses for a single-room maternity care unit. This cross-training program included development of a skills list for the labor/delivery and nursery/postpartum areas and an instruction program including formal lectures, independent study, and clinical experience. The clinical part of the program was a preceptor-based experience. The results of this program indicated that competency-based skills and objective selection criteria are mandatory for a successful cross-training program.

TBNET - Collaborative research on tuberculosis in Europe.

Networking is a key feature of scientific success. The Tuberculosis Network European Trialsgroup (TBNET) was founded in 2006 as a non-profit, non-governmental peer-initiated scientific organization to collaboratively address research priorities in the area of tuberculosis in Europe. Today, TBNET is the largest tuberculosis research organization in Europe with nearly 500 members from 22 EU countries and 49 countries worldwide (www.tb-net.org). Apart from small multicenter basic research studies, a particular strength of TBNET is the performance of large collaborative projects, pan-European multicenter studies and database projects. In recent years, research from TBNET has substantially contributed to the understanding of the management, risk and prognosis of patients with multidrug (MDR) and extensively drug-resistant (XDR) tuberculosis and led to a better understanding of the clinical value of novel tests for the identification of adults and children with tuberculosis and latent infection with Mycobacterium tuberculosis. In 2009, two branches of TBNET were founded to specifically address tuberculosis in the pediatric population (ptbnet) and non-tuberculous mycobacterial diseases (NTM-NET). In addition to the research activities, TBNET is developing expert consensus documents for clinical management and provides training and capacity building especially for members from Eastern European countries, where tuberculosis is still a prevalent health problem.

Executive functions recover earlier than episodic memory after microsurgical transsphenoidal resection of pituitary tumors in adult patients--a longitudinal study.

Pituitary tumors may lead to cognitive dysfunction, and the most prevalent deficits are impaired memory and attention. To investigate whether memory and executive functions improve after surgical treatment we performed a prospective longitudinal study comprising 106 patients with pituitary tumors. Psychometric evaluation was performed with the d2-Letter Cancellation test, the Trail Making test, the Digit Span test and the Intelligence Structure test-Verbal Memory test at three timepoints: preoperatively, and at 3 months and 12 months after surgery. The preoperative and postoperative maximum suprasellar tumor extension and hormone status was assessed in all participants. The main finding was that concentration, working memory, and attentional speed improved significantly within the first 3 months after surgery (p<0.05), while improvement of episodic memory was not observed until 12 months after surgery (p<0.001). In the patients harbouring non-functioning adenomas, prolactinomas or other sellar lesions, the most important factor promoting improvement of neurocognitive function was the removal of the suprasellar tumor extension.

Migration of T-cell subsets in multiple sclerosis and the effect of interferon-beta1a.

OBJECTIVES: Migration of inflammatory cells across the blood-brain barrier is a central event in the formation of multiple sclerosis (MS) lesions and is known to be enhanced in MS patients. This study investigates the migration of CD4+ and CD8+ T-cell subsets and the effects of interferon-beta1a (IFN-beta1a) treatment on migration and matrix metalloproteinase-9 (MMP-9) production of these T-cell subsets. MATERIALS AND METHODS: An ex vivo transwell system was established to compare the migratory behaviour of lymphocytes isolated from normal controls and untreated MS patients. In addition, MS patients were investigated longitudinally after initiation of IFN-beta1a treatment. RESULTS: Migration of CD4+ T cells (P < 0.05), but not of CD8+ T cells, was enhanced in untreated MS patients compared with controls and was normalized by treatment with IFN-beta1a. In addition, IFN-beta1a treatment reduced MMP-9 production of CD4+ but not CD8+ T cells. CONCLUSION: Our results indicate that CD4+ T cells, but not CD8+ T cells, contribute to the enhanced ex vivo migration observed in MS.

Peer Reviewed: New Instrument Brings PAH Analysis to the Field.

A field-portable scanning spectrofluorometer has completed site tests and is nearing commercialization.

[Coincidence of silicosis and lupus erythematosis]. / Gemeinsames Auftreten von Silikose und Lupus erythematodes.

From 1975 to 1989 37 patients with Lupus erythematodes exposed to quartz dust over many years were observed. Thirty of them suffered from silicosis. The coincidence of silicosis and Lupus erythematodes can be an expression of a common pathogenesis.

[Occupationally-induced progressive scleroderma and the heart]. / Berufsbedingte progressive Sklerodermie und Herz.

A 60-year-old man with progressive systemic sclerosis (PSS) had worked as underground miner in ore mining for 26 years with intensive exposure to crystalline silica. The PSS was acknowledged as an occupational disease. Parallel to the progress of the PSS there developed disturbances of the conduction system and cardiac rhythm with left heart failure. Despite treatment sudden death set in. A myocardial fibrosis was found histopathologically. This is a consequence of the PSS and therefore the occupational disease is the cause of death. Cardiac involvement means a poor prognosis and necessitates both evaluation of the damage in percent caused by the occupational disease and interdisciplinary teamwork in the dispensary care of patients.

Peer reviewed: environmental biosensors: a status report.

New instruments and methods being developed show promise for continuous, in situ monitoring of toxic compounds.