[Linguistic Validation of the "German Lung Fibrosis Health Related Quality of Life Questionnaire"]. / Sprachliche Validierung des Fibrose-Fragebogens zur Erfassung der Lebensqualität bei Patienten mit idiopathischer Lungenfibrose und idiopathischer nichtspezifischer interstitieller Pneumonie.

Health status and quality of life are impaired in patients with idiopathic pulmonary fibrosis (IPF) and idiopathic non-specific interstitial fibrosis (iNSIP). In Germany exists only the K-BILD questionnaire for patients with ILD 1 in a professional translation by Kreuter et al. 2 This questionnaire focuses on the main problems in patients with progressive lung fibrosis in a limited manner. Therefore a new quality of life questionnaire for patients with idiopathic pulmonary fibrosis was developed and linguistically validated. METHODS: The linguistic validation of our questionnaire was carried out in a multistage process in collaboration with the developer of the questionnaire and bilingual, professional translators. Review by the developers and back translations as well as clinical assessment by IPF- and iNSIP-patients ensured that the translated questionnaire reflected the intention of the original English version of our questionnaire.Cross-validation was carried out with the St. Georges Respiratory Questionnaire (SGRQ). RESULTS: The new questionnaire concerning the health status was composed in English and German language. The questions cover five scales (sensitivity, selectivity and symptoms like breathlessness and cough and a visual analog scale on general health status) with 23 items. CONCLUSIONS: The results show that the FFB maps the special needs of the patients with IPF and iNSIP well and can support clinical and scientific questions and can be helpful in monitoring the clinical course.

[Patient Education Programs in Child and Adolescent Rehabilitation]. / Patientenschulung in der Kinder- und Jugendlichenrehabilitation.

Comprehensive evidence has been provided for the significant increase in most chronic physical illnesses among children and adolescents. Therefore, early diagnosis and multimodal intervention in childhood and adolescence is required to prevent a chronic course of disease. Thus, patient education is essential for the medical child and adolescent rehabilitation. In particular, in developing asthma, atopic dermatitis and obesity training in the past, a basic consensus on the theory and methodology of patient education has emerged. Specifically, in addition to illness-specific modules, generic modules and treatment objectives should be incorporated.

[What does really help against cancer-related fatigue? An overview of systematic reviews]. / Was hilft wirklich bei tumorbedingter Fatigue? Ein Überblick über systematische Übersichtsarbeiten.

Cancer-related fatigue, a subjective feeling of a distinctive physical, emotional and/or cognitive tiredness, is a common phenomenon in patients with cytotoxic chemotherapy or radiotherapy. Research on cancer-related fatigue has been intensified in the last decade. The objective of this work was to give an overview of the effectiveness of non-pharmacological interventions for cancer-related fatigue. Therefore, the databases of the Cochrane Library, PubMed, CINAHL and DAHTA were searched for systematic reviews. Two persons independently selected the reviews and assessed the methodological quality. We used the measurement tool AMSTAR to assess the methodological quality of each systematic review. The results were summarised in a qualitative synthesis. A total of 24 reviews were included in the analysis. The results show that physical activity and psycho-social support can reduce fatigue in cancer patients. Particularly, nurse-led fatigue specific interventions proved to be effective. Currently the evidence for other intervention types is weak; however there exist some promising approaches. Despite a large number of randomised clinical trials as well as systematic reviews the evidence base is still deficient in many respects. The results can be used by nurses in clinical care, counselling and education of cancer patients.

[Cancer-related fatigue. Psychosocial support]. / Tumorbedingte Fatigue: Psychosoziale hilfen.

Cancer-related fatigue is a subjective sensation of uncontrollable physical, emotional and/or cognitive tiredness and weakness, which occurs in the context of cancer or cancer-treatment. Cancer-related fatigue occurs at all stages of cancer treatment and can persist long after medical treatment. It profoundly affects patients' quality of life and limits their personal, social, and occupational lives. Cancer-related fatigue is also associated with significant levels of distress, and it imposes financial burdens by limiting a patient's ability to work. Current psychosocial interventions with strong or sufficient evidence include physical training, cognitive-behavioral training, relaxation techniques, psychoeducation and patient education. This article gives an overview of currently available psychosocial interventions and information on their implementation.

[Cancer-related fatigue and its psychosocial burden]. / Tumorbedingte Fatigue und ihre psychosozialen Belastungen.

Cancer-related fatigue (CRF) is a highly prevalent and the most distressing symptom during and after treatment for cancer. It is characterized by feelings of physical and mental tiredness, weakness, and lack of energy and is not influenced by rest or sleep. Approximately 40% of patients suffer from CRF at diagnosis and nearly all patients experience fatigue during the course of cancer therapy. The impact of CRF on daily living and patient quality of life (QoL) is substantial. It profoundly affects patient quality of life and limits personal, social and occupational roles. The fatigue is also associated with significant levels of distress and it imposes a financial burden by limiting the ability to work. The underlying causes of CRF are poorly understood as are the relationship between fatigue and psychosocial distress, depression or anxiety. This paper seeks to give an overview of cancer-related fatigue and its psychosocial burden.

[Cancer-related fatigue and its psychosocial burden]. / Tumorbedingte Fatigue und ihre psychosozialen Belastungen.

Cancer-related fatigue (CRF) is a highly prevalent and the most distressing symptom during and after treatment for cancer. It is characterized by feelings of physical and mental tiredness, weakness, and lack of energy and is not influenced by rest or sleep. Approximately 40% of patients suffer from CRF at diagnosis and nearly all patients experience fatigue during the course of cancer therapy. The impact of CRF on daily living and patient quality of life (QoL) is substantial. It profoundly affects patient quality of life and limits personal, social and occupational roles. The fatigue is also associated with significant levels of distress and it imposes a financial burden by limiting the ability to work. The underlying causes of CRF are poorly understood as are the relationship between fatigue and psychosocial distress, depression or anxiety. This paper seeks to give an overview of cancer-related fatigue and its psychosocial burden.

[Developmental model of obesity in early childhood]. / Entwicklungsmodell der Adipositas im Kindesalter.

Periods of heightened vulnerability to weight gain have been identified, and research supports the notion that obesity has its origins in early life. Maternal overweight, maternal smoking during pregnancy, high or low birth weight, rapid growth in early infancy, and early adiposity rebound all have been implicated in the development of obesity. This paper focuses on susceptibility to increased overweight and adiposity during the prenatal period, infancy and mid-childhood, and on how factors operating in each of these periods by their timing and duration, and also whether other co-factors are present. The persistence of obesity from early childhood emphasizes the importance of understanding growth trajectories, and a developmental view on early risk factors of adiposity. A systematic review of early risk factors may help developing prevention strategies to overcome strong influences of obesogenic environments at young age.

[Patient education in pulmonary rehabilitation: results of an implementation study]. / Patientenschulungsprogramme in der pneumologischen Rehabilitation: Ergebnisse einer Implementationsstudie.

Patient education is considered to be a major feature of medical rehabilitation in chronic disorders. While the substantial advances in the proposition of patient education programmes in in-patient health-care remain unquestioned, there are some deficits in actually performing such programmes in clinical practice. Only few clinics adhere to the protocol and recommendations for patient education. Mostly there are deviations in the actual performance of asthma education, e. g., mixing of different education schemes or using self-developed material. The reasons why clinics hesitate to use evaluated patient education programmes is still unclear. One can assume that there are problems due to organisation, structure or staff. This project aimed at observing the process of implementation of a new asthma education programme in order to identify barriers and helpful factors for the implementation. We conducted the study in three rehabilitation centres that did not use evaluated asthma education programmes. In these clinics we implemented the new education programme. After identifying the structure of the clinic before and after the implementation, interviewing the trainers and other staff members, we could assess the specific resources and barriers. We then included these aspects into recommendations for implementation. The most important barriers we found were too few staff and problems in planning the time and rooms for the programme. There was a high level of acceptance among all staff members and patients. The entire programme causes costs of 97 euro per patient. The costs at the beginning of the implementation were higher than those for the routine use.

[Asthma among senior adults]. / Der ältere Asthmapatient.

Elderly patients with asthma are a specific group with particular needs. These must be addressed in order to provide appropriate asthma care. Asthma causes higher morbidity and mortality rates among the elderly patients. Older patients often fail or have problems with compliance and self-management due to age-specific factors. Older patients with asthma are often misdiagnosed, due to an impaired patient perception of symptom severity, different opinions of what kind of asthma-control is possible, or not sufficient communication skills. Often the quality of life is impaired by asthma. Improvement in self management skills in a special way may enhance the health status of elderly patients with asthma.

[Asthma management: what impact does knowing about asthma have on the ability of patients to self-manage the disease?]. / Asthmamanagement: Welche Bedeutung hat das krankheits- und behandlungsbezogene Wissen des Patienten?

Knowledge about asthma is frequently assumed to be a prerequisite for optimal asthma management. But the relevance of asthma knowledge for implementing changes of behaviour in the everyday life of patients, their self-management, compliance and coping remains unclear. Taken by itself, knowledge about asthma does not have a direct impact on practical skills of disease management, but it has an indirect effect on it through patients' ability to adapt to the disease.. In order to impart knowledge it can be helpful to consider patients} experiences, their view of illness and strategies of coping. In some cases using a questionnaire about patients' knowledge of asthma was helpful to identify those patients who have little such specific knowledge. They could then be channelled into specific interventions, for example asthma education programs.

[How do patients with COPD circumvent their disease? Psychological factors]. / Wie gehen COPD-Patienten mit ihrer Erkrankung um? Psychologische Grundlagen.

Chronic illness permanently changes a patient;s lifestyle and requires continuous adaptation. Chronic diseases like COPD and its treatment place extensive behavioral demands on patients. The need for precisely scheduled daily medication, regular physical exercise, visits to health care providers and monitoring are some of the demands. Exacerbations, inspiratory dyspnea, immobility, and the management of unpredictable situations aggravate the situation. These demands invade nearly every aspect of patients} lives. The quality of patients}self-management of disease depends largely on their assessment of health related quality of life, functioning, ability to comply and coping. COPD patients often have perceived barriers and factors, which will hinder or facilitate an optimal self-management. For instance their individual treatment goals can differ from those of the physician, or patients feel distressed about having a chronic disease. The comprehension of psychological factors in medical treatment is essential not only to be more effective in improving patients' confidence in their ability to follow a self-care regimen but also have beneficial effects in achieving treatment goals.

Long term culture of epithelia in a continuous fluid gradient for biomaterial testing and tissue engineering.

Epithelia perform barrier functions being exposed to different fluids on the luminal and basal side. For long-term testing of new biomaterials as artificial basement membrane substitutes, it is important to simulate this fluid gradient. Individually-selected biomaterials can be placed in tissue carriers and in gradient containers, where different media are superfused. Epithelia growing on the tissue carriers form a physiological barrier during the whole culture period. Frequently however, pressure differences between the luminal and basal compartments occur. This is caused by a unilateral accumulation of gas bubbles in the container compartments resulting in tissue damage. Consequently, the occurence of gas bubbles has to be minimized. Air bubbles in the perfusion culture medium preferentially accumulate at sites where different materials come into contact. The first development is new screw caps for media bottles, specifically designed to allow fluid contact with only the tube and not the cap material. The second development is the separation of remaining gas bubbles from the liquid phase in the medium using newly-developed gas expander modules. By the application of these new tools, the yield of embryonic renal collecting duct epithelia with intact barrier function on a fragile natural support material can be significantly increased compared to earlier experiments.

Modulation of cell differentiation in perfusion culture.

An in vitro model was used to investigate the terminal differentiation mechanisms leading from embryonic to adult renal tissue. For these experiments the capsula fibrosa with adherent embryonic tissue was isolated from neonatal rabbit kidneys. These explants were mounted onto special tissue carriers and cultured in medium containing serum for 24 h. During that time collecting duct (CD) cells grew out and formed a monolayered epithelium covering the whole surface of the explant. The carriers were then transferred to perfusion culture containers to obtain an optimal degree of differentiation. A special type of container allowed us to continuously superfuse the epithelia with individual media on the luminal and basal sides. Using this method it became possible to culture embryonic CD epithelia in a fluid gradient for weeks. The epithelia were superfused with standard Iscove's modified Dulbecco's medium (IMDM) on the basal side, while IMDM containing additional NaCl was used on the luminal side. In controls IMDM was superfused on both the luminal and basal sides. It was found that the degree of differentiation in the CD epithelia is dependent on the influence of fluid gradient exposure. Perfusion culture under isotonic conditions revealed that less than 5% of cells were immunopositive for principal and intercalated cell features, while epithelia cultured in a luminal-basal gradient showed more than 80% positive cells. Immunoreactivity for characteristic markers started to develop after an unexpectedly long latent period of 3-6 days, then increased continuously during the following 5 days and reached a maximum on day 14. After switching back from the gradient to isotonic culture conditions the immunoreactivity for some markers decreased within 5 days, while other characteristic features remained stable. Thus, differentiation was not only under the control of growth factors but was also regulated by the electrolyte environment.

Expression of the gap junction protein connexin43 in the subependymal layer and the rostral migratory stream of the mouse: evidence for an inverse correlation between intensity of connexin43 expression and cell proliferation activity.

Connexins constitute the channel-forming proteins of gap junctions. Gap junctions are considered to be involved in the regulation of cell proliferation. To verify this hypothesis for connexin43, the most abundant connexin in brain tissue, we have analyzed the expression of this gap junction protein in the subependymal layer and the rostral migratory stream of the murine telencephalon. These regions reveal high proliferative activity, even during postnatal stages and in adulthood. Proliferating cells were labeled in vivo by means of the bromodeoxyuridine method and were later processed for double immunocytochemistry by using an antibody to connexin43. The relationship between connexin43 expression and cell proliferation was also determined in primary cell cultures of olfactory bulbs from newborn mice. The intercellular coupling efficiency of cultured bulbar cells was also analyzed by dye-transfer experiments in combination with the bromodeoxyuridine technique. In the rostral migratory stream, connexin43 was upregulated during postnatal development, coinciding with a decrease of BrdU incorporation. Comparative quantification of the intensity of connexin43 immunoreactivity by confocal laser microscopy and of BrdU-labeled cells showed a clear reverse correlation between connexin43 expression and cell proliferation in the rostral migratory stream during postnatal development. A marked reverse correlation of both parameters was also observed in primary cell cultures from olfactory bulbs at day 6 after seeding.

Three-dimensional organization of the developing vasculature of the kidney.

Kidney function depends on a well-developed vascular system. Any impairment of the blood supply disturbs the integrity and function of the organ. The differentiation of renal vessels has been investigation for many years, but little is known about the relationship between nephrogenesis and vessel development. In the present work the spatial organization of the differentiating vessels was analyzed in precisely oriented tissue sections and in optical sections acquired by laser scan microscopy. Developing vessels as well as small capillaries were visualized with two endothelium-detecting antibodies. Small vessels running in parallel towards the organ capsule were detected in numerous cortico-medullary-oriented tissue sections. Cross-sections of the nephrogenic zone showed a regularly arranged network, which was composed of cells detected by both monoclonal antibodies. Parts of this network were localized in regions of the nephrogenic zone which have been assumed to be free of vessels or vessel-like structures for a long time. These results were confirmed by the laser-scan-microscopic analysis of complete cortex explants. The extraordinarily regular arrangement of the endothelial network in the nephrogenic zone allowed us to reconstruct the developing vascular system. The results presented here underline the close relationship between nephrogenesis and vessel development.

Expression of the tight junction protein ZO-1 in the olfactory system: presence of ZO-1 on olfactory sensory neurons and glial cells.

The olfactory system is a unique part of the central nervous system since it retains neuronal turnover and regenerative capacities in adulthood. Thus it provides an ideal model to study plasticity of membrane moities involved in cell-cell interactions. One structure particularly involved in cell-cell interaction is the tight junction, which establishes polarization of epithelial cells and creates diffusion barriers to paracellular passages. ZO-1 is a phosphoprotein peripherally associated with tight junctions. We have studied expression of ZO-1 protein in the developing and adult olfactory system of the mouse in order to get information about the localization and developmental expression of this tight junction component. ZO-1 expression has also been determined in cell cultures of olfactory bulbs. ZO-1 was present in the olfactory placode prior to formation of tight junctions. ZO-1 was localized in the developing and mature olfactory epithelium at heterotypic contacts between supporting cells and olfactory neurons as well as at homotypic contacts between both these cell types. Confocal microscopy showed quantitative differences in the ZO-1 expression among different olfactory dendrites. In the olfactory nerves ZO-1 immunolabeling was detectable between olfactory ensheathing cells. From the seventh postnatal day ZO-1 immunolabeling was detected at the mitral cell layer of the bulb on cells tentatively identified as oligodendrocytes. Myelinated tracts of the bulb were ZO-1 negative. Cell cultures of olfactory bulbs showed ZO-1 immunoreaction, mostly localized on glial fibrillary acidic protein (GFAP)-positive cells. Our results provide further evidence that ZO-1 serves functions unrelated to the tight junction complex and indicate molecular heterogeneity of these cell-cell contacts.

[Intraoperative pressure measurement at the median nerve in carpal tunnel syndrome and its surgical significance]. / Intraoperative Druckmessung am N. medianus beim Karpaltunnelsyndrom und deren operative Bedeutung.

The authors measured the intraoperative pressures on the median nerve in local anesthesia in thirty patients. Pressures were recorded at the distal antebrachial fascia near the carpal tunnel, at the proximal and distal carpal tunnel and at the level of the palmar fascia distal to the carpal tunnel. The two passive and three active movements examined generally led to a pressure elevation. Passive movements had a greater effect on pressure at the proximal carpal tunnel. Active movements led to a high pressure level in the proximal and distal carpal tunnel higher than those observed during passive movements. Beneath the distal antebrachial fascia near the carpal tunnel, the pressure level was higher than beneath the antebrachial fascia at a greater distance from the carpal tunnel. Pressure levels beneath the distal antebrachial fascia correlated with the patient's age. Pressure values beneath the palmar fascia were low during passive and active movements. As a consequence, division of the flexor retinaculum and the distal antebrachial fascia up to 3 cm proximal of the carpal tunnel is necessary, whereas dissection of the palmar fascia distal to the carpal tunnel is not.

Polarized distribution of binding sites for concanavalin A and wheat-germ agglutinin in the zona pellucida of goodeid oocytes (teleostei).

Zonae pellucidae of the viviparous goodeid teleosts Girardinichthys viviparus, Xenoophorus captivus, and Xenotoca eiseni were investigated ultrastructurally, and binding sites for ConA and WGA were localized on cross-sections using a colloidal gold technique. In late stages of development, the oocytes are surrounded by a three-zonated acellular matrix multiply perforated by pore canals allowing long microvilli of the oocyte to penetrate interstices of the follicle epithelium. Together, the surface of the microvilli and zona pellucida is coated by a thin layer of homogeneous slightly electron-dense material. In early oogenesis, the thin acellular layer is entirely packed with binding sites for WGA, whereas those for ConA occur only sparsely. Three-zonated zonae pellucidae amply contain both WGA and ConA receptors. The asymmetric labelling pattern obtained with both lectin protein gold preparations indicates a polarized organization of the different glycoconjugates. WGA receptors are concentrated within the outer region of the zona pellucida. Labelling with ConA-HRP-Au complexes produced heavy deposits of marker beads within the inner two thirds of the zona pellucida and weak labelling of the superficial coat. After prolonged digestion with neuraminidase, WGA binding sites were no longer detectable.

Maternal-embryonic relationships in the goodeid teleost, Xenoophorus captivus. The vacuolar apparatus in trophotaenial absorptive cells and its role in macromolecular transport.

The endodermal trophotaenial epithelium in goodeid embryos acts as a placental exchange site. Fine structural and cytochemical data indicate that the trophotaenial absorptive cells are endocytotically highly active. To test their micropinocytotic capacity and characterize the cellular mechanisms involved in membrane, solute and ligand movements, living embryos of Xenoophorus captivus were incubated in saline media containing horseradish peroxidase (HRP) and/or cationized ferritin (CF) in vitro, and the uptake of these tracer proteins examined by both time sequence analysis and pulse-chase procedures. In some embryos, the effects of prolonged exposure to CF injected into the ovarian cavity, was also investigated. Labelling of the free cell surface was detectable with CF only, but interiorization of both probes was quick from all incubation media. Adsorptive pinocytosis of CF and fluid-phase uptake of HRP sequentially labelled pinocytic vesicles, endosomes, and lysosome-like bodies. In addition, CF-molecules were sequestered within apical tubules and small vesicles. HRP was largely excluded from both organelles and ended up in the lysosomal compartment. For CF, two alternative pathways were indicated by the pulse-chase experiments; transcellular passage and regurgitation of tracer molecules to the apical cell surface. The latter procedure involves membrane and receptor recycling, in which apical tubules are thought to mediate. In double-tracer experiments, using an 8:1 excess of HRP, external labelling with CF was light or lacking after 1-3 min, and the initial uptake-phase produced pinocytic vesicles and endosomes that mainly contained HRP-reaction product. Prolonged incubation, however, resulted in densely CF-labelled plasmalemmal invaginations and pinocytic vesicles that predominantly carried ferritin granules. After 60 min, the vacuoles of the endosomal compartment contained either high concentrations of HRP-reaction product, both tracers side by side, or virtually exclusively CF.

Microspectrophotometric and scanning microphotometric studies of carp (Cyprinus carpio L.) erythrocytes.

Carp (Cyprinus carpio) hemoglobin readily autoxidizes in blood smears. Quantification of Soret-band absorbance in individual erythrocytes by means of scanning cytophotometry therefore requires more elaborate methods of preparation of blood samples. Of the fixatives that have been tested, suspension of whole blood in isotonic salt solutions containing glutaraldehyde was most suitable. Glutaraldehyde-fixed red blood cells are totally resistant to hemolysis. In the course of fixation, hemoglobin is transformed to methemoglobin. Spectrophotometry indicated extensive similarities between glutaraldehyde-fixed carp methemoglobin and human methemoglobin. In aqueous solutions, the intensity of the Soret-peak was pH-dependent. The allosteric modifier organic polyphosphate caused an R----T transition, resulting in increased molar extinctions. Dried preparations showed Soret-spectra that were not influenced from either pH or organic polyphosphate concentration of the aqueous suspensions in which the erythrocytes had been stored. The same was true for slide preparations of cyanomethemoglobin, easily derived from methemoglobin on addition of potassium cyanide. In the absence of oxygen fresh blood cells from carp slowly transform their hemoglobin into deoxyhemoglobin. Spectra of the intermediate stages of deoxygenation, Hb4(O2)3, Hb4(O2)2 and Hb4(O2), as well as mixtures of these intermediates, could be monitored.