[Alzheimer dementia: course and burden on caregivers : Data over 18 months from German participants of the GERAS study]. / Alzheimer-Demenz: Verlauf und Belastung der Pflegepersonen : 18-Monats-Daten der deutschen Teilnehmer der GERAS-Studie.

The GERAS study is an international observational study with dementia patients of the Alzheimer type (AD) and their caregivers in everyday care. The 18-month data recorded in Germany are presented. Disease progression, medical and psychosocial consequences for both patients and caregivers were recorded using commonly used tests in clinical care: the mini mental status examination (MMSE), Alzheimer's disease assessment scale (ADAS-Cog14), Alzheimer's disease cooperative study activities of daily living inventory (ADCS-ADL), neuropsychiatric inventory (NPI-12), resource utilization in dementia (RUD) and the Zarit burden interview (ZBI). Definition of AD severity level (MMSE): 21-26 mild (miAD), 15-20 moderate (moAD), <15 moderately severe to severe (m/sAD). For the 550 participants (mean age: 75.2 years, SD 7.6 years), miAD (41.5%), moAD (28.4%) and m/sAD (30.2%), the MMSE worsened: in miAD by -2.4 (CI -3.1/-1.7), in moAD by -3.9 (CI -5.0/-2.8) and in m/sAD by -2.5 (CI -3.5/-1.5) at 18 months and the ADAS-Cog14 by 6.2 (miAD-CI 4.6/7.8) and 7.1 points (moAD CI 3.9/10.3). Changes in overall ADCS-ADL amounted to -8.4 (CI -10.1/-6.2) for miAD, -12.9 (CI -15.3/-10.4) for moAD and -10.2 points (CI-12.8/-7.7) for m/sAD. Caregiver burden (NPI-12) rose in miAD by 1.2 points (CI -0.2/2.2), in moAD by 3.4 (CI 1.8/5.1) and in m/sAD by 1.5 points (CI 0.2/3.3). At study start, the total time required by caregivers (RUD) was 3.1 h/day (SD 5.4 h/day) for miAD, 6.6 (SD 7.5) for moAD and 12.7 (SD 9.3) for m/sAD. With 4.4 (SD 9.4) h/day, the increase after 18 months was highest in moAD. Caregiver burden (ZBI) increased most markedly in moAD with 7.2 (CI 4.2/9.7), 90.7% of the patients received antidementia drugs, while 26.6% received psychotropic medication.

Recent Developments in Pharmacotherapy of Alcoholism.

INTRODUCTION: Alcohol use disorders are common, but only a small minority of patients receive adequate treatment. Cognitive-behavioural therapies, motivational enhancement interviewing and brief interventions are established treatments, but few pharmacotherapies are available. AREAS COVERED: This narrative focuses on the neurobiological basis of alcohol use disorders and on emerging drugs that either have recently been approved or look likely to find their way into clinical practice. To date, acamprosate and the opioid antagonist naltrexone have been approved for treatment of alcohol dependence. Recently, the mu-opioid antagonist and partial kappa agonist nalmefene was approved by the European Medicines Agency for reduction of alcohol consumption. Novel clinical approaches include drugs established for other indications such as the GABA-B receptor agonist baclofen, anticonvulsants such as topiramate and gabapentin, the partial nicotine receptor agonist varenicline, and other drugs. Developments in pharmacogenetics are discussed. CONCLUSIONS: The development of pharmaceutical agents to treat alcohol use disorders has lagged behind that of depression and schizophrenic psychosis and is hampered by an incomplete understanding of the neurobiological background. Pharmacogenetics may improve treatment in the future.

[Mirtazapine and hyperemesis gravidarum]. / Mirtazapin bei Hyperemesis gravidarum.

The case of a 29-year-old patient in the 21st gestational week with severe hyperemesis gravidarum which did not respond to conventional antiemetic treatment is reported. Nausea and vomiting improved within 48 h after i.v. administration of 30 mg mirtazapine/day. The pathophysiological and therapeutic implications are discussed.

[Psychotic and non-psychotic denial of pregnancy]. / Psychotische und nicht psychotische Verleugnung der Schwangerschaft.

We report about two patients with denial of pregnancy. While the first patient was free of psychopathological symptoms besides denial of pregnancy until rupture of the membranes, and was able to accomodate the new born, the second patient with psychotic denial of pregnancy could not accomodate the child because of the schizophrenia, so that an adoption was necessary. On the basis of the two cases aetiological, epidemiological, clinical und prognostic implications of psychotic and non-psychotic denial of pregnancy are discussed.

Effects of alcohol consumption on iron metabolism.

BACKGROUND/OBJECTIVES: Patients with alcohol abuse frequently suffer from malnutrition which may result in insufficient iron distribution and iron overload or deficiency. Iron metabolism can be described by a combination of biochemical soluble transferrin receptor, ferritin, C-reactive protein (CRP), and hematological parameters. Here, vitamin B12 and folic acid state were assessed. Results on iron metabolism in patients with alcohol dependence in comparison with social drinkers are presented. MATERIALS/METHODS: Samples from 101 patients with dependent alcohol consumption were included. The control group comprised 115 social drinkers. Inclusion criteria for patients with chronic regular drinking/social drinkers were positive/negative score of the Alcohol Use Disorders Identification Test (AUDIT), and positive/negative score for alcohol abuse/dependence (DSM-IV criteria). RESULTS: Absolute values for ferritin and sTfR are increased in patients with alcohol dependence with current consumption (ALC) compared with social drinkers. No major differences are observed in the ratio of sTfR/log ferritin in comparison with social drinkers. Hemoglobin concentrations correlated between the two groups. Mean corpuscular volume (MCV) was significantly increased in the ALC collective compared to social drinkers. Eighty patients of the alcohol-dependent group had sufficient iron repletion, 11 had iron overload, 6 are suspicious for functional iron deficiency, and 4 are suspicious for reduced iron supply. No vitamin B12/folate deficiencies are observed in alcohol-dependent patients. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: No major abnormalities of iron metabolism are seen in patients with chronic alcohol ingestion besides the well-known macrocytic anemia. Iron overload is relatively frequent and observed in 9% of cases. No differences in vitamin B12 and folate levels were found between individuals with alcohol dependence and social drinkers.

Endocytosis of interleukin 2 receptors in human T lymphocytes: distinct intracellular localization and fate of the receptor alpha, beta, and gamma chains.

Members of the cytokine receptor family are composed of several noncovalently linked chains with sequence and structure homologies in their extracellular domain. Receptor subfamily members share at least one component: thus the receptors for interleukin (IL) 2 and IL15 have common beta and gamma chains, while those for IL2, 4, 7, and 9 have a common gamma chain. The intracellular pathway followed by IL2 receptors after ligand binding and endocytosis was analyzed by immunofluorescence and confocal microscopy in a human T lymphocytic cell line. Surprisingly, the alpha, beta, and gamma chains had different intracellular localizations after being endocytosed together. The alpha chain was always in transferrin-positive compartments (early/recycling endosomes), both at early and late internalization times, but was never detected in rab7-positive compartments (late endosomes). On the other hand, at late internalization times, the beta and gamma chains were excluded from transferrin-positive organelles and did not colocalize with alpha. Furthermore, beta could be found in rab7-positive vesicles. These differences suggest that the alpha chain recycles to the plasma membrane, while the beta and gamma chains are sorted towards the degradation pathway. The half-lives of these three chains on the cell surface also reflect their different intracellular fates after endocytosis. The beta and gamma chains are very short-lived polypeptides since their half-life on the surface is only approximately 1 h, whereas alpha is a much more stable surface protein. This shows for the first time that components of a multimeric receptor can be sorted separately along the endocytic pathway.

Imaging nanometre-sized hot spots on smooth au films with high-resolution tip-enhanced luminescence and Raman near-field optical microscopy.

A novel near-field optical microscope based on a parabolic mirror is used for recording high-resolution tip-enhanced photoluminescence (PL) and Raman images with unprecedented sensitivity and contrast. The measurements reveal small islands on the Au surface with dimensions of only a few nanometres with locally enhanced Au PL. These islands appear as nanometre-sized hot spots in tip-enhanced Raman microscopy when benzotriazole molecules adsorbed on the Au surface serve as local sensors for the optical field. The spectra show that localized plasmons are the cause of both the locally enhanced Au PL and enhanced Raman scattering. This finding suggests that the dispersive background in the surface-enhanced Raman spectra can be explained simply by the enhanced Au PL in the gap. Furthermore, our results show that the surface flatness must be better than 1 nm, to provide an optically homogeneous substrate for near-field enhanced PL and Raman spectroscopy.

Domino reactions for library synthesis of small molecules in combinatorial chemistry.

Domino reactions are highly efficient processes that allow the synthesis of complex molecules starting from simple substrates, in a straightforward fashion. The transformations are extremely useful for the design of small-molecule libraries by combinatorial chemistry if multicomponent domino reactions are employed. The reactions can be performed in solution, as well as on solid support, and give access to highly diverse molecules; in addition, their use in automated synthesis is possible.

Spontaneous mutation at a 5-methylcytosine hotspot is prevented by very short patch (VSP) mismatch repair.

In many strains of Escherichia coli, the product of gene dcm methylates the internal cytosines in the sequence 5'CC(A or T)GG. Spontaneous deamination of 5-methylcytosine produces thymine which, if not corrected, can result in a transition mutation. 5-Methylcytosines in the lacI gene are hotspots for spontaneous C to T mutations. dcm is linked to vsr, a gene required for very short patch (VSP) repair. VSP repair corrects T.G mispairs in the following contexts:CTAAGGGGTCC, CTTGGGGACC, TAGGGTCC and CTAGGGTC. I have investigated the relationships between cytosine methylation, mutation, and VSP repair. Spontaneous mutations in the repressor (cI) gene of lambda prophage were isolated in wild-type and mutant lysogens. A hotspot for spontaneous mutation that corresponds with a 5-methylcytosine was observed in wild-type lysogens but was not present in bacteria lacking both methylase and VSP repair activity. Introduction of a plasmid containing dcm+ and vsr+ restored the mutation hotspot. If the added plasmid carried only dcm+, the frequency of spontaneous mutations at the 5-methylcytosine was over 10-fold higher than in Dcm+Vsr+ lysogens. The addition of vsr on a plasmid to a wild-type lysogen resulted in a 4-fold reduction in mutation at the hotspot. These findings support the previously untested hypothesis that VSP repair prevents mutations resulting from deamination of 5-methylcytosine.

Very short patch mismatch repair in phage lambda: repair sites and length of repair tracts.

Five amber mutations in the repressor (cI) gene of bacteriophage lambda recombine anomalously with nearby cI mutations. When any of these markers is used in four-factor crosses, cI+ recombinants that are expected to require three cross-overs occur at high frequencies. These recombinants are attributable to very-short-patch (VSP) repair of specific mismatches in DNA heteroduplexes formed during recombination between the markers flanking cI. The sites of the repair-prone mutations and the lengths of repair tracts have now been determined. Amber mutations subject to VSP repair are C to T transitions in 5'CCATGG, the sequence methylated by the product of gene dcm, and also in the related 5'CAGG or 5'CCAG sequences. Ambers arising in CAG sequences found in other contexts, or in codons other than CAG, were not subject to VSP repair. Repair tracts rarely, if ever, exceed ten nucleotides in length, and can be as short as two nucleotides. A repair-prone mutation does not stimulate recombination between flanking cI markers.

Recombination between IS5 elements: requirement for homology and recombination functions.

Intermolecular recombination between two IS5 elements was measured, using bacteriophage lambda recombination vectors, and was compared to recombination between two copies of an SV40 segment cloned into the same vectors. Experiments were conducted in the presence and in the absence of RecA and Red functions, and with the recombining inserts in the same or in reversed orientation. Under all conditions, IS5 elements recombined in a manner similar to the SV40 inserts, indicating that IS-encoded functions did not confer measurable additional intermolecular recombination ability to IS5 in E. coli K-12. Bacteriophages containing reversed IS5 inserts, for which the 16 base pair (bp) termini are identical in 15 positions and which display 12 bp of uninterrupted homology, recombined at approximately the same low frequency under Rec+ and Rec- conditions, indicating that these short homologies were not good substrates for the Rec system. Bacteriophages having reversed inserts recombined better under Red+ than under Red- conditions, but the crossovers were located in nonhomologous regions flanking the element termini. This suggests that 12-bp homologies are not good substrates for the Red system.

Crosses between insertion and point mutations in lambda gene cI: stimulation of neighboring recombination by heterology.

Intragenic recombination between lambda cI point mutations and insertions was studied in four-factor crosses. In crosses between two point mutations, there is a linear relationship between recombination frequency and distance. However, in crosses between an insertion and point mutations, there is additional recombination in the regions 200 base pairs to the right and to the left of the insertion. The recombinational stimulation occurred with IS insertions and also with insertions consisting of HindIII fragments of SV40 and with a deletion that removes part of cI. This indicated that the stimulation was a result of heterology per se rather than of information encoded by the insertions. Either Rec or Red functions are sufficient for enhanced recombination near a heterology. The stimulation is attributed to more frequent resolution of recombinational intermediates in the neighborhood of a heterology. "Stalling" of migrating branches or invading strands at a heterology may increase the probability of local DNA cleavage.

Does Chi give or take?

In lytic cycle crosses with Red-Gam-lambda phage, particles were examined that had undergone an Int-mediated exchange. It was assumed that this exchange dimerized the circular lambda, making it packageable. Among these Int-mediated recombinants, particles were identified that had, in addition, enjoyed a close double exchange mediated by the RecBC pathway. Such close double exchanges indicate localized negative interference and are analogous to eukaryotic conversions that have retained parental configuration of flanking markers. These events are stimulated by Chi, a recombinator specific to the RecBC pathway. When Chi is present in only one parent in the cross, the complementary double exchange recombinants are Chi stimulated to the same degree. This behavior of Chi contrasts with that of characterized eukaryotic recombinators.

A high numerical aperture parabolic mirror as imaging device for confocal microscopy.

We explore the diffraction limited focusing and confocal imaging properties of a high NA parabolic mirror for confocal imaging and spectroscopy of nanoparticles and single molecules. Vector field calculations of the electric fields near focus for both linear and radially polarized illumination are discussed and show that the optical field can be similar tightly focused as in the case of a high NA objective lens. Furthermore they show that a high NA parabolic mirror allows an easy orientation of the polarization of the illuminating light in all spatial directions. The simulation of confocal imaging of single molecules is discussed and yields, that the use of radially polarized excitation light gives an easy access to their orientations.

Confocal microscopy with a high numerical aperture parabolic mirror.

A novel high-resolution stage scanning confocal microscope for fluorescence microscopy and spatially resolved spectroscopy with a high numerical aperture (NA 1) parabolic mirror objective is investigated. A spatial resolution close to the diffraction limit is achieved. As microscopic fluorescent test objects, dye-loaded zeolite microcrystals (diameter approx. 0.4 microm) and single fluorescent molecules were used. Confocal fluorescence images show a spatial resolution of .x = 0.8 . both at room temperature and at 1.8 K. Imaging of a quasi-point light source and focusing by the parabolic mirror were investigated experimentally and theoretically. Deviations between the theoretical results for a perfect parabolic mirror and the experimental results can be attributed to small deviations of the mirror profile from an ideal parabola.

Amelioration of experimental lipid keratopathy by photochemically induced thrombosis of feeder vessels.

The photochemical interaction between intravenously injected rose bengal dye and 514.5-nm argon laser irradiation was employed to initiate permanent thrombotic occlusions in the corneal neovasculature of rabbit eyes with experimentally induced lipid keratopathy. This photothrombotic procedure did not produce corneal edema or polymorphonuclear leukocyte infiltration, as was found in previous studies employing laser-induced photocoagulation. Thus, by means of the new technique, we avoided the formation of additional neovascularization and lipid deposition. Vascular occlusion by photothrombosis, effected with 8.5 times less incident intensity and 27.5 times less total light exposure than with photocoagulation, yielded an average reduction of corneal cholesterol content of 36% as opposed to an increase of 24% found with previous argon laser photocoagulation.

Repetitive behaviors in chronically institutionalized schizophrenic patients.

Repetitive dysfunctional behaviors (e.g., polydipsia, bulimia, hoarding, mannerisms) are frequently observed in chronically institutionalized schizophrenics, cause significant morbidity and are readily reproduced in animal models. The goal of this study was to assess the frequency and severity of these behaviors. Thirty-two chronic schizophrenics on an extended treatment unit were rated on the Elgin Behavioral Rating Scale, which includes eight repetitive behaviors and eight positive and negative symptoms. Forty-seven percent of the patients exhibited at least one severe, or 2 moderate, repetitive behaviors, while 63% exhibited at least one severe or 2 moderate positive or negative symptoms. The mean total score (+/- SD) on the eight repetitive behaviors (10.3 +/- 6.1) was about 2/3 that for the eight positive and negative symptoms (15.3 +/- 8.9, t = 4.1, p = .0001). Interrater reliability for the repetitive behaviors was similar to that for the positive and negative symptoms. Repetitive behaviors were positively related to male gender, white race and total length of hospitalization. Repetitive dysfunctional behaviors are frequently observed and can be reliably rated in chronically institutionalized schizophrenics.