Vector-borne Trypanosoma brucei parasites develop in artificial human skin and persist as skin tissue forms.

Transmission of Trypanosoma brucei by tsetse flies involves the deposition of the cell cycle-arrested metacyclic life cycle stage into mammalian skin at the site of the fly's bite. We introduce an advanced human skin equivalent and use tsetse flies to naturally infect the skin with trypanosomes. We detail the chronological order of the parasites' development in the skin by single-cell RNA sequencing and find a rapid activation of metacyclic trypanosomes and differentiation to proliferative parasites. Here we show that after the establishment of a proliferative population, the parasites enter a reversible quiescent state characterized by slow replication and a strongly reduced metabolism. We term these quiescent trypanosomes skin tissue forms, a parasite population that may play an important role in maintaining the infection over long time periods and in asymptomatic infected individuals.

[Mild behavioral impairment checklist : English-German translation and feasibility study assessing its use in clinical practice]. / "Mild-behavioral-impairment"-Checkliste : Englisch-deutsche Übersetzung und Beurteilung der Anwendbarkeit in klinischer Praxis.

BACKGROUND: The mild behavioral impairment (MBI) syndrome is defined by the emergence in later life of persistent neuropsychiatric symptoms. The MBI checklist (MBI-C) can be used for systematic detection and documentation of such symptoms. OBJECTIVE: Development of a German version of the MBI­C and assessment of its application in a clinical setting. MATERIAL AND METHODS: The MBI­C was translated from English into German in collaboration with the main author of the original version, and its practical application was then tested on a study population (n = 21) in a gerontopsychiatric inpatient clinic. Patient compliance, understanding of questions, time effort, evaluation procedure and possible discrepancy between patient and family member evaluations were assessed. RESULTS: The German translation of the original MBI­C obtained certification as an official version and can be downloaded at https://mbitest.org . All 34 questions were fully completed by the study population, the level of understanding of questions was good, with the mean time effort being 16 min. In some cases, significant differences between patients' and family members' responses were found. DISCUSSION: The presence of MBI may indicate the development of an otherwise presymptomatic neurodegenerative dementia syndrome. Hence, the MBI­C could aid in the early detection of neurodegenerative dementia. By means of the translated version of the MBI­C presented in this study, this hypothesis can now be tested in German-speaking countries.

Factors associated with generic health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study.

BACKGROUND: Health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients, but determining factors for HRQOL are still not unequivocal. This study measures HRQOL among patients with COPD and aims to determine factors associated with HRQOL. METHODS: Data for cross-sectional analyses were obtained from the baseline of a cohort study. The study population includes adult COPD patients (disease duration ≥3 months), recruited from primary and secondary care settings in Germany, without acute psychiatric/neurologic disease (exception: affective/ anxiety disorders). HRQOL was assessed using the Short-Form 12 (SF-12) Health Survey Questionnaire, comprising a physical and mental component. Independent variables encompass socio-demographic, disease-specific, treatment-related and psychological factors. Multivariable linear regression analyses were conducted. RESULTS: In total, 206 COPD patients (60.7% male; mean age: 65.3 years) took part in the study. In multivariable analysis, the physical component score showed a significant negative association with the COPD Assessment Test (CAT) (P<0.001) and a higher total number of prescribed medications (P=0.001). A higher forced expiratory volume in 1 second (FEV1) value in percent predicted was significantly related to the physical component score in a positive manner (P=0.006). The mental component score was significantly associated with elevated patient-reported symptoms of anxiety (P=0.002) or depression (P<0.001), measured by the hospital anxiety and depression scale (HADS) in a negative way. Like for the physical component score (P<0.001), a worse CAT score was significantly associated with a lower mental component score (P=0.033). CONCLUSIONS: Focusing on patient reported outcomes and screening for depression and anxiety with potential successive treatment might be promising approaches to improve HRQOL in patients with COPD.

Specific, but not general beliefs about medicines are associated with medication adherence in patients with COPD, but not asthma: Cohort study in a population of people with chronic pulmonary disease.

BACKGROUND: Beliefs about medicines are regarded as influencing factors on medication adherence (Horne, 1997). Adherence levels in patients with chronic pulmonary diseases are low (Bourbeau and Bartlett, 2008; Sumino and Cabana, 2013). A better understanding of the predictive role of patients' beliefs about medicines for adherence might be a crucial step to improve medication adherence. OBJECTIVE: This prospective study investigated the association between beliefs about medicines and medication adherence in patients with asthma and COPD. METHODS: The Beliefs about Medicines Questionnaire (BMQ) and the Medication Adherence Rating Scale (MARS) were administered to 402 patients (49% asthma, 51% COPD, 50% female, mean age 56.7 years (SD = 15.9)) at baseline. Follow-ups were carried out after 3 (N = 255) and 12 months (N = 171). Multivariable logistic regression analyses were performed analysing the association between the BMQ subscales at baseline and adherence at each follow-up inquiry. Sociodemographic, psychosocial, and disease related factors were considered as potential confounders. RESULTS: One third of the patients showed adherent behavior (18% and 46% of people with asthma and COPD). In the COPD sample, the subscale Specific-necessity showed a significant positive association with adherence at the 3-months-follow-up (OR = 2.6, 95% CI 1.4-5.1) and the subscale Specific-concerns showed a significant inverse association with adherence at the 3-months-follow-up (OR = 0.6, 95% CI 0.3-0.95) and the 12-months-follow-up (OR = 0.4, 95% CI 0.2-0.8). No significant association was found for the asthmatic sample. CONCLUSIONS: Beliefs about medicines are important factors predicting future medication adherence in patients with COPD, but not asthma. Physicians should primarily focus on the specific beliefs of their patients in order to diminish medication non-adherence.

Differences in medication adherence are associated with beliefs about medicines in asthma and COPD.

Adherence to medication is crucial for achieving treatment control in chronic obstructive lung diseases. This study refers to the "necessity-concerns framework" and examines the associations between beliefs about medicines and self-reported medication adherence in people with chronic obstructive lung disease. 402 patients (196 with asthma, 206 with COPD) participated in the study and completed a questionnaire comprising the "Beliefs about Medicines-Questionnaire" (BMQ) and the "Medication Adherence Report Scale" (MARS). Multivariable logistic regression analyses with the BMQ-subscales as explanatory and the dichotomized MARS-score as dependent variable were computed for the asthma and the COPD sample, respectively, and adjusted for potentially confounding variables. 19% of asthma patients and 34% of COPD patients were completely adherent to their prescribed medication. While specific beliefs about the necessity of medicines were positively associated with medication adherence both in patients with asthma and with COPD, general beliefs about harm and overuse of medicines by doctors were negatively associated with medication adherence only among patients with asthma. The findings of this study suggest that patients' specific beliefs about the necessity of medicines represent an important modifiable target for improving patient-doctor consultations when prescribing medicines.

Factors associated with generic health-related quality of life in adult asthma patients in Germany: Cross-sectional study.

OBJECTIVES: Given a 9% lifetime prevalence of asthma in Germany and the impairment of health-related quality of life (HRQOL) that goes along with it, it is important to understand parameters affecting HRQOL in asthma patients. Objective of this study was therefore to determine factors associated with generic HRQOL in asthma patients. METHODS: Data for cross-sectional analyses were obtained from the baseline of an ongoing cohort study. INCLUSION CRITERIA: physician-diagnosed asthma; age ≥18 years; disease duration ≥3 months; no acute psychiatric/neurological disease; sufficient knowledge of German. HRQOL was assessed by the Short Form 12 Health Survey Questionnaire (SF-12), which comprises a physical (PCS-12) and a mental component (MCS-12). Information on a broad range of parameters potentially influencing HRQOL was collected by examining the patients' medical records and via a self-administered questionnaire. Those parameters were of socio-demographic, disease-specific, treatment-related or psychosocial nature. We conducted multivariable linear regression analyses to assess determinants of HRQOL. RESULTS: In total, 196 asthma patients participated in the study (mean age: 48 years (range: 18-90); 60.2% females). In multivariable analysis, PCS-12 was negatively associated with older age, being female, insufficient disease control, higher number of medications in tablet form and reporting symptoms of depression. MCS-12 was negatively associated with being female, living alone, insufficient disease control, and reporting symptoms of anxiety or depression. CONCLUSIONS: Focusing on disease control and screening for depression and anxiety may be promising approaches to improve HRQOL in adult asthma patients. If a patient shows alarming symptoms of anxiety and/or depression, the patient should then be referred for psychiatric treatment.

Robotic-assisted fertility-sparing surgery for early ovarian cancer.

OBJECTIVE: To show the feasibility and safety of robotic-assisted laparoscopic fertility-sparing surgery for earlystage ovarian cancer in women of reproductive age. METHODS AND DESIGN: The first patient was a 29-year-old para 0 woman with well-differentiated endometrioid adenocarcinoma of the ovary and complex endometrial hyperplasia with marked atypia. The second patient was a 31-year-old para 0 woman with an immature grade 1 teratoma. Both patients underwent robotic-assisted laparoscopic surgical staging. RESULTS: In the first patient, there were no intra- or postoperative complications. Operative time was 5 hours 43 minutes and estimated blood loss was 100 mL. She was discharged home on postoperative day 1. She received 3 cycles of carboplatin and paclitaxel, as well as medroxyprogesterone acetate for the duration of chemotherapy. She conceived twice spontaneously since surgery and had two successful deliveries. She currently has no evidence of disease. In the second patient, there were no intra- or postoperative complications. Operative time was 2 hours 52 minutes and estimated blood loss was 200 mL. She was discharged home on postoperative day 1. She declined adjuvant chemotherapy with bleomycin, etoposide, and cisplatin. She conceived spontaneously 4 months later and had a normal vaginal delivery. She currently has no evidence of disease. CONCLUSIONS: Because fertility-sparing surgery is now accepted as a viable option in young women with earlystage ovarian cancer, less invasive techniques are being used. With the advent of robotic-assisted surgery and its advantages over conventional laparoscopy, we show that it is a safe and feasible approach in select patients. This is the first reported series on robotic fertility-sparing surgery, but more research is needed.

Comparison of perioperative outcomes and complication rates between conventional versus robotic-assisted laparoscopy in the evaluation and management of early, advanced, and recurrent stage ovarian, fallopian tube, and primary peritoneal cancer.

OBJECTIVE: The objective of this study was to examine perioperative outcomes, including complication rates, of conventional laparoscopy (CL) versus robotic-assisted laparoscopy (RALS) in the evaluation and management of early, advanced, and recurrent ovarian, fallopian tube, and peritoneal cancer. METHODS: This is a retrospective analysis of a prospectively maintained database of surgery performed from July 2008 to December 2012. Sixty-three women had 83 surgeries performed; 22 surgeries for early-stage disease (International Federation of Gynecology and Obstetrics stage I) and 61 for advanced and/or recurrent disease. RESULTS: Of the 22 for early stage, 10 were CL, 9 were RALS, and 3 were laparoscopy converted to laparotomy (LP). There was no significant difference between CL and RALS in estimated blood loss (EBL, P = 0.27) or length of stay (LOS, P = 0.43); however, both had significantly less EBL (P = 0.03 and 0.03, respectively) and LOS (P = 0.03 and 0.03) than LP. There was no difference in OR time among the groups (P = 0.79). One patient (33%) had an intraoperative complication in LP. One patient (10%) had a postoperative complication in CL, 2 (22%) in RALS, and 1 (33%) in LP, with no significant difference (P = 0.61).Among the 42 patients with advanced/recurrent disease, 61 surgeries were performed: 14 diagnostic procedures and 47 cytoreductive surgeries. Of the 47, there was no difference in operating room time (P = 0.10). There was no difference in EBL or LOS between CL and RALS (P = 0.82, P = 0.87); however, both were less in CL (P < 0.001 and P = 0.02) and RALS (P = 0.01 and P = 0.02) compared with LP. There were 5 (63%) intraoperative transfusions in LP and none in CL or RALS. When including all surgeries for advanced/recurrent disease, there was 1 intraoperative complication (12%) in LP. There was no difference in postoperative complications between groups (P = 0.89); 8 patients (19%) had postoperative complications in CL, 2 (18%) in RALS, and 2 (25%) in LP. Overall, there were no grade 4 or 5 complications and no perioperative or intraoperative deaths. CONCLUSIONS: In our experience, perioperative outcomes are comparable between CL and RALS in both early and advanced/recurrent disease and not inferior to laparotomy, making CL and RALS an acceptable approach in selected patients.

Role of minimally invasive surgery in ovarian cancer.

The standard treatment of ovarian cancer includes upfront surgery with intent to accurately diagnose and stage the disease and to perform maximal cytoreduction, followed by chemotherapy in most cases. Surgical staging of ovarian cancer traditionally has included exploratory laparotomy with peritoneal washings, hysterectomy, salpingo-oophorectomy, omentectomy, multiple peritoneal biopsies, and possible pelvic and para-aortic lymphadenectomy. In the early 1990s, pioneers in laparoscopic surgery used minimally invasive techniques to treat gynecologic cancers, including laparoscopic staging of early ovarian cancer and primary and secondary cytoreduction in advanced and recurrent disease in selected cases. Since then, the role of minimally invasive surgery in gynecologic oncology has been continually expanding, and today advanced laparoscopic and robotic-assisted laparoscopic techniques are used to evaluate and treat cervical and endometrial cancer. However, the important question about the place of the minimally invasive approach in surgical treatment of ovarian cancer remains to be evaluated and answered. Overall, the potential role of minimally invasive surgery in treatment of ovarian cancer is as follows: i) laparoscopic evaluation, diagnosis, and staging of apparent early ovarian cancer; ii) laparoscopic assessment of feasibility of upfront surgical cytoreduction to no visible disease; iii) laparoscopic debulking of advanced ovarian cancer; iv) laparoscopic reassessment in patients with complete remission after primary treatment; and v) laparoscopic assessment and cytoreduction of recurrent disease. The accurate diagnosis of suspect adnexal masses, the safety and feasibility of this surgical approach in early ovarian cancer, the promise of laparoscopy as the most accurate tool for triaging patients with advanced disease for surgery vs upfront chemotherapy or neoadjuvant chemotherapy, and its potential in treatment of advanced cancer have been documented and therefore should be incorporated in the surgical methods of every gynecologic oncology unit and in the training programs in gynecologic oncology.