Translocation of a gut pathobiont drives autoimmunity in mice and humans.

Despite multiple associations between the microbiota and immune diseases, their role in autoimmunity is poorly understood. We found that translocation of a gut pathobiont, Enterococcus gallinarum, to the liver and other systemic tissues triggers autoimmune responses in a genetic background predisposing to autoimmunity. Antibiotic treatment prevented mortality in this model, suppressed growth of E. gallinarum in tissues, and eliminated pathogenic autoantibodies and T cells. Hepatocyte-E. gallinarum cocultures induced autoimmune-promoting factors. Pathobiont translocation in monocolonized and autoimmune-prone mice induced autoantibodies and caused mortality, which could be prevented by an intramuscular vaccine targeting the pathobiont. E. gallinarum-specific DNA was recovered from liver biopsies of autoimmune patients, and cocultures with human hepatocytes replicated the murine findings; hence, similar processes apparently occur in susceptible humans. These discoveries show that a gut pathobiont can translocate and promote autoimmunity in genetically predisposed hosts.

[Development of untreated patients and therapy drop-outs--catamnesis 10 years after initial contact]. / Entwicklungen von nicht behandelten Patienten und Therapieabbrechern--Katamnesen 10 Jahre nach dem Erstkontakt.

In general, psychotherapy-research assesses the effect of psychotherapeutic treatment. But how do patients develop, who could not be motivated for psychotherapy or who dropped out of psychotherapy? And what happens to patients who did not seem to be suitable for psychotherapy. According to the methodology of comparative case-study, 25 patients of these marginal groups were questioned in a psychoanalytical interview 10 years after the inpatient preliminary four-day examination. In comparison to 33 regularly treated patients, two typical patterns of development could be distinguished: with patients, who could not be motivated, symptoms reoccurred after a longer period of false solution; then, they were better motivated and could profit by psychotherapy. Patients who dropped out of psychotherapy or who were rejected, went through a relatively robust period as well, before symptoms reoccurred; but the they showed less interest in psychotherapy and tended to seek medical treatment.

[Follow-up of psychotic patients. 10 years after inpatient psychiatric-psychotherapeutic treatment]. / Die Entwicklung psychotischer Patienten. Zehn Jahre nach stationärer psychiatrisch-psychotherapeutischer Behandlung.

We report on a catamnestic study, based on the principles of process-oriented therapy-research, in which patients were interviewed in a semi open way 10 years after their hospital-treatment. Based on our findings we may establish that further developments of neurotic and psychotic patients can be influenced by the choice of therapeutic method, although in a different way. For both groups of patients the influence of conflict-centered, psychoanalytically oriented psychotherapy can exert itself in a progressive way often only in a crisis, some time after the hospital-treatment. A qualifying condition for the choice of this therapeutic method in working with psychotic patients is the achievement of a sufficient ego-stability by the patient. Provided this has been respected, there is still a fundamental difference between the post-therapeutic crisis in neurotic and in psychotic patients: whereas for the neurotic it occurs in the process of working-through his internal conflict, for the psychotic patient it is caused by external influences. Some necessary conditions for the patient in mastering such a crisis in a progressive way are described.

Effects of active and passive recovery on lactate removal and subsequent isokinetic muscle function.

The effect of active and passive recovery on the removal of accumulated blood lactate and subsequent muscle function were tested using five male subjects. The experimental protocol consisted of two exercise sessions performed on a mechanical brake cycle ergometer at 150% VO2max for 60 seconds. Termination of the supramaximal work bouts were followed by a 20 minutes active recovery period cycling at 30% VO2max and a 20 minutes passive recovery period sitting quietly. Following the recovery modes, isokinetic measures of peak torque, total work output and fatigue were evaluated in the dominant quadricep muscle group. During the control test, exercise performance was limited to that of isokinetic evaluation. The order of the experimental and control tests were randomly assigned. Postexercise blood lactate levels prior to the isokinetic muscle test were 9.2 and 9.1 mM during the active and passive recovery conditions respectively. Blood lactate concentration during the control test was .4 mM prior to the isokinetic muscle test. The rate of blood lactate disappearance was significantly greater during active recovery (3.5 mM) when compared with passive recovery (7.2 mM). Blood lactate concentration during the control test was significantly lower (.4 mM) in comparison to both active and passive lactate concentrations prior to the isokinetic muscle test. Despite significant differences in blood lactate between active and passive recovery conditions, there was no difference in isokinetic measures of maximal strength, work output and muscle fatigue between recovery modes. Further indication that lactate is unrelated to muscle function was the nonsignificant finding in muscle function between the control and experimental conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

CCK receptor antagonist loxiglumide alters uptake of CCK in perfused liver and pancreatic acini of the rat.

The aim of the present study was to analyze the effect of the specific cholecystokinin (CCK) receptor antagonist loxiglumide on hepatic and pancreatic processing of CCK-8 and the CCK analogue cerulein. Rat liver perfusion was performed in a non-recirculating system. CCK concentrations were measured by radioimmunoassay in perfusates from the inflow cannula (portal vein) and the outflow cannula (hepatic vein). In rat pancreatic acini, the effect of loxiglumide on internalization and surface-binding of radiolabelled CCK-8 was determined. Cerulein (20 nM, 2 nM) was extracted in a single pass through the liver by 29.7 and 25.4%, respectively. The hepatic uptake of CCK-8 (50 pM, 2 nM) was more than 90 and 89.9%, respectively. Loxiglumide drastically inhibited hepatic extraction of both peptides and reduced internalization of 125I-CCK-8 in pancreatic acini dose dependently by 39-93%. These results demonstrate that the potent CCK receptor antagonist loxiglumide significantly decreased CCK uptake by the liver and pancreas.

[Termination of treatment in inpatient psychotherapy]. / Behandlungsabbrüche in der stationären Psychotherapie.

There are relatively few studies on the subject of dropping out of psychotherapy. This lead us to study before, during and after treatment all patients, who had been referred to our hospital for psychotherapeutical treatment over a time of one year. We compared a posteriori those patients, who had completed psychotherapy in our hospitalized setting in a regular fashion (n = 362) to those, who had dropped out (n = 43). It was found that the latter group showed (statistically significant) properties, which could be used to direct our attention to the danger of dropping out even before treatment. If our findings and first hypotheses concerning the reasons for dropping out of psychotherapy can be confirmed by future studies, we can derive from them relevant suggestions for the handling of this risky group of patients during treatment.

[Therapeutic goal of the patient as a criterion for prognosis and success of inpatient psychotherapy]. / Das Therapieziel des Patienten als ein Kriterium für Prognose und Erfolg in der stationären Psychotherapie.

We assumed that a patient's statements about what he/she wants to achieve by psychotherapy (subjective therapy-goals) may contain information about his/her capability and willingness to cooperate in the therapeutic process; insofar they are relevant for the study of indications and outcome of a psychotherapeutic treatment. We studied therapy-goals given by 480 patients during their first therapeutic contact. We differentiated the data according to contents resp. directions of expectation and conceptualized the level of intended change. 75 of the 480 patients did not receive any treatment, 43 gave up therapy prematurely. In answering the question "what do you want to achieve by psychotherapy?", which forms a part of the first interview as well as of our anamnestic questionnaire, both groups showed prognostically relevant differences in comparison to fully treated patients. For the remaining 362 patients, who had been admitted, their initial goals were compared with finally attained goals. This yielded significant results concerning success of treatment, which were validated by a simultaneous rating of therapy-goals for every individual patient by researchers resp. therapists.

[Inpatient preliminary examination. A model for the improvement of clinical psychotherapy]. / Die stationäre Voruntersuchung. Ein Modell zur Verbesserung der klinischen Psychotherapie.

Hospitalization of patients for four days in order to carry out a psychodiagnostic examination is a model which, so far, has not been practised anywhere else in Germany. Experience in the Wittgenstein hospital during more than six years has shown that such a preliminary examination is able to achieve more than solving the problem of a possible indication for inpatient psychotherapy. The four-day sojourn in the hospital allows, moreover, a motivation of the patient, who often enough is rather ill prepared, toward future treatment, causing discontinuation of treatment to be rare. Additionally, the preliminary examination bridges the gap of the waiting period of several month which is common with psychotherapeutic institutions nowadays before inpatient treatment can begin, and therefore acts therapeutically in the sense that by means of the diagnosis the patients attention is already focussed upon the psychic origin of his complaint. By the drawing-up of an appropriate therapeutic plan at the end of the preliminary examination and by his assignment to a suitable ward the patient is supplied with a comprehensible directive with regard to his future therapy, and he is able to on the spot acquaint himself with the staff and with the premises of the institution.

Carcinoembryonic antigen in a black hospital population.

Sixteen normal individuals and 100 hospital patients, all black, were tested for abnormal carcinoembryonic antigen (CEA) levels. Male and female subjects (smokers and non-smokers) were tested. The results of the tests are discussed. For normal subjects, the CEA values ranged from 0.0 ng/ml to 2.6 ng/ml. Among hospital patients with neoplastic disease, male patients with lung disease showed elevated CEA titers but their female counterparts did not. On the other hand, female patients with breast cancer, in contrast to their male counterparts, had raised values of CEA. The clinical indices for laboratory tests of sensitivity, specificity, and predictive value were calculated and determined to be 71.5, 56, and 47.5 percent, respectively.

Diagnostic value of creatine phosphokinase (CPK) isoenzymes in the absence of elevated total CPK.

The value of creatine phosphokinase (CPK) isoenzymes, in the presence of normal total CPK, for assessing myocardial infarction is discussed. Forty-six patients in a coronary care unit were studied to ascertain the clinical usefulness of CPK isoenzymes for diagnosing myocardial infarction when the levels of total CPK were within normal range. The majority of patients studied had some cardiac abnormality on either ECG or x-ray examination. Approximately 50 percent of patients had chest pain, but only five of the 46 had a detectable CPK isoenzyme level on CPK electrophoresis. The results of this study suggest that CPK isoenzymes do not add anything of diagnostic value to the clinical picture if the total CPK is normal.

Edwardsiella tarda associated with osteomyelitis.

A case of osteomyelitis associated with Edwardsiella tarda is reported. Specimens from a wound exudate of a 58-year-old female with osteomyelitis revealed on a direct gram-stained smear, pleomorphic, gram-negative rods. Growth of the organism on differential media and analysis of its Analytab (API)(*) patterns produced results consistent with E. tarda. The identification of the organism was confirmed by the Center for Disease Control, Atlanta. This represents the first reported case of a wound infection attributable to this organism.