Birth and early parenting during the COVID-19 pandemic: A cross-sectional study in the Austrian and German population.

BACKGROUND: During the COVID-19 pandemic, new mothers and their babies represent a particularly vulnerable group. This study investigates the effects of the pandemic on the pregnancy and childbirth experience, as well as on postnatal stress and depression levels. METHODS: An online survey was completed by 1964 Austrian and German mothers who gave birth during the COVID-19 pandemic. The survey included the Pregnancy Distress Questionnaire (PDQ), the Childbirth Experience Questionnaire (CEQ), the Edinburgh Postnatal Depression Score (EPDS), the Perceived Stress Score (PSS), and additional pregnancy- and pandemic-related questions. We conducted multilinear regression models in order to investigate which factors predict childbirth experience, stress and depression scores. FINDINGS: There was a high prevalence of depression symptoms (42%), though the mean EPDS score was 8·71 (SD = 5·70), below the cut-off for depression of 10. The prevalence of high stress scores was 9%, and the mean PSS score was 17·7 (SD = 6·64), which indicates moderate perceived stress. The pandemic reduced the time spent with grandparents, as well as the help received by the mother from relatives and friends. Not receiving help was associated with higher stress and depression scores. In the multilinear regression models, the most important predictor for a negative childbirth experience was a high-risk pregnancy, while the strongest predictors for high stress and depression levels were low social support and negatively perceived pandemic repercussions on financial, social or health aspects of family life. INTERPRETATION: The results suggest that the pandemic had an impact on maternal mental health. While the perceived consequences due to the pandemic negatively affected the postnatal depression and stress levels, perceived social support acted as a protective factor.

Arylic versus Alkylic-Hydrophobic Linkers Determine the Supramolecular Structure and Optoelectronic Properties of Tripodal Amphiphilic Push-Pull Thiazoles.

The supramolecular structures and their constituents essentially determine the optoelectronic properties of thin films. The introduction of amphiphilicity to the constituents and interface assembly is one established technique to control supramolecular structures and resulting material properties. To yield amphiphilicity, rather hydrophobic chromophores are linked to hydrophilic head groups via flexible alkyl chains. In the present work, we investigate whether replacement of the alkyl linkers by a phenylene linker, that is, replacing an electrically isolating moiety with a potentially semiconducting one, increases the conductivity through the resulting layers. After investigating the influence of the linker on molecular properties of the 2-(4- N, N-dimethylaminophenyl)-4-hydroxy-5-nitrophenyl-1,3 thiazoles exemplarily used in this work, we produce supramolecular structures by means of the Langmuir-Blodgett (LB) technique. Atomic force microscopy (AFM) and UV-vis absorption spectroscopy reveal that thin films made from the more rigid thiazole bearing the arylic linker feature a more homogeneous and stable supramolecular structure as compared to those made from the thiazole dye containing the flexible alkylic linker. Finally, conductive AFM (cAFM) results disclose that the LB films made from the thiazole bearing the π-conjugated arylic linker are less conductive than their counterparts based on the alkylic linkers. In the latter layers, the alkylic linkers provide sufficient motional degrees of freedom to allow for supramolecular rearrangement upon electrical operation during cAFM measurements, hence yielding supramolecular structures featuring increased conductivity with successive cAFM measurements. This work highlights the importance of supramolecular structures for optoelectronic properties by presenting a case where supramolecular effects excel the property changes introduced by molecular modifications.

Enhancing the supramolecular stability of monolayers by combining dipolar with amphiphilic motifs: a case of amphiphilic push-pull-thiazole.

Equipping a thiazole dye with push and pull moieties adds dipolar intermolecular interactions and two hydrophilic anchors to a centrally anchored π-stacking and otherwise mono-amphiphilic dye. We show that, despite the resulting irregular shape of the tripodal amphiphile, the enhanced intermolecular interactions and amphiphilicity yield smooth and stable thin films. Furthermore, we present a first approach for deriving supramolecular binding energies from the Langmuir-Blodgett hysteresis data.

[Pain management in chronic pancreatitis and chronic inflammatory bowel diseases]. / Schmerztherapie bei chronischer Pankreatitis und chronisch-entzündlichen Darmerkrankungen.

Apart from local inflammation and defects in secretion, central mechanisms are important for pain etiology in chronic pancreatitis. Therefore, centrally acting co-analgetic agents can be used in addition to classical pain medications. Endoscopic interventions are preferred in patients with obvious dilation of the pancreatic duct. Surgical interventions are generally more effective although they are usually reserved for patients with prior failure of conservative treatment. Diverse surgical options with different efficacies and morbidities are used in individual patients.One of the main problems in chronic inflammatory bowel diseases is abdominal pain. Primarily the underlying disease needs to be adequately treated. Symptomatic pain management will most likely include treatment with acetaminophen and tramadol as well as occasionally principles of a multimodal pain regimen. For the treatment of arthralgia as well as enteropathy-associated arthritis the same treatment options are available as for other spondyloarthritic disorders.

[Pharmacotherapy in patients with ulcerative colitis]. / Medikamentöse Versorgung von Patienten mit Colitis ulcerosa.

BACKGROUND: Patients with ulcerative colitis experience various impairments. The pharmacological treatment of the disease comprises 5-aminosalicylic acid, corticosteroids as well as immunomodulatory and biological agents. Little self-reported data exist on the prescription of these drugs. METHODS: This cross-sectional study was conducted in 2005 as a postal survey in different regions of Germany [Kiel/Lübeck, Halle (Saale), Minden, Regensburg]. Patients with ulcerative colitis (UC) were recruited from specialised gastroenterological practices, university outpatient clinics, and the member registry of a prominent patient organisation (DCCV). Participants returned a questionnaire including established items and scales on physical and psychosocial well-being as well as the self-reported current medication. RESULTS: A total of 444 patients with ulcerative colitis returned the questionnaires. Most of the participants were female, had a high level of school education and were currently employed. Twenty-eight percent of the participants reported to receive corticosteroids and 71 % reported a current treatment with 5-aminosalicylic acid. Approximately one quarter of our study population reported a treatment with immunomodulatory agents. Analgesics were reported to be prescribed only in 15 % of the patients, primarily in patients with depressive symptoms. Patients recruited from specialised gastroenterological practices and university outpatient clinics were more likely to report the prescription of 5-aminosalicylic acid and immunomodulatory drugs than members of the patient organisation. Only 7 % of our patients received loperamide, however, probiotics (12 %) and complementary agents (36 %) seem to have an important role with regard to prevalence of intake. About 40 % of women but only 28 % of the men reported to use complementary agents. Persons with a duration of illness of less than 11 years (median split) were almost twice as likely to take corticosteroids than persons with a longer duration of ulcerative colitis. DISCUSSION: Our results suggest an estimation of prescription rates in ulcerative colitis. However, they raise new questions, for example, concerning a potential underuse of immunomodulatory agents in this patient population. With regard to the identified differences in prescription rates according to psychosocial characteristics further studies are needed to examine these relationships.

Short-term health-related quality of life and symptom control with docetaxel, cisplatin, 5-fluorouracil and cisplatin (TPF), 5-fluorouracil (PF) for induction in unresectable locoregionally advanced head and neck cancer patients (EORTC 24971/TAX 323).

BACKGROUND: The EORTC 24971/TAX 323, a phase III study of 358 patients with unresectable locoregionally advanced squamous cell carcinoma of the head and neck, showed an improved progression-free and overall survival (OS) with less toxicity when docetaxel (T) was added to cisplatin and 5-fluorouracil (PF) for induction and given before radiotherapy (RT). The impact of the addition of docetaxel on patients' health-related quality of life (HRQOL) and symptoms was investigated. METHODS: HRQOL was assessed at baseline, at end of cycle 2, and 4, 6, and 9 months after completion of RT using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) and the EORTC QLQ Head and Neck Cancer-Specific Module (EORTC QLQ-H&N35). The primary HRQOL scale was global HRQOL per protocol. RESULTS: Compliance to HRQOL assessments was 97% at baseline, but dropped to 54% by 6 months. Data were analysed up to 6 months. There was a trend towards improved global HRQOL during the treatment period. At 6 months after the end of RT, global HRQOL was higher in the TPF arm than in the PF arm, but the low compliance does not allow to draw definitive conclusions. Swallowing and coughing problems decreased more in the TPF arm than in the PF arm at the end of cycle 2, but to a limited extent. CONCLUSION: Induction chemotherapy with TPF before RT not only improves survival and reduces toxicity compared with PF but also seems to improve global HRQOL in a more sustainable manner.

Use of methotrexate in patients with inflammatory bowel diseases.

Methotrexate (MTX) is one of the immunosuppressants commonly used in inflammatory bowel diseases. There is very good evidence for its use in patients with steroid-dependent or steroid-refractory Crohn's disease for induction as well as maintenance of remission. Optimal dose as well as mode of application is still a matter of debate. The only large randomised controlled trials used 25 mg/wk for induction and 15 to 25 mg/wk for maintenance of remission, both applied intramuscularly. Current guidelines recommend methotrexate in patients with extensive disease, steroid-refractory, and steroid-dependent disease. They even suggest MTX for patients with infrequent relapses in the need of repetitive corticosteroid therapy. In clinical practice it is mainly used in patients who failed treatment with thiopurines (azathioprine or 6-mercaptopurine) or who are intolerant to these drugs. MTX can also be used in paediatric patients, whereas the evidence for its effectiveness in fistulising disease is very weak. Two small studies did not prove that MTX is efficacious in ulcerative colitis. Even though case series suggest otherwise, its use is not recommended by current guidelines for patients with ulcerative colitis.

[What has been confirmed in the treatment of inflammatory bowel disease?]. / Was ist gesichert in der Therapie chronisch entzündlicher Darmerkrankungen?

The therapy of inflammatory bowel diseases is currently guided by clinical variables. An escalation of immunosuppressive therapy is required in case of treatment failure. However, clinical remission does not necessarily imply mucosal healing. In parallel to the treatment of rheumatoid arthritis a novel concept is emerging suggesting that an early anti-inflammatory treatment can reduce structural changes in inflammatory bowel diseases. The studies supporting this novel therapeutic strategy that mucosal healing might build the future therapeutic goal will be discussed. In order to adjust the therapy, risk factors indicating a complicated disease course will be identified, resulting in the development of an individual disease course. The benefit of these strategies will be discussed together with therapy-associated complications.

Regulation of the Amount of Starch in Plant Tissues by ADP Glucose Pyrophosphorylase.

Starch, a major storage metabolite in plants, positively affects the agricultural yield of a number of crops. Its biosynthetic reactions use adenosine diphosphate glucose (ADPGlc) as a substrate; ADPGlc pyrophosphorylase, the enzyme involved in ADPGlc formation, is regulated by allosteric effectors. Evidence that this plastidial enzyme catalyzes a rate-limiting reaction in starch biosynthesis was derived by expression in plants of a gene that encodes a regulatory variant of this enzyme. Allosteric regulation was demonstrated to be the major physiological mechanism that controls starch biosynthesis. Thus, plant and bacterial systems for starch and glycogen biosynthesis are similar and distinct from yeast and mammalian systems, wherein glycogen synthase has been demonstrated to be the rate-limiting regulatory step.

S3-guideline "helicobacter pylori and gastroduodenal ulcer disease" of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e. V., German society for rheumatology, AWMF-registration-no. 021 / 001.

This guideline updates a prior consensus recommendation of the German Society for Digestive and Metabolic Diseases (DGVS) from 1996. It was developed by an interdisciplinary cooperation with representatives of the German Society for Hygiene and Microbiology, the Society for Pediatric Gastroenterology and Nutrition (GPGE), and the German Society for Rheumatology. The guideline is methodologically based on recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) for providing a systematic evidence-based S 3 level consensus guideline and has also implemented grading criteria according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) process. Clinical applicability of study results as well as specifics for Germany in terms of epidemiology, antibiotic resistance status, diagnostics, and therapy were taken into account.

A phase I/II study of bortezomib and capecitabine in patients with metastatic breast cancer previously treated with taxanes and/or anthracyclines.

BACKGROUND: Proteasome inhibitors are a novel class of compounds entering clinical trials as a method to increase tumour sensitivity to standard chemotherapy. This phase I/II trial was carried out to evaluate the combination of capecitabine and the proteasome inhibitor bortezomib in anthracycline and/or taxane-pretreated patients with metastatic breast cancer. PATIENTS AND METHODS: A total of 35 patients were treated with bortezomib (1.0-1.3 mg/m(2) on days 1, 4, 8 and 11) and capecitabine (1500-2500 mg/m(2) on days 1-14) in 3-week intervals for up to eight cycles. RESULTS: The maximum tolerated doses (MTDs) were bortezomib 1.3 mg/m(2) and capecitabine 2500 mg/m(2). The treatment was generally well tolerated and associated with toxic effects that were consistent with the known side-effects of the individual agents. The intent-to-treat overall response rate was 15% and an additional 27% of patients had stable disease (SD). In the 20 patients treated at the MTD, the response rate was 15% and 40% had SD. Median time to progression and overall survival were 3.5 months [95% confidence interval (CI) 1.9-4.4] and 7.5 months (95% CI 5.6-14.6), respectively. Median duration of response was 4.4 months. CONCLUSION: The combination of bortezomib and capecitabine is well tolerated and has moderate antitumour activity in heavily pretreated patients.

Microbial Spectrum of Intra-Abdominal Abscesses in Perforating Crohn's Disease: Results from a Prospective German Registry.

BACKGROUND: Intra-abdominal abscesses [IAAs] are common life-threatening complications in patients with Crohn's disease [CD]. In addition to interventional drainage and surgical therapy, empirical antibiotic therapy represents a cornerstone of treatment, but contemporary data on microbial spectra and antimicrobial resistance are scarce. METHODS: We recruited 105 patients with CD and IAAs from nine German centres for a prospective registry in order to characterize the microbiological spectrum, resistance profiles, antibiotic therapy and outcome. RESULTS: In 92 of 105 patients, microbial investigations of abscess material revealed pathogenic microorganisms. A total of 174 pathogens were isolated, with a median of 2 pathogens per culture [range: 1-6]. Most frequently isolated pathogens were E. coli [45 patients], Streptococcus spp. [28 patients], Enterococci [27 patients], Candida [13 patients] and anaerobes [12 patients]. Resistance to third-generation cephalosporins, penicillins with beta-lactamase inhibitors and quinolones were observed in 51, 36 and 35 patients, respectively. Seven patients had multiple-drug-resistant bacteria. Thirty patients received inadequate empirical treatment, and this was more frequent in patients receiving steroids or immunosuppression [37%] than in patients without immunosuppression [10%: p = 0.001] and was associated with a longer hospital stay [21 days vs 13 days, p = 0.003]. CONCLUSION: Based on antimicrobial resistance profiles, we herein report a high rate of inadequate empirical first-line therapy for IAAs in CD, especially in patients receiving immunosuppression, and this is associated with prolonged hospitalization.

Mechanism of resistance to the phosphaturic effect of the parathyroid hormone in the hamster.

The effect of parathyroid hormone and calcitonin on the renal excretion of phosphate, calcium, and cyclic AMP was evaluated in the thyroparathyroidectomized hamster, a mammal apparently reisstant to the phosphaturic effect of parathyroid hormone. Parathyroid hormone did not increase phosphate excretion, although it decreased excretion of calcium and increased urinary excretion of cyclic AMP. This lack of a phosphaturic response to parathyroid hormone was not reversed by administration of 25-OH vitamin D or infusions of calcium or phosphate. Calcitonin, another potentially phosphaturic hormone, also vailed to increase phosphate excretion but markedly elevated urinary excretion of cyclic AMP. In hamsters pretreated with infusion of urinary ammonium chloride, which decreased plasma and urinary pH, both parathyroid hormone and calcitonin increased excretion of phosphate as well as that of cyclic AMP. Acetazolamide had no phosphaturic effect in ammonium chloride-loaded hamsters, and it decreased cyclic AMP and calcium excretion. Alkalinization of urine by acetazolamide did not prevent the phosphaturic effect of parathyroid hormone in ammonium chloride-loaded hamsters, but it blocked the increase in urinary cyclic AMP excretion. Parathyroid hormone and calcitonin both stimulated adenylate cyclase in a cell-free system (600-g pellet) from hamster renal cortex, elevated tissue cyclic AMP levels, and activated protein kinase in tissue slices from hamster renal cortex. In acid medium, the increase in cyclic AMP and activation of protein kinase in response to parathyroid hormone was diminished, but addition of acetazolamide restored responsiveness of both parameters to control values. Acetazolamide, on the other hand, did not influence adenylate cyclase or its response to parathyroid hormone or cyclic AMP phosphodiesterase activity. We conclude that the lack of a phosphaturic effect of parathyroid hormone and calcitonin in the hamster depends on steps in the cellular action of these hormones, steps that are sensitive to pH subsequent to cyclic AMP generation and protein kinase activation. In addition, acetazolamide may potentiate the phosphaturic effect of parathyroid hormone by promoting accumulation of cyclic AMP in tissue. Thus, the hamster is a particularly useful model for studies of syndromes in which there is renal resistance to phosphaturic hormones.

Neurological and neurophysiological examinations on workers with chronic poisoning by 2,3,7,8-TCDD: follow-up 35 years after exposure.

Between 1965 and 1968, about 350 workers were accidentally exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in a chemical plant, which was producing herbicides based on the trichlorophenoxyacetic acid. About 80 workers developed signs of poisoning. The estimated mean concentration of TCDD at the time of exposure was about 5000 pg/g of plasma fat. Only 15 subjects from the original cohort remained available for the recent follow-up in 2004. All were men, mean age 60 years. The mean current TCDD plasma concentration was 128 pg/g. Neurological examination revealed some CNS impairment in eight subjects. Signs of polyneuropathy were found in nine subjects, confirmed by NCV studies in three cases. Electroencephalography was abnormal in three cases; Visual-evoked potential in five cases. Acquired dyschromatopsia was detected in six patients. SPECT showed focal reduction of perfusion in various brain locations in all but one patient. Two neuropsychological variables and the frequency of abnormal neurophysiological tests in individual patients correlated with TCDD plasma level. The findings support the hypothesis that TCDD can damage the nervous system. In addition to a direct neurotoxic effect of TCDD, changes secondary to vasculopathy should be considered, in the pathophysiology of the damage, because of the high frequency of lipid metabolism disorders and their complications.