金黄色葡萄球菌成人与儿童感染株体外抗菌活性的比较

目的：了解金黄色葡萄球菌(简称金葡菌)的成人感染株与儿童感染株在体外抗菌活性的差异。方法：采用血浆凝固酶、金葡菌单克隆抗体及Vitek-32型仪进行菌株鉴定,纸片琼脂扩散法(K-B法)对84株儿童感染株及74株成人感染株进行药物敏感性试验,耐甲氧西林金葡菌（MRSA）的检测采用头孢西丁纸片法。结果：成人感染株与儿童感染株的MRSA发生率分别为47%和8%,两者之间差异有显著性(P<0.01);所有菌株对万古霉素敏感,所有儿童感染株对夫西地酸敏感;成人感染株与儿童感染株对头孢唑啉、头孢呋辛、头孢西丁、庆大霉素及左氧氟沙星的耐药率差异有显著性（P<0.01）。结论：金葡菌成人感染株较儿童感染株耐药和多重耐药性严重,临床医生应针对不同感染人群合理使用抗菌药物。［中国当代儿科杂志,2009,11（12）：961-963］     

北京地区儿童脓疱疮来源金黄色葡萄球菌耐药性分析

目的分析儿童脓疱疮来源的金黄色葡萄球菌(简称金葡菌)耐药趋势,为治疗儿童脓疱疮提供理论依据。方法对2003年6月-2007年12月就诊于本科门诊的脓疱疮患儿皮损分泌物分离的金葡菌,应用琼脂稀释法药敏试验检测14种抗生素对分离的金葡菌的耐药率,应用WHONET 5.3软件对药敏结果进行分析。结果 984株金葡菌对14种抗生素的药敏试验结果显示,耐药率前3位依次为青霉素、红霉素和克林霉素,其中金葡菌对青霉素的耐药率连续5 a均超过92.0%,对红霉素耐药率均高于80.0%,明显高于其他药物。氯霉素、庆大霉素和四环素耐药率相对稳定,未见明显增减。甲氧西林、头孢菌素和环丙沙星的耐药率相对较低,未超过5.0%;耐甲氧西林金葡菌的发生率低于2%,仅发现1株莫匹罗星耐药菌株,未发现万古霉素和夫西地酸耐药菌株。结论北京地区儿童脓疱疮来源的社区获得性耐甲氧西林金葡菌分离率较低。青霉素、红霉素、克林霉素和四环素等药物在本地区已不适于治疗金葡菌感染的脓疱疮。虽然金葡菌对氯霉素、庆大霉素和环丙沙星敏感性较好,但是鉴于这3类抗生素的不良反应对儿童的影响,应用时应严格掌握其临床适应证。莫匹罗星、夫西地酸、万古霉素和头孢菌素可作为治疗脓疱疮的局部或全身首选用药。     

小儿金黄色葡萄球菌林可霉素诱导试验及耐药分析

目的 了解小儿金黄色葡萄球菌林可霉素诱导试验及耐药现状.方法 对2006年青岛市儿童医院门诊和住院患儿所有标本中分离出的212侏金黄色葡萄球菌进行分析.药敏试验使用纸片扩散法,结果 判断参考美国国家临床实验室标准委员会(NCCLS)的标准.结果 在212株金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌15株(5.2%),对甲氧西林敏感的金黄色葡萄球菌201株(94.8%).对红霉素耐药、克林霉素敏感的15株经克林霉素诱导试验检测11株呈阳性.结论 儿童林可霉素诱导试验阳性率比成人高,儿童大环内酯类耐药率高需引起临床重视.     

儿童肺炎金黄色葡萄球菌分离株的分子生物学特征及耐药性研究

目的了解儿童金黄色葡萄球菌(金葡菌)肺炎致病株分子特征及耐药性,供临床诊治参考。方法收集2016年1月至2017年3月首都医科大学附属北京儿童医院确诊为金葡菌肺炎患者分离株,采用头孢西丁纸片法和mecA检测鉴定耐甲氧西林金葡菌(MRSA)或甲氧西林敏感金葡菌(MSSA);对所有菌株进行多位点序列分型(MLST)和葡萄球菌蛋白A(spa)分型,并对MRSA菌株进行葡萄球菌盒氏染色体(SCCmec)分型;采用PCR方法检测21种超抗原(SAgs)基因、杀白细胞素(PVL)基因、黏附基因fnbB、cna;采用琼脂稀释法、E-test检测14种抗生素体外药物敏感性。结果共收集42株金葡菌,其中MRSA、MSSA各21株。MRSA的优势克隆为ST59-SCCmecⅣa-t437(71.4%);MSSA的分型较为分散,以ST25-t078(14.2%)最多见。42株金葡菌中有36株(85.7%)至少携带1种超抗原基因,最常见的超抗原基因型为sek-seq(21.4%);MRSA pvl基因携带率(52.3%)明显高于MSSA(14.2%),而MSSA fnbB及cna基因携带率(42.8%和47.6%)明显高于MRSA(均为9.5%),差异均有统计学意义(均P<0.05)。本组金葡菌多重耐药率达90.4%(38/42株)。结论MRSA在儿童金葡菌肺炎致病株中检出率高,其主要克隆型为ST59-SCCmecⅣa-t437。儿童肺炎金葡菌分离株的超抗原基因携带率和多重耐药率较高,MRSA菌株常携带pvl基因,而MSSA菌株携带fnbB、cna更常见。     

193株B组链球菌对抗菌药物的耐药性研究

目的　了解我国北京和广州地区B组链球菌 (GBS)抗生素耐药菌谱情况。方法　采用标准K B纸片法测定GBS菌对临床常用 7种抗生素耐药性。结果　 193株GBS菌均对青霉素类、头孢菌素类抗生素敏感 ;但青霉素和氨苄青霉素中度敏感率分别为 17%和 19% ;北京地区 1998年到 1999年分离GBS菌株对红霉素耐药率从8%增加到 16 % ,对克林霉素耐药率从 2 0 %增加到 2 8% ;广州地区 1999年分离的GBS菌株对红霉素和克林霉素耐药率分别为 4 5 %和 2 6 % ,与北京地区 1998年和 1999年分离的GBS菌株对红霉素的耐药率比较 ,经统计学处理P <0 0 5 ,差异有显著性。结论　青霉素、氨苄青霉素可作为治疗GBS感染首选药物 ;头孢菌素类抗生素可作为二线的选择药物。红霉素和克林霉素作为预防和治疗GBS感染的药物在国内会受到一定的限制。     

金黄色葡萄球菌207株药敏分析

目的 分析2003-2006年儿科住院患儿金黄色葡萄球菌(SAU)检出率及耐甲氧西林金黄色葡萄球菌(MRSA)发生率的变化和21种抗生素对SAU分离株的抗菌效应,为临床合理用药提供依据.方法 2003年1月-2006年12月上海交通大学附属第六人民医院儿科住院患儿207例,入院48 h内采集标本,其中咽拭子培养75株、痰培养57株、脐分泌物培养25株、脓液培养23株、血培养20株、胸腔穿刺液培养和中段水培养各3株、脑脊液培养1株.菌种鉴定采用SAU乳胶凝集试验,21种常用抗生素的药敏试验分析采用纸片扩散法(K-B法),其方法及结果判读按2006年美国临床实验室标准进行.MRSA菌株筛选用苯唑西林和(或)头孢西丁纸片法,用WHONET 5软件分析结果;SAU的检出率和MRSA的发生率趋势变化检验采用Cochran-Mantel-Haenszel趋势检验分析.结果 SAU 207株中甲氧西林敏感金黄色葡萄球菌177例,占85.5%;MRSA 30例,占14.5%.SAU对青霉素、苯唑西林、一代头孢(头孢唑啉)、二代头孢(头孢呋辛)、三代头孢(头孢噻肟、头孢曲松)、红霉素、克林霉素、甲氧苄啶-磺胺甲基异噁唑、环丙沙星、磷霉素和利福平的敏感率分别为4.8%、85.5%、84.9%、90.0%、88.3%、37.5%、46.3%、92.7%、74.2%、97.2%和94.0%.菌株均对糖肽类抗生素(如万古霉素和替考拉宁)和左氧氟沙星敏感.2003-2006年不同年份SAU的检出率与MRSA的发生率分别为9.6%、19.8%、25.0%、39.5%和5.0%、5.9%、12.7%、24.7%.结论 SAU分离株对青霉素和红霉素的耐药率高,而对头孢菌素和苯唑西林相对有较高的敏感性,SAU检出率和MRSA发生率逐年上升,儿科应加强对SAU的监测.     

1?082例呼吸道感染住院患儿鼻咽部携带卡他莫拉菌状况及其耐药性分析

目的了解呼吸道感染儿童鼻咽部卡他莫拉菌的携带情况及分离株对常见抗菌药物的敏感性。方法采集1 082例呼吸道感染患儿鼻咽拭子并分离卡他莫拉菌,采用E-test法和纸片扩散法检测菌株对11种常见抗菌药物的敏感性,结合3种判读标准解读检测结果。用头孢硝噻吩纸片法检测分离株是否产β-内酰胺酶。结果 1 082例呼吸道感染患儿中,鼻咽部卡他莫拉菌携带率为7.12%(77/1 082)。所有菌株均产β-内酰胺酶。无论使用哪种判读标准,所有菌株对阿莫西林-克拉维酸均敏感;对环丙沙星和四环素的敏感率95.0%。根据EUCAST和CLSI标准,分离株对磺胺甲噁唑-甲氧苄啶的敏感率高达98.7%,对所检测的3种头孢菌素的敏感率均超过80%。但根据BSAC标准判读时,菌株对头孢呋辛的敏感率仅为2.6%,对氨苄西林耐药率为81.8%。依据CLSI判读时,分离株对红霉素的不敏感率为79.2%,根据EUCAST或BSAC判断时,其不敏感率高达90.9%,且超过三分之一的菌株(27/77,35.1%)MIC值256 mg/L。结论呼吸道感染患儿鼻咽部卡他莫拉菌分离株均产β-内酰胺酶,对阿莫西林-克拉维酸全部敏感,对第三代和第四代头孢菌素、磺胺甲噁唑-甲氧苄啶敏感率高,但多对氨苄青霉素、头孢呋辛和红霉素耐药。     

金黄色葡萄球菌儿童株耐药性研究和mecA基因检测

目的了解金黄色葡萄球菌（简称金葡菌）儿童株对常用抗生素的耐药特点,评价苯唑西林耐药性相关基因raecA-PCR的临床价值。方法用金葡菌乳胶凝集试验和Vitek系统GPI卡鉴定金葡菌,用纸片扩散法完成12种常用抗生素的药敏试验,同时用E-test法进行苯唑西林和万古霉素耐药性检测,并对所有菌株采用PCR技术检测mecA基因。结果金黄色葡萄球菌共259株,包括185株临床株和74株健康携带株,其中95．8％的菌株产生B内酰胺酶而对青霉素G耐药,91．1％的菌株对苯唑西林敏感,对头孢噻肟和头孢曲松的敏感率均为91．9％;对红霉素、四环素、克林霉素、甲氧苄啶磺胺甲基异恶唑、氯霉素、氧氟沙星和利福平的耐药率分别为48．3％、30．9％、21．6％、11．2％、10．0％、2．3％和1．5％;所有菌株均对万古霉素敏感。临床株对苯唑西林、头孢噻肟和头孢曲松的耐药率高于携带株（P〈0．05）,对红霉素的耐药率低于携带株（P〈0．01）。mecA-PCR结果显示：标准株ATCC25923和所有苯唑西林敏感株mecA基因均阴性,中介株mecA基因阳性1株,耐药株中均阳性。结论本研究中金葡菌对苯唑西林的耐药率不高,而mecA-PCR技术可以作为快速检测耐苯唑西林金葡菌的有效方法。     

新生儿重症监护病房新生儿鼻部金黄色葡萄球菌定植和菌株的分子特征

目的 探讨NICU患儿鼻部金黄色葡萄球菌（简称金葡菌）的定植情况及分离株的基因型和毒力特征。 方法 采集NICU患儿的鼻拭子,分离培养金葡菌,采用头孢西丁纸片法和mecA检测鉴定甲氧西林耐药金葡菌（MRSA）或敏感金葡菌（MSSA）;分析所有菌株MLST和spa分型,并对MRSA菌株进行SCCmec分型,采用PCR方法检测pvl和sasX和21种超抗原毒力基因。 结果 从429例鼻拭子标本分离出79株金葡菌,定植率18.4%,其中MRSA 22株（27.8%）。79株金葡菌共检测出17种MLST型和29种spa型,最常见型分别为ST59（31.6%）和t437（22.8%）。22株MRSA最常见的SCCmec型为Ⅳa（81.8%）。ST59-Ⅳa-t437（63.6%）和ST188-t189（15.8%）分别是MRSA、MSSA最常见的流行克隆。最主要的毒力基因型为seb-sek-seq（10.1%）。MRSA株seb、sek、seq和pvl的携带率明显高于MSSA株,而sei携带率明显低于MSSA株。 结论 NICU患儿鼻部金葡菌定植率较高,ST59-Ⅳa-t437和ST188-t189分别是MRSA、MSSA最常见的流行克隆;分离株毒力基因携带率较高,MRSA与MSSA菌株的毒力基因型存在差异。     

56株B族链球菌血清型耐药性及多位点序列分型研究

目的研究B族链球菌(GBS)的血清型、耐药性和多位点序列分型,供防治GBS感染参考。方法 2012—2013年间共收集到56株GBS菌株,自就诊于北京市妇产医院和北京大兴医院的妊娠35~37周孕妇的阴道和直肠拭子的分离培养。采用乳胶凝集试验检测菌株的血清型,E-test法和纸片扩散法检测细菌对9种抗生素的敏感性,PCR方法检测红霉素耐药基因erm B和mef A,管家基因测序确定菌株的序列型(ST),e BURST软件分析菌株间亲缘性关系。结果 56株菌共鉴定出5种血清型,常见型为Ⅲ型(32.1%)、Ⅰa型(17.9%)、Ⅰb型(16.1%)和Ⅴ型(14.3%)。分离株对青霉素和头孢曲松均敏感,对左氧氟沙星、红霉素、克拉霉素、阿奇霉素、泰利霉素、克林霉素和四环素的不敏感率依次为39.3%、85.7%、92.9%、98.2%、30.4%、73.2%和91.0%。56株菌株共检测出14种STs,ST19(30.4%)最为常见。Ⅲ型菌株主要属于ST19(14/18),92.9%的Ⅲ/ST19型菌株对左氧氟沙星耐药,75%的左氧氟耐药菌株属于CC19。44株红霉素耐药菌株中,32株(72.7%)erm B阳性。结论北京GBS菌株以Ⅲ、Ⅰa、Ⅰb、Ⅴ型常见;GBS菌株对青霉素和头孢曲松敏感,对红霉素和克林霉素等耐药率高,超过90%的Ⅲ/ST19型菌株耐左氧氟沙星;红霉素耐药菌株多携带erm B。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.