Cognitive function in the acute course of allogeneic hematopoietic stem cell transplantation for hematological malignancies

The aim of the study was to assess cognitive performance in patients with hematological malignancies before, and 3 months after, allogeneic hematopoietic stem cell transplant (HSCT). A consecutive sample of 39 patients was assessed before admission with a comprehensive neuropsychological test battery and health-related quality-of-life (HRQoL) questionnaires; 19 of these patients were retested around 100 days post HSCT. Test results were compared with normative data and revealed minimal differences at both time points in the level of group-means. One parameter - simple reaction time - was significantly worse (prolonged) at second measurement after HSCT. According to the definition of an impairment score (more than three impaired functions), 26% of patients were classified as impaired before as well as after HSCT. Neuropsychological test results did not vary systematically according to medical variables such as extent of pretreatment, graft-versus-host-disease (GvHD) and kind of conditioning protocol. As a dimension of HRQoL, self-rated cognitive function was in the normal range before and after HSCT. Significant correlations between HRQoL and neuropsychological parameters were related to symptom scales. This study showed impairments of neuropsychological performance for a subgroup of patients before and after allogeneic HSCT. Systematic effects of conditioning, medical variables or self-rated HRQoL could not be observed.     

A world of knowledge for the nation's health: the U.S. National Library of Medicine

The origins, history, current collections and services, and projected future services of the U.S. National Library of Medicine are described, and the seminal figure in its development is profiled. The library, now located on the campus of the National Institutes of Health, was founded in 1836 as the Library of the Army Surgeon General's Office. The current facility holds more than 3.5 million items and offers innovative information services to health-care professionals worldwide. The leading figure in the library's development was Army physician John Shaw Billings, whose accomplishments included the international expansion and bibliographic organization of the holdings and creation of the Index Medicus and Index-Catalogue. The computerized services offered by the library include the MEDLINE database, which is based on Index Medicus, and pharmacy-related databases. Health-care practitioners can gain access to the library's resources through the Regional Medical Library Network. Among projects under development at the Lister Hill National Center for Biomedical Communications are microcomputer and optical disk technologies, the preservation of paper collections, and a unified medical language system. The U.S. National Library of Medicine has served the health-care community for 150 years; many services in the area of biomedical communications are available to pharmacists and other practitioners through the library and the Regional Medical Library Network.     

Vergleichende Untersuchungen zur Resorption von Glucose,Galaktose und Lactose am Menschen und an der Ratte

Zusammenfassung Es wird eine neue Methodik zur Prüfung der Resorption wasserlöslicher Substanzen beschrieben. Neben diesen Prüfsubstanzen (z.B. verschiedene Zucker) wird eine sog. Kontrollsubstanz verabreicht, die wasserlöslich, nicht toxisch, gut nachweisbar und nicht resorbierbar ist. Diesen Ansprüchen genügt in hervorragender Weise Kollidon (Polyvinylpyrrolidon, MG 30000), dessen Konzentration im Darm nach verschiedenen Prüfzeiten zu der Konzentration der gleichzeitig verabreichten Prüfsubstanzen in Beziehung gesetzt wird. Daraus läßt sich das Ausmaß der Resorption unschwer ermitteln. Die Resorptionsprüfung bei der Ratte erfolgte durch Aufarbeitung des gesamten Darminhaltes nach 15, 30 und nach 60 min. Beim Menschen wurde die Prüfung der Resorption im Duodenum mit einer Doppelballonsonde durchgeführt (Prüfzeiten: 5, 15 und 30 min). Über die Ergebnisse der bei 69 Versuchspersonen und bei 349 Ratten durchgeführten Untersuchungen zur Resorption von Glucose, Galaktose und Lactose wird in den beiden folgenden Mitteilungen berichtet.Mit Unterstützung der Deutschen Forschungsgemeinschaft.     

Free Radical Copolymerisation of N‐Methylmaleimide and 2,3‐Dihydrofuran Initiated by their Radical Cations. A Low Temperature EPR Study of a Binary System

2,3‐Dihydrofuran radical cations were generated at 77 K by electron beam irradiation of a freon matrix containing both 2,3‐dihydrofuran and N‐methylmaleimide monomers. N‐Methylmaleimide radical cations initially formed are rapidly transformed into radical cations of the better electron donor 2,3‐dihydrofuran. The transformations of the radical cations and subsequent radicals with increasing temperature were followed by EPR. The spectra were compared with density functional calculations (B3LYP, Gaussian 98 W). The 2,3‐dihydrofuran radical cation is found to initiate free radical copolymerisation.     

Radical formation in electron‐irradiated acrylates studied by pulse radiolysis and electron paramagnetic resonance

Electron pulse radiolysis with optical and conductometric detection as well as low‐temperature electron paramagnetic resonance (EPR) were used to study the mechanism of electron‐irradiation induced polymerisation and cross‐linking of acrylates such as triethyleneglycol (TPGDA) and butandiol (BDDA) diacrylate. Irradiation of acrylates with fast electrons generates radical cations and anions that rapidly transform to radicals. Using butyl chloride or tetrahydrofuran and water as solvents cationic and anionic pathways of radical formation were studied separately. Acrylate radical cations either deprotonate forming vinyl‐type radicals or generate covalently bonded or resonance stabilised dimer cations. Vinyl‐type radicals as well as dimer cations are able to initiate polymerisation. EPR results show that a structural transformation of TPGDA primary cations takes place by H‐transfer from the ester to the positively charged carbonyl group. Addition of solvated electrons to acrylates forms anions. Protonation of the anion at the carbonyl site leads to ketyl‐type radicals which are also able to initiate polymerisation. It is concluded that after electron‐irradiation of acrylates both cations as well as anions are important precursors of radicals which induce radical polymerisation and cross‐linking.     

Botulinum toxin improves reduced dorsiflexion after Achilles tendon surgery

Generally, outcome after surgical repair of complete Achilles tendon rupture is good. However, some patients have ongoing problems with dorsiflexion of the ankle joint. We report on eight patients, who did not achieve heel contact because of reduced ankle dorsiflexion 5 months after surgical repair of complete Achilles tendon rupture. All patients received at least three cycles of injections with 200–300 units of Botulinum toxin A (BOTOX^®) into the gastrocnemius and soleus muscle. Weakening of the triceps surae by Botulinum toxin allowed patients to perform the required exercises and to tolerate casting at night. Thus, all patients were able to tolerate plantigrade foot position 9 months after beginning of Botulinum toxin treatment. At final follow-up after 2 years, pain had significantly improved, and a mean dorsiflexion of 21° was reached. In conclusion, treatment of the calf muscles with BOTOX^® is a safe and effective method to improve restricted dorsiflexion in patients after Achilles tendon repair.     

Präkonditionierung vor viszeralonkologischen Operationen

Background

Postoperative complications after complex visceral oncological surgery can lead to substantial impairment of patients. In addition, preoperative physical performance and the severity of postoperative complications determine the long-term recovery process of physical function. Therefore, preconditioning in the preoperative period should be an important part of the preoperative/neoadjuvant treatment.

Objective

The aim of this article is a critical appraisal of current concepts of prehabilitation as well as their development potential and applicability in visceral surgery.

Material and methods

Based on a selective literature review, current studies and implemented concepts are presented and therapy algorithms are provided.

Results

This study differs in primary outcome, design and temporal framework of the intervention. The study results showed positive effects of an active increase in physical fitness in the preoperative period with respect to the quality of life, convalescence and postoperative pulmonary complication rate.

Discussion

In addition to the assessment of the individual risk of complications by means of spiroergometry, a targeted nutrition and exercise program can increase the individual performance level prior to visceral surgery and, thus, influence the postoperative risk of complications. The performance should be understood as a modifiable risk factor, which can also be positively influenced in the preoperative phase, even in a short time period. Individual preoperative care optimizes the physical and psychological situation of patients. To ensure the required individual care, approaches must be created and pursued, which can be implemented in a decentralized way.

     

Diagnostik psychosozialer Belastungen bei Arbeitsunfallpatienten

Trauma und Berufskrankheit - Das vom Hamburger Institut für Medizinische Psychologie bearbeitete Teilprojekt aus dem Gesamtvorhaben „Evaluation der Ergebnisqualität des besonderen...     

Course and predictors of posttraumatic stress among male train drivers after the experience of 'person under the train' incidents

ObjectiveThe present prospective study aimed to identify the frequency and course of posttraumatic stress symptoms, anxiety, depression, and quality of life in train drivers after the experience of ‘person under the train’ incidents. Furthermore, associations between predictors of posttraumatic stress stratified by pre-, peri- and posttraumatic factors, psychological distress, quality of life (QoL), sense of coherence, lack of meaning in life, and post-trauma thoughts are analyzed.MethodsPatients (100% male, mean age 48 years) were assessed at the beginning (n = 73), at the end (n = 71) and six months (n = 49) after a four-week rehabilitation program and completed validated self-report questionnaires (e.g. Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Short-Form Health Survey).ResultsTrain drivers experienced averagely 1.8 ‘person under the train’ incidents (range 1–8); the majority (81%) was involved in a railway suicide. At the beginning of the rehabilitation, 44% of the patients were classified as having moderate to severe PTSD, and 14% as having severe PTSD. Posttraumatic stress decreased significantly over time (p = .003, η² = .17). We found no significant differences in the course of posttraumatic stress, anxiety, depression, distress and QoL between patients who experienced one or more than one railway related accident or suicide. Anxiety, sense of guilt and sense of alienation emerged as the most important factors in predicting posttraumatic stress six months after rehabilitation (R² = 0.55).ConclusionFindings emphasize the importance of rehabilitation programs for train drivers after railway-related incidents. However, research is needed to develop effective rehabilitation interventions particularly tailored to this patient group.     

RU 58841-myristate--prodrug development for topical treatment of acne and androgenetic alopecia

Acne and androgenetic alopecia are linked to androgen effects and therefore should improve following topical application of antiandrogens. We present a new antiandrogen prodrug, RU 58841-myristate (RUM) for topical therapy. Almost devoid of affinity to the androgen receptor, as derived from investigations in the mouse fibroblast cell line 29 +/GR +, RUM is rapidly metabolised to the potent antiandrogen RU 58841 by cultured human foreskin fibroblasts and keratinocytes, male occipital scalp skin dermal papilla cells, and by cells of the sebaceous gland cell line SZ95. In order to improve a specific targeting of the hair follicle, RUM was loaded on solid lipid nanoparticles (SLN), which are already known to support dermal targeting effects. Physically stable RUM loaded SLN were produced by hot homogenization. Penetration/permeation studies carried out using the Franz diffusion cell proved only negligible permeation of reconstructed epidermis and excised porcine skin within 6 h, implying a more topical action of the drug. Targeting to the hair follicle using SLN was visualised by fluorescence microscopy, following the application of Nile Red labelled SLN to human scalp skin. Transmission electron microscopy (TEM) allowed to detect intact silver labelled SLN in porcine hair follicles of preparations applied to the skin for 24 h. RUM loaded SLN should be considered for topical antiandrogen therapy of acne and androgenetic alopecia.