Transurethral resection and surveillance of bladder cancer supported by 5-aminolevulinic acid-induced fluorescence endoscopy

Purpose: We determined whether neoplastic disease, which was missed under white light can be found during transurethral resection of bladder cancer by 5-aminolevulinic acid-induced porphyrin fluorescence. Materials and Methods: 5-Aminolevulinic acid-induced fluorescence endoscopy was carried out in 328 cases. A 3% 5-aminolevulinic acid solution was instilled intravesically in a mean time of 2.8 h before endoscopy, The fluorescence was excited by a special incoherent light source which provided blue light in addition to white light. Results: In 82 (25%) cases additional neoplastic lesions were found only because of their red porphyrin fluorescence which was induced by 5-aminolevulinic acid. 31% of these neoplastic foci which were found in normal and nonspecific inflamed mucosa had a poorly differentiated histology. Conclusions: 5-Aminolevulinjc acid facilitates detection of neoplastic disease during transurethral resection of bladder cancer and increases the accuracy of diagnosis

Immunologic and Molecular Characteristics of Encephalitozoon-Like Microsporidia Isolated from Humans and Rabbits Indicate That Encephalitozoon cuniculi Is a Zoonotic Parasite

To assess the zoonotic potential of Encephalitozoon-like microsporidia, we isolated and cultivated spores from specimens of urine, respiratory secretions, and stool from six patients infected with human immunodeficiency virus and from nine rabbits. Because spores of Encephalitozoon-like species are indistinguishable by microscopy, we characterized the isolates by western blot analysis and by restriction enzyme analysis of the small subunit (SSU) rDNA after amplification by the polymerase chain reaction. We identified Septata intestinalis in one patient and Encephalitozoon hellem in two symptomatic patients. Encephalitozoon cuniculi was found in all rabbits and in three patients. One of these patients had clinical manifestations of infection with this parasite (severe interstitial pneumonitis). We observed abatement of symptoms and cessation of parasite excretion when these patients were treated with albendazole. Our findings suggest that E. cuniculi may be pathogenic in humans and that it is a zoonotic parasit

Photodynamic therapy of prostate cancer by means of 5-aminolevulinic acid-induced protoporphyrin IX - In vivo experiments on the dunning rat tumor model

Objective: In order to expand the use of photodynamic therapy (PDT) in the treatment of prostate carcinoma (PCA), the aim of this study was to evaluate PDT by means of 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX ( PPIX) in an in vivo tumor model. Methods: The model used was the Dunning R3327 tumor. First of all, the pharmacokinetics and the localization of PPIX were obtained using fluorescence measurement techniques. Thereafter, PDT using 150 mg 5-ALA/kg b.w.i.v. was performed by homogenous irradiation of the photosensitized tumor (diode laser lambda = 633 nm). The tumors necrosis was determined histopathologically. Results: The kinetics of PPIX fluorescence revealed a maximum intensity in the tumor tissue within 3 and 4.5 h post-application of 5-ALA. At this time, specific PPIX fluorescence could be localized selectively in the tumor cells. The PDT-induced necrosis (n = 18) was determined to be 94 B 12% (range 60-100%), while the necrosis of the controls ( n = 12) differs significantly (p < 0.01), being less than 10%. Conclusion: These first in vivo results demonstrate the effective potential of 5-ALA-mediated PDT on PCA in an animal model. Copyright (C) 2004 S. Karger AG, Basel

Ansätze für eine "neue Normalarbeitszeit": ein Diskussionsbeitrag

Auf Basis von vorhandenen empirischen Untersuchungen, einschlägigen Dokumenten und Interviews mit Expertinnen und Experten werden die Beschäftigungs- und Arbeitsbedingungen in der Pflege und Betreuung mit Fokus auf Langzeitpflege beschrieben. Dabei geht es insbesondere um die Beschäftigungs- und Branchenbedingungen in der stationären sowie mobilen Pflege und Betreuung, die Einkommenssituation, die Arbeitsbedingungen und Belastungen sowie um Ausweichstrategien der Beschäftigten (Arbeitsplatzwechsel und Unterbrechungen, Berufsausstieg und Pensionszugang). Die wesentlichsten Ergebnisse sind: Schwere körperliche Arbeit, hohe emotionale Belastungen und geringe Entlohnung sind wesentliche Kennzeichen, wobei die Anforderungen kontinuierlich zunehmen. Teilzeitarbeit und Berufsunterbrechungen - auch in Form von Arbeitslosigkeit - sind Teil der Erwerbsbiografie, um den enormen Belastungen über Jahre standzuhalten. Diese individuellen Ausweichstrategien gehen aber zulasten der Erwerbseinkommen und Transferleistungen der vornehmlich weiblichen Pflege- und Betreuungskräfte.We discuss why current working hour regulations incentivize strenuous working times, not sufficiently recognizing scientific results regarding the effects of these stress factors. We introduce a new concept: To assess the stress and strain due to working hours by comparing it to a reference "new normal working time", which is flexitime from Monday to Friday during daytime. We present suggestions on how to assess working hours this way and how to compensate for strenuous working hours by giving additional work-free time instead of financial compensation. The most important results are: Development of the concept of "new normal working time"; Suggestion on the assessment of working hours based on the stress and strain they produce; Discussion of upper stress and strain limits, and practical implications

Ansätze für eine Neue Normalarbeitszeit: Ein Diskussionsbeitrag

Die aktuelle Regulierung von Arbeitszeiten schafft Anreize für belastende Zeiten und berücksichtigt nur unzureichend wissenschaftliche Erkenntnisse zu den Auswirkungen dieser Belastungen. Dieser Beitrag stellt einen neuen Ansatz vor: Ausgehend von einer einerseits weit verbreiteten und andererseits auch sozial- und gesundheitspolitisch wünschenswerten ‚Neuen Normalarbeitszeit‘, nämlich der Gleitzeit von Montag bis Freitag tagsüber, sollen abweichende Ar-beitszeiten hinsichtlich ihrer Belastung bewertet werden. Eine angemessene Kompensation in zusätzlicher Freizeit statt finanzieller Zulagen soll dann diese Belastung ausgleichen statt sie finanziell abzugelten. Damit würden auch bestehende Anreize für ein freiwilliges Verbleiben in belastenden Arbeitszeiten reduziert

Caring in the Margins: A Scholarship of Accompaniment for Advanced Transcultural Nursing Practice

Nurses must learn essential skills based in transcultural nursing to address issues of equity and social justice. The development of a model for nursing practice for an urban nurse-led drop-in center for individuals experiencing marginalization provides an opportunity for student nurses to learn transcultural nursing skills that shifts care from acknowledging the need of others to accompanying others on their health journey. The practice model provides the opportunity for undergraduate and graduate nursing students at Augsburg University to de-emphasize tasks and build relationships. Students learn to listen to others\u27 stories and acknowledge their struggles in the margins. Four stages of nursing practice skills, acknowledging others\u27 needs, attending to their struggles, affirming strengths, and ultimately accompanying others, are taught and experienced. At the core of the nursing practice model is the concept of “hospitality.” The nursing practice model serves as guide for student nurses to learn to suspend disbeliefs, withhold judgment, and ultimately reduce stereotypes and stigma to offer a safe space for individuals living in the margins seeking care. The future of nursing requires essential knowledge, skills, and attitudes that shift care from need-based care to accompaniment to address health inequities and provide culturally appropriate care

A Drosophila Neurexin Is Required for Septate Junction and Blood-Nerve Barrier Formation and Function

AbstractSeptate and tight junctions are thought to seal neighboring cells together and to function as barriers between epithelial cells. We have characterized a novel member of the neurexin family, Neurexin IV (NRX), which is localized to septate junctions (SJs) of epithelial and glial cells. NRX is a transmembrane protein with a cytoplasmic domain homologous to glycophorin C, a protein required for anchoring protein 4.1 in the red blood cell. Absence of NRX results in mislocalization of Coracle, a Drosophila protein 4.1 homolog, at SJs and causes dorsal closure defects similar to those observed in coracle mutants. nrx mutant embryos are paralyzed, and electrophysiological studies indicate that the lack of NRX in glial–glial SJs causes a breakdown of the blood-brain barrier. Electron microscopy demonstrates that nrx mutants lack the ladder-like intercellular septa characteristic of pleated SJs (pSJs). These studies identify NRX as the first transmembrane protein of SJ and demonstrate a requirement for NRX in the formation of septate-junction septa and intercellular barriers

The Critical Juncture Concept’s Evolving Capacity to Explain Policy Change

This article examines the evolution of our understanding of the critical junctures concept. The concept finds its origins in historical intuitionalism, being employed in the context of path dependence to account for sudden and jarring institutional or policy changes. We argue that the concept and the literature surrounding it—now incorporating ideas, discourse, and agency—have gradually become more comprehensive and nuanced as historical institutionalism was followed by ideational historical institutionalism and constructivist and discursive institutionalism. The prime position of contingency has been supplanted by the role of ideas and agency in explaining critical junctures and other instances of less than transformative change. Consequently, the concept is now capable of providing more comprehensive explanations for policy change