Apheresis therapies for NMOSD attacks A retrospective study of 207 therapeutic interventions

Objective To analyze whether 1 of the 2 apheresis techniques, therapeutic plasma exchange (PE) or immunoadsorption (IA), is superior in treating neuromyelitis optica spectrum disorder (NMOSD) attacks and to identify predictive factors for complete remission (CR). Methods This retrospective cohort study was based on the registry of the German Neuromyelitis Optica Study Group, a nationwide network established in 2008. It recruited patients with neuromyelitis optica diagnosed according to the 2006 Wingerchuk criteria or with aquaporin-4 (AQP4-ab)-antibody-seropositive NMOSD treated at 6 regional hospitals and 16 tertiary referral centers until March 2013. Besides descriptive data analysis of patient and attack characteristics, generalized estimation equation (GEE) analyses were applied to compare the effectiveness of the 2 apheresis techniques. A GEE model was generated to assess predictors of outcome. Results Two hundred and seven attacks in 105 patients (87% AQP4-ab-antibody seropositive) were treated with at least 1 apheresis therapy. Neither PE nor IA was proven superior in the therapy of NMOSD attacks. CR was only achieved with early apheresis therapy. Strong predictors for CR were the use of apheresis therapy as first-line therapy (OR 12.27, 95% CI: 1.04-144.91, p = 0.047), time from onset of attack to start of therapy in days (OR 0.94, 95% CI: 0.89-0.99, p = 0.014), the presence of AQP4-abantibodies (OR 33.34, 95% CI: 1.76-631.17, p = 0.019), and monofocal attack manifestation (OR 4.71, 95% CI: 1.03-21.62, p = 0.046). Conclusion: s Our findings suggest early use of an apheresis therapy in NMOSD attacks, particularly in AQP4-ab-seropositive patients. No superiority was shown for one of the 2 apheresis techniques

Influence of female sex and fertile age on neuromyelitis optica spectrum disorders

Background: Gender and age at onset are important epidemiological factors influencing prevalence, clinical presentation, and treatment response in autoimmune diseases. Objective: To evaluate the impact of female sex and fertile age on aquaporin-4-antibody (AQP4-ab) status, attack localization, and response to attack treatment in patients with neuromyelitis optica (NMO) and its spectrum disorders (neuromyelitis optica spectrum disorder (NMOSD)). Methods: Female-to-male ratios, diagnosis at last visit (NMO vs NMOSD), attack localization, attack treatment, and outcome were compared according to sex and age at disease or attack onset. Results: A total of 186 NMO/SD patients (82% female) were included. In AQP4-ab-positive patients, female predominance was most pronounced during fertile age (female-to-male ratio 23:1). Female patients were more likely to be positive for AQP4-abs (92% vs 55%;p40years. Conclusion: Our data suggest an influence of sex and age on susceptibility to AQP4-ab-positive NMO/SD. Genetic and hormonal factors might contribute to pathophysiology of NMO/SD

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Transfer metakognitiver Strategien beim selbstregulierten Lernen

Die Fähigkeit, seinen eigenen Lernprozess mithilfe von Lernstrategien zu regulieren, kann als grundlegende Voraussetzung für lebenslanges Lernen gesehen werden. Entsprechend sollte diese Fähigkeit in der Schule vermittelt werden. Forschung zu Effekten von Lernstrategietrainings scheitern allerdings zumeist daran, Effekt auf trainingsunähnliche (ferne Transfer-) Aufgaben im regulären Unterricht nachweisen zu können. Im Rahmen der Dissertation wurde entsprechend die Frage nach Transferprozessen im Rahmen von Lernstrategietrainings gestellt. Drei Interventionsstudien an Ganztagsgymnasien konnten nahen und fernen Transfer sowie zum Teil eine Verbesserung der Ausführungsqualität von kognitiven Strategien zeigen.The ability to regulate one’s own learning process by applying learning strategies can be seen as a basic requirement for lifelong learning. Accordingly, this ability should be taught in schools. However, research on effects of learning strategy training fails mostly in demonstrating effects on training-unrelated (far transfer) tasks in regular lessons. This dissertation poses the question of transfer processes in the context of learning strategy trainings. Three intervention studies at all-day schools demonstrated near and far transfer as well as, partly, an impovement in the performance quality of cognitive strategies

Selbstreguliertes Lernen in den Naturwissenschaften. Praxismaterial für die 5. und 6. Jahrgangsstufe

Die Autoren stellen in „Selbstreguliertes Lernen in den Naturwissenschaften“ ein Training vor, welches das selbstregulierte Lernen aus Sachtexten und durch Experimentieren fördert. Schülerinnen und Schüler der fünften und sechsten Jahrgangsstufe lernen in diesem Training, wie sie selbstregulative Strategien nutzen können, um Lese- und Experimentierstrategien lernförderlich anzuwenden. Das Training ist im Rahmen des Schulentwicklungsprojektes „Ganz In. Mit Ganztag mehr Zukunft. Das neue Ganztagsgymnasium NRW“ (www.ganz-in.de) entstanden. Die Lernförderlichkeit und Praktikabilität des Trainings konnten mit Hilfe wissenschaftlicher Methoden im Schulalltag mehrmals erfolgreich bestätigt werden. (DIIPF/Orig.

Individual support and self-regulated learning. Conditions and options for classroom teaching and distance learning

Dieser Beitrag stellt das selbstregulierte Lernen als Form der individuellen Förderung vor und thematisiert vor allem darauf bezogene Lernstrategien und deren Relevanz für den Lernprozess. Zudem werden Wege der schulischen Förderung von Schüler*innen wissenschaftlich fundiert dargestellt. Daran anschließend werden konkrete Handlungsoptionen für die schulische Praxis im Kontext des Präsenzunterrichts und „Fernunterrichts“ abgeleitet, um zu verdeutlichen, wie das selbstregulierte Lernen genutzt werden kann, um mit den aktuellen Herausforderungen zu Zeiten von Corona umzugehen. (DIPF/Orig.)This article presents self-regulated learning as a form of individual support and focuses on related learning strategies and their relevance for the learning process. In addition, measures of student support in schools are presented in a scientifically profound manner. Subsequently, concrete courses of action for school practice in the context of classroom teaching and distance learning are derived, in order to illustrate how self-regulated learning can be used to address the current challenges during the coronavirus pandemic. (DIPF/Orig.

Development of a novel sample reuse approach to measure the impact of lean meat, bone and adipose tissue on the development of volatiles in vacuum-packed chilled lamb stored at 2 °C for 15 days

The impact of different ratios of lean meat, adipose tissue (fat) and bone on the volatile organic compound (VOC) profile of vacuum-packed (VP) lamb stored at 2 °C for up to 15 days was investigated using two sampling approaches. VOC development in individual samples was followed over time using either a traditional sampling regime where replicate samples were sampled (single-use) at a given time or a novel approach where replicate samples were resampled (reuse) over time. VOCs present in the headspace of the packaged samples were detected using proton-transfer-reaction mass spectrometry (PTR-MS) with complementary solid phase micro-extraction gas chromatography–mass spectrometry (SPME-GC-MS) analysis on a subset of samples. Bacteria numbers were determined using standard microbiological methods. Meat packaged with 20% added adipose tissue contained slightly higher numbers of bacteria at the start of the trial with correspondingly higher VOC levels compared to lean meat alone. Storage time (as a proxy for microbial numbers) was the main driver for VOC production. Differences between the reuse and the single-use sample sets were minimal, suggesting that resampling of VP lamb samples may be a useful approach to study the development of low frequency spoilage patterns over time