What to Expect: Medical Quality Outcomes and Achievements of a Multidisciplinary Inpatient Musculoskeletal System Rehabilitation

The incidence of chronic diseases is rising. Rehabilitation plays a vital role in preventing and minimizing the functional limitations associated with chronic conditions and aging. Routine outcome measures include disease-specific and unspecific general health parameters. This study evaluates indicators for medical quality outcomes from 10,373 patients (61.00 ± 13.65 years, 51.7% women) who have undergone orthopedic rehabilitation for three weeks. Inpatient rehabilitation reduces lifestyle-related risk factors, optimizes organ functioning and improves the well-being in the majority of patients (81.3%; SMD = 0.52 ± 0.38). Improvements of unspecific and indication specific outcome parameters can be observed in a comparable magnitude. However, disease specific and unspecific health factors are not directly related to each other (r = 0.19). Age, gender, ICD-classification and time of rehabilitation have an influence on initial values and on indication-specific medical outcomes but are insignificant with regards to improvements in unspecific medical outcome parameters. Inpatient rehabilitation includes two main pathways of medical practice, which can be clearly distinguished in terms of their therapeutic outcome. There are general health interventions, such as lifestyle modifications, diet and physical exercise, and symptom-specific treatments. So multidisciplinary medical rehabilitation improves general well-being and physical functioning as well as reduces risk factors in the majority of patients

Early vs late histological confirmation of coeliac disease in children with new-onset type 1 diabetes

AIM Screening for coeliac disease in asymptomatic children with new-onset type 1 diabetes is controversial. The aim of this study was to analyse whether the confirmation of coeliac disease in children with new-onset type 1 diabetes and positive screening results can be postponed. METHODS This was a multicentre population-based cohort study based on the German/Austrian/Swiss/Luxembourgian Prospective Diabetes Follow-up Registry (Diabetes Patienten Verlaufsdokumentation [DPV]). Participants aged ≤18 years diagnosed with type 1 diabetes between 1995 and June 2021 and with elevated IgA tissue transglutaminase antibodies (anti-tTGA) at diabetes onset on screening for coeliac disease were included. We compared outcomes of participants with a diabetes duration of more than 1 year between those in whom coeliac disease was confirmed histologically within the first 6 months and those in whom coeliac disease was confirmed between 6 and 36 months after diabetes diagnosis. RESULTS Of 92,278 children and adolescents with a diagnosis of type 1 diabetes, 26,952 (29.2%) had documented anti-tTGA data at diabetes onset. Of these, 2340 (8.7%) had an elevated anti-tTGA level. Individuals who screened positive were younger (median age 9.0 vs 9.8 years, p<0.001) and more often female (53.1% vs 44.4%, p<0.001). A total of 533 participants (22.8% of those who screened positive) had a documented biopsy, of whom 444 had documented histological confirmation of coeliac disease. Of 411 participants with biopsy-proven coeliac disease within the first 36 months of diabetes and follow-up data, histological confirmation was performed in 264 (64.2%) within the first 6 months and in 147 (35.8%) between 6 and 36 months after diabetes onset. At follow-up (median diabetes duration 5.3 years and 5.1 years, respectively), estimated median HbA1c levels (62.8 mmol/mol vs 62.2 mmol/mol [7.9% vs 7.8%]), cardiovascular risk markers (lipids, rate of microalbuminuria, blood pressure), rates of acute diabetes complications (diabetic ketoacidosis, severe hypoglycaemia) and the proportions of participants reaching anti-tTGA levels within the normal range did not differ between groups. Participants with delayed histological confirmation of coeliac disease showed no negative effects on growth or weight gain during the observation period. CONCLUSIONS Our study suggests that the histological confirmation of coeliac disease in asymptomatic individuals with new-onset type 1 diabetes could be postponed

Promoting ecological solutions for sustainable infrastructure

Linear infrastructure networks such as roads, railways, navigation and irrigation canals, and power lines have grown exponentially since the mid-20th century. Most of these networks built before the 1990s have a significant impact on the environment. While there is no doubt that humanity needs infrastructure to ensure safe, secure and sufficient access to food, water and energy, it is essential to prevent the loss of biodiversity and ecosystems which are also at the basis of the provision of such fundamental services. Those complex, interconnected issues cannot be tackled without research and innovation, both in the fields of biodiversity and of infrastructure.IENE (Infrastructure Ecology Network Europe) was set up in 1996 to meet this need. Its mission is to promote the exchange of knowledge, experience and best practice in safe and sustainable pan-European transport infrastructure. With a status of an association today, this independent network has more than 400 members consisting of researchers, engineers, decision makers and infrastructure operators. IENE functions as an international and interdisciplinary forum. It supports cross-border cooperation in research, mitigation, planning, design, construction and maintenance in the field of biodiversity and transport infrastructure.Every two years, IENE organises an international conference to present cutting-edge research, identify pressing issues and problems, discuss effective solutions and map out future activities in the field of transport ecology and infrastructure. We are very glad to present you in this special issue some of the best scientific outcomes of the IENE 2020 conference, hoping that it will contribute to further breakthroughs in science and uptake in policy-making and practices on the ground. We commend the organising team of the University of Evora, Portugal, for their excellent programming of the conference and for having gathered exceptional scientists on the topic of biodiversity and infrastructure. They managed to host a high-quality event, despite the many adjustments that had to be done because of the covid-19, including postponing the conference to January 2021 and holding it entirely online.The topic of IENE conference 2020 was “Linear Infrastructure Networks with Ecological Solutions” and the motto was “working together”. This means that every stakeholder has a role to play, and that biodiversity should be considered at all governance scales and during all phases of the set-up of infrastructure. The papers selected here are of particular interest to follow the path set forth in the conference’s final declaration, that is included in this issue

Assessing climate impact indicators:Evaluation criteria and observed strengths and weaknesses

This report documents and reviews a selected set of climate change and impact indicators. They are documented according to reference criteria that were based on a literature study and later refinement in expert discussions. Methodological description, data requirements and availability, treatment of uncertainty, fitness for purpose of indicator time series, and seven other relevant criteria are documented for a total of 81 climate change and impact related indicators. The indicators were grouped into three tiers that reflect their main purpose of use, ranging from change in climate variables to the socio-economic consequences of climate change. A key observation is the limited availability of indicators that explicitly link climate change with socio-economic phenomena. This might be explained by the complexity of the system that hinders quantitative attribution of economic and multi-level societal development to climatic factors. The strengths and weaknesses of indicators are discussed at a general level and also outlined both on an indicator-by-indicator basis and with respect to their potential uses. The report presents a consistent set of criteria and approaches for the incorporation of indicator information into climate information portals. The collected information on climate change and impact indicators can support the development of the Copernicus Climate Services and the indicators that such services will promote

The use of tumour necrosis factor alpha-blockers in daily routine. An Austrian consensus project

To define relevant disease parameters and their respective limits indicating the initiation of TNF-α-blockers in individual patients. Subsequently, to analyze retrospectively patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS), who started TNF-α inhibition in 2006. Points to consider, regarded relevant for individual treatment decisions as well as their assessment methods, were ascertained by experts’ consensus applying the Delphi technique. Subsequently, these parameters’ thresholds with respect to the initiation of a TNF-α-blocker were identified. Thereafter, the rheumatologists representing 12 centres all over Austria agreed to retrospectively analyze their patients started on a TNF-α-blocker in 2006. Experts’ opinion regarding disease parameters relevant to initiate TNF-α-blockers in RA patients only slightly differed from those applied in clinical trials, but the parameters’ threshold values were considerably lower. For PsA patients, some differences and for AS patients, considerable differences between experts’ opinion and clinical studies appeared, which held also true for decisive parameters’ means and thresholds. Six hundred and fifty patients, started on TNF-blockers in 2006, could be analyzed retrospectively, 408 RA patients (53.3 years mean, 340 females), 93 PsA patients (48.9 years mean, 59 males) and 149 AS patients AS (42.2 years mean, 108 males), representing approximately 25% of all Austrian patients initiated on a TNF-blocker in this respective year. Far more individualized, patient-oriented treatment approaches, at least in part, are applied in daily routine compared with those derived from clinical trials or recommendations from investigative rheumatologists

Bacterial vesicles block viral replication in macrophages via TLR4-TRIF-axis

Abstract Gram-negative bacteria naturally secrete nano-sized outer membrane vesicles (OMVs), which are important mediators of communication and pathogenesis. OMV uptake by host cells activates TLR signalling via transported PAMPs. As important resident immune cells, alveolar macrophages are located at the air-tissue interface where they comprise the first line of defence against inhaled microorganisms and particles. To date, little is known about the interplay between alveolar macrophages and OMVs from pathogenic bacteria. The immune response to OMVs and underlying mechanisms are still elusive. Here, we investigated the response of primary human macrophages to bacterial vesicles (Legionella pneumophila, Klebsiella pneumoniae, Escherichia coli, Salmonella enterica, Streptococcus pneumoniae) and observed comparable NF-κB activation across all tested vesicles. In contrast, we describe differential type I IFN signalling with prolonged STAT1 phosphorylation and strong Mx1 induction, blocking influenza A virus replication only for Klebsiella, E.coli and Salmonella OMVs. OMV-induced antiviral effects were less pronounced for endotoxin-free Clear coli OMVs and Polymyxin-treated OMVs. LPS stimulation could not mimic this antiviral status, while TRIF knockout abrogated it. Importantly, supernatant from OMV-treated macrophages induced an antiviral response in alveolar epithelial cells (AEC), suggesting OMV-induced intercellular communication. Finally, results were validated in an ex vivo infection model with primary human lung tissue. In conclusion, Klebsiella, E.coli and Salmonella OMVs induce antiviral immunity in macrophages via TLR4-TRIF-signaling to reduce viral replication in macrophages, AECs and lung tissue. These gram-negative bacteria induce antiviral immunity in the lung through OMVs, with a potential decisive and tremendous impact on bacterial and viral coinfection outcome. Video Abstrac