Onlinebasierte, qualifizierte Zweitmeinung für Patienten mit kolorektalem Karzinom — eine Pilotstudie der Felix Burda Stiftung in Zusammenarbeit mit dem Netzwerk gegen Darmkrebs

BACKGROUND Modern, individualised therapies can improve the survival of patients with colorectal cancer. However, not all patients are referred for treatment to a certified colorectal cancer centre, where a tumor board supports the implementation of their therapy in accordance to guidelines. This study examines the feasibility and demand of a structured, online-based, qualified second opinion for patients with colorectal cancer. METHOD A 15-month pilot study between 2009 and 2011, offered patients with colorectal cancer to obtain a qualified second opinion of a tumour board based on an electronic patient record completed online with the assistance of a case manager. Life-satisfaction levels and quality of life (EORCT QLQ-C30) of the participants has been monitored for a year. RESULTS In 95 % of the cases, a complete electronic patient record and a second opinion could be generated. Less than half of the participants received their first therapy recommendation from a clinic with a tumour board. The second opinion confirmed the initial medical opinion in 40 % of the cases - 33 % showed a partial and 27 % showed a significant deviation. In case of a deviation, the implementation of the second opinion improved the patients' quality of life. CONCLUSION Generating an online-based, qualified second opinion by an interdisciplinary tumour board is technically and logistically well feasible. The online-based second opinion could significantly improve the quality of treatment for patients with colorectal cancer in the future and thus improve their quality of life.HINTERGRUND Moderne, individualisierte Therapien können das Überleben von Patienten mit kolorektalem Karzinom verbessern. Jedoch werden nicht alle Patienten zur Behandlung in ein zertifiziertes Darmkrebszentrum überwiesen, wo ihre Therapie, unterstützt durch ein Tumorboard, leitliniengerecht durchgeführt wird. Daher wird derzeit die Zweitmeinung bei Krebserkrankungen diskutiert. Diese Studie beschreibt Ergebnisse einer Pilotstudie hinsichtlich der Machbarkeit und des Bedarfs einer strukturierten, onlinebasierten, qualifizierten Zweitmeinung für Patienten mit kolorektalem Karzinom. METHODEN Im Rahmen einer 15-monatigen Pilotphase zwischen 2009 und 2011 konnten Patienten mit kolorektalem Karzinom mittels einer onlinebasierten Elektronischen Patientenakte, unterstützt durch einen Case Manager, kostenfrei eine qualifizierte Zweitmeinung eines Tumorboards einholen. Ihre Zufriedenheit und ihre Lebensqualität (EORCT QLQ-C30) wurden über ein Jahr nachbeobachtet. ERGEBNISSE In 95 % der Fälle konnten eine vollständige Elektronische Patientenakte und eine Zweitmeinung erstellt werden. Weniger als die Hälfte der Teilnehmer erhielt die erste Therapieempfehlung aus einer Klinik mit Tumorboard. Die Erstmeinung konnte in 40 % der Fälle durch die Zweitmeinung bestätigt werden, in 33 % zeigte sich ein teilweises, in 27 % ein deutliches Abweichen. Bei Umsetzung der abweichenden Zweitmeinung verbesserte sich die Lebensqualität der Patienten. SCHLUSSFOLGERUNG Die Erstellung einer onlinebasierten, qualifizierten Zweitmeinung durch ein interdisziplinäres Tumorboard ist technisch und logistisch gut durchführbar. Die onlinebasierte Zweitmeinung könnte zukünftig die Qualität der Behandlung von Patienten mit kolorektalem Karzinom deutlich verbessern und damit ihre Lebensqualität erhöhen

Evaluation of the in vitro skin permeation of antiviral drugs from penciclovir 1% cream and acyclovir 5% cream used to treat herpes simplex virus infection

<p>Abstract</p> <p>Background</p> <p>Herpes simplex virus infection (HSV) is a common and ubiquitous infection of the skin which causes mucocutaneous lesions called cold sores (herpes labialis) or fever blisters. It is estimated that approximately 80% of the population worldwide are carriers of the Herpes simplex virus, approximately 40% suffer from recurrent recurrent infections. This study evaluates the <it>in vitro </it>skin permeation and penetration of penciclovir and acyclovir from commercialized creams for the treatment of herpes labialis (cold sores), using non viable excised human abdominal skin samples, which were exposed to 5 mg/cm²of acyclovir 5% cream or penciclovir 1% cream.</p> <p>Methods</p> <p>After 24 h of cream application, excess cream was washed off and layers of stratum corneum were removed by successive tape stripping. Amounts of active ingredients having penetrated through the skin were measured, as well as the amounts in the washed-off cream, in skin strips and creams remaining in the skin. Molecular modelling was used to evaluate physico-chemical differences between the drugs. Western blot analysis enabled to determine whether the marker of basal cells keratin 5 could be detected in the various tape strips.</p> <p>Results</p> <p>Application of penciclovir 1% cream yielded higher concentration of drug in the deeper layers of the epidermis as well as a higher drug flux through the skin. Molecular modelling showed two higher hydrophobic moieties for acyclovir. Presence of the basal cell marker keratin 5 was underscored in the deeper tape strips from the skin, giving evidence that both drugs can reach their target cells.</p> <p>Conclusion</p> <p>Penciclovir 1% cream has the tendency to facilitate the diffusion of the drug through the stratum corneum into the deeper epidermis layers, in which it could reach the target basal cells at effective therapeutical concentration. The small difference in the surface properties between both molecules might also contribute to favour the passage of penciclovir through the epidermis into the deeper basal cells.</p

Determination of nutrient salts by automatic methods both in seawater and brackish water: the phosphate blank

9 páginas, 2 tablas, 2 figurasThe main inconvenience in determining nutrients in seawater by automatic methods is simply solved: the preparation of a suitable blank which corrects the effect of the refractive index change on the recorded signal. Two procedures are proposed, one physical (a simple equation to estimate the effect) and the other chemical (removal of the dissolved phosphorus with ferric hydroxide).Support for this work came from CICYT (MAR88-0245 project) and Conselleria de Pesca de la Xunta de GaliciaPeer reviewe

The German National Registry of Primary Immunodeficiencies (2012-2017)

Introduction: The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs. Methods: Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel. Results: The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1–25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0–88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE- syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%—subcutaneous; 29%—intravenous; 1%—unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy. Conclusion: The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment

Immunomodulatory and antitumoral effects of triterpenoid saponins

Genuine saponins of Solidago virgaurea L., Heteropappus altaicus (Willd.) Novopokr., Heteropappus biennis (Ldb.) Tamamsch. and Helianthus annuus L. (Asteraceae) as well as related carbohydrate modified glycosides of polygalacic acid and echinocystic acid and some commercial available triterpenoid saponins were investigated in view of their immunomodulating and antitumoral effects. Mitogeneic effects on murine spleen and thymus cells, as well on human mononuclear cells in vitro could be demonstrated. The activity of murine bone marrow macrophages was stimulated in a chemoluminescence assay, and further an induction of cytotoxic macrophages and a TNF alpha release from murine macrophages was observed. The mitogeneic and TNF alpha releasing virgaureasaponin E (1) showed in vivo antitumoral effects in the allogeneic sarcoma 180 tumor model and in the syngeneic DBA/2-MC.SC-1 fibrosarcoma tumor model. In mice, treated with 1, phagocytosis of bone marrow cells and proliferation of spleen and bone marrow cells were stimulated in an ex vivo assay whereby the TNF alpha concentration in blood considerably increased compared to the control group

The Heart of China revisited: II Early Paleozoic (ultra)high-pressure and (ultra)high-temperature metamorphic Qinling orogenic collage

Orogens with multiple (ultra)high-pressure ((U)HP) and (ultra)high-temperature ((U)HT) metamorphic events provide a complex but telling record of oceanic and continental interaction. The Early Paleozoic history of the Heart of China, the Qinling orogenic collage, offers snapshots of at least three (U)HP and two (U)HT metamorphic events. The preservation of remnants of both oceanic and continental domains together with a 110 Myr record of magmatism allows the reconstruction of the processes that resulted in this disparate metamorphism. Herein, we first illuminate the pressure-temperature-time (P-T-t) evolution of the Early Paleozoic (U)HP and (U)HT events by refining the petrographic descriptions and P-T estimates, assess published, and employ new U/Th-Pb zircon, monazite, and titanite, and Ar-40-Ar-39 phengite geochronology to date the magmatic and metamorphic events. Then we explore how the metamorphic and magmatic events are related tectonically and how they elucidate the affinities among the various complexes in the Qinling orogenic collage. We argue that a Meso-Neoproterozoic crustal fragmentthe Qinling complexlocalized subduction-accretion events that involved subduction, oceanic-arc formation, and back-arc spreading along its northern margin, and mtantle-wedge exhumation and spreading-ridge subduction along its southern margin