Evidenzbasierte Psychotherapie der Panikstörung mit und ohne Agoraphobie : ein Überblick zur S1-Leitlinie der Deutschen Gesellschaft für Psychologie

Alpers GW, Gerlach AL, Heinrichs N. Evidence-based psychotherapy of panic disorder with or without agoraphobia. Psychotherapeut. 2011;56(6):535-548.From the evidence reported in the recent guidelines [Heinrichs et al. (2009) Evidenzbasierte Leitlinie zur Psychotherapie der Panikstorung mit und ohne Agoraphobie. Hogrefe, Gottingen] the following conclusions can be drawn with respect to the treatment of panic disorder with or without agoraphobia, as well as for agoraphobia without panic disorder: Every psychotherapy should be preceded by suitable diagnostics and a case formulation. The effectiveness of every psychotherapy should be evaluated with well established measures. For the treatment of panic disorder without agoraphobia, cognitive behavioral treatment (CBT) and applied relaxation have been shown to be effective (evidence grade 1). For panic disorder with agoraphobia, CBT, combination treatment (CBT plus medication), as well as panic-focused psychodynamic psychotherapy in the outpatient setting have shown short-term effectiveness (evidence grade 1). Longer lasting effects have been documented for CBT (evidence grade 1). For agoraphobia without panic disorder, CBT with a focus on situational exposure can be recommended (evidence grade 1)

GEF-H1 Mediated Control of NOD1 Dependent NF-κB Activation by Shigella Effectors

Shigella flexneri has evolved the ability to modify host cell function with intracellular active effectors to overcome the intestinal barrier. The detection of these microbial effectors and the initiation of innate immune responses are critical for rapid mucosal defense activation. The guanine nucleotide exchange factor H1 (GEF-H1) mediates RhoA activation required for cell invasion by the enteroinvasive pathogen Shigella flexneri. Surprisingly, GEF-H1 is requisite for NF-κB activation in response to Shigella infection. GEF-H1 interacts with NOD1 and is required for RIP2 dependent NF-κB activation by H-Ala-D-γGlu-DAP (γTriDAP). GEF-H1 is essential for NF-κB activation by the Shigella effectors IpgB2 and OspB, which were found to signal in a NOD1 and RhoA Kinase (ROCK) dependent manner. Our results demonstrate that GEF-H1 is a critical component of cellular defenses forming an intracellular sensing system with NOD1 for the detection of microbial effectors during cell invasion by pathogens

Antidepressant medication and the assimilation of problematic experiences in psychotherapy

The authors assessed whether the psychotherapeutic process is enhanced by the addition of antidepressant medication. Mildly to moderately depressed patients received client-centered therapy with or without medication. Patients were assessed for symptoms of depression and the ability to assimilate problematic experiences successfully. Ratings of improvement on Stiles's Scale for the Assimilation of Problematic Experiences rose significantly in both treatment conditions. There was no significant effect of the addition of antidepressant medication on the psychotherapeutic process. However, patients without medication tended to reach higher stages of assimilation (e.g., problem clarification and insight). Psychotherapy alone seems as effective in reducing depression as that with the addition of pharmacotherapy and may be superior in supporting the psychotherapeutic process in the longer term. The question remains as to the nature of the conditions in which one may achieve additive effects of psychotherapy and medication

AG TURBO, TURBOTECH II: Vorhaben 1.134 - Optimierung des Stroemungsverhaltens von Verdichtergittern mit CDA-Profilierung. Der Einfluss periodisch instationaerer Zustroemung auf das Transitionsverhalten von Verdichtergittern Abschlussbericht

For the aerodynamic design of turbomachine blades current methods generally apply steady flow theory and consider unsteady effects like blade row interaction, shock-boundary layer interaction, potential effects and secondary flow effects only by means of empirical or semi-empirical correlations. In the context of a modern, cost-oriented blade design efforts are made to increase the aerodynamic blade loading by considering these unsteady effects whereby efficiency and performance are kept constant. This results in a blade count reduction and consequently a weight reduction, but entails a highly three-dimensional and unsteady flow field, which makes great demands on numerical design codes. The primary goals of this work was to investigate the unsteady flow behavior in compressor cascades with controlled diffusion blading under the influence of upstream wakes and to obtain a detailed insight into the physics of unsteady boundary layer behavior. With the obtained data base a validation of unsteady codes should be conducted. The investigated cascades V110 and V111 are representative for the mid section of stator blades in a high pressure compressor. At the investigated low Reynolds number a loss reduction up to 20% was observed, while at the high Reynolds number a loss increase up to 30% compared to the steady flow case was noted. The numerical results obtained by the unsteady Reynolds-averaged Navier-Stokes code TRACEU which includes a transition correlation showed a very good agreement with the experimental results. Further on indications for new design criteria considering unsteady flow effects were provided. (orig.)Bei der aerodynamischen Auslegung von Turbomaschinenbeschaufelungen beruecksichtigten bisherige Verfahren instationaere Stroemungseffekte wie Schaufelreihen-Interaktion, Stoss-Grenzschicht-Wechselwirkung, Einfluss des Potentialfeldes und Sekundaerstroemungseffekte nur partiell ueber empirische und halbempirische Korrelationen. Im Rahmen einer modernen kostenorientierten Schaufelauslegung wird versucht, durch Optimierung der Schaufelprofile unter Beruecksichtigung der obengenannten instationaeren Effekte bei gleichbleibendem Wirkungsgrad und Leistungsverhalten die aerodynamische Schaufelbelastung zu erhoehen, wodurch eine Reduzierung der Schaufelzahl und damit eine kompaktere Bauweise mit geringerem Gewicht ermoeglicht wird. Das Resultat einer diese Effekte beruecksichtigenden Optimierung ist ein aeusserst komplexes, hochgradig dreidimensionales und instationaeres Stroemungsfeld, das hohe Anforderungen an die numerischen Auslegungsverfahren stellt. Primaeres Ziel dieser Arbeit war, durch eine detaillierte Untersuchung des instationaeren Stroemungsverhaltens um Verdichterschaufeln mit CDA-Profilierung unter dem Einfluss von Nachlaufdellen stromaufliegender Schaufelreihen einen tieferen Einblick in die physikalischen Vorgaenge innerhalb der Schaufelgrenzschicht zu ermoeglichen und mit Hilfe der experimentellen Daten instationaere numerische Verfahren zu validieren. Fuer die beiden untersuchten Verdichtergitter V110 und V111 wurde bei niedriger Zustroem-Reynoldszahl eine bis zu 20%-ige Verlustreduzierung und bei hoher Reynoldszahl ein bis zu 30%-iger Verlustanstieg gegenueber dem stationaeren Fall verzeichnet. Die Nachrechnung der experimentellen Ergebnisse mit dem instationaeren Reynolds-gemittelten Navier-Stokes-Verfahren TRACEU mit Transitionsmodellierung lieferte sehr gute Ergebnisse. Desweiteren wurden Hinweise fuer eine zukuenftige, die instationaeren Effekte beruecksichtigende Schaufelauslegung erteilt. (orig.)SIGLEAvailable from TIB Hannover: RR 6618(2000,6)+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung und Forschung, Berlin (Germany)DEGerman

Value of different ultrasound elastography techniques in patients with venous malformations prior to and after sclerotherapy

AIM: Comparison of different ultrasound elastography techniques for detection of changes after sclerotherapy within venous malformations. MATERIALANDMETHODS: In patients with venous malformations sonographywas executed at exactly the same position prior to and after ethanol-gel sclerotherapy. Both examinations included B-Mode, vascular sonography with Color-Coded Duplex Sonography, and additional sonography with different elastography techniques (strain, qualitative and quantitative Acoustic Radiation Force Impulse (ARFI) elastography) with a linear transducer (6-9 MHz). Qualitative elastograms were read in consensus and scored. Differences of elasticity scores were statistically analyzed, p-values < 0.05 were regarded significant. RESULTS: Elasticity scores of strain and qualitative ARFI elastography in 25 patients (21 females, averagely 24.4 years old) were comparable before treatment (p = 0.69). After therapy qualitative ARFI scores changed significantly compared to pre-treatment scores (p = 0.0017), whereas strain elastography scores revealed no significant changes (p = 0.13). Quantitative ARFI values obtained after sclerotherapy within the venous malformations were significantly higher compared to pretreatment values (p = 0.049), and significantly higher to values obtained in surrounding tissue (p = 0.030). Comparison of preand post-treatment ARFI values of the surrounding tissue was not significant (p = 0.67). CONCLUSION: Elasticity scores of qualitative ARFI elastography reliably detect ethanol-gel induced changes in venous malformations. Quantitative ARFI may be a tool for therapy planning, and for monitoring sclerotherapy outcome as well as the effect of sclerosing agents on malformation and surrounding tissue in patients with venous malformations