Erregungszustände und γ-Hydroxybutyrat

Zusammenfassung: Erregungszustände können Ausdruck unterschiedlicher Krankheitsbilder sein. Gamma-Hydroxybutyrat (GHB) wird wegen euphorisierender Effekte missbraucht und kann zu Agitation, Bewusstseinsstörungen und Koma führen. Wir stellen einen 50-jährigen Patienten mit wiederholten GHB-Intoxikationen bei abstinenter Alkoholabhängigkeit und einen videodokumentierten Erregungszustand vor. Die Differenzialdiagnose wird vor dem Hintergrund der aktuellen Literatur diskutiert. GHB-Intoxikation und -Abhängigkeit stellen auch im nervenärztlichen Kontext wichtige Krankheitsbilder da

Efficacy of bifocal diagnosis-independent group psychoeducation in severe psychiatric disorders: results from a randomized controlled trial

Despite evidence for its efficacy, diagnosis-specific psychoeducation is not routinely applied. This exploratory randomized controlled trial analyses the efficacy of an easily implementable bifocal diagnosis-mixed group psychoeducation in the treatment of severe psychiatric disorders regarding readmission, compliance and clinical variables, for example global functioning. Inpatients of the Psychiatric Hospital of the University of Basel (N=82) were randomly assigned to a diagnosis-mixed psychoeducational (PE) or a non-specific intervention control group. Relatives were invited to join corresponding family groups. Results at baseline, 3- and 12-month follow-ups are presented. Better compliance after 3months and a lower suicide rate were significant in favour of PE. For most other outcome variables, no significant differences, however advantages, in PE were found. In summary, it can be concluded that diagnosis-mixed group psychoeducation is effective in the treatment of severe psychiatric disorders. The effects can be classified as induced by distinctive psychoeducational elements. Findings similar to those on psychosis-specific programmes justify clinical application and further investigatio

Mimicking the Human Tympanic Membrane: The Significance of Scaffold Geometry

The human tympanic membrane (TM) captures sound waves from the environment and transforms them into mechanical motion. The successful transmission of these acoustic vibrations is attributed to the unique architecture of the TM. However, a limited knowledge is available on the contribution of its discrete anatomical features, which is important for fabricating functional TM replacements. This work synergizes theoretical and experimental approaches toward understanding the significance of geometry in tissue-engineered TM scaffolds. Three test designs along with a plain control are chosen to decouple some of the dominant structural elements, such as the radial and circumferential alignment of the collagen fibrils. In silico models suggest a geometrical dependency of their mechanical and acoustical responses, where the presence of radially aligned fibers is observed to have a more prominent effect compared to their circumferential counterparts. Following which, a hybrid fabrication strategy combining electrospinning and additive manufacturing has been optimized to manufacture biomimetic scaffolds within the dimensions of the native TM. The experimental characterizations conducted using macroindentation and laser Doppler vibrometry corroborate the computational findings. Finally, biological studies with human dermal fibroblasts and human mesenchymal stromal cells reveal a favorable influence of scaffold hierarchy on cellular alignment and subsequent collagen deposition

Understanding Barriers to the Realization of Human Rights Among Older Women With Mental Health Conditions

There is increasing emphasis in research and at the level of international human rights bodies such as the United Nations on the gendered contours of age-based disadvantage and discrimination, and the cumulative effects of gender inequalities over the life-course on outcomes in later life. However, to date, the role of mental health in shaping the age/gender nexus in the realization of human rights has received little attention. In response, this paper aims to 1) elucidate the economic, social and cultural disadvantages and discrimination faced by older women living with mental health conditions; and 2) identify opportunities to protect their human rights. It concludes that older women face inequalities and disadvantages at the intersections of age, gender, and mental health and wellbeing that compromise their capacity to age well, illuminating the urgent need for a UN Convention on the Human Rights of Older Persons that considers the role of mental health in shaping the realization of human rights among older people. (Am J Geriatr Psychiatry 2021; 29:1009-1014

Escherichia coli phylogenetic group determination and its application in the identification of the major animal source of fecal contamination

<p>Abstract</p> <p>Background</p> <p><it>Escherichia coli </it>strains are commonly found in the gut microflora of warm-blooded animals. These strains can be assigned to one of the four main phylogenetic groups, A, B1, B2 and D, which can be divided into seven subgroups (A₀, A₁, B1, B2₂, B2₃, D₁and D₂), according to the combination of the three genetic markers <it>chuA</it>, <it>yjaA </it>and DNA fragment TspE4.C2. Distinct studies have demonstrated that these phylo-groups differ in the presence of virulence factors, ecological niches and life-history. Therefore, the aim of this work was to analyze the distribution of these <it>E. coli </it>phylo-groups in 94 human strains, 13 chicken strains, 50 cow strains, 16 goat strains, 39 pig strains and 29 sheep strains and to verify the potential of this analysis to investigate the source of fecal contamination.</p> <p>Results</p> <p>The results indicated that the distribution of phylogenetic groups, subgroups and genetic markers is non-random in the hosts analyzed. Strains from group B1 were present in all hosts analyzed but were more prevalent in cow, goat and sheep samples. Subgroup B2₃was only found in human samples. The diversity and the similarity indexes have indicated a similarity between the <it>E. coli </it>population structure of human and pig samples and among cow, goat and sheep samples. Correspondence analysis using contingence tables of subgroups, groups and genetic markers frequencies allowed the visualization of the differences among animal samples and the identification of the animal source of an external validation set. The classifier tools Binary logistic regression and Partial least square -- discriminant analysis, using the genetic markers profile of the strains, differentiated the herbivorous from the omnivorous strains, with an average error rate of 17%.</p> <p>Conclusions</p> <p>This is the first work, as far as we are aware, that identifies the major source of fecal contamination of a pool of strains instead of a unique strain. We concluded that the analysis of the <it>E. coli </it>population structure can be useful as a supplementary bacterial source tracking tool.</p

Limb remote ischemic conditioning of the recipient protects the liver in a rat model of arterialized orthotopic liver transplantation

Background Ischemic-reperfusion (IR) injury still represents a major concern in clinical transplantation, especially in the era of extreme organ shortage and extended criteria donor organs. In the present study we aimed to investigate the hepatoprotective effects of remote ischemic conditioning (RIC) in a rat model of arterialized orthotopic liver transplantation (OLT). Methods Male Lewis rats were used (n = 144 / 72 OLT cases; 240-340g) as donors and recipients. Livers were flushed and stored in 4 degrees C HTK-solution for 8h before implantation. Recipients were randomly allocated into three experimental groups: RIC 1, RIC 2, Control. In RIC 1, RIC 2 groups, RIC was applied in the recipient before hepatectomy or after reperfusion (4x5-5min IR via clamping the infrarenal aorta), respectively. Animals were sacrificed at 1, 3,24,168h post-reperfusion (n = 6 recipient/group/time point). Hepatocellular injury, graft circulation, serum cytokines, tissue redox-stress and adenosine-triphosphate (ATP) levels have been assessed. Additional markers were analyzed, using Western blotting and reverse-transcription polymerase chain reaction. Results RIC 1 group showed significantly (p<0.05) improved portal venous and microcirculation flow as well as velocity. RIC has significantly reduced tissue injury according to the serum levels of transaminases and results of histopathological evaluation. Reduced TUNEL-staining (p<0.01 RIC 1-2 vs. Control) and elevated pBAD/BAD ratio was detected in the RIC groups (p<0.01 RIC 1 vs. Control). Supporting findings were obtained from measurements of serum IL-10 as well as tissue malondialdehyde and ATP levels. Hemoxygenase-1 (HO-1) mRNA-expression was significantly higher in RIC 1 compared to Control (p<0.05 RIC 1 vs. Control). Conclusion These results suggest that RIC might confer potent protection against the detrimental effects of IR injury including tissue damage, apoptosis, graft circulation, inflammation, tissue energetic status in OLT. HO-1 overexpression might play an orchestrating role in RIC mediated organ protection. An earlier intervention (RIC 1 protocol) was more effective than remote conditioning after graft reperfusion

Spatially-explicit and spectral soil carbon modeling in Florida.

Profound shifts have occurred over the last three centuries in which human actions have become the main driver to global environmental change. In this new epoch, the Anthropocene, human-driven changes such as population growth, climate and land use change, are pushing the Earth system well outside its normal operating range causing severe and abrupt environmental change. In this context, we present research highlights from Florida (150,000 km2) showing how anthropogenic-induced changes have had major impacts on carbon dynamics in soils, including (i) modeling of carbon and nutrient dynamics and soil carbon sequestration impacted by climate and land use change; (ii) geospatial assessment of soil carbon stocks and pools, and (iii) spectral-based soil carbon modeling. Our research is embedded in the STEP-AWBH modeling concept which explicitly incorporates Human forcings and time-dependent evolution of Atmospheric, Water, and Biotic factors into the modeling process. Spatially-explicit soil carbon observations were fused with ancillary environmental data and various statistical and geostatistical methods were used to upscale soil carbon across the region. Our results suggest that soil hydrologic and taxonomic, biotic (vegetation and land use), and climatic properties show complex interactions explaining the variation of soil carbon within this heterogeneous subtropical landscape

Clinical nutrition issues in 2022: What is missing to trust supplemental parenteral nutrition (SPN) in ICU patients?

A multidisciplinary group of international physicians involved in the medical nutrition therapy (MNT) of adult critically ill patients met to discuss the value, role, and open questions regarding supplemental parenteral nutrition (SPN) along with oral or enteral nutrition (EN), particularly in the intensive care unit (ICU) setting. This manuscript summarizes the discussions and results to highlight the importance of SPN as part of a comprehensive approach to MNT in critically ill adults and for researchers to generate new evidence based on well-powered randomized controlled trials (RCTs). The experts agreed on several key points: SPN has shown clinical benefts, resulting in this strategy being included in American and European guidelines. Nevertheless, its use is heterogeneous across European countries, due to the persistence of uncertainties, such as the optimal timing and the risk of overfeeding in absence of indirect calorimetry (IC), which results in divergent opinions and barriers to SPN implementation. Education is also insufcient. The experts agreed on actions needed to increase evidence quality on SPN use in specifc patients at a given time point during acute critical illness or recovery.MPC receives funding from the Research Foundation Flanders (FWO) (Grant No. 1832817N) and Onderzoeksraad, KU Leuven (Grant No. C24/17/070) and from the Private Charity Organization “Help Brandwonden Kids.info:eu-repo/semantics/publishedVersio