Public-private partnership in disaster management:A case study of the Gold Coast

Hypoxemic respiratory failure of the neonatal organism involves increased acid sphingomyelinase (aSMase) activity and production of ceramide, a second messenger of a pro-inflammatory pathway that promotes increased vascular permeability, surfactant alterations and alveolar epithelial apoptosis. We comparatively assessed the benefits of topical aSMase inhibition by either imipramine (Imi) or phosphatidylinositol-3,5-bisphosphate (PIP2) when administered into the airways together with surfactant (S) for fortification. In this translational study, a triple-hit acute lung injury model was used that entails repeated airway lavage, injurious ventilation and tracheal lipopolysaccharide instillation in newborn piglets subject to mechanical ventilation for 72 hrs. After randomization, we administered an air bolus (control), S, S+Imi, or S+PIP2. Only in the latter two groups we observed significantly improved oxygenation and ventilation, dynamic compliance and pulmonary oedema. S+Imi caused systemic aSMase suppression and ceramide reduction, whereas the S+PIP2 effect remained compartmentalized in the airways because of the molecule's bulky structure. The surfactant surface tensions improved by S+Imi and S+PIP2 interventions, but only to a minor extent by S alone. S+PIP2 inhibited the migration of monocyte-derived macrophages and granulocytes into airways by the reduction of CD14/CD18 expression on cell membranes and the expression of epidermal growth factors (amphiregulin and TGF-β1) and interleukin-6 as pro-fibrotic factors. Finally we observed reduced alveolar epithelial apoptosis, which was most apparent in S+PIP2 lungs. Exogenous surfactant “fortified” by PIP2, a naturally occurring surfactant component, improves lung function by topical suppression of aSMase, providing a potential treatment concept for neonates with hypoxemic respiratory failure

Venular basement membranes contain specific matrix protein low expression regions that act as exit points for emigrating neutrophils.

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Concepts of GPCR-controlled navigation in the immune system

G-protein-coupled receptor (GPCR) signaling is essential for the spatiotemporal control of leukocyte dynamics during immune responses. For efficient navigation through mammalian tissues, most leukocyte types express more than one GPCR on their surface and sense a wide range of chemokines and chemoattractants, leading to basic forms of leukocyte movement (chemokinesis, haptokinesis, chemotaxis, haptotaxis, and chemorepulsion). How leukocytes integrate multiple GPCR signals and make directional decisions in lymphoid and inflamed tissues is still subject of intense research. Many of our concepts on GPCR-controlled leukocyte navigation in the presence of multiple GPCR signals derive from in vitro chemotaxis studies and lower vertebrates. In this review, we refer to these concepts and critically contemplate their relevance for the directional movement of several leukocyte subsets (neutrophils, T cells, and dendritic cells) in the complexity of mouse tissues. We discuss how leukocyte navigation can be regulated at the level of only a single GPCR (surface expression, competitive antagonism, oligomerization, homologous desensitization, and receptor internalization) or multiple GPCRs (synergy, hierarchical and non-hierarchical competition, sequential signaling, heterologous desensitization, and agonist scavenging). In particular, we will highlight recent advances in understanding GPCR-controlled leukocyte navigation by intravital microscopy of immune cells in mice

Efficacy of a certified modular ultrasound curriculum

Background In recent years, ultrasound (US) has become more incorporated into anesthesia and intensive care medicine. The German Anesthesia Society established a modular curriculum to teach US skills. Until now, the efficacy of this modular curriculum has not been validated. Objective The main objective of this study was to determine whether there is an increase of knowledge and of psychomotor skills for the trainees in this curriculum. Material and methods After ethical committee approval, 41 anesthesia physicians were enrolled. To determine the increase of knowledge and of practical skills theoretical and practical tests performed were evaluated before and after two different US courses. Results Comparing before and after course tests, the participants showed significant improvement in theoretical multiple choice tests (p = 0.008). Regarding psychomotor skills following course 1, the trainees improved significantly in the time needed to perform the two practical tests (p = 0.03), but not in the performance of the test. Better needle visualization during simulated US-guided vessel puncture (p = 0.52) and better identification of the anatomical structures in the axillary region (p = 0.56) could not be achieved. Conclusion This study shows that although this US course curriculum has positively enhanced the trainees’ theoretical knowledge of US practice, it does not enhance the practical application of that theoretical knowledge. To improve this curriculum, a supervised clinically practical training should follow the course.Hintergrund Ultraschall (US) hat in den letzten Jahren zunehmend Einzug in die Anästhesie und Intensivmedizin erhalten. Die Deutsche Gesellschaft für Anästhesiologie & Intensivmedizin hat ein modulares Kurssystem zur Vermittlung von US-Kompetenzen entwickelt. Die Wirksamkeit dieses modularen Curriculums wurde bisher nicht validiert. Ziel Ziel dieser Studie war zu ermitteln, ob es bei den Teilnehmern durch den Besuch von Modulen dieses Kurssystems zu einer Verbesserung theoretischer Kenntnisse und praktischer Fertigkeiten kommt. Material und Methode Nach Zustimmung durch die Ethikkommission wurden 41 Anästhesisten in die Studie eingeschlossen. Um den Zugewinn an Wissen und praktischen Fertigkeiten zu ermitteln, wurden theoretische und praktische Tests vor und nach zwei verschiedenen US-Kursen ausgewertet. Ergebnisse Nach den Kursen zeigten die Teilnehmer eine signifikante Verbesserung in den Ergebnissen der Multiple-Choice-Tests (p = 0,008). Hinsichtlich der psychomotorischen Fähigkeiten nach Kurs 1 verbesserten sich die Teilnehmer in der zur Durchführung der beiden praktischen Tests benötigten Zeit signifikant (p = 0,03), nicht aber in der Durchführung der Tests. Die praktischen Aufgaben konnten nach dem Kurs 1 zwar signifikant schneller durchgeführt werden (p = 0,03), die Qualität der Nadelführung (p = 0,52) und die korrekte Benennung anatomischer Strukturen in der Achselregion konnten aber nicht verbessert werden. Schlussfolgerung Diese Studie zeigt, dass obwohl dieses Kurssystem die theoretischen Kenntnisse über die US-Praxis verbessert hat, die praktische Anwendung dieses theoretischen Wissens aber nicht verbessert werden konnten. Um dieses Curriculum zu verbessern, sollte es von einem praktischen Training unter Anleitung ergänzt werden

Control of Leukocyte Trafficking by Stress-Associated Hormones

Leukocyte migration is a crucial process in both homeostatic and inflammatory conditions. The spatiotemporal distribution of immune cells is balanced between processes of cellular mobilization into the bloodstream, their adhesion to vascular beds and trafficking into tissues. Systemic regulation of leukocyte mobility is achieved by different signals including neuronal and hormonal cues, of which the catecholamines and glucocorticoids have been most extensively studied. These hormones are often associated with a stress response, however they regulate immune cell trafficking also in steady state, with effects dependent upon cell type, location, time-of-day, concentration, and duration of signal. Systemic administration of catecholamines, such as the sympathetic neurotransmitters adrenaline and noradrenaline, increases neutrophil numbers in the bloodstream but has different effects on other leukocyte populations. In contrast, local, endogenous sympathetic tone has been shown to be crucial for dynamic daily changes in adhesion molecule expression in the bone marrow and skeletal muscle, acting as a key signal to the endothelium and stromal cells to regulate immune cell trafficking. Conversely, glucocorticoids are often reported as anti-inflammatory, although recent data shows a more complex role, particularly under steady-state conditions. Endogenous changes in circulating glucocorticoid concentration induce redistribution of cells and potentiate inflammatory responses, and in many paradigms glucocorticoid action is strongly influenced by time of day. In this review, we discuss the current knowledge of catecholamine and glucocorticoid regulation of leukocyte migration under homeostatic and stimulated conditions

Integrationsperspektive duales System? Gelingensbedingungen für die Eingliederung Geflüchteter in die betriebliche Ausbildung

Die duale Ausbildung ist ein wichtiger Faktor für die Integration Geflüchteter. In seiner Dissertation untersucht der Autor aus einer betrieblichen Perspektive, unter welchen Voraussetzungen und Bedingungen die Ausbildung gelingen kann. Grundlage der Studie sind 29 problemzentrierte Interviews, die mit Betrieben in Nordrhein-Westfalen geführt wurden. Anhand der Auswertungen werden betriebliche Prozesse veranschaulicht und analysiert. Hierbei zeigen sich die Bedingungen, unter denen die Ausbildung Geflüchteter gelingen kann, sowie die Herausforderungen für die Betriebe. (DIPF/Orig.