575 research outputs found
DC generation from peripheral blood mononuclear cells in patients with chronic myeloid leukemia: Influence of interferons on DC yield and functional properties
In Chronic Myeloid Leukemia (CML), standard treatment consists of modern tyrosine-kinase inhibitors (TKI). Nevertheless, there is evidence that immune responses against leukemia-associated antigens (LAA) may play an important role in disease control. Dendritic cell (DC)- based immunotherapy is able to induce T cell responses against LAA and might therefore pose an interesting therapeutic option in CML, especially in the setting of minimal residual disease (MRD). GMP production of DC for clinical vaccination remains a time- and cost- intensive procedure and standardized DC generation is warranted. We asked whether maturation-induction with IFN-{gamma} and IFN-{alpha} has an influence on functional properties of DC derived from peripheral blood mononuclear cells (PBMC) in CML patients. Monocyte-derived DC from healthy donors and from patients with CML were analyzed after maturation-induction with our TNF-{alpha}-containing standard cytokine cocktail with or without addition of IFN-{alpha} and/or IFN-{gamma}. Our results confirm that the addition of IFN-{gamma} leads to enhanced IL-12 secretion in healthy donors. In contrast, in CML patients, IFN-{gamma} was not able to increase IL-12 secretion, possibly due to a higher degree of cell adherence and lower cell yield during the cell culture. Our data suggest, that- in contrast to healthy donors-, additional interferons are not beneficial for maturation induction during large-scale DC production in patients with CML
Quality measurement of out-patient neuropsychological therapy after stroke in Germany: definition of indicators and retrospective pilot study
Background: In contrast to the hospital setting, today little work has been directed to the definition, measurement, and improvement of the quality of out-patient medical and therapeutic care. We developed a set of indicators to measure the quality of out-patient neuropsychological therapy after stroke.
Methods: The indicators cover core and interdisciplinary aspects of out-patient neuropsychological work such as mediation of patients into social care in case of need. Selection of the quality-indicators was done together with a consensus group of out-patient therapists and supported by evidence, validity, reliability as well as estimated relevance and variability with the quality of care. The set of indicators was further tested in a retrospective cohort study. Anonymous data of 104 patients were collected from out-patient clinical records of five clinics between November 2017 and April 2018. Associations between process and outcome quality were estimated exploitatively.
Results: Results allowed for the identification of areas with greater variability in the quality of process care and indicated that attention training as recommended by current guidelines had the lowest overall rate for meeting the quality-aim (met in 44% of the cases). This was followed by time<1month until the start of therapy (63% met) and mediation into social care in case of need (65% met). We further observed that overall quality and involving relatives in the therapy was associated with higher rates of professional reintegration (p-value=0.03). However, the need for mediation into social care was associated with a reduced chance for successful professional reintegration (p-value=0.009).
Conclusion: In conclusion, we describe a first set of quality indicators which cover different aspects of out-patient neuropsychological therapy and sufficient variability with care. First data further suggests that meeting the specified quality aims may indeed have relevant effects on outcomes
Impact of Genetic Polymorphisms on the Smoking-related Risk of Periodontal Disease: the Population-based Study SHIP
Periodontitis is a bacterial inflammatory disease leading to attachment loss with the consequence of tooth loss. There exists a multifactorial risk pattern including bacterial challenge, smoking, age, sex, diabetes, socio-economic and genetic factors. Smoking has the highest impact on the course of the disease modulated by all the other factors. Here, we report the relationship between smoking and the polymorphisms of genetic polymorphisms inflicted in the pathogenesis
Social work after stroke: identifying demand for support by recording stroke patients' and carers' needs in different phases after stroke.
BACKGROUND: Previous studies examining social work interventions in stroke often lack information on content, methods and timing over different phases of care including acute hospital, rehabilitation and out-patient care. This limits our ability to evaluate the impact of social work in multidisciplinary stroke care. We aimed to quantify social-work-related support in stroke patients and their carers in terms of timing and content, depending on the different phases of stroke care. METHODS: We prospectively collected and evaluated data derived from a specialized "Stroke-Service-Point" (SSP); a "drop in" center and non-medical stroke assistance service, staffed by social workers and available to all stroke patients, their carers and members of the public in the metropolitan region of Berlin, Germany. RESULTS: Enquiries from 257 consenting participants consulting the SSP between March 2010 and April 2012 related to out-patient and in-patient services, therapeutic services, medical questions, medical rehabilitation, self-help groups and questions around obtaining benefits. Frequency of enquiries for different topics depended on whether patients were located in an in-patient or out-patient setting. The majority of contacts involved information provision. While the proportion of male and female patients with stroke was similar, about two thirds of the carers contacting the SSP were female. CONCLUSION: The social-work-related services provided by a specialized center in a German metropolitan area were diverse in terms of topic and timing depending on the phase of stroke care. Targeting the timing of interventions might be important to increase the impact of social work on patient's outcome
identifying demand for support by recording stroke patientsâ and carersâ needs in different phases after stroke
Background Previous studies examining social work interventions in stroke
often lack information on content, methods and timing over different phases of
care including acute hospital, rehabilitation and out-patient care. This
limits our ability to evaluate the impact of social work in multidisciplinary
stroke care. We aimed to quantify social-work-related support in stroke
patients and their carers in terms of timing and content, depending on the
different phases of stroke care. Methods We prospectively collected and
evaluated data derived from a specialized âStroke-Service-Pointâ (SSP); a
âdrop inâ center and non-medical stroke assistance service, staffed by social
workers and available to all stroke patients, their carers and members of the
public in the metropolitan region of Berlin, Germany. Results Enquiries from
257 consenting participants consulting the SSP between March 2010 and April
2012 related to out-patient and in-patient services, therapeutic services,
medical questions, medical rehabilitation, self-help groups and questions
around obtaining benefits. Frequency of enquiries for different topics
depended on whether patients were located in an in-patient or out-patient
setting. The majority of contacts involved information provision. While the
proportion of male and female patients with stroke was similar, about two
thirds of the carers contacting the SSP were female. Conclusion The social-
work-related services provided by a specialized center in a German
metropolitan area were diverse in terms of topic and timing depending on the
phase of stroke care. Targeting the timing of interventions might be important
to increase the impact of social work on patientâs outcome
a pilot study
Muscular weakness in myasthenia gravis (MG) is commonly assessed using
Quantitative Myasthenia Gravis Score (QMG). More objective and quantitative
measures may complement the use of clinical scales and might detect
subclinical affection of muscles. We hypothesized that muscular weakness in
patients with MG can be quantified with the non-invasive Quantitative Motor
(Q-Motor) test for Grip Force Assessment (QGFA) and Involuntary Movement
Assessment (QIMA) and that pathological findings correlate with disease
severity as measured by QMG. Methods This was a cross-sectional pilot study
investigating patients with confirmed diagnosis of MG. Data was compared to
healthy controls (HC). Subjects were asked to lift a device (250 and 500 g)
equipped with electromagnetic sensors that measured grip force (GF) and three-
dimensional changes in position and orientation. These were used to calculate
the position index (PI) and orientation index (OI) as measures for involuntary
movements due to muscular weakness. Results Overall, 40 MG patients and 23 HC
were included. PI and OI were significantly higher in MG patients for both
weights in the dominant and non-dominant hand. Subgroup analysis revealed that
patients with clinically ocular myasthenia gravis (OMG) also showed
significantly higher values for PI and OI in both hands and for both weights.
Disease severity correlates with QIMA performance in the non-dominant hand.
Conclusion Q-Motor tests and particularly QIMA may be useful objective tools
for measuring motor impairment in MG and seem to detect subclinical
generalized motor signs in patients with OMG. Q-Motor parameters might serve
as sensitive endpoints for clinical trials in MG
Phosphatidylinositol 3-Akt-kinase-dependent phosphorylation of p21(Waf1/Cip1) as a novel mechanism of neuroprotection by glucocorticoids
The role of glucocorticoids in the regulation of apoptosis remains incongruous. Here, we demonstrate that corticosterone protects neurons from apoptosis by a mechanism involving the cyclin-dependent kinase inhibitor p21(Waf1/Cip1). In primary cortical neurons, corticosterone leads to a dose- and Akt-kinase-dependent upregulation with enhanced phosphorylation and cytoplasmic appearance of p21(Waf1/Cip1) at Thr 145. Exposure of neurons to the neurotoxin ethylcholine aziridinium (AF64A) results in activation of caspase-3 and a dramatic loss of p21(Waf1/Cip1) preceding apoptosis in neurons. These effects of AF64A are reversed by pretreatment with corticosterone. Corticosterone-mediated upregulation of p21(Waf1/Cip1) and neuroprotection are completely abolished by glucocorticoid and mineralocorticoid receptor antagonists as well as inhibitors of PI3- and Akt-kinase. Both germline and somatically induced p21(Waf1/Cip1) deficiency abrogate the neuroprotection by corticosterone, whereas overexpression of p21(Waf1/Cip1) suffices to protect neurons from apoptosis. We identify p21(Waf1/Cip1) as a novel antiapoptotic factor for postmitotic neurons and implicate p21(Waf1/Cip1) as the molecular target of neuroprotection by high-dose glucocorticoids
Bacteriological studies of blood, tissue fluid, lymph and lymph nodes in patients with acute dermatolymphangioadenitis (DLA) in course of âfilarialâ lymphedema
Filarial lymphedema is complicated by frequent episodes of dermatolymphangioadenitis (DLA). Severe systemic
symptoms during attacks of DLA resemble those of septicemia. The question we asked was whether bacterial isolates
can be found in the peripheral blood of patients during the episodes of DLA. Out of 100 patients referred to us with
âfilarialâ lymphedema 14 displayed acute and five subacute symptoms of DLA. All were on admission blood
microfilariae negative but had a positive test in the past. Blood bacterial isolates were found in nine cases, four acute
(21%) and five subacute (26%). In 10 acute cases blood cultures were found negative. Six blood isolates belonged to
Bacilli, four to Cocci and one was Sarcina. To identify the sites of origin of bacterial dissemination, swabs taken from
the calf skin biopsy wounds and tissue fluid, lymph and lymph node specimens were cultured. Swabs from the calf
skin biopsy wound contained isolates in nine (47%) cases. They were Bacilli in nine, Cocci in three, Acinetobacter and
Erwinia in two cases. Tissue fluid was collected from 10 patients and contained Bacilli in four (40%) and
Staphylococci in three (30%). Lymph was drained in four patients and contained isolates in all samples (100%). They
were Staphylococcus epidermis, xylosus and aureus, Acinetobacter, Bacillus subtilis and Sarcina. Three lymph nodes
were biopsied and contained Staphylococcus chromogenes, xylosus, Enterococcus and Bacillus cereus. In six cases the
same phenotypically defined species of bacteria were found in blood and limb tissues or fluids. In the âcontrolâ group of patients with lymphedema without acute or subacute changes all blood cultures were negative. Interestingly, swabs
from biopsy wound of these patients contained isolates in 80%, tissue fluid in 68%, lymph in 70% and lymph nodes
in 58% of cases. In healthy controls, tissue fluid did not contain bacteria, and lymph isolates were found only in 12%
of cases. This study demonstrates that patients with acute episodes of DLA reveal bacteriemia in a high percentage
of cases. Diversity of blood and tissue bacterial isolates in these patients points to a breakdown of the skin immune
barrier in lymphedema and subsequently indiscriminate bacterial colonization of deep tissues and spread to an blood
circulation. © 1999 Elsevier Science B.V. All rights reserved
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