[Requirements for a sustainable standardization and digitalization in clinical emergency and acute medicine]

Digitalization and standardization of documentation in medicine are increasingly progressing. In the decision of the Federal Joint Committee (G-BA) for a staged system of emergency structures in hospitals and in the report of the expert committee for development in the healthcare system on needs-oriented guidance of healthcare, the actuality of the topic is underlined with concrete naming of future tasks. The section on emergency admission protocols of the German Interdisciplinary Association of Intensive and Emergency Care Medicine (DIVI) has been working for years on this topic and has repeatedly reported on the progress of the topic in clinical emergency care. Standardization and digitalization represent the foundation for health services research spread across locations as well as the possibility for benchmarking. Digitalization makes the secondary use of primary clinical routine data possible. Digitalization decreases redundancies of data transmission by avoiding manual data input in, for example registers.

Hartmann wavefront sensor characterization of a high charge vortex beam in the extreme ultraviolet spectral range

We demonstrate for the first time, to the best of our knowledge, the ability of extreme ultraviolet (XUV) Hartmann wavefront sensors to characterize high charge vortex beams produced by high-order harmonic generation up to the order of 25. We also show that phase matched absorption limited high harmonic generation is able to maintain the high charge vortex structure of the XUV beam even in a rather long (1 cm) generation medium.

Exploring the feasibility of targeted chronic hepatitis B screening in the emergency department: A pilot study

OBJECTIVE

To explore the feasibility of an ED chronic hepatitis B (CHB) screening programme.

METHODS

Adult patients born in intermediate-high CHB prevalent regions completed a pre-screening questionnaire and were offered CHB testing. ED staff were surveyed to gauge potential barriers to the programme.

RESULTS

Eighty patients demonstrated limited knowledge of hepatitis B virus transmission and perceived many barriers to screening. Among 65 tested for CHB, no new cases were detected but 36 (55.4%, 95% CI 42.6-67.5) were susceptible to infection. Staff supported the programme but reported potential barriers.

CONCLUSION

Targeted ED CHB screening is feasible but effectiveness and cost-effectiveness need further exploration.

Members of a community mental health team

The aim was to find out if professions differed in their contributions to the workload of two multi-professional community mental health teams. Both teams aimed to provide community mental health care in London, targeting those with severe mental illness and using the care programme approach. Junior psychiatrists had fewer contacts than other professionals but medical staff tended to contribute more to assessments. Community mental health nurses tended to have the most contacts. Community mental health team planners should be aware of inter-professional differences when designing teams.

Comparing the German Emergency Department Medical Record with the US HL7 Data Elements for Emergency Department Systems

Interoperability between emergency department (ED) information systems requires a shared data specification. In 2013 Health Level Seven International, an international standards body, approved a specification for Data Elements for Emergency Department Systems (DEEDS) for use in the United States. A similar specification was created in Germany for national employment, defining data elements and forms. This study presents the first step in the efforts to harmonize the two data definitions for International approval by comparing the meaning of the German Emergency Department Medical Record (GEDMR) data element definitions with the US DEEDS using a methodology for terminology mapping from ISO/TR 12300. The comparison between GEDMR and DEEDS did show significant differences in certain domains. The results support development of an international standard for ED data elements.

[Legal medicine specialists within the framework of acute care : Analysis of legal medicine consultations in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt]

BACKGROUND

In acute medical care, there are patients who have been injured by the influence of others. The aim of this study was to analyze all cases which were presented to the Institute for Legal Medicine of the University Halle (Saale). The cases where analyzed in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt.

MATERIALS AND METHODS

The consultations of the Institute for Legal Medicine Halle-Wittenberg for 2012-2015 were evaluated with regard to the age and gender distribution, the reasons for the consultation and time until the request for consultations. These cases were statistically compared to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt 2014-2015.

RESULTS

A total of 536 cases (55.6% male and 44.4% female patients) were evaluated. In all, 62.1% of patients were under 18 years of age; 43.5% of all consultations were requested by pediatric (surgery) clinics. The most common reasons for consultation were sexual child abuse or violence against children (50.7%). Compared to the victims' statistics, significantly more children were examined by legal medicine specialists than could have been expected (p < 0.001). In adult patients, the most common causes for consultation were acts of violence (20.4%) and domestic violence (10.1%). Among adults, significantly more women and fewer men were presented than expected (p = 0.001).

CONCLUSION

There were only a small number of consultations of legal medicine specialists in relation to the victims' statistics. Most of them were children and women. The temporal latency between the act of violence and the consultations was one day and more. The latency and the renunciation of the consultation of the legal medicine specialists can lead to loss of evidence.

Cross-talk between sumoylation and phosphorylation in mouse spermatocytes

The meiotic G2/M1 transition is mostly regulated by posttranslational modifications, however, the cross-talk between different posttranslational modifications is not well-understood, especially in spermatocytes. Sumoylation has emerged as a critical regulatory event in several developmental processes, including reproduction. In mouse oocytes, inhibition of sumoylation caused various meiotic defects and led to aneuploidy. However, the role of sumoylation in male reproduction has only begun to be elucidated. Given the important role of several SUMO targets (including kinases) in meiosis, in this study, the role of sumoylation was addressed by monitoring the G2/M1 transition in pachytene spermatocytes in vitro upon inhibition of sumoylation. Furthermore, to better understand the cross-talk between sumoylation and phosphorylation, the activity of several kinases implicated in meiotic progression was also assessed upon down-regulation of sumoylation. The results of the analysis demonstrate that inhibition of sumoylation with ginkgolic acid (GA) arrests the G2/M1 transition in mouse spermatocytes preventing chromosome condensation and disassembling of the synaptonemal complex. Our results revealed that the activity of PLK1 and the Aurora kinases increased during the G2/M1 meiotic transition, but was negatively regulated by the inhibition of sumoylation. In the same experiment, the activity of c-Abl, the ERKs, and AKT were not affected or increased after GA treatment. Both the AURKs and PLK1 appear to be "at the right place, at the right time" to at least, in part, explain the meiotic arrest obtained in the spermatocyte culture.

An Examination of Not-For-Profit Stakeholder Networks for Relationship Management: A Small-Scale Analysis on Social Media

Using a small-scale descriptive network analysis approach, this study highlights the importance of stakeholder networks for identifying valuable stakeholders and the management of existing stakeholders in the context of mental health not-for-profit services. We extract network data from the social media brand pages of three health service organizations from the U.S., U.K., and Australia, to visually map networks of 579 social media brand pages (represented by nodes), connected by 5,600 edges. This network data is analyzed using a collection of popular graph analysis techniques to assess the differences in the way each of the service organizations manage stakeholder networks. We also compare node meta-information against basic topology measures to emphasize the importance of effectively managing relationships with stakeholders who have large external audiences. Implications and future research directions are also discussed.

Inhibition of CDK1 activity by sumoylation

Sumoylation (a covalent modification by Small Ubiquitin-like Modifiers or SUMO proteins) has been implicated in the regulation of various cellular events including cell cycle progression. We have recently identified CDK1, a master regulator of mitosis and meiosis, as a SUMO target both in vivo and in vitro, supporting growing evidence concerning a close cross talk between sumoylation and phosphorylation during cell cycle progression. However, any data regarding the effect of sumoylation upon CDK1 activity have been missing. In this study, we performed a series of in vitro experiments to inhibit sumoylation by three different means (ginkgolic acid, physiological levels of oxidative stress, and using an siRNA approach) and assessed the changes in CDK1 activity using specific antibodies and a kinase assay. We have also tested for an interaction between SUMO and active and/or inactive CDK1 isoforms in addition to having assessed the status of CDK1-interacting sumoylated proteins upon inhibition of sumoylation. Our data suggest that inhibition of sumoylation increases the activity of CDK1 probably through changes in sumoylated status and/or the ability of specific proteins to bind CDK1 and inhibit its activity.

Interleukin 13- and interleukin 17A-induced pulmonary hypertension phenotype due to inhalation of antigen and fine particles from air pollution

Pulmonary hypertension has a marked detrimental effect on quality of life and life expectancy. In a mouse model of antigen-induced pulmonary arterial remodeling, we have recently shown that coexposure to urban ambient particulate matter (PM) significantly increased the thickening of the pulmonary arteries and also resulted in significantly increased right ventricular systolic pressures. Here we interrogate the mechanism and show that combined neutralization of interleukin 13 (IL-13) and IL-17A significantly ameliorated the increase in right ventricular systolic pressure, the circumferential muscularization of pulmonary arteries, and the molecular change in the right ventricle. Surprisingly, our data revealed a protective role of IL-17A for the antigen- and PM-induced severe thickening of pulmonary arteries. This protection was due to the inhibition of the effects of IL-13, which drove this response, and the expression of metalloelastase and resistin-like molecule α. However, the latter was redundant for the arterial thickening response. Anti-IL-13 exacerbated airway neutrophilia, which was due to a resulting excess effect of IL-17A, confirming concurrent cross inhibition of IL-13- and IL-17A-dependent responses in the lungs of animals exposed to antigen and PM. Our experiments also identified IL-13/IL-17A-independent molecular reprogramming in the lungs induced by exposure to antigen and PM, which indicates a risk for arterial remodeling and protection from arterial constriction. Our study points to IL-13- and IL-17A-coinduced inflammation as a new template for biomarkers and therapeutic targeting for the management of immune response-induced pulmonary hypertension.

Effects of cerebrolysin on motor-neuron-like NSC-34 cells

Although the peripheral nervous system is capable of regeneration, this capability is limited. As a potential means of augmenting nerve regeneration, the effects of cerebrolysin (CL)--a proteolytic peptide fraction--were tested in vitro on the motor-neuron-like NSC-34 cell line and organotypic spinal cord cultures. Therefore, NSC-34 cells were subjected to mechanical stress by changing media and metabolic stress by oxygen glucose deprivation. Afterwards, cell survival/proliferation using MTT and BrdU-labeling (FACS) and neurite sprouting using ImageJ analysis were evaluated. Calpain-1, Src and α-spectrin protein expression were analyzed by Western blot. In organotypic cultures, the effect of CL on motor neuron survival and neurite sprouting was tested by immunohistochemistry. CL had a temporary anti-proliferative but initially neuroprotective effect on OGD-stressed NSC-34 cells. High-dosed or repeatedly applied CL was deleterious for cell survival. CL amplified neurite reconstruction to limited extent, affected calpain-1 protein expression and influenced calpain-mediated spectrin cleavage as a function of Src expression. In organotypic spinal cord slice cultures, CL was not able to support motor neuron survival/neurite sprouting. Moreover, it hampered astroglia and microglia activities. The data suggest that CL may have only isolated positive effects on injured spinal motor neurons. High-dosed or accumulated CL seemed to have adverse effects in treatment of spinal cord injury. Further experiments are required to optimize the conditions for a safe clinical administration of CL in spinal cord injuries.

Regulation of microRNA expression in the lungs by exposure to air pollution & antigen (HUM2P.340)

Pulmonary Hypertension is characterized by pulmonary arterial remodeling and increased pressure in the pulmonary circulation. It is often associated with inflammation in the lungs and can lead to right heart failure. Our work shows that urban ambient pollution exacerbates the experimental pulmonary hypertension phenotype just like other types of inflammatory lung conditions. We aimed to identify microRNAs (miRNAs) that are differentially expressed in our mouse model. In addition, we examined plasma samples from individuals occupationally exposed to high levels of air pollution or cigarette smoke, and from controls. Our study is the first to show significantly de-regulated expression of three microRNA species (miR-135a, miR-21, miR-204) in the lungs of mice that were exposed to antigen and particulate matter and developed pulmonary hypertension. De-regulated levels of miR-21 and miR-204 have been reported in human pulmonary hypertension and in experimental pulmonary hypertension. MiR-135a is targeting STAT6 and upregulated expression has been reported in experimental asthma. Using human samples, our study showed that plasma levels of miR-21 and miR-135a, but not levels of miR-204, clustered individuals with high dose exposures and individuals with low dose environmental exposures. Current studies are aimed at identifying the cytokines that control these miRNAs’ expression. The long range goal is to identify miRNAs that indicate an at-risk state of the pulmonary vasculature.

Cell division responsive peptides for optimized plasmid DNA delivery: the mitotic window of opportunity?

The delivery of plasmid DNA remains hard to achieve, especially due to the presence of the nuclear membrane barrier. During cell division, however, the nuclear membrane is temporarily disassembled. We evaluated two different strategies to optimize plasmid DNA delivery in dividing cells: 1) phosphorylation responsive peptides that release plasmid DNA preferentially during mitosis and 2) chromatin targeting peptides to anchor plasmid DNA in newly formed nuclei upon cell division. Peptide/DNA particles alone were not efficient in penetrating cells. Upon co-delivery with lipid-based carriers, however, transfection efficiency drastically improved when compared to controls. For the phosphorylation responsive peptides, the presence of the phosphorylation sequence slightly increased transfection efficiency. For the chromatin targeting peptides, however, the chromatin targeting sequence did not seem to be the main reason for the improvement of transfection efficiency when applied in living cells. In conclusion, the pre-condensation of plasmid DNA with peptides improves lipid based delivery, but the nature of the peptides (cell responsive or not) does not seem to be the main reason for the improvement. It seems that the nuclear entry of foreign plasmid DNA is still under tight control, even during the mitotic window of opportunity.

Abstract OT3-3-04: ALOPREV: first cooling scalp trial for prevention of persisting alopecia after docetaxel for early breast cancer patients

During SABCS 2009, Western France Observatory of Cancer has presented “ALOPERS” results from more than one hundred patients with persisting alopecia or suboptimal hair regrowth after chemotherapy for early breast cancer. Docetaxel 75–100 mg/msq was concerned for majority of patients. 43% of patients experienced alopecia more than 24 months after their last chemotherapy infusion. Optimal information of patients about alopecia and persisting alopecia appears to be mandatory before treatment: 47% of patients undergo a psychological shock during hair loss. Morevover, BCIRG 001 study (TAC versus FAC) led to the conclusion that docetaxel 75 mg/msq is responsible for persisting alopecia for 3% of patients. So, by extrapolating, in France, each year, docetaxel could induce a persisting alopecia in 300 patients. To confirm this figure, “ERALOP” study is in progress to evaluate precisely the incidence of persisting alopecia after docetaxel in early breast cancer patients and then theses data will be communicated to ANSM. It must be noticed that 8% of patients refused to be treated because of the risk of persistant alopecia (Trueb et al, 2010). That's why it is a worldwide public health problem, with personal and societal implications.

As alopecia is universal after FEC100 regimen, the cooling scalp has been supposed to be very effective during docetaxel 1 hour infusion and to allow a better hair regrowth but with a high risk in term of tolerance. Since 2012, a prospective clinical trial “ALOPREV” has begun in Western France to evaluate tolerance of cooling scalp, after 3–4 courses of FEC100 regimen and during 3–4 courses of docetaxel 100 mg/msq, for patients treated for early breast cancer. So, ALOPREV is designed as a safety trial. First, cooling scalp major toxicities (headache, neck pain, discomfort associated with cold, sinusitis) are evaluated during each docetaxel course by the patient. Then, auto-questionnary about hair loss and regrowth, nails disorders and others toxicities due to docetaxel and questionnary about quality of life (EORTC QLQ-C30 and BR-23 scales) is completed by the patients before, during and after treatment. Patients will be followed-up 12 months and final toxicities will be reported by physicians. According to our daily practice, it will demonstrate that 60% of patients could tolerate two consecutive cooling scalps during docetaxel infusion, and with statistical considerations (alpha-beta risks and 10% of ineligibility). So 160 patients must be included during inclusion period (18 months). 10 public or private care centers have been opened (45 investigators). This trial implicates particularly nurses teams and all patients will sign an informed consent before FEC100 courses. ALOPREV started two months ago and 25 patients are already enrolled.

In conclusion, cooling scalp is known to be safe, manageable and partially effective before hair loss. ALOPREV will evaluate safety and efficacy to avoid persisting alopecia after hair loss.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr OT3-3-04.

UV photodissociation dynamics of deprotonated 2'-deoxyadenosine 5'-monophosphate [5'-dAMP-H]-

The UV photodissociation dynamics of deprotonated 2'-deoxyadenosine 5'-monophosphate ([5'-dAMP-H](-)) has been studied using a unique technique based on the coincident detection of the ion and the neutral fragments. The observed fragment ions are m/z 79 (PO(3)(-)), 97 (H(2)PO(4)(-)), 134 ([A-H](-)), 177 ([dAMP-H-A-H(2)O](-)), and 195 ([dAMP-H-A](-)), where "A" refers to a neutral adenine molecule. The relative abundances are comparable to that found in previous studies on [5'-dAMP-H](-) employing different excitation processes, i.e., collisions and UV photons. The fragmentation times of the major channels have been measured, and are all found to be on the microsecond time scale. The fragmentation mechanisms for all channels have been characterized using velocity correlation plots of the ion and neutral fragment(s). The findings show that none of the dissociation channels of [5'-dAMP-H](-) is UV specific and all proceed via statistical fragmentation on the ground state after internal conversion, a result similar to fragmentations induced by collisions.

Effect of a low concentration of a cationic steroid antibiotic (CSA-13) on the formation of a biofilm by Pseudomonas aeruginosa

AIMS

Cationic steroids like CSA-13 have been designed by analogy with antimicrobial cationic peptides and have bactericidal properties. The purpose of this work was to evaluate the effect of a low concentration (1 mg l(-1)) of CSA-13 on the formation of a biofilm by eight strains of Pseudomonas aeruginosa (four mucoid and four nonmucoid strains) on an inert surface.

METHOD AND RESULTS

The biofilm formation was measured with the Crystal Violet method. CSA-13 inhibited the formation of a biofilm by three strains. The zeta potential varied among the strains. The inhibition by the cationic steroid analogue affected the populations of bacteria with the lowest zeta potential. P. aeruginosa bound a fluorescent, more hydrophobic analogue of CSA-13 but there was no correlation between this binding and the inhibition by CSA-13 of biofilm formation. The interaction of CSA-13 with bacteria did not modify their ability to produce rhamnolipids.

CONCLUSIONS

A low concentration of CSA-13 inhibits the formation of a biofilm by P. aeruginosa through electrostatic interactions and without affecting the production of rhamnolipids.

SIGNIFICANCE AND IMPACT OF THE STUDY

A low, nontoxic concentration of CSA-13 might be beneficial for the prevention of biofilm formation.