[Actual care and funding situation with regard to mother-child units for psychic disorders associated with pregnancy in Germany]

CONCERN: The current care and financial situation of mother-child units for psychic disorders associated with pregnancies in Germany should be documented in preparation for the development of the new reimbursement system for psychiatry and psychosomatics.

METHOD

In accordance with the last survey of 2005, a brief questionnaire was developed and a nationwide poll was conducted.

RESULTS

The survey revealed severe (10 fold) service deficits for severely and gravely mentally ill mothers, who require an inpatient treatment with specific professional competence. Compared with the last poll, these service deficits have increased. This is due to continued insufficient funding and unresolved financing in the new reimbursement system. With the establishment of an additional code for mother-child treatment the precondition for ensuring the funding of this important care form in the new reimbursement system was created.

CONCLUSION

It is to be hoped that the decision-makers of health policy will finally face up to their social responsibility and ensure adequate funding of the additional diagnostic and therapeutic expenditure of mother-child treatment. The health care providers have an obligation to implement a transparent record of services of the additional expenditure and to augment the national evaluation approaches to inpatient mother-child treatments.

Prädiktoren des Hörverstehens bei Jugendlichen deutscher und Jugendlichen nichtdeutscher Herkunftssprache 3Dieser Beitrag wurde unter der geschäftsführenden Herausgeberschaft von Jens Möller angenommen

Zusammenfassung:Trotz der zentralen Bedeutung des Hörverstehens für weitere sprachliche Leistungen existieren bislang nur wenige Untersuchungen, die Hörverstehensleistungen und deren Prädiktoren bei Schülerinnen und Schülern unterschiedlicher Herkunftssprache vergleichend analysieren. Die vorliegende Studie untersucht deutschsprachiges Hörverstehen und dessen Determinanten bei Jugendlichen deutscher (L1) und Jugendlichen nichtdeutscher (L2) Herkunftssprache. Im Rahmen der Erhebung bearbeiteten 424 Neuntklässler Aufgaben zum deutschsprachigen Hörverstehen sowie zur phonologischen Bewusstheit, zum Arbeitsgedächtnis, zu morphosyntaktischen Fähigkeiten und zum Wortschatz. Ausgehend von theoretischen Annahmen und empirischen Befunden wird angenommen, dass L2-Jugendliche schwächere Hörverstehensleistungen aufweisen sowie über einen geringeren Wortschatz verfügen als L1-Jugendliche. Weiterhin wird ein im Vergleich zu L1-Jugendlichen stärkerer Einfluss des Wortschatzes, der phonologischen Bewusstheit und des Arbeitsgedächtnisses auf die Hörverstehensleistung bei L2-Jugendlichen angenommen. Die strukturanalytische Modellierung dieser Determinanten des Hörverstehens zeigt, dass L2-Jugendliche geringere Wortschatzkenntnisse aufweisen als L1-Jugendliche. Schwächen im Bereich des Hörverstehens finden sich nur für Jugendliche, die Türkisch als Erstsprache gelernt haben. Bei allen Jugendlichen wird die Hörverstehensleistung durch die morphosyntaktischen Kompetenzen sowie den Wortschatz determiniert; bei Jugendlichen mit Türkisch als Erstsprache findet sich zusätzlich ein Effekt der phonologischen Bewusstheit auf die Hörverstehensleistung. Die Implikationen der Befunde für theoretische Annahmen zu Hörverstehensleistungen in einer Zweitsprache werden diskutiert.

Unlösbare Items im KFT 4-12+R

Zusammenfassung. Der vorliegende Beitrag weist darauf hin, dass im Kognitiven Fähigkeitstest für 4. bis 12. Klassen (Revision), Untertest Figurenanalogien, Parallelform B ( Heller & Perleth, 2000 ) neben einem bereits als unlösbar erkannten Item eine weitere unlösbare Aufgabe enthalten ist. Wir präsentieren die Itemkennwerte und Antwortmuster von 305 Schülerinnen und Schülern der 9. Jahrgangsstufe aus Hauptschulen in Berlin und Bayern. Itemanalysen auf Basis der Item-Response-Theorie und nach Klassischer Testtheorie belegen für das fragliche Item einen unzureichenden Itemfit für das eindimensionale Raschmodell sowie mangelnde Trennschärfe nach Klassischer Testtheorie. Die Distraktorenanalyse weist für dieses Item einen der Distraktoren als trennschärfer und für das Modell passender als das eigentliche Target aus.

Crisis Management 2.0

In this paper, the authors propose a systematization of social software use in crisis situations, examining different types of cooperation and challenges. The authors discuss how the organizational actors involved in crisis management (police, fire-fighters, organizations, etc.) and the affected citizens are communicating and can communicate and collaborate through the use of social software. After defining the term ‘social software,’ the authors outline its use in crisis management. They present two case studies where they have examined the use of social software in 2010: first during the disruption of air travel caused by the eruptions of the volcano Eyjafjallajökull in Iceland and second during the mass panic at the Love Parade music festival in Germany. Based on both previous work and case studies, the authors discuss potentials and weaknesses and propose a classification matrix for different types of cooperation as a step toward a systematization of social software use in crisis situations.

A comparative microanatomical study on cross-sections of superficial branch of radial nerve in proximal and distal parts of the forearm: a cadaveric study

PURPOSE OF STUDY

Changes in peripheral nerve anatomy with age may be the cause for poor prognosis after nerve repair in elderly cases. The aim of the present study is to find out and compare the cross-sectional microanatomy as well as age-related changes in the non-fascicular components of superficial branch of radial nerve at cubital fossa (SBRN-1) and above wrist (SBRN-2).

METHODS

Thirty-eight fresh human (14 male and five female) cadaveric SBRN-1 and SBRN-2 were collected from both sides of 19 cadavers and study has been performed at different magnifications after routine histological (Masson's trichrome stain) processing was done for morphometric analysis (total cross-sectional area [Asc], fascicular area [Af], non-Af [Anonf], adipose [FAT] area and non-adipose area [nFAT]).

RESULTS

SBRN-1 and SBRN-2 belonged to polyfascicular type and showed difference in amount of connective and adipose tissues in Anonf. The number of fascicles in SBRN-1 ranged from 2 to 6 (3.66±0.21, mean±SEM) and in SBRN-2 ranged from 7.5 to 11.5 (9.24±0.26). On comparing the percentage level of adipose tissue (FAT) in total cross-section area (Asc) and in Anonf of SBRN-1 and SBRN-2, the level of adipose tissue was increased with age.

CONCLUSIONS

The amount of adipose tissue in SBRN-1 and SBRN-2 Anonf was found to be high in most of the elderly cases. On comparison, there was not much difference between SBRN-1 and SBRN-2, but, the fascicle count was found to be increasing gradually from proximal to distal part of the SBRN.

Planck spectroscopy and quantum noise of microwave beam splitters

We use a correlation function analysis of the field quadratures to characterize both the blackbody radiation emitted by a 50 Ω load resistor and the quantum properties of two types of beam splitters in the microwave regime. To this end, we first study vacuum fluctuations as a function of frequency in a Planck spectroscopy experiment and then measure the covariance matrix of weak thermal states. Our results provide direct experimental evidence that vacuum fluctuations represent the fundamental minimum quantum noise added by a beam splitter to any given input signal.

Dual-path state reconstruction scheme for propagating quantum microwaves and detector noise tomography

Quantum state reconstruction of weak propagating microwaves to date requires the use of linear amplifiers. We introduce a theory which, even in the presence of significant amplifier noise, allows one to use these devices for measuring all quadrature moments of propagating quantum microwaves based on cross correlations from a dual-path amplification setup. Simultaneously, the detector noise properties are determined, allowing for tomography. We demonstrate the feasibility of our novel concept by proof-of-principle experiments with classical mixtures of weak coherent microwaves.

Thymoma and paraneoplastic myasthenia gravis

Paraneoplastic autoimmune diseases associate occasionally with small cell lung cancers and gynecologic tumors. However, myasthenia gravis (MG) occurs in at least 30% of all patients with thymomas (usually present at MG diagnosis). These epithelial neoplasms almost always have numerous admixed maturing polyclonal T cells (thymocytes). This thymopoiesis-and export of mature CD4(+)T cells-particularly associates with MG, though there are rare/puzzling exceptions in apparently pure epithelial WHO type A thymomas. Other features potentially leading to inefficient self-tolerance induction include defective epithelial expression of the autoimmune regulator (AIRE) gene and/or of major histocompatibility complex class II molecules in thymomas, absence of myoid cells, failure to generate FOXP3(+) regulatory T cells, and genetic polymorphisms affecting T-cell signaling. However, the strong focus on MG/neuromuscular targets remains unexplained and suggests some biased autoantigen expression, T-cell selection, or autoimmunization within thymomas. There must be further clues in the intriguing serological and cellular parallels in some patients with late-onset MG but without thymomas-and in others with AIRE mutations-and in the contrasts with early-onset MG, as discussed here.

Sunitinib in metastatic thymic carcinomas: laboratory findings and initial clinical experience

BACKGROUND

Thymic carcinoma (TC) is a rare aggressive tumour. Median survival with current treatments is only 2 years. Sunitinib is a multi-targeted tyrosine kinase inhibitor that has shown benefit in various other cancers.

METHODS

Laboratory analyses of snap-frozen tumour tissues were performed to detect activation and genetic mutations of receptor tyrosine kinases (RTKs) in TC samples. On the basis of molecular analyses showing activation of multiple RTKs in their tumour, four patients with metastatic TCs refractory to conventional therapies were treated with sunitinib according to standard protocols.

RESULTS

RTK analysis in three of the patients showed activation of multiple RTKs, including platelet-derived growth factor-beta and vascular endothelial growth factor 3. Mutations of EGFR, c-KIT, KRAS, and BRAF genes were not found. Administration of sunitinib yielded a partial remission (lasting 2 to 18+ months) according to the RECIST criteria in three patients and stable disease with excellent metabolic response in 18F-FDG-PET in another one. The overall survival with sunitinib treatment ranges from 4 to 40+ months. Withdrawal of the drug in one patient prompted rapid tumour progression that could be controlled by re-administration of sunitinib.

CONCLUSIONS

Sunitinib is an active treatment for metastatic TC. A panel of molecular analyses may be warranted for optimal patient selection.

Response of the central metabolism of Corynebacterium glutamicum to different flux burdens

To evaluate the importance of reactions within the central metabolism under different flux burdens the fluxes within the pentose phosphate pathway (PPP), as well as the other reactions of the central metabolism, were intensively analyzed and quantitated. For this purpose, Corynebacterium glutamicum was grown with [1-(13)C]glucose to metabolic and isotopic steady state and the fractional enrichments in precursor metabolites (e.g., pentose 5-phosphate) were quantified. Matrix calculus was used to express these data together with metabolite mass data. The detailed analysis of the dependence of (13)C enrichments on exchange fluxes enabled the transketolase-catalyzed exchange rate (2 pentose 5-phosphate <--> sedoheptulose 7-phosphate + glyceraldehyde 3-phosphate) to be quantified as 74.3% (molar metabolite flux) at a net flux of 10.3% and the exchange rate (pentose 5-phosphate + erythrose 4-phosphate <--> fructose 6-phosphate + glyceraldehyde 3-phosphate) to be quantified as 5.6% at a net flux of 8.1%. The flux entering the tricarboxylic acid cycle was 93.3%. The same comprehensive flux analysis as performed for the nonexcreting condition was done with the identical strain that had been forced to excrete L-glutamate. Because we had already quantified the fluxes for L-lysine excretion with an isogenic strain, three directly comparable flux situations are thus available. Consequently, this comparison permits a direct cause-and-effect relationship to be specified. In response to the different flux burdens of the cell, the PPP flux decreased from a maximum of 67% to 26%, with the glycolytic flux increasing accordingly. The carbon flux through isocitrate dehydrogenase increased from 20% to 36%. The bidirectional carbon flux between pyruvate and oxaloacetate decreased from 36% to 9%. Since the cause of the three different flux states was the allelic exchange in the final L-lysine assembling pathway or the glutamate export activity, respectively, the flexible response is the effect. This shows conclusively the enormous flexibility within the central metabolism of C. glutamicum to supply precursors upon their withdrawal for the synthesis of amino acids. (c) 1997 John Wiley & Sons, Inc. Biotechnol Bioeng 56: 168-180, 1997.

A human recombinant autoantibody-based immunotoxin specific for the fetal acetylcholine receptor inhibits rhabdomyosarcoma growth in vitro and in a murine transplantation model

Rhabdomyosarcoma (RMS) is the most common malignant soft tissue tumor in children and is highly resistant to all forms of treatment currently available once metastasis or relapse has commenced. As it has recently been determined that the acetylcholine receptor (AChR) gamma-subunit, which defines the fetal AChR (fAChR) isoform, is almost exclusively expressed in RMS post partum, we recombinantly fused a single chain variable fragment (scFv) derived from a fully human anti-fAChR Fab-fragment to Pseudomonas exotoxin A to generate an anti-fAChR immunotoxin (scFv35-ETA). While scFv35-ETA had no damaging effect on fAChR-negative control cell lines, it killed human embryonic and alveolar RMS cell lines in vitro and delayed RMS development in a murine transplantation model. These results indicate that scFv35-ETA may be a valuable new therapeutic tool as well as a relevant step towards the development of a fully human immunotoxin directed against RMS. Moreover, as approximately 20% of metastatic malignant melanomas (MMs) display rhabdoid features including the expression of fAChR, the immunotoxin we developed may also prove to be of significant use in the treatment of these more common and most often fatal neoplasms.

Hormone therapy/adjuvant chemotherapy induced deleterious effects on the bone mass of breast cancer patients and the intervention of physiotherapy: a literature review

In recent years, breast cancer has witnessed some notable improvements regarding early diagnosis and new therapeutical strategies, mainly because of the utilization of new drugs and systemic treatment protocols, which have had a direct impact in the increase of these patients' global survival rate. At the same time, it is an ever-growing concern among oncology professionals to identify and minimize as much as possible the effects of long-term toxicity resulting from cancer therapies. Within this context, physiotherapy fits as a preventive and rehabilitating factor regarding functional and skeletal alterations, deriving not only from the direct action of breast cancer, but also from the treatment to which these patients are submitted.

OBJECTIVES

The aim of this study was to revise the scientific literature on possible adjuvant chemotherapy-induced secondary deleterious effects on the bone mass of patients diagnosed with breast cancer, and also to revise the literature on the intervention of physiotherapy in cases of secondary bone mass loss caused by adjuvant chemotherapy in patients suffering from breast cancer.

METHODOLOGY

The research was carried out by consulting the following medical websites: Medicus Medline Index, Lilacs, Sciello, PubMed (National Library of Medicine), Google Academic and Capes (a Brazilian website for scientific information). The selection gathers articles written in different languages, English in special, published from January 1998 to October 2008.

RESULTS

24 studies explicitly mention chemotherapy-induced direct and/or indirect effects upon bone mass. Different authors refer to bone mass loss as one possible secondary deleterious effect resulting from adjuvant chemotherapy applied in breast cancer treatment. Nonetheless, no scientific articles were found on the subject of physiotherapy intervention aimed at patients in this specific condition.

CONCLUSION

The results achieved in this revision study point out the possible chemotherapy-induced late deleterious effects on patients diagnosed with breast cancer, as well as the additional risks for the development of further osteoporotic conditions. Hormone therapy and adjuvant chemotherapy treatments may in fact augment and accelerate the loss of bone mass, be it directly, through the action of chemotherapeutical drugs, or indirectly, through the reduction of estrogenic levels and precocious menopause. The scarce material on the rehabilitation of bone mass loss deriving from adjuvant treatments reveals, as it seems, a strong need for new studies on the subject.

The PTPN22gain-of-function+1858T(+) genotypes correlate with low IL-2 expression in thymomas and predispose to myasthenia gravis

Protein tyrosine phosphatase, non-receptor type 22 (PTPN22) inhibits T-cell activation and interleukin-2 (IL-2) production. The PTPN22(gain-of-function)+1858T(+) genotypes predispose to multiple autoimmune diseases, including early-onset (non-thymomatous) myasthenia gravis (MG). The disease association and the requirement of IL-2/IL-2 receptor signaling for intrathymic, negative T-cell selection have suggested that these genotypes may weaken T-cell receptor (TCR) signaling and impair the deletion of autoreactive T cells. Evidence for this hypothesis is missing. Thymoma-associated MG, which depends on intratumorous generation and export of mature autoreactive CD4(+) T cells, is a model of autoimmunity because of central tolerance failure. Here, we analyzed the PTPN22 +1858C/T single nucleotide polymorphism in 426 German Caucasian individuals, including 125 thymoma patients (79 with MG), and investigated intratumorous IL-2 expression levels. Unlike two previous studies on French and Swedish patients, we found strong association of PTPN22 +1858T(+) genotypes not only with early-onset MG (P=0.00034) but also with thymoma-associated MG (P=0.0028). IL-2 expression in thymomas with PTPN22 +1858T(+) genotypes (P=0.028) was lower, implying weaker TCR signaling. We conclude that the PTPN22(gain-of-function) variant biases towards MG in a subgroup of thymoma patients possibly by impeding central tolerance induction.

[Lymphomas of the spleen]

The spleen is commonly affected by malignant lymphomas and the macroscopic findings of the spleen correlate with different lymphoma entities. However, most lymphomas are not primarily diagnosed in splenectomy specimens. Exceptions include splenic marginal zone lymphomas and hepatosplenic T-cell lymphomas that are typically diagnosed from histological findings. In addition, hairy-cell leukemia, LGL leukemia and T-cell prolymphocytic leukemia typically show characteristic patterns of infiltration in the spleen which may be diagnostically useful. The different infiltration patterns of these tumors are discussed here.

[Inflammatory reactions of the spleen]

Inflammatory reactions of the spleen occur in the context of two pathophysiological settings. First, lymphoid hyperplasia of the spleen can be the result of a principally physiological production of immune effector cells e.g. due to systemic viral infections, autoimmune diseases and acquired or inherited immunodeficiencies. Second, the spleen itself may be the target of a pathological inflammatory reaction; this setting is exemplified by abscess formation due to septicopyemic spread of bacteria and by granulomatous inflammations, e.g. due to tuberculosis or sarcoidosis. Differential diagnostic considerations have to include splenic inflammatory pseudotumors, mycobacterial spindle cell tumors and lymphomas with granulomatous or histiocyte-rich reactive changes.

1,3-Dimethylbenzo[b]dibenzothiophene

The molecule of the title compound, C₁₈H₁₄S, is approximately planar (r.m.s. deviation = 0.029 Å). The crystal packing is stabilized by weak inter­molecular C—H⋯π inter­actions.