Conception and pilot testing of a self-management health application for patients with pollen-related allergic rhinitis and allergic asthma-the APOLLO app

It has been shown that pollen information services are an important self-management tool for patients with pollen-related allergic rhinitis (AR) and allergic asthma (AA). This study aimed to design an online application for patients with AR and AA, which supports patients to better manage their disease as well as to evaluate the app and present the first results of the pilot study. The pollen data were obtained from the electronic pollen information network of Bavaria, Germany. Participants were asked to fill in their allergy-related complaints in the app over a 60-day period. Subsequently, the app was evaluated. Indices and diagrams visualized the participants' individual complaints as well as the daily pollen concentration in the air. In order to motivate participants to complete the app on a daily basis, we used elements of gamification. Two thirds of the participants (N = 46) reported feeling better informed about pollen counts and their allergy when using the app. The app's simple and comprehensible design was rated positively. More than 80% of the participants would recommend the app to their family and friends. The app can be a tool for patients with AR and AA to better understand their disease.

Relationship of obesity to mortality in 47,399 patients from nationwide LIPIDOGRAM 2004–2015 cohort studies

Background

Evidence suggests that obesity may be associated with lower mortality rates in various cohorts of patients (obesity paradox). One possible explanation is unmeasured confounding factors induced by selection bias (collider stratification bias). Therefore, data from large cohorts with few exclusion criteria are of value as they may minimize this effect.

Purpose

To assess the association between two obesity measures body mass index (BMI; kg/m2) and waist circumference (WC; cm) with mortality in nationwide cohort of 47,399 patients.

Methods

Lipidogram studies were carried out in Poland in 2004, 2006 and 2015 in the population representative for patients in primary care setting. The median follow up was 5570 days. Patients were recruited in all 16 administrative regions in Poland and physicians were proportionally to the number of inhabitants in a given administrative region. Each patient was given a questionnaire on chronic diseases, treatment and lifestyle. Questionnaire was administered by physician. Association between BMI, WC and mortality was assessed by multivariate Cox regression and spline regression models. Weight status was classified as underweight (BMI <18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25–29.9), class I obesity (BMI 30–34.9), class II obesity BMI (35–39.9), and class III obesity BMI (>40).

Results

The prevalence of hypertension, dyslipidemia, diabetes and coronary artery disease, showed a graded association with BMI, whilst smoking was most frequent in underweight patients. Correlation between BMI and WC was 0.748. As compared to normal weight patients' class III obese patients had highest mortality (HR 1.91; 95% CI: 1.650–2.202), following by class II obesity (HR 1.47, 95% CI: 1.33–1.62) and underweight patients (HR 1.47; 95% CI 1.1–1.8). Overweight patients had also slightly increased risk of dying as compared to normal weight patients (HR 1.12; 95% CI: 1.05–1.19). Similar U-shaped curve was observed for waist circumference. After adjustment for age, sex, smoking, diabetes, hypertension and LDL cholesterol highest mortality was observed for underweight patients (HR 1.88; 95% CI: 1.44–2.45), following by class III obesity (HR–1.51; 95% CI 1.31–1.75). Class I obesity and being overweight was associated with lower risk (HR 0.88; 95% CI: 0.82–0.94 and HR 0.86; 95% CI: 0.81–0.92, respectively).

Conclusions

No evidence of obesity paradox was present in unadjusted analysis. Lower mortality was observed in overweight and class I obese patients only after adjustment for risk factors and diseases typically associated with obesity. Results of multivariate analysis indicate that diseases that develop in obese patients are significantly associated with mortality more than obesity itself. Confounding may be responsible for discussed obesity paradox in literature therefore preventive measures to maintain BMI within normal range and prevent development of its complications should not be abolished.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): The present study was funded by an unrestricted educational grant from Valeant. As a supporter of the study, Valeant played no role in the study design, data analysis, data interpretation, or writing of the report. The present study was also supported by Silesian Analytical Laboratories (SLA, Katowice, Poland).

LDL levels and long-term all-cause mortality in patients from nationwide LIPIDOGRAM 2004–2015 cohort studies

Background

Data from multiple randomized clinical trials show that lowering LDL cholesterol with statins is associated with significant reduction of outcomes both in primary and secondary prevention. Despite this some epidemiological studies reported increased risk with lowest LDL levels. The reason for this apparent discrepancy is probably due to unbalanced confounding in epidemiological studies.

Purpose

To assess long term survival in propensity matched cohort from the LIPIDOGRAM study in patients on statin therapy.

Methods

Lipidogram studies were carried out in Poland in 2004, 2006 and 2015 in the population representative for patients in primary care setting. The median follow up was 5570 days. Patients were recruited in all 16 administrative regions in Poland and physicians (n>1100) were proportionally distributed to the number of inhabitants in a given administrative region. Each patient was asked to fill the questionnaire on chronic diseases, treatment and lifestyle. Questionnaire was supervised by physician. Patients who were taking statins at the time of enrollment were matched to patients who were not on statin therapy. Groups were matched with regard to age, sex, body mass index, LDL cholesterol, diabetes mellitus, hypertension, previous myocardial infarction, chronic kidney disease, previous ischemic stroke, and atrial fibrillation. Nearest neighbor matching method was employed.

Results

To 13676 patients (28.9% of the LIPIDOGRAM 2004–2015 cohort) that took statin at the time of enrollment and 13676 patients not on statin treatment were matched. There were no significant differences between two groups with regard to all variables used in matching procedure including LDL cholesterol level. After 15 years of follow up There were 2585 deaths (18.9%) in patients who were treated with statin at the time of enrollment as compared to 2824 (20.6%) in patients with no treatment for dyslipidemia (absolute risk reduction (ARR) of −1.7%, p=0.003) Hazard ratio for mortality in patients who were not treated with statin at the enrollment in this propensity matched cohort was 1.11 (95% CI; 1.05–1.17, p=0.0002).

Conclusions

Despite similar LDL levels patients treated with statin at the time of enrollment had lower mortality risk as compared to patients not taking statins in long-term follow-up. Lower LDL levels that are not due to statin therapy might imply other underlying conditions that influence prognosis. Therefore, data from epidemiological studies that contradict results of balanced randomized trials due to intrinsic limitations should be approached with skepticism.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): The present study was funded by an unrestricted educational grant from Valeant. As a supporter of the study, Valeant played no role in the study design, data analysis, data interpretation, or writing of the report. The present study was also supported by Silesian Analytical Laboratories (SLA, Katowice, Poland).

Lean metabolic syndrome is associated with similar long-term prognosis as metabolic syndrome in overweight/obese patients. Analysis 47,399 Patients from nationwide LIPIDOGRAM 2004–2015 cohort studies

Background

Obesity was once though as an indispensable component of metabolic syndrome. Therefore, there a lot of definitions of metabolic syndrome with only few not including obesity as a criterion. The necessity of the obesity criterion in the metabolic health assessment is being questioned, as similar metabolic disturbances can occur in normal weight individuals. This relatively new concept is often referred as lean metabolic syndrome. Data on long term prognosis is scarce.

Purpose

To evaluate association between metabolic health and long-term prognosis.

Methods

Lipidogram studies were carried out in Poland in 2004, 2006 and 2015 in the population representative for patients in primary care setting. Patients were recruited in all 16 administrative regions in Poland and physicians were proportionally to the number of inhabitants in a given administrative region. Each patient was given a questionnaire on chronic diseases, treatment and lifestyle. Questionnaire was administered by physician. The diagnosis of metabolic syndrome was based on the presence of at least two of the following: 1) systolic blood pressure (SBP) ≥130 mmHg or diastolic blood pressure (DBP) ≥85 mmHg, 2) triglycerides (TG) >150 mg/dl, 3) high-density lipoprotein cholesterol (HDL-C) <40 mg/dl men and <50 mg/dl in women, 4) total cholesterol (TC) >200 mg/dl, and 5) fasting glucose (FBG) >100 mg/dl. Basing on those criteria and BMI with a cut off value of 25 kg/m2, patients were divided into four categories: healthy slim, metabolically healthy overweight/obese, lean metabolic syndrome and overweight/obese metabolic syndrome. The median follow up was 5570. this analysis data were censored at 3650 days.

Results

The median age of the study participants was 56.4 years. 7901 (16.7%) fell into category healthy slim, 14607 (30.8%) were classified as metabolically healthy overweight/obese, 3827 (8.1%) fulfilled criteria for lean metabolic syndrome whilst the remaining 21063 (44.4%) patients were diagnosed with overweight/obese metabolic syndrome. There were 4065 deaths during 10 years follow-up. Patients with lean metabolic syndrome had similar risk as patients with overweight/obese metabolic syndrome (HR=1.33, 95% CI: 1.17–1.52, p<0.001 and HR=1.32, 95% CI: 1.20–1.45, p<0.001). Metabolically heathy overweight/obese patients had only slightly higher risk of dying than healthy slim patients but this difference was less pronounced (HR=1.11, 95% CI: 1.08–1.23, p=0.03).

Conclusions

Lean metabolic syndrome confers similar risk as metabolic syndrome in overweigh/obese patients.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): The present study was funded by an unrestricted educational grant from Valeant. As a supporter of the study, Valeant played no role in the study design, data analysis, data interpretation, or writing of the report. The present study was also supported by Silesian Analytical Laboratories (SLA, Katowice, Poland).

The oral bioavailability of di-2-ethylhexyl phthalate (DEHP), di-isononyl phthalate (DiNP) and di-(isononyl)-cyclohexane-1,2-dicarboxylate (DINCH®) in house dust

Phthalates and other plasticizers are detected in high amounts in the indoor environment and therefore house dust can be an exposure source. Especially children have a relatively high unintended uptake of house dust, thus a higher exposure to plasticizers compared to adults may be possible. As accurate as possible exposure assessment data of the oral bioavailability of these compounds are necessary, however only one in vivo study with piglets is available so far. The aim of this study was to examine the oral bioavailability of phthalates and DINCH® in humans, which occur in typical house dust samples. We focused on the high molecular weight phthalates DEHP and DINP and their substitute DINCH®. Eleven volunteers ingested 6 g of house dust sieved to 2 mm. The urine was collected over a period of 36 h. The excreted plasticizers metabolites were quantified by an LC-MS/MS method. The mean recovery of urine metabolites was 51 % ± 20 % for DEHP, 26 % ± 13 % for DINP and 19 % ± 6% for DINCH® based on the parent compounds administered as dust samples. The metabolites of DEHP, DINP and DINCH® reached their maximum concentration after 2-19 hours post dose in urine. The bioavailability of DEHP was in agreement among the different dust samples. For DEHP, we were able to confirm previous findings from the oral bioavailability study with piglets and we could not observe a significant difference between the dust particle size (65 μm vs 2 mm) and the bioavailability. Considering the observed bioavailability, an estimated dust intake of 50 mg/d for toddlers can substantially contribute to the total plasticizer exposure.

[Guideline for the Diagnosis and Treatment of Asthma - Addendum 2020 - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]

The present addendum of the guideline for the diagnosis and treatment of asthma (2017) complements new insights into the diagnosis and management of asthma as well as for the newly approved drugs for the treatment of asthma. Current, evidence-based recommendations on diagnostic and therapeutic approaches are presented for children and adolescents as well as for adults with asthma.

[Statement of the German Society for Pulmonology and Respiratory Medicine Regarding the Regulation to Use FFP and Surgical Masks in the General Population]

On January 19, 2021, a new regulation on the mask requirement was issued in an initiative by the federal and state governments. This regulation obliges citizens to wear medical masks on public transport and in shops. In its statement, the German Society for Pneumology and Respiratory Medicine (DGP) describes the technical background of the various medical masks and explains their functionality using the associated standards. The DGP comes to the conclusion that FFP masks of the EN 149 standard were designed for the self-protection of the wearer and ensure this if the mask is worn properly and closes tightly to the face. Incorrect use must be avoided at all costs. Surgical masks in accordance with the EN 14683 standard were designed to protect against bacteria-carrying aerosols and, due to their design, have a rather low self-protection component. Community masks are not yet subject to any official standard. Community masks with electrostatic properties and high filtration performance could represent a reusable alternative in the future. Depending on the severity of their illness, patients with heart and/or lung diseases require a stress test with a mask to minimize medical risks.

Respiratory diseases and allergy in farmers working with livestock: a EAACI position paper

Farmers constitute a large professional group worldwide. In developed countries farms tend to become larger, with a concentration of farm operations. Animal farming has been associated with negative respiratory effects such as work-related asthma and rhinitis. However, being born and raised or working on a farm reduces the risk of atopic asthma and rhinitis later in life. A risk of chronic bronchitis and bronchial obstruction/COPD has been reported in confinement buildings and livestock farmers. This position paper reviews the literature linking exposure information to intensive animal farming and the risk of work-related respiratory diseases and focuses on prevention. Animal farming is associated with exposure to organic dust containing allergens and microbial matter including alive microorganisms and viruses, endotoxins and other factors like irritant gases such as ammonia and disinfectants. These exposures have been identified as specific agents/risk factors of asthma, rhinitis, chronic bronchitis, COPD and reduced FEV₁. Published studies on dust and endotoxin exposure in livestock farmers do not show a downward trend in exposure over the last 30 years, suggesting that the workforce in these industries is still overexposed and at risk of developing respiratory disease. In cases of occupational asthma and rhinitis, avoidance of further exposure to causal agents is recommended, but it may not be obtainable in agriculture, mainly due to socio-economic considerations. Hence, there is an urgent need for focus on farming exposure in order to protect farmers and others at work in these and related industries from developing respiratory diseases and allergy.

The impact of COPD on polyneuropathy: results from the German COPD cohort COSYCONET

Background

Peripheral neuropathy is a common comorbidity in COPD. We aimed to investigate associations between alterations commonly found in COPD and peripheral neuropathy, with particular emphasize on the distinction between direct and indirect effects.

Methods

We used visit 4 data of the COPD cohort COSYCONET, which included indicators of polyneuropathy (repeated tuning fork and monofilament testing), excluding patients with diabetes a/o increased HbA1c. These indicators were analysed for the association with COPD characteristics, including lung function, blood gases, 6-min walk distance (6-MWD), timed-up-and-go-test (TUG), exacerbation risk according to GOLD, C-reactive protein (CRP), and ankle-brachial index (ABI). Based on the results of conventional regression analyses adjusted for age, BMI, packyears and gender, we utilized structural equation modelling (SEM) to quantify the network of direct and indirect relationships between parameters.

Results

606 patients were eligible for analysis. The indices of polyneuropathy were highly correlated with each other and related to base excess (BE), ABI and TUG. ABI was linked to neuropathy and 6-MWD, exacerbations depended on FEV₁, 6-MWD and CRP. The associations could be summarized into a SEM comprising polyneuropathy as a latent variable (PNP) with three measured indicator variables. Importantly, PNP was directly dependent on ABI and particularly on BE. When also including patients with diabetes and/or elevated values of HbA1c (n = 742) the SEM remained virtually the same.

Conclusion

We identified BE and ABI as major determinants of peripheral neuropathy in patients with COPD. All other associations, particularly those with lung function and physical capacity, were indirect. These findings underline the importance of alterations of the micromilieu in COPD, in particular the degree of metabolic compensation and vascular status.

The Impact of an Inert Gas Atmosphere on the Kinetics of Changes in the Physical and Chemical Properties of Carrot Lyophilisate

The purpose of this study was to analyse the impact of blanching, the atmosphere of nitrogen and storage time on carotenoids content, colour and sorption properties of freeze-dried carrot. The material was stored for up to 16 weeks, in the dark, at room temperature. The colour was measured on the surface and in cross sections. As the storage time increased, there was a continual decrease in the carotenoids content in the carrot packed in atmospheric air. In the carrots packed in the atmosphere of nitrogen, no changes in carotenoid content were observed. The colour parameters correlated with the changes in the carotenoids content. The colour parameters changed on the surface and in cross sections in the same manner. During storage, a significant decrease in sorption properties of freeze-dried carrots was noted after 2 weeks of storage.

Combination of Methotrexate and Prednizone Decreases Circulating Concentrations of Interleukin 1Beta and Interleukin 6 in Patients with Rheumatoid Arthritis. Poor Correlation of Cytokine Suppression with Clinical Improvement

Objective

To evaluate the effect of methotrexate (MTX) in combination with prednizone on cytokine levels, acute phase proteins and thiobarbituric acid reactive substances (TBAR - an indicator of peroxidative damage to tissue lipids) in the blood of rheumatoid arthritis (RA) patients and to investigate their assgciations with clinical disease activity.

Methods

We measured blood concentrations of interleukin-1 R (IL-1p), interleukin- 6 (IL-6), TBARs and classical clinical and laboratory indices of disease activity in 36 RA subjects before and after 3 and 6 month treatment with MTX and prednizone. Only RA subjects who stopped any disease-modifying anti rheumatic drugs treatment for last 3 months were included in the study. Baseline cytokine and TBARs levels were compared with those obtained with 20 healthy controls.

Results-

Compared to controls RA subjects had elevated levels of circulating IL-1beta (63.3 ±47.6 vs 13.7 ± 7.8 pg/ml, p< 0.01), IL-6 (147.2 ± 76.5 vs 15.9 ± 13.3 pg/ml, p< 0.001) and TBARs (3.11 ± 0.42 vs 1.34 ± 0.45 nmol/1, p< 0.001) concentrations. MTX in combination with prednizone improved patient clinical status that was accompanied by 1.96-, 1.25-, and 1.35-fold decrease in IL-1beta, IL-6 and TBARs after 6 month treatment (p<0.001), respectively. Although, IL-1 and IL-6 revealed a few correlations with classical indices of disease activity no association was found between patient clinical status improvement and cytokine changes over 6 month treatment. Conclusions: MTX in combination with prednizone decreases blood levels of IL-1beta and IL-6 and inhibits the intensity of free radical- mediated processes in RA subjects. Monitoring of plasma concentrations of these cytokines could not predict the treatment efficacy.

Acute health effects of desktop 3D printing (fused deposition modeling) using acrylonitrile butadiene styrene and polylactic acid materials: An experimental exposure study in human volunteers

3D printers are increasingly run at home. Nanoparticle emissions from those printers have been reported, which raises the question whether adverse health effects from ultrafine particles (UFP) can be elicited by 3D printers. We exposed 26 healthy adults in a single-blinded, randomized, cross-over design to emissions of a desktop 3D printer using fused deposition modeling (FDM) for 1 hour (high UFP-emitting acrylonitrile butadiene styrene [ABS] vs low-emitting polylactic acid [PLA]). Before and after exposures, cytokines (IL-1β, IL-6, TNF-α, INF-γ) and ECP in nasal secretions, exhaled nitric oxide (FeNO), urinary 8-isoprostaglandin F_2α (8-iso PGF_2α ), and self-reported symptoms were assessed. The exposures had no significant differential effect on 8-iso PGF_2α and nasal biomarkers. However, there was a difference (P < .05) in the time course of FeNO, with higher levels after ABS exposure. Moreover, indisposition and odor nuisance were increased for ABS exposure. These data suggest that 1 hour of exposure to 3D printer emissions had no acute effect on inflammatory markers in nasal secretions and urine. The slight relative increase in FeNO after ABS printing compared to PLA might be due to eosinophilic inflammation from inhaled UFP particles. This possibility should be investigated in further studies using additional biomarkers and longer observation periods.

Pregnancy and perinatal conditions and atopic disease prevalence in childhood and adulthood

BACKGROUND

Previous studies showed controversial results for the influence of pregnancy-related and perinatal factors on subsequent respiratory and atopic diseases in children. The aim of this study was to assess the association between perinatal variables and the prevalence of asthma, bronchial hyperreactivity (BHR), flexural eczema (FE), allergic rhinitis, and sensitization in childhood and early adulthood.

METHODS

The studied population was first examined in Munich and Dresden in 1995/1996 at age 9-11 years. Participants were followed until age 19-24 years using questionnaires and clinical examinations. Associations between perinatal data and subsequent atopic diseases were examined using logistic regression analyses adjusting for potential confounders.

RESULTS

Cesarean section was statistically significantly associated with BHR in early adulthood (odds ratio 4.8 [95% confidence interval 1.5-15.2]), while assisted birth was associated with presence of asthma symptoms in childhood (2.2 [1.2-3.9]), FE symptoms (2.2 [1.2-4.3]) and doctor's diagnosis of atopic dermatitis (1.9 [1.0-3.4]) in childhood, and sensitization in early adulthood (2.2 [1.1-4.3]). Lower birth length (1.9 [1.1-3.2]), lower birthweight (0.5 [0.3-0.9]), and higher birthweight (0.6 [0.4-1.0]) were predictive of sensitization in early adulthood compared to average birth length and birthweight, respectively. None of the other perinatal factors showed statistically significant associations with the outcomes.

CONCLUSIONS

Our results indicate that children who are born by cesarean section and especially by assisted birth, might be at greater risk for developing asthma, FE, and sensitization and should hence be monitored. Prenatal maternal stress might partly explain these associations, which should be further investigated.

[Guideline for the Diagnosis and Treatment of COPD Patients - Issued by the German Respiratory Society and the German Atemwegsliga in Cooperation with the Austrian Society of Pneumology]

This document is a revision of the guideline for diagnosis and treatment of COPD that replaces the version from 2007. A multitude of recent reports regarding risk factors, diagnosis, assessment, prevention and pharmacological as well as non-pharmacological treatment options made a major revision mandatory. The new guideline is based on the GOLD document taking into account specifics in Germany and Austria.

Patientenfragebogen zur Erfassung der Ursachen interstitieller und seltener Lungenerkrankungen – klinische Sektion der DGP

Hintergrund Interstitielle Lungenerkrankungen (ILD) umfassen verschiedenste heterogene, zumeist chronische Erkrankungen des Interstitiums und/oder der Alveolen mit bekannten und unbekannten Ursachen. Die Diagnostik der ILD ist sehr komplex und sollte interdisziplinär erfolgen. Eine der wesentlichen Basisuntersuchungen ist eine umfangreiche Anamnese. Hierzu kam im deutschsprachigen Raum bisher der Frankfurter Bogen von 1985 zur Anwendung, der mittlerweile jedoch sprachlich und inhaltlich einer Überarbeitung bedurfte.

Methode Unter Schirmherrschaft der klinischen Sektion der DGP erfolgte die Erstellung eines neuen Patientenfragebogens zur Diagnostik interstitieller und seltener Lungenerkrankungen. Der Fragebogen entstand unter Mitarbeit von Pneumologen mit ILD-Expertise, Arbeitsmedizinern und Psychologen sowie der Unterstützung von Selbsthilfegruppen. Abschließend wurde der Fragebogen mithilfe von Patienten sprachlich optimiert.

Ergebnisse Der neu erstellte Patientenfragebogen zur Diagnostik interstitieller und seltener Lungenerkrankungen umfasst mehrere Bereiche: Initiale und aktuelle Symptome, Fragen zur Vorgeschichte inklusive Medikation, pulmonale und extrapulmonale Vorerkrankungen, mögliche Expositionen im häuslichen, privatem und beruflichem Umfeld sowie Familienanamnese und Reisetätigkeiten.

Schlussfolgerung Der neu erstellte Fragebogen kann in der klinischen Routine die Diagnostik bei Patienten mit Verdacht auf eine interstitielle Lungenerkrankung wesentlich erleichtern.

Increased Exhaled H2O2 and Impaired Lung Function in Patients Undergoing Bioincompatible Hemodialysis

Background

Chronic renal failure (CRF) and hemodialysis (HD) accumulate an inflammatory milieu, contributing to increased systemic and airway oxidative stress that may lead to lung damage.

Objectives

This study was designed to assess exhaled hydrogen peroxide (H2O2), lung function and whole blood chemiluminescence in HD and CRF patients and healthy controls.

Methods

The study included 59 patients (Polyamide S™ or Hemophan® membranes-19, cuprophane-16, hemodiafiltration-14, continuous ambulatory peritoneal dialysis-10), 16 CRF and 16 healthy controls. The assessment of lung function included FVC (forced vital capacity), FEV1 (forced expiratory volume in the first second) and DLCOc (single breath CO diffusing capacity). Exhaled H2O2 was determined fluorometrically and resting and n-formyl-methionyl-leucyl-phenylalanine (fMLP) luminol-dependent whole blood chemiluminescence (LBCL) were measured simultaneously.

Results

Only cuprophane HD patients presented decreased lung function (FVC 63.8±17.4%, FEV1 55.9±20.3 and DLCOc 72.1± 9.3 % of predicted; p<0.05 vs. controls). These patients exhaled the highest H2O2 levels in comparison to CRF (p<0.01): median 0.36 μM (range R: 0.09–0.56 μM) and controls (p<0.05): 0.17 μM (0.2–17.8 μM). These levels were not decreased during the HD session: preHD 1.25 μM (0.2–16.5μM) and postHD 1.3 μM (0.2–17.8 μM). As a marker of systemic oxidative stress, fMLP-induced LBCL (total light emission) was increased in these patients (1570.6 aUxs /10phagocytes; R: 274.2–8598.9) and in the CRF group (2389.4 aUxs /10phagocytes; R: 491.5–6184; p<0.05 vs. controls). Other patient groups did not express elevated LBCL and revealed decreased exhaled H2O2 after a session.

Conclusions

An increased oxidative burden in the lungs may contribute to functional lung impairment in patients dialyzed with a cellulose membrane. Biocompatible dialysis with other modalities might reduce airway-borne oxidative stress and is not related with lung damage.

Psychological and cognitive effects of laser printer emissions: A controlled exposure study

The possible impact of ultrafine particles from laser printers on human health is controversially discussed although there are persons reporting substantial symptoms in relation to these emissions. A randomized, single-blinded, cross-over experimental design with two exposure conditions (high-level and low-level exposure) was conducted with 23 healthy subjects, 14 subjects with mild asthma, and 15 persons reporting symptoms associated with laser printer emissions. To separate physiological and psychological effects, a secondary physiologically based categorization of susceptibility to particle effects was used. In line with results from physiological and biochemical assessments, we found no coherent, differential, or clinically relevant effects of different exposure conditions on subjective complaints and cognitive performance in terms of attention, short-term memory, and psychomotor performance. However, results regarding the psychological characteristics of participants and their situational perception confirm differences between the participants groups: Subjects reporting symptoms associated with laser printer emissions showed a higher psychological susceptibility for adverse reactions in line with previous results on persons with multiple chemical sensitivity or idiopathic environmental intolerance. In conclusion, acute psychological and cognitive effects of laser printer emissions were small and could be attributed only to different participant groups but not to differences in exposure conditions in terms of particle number concentrations.

[Guideline for the Diagnosis and Treatment of Asthma - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]

The present guideline is a new version and an update of the guideline for the diagnosis and treatment of asthma, which replaces the previous version for german speaking countries from the year 2006. The wealth of new data on the pathophysiology and the phenotypes of asthma, and the expanded spectrum of diagnostic and therapeutic options necessitated a new version and an update. This guideline presents the current, evidence-based recommendations for the diagnosis and treatment of asthma, for children and adolescents as well as for adults with asthma.

Health effects of laser printer emissions: a controlled exposure study

Ultrafine particles emitted from laser printers are suspected to elicit adverse health effects. We performed 75-minute exposures to emissions of laser printing devices (LPDs) in a standardized, randomized, cross-over manner in 23 healthy subjects, 14 mild, stable asthmatics, and 15 persons reporting symptoms associated with LPD emissions. Low-level exposures (LLE) ranged at the particle background (3000 cm^-3 ) and high-level exposures (HLE) at 100 000 cm^-3 . Examinations before and after exposures included spirometry, body plethysmography, transfer factors for CO and NO (TLCO, TLNO), bronchial and alveolar NO, cytokines in serum and nasal secretions (IL-1β, IL-5, IL-6, IL-8, GM-CSF, IFNγ, TNFα), serum ECP, and IgE. Across all participants, no statistically significant changes occurred for lung mechanics and NO. There was a decrease in volume-related TLNO that was more pronounced in HLE, but the difference to LLE was not significant. ECP and IgE increased in the same way after exposures. Nasal IL-6 showed a higher increase after LLE. There was no coherent pattern regarding the responses in the participant subgroups or single sets of variables. In conclusion, the experimental acute responses to short but very high-level LPD exposures were small and did not indicate clinically relevant effects compared to low particle number concentrations.

Varying effects of EGF, HGF and TGFβ on formation of invadopodia and invasiveness of melanoma cell lines of different origin

The understanding of melanoma malignancy mechanisms is essential for patient survival, because melanoma is responsible for ca. 75% of deaths related to skin cancers. Enhanced formation of invadopodia and extracellular matrix (ECM) degradation are two important drivers of cell invasion, and actin dynamics facilitate protrusive activity by providing a driving force to push through the ECM. We focused on the influence of epidermal growth factor (EGF), hepatocyte growth factor (HGF) and transforming growth factor β (TGFβ) on melanoma cell invasiveness, since they are observed in the melanoma microenvironment. All three factors stimulated invasion of A375 and WM1341D cells derived from primary tumor sites. In contrast, only EGF and HGF stimulated invasion of WM9 and Hs294T cells isolated from lymph node metastasis. Enhanced formation of invadopodia and ECM degradation underlie the increased amount of invasive cells after stimulation with the tested agents. Generally, a rise in invasive potential was accompanied by a decrease in actin polymerization state (F:G ratio). The F:G ratio remained unchanged or was even increased in cell lines from a metastasis treated with TGFβ. Our findings indicate that the effects of stimulation with EGF, HGF and TGFβ on melanoma cell invasiveness could depend on melanoma cell progression stage.

Molecular alterations in bone marrow mesenchymal stromal cells derived from acute myeloid leukemia patients

The contribution of molecular alterations in bone marrow mesenchymal stromal cells (BM-MSC) to the pathogenesis of acute myeloid leukemia (AML) is poorly understood. Thus we assessed genome-wide genetic, transcriptional and epigenetic alterations in BM-MSC derived from AML patients (AML BM-MSC). Whole-exome sequencing (WES) of AML BM-MSC samples from 21 patients revealed a non-specific pattern of genetic alterations in the stromal compartment. The only mutation present in AML BM-MSC at serial time points of diagnosis, complete remission and relapse was a mutation in the PLEC gene encoding for cytoskeleton key player Plectin in one AML patient. Healthy donor controls did not carry genetic alterations as determined by WES. Transcriptional profiling using RNA sequencing revealed deregulation of proteoglycans and adhesion molecules as well as cytokines in AML BM-MSC. Moreover, KEGG pathway enrichment analysis unravelled deregulated metabolic pathways and endocytosis in both transcriptional and DNA methylation signatures in AML BM-MSC. Taken together, we report molecular alterations in AML BM-MSC suggesting global changes in the AML BM microenvironment. Extended investigations of these altered niche components may contribute to the design of niche-directed therapies in AML.

Does office space occupation matter? The role of the number of persons per enclosed office space, psychosocial work characteristics, and environmental satisfaction in the physical and mental health of employees

The study examined the effects of office space occupation, psychosocial work characteristics, and environmental satisfaction on physical and mental health of office workers in small-sized and open-plan offices as well as possible underlying mechanisms. Office space occupation was characterized as number of persons per one enclosed office space. A total of 207 office employees with similar jobs in offices with different space occupation were surveyed regarding their work situation (psychosocial work characteristics, satisfaction with privacy, acoustics, and control) and health (psychosomatic complaints, irritation, mental well-being, and work ability). Binary logistic and linear regression analyses as well as bootstrapped mediation analyses were used to determine associations and underlying mechanisms. Employee health was significantly associated with all work characteristics. Psychosocial work stressors had the strongest relation to physical and mental health (OR range: 1.66-3.72). The effect of office space occupation on employee health was mediated by stressors and environmental satisfaction, but not by psychosocial work resources. As assumed by sociotechnical approaches, a higher number of persons per enclosed office space was associated with adverse health effects. However, the strongest associations were found with psychosocial work stressors. When revising office design, a holistic approach to work (re)design is needed.

J_{eff} Description of the Honeycomb Mott Insulator α-RuCl_{3}

Novel ground states might be realized in honeycomb lattices with strong spin-orbit coupling. Here we study the electronic structure of α-RuCl_{3}, in which the Ru ions are in a d^{5} configuration and form a honeycomb lattice, by angle-resolved photoemission, x-ray photoemission, and electron energy loss spectroscopy supported by density functional theory and multiplet calculations. We find that α-RuCl_{3} is a Mott insulator with significant spin-orbit coupling, whose low energy electronic structure is naturally mapped onto J_{eff} states. This makes α-RuCl_{3} a promising candidate for the realization of Kitaev physics. Relevant electronic parameters such as the Hubbard energy U, the crystal field splitting 10 Dq, and the charge transfer energy Δ are evaluated.