Long-Term Observation of Patients With Cancer - an Entity-Independent Registry for Healthcare and Translational Research at the University Medicine Dresden (Cancer-Reg-VT)

INTRODUCTION

Translational research is important, especially in medicine where decisions affect people's lives. Clinical registries and the studies embedded in them allow the depiction of actual care practice under routine conditions. Translating the findings of health services research back into clinical research through prospective cohort studies has the potential to drive medical innovations faster, more effectively and, above all, in a more targeted manner. These must therefore be a central component of cutting-edge oncological research.

OBJECTIVE

The aim of the registry is the establishment of clinical cohorts and the provision of a comprehensive, high-quality data set for oncological diseases.

METHODS/DESIGN

The registry will prospectively record all patients treated for cancer at Dresden University Hospital (UKD). In addition to the data from the hospital information systems (ORBIS, TDS, GEPADO, etc.), monitoring of health-related quality of life (HRQOL) is to be carried out at regular intervals at the beginning and during the course of treatment. In addition, individual linkage with data from clinical cancer registries and health insurance companies (including AOK PLUS) is planned for a period of five years before and after inclusion. All these data will be merged in a registry database. The selection of variables and measurement time points is closely based on the guidelines for colorectal carcinoma of the international initiative ICHOM (International Consortium for Health Outcomes Measurement). The study management software (STeVe) separates personal identification characteristics (IDAT) and medical data (MDAT) at an early stage. The independent trust centre of the TU Dresden (Treuhandstelle) ensures that no personal data enter the registry database. It is thereby also ensured that the data owners involved (UKD, biobank, health insurance company, cancer registry, patient) only receive the personal data they need for allocation. The MOSAIC software tools recommended by the TMF (Technologie- und Methodenplattform für die vernetzte medizinische Forschung e.V.) are used to manage the pseudonyms.

DISCUSSION/CONCLUSION

With the registry, previously missing evidence on the effectiveness, safety and costs of diagnostic and therapeutic measures can be made, taking into account long-term and patient-reported outcomes of routine care. The data potentially allow for the identification of barriers to and facilitators of innovative promising cancer diagnostics and therapies. They also enable generation of scientifically relevant hypotheses in the field of translational and outcomes research.

Data integration between clinical research and patient care: A framework for context-depending data sharing and in silico predictions

The transfer of new insights from basic or clinical research into clinical routine is usually a lengthy and time-consuming process. Conversely, there are still many barriers to directly provide and use routine data in the context of basic and clinical research. In particular, no coherent software solution is available that allows a convenient and immediate bidirectional transfer of data between concrete treatment contexts and research settings. Here, we present a generic framework that integrates health data (e.g., clinical, molecular) and computational analytics (e.g., model predictions, statistical evaluations, visualizations) into a clinical software solution which simultaneously supports both patient-specific healthcare decisions and research efforts, while also adhering to the requirements for data protection and data quality. Specifically, our work is based on a recently established generic data management concept, for which we designed and implemented a web-based software framework that integrates data analysis, visualization as well as computer simulation and model prediction with audit trail functionality and a regulation-compliant pseudonymization service. Within the front-end application, we established two tailored views: a clinical (i.e., treatment context) perspective focusing on patient-specific data visualization, analysis and outcome prediction and a research perspective focusing on the exploration of pseudonymized data. We illustrate the application of our generic framework by two use-cases from the field of haematology/oncology. Our implementation demonstrates the feasibility of an integrated generation and backward propagation of data analysis results and model predictions at an individual patient level into clinical decision-making processes while enabling seamless integration into a clinical information system or an electronic health record.

[Urinary bladder cancer as a late sequela of spinal cord injury : Decision-making aids for assessment of this causal association]

BACKGROUND

There is to date no convincing literature that has assessed the association between traumatic spinal cord injury (SCI) and the later development of urinary bladder cancer. The aim of this work is to present medical experts as well as the national accident insurance and the social courts decision-making aids based on the latest medical scientific knowledge, for assessment of this causal association.

MATERIALS AND METHODS

A study conducted between April 1998 and March 2017 in the BG Trauma Hospital Hamburg forms the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 32 out of 6432 treated outpatient and inpatient SCI patients. Furthermore, relevant published literature was taken into consideration for the decision-making aids.

RESULTS

It was found that urinary bladder cancer in SCI patients occurs at a considerably younger age as compared to the general population, more frequently shows muscle invasive carcinoma with a higher grade at first diagnosis and a higher proportion of the more aggressive squamous cell carcinoma than that of the general population. Correspondingly, the survival time is extremely unfavorable. For medical experts a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance.

CONCLUSION

The results showed that urinary bladder cancer in SCI patients differs considerably from that of able-bodied patients. These differences drastically shorten the survival time. A study on patients with spina bifida, i.e., a congenital spinal cord disorder, corroborates these observations. They indicate histopathological differences that have so far been intangible.

On the Role of Plastoquinone in Photosynthesis

Dibromothymoquinone and its hydroquinone are inhibitors of non cyclic electron flow from water to NADP, anthraquinone or methylviologen. The inhibition is competetively reversed by plastoquinone. It appears that dibromothymoquinone is an antagonist of plastoquinone and that it prevents the enzymic (by the next endogenous carrier of the chloroplast electron transport chain) but not the chemical (by ferricyanide) reoxidation of reduced plastoquinone. This follows from the result that the photoreduction of ferricyanide and DCPIP * is not inhibited by dibromothymoquinone in sonicated chloroplasts and is inhibited in intact chloroplasts to only 60% or 80% respectively. It is concluded that dibromothymoquinone does not inhibit photoreductions by photosystem II.

According to their response to dibromothymoquinone, cyclic photophosphorylations can be subdivided in those requiring plastoquinone and those which do not. Menadione catalyzed cyclic photophosphorylation is inhibited by dibromothymoquinone, whereas the PMS catalyzed system is not. The DAD cyclic system is only partly inhibited by dibromothymoquinone. The PMS catalyzed cyclic photophosphorylation in the presence of dibromothymoquinone is antimycin sensitive, which suggests that the PMS system can switch from a plastoquinone dependent system to a plastoquinone independent, but cytochrome b dependent system, which is now antimycin sensitive. Ferredoxin catalyzed cyclic photophosphorylation is inhibited by dibromothymoquinone as well as by antimycin. The data indicate that non cyclic electron flow through both photosystems is obligatory dependent on plastoquinone, whereas cyclic systems do not necessarily include plastoquinone. The relevance of the results to the possibility of different coupling sites in cyclic and non cyclic electron flow systems is discussed.

Transition Metal Squarates I. Chain Structures M (C4O4) · 4 H2O

The transition metal squarates M(C4O4) · 4 H2O (M2+ = Mn2+, Fe2+, Co2+. Ni2+, and Zn2+) are isotypic. They crystallize monoclinically, space group Ce-Cf, and consist of one-dimensional chain molecules

[xxx]

with the chain axes alternatively in direction [110] and [110]. The transition metal is octahedrally coordinated by two oxygen atoms of two C4O4 2- -anions in rrarcs-position and 4 water molecules. Neighbouring chains are interlinked by hydrogen bonds. The distance between the planes of the parallel C4-rings of neighbouring chains is similar to the layer distance in graphite.

Azido-chelatkobalt(III)-Komplexe / Azido Chelate Cobalt(III) Complexes

The preparation and characterization of a series of azido chelate complexes of cobalt(III), N3Co(chel)2B (chel = anionic bidentate ligand, B = base e.g. PPh3, P(OEt)3) and N3Co(chel′)B (chel′ = anionic tetradentate ligand) is reported. In addition, analogous chelate cobalt(III) complexes containing the pesudo halides NCO-, NCS -, CN -, C ≡ CR-, C(CN)3-, CH2NO2- have been prepared.

[Reptile-associated Salmonellosis in a Breastfed Infant]

BACKGROUND

Although salmonellosis is one of the most common childhood illnesses associated with enteric bacteria, breastfed babies do not often get infected with Salmonella. In such cases it is therefore necessary to look carefully for the source of infection.

PATIENT

It is reported an 8-week-old female infant with acute haemorrhagic diarrhoea and fever. With symptomatic therapy and breast-feeding her condition improved without antibiotic therapy. Microbiological diagnosis and subtyping identified infection with Salmonella enterica serovar Pomona. The source of the infection was a bearded dragon ( Pogona SPP.) living in a neighborhood household. Monitoring of the child showed shedding of the bacterium over a nine month period.

CONCLUSION

In all cases of salmonellosis in breastfed babies, the source of infection should be carefully determined. Small numbers of bacteria can cause a symptomatic infection in this age group. Therefore an intensive search of the transmission route is indicated to develop prevention strategies.

[Reptile-associated Salmonellosis in Infants in Germany]

Salmonellosis is an important disease in childhood. Increasing infections caused by meat and raw egg consumption starts in the second year of life. The transmission from reptiles to infants is an alternative route. Reptile-associated salmonellosis is becoming more significant for pediatricians and microbiologists due to the increasing numbers of household exotic pets. Investigations of routes of infections in connection with the local health authorities including microbiological, serological and molecular biological tests is possible in case of atypical salmonellosis. During recent years (2006-2008) an increasing number of salmonellosis cases caused by reptiles. Most of the 26 patients were infants of less than one year of age. Also Salmonella strains of subspecies II, IIIa, IIIb and IV play an important role. The US Centers for Disease Control and Prevention (CDC) has published recommendations which includes washing hands with soap and water after handling reptiles or the cages and keeping reptiles out of food preparation areas. The CDC has also adviced that children less than five years should not have reptiles as pets.

Doppelseitige Hodenschussverletzung

Gunshot injuries to the testicles are rare and usually result in testicular atrophy. In the case of severe bilateral testicular injuries, this could cause not only infertility but also the need for lifetime testosterone-substitution. We report an 18-year-old patient with bilateral testicular gunshot injury. During the surgical exploration an orchiectomy of the complete ruptured left testicle was necessary. Debridement of the damaged tissue and a partial orchiectomy was performed on the right side. After the operation, the patient developed an incretory hypogonadism and oligozoospermia. During follow-up, an improvement in the sperm count and of the hormonal status occurred. These finally reached normal levels. After genital traumata, immediate surgical exploration should be performed. Based on the above results, the patient benefits from conservative debridement and primary repair of the injured testicle, if possible. An improvement in hormonal status and sperm parameters after testicular injury and consecutive testicular malfunction can occur. Regeneration of the testicular tissue seems possible.

Oral immunisation of wild boar against classical swine fever: concluding analysis of the recent field trials in Germany

The recent oral immunisation trials in wild boar against classical swine fever (CSF) in Germany are described and evaluated in summary. After the first field study in Lower Saxony from 1993-1995 further immunisation trials started in Mecklenburg-Western Pomerania, Brandenburg, Lower Saxony, Baden-Württemberg and Saxony-Anhalt. The immunisation strategies and the size of the vaccination zones were different in the individual federal states. In principle, the bait vaccine based on the CSF virus strain "C" were laid out by hand. Later also the aerial distribution was carried out in selected areas of Mecklenburg-Western Pomerania. The application of baits by plane was introduced at the beginning of the immunisation measures in Saxony-Anhalt apart from the manual distribution. Up to now, the field trials show that the oral immunisation can be an additional tool for CSF control by increasing of herd immunity and reduction of the CSFV prevalence. However, the immunisation was not sufficient enough for young boars in the most field studies. Based on the evaluation of the immunisation experiments an improved immunisation procedure is recommended.

Genetically modified feeds in animal nutrition. 2nd communication: glufosinate tolerant sugar beets (roots and silage) and maize grains for ruminants and pigs

To analyse substantial equivalence of genetically modified sugar-beets and maize, in which the glufosinate-tolerant (Pat) gene is inserted, crude nutrients, the amino acid and the fatty acid profiles as well as the composition of the NDF-fraction of maize grains were determined and compared with those of the corresponding non-transgenic cultivars. Due to the genetic manipulation differences in crude nutrient contents including sugar and starch were not detected. The amino acid profile of maize grains was analysed to be the same. Fatty acid profile and composition of cell wall constituents did not show any influences as well. Digestibility of Pat-sugar-beets and maize grains for pigs did not demonstrate meaningful differences as compared to the corresponding non-transgenic cultivars. Digestibility of sugar-beet roots and sugar-beet top silage for ruminants proved to be also in the scope of natural variance. As the digestibility of the macro nutrients remained unaffected, the Pat-gene introduction into both crops did not show an influence on the energetic feeding value. For pigs the ME-content of Pat-sugar-beets was determined to be 14.1 MJ/kg DM versus 13.7 MJ of the non-transgenic cultivars. ME-content of Pat-maize grains was 16.0 MJ/kg DM versus 15.8 MJ for controls. For ruminants the feeding value of Pat-sugar-beets was found to be 8.5 MJ NEL/kg DM or 13.2 MJ ME/kg DM, regardless of whether the Pat-gene was inserted or not. The corresponding energy values of sugar-beet top silage ranged between 5.2 and 5.5 MJ NEL/kg DM or 8.6 and 9.1 MJ ME/kg DM, with differences considered in the biological range.

Genetically modified feeds in animal nutrition. 1st communication: Bacillus thuringiensis (Bt) corn in poultry, pig and ruminant nutrition

During the last few years, animal nutrition has been confronted with genetically modified organisms (GMO), and their significance will increase in the future. The study presents investigations on the substantial equivalence of the transgenic Bt (Bacillus thuringiensis) corn and the corresponding nontransgenic hybrid Cesar and parameters of nutrition physiology such as digestibility and energy content for poultry, pigs and ruminants. The results of the analysed corn samples as well as of the silage samples illustrated substantial equivalence in all investigated ingredients, such as crude nutrients, amino acids, fatty acids, minerals and non-starch polysaccharides. The results of the experiments using poultry, pigs, wethers and fattening bulls were not influenced by the genetic modification of corn. The determined values for the digestibilities and the energy contents for poultry, pigs and wethers were not affected by the used corn variety. Neither the examined parameters of the fattening experiments with bulls nor the slaughter results showed any significant differences between the bulls fed on silages made from the nontransgenic or transgenic corn.

Effects of client-centered psychotherapy for personality disorders alone and in combination with psychopharmacological treatment. An empirical follow-up study

BACKGROUND

: There is an increasing interest concerning the treatment of patients with personality disorders (PD) in data on the efficacy of psychotherapeutic strategies especially when combined with medication.

METHODS

The efficacy of an inpatient client-centered treatment program (CCT) was studied prospectively in 142 patients with PD and additional depressive, anxiety or eating disorders (ICD-10).

RESULTS

Significant improvements in depression, self-esteem and social adjustment were achieved up to discharge, which remained stable at the 1-year follow-up. The efficacy with regard to individual variables or the total result could not be further enhanced by a combination with psychopharmacological treatment (CCT + MED), consisting mainly of antidepressants. Within the subgroups of patients with socially deviant (F60.0-2), emotionally unstable/borderline (F60.3) and histrionic/narcissistic PD (F60.4, F60.8), CCT was significantly superior to CCT + MED in the reduction of depression (Bech-Rafaelsen Melancholia Scale ratings), whereas the response was enhanced by medication in the subgroup of patients with socially dependent 'cluster C' PD (F60.5-7).

CONCLUSIONS

The results are discussed with regard to client-centered therapeutic concepts and to the further development of differential combination strategies.

Influence of folic acid supplements on the carry-over of folates from the sow to the piglet

This experiment aimed to investigate the influence of folic acid supplements on the carry-over of folates from the sow to the fetus during late gestation and to the suckling piglet. Two groups of sixteen German Landrace sows received, during gestation and lactation, a diet supplemented with either 0 or 10 mg folic acid/kg. Increased folic acid concentrations in the serum of sows were detected only at the end of gestation (day 100) and at the end of lactation (day 28). The supplementation with folic acid to the sows' diet improved the folic acid supply of the fetus compared with unsupplemented controls; values were respectively 92.6 v. 56.2 nmol folates/l serum in newborn piglets and 171.9 v. 76.3 micromol folates/g fresh liver in stillborn piglets (P < 0.05). Folate concentrations in colostrum and milk (day 28) were 3.6- and 5.0-times higher in supplemented than unsupplemented sows. This treatment effect was also reflected in the serum of piglets until weaning. Therefore, the folic acid supply for the suckling piglet is dependent mainly upon the carry-over of maternal folates via colostrum and milk.

Valine 77 of heterocystous ferredoxin FdxH2 in Anabaena variabilis strain ATCC 29413 is critical for its oxygen sensitivity

Ferredoxins are small iron sulfur proteins necessary for electron donation. FdxH1 and FdxH2 are associated with two different nif gene clusters where they transfer electrons for the reduction of nitrogenase complex. FdxH1 was observed to be stable towards oxygen, whereas, FdxH2 was relatively unstable. We had identified the amino acid involved in oxygen sensitivity of ferredoxin protein using protein modeling. The exchange of valine to leucine at position 77 was critical for ferredoxin proteins in relation to its oxygen sensitivity. This exchange leads to a longer side chain, which inhibits the accessibility of oxygen to the iron sulfur cluster. Site directed mutagenesis and in vitro experiments confirms that valine indeed is involved in the oxygen sensitivity. The exchange of leucine to valine in FdxH1 makes it oxygen unstable. Thus, from the above results we can conclude that the position of leucine at position 77 is critical for oxygen sensitivity of ferredoxin and protein modeling can be used to identify specific amino acids in other oxygen-sensitive proteins.

[Conflict-centered individual therapy or integration of psychotherapy methods. Process of change in client-centered psychotherapy with and without behavioral exposure therapy in agoraphobia with panic disorder]

The mechanisms of change due to different psychotherapeutic treatments of anxiety disorders are the subject of the present study. Sixty-eight patients with agoraphobia and panic (DSM III R No. 300.21, ICD 10 No. F 40.01) were included, exclusively treated with client-centered treatment (n = 28) or with additional behavioral exposure treatment (n = 40) in an inpatient setting. The patients were examined on admission, at discharge, and at 6 and 12 months follow-ups with the Structured Clinical Interview for DSM III R (SKID), the Freiburg Personality Inventory (FPI R), and the Giessen Test (GIESS). Both treatment modalities significantly reduced panic and avoidance. Differences were found in personality scales. The support of autonomy was superior by client-centered treatment alone: client-centered treated (CCT) patients felt less dependent on the expectations of others, less under stress, and had fewer psychosomatic complaints. Patients with additional exposure treatment feel accepted by their social environment earlier. The results are discussed with regard to open questions of therapy integration and different mechanisms of change.

Identification of amino acid residues of nitrite reductase from Anabaena sp. PCC 7120 involved in ferredoxin binding

The nitrite reductase gene (nirA) from the filamentous, heterocyst-forming cyanobacterium Anabaena sp. PCC 7120 (A. PCC 7120) was expressed in Escherichia coli using the pET-system. Co-expression of the cysG gene encoding siroheme synthase of Salmonella typhimurium increased the amount of soluble, active nitrite reductase four fold. Nitrite reductase was purified to homogeneity. In order to identify amino acid residues involved in ferredoxin (PetF)-nitrite reductase electron transfer in A. PCC 7120, we performed a sequence comparison between ferredoxin-dependent nitrite reductases from various species. The alignment revealed a number of conserved residues possibly involved in ferredoxin nitrite reductase interaction. The position of these residues relative to the [4Fe4S]-cluster as the primary electron acceptor was tentatively localized in a three dimensional structure of the sulfite reductase from E. coli, which is closest related to nitrite reductase among the proteins with known tertiary structure. The exchange of certain positively charged amino acid residues of the nitrite reductase with uncharged residues revealed the influence of these residues on the interaction of nitrite reductase with reduced ferredoxin. We identified at least two separate regions of nitrite reductase that contribute to the binding of ferredoxin.

[Continent cutaneous urinary diversion of ileal neobladders by transverse tubularized ileum segments (Yang- or Monti-principle)]

The method using transvers retubularized segment of ileum as an efferent conduit in Hautmann's neobladder is easy to perform and it can be repeated in revision procedures. We performed the procedure in nine patients who underwent radical cystectomy. At 8-16 months after operation, the resulting stomas were easy to catheterize. Of the nine patients, eight were continent. We find the procedure to be a good alternative when the appendix is absent and a cutaneous stoma is needed. It could be the preferred method in ileal neobladders with cutaneous outlet.

Transcriptional and mutational analysis of the uptake hydrogenase of the filamentous cyanobacterium Anabaena variabilis ATCC 29413

A 10-kb DNA region of the cyanobacterium Anabaena variabilis ATCC 29413 containing the structural genes of the uptake hydrogenase (hupSL) was cloned and sequenced. In contrast to the hupL gene of Anabaena sp. strain PCC 7120, which is interrupted by a 10.5-kb DNA fragment in vegetative cells, there is no programmed rearrangement within the hupL gene during the heterocyst differentiation of A. variabilis. The hupSL genes were transcribed as a 2.7-kb operon and were induced only under nitrogen-fixing conditions, as shown by Northern blot experiments and reverse transcriptase PCR. Primer extension experiments with a fluorescence-labeled oligonucleotide primer confirmed these results and identified the 5' start of the mRNA transcript 103 bp upstream of the ATG initiation codon. A consensus sequence in the promoter that is recognized by the fumarate nitrate reductase regulator (Fnr) could be detected. The hupSL operon in A. variabilis was interrupted by an interposon deletion (mutant strain AVM13). Under N(2)-fixing conditions, the mutant strain exhibited significantly increased rates in H(2) accumulation and produced three times more hydrogen than the wild type. These results indicate that the uptake hydrogenase is catalytically active in the wild type and that the enzyme reoxidizes the H(2) developed by the nitrogenase. The Nif phenotype of the mutant strain showed a slight decrease of acetylene reduction compared to that of the wild type.

Ebermast mit unterschiedlicher Proteinversorgung

Abstract. Title ofthe paper: Boar fattening with different protein supply in the diet In the literature numerous studies are found that proof a superior fattening performance and carcass composition for boars compared to female and castrated pigs. The results in the feeding experiment presented here do not confirm this to the same extend. Even with a high protein and lysine supplementation growth performance of boars was lower than in females. Lean content was determined by FOM grading which might underestimate the boars. Lean to fat ratio (areas of M. long dorsi and back fat) however was significantly different between castrates and all boar groups due to the reduced fat deposition. Sensoric tests detected significant boar taint in the majority ofthe samples from male carcasses. Considering the tendency on the market for increasing carcass weights and the risk of boar taint in heavier pigs boar fattening can not be recommended in Germany.

Identification of amino acids responsible for the oxygen sensitivity of ferredoxins from Anabaena variabilis using site-directed mutagenesis

The filamentous cyanobacterium Anabaena variabilis (ATCC 29413) possesses two molybdenum dependent nitrogenase systems, nif1 and nif2. The nif1 system is regulated by a developmental program involving heterocyst differentiation; the nif2 system is expressed in all cells only under anaerobic conditions and the expression is controlled environmentally. The genes fdxH1 and fdxH2, encoding two [2Fe-2S] ferredoxins, are part of the these two distinct and differently regulated nif gene clusters. The sensitivity of both ferredoxins to oxygen was different; the half-life of FdxH2 in air was only approximately 1.5 h, while FdxH1 retained 80% of its nitrogenase activity after 24 h. We used site-directed mutagenesis to identify the role of individual amino acid residues responsible for oxygen sensitivity and found out that the FdxH2 double mutant I76A/V77L was much more resistant to oxygen than the wild-type ferredoxin (FdxH2) and similar to FdxH1. By modelling it was shown that the accessibility of the cavity around the iron-sulfur cluster was responsible for that.

The isiB gene encoding flavodoxin is not essential for photoautotrophic iron limited growth of the cyanobacterium Synechocystis sp. strain PCC 6803

When iron becomes limiting, Synechocystis 6803 induces the synthesis of flavodoxin. As a basis for genetic analysis, the flavodoxin-encoding isiB gene of Synechocystis 6803 was cloned and sequenced. The isiB gene was disrupted by insertion of an interposon within the isiB coding region resulting in two Synechocystis 6803 mutant strains, CKF-I and CKF-II. They were distinguished from each other by the orientation of the kanamycin resistance cassette. Photoautotrophic growth of the mutant strains under iron limiting conditions, which are sufficient for induction of flavodoxin in the wild-type cells, demonstrated that IsiB was not essential for Synechocystis 6803.

Interaction of positively charged amino acid residues of recombinant, cyanobacterial ferredoxin:NADP+ reductase with ferredoxin probed by site directed mutagenesis

The petH genes encoding ferredoxin:NADP+ reductase (FNR) from two Anabaena species (PCC 7119 and ATCC 29413) were cloned and overexpressed in E. coli. Several positively charged residues (Arg, Lys) have been implicated to be involved in ferredoxin binding and electron transfer by cross-linking, chemical modification and protection experiments, and crystallographic studies. The following substitutions were introduced by site-directed mutagenesis: R153Q, K209Q, K212Q, R214Q, K275N, K430Q and K431Q in Anabaena 29413 FNR, and R153E, K209E, K212E, R214E, K275E, R401E, K427E, and K431E in Anabaena 7119 FNR. Comparison of the diaphorase activities, the specific rates of ferredoxin dependent NADP(+)-photoreduction and cytochrome c reduction catalyzed by FNR showed that all these amino acid residues were required for efficient electron transfer between FNR and ferredoxin. Replacement of any one of these basic residues produced a much more pronounced effect on the cytochrome c reductase activity, where FNR, reduced by NADPH, acted as electron donor, than in the reduction of NADP+ by photosystem I via FNR. A mutation involving the replacement of positive charge by a neutral amide produced in all cases a smaller inhibitory effect on the activity than a charge reversal mutation. In addition, it has been found that R214 was necessary for stable integration of the non covalently bound FAD-cofactor.

[Effects of inpatient client-centered psychotherapy in various illness: 1-year follow-up]

The long-term effect (1-year-follow-up) of an inpatient client-centred psychotherapy programme was evaluated in 202 severe and chronically disturbed patients with a bread diagnose range (ICD-10 F1-F6). These 202 patients represented 74% of a total of 272 patients who had originally been examined and tested at admission and had now been re-identified after a follow-up of one year. Patients were investigated via Clinical Global Impressions (CGI), Bech-Rafaelsen-Melancholia-Scale (BRMES) and the Personality Inventory (Giessen-Test). Severity of illness, depressivity and self-and-other acceptance improved significantly; social incompetence was especially reduced in patients who had personality disorders. The range of effects reached from good to very good improvement: the magnitude of effect on social variables is probably even under estimated due to high pre-therapy variance. At follow-up 68% of the patients were in occupation or professional education. 32% needed no further treatment. Readmission rate was 14%. Results are discussed with regard to specific client-centred therapy.

The benefit of an insight-oriented and experiential approach on panic and agoraphobia symptoms. Results of a controlled comparison of client-centered therapy alone and in combination with behavioral exposure

BACKGROUND

It is a common view that psychodynamic treatment does not help much to ameliorate the symptoms of panic and agoraphobia. The effects of an insight-oriented treatment on central anxiety symptoms are the subject of the present controlled study.

METHODS

Forty patients with severe panic and agoraphobia were admitted to an inpatient anxiety treatment program. Most of the patients had been treated by pharmacological means unsuccessfully. The patients were randomly assigned to pure client-centered therapy or to additional behavioral exposure treatment. Client-centered and behavioral agoraphobia manuals were used. The patients were examined on admission, at discharge and at 3, 6, and 12 months follow-up for panic (Structured Clinical Interview for DSM III-R--SCID), anxiety (Hamilton Anxiety Scale), agoraphobia (SCID, Fear Survey Schedule), and depressive (Hamilton Depression Scale) symptoms.

RESULTS

Both client-centered treatment and a combination with exposure treatment reduced panic, avoidance and depressive symptoms significantly. For a short period the combined treatment was superior in patients' coping actively with anxiety and improving agoraphobic symptoms. However, at 1-year follow-up there was no further difference in the reduction of anxiety and depressive symptoms.

CONCLUSIONS

The results are discussed with regard to the combination of these forms of therapy and to widespread skepticism about the efficacy of insight-oriented treatment.

[Defenses in rating scales and therapy success]

Evaluation of psychotherapeutic or psychopharmacological treatment frequently uses rating scales without regard for patient's defensiveness. This study demonstrates on 309 psychotherapy patients treated with inpatient client-centered therapy and followed-up 1 year after treatment that defensiveness, measured with validity scales of personality inventories MMPI-K, FPI-R and Giessen-Test, influences ratings (scales CGI, HAMA, HAMD, BRMES) before and after therapy. Patients who deny psychopathology on admission do so at discharge and to some extent at follow-up. The extent of effect is significantly diminished with an increase in frankness in these patients, indicated by the significant improvement in validity scales. Inpatient client-centered psychotherapy improved defensiveness in the case of initial self-criticism and diminished it in the case of initial retentiveness.

Identification and characterization of the nifV-nifZ-nifT gene region from the filamentous cyanobacterium Anabaena sp. strain PCC 7120

The nifV and leuA genes, which encode homocitrate synthase and alpha-isopropylmalate synthase, respectively, were cloned from the filamentous cyanobacterium Anabaena sp. strain PCC 7120 by a PCR-based strategy. Since the N-terminal parts of NifV and LeuA from other bacteria are highly similar to each other, a single pair of PCR primers was used to amplify internal fragments of both Anabaena strain 7120 genes. Sequence analysis of cloned PCR products confirmed the presence of two different nifV-like DNA fragments, which were subsequently used as nifV- and leuA-specific probes, respectively, to clone XbaI fragments of 2.1 kbp (pOST4) and 2.6 kbp (pOST2). Plasmid pOST4 carried the Anabaena strain 7120 nifV-nifZ-nifT genes, whereas pOST2 contained the leuA and dapF genes. The nifVZT genes were not located in close proximity to the main nif gene cluster in Anabaena strain 7120, and therefore nifVZT forms a second nif gene cluster in this strain. Overlaps between the nifV and nifZ genes and between the nifZ and nifT genes and the presence of a 1.8-kb transcript indicated that nifVZT might form one transcriptional unit. Transcripts of nifV were induced not only in a nitrogen-depleted culture but also by iron depletion irrespective of the nitrogen status. The nifV gene in Anabaena strain 7120 was interrupted by an interposon insertion (mutant strain BMB105) and by a plasmid integration via a single crossover with a nifV internal fragment as a site for recombination (mutant strain BMB106). Both mutant strains were capable of diazotrophic growth, and their growth rates were only slightly impaired compared to that of the wild type. Heterologous complementation of the Rhodobacter capsulatus nifV mutant R229I by the Anabaena strain 7120 nifV gene corroborated the assumption that Anabaena strain 7120 nifV also encodes a homocitrate synthase. In contrast, the Anabaena strain 7120 leuA gene did not complement the nifV mutation of R229I efficiently.

Glutamate 94 of [2Fe-2S]-ferredoxins is important for efficient electron transfer in the 1:1 complex formed with ferredoxin-glutamate synthase (GltS) from Synechocystis sp. PCC 6803

We have analyzed the role of critical amino acid residues involved in the interaction between ferredoxin and ferredoxin-glutamate synthase (GOGAT) encoded by the gltS gene from the cyanobacterium Synechocystis sp. PCC 6803. Our results indicated that the glutamate 94 residue of Anabaena 7120 ferredoxin (= E92 of the Synechocystis 6803 ferredoxin) was necessary for an efficient electron transfer to GOGAT comparable to ferredoxin:NADP-reductase, nitrite reductase and nitrate reductase [Schmitz and Böhme (1995) Biochim. Biophys. Acta 1231, 335-341]. The K(m) value determined for wt-ferredoxins and mutant E94Q (and E92Q) was 1 muM, respectively, and activity loss of E94Q was due to a lowered Vmax. Exchange of residue F65 for aliphatic substitutions, which was crucial to electron transfer to ferredoxin:NADP-reductase and nitrite reductase, exhibited only small effects on glutamate synthase-dependent activity while heterocyst ferredoxin and flavodoxin were almost inactive as electron donors. In contrast to data reported for the spinach system, the stoichiometry of the cross-linked complex between ferredoxin and glutamate synthase was 1:1.

Long tandemly repeated repetitive (LTRR) sequences in the filamentous cyanobacterium Anabaena sp. PCC 7120

Nucleotide sequence analysis of the DNA region carrying transposon Tn5-1087b from the Anabaena 7120 nitrogen fixation-deficient mutant YC16 revealed the presence of a novel repeated DNA element in cyanobacteria designated long tandemly repeated repetitive (LTRR) sequence. The LTRR element is 37 bp long and contains an inverted repeat sequence. 17 copies of the LTRR element, 13 of which were completely identical, were identified within a 1.3 kb DNA fragment, which was flanked by two divergently transcribed genes homologous to bacteriophage T4 'gene 15' and Rhizobium meliloti exoD, respectively. LTRR-like sequences occur in several DNA regions in Anabaena 7120 and in other cyanobacteria. Furthermore, the presence of an LTRR-like DNA region in mitochondrial plasmids of Vicia faba indicates strong conservation of such structures during evolution.

Expression of ferredoxin-NADP+ reductase in heterocysts from Anabaena sp

The expression of ferredoxin-NADP+ reductase (FNR) from Anabaena sp. PCC 7119 in heterocysts and vegetative cells has been quantified. Specific reductase activity in heterocysts was approximately 10 times higher than in vegetative cells, corresponding to the increased FNR protein content. This was confirmed by immunoquantification of the FNR protein from whole filaments of Anabaena sp. PCC 7120 grown in media with and without combined nitrogen. Transcription of the petH gene was markedly enhanced in the absence of combined nitrogen. This suggests that the increased RNA level is mainly responsible for the up-regulation of FNR in heterocysts. As has been observed for nif genes, iron deficiency also increased transcription of petH. Characterization of the FNR purified from isolated heterocysts showed no detectable differences from the enzyme from vegetative cells. Although nitrogen stress was a key regulatory factor, localization of the petH gene in the genomic map of Anabaena PCC 7120 showed that this gene is not physically associated with the nif cluster.

Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. Results of an investigation by semistructured interview of schizophrenic and neurotic patients and methadone-substituted opiate addicts

Little is known about sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. In the present study schizophrenic patients (n = 45, mostly under neuroleptic treatment), neurotic patients (n = 50, mostly treated without medication), methadone-substituted opiate addicts (n = 37), and normal controls (n = 41) were included. They were interviewed with the aid of a sex-differentiated semistructured questionnaire on sexual function. All the methadone-substituted opiate addicts and nearly all the schizophrenic patients suffered from dysfunctions in at least one criterion. The three clinical groups differed significantly from the controls in sexual interest, emotional arousal, physiological arousal (erectile function/vaginal lubrication), performance (ejaculatory function/vaginism, dyspareunia), and orgasm satisfaction. Characteristic patterns of dysfunction were found in the male patients. The schizophrenic patients had significantly more dysfunctions of interest, physiological arousal, performance, and orgasm than the controls. Emotional arousal, erectile and ejaculatory functions, and orgasm satisfaction were impaired more frequently in the male schizophrenics than in the neurotic patients. Reduced sexual interest, emotional arousal, and orgasm satisfaction were reported more frequently by the methadone-substituted opiate addicts than by the neurotic men. Emotional arousal was even more frequently reduced than in the schizophrenic men. There was no correlation between sexual dysfunction and particular neuroleptics or neuroleptic or methadone dosage. The results are compared with the literature and suggestions made for further investigations.

Differential activities of heterocyst ferredoxin, vegetative cell ferredoxin, and flavodoxin as electron carriers in nitrogen fixation and photosynthesis in Anabaena sp

In cyanobacteria an increasing number of low potential electron carriers is found, but in most cases their contribution to metabolic pathways remains unclear. In this work, we compare recombinant plant-type ferredoxins from Anabaena sp. PCC 7120, encoded by the genes petF and fdxH, respectively, and flavodoxin from Anabaena sp. PCC 7119 as electron carriers in reconstituted in vitro assays with nitrogenase, Photosystem I, ferredoxin-NADP(+) reductase and pyruvate-ferredoxin oxidoreductase. In every experimental system only the heterocyst ferredoxin catalyzed an efficient electron transfer to nitrogenase while vegetative cell ferredoxin and flavodoxin were much less active. This implies that flavodoxin is not able to functionally replace heterocyst ferredoxin. When PFO-activity in heterocyst extracts was reconstituted under anaerobic conditions, both ferredoxins were more efficient than flavodoxin, which suggested that this PFO was of the ferredoxin dependent type. Flavodoxin, synthesized under iron limiting conditions, replaces PetF very efficiently in the electron transport from Photosystem I to NADP(+), using thylakoids from vegetative cells.

[Change in causal attributions and coping caused by inpatient client-centered psychotherapy]

During 3-month client-centered hospital treatment 108 patients with neurotic depression, anxiety disorders and other neuroses (DSM-III-R) recovered from depressivity (Giessen-Test, MES), negative attributional styles and regressive coping (KCF). Gains were maintained over follow-up one and two years after therapy. Not only cognitive, but also rogerian psychotherapy leads to significant increment in cognitive coping efforts, even when grade of depressivity is regarded. Attributional style and coping strategies depended on grade of depressivity and status of patient (admission or follow-up); cognitions did not discriminate dysthymic (depressive) patients from other neurotic disorders.

Transcriptional and translational analysis of ferredoxin and flavodoxin under iron and nitrogen stress in Anabaena sp. strain PCC 7120

In Anabaena sp. strain PCC 7120, vegetative cell ferredoxin synthesis under iron starvation was repressed 25-fold, whereas heterocyst ferredoxin synthesis decreased only 2.8-fold. Induction of flavodoxin under iron depletion was independent of the availability of combined nitrogen. Under iron stress but in the presence of combined nitrogen, fdxH and nifH genes were transcriptionally active; although excision of the 11-kb element seemed to be completed, nitrogenase activity and the fdxH gene product were not detectable.