77 FR 37823 - Export Sales Reporting Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-25

... CFR Part 20 RIN 0551-AA81 Export Sales Reporting Requirements AGENCY: Office of the Secretary, USDA... frozen box/primal cuts) and distillers dried grain (DDG) to the Export Sales Reporting Requirements... basis, information on the export sales of pork and DDG to the Foreign Agricultural Service (FAS). DATES...

77 FR 13990 - Export Sales Reporting Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-08

... DEPARTMENT OF AGRICULTURE Office of the Secretary 7 CFR Part 20 RIN 0551-AA70 Export Sales... grain (DDG) to the Export Sales Reporting Requirements. Under this proposed rule, all exporters of U.S. pork and DDG would be required to report on a weekly basis, information on the export sales of pork and...

Feeding supplemental dried distiller's grains increases faecal shedding of Escherichia coli O157 in experimentally inoculated calves.

PubMed

Jacob, M E; Parsons, G L; Shelor, M K; Fox, J T; Drouillard, J S; Thomson, D U; Renter, D G; Nagaraja, T G

2008-04-01

Escherichia coli O157 is an important foodborne pathogen and asymptomatic cattle serve as major reservoirs for human infection. We have shown a positive association between feeding distiller's grains and E. coli O157 prevalence in feedlot cattle. The objective of this study was to determine the effect of feeding dried distiller's grain (DDG) on faecal shedding of E. coli O157 in calves experimentally inoculated with E. coli O157. Holstein calves (five per treatment group), fed steam-flaked corn-based high-grain diets supplemented with 0% (control) or 25% DDG, were orally inoculated with a five-strain mixture (6 x 10(9) CFU/calf) of nalidixic acid-resistant (NalR) E. coli O157. Faecal samples were taken three times per week for 6 weeks to determine the prevalence and concentration of Nal E. coli O157. At the end of the study (day 43), calves were euthanized and necropsied. Ruminal, caecum, colon, and rectal contents, and rectoanal mucosal swab (RAMS) samples were collected at necropsy to determine NalR E. coli O157 concentration. There was a trend for an interaction between treatment and faecal sampling day. The concentration of NalR E. coli O157 in the faeces was significantly higher in faecal samples from calves fed DDG compared with control calves on days 35, 37, 39 and 42. At necropsy, the concentration of NalR E. coli O157 was higher in the caecum (P = 0.01), colon (P = 0.03) and rectum (P = 0.01) from calves fed DDG compared with control animals. The number of sites at necropsy positive for NalR E. coli O157 was higher in calves fed DDG compared with calves in the control treatment (P < 0.001). Our results indicate that E. coli O157 gut persistence and faecal prevalence increased in calves fed DDG, which potentially have important implications for food safety.

Comparison of wet brewers' grains or dried distillers' grains as supplements to conserved bermudagrass forage as winter feeding options for beef cows.

PubMed

Thomas, M V; Hersom, M J; Thrift, T A; Yelich, J V

2017-01-01

The objective of this study was to examine the use of 2 byproduct supplements and conserved warm-season forage as winter feeding options for primiparous beef cows. Gestating Angus ( = 48) and Brangus ( = 24) 2-yr-old cows were stratified by BW and breed to 1 of 12 pens. Pens were randomly assigned 1 of 2 supplements, wet brewers' grains (WBG) or dried distillers' grains (DDG). Coastal bermudagrass hay or round bale silage (RBS) was fed free choice (6 pens each) and cows received WBG or DDG supplements at a daily rate of 0.05% BW (DM basis) prorated for feeding 3 d/wk. Total BW and BCS changes did not differ ( = 0.65 and = 0.93, respectively) between DDG- and WBG-supplemented cows. Total amount of forage DM offered and mean calculated daily forage DM offered did not differ ( = 0.59 and = 0.20, respectively) between supplement treatments. Estimated daily mean and total supplement DM offered was greater ( < 0.001) for WBG than for DDG treatments. The same 2 supplements and forage sources were used in an unbalanced 6 × 4 design to measure intake, digestibility, and rumen parameters in ruminally fistulated steers. Supplement did not affect forage DMI of hay ( = 0.31) or RBS ( = 0.63). Total DMI was not different ( = 0.37 and = 0.73) for hay-based and RBS-based diets, respectively. Total tract digestibility tended to be greater ( = 0.06) for DDG than for WBG in hay diets but was not different ( = 0.76) for RBS diets. Daily mean ruminal pH was greater ( = 0.03) for WBG than for DDG when supplemented to hay-based diets. In RBS diets, a supplement × hour interaction ( = 0.05) existed for ruminal pH. Daily mean ruminal ammonia N concentration was greater ( < 0.001) for WBG-supplemented diets compared with DDG-supplemented diets. A supplement × hour interaction existed for ruminal ammonia in hay- ( < 0.001) and RBS- ( = 0.09) based diets. Ruminal pH and ammonia N concentrations stayed in ranges adequate to support ruminal metabolism and cattle performance. Marginal differences in ruminal measures between high-moisture and dry byproduct supplements resulted in no differences in cow performance when offered with hay or high-moisture forage. High-moisture forage sources can be coupled with high-moisture byproduct supplements.

Insights from Existing Data on the DoD Industrial Base: Guided Missile and Space Vehicle Manufacturing Example

DTIC Science & Technology

2015-05-01

ELECTRIC BOAT CORP 798 SDB Air Force RAYTHEON CO 790 DDG 51 Navy HUNTINGTON INGALLS INC 694 DDG 51 Navy HUNTINGTON INGALLS INC 598 V22 Navy...Business Subcontractors SB subcontractors SB contracts SB dollars # % # % Amount % SDB , self identified 6 5 10 5 6,658,000 2 Woman Owned 17 15 37 17

In growing pigs, the true ileal and total tract digestibility of acid hydrolyzed ether extract in extracted corn oil is greater than in intact sources of corn oil or soybean oil.

PubMed

Kim, B G; Kil, D Y; Stein, H H

2013-02-01

An experiment was conducted to determine the true ileal digestibility (TID) and the true total tract digestibility (TTTD) of acid-hydrolyzed ether extract (AEE) in extracted corn oil, high-oil corn, distillers dried grains with solubles (DDGS), corn germ, and high protein distillers dried grains (HP DDG) and to compare these values to the TID and TTTD of AEE in full-fat soybeans. Nineteen barrows with an initial BW of 52.2 kg (SD = 3.8) were fitted with a T-cannula in the distal ileum and allotted to a 19 × 11 Youden square design with 19 diets and 11 periods. A basal diet based on cornstarch, casein, sucrose, and corn bran was formulated. Eighteen additional diets were formulated by adding 3 levels of extracted corn oil, high-oil corn, DDGS, corn germ, HP DDG, or full-fat soybeans to the basal diet. The apparent ileal and the apparent total tract digestibility of AEE were calculated for each diet. The endogenous flow of AEE associated with each ingredient and values for TID and TTTD were calculated using the regression procedure. Results indicated that digested AEE in ileal digesta and feces linearly increased as AEE intake increased regardless of ingredient (P < 0.001) and the regression of ileal and fecal AEE output against AEE intake was significant for all ingredients (P < 0.001; r(2) > 0.77). However, the ileal and fecal endogenous losses of AEE were different (P < 0.05) from 0 only for extracted corn oil, HP DDG, and full-fat soybeans. The TID of AEE was greater (P < 0.05) for extracted corn oil (95.4%) than for all other ingredients. The TID of AEE in HP DDG (76.5%) was not different from the TID of AEE in full-fat soybeans (85.2%) but greater (P < 0.05) than high-oil corn, DDGS, and corn germ (53.0, 62.1, and 50.1%, respectively). The TTTD of AEE was greater (P < 0.05) for extracted corn oil (94.3%) than for all other ingredients, and the TTTD in full-fat soybeans (79.7%) was greater (P < 0.05) than the TTTD of AEE in high-oil corn, DDGS, corn germ, and HP DDG (41.4, 51.9, 43.9, and 70.2%, respectively). The TTTD of AEE in HP DDG was also greater (P < 0.05) than in high-oil corn, DDGS, and corn germ. In conclusion, the intact sources of oil originating from high-oil corn, DDGS, corn germ, or HP DDG are much less digestible than extracted corn oil, and with the exception of HP DDG, these sources of corn oil are also less digestible than the intact oil in full fat soybeans.

Effects of feeding distillers dried grains with solubles, high-protein distillers dried grains, and corn germ to growing-finishing pigs on pig performance, carcass quality, and the palatability of pork.

PubMed

Widmer, M R; McGinnis, L M; Wulf, D M; Stein, H H

2008-08-01

An experiment was conducted to investigate pig performance, carcass quality, and palatability of pork from pigs fed distillers dried grains with solubles (DDGS), high-protein distillers dried grains (HPDDG), and corn germ. Eighty-four pigs (initial BW, 22 +/- 1.7 kg) were allotted to 7 dietary treatments with 6 replicates per treatment and 2 pigs per pen. Diets were fed for 114 d in a 3-phase program. The control treatment was based on corn and soybean meal. Two treatments were formulated using 10 or 20% DDGS in each phase. Two additional treatments contained HP-DDG in amounts sufficient to substitute for either 50 or 100% of the soybean meal used in the control treatment. An additional 2 treatments contained 5 or 10% corn germ, which was calculated to provide the same amount of fat as 10 or 20% DDGS. Results showed that for the entire experiment, pig performance was not affected by DDGS or HP-DDG, but final BW increased (linear, P < 0.05) as corn germ was included in the diets. Carcass composition and muscle quality were not affected by DDGS, but LM area and LM depth decreased (linear, P < 0.05) as HP-DDG was added to the diets. Lean meat percentage increased and drip loss decreased as corn germ was included in the diets (quadratic, P < 0.05). There was no effect of DDGS on fat quality except that belly firmness decreased (linear, P < 0.05) as dietary DDGS concentration increased. Including HP-DDG or corn germ in the diets did not affect fat quality, except that the iodine value increased (linear, P < 0.05) in pigs fed HP-DDG diets and decreased (linear, P < 0.05) in pigs fed corn germ diets. Cooking loss, shear force, and bacon distortion score were not affected by the inclusion of DDGS, HP-DDG, or corn germ in the diets, and the overall palatability of the bacon and pork chops was not affected by dietary treatment. In conclusion, feeding 20% DDGS or high levels of HP-DDG to growing-finishing pigs did not negatively affect overall pig performance, carcass composition, muscle quality, or palatability but may decrease fat quality. Feeding up to 10% corn germ did not negatively affect pig performance, carcass composition, carcass quality, or pork palatability but increased final BW of the pigs and reduced the iodine value of belly fat.

Advanced Metalworking Solutions For Naval Systems That Go In Harm’s Way

DTIC Science & Technology

2015-01-01

destroyers USS Momsen (DDG 92) and USS Preble (DDG 88) are underway in formation. U.S. Navy photo Front cover: Ingalls Shipbuilding welding photo...applies a variety of innovative welding technologies to address the challenges associated with joining weapon system components. Joining Technologies...friction stir welding process to manufacture edge-cooled naval electronic cold plate assemblies. The modular, high- performance, and scalable

Evaluating the Impact of the Fully Burdened Cost of Fuel

DTIC Science & Technology

2009-09-01

174,864,115( ) AverageDFMCost DDG NumberDDGsCE CostOfFuel gal DestroyerDFMConsumed gal perDDG gal gal    (3.1) Underway Not Underway Auxillary Cost...DFM Underway 4,512,879 5,722,483 10,235,362 Barrels DFM Not Underway 438,907 518,164 957,071 Barrels DFM Auxillary 9,165 16,226 25,392 2008 DFM

DDG 51 Operational Evaluation: Measures of Workload from Combat Information Center Communication Patterns

DTIC Science & Technology

1992-09-01

RAIDS ......... 39 ix I. INTRODUCTION Communication is the act of sharing information. This thesis is about human communication , but human ...high costs, high stakes, high drama, and Ligh workload. From a methodological perspective, this thesis is about using natural human communication patterns...34* Fourth. The Operational Test and Evaluation (OPEVAL) of USS ARLEIGH BURKE (DDG 51) presented an opportunity to examine human communication patterns

Direct discontinuous Galerkin method and its variations for second order elliptic equations

DOE PAGES

Huang, Hongying; Chen, Zheng; Li, Jin; ...

2016-08-23

In this study, we study direct discontinuous Galerkin method (Liu and Yan in SIAM J Numer Anal 47(1):475–698, 2009) and its variations (Liu and Yan in Commun Comput Phys 8(3):541–564, 2010; Vidden and Yan in J Comput Math 31(6):638–662, 2013; Yan in J Sci Comput 54(2–3):663–683, 2013) for 2nd order elliptic problems. A priori error estimate under energy norm is established for all four methods. Optimal error estimate under L 2 norm is obtained for DDG method with interface correction (Liu and Yan in Commun Comput Phys 8(3):541–564, 2010) and symmetric DDG method (Vidden and Yan in J Comput Mathmore » 31(6):638–662, 2013). A series of numerical examples are carried out to illustrate the accuracy and capability of the schemes. Numerically we obtain optimal (k+1)th order convergence for DDG method with interface correction and symmetric DDG method on nonuniform and unstructured triangular meshes. An interface problem with discontinuous diffusion coefficients is investigated and optimal (k+1)th order accuracy is obtained. Peak solutions with sharp transitions are captured well. Highly oscillatory wave solutions of Helmholz equation are well resolved.« less

Direct discontinuous Galerkin method and its variations for second order elliptic equations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huang, Hongying; Chen, Zheng; Li, Jin

In this study, we study direct discontinuous Galerkin method (Liu and Yan in SIAM J Numer Anal 47(1):475–698, 2009) and its variations (Liu and Yan in Commun Comput Phys 8(3):541–564, 2010; Vidden and Yan in J Comput Math 31(6):638–662, 2013; Yan in J Sci Comput 54(2–3):663–683, 2013) for 2nd order elliptic problems. A priori error estimate under energy norm is established for all four methods. Optimal error estimate under L 2 norm is obtained for DDG method with interface correction (Liu and Yan in Commun Comput Phys 8(3):541–564, 2010) and symmetric DDG method (Vidden and Yan in J Comput Mathmore » 31(6):638–662, 2013). A series of numerical examples are carried out to illustrate the accuracy and capability of the schemes. Numerically we obtain optimal (k+1)th order convergence for DDG method with interface correction and symmetric DDG method on nonuniform and unstructured triangular meshes. An interface problem with discontinuous diffusion coefficients is investigated and optimal (k+1)th order accuracy is obtained. Peak solutions with sharp transitions are captured well. Highly oscillatory wave solutions of Helmholz equation are well resolved.« less

Navy DDG-51 and DDG-1000 Destroyer Programs: Background and Issues for Congress

DTIC Science & Technology

2012-03-02

challenging ship redesign as well as a new power and cooling architecture coupled with the challenges to construct such a dense ship, will make...costs. Our prior work has shown that construction of lead ships is challenging , the risk of cost growth is high, and having sufficient construction...not include a thorough trade-off analysis that would compare the relative costs and benefits of different solutions under consideration or provide

Navy DDG-51 and DDG-1000 Destroyer Programs: Background and Issues for Congress

DTIC Science & Technology

2013-10-22

two technologies previously identified as the most challenging — digital-beam-forming and transmit-receive modules—have been demonstrated in a...job of coming up with an affordable solution to a leap-ahead capability for the fleet.”31 In his presentation, Vandroff showed a slide comparing the...foreign ballistic missile data in support of international treaty verification. CJR represents an integrated mission solution : ship, radar suite, and

Growth performance, rumen fermentation, nutrient utilization, and metabolic profile of dairy heifers limit-fed distillers dried grains with ad libitum forage.

PubMed

Manthey, A K; Anderson, J L

2018-01-01

The objective of this study was to determine the effects of feeding a corn- and soybean-product-based concentrate mix or distillers dried grains with solubles concentrate mix with ad libitum grass hay to dairy heifers. A 16-wk randomized complete block design study was conducted using 24 heifers [18 Holstein and 6 Brown Swiss; 219 ± 2 d of age (±standard deviation); 230 ± 4 kg of body weight] to evaluate the effect of diet on dry matter intake (DMI), growth performance, rumen fermentation, metabolic profile, and nutrient digestibility. Treatments were (1) corn and soybean product concentrate mix, and (2) distillers-dried-grains-with-solubles-based concentrate mix (DDG). Both concentrate mixes were limit-fed at 0.8% of body weight and grass hay was offered ad libitum. Heifers were individually fed using Calan gates and orts were recorded daily at feeding. Heifers were weighed every 2 wk and ration concentrate mix offered was adjusted accordingly. Frame measurements and body condition score were recorded every 2 wk. Rumen fluid was collected via esophageal tubing during wk 12 and 16 for pH, ammonia N, and volatile fatty acid analysis. Jugular blood samples were collected every 4 wk for metabolite and metabolic hormone analysis. Total-tract digestibility of nutrients was evaluated during wk 16 by fecal grab sampling. No treatment by week interactions were observed for any of the growth measurements and growth measurements and DMI did not differ between treatments. A treatment by time interaction was observed for rumen butyrate percentage with heifers fed DDG having a greater percentage. Total volatile fatty acid concentration, acetate molar percentage, and acetate:propionate decreased with the DDG treatment, whereas propionate molar percentage increased. No treatment by week interactions were observed for any of the metabolites or metabolic hormones measured. A tendency was observed for glucose and plasma urea nitrogen concentration to decrease with DDG. Plasma cholesterol and insulin increased with DDG. Results demonstrated that limit-feeding heifers DDG at 0.8% of body weight with ad libitum grass hay maintained growth performance, average daily gain, DMI, and gain:feed, with shifts in the metabolic profile compared with the corn and soybean product concentrate mix. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Navy DDG-1000 and DDG-51 Destroyer Programs: Background, Oversight Issues, and Options for Congress

DTIC Science & Technology

2009-06-04

Aegis combat system and the arming of the ship with the SM-3, a version of the Navy’s Standard Missile that is designed for BMD operations.6 Total...and assigning the construction of those ships to GD/BIW and/or NGSB; • procuring AGS- armed versions of the basic LPD-17 class hull—another option...subcommittee of the House Armed Services Committee.24 22 Christopher P. Cavas, “All

Extending Depot Length and Intervals for DDG 51 Class Ships: Examining the 72 Month Operational Cycle

DTIC Science & Technology

2016-01-01

tenance period to achieve planned expected service life ( ESL ), as well as the length, workload, and periodicity of a continuous maintenance...a ship’s service life but extends the length of each deployment. Figure 2.1 compares the number of deployments that can be made over the ESL of...ships in different cycle lengths. The ESL of DDG-51 Arleigh Burke–class destroyers Flight I and II is 35 years, and Flight IIA has an ESL of 40 years

Arleigh Burke Destroyers: Delaying Procurement of DDG 51 Flight III Ships Would Allow Time to Increase Design Knowledge

DTIC Science & Technology

2015-08-01

activities for DDG 51, AMDR, Aegis, and other related programs, such as the Evolved Sea Sparrow Missile. We also reviewed DOD studies and past GAO...systems—from initial SPY-6 radar detection of a target, such as an anti- ship cruise missile, through target interception by an Evolved Sea Sparrow ...required to accredit the Aegis modeling and simulation capability, (2) the Evolved Sea Sparrow Missile Block 2—a key element of Flight III’s self

Feasibility of Developing a Surrogate Missile System for the Purpose of Combat Systems Testing, Evaluation, and Watchstander Proficiency

DTIC Science & Technology

2014-06-01

Certification The USS Comte De Grasse, DDG 125, is weeks away from commissioning. As a new Baseline Flight III DDG, her AEGIS Weapon system has...The part is replaced, and the next STM firing is a complete success. Comte De Grasse is cleared to conduct follow-on SM firings. a. Scenario...17 “Solid Rocket Boosters,” NASA, last modified August 31, 2000, http://science.ksc.nasa.gov/shuttle/technology/sts-newsref/srb.html 53 Another

Navy DDG-51 and DDG-1000 Destroyer Programs: Background and Issues for Congress

DTIC Science & Technology

2011-04-19

and capital plant investments that can reduce the production cost of the item being procured, and because MYP also permits certain long lead-time...result of the program’s restructuring, the ship is now to be equipped with “an upgraded multifunction radar [ MFR ] and no volume search radar [VSR...like the Navy’s 22 Ticonderoga (CG-47) class cruisers,2 are equipped with the Aegis combat system, an integrated ship combat system named for the

Navy DDG-1000 and DDG-51 Destroyer Programs: Background, Oversight Issues, and Options for Congress

DTIC Science & Technology

2008-10-22

House Armed Services Committee, Navy officials announced a major change in the service’s position on what kind of destroyers it wants to procure over the...software program for the Aegis combat system and the arming of the ship with the SM-3, a version of the Navy’s Standard Missile that is designed for BMD...Assistant Secretary of the Navy (Ship Programs), before the Subcommittee on Seapower and Expeditionary Forces of the House Armed Services Committee, on

Navy DDG-1000 and DDG-51 Destroyer Programs: Background, Oversight Issues, and Options for Congress

DTIC Science & Technology

2008-09-11

July 31, 2008, hearing before the Seapower and Expeditionary Forces subcommittee of the House Armed Services Committee, Navy officials announced a major...Aegis combat system and the arming of the ship with the SM-3, a version of the Navy’s Standard Missile that is designed for BMD operations.7 The Navy has...the Navy (Ship Programs), before the Subcommittee on Seapower and Expeditionary Forces of the House Armed Services Committee, on Surface Combatant

Navy DDG-1000 and DDG-51 Destroyer Programs: Background, Oversight Issues, and Options for Congress

DTIC Science & Technology

2008-10-09

of the House Armed Services Committee, Navy officials announced a major change in the service’s position on what kind of destroyers it wants to...among other things, the addition of a new software program for the Aegis combat system and the arming of the ship with the SM-3, a version of the...Expeditionary Forces of the House Armed Services Committee, on Surface Combatant Requirements and Acquisition Strategies, July 31, 2008, 11 pp., and the spoken

Department of Defense Fiscal Years 1990 and 1991 Budget Revision

DTIC Science & Technology

1989-04-01

Japan Yen 123.52 132.61 Netherlands Guilder 1.97 2.13 Norway Krone 6.61 6.87 Portugal Escudo 144.99 156.20 South Korea Won 697.84 669.34 Spain Peseta...and the continental United States. In addition, due to fiscal constraints, one active component AH-I helicopter battalion will be inactivated in FY...1992 due to fiscal constraints. In addition, retirement of 14 of the DDG-2 and DDG-37 class destroyers will be accelerated with an additional 9 in FY

An Examination of Options to Reduce Underway Training Days through the Use of Simulation

DTIC Science & Technology

2008-01-01

West Coast DDG-51s to Complete ULT During CY 2004–2006 . . . . . . . . . 20 3.2. Number of Exercises Required for a DDG-51–Class Ship, by Mission...questions. We also benefited from discussions with CAPT Bill Johnson of Commander, Naval Sur- face Forces, Pacific, and CAPT Ken Krogman of Commander, Naval...training and is operationally assigned to a numbered fleet commander. West Coast ships are assigned to Commander, Third Fleet (COMTHIRDFLT), and

Advanced Metalworking Solutions For Naval Systems That Go Harm’s Way

DTIC Science & Technology

2016-11-01

savings based on using the tools on a single hull of each of the programs that Ingalls constructs. Newport M an uf ac tu rin g To ol in g De ve lo pm...abrasive blasting on hull exteriors during construction. A project team comprised of the DDG 51 Program Office, Ingalls, and NMC developed an easy-to...Ingalls (DDG 51, LHA, LPD, and NSC). S2564 Hull Production Automation Methods Ingalls is also benefitting from the efforts of an NMC-led project team

Impact of Data-driven Respiratory Gating in Clinical PET.

PubMed

Büther, Florian; Vehren, Thomas; Schäfers, Klaus P; Schäfers, Michael

2016-10-01

Purpose To study the feasibility and impact of respiratory gating in positron emission tomographic (PET) imaging in a clinical trial comparing conventional hardware-based gating with a data-driven approach and to describe the distribution of determined parameters. Materials and Methods This prospective study was approved by the ethics committee of the University Hospital of Münster (AZ 2014-217-f-N). Seventy-four patients suspected of having abdominal or thoracic fluorine 18 fluorodeoxyglucose (FDG)-positive lesions underwent clinical whole-body FDG PET/computed tomographic (CT) examinations. Respiratory gating was performed by using a pressure-sensitive belt system (belt gating [BG]) and an automatic data-driven approach (data-driven gating [DDG]). PET images were analyzed for lesion uptake, metabolic volumes, respiratory shifts of lesions, and diagnostic image quality. Results Forty-eight patients had at least one lesion in the field of view, resulting in a total of 164 lesions analyzed (range of number of lesions per patient, one to 13). Both gating methods revealed respiratory shifts of lesions (4.4 mm ± 3.1 for BG vs 4.8 mm ± 3.6 for DDG, P = .76). Increase in uptake of the lesions compared with nongated values did not differ significantly between both methods (maximum standardized uptake value [SUVmax], +7% ± 13 for BG vs +8% ± 16 for DDG, P = .76). Similarly, gating significantly decreased metabolic lesion volumes with both methods (-6% ± 26 for BG vs -7% ± 21 for DDG, P = .44) compared with nongated reconstructions. Blinded reading revealed significant improvements in diagnostic image quality when using gating, without significant differences between the methods (DDG was judged to be inferior to BG in 22 cases, equal in 12 cases, and superior in 15 cases; P = .32). Conclusion Respiratory gating increases diagnostic image quality and uptake values and decreases metabolic volumes compared with nongated acquisitions. Data-driven approaches are clinically applicable alternatives to belt-based methods and might help establishing routine respiratory gating in clinical PET/CT. (©) RSNA, 2016 Online supplemental material is available for this article.

Immunohistochemical study of Ulex europaeus agglutinin 1 (UEA-1) binding of megakaryocytes in bone marrow biopsy specimens: demonstration of heterogeneity in staining pattern reflecting the stages of differentiation.

PubMed

Liu, S M; Li, C Y

1996-01-01

During differentiation, megakaryocytes undergo nuclear endoreplication, an increase in cell size, cytoplasmic granulation, and release of platelets. The changes in highly lobulated nuclei with varying degree of polyploidy and increasing cell size are easily recognized morphologically. However, the actual cytoplasmic changes are more difficult to perceive morphologically. With the peroxidase-antiperoxidase (PAP) method using UEA-1 as the binding protein to the alpha-L-fucose of glycoprotein synthesized by megakaryocytes, we observed significant variation in cytoplasmic staining of megakaryocytes in routinely processed bone marrow biopsy sections. A total of 3344 megakaryocytes in bone marrow sections from 10 patients with nonhematologic diseases and from 10 patients with idiopathic thrombocytopenic purpura (ITP) was studied. According to the intensity and pattern of cytoplasmic staining, we divided megakaryocytes into at least six groups: (1) low granular (LG), (2) diffuse granular (DG), (3) diffuse dense granular (DDG), (4) marginal granular (MG), (5) denuded (DMK), and (6) endomitotic (EndoM). Most of the megakaryocytes were DG (mean, 42.75% +/- 19.21%) and DDG (mean, 50.25% +/- 21.23%). In correlation with nuclear morphology and cell size, it appears that substances binding to UEA-1 are located in the paranuclear region in early megakaryocytes and produce a low granular focal staining pattern (LG cells). Next, the granules spread throughout the cytoplasm (DG cells) and increase in quantity (DDG). This is followed by migration of granules to the periphery of the cytoplasm (MG cells) and is associated with the liberation of platelets and eventual formation of DMK megakaryocytes. Endomitosis, regulated by unknown factors, occurred in the MG stage. In comparing the group with nonhematologic disease (mean DG, 35.4% +/- 18.48%; DDG, 58.4% +/- 21.8%) and the group with ITP (mean DG, 50.1% +/- 17.82%; DDG, 42.1% +/- 18.12%), we found an increasing proportion of DG megakaryocytes in ITP, which suggests a left-shifted maturation of megakaryocytes. By understanding the staining pattern seen in the different stages of megakaryocytic differentiation, UEA-1 staining may be a practical method for studying megakaryocytopoiesis in routinely processed paraffin sections of bone marrow biopsy samples.

Extracting a respiratory signal from raw dynamic PET data that contain tracer kinetics.

PubMed

Schleyer, P J; Thielemans, K; Marsden, P K

2014-08-07

Data driven gating (DDG) methods provide an alternative to hardware based respiratory gating for PET imaging. Several existing DDG approaches obtain a respiratory signal by observing the change in PET-counts within specific regions of acquired PET data. Currently, these methods do not allow for tracer kinetics which can interfere with the respiratory signal and introduce error. In this work, we produced a DDG method for dynamic PET studies that exhibit tracer kinetics. Our method is based on an existing approach that uses frequency-domain analysis to locate regions within raw PET data that are subject to respiratory motion. In the new approach, an optimised non-stationary short-time Fourier transform was used to create a time-varying 4D map of motion affected regions. Additional processing was required to ensure that the relationship between the sign of the respiratory signal and the physical direction of movement remained consistent for each temporal segment of the 4D map. The change in PET-counts within the 4D map during the PET acquisition was then used to generate a respiratory curve. Using 26 min dynamic cardiac NH3 PET acquisitions which included a hardware derived respiratory measurement, we show that tracer kinetics can severely degrade the respiratory signal generated by the original DDG method. In some cases, the transition of tracer from the liver to the lungs caused the respiratory signal to invert. The new approach successfully compensated for tracer kinetics and improved the correlation between the data-driven and hardware based signals. On average, good correlation was maintained throughout the PET acquisitions.

Temporal associations for spatial events: the role of the dentate gyrus.

PubMed

Morris, Andrea M; Curtis, Brian J; Churchwell, John C; Maasberg, David W; Kesner, Raymond P

2013-11-01

Previous research suggests that the dorsal dentate gyrus (DG) hippocampal subregion mediates spatial processing functions. However, a novel role for the DG in temporal processing for spatial information has begun to emerge based on the development of a computational model of neurogenesis. According to this model, adult born granule cells in the DG contribute to a temporal associative integration process for events presented closer in time. Currently, there is a paucity of behavioral evidence to support the temporal integration theory. Therefore, we developed a novel behavioral paradigm to investigate the role of the dDG in temporal integration for proximal and distal spatial events. Male Long-Evans rats were randomly assigned to a control group or to receive bilateral intracranial infusions of colchicine into the dDG. Following recovery from surgery, each rat was tested on a cued-recall of sequence paradigm. In this task, animals were allowed to explore identical objects placed in designated spatial locations on a cheeseboard maze across 2 days (e.g., Day 1: A and B; Day 2: C and D). One week later, animals were given a brief cue (A or C) followed by a preference test between spatial location B and D. Control animals had a significant preference for the spatial location previously paired with the cue (the temporal associate) whereas dDG lesioned animals failed to show a preference. These findings suggest that selective colchicine-induced dDG lesions are capable of disrupting the formation of temporal associations between spatial events presented close in time. Copyright © 2013 Elsevier B.V. All rights reserved.

Data-driven gating in PET: Influence of respiratory signal noise on motion resolution.

PubMed

Büther, Florian; Ernst, Iris; Frohwein, Lynn Johann; Pouw, Joost; Schäfers, Klaus Peter; Stegger, Lars

2018-05-21

Data-driven gating (DDG) approaches for positron emission tomography (PET) are interesting alternatives to conventional hardware-based gating methods. In DDG, the measured PET data themselves are utilized to calculate a respiratory signal, that is, subsequently used for gating purposes. The success of gating is then highly dependent on the statistical quality of the PET data. In this study, we investigate how this quality determines signal noise and thus motion resolution in clinical PET scans using a center-of-mass-based (COM) DDG approach, specifically with regard to motion management of target structures in future radiotherapy planning applications. PET list mode datasets acquired in one bed position of 19 different radiotherapy patients undergoing pretreatment [ 18 F]FDG PET/CT or [ 18 F]FDG PET/MRI were included into this retrospective study. All scans were performed over a region with organs (myocardium, kidneys) or tumor lesions of high tracer uptake and under free breathing. Aside from the original list mode data, datasets with progressively decreasing PET statistics were generated. From these, COM DDG signals were derived for subsequent amplitude-based gating of the original list mode file. The apparent respiratory shift d from end-expiration to end-inspiration was determined from the gated images and expressed as a function of signal-to-noise ratio SNR of the determined gating signals. This relation was tested against additional 25 [ 18 F]FDG PET/MRI list mode datasets where high-precision MR navigator-like respiratory signals were available as reference signal for respiratory gating of PET data, and data from a dedicated thorax phantom scan. All original 19 high-quality list mode datasets demonstrated the same behavior in terms of motion resolution when reducing the amount of list mode events for DDG signal generation. Ratios and directions of respiratory shifts between end-respiratory gates and the respective nongated image were constant over all statistic levels. Motion resolution d/d max could be modeled as d/dmax=1-e-1.52(SNR-1)0.52, with d max as the actual respiratory shift. Determining d max from d and SNR in the 25 test datasets and the phantom scan demonstrated no significant differences to the MR navigator-derived shift values and the predefined shift, respectively. The SNR can serve as a general metric to assess the success of COM-based DDG, even in different scanners and patients. The derived formula for motion resolution can be used to estimate the actual motion extent reasonably well in cases of limited PET raw data statistics. This may be of interest for individualized radiotherapy treatment planning procedures of target structures subjected to respiratory motion. © 2018 American Association of Physicists in Medicine.

Seasonal variation in non-structural carbohydrates, sucrolytic activity and secondary metabolites in deciduous and perennial Diospyros species sampled in Western Mexico

PubMed Central

Ramírez-Briones, Ernesto; Rodríguez-Macías, Ramón; Salcedo-Pérez, Eduardo; Martínez-Gallardo, Norma; Tiessen, Axel; Molina-Torres, Jorge; Délano-Frier, John P.; Zañudo-Hernández, Julia

2017-01-01

This study was performed to test the working hypothesis that the primary determinants influencing seasonal driven modifications in carbon mobilization and other key biochemical parameters in leaves of poorly known Diospyros digyna (Ddg; semi-domesticated; perennial) and D. rekoi (Dre; undomesticated; deciduous) trees are determined by environmental growing conditions, agronomic management and physiological plasticity. Thus, biochemical changes in leaves of both trees were recorded seasonally during two successive fruiting years. Trees were randomly sampled in Western Mexico habitats with differing soil quality, climatic conditions, luminosity, and cultivation practices. Leaves of Ddg had consistently higher total chlorophyll contents (CT) that, unexpectedly, peaked in the winter of 2015. In Dre, the highest leaf CT values recorded in the summer of 2015 inversely correlated with low average luminosity and high Chl a/ Chlb ratios. The seasonal CT variations in Dre were congruent with varying luminosity, whereas those in Ddg were probably affected by other factors, such as fluctuating leaf protein contents and the funneling of light energy to foliar non-structural carbohydrates (NSCs) accumulation, which were consistently higher than those detected in Dre leaves. Seasonal foliar NSC fluctuations in both species were in agreement with the carbon (C) demands of flowering, fruiting and/ or leaf regrowth. Seasonal changes in foliar hexose to sucrose (Hex/ Suc) ratios coincided with cell wall invertase activity in both species. In Dre, high Hex/ Suc ratios in spring leaves possibly allowed an accumulation of phenolic acids, not observed in Ddg. The above results supported the hypothesis proposed by showing that leaf responses to changing environmental conditions differ in perennial and deciduous Diospyros trees, including a dynamic adjustment of NSCs to supply the C demands imposed by reproduction, leaf regrowth and, possibly, stress. PMID:29073239

A defect in the inflammation-primed macrophage-activation cascade in osteopetrotic rats.

PubMed

Yamamoto, N; Lindsay, D D; Naraparaju, V R; Ireland, R A; Popoff, S N

1994-05-15

Macrophages were activated by administration of lysophosphatidylcholine (lyso-Pc) or dodecylglycerol (DDG) to wild-type rats but not in osteopetrotic (op) mutant rats. In vitro treatment of wild-type rat peritoneal cells with lyso-Pc or DDG efficiently activated macrophages whereas treatment of op mutant rat peritoneal cells with lyso-Pc or DDG did not activate macrophages. The inflammation-primed macrophage activation cascade in rats requires participation of B lymphocytes and vitamin D binding protein (DBP). Lyso-Pc-inducible beta-galactosidase of wild-type rat B lymphocytes can convert DBP to the macrophage-activating factor (MAF), whereas B lymphocytes of the op mutant rats were shown to be deficient in lyso-Pc-inducible beta-galactosidase. DBP is conserved among mammalian species. Treatment of human DBP (Gc1 protein) with commercial glycosidases yields an extremely high titrated MAF as assayed on mouse and rat macrophages. Because the enzymatically generated MAF (GcMAF) bypasses the role of lymphocytes in macrophage activation, the op mutant rat macrophages were efficiently activated by administration of a small quantity (100 pg/rat) of GcMAF. Likewise, in vitro treatment of op rat peritoneal cells with as little as 40 pg GcMAF/ml activated macrophages.

Single Channel Testing for Characterization of the Direct Gas Cooled Reactor and the SAFE-100 Heat Exchanger

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bragg-Sitton, S.M.; Propulsion Research Center, NASA Marshall Space Flight Center, Huntsville, AL 35812; Kapernick, R.

2004-02-04

Experiments have been designed to characterize the coolant gas flow in two space reactor concepts that are currently under investigation by NASA Marshall Space Flight Center and Los Alamos National Laboratory: the direct-drive gas-cooled reactor (DDG) and the SAFE-100 heatpipe-cooled reactor (HPR). For the DDG concept, initial tests have been completed to measure pressure drop versus flow rate for a prototypic core flow channel, with gas exiting to atmospheric pressure conditions. The experimental results of the completed DDG tests presented in this paper validate the predicted results to within a reasonable margin of error. These tests have resulted in amore » re-design of the flow annulus to reduce the pressure drop. Subsequent tests will be conducted with the re-designed flow channel and with the outlet pressure held at 150 psi (1 MPa). Design of a similar test for a nominal flow channel in the HPR heat exchanger (HPR-HX) has been completed and hardware is currently being assembled for testing this channel at 150 psi. When completed, these test programs will provide the data necessary to validate calculated flow performance for these reactor concepts (pressure drop and film temperature rise)« less

Feed preferences and performance of nursery pigs fed diets containing various inclusion amounts and qualities of distillers coproducts and flavor.

PubMed

Seabolt, B S; van Heugten, E; Kim, S W; Ange-van Heugten, K D; Roura, E

2010-11-01

We evaluated the preferences of nursery pigs for diets containing increasing distillers dried grains with solubles (DDGS), varying in color, or high-protein distillers dried grains (HP-DDG) and the effects of flavor supplementation on pig preference and growth performance. In Exp. 1 through 5, diet preference was determined in weanling pigs adjusted to a commercial diet for at least 10 d, and then housed individually for a 2-d double-choice preference test. In Exp. 1, a total of 60 pigs (11.6 ± 0.3 kg of BW) were given a choice between a reference diet (0% DDGS) and test diets containing 0, 10, 20, or 30% DDGS. In Exp. 2, a total of 80 pigs (10.8 ± 0.1 kg of BW) were given a choice between a reference diet (0% HP-DDG) and diets containing 0, 10, 20, or 30% HP-DDG. In Exp. 3, a total of 80 pigs (10.3 ± 0.2 kg of BW) were given a choice between a reference diet (0% DDGS) and a diet containing 0%, 30% light, or 30% dark DDGS. In Exp. 4, a total of 80 pigs (11.2 ± 0.2 kg of BW) were given a choice between a reference diet without DDGS and a diet containing either 0% DDGS, 10 or 20% light DDGS, or 10 or 20% dark DDGS. In Exp. 5, a total of 108 pigs (9.0 ± 0.2 kg of BW) were given a choice between a reference diet (0% DDGS and no flavor) and a diet without or with flavor and containing 0, 10, or 20% DDGS. In Exp. 1 and 2, DDGS and HP-DDG, respectively, linearly decreased (P < 0.01) pig preference. In Exp. 3, dark DDGS were preferred (P < 0.05) compared with light DDGS. In Exp. 4, preferences were linearly reduced (P < 0.01) with DDGS inclusion, and dark DDGS tended (P = 0.06) to be preferred compared with light DDGS. In Exp. 5, DDGS reduced preference (P < 0.01) and flavor reduced preference (P < 0.01) regardless of DDGS level. In Exp. 6, a total of 192 pigs (6.7 ± 0.1 kg of BW) were fed starter 1 diets without or with flavor for 1 wk. Subsequently, pigs were fed starter 2 and 3 diets (2 wk each) containing 0, 10, or 20% DDGS while continuing to receive their respective flavor treatment. Flavor addition during the starter 1 phase increased ADFI (P = 0.02), and DDGS inclusion tended to decrease ADG (P = 0.06) and decreased ADFI (P = 0.03) during the starter 2 phase. Volatile components in DDGS and HP-DDG varied greatly depending on the source. Nursery pigs preferred a diet without DDGS or HP-DDG, and this appeared to be unrelated to color differences between sources. Knowledge of volatile compounds that enhance or suppress the palatability of feed may lead to further development of feed additives for masking relatively unpalatable, albeit cost-effective, ingredients.

Lipase regio- and stereoselectivities toward three enantiomeric pairs of didecanoyl-deoxyamino-O methyl glycerol: a kinetic study by the monomolecular film technique.

PubMed

Douchet, Isabelle; De Haas, Gerard; Verger, Robert

2003-03-01

A kinetic study was carried out on the regio- and stereoselectivities of 12 lipases of animal and microbial origin. For this purpose, monomolecular films consisting of three pairs of enantiomers (didecanoyl-deoxyamino-O methyl glycerol, DDG) containing a single hydrolyzable decanoyl ester bond and two lipase-resistant groups were spread at the air-water interface. Each of the lipases tested displayed a particular type of behavior, on the basis of which they were classified in two groups, depending on their ability to hydrolyze the sn-2 position. From the qualitative point of view, the sn-2 preference measured on triacylglycerides and DDG were in good agreement. The inductive chemical effect might explain why a greater level of hydrolytic activity was observed with the diglycerides than with DDG. With most of the lipases tested, it was observed that the enantiomeric pair having two distal acyl chains was more clearly differentiated stereochemically than the two homologous pairs with two adjacent acyl chains. This finding is consistent with the hypothesis that during the chiral recognition process two of the three attachment points may be the external (distal) hydrophobic chains, which is in line with the hypothesis of a tuning fork conformation of a triglyceride in the lipase active site. Copyright 2003 Wiley-Liss, Inc.

Dynamic Response Testing in an Electrically Heated Reactor Test Facility

NASA Astrophysics Data System (ADS)

Bragg-Sitton, Shannon M.; Morton, T. J.

2006-01-01

Non-nuclear testing can be a valuable tool in the development of a space nuclear power or propulsion system. In a non-nuclear test bed, electric heaters are used to simulate the heat from nuclear fuel. Standard testing allows one to fully assess thermal, heat transfer, and stress related attributes of a given system, but fails to demonstrate the dynamic response that would be present in an integrated, fueled reactor system. The integration of thermal hydraulic hardware tests with simulated neutronic response provides a bridge between electrically heated testing and fueled nuclear testing. By implementing a neutronic response model to simulate the dynamic response that would be expected in a fueled reactor system, one can better understand system integration issues, characterize integrated system response times and response characteristics, and assess potential design improvements at a relatively small fiscal investment. Initial system dynamic response testing was demonstrated on the integrated SAFE-100a heat pipe (HP) cooled, electrically heated reactor and heat exchanger hardware, utilizing a one-group solution to the point kinetics equations to simulate the expected neutronic response of the system. Reactivity feedback calculations were then based on a bulk reactivity feedback coefficient and measured average core temperature. This paper presents preliminary results from similar dynamic testing of a direct drive gas cooled reactor system (DDG), demonstrating the applicability of the testing methodology to any reactor type and demonstrating the variation in system response characteristics in different reactor concepts. Although the HP and DDG designs both utilize a fast spectrum reactor, the method of cooling the reactor differs significantly, leading to a variable system response that can be demonstrated and assessed in a non-nuclear test facility. Planned system upgrades to allow implementation of higher fidelity dynamic testing are also discussed. Proposed DDG testing will utilize a higher fidelity point kinetics model to control core power transients, and reactivity feedback will be based on localized feedback coefficients and several independent temperature measurements taken within the core block. This paper presents preliminary test results and discusses the methodology that will be implemented in follow-on DDG testing and the additional instrumentation required to implement high fidelity dynamic testing.

75 FR 4272 - Certifications and Exemptions Under the International Regulations for Preventing Collisions at...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

... FURTHER INFORMATION CONTACT: Lieutenant Commander Ted Cook, (Admiralty and Maritime Law), Office of the... DUNHAM DDG 109 X X X 14.5 * * * * * * * * * * * * Approved: January 14, 2010. M. Robb Hyde, Commander...

Callose deposition during gravitropism of Zea mays and Pisum sativum and its inhibition by 2-deoxy-D-glucose

NASA Technical Reports Server (NTRS)

Jaffe, M. J.; Leopold, A. C.

1984-01-01

In etiolated corn (Zea mays L.) and etiolated pea (Pisum sativum L.) seedlings, a gravitropic stimulation induces the deposition of callose. In the corn coleoptiles this occurs within 5 min of gravity stimulation, and prior to the beginning of curvature. Both gravitropic curvature and callose deposition reach their maxima by 12 h. Within the first 2 h more callose is deposited on the upper (concave) side, but after 2-3 h, this deposition pattern is reversed. An inhibitor of protein glycosylation, 2-deoxy-D-glucose (DDG), inhibits callose production and considerably retards gravitropic bending in both species of plants. Mannose can relieve the inhibition of gravitropic bending by DDG. The pea mutant "Ageotropum", which does not respond to gravity when etiolated, also fails to produce callose in response to a gravitic stimulus. These correlations indicate that callose deposition may be a biochemical component of gravitropism in plant shoots.

Comparison of amino acid digestibility of feedstuffs determined with the precision-fed cecectomized rooster assay and the standardized ileal amino acid digestibility assay.

PubMed

Kim, E J; Utterback, P L; Applegate, T J; Parsons, C M

2011-11-01

The objective of this study was to evaluate and compare amino acid digestibility of several feedstuffs using 2 commonly accepted methods: the precision-fed cecectomized rooster assay (PFR) and the standardized ileal amino acid assay (SIAAD). Six corn, 6 corn distillers dried grains with or without solubles (DDGS/DDG), one wet distillers grains, one condensed solubles, 2 meat and bone meal (MBM) and a poultry byproduct meal were evaluated. Due to insufficient amounts, the wet distillers grains and condensed solubles were only evaluated in roosters. Standardized amino acid digestibility varied among the feed ingredients and among samples of the same ingredient for both methods. For corn, there were generally no differences in amino acid digestibility between the 2 methods. When differences did occur, there was no consistent pattern among the individual amino acids and methods. Standardized amino acid digestibility was not different between the 2 methods for 4 of the DDG samples; however, the PFR yielded higher digestibility values for a high protein DDG and a conventionally processed DDGS. The PFR yielded higher amino acid digestibility values than the SIAAD for several amino acids in 1 MBM and the poultry byproduct meal, but it yielded lower digestibility values for the other MBM. Overall, there were no consistent differences between methods for amino acid digestibility values. In conclusion, the PFR and SIAAD methods are acceptable for determining amino acid digestibility. However, these procedures do not always yield similar results for all feedstuffs evaluated. Thus, further studies are needed to understand the underlying causes in this variability.

Persistent PlatformsThe DDG 51 Case

DTIC Science & Technology

2015-09-30

Retrieved from http://insidedefense.com Biernacki, P., & Waldorf, D. (1981). Snowball sampling : Problems and techniques of chain referral sampling ...indicators of successful shipbuilding practices (Government Accountability Office [GAO], 2009). This paper uses the “ snowball ” technique of data gathering

Field Evaluation of Plant Defense Inducers for the Control of Citrus Huanglongbing.

PubMed

Li, Jinyun; Trivedi, Pankaj; Wang, Nian

2016-01-01

Huanglongbing (HLB) is currently the most economically devastating disease of citrus worldwide and no established cure is available. Defense inducing compounds are able to induce plant resistance effective against various pathogens. In this study the effects of various chemical inducers on HLB diseased citrus were evaluated in four groves (three with sweet orange and one with mandarin) in Florida (United States) for two to four consecutive growing seasons. Results have demonstrated that plant defense inducers including β-aminobutyric acid (BABA), 2,1,3-benzothiadiazole (BTH), and 2,6-dichloroisonicotinic acid (INA), individually or in combination, were effective in suppressing progress of HLB disease. Ascorbic acid (AA) and the nonmetabolizable glucose analog 2-deoxy-D-glucose (2-DDG) also exhibited positive control effects on HLB. After three or four applications for each season, the treatments AA (60 to 600 µM), BABA (0.2 to 1.0 mM), BTH (1.0 mM), INA (0.1 mM), 2-DDG (100 µM), BABA (1.0 mM) plus BTH (1.0 mM), BTH (1.0 mM) plus AA (600 µM), and BTH (1.0 mM) plus 2-DDG (100 µM) slowed down the population growth in planta of 'Candidatus Liberibacter asiaticus', the putative pathogen of HLB and reduced HLB disease severity by approximately 15 to 30% compared with the nontreated control, depending on the age and initial HLB severity of infected trees. These treatments also conferred positive effect on fruit yield and quality. Altogether, these findings indicate that plant defense inducers may be a useful strategy for the management of citrus HLB.

Decision generation tools and Bayesian inference

NASA Astrophysics Data System (ADS)

Jannson, Tomasz; Wang, Wenjian; Forrester, Thomas; Kostrzewski, Andrew; Veeris, Christian; Nielsen, Thomas

2014-05-01

Digital Decision Generation (DDG) tools are important software sub-systems of Command and Control (C2) systems and technologies. In this paper, we present a special type of DDGs based on Bayesian Inference, related to adverse (hostile) networks, including such important applications as terrorism-related networks and organized crime ones.

77 FR 16768 - Export Sales Reporting Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-22

... DEPARTMENT OF AGRICULTURE Office of the Secretary 7 CFR Part 20 RIN 0551-AA70 Export Sales... for pork (fresh, chilled, and frozen box/primal cuts) and distillers dried grain (DDG) to the Export...: Contact Peter W. Burr, Branch Chief, Export Sales Reporting Branch, Import Policies and Export Reporting...

Navy Underway

Science.gov Websites

Change of Command DDG-51 Program Marks Start of Construction Milestones at BIW, HII 2017 Sailors of the Deployed NETSAFA Holds Change of Command Pacific Partnership 2018 Kicks-Off in Thailand for First Time Forrest Sherman Holds Change of Command Suicide Prevention: ASIST Course Teaches Service Members to

The Segmental and Suprasegmental Phonology of Fataluku

ERIC Educational Resources Information Center

Heston, Tyler M.

2015-01-01

This dissertation describes the segmental and prosodic phonology of Fataluku (IPA [fataluku], ISO 639-3 ddg), a highly underdocumented Papuan language in East Timor (island Southeast Asia). Fataluku is classified as a member of the Timor-Alor-Pantar language (TAP) family, which currently includes approximately 25 members spread across Timor and…

50 CFR 216.175 - Requirements for monitoring and reporting.

Code of Federal Regulations, 2011 CFR

2011-10-01

...., FFG, DDG, or CG). (G) Length of time observers maintained visual contact with marine mammal. (H) Wave... height in feet (high, low and average during exercise). (I) Narrative description of sensors and... sensor. (F) Length of time observers maintained visual contact with marine mammal. (G) Wave height. (H...

50 CFR 218.105 - Requirements for monitoring and reporting.

Code of Federal Regulations, 2011 CFR

2011-10-01

...., FFG, DDG, or CG); (G) Length of time observers maintained visual contact with marine mammal(s); (H...., participating in exercise; (H) Wave height in feet (high, low and average during exercise); and (I) Narrative... observers maintained visual contact with marine mammal; (G) Wave height; (H) Visibility; (I) Whether...

50 CFR 218.105 - Requirements for monitoring and reporting.

Code of Federal Regulations, 2010 CFR

2010-10-01

...., FFG, DDG, or CG); (G) Length of time observers maintained visual contact with marine mammal(s); (H...., participating in exercise; (H) Wave height in feet (high, low and average during exercise); and (I) Narrative... observers maintained visual contact with marine mammal; (G) Wave height; (H) Visibility; (I) Whether...

50 CFR 216.275 - Requirements for monitoring and reporting.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., what type of surface vessel, i.e., FFG, DDG, or CG) (G) Length of time observers maintained visual... exercise) (I) Narrative description of sensors and platforms utilized for marine mammal detection and... calves were observed (E) Initial detection sensor (F) Length of time observers maintained visual contact...

78 FR 16777 - Export Sales Reporting Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-19

... DDG] would facilitate market transparency and allow our industry and our corn marketing partners with... commodities to be used for seed which have been treated in such a manner that their use is limited to seed for planting purposes or on which a certificate has been issued by a recognized seed testing laboratory setting...

Effects of Environmental Enrichment on Doublecortin and BDNF Expression along the Dorso-Ventral Axis of the Dentate Gyrus.

PubMed

Gualtieri, Fabio; Brégère, Catherine; Laws, Grace C; Armstrong, Elena A; Wylie, Nicholas J; Moxham, Theo T; Guzman, Raphael; Boswell, Timothy; Smulders, Tom V

2017-01-01

Adult hippocampal neurogenesis (AHN) in the dentate gyrus is known to respond to environmental enrichment, chronic stress, and many other factors. The function of AHN may vary across the septo-temporal axis of the hippocampus, as different subdivisions are responsible for different functions. The dorsal pole regulates cognitive-related behaviors, while the ventral pole mediates mood-related responses through the hypothalamic-pituitary-adrenal (HPA) axis. In this study, we investigate different methods of quantifying the effect of environmental enrichment on AHN in the dorsal and ventral parts of the dentate gyrus (dDG and vDG). To this purpose, 11-week-old female CD-1 mice were assigned for 8 days to one of two conditions: the Environmental Enrichment (E) group received (i) running wheels, (ii) larger cages, (iii) plastic tunnels, and (iv) bedding with male urine, while the Control (C) group received standard housing. Dorsal CA ( Cornu Ammonis ) and DG regions were larger in the E than the C animals. Distance run linearly predicted the volume of the dorsal hippocampus, as well as of the intermediate and ventral CA regions. In the dDG, the amount of Doublecortin (DCX) immunoreactivity was significantly higher in E than in C mice. Surprisingly, this pattern was the opposite in the vDG (C > E). Real-time PCR measurement of Dcx mRNA and DCX protein analysis using ELISA showed the same pattern. Brain Derived Neurotrophic Factor (BDNF) immunoreactivity and mRNA displayed no difference between E and C, suggesting that upregulation of DCX was not caused by changes in BDNF levels. BDNF levels were higher in vDG than in dDG, as measured by both methods. Bdnf expression in vDG correlated positively with the distance run by individual E mice. The similarity in the patterns of immunoreactivity, mRNA and protein for differential DCX expression and for BDNF distribution suggests that the latter two methods might be effective tools for more rapid quantification of AHN.

75 FR 68213 - Certifications and Exemptions Under the International Regulations for Preventing Collisions at...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-05

... naval ship: Annex I, paragraph 3(c), pertaining to the placement of task lights not less than two meters... safety, Navigation (water), and Vessels. 0 For the reasons set forth in the preamble, amend part 706 of... vessel in the athwartship direction * * * * * * * USS OSCAR AUSTIN DDG 79 1.89 meters...

Littoral Combat Ship (LCS) Civilian Aviation Alternative Support Study: Report of Findings and Recommendations

DTIC Science & Technology

2006-07-30

instructions for: amphibious class (LHA, LHD, LSD , LPD, LST), combatant class (CG 16, CG 47, DD 963, DDG 51, FFG 7, PHM 1, PG 1), command class (LCC 19...20376-7003Kevin Boissonneault – Kevin.Boissonneault@Navy.Mil NAVAIR 4.10.1.2 48110 Shaw Road Bldg 2187, Suite 1180 49. Patuxent River, MD 20670

ManTech Affordability for Defense Weapon Systems

DTIC Science & Technology

2009-11-01

the Virginia Class Submarine Development of Friction Stir Welding for Navy Expeditionary Fighting Vehicle (EFV) Hull Components Procurement...Tile 2007 – Translational Friction Stir Welding 2006 – Engine Rotor Life Extension 2006 – Uncooled Focal Plane Array Producibility 2005 – Large...DDG 1000 with Hybrid Laser Arc Welding The Problem: T-Beam stiffeners, used extensively for decks, bulkheads, and other ship structures, are being

Organizational Analysis of Food Service Management

DTIC Science & Technology

2011-06-01

35  d.  Senior Culinary Specialists on “Twilight” Tour ...................35  e.  NAVSUP Controls Quality of Life...Supply Centers COMSUBFOR Commander Submarine Force CS Culinary Specialist CSCS Culinary Specialist Senior Chief CVN Carrier Vessel Nuclear DDG Guided...attention of the Culinary Specialists. The type of assist visit can be tailored to the requirements identified by the requesting command. Normally

Music exposure improves spatial cognition by enhancing the BDNF level of dorsal hippocampal subregions in the developing rats.

PubMed

Xing, Yingshou; Chen, Wenxi; Wang, Yanran; Jing, Wei; Gao, Shan; Guo, Daqing; Xia, Yang; Yao, Dezhong

2016-03-01

Previous research has shown that dorsal hippocampus plays an important role in spatial memory process. Music exposure can enhance brain-derived neurotrophic factor (BDNF) expression level in dorsal hippocampus (DH) and thus enhance spatial cognition ability. But whether music experience may affect different subregions of DH in the same degree remains unclear. Here, we studied the effects of exposure to Mozart K.448 on learning behavior in developing rats using the classical Morris water maze task. The results showed that early music exposure could enhance significantly learning performance of the rats in the water maze test. Meanwhile, the BDNF/TrkB level of dorsal hippocampus CA3 (dCA3) and dentate gyrus (dDG) was significantly enhanced in rats exposed to Mozart music as compared to those without music exposure. In contrast, the BDNF/TrkB level of dorsal hippocampus CA1 (dCA1) was not affected. The results suggest that the spatial memory improvement by music exposure in rats may be associated with the enhanced BDNF/TrkB level of dCA3 and dDG. Copyright © 2016 Elsevier Inc. All rights reserved.

Using Additive Manufacturing to Mitigate the Risks of Limited Key Ship Components of the Zumwalt-Class Destroyer

DTIC Science & Technology

2016-12-01

4 3. Design and Production Maturity...issues (PEO Ships, 2016). 6 3. Design and Production Maturity Despite the fact that the Navy accepted the first ship, USS Zumwalt (DDG 1000...The modern day of AM is a process that uses Computer-Aided Design (CAD) software to create three-dimensional (3D) products by adding one layer on top

2008 Maneuver Support Science and Technology Conference and Exhibition

DTIC Science & Technology

2008-07-30

Web Boeing 707 Civilian Nuclear PowerHyman G. Rickover KC-135 Nautilus SSN 571 ~ 1954 ~ 1955 1960’s DDG 1000 “Electric Navy” AMSC - 50,000 SHP ...Systems Integration? “The Project Manager shall have a comprehensive plan for HSI in place early in the acquisition process to optimize...Applications research for specific military problems • Components, subsystems, models, new concepts • Understanding to solve

Effects of Environmental Enrichment on Doublecortin and BDNF Expression along the Dorso-Ventral Axis of the Dentate Gyrus

PubMed Central

Gualtieri, Fabio; Brégère, Catherine; Laws, Grace C.; Armstrong, Elena A.; Wylie, Nicholas J.; Moxham, Theo T.; Guzman, Raphael; Boswell, Timothy; Smulders, Tom V.

2017-01-01

Adult hippocampal neurogenesis (AHN) in the dentate gyrus is known to respond to environmental enrichment, chronic stress, and many other factors. The function of AHN may vary across the septo-temporal axis of the hippocampus, as different subdivisions are responsible for different functions. The dorsal pole regulates cognitive-related behaviors, while the ventral pole mediates mood-related responses through the hypothalamic-pituitary-adrenal (HPA) axis. In this study, we investigate different methods of quantifying the effect of environmental enrichment on AHN in the dorsal and ventral parts of the dentate gyrus (dDG and vDG). To this purpose, 11-week-old female CD-1 mice were assigned for 8 days to one of two conditions: the Environmental Enrichment (E) group received (i) running wheels, (ii) larger cages, (iii) plastic tunnels, and (iv) bedding with male urine, while the Control (C) group received standard housing. Dorsal CA (Cornu Ammonis) and DG regions were larger in the E than the C animals. Distance run linearly predicted the volume of the dorsal hippocampus, as well as of the intermediate and ventral CA regions. In the dDG, the amount of Doublecortin (DCX) immunoreactivity was significantly higher in E than in C mice. Surprisingly, this pattern was the opposite in the vDG (C > E). Real-time PCR measurement of Dcx mRNA and DCX protein analysis using ELISA showed the same pattern. Brain Derived Neurotrophic Factor (BDNF) immunoreactivity and mRNA displayed no difference between E and C, suggesting that upregulation of DCX was not caused by changes in BDNF levels. BDNF levels were higher in vDG than in dDG, as measured by both methods. Bdnf expression in vDG correlated positively with the distance run by individual E mice. The similarity in the patterns of immunoreactivity, mRNA and protein for differential DCX expression and for BDNF distribution suggests that the latter two methods might be effective tools for more rapid quantification of AHN. PMID:28966570

PREFACE: Dielectrics 2009: Measurement Analysis and Applications

NASA Astrophysics Data System (ADS)

Vaughan, Alun; Williams, Graham

2009-07-01

The conference Dielectrics 2009: Measurements, Analysis and Applications represents a significant milestone in the evolution of dielectrics research in the UK. It is reasonable to state that the academic study of dielectrics has led to many fundamental advances and that dielectric materials underpin the modern world in devices ranging from field effect transistors, which operate at extremely high fields, albeit low voltages, to the high voltage plants that provide the energy that powers our economy. The origins of the Dielectrics Group of the Institute of Physics (IOP), which organized this conference, can be traced directly back to the early 1960s, when Professor Mansel Davies was conducting research into the dielectric relaxation behaviour of polar liquids and solids at The Edward Davies Chemical Laboratories of the University College of Wales, Aberystwyth. He was already well-known internationally for his studies of molecular structure and bonding of small molecules, using infra-red-spectroscopy, and of the physical properties of hydrogen-bonded liquids and solids, using thermodynamic methods. Dielectric spectroscopy was a fairly new area for him and he realized that opportunities for scientists in the UK to gather together and discuss their research in this developing area of physical chemistry/chemical physics were very limited. He conceived the idea of forming a Dielectrics Discussion Group (DDG), which would act as a meeting point and provide a platform for dielectrics research in the UK and beyond and, as a result, a two-day Meeting was convened in the spring of 1968 at Gregynog Hall of the University of Wales, near Newtown, Montgomeryshire. It was organized by Mansel Davies, Alun Price and Graham Williams, all physical chemists from the UCW, Aberystwyth. Fifty scientists attended, being a mix of physical chemists, theoretical chemists, physicists, electrical engineers, polymer and materials scientists, all from the UK, except Dr Brendan Scaife of Trinity College, Dublin. The Meeting discussed dielectric relaxation behaviour arising from molecular motions of dipolar molecules in the liquid and elastomeric states (now known as soft condensed matter) with measurements spanning a frequency range from a few Hz, through power and radiofrequencies, UHF and VHF, the microwave range and into the far infra-red. As a result of its success, it was decided at the Meeting that a continuing Dielectrics Discussion Group would be established to meet not more frequently than once a year. It was appreciated at the time that the subject of 'Dielectrics' covered many sub-areas, broadly classified into those of polarization, relaxation, conduction and high-field phenomena. For the DDG, a solution was to run annual meetings on chosen themes in dielectrics research, where the theme would change from one meeting to the next. Topics addressed in the early years of the DDG included high field phenomena and impurity effects, heterogeneous systems and biomaterials, polarization and conduction and non-linear dielectrics and ferroelectrics. The number of participants at these early meetings grew from 50 to the low 100's, which reflected both the increased awareness of the Group and increased participation from researchers in Continental Europe. However, the majority of participants in this period were from the UK, which reflected the considerable activities in dielectrics research in University, Industry and Government laboratories in the UK. There followed a series of DDG Meetings until 1974, at which point, the DDG became a registered charity: The Dielectrics Society. Many of the earlier meetings were held in the attractive and convenient venues of Oxford and Cambridge colleges but, in the early 1990's, a new venue for the meetings was established at the University of Kent at Canterbury. In 2001, the next major change occurred when The Dielectrics Society was incorporated into the Institute of Physics, becoming their Dielectrics Group. From 1968 to 2001 the Annual Meetings focused on numerous topics, including relaxation and conduction processes in liquids, solids, liquid crystals, synthetic polymers and biopolymers, piezoelectric materials, electrets and ferroelectrets, interfacial phenomena, high field conduction and breakdown phenomena in solids, liquids and gases and, importantly, the remarkable developments in dielectric instrumentation during this period. These activities reflected the need, and willingness, to move dielectrics researches with the times. As examples of the variety and diversity of these meetings we may refer briefly to the 1981, 1989 and 1996 Meetings. The 1981 Oxford Meeting on High Field Phenomena in Dielectrics included strong themes on fundamental and practical effects of high E-fields on the dielectric and conduction behaviour of liquids and solids, electrical treeing and dielectric breakdown, non-linear dielectric effects, electrets, thin-film devices and electro-rheology. The late 1980's had seen large initiatives in the UK and globally in the general area of Molecular Electronics so, in timely fashion, this was the subject of the 1989 Meeting in Bangor. The 1996 Smart Dielectrics Meeting at Canterbury reported subsequent advances in designer materials having electro-responsive and electro-optical properties. The programme concerned electro- and photo-active materials, mainly organic, in the form of polar dielectrics, polyelectrolytes, organic semi- and photo-conductors, photo-refractive polymer films, organic ferroelectric films, liquid crystalline polymer films, piezo- and pyro-electric polymer films, electroluminescent polymers, electro-rheological fluids and non-linear optical polymer films as described by leading international scientists. The physico-chemical functions of the materials were demonstrated and interpreted in terms of fundamental molecular properties. An Archive, containing full details of all the Meetings of the DDG and the Dielectrics Society, has been placed on the Website of the IOP Dielectrics Group by Professor John Fothergill. The 2009 meeting of The Dielectrics Group of the IOP at Reading was therefore held to celebrate 40 years of coordinated dielectrics research activity in the UK and beyond, as presented at these DDG and Dielectrics Society Meetings. To reflect the range of topics addressed since the first DDG meeting in 1968, the organizing committee chose to break away from the tradition of a strongly- themed event and, rather, adopted a general, inclusive approach, albeit based upon four broad technical areas: Theme 1: Molecular and bulk relaxation processes Theme 2: Space charge and charge transport in insulators Theme 3: Functional materials Theme 4: Bio-dielectrics and complex systems. The result was a highly successful conference that attracted some 90 delegates from 11 countries, giving the event a truly international flavour, and which included both regular and new attendees. Consequently, the organizing committee would like to thank, our colleagues at the IOP, the invited speakers, our sponsors at National Grid, EDF Energy and Dow Wire and Cables and all the delegates for making the event such a success. Professor Alun Vaughan, Professor Graham Williams

Army Research Laboratory (ARL) 2009 Annual Review

DTIC Science & Technology

2009-01-01

shooting performance simulator with a high - speed weapon tracking system that provides real-time continuous weapon aim point data . This 13-acre...HMMVV’s (humvees), helicopter and plane parts and in new Navy DDX and DDG ships . As a result of the high performance and low weight of composite...improve Soldier-system performance . a high -resolution understanding of the Soldier’s Dr. Laurel Allender Director for Human Research and

Army Research Laboratory 2009 Annual Review

DTIC Science & Technology

2009-01-01

and in new Navy DDX and DDG ships . As a result of the high performance and low weight of composite materials, it is very likely that the Services...labs, an explosives casting lab, and it also has explosives x-ray capability . An indoor small arms shooting performance simulator with a high ...of nervous systems, rather than simply depending upon the adaptive abilities of Soldiers, and radically improve Soldier-system performance . a high

Effectiveness of a Littoral Combat Ship as a Major Node in a Wireless Mesh Network

DTIC Science & Technology

2017-03-01

17 Figure 6. Cloud Relay Groups . Source: Persistent Systems (2014a). .......................18 Figure 7. SolarWinds Network Performance Monitor...CIG Commander’s Initiative Group CLI Command Line Interface CN Core Network CODA Common Optical Digital Architecture CPS Cyber-Physical Systems...CSBA Center for Strategic and Budgetary CSG Carrier Strike Group DAMA Demand Assigned Multiple Access DDG Guided Missile Destroyer DL Distributed

Developments in Science and Technology

DTIC Science & Technology

1984-01-01

University of Maryland) A New Sutureless Method for the Anastomosis of Blood Vessels 142 J. J. Wozniak Arterial Response to Hemodynamic Siear Stress 145...structure of shipboard combat systems such as the Ae- gis Combat System, Terrier and Tartar New Threat Upgrades, and the multimis- sion DDG-51 Combat...ships and their aircraft are coordinated at the battle group lev- el to achieve new levels of antiair-warfare etfectiveness. The development of long-range

Ship Design

NASA Technical Reports Server (NTRS)

1982-01-01

Guided missile cruiser equipped with advanced Aegis fleet defense system which automatically tracks hundreds of attacking aircraft or missiles, then fires and guides the ship's own weapons in response. Designed by Ingalls Shipbuilding for the US Navy, the U.S.S. Ticonderoga is the first of four CG-47 cruisers to be constructed. NASTRAN program was used previously in another Navy/Ingalls project involving design and construction of four DDG-993 Kidd Class guided missile destroyers.

Hydrodynamic Energy Saving Enhancements for DDG 51 Class Ships

DTIC Science & Technology

2012-02-01

temperature and pressure in the hydraulic pitch control system, expansion and contraction of the pitch control rods, improper pitch calibration procedure ...outdated pitch calibration, etc. Experience during hot pitch calibration procedures conducted by NSWCCD prior to powering trials has indicated that...18% increase in power.10 Sea trials conducted during a long-term evaluation on the USS WHIPPLE (FF 1062), showed that by 800 days out of drydock

DDG-1000 Missile Integration: A Case Study

DTIC Science & Technology

2014-03-01

hazards of electromagnetic radiation to ordnance (HERO) from those emitters, are not addressed in the JUWL program because legacy requirements are...UU NSN 7540–01–280–5500 Standard Form 298 (Rev. 2–89) Prescribed by ANSI Std. 239–18 ii THIS PAGE INTENTIONALLY LEFT BLANK iii Approved...weapon link on a xvii new frequency. All other requirements, such as pre- and post-launch interfaces, electromagnetic vulnerability requirements

Learning by Doing: The PLA Trains at Home and Abroad

DTIC Science & Technology

2012-11-01

Government . Authors of Strategic Studies Institute (SSI) publica- tions enjoy full academic freedom, provided they do not disclose classified information...the U.S. Government . EXECUTIVE SUMMARY This chapter examines Chinese naval moderniza- tion demonstrated during a decade of training ashore and...Ukraine, Greece, Portugal, Brazil, Ecuador , and Peru: Luhu class (旅沪级) DDG Qingdao (青岛舰), replenishment ship Taicang (太仓舰 around the world deployment

Advanced Metalworking Solutions for Naval Systems that go in Harm’s Way

DTIC Science & Technology

2009-01-01

friction stir welding (FSW) and advanced machining and casting techniques to produce a prototype Automated weld seam facing on DDG 1000 ships will...transportable friction stir welding (FSW) machine. FSW is a solid state joining technology that offers benefits over traditional welding for several...addition, by locating FSW operation at the construction yard, the aluminum panels that will be friction stir - welded are built to the size needed instead

Analysis of Shiphandlers’ Eye-Gaze and Simulation Data for Improvements in COVE-ITS System

DTIC Science & Technology

2017-06-01

study . For experts, we mainly focused on recruiting the instructors stationed at SWOS to volunteer for the study . Students attending...experience on a DDG-51 destroyer were also considered for the expert group. Eleven SWOs volunteered for the study , ten males and one female. One student ...failure on the eye tracking glasses. Hence, we had nine participants who completed the study : five ADOC students , one ADOC instructor, two

Evaluation of Resuspension from Propeller Wash in DoD Harbors

DTIC Science & Technology

2016-09-01

Environmental Research and Development Center FANS FOV ICP-MS Finite Analytical Navier-Stoker Solver Field of View Inductively Coupled Plasma with...Model (1984) and the Finite Analytical Navier- Stoker Solver (FANS) model (Chen et al., 2003) were set up to simulate and evaluate flow velocities and...model for evaluating the resuspension potential of propeller wash by a tugboat and the FANS model for a DDG. The Finite -Analytic Navier-Stokes (FANS

The effect of brown midrib corn silage and dried distillers' grains with solubles on milk production, nitrogen utilization and microbial community structure in dairy cows

USDA-ARS?s Scientific Manuscript database

Thirty-six Holstein cows, four of which were ruminally cannulated, (mean ± SD, 111 ± 35 DIM; 664 ± 76.5 kg BW) were used in replicated 4×4 Latin squares to investigate the effects of brown midrib (bm3) and conventional (DP) corn silages and the inclusion of dried distillers grains with solubles (DDG...

The Littoral Combat Ship: How We Got Here, and Why

DTIC Science & Technology

2014-01-01

Burke DDG, equating to a threshold (minimally acceptable) target cost of 7 $ 400 million per ship.36 However, in February 2003, with the program still...expected to provide the ship’s “Sunday punch.” As these simple calculations suggest, building a missionized LCS for $ 400 million would be challenging...was a family of fast, stealthy, 400 to 1,200-ton littoral combatants called Streetfighters which would operate in distributed groups. While the

Dentate gyrus supports slope recognition memory, shades of grey-context pattern separation and recognition memory, and CA3 supports pattern completion for object memory.

PubMed

Kesner, Raymond P; Kirk, Ryan A; Yu, Zhenghui; Polansky, Caitlin; Musso, Nick D

2016-03-01

In order to examine the role of the dorsal dentate gyrus (dDG) in slope (vertical space) recognition and possible pattern separation, various slope (vertical space) degrees were used in a novel exploratory paradigm to measure novelty detection for changes in slope (vertical space) recognition memory and slope memory pattern separation in Experiment 1. The results of the experiment indicate that control rats displayed a slope recognition memory function with a pattern separation process for slope memory that is dependent upon the magnitude of change in slope between study and test phases. In contrast, the dDG lesioned rats displayed an impairment in slope recognition memory, though because there was no significant interaction between the two groups and slope memory, a reliable pattern separation impairment for slope could not be firmly established in the DG lesioned rats. In Experiment 2, in order to determine whether, the dDG plays a role in shades of grey spatial context recognition and possible pattern separation, shades of grey were used in a novel exploratory paradigm to measure novelty detection for changes in the shades of grey context environment. The results of the experiment indicate that control rats displayed a shades of grey-context pattern separation effect across levels of separation of context (shades of grey). In contrast, the DG lesioned rats displayed a significant interaction between the two groups and levels of shades of grey suggesting impairment in a pattern separation function for levels of shades of grey. In Experiment 3 in order to determine whether the dorsal CA3 (dCA3) plays a role in object pattern completion, a new task requiring less training and using a choice that was based on choosing the correct set of objects on a two-choice discrimination task was used. The results indicated that control rats displayed a pattern completion function based on the availability of one, two, three or four cues. In contrast, the dCA3 lesioned rats displayed a significant interaction between the two groups and the number of available objects suggesting impairment in a pattern completion function for object cues. Copyright © 2015 Elsevier Inc. All rights reserved.

Fire Performance of Shipboard Electronic Space Materials

DTIC Science & Technology

2006-09-15

5d. PROJECT NUMBER 61-8513-0-6-5 John B. Hoover, Clarence L. Whitehurst, Eric B. Chang, and Frederick W. Williams 5e . TASK NUMBER 5f. WORK UNIT NUMBER...representative of current US Navy surface ship electronic spaces. It is expected that lessons learned from tests of this configuration will be applicable... NGSS ) for use on current construction DDG-51 class destroyers. The panels consist of a Nomex honeycomb core with a GRP (glass reinforced plastic

Effects of Carbon Nanomaterial Reinforcement on Composite Joints Under Cyclic and Impact Loading

DTIC Science & Technology

2012-03-01

prepreg . 2 Figure 1. Composite decks on DDG1000. (From [3]) Figure 2. USV built from nanotube-reinforced carbon fiber composites. (From [2...been proven that the infusion of CNTs enhances the strength and fracture toughness of CFRP laminates under static loading (mode I and mode II...Kostopoulos et al. [5] investigated the influence of the multi-walled carbon nanotubes (MWCNTs) on the impact and after-impact behavior of CFRP laminates

A new generation T56 turboprop engine

DOE Office of Scientific and Technical Information (OSTI.GOV)

McIntire, W.L.

1984-06-01

The focus of the T56 Series IV turboprop engine development program is to improve power and fuel consumption through incorporation of demonstrated technology improvements while retaining the long term durability and cost effective design of the T56 family. The T56-A-427, the Navy Series IV derivative of the 5000 shp (3728.5 kW) class T56 turboprop engine, resulted from over ten years of technology development via Advanced Turbine Engine Gas Generator (ATEGG), Joint Technology Demonstrator Engine (JTDE), and advanced component programs at Allison Gas Turbine Operations. An example of government and industry cooperation to transfer advanced gas turbine technology is the Airmore » Force Engine Model Derivative Program (EMDP). The initial full-scale demonstration in this program confirmed a 10-1/2% reduction in specific fuel consumption (sfc) and a power growth of 21% in the basic T56 frame. Continued early demonstrations and development by IR and D, Navy funds, and Allison discretionary funds showed a further sfc reduction to 13% and power increase of 28%. The full-scale development program is now underway to provide production engines in late 1986. Engines will be available for the Grumman E-2 and C-2 aircraft, with follow-on adaptions for Lockheed C-130/L100 and P-3 aircraft, and generator sets for DD 963, DDG 993, CG 47 and DDG 51 warships.« less

Pilot-scale submersed cultivation of R. microsporus var. oligosporus in thin stillage, a dry-grind corn-to-ethanol co-product

NASA Astrophysics Data System (ADS)

Erickson, Daniel Thomas

An innovative process to add value to a corn-to-ethanol co-product, Thin stillage, was studied for pilot-scale viability. A 1500L bioreactor was designed, operated, and optimized to cultivate Rhizopus microsporus var. oligosporus via submersed fermentation in Thin Stillage. The biomass was harvested and processed into a feed suitable for storage and ultimately for animal feeding trials. Characterization of the biomass and feed trials revealed that there is substantial potential as a nutrient dense feed supplement with 41.1% protein, 26.3% fat, and metabolizable energy on s dried basis. The amino acid profile is superior to that of DDGS, with most notably 1.7% Lys on dried basis. This process produces a significantly more nutrient dense product than DDGS, and could increase water-reclaimation in a dry-grind corn to ethanol plant. Industrially it would replace the energy intensive process of converting thin stillage into syrup that adds only $10-25/ton to DDG, while maintaining production of DDG. Using thin stillage as used a growth media for R. microsporus var. oligosporus, should not only lead to saving in energy costs, but also generate a high-value co-product which could lead to economic gains. Also there is still unexplored potential of enzymes, chitin, and co-culturing to further add value.

Elastolysen und Hauterkrankungen mit Verlust der elastischen Fasern.

PubMed

Tronnier, Michael

2018-02-01

Die elastischen Fasern sind neben den kollagenen Fasern der wichtigste Bestandteil des Bindegewebsgerüstes der Haut. Eine Verminderung oder ein Verlust der elastischen Fasern ist bei einer Vielzahl von klinisch sich unterschiedlich präsentierenden Erkrankungen, hereditär oder erworben, beschrieben. Bei den Erkrankungen, die mit einer Entzündung einhergehen ist die Elastophagozytose ein wichtiges histologisches Merkmal. Die Therapie der Erkrankungen dieser Gruppe ist grundsätzlich schwierig. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Destroyer Engineered Operating Cycle (DDEOC), System Maintenance Analysis DDG-37 Class, Salt Water Circulating System SMA 37-106-256, Review of Experience

DTIC Science & Technology

1978-07-01

horizontally mounted, single-end suction, single- stage centrifugal pumps. The rotating elements are mounted on the shaft of the driving motor, and the pump...annual open-and-inspect requirement for MIP E-17/296-21, MRC 21 A14V A. Industrial Facility Improvements -- None IMA Improvements -- None Intergrated ...Circulating Pump, Warren Pumps, Inc., NAVSHIPS 347-3146, January 1959. 4. Technical Manual - Horizontal Close-Co!;pled Pumps Sea (Salt) Water

Naval War College Review. Volume 63, Number 3, Summer 2010

DTIC Science & Technology

2010-01-01

3 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7... PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Naval War College,,686 Cushing Rd.,,Newport,,RI,02841 8. PERFORMING ORGANIZATION REPORT NUMBER 9...63 George V. Galdorisi and Scott C. Truver The Navy currently plans to build only three of the Zumwalt (DDG 1000) guided-missile destroyers. But the

The Maritime Security of the Baltic Approaches. NATO and the Warsaw Pact.

DTIC Science & Technology

1983-06-01

the last of which was transferred in 1970 when Poland received a SAM Kotlin class destroyer. They have also received several coastal patrol craft...conscripts). 4 W-class submarines. I Kotlin destroyer with two Goa SAM. 13 Osa FAC(M) with Styx SSM. 17 FAC(T): 4 Pilica, 10 Wisla, 3 P-6. 23 large...cruisers CG (Kara, Kresta, Kynda) 2 2 - Light cruisers CL (Sverdlov, Chapaev 4 5 2 Guided missile destroyers DDG (Kashin, Kilden, Kanin, Kivak, Kotlin (SAM

Cost Prediction via Quantitative Analysis of Complexity in U.S. Navy Shipbuilding

DTIC Science & Technology

2014-06-01

in regards to the analysis of advanced sensors and weaponry, the summation of singular values via a singular value decomposition will be used in the...In the DDG 51 class, the Main Reduction Gear (MRG) reduces the 3600-RPM produced by the LM-2500 gas turbines to approximately 168-RPM (at full...RDT&E efforts are currently underway to reduce complexity of the MCS by developing a wireless approach that will concurrently boost the host ship’s

Final EIS for the Proposed Homeporting of Additional Surface Ships at Naval Station, Mayport, FL. Volume 1. Final Environmental Impact Statement

DTIC Science & Technology

2008-11-21

to air squadrons. 4. USS John F. Kennedy was decommissioned in 2007. Source: Adapted from DoN 2006a Final EIS for the Proposed Homeporting of...Tugs Slot Small Craft 650 35 YD/YC/LCM Source: Adapted from Naval Facilities Engineering Service Center 2002 MCM = Mine Countermeasures DDG...It would include nonradiologically controlled spaces for administrative and other support functions. The design would be a site- adapted replication of

Hydrostatic and Hydrodynamic Analysis of a Lengthened DDG-51 Destroyer Modified Repeat

DTIC Science & Technology

2010-06-01

4.5 nm, and begins firing at 1 nm with a maximum probable kill at 460 m . The system can react in 3 seconds, has a muzzle velocity of 1,030 m / s , fires...of the barrel is approximately 800 m / s with a max altitude of 15,000 m . The five-inch, 62-caliber gun can fire conventional, Improved Conventional...CA 93943-5000 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING /MONITORING AGENCY NAME( S ) AND ADDRESS(ES) N/ A 10. SPONSORING

Viable Short-Term Directed Energy Weapon Naval Solutions: A Systems Analysis of Current Prototypes

DTIC Science & Technology

2013-06-01

Background and Issues for Congress 2013). The current DDG-51 electrical plant consists of three Gas Turbine Generator Sets ( GTGs ) rated at 2500 kW each...the generator rating (currently 2500kW), the practice is to have a minimum of two GTGs on line at all times to ensure continuity of service should...there be a system fault, or casualty to one of the GTGs (Mahoney, et al. 2010). This operation of at least two generators at all times essentially

[Quality assessment of dermatology in the G-DRG system 2004].

PubMed

Fürstenberg, T; Hensen, P; Rompel, R; Roeder, N

2004-11-01

Since January 2004, all German hospitals have been obliged to operate with a new hospital funding system based on DRGs. For the DRG system to serve as a fair basis for reimbursement requires that the dermatologic services be adequately covered in the classification system. The German Dermatologic Society (DDG) in cooperation with the DRG-Research Group of the University Hospital Muenster carried out a DRG evaluation study. Based on these results, suggestions for the adjustment of the G-DRG system were proposed by the DDG in the G-DRG adaptation round for 2004. Based on data of the DRG evaluation project (14,555 dermatological cases from 19 hospitals) the homogeneity in the G-DRG system 2004 was examined and compared with the quality of depiction in the G-DRG version 1.0. The correlation between expenditure and case mix index in the hospitals improved in the G-DRG system 2004. Most proposals submitted by the German Dermatologic Society for the adaptation into the G-DRG system 2004 were accepted. Some fundamental problems such as reimbursement of high cost drugs and special services, as well as the reimbursement of high and low outliers, were only marginally addressed. The G-DRG system 2004 will need to be continuously adapted in the field of dermatology. Based on this work, the German Dermatologic Society has made suggestions to be adapted in the G-DRG system 2005 and submitted them to the German DRG Institute.

Early Life Stress and Sleep Restriction as Risk Factors in PTSD: An Integrative Pre-Clinical Approach

DTIC Science & Technology

2015-04-01

dDG GABAAR alpha 1 expression in both J+UWT(+),EE (J) and EE (A) rats compered to Control. In addition, EE (A) rats exhibit lower expression of BLA...GABAAR alpha 1 expression compered to Control. (*= pɘ.05,**= pɘ.01). 48 7: One way ANOVA [F (3,47)= 4.79, pɘ.01] revealed a significant main...effect for the exposure. Further Post hoc comparisons revealed increased vDG GABAAR alpha 1 expression in both J+UWT(+) and EE (A) rats compered to EE (J

Multi-Level Scenario Module 1: 7th Division

DTIC Science & Technology

2009-03-01

MQ1B Recon Sq 1x RC135S Recon Sq 5x RC135VW Cythera Paros Shaw Peterson Fighter Sq 24x F16CD BLK-50 Fighter Sq 24x F15E Fighter Sq 24x A/0A10A Airlift Sq...Mountain Home Amphibious Assault Ship, Multipurpose (LHD) Amphibious Transport Dock (LPD) Dock Landing Ship ( LSD ) Guided Missile Cruiser (CG...Destroyer (DDG) x2 Submarine, Nuclear Powered (SSN) x 6 Guided Missile Submarine, Nuclear Powered (SSGN) Cythera Paros Shaw Peterson Guided

Destroyer Engineered Operating Cycle (DDEOC). System Maintenance Analysis CG-16 and CG-26 Class 1200 PSI Propulsion Plant SWAB Group 200 SMA 1626-200. Review of Experience,

DTIC Science & Technology

1979-11-01

shaft seals during the CASREP data period. Five of these CASREPs reported excessive leakage , two reported ruptured inflatable seals , and one reported...failures, like the DDG-37 Class CASREPs, were related to lube oil problems, steam valve problems, or leaking packing ( steam or oil seals ) that had become...sources of this water: (1) gradual deterioration of the turbine labyrinth seals , (2) leaking of exhaust and relief valves, and (3) condensation in the

Smoke Management for Naval Surface Ships,

DTIC Science & Technology

1987-04-03

I I ~~1’ ~ %************ .. I, -. ~ 0 -3-- Go LLO 605 or -r TT LO z z 4 0 LjL 0 ~ ~ e OR C . (9f oTfT 𔄁 0 ’ 9 -4 eq ~IL4 A A em nIIF ~E (j~ 4) C 0 C... 9 5 Smoke Penetration, 02 Deck (Fire on 0 1 Deck) ................... 1 6 Smoke Clean-up, 02 Deck (Fire on 0 1 Deck) ..................... 17 7...19 9 HAC orDDO 5,First Platform, Frame 126 -174 Item (a) Normal Ventilation.................................................. 20 9 HAC for DDG 5

Molekulare Diagnostik von Hautinfektionen am Paraffinmaterial - Übersicht und interdisziplinärer Konsensus.

PubMed

Sunderkötter, Cord; Becker, Karsten; Kutzner, Heinz; Meyer, Thomas; Blödorn-Schlicht, Norbert; Reischl, Udo; Nenoff, Pietro; Geißdörfer, Walter; Gräser, Yvonne; Herrmann, Mathias; Kühn, Joachim; Bogdan, Christian

2018-02-01

Nukleinsäure-Amplifikations-Techniken (NAT), wie die PCR, sind hochsensitiv sowie selektiv und stellen in der mikrobiologischen Diagnostik wertvolle Ergänzungen zur kulturellen Anzucht und Serologie dar. Sie bergen aber gerade bei formalinfixiertem und in Paraffin eingebettetem Gewebe ein Risiko für sowohl falsch negative als auch falsch positive Resultate, welches nicht immer richtig eingeschätzt wird. Daher haben Vertreter der Deutschen Gesellschaft für Hygiene und Mikrobiologie (DGHM) und der Deutschen Dermatologischen Gesellschaft (DDG) einen Konsensus in Form einer Übersichtsarbeit erarbeitet, wann eine NAT am Paraffinschnitt angezeigt und sinnvoll ist und welche Punkte dabei in der Präanalytik und Befundinterpretation beachtet werden müssen. Da bei Verdacht auf eine Infektion grundsätzlich Nativgewebe genutzt werden soll, ist die PCR am Paraffinschnitt ein Sonderfall, wenn beispielsweise bei erst nachträglichaufgekommenem Verdacht auf eine Infektion kein Nativmaterial zur Verfügung steht und nicht mehr gewonnen werden kann. Mögliche Indikationen sind der histologisch erhobene Verdacht auf eine Leishmaniose, eine Infektion durch Bartonellen oder Rickettsien, oder ein Ecthyma contagiosum. Nicht sinnvoll ist oder kritisch gesehen wird eine NAT am Paraffinschnitt zum Beispiel bei Infektionen mit Mykobakterien oder RNA-Viren. Die Konstellation für eine NAT aus Paraffingewebe sollte jeweils benannt werden, die erforderliche Prä-Analytik, die jeweiligen Grenzen des Verfahrens und die diagnostischen Alternativen bekannt sein. Der PCR-Befund sollte entsprechend kommentiert werden, um Fehleinschätzungen zu vermeiden. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Detector Simulations with DD4hep

NASA Astrophysics Data System (ADS)

Petrič, M.; Frank, M.; Gaede, F.; Lu, S.; Nikiforou, N.; Sailer, A.

2017-10-01

Detector description is a key component of detector design studies, test beam analyses, and most of particle physics experiments that require the simulation of more and more different detector geometries and event types. This paper describes DD4hep, which is an easy-to-use yet flexible and powerful detector description framework that can be used for detector simulation and also extended to specific needs for a particular working environment. Linear collider detector concepts ILD, SiD and CLICdp as well as detector development collaborations CALICE and FCal have chosen to adopt the DD4hep geometry framework and its DDG4 pathway to Geant4 as its core simulation and reconstruction tools. The DDG4 plugins suite includes a wide variety of input formats, provides access to the Geant4 particle gun or general particles source and allows for handling of Monte Carlo truth information, eg. by linking hits and the primary particle that caused them, which is indispensable for performance and efficiency studies. An extendable array of segmentations and sensitive detectors allows the simulation of a wide variety of detector technologies. This paper shows how DD4hep allows to perform complex Geant4 detector simulations without compiling a single line of additional code by providing a palette of sub-detector components that can be combined and configured via compact XML files. Simulation is controlled either completely via the command line or via simple Python steering files interpreted by a Python executable. It also discusses how additional plugins and extensions can be created to increase the functionality.

Type II diabetes and its therapy in clinical practice - results from the standardised non-interventional registry SIRTA.

PubMed

Gallwitz, B; Kusterer, K; Hildemann, S; Fresenius, K

2014-12-01

Modern antidiabetic therapies should achieve low HbA1c values and avoid hypoglycaemic complications. The registry SIRTA included 1522 patients with type II diabetes mellitus (T2DM) from 306 German medical practices. Patients had an HbA1c > 6.5% under the maximum tolerated metformin dose. If required, they received combination therapy with other antidiabetics according to the guideline of the German Diabetes Society [Deutsche Diabetes Gesellschaft (DDG)] or usual medical practice. Patients were followed up for 6 months. The target criteria included the achievement of HbA1c target values and the emergence of severe hypoglycaemic episodes. Most patients (64.0%) were planned to achieve an HbA1c target < 6.5%, the standard target recommended by the 2009 DDG guideline valid throughout the registry. Primarily to reduce the individual risk for hypoglycaemia, 32.4% of patients had a less strict HbA1c-target of 6.5-7.0%. These targets were achieved by 31.3% and 44.3% of patients, respectively. Combination therapies increased from 45% to 56% over the 6 months registry. Four patients had severe hypoglycaemias (0.26%). The registry confirms results from other epidemiologic studies on the therapy of T2DM in everyday practice. The treatment strategies applied effectively reduced blood glucose and avoided severe hypoglycaemias. An early therapy of insufficiently controlled patients with T2DM is important, as lower baseline values facilitated achieving HbA1c targets. © 2014 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

Traumatic brain injury causes an FK506-sensitive loss and an overgrowth of dendritic spines in rat forebrain.

PubMed

Campbell, John N; Register, David; Churn, Severn B

2012-01-20

Traumatic brain injury (TBI) causes both an acute loss of tissue and a progressive injury through reactive processes such as excitotoxicity and inflammation. These processes may worsen neural dysfunction by altering neuronal circuitry beyond the focally-damaged tissue. One means of circuit alteration may involve dendritic spines, micron-sized protuberances of dendritic membrane that support most of the excitatory synapses in the brain. This study used a modified Golgi-Cox technique to track changes in spine density on the proximal dendrites of principal cells in rat forebrain regions. Spine density was assessed at 1 h, 24 h, and 1 week after a lateral fluid percussion TBI of moderate severity. At 1 h after TBI, no changes in spine density were observed in any of the brain regions examined. By 24 h after TBI, however, spine density had decreased in ipsilateral neocortex in layer II and III and dorsal dentate gyrus (dDG). This apparent loss of spines was prevented by a single, post-injury administration of the calcineurin inhibitor FK506. These results, together with those of a companion study, indicate an FK506-sensitive mechanism of dendritic spine loss in the TBI model. Furthermore, by 1 week after TBI, spine density had increased substantially above control levels, bilaterally in CA1 and CA3 and ipsilaterally in dDG. The apparent overgrowth of spines in CA1 is of particular interest, as it may explain previous reports of abnormal and potentially epileptogenic activity in this brain region.

Destroyer Engineered Operating Cycle (DDEOC) System Maintenance Analysis DDG-37 Class Firemain and Auxiliary Machinery Cooling Water Systems SMA 37-201- 521. Review of Experience

DTIC Science & Technology

1978-02-01

establish a PMS requirement to operate firepumps 1 and 6 daily to warm up and dry out the electric motor windings. Equaliza- tion of the use of the...daily to warm up and dry out the electric motor windings and the recommendations of Section 3.2.2.1 to establish a uniform firepump operating policy...bolted up . This problem, as discussed in Section 3.3.1.3, should be reduced by the promulgation and use of the comprehensive centrifugal pump overhaul

Sequestration: Documenting and Assessing Lessons Learned Would Assist DOD in Planning for Future Budget Uncertainty

DTIC Science & Technology

2015-05-01

to shore power outside of the restricted port hours. • Officials from the Navy’s CH-53K King Stallion helicopter program office told us that...1,777 8% 23 (1%) 1,754 (99%) Procurement 4,688 74,169 78,857 6,218 8% 1,081 (17%) 5,137 (83%) CH-53K King Stallion Helicopter RDT&E 1,836 605,404...Information Network - Tactical Increment 3 X Navy AIM-9X Block II Sidewinder Missile X CH-53K King Stallion Helicopter X X X DDG 1000 Zumwalt

Comparing the Predictive Capabilities of Level Three EVM Cost Data with Level Five EVM Cost Data

DTIC Science & Technology

2014-03-27

Management (EVM) Data Manual , 2008). Performance Assessments and Root Cause Analysis (PARCA) directly oversees EVM- CR. A contractor must submit seven...Massive Ordance Penetrator (F33657-99-D-0028) 126 66 17 9 7 Chem Demil - CMA (DAAA09-97-C-0025) 2494 1520 63 19 9 Chem Demil - CMA (DACA87-89-C-0076) 441...Engagement Capability N00024-05-C-5100 1 50 Army Chem Demil - CMA DACA87-89-C-0076 0 1 Army Chem Demil - CMA DAAA09-97-C-0025 1 2 Navy DDG 1000 - ZUMWALT

Molecular diagnosis of skin infections using paraffin-embedded tissue - review and interdisciplinary consensus.

PubMed

Sunderkötter, Cord; Becker, Karsten; Kutzner, Heinz; Meyer, Thomas; Blödorn-Schlicht, Norbert; Reischl, Udo; Nenoff, Pietro; Geißdörfer, Walter; Gräser, Yvonne; Herrmann, Mathias; Kühn, Joachim; Bogdan, Christian

2018-02-01

Nucleic acid amplification techniques (NATs), such as PCR, are highly sensitive and specific methods that have become valuable supplements to culture and serology in the diagnosis of infectious disorders. However, especially when using formalin-fixed and paraffin-embedded tissue, these techniques are associated with both false-negative and false-positive results, a pitfall that is frequently misjudged. Representatives of the German Society of Hygiene and Microbiology (DGHM) and the German Society of Dermatology (DDG) therefore set out to develop a consensus - in the form of a review article - on the appropriate indications for NATs using paraffin-embedded tissue, its contraindications, and the key points to be considered in the pre- and post-analytical phase. Given that fresh, naive tissue is preferably to be used in the workup of a suspected infection, PCR analysis on paraffin sections represents an exception. The latter may be considered if an infection is suspected at a later point in time and fresh tissue has not been preserved or can no longer be obtained. Potential indications include confirmation of histologically suspected infections with Leishmania spp., Bartonella spp., Rickettsia spp., or in case of ecthyma contagiosum. Infections with, for example, mycobacteria or RNA viruses, on the other hand, are not considered useful indications for NATs using paraffin sections. In order to avoid misinterpretation of test results, it is essential that laboratory reports on NATs using paraffin-embedded tissue contain information on the indication/diagnostic circumstances, the required and chosen pre-analytical steps, the limitations of the method, and on diagnostic alternatives. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Navy Force Structure and Shipbuilding Plans: Background and Issues for Congress

DTIC Science & Technology

2014-08-01

submarines (SSBNs) 12b 12-14b 12b 12b 14 14 14 14 14 Cruise missile submarines (SSGNs) 0c 0-4c 4c 0c 4 4 4 4 2 or 4d Attack submarines ( SSNs ...aircraft carrier 1 1 Virginia ( SSN -774) class attack submarine 2 2 2 2 2 10 Arleigh Burke (DDG-51) class destroyer 2 2 2 2 2 10 Littoral Combat Ship...shows the Navy’s FY2015 30-year (FY2015-FY2044) shipbuilding plan. Table 3. Navy FY2015 30-Year (FY2015-FY2044) Shipbuilding Plan FY CVN LSC SSC SSN

Photodynamic therapy--aspects of pain management.

PubMed

Fink, Christine; Enk, Alexander; Gholam, Patrick

2015-01-01

Topical photodynamic therapy (PDT) is a highly effective and safe treatment method for actinic keratoses with an excellent cosmetic outcome and is commonly used for the therapy of large areas of photodamaged skin with multiple clinically manifest and subclinical lesions. However, the major drawback of photodynamic therapy is the pain experienced during the treatment that can be intense and sometimes even intolerable for patients, requiring interruption or termination of the process. Several strategies for controlling pain during photodynamic therapy have been studied but few effective methods are currently available. Therefore, this review puts the spotlight on predictors on pain intensity and aspects of pain management during photodynamic therapy. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Nebenwirkungen von TNF-alpha-Inhibitoren am Hautorgan.

PubMed

Lindhaus, Claudia; Tittelbach, Jörg; Elsner, Peter

2017-03-01

TNF-alpha-Inhibitoren werden seit Anfang der 1990er Jahre erfolgreich zur Behandlung diverser immunvermittelter entzündlicher Erkrankungen eingesetzt. Inzwischen gibt es eine umfangreiche Datenlage bezüglich ihrer Sicherheit. Nebenwirkungen sind bezogen auf die Häufigkeit der Anwendung selten und meist nicht schwerwiegend. Zu den Nebenwirkungen am Hautorgan zählen lokale injektionsassoziierte Reaktionen, Infektionen, immunvermittelte Reaktionen sowie Neoplasien. Die häufigsten schwerwiegenden Nebenwirkungen sind infektiöser Natur. Mykobakterielle Infektionen, aber auch non-mykobakterielle Erreger, Viren und Pilze können potenziell letale, systemische Infektionen auslösen. Im Folgenden wird eine Übersicht über das gegenwärtige Wissen bezüglich der Nebenwirkungen von TNFα-Inhibitoren am Hautorgan gegeben. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Akne.

PubMed

Degitz, Klaus; Ochsendorf, Falk

2017-07-01

Akne ist eine chronische Erkrankung mit hoher Prävalenz unter Jugendlichen. Pathogenetische Hauptfaktoren (und ihre klinischen Korrelate) sind gesteigerte Talgproduktion (Seborrhoe), follikuläre Hyperkeratose (Komedonen) und perifollikuläre Entzündungsvorgänge (Papulopusteln). Die Krankheit wird von endogenen (Androgene, IGF-1, neuroendokrine Faktoren) und exogenen (Propionibacterium acnes, Diät, mechanische Irritation, Inhaltsstoffe medizinischer oder kosmetischer Externa) Einflüssen moduliert. Akne geht mit zum Teil hoher Morbidität einher und kann bereits bei leichter Ausprägung eine erhebliche Verschlechterung der Lebensqualität bewirken. Zu Therapie stehen wirksame topische und systemische Behandlungsverfahren zur Verfügung. Eine optimale Behandlung erfordert eine stadiengerechtes Management und kontinuierliche ärztliche Begleitung der Patienten über den erforderlichen Behandlungszeitraum. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Ship Systems Staging Diagrams for DDG-37 Class Ships.

DTIC Science & Technology

1977-12-01

progressing I 8 - _ _ - - - - I —-——- -- - - .4 — Drawing numbering — Material identification and ordering - — Pre-Overhaul Test and Inspection... DAMAGE CCNIROL 4CC NB t4—0C3 NIZZIE— MENI TC P TYPE N’) 64—004 NOZZI F— ~~AT FR QUENCH CA GA— MISCE LL~~NrouS G~~Cu~~S ( F L E X ) Oil 08— M JITIPLEX I~ AN...ICN A L INT ERLCC K .1 03 88—7 48 VALVE — P ILOT. PN~~ UMAT 1C CPERA TED 04 01— Gd PUM P—CFN TRI FUGA L . BOILER FEED 05 3 8 — 2 4 9 V A L V E — C O

Beliefs, perceptions and psychosocial impact of acne amongst Singaporean students in tertiary institutions.

PubMed

Su, Peiqi; Chen Wee Aw, Derrick; Lee, Siew Hui; Han Sim Toh, Matthias Paul

2015-03-01

Acne vulgaris is a common skin condition which can have a negative impact on a patient's quality of life. A survey was distributed among students at tertiary institutions. Data was collected on participants' own rating of acne grade and how acne affected their social life. A clinician on-site graded the participants' acne. Of the 429 students who participated in the survey, 59.8 % felt embarrassed or self-conscious because of their acne. There was a low but statistically significant correlation (Spearman's Correlation Coefficient = 0.471, p < 0.001) between participants' and clinicians' grading of acne. Acne vulgaris causes a considerable amount of psychosocial stress. There are unfounded beliefs surrounding acne and unawareness of treatment options available. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Modular shipbuilding and its relevance to construction of nuclear power plants. Master's thesis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Seubert, T.W.

1988-05-01

The modern techniques of modular shipbuilding based on the Product Work Breakdown Structure as developed at the Ishikawajima-Harima Heavy Industries Co., Ltd. of Japan are examined and compared to conventional shipbuilding methods. The application of the Product Work Breakdown Structure in the building of the U.S. Navy's DDG-51 class ship at Bath Iron Works is described and compared to Japanese shipbuilding practices. Implementation of the Product Work Breakdown Structure at Avondale Shipyards, Incorporated is discussed and compared to Bath Iron Works shipbuilding practices. A proposed generic implementation of the Product Work Breakdown Structure to the modular construction of nuclear powermore » plants is described. Specific conclusions for the application of Product Work Breakdown Structure to the construction of a light water reactor nuclear power plant are discussed.« less

G-DRG Version 2009: new developments.

PubMed

Müller, Marcel L; Forschner, Andrea; Wenke, Andreas; Luger, Thomas A; Rompel, Rainer; Roeder, Norbert; Hensen, Peter

2009-04-01

The update of the G-DRG system for the year 2009 has been successfully negotiated. Like in the past years, changes are minimal and not dramatic, but they significantly enhance the quality of the DRG system. Once again, the German DRG system demonstrates its versatility and reliability for clinical reimbursement purposes. In the field of dermatology, several improvements or enhancements can be identified; the average case mix index that declined in the past years should now rise by 0.5 percent for 2009. Oncology cases are affected especially by this increase. Some refinements advanced for several years by the German Dermatologic Society (DDG) have been recognized --complex therapies like vacuum wound therapy, isolation due to multi-resistant infections and multiple primary tumors now have better cost weights. Although there still remain some minor problems like reimbursement of cost-intensive treatments, German dermatology is in summary very well prepared for the year 2009.

Pediatric dermatohistopathology--histopathology of skin diseases in newborns and infants.

PubMed

Wobser, Marion; Ernestus, Karen; Hamm, Henning

2015-06-01

While neonatal skin physiology has been thoroughly examined using non-invasive techniques in recent years, only few systematic studies and review articles addressing the histopathology of neonatal skin have been published thus far. In most cases, histopathological findings of dermatoses in neonatal skin do not significantly differ from those seen in adult skin. Nevertheless, a comprehensive knowledge of embryonic and fetal skin development as well as the microanatomical structure of neonatal skin can contribute to a better understanding of various dermatoses of infancy. In the first part of this review article, we present the histopathological features of such skin diseases, which, though generally rare, almost exclusively appear during the first weeks of life due to distinctive structural and functional features of neonatal skin. The second part is dedicated to classic dermatoses of infancy and their histopathological features. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Are the classic diagnostic methods in mycology still state of the art?

PubMed

Wiegand, Cornelia; Bauer, Andrea; Brasch, Jochen; Nenoff, Pietro; Schaller, Martin; Mayser, Peter; Hipler, Uta-Christina; Elsner, Peter

2016-05-01

The diagnostic workup of cutaneous fungal infections is traditionally based on microscopic KOH preparations as well as culturing of the causative organism from sample material. Another possible option is the detection of fungal elements by dermatohistology. If performed correctly, these methods are generally suitable for the diagnosis of mycoses. However, the advent of personalized medicine and the tasks arising therefrom require new procedures marked by simplicity, specificity, and swiftness. The additional use of DNA-based molecular techniques further enhances sensitivity and diagnostic specificity, and reduces the diagnostic interval to 24-48 hours, compared to weeks required for conventional mycological methods. Given the steady evolution in the field of personalized medicine, simple analytical PCR-based systems are conceivable, which allow for instant diagnosis of dermatophytes in the dermatology office (point-of-care tests). © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Activity of binary mixtures of drospirenone with progesterone and 17α-ethinylestradiol in vitro and in vivo.

PubMed

Rossier, Nadine Madeleine; Chew, Geraldine; Zhang, Kun; Riva, Francesco; Fent, Karl

2016-05-01

Despite potential exposure of aquatic organisms to mixtures of steroid hormones, very little is known on their joint activity in fish. Drospirenone (DRS) is a new synthetic progestin used in contraceptive pills in combination with 17α-ethinylestradiol (EE2). Here we systematically analyzed effects of DRS in binary mixtures with progesterone (P4) and EE2. First, we determined the in vitro activity of single compounds in recombinant yeast assays that express the human progesterone, androgen, or estrogen receptor, followed by determination of mixture activities of DRS and P4, DRS and EE2, as well as medroxyprogesterone acetate (MPA) and dydrogesterone (DDG). Mixtures of DRS and P4, as well as of DRS and EE2 showed additive progestogenic and androgenic activities. However, DDG and MPA showed non-additive progestogenic and androgenic activities. We then analyzed the in vivo activity of single compounds and mixtures of DRS and P4, as well as DRS and EE2, by assessing transcriptional changes of up to 14 selected target genes in zebrafish embryos at 48h post fertilization (hpf), and in eleuthero-embryos at 96hpf and 144hpf. DRS, P4, and EE2 led to significant transcriptional alteration of genes, including those encoding hormone receptors (pgr, esr1), a steroidogenic enzyme (hsd17b3), and estrogenic markers (vtg1, cyp19b), in particular at 144 hpf. In general, DRS showed stronger transcriptional changes than P4. In mixtures of DRS and P4, they were mainly non-additive (antagonistic interaction). In mixtures of DRS and EE2, transcriptional responses of esr1, vtg1 and cyp19b were dominated by EE2, suggesting an antagonistic interaction or independent action. Equi-effective mixtures of DRS and EE2, based on progesterone receptor transcripts, showed antagonistic interactions. Our data suggest that interactions in mixtures assessed in vitro in recombinant yeast cannot be translated to the in vivo situation. The receptor-based responses did not correspond well to the transcriptional responses in embryos which are much more complex due to the interplay between hormonal pathways, receptor crosstalk, and hormonal feedback loops. Copyright © 2016 Elsevier B.V. All rights reserved.

New developments in occupational dermatology.

PubMed

Diepgen, Thomas L

2016-09-01

Occupational skin diseases according to BK No. 5101 - "severe or recurrent skin diseases which have forced the person to discontinue all occupational activities that caused or could cause the development, worsening, or recurrence of the disease" - is the most commonly reported notifiable occupational diseases in Germany. Following the optimization of measures of primary, secondary, and tertiary prevention, today most individuals affected are able to continue their profession. With the revision of the German ordinance on occupational diseases (BKV) in January 2015, skin cancer caused by UV irradiation was added to the list of occupational diseases. The new occupational disease (BK) 5103 is defined as "squamous cell carcinoma or multiple actinic keratoses of the skin caused by natural UV irradiation". In this context, "multiple" signifies the occurrence of either more than five individual actinic keratosis lesions over the course of 12 months or the presence of field cancerization of > 4 cm(2) . In the following review, important aspects of this new occupational disease will be highlighted and discussed. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Rosazea-Management: Update über allgemeine Maßnahmen und topische Therapieoptionen.

PubMed

Schaller, M; Schöfer, H; Homey, B; Hofmann, M; Gieler, U; Lehmann, P; Luger, T A; Ruzicka, T; Steinhoff, M

2016-12-01

Obwohl bislang für die Rosazea keine kurative Therapie besteht, können verschiedene Optionen zur Behandlung der Symptome und zur Vorbeugung von Exazerbationen empfohlen werden. Neben Selbsthilfemaßnahme wie der Vermeidung von Triggerfaktoren und einer geeigneten Hautpflege sollte das Rosazea-Management bei Patienten mit erythematöser und leichter bis schwerer papulopustulöser Rosazea die Anwendung topischer Präparate als First-Line-Therapie umfassen. Da Überlappungen der charakteristischen Rosazea-Symptome im klinischen Alltag die Regel sind, sollte die medikamentöse Therapie auf die individuellen Symptome zugeschnitten werden; auch eine Kombinationstherapie kann erforderlich sein. Zu den für die Behandlung der Hauptsymptome der Rosazea zugelassenen Wirkstoffen gehören Brimonidin gegen das Erythem sowie Ivermectin, Metronidazol oder Azelainsäure gegen entzündliche Läsionen. Ihre Wirksamkeit wurde in zahlreichen validen, gut kontrollierten Studien belegt. Darüber hinaus existieren verschiedene nicht zugelassene topische Behandlungsmöglichkeiten, deren Wirksamkeit und Sicherheit noch in größeren, kontrollierten Studien zu untersuchen ist. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

High-definition optical coherence tomography - an aid to clinical practice and research in dermatology.

PubMed

Cao, Taige; Tey, Hong Liang

2015-09-01

At present, beyond clinical assessment, the diagnosis of skin diseases is primarily made histologically. However, skin biopsies have many disadvantages, including pain, scarring, risk of infection, and sampling error. With recent advances in skin imaging technology, the clinical use of imaging methods for the practical management of skin diseases has become an option. The in vivo high-definition optical coherence tomography (HD-OCT) has recently been developed and commercialized (Skintell; Agfa, Belgium). Compared with conventional OCT, it has a higher resolution; compared with reflectance confocal microscopy, it has a shorter time for image acquisition as well as a greater penetration depth and a larger field of view. HD-OCT is promising but much work is still required to develop it from a research tool to a valuable adjunct for the noninvasive diagnosis of skin lesions. Substantial work has been done to identify HD-OCT features in various diseases but interpretation can be time-consuming and tedious. Projects aimed at automating these processes and improving image quality are currently under way. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Testing of an Integrated Reactor Core Simulator and Power Conversion System with Simulated Reactivity Feedback

NASA Technical Reports Server (NTRS)

Bragg-Sitton, Shannon M.; Hervol, David S.; Godfroy, Thomas J.

2009-01-01

A Direct Drive Gas-Cooled (DDG) reactor core simulator has been coupled to a Brayton Power Conversion Unit (BPCU) for integrated system testing at NASA Glenn Research Center (GRC) in Cleveland, OH. This is a closed-cycle system that incorporates an electrically heated reactor core module, turbo alternator, recuperator, and gas cooler. Nuclear fuel elements in the gas-cooled reactor design are replaced with electric resistance heaters to simulate the heat from nuclear fuel in the corresponding fast spectrum nuclear reactor. The thermodynamic transient behavior of the integrated system was the focus of this test series. In order to better mimic the integrated response of the nuclear-fueled system, a simulated reactivity feedback control loop was implemented. Core power was controlled by a point kinetics model in which the reactivity feedback was based on core temperature measurements; the neutron generation time and the temperature feedback coefficient are provided as model inputs. These dynamic system response tests demonstrate the overall capability of a non-nuclear test facility in assessing system integration issues and characterizing integrated system response times and response characteristics.

Testing of an Integrated Reactor Core Simulator and Power Conversion System with Simulated Reactivity Feedback

NASA Technical Reports Server (NTRS)

Bragg-Sitton, Shannon M.; Hervol, David S.; Godfroy, Thomas J.

2010-01-01

A Direct Drive Gas-Cooled (DDG) reactor core simulator has been coupled to a Brayton Power Conversion Unit (BPCU) for integrated system testing at NASA Glenn Research Center (GRC) in Cleveland, Ohio. This is a closed-cycle system that incorporates an electrically heated reactor core module, turboalternator, recuperator, and gas cooler. Nuclear fuel elements in the gas-cooled reactor design are replaced with electric resistance heaters to simulate the heat from nuclear fuel in the corresponding fast spectrum nuclear reactor. The thermodynamic transient behavior of the integrated system was the focus of this test series. In order to better mimic the integrated response of the nuclear-fueled system, a simulated reactivity feedback control loop was implemented. Core power was controlled by a point kinetics model in which the reactivity feedback was based on core temperature measurements; the neutron generation time and the temperature feedback coefficient are provided as model inputs. These dynamic system response tests demonstrate the overall capability of a non-nuclear test facility in assessing system integration issues and characterizing integrated system response times and response characteristics.

Therapeutic management of cutaneous and genital warts.

PubMed

Ockenfels, Hans Michael

2016-09-01

During their lifetime, at least 10 % of the population will be infected by human papillomaviruses (HPV), clinically characterized by the formation of cutaneous or genital warts. Although warts are ubiquitous, there are no defined treatments. Especially in the first six months, warts frequently resolve without therapeutic intervention. This complicates the interpretation of study data, given that many studies do not differentiate between newly infected patients and those with infections that have persisted for a long time. Similarly, most studies do not take location, size, and thickness of lesions into account, either. The objective of the present review article is to analyze the study data currently available, taking into consideration both subtypes and locations - factors exceedingly crucial in clinical practice. In particular, the distinction between new-onset and chronic recalcitrant warts is reflected in a therapeutic algorithm. In the case of genital warts, the algorithm is more clearly determined by the extent of the area affected rather than the longevity of lesions. In immunocompetent individuals, any therapeutic intervention must be aimed at achieving complete resolution. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

New systemic agents in dermatology with respect to fertility, pregnancy, and lactation.

PubMed

Grunewald, Sonja; Jank, Alexander

2015-04-01

With the increasing use of new, predominantly biologic drugs in dermatology, questions frequently arise in clinical practice as to their safety in women wishing to conceive as well as during pregnancy and lactation. Apart from the Summary of Product Characteristics and the Physician's Desk Reference, reliable information may be obtained from databases such as the one compiled by the Center for Pharmacovigilance and Consultation on Embryonal Toxicology at Charité University Medical Center Berlin (https://www.embryotox.de). Another source of information is researching recent publications, for example via PubMed (http://www.ncbi.nlm.nih.gov/pubmed). This article presents current knowledge from the sources mentioned above, and gives detailed information about the use of new biologic agents in women wishing to conceive as well as during pregnancy and lactation. Drugs reviewed include: infliximab, adalimumab, etanercept, metastatic for psoriasis, vemurafenib, dabrafenib, imatinib, ipilimumab for melanoma, vismodegib for basal cell carcinoma, rituximab for cutaneous lymphoma as well as omalizumab and anakinra used in the treatment of allergies. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Large-scale alcohol production from corn, grain sorghum, and crop residues

DOE Office of Scientific and Technical Information (OSTI.GOV)

Turhollow, A.F. Jr.

1982-01-01

The potential impacts that large-scale alcohol production from corn, grain sorghum, and crop residues may have on US agriculture in the year 2000 are investigated. A one-land-group interregional linear-programming model is used. The objective function is to minimize the cost of production in the agricultural sector, given specified crop demands and constrained resources. The impacts that levels of alcohol production, ranging from zero to 12 billion gallons, have at two projected levels of crop demands, two grain-to-alcohol conversion and two milling methods, wet and dry, rates are considered. The impacts that large-scale fuel alcohol production has on US agriculture aremore » small. The major impacts that occur are the substitution of milling by-products, DDG, gluten feed, and gluten meal, for soybean meal in livestock feed rations. Production of 12 billion gallons of alcohol is estimated to be equivalent to an 18 percent increase in crop exports. Improving the grain-to-alcohol conversion rate from 2.6 to 3.0 gallons per bushels reduces the overall cost of agricultural production by $989 billion when 12 billion gallons of alcohol are produced.« less

Biosimilars in psoriasis: what can we expect?

PubMed

Radtke, Marc Alexander; Augustin, Matthias

2014-04-01

Biosimilars are biotechnologically processed drugs whose amino acid sequence is identical to the original biopharmaceutical. They are of considerable clinical, economical, and health care interest. As patents for biologicals used to treat psoriasis expire, biosimilars will become more and more important within the field of dermatology. The patents for the two top-selling drugs (adalimumab and etanercept) will terminate in the next few years. Applications for biosimilars will presumably be submitted to the EMA and the FDA for all patent-free biologicals. Both regulatory bodies have issued guidelines on the assessment of bioequivalence, as well as the benefits and risks of biosimilars. While the preclinical requirements of the FDA and EMA are largely comparable, the formal requirements for clinical bioequivalence, including clinical efficacy and safety, differ markedly. Therefore, from a medical and health care perspective before biosimilars enter the market, specific evidence-based regulatory conditions need to be created and fulfilled. Only then biosimilars can be a less expensive option for a large number of patients, providing them with substances of the same value. Adequate, unequivocal proof of their bioequivalence, quality, and related patient safety should have priority over any ostensible economic benefits. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Delayed immediate-type hypersensitivity to red meat and innards: current insights into a novel disease entity.

PubMed

Fischer, Jörg; Biedermann, Tilo

2016-01-01

The development of component-resolved diagnostics instead of whole extracts has brought about major advances in recent years. Particularly remarkable has been the identification of new disease entities based on the detection of IgE antibodies against specific individual components. In this context, delayed immediate-type hypersensitivity to red meat and innards plays a key role. This disorder is more common in German-speaking countries and likely still underdiagnosed. Affected individuals exhibit delayed type I reactions following the consumption of red meat or innards (responses to the latter are more rapid). All patients have IgE antibodies against the oligosaccharide galactose-α-1,3-galactose - alpha-gal. Those affected also have to avoid alpha-gal-containing drugs such as cetuximab or gelatin-containing colloidal solutions. Also referred to as alpha-gal syndrome, this condition is unique in that it is characterized by type I hypersensitivity to a sugar instead of a protein. Given that many patients have a history of recurrent episodes of acute urticaria or angioedema, dermatologists should be familiar with the alpha-gal syndrome. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Dapsone for topical use in extemporaneous preparations.

PubMed

Wohlrab, Johannes; Michael, Julia

2018-01-01

The sulfone dapsone has an established role in systemic therapy. Its pharmacological and toxicological properties are well known. Topically, dapsone is used in a gel formulation for the treatment of acne vulgaris. In addition, there have been individual case reports on the efficacy of topical dapsone preparations in the treatment of various neutrophilic dermatoses. To date, no finished medicinal product for topical use has been available in Germany. Against this background, we set out to develop extemporaneous preparations containing dapsone (5 %) that meet the quality requirements of the European Pharmacopoeia as well as the manufacturing requirements of the German Ordinance on the Operation of Pharmacies (ApBetrO). These formulations included the incorporation of dapsone in a hydrophobic cream base ("hydrophobe Basiscreme DAC") as well as in methylprednisolone aceponate 0.1 % ointment (alternatively, in the latter's cream base without active ingredient). Tests aimed at investigating the physical, chemical, and microbiological stability of these formulations showed them to meet the aforementioned quality requirements. The extemporaneous formulations presented herein broaden the therapeutic options for topical treatment, in particular for patients with chronic inflammatory dermatoses associated with a neutrophilic pathogenesis. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Effects of feeding corn modified wet distillers grain plus solubles co-ensiled with direct-cut forage on feedlot performance, carcass characteristics, and diet digestibility of finishing steers.

PubMed

Arias, R P; Unruh-Snyder, L J; Scholljegerdes, E J; Baird, A N; Johnson, K D; Buckmaster, D; Lemenager, R P; Lake, S L

2012-10-01

Two experiments were conducted to evaluate the effects of feeding corn modified wet distillers grain plus solubles (MWDGS) co-ensiled with direct-cut forage (DC) to beef steers, on feedlot performance and total tract digestibility. In Exp. 1, sixty-four crossbred Angus steers (n = 64; 329 ± 43 kg) were blocked by BW and randomly assigned to 1 of 4 dietary treatments: 1) corn-silage and soybean meal (CON), 2) DC co-ensiled with MWDGS (CO-EN), 3) haylage mixed with MWDGS at feeding (H+WDG), and 4) haylage mixed with dry distillers grains plus solubles at feeding (H+DDG). Steers were harvested when they reached an endpoint of 1.1 cm of 12th-rib back fat. In Exp. 2, four ruminally cannulated beef steers (initial BW = 556 ± 31 kg) were used in a 4 × 4 Latin square to evaluate digestibility of diets used in Exp. 1. Experimental periods were 14 d in length with 10 d for diet adaptation and 4 d for sample collection. Three linear orthogonal contrasts were used to compare effects of 1) CON vs. diets containing distillers grains (DGD), 2) CO-EN vs. diets where distillers grains were mixed at feeding (MIX), and 3) H+WDG vs. H+DDG. In Exp. 1, DMI was less (P < 0.001) for steers fed CON compared with those fed DGD and greatest (P < 0.001) for steers fed CO-EN compared with MIX. Corn-silage- and soybean-meal-fed steers had more days on feed than those fed DGD (P = 0.001). Body weight gain (P = 0.02) was greater for CO-EN compared with MIX. Fat thickness at the 12th and 13th ribs was greater (P = 0.03) for DGD steers compared with CON steers. Hot carcass weight was greater (P = 0.03) for steers fed CO-EN compared with those fed MIX. Steers fed CON resulted in greater marbling scores (P = 0.01) compared DGD-fed steers. Longissimus muscle area was greater (P = 0.01) for CON-fed steers compared with all other treatments. In Exp. 2, no differences (P > 0.10) in DM, OM, or N intakes were observed. Apparent total tract DM (P = 0.01) and N (P = 0.02) digestibility were greatest in steers fed CON compared with all others. Steers fed DGD had less (P = 0.02) rumen NH(3) concentrations compared with CON. The CON diet resulted in greater molar concentrations of VFA (P = 0.03) and decreased acetate to propionate ratio (P = 0.03) compared with all DGD. These data suggest that feeding MWDGS co-ensiled with direct-cut forage results in reduced diet digestibility but equal or greater feedlot performance and similar carcass and characteristics when compared with a corn diet supplemented with soybean meal and diets where MWDGS and DDGS were added at the mixer.

Impact of red versus blue light on tolerability and efficacy of PDT: a randomized controlled trial.

PubMed

Gholam, Patrick; Bosselmann, Ina; Enk, Alexander; Fink, Christine

2018-06-01

Various light sources may be used for photodynamic therapy of actinic keratosis since photosensitizing agents are activated by different wavelengths. However, the relative impact of red and blue light irradiation on the efficacy and tolerability of therapy is controversial. The aim of this study is to compare the efficacy and tolerability of therapy with red versus blue light sources, as well as the patients' evaluation of cosmetic results, clinical response, painfulness and preferred light source for future photodynamic treatments. This is a prospective, single-center, randomized, controlled, open-label study with 28 patients undergoing elective photodynamic therapy. Red and blue light sources both showed very good results with a complete response rate of 84 % and 85 % respectively. Pain during photodynamic therapy was 6.1 vs. 5.4 (and 2.1 vs. 1.5 eight hours after therapy) on the visual analogue scale. Although these differences were statistically significant, the clinical relevance is low, since the number of therapy interruptions were equally distributed in both groups, and patients' subjective evaluation of the treatment showed no personal preference towards the light sources. Both light sources showed very good clinical results and satisfactory tolerability in this study. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Corn ethanol production, food exports, and indirect land use change.

PubMed

Wallington, T J; Anderson, J E; Mueller, S A; Kolinski Morris, E; Winkler, S L; Ginder, J M; Nielsen, O J

2012-06-05

The approximately 100 million tonne per year increase in the use of corn to produce ethanol in the U.S. over the past 10 years, and projections of greater future use, have raised concerns that reduced exports of corn (and other agricultural products) and higher commodity prices would lead to land-use changes and, consequently, negative environmental impacts in other countries. The concerns have been driven by agricultural and trade models, which project that large-scale corn ethanol production leads to substantial decreases in food exports, increases in food prices, and greater deforestation globally. Over the past decade, the increased use of corn for ethanol has been largely matched by the increased corn harvest attributable mainly to increased yields. U.S. exports of corn, wheat, soybeans, pork, chicken, and beef either increased or remained unchanged. Exports of distillers' dry grains (DDG, a coproduct of ethanol production and a valuable animal feed) increased by more than an order of magnitude to 9 million tonnes in 2010. Increased biofuel production may lead to intensification (higher yields) and extensification (more land) of agricultural activities. Intensification and extensification have opposite impacts on land use change. We highlight the lack of information concerning the magnitude of intensification effects and the associated large uncertainties in assessments of the indirect land use change associated with corn ethanol.

DRG benchmarking: analysis of service structures and -differences in dermatology departments.

PubMed

Fürstenberg, Torsten; Gierling, Patrick; Irps, Sebastian; Gollnick, Harald; Kaufmann, Roland; Stadler, Rudolf; Rompel, Rainer; Hensen, Peter

2014-07-01

In the context of DRG-based hospital funding, the analysis of services provided in dermatologic inpatient care is highly relevant. We analyzed and compared clinical service structures and varieties in dermatologic hospitals through a benchmarking technique. For this multicenter cross-sectional study, routine data from 46 German dermatologic clinics and departments were collected, processed, and analyzed. In total, 95 257 data sets from 2011 were available. The data were grouped according to the G-DRG-system 2013 version. The average length of stay for all cases was 6.3 days (DRG "inliers": 5.7 days), and average patient age was 52 years. In total, 55 % of all cases were grouped to medical, 45 % to surgical DRGs. 71 % of all hospitals provide services within or close to this average value (± 10 %). No association was found between the number of hospital beds and the variety of clinical services provided in our sample. We found huge varieties in several parameters assessing the coding quality. The results reflect the heterogeneous reality in German inpatient dermatology. The varieties in dermatologic service range still depend on patient-related factors as well as infrastructural conditions and the resources available at each site. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Hand dermatitis--differential diagnoses, diagnostics, and treatment options.

PubMed

Mahler, Vera

2016-01-01

The pathogenesis of hand dermatitis is multifactorial, and includes factors such as genetic predisposition and exposure. A high incidence rate is associated with female gender, contact allergy, atopic dermatitis, and wet work. The most important risk factors for the persistence of hand dermatitis include its extent, contact allergic or atopic etiology, childhood dermatitis, and early onset (before the age of 20). The cost of illness of hand dermatitis corresponds to this seen in moderate to severe psoriasis. The diagnostic workup of hand dermatitis and its differential diagnoses requires a detailed assessment of occupational and recreational exposure. In case of possible work-related triggers, early notification of the accident insurer should be sought (via the dermatologist's report). Exposure to a contact allergen is a contributing factor in one-half of all cases of hand dermatitis. It is therefore imperative that all patients with hand dermatitis persisting for more than three months undergo patch testing. Successful and sustainable treatment of hand dermatitis starts with the proper identification and elimination of individual triggers, including the substitution of identified contact allergens and irritants, as well as optimizing preventive measures. Graded therapy taking the clinical severity into account is essential. Validated instruments may be used to monitor therapeutic efficacy. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Macrophages - sensors and effectors coordinating skin damage and repair.

PubMed

Willenborg, Sebastian; Eming, Sabine A

2014-03-01

Restoration of skin integrity and homeostasis following injury is a vital process. Wound healing disorders, including chronic skin ulcers and pathological scarring, are of major clinical impact. The current therapeutic approaches are often not sufficient. The development of novel efficient therapies requires a thorough understanding of the underlying molecular mechanisms. A cardinal feature of non-healing skin ulcers and excessive scarring is a prolonged inflammatory response at the wound site, which aborts the healing response. Modulation of the local immune response may be an effective therapeutic strategy to correct impaired healing conditions. Yet, the specific mechanisms of inflammation, particularly the role of the diverse leukocyte lineages attracted to the site of tissue damage, have not been resolved. Recent findings in diverse experimental model systems and clinical studies have refined the understanding of monocyte/macrophage biology and the role of cells of the monocytic lineage in tissue regeneration. Thus, monocytes/macrophages are emerging as novel and interesting therapeutic targets to interfere in wound healing pathologies. In this article we will review the role of monocytes/macrophages in skin repair in the light of the recent literature and findings from our own group. This article will provide a rationale for monocyte/macrophage-based therapies to facilitate the healing response. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Xeroderma pigmentosum: diagnostic procedures, interdisciplinary patient care, and novel therapeutic approaches.

PubMed

Lehmann, Janin; Schubert, Steffen; Emmert, Steffen

2014-10-01

Xeroderma pigmentosum (XP) is an autosomal recessive disease, caused by a gene defect in the nucleotide-excision-repair (NER) pathway or in translesional DNA synthesis. At the age of eight, patients already develop their first skin cancers due to this DNA repair defect. In contrast, in the Caucasian population the first tumor formation in UV exposed skin regions occurs at a mean age of 60. The clinical picture among patients suffering from XP is highly diverse and includes signs of accelerated skin aging, and UV-induced skin cancers, as well as ophthalmologic and neurological symptoms. Patients should therefore receive interdisciplinary care. This includes dermatologists, ophthalmologists, ENT specialists, neurologists, and human geneticists. Patients with XP are clinically diagnosed, but this may be supported by molecular-genetic and functional analyses. These analyses allow pinpointing the exact disease-causing gene defect (complementation group assignment, detection of the type and location of the mutation within the gene). The resulting information is already relevant to predict the course of disease and symptoms and probably will be utilized for individualized therapeutic approaches in the future. Recently, enhanced repair of UV photolesions in xeroderma pigmentosum group C cells induced by translational readthrough of premature termination codons by certain antibiotics could be demonstrated. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Lymphomatoid papulosis - making sense of the alphabet soup: a proposal to simplify terminology.

PubMed

Kempf, Werner; Mitteldorf, Christina; Karai, Laszlo J; Robson, Alistair

2017-04-01

Clinically, lymphomatoid papulosis (LYP) is characterized by recurrent papulonodular lesions. Unlike this stereotypical clinical presentation, the histological spectrum of LYP is very wide, comprising distinct growth patterns, variably sized neoplastic cells, and different immunophenotypes. The revised 2016 WHO classification includes the histological LYP types A to E as well as another type characterized by a specific chromosomal alteration. In addition, new LYP types are going to be proposed, based not only on histological but also on clinical and genetic features. The ensuing expansion of the alphabetical list of histological types will add to the complexity of the terminology of LYP, thereby potentially increasing the risk of complicating rather than facilitating the diagnostic approach to the disease. Moreover, there may be overlap between individual disease types. This development raises the question as to how to simplify the terminology of LYP while still respecting its histological complexity. Herein, we advocate a practical approach to the terminology of LYP based on descriptive terms rather than the designation of LYP types by alphabetical characters. Our proposal aims to contribute to a pragmatic and user-friendly approach, thus not only facilitating the diagnostic process but also the communication between clinicians and pathologists. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Lipomatosen.

PubMed

Al Ghazal, Philipp; Grönemeyer, Lisa-Lena; Schön, Michael P

2018-03-01

Als Lipomatosen bezeichnet man gutartige, meist ohne eindeutige Auslöser auftretende Vermehrungen des Fettgewebes, oft mit typischem Verteilungsmuster. Im Gegensatz zu umschriebenen Lipomen entwickeln sie sich meist diffus-symmetrisch und sind nicht von einer fibrösen Pseudokapsel umgeben. Am häufigsten ist die benigne symmetrische Lipomatose (BSL; Launois-Bensaude-Syndrom), von der aufgrund des Verteilungsmusters des hyperplastischen Fettgewebes vier Typen unterschieden werden. Ätiologie und Pathogenese der Erkrankung sind noch weitgehend unbekannt, wobei manche Formen eine hereditäre Basis zu haben oder mit vermehrtem Alkoholkonsum assoziiert zu sein scheinen. In einigen Fällen wurden mitochondriale Fehlfunktionen nachgewiesen. Lipomatosen können isoliert, aber auch mit Begleitsymptomen oder -erkrankungen (Komorbidität) vergesellschaftet auftreten. Wirksame medikamentöse Therapien sind nicht bekannt; chirurgische Verfahren können hingegen zur Besserung der Symptome führen. Die von der BSL abzugrenzende Lipomatosis dolorosa tritt bevorzugt bei Frauen mittleren Alters auf und ist durch Vermehrung des Fettgewebes sowie starke Schmerzen in den betroffenen Bereichen gekennzeichnet. Verschiedene Differenzialdiagnosen und Begleiterkrankungen sind abzuklären, insbesondere Depressionen. Evidenzbasierte Therapieempfehlungen existieren nicht. Repetitive Lidocain-Infusionen können temporäre Besserungen bewirken; nach chirurgischen Interventionen treten häufig Rezidive auf, allerdings werden auch langfristige Erfolge erzielt. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Psychosocial burden and desire for support in outpatients with skin cancer.

PubMed

Buchhold, Britta; Wiesmann, Ulrich; Bahlmann, Johannes; Lutze, Stine; Eggert, Claudia; Arnold, Andreas; Daeschlein, Georg; Jünger, Michael; Hannich, Hans-Joachim

2016-04-01

An important basis for adequate psycho-oncological and psychosocial care of cancer patients is the regular assessment of their psychosocial distress and thus their need for care. For this purpose, there are numerous questionnaires available. The objective of the present study was to assess whether distressed patients require professional support and which screening instrument outpatients with skin cancer prefer. In a cross-sectional survey, we asked outpatients with skin cancer to fill out three questionnaires assessing psychosocial stress, and to indicate which one they considered most adequate. Patients were offered the following three instruments: Hornheide Questionnaire (27 items), Hornheide Screening Instrument (7 items), and the Distress Thermometer. In addition, we inquired about the patients' desire for support. (1) Comparing subjective distress and patients' declared desire for support revealed a marked divergence. While one-third of the 137 patients were identified as being in need of care, only 11.5% of the sample requested such support. (2) 63.7% of patients chose the long version of the Hornheide Questionnaire. In addition to their psychosocial burden, patients' desire for support should be assessed. Moreover, apart from screening tools, other ways to provide access to psychosocial care should be considered. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Trauma-induced pemphigus: a case series of 36 patients.

PubMed

Daneshpazhooh, Maryam; Fatehnejad, Mina; Rahbar, Ziba; Balighi, Kamran; Ghandi, Narges; Ghiasi, Maryam; Abedini, Robabeh; Lajevardi, Vahideh; Chams-Davatchi, Cheyda

2016-02-01

Pemphigus is a group of autoimmune diseases characterized by intraepidermal acantholytic blisters. Isomorphic responses, or Koebner phenomenon (KP), defined as the appearance of typical lesions of a disease following trauma are rarely reported in pemphigus. Our aim was to present patients who developed new pemphigus lesions as a result of skin trauma. The medical files of pemphigus patients from the Autoimmune Bullous Diseases Research Center, who had a history of trauma before the onset or flare of their disease, between 1999 and 2013 were reviewed. Thirty-six pemphigus vulgaris (PV) patients had a history of trauma. Thirteen patients developed new-onset PV and the other 23 had previously been diagnosed with PV. Pemphigus lesions developed most often following major surgeries including abdominal, orthopedic, and chest surgeries as well as dental procedures, blunt physical trauma, and skin surgeries. Moreover, post-cataract laser surgery, burns, radiation therapy, and physiotherapy were also shown to induce pemphigus. Mean time between trauma and lesions was 4.7 weeks for recurrent PV and 15.0 weeks for new-onset PV. Unnecessary surgery and blunt trauma should be avoided in pemphigus patients. Furthermore, posttraumatic pemphigus should be suspected in poorly healing surgical wounds and confirmatory biopsies are mandatory. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Vasculitic wheel - an algorithmic approach to cutaneous vasculitides.

PubMed

Ratzinger, Gudrun; Zelger, Bettina Gudrun; Carlson, J Andrew; Burgdorf, Walter; Zelger, Bernhard

2015-11-01

Previous classifications of vasculitides suffer from several defects. First, classifications may follow different principles including clinicopathologic findings, etiology, pathogenesis, prognosis, or therapeutic options. Second, authors fail to distinguish between vasculitis and coagulopathy. Third, vasculitides are systemic diseases. Organ-specific variations make morphologic findings difficult to compare. Fourth, subtle changes are recognized in the skin, but may be asymptomatic in other organs. Our aim was to use the skin and subcutis as a model and the clinicopathologic correlation as the basic process for classification. We use an algorithmic approach with pattern analysis, which allows for consistent reporting of microscopic findings. We first differentiate between small and medium vessel vasculitis. In the second step, we differentiate the subtypes of small (capillaries versus postcapillary venules) and medium-sized (arterioles/arteries versus veins) vessels. In the final step, we differentiate, according to the predominant cell type, into leukocytoclastic and/or granulomatous vasculitis. Starting from leukocytoclastic vasculitis as a central reaction pattern of cutaneous small/medium vessel vasculitides, its relations or variations may be arranged around it like spokes of a wheel around the hub. This may help establish some basic order in this rather complex realm of cutaneous vasculitides, leading to a better understanding in a complicated field. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

[Cinnamon in type 2 diabetics].

PubMed

Ammon, Hermann P T

2008-05-01

At present numerous preparations containing cinnamon are in the market. And it is claimed that they are suitable as dietetic food or food additive to regulate glucose metabolism in patients with type 2 diabetes. Background for this proposition are the results of some pharmacological and clinical studies, showing improvement of glucose tolerance in streptozotocin-diabetic animals, stimulation of insulin secretion in vitro and lowering blood glucose in type 2 diabetic patients during simultaneous treatment with oral antidiabetics. This led to a controversy between producers of food additives on the one side and scientists in the field of pharmacology and diabetology on the other. In this connection in a scientific statement the German Diabetes Association (DDG) and the German Pharmaceutical Society (DPhG) kept on distance from the use of cinnamon as a dietetic food/food supplement. The point is the interpretation of what is considered to be a food and what is a drug for medical purposes. Since cinnamon has been used for long as a spice, the nutrition site claims cinnamon as a food. In contrary the medical site in this case claims cinnamon as a drug because of its pharmacological effects on glucose tolerance, insulin resistance, insulin release and blood-sugar. In the meantime this is a case of jurisdiction.

Body dysmorphic concerns, social adaptation, and motivation for psychotherapeutic support in dermatological outpatients.

PubMed

Ritter, Viktoria; Fluhr, Joachim W; Schliemann-Willers, Sibylle; Elsner, Peter; Strauß, Bernhard; Stangier, Ulrich

2016-09-01

Dermatologists are increasingly confronted with patients affected by body dysmorphic disorder (BDD). BDD is characterized by excessive preoccupation with one or more perceived defect(s) or flaw(s) in physical appearance which are not observable or appear slight to others. So far, there have been only few studies examining the prevalence of BDD in dermatological outpatients. In addition, the need for psychotherapeutic support in dermatological outpatients with body dysmorphic concerns has not yet been systematically examined. The objective of the present study was therefore to investigate the frequency of body dysmorphic concerns as well as social adaptation and the need for psychotherapeutic support in the aforementioned patient group. A total of 252 dermatological outpatients seen at a German university hospital were consecutively enrolled, and examined using the Dysmorphic Concerns Questionnaire, the Social Adaptation Self-Evaluation Scale, and the German version of the University of Rhode Island Change Assessment Scale. 7.9 % of all outpatients (unselected sample) showed positive test results, suggesting clinically relevant body dysmorphic concerns. Patients with clinically relevant body dysmorphic concerns exhibited poor social adaptation. Contrary to expectations, these patients revealed a high motivation for change, indicating the necessity for psychotherapeutic support. Our findings confirm previous prevalence rates of BDD in dermatological outpatients, and highlight the need for providing psychotherapeutic support to dermatological patients. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Current options for the treatment of pathological scarring.

PubMed

Poetschke, Julian; Gauglitz, Gerd G

2016-05-01

Scarring is the consequence of surgery, trauma or different skin diseases. Apart from fresh, immature scars,that transform into mature scars over the course of would healing and that do not require further treatment,linear hypertrophic scars, widespread hypertrophic scars, keloids and atrophic scars exist. Symptoms like pruritusand pain, stigmatization as well as functional and aesthetic impairments that are very disturbing for the affected patients can bethe basis for the desire for treatment. Today, a multitude of options for the treatment and prevention of scars exists. Topical agents based on silicone or onion extract, intralesional injections of cristalline glucocorticoids (oftentimes in combinationwith cryotherapy) or 5-Fluorouracil as well as ablative and nonablative laser treatment are used. Current guidelines summarize the multitude of available treatment options and the currently available datafor the treating physicians, allowing them to make clear therapy recommendations for every single scar type. Relieving patients of their discomfort and doing their aesthetic demands justice is thus possible. Apart from scar prevention becoming more and more important, the increased use of modernlaser treatment options constitutes a key point in clinical scar treatment. At the same time the attention is turned to evaluating current therapeutic options with the help of contemporary study designs so as to graduallyimprove the level of evidence in scar treatment. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Nagelbefall kann bei Patienten mit Psoriasis auf eine Enthesiopathie hinweisen.

PubMed

Castellanos-González, Maria; Joven, Beatriz Esther; Sánchez, Julio; Andrés-Esteban, Eva María; Vanaclocha-Sebastián, Francisco; Romero, Pablo Ortiz; Díaz, Raquel Rivera

2016-11-01

Obwohl subklinische Enthesiopathie ein gut etabliertes diagnostisches Merkmal der Psoriasisarthritis (PsA) ist, wird sie häufig übersehen, da viele Patienten asymptomatisch sind. Gäbe es klinische Hinweise auf das Vorliegen einer Enthesiopathie, würde dies den Klinikern die Möglichkeit eröffnen, eine PsA frühzeitig zu diagnostizieren. Es wurde eine monozentrische prospektive Studie mit insgesamt 90 Psoriasis-Patienten durchgeführt, um mittels Ultraschall das Vorliegen von Enthesenanomalien zu untersuchen und eine Korrelation mit dem Befall der Nägel festzustellen. Enthesenanomalien wurden bei 23 Patienten (25,5 %) gefunden, von denen 19 (82,6 %) Nagelbefall aufwiesen. Bei 4 Patienten waren die Nägel nicht betroffen. Enthesiopathie lag bei 31,1 % (19/61) der Patienten mit Onychopathie vor, von den Patienten ohne Nagelbefall litten nur 13,8 % (4/29) an Enthesiopathie (p = 0,07). Zwischen dem Target-NAPSI-Score und dem Vorliegen einer Enthesiopathie bestand eine signifikante Korrelation. Eine signifikante Korrelation bestand darüber hinaus auch zwischen dem Vorliegen einer Enthesiopathie und der Anzahl der betroffenen Nägel (p = 0,035). Klinische Belege für eine Onychopathie können der Schlüssel für die frühe Diagnose einer Enthesiopathie bei Psoriasis-Patienten sein. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Wirksamkeit und Sicherheit von Fumarsäureestern in Kombination mit Phototherapie bei Patienten mit moderater bis schwerer Plaque-Psoriasis (FAST).

PubMed

Weisenseel, Peter; Reich, Kristian; Griemberg, Wiebke; Merten, Katharina; Gröschel, Christine; Gomez, Natalie Nunez; Taipale, Kirsi; Bräu, Beate; Zschocke, Ina

2017-02-01

Die Behandlung von Psoriasis-Patienten mit einer Kombination aus Fumarsäureestern (FSE, Fumaderm ® ) und Phototherapie (UV) ist verbreitet, wurde aber im Rahmen von Studien wenig untersucht. Bisher liegen lediglich Daten aus einer kleinen Pilotstudie vor. Intention dieser Studie war, eine FSE/UV-Kombinationsbehandlung an einem größeren Patientenkollektiv mit mittelschwerer bis schwerer Psoriasis zu untersuchen. In dieser prospektiven, multizentrischen, nichtinterventionellen Studie wurden Daten von Patienten mit FSE/UV-Kombinationstherapie hinsichtlich der Wirksamkeit (PGA' PASI, DLQI, EQ-5D), Sicherheit und Dosierung über einen Zeitraum von zwölf Monaten erfasst und mit Daten einer retrospektiven Studie mit FSE-Monotherapie verglichen. Es wurden Daten von 363 Patienten ausgewertet. Unter der Kombinationstherapie verbesserten sich alle Wirksamkeitsparameter deutlich. Im Vergleich zur Monotherapie mit FSE konnte durch die Kombination mit UV ein schnellerer Wirkeintritt erzielt werden, wobei nach zwölf Monaten kein Unterschied in der Wirksamkeit bestand. Die Dauer und Art der Phototherapie zeigte keinen Einfluss auf die Wirksamkeitsparameter. Allgemein wurde die Kombinationstherapie gut vertragen. Unerwünschte Ereignisse wurden bei 7 % der Patienten berichtet. Die FSE/UV Kombinationstherapie zeigt eine gute Wirksamkeit und Verträglichkeit und kann zu einem schnelleren Wirkeintritt führen. Eine Kombinationstherapie erscheint vor allem in den ersten drei Monaten der FSE Behandlung sinnvoll. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Plattenepithelkarzinom in Verbindung mit einer roten Tätowierung.

PubMed

Schmitz, Inge; Prymak, Oleg; Epple, Matthias; Ernert, Carsten; Tannapfel, Andrea

2016-06-01

Obwohl Tätowierungen in den letzten Jahren außerordentlich beliebt geworden sind, wurde in der Literatur bisher nur über wenige Fälle schwerer Reaktionen berichtet, die zu einer malignen Transformation führten. Dies steht im Kontrast zu der praktisch unüberschaubaren Zahl an Tätowierungen weltweit. Die Zusammensetzung der für Tätowierungen verwendeten Farbstoffe variiert stark, und selbst gleiche Farbtöne können unterschiedliche Komponenten enthalten. Das Ziel unserer Studie war es zu untersuchen, auf welche Weise Tätowierungen möglicherweise Hautkrebs auslösen können. Wir berichten über den seltenen Fall einer 24-jährigen Frau, bei der sich sieben Monate nachdem sie eine Tätowierung auf dem Fußrücken erhalten hatte in unmittelbarer Nähe des verwendeten roten Farbstoffs ein Plattenepithelkarzinom entwickelte. Die Komplikationen begannen mit einer unspezifischen Schwellung. Die Läsion wurde histologisch untersucht. Die Zusammensetzung des inkorporierten Farbstoffs wurde mittels Rasterelektronenmikroskopie in Kombination mit energiedispersiver Elementanalyse analysiert. Zur weiteren Charakterisierung wurden Thermogravimetrie und Pulverdiffraktometrie eingesetzt. Der Tätowierungsfarbstoff enthielt hauptsächlich Bariumsulfat; Spuren von Al, S, Ti, P, Mg und Cl ließen sich ebenfalls nachweisen. Bei der Analyse zeigten sich Pigmentgranula unterschiedlicher Größe. In seltenen Fällen kann Tätowierungstinte karzinogene Effekte haben, die multifaktoriell zu sein scheinen. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

German "National Cancer Aid Monitoring" 2015-2019 - study protocol and initial results.

PubMed

Schneider, Sven; Görig, Tatiana; Schilling, Laura; Breitbart, Eckhard W; Greinert, Rüdiger; Diehl, Katharina

2017-09-01

The National Cancer Aid Monitoring of Tanning Bed Use (NCAM) project is a major German study that aims to observe the most significant risk factors for skin cancer: natural sunlight and artificial UV radiation. NCAM is a nationwide cross-sectional survey that will initially involve four rounds of data collection (so-called waves) between 2015 and 2018. Every year, a representative nationwide sample consisting of 3,000 individuals aged between 14 and 45 years will be surveyed. The cross-sectional survey will be complemented by a panel of n  =  450 current tanning bed users. The initial wave in 2015 shows an overall prevalence of tanning bed use of 29.5 %. Eleven percent of all participants had used a tanning bed within the past twelve months. Determinants of current tanning bed use included younger age, female gender, and full-time/part-time employment. The main motivations for tanning bed use reported were relaxation and increased attractiveness. NCAM is the first study worldwide to monitor skin cancer risk factors at one-year intervals using a large, nationally representative sample. Initial results indicate that, despite WHO warnings, millions of Germans use tanning beds, and that many of these users are adolescents despite legal restrictions aimed at preventing minors from using tanning beds. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Liquid Biopsy zur Überwachung von Melanompatienten.

PubMed

Gaiser, Maria Rita; von Bubnoff, Nikolas; Gebhardt, Christoffer; Utikal, Jochen Sven

2018-04-01

In den letzten sechs Jahren wurden verschiedene innovative systemische Therapien zur Behandlung des metastasierten malignen Melanoms (MM) entwickelt. Die konventionelle Chemotherapie wurde durch neuartige Primärtherapien abgelöst, darunter systemische Immuntherapien (Anti-CTLA4- und Anti-PD1-Antikörper; Zulassung von Anti-PDL1-Antikörpern erwartet) und Therapien, die gegen bestimmte Mutationen gerichtet sind (BRAF, NRAS und c-KIT). Daher stehen die behandelnden Ärzte neuen Herausforderungen gegenüber, beispielsweise der Stratifizierung von Patienten für geeignete Behandlungen und der Überwachung von Langzeit-Respondern auf Progression. Folglich werden zuverlässige Methoden zur Überwachung von Krankheitsprogression oder Behandlungsresistenz benötigt. Lokalisierte und fortgeschrittene Krebserkrankungen können zur Bildung zirkulierender Tumorzellen und Tumor-DNA (ctDNA) führen, die sich in Proben von peripherem Blut nachweisen und quantifizieren lassen (Liquid Biopsy). Im Fall von Melanompatienten können die Ergebnisse von Liquid Biopsy als neuartige prädiktive Biomarker bei therapeutischen Entscheidungen hilfreich sein, insbesondere im Zusammenhang mit mutationsbasierten zielgerichteten Therapien. Die Herausforderungen bei der Anwendung der Liquid Biopsy beinhalten strikte Kriterien für den Phänotyp der zirkulierenden MM-Zellen oder ihrer Fragmente und die Instabilität von ctDNA im Blut. In diesem Übersichtsartikel diskutieren wir die Beschränkungen der Liquid Biopsy hinsichtlich ihrer Anwendung in der Routinediagnostik. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Update zum klinischen Einsatz von Inhibitoren mutierter Phosphokinasen beim Melanom.

PubMed

Cosgarea, Ioana; Ritter, Cathrin; Becker, Jürgen C; Schadendorf, Dirk; Ugurel, Selma

2017-09-01

Die Behandlungsstrategie beim metastasierten Melanom hat sich mit der Identifizierung therapeutisch angreifbarer molekularer Zielstrukturen innerhalb zellulärer Signalwege radikal geändert. Durch die Zulassung von Substanzen, die gezielt an den zentralen Schaltmolekülen, den Phosphokinasen, angreifen, können diese Signalwege selektiv abgeschaltet werden. Dies ist insbesondere bei denjenigen Tumoren von Interesse, deren Signalwege durch aktivierende Mutationen der für die Schaltmoleküle kodierenden Gene konstitutiv aktiviert sind. Aktuell ist diese therapeutische Strategie insbesondere für Patienten bedeutsam, deren Melanome eine Mutation im BRAF-Gen aufweisen. Diese Patienten können durch eine Kombinationstherapie aus Inhibitoren der Phosphokinasen BRAF und MEK langfristig mit sehr guter Krankheitskontrolle behandelt werden. Unter dieser Kombinationstherapie wird aktuell ein progressionsfreies Überleben von über zehn Monaten und ein Gesamtüberleben von mehr als zwei Jahren bei guter Lebensqualität erzielt. Da unter längerfristiger Therapie mit Kinaseinhibitoren jedoch bei einem Großteil der Patienten eine Resistenzbildung auftritt, sind aktuelle klinische Therapiestudien auf die Suche nach geeigneten Kombinationspartnern unter Blockierung anderer Signalwege oder unter Aktivierung der T-Zell-vermittelten Immunantwort ausgerichtet. Der vorliegende Übersichtsartikel stellt sowohl die aktuell verfügbaren als auch die in der klinischen Testung befindlichen zukünftigen Optionen der zielgerichteten Therapie des Melanoms dar. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Erhöhtes Lungenkrebs-Risiko bei Ekzempatienten: eine landesweite Kohortenstudie in Taiwan.

PubMed

Juan, Chao-Kuei; Shen, Jui-Lung; Lin, Cheng-Li; Kim, Karen Wang; Chen, Wen-Chi

2016-09-01

Der Zusammenhang zwischen Lungenkrebs und Ekzemen bleibt umstritten. Frühere Studien haben zu widersprüchlichen Ergebnissen geführt. Diese retrospektive populationsbasierte Kohortenstudie zielt darauf ab, das Risiko von Lungenkrebs im Zusammenhang mit Ekzemen abzuklären. In der Forschungsdatenbank der taiwanesischen nationalen Krankenversicherung identifizierten wir 43719 Patienten, bei denen in den Jahren 2000 bis 2010 ein Ekzem neu diagnostiziert wurde. Die Vergleichskohorte bildeten 87438 zufällig ausgewählte, altersangepasste Patienten ohne Ekzem. Die Fälle aus diesen beiden Kohorten wurden bis 2011 verfolgt. Zur Kalkulation des Lungenkrebsrisikos bei Ekzempatienten wurde die Cox-Regression verwendet. Die Datenbank enthielt keine Informationen über Raucherstatus, Alkoholkonsum, sozioökonomischen Status oder Familienanamnese. Nach der Bereinigung um Alter und Komorbidität hatte die Population mit Ekzemen ein um 2,80 erhöhtes Risiko für die Entwicklung von Lungenkrebs gegenüber der Vergleichskohorte (bereinigte Hazard-Ratio 2,80, 95 % Konfidenzinterval 2,59-3,03). Ekzempatienten mit Begleiterkrankungen, darunter Asthma, chronisch obstruktive Lungenerkrankungen, alkoholbedingten Leberschäden oder Diabetes, hatten ein höheres Lungenkrebsrisiko als Patienten ohne Ekzeme oder Komorbidität. Ekzeme gehen mit einem höheren Risiko für die Entwicklung von Lungenkrebs einher. Weitere Studien mit umfassenderen Informationen über weitere potentielle Einflussfaktoren sind sinnvoll. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Prä- und perioperative Aspekte der Versorgung dermatochirurgischer Patienten.

PubMed

Müller, Cornelia S L; Hubner, Wakiko; Thieme-Ruffing, Sigrid; Pföhler, Claudia; Vogt, Thomas; Volk, Thomas; Gärtner, Barbara C; Bialas, Patric

2017-02-01

Die Dermatochirurgie nimmt hinsichtlich vieler Punkte eine Sonderstellung unter den operativen Fächern ein. Hierzu gehört in erster Linie die Tatsache, dass bis auf wenige Ausnahmen fast alle Eingriffe traditionell in Lokal- bzw. Regionalanästhesie und oft auch in räumlich-infrastruktureller Trennung von den großen Zentral-Operationssälen stattfinden können. Die peri- und postoperative Überwachung obliegt dabei dem dermatochirurgischen Operationsteam. Das sui generis kleinere OP-Team hat somit eine ganze Reihe perioperativer Notwendigkeiten zu beachten, um die sich in den "großen" chirurgischen Fächern eine Vielzahl verschiedener beteiligter Fachgruppen gemeinsam kümmern. Hierzu gehören neben Hygieneaspekten, Kenntnissen in der Überwachung der Patienten sowie dem Aspekt der surgical site infections auch Fragen zur postoperativen Schmerztherapie sowie detailliertes pharmakologisches Wissen über die zur Anwendung kommenden Lokalanästhetika und das Handling der damit assoziierten toxischen und allergischen Reaktionen. Eine interdisziplinäre Zusammenarbeit und Verantwortung für den Patienten ist notwendig und erfordert die Erarbeitung und Umsetzung qualitätsorientierter und evidenzbasierter Handlungsanweisungen, die im dermatochirurgischen OP-Setting meist weit über das eigentliche Fach hinausgehen. Ziel dieses Weiterbildungsartikels soll die komprimierte Darstellung der genannten fachübergreifenden Standpunkte bezüglich der wichtigsten perioperativen Aspekte sein. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Gonococcal infections in Austria: a long-term observation of prevalence and resistance profiles from 1999 to 2014.

PubMed

Stary, Angelika; Heller-Vitouch, Claudia; Binder, Michael; Geusau, Alexandra; Stary, Georg; Rappersberger, Klemens; Komericki, Peter; Hoepfl, Reinhard; Haller, Maria

2015-11-01

The increase in minimum inhibitory concentrations (MICs) of cephalosporins for Neisseria gonorrhoeae has given rise to concerns regarding potentially untreatable gonococcal infections. The goal was to ascertain the prevalence of gonorrhea in a Viennese patient group and determine resistance patterns. Another objective was to evaluate resistance profiles and MIC values of gonococcal isolates in an Austria-wide surveillance project. From 1999 to 2014, 350,000 individuals were tested for gonococci at the Viennese Outpatient Clinic. In addition, from 2010 to 2014, the MICs of recommended antibiotics was determined in 3,584 gonococcal isolates, initially by agar dilution and breakpoint determination, and, from 2012 onwards, by Etest®. During the observation period, the prevalence of gonorrhea increased eightfold, with a significantly greater number of quinolone, penicillin, and tetracycline- resistant strains. In gonococcal strains isolated from across Austria, there was an increase in cefixime and ceftriaxone MICs toward breakpoints. Twenty-one isolates showed cefixime resistance, and while there was an increase in azithromycin resistance from 0.9 % (2013) to 3.2 % (2014), no resistance to ceftriaxone was observed. Currently, there is no imminent risk of untreatable gonorrhea in Austria. However, continuing the use of gonococcal cultures as a diagnostic tool for establishing resistance profiles is essential in order to monitor trends in the development of Neisseria (N.) gonorrhoeae resistance. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Azelaic acid 20 % cream: effects on quality of life and disease severity in adult female acne patients.

PubMed

Kainz, Julius Thomas; Berghammer, Gabriele; Auer-Grumbach, Piet; Lackner, Verena; Perl-Convalexius, Sylvia; Popa, Rodica; Wolfesberger, Barbara

2016-12-01

Data on the efficacy of acne treatments and their impact on quality of life (QoL) in adult patients is sketchy. Assessment of the efficacy of azelaic acid 20 % cream (Skinoren ® ) on acne severity and disease-related QoL. Noninterventional study in adult female patients with mild to moderate acne. Efficacy variables included DLQI and acne severity on the face, chest, and back using the Investigator's Global Assessment (IGA) scale (grade 1 = nearly clear skin; 2 = mild acne; 3 = moderate acne). Visits were scheduled at baseline, at 4-8 weeks, and at twelve weeks. Of the 251 women enrolled, 59 % had grade 1 acne at baseline; 31 %, grade 2; and 10 %, grade 3; the most commonly affected area of the body was the face (IGA grades 2 or 3: 79 %). After twelve weeks, there was significant improvement of acne on the face (IGA grades 0 or 1: 82 %), chest, and back. Median DLQI decreased from nine at baseline to five after twelve weeks. Ninety percent of physicians and patients rated the tolerability of the treatment as very good or good. Treatment with azelaic acid 20 % cream significantly improves acne severity and disease-related QoL in adult women. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Increased risk of lung cancer in patients with eczema: a nationwide cohort study in Taiwan.

PubMed

Juan, Chao-Kuei; Shen, Jui-Lung; Lin, Cheng-Li; Kim, Karen Wang; Chen, Wen-Chi

2016-09-01

The association between lung cancer and eczema remains controversial. Previous studies have yielded conflicting results. This retrospective population-based cohort study is aimed at clarifying the risk of lung cancer associated with eczema. By using the Taiwan National Health Insurance Research Database, we identified 43,719 patients who had been newly diagnosed with eczema in the years 2000 to 2010. The comparison cohort included 87,438 randomly selected, age-matched patients without eczema. The cases of these two cohorts were followed until 2011. The Cox proportional hazard regression model was used to calculate the risk of lung cancer in eczema patients. The database did not contain any information regarding smoking, alcohol consumption, socioeconomic status, or family history. After adjusting for age and comorbidity, the population with eczema had a 2.80-fold greater risk of developing lung cancer compared with the population in the comparison cohort (adjusted hazard ratio 2.80, 95 % confidence interval 2.59-3.03). Eczema patients with comorbid diseases including asthma, chronic obstructive -pulmonary disease, alcoholic liver damage, or diabetes were at a higher risk of lung cancer compared with the non-eczema patients without comorbidity. Eczema is associated with a greater risk for the development of lung cancer. Further studies with more comprehensive information on potential confounders are warranted. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Tinea capitis: temporal shift in pathogens and epidemiology.

PubMed

Ziegler, Wiebke; Lempert, Sigrid; Goebeler, Matthias; Kolb-Mäurer, Annette

2016-08-01

Tinea capitis is the most common type of dermatomycosis in children. Its pathogen profile shows geographic variations as well as temporal shifts. Data from 150 patients with mycologically confirmed tinea capitis treated at the Department of Dermatology, University Hospital Würzburg, between 1990 and 2014 were analyzed with respect to gender, age, and pathogen spectrum. Two time periods, each 12.5 years long, were compared. Although tinea capitis was most frequently diagnosed in children between the ages of 0 and 5, the percentage of adults (16 %) was higher than previously reported. The zoophilic dermatophyte Microsporum canis was most frequently identified as the causative agent of tinea capitis. However, there was a rise in infections caused by the anthropophilic fungi Trichophyton tonsurans and Trichophyton rubrum, and also a trend towards a lower percentage of zoophilic versus anthropophilic pathogens. Over the course of time, we observed an increase in the diversity of the pathogen spectrum. Dermatophytes such as Trichophyton soudanense, the Trichophyton anamorph of Arthroderma benhamiae, Trichophyton schoenleinii, and Microsporum audouinii were isolated either for the first time or for the first time after a long hiatus. Although Microsporum canis infections still predominate, there has been an increase in anthropophilic pathogens. Given the unexpectedly high percentage of adults, tinea capitis should be included in the differential diagnostic considerations in all age groups. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

An adaptive tracker for ShipIR/NTCS

NASA Astrophysics Data System (ADS)

Ramaswamy, Srinivasan; Vaitekunas, David A.

2015-05-01

A key component in any image-based tracking system is the adaptive tracking algorithm used to segment the image into potential targets, rank-and-select the best candidate target, and the gating of the selected target to further improve tracker performance. This paper will describe a new adaptive tracker algorithm added to the naval threat countermeasure simulator (NTCS) of the NATO-standard ship signature model (ShipIR). The new adaptive tracking algorithm is an optional feature used with any of the existing internal NTCS or user-defined seeker algorithms (e.g., binary centroid, intensity centroid, and threshold intensity centroid). The algorithm segments the detected pixels into clusters, and the smallest set of clusters that meet the detection criterion is obtained by using a knapsack algorithm to identify the set of clusters that should not be used. The rectangular area containing the chosen clusters defines an inner boundary, from which a weighted centroid is calculated as the aim-point. A track-gate is then positioned around the clusters, taking into account the rate of change of the bounding area and compensating for any gimbal displacement. A sequence of scenarios is used to test the new tracking algorithm on a generic unclassified DDG ShipIR model, with and without flares, and demonstrate how some of the key seeker signals are impacted by both the ship and flare intrinsic signatures.

Tinea capitis: Erregerspektrum und Epidemiologie im zeitlichen Wandel.

PubMed

Ziegler, Wiebke; Lempert, Sigrid; Goebeler, Matthias; Kolb-Mäurer, Annette

2016-08-01

Die Tinea capitis ist die häufigste Dermatomykose des Kindesalters. Das Erregerprofil zeigt unterschiedliche geographische Verteilungsmuster und variiert im Laufe der Zeit. Zwischen 1990-2014 an der Würzburger Universitätsklinik für Dermatologie erhobene Daten von 150 Patienten mit mykologisch gesicherter Tinea capitis wurden hinsichtlich Alter, Geschlecht und Erregerspektrum analysiert und über zwei Zeiträume von jeweils 12,5 Jahren miteinander verglichen. Obwohl eine Tinea capitis am häufigsten bei Kindern der Altersgruppe zwischen 0 und 5 Jahren diagnostiziert wurde, lag der Anteil betroffener Erwachsener mit 16 % höher als bislang berichtet. Der zoophile Dermatophyt Microsporum canis konnte am häufigsten als Erreger der Tinea capitis identifiziert werden, jedoch war ein Anstieg von Infektionen mit den anthropophilen Pilzen Trichophyton tonsurans und Trichophyton rubrum zu verzeichnen. Tendenziell sank der Anteil zoophiler im Verhältnis zu den anthropophilen Erregern. Im zeitlichen Verlauf zeigte sich eine zunehmende Heterogenität des Erregerspektrums: Dermatophyten wie Trichophyton soudanense und Trichophyton violaceum, Trichophyton anamorph von Arthroderma benhamiae sowie Trichophyton schoenleinii und Microsporum audouinii konnten erstmalig bzw. nach langer Zeit wieder erneut isoliert werden. Wenngleich Microsporum-canis-Infektionen noch dominieren, sind zunehmend anthropophile Erreger nachzuweisen. Angesichts des unerwartet hohen Anteils von Erwachsenen sollte eine Tinea capitis in allen Altersgruppen differenzialdiagnostisch in Betracht gezogen werden. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Methotrexate for topical application in an extemporaneous preparation.

PubMed

Wohlrab, Johannes; Neubert, Reinhard H H; Michael, Julia; Naumann, Sandy

2015-09-01

The antifolate agent methotrexate is routinely used for systemic therapy of cancer and chronic inflammatory diseases. Successful topical use has been described for individual therapeutic attempts, in case series, and small studies, especially for mycosis fungoides (premycotic stage) and lymphomatoid papulosis. With respect to its clinical use in selected treatment scenarios, there have been no approved preparations or regulated instructions for pharmaceutical compounding. Two high performance liquid chromatography methods were established for the determination of the active substance within a galenic formulation as well as within extracts of biological material. Suitable vehicles for epicutaneous application were developed and preclinically tested for stability, release, and pharmacokinetics of the active substance as well as their safety. The tests show that methotrexate may be readily incorporated into "Basiscreme DAC". It remains stable up to a concentration of 0.5%. This preparation releases enough active substance to achieve relevant local bioavailability in the respective target compartments of the skin. There is no evidence of safety risks due to relevant systemic bioavailability after topical application on a limited area of the skin. In summary, this approved prescription for extemporaneous preparation complies with the requirements of the German Ordinance on the Operation of Pharmacies (Article 7 ApBetrO), and the available data proves its stability and pharmaceutical quality. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Trichophyton species of Arthroderma benhamiae - a new infectious agent in dermatology.

PubMed

Nenoff, Pietro; Uhrlaß, Silke; Krüger, Constanze; Erhard, Marcel; Hipler, Uta-Christina; Seyfarth, Florian; Herrmann, Jürgen; Wetzig, Tino; Schroedl, Wieland; Gräser, Yvonne

2014-07-01

In Germany, infections due to the zoophilic dermatophyte Trichophyton (T.) species of Arthroderma benhamiae are being more frequently diagnosed. The source of infection of this emerging pathogen overlaps with that of the zoophilic species T. interdigitale. The most common source are guinea pigs. T. species of Arthroderma benhamiae causes inflammatory dermatophytosis in children and adolescents. In addition to tinea capitis, it may cause both tinea corporis, tinea manus and frequently tinea faciei. In Germany, T. species of Arthroderma benhamiae is a frequent zoophilic dermatophyte, which in regions is probably more frequent than Microsporum canis. The mycological identification of the isolates with their yellow stained colonies is based on their macroscopic and microscopic features. However, some exhibit colony features consistent with those of T. interdigitale. These strains only can be identified unambiguously by means of molecular techniques. Using detection methods such as PCR-ELISA or real-time PCR, the dermatophyte can be identified directly from clinical material. Sequencing of the internal transcribed spacer region (ITS) of the ribosomal DNA has been approved as culture confirmation test for T. species of Arthroderma benhamiae. In addition, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF MS) is useful. Widespread dermatophytosis due to T. species of Arthroderma benhamiae, in particular of tinea capitis, requires oral antifungal agents. Terbinafine is most effective, alternatives are fluconazole and itraconazole. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Retrospective data collection of psoriasis treatment with fumaric acid esters in children and adolescents in Germany (KIDS FUTURE study).

PubMed

Reich, Kristian; Hartl, Christoph; Gambichler, Thilo; Zschocke, Ina

2016-01-01

Given that there is no standard systemic treatment for children and adolescents with plaque psoriasis, this non-interventional, multicenter, retrospective study collected data on the efficacy and safety of long-term treatment with fumaric acid esters (FAEs) in this particular patient group. In patients younger than 18 years of age at the start of FAE treatment, data on efficacy and safety was retrospectively collected for at least 36 months. Data from 127 patients (aged 6-17 years) was collected for treatment durations of up to 60 months. Physician's Global Assessment, Psoriasis Area and Severity Index, and Body Surface Area showed marked improvement in the first six months. After 36 months, these parameters had, on average, improved by up to two-thirds of baseline values. Thirty-seven patients experienced at least one adverse event (AE), which was FAE-related in 36 individuals. Three AEs (proteinuria (one case), flushing (two cases)) persisted during the observation period while on treatment. Fifteen AEs led to the discontinuation of therapy; nearly all of these cases were related to gastrointestinal disorders. The KIDS FUTURE study - for the first time - included a larger population of children and adolescents with psoriasis who were treated with FAEs. The data obtained suggests that long-term FAE therapy in this patient group may be effective and safe. The results are currently being verified in an ongoing clinical study. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Ustekinumab in der Therapie der Pustulosis palmoplantaris - Eine Fallserie mit neun Patienten.

PubMed

Buder, Valeska; Herberger, Katharina; Jacobi, Arnd; Augustin, Matthias; Radtke, Marc Alexander

2016-11-01

Die Pustulosis palmoplantaris ist eine chronisch entzündliche Hauterkrankung, die mit bedeutenden Einschränkungen der Lebensqualität und der Belastbarkeit einhergeht. Aufgrund von Zulassungsbeschränkungen und einem häufig therapierefraktären Verlauf sind die Behandlungsmöglichkeiten limitiert. Nach zuvor frustranen Therapien erhielten 9 Patienten mit Pustulosis palmoplantaris nach Ausschluss einer latenten Tuberkulose Ustekinumab (45 mg Ustekinumab bei < 100 kg Körpergewicht [KG], 90 mg Ustekinumab > 100 kg KG) in Woche 0, 4, 12 und 24. Reguläre Visiten erfolgten nach 4 und 12 Wochen, im weiteren Verlauf alle 12 Wochen. Das Durchschnittsalter bei Therapiebeginn betrug 48 Jahre. Drei Patienten waren männlich. Bei n  =  4 Patienten (44,4 %) wurde eine Verbesserung um 75 % des Palmoplantar-Psoriasis-Area-Severity-Index (PPPASI) erreicht. Insgesamt verbesserte sich der PPPASI nach 24 Wochen durchschnittlich um 71,6 %. Eine komplette Abheilung zeigte sich bei n  =  2 Patienten nach 24 Wochen. Bis auf lokale Injektionsreaktionen und leichte Infekte wurden keine unerwünschten Wirkungen beobachtet. Die Fallserie ist ein weiterer Beleg für die Wirksamkeit und Verträglichkeit von Ustekinumab in der Therapie der Pustulosis palmoplantaris. Zur Beurteilung der Langzeitwirkung und -sicherheit sowie der Wirksamkeit einer intermittierenden Therapie sind kontrollierte Studiendaten sowie Beobachtungen im Rahmen von Patientenregistern notwendig. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Kombinierte Hoch-/Niedrig-Dosis-Therapie mit systemischen Glukokor-tikoiden bei schweren Verlaufsformen der Alopecia areata im Kindesalter.

PubMed

Jahn-Bassler, Karin; Bauer, Wolfgang Michael; Karlhofer, Franz; Vossen, Matthias G; Stingl, Georg

2017-01-01

Schwere Verlaufsformen der Alopecia areata (AA) im Kindesalter sind aufgrund limitierter Optionen therapeutisch herausfordernd. Systemische, hochdosierte Glukokortikoide weisen die schnellste Ansprechrate auf, nach dem Absetzen kommt es allerdings zu Rezidiven. Eine längerfristige Hochdosis-Anwendung ist aufgrund der zu erwartenden Nebenwirkungen nicht empfehlenswert. Eine dauerhafte Steroiderhaltungstherapie unterhalb der Cushing-Schwellen-Dosis nach Bolustherapie könnte die Krankheitsaktivität ohne Nebenwirkungen längerfristig unterdrücken. Im Rahmen einer offenen Anwendungsbeobachtung wurden 13 Kinder mit schweren Formen der AA in diese Studie eingeschlossen. Bei sieben Kindern lag eine AA totalis/universalis vor, bei sechs eine multifokale AA mit Befall von mehr als 50 % der Kopfhaut. Das Therapieregime sah eine initiale Prednisolon-Dosierung von 2 mg/kg Körpergeweicht (KG) vor und wurde innerhalb von neun Wochen auf eine Erhaltungsdosierung unter der individuellen Cushing-Schwelle reduziert. Der Nachbeobachtungszeitraum betrug ein bis drei Jahre. Wir beobachteten in 62 % aller Fälle ein komplettes Nachwachsen der Haare. Die mittlere Dauer bis zum Ansprechen lag bei 6,6 Wochen und konnte mit der Erhaltungstherapie über den gesamten Beobachtungszeitraum aufrechterhalten werden. An Nebenwirkungen wurden ausschließlich eine Gewichtszunahme (1-3 kg) bei allen Behandelten sowie eine milde Steroidakne in 23 % der Fälle beobachtet. Die kombinierte Hoch-/Niedrig-Dosis-Therapie mit systemischen Glukokortikoiden mittels Prednisolon zeigte eine hohe, dauerhafte Ansprechrate ohne signifikante Nebenwirkungen. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Tannins from Potentilla officinalis display antiinflammatory effects in the UV erythema test and on atopic skin.

PubMed

Hoffmann, Julia; Wölfle, Ute; Schempp, Christoph M; Casetti, Federica

2016-09-01

Rich in tannins, the rhizome of Potentilla officinalis (PO) has traditionally been used in the topical treatment of inflammatory disorders of the skin and mucous membranes. The objective of the present study was to examine the antiinflammatory effects of PO in the UV erythema test as well as in patients with atopic skin. Using the UV erythema test, the antiinflammatory effects of a PO extract (2 %) - compared to 1 % hydrocortisone acetate - were assessed in a randomized, prospective, placebo-controlled double-blind study of 40 healthy volunteers. In the context of a prospective non-controlled trial, the efficacy and tolerability of 2 % PO cream (applied to defined test areas twice daily for two weeks) was evaluated in twelve adults and twelve children with atopic skin using a partial SCORAD. In addition, the effects on the degree of erythema in the test areas was measured photometrically. In the UV erythema test, PO cream significantly reduced the erythema index compared to the vehicle. The antiinflammatory effects of PO cream were comparable to those of 1 % hydrocortisone acetate cream. The clinical study with atopic patients revealed a significant reduction in the partial SCORAD as well as erythema in the test areas. No adverse events were recorded. PO cream displays antiinflammatory effects in vivo. It is effective in and well tolerated by patients with atopic skin. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Interest in tanning beds and sunscreen in German-speaking countries.

PubMed

Kirchberger, Michael C; Kirchberger, Laura F; Eigentler, Thomas K; Reinhard, Raphael; Berking, Carola; Schuler, Gerold; Heinzerling, Lucie; Heppt, Markus V

2017-12-01

The growing incidence of nearly all types of skin cancer can be attributed to increased exposure to natural or artificial ultraviolet (UV) radiation. However, there is a scarcity of statistical data on risk behavior or sunscreen use, which would be important for any prevention efforts. Using the search engine Google ® , we analyzed search patterns for the terms Solarium (tanning bed), Sonnencreme (sunscreen), and Sonnenschutz (sun protection) in Germany, Austria, and Switzerland between 2004 and 2016, and compared it to search patterns worldwide. For this purpose, "normalized search volumes" (NSVs) were calculated for the various search queries. The corresponding polynomial functions were then compared with each other over the course of time. Since 2001, there has been a marked worldwide decrease in the search queries for tanning bed, whereas those for sunscreen have steadily increased. In German-speaking countries, on the other hand, there have - for years - consistently been more search queries for tanning bed than for sunscreen. There is an annual periodicity of the queries, with the highest NSVs for tanning bed between March and May and those for sunscreen in the summer months around June. In Germany, the city-states of Hamburg and Berlin have particularly high NSVs for tanning bed. Compared to the rest of the world, German-speaking countries show a strikingly unfavorable search pattern. There is still great need for education and prevention with respect to sunscreen use and avoidance of artificial UV exposure. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Spitznävi: unterschiedliche klinische, dermatoskopische und histopathologische Merkmale in der Kindheit.

PubMed

Dika, Emi; Neri, Iria; Fanti, Pier Alessandro; Barisani, Alessia; Ravaioli, Giulia Maria; Patrizi, Annalisa

2017-01-01

Die Charakterisierung der klinischen Merkmale und des biologischen Potenzials von Spitznävi hat in den letzten Jahrzehnten breites Interesse gefunden. Das Ziel dieser Arbeit ist die Beschreibung der klinischen und dermatoskopischen Merkmale von Spitznävi sowie des klinischen Ergebnisses nach chirurgischer Exzision von Spitznävi in drei pädiatrischen Altersgruppen. Restrospektive Studie zur Analyse von klinischen Merkmalen, videodermatoskopischen Bildern, histopathologischen Diagnosen und Behandlungsergebnissen. Der Grad der Pigmentierung wurde sowohl klinisch als auch histopathologisch beurteilt. Bei 71 Patienten wurden 72 spitzoide Neoplasien entfernt. Videodermatologische Bilder lagen für 41 Patienten vor. Das Muster der Pigmentierung korrelierte signifikant mit dem Alter der Patienten: Hyperpigmentierte Läsionen waren bei Vorschulkindern selten, bei Patienten von 7 bis 12 Jahren und ab 13 Jahren dagegen häufiger. Eine histopathologische Diagnose von atypischen Spitznävi wurde selten durchgeführt. Keiner der Patienten, bei denen ursprünglich ein atypischer Spitznävus diagnostiziert worden war, entwickelte ein Lokalrezidiv oder Metastasen während der anschließenden Nachbeobachtung. Pigmentierte Spitznävi traten im Alter ab 13 Jahren häufiger auf. Die Studie bestätigt andere Berichte über die Altersverteilung von Pigmentierungsmustern und hebt die geringe Anzahl atypischer Spitznävi bei pädiatrischen Patienten hervor sowie das Ausbleiben von Rezidiven bei der langfristigen Nachbeobachtung. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Radiosensibilisierung durch BRAF Inhibitoren.

PubMed

Strobel, Sophia Boyoung; Pätzold, Sylvie; Zimmer, Lisa; Jensen, Alexandra; Enk, Alexander; Hassel, Jessica Cecile

2017-07-01

In der letzten Zeit wurden in der Literatur vermehrt erhöhte Hauttoxizitäten während einer Kombinationstherapie mit BRAF Inhibitoren und Radiotherapie beschrieben. Wir berichten über sieben Melanompatienten in einem nicht resezierbaren Stadium III oder IV, die eine kombinierte Behandlung aus Bestrahlung und BRAF-Inhibitor erhielten. Bei allen Patienten konnte durch die Kombinationstherapie ein gutes lokales Ansprechen erreicht werden. Nur bei zwei Patienten wurde eine schwere Radiodermatitis (CTCAE Grad 3 bzw. 4) beobachtet. Bei diesen Patienten, die beide Vemurafenib erhielten, trat die Radiodermatitis nach ein bzw. zwei Wochen auf und resultierte in einer Unterbrechung der BRAF-Inhibitor Behandlung.. Die kumulative Dosis bis zum Zeitpunkt der Strahlendermatitis betrug 10 Gy bzw. 35 Gy. Bei allen anderen Vemurafenibpatienten konnten nur milde Reaktionen im Sinne einer Radiodermatitis CTCAE Grad 2, beim Dabrafenibpatienten CTCAE Grade 1 diagnostiziert werden. Bei einem Patienten wurde eine Recalldermatitis nach 14 Tagen einer beendeten Strahlentherapie mit einer kumulativen Dosis von 30 Gy diagnostiziert. Schwere Toxizitätsreaktionen der Haut unter einer BRAF-Inhibitionen treten nicht häufig auf und sind meistens gut therapierbar. Deshalb sollte die Kombinationstherapie bei aggressiv wachsenden Melanomen eine Therapieoption bleiben. Obwohl ein erhöhtes Risiko der Hauttoxizität unter einer Kombinationstherapie von Radiatio und BRAF-Inhibitoren besteht, wird diese von den meisten Patienten gut toleriert. Sequenzielle Therapie anstelle von gleichzeitiger Behandlung scheint die Toxizitätreaktionen nicht zu verhindern. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Back to the roots - dermatology in ancient Egyptian medicine.

PubMed

Hartmann, Anke

2016-04-01

Although ancient Greek and Roman medicine is generally considered the origin of European medicine, there is evidence in ancient Egyptian texts suggesting a precursor role of ancient Egyptian medicine in this regard. What did Greek and Roman physicians learn from their Egyptian counterparts? Of the medical papyri discovered to date, the largest and most significant - the Ebers papyrus and the Smith papyrus - originate from the beginning of the New Kingdom, however, they were - at least in part - already written during the Old Kingdom. Considering the times, the spectrum of diseases treated as well as the range of conservative and surgical treatment methods was truly astounding. Taking a medical history, performing a thorough manual examination, and assessing clinical findings constituted key components in establishing a diagnosis. Apart from hygienic aspects, skin and hair disorders, the treatment of acute and chronic wounds and injuries as well as cosmetic procedures took on an important role. Even back then, physicians sought to assess inflammatory processes with respect to their cardinal features, implement graded wound therapy, and treat diseases with allopathic drugs. The 'channel theory' prevalent at that time, in which the unimpeded flow of bodily fluids was considered a fundamental prerequisite for health, may likely be regarded as precursor of ancient Greek humoral pathology. The latter became the basis for the subsequently established theory of the four humors, and was thus essential for the entire field of medieval medicine. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Compression therapy in patients with venous leg ulcers.

PubMed

Dissemond, Joachim; Assenheimer, Bernd; Bültemann, Anke; Gerber, Veronika; Gretener, Silvia; Kohler-von Siebenthal, Elisabeth; Koller, Sonja; Kröger, Knut; Kurz, Peter; Läuchli, Severin; Münter, Christian; Panfil, Eva-Maria; Probst, Sebastian; Protz, Kerstin; Riepe, Gunnar; Strohal, Robert; Traber, Jürg; Partsch, Hugo

2016-11-01

Wund-D.A.CH. is the umbrella organization of the various wound care societies in German-speaking countries. The present consensus paper on practical aspects pertinent to compression therapy in patients with venous leg ulcers was developed by experts from Germany, Austria, and Switzerland. In Europe, venous leg ulcers rank among the most common causes of chronic wounds. Apart from conservative and interventional wound and vein treatment, compression therapy represents the basis of all other therapeutic strategies. To that end, there are currently a wide variety of materials and systems available. While especially short-stretch bandages or multicomponent systems should be used in the initial decongestion phase, ulcer stocking systems are recommended for the subsequent maintenance phase. Another - to date, far less common - alternative are adaptive Velcro bandage systems. Medical compression stockings have proven particularly beneficial in the prevention of ulcer recurrence. The large number of treatment options currently available enables therapists to develop therapeutic concepts geared towards their patients' individual needs and abilities, thus resulting in good acceptance and adherence. Compression therapy plays a crucial role in the treatment of patients with venous leg ulcers. In recent years, a number of different treatment options have become available, their use and application differing among German-speaking countries. The present expert consensus is therefore meant to outline concrete recommendations for routine implementation of compression therapy in patients with venous leg ulcers. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Trizentrische Analyse von Kofaktoren und Komorbidität des Pyoderma gangraenosum.

PubMed

Jockenhöfer, Finja; Herberger, Katharina; Schaller, Jörg; Hohaus, Katja Christina; Stoffels-Weindorf, Maren; Ghazal, Philipp Al; Augustin, Matthias; Dissemond, Joachim

2016-10-01

Das Pyoderma gangraenosum (PG) ist eine seltene, inflammatorische destruktiv-ulzerierende neutrophile Erkrankung mit weitgehend unklarer Pathophysiologie. In dieser Studie wurden die potenziell relevanten Kofaktoren und Begleiterkrankungen von Patienten mit PG aus drei dermatologischen Wundzentren in Deutschland differenziert ausgewertet. Von den insgesamt 121 analysierten Patienten waren Frauen (66,9 %) häufiger betroffen als Männer. Das Alter der Patienten war 18-96 Jahre (Mittelwert [MW]: 59,8); die Wunden hatten eine Größe von 1-600 cm² (MW: 65,6 cm²) und waren überwiegend sehr schmerzhaft (VAS 1-10, MW: 7). Die Unterschenkel waren am häufigsten (71,9 %) betroffen. Bei 12 (9,9 %) Patienten bestanden chronisch entzündliche Darmerkrankungen (5,8 % Colitis ulcerosa; 4,1 % Morbus Crohn), bei 14,1 % der Patienten wurde eine Begleiterkrankung aus dem rheumatischen Formenkreis beschrieben. Neoplasien bestanden bei 20,6 % der Patienten, von denen 6,6 % als hämatologische und 14,1 % als solide Neoplasien klassifiziert wurden. Aus dem Kreis des metabolischen Syndroms wurde bei 69,4 % Patienten eine Adipositas, bei 57,9 % eine arterielle Hypertonie und bei 33,9 % ein Diabetes mellitus diagnostiziert. Diese Datenanalyse bestätigt Assoziationen des PG mit dem metabolischen Syndrom und mit Neoplasien, die zukünftig frühzeitig bei einer zielgerichteten Diagnostik der Patienten beachtet und behandelt werden sollten. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Survey of sensitizing components of oxidative hair dyes (retail and professional products) in Germany.

PubMed

Kirchlechner, Stephan; Hübner, Anja; Uter, Wolfgang

2016-07-01

Components of oxidative hair dyes, such as p-toluylenediamine, are very potent contact sensitizers to which many consumers as well as hairdressers and their clients are commonly exposed. Based on the qualitative composition of both retail and professional haircare products as determined by package labeling (according to INCI), we conducted a survey on the exposure to active components of oxidative hair dyes in Germany. The joint occurrence of components is also discussed. Nearly all of the 20 most commonly used substances are potent or very potent contact sensitizers. Contained in 88 % of all products, p-toluylenediamine is the most common component. There are only minor differences between retail and professional products. A frequent combination of substances includes p-toluylenediamine (sulfate), resorcinol as well as m-aminophenol. However, their actual concentrations (which were not investigated in this study) may vastly differ depending on the shade of the individual hair dye. Descriptive univariate analysis reveals that the currently used patch test series "Hairdressing Chemicals", as recommended by the German Contact Allergy Research Group (DKG), does not adequately cover the spectrum of allergens consumers and professionals are exposed to. Other studies have also suggested that a number of other allergens should be tested as well. Taking into account the dynamic kinetics of oxidative hair dyes with respect to allergy development, the effects of combined simultaneous exposure to multiple allergens on the risk of sensitization requires further research. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Guidelines for diagnosis, prevention and treatment of hand eczema--short version.

PubMed

Diepgen, Thomas L; Andersen, Klaus E; Chosidow, Oliver; Coenraads, Peter Jan; Elsner, Peter; English, John; Fartasch, Manigé; Gimenez-Arnau, Ana; Nixon, Rosemary; Sasseville, Denis; Agner, Tove

2015-01-01

The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful medical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in "head-to-head" RCTs are needed. The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medical Societies in Germany). No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Screening and Evaluation of Deleterious SNPs in APOE Gene of Alzheimer's Disease.

PubMed

Masoodi, Tariq Ahmad; Al Shammari, Sulaiman A; Al-Muammar, May N; Alhamdan, Adel A

2012-01-01

Introduction. Apolipoprotein E (APOE) is an important risk factor for Alzheimer's disease (AD) and is present in 30-50% of patients who develop late-onset AD. Several single-nucleotide polymorphisms (SNPs) are present in APOE gene which act as the biomarkers for exploring the genetic basis of this disease. The objective of this study is to identify deleterious nsSNPs associated with APOE gene. Methods. The SNPs were retrieved from dbSNP. Using I-Mutant, protein stability change was calculated. The potentially functional nonsynonymous (ns) SNPs and their effect on protein was predicted by PolyPhen and SIFT, respectively. FASTSNP was used for functional analysis and estimation of risk score. The functional impact on the APOE protein was evaluated by using Swiss PDB viewer and NOMAD-Ref server. Results. Six nsSNPs were found to be least stable by I-Mutant 2.0 with DDG value of >-1.0. Four nsSNPs showed a highly deleterious tolerance index score of 0.00. Nine nsSNPs were found to be probably damaging with position-specific independent counts (PSICs) score of ≥2.0. Seven nsSNPs were found to be highly polymorphic with a risk score of 3-4. The total energies and root-mean-square deviation (RMSD) values were higher for three mutant-type structures compared to the native modeled structure. Conclusion. We concluded that three nsSNPs, namely, rs11542041, rs11542040, and rs11542034, to be potentially functional polymorphic.

Analysis of patients' willingness to be mobile, taking into account individual characteristics and two exemplary indications.

PubMed

Augustin, Jobst; Schäfer, Ines; Augustin, Matthias; Zander, Nicole

2017-04-01

With respect to health care planning, it is commonly assumed that patients consult the nearest physician. In reality, however, patients frequently accept great-er efforts/expenses than necessary to see a physician. The objective of the present study was to determine under which circumstances patients were willing to accept additional efforts/expenses, and which role sociodemographic and clinical characteristics play in this regard. Data collection was carried out in the context of a multicenter cross-sectional study among office-based and hospital-affiliated (University Medical Center Hamburg-Eppendorf) dermatologists. Patients (n = 309) with psoriasis and chronic wounds were surveyed about their mobility patterns and disease severity. Data analysis was performed using descriptive and multivariate methods. The willingness to accept additional efforts/expenses is primarily determined by a physician's expertise and service portfolio. Comparing both diagnoses showed that psoriasis patients usually traveled longer distances than wound patients. Among psoriasis patients, one significant predictor for accepting additional efforts/expenses was the level of education. With regard to wound patients, key factors included wound size (severity). The present study revealed complex mobility patterns among patients, which are affected by numerous personal as well as clinical factors. Depending on the diagnosis and individual preferences, additional efforts/expenses can - among other things - be explained by disease severity. Further studies are required to obtain more conclusive data. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Changes in transcription during recovery from heat injury in Salmonella typhimurium and effects of BCAA on recovery.

PubMed

Hsu-Ming, Wen; Naito, Kimitaka; Kinoshita, Yoshimasa; Kobayashi, Hiroshi; Honjoh, Ken-ichi; Tashiro, Kousuke; Miyamoto, Takahisa

2012-06-01

Mechanisms of recovery from heat injury in Salmonella typhimurium were elucidated. Recovery of the heat-injured S. typhimurium cells in TSB resulted in full recovery after 3 h of incubation at 37°C. The DNA microarray analysis of 30- and 60-min recovering cells resulted in an increase in transcription of 89 and 141 genes, respectively. Among them, 15 genes, with known function, seemed to be somewhat involved in recovery. They encoded proteins involved in branched-chain amino acid (BCAA) transport (livJ, livH), cell envelope integrity (ddg), heat-shock response (cpxP, rrmJ), phage shock protein (pspA), ribosome modulation factor (rmf), virulence (sseB) transcriptional regulation (rpoE, rpoH, rseA, rseB, rseC) and ArcB signal transduction (sixA) and cytoplasmic membrane protein (fxsA). Among them, the effects of BCAA supplementation on recovery from heat injury were studied to confirm the importance of the BCAA transport liv genes during recovery. It was found that supplementation of TSB with 0.1% BCAA resulted in an enhanced recovery of injured cells in comparison to those recovered in TSB without BCAA. Supplementation of BCAA at 0.1% resulted in a cell count increase 4.4-fold greater than that of the control after 1 h incubation. It seems that BCAA promoted the recovery by promoting protein synthesis either directly through their use in translation or indirectly through stimulation of protein synthesis by activation of the Lrp protein.

B-Zell-Lymphome der Haut - Pathogenese, Diagnostik und Therapie.

PubMed

Nicolay, Jan P; Wobser, Marion

2016-12-01

Primär kutane B-Zell-Lymphome (PCBCL) beschreiben reifzellige lymphoproliferative Erkrankungen der B-Zell-Reihe, die primär die Haut betreffen. Die Biologie und der klinische Verlauf der einzelnen PCBCL-Subtypen variieren untereinander stark und unterscheiden sich grundsätzlich von primär nodalen und systemischen B-Zell-Lymphomen. Primär kutane Marginalzonenlymphome (PCMZL) und primäre kutane follikuläre Keimzentrumslymphome (PCFCL) werden auf Grund ihres unkomplizierten Verlaufs und ihrer exzellenten Prognose zu den indolenten PCBCL gezählt. Demgegenüber stellen die diffus großzelligen B-Zell-Lymphome, hauptsächlich vom Beintyp (DLBCL, LT) die aggressiveren PCBCL-Varianten mit schlechterer Prognose dar. Für die Ausbreitungsdiagnostik und die Therapieentscheidung sind eine genaue histologische und immunhistochemische Klassifizierung sowie der Ausschluss einer systemischen Beteiligung in Abgrenzung zu nodalen oder systemischen Lymphomen notwendig. Die Diagnostik sollte dabei durch molekularbiologische Untersuchungen unterstützt werden. Therapeutisch stehen für die indolenten PCBCL primär operative und radioonkologische Maßnahmen im Vordergrund sowie eine Systemtherapie mit dem CD20-Antikörper Rituximab bei disseminiertem Befall. Die aggressiveren Varianten sollten in erster Linie mit Kombinationen aus Rituximab und Polychemotherapieschemata wie z. B. dem CHOP-Schema oder Modifikationen davon behandelt werden. Auf Grund der in allen seinen Einzelheiten noch nicht vollständig verstandenen Pathogenese und Biologie sowie des begrenzten Therapiespektrums der PCBCL besteht hier, speziell beim DLBCL, LT, noch erheblicher Forschungsbedarf. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Gerbstoffe aus Potentilla officinalis wirken entzündungshemmend im UV-Erythem-Test und bei Anwendung auf atopischer Haut.

PubMed

Hoffmann, Julia; Wölfle, Ute; Schempp, Christoph M; Casetti, Federica

2016-09-01

Das Rhizom von Potentilla officinalis (PO) ist reich an Gerbstoffen und wird traditionell zur äußerlichen Behandlung von Entzündungen der Haut und der Schleimhäute verwendet. Ziel der vorliegenden Arbeit war die Bestätigung der antiinflammatorischen Eigenschaften von PO mittels eines UV-Erythem-Tests und einer klinischen Anwendungsstudie bei atopischer Haut. Die antiinflammatorische Wirkung eines PO-Extrakts (standardisiert auf 2 % Trockensubstanz) wurde in einer prospektiven, randomisierten, placebokontrollierten Doppelblindstudie mit 40 gesunden Erwachsenen im UV-Erythem-Test im Vergleich zu 1 % Hydrocortisonacetat untersucht. Im Rahmen einer prospektiven nicht kontrollierten Studie wurde die Wirkung und Verträglichkeit der 2 % PO-Creme an zwölf Erwachsenen und zwölf Kindern mit atopischer Haut nach Anwendung über zwei Wochen in einem definierten Testareal anhand eines Teil-SCORAD untersucht. Zusätzlich wurde die Beeinflussung der Hautrötung im Testareal photometrisch gemessen. Im UV-Erythem-Test zeigte die PO-Creme eine signifikante Reduktion des Erythemindex im Vergleich zum Vehikel. Die antiinflammatorische Wirkung des Verums entsprach der der 1 % Hydrocortisonacetat-Creme. Die klinische Studie bei Atopikern zeigte eine signifikante Abnahme des Teil-SCORAD und des Erythems im Testareal. Es wurden keine Unverträglichkeitsreaktionen beobachtet. PO als 2%ige Zubereitung besitzt entzündungshemmende Eigenschaften und ist wirksam und gut verträglich auf atopischer Haut. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Incidence of autoimmune bullous diseases in Serbia: a 20-year retrospective study.

PubMed

Milinković, Mirjana V; Janković, Slavenka; Medenica, Ljiljana; Nikolić, Miloš; Reljić, Vesna; Popadić, Svetlana; Janković, Janko

2016-10-01

While most previous surveys on the clinico-epidemiological features of autoimmune bullous diseases (AIBDs) have predominantly focused on a single disease entity or just one disease group, there have been only few studies examining the incidence of various AIBDs. In the present study, we set out to determine the spectrum of AIBDs, to estimate the incidence of the most common AIBDs, and to examine their temporal trends in Central Serbia over a period of 20 years. We retrospectively recruited 1,161 new AIBD cases diagnosed in Central Serbia during the period from January 1991 to December 2010. The diagnosis was based on strict clinical, histological, and immunohistological evaluation. The incidence rates were: 4.35 per million population/year (pmp/year) for pemphigus, 4.47 pmp/year for pemphigoid, 1.42 pmp/year for dermatitis herpetiformis (DH), 0.25 pmp/year for linear IgA disease, and 0.08 pmp/year for epidermolysis bullosa acquisita. In the period observed, age-adjusted incidence rates significantly increased for pemphigus and particularly for pemphigoid, whereas they decreased, albeit not significantly, for DH. For the first time, our study evaluates the incidence rates of the entire spectrum of AIBDs in Serbia, and examines their temporal trends over a 20-year period. To the best of our knowledge, our finding of similar incidence rates for pemphigus and pemphigoid has previously not been reported. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Temporal course of avascular femoral head necrosis in patients with pemphigus vulgaris.

PubMed

Balighi, Kamran; Daneshpazhooh, Maryam; Aghazadeh, Nessa; Saeidi, Vahide; Shahpouri, Farzam; Hejazi, Pardis; Chams-Davatchi, Cheyda

2016-10-01

Pemphigus vulgaris (PV) is typically treated with systemic corticosteroids and immunosuppressive agents. Avascular necrosis (AVN) of the femoral head is a well-recognized major complication of corticosteroid therapy. The characteristics of this serious complication in PV remain unknown. Uncontrolled, retrospective study of all PV-related AVN cases diagnosed at an Iranian autoimmune bullous disease clinic between 1985 and 2013. Of the 2,321 medical records of PV patients reviewed, 45 (1.93 %) cases showed femoral AVN, with 30 (66.7 %) individuals being male. The mean age at diagnosis of AVN was 47.4 ± 14.2 years. The mean interval between the diagnosis of PV and the onset of AVN was 25.3 ± 18.3 months. With the exception of eight cases (17.8 %), the majority of patients developed AVN within three years after the diagnosis of PV. The mean cumulative dose of prednisolone in patients with AVN was 13,115.8 ± 7041.1 mg. There was a strong correlation between the total prednisolone dose and the time of onset of AVN (p = 0.001). In patients with a history of alendronate intake, that interval was significantly shorter (p = 0.01). Occurring in about 2 % of patients, AVN is a serious complication of corticosteroid treatment in patients with PV, predominantly in the first three years of treatment. In individuals receiving higher doses of prednisolone, AVN tends to occur earlier. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

The significance of blue color in dermatoscopy.

PubMed

Popadić, Mirjana; Sinz, Christoph; Kittler, Harald

2017-03-01

Skin lesions with blue color are frequently excised to rule out malignancy. The objective of the present study was to investigate the significance of blue color. We retrospectively scanned dermatoscopic images for blue color and classified them according to pattern analysis. Of 1,123 pigmented skin lesions, 144 (12.8 %) showed blue color, 92 of which (63.9 %) were malignant. Among lesions with blue color, the most common benign diagnoses were nevi (n = 35, 24.3 %) and seborrheic keratoses (n = 8, 5.6 %). Of 103 (71.5 %) lesions with a structureless blue pattern, eight (7.8 %) were entirely blue and 95 (92.2 %) were partly blue, of which 81 (78.6 %) showed peripheral or patchy and 14 (13.6 %) central blue color. Most lesions with peripheral or patchy blue color were melanomas (n = 47, 58 %), whereas most lesions with central blue color were nevi (n = 9, 64.3 %). Of 28 lesions with blue clods, 17 (60.7 %) were basal cell carcinomas. With respect to malignancy, the positive predictive value of blue color was 63.9 % (95 % CI: 56.0-71.8 %). Among malignant lesions with blue color, structureless peripheral or patchy blue color is a clue for melanoma, while blue clods point to basal cell carcinoma. Pitfalls include seborrheic keratoses, which may show blue color, as well as some nevi, especially combined nevi. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Kompressionstherapie bei Patienten mit Ulcus cruris venosum.

PubMed

Dissemond, Joachim; Assenheimer, Bernd; Bültemann, Anke; Gerber, Veronika; Gretener, Silvia; Kohler-von Siebenthal, Elisabeth; Koller, Sonja; Kröger, Knut; Kurz, Peter; Läuchli, Severin; Münter, Christian; Panfil, Eva-Maria; Probst, Sebastian; Protz, Kerstin; Riepe, Gunnar; Strohal, Robert; Traber, Jürg; Partsch, Hugo

2016-11-01

Wund-D.A.CH. ist der Dachverband deutschsprachiger Fachgesellschaften, die sich mit den Thematiken der Wundbehandlung beschäftigen. Experten verschiedener Fachgesellschaften aus Deutschland, Österreich und der Schweiz haben nun einen aktuellen Konsens der Kompressionstherapie für Patienten mit Ulcus cruris venosum erstellt. In Europa ist das Ulcus cruris venosum eine der häufigsten Ursachen für chronische Wunden. Neben der konservativen und interventionellen Wund- und Venentherapie, ist die Kompressionstherapie die Basis der Behandlungsstrategien. Die Kompressionstherapie kann heute mit sehr unterschiedlichen Materialien und Systemen durchgeführt werden. Während in der Entstauungsphase insbesondere Verbände mit Kurzzugbinden oder Mehrkomponentensysteme zur Anwendung kommen, sind es anschließend überwiegend Ulkus-Strumpfsysteme. Eine weitere, bislang wenig verbreitete Alternative sind adaptive Kompressionsbandagen. Insbesondere für die Rezidivprophylaxe werden medizinische Kompressionsstrümpfe empfohlen. Durch die Vielzahl der heute zur Verfügung stehenden Behandlungsoptionen, kann für nahezu alle Patienten ein Konzept entwickelt werden, dass sich an den individuellen Bedürfnissen und Fähigkeiten orientiert und daher auch akzeptiert und durchgeführt wird. Die Kompressionstherapie ist für die Behandlung von Patienten mit Ulcus cruris venosum essentiell. In den letzten Jahren sind viele verschiedene Therapieoptionen verfügbar, die in den deutschsprachigen Ländern unterschiedlich angewendet oder durchgeführt werden. Daher soll dieser Expertenkonsens dazu beitragen, konkrete Empfehlungen für die praktische Durchführung der Kompressionstherapie von Patienten mit Ulcus cruris venosum darzustellen. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Azelainsäure 20 % Creme: Auswirkung auf Lebensqualität und Krankheitsaktivität bei erwachsenen Patientinnen mit Acne vulgaris.

PubMed

Kainz, Julius Thomas; Berghammer, Gabriele; Auer-Grumbach, Piet; Lackner, Verena; Perl-Convalexius, Sylvia; Popa, Rodica; Wolfesberger, Barbara

2016-12-01

Zur Wirksamkeit von Aknetherapien und deren Auswirkungen auf die Lebensqualität erwachsener Patienten liegen kaum Daten vor. ZIEL: Erhebung der Wirkung von Azelainsäure 20 % Creme (Skinoren ® ) auf Akne-Schweregrad und krankheitsbedingte Lebensqualität. Nichtinterventionelle Studie bei erwachsenen Patientinnen mit leichter bis mittelschwerer Akne. Wirksamkeitsparameter waren DLQI sowie Akne-Schweregrad im Gesicht, am Dekolleté sowie am Rücken im Gesamturteil des Prüfarztes (IGA-Skala: Grad 1 = annähernd reine Haut; 2 = leichte Akne; 3 = mittelschwere Akne). Visiten waren zu Studienbeginn sowie nach 4-8 und zwölf Wochen geplant. Von den 251 eingeschlossenen Patientinnen lag zu Studienbeginn bei 59 %, 31 % bzw. 10 % ein IGA-Grad von 1, 2 bzw. 3 vor; die am häufigsten betroffene Hautpartie war das Gesicht (IGA-Grad 2 oder 3: 79 %). Nach zwölf Behandlungswochen war eine signifikante Besserung der Acne vulgaris im Gesicht (IGA-Grad 0 oder 1: 82 %) sowie auf Dekolleté und Rücken feststellbar. Der mediane DLQI-Wert sank von neun zu Studienbeginn auf fünf nach zwölf Behandlungswochen. Neunzig Prozent der behandelnden Ärzte und Patientinnen beurteilten die Verträglichkeit der Behandlung als sehr gut oder gut. Die Anwendung von 20%iger Azelainsäure-Creme führt bei erwachsenen Frauen zu einer signifikanten Besserung der Acne vulgaris und der krankheitsbedingten Lebensqualität. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Analyse der pharmazeutischen Versorgungssituation von Patienten mit Psoriasis-Arthritis auf Basis von Routinedaten der Gesetzlichen Krankenversicherung.

PubMed

Sondermann, Wiebke; Ventzke, Julia; Matusiewicz, David; Körber, Andreas

2018-03-01

Die Psoriasis-Arthritis (PsA) gehört zu den chronisch entzündlichen Gelenkerkrankungen. Trotz zahlreicher versorgungswissenschaftlicher Studien in Deutschland liegen zur pharmazeutischen Versorgungssituation von PsA-Patienten bisher kaum aktuelle Ergebnisse vor. Mit Hilfe einer systematischen Literaturrecherche sowie anhand von Routinedaten der Allgemeinen Ortskrankenkasse (AOK) Rheinland/Hamburg wird ein aktueller Überblick über die pharmazeutische Versorgung von PsA-Patienten in Deutschland gegeben. Selektiert wurden Versicherte aus dem ambulanten und stationären Bereich, die im 1. und 2. Quartal des Jahres 2014 die gesicherte Abrechnungsdiagnose Psoriasis-Arthritis L40.5+ aufwiesen. Anschließend wurden auf Basis dieser "vorab definierten" Kohorte die Arzneimitteldaten für 5 Jahre (01.01.2010-31.12.2014) abgerufen. Es konnten insgesamt n  =  3205 Versicherte (45 % männlich, 55 % weiblich) der AOK Rheinland/Hamburg mit einer gesicherten PsA-Diagnose selektiert werden. Das Durchschnittsalter betrug 58,9 Jahre. 53,7 % der PsA-Patienten wurden mit systemischen PsA-relevanten Arzneimitteln versorgt. Nichtsteroidale Antirheumatika (NSAR) wurden am häufigsten verordnet, gefolgt von systemischen Glucocorticoiden. Von den selektierten PsA-Patienten, die eine Systemtherapie erhielten, wurden 72,1 % mittels einer Disease-modifying-antirheumatic-Drug (DMARD)-Monotherapie behandelt, gefolgt von der Kombinationstherapie aus DMARDs und Biologika (20,9 %). Die pharmakologische Therapie der PsA muss eine Gewährleistung zwischen adäquater Versorgung der PsA mit Verhinderung der Krankheitsprogression und ökonomischer Verantwortung darstellen. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Verantwortlicher Umgang mit Antibiotika: Notwendigkeit der Antibiotikareduktion in der Aknetherapie.

PubMed

Gollnick, Harald P M; Buer, Jan; Beissert, Stefan; Sunderkätter, Cord

2016-12-01

Der übermäßige oder unkritische weltweite Einsatz von Antibiotika in der Medizin hat die Ausbreitung von Antibiotikaresistenzen beschleunigt. In einigen Bereichen sind viele Antibiotika bei bakteriellen Infektionen, die zuvor noch gut auf antibakterielle Wirkstoffe reagierten, mittlerweile wirkungslos geworden. Dermatologen/Venerologen setzten orale und topische Antibiotika bei der Behandlung von Acne vulgaris routinemäßig ein, obwohl Akne weder eine infektiöse Erkrankung ist noch alleine durch das Propionibacterium getriggert wird. Vielmehr ist sie eine komplexe, chronische entzündliche Hauterkrankung, die durch verschiedene pathogenetische Faktoren wie follikuläre Hyperkeratose, erhöhter Sebumproduktion, bakterielle Proliferation und Entzündung zustande kommt. Folglich sollte eine erfolgreiche Therapie auf die Bekämpfung verschiedener pathogenetischer Faktoren und nicht nur auf die von Propionibacterium acnes abzielen. Daher wurden topische Retinoide und Benzoylperoxid als Mittel der ersten Wahl definiert. Monotherapien mit lokalen Antibiotika sollten insgesamt vermieden werden. Systemische Antibiotika der Tetrazyklin-Gruppe haben bei bestimmen Krankheitsstadien ihren Sinn, ihre Wirkung könnte aber eher auf der antientzündlichen als auf der antibiotischen Reaktion beruhen. Gesundheitsbehörden ermahnen alle Gesundheitsdienstleister, den Einsatz von Antibiotika einzuschränken. Das Nutzen-Risiko-Verhältnis muss bei der Entscheidung für oder gegen eine antibiotische Therapie bei einem einzelnen Patienten immer auch in Bezug auf das öffentliche Interesse am Erhalt der Wirksamkeit von Antibiotika abgewogen werden. Im Folgenden werden das aktuelle Krankheitskonzept zu Acne vulgaris und die sich daraus ableitenden Konsequenzen für den Einsatz von Antibiotika vorgestellt. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Gebrauch von Komplementärmedizin bei Patienten mit metastasierendem Melanom unter Therapie mit Ipilimumab innerhalb einer klinischen Studie.

PubMed

Huebner, Jutta; Mohr, Peter; Simon, Jan-Christoph; Fluck, Michael; Berking, Carola; Zimmer, Lisa; Loquai, Carmen

2016-05-01

In Deutschland wenden 40-90 % aller Krebspatienten Methoden der komplementären and alternativen Medizin (KAM) an. Bis dato gibt es kein Datenmaterial zum Einsatz der KAM bei Melanompatienten. Das Ziel unserer Studie war es, Daten über den Gebrauch, die Informationsquellen und Ziele von Patienten mit metastasierendem Melanom zu erfassen. Einhundertsechsundfünfzig Patienten aus 25 Studienzentren nahmen an der DecOG-MM-PAL Multibasket Studie teil. Die beteiligten Personen wurden auch gebeten, an einer Nebenstudie teilzunehmen, die ihren Gebrauch von KAM erfassen sollte. Dazu wurde während der Behandlung ein standardisierter Fragebogen zu genau festgelegten Zeitpunkten ausgeteilt. Insgesamt gingen 55 Fragebögen von 32 (21 %) Melanompatienten ein. Von diesen gaben 17 (53 %) ein Interesse an KAM an, und sieben (22 %) machten von KAM Gebrauch. Die Hauptinformationsquellen (31 %) waren Familienmitglieder und Freunde, gefolgt von Ärzten (19 %). Die Hauptgründe für die Anwendung von KAM waren die Stärkung des Immunsystems (41 %) und des Körpers (34 %). Nahrungsergänzungsmittel (Vitamine und Spurenelemente) wurden am häufigsten angewendet (28 %). Eine relativ hohe Anzahl an Patienten mit metastasierendem Melanom machte trotz Teilnahme an einer klinischen Studie von KAM Gebrauch. Wechselwirkungen könnten durch biologisch basierte KAM auftreten, und hier besonders bei immunmodulierenden KAM- Strategien. Um Risiken zu vermeiden, sollte die Kommunikation zwischen den Ärzten und den Patienten verbessert werden. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Krankheitsverlauf, medizinische Versorgung und Lebensqualität von Patienten mit kongenitalen melanozytären Nävi - Auswertung des deutschsprachigen KMN-Registers.

PubMed

Elisabeth Wramp, Maria; Langenbruch, Anna; Augustin, Matthias; Zillikens, Detlef; Krengel, Sven

2017-02-01

Kongenitale melanozytäre Nävi (KMN) bedeuten für Patienten und Familien eine psychologische Belastung und bergen zudem medizinische Risiken. Das 2005 gegründete deutschsprachige KMN-Register wurde nun einer Zwischenauswertung bezüglich des Krankheitsverlaufes, der medizinischen Versorgung und der Lebensqualität unterzogen. 100 Patienten, die sich in den Jahren 2005 bis 2012 mit einem Erstmeldebogen registriert hatten, wurde im Rahmen einer prospektiven Kohortenstudie Anfang 2013 ein Folgemeldebogen zugesandt. Außerdem wurden mithilfe standardisierter Fragebögen Daten zu Lebensqualität (dermatology life quality index, DLQI) und Stigmatisierungserfahrungen (perceived stigmatization questionnaire, PSQ; social comfort questionnaire, SCQ) erhoben. 83 % der Patienten oder deren Eltern antworteten (Altersdurchschnitt 11,2 Jahre, Median 6 Jahre; mittleres Follow-up 4,4 Jahre). Im Gesamtkollektiv wurden vier Melanome diagnostiziert, davon zwei zerebrale Melanome im Kindesalter, ein kutanes Melanom im Erwachsenenalter und eines, das sich als proliferierender Knoten erwies. Bei vier Kindern wurde eine neurokutane Melanozytose festgestellt, drei davon mit neurologischer Symptomatik. Chirurgisch behandelt wurden 88 % (73/83). Achtundsiebzig Prozent der Befragten berichteten eine geringe oder keine Beeinträchtigung der Lebensqualität. Die wahrgenommene Stigmatisierung beziehungsweise Beeinträchtigung des sozialen Wohlbefindens war generell ebenfalls gering. Die Ergebnisse geben einen Überblick über die Situation von Patienten mit KMN in Deutschland, Österreich und der Schweiz. Ein Melanom entwickelte sich in 3 %, eine ZNS-Beteiligung bestand in 4 % der Fälle. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Einsatz und Wirksamkeit von Systemtherapien bei Erwachsenen mit schwerer Neurodermitis: Erste Ergebnisse des deutschen Neurodermitis-Registers TREATgermany.

PubMed

Schmitt, Jochen; Abraham, Susanne; Trautmann, Freya; Stephan, Victoria; Fölster-Holst, Regina; Homey, Bernhard; Bieber, Thomas; Novak, Natalija; Sticherling, Michael; Augustin, Matthias; Kleinheinz, Andreas; Elsner, Peter; Weidinger, Stephan; Werfel, Thomas

2017-01-01

Versorgungsregister dienen der Erfassung des Einsatzes und der Wirksamkeit von Therapien unter realen Versorgungsbedingungen und sind als Basis einer evidenzbasierten Gesundheitsversorgung unverzichtbar. Das deutsche Neurodermitis-Register TREATgermany wurde als weltweit erstes Register für Patienten mit schwerer Neurodermitis 2011 initiiert. Erwachsene mit schwerer Neurodermitis (aktuelle/frühere antientzündliche Systemtherapie und/oder objektiver SCORAD ≥ 40) werden über einen Zeitraum von 24 Monaten prospektiv beobachtet. Anhand validierter Erhebungsinstrumente werden die klinische Erkrankungsschwere (EASI, SCORAD), Lebensqualität (DLQI), Symptome, globale Erkrankungsschwere sowie die Patientenzufriedenheit erfasst und die durchgeführten Therapien dokumentiert. Die vorliegende Analyse beschreibt die Charakteristika, Therapiewahl und Wirksamkeit der eingesetzten antiinflammatorischen Systemtherapien der bis Oktober 2014 eingeschlossenen Patienten. An fünf Zentren wurden insgesamt 78 Patienten (Durchschnittsalter 39 Jahre, 61 % männlich) eingeschlossen. Bei den Patienten besteht eine hohe Inanspruchnahme ambulanter und stationärer Leistungen. Ciclosporin war das am häufigsten eingesetzte Systemtherapeutikum und zeigte die höchste klinische Effektivität (EASI-50-Ansprechrate 51 %; EASI-75-Ansprechrate 34 % nach zwölfwöchiger Therapie). Azathioprin, Methotrexat (MTX), Prednisolon oral, Mycophenolat, Alitretinoin und Leflunomid wurden ebenfalls bei einzelnen Patienten eingesetzt. Die vorliegende Registerauswertung gibt wichtige Hinweise zur derzeitigen Versorgung von Erwachsenen mit schwerer Neurodermitis in Deutschland, dokumentiert die hohe Erkrankungslast, den Nutzen vorhandener Therapien und den Bedarf an weiteren, effektiven und in der Langzeitanwendung sicheren Therapieoptionen. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Sentinel-Lymphknoten-Biopsie des Melanoms mittels Indocyaningrün und "FOVIS"-System.

PubMed

Göppner, Daniela; Nekwasil, Stephan; Jellestad, Anne; Sachse, Alexander; Schönborn, Karl-Heinz; Gollnick, Harald

2017-02-01

Der Nachweis metastatischer Infiltrate im Sentinel-Lymphkoten (SLN) gilt als wesentlicher prognostischer Faktor des Melanoms. Alternativ zur Farbstoffmethode mit Patentblau zum Goldstandard der SLN-Biopsie (SLNB) mittels Radiokolloid wird die fluoreszenzoptische Darstellung mit Hilfe von Indocyaningrün (ICG) und Nahinfrarot (NIR)-Kamerasystem kommuniziert. Im Vergleich zur konventionellen Methode wurde die Wertigkeit des ICG-/NIR-Verfahrens in Abhängigkeit vom Body-Mass-Index (BMI) des Patienten und der Konzentration von ICG bezüglich der Visualisierung des Lymphabstroms und des SLNs untersucht. An zehn Patienten wurde die SLNB mittels Technetium-99m, Patentblau und ICG durchgeführt. Die Fluoreszenz-Darstellung von Lymphbahnen und SLN erfolgte in Echtzeit mittels der NIR-Kameratechnik "FOVIS". Je nach erzielter Bildqualität wurde ICG in einer Dosis von 0,25 mg bis 2,5 mg intrakutan appliziert. Neun der zehn SLN wurden fluoreszenzoptisch identifiziert (90 %), alle zehn radioaktiv (100 %), nur acht (80 %) mittels ICG-Grünfärbung bzw. Patenblau-Markierung. Transdermal wurde ein SLN dargestellt (10 %). In Korrelation zum BMI waren höhere ICG-Mengen, bis zu 2,5 mg intrakutan absolut, in der Darstellung der Lymphbahnen von Vorteil. Die SLN-Fluoreszenzmarkierung mit dem ICG/NIR-Kamera-System "FOVIS" stellt eine sichere Alternative zur Farbstoffmethode mit Patentblau ergänzend zur Radiokolloidmethode mit Technetium-99m dar. Weitere Studien zur optimalen Dosierung von ICG und transdermalen Bildgebung in Relation zum BMI sind notwendig. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Potenzielle Arzneimittelwechsel-wirkungen und unerwünschte Arzneimittelwirkungen bei stationären dermatologischen Patienten.

PubMed

Koch, Lukas; Kränke, Birger; Aberer, Werner

2016-11-01

Informationen zur Häufigkeit von Arzneimittelwechselwirkungen und unerwünschten Arzneimittelwirkungen zu präsentieren und Hilfestellung zu leisten, wie diese wichtigen Probleme in der pharmakologischen Behandlung stationärer dermatologischer Patienten minimiert werden können. Die Medikation von 1 099 stationären dermatologischen Patienten wurde retrospektiv mittels einer Internet-basierten Software für Medikamenteninteraktionen (Diagnosia ® Check) auf Arzneimittelwechselwirkungen und unerwünschte Arzneimittelwirkungen analysiert. Wir beschreiben eine Gesamthäufigkeit relevanter Arzneimittelwechselwirkungen von 51,7 % mit durchschnittlich 3,2 Interaktionen pro betroffenem stationären Patienten. Arzneimittelkombinationen, die gemieden werden sollten, wurden bei 5,7 % der Studienpopulation festgestellt. Der wichtigste Risikofaktor war die Gesamtzahl der verabreichten Medikamente. Die Arzneimittelgruppen, die bei der Mehrzahl der Wechselwirkungen beteiligt waren, waren Analgetika, Herz-Kreislauf-Medikamente und gerinnungshemmende Medikamente sowie Antidepressiva. Das Risiko unerwünschte Arzneimittelwirkungen auszubilden wurde bei 53,1 % der stationären Patienten als "hoch" eingestuft. Die fünf wichtigsten unerwünschten Nebenwirkungen in dieser Patientengruppe waren Blutungen, Obstipation, anticholinerge Effekte, Sedierung und orthostatische Effekte. Potenzielle Arzneimittelwechselwirkungen sowie unerwünschte Arzneimittelwirkungen sind bei stationären dermatologischen Patienten alarmierend häufig. Bei jedem zweiten Patienten besteht die Gefahr, derartige Wechselwirkungen oder unerwünschte Nebenwirkungen zu erleiden und jeder zwanzigste Patient erhält eine Arzneimittelkombination, die nicht verabreicht werden sollte. Erhöhte Wachsamkeit ist erforderlich, um die gefährdeten Patienten zu erkennen. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Neue Laser und Strahlquellen - alte und neue Risiken?

PubMed

Paasch, Uwe; Schwandt, Antje; Seeber, Nikolaus; Kautz, Gerd; Grunewald, Sonja; Haedersdal, Merete

2017-05-01

Die Entwicklungen im Bereich dermatologischer Laser, hochenergetischer Blitzlampen, LED und neuer Energie- und Strahlquellen der letzten Jahre haben gezeigt, dass mit neuen Wellenlängen, Konzepten und Kombinationen zusätzliche, zum Teil über den ästhetischen Bereich hinaus gehende therapeutische Optionen für den Dermatologen erschlossen werden konnten. Wurden bisher zum Beispiel mit fraktionalen Lasern Falten behandelt, sind eben diese Systeme heute in Kombination mit Medikamenten wichtige Werkzeuge bei der Behandlung von Narben, bei Feldkanzerisierung und epithelialen Tumoren. Die Anforderungen an den die Indikation stellenden und vorzugsweise therapierenden Arzt steigen mit der immer komplexer werdenden Technik und den zunehmenden Komorbiditäten und Komedikationen einer älter werdenden Patientenklientel. Parallel etabliert wurden, zunächst für einige wenige Indikationen, Geräte für die Heimanwendung, die sich durch geringe Leistung und spezielle Sicherheitsvorkehrungen zur Vermeidung von Unfällen, Risiken und Nebenwirkungen auszeichnen. Trotz der reduzierten Effizienz solcher Selbstbehandlungsmaßnahmen steigt die Wahrscheinlichkeit einer Fehlanwendung, da die Grundvoraussetzung für eine korrekte Therapie, nämlich die exakte Diagnose und Indikationsstellung, nicht vorausgesetzt werden kann. Bei einer Haarentfernung können so Pigmenttumoren, bei einer Faltentherapie neoplastische Hautveränderungen adressiert und zu erwartende, unvorhergesehene und neue Nebenwirkungen und Komplikationen induziert werden. In diesem Szenario ist es wichtig, alle potenziellen Anwender dieser neuen Technologien vor deren Einsatz so zu qualifizieren, dass den Therapierten maximale Therapiesicherheit bei höchster Effizienz unter dem Leitbild diagnosis certa - ullae therapiae fundamentum garantiert wird. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Deutsches "Nationales Krebshilfe-Monitoring" 2015-2019 - Studienprotokoll und erste Ergebnisse.

PubMed

Schneider, Sven; Görig, Tatiana; Schilling, Laura; Breitbart, Eckhard W; Greinert, Rüdiger; Diehl, Katharina

2017-09-01

Das Projekt "Nationales Krebshilfe-Monitoring zur Solariennutzung" (National Cancer Aid Monitoring of Tanning Bed Use, NCAM) ist eine deutsche Großstudie mit dem Ziel, die wichtigsten Risikofaktoren für Hautkrebs zu beobachten: natürliches Sonnenlicht und künstliche UV-Strahlung. NCAM ist eine bundesweite Querschnittstudie mit zunächst vier Runden der Datenerfassung (sogenannten Wellen) zwischen 2015 und 2018. Jedes Jahr wird eine bundesweit repräsentative Stichprobe aus 3.000 Personen im Alter von 14 bis 45 Jahren befragt. Die Querschnittsbefragung wird durch eine Kohorte von n = 450 aktuellen Solariennutzern ergänzt. Die erste Welle im Jahr 2015 ergab eine Gesamtprävalenz der Solariennutzung von 29,5 %. Elf Prozent aller Teilnehmer hatten in den vergangenen zwölf Monaten ein Solarium genutzt. Zu den Determinanten der aktuellen Solariennutzung gehörten jüngeres Alter, weibliches Geschlecht und Vollzeit-/Teilzeitbeschäftigung. Die hauptsächlichen Beweggründe, die für die Nutzung eines Solariums genannt wurden, waren Entspannung und Attraktivitätssteigerung. NCAM ist weltweit die erste Studie zur Überwachung der Risikofaktoren für Hautkrebs in jährlichen Intervallen anhand einer großen, landesweit repräsentativen Stichprobe. Erste Ergebnisse deuten darauf hin, dass Millionen Deutsche trotz Warnungen der WHO Solarien nutzen, und dass viele dieser Nutzer Jugendliche sind - trotz gesetzlicher Beschränkungen, die das Ziel haben, die Nutzung von Solarien durch Minderjährige zu verhindern. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Spirituelles Wohlbefinden und Coping bei Sklerodermie, Lupus erythematodes und malignem Melanom.

PubMed

Pilch, Michaela; Scharf, Sabina Nadine; Lukanz, Martin; Wutte, Nora Johanna; Fink-Puches, Regina; Glawischnig-Goschnik, Monika; Unterrainer, Human-Friedrich; Aberer, Elisabeth

2016-07-01

Religiös-spirituelles Wohlbefinden ist verbunden mit höherer Vitalität und verminderter Depressionsneigung. In unserer Studie untersuchten wir die Strategien zur Krankheitsbewältigung und die Rolle von Religiosität-Spiritualität (R-S) zur Verbesserung des subjektiven Wohlbefindens. 149 Patienten (107 Frauen), 44 mit systemischer Sklerodermie (SKL), 48 mit Lupus erythematodes (LE) und 57 mit malignem Melanom (MM), Stadium I-II, wurden mittels eines selbstentwickelten Fragebogens zum subjektiven Wohlbefinden, zu den mit der Erkrankung einhergehenden Umständen sowie mit dem Multidimensionalen Inventar (MI-RSB) zu R-S befragt. LE-Patienten sind zum Zeitpunkt der Diagnosestellung stärker belastet als SKL- und MM-Patienten. SKL- und LE-Patienten können erst nach Jahren die Erkrankung akzeptieren. Der Gesamtscore des religiös-spirituellen Befindens liegt bei LE-Patienten signifikant unter dem Wert der Normalbevölkerung. Fotosensitivität und Gelenksschmerzen sind bei LE-Patienten negativ assoziiert mit der Fähigkeit Vergeben zu können. SKL-Patienten mit Gesichtsveränderungen und Lungenbeteiligung zeigen höhere allgemeine Religiosität. MM-Patienten haben höhere Werte für transzendente Hoffnung. Vorträge über die Krankheit und psychologische Betreuung sind die wichtigsten Bedürfnisse von Patienten mit SKL, LE und MM an ihre Betreuer. Religiös-spirituelle Angebote zur Krankheitsverarbeitung scheinen derzeit eine untergeordnete Rolle zu spielen, könnten aber eine wichtige Ressource sein, der man in Zukunft mehr Aufmerksamkeit schenken sollte. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

AllergenFP: allergenicity prediction by descriptor fingerprints.

PubMed

Dimitrov, Ivan; Naneva, Lyudmila; Doytchinova, Irini; Bangov, Ivan

2014-03-15

Allergenicity, like antigenicity and immunogenicity, is a property encoded linearly and non-linearly, and therefore the alignment-based approaches are not able to identify this property unambiguously. A novel alignment-free descriptor-based fingerprint approach is presented here and applied to identify allergens and non-allergens. The approach was implemented into a four step algorithm. Initially, the protein sequences are described by amino acid principal properties as hydrophobicity, size, relative abundance, helix and β-strand forming propensities. Then, the generated strings of different length are converted into vectors with equal length by auto- and cross-covariance (ACC). The vectors were transformed into binary fingerprints and compared in terms of Tanimoto coefficient. The approach was applied to a set of 2427 known allergens and 2427 non-allergens and identified correctly 88% of them with Matthews correlation coefficient of 0.759. The descriptor fingerprint approach presented here is universal. It could be applied for any classification problem in computational biology. The set of E-descriptors is able to capture the main structural and physicochemical properties of amino acids building the proteins. The ACC transformation overcomes the main problem in the alignment-based comparative studies arising from the different length of the aligned protein sequences. The conversion of protein ACC values into binary descriptor fingerprints allows similarity search and classification. The algorithm described in the present study was implemented in a specially designed Web site, named AllergenFP (FP stands for FingerPrint). AllergenFP is written in Python, with GIU in HTML. It is freely accessible at http://ddg-pharmfac.net/Allergen FP. idoytchinova@pharmfac.net or ivanbangov@shu-bg.net.

Zeitlicher Verlauf der avaskulären Nekrose des Hüftkopfes bei Patienten mit Pemphigus vulgaris.

PubMed

Balighi, Kamran; Daneshpazhooh, Maryam; Aghazadeh, Nessa; Saeidi, Vahide; Shahpouri, Farzam; Hejazi, Pardis; Chams-Davatchi, Cheyda

2016-10-01

Pemphigus vulgaris (PV) wird in der Regel mit systemischen Corticosteroiden und Immunsuppressiva behandelt. Avaskuläre Nekrose (AVN) des Hüftkopfes ist eine gut bekannte schwerere Komplikation einer Corticosteroid-Therapie. Die Charakteristika dieser schweren Komplikation bei PV sind nach wie vor unbekannt. Nicht kontrollierte, retrospektive Untersuchung aller PV-bedingten AVN-Fälle, die in einer iranischen Klinik für bullöse Autoimmunerkrankungen zwischen 1985 und 2013 diagnostiziert wurden. Anhand der Krankenakten von 2321 untersuchten PV-Patienten wurden 45 Fälle (1,93 %) von femoraler AVN identifiziert. Dreißig davon waren Männer. Das mittlere Alter bei der Diagnose der AVN betrug 47,4 ± 14,2 Jahre. Der mittlere Zeitraum zwischen der Diagnose des PV und dem Einsetzen der AVN lag bei 25,3 ± 18,3 Monaten. Mit Ausnahme von acht Fällen (17,8 %) setzte die AVN bei der Mehrheit der Patienten innerhalb von drei Jahren nach Diagnose des PV ein. Die mittlere kumulative Dosis von Prednisolon bei Patienten mit AVN betrug 13.115,8 ± 7041,1 mg. Zwischen der Prednisolon-Gesamtdosis und dem Zeitraum bis zum Einsetzen der AVN bestand eine starke Korrelation (p = 0,001). Bei Patienten mit Alendronateinnahme in der Vorgeschichte war dieser Zeitraum signifikant kürzer (p = 0,01). Die AVN ist eine schwere Komplikation einer Corticosteroid-Behandlung bei Patienten mit PV. Sie wird bei 2 % der Patienten beobachtet und tritt vor allem in den ersten drei Behandlungsjahren auf. Bei Patienten, die höhere Dosen von Prednisolon erhalten, setzt die AVN tendenziell früher ein. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Kompressionstherapie - Versorgungspraxis: Informationsstand von Patienten mit Ulcus cruris venosum.

PubMed

Protz, Kerstin; Heyer, Kristina; Dissemond, Joachim; Temme, Barbara; Münter, Karl-Christian; Verheyen-Cronau, Ida; Klose, Katharina; Hampel-Kalthoff, Carsten; Augustin, Matthias

2016-12-01

Eine Säule der kausalen Therapie bei Patienten mit Ulcus cruris venosum ist die Kompressionstherapie. Sie unterstützt die Abheilung, reduziert Schmerzen und Rezidive und steigert die Lebensqualität. Bislang existieren kaum wissenschaftliche Daten zu dem Versorgungsstand und fachspezifischem Wissen von Patienten mit Ulcus cruris venosum. Standardisierte Fragebögen wurden bundesweit in 55 Pflegediensten, 32 Arztpraxen, vier Wundzentren und -sprechstunden sowie einem Pflegetherapiestützpunkt von Patienten mit Ulcus cruris venosum bei Erstvorstellung anonym ausgefüllt. Insgesamt nahmen 177 Patienten (Durchschnittsalter 69,4 Jahre; 75,1 % Frauen) teil. Ein florides Ulcus cruris venosum bestand im Mittel 17 Monate. 31,1 % hatten keine Kompressionstherapie, 40,1 % Binden und 28,8 % Strümpfe. Bei der Bestrumpfung hatten 13,7 % Kompressionsklasse III, 64,7 % Kompressionsklasse II und 19,6 % Kompressionsklasse I. 70,6 % legten die Strümpfe nach dem Aufstehen an, 21,1 % trugen sie Tag und Nacht. 39,2 % bereiteten die Strümpfe Beschwerden. Lediglich 11,7 % hatten eine An- und Ausziehhilfe. Die Binden wurden im Mittel 40,7 Wochen getragen und bei 69 % nicht unterpolstert. Bei 2,8 % wurde der Knöchel- und Waden-Umfang zur Erfolgskontrolle gemessen. Venensport machten 45,9 %. Ein Drittel hatte keine Kompressionsversorgung, obwohl diese eine Basismaßnahme der Therapie des Ulcus cruris venosum ist. Zudem ist deren korrekte Auswahl und Anwendung angesichts der langen Bestandsdauer der Ulzerationen zu hinterfragen. Weiterführende Fachkenntnisse bei Anwendern und Verordnern sowie Patientenschulungen sind erforderlich. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Der Einfluss von Alitretinoin auf die Lebensqualität bei Patienten mit schwerem chronischen Handekzem: FUGETTA - Beobachtungsstudie unter Praxisbedingungen.

PubMed

Augustin, Matthias; Thaçi, Diamant; Kamps, Anja

2016-12-01

Alitretinoin ist die einzige zugelassene Behandlung für schweres chronisches Handekzem (CHE), das refraktär gegenüber potenten topischen Corticosteroiden ist. Bei dieser Studie (FUGETTA) wurde die Wirksamkeit von leitliniengerecht angewendetem oralem Alitretinoin sowie dessen Einfluss auf die Lebensqualität (LQ) bei Patienten mit schwerem refraktärem CHE beurteilt. Multizentrische, offene, nichtinterventionelle Beobachtungsstudie, durchgeführt in Deutschland. Die Patienten wurden nach Ermessen ihres behandelnden Arztes mit Alitretinoin 10 mg oder 30 mg einmal täglich über maximal 24 Wochen behandelt. Die Wirksamkeit wurde anhand des Physician Global Assessment (PGA) und des Dermatology Life Quality Index (DLQI) bewertet. Zudem wurden unerwünschte Ereignisse (UE) erfasst. Die Studienpopulation bestand aus 658 Patienten (30 mg: n = 581; 10 mg: n = 77). Bei Beobachtungsbeginn litten die meisten Patienten (83 %) gemäß PGA an einem schweren CHE. Bei Beobachtungsende war das Handekzem bei 48 % der Patienten gemäß PGA vollständig oder fast vollständig abgeheilt (30 mg: 49 %; 10 mg: 43 %). Die mittlere Verbesserung des DLQI-Scores in Woche 24 betrug 58 % (30 mg: mittlere [SD] Veränderung gegenüber dem Ausgangswert -10,4 [8,04]) und 70 % (10 mg: mittlere [SD] Veränderung gegenüber dem Ausgangswert -10,8 [7,29]). Die Gesamtinzidenz von NW war niedrig und in den beiden Gruppen ähnlich. Alitretinoin führte zu einer schnellen, deutlichen Verbesserung der LQ bei Patienten mit schwerem CHE. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Umgang mit Antithrombotika bei Operationen an der Haut vor und nach Publikation der entsprechenden S3-Leitlinie.

PubMed

Gaskins, Matthew; Dittmann, Martin; Eisert, Lisa; Werner, Ricardo Niklas; Dressler, Corinna; Löser, Christoph; Nast, Alexander

2018-03-01

Laut einer Befragung im Jahre 2012 war der Umgang mit Antithrombotika bei dermatochirurgischen Eingriffen in Deutschland sehr heterogen. 2014 wurde erstmals eine evidenzbasierte Leitlinie zu diesem Thema veröffentlicht. Es wurde eine anonyme Befragung derselben Stichprobe zum Umgang mit Antithrombotika sowie zu Kenntnissen der Leitlinie durchgeführt. Die Ergebnisse wurden als relative Häufigkeiten berichtet und denen aus 2012 gegenübergestellt. 208 Antwortbögen wurden ausgewertet (Rücklaufquote: 36,6 %). Die große Mehrheit der Dermatologen erklärte, kleinere Eingriffe unter Fortführung der Therapie mit Phenprocoumon, niedrig dosierter Acetylsalicylsäure (≤ 100 mg) und Clopidogrel sowie mit direkten oralen Antikoagulanzien durchzuführen. Bei größeren Eingriffen war der Umgang hingegen weiterhin heterogen, insbesondere unter niedergelassenen Dermatologen. Der Anteil der Dermatologen, die Phenprocoumon, Acetylsalicylsäure und Clopidogrel leitlinienkonform verwendeten, hat sich insgesamt vergrößert. Führten 2012 beispielsweise 53,8 % der Klinikärzte bzw. 36,3 % der niedergelassenen Dermatologen eine große Exzision unter Fortführung der Therapie mit niedrig dosierter Acetylsalicylsäure durch, taten dies 2017 90,2 % bzw. 57,8 % (Phenprocoumon: 33,8 % bzw. 11,9 % auf 63,9 % bzw. 29,9 %; Clopidogrel: 36,9 % bzw. 23,2 % auf 63,9 % bzw. 30,6 %). Unter den Klinikärzten war ein hoher Anteil mit der Leitlinie vertraut und fand diese hilfreich. Eine Zunahme des leitlinienkonformen Verhaltens war bei allen Eingriffen zu verzeichnen. Bei größeren Eingriffen zeigte sich trotz deutlicher Verbesserung die Notwendigkeit verstärkter Anstrengungen zur Leitlinienumsetzung bzw. zur Identifizierung von Implementierungsbarrieren. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Retrospektive Analyse von Zufallsbefunden, die bei Patienten mit kutanem malignen Malignom durch (18) F-Fluordeoxyglucose-PET/CT erhoben wurden.

PubMed

Conrad, Franziska; Winkens, Thomas; Kaatz, Martin; Goetze, Steven; Freesmeyer, Martin

2016-08-01

Bei der (18) F-Fluordeoxyglucose-Positronenemissionstomographie/Computertomographie (FDG-PET/CT) ergeben sich häufig Zufallsbefunde. In der vorliegenden Studie konzentrierten wir uns auf mittels FDG-PET/CT erhaltene Zufallsbefunde bei Patienten mit kutanem Melanom und überprüften deren Relevanz hinsichtlich weiterer diagnostischer Maßnahmen und Interventionen. Die Krankenakten von 181 konsekutiven Melanom-Patienten wurden retrospektiv ausgewertet, um das Management von Zufallsbefunden zu dokumentieren. Der Schwerpunkt lag dabei auf den histologischen Befunden. Bei 33 von 181 (18 %) Patienten lagen 39 relevante Zufallsbefunde vor, und zwar im Kolorektalbereich (n = 15 Patienten), in der Schilddrüse (n = 8), der Prostata (n = 2), dem Bewegungsapparat (n = 2), in Lymphknoten (n = 2), der Parotis (n = 1), den Mandeln (n = 1), den Nieren (n = 1) und der Gallenblase (n = 1). Bei 25 Patienten schlossen sich weitere diagnostische Verfahren an, wobei in 21 Fällen ein klinisches Korrelat nachgewiesen wurde. Bei 16 von 21 Patienten ergab sich eine Neoplasie, darunter fünf maligne Läsionen (vier Kolonkarzinome und ein Prostatakarzinom). Die Malignome wurden frühzeitig diagnostiziert und in der Mehrzahl der Fälle erfolgreich entfernt. Der Einsatz der FDG-PET/CT als Routine-Diagnostik wird in den Leitlinien empfohlen und ist indiziert bei malignem Melanom ab Stadium IIC. In dieser Studie wurden auf effektive Weise ansonsten nicht erkannte Krebserkrankungen, insbesondere Kolonkarzinome, detektiert. In den meisten Fällen war eine frühe Intervention möglich. Zufallsbefunde durch FDG-PET/CT sollten, unter Berücksichtigung des Zustands und der Wünsche des Patienten, mit den geeigneten diagnostischen Maßnahmen abgeklärt werden. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Mitotic rate in primary melanoma: interobserver and intraobserver reliability, analyzed using H&E sections and immunohistochemistry.

PubMed

Garbe, Claus; Eigentler, Thomas K; Bauer, Jürgen; Blödorn-Schlicht, Norbert; Cerroni, Lorenzo; Fend, Falko; Hantschke, Markus; Kurschat, Peter; Kutzner, Heinz; Metze, Dieter; Mielke, Volker; Preßler, Harald; Reusch, Michael; Reusch, Ursula; Stadler, Rudolf; Tronnier, Michael; Yazdi, Amir; Metzler, Gisela

2016-09-01

In 2009, the AJCC issued a revised melanoma staging system. In addition to tumor thickness and ulceration, the mitotic rate was introduced as the third major prognostic parameter for the classification of primary cutaneous melanoma. Given that, according to the 2009 AJCC classification, the detection of one or more dermal tumor mitoses leads to an upstaging - from stage Ia to Ib - of melanomas with a tumor thickness of ≤ 1.0 mm, we set out to investigate the reproducibility of this new parameter. In order to assess interobserver reliability, 17 dermatopathologists und pathologists - all well versed in the diagnosis of cutaneous melanoma - analyzed the mitotic rate in 15 thin primary cutaneous melanomas (mean tumor thickness 0.91 mm) using identical slides. Mitotic rates were determined on H&E and phosphohistone H3 (Ser10)-stained samples. Without knowledge of their previous assessment, five of the aforementioned examiners reevaluated the samples after more than one year in order to ascertain intraobserver reliability. Interobserver reliability of the mitotic rate in thin primary melanomas is disappointing and independent of whether H&E or immunohistochemically stained samples are used (kappa value: 0.088 [H&E], 0.154 [IH], respectively). Kappa values improved to 0.345 (H&E) and 0.403 (IH) when using a cutoff of 0/1 vs. 2+ mitoses. Similarly unsatisfactory, kappa values for intraobserver reliability ranged from 0.18 and 0.348, depending on the individual examiner. Given the unsatisfactory reproducibility and large variations in assessing the mitotic rate, it remains a matter of debate whether this diagnostic parameter should play a role in therapeutic decisions. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Pressure profiles of sport compression stockings.

PubMed

Reich-Schupke, Stefanie; Surhoff, Stefan; Stücker, Markus

2016-05-01

While sport compression stockings (SCS) have become increasingly popular, there is no regulatory norm as exists for medical compression stockings (MCS). The objective of this pilot study was to compare five SCS with respect to their pressure profiles ex vivo and in vivo, and in relation to German standards for MCS (RAL norm). In vivo (10 competitive athletes; standardized procedure using the Kikuhime pressure monitor) and ex vivo (tested at the Hohenstein Institute) pressure profiles were tested for the following products: CEP Running Progressive Socks, Falke Running Energizing, Sigvaris Performance, X-Socks Speed Metal Energizer, and 2XU Compression Race Socks. Ex vivo ankle pressures of CEP (25.6 mmHg) and 2XU (23.2 mmHg) corresponded to class 2 MCS; that of Sigvaris (20.8 mmHg), to class 1 MCS. The remaining SCS achieved lower pressure values. The pressure gradients showed marked differences, and did not meet MCS standards. Average in vivo pressures were higher for 2XU, CEP, and Sigvaris than for Falke and X-Socks. However, in vivo values for all SCS were below those of class 1 MCS. None of the SCS showed the decreasing pressure gradient (from distal to proximal) required for MCS. In vivo and ex vivo pressure profiles of all SCS examined showed marked heterogeneity, and did not meet MCS standards. Consequently, the clinical and practical effects of SCS cannot be compared, either. It would therefore be desirable to establish a classification that allows for the categorization and comparison of various SCS as well as their selection based on individual preferences and needs (high vs. low pressure, progressive vs. degressive profile). © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

New lasers and light sources - old and new risks?

PubMed

Paasch, Uwe; Schwandt, Antje; Seeber, Nikolaus; Kautz, Gerd; Grunewald, Sonja; Haedersdal, Merete

2017-05-01

Recent developments (new wavelengths, treatment concepts, and combinations) in the field of lasers, intense pulsed light (IPL), LED, as well as new energy and light sources have opened up new therapeutic options that extend beyond mere aesthetic indications. Thus, while fractional lasers used to be employed to merely treat wrinkles, the same devices - in the context of laser-assisted drug delivery - have now become important tools in the treatment of scars, field cancerization, and epithelial tumors. The requirements posed to physicians, both with respect to establishing the indication and conducting treatment, have been growing along with the increase in technological complexity as well as the rising number of comorbidities and comedications in a patient population that continues to age. At the same time, home-use devices have been introduced for a variety of indications. These devices are characterized by low power and special safety features aimed at preventing accidents, risks, and side effects. Despite the reduced efficacy of such self-treatment devices, there is an increased risk of misuse, given that the basic prerequisite for adequate treatment cannot be ensured, to wit, the exact diagnosis and therapeutic indication. Consequently, during hair removal or anti-wrinkle treatment, pigmented lesions and cutaneous neoplasms may be altered, thus giving rise to expected, unexpected and new side effects and complications. In the aforementioned setting, it is important that all potential users of these new technologies be properly trained in a manner that ensures those treated a maximum of safety and efficacy in accordance with the guiding principle "diagnosis certa - ullae therapiae fundamentum". © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Prognostischer Wert der Fläche und Dichte von Lymphgefäßen bei kutanem Plattenepithelkarzinom.

PubMed

Krediet, Jorien Tannette; Kanitakis, Jean; Bob, Adrienne; Schmitter, Julia; Carine Krediet, Annelot; Röwert, Joachim; Stockfleth, Eggert; Painsi, Clemens; Hügel, Rainer; Terhorst, Dorothea; Lange-Asschenfeldt, Bernhard

2016-11-01

Kutane Plattenepithelkarzinome (SCC) sind bekannt für ihre Fähigkeit, über Lymphgefäße zu metastasieren. In neueren Studien wird das Ausmaß der Lymphangiogenese als möglicher prognostischer Faktor bei einigen Hauttumoren genannt. Ziel dieser Studie war die Quantifizierung der Lymphangiogenese bei SCC entweder durch computergestützte Bildanalyse oder mithilfe der Zählmethode nach Chalkley. Gefäßparameter wurden im Hinblick auf ihre Vorhersagekraft für die Bildung von Tumormetastasen beurteilt und verglichen. In dieser Fallkontrollstudie wurden die klinischen und histologischen Daten von jeweils 15 SCC-Patienten mit bzw. ohne Metastasen retrospektiv analysiert. In den SCC-Proben wurde der für das Lymphendothel spezifische Marker D2-40 und der pan-vaskuläre Marker CD31 immunhistochemisch angefärbt und durch computergestützte morphometrische Bildanalyse in Hotspots sowie mithilfe der digitalisierten Zählmethode nach Chalkley analysiert. Die Dichte von Lymphgefäßen, die relative Lymphgefäßfläche und die mit der Chalkley-Methode ermittelte Zahl an Lymphgefäßen (Chalkley-Count) waren bei metastasierten SCC signifikant erhöht. Die Tumordicke war bei metastasierten SCC signifikant höher und besaß die höchste Vorhersagekraft für eine Metastasierung. Die Tumordicke war ein signifikanter Prädiktor für Lymphangiogeneseparameter. Die Lymphangiogenese ist bei metastasierten SCC erhöht, doch ihr Ausmaß wird von der Tumordicke beeinflusst. Die Tumordicke bildet weiterhin den zuverlässigsten prädiktiven Faktor für die Metastasierung. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Thermally Simulated Testing of a Direct-Drive Gas-Cooled Nuclear Reactor

NASA Technical Reports Server (NTRS)

Godfroy, Thomas; Bragg-Sitton, Shannon; VanDyke, Melissa

2003-01-01

This paper describes the concept and preliminary component testing of a gas-cooled, UN-fueled, pin-type reactor which uses He/Xe gas that goes directly into a recuperated Brayton system to produce electricity for nuclear electric propulsion. This Direct-Drive Gas-Cooled Reactor (DDG) is designed to be subcritical under water or wet-sand immersion in case of a launch accident. Because the gas-cooled reactor can directly drive the Brayton turbomachinery, it is possible to configure the system such that there are no external surfaces or pressure boundaries that are refractory metal, even though the gas delivered to the turbine is 1144 K. The He/Xe gas mixture is a good heat transport medium when flowing, and a good insulator when stagnant. Judicious use of stagnant cavities as insulating regions allows transport of the 1144-K gas while keeping all external surfaces below 900 K. At this temperature super-alloys (Hastelloy or Inconel) can be used instead of refractory metals. Super-alloys reduce the technology risk because they are easier to fabricate than refractory metals, we have a much more extensive knowledge base on their characteristics, and, because they have a greater resistance to oxidation, system testing is eased. The system is also relatively simple in its design: no additional coolant pumps, heat exchanger, or freeze-thaw systems are required. Key to success of this concept is a good knowledge of the heat transfer between the fuel pins and the gas, as well as the pressure drop through the system. This paper describes preliminary testing to obtain this key information, as well as experience in demonstrating electrical thermal simulation of reactor components and concepts.

Direct-Drive Gas-Cooled Reactor Power System: Concept and Preliminary Testing

NASA Technical Reports Server (NTRS)

Wright, S. A.; Lipinski, R. J.; Godfroy, T. J.; Bragg-Sitton, S. M.; VanDyke, M. K.

2002-01-01

This paper describes the concept and preliminary component testing of a gas-cooled, UN-fueled, pin-type reactor which uses He/Xe gas that goes directly into a recuperated Brayton system to produce electricity for nuclear electric propulsion. This Direct-Drive Gas-Cooled Reactor (DDG) is designed to be subcritical under water or wet- sand immersion in case of a launch accident. Because the gas-cooled reactor can directly drive the Brayton turbomachinery, it is possible to configure the system such that there are no external surfaces or pressure boundaries that are refractory metal, even though the gas delivered to the turbine is 1144 K. The He/Xe gas mixture is a good heat transport medium when flowing, and a good insulator when stagnant. Judicious use of stagnant cavities as insulating regions allows transport of the 1144-K gas while keeping all external surfaces below 900 K. At this temperature super-alloys (Hastelloy or Inconel) can be used instead of refractory metals. Super-alloys reduce the technology risk because they are easier to fabricate than refractory metals, we have a much more extensive knowledge base on their characteristics, and, because they have a greater resistance to oxidation, system testing is eased. The system is also relatively simple in its design: no additional coolant pumps, heat exchanger, or freeze-thaw systems are required. Key to success of this concept is a good knowledge of the heat transfer between the fuel pins and the gas, as well as the pressure drop through the system. This paper describes preliminary testing to obtain this key information, as well as experience in demonstrating electrically heated testing of simulated reactor components.

Inzidenz von bullösen Autoimmunerkrankungen in Serbien: eine retrospektive Studie über 20 Jahre.

PubMed

Milinković, Mirjana; Janković, Slavenka; Medenica, Ljiljana; Nikolić, Miloš; Reljić, Vesna; Popadić, Svetlana; Janković, Janko

2016-10-01

Die meisten früheren Arbeiten zu den klinisch-epidemiologischen Merkmalen von bullösen Autoimmunerkrankungen (AIBD) konzentrierten sich vor allem auf eine einzige Krankheitsentität oder nur eine Krankheitsgruppe; nur in wenigen Studien wurde die Inzidenz verschiedener AIBD untersucht. Bei der vorliegenden Studie war es unser Ziel, das gesamte Spektrum der AIBD zu betrachten, die Inzidenz der häufigsten AIBD zu ermitteln und die zeitlichen Trends ihres Auftretens in Zentralserbien über einen Zeitraum von 20 Jahren zu untersuchen. Wir rekrutierten retrospektiv 1161 AIBD-Fälle, die in Zentralserbien von Januar 1991 bis Dezember 2010 neu diagnostiziert wurden. Die Diagnose stützte sich auf eine strikte klinische, histologische und immunhistologische Beurteilung. Folgende Inzidenzraten wurden für die einzelnen Erkrankungen ermittelt: 4,35 pro eine Million Einwohner/Jahr (pME/Jahr) für Pemphigus, 4,47 pME/Jahr für Pemphigoid, 1,42 pME/Jahr für Dermatitis herpetiformis (DH), 0,25 pME/Jahr IgA-Dermatose und 0,08 pME/Jahr für Epidermolysis bullosa acquisita. Im betrachteten Zeitraum stieg die altersbereinigte Inzidenzrate für Pemphigus und insbesondere für Pemphigoid signifikant an, während sie für DH, allerdings nicht signifikant, abnahm. Unsere Studie befasst sich zum ersten Mal mit den Inzidenzraten des gesamten Spektrums der AIBD in Serbien und untersucht die zeitlichen Trends ihres Auftretens über einen Zeitraum von 20 Jahren. Nach unserem besten Wissen wurde ein ähnlicher Befund wie der unsere, dass nämlich die Inzidenzraten von Pemphigus und Pemphigoid vergleichbar sind, bisher noch nicht publiziert. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Computational and Mathematical Modeling of Coupled Superconducting Quantum Interference Devices

NASA Astrophysics Data System (ADS)

Berggren, Susan Anne Elizabeth

This research focuses on conducting an extensive computational investigation and mathematical analysis into the average voltage response of arrays of Superconducting Quantum Interference Devices (SQUIDs). These arrays will serve as the basis for the development of a sensitive, low noise, significantly lower Size, Weight and Power (SWaP) antenna integrated with Low-Noise Amplifier (LNA) using the SQUID technology. The goal for this antenna is to be capable of meeting all requirements for Guided Missile Destroyers (DDG) 1000 class ships for Information Operations/Signals Intelligence (IO/SIGINT) applications in Very High Frequency/Ultra High Frequency (V/UHF) bands. The device will increase the listening capability of receivers by moving technology into a new regime of energy detection allowing wider band, smaller size, more sensitive, stealthier systems. The smaller size and greater sensitivity will allow for ships to be “de-cluttered” of their current large dishes and devices, replacing everything with fewer and smaller SQUID antenna devices. The fewer devices present on the deck of a ship, the more invisible the ship will be to enemy forces. We invent new arrays of SQUIDs, optimized for signal detection with very high dynamic range and excellent spur-free dynamic range, while maintaining extreme small size (and low radar cross section), wide bandwidth, and environmentally noise limited sensitivity, effectively shifting the bottle neck of receiver systems forever away from the antenna itself deeper into the receiver chain. To accomplish these goals we develop and validate mathematical models for different designs of SQUID arrays and use them to invent a new device and systems design. This design is capable of significantly exceeding, per size weight and power, state-of-the-art receiver system measures of performance, such as bandwidth, sensitivity, dynamic range, and spurious-free dynamic range.

2'-Deoxyribosyltransferase from Leishmania mexicana, an efficient biocatalyst for one-pot, one-step synthesis of nucleosides from poorly soluble purine bases.

PubMed

Crespo, N; Sánchez-Murcia, P A; Gago, F; Cejudo-Sanches, J; Galmes, M A; Fernández-Lucas, Jesús; Mancheño, José Miguel

2017-10-01

Processes catalyzed by enzymes offer numerous advantages over chemical methods although in many occasions the stability of the biocatalysts becomes a serious concern. Traditionally, synthesis of nucleosides using poorly water-soluble purine bases, such as guanine, xanthine, or hypoxanthine, requires alkaline pH and/or high temperatures in order to solubilize the substrate. In this work, we demonstrate that the 2'-deoxyribosyltransferase from Leishmania mexicana (LmPDT) exhibits an unusually high activity and stability under alkaline conditions (pH 8-10) across a broad range of temperatures (30-70 °C) and ionic strengths (0-500 mM NaCl). Conversely, analysis of the crystal structure of LmPDT together with comparisons with hexameric, bacterial homologues revealed the importance of the relationships between the oligomeric state and the active site architecture within this family of enzymes. Moreover, molecular dynamics and docking approaches provided structural insights into the substrate-binding mode. Biochemical characterization of LmPDT identifies the enzyme as a type I NDT (PDT), exhibiting excellent activity, with specific activity values 100- and 4000-fold higher than the ones reported for other PDTs. Interestingly, LmPDT remained stable during 36 h at different pH values at 40 °C. In order to explore the potential of LmPDT as an industrial biocatalyst, enzymatic production of several natural and non-natural therapeutic nucleosides, such as vidarabine (ara A), didanosine (ddI), ddG, or 2'-fluoro-2'-deoxyguanosine, was carried out using poorly water-soluble purines. Noteworthy, this is the first time that the enzymatic synthesis of 2'-fluoro-2'-deoxyguanosine, ara G, and ara H by a 2'-deoxyribosyltransferase is reported.

A novel NOTCH3 mutation identified in patients with oral cancer by whole exome sequencing.

PubMed

Yi, Yanjun; Tian, Zhuowei; Ju, Houyu; Ren, Guoxin; Hu, Jingzhou

2017-06-01

Oral cancer is a serious disease caused by environmental factors and/or susceptible genes. In the present study, in order to identify useful genetic biomarkers for cancer prediction and prevention, and for personalized treatment, we detected somatic mutations in 5 pairs of oral cancer tissues and blood samples using whole exome sequencing (WES). Finally, we confirmed a novel nonsense single-nucleotide polymorphism (SNP; chr19:15288426A>C) in the NOTCH3 gene with sanger sequencing, which resulted in a N1438T mutation in the protein sequence. Using multiple in silico analyses, this variant was found to mildly damaging effects on the NOTCH3 gene, which was supported by the results from analyses using PANTHER, SNAP and SNPs&GO. However, further analysis using Mutation Taster revealed that this SNP had a probability of 0.9997 to be 'disease causing'. In addition, we performed 3D structure simulation analysis and the results suggested that this variant had little effect on the solubility and hydrophobicity of the protein and thus on its function; however, it decreased the stability of the protein by increasing the total energy following minimization (-1,051.39 kcal/mol for the mutant and -1,229.84 kcal/mol for the native) and decreasing one stabilizing residue of the protein. Less stability of the N1438T mutant was also supported by analysis using I-Mutant with a DDG value of -1.67. Overall, the present study identified and confirmed a novel mutation in the NOTCH3 gene, which may decrease the stability of NOTCH3, and may thus prove to be helpful in cancer prognosis.

Extemporaneous formulations in Germany - relevance for everyday clinical practice.

PubMed

Staubach, Petra; Salzmann, Stefan; Peveling-Oberhag, Adriane; Weyer, Veronika; Zimmer, Sebastian; Gradl, Gabriele; Lang, Berenice M

2018-05-01

Extemporaneous formulations broaden the spectrum of therapeutic options for topical treatment in particular and thus improve patient care. The latest amendment to the Regulation on the Operation of Pharmacies issued in 2012 brought about changes in prescribing and manufacturing practices. The aim of the present study was to assess the relevance of extemporaneous formulations in everyday clinical practice. We used data from the German Institute for Drug Use Evaluation (DAPI) to analyze the prescribing practice for compounded preparations in Germany between the fourth quarter of 2011 and the third quarter of 2014. In doing so, we determined the total cost associated with extemporaneous formulations covered by statutory health insurance funds in the outpatient setting. Approximately three out of ten prescriptions (30.54 %) by German dermatologists during the observation period were extemporaneous formulations. While dermatologists make up only 2.7 % of physicians working in the statutory health care system in Germany, they prescribe more than half of all compounded preparations (53.6 %). Each dermatologist prescribed an average of 270.4 formulations per quarter; that number was 13.5 (1.3 %) for all other medical specialties. On average, 1,983,687 extemporaneous formulations overall (1.3 % of all prescriptions) were prescribed per quarter, corresponding to a total cost of € 40,944,982 (0.55 %). Apart from finished medicinal products, extemporaneous formulations play a key role in outpatient care. Based on the principles of evidence-based and patient-oriented medicine, the quality of compounded preparations and the prescribing practice of physicians (standardized vs. individual formulations) should be further investigated to optimize the quality of these preparations. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Occupational skin cancer due to UV-irradiation--Analyses of notified cases as "virtually-certain" occupational disease in Germany between 2005 and 2011.

PubMed

Schmitt, Jochen; Diepgen, Thomas L

2014-06-01

UV-induced skin cancer is not yet included in the German ordinance on occupational diseases and can only be notified and recognized acknowledged as "virtually-certain" occupational disease. The objective of the study was to analyze notified and acknowledged cases of occupational skin cancer due to UV-irradiation in Germany between 2005 and 2011. All notified cases of occupational skin cancer due to UV-irradiation have been analyzed which have been registered by the German Statutory accident insurance as of May 2012 were analyzed. The data analyze was descriptive stratified annually for presenting time trends.Data analysis was descriptive, stratified by year to defect time trends. Notified cases have increased annually with a total of 548 registered cases of occupational skin cancer induced by UV-irradiation between 2005 and 2011, and 74 recognized acknowledged cases. In 56 cases the procedure was not yet finished. Squamous cell carcinoma (SCC) and in-situ squamous cell carcinoma (actinic keratosis, Bowen's disease) were most frequent and have been the most frequentlyobserved in 333 notified cases. and between 15.6 % and 24.9 % have been recognizedof cases with SCC and actinic keratosis were recognized, respectively. 184 patients with basal cell carcinoma were notified but only 6.5 % recognized acknowledged and only 3 cases with exclusive basal cell carcinoma. Out of 50 notified patients with Mmelanoma only one was recognizedacknowledged. The results are in good agreement with the proposal of the German Minister of labor to establish UV-induced skin cancer as a new occupational disease. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Pain and pain management in dermatology.

PubMed

Beiteke, Ulrike; Bigge, Stefan; Reichenberger, Christina; Gralow, Ingrid

2015-10-01

It is estimated that 23 million Germans suffer from chronic pain. A recent survey has revealed that 30 % of chronic pain patients are dissatisfied with their pain management. Furthermore, five million Germans suffer from neuropathic pain, 20 % of whom are inadequately treated. Pain is also a symptom of many dermatologic diseases, which is mostly somatic and may be classified as mild in the majority of cases. Nevertheless, research on the quality of life (QoL) has increasingly shown a marked impairment of QoL by moderate pain such as in psoriatic arthritis. -Severe pain is associated with herpes zoster (shingles), leg ulcers, and pyoderma gangrenosum. This article addresses the basics of pain classification and, in a short excerpt, pain transduction/transmission and modulation. The use of standardized diagnostic -scales is recommended for the purpose of recording and monitoring pain intensity, which allows for the optimization of therapy and consistent interdisciplinary -communication. Any dermatology residency program includes the acquisition of knowledge and skills in pain management. This review therefore aims to present fundamental therapeutic concepts based on the expanded WHO analgesic ladder, and describes a step-wise therapeutic approach and combination therapies. The article focuses on the pain management of the above-mentioned severely painful, conservatively treated dermatoses. Besides well-established therapeutic agents and current -therapeutic standards, it discusses specific options based on guidelines (where available). Current knowledge on peri- and postoperative pain management is briefly outlined. This article addresses: ▸ The fundamentals of the classification and neurophysiology of pain; ▸ Standards for pain documentation in children and adults; ▸ General standards for pharmaceutical pain management; ▸ Current specific treatment options for postherpetic neuralgia, leg ulcers, and -pyoderma gangrenosum in conjunction with the expanded WHO analgesic -ladder. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Vernarbende Alopezien.

PubMed

Kanti, Varvara; Röwert-Huber, Joachim; Vogt, Annika; Blume-Peytavi, Ulrike

2018-04-01

Primär vernarbende Alopezien (PVA) werden nach der Klassifikation der North American Hair Research Society nach ihrem prominenten entzündlichen Infiltrat in vier Gruppen eingeteilt: PVA mit lymphozytärem, neutrophilem, gemischtzelligem oder unspezifischem Entzündungsmuster. Der Haarausfall kann subklinisch beginnen und langsam fortschreiten, so dass der genaue Erkrankungsbeginn oft schwer nachzuvollziehen ist. Die Diagnose wird häufig verzögert gestellt. Während die meisten vernarbenden Alopezien bei vollständiger Ausprägung anhand des klinischen Bildes klar zugeordnet werden können, ist die Diagnosestellung in der Frühphase oder im Endstadium häufig schwierig. Bei Erstvorstellung sollte eine ausführliche Anamnese und dermatologische Ganzkörperuntersuchung, inklusive Trichoskopie durchgeführt werden. In klinisch unklaren Fällen sollte eine Biopsie erfolgen. Aufgrund der Seltenheit der PVA gibt es bisher nur eine niedrige Evidenz über die Wirksamkeiten der Vielzahl der verschiedenen angewandten Therapien. Ziele der Therapie einer PVA sind, den Haarausfall zu stoppen oder zumindest zu verzögern, die klinischen Entzündungszeichen zu reduzieren, weitere Vernarbung zu verhindern sowie die subjektiven Symptome zu lindern. Ein Nachwachsen in bereits vernarbten Arealen sollte nicht erwartet werden. Eine antientzündliche Therapie mit topischen Kortikosteroiden der Klasse III-IV und/oder mit intrakutanen intraläsionalen Triamcinolonacetonid-Injektionen kommt bei den meisten PVA in Betracht. Die Wahl der systemischen Therapie hängt von der Art des prädominierenden entzündlichen Infiltrates ab und umfasst antimikrobielle/antibiotische oder immunmodulatorische/immunsuppressive Ansätze. Psychologische Unterstützung und Camouflage-Techniken sollten den Patienten angeboten werden. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

ABCB1-Gen-Polymorphismus in einer polnischen Kohorte ist mit Risiko für bullöses Pemphigoid assoziiert.

PubMed

Rychlik-Sych, Mariola; Barańska, Małgorzata; Dudarewicz, Michał; Skrętkowicz, Jadwiga; Żebrowska, Agnieszka; Owczarek, Jacek; Waszczykowska, Elżbieta

2017-05-01

Polymorphismen im ABCB1-Gen, das für das P-Glykoprotein kodiert, können die intrazelluläre Konzentration von Xenobiotika beeinflussen und so zur Entwicklung von Autoimmunerkrankungen, einschließlich des bullösen Pemphigoids (BP), beitragen. In der vorliegenden Studie sollte untersucht werden, ob in einer polnischen Kohorte die C3435T- und G2677T/A-Polymorphismen im ABCB1-Gen mit dem Risiko für ein BP assoziiert sind. Die Studie umfasste 71 Patienten mit BP und 156 gesunde Probanden. Der C3435T-Polymorphismus wurde mittels PCR-RFLP bestimmt und der G2677T/A-Polymorphismus mittels Allel-spezifischer PCR. Es gab zwar keine Korrelation zwischen dem C3435-Polymorphismus und dem BP-Risiko, aber wir konnten eine derartige Assoziation hinsichtlich des G2677T/A-Polymorphismus nachweisen. Das relative Risiko eines BP war bei Personen mit dem 2677TA-Genotyp um mehr als den Faktor fünf erhöht (OR = 5,52; p = 0,0063) und bei Trägern des 2677TT-Genotyps mehr als verdoppelt (OR = 2,40; p = 0,0076). Mit 2,40 (p = 0,000018) war die OR bei Trägern des 2677T-Allels ebenfalls erhöht. Die höhere Prävalenz des 2677GG-Genotyps und des 2677G-Allels bei der Kontrollgruppe sowie eine OR < 1,0 (0,22 beziehungsweise 0,33) legen eine Schutzfunktion des 2677G-Allels hinsichtlich der Ausbildung eines BP nahe. Die Ergebnisse der vorliegenden Studie zeigen, dass der G2677T/A-Polymorphismus im ABCB1-Gen das Risiko für die Entstehung eines BP beeinflussen könnte. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Intraläsionale Therapie niedrig maligner primär kutaner B-Zell-Lymphome mit Anti-CD20-Antikörper: Nebenwirkungen korrelieren mit gutem klinischen Ansprechen.

PubMed

Eberle, Franziska C; Holstein, Julia; Scheu, Alexander; Fend, Falko; Yazdi, Amir S

2017-03-01

Die intraläsionale Gabe von Anti-CD20-Antikörpern (Rituximab) wurde als effektive Therapieoption für Patienten mit niedrig malignen primär kutanen B-Zell-Lymphomen beschrieben. Bis heute wurden allerdings keine Parameter identifiziert, welche reproduzierbar ein gutes klinisches Ansprechen dieser Therapie vorhersagen. Ziel dieser Studie ist, sowohl das klinische Ansprechen und die unerwünschten Nebenwirkungen als auch die Patientenwahrnehmung hinsichtlich intraläsionaler Injektionen von anti-CD20-Antikörpern zur Behandlung indolenter primär kutaner B-Zell-Lymphome im Vergleich mit anderen Therapien zu evaluieren. Elf Patienten mit einem primär kutanen B-Zell-Lymphom, namentlich primär kutanes Keimzentrumslymphom (n = 9) und primär kutanes Marginalzonenlymphom (n = 2), welche mittels intraläsionalem Anti-CD20-Antikörper behandelt wurden, wurden retrospektiv evaluiert hinsichtlich der Ansprechrate und unerwünschter Nebenwirkungen sowie in Bezug auf deren Selbsteinschätzung dieser und anderer Therapien des primär kutanen B-Zell-Lymphoms. Patienten, deren primär kutanes B-Zell-Lymphom mittels intraläsionaler Gabe von Anti-CD20-Antikörper behandelt wurde, zeigten ein komplettes oder partielles Ansprechen in 45 % beziehungsweise 27 % aller Patienten. Speziell Patienten mit grippeähnlichen Symptomen nach erfolgter Injektion zeigten ein gutes Ansprechen. Die Mehrheit der Patienten empfand die Therapie mit Rituximab als die beste Therapie im Vergleich zu anderen Therapien wie beispielsweise chirurgische Exzision oder Radiotherapie. Intraläsionales Rituximab ist eine effektive Therapie mit hoher Patientenzufriedenheit. Starke therapiebedingte Nebenwirkungen wie Fieber, Schüttelfrost und Kopfschmerzen nach Gabe von Rituximab könnten als Indikator für gute Wirksamkeit dienen. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Evaluation and identification of damaged single nucleotide polymorphisms in COL1A1 gene involved in osteoporosis

PubMed Central

Alsaif, Mohammed A.; Al Shammari, Sulaiman A.; Alhamdan, Adel A.

2012-01-01

Introduction Single-nucleotide polymorphisms (SNPs) are biomarkers for exploring the genetic basis of many complex human diseases. The prediction of SNPs is promising in modern genetic analysis but it is still a great challenge to identify the functional SNPs in a disease-related gene. The computational approach has overcome this challenge and an increase in the successful rate of genetic association studies and reduced cost of genotyping have been achieved. The objective of this study is to identify deleterious non-synonymous SNPs (nsSNPs) associated with the COL1A1 gene. Material and methods The SNPs were retrieved from the Single Nucleotide Polymorphism Database (dbSNP). Using I-Mutant, protein stability change was calculated. The potentially functional nsSNPs and their effect on proteins were predicted by PolyPhen and SIFT respectively. FASTSNP was used for estimation of risk score. Results Our analysis revealed 247 SNPs as non-synonymous, out of which 5 nsSNPs were found to be least stable by I-Mutant 2.0 with a DDG value of > –1.0. Four nsSNPs, namely rs17853657, rs17857117, rs57377812 and rs1059454, showed a highly deleterious tolerance index score of 0.00 with a change in their physicochemical properties by the SIFT server. Seven nsSNPs, namely rs1059454, rs8179178, rs17853657, rs17857117, rs72656340, rs72656344 and rs72656351, were found to be probably damaging with a PSIC score difference between 2.0 and 3.5 by the PolyPhen server. Three nsSNPs, namely rs1059454, rs17853657 and rs17857117, were found to be highly polymorphic with a risk score of 3-4 with a possible effect of non-conservative change and splicing regulation by FASTSNP. Conclusions Three nsSNPs, namely rs1059454, rs17853657 and rs17857117, are potential functional polymorphisms that are likely to have a functional impact on the COL1A1 gene. PMID:24273577

Occupational syncarcinogenesis in the skin - combined effects of two carcinogens from the German occupational disease list.

PubMed

Dickel, Heinrich; Blome, Otto; Dickel, Beate; Bruckner, Thomas; Stockfleth, Eggert; Soemantri, Silas Paras

2016-12-01

Though scientifically undisputed, cutaneous syncarcinogenesis is not reflected in German occupational disease (OD) regulations, which tend to be guided by the tenet of monocausality. Recognition of nonmelanoma skin cancer (NMSC) and its precursor lesions as OD requires individual assessment as to whether the requirements pursuant to either OD 5103 (occupational exposure to natural UV radiation) or OD 5102 (occupational exposure to polycyclic aromatic hydrocarbons) are fulfilled. Retrospective analysis of 28 patients (median age 72.5 years) with NMSC and respective precursor lesions who had been occupationally exposed to natural UV radiation and polycyclic aromatic hydrocarbons. All cases had undergone expert medical assessment between September 2012 and September 2015. According to our assessments, all 28 cases met the occupational requirements pursuant to OD 5103 and 5102. In 26 cases (93 %), we recommended recognition of skin cancer as occupational disease pursuant to both OD 5103 and OD 5102. The competent occupational insurance association (BG) followed our recommendation in four cases. In eight cases, recognition was solely based on OD 5103; in ten cases, only on OD 5102. Four cases were denied recognition. Following adequate cumulative occupational exposure to natural UV light as well as occupational exposure to polycyclic aromatic hydrocarbons, NMSC or its precursor lesions arising in UV-exposed areas should be reported to the competent occupational insurance association as "OD 5103 and 5102 in terms of syncarcinogenesis". Apart from the fact that the ensuing recognition proceedings will be able to more adequately reflect real-life workplace conditions, filing a report pursuant to both ODs also allows for recognition of basal cell carcinoma as occupational disease. According to current regulations, this would not be possible, if the assessment were solely based on OD 5103. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Guideline for the diagnosis of drug hypersensitivity reactions: S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM).

PubMed

Brockow, Knut; Przybilla, Bernhard; Aberer, Werner; Bircher, Andreas J; Brehler, Randolf; Dickel, Heinrich; Fuchs, Thomas; Jakob, Thilo; Lange, Lars; Pfützner, Wolfgang; Mockenhaupt, Maja; Ott, Hagen; Pfaar, Oliver; Ring, Johannes; Sachs, Bernhardt; Sitter, Helmut; Trautmann, Axel; Treudler, Regina; Wedi, Bettina; Worm, Margitta; Wurpts, Gerda; Zuberbier, Torsten; Merk, Hans F

Drug hypersensitivity reactions are unpredictable adverse drug reactions. They manifest either within 1-6 h following drug intake (immediate reactions) with mild to life-threatening symptoms of anaphylaxis, or several hours to days later (delayed reactions), primarily as exanthematous eruptions. It is not always possible to detect involvement of the immune system (allergy). Waiving diagnostic tests can result in severe reactions on renewed exposure on the one hand, and to unjustified treatment restrictions on the other. With this guideline, experts from various specialist societies and institutions have formulated recommendations and an algorithm for the diagnosis of allergies. The key principles of diagnosing allergic/hypersensitivity drug reactions are presented. Where possible, the objective is to perform allergy diagnostics within 4 weeks-6 months following the reaction. A clinical classification of symptoms based on the morphology and time course of the reaction is required in order to plan a diagnostic work-up. In the case of typical symptoms of a drug hypersensitivity reaction and unequivocal findings from validated skin and/or laboratory tests, a reaction can be attributed to a trigger with sufficient confidence. However, skin and laboratory tests are often negative or insufficiently reliable. In such cases, controlled provocation testing is required to clarify drug reactions. This method is reliable and safe when attention is paid to indications and contraindications and performed under appropriate medical supervision. The results of the overall assessment are discussed with the patient and documented in an "allergy passport" in order to ensure targeted avoidance in the future and allow the use of alternative drugs where possible.

Comparison of ethanol production from corn cobs and switchgrass following a pyrolysis-based biorefinery approach.

PubMed

Luque, Luis; Oudenhoven, Stijn; Westerhof, Roel; van Rossum, Guus; Berruti, Franco; Kersten, Sascha; Rehmann, Lars

2016-01-01

One of the main obstacles in lignocellulosic ethanol production is the necessity of pretreatment and fractionation of the biomass feedstocks to produce sufficiently pure fermentable carbohydrates. In addition, the by-products (hemicellulose and lignin fraction) are of low value, when compared to dried distillers grains (DDG), the main by-product of corn ethanol. Fast pyrolysis is an alternative thermal conversion technology for processing biomass. It has recently been optimized to produce a stream rich in levoglucosan, a fermentable glucose precursor for biofuel production. Additional product streams might be of value to the petrochemical industry. However, biomass heterogeneity is known to impact the composition of pyrolytic product streams, as a complex mixture of aromatic compounds is recovered with the sugars, interfering with subsequent fermentation. The present study investigates the feasibility of fast pyrolysis to produce fermentable pyrolytic glucose from two abundant lignocellulosic biomass sources in Ontario, switchgrass (potential energy crop) and corn cobs (by-product of corn industry). Demineralization of biomass removes catalytic centers and increases the levoglucosan yield during pyrolysis. The ash content of biomass was significantly decreased by 82-90% in corn cobs when demineralized with acetic or nitric acid, respectively. In switchgrass, a reduction of only 50% for both acids could be achieved. Conversely, levoglucosan production increased 9- and 14-fold in corn cobs when rinsed with acetic and nitric acid, respectively, and increased 11-fold in switchgrass regardless of the acid used. After pyrolysis, different configurations for upgrading the pyrolytic sugars were assessed and the presence of potentially inhibitory compounds was approximated at each step as double integral of the UV spectrum signal of an HPLC assay. The results showed that water extraction followed by acid hydrolysis and solvent extraction was the best upgrading strategy. Ethanol yields achieved based on initial cellulose fraction were 27.8% in switchgrass and 27.0% in corn cobs. This study demonstrates that ethanol production from switchgrass and corn cobs is possible following a combined thermochemical and fermentative biorefinery approach, with ethanol yields comparable to results in conventional pretreatments and fermentation processes. The feedstock-independent fermentation ability can easily be assessed with a simple assay.

S1 guidelines on the diagnosis and treatment of scabies - short version.

PubMed

Sunderkötter, Cord; Feldmeier, Hermann; Fölster-Holst, Regina; Geisel, Bertram; Klinke-Rehbein, Sabine; Nast, Alexander; Philipp, Sandra; Sachs, Bernhardt; Stingl, Julia; Stoevesandt, Johanna; Hamm, Henning

2016-11-01

The goals of this German guideline are the improvement of diagnosis and therapy of scabies, the implementation of a coordinated action in outbreaks of scabies, and the control of this infestation in large migration or refugee flows.Sarcoptes scabiei var. hominis is transmitted by direct skin-to-skin contact of sufficient duration. The infectivity of female mites when removed from patients does not exceed 48 hours at room temperature (21°C) and relative humidity of 40-80%. The risk of infection rises proportionally to the number of mites on the skin and is particularly high in crusted scabies. As elderly persons tend to develop crusted scabies due to disease- or medication-related immunosuppression, there is an increased risk for outbreaks of scabies at nursing homes and extended-care facilities. The guideline contains detailed recommendations for management of such outbreaks. In refugees the prevalence of scabies is higher than in the general population in Germany, but the risk for outbreaks is not high. Scabies infestation should be considered when a recent onset of itching is associated with eczema and presence of burrows or comma-like papules at predilection sites. It is confirmed by dermatoscopic detection of mites or by microscopic identification of mites, mite eggs or fecal matter (scybala) from skin scrapings.The treatment of choice for common scabies is topical permethrin 5% cream applied for 8-12 hours. Permethrin can be considered for off-label use also in infants of less than 3 months of age and pregnant women. For this group crotamiton is another option, which, besides benzyl benzoate, presents a good second line therapy for the other indications. Indications for oral ivermectin, which has just been licensed in Germany, include patients with immunosuppression, severe dermatitis, and low adherence.Crusted scabies is preferentially treated by a combination of topical permethrin and oral ivermectin. Affected patients should be isolated, and all contact persons should be treated. The guideline contains lists for additional measures, including possible treatment of contact persons, clothes, linen and other possibly infested articles. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

[Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany].

PubMed

Boecken, Gerhard; Sunderkötter, Cord; Bogdan, Christian; Weitzel, Thomas; Fischer, Marcellus; Müller, Andreas; Löbermann, Micha; Anders, Gerlind; von Stebut, Esther; Schunk, Mirjam; Burchard, Gerd; Grobusch, Martin; Bialek, Ralf; Harms-Zwingenberger, Gundel; Fleischer, Bernhard; Pietras, Mathias; Faulde, Michael; Erkens, Kay

2011-11-01

The incidence of cutaneous and mucocutaneous Leishmaniasis (CL/MCL) is increasing globally, also in Germany, although the cases are imported and still low in number. The current evidence for the different therapies has many limitations due to lack of sufficient studies on the different Leishmania species with differing virulence. So far there is no international gold standard for the optimal management. The aim of the German joint working group on Leishmaniasis, formed by the societies of Tropical Medicine (DTG), Chemotherapy (PEG) and Dermatology (DDG), was to establish a guideline for the diagnosis and treatment of CL and MCL in Germany, based on evidence (Medline search yielded 400 articles) and, where lacking, on consensus of the experts. As the clinical features do not necessarily reflect the involved Leishmania species and, as different parasite species and even geographically distinct strains of the same species may require different treatments or varying dosages or durations of therapy, the guidelines suggest for Germany to identify the underlying parasite prior to treatment. Because of relevant differences in prognosis and ensuing therapy species should be identified in i) New World CL/MCL (NWCL/ MCL) to distinguish between L. mexicana-complex and subgenus Viannia, ii) in suspected infections with L. mexicana-complex to distinguish from L. amazonensis, and iii) in Old World CL (OWCL) to distinguish between L. infantum and L. major, L. tropica, or L. aethiopica. A state-of-the-art diagnostic algorithm is presented. For recommendations on localized and systemic drug treatment and physical procedures, data from the accessible literature were adjusted according to the involved parasite species and a clinical differentiation into uncomplicated or complex lesions. Systemic therapy was strictly recommended for i) complex lesions (e. g. > 3 infected lesions, infections in functionally or cosmetically critical areas such as face or hands, presence of lymphangitis), ii) lesions refractory to therapy, iii) NWCL by the subgenus Viannia or by L. amazonensis, iv) in MCL and v) in recalcitrant, or disseminating or diffuse cutaneous courses. In e. g. infection with L. major it encompasses miltefosine, fluconazole and ketoconazole, while antimony or allopurinol were here considered second choice. Local therapy was considered appropriate for i) uncomplicated lesions of OWCL, ii) L. mexicana-complex and iii) pregnant women. In e. g. infection with L. major it encompasses perilesional antimony, combined with cryotherapy, paromomycin 15 %/in methylbenzethoniumchlorid 12 % and thermotherapy. The group also stated that there is an urgent need for improving the design and the way of publishing of clinical trials in leishmaniasis.

Digestibility of dietary fiber in distillers coproducts fed to growing pigs.

PubMed

Urriola, P E; Shurson, G C; Stein, H H

2010-07-01

The objective of this work was to measure the apparent ileal digestibility (AID) and the apparent total tract digestibility (ATTD) of dietary fiber in different sources of distillers dried grains with solubles (DDGS) and to calculate hindgut fermentation of dietary fiber in DDGS fed to growing pigs. Diets, ileal digesta, and fecal samples from pigs fed corn or diets containing 1 of 28 sources of distillers coproducts were analyzed for fiber. Of the 28 sources of coproducts, 24 sources were corn DDGS (C-DDGS), 1 source was sorghum DDGS (S-DDGS), 1 source was DDGS from a blend of sorghum and corn (SC-DDGS), 1 source was C-DDGS from beverage production (DDGS(beverage)), and a source of corn distillers dried grain (DDG) was also included in the experiment. Total dietary fiber (TDF) and DM were analyzed in all DDGS sources, ileal digesta, and fecal samples. Hindgut fermentation was calculated by subtracting values for AID from values for ATTD. In 10 sources of DDGS and in ileal and fecal samples from pigs fed those sources, crude fiber, ADF, NDF, insoluble dietary fiber (IDF), and soluble dietary fiber (SDF) were also determined. Concentrations of CP, ether extract, and ash were also analyzed in these samples, and concentrations of organic residue (OR) were calculated by subtracting the concentration of CP, ether extract, and water from OM. The AID and the ATTD of TDF differed (P < 0.01) among sources of C-DDGS. The average AID of TDF in 10 sources of C-DDGS (21.5%) was not different (P > 0.05) from the AID of TDF in corn (16.5%), but the ATTD and the hindgut fermentation of TDF in the 10 sources of C-DDGS (44.5 and 23.0%, respectively) were greater (P < 0.05) than in corn (23.1 and 6.6%, respectively). The AID of crude fiber, NDF, IDF, SDF, and TDF were not different between C-DDGS and S-DDGS, but the AID of ADF was greater (P < 0.01) in S-DDGS (57.4%) than in C-DDGS (36.8%). The ATTD of OR in S-DDGS (72.5%) and SC-DDGS (68.4%) were less (P < 0.05) than in C-DDGS (77.1%), but the ATTD of ADF, NDF, IDF, SDF, and TDF were not different among the 3 sources of DDGS. The AID, ATTD, and hindgut fermentation of TDF were not different between DDGS from an ethanol plant and DDGS from a beverage plant. The average AID, ATTD, and hindgut fermentation of TDF in the 24 sources of C-DDGS were 23.0, 47.3, and 24.4%, respectively. It is concluded that the AID and ATTD of fiber differ among sources of DDGS and those differences may contribute to differences in the digestibility of energy in DDGS.

Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern.

PubMed

Amendola, Richard L; Goetz, Devon D; Liu, Steve S; Callaghan, John J

2017-02-01

Short stem cementless femoral components were developed to aid insertion through smaller incisions, preserve metaphyseal bone, and potentially decrease or limit the incidence of thigh pain. Despite some clinical success, the senior author (DDG) believed a higher percentage of his patients who had received a cementless short stem design were experiencing thigh pain, which, coupled with concerns about bone ingrowth fixation, motivated the review of this case series. (1) What is the proportion of patients treated with a short stem cementless THA femoral component that develop thigh pain and what are the hip scores of this population? (2) What are the radiographic results, specifically with respect to bone ingrowth fixation and stress shielding, of this design? (3) Are there particular patient or procedural factors that are associated with thigh pain with this short stem design? Two hundred sixty-one primary THAs were performed in 238 patients by one surgeon between November 2010 and August 2012. During this time period, all patients undergoing primary THA by this surgeon received the same cementless short titanium taper stem. Seven patients (eight hips) died and five patients (five hips) were lost to followup, leaving 226 patients (248 hips) with a mean followup of 3 years (range, 2-5 years). Patients rated their thigh pain during activity or rest at final followup on a 10-point visual analog scale. Harris hip scores (HHS) were obtained at every clinic appointment. Thigh pain was evaluated at the final followup or by contacting the patient by phone. Radiographs were evaluated for bone-implant fixation, bone remodeling, and osteolysis. An attempt was made to correlate thigh pain with patient demographics, implant specifications, or radiographic findings. Seventy-six percent of hips (180 of 238) had no thigh pain, 16% of hips (37 of 238) had mild thigh pain, and 9% (21 of 238) had moderate or severe thigh pain. Preoperatively, mean HHS was 47 (SD, 16) and at last followup, mean HHS was 88 (SD, 13). There were two femoral revisions, one for severe thigh pain and the other for infection. All but two components demonstrated bone ingrowth fixation (99%). Femoral stress shielding was mild in 64% of hips (135 of 212), moderate in 0.5% (one of 212), and severe in no hips. There is an inverse linear relationship between age and severity of thigh pain (r = -0.196; p < 0.0024). Although reliable fixation was achieved and good HHS were attained, the frequency and severity of thigh pain with this short cementless stem were concerning. The surgeon has subsequently abandoned this short stem design and returned to a conventional length stem. Future study direction might investigate the biomechanical grounds for the thigh pain associated with this stem design. Level IV, therapeutic study.

Abridged version of the AWMF guideline for the medical clinical diagnostics of indoor mould exposure: S2K Guideline of the German Society of Hygiene, Environmental Medicine and Preventive Medicine (GHUP) in collaboration with the German Association of Allergists (AeDA), the German Society of Dermatology (DDG), the German Society for Allergology and Clinical Immunology (DGAKI), the German Society for Occupational and Environmental Medicine (DGAUM), the German Society for Hospital Hygiene (DGKH), the German Society for Pneumology and Respiratory Medicine (DGP), the German Mycological Society (DMykG), the Society for Pediatric Allergology and Environmental Medicine (GPA), the German Federal Association of Pediatric Pneumology (BAPP), and the Austrian Society for Medical Mycology (ÖGMM).

PubMed

Wiesmüller, Gerhard A; Heinzow, Birger; Aurbach, Ute; Bergmann, Karl-Christian; Bufe, Albrecht; Buzina, Walter; Cornely, Oliver A; Engelhart, Steffen; Fischer, Guido; Gabrio, Thomas; Heinz, Werner; Herr, Caroline E W; Kleine-Tebbe, Jörg; Klimek, Ludger; Köberle, Martin; Lichtnecker, Herbert; Lob-Corzilius, Thomas; Merget, Rolf; Mülleneisen, Norbert; Nowak, Dennis; Rabe, Uta; Raulf, Monika; Seidl, Hans Peter; Steiß, Jens-Oliver; Szewszyk, Regine; Thomas, Peter; Valtanen, Kerttu; Hurraß, Julia

2017-01-01

This article is an abridged version of the AWMF mould guideline "Medical clinical diagnostics of indoor mould exposure" presented in April 2016 by the German Society of Hygiene, Environmental Medicine and Preventive Medicine ( Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin, GHUP ), in collaboration with the above-mentioned scientific medical societies, German and Austrian societies, medical associations and experts. Indoor mould growth is a potential health risk, even if a quantitative and/or causal relationship between the occurrence of individual mould species and health problems has yet to be established. Apart from allergic bronchopulmonary aspergillosis (ABPA) and mould-caused mycoses, only sufficient evidence for an association between moisture/mould damage and the following health effects has been established: allergic respiratory disease, asthma (manifestation, progression and exacerbation), allergic rhinitis, hypersensitivity pneumonitis (extrinsic allergic alveolitis), and increased likelihood of respiratory infections/bronchitis. In this context the sensitizing potential of moulds is obviously low compared to other environmental allergens. Recent studies show a comparatively low sensitizing prevalence of 3-10% in the general population across Europe. Limited or suspected evidence for an association exist with respect to mucous membrane irritation and atopic eczema (manifestation, progression and exacerbation). Inadequate or insufficient evidence for an association exist for chronic obstructive pulmonary disease, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis and cancer. The risk of infection posed by moulds regularly occurring indoors is low for healthy persons; most species are in risk group 1 and a few in risk group 2 ( Aspergillus fumigatus, A. flavus ) of the German Biological Agents Act ( Biostoffverordnung ). Only moulds that are potentially able to form toxins can be triggers of toxic reactions. Whether or not toxin formation occurs in individual cases is determined by environmental and growth conditions, above all the substrate. In the case of indoor moisture/mould damage, everyone can be affected by odour effects and/or mood disorders. However, this is not a health hazard. Predisposing factors for odour effects can include genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for mood disorders may include environmental concerns, anxiety, condition, and attribution, as well as various diseases. Risk groups to be protected particularly with regard to an infection risk are persons on immunosuppression according to the classification of the German Commission for Hospital Hygiene and Infection Prevention ( Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO ) at the Robert Koch- Institute (RKI) and persons with cystic fibrosis (mucoviscidosis); with regard to an allergic risk, persons with cystic fibrosis (mucoviscidosis) and patients with bronchial asthma should be protected. The rational diagnostics include the medical history, physical examination, and conventional allergy diagnostics including provocation tests if necessary; sometimes cellular test systems are indicated. In the case of mould infections the reader is referred to the AWMF guideline "Diagnosis and Therapy of Invasive Aspergillus Infections". With regard to mycotoxins, there are currently no useful and validated test procedures for clinical diagnostics. From a preventive medicine standpoint it is important that indoor mould infestation in relevant dimension cannot be tolerated for precautionary reasons. With regard to evaluating the extent of damage and selecting a remedial procedure, the reader is referred to the revised version of the mould guideline issued by the German Federal Environment Agency ( Umweltbundesamt, UBA ).

Advancing the Renewable Industry in Minnesota

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sparby, Michael; Doering, Alan; Timmerman, Denny

This report deals with seven topics: 1. "Utilizing Ash Wastes as a Nutrient Source for Corn": As forms of gasification and combustion grow in the area of renewable energy in Minnesota the question arises regarding the utilization/application of the ash co product produced from these processes. Currently there are four facilities in Minnesota producing an ash co product (three ethanol facilities and one combusting biomass to produce energy). These ash wastes are generated from using ethanol by-products as a fuel or heating source for fermentation. Other ash wastes from agricultural sources include turkey litter ash. When applied to agricultural fields,more » ash wastes can be a source of nutrients for agricultural crops. Chemical analyses of ash wastes vary, but 200 to 300 lb of P 2O 5 and K 2O per ton of ash is typical. The value of ash wastes as a fertilizer has increased because commercial fertilizer prices have increased significantly over the last few years. Specifically: Compaction/Agglomeration research- Research included development of an appropriate product for use in current delivery systems by densifying the ash into the form of pellets or briquettes which may reduce fertilizer input cost to farmers. The initiative addresses the use of phosphorus and potassium from co-firing or gasification processes as a fertilizer source. 2. "Use of Glycerol as a Corn Replacement in Calf Starter Diets": Glycerol is a sugar alcohol by-product of bio-diesel production. About 1 gallon of glycerin is produced for every 10 gallons of bio-diesel of which the glycerol content may vary between 63 and almost 100%. There is some uncertainty of the exact energy value of glycerol as an ingredient for animal feed but it has been successfully used as a replacement for corn up to 10% of the diet dry matter for lactating dairy cows. There is a lack of information on incorporating glycerol into diets for pre- and post weaned dairy heifer calves which has the potential to expand the market for this by product. Preliminary work at SROC indicates that there are no palatability problems using glycerol up to 6% of the mix in post weaning pellets for group fed dairy heifers. 3. "Intervention Strategies for Reduction of Food-borne Pathogens in Cattle Fed Ethanol Byproducts": Ethanol plants and cattle producers create a symbiotic relationship: The use of wet and dry distiller’s grains in beef cattle rations provides significant improvement in overall feedlot performance for many producers in Minnesota and the Upper Midwest. Distiller’s grain is the coproduct that remains following the distillation of ethanol. It may be dehydrated to produce dried distiller’s grain (DDG) which is then commonly used as livestock feed. The use of distiller’s grains in livestock rations has been the subject of numerous research projects over the past ten years. Recently published research data conducted at Kansas State University (K-State) has created controversy over the feeding of distiller’s grains in beef cattle rations. The research indicates that cattle fed distiller’s grain may have an increased probability of Escherichia coli O157 in their hindgut. Specifically: This research assessment was a two part project consisting of feeding trials conducted at the University of Minnesota and an intervention study conducted at Kansas State University. This report is the Kansas State University portion. This report is a task-level final technical report. 4. "Impact of Distillers' Grains and Glycerin on Cattle Fecal Shedding of Escherichia coli O157:H7" 5. "Study Assessing the Opportunities and Potential of Soybean Based Products and Technologies": Based on demand/market potential, economic feasibility, stage of development and strength of institutional support, Informa Economics, Inc. ("Informa") narrowed down a list of more than 100 emerging soybean products and to 8 of the most promising for soybean, considered to have the greatest potential to add significant value to Minnesota's soybean commodity production. However, as with the potential of any biobased product or technology, the development of these emerging soybean products and technologies will be heavily reliant on future market price environments (especially for petroleum) and government policies. This report identifies what the contractor believes are the top 8 products and technologies for soybeans at the time of publishing. 6. "Study Assessing the Opportunities and Potential of Corn-Based Products and Technologies": Based on demand/market potential, economic feasibility, stage of development and strength of institutional support, Informa Economics, Inc. ("Informa") narrowed down a list of more than 100 emerging corn products and technologies to 8 of the most promising for corn, considered to have the greatest potential to add significant value to Minnesota's corn commodity production. However, as with the potential of any biobased product or technology, the development of these emerging corn products and technologies will be heavily reliant on future market price environments (especially for petroleum) and government policies. This report identifies what the contractor believes are the top 8 products and technologies for corn at the time of publishing. 7. "Distributed Power Generation Technology (Roseau Gasification)."« less

Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto- Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD).

PubMed

Pfaar, Oliver; Bachert, Claus; Bufe, Albrecht; Buhl, Roland; Ebner, Christof; Eng, Peter; Friedrichs, Frank; Fuchs, Thomas; Hamelmann, Eckard; Hartwig-Bade, Doris; Hering, Thomas; Huttegger, Isidor; Jung, Kirsten; Klimek, Ludger; Kopp, Matthias Volkmar; Merk, Hans; Rabe, Uta; Saloga, Joachim; Schmid-Grendelmeier, Peter; Schuster, Antje; Schwerk, Nicolaus; Sitter, Helmut; Umpfenbach, Ulrich; Wedi, Bettina; Wöhrl, Stefan; Worm, Margitta; Kleine-Tebbe, Jörg; Kaul, Susanne; Schwalfenberg, Anja

The present guideline (S2k) on allergen-specific immunotherapy (AIT) was established by the German, Austrian and Swiss professional associations for allergy in consensus with the scientific specialist societies and professional associations in the fields of otolaryngology, dermatology and venereology, pediatric and adolescent medicine, pneumology as well as a German patient organization (German Allergy and Asthma Association; Deutscher Allergie- und Asthmabund, DAAB) according to the criteria of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). AIT is a therapy with disease-modifying effects. By administering allergen extracts, specific blocking antibodies, toler-ance-inducing cells and mediators are activated. These prevent further exacerbation of the allergen-triggered immune response, block the specific immune response and attenuate the inflammatory response in tissue. Products for SCIT or SLIT cannot be compared at present due to their heterogeneous composition, nor can allergen concentrations given by different manufacturers be compared meaningfully due to the varying methods used to measure their active ingredients. Non-modified allergens are used for SCIT in the form of aqueous or physically adsorbed (depot) extracts, as well as chemically modified allergens (allergoids) as depot extracts. Allergen extracts for SLIT are used in the form of aqueous solutions or tablets. The clinical efficacy of AIT is measured using various scores as primary and secondary study endpoints. The EMA stipulates combined symptom and medication scores as primary endpoint. A harmonization of clinical endpoints, e. g., by using the combined symptom and medication scores (CSMS) recommended by the EAACI, is desirable in the future in order to permit the comparison of results from different studies. The current CONSORT recommendations from the ARIA/GA2LEN group specify standards for the evaluation, presentation and publication of study results. According to the Therapy allergen ordinance (TAV), preparations containing common allergen sources (pollen from grasses, birch, alder, hazel, house dust mites, as well as bee and wasp venom) need a marketing authorization in Germany. During the marketing authorization process, these preparations are examined regarding quality, safety and efficacy. In the opinion of the authors, authorized allergen preparations with documented efficacy and safety, or preparations tradeable under the TAV for which efficacy and safety have already been documented in clinical trials meeting WAO or EMA standards, should be preferentially used. Individual formulations (NPP) enable the prescription of rare allergen sources (e.g., pollen from ash, mugwort or ambrosia, mold Alternaria, animal allergens) for specific immunotherapy. Mixing these allergens with TAV allergens is not permitted. Allergic rhinitis and its associated co-morbidities (e. g., bronchial asthma) generate substantial direct and indirect costs. Treatment options, in particular AIT, are therefore evaluated using cost-benefit and cost-effectiveness analyses. From a long-term perspective, AIT is considered to be significantly more cost effective in allergic rhinitis and allergic asthma than pharmacotherapy, but is heavily dependent on patient compliance. Meta-analyses provide unequivocal evidence of the efficacy of SCIT and SLIT for certain allergen sources and age groups. Data from controlled studies differ in terms of scope, quality and dosing regimens and require product-specific evaluation. Therefore, evaluating individual preparations according to clearly defined criteria is recommended. A broad transfer of the efficacy of certain preparations to all preparations administered in the same way is not endorsed. The website of the German Society for Allergology and Clinical Immunology (www.dgaki.de/leitlinien/s2k-leitlinie-sit; DGAKI: Deutsche Gesellschaft für Allergologie und klinische Immunologie) provides tables with specific information on available products for AIT in Germany, Switzerland and Austria. The tables contain the number of clinical studies per product in adults and children, the year of market authorization, underlying scoring systems, number of randomized and analyzed subjects and the method of evaluation (ITT, FAS, PP), separately given for grass pollen, birch pollen and house dust mite allergens, and the status of approval for the conduct of clinical studies with these products. Strong evidence of the efficacy of SCIT in pollen allergy-induced allergic rhinoconjunctivitis in adulthood is well-documented in numerous trials and, in childhood and adolescence, in a few trials. Efficacy in house dust mite allergy is documented by a number of controlled trials in adults and few controlled trials in children. Only a few controlled trials, independent of age, are available for mold allergy (in particular Alternaria). With regard to animal dander allergies (primarily to cat allergens), only small studies, some with methodological deficiencies are available. Only a moderate and inconsistent therapeutic effect in atopic dermatitis has been observed in the quite heterogeneous studies conducted to date. SCIT has been well investigated for individual preparations in controlled bronchial asthma as defined by the Global Initiative for Asthma (GINA) 2007 and intermittent and mild persistent asthma (GINA 2005) and it is recommended as a treatment option, in addition to allergen avoidance and pharmacotherapy, provided there is a clear causal link between respiratory symptoms and the relevant allergen. The efficacy of SLIT in grass pollen-induced allergic rhinoconjunctivitis is extensively documented in adults and children, whilst its efficacy in tree pollen allergy has only been shown in adults. New controlled trials (some with high patient numbers) on house dust mite allergy provide evidence of efficacy of SLIT in adults. Compared with allergic rhinoconjunctivitis, there are only few studies on the efficacy of SLIT in allergic asthma. In this context, newer studies show an efficacy for SLIT on asthma symptoms in the subgroup of grass pollen allergic children, adolescents and adults with asthma and efficacy in primary house dust mite allergy-induced asthma in adolescents aged from 14 years and in adults. Aspects of secondary prevention, in particular the reduction of new sensitizations and reduced asthma risk, are important rationales for choosing to initiate treatment early in childhood and adolescence. In this context, those products for which the appropriate effects have been demonstrated should be considered. SCIT or SLIT with pollen or mite allergens can be performed in patients with allergic rhinoconjunctivitis using allergen extracts that have been proven to be effective in at least one double-blind placebo-controlled (DBPC) study. At present, clinical trials are underway for the indication in asthma due to house dust mite allergy, some of the results of which have already been published, whilst others are still awaited (see the DGAKI table "Approved/potentially completed studies" via www.dgaki.de/Leitlinien/s2k-Leitlinie-sit (according to www.clinicaltrialsregister.eu)). When establishing the indication for AIT, factors that favour clinical efficacy should be taken into consideration. Differences between SCIT and SLIT are to be considered primarily in terms of contraindications. In individual cases, AIT may be justifiably indicated despite the presence of contraindications. SCIT injections and the initiation of SLIT are performed by a physician experienced in this type of treatment and who is able to administer emergency treatment in the case of an allergic reaction. Patients must be fully informed about the procedure and risks of possible adverse events, and the details of this process must be documented (see "Treatment information sheet"; available as a handout via www.dgaki.de/Leitlinien/s2k-Leitlinie-sit). Treatment should be performed according to the manufacturer's product information leaflet. In cases where AIT is to be performed or continued by a different physician to the one who established the indication, close cooperation is required in order to ensure that treatment is implemented consistently and at low risk. In general, it is recommended that SCIT and SLIT should only be performed using preparations for which adequate proof of efficacy is available from clinical trials. Treatment adherence among AIT patients is lower than assumed by physicians, irrespective of the form of administration. Clearly, adherence is of vital importance for treatment success. Improving AIT adherence is one of the most important future goals, in order to ensure efficacy of the therapy. Severe, potentially life-threatening systemic reactions during SCIT are possible, but - providing all safety measures are adhered to - these events are very rare. Most adverse events are mild to moderate and can be treated well. Dose-dependent adverse local reactions occur frequently in the mouth and throat in SLIT. Systemic reactions have been described in SLIT, but are seen far less often than with SCIT. In terms of anaphylaxis and other severe systemic reactions, SLIT has a better safety profile than SCIT. The risk and effects of adverse systemic reactions in the setting of AIT can be effectively reduced by training of personnel, adhering to safety standards and prompt use of emergency measures, including early administration of i. m. epinephrine. Details on the acute management of anaphylactic reactions can be found in the current S2 guideline on anaphylaxis issued by the AWMF (S2-AWMF-LL Registry Number 061-025). AIT is undergoing some innovative developments in many areas (e. g., allergen characterization, new administration routes, adjuvants, faster and safer dose escalation protocols), some of which are already being investigated in clinical trials. Cite this as Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, Friedrichs F, Fuchs T, Hamelmann E, Hartwig-Bade D, Hering T, Huttegger I, Jung K, Klimek L, Kopp MV, Merk H, Rabe U, Saloga J, Schmid-Grendelmeier P, Schuster A, Schwerk N, Sitter H, Umpfenbach U, Wedi B, Wöhrl S, Worm M, Kleine-Tebbe J. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases - S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD). Allergo J Int 2014;23:282-319.