Technische Universität Dresden: Qucosa
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Expositionstherapie bei Panikstörung und Agoraphobie im Kontext bestehender antidepressiver Medikation
No full textHintergrund:
Kognitive Verhaltenstherapie (KVT) und Pharmakotherapie mit Antidepressiva stellen bei Agoraphobie und/oder Panikstörung jeweils hochwirksame Behandlungsmethoden dar. Eine Kombination von KVT und Antidepressiva wird jedoch aufgrund potenziell ungünstiger Interferenzeffekte diskutiert. Untersucht wurden die Assoziationen einer bestehenden antidepressiven Medikation mit Panik- und agoraphobischer Symptombelastung und deren Veränderung im Kontext einer strukturierten fünfwöchigen tagesklinischen und auf Expositionen fokussierten Behandlung in einem naturalistischen Setting.
Methodik:
Von insgesamt n = 488 Patient*innen konnte für n = 380 retrospektiv die Medikamenteneinnahme während der Behandlung ermittelt werden: n = 100 (26,3 %) nahmen Antidepressiva verschiedener Wirkstoffklassen ein. Die Berechnungen erfolgten mittels multipler linearer Regressionsanalyse, t‑Tests, Responseanalysen und χ2-Tests.
Ergebnisse:
Patient*innen mit bestehender antidepressiver Medikation erfüllten häufiger die Kriterien einer komorbiden depressiven Störung (p < 0,001). Das Maß der Symptomveränderung und die Therapieresponseraten unterschieden sich nicht zwischen Patient*innen mit und ohne Antidepressiva in Bezug auf die Angstsymptomatik.
Diskussion:
Im untersuchten Kontext profitierten Patient*innen mit und ohne bestehende antidepressive Medikation in gleichem Maße von KVT in Bezug auf die Angstsymptomatik.Background:
Cognitive behavioral therapy (CBT) and pharmacotherapy with antidepressants are both a highly effective treatment for agoraphobia and/or panic disorder; however, a combination of CBT and antidepressants is under debate due to potentially unfavorable interference effects. The associations of existing antidepressant medication with panic and agoraphobia symptom burden and their change in the context of a structured 5‑week day hospital and exposure-focused treatment in a naturalistic setting were investigated.
Methods:
Out of a total of n = 488 patients medication use during treatment was retrospectively determined for n = 380: n = 100 (26.3%) were taking antidepressants of different drug classes. Calculations were performed using multiple linear regression analysis, t‑tests, response analyses, and χ2-tests.
Results:
Patients with existing antidepressant medication more often met the criteria for comorbid depressive disorder (p < 0.001). The measure of symptom change and treatment response rates did not differ between patients with and without antidepressants with respect to anxiety symptoms.
Discussion:
In the context studied, patients with and without existing antidepressant medication benefited equally from CBT with respect to anxiety symptoms
Betriebliche Sozialberatungen als Weiterbildungsanbieter? – Schnittstellen und Perspektiven
No full textIm Beitrag wird die Weiterbildungsarbeit im Rahmen der betrieblichen Sozialberatung untersucht. Als empirische Basis dient eine qualitative Querschnittstudie, in der 16 Experteninterviews mit Fachkräften der betrieblichen Sozialberatung in Deutschland geführt wurden. Die Studie erweitert den Stand der Forschung zur betrieblichen Weiterbildung, indem sie Einblick in die Heterogenität der Veranstaltungsarten und Veranstaltungsthemen sowie in das Handeln betrieblicher Sozialberatender bei der Entwicklung und Durchführung von Weiterbildungsangeboten gibt.This paper examines how far occupational social workers offer continuing education measures. The empirical basis of the paper is a qualitative cross-sectional study, in which 16 expert interviews were conducted with occupational social workers in Germany. The study expands the state of research on workplace continuing education by providing insight into the heterogeneity of forms and topics of continuing education measures as well as into approaches of occupational social workers in the development and conduction of such measures
Outcome After Conservative and Endovascular Treatment of Stanford Type B Aortic Intramural Hematomas - A Single-Center Retrospective Study
No full textObjectives:
Aortic intramural hematoma (IMH) is a rare disease. Thus far, only limited data is available and the indications for conservative and endovascular treatment are not well defined. The aim of this study was to investigate clinical presentation, course, CT imaging features and outcome of patients with type B aortic IMHs.
Methods:
We included all patients with type B IMHs between 2012 and 2021 in this retrospective monocentric study. Clinical data, localization, thickness of IMHs and the presence of ulcer-like projections (ULPs) was evaluated before and after treatment.
Results:
Thirty five patients (20 females; 70.3 y ± 11 y) were identified. Almost all IMHs (n = 34) were spontaneous and symptomatic with back pain (n = 34). At the time of diagnosis, TEVAR was deemed indicated in 9 patients, 26 patients were treated primarily conservatively. During the follow-up, in another 16 patients TEVAR was deemed indicated. Endovascularly and conservatively treated patients both showed decrease in thickness after treatment. Patients without ULPs showed more often complete resolution of the IMH than patients with ULPs (endovascularly treated 90.9% (10/11) vs 71.4% (5/7); conservatively treated 71.4% (10/14) vs 33.3% (1/3); P = .207). Complications after TEVAR occurred in 32% and more frequently in patients treated primarily conservatively (37.5% vs 22.2%). No in-hospital mortality was observed during follow-up.
Conclusions:
Prognosis of IMH seems favourable in both surgically as well as conservatively treated patients. However, it is essential to identify patients at high risk for complications under conservative treatment, who therefore should be treated by TEVAR. In our study, ULPs seem to be an adverse factor for remodeling
Flat input based canonical form observers for non-integrable nonlinear discrete-time systems
No full textWe define flat inputs for discrete-time systems and carry over a flat input based observer design strategy for non-integrable nonlinear continuous-time systems to the discrete-time case. This approach allows to design observers for nonlinear discrete-time systems that cannot be transformed into observer canonical form, i.e., conventional observer design strategies fail. This approach is illustrated by two examples
Study protocol: the pragmatic, exploratory DELTA-JU trial of the group-based multimodal DELTA intervention for abstinent adolescents with substance use disorders living in youth welfare institutions
No full textBackground: The DELTA intervention contains 16 weekly group sessions plus additional individual sessions and educational session for parents. It aims to reduce substance use and related problems such as substance use disorders (SUD) in adolescents. Recent results indicated positive effects in psychiatric outpatients. Conducting DELTA in youth welfare settings seems feasible, however, organizational and content adjustments such as smoking cessation elements should be added in order to reduce relapse risks and to prevent negative health consequences. - Methods/design: The pre-registered DELTA-JU study (German Clinical Trials Register, DRKS00027913) is separated into three stages: In the adjustment stage during months 1–4, we will revise the DELTA manual based on semi-structured interviews (n = 10) with personnel from youth welfare institutions specialized in serving adolescents with SUD in the study region, analyzed with content analysis. In the sampling stage during months 5–22, participants qualifying for a SUD and willing to regularly participate in the 16 weekly DELTA-JU group sessions will be enrolled to either one of two arms (cluster randomization: immediate intervention, waitlist with subsequent intervention 16 weeks later). Adolescents will be assessed at baseline and follow-up (16 weeks after first group session) with an additional pre-assessment (16 weeks before intervention starts) for the waitlist group. Assessment procedures include questionnaires and clinical interviews among others. At the same time, institutional personnel will receive a 1-day workshop on SUD-relevant topics based on the DELTA parental education group and on feedback from the qualitative interviews. Personnel will also be assessed twice with questionnaires. In the dissemination stage during months 23–24, final study evaluation results will be prepared and submitted for publication. - Discussion: This study will create a setting-specific manual for vulnerable adolescents suffering from SUDs, and, in many cases, from co-occurring mental disorders. If shown to be effective, DELTA-JU can be disseminated within other institutions of youth welfare
Transcriptome analysis reveals an Atoh1b-dependent gene set downstream of Dlx3b/4b during early inner ear development in zebrafish
No full textThe vertebrate inner ear is the sensory organ mediating hearing and balance. The entire organ develops from the otic placode, which itself originates from the otic-epibranchial progenitor domain (OEPD). Multiple studies in various species have shown the importance of the forkhead-box and distal-less homeodomain transcription factor families for OEPD and subsequent otic placode formation. However, the transcriptional networks downstream of these factors are only beginning to be understood. Using transcriptome analysis, we here reveal numerous genes regulated by the distal-less homeodomain transcription factors Dlx3b and Dlx4b (Dlx3b/4b). We identify known and novel transcripts displaying widespread OEPD expression in a Dlx3b/4b-dependent manner. Some genes, with a known OEPD expression in other vertebrate species, might be members of a presumptive vertebrate core module required for proper otic development. Moreover, we identify genes controlling early-born sensory hair cell formation as well as regulating biomineral tissue development, both consistent with defective sensory hair cell and otolith formation observed in dlx3b/4b mutants. Finally, we show that ectopic Atoh1b expression can rescue early sensorigenesis even in the absence of Dlx3b/4b. Taken together, our data will help to unravel the gene regulatory network underlying early inner ear development and provide insights into the molecular control of vertebrate inner ear formation to restore hearing loss in humans ultimately
Traffic-Related High Sleep Disturbance in the LIFE-Adult Cohort Study: A Comparison to the WHO Exposure-Response-Curves
No full textSleep is negatively affected by environmental noise. In the present study, we investigated self-reported high sleep disturbances (being “highly sleep disturbed”—HSD) from road traffic (primary and secondary road networks), rail (train and tram) and air traffic noise in the LIFE-Adult cohort study in Leipzig, Germany. For this, we used exposure data from 2012 and outcome data of Wave 2 (collected during 2018–2021). HSD was determined and defined according to internationally standardized norms. The highest risk for transportation noise-related HSD was found for aircraft noise: the odds ratio (OR) was 19.66, 95% CI 11.47–33.71 per 10 dB increase in Lnight. For road and rail traffic, similar risk estimates were observed (road: OR = 2.86, 95% CI 1.92–4.28; rail: OR = 2.67, 95% CI 2.03–3.50 per 10 dB Lnight increase). Further, we compared our exposure-risk curves with the curves of the WHO environmental noise guidelines for the European region. The proportion of individuals with HSD for a given noise level was lower for rail traffic but higher for aircraft noise in the LIFE study than in the WHO curves. For road traffic, curves are not directly comparable because we also included the secondary road network. The results of our study add to the body of evidence for increased health risks by traffic noise. Moreover, the results indicate that aircraft noise is particularly harmful to health. We recommend reconsidering threshold values for nightly aircraft exposure
Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study
No full textBackground: Appendicitis is a frequent condition, with peak incidences in the second decade of life. Its pathogenesis is under debate, but bacterial infections are crucial, and antibiotic treatment remains essential. Rare bacteria are accused of causing complications, and various calculated antibiotics are propagated, yet there is no comprehensive microbiological analysis of pediatric appendicitis. Here we review different pre-analytic pathways, identify rare and common bacterial pathogens and their antibiotic resistances, correlate clinical courses, and evaluate standard calculated antibiotics in a large pediatric cohort.
Method: We reviewed 579 patient records and microbiological results of intraoperative swabs in standard Amies agar media or fluid samples after appendectomies for appendicitis between May 2011 and April 2019. Bacteria were cultured and identified via VITEK 2 or MALDI-TOF MS. Minimal inhibitory concentrations were reevaluated according to EUCAST 2022. Results were correlated to clinical courses.
Results: Of 579 analyzed patients, in 372 patients we got 1330 bacterial growths with resistograms. 1259 times, bacteria could be identified to species level. 102 different bacteria could be cultivated. 49% of catarrhal and 52% of phlegmonous appendices resulted in bacterial growth. In gangrenous appendicitis, only 38% remained sterile, while this number reduced to 4% after perforation. Many fluid samples remained sterile even when unsterile swabs had been taken simultaneously. 40 common enteral genera were responsible for 76.5% of bacterial identifications in 96.8% of patients. However, 69 rare bacteria were found in 187 patients without specifically elevated risk for complications.
Conclusion: Amies agar gel swabs performed superior to fluid samples and should be a standard in appendectomies. Even catarrhal appendices were only sterile in 51%, which is interesting in view of a possible viral cause. According to our resistograms, the best in vitro antibiotic was imipenem with 88.4% susceptible strains, followed by piperacillin-tazobactam, cefuroxime with metronidazole, and ampicillin-sulbactam to which only 21.6% of bacteria were susceptible. Bacterial growths and higher resistances correlate to an elevated risk of complications. Rare bacteria are found in many patients, but there is no specific consequence regarding antibiotic susceptibility, clinical course, or complications. Prospective, comprehensive studies are needed to further elicit pediatric appendicitis microbiology and antibiotic treatment
Highly Selective Alkaline Oxide Promoted Ni/silica for the Production of Cyclohexanol/-one from Lignin-Derived Guaiacol
No full textCatalytic hydrodeoxygenation (HDO) is a promising route to upgrade bio-oils from plants or pyrolysis to basic chemicals. KA-oil (cyclohexanol/-one) is an example of a highly valuable feedstock for the industrial synthesis of caprolactam and perlon, which can potentially be produced via a completely sustainable route. This work investigates the alkaline promoter effects on Ni-based catalysts for the selective HDO of lignin surrogate guaiacol using mesoporous Ni/MgO and co-impregnated Ni-MgO/SiO2 catalysts. Due to preferred demethoxylation by alkaline oxides and their accumulation on nickel corners, responsible for dehydration, conversion, and selectivity for KA-oil rise. Furthermore, influences of operating parameters are investigated and optimized by design of experiments (DoE), while long-term stability (24 h) and water resistance remain high. In a final proof of concept, the application of Ni-CaO/SiO2 was the most promising material (U=93 %, S=86 %), demonstrating a sustainable route from lignin-based bio-oil to produce a bulk commodity for caprolactam synthesis
Serum immune checkpoint profiling identifies soluble CD40 as a biomarker for pancreatic cancer
No full textPancreatic ductal adenocarcinoma (PDAC) responds poorly to systemic treatment, including new immunotherapeutic approaches. Biomarkers are urgently needed for early disease detection, patient stratification for treatment, and response prediction. The role of soluble CD40 (sCD40) is unknown in PDAC. In this study, we performed a quantitative multiplex analysis of 17 immune checkpoint proteins in serum samples from patients with various stages of PDAC in a discovery study (n = 107) and analyzed sCD40 by ELISA in a validation study (n = 317). Youden’s J statistic was used for diagnostic cut-off optimization. A Cox proportional hazards regression model was applied in an empiric approach for prognostic threshold optimization. Kaplan–Meier estimator and multivariable Cox regression analyses were used for survival analysis. sCD40 was significantly increased in the serum of patients with PDAC compared to healthy cohorts and patients with IPMN. In the validation cohort, the area under the receiver operating characteristic (ROC) c-statistic was 0.8, and combining sCD40 with CA19-9 yielded a c-statistic of 0.95. sCD40 levels were independent of the tumor stage. However, patients who received neoadjuvant chemotherapy had significantly lower sCD40 levels than those who underwent upfront surgery. Patients with a sCD40 level above the empirical threshold of 0.83 ng/ml had a significantly reduced overall survival with a hazard ratio of 1.4. This observation was pronounced in patients after neoadjuvant chemotherapy. Collectively, soluble CD40 may be considered as both a diagnostic and prognostic non-invasive biomarker in PDAC