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Background: The COVID-19 pandemic has led to a flood of — often contradictory — evidence. HCWs had to develop strategies to locate information that supported their work. We investigated the information-seeking of different HCW groups in Germany. Methods: In December 2020, we conducted online surveys on COVID-19 information sources, strategies, assigned trustworthiness, and barriers — and in February 2021, on COVID-19 vaccination information sources. Results were analyzed descriptively; group comparisons were performed using χ\(^2\)-tests. Results: For general COVID-19-related medical information (413 participants), non-physicians most often selected official websites (57%), TV (57%), and e-mail/newsletters (46%) as preferred information sources — physicians chose official websites (63%), e-mail/newsletters (56%), and professional journals (55%). Non-physician HCWs used Facebook/YouTube more frequently. The main barriers were insufficient time and access issues. Non-physicians chose abstracts (66%), videos (45%), and webinars (40%) as preferred information strategy; physicians: overviews with algorithms (66%), abstracts (62%), webinars (48%). Information seeking on COVID-19 vaccination (2700 participants) was quite similar, however, with newspapers being more often used by non-physicians (63%) vs. physician HCWs (70%). Conclusion: Non-physician HCWs more often consulted public information sources. Employers/institutions should ensure the supply of professional, targeted COVID-19 information for different HCW groups.
Juvenile neuronal ceroid lipofuscinosis (JNCL or Batten disease) caused by mutations in the CLN3 gene is the most prevalent inherited neurodegenerative disease in childhood resulting in widespread central nervous system dysfunction and premature death. The consequences of CLN3 mutation on the progression of the disease, on neuronal transmission, and on central nervous network dysfunction are poorly understood. We used Cln3 knockout (Cln3\(^{Δex1-6}\)) mice and found increased anxiety-related behavior and impaired aversive learning as well as markedly affected motor function including disordered coordination. Patch-clamp and loose-patch recordings revealed severely affected inhibitory and excitatory synaptic transmission in the amygdala, hippocampus, and cerebellar networks. Changes in presynaptic release properties may result from dysfunction of CLN3 protein. Furthermore, loss of calbindin, neuropeptide Y, parvalbumin, and GAD65-positive interneurons in central networks collectively support the hypothesis that degeneration of GABAergic interneurons may be the cause of supraspinal GABAergic disinhibition.
Evolutionary conserved networks of human height identify multiple Mendelian causes of short stature
(2019)
Height is a heritable and highly heterogeneous trait. Short stature affects 3% of the population and in most cases is genetic in origin. After excluding known causes, 67% of affected individuals remain without diagnosis. To identify novel candidate genes for short stature, we performed exome sequencing in 254 unrelated families with short stature of unknown cause and identified variants in 63 candidate genes in 92 (36%) independent families. Based on systematic characterization of variants and functional analysis including expression in chondrocytes, we classified 13 genes as strong candidates. Whereas variants in at least two families were detected for all 13 candidates, two genes had variants in 6 (UBR4) and 8 (LAMA5) families, respectively. To facilitate their characterization, we established a clustered network of 1025 known growth and short stature genes, which yielded 29 significantly enriched clusters, including skeletal system development, appendage development, metabolic processes, and ciliopathy. Eleven of the candidate genes mapped to 21 of these clusters, including CPZ, EDEM3, FBRS, IFT81, KCND1, PLXNA3, RASA3, SLC7A8, UBR4, USP45, and ZFHX3. Fifty additional growth-related candidates we identified await confirmation in other affected families. Our study identifies Mendelian forms of growth retardation as an important component of idiopathic short stature.
Clinical relevance of systematic phenotyping and exome sequencing in patients with short stature
(2018)
Purpose
Short stature is a common condition of great concern to patients and their families. Mostly genetic in origin, the underlying cause often remains elusive due to clinical and genetic heterogeneity.
Methods
We systematically phenotyped 565 patients where common nongenetic causes of short stature were excluded, selected 200 representative patients for whole-exome sequencing, and analyzed the identified variants for pathogenicity and the affected genes regarding their functional relevance for growth.
Results
By standard targeted diagnostic and phenotype assessment, we identified a known disease cause in only 13.6% of the 565 patients. Whole-exome sequencing in 200 patients identified additional mutations in known short-stature genes in 16.5% of these patients who manifested only part of the symptomatology. In 15.5% of the 200 patients our findings were of significant clinical relevance. Heterozygous carriers of recessive skeletal dysplasia alleles represented 3.5% of the cases.
Conclusion
A combined approach of systematic phenotyping, targeted genetic testing, and whole-exome sequencing allows the identification of the underlying cause of short stature in at least 33% of cases, enabling physicians to improve diagnosis, treatment, and genetic counseling. Exome sequencing significantly increases the diagnostic yield and consequently care in patients with short stature.
Zusammenfassungen 83 5 Zusammenfassungen 5.1 Zusammenfassung Durch Expressionsklonierung wurde 1994 der erste organische Kationentransporter, rOCT1, aus der Ratte isoliert (Gründemann et al., 1994). 1999 wurde eine Aminosäure in der 11. Transmembrandomäne von rOCT1 entdeckt, welche Teil der Substratbindungstasche dieses Transporters war (Gorboulev et al., 1999). Zielsetzung der vorliegenden Arbeit war es weitere funktionell relevante Aminosäuren zu identifizieren. Ein Vergleich der „Helical Wheels“ aller 12 hypothetischen Transmembrandomänen zeigte eine Akkumulation von 5 OCT und OCTN spezifischen Aminosäuren in der vierten Transmembrandomäne auf einer Seite. Bei diesen Aminosäuren handelte es sich um K215, W218, Y222, T226 und V229. Es wurden verschiedene Punktmutationen an diesen Positionen eingeführt. Es zeigte sich mit Hilfe radioaktiv markierter Substrate von rOCT1, dass selbst Substitutionen durch strukturell verwandte Aminosäuren bei den flankieren Aminosäuren zu einem Ausfall des rOCT1 vermittelten Substrattransport führte. Weiterhin schien an Position 218 für den rOCT1- vermittelten Transport von TEA eine aromatische Aminosäure von großer funktioneller Relevanz zu sein. Wir vermuten hier eine Kationen p-Elektronen Interaktion des aromatischen Ringsystems des Tryptophans mit der positiven Ladung des TEA. Versuche mit den Mutanten des Tyrosins 222 zeigten ebenfalls Änderungen bei den Transportraten und Affinitäten verschiedener Substrate. Eine Kationen-p Interaktion konnte ausgeschlossen werden, jedoch war die Affinität der Mutante Y222F zum TPeA um einen Faktor 20 gegenüber dem Wildtyp erhöht. Weiterführende Untersuchungen mit der Zwei- Elektrodenspannungsklemme zeigten unterschiedliche Affinitäten des TPeA zum Wildtyp im Vergleich zum mutierten Protein in seiner nach außen bzw. nach innen gerichteten Konformation. War die Form der Inhibierung des TEA-induzierten Stromes durch TPeA beim Wildtyp kompetitiv, so zeigte sie bei der Mutante einen nicht-kompetitiven Charakter. Die Mutante T226A zeigte ebenfalls Änderungen in Affinität und Selektivität. Bei allen transportierenden Mutanten zeigte sich, dass der Transport von MPP nicht oder kaum verändert war, hingegen wurden sehr starke Änderungen der Transportcharakteristika von TEA gefunden, was auf verschiedene Substratbindungsstellen in rOCT1 hinweist. Diese Versuche zeigen deutlich die funktionelle Relevanz und die Beteiligung der mutierten Aminosäurepositionen an der Substratbindetasche von rOCT1. In Versuchen, in welchen Chinin als Inhibitor des rOCT2 vermittelten Transports genutzt wurde, passierte Chinin mittels Diffusion in seiner ungeladenen Form die Oozytenmembran und hemmte rOCT2 von der Innenseite. Dies könnte der Grund für die nicht-kompetitive Form der Inhibition der TEA-Aufnahme durch Chinin sein. Diese Versuche wurden dadurch bestätigt, dass die protonierte Form des Chinins eine kompetitive Form der Inhibition zeigte und den Transporter von außen hemmte.
The plant cuticle as an interface between the plant interior and the adjoining atmosphere plays an important role in any interaction between the plant and its environment. Transport processes across the cuticles were the object of countless research since many decades. However, bulk of the work done was focused on transport of lipophilic molecules. It is highly plausible to examine the penetration of lipophilic compounds, since the cuticle is dominated by lipophilic compartments itself, and the most crop protection agents have lipophilic character. As a result of this research, cuticular transport of lipophilic compounds is relatively well understood. Since several years, examinations were expanded on transport of hydrophilic molecules. In the present study, a direct comparison was made between transport properties of lipophilic and hydrophilic compounds, which allows an objective assessment of the mechanism governing their penetration. The results of this present study debunked the existence of two different pathways across isolated cuticles of Hedera helix (English ivy), a lipophilic and a hydrophilic pathway. This finding was supported by examinations regarding to accelerator and temperature effects on the mobility of both pathways, because the hydrophilic path is insensitive to them - in contrary to the lipophilic one. The lipophilic pathway is rigorously restricted to lipophilic molecules and the hydrophilic pathway is only accessible for hydrophilic molecules. Uncharged hydrophilic compounds can cross the cuticle even the molecules are of relatively large dimensions. In contrast to that, dissociable compounds with a molar volume higher than 110 cm³ mol-1 are excluded from cuticular penetration. Differences in the mobility of uncharged and dissociable molecules might be a hint towards the chemical nature of the polar pathways. It is assumed, that both, cellulose and pectin fibrils, traverse the cuticle which are originated from the epidermal cell wall. While uncharged carbohydrates might be able to penetrate across a pathway made up of cellulose and pectin, dissociated amino acids might be restricted to the cellulose path. This could be a plausible explanation for the higher mobility and the higher cuticle/water partition coefficients of the carbohydrates compared with the amino acids. A hydrophilic pathway was found with isolated grapevine cuticles, too. The apparent size selectivity of the hydrophilic pathway implies transport via narrow pores. From the present data, a mean pore radius of 0.31 nm (H. helix) or rather 0.34 nm (V. vinifera) was calculated. The absolute number of pores per cm² is 1.1 x 109 for H. helix and 3.3 x 109 for V. vinifera cuticles. This finding and the enlarged pore size distribution of grapevine cuticles might be an explanation for the transport of uncharged and dissociable hydrophilic compounds of higher molar volume like paraquat dichloride - in contrast to ivy membranes Wax extraction of ivy membranes uncovers additional pores, which explains the increased mobilities of the hydrophilic compounds across dewaxed membranes. From these extensive measurements it is very conspicuous, that the bulk of cuticular water transpiration occurs via the polar pathway. Since the work was focused on cuticular penetration of primary metabolites like amino acids and carbohydrates, a mechanistic explanation of leaching processes is obtained, simultaneously. In cuticular research, an inconsistent terminology regarding the transport path of the hydrophilic compounds was used. The term ‘hydrophilic pathway’ is definitely correct, since it makes no statement with regard to the shape of this path. In contrast to that, the terms ‘polar pore’ or ‘aqueous pore’ could imply that there is a tube or rather a water-filled tube traversing the cuticle. However - at this point of time – the imagination about the shape of this path is a pathway across interfibrilar gaps within polysaccharide strains. The proposed diameter of these interfibrilar gaps fits very well to the diameter determined in this study. Therefore, the imagination of a pore is not unfounded, but it is a very narrow pore, definitely. Additionally, this pathway is a very straight pathway which corresponds to this simplified imagination. An expanded study was done with paraquat dichloride, which was applied as aqueous droplets on grapevine cuticles. It is assumed that these model membranes reflect transport properties which are very close to that of relevant crops and weeds. The predominating parameter for paraquat penetration is the moisture, either originated from a relative humidity of at least 75% or provided by added chemicals. There is a tendency for good suitability of hygroscopic additives. Increased paraquat penetration was also obtained by raised concentrations and removal of the cuticular waxes.
Backround: In February 2021, the first formal evidence and consensus-based (S3) guidelines for the inpatient treatment of patients with COVID-19 were published in Germany and have been updated twice during 2021. The aim of the present study is to re-evaluate the dissemination pathways and strategies for ICU staff (first evaluation in December 2020 when previous versions of consensus-based guidelines (S2k) were published) and question selected aspects of guideline adherence of standard care for patients with COVID-19 in the ICU. Methods: We conducted an anonymous online survey among German intensive care staff from 11 October 2021 to 11 November 2021. We distributed the survey via e-mail in intensive care facilities and requested redirection to additional intensive care staff (snowball sampling). Results: There was a difference between the professional groups in the number, selection and qualitative assessment of information sources about COVID-19. Standard operating procedures were most frequently used by all occupational groups and received a high quality rating. Physicians preferred sources for active information search (e.g., medical journals), while nurses predominantly used passive consumable sources (e.g., every-day media). Despite differences in usage behaviour, the sources were rated similarly in terms of the quality of the information on COVID-19. The trusted organizations have not changed over time. The use of guidelines was frequently stated and highly recommended. The majority of the participants reported guideline-compliant treatment. Nevertheless, there were certain variations in the use of medication as well as the criteria chosen for discontinuing non-invasive ventilation (NIV) compared to guideline recommendations. Conclusions: An adequate external source of information for nursing staff is lacking, the usual sources of physicians are only appropriate for the minority of nursing staff. The self-reported use of guidelines is high.
BACKGROUND: The barrier to diffusion of organic solutes across the plant cuticle is composed of waxes consisting of very long-chain aliphatic (VLCA) and, to varying degrees, cyclic compounds like pentacyclic triterpenoids. The roles of both fractions in controlling cuticular penetration by organic solutes, e.g. the active ingredients (AI) of pesticides, are unknown to date. We studied thepermeabilityof isolated leaf cuticularmembranes from Garcinia xanthochymus andPrunus laurocerasus for lipophilic azoxystrobin and theobromine as model compounds for hydrophilic AIs.
RESULTS: The wax of P. laurocerasus consists of VLCA (12%) and cyclic compounds (88%), whereas VLCAs make up 97% of the wax of G. xanthochymus.We showthat treating isolated cuticles with methanol almost quantitatively releases the cyclic fraction while leaving the VLCA fraction essentially intact. All VLCAs were subsequently removed using chloroform. In both species, the permeance of the two model compounds did not change significantly after methanol treatment, whereas chloroform extraction had a large effect on organic solute permeability.
CONCLUSION: The VLCA wax fractionmakes up the permeability barrier for organic solutes, whereas cyclic compounds even in high amounts have a negligible role. This is of significance when optimizing the foliar uptake of pesticides.
Background
Traumatic separation of the pubic symphysis can destabilize the pelvis and require surgical fixation to reduce symphyseal gapping. The traditional approach involves open reduction and the implantation of a steel symphyseal plate (SP) on the pubic bone to hold the reposition. Despite its widespread use, SP-fixation is often associated with implant failure caused by screw loosening or breakage.
Methods
To address the need for a more reliable surgical intervention, we developed and tested two titanium cable-clamp implants. The cable served as tensioning device while the clamp secured the cable to the bone. The first implant design included a steel cable anterior to the pubic symphysis to simplify its placement outside the pelvis, and the second design included a cable encircling the pubic symphysis to stabilize the anterior pelvic ring. Using highly reproducible synthetic bone models and a limited number of cadaver specimens, we performed a comprehensive biomechanical study of implant stability and evaluated surgical feasibility.
Results
We were able to demonstrate that the cable-clamp implants provide stability equivalent to that of a traditional SP-fixation but without the same risks of implant failure. We also provide detailed ex vivo evaluations of the safety and feasibility of a trans-obturator surgical approach required for those kind of fixation.
Conclusion
We propose that the developed cable-clamp fixation devices may be of clinical value in treating pubic symphysis separation.
Vaccination hesitancy is a threat to herd immunity. Healthcare workers (HCWs) play a key role in promoting Coronavirus disease 2019 (COVID-19) vaccination in the general population. We therefore aimed to provide data on COVID-19 vaccination acceptance/hesitancy among German HCWs. For this exploratory, cross-sectional study, an online survey was conducted in February 2021. The survey included 54 items on demographics; previous vaccination behavior; trust in vaccines, physicians, the pharmaceutical industry and health politics; fear of adverse effects; assumptions regarding the consequences of COVID-19; knowledge about vaccines; and information seeking behavior. Odds ratios with 95% confidence intervals were calculated and chi-square tests were performed. Four thousand five hundred surveys were analyzed. The overall vaccination acceptance was 91.7%. The age group ≤20 years showed the lowest vaccination acceptance. Factors associated with vaccination hesitancy were lack of trust in authorities and pharmaceutical companies. Attitudes among acquaintances were associated with vaccination hesitancy too. Participants with vaccination hesitancy more often obtained information about COVID-19 vaccines via messenger services or online video platforms and underperformed in the knowledge test. We found high acceptance amongst German HCWs. Several factors associated with vaccination hesitancy were identified which could be targeted in HCW vaccination campaigns.
(1) Background: Health care workers (HCWs) play a key role in increasing anti-COVID vaccination rates. Fear of potential side effects is one of the main reasons for vaccine hesitancy. We investigated which side effects are of concern to HCWs and how these are associated with vaccine hesitancy. (2) Methods: Data were collected in an online survey in February 2021 among HCWs from across Germany with 4500 included participants. Free-text comments on previously experienced vaccination side effects, and fear of short- and long-term side effects of the COVID-19 vaccination were categorized and analyzed. (3) Results: Most feared short-term side effects were vaccination reactions, allergic reactions, and limitations in daily life. Most feared long-term side effects were (auto-) immune reactions, neurological side effects, and currently unknown long-term consequences. Concerns about serious vaccination side effects were associated with vaccination refusal. There was a clear association between refusal of COVID-19 vaccination in one's personal environment and fear of side effects. (4) Conclusions: Transparent information about vaccine side effects is needed, especially for HCW. Especially when the participants' acquaintances advised against vaccination, they were significantly more likely to fear side effects. Thus, further education of HCW is necessary to achieve good information transfer in clusters as well.