Kinderklinik und Poliklinik
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- Kinderklinik und Poliklinik (294)
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Sonstige beteiligte Institutionen
- Department of Medicinal Chemistry, University of Vienna, Althanstraße 14, 1090 Vienna, Austria (1)
- Department of Paediatric Radiology, Institute of Diagnostic and Interventional Radiology, Josef-Schneider-Straße 2, Wuerzburg 97080, Germany (1)
- Department of Pediatrics, Pediatrics I, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria (1)
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Althanstraße 14, 1090 Vienna, Austria (1)
- Interdisciplinary Center for Clinical Research (IZKF), Würzburg, Germany (1)
- Kinderklinik Bad Mergentheim (1)
- Klinik für Kinder- und Jugendmedizin des Caritas-Krankenhauses Bad Mergentheim (1)
- Orthopädische Klinik König-Ludwig-Haus (1)
EU-Project number / Contract (GA) number
- 229289 (1)
- 241778 (1)
- 609,020 (1)
- HEALTH-F2-2009-241778 (1)
Impfungen sind essenziell zur Prävention vieler Erkrankungen. Für die Impfentscheidung von Patienten spielt die ärztliche Beratung eine wichtige Rolle. Die universitäre Lehre sollte das notwendige Wissen zu Impfungen vermitteln. Die vorliegende Studie untersuchte die Selbsteinschätzung des Impfwissens von Medizinstudierenden sowie die Struktur der Impfausbildung im Medizinstudium. In einer Umfrage wurden Medizinstudierende an den damaligen fünf medizinischen Fakultäten in Bayern im Sommer- und Wintersemester 2018 zu ihrem Impfwissen und ihrer Impfausbildung befragt.
In der nicht vollständig geklärten Pathogenese der juvenilen idiopathischen Arthritis (JIA) spielen insbesondere Effektor-T-Zellen und regulatorische T-Zellen (Tregs), sowie das Kontinuum ihrer plastischen Zelltypen eine wichtige Rolle. Im arthritischen Milieu, das auch Interleukin-17 (IL-17) beinhaltet, verschiebt sich das Gleichgewicht dieser Zellen hin zur Inflammation. Ziel dieser Arbeit war es, die T-Zellbalance im peripheren Blut von JIA-Patienten mit gesunden Kontrollen (HC) zu vergleichen, sowie den Einfluss von IL-17, anti-IL-17 und eines Th17-stimulierenden, proinflammatorischen Zytokinmilieus auf Phänotyp und Funktion der Tregs zu untersuchen.
Es erfolgte die durchflusszytometrische Analyse des Lymphozytenpools von 16 JIA- und 10 HC-Probanden. Isolierte CD25+CD127-CD4+ Tregs wurden mit den genannten Stimuli kultiviert und danach durchflusszytometrisch phänotypisch sowie in Co-Kultur mit peripheren mononukleären Zellen (PBMCs) auf ihre Suppressionsfunktion untersucht.
Wir stellten erhöhte Proportionen von Th17-Zellen, Tregs und effector-like Tregs in JIA-Patienten fest. Bei Stimulation mit dem Th17-Cocktail zeigte sich eine verminderte Suppression der Effektor-Zellen durch Tregs bei zeitgleich vermehrter FoxP3-Expression insbesondere in JIA-Tregs. Secukinumab bewirkte eine Anpassung der FoxP3-Expression der Tregs in der Patientengruppe auf etwa das Niveau der gesunden Kontrollen.
Insgesamt bestätigt diese Arbeit eine proinflammatorische Dysbalance bei JIA-Patienten mit Shift zu Th17-like Tregs als möglicherweise pathologischen Phänotyp. Ursache für die verminderte Suppression ist vermutlich eine gesteigerte Resistenz der Effektor-Zellen durch das Inflammationsmilieu. Die vermehrte FoxP3-Expression der JIA-Tregs ist am ehesten durch eine gesteigerte Zellaktivierung zu erklären. Diese erhöhte Sensitivität der Tregs für inflammatorische Stimuli mit vermehrter Aktivierung ist ein möglicher Ansatzpunkt für zukünftige Therapien. Die Adjustierung der FoxP3-Expression unter Secukinumab in der JIA-Gruppe auf Niveau der Kontrollen bildet daher einen denkbaren zusätzlichen therapeutischen Effekt der IL-17A Blockade durch potenzielle intrinsische Stabilisierung des Phänotyps der Tregs bei der JIA ab.
Bei der HPP handelt es sich um eine seltene, erblich bedingte Stoffwechselerkrankung, die unter anderem mit einer Störung des Knochen- und Mineralstoffwechsels einhergeht. Ziel dieser Arbeit war es, die objektiv messbare Aktivität und die HRQoL der jungen HPP-Patientinnen und -Patienten zu untersuchen. Dazu sollten die hierbei erhobenen Daten des erkrankten Patientenkollektivs mit den Daten des gesunden Kontrollkollektivs verglichen werden. Dies geschah unter der Verwendung von Accelerometrie, Spiroergometrie und etablierten Fragebögen in 18 Probandinnen und Probanden und 18 Gesundkontrollen.
In den Fragebögen zeigten sich deutliche Defizite, welche sich nur zum Teil in den objektiven Untersuchungen wiederspiegelten. Weitere Untersuchungen mit einer größeren Studienpopulation und Validierung der Untersuchungsmethoden für die HPP werden zukünftig benötigt.
Linear, dimeric, tetrameric, and cyclic peptides derived from lactoferricin B, containing the RRWQWR motif, were designed, synthesized, purified, and characterized using RP-HPLC chromatography and MALDI-TOF mass spectrometry. The antibacterial activity of the designed peptides against E. coli (ATCC 11775 and 25922) and their cytotoxic effect against MDA-MB-468 and MDA-MB-231 breast cancer cell lines were evaluated. Dimeric and tetrameric peptides showed higher antibacterial activity in both bacteria strains than linear peptides. The dimeric peptide (RRWQWR)\(_2\)K-Ahx exhibited the highest antibacterial activity against the tested bacterial strains. Furthermore, the peptides with high antibacterial activity exhibited significant cytotoxic effect against the tested breast cancer cell lines. This cytotoxic effect was fast and dependent on the peptide concentration. The tetrameric molecule containing RRWQWR motif has an optimal cytotoxic effect at a concentration of 22 µM. The evaluated dimeric and tetrameric peptides could be considered as candidates for developing new therapeutic agents against breast cancer. Polyvalence of linear sequences could be considered as a novel and versatile strategy for obtaining molecules with high anticancer activity.
Introduction: Malignant rhabdoid tumors (MRT) predominantly affect infants and young children. Patients below six months of age represent a particularly therapeutically challenging group. Toxicity to developing organ sites limits intensity of treatment. Information on prognostic factors, genetics, toxicity of treatment and long-term outcomes is sparse. Methods: Clinical, genetic, and treatment data of 100 patients (aged below 6 months at diagnosis) from 13 European countries were analyzed (2005–2020). Tumors and matching blood samples were examined for SMARCB1 mutations using FISH, MLPA and Sanger sequencing. DNA methylation subgroups (ATRT-TYR, ATRT-SHH, and ATRT-MYC) were determined using 450 k / 850 k-profiling. Results: A total of 45 patients presented with ATRT, 29 with extracranial, extrarenal (eMRT) and 9 with renal rhabdoid tumors (RTK). Seventeen patients demonstrated synchronous tumors (SYN). Metastases (M+) were present in 27% (26/97) at diagnosis. A germline mutation (GLM) was detected in 55% (47/86). DNA methylation subgrouping was available in 50% (31 / 62) with ATRT or SYN; for eMRT, methylation-based subgrouping was not performed. The 5-year overall (OS) and event free survival (EFS) rates were 23.5 ± 4.6% and 19 ± 4.1%, respectively. Male sex (11 ± 5% vs. 35.8 ± 7.4%), M+ stage (6.1 ± 5.4% vs. 36.2 ± 7.4%), presence of SYN (7.1 ± 6.9% vs. 26.6 ± 5.3%) and GLM (7.7 ± 4.2% vs. 45.7 ± 8.6%) were significant prognostic factors for 5-year OS. Molecular subgrouping and survival analyses confirm a previously described survival advantage for ATRT-TYR. In an adjusted multivariate model, clinical factors that favorably influence the prognosis were female sex, localized stage, absence of a GLM and maintenance therapy. Conclusions: In this cohort of homogenously treated infants with MRT, significant predictors of outcome were sex, M-stage, GLM and maintenance therapy. We confirm the need to stratify which patient groups benefit from multimodal treatment, and which need novel therapeutic strategies. Biomarker-driven tailored trials may be a key option.
Adrenocortical tumors are rare in children. This systematic review summarizes the published evidence on pediatric adrenocortical carcinoma (ACC) to provide a basis for a better understanding of the disease, investigate new molecular biomarkers and therapeutic targets, and define which patients may benefit from a more aggressive therapeutic approach. We included 137 studies with 3680 ACC patients (~65% female) in our analysis. We found no randomized controlled trials, so this review mainly reflects retrospective data. Due to a specific mutation in the TP53 gene in ~80% of Brazilian patients, that cohort was analyzed separately from series from other countries. Hormone analysis was described in 2569 of the 2874 patients (89%). Most patients were diagnosed with localized disease, whereas 23% had metastasis at primary diagnosis. Only 72% of the patients achieved complete resection. In 334 children (23%), recurrent disease was reported: 81% — local recurrence, 19% (n = 65) — distant metastases at relapse. Patients < 4 years old had a different distribution of tumor stages and hormone activity and better overall survival (p < 0.001). Although therapeutic approaches are typically multimodal, no consensus is available on effective standard treatments for advanced ACC. Thus, knowledge regarding pediatric ACC is still scarce and international prospective studies are needed to implement standardized clinical stratifications and risk-adapted therapeutic strategies.
Outpatient antibiotic use is closely related to antimicrobial resistance and in Germany, almost 70% of antibiotic prescriptions in human health are issued by primary care physicians (PCPs). The aim of this study was to explore PCPs, namely General Practitioners' (GPs) and outpatient pediatricians' (PDs) knowledge of guideline recommendations on rational antimicrobial treatment, the determinants of confidence in treatment decisions and the perceived need for training in this topic in a large sample of PCPs from southern Germany. Out of 3753 reachable PCPs, 1311 completed the survey (overall response rate = 34.9%). Knowledge of guideline recommendations and perceived confidence in making treatment decisions were high in both GPs and PDs. The two highest rated influencing factors on prescribing decisions were reported to be guideline recommendations and own clinical experiences, hence patients' demands and expectations were judged as not influencing treatment decisions. The majority of physicians declared to have attended at least one specific training course on antibiotic use, yet almost all the participating PCPs declared to need more training on this topic. More studies are needed to explore how consultation-related and context-specific factors could influence antibiotic prescriptions in general and pediatric primary care in Germany beyond knowledge. Moreover, efforts should be undertaken to explore the training needs of PCPs in Germany, as this would serve the development of evidence-based educational interventions targeted to the improvement of antibiotic prescribing decisions rather than being focused solely on knowledge of guidelines.
The signal modelling framework JimenaE simulates dynamically Boolean networks. In contrast to SQUAD, there is systematic and not just heuristic calculation of all system states. These specific features are not present in CellNetAnalyzer and BoolNet. JimenaE is an expert extension of Jimena, with new optimized code, network conversion into different formats, rapid convergence both for system state calculation as well as for all three network centralities. It allows higher accuracy in determining network states and allows to dissect networks and identification of network control type and amount for each protein with high accuracy. Biological examples demonstrate this: (i) High plasticity of mesenchymal stromal cells for differentiation into chondrocytes, osteoblasts and adipocytes and differentiation-specific network control focusses on wnt-, TGF-beta and PPAR-gamma signaling. JimenaE allows to study individual proteins, removal or adding interactions (or autocrine loops) and accurately quantifies effects as well as number of system states. (ii) Dynamical modelling of cell–cell interactions of plant Arapidopsis thaliana against Pseudomonas syringae DC3000: We analyze for the first time the pathogen perspective and its interaction with the host. We next provide a detailed analysis on how plant hormonal regulation stimulates specific proteins and who and which protein has which type and amount of network control including a detailed heatmap of the A.thaliana response distinguishing between two states of the immune response. (iii) In an immune response network of dendritic cells confronted with Aspergillus fumigatus, JimenaE calculates now accurately the specific values for centralities and protein-specific network control including chemokine and pattern recognition receptors.
Background and purpose
Pediatric adrenocortical carcinoma (pACC) is a rare disease with poor prognosis. Publications on radiotherapy (RT) are scarce. This review summarizes the current data on RT for pACC and possibly provides first evidence to justify its use in this setting.
Materials and methods
We searched the PubMed and Embase database for manuscripts regarding RT for pACC.
Results
We included 17 manuscripts reporting on 76 patients treated with RT, after screening 2961 references and 269 full articles. In addition, we added data of 4 unreported pACC patients treated by co-authors. All reports based on retrospective data. Median age at first diagnosis was 11.1 years (70% female); 78% of patients presented with hormonal activity. RT was mostly performed for curative intent (78%). 88% of RT were administered during primary therapy. The site of RT was predominantly the local tumor bed (76%). Doses of RT ranged from 15 to 62 Gy (median 50 Gy). Information on target volumes or fractionation were lacking. Median follow-up was 6,9 years and 64% of the patients died of disease, with 33% alive without disease. In 16 of 48 patients with available follow-up data after adjuvant RT (33%) no recurrence was reported and in 3 of 9 patients palliative RT seemed to induce some benefit for the patient.
Conclusions
Our first systematic review on RT for pACC provides too few data for any general recommendation, but adjuvant RT in patients with high risk might be considered. International collaborative studies are urgently needed to establish better evidence on the role of RT in this rare malignancy.
Background
Multiple myeloma (MM) is the third most common hematologic malignancy with increasing importance due to improving treatment strategies and long-term outcomes in an aging population. This study aims to analyse influencing factors on health-related quality of life (HRQoL), such as treatment strategies, participation in a clinical trial and patient characteristics like anxiety, depression, gender, and age. A better understanding of the individual factors in context with HRQoL could provide a helpful instrument for clinical decisions.
Methods
In this prospective observational study, the HRQoL of MM patients with different therapies (first-line and relapse) was quantified by standardized questionnaires (EORTC QLQ-C30 and -MY20) in the context of sociodemographic data, individual anxiety and depressiveness (PHQ-4), and a selected number of clinical parameters and symptoms at defined time-points before, during, and after therapy.
Results
In total, 70 patients were included in the study. The median age of the study cohort was 62 years. 44% were female and 56% were male patients. More than half of the patients were fully active with an ECOG 0. Global health status was significantly higher in patients with first-line treatment and even increased after start of therapy, while the pain level decreased. In contrast, patients with relapsed MM reported a decreasing global health status and increasing pain. Additionally, there was a higher global health status in less anxious/depressive patients. HRQoL decreased significantly after start of chemotherapy in the parameters body image, side effects of treatment, and cognitive functioning. Tandem stem-cell transplantation was not found to be a risk factor for higher impairment of HRQoL. Participation in a clinical study led to an improvement of most aspects of HRQoL. Among others, increased anxiety and depression, female gender, older age, impaired performance status, and recurrent disease can be early indicators for a reduced HRQoL.
Conclusion
This study showed the importance of regular longitudinal assessments of patient reported outcomes (PROs) in routine clinical care. For the first time, to our knowledge, we were able to demonstrate a potential impact between participation in clinical trials and HRQoL. However, due to frequently restrictive inclusion criteria for clinical trials, these MM patients might not be directly comparable with patients treated within standard therapy concepts. Further studies are needed to clarify the relevance of this preliminary data in order to develop an individualized, patient-centred, therapy concept.