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Cardiovascular disease is a complex disorder involving multiple pathophysiological processes, several of which involve activation of toll-like receptors (TLRs) of the innate immune system. As sentinels of innate immunity TLRs are nonclonally germline-encoded molecular pattern recognition receptors that recognize exogenous as well as tissue-derived molecular dangers signals promoting inflammation. In addition to their expression in immune cells, TLRs are found in other tissues and cell types including cardiomyocytes, endothelial and vascular smooth muscle cells. TLRs are differentially regulated in various cell types by several cardiovascular risk factors such as hypercholesterolemia, hyperlipidemia, and hyperglycemia and may represent a key mechanism linking chronic inflammation, cardiovascular disease progression, and activation of the immune system. Modulation of TLR signaling by specific TLR agonists or antagonists, alone or in combination, may be a useful therapeutic approach to treat various cardiovascular inflammatory conditions such as atherosclerosis, peripheral arterial disease, secondary microvascular complications of diabetes, autoimmune disease, and ischemia reperfusion injury. In this paper we discuss recent developments and current evidence for the role of TLR in cardiovascular disease as well as the therapeutic potential of various compounds on inhibition of TLR-mediated inflammatory responses.

Aim: This is an evaluation study of the impact of the adapted RCN Clinical Leadership Programme on the development of leadership competencies of nurse leaders in Switzerland., Background: Transformational leadership competencies are essential for delivering high-quality care within health-care organizations. However, many countries have identified a lack of leadership skills in nurse leaders. Consequently, the development of leadership competencies is a major objective for health-care centres., Methods: This article describes the quantitative results of a mixed methods study. A one-group pre-test-post-test quasi-experimental design was used. A convenience sample of 14 ward leaders were assessed three times using the Leadership Practices Inventory (LPI). Descriptive and inferential data analysis techniques were employed., Results: In total 420 observer-assessment questionnaires and 42 self-assessment questionnaires were distributed. Our main finding was that nurse leaders following the programme, demonstrated significant improvement in two subscales of the LPI -'inspiring a shared vision' and 'challenging the process'., Conclusion: This study showed improvement in two leadership practices of nurse leaders following a programme that has been adapted to Swiss health care., Implications for Nursing Management: Findings concur with others studies that suggest that investments in educational programs to facilitate leadership skills in nurse leaders are justified., (© 2011 Blackwell Publishing Ltd.)

Patients with end-stage renal disease who receive a kidney through transplantation enter a new phase in their illness trajectory. The question emerged which knowledge and skills are essential for a safe self-management immediately after the transplantation. The aim of this project was to develop an evidence-based in-patient education programme for renal transplant recipients. A participative action research approach was chosen. An interprofessional group, led by an advanced practice nurse, initiated the project. Based on a systematic literature review and on qualitative interviews with both patients and experts, an in-patient educational programme was developed and implemented. The main elements of the programme focused on taking medications appropriately and on the observation and interpretation of symptoms. The content of the programme was documented in a brochure for patients. The structure of the programme was documented in a guideline with a standardised procedure. The procedure was based on patients' needs and preferences, and therefore provides tailored education. Besides the support received in gaining relevant knowledge, patients are supported in developing practical skills, problem solving, and decision making. An initial evaluation revealed that patients with cognitive impairment have special needs for education that exceeds what exists in the developed programme. As the programme is revised, additional contents on psychosocial issues will be included and the programme will be planned along the clinical pathway. Furthermore, it should begin during the pre-transplant period and continue in a longterm follow-up.

Study Objective: To date, no German triage tool with proven reliability and validity exists. The goal of this project is to translate and culturally adapt the Emergency Severity Index (ESI) and to assess reliability and validity of the German version., Methods: The ESI was translated following principles recommended for the translation and cultural adaptation of instruments. We performed a prospective, single-center cohort study. Reliability was assessed by calculating Cohen's weighted κ for agreement of 2 experts who reviewed the triage nurses' notes. To assess validity, associations of the number of resources, hospitalization, admission to intensive care, length of stay, and mortality with the assigned ESI level were investigated., Results: Only small cultural adaptations had to be made during the translation process. Interrater agreement was high (κ(w) = 0.985) in a sample of 125 patients. For the assessment of validity, a sample of 2,114 patients was used. Spearman's rank correlation coefficient between ESI category and number of resources was ρ = -0.567. The association (Kendall's τ) between ESI category and disposition, and hospitalization was τ = -0.429 and τ = -0.453, respectively. The areas under the curves for the predictive ability of the ESI for hospitalization in general and hospitalization to an ICU were 0.788 and 0.856, respectively. The association between emergency department length of stay and ESI category was also significant (Kruskal-Wallis χ² = 450.8; df = 4; P < .001). Furthermore, the association between ESI category and survival probability was significant (log-rank χ² = 36.06; df = 3; P < .001)., Conclusion: Translation of the ESI following guidelines was feasible and resulted in a reliable and valid German version., (Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.)

Patients with chronic heart failure (HF) are limited in their quality of life, have a poor prognosis and face frequent hospitalisations. Patient self-management was shown to improve quality of life, reduce rehospitalisations and costs in patients with chronic HF. Comprehensive disease management programmes are critical to foster patient self-management. The chronic care model developed by the WHO serves as the basis of such programmes. In order to develop self-management skills a needs orientated training concept is mandatory, as patients need both knowledge of the illness and the ability to use the information to make appropriate decisions according to their individual situation. Switzerland has no established system for the care of patients with chronic diseases in particular those with HF. For this reason a group of Swiss experts for HF designed a model for disease management for HF patients in Switzerland. Since 2009 the Swiss Heart Foundation offers an education programme based on this model. The aim of this programme is to offer education and support for practitioners, patients and families. An initial pilot evaluation of the program showed mixed acceptance by practitioners, whereas patient assessed the program as supportive and in line with their requirements.

Individuals with chronic heart failure are a vulnerable group of patients, with a poor prognosis and frequent hospitalisations. Research shows that multidisciplinary education outpatient programmes for heart failure (HF) increases the quality of life of these patients and decreases mortality and rehospitalisation respectively. As a result of this research, the University Hospital Basel has developed and implemented a multidisciplinary, nurse-led inpatient programme. The article describes the development and difficulties of the programme from its beginning until the verification of its effectiveness. Based on a systematic review of the literature and principles of action research the programme was developed by a group of nurses specialised in HF and two physicians under the guidance of an Advanced Practice Nurse student. The group developed a patient pathway and guidelines describing education, skills training sessions for patients, as well as descriptions of responsibilities and tasks of the different members of the multidisciplinary team. To date, an individualised programme with information material and specific documentation is offered to patients who receive personalised recommendations before their discharge. For the nurses the implementation of the programme was a new challenge of structured counselling in their normal "busy" routine because of this challenge the nurses needed continuing coaching.

In 2000, the Institute of Nursing Science in Basel started with a clinically oriented Master programme in Advanced Nursing Practice (ANP). The nursing expertise achieved with this degree includes enhanced skills and know-how in a specialised area. Together with their nurse colleagues, the clinically, scientifically, and practice-orientated Advanced Practice Nurses (APNs) support and develop nursing practice in Switzerland further, especially for chronically ill and geriatric patients. It is estimated that 25 % of older adults aged 80-years and older experience at least one hospitalisation per year. Beside the acute diagnosis, they suffer from several chronic illnesses. These highly complex and fragile patients need to be cared for by nurses with enhanced practice skills in gerontology. At the acute geriatric ward of the University Hospital Basel a practice development project is ongoing under the guidance of an APN to support person-oriented, geriatric care. The practice development project is led by the principles of action research. The circular process of "look-think-act" facilitates the critical examination of nursing practice. First results show shorter length of hospital stay for patients and improved job-satisfaction and self-efficacy for nurses. This article shortly reveals the history of ANP and highlights the development, implementation, and first results of the practice development project.

Having an ill child that is being treated in a pediatric intensive care unit (PICU) is tremendously stressful for the parents, both physically and emotionally. To help them cope with the circumstances they find themselves in, parents often develop expectations which are addressed to the team of the PICU, and which they find important to be fulfilled. Many of these expectations are culturally shaped. At present, there exist no data from German speaking area. Thus, this qualitative study was undertaken to fill this gap. Episodic interviews were conducted with five mothers and two fathers. Using the content analysis technique described by Mayring, one main category and six subcategories emerged from the data. "Concering about the sick child" was of particular importance for the parents. Their own expectations were reflected in the six subcategories: "Knowing that the child is receiving good care", "Being with the child", "Being involved", "Experiencing care for oneself and one's child", "Being informed" and "Experiencing continuity". These results are congruent with prior research reported in the international literature. Having a desire for a continuous medical support and the clear separation of roles between physicians and nurses are new findings from this investigation which have not been described previously.

NK cells express toll-like receptors (TLR) that recognize conserved pathogen or damage associated molecular patterns and play a fundamental role in innate immunity. Low molecular weight dextran sulfate (DXS), known to inhibit the complement system, has recently been reported by us to inhibit TLR4-induced maturation of human monocyte-derived dendritic cells (MoDC). In this study, we investigated the capability of DXS to interfere with human NK cell activation triggered directly by TLR2 agonists or indirectly by supernatants of TLR4-activated MoDC. Both TLR2 agonists and supernatants of TLR4-activated MoDC activated NK cells phenotypically, as demonstrated by the analysis of NK cell activation markers (CD56, CD25, CD69, NKp30, NKp44, NKp46, DNAM-1 and NKG2D), and functionally as shown by increased NK cell degranulation (CD107a surface expression) and IFN-gamma secretion. DXS prevented the up-regulation of NK cell activation markers triggered by TLR2 ligands or supernatants of TLR4-activated MoDC and dose-dependently abrogated NK cell degranulation and IFN-gamma secretion. In summary our results suggest that DXS may be a useful reagent to inhibit the direct and indirect TLR-mediated activation of NK cells., ((c) 2010 Elsevier Ltd. All rights reserved.)

Dendritic cells (DC) are professional antigen presenting cells that represent an important link between innate and adaptive immunity. Danger signals such as toll-like receptor (TLR) agonists induce maturation of DC leading to a T-cell mediated adaptive immune response. In this study, we show that exogenous as well as endogenous inflammatory stimuli for TLR4 and TLR2 induce the expression of HIF-1alpha in human monocyte-derived DC under normoxic conditions. On the functional level, inhibition of HIF-1alpha using chetomin (CTM), YC-1 and digoxin lead to no consistent effect on MoDC maturation, or cytokine secretion despite having the common effect of blocking HIF-1alpha stabilization or activity through different mechanisms. Stabilization of HIF-1alpha protein by hypoxia or CoCl(2) did not result in maturation of human DC. In addition, we could show that TLR stimulation resulted in an increase of HIF-1alpha controlled VEGF secretion. These results show that stimulation of human MoDC with exogenous as well as endogenous TLR agonists induces the expression of HIF-1alpha in a time-dependent manner. Hypoxia alone does not induce maturation of DC, but is able to augment maturation after TLR ligation. Current evidence suggests that different target genes may be affected by HIF-1alpha under normoxic conditions with physiological roles that differ from those induced by hypoxia.

Competent nursing and effective leadership are essential attributes for the provision of high-quality care which is patient-centred, evidence-based and outcome-oriented. The Department of Clinical Nursing science (DCN) of the University Hospital Basel (USB) initiated and implemented programmes of targeted practice development to promote competence in nursing and leadership. With the aim of generating data on nursing and leadership competencies, as well as on the quality of nursing care and the nursing work environment, an evaluation study with a mixed-method design was implemented in 2007. Within the quantitative portion of the study 679 nurses and 27 nurse managers participated. The descriptive results showed that nurses rated their overall level of competence on the Nurse Competence Scale high with a mean score of 75.1 (VAS 0 - 100). The rating of leadership competencies of nurse managers on the Leadership Practice Inventory was in the upper third of the 10-point Likert scale with mean scores of 40 to 50 (6 - 60). In order to permit ongoing monitoring of practice development, follow-up evaluations at regularly scheduled intervals are planned. With the introduction of a reimbursement system on the basis of Diagnosis Related Groups into Swiss health care, effective monitoring of nursing service contextual factors is crucial, now and in the future.

Bladder exstrophy (BE) is a rare but severe urogenital malformation that requires complex clinical management. It can lead to physical restriction as well as to psychosocial and psychosexual malfunction. For the first time, this qualitative study describes the experiences of persons living with BE from childhood into adulthood. The primary goal was to explore the experiences of persons with BE in order to optimise treatment, care and counselling at the children hospital in Zurich. Semi-structured interviews were conducted with 4 women and 16 men (38 to 68 years). Using content analysis techniques, three major categories with two respectively four and five subcategories emerged from the data. The first category "having a good life despite BE" describes the perception of the affected persons to lead a life worth living despite BE. It was categorised by episodes and experiences that were repeated throughout the persons' life, such as "being in hospital", "living with symptoms", "being different", "showing oneself" and "gathering information". The second category "the affected ones" demonstrated that "parents" and "partners" were affected too and provided considerable support to the person with BE. The third category "the influencing factors" revealed that the perception of living with BE was influenced by individual and contextual factors. The results of this study illustrated that persons with BE can live a good life, despite repeated health-related challenges, if the support provided by their caregivers permits a positive attitude towards their illness. For this, patients with BE and their family members require continuous and highly competent treatment, care and education by an interdisciplinary team.

Background: Based on actual evidence, about one third of deliria can be prevented. Hereby, preventive measures can address both delirium predisposing as well as delirium precipitating factors., Methods: In 2004 an interdisciplinary practice developmental project was developed, implemented and evaluated at the University Hospital Basel by action-based research., Interventions: Preventive measures for delirium were developed, resource nurses trained and a systematic delirium screening procedure established., Results: Nurses and doctors highly accepted the common approach. The delirium rate declined from 25% to 11%. The working load for nurses did not increase on the intervention wards, but decreased at night, whereas the night working load increased on the control wards., Conclusion: An interprofessional and interdisciplinary approach for the prevention of delirium has multiple winners: the patient, nurses and doctors.

The prevalence of deliria is increasing exponentially with cumulative age. At the University Hospital of Basel 16 % of patients in the 70-79 year age-group, 27 % in the 80-89 year age-group and 39 % of the over 90 year old are rated as confused and disoriented. Delirious patients suffer from functional decline and show a significant higher mortality and institutionalization rate after hospital discharge. Nurses have an important role in the multi-component delirium-management. In addition to the assessment of medication, laboratory parameters, oxygenation or urinary excretion, patient-oriented evaluations, pain and stress management, assessment of patient perception and communication are of particular importance. To meet these goals, nurses need knowledge, education and proof of clinical evidence.

Endothelin-1 (ET-1) is mainly secreted by endothelial cells and acts as a potent vasoconstrictor. In addition ET-1 has also been shown to have pleiotropic effects on a variety of other systems including adaptive immunity. There are two main ET-1 receptors, ET(A) and ET(B), which have different tissue and functional distributions. Dendritic cells (DC) are pivotal antigen-presenting cells linking the innate with the adaptive immune system. DC are sentinels expressing pattern-recognition receptors, e.g. the toll-like receptors (TLR) for detecting danger signals released from pathogens or tissue injury. Here we show for the first time that stimulation of human monocyte-derived DC with exogenous as well as endogenous selective TLR4 and TLR2 agonists induces the production of ET-1 in a dose- and time-dependent manner. 'Alternative' activation of DC in the presence of 1alpha,25-dihydroxyvitamin D(3) results in a marked potentiation of the endothelin response, whereas prostaglandin E(2) or dexamethasone do not increase ET-1 production. Furthermore, chetomin, an inhibitor of the transcription factor hypoxia-inducible factor 1alpha (HIF-1alpha), prevents TLR-mediated secretion of ET-1. Surprisingly, stimulation of human monocytes with LPS does not lead to secretion of detectable amounts of ET-1. These results suggest a role of ET-1 as an important player in human DC biology and innate immunity in general.

Couples experience cancer as a dyad. Step by step, they have to learn to integrate the illness into their lives. It can be assumed that psychosocial nursing interventions would offer them helpful support. Yet, there is no evidence showing which interventions are the most effective in supporting the couple in the illness management. This literature review was undertaken to explore this issue and was guided by following questions: 1) What kind of psychosocial intervention programmes exist for couples experiencing cancer? 2) Which instruments were used to measure the effectiveness of the interventions and what were the results? 3) What was the contribution of the interventions to an improved dyadic illness management process? Five articles were retrieved that met both the in- and exclusion criteria. The intervention programs varied regarding content and structures. The instruments used in the studies were very heterogeneous, making comparisons difficult. Even so, the results of the review found that psychosocial interventions decreased the levels of depression and hopelessness in both partners. The interventions also made it easier for the partners to advise and support each other in everyday situations. The conclusion was drawn that targeted information materials, structured information, and professional support represent effective psychosocial nursing interventions for couples living with cancer.

In intensive care units, patients are sedated to reduce the stress caused by illness and/or treatments such as artificial respiration. Regular assessment of the degree of sedation as part of the goal-directed therapy has been recommended as a standard of care. The Swiss Society of Intensive Care Medicine requires all accredited Swiss intensive care units to periodically document the degree of sedation by means of a sedation scale as part of the minimal data set (MDSi). The ten-level Richmond Agitation-Sedation Scale (RASS) is one of two proposed scales for the assessment of the degree of sedation. Because validated versions of the recommended sedation scales exist in English only, the RASS was translated by a systematic iterative procedure in six steps. The iterative translation of the RASS for use in Swiss intensive care units described in this article is an example of interdisciplinary teamwork. Translation of clinical assessment tools for clinical use should be carried out as carefully and stringently as the development of research tools. Based on the experience gained in the described project we recommend the following points to consider when translating clinical assessment tools: a) referring to literature not only on the subject of translation but also on the process of translation itself, b) involving professional translators as language experts, and c) consulting the author(s) of the original version.

This article describes the development and content of the portfolio of the Surgical Intensive Care Unit. The first step was to evaluate clinical practice using a SWOT (strengths, weakness, opportunities and threats) analysis; development and trends within surgical intensive care were analyzed with a literature search. From these results, three areas were identified as essential for the development of practice: (1) best practice/best care, (2) research, and (3) development into a reference center. For each area, clearly specified objectives, outcomes, measures, responsibilities, and resources were defined and an extensive multi-year action plan was established. Best Practice/Best Care consisted of the improvement of performance and patient outcomes, the support and promotion of personnel, and the implementation of evidence-based nursing practice. Combining Best Practice/Best Care with the goals and measures of the second area, Research, formed the basis for realizing the vision of the Surgical Intensive Care Unit to become "a nationally and internationally recognized reference center for surgical intensive care for defined topics and patient groups." Concrete strategies for achieving this goal were established in the third area.

Fusion inhibitors can be an effective salvage therapy in HIV-patients with multiple resistances. However, the management and maintenance of the therapy, which requires percutaneous self-administration, can be a difficult task for patients. Preparation and administration are time-consuming and may force patients to alter their daily routine. Therefore, appropriate counselling and training is important. Evidence-based guidelines can help health care professionals to provide continuing high quality care. The department of Clinical Nursing Science at the University Hospital Basel have developed a nursing guideline, which formulates patient-management from decision-making up to the support needed in long-time treatment maintenance. The main focus of this article lies on the theoretical framework of this guideline and a description of its key elements. These are important aspects of managing the treatment of chronic illness in general. Therefore, this article addresses all health care providers supporting chronically ill patients in their medication management.

Unlabelled: An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context., Aims: Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented., Methods: Argumentation developed using data based papers and policy reports on Advanced Practice Nursing., Results: The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role., Conclusion: Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.

There is almost no empirical data about how mothers of newborn babies with a cleft lip and/or palate manage the transition from the hospital to home. This qualitative study therefore focuses on the experiences of mothers of newborn babies with a cleft lip and palate. Two problem-oriented interviews were conducted with five women. Using a qualitative content analysis, one main category and four sub-categories were defined. The main category called "receive the right kind of help" shows that the women depended on different types of support, concerning various topics from the diagnosis to everyday family life. This is reflected in the sub-categories: a) it is the way it is, b) sudden disappearance of the child, c) time-consuming and difficult nutrition and d) master everyday family-life. These sub-categories display the experiences of mothers of newborn babies with a cleft lip and palate during the transition from hospital to home and point to the big challenge of these mothers in transition. Most important is that health professionals seek to better understand mothers' experiences in this important phase in order to optimize both the support in hospital and outpatient facilities.

Complement is an essential part of the innate immune system and plays a crucial role in organ and islet transplantation. Its activation, triggered for example by ischemia/reperfusion (I/R), significantly influences graft survival, and blocking of complement by inhibitors has been shown to attenuate I/R injury. Another player of innate immunity are the dendritic cells (DC), which form an important link between innate and adaptive immunity. DC are relevant in the induction of an immune response as well as in the maintenance of tolerance. Modulation or inhibition of both components, complement and DC, may be crucial to improve the clinical outcome of solid organ as well as islet transplantation. Low molecular weight dextran sulfate (DXS), a well-known complement inhibitor, has been shown to prevent complement-mediated damage of the donor graft endothelium and is thus acting as an endothelial protectant. In this review we will discuss the evidence for this cytoprotective effect of DXS and also highlight recent data which show that DXS inhibits the maturation of human DC. Taken together the available data suggest that DXS may be a useful reagent to prevent the activation of innate immunity, both in solid organ and islet transplantation.

Chronic abdominal wounds lead to prolonged hospital stays. However, no data exist that describe the experience of persons living with a chronic abdominal wound. The aim of this qualitative study was to explore the experience of persons living with chronic abdominal wounds and elicit their expectations in health professionals. Narrative interviews were conducted with five women and four men. Using content analysis techniques, five categories with one to four subcategories emerged from the data. "Returning to everyday life without a wound" represents the main goal of the participants and is driven by their hope to achieve this outcome. "Everyday life with the wound" illustrates the reality of participants' lives, which is affected by suffering. "The patients' work" demonstrates the component that patients contribute to managing their wound. "The work of primary support persons" shows the importance of the work of people close to the patient. "The work of professionals" includes the expectations that patients have in their caregivers. Teamwork between professionals, patients and primary support persons seems to be an essential condition for the successful healing of an abdominal wound.

Malnutrition is a world-wide problem that does not only affect developing countries. People in industrialised countries, in particular the elderly, the poor and the sick, are at risk. In Switzerland, it is estimated that between 15 and 20% of patients (depending on patient population) show signs of malnutrition upon hospital admission. In response and based on a systematic review of the literature, a working group of the internal medicine department at the University Hospital Basel has developed a malnutrition programme comprising a screening instrument, a multidisciplinary care guideline, an information brochure, and a training programme for nursing staff. It is the aim of this article to report how the programme to recognise and treat malnutrition was developed, implemented, and evaluated.

Low molecular weight dextran sulfate (DXS) has been reported to inhibit the classical, alternative pathway as well as the mannan-binding lectin pathway of the complement system. Furthermore, it acts as an endothelial cell protectant inhibiting complement-mediated endothelial cell damage. Endothelial cells are covered with a layer of heparan sulfate (HS), which is rapidly released under conditions of inflammation and tissue injury. Soluble HS induces maturation of dendritic cells (DC) via TLR4. In this study, we show the inhibitory effect of DXS on human DC maturation. DXS significantly prevents phenotypic maturation of monocyte-derived DC and peripheral myeloid DC by inhibiting the up-regulation of CD40, CD80, CD83, CD86, ICAM-1, and HLA-DR and down-regulates DC-SIGN in response to HS or exogenous TLR ligands. DXS also inhibits the functional maturation of DC as demonstrated by reduced T cell proliferation, and strongly impairs secretion of the proinflammatory mediators IL-1beta, IL-6, IL-12p70, and TNF-alpha. Exposure to DXS leads to a reduced production of the complement component C1q and a decreased phagocytic activity, whereas C3 secretion is increased. Moreover, DXS was found to inhibit phosphorylation of IkappaB-alpha and activation of NF-kappaB. These findings suggest that DXS prevents TLR-induced maturation of human DC and may therefore be a useful reagent to impede the link between innate and adaptive immunity.