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The importance of glucose metabolism in patients with acute coronary syndrome has been increasingly recognized. We conducted a retrospective study of the associations between prior glycated hemoglobin (HbA1c) levels, admission glucose values, HbA1c-derived estimated average glucose levels (eAG), admission glucose delta (admission glucose − eAG), and mortality in patients presenting with ST-segment elevation myocardial infarction. A total of 676 and 566 patients were included in the in-hospital and 12-month mortality models, respectively. Mean admission blood glucose values were higher in the in-hospital and 12-month mortality groups in patients with no prior diagnosis of diabetes (P < 0.001). Pre, post, and admission HbA1c levels and eAG levels were not associated with in-hospital or 12-month all-cause mortality. The admission glucose delta was higher in patients with in-hospital mortality (87.3 ± 122.7 mg/dL) than in patients who survived (35.88 ± 81.23 mg/dL; P = 0.040). The in-hospital death rate was significantly higher (17% vs 4%, P = 0.017) for patients with admission glucose delta ≥140 mg/dL compared to lower values. In conclusion, HbA1c-derived admission glucose delta is associated with in-hospital mortality in patients with ST-segment elevation myocardial infarction. The mechanisms for the association of acute hyperglycemia with increased acute coronary syndrome mortality are unclear.

Background The use of ustekinumab (UST) and vedolizumab (VDZ) as second line therapy in Crohn’s disease (CD) patients failing tumour necrosis factor alpha inhibitors is still debated. The aim of the study was to compare in a large multicentre observational retrospective cohort, the effectiveness of UST and VDZ as second line therapy as assessed by clinical and objective outcomes including endoscopy and gastro intestinal (GI)-imaging. Methods Clinical response, remission and steroid-free remission at week 26 and 52 were evaluated in a retrospective cohort of CD patients previously experienced TNF-alpha inhibitors (primary or secondary failure, and intolerant). Objective response and remission were evaluated by one or more techniques including ileocolonoscopy, magnetic resonance (MR)/computer tomography (CT) enteroclysis and small bowel ultrasound (US) performed within 3 months before the beginning of the treatment and after one year of therapy. Inverse propensity of treatment weighting (IPTW) and propensity score matching (PMS) methods were used for statistical analysis. Results 470 CD patients (239 UST and 231 VDZ) were included in the study. At week 26 clinical response, clinical remission and steroid free remission were similar between the two groups (Figure 1) At week 52, clinical remission and steroid-free remission rates were significantly higher in VDZ-treated patients (clinical remission: UST 42.5% vs VDZ 55.5%, p=0.01; steroid-free clinical remission UST 40.6% vs VDZ 51.1%, p=0.038; Figure 1). 302 patients (135 UST and 167 VDZ) had objective evaluation of disease activity at baseline and week 52. At week 52 objective response and remission rates were similar between the groups. (Figure 2). Clinical response at week 26 predicted steroid-free remission at week 52 in both UST- and VDZ-treated patients. Safety profiles were similar between the two groups. Conclusion One-year treatment with VDZ was associated with higher rate of clinical remission as compared to UST, but no difference was observed between the two groups when objective outcomes were investigated

Background There is no head-to-head trial comparing ustekinumab (UST) and vedolizumab (VDZ) in Crohn’s disease (CD). Recently, real-world studies evaluated the two biologics in patients refractory to anti-TNF therapy, i.e. as second-line agents. Conversely, no study specifically focused on the effectiveness of UST and VDZ as third-line agents, i.e. after failure with at least one TNF-α inhibitor plus failure with VDZ or UST. We performed a multicentre, real-world assessment of the effectiveness of UST and VDZ in these highly-refractory patients with CD. Methods Data of consecutive patients with CD treated with UST and VDZ as third-line therapy until October, 2021 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease (SN-IBD). The effectiveness was evaluated at, 8, 26, and, 52 weeks, and as treatment persistence at the end of follow up. The clinical outcomes were steroid-free clinical remission (SFCR - Harvey-Bradshaw Index Results 143 patients (UST: n=113; VDZ: n=30) were included. After, 8 weeks, SFCR was reported in, 38.1% of patients treated with UST and in, 43.3% of patients treated with VDZ (p=0.75), while CR was reported in, 61.9% of patients treated with UST and in, 60.0% patients treated with VDZ (p=1.00). After, 26 weeks, the rates of SFCR and CR were, 41.6% for UST and, 50.0% for VDZ (p=0.60), and, 61.4% for UST and, 66.7% for VDZ (p=0.81), respectively. After, 52 weeks, the rates of SFCR and CR were, 51.8% for UST and, 57.1% for VDZ (p=0.78), and, 65.9% for UST and, 71.4% for VDZ (p=0.77), respectively. Lack of difference in effectiveness between the two drugs at any time point was confirmed by multiple logistic regression models. After, 26 weeks, 88.7% of patients treated with UST and, 81.4% of patients treated with VDZ were still on treatment. Univariable Cox survival analysis showed a higher probability of treatment discontinuation for VDZ compared with UST (HR for VDZ:, 2.66; p=0.008), even if such difference was not confirmed at the multiple Cox proportional hazard regression model (HR for VDZ:, 1.94; p=0.08), where only age (HR, 0.98; p=0.04) and use of systemic steroids at baseline (HR, 3.29; p=0.003) were found to be independent predictors of treatment discontinuation. Conclusion This is the first real-world study assessing VDZ and UST as third-line therapy in patients with CD. Both drugs showed surprisingly high effectiveness, without significant differences between them.

Background New therapeutic approaches for ulcerative colitis (UC) are becoming available but still there is no robust evidence for predictors of poor outcome. We aimed to evaluate factors associated with a more aggressive UC course. Methods Data of all UC outpatients followed for at least 3 years after diagnosis were retrospectively collected. Demographic, anamnestic data, disease characteristics and treatment were collected. Disease patterns were defined according to the IBSEN study (Henriksen M. et al1). Disease worsening at 3 years was defined as the presence of disease extension at endoscopy, proctocolectomy and or early use of biologics. Risk factors for chronically active disease were assessed. Moreover, the following outcomes were explored according to disease extent at diagnosis (E1-E2 vs E3): corticosteroid free remission, hospitalization, early use of immunomodulators and biologics, colorectal cancer, adherence, mucosal healing at 3 years. Survival analysis was carried out to estimate the probability of receive a biological treatment within 3 and 5 years from diagnosis according to disease extent (E1 vs E2 vs E3) and disease patterns. Results A total of 345 UC patients were included and followed for a mean period of 94 months. Patients with extensive colitis had a higher rate of colectomy (p < 0.001), hospitalizations (p=0.004) and of chronically active disease 3 years after diagnosis (p < 0.001) and were more likely to receive early biologics and IMM (p= 0.04 and p=0.01 respectively) (Figure 1). The only factor associated with chronic active disease was non-adherence (p < 0.03; OR 0.49, 95% CI: 0.26–0.95) (Table 1). No differences were found for the probability to receive biologics within 3 and 5 years from diagnosis according to Montreal extension at diagnosis and disease pattern. Conclusion Patients diagnosed with pancolitis were more likely to underwent colectomy or to have a chronically active disease with a higher rate of hospitalization, early use of IMM or biologics. The only predictor for chronically active UC was the lack of adherence to therapy within the first 3 years after diagnosis. Reference 1. Henriksen M, et al; IBSEN Study Group. Ulcerative colitis and clinical course: results of a 5-year population-based follow-up study (the IBSEN study). Inflamm Bowel Dis. 2006;12:543–50. The study was supported by a grant from Ferring S.p.A.

Data Availability Statement: The original contributions presented in the study are included in the article/Supplementary Material; further inquiries can be directed to the corresponding author. Copyright © 2021 Haas, Fries, Venkitaraman and Esposito. Revealing mechanisms underpinning cell function requires understanding the relationship between different biochemical reactions in living cells. However, our capabilities to monitor more than two biochemical reactions in living cells are limited. Therefore, the development of methods for real-time biochemical multiplexing is of fundamental importance. Here, we show that data acquired with multicolor (mcFLIM) or spectrally resolved (sFLIM) fluorescence lifetime imaging can be conveniently described with multidimensional phasor transforms. We demonstrate a computational framework capable of demixing three Forster resonance energy transfer (FRET) probes and quantifying multiplexed biochemical activities in single living cells. We provide a comparison between mcFLIM and sFLIM suggesting that sFLIM might be advantageous for the future development of heavily multiplexed assays. However, mcFLIM—more readily available with commercial systems—can be applied for the concomitant monitoring of three enzymes in living cells without significant losses. Gates Foundation studentship; Medical Research Council core grants (MC_UU_12022/1 and MC_UU_12022/8); Wellcome Trust (090340/Z/09/Z); Cancer Research UK (C54674/A27487).

Background Efficacy and safety of ustekinumab for the treatment of Ulcerative colitis (UC) has been demonstrated in phase III clinical trials, but real world data are scarce. The aim of this study was to assess effectiveness and safety of ustekinumab in an Italian cohort of UC patients. Methods Data of patients with UC who started using ustekinumab were collected. Primary endpoint was steroid-free clinical remission at 24 and 52 weeks of therapy. Secondary endpoints were: treatment response, endoscopic remission, treatment persistence at 12 months and safety. Results A total of 68 patients (males 63.2 %; mean age (SD) 31 years (14.5)) were included. All patients were biologics experienced. At 24 and 52 weeks, 32 % and 50 % of patients achieved steroid-free clinical remission, 85% and 81% had clinical response, respectively. (Table 1) At the end of follow-up there were a significant reduction of pMS from baseline (p Conclusion Data from our small real-life cohort of treatment-refractory UC patients suggest satisfactory effectiveness of ustekinumab and an excellent safety. More data assessing mucosal healing after one year of treatment are needed

Background The efficacy of Ustekinumab (UST) on Crohn’s disease (CD) associated spondyloarthropathy (SpA) was evaluated neither in randomized controlled trials nor in real-world studies. Web-based data from the cohort of the Sicilian Network for Inflammatory Bowel Disease (SN-IBD) were extracted to perform a multicentre, real-world assessment of the effectiveness of UST on CD-associated SpA Methods All consecutive CD patients with active SpA at the initiation of the treatment with UST from January 2019 (the date on which the drug became available for clinical practice in Sicily) to August 2019 were extracted from the SN-IBD cohort. The study outcomes were evaluated at 8 and 24 weeks. The primary outcome was the articular response, defined as the disappearance of objective signs of arthritis (swelling and/or articular stiffness) and resolution of pain. As ancillary end-points, the clinical response (reduction of Harvey-Bradshaw Index ≥ 3 compared with baseline with a concomitant reduction of at least ≥ 50% of steroid dosage compared with baseline) and the steroid-free remission (Harvey-Bradshaw Index < 5 without steroids use) were assessed. Results Out of 131 total patients treated with UST, 30 consecutive patients (22.9%) had active SpA at baseline (axial SpA: 3/30; peripheral SpA: 18/30; axial plus peripheral SpA: 9/30). After 8 weeks, 10 patients (33.3%) reported an articular response [0/3 patients with axial SpA, 7/18 patients (38.9%) with peripheral SpA, and 3/9 patients (33.3%) with axial and peripheral SpA]. After 24 weeks, 13 patients (43.3%) had an articular response [0/3 patients with axial SpA, 10/18 patients (55.5%) with peripheral SpA, and 3/9 patients (33.3%) with axial and peripheral SpA]. None of these 13 responders was taking systemic steroids at 24 weeks. The concomitant presence of a clinical response on intestinal symptoms was associated with the articular response at 24 weeks at univariable analysis (OR 5.14, CI 1.09-32.70, p=0.038). Conclusion UST obtained a response on articular symptoms in nearly half of the patients with CD and active SpA at baseline after 24 weeks. The rate of response was higher in case of peripheral arthropathy. The articular response was associated with the clinical response on intestinal symptoms.

Hintergrund: Es werden erste Ergebnisse einer multizentrischen Studie zur Evaluation der nachhaltigen Effekte in der wohnortnahen ambulanten Neuro-Rehabilitation unter besonderer Berucksichtigung des sozialgesetzlich verankerten Rehabilitationsauftrages zu Teilhabe und selbstbestimmter Lebensfuhrung beschrieben. Methodik: In einer multizentrischen Beobachtungsstudie wurden in 17 ambulanten neurologischen Rehabilitationseinrichtungen Rehabilitanden nach Schlaganfall oder Schadel-Hirn-Trauma zu 4 Messzeitpunkten (zu Beginn, am Ende sowie 4 und 12 Monate nach der ambulanten NeuroReha) schriftlich befragt. Zusatzlich erfolgte eine Fremdeinschatzung des Patientenstatus zu Beginn und am Ende der Rehabilitationsmasnahme durch behandelnde Arzte. Ergebnisse und Schlussfolgerungen: Die Ergebnisse einer reprasentativen Stichprobe (n=405) aus ambulanten neurologischen Rehabilitationszentren in Deutschland sprechen eindeutig dafur, dass im Rahmen der ambulanten Schlaganfallrehabilitation positive und nachhaltige Effekte im Sinne des sozialrechtlich verankerten Auftrags zu Teilhabe und selbstbestimmter Lebensfuhrung erreicht werden. Die Effekte sind auch noch 12 Monate nach Rehabilitationsende nachweisbar. Zwischen den erhobenen Outcomeparametern zeigen sich einige Unterschiede. Die Ergebnisse zeigen zahlreiche klinische Implikationen auf.

Hintergrund: Die Beachtung des Konstrukts Resilienz als psychische Widerstandsfahigkeit, erscheint im Kontext der Neurorehabilitation vielversprechend. Resilienz stellt dabei einen Kontextfaktor dar, der sich auf das Reha-Outcome und die Teilhabe am Leben in der Gesellschaft auswirkt. Zur Erfassung von Resilienz als Personlichkeitsmerkmal steht z. B. die Kurzform der Resilienzskala (RS-13) von Schumacher et al. zur Verfugung und besitzt akzeptable bis gute psychometrische Eigenschaften. Bislang gibt es kaum Forschung zu Resilienz in der Neurorehabilitation sowie zum Einsatz der Resilienzskala bei neurologischen Patienten. In der hier berichteten Untersuchung sollte untersucht werden, ob sich die RS-13 in psychometrischer Hinsicht auch fur den Einsatz in der ambulanten neurologischen Rehabilitation eignet. Methodik: Die RS-13 wurde innerhalb einer multizentrischen Beobachtungsstudie mit langsschnittlichem Design in 17 ambulanten neurologischen Rehabilitationseinrichtungen eingesetzt. Die RS-13 kam in den ersten beiden Messzeitpunkten zum Einsatz, da dies zur Beantwortung der Fragestellung hinreichend erschien. Ergebnisse und Schlussfolgerungen: Insgesamt sprechen die vorliegenden Ergebnisse der Daten von insgesamt 396 Rehabilitanden dafur, dass die RS-13 mit akzeptablen psychometrischen Eigenschaften auch in der ambulanten neurologischen Rehabilitation eingesetzt werden kann. Es zeigen sich hohe statistische Assoziationen sowohl zu verschiedenen Kontext- als auch Outcomevariablen. Inhaltlich sprechen die Ergebnisse eher fur die Nutzung der Gesamtskala als die von den Testautoren vorgeschlagene 2-faktorielle Struktur. Eine fruhzeitige Erfassung und Berucksichtigung von Resilienz konnte in der Therapiesteuerung den rehabilitativen Prozess durch einen zielfokussierenden Ressourceneinsatz sinnvoll erganzen. Vielversprechend erscheinen aufgrund von Assoziationen mit dem Reha-Outcome zudem therapeutische Interventionen, die auf eine Veranderung der Resilienz im Sinne der Selbstakzeptanz abzielen.

Fluorescence lifetime sensing enables researchers to probe the physicochemical environment of a fluorophore providing a window through which we can observe the complex molecular make-up of the cell. Fluorescence lifetime imaging microscopy (FLIM) quantifies and maps cell biochemistry, a complex ensemble of dynamic processes. Unfortunately, typical high-resolution FLIM systems exhibit rather limited acquisition speeds, often insufficient to capture the time evolution of biochemical processes in living cells. Here, we describe the theoretical background that justifies the developments of high-speed single photon counting systems. We show that systems with low dead-times not only result in faster acquisition throughputs but also improved dynamic range and spatial resolution. We also share the implementation of hardware and software as an open platform, show applications of fast FLIM biochemical imaging on living cells and discuss strategies to balance precision and accuracy in FLIM. The recent innovations and commercialisation of fast time-domain FLIM systems are likely to popularise FLIM within the biomedical community, to impact biomedical research positively and to foster the adoption of other FLIM techniques as well. While supporting and indeed pursuing these developments, with this work we also aim to warn the community about the possible shortcomings of fast single photon counting techniques and to highlight strategies to acquire data of high quality.

Personbezogene Kontextfaktoren spielen eine wichtige Rolle in der Konzeption der Internationalen Klassifikation der Funktionsfahigkeit, Behinderung und Gesundheit (ICF). Die Weltgesundheitsorganisation hat die personbezogenen Faktoren der ICF noch nicht fur die weltweite Nutzung klassifiziert, obwohl auch diese Faktoren eine positive wie negative Wirkung auf die Funktionsfahigkeit eines Menschen haben konnen. Die Arbeitsgruppe ICF des Fachbereichs „Praktische Sozialmedizin und Rehabilitation“ der Deutschen Gesellschaft fur Sozialmedizin und Pravention (DGSMP) hat 2010 einen Entwurf fur eine Klassifizierung personbezogener Faktoren vorgelegt, der 72 Kategorien in 6 Kapiteln ordnet. In Erganzung dazu verfolgt das vorliegende Positionspapier das Ziel, die Diskussion uber die vierte Komponente der ICF anzuregen, zu einem breiten und gemeinsamen Verstandnis des Wesens der personbezogenen Faktoren beizutragen und den Dialog hierzu mit allen in Gesundheitsberufen tatigen Personen sowie Menschen mit oder ohne Gesundheitsproblem zu vertiefen, um eine umfassende Sicht auf den Gesundheitszustand zu fordern.

Hintergrund: Instrumente zur Erfassung von gesellschaftlicher Teilhabe sind im deutschen Sprachraum kaum verfugbar und wurden bislang nur vereinzelt in empirischen Arbeiten eingesetzt. Der 2005 entwickelte Index zur Messung von Einschrankungen der Teilhabe (IMET) misst indikationsubergreifend das in der Internationalen Klassifikation der Funktionsfahigkeit, Behinderung und Gesundheit (ICF) formulierte Konstrukt Teilhabe bei Personen mit unterschiedlichen chronischen Krankheiten. Der IMET wurde neben zahlreichen weiteren Instrumenten in einer eigenen Studie eingesetzt und mit Daten einer vergleichbaren, unveroffentlichten Studie verglichen. Neben der Uberprufung der Eignung des IMET wurden die Effekte in der ambulanten Neurorehabilitation untersucht und mit Ergebnissen aus einem stationaren Setting verglichen. Methode: In einer multizentrischen Beobachtungsstudie wurden konsekutiv Patienten aus 6 ambulanten Neurorehazentren zu drei Messzeitpunkten (zu Beginn, am Ende und vier Monate nach der Reha) schriftlich befragt. Zusatzlich erfolgte eine Fremdeinschatzung zu Beginn und am Ende der Reha. Zum Vergleich der eigenen Daten wurden Daten einer stationar behandelten Stichprobe bereitgestellt. Ergebnisse: IMET scheint das derzeit im deutschen Sprachraum am besten geeignete Instrument zur globalen, ICF-basierten und okonomischen Erfassung von Teilhabe zu sein. Vor allem auf den Skalen Teilhabe, Allgemeiner Gesundheitszustand sowie Leistungsfahigkeit in Alltag und Freizeit wurden die grosten Verbesserungen verzeichnet. Im Vergleich zur stationaren Stichprobe verbessert sich lediglich die Teilhabesituation der ambulanten Rehabilitanden. Teilhabeorientierte ambulante Neurorehabilitation scheint sich im Ergebnis in erster Linie positiv auf die Teilhabe und assoziierte Parameter auszuwirken.

Die Deutsche Gesellschaft fur Neurowissenschaftliche Begutachtung, damals noch Arbeitsgemeinschaft neurologische Begutachtung, hat 2005 gemeinsam mit anderen Fachgesellschaften erstmals eine Leitlinie zur Begutachtung nach gedecktem Schadel-Hirntrauma erarbeitet und publiziert 1 . In der Zwischenzeit hat es weitreichende Fortschritte in der Bildgebung, aber auch z. B. in der neuropsychologischen Diagnostik gegeben. Diese machten eine Uberarbeitung der Leitlinie notwendig, die hier vorgestellt wird. Zwischenzeitlich ist der Umgang mit Leitlinien in Deutschland systematisiert worden, sodass die neue Version der Leitlinie im Leitlinienregister der Arbeitsgemeinschaft Medizinischer Fachgesellschaften angemeldet wurde und dort publiziert werden soll.

International audience; The healing of the intestine is becoming an important objective in the management of inflammatory bowel diseases. It is associated with improved disease outcome. Therefore the assessment of this healing both in clinical studies and routine practice is a key issue. Endoscopy for the colon and terminal ileum and computerized tomography or magnetic resonance imaging for the small bowel are the most direct ways to evaluate intestinal healing. However, there are many unsolved questions about the definition and the precise assessment of intestinal healing using these endoscopic and imaging techniques. Furthermore, these are relatively invasive and expensive procedures that may be inadequate for regular patients' monitoring. Therefore, biomarkers such as C-reactive protein and fecal calprotectin have been proposed as surrogate markers for intestinal healing. Nevertheless, the sensitivity and specificity of these markers for the prediction of healing may be insufficient for routine practice. New stool, blood or intestinal biomarkers are currently studied and may improve our ability to monitor intestinal healing in the future.

Rehabilitation plays a central role in the treatment of neurological diseases. The enormous progress in neurosciences sets a major challenge for restorative neurology. Because of the demographic development in Germany with increasing numbers of old-aged people, also the number of age-related neurological diseases will increase. Thus, inpatient and outpatient neurological rehabilitation facilities must be generally available in order to achieve community integration for those affected. In a shift of paradigms German social laws stipulate now that participation in social life has to be the goal of all rehabilitation efforts rather than functional improvement alone. Correspondingly, new structural option have to be offered. It seems important to implement rational, evidence-based treatment and to adopt known community-based integration strategies in order to meet the high targets set by the official health policy. The current economic competition between rehabilitation suppliers should not undermine these goals by means of a "rehabilitation light”.

The SGB IX, book 9 of the German social code (Sozialgesetzbuch, SGB), which is the legal basis of rehabilitation in Germany, states "participation and self-determined conduct of life" as the ultimate ambition of rehabilitation. This concept of participation and disability is based on the WHO model expressed in the International Classification of Functioning, Disability and Health (ICF). In this model, participation after the onset of a health problem may not only be infringed by disturbances in body functions and structures and the resulting activity limitations but also by contextual factors such as environmental and personal factors. In an outpatient neurological rehabilitation centre we prospectively rated for 49 patients the influence of these contextual factors as well as of objectively assessed functional/activity limitations on the overall disability. On average, functional/activity limitations were rated as contributing 58.4% (SD=17.2%), personal factors 26.4% (SD=12.7%) and environmental factors 15.1% (SD=11.2%) to the overall disability. The functional/activity limitations closely matched the expected limitations based on the underlying brain lesions. The degree of disability based on contextual factors was not related to activity limitations based on disturbances of body functions and structures. Also, demographic variables such as age, sex or chronicity were not significantly linked to contextual factors. Since contextual factors together contributed 41.6% (SD=17.2%) to the overall disability they have major relevance for the rehabilitation process, because they essentially decide on the extent to which abilities acquired by the rehabilitant during rehabilitation actually be transfered to his everyday life. Therefore, rehabilitation programmes need to include assessment and treatment of contextual factors. It hence is necessary to develop instruments to quantify contextual factors.

Die Anhedonie als Kardinalsymptom der Depression lasst sich in neurobiologischen Modellvorstellungen als Folge einer Transmitterdysbalance vor allem des dopaminergen Verstarkungssystems verstehen. Die zugrunde liegenden frontobasal gelegenen neuroanatomischen Strukturen schliesen auch Orte der zentralen Riechverarbeitung mit ein. Daraus entwickelte sich die Frage, ob sich die Anhedonie experimentell erfassen und quantifizieren lasst, indem depressiv Erkrankte Duftreize hedonisch bewerten. Die Verarbeitung von Duftreizen wurde bei 16 Depressiven im Vergleich zu einer gesunden altersgematchten Kontrollgruppe experimentell uberpruft, bei funf Patienten als Langsschnittuntersuchung in Depression und in Remission. Im Gruppenvergleich finden sich die olfaktorischen Wahrnehmungsschwellen ebenso wie die Intensitatsbewertung nicht signifikant unterschiedlich. Die hedonische Bewertung der Testdufte zeigt sich nicht signifikant verschieden. Eine Paarvergleich-Praferenz-Aufgabe ergibt keine Gruppenunterschiede fur die intrahemispharische hedonische Bewertung in Konsistenz der Rangbildung und Duftpaarvertauschungen. Die Beurteilung von Hedonik, Intensitat und Vertrautheit der Testdufte ergibt keine signifikanten Unterschiede zwischen den Gruppen. Auch in der Langsschnittuntersuchung zeigen sich keine Unterschiede in der sensorischen Wahrnehmung und der hedonischen Bewertung von Duftreizen sowohl zwischen dem Zustand Depression und Remission als auch im Vergleich zur gesunden Kontrollgruppe. Die komplexen Veranderungen, die Depression mit dem Kardinalsymptom Anhedonie als Ausdruck einer Storung des dopaminergen Verstarkungssystems verursachen, haben offensichtlich keinen Einfluss auf die primare olfaktorische Sinnesleistung und die zentrale Bewertung der Dufte. Anhedonie muss daher als ein komplexes Konstrukt weiterer zentraler Verarbeitung gesehen werden, die sich noch nicht in der hedonischen Bewertung von Sinnesreizen abbildet.

Background: Despite the role of metacognition in psychopathology, no studies have explored this construct in the area of gastrointestinal disorders. Moreover, for many times there was a categorization between organic and functional gastrointestinal disorders. The aim of this study was to compare dysfunctional metacognitive beliefs between patients with functional bowel disorders and patients with organic bowel disorders. The purpose of this work was also to examine the relations between metacognitions, alexithymia and symptoms of the patients on the basis of diagnosis. Methods: A between-subject non parametric and correlational design was employed. We formed three clinical groups from a population of patients with gastrointestinal disorders and on the basis of the ‘organic’ and ‘functional’ diagnosis. All the participants underwent the Metacognitions Questionnaire 30, the Toronto Alexithymia Scale-20 and the Gastrointestinal Symptom Rating Scale. Results: There were no significant differences between the three clinical groups on MCQ-30 and TAS-20 scores. However, there were significant correlations based on diagnosis of the gastrointestinal disorder between alexithymic features and metacognitive dysfunctional beliefs. Conclusions: Our results underline the role of metacognitions for both patients with organic and functional gastrointestinal disorders. Moreover, the results highlight the importance to consider these aspects in patients with organic gastrointestinal disorder. Keywords: alexithymia; Crohn’s disease; IBS; metacognition; ulcerative colitis., Mediterranean Journal of Clinical Psychology, Vol 2, No 1 (2014)

Objective: Impaired quality of life (QOL) in patients with ulcerative colitis (UC) may be a prominent feature of the disease, and in some cases, may become an indication for surgical treatment. The objective of this study was to assess QOL in patients who underwent proctocolectomy with ileo-anal anastomosis with a J pouch for severe UC and to compare it with patients with UC of different severity who were under medical treatment. Methods: We used a validated, disease-specific research instrument (a 29 item, self-administered questionnaire) that examines the following four functions: intestinal (score 0–24) and systemic symptoms (0–21), and emotional (0–27) and Social Function (0–15). High scores indicate an impairment of the function examined and the sum of the four scores (maximal total score = 87) reflects the patient's QOL. We studied 29 operated patients (22 men, mean age 35 yr, mean time after intervention 3.8 yr) and compared their scores with those of 57 UC patients (39 men, mean age 36 yr) with different degrees of disease activity, and with those of 72 healthy controls (38 men, mean age 31 yr). Results: In UC, scores were significantly higher than in controls, increasing with the severity of the disease. Even patients in remission had higher scores than controls in the “systemic” (4.6 vs. 2.0) and emotional (5.6 vs. 2.5) functions. Patients who underwent surgical treatment had much better scores than patients with severe disease (total score 20.1 vs. 38.2), with values comparable to those of patients in remission or with mild disease activity. There was no significant gender difference, either for UC and ileo-anal anastomosis patients, or in healthy controls. Conclusion: In patients with UC, even in remission, there is a measurable impairment of QOL, which increases with the severity of disease. Operated patients have a QOL that is comparable to that of patients in remission or with mild disease, and proctocolectomy with ileo-anal anastomosis may restore an acceptable QOL in patients with moderate/severe UC.

Personal contextual factors play an essential part in the model of the International Classification of Functioning, Disability and Health (ICF). The WHO has not yet classified personal factors for global use although they impact on the functioning of persons positively or negatively. In 2010, the ICF working group of the German Society of Social Medicine and Prevention (DGSMP) presented a proposal for the classification of personal factors into 72 categories previously arranged in 6 chapters. Now a positioning paper has been added in order to stimulate a discussion about the fourth component of the ICF, to contribute towards a broader and common understanding about the nature of personal factors and to incite a dialogue among all those involved in health care as well as those people with or with-out health problems in order to gain a comprehensive perspective about a person's condition.

BACKGROUND & AIMS: Hepatobiliary complications occur in inflammatory bowel disease and may be caused by the translocation of intestinal toxins from portal blood into bile through leaky hepatocyte tight junctions. The role of tight junctions in the pathogenesis of hepatobiliary complications in experimental inflammatory bowel disease was investigated. METHODS: Colitis was induced in rats by intracolonic instillation of trinitrobenzene sulfonic acid. The function of hepatocellular tight junctions was evaluated in perfused livers by measuring early (paracellular) horseradish peroxidase excretion into the bile and by electron microscopy and semiquantitative analysis of lanthanum penetration through the tight junction and into bile canaliculi. Immunofluorescent localization of cingulin and ZO-1 was used to study the structure of hepatocyte junctions. RESULTS: Colitis was associated with increased serum bilirubin and bile acid concentrations, a 2.5-fold increase in paracellular biliary excretion of horseradish peroxidase, and a ninefold increase in lanthanum permeability. Liver histology and cingulin and ZO-1 localizations were similar to normal liver. CONCLUSIONS: Experimental colitis is associated with hepatobiliary complications and an increased hepatocyte tight junctional permeability to horseradish peroxidase and lanthanum. Subtle alterations in tight junction function may be involved in the pathogenesis of hepatobiliary injuries in inflammatory bowel disease. (Gastroenterology 1997 Oct;113(4):1347-54)

Ammonia has a key role in the development of hepatic encephalopathy (HE). In the brain, glutamine synthetase (GS) rapidly converts blood-borne ammonia into glutamine which in high concentrations may cause mitochondrial dysfunction and osmolytic brain edema. In astrocyte-neuron cocultures and brains of healthy rats, inhibition of GS by methionine sulfoximine (MSO) reduced glutamine synthesis and increased alanine synthesis. Here, we investigate effects of MSO on brain and interorgan ammonia metabolism in sham and bile duct ligated (BDL) rats. Concentrations of glutamine, glutamate, alanine, and aspartate and incorporation of 15NH4+ into these amino acids in brain, liver, muscle, kidney, and plasma were similar in sham and BDL rats treated with saline. Methionine sulfoximine reduced glutamine concentrations in liver, kidney, and plasma but not in brain and muscle; MSO reduced incorporation of 15NH4+ into glutamine in all tissues. It did not affect alanine concentrations in any of the tissues but plasma alanine concentration increased; incorporation of 15NH4+ into alanine was increased in brain in sham and BDL rats and in kidney in sham rats. It inhibited GS in all tissues examined but only in brain was an increased incorporation of 15N-ammonia into alanine observed. Liver and kidney were important for metabolizing blood-borne ammonia.

To date there is a lack of tools to measure participation and the already existing measures are not properly used as yet. In 2005 the IMET (Index zur Messung von Einschränkungen der Teilhabe) was developed and is able to measure the ICF associated construct participation as a generic instrument in chronic diseases. IMET and numerous instruments were applied in our own study and results were compared with results of an unpublished study. In addition, to test IMET for its use in neurorehabilitation the effects of outpatient neurorehabilitation were investigated and compared with results obtained in an inpatient setting.In a multicentric observational study, consecutively treated patients of 6 outpatient neurorehabilitation centres were asked to fill in a questionnaire at three time points (admission and discharge in the course of rehabilitation and at 4 months follow-up). Additionally, clinical experts were asked to rate the patients' status at admission and discharge. The data were compared with results of a sample of inpatients of an unpublished study.The IMET seems to be the to date best instrument to measure participation in a global, ICF-defined and economic way. Especially participation, general health status and capacity in leisure time and daily routine show the biggest improvements. In comparison, the outpatients show improvements in their participation status. Participation-oriented outpatient neurorehabilitation seems to have a considerable impact on participation status in neurological patients through the course of rehabilitation.

In 2005, the "Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung" (German Society for Neuroscientific Legal Evaluation) together with other Societies published a guideline for the legal evaluation of patients with closed head injuries. Meanwhile, not only scientific progress in imaging techniques but also in other fields such as neuropsychology has necessitated a revision, which is presented here. In the mean time, the handling of guidelines has been systematised in Germany so that a registration with the Cooperation of German Medical Learned Societies is applied for and publication in the German Guideline Registry is expected.

The colon of 32 healthy Sprague-Dawley rats was studied microradiographically. The colonic arterial distribution of 18 rats was examined after injecting barium sulfate into the isolated aorta. The mucosal surface in 9 rats was studied using double-contrast technique after colon explantation. In 5 animals arterial and mucosal studies were carried out simultaneously. The radiographic thickness of the colonic wall was measured using a comparative microscope. The specimens were observed, photographed and examined histologically. Unlike the cecum and distal colon which, when insufflated, do not have mucosal folds, the proximal colon exhibits folds in an oblique direction corresponding to that of the arteries, and the colonic wall in this region is thicker. Comparison between arterial and mucosal microradiographic anatomy and wall thickness enables the proposition of a simple nontopographic division of the rat colon into cecum, proximal colon and distal colon.