National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project.

BACKGROUND: In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program 'Palliative care in Pandemics' (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON). METHODS: Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified. DISCUSSION: For a future "pandemic preparedness" national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.

[Periodontal disease--an additional risk factor for cardiovascular diseases?].

In 1989, a case-control study was published, linking between coronary heart disease and periodontal disease in the studied population. Since then, a number of additional studies, focused the attention to the possible role of dental infections in the pathogenesis of atherosclerosis. Some of these newer cohort studies, are prospective in nature, measuring incidence of the two diseases in large patient populations. The present article reviews these studies, and the proposed mechanisms which might explain the relationships between these two systemically distinct diseases.

Public health and the safety of milk and milk products from sheep and goats.

Goats and sheep rank third and fourth in terms of global milk production from different species, but unlike cow milk, which has stringent hygiene and quality regulations, microbiological standards for the production and distribution of goat milk and sheep milk are more relaxed. Difficulties in managing the sanitary quality of sheep and goat milk derive from a series of factors including the low level of production per head, the milking system, the difficulty involved in machine milking, the conditions under which the herds or flocks are raised, adverse climatic conditions and the spread of production over a wide geographic area. Fresh goat milk is consumed by infants and others with allergies to cow milk and is also used for on-farm manufactured cheese, with or without thermal treatment. The high fat content and peculiar taste of cheeses made from ewe milk are also very popular. These cheese varieties, which are mostly still of 'artisan-type', are not covered by regulatory definitions and the dispute over the use of raw versus pasteurised milk is still alive. However, in documented intoxications recorded after the consumption of cheese, there has always been evidence of incorrect temperature control during pasteurisation, the deliberate addition of raw milk, or contamination during storage. Compositional differences between the milk from cows, ewes and goats (chemical composition of lipids, phosphatase level, freezing point, natural bacterial inhibitor levels, somatic cell count, etc.) preclude the nondiscriminatory use of bovine standards for regulatory purposes. Quality standards adjusted for the specifics of ewe/goat milk should be considered. The production of safe cheese is linked to a series of conditions which ensure consumer health, primarily pasteurisation. In the absence of pasteurisation, all cheeses made from raw milk should be subjected to strict periodic controls.

Feed contamination with Candida krusei as a probable source of mycotic mastitis in dairy cows.

Over 3 months, yeasts were isolated in pure culture from milk samples obtained from 8 lactating cows with acute mastitis and from 1 cow with subacute mastitis. Eight of the isolates were identified as Candida krusei; 1 isolate was not submitted for identification. The affected cows were assigned to separate milking groups and had not been treated by intramammary administration of antibiotic before the outbreak. Remission of disease without treatment was observed, followed by shedding of the yeast in milk for 2 to 5 weeks. Median somatic cell counts in the affected cows before, during, and 2 months after the onset of clinical signs were 93,000; 1,793,000; and 135,000 cells/ml, respectively. Wheat silage was found to be the probable source of the infecting microorganism, whereas inadequate milking hygiene resulted in its persistence in the herd. Following replacement of the silage and improvement of the milking hygiene, the outbreak ceased. Candida krusei thus may cause mastitis in cattle not only following intramammary antibiotic treatment, but also in conditions of heavy environmental contamination, in conjunction with inadequate milking hygiene.

Inhibition of p185c-erbB-2 proto-oncogene expression by antisense oligodeoxynucleotides down-regulates p185-associated tyrosine-kinase activity and strongly inhibits mammary tumor-cell proliferation.

The c-erbB-2 proto-oncogene codes for a 185-kd putative growth factor receptor that is highly homologous to but distinct from the epidermal growth factor (EGF) receptor. Amplification and overexpression of c-erbB-2 occurs in a number of human tumors, in some of which it is a negative prognostic factor. This study investigates the possibility of inhibiting tumor-cell proliferation by blocking c-erbB-2 expression in the human mammary carcinoma cell line SK-Br-3 using chemically modified antisense oligodeoxynucleotides. Expression of the p185c-erbB-2 protein product was selectively reduced within 48 hours and resulted in a growth arrest of SK-Br-3 cells. Biochemical studies of tyrosine-kinase and S6-kinase activities after antisense inhibition of c-erbB-2 show that p185c-erbB-2 activates the S6-kinase signalling pathway in a nonlinear, dose-dependent manner. This may be relevant for the design of therapeutic strategies involving the inhibition of c-erbB-2 (proto)- oncogene expression.

Opposite functions of jun-B and c-jun in growth regulation and neuronal differentiation.

Induction of the jun-B and/or c-jun transcription factors is part of the immediate early response to diverse stimuli that induce alterations in cellular programs. While c-jun is a protooncogene whose expression is required for induction of cell proliferation, jun-B has recently been found to be induced by stimuli inducing differentiation in various cell lines. Furthermore, its expression is largely restricted to differentiating cells during embryogenesis. To determine the functional significance of these findings, we used antisense phosphorothioate oligodeoxynucleotides to inhibit expression of the two genes in proliferating and neuronally differentiating cells. While selective inhibition of c-jun expression reduced proliferation rates, inhibition of jun-B protein synthesis markedly increased proliferation in 3T3 fibroblasts, human mammary carcinoma cells and PC-12 pheochromocytoma cells, suggesting jun-B involvement in negative growth control. Neuronal differentiation of PC-12 cells induced by nerve growth factor (NGF) was prevented by inhibition of jun-B protein synthesis. PC-12 cells not only failed to grow neurites but also remained in the proliferative state. Furthermore, in cultured primary neurons from rat hippocampus, inhibition of jun-B expression, again, markedly reduced morphological differentiation. Conversely, inhibition of c-jun protein synthesis enhanced morphological differentiation of both primary neurons and PC-12 tumor cells. Thus, jun-B expression is required for neuronal differentiation and its balance with c-jun activity is involved in regulating key steps in proliferation and differentiation processes.

Evaluation of Heat Treatment of Turkey Breast Meat by Biochemical Methods.

A biochemical method for the verification of heat treatment of turkey breast meat was developed. The activities of 12 enzymes and residual soluble proteins were studied following heat treatment at various temperatures for different durations. The enzymes aspartate aminotransferase, creatine kinase, malic dehydrogenase, lactic dehydrogenase, isocitric dehydrogenase, and aldolase, showing initial preheating high specific activities, were shown to be valuable markers for the evaluation of heat treatment. Other enzymes, showing low specific activities were of little diagnostic value. Enzyme activities decreased in response to the maximum temperature levels and duration in which the meat was treated. The activities of the enzymes creatine kinase, malic dehydrogenase, lactic dehydrogenase, and isocitric dehydrogenase as well as the residual soluble proteins were shown to be good markers for the evaluation of heat treatment of fresh meat. Soluble residual proteins could also be estimated with commercial test strips. The use of hemoglobin-myoglobin oxidative activity was tried and shown to be a potential test using existing commercial test strips.

Migration of mouse 3T3 fibroblasts in response to a serum factor.

A serum factor that promotes migration of (mouse) 3T3 fibroblast cells is shown to be distinct from the growth-promoting and cell-survival factors of serum. The factor promotes migration of cells from the edge of a wound in confluent 3T3 cells, but cell migration under these conditions does not lead to the initiation of DNA synthesis. Subsequent addition of serum initiates DNA synthesis in the migrating cells. The results establish that breaking contacts between quiescent 3T3 cells is not sufficient to initiate DNA synthesis. The DNA synthesis observed in migrating 3T3 cells in the typical "woundhealing" experiment presumably results because the migrating cells have an increased ability to use serum factors. Serum-factor requirements for "wound healing" in cultured 3T3 cells are discussed.

Serum factor requirements of normal and simian virus 40-transformed 3T3 mouse fibroplasts.

Evidence is presented to show the presence in normal rat serum of four different serum factors essential for growth of 3T3 or SV40-transformed 3T3 mouse fibroblasts: a factor that specifically promotes growth of normal 3T3 cells; two factors that specifically promote growth of transformed 3T3 cells; and a factor that sustains viability of both normal and transformed 3T3 cells in serum-free medium, probably without inducing growth of the cells. These factors are separated and partially purified.