[Psychosocial counseling of skin cancer patients in these times of diagnosis related groups (DRG)]. / Psychosoziale Betreuung von Patienten mit Hauttumoren in Zeiten der Diagnosis Related Groups (DRG).

Patients with skin cancer suffer from very specific distress. Highly distressed patients need an unburdening support, enabling them to develop an active- cognitive coping style. In the past, an approach to psycho-oncological intervention which proved beneficial offered basic support to all patients and additional help to overburdened patients and their relatives. The introduction of the diagnosis related groups (DRG)-a system of all inclusive compensation-has endangered this approach because psychosocial care is not sufficient recognized and reimbursed for by DRG. Within the framework of already implemented structural alterations and focal shifts of content, different approaches to future psycho-oncological care for patients with skin cancer will be presented.

[The validity of the Hornheide questionnaire for psychosocial support in skin tumor patients: a survey in an Austrian and German outpatient population with melanoma]. / Die Validität des Hornheider Fragebogens zur psychosozialen Unterstützung bei Tumorpatienten. Eine Untersuchung an zwei repräsentativen ambulanten Stichproben von Melanompatienten.

Tumour patients are subject to different degrees of psychosocial distress depending on the course of disease, personality variables and amount of social support available. Often patients do not spontaneously talk about their distress and attending physicians fail to detect it. Therefore, it is important that the presence of distress is ascertained by specific screening instruments so that appropriate supportive measures can be instituted. The Hornheide Questionnaire (HQ) employed for investigating the need for psychosocial support in the case of patients with skin tumours and with tumours in the head and neck region represents such a specific screening instrument. The present study investigates the validity of the HQ on the basis of two representative samples from two different University Clinics for treatment and follow-ups of melanoma patients. With the help of the HQ, 215 patients at the Dermatology Out-patient Unit of the University of Innsbruck and 223 patients at the University of Freiburg were investigated with regard to their subjective experience of distress. The external constructive validity criteria were established on the basis of the Freiburg Questionnaire of Disease-Coping, the questionnaire of social support and Beck's Depression Inventory. There were significant differences between individuals in the severity of distress in different age groups and in patients in different tumour stages. The internal consistency of the HQ and its subscales proved to be satisfactory demarcation from other psychosocial dimensions and an adequate correlation with similar dimensions (depression, depressive illness coping, social support, compliance). The HQ appears to be an economical and valid screening instrument for detecting the need for psychosocial support in melanoma patients in the out-patient follow-up stage.

[Need for psychosocial management of facial and skin tumor patients]. / Psychosozialer Betreuungsbedarf bei Gesichts- und Hauttumorpatienten.

Starting from the current level of research on the amount and detection of support requirements of tumour patients a lack of practicable screening instruments in psychooncology becomes evident for valid and reliable identification of highly distressed patients in order to offer them treatment-integrated specific interventions. The following report bases on the results of a research project with facial and skin cancer patients and so closes the gap. Patients in need of support can be identified by means of the "Hornheide Questionnaire", developed for this purpose. The support requirement is ascertained by a connexion of a patient self-assessment and an expert-defined cut-off point. Extensive data concerning support requirements and indications are presented and discussed.

[Therapy studies in dermatologic oncology. Recommendations for patient education]. / Therapiestudien in der dermatologischen Onkologie. Empfehlungen für das Aufklärungsgespräch mit dem Patienten.

Guidelines of good clinical practice regulate controlled clinical studies. Goal of the study, type of treatment and possible side effects have to be explained. The physician faces problems, if the study includes a "no treatment group". Referring to the literature and based on our own experience with tumor patients, several criteria are proposed to optimize the recruitment of patients. Important points are: Explanations should be given by an experienced doctor. He must be informed about the study and therapeutic alternative treatments. The atmosphere for the talk must be quiet. The participation of a person whom the patient trusts is desirable. The necessity of the study must be explained. Randomization in different study groups should be discussed without any preference. Prognosis should be explained without any detailed statistical data. Form of treatment, possible side effects and control examinations have to be discussed. The family physician's cooperation should be stressed. Personal autonomy in the patient's decision to participate in the study must be emphasized. Enough time for reflection must be granted before the final decision. It must be assured that the patient receives the same medical attention even after rejecting the study. These recommendations might help to avoid major mistakes which are harmful for the doctor-patient-relationship and further tumor therapy. A good initial discussion forms the basis for effective cooperation during tumor treatment. It may counteract the personal fear and negative reports in media of being "a guinea pig". The patient will appreciate the efforts of the doctor to provide optimal therapy. Furthermore, he will realize that such studies are necessary to improve future therapies.

Infections with various types of organisms stimulate transcription from a short promoter fragment of the potato gst1 gene.

By histochemical GUS staining, we demonstrate that transcription from a short promoter fragment of the potato gst1 gene is locally induced after infection of a host plant with various types of pathogenic or symbiotic organisms. This regulatory unit is not active in noninfected tissues, except root apices and senescing leaves. Measuring the expression of a fusion between the promoter fragment and the gus gene in transgenic plants, therefore, allows comparison of the induction of defense reactions in different types of plant-microbe interactions, in one and the same plant.

Pathogen-defence gene prp1-1 from potato encodes an auxin-responsive glutathione S-transferase.

Genetic studies have previously implicated the prp1 gene family in the defence of potato against infection with the late blight fungus Phytophthora infestans. Here, we show that the concentrations of PRP1 mRNA as well as protein rapidly increase in potato leaves after fungal infection and stay at high levels during an extended period of the infection cycle. After separation of subcellular components by differential centrifugation, PRP1 protein was identified in the cytosolic fraction. Expression studies with chimeric promoter/beta-glucuronidase gene constructs in transgenic potato plants provided evidence that transcription of the prp1-1 gene, representing one member of the prp1 gene family, is at least partly responsible for the accumulation of PRP1 mRNA and protein upon fungal infection. After expression of the prp1-1-coding sequence in Escherichia coli, the corresponding 26-kDa protein exhibited glutathione S-transferase activity with Km values of 9.8 mM and 0.11 mM for the artificial standard substrate 1-chloro-2,4-dinitrobenzene and glutathione, respectively. Photoaffinity labeling of the protein with tritiated 5-azido-indole-3-acetic acid suggested that the phytohormone indole-3-acetic acid or a structurally related compound serve as a regulator or substrate of the prp1-1 encoded glutathione S-transferase. This assumption was further supported by the inhibitory effect of the phytohormone on the enzyme activity in vitro. The implications of these findings for a potential involvement of indole-3-acetic acid in the control of defence reactions are discussed.

Promoter sequences of a potato pathogenesis-related gene mediate transcriptional activation selectively upon fungal infection.

Transcription of at least one member of the potato prp1 gene family, prp1-1, is activated at early stages of potato infection with the late blight fungus Phytophthora infestans. In this paper we present evidence that mRNA encoded by prp1-1 does not accumulate in response to abiotic environmental cues which stimulate transcription of other defence-related genes. Regulatory elements were identified in the 5' terminal region of prp1-1 by assaying the expression pattern of chimeric promoter/beta-glucuronidase gene constructs in transgenic potato. A 273 bp fragment comprising the promoter sequence between positions -402 and -130 was sufficient for rapid and strictly localized transcriptional activation at infection sites during the development of late blight disease. Like the native promoter, this truncated promoter did not mediate transcriptional activation in response to other abiotic stimuli. The use of the identified regulatory region to generate conditional mutations selectively at infection sites is discussed.

[Quality of life of patients with malignant facial and skin tumors--development of a questionnaire and initial findings of a study]. / Lebensqualität von Patienten mit bösartigen Gesichts- und Hauttumoren--Entwicklung eines Fragebogens und erste Ergebnisse einer Studie.

Assisted by Deutsche Krebshilfe, the German cancer aid fund, a questionnaire for assessment of quality of life in patients with life-threatening skin tumours and disfiguring tumour sequels was developed at Fachklinik Hornheide between 1986 and 1988. A first step toward determining quality of life and for enhancing treatment-integrated rehabilitative work is the assessment of the subjective distress and problems experienced due to the illness and its treatment. This is the objective of the Hornheider Fragebogen, a questionnaire developed in the framework of the study on the basis of extensive literature search, structured interviews with patients and treating staff. This self-assessment instrument was answered by 131 patients with malignant tumours of the skin, twice during in-patient treatment and a third time some 6 months after discharge. Statistical analysis of the data collected proved the questionnaire to be valid, reliable and practicable. Additionally, it has been possible to draw up a number of significant results of immediate relevancy. It turned out that persons who are unemployed, divorced, or married but separated, as well as persons without school leaving certificate, experienced greater distress and more problems in many dimensions than the other respondents. The questionnaire was viewed as meaningful and as helpful by the patients in order to voice unspecific anxiety and questions. Also, the study entailed positive implications for our rehabilitative work already in this initial testing phase, by enabling us to give more specific support to the patients. The Hornheider Fragebogen, after review and abridgment, consists of 27 problem-oriented questions relating to eight dimensions of life.

Structural analysis and activation by fungal infection of a gene encoding a pathogenesis-related protein in potato.

The structure, genomic organization, and temporal pattern of activation of a gene encoding a pathogenesis-related protein (PR1) in potato (Solanum tuberosum) have been analyzed. The gene is rapidly activated in leaves from the potato cultivar Datura, containing the resistance gene R1, in both compatible and incompatible interactions with appropriate races of the late-blight fungus Phytophthora infestans. Activation is also observed in leaves treated with fungal elicitor. The gene occurs in multiple, very similar copies and encodes a polypeptide (Mr = 25,054; pI = 5.5) that is classified as a PR protein by several criteria. Small fragments with great sequence similarity to portions of the two exons were found closely linked to the expressed gene, which altogether represents a simple case of genome organization in potato. The coding sequence of the prp1 gene and the deduced amino acid sequence are strikingly similar to the corresponding sequences of a 26-kDa heat shock protein from soybean.

Characterization of nodule-specific cDNA clones from Sesbania rostrata and expression of the corresponding genes during the initial stages of stem nodules and root nodules formation.

We have constructed a Sesbania rostrata stem nodule-specific cDNA library. By screening with heterologous probes from pea and soybean, we have isolated several nodulin cDNA clones. On the basis of nucleotide and amino acid sequence homology, two nearly full-length cDNA clones coding for two different leghemoglobin-like proteins have been identified. The inserts of two other clones reveal a high degree of amino acid sequence homology (81% and 72%) to the early nodulin Enod2 from soybean; the characteristic heptapeptide repeat units PPHEKPP and PPYEKPP of the soybean Enod2 are conserved in the proteins encoded by these Sesbania cDNA clones. The time course of Enod2 and leghemoglobin mRNA appearance during the formation of stem nodules and root nodules on S. rostrata was analyzed by northern blot hybridization. Significant differences were found for the initiation of mRNA accumulation of these nodulins between S. rostrata and soybean.

The Pea rbcS-3A Promoter Mediates Light Responsiveness but not Organ Specificity.

The expression of the pea rbcS-3A gene is responsive to light and restricted to chloroplast-containing cells. Previously, we identified transcriptional elements between -410 and -50 relative to the transcription start site as being sufficient for this regulated expression. Here we investigate the role of the promoter region (-50 to +15) in rbcS-3A expression. We demonstrate an interaction between the promoter and upstream sequences located between -189 and -166, which is important for high level expression. In addition we show that, when the rbcS promoter is driven by a weak test enhancer, it can confer light-responsive but not organ-specific expression upon a bacterial reporter gene.

Artificial combination of two cis-regulatory elements generates a unique pattern of expression in transgenic plants.

We show that a 36-base-pair-long upstream fragment from the soybean hsp17.3-B gene comprising two partly overlapping heat-shock element (HSE)-like sequences can confer heat inducibility to a reporter gene in transgenic tobacco. The heat-shock response does not display organ specificity and is not affected by light. Insertion of these HSE-like elements into the pea rbcS-3A 5' flanking fragment (position -410 to +15) either at position -410 (5' to the enhancer) or at position -49 (between the enhancer and the "TATA" box) renders the transcript level of the reporter gene light-inducible and organ-specific under heat-shock conditions. These results demonstrate the possibility of generating a unique pattern of expression (e.g., light-dependent and organ-specific heat-shock response) by artificial combination of appropriate cis-acting regulatory elements. Moreover, by using the HSE-like sequences as a weak heat-inducible enhancer in the chimeric regulatory regions we uncover the function of negative elements within the pea rbcS-3A upstream region. These negative elements are responsible for a repressed transcript level in roots as well as in dark-adapted leaves. Therefore, the upstream fragment containing two HSE-like elements can be considered a useful tool to test the function of other cis-acting elements.

The region distal to the rRNA operon from chloroplasts of maize contains genes coding for tRNA(Arg)(ACG) and tRNA (Asn)(GUU).

The nucleotide sequence distal to the rRNA operon from maize chloroplasts has been analyzed. It contains genes coding for tRNA(Arg)(ACG) and tRNA(Asn)(GUU). The tRNA(Arg)(ACG) gene, which is separated from the last rRNA gene of the rRNA operon, the 5S rDNA, by an intergenic region of 252 bp, has the same orientation as the rRNA operon. By S1 and primer extension mapping, the existence of transcripts from the entire 5S rDNA/tDNA(Arg)(ACG) intergenic region can be demonstrated. It is, therefore, concluded that tRNA(Arg)(ACG) represents a trailer tRNA which is cotranscribed with 5S rRNA as part of the primary rRNA transcript. The tDNA(Asn)(GUU), which is separated from tDNA(Arg)(ACG) by an intergenic region of 253 bp, has the opposite orientation with respect to the rRNA operon; it, therefore, represents a separate transcriptional unit whose promoter remains to be located. It is proposed that the two tRNA genes possess a common terminator region, which functions in both directions of transcription.

Identification of an rRNA operon promoter from Zea mays chloroplasts which excludes the proximal tRNAValGAC from the primary transcript.

The transcriptional start site of the tRNA operon from Zea mays chloroplasts has ben identified by a combination of S1 mapping and Southern hybridization with in vitro capped chloroplast RNA as radioactive probe. This is the first example in which the transcriptional start site of a chloroplast gene has ben established by identification of the triphosphate-bearing RNA terminus. The start site is located at position -117 proximal to the 16S rRNA gene and is preceded by -10 and -35 sequences homologous to prokaryotic promoters. The primary transcript directed by this promoter does not include tRNAValGAC sequences which are coded further upstream between positions -302 and -231. A major processing site of the primary rRNA transcript was identified at position -30 which is embedded in a secondary structure typical for prokaryotic RNase III processing sites. Several putative processing and start sites of the tRNAValGAC transcripts have been mapped by primer extension with reverse transcriptase.

Cotranscription and processing of 23S, 4.5S and 5S rRNA in chloroplasts from Zea mays.

The termini of rRNA processing intermediates and of mature rRNA species encoded by the 3' terminal region of 23S rDNA, by 4.5S rDNA, by the 5' terminal region of 5S rDNA and by the 23S/4.5S/5S intergenic regions from Zea mays chloroplast DNA were determined by using total RNA isolated from maize chloroplasts and 32P-labelled rDNA restriction fragments of these regions for nuclease S1 and primer extension mapping. Several processing sites detectable by both 3' and 5' terminally labelled probes could be identified and correlated to the secondary structure for the 23S/4.5S intergenic region. The complete 4.5S/5S intergenic region can be reverse transcribed and a common processing site for maturation of 4.5S and 5S rRNA close to the 3' end of 4.5S rRNA was detected. It is therefore concluded that 23S, 4.5S and 5S rRNA are cotranscribed.

[Rehabilitation of patients with facial and skin disfigurement using behavior therapy desensitization in swimming pools]. / Rehabilitation von Gesichts- und Hautversehrten durch verhaltenstherapeutische Desensibilisierung im Schwimmbad.

On account of negative reactions encountered in their social environment, as well as unfulfillable aesthetic expectations they themselves hold concerning their physical appearance, persons with facial or other damages to the skin are weakened in their selfworth to a degree that they no longer dare to show their body. Repeated frustrations have entailed a level of sensitization that withdrawal into isolation appears the only course of action possible. In the Hornheide special clinic, an integrated rehabilitation model has been developed and tested, incorporating a special desensitization procedure by exposure to swimming pool situations, which is described in detail in the present article.

Structural and functional analysis of an rRNA operon and its flanking tRNA genes from Zea mays chloroplasts.

The complete analysis of an rRNA operon from Zea mays chloroplasts and its comparison with other plastidic or bacterial rRNA operons is presented. The maize operon contains structural genes for 16S, 23S and 4.5S rRNA species, a leader region proximal to the 16S rRNA gene and a 2.4 kb spacer between the 16S and 23S rRNA genes. Within the spacer DNA sequence are two tRNA genes which code for a tRNAIle and tRNAAla species but each gene is split by large intervening sequences of 949 and 806 bp, respectively. 4.5S rRNA is a structural equivalent of the 3' terminal region of bacterial 23S rRNA. The operon is flanked at its 5' side by a tRNAVal gene and at its 3' side by a 5S rRNA gene. Both these genes are probably not included in the large, primary precursor rRNA transcript.