[Group Training of Patients with Chronic Lung Diseases under Outpatient Conditions - Recommendations of the Working Group Lung Sports in Germany and the German Airways League]. / Ambulanter Lungensport und körperliches Training bei Patienten mit Atemwegs- und Lungenkrankheiten.

To improve acceptance and use of physical training by patients with chronic lung diseases, recommendations for performing lung exercises on an outpatient basis in a group setting are given by experts in physical training, sports therapists and pulmonologists. The evidence-based positive effects of physical training were analyzed for asthma , COPD, interstitial lung diseases, cystic fibrosis, lung carcinoma, and pulmonary hypertension. The requirements for lung exercises in outpatient groups as well as compensation by care providers were given on the basis of legal regulations. Furthermore, the main items of the training units as well as supervision by specially trained group leaders in relation to the severity of the underlying lung disease are described. Finally, aspects of safety of the participating patients are discussed, including the prevention of infection with corona-2-virus.

[Guideline for the Diagnosis and Treatment of Asthma - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]. / S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma.

The present guideline is a new version and an update of the guideline for the diagnosis and treatment of asthma, which replaces the previous version for german speaking countries from the year 2006. The wealth of new data on the pathophysiology and the phenotypes of asthma, and the expanded spectrum of diagnostic and therapeutic options necessitated a new version and an update. This guideline presents the current, evidence-based recommendations for the diagnosis and treatment of asthma, for children and adolescents as well as for adults with asthma.

[Relevance of Outpatient, Equipment-based Exercise Training in Patients with Chronic Respiratory Diseases]. / Stellenwert ambulanter, gerätegestützter Trainingstherapie bei Atemwegs- und Lungenkrankheiten.

Exercise training is one of the most important components in disease management for patients with chronic respiratory diseases. The clinically relevant benefits of endurance and strength training on dyspnea, exercise capacity and quality of life have been evaluated very well. However, there are some legal limitations by the German Working Group for Rehabilitation (BAR) concerning outpatient exercise training programs (beyond pulmonary rehabilitation): only group-based callisthenic training programs receive funding from health care insurances while professional equipment-based training programs are excluded despite their outstanding effectiveness.This review provides an overview on the methodology and the benefits of outpatient exercise training programs for patients with chronic respiratory diseases, and it critically discusses the organizational structures of these programs in Germany.

Proteasomes generate spliced epitopes by two different mechanisms and as efficiently as non-spliced epitopes.

Proteasome-catalyzed peptide splicing represents an additional catalytic activity of proteasomes contributing to the pool of MHC-class I-presented epitopes. We here biochemically and functionally characterized a new melanoma gp100 derived spliced epitope. We demonstrate that the gp100(mel)47-52/40-42 antigenic peptide is generated in vitro and in cellulo by a not yet described proteasomal condensation reaction. gp100(mel)47-52/40-42 generation is enhanced in the presence of the ß5i/LMP7 proteasome-subunit and elicits a peptide-specific CD8(+) T cell response. Importantly, we demonstrate that different gp100(mel)-derived spliced epitopes are generated and presented to CD8(+) T cells with efficacies comparable to non-spliced canonical tumor epitopes and that gp100(mel)-derived spliced epitopes trigger activation of CD8(+) T cells found in peripheral blood of half of the melanoma patients tested. Our data suggest that both transpeptidation and condensation reactions contribute to the frequent generation of spliced epitopes also in vivo and that their immune relevance may be comparable to non-spliced epitopes.

A new potassium-based intermediate and its role in the desorption properties of the K-Mg-N-H system.

New insights into the reaction pathways of different potassium/magnesium amide-hydride based systems are discussed. In situ SR-PXD experiments were for the first time performed in order to reveal the evolution of the phases connected with the hydrogen releasing processes. Evidence of a new K-N-H intermediate is shown and discussed with particular focus on structural modification. Based on these results, a new reaction mechanism of amide-hydride anionic exchange is proposed.

[Psycho-oncology in dermatology]. / Psychoonkologie in der Dermatologie.

Psycho-oncology is a young discipline-in dermatology as well as in the medicine. The topic is heterogeneous and not clearly defined. The proportion of indications for emotional care in oncology is up to 50%, depending on the method of diagnosis. In daily dermatological practice, careful distribution of information and helping with coping are essential in order to not overwhelm the patient. The doctor should ask questions about the patient's expectations, fears, and any unclear items.

[Primary cutaneous manifestation of Wegener's granulomatosis]. / Primär kutane Manifestation einer Wegener-Granulomatose.

HISTORY: A 57-year-old man was admitted with hemorrhagic papules and necrotising nodules on both elbows and upper legs. Recurrent arthralgia occurred. INVESTIGATIONS: The skin biopsy showed a cutaneous necrotising vasculitis. Positive test results for c-ANCA and proteinase 3 antibodies and a slightly increased WBC and a mild proteinuria were noticeable. DIAGNOSIS, TREATMENT AND COURSE: The diagnosis of an early systemic Wegener's granulomatosis was based on elevated proteinase 3-titres and cutaneous histologic findings as necrotising vasculitis and granulomatous inflammation. Treatment with prednisolone followed by methotrexate resolved the cutaneous symptoms and the arthralgia completely. Three months later the patient developed a progredient methotrexate toxicity caused by a glomerulonephritis. CONCLUSION: Wegener's granulomatosis should be considered if a cutaneous necrotising vasculitis is diagnosed. A cutaneous manifestation could be an early symptom. Methotrexate could be used for treatment of mild courses of Wegener's disease without renal involvement.

[Pulmonary rehabilitation in COPD]. / Rehabilitation bei COPD.

COPD as a widespread disease will need much more attention of all health care providers in future. Otherwise COPD could lead to increasing costs, especially caused by the systemic nature of this disease and the large number of comorbidities as well as an increase of morbidity with reduced personal fitness and quality of life. As a result, the occupational and social participation subsequently decrease. Specific diagnostic in rehabilitation shows these consequences and a multimodal, multi-professional therapeutic management can be started. This means an optimized pharmacotherapy, different steps of intensity of indoor or outdoor rehabilitation with a training for patients, withdrawal therapy, psycho-social support and in severe cases non invasive artificial respiration. The indication for rehabilitation and the legal requirements are shown, as well as the ways to get rehabilitation and the possibilities of a rehabilitation chain including rehabilitation follow up and physical training. It has been proved that rehabilitation improves the symptoms of the disease, the personal fitness and the quality of life. Futhermore, rehabilitation reduces the days and the time spent in hospital and eventually reduces fear and depression. Therefore if consequently followed, rehabilitation in COPD is a valid therapeutic measure that can diminish the epidemiologic burden of this widespread disease.

[Recommendations for planning and realisation of exercise training in outpatient lung sports groups]. / Empfehlungen zur Planung und Durchführung des körperlichen Trainings im Lungensport.

Asthma and COPD are common diseases inducing high costs. In national and international guidelines exercise training is stated as the main component amongst the nonmedical treatment options. With exercise training beneficial effects in exercise performance, quality of life and health-related costs can be obtained. Options for exercise training all over the country should be established. Therefore not only inpatient, but also outpatient structures, especially lung sports groups have to be organized to enable a continuous training. For this special way of long term training no systematic guidelines do exist. Further aggravating factors are the different basic vocational education of the trainers and the heterogeneity of the participants. The intention of the authors was to develop recommendations for a structured training and training sensitive to the target group. The realisation of training with this approach should approximate training to evidence based knowledge and contribute to the quality of training patients with lung diseases.

[Vulvodynia]. / Vulvodynie.

Vulvodynia is a complex syndrome of chronic vulvar pain. It is divided into several subtypes: 1. cyclic vulvovaginitis (pain occurs after coitus), 2. vulvar vestibulitis syndrome (pain mainly with intercourse), 3. dysaesthetic vulvodynia (psychosomatic; diagnosis of exclusion), 4. vulvar dermatoses (e.g. pemphigus vulgaris, contact dermatitis). Additional causes have been described in single cases. Though vulvodynia is often accompanied by psychological distress, somatic causes have to be considered in each case.