Opinions and Attitudes of Pulmonologists About Augmentation Therapy in Patients with Alpha-1 Antitrypsin Deficiency. A Survey of the EARCO Group.

BACKGROUND: Augmentation therapy (AT) is the only specific treatment licensed for patients with alpha-1 antitrypsin deficiency (AATD) associated lung disease. Since patients with severe AATD may have a very different prognosis and AT requires intravenous infusions for life, the decision to initiate AT may be challenging. METHODS: This survey was conducted on 63 experts in AATD from 13 European countries about their opinions and attitudes regarding AT. Participants were asked to rank the importance of 11 identified factors related with the prescription of AT. In addition, each participant was asked to respond to the indication of AT for 30 out of 500 hypothetical cases developed with the combinations of the 11 factors. Each case was evaluated by 3 experts to check the concordance. RESULTS: The variables that scored higher on preferences for initiating AT were AAT genotype (score 8.6 from a Likert scale 0-10 (SD: 1.7)), AATD serum level (8.2 (SD:2.4)) and FEV1 (%) decline (7.9 (SD:2.4)). Among the 500 different cases, there was an agreement in indication of AT among the 3 experts in 291 (58.2%). Regarding the variables associated with AT, it was indicated to 81.9% of Pi*ZZ, 52.4% of Pi*SZ and 9.8% of Pi*MZ (p < 0.0001). For Pi*ZZ patients, multivariate analysis identified younger age, reduced FEV1 (%), higher FEV1 decline and worse emphysema as significantly associated with prescription (AUC = 0.8114); for Pi*SZ variables were younger age, worse FEV1 (%) and worse emphysema (AUC = 0.7414); and for Pi*MZ younger age, worse DLCO (%), higher DLCO decline and dyspnea (AUC = 0.8387). CONCLUSION: There is a high variability in the criteria for prescription of AT among European experts. Most cases were recommended AT according to guidelines, but a significant number of patients with genotype Pi*SZ and almost 10% Pi*MZ were recommended to initiate AT despite the lack of evidence of efficacy in these genotypes.

[Breast cancer - state of the art - Short overview of the current standard of treatment]. / Was ist neu bei der Diagnostik und Therapie des Mammakarzinoms? ­ Aktuelle Standards in der Behandlung von Brustkrebs.

INTRODUCTION: Breast cancer is the most frequently diagnosed type of cancer in women and there are continuously new findings in research for further treatment approaches. EARLY DIAGNOSIS: Mammography is already a well-established prevention method in Germany for women aged 50-69, reducing mortality rates significantly. The benefit of extending the screening period including women older than 70 years has been proven recently. Intensive research in hereditary breast cancer makes it possible to identify high risk patients and include them to a more frequent screening program with additional MRI. THERAPY: In early as well as in advanced stages of breast cancer the treatment should be as targeted and as noninvasive as possible. After neoadjuvant therapy a mastectomy is needed less frequently and axillary lymph node dissection can be limited to rare cases. Molecular subtyping allows more individualized treatment in curative and palliative intention. RECONSTRUCTIVE SURGERY: BIA-ALCL is an uncommon and highly treatable T-cell lymphoma associated with textured silicone or saline filled breast implants. Despite increasing incidence the usage of those implants is possible - but only after adequate information. FOLLOW-UP: Due to new insights into the biology of breast cancer the period of follow-up care has been expanded to ten years. OUTLOOK: The detection of an ESR1 mutation could possibly be used as a predictive marker regarding endocrine therapy in the future. Furthermore, there are promising results for blocking the PD-1 axis in primary systemic chemotherapy for triple-negative breast cancer.

Response to ostracism in patients with chronic depression, episodic depression and borderline personality disorder a study using Cyberball.

BACKGROUND: Social exclusion (ostracism) can lead to interactional frustration and may play an important role as trigger and symptom amplifier in affective disorders. To investigate immediate emotional and behavioral reactions as well as coping, social exclusion can be mimicked in experimental situations, e.g. in the Cyberball paradigm, a virtual ball tossing game which is well established in social psychology. The present cross-diagnostic study compares the responses to social exclusion in patients with chronic depression (CD), episodic depression (ED) and borderline personality disorder (BPD) in comparison to a healthy control group. METHODS: After baseline characterization, 120 participants (29 patients with CD, 20 with ED, 28 with BPD and 43 healthy controls) played Cyberball with two virtual players and complete exclusion after three times receiving the ball. Thereafter, standard questionnaires were applied for measuring needs, threats, inner tension, emotions and behavioral intentions. RESULTS: Patients with CD showed a higher intensity of ostracism and aversive impact, as well as the wish to escape the situation (behavioral intention) compared to ED. In most categories, CD and ED had scores between BPD and healthy controls (with this sequence) and with BPD patients showing the largest difference to healthy controls. LIMITATIONS: The assessment did neither include objective behavioral measures (which is a general limitation in the majority of studies using Cyberball) nor any biological variables. The sample sizes of the diagnostic subgroups were moderate. CONCLUSIONS: These findings support the hypothesis that social exclusion situations lead to a more aversive emotional and behavioral reaction in CD compared to ED. Psychological and biological underpinnings of these reactions should be addressed in future transdiagnostic studies. Moreover, psychotherapy in CD should focus on specific needs of CD patients for developing a functional coping in threatening interpersonal situations.