[Shared decision-making in prostate cancer patients]. / Partizipative Entscheidungsfindung bei Prostatakrebspatienten.

BACKGROUND: Shared decision-making (SDM) is becoming increasingly important in medical care. The relevance of SDM after diagnosis is especially noticeable in the care of prostate cancer patients, since affected patients can choose from different treatment strategies. OBJECTIVES: What are the experiences of patients regarding SDM in the treatment of prostate cancer? METHODS: Interviews with qualitative-exploratory study design were carried out and evaluated. The interviews were recorded with the help of audio tapes and literally transcribed and pseudonymized based on Kuckartz. The evaluation was done by theoretical coding according to Glaser and Strauss. This enabled the development of an object-based theory of interview data. RESULTS: The study shows that all interviewees experienced SDM and were able to reflect on this process. The interviewed patients had a high level of information regarding their disease status and treatment options, in which individual preferences played a key role. Some patients saw potential for optimization in the physician-patient conversation, taking personal preferences into account. CONCLUSIONS: Patients are not limited to medical information only, but have taken an active role in their treatment decision. Many of the participants consulted several physicians to obtain second opinions. Since the survey focuses on the patients' perspective, it remains unclear whether a joint exchange of information and decision-making has taken place from a medical point of view.

Transient binding accounts for apparent violation of the generalized Stokes-Einstein relation in crowded protein solutions.

The effect of high concentration, also referred to as crowding conditions, on Brownian motion is of central relevance for the understanding of the physical, chemical and biological properties of proteins in their native environment. Specifically, the simple inverse relationship between the translational diffusion coefficient and the macroscopic solution viscosity as predicted by the generalized Stokes-Einstein (GSE) relation has been the subject of many studies, yet a consensus on its applicability has not been reached. Here, we use isotope-filtered pulsed-field gradient NMR to separately assess the µm-scale diffusivity of two proteins, BSA and an SH3 domain, in mixtures as well as single-protein solutions, and demonstrate that transient binding can account for an apparent violation of the GSE relation. Whereas GSE behavior applies for the single-protein solutions, it does not hold for the protein mixtures. Transient binding behavior in the concentrated mixtures is evidenced by calorimetric experiments and by a significantly increased apparent activation energy of diffusion. In contrast, the temperature dependence of the viscosity, as well as of the diffusivity in single-component solutions, is always dominated by the flow activation energy of pure water. As a practically relevant second result, we further show that, for high protein concentrations, the diffusion of small molecules such as dioxane or water is not generally a suitable probe for the viscosity experienced by the diffusing proteins.

Oral mucosa model based on a collagen-elastin matrix.

BACKGROUND AND OBJECTIVE: The collagen-elastin matrix (Matriderm(®)) is used to treat deep and full-thickness burns and was recently described as a suitable scaffold for tissue engineering. The aim of the present study was to investigate the biocompatibility of Matriderm(®) for gingival use through creation of an oral mucosa model ex vivo. MATERIAL AND METHODS: Gingival fibroblasts and keratinocytes were cultured. A dermal area on the base of the collagen-elastin matrix was repopulated with fibroblasts. After 14 days, keratinocytes were seeded on this dermal area to engineer a multilayered mucosa. Analysis of the architecture was performed using light and electron microscopy. Immunohistochemical detection of collagen IV and cytokeratin was carried out. RESULTS: Based on this scaffold we generated a multilayered oral mucosa-like structure. Histological, immunohistochemical and electron microscopic analysis of the dermal/epidermal junction showed a typical basement membrane and hemidesmosomal structures. Neighboring keratinocytes formed desmosomes in the epidermal sections. Cytokeratin was detectable in all epidermal layers. These experiments revealed that the collagen-elastin matrix was highly biocompatible with gingival cells under ex vivo conditions. CONCLUSION: Employing tissue-engineering techniques with dermal and epidermal cells from the gingiva, a multilayered oral mucosa was generated and characterized with respect to biocompatibility for Matriderm(®). The results indicate that Matriderm(®) is suitable for the ex vivo growth of gingival tissue cells and is a useful scaffold with possible applications in periodontal therapy.

Production of interleukin-13 is influenced by the interleukin-4 -34TT and -590TT genotype in patients with aggressive periodontitis.

Aggressive periodontitis (AgP) is a specific form of periodontal disease, with rapid destruction of the tissues supporting the teeth in otherwise young healthy individuals. We recently showed a higher frequency of the interleukin-4 (IL-4) -34TT and -590TT genotype in AgP patients compared to controls (P<0.05). Herein, we demonstrated that this specific IL-4 genotype exerts its function by increasing expression of IL-4 and STAT6, and producing higher concentrations of IL-4 in activated CD4+ cells of patients with AgP. In the present study, we investigated the effects of the IL-4-specific genotype on IL-13, IL-2 and IFN-γ expression and production in activated CD4+ cells of patients with AgP and healthy controls. Results revealed higher IFN-γ and IL-2 expression and significantly increased IL-13 production in the cells of the patients who were homozygous for the -34T and -590T alleles in comparison with the patients who were homozygous for the -34C and -590C alleles (P<0.05). Results of controls with the -34C and -590C alleles were similar to those of AgP with the same genotype. To our knowledge, the present study is the first to show an effect of the -34TT and -590TT genotype on IL-13 production. There is an increased production of IL-13 by the T cells of aggressive periodontitis patients with the IL-4 genotype.

Establishment and characterization of immortalized human gingival keratinocyte cell lines.

BACKGROUND AND OBJECTIVE: Primary human keratinocytes are used to analyze the properties of the oral epithelium and the early stages of oral bacterial infections. In vitro, these cells are characterized by their short life span and restricted availability. Approaches for culturing these cells will end after approximately 6-10 passages as a result of entry into apoptosis. For this reason, it is important to generate cell lines suitable for obtaining an unlimited source of cells. Therefore, the aim of the present study was to generate gingival keratinocyte cell lines and to compare their in vitro behaviour with those of primary human gingival keratinocytes. MATERIAL AND METHODS: Primary human gingival keratinocytes were immortalized with a combination of the human papilloma virus onkoproteins E6 and E7. The pattern of the cytokeratins, involucrin and filaggrin was investigated by intracellular staining using flow cytometry. This method allows quantitative analysis of the expression of a variety of intracellular or extracellular markers. RESULTS: The immortalized cell lines showed many morphological similarities, expressing a cytokeratin pattern that is comparable with that of primary gingival keratinocytes. Furthermore, they developed transepithelial electrical resistance, which is a marker for the generation of tight junctions. These results indicate that the cells might be able to act as an epithelial barrier, reflecting the reaction of primary human cells. CONCLUSION: The establishment of a continuous line of human gingival epithelial cells with functional characteristics of the epithelial barrier provides a valuable in vitro model for using to study the early steps of gingival/periodontal infections.

Synthesis of [6"-3H]-, (6"-2H)- and (2-2H)-maltotriose.

To prepare labeled precursors for biosynthetic studies, methods for the specific introduction of tritium and deuterium into the reducing and the terminal glucose unit of maltotriose were developed. Thus [6"-3H]- and (6"-2H)-maltotriose (17) and (18) were prepared via selective methoxytritylation, deprotection and subsequent modified Pfitzner-Moffatt oxidation, followed by reduction with sodium borotritiide or sodium borodeuteride, respectively. A simple two step procedure utilizing the Lobry de Bruyn/van Ekenstein transformation gave (2-2H)maltotriose (20).