[Psychotherapy and pharmacotherapy for harmful tobacco use and tobacco dependency]. / Psycho- und Pharmakotherapie bei schädlichem Tabakgebrauch und -abhängigkeit.

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

[Evaluation of a structured smoking cessation program for primary care medicine]. / Evaluierung eines strukturierten Tabakentwöhnungsprogramms für die ärztliche Praxis.

BACKGROUND: Despite the fact that 9 of 10 general practitioners in Germany believe that smoking cessation is an important topic structured programs are only rarely offered to patients. Beside a lack of time and missing reimbursement, physician's limited treatment skills are frequent reasons for this observation. Therefore we aimed to develop a structured, easy to learn and time-effective smoking cessation program for the general practice. Evidence based treatment elements were combined and standardized by a step by step treatment guideline. METHODS: In a non-interventional observation we tested the program's integration in the daily routines of physicians, the rate of continuous tobacco abstinence after 12 weeks and both patient's and physician's satisfaction with the program and the medication. RESULTS: 44 physicians participated in the study. 184 patients were observed over a mean period of 12.8 weeks and were treated with an individually adapted nicotine replacement therapy for 10 weeks. At the end of treatment (12.1 weeks after the target quit date) 48.4% of the patients reported continuous abstinence. The combination of structured counseling with nicotine substitution in this program was easily implemented in doctor's practice, induced a high user satisfaction and a long usage of medication. The encouraging abstinence rate could have been influenced by selecting highly motivated patients, by offering structured and regular consultations at fixed intervals over the first weeks and by the treatment with the individually adapted nicotine substitution. CONCLUSION: This study shows an easy way to implement an individual and structured smoking cessation therapy in primary care medicine in Germany. Nevertheless, the results should be confirmed in larger cohorts and on a higher methodological level.

[Do smoking hospital inpatients get therapies for cessation? Experiences of health care professionals]. / Bekommen rauchende Patienten in der Klinik Angebote zur Entwöhnung? Erfahrungen von Mitarbeitern.

AIMS: To conduct a preliminary study into the attitudes and current practices of health professionals towards providing tobacco dependence treatment to hospitalized patients. METHODS: A staff survey was distributed within four hospital departments at the University Medical Center Freiburg. Surveys were received from 92 respondents (response rate 28.3%, of them 65.2% nurses and 27.3% doctors). RESULTS: Most of respondents reported that they 'often' or 'always' ask patients whether they smoke and advise patients to quit, but only 27.5% encourage patients to set a quit date or informed them about medication (21.7%). Few health professionals (14.1%) believed that they were adequately trained to provide tobacco dependence treatment, and knowledge of guidelines for treatment was minimal. Lack of time was cited as a barrier by half of respondents. DISCUSSION: The results of this small study of health professionals reveal a high level of recognition of the importance of providing tobacco dependence treatment, but that they do not routinely assist patients. Insufficient training was mentioned as the major barrier to provide more effective assistance and should be acknowledged in regular trainings.

[Nicotine. Influence on sleep and its relevance for psychiatry and psychotherapy]. / Nikotin. Einfluss auf den Schlaf und Relevanz für Psychiatrie und Psychotherapie.

BACKGROUND: Nicotine, by its impact on several neurotransmitter systems, influences sleep. Sleep disturbance is a common symptom in different psychiatric disorders and there is a high prevalence of smoking in psychiatric patients. METHODS: Systematic literature search. RESULTS: Symptoms of insomnia are observed during nicotine consumption and its withdrawal. The effects of therapeutic nicotine substitution after smoking cessation on sleep are often masked by withdrawal symptoms. Depressive non-smokers experience an improvement of mood under nicotine administration and in turn, depressive symptoms and sleep impairment during nicotine withdrawal have a negative impact on abstinence rates. CONCLUSION: Sleep disturbance is a comorbid risk factor influencing abstinence during smoking cessation. In depressive patients the complex relationship between affect, sleep, nicotine consumption and its withdrawal should be carefully monitored. In such subgroups of smokers willing to quit this has to be taken care of in therapeutic interventions.

Hematopoietic recovery of ex vivo perfusion culture expanded bone marrow and unexpanded peripheral blood progenitors after myeloablative chemotherapy.

Ex vivo culture of hematopoietic progenitor cells for autologous transplantation has generated world-wide interest, since it offers the prospect of using a limited cell number, and may allow more efficient gene transfer and passive elimination of contaminating tumor cells. In this study, we expanded bone marrow (BM) cells from 10 breast cancer patients to determine whether small BM aliquots can durably restore hematopoiesis, and whether thrombopoietin (TPO) improves hematopoietic reconstitution after myeloablative chemotherapy. We used the AastromReplicell System (ARS), performing a computer-controlled, stromal-based cell expansion process with frequent medium, cytokine and gas exchange. For the inoculation of 9 x 10(8) MNC, a median BM volume of 97.8 ml (range, 72.4-272) was harvested. We found a median 4.5-fold nucleated cell expansion, an 18-fold CFU-GM expansion, and 69% of input LTC-IC numbers. Nucleated and Lin-/CD34+ cells were infused with a median of 43.5 x 10(6)/kg (range, 34.1-71.7) and 2.8 x 10(5)/kg (range, 0.95-5.9), respectively. Despite tumor cell detection by immunocytochemical staining in 3/10 patients before expansion, tumor cells were not detectable in 9/10, and in one patient 1 log reduced post ARS culture. Following high-dose STAMP V chemotherapy, all patients received 12-day expanded BM cells. The median time to engraftment was 17 days (range, 11-20) for WBC >1000/microl, and 28 days (range, 21-55) for platelets >20,000/microl. A correlation between post-expansion Lin-/CD34+ cells and engraftment for ANC >500/microl, WBC >1000/microl and platelets >20,000/microl was observed. Hematopoiesis has been maintained for a median of 15 (range, 6-24) months. Our results demonstrate that transplantation of ex vivo expanded small BM aliquots allows hematopoietic reconstitution after myeloablative chemotherapy. Ex vivo generated ARS cells can reduce the risk of tumor cell reinoculation with autotransplants and may be valuable in settings in which only small stem cell doses are available, eg when using cord blood transplants or in non-mobilizing patients.

Regeneration of transgenic, microspore-derived, fertile barley.

We have developed a system for the biolistic transformation of barley using freshly-isolated microspores as the target tissue. Independent transformation events led, on average, to the recovery of one plant per 1×10(7) bombarded microspores. Putative transformants have been regenerated using phosphinothricin as a selective agent. R0 plants have been transferred to soil approximately 2 months after bombardment. Integration of the marker genes bar and uidA has been confirmed by Southern analysis. The marker genes are inherited in all progeny plants confirming the expected homozygous nature of the R0 plants.

Plant regeneration from embryogenic cell suspensions derived from anther cultures of barley (Hordeum vulgare L.).

We have established embryogenic cell suspension cultures of barley (Hordeum vulgare L. cultivars Igri, Gimpel, Princesse, and Baronesse) from anther-derived embryogenic callus. Suspension cultures of cultivars Igri and Gimpel were regenerable. The most successful cultivar was Igri, from which a number of independent cell lines producing plantlets were established. Plants could be transferred to soil; up to now, 50% of more than 200 regenerated plants were morphologically normal and fertile. The relative frequency of sterile plants increased as suspensions aged. Suspensions older than 1 year produced embryogenic callus but only albino plantlets could be regenerated.

Regeneration of fertile plants from protoplasts derived from embryogenic cell suspensions of barley (Hordeum vulgare L.).

We report regeneration of fertile plants from barley (Hordeum vulgare L. cv. Igri) protoplasts isolated from regenerable suspension cultures initiated from anther-derived embryogenic callus. Plants were routinely regenerated from these suspension cultures, which maintained their regenerative capacity for several months. It was first possible to isolate protoplasts from suspensions after three months of culture and after four months protoplasts capable of division could be isolated. Protoplasts maintained the regenerative capacity of the donor cells and formed embryogenic callus. Green plants were regenerated from protoplast-derived calli, although the proportion of albino plantlets was high. Viable regenerants were transferred to soil and fertile plants were recovered.