[Intensive care of patients with [infarct-related] cardiogenic shock : Abridged version of the S1 guideline]. / Intensivpflegerische Versorgung von Patient:innen mit [infarktbedingtem], kardiogenen Schock : Kurzversion der S1-Leitlinie.

BACKGROUND: Cardiovascular diseases and (infarct-related) cardiogenic shock are among the most frequent causes of death in Germany. Adequate clinical care often poses great challenges for hospitals. The complex care of patients in a multi-professional team places high demands on all those involved in the care process. Since nurses in particular are in close contact with patients and play a decisive role in shaping and controlling therapy, a national (intensive) care guideline is urgently needed. METHODS: Within the framework of the guideline programme of the Association of the Scientific Medical Societies in Germany (AWMF), an S1 guideline was developed with the participation of six professional societies and published in May 2022. The guideline group defined relevant topics, which were processed through a systematic literature search in peer-reviewed journals. Based on the S1 classification, no separate evidence review was conducted. A formal consensus-building process was used to classify the recommendations. RESULTS: The guideline contains 36 recommendations ranging from nursing care in the central emergency department to the cardiac catheterisation laboratory, intensive care unit and follow-up care. In addition, recommendations are made on the necessary qualifications and structural requirements in the respective areas in order to ensure a high-quality (nursing) care process. CONCLUSION: This is the first national intensive care guideline. It is aimed at nurses involved in the care of patients with (infarct-related) cardiogenic shock. The guideline is valid until 30.12.2026.

A genome-wide association study of kynurenic acid in cerebrospinal fluid: implications for psychosis and cognitive impairment in bipolar disorder.

Elevated cerebrospinal fluid (CSF) levels of the glia-derived N-methyl-D-aspartic acid receptor antagonist kynurenic acid (KYNA) have consistently been implicated in schizophrenia and bipolar disorder. Here, we conducted a genome-wide association study based on CSF KYNA in bipolar disorder and found support for an association with a common variant within 1p21.3. After replication in an independent cohort, we linked this genetic variant-associated with reduced SNX7 expression-to positive psychotic symptoms and executive function deficits in bipolar disorder. A series of post-mortem brain tissue and in vitro experiments suggested SNX7 downregulation to result in a caspase-8-driven activation of interleukin-1ß and a subsequent induction of the brain kynurenine pathway. The current study demonstrates the potential of using biomarkers in genetic studies of psychiatric disorders, and may help to identify novel drug targets in bipolar disorder.

Comparison of screening methods to identify methicillin-resistant Staphylococcus aureus.

Screening methods to identify methicillin-resistant Staphylococcus aureus (MRSA) were compared using 96 isolates representing 17 distinct clones. The sensitivity of four commercial agglutination tests was determined in comparison to the tube coagulation test, and the results related to the presence of the coagulase gene. The broth screening test, agar dilution test and disc diffusion test were carried out, and the results related to the presence of the mecA gene. Mannitol salt agar and Iso-Sensitest agar with varying salt supplements were used. All agglutination tests had high rates of detection of Staphylococcus aureus (95.8-99.0%). Resistance in mecA gene-positive Staphylococcus aureus isolates was correctly detected by the oxacillin broth test, the agar dilution test and the disc diffusion test on mannitol salt agar, whereas on Iso-Sensitest agar detection rates were lower (between 68.5% and 94.4%, depending on the salt supplement). Incubation of the Iso-Sensitest plates for 48 hours significantly improved the rate of detection of resistance, but increased the major error rate up to 71.4%. MecA gene-positive Staphylococcus aureus isolates not detected by the disc diffusion test on Iso-Sensitest agar had significantly lower oxacillin minimal inhibitory concentration values and were significantly less resistant to a variety of antibiotics. Thus, mannitol salt agar might be a suitable medium for use in the disc diffusion and agar dilution test to detect resistance to oxacillin in Staphylococcus aureus.

Increased cytosolic free sodium in platelets from patients with early-stage chronic renal failure.

Cytosolic free sodium concentration ([Na+]i) and sodium transport systems were measured in intact platelets from 19 patients with early-stage chronic renal failure and 33 healthy control subjects using the novel fluorescent dye sodium-binding-benzofuran-isophthalate. Resting [Na+]i was significantly greater in patients with chronic renal failure compared to control subjects (40.8 +/- 3.1 mmol/l versus 32.2 +/- 2.0 mmol/l, mean +/- SEM, P < 0.05). After inhibition of Na-K-ATPase by 1 mmol/l ouabain a higher net sodium influx was observed in platelets from patients with chronic renal failure compared to control subjects (49.8 +/- 8.7 mmol/l versus 28.5 +/- 5.2 mmol/l, P < 0.05). The platelet Na-H exchanger was similar in the two groups. Cytosolic free calcium concentration ([Ca2+]i) was measured using fura2 and did not show significant differences between the two groups. To evaluate whether a circulating factor may be associated with elevated [Na+]i, a linked-enzyme Na-K-ATPase assay was included. Compared to control subjects plasma from patients with chronic renal failure produced a significant inhibition of steady-state Na-K-ATPase activity by 11.2 +/- 3.0% (P < 0.01). It is concluded that early-stage renal failure is associated with significant impairment of platelet sodium metabolism.

Skin signs in pulmonary disease.

We have described many of the cutaneous findings that can be associated with pulmonary disease. Some, such as the vascular reaction patterns, are quite common. Others, particularly those related to the genetic disorders are rather seldom seen. Our intent, however, is to show how recognition of cutaneous markers can assist the internist in caring for their patients with pulmonary disease.

Dominant disorders with multiple organ involvement.

Diagnosis of the preceding disorders may be difficult because of their wide range of clinical expression. The genetic patterns of incontinentia pigmenti, incontinentia pigmenti achromians, and focal dermal hypoplasia are still unclear, and literature regarding this subject may be confusing. Therefore, it is necessary to observe strict clinical criteria for diagnosis of these syndromes, and genetic counseling of affected individuals and families should be undertaken with care.

Subungual tumors in incontinentia pigmenti.

A 22-year-old woman presented with intermittently painful subungual keratotic tumors of the hands as a late manifestation of incontinentia pigmenti. Scalloped bony deformities of the distal phalanges of both hands were noted on roentgenograms. The origin of these lytic deformities is uncertain; they may be secondary pressure phenomena or, alternatively, they may be an intrinsic manifestation of incontinentia pigmenti. These subungual tumors clinically resemble verrucae, keratoacanthomas, squamous cell carcinomas, or subungual fibromas. Therefore, it is important to recognize that subungual keratotic tumors may be a late manifestation of incontinentia pigmenti.

[Iatrogenic radiogenic tumors. Observations on the incidence of tumors in the irradiation field following x-ray therapy]. / Iatrogene radiogene Tumoren. Beobachtungen zum Auftreten von Tumoren im Strahlenfeld nach vorangegangener Röntgentherapie.

A report is given on 18 patients with malignant tumors in the region of prior irradiation fields after a period of 28 years on an average. The irradiation was given because of malignant tumors in eight cases and for benign diseases in nine cases. The malignant tumors induced by ionizing radiation of the skin are often seen in multiple localisation. The risk of radiation induced cancer is given after irradiation for gynecological disorders and disorders of the superficial skin. The problem is discussed with the relevant literature.

[Nevoid perifollicular fibromas (Zackheim and Pinkus)]. / Nävoide perifollikuläre Fibrome (Zackheim und Pinkus).

We present a short report on a patient with nevoid perifollicular fibromas. The histology, differential diagnosis and etiology of these proliferations, which arise only from connective tissue, are discussed on the basis of the literature.

The influence of infantile handling, age and strain on alcohol selection in mice.

Male mice from three inbred strains (C57B1/10J, BALB/cJ and C3H/2lbg) were assigned to infantile handling or control conditions. In a cross-sectional developmental design, handled and control mice were tested for two-choice selection of 10% (v/v) ethanol vs. tap water at 60, 90 or 120 days of age. The volume of fluid consumed from both tubes was recorded for fifteen days. In 60 day old mice, handling produced a trend toward increased total fluid consumption in the C57 mice and a trend toward increased ethanol selection in the BALBs. In 90 day old mice, there were trends noted toward handling-related decreased fluid consumption in BALBs. Also noted was a trend toward handling related increased ethanol selection in C57 mice. In 120 day old mice, a handling-related increase in alcohol selection was noted in the C3H strain.

[Another case of articular hydrops in dermatitis herpetiformis Duhring]. / Uber eine weitere Beobachtung von Hydrops articularis bei Dermatitis herpetiformis Duhring.

In addition to the 1968 report on two patients suffering from Duhring's disease (DD) associated with hydrarthrosis by Zaun, we now present a third case of the same combination of signs. In all three patients, painful joint swelling regularly preceded the manifestation of cutaneous eruptions. Joint pains and swelling did not respond to usual antirheumatic treatment, but always remitted together with the skin eruptions under medication of sulphones.

[Formaldehyde sediment in incubators following disinfection]. / Formaldehydrückstände in Inkubatoren nach der Desinfektion.

Measurements in incubators revealed the presence of formaldehyde concentrations involving a health risk for premature and normal newborns kept and cared for in incubators. Prior to measurements, the incubators had been disinfected by means of formaldehyde vapours in an "Aseptor" disinfecting cabinet (Drägerwerk AG, Lübeck) and then ventilated in strict adherence to operating instructions. The elevated formaldehyde concentrations found had been due to residues of paraformaldehyde and urotropin on the surfaces of the disinfected apparatus, liberating formaldehyde by hydrolysis depending on temperature and relative humidity. There should be a basic reconsideration of the present practice of incubator disinfection. From experiments with activated-carbon filters in incubators it would seem that there is a chance of reducing such formaldehyde concentrations.

Down regulation and recovery of the epidermal growth factor receptor in serum supplemented versus defined medium.

The down regulation of surface membrane receptors for 125I) epidermal growth factor (EGF) has been evaluated in normal and SV40-transformed human fibroblasts (WI38) under conditions of serum-supplemented versus defined growth media. Both normal and transformed WI38 cells down regulate and recover the EGF receptor and these processes do not differ significantly in serum-supplemented versus defined media. These data are in contrast to a recent study that reported that the HeLa cell does not down regulate the EGF receptor in defined media, whereas it does in serum-supplemented media.

[New fluorescence microscopic technic for the identification of Trichomonas vaginalis]. / Ein neues fluoreszenzoptisches Verfahren zum Nachweis von Trichomonas vaginalis.

A new fluorescent dye for the identification of trichomonas vaginalis is described. Specimens under investigation were mixed with 4',6-diamidino-2-phenylindol (Dapi) and examined using white light and UV-light. The combined use of the two techniques allows to recognize the mobile non fluorescing and the dead intensive yellow fluorescing trichomonads. Devitalized epithelial cells, bacteria and leucocytes in contrast to living trichomonas are stained yellow in a few minutes. This is of diagnostic help.

[Fluorescent test of mycoplasma colonies by agar diffusion technique (author's transl)]. / Ein Agar-Diffusionstest zum fluoreszenzoptischen Nachweis von Mykoplasmenkolonien.

An agar diffusion test to directly stain mycoplasma colonies using a new fluorochrome 4,6-diamidino-2-phenyl-indol (DAPI) is described. Next to a colony in question a well is punched into the agar and filled with DAPI. 30 min later the colonies in the diffusion zone show a light yellow - light green fluorescence. Due to the high affinity of DAPI to DNA it is easily possible to distinguish between granular mycoplasma colonies and unspecific substances e.g. proteins and lipids from clinical material.

[New fluorescent microscopical technique in diagnostic microbiology (author's transl)]. / Neues fluoreszenzoptisches Verfahren in der medizinisch-diagnostischen Mikrobiologie

The practicability of 4',6-diamidino-2-phenylindole (DAPI) in the fluorescent microscopical demonstration of bacterial and other cellular structures for medical diagnostic purposes was investigated. Polar bodies in diphtheria bacilli and spores of spore-forming bacteria showed up well. The demonstration of phagocytosed bacteria in urinary sediment and the morphology of human spermatozoa are particularly impressive. Noteworthy advantages of DAPI are its stability (no bleaching of stained preparations), its use in minute quantities, rapid staining (within minutes), and simplicity of use.