Background: Medulloblastoma (MB) is the most common pediatric brain tumor. Current treatment regimes consisting of primary surgery followed by radio- and chemotherapy, achieve 5-year overall survival rates of only about 60 %. Therapy-induced endocrine and neurocognitive deficits are common late adverse effects. Thus, improved antitumor strategies are urgently needed. In this study, we combined irradiation (IR) together with epigenetic modifiers and differentiation inducers in a multimodal approach to enhance the efficiency of tumor therapy in MB and also assessed possible late adverse effects on neurogenesis. Methods: In three human MB cell lines (DAOY, MEB-Med8a, D283-Med) short-time survival (trypan blue exclusion assay), apoptosis, autophagy, cell cycle distribution, formation of gH2AX foci, and long-term reproductive survival (clonogenic assay) were analyzed after treatment with 5-aza-2′-deoxycytidine (5-azadC), valproic acid (VPA), suberanilohydroxamic acid (SAHA), abacavir (ABC), all-trans retinoic acid (ATRA) and resveratrol (RES) alone or combined with 5-aza-dC and/or IR. Effects of combinatorial treatments on neurogenesis were evaluated in cultured murine hippocampal slices from transgenic nestin-CFPnuc C57BL/J6 mice. Life imaging of nestin-positive neural stem cells was conducted at distinct time points for up to 28 days after treatment start. Results: All tested drugs showed a radiosynergistic action on overall clonogenic survival at least in two-outof-three MB cell lines. This effect was pronounced in multimodal treatments combining IR, 5-aza-dC and a second drug. Hereby, ABC and RES induced the strongest reduction of clongenic survival in all three MB cell lines and led to the induction of apoptosis (RES, ABC) and/or autophagy (ABC). Additionally, 5-aza-dC, RES, and ABC increased the S phase cell fraction and induced the formation of gH2AX foci at least in oneout-of-three cell lines. Thereby, the multimodal treatment with 5-aza-dC, IR, and RES or ABC did not change the number of normal neural progenitor cells in murine slice cultures. Conclusions: In conclusion, the radiosensitizing capacities of epigenetic and differentiation-inducing drugs presented here suggest that their adjuvant administration might improve MB therapy. Thereby, the combination of 5-aza-dC/IR with ABC and RES seemed to be the most promising to enhance tumor control without affecting the normal neural precursor cells.

Aktuellen Umfragen zufolge leiden in Deutschland elf Millionen Erwachsene an chronischen Schmerzen. Die Therapie der betroffenen Patienten und die Verhinderung der Chronifizierung ist daher eine wichtige Aufgabe unserer Zeit. Multimodale Schmerztherapien haben in der Behandlung chronischer Schmerzstörungen gute Ergebnisse gezeigt. Über den Effekt dieser Behandlung auf die Optimierung beziehungsweise Reduzierung der schmerzbezogenen Medikation wurde bisher kaum berichtet. Zusätzlich zu den bekannten Ergebnisparametern wie Schmerzintensität, Funktionserleben, Depression, Angst und Lebensqualität wurde daher in diese Studie auch die Veränderung der Medikation nach Behandlung beziehungsweise zum Zeitpunkt einer Ein-Jahres-Katamnese erfasst. Die schmerzbezogene Medikation wurde mit der sogenannten Medication Quantification Scale (MQS) bewertet, die eine Möglichkeit darstellt, die Medikamenteneinnahme gemäß Stoffgruppe, Dosis und potentieller Toxizität in einer einzigen vergleichbaren Maßzahl zu quantifizieren. Die Studie konnte zeigen, dass multimodale Schmerzbehandlungen zu guten bis sehr guten, weitgehend anhaltenden Effekten und einer hohen Patienten-Zufriedenheit führen. Es konnte darüber hinaus eine relevante Reduktion der schmerzbezogenen Medikation erreicht werden, die in den meisten Fällen noch ein Jahr später konstant blieb. Patienten, bei denen während des Programms eine Reduzierung der Medikamente erreicht werden konnte, hatten zudem die besseren Therapieergebnisse im Vergleich zu den Gruppen mit gleicher oder höherer Medikation.

No description available.

Background: Medulloblastoma (MB) is the most common pediatric brain tumor. Current treatment regimes consisting of primary surgery followed by radio- and chemotherapy, achieve 5-year overall survival rates of only about 60 %. Therapy-induced endocrine and neurocognitive deficits are common late adverse effects. Thus, improved antitumor strategies are urgently needed. In this study, we combined irradiation (IR) together with epigenetic modifiers and differentiation inducers in a multimodal approach to enhance the efficiency of tumor therapy in MB and also assessed possible late adverse effects on neurogenesis. Methods: In three human MB cell lines (DAOY, MEB-Med8a, D283-Med) short-time survival (trypan blue exclusion assay), apoptosis, autophagy, cell cycle distribution, formation of gH2AX foci, and long-term reproductive survival (clonogenic assay) were analyzed after treatment with 5-aza-2′-deoxycytidine (5-azadC), valproic acid (VPA), suberanilohydroxamic acid (SAHA), abacavir (ABC), all-trans retinoic acid (ATRA) and resveratrol (RES) alone or combined with 5-aza-dC and/or IR. Effects of combinatorial treatments on neurogenesis were evaluated in cultured murine hippocampal slices from transgenic nestin-CFPnuc C57BL/J6 mice. Life imaging of nestin-positive neural stem cells was conducted at distinct time points for up to 28 days after treatment start. Results: All tested drugs showed a radiosynergistic action on overall clonogenic survival at least in two-outof-three MB cell lines. This effect was pronounced in multimodal treatments combining IR, 5-aza-dC and a second drug. Hereby, ABC and RES induced the strongest reduction of clongenic survival in all three MB cell lines and led to the induction of apoptosis (RES, ABC) and/or autophagy (ABC). Additionally, 5-aza-dC, RES, and ABC increased the S phase cell fraction and induced the formation of gH2AX foci at least in oneout-of-three cell lines. Thereby, the multimodal treatment with 5-aza-dC, IR, and RES or ABC did not change the number of normal neural progenitor cells in murine slice cultures. Conclusions: In conclusion, the radiosensitizing capacities of epigenetic and differentiation-inducing drugs presented here suggest that their adjuvant administration might improve MB therapy. Thereby, the combination of 5-aza-dC/IR with ABC and RES seemed to be the most promising to enhance tumor control without affecting the normal neural precursor cells.

Background Based on changes in pharmacokinetics and –dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited. Methods This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients’ records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs’ medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed. Results Content analysis of 1846 patients’ records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics. Conclusions It is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs’ experiences in daily practice, FPs’ knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs’ daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs’ advanced training.

No description available.

Objectives Intra-articular injections of local anaesthetics (LA), glucocorticoids (GC), or hyaluronic acid (HA) are used to treat osteoarthritis (OA). Contrast agents (CA) are needed to prove successful intra-articular injection or aspiration, or to visualize articular structures dynamically during fluoroscopy. Tranexamic acid (TA) is used to control haemostasis and prevent excessive intra-articular bleeding. Despite their common usage, little is known about the cytotoxicity of common drugs injected into joints. Thus, the aim of our study was to investigate the effects of LA, GC, HA, CA, and TA on the viability of primary human chondrocytes and tenocytes in vitro. Methods Human chondrocytes and tenocytes were cultured in a medium with three different drug dilutions (1:2; 1:10; 1:100). The following drugs were used to investigate cytotoxicity: lidocaine hydrochloride 1%; bupivacaine 0.5%; triamcinolone acetonide; dexamethasone 21-palmitate; TA; iodine contrast media; HA; and distilled water. Normal saline served as a control. After an incubation period of 24 hours, cell numbers and morphology were assessed. Results Using LA or GC, especially triamcinolone acetonide, a dilution of 1:100 resulted in only a moderate reduction of viability, while a dilution of 1:10 showed significantly fewer cell counts. TA and CA reduced viability significantly at a dilution of 1:2. Higher dilutions did not affect viability. Notably, HA showed no effects of cytotoxicity in all drug dilutions. Conclusion The toxicity of common intra-articular injectable drugs, assessed by cell viability, is mainly dependent on the dilution of the drug being tested. LA are particularly toxic, whereas HA did not affect cell viability.

Hippokampale Sharp Wave-Ripples (SWRs) sind elektrografische Ereignisse, die für die Konsolidierung von Erinnerungen eine Rolle spielen. Eine SWR ist durch eine schnelle Oszillation (>90 Hz, ''ripple'') charakterisiert, die sich mit der langsameren ''sharp wave'' ( / Hippocampal sharp wave-ripples (SWRs) are electrographic events that have been implicated in memory consolidation. A SWR is characterized by a fast (> 90 Hz) oscillation, the ripple, superimposed on a slow (< 30 Hz) sharp wave. In vivo, the fast component can express frequencies either in the ripple range (140-200 Hz) or fast-gamma range (90-140 Hz). Episodes in both bands exhibit intra-ripple frequency accommodation (IFA). In vitro, ripples are frequency-resistant to GABA modulators. These features constrain the type of mechanisms underlying the generation of the fast component. A prominent hypothesis proposes that a recurrent network of parvalbumin-immunoreactive basket cells (PV+BC) is responsible of setting the ripple frequency. The focus of the present thesis is on testing to which extent the PV+BC network can account for the aforementioned features of SWRs, which remain unexplained. Here, I simulated and analyzed a physiologically constrained in silico model of the PV+BC network in CA1 under different conditions of excitatory drive. The response of the network to transient excitation exhibits both IFA in the ripple band and frequency resistance to GABA modulators. The expression of IFA in the fast gamma band requires the involvement of pyramidal cells in a closed loop with the PV+BC network. The model predicts a peculiar relationship between the instantaneous frequency of ripples and the time course of the excitatory input to CA1. This prediction was confirmed in an in vitro model of SWRs. Additionally, I study the involvement of oriens lacunosum-moleculare interneurons (O-LM) during SWRs in vitro. I characterize the excitatory currents received by O-LM cells during SWRs and investigate the factors that determine their recruitment.

No description available.

No description available.