Universitatsklinikum Ulm

Neu-Ulm, Germany

Universitatsklinikum Ulm

Neu-Ulm, Germany

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Anxiety and depression are frequent comorbid symptoms in children and adolescents with posttraumatic stress disorder (PTSD). Therefore, is it important to identify treatments that are effective not only with regard to the core symptoms of PTSD, but also regarding anxiety and depression. Methods: This study investigates in a sample of 159 participants (age 7-17 years, 72% female) of a randomized controlled trial: (a) the frequency of clinically relevant symptoms of anxiety and depression, (b) the correlation of symptoms of anxiety and depression with posttraumatic stress symptoms (PTSS), and (c) the remission of comorbid symptoms of anxiety and depression after 12 sessions of trauma-focused cognitive behavioral therapy (TF-CBT) compared with a waitlist group (WL). All participants had been exposed to at least one traumatic event and had developed clinically relevant PTSS. PTSS were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA), whereas symptoms of anxiety were assessed via the Screen for Child Anxiety-Related Disorders (SCARED) and symptoms of depression were measured with the Child Depression Inventory (CDI). Clinical assessments were performed repeatedly at baseline and after treatment or 4 months of waiting time. Results: At baseline, 121 (76%) of the patients showed clinically relevant symptoms of anxiety and 91 (57%) had clinically relevant symptoms of depression. The triplet of PTSS, anxiety, and depression occurred in 78 (49%) children and adolescents. PTSS were significantly correlated with caregiver-reported anxiety (r = .42, p < .001) and selfreported depression (r = .49, p < .001). Using repeated measures ANOVA, we found that patients treated with TF-CBT showed not only significantly greater remission of their PTSS compared with patients on the WL (F(1, 157) = 12.31, p = .001), but also of their caregiverreported symptoms of anxiety, F(1, 147) = 6.29, p = .013, but not of their self-reported symptoms of anxiety, F(1, 155) = 2.37, p = .126. TFCBT was also superior to WL regarding a remission of self-reported symptoms of depression, F(1, 155) = 8.11, p = .005. Beyond a large effect on PTSS (d = 1.51), TF-CBT generated moderate effects regarding symptoms of anxiety (self-report: d = 0.51; caregiver report: d = 0.51) and depression (d = 0.62). Conclusions and Relevance: Our results confirm the high prevalence of anxiety and depression in traumatized children and adolescents. Moreover, they demonstrate transdiagnostic effects of TF-CBT. Therefore, TF-CBT seems to be an appropriate treatment for traumatized children and adolescents with comorbid anxiety and depression. © 2017 Hogrefe Verlag.


Bruns H.,Friedrich - Alexander - University, Erlangen - Nuremberg | Stenger S.,Universitatsklinikum Ulm
Future Microbiology | Year: 2014

Mycobacterium tuberculosis is a facultative intracellular pathogen. It infects macrophages where it avoids elimination by interfering with host defense mechanisms. Until recently, it was assumed that the acidification of phagosomes is the major strategy of macrophages to eliminate M. tuberculosis. However, there is emerging evidence demonstrating that human macrophages are equipped with additional antimicrobial effector functions. Specifically, autophagy, efferocytosis and antimicrobial peptides have been identified as mechanisms to restrict mycobacterial proliferation. Here we review recent findings on effector functions of human macrophages and mechanisms of the pathogen to interfere with them. © 2014 Future Medicine Ltd.


Raschbichler V.,Ludwig Maximilians University of Munich | Lieber D.,Universitatsklinikum Ulm | Bailer S.M.,Ludwig Maximilians University of Munich
Traffic | Year: 2012

Transport of proteins between cytoplasm and nucleus is mediated by transport factors of the importin α- and β-families and occurs along a gradient of the small GTPase Ran. To date, in vivo analysis as well as prediction of protein nuclear export remain tedious and difficult. We generated a novel bipartite assay called NEX-TRAP (Nuclear EXport Trapped by RAPamycin) for in vivo analysis of protein nuclear export. The assay is based on the rapamycin-induced dimerization of the modules FRB (FK506-rapamycin (FR)-binding domain) and FKBP (FK506-binding protein-12): a potential nuclear export cargo is fused to FRB, to EYFP for direct visualization as well as to an SV40-derived nuclear localization signal (NLS) for constitutive nuclear import. An integral membrane protein that resides at the trans Golgi network (TGN) is fused to a cytoplasmically exposed FKBP and serves as reporter. EYFP-NLS-FRB fusion proteins with export activity accumulate in the nucleus at steady state but continuously shuttle between nucleus and cytoplasm. Rapamycin-induced dimerization of FRB and FKBP at the TGN traps the shuttling protein outside of the nucleus, making nuclear export permanent. Using several example cargoes, we show that the NEX-TRAP is superior to existing assays owing to its ease of use, its sensitivity and accuracy. Analysis of large numbers of export cargoes is facilitated by recombinational cloning. The NEX-TRAP holds the promise of applicability in automated fluorescence imaging for systematic analysis of nuclear export, thereby improving in silico prediction of nuclear export sequences. © 2012 John Wiley & Sons A/S.


Noll-Hussong M.,Universitatsklinikum Ulm
Zeitschrift fur Gerontologie und Geriatrie | Year: 2014

Background: Clinically relevant posttraumatic stress disorders are almost always associated with physical symptoms, which are, on the one hand, classified as somatoform and, on the other hand, may also present as somatic comorbidities. The psychological, neurobiological, endocrinological and immunological correlations are only now beginning to be understood. Thereby, integration into a meaningful biopsychosocial model is still pending. Purpose: The following article gives a concise summary of the knowledge concerning the relationship between body and psyche in posttraumatic stress spectrum disorders and provides the neuroscientific foundation which could establish a biological link between the phenomenologies of the disorder. Results: Neurobiological data on posttraumatic disorders and somatoform disorders are diverse and not uniform. This is even more true when it comes to those disorders that are within the intersection of these two entities and, above all, their special features in the elderly. Psychophysiological, neuroanatomical, endocrine-immunological, genetic, and epigenetic factors play an important role here. With regard to posttraumatic stress disorder, for example, higher autonomic reactivity was observed, which indicates an acquired general sensitization of the nervous system. © 2014 Springer-Verlag Berlin Heidelberg.


We evaluated the frequency, genetic architecture, clinico-pathologic features and prognostic impact of RUNX1 mutations in 2439 adult patients with newly-diagnosed acute myeloid leukemia (AML). RUNX1 mutations were found in 245 of 2439 (10%) patients; were almost mutually exclusive of AML with recurrent genetic abnormalities; and they co-occurred with a complex pattern of gene mutations, frequently involving mutations in epigenetic modifiers (ASXL1, IDH2, KMT2A, EZH2), components of the spliceosome complex (SRSF2, SF3B1) and STAG2, PHF6, BCOR. RUNX1 mutations were associated with older age (16–59 years: 8.5%; ⩾60 years: 15.1%), male gender, more immature morphology and secondary AML evolving from myelodysplastic syndrome. In univariable analyses, RUNX1 mutations were associated with inferior event-free (EFS, P<0.0001), relapse-free (RFS, P=0.0007) and overall survival (OS, P<0.0001) in all patients, remaining significant when age was considered. In multivariable analysis, RUNX1 mutations predicted for inferior EFS (P=0.01). The effect of co-mutation varied by partner gene, where patients with the secondary genotypes RUNX1mut/ASXL1mut (OS, P=0.004), RUNX1mut/SRSF2mut (OS, P=0.007) and RUNX1mut/PHF6mut (OS, P=0.03) did significantly worse, whereas patients with the genotype RUNX1mut/IDH2mut (OS, P=0.04) had a better outcome. In conclusion, RUNX1-mutated AML is associated with a complex mutation cluster and is correlated with distinct clinico-pathologic features and inferior prognosis.Leukemia advance online publication, 10 June 2016; doi:10.1038/leu.2016.126. © 2016 Macmillan Publishers Limited


Background: Hemoglobinopathies are among the most common inherited diseases around the world. They have become much more common recently in northern and central Europe, including Germany, due to immigration. Method: Selective review of the literature with consideration of national guidelines. Results: The hemoglobinopathies encompass all genetic diseases of hemoglobin. They fall into two main groups: thalassemia syndromes and structural hemoglobin variants (abnormal hemoglobins). α- and β-thalassemia are the main types of thalassemia; the main structural hemoglobin variants are HbS, HbE and HbC. There are many subtypes and combined types in each group. The highly variable clinical manifestations of the hemoglobinopathies range from mild hypochromic anemia to moderate hematological disease to severe, lifelong, transfusion-dependent anemia with multiorgan involvement. Stem-cell transplantation is the preferred treatment for the severe forms of thalassemia. Supportive, rather than curative, treatment consists of periodic blood transfusions for life, combined with iron chelation. Drugs to treat the symptoms of sickle-cell disease include analgesics, antibiotics, ACE inhibitors and hydroxyurea. Blood transfusions should be given only when strictly indicated. More than 90% of patients currently survive into adulthood. Optimally treated patients have a projected life span of 50 to 60 years. Conclusion: Hemoglobinopathies are a public health issue in today's multiethnic German population. Adequate care of the affected patients requires a wide variety of diagnostic and therapeutic measures.


Arhel N.,Universitatsklinikum Ulm | Kirchhoff F.,Universitatsklinikum Ulm
Biochimica et Biophysica Acta - Molecular Basis of Disease | Year: 2010

Current treatment of HIV/AIDS consists of a combination of three to five agents targeting different viral proteins, i.e. the reverse transcriptase, protease, integrase and envelope, and aims to suppress viral replication below detectable levels. This "highly active antiretroviral therapy" (HAART) has brought an enormous benefit for life expectancy and quality in HIV-1-infected individuals, at least in industrialized countries. However, significant limitations with regard to efficiency, drug resistance, side effect and costs still exist. Recent data suggest that cellular factors also represent useful targets for therapy. Here, we summarize findings from several genome-wide screens that identified a large number of cellular factors exploited by HIV-1 at each step of its life cycle. Furthermore, we discuss the evidence that humans are equipped with powerful intrinsic defense mechanisms against retroviruses but that HIV-1 has evolved elaborate ways to counteract or evade them. Preventing the use of host cell proteins obligatory for viral replication or strengthening the cellular defense mechanisms may help to reduce viral replication to harmless levels. A better understanding of the host factors that promote or restrict HIV-1 replication may thus lead to the development of novel therapeutics against HIV/AIDS. © 2009 Elsevier B.V. All rights reserved.


Cerebrospinal fluid (CSF) analysis is of utmost importance to establish an early diagnosis of central nervous system (CNS) infections and to start appropriate therapy. The CSF white cell count, lactate concentration and total protein levels are usually available very quickly even from non-specialized laboratories and the combination of these parameters often provides sufficient information for decision-making in emergency cases. It is, however, not always possible to identify the underlying infective agent despite further CSF analyses, such as bacterial and fungal staining, evaluation of the blood-CSF barrier function, intrathecal immunoglobulin synthesis and oligoclonal IgG bands. Therefore, close communication between the laboratory and the clinician is an important prerequisite to specify additional pathogen-related diagnostic measures for successful confirmation of the diagnosis.


In this study, we evaluated the frequency and prognostic impact of DNMT3A mutations (DNMT3A(mut)) in 1770 younger adult patients with acute myeloid leukemia (AML) in the context of other genetic alterations and the European LeukemiaNet (ELN) classification. DNMT3A(mut) were found in 20.9% of AMLs and were associated with older age (P < .0001), higher white blood cell counts (P < .0001), cytogenetically normal AML (CN-AML; P < .0001), NPM1 mutations (P < .0001), FLT3 internal tandem duplications (P < .0001), and IDH1/2 mutations (P < .0001). In univariable and multivariable analyses, DNMT3A(mut) did not impact event-free, relapse-free (RFS), or overall survival (OS) in either the entire cohort or in CN-AML; a negative prognostic effect was found only in the ELN unfavorable CN-AML subset (OS, P = .011). In addition, R882 mutations vs non-R882 mutations showed opposite clinical effects-unfavorable for R882 on RFS (all: hazard ratio [HR], 1.29 [P = .026]; CN-AML: HR, 1.38 [P = .018]) and favorable for non-R882 on OS (all: HR, 0.77 [P = .057]; CN-AML: HR, 0.73 [P = .083]). In our statistically high-powered study with minimized selection bias, DNMT3A(mut) represent a frequent genetic lesion in younger adults with AML but have no significant impact on survival end points; only moderate effects on outcome were found, depending on molecular subgroup and DNMT3A(mut) type.


Harter G.,Universitatsklinikum Ulm | Michel D.,Universitatsklinikum Ulm
Expert Opinion on Pharmacotherapy | Year: 2012

This editorial summarizes recent developments in the management of ganciclovir-resistant human cytomegalovirus (HCMV) infections. All current drugs available for systemic treatment, including ganciclovir (GCV), valganciclovir, foscarnet and cidofovir, target the viral polymerase. However, all such compounds are hampered by dose-related toxicities and the emergence of resistance. Different approaches (e.g., PCR-based direct sequencing, pyrosequencing, mass spectrometry-based comparative sequencing) allow the fast detection of resistant HCMV and are well suited to therapy monitoring. However, more studies are required on the dynamic of mixed HCMV populations under drug pressure. Alternate antiviral compounds with new mechanisms of action, such as artesunate, leflunomid, letermovir and maribavir, are now being investigated in clinical studies. An advantage of some of the new substances is lesser toxicity issues, which might lead to new prophylactic and treatment strategies. © 2012 Informa UK, Ltd.

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