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Aspiration pneumonia is a common cause of death in dysphagia patients. In this review, we investigate whether a structured oral care approach can help to reduce pneumonia risk in dysphagic patients. In addition, guidelines for the implementation of oral care on the basis of the analyzed studies are presented. Oral care has positive effects on the risk of pneumonia in dysphagia patients. Oral care should be based on the principles of simplicity, safety, efficiency and effectiveness, universality and economy and it should include all parts of the oral cavity. Effective oral care takes less than five minutes a day. The tactile stimulation prepares the patient for dysphagia therapy and can be considered wisely-invested time., Aspirationspneumonien sind eine häufige Todesursache bei Dysphagiepatient*innen. In diesem Beitrag wird durch die Evaluation relevanter Studien die Frage untersucht, ob die therapeutische Mundpflege bei Dysphagiepatient*innen zur Verringerung des Pneumonierisikos beitragen kann. Zudem wird auf dieser Grundlage eine Handlungsempfehlung für die Umsetzung der Mundpflege entwickelt. Die ausgewählten Studien zeigen, dass die Mundpflege einen positiven Effekt auf das Pneumonie-Risiko von Dysphagiepatient*innen hat. Sie sollte auf den Grundsätzen Einfachheit, Sicherheit, Arbeitskräfteentlastung, Wirksamkeit, Universalität, Wirtschaftlichkeit und vollständige Mundpflege aller Teile der Mundhöhle beruhen und nimmt weniger als fünf Minuten täglich ein. Sie bereitet durch die taktile Stimulation auf die anschließende Dysphagie-Therapie vor und ist somit sinnvoll investierte Therapiezeit.

BACKGROUND Dysphagia is a major clinical concern in multiple system atrophy (MSA). A detailed evaluation of its major endoscopic features compared with Parkinson's disease (PD) is lacking. OBJECTIVE This study systematically assessed dysphagia in MSA compared with PD and correlated subjective dysphagia to objective endoscopic findings. METHODS Fifty-seven patients with MSA (median, 64 [interquartile range (IQR): 59-71] years; 35 women) underwent flexible endoscopic evaluation of swallowing using a specific MSA-flexible endoscopic evaluation of swallowing task protocol. Findings were compared with an age-matched cohort of 57 patients with PD (median, 67 [interquartile range: 60-73] years; 28 women). In a subcohort, subjective dysphagia was assessed using the Swallowing Disturbance Questionnaire and correlated to endoscopy findings. RESULTS Patients with MSA predominantly showed symptoms suggestive of oral-phase disturbance (premature spillage, 75.4%, piecemeal deglutition, 75.4%). Pharyngeal-phase symptoms occurred less often (pharyngeal residues, 50.9%; penetration/aspiration, 28.1%). In contrast, pharyngeal symptoms were the most common finding in PD (pharyngeal residues, 47.4%). Oral symptoms occurred less frequently in PD (premature spillage, 15.8%, P

Die Therapie von Dysphagien (Schluckstörungen) stellt das multiprofessionelle Team vor Herausforderungen. Die Komplexität des Schluckvorgangs muss berücksichtigt werden. Nur so kann es gelingen, Pathomechanismen zu identifizieren und eine effiziente Therapie anzubieten. Unter Berücksichtigung der spezifischen Merkmale des Systems Schlucken werden evidenzbasierte Therapieverfahren etabliert. Traditionelle Therapieansätze mit dem Fokus auf Kräftigung der schluckrelevanten Muskulatur werden diesem komplexen Anspruch nicht gerecht.

Background Nitrogen dioxide (NO2) triggers hypersensitive response (HR)-like cell death in Arabidopsis thaliana. A high-throughput mutant screen was established to identify genes involved in this type of programmed cell death. Results Altogether 14,282 lines of SALK T-DNA insertion mutants were screened. Growing 1000 pooled mutant lines per tray and simultaneous NO2 fumigation of 4 trays in parallel facilitated high-throughput screening. Candidate mutants were selected based on visible symptoms. Sensitive mutants showed lesions already after fumigation for 1 h with 10 ppm (ppm) NO2 whereas tolerant mutants were hardly damaged even after treatment with 30 ppm NO2. Identification of T-DNA insertion sites by adapter ligation-mediated PCR turned out to be successful but rather time consuming. Therefore, next generation sequencing after T-DNA-specific target enrichment was tested as an alternative screening method. The targeted genome sequencing was highly efficient due to (1.) combination of the pooled DNA from 124 candidate mutants in only two libraries, (2.) successful target enrichment using T-DNA border-specific 70mer probes, and (3.) stringent filtering of the sequencing reads. Seventy mutated genes were identified by at least 3 sequencing reads. Ten corresponding mutants were re-screened of which 8 mutants exhibited NO2-sensitivity or -tolerance confirming that the screen yielded reliable results. Identified candidate genes had published functions in HR, pathogen resistance, and stomata regulation. Conclusions The presented NO2 dead-or-alive screen combined with next-generation sequencing after T-DNA-specific target enrichment was highly efficient. Two researchers finished the screen within 3 months. Moreover, the target enrichment approach was cost-saving because of the limited number of DNA libraries and sequencing runs required. The experimental design can be easily adapted to other screening approaches e.g. involving high-throughput treatments with abiotic stressors or phytohormones.

Coronavirus disease 2019 (COVID-19) can lead to severe disease courses with multiple organ involvement, respiratory and neurological functional impairments. Swallowing disorders (dysphagia) in this patient group can result from primary damage to the central and peripheral neuronal swallowing network but also from the frequently prolonged intensive care treatment and mechanical ventilation. Clinical observations indicate persistence of dysphagia in post-acute COVID-19 syndrome (long COVID), so that these patients probably also need long-term interventions for rehabilitation of safe and sufficient oral feeding. Therefore, structured disease-specific monitoring of dysphagia symptoms should be integrated into the treatment of COVID-19 patients and respiratory therapy should be an essential part of dysphagia management to re-establish cough effectiveness and breathing-swallowing coordination. Challenges arise from necessary adjustments to established treatment standards to prevent infections. Furthermore, the selection and intensity of therapeutic measures have to be adapted to the capacities and the specific pathophysiology of COVID-19 and long COVID patients to prevent further functional deterioration.Eine COVID-19-Erkrankung kann zu schweren Krankheitsverläufen mit multiplen Organbeteiligungen und respiratorischen und neurologischen Funktionseinschränkungen führen. Schluckstörungen (Dysphagien) können in dieser Patientengruppe durch primäre Schädigungen des zentralen und peripheren neuronalen Netzwerkes der Schluckfunktion entstehen, aber auch bedingt durch die häufig längere intensivmedizinische Behandlung und Beatmung. Erste klinische Befunde zeigen persistierende Dysphagien im Rahmen des Post-COVID-Syndroms („Long-COVID“), sodass die Patienten auch längerfristige Maßnahmen zur Rehabilitation einer sicheren und suffizienten oralen Nahrungsaufnahme benötigen. Daher sollte in die Behandlung von COVID-19-Patienten ein strukturiertes erkrankungsspezifisches Monitoring in Bezug auf Dysphagiesymptome integriert werden, und atemtherapeutische Maßnahmen zur Regulation von Husteneffektivität und Atem-Schluck-Koordination sollten auch bei diesen Patienten essenzieller Bestandteil des Dysphagiemanagements sein. Herausforderungen ergeben sich dabei einerseits durch die erforderlichen Anpassungen etablierter Behandlungsstandards an den Infektionsschutz. Zudem müssen Auswahl und Durchführungsintensität therapeutischer Maßnahmen an die Kapazitäten und die spezifische Pathophysiologie der COVID-19- und Long-COVID-Patienten angepasst werden, um weitere funktionelle Verschlechterungen zu vermindern.

Research Objectives Objectives: SARA is a clinical tool designed to assess concerns of aspiration during the pharyngeal phase of swallowing. The study was implemented to assess the intra-rater and inter-rater reliability of the scale in children with cerebral palsy (CP). We were also able to demonstrate the feasibility of scoring from videorecorded mealtimes, which indicates the application of this tool in a pandemic situation like COVID. Design Mixed methods. Setting Pragmatic. Without direction or change in position, children were fed four different food textures. The use of videorecorded mealtimes to evaluate swallowing would be comparable to administering the tool during a telehealth session. Participants SARA trained SLPs (n=4) scored the mealtime videos of parent/caregivers administering four different textures (up to 5 trials/texture) to 66 children with CP (ages 24 - 83 months). Thirteen videos (n = 214 trials) were used to establish intra-rater reliability and 12 videos (n = 195 trials) were used to calculate inter-rater reliability. Interventions Not applicable. Main Outcome Measures Not applicable. Results The intra-rater reliability was excellent for total score (ICC = .996) and for item score (ICC = .94). The swallowing behavior identification was substantial (Cohen's Kappa = .74). The inter-rater reliability was excellent for SARA total score (ICC = .917), acceptable for item score (ICC = .704), but fair for swallowing behaviors identification (Fleiss’ Kappa = .371). Conclusions The SARA standardized definitions demonstrate this may be a reliable tool for clinicians to identify aspiration risk in children with CP even in a telehealth setting. Owing to the low item identification behavior reliability, the next study should standardize the swallowing definitions using an expert panel of professionals working with dysphagia. Author(s) Disclosures No conflicts.

BACKGROUND Common ragweed has been spreading as a neophyte in Europe. Elevated CO2 levels, a hallmark of global climate change, have been shown to increase ragweed pollen production, but their effects on pollen allergenicity remain to be elucidated. METHODS Ragweed was grown in climate-controlled chambers under normal (380 ppm, control) or elevated (700 ppm, based on RCP4.5 scenario) CO2 levels. Aqueous pollen extracts (RWE) from control- or CO2 -pollen were administered in vivo in a mouse model for allergic disease (daily for 3-11 days, n = 5) and employed in human in vitro systems of nasal epithelial cells (HNECs), monocyte-derived dendritic cells (DCs), and HNEC-DC co-cultures. Additionally, adjuvant factors and metabolites in control- and CO2 -RWE were investigated using ELISA and untargeted metabolomics. RESULTS In vivo, CO2 -RWE induced stronger allergic lung inflammation compared to control-RWE, as indicated by lung inflammatory cell infiltrate and mediators, mucus hypersecretion, and serum total IgE. In vitro, HNECs stimulated with RWE increased indistinctively the production of pro-inflammatory cytokines (IL-8, IL-1β, and IL-6). In contrast, supernatants from CO2 -RWE-stimulated HNECs, compared to control-RWE-stimulated HNECS, significantly increased TNF and decreased IL-10 production in DCs. Comparable results were obtained by stimulating DCs directly with RWEs. The metabolome analysis revealed differential expression of secondary plant metabolites in control- vs CO2 -RWE. Mixes of these metabolites elicited similar responses in DCs as compared to respective RWEs. CONCLUSION Our results indicate that elevated ambient CO2 levels elicit a stronger RWE-induced allergic response in vivo and in vitro and that RWE increased allergenicity depends on the interplay of multiple metabolites.

BACKGROUND Simple water-swallowing screening tools are not predictive of aspiration and dysphagia in patients with Parkinson's Disease (PD). We investigated the diagnostic accuracy of a multi-texture screening tool, the Gugging Swallowing Screen (GUSS) to identify aspiration and dysphagia/penetration in PD patients compared to flexible endoscopic evaluation of swallowing (FEES). METHODS Swallowing function was evaluated in 51 PD participants in clinical 'on-medication' state with the GUSS and a FEES examination according to standardized protocols. Inter-rater reliability and convergent validity were determined and GUSS- and FEES-based diet recommendations were compared. KEY RESULTS Inter-rater reliability of GUSS ratings was high (rs = 0.8; p

Purpose: Dysphagia is common in patients with Parkinson's disease (PD) and often leads to pneumonia, malnutrition, and reduced quality of life. This study investigates the ability of the Eating Assessment Tool-10 (EAT-10), an established, easy self-administered screening tool, to detect aspiration in PD patients. This study aims to validate the ability of the EAT-10 to detect FEES-proven aspiration in patients with PD. Methods: In a controlled prospective cross-sectional study, a total of 50 PD patients completed the EAT-10 and, subsequently, were examined by Flexible Endoscopic Evaluation of Swallowing (FEES) to determine the swallowing status. The results were rated through the Penetration-Aspiration Scale (PAS) and data were analyzed retrospectively. Results: PAS and EAT-10 did not correlate significantly. Selected items of the EAT-10 could not predict aspiration or residues. 19 (38%) out of 50 patients with either penetration or aspiration were not detected by the EAT-10. The diagnostic accuracy was established at only a sufficient level (AUC 0.65). An optimal cut-off value of >= 6 presented a sensitivity of 58% and specificity of 82%. Conclusions: The EAT-10 is not suited for the detection of penetration and aspiration in PD patients. Therefore, it cannot be used as a screening method in this patient population. There is still a need for a valid, simple, and efficient screening tool to assist physicians in their daily diagnostics and to avoid clinical complications.

Common ragweed has been spreading as a neophyte in Europe. Elevated CORagweed was grown in climate-controlled chambers under normal (380 ppm, control) or elevated (700 ppm, based on RCP4.5 scenario) COIn vivo, COOur results indicate that elevated ambient CO

Environmental factors affect the health and wellbeing of urban residents. However, they do not act individually on humans, but instead show potential synergistic or antagonistic effects. Questions that arise from this are: How does a combination of air pollutants with other environmental factors impact health? How well are these associations evidenced? What methods can we use to look at them? In this article, methodical approaches regarding the effects of a combination of various environmental factors are first described. Environmental factors are then examined, which together with different air pollutants, have an impact on human health such as ambient temperature, noise, and pollen as well as the effect of green spaces. Physical activity and nutrition are addressed regarding the attenuation of health effects from air pollution.While there is often clear evidence of health effects of single environmental stressors, there are still open questions in terms of their interaction. The research methods required for this still need to be further developed. The interrelationship between the different environmental factors make it clear that (intervention) measures for reducing single indicators are also interlinked. Regarding traffic, switching from passive to active transport (e.g., due to safe cycle paths and other measures) leads to less air pollutants, smaller increases in temperature in the long term, and at the same time improved health of the individual. As a result, sensible planning of the built environment has great potential to reduce environmental stressors and improve people's health and wellbeing.Umweltfaktoren wirken sich auf Gesundheit und Wohlbefinden der Bewohnerinnen und Bewohner von Städten aus. Sie wirken jedoch nicht nur einzeln auf den Menschen, sondern zeigen mögliche synergistische oder antagonistische Effekte. Fragen, die sich daraus ergeben, sind: Wie wirkt eine Kombination von Luftschadstoffen mit anderen Umweltfaktoren auf die Gesundheit? Wie gut sind diese Zusammenhänge belegt? Wie können diese methodisch betrachtet werden? In diesem Beitrag werden zunächst methodische Ansätze zur Untersuchung von Kombinationswirkungen verschiedener Umweltfaktoren beschrieben. Anschließend werden Umweltfaktoren untersucht, die zusammen mit verschiedenen Luftschadstoffen auf die menschliche Gesundheit wirken, wie Außentemperatur, Lärm und Pollen sowie das Vorhandensein von Grünflächen. Körperliche Betätigung und Ernährung werden in Bezug auf die Minderung von gesundheitlichen Luftschadstoffeffekten angesprochen.Während für die Gesundheitseffekte der einzelnen Umweltstressoren häufig klare Evidenz vorliegt, sind für ihr Zusammenspiel inhaltlich noch nicht alle Fragen konsistent beantwortet. Die (statistischen) Methoden müssen noch weiterentwickelt werden. Das Verhältnis der unterschiedlichen Umweltfaktoren zueinander macht deutlich, dass auch (Interventions‑)Maßnahmen zur Verringerung einzelner Faktoren zusammenhängen. So führt etwa im Verkehr der Umstieg von passivem auf aktiven Transport (z. B. durch sichere Radwege und weitere Maßnahmen) zu weniger Luftschadstoffen, langfristig zu geringeren Erhöhungen der Lufttemperatur und gleichzeitig zu einer Verbesserung der Gesundheit des Einzelnen. Demzufolge liegt in einer sinnvollen Planung der bebauten Umwelt ein großes Potenzial zur Reduktion der Umweltstressoren und zur Verbesserung der Gesundheit und des Wohlbefindens der Menschen.

Environmental factors affect the health and wellbeing of urban residents. However, they do not act individually on humans, but instead show potential synergistic or antagonistic effects. Questions that arise from this are: How does a combination of air pollutants with other environmental factors impact health? How well are these associations evidenced? What methods can we use to look at them? In this article, methodical approaches regarding the effects of a combination of various environmental factors are first described. Environmental factors are then examined, which together with different air pollutants, have an impact on human health such as ambient temperature, noise, and pollen as well as the effect of green spaces. Physical activity and nutrition are addressed regarding the attenuation of health effects from air pollution. While there is often clear evidence of health effects of single environmental stressors, there are still open questions in terms of their interaction. The research methods required for this still need to be further developed. The interrelationship between the different environmental factors make it clear that (intervention) measures for reducing single indicators are also interlinked. Regarding traffic, switching from passive to active transport (e.g., due to safe cycle paths and other measures) leads to less air pollutants, smaller increases in temperature in the long term, and at the same time improved health of the individual. As a result, sensible planning of the built environment has great potential to reduce environmental stressors and improve people’s health and wellbeing Umweltfaktoren wirken sich auf Gesundheit und Wohlbefinden der Bewohnerinnen und Bewohner von Städten aus. Sie wirken jedoch nicht nur einzeln auf den Menschen, sondern zeigen mögliche synergistische oder antagonistische Effekte. Fragen, die sich daraus ergeben, sind: Wie wirkt eine Kombination von Luftschadstoffen mit anderen Umweltfaktoren auf die Gesundheit? Wie gut sind diese Zusammenhänge belegt? Wie können diese methodisch betrachtet werden? In diesem Beitrag werden zunächst methodische Ansätze zur Untersuchung von Kombinationswirkungen verschiedener Umweltfaktoren beschrieben. Anschließend werden Umweltfaktoren untersucht, die zusammen mit verschiedenen Luftschadstoffen auf die menschliche Gesundheit wirken, wie Außentemperatur, Lärm und Pollen sowie das Vorhandensein von Grünflächen. Körperliche Betätigung und Ernährung werden in Bezug auf die Minderung von gesundheitlichen Luftschadstoffeffekten angesprochen. Während für die Gesundheitseffekte der einzelnen Umweltstressoren häufig klare Evidenz vorliegt, sind für ihr Zusammenspiel inhaltlich noch nicht alle Fragen konsistent beantwortet. Die (statistischen) Methoden müssen noch weiterentwickelt werden. Das Verhältnis der unterschiedlichen Umweltfaktoren zueinander macht deutlich, dass auch (Interventions‑)Maßnahmen zur Verringerung einzelner Faktoren zusammenhängen. So führt etwa im Verkehr der Umstieg von passivem auf aktiven Transport (z. B. durch sichere Radwege und weitere Maßnahmen) zu weniger Luftschadstoffen, langfristig zu geringeren Erhöhungen der Lufttemperatur und gleichzeitig zu einer Verbesserung der Gesundheit des Einzelnen. Demzufolge liegt in einer sinnvollen Planung der bebauten Umwelt ein großes Potenzial zur Reduktion der Umweltstressoren und zur Verbesserung der Gesundheit und des Wohlbefindens der Menschen

The Test of Masticating and Swallowing Solids (TOMASS) is a validated assessment tool measuring the efficiency of solid bolus intake by four quantitative parameters: discrete bites, masticatory cycles, swallows and time to ingest a single cracker. A normative database for adults (20-80+ years) has previously been established. The objective of this study was to investigate the applicability and reliability of the TOMASS in children and adolescents (TOMASS-C) and to establish the normative database for this younger population. We collected data from 638 participants (male: 311, female: 327) in five age groups (4-18 years) with five different but very similar test crackers in four countries. Significant effects of bolus type (cracker), age group and gender on the TOMASS parameters were identified, requiring stratification of the TOMASS-C database by these variables. Intra-rater reliability was excellent (ICC > 0.94) for all parameters; inter-rater reliability was moderate for "number of swallows" (ICC = 0.54), good for "bites" (ICC = 0.78) and "time" (ICC = 0.82), and excellent for "masticatory cycles" (ICC = 0.96). The "Test of Masticating and Swallowing Solids in Children (TOMASS-C)" was identified to be a reliable diagnostic tool for the comprehensive measurement of discrete oral stage components of solid bolus ingestion, standardised by a large normative database that covers age groups from preschoolers to young adults. While differences between gender groups were less pronounced than in the adult population, previous results relating to changes in masticatory and swallowing as a function of age are confirmed by our data.

Background Clinical swallowing assessment is largely limited to qualitative assessment of behavioural observations. There are limited quantitative data that can be compared with a healthy population for identification of impairment. The Test of Masticating and Swallowing Solids (TOMASS) was developed as a quantitative assessment of solid bolus ingestion. Aims This research programme investigated test development indices and established normative data for the TOMASS to support translation to clinical dysphagia assessment. Methods & Procedures A total of 228 healthy adults (ages 20–80+ years) stratified by age and sex participated in one or more of four consecutive studies evaluating test–retest and interrater reliability and validity to instrumental assessment. For each study the test required participants to ingest a commercially available cracker with instructions to ‘eat this as quickly as is comfortably possible’. Further averaged measures were derived including the number of masticatory cycles and swallows per bite, and time per bite, masticatory cycle and swallow. Initial analyses identified significant differences on salient measures between two commercially available crackers that are nearly identical in shape, size and ingredients, suggesting the need for separate normative samples for specific regional products. Additional analyses on a single cracker identified that the TOMASS was sensitive at detecting changes in performance based on age and sex. Test–retest reliability across days and interrater reliability between clinicians was high, as was validation of observational measures to instrumental correlates of the same behaviours. Therefore, normative data are provided for the TOMASS from a minimum of 80 healthy controls, stratified by age and sex, for each of seven commercially available crackers from broad regions worldwide. Outcomes & Results Analyses on a single cracker identified Arnott's Salada, and that TOMASS measures were sensitive for detecting changes in performance based on age and sex. Interrater and test–retest reliability across days were high, as was validation of observational measures to instrumental correlates of the same behaviours. Significant differences were identified between two commercially available crackers, nearly identical in shape, size and ingredients, thus normative samples for specific regional products were required. Normative data were then acquired for the TOMASS from a minimum of 80 healthy controls, stratified by age and sex, for each of seven commercially available crackers from broad regions worldwide. Conclusions & Implications The TOMASS is presented as a valid, reliable and broadly normed clinical assessment of solid bolus ingestion. Clinical application may help identify dysphagic patients at bedside and provide a non-invasive, but sensitive, measure of functional change in swallowing.

Common ragweed (Ambrosia artemisiifolia L.) is a highly allergenic annual ruderal plant and native to Northern America, but now also spreading across Europe. Air pollution and climate change will not only affect plant growth, pollen production and duration of the whole pollen season, but also the amount of allergenic encoding transcripts and proteins of the pollen. The objective of this study was to get a better understanding of transcriptional changes in ragweed pollen upon NO2 and O3 fumigation. This will also contribute to a systems biology approach to understand the reaction of the allergenic pollen to air pollution and climate change. Ragweed plants were grown in climate chambers under controlled conditions and fumigated with enhanced levels of NO2 and O3. Illumina sequencing and de novo assembly revealed significant differentially expressed transcripts, belonging to different gene ontology (GO) terms that were grouped into biological process and molecular function. Transcript levels of the known Amb a ragweed encoding allergens were clearly up-regulated under elevated NO2, whereas the amount of allergen encoding transcripts was more variable under elevated O3 conditions. Moreover transcripts encoding allergen known from other plants could be identified. The transcriptional changes in ragweed pollen upon elevated NO2 fumigation indicates that air pollution will alter the transcriptome of the pollen. The changed levels of allergenic encoding transcripts may have an influence on the total allergenic potential of ragweed pollen.

Ragweed pollen is the main cause of allergenic diseases in Northern America, and the weed has become a spreading neophyte in Europe. Climate change and air pollution are speculated to affect the allergenic potential of pollen. The objective of this study was to investigate the effects of NO2 , a major air pollutant, under controlled conditions, on the allergenicity of ragweed pollen. Ragweed was exposed to different levels of NO2 throughout the entire growing season, and its pollen further analysed. Spectroscopic analysis showed increased outer cell wall polymers and decreased amounts of pectin. Proteome studies using two-dimensional difference gel electrophoresis and liquid chromatography-tandem mass spectrometry indicated increased amounts of several Amb a 1 isoforms and of another allergen with great homology to enolase Hev b 9 from rubber tree. Analysis of protein S-nitrosylation identified nitrosylated proteins in pollen from both conditions, including Amb a 1 isoforms. However, elevated NO2 significantly enhanced the overall nitrosylation. Finally, we demonstrated increased overall pollen allergenicity by immunoblotting using ragweed antisera, showing a significantly higher allergenicity for Amb a 1. The data highlight a direct influence of elevated NO2 on the increased allergenicity of ragweed pollen and a direct correlation with an increased risk for human health.

Common ragweed (Ambrosia artemisiifolia L.) is a highly allergenic annual ruderal plant and native to Northern America, but now also spreading across Europe. Air pollution and climate change will not only affect plant growth, pollen production and duration of the whole pollen season, but also the amount of allergenic encoding transcripts and proteins of the pollen. The objective of this study was to get a better understanding of transcriptional changes in ragweed pollen upon NO

This mini-review summarizes the available data of the air pollutants NO2 and ozone on allergenic pollen from different plant species, focusing on potentially allergenic components of the pollen, such as allergen content, protein release, IgE-binding, or protein modification. Various in vivo and in vitro studies on allergenic pollen are shown and discussed.

Pollen allergies have been rapidly increasing over the last decades. Many allergenic proteins and non-allergenic adjuvant compounds of pollen are involved in the plant defense against environmental or microbial stress. The first aim of this study was to analyze and compare the colonizing microbes on allergenic pollen. The second aim was to investigate detectable correlations between pollen microbiota and parameters of air pollution or pollen allergenicity. To reach these aims, bacterial and fungal DNA was isolated from pollen samples of timothy grass (Phleum pratense, n = 20) and birch trees (Betula pendula, n = 55). With this isolated DNA, a terminal restriction fragment length polymorphism analysis was performed. One result was that the microbial diversity on birch tree and timothy grass pollen samples (Shannon/Simpson diversity indices) was partly significantly correlated to allergenicity parameters (Bet v 1/Phl p 5, pollen-associated lipid mediators). Furthermore, the microbial diversity on birch pollen samples was correlated to on-site air pollution (nitrogen dioxide (NO2), ammonia (NH3), and ozone (O3)). What is more, a significant negative correlation was observed between the microbial diversity on birch pollen and the measured NO2 concentrations on the corresponding trees. Our results showed that the microbial composition of pollen was correlated to environmental exposure parameters alongside with a differential expression of allergen and pollen-associated lipid mediators. This might translate into altered allergenicity of pollen due to environmental and microbial stress.

Background: The Borderline Symptom List (BSL) was developed as a self-rating instrument to specifically quantify borderline-typical symptomatology. The items are based on the criteria of the DSM-IV, the Diagnostic Interview for Borderline Personality Disorder – revised version, the opinions of clinical experts and borderline patients. The psychometric properties and validity of the BSL have been investigated in several studies. Sampling and Methods: A total of 380 borderline patients and 204 healthy controls scored the items. A factor analysis of the BSL items suggests the following subscales: ‘self-perception’, ‘affect regulation’, ‘self-destruction’, ‘dysphoria’, ‘loneliness’, ‘intrusions’ and ‘hostility’. Results: Theinternal reliability as well as the test-retest reliability within 1 week are high. Different aspects of validity (e.g. comparison between groups) provide favorable results. Pre-post comparisons after 3 months of dialectical behavioral treatment reveal a significant reduction of the total score and of 5 of the 7 subscales. Conclusions: This indicates that the BSL is sensitive to therapeutically induced change of borderline-typical impairment.

Background B cells play a central role in IgE-mediated allergies. In damaged airway epithelium, they are exposed directly to aeroallergens. We aimed to assess whether direct exposure of B cells to pollen constituents affects allergic sensitization. Methods B cells from murine splenocytes and from blood samples of healthy donors were incubated for 8 days under Th2-like conditions with aqueous ragweed pollen extracts (Amb-APE) or its constituents. Secreted total IgM, IgG, and IgE was quantified by ELISA. Additionally, birch, grass, or pine-pollen extracts were tested. The number of viable cells was evaluated by ATP measurements. B-cell proliferation was measured by CFSE staining. IgE class switch was analyzed by quantitation of class switch transcripts. In an OVA/Alum i.p.-sensitization mouse model, Amb-APE was intranasally instilled for 11 consecutive days. Results Upon Th2 priming of murine B cells, ragweed pollen extract caused a dose-dependent increase in IgE production, while IgG and IgM were not affected. The low-molecular-weight fraction and phytoprostane E1 (PPE1) increased IgE production, while Amb a 1 did not. PPE1 enhanced IgE also in human memory B cells. Under Th1 conditions, Amb-APE did not influence immunoglobulin secretion. The IgE elevation was not ragweed specific. It correlated with proliferation of viable B cells, but not with IgE class switch. In vivo, Amb-APE increased total IgE and showed adjuvant activity in allergic airway inflammation. Conclusions Aqueous pollen extracts, the protein-free fraction of Amb-APE, and the pollen-contained substance PPE1 specifically enhance IgE production in Th2-primed B cells. Thus, pollen-derived nonallergenic substances might be responsible for B-cell-dependent aggravation of IgE-mediated allergies.

Background Ragweed (Ambrosia artemisiifolia) is a strong elicitor of allergic airway inflammation with worldwide increasing prevalence. Various components of ragweed pollen are thought to play a role in the development of allergic responses. The aim of this study was to identify critical factors for allergenicity of ragweed pollen in a physiological model of allergic airway inflammation. Methods Aqueous ragweed pollen extract, the low molecular weight fraction or the major allergen Amb a 1 was instilled intranasally on 1–11 consecutive days, and allergic airway inflammation was evaluated by bronchoalveolar lavage, lung histology, serology, gene expression in lung tissue, and measurement of lung function. Pollen-derived adenosine was removed from the extract enzymatically to analyze its role in ragweed-induced allergy. Migration of human neutrophils and eosinophils toward supernatants of ragweed-stimulated bronchial epithelial cells was analyzed. Results Instillation of ragweed pollen extract, but not of the major allergen or the low molecular weight fraction, induced specific IgG1, pulmonary infiltration with inflammatory cells, a Th2-associated cytokine signature in pulmonary tissue, and impaired lung function. Adenosine aggravated ragweed-induced allergic lung inflammation. In vitro, human neutrophils and eosinophils migrated toward supernatants of bronchial epithelial cells stimulated with ragweed extract only if adenosine was present. Conclusions Pollen-derived adenosine is a critical factor in ragweed-pollen-induced allergic airway inflammation. Future studies aim at therapeutic strategies to control these allergen-independent pathways.

Objective: Tracheotomized patients often suffer from impairments in mucociliary clearance and limited capacities for active expectoration of secretions. We investigated the effects of a specific respiratory intervention method (bagging) for tracheotomized patients on respiratory parameters (pO(2), pCO(2), SpO(2), respiratory rates), swallowing frequency, vigilance and secretion viscosity. Methods: The bagging method supports enforced mobilization and expectoration of secretions by application of a series of manual hyperinflations with a resuscitation bag during active inspiration and manual cough support on the chest. 30 tracheotomized neurological patients participated in a multiple-baseline study including a three-weeks intervention period and a follow-up measurement three weeks after termination of the treatment. Results: Most outcome parameters improved significantly during the intervention period: pO(2) (p

Die empirischen Forschungsaktivitaten und klinischen Erfahrungen in der Behandlung von Patienten mit Dysphagie haben in den letzten Jahrzehnten unser Verstandnis der funktionellen sensomotorischen Zusammenhange der Schluckfunktion immer weiter vertieft. So wissen wir heute, dass der obere aerodigestive Trakt, der die fur uns uberlebenswichtigen Funktionen der Atmung und der Nahrungsaufnahme koordiniert, die komplexeste neuromuskulare Einheit des menschlichen Korpers ist (Brodsky u. Arvedson 2002, Miller 1999). Dysphagien werden daher als differenzierte Storungsbilder definiert, deren Behandlung die Integration unterschiedlicher interdisziplinarer Expertisen erfordert.

In 2000 a multidisciplinary protocol for weaning dysphagic patients from the tracheotomy tube and a decannulation decision chart created according to principles of the F.O.T.T.((R)) Concept (Face and Oral Tract Therapy) were introduced in the Swiss Neurological Rehabilitation Centre REHAB in Basel. In the present study we introduce these guidelines and present an evaluation of the treatment and decannulation procedure. We retrospectively compared data from patients before and after introduction of the multidisciplinary procedure with regard to mean cannulation times and success of decannulation. Furthermore, we analyzed the rehabilitation progress of the group who underwent multidisciplinary treatment as well as the participation of the speech language therapist. The results show that the treatment introduced to improve swallowing functions and wean patients from the tracheotomy tube led to a fast and safe decannulation of our patients. The mean length of cannulation time was reduced significantly. After decannulation the patients showed clear functional improvements. Interdisciplinary treatment using the approach discussed in this study can be considered efficient and an important basis for further functional progress in the rehabilitation process.

BACKGROUND: Pollen of common ragweed (Ambrosia artemisiifolia) is a main cause of allergic diseases in Northern America. The weed has recently become spreading as a neophyte in Europe, while climate change may also affect the growth of the plant and additionally may also influence pollen allergenicity. To gain better insight in the molecular mechanisms in the development of ragweed pollen and its allergenic proteins under global change scenarios, we generated SuperSAGE libraries to identify differentially expressed transcripts. RESULTS: Ragweed plants were grown in a greenhouse under 380ppm CO2 and under elevated level of CO2 (700ppm). In addition, drought experiments under both CO2 concentrations were performed. The pollen viability was not altered under elevated CO2, whereas drought stress decreased its viability. Increased levels of individual flavonoid metabolites were found under elevated CO2 and/or drought. Total RNA was isolated from ragweed pollen, exposed to the four mentioned scenarios and four SuperSAGE libraries were constructed. The library dataset included 236,942 unique sequences, showing overlapping as well as clear differently expressed sequence tags (ESTs). The analysis targeted ESTs known in Ambrosia, as well as in pollen of other plants. Among the identified ESTs, those encoding allergenic ragweed proteins (Amb a) increased under elevated CO2 and drought stress. In addition, ESTs encoding allergenic proteins in other plants were also identified. CONCLUSIONS: The analysis of changes in the transcriptome of ragweed pollen upon CO2 and drought stress using SuperSAGE indicates that under global change scenarios the pollen transcriptome was altered, and impacts the allergenic potential of ragweed pollen.

The categorical diagnosis of borderline personality disorder (BPD) is currently discussed as sufficiently reliable and valid. However, specific standardized instruments to measure the degree of the symptomatology are currently not available. Based on the criteria of DSM-IV, the Diagnostic Interview for Borderlines (DIB-R) and the opinion of clinical experts and borderline-patients, a self-rating scale was developed to quantify the intrapsychic strain of patients with BPD. 308 female borderline-patients scored the 99 items. Factor analyses revealed seven factors: self-image, affect regulation, autoaggression, dysthymia, social isolation, intrusions and hostility. Analyses of reliability and validity revealed promising results.

Zusammenfassung. Subjektive Gesundheitsvorstellungen, definiert als die Gesamtheit aller gesundheitsbezogenen Vorstellungen, werden in ihrer Bedeutung für die Erklärung eines gesundheitsförderlichen Lebensstils diskutiert und können einen Beitrag für die wissenschaftliche Fundierung subjektorientierter Angebote zur Gesundheitsförderung und Gesundheitsbildung leisten. In einer kombinierten Fragebogen- und Interviewstudie werden die subjektiven Gesundheitsvorstellungen (u. a. Gesundheitsdefinitionen, gesundheitsbezogene Einflußfaktoren) und der gesundheitsförderliche Lebensstil von N = 169 Herzinfarktpatienten und -patientinnen zu drei Erhebungszeitpunkten (Beginn und Ende der stationären Rehabilitation sowie sechs Monate nach Ende der Rehabilitation) erfaßt. Patienten und Patientinnen nach einem Herzinfarkt verfügen, ebenso wie gesunde Menschen, über mehrdimensionale und überwiegend positiv formulierte Gesundheitsdefinitionen und haben differenzierte Vorstellungen hinsichtlich positiver und negativer Einflüsse auf die Gesundheit. Personen mit einem ausgeprägteren gesundheitsförderlichen Lebensstil nehmen ihren persönlichen Lebensstil sowie die soziale Unterstützung als wichtige Einflußfaktoren für ihre Gesundheit wahr und haben eine höhere allgemeine Selbstwirksamkeitserwartung.

Der Chemieunfall in Seveso 1976 war eine der gr6f~ten Umweltkatastrophen Europas. Durch die extreme Giftigkeit der ausgetretenen polychlorierten Dibenzodioxine nahm die Offentlichkeit pl6tzlich das Thema Chemikaliensicherheit wahr. Wie so oft in solchen F~illen reagierte der Gesetzgeber darauf und erweiterte die europfiische Kennzeichnungsrichtlinie um ein Anmeldeverfahren for neu zu vermarktende Chemikalien. Als das deutsche Chemikaliengesetz am 1. Januar 1982 in Kraft trat, begann ein neues Rechtsgebiet, das nut in Teilbereichen auf Vorg~inger zurOckblicken konnte.

REACH establishes a new principle for assessing the risks of chemicals towards humans and the environment: producers and importers of substances bear the main weight of the new substance stewardship. They have to register the substances which are produced or imported with the central EU Chemicals Agency. This includes consideration of uses and possible releases of the chemical throughout the product chain. In addition, producers and importers of chemicals have to ensure that management measures are adequate to control the associated risks over the life-cycle of the chemical. By introducing the 'no data - no market' principle REACH intends to build a dynamic system of growing risk knowledge and risk control for chemicals. In turn, authorities will withdraw from compiling detailed risk assessments and risk reduction strategies. Local, reversible risks and point emission sources will no longer be a topic of expert committees at EU level. During the registration procedure authorities might serve as helpers e.g. by establishing help-desks to support the compilation of the registration dossiers. For the evaluation step of REACH authorities will be able to concentrate on substances and uses of high concern which pose a risk to humans and the environment. Where risks are identified as not adequately controlled and therefore needing regulation at Community level, authorities will propose the respective substances as candidates for authorisation. In addition authorities might suggest restrictions for certain uses. For these legal elements the responsibility still lies with the authorities. Chemicals with persistent, bioaccumulative and toxic properties (PBT-substances) are considered as substances of very high concern and therefore should be subject to authorisation. Producers and importers are required to identify potential PBT-substances in the registration dossiers. Since the responsibility for introducing legal measures remains with the authorities, they also need to implement mechanisms to identify potential candidates during the evaluation procedure.