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In der neurologischen Rehabilitation werden in zunehmendem Maße tracheotomierte Patienten mit schweren Dysphagien behandelt. Daher sollte den hierzu bisher entwickelten Interventionsverfahren eine evidenzbasierte Grundlage gegeben werden. In der vorliegenden Arbeit wird ein multidisziplinärer Behandlungsansatz zur Trachealkanülenentwöhung und Dekanülierung vorgestellt, der auf der Grundlage der relevanten Forschungsliteratur und klinischen Beobachtungen entwickelt wurde. Des Weiteren wird erstmals eine systematische Evaluation eines multidisziplinären Trachealkanülenmangements vorgenommen und es werden explorative Daten zum Rehabilitationsverlauf dargestellt. In einem retrospektiven Vergleich wurden hierzu die Dekanülierungs- und Komplikationsraten sowie die Dauer der Trachealkanülenentwöhnung zweier Patientengruppen gegenübergestellt, die vor bzw. nach Einführung des beschriebenen multidisziplinären Trachealkanülenmanagements im REHAB Basel, Schweiz, behandelt wurden. Der rehabilitative Verlauf der multidisziplinär behandelten Gruppe wurde mittels der Messinstrumente FIM (Functional Independence Measure) und EFA (Early Functional Abilities) untersucht. Der Vergleich der Dekanülierungs- und Komplikationsraten ergab eine vergleichbare Effektivität der beiden Behandlungsansätze. Darüber hinaus zeigte sich eine signifikante Verkürzung der Kanülenentwöhnungsphase bei Anwendung des multidisziplinären Vorgehens, so dass dieses als effizenter zu beurteilen ist. Die Verlaufsanalyse der multidisziplinär behandelten Patienten ergab erst nach der Dekanülierung einen signifikanten Zuwachs der funktionellen Selbständigkeit in Alltagsaktivitäten. Bei der Mehrzahl der Patienten konnte ein vollständiger oraler Kostaufbau nach der Dekanülierung erreicht werden.
Invasive alien species pose a great threat to the integrity of natural communities by competition with and predation on native species. In Germany the invasive raccoon dog (Nyctereutes procyonoides) and the native red fox (Vulpes vulpes) occupy a similar ecological niche. Therefore, the aim of our study was to discover the extent of exploitative diet competition between these two generalist carnivores. Carcasses of red foxes (n=256) and raccoon dogs (n=253) were collected throughout Mecklenburg Western-Pomerania (north-east Germany) and stomachs contains were analysed. Frequency of occurrence and biomass share indicate that both canids are omnivorous and pursue opportunistic feeding strategies. Small mammals and edible plant material were the most important food resources for red foxes and raccoon dogs. Nonetheless, interspecies differences were recorded for edible plant material, small mammals and insects. While red foxes mostly feed on voles, raccoon dogs consumed mice and shrews as often as voles. Only raccoon dogs preyed on amphibians. There were no differences in carrion consumption, both species scavenged on wild boar and we found clear competition for carrion year-round. Moreover, there was evidence that two red foxes foraged on raccoon dogs and vice versa. The mean annual interspecies diet overlap index was relatively high. The diets determined for raccoon dogs and red foxes were quite similar and a similar food niche breadth was recorded. However, only minor competition is assumed to take place since differences in feeding habits do exist.
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 (r(s) = 0.8; p < 0.001). Aspiration was identified by the GUSS with a sensitivity of 50%, and specificity of 51.35% (PPV 28%, NPV 73%, LR+ 1.03, LR- 0.97), dysphagia/penetration was identified with 72.97% sensitivity and 35.71% specificity (PPV 75%, NPV 33.33%, LR+ 1.14, LR- 0.76). Agreement between GUSS- and FEES-based diet recommendations was low (r(s) = 0.12, p = 0.42) with consistent NPO (Nil per Os) allocation by GUSS and FEES in only one participant.
Conclusions and Inferences
The multi-texture screening tool GUSS in its current form, although applicable with good inter-rater reliability, does not detect aspiration in PD patients with acceptable accuracy. Modifications of the GUSS parameters "coughing," "voice change" and "delayed swallowing" might enhance validity. The GUSS' diet recommendations overestimate the need for oral intake restriction in PD patients and should be verified by instrumental swallowing examination.
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 (r(s) = 0.8; p < 0.001). Aspiration was identified by the GUSS with a sensitivity of 50%, and specificity of 51.35% (PPV 28%, NPV 73%, LR+ 1.03, LR- 0.97), dysphagia/penetration was identified with 72.97% sensitivity and 35.71% specificity (PPV 75%, NPV 33.33%, LR+ 1.14, LR- 0.76). Agreement between GUSS- and FEES-based diet recommendations was low (r(s) = 0.12, p = 0.42) with consistent NPO (Nil per Os) allocation by GUSS and FEES in only one participant.
Conclusions and Inferences
The multi-texture screening tool GUSS in its current form, although applicable with good inter-rater reliability, does not detect aspiration in PD patients with acceptable accuracy. Modifications of the GUSS parameters "coughing," "voice change" and "delayed swallowing" might enhance validity. The GUSS' diet recommendations overestimate the need for oral intake restriction in PD patients and should be verified by instrumental swallowing examination.
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<.01), SpO(2) (p<.01), respiratory rates (p<.01), swallowing rates (p<.01), and vigilance scores (p<.01). The quality of bronchial secretions improved in all participants. All effects were sustained up to the follow-up measurements. Conclusion: This preliminary data indicates positive effects for a respiratory intervention method (bagging) on respiratory function and additional respiration-related functions in tracheotomized neurological patients. This easy-to-learn and inexpensive method might expand the range of treatment options for tracheotomized and non-responsive patients.
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 < 0.001; piecemeal deglutition, 1.8%, P < 0.01). Patients with MSA had a greater risk for oral-phase disturbances with increased disease severity (P < 0.05; odds ratio, 3.15). Patients with MSA showed a significantly higher intraindividual interswallow variability compared with PD. When correlating Swallowing Disturbance Questionnaire scores with endoscopy results, its cutoff, validated for PD, was not sensitive enough to identify patients with MSA with dysphagia. We developed a subscore for identifying dysphagia in MSA and calculated a new cutoff (sensitivity 85%, specificity 100%).
Conclusions
In contrast with patients with PD, patients with dysphagic MSA more frequently present with oral-phase symptoms and a significantly higher intraindividual interswallow variability. A novel Swallowing Disturbance Questionnaire MSA subscore may be a valuable tool to identify patients with MSA with early oropharyngeal dysphagia.
- Ulrike Leitner: Einleitung
- Frank Baron: From Alexander von Humboldt to Frederic Edwin Church: Voyages of Scientific Exploration and Artistic Creativity
- Rex Clark: Alexander von Humboldt‘s Images of Landscape and the ‚Chaos of the Poets
- Detlev Doherr: The Humboldt Digital Library: Exploring Innovative Structures
- Wolfgang Griep: Die Bedeutung der Umkreisquellen für Alexander von Humboldts südamerikanische Reise
- Ulrike Leitner: Vielschichtigkeit und Komplexität im Reisewerk Alexander von Humboldts – Bibliographischer Hintergrund
- Markus Schnoepf: El Proyecto Humboldt: Una biblioteca digital para las expediciones científicas a las Islas Canarias
Inhalt:
Alexander von Humboldt-Forschungsstelle: Ingo Schwarz zum 65. Geburtstag
Ottmar Ette: Findung und Erfindung einer Leserschaft. Neuere Editionsprojekte zu Alexander von Humboldt als Grundlage und Herausforderung künftigen Forschens
Eberhard Knobloch: Alexandre de Humboldt et le Marquis de Laplace
Oliver Schwarz: Alexander von Humboldt als astronomischer Arbeiter, Diskussionspartner und Ideengeber
Petra Werner: Innenwelten und bleiche Gärten. Alexander von Humboldt untertage und in der Caripe-Höhle
Christian Suckow: Alexander von Humboldt in Ust’-Kamenogorsk
Anne Jobst: Neue Briefe Christian Gottfried Ehrenbergs an Alexander von Humboldt
Thomas Schmuck: Humboldt, Baer und die Evolution
Manfred Ringmacher: Zwei Briefe auf Guaraní in Alexander von Humboldts Handschrift
Ute Tintemann: Julius Klaproths Mithridates-Projekt, Alexander von Humboldt und das Verlagshaus Cotta
Ulrike Leitner: „Ja! Wenn Berlin Bonn wäre!“ Friedrich Rückerts Berufung nach Berlin
Frank Holl: „Zur Freiheit bestimmt“ – Alexander von Humboldts Blick auf die Kulturen der Welt
Sebastian Panwitz: Das Humboldt-Mendelssohn-Haus Jägerstraße 22. Ein Quellenfund
Laura Péaud: Du Mexique à l‘Oural : l‘expertise humboldtienne au service du politique
Bärbel Holtz: „Cicerone“ des Königs? Alexander von Humboldt und Friedrich Wilhelm III.
Menso Folkerts: Ein unerwartetes Zusammentreffen in Sanssouci. Alexander von Humboldt und Karl Ludwig Hencke an der Tafel Friedrich Wilhelms IV.
Ulrich Päßler: Preußens Mann in Washington. Fünf Briefe Friedrich von Gerolts an Alexander von Humboldt (1858/1859)
Bill Roba: German-Iowan Strategies in Celebrating the Centennial of Alexander von Humboldt’s Birth
Regina Mikosch: Ingo Schwarz‘ Veröffentlichungen zur Alexander von Humboldt
Über die Autoren
Prostanoid receptors belong to the class of heptahelical plasma membrane receptors. For the five prostanoids, eight receptor subtypes have been identified. They display an overall sequence similarity of roughly 30%. Based on sequence comparison, single amino acids in different subtypes of different species have previously been identified by site-directed mutagenesis or in hybrid receptors that appear to be essential for ligand binding or G-protein coupling. Based on this information, a series of mutants of the human FP receptor was generated and characterized in ligand- binding and second-messenger-formation studies. It was found that mutation of His-81 to Ala in transmembrane domain 2 and of Arg-291 to Leu in transmembrane domain 7, which are putative interaction partners for the prostanoid's carboxyl group, abolished ligand binding. Mutants in which Ser-263 in transmembrane domain 6 or Asp-300 in transmembrane domain 7 had been replaced by Ala or Gln, respectively, no longer discriminated between prostaglandins PGF(2alpha) and PGD(2). Thus distortion of the topology of transmembrane domains 6 and 7 appears to interfere with the cyclopentane ring selectivity of the receptor. PGF(2alpha)-induced inositol formation was strongly reduced in the mutant Asp-300Gln, inferring a role for this residue in agonist-induced G-protein activation.
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.
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.
Sediments of Lake Donggi Cona on the northeastern Tibetan Plateau were studied to infer changes in the lacustrine depositional environment, related to climatic and non-climatic changes during the last 19 kyr. The lake today fills a 30x8 km big and 95 m deep tectonic basin, associated with the Kunlun Fault. The study was conducted on a sediment-core transect through the lake basin, in order to gain a complete picture of spatio-temporal environmental change. The recovered sediments are partly finely laminated and are composed of calcareous muds with variable amounts of carbonate micrite, organic matter, detrital silt and clay. On the basis of sedimentological, geochemical, and mineralogical data up to five lithological units (LU) can be distinguished that document distinct stages in the development of the lake system.
The onset of the lowermost LU with lacustrine muds above basal sands indicates that lake level was at least 39 m below the present level and started to rise after 19 ka, possibly in response to regional deglaciation. At this time, the lacustrine environment was characterized by detrital sediment influx and the deposition of siliciclastic sediment. In two sediment cores, upward grain-size coarsening documents a lake-level fall after 13 cal ka BP, possibly associated with the late-glacial Younger Dryas stadial. From 11.5 to 4.3 cal ka BP, grain-size fining in sediment cores from the profundal coring sites and the onset of lacustrine deposition at a litoral core site (2 m water depth) in a recent marginal bay of Donggi Cona document lake-level rise during the early to mid-Holocene to at least modern level. In addition, high biological productivity and pronounced precipitation of carbonate micrites are consistent with warm and moist climate conditions related to an enhanced influence of summer monsoon. At 4.3 cal ka BP the lake system shifted from an aragonite- to a calcite-dominated system, indicating a change towards a fully open hydrological lake system. The younger clay-rich sediments are moreover non-laminated and lack any diagenetic sulphides, pointing to fully ventilated conditions, and the prevailing absence of lake stratification. This turning point in lake history could imply either a threshold response to insolation-forced climate cooling or a response to a non-climatic trigger, such as an erosional event or a tectonic pulse that induced a strong earthquake, which is difficult to decide from our data base.