Application of quality indicators and critical lessons learned assessment as a research approach for the evaluation of rescue missions during terrorist attacks.

In Wuerzburg, Germany, a terrorist attack and a killing rampage occurred five years apart (2016 and 2021). Following a structured evaluation of the rescue mission in 2016, a bundle of quality indicators and ten "lessons learned" were defined. Aim of the presented study was to compare the two rescue missions and to critically review the lessons learned from 2016 for their implementation and feasibility.

Erratum: Influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations on cluster events among patients and staff in a tertiary-care hospital in Germany - CORRIGENDUM.

[This corrects the article DOI: 10.1017/ash.2021.

[Complete information technology blackout in hospitals : Development of a concept for maintaining patient care].

The complete blackout of information technology (IT) in a hospital represents a major incident with acute loss of functionality. The immediate consequence is a rapidly progressive loss of treatment capacity. The major priority for the acute management of such an event is to keep patients safe and prevent life-threatening situations.

[The Mainz Pain Staging System is also suitable for grading chronic pain in inpatient geriatric patients].

Introduction: The Mainz Pain Staging System (MPSS), which has been validated primarily in middle-aged and chronic low back pain patients, is designed to predict prognosis and control the use of resources at baseline. In multi-morbid and functionally impaired patients (geriatric patients) with multiple causes of pain, it is unclear whether this instrument can be implemented at all and whether it permits statements to be made on the severity of pain chronification.

Materials And Methods: Therefore, 173 consecutive patients with pain were classified in the second week of inpatient geriatric treatment according to the MPSS.

Synthesis of Fluorescent Membrane-Spanning Lipids for Studies of Lipid Transfer and Membrane Fusion.

For uncompromised in vitro assays for intermembrane lipid transfer and membrane fusion fluorescent membrane-spanning lipids have proved to be invaluable tools. These lipids in contrast to phosphoglycerolipids and sphingolipids are resistant to spontaneous as well as protein-mediated intermembrane transfer. Here I describe the synthesis of some homo-substituted fluorescent bipolar membrane-spanning lipids that bear a fluorescent tag either directly or via a phosphoethanolamine spacer to the lipid core.

Labeled gangliosides: their synthesis and use in biological studies.

The unveiling of ganglioside metabolism and biological function in the last decades depended on the extensive study of inherited human disease, studies with cultured cells, and specifically designed mouse models. Nonetheless, only few of the accomplishments made so far would have been possible without the use of labeled gangliosides, such as their radiolabeled and/or fluorescent analogs, as well as other modified gangliosides bearing cross-linking, affinity, or paramagnetic groups. Over the years, chemists and biochemists have made tremendous progress toward developing labeled gangliosides for their application in biological systems.

Synthesis of Photoactivatable and Paramagnetic Gangliosides.

For the physicochemical studies aimed at elucidating the dynamic of gangliosides in membranes and their interaction with proteins and membrane lipids, photoactivatable and paramagnetic ganglioside derivatives have proved to be invaluable tools. Here, protocols for the synthesis of such ganglioside derivatives are described. These derivatives bear in their ceramide portion either a highly photoreactive (3-trifluoromethyl)phenyldiazirinyl- or a spin active doxyl-labeled acyl chain in place of their natural acyl chain.

Synthesis of Fluorescent Gangliosides.

Labeled gangliosides are invaluable tools to study their transport and metabolism within cells as well as to determine their distribution in membranes, and their interaction with membrane lipids and proteins. Here I describe established procedures to synthesize ganglioside derivatives with a fluorescent tag either attached to its sialooligosaccharide or ceramide portion. These procedures are chosen as to minimize the integrity of the ganglioside molecule and hence, to leave their native skeleton formally intact.

Synthetic Glycoforms Reveal Carbohydrate-Dependent Bioactivity of Human Saposin D.

The main glycoforms of the hydrophobic lysosomal glycoprotein saposin D (SapD) were synthesized by native chemical ligation. An approach for the challenging solid-phase synthesis of the fragments was developed. Three SapD glycoforms were obtained following a general and robust refolding and purification protocol.

Lipids regulate the hydrolysis of membrane bound glucosylceramide by lysosomal β-glucocerebrosidase.

Glucosylceramide (GlcCer) is the primary storage lipid in the lysosomes of Gaucher patients and a secondary one in Niemann-Pick disease types A, B, and C. The regulatory roles of lipids on the hydrolysis of membrane bound GlcCer by lysosomal β-glucocerebrosidase (GBA1) was probed using a detergent-free liposomal assay. The degradation rarely occurs at uncharged liposomal surfaces in the absence of saposin (Sap) C.

Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version.

In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management.

Membrane-spanning lipids for an uncompromised monitoring of membrane fusion and intermembrane lipid transfer.

A Förster resonance energy transfer-based fusion and transfer assay was developed to study, in model membranes, protein-mediated membrane fusion and intermembrane lipid transfer of fluorescent sphingolipid analogs. For this assay, it became necessary to apply labeled reporter molecules that are resistant to spontaneous as well as protein-mediated intermembrane transfer. The novelty of this assay is the use of nonextractable fluorescent membrane-spanning bipolar lipids.

Membrane lipids regulate ganglioside GM2 catabolism and GM2 activator protein activity.

Ganglioside GM2 is the major lysosomal storage compound of Tay-Sachs disease. It also accumulates in Niemann-Pick disease types A and B with primary storage of SM and with cholesterol in type C. Reconstitution of GM2 catabolism with β-hexosaminidase A and GM2 activator protein (GM2AP) at uncharged liposomal surfaces carrying GM2 as substrate generated only a physiologically irrelevant catabolic rate, even at pH 4.

Partial synthesis of ganglioside and lysoganglioside lipoforms as internal standards for MS quantification.

Within recent years, ganglioside patterns have been increasingly analyzed by MS. However, internal standards for calibration are only available for gangliosides GM1, GM2, and GM3. For this reason, we prepared homologous internal standards bearing nonnatural fatty acids of the major mammalian brain gangliosides GM1, GD1a, GD1b, GT1b, and GQ1b, and of the tumor-associated gangliosides GM2 and GD2.

Labeled chemical biology tools for investigating sphingolipid metabolism, trafficking and interaction with lipids and proteins.

The unraveling of sphingolipid metabolism and function in the last 40 years relied on the extensive study of inherited human disease and specifically-tailored mouse models. However, only few of the achievements made so far would have been possible without chemical biology tools, such as fluorescent and/or radio-labeled and other artificial substrates, (mechanism-based) enzyme inhibitors, cross-linking probes or artificial membrane models. In this review we provide an overview over chemical biology tools that have been used to gain more insight into the molecular basis of sphingolipid-related biology.

FCS in STED microscopy: studying the nanoscale of lipid membrane dynamics.

Details of molecular membrane dynamics in living cells such as lipid-protein interactions or the incorporation of molecules into lipid "rafts" are often hidden to the observer because of the limited spatial resolution of conventional far-field optical microscopy. Fortunately, the superior spatial resolution of far-field stimulated-emission-depletion (STED) nanoscopy allows gaining new insights. Applying fluorescence correlation spectroscopy (FCS) in focal spots continuously tuned down to 30 nm in diameter distinguishes free from anomalous molecular diffusion due to transient binding, as for the diffusion of fluorescent phosphoglycero- and sphingolipid analogs in the plasma membrane of living cells.

[Pain assessment in elderly nursing home residents: methods paper for the S3-guideline development].

In Germany, there is currently no guideline for pain assessment in elderly people. Pain management in nursing home residents is, however, legally required. For this particular group, especially for people with dementia, suitable interdisciplinary orientations for health care are lacking in Germany.

Partitioning, diffusion, and ligand binding of raft lipid analogs in model and cellular plasma membranes.

Several simplified membrane models featuring coexisting liquid disordered (Ld) and ordered (Lo) lipid phases have been developed to mimic the heterogeneous organization of cellular membranes, and thus, aid our understanding of the nature and functional role of ordered lipid-protein nanodomains, termed "rafts". In spite of their greatly reduced complexity, quantitative characterization of local lipid environments using model membranes is not trivial, and the parallels that can be drawn to cellular membranes are not always evident. Similarly, various fluorescently labeled lipid analogs have been used to study membrane organization and function in vitro, although the biological activity of these probes in relation to their native counterparts often remains uncharacterized.

STED nanoscopy reveals molecular details of cholesterol- and cytoskeleton-modulated lipid interactions in living cells.

Details about molecular membrane dynamics in living cells, such as lipid-protein interactions, are often hidden from the observer because of the limited spatial resolution of conventional far-field optical microscopy. The superior spatial resolution of stimulated emission depletion (STED) nanoscopy can provide new insights into this process. The application of fluorescence correlation spectroscopy (FCS) in focal spots continuously tuned down to 30 nm in diameter distinguishes between free and anomalous molecular diffusion due to, for example, transient binding of lipids to other membrane constituents, such as lipids and proteins.

Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version.

Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2(nd) Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%).

Role of endosomal membrane lipids and NPC2 in cholesterol transfer and membrane fusion.

We examined the effect of Niemann-Pick disease type 2 (NPC2) protein and some late endosomal lipids [sphingomyelin, ceramide and bis(monoacylglycero)phosphate (BMP)] on cholesterol transfer and membrane fusion. Of all lipid-binding proteins tested, only NPC2 transferred cholesterol at a substantial rate, with no transfer of ceramide, GM3, galactosylceramide, sulfatide, phosphatidylethanolamine, or phosphatidylserine. Cholesterol transfer was greatly stimulated by BMP, little by ceramide, and strongly inhibited by sphingomyelin.

GM1 structure determines SV40-induced membrane invagination and infection.

Incoming simian virus 40 (SV40) particles enter tight-fitting plasma membrane invaginations after binding to the carbohydrate moiety of GM1 gangliosides in the host cell plasma membrane through pentameric VP1 capsid proteins. This is followed by activation of cellular signalling pathways, endocytic internalization and transport of the virus via the endoplasmic reticulum to the nucleus. Here we show that the association of SV40 (as well as isolated pentameric VP1) with GM1 is itself sufficient to induce dramatic membrane curvature that leads to the formation of deep invaginations and tubules not only in the plasma membrane of cells, but also in giant unilamellar vesicles (GUVs).