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IntroductionIn patients with SARS-CoV-2, innate immunity is playing a central role, depicted by hyperinflammation and longer lasting inflammatory response. Reliable inflammatory markers that cover both acute and long-lasting COVID-19 monitoring are still lacking. Thus, we investigated one specific inflammatory marker involved as one key player of the immune system, kynurenine (Kyn), and its use for diagnosis/detection of the Long-/Post-COVID syndrome in comparison to currently used markers in both serum and saliva samples.Material and methodsThe study compromised in total 151 inpatients with a SARS-CoV-2 infection hospitalized between 03/2020 and 09/2021. The group NC (normal controls) included blood bank donors (n=302, 144f/158m, mean age 47.1 ± 18.3 years (range 18-75)). Two further groups were generated based on Group A (n=85, 27f/58m, mean age 63.1 ± 18.3 years (range 19-90), acute admission to the hospital) and Group B (n=66, 22f/44m, mean age 66.6 ± 17.6 years (range 17-90), admitted either for weaning or for rehabilitation period due to Long-COVID symptoms/syndrome). Plasma concentrations of Kyn, C-Reactive Protein (CRP) and interleukin-6 (IL-6) were measured on admission. In Group B we determined Kyn 4 weeks after the negative PCR-test. In a subset of patients (n=11) concentrations of Kyn and CRP were measured in sera and saliva two, three and four months after dismission. We identified 12 patients with Post-COVID symptoms >20 weeks with still significant elevated Kyn-levels.ResultsMean values for NC used as reference were 2.79 ± 0.61 µM, range 1.2-4.1 µM. On admission, patients showed significantly higher concentrations of Kyn compared to NC (p-values < 0.001). Kyn significantly correlated with IL-6 peak-values (r=0.411; p-values <0.001) and CRP (r=0.488, p-values<0.001). Kyn values in Group B (Long-/Post-COVID) showed still significant higher values (8.77 ± 1.72 µM, range 5.5-16.6 µM), whereas CRP values in Group B were in the normal range.ConclusionSerum and saliva Kyn are reflecting the acute and long-term pathophysiology of the SARS-CoV-2 disease concerning the innate immune response and thus may serve a useful biomarker for diagnosis and monitoring both Long- and Post-COVID syndrome and its therapy.

Background Treatment of advanced‐stage idiopathic Parkinson's disease (PD) is a demanding challenge, and in Germany, medication regimen adjustments are often made during inpatient stays. Admissions often follow an acute worsening of symptoms and functioning. In order to reduce long and expensive inpatient stays, and to provide more frequent consultations, a 24/7 live stream telemedicine home treatment service was established. Methods A pilot study was conducted in which laptops were distributed to 50 patients for 1 year to see whether such a service was feasible (in terms of patient participation and compliance) and whether this intervention affected the patient's condition, measured in UPDRS, Mini–Mental Status Examination (MMSE), 39‐item Parkinson's Disease Questionnaire (PDQ39), and H & Y Scale. Results Seventy‐two percent (36) of the patients were compliant and did not experience technical issues. Patients lived, on average, 198 ± 183 km away from the specialist clinic. In total, 264 video conversations took place with 6.9 ± 7.2 (0–29) calls per patient. We found a significant improvement in PDQ39 scores, but not in UPDRS, MMSE, or H & Y scores, at 1 year. Conclusions Our data shows that 24/7 live stream telemedicine is feasible and can help to improve quality of life. However, a detailed preliminary review of the patient's willingness to use such a service should be made to obtain the best results. Improvement of the technical setup and network coverage would facilitate an improved service and increase efficiency.

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing autoimmune disease of the central nervous system, affecting mainly optic nerves and spinal cord. NMOSD pathophysiology is associated with anti-aquaporin-4 (AQP4) immunoglobulin G (IgG) autoantibodies. Rapid extracorporeal elimination of autoantibodies with apheresis techniques, such as immunoadsorption (IA), was proven to be an effective treatment of NMOSD attacks. Data on the long-term use of IA to prevent attacks or progression of NMOSD are lacking. Objectives: The aim of this study was to evaluate efficacy and safety of maintenance IA for preventing recurrence of NMOSD attacks in patients refractory to other immunotherapies. Design: Case study. Methods: Retrospective analysis of two female patients with severe NMOSD refractory to conventional immunotherapies was performed. Both patients had responded to tryptophan IA (Tr-IA) as attack therapy and subsequently were treated with biweekly maintenance Tr-IA. Results: Patient 1 (AQP4-IgG seropositive, age 42 years) had 1.38 attacks of optic neuritis per year within 10.1 years before commencing regular Tr-IA. With maintenance Tr-IA for 3.1 years, one mild attack occurred, which was responsive to steroid pulse therapy. Expanded Disability Status Scale (EDSS) was stable at 5.0. Visual function score of the last eye improved from 3 to 1. Patient 2 (AQP4-IgG seronegative, age 43 years) experienced 1.7 attacks per year, mainly acute myelitis and optic neuritis, during the period of 10.0 years before the start of Tr-IA. During regular Tr-IA treatment, no further NMOSD attack occurred. The patient was clinically stable without any additional immunosuppressive treatment for 5.3 years. EDSS improved from 6.0 to 5.0, and the ambulation score from 7 to 1. Tolerability of Tr-IA was good in both patients. No serious adverse events occurred during long-term clinical trajectories. Conclusion: Tr-IA was well tolerated as maintenance treatment and resulted in clinical stabilization of two patients with highly active NMOSD, who were refractory to standard drug therapy.

Übersicht S11Indikationen für die Apomorphininjektionstherapie ! Apomorphininjektionen stellen bei Patienten, die trotz optimierter oraler Therapie wiederholte "Off"-Perioden haben, eine sinnvolle Option dar (• " Tab. 1). Am besten funktioniert diese Therapie bei Patienten mit sog. "Wearing-off"-Symptomatologie, aber auch Patienten mit einfacherer "On-off"-Symptomatik können davon profitieren. Bei komplexen "On-off"-Fluktuationen und / oder Dyskinesien sind die Apomorphininjektionen oft zu kompliziert in der Handhabung und es ist in der Regel besser, eine kontinuierliche Applikationsform der Medikation wie z. B. eine Apomorphininfusionstherapie zu überlegen. Es ist empfehlenswert, dass der Patient / die Patientin vor der Therapieentscheidung ein Bewegungsprotokoll führt und es mit dem Arzt gemeinsam analysiert, um festzustellen, ob eine intermittierende Injektionstherapie geeignet ist. Eine weitere wichtige Voraussetzung für den Therapieerfolg ist eine deutliche Dopa-Sensitivität der Parkinsonsymptomatik. Meistens ist der Effekt von L-Dopa nahezu identisch mit dem von Apomorphin, sowohl in Bezug auf die Gesamtwirkung als auch hinsichtlich der unterschiedlich starken Beeinflussung der verschiedenen Parkinsonsymptome. Wichtig ist es auch, dass der Patient (oder der pflegende Angehörige) die Prinzipien der Parkinsonerkrankung bezüglich der motorischen Fluktuationen und deren Therapie verstehen kann. Der Patient muss lernen, bei welchen Symptomen er sich injizieren soll. Er muss darum erkennen können, ob er eine "On"-Phase, eine "Off"-Phase oder eine "On-Phase mit Dyskinesien" hat. Das bedeutet auch, dass Patienten mit signifikanten Zusammenfassung ! Subkutane Apomorphininjektionen sind eine wertvolle und effektive Therapie für Parkinsonpatienten, die trotz optimierter oraler Therapie noch wiederholte "Off"-Phasen zeigen. Die durchschnittliche tägliche "Off"-Zeit kann halbiert werden und die noch bestehenden "Off"-Perioden sind milder ausgeprägt. Diese Effekte sind auch über längere Zeit stabil und es gibt keinen Anhalt für eine Toleranzentwicklung. Die Nebenwirkungen sind meistens gering ausgeprägt. Der beste Effekt wird erreicht, wenn Apomorphin bei relativ jungen, aktiven und kognitiv nicht eingeschränkten Patienten eingesetzt wird. Subkutane Apomorphininjektionen können oft das Weiterarbeiten und das Führen eines normalen Lebens ermöglichen. Apomorphin bietet eine zuverlässige Möglichkeit, schnell aus einer "Off"-Phase zu kommen. Dies führt zu mehr Unabhängigkeit und Selbstvertrauen bei den Betroffenen.Abstract !