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The conduct of clinical trials in paediatrics is essential to improve drug therapy in children. In Europe, paediatric clinical trials have been supported by the European Paediatric Regulation since 2007, but there is still a great need for high-quality clinical trials.The personnel and time required to conduct clinical trials in accordance with EU Regulations 536/2014 and 745/2017 is considerably higher compared to other studies, such as observational studies. It is important that this additional workload for the trial centre is fully compensated, also taking into account EU state aid rules. In paediatric trials, it is necessary to take into account the special requirements of paediatric and adolescent medicine when calculating the additional costs. Within the framework of the pan-European paediatric study network c4c/GermanNetPaeT, a working group dealt with specific aspects of cost calculation in order to support paediatric study centres in internal cost calculation as well as in the subsequent preparation of financing requirements for industrial sponsors or public funders. In several workshops the working group developed a cost calculation template with the content derived from the “Joint recommendations for a total services account as a factor in simplifying contracts” of the Deutsche Hochschulmedizin (DHM, German University Medicine), the Netzwerk der Koordinierungszentren für Klinische Studien (KKS Network, Network of Coordinating Centres for Clinical Trials) and the Verband Forschender Arzneimittelhersteller (vfa, German Association of Research-Based Pharmaceutical Companies).By estimating the specific time required for measures and investigations as part of a sample study, the background to the increased time required was discussed and a list with aspects to be considered for cost calculation was compiled together with the study centres. The paediatrics-specific aspects mentioned in detail are intended to increase understanding of the particular problem of higher costs for clinical trials involving children and adolescents and the need for correspondingly appropriate remuneration. This transparent and comprehensible presentation of the higher financial requirements for both the study centres and the financial supporters is intended to promote the high-quality conduct of clinical trials in paediatric study centres in the long term.

Until the German reunification, public perception of the graves and cemeteries of Russian prisoners of war has been rather marginal in both German states, in Europe and in the Soviet Union. Due to Stalinist repression, the names of Russian prisoners of war were intentionally not named; captivity remained a taboo issue in the soviet sphere of control until the collapse of the Soviet Union. During the Cold War, the cemeteries of Russian prisoners of war on the sites of former camps were reshaped and reinterpreted. It is only after the discussions that started in the mid-1990s regarding the participation of the Wehrmacht in war crimes that the graves and cemeteries of Russian prisoners of war are treated in a scholarly way. The article sketches this continuous process in an European context.

In case of presbyopia or cataract the "artificial accommodation system" represents one future possibility to durably restore the ability to accommodate. The work presented describes recent progress in the development of the artificial accommodation system. Major advances were achieved in the fields of the actuator system for the active optics, the pupil near reflex sensor, the communication system, the power supply system as well as in system integration. Beside the technical advances, first trials were performed to implant the artificial accommodation system into animals. These trials showed that the new lens shaped design and the C-shaped haptics are beneficial for implantation and secure fixation of the implant inside the capsular bag., (Georg Thieme Verlag KG Stuttgart · New York.)

Presbyopia and cataract are gaining more and more importance in the ageing society. Both age-related complaints are accompanied with a loss of the eye's ability to accommodate. A new approach to restore accommodation is the Artificial Accommodation System, an autonomous micro system, which will be implanted into the capsular bag instead of a rigid intraocular lens. The Artificial Accommodation System will, depending on the actual demand for accommodation, autonomously adapt the refractive power of its integrated optical element. One possibility to measure the demand for accommodation non-intrusively is to analyse eye movements. We present an efficient algorithm, based on the CORDIC technique, to calculate the demand for accommodation from magnetic field sensor data. It can be shown that specialised algorithms significantly shorten calculation time without violating precision requirements. Additionally, a communication strategy for the wireless exchange of sensor data between the implants of the left and right eye is introduced. The strategy allows for a one-sided calculation of the demand for accommodation, resulting in an overall reduction of calculation time by 50 %. The presented methods enable autonomous microsystems, such as the Artificial Accommodation System, to save significant amounts of energy, leading to extended autonomous run-times., (© Georg Thieme Verlag KG Stuttgart · New York.)

Colorectal carcinoma is one of the most common tumour entities in Western countries. Colorectal carcinoma and type 2 diabetes mellitus share common risk factors. Recent epidemiological studies show an increased risk for colorectal carcinomas in patients with type 2 diabetes mellitus, even more pronounced at therapy with sulfonylureas or insulin. Moreover, a 3-fold risk increase for patients with insulin-dependent type 2 diabetes mellitus in comparison to the general population has been observed. The hyperinsulinaemia hypothesis is based on the premise that elevated plasma levels of insulin and free IGF-1 promote the proliferation of colon cells and lead to a survival benefit of transformed colon carcinoma cells. This is reflected by an altered tumour biology; in patients with type 2 diabetes, tumour progression is more rapid and tumour-associated mortality is increased. Colorectal carcinoma represents an entity that is well amenable to and can potentially be avoided by screening colonoscopy. Recommendations for colorectal carcinoma screening should employ the recent epidemiologic evidence. All patients with type 2 diabetes should be recommended to undergo colonoscopy before starting insulin therapy, and screening intervals should not exceed 5 years. This work provides a review of the evidence, and an algorithm is proposed for a modified screening in patients with type 2 diabetes.

Differences of elasticity in tissue phantoms with inclusions of different elasticity were mapped by means of MR elastography (MRE). This new magnetic resonance imaging technique is based on the phase shift of the MR signal by switching a motion sensitizing magnetic field gradient simultaneously with the coupling of a shear wave. Wave patterns showing snapshots of the shear wave that propagates through the investigated substance were depicted in tomographic phase images. It was investigated wether a visualization of differences in elasticity of soft tissues was possible on the basis of differences in the wavelength. For this purpose, tissue phantoms with cylindrical inclusions were produced from agar gels, with agar concentrations between 1.0 and 1.5%. The diameters of the inclusions were of the order of a few centimetres. For diameters as small as 4 cm, there were still distinct differences in the wavelength between the matrix and the inclusion. The results of our study suggest that this technique has the potential for future application as an additional imaging method for tumor detection.

Mitochondrial disease are a heterogeneous group, combining multiple symptoms resulting from defects in various organs. Thus identification of a particular mitochondrial disease due to clinical symptoms is not possible. However, simple biochemical tests can provide guiding and reliable results quickly. We present a classification of the mitochondrial diseases, describing important clinical symptoms and explaining a diagnostic plan to identify defects of biochemical mitochondrial pathways.

In 17 illustrations, a modification of Fujita's technique of UPPP is presented. This operation consists of excising redundant velar tissues from the free margin of the soft palate, tonsillar pillars, and uvula without reducing the muscles of the velum. In addition, the uvula muscle is almost completely preserved. Seventy patients, with habitual snoring or with obstructive sleep apnea syndrome, who underwent this surgery were followed-up from six to 24 months and did not show any palatal insufficiency with air and liquid escape through the nose. Additional remarks are made concerning the difficulties encountered during intubation of 60 percent of patients with chronic rhonchopathy.

Survival rate and incidence of myocardial infarction after aortocoronary bypass operation in 274 patients are presented. Mortality was 5.1% within the first postoperative month and the 5-year-survival rate was 86%. There were 24 perioperative myocardial infarctions and another 21 infarctions over the next 5 years. Comparison of these data with the natural history of coronary heart disease suggests a possible prolongation of survival after bypass surgery. The incidence of myocardial infarction appears to be unchanged.