Search

Laufende Verbesserungen der Energieeffizienz und des Wasserverbrauchs von Haushaltswaschmaschinen haben die Umweltbelastung durch Haushaltswäsche erheblich reduziert. Im Sinne der Nachhaltigkeit sind niedrige Waschtemperaturen wünschenswert, können aber, wie auch die Verwendung bleichmittelfreier Waschmittel, die Frische und Hygiene der Wäsche beeinträchtigen. Aus diesem Grund sind Innovationen für nachhaltige Waschmittel von morgen notwendig. In diesem Artikel wird gezeigt, dass mit Dispersin, einem Enzym auf natürlicher Basis, selbst bei niedrigen Temperaturen und mit Flüssigwaschmitteln eine verbesserte Tiefenreinigung der Textilien und Vermeidung unangenehmer Gerüche auf der Wäsche sowie in den Waschmaschinen möglich ist. Damit wird aufgezeigt, dass es möglich ist, Waschmittel zu formulieren, mit denen Verbraucher ihre Kleidung nachhaltig waschen können, ohne Kompromisse hinsichtlich der Waschleistung eingehen zu müssen. [ABSTRACT FROM AUTHOR]

Background and Study Objectives: The assessment of the renal function of patients with a deep vein thrombosis/pulmonary embolism (VTE patients) is of utmost importance for the selection/dosage of an agent in the initial anticoagulation management of these patients because the majority of available anticoagulants are cleared renally. Specifically, there is a high risk of drug accumulation and subsequent bleedings in patients with severe renal insufficiency. Consequently, specific recommendations have been made for the initial anticoagulation management of these patients in both product labels and AWMF treatment recommendations: some drugs should not be used in these patients, for other drugs a careful use, intensified screening (anti-Xa), or, in the case of enoxaparin, a dose-adjustment are recommended.This literature review aimed to answer the following questions: · What is the prevalence of renal insufficiency in VTE patients?. · Which data are available with regard to the real-world initial anticoagulation management and corresponding clinical outcomes (recurrent VTE events, bleedings, mortality) of these patients?, Methodology: We did a systematic review of existing publications in german or english published in 2004-2014. Only quantitative analyses have been included in the review., Results: We identified 1,135 publications, 37 of them were included in our review. The prevalence of renal insufficiency in VTE patients, defined as CrCl < 60 ml / min, was reported to be 12.3 %-71.9 % related to all VTE patients. The prevalence of severe renal insufficiency, defined as CrCl < 30 ml / min, was reported to be 3,3 %-13,6 %. The substantial ranges in reported prevalences are mainly due to differences in the characteristics of patients addressed in the different publications.A CrCl < 30 ml / min is an independent predictor for both mortality and lethal recurrent pulmonary embolism, possibly also for severe bleedings in VTE patients. In addition to that, a severe renal insufficiency may also be a predictor for the probability that a first VTE event occurs.Several anticoagulants approved for the initial anticoagulation management of VTE patients face the risk of drug accumulation in renally insufficent patients. So, for example, a standard enoxaparin dosage was shown to be associated with elevated bleeding risk compared to adjusted enoxaparin dosage in renally insufficient patients. However, similar data do not exist for other low molecular weight heparins (LMWHs) or unfractioned heparins (UFHs). Only for two LMWHs, Certoparin and Tinzaparin, safety data with regard to renally insufficient patients have been published so far.None of the included studies showed advantages of UFH therapy in comparison to LMWH therapy in initial anticoagulation management of VTE patients. In contrast to that, available evidence shows disadvantageous efficacy/safety of UFH in comparison to LMWH treatment. However, this evidence is not based on head-to-head comparisons but is derived from registry and observational study data only., Conclusion: A detailed knowledge of product labels is of utmost importance in the inital anticoagulation treatment of VTE patients because several agents may not be used in the addressed patients with severe renal insufficiency at all while others may be used based on specific dosage/surveillance schemes only. We also recommend to critically appraise the current AWMF treatment guideline because it still recommends initial anticoagulation management with UFHs in VTE patients with severe renal insufficiency. Available data do not support that recommendation., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Objective: Based on claims-data of 5.43 million members of a large German statutory health insurance fund in 2008 (Techniker Krankenkasse), the aim of this contribution is to update and more precisely quantify age- and gender-specific prevalence and incidence of type 2 diabetes mellitus (T2DM) in a German setting., Methods: A patient was classified as T2DM prevalent if he or she had received at least two outpatient diagnoses of T2DM in two different quarters of the year and/or had received at least one T2DM diagnosis during inpatient treatment between 01/01/2006 and 12/31/2008. A patient was considered to have had new onset T2DM in 2008 under one of three conditions: 1. no diagnosis of T2DM in 2006 and 2007, 2. no presripction of oral antidiabetics in 2006 and 2007, 3. either one inpatient or two outpatient diagnoses of T2DM conducted in two different quarters of 2008 or one outpatient T2DM diagnosis in 2006/07 when the second diagnosis was made in 2008., Results: A total of 254,524 patients had T2DM. Compared to the total membership of the medical insurance fund, the prevalence of T2DM was 4.69 %. The average age was 64.8 years, and 66.37 % were male. The incidence of T2DM in our sample was 2.814 cases per 1,000 person-years in men and 1.690 cases in 1,000 person-years in women. Based on our sample and on official population data, 4,704,585 patients (5.75 %) in Germany would be T2DM prevalent in 2009. The number of incident T2DM cases would amount to 215,746 patients (0.264 %)., Conclusions: T2DM is one of the most common chronic diseases in Germany. The expected demographic changes in Germany will increase the burden on the German health system caused by T2DM., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The G-DRG system reimburses sledge endoprosthetic implantations (UKA) at a much lower rate than surface replacements (TKA), at significantly different cost weights (CW). Therefore, when only G-DRG payments are considered, the complete endoprosthesis implantation produces higher gains. An orientation on these revenues alone, however, does not provide the basis for an economically sound decision-making process. The aim of this study is to present a comparison of the variable costs of the two procedures., Material and Methods: The mean cost and performance data of 28 Endo-Model UKA implantations and of 85 NexGen CR TKA replacements were compared with each other in 2007., Results: From the perspective of the hospital, when the correct medical indication is present, UKA treatment is of greater economic advantage. In this way the total unit contribution margin can be improved, and although the relative weighting is comparatively low, the costs are significantly lower than in a comparative analysis of the TKA., Conclusion: For the desired maximisation of the unit contribution margin, assuming that it is the proper medical indication, the recommendation for the hospital would be implantation of the UKA. Considered from the economic perspective of gains and costs, the assumption that a TKA would be advantageous could not be confirmed in the present study., (© Georg Thieme Verlag KG Stuttgart · New York.)

The total pancreatectomy without duodenectomy was carried out in 16 dogs. The postoperative diabetes mellitus leads to death on average until the 11th postoperative day. A prolongation of the survival time was possible only by an insulin injection or by pancreas transplantation. Bleedings and circulatory disturbances of the duodenum occurred in 3 of 16 dogs as a complication of the operation. The diabetes mellitus was confirmed by the estimation of the fasting blood glucose and the glucose stimulated plasma insulin concentration. The irreversible hyperglycemia syndrome after pancreatectomy proved as a pattern for the pancreas segmental transplantation.