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Individuals with minor ischaemic stroke and intracranial occlusion are at increased risk of poor outcomes. Intravenous thrombolysis with tenecteplase might improve outcomes in this population. We aimed to test the superiority of intravenous tenecteplase over non-thrombolytic standard of care in patients with minor ischaemic stroke and intracranial occlusion or focal perfusion abnormality.

Background: Various approaches for endoscopic and minimally invasive thyroid operations have been reported, with some becoming popular to date. The aim of these procedures is to reduce and prevent visible scars in the neck. This led to the transoral endoscopic thyroidectomy vestibular approach (TOETVA) technique applicable in small thyroid specimen. To amend TOETVA and to broaden the indication for transoral thyroid surgery, our aim was to combine the TOETVA with the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) facelift approach. Methods: After successful implementation of the TOETVA technique in 2017, we evaluated the transoral technique regarding feasibility and safety in well-selected patients in Germany and Austria. With the combination of TOETVA and EndoCATS, we were able to optimize the extraction process of the specimen by avoiding damage to the thyroid capsule and to broaden the indication of transoral surgery by operating on thyroid glands with higher volume. Patients’ characteristics, surgical outcome and complications were determined. Results: Seventy-one transoral procedures were performed in 70 patients. The TOETVA procedure was performed in 60 patients, and 10 female patients underwent TOVARA with transoral thyroid lobe mobilization and removal of the specimen via the retroauricular access. Overall, median operation time was 205 min (range 96–370 min) and permanent RLNP rate was 1% accordant to 99 nerves at risk (39 hemithyroidectomies, 29 total thyroidectomies, 2 parathyroid resections, and 1 thyroglossal cyst resection). No conversion to conventional open surgery was necessary. Long-term mental nerve injury occurred in two patients. No infection was identified. Conclusions: Transoral thyroid and parathyroid surgery via the vestibular approach is both feasible and safe in Western Europe. The combination of the TOETVA with the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) facelift approach, called TOVARA, is a promising opportunity to allow for thyroid surgery without a visible scar in specimen with volume of more than 40 ml also.

G. Klein (*) In the machine and vehicle construction industries gears are a central basic element for transmission of movement and power. In addition to the most frequently used gears [...]

Die Bedeutung des Gefüges für die Steuerung der mechanischen Festigkeit silikatkeramischer Werkstoffe wird bereits bei der Auswahl geeigneter Rohstoffe deutlich, wenn es um die gezielte Bildung amorpher und kristalliner Phasen geht. Diese können im Werkstoff zu Gefügespannungen führen [1] oder aufgrund ihrer Morphologie das Gefüge beispielsweise durch Verzahnung verstärken [2]. Auf dem Weg zu einem leistungsfähigeren Werkstoff, komplexen Produktgeometrien und Wettbewerbsfähigkeit soll diese Arbeit als ein Beitrag zum Verständnis festigkeitsrelevanter Mechanismen dieser Werkstoffgruppe verstanden werden. Die Modifikation eines Feinsteinzeuges durch eine Rohstoffsubstitution beispielsweise mit Aluminiumoxid, Quarz und Nephelinsyenit führt zu einer signifikanten Steigerung der mechanischen Festigkeit. Die damit einhergehenden Wirkmechanismen werden durch röntgenographische Untersuchungen und konventionelle Messmethodik gezeigt und bewertet. The importance of the microstructure of silicate ceramic materials for their mechanical strength becomes immediately clear when selecting the raw materials to achieve a particular combination of amorphous and crystalline phases. These can lead to internal stresses in the material [1] or alternatively to a strengthening through the interlocking of their morphologies within the microstructure [2]. The aim of this work is to contribute to a general understanding of the mechanisms relevant to strength within this class of materials. This is part of a drive towards more effective materials, complex product geometries and increased competitiveness. Modification of a porcelain stoneware body by raw materials substitution with alumina, quartz and nepheline syenite leads to a significant increase in the mechanical strength of components. The accompanying mechanisms are revealed and evaluated by X-ray-based and conventional analytical methods.

B-cell CLL/lymphoma 6 (BCL6) exerts oncogenic effects in several human hematopoietic malignancies including chronic myeloid leukemia (CML), where BCL6 expression was shown to be essential for CML stem cell survival and self-renewal during imatinib mesylate (IM) treatment. As several lines of evidence suggest that interferon γ (IFNγ) production in CML patients might have a central role in the response to tyrosine kinase inhibitor (TKI) therapy, we analyzed if IFNγ modulates BCL6 expression in CML cells. Although separate IFNγ or IM treatment only slightly upregulated BCL6 expression, combined treatment induced remarkable BCL6 upregulation in CML lines and primary human CD34+ CML stem cells. We proved that during combined treatment, inhibition of constitutive signal transducer and activator of transcription (STAT) 5 activation by IM allowed the specific enhancement of the STAT1 dependent, direct upregulation of BCL6 by IFNγ in CML cells. By using colony-forming assay, we found that IFNγ enhanced the ex vivocolony or cluster-forming capacity of human CML stem cells in the absence or presence of IM, respectively. Furthermore, inhibition of the transcriptional repressor function of BCL6 in the presence of IM and IFNγ almost completely blocked the cluster formation of human CML stem cells. On the other hand, by using small interfering RNA knockdown of BCL6, we demonstrated that in an IM-treated CML line the antiapoptotic effect of IFNγ was independent of BCL6 upregulation. We found that IFNγ also upregulated several antiapoptotic members of the BCL2 and BIRC gene families in CML cells, including the long isoform of MCL1, which proved to be essential for the antiapoptotic effect of IFNγ in an IM-treated CML line. Our results suggest that combination of TKIs with BCL6 and MCL1 inhibitors may potentially lead to the complete eradication of CML stem cells.

The development toward increasing processing speeds and more complex procedures in molding and slip casting within the ceramic industry is leading to reject rates between 5 and 10%. The influences of mineralogy, chemical composition, grain size and shape, and many other factors, are generally inadequately considered. Moreover, there is a general lack of rheological procedures and parameters for quantifying the flow behavior of raw materials containing clay minerals. Dynamic behavior is evaluated by recording structural conditions and the associated times. This approach generates comparative values that are adequate for quality control but it does not deliver information about the real behavior of the dispersion (slurry). A novel analytical method, which generates information on the rate of construction and destruction of structure, will be shown. Furthermore, combinations of thixotropic and rheopectic reactions are recorded and included in the method. As a result of there being several alternative procedures for measuring the static behavior of clay mineral slurries, large variations in measurement values are observed. A unified measurement procedure and factors relating to raw materials that influence flow behavior is presented.

Many ischemic strokes or transient ischemic attacks are labeled cryptogenic but may have undetected atrial fibrillation (AF). We sought to identify those most likely to have subclinical AF.

This pilot project was designed to identify individuals at high risk for lung cancer in a family practice clinic setting, and to detect lung cancer in this high-risk group. Patients [...]

PURPOSE: To devise a simple questionaire to identify patients who are at high risk for lung cancer, and to detect cancer in these high risk patients by screening with sputum [...]

Few studies have been conducted on changes in the susceptibility of bacteria due to long-term use of biocides. A total of 375 avian Salmonellaisolates collected in Germany from healthy or diseased animals during two time periods, 1979 through 1994 and 2004 through 2010, were included in the present study. The isolates were tested for their MICs of triclosan, acriflavine, benzalkonium chloride, and chlorhexidine by broth macrodilution. MIC50, MIC90, and the distribution of MICs were compared. The MIC ranges were 0.0625 to 0.5 μg/ml for triclosan, 16 to 256 μg/ml for acriflavine, 8 to 128 μg/ml for benzalkonium chloride, and 0.5 to 32 μg/ml for chlorhexidine. MIC50s and MIC90s were equal or differed by not more than one dilution step. For isolates from healthy poultry collected during the two time periods, statistical analysis revealed a significant increase only in MICs for chlorhexidine. Salmonellae from diseased birds were more susceptible to triclosan and benzalkonium chloride but less susceptible to acriflavine and chlorhexidine. Overall, only 25 strains had the highest detected MIC of 0.5 μg/ml triclosan, but an association with multidrug resistance could not be confirmed.

The elimination of specified risk material from food is crucial to restricting the risk to public health arising from bovine spongiform encephalopathy. The distribution of lymphoreticular tissue as potential specified risk material of the bovine lingual tonsil is described in relation to topographical anatomical landmarks. The definition of a proper landmark is a prerequisite for establishing adequate legal regulations concerning the removal of the lingual tonsil after slaughter. The main parameter to identify the lymphoreticular tissue in this study was the immunohistochemical identification of the follicular dendritic cells in the lingual tonsil. Lymph nodules were detected in areas up to 30 mm rostral of a given macroscopic landmark, i.e., the most caudal of the papillae vallatae. This area must therefore be adequately removed from the bovine tongue in the slaughterhouse. The current method for the removal of the lingual tonsil tissue according to Regulation (EC) 999/2001 at the slaughterhouse and alternatives to this method are discussed.

The influence on Yersinia enterocoliticacounts of a gradual increase of carbon dioxide concentrations (percentage by volume in air) during packaging and storage of ground pork meat artificially contaminated with this pathogen was evaluated. Ground meat was packaged under customary conditions using modified atmospheres with various carbon dioxide percentages (0, 30, 50, 70, and 100% CO2by volume; for atmospheres of less than 100% CO2, the rest of the gas was O2). The packs were stored at 2°C for 12 days. During the entire storage time, counts of Y. enterocoliticawere determined by the spread plate method for direct plate counts (DPCs). Microbiological shelf life of the stored ground pork also was assessed by total mesophilic aerobic bacterial plate counts (APCs). Y. enterocoliticacounts were not significantly different (P≥ 0.05) in the ground pork packaged under the various CO2-enriched atmospheres. The growth of Y. enterocoliticawas nearly entirely inhibited in all tested modified atmospheres containing the protective CO2. However, in ground pork packaged with 100% oxygen, there was a significant decrease (P≤ 0.05) in the DPC for Y. enterocoliticafrom 4.30 log CFU/g (day 0) to 3.09 log CFU/g at the end of the storage time (day 12). The decrease was presumably due to the marked increase in APC seen only in those packages stored under 100% O2. Packaging with high CO2concentrations had significant inhibitory effect (P≤ 0.05) on the growth of mesophilic aerobic bacteria.

Alle Betriebsfluide im Automobil wie Öle, Kraftstoff, Luft und weitere werden filtriert. Mit Hilfe von Filtern und Separatoren werden Partikel mechanisch abgeschieden. Adsorption und Desorption sind weitere Standardprozesse, die zur Reinigung von Fluiden in Fahrzeugen eingesetzt werden. Dabei werden u. a. semipermeable Membranen eingesetzt, um selektiv Moleküle zurückzuhalten. Thermische und katalytische Regenerationsverfahren zur Entfernung abgeschiedener Rußpartikel und Moleküle haben die verfahrenstechnische Palette erweitert, die Einsatztemperaturen im Automobil reichen von –40°C bis über 1000°C. Bei den verwendeten Filtermedien handelt es sich um imprägnierte Papiere auf Zellulosebasis, Vliesstoffe und Meltblown aus synthetischen Fasern und, zumeist bei höheren Temperaturen, um Keramik, Metallgewebe und poröse Sintermetalle. Von der Struktur her gibt es homogen aufgebaute Tiefenfilter, Filtermedien mit Dichtegradienten und sogenannte Composites mit ≥ 2 Lagen, die funktionell aufeinander abgestimmt sind. Zunehmend betrachtet man auch Oberflächenfilter, z. B. mit Nanofasern, und neuerdings für spezielle Anwendungen Membranen. Je nach Fahrzeugtyp und Ausstattung werden in modernen Fahrzeugen acht bis 15 dieser Filterelemente verbaut, bei großen Lastkraftwagen sind es teilweise über 20 Abscheider, wobei kleine Polizeifilter aus Metallgewebe oder Sintermetall in den Hydraulikkreisläufen nicht mitgezählt wurden. Es wird ein Überblick über die komplexen mobilen Anwendungen und die wichtigsten Filterelemente und Separatoren in Fahrzeugen gegeben, ergänzt durch neue Entwicklungstrends aus aktuellen Serienfahrzeugen.

Zur Trennung von Emulsionen im Zentrifugalfeld kommen neben Zentrifugen und Separatoren vermehrt Hydrozyklone zum Einsatz. Bei der Modellierung der Auftrennung von Emulsionen in Zentrifugalabscheidern muss der Einfluss der Tropfenwechselwirkungen auf die Trennung berücksichtigt werden. Dies geschieht in der vorliegenden Arbeit durch die gekoppelte Lösung von Populationsbilanzen und den strömungsmechanischen Grundgleichungen mit dem Simulationsprogramm Fluent™.

Abstract: Bacillus stearothermophilus heat treatment studies at different pH levels were carried out in order to predict the final microbiological load as affected by the temperature and pH treatment. For that, distribution functions were obtained for the initial number of microorganisms, the decimal reduction coefficient, the z T and the z pH parameters, and Monte Carlo Simulation was used as a tool to determine this microbial load after a heat treatment introducing in this way the variability and uncertainty. The mean value of the predictions made by Monte Carlo Simulation, when compared with independent data, rendered Accuracy Factors close to 1, values close to 1 indicated good predictions. Bias values were close to 1, but some values were below 1 and others above 1. The tornado graphs indicated that the main factor contributing to the final load after the heat treatment was the initial number of microorganisms followed by the temperature and pH.

A total of 267 cysts were collected from March to December 2004 from two main abattoirs in northern Germany. The cysts were classified by the usual organoleptic methods during meat inspection as Cysticercus bovis. The reported prevalence of cysticercosis in the abattoirs was 0.48 and 1.08%, respectively. The cysts were examined macroscopically for description of their morphology and constituents and classified as viable or degenerating (dead). The DNA was extracted from these cysts and subjected to polymerase chain reaction (PCR) for evaluation of the detection methods used and to make certain that the cysts did indeed belong to C. bovis, as indicated at the slaughterhouses. Two sets of primers were used with different sensitivity levels. The first, HDP1, was able to detect 200 fg of Taenia saginataDNA and 100 pg of C. bovisDNA. The other primer set, HDP2, was able to detect 1 pg of T. saginataDNA and 1 ng of C. bovisDNA. No more than 52.4% of the samples tested positive for C. bovisin the PCR using both primers, while 20% of the viable cysts and 49.2% of the degenerating cysts tested negative with both primers.A total of 267 cysts were collected from March to December 2004 from two main abattoirs in northern Germany. The cysts were classified by the usual organoleptic methods during meat inspection as Cysticercus bovis. The reported prevalence of cysticercosis in the abattoirs was 0.48 and 1.08%, respectively. The cysts were examined macroscopically for description of their morphology and constituents and classified as viable or degenerating (dead). The DNA was extracted from these cysts and subjected to polymerase chain reaction (PCR) for evaluation of the detection methods used and to make certain that the cysts did indeed belong to C. bovis, as indicated at the slaughterhouses. Two sets of primers were used with different sensitivity levels. The first, HDP1, was able to detect 200 fg of Taenia saginataDNA and 100 pg of C. bovisDNA. The other primer set, HDP2, was able to detect 1 pg of T. saginataDNA and 1 ng of C. bovisDNA. No more than 52.4% of the samples tested positive for C. bovisin the PCR using both primers, while 20% of the viable cysts and 49.2% of the degenerating cysts tested negative with both primers.

In mass catering facilities of the German Armed Forces, foodborne outbreaks are commonly attributed to Bacillus cereus, and spores of this organism are regularly found on equipment surfaces. B. cereusis the causative agent of foodborne emetic or diarrheic disease. Hence, the use of sporicidal disinfectants may provide a starting point for successful risk mitigation of diseases associated with B. cereus. In this study, the amphoteric surfactant–based disinfectant (product A) that has been routinely used in catering facilities of the German Armed Forces and a peracetic acid–based disinfectant (product B) were compared for their efficacy against B. cereusspores in laboratory tests and under field conditions. In a carrier test for B. cereusspores, product A displayed no efficacy against spores of the test strain. In contrast, a substantial reduction in spore concentration (>5-log reduction) was achieved with product B. In a controlled trial conducted in seven Army catering facilities, the reduction in the number of B. cereus–positive samples was significantly greater (P< 0.001) for product B (from 28% initial contamination to 3% after application) than for product A (from 33 to 21%). Product B was estimated to be 6.25 times more efficacious than product A. Field trials confirmed the higher efficacy of the peracetic acid–based disinfectant to reduce B. cereuscontamination on surfaces as found for the in vitro experiments. The tests used to assess the sporicidal effects of disinfectants were adequate under practice conditions and could be used for sporicidal testing of disinfectants for catering and food production establishments.

The diagnosis of Wolff-Parkinson-White syndrome is generally straightforward; however, the management may not be, and requires an understanding of the competing risks of various treatment options and that of the clinical setting in which the diagnosis is made. The symptomatic patient with Wolff-Parkinson-White has an increased risk of atrial fibrillation and a small but significant risk of sudden cardiac death. Therapy is based on reduction in symptom burden and attenuation of the risk of pre-excited atrial fibrillation. Catheter ablation is the most effective means of achieving this goal with abolition of symptoms and risk of pre-excited atrial fibrillation. Medication is often employed in the acute setting to terminate paroxysms of arrhythmia associated with the accessory pathway and reduce the subsequent burden of symptoms until ablation can be performed. An overview of the agents commonly used is provided together with recommendations.

Syncope is a transient, self-limited loss of consciousness, usually leading to falling. The underlying mechanism is a transient global cerebral hypoperfusion. In contrast, loss of consciousness attributable to seizures, somatization disorders and metabolic disorders (hyperventilation, hypoglycemia, hypoxia) are classified as non-syncopal attacks, since they do do not result from sudden transient global cerebral hypoperfusion. Most frequently syncope is due to neurally mediated or vasovagal syncope; in ∼20%, syncope is caused by structural heart disease. Since prognosis of syncope depends on the underlying mechanism, a complete evaluation of the syncope patient is mandatory, including a detailed medical history, thorough physical examination with supine and standing blood pressure measurements, and a 12-lead electrocardiogram. If an underlying structural heart disease is suspected or apparent or ECG is abnormal, a potential underlying cardiac diasease should be pursued by echocardiography, stress ECG and if necessary cardiac catherization and/or EP study. Therapy focuses on treatment of the underlying disease, treatment of bradycardia by pacemakers or tachycardia by radiofrequency ablation and/or implantable defibrillators. If there is no evidence for structural heart disease and ECG is normal, neurally mediated syncope should be considered, particularly if clinical features of syncope are suggestive. Provocation of syncope during tilt testing confirms the underlying mechanism of syncope. Treatment of neurally mediated syncopes focuses on education regarding avoidance of triggering events, recognition of premonitory symptoms and maneuvers to abort the episode. Die Synkope ist ein transienter, selbstlimitierender Bewusstseinsverlust, häufig mit Sturzfolge. Zugrundliegender Mechanismus ist eine transiente globale cerebrale Minderperfusion. Im Gegensatz hierzu werden Anfallsleiden oder metabolische Entgleisungen wie Hypoxie, Hypoglykämie, Hyperventilation als nicht-synkopale Ereignisse klassifiziert, da sie nicht durch eine transiente globale cerebrale Minderperfusion hervorgerufen werden. Am häufigsten ist die neurokardiogene oder vasovagale Synkope, in bis zu 20% der Synkopen lässt sich eine zugrundeliegende strukturelle Herzerkrankung finden. Da die Prognose der Synkope von der zugrundeliegenden Erkrankung abhängt, ist eine genaue Untersuchung des Synkopenpatienten unbedingt notwendig. Hierzu zählt eine genaue Anamneseerhebung, eine ausführliche körperliche Untersuchung mit liegender und stehender Blutdruckmessung und ein 12-Kanal-EKG. Wird eine strukturelle Herzerkrankung vermutet oder ist diese bereits bekannt oder liegt ein abnormales EKG vor, sollte eine mögliche strukturelle Herzerkrankung weiter mit Echokardiographie, Belastungs- EKG und ggfs. Herzkatheteruntersuchung und/oder elektrophysiologischer Untersuchung abgeklärt werden. Die Therapie wird sich in diesen Fällen auf die Behandlung der Grunderkrankung, Behandlung von Bradykardien mit Schrittmachern oder von Tachykardien mit Radiofrequenzablation und/oder implantierbaren Defibrillatoren konzentrieren. Besteht kein Hinweis auf eine strukturelle Herzerkrankung und ist das EKG normal, sollten Reflex vermittelte Synkopen in Betracht gezogen werden, vor allem bei suggestiver Anamnese. Die Provokation einer Synkope auf dem Kipptisch kann die Verdachtsdiagnose erhärten. Die Behandlung wird sich bei den Reflex vermittelten Synkopen meist auf die Aufklärung von Synkopen triggerenden Auslösern und Erkennung von Prodromi beschränken, um rechtzeitig Gegenmaßnahmen vor Eintreten einer Bewusstlosigkeit zu ergreifen.

Outbreaks of gastroenteritis have been repeatedly associated with the consumption of raw meat and raw meat products. To assess the potential of this problem in Germany, frequency of consumption and knowledge about and handling of raw meat during food preparation in the German population was estimated. We conducted a population-based nationwide cross-sectional survey in private households in March 2001 by random telephone numbers. Consenting German-speaking persons were randomly chosen among household members for standardized interviews. Proportions were standardized by age, sex, and region (eastern and western Germany). A total of 510 people were interviewed (response 45.1%), including 62.3% women and 31.8% considered at high risk (children younger than 10 years old, elderly more than 65 years old, and chronically ill persons). The mean age was 45.7 years. Of those who ate raw ground meat at least once a week, 17.8% lived in eastern Germany and 5.1% in western Germany, (chi-square test, P< 0.001). Teewurst was eaten by 50.8% of all respondents and 53.8% of respondents in the high-risk group. That salami or Teewurst were raw meat products was known to 58.1 and 36.3% of the respondents, respectively. Respondents reported not washing their hands (46.6%) or cleaning their cutting boards with soap (48.1%) after preparing raw meat. A total of 10.3% of the respondents had diarrhea during the last 3 months. Although knowledge is poor, consumption of raw meat products is widespread in Germany, even among high-risk persons. More information is necessary on which products contain raw meat, the potential risk of diarrhea after raw meat products are consumed, and appropriate handling of raw meat products.

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Bytecode subroutines are a major complication for Java bytecode verification: They are difficult to fit into the dataflow analysis that the JVM specification suggests. Hence, subroutines are left out or are restricted in most formalizations of the bytecode verifier. We examine the problems that occur with subroutines and give an overview of the most prominent solutions in the literature. Using the theorem prover Isabelle/HOL, we have extended our substantial formalization of the JVM and the bytecode verifier with its proof of correctness by the most general solution for bytecode subroutines.

Prudent water management on turfgrass is an important issue. There is a need to define best management practices (BMPs), including optimal irrigation frequency for tall fescue (Festuca arundinaceaSchreb.) when irrigated at a level that would be less than a typical industry practice of ETcrop/irrigation uniformity, where ETcrop= crop evapotranspiration = reference evapotranspiration (ETo) × crop coefficient (Kc). A 2‐yr field study was conducted in Riverside, CA, to determine if the visual quality of tall fescue could be improved during the warm season by altering irrigation frequency (two, three, or four irrigation events per week), cultivar selection (a dwarf cultivar, ‘Shortstop’ or a turf‐type cultivar, ‘Jaguar III’), and mowing height (3.8 or 6.4 cm) when irrigated at 80% ETcrop/irrigation uniformity. Volumetric soil water content at the 30‐, 61‐, and 91‐cm depths was also measured on each Jaguar III sub‐subplot. During the first year, visual quality was significantly higher for Jaguar III and the lower mowing height. During the second year, overall visual turfgrass quality was significantly highest for plots irrigated twice per week. Visual turfgrass quality was significantly correlated with soil water content. In summary, data from this study support recommendations for deeper, less frequent irrigation of established tall fescue grown on sandy loam soils in southern California interior valleys with an irrigation budget of 80% ETcrop/irrigation uniformity.

An efficient method for the solid-phase synthesis of trisubstituted [1,3,5]triazino[1,2-a]benzimidazole-2,4(3H,10H)-diones from resin-bound amino acids is described. N-acylation of the primary amine of a resin-bound amino acid with 4-fluoro-3-nitrobenzoic acid, followed by displacement of the fluoro group and reduction of the nitro group, generated a resin-bound o-dianilino derivative. The dianilino compound was treated with cyanogen bromide to generate the corresponding iminobenzimidazole, which, following treatment with N-(chlorocarbonyl)isocyanate, afforded the resin-bound triazinodione derivative. Alkylation of the triazinodione compound with an alkyl halide yielded, following cleavage of the solid-support, the trisubstituted [1,3,5]triazino[1,2-a]benzimidazole-2,4(3H,10H)-dione.

The appearance of decreased 2-18Ffluoro-2-deoxy-d-glucose (FDG) uptake in the mesial temporal region in temporal lobe epilepsy may simply reflect loss of gray matter due to hippocampal atrophy. Increased partial volume effects due to atrophic hippocampi may further increase appearance of hypometabolism.

Maßnahmen zur Sekundärprävention bei koronarer Herzerkrankung werden in Deutschland unzureichend umgesetzt. Wir untersuchten daher den Einfluss einer stationären Rehabilitation auf die Umsetzung der aktuellen Leitlinien bei Patienten mit schwerer koronarer Herzerkrankung (KHK). Hierzu entwickelten wir ein Fall-Kontroll-Design in betroffenen Geschwisterpaaren, von denen ein Geschwister an der Rehabilitation teilnahm und das weitere Geschwister darauf verzichtete. ??In 15 kardialen Rehabilitationskliniken wurden durch Aktenstudium 1500 Familien identifiziert, in welchen zwei Geschwister eine dokumentierte schwere koronare Herzerkrankung, d.h. Zustand nach Herzinfarkt oder Zustand nach revaskularisierenden Maßnahmen, aufwiesen. Aus dieser Gruppe ließen sich 268 Geschwisterpaare identifizieren, welche sich hinsichtlich einer Teilnahme an einer stationären Rehabilitationsmaßnahme diskordant verhielten. In diesen Geschwisterpaaren wurde im Durchschnitt 5,2 Jahre nach Herzinfarkt oder Revaskularisation ein standardisiertes Interview sowie eine Evaluation der Risikofaktoren durchgeführt. ??Während sich die Geschwister zum Zeitpunkt der Manifestation der koronaren Herzerkrankung mit oder ohne konsekutive stationäre Rehabilitation nicht unterschieden, fanden sich während der Follow-up-Untersuchung bei Teilnehmern der stationären Rehabilitation (Reha-Geschwister) eine signifikant häufigere Einnahme von antihypertensiver Medikation (92,2 vs. 82,1%, p<0,01) sowie signifikant niedrigere Werte für den systolischen und diastolischen Blutdruck (137±1 vs. 145±1 mmHg und 82±1 vs. 85±1 mmHg, jeweils p<0,01). Weiterhin fanden sich bei Reha-Geschwistern zum Zeitpunkt des Interviews signifikant häufiger die Einnahme von CSE-Hemmern (57,5 vs. 43,1%, p<0,01) und signifikant niedrigere Gesamtcholesterinwerte (225±3 vs. 236±3, p<0,01) sowie ein signifikant niedrigeres LDL-Cholesterin (148±3 vs. 158±3, p<0,01). Auch der Nikotinkonsum wurde häufiger bei Reha-Geschwistern eingestellt (80,8 vs. 57,6%, p<0,01). Auffallend war weiterhin ein temporaler Trend im Untersuchungszeitraum zugunsten einer besseren Therapie des arteriellen Hypertonus bei Teilnehmern der stationären Rehabilitation. Komplementär hierzu stieg in dieser Gruppe von 1997 bis 2000 der Anteil der mit CSE-Hemmern-behandelten Patienten signifikant an, entsprechend fiel das LDL-Cholesterin im Untersuchungszeitraum signifikant ab. Auch die Geschwister, die nicht an der stationären Rehabilitation teilgenommen hatten, wiesen, wenn auch in geringerem Umfang, diese günstigen Trends auf. ??In den letzten 4 Jahren wurde die Umsetzung der Maßnahmen zur Sekundärprävention bei koronarer Herzerkrankung deutlich verbessert. Insgesamt findet sich bei Patienten, die an einer stationären Rehabilitationmaßnahme teilgenommen haben, eine bessere Umsetzung der Therapieleitlinien zur Sekundärprävention und ein signifikant günstigeres Risikoprofil als bei denjenigen KHK-Patienten, welche keine stationäre Rehabilitation wahrnahmen. In Germany, measures for secondary prevention in patients with coronary artery disease are poorly utilized. We therefore investigated whether a cardiac in-hospital rehabilitation and education programe may enhance the implementation of respective guidelines in patients with severe coronary artery disease (CAD). Specifically, we developed a case-control design in siblings with severe CAD in order to achieve optimal matching for patients with or without participation in the rehabilitation program. ??By the screening of more than 200000 patient charts in 15 cardiac rehabilitation clinics, we identified 1500 families in which at least two siblings suffered from severe coronary artery disease. In 268 such sibling pairs, siblings were discordant with respect to participation in a 3–4 week cardiac in-hospital rehabilitation program. The coronary risk profile was studied, first, retrospectively at the time of hospitalization for acute MI or revascularization procedures and, secondly, prospectively at the time of follow-up (on average 5.2 years later). ??At the time of the acute cardiac event, both groups showed an equal risk factor distribution suggesting appropriate matching. However, at follow-up the number of individuals taking antihypertensive medication and displaying effective antihypertensive treatment (=140/90mmHg) was significantly higher in the rehabilitation group (92.2 vs. 82.1%, p<0.01; 59.7 vs. 37.2%). Accordingly, rehabilitation siblings presented with significantly lower systolic (137±1 vs. 145±1 mmHg; p<0.01) and diastolic blood pressure (82±1 vs. 85±1mmHg; p<0.01). The utilization of CSE inhibitors was also significantly higher in siblings participating in the rehabilitation program (57.5 vs. 43.1%; p<0.01), leading to significantly lower blood lipid levels in these siblings (total cholesterol 225±3 vs. 236±3 mg/dL, p<0.01; LDL cholesterol 148±3 vs. 158±3mg/dL, p<0.01). Moreover, participation in the cardiac rehabilitation stimulated markedly more smokers to quit (80.8 vs. 57.6%, p<0.01). Additionally, there was a strong temporal trend from 1997 until 2000 towards improved control of arterial hypertension in rehabilitation siblings. In parallel, the utilization of CSE inhibitors increased over time and LDL cholesterol decreased. These favorable temporal trends were also observed in siblings not participating in the rehabilitation program, however, to a lesser extent. ??Taken together, in the last four years, the implementation of secondary preventive strategies in patients with cardiac disease improved. Siblings who participated in a rehabilitation program displayed a better control of cardiovascular risk factors as compared to those not participating in such a program. Thus, an in-hospital cardiac rehabilitation program may successfully encourage the implementation of measures for secondary prevention and enhance the treatment of coronary risk factors.

Several reports indicate the benefit of ACE inhibitors for patients with left ventricular systolic dysfunction after acute myocardial infarction (MI). We sought to determine the implementation of the treatment guidelines in patient samples from the general population. Furthermore we aimed to identify patient characteristics associated with the use of ACE inhibitors. ??Screening of two MI-registries allowed the identification of 226 MI patients with left ventricular dysfunction. Patients were considered to be eligible for ACE inhibitor therapy when a EF =40% was documented in the patient records of cardiac rehabilitation clinics (REG-MI, n=147) or detected by standardised echocardiography (KORA, n=78). On average 5.5 years following MI, a standardised questionnaire and a detailed medical history was obtained. Specifically, information was collected regarding current medication and potential contraindications for ACE inhibitors. ??MI patients with LV dysfunction received ACE inhibitors in 62% (REG-MI) and 45% (KORA). The doses prescribed were substantially smaller than target doses used in the large-scale studies (REG-MI: 40±4%, KORA: 23±3%, % of target doses). Only 13% (REG-MI) and 3% (KORA) received more than 50% of the target dosage. Additionally, actual doses of the most frequently used ACE inhibitors were significantly different (captopril: 23±2%, enalapril: 42±5% of target doses). The likelihood of receiving ACE inhibitors was significantly higher in patients with written recommendation for such medication (odds ratio 6.02, confidence interval 1.93–20.16) and in patients visiting cardiologists (odds ratio 3.69, confidence interval 1.26–11.07) as revealed by multivariate analysis of the REG-MI database. ??Despite national and international guidance, a large proportion of MI patients with left ventricular dysfunction is not receiving ACE inhibitors, and when used, the doses prescribed are markely smaller than target doses used in clinical trials that established the utility of these drugs. Medical care by cardiologists and written recommendation of ACE inhibition in patient records were independent predictors of a more appropriate prescription of ACE inhibitors. Bei Myokardinfarktpatienten mit eingeschränkter Ventrikelfunktion ist die prognostische und symptomatische Effizienz von ACE-Inhibitoren hinreichend belegt. Die Umsetzung der entsprechenden Therapierichtlinien in der Allgemeinbevölkerung sowie die Analyse von Faktoren, welche auf die Implementation einer adäquaten Therapie Einfluss haben, waren Gegenstand dieser Studie. ??Myokardinfarktpatienten mit einer Ejektionsfraktion (EF) =40% wurden anlässlich von Follow-up-Untersuchungen (im Mittel fünf bis sechs Jahre nach Infarkt) des Augsburger Myokardinfarkt-Familienregisters (KORA; n=78) sowie des Regensburger Myokardinfarkt-Familienregisters (REG-MI; n=147) identifiziert. Die EF wurde echokardiografisch bestimmt (KORA) oder den Arztbriefen entnommen (REG-MI). Angaben zur aktuellen Medikation, Ko-Morbidität und ärztlichen Versorgung wurden standardisiert erhoben. Von Herzinfarktpatienten mit linksventrikulärer Dysfunktion nahmen 45% (KORA) bzw. 62% (REG-MI) ACE-Hemmer ein. Allerdings lag die Dosierung nur bei 23±3% bzw. 40±4% der empfohlenen Tagesdosis. Eine ausreichende Therapie (>50% der in Therapiestudien empfohlenen Dosis) fand sich bei 3% (KORA) bzw. 13% (REG-MI). Auffallend war, dass sich Captopril (50% aller Patienten) und Enalapril (26% aller Patienten) in der Einnahme der empfohlenen Tagesdosis deutlich unterschieden (23±2% vs. 42±5%, p<0,01). Als wesentliche Prädiktoren einer Therapie mit ACE-Inhibitioren fanden sich im REG-MI eine entsprechende Empfehlung in den Krankenhausentlassungspapieren sowie die ambulante Behandlung durch Fachärzte (jeweils p<0,01). ??Wir folgern, dass etwa die Hälfte der Myokardinfarktpatienten mit eingeschränkter EF ACE-Hemmer einnimmt, deren Dosierung allerdings weit unterhalb der durch Studiendaten abgesicherten Größenordnung liegt. Zudem fallen erhebliche Unterschiede in der Dosierung einzelner Präparate auf. Für die Durchführung einer ACE-Hemmertherapie sind eine entsprechende Empfehlung im Arztbrief und eine durch den Facharzt gesteuerte Behandlung wesentliche unabhängige Prädiktoren.

Development of a selective culture medium for the enumeration of bifidobacteria in fermented milks. The use of selective culture media is necessary to demonstrate the presence of bifidobacteria in European fermented milks, since Lactobacillus (L.) acidophilus, L. delbrueckii ssp. bulgaricus and Streptococcus (S.) thermophilus usually dominate the flora in these products. But a fully selective medium suppressing these microorganisms does not exist as yet. Therefore, the selectivity and productivity of three media were tested qualitatively and quantitatively: DIC (pH 6.8) and BEE (pH 5.0) were based on TPY and Columbia agar with dicloxacillin and propionic acid respectively, as inhibitory agents. A new combination, DP (pH 6.8), was created on the base of Columbia agar with both propionic acid and dicloxacillin as additives. The elective medium BIO, which is based on RCM agar supplemented with lactose and human erythrocyte concentrate was used as control medium. The samples tested were either single strains of Bifidobacterium spp., L. acidophilus, L. delbrueckii ssp. bulgaricus and S. thermophilus or mixte cultures in form of starter cultures or fermented milks. DIC allowed a good growth of bifidobacteria as well as L. acidophilus. On BEE bifidobacteria as well as L. delbrueckii ssp. bulgaricus grew irregularly. DP allowed a quantitatively sufficient growth of bifidobacteria and prevented the growth of accompanying L. acidophilus, L. delbrueckii ssp. bulgaricus and S. thermophilus strains. Therefore, DP is advantageous over DIC and BEE and can be recommended for the selective isolation of bifidobacteria from starter cultures and from different fermented milks products in Europe. L'importance sur le march? europ?en des laits ferment?s aux vertus pr?sum?es probiotiques augmente r?guli?rement. La flore bact?rienne dans le produit est souvent domin?e par Streptococcus (S.) thermophilus, Lactobacillus (L.) delbrueckii ssp. bulgaricus et L. acidophilus, alors que les bifidobact?ries ne sont pr?sentes qu'en faible concentration. Leur d?nombrement n?cessite donc l'utilisation d'un milieu s?lectif. Or il n'existe ? ce jour aucune m?thode standard de d?nombrement des bifidobact?ries. Trois milieux de culture ont donc ?t? test?s pour leur s?lectivit? et productivit? envers les bifidobact?ries : le milieu DIC (pH 6,8) est bas? sur la g?lose TPY contenant de la dicloxacilline comme agent inhibiteur et le milieu BEE (pH 5,0) est une g?lose Columbia suppl?ment?e en acide propionique. Le nouveau milieu DP (pH 6,8), a comme base la g?lose Columbia additionn?e d'acide propionique et de dicloxacilline comme agents inhibiteurs. Les bifidobact?ries se d?veloppent sur les 3 milieux. En revanche alors que DP inhibe la croissance de L. acidophilus, L. delbrueckii ssp. bulgaricus et S. thermophilus, DIC n'a pas d'effet inhibiteur sur L. acidophilus et L. delbrueckii ssp. bulgaricus se multiplie parfois sur BEE. Le milieu DP peut ?tre recommand? pour l'isolement s?lectif des bifidobact?ries provenant de laits ferment?s.

We have reexamined the structure of inositol phosphates present in trophozoites of the parasitic amoeba Entamoeba histolytica and show here that, rather than being myo-inositol derivatives (Martin, J.-B., Bakker-Grunwald, T., and Klein, G. (1993) Eur. J. Biochem. 214, 711-718), these compounds belong to a new class of inositol phosphates in which the cyclitol isomer is neo-inositol. The structures of neo-inositol hexakisphosphate, 2-diphospho-neo-inositol pentakisphosphate, and 2, 5-bisdiphospho-neo-inositol tetrakisphosphate, which are present in E. histolytica at concentrations of 0.08-0.36 mM, were solved by two-dimensional (31)P-(1)H NMR spectroscopy. No evidence for the co-existence of their myo-inositol counterparts has been found. These neo-inositol compounds were not substrates of 6-diphospho-inositol pentakisphosphate 5-kinase, an enzyme purified from Dictyostelium discoideum that phosphorylates 6-diphospho-myo-inositol pentakisphosphate and more slowly also myo-inositol hexakisphosphate, specifically on position 5. Because preliminary data indicate that large amounts of the same neo-inositol phosphate and diphosphate esters are also present in another primitive amoeba, Phreatamoeba balamuthi, the occurrence of high concentrations of neo-inositol polyphosphates may be much more general than previously thought.

Ideal Decision Support Systems (DSS) provide aid in the attainment of a solution to a particular problem of the user. However, during system interaction, the dialogue design of the DSS has the potential to influence the outcome of the solution. This side effect may or may not be desirable, but system designers must be aware of the potential impact. A laboratory study described in this report examines the significance of the impact. A total of 46 subjects conducted decisions on forecasting methods under two different design structures for DSS interfaces. An increase in guidance provided by the system led to a significant change in the decision model selected. This change in model selected resulted in a number of different solutions to the study's forecasting problem. In application settings, such impacts need to be evaluated prior to implementation to avoid the situations where the software influences the decision process.

Zusammenfassung: Fragestellung: Die Messung des Herzzeitvolumens (HZV) mittels Pulmonalarterienkatheter (PAK) wird wegen der Invasivitt und fehlender kontrollierter Studien zum Nachweis der Effektivitt kritisch diskutiert. Wir untersuchten, ob mit einem wenig invasiven kombinierten Ultraschallverfahren (transsophageale Doppler- und M-Mode-Ultraschallsonde, Dynemo 3000, Fa. Sometec, Paris, Frankreich) vergleichbare und zuverlssige Werte fr den aortalen Blutfluss (ABF) zu erzielen sind. Methodik: Wir bestimmten bei 75 Patienten whrend kardiochirurgischer oder groer allgemeinchirurgischer Eingriffe zeitgleich HZV und ABF zu 313 Messzeitpunkten. Ergebnisse: Das korrekte Plazieren der Ultraschallsonde gelang in weniger als 2 min. Die Qualitt der Ultraschallsignale erwies sich als gut und stabil. Der Korrelationskoeffizient zwischen HZV und ABF betrug 0,89 mit HZV=0,97ABF+1,1 bei positivem Bland-Altmann-Test. Schlussfolgerung: Die Bestimmung des ABF mittels Dynemo 3000 ist den durch einen PAK gewonnenen Werten fr das HZV vergleichbar. Die Methode kann daher als wenig invasives Verfahren zur Bestimmung der Auswurfmenge des Herzens empfohlen werden.

Ziel:Ziel dieser Arbeit ist die Gegenüberstellung der operativen Therapie extrakranieller Karotis interna-Aneurysmen zur endovaskulären Therapie mittels Stents und Coils bzw. Stentgrafts.¶ Methodik:Retrospektiv wurden die Daten von 19 Patienten mit 22 Aneurysmen der extrakraniellen Arteria carotis interna im Zeitraum von 1987–1999 analysiert. Das follow-up erfolgte durch jährliche klinische, duplexsonographische und teilweise angiographische Kontrollen.¶ Ergebnisse:14 Aneurysmen wurden offen chirurgisch rekonstruiert, 8 Aneurysmen wurden einer endovaskulären Behandlung zugeführt. In der chirurgisch behandelten Gruppe kam es in 26,6% zu einer passageren, in 6,6% zu einer permanenten Hirnnervenläsion, ein neurologisches Defizit war nicht zu beklagen. In der Gruppe der endovaskulär behandelten Patienten kam es in 12,5% zu einem zerebralen neurologischen Defizit, in einem Fall (12,5%) kam es im weiteren Verlauf nach 14 Monaten zu einer behandlungsbedürftigen Stenose.¶ Schlußfolgerungen:Die gefäßchirurgische Rekonstruktion von Aneurysmen der extrakraniellen Arteria carotis interna stellt nach Möglichkeit die Methode der Wahl dar. Bei inoperablen oder sehr hoch an der Schädelbasis gelegenen Aneurysmen sollte eine endovaskuläre Therapie in Erwägung gezogen werden. Purpose:The purpose of this study is to compare surgical treatment of extracranial carotid aneurysms with endovascular treatment using stents and coils or stentgrafts.¶ Methods:In a retrospective study the data from 19 patients with 22 extracranial carotid aneurysms between 1987 and 1999 were analyzed. Annual clinical follow-up using duplex sonography and in some cases angiographic control was done.¶ Results:Fourteen aneurysms were reconstructed surgically, endovascular treatment was performed in eight cases. A temporary lesion of cranial nerves occurred in 26.6%, a permanent lesion in 6.6% of the surgically treated group. No neurological deficits were apparent. In the patient group which underwent endovascular treatment, 12.5% had a cerebral neurological deficit. In one case the treatment of a stenosis was necessary after 14 months.¶ Conclusions:Surgical reconstruction of extracranial carotid aneurysms is the method of choice. Endovascular treatment should be considered when aneurysms are inoperable or located high at the cranial base.

Chromosomal deletions on 3p have been described in a large number of human tumors, suggesting the presence of a tumor suppressor gene(s). Using an experimental system, called the elimination test, we previously identified a 1 Mb segment, the common eliminated region 1 (C3CER1). C3CER1 was also covered by a PAC contig. Using the sequence of two overlapping PACs from C3CER1, we localized the humanKIAA0028cDNA, encoding the precursor of mitochondrial leucyl-tRNA synthetase. We also characterized a novel human LIM domain-containing gene (LIMD1) and its mouse ortholog (Limd1). LIM domains consist of a cysteine-rich consensus sequence containing two distinct zinc-binding subdomains, which mediate protein-protein interactions. The predicted protein sequences of the human and mouse genes reveal three LIM domains located at the C-terminal end, which indicates that they belong to the group 3 of the gene family encoding LIM motifs. We characterized the genomic structure of the humanLIMD1gene and assigned the mouseLimd1gene to the chromosome 9F subtelomeric region. Both genes are ubiquitously expressed at the mRNA level. The LIM motif has been previously identified in many developmentally important factors from various eukaryotes. These factors have been shown to play a role in intracellular signaling, transcriptional regulation and cellular differentiation during development. The human C3CER1-locatedLIMD1gene should therefore be further studied for its possible role in tumor suppression.