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Das Screening auf kolorektale Karzinome der Zukunft wird nichtinvasiv sein. Die Tests mussen eine hohe Spezifitat, aber auch eine ausreichende Sensitivitat aufweisen, um moglich keine falsch-negativen Befunde zu generieren. Bis dato erfullt kein Bluttest die Kriterien, die fur den „faecal immunochemical test“ (FIT) erreicht werden. Aktuell ist die Kombination aus familienanamnestischer Erhebung, der Erfassung von klinischen Risikofaktoren und der genomweiten Analyse von Risikofaktoren (GWA) die beste nichtinvasive Filtertechnologie. Next Generation Sequencing (NGS) und die Nutzung der kunstlichen Intelligenz wird das nichtinvasive Screening des kolorektalen Karzinoms, aber auch anderer Karzinome vorantreiben.

Die risikoadaptierte Dickdarmkrebsvorsorge fuhrt dazu, dass die ergriffenen Masnahmen wesentlich haufiger mit pathologischen Befunden verbunden sind und somit weniger gesunde Menschen im Rahmen der Vorsorge invasiv untersucht werden mussen. Dies wiederum wirkt sich auf Kosten und die Komplikationsrate der Vorsorgemasnahmen aus und gestaltet Vorsorge letztlich attraktiver. Bis dato wurde zur Risikoadaptation vor allem das familiare Risiko identifiziert. Klare Regeln, wie dieses Risiko flachendeckend evaluiert werden kann, gibt es nicht. Leitlinienempfehlungen besagen einen Start mit invasiven Vorsorgemasnahmen 10 Jahre vor Erkrankung der Indexperson. Der Tatsache, dass Manner fruher an Darmkrebs erkranken als Frauen, tragt der Beschluss des Gemeinsamen Bundesausschusses insofern Rechnung, als das Startalter fur die erste von 2 Vorsorgekoloskopien bei Mannern auf das 50. Lebensjahr vorgezogen wurde. Neuere strukturierte epidemiologische Untersuchungen zeigen, dass eine Risikoadaptation sehr viel differenzierter und letztlich auch aussagekraftiger funktionieren konnte. Hierzu bedarf es strukturierter Erhebungen bei den infrage kommenden Personengruppen (z. B. beim Check-up mit 35 Jahren). Die logische Konsequenz aus einer differenzierten Risikostratifikation ist ein unterschiedlicher Beginn der invasiven Untersuchungen und auf jeden Fall der Einsatz invasiver diagnostischer Methoden (Vorsorgekoloskopie) bei erhohtem Risiko.

Derzeit stellt die multiparametrische Magnetresonanztomographie (MRT) die diagnostisch genaueste Methode zur Darstellung eines Prostatakarzinoms dar. Der Goldstandard zur Prostatabiopsie ist aufgrund der einfachen Anwendung die systematische Biopsie mit dem transrektalen Ultraschall (TRUS). Durch die Kombination konnen die Vorteile beider Methoden genutzt werden. Mittlerweile befinden sich mehrere Bildgebungssysteme zur fusionsbildgestutzten Biopsie in der Erprobung. Erste Daten zeigen hohere Karzinomdetektionsraten als bei der systematischen TRUS-Biopsie. Allerdings stellen die Verformung der Prostata und die intrakorporale Beweglichkeit Herausforderungen dar, die noch nicht abschliesend gelost sind. Der vorliegende Artikel gibt eine Ubersicht uber den aktuellen Stand der MRT-gestutzten Biopsieverfahren und beleuchtet die aktuelle Datenlage.

Die fruhzeitige Diagnose eines gastrointestinalen Tumors kann zu einer Reduktion der Mortalitat und zu einer Verbesserung der Prognose fuhren. Die Effektivitat der Screeningprogramme ist fur das kolorektale Karzinom belegt. Entsprechende Algorithmen haben sich durchgesetzt. Bei anderen Tumoren bleibt die abschliesende Beurteilung von Screeningmasnahmen z. T. unbeantwortet. Inzidenz der Erkrankung, Kosten der Masnahmen und das Risiko einer sog. Uberdiagnose mussen dabei gegeneinander abgewogen werden.

Anhaltende Schluckbeschwerden bei unspezifischer Osophagitis, die auf eine PPI-Therapie nicht ansprechen, sollten Anlass zu weiterer Diagnostik sein. In unserem Fall geht es um eine 68-jahrige Patientin, bei der schlieslich ein Lichen ruber planus des Osophagus gefunden wurde. Dieses seltene Krankheitsbild ist in der Regel mit Immunsuppressiva gut zu therapieren.

Perforation during colonoscopy is a rare but severe complication.Retrospective analysis was done of 15 patients operated on for perforation from colonoscopy between January 2000 and December 2006.Three perforations occurred during diagnostics and 12 during interventional colonoscopy. Two perforations occurred as transmural thermal injury to the colon wall. Peritonitis was found in four cases and correlated significantly with mean time between perforation and operation. Twelve perforations were sutured laparoscopically and three by laparotomy. Hospital stay was significantly shorter after laparoscopic treatment than by laparotomy. One patient had a postoperative wound infection, and mortality was 0%.Early laparoscopic suturing is a safe and effective method in the treatment of perforation from colonoscopy.

A research program has been started to study experimentally the near-threshold photodissociation of nuclides in the chain of cosmic heavy element production with bremsstrahlung from the ELBE accelerator. An important prerequisite for such studies is good knowledge of the bremsstrahlung distribution which was determined by measuring the photodissociation of the deuteron and by comparison with model calculations. First data were obtained for the astrophysically important target nucleus 92-Mo by observing the radioactive decay of the nuclides produced by bremsstrahlung irradiation at end-point energies between 11.8 MeV and 14.0 MeV. The results are compared to recent statistical model calculations., Comment: 6 pages, 8 figures, Proceedings Nuclear Physics in Astrophysics II, May 16-20, 2005, Debrecen, Hungary. The original publication is available at www.eurphysj.org

With the increasing use of complementary and alternative medicine (CAM) in the US, academic medical centres need to provide evidence-based CAM information and services. To develop a CAM programme involving practice, education and research at our tertiary-care academic medical centre, we initiated a four-pronged approach: (i) creation of an interdisciplinary CAM interest group, (ii) a survey of CAM use among 1514 patients seen at our institution, (iii) a survey of knowledge and attitudes toward CAM among 660 physicians in our institution’s Department of Internal Medicine and (iv) a pilot study of CAM consultations provided at no cost to 102 patients. Bringing together individuals from multiple disciplines across our institution resulted in numerous alliances and collaborations. We documented that many of our internists thought that addressing CAM therapies would improve patient satisfaction and that our patients used CAM therapies and found CAM consultations helpful. Our present programme is devoted to practice (a CAM consultation service has been implemented), education (medical school lectures and a postgraduate-level curriculum in CAM medicine have been developed) and research (there are several ongoing clinical trials).

The use of a separation step, such as liquid chromatography, prior to inductively coupled plasma mass spectrometry (ICP-MS) has become a common tool for highly selective and sensitive analyses. This type of coupling has several benefits including the ability to perform speciation analysis or to remove isobaric interferences. Several limitations of conventional instruments result from the necessity to scan or pulse the mass spectrometer to obtain a complete mass spectrum. When the instrument is operated in such a non-continuous manner, duty cycle is reduced, resulting in poorer absolute limits of detection. Additionally, with scanning instruments, spectral skew can be introduced into the measurement, limiting quantitation accuracy. To address these shortcomings, a high-performance liquid chromatograph has been coupled to an ICP-MS capable of continuous sample introduction and simultaneous multimass detection. These features have been realized with a novel detector array, the focal plane camera. Instrument performance has been tested for both speciation analysis and for the elimination of isobaric interferences. Absolute limits of detection in the sub picogram to tens of picograms regime are obtainable, while the added mass dimension introduced by simultaneous detection dramatically increases chromatographic peak capacity.

Zwar ist die Komplikationsrate der gastroosophagealen Refluxkrankheit gering, doch zeigen die Patienten eine starke Einschrankung ihrer Lebensqualitat bis hin zu ihrer Arbeitsfahigkeit. Zur Therapie stehen neben der Anderung des Lebensstils verschiedene medikamentose Optionen offen. Der vorliegende Beitrag beschreibt diese Therapieoptionen unter dem Gesichtspunkt der evidenzbasierten Medizin. Bei guter Wirksamkeit und Vertraglichkeit insbesondere von Protonenpumpeninhibitoren sind auch Kostenaspekte der konservativen gegenuber der chirurgischen bzw. endoskopischen Therapie zu berucksichtigen. Ein Ausblick auf kunftige medikamentose Therapieoptionen umfasst v. a. Cyclooxygenase-2-Hemmer und den GABA-Rezeptoragonisten Baclofen.

Diabetes represents one of the greatest public health threats of the twenty-first century. It is well recognized that diabetes is an important risk factor for the development of cardiovascular disease including heart failure. Although heart failure in diabetic patients is often multifactorial, there is evidence that diabetes can have direct affects on cardiac function, a condition referred to as diabetic cardiomyopathy. The relationship between metabolic disease and cardiac dysfunction has been an area of intense basic and clinical investigation for nearly 4 decades. Despite these efforts, specific therapies to prevent and/or reverse diabetic cardiomyopathy have been lacking. This review will discuss the current state of the field with a focus on strategies to minimize the impact of metabolic stress on cardiac dysfunction and heart failure.

The quality control of rain amount data is usually based on a posteriori defined sets of empirical thresholds, e.g. when crosscheking neighbouring observations. While these procedures are well suited for very long time series, it is difficult to adopt the rules for time series of special observation periods with higher resolution in time. We propose a linear Kalman filter and present several methods, how to fit it onto the stochastic structure of the time series in the presence of many zeroes. These zeroes may indicate light rain or no rain and, therefore, are considered censored. They do not fit into the stochastic structure of the non-zero values and have to be treated separately. Fitting one out of four model parameters of the Kalman filter also determinates two other dependent ones. Only one model parameter has to be known from independent sources. The fitting algorithms are tested with artificial rain rate time series with known stochastic structure and several zero rain data points. Furthermore, applied to time series of observed hourly rain amounts for 4 consecutive winter months, the Kalman filter shows its sensitivity for faulty data points. The detection of conspicuous data by the method of Kalman filtering is discussed.

Measurements of the temperature dependent microwave dielectric permittivity of PVDF and 60%–40% VDF-TrFE copolymer are presented. A cavity perturbation method is used. At room temperature a surprisingly high absorption of microwave power is observed, which decreases with decreasing temperature. This behavior seems to be connected with the ferroelectric-to-para-electric phase transition. With the copolymers a dependence of the complex permittivity on annealing temperature is found. A model considering paraelectric fluctuations is proposed.

Nonlinear interactions and feedbacks in frontal dynamics are studied with two-dimensional quasigeostrophic, semigeostrophic and primitive equation models for given cases of moderate surface cold fronts. According to the degree of approximation these feedbacks are in effect as a result of geostrophic and ageostrophic advection configuring the further frontal development and the associated energy-transfers between the geostrophic and the ageostrophic scales. The most prominent feedback processes, including the feedback connected with the ageostrophic along-front windvag, are theoretically reviewed. In cases of smallvag values, their effects on form and horizontal scale of the frontal secondary circulation are discussed by comparing the products of different model versions and the cross-frontal spectral analysis of the ageostrophic wind fields. To scrutinize the role played by thevag-field, further experiments were based on a hierarchy ofvag-substitutes parameterized by the momentum equation of the crossfrontal winddu/dt=fvag. Tentative results show the tendency towards very localized effects.

Results are presented from the search for energetic charged particles possibly emitted from a deuterium loaded palladium electrode in an electrolysis cell. Within the sensitivity of our experimental set-up, we could not find events originating from ‘cold nuclear fusion’ processes. Based on this outcome, an upper limit for the non-observation of CNF of 2.0×10−2s−1 emitted charged particles per cm3(Pd) resp. 1.6×10−24s−1 emitted charged particles per D pair has been deduced.

Die gastroosophageale Refluxkrankheit (GERD) umfasst 3 Entitaten: die Refluxosophagitis, die nicht-erosive Refluxkrankheit und den Barrett-Osophagus. Letztere zeigt ein — wenn auch geringes — Entartungsrisiko, sodass eine endoskopische Untersuchung bei GERD-Patienten angestrebt werden sollte. Neben Lifestyle-Veranderungen stehen bei der symptomatischen Therapie Protonenpumpeninhibitoren (PPI) im Vordergrund. Wird hierunter eine Therapieresistenz beobachtet, sollten zunachst die regelmasige Einnahme und die Einnahmezeit der PPI uberpruft werden, danach erst sollte eine Dosiserhohung erfolgen. Nur bei wenigen Patienten ist eine operative Therapie indiziert. Endoskopische Therapieverfahren sollten im Rahmen von klinischen Studien eingesetzt werden.

Patient management system software can facilitate improved outcomes for orally anticoagulated patients. The pharmacist-staffed anticoagulation management service (AMS) at the Alaska Native Medical Center transitioned from a warfarin dosing algorithm to a software-based patient management system that included dose adjustment recommendations. A quality assurance assessment approved by the institution’s medical director of research was conducted to determine the effect on patient outcomes. A retrospective comparison of AMS patient outcomes was conducted for the time period of 113 days before (PRE) and after (POST) the May 11, 2006 implementation of Dawn AC software, an anticoagulation patient management system. All orally anticoagulated patients, regardless of indication, seen in the AMS from January 18 to August 31, 2006, were evaluated. The software was populated with all PRE and POST patient data including International Normalized Ratio (INR) values from January 18 through August 31. Time within therapeutic range was calculated within the software by the Rosendaal method and was analyzed using a 2-sample binomial test of equal proportions. The mean interval between INR measurements was measured. Patient outcomes included any hemorrhagic or thrombotic event that led to a hospitalization or a visit to the emergency department (ED) or outpatient clinic (OPD) and were analyzed using an exact 2-sample Poisson test. Outcomes and INR values were analyzed for patients in the PRE group (N = 94) with a total of 7,828 days of treatment (83.3 average treatment days per patient; 21.4 patienttreatment-years) while the POST group (N = 110) had a total of 8,956 days of treatment (81.4 average treatment days per patient; 24.5 patient-treatment-years). The overall time within therapeutic range decreased from 64.0% in the PRE group to 61.6% in the POST group (P \ 0.01). The mean interval between INR measurements in the PRE group was nearly equal to the POST group (15.8 vs. 15.9 days). No thrombotic events occurred in the PRE or POST groups. The occurrence of hemorrhagic events decreased from 16 in the PRE group; 0.75 events per patient-treatment-year; to 11 in the POST group; 0.45 (P = 0.25). The occurrence of all hemorrhagic visits (initial event and any follow up) to ED and OPD decreased from 20 visits in the PRE group; 0.93 visits per patient-treatment-year to 14 visits in the POST group; 0.57; however this difference was not statistically significant (P = 0.17). The incidence of hemorrhagic ED visits was identical between the PRE and POST groups (8 visits; 0.37 visits per patient-treatment-year vs. 9 visits; 0.37); (P = 1). The incidence of hemorrhagic OPD visits was higher in the PRE group versus the POST group (12 visits; 0.56 visits per patient-treatmentyear vs. 5 visits; 0.20); (P = 0.05). One admission occurred in both the PRE and POST groups (0.05 admissions per patient-treatment-year vs. 0.04); (P-value not calculated due to sample size limitations). The number of admission days was lower for the PRE group, (4 days; 0.19 days per patient-treatment-year) than the POST group (6 days; 0.24); (P-value not calculated due to sample size limitations). Despite a significant decrease in time within therapeutic range, a decrease in hemorrhagic events and a significant decrease in hemorrhagic outpatient clinic visits occurred among Alaska Native people after implementation of oral anticoagulation patient management software.

The half-life of the 184.3 keV state in165Dy has been remeasured asT1/2=1.0±0.1 ns in order to deduce a reliable value for the transition matrix element of the depopulatingE l,ΔK=1 transition. Experimental E1,ΔK=1 transition matrix elements in odd-odd deformed nuclei are found to be systematically larger than similar values in adjacent odd-A isotones. This effect is supposed to be associated with higher-order vibrational admixtures coupled via RPC andp— n interaction mixings.

Fragment mass distributions are presented obtained in the heavy-ion reactions22Ne+249Cf,32S+238U,40Ar+232Th and56Fe+208Pb leading to composite systems with equal nuclear charge numberZ=108. The experiments were performed at the heavy-ion cyclotron U 300 of the Laboratory of Nuclear Reactions in Dubna. The spectrometer DEMAS was used to measure the time-of-flight values and the laboratory angles of the correlated fragments. The shape of the mass distributions strongly depends on the initial mass asymmetry. When decreasing the bombarding energy down to values near the Coulomb barrier, the mass distributions obtained in the reactions32S+238U and40Ar+232Th exhibit relative maxima ofM≈205 interpreted to be due to stabilizing effects of nuclear shells during the fragmentation process.

TotaT kinetic energy vs. fragment mass distributions have been measured in the reactions of64Zn projectiles with114Sn,natAg and139La nuclei at incidence energies of 20–50% above the Coulomb barrier. Conclusions are drawn on the possible influence of nuclear structure effects on the energy dissipation and the mass drift behaviour of the present collision systems.