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This report describes the synthesis of a [2.2]paracyclophane-derived annulated 3-amino-imidazole ligand library through a Groebke-Blackburn-Bienaymé three-component reaction (GBB-3CR) approach employing formyl-cyclophanes in combination with diverse aliphatic and aromatic isocyanides and heteroaromatic amidines. The GBB-3CR process gives access to skeletally-diverse cyclophanyl imidazole ligands, namely 3-amino-imidazo[1,2-a]pyridines and imidazo[1,2-a]pyrazines. Additionally, a one-pot protocol for the GBB-3CR by an in situ generation of cyclophanyl isocyanide is demonstrated. The products were analyzed by detailed spectroscopic techniques, and the cyclophanyl imidazo[1,2-a]pyridine was confirmed unambiguously by single-crystal X-Ray crystallography. The cyclophanyl imidazole ligands can be readily transformed to showcase their useful utility in preparing N,C-palladacycles through regioselective ortho-palladation., (© 2021 The Authors. Chemistry - A European Journal published by Wiley-VCH GmbH.)

The modular synthesis of Au(I)/Ru(II) decorated mono- and heterobimetallic complexes with π-conjugated [2.2]paracyclophane is described. [2.2]Paracyclophane serves as a rigid spacer which holds the metal centers in precise spatial orientations and allows metal-to-metal distance modulation. A broad set of architectural arrangements of pseudo -geminal, -ortho, -meta, and -para substitution patterns were employed. Metal-to-metal distance modulation of Au(I)/Ru(II) heterobimetallic complexes and the innate transannular π-communication of the cyclophanyl scaffold provides a promising platform for the investigations of structure-activity relationship and cooperative effects. The Au(I)/Ru(II) heterobimetallic cyclophanyl complexes are stable, easily accessible, and exhibit promising catalytic activity in the visible-light promoted arylative Meyer-Schuster rearrangement., (© 2021 The Authors. Chemistry - A European Journal published by Wiley-VCH GmbH.)

Late-stage modification is highly desirable for the diversification and modification of biologically active compounds. Peripheral editing (e.g., C-H activation) has been the predominant methodology, whereas skeletal editing is in its infancy. The single-atom N-deletion using anomeric amide reagents constitutes a powerful tool to modify the underlying molecular skeletons of secondary amines. N-pivaloyloxy-N-alkoxyamide is easily prepared on a large scale and promotes C-C bond formation in good yields under the extrusion of N 2 for a variety of (cyclic) aliphatic amines. The exploitation of widely available amines allows the use of existing amine synthesis protocols to translate into the construction of new C-C bonds, enabling ring contraction and the potential for structure optimization of biologically active compounds., (© 2021 The Authors. Angewandte Chemie International Edition published by Wiley-VCH GmbH.)

Background:  With the increasing use of the Lu-177-PSMA-RLT for the treatment of advanced castrate resistant prostate cancer (mCRPC), an estimation of the necessary therapy beds in nuclear medicine departments is of great importance in the view of the high number of cases of advanced prostate cancer, and as a basis to avoid a potentially infrastructure-related bottleneck for patient care in this field., Methods:  The number of therapy beds available in German nuclear medicine departments was included in a basic calculation in view of the overall potential for therapy beds to be expected in the event of a possible approval of a therapeutic agent for the Lu-177-PSMA-RLT for mCRPC patients. A potential expansion of the Lu-PSMA-therapy indications was not taken into account., Results:  The basic calculation shows for a nationwide nuclear medicine bed capacity of approx. 234 000 treatment days a relatively small bed reserve of approx. 19 000 nuclear medicine bed days, which corresponds to a reserve of 63 beds for the research question. There are regional differences in bed capacity: while for some federal states there is an under-capacity of nuclear medicine therapy beds with an approved Lu-177-PSMA-RLT, this is less the case for other federal states., Discussion:  This basic calculation shows that the capacity of nuclear medicine therapy beds is likely to be very well utilized with a prospectively approved therapeutic agent for Lu-177-PSMA-RLT, and could even reach its limits in some German federal states. With a prospective expansion of the range of indications or the foreseeable clinical establishment of further therapeutic radiopharmaceuticals, the number of therapy beds could represent a bottleneck factor for the comprehensive patient treatment in the medium term., Competing Interests: Alle Autoren geben an, dass Sie bezüglich dieses Artikels keine Interessenkonflikte haben. Disclosures: Frederik Giesel: geringer Patentanteil an PSMA-1007; Beratertätigkeit bei ABX, Sofie Biosciences und Telix. Außerhalb dieses wissenschaftlichen Artikels: geringer Patentanteil an FAPI. Matthias Eiber: Berater bei Blue Earth Diagnostics, Telix und Janssen. Er hält Patentanteile an rhPSMA. Darüber hinaus hat er Honorare von Progenics und Rotop erhalten. Kambiz Rahbar: Beratertätigkeiten bei ABX, AAA und Bayer. Darüber hinaus habe er Honorare von AAA, Janssen Cielag, AMGEN und SIRTEX für Vorträge erhalten., (Thieme. All rights reserved.)

Although advances in machine-learning healthcare applications promise great potential for innovative medical care, few data are available on the translational status of these new technologies. We aimed to provide a comprehensive characterization of the development and status quo of clinical studies in the field of machine learning. For this purpose, we performed a registry-based analysis of machine-learning-related studies that were published and first available in the ClinicalTrials.gov database until 2020, using the database's study classification. In total, n = 358 eligible studies could be included in the analysis. Of these, 82% were initiated by academic institutions/university (hospitals) and 18% by industry sponsors. A total of 96% were national and 4% international. About half of the studies (47%) had at least one recruiting location in a country in North America, followed by Europe (37%) and Asia (15%). Most of the studies reported were initiated in the medical field of imaging (12%), followed by cardiology, psychiatry, anesthesia/intensive care medicine (all 11%) and neurology (10%). Although the majority of the clinical studies were still initiated in an academic research context, the first industry-financed projects on machine-learning-based algorithms are becoming visible. The number of clinical studies with machine-learning-related applications and the variety of medical challenges addressed serve to indicate their increasing importance in future clinical care. Finally, they also set a time frame for the adjustment of medical device-related regulation and governance.

Selective activation/functionalization of C-H bonds has emerged as an atom- and step-economical process at the forefront of modern synthetic chemistry. This work reports palladium-catalyzed exclusively para-selective C-H activation/aryl-aryl bond formation with a preference over N-arylation under the Buchwald-Hartwig amination reaction of 4-phenylamino[2.2]paracyclophane. This innovative synthetic strategy allows a facile preparation of [2.2]paracyclophane derivatives featuring disparate para-substitutions at C-4 and C-7 positions in a highly selective manner, gives access to a series of potential candidates for [2.2]paracyclophane-derived new planar chiral ligands. The unprecedented behavior in reactivity and preferential selectivity of C-C coupling over C-N bond formation via C-H activation is unique to the [2.2]paracyclophane scaffold compared to the non-cyclophane analogue under the same reaction conditions. Selective C-H activation/aryl-aryl bond formation and sequential C-N coupling product formation is evidenced unambiguously by X-ray crystallography., (© 2020 The Authors. Published by Wiley-VCH GmbH.)

The recent development of dedicated prostate-specific membrane antigen (PSMA) targeted radioligands shows the potential to change and improve the diagnosis and therapy of prostate cancer. There is an increasing number of prospective trials to further establish these tracers in the clinical setting. We analyzed data from the ClinicalTrials.gov registry including all listed prospective trials with PSMA-ligands for prostate cancer as of October 2019 concerning the different tracers and study characteristics. We found n = 104 eligible studies with a total of n = 25 different tracers in use: most frequently [ 68 Ga]Ga-PSMA-11 (32%), followed by [ 18 F]DCFPyL (24%) and [ 177 Lu]Lu-PSMA-617 (10%). 85% are single-center, 15% multi-center studies. 95% national and 5% international studies. 34% are phase-II, 24% phase-I, 13% phase-I/-II, 12% phase-II/-III and phase-III and 7% early-phase-I. The primary purpose was classified as diagnostic in 72% of cases and therapeutic in 23% of cases. Most studies were executed in the USA (70%), followed by Canada (13%) and France (6%). This quantitative descriptive registry analysis indicates the rapid and global clinical developments and current status of PSMA-radioligands with emphasis on radiopharmaceutical and organizational aspects. It will be very interesting to see which tracers will prevail in the clinical setting.

We report the synthesis and catalytic application of a highly stable distance-defined Au/Ru heterobimetallic complex. [2.2]Paracyclophane serves as a backbone, holding the two metal centers in a spatial orientation and metal-metal fixed distance. The Au/Ru heterobimetallic complex is highly stable, easily accessible and exhibits promising catalytic activity in a visible-light mediated dual Au/Ru Meyer-Schuster rearrangement.

In this perspective, we review those stereoselective photocatalytic reactions that use synergy between photoredox catalysts and transition metal catalysts. In particular, we highlight the orchestrated interaction between two and more metals which not only enhance the turnover numbers, but also lead to increased selectivities. Aspects of green chemistry and sustainable developments are included. In this review, C-C, C-O, C-N and C-S forming reactions are discussed and a perspective on future developments is given.

The aim of this paper is to highlight key aspects to be considered from a radiopharmaceutical point of view when performing prospective multicentre clinical trials using short-lived PSMA-PET-radiopharmaceuticals as investigational medicinal product (IMP). Early prospective multicentre clinical trials are playing an increasingly important role in nuclear medicine translational research; in order to be able to establish new PET tracers with a short physical half-life (e. g. for prostate cancer diagnostics) in the regulatory approval process, nuclear medicine centres are working together across multiple sites in order to be able to achieve the required number of patients to be included within the clinical study in a reasonable time frame. In the following, we discuss the necessary regulatory environment for the preparation of PSMA PET-radiopharmaceuticals as corresponding investigational medicinal product (IMP) using the example of the prospective multicentre clinical trial (phases-I and -II) "[ 68 Ga]Ga-PSMA-11 in high-risk prostate cancer", and discuss regulatory and organisational issues that need to be taken into account in a decentralized PSMA-PET tracer production from the radiopharmacy perspective., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Medical devices play a central role in the diagnosis and treatment of diseases but also bring the potential for adverse events, hazards or malfunction with serious consequences for patients and users. Medical device manufacturers are therefore required by law to monitor the performance of medical devices that have been approved by the competent authorities (post market surveillance). Conducting a nationwide online-survey in the German medical device sector in Q2/2014 in order to explore the current status of the use of post market instruments we obtained a total of 118 complete data sets, for a return rate of 36%. The survey included manufacturers of different sizes, producing medical devices of all risk classes. The post market instruments most frequently reported covered the fields of production monitoring and quality management as well as literature observation, regulatory vigilance systems, customer knowledge management and market observation while Post Market Clinical Follow-up and health services research were being used less for product monitoring. We found significant differences between the different risk classes of medical devices produced and the intensity of use of post market instruments. Differences between company size and the intensity of instruments used were hardly detected. Results may well contribute to the development of device monitoring which is a crucial element of the policy and regulatory system to identify device-related safety issues., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Recent years have seen great interest in finding new ways to develop innovative, safe, and effective medical devices. While there has been considerable research on the lead user and open innovation approach, relatively little attention has been given to postmarket surveillance as a valuable source of safety-related information on medical devices., Methods: An online questionnaire was sent to 118 postmarket surveillance experts throughout Germany to find out (1) what instruments medical device manufactures use to promote an internal transfer of postmarket surveillance knowledge and (2) to what extent this can lead to impulses for research and development meant to improve or develop new medical devices., Results: Our results showed that technical and human resource-related instruments are of particularly high importance for the intraorganizational transfer of postmarket knowledge., Conclusions: The transfer of this postmarket-related device knowledge can have a positive impact on the improvement or development of (especially incremental) medical device innovations, thus contributing to a company's success and strengthening device-related patient safety at the same time.

Background: Patient-ventilator asynchrony that prolongs weaning and increases morbidity and mortality is common during invasive ventilation of patients with chronic obstructive pulmonary disease (COPD). In this context, the inspiratory cycling criteria (iCC) of the ventilator during assisted pressure support (PS) ventilation is a poorly acknowledged key factor. We investigated the changes of flow and pressure parameters that resulted from varying the iCC in a simulated COPD lung model., Methods: A lung simulator was connected to an ICU ventilator through an endotracheal tube. We studied iCC settings from 10% to 70% at different respiratory rates (RR) (15 and 30 bpm) and pressure support (PS) (5 and 15 cmH2O) settings and registered asynchrony-index, double-triggering, expiratory trigger latency (TLEXP), intrinsic PEEP (PEEPi), expiratory pressure time product (PTPEXP) and tidal volume., Results: At iCC≤20%, asynchrony occurred in 50% of all recordings in high RR/high PS. At a low RR, double triggering occurred at high iCC settings. It appeared at 50% iCC with low PS and at 60% iCC with high PS. TLEXP was positive at iCC 10% to 30% but decreased with increasing iCC (P<0.001). At low RR/high PS settings, PEEPi decreased at iCC≤40% but increased at iCC≥50%. High RR/low PS constantly reduced PTPEXP up to 60% iCC. Changes in iCC strongly influenced the resulting tidal volume., Conclusions: Non-adapted ventilator iCC can cause patient-ventilator asynchrony. The success of assisted invasive ventilation and weaning relies on meticulous adjustments.

Background: During noninvasive ventilation (NIV) of COPD patients, delayed off-cycling of pressure support can cause patient ventilator mismatch and NIV failure. This systematic experimental study analyzes the effects of varying cycling criteria on patient-ventilator interaction., Methods: A lung simulator with COPD settings was connected to an ICU ventilator via helmet or face mask. Cycling was varied between 10 and 70% of peak inspiratory flow at different breathing frequencies (15 and 30 breaths/min) and pressure support levels (5 and 15 cm H2O) using the ventilator's invasive and NIV mode with and without an applied leakage., Results: Low cycling criteria led to severe expiratory cycle latency. Augmenting off-cycling reduced expiratory cycle latency (P < .001), decreased intrinsic PEEP, and avoided non-supported breaths. Setting cycling to 50% of peak inspiratory flow achieved best synchronization. Overall, using the helmet interface increased expiratory cycle latency in almost all settings (P < .001). Augmenting cycling from 10 to 40% progressively decreased expiratory pressure load (P < .001). NIV mode decreased expiratory cycle latency compared with the invasive mode (P < .001)., Conclusion: Augmenting the cycling criterion above the default setting (20-30% peak inspiratory flow) improved patient ventilator synchrony in a simulated COPD model. This suggests that an individual approach to cycling should be considered, since interface, level of pressure support, breathing frequency, and leakage influence patient-ventilator interaction and thus need to be considered., (Copyright © 2016 by Daedalus Enterprises.)

Background: The use and organisation of medical technology has an important role to play for patient and user safety in anaesthesia., Objectives: Specification of the recommendations of the German Coalition for Patient Safety (APS) for users and operators of anaesthesia equipment, explore opportunities and challenges for the safe use and organisation of anaesthesia devices., Methods: We conducted a literature search in Medline/PubMed for studies dealing with the APS recommendations for the prevention of medical device-related risks in the context of anaesthesia. In addition, we performed an internet search for reports and recommendations focusing on the use and organisation of medical devices in anaesthesia. Identified studies were grouped and assigned to the recommendations. The division into users and operators was maintained., Results: Instruction and training in anaesthesia machines is sometimes of minor importance. Failure to perform functional testing seems to be a common cause of critical incidents in anaesthesia. There is a potential for reporting to the federal authority. Starting points for the safe operation of anaesthetic devices can be identified, in particular, at the interface of staff, organisation, and (anaesthesia) technology., Conclusions: The APS recommendations provide valuable information on promoting the safe use of medical devices and organisation in anaesthesia. The focus will be on risks relating to the application as well as on principles and materials for the safe operation of anaesthesia equipment., (Copyright © 2015. Published by Elsevier GmbH.)

Purpose: In the last years, German hospitals have implemented different measures to increase patient safety. Special importance has been attached to near miss reporting systems (critical incident reporting system, CIRS) as instruments for risk identification in health care, instruments that promise high potential for organisational learning. To gain insight into the current status of critical incident reporting systems and other instruments for clinical risk management, a survey among 341 hospitals was carried out in 2009. Questions covered a process of six steps: from risk strategy to methods for risk identification, to risk analysis and risk assessment, to risk controlling and risk monitoring., Material and Methods: Structured telephone interviews were conducted with 341 German hospitals, featuring in their statutory quality reports certain predefined key terms that indicated the concluded or planned implementation of clinical risk management. The main objective of those interviews was to check the relation between status/organisation of self-reported risk management and both operator (private, public, NPO) and size of hospital., Results: The implementation of near miss reporting systems (CIRS) in German hospitals has been constantly rising since 2004: in 2009, 54 % of the interviewed hospitals reported an implemented CIRS; of these, 72 % reported the system to be hospital-wide. An association between CIRS and private, public or NPO-operator could not be detected (Fisher p = 1.000); however, the degree of CIRS implementation was significantly increasing with the size of the hospital, i.e., the number of beds (Fisher p = 0.008): only 38 % of the hospitals with less than 100 beds reported CIRS implementation against 52 % of those between 100 to 500 beds, and 67 % of those with more than 500 beds. While 62 % of the hospitals interviewed reported the maintenance of a risk management committee, only 14 % reported the implementation of risk analysing techniques. As to clinical risk management, 92 % of the hospitals see potential for internal improvement; 44 % have already communicated with external consultants., Conclusion: While identification of clinical risks with near miss and other incident reporting systems meets increasing acceptance, the learning potential based on incident reporting is not yet appropriately being used. There is a deficit regarding systematic and comprehensive risk assessment and controlling; this will have to be met by improving the organisational framework for clinical risk management., (© Georg Thieme Verlag KG Stuttgart · New York.)

There exists quite a number of risk factors for primary and secondary prevention of stroke. Only in a synopsis with different etiologies and with different personal data one can define their dignity.

In healthy subjects, mental practice is known to improve motor performance. It is also known to be accompanied by a higher central nervous activity. Since such effects seem to be desirable for rehabilitation, we investigated the possibility of detecting changes in central nervous activity by means of EEG in stroke patients, and whether these changes were similar to those observed in healthy subjects. 12 left-sided hemiplegic patients who underwent a specific post-stroke rehabilitation treatment were requested to perform a simple arm movement sequence. In the following mental practice period the patients were requested to image the same sequence without any real movement. EEG background activity was recorded during rest and imagination periods. After the calculation of z-transformed power values within the theta, alpha, and beta-1 band, differences between rest and imagination periods were evaluated for their significance. Stroke patients show significant decreases of theta, alpha, as well as beta-1 power during mental practice in comparison to the rest period. These changes are similar to those obtained in healthy subjects. Theta power decreases in central and parietal leads. Central alpha power diminishes only during imagination of the contralateral arm. This phenomenon as well as the decrease of beta-1 power in central derivation were also obtained during real motor performance and might indicate an activation of the sensorimotor cortex. In accordance with the hypothesis of internal feedback mechanisms, this activation is a necessary prerequisite for motor learning during mental practice.

A case report is given of a 28 year old homosexual suffering from segmental proctitis caused by Chlamydia. The patient had watery diarrhea and fever since 3 weeks. Stool specimen testing was negative in regard to Salmonella, Shigella and worm eggs. Infection with N. gonorrhoea, Herpes simplex virus, Toxoplasma gondi, Yersinia and M. tuberculosis could be excluded. Serological testing yielded results suggestive of an old lues infection successfully treated. On histological examination typical reticulocytary suppurating granuloma were found. Therapy of choice of Chlamydia-proctitis is tetracyclines.

A nonradioactive DNA-detection procedure using biotinylated DNA probes in the screening of cells from cervical swabs for DNA sequences homologous to human papillomavirus (HPV) DNA was tested. This alternative DNA-detection method yielded results comparable to those obtained with radioisotope-labeled DNA probes in 32 cases tested. This procedure obviates the special precautions required for radioisotope materials. Accordingly, this technique can be made available to many laboratories, and conclusive evidence as to the relation of HPV infection to cervical cancer may thus be accumulated.

In order to carry out a serological control for rubella mass vaccination with the least possible organization and financial expense a study was made to see whether the more economical hemolysis in gel test (HIG) achieved comparable results to the hemagglutination inhibition test (HHT) and whether the reliability of investigation of capillary blood corresponded to that of venous blood. The prevaccination immunity of 935 schoolgirls was tested with the HHT and HIG tests with venous and capillary blood. The results of the HIG test with both venous and capillary blood were equal in all 935 cases, so that the investigation of capillary blood is suitable for the determination of rubella specific antibodies.

The rehabilitation of patients with stroke was a long time a neglected problem. Meanwhile there are several hospitals with comprehensive rehabilitation services with physical, occupational, speech, psychological and social assessments. The effectiveness were investigated in 296 stroke patients. 195 patients from two internal hospitals were compared with 101 patients from a hospital rehabilitation unit. Both groups were very similar according of age, sex, nature of stroke and the most of other factors. The effect were evaluated on the basic of ADL-classes (activities of daily living) at the time of discharge. The success of the special rehabilitation was better in patients with aphasia, flaccid and strong spastic hemiparesis, complicated diseases, lower motivation and mild or moderate psychoorganic syndromes. Absent of ability to cooperate limited the rehabilitation outcomes. In mild and severe followings of stroke were found same results in both groups. High age of life alone are not decreased the prognosis.

Immunity to rubella virus was examined in blood samples of 5870 school girls. Only in 22.7% of the girls a vaccination proved necessary. HDC vaccine (strain RA 27/3) was used. By postvaccinal control successful vaccination could be demonstrated in 99.6% of the vaccinated girls. The hemolysis in gel test (HIG) (3557 samples) and an enzyme-linked immunosorbent assay (ELISA) (1134 samples) were compared with the hemagglutination inhibition test (HI) as to their reliability and sensitivity in demonstrating rubella virus antibodies. HIG and HI exhibited identical results, whereas with the ELISA diverging results were obtained in 14% of the samples. 30 girls being antibody-positive only in the ELISA were vaccinated. Only 28 of these girls developed rubella specific IgM-antibodies after vaccination. This results strongly suggests that at least in these 28 prevaccinal samples the ELISA yielded false positive results.

Four different tests for detection of rubella-specific IgM antibodies were compared: two Ig separation methods (centrifugation and chromatography) with subsequent haemagglutination inhibition test and two commercially available ELISA tests. The 114 sera tested had been sent to the diagnostic laboratory, mostly with insufficient clinical histories. Agreement between the centrifugation method and one of the ELISA tests was good (2 divergent results with 107 sera tested), while the other ELISA test yielded more positive (partly perhaps non-specific) results. The chromatographic method did not separate the Ig classes as reliably as the centrifugation method, but because of its simplicity it may be useful, if adequate test controls are performed. The divergent results are discussed. It is postulated that in cases with pending induced abortion, two independent tests should be performed.

44 patients with acute hepatitis B virus (HBV) infection were observed until recovery and formation of anti-HBs or in case of development of chronic infection for up to 18 months. With the exception of 3 patients the infection resolved clinically within 3 to 16 weeks, HBs and HBe antigen were eliminated. Anti-HBs and anti-HBe formation could be demonstrated in 39 patients. An accurate prognosis of the course of the disease could be predicted in 42 out of 43 patients by comparison of the serum HBs antigen concentrations at the beginning of clinical symptoms with those after 4 weeks. Inclusion of HBe antigen demonstration enabled predictability in all patients. In 15 patients with acute HBV infection the risk of infection (occupational exposure, transfusion etc.) was known. By investigation of contact persons (family members, sex partners etc.) of the remaining patients HBs antigen und partly HBe antigen in serum could be demonstrated in 11.8% of these persons (11 out of 93). In contrast, in contact persons of patients with known risk of infection HBs antigen could be demonstrated in only one case (1 out of 36). No one of the HBs antigen positive contact persons was aware of the possibility of infectiousness. They did not perceive any connection between their own chronic infection and acute HBV infection occurring around them.

162 patients with stroke (cerebrovascular accident) were investigated of some social problems. The patients were treated in two internal clinics or in a rehabilitation center for stroke-patients. The assessments were accomplished in 30 months after clinical treatment. The average of age was 69 years. The percentage of women was 61%. The majority of patients lives in own flats, 12% in a nursing home. The furniture of flats, was often not approximated for disabled persons. The care almost was undertaken through relatives. More institutional support could be helpful in few cases. Help was wished in according to conditions of flats, meals on wheels, programs for self-activities, references to nursing, technical helpings and transportation services. These investigations suggest that the families are an important factor in rehabilitation of stroke. They need social and psychological support. The attitude of family determinated essential the prognosis of rehabilitation.

In 1980 and 1981 the blood samples of 2040 pregnant women from the Department of Obstetrics of the University Hospital of Cologne have been examined for HBs-antigen. In 37 samples (1.8%) HBs-antigen was detected. As there are considerable racial as well as geographic differences in the frequency of HBs-antigenemia, we differentiated between German and foreign women. In 10 out of 1519 (0.7%) German and in 27 out of 521 (5.2%) foreign women, respectively, HBs-antigen could be demonstrated. Only 1 woman was known to be HBs-antigen positive. Until now, 38 children have been born in the University Hospital to 33 HBs-antigen-positive mothers. After birth, 35 children received hepatitis B immune globulin (HBIG). So far, none of these immunised children exhibited signs of a hepatitis B infection--22 children have been followed up 5-19 months, and 13 children 1-4 months. Three newborns did not receive HBIG: One child was already infected at time of birth, the 2 other children were erroneously not given HBIG. One of these 2 children fell ill at the age of 5 months with clinical and serological manifestations of hepatitis B, the other child appears healthy up to date (11 weeks).

The authors describe the basis of the current concept of rehabilitation of patients with stroke. This concept is based on recent neurophysiological findings about the processes of information, learning, and memory. This indicates that the plasticity of cerebral structures depends especially on the possibilities either to rebuild or to compensate for destroyed structures with programs of rehabilitation. A comparison is given of 101 stroke patients rehabilitated according to a conventional program and the better results for 295 stroke victims rehabilitated according to a more modern rehabilitation program. Another investigation showed, as an example of the Babinsky phenomenon, that stroke patients can develop the ability to suppress. The results and dynamics of rehabilitation of stroke are an encouragement to continue researching new ways for more effective rehabilitation.

The infectious morbidity due to intra-amniotic fetal monitoring was studied morphologically in 100 spontaneous deliveries with intra-amniotic fetal monitoring. The control group consisted of 100 spontaneous deliveries with external fetal monitoring. It was shown that internal fetal monitoring does not increase the infectious morbidity with total labours of up to 12 hours. The occurrence of inflammatory cell infiltrates in the placenta, the membranes and the umbilical cord is not in each case due to a bacterial intra-uterine infection. The pathogenesis of these infiltrates is discussed comparing the results of the literature and this study.

The modern concept of rehabilitation of patients with stroke is based on new neurophysiological investigations about processes of movements, learning and memory. Therefore the rehabilitation is multidimensional. The complete patterns of symptoms must be considered. The training of cognitive functions has the same importance as the treatment of disorders of movements. The effects of this concept are investigated in 295 patients in accordance with self-activities and ability of walking. The results have been compared with 101 patients without consideration of all gnostic defects. The results of the modern rehabilitation concept were better. Patients with aphasia having similar good results but patients with diminished ability to cooperation having unfavourable prognosis of rehabilitation.

The performances of a vertical and a swinging bucket rotor in the diagnosis of rubella-specific IgM were compared using two sets of predominantly low titre rubella IgM positive sera. Applying a number of subtle criteria, the vertical rotor was shown to separate IgM and IgG less well than the swinging bucket rotor. If the vertical rotor was loaded with pretreated sera with IgG content decreased severalfold, its performance was similar to that of the swinging bucket rotor with native serum. The findings are discussed from the aspect of the main indication of rubella IgM testing, and it was concluded that for the majority of cases the vertical rotor would not present an alternative to the swinging bucket rotor.

Cytomegalovirus infection after renal transplantation impairs the survival rate of patient and graft. An incidence of 24 to 92% of CMV infections after renal transplantation is reported, but only 15 to 77% of these patients show clinical symptoms. Contaminated donor organs, blood transfusions and reactivation by immunosuppression are the main causes of this infection. Active immunisation cannot prevent the reactivation of the infection, but also antiviral agents can hardly influence the course of the disease. Passive immunisation showed promising effects in bone-marrow transplantation and is now also tried in renal transplantation. The first results of a randomized study do not allow a final conclusion, but show less clinical symptomatic CMV infections, and statistically significant less herpes simplex infections in the group receiving anti CMV IgG prophylaxis.