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Zusammenfassung Hintergrund Jeder Mensch, der nach dem Sozialgesetzbuch (SGB) pflegebedürftig (SGB XI § 14) ist, ist „behindert“ gemäß SGB IX und hat daher nach deutschem Recht und der UN-Behindertenrechtskonvention Anspruch auf Förderung von selbstbestimmter Teilhabe. Damit Teilhabe nicht nur eine abstrakte Zielvorstellung bleibt, sondern in der Alltagspraxis verwirklicht werden kann, stellt sich die Frage, wie die Organisationen zu konfigurieren sind, um individuelle Teilhabeziele des Teilhabeplans, über sektorale, disziplinäre und professionelle Grenzen hinweg, bei Pflegebedürftigkeit und komplexen Versorgungsbedarfen zu verwirklichen. Die Sozialmedizin untersucht die Zusammenhänge zwischen Versorgungssystem, sozialen Bezügen und Gesundheit bzw. Krankheit. Sie kann eine „Brückenfunktion“ zu den Sozialwissenschaften, zu der Pflegewissenschaft und zu den Therapiewissenschaften ausüben. Die strukturell bedingte und routinierte bisherige Koordination durch die Ärzte soll anhand einer methodengestützten Prozessanalyse überprüft werden, um die Organisation der Rehabilitation konsequent an der Person mit Rehabilitationspotential auszurichten. Dabei sollen Menschen, die älter als 70 Jahre sind, an einer geriatrisch relevanten Multimorbidität leiden und zugleich Rehabilitationspotenzial aufweisen, im Fokus der Analyse stehen. Ziel Ziel der vorliegenden Arbeit ist es, anhand eines Fallbeispiels ein Konfigurationsmodell auf Basis der Theorie des Sense Making (Dervin 1998) für die Organisation multiprofessioneller Zusammenarbeit zu entwickeln. Dieses Modell kann dann in einem weiterführenden Schritt auf seine Wirkungen hin überprüft werden. Methodik Für die Konfiguration der Organisation wird neben organisationstheoretischen Überlegungen und pflegewissenschaftlichen Konzepten die Kontaktpunktanalyse auf Basis der Theorie des Sense Making auf ein Fallbeispiel der geriatrischen Rehabilitation übertragen. Die Fallanalyse dient dabei der exemplarischen Ausführung des Modells in dem spezifischen Feld der therapeutisch-aktivierenden Pflege, der Therapie und der Rehabilitation. Ergebnisse Als Ergebnis der fallbasierten Kontaktpunktanalyse liegt für das multiprofessionelle Reha Team ein dynamisches Modell der rotierenden Koordinierungsverantwortung vor. Dessen Wirkungen (und Nebenwirkungen) auf die Effektivität der multiprofessionellen Zusammenarbeit und auf die Erreichung der individuellen Teilhabeziele sind zu evaluieren. Bei der Wirkungsanalyse ist ein mehrdimensionaler Ansatz zu wählen, der neben von außen beobachtbaren und messbaren Ergebnissen (z. B. Selbständigkeitsmaße, wie den Barthel-Index oder FIM, Krankenhausaufnahmerate, Erhöhung des Pflegebedarfs) stets die Erfüllung des individuellen Teilhabeziels, der Selbstbestimmung und der individuellen Lebensqualität der Person mit Versorgungsbedarf einschließt. Schlussfolgerungen Das dynamische Modell der rotierenden Koordinierungsverantwortung kann für bereits umgesetzte geriatrische Rehabilitationsprozesse und Organisationsformen genutzt werden. Im Rahmen von Versorgungs- und Organisationsforschungsprojekten kann das Organisationsmodell eingesetzt, evaluiert, weiterentwickelt und langfristig, bei zunehmenden wissenschaftlichen Nachweisen erwünschter Wirkungen, in das Gesundheitssystem implementiert werden. Dabei sind die Nebenwirkungen und Side Effects nicht außer Acht zu lassen.Die vorliegende Publikation wurde in Zusammenarbeit mit der Arbeitsgruppe „Pflege“ des Fachbereichs „Praktische Sozialmedizin und Rehabilitation“ der Deutschen Gesellschaft für Sozialmedizin und Prävention der DGSMP erstellt.

ZusammenfassungNeben der Betrachtung der Individualmedizin hat die Sozialmedizin die sozialen Bezüge von Gesundheit und Krankheit im Fokus. Sie reflektiert in diesem Zusammenhang die Strukturen des gesamten Gesundheitssystems, dessen Funktionen und Funktionsdefizite. Sie befasst sich mit den spezifischen Wechselwirkungen zwischen Medizin und Gesellschaft und hat eine Brückenfunktion zu den klassischen Sozialwissenschaften 1. Von besonderem Interesse sind dabei die Schnittstellen in der sektoralen Versorgung. Die Arbeitsgruppe „Pflege“ des Fachbereichs „Praktische Sozialmedizin und Rehabilitation“ der Deutschen Gesellschaft für Sozialmedizin und Prävention, DGSMP, betrachtet wesentliche Schnittstellen in unserem sektoralen Versorgungssystem aus sozialmedizinischer Sicht in ihrer derzeitigen Funktion und Perspektive, v. a in Anbetracht der demografischen Herausforderungen der Zukunft. Von besonderer Bedeutung ist hierbei die Schnittstelle zwischen medizinischer und pflegerischer Versorgung im akutstationären und häuslichen Bereich sowie im Bereich der geriatrischen Versorgung einschließlich präventiver Maßnahmen. Mit diesem Beitrag soll eine Diskussion angeregt werden.

Every person who is in the need of long-term care (according to German Social Code SGB XI §14) fulfills the requirements of disability according to German Social Code SGB IX, § 2. The right of participation and autonomy must be specially protected and realized for persons with long-term care needs because these persons have a limited capacity to advance their interests. The rights of people in the need of long-term care or assistance are protected not only by the national constitution but also by the UN Disability Rights Convention. Participation is an important principle of these extra-statutory regulations and has an extraordinary significance and individual meaning for quality of life. For concretizing the aim of participation and for realizing participation in daily practice, the following question arises: How must organizations be configured to achieve individual aims of participation for persons with long-term care need, complex health care needs and with potential for rehabilitation across sectoral, disciplinary and professional borders? This analysis focuses on people older than 70 years with geriatric-relevant multimorbidity and with potential for rehabilitation.The aim of this study was to create a configuration model for the organization of interdisciplinary cooperation in rehabilitation out of a case study and on the basis of the service blueprinting method [1]. In a next step this configuration model can be evaluated concerning its effectiveness for achieving individual participation goals and quality of life of persons with long-term care need and with potential for rehabilitation.For creating the configuration model, the service blueprinting method [1] on the basis of Dervin's sense making theory [11] was applied to a case vignette of geriatric rehabilitation against a background of organization theories and nursing science concepts. With the case study the configuration model can be applied exemplarily at the setting of restorative care, therapy and rehabilitation. With the service blueprinting method, the rehabilitation process is aligned onto the geriatric patient's individual health care needs, perceptions of participation and quality of life.As a result of the sequencing and service blueprinting process we offer a dynamic model for the coordination of responsibility of interdisciplinary rehabilitation teams with a user-centered alignment. Its effectiveness (and side-effects) for interdisciplinary cooperation and for patient's individual goals of participation and quality of life must be evaluated in further studies. A mixed-method design should be used to evaluate objective outcome parameters such as dependency on nursing care, hospital admission rates and subjective outcome parameters such as patient's perception of participation, autonomy and quality of life.The configuration model can be used for evaluating already implemented geriatric rehabilitation processes and organizations. The configuration model can be used in health care research or organizational research. After more evidence for desirable effects, it can be implemented into the health care system. Side effects should be monitored.This paper was written in cooperation with the working group "Nursing", department "Practical Social Medicine and Rehabilitation" of the German Society of Social Medicine and Prevention (Deutsche Gesellschaft für Sozialmedizin und Prävention DGSMP e.V.).Jeder Mensch, der nach dem Sozialgesetzbuch (SGB) pflegebedürftig (SGB XI § 14) ist, ist „behindert“ gemäß SGB IX und hat daher nach deutschem Recht und der UN-Behindertenrechtskonvention Anspruch auf Förderung von selbstbestimmter Teilhabe. Damit Teilhabe nicht nur eine abstrakte Zielvorstellung bleibt, sondern in der Alltagspraxis verwirklicht werden kann, stellt sich die Frage, wie die Organisationen zu konfigurieren sind, um individuelle Teilhabeziele des Teilhabeplans, über sektorale, disziplinäre und professionelle Grenzen hinweg, bei Pflegebedürftigkeit und komplexen Versorgungsbedarfen zu verwirklichen. Die Sozialmedizin untersucht die Zusammenhänge zwischen Versorgungssystem, sozialen Bezügen und Gesundheit bzw. Krankheit. Sie kann eine „Brückenfunktion“ zu den Sozialwissenschaften, zu der Pflegewissenschaft und zu den Therapiewissenschaften ausüben. Die strukturell bedingte und routinierte bisherige Koordination durch die Ärzte soll anhand einer methodengestützten Prozessanalyse überprüft werden, um die Organisation der Rehabilitation konsequent an der Person mit Rehabilitationspotential auszurichten. Dabei sollen Menschen, die älter als 70 Jahre sind, an einer geriatrisch relevanten Multimorbidität leiden und zugleich Rehabilitationspotenzial aufweisen, im Fokus der Analyse stehen. ZIEL: Ziel der vorliegenden Arbeit ist es, anhand eines Fallbeispiels ein Konfigurationsmodell auf Basis der Theorie des Sense Making (Dervin 1998) für die Organisation multiprofessioneller Zusammenarbeit zu entwickeln. Dieses Modell kann dann in einem weiterführenden Schritt auf seine Wirkungen hin überprüft werden.Für die Konfiguration der Organisation wird neben organisationstheoretischen Überlegungen und pflegewissenschaftlichen Konzepten die Kontaktpunktanalyse auf Basis der Theorie des Sense Making auf ein Fallbeispiel der geriatrischen Rehabilitation übertragen. Die Fallanalyse dient dabei der exemplarischen Ausführung des Modells in dem spezifischen Feld der therapeutisch-aktivierenden Pflege, der Therapie und der Rehabilitation.Als Ergebnis der fallbasierten Kontaktpunktanalyse liegt für das multiprofessionelle Reha Team ein dynamisches Modell der rotierenden Koordinierungsverantwortung vor. Dessen Wirkungen (und Nebenwirkungen) auf die Effektivität der multiprofessionellen Zusammenarbeit und auf die Erreichung der individuellen Teilhabeziele sind zu evaluieren. Bei der Wirkungsanalyse ist ein mehrdimensionaler Ansatz zu wählen, der neben von außen beobachtbaren und messbaren Ergebnissen (z. B. Selbständigkeitsmaße, wie den Barthel-Index oder FIM, Krankenhausaufnahmerate, Erhöhung des Pflegebedarfs) stets die Erfüllung des individuellen Teilhabeziels, der Selbstbestimmung und der individuellen Lebensqualität der Person mit Versorgungsbedarf einschließt.Das dynamische Modell der rotierenden Koordinierungsverantwortung kann für bereits umgesetzte geriatrische Rehabilitationsprozesse und Organisationsformen genutzt werden. Im Rahmen von Versorgungs- und Organisationsforschungsprojekten kann das Organisationsmodell eingesetzt, evaluiert, weiterentwickelt und langfristig, bei zunehmenden wissenschaftlichen Nachweisen erwünschter Wirkungen, in das Gesundheitssystem implementiert werden. Dabei sind die Nebenwirkungen und Side Effects nicht außer Acht zu lassen.Die vorliegende Publikation wurde in Zusammenarbeit mit der Arbeitsgruppe „Pflege“ des Fachbereichs „Praktische Sozialmedizin und Rehabilitation“ der Deutschen Gesellschaft für Sozialmedizin und Prävention der DGSMP erstellt.

Objective: By the "Second Bill to Strengthen Long-Term Care", a new concept of long-term care dependency will be introduced, valid from 2017. Long-term care dependency according to Social Code XI will be defined covering more aspects than today. Therefore, the working group "Nursing Care" of the division "Social Medicine in Practice and Rehabilitation" in the German Society for Social Medicine and Prevention presents their results after working on the social medicine perspective of the definition and prevention of long-term care dependency. Methods: Both the definition and strategies to prevent long-term care dependency are systematically taken into consideration from the point of view of social medicine on the basis of the International Classification of Functioning, Disability and Health (ICF), as long-term care dependency means a defined condition of disability. Results: Both the current and the new concept of long-term care dependency focus activity limitations. The perspective of social medicine considers the interactions of health condition, its effects on daily activities and personal as well as environmental factors. From this point of view approaches for social benefits concerning prevention and rehabilitation can be identified systematically so as to work against the development and progression of long-term care dependency. The reference to the ICF can facilitate the communication between different professions. The new "graduation" of long-term care dependency would allow an international "translation" referring to the ICF. Conclusion: Experts from the field of social medicine as well as those of nursing care, care-givers and nursing researchers have in common the objective that persons in need of nursing care can participate in as many aspects of life of importance to them in an autonomous and self-determined way. The point of view of social medicine on long-term care dependency is fundamental for all occupational groups that are involved and for their successful cooperation.

We prospectively investigated urinary iodine concentration (UIC) in pregnant women and in female, non-pregnant controls in the canton of Berne, Switzerland, in 1992. Mean UIC of pregnant women [205 +/- 151 microg iodine/g creatinine (microg l/g Cr); no. = 153] steadily decreased from the first (236 +/- 180 microg l/g Cr; no. = 31) to the third trimester (183 +/- 111 microg l/g Cr, p < 0.0001; no. = 66) and differed significantly from that of the control group (91 +/- 37 microg l/g Cr, p < 0.0001; no. = 119). UIC increased 2.6-fold from levels indicating mild iodine deficiency in controls to the first trimester, demonstrating that high UIC during early gestation does not necessarily reflect a sufficient iodine supply to the overall population. Pregnancy is accompanied by important alterations in the regulation of thyroid function and iodine metabolism. Increased renal iodine clearance during pregnancy may explain increased UIC during early gestation, whereas increased thyroidal iodine clearance as well as the iodine shift from the maternal circulation to the growing fetal-placental unit, which both tend to lower the circulating serum levels of inorganic iodide, probably are the causes of the continuous decrease of UIC over the course of pregnancy. Mean UIC in our control group, as well as in one parallel and several consecutive investigations in the same region in the 1990s, was found to be below the actually recommended threshold, indicating a new tendency towards mild to moderate iodine deficiency. As salt is the main source of dietary iodine in Switzerland, its iodine concentration was therefore increased nationwide in 1998 for the fourth time, following increases in 1922, 1965 and 1980.

The factors mediating the accumulation of thyroglobulin are of great importance to the understanding of the pathogenesis of human and experimentally induced colloid goiters. To elucidate further the underlying cellular mechanism, thyroid fragments from newborn rats were incorporated into semisolid alginate beads and were cultured as three-dimensional organoids for up to 21 d. In five parallel cultures, the medium contained either no supplements (group A), Nal (group B), thyroid-stimulating hormone (TSH) (group C), Nal plus TSH in the same concentrations as B and C (group D), or Nal and TSH (as in group D) plus methimazole (MMI, group E). The thyroid organoids maintained morphological integrity, functional activity, and ability to proliferate in vitro. Addition of iodine to the cultures significantly increased mean (+/-SEM) follicular diameters from 19.5 +/- 0.7 microm in controls to 33.9 +/- 2.2 microm (p < 0.0001) when NaI was added alone (group B), and 30.4 +/- 1.7 microm (p < 0.0001) when combined with TSH (group D). The effect of NaI on follicular size was abolished by MMI (group E, follicular diameter 23.5 +/- 1.3 microm). The results presented support the recent finding, using a rat colloid goiter model, that not only TSH but also iodine organification or its inhibition are important factors in modulating follicular morphology.

In addition to the consideration of individual medicine, social medicine focuses on the social references of health and sickness. In this context, it reflects the structures of the entire health care system, its functions and its functional deficits. It deals with the specific interaction between medicine and society and functions such as a link to the classical social sciences (1). Of particular interest in this context are the interfaces to sectoral health care provision. The working group "Nursing Care" of the Department "Practical Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention examines the fundamental interfaces in our sectoral health care system from the perspective of social medicine in their current functions and perspectives, particularly in view of the future demographic challenges to be faced. Of particular importance is the interface between medicinal and nursing care in the areas of acute inpatient and homecare as well as in the area of geriatric care, including preventive measures. The aim of this article is to start a discussion on this subject.Neben der Betrachtung der Individualmedizin hat die Sozialmedizin die sozialen Bezüge von Gesundheit und Krankheit im Fokus. Sie reflektiert in diesem Zusammenhang die Strukturen des gesamten Gesundheitssystems, dessen Funktionen und Funktionsdefizite. Sie befasst sich mit den spezifischen Wechselwirkungen zwischen Medizin und Gesellschaft und hat eine Brückenfunktion zu den klassischen Sozialwissenschaften 1. Von besonderem Interesse sind dabei die Schnittstellen in der sektoralen Versorgung. Die Arbeitsgruppe „Pflege“ des Fachbereichs „Praktische Sozialmedizin und Rehabilitation“ der Deutschen Gesellschaft für Sozialmedizin und Prävention, DGSMP, betrachtet wesentliche Schnittstellen in unserem sektoralen Versorgungssystem aus sozialmedizinischer Sicht in ihrer derzeitigen Funktion und Perspektive, v. a in Anbetracht der demografischen Herausforderungen der Zukunft. Von besonderer Bedeutung ist hierbei die Schnittstelle zwischen medizinischer und pflegerischer Versorgung im akutstationären und häuslichen Bereich sowie im Bereich der geriatrischen Versorgung einschließlich präventiver Maßnahmen. Mit diesem Beitrag soll eine Diskussion angeregt werden.

Combined knowledge of the functional kinematics and kinetics of the human body is critical for understanding a wide range of biomechanical processes including musculoskeletal adaptation, injury mechanics, and orthopaedic treatment outcome, but also for validation of musculoskeletal models. Until now, however, no datasets that include internal loading conditions (kinetics), synchronized with advanced kinematic analyses in multiple subjects have been available. Our goal was to provide such datasets and thereby foster a new understanding of how in vivo knee joint movement and contact forces are interlinked – and thereby impact biomechanical interpretation of any new knee replacement design. In this collaborative study, we have created unique kinematic and kinetic datasets of the lower limb musculoskeletal system for worldwide dissemination by assessing a unique cohort of 6 subjects with instrumented knee implants (Charité – Universitätsmedizin Berlin) synchronized with a moving fluoroscope (ETH Zürich) and other measurement techniques (including whole body kinematics, ground reaction forces, video data, and electromyography data) for multiple complete cycles of 5 activities of daily living. Maximal tibio-femoral joint contact forces during walking (mean peak 2.74 BW), sit-to-stand (2.73 BW), stand-to-sit (2.57 BW), squats (2.64 BW), stair descent (3.38 BW), and ramp descent (3.39 BW) were observed. Internal rotation of the tibia ranged from 3° external to 9.3° internal. The greatest range of anterio-posterior translation was measured during stair descent (medial 9.3 ± 1.0 mm, lateral 7.5 ± 1.6 mm), and the lowest during stand-to-sit (medial 4.5 ± 1.1 mm, lateral 3.7 ± 1.4 mm). The complete and comprehensive datasets will soon be made available online for public use in biomechanical and orthopaedic research and development., Journal of Biomechanics, 65, ISSN:0021-9290, ISSN:1873-2380

Although total knee arthroplasty (TKA) has become a standard surgical procedure for relieving pain, knowledge of the in vivo knee joint kinematics throughout common functional activities of daily living is still missing. The goal of this study was to analyse knee joint motion throughout complete cycles of daily activities in TKA subjects to establish whether a significant difference in joint kinematics occurs between different activities. Using dynamic videofluoroscopy, we assessed tibio-femoral kinematics in six subjects throughout complete cycles of walking, stair descent, sit-to-stand and stand-to-sit. The mean range of condylar anterior–posterior translation exhibited clear task dependency across all subjects. A significantly larger anterior–posterior translation was observed during stair descent compared to level walking and stand-to-sit. Local minima were observed at approximately 30° flexion for different tasks, which were more prominent during loaded task phases. This characteristic is likely to correspond to the specific design of the implant. From the data presented in this study, it is clear that the flexion angle alone cannot fully explain tibio-femoral implant kinematics. As a result, it seems that the assessment of complete cycles of the most frequent functional activities is imperative when evaluating the behaviour of a TKA design in vivo., Journal of the Royal Society. Interface, 16 (151), ISSN:1742-5689, ISSN:1742-5662

Understanding the functionality of total ankle arthroplasties (TAA) requires thorough knowledge of the kinematics during activities of daily life. Videofluoroscopy enables the in vivo measurement of the 3D kinematics of implant components more accurately than by means of skin marker tracking. The aim of the present preliminary study was to quantify the 3D kinematics of a TAA during the stance phase of level and slope walking using single plane videofluoroscopy.The experimental set up consisted of a videofluoroscopy system (BV Pulsera, Philips Medical Systems, Switzerland, 25 Hz, 1 ms shutter time) integrated in a walkway, allowing the assessment of free level gait, uphill, downhill and cross-slope walking. 2D/3D registration was performed using the CAD models of the TAA. In a preliminary feasibility study, the presented method was applied on four patients with successful unilateral TAA (Mobility™ Total Ankle, DePuy) with good outcomes.Isolated 3D TAA kinematics was quantified with a rotational and translational error of 0.2 degrees and 0.4 mm in plane and 1.3 degrees and 2.1 mm out of plane. In the feasibility study it was found that only minor limitations occurred in sagittal plane motion. Any restrictions were caused by a limitation in dorsiflexion, whereas plantarflexion was for all gait conditions sufficiently provided. Transverse and frontal plane rotation was marginal, the main rotation occurred around the talar construction axis itself.The presented method enabled accurate estimation of the 3D TAA kinematics in vivo, without being limited by skin movement artifacts and isolated from subtalar motion. Since the available amount of dorsiflexion is the crucial factor to allow unrestrictive gait, walking uphill is an appropriate motion task to challenge and evaluate the performance of the TAA.The presented method has the potential to identify specific kinematic patterns and thereby help clinicians and implant developers to evaluate current designs and future design modifications.

The aim of this study was to compare the angles and corresponding moments in the knee and hip during squats. Twenty subjects performed restricted and unrestricted squats with barbell loads that were 0, ¼, and ½ their body weight. The experimental setup consisted of a motion capture system and 2 force plates. The moments were calculated using inverse dynamics. During the unrestricted squats, the maximum moments in the knee were significantly higher, and those in the hip were significantly lower than during restricted squats. At the lowest position, the maximum knee flexion angles were approximately 86° for the restricted and approximately 106° for the unrestricted techniques, whereas the maximum hip flexion angle was between 95° and 100°. The higher moments in the hip during restricted squats suggest a higher load of the lower back. Athletes who aim to strengthen their quadriceps should consider unrestricted squats because of the larger knee load and smaller back load.

Since the implementation of the computer-aided system for assessing facial palsy in 1999 by Frey et al (Plast Reconstr Surg. 1999;104:2032-2039), no similar system that can make an objective, three-dimensional, quantitative analysis of facial movements has been marketed. This system has been in routine use since its launch, and it has proven to be reliable, clinically applicable, and therapeutically accurate. With the cooperation of international partners, more than 200 patients were analyzed. Recent developments in computer vision--mostly in the area of generative face models, applying active--appearance models (and extensions), optical flow, and video-tracking-have been successfully incorporated to automate the prototype system. Further market-ready development and a business partner will be needed to enable the production of this system to enhance clinical methodology in diagnostic and prognostic accuracy as a personalized therapy concept, leading to better results and higher quality of life for patients with impaired facial function.

Botanica Helvetica, 118 (1), ISSN:0253-1453, ISSN:1420-9063

Entangled two-quantum states may be a sensitive probe for a loss of quantum coherence due to apparent violations of quantum mechanics, e.g. as caused by gravitation. We show that there exists a modest experiment sensitive to any one of the nine phenomenological parameters which describe decoherence in the neutral kaon system.

Objective: Because of known significant seasonal fluctuations of iodine concentration in cow's milk (ICM) in Switzerland (winter/summer (w/s) ICM ratio averages 5.6), we looked for seasonal variations and familial aspects in urinary iodine and sodium concentrations (UIC, UNaC). Design: Prospective sequential cohort investigation. Setting: University hospital. Subjects: Thirteen children (six girls, seven boys) aged 3–10 y and their parents (n=9) aged 30–47 y. Interventions: The volunteers collected 1729 spot urine samples (5.1996–5.1998). UIC data from winter (UICw: December–February) and summer seasons (UICs: July–September) were compared with UNaC and average milk consumption. Iodine intakes from milk and salt were modelized. Results: Highest seasonal fluctuations of UIC were found in six pre-school children (w/s UIC group average=1.56, significant), followed by seven school children (w/s UIC group average=1.24, N.S.); none existed in adults. UIC/UNaC showed corresponding seasonal fluctuations in children, but not in adults. Winter milk was an important iodine source for children, as proven indirectly by similar seasonal fluctuations of ICM, UIC, UIC/UNaC and an important part within UIC due to milk. Conclusions: Contribution to UIC from milk intake during winter was high in children (40–50%) and lower in adults (about 20%). Compared with children, dietary habits of adults are more complex and their iodine supply depends mainly on iodized salt and not on milk, so the effect of seasonal ICM variations on UIC is less marked. Because of significant seasonal UIC fluctuations in consumers of fresh milk products in Switzerland, results of future UIC studies conducted during summer and winter seasons should be compared cautiously, especially in young children. Furthermore, consumption of milk is to be promoted, since, besides calcium and vitamins, it is an essential source of iodine. UNaC determination should be included in epidemiologic studies if the dietary source of iodine is questioned. Sponsorship: This work was supported by grants from the University Hospital in Bern, the Swiss Federal Office of Public Health, the ‘Swiss National Foundation for Scientific Research’ (32-49424.96), the ‘Fondation Genevoise de Bienfaisance V Rossi di Montelera’, the ‘Schweizerische Lebensversicherungs- und Rentenanstalt’ and the ‘Schupbach Foundation of the University of Bern’.

OBJECTIVE: Before a scheduled increase of salt iodide content up to 20 p.p.m. in Switzerland, urinary iodine concentration (UIC, microg/l) of a randomly selected, area-covering, age-stratified population subgroup was sampled in spring 1997. In contrast to former published studies on UIC, we minimized biases by age, gender, rural/urban, socio-economic and cultural influences. METHODS: We contacted 750 households in the Bernese region using random telephone numbers. Per household, one proband selected by play dice collected a spot urine sample. We defined seven age categories: infants, children, adolescents, adults I-III and seniors, aged 0-5, 6-12, 13-20, 21-35, 36-50, 51-65 and >65 years respectively. Randomized UIC data were compared with WHO criteria of iodine deficiency (ID) and previous non-randomized, age-dependent Swiss UIC data. To recruit a perfect random group of volunteers proved difficult, as study participation of adolescent and male populations was somewhat lower than that of elder and female (P

Two methods for the determination of iodine in urine or serum based on the Sandell-Kolthoff reaction were compared. The first was an autoanalyser method (AAII, Technicon) where the mineralisation takes place in a continuous flow manner. This procedure was used at the Department of Clinical Chemistry of the University Hospital of Berne (Switzerland) from 1968 until 1993. The second method was evaluated and adapted in our own laboratory. Each sample and the iodate-standards are mineralised in a Pyrex glass tube and the decolorisation reaction takes place in a 96-well-microtiter plate which was read by a PC-controlled photometer at 405 nm. This method, with a detection limit of 0.1 μmol/l showed good analytical recovery (90 to 110%) and a low imprecision (intra-assay coefficient of variation (CV) of 5% and an inter-assay CV of 7.5%). In contrast to the autoanalyser method, the microtiter plate-method is suitable both for series up to 24 samples (3-fold) and for single samples. A comparison of 87 samples in the range of 0.1 to 60 μmol/l which were measured with both Sandell-Kolthoff based methods showed no obvious discrepancy. These two methods showed a good agreement for the determination of urinary iodine. This guarantees that the results of earlier epidemiological studies can be compared with recent studies performed in our and many other laboratories.

Total knee joint transplantation has been performed in animal models and humans. This study investigates the impact of this operation on knee joint function in a dog model. Therefore, replantation was compared to transplantation during a 6-month follow-up period in four dogs in each group. The peak vertical ground reaction force normalized in all legs undergoing replantation and in two of four after transplantation. A third transplant recipient reduced loading from the 4th month due to a local complication, and the fourth succumbed to sepsis 3 months postoperatively. A weight-bearing index (WBI), defined as loading of the grafted divided by loading of both hind-limbs decreased from 0.48 +/- 0.08 preoperatively to 0.13 +/- 0.10 by 1 month after replantation and from 0.53 +/- 0.07 to 0 after transplantation. After 6 months, weight-bearing of all replant recipients was restored, but reduced in two transplant recipients with graft function. Full recovery after replantation, but impaired function after transplantation, was also reflected in the histological results: normal histological pictures of blood vessels, cartilage, bone and soft tissues were found in all replant recipients, but infiltrative vasculopathy indicating chronic rejection was found in the transplanted joints. The results of this animal study confirm that the procedure can lead to satisfactory functional results but also emphasize the need for perfect control of immunosuppression.

Constitutively activating TSH receptor mutations have been established as the most common molecular basis for the pathogenesis of toxic thyroid nodules. These mutations result in uncontrolled signalling through the TSH receptor that is likely to cause hyperfunction and proliferation. The incidence of toxic multinodular goitres has been demonstrated to be related to iodine deficiency. Moreover, scintigraphically autonomous areas are found in 40% of euthyroid goitres from iodine-deficient areas. To investigate the molecular cause of these autonomous areas, small autoradiographically hot areas were examined for somatic TSH receptor mutations using archival tissue sections from 14 patients with euthyroid goitres, which had been originally prepared nearly 20 years ago. All patients had received (125)I 17 h preoperatively for the autoradiographic investigation of their thyroid. Areas with high and low (125)I-labelling on autoradiography sections were collected separately either from serial paraffin-embedded tissue sections, or Eukitt-embedded tissue sections containing the autoradiograph. After genomic DNA extraction, the transmembrane segment of the TSH receptor was PCR-amplified and directly sequenced. Somatic TSH receptor mutations were identified in areas with high (125)I-labelling in four patients: A623I, L629P, F631L, and T632I. This is the first evidence that TSH receptor mutations occur in microscopic areas with increased (125)I-labelling in euthyroid goiters and it suggests that TSH receptor mutations in these areas confer the potential to develop into toxic thyroid nodules. It is therefore very likely that toxic thyroid nodules originate from small autonomous areas in iodine-deficient euthyroid goitres that contain a TSH receptor mutation.

The values and limits of morphological, immunohistochemical and autoradiographic methods in studies of thyroid autonomy are briefly discussed. For meaningful studies of molecular aspects of thyroid autonomy--such as for example TSH receptor and Gs-alpha gene mutations--it is absolutely crucial that the tissue analysed is well characterized and really is autonomous. This is particularly important in view of the well known heterogeneity of human goiter tissue in respect to many if not all functional and proliferative parameters. To prove functional and proliferative autonomy of thyroid tissue, autoradiography is a very helpful tool, while simple morphology and immunohistochemistry do not contribute substantially to this aim.

This paper is a comprehensive review article on capillary electrophoresis (CE) in clinical and forensic analysis. It is based upon the literature of 1997 and 1998, presents CE examples in major fields of application, and provides an overview of the key achievements encountered, including those associated with the analysis of drugs, serum proteins, hemoglobin variants, and nucleic acids. For CE in clinical and forensic analysis, the past two years witnessed a breakthrough to routine applications. As most coauthors of this review are associated with diagnostic or forensic laboratories now using CE on a routine basis, this review also contains data from routine applications in drug, protein, and DNA analysis. With the first-hand experience of providing analytical service under stringent quality control conditions, aspects of quality assurance, assay specifications for clinical and forensic CE and the pros and cons of this maturing, cost- and pollution-controlled age technology are also discussed.

To shed some light on the physicochemical properties of the thyroid follicular colloid, we have screened retrospectively the autoradiographs of 60 human nodular goiters labeled 17 h preoperatively with 100 microCi 125I for evidence of colloid compartmentalization. In 87% (52/60) of all goiters examined, sporadic or multiple colloidal inclusions ('colloid stones') not mixing with newly labeled Tg were detected. The detailed analysis of 17 goiters revealed a mean incidence of 0.09+/-0.11 'colloid stones' of variable size per follicle ranging from 0.02+/-0.01 (10) to 0.43+/-0.09 (5) (mean values +/- S.D., number of sections examined in brackets). In this study we did not find a clear-cut association of incidence of 'colloid stones' with sex, age or nosologic group (hyperthyroid, preclinically hyperthyroid, euthyroid). The existence of different colloidal compartments as demonstrated in this and other studies is of considerable importance for thyroid function, interpretation of iodine kinetics, and studies on the role of iodine on growth and function of the thyrocytes. Different thyroidal iodine compartments could well be of functional relevance, for example in the adaptation of thyroid hormone secretion to antithyroid drugs or in severe and prolonged iodine deficiency, when very slow compartments become an important source of minimal quantities of iodine and thyroid hormone. 'Colloid stones', for example, may well explain the repeatedly observed, surprisingly large total iodine store in human endemic goiters, even in the presence of severe iodine deficiency. It is evident that the existence of multiple iodine compartments and, in particular, of particulate slow-turnover pools complicates the interpretation of total glandular iodine measurements with modern techniques such as X-ray fluorescence and positron emission tomography.

Extracellular matrix (ECM) and basement membrane (BM) components were studied by immunohistological methods in native rat thyroid tissue, and in rat thyroid tissue and FRTL-5 cells cultured in a three-dimensional alginate bead system. In all three situations, the presence of collagen IV, laminin, perlecan, and fibronectin was demonstrated. There were marked differences between rat thyroid tissue and FRTL-5 cells in culture. Rat thyroid tissue maintained a follicular structure, whereas FRTL-5 cells did not form follicles. Rat thyroid cells multiplied more slowly than FRTL-5 cells and thyroglobulin (Tg) was visible in the follicular lumen, while in FRTL-5 cells Tg was only seen intracellularly. Tg iodination was much lower in FRTL-5 cells than in rat cells. In rat thyroid cells, positive staining for collagen IV, laminin, and perlecan was seen in thin membranes around individual follicles, and for fibronectin around groups of follicles. In FRTL-5 cells, these ECM/BM components could be identified, but were not organized into equally regular networks around groups of cells. These results demonstrate that of the two types of cells examined, primary cultures of rat thyroid cells in alginate beads maintain structural and functional similarities to native thyroid tissue and would therefore be suitable for future in vitro studies of thyroidal ECM/BM and their interrelationship with growth and function of this organ. FRTL-5 cells cultured in alginate beads show some functional, but not structural similarities to native thyroid tissue and so would be less valuable for use in such studies.

The extracellular matrix (ECM) and basement membranes (BM, a specialized form of ECM) greatly influence proliferation, differentiation, and function of cells and the structure of tissues. While a considerable amount of information is available on thyroid cellular proliferation, differentiation and function, much less is known about thyroid ECM and BM. In this study the presence of the ECM/BM components fibronectin, collagen IV, alpha1, beta1, gamma1 laminin, several laminin variants, osteonectin, and perlecan was demonstrated in cryosections of nonadenomatous and toxic adenoma human thyroid tissue. Also, positive immunohistochemical staining for collagen IV, laminin, perlecan, and fibronectin was obtained in sections of human thyroid tissue cultured in a three-dimensional (alginate) culture system. The present study provides methods and data that will facilitate the investigation of the interaction between cells and ECM in thyroid tissue.

Wrist injuries are frequently observed after falls in snowboarding. In this study, laboratory experiments mimicking forward and backward falls were analysed. In six different falling scenarios, participants self-initiated falls from a static initial position. Eighteen volunteers conducted a total of 741 trials. Measurements were taken for basic parameters describing the kinematics as well as the biomechanical loading during impact, such as impact force, impact acceleration, and velocity. The effective mass affecting the wrist in a fall also was determined. The elbow angle at impact showed a more extended arm in backward falls compared to forward falls, whereas the wrist angle at impact remained similar in forward and backward falls. The study results suggest a new performance standard for wrist guards, indicating the following parameters to characterize an impact: an effective mass acting on one wrist of 3-5 kg, an impact angle of 75 degrees of the forearm relative to the ground, and an impact velocity of 3 m/s.

Journal of foot and ankle research, 5 (Supplement 1), ISSN:1757-1146

Background Total ankle arthroplasty (TAA) subjects often suffer pain on the anteromedial side of their ankle joint. Whether this prevalent pain is caused by a changed motion pattern of the TAA is unclear. Therefore, this study assessed the kinematic differences in the motion of the TAA components during gait, comparing TAA subjects with elevated versus absent levels of pain. Methods Eleven TAA subjects (5 with pain vs. 6 without pain), all with unilateral Mobility™ TAA and at least two years post-operation, were recruited and stratified based on standard clinical assessed patient data. The 3D motion of the TAA was assessed by means of videofluoroscopy during level, uphill and downhill walking. Results The hypothesis that the pain group shows a different kinematic motion pattern than the no pain group could not be confirmed. Conclusions The same kinematic motion pattern causes pain in some patients, but not in others. Further investigation concerning ligament stresses is needed.

Some years ago, we reported that colloid goiters could be produced experimentally in mice and rats by injection of TSH over a few days in the presence of ample iodine supply. This clearly showed that colloid accumulation and intense TSH stimulation are not mutually exclusive. In the present study, large colloid goiters, sharing many morphological and biochemical characteristics with human colloid goiters, were induced in rats and mice by treatment with 5,5-diphenyl-2-thiohydantoin (DPTH). This drug increases fecal loss of thyroid hormone and inhibits conversion of T4 to T3. Thus, DPTH raises TSH and induces macrofollicular colloid-rich goiters. In contrast to this, goiters induced by combined treatment with methimazole (MMI) or sodium perchlorate and DPTH are microfollicular, although serum TSH is increased to the same level as in rats treated with DPTH alone. The degree of iodine organification obviously determines if the follicle will sprout and form daughter follicles or if it will expand its hull. Thyroglobulin content of DPTH goiters is lower than that of normal glands but considerably higher than after MMI treatment, whereas total iodine content of DPTH goiters is only slightly lower than in normal glands, but also much higher than in MMI goiters. In DPTH goiters, a high proportion of total iodine is in the particulate fraction which probably contains the periodic acid Schiff-positive bodies floating in the colloid of DPTH treated glands. Acute DPTH administration does not inhibit iodide organification, but after treatment with DPTH for 1 day, chromatography suggests some inhibition of iodine organification and hormone synthesis by DPTH, but much less than by MMI. DPTH treatment causes considerable tissue damage and repair, such as follicular cell necrosis and invasion of the colloid by macrophages and granulation tissue. Therefore, DPTH goiters might well be a useful model not only for colloid goiter formation but also for inflammatory processes in the thyroid gland.

Aeschimann S, Gerber H, von Grünigen C, Oestreicher M, Studer H. The degree of inhibition of thyroid follicular cell proliferation by iodide is a highly individual characteristic of each cell and differs profoundly in vitro and in vivo. Eur J Endocrinol 1944;130:595–600. ISSN 0804–4643 Pharmacological concentrations of iodide (>1 × 10−6 mol/l) are known to inhibit thyroid follicular cell growth in vitro. However, the inhibitory effect varies widely, depending on experimental conditions, and usually does not exceed 50%. We demonstrate that iodide (10−4 mol/l) inhibits the growth of FRTL-5 cells in different passages by 11–67%. When five subclones of FRTL-5 cells were compared to the wild type, iodide-induced growth inhibition varied between 25% and 46%. The individual degree of inhibition of each clone was reproducible in two subsequent passages, suggesting that it is a stable constitutive trait. When FRTL-5 cells were grown first in three-dimensional clusters and then transplanted onto nude mice with high endogenous thyrotropin secretion, iodide at a serum concentration of less than 5.7 × 10−7 mol/l nearly completely blocked cell replication in the transplants but not in the mice's own thyroid. Five cell lines, prepared from autonomously growing hyperthyroid feline multinodular goiters, were nearly completely resistant to the growth-inhibitory effect of iodide. These observations suggest that the sensitivity towards the growth-inhibiting effect of iodide is a highly variable, stable trait of each thyrocyte, even in cloned cell populations. Some FRTL-5 cells and, even more so, cells prepared from autonomously growing nodular feline goiters are resistant constitutively to the growth-inhibiting effect of iodide. Three-dimensional clusters of FRTL-5 cells growing as transplants in recipient mice are growth-arrested totally by iodide concentrations more than 175 times lower than those partially inhibiting monolayer cultures, while growth of the intact thyroid of the recipient mouse remains unaffected or is even enhanced. Thus, the sensitivity of thyrocytes toward iodide is different fundamentally in vitro and in vivo. Hugo Studer, Medizinische Universitaetsklinik, Inselspital, CH-3010 Bern, Switzerland

Background The aims of this study were to evaluate the construct validity (known group), concurrent validity (criterion based) and test-retest (intra-rater) reliability of manual goniometers to measure passive hip range of motion (ROM) in femoroacetabular impingement patients and healthy controls. Methods Passive hip flexion, abduction, adduction, internal and external rotation ROMs were simultaneously measured with a conventional goniometer and an electromagnetic tracking system (ETS) on two different testing sessions. A total of 15 patients and 15 sex- and age-matched healthy controls participated in the study. Results The goniometer provided greater hip ROM values compared to the ETS (range 2.0-18.9 degrees; P < 0.001); good concurrent validity was only achieved for hip abduction and internal rotation, with intraclass correlation coefficients (ICC) of 0.94 and 0.88, respectively. Both devices detected lower hip abduction ROM in patients compared to controls (P < 0.01). Test-retest reliability was good with ICCs higher 0.90, except for hip adduction (0.82-0.84). Reliability estimates did not differ between the goniometer and the ETS. Conclusions The present study suggests that goniometer-based assessments considerably overestimate hip joint ROM by measuring intersegmental angles (e.g., thigh flexion on trunk for hip flexion) rather than true hip ROM. It is likely that uncontrolled pelvic rotation and tilt due to difficulties in placing the goniometer properly and in performing the anatomically correct ROM contribute to the overrating of the arc of these motions. Nevertheless, conventional manual goniometers can be used with confidence for longitudinal assessments in the clinic., BMC Musculoskeletal Disorders, 11, ISSN:1471-2474

Background Failure to achieve stable fixation with medial support in proximal humeral fractures can result in varus malalignment and cut-through of the proximal screws. The purpose of this study was to investigate the influence of an intramedullary fibula bone graft on the biomechanical properties of proximal humeral fractures stabilized by angular stable plate fixation in a bone model under cyclic loading. Methods Two fixation techniques were tested in 20 composite analog humeri models. In group F– (n = 10), fractures were fixed by an anatomically formed locking plate system. In group F+ (n = 10), the same fixation system was used with an additional fibular graft model with a length of 6 cm inserted in an intramedullary manner. Active abduction was simulated for 400 cycles by use of a recently established testing setup. Fragment gap distance was measured, and thereby, intercyclic motion, fragment migration, and residual plastic deformation were determined. Results The addition of a fibular graft to the fixation plate led to 5 times lower intercyclic motion, 2 times lower fragment migration, and 2 times less residual plastic deformation. Neither screw pullout, cut-through, nor implant failure was observed. Conclusion Medial support with an intramedullary fibular graft in an angular stable fixation of the proximal humerus in vitro increases overall stiffness of the bone-implant construct and reduces migration of the humeral head fragment. This technique might provide a useful tool in the treatment of displaced proximal humeral fractures, especially when there is medial comminution.

Study Design. Cross-sectional study. Objective. Comparison of the timing of onset of lateral abdominal muscle activity during rapid arm movements in patients with nonspecific chronic low back pain (cLBP) and back-pain-free controls. Summary of Background Data. Rapid movements of the arm are normally associated with prior activation of trunk-stabilizing muscles in readiness for the impending postural perturbation. Using invasive intramuscular electromyography techniques, studies have shown that this feed-forward function is delayed in some patients with low back pain (LBP). Ultrasound tissue Doppler imaging (TDI) provides an ultrasound method for quantifying muscle activation in a noninvasive manner, allowing investigation of larger groups of patients and controls. Methods. Ninety-six individuals participated (48 patients with cLBP and 48 matched LBP-free controls). During rapid shoulder flexion, abduction, and extension, surface electromyographic signals from the deltoid and motion-mode TDI images from the contralateral lateral abdominal muscles were recorded simultaneously. The onset of muscle activity was given by changes in the tissue velocity of the abdominal muscles, as measured with TDI. Pain and disability in the patients were assessed using standardized questionnaires. Data were analyzed using repeated measures analysis of variance. Results. In both groups, feed-forward activity of the lateral abdominal muscles was recorded during arm movements in all directions. The main effect of “group membership” revealed no significant difference between the groups for the earliest onset of abdominal muscle activity (P 0.398). However, a significant “group body side” interaction (P 0.015) was observed, and this was the result of earlier onsets in the cLBP group than controls for the abdominal muscles on the right (but not left) body side. No relationship was found between the time of onset of the earliest abdominal muscle activity and pain intensity, pain frequency, pain medication usage, or Roland Morris disability scores. Conclusion. Patients with cLBP did not show a delayed onset of feed-forward activation of the lateral abdominal muscles during rapid arm movements. Earlier activation was observed for one body side compared with the controls. However, the clinical relevance of this finding remains obscure, especially because there was no relationship between the onset of activation and any clinical parameters.

The clonality of human tumors can be studied by X inactivation/methylation analysis in female patients heterozygous for X-linked DNA polymorphisms. We present a detailed study on clonal tumor analysis with M27 beta, a highly informative probe detecting a polymorphic X chromosomal locus, DXS255. The polymorphism detected at this locus is due to variable numbers of tandem repeats. The rate of constitutional heterozygosity detected by M27 beta was 88%. Normal tissue from gastrointestinal mucosa and thyroid showed random, hence polyclonal, patterns. Nonrandom clonal X inactivation was detected in all 22 malignant neoplasms that had been shown to be clonal by other DNA markers, such as antigen receptor gene rearrangements or clonal loss of heterozygosity at 17p and other loci. 16/48 normal blood leukocyte samples (33%) showed considerably skewed X inactivation patterns. Comparison of blood leukocytes and normal tissue indicated that in a given individual, X inactivation patterns may be tissue specific. M27 beta was used to study the clonal composition of 13 benign thyroid nodules from 12 multinodular goiters with rapid recent growth, traditionally termed "adenomas." Nine of them were clonal, whereas four nodules and tissue from a case of Graves' goiter were not, indicating that some, but not all, such thyroid nodules may represent true clonal neoplasms. The M27 beta probe permits one to study the clonal composition by the X inactivation approach of a wide variety of solid tumors from most female patients. As a control, normal tissue homologous to the tumor type of interest is preferable to DNA from blood leukocytes, since the latter may show nonrandom X inactivation patterns in a fairly high proportion of cases. M27 beta may, therefore, be of limited use for the clonal analysis of neoplasms derived from hematopoietic cells.

Our overall aim is to monitor iodine supply in a prospective study before and after the September 1998 increase of salt iodide content in Switzerland. Because iodide is supplied by alimentation, we moreover wondered whether urinary iodine concentration (UI) is governed by circadian rhythmicity. Forty-two subjects (18 males and 24 females, including 13 children) collected 3023 urine spots between May 1996 and May 1998, at a rate of three to five samples per month, at any time of the day. The results show that circadian rhythmicity of UI in adults and children was found independent of the individual subject, age, gender, and season. Lowest UI levels were found between 8-11 h. A curve increasing progressively between 12 and 24 h was obtained. UI returned to base-line levels between 21 and 22 h in children only. UI peaks occurred 4-5 h after main meals; children's peaks occurred later than that of adults. Although the existence of a circadian rhythm of UI is probably universal, its profile, however, depends on alimentation. Because nadir of UI is represented by morning spots, this might seem an appropriate collecting period. In view of the significant circadian rhythmicity of UI, studies with restriction of sampling time to morning hours, for example, cannot be directly compared with studies in which urine is sampled all over the day.