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BACKGROUND AND PURPOSE: It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction to common metal allergens, and revision surgery in patients who underwent knee arthroplasty.PATIENTS AND METHODS: The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test database from the greater Copenhagen area (n = 27,020).RESULTS: 327 patients were registered in both databases. The prevalence of contact allergy to nickel, chromium, and cobalt was comparable in patients with and without revision surgery. However, in patients with 2 or more episodes of revision surgery, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery.INTERPRETATION: While we could not confirm that a positive patch test reaction to common metals is associated with complications and revision surgery after knee arthroplasty, metal allergy may be a contributor to the multifactorial pathogenesis of implant failure in some cases. In cases with multiple revisions, cobalt and chromium allergies appear to be more frequent.

Metal release from total hip replacements (THRs) is associated with aseptic loosening (AL). It has been proposed that the underlying immunological response is caused by a delayed type IV hypersensitivity-like reaction to metals, i.e., metal allergy. The purpose of this study was to investigate the immunological response in patients with AL in relation to metal release and the prevalence of metal allergy. THR patients undergoing revision surgery due to AL or mechanical implant failures were included in the study along with a control group consisting of primary THR patients. Comprehensive cytokine analyses were performed on serum and periimplant tissue samples along with metal analysis using inductive coupled plasma mass spectrometry (ICP-MS). Patient patch testing was done with a series of metals related to orthopedic implant. A distinct cytokine profile was found in the periimplant tissue of patients with AL. Significantly increased levels of the proinflammatory cytokines IL-1&beta, IL-2, IL-8, IFN-&gamma, and TNF-&alpha, but also the anti-inflammatory IL-10 were detected. A general increase of metal concentrations in the periimplant tissue was observed in both revision groups, while Cr was significantly increased in patient serum with AL. No difference in the prevalence of metal sensitivity was established by patch testing. Increased levels of IL-1&beta, IL-8, and TNF-&alpha, point to an innate immune response. However, the presence of IL-2 and IFN-&gamma, indicates additional involvement of T cell-mediated response in patients with AL, although this could not be detected by patch testing.

Fabry disease (FD) is a multisystem lysosomal storage disorder caused by mutations in the GLA gene. The clinical significance of the mutation p.D313Y is still under debate. Retrospective chart analysis of clinical (neurological, cardiac, renal, and ophthalmological), genetic, and biochemical (lyso-globotriaosylsphingosine, lyso-Gb3; enzyme activity) data was performed in all our patients carrying the p.D313Y mutation. Fourteen patients from 5 families (10 female, 4 male; age range 10-51) were included. Symptoms and organ manifestations compatible with FD could be identified in 10 patients. Cerebrovascular events occurred in 4 females. Seven patients reported pain or acroparaesthesia. Cornea verticillata was found in 1 patient, mild retinal vascular tortuosity in 5 patients. Lyso-Gb3 was elevated in 2 females with cerebrovascular involvement. Classical cardiac, renal or skin manifestations could not be identified. The mutation p.D313Y in the GLA gene may lead to organ manifestations and elevation of the Fabry-specific biomarker lyso-Gb3. Neurological symptoms (stroke and pain) and ocular manifestations seem to be the leading findings. Annual routine visits are recommended for patients carrying the p.D313Y mutation. Enzyme replacement therapy might be considered in symptomatic patients.

Hintergrund und Ziel In den letzten Jahren hat Palmol als Bioenergietrager immer mehr an Bedeutung gewonnen, da es aufgrund seines hohen Flachenertrags auserst kostengunstig produziert werden kann. Gleichzeitig gerat Palmol vermehrt in die Kritik, weil neue Studien die okologisch nachteiligen Folgen des Anbaus hoher einschatzen als ursprunglich vermutet. Aufgrund der grosen Nachfrage nach Palmol werden die okologisch vertraglichen Anbauflachen zunehmend knapp. Daher wird Naturwald gerodet, um neue Plantagen anzulegen, was zu einem Verlust an Biodiversitat und zur Emission von Treibhausgasen fuhrt. Mithilfe einer Okobilanz konnen die gesamten Umweltauswirkungen, die sich bei der Produktion und Nutzung von Palmol ergeben, erfasst werden. Ein Teilaspekt der Okobilanz ist die Treibhausgasbilanz, die aufgrund des Klimawandels zurzeit besonders grundlich betrachtet wird. Bei Palmol liese sich diese Treibhausgasbilanz entscheidend verbessern, wenn die Palmolgewinnung optimiert wurde. Das Ziel des Artikels ist es daher, die Optimierungspotenziale fur Palmol hinsichtlich Ressourcenschonung und Klimaschutz im Einzelnen darzustellen. Ergebnisse und Diskussion Sowohl bei bestehenden Plantagen als auch bei Neuanlagen konnen enorme Mengen an Treibhausgasen gegenuber heute eingespart werden, indem zum einen die Plantagen effektiver betrieben und die anfallenden Reststoffe vollstandig genutzt werden, und zum anderen eine Neuanlage von Plantagen auf Brachflachen erfolgt, anstatt Regenwald zu roden oder andere Plantagen umzuwidmen. Die Ergebnisse zeigen, dass das Gesamtpotenzial zur Optimierung hoch ist. Zum einen erhalt man eine bessere Treibhausgasbilanz, wenn das Plantagenmanagement effizienter gestaltet wird. Zum anderen konnen grose Mengen an Reststoffen, die bei der Palmolherstellung anfallen, genutzt werden. Vor allem die Fasern und Schalen der Olpalmenfruchte sowie die Nutzung des bei der Aufbereitung der Olmuhlenabwasser entstehenden Biogases konnen zur Stromerzeugung verwendet werden und so die Okobilanz entscheidend verbessern. Bei optimierter Bewirtschaftung lassen sich auf bestehenden Plantagen jahrlich etwa 4,8 t an Treibhausgasen pro Hektar und Jahr auf der Basis von CO2-Aquivalenten einsparen, was sich vor allem auf die Reduktion von Methan aus den Olmuhlenabwassern zuruckfuhren lasst. Emissionen werden ebenfalls entscheidend gesenkt, wenn neue Plantagen auf vorhandenen Brachflachen anstelle von Naturwaldflachen angelegt werden. Damit ist eine weitere Einsparung von 4,8 t CO2-Aquivalenten pro Hektar und Jahr moglich. Die Errichtung einer Plantage auf Brachflachen ist zwar kostenintensiver als die Errichtung auf Naturwaldflachen, tragt aber nicht nur zu einer positiveren Treibhausgasbilanz von Palmol, sondern auch zum Schutz der Biodiversitat bei. Nutzt man also das gesamte Potenzial vollstandig aus, so lassen sich jahrlich 10,2 t mehr an CO2-Aquivalenten pro Hektar einsparen als bei der heute ublichen Produktion und Nutzung von Palmol. Schlussfolgerungen und Ausblick Da die okologisch vertraglichen Anbauflachen aufgrund der grosen Nachfrage nach Palmol auf dem Weltmarkt zunehmend knapp werden, ist eine Optimierung der bislang ungenutzten Potenziale aus okologischer, aber auch aus okonomischer Sicht unbedingt erstrebenswert. So sollte auf das Errichten von Neuplantagen auf Naturwaldflachen zugunsten einer Anlage auf Brachflachen verzichtet werden. Zudem sollte das Plantagenmanagement optimiert und ein effizientes Konzept zur Reststoffverwertung und Abwasserbehandlung erstellt werden. Eine wichtige Voraussetzung fur eine nachhaltige Palmolproduktion ist, die vorhandenen Optimierungspotenziale auch auszuschopfen. Da dies aufgrund hoher Anfangsinvestitionskosten zur Zeit nicht geschieht, ist es ratsam, entsprechende Masnahmen zur Realisierung der genannten Optimierungspotenziale zu ergreifen, so z. B. moglichst rasch ein international gultiges Zertifizierungssystem zu verabschieden und damit Anreize zu bieten, okologisch verbessert zu produzieren.

New investigations in the Neogene Boudinar basin (Morocco) provide new information about the Messinian Salinity Crisis (MSC) and Zanclean reflooding in the southern part of the Alboran realm (westernmost Mediterranean). Based on a new field, sedimentological and palaeontological analyses, the age and the geometry of both the Messinian erosional surface (MES) and the overlying deposits have been determined. The MES is of late Messinian age and was emplaced in subaerial settings. In the Boudinar basin, a maximum of 200. m of Miocene sediments was eroded, including late Messinian gypsum blocks. The original geometry of the MES is preserved only when it is overlain by late Messinian continental deposits, conglomeratic alluvial fans or lacustrine marly sediments. These sediments are interpreted as indicators of the sea-level fall during the MSC. Elsewhere in the basin, the contact between late Messinian and early Pliocene deposits is a low-angle dipping, smooth surface that corresponds to the early Pliocene transgression surface that subsequently re-shaped the regressive MES. The early Pliocene deposits are characterized by: (i) their onlap onto either the basement of the Rif chain or the late Miocene deposits; (ii) lagoonal deposits at the base to offshore marls and sands at the top (earliest Pliocene; 5.33-5.04. Ma interval; foraminifer zone PL1); (iii) marine recovery occurring in the 5.32-5.26. Ma interval; and (iv) the change from lagoonal to offshore environments occurring within deposits tens of metres thick. This information indicates that at least the end of the reflooding period was progressive, not catastrophic as previously thought. © 2015 Elsevier B.V..

Direct oxidation of benzene to phenol over Fe-ZSM-5 catalyst was chosen as a model reaction to characterize the influence of microwave irradiation on ad-/desorption processes during heterogeneously catalyzed reactions. The direct oxidation of benzene was investigated under different reaction conditions (temperature, residence time, reactant-concentrations) and microwave power in a specially designed reactor. The results obtained by additional microwave radiation were compared to those obtained by conventional heating under similar reaction conditions. In addition, ex situ TG-MS analyses were also conducted to study the sorption behaviour. Extensive investigations were carried out to determine adsorption–desorption effects (benzene, phenol and a mixture of both) and the coking behaviour under microwave conditions. Microwave induces a trend towards increased phenol selectivity and relative deactivation during the reaction. However, there was no conclusive improvement in the performance was obtained by means of microwave heating.

OBJECTIVE: To assess characteristics and outcome of emergency patients with acute malaria. PATIENTS AND METHODS: We retrospectively assessed the clinical and laboratory parameters of 137 consecutive patients (87 males, 50 females; median age 37 years, range 17 - 67 years) presenting with acute malaria to our tertiary care center between 1992 and 2002. RESULTS: Falciparum malaria was diagnosed in 116/137 and tertian malaria in 19/137 patients; a single patient was infected with both parasites while in another case the type of parasite remained unclear. Infections were acquired in Africa (121), Asia , and in the Americas . One traveler visited multiple continents. Only 36 % (50/137) of patients had used malaria chemoprophylaxis. 128/137 patients were treated as in-patients; 22 of these had to be treated on an intensive care unit. According to the criteria of the German Society of Tropical Medicine, 44/137 (32 %; 95 % confidence interval (CI): 25 - 40 %) patients suffered from complicated malaria. The overall mortality rate was 2/137 (1.5 %; 95 % CI: 0,4 - 5.2 %); the mortality rate of complicated malaria tropica was 2/44 (4,5 %; 95 % CI 1,3 - 15 %). Patients with complicated malaria were significantly older than those with uncomplicated malaria. Median length of hospital stay was 4 days in uncomplicated and 9 days in complicated cases. Based on costs of EUR 2500 per case, an attack rate of > 3 % in East African travelers and a cost of EUR 55 for a chemoprophylaxis with mefloquine, chemoprophylaxis is cost-effective. CONCLUSION: In our retrospective analysis, complicated malaria tropica was associated with older age. Although malaria causes considerable morbidity, the overall mortality from severe malaria is low. Reinforcement of chemoprophylaxis especially in travelers to Africa could reduce malaria cases and is cost-effective.

New field and micropalaeontological investigations have been conducted in four of the Pliocene rias of the internal zone of the Rif in Morocco, on the southern margin of the Alboran Sea. We found that marine sediments outcropping in these rias were deposited mainly during the Early Zanclean, between 5.04 and 3.8 Ma. After a transgressive episode that led to the deposition of terrestrial to marine conglomerates, dark clays deposited first at shallow palaeo-depths and then at bathyal palaeo-depths. The rias were then infilled with a shallowing upward succession comprising marine clays and sandstone and, locally, terrestrial sediments that indicate their final emersion. No Gilbert-deltas were observed in these rias. The presence of transgressive deposits at the bottom of the rias, also identified in other basins of the external zone of the Rif, and the absence of Gilbert deltas question a catastrophic reflooding after the Messinian Salinity Crisis in this area. © 2014 Académie des sciences.

Beginning with the first oil crisis, the economic development in West Germany and most other industrialized countries is no longer what it used to be: growth rates sharply diminished, unemployment became a burning problem and inflation-rates did hardly respond to the slackening demand. But it came even worse: what in the mid-seventies had been called stagflation turned into a severe recession in the eighties. And even if the picture improves in the near future, the mid-term and long-term prospects are in no way very promising. As usual, it took some time until the crisis and its severity was widely recognized. But while there is some consensus as to the statistical diagnesis, there is still a wide range of opinions as to the origins (and to the therapy) of the crisis. With the risk of simplifying too much, in Germany (and elsewhere) two extreme views can be separated: one view which attributes the current problems to the growing inflexibility of the system, at least partly caused by too many direct and indirect government activities; he other view, which does not see the origin of the difficulties in changing behaviour of the economic agents which the first view tends to emphasize, but in dramatic changes of some exogenous variables, such as the various supply and demand shocks of the seventies.

To assess characteristics and outcome of emergency patients with acute malaria.We retrospectively assessed the clinical and laboratory parameters of 137 consecutive patients (87 males, 50 females; median age 37 years, range 17 - 67 years) presenting with acute malaria to our tertiary care center between 1992 and 2002.Falciparum malaria was diagnosed in 116/137 and tertian malaria in 19/137 patients; a single patient was infected with both parasites while in another case the type of parasite remained unclear. Infections were acquired in Africa (121), Asia , and in the Americas . One traveler visited multiple continents. Only 36 % (50/137) of patients had used malaria chemoprophylaxis. 128/137 patients were treated as in-patients; 22 of these had to be treated on an intensive care unit. According to the criteria of the German Society of Tropical Medicine, 44/137 (32 %; 95 % confidence interval (CI): 25 - 40 %) patients suffered from complicated malaria. The overall mortality rate was 2/137 (1.5 %; 95 % CI: 0,4 - 5.2 %); the mortality rate of complicated malaria tropica was 2/44 (4,5 %; 95 % CI 1,3 - 15 %). Patients with complicated malaria were significantly older than those with uncomplicated malaria. Median length of hospital stay was 4 days in uncomplicated and 9 days in complicated cases. Based on costs of EUR 2500 per case, an attack rate of3 % in East African travelers and a cost of EUR 55 for a chemoprophylaxis with mefloquine, chemoprophylaxis is cost-effective.In our retrospective analysis, complicated malaria tropica was associated with older age. Although malaria causes considerable morbidity, the overall mortality from severe malaria is low. Reinforcement of chemoprophylaxis especially in travelers to Africa could reduce malaria cases and is cost-effective.

Data on current and historical usage of alpha, beta, and gamma-hexachlorocyclohexane (HCH) in Europe are presented. The data were collected and estimated as a part of a project studying the regional cycling of persistent organic pollutants (POPs) in the Baltic environment (Popcycling-Baltic). Better data on sources, environmental discharges and atmospheric emissions of HCH and other POPs are needed to study, and hopefully reduce, the impact of these pollutants on the environment. Substantial uncertainties are assigned to the estimated data for individual countries and years, but it seems likely that the general trend of usage in Europe is captured. The quality of the estimates is thought to improve in general throughout the period, thus, reflecting the availability of reliable data. The results suggest that 382,000 t of technical HCH and 81,000 t of lindane were used in Europe from 1970 to 1996. This is equivalent to an estimated cumulative usage of 259,000 t alpha-HCH, 235,000 t gamma-HCH and 20,000 t beta-HCH. The usage of technical HCH was the major source of gamma-HCH until the late 1970s, and thereafter lindane became the dominating source of this isomer. The use of gamma-HCH in 1996 was estimated to still be nearly one-third of the European usage in 1970. The pattern of decreasing concentrations in biota follows the pattern of reductions in usage for the studied period within the Baltic area.

Multiple sclerosis is one of the most frequent neurological diseases. Till today too little attention has been laid upon its psychosomatic aspects. In the psychosomatic-somatopsychic-global sense of a therapy a differentiated enlightenment performed step by step, is recommended in the first part of this article. This includes a differentiation of the melting-pot-like unspecific diagnoses into subdiagnoses with different prognoses. This is important for the coping-mechanisms to be performed by the patient, in which necessarily he must be supported by his doctor. The second part shows a psychodynamic factor to the onset of this disease which is caused by several different factors. This psychodynamic factor is characterized by the shift of an intraindividual struggle of power into the soma and it performs a dispute between two parts of the self, Introjects asking for performance on one side, the unfulfilled wish of love and bestowal on the other side. This wish is fulfilled directly by the symptoms of multiple scleroses--at a high price. As a conclusion of this article a giving up of the artificial distinction between psychosomatic and somatic diseases is suggested by taking MS as an example.

Die Beratung und Betreuung von erwachsenen Patienten sollte dem Prinzip der partnerschaftlichen Kommunikation und Interaktion folgen und den Erwachsenen in den Stand setzen, eigenstandig in Kenntnis der Vorteile und Nachteile einer kieferorthopadischen Behandlung zu entscheiden und einsichtig am Prozedere der Behandlung nach Masgabe der vom Patienten zu erbringenden Leistungen zu partizipieren.

Das neue Mikrobestimmungsverfahren beruht auf der coulometrischen Titration von S2O3 2− nach vorheriger Abbaureaktion der Polythionate mit Sulfit bzw. Cyanid. Es werden 10 ml Probelosung (S4O6 2−: 5 · 10−5 bis 1 · 10−3 M; S5O6 2−; 2,5 · 10−5 bis 1· 10−3 M; S6O6 2−: 1,66 · 10−5 bis 1 · 10−3 M) benotigt. Die Titrationskurve wird von einem Schreiber registriert. Die Reproduzierbarkeit der jeweiligen Einzelbestimmung liegt bei VK p±0,1 bis ± 1,6%.

High-voltage ionophoretic separation of polysulphanedisulphonates on thin-layer foils in a temperature-controlled chamber A description is given of the high-voltage ionophoretic separation of polysulphanedisulphonates on coated foils followed by a quantitative evaluation of the zones. By application of thin-layer foils the advantages of both paper and thin-layer ionophoresis are combined. The separations are carried out in a chamber developed for high-voltage paper ionophoresis. Addition of extra thermoelements makes measurement of the separation temperature in the supporting material possible.

Die Kopplung von Dunnschicht-Hochspannungsionophorese mit coulometrischer Titration bzw. Remissionsspektrophotometrie ermoglicht die Ermittlung der Zusammensetzung von Polythionatgemischen. Der Zeitbedarf betragt fur den Trennvorgang 30 min und fur die coulometrische Bestimmung einer Zone ca. 15 min. Das erforderliche Probevolumen liegt im μl-Bereich.

Bei den Verfahren zur Darstellung einzelner Polythionate besteht die Moglichkeit, das diese durch andere Polythionate verunreinigt anfallen. In solchen Fallen ist die Reinheitsbestimmung problematisch. Die in der Literatur beschriebenen klassischen Analysenverfahren werden fur ein spezielles Beispiel kritisch betrachtet und mit dem Mikroverfahren der Kopplung von Dunnschicht-Hochspannungsionophorese mit coulometrischer Titration verglichen.

Anthropogenic emissions of trace elements to the atmosphere are an inherent part of industrial processes. Throughout the last six thousand years of recorded history, man has developed and used industrial processes to prepare metals for military and agricultural use, as well as for coins and jewelry. The records are incomplete for the total amount of metals used and for the quantity of metals emitted to the atmosphere. Nevertheless, it is clear that, in some regional cases, such emissions have exceeded flux from natural sources by several orders of magnitude.

Das 2wertige Kation Magnesium beeinflust die Kontraktilitat der Muskulatur und tragt zur Erhaltung der Zellmembranfunktion bei [1, 4].

The CYVADIC combination has been the preferred treatment for soft tissue sarcomas for the last 10 years. Other combinations of therapy are necessary because the remission rate achieved with CYVADIC is only thirty per cent. Alternative therapies for these tumours are combinations including cis-platinum, ifosfamide, epipodophyllin and high-dose methotrexate. Our therapeutic results with combinations of cis-platinum and ifosfamide are comparable to CYVADIC. However, side-effects such as nausea, vomiting and fatigue due to cis-platinum in the palliative treatment of these tumours are intolerable for many patients. A combination of adriamycin and ifosfamide, which exhibits a higher remission rate of 44% and lower toxicity than CYVADIC, is giving encouraging results.

Systematic faunal studies in the district Schwerin showed at the present time there are 3 more or less damage-biotopes existing in the districts of Perleberg, Ludwigslust and Parchim; 5 river sources can be considered as potential sources, 5 are temporary and 2 are ephemeral whilst in 3 further areas environmental influences such as effluent impairs the flow of the river and the developmental stages of Simuliidae were not observed.--The following species were found: Boophthora erythrocephala, Wilhelmia salopiensis, Wilhelmia equina, Odagmia ornata, Eusimulium aureum and Eusimulium lundstroemi.--The damage statistics covering the period 1966--1971 showed in the district of Schwerin, due to Simuliid attacks, 38 cattle died, 170 were seriously ill; in 1967 5 horses were seriously ill; in 1971, 3 pigs died and 27 were seriously ill.--The symptoms were manifested by pathological petechiae, scabs and oedema, also by insufficiency of the heart and circulatory system, diminished performance and growth disturbance. In severe cases heart and circulation failure occurred, paresis, coma and death followed.--The real economic significance of the Simuliid attacks rest with its strong and prolonged distrubance in young animals, as well as in pronounced irreparable diminished performance in diseased dairy cattle.