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Background & Aims: HBV coinfection is common among people living with HIV (PLWH) and is the most important cause of hepatocellular carcinoma (HCC). While risk prediction tools for HCC have been validated in patients with HBV monoinfection, they have not been evaluated in PLWH. Thus, we performed an external validation of PAGE-B in people with HIV/HBV coinfection.Methods: We included data on PLWH from four European cohorts who were positive for HBsAg and did not have HCC before starting tenofovir. We estimated the predictive performance of PAGE-B for HCC occurrence over 15 years in patients receiving tenofovir-containing antiretroviral therapy. Model discrimination was assessed after multiple imputation using Cox regression with the prognostic index as a covariate, and by calculating Harrell's c-index. Calibration was assessed by comparing our cumulative incidence with the PAGE-B derivation study using Kaplan-Meier curves.Results: In total, 2,963 individuals with HIV/HBV coinfection on tenofovir-containing antiretroviral therapy were included. PAGE-B was Conclusions: For individuals with HIV/HBV coinfection, PAGE-B is a valid tool to determine the need for HCC screening. Impact and implications: Chronic HBV infection is the most important cause of hepatocellular carcinoma (HCC) among people living with HIV. Valid risk prediction may enable better targeting of HCC screening efforts to high-risk individuals. We aimed to validate PAGE-B, a risk prediction tool that is based on age, sex, and platelets, in 2,963 individuals with HIV/HBV coinfection who received tenofovir-containing antiretroviral therapy. In the present study, PAGE-B showed good discrimination, adequate calibration, and a cut-off of

ZusammenfassungInfantile Hämangiome im Lid- und Orbitabereich können trotz ihres selbstlimitierenden natürlichen Verlaufs zu funktionellen Defiziten infolge einer Amblyopie oder Optikuskompression führen oder ein ästhetisch störendes Erscheinungsbild entwickeln und bedürfen dann einer Therapie.Seit der „zufälligen” Entdeckung des Effektes von Propranolol auf infantile Hämangiome im Jahr 2008 wird diese Substanz zur Behandlung komplizierter Hämangiome eingesetzt, die ansonsten den Einsatz von Kortikosteroiden, Laser oder operativen Verfahren erfordert hätten. Propranolol systemisch ist derzeit bei komplizierten Hämangiomen der Lider und Orbita aufgrund des raschen und komplikationsarmen Therapieeffektes Therapie der ersten Wahl.Dargestellt werden Pathogenese, Klassifikation, Indikation zur Therapie, Therapieoptionen sowie deren Effektivität für infantile Hämangiome im Lid- und Orbitabereich.Weitere klinische Studien zur Optimierung von Dosierung, Behandlungsdauer und Art der Anwendung von Propranolol (lokal oder systemisch) sind jedoch weiterhin erforderlich, um den Regressionseffekt und die Regressionsrate weiter zu verbessern.

In spite of the self-limiting natural course of infantile haemangiomas of the eyelids and orbit, the effects of amblyopia, compression of the optic nerve, and impairment of the aesthetic appearance may develop. Since the serendipitous discovery of the effects of propranolol, a non-selective beta-blocker, on infantile haemangioma in 2008, it has largely replaced the former standard treatments with corticosteroids, laser or surgical procedures. This review discusses the pathogenesis, classification, indication for treatment, and treatment options for infantile haemangiomas. In addition, the results of patients with infantile haemangiomas of the eyelids and orbit treated with systemic propranolol are shown. With additional confirmation of data, including a positive effect-risk-analysis, propranolol will potentially replace high-dose corticosteroids and surgery in the treatment of infantile haemangiomas in the eyelids and orbit. Further clinical studies are necessary to optimise the dosage, treatment period, and application modalities (oral or topical). In the future, propranolol accompanied with paediatric-cardiological monitoring should emerge as the first-line therapy for problematic infantile haemangiomas.

In the past planar superconductive undulators have been successfully developed and tested with beam. They produce linearly polarized light (X-rays) and allow to tune the emitted wavelength electrically. In this paper a novel type of superconductive undulators is introduced which allows to tune electrically in addition to the wavelength the polarization direction. A short prototype was built and tested in a LHe bath.

TOPIC Family member homicide. PURPOSE To explore the unique facets of bereavement for a family member of a homicide victim in order to assist clinicians during assessment, evaluation, and intervention with children. SOURCES The authors' experience in working with children at a child grief center and published literature. CONCLUSIONS Children experience grief uniquely and use differing methods of coping and adaptation. Knowledge of these differences can assist clinicians with promotion of adaptive coping and grieving in children who have been exposed to murder.

In spite of the self-limiting natural course of infantile haemangiomas of the eyelids and orbit, the effects of amblyopia, compression of the optic nerve, and impairment of the aesthetic appearance may develop. Since the serendipitous discovery of the effects of propranolol, a non-selective beta-blocker, on infantile haemangioma in 2008, it has largely replaced the former standard treatments with corticosteroids, laser or surgical procedures. This review discusses the pathogenesis, classification, indication for treatment, and treatment options for infantile haemangiomas. In addition, the results of patients with infantile haemangiomas of the eyelids and orbit treated with systemic propranolol are shown. With additional confirmation of data, including a positive effect-risk-analysis, propranolol will potentially replace high-dose corticosteroids and surgery in the treatment of infantile haemangiomas in the eyelids and orbit. Further clinical studies are necessary to optimise the dosage, treatment period, and application modalities (oral or topical). In the future, propranolol accompanied with paediatric-cardiological monitoring should emerge as the first-line therapy for problematic infantile haemangiomas.

The initial assessment of patients with infectious diseases is challenging because of the extremely broad differential diagnosis as well as different host pathogen interactions influenced by a different immune status. The formal initial assessment, including the present and past medical history, thorough physical examination, clinical first impressions as well as routine laboratory analyses, is the basis of every preliminary diagnosis. Specific chief complaints have to be recognized in order to narrow down the differential diagnosis. In cases of life-threatening illnesses, such as septicemia, endocarditis, bacterial meningitis and severe pneumonia, the first diagnostic and therapeutic steps should be performed in a rapid sequence: bacterial blood samples, sputum and/or liquor samples are required and the initial antibiotic therapy has to be chosen empirically as the relevant bacterial spectrum related to the suspected illness must be covered. In less urgent cases it is recommended that a multi-step diagnostic approach be carried out which takes the differential diagnosis into account and prioritizes the probabilities. In the latter situation antibiotic treatment should be delayed to diagnose the infection correctly. Importantly, atypical courses must necessitate careful and critical reassessment of the diagnosis.

Compton spectra of a-oxalic acid dihydrate single-crystal slices and powder samples were measured in a helium atmosphere using 59.537 keV 241 Am radiation. In the anisotropic case, the scattering vector was oriented parallel to the shortest hydrogen bond, in the direction of the C = O bond, parallel to the C - O bond and perpendicular to the (a, c)-plane. The comparison of theoretical reciprocal form factors, calculated with a local density-approximation (LDA) method for an α-(COOH)2 • 2H2O cluster in triple-zeta basis-set quality, with the experimental data has demonstrated that there is a considerable influence of intermolecular interactions on the electronic structure. Further calculations including the intermolecular interactions of the first coordination sphere by symmetrical orthogonalisation of the LDA wave functions clearly improved the agreement of experiment and theory. A theoretical analysis of the reciprocal form factor Ba (s) in the direction of the three different hydrogen bonds of α-oxalic acid dihydrate on the basis of the cluster calculations has shown that in the region above s = 1.9 Å all these bonds are dominated by electrostatic attrac-tion and exchange repulsion of the donor and the acceptor system.

Immune-mediated inflammatory diseases and applied immunosuppressive or modulating medications predispose patients for more frequent and more severe infections. Partly, these can be prevented by vaccinations. However immunization rates in daily life are low. The indication for vaccination, the capacity of sufficient antibody response and possible adverse reactions--such as vaccination-induced infection in live-vaccines--must be carefully evaluated and timing should be planned accordingly. In addition to vaccinations according general recommendation patients with immunosuppression benefit from vaccinations against seasonal influenza and S. pneumoniae. Induction of flares of the underlying disease after vaccination could not be confirmed.

We report about a patient with purulent pericarditis due to Neisseria meningitidis pretreated with antibiotics. Clinical signs were suggestive of pericardial tamponade. Cultures from blood and pericardial aspirate remained negative. Broad-range polymerase chain reaction from pericardial fluid detected Neisseria sp.. Latex agglutination assay from pleural fluid showed positive reaction with meningococcal antigen serogroup C. Meningococcal pericarditis without meningitis is a rare manifestation. Non-culture based diagnostic methods in patients with such severe infections and negative cultures play an important role.

Vaccination strategies in immunocompromised patients differ from those in immunocompetent patients: The risk of severe and complicated infections is increased, the immune response to vaccination might be hampered and side-effects--especially vaccination-induced infections after live-vaccines--must carefully be weighed against benefit of vaccination. Encouragement of vaccination, adequate timing, boostering and newer immunological strategies can improve immunity. This article summarizes vaccination problems in patients with HIV/AIDS, Solid-organ transplantation, haematological stem cell transplantation, splenectomy and immunosuppressive drugs.

Following the successful performance of a beam test with a superconductive undulator at the synchrotron light source ANKA there are plans to equip most of the straight sections with superconductive undulators. In this paper the first results of the measurements are presented and future plans are summarized.

The first beam measurements with a cold-bore superconducting in-vacuum undulator in a storage ring are reported. Undulators are x-ray generators in light sources. The physical limitations of these devices limit the intensity and the brilliance of the x-ray beam. At present the undulators are made from permanent magnets. It was shown in earlier papers that at low electron beam intensities superconductive wires in the vacuum beam pipe can overcome the limitations inherent to permanent magnet undulators. It was argued that the use of these novel devices in light sources with high beam currents may be limited by the extreme anomalous skin effect regime in Cu at 4.2 K, which has so far undergone very little investigation, and the power deposited by the infrared part of the synchrotron radiation. The purpose of this paper is to present measurements of these effects at the synchrotron light source ANKA with stored currents up to 200 mA.

Superconductive undulators with a small period length are a novel tool in generating X-ray beams with high brlliance. The concept and the first prototype for a s storage ring was developed for ANKA, a 2.5 GeV synchrotron light source in Karlsruhe, Germany.

African tick bite fever (ATBF) is an infectious disease commonly observed in travelers to sub-Saharan Africa. Because the presentation of the disease is often not specific, ATBF is frequently not diagnosed or confused with Mediterranean spotted fever. We present the case of a 63-year-old woman with typical history and symptoms. The diagnosis of ATBF was serologically confirmed by immunofluoroscence. ATBF is an important differential diagnosis of fever in patients returning from sub-Saharan Africa.

In the treatment of leukemia by stem cell transplantation, the immunological effects of allogeneic T-lymphocytes presumably play a greater part than high-dosage total-body irradiation (TBI) and chemotherapy. Using this immunological effect, attempts are currently being made to reduce the dosage of pre-treatment that is toxic to stem cell, such as TBI, thereby making transplantation available for a larger group of patients at high risk for transplantation. This study presents preliminary results of three current studies of this approach.Elderly patients with chronic myeloid leukemia (CML) have an increased transplantation risk. They were conditioned with TBI that was reduced stepwise (n = 27). Patients with advanced and refractory myeloid leukemia were treated with chemotherapy and dose-reduced TBI (FLAMSA protocol; n = 54). In patients with multiple myeloma, autologous transplantation with high-dose chemotherapy preceded allogeneic transplantation possible after dose-reduced conditioning (Tandem protocol; n = 6).All three protocols of TBI gave results that were not worse than those of previous studies. Relapse ocurred not more frequently in patients with CML. In patients with high-risk AML the FLAMSA protocol gave better results. Autologous-allogeneic tandem transplantation was well tolerated and led to a good response in all patients.Allogeneic transplantation after dose-reduced conditioning opens up new possibilities with respect to widening indications for transplantation and improving results in hematological diseases with previously unsatisfactory treatment.

Objective: To review current knowledge of risk factors associated with schizophrenia and the development of diagnostic markers aimed at the delay or attenuation of the first psychotic episode. Method: Studies relating to the development of disease and the risk factors that could inform predictive markers are reviewed, including high-risk studies, birth-cohort studies, and retrospective and follow-back studies. Results: Future schizophrenic patients present with delayed developmental milestones, speech and behavioural difficulties, and lower IQ scores than non-cases. Conclusion: Results are consistent with the notion that schizophrenia is a developmental disease and that such antecedents are present; further research is required to improve the specificity of diagnostic markers and predictive power before these can be used to prevent or delay psychotic episodes of schizophrenia.

Geoelectrical and seismic methods are probably the best choice in a water exploration in karst areas, which are very difficult environments for any geophysical exploration because of very high surface inhomogeneities.

The study was supposed to develop a method allowing to combine interstitial hyperthermia with high dose rate afterloading therapy. For hyperthermia, metallic hollow needles, which are also used in brachytherapy, are connected with the RF source by a computer-controlled relay switch. The temperature is measured by thermistors incorporated into the needles. Several heating methods are investigated in a homogenous phantom and compared by means of the experimentally determined temperature/time evolutions and isotherms (in a stationary state).

The combination of interstitial radiotherapy and interstitial hyperthermia is more promising in the treatment of tumors than one of these methods alone. The unit developed by us uses the afterloading needles for heating up the tumor tissue with ohm current and for controlling the distribution of temperature in the target volume. Up to twelve needles are provided by one commutator with the R.F. current controlled by the computer. The temperature is measured by three thermistors per needle which are arranged at an axial distance of 2 cm each. The linearization of the thermistor characteristics and the control of cummutator and R.F. generator is performed by the computer over an interface constructed by us. In order to achieve a homogeneous distribution of temperature in the target volume and to avoid hot spots, we have examined several needle configurations by measuring in an homogeneous phantom.

Two newborns with cogestive heart failure due to a congenital arterio-venous fistula involving the great vein of Galen are described. The main diagnostic criteria of this anomaly are a hyperactive heart, bounding carotid artery pulses, and a continuous murmur over the skull. The anomaly was visualized by cerebral angiography. In view of the frequent complications such as the development of hydrocephalus, operative treatment seems indicated.

Interstitial localized current field (LCF) hyperthermia has gained a good reputation as an excellent method for heating localized tumors (Joseph et al. 1981; Manning et al. 1982; Cosset et al. 1984; Goffinet et al. 1985; Vora et al. 1986; Linares et al. 1986; Emami and Perez 1985). Heating is performed by means of ohmic currents flowing through tissue between implanted electrodes. To gain a homogeneous temperature distribution throughout the tumor volume even if perfusion is not uniform it is necessary to continuously measure temperature inside the tumor at many points of interest. Temperature differences can be reduced by altering the specific absorption rate (SAR).