Differences in polygenic associations with educational attainment between West and East Germany before and after reunification

Here we examine geographical and historical differences in polygenic associations with educational attainment in East and West Germany around reunification. We test this in n = 1902 25-85-year-olds from the German SOEP-G[ene] cohort. We leverage a DNA-based measure of genetic influence, a polygenic index calculated based on a previous genome-wide association study of educational attainment in individuals living in democratic countries. We find that polygenic associations with educational attainment were significantly stronger among East, but not West, Germans after but not before reunification. Negative control analyses of a polygenic index of height with educational attainment and height indicate that this gene-by-environemt interaction is specific to the educational domain. These findings suggest that the shift from an East German state-socialist to a free-market West German system increased the importance of genetic variants previously identified as important for education.

A proof-of-concept study applying machine learning methods to putative risk factors for eating disorders: results from the multi-centre European project on healthy eating

BACKGROUND

Despite a wide range of proposed risk factors and theoretical models, prediction of eating disorder (ED) onset remains poor. This study undertook the first comparison of two machine learning (ML) approaches [penalised logistic regression (LASSO), and prediction rule ensembles (PREs)] to conventional logistic regression (LR) models to enhance prediction of ED onset and differential ED diagnoses from a range of putative risk factors.

METHOD

Data were part of a European Project and comprised 1402 participants, 642 ED patients [52% with anorexia nervosa (AN) and 40% with bulimia nervosa (BN)] and 760 controls. The Cross-Cultural Risk Factor Questionnaire, which assesses retrospectively a range of sociocultural and psychological ED risk factors occurring before the age of 12 years (46 predictors in total), was used.

RESULTS

All three statistical approaches had satisfactory model accuracy, with an average area under the curve (AUC) of 86% for predicting ED onset and 70% for predicting AN v. BN. Predictive performance was greatest for the two regression methods (LR and LASSO), although the PRE technique relied on fewer predictors with comparable accuracy. The individual risk factors differed depending on the outcome classification (EDs v. non-EDs and AN v. BN).

CONCLUSIONS

Even though the conventional LR performed comparably to the ML approaches in terms of predictive accuracy, the ML methods produced more parsimonious predictive models. ML approaches offer a viable way to modify screening practices for ED risk that balance accuracy against participant burden.

Effects of the COVID-19 pandemic on suicide attempts in a rural region in Germany, a 5-year observational study

BACKGROUND

The COVID-19 pandemic and public life restrictions may have a negative impact on people's mental health. Therefore, we analyzed whether this condition affected the occurrence of suicide attempts (SA) over 20 months during the pandemic period.

METHODS

We included patient records according to DSM-5 criteria for suicidal behavior disorders (n = 825) between Jan 1, 2017, and Dec 31, 2021. We applied interrupted time-series Poisson regression models to investigate the effect of the pandemic on SA occurrence, time trends, and seasonal patterns in the whole group of patients as well as stratified by age and gender.

RESULTS

There was no significant effect of the pandemic on the occurrence of SA in the overall group. However, we observed a significant impact of the pandemic on the seasonal pattern of SA, also the variance differed significantly (pre-pandemic mean ± variance: 13.33 ± 15.75, pandemic: mean ± variance: 13.86 ± 7.26), indicating less periodic variation in SA during the pandemic. Male patients and young adults mainly contributed to this overall effect. Subgroup analysis revealed a significant difference in SA trends during the pandemic in older adults (>55 years) compared with younger adults (18-35 years); SA numbers increased in older adults and decreased in younger adults as the pandemic progressed.

LIMITATIONS

A few patients may have received initial care in an emergency department after SA without being referred to psychiatry.

CONCLUSIONS

In general, the COVID-19 pandemic and related measures did not significantly affect the occurrence of SA but did significantly affect the dynamics. In addition, the pandemic appeared to affect suicidal behavior differently across age groups as it progressed. Particularly for the older adult group, negative long-term effects of the pandemic on suicidal behavior can be derived from the present results, indicating the need to strengthen suicide prevention for the elderly.

Exome Sequencing of 5 Families with Severe Early-Onset Periodontitis

Periodontitis is characterized by alveolar bone loss leading to tooth loss. A small proportion of patients develop severe periodontitis at the juvenile or adolescent age without exposure to the main risk factors of the disease. It is considered that these cases carry rare variants with large causal effects, but the specific variants are largely unknown. In this study, we performed exome sequencing of 5 families with children who developed stage IV, grade C, periodontitis between 3 and 18 y of age. In 1 family, we found compound heterozygous variants in the gene CTSC (p.R272H, p.G139R), 1 of which was previously identified in a family with prepubertal periodontitis. Subsequent targeted resequencing of the CTSC gene in 24 patients <25 y of age (stage IV, grade C) identified the known mutation p.I453V (odds ratio = 4.06, 95% CI = 1.6 to 10.3, P = 0.001), which was previously reported to increase the risk for adolescent periodontitis. An affected sibling of another family carried a homozygous deleterious mutation in the gene TUT7 (p.R560Q, CADD score >30 [Combined Annotation Dependent Depletion]), which is implicated in regulation of interleukin 6 expression. Two other affected siblings shared heterozygous deleterious mutations in the interacting genes PADI1 and FLG (both CADD = 36), which contribute to the integrity of the environment-tissue barrier interface. Additionally, we found predicted deleterious mutations in the periodontitis risk genes ABCA1, GLT6D1, and SIGLEC5. We conclude that the CTSC variants p.R272H and p.I453V have different expressivity and diagnostic relevance for prepubertal and adolescent periodontitis, respectively. We propose additional causal variants for early-onset periodontitis, which also locate within genes that carry known susceptibility variants for common forms. However, the genetic architecture of juvenile periodontitis is complex and differs among the affected siblings of the sequenced families.

Restricting evidence syntheses of interventions to English-language publications is a viable methodological shortcut for most medical topics: a systematic review

OBJECTIVES

To assess the impact of restricting systematic reviews of conventional or alternative medical treatments or diagnostic tests to English-language publications.

STUDY DESIGN AND SETTING

We systematically searched MEDLINE (Ovid), the Science Citation Index Expanded (Web of Science), and Current Contents Connect (Web of Science) up to April 24, 2020. Eligible methods studies assessed the impact of restricting systematic reviews to English-language publications on effect estimates and conclusions. Two reviewers independently screened the literature; one investigator performed the data extraction, a second investigator checked for completeness and accuracy. We synthesized the findings narratively.

RESULTS

Eight methods studies (10 publications) met the inclusion criteria; none addressed language restrictions in diagnostic test accuracy reviews. The included studies analyzed nine to 147 meta-analyses and/or systematic reviews. The proportions of non-English-language publications ranged from 2% to 100%. Based on five methods studies, restricting literature searches or inclusion criteria to English-language publications led to a change in statistical significance in 23/259 meta-analyses (9%). Most commonly, the statistical significance was lost, but had no impact on the conclusions of systematic reviews.

CONCLUSION

Restricting systematic reviews to English-language publications appears to have little impact on the effect estimates and conclusions of systematic reviews.

First case of canine visceral leishmaniasis in the midwestern of Santa Catarina State, Brazil

Canine visceral leishmaniasis (CVL) caused by Leishmania (Leishmania) infantum is transmitted by phlebotomine sandflies and a major zoonotic disease in Brazil. Due to the southward expansion of the disease within the country and the central role of dogs as urban reservoirs of the parasite, we have investigated the occurrence of CVL in two municipalities Erval Velho and Herval d'Oeste in the Midwest region of Santa Catarina state. Peripheral blood samples from 126 dogs were collected in both cities and tested for anti-L. infantum antibodies by indirect enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence reaction (IIF) and for the presence of parasite DNA by polymerase chain reaction (PCR) in peripheral blood. From examined dogs, 35.71% (45/126) were positive for at least one of the three tests and two (1.6%) were positive in all performed tests. Twelve dogs (9.5%) were positive for both ELISA and IIF, while 21 dogs were exclusively positive for ELISA (16.7%), and 15 (11.9%) for IIF. L. infantum k-DNA was detected by PCR in 9 out of 126 dogs (7.1%) and clinical symptoms compatible with CVL were observed for 6 dogs. Taken together, these results indicate the transmission of CVL in this region, highlighting the needs for epidemiological surveillance and implementation of control measures for CVL transmission in this region.

Nanojoining with Ni Nanoparticles for Turbine Applications

Thermal joining can lead to high thermal stresses, undesired structural changes, and the associated loss of properties. In the turbine industry, monocrystalline materials are often used to take advantage of their high creep resistance and heat resistance. For process-related reasons, components are mechanically machined, and the contours usually have slightly work-hardened areas due to the mechanical processing. Downstream thermal processes at temperatures above 1100 °C can lead to recrystallization (Rx) at these areas, so that the properties are negatively affected. Usually, the joining temperatures for high-temperature brazing are in the range of 1200 °C, both in new installations and in the case of repairs. It is therefore desirable to reduce the joining temperature without changing the choice of filler material, which can lead to susceptibility to corrosion and oxidation. According to investigations of the last years, nanojoining with nanoparticles offers great potential. The joining temperature can be lowered due to the "surface effect." A considerable reduction in the size of the particles leads to a significant increase in surface atoms and thus in the specific surface area. The connection of the materials occurs predominantly due to sintering processes. After the joining process, the properties of a bulk material are available again. Mechanical properties comparable to those of brazing have already been achieved with silver nanoparticles (Hausner in WWA 56, 2015). Up to now, publications on the topic of nanojoining have largely referred to silver nanoparticles/silver sintering. Due to the temperature application range, silver filler material cannot be used in gas turbines. Therefore, the first results of nickel nanoparticles for joining of the nickel-based superalloy PWA 1483 using induction heating are described in this paper. During joining, the parameters brazing temperature, holding time and the surface treatment of the base materials were varied. It becomes clear that the microstructure of the joint is dependent on temperature and holding time. Moreover, if the temperature is too low and holding time too short, only insufficiently sintering occurs, which leads to sample failure during the metallographic preparation. On the other hand, samples with a tensile shear strength of up to 165 MPa can be achieved with convenient joining conditions.

Clinical utility of skin cancer and melanoma risk scores for population screening: TRoPICS study

BACKGROUND

Screening for skin cancer can be cost-effective if focused on high-risk groups. Risk prediction tools have been developed for keratinocyte cancers and melanoma to optimize advice and management. However, few have been validated in a clinical setting over the past few years.

OBJECTIVES

To assess the clinical utility of risk assessment tools to identify individuals with prevalent skin cancers in a volunteer-based screening clinic.

METHODS

Participants were adults presenting for a skin check at a volunteer-based skin cancer screening facility. We used previously published tools, based on questionnaire responses, to predict melanoma and keratinocyte cancers [KCs; basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)] and classified each participant into one of five risk categories. Participants subsequently underwent a full skin examination by a dermatologist. All suspicious lesions were biopsied, and all cancers were histopathologically confirmed.

RESULTS

Of 789 people who presented to the clinic, 507 (64%) consented to the study. Twenty-two BCCs, 19 SCCs and eight melanomas were diagnosed. The proportion of keratinocyte cancers diagnosed increased according to risk category from <1% in the lowest to 24% in the highest risk category (P < 0.001). Subtype analysis revealed similar proportionate increases in BCC or SCC prevalence according to risk category. However, a similar proportion of melanoma cases were detected in the low-risk and high-risk groups.

CONCLUSION

The risk prediction model for keratinocyte cancers can reliably identify individuals with a significant skin cancer burden prior to a skin examination in the community setting. The prediction tool for melanoma needs to be tested in a larger sample exposed to a wider range of environmental risk factors.

Long-Term Venovenous Connection for Extracorporeal Carbon Dioxide Removal (ECCO2R)-Numerical Investigation of the Connection to the Common Iliac Veins

Purpose

Currently used cannulae for extracorporeal carbon dioxide removal (ECCO₂R) are associated with complications such as thrombosis and distal limb ischemia, especially for long-term use. We hypothesize that the risk of these complications is reducible by attaching hemodynamically optimized grafts to the patient’s vessels. In this study, as a first step towards a long-term stable ECCO₂R connection, we investigated the feasibility of a venovenous connection to the common iliac veins. To ensure its applicability, the drainage of reinfused blood (recirculation) and high wall shear stress (WSS) must be avoided.

Methods

A reference model was selected for computational fluid dynamics, on the basis of the analysis of imaging data. Initially, a sensitivity analysis regarding recirculation was conducted using as variables: blood flow, the distance of drainage and return to the iliocaval junction, as well as the diameter and position of the grafts. Subsequently, the connection was optimized regarding recirculation and the WSS was evaluated. We validated the simulations in a silicone model traversed by dyed fluid.

Results

The simulations were in good agreement with the validation measurements (mean deviation 1.64%). The recirculation ranged from 32.1 to 0%. The maximum WSS did not exceed 5.57 Pa. The position and diameter of the return graft show the highest influence on recirculation. A correlation was ascertained between recirculation and WSS. Overall, an inflow jet directed at a vessel wall entails not only high WSS, but also a flow separation and thereby an increased recirculation. Therefore, return grafts aligned to the vena cava are crucial.

Conclusion

In conclusion, a connection without recirculation could be feasible and therefore provides a promising option for a long-term ECCO₂R connection.

[Pyogenic granuloma with satellitosis]

A 16-year-old female developed a satellite-like recurrence of a pyogenic granuloma on her thorax 2 weeks after complete excision. Treatment with a pulsed dye laser led to a complete resolution. BRAF and RAS mutations detected in the pyogenic granuloma are considered major driver mutations. Whether these findings are also of importance for the etiopathogenesis of satellitosis is unknown. In our patient, no BRAF or NRAS mutation could be detected.

A-51 A Novel Memory Catastrophizing Scale

Objective

A weak relationship exists between subjective memory complaints and performance on objective measures of learning and memory. A memory catastrophizing scale may explain this relationship. Our objective is to preliminarily explore a scale which assesses catastrophizing.

Method

The sample consisted of 46 patients (21 normal profiles, 25 mild cognitive impairment; mean age 56.1 ± 15.4) in a community-based neurology clinic. Each patient completed a clinical interview and comprehensive neuropsychological battery. The California Verbal Learning Test II (CVLT-II) was used to assess memory; the Beck Depression Inventory and Beck Anxiety Inventory were used to assess depressive and anxiety symptoms; a novel Memory Catastrophizing Scale (MCS) was used to assess subjective memory.

Results

A reliability analysis revealed internal consistency throughout the MCS (Cronbach’s alpha = .958). A bivariate correlation revealed that memory catastrophizing was significantly positively correlated with depressive (r = 0.623, p < 0.01) and anxiety (r = 0.433, p < 0.01) symptomology. Bivariate correlations demonstrated significant positive correlations between subjective memory complaints and memory (CVLT-II SDFR r = 0.502, p < .05; SDCR r = 0.434, p = 0.05; LDCR r = 0.512, p < .05) only among NP patients. The mean MCS score was 26 (±17), with a median of 17, a skewness of 0.40 and kurtosis of -0.77.

Conclusion

Our results support past research suggesting that there is a weak relationship between subjective and objective memory performances. Catastrophizing as a concept may explain the relationship between mood and performance on testing, especially amongst individuals without a known neurological pathology seeking treatment at a community-based neurological clinic.

[Segmental neurofibromatosis]

Thirteen years ago, a 48-year-old man developed numerous neurofibromas in a circumscribed area on the right chest. At the same time, a bilateral seminoma was diagnosed and treated curatively. There was no evidence for other complications of neurofibromatosis. The family history was inconspicuous. The segmental neurofibromatosis (SN) presented in this patient is the result of a mosaic formation resulting from a mutation of the NF1 gene, a tumor suppressor gene. Concomitant, typical diseases of neurofibromatosis generalisata (NFG), including malignant neoplasms, are the exception to SN.

[Ear aid in Myanmar]

As the example of a small team working in Myanmar since 2010 has demonstrated, it is possible to achieve sustainable success in medical education and training in foreign countries with relatively little effort, in this case in middle ear surgery. The main requirements are outstanding communication within the team as well as with the authorities, organizations, and colleagues on site. Equally important is mindful and respectful work in the hosting country and the consideration of cultural particularities. Essential contributing factors for long-term success are intercultural exchange, interpersonal relationships, and especially the motivation of colleagues on site, which together create a foundation of trust. This trust combined with regular exchange visits enables constant professional development according to the current needs.

Disturbed glutathione antioxidative defense is associated with structural brain changes in neuroleptic-naïve first-episode psychosis patients

BACKGROUND

Oxidative stress and impaired antioxidant defense are reported in schizophrenia and are thought to be associated with disturbed neurodevelopment, brain structural alterations, glutamatergic imbalance, negative symptomatology, and cognitive impairment. To test some of these assumptions we investigated the glutathione (GSH) antioxidant defense system (AODS) and brain structural abnormalities in drug-naïve individuals with first acute episode of psychosis (FEP).

METHOD

The study involved 27 drug-naïve FEP patients and 31 healthy controls (HC). GSH AODS markers and TBARS (thiobarbituric acid reactive substances) were measured in blood plasma and erythrocytes. High-resolution T₁-weighted 3T MRI were acquired from all subjects. To investigate brain structural abnormalities and effects of illness on interactions between GSH metabolites or enzyme activities and local grey matter density, voxel-based morphometry (VBM) with the computational anatomy toolbox (CAT12) was used. Symptomatology was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Symptom Checklist 1990 revised (SCL-90-R).

RESULTS

(i) In FEP patients, glutathione reductase activity (GSR) was lower than in the HC group. GSR activity in plasma was inversely correlated with SCL-90-R scores of depression and PANSS scores of the negative symptom subscale. (ii) A reduction of GM was observed in left inferior frontal, bilateral temporal, as well as parietal cortices of FEP patients. (iii) Interaction analyses revealed an influence of illness on GSR/GM associations in the left orbitofrontal cortex (BA 47).

CONCLUSION

Our findings support the notion of altered GSH antioxidative defense in untreated acute psychosis as a potential pathomechanism for localized brain structural abnormalities. This pathology relates to a key brain region of social cognition, affective motivation control and decision making, and is clinically accompanied by depressive and negative symptoms.

Purification of Urokinase by a Beta-Naphthamidine Affinity Column

Urokinase was purified by affinity chromatography using 6-amino-naphthamidine-(2), a new specific ligand based on the urokinase inhibitor β-naphthamidine. Urokinase was firmly bound at pH 7.0 and could be eluted at pH 3.0. The protein which passed the column at pH 7.0 without being bound did not contain any urokinase activity. This is an important property because it can be utilized for raising a monospecific urokinase antiserum by absorbing unspecific antibodies with only a minor loss of antiserum titre.

Cornucopia of Structures in the Pseudobinary System (SnSe) xBi2Se3: A Crystal-Chemical Copycat

Pseudobinary phases (SnSe) _xBi₂Se₃ exhibit a very diverse structural chemistry characterized by different building blocks, all of which are cutouts of the NaCl type. For SnSe contents between x = 5 and x = 0.5, several new phases were discovered. Next to, for example, Sn₄Bi₂Se₇ ( x = 4) in the NaCl structure type and SnBi₄Se₇ ( x = 0.5) in the layered defect GeSb₂Te₄ structure type, there are at least four compounds (0.8 ≤ x ≤ 3) with lillianite-like structures built up from distorted NaCl-type slabs (L4,4-type Sn_2.22Bi_2.52Se₆, L4,5-type Sn_9.52Bi_10.96Se₂₆, L4,7-type Sn_11.49Bi_12.39Se₃₀, and L7,7-type Sn_3.6Bi_3.6Se₉). For two of them (L4,7 and L7,7), the cation distributions were determined by resonant X-ray scattering, which also confirmed the presence of significant amounts of cation vacancies. Thermoelectric figures of merit ZT range from 0.04 for Sn₄Bi₂Se₇ to 0.2 for layered SnBi₄Se₇; this is similar to that of the related compounds SnBi₂Te₄ or PbBi₂Te₄. Compounds of the lillianite series exhibit rather low thermal conductivities (∼0.75 W/mK for maximal ZT). More than other "sulfosalts", compounds in the pseudobinary system SnSe-Bi₂Se₃ adapt to changes in the cation-anion ratio by copying structure types of compounds containing lighter or heavier homologues of Sn, Bi, or Se and can incorporate significant amounts of vacancies. Thus, (SnSe) _xBi₂Se₃ is a multipurpose model system with vast possibilities for substitutional and structural modification aiming at the optimization of thermoelectric or other properties.

[Skin cancer screening and treatment costs : Utilisation of the skin cancer screening and skin cancer treatment costs in organ transplant recipients]

BACKGROUND

Organ transplant recipients have an up to 250-times higher risk to develop skin cancer. This article evaluated the utilisation of skin cancer screening and the treatment costs for skin cancer in organ transplant recipients. Patients of the health insurance AOK Bremen/Bremerhaven had been identified and the need for skin cancer prevention trainings was derived.

METHODS

The number of organ transplant recipients (ICD code Z94.0-4) with and without any history of skin cancer (ICD code C43/C44), the utilisation of dermatologic health care services, and the costs for treatments with the diagnosis Z94.0-4 with and without C43/C44 were evaluated. The analyses were carried out for the period from 2009-2014 by using the accounting systems of the AOK.

RESULTS

Between 2009 and 2014, 231 organ transplant recipients had been recorded. By mid-2014, 20% of these insured persons developed skin cancer and the mean incidence was 2.76% per year. On average, 43% of these patients were seen by a dermatologist at least once a year, whereby only 15% of the organ transplant recipients participated in the annual skin cancer screening. In 29% of the patients without any history of skin cancer, a skin examination was never performed by a dermatologist or a general practitioner. In all, 17 inpatient cases of organ transplant recipients with the primary diagnosis C43/C44 were analyzed. This resulted in total costs of 54,707 € (on average about 3200 € per case).

CONCLUSIONS

The increased incidence of skin cancer and the associated treatment costs indicate the need for skin cancer prevention training.

The Design of Quality Control

Quality control of medical data and judgements plays an essential part in the efforts to put medicine on a sounder basis. In the past, control procedures have been neglected because of the bulky work often connected with them; now, however, modern mechanical and electronic equipment opens up the possibility to check thoroughly with a justifiable expenditure of time and effort. Profound checking of the data is especially necessary if statistical analyses are to be carried out, because even extremely sophisticated calculations will in reality be of little value if they rest on uncertain foundations.

Scientific quality control makes use of different methods. Formal errors (e. g., slips of the pen, mistakes in coding, etc.) can often be detected by comparing the data with confidence limits or by testing for incompatibility. Such controls can very well be made by computers. Frequency distributions can occasionally be checked for plausibility. For this sort of control analysis, the probability paper is best suited. The most effective possibility to avoid or to find errors is repeated or multiple examination. Statistical models can be used to estimate the effects of defined errors on the results of an investigation. Possibilities of quality control should already be envisaged in the planning stage of an investigation.

Staging Cancer: TNM Literature 1963—1982

The prognosis of a malignant tumour largely depends on the stage of the disease at the beginning of a specific therapy; statistics of therapy are comparable only if they show the distribution of the cases to the different stages of the disease. Aiming to improve the comparability of the data and findings acquired from the cancer patient, the UICC has, for more than 30 years, been endeavouring to develop uniform rules for acquiring the stage of the disease and the degree of spread with malignant tumours. For this purpose, UICC has developed the TNM system which makes it possible to state accurately and in a reproduceable form the stage of the primary tumour (T) and the regional lymphatic nodes (N) as well as the possible existence of metastases (M). The third edition of the TNM rules appeared in English in 1978, in the following years in numerous other languages. Today the TNM system represents the only basis for the documentation of the cancer stage which has been introduced worldwide. However, it is by no means »complete«; for some forms of cancer proposals for TNM classification are still outstanding (e.g., tumours of the pancreas, the central nervous system, the bones and the soft tissues). Moreover, malignant lymphomas cannot be classified according to the principles of TNM. Here the so-called »Ann Arbor Classification« from the year 1971 is recommended.

The UICC has called upon its national committees to check the classification proposals available so far as to their usefulness and practicability. Corresponding field studies are under way in several countries. This bibliography covers a section of the TNM literature of the last 20 years. From a total number of about 2,000 publications, applying the TNM system, we selected 300 which discuss the system critically and, in most instances, make suggestions for its improvement. The first part of the bibliography contains an alphabetically arranged list of the titles according to authors’ names; the second part differentiates the tumors dealt with by their site.

We thank Mrs. L. Blumenthal, Mrs. I. Schäfer and Mrs. U. Wolber for their cooperation in setting up this bibliography.

Ätiologische upd pathogenetische Untersuchungen beim Lupus vulgaris

Der Lupus vulgaris — die in Mitteleuropa häufigste und soziologisch bedeutsamste Form der Hauttuberkulose — eignet sieh als Modell für ätiologische Untersuchungen insofern besonders gut, weil die Lupuskranken in Deutschland seit 1934 in zentralen Institutionen registriert werden und dadurch nahezu alle Erkrankten in der Population erfaßt und langzeitig beobachtet worden sind. Die Lupuskartei des Landes Schleswig-Holstein überwacht den Krankheitsverlauf der registrierten Kranken seit über 10 Jahren mittels des maschinellen Lochkartenverfahrens. Jeder Patient wird jährlich einmal nachuntersucht; die dabei erhobenen Befunde werden auf Lochkarten übernommen. Die chronologisch geordneten Lochkarten jedes Patienten gestatten einen genauen Uberblick über den individuellen Krankheitsverlauf.

Seitdem man erkannt hat, daß Entstehung und klinische Variabilität des tuberkulösen Geschehens nicht allein durch das bloße Vorliegen von Tuberkelbakterien hinreichend erklärt werden können, hat die Suche nach krankheitsauslösenden und den Krankheitsverlauf beeinflussenden „Mitfaktoren” erneute Aktualität gewonnen. Die eigenen diesbezüglichen Untersuchungen an über 2 000 Lupuskranken haben ergeben, daß als derartige Mitfaktoren neben dem Geschlecht gewisse exogene Momente (wie körperliche Überbeanspruchung, schlechte Ernährung, bestimmte klimatische Bedingungen und soziales Milieu), eine Rolle spielen, dagegen nicht — wie man bisher geglaubt hat — das Lebensalter. Eine vorhergehende Lymphknoten-tuberkulöse fördert ebenfalls die Entstehung eines Lupus vulgaris. Die tuberkulöse Gesamtbelastung des Organismus ist entscheidend für den Verlauf der Hauttuberkulose. Der Lupus vulgaris verkürzt an sich die Lebenserwartung nicht; die Frühsterblichkeit der Lupösen ist allein auf ihre erhöhte Sterblichkeit an Lungentuberkulose zurückzuführen. Mit den bei den internen Organtuberkulosen entwickelten immunpathologischen Vorstellungen allein läßt sich das klinische Phänomen „Lupus vulgaris” nicht ausreichend plausibel erklären.

Über die Selektivität der sog. I-Zahl im „Allgemeinen Krankenblattkopf” und die Brauchbarkeit ihrer einzelnen Komponenten

Die im „Allgemeinen Krankenblattkopf” empfohlene 9 stellige Identifikationszahl (sog. I-Zahl) wurde anhand eines Krankengutes von über 19 000 Patienten der Universitäts-Hautklinik Kiel auf ihre Selektivität hin geprüft. Der methodische Weg der hierfür erforderlichen Materialaufbereitung und -kontrolle wird geschildert. Insgesamt ergaben sich 63/19 378 (= 0.325 %) Doppelbesetzungen, d. h. auf 1000 Patienten kamen rund 3 mal je 2 Personen mit gleicher I-Zahl vor. Die gute Brauchbarkeit der I-Zahl als selektive Patienten-Kennzahl in der Klinik ist damit zahlenmäßig unter Beweis gestellt.

Von den einzelnen Komponenten der I-Zahl ist der Kombinationsschlüssel für die Erfassung von Geschlecht -|- Mehrlingseigenschaft als unvorteilhaft zu bezeichnen, da die zusätzliche Erfassung der Mehrlingseigenschaft nichts zu einer Verbesserung der Selektivität der I-Zahl beiträgt. Eine solche würde erst erreicht, wenn statt der Mehrlingseigenschaft die Geburtsrangfolge registriert würde. Es ist aber fraglich, ob der mit jedem derartigen Kombinationsschlüssel zwangsläufig verbundene Mehraufwand an Arbeit überhaupt lohnt.

Der im „Allgemeinen Krankenblattkopf” empfohlene Namensschlüssel hat sich dagegen sehr bewährt. Sein Anteil an der Gesamtselektivität der I-Zahl ist eine Funktion der Besetzungsstärke der Geburtsjahre, die sich in Form einer Binomial Verteilung darstellen läßt. Diese Formel wird entwickelt und anhand der eigenen Zahlen getestet, wobei sich eine sehr gute Übereinstimmung zwischen Theorie und Praxis ergibt.

Aus Archivierungsgründen wäre es vorzuziehen, die I-Zahl statt mit der Codeziffer für das Geschlecht mit dem Geburtsdatum beginnen zu lassen.

Problems of Medical Diagnosis

The present bibliography aims at informing and stimulating researchers when studying the multiple facets of medical diagnosis. The complexity of investigation in this domain can be judged by the fact that papers dealing with medical diagnosis do not appear in medical journals only. Clearly, medical diagnosis is no longer a strictly medical problem. Mathematical and statistical models and analyses must be created and improved before computer programs for diagnostics can be elaborated.

Der Krankenblattkopf der Heidelberger Kliniken

Aufbauend auf den mit dem »Allgemeinen Krankenblattkopf« gewonnenen Erfahrungen wurde ein modifizierter Krankenblattkopf entwickelt, der seit Januar 1966 bei den Kliniken der Universitäten Heidelberg und Mannheim in Gebrauch ist. — Nach kritischer Stellungnahme zu den Punkten der Originalempfehlung von 1961, die sich nicht bewährt haben, beschreiben Verff. Form und Inhalt der neuen Version sowie die Methodik der Verarbeitung der hierin erfaßten Basisinformationen über den Patienten. Abschließend werden einige Ergänzungs- bzw. Änderungsvorschläge diskutiert, die bei zukünftigen Planungen berücksichtigt werden sollten.

Ergebnisse einer Umfrage zur Zeitschriften-Grundausstättung einer medizinisch en Fakultätsbibliothek

Zur Ermittlung des unbedingt erforderlichen Zeitschriften-Grundstockes für die geplante Medizinische Fakultätsbibliothek an der Universität Heidelberg wurden die Angehörigen des Lehrkörpers gebeten, in einer Liste von 890 verschiedenen Zeitschriftentiteln aus den Bereichen der Medizin ünd der Naturwissenschaften den jeweils für sie persönlich zutreffenden Dringlichkeitsgrad zu vermerken. 92 Dozenten beteiligten sich an der Umfrage; ihre Antworten wurden einem Gewichtungsverfahren unterzogen, das eine objektive Vergleichbarkeit gestattet.

Die Umfrage bestätigte die alte Bibliothekserfahrung, daß nur relativ wenige Zeitschriften sehr häufig, die meisten dagegen relativ selten bzw. nur von einem kleinen Benutzerkreis gelesen werden. Nur 10 (= 1, 1%) der 890 in der Titelliste enthaltenen Periodika wurden von mehr als 50% der Dozenten als »häufig gebraucht« gekennzeichnet. Die Theoretiker scheinen einen wesentlich breiteren Sektor der medizinischen und naturwissenschaftlichen Fachliteratur zu lesen als die Kliniker; sie gaben fast doppelt so viele Titel als »dringend benötigt« an wie letztere. Bei den Klinikern wurden deutschsprachige Fachzeitschriften am häufigsten gewünscht; bei den Theoretikern überwiegen die englischsprachigen Periodika. Zeitschriften in anderen Sprachen spielen nur eine untergeordnete Rolle.

Die 50 am häufigsten gelesenen Zeitschriften sowie die jeweils 3 am höchsten bewerteten Fachblätter in 64 unterschiedenen Spezialgebieten werden mitgeteilt.

A Stochastic Model for the Inheritance of the Cancer Proneness Phenotype

A continuous parameter, stationary Gaussian process is introduced as a first approach to the probabilistic representation of the phenotype inheritance process. With some specific assumptions about the components of the covariance function, it may describe the temporal behaviour of the “cancer-proneness phenotype” (CPF) as a quantitative continuous trait. Upcrossing a fixed level (“threshold”) u and reaching level zero are the extremes of the Gaussian process considered; it is assumed that they might be interpreted as the transformation of CPF into a “neoplastic disease phenotype” or as the non-proneness to cancer, respectively.

Patient Scheduling — (Bibliography)

The entire field of information processing in medicine is today already spread out and branched to such an extent that it is no longer possible to set up a survey on relevant literature as a whole. But even in narrow parts of medical informatics it is hardly possible for the individual scientist to keep up to date with new literature. Strictly defined special bibliographies on certain topics are most helpful.

In our days, problems of optimal patient scheduling and exploitation of resources are gaining more and more importance. Scientists are working on the solution of these problems in many places.

The bibliography on »Patient Scheduling« presented here contains but a few basic theoretical papers on the problem of waiting queues which are of importance in the area of medical care. Most of the papers cited are concerned with practical approaches to a solution and describe current systems in medicine.

In listing the literature, we were assisted by Mrs. Wieland, Mr. Dusberger and Mr. Henn, in data acquisition and computer handling by Mrs. Gieß and Mr. Schlaefer. We wish to thank all those mentioned for their assistance.

The Process of Medical Diagnosis: Routes of Mathematical Investigations

This paper is an analysis of the most important mathematical aspects of medical diagnosis: logical probability, rationality and decision theory, gambling models, pattern analysis, hazy and fuzzy subsets theory and, finally, the stochastic inquiry process.

The Collection and Processing of Medical History Data

A Bibliography of Manual, Automated, and Computer-Processed Techniques E. R. McLean, Stefanie Y. Foote, G. Wagnek

The taking of a patient’s history, which has always played a central part in the practice of medicine, is one of the physician’s most time—consuming activities. As a consequence, the resultant history occasionally suffers from this time pressure and is not as complete and thorough as it might be. Over the years, a number of techniques have been developed to aid the physician in this task. The first attempt at systematizing medical history taking dates back to Martinet in 1825. In the most simple approach, the doctor collects the history data by interviewing the patient himself; alternatively, he can use the assistance of a resident, nurse, or other assistant. After the Second World War, attempts were made to improve the process by means of pencil-and-paper questionnaires. These were filled out by the patient and then reviewed by the physician upon completion.

With the advent of the computer, it has become possible to key-punch or optically scan these question-naires; and then, using batch processing, to provide the examining doctor with a computer-summarized report. By making use of remote terminals, patients can be interviewed by means of conversational, interactive computer programs which both ask questions and records responses. These time-shared systems, while the ijiost costly and complex, offer the greatest potential for multi-level branching and comprehensive questioning.

Since this aspect of the delivery of medical care is still in the developmental stage, a number of approaches are being tried, each with respective strengths and weaknesses. The accompanying biblio-graphy, comprising 720 citations, offers a comprehensive review of these techniques. It is a combination of two distinct research efforts: one, compiled by G. Wagner and B. Schwan, Heidelberg, in 19(39 and published in Anamnese, Hans-J. Heite (Ed.), F. Κ. Schattauer Verlag, Stuttgart 1971; and the other compiled by Ε. R. McLean and S. V. Foote in 1974 at the Center for Information Studies, Graduate School of Management, University of California, Los Angeles. This composite bibliography mainly restricts itself to the literature of the last 30 years. References to older literature can be taken from standard works, such as G. Grund and E. Stevenson.

Computer-assisted Writing of Medical Reports — A Bibliography

Since the middle of the sixties, the possibilities of electronic data processing have been used to an increasing extent not only for internal communication in the hospital itself but also for external communication between hospital, medical practitioners, health offices etc. The problems arising when writing a medical report or an epicrisis are very similar so that we considered both aspects of the problem of automating the setting up of reports in this bibliography.

We are not conceited enough to believe that we have covered all relevant papers concerning this widely dispersed subject. Surely, however, this bibliography will offer a good approach to special studies. We should appreciate advice about missing references.

Screening for Cancer: Publications 1971—1980

The number of publications dealing with different aspects of the problems of screening for cancer is growing so fast that only very few specialists can have a complete knowledge of the literature in this domain. For this reason, we are restricting our compilation to relevant publications from 1971—1980. We deliberately omitted short notes, abstracts, editorials, technical reports, letters to the editor as well as papers written in a language with restricted circulation (e. g. Russian and Japanese). Nevertheless, the bibliography includes almost 1,200 titles.

As D. M. Eddy noticed in 1980, the screening problem resembles many other problems in medicine: it is important, it is urgent, but it is also very complicated. We experienced this complexity when trying to fit the many aspects of our topic into a classification. This finally took the following shape:

KRAZTUR — A Generator for Medical Documentation and Information Systems

KRAZTUR, a generator for the generation of programs or systems for clinical documentation and data processing, is described in its essential functions.

Beitrag zur Datenverarbeitung in der Anaesthesiologie

Die Arbeit stellt einen in praxi bewährten Narkose-Dokumentationsbogen vor, der dazu dienen soll, den Betriebsablauf einer Anaesthesie-Abteilung und ihre Inanspruchnahme in verschiedenen medizinischen Fachbereichen zu erfassen, über die Angemessenheit der angewendeten Narkosetechnik und Allgemeinbehandlung und ihre Beziehungen zum Risiko des Patienten und zur Komplikationshäufigkeit während der Narkose Auskunft zu geben sowie Zusammenhangsfragen zwischen Narkosetechnik, Narkotika und Komplikationen zu untersuchen. Dabei wird auch das Problem einer sinnvollen Datenreduktion unter dem Aspekt einer zweckmäßigen Tabellenauswahl für Ort und Art des operativen Eingriffs, Narkotika und Komplikationen während der Narkose diskutiert.

VARTAB — A System to create VARiable TABulations without any Knowledge in Programming

Also in the field of medicine the computer is used increasingly for statistical evaluation of data. Unfortunately, the physician ▪— unlike the natural scientist — is, as a rule, not yet able to write himself the programs for the processing of his own data. This situation, on the one hand, frustrates the medical scientist, and, on the other hand, burdens the official programmers, who are expected to help the doctor.

The steadily growing number of requests for programming support led us to develop a variable tabulation program (VARTAB) the rules of which are so simple that they can be learned in very short time also by physicians who have no programming knowledge at all. The VARTAB system consists of two parts: 1. a data-standardizing conversion program STAND and 2. the tabulation outprint program TABOUT. The concepts of both programs, the work to be done by the user and the potential and the restrictions of the system are discussed in detail.

Time Course of ECG Depolarization and Repolarization Changes during Ischemia in PTCA Recordings

Objectives: In this work we studied the temporal evolution of changes in the electrocardiogram (ECG) as a consequence of the induced ischemia during prolonged coronary angioplasty, comparing the time course of indexes reflecting depolarization and those reflecting repolarization.

Methods: We considered both local (measured at specific points of the ECG) and global (obtained from the Karhunen-Loève transform) indexes. In particular, the evolution of Q, R and S wave amplitudes during ischemia was analyzed with respect to classical indexes such as ST level. As a measurement of sensitivity we used an Ischemic Changes Sensor (ICS), which reflects the capacity of an index to detect changes in the ECG.

Results: The results showed that, in leads with low-amplitude ST-T complexes, the S wave amplitude was more sensitive in detecting ischemia than was the commonly used index ST60. It was found that in such leads the S wave amplitude initially exhibited a delayed response to ischemia when compared to ST60, but its performance was better from the second minute of occlusion. The global indexes describing the ST-T complex were, in terms of the ICS, superior to the S wave amplitude for ischemia detection.

Conclusions: Ischemic ECG changes occur both at repolarization and depolarization, with alterations in the depolarization period appearing later in time. Local indexes are less sensitive to ischemia than global ones.

99Mo-markiertes Natriummolybdat — Herstellung und Eigenschaften sowie Verhalten im menschlichen Körper

Trägerfreies 99Mo (Halbwertzeit 67 h) läßt sich aus den Spaltprodukten bei Bestrahlung von Uran mit thermischen Neutronen gewinnen. Etwa 45 h nach seiner radiochemischen Aufarbeitung steht 99Mo im Gleichgewicht mit dem Tochterprodukt 99mTc (Halbwertzeit 6 h). Nach intravenöser Injektion eines derartigen Molybdat-Technetat-Gemisches wird 99Mo sehr rasch und in hohem Grad in der Leber angereichert und ermöglicht deshalb eine szintigraphische Darstellung dieses Organs, während 99mTc vorwiegend von Schilddrüse, Magen und Speicheldrüsen aufgenommen wird. Da die Strahlung von 99Mo zum Nachweis weit weniger geeignet ist als die von 99mTc, wird 99Mo zweckmäßig über das Tochterprodukt gemessen, das beim Zerfall von 99Mo in der Leber gebildet wird und offenbar liegenbleibt. Entsprechend dem „Wachsen” von 99mTc in der Leber ist der optimale Zeitpunkt für die Szintigraphie etwa 24 h p.i. Die Strahlenbelastung beträgt für die Leber als kritisches Organ etwa 5 rad pro 100 µC injizierter 99Mo-Aktivität.

Nach unseren Untersuchungen können wir die Eignung von 99Mo Molybdat zur Leberszintigraphie auf Grund seiner Eigenschaften und seines Verhaltens im menschlichen Körper bestätigen.

[Pilomatrixoma in a tattoo]

A 31-year-old man developed a fast-growing tumor on the right upper arm within a black tattoo, which could be classified histologically as pilomatrixoma. While the age of the patient and the rapid growth of the tumor cannot be regarded as typical findings of pilomatrixomas, the localization on the upper arm is one of their predilection points. Despite the wide spread use of tattoos in the last few decades, tumor development in tattooed skin is rarely reported. It is still controversial whether the ingredients of the tattoo agents can be responsible for tumor induction.

Common and distinct patterns of grey-matter volume alteration in major depression and bipolar disorder: evidence from voxel-based meta-analysis

Finding robust brain substrates of mood disorders is an important target for research. The degree to which major depression (MDD) and bipolar disorder (BD) are associated with common and/or distinct patterns of volumetric changes is nevertheless unclear. Furthermore, the extant literature is heterogeneous with respect to the nature of these changes. We report a meta-analysis of voxel-based morphometry (VBM) studies in MDD and BD. We identified studies published up to January 2015 that compared grey matter in MDD (50 data sets including 4101 individuals) and BD (36 data sets including 2407 individuals) using whole-brain VBM. We used statistical maps from the studies included where available and reported peak coordinates otherwise. Group comparisons and conjunction analyses identified regions in which the disorders showed common and distinct patterns of volumetric alteration. Both disorders were associated with lower grey-matter volume relative to healthy individuals in a number of areas. Conjunction analysis showed smaller volumes in both disorders in clusters in the dorsomedial and ventromedial prefrontal cortex, including the anterior cingulate cortex and bilateral insula. Group comparisons indicated that findings of smaller grey-matter volumes relative to controls in the right dorsolateral prefrontal cortex and left hippocampus, along with cerebellar, temporal and parietal regions were more substantial in major depression. These results suggest that MDD and BD are characterised by both common and distinct patterns of grey-matter volume changes. This combination of differences and similarities has the potential to inform the development of diagnostic biomarkers for these conditions.