[Epidemiology of chronic hepatitis C in Germany--an analysis of 10,326 patients in hepatitis centres and outpatient units]

Little is known about the epidemiology of chronic hepatitis C (CHC) in Germany and especially about the importance of transmission, duration of infection, genotypes, symptoms and quality of life of the patients. The current study prospectively evaluates epidemiological and clinical data of patients infected with the hepatitis C virus (HCV). Using online data entry, various characteristics of 10,326 untreated patients with CHC were documented from March 2003 until May 2006 in 352 centres all over Germany. Mean age of patients was 43.4 years. Patients infected by i.v. drug abuse were considerably younger (36.5 years) than the remaining patients (49.2 years). As indicated by their native language, 64.4% of the patients came from Germany and 19.2% from Russia. 61.7% were infected with genotype 1 and 34.9% with genotype 2 or 3. 45.5% of the patients had been infected by i.v. drug abuse. In at least 5.4% of the patients liver cirrhosis had been proved by biopsy. 63.5% of the patients felt an impairment of quality of life caused by CHC. In many patients infected with hepatitis C socio-economic issues are existent. This is reflected, i.e., in very high rates of unemployment in special subpopulations. Coinfections with hepatitis B and HIV occurred in 1.5% and 4.7%, respectively. Nearly 80% of patients were managed near their homes. The data of the 10 326 patients represent about 2% of all German patients with CHC. This database is up to now the largest of its kind and gives a representative insight into the epidemiological situation of CHC in Germany.

EPR study of some rare-earth ions (Dy3+, Tb3+, and Nd3+) in YBa2Cu3O6-compound

We investigate the low temperature X-band electron paramagnetic resonance (EPR) of YBa(2)Cu(3)O(x) compounds with x congruent with 6.0 doped with Dy(3+), Tb(3+), and Nd(3). The EPR spectra of Dy(3+) and Tb(3+) have been identified. The EPR of Tb(3+) is used also to study the effect of suppression of high T(c) superconductivity by doping with Tb(3+). The EPR of Nd(3+) is probably masked by the intense resonance of Cu(2+). All experimental EPR results compare well with theoretical estimations.

[Noninvasive cardiac diagnosis for quantifying scarring, ischemia and pump function within the scope of a study. 20 useful facets in routine cardiology nuclear medicine practice]

Myocardial perfusion SPECT (MPS) commonly is interpreted qualitatively and not quantitatively. Most of the prognostic literature is based on a semi-quantitative visual analysis (SQA) of MPS. However, data about the comparison between the SQA and coronary angiography (cath) is lacking. We therefore evaluated 167 patients who underwent MPS and subsequent cath. SQA using a 20 segment model was used for MPS interpretation. Patients with a small to moderate amount of ischemia (SDS < or = 4; mean 1.2 +/- 1.5) and with extensive ischemia (SDS > 4; mean 9.6 +/- 4.7) were then compared with respect to clinical and cath variables. Patients with extensive ischemia had more advanced CAD as demonstrated by several cath variables (more often triple vessel and LAD-disease). SQA therefore is a useful tool for MPS interpretation and decision making in patients with (suspected) CAD.

[Rapidly progressing respiratory insufficiency of uncertain etiology]

In a 59-year-old male patient, chronic dry cough and dyspnoea on exertion preexisting for several years became rapidly progressive within a few weeks prior to hospitalisation. He died one month after admission from respiratory failure. Three months before admission, history, pulmonary function tests, and computed tomography (CT) of the chest revealed no evidence of asthma, COPD, or any other lung disease. Clinical examination showed no clubbing, but end-inspiratory velcro-rales were audible over both lungs. Inhaled steroids and diuretics did not bring clinical amelioration. On admission there were basal consolidations, bronchiectases, and predominant fibrotic changes with honeycombing and subpleural thickening over both lungs, in the absence of any ground-glass pattern in the CT. At the same time lymphocytosis predominated in bronchoalveolar lavage (BAL). The search for pneumonia, viral infection, tumour, vasculitis, or a drug-related disorder remained negative. Pathological examination at autopsy showed nonuniform fibrosing alveolitis.

Neurotoxicity of isolated limb perfusion with tumor necrosis factor

Hyperthermic isolated limb perfusion (HILP) with tumor necrosis factor alpha (TNFalpha) is effective for advanced melanoma and sarcoma of the limbs. Ten patients undergoing HILP with TNFalpha were evaluated by neurological examinations, nerve conduction studies (NCS), sympathetic skin responses (SSR) and conventional and quantitative electromyography (EMG), performed before, 7 days and 6 weeks following HILP. Seven patients showed minimal clinical signs of peripheral nerve damage following HILP; in two the injury was evident electrophysiologically: 7 days following HILP five patients had paresthesias and/or hypoesthesia, one had a mild foot drop and one had autonomic disturbances in the affected limb. SSR was low in two patients in the affected limb, sensory nerve action potentials were not elicited in one, with normal motor NCS and EMG. At 6 weeks, four patients continued to have mild paresthesias and one had dysautonomia of the perfused limb. Sensory responses and SSR did not change, motor abnormalities were not found. These findings show that HILP with TNFalpha induces a mild, mainly sensory neuropathy in perfused limbs, not disturbing functionality and improving over time.

Study on the composition of the volatile fraction of Hamamelis virginiana

The volatile fractions, obtained by water distillation from the leaves and bark of Hamamelis virginiana L. were analysed in detail by GC-MS. About 175 (leaves) and 168 (bark) compounds have been identified or at least partly characterized on the basis of a computerized database (SeKoMS). The dominating substances were represented by a homologous series of alkanes, alkenes, aliphatic alcohols, related aldehydes, ketones, and fatty acid esters. Importantly, significant differences in the terpenoid and phenylpropanoid patterns of the products obtained from the bark and leaves are apparent: whereas the product of bark distillation was found to typically contain phenylpropanoids and mainly sesquiterpenoids, that obtained from the leaves included some distinct monoterpenoids detected in comparably higher amounts. The chemical composition of the volatiles, when taken together with the absence of specific accumulation sites of lipophilics, emphasizes the definition "volatile fraction" rather than "essential oil".

Freedom through a single switch: coping and communicating with artificial ventilation

Challenging clients often stretch the limits of the imagination in terms of developing creative technologies to allow access to computers, communication devices and environmental controls. This paper provides a description of an innovative system that enables clients with motor neurone disease/amyotrophic lateral sclerosis (MND/ALS), on full ventilatory support and virtually no movement, to communicate and manipulate their environments, through the use of a myoelectrically controlled switch.

Histological investigation of walnut cotyledon fragments for a better understanding of in vitro adventitious root initiation

Rapid formation of adventitious roots by walnut cotyledon fragments in vitro was traced by light microscopy. It was shown that this plant model is characterized by two major developmental processes: a) confined elongation of the cotyledon petiole caused by a limited number of cell divisions and b) formation of a morphogenetic zone around each initially wounded vascular bundle within 36 h after detachment of the embryonic axis. During the first phase of development, granular storage protein bodies dissolved, and starch grains were deposited mainly in the distal portion of the cotyledon fragments. Rapidly, new globular protein bodies were formed, and phenolic inclusions accumulated in the vacuoles of epidermal and subepidermal cells and of individual cells close to the vascular bundles. Each adventitious root was found to be in continuity with a single vascular bundle of the cotyledon petiole. A short auxin treatment suppressed the formation of large roots and induced numerous tiny rootlets dispersed all over the surface of the cotyledons.

Glutamate Dehydrogenase Is Not Essential for Glutamate Formation by Corynebacterium glutamicum

Two Corynebacterium glutamicum strains, one being glutamate dehydrogenase (GDH) negative and the other possessing 11-fold-higher specific GDH activity than the parental wild type, were constructed and used to analyze the role of GDH in C. glutamicum . The results indicate (i) that GDH is dispensable for glutamate synthesis required for growth and (ii) that although a high level of GDH increases the intracellular glutamate pool, the level of GDH has no influence on glutamate secretion.

Localization of proanthocyanidins using in situ-hydrolysis with sulfuric acid

A valuable method for specific localization of proanthocyanidins in plant tissues is given. The specificity is based on the acid hydrolysis of condensed tannins in situ via hot sulfuric acid, yielding bright red anthocyanidins. This treatment did not cause noticeable damage of tissue embedded in glycol methacrylate prior to sectioning. Further proof of specificity was achieved by control staining with the flavan-3-ol-selective p-dimethylaminocinnamaldehyde (DMACA) reagent. In addition, comparison of adjacent sections stained with the DMACA reagent may give coarse information about the degree of polymerization of the proanthocyanidins.

Carrier-mediated glutamate secretion by Corynebacterium glutamicum under biotin limitation

Previous studies have demonstrated the involvement of a carrier system in glutamate secretion by Corynebacterium glutamicum under biotin limitation (Hoischen, C. and Krämer, R. (1989) Arch. Microbiol. 151, 342-347). In a detailed analysis of the export process we found secretion to be independent of secondary forces: (i) glutamate was secreted at high rate even when external glutamate exceeded the internal concentration, (ii) movement of neither protons nor potassium or chloride ions was found to be coupled to glutamate secretion, and (iii) secretion continued unaffected after breakdown of the membrane potential. Instead, under conditions leading to variation of glutamate secretion activity, a correlation of secretion rate and the intracellular ATP-pool was observed. Thus, ATP or a related high-energy metabolite is thought to be involved in the activity of the glutamate secretion system.

Physician cancer pain education: a report from the Wisconsin Cancer Pain Initiative

The Wisconsin Cancer Pain Initiative was established in 1986 to address the various public and professional barriers to cancer pain management. This report discusses the initiative's model for physician education, which includes increasing factual knowledge, legitimizing cancer pain as an important treatment priority, and developing clinical role models. Our progress in implementing this education model will be discussed.

Cloning and nucleotide sequence of the structural genes encoding the formate dehydrogenase of Wolinella succinogenes

The formate dehydrogenase of Wolinella succinogenes is a membraneous molybdo-enzyme which is involved in phosphorylative electron transport. The gene (fdhA) encoding the largest subunit was isolated from a gene bank by immunological screening. The fdhA gene was located in an apparent transcriptional unit (fdhA,B,C,D) together with three more structural genes. The N-terminal sequences of three polypeptides present in the isolated enzyme were found to map within the fdhA, B and C structural genes. A polypeptide corresponding to fdhD was not detected in the enzyme preparation. This suggested that the functional formate dehydrogenase was made up of three or four different subunits. The genes fdhA and C encode larger preproteins which differ from the corresponding mature proteins by N-terminal signal peptides. The N-terminal half of the mature FdhA is homologous to the larger subunits of the formate dehydrogenases of E. coli (formate-hydrogenlyase linked) and Methanobacterium formicicum as well as to three bacterial reductases containing molybdenum. It harbours a conserved cysteine cluster and two more domains which may be involved in binding the molybdenum cofactor. FdhB may represent an iron-sulphur protein, twelve cysteine residues of which are arranged in two clusters which are typical of ligands of the iron-sulfur centers in ferredoxins. FdhC is a hydrophobic protein with four predicted transmembrane segments, which appears to be identical with the cytochrome b present in the isolated formate dehydrogenase. It may form the membrane anchor of the enzyme and react with the bacterial menaquinone.

A new method for selective localization of flavan-3-ols in plant tissues involving glycolmethacrylate embedding and microwave irradiation

A method for selective staining of flavan-3-ols in plant tissues fixed with glutaraldehyde is given. The use of glycolmethacrylate as embedding medium allows the sulphuric acid-containing staining solution to be heated without destroying the fine structure of the tissue. The distribution of flavan-3-ols and proanthocyanidins in different plant tissues is discussed.

Psychological support and psychiatric management of patients with automatic implantable cardioverter defibrillators

There are well over 6,000 automatic implantable cardioverter defibrillators (AICD) that have been implanted in the United States since 1980. The device clearly reduces arrhythmic mortality in high risk patients. Many AICD patients have other cardiac diseases, most commonly, coronary artery disease with associated prior myocardial infarctions. These patients have special psychosocial stresses that may make them vulnerable to depression and other psychological disturbances. Psychological support together with psychiatric treatment, if needed, should be provided to these patients. Use of psychotropic medications should be closely monitored, especially in this population, as many of these drugs can exacerbate ventricular tachyarrhythmias. Special precautions should also be taken when administering electroconvulsive therapy in these patients.

[Comparative clinical studies of myocardial blood flow in coronary heart disease with two nifedipine preparations]

Clinical, ergometric and scintigraphic examinations were performed before and after oral administration of a commercially available nifedipine preparation used as a standard (reference preparation; dosage: 3 x 10 mg/d) in 21 patients with angiographically verified coronary artery disease. In an open comparison study the same parameters were investigated after a 4 week course of a different nifedipine preparation as a test preparation (Corotrend; dosage: 3 x 10 mg/d). The study was performed in order to determine whether there were quantitative differences in myocardial microperfusion when different galenical preparations of nifedipine were used. There were no statistically significant differences between the two nifedipine preparations in the test parameters recorded. Both substances were associated with highly significant increases in microperfusion as compared to findings in the washout phase. Clinical effects on incidence of chest pain and on reductions in blood pressure were comparable. Patients demonstrated slightly better exercise tolerance with the reference agent, and computerised impulse-rate analysis of the tomoscintigrams demonstrated somewhat better microperfusion with this drug, though the differences between the two agents did not attain statistical significance. As the result of this analysis the two drugs would appear to be equivalent in clinical potency.

Case review and quantity of outpatient care

Case review for patients belonging to a health maintenance organization was implemented in a hospital-based, multidisciplinary, outpatient clinic after the influx of 28,000 Medicaid enrollees. One-year follow-up of 138 patients with prepaid mental health insurance and 283 patients with fee-for-service mental health insurance revealed an annual mean of 6.1 treatment sessions; 78% completed treatment within eight sessions. The modal treatment was a single visit. Prepaid and fee-for-service patients did not differ in amount of care, although significant differences were found for insurance subgroups. These preliminary results suggest that case review has little effect on quantity of care.

Behavioral medicine programs in teaching hospitals

Behavioral medicine is a relatively new interdisciplinary field which combines biomedical and behavioral science knowledge, and applies them to prevention, diagnosis, treatment and rehabilitation. Behavioral medicine programs provide a valuable service to patients with chronic illness, psychosomatic or functional disorders, treatment noncompliance, and behavioral risk factors. Behavioral medicine faculty are also active in teaching and research on patient behavior, interviewing skills, health promotion and counseling, and management of chronic illnesses. However, the survival of behavioral medicine programs in teaching hospitals depends on their economic viability and academic status. Positive action is needed to ensure their continued growth and development.

Common-sense models of illness: The example of hypertension

Our premise was that actions taken to reduce health risks are guided by the actor's subjective or common-sense constructions of the health threat. We hypothesized that illness threats are represented by their labels and symptoms (their identity), their causes, consequences, and duration. These attributes are represented at two levels: as concrete, immediately perceptible events and as abstract ideas. Both levels guide coping behavior. We interviewed 230 patients about hypertension, presumably an asymptomatic condition. When asked if they could monitor blood pressure changes, 46% of 50 nonhypertensive, clinic control cases said yes, as did 71% of 65 patients new to treatment, 92% of 50 patients in continuing treatment, and 94% of 65 re-entry patients, who had previously quit and returned to treatment. Patients in the continuing treatment group, who believed the treatment had beneficial effects upon their symptoms, reported complying with medication and were more likely to have their blood pressure controlled. Patients new to treatment were likely to drop out of treatment if: they had reported symptoms to the practitioner at the first treatment session, or they construed the disease and treatment to be acute. The data suggest that patients develop implicit models or beliefs about disease threats, which guide their treatment behavior, and that the initially most common model of high blood pressure is based on prior acute, symptomatic conditions.