[Patterns of care of patients with localized prostate cancer in Germany: a health care study with focus on active surveillance]. / Die Versorgung von Patienten mit lokal begrenztem Prostatakarzinom in Deutschland : Active-Surveillance-Ergebnisse einer nicht-interventionellen Versorgungsstudie.

BACKGROUND: To date, evidence on active surveillance (AS) is restricted to protocol-based studies and the current practice pattern outside medical centers is unknown. OBJECTIVES: The goal of this work was to capture the current treatment pattern of AS for localized prostate cancer (PCa) in patients managed by office-based urologists in Germany. MATERIALS AND METHODS: Our cohort consisted of 361 patients included in the AS arm of the HAROW (Hormonal Treatment, Active Surveillance, Radiation Therapy, OP, Watchful Waiting) study, an observational health service study in Germany. Descriptive characteristics and active-treatment-free survival (ATFS), surgical outcomes, and triggers for active treatment were assessed. RESULTS: Currently, only 15% of all patients with localized PCa were treated with AS. At baseline, 83% and 58% of all AS patients met the Chism and PRIAS low-risk criteria, respectively. After a median follow-up of 24 months, no systemic progression was observed, 5 patients died of non-disease-specific causes and active treatment was delivered in 20.5% of all patients. Triggers for active therapy were progression at biopsy (42%), rise in prostate-specific antigen level (27%), medical advice (16%) and patient's preference (10%), respectively. CONCLUSION: Our short-term results indicate that - in the hands of office-based urologists - active surveillance might represent a feasible treatment option for patients with localized PCa. The majority of patients were free of active treatment 2 years after AS initiation. Generally accepted inclusion and progression criteria are lacking and should be developed in order to facilitate and standardize AS in patients with low-risk PCa.

[Robot-assisted laparoscopic pyeloplasty in adults: Excellent long-term results of primary pyeloplasty]. / Roboterassistierte laparoskopische Pyeloplastik bei Erwachsenen : Exzellente Langzeitergebnisse der primären Pyeloplastik.

PURPOSE: With the development of the robot-assisted surgical technique, robot-assisted pyeloplasty (RAP) has become established as an alternative to open and laparoscopic surgery. Currently there are only a few single-center studies with larger numbers of cases and long-term results. The aim of this study was to investigate perioperative and long-term postoperative success rates of Anderson-Hynes robot-assisted pyeloplasty (RAP) at a single center. MATERIALS AND METHODS: We retrospectively reviewed our RAP experience of 61 patients performed by two surgeons between 2004 and 2013 regarding operating time, length of hospital stay, perioperative complication, and success. Overall success was measured in terms of necessary redo pyeloplasty. We also identified patients with temporary stent placement due to symptomatic hydronephrosis or with further obstruction in diuretic renography. RESULTS: Median age, operating time, and follow-up were 33 years, 195 min, and 64 months, respectively. No conversion to open procedure was necessary. The success rate was 98% (n=60) with 1 patient undergoing open redo pyeloplasty due to a recurrent stenosis. Temporary stent placement was required in 3 patients due to pyelonephritis and dilatation. CONCLUSION: Satisfying long-term success rates including low complication rates of RAP were obtained in this study. RAP presents a safe and standardized procedure for symptomatic ureteropelvic junction obstruction.

Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment.

BACKGROUND: Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status. METHODS: We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes. RESULTS: In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively. CONCLUSIONS: Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis.

[PSA screening 2013: background and perspectives]. / PSA-Screening 2013: Hintergründe und Aussichten.

In the healthcare political discussions on treatment measures, the controversy over prostate-specific antigen (PSA) screening has taken a leading role in comparison to, for example the relatively undisputed role of breast and colon screening. This has fortunately led to an in-depth critical analysis of the available data. One advantage is the benefit on survival which increases with longer follow-up observation times. When carrying out studies the quantitative extent of this benefit can become obscured by prescreening, prevalent screening, lack of compliance, contamination and healthy screen bias. Nevertheless, the European randomized screening study of prostate cancer (ERSPC) study, for example, showed sufficient statistical power to confirm a screening benefit after 9 or 11 years (evidence level A). However, even for prostate cancer the internal problems of preventive medicine of overdiagnosis and overtherapy are also partially dependent on the age range of the screening population and the screening frequency (28-52%). Unnecessary deficits in the quality of life reduce the benefit of survival in these patients. By using a PSA fine tuning and risk stratification, approximately one third of diagnoses and therapies can be avoided. Additionally, the active surveillance of tumors unsuitable for treatment together with an improved quality of therapy should become of greater importance.

Somatostatin-based radiopeptide therapy with [177Lu-DOTA]-TOC versus [90Y-DOTA]-TOC in neuroendocrine tumours.

PURPOSE: Somatostatin-based radiopeptide treatment is generally performed using the ß-emitting radionuclides (90)Y or (177)Lu. The present study aimed at comparing benefits and harms of both therapeutic approaches. METHODS: In a comparative cohort study, patients with advanced neuroendocrine tumours underwent repeated cycles of [(90)Y-DOTA]-TOC or [(177)Lu-DOTA]-TOC until progression of disease or permanent adverse events. Multivariable Cox regression and competing risks regression were employed to examine predictors of survival and adverse events for both treatment groups. RESULTS: Overall, 910 patients underwent 1,804 cycles of [(90)Y-DOTA]-TOC and 141 patients underwent 259 cycles of [(177)Lu-DOTA]-TOC. The median survival after [(177)Lu-DOTA]-TOC and after [(90)Y-DOTA]-TOC was comparable (45.5 months versus 35.9 months, hazard ratio 0.91, 95% confidence interval 0.63-1.30, p = 0.49). Subgroup analyses revealed a significantly longer survival for [(177)Lu-DOTA]-TOC over [(90)Y-DOTA]-TOC in patients with low tumour uptake, solitary lesions and extra-hepatic lesions. The rate of severe transient haematotoxicities was lower after [(177)Lu-DOTA]-TOC treatment (1.4 vs 10.1%, p = 0.001), while the rate of severe permanent renal toxicities was similar in both treatment groups (9.2 vs 7.8%, p = 0.32). CONCLUSION: The present results revealed no difference in median overall survival after [(177)Lu-DOTA]-TOC and [(90)Y-DOTA]-TOC. Furthermore, [(177)Lu-DOTA]-TOC was less haematotoxic than [(90)Y-DOTA]-TOC.

Is γ-ray emission from novae affected by interference effects in the 18F(p,α)15O reaction?

The (18)F(p,α)(15)O reaction rate is crucial for constraining model predictions of the γ-ray observable radioisotope (18)F produced in novae. The determination of this rate is challenging due to particular features of the level scheme of the compound nucleus, (19)Ne, which result in interference effects potentially playing a significant role. The dominant uncertainty in this rate arises from interference between J(π)=3/2(+) states near the proton threshold (S(p)=6.411 MeV) and a broad J(π)=3/2(+) state at 665 keV above threshold. This unknown interference term results in up to a factor of 40 uncertainty in the astrophysical S-factor at nova temperatures. Here we report a new measurement of states in this energy region using the (19)F((3)He,t)(19)Ne reaction. In stark contrast to previous assumptions we find at least 3 resonances between the proton threshold and E(cm)=50 keV, all with different angular distributions. None of these are consistent with J(π)=3/2(+) angular distributions. We find that the main uncertainty now arises from the unknown proton width of the 48 keV resonance, not from possible interference effects. Hydrodynamic nova model calculations performed indicate that this unknown width affects (18)F production by at least a factor of two in the model considered.

Conditions of practice in perceptual skill learning.

This study uses three experiments with different kinds of training conditions to investigate the "easy-to-hard" principle, context interference conditions, and feedback effects for learning anticipatory skills in badminton. Experiment 1 (N = 60) showed that a training program that gradually increases the difficulty level has no advantage over the randomized variant. Experiment 2 (N = 60) pointed out that when comparing the blocked (lateral before depth dimension) perceptual training group with the random perceptual training group a significant advantage for the random group was found in the retention test (depth error). Experiment 3 (N = 40) demonstrated that training with reduced feedback (66 %) is no more effective than 100% feedback training in a group of novice performers.

Continuous telemetric monitoring of fetal oxygen partial pressure during labor.

INTRODUCTION: Upright or ambulatory birth positions are favorable for fetal oxygenation. Studies of fetal oxygenation with regard to maternal position require free maternal mobility. Therefore, telemetry for a fetal sensor for such investigations is a pre-requisite. Telemetry-if technically feasible-could enable monitoring of fetal oxygen partial pressure using an existing sensor without restricting the mobility of the parturient woman. We have developed a telemetry system for use with a fetal transcutaneous partial oxygen pressure sensor (ttcpO(2)) and have studied effects of maternal position and position changes during normal labor. MATERIALS AND METHODS: The monitoring system consists of three parts: the telemetry unit with the ttcpO(2) sensor to transmit the tcpO(2) and the heating output telemetrically, a modified CTG monitor and a personal computer storing the measurements. All data were plotted on the CTG recording paper and fed into a new purpose-designed software, displaying fetal heart rate, the uterine contraction intensity, ttcpO(2) and the heating output. Three laboring women, randomly and successively adopting "classical birth positions" (supine or side positions), sitting or vertical or walking position, were studied. RESULTS: Fetal heart rate, uterine contractions, ttcpO(2) and heating output are influenced by the birth positions and by changes of the birth position. In the classical supine and side position there seemed to be lower fetal oxygenation. Sitting, standing and especially walking were more favorable. DISCUSSION: Telemetry is useful to study a possible clinical benefit of individual birth positions.

The impact of different intensities of regular donor plasmapheresis on humoral and cellular immunity, red cell and iron metabolism, and cardiovascular risk markers.

BACKGROUND AND OBJECTIVES: Major studies are still lacking on the impact of differing intensities of long-term donor plasmapheresis, not only on total serum protein, albumin and immunoglobulin G (IgG), but also on humoral and cellular immunity, red cell and iron metabolism, and biochemical cardiovascular risk markers. MATERIALS AND METHODS: Three groups of donors, comprising 483 individuals undergoing differing intensities of long-term serial plasmapheresis, were entered into a cross-sectional study. A fourth control group consisted of 100 non-donors. In addition to measuring total protein, albumin and IgG levels, we determined parameters of humoral and cellular immunity, red cell and iron metabolism and recognized biochemical cardiovascular risk factors. RESULTS: The median annual net amount of plasma donated by the three donor groups was 37, 16 and 10 l, respectively (P < 0.0001). Donors had significantly lower total serum protein, albumin and IgG levels than non-donors (P < 0.0001), but the intensity of plasmapheresis had no influence on those parameters. Like non-donors, all plasma donors had normal humoral and cellular immunity. No increased rates of iron store depletion were observed in the three groups of plasma donors. Plasma donors were not at increased cardiovascular risk. CONCLUSIONS: Regular donor plasmapheresis of up to 45 l of plasma per year appears to be as safe as more moderate plasmapheresis programmes, with respect to the parameters analysed in this study. Individuals donating under these conditions did not develop impaired humoral and cellular immunity, iron store depletion, or increased cardiovascular risk with regard to established biochemical risk markers. Prospective studies are required to determine more exactly than in retrospective analyses the reasons why donors withdraw from plasmapheresis programmes.

Comparison of different cardiac markers in monitoring percutaneous coronary interventions with frequent use of stents and gpIIbIIIa-antagonists.

Studies from the early 1990s found elevations of creatine kinase (CK) and its isoform CK-MB in 5-30% of patients after PCI, indicating minor myocardial damage. Less is known about the influence of modern improved PCI-techniques on the frequency of elevated cardiac markers and the correlation between different commonly used markers, especially cardiac troponins. From 1997 to 2001, 1486 patients undergoing PCI during the regular working hours were included in the prospective "Ludwigshafen Infarctlet Registry". Myocardial infarction in the past 48 hours was an exclusion criterion. Clinical and procedural data were documented. Follow-up data were obtained from discharge up to one year. PCI-related elevations of troponin T were found in 18%, of total-CK in 11%, of CK-MB in 33% and of myoglobin in 23% of cases. The correlation between the different markers was poor. Compared with troponin T, other markers showed low sensitivity (total-CK 58%, CK-MB 27%, myoglobin 22%) and, especially total-CK, low specificity. Stenting, side branch occlusion or major dissection, complex lesion morphology, gpIIbIIIa-antagonist application, proximal stenosis and unstable angina were independent predictors of an elevated troponin T in multivariate analysis. Due to this weak correlation between more specific and sensitive troponins and the other markers, troponins are preferred in monitoring after PCI. In addition to lesion characteristics, particularly stenting is associated with an increased rate of elevated troponin.

[Diagnosis of chronic prostatitis: 4 or 2 glass sample?]. / Diagnostik bei der chronischen Prostatitis: 4- oder 2-Gläserprobe?

Chronic pelvic pain syndrome is still an important clinical problem. The NIH-prostatitis classification introduced 1998 for diagnosis and treatment measures is based on extended microbiological analysis of urine, expressed prostate secretion (4-glass test), and ejaculate. We investigated if a simple urine analysis of an urine sample before and after prostatic massage (2-glass test) could replace the 4-glass test. 143 patients with the diagnosis chronic prostatitis were included in this prospective study. The results showed that the expensive and time consuming 4-glass test can be replaced by a simple 2-glass test. Extended examinations should only be performed in special cases.

[Four-glass or two glass test for chronic prostatitis]. / 4- oder 2-Gläserprobe bei der chronischen Prostatitis?

Chronic pelvic pain syndrome is still an important clinical problem. The NIH prostatitis classification introduced in 1998 for diagnosis and treatment measures is based on extended microbiological analysis of urine and expressed prostate secretion (4-glass test). In 1997 J.C. Nickel proved that the culture and microscopic examination of urine before and after prostatic massage leads to the same results as the 4-glass test. In our prospective study on 143 patients with a diagnosis of chronic prostatitis, we analyzed this statement and came to the same results. We therefore recommend replacing the expensive and time-consuming 4-glass test by a simple preprostatic and postprostatic massage urine culture. Further examinations should only be performed in special cases.

Measurement of antithrombin activity by thrombin-based and by factor Xa-based chromogenic substrate assays.

Functionally active antithrombin can be quantified by chromogenic substrate assays utilizing the heparin cofactor activity of antithrombin and the inhibition rates of thrombin or of activated factor X (FXa). Thrombin-based assays but not FXa-based assays may overestimate the antithrombin activity due to their sensitivity toward heparin cofactor II. We focused on the question whether an overestimation of antithrombin activity by thrombin-based assays involves the risk of misdiagnosing antithrombin-deficient individuals as being non-deficient. We determined antithrombin using two thrombin-based assays and one FXa-based assay in 27 plasma samples from patients with acquired antithrombin deficiency spiked with lepirudin, in antithrombin-deficient plasma and in mixtures of antithrombin-deficient plasma and normal plasma. We also measured antithrombin in healthy subjects, in patients with inherited and acquired antithrombin deficiency and in patients under high-dose heparin treatment. At therapeutic final concentrations of lepirudin, antithrombin activities were considerably overestimated by the thrombin-based assays but not by the FXa-based assay. The residual antithrombin activities in antithrombin-deficient plasma determined by the thrombin-based assays were markedly higher than the corresponding values obtained with the FXa-based assay. The thrombin-based assays also overestimated antithrombin activity in patients under high-dose heparin. However, the degree of overestimation in the range between 50 and 100 IU/dl was too low to misidentify individuals with inherited or acquired antithrombin deficiency as normal. We conclude that functionally active antithrombin can be reliably determined using FXa-based chromogenic substrate assays in all settings examined. Thrombin-based assays must not be used in patients under treatment with hirudin or other direct thrombin inhibitors.

Urinalysis with the new fully automated analyzer Supertron.

Supertron is a new fully automated urinalysis system which provides semi-quantitative results for erythrocytes, leukocytes, glucose, protein, urobilinogen, bilirubin, nitrite, ketone bodies, pH and specific gravity at a maximum throughput of 300 test strips per hour. Processing is fully automated starting from sample selection to test strip dipping and photometric measurement of the reagent field. In addition, results can be transmitted automatically to the integrated printer and/or host computer as needed. Within-run precision is good. The results of repeated measurements (n = 20) of most analytes fell in the same concentration block. Only one of three urine pools for erythrocytes, nitrite, ketone bodies, pH and specific gravity gave results which overlapped two neighbouring blocks. A comparison of the ten test strip analytes between Supertron and Miditron revealed a concordance of 96 to 100% in 390 urine specimens. A comparison of erythrocytes and leukocytes vs. the counting chamber method showed a concordance of 86 to 98% in 239 urine specimens. Also tested in detail were the stability of the test strips over 24 hours in Supertron's sorter drum and how well the integrated mixing rod was capable of mixing the urine specimens. Both were found to be good. The test strip stability exceeds the 10 h stability guaranteed by the manufacturer, and no differences were found after urine samples were left for 60 minutes on the tray.

Optical Characterization in Microelectronics Manufacturing.

To successfully construct semiconductor devices, the semiconductor industry must measure fundamental material parameters, especially when developing new materials; measure the quality of the material as it is grown; accurately determine the details of thin films, quantum wells, and other microstructures that control or affect device performance; and measure properties of the devices themselves. Properties that need to be determined, therefore, include basic band structure and transport parameters, such as energy gap values and carrier scattering times; the presence and concentration of impurities and defects; alloy parameters; layer thicknesses; the distribution of materials in complex structures; and many others. This process of determining a wide range of material, structural, and device parameters is called characterization. The semiconductor industry uses many characterization methods which draw on electrical, chemical, and other approaches. Among these, optical characterization techniques, defined as those using electromagnetic radiation from the ultraviolet to the far infrared, stand out because they arc nondestructive and require minimal sample preparation since no contacts arc needed. These features arc of great importance for production use or to examine finished devices. Another benefit is that, unlike electrical methods which require fixed contacts, optical techniques can give two- or three-dimensional maps of properties over the extent of a semiconductor wafer. The six techniques described in this paper (cllipsometry, infrared spectroscopy, microscopy, modulation spectroscopy, photolumincscence, and Raman scattering) were chosen because they are currently or potentially widely used in the industry; they measure a broad array of semiconductor parameters; and they operate in different regions of the electromagnetic spectrum. The discussion of each technique indicates the basic semiconductor quantities measured, gives the scientific basis of the technique, and indicates how the measurement is made. Illustrative examples from the literature are discussed in detail, showing applications to important semiconductor materials. More information can be obtained from the detailed list of references included.

Development and evaluation of a reagent carrier with a new reaction sequence for the determination of creatinine in blood, plasma, serum and urine.

After a short outline of the history of creatinine determination methods we describe the development of a dry-reagent-carrier system for the reflometric determination of the creatinine concentration in blood, plasma, serum and urine (Reflotron Creatinine (new)). The method is based on a sequence of enzymatically catalyzed reactions producing H2O2, but which in contrast to the previously used procedure do not lead to the formation of creatine as an intermediate. Hence, pretreatment of sample material to eliminate endogenous creatine is no longer necessary. In the indicator reaction, use is made of an imidazole derivative as the chromogen. The dye formed in the presence of peroxidase can be measured by reflectance photometry beyond the long-wave absorption bands of haemoglobin and bilirubin at 642 nm. We present in detail the results of the multicentre evaluation of the analytical properties of this new test principle. The data obtained show that Reflotron Creatinine (new) correlates well with the routine method Creatinine PAP, which was used as a comparison method, with respect to accuracy and precision and even surpasses it with respect to specificity. Advantages over the first generation of Reflotron Creatinine are: shorter reaction time, longer stability of the reagent carrier, no interference by bilirubin and reduced interference by haemoglobin.

Biochemical, hematological and endocrinological parameters during repeated intense short-term running in comparison to ultra-long-distance running.

In order to see the differences in the acute effects of two kinds of running on biochemical, hematological and hormonal parameters, we investigated in one 24 h race (same exterior conditions) two groups of runners (NR = nonstop runners; RR = relay runners). From each participant blood samples were taken before, 3 times during and after the race. In both groups the lipid parameters cholesterol, triglycerides and LDL-cholesterol declined significantly, triglycerides even to 40% of their initial value, whereas HDL-cholesterol increased significantly. Renal parameters showed similar increases in both groups except for uric acid, which rose by 73% in RR compared with only 23% increase in NR. A difference was also found in the lactate and glucose concentrations, showing a four-fold increase and a 34% increase at 4 h respectively in RR, whereas the NR remained constant. Changes in the hematological parameters were similar in both groups. Cortisol and prolactin showed similar alterations during the race but LH and testosterone declined to approximately half of their initial concentration (p greater than 0.05) in NR after 4 to 8 h, in contrast to RR, where the concentration of LH or testosterone remained constant or changed only moderately but insignificantly during the race. Our investigation indicates that in ultra-long-distance running and intense short-term exercise performed under the same exterior conditions, many parameters show similar changes but great differences can be found as well if certain hormones, glucose metabolism and renal parameters are considered.

[Change in the income status of the disabled after introduction of long-term care insurance]. / Veränderung der Einkommenssituation von Pflegebedürftigen nach Einführung einer Pflegeversicherung.

Up to the present time, long-term-care needs in the Federal Republic of Germany have only been covered to a limited extent through health insurance. The needs of the majority of those requiring long-term care must be covered from their pension funds or acquired wealth. This often does not suffice, which results in those needing long-term care becoming recipients of social assistance. The introduction of a long-term-care insurance should bring an end to this situation, which is considered unacceptable. At present, two competing schemes for covering the social risk of long-term care are being discussed: a social security insurance and a private insurance. When comparing the planned benefits under consideration, the social security insurance is more favorable in regards to nursing-home treatment, as well as with at-home care and benefits in kind. The private insurance is more favorable when considering nursing-home treatment and monetary benefits. If the private insurance is adopted, over 31% of those formerly relying on nursing-home care would no longer need social assistance. In the case of social security insurance, almost 46% would no longer require social assistance. Most of the remaining individuals requiring social assistance would be women.

New method for the determination of pancreatic amylase evaluated.

We have carried out a multicenter evaluation of a new reagent carrier for Reflotron, specific for pancreatic amylase where the salivary isoenzyme is inhibited by two specific monoclonal antibodies. This new procedure combines easy handling with low imprecision (median CV less than 3%) in control material, serum, heparinized blood, and plasma) and close correlation (r = 0.991 to 0.999) with established manual and automated methods. The same close correlation was found with values obtained from either venous or capillary finger-stick blood. Salivary amylase up to 54 kU/L (37 degrees C) was inhibited to about 97%. Endogenous interference by hemoglobin, bilirubin, triglycerides, cholesterol, or hematocrit was found to be negligible within a wide range of interferent concentrations. Out of a panel of 28 commonly used drugs it was shown that only two (ascorbic acid and paracetamol), and then only at toxic concentrations, caused a deviation in amylase activity of greater than 10%. From the results of this study we conclude that this new method is suitable for highly precise and accurate measurements of pancreatic amylase in emergency and routine laboratories.