[Guideline-conform exact diagnosis and coding of dementia]. / Leitliniengerechte exakte Diagnose und Codierung der Demenz.

All of the currently available guidelines specify a two-stage procedure. The first stage entails performing a comprehensive description, diagnosis and confirmation of the dementia syndrome. The second stage involves the precise etiological classification. Alzheimer's disease represents the most common cause followed by vascular dementia and Parkinson's disease dementia, Lewy body dementia, frontotemporal lobar degeneration and others. Dementia encompasses a variety of underlying conditions. This review gives an overview of the clinically oriented diagnosis according to the updated S3 guidelines in Germany.

Influence of mitochondrial enzyme deficiency on adult neurogenesis in mouse models of neurodegenerative diseases.

Mitochondrial defects including reduction of a key mitochondrial tricarboxylic acid cycle enzyme alpha-ketoglutarate-dehydrogenase complex (KGDHC) are characteristic of many neurodegenerative diseases. KGDHC consists of alpha-ketoglutarate dehydrogenase, dihydrolipoyl succinyltransferase (E2k), and dihydrolipoamide dehydrogenase (Dld) subunits. We investigated whether Dld or E2k deficiency influences adult brain neurogenesis using immunohistochemistry for the immature neuron markers, doublecortin (Dcx) and polysialic acid-neural cell adhesion molecule, as well as a marker for proliferation, proliferating cell nuclear antigen (PCNA). Both Dld- and E2k-deficient mice showed reduced Dcx-positive neuroblasts in the subgranular zone (SGZ) of the hippocampal dentate gyrus compared with wild-type mice. In the E2k knockout mice, increased immunoreactivity for the lipid peroxidation marker, malondialdehyde occurred in the SGZ. These alterations did not occur in the subventricular zone (SVZ). PCNA staining revealed decreased proliferation in the SGZ of E2k-deficient mice. In a transgenic mouse model of Alzheimer's disease, Dcx-positive cells in the SGZ were also reduced compared with wild type, but Dld deficiency did not exacerbate the reduction. In the malonate lesion model of Huntington's disease, Dld deficiency did not alter the lesion-induced increase and migration of Dcx-positive cells from the SVZ into the ipsilateral striatum. Thus, the KGDHC subunit deficiencies associated with elevated lipid peroxidation selectively reduced the number of neuroblasts and proliferating cells in the hippocampal neurogenic zone. However, these mitochondrial defects neither exacerbated certain pathological conditions, such as amyloid precursor protein (APP) mutation-induced reduction of SGZ neuroblasts, nor inhibited malonate-induced migration of SVZ neuroblasts. Our findings support the view that mitochondrial dysfunction can influence the number of neural progenitor cells in the hippocampus of adult mice.

Decision making guidelines for mining historic landfill sites in Flanders.

This study aims at showing how the United Nations Framework Classification for Resources (UNFC) can help to classify potential landfill mining projects with different levels of maturity, from exploration to production, under technical, socio-economic and project-planning aspects. Taking the example of three former landfill sites in Flanders general decision making guidelines regarding the future management of old landfills are provided. Using the ECLAR methodology for the evaluation (E) and classification (CL) of anthropogenic resources (AR), the individual projects, where clean land and/or materials are recovered, are mapped under the three-dimensional UNFC system. The Bornem project, yields a negative Net Present Value (NPV) of -17 Mio € (-44 €/t of excavated waste), i.e. the project is currently not economically viable. In case of changing key parameters the landfill has, however, reasonable prospects for future economic extraction. The Turnhout land development turned out to be economically viable with a NPV of 361,000 € (8 €/t of excavated waste). The Zuienkerke remediation project is at a too early stage to determine its socioeconomic viability. The main focus to compare and prioritize potential landfill mining projects in Flanders should be on (1) site specific conditions (e.g. landfill's composition, land prices), (2) project related factors (e.g. remediation required vs. resource/land recovery, selected technologies and project set-ups, private vs. public evaluation perspective) and (3) the timing of mining, considering future development of costs, prices, laws, available data and information.

Healthcare reform and expenditure on drugs. The German situation.

Germany is in a period of transition with regard to healthcare reform. The number and intensity of cost control interventions increased during the last decade in an attempt to contain healthcare expenditure. The German legislature has implemented long term macroeconomic measures such as contribution rate stability and global budgeting. The mid-term goal is to reduce the structural deficits of the current system. This paper argues that reference prices, introduced in the 1989 Healthcare Reform Act, did not produce the expected savings. An analysis of the effects of the 1993 Healthcare Structure Act on pharmaceutical expenditure is also presented. Compared with the implementation of the reference price system, the introduction of global budgeting in 1993 has had a more effective and lasting cost-containment impact. The paper concludes with a review of the main aspects of the current reform discussion.

Exploring an ultracold fermi-fermi mixture: interspecies feshbach resonances and scattering properties of 6Li and 40K.

We report on the observation of Feshbach resonances in an ultracold mixture of two fermionic species, (6)Li and (40)K. The experimental data are interpreted using a simple asymptotic bound state model and full coupled channels calculations. This unambiguously assigns the observed resonances in terms of various s- and p-wave molecular states and fully characterizes the ground-state scattering properties in any combination of spin states.

Synchronization of delay-coupled oscillators: a study of semiconductor lasers.

Two delay-coupled semiconductor lasers are studied in the regime where the coupling delay is comparable to the time scales of the internal laser oscillations. Detuning the optical frequency between the two lasers, novel delay-induced scenarios leading from optical frequency locking to successive states of periodic intensity pulsations are observed. We demonstrate and analyze these dynamical phenomena experimentally using two distinct laser configurations. A theoretical treatment reveals the universal character of our findings for delay-coupled systems.

[Clinical relevance of immunoglobulin M antibody fraction against hepatitis B core antigen (anti-HBc-IgM) (author's transl)]. / Klinische Bedeutung der Immunglobulin-M-Antikörperfraktion gegen das Hepatitis-B-core-Antigen (anti-HBc-IgM).

Forty-four anti-HBc positive patients with various liver diseases were followed up over 2-3 years with enzyme-immunological determinations of the IgM fraction of anti HBc (anti-HBc-IgM). Patients with acute virus hepatitis B (n = 10) had anti-HBc-IgM titres greater than or equal to 10(-3) in the acute phase. In the reconvalescent phase the titre decreased significantly but was still detectable at a level of 10(-1) two years after the onset of the disease. In patients with HBs-antigen positive chronic active hepatitis (n = 25) the anti-HBc-IgM was always detectable when HBe-antigen was positive. Patients with HBe-antigen negative chronic active hepatitis B showed various anti-HBc-IgM findings. Patients with liver diseases not due to hepatitis B virus infections (n = 9) were always anti-HBc-IgM negative. Thus with the help of anti-HBc-IgM determinations acute hepatitis B virus infection can be diagnosed in HBs-antigen negative people. On the other hand it is not suitable for differentiation between acute and chronic hepatitis B infections in HBs-antigen positive persons.