[Early diagnosis of hepatitis C transmission after needlestick injury]. / Frühzeitige Diagnose einer Hepatitis-C-Übertragung nach Nadelstichverletzung.

Occupational transmission of hepatitis C (HCV) is rare but has been repeatedly described in the published literature. Early diagnosis and therapy of acute hepatitis C is associated with an excellent chance of permanent HCV elimination. The majority of chronic HCV infections, however, lead to a slowly progressive hepatitis with associated morbidity and risk of liver cirrhosis. For this reason the need for antiviral therapy has to be evaluated immediately.

[Prevention of nosocomial transmission of human immunodeficiency virus (HIV) from HIV-positive healthcare workers. Recommendations of the German Association for the Control of Viral Diseases (DVV) e.V. and the Society for Virology (GfV) e.V]. / Prävention der nosokomialen Übertragung von humanem Immunschwächevirus (HIV) durch HIV-positive Mitarbeiterinnen und Mitarbeiter im Gesundheitswesen. Empfehlungen der Deutschen Vereinigung zur Bekämpfung der Viruskrankheiten (DVV) e.V. und der Gesellschaft für Virologie (GfV) e.V.

To the best of our knowledge, the German Association for the Control of Viral Diseases (DVV) e.V. and the Society for Virology (GfV) e.V. are the first in Europe to provide precise recommendations for the management of health care workers (HCWs) who are infected with human immunodeficiency virus (HIV). Requirements for HIV-infected HCWs need to be clearly defined. With a permanent viral burden of less than or equal to 50 copies/mL, HIV-positive HCWs are allowed to perform any surgery and any invasive procedure, as long as the infected HCW uses double-gloving, undergoes follow-up routinely by occupational medicine professionals, undergoes a quarterly examination of viral burden, and has a regular medical examination by a physician who has expertise in the management of HIV. Unrestricted professional activity is only possible with a strict compliance to take antiretroviral therapy and if the HIV-infected HCW strictly adheres to the recommended infection control procedures. Complete compliance with the recommendation almost certainly leads to no HIV transmission risk in patient care.

[Standardized documentation in emergency departments with the core dataset of the DIVI]. / Standardisierte Dokumentation im Schockraum mit dem Kerndatensatz "Notaufnahme" der DIVI.

In Germany the documentation of every prehospital emergency medical treatment has been standardized since 1997 based on the core data-set MIND (minimal emergency physician data-set). Against this background it is very surprising that there is still no standardized data-set implemented for the documentation of early inhospital emergency care. In order to create such a data-set the current state of documentation in many different hospitals all over the country was scrutinized. In addition existing registries and international requirements were taken into consideration. Finally, a modular data-set was created using a Delphi process. This data-set was tested, clinically validated and finally ratified by the executive committee of the DIVI (German Interdisciplinary Association of Critical Care Medicine). The modular data-set was designed in such a way that a basic module forms the foundation for every patient. Process-oriented modules (e.g. surveillance) and symptom-oriented modules (e.g. trauma, neurology) were added if necessary. Along with this data-set a set of six modules was created for graphical representation when required. This high level of standardization not only allows an internal and external quality assessment but also provides a sophisticated documentation system especially to the trauma team in the emergency department. In terms of content major parameters of interhospital quality management are recorded and important factors of process management, such as MTS (Manchester triage system), ATLS (advanced trauma life support) and EWS (early warning score) have been implemented. The data-set includes all necessary information for transfers between physicians and non-academic staff as well as between physicians and could also be used as a fundamental discharge letter. Moreover, this new core data-set is the implementation of items required by existing registries into the daily routine documentation in order to reduce unnecessarily time-consuming and error-prone secondary data acquisition. For example, all items of the preclinical and emergency room documentation for the TraumaRegister DGU® (documentation phase S, A and B of the standard and QM form) have been included. This is sufficient for participation as a TraumaNetzwerk DGU® member as far as the early clinical treatment of multiple injured patients is concerned.

Reproducibility of muscle oxygen saturation.

The present study evaluated the reproducibility of tissue oxygenation in relation to oxygen consumption (VO2) across cycle exercise intensities in a test-retest design. 12 subjects (25.7±2.1 years; 24.7±1.9 kg · m(-2)) twice performed an incremental bicycle exercise protocol, while tissue oxygen saturation (StO2) in the vastus lateralis muscle was monitored by a commercially available NIRS unit and VO2 determined by an open-circuit indirect calorimetric system. Coefficients of variation across rest, workloads corresponding to 25, 50 and 75% of individual maximum capacity, and maximum load were 5.8, 4.6, 6.1, 8.0, 11.0% (StO2) and 7.6, 6.0, 3.7, 3.4, 3.1% (VO2), respectively. 95 % CI of relative test-retest differences ranged from -5.6 to +5.4% at 25% load to -17.2 to +7.5% at maximum load for StO2 and from -7.3 to +7.7% at rest to -3.3 to +3.2% at maximum load for VO2. With advancing exercise intensity, within-subject variability of StO2 was augmented, whereas VO2 variability slightly attenuated. NIRS measurements at higher workloads need to be interpreted with caution.

[Mountainbike injuries in world-cup and recreational athletes]. / Mountainbikeverletzungen bei Leistungs- und Breitensportlern.

This study investigated the incidence and frequency of injuries in mountainbike sports among competitive and recreational athletes. In a retrospective study design mountain-bike athletes were interviewed by means of a standardized questionnaire with regard to sports injuries and damages within the previous two years. The evaluation of time relative injury-rate was carried out under consideration of class and competition discipline. 75 % of the distributed questionnaires returned completed by 106 World-Cup (39 female symbol 67 male symbol, 23.1 y) and 134 recreational athletes (17 female symbol 117 male symbol, 27.4 y). Approximately 80 % of the World-Cup and about 50 % of the recreational athletes reported about at least one severe injury. World-Cup downhill athletes (1.08 injuries/ 1000 h) show a more than doubled time-related injury-rate in comparison with Cross-Country athletes (0.39 injuries/ 1000 h). Injuries of the lower (47 vs. 35 %) and upper extremity (40 vs. 41 %) show comparable prevalence for competitive and recreational cyclists. In the group of recreational athletes open wounds dominate, competitive athletes demonstrate a significant higher fracture-rate (p < 0.01). Within the World-Cup athletes head injuries stand out (n = 40). Although World-Cup participation does not result in essential injury-increase, the downhill discipline is characterized by a higher injury risk. Presumably in view of the performance orientation, there is a higher degree of risk readiness. Despite the riding performance and the obligatory safety equipment a remarkable number of bone and head injuries results.

Short telomeres and high telomerase activity in T-cell prolymphocytic leukemia.

To test the role of telomere biology in T-cell prolymphocytic leukemia (T-PLL), a rare aggressive disease characterized by the expansion of a T-cell clone derived from immuno-competent post-thymic T-lymphocytes, we analyzed telomere length and telomerase activity in subsets of peripheral blood leukocytes from 11 newly diagnosed or relapsed patients with sporadic T-PLL. Telomere length values of the leukemic T cells (mean+/-s.d.: 1.53+/-0.65 kb) were all below the 1st percentile of telomere length values observed in T cells from healthy age-matched controls whereas telomere length of normal T- and B cells fell between the 1st and 99th percentile of the normal distribution. Leukemic T cells exhibited high levels of telomerase and were sensitive to the telomerase inhibitor BIBR1532 at doses that showed no effect on normal, unstimulated T cells. Targeting the short telomeres and telomerase activity in T-PLL seems an attractive strategy for the future treatment of this devastating disease.

Impact of culture conditions on the proliferative lifespan of human T cells in vitro.

BACKGROUND: In human T cells, telomerase is transiently expressed upon activation and stimulation and, as shown previously, telomerase levels are able to control the lifespan of T cells. To improve T-cell expansion it is of critical importance to understand the effects of culture parameters on telomerase activity and lifespan. METHODS: We investigated the influence of culture condition (FCS, human AB serum and autologous serum) and stimulation (PHA/feeder cells, anti-CD3/CD28 beads) on the lifespan, clonogenicity (number of positive wells), cell cycle, telomerase activity and telomere length of T cells in vitro. RESULTS: The proliferative lifespan of T cells expanded with PHA/feeder cells and autologous serum from different donors was doubled compared with stimulation with PHA/feeder cells and AB serum. No or only a small difference was found for T cells expanded with anti-CD3/CD28 beads and autologous or AB serum. The use of autologous serum also increased the clonogenicity to about three-fold compared with the use of AB serum or FCS, without any signs of differences in the fractions of cycling cells. Interestingly, T cells cultured with autologous serum exhibited a significantly higher telomerase activity at day 6 after stimulation and a reduced decline of telomerase activity compared with cultures with AB serum. DISCUSSION: The use of autologous serum combined with PHA stimulation and feeder cells remarkably extends the proliferative lifespan and clonogenicity and increases the telomerase activity of human T cells in vitro. This might be useful for applications where large numbers of specific T cells are required.

[Ultrasound-controlled anthropometry--on the development of a new method in asymmetry diagnosis]. / Die Ultraschallgesteuerte Anthropometrie (UGA)--Zur Entwicklung eines neuen Verfahrens in der Asymmetriediagnostik.

UNLABELLED: Recently computer-based methods allow the registration of asymmetries in skeleton-axis. In comparison to classical methods the Ultrasound-Guided-Anthropometry (UGA) has been tested in regard to its quality criteria for representing body specific marks in three dimensions. In a sample of healthy subjects objectivity (n = 13), retest-reliability and internal validity (n = 26) have been determined. For analysis of system-quality a standardized cuboid phantom (side length 400 mm) has been measured. RESULTS: objectivity r = 0.93-0.98 (p < .05), retest-reliability r = 0.97-0.99 (p < .05) and internal validity between both methods r = 0.92-0.97 (p < .05). The analysis of system-quality produced an error in measurement of 0.65% (0.58 +/- 1.29 mm). UGA as a screening method is not a substitute for case-history or classical anthropometry, but it offers useful parameters which facilitate decision making for further diagnostic procedures.