Role of the Iodide-Methylammonium Interaction in the Ferroelectricity of CH3 NH3 PbI3.

Excellent conversion efficiencies of over 20 % and facile cell production have placed hybrid perovskites at the forefront of novel solar cell materials, with CH3 NH3 PbI3 being an archetypal compound. The question why CH3 NH3 PbI3 has such extraordinary characteristics, particularly a very efficient power conversion from absorbed light to electrical power, is hotly debated, with ferroelectricity being a promising candidate. This does, however, require the crystal structure to be non-centrosymmetric and we herein present crystallographic evidence as to how the symmetry breaking occurs on a crystallographic and, therefore, long-range level. Although the molecular cation CH3 NH3 + is intrinsically polar, it is heavily disordered and this cannot be the sole reason for the ferroelectricity. We show that it, nonetheless, plays an important role, as it distorts the neighboring iodide positions from their centrosymmetric positions.

Molecular detection of Salmonella serovars Enteritidis, Heidelberg and Typhimurium directly from pre-enriched poultry samples.

1. Salmonella is one of the most important pathogens in public health and it is usually associated with food-borne diseases. Salmonella serovars Enteritidis and Typhimurium are widespread in the world with outbreaks frequently associated with consumption of poultry products; furthermore, there is an increasing public health concern with the wide dissemination of the serovar Heidelberg in poultry flocks. 2. The aim of the experiment was to develop and to validate rapid methods to detect Salmonella serovars Enteritidis, Typhimurium, and Heidelberg by real-time PCRs and test isolates from pre-enriched poultry samples. 3. Three real-time PCRs were developed and used in combination to detect the serovars Enteritidis, Typhimurium and Heidelberg. These assays were validated by the analysis of 126 Salmonella isolates, eight other enteric bacterial species and 34 naturally contaminated poultry samples after pre-enrichment with buffered peptone water (BPW). 4. Real-time PCRs detected the isolates of the most important poultry serovars (Enteritidis, Typhimurium and Heidelberg) with 100% inclusivity and exclusivity in each assay. The PCR identified monophasic variants of the serovars Typhimurium and Heidelberg. All PCRs were validated in detecting these specific serovars directly from pre-enriched poultry samples. The whole analytical procedure was performed in less than 24 h in a veterinary diagnostic laboratory.

Why does a point of care guided transfusion algorithm not improve blood loss and transfusion practice in patients undergoing high-risk cardiac surgery? A prospective randomized controlled pilot study.

BACKGROUND: Adult cardiac surgery is often complicated by elevated blood losses that account for elevated transfusion requirements. Perioperative bleeding and transfusion of blood products are major risk factors for morbidity and mortality. Timely diagnostic and goal-directed therapies aim at the reduction of bleeding and need for allogeneic transfusions. METHODS: Single-centre, prospective, randomized trial assessing blood loss and transfusion requirements of 26 adult patients undergoing elective cardiac surgery at high risk for perioperative bleeding. Primary endpoint was blood loss at 24 h postoperatively. Random assignment to intra- and postoperative haemostatic management following either an algorithm based on conventional coagulation assays (conventional group: platelet count, aPTT, PT, fibrinogen) or based on point-of-care (PoC-group) monitoring, i.e. activated rotational thromboelastometry (ROTEM®) combined with multiple aggregometry (Multiplate®). Differences between groups were analysed using nonparametric tests for independent samples. RESULTS: The study was terminated after interim analysis (n = 26). Chest tube drainage volume was 360 ml (IQR 229-599 ml) in the conventional group, and 380 ml (IQR 310-590 ml) in the PoC-group (p = 0.767) after 24 h. Basic patient characteristics, results of PoC coagulation assays, and transfusion requirements of red blood cells and fresh frozen plasma did not differ between groups. Coagulation results were comparable. Platelets were transfused in the PoC group only. CONCLUSION: Blood loss via chest tube drainage and transfusion amounts were not different comparing PoC- and central lab-driven transfusion algorithms in subjects that underwent high-risk cardiac surgery. Routine PoC coagulation diagnostics do not seem to be beneficial when actual blood loss is low. High risk procedures might not suffice as a sole risk factor for increased blood loss. TRIAL REGISTRATION: NCT01402739 , Date of registration July 26, 2011.

[Cardiovascular disease in pediatric patients under chronic peritoneal dialysis]. / Compromiso cardiovascular en pacientes pediátricos en diálisis peritoneal crónica.

Peritoneal dialysis (PD) is the most common renal replacement therapy used in pediatric patients with end stage renal disease. This population has a mortality rate 1,000 times greater compare to pediatric population, mainly due to cardiovascular causes. OBJECTIVE: To characterize pediatric patients on chronic PD in relation to dialysis and cardiovascular outcome. PATIENTS AND METHODS: Cross sectional study. Patients in stable PD according to DOQI criteria were selected. Epidemiological, dialytic, biochemical and cardiovascular variables were registered. Left Ventricular Mass Index (LVMI) was calculated by height/age (g/m2.7). Left Ventricular Hypertrophy (LVH) was diagnosed with > 38.6 g/m2.7, severe LVH > 51 g/m2.7. Data were analyzed using STATA 11.0. continuous variables using ANOVA test and categorical variables were analyzed using χ2 test or Fisher’s exact test. RESULTS: 21 patients, 11 males. Mean age 9.2 ± 3.52 years. The most frequent diagnosis was renal dysplasia (52%). Residual and Peritoneal KtV were 0.8 and 1.9 respectively. Fifty-two percent of patients showed LVH, 91% in severe range. A significant relationship between ultrafiltration/m2 and systolic blood pressure was depicted. Also a significant relationship between left ventricular mass index and hemoglobin (p < 0.05) was founded. CONCLUSIONS: The majority of the population showed left ventricular hypertrophy -particularly severe LVH-, which confirms an increased CV risk in this population. Blood pressure and loss of ultrafiltration were founded to be correlated to LVH.

Compromiso cardiovascular en pacientes pediátricos en diálisis peritoneal crónica / Cardiovascular disease in pediatric patients under chronic peritoneal dialysis

La diálisis peritoneal (DP) es la terapia de reemplazo renal más usada en niños portadores de enfermedad renal crónica terminal. La enfermedad cardiovascular es la principal causa de mortalidad en estos pacientes. OBJETIVO: Caracterizar pacientes pediátricos en DP crónica desde el punto de vista cardiovascular. PACIENTES Y MÉTODO: Estudio de corte transversal en pacientes en DP, estables según criterios DOQI. Se registraron variables epidemiológicas, dialíticas, bioquímicas y cardiovasculares. Se evaluó hipertrofia ventricular izquierda (HVI) por ecocardiografía. El índice de masa ventricular izquierda (IMVI) se calculó por índice talla/edad (g/m2.7). Se consideró HVI > 38,6 g/m2.7, y severa HVI > 51 g/m2.7. Se analizaron las variables continuas mediante ANOVA, y categóricas por χ2 o método exacto de Fisher. Se analizaron los datos en STATA 11.0. RESULTADOS: Se incluyeron 21 pacientes, 11 varones, edad 9,2 ± 3,5 años. El diagnóstico más frecuente fue displasia renal (52%). El KtV residual promedio fue de 0,8, y peritoneal 1,9. En la ecocardiografía, un 52% presentó HVI, un 91% de ellos en rango severo. Se demostró una relación significativa entre ultrafiltración y presión arterial sistólica, y entre IMVI y hemoglobina (p < 0,05). CONCLUSIONES: En este estudio reportamos una incidencia de HVI mayor al 50%, en su mayoría grado severo, lo cual evidencia el importante compromiso cardiovascular en estos pacientes. La hipertensión arterial y falla de ultrafiltración destacan como importantes factores relacionados a la hipertrofia ventricular izquierda.

Peritoneal dialysis (PD) is the most common renal replacement therapy used in pediatric patients with end stage renal disease. This population has a mortality rate 1,000 times greater compare to pediatric population, mainly due to cardiovascular causes. OBJECTIVE: To characterize pediatric patients on chronic PD in relation to dialysis and cardiovascular outcome. PATIENTS AND METHODS: Cross sectional study. Patients in stable PD according to DOQI criteria were selected. Epidemiological, dialytic, biochemical and cardiovascular variables were registered. Left Ventricular Mass Index (LVMI) was calculated by height/age (g/m2.7). Left Ventricular Hypertrophy (LVH) was diagnosed with > 38.6 g/m2.7, severe LVH > 51 g/m2.7. Data were analyzed using STATA 11.0. continuous variables using ANOVA test and categorical variables were analyzed using χ2 test or Fisher's exact test. RESULTS: 21 patients, 11 males. Mean age 9.2 ± 3.52 years. The most frequent diagnosis was renal dysplasia (52%). Residual and Peritoneal KtV were 0.8 and 1.9 respectively. Fifty-two percent of patients showed LVH, 91% in severe range. A significant relationship between ultrafiltration/m2 and systolic blood pressure was depicted. Also a significant relationship between left ventricular mass index and hemoglobin (p < 0.05) was founded. CONCLUSIONS: The majority of the population showed left ventricular hypertrophy -particularly severe LVH-, which confirms an increased CV risk in this population. Blood pressure and loss of ultrafiltration were founded to be correlated to LVH.

Safety and immunogenicity of neoadjuvant treatment using WT1-immunotherapeutic in combination with standard therapy in patients with WT1-positive Stage II/III breast cancer: a randomized Phase I study.

PURPOSE: This Phase I, multicenter, randomized study (ClinicalTrials.gov NCT01220128) evaluated the safety and immunogenicity of recombinant Wilms' tumor 1 (WT1) protein combined with the immunostimulant AS15 (WT1-immunotherapeutic) as neoadjuvant therapy administered concurrently with standard treatments in WT1-positive breast cancer patients. METHODS: Patients were treated in 4 cohorts according to neoadjuvant treatment (A: post-menopausal, hormone receptor [HR]-positive patients receiving aromatase inhibitors; B: patients receiving chemotherapy; C: HER2-overexpressing patients on trastuzumab-chemotherapy combination; D: HR-positive/HER2-negative patients on chemotherapy). Patients (cohorts A-C) were randomized (2:1) to receive 6 or 8 doses of WT1-immunotherapeutic or placebo together with standard neoadjuvant treatment in a double-blind manner; cohort D patients received WT1-immunotherapeutic in an open manner. Safety was assessed throughout the study. WT1-specific antibodies were assessed pre- and post-vaccination. RESULTS: Sixty-two patients were randomized; 60 received ≥ one dose of WT1-immunotherapeutic. Two severe toxicities were reported: diarrhea (cohort C; also reported as a grade 3 serious adverse event) and decreased left ventricular ejection fraction (cohort B; also reported as a grade 2 adverse event). Post-dose 4 of WT1-immunotherapeutic, 10/10 patients from cohort A, 0/8 patients from cohort B, 6/11 patients from cohort C, and 2/3 patients from cohort D were humoral responders. The sponsor elected to close the trial prematurely. CONCLUSIONS: Concurrent administration of WT1-immunotherapeutic and standard neoadjuvant therapy was well tolerated and induced WT1-specific antibodies in patients receiving neoadjuvant aromatase inhibitors. In patients on neoadjuvant chemotherapy or trastuzumab-chemotherapy combination, the humoral response was impaired or blunted, likely due to either co-administration of corticosteroids and/or the chemotherapies themselves.

[Preoperative therapy switch before glaucoma filtration surgery : Influence of the systemic antiglaucomatous and local antiphlogistic therapy on the intraocular pressure]. / Präoperative Therapieumstellung vor filtrierender Glaukomchirurgie : Einfluss der systemischen augendrucksenkenden sowie der lokalen antiphlogistischen Therapie auf den Augendruck.

BACKGROUND: The preoperative switch from local to systemic antiglaucomatous therapy and the additional application of local antiphlogistic drugs represents an important component of perioperative wound healing modulation within the framework of glaucoma filtration surgery. OBJECTIVE: The aim of the present study was to compare the intraocular pressure (IOP) under a maximum local and oral antiglaucomatous therapy with or without additional application of local steroids. METHODS: A retrospective clinical analysis of 121 consecutive patients who underwent primary trabeculectomy for open-angle glaucoma in 2013 and who attended the outpatient clinic at least 3 weeks before surgery was carried out. The patients were set on preoperative therapy as follows: continuation of the maximum local antiglaucomatous therapy (with or without local dexamethasone 1 mg/ml 3 times daily) or administration of 750 mg acetazolamide orally per day (with or without local steroids). RESULTS: The switch to oral antiglaucomatous therapy led to a mean IOP rise of 3.14 mm Hg which was short of statistical significance (p = 0.052). The additional administration of local steroids did not significantly influence the IOP (p = 0.218). Some patients with oral acetazolamide therapy and local steroid application showed large increases in IOP up to 30 mm Hg. CONCLUSION: The mean IOP rise of 3.14 mm Hg 3 weeks after replacement of antiglaucomatous eye drops by acetazolamide was short of missing statistical significance and seems to be clinically negligible for this relatively short period. The advantages of a lower postoperative fibrotic activity have to be weighed up against this change in IOP. Surprisingly, the effect of administration of local steroids for 3 weeks was minor compared to the effect of the switch from local to oral antiglaucomatous medication. Individual major IOP increases under the preoperative therapy change should be taken into consideration.

Comprehensive assessment of food and nutrient intake of children and adolescents in Germany: EsKiMo II - the eating study as a KiGGS module.

BACKGROUND: As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), food and nutrient intake of children and adolescents aged 6-17 years living in Germany is assessed in EsKiMo II - the Eating Study as a KiGGS Module. METHODS: EsKiMo II is a cross-sectional study, conducted from June 2015 until September 2017. The study population comprises 6 to 17-year-old study participants from the cross-sectional sample of KiGGS Wave 2 in 167 KiGGS sample points, which are revisited by trained nutritionists. Dietary intake is assessed by weighted food records during three consecutive days plus one randomly selected day within the following 3 months for children aged 6-11 years. Dietary intake for adolescents aged 12-17 years is assessed by computer-assisted dietary history interviews, reflecting the past four weeks, using the software DISHES. Further information, for example, about specific diets and dietary supplement intake, is reported during a standardised computer assisted interview for all participants. Food items are coded by the German Food Code and Nutrient Database (BLS 3.02). DISCUSSION: EsKiMo II provides actual data on the dietary behaviour of children and adolescents living in Germany and their determinants. Results of EsKiMo II will be relevant for decision-making, measures, and evaluations within nutrition, consumer and health policy.

Safety and immunogenicity of the PRAME cancer immunotherapeutic in metastatic melanoma: results of a phase I dose escalation study.

PURPOSE: The PRAME tumour antigen is expressed in several tumour types but in few normal adult tissues. A dose-escalation phase I/II study (NCT01149343) assessed the safety, immunogenicity and clinical activity of the PRAME immunotherapeutic (recombinant PRAME protein (recPRAME) with the AS15 immunostimulant) in patients with advanced melanoma. Here, we report the phase I dose-escalation study segment. PATIENTS AND METHODS: Patients with stage IV PRAME-positive melanoma were enrolled to 3 consecutive cohorts to receive up to 24 intramuscular injections of the PRAME immunotherapeutic. The RecPRAME dose was 20, 100 or 500 µg in cohorts 1, 2 and 3, respectively, with a fixed dose of AS15. Adverse events (AEs), including predefined dose-limiting toxicity (DLT) and the anti-PRAME humoral response (ELISA), were coprimary end points. Cellular immune responses were evaluated using in vitro assays. RESULTS: 66 patients were treated (20, 24 and 22 in the respective cohorts). AEs considered by the investigator to be causally related were mostly grade 1 or 2 injection site symptoms, fatigue, chills, fever and headache. Two DLTs (grade 3 brain oedema and proteinuria) were recorded in two patients in two cohorts (cohorts 2 and 3). All patients had detectable anti-PRAME antibodies after four immunisations. Percentages of patients with predefined PRAME-specific-CD4+T-cell responses after four immunisations were similar in each cohort. No CD8+ T-cell responses were detected. CONCLUSIONS: The PRAME immunotherapeutic had an acceptable safety profile and induced similar anti-PRAME-specific humoral and cellular immune responses in all cohorts. As per protocol, the phase II study segment was initiated to further evaluate the 500 µg PRAME immunotherapeutic dose. TRIAL REGISTRATION NUMBER: NCT01149343, Results.

Detection of genetically modified maize in processed products, dry grains, and corn ears intended for fresh consumption in South Brazil.

Conventional and genetically modified (GM) maize cultivars have been widely planted in Brazil to produce grains for processed food, feed, or to be consumed fresh as corn ears. This study used real-time PCR to detect GM maize in processed products and fresh commercial corn ears produced in the last two years in South Brazil. Eighteen conventional and GM maize cultivars were obtained from seed production companies and 50 commercial samples (including canned corn, corn flour, dry grains, and fresh corn ears) were purchased in small local stores and supermarkets. All samples were analyzed by real time TaqMan PCR to detect one constitutive maize gene (hmg) and three genetic regions present in GM plants (p-35S promoter, major gene cry 1A.105, and t-Nos terminator). Each commercial sample was classified as conventional or GM based on the PCR results. PCR targeting the hmg gene generated positive results from all DNA samples, which were further tested with the GM targets. These targets were not detected in the five conventional maize cultivars, but were detected in the GM seeds hosting these fragments. Analysis of processed foods identified four cultivars as conventional and six as GM, which were mostly correctly labeled. Seven (53.8%) dry grain samples were classified as conventional, while six (46.2%) were classified as GM. Three (11.1%) corn ear samples were identified as conventional, and the remaining 24 (88.9%) were GM maize. These results demonstrate the high frequency of GM maize in processed products, including fresh corn ears intended for consumption in South Brazil.

[Lymphoepithelial carcinoma of the eye]. / Lymphoepitheliales Karzinom am Auge.

A lymphoepithelial carcinoma of the conjunctiva was excised in an 80-year-old female patient. The otorhinolaryngeal (ENT) examination did not show any abnormalities and nasopharyngeal or systemic metastases were absent. A strictly controlled clinical follow-up of the excision site was scheduled. A lymphoepithelial carcinoma of the eye is very rare and it is classified under the nasopharyngeal carcinomas. The diagnostics and therapy are an interdisciplinary task involving ENT, radiology, pathology and oncology and if the tumor cannot be completely excised, radiotherapy is also included.

Bumblebee Flight in Heavy Turbulence.

High-resolution numerical simulations of a tethered model bumblebee in forward flight are performed superimposing homogeneous isotropic turbulent fluctuations to the uniform inflow. Despite tremendous variation in turbulence intensity, between 17% and 99% with respect to the mean flow, we do not find significant changes in cycle-averaged aerodynamic forces, moments, or flight power when averaged over realizations, compared to laminar inflow conditions. The variance of aerodynamic measures, however, significantly increases with increasing turbulence intensity, which may explain flight instabilities observed in freely flying bees.

[Reaching Target Groups--Shaping Accessibility. Results of a Survey Among Experts on Recommendations for Science and Practice]. / Zielgruppen erreichen--Zugangswege gestalten. Ergebnisse einer Befragung von Expertinnen und Experten zu Empfehlungen für Wissenschaft und Praxis.

In an online survey, in which 18 experts participated, recommendations for research and practice to improve access to target groups were discussed. The recommendations were developed within the context of the KNP project. For the implementation of the recommendations, not only is an increased cooperation between science and practice particularly important, but also materials and training as well as standardization of methods. Furthermore, financial resources, especially for conducting evaluation studies are needed.

[Changing structures--Integrating health]. / Strukturen ändern--Gesundheit integrieren.

Changes in (municipal) structures for the improvement of health are often required but, in contrast to behavioural measures, less frequently implemented and scientifically evaluated. Results on this subject for Germany are scarce. In recent years, municipal prevention and health promotion programmes received new impetus from the expansion of the German "Early Assistance" initiative. Early assistance programmes to help children grow up healthy initiated municipal processes such as the establishment of networks between health services and youth welfare services, prevention chains and nationwide initiatives. This has moved issues such as equal opportunities for health into the centre of politically driven structural development efforts. Neighbourhood management groups and municipal round tables on prevention-specific topics etc. have been established throughout Germany. Regarding this structural development, 6 projects from the field of prevention research give a good indication as to how the structure of municipal concepts can be effectively implemented.

[Drusen characteristics after internal limiting membrane peeling]. / Verhalten von Drusen nach "internal limiting membrane peeling".

BACKGROUND: There are some reports showing isolated cases of drusen regression after pars plana vitrectomy (ppV) with peeling of the internal limiting membrane (iLM). Drusen characteristics after iLM peeling was investigated in this study. PATIENTS AND METHODS: The data of 527 patients who had received iLM peeling between 2004 and 2012 were retrospectively collected and those patients with retinal drusen were selected for the study. Fundus photographs before and after vitrectomy due to a macular hole or epiretinal gliosis were compared and drusen arrangement in the peeling site was analyzed. The aim of the study was to show whether there was drusen regression 2-5 months after surgery. RESULTS: Out of the 527 patients 11 showed central macular drusen, 4 with confluent large drusen (> 63 µm diameter) and 7 with small hard drusen (≤ 63 µm diameter). One patient showed drusen regression after iLM peeling without any changes in the other eye and all other patients showed no differences in the drusen findings (n = 6) or even some additional drusen (n = 4) without drusen alterations in the other eye. CONCLUSION: The results of this study could not confirm some reports showing drusen regression after iLM peeling in the peeling site in general and there was only one single case of central drusen regression.

[Reliability and safety of intravitreal Ozurdex injections. The ZERO study]. / Zuverlässigkeit und Sicherheit von intravitrealen Ozurdex-Injektionen. Die ZERO-Studie.

BACKGROUND: Since July 2010 Ozurdex® is approved in Germany for treatment of macular edema from retinal vein occlusion (RVO). The objective of this observational study was a systemic summary and analysis of clinical experience regarding complications and side effects of intravitreal administration of dexamethasone. PATIENTS AND METHODS: In a retrospective, multicenter study conducted at 10 centers, 342 eyes with RVO were treated with intravitreal dexamethasone (Ozurdex®, Allergan). After treatment the patients were followed-up over a period of 8 months and intraoperative, perioperative and postoperative complications, such as elevated intraocular pressure and dislocation of implants were systematically recorded. RESULTS: No infections, endophthalmitis, perioperative hypotension, intraoperative lens injuries or retinal detachment occurred. Elevated intraocular pressure was the most common complication accounting for nearly 20 %. In 9 % of patients the intraocular pressure increased by more than 10 mmHg compared to baseline and in 6 patients to > 35 mmHg. In cases of known glaucoma intraocular pressure elevation was not significantly more frequent compared to non-glaucoma patients. In four cases a progression of lens opacity led to phacoemulsification and two implant dislocations in the anterior chamber required surgical repositioning in the vitreous cavity. In two cases a postinterventional macular hole was observed. CONCLUSIONS: In the clinical routine Ozurdex treatment has proven to be a therapy method with minimal side effects. In Ozurdex administration intraocular pressure elevation was observed as the most common side effect; however, this generally did not require surgical intervention. Caution is advised in patients with an anterior chamber lens and iridectomy. Macular holes as a rare complication might result from vitreous traction during the administration process. In summary, even in the clinical routine application of Ozurdex the complication rate was not higher than in registration studies.

The novel tyrosine kinase inhibitor AKN-028 has significant antileukemic activity in cell lines and primary cultures of acute myeloid leukemia.

Aberrantly expressed tyrosine kinases have emerged as promising targets for drug development in acute myeloid leukemia (AML). We report that AKN-028, a novel tyrosine kinase inhibitor (TKI), is a potent FMS-like receptor tyrosine kinase 3 (FLT3) inhibitor (IC(50)=6 nM), causing dose-dependent inhibition of FLT3 autophosphorylation. Inhibition of KIT autophosphorylation was shown in a human megakaryoblastic leukemia cell line overexpressing KIT. In a panel of 17 cell lines, AKN-028 showed cytotoxic activity in all five AML cell lines included. AKN-028 triggered apoptosis in MV4-11 by activation of caspase 3. In primary AML samples (n=15), AKN-028 induced a clear dose-dependent cytotoxic response (mean IC(50) 1 µM). However, no correlation between antileukemic activity and FLT3 mutation status, or to the quantitative expression of FLT3, was observed. Combination studies showed synergistic activity when cytarabine or daunorubicin was added simultaneously or 24 h before AKN-028. In mice, AKN-028 demonstrated high oral bioavailability and antileukemic effect in primary AML and MV4-11 cells, with no major toxicity observed in the experiment. In conclusion, AKN-028 is a novel TKI with significant preclinical antileukemic activity in AML. Possible sequence-dependent synergy with standard AML drugs and good oral bioavailability has made it a candidate drug for clinical trials (ongoing).

Nutritional and hydration status in elderly subjects: clinical rating versus bioimpedance analysis.

Malnutrition and dehydration are common in elderly. A simple, reliable instrument to assess nutritional and hydration status would be very helpful. Bioelectrical impedance analysis (BIA) has been promising in this context, but data of elderly persons and geriatric in-hospital patients are rare. Therefore, we first compared BIA measurements (resistance, reactance, phase angle and a resulting vectorgraph) with a clinical assessment in 31 community-dwelling women and 30 female nursing-home residents. The results of the BIA measurement correlated well to weight, hand grip strength, and calf circumference. We then compared BIA measurements with clinical judgement of hydration status in 103 acute geriatric hospital in-patients. Concordance between the results of clinical judgement and BIA measurements was only 43.7%. In assessing geriatric in-patients, there is little concordance between the clinical and the bioelectrical evaluation of the hydration status.

[Strategies for action to tackle health inequalities in Germany]. / Strategien zur Verminderung gesundheitlicher Ungleichheiten in Deutschland.

Against the background of health inequalities, the German Federal Centre for Health Education (BZgA) has coordinated the European project 'Closing the Gap: Strategies for Action to Tackle Health Inequalities in Europe'. Describing the state of the art of reducing health inequalities in each participating country has been one output of the EU project. The aim of this contribution is to present information for Germany with regard to research, political background, initiatives, quality and evaluation of interventions and public awareness. Despite the lack of a national strategy to tackle health inequalities, it can be concluded that there is a range of important activities which are supported by the federal government and which comprise different actors and sectors. Knowledge transfer across Europe can be helpful within the conception of a concerted action.

Limitación crónica al flujo aéreo en pacientes con secuelas de tuberculosis pulmonar: Caracterización y comparación con EPOC / Chronic airways obstruction in patients with tuberculosis sequelae: a comparison with EPOC

Chronic airway obstruction (CAO) resulting from tuberculosis (TB) sequelae (CAO-TB) is a frequent condition in our population. However the information in the medical literature is scarce. The management of these patients usually follows guidelines for other illnesses such as chronic obstructive pulmonary disease (COPD) or asthma. To better characterize CAO-TB, 25 patients with this condition that never smoked nor were diagnosed having asthma, were studied by means of spirometry, arterial blood gases and 6-minute walk test. Furthermore, they were compared with 12 COPD patients with similar FEV1 values. CAO-TB patients had history of tuberculosis 35 ± 11 years earlier, and all of them presented with lung scarring in one or both upper lobes. They were younger than COPD (58 ± 11 vs 69 ± 6 y.o.; p = 0.001) and females predominated over males (20/5 vs 2/10; p = 0.001). The FEV1/FVC ratio pre- and post-bronchodilator were higher in CAO-TB than in COPD patients (67 percent ± 12 vs 54 percent ± 9 pre; p = 0.001; 65 percent ± 14 vs 51 percent ± 7; p = 0.003 post, respectively). There were no differences in the remaining spirometric indices nor in arterial blood gases. The 6-min distance walked was comparable in both groups: 343 m (69 percent) in CAO-TB and 361 m (76 percent) in COPD. There were no differences in the oxygen saturation nor in heart rate neither at the beginning nor at the end of the 6-min walk test. However, CAO-TB patients had a higher respiratory rate at the beginning (22.7 ± 4.7 vs 19.8 ± 3.1 breath/min; p = 0.05) and at the end of the walk test (27.3 ± 6.7 vs 21.9 ± 3.3; p = 0.01) than COPD patients; although the Borg dyspnoea score was not different (1 ± 0,7 vs 1 ± 0.5 initial, 3 ± 1.5 vs 2.5 ± 0.8 final). Furthermore, a significant linear correlation between respiratory rate and Borg score was found both at the beginning (r = 0.747; p < 0.001) and at the end (r = 0.507; p = 0.01) of the walk test. In conclusion, CAO-TB patients are functionally comparable to COPD patients, although they have higher respiratory rate and develop more dyspnoea because of their added restrictive impairment. In addition to spirometry, tests for assessment of dyspnoea such as 6-minute walk test must be considered, to evaluate the response to treatment in CAO-TB patients.

La limitación crónica al flujo aéreo (LCFA) secundaria a secuelas de tuberculosis (LCFA-TB) es relativamente frecuente en nuestro medio, pero la información sobre esta condición en la literatura es escasa. El manejo terapéutico de estos enfermos suele seguir las guías de otras entidades como la Enfermedad Pulmonar Obstructiva Crónica (EPOC) y el Asma Bronquial. Con el objetivo de caracterizar la LCFA-TB, 25 enfermos con esta condición, que nunca fumaron ni tuvieron asma, fueron estudiados mediante espirometría, gasometría arterial y prueba de caminata de 6 minutos. Los pacientes LCFA-TB fueron comparados con 12 pacientes EPOC que tenían un grado similar de obstrucción. Los enfermos con LCFA-TB habían presentado tuberculosis 35 ± 11 años antes y tenían lesiones fibrosas con retracción en uno o ambos lóbulos superiores. Eran más jóvenes que los pacientes con EPOC (58 ± 11 vs 69 ± 6 años; p = 0,001) y predominaban las mujeres sobre los hombres (20/5 vs 2/10; p = 0,001). La relación VEF1/CVF basal fue más elevada en los pacientes con LCFA-TB que en los con EPOC (67 por ciento ± 12 vs 54 por ciento ± 9; p = 0,001) al igual que la relación VEF1/CVF posterior a broncodilatador (65 por ciento ± 14 vs 51 por ciento ± 7; p = 0,003). No hubo diferencias en los demás índices espirométricos ni en los gases arteriales. La distancia recorrida en 6 minutos fue similar en ambos grupos de pacientes: 343 m (69 por ciento) en LCFA-TB y 361 m (76 por ciento) en EPOC. No hubo diferencias en la oximetría ni en la frecuencia cardíaca inicial ni final. En cambio, los pacientes con LCFA-TB presentaron una frecuencia respiratoria (FR) más elevada que los pacientes con EPOC, tanto al comienzo (22,7 ± 4,7 vs 19,8 ± 3,1; p = 0,05) como al final de la prueba (27,3 ± 6,7 vs 21,9 ± 3,3; p = 0,01). Aunque no hubo diferencias en el grado de disnea (escala de Borg: 1 ±0,7 vs 1 ± 0,5 inicial, 3 ± 1,5 vs 2,5 ± 0,8 final). Además, existió una correlación significativa entre la FR y los puntos de la escala de Borg al inicio de la prueba (r = 0,747; p < 0,001) y al final de ésta (r = 0,507; p = 0,01). En conclusión, los pacientes con LCFA-TB tienen un comportamiento funcional parecido a los pacientes con EPOC, aunque por el componente restrictivo de su limitación ventilatoria presentan más polipnea y tienden a desarrollar más disnea con el ejercicio. La valoración de la respuesta al tratamiento en estos enfermos debiera considerar, además de la espirometría, pruebas de evaluación de disnea como la distancia recorrida en seis minutos.