Afferent vagal stimulation via gastric electrical stimulation alters sympathetic-vagal balance in domestic pigs - a pilot trial.

The disturbance of the sympathetic-vagal balance with increasing sympathetic activity and consecutive increase in cytokine release is a major threat in numerous hyperinflammatory syndromes. Therapeutic interventions that modulate the activity in the sympathetic-vagal system are suggested as an effective treatment in these incidences. The purpose of this pilot study was to investigate the effect of electrical stimulation of the gastric wall on sympathetic-vagal balance. German domestic pigs (n=5) were prepared with a modified gastric tube (mGT) for repetitive gastric electrical stimulation (GES). Electrocardiogram was recorded continuously and heart rate variability (HRV) as measure of sympathetic-vagal activity was calculated for three-minute epochs at baseline condition before GES and during GES condition. In comparison to baseline, activity of the autonomic nervous system (ANS) shifted significantly toward increased dominance of vagal activity during GES with a decrease of normalized low frequency (nLF from 58.00 to 25.52) as marker of sympathetic dominance and parallel increase of normalized high frequency (nHF from 41.48 to 74.16) as marker of vagal dominance. During GES, compared to baseline, no difference in heart rate was found. These results indicate that electrical stimulation of the gastric wall may result in shifting the sympathetic-vagal balance toward a parasympathetic predominance.

[Potential of Information and Communications Technology to Improve Intersectoral Processes of Care: A Case Study of the Specialised Outpatient Palliative Care]. / Potenziale der Informations- und Kommunikationstechnologie zur Optimierung intersektoraler Versorgungsprozesse: Ein Fallbeispiel der spezialisierten ambulanten Palliativversorgung.

OBJECTIVE: The added value of information and communications technologies should be demonstrated precisely in such areas of care in which the importance of intersectoral and interdisciplinary cooperation is particularly high. In the context of the accompanying research of a supply concept for palliative care patients, the potential of a digital documentation process was comparatively analysed with the conventional paper-based workflow. METHODS: Data were collected in the form of a multi-methodological approach and processed for the project in 3 stages: (1) Development and analysis of a palliative care process with the focus on all relevant steps of documentation. (2) Questionnaire design and the comparative mapping of specific process times. (3) Sampling, selection, and analysis of patient records and their derivable insights of process iterations. RESULTS: With the use of ICT, the treatment time per patient is reduced by up to 53% and achieves a reduction in costs and workload by up to 901 min. The result of an up to 213% increase in the number of patient contacts allows a higher continuity of care. Although the 16% increase in documentation loyalty improves the usability of cross-team documented information, it partially extends the workload on the level of individual actors. By using a digital health record around 31% more patients could be treated with the same staffing ratio. CONCLUSIONS: The multi-stage analysis of the palliative care process showed that ICT has a decisive influence on the process dimension of intersectoral cooperation. Due to favourable organisational conditions the pioneering work of palliative care also provides important guidance for a successful use of ICT technologies in the context of innovative forms of care.

Short communication: Effects of analgesic use postcalving on cow welfare and production.

The aim of this study was to assess the welfare and production of cows given an analgesic drug (carprofen, 1.4 mg/kg i.v.) within 6h after calving. The study was performed in a dairy farm with approximately 1,000 milking cows. Behavior, clinical indices, and production data (milk yield and fertility) of cows treated with carprofen (n = 19) or a placebo (n = 20) were compared. Additionally, differences related to parity (primiparous vs. multiparous) were analyzed. No significant differences were observed in the time of placental expulsion or incidence of clinical disease over the 3 d postpartum, but more animals from the analgesia group were observed eating during the first hours after calving.For unassisted calvings, the rectal temperature 24h postpartum was lower in the cows given analgesic. Total lactation yields at 305 d in milk were higher in the primiparous cows treated with carprofen. Fewer cows were pregnant at 220 d postpartum in the treated group as the use of carprofen increased the time from calving to conception. This study suggests that pain management after parturition leads to earlier feed intake after calving and that this may lead to higher milk yield in first-lactation animals.

Breast cancer management and outcome according to surgeon's affiliation: a population-based comparison adjusted for patient's selection bias.

BACKGROUND: Studies have reported that breast cancer (BC) units could increase the quality of care but none has evaluated the efficacy of alternative options such as private BC networks, which is our study objective. PATIENTS AND METHODS: We included all 1404 BC patients operated in the public unit or the private network and recorded at the Geneva Cancer Registry between 2000 and 2005. We compared quality indicators of care between the public BC unit and the private BC network by logistic regression and evaluated the effect of surgeon's affiliation on BC-specific mortality by the Cox model adjusting for the propensity score. RESULTS: Both the groups had high care quality scores. For invasive cancer, histological assessment before surgery and axillary lymph node dissection when indicated were less frequent in the public sector (adjusted odds ratio (OR): 0.4, 95% confidence interval (CI) 0.3-0.7, and OR: 0.4, 95% CI 0.2-0.8, respectively), while radiation therapy after breast-conserving surgery was more frequent (OR: 2.5, 95% CI 1.4-4.8). Surgeon affiliation had no substantial effect on BC-specific mortality (adjusted hazard ratio (HR): 0.8, 95% CI 0.5-1.4). CONCLUSIONS: This study suggests that private BC networks could be an alternative to public BC units with both structures presenting high quality indicators of BC care and similar BC-specific mortality.

[Special training therapy to reduce inflammation in Anti-Jo-1 syndrome]. / Spezielle Trainingstherapie zur Reduktion der Inflammation bei Anti-Jo-1-Syndrom.

A 46-year-old patient was frequently seen with a medically treated Anti-Jo-1 syndrome. The patient had already been treated with azathioprine and oral corticosteroids on account of decreasing lung function, dyspnoea, fatigue, and beginning signs of myositis. Although high doses of steroids and azathioprine were administered, the muscleskeletal syndromes increased steadily. The patient used to be an active long-distance runner (20 km), but now was unable to perform that kind of physical exercise. It was decided to start a treatment with the GalileoTM training device for active muscle training of the lower extremities. Before and after three months of training the following assessment was performed: measurement of health-related quality of life (St. Georges respiratory questionnaire, SGRQ), ultrasound measurement of the cross-sectional area of the quadriceps muscle, 6 minute walk test (6 MWT), lung function testing, and assessment of serum markers of inflammation (TNF-alpha, interleukin-8, CRP, CK, myoglobin). After only two months, training with the GalileoTM five times a week has improved the patient's conditions dramatically. The training will be continued.

A four-parameter system for rationalising the electronic properties of transition metal-radical ligand complexes.

A system of four principal parameters is reported that provides a unified description of the electronic and chemical properties of radical-ligand coordination compounds. This type of parametrisation applies to compositionally different types of radical-ligands, and the principal parameters rank in the following order: (a) coordination mode (metal-ligand orbital alignment) > (b) metal linkage > (c) ligand charge > (d) geometric strain (on orbital overlap). A series of group-10 metal complexes of an open-shell thiolate-arene-thiolate ligand suits to differentiate between three of the four effects in a clear-cut fashion, which allowed sorting these into a semi-quantitative order for the first time. Combined experimental and TD-DFT data aided in distinguishing structural effects from metal specific contributions such as relativistic effects. The applicability of spectroscopic and structure properties to serve as characteristic markers for comparison is discussed with regard to the large body of planar radical-ligand structures.

[On the comprehensibility of German hospital quality reports: systematic evaluation and need for action]. / Zur Verständlichkeit der Qualitätsberichte deutscher Krankenhäuser: Systematische Auswertung und Handlungsbedarf.

OBJECTIVE: This paper focuses on the current resolutions for quality reports of German hospitals as released in 2007 as well as on comprehensibility of these reports for patients. It is meant to analyse the textual information given by these quality reports. Its main objective was to attain a reliable assessment of their comprehensibility for patients on the basis of objective measuring methods. A further goal was to qualify eventual differences between large and small or private and public hospital operators. On the basis of the attained results conclusions on the appropriateness of the current legal situation and the existing criteria for quality reports were to be drawn. METHOD: The textual system part of 200 German hospital reports was analysed as published in the Internet (latest download 28th May, 2007). The selection took place by means of a controlled sample. The sample structure essentially corresponds to the German hospital system structure in terms of bed numbers and its ratio of public and private operators. The analysis measured all formal text patterns as well as technical terms by means of a computer-aided device. The readability index for each text was calculated according to all known readability formulas for the German language. RESULTS: German hospital quality reports are readable only for those patients who dispose of above-average communicative skills. The analysed reports contain more than 10% technical terms while 17% of the chosen words and 60% of all sentences are too long. 10% of all sentences are too complex and 25% comprise more than three technical terms. To understand these texts at least an entrance qualification for higher education is required in accordance to readability indices. The texts' degree of complexity is comparable to that of philosophical papers. Most textual information given by German hospital quality reports is proven to be unreadable and incomprehensible for most patients. There are no fundamental differences concerning hospital size and operator. CONCLUSIONS: The reports' readability and comprehensibility for patients have only scarcely been considered in the current legal resolutions, and there is no undergoing process of improvement. The analysis has shown that there is in fact an urgent need for action. Future reports should therefore ensure that their textual content is formulated in a readable and comprehensible recipient-friendly manner. To enhance customer-oriented transparency within the German public health service patients should be able to fully understand what hospitals want to communicate. Therefore the further process of research will focus on the development of specific criteria for the production of textual reports. This has to be done in co-operation with patients and resident general practitioners.

[Ginkgo biloba extract EGb 761 in the treatment of dementia: evidence of efficacy and tolerability]. / Ginkgo-Spezialextrakt EGb 761(R) in der Behandlung der Demenz: Evidenz für Wirksamkeit und Verträglichkeit.

The Ginkgo biloba extract EGb 761 interferes with pathomechanisms relevant to dementia, such as Abeta aggregation, mitochondrial dysfunction, insulin resistance, and hypoperfusion. The efficacy of EGb 761 in the treatment of dementia (Alzheimer's disease and vascular dementia) has been studied in 10 randomised, controlled, double-blind clinical trials. In three of the four large trials conducted in accordance with recent recommendations EGb 761 was significantly superior to placebo with respect to cognitive performance and one or more further (global, functional or behavioural) outcomes demonstrating the clinical relevance of the findings. The findings from the six smaller trials are in line with those of the large trials. One trial was inconclusive, but of questionable external validity due to uncommonly rigorous patient selection. Subgroup analyses of this study together with the findings from the most recent clinical trial suggest that EGb 761 may be most beneficial to patients with neuropsychiatric symptoms, who actually constitute the majority of dementia patients. Delay in symptom progression, rates of clinically significant treatment response and numbers needed to treat (NNT) found for EGb 761 are in the same range as those reported for cholinesterase inhibitors. In an exploratory trial comparing EGb 761 and donepezil, no statistically significant or clinically relevant differences were seen. Hence, EGb 761 has its place in the treatment of dementia.

Lornoxicam characteristically modulates cerebral pain-processing in human volunteers: a functional magnetic resonance imaging study.

BACKGROUND: Lornoxicam like other non-steroidal anti-inflammatory drugs (NSAIDs) is widely used for postoperative pain therapy. Evaluation of the effect of lornoxicam on cerebral processing of surgical pain was thus the aim of the present functional magnetic resonance imaging (fMRI) study. METHODS: An fMRI-compatible pain model that mimics surgical pain was used to induce pain rated 4-5 on a visual analogue scale (VAS) at the anterior margin of the right tibia in volunteers (n=22) after i.v. administration of saline (n=11) or lornoxicam (0.1 mg kg(-1)) (n=11). RESULTS: Lornoxicam, which significantly reduced pain sensation [VAS: mean (sd) 4.6 (0.7) vs 1.2 (1.5)], completely suppressed pain-induced activation in the SII/operculum, anterior cingulate cortex, insula, parietal (inferior), prefrontal (inferior, medial), temporal (inferior, medial/superior) lobe, cerebellum, and contralateral (e.g. left-sided) postcentral gyrus (SI). Only the hippocampus and the contralateral superior parietal lobe (BA 7) were activated. CONCLUSIONS: As compared with saline, lornoxicam typically suppressed pain-induced brain activation in all regions except the hippocampus. Furthermore, de novo activation was found in the contralateral, superior parietal lobe (BA 7).

Consequences of one-lung flooding: a histological and immunological investigation.

BACKGROUND: Videothoracoscopic lung sonography after partial fluid instillation could be a new method for endoscopic detection of lung lesions. Histopathological consequences of unilateral diagnostic or therapeutic lung flooding under bronchoalveolar lavage has yet to be defined. The aim of the study was to investigate histological and immunohistological alterations induced by one-lung flooding (OLF). METHODS: 13 female pigs were subjected to OLF (15 ml isotonic electrolyte solution per kg for 60 minutes), and lung tissue was collected 30 minutes, 2 hours, 24 hours, 48 hours, 6 days, 8 days, and 10 weeks after flooding. Histological examinations and immunohistochemical labeling for surfactant protein A (SP-A) were performed. Cellular proliferation was measured by Ki67 immunohistochemical labeling. Apoptosis was detected through enzymatic in-situ labeling of apoptosis-induced DNA strand breaks by means of the TUNEL (TdT-mediated dUTP nick end labeling) method. RESULTS: Histological analyses revealed the presence of inflammatory cell infiltrates in the interstitium at 24 hours after OLF. However, no destruction of the alveolar wall and no pulmonary oedema were observed. In addition, OLF was not associated with any decrease in surfactant protein A immunoreactivity. Two hours after OLF, the number of apoptotic cells was increased (OLF: 7% vs. CONTROL: 0.6%, p < 0.05), but cellular proliferation was unchanged. Conversely, at 48 h after OLF, the number of apoptotic cells had returned to control levels, but cellular proliferation had increased (OLF: 5% vs. CONTROL: 1.1%, p < 0.05). Cellular proliferation returned to baseline levels eight days after OLF. CONCLUSIONS: These data demonstrate that OLF is not associated with destruction of the alveolar texture, atelectasis-provoking surfactant loss, or any irreversible damage to the pulmonary parenchyma. Lung flooding for the purpose of videothoracoscopic lung sonography is safe and justifiable. But repeated lung flooding under bronchoalveolar lavage involving the same lung area within 1 week is not to be recommended.

[Preparation for clinical introduction of advanced laparoscopic procedures: laparoscopic renal autotransplantation]. / Vorbereitung zur klinischen Etablierung fortgeschrittener urologischer Operationstechniken: Laparoskopische Autotransplantation am Tiermodell.

BACKGROUND: After long term clinical training at teaching hospitals, individuals or complete teams have reported on the establishment of laparoscopic nephrectomy and prostatectomy. This, however, is difficult to realize at many clinics due to the current staffing situation. In the following an alternative approach will be presented. METHODS: After 50 hours of practice on a pelvic trainer during which the laparoscopic handling and especially various suturing techniques were learnt (A) a total of 15 pigs (approx. 40 kg, in general aesthesia, right sided positioned, with 7 ports) have been operated from February to August 2006: 1. laparoscopic nephrectomy, 2. laparoscopic in-situ cold perfusion, 3. laparoscopic renal autotransplantation (B). Directly after this a two month clinical training at a recognized laparoscopic center took place (C). RESULTS: After completion of phase A, an extended experimental operation phase B followed, marked by complications such as: bleeding (n=5), skin emphysemas (n=3), technical failures (n=2), non-optimal placement of ports (n=6), problems with placement the cold perfusion catheters (n=7), and unsuitable surgical instruments (n=2). Eleven laparoscopic nephrectomies were successful; only during the last three operations a sufficient end-to side anastomosis has been achieved (anastomosis time range 80110 min of which was 50% in cold ischemia). During the external clinical training (C) (through 2. and 1. assistance) five endoscopic extraperitoneal prostatectomies (surgery time range 145-235 min) and two radical nephrectomies have been independently carried out (180-230 min). CONCLUSIONS: Using the pig model laparoscopic renal autotransplantation ideally combines ablative and reconstructive operation techniques. For this reason it is especially suitable for young urologists learning to perform nephrectomies and prostatectomies. For beginners in laparoscopy this entails long but mentor independent learning phases A, B thereby shortening the subsequent clinical training at the teaching hospital (C).

Anodic cell-protein deposition on inverse inkjet printed micro structured gold surfaces.

The transformation of fibrinogen into fibrin is biologically activated in a complex multi-step process known as the coagulation cascade. This transformation can also be triggered by anodic surfaces. It has been suggested that this mechanism is a result of an electron transfer from the anode to the fibrinogen molecule resulting in the formation of fibrin. In this study we used this pathway to simultaneously deposit vital cells (fibroblasts and keratinocytes) and fibrin on micro structured gold electrodes. The electrodes were produced using a novel inverse inkjet-printing technology in combination with subsequent gold-sputtering, resulting in minimal structure-sizes of 35 microm (+/-6 microm). Cell deposition and fibrin-coagulation were found to occur on the anode only, following exactly the micro structured electrode surface. Successful deposition was limited by the minimal voltage (0.8 V) needed for the formation of fibrin and the maximum voltage (1.85 V) resulting in the deterioration of the Au-electrodes due to electrolysis and possible damaging of the deposited cells due to the formation of molecular chlorine. Furthermore, it was demonstrated that this technique is suitable to co-cultivate different cell types in a layered fashion. Subsequent to the electrically mediated anodic cell-protein deposition, cells were cultivated for up to 4 days and then characterized by vital fluorescence staining, methyl violet-staining and scanning electron microscopy. Cell-vitality was found to be dependent on the experimental setup; in this study non-vital cells were only observed, when sequentially depositing two different cell types. Finally, the coagulation mechanism was studied using HPLC, SDS-gel-chromatography and ATR/FTIR.

[CT-guided interventions in children]. / Computertomografisch gesteuerte Interventionen bei Kindern.

In pediatric CT-guided interventions specific features have to be taken into account. Due to a lack of cooperation or limited ability to cooperate, procedures are often performed using analgosedation or general anesthesia. To provide radiation protection, justified indication for CT-guided intervention is necessary and sonography and MRI are to be preferred whenever possible. CT examinations also need to be dose-adapted with sequential scanning and a tube voltage and tube current reduction compared to pediatric diagnostic CT studies must be ensured. Gonad shields are recommended for male patients. Biopsy device selection depends on the assumed tumor entity since histology and also immunohistochemical, molecular pathological and cytogenetical analysis are necessary to differentiate pediatric tumors (small, round, blue cell tumors). In addition to diagnostic procedures, therapeutic interventions (drainage, injection therapies, neurolysis, and radiofrequency ablation) can also be used in children and can provide an alternative to surgery in selected cases. With justified indications and precise performance, CT-guided interventions can be successful in pediatric patients with limited risks.

[Urethroplasty with tissue matrix. Microsurgical animal experiments with small intestinal submucosa]. / Urethroplastik mit Gewebematrix. Mikrochirurgische Tierexperimente mit "small intestinal submucosa".

BACKGROUND: The purpose of this study was to examine whether use of small intestinal submucosa in microsurgical urethroplasty in Wistar rats represents an alternative. METHODS: In 20 Wistar rats microsurgical urethroplasty with small intestinal submucosa was done to repair distal or proximal urethral defects. Four weeks later urethral calibration and urethrography were performed in addition to histological studies. RESULTS AND CONCLUSIONS: Of the 20 animals, 19 survived the observation period without evidence of fistulas, strictures, stenoses, or necroses. The histological results confirmed an intact tissue layer.

Perspectives for the tissue engineering of cartilage from a biological and biomaterial point of view.

Tissue engineering has become a fast growing interdisciplinary branch of research at the interface between life and engineering sciences with important clinical end-points. In this context the regeneration of articular cartilage represents an exciting challenge since hyaline cartilage has a limited capacity for self-repair. Today the use of different scaffold materials combined with in vitro expanded chondrocytes and signalling molecules poses great hopes for an optimal treatment of articular cartilage defects. However, until today the optimal construct of scaffolds, cells and signalling molecules has not yet been found. Since repair and regeneration recapitulate in part ontogenetic processes, the present paper summarizes the regulative mechanisms of endochondral ossification in the growth plate of the long bones to identify possible new signalling molecules for the improvement of tissue engineering-based solutions in the treatment of cartilage defects. The growth plate represents a highly organized structure of chondrocytes and extracellular matrix components in distinguishable proliferation and differentiation stages. It is regulated by various paracrine and hormonal factors. In a second part we present actual trends in scaffold design based on synthetic polymers and natural polymers, stressing their potential use in the regeneration of cartilage defects from the point of view of bioactivity and biocompatibility. In conclusion, both new signalling molecules from basic research and innovative scaffold materials with variable physico-chemical properties open up new and interesting perspectives for the research in optimized tissue engineeredbased therapeutic strategies to treat cartilage defects.

Coordination chemistry of stannylene-based Lewis pairs - insertion into M-Cl and M-C bonds. From base stabilized stannylenes to bidentate ligands.

The coordination chemistry of intramolecular stannylene phosphorus Lewis pairs incorporated into four membered ring systems is presented. Previously reported coordination chemistry of stannylene and phosphorus towards palladium(0) is extended by using Pd(nbe)3 as a precursor, yielding co-ligand free complexes. An equilibrium of one or two stannylene phosphorus ligands coordinated to Pd(0) was observed with tin acting either as a donor or an acceptor towards palladium. Furthermore, the reactions with transition metal(i) chlorides, [(cod)IrCl]2, [(cod)RhCl]2 and Me2SAuCl are reported. They proceed via insertion of stannylene into the M-Cl bonds, yielding metal complexes with chelating stannide phosphorus ligands. For gold, a dinuclear complex with bridging P-Sn ligands was formed. Furthermore, the reaction of a P → Sn Lewis pair in a three membered ring system with (cod)PtMe2 is reported.

Development of somatosensory-evoked potentials in foetal sheep: effects of betamethasone.

AIM: Antenatal glucocorticoids are used to accelerate foetal lung maturation in babies threatened with premature labour. We examined the influence of glucocorticoids on functional and structural maturation of the central somatosensory pathway in foetal sheep. Somatosensory-evoked potentials (SEP) reflect processing of somatosensory stimuli. SEP latencies are determined by afferent stimuli transmission while SEP amplitudes reveal cerebral processing. METHODS: After chronic instrumentation of foetal sheep, mothers received saline (n = 9) or three courses of betamethasone (human equivalent dose of 2 × 110 µg kg-1 betamethasone i.m. 24 h apart, n = 12) at 0.7, 0.75 and 0.8 of gestational age. Trigeminal SEP were evoked prior to, 4 and 24 h after each injection and at 0.8 of gestational age before brains were histologically processed. RESULTS: Somatosensory-evoked potentials were already detectable at 0.7 of gestation age. The early and late responses N20 and N200 were the only reproducible peaks over the entire study period. With advancing gestational age, SEP latencies decreased but amplitudes remained unchanged. Acutely, betamethasone did not affect SEP latencies and amplitudes 4 and 24 h following administration. Chronically, betamethasone delayed developmental decrease in the N200 but not N20 latency by 2 weeks without affecting amplitudes. In parallel, betamethasone decreased subcortical white matter myelination but did not affect network formation and synaptic density in the somatosensory cortex. CONCLUSION: Somatosensory stimuli are already processed by the foetal cerebral cortex at the beginning of the third trimester. Subsequent developmental decrease in SEP latencies suggests ongoing maturation of afferent sensory transmission. Antenatal glucocorticoids affect structural and functional development of the somatosensory system with specific effects at subcortical level.

Estradiol prodrugs (EP) for efficient oral estrogen treatment and abolished effects on estrogen modulated liver functions.

Oral compared to parenteral estrogen administration is characterized by reduced systemic but prominent hepatic estrogenic effects on lipids, hemostatic factors, GH-/IGF I axis, angiotensinogen. In order to avoid such adverse metabolic effects of oral treatment, estradiol (E2) prodrugs (EP) were designed which bypass the liver tissue as inactive molecules. Carbone17-OH sulfonamide [-O2-NH2] substituted esters of E2 (EC508, others) were synthesized and tested for carbonic anhydrase II (CA-II) binding. CA II in erythrocytes is thought to oppose extraction of EP from portal vein blood during liver passage. Ovariectomized (OVX, day minus 14) rats were orally treated once daily from day 1-3. Sacrifice day 4. Uteri were dissected and weighed. Cholesterol fractions and angiotensinogen were determined in plasma. Oral E2 and ethinyl estradiol (EE) generated dose related uterine growth and important hepatic estrogenic effects. EP induced uterine growth at about hundred-fold lower doses. This was possible with almost absent effects on plasma cholesterol or angiotensinogen. Preliminary pharmacokinetic studies with EC508 used intravenous and oral administration in male rats. Resulting blood levels revealed complete oral bioavailability. Further high blood- but low plasma concentrations indicated erythrocyte binding of EC508 in vivo as potential mechanism of low extraction at liver passage. Very high systemic estrogenicity combined with markedly lower or absent adverse hepatic estrogenic effects is evidence for a systemic release of E2 from sulfonamide EP. In conclusion, tested oral EP bypass the liver in erythrocytes furnishing systemic estradiol at hydrolysis. This mechanism avoids the hepatic estrogenic impact of conventional oral estrogen therapy.

Gentamicin coating of plasma chemical oxidized titanium alloy prevents implant-related osteomyelitis in rats.

Implant related infection is one of the most feared and devastating complication associated with the use of orthopaedic implant devices. Development of anti-infective surfaces is the main strategy to prevent implant contamination, biofilm formation and implant related osteomyelitis. A second concern in orthopaedics is insufficient osseointegration of uncemented implant devices. Recently, we reported on a macroporous titanium-oxide surface (bioactive TiOB) which increases osseointegration and implant fixation. To combine enhanced osseointegration and antibacterial function, the TiOB surfaces were, in addition, modified with a gentamicin coating. A rat osteomyelitis model with bilateral placement of titanium alloy implants was employed to analyse the prophylactic effect of gentamicin-sodiumdodecylsulfate (SDS) and gentamicin-tannic acid coatings in vivo. 20 rats were randomly assigned to four groups: (A) titanium alloy; PBS inoculum (negative control), (B) titanium alloy, Staphylococcus aureus inoculum (positive control), (C) bioactive TiOB with gentamicin-SDS and (D) bioactive TiOB plus gentamicin-tannic acid coating. Contamination of implants, bacterial load of bone powder and radiographic as well as histological signs of implant-related osteomyelitis were evaluated after four weeks. Gentamicin-SDS coating prevented implant contamination in 10 of 10 tibiae and gentamicin-tannic acid coating in 9 of 10 tibiae (infection prophylaxis rate 100% and 90% of cases, respectively). In Group (D) one implant showed colonisation of bacteria (swab of entry point and roll-out test positive for S. aureus). The interobserver reliability showed no difference in the histologic and radiographic osteomyelitis scores. In both gentamicin coated groups, a significant reduction of the histological osteomyelitis score (geometric mean values: C = 0.111 ± 0.023; D = 0.056 ± 0.006) compared to the positive control group (B: 0.244 ± 0.015; p < 0.05) was observed. The radiographic osteomyelitis scores confirmed these histological findings.

Gastric inhibitory polypeptide. Its physiologic release and insulinotropic action in the dog.

Studies were carried out in conscious dogs in which the immunoreactive gastric inhibitory polypeptide (IR-GIP) response to graded doses of oral fat (triglycerides) and glucose was investigated. The IR-GIP response to the doses of triglycerides used was greater and more prolonged than the response to the glucose loads employed. In addition, the relative insulinotropic potencies of exogenous porcine GIP and IR-GIP released by fat as against those released by oral glucose were assessed. When glucose was administered by the oral route, the immunoreactive insulin (IRI) response was magnified above the IRI response to a comparable intravenous glucose load. The serum IRI response to oral glucose was accompanied by a concomitant rise in serum IR-GIP levels, suggesting a causal relationship. IR-GIP released by oral fat was shown to augment the IRI response to an intravenous glucose load, resulting in an improvement of glucose tolerance. Fat-released IR-GIP augmented IRI levels to a lessor degree than either oral glucose or an infusion of porcine GIP.