Challenging the in-vivo assessment of biomechanical properties of the uterine cervix: A critical analysis of ultrasound based quasi-static procedures.

Measuring the stiffness of the uterine cervix might be useful in the prediction of preterm delivery, a still unsolved health issue of global dimensions. Recently, a number of clinical studies have addressed this topic, proposing quantitative methods for the assessment of the mechanical properties of the cervix. Quasi-static elastography, maximum compressibility using ultrasound and aspiration tests have been applied for this purpose. The results obtained with the different methods seem to provide contradictory information about the physiologic development of cervical stiffness during pregnancy. Simulations and experiments were performed in order to rationalize the findings obtained with ultrasound based, quasi-static procedures. The experimental and computational results clearly illustrate that standardization of quasi-static elastography leads to repeatable strain values, but for different loading forces. Since force cannot be controlled, this current approach does not allow the distinction between a globally soft and stiff cervix. It is further shown that introducing a reference elastomer into the elastography measurement might overcome the problem of force standardization, but a careful mechanical analysis is required to obtain reliable stiffness values for cervical tissue. In contrast, the maximum compressibility procedure leads to a repeatable, semi-quantitative assessment of cervical consistency, due to the nonlinear nature of the mechanical behavior of cervical tissue. The evolution of cervical stiffness in pregnancy obtained with this procedure is in line with data from aspiration tests.

[Prediction of psychosis by stepwise multilevel assessment--the Basel FePsy (Early Recognition of Psychosis)-Project]. / Vorhersage von Psychosen durch stufenweise Mehrebenenabklärung--Das Basler FePsy(Früherkennung von Psychosen)-Projekt.

BACKGROUND: We have conducted various studies in Basel with the aim of improving the methods for the early detection of psychosis (Früherkennung von Psychosen, FePsy). METHODS: From 1.3.2000 to 29.2.2004 234 individuals were screened using the Basel Screening Instrument for Psychosis (BSIP). 106 patients were identified as at risk for psychosis; out of these 53 remained in follow-up for up to 7 years (mean 5.4 years). The assessments were done with a specifically developed instrument for history taking, various scales for the psychopathology, assessments of neuropsychology and fine motor functioning, clinical and quantitative EEG, MRI of the brain, laboratory etc. RESULTS: Based on the BSIP alone, a relatively reliable prediction was possible: 21 (39.6%) of the individuals identified as at risk developed psychosis within the follow-up time. Post-hoc prediction could be improved to 81% by weighting psychopathology and including neuropsychology. Including the other domains obviously allows further improvements of prediction. CONCLUSIONS: The risk for psychosis should be assessed in a stepwise procedure. In a first step, a clinically oriented screening should be conducted. If an at-risk status is found, further assessments in various domains should be done in a specialised centre.

Rapid comprehensive characterization of crude oils by thermogravimetry coupled to fast modulated gas chromatography-single photon ionization time-of-flight mass spectrometry.

Comprehensive multi-dimensional hyphenation of a thermogravimetry device (i.e. a thermobalance) to gas chromatography and single photon ionization-time-of-flight mass spectrometry (TG-GC×SPI-MS) has been used to investigate two crude oil samples of different geographical origin. The source of the applied vacuum ultraviolet radiation is an electron beam pumped rare gas excimer lamp (EBEL). The soft photoionization favors the formation of molecular ions. Introduction of a fast, rapidly modulated gas chromatographic separation step in comparison with solely TG-SPI-MS enables strongly enhanced detection especially with such highly complex organic matrices as crude oil. In contrast with former TG-SPI-MS measurements, separation and identification of overlying substances is possible because of different GC retention times. The specific contribution of isobaric compounds to one mass signal is determined for alkanes, naphthalenes, alkylated benzenes, and other compounds.

Rapid on-site detection of explosives on surfaces by ambient pressure laser desorption and direct inlet single photon ionization or chemical ionization mass spectrometry.

Considering current security issues, powerful tools for detection of security-relevant substances such as traces of explosives and drugs/drug precursors related to clandestine laboratories are required. Especially in the field of detection of explosives and improvised explosive devices, several relevant compounds exhibit a very low vapor pressure. Ambient pressure laser desorption is proposed to make these substances available in the gas phase for the detection by adapted mass spectrometers or in the future with ion-mobility spectrometry as well. In contrast to the state-of-the-art thermal desorption approach, by which the sample surface is probed for explosive traces by a wipe pad being transferred to a thermal desorber unit, by the ambient pressure laser desorption approach presented here, the sample is directly shockwave ablated from the surface. The laser-dispersed molecules are sampled by a heated sniffing capillary located in the vicinity of the ablation spot into the mass analyzer. This approach has the advantage that the target molecules are dispersed more gently than in a thermal desorber unit where the analyte molecules may be decomposed by the thermal intake. In the technical realization, the sampling capillary as well as the laser desorption optics are integrated in the tip of an endoscopic probe or a handheld sampling module. Laboratory as well as field test scenarios were performed, partially in cooperation with the Federal Criminal Police Office (Bundeskriminalamt, BKA, Wiesbaden, Germany), in order to demonstrate the applicability for various explosives, drugs, and drug precursors. In this work, we concentrate on the detection of explosives. A wide range of samples and matrices have been investigated successfully.

[Position paper nuclear cardiology: update 2008]. / Positionsbericht Nuklearkardiologie Update 2008: Aktueller Stand der szintigraphischen Methodik.

Nuclear cardiology is well established in clinical diagnostic algorithms for many years. This is an update 2008 of the first common position paper of the German Association of Nuclear Medicine and the German Association of Cardiology, Heart and Circulation Research published in 2001 aiming at an overview of state-of-the-art scintigraphic methods.

Efficacy, safety and tolerability of recombinant factor VIII (REFACTO) in patients with haemophilia A: interim data from a postmarketing surveillance study in Germany and Austria.

An open-label, multicentre, postmarketing surveillance study conducted in Germany and Austria with recombinant factor VIII (REFACTO) has enrolled 217 patients (mean age 26.3 years) from 38 haemophilia centres during the first 4.8 years. Most patients (188/217; 86.6%) had severe to moderately severe haemophilia A, of whom 153 completed sufficient diary information for the main efficacy analysis. These 153 patients experienced a median of 6.6 (interquartile range 1.4-18.6) bleeding episodes per year. Patients treated with prophylaxis experienced a median of 4.4 (1.1-9.3) bleeds per year, while patients treated on-demand experienced a median of 22.8 (11.3-29.0) bleeds per year. Overall, most physicians (41/43 [95.3%]) were 'very satisfied' or 'satisfied' with the efficacy of REFACTO in the treatment of bleeding episodes. A total of 137 non-serious adverse events have been reported in 52/217 patients (24.0%) to date. In addition, 129 serious adverse events in 87 patients (40%) were reported, including 41 cases of 'less than expected therapeutic effect' (LETE). Of these, 39 LETE cases were reported in one centre; however, patients in this centre experienced considerably fewer bleeding episodes per year than patients outside this centre. Overall, six patients (2.8%) have developed de novo inhibitors, three of which were considered high titre. Four of these patients were at high risk (0-50 exposure days [ED]) of inhibitor formation, one was at intermediate risk (51-100 ED) and one was at low risk (>100 ED). These results emphasize the benefit of postmarketing surveillance and, overall, this study confirms the efficacy, safety and tolerability of REFACTO in the treatment of patients with haemophilia A.

Comparison of the performance of microtube column systems and solid-phase systems and the tube low-ionic-strength solution additive indirect antiglobulin test in the detection of red cell alloantibodies.

To compare the performance of seven currently available test systems in the detection of erythrocyte alloantibodies (ab), we tested in parallel 446 sera samples containing red cell ab [368 sera samples with ab that are assumed to be clinically significant (cs-ab) and 78 sera samples with ab that are assumed to be of minor clinical significance (ms-ab)] using the tube spin low-ionic-strength solution (addition method) indirect antiglobulin test (tube LISS-IAT), three microtube column agglutination techniques (DiaMed-ID, Ortho BioVue and Bio-Rad Scangel), one affinity adherence test system (CLB/Mast CellBind Screen) and two solid-phase tests [Biotest Solidscreen II and Immucor Capture-R Ready-Screen (4)]. To address the specificity of the three test systems under routine conditions, results of 4566 patient samples obtained using the tube LISS-IAT, results of 5205 patient samples obtained using the Scangel and results of 3560 samples obtained using the Capture-R were evaluated. The DiaMed-ID detected 344 cs-ab and 43 ms-ab, BioVue 333 cs-ab and 48 ms-ab, Scangel 348 cs-ab and 62 ms-ab, CellBind Screen 346 cs-ab and 47 ms-ab, Solidscreen 330 cs-ab and 38 ms-ab, Capture-R 358 cs-ab and 45 ms-ab and LISS-IAT 159 cs-ab and 12 ms-ab. In routine practice, erythrocyte cs-ab could be identified in 61 (67.8%) of 90 reactive sera (specificity: 98.6%) in the tube LISS-IAT, in 169 (58.7%) of 288 (94.4%) in Bio-Rad Scangel and in 101 (51.0%) of 198 reactive sera (94.3%) in Capture-R. We conclude that the sensitivity of the microcolumn, affinity adherence and solid-phase test systems in the detection of cs-ab was similar and was markedly superior to that of the conventional tube LISS-IAT. All high-sensitive test systems produced higher rates of false positives and ms-ab compared to the tube test. An individual cost-benefit analysis, considering the recent knowledge about the clinical significance of weak-reactive cs-ab, should be performed in every institution to decide whether and if so which high-sensitive screening system should be applied.

Hepatitis B virus vaccination of blood donors--what costs may be expected?

Although the risk of transfusion-transmitted hepatitis B virus (TT-HBV) infection is very low, it still exists. Therefore, introduction of further precautions to reduce this risk is discussed at present. However, so far no data are available about the HBV vaccination status among blood donors (BDs). We compared HBV vaccination status of apheresis donors (ADs) of a university based and whole BDs (WBDs) of a Red Cross blood donation service using a standardized questionnaire. On the basis of these data, the estimated costs over 10 years for HBV vaccination were calculated for two different strategies and compared with the costs for HBV nucleic acid amplification technology (NAT) testing. 22.3% of the WBDs and 41.2% of the ADs indicated having received at least one HBV vaccine dose. This difference was related to the different demographic structures of the two BD populations (BDPs). With regard to the primary costs for the blood donation service, HBV vaccination of BDs could be an alternative to HBV NAT testing, especially for BDPs with an already high HBV vaccination rate and a high donation frequency.

Treatment patterns and cost-of-illness of severe haemophilia in patients with inhibitors in Germany.

To evaluate current treatment patterns and resource utilization as well as related cost in the management of severe haemophilia patients with inhibitors in Germany, a cost-of-illness study was conducted. Generally, data were generated by structured literature search. Missing data were collected by expert interviews. All data were validated by a panel of German experts in haemophilia care. In Germany, immune tolerance therapy (ITT) is first-line therapy in inhibitor management for children in the initial year after inhibitor development, particularly for high responders (HR). In adult HR patients ITT is applied but to a remarkably lower extent than in children. To treat bleeding episodes, factor VIII (FVIII) is first-line therapy in low responders (LR). For paediatric HR patients, bleeds are mainly treated with recombinant FVIIa (rFVIIa). In adult HR patients, activated prothrombin complex concentrate (aPCC) and rFVIIa are more equally distributed as treatment options. Treatment costs were calculated for paediatric patients (15 kg) and adult patients (75 kg) from third party payers' perspective. Cost for ITT ranges from Euro 70,290 (2 months; LR) to Euro 3 812,400 (24 months; with aPCC; HR) in a paediatric patient. For an adult patient ITT cost ranges from Euro 287,500 (6 months; LR) to Euro 17,253,000 (36 months; HR). For on average 12.5 acute bleeds, average annual treatment costs amount to Euro 77,000 for a child and Euro 354,000 for an adult. Assessing the results it has been taken into consideration that ITT can last longer and annual number of bleeds can be extremely higher than on average 12.5 episodes. This indicates more health care resource consumption in some patients.

[Computer based documentation of ultrasound data]. / EDV-unterstützte Dokumentation von Ultraschalluntersuchungen.

Usually, hospitals and private doctors are well equipped with computers. However, the documentation of ultrasound data is commonly paper-based. The paper presents a computer-based ultrasound data recording and reporting, using the ultrasound documentation software Digisono.

[Prenatal ultrasonography in Switzerland--a repersentative national survey] . / Schwangerschaftsultraschall in der Schweiz--eine repräsentative nationale Erhebung.

BACKGROUND: The cost-effectiveness ratio of routine ultrasound during pregnancy has been debated for years. However, there is a lack of population based data concerning both costs and benefit. AIM: Population based survey of ultrasound examinations (US) during pregnancy in Switzerland with respect to quantity, indications and results; estimation of total costs, the proportion paid by health insurance and the costs for routine US. METHOD: During a representative week all certified physicians and obstetrical out-patient departments in Switzerland were asked to participate in an anonymous questionnaire based national survey on the use of ultrasound during pregnancy. RESULTS: With 62.9% of the physicians and 90.6% of the out-patient departments participating a total of 6455 questionnaires were returned. On average, 4.6 US were done per pregnancy or about 520,000 scans per year. At a mean price of $ 50 per scan total costs equalied $ 26 million a year. $ 19.5 million were covered by health insurance and the rest was not billed by the physicians. The indication for the scan was a medical problem in 48%, a routine scan in 36.9% of cases a first and a second trimester scan is paid for and in 15.1% reassurance of either the women or the physician. Abnormal results were found in 40.7% of medical indications, in 15% of routine scans and in 12.6% of reassurance cases. CONCLUSION: The considerable number of scans done for reasons of reassurance and not changed for does support our hypothesis that ultrasound during pregnancy has become a tool to routinely check the general state of the fetus comparable to the stethoscope of the general practitioner. One in seven US yielded a pathological result. Maximal cost savings for the health insurance amount to about 9 million a year. This amount has to be balanced by the health benefit, respectively if routine US were abolished.

[Value of panendoscopy in assessment of mouth cavity, pharyngeal and laryngeal cancers]. / Wertigkeit der Panendoskopie in der Abklärung von Mundhöhlen-, Pharynx- und Larynxkarzinomen.

The concept of multiple squamous cell carcinoma in the region of the upper aerodigestive tract was first described over 100 years ago by Billroth. The aim of our study was to assess the incidence of synchronous and metachronous second primary tumours and refine the role of panendoscopy in diagnosing them. The charts of 358 patients presenting for initial treatment of primary squamous cell carcinoma of the upper aerodigestive tract between January 1990 and December 1995 were reviewed. The incidence of second primary tumours was 16.2%, 6.4% being synchronous and 9.8% metachronous. In only 3.1% of all patients was a synchronous tumour clinically silent and only revealed by panendoscopy. Synchronous tumours were most likely to be located in the oral cavity, pharynx or larynx (61%), whereas metachronous second primary tumours were most likely to be located in the lung (57%). Though the incidence of synchronous second primary tumours revealed by routine panendoscopy is low (3%), we still recommend this investigation because it is often necessary for exact assessment of the first primary tumour. Further, it is ideal for training in the use of rigid endoscopy. In our opinion panendoscopy involves minimal time, cost and morbidity.

A survey of blood utilization in children and adolescents in a German university hospital.

There are no detailed data on blood use with regard to diagnoses of recipients during infancy, childhood and adolescence. Available information on this issue is incomplete and no longer current. We conducted a survey of blood component use in children and adolescents in an acute-care university hospital in the greater area of Nuremberg between June 1994 and September 1996. Packed red blood cells (RBCs), fresh-frozen plasmas (FFPs) and platelet (PLT) components were evaluated for the recipients discharge diagnoses. Source study files were extracted from the hospital transfusion service and the medical records department. Transfused units were listed by broad diagnostic categories and leading diagnostic groups formed from principal diagnoses of the recipients according to the International Classification of Diseases, 9th edn (ICD-9). 34.3% of 2869 RBC cell units, 35.0% of 1095 FFP units and 5.0% of 1028 PLT components were used in patients with congenital diseases, mainly cardiac defects. The disease category neoplastic diseases was next most frequently associated with blood transfusion diagnosed in recipients of 23.9% of all RBCs, 15.6% of all FFP units and in 66.4% of all PLT units. Malignant diseases and benign haematological diseases (diagnostic categories II and IV) accounted for 68.9% of all costs of blood component transfusion. These findings demonstrate the increased importance of platelet transfusion for the organization of local and regional blood donation programmes and for cost analysis exercises. The study shows that detailed information on local blood use may be obtained quickly using available data collections of transfusion services and medical record departments.

Noninvasive assessment of coronary artery bypass patency: determination of myocardial thallium-201 washout rates.

This prospective study was undertaken to investigate the response of thallium-201 washout rates to coronary artery bypass surgery. Thirty-four patients with coronary heart disease were studied before and after coronary artery bypass grafting, 27 patients with normal coronary arteries serving as controls. All patients underwent cardiac catheterization and thallium-201 serial imaging, including assessment of myocardial washout rates. Pre-operatively, thallium-201 washout rates yielded a considerably higher sensitivity in detection of coronary artery disease, without significant loss of specificity compared to qualitative evaluation of serial static thallium-201 scintigrams. Post-operatively, 50 of 57 segments supplied by a patent graft showed normal washout rates, while in 9 out of 11 segments an occlusion of the graft was indicated by decreased washout rates. Compared to pre- and post-operative qualitative interpretation of static thallium-201 images, the post-operative assessment of washout rates increased both sensitivity (82% vs. 64%) and specificity (88% vs. 77%) for the evaluation of bypass graft patency. Thus, quantitative assessment of thallium-201 washout rates improves the diagnostic reliability of noninvasive detection of myocardial ischaemia with regard to the evaluation of coronary artery bypass graft patency.

Processing of 201T1 serial images for the assessment of myocardial clearance and redistribution.

Regional activity changes over the myocardium after IV injection of 201T1 were assessed in 90 patients by applying a superposition algorithm for paired images. The kinetics were expressed as quotients C1/C2 of the initial divided by the delayed count rate within any myocardial segment. Regarding the total left ventricular myocardium, normal subjects showed count rate ratios (C30 min/C4 h) of 1.75 +/- 0.075 (SD, n = 19) when the nuclide was injected under submaximal (80% of maximum) exercise. In patients with triple-vessel disease (n=21) the corresponding values were 1.46 +/- 0.05, in single-vessel (n=14) disease the quotients averaged 1.62 +/- 0.12. Average quotients in poststenotic myocardial segments increased from 1.46 before to 1.73 following bypass surgery in cases of graft patency (n=8), while a decrease was observed in a patient with occlusion of the bypass graft. In small-vessel disease and in congestive cardiomyopathy, global values of 1.50 +/- 0.07 (n=7) and 1.53 +/- 0.12 (n=19) were obtained. The display of C1/C2 matrices provided typical patterns in uptake defects caused by ischemic heart disease and by congestive cardiomyopathy. The procedure described may provide diagnostic information in addition to conventional myocardial scintigraphy in triple-vessel disease, in patients with angina who fail to demonstrate hemodynamically significant coronary artery stenoses, and in patients with inhomogeneous T1-scintigrams.

[Social integrations related to institutionalized and noninstitutionalized forms of care of elderly people]. / Das soziale Umfeld und Betreuungsformen von Hochbetagten.

This is a report about a research project analyzing costs and effectiveness of institutionalized and ambulatory care of older people. For this analysis economic factors as well as social factors are considered. On the sociological part multiple objective conditions (e.g. state health, financial situation and family relations) were correlated with subjective factors as feelings of well-being and various personal attitudes. To this purpose approximately 900 elderly persons (3 samples: 1. inhabitants of homes of the aged, 2. ambulant served (meals on wheels, home help and community nurses), 3. random sample of persons living at their own home. The 3 samples were taken in an urban, semiurban and rural area. Some remarkable differences between the 3 samples could be shown referring to the general physical and mental status and rate of impairment, in the state of care, familiar situation, social integration and subjective attitude (e.g. demonstrating that the inhabitants of homes for the aged were less socially integrated and less satisfied.

[Trends in modern international gerontological research. Sociological aspects]. / Tendenzen neuerer internationaler gerontologischer Forschung. Soziologische Aspekte.

Some new trends of the following theoretical models of the sociology of aging are discussed: 1. Models of life cycle which allow a clearer differentiation between the age groupings. 2. The logic of the scientific analysis and the lack of further analysis of the specific sociological content of the disengagement theory. 3. Quantitative and qualitative aspects of roles in the old age and age cohorts. 4. The significance of exchange-theory to analyse the special social situation of the elderly. 5. New results discussing the situation of the elderly as a minority group or subculture. 6. Organisational analysis of the welfare programs of the elderly.