[Memorandum 'Development of health services research in Bavaria from the perspective of the Bavarian State Working Group 'Health Services Research (LAGeV)': status quo - potential - strategies']. / Memorandum "Weiterentwicklung der Gesundheitsversorgungsforschung in Bayern aus Sicht der Landesarbeitsgemeinschaft Gesundheitsversorgungsforschung: Status quo - Entwicklungspotenziale - Strategien".

The aim of the memorandum on the development of health services research (HSR) in Bavaria is to operationalise the global objectives of the State Working Group "Health Services Research" (LAGeV) and to collectively define future topics, specific implementation steps, methods as well as ways of working for the future course of the LAGeV. The LAGeV is an expert committee that integrates and links the competencies of different actors from science, politics and health care regarding HSR and facilitates their cooperation. The memorandum is based on an explorative survey among the LAGeV members, which identified the status quo of health services research in Bavaria, potential for development, important constraints, promoting factors, specific recommendations as well as future topics for the further development of HSR in Bavaria. From the perspective of the LAGeV members, the 12 most important future topics are: 1) Interface and networking research, 2) Innovative health care concepts, 3) Health care for multimorbid patients, 4)Health care for chronically ill patients, 5) Evaluation of innovations, processes and technologies, 6) Patient orientation and user focus, 7) Social and regional inequalities in health care, 8) Health care for mentally ill patients, 9) Indicators of health care quality, 10) Regional needs planning, 11) Practical effectiveness of HSR and 12) Scientific use of routine data. Potential for development of HSR in Bavaria lies a) in the promotion of networking and sustainable structures, b) the establishment of an HSR information platform that bundles information and results in regard to current topics and aims to facilitate cooperation as well as c) in the initiation of measures and projects. The latter ought to pinpoint health care challenges and make recommendations regarding the improvement of health care and its quality. The cooperation and networking structures that were established with the LAGeV should be continuously expanded and be used to work on priority topics in order to achieve the global objectives of the LAGeV.

[Preoperational study for the improvement of hygiene conditions in long-term care facilities]. / Modellprojekt zur Verbesserung der Hygiene in stationären Pflegeeinrichtungen.

Hygiene is becoming more and more important in long-term care facilities. Long-term care facilities are subject to monitoring by the Public Health Service (PHS) and other authorities. For the PHS in Bavaria the Bavarian Health and Food Safety Authority (Landesamt für Gesundheit und Lebensmittelsicherheit, LGL) published a hygiene monitoring concept and there exists an inspection guide developed by a specialist department for nursing homes and institutions for the handicapped (Fachstelle für Pflege und Behinderteneinrichtungen, FQA). Because inspections are performed in multiprofessional teams, it makes sense to use a coordinated inspection catalog. The aim was to integrate hygienic requirements specified in the Bavarian guidelines for hygiene by the LGL into the inspection guide published by the FQA to obtain a quality assured surveillance. The involved parties were questioned about the inspection guide and their hygiene management and then the hygiene criteria of the LGL were implemented into the inspection guide. Questions dealing with hygiene requirements concerning intensive care, management of multidrug resistant bacteria and interviews with the person responsible for infection control in the facility itself were developed for the first time and were integrated into the inspection guide. The revised inspection guide was tested for its applicability. With the revised inspection guide there now exists a tool which allows not only comprehensive inspections of the facilities including hygiene issues but also a good cooperation of the various parties involved. There are many actions which have to be conveyed into the future, especially programs to train staff to apply the inspection guide and to enhance the ability of all participants to act in cooperation. The guide will also allow the facilities to cooperate more easily and more closely, as the guide takes the respective problems and challenges of the different facilities into consideration. Additionally the development of legal guidelines regarding hygiene can support general healthcare of residents.

[Infection control management and practice in home care - analysis of structure quality]. / Infektionshygiene in der ambulanten Pflege - Eine Untersuchung zur Strukturqualität.

BACKGROUND: Surveillance of infection control management and practices in home care is an important task of the public health service. While infection control aspects in residential homes for the aged and nursing are increasingly being discussed this subject has been poorly recognised in home care. AIM: The aim of this study was to identify problems in hygiene regarding the transmission of infectious diseases as well as quality assessment in home care. Based on the results of this study implications for infection control in home care facilities for public health services should be developed. METHOD: Statistical analyses were performed on the primary quality assessment data of home care facilities collected by the medical service of health insurances via computer-assisted personal interviews between March 2006 and March 2009. Structure quality in 194 home care facilities was analysed as well as human resources and organisational conditions. Analyses were also done in the context of the clients' risk factor load. All analyses were performed by stratifying for the size of the home care services. To assess how the involved characteristics vary according to the size of the home care services chi-square tests and non-parametric tests were calculated. RESULTS: About 80% of the assessed home care services disposed of an infection control management plan. Compared to larger services smaller home care services, especially services with less than 10 clients had a poor structure in infection control management and practice. They also carried a higher load of risk factors in clients. The larger services had significantly less human resources. CONCLUSIONS: Surveillance of infection control management and practices by the public health services should focus on the structure of the smaller home care services. At the same time smaller home care services should be supported by offering training for the staff or counselling regarding hygiene-related aspects. Furthermore, the outcome quality of the larger home care services with poorer human resources (one full-time nurse cares for more than 10 dependants) should also be assessed in the frame of infection surveillance.

[Universal newborn hearing screening (UNHS): is it possible to successfully implement it nationwide?]. / Universelles Neugeborenen-Hörscreening (UNHS) - Ist eine erfolgreiche Umsetzung flächendeckend möglich?

BACKGROUND: Since 01.01.2009 in Germany a newborn hearing screening (UNHS) is obligatory for every child. The UNHS is part of the guidelines for the prevention of diseases for children up to 6 years of age (Kinder-Richtlinien). 2 years after its introduction in Bavaria, we now evaluate whether the UNHS has been implemented successfully,and if the quality criteria of the guidelines have been met. METHODS: In the guidelines details for the procedure and screening quality are given. The UNHS data from the screening facilities in Bavaria were evaluated for process quality criteria like screening coverage, screening method, REFER rate (rate of failed tests) and child age at diagnosis. RESULTS: More than 96 % of all newborns were screened. The REFER rate for 2010 was 4.5 %. Only 18 % of the controls were done by a paediatric audiologist.In 38.5 % of the newborns an intervention of the screening centre was necessary to assure controlling of a failed screening test. In 2009 the median age at diagnosis for a bilateral hearing loss was 5.5 months, and the start of therapy was 6.2 months. CONCLUSION: In Bavaria the UNHS was implemented successfully. A tracking system for all children who failed the hearing screening test is pivotal for the early diagnosis of children with bilateral hearing deficiency.

[H1N1 pandemic. Measures and experiences on the state level]. / H1N1-Pandemie. Maßnahmen und Erfahrungen auf Landesebene.

In order to establish a joint pandemic strategy, the German states ("Länder") together with the German federal government ("Bund") agreed on joint preparations for pandemic scenarios. This included the description of procedures, such as infection control measures, stockpiling of antiviral drugs, and contracts with vaccine manufacturers to ensure supply of vaccines in the event of a pandemic. The situation during the influenza H1N1 pandemic differed from that planned so that many short-term adjustments were required. It highlighted the need to make pandemic planning more flexible. In spite of several obstacles which had to be overcome during the situation, the states managed to achieve a relatively coordinated procedure and provided the availability of vaccines. In the course of the pandemic, gaps and shortcoming in existing surveillance systems were identified, which should lead to further improvements. A key point for future pandemic events is successful communication between all interested parties, especially with the medical profession, to increase the acceptance of public policies.

Dissection of biochemical borderline phenotypes in carriers and genetic variants of medium-chain acyl-CoA dehyrogenase deficiency: implications for newborn screening [corrected].

Medium-chain acyl-CoA dehydrogenase deficiency (MCADD) represents a potentially fatal fatty acid beta-oxidation disorder. Newborn screening (NBS) by tandem mass spectrometry (MS/MS) has been implemented worldwide, but is associated with unresolved questions regarding population heterogeneity, burden on healthy carriers, cut-off policies, false-positive and negative rates. In a retrospective case-control study, 333 NBS samples showing borderline acylcarnitine patterns but not reaching recall criteria were genotyped for the two most common mutations (c.985A>G/c.199C>T) and compared with genotypes and acylcarnitines of 333 controls, 68 false-positives, and 34 patients. c.985A>G was more frequently identified in the study group and false-positives compared to controls (1:4.3/1:2.3 vs. 1:42), whereas c.199C>T was found more frequently only within the false-positives (1:23). Biochemical criteria were devised to differentiate homozygous (c.985A>G), compound heterozygous (c.985A>G/c.199C>T), and heterozygous individuals. Four false-negatives were identified because our initial algorithm required an elevation of octanoylcarnitine (C(8)) and three secondary markers in the initial and follow-up sample. The new approach allowed a reduction of false-positives (by defining high cut-offs: 1.4 micromol/l for C(8); 7 for C(8)/C(12)) and false-negatives (by sequencing the ACADM gene of few suspicious samples). Our validation strategy is able to differentiate healthy carriers from patients doubling the positive predictive value (42-->88%) and to target NBS to MCADD-subsets with potentially higher risk of adverse outcome. It remains controversial, if NBS programs should aim at identifying all subsets of all diseases included. Because the natural course of milder variants cannot be assessed by observational studies, our strategy could serve as a general model for evaluation of MS/MS-based NBS.

[Dietary intake of non-dioxin-like polychlorinated biphenyls (PCB) in Bavaria, Germany. Results from the Integrated Exposure Assessment Survey (INES)]. / Nahrungsbedingte Zufuhr von nicht-dioxinähnlichen polychlorierten Biphenylen (PCB) in Bayern. Ergebnisse von INES (Integrated Exposure Assessment Survey).

Polychlorinated biphenyls (PCB) were widely used in numerous industrial and commercial applications in high quantities in the past. Based on their persistence in the environment, their tendency to accumulate in the organism and their specific health effects, PCBs have to be assessed as critical substances. Because the dietary intake was assumed to be the main intake route, the Integrated Exposure Assessment Survey (INES) aimed to measure the recent exposure to PCBs in Germany. The study consisted of 10 female and 10 male participants living in Munich and surroundings. The participants collected dietary duplicates of all food consumed and prepared as for consumption over 7 consecutive days. Altogether the 6 non-dioxin-like PCB congeners 28, 52, 101, 138, 153 and 180 ndl-PCB or, respectively, indicator PCB and furthermore the congener 118 were detected using a gas chromatographic method. Dietary intake was calculated using the amount of food eaten daily and the results from the duplicates. Using the sum of PCB 138, 153 and 180 multiplied by 4, the daily intake ranged from 4.0 to 24.1 ng/kg b.w. (median: 9.5 ng/kg b.w.). On the contrary, the daily intake was 2.9 to 20.6 ng/kg b.w. (median: 11.2 ng/kg b.w.) if the sum of the 6 indicator PCBs multiplied by factor 2 was used for quantification. No sex-related difference of the dietary intake was observable. Overall, it can be concluded that the dietary PCB intake has further decreased in the last years in Germany. At present, the toxicological database is not suitable to assess the risks coming solely from the non-dioxin-like PCBs because it is not possible to differentiate between non dioxin-like and dioxin-like effects in toxicological studies. Nevertheless, a further reduction of PCB exposure via food by searching for possible sources is needed.

[Evaluation of a pilot study on measles vaccination in Bavarian preschool children]. / Evaluation einer Pilotstudie zu Masern-Impfraten in bayerischen Kindergärten.

Several areas of Bavaria show measles vaccination coverage in preschool children below 95%. Repeated outbreaks could be attributed to this situation. A recollection model in nurseries was tested in order to document the vaccination rate in this age group and to measure the percentage of vaccinations due to intervention. Parents of new entrants to nurseries in a randomly selected rural district were asked to provide measles vaccination records of their kids and to fill in a questionnaire. 121 out of 144 vaccination records (85%) documented a complete immunisation status for measles. 12 children had not been vaccinated against measles, 10 children had received one vaccination. Eight out of these 22 children obtained supplementary measles immunisation at the time of ascertainment. The results provided are of limited statistical significance due to the small sample size. Further intervention studies have to be conducted and should even include measures supported by legal regulations.

[An interventional study to improve breast-feeding conditions in obstetric clinics of a model region in Bavaria]. / Eine Interventionsstudie zur Verbesserung von Stillbedingungen in Geburtskliniken einer Modellregion in Bayern.

Breastfeeding is influenced amongst other aspects by the support of the medical staff in clinics. Therefore WHO and UNICEF have implemented the programme "ten steps to successful breastfeeding" and the certificate "Baby friendly hospital" to promote breastfeeding in clinics. When the study "Breastfeeding in Bavaria" was started only two clinics in Bavaria were certified as baby friendly. In a Bavarian region where breastfeeding rates were significantly lower than in other regions an intervention study will be conducted. The aim of the study is to educate the clinic staff in the support of breastfeeding mothers. This paper describes the aims and methods of this intervention study.

[A concept to improve vaccination coverage in Bavaria]. / Konzept zur Verbesserung der Impfraten in Bayern.

The aim of the Bavarian immunisation concept is the effective implementation of national vaccination recommendations taking into account known characteristics in Bavaria and social groups with limited access to vaccinations. Furthermore, it intends to coordinate the various players in the field of vaccine-prevention of disease. Key points of this concept are, among others, improvement of the available data, definition of vaccination aims, implementation of vaccination recall systems during the regular examination on entering primary and secondary school, coordination and enforcement of vaccination campaigns in schools as well as steps for the qualification and motivation of the physicians involved in vaccination. In addition, an independent committee for the coordination of professionals and institutions participating in vaccine prevention in Bavaria was created. This "Bayerische Landesarbeitsgemeinschaft Impfen (LAGI)", which was established at the end of 2006 includes representatives from medical associations and corporations, health insurance companies and public health agencies and is the key for the realisation and further development of this concept.

Restricted isotype, distinct variable gene usage, and high rate of gp120 specificity of HIV-1 envelope-specific B cells in colostrum compared with those in blood of HIV-1-infected, lactating African women.

A successful HIV-1 vaccine must elicit immune responses that impede mucosal virus transmission, though functional roles of protective HIV-1 Envelope (Env)-specific mucosal antibodies remain unclear. Colostrum is a rich source of readily accessible mucosal B cells that may help define the mucosal antibody response contributing to prevention of postnatal HIV-1 transmission. To examine the HIV-1 Env-specific colostrum B-cell repertoire, single B cells were isolated from 17 chronically HIV-infected, lactating women, producing 51 blood and 39 colostrum HIV-1 Env-specific B-cell antibodies. All HIV-1 Env-specific colostrum-derived antibodies were immunoglobulin (Ig)G1 isotype and had mean heavy chain complementarity-determining region 3 (CDR3) lengths and mutation frequencies similar to those isolated from blood. However, variable heavy chain (VH) gene subfamily 1(∼)69 usage was higher among colostrum than blood HIV-1 Env-reactive antibodies (49% vs. 20%, P=0.006, Fisher's exact test). Additionally, more HIV-1 Env-specific colostrum antibodies were gp120 specific than those isolated from blood (44% vs. 16%, P=0.005, Fisher's exact test). One cross-compartment HIV-1 Env-specific clonal B-cell lineage was identified. These unique characteristics of colostrum B-cell antibodies suggest selective homing of HIV-1-specific IgG1-secreting memory B cells to the mammary gland and have implications for targeting mucosal B-cell populations by vaccination.

Long-term nutritional status of an enterally nourished institutionalized population.

Growth and nitrogen nutriture were evaluated during a yearlong study of 11 profoundly retarded nonambulatory institutionalized youth who were fed by gastrostomy and received anticonvulsants. The effects of dietary fiber and vitamin D were assessed by determining plasma levels and balances of zinc, magnesium, calcium, and phosphorus in a subset of six patients. Increase in body weight was 3.4 +/- 2.4 kg (means + SD), in height, 5.9 +/- 3.9 cm during the year. N balance remained positive throughout the study. Zn and Ca balances suggested that needs for this population may be greater than or equal to 150% of the Recommended Dietary Allowance. Vitamin D supplementation had no effect. Soy polysaccharide fiber intakes of 18-24 g/d compared with 0 or 12-20 g fiber/d significantly improved N and P retentions. Although the determination of nutrient needs of a severely disabled population is complex, our results suggest N and energy but not Zn and Ca allowances for a healthy population may be satisfactory guidelines.

Nocturnal asthma. Beta 2-adrenoceptors on peripheral mononuclear leukocytes, cAMP- and cortisol-plasma concentrations.

To evaluate pathophysiologic mechanisms of the predominantly nocturnal complaints in atopic bronchial asthma, the expression and function of beta 2-adrenoceptors on peripheral mononuclear leukocytes (pMNL), the cAMP--as well as the cortisol--plasma concentrations were studied in eight healthy men and ten so far untreated male asthmatic patients at 4-h intervals for 24 h. No difference was seen in the beta 2-adrenoceptor density (Bmax) on pMNL between healthy and asthmatic men (24-h means +/- SE: 908 +/- 59 sites per cell and 821 +/- 54 sites per cell, respectively). The equilibrium dissociation constant (Kd), however, was significantly higher in the asthmatic patients (24-h mean +/- SE: 8.8 +/- 1.2 pmol/L vs 3.0 +/- 0.2 pmol/L in healthy men, p less than 0.0001), which is equivalent to a lower affinity of the beta 2-adrenoceptors for the radioligand 125iodocyanopindolol. Bmax showed a statistically significant circadian variation, but Kd did not. The circadian variation in Bmax was reflected in the basal intracellular cyclic adenosine-monophosphate (cAMP) content of the cells investigated. High Kd values (equivalent to low receptor affinities) tended to be associated with small increases of the intracellular cAMP content after in vitro stimulation by 10(-7) mol/L isoprenaline (isoproterenol) (24-h mean +/- SE: 1.4 +/- 0.2 pmol/10(6) cells; r = -0.529, p = 0.05 at r = -0.549, n = 10). Plasma cAMP concentrations were found to be significantly lower in the asthmatic patients (24-h means +/- SE: 22.9 +/- 1.3 nmol/L vs 29.1 +/- 1.1 nmol/L, p less than 0.0001). Plasma cortisol concentrations were significantly higher in the asthmatic patients (24-h means +/- SE: 0.500 +/- 0.084 mumol/L vs 0.319 +/- 0.063 mumol/L). The results support the hypothesis that a lesion of the beta-adrenergic system contributes to the pathophysiology of atopic bronchial asthma. In the patients investigated in this study, such a lesion could be demonstrated in the affinity rather than in the number of beta 2-adrenoceptors expressed on peripheral cells of the immune system (pMNL). According to present-day knowledge of adrenergic effects on pMNL, such an affinity decrease of beta 2-adrenoceptors could account for overshooting immune responses. In association with other factors influencing respiratory function, it could be responsible for the predominantly nocturnal complaints in atopic bronchial asthma. Plasma cortisol concentrations did not appear to be related to the principal cause of "nocturnal asthma;" they rather reflected an endogenous defense mechanism to the disease.

Biological clearance of HEMA in guinea pigs.

No toxicokinetic data are available about the dental composite component 2-hydroxyethylmethacrylate (HEMA) in vivo in the literature. Therefore, the excretion of HEMA in feces and urine in vivo and, using the pendular perfusion technique with segments of jejunum and colon, in the biliary and enteric excretion in situ were investigated in anesthetized guinea pigs. In the in situ experiments, guinea pigs (n = 4) received HEMA (0.02 mmol/kgbw labelled with a tracer dose 14C-HEMA 0.3 kBq/gbw) injected into the jugular vein. In the in vivo experiments, guinea pigs (n = 4) received HEMA (+ 14C-HEMA, same dose as above) via gastric tube. Urine and feces were collected for 24h. In the in situ experiments, organs from guinea pigs were removed 60 min after the beginning of the experiment, and then the 14C-radioactivity was measured. During the 60 min perfusion period the calculated amount of 14C-activity excreted into the total jejunum and colon was 6.0 +/- 1.0% and 2.7 +/- 0.7% of the dose administered, respectively (mean +/- sem). Of the 14C-HEMA dose, 5.3 +/- 0.3% was found in the bile. Significantly (p < 0.05) higher bile/blood concentration ratios were found at 10-40 min after the injection of HEMA, as compared to the ratio at 60 min. The total 14C-recovery in all organs tested was 20.0 +/- 2.6%. During 24h the amounts of 14C-activity excreted in the feces and urine were 1.1 +/- 0.1% or 17.1 +/- 1.50% of the dose administered, respectively (mean +/- sem). The total 14C-recovery in all organs tested was 11.6 +/- 0.6%. In a second series of in vivo experiments, exhaled air from the animals was captured during the 24h experimental period. 14C was exhaled to 63.6 +/- 2.11% of the administered 14C-HEMA dose (mean +/- sem; n = 4) as 14C-carbondioxide. The results indicate a rapid clearance of 14C-HEMA and/or 14C-HEMA metabolite(s) from the organism, exhalation being the major route of elimination.

Effect of thiols on beta 2-adrenoceptors in human mononuclear leucocytes.

The effect of the disulfide reducing agent dithiothreitol (DTT) and other thiols on binding of the beta-adrenoceptor antagonist (-)-125iodocyanopindolol (125ICYP) to human mononuclear leucocytes (MNL) was investigated. Saturation experiments and dissociation kinetics revealed two classes of specific 125ICYP binding sites, one of high and the other of low affinity, respectively. In intact MNL DTT caused a decrease in specific binding. This was due almost selectively to a decrease in the affinity of high affinity binding sites, which decreased gradually in a concentration-dependent manner to the affinity of low affinity binding sites. In MNL membranes DTT decreased not only the affinity but also the number of high affinity binding sites. The DTT effect was completely reversible by simple reoxidation on air. The structural isomers (+/-)-DTT. (-)-DTT and dithioerythritol revealed identical effects on specific binding, whereas the monothiols mercaptoethanol and alpha-monothioglycerol, having a lower redox potential, were considerably less effective. In the same concentration range that influenced specific binding. DTT stimulated intracellular cAMP production. These results suggest functionally important disulfide bridges which regulate the affinity of beta-adrenoceptor binding sites in human MNL. They stabilize the receptor in a high affinity state; their reduction causes the conversion of the high affinity state into a low affinity state in a process associated with stimulation of adenylate cyclase. Available evidence indicates that a similar transformation is made by beta-adrenoceptor agonists. Consequently low affinity 125ICYP binding sites preexistent in untreated cells could represent a reduced receptor state resulting from agonist-receptor interaction in vivo.

A novel apparatus for the exposure of cultured cells to volatile agents.

This article presents a novel exposure apparatus that allows the exposure of cultured cells to volatile chemicals, e.g., inhalation anesthetics. The apparatus consists of an exposure chamber and a tightly linked vaporizer unit with pumps and valves allowing adjustable fluxes of mixtures of test chemicals and carrier gas under open and closed-circuit conditions. The exposure chamber uses commercially available cell culture flasks and accommodates up to 12 flasks simultaneously. Both modules fit into a standard culture incubator. The exposure chamber may be mounted onto an oscillating axis to tilt the cultures periodically forth and back, thus allowing direct contact of the cells with test atmosphere. The vaporizer unit is connected to a personal computer which lets the experimenter set the "open" and "close" intervals of individual valves thereby controlling the composition and flow rate of the test gas mixture. The vapor concentration of test chemicals can be monitored at the inlet and outlet using infrared photodetectors or mass spectrometers. Computer-aided processing of exposure protocols allows unattended runs. Exposure protocols can be scripted and stored on disk, thus ensuring interexperimental reproducibility of complex exposure profiles. As an application example, the effect of three volatile anesthetics, halothane, enflurane, and isoflurane, on the viability of three commercially available cell lines (A549--human lung carcinoma, HTC-rat hepatoma, MDCK--Madin-Darby canine kidney) was investigated. After exposure to haloalkyl vapors (3%) for 6 and 24 h, respectively, significantly increased LDH levels versus controls, indicating cellular membrane damage, were detected in A549 and hepatoma cells after exposure for 24 h. Hepatoma cells showed a significant LDH release also after 6 h exposure to isoflurane. On the other hand, LDH release from MDCK cells was not significantly different from controls even after 24 h of continuous exposure to any of the tested anesthetics.

Effects of Lewisite on cell membrane integrity and energy metabolism in human keratinocytes and SCL II cells.

Lewisite is a highly toxic arsenic compound which can cause skin damage. In the present study effects of Lewisite on cell membrane integrity and energy metabolism as well as antidotal effects of DL-2,3-dimercaptopropanesulfonate (DMPS), and meso-2,3-dimercaptosuccinic acid (m-DMSA) were investigated in a keratinocyte derived cell line (SCL II) and primary human keratinocytes (HK). Cells were incubated in Lewisite (60 microM) containing medium for 5 min. During the following 6 h lactate dehydrogenase (LDH) activity in the supernatant, intracellular ATP content, tetrazolium reduction, glucose consumption and lactate formation were measured. Glucose consumption and lactate production were decreased in both cell lines after Lewisite exposure. In SCL II cells an increase of LDH activity in the supernatant, a decrease of ATP content, and an impaired ability to reduce tetrazolium was found 3 h after Lewisite exposure. In HK cultures tetrazolium reduction was significantly decreased already after 2 h, whereas LDH increase in the supernatant and ATP content decrease occurred only at 6 h after Lewisite exposure. When DMPS or m-DMSA was added directly after Lewisite exposure to SCL II cells, glucose consumption and lactate formation were restored and LDH leakage was prevented. SCL II cells might be more prone to membrane damage whereas in keratinocytes mitochondrial impairment seems to be the predominant effect of Lewisite.

Dietary fiber and long-term large bowel response in enterally nourished nonambulatory profoundly retarded youth.

The objective of this year-long research was to determine the effects of three levels of a purified dietary fiber source, soy polysaccharide, on the long-term bowel function of 11 youth, aged 7 to 17 years, who were nonambulatory, profoundly disabled, constipated, and fed by gastrostomy. From day 1 to 60 the diet was a fiber-free enteral feeding; from day 61 to 300, 12 to 20 g/day total fiber was added to the diet; and from day 301 to 360, 18 to 25 g/day. Complete stool collections were made from day 51 to 60, day 111 to 120, day 291 to 300, day 321 to 330, and day 351 to 360. The second fiber addition significantly increased mean (+/- SD) daily stool frequency from 0.6 +/- 0.2 during the fiber-free diet to 1.1 +/- 0.5. The first addition of fiber compared to the fiber-free diet significantly increased stool moisture from 70 +/- 7% to 76 +/- 8% and wet stool weight from 30 +/- 13 g/day to 53 +/- 21; mean stool weight during days 351 to 360 was 87 +/- 45 g/day. Daily dry stool weight significantly increased with the second fiber addition. Soy polysaccharide fiber improved bowel function in this nonambulatory profoundly disabled population.

The use of robots and computers in the organisation of studies on the circadian variation of beta 2-adrenoceptor sites in peripheral mononuclear leucocytes.

We have developed a partially automated method for the performance of equilibrium radioligand binding studies which is applied by our group in investigations on circadian variations and stimulation studies on beta 2-adrenoceptor sites in human peripheral mononuclear leucocytes (pMNL). Using a Tecan Robotic Sample Processor, binding assays with 12 concentrations of 125iodocyanopindolol (1-150 pmol/l, total binding in triplicates, unspecific binding in the presence of 10(-5) mol/l timolol in duplicates) are prepared automatically with all titer tubes per experiment arranged in a microtiterplate-sized rack. After incubation in a waterbath for 2hr at 37 degrees C, the whole rack is centrifuged at 5000g and transferred back to the lab robot. Bound radioactivity is separated from the unbound ligand by removing the supernatant by the machine. The radioactive counts are evaluated using personal computers. The lab robot enhances reproducibility of experimental results and frees lab workers from time-consuming pipetting jobs. Radioactive exposure is minimized to the time preparing the radioligand working solution and transferring the sample tubes from the robot to the waterbath, to the centrifuge and back to the robot. The variability of our software allows easy adaptation to other binding studies with intact cells.