[The integration of telemedicine concepts in the regional care of rural areas: Possibilities, limitations, perspectives]. / Telemedizinische Versorgungskonzepte in der regionalen Versorgung ländlicher Gebiete : Möglichkeiten, Einschränkungen, Perspektiven.

In rural areas with a low population density and (imminent) gaps in regional health care, telemedicine concepts can be a promising option in supporting the supply of medical care.Telemedicine connections can be established between different health care providers (e.g., hospitals) or directly between health care providers and patients.Different scenarios for the implementation of telemedicine have been developed, from the monitoring of chronically ill patients to the support of acute care. Examples of frequently applied telemedicine concepts are teleradiology, telemedicine stroke networks, and the telemedicine monitoring of patients with heart failure. The development of concepts for other indications and patient groups is apparently difficult in Germany; one reason could be that research institutions are involved in only a small number of projects. However, the participation of research institutes would be of importance in creating more scientific evidence. The development of appropriate evaluation designs for analyzing the effectiveness of telemedicine concepts and economic effects is an important task and challenge for the future. Mandatory evaluation criteria should be developed to provide a basis for the translation of positively evaluated telemedicine concepts into routine care.

Effect of metformin therapy and dietary supplements on semen parameters in hyperinsulinaemic males.

Previous reports indicated that hyperinsulinaemic men may exhibit a higher percentage of poorly compacted DNA in their spermatozoa and less success in an IVF programme (Andrologia, 45, 2003, 18; Andrologia, 2014, doi: 10.1111/and.12227). The aim of this study was to investigate the effect of metformin (Glucophage®) and antioxidant treatment (StaminoGro®) on the semen parameters of hyperinsulinaemic men. Nineteen hyperinsulinaemic male patients were treated for 3 months with metformin alone (Group A), and fifteen patients used metformin in combination with the nutritional supplement (Group B). Combined data of the two groups (pre- and post-treatment) differ significantly regarding sperm morphology (P = 0.0003) and CMA3 (P < 0.0001) values. The improvement in sperm morphology after treatment was similar for the two respective groups (P < 0.05). The morphological normal sperm forms increased from the mean percentage of 3.9 to 5.5% and from 4.2 to 5.5% for Group A and B respectively. Where a combination of metformin and the supplement were used (Group B), the combination treatment proved to be superior in obtaining enhanced chromatin packaging quality although not statistically significant (P = 0.5929) when compared with the metformin (Group A) group. The chromatin packaging quality in Group B improved with 10% while the improvement in Group A was approximately 8.3%. Therefore, infertile hyperinsulinaemic men can benefit from metformin treatment and should be advised on the use of nutritional supplements with antioxidant properties.

Use of complementary medicinal therapies in West Pomerania: a population-based study.

OBJECTIVES: Prior studies suggested a high prevalence of complementary and alternative medicine (CAM) in Germany. The objectives of this study were (1) to describe in more detail the utilization of CAM, (2) to compare characteristics between CAM users and non-users, and (3) to delineate information on source of prescription and insurance coverage of 14 specific CAM therapies. METHODS: We extracted information derived from a computer-aided personal interview on the use of CAM, medical history, behavioral, and sociodemographic characteristics, all of which were generated by the Study of Health in Pomerania (formerly part of East Germany), a cross-sectional population-based survey. We analyzed data from 4291 individuals aged 20-79 years. RESULTS: Use of any CAM within the previous year was reported by 6.0% of the population. The modality used most widely among CAM users was active and passive exercise therapy (including various massage therapies). CAM users, when compared to non-users, were more likely to be female, experienced more years of education, were more physically active, less often overweight, reported a lower self-rated physical health status, and were more likely to visit an outpatient facility during the last year. There were higher proportions of several chronic diseases in CAM users than non-users. The results of this survey suggest that CAM therapies were most often utilized to alleviate pain. Most CAM therapies were prescribed by a physician. Reimbursement schemes were complex and differed according to therapy. CONCLUSIONS: The low estimate of CAM use might be explained by specific characteristics of the study region, including changes after the German reunification. CAM users and non-users differ with respect to several behavioral, sociodemographic and medical characteristics.

[Smoking as potential confounder in german epidemiological studies: standardization of assessment, quantification, and analysis]. / Rauchen als möglicher Confounder in epidemiologischen Studien: Standardisierung der Erhebung, Quantifizierung und Analyse.

Tobacco smoking is one of the most frequently examined risk factors in epidemiological studies due to the high frequency of smoking in the population and its high risk potential. This paper discusses the issue of standardization of the assessment of tobacco exposure in German epidemiological studies based on a suggestion of the working group "Epidemiological methods" of the German Society of Epidemiology (DGEpi), the German Society of Social Medicine and Prevention (DGSMP), and German Society of Medical Informatics, Biometry and Epidemiology (GMDS) together with the working group "Epidemiology in the workplace" of the DGEpi and the German Society of Occupational and Environmental Medicine (DGAUM). The main element is a short questionnaire for German adults for the assessment of tobacco smoking in epidemiological studies where smoking is a potential confounder. In addition, information on the consideration of intermittent periods of non-smoking, a very short questionnaire for medical examinations in the workplace or non-responder interviews as well as the quantification and statistical modelling of smoking are presented. A brief discussion of scientific problems and questionnaires related to the exposure to environmental tobacco smoke is given.

Gynaecological health care utilization and use of sex hormones--the study of Health in Pomerania.

BACKGROUND: In Germany, there is a lack of population-based data related to the use of gynaecological health care services. The objectives of our analyses utilizing a population-based cross-sectional survey conducted in one geographically defined area [Study of Health in Pomerania (SHIP)] are to assess the prevalences of: (i) attendance of gynaecological outpatient facilities and of (cervical) cancer screening; (ii) gynaecological and breast surgery; (iii) use of oral contraceptives (OC) and menopausal hormone therapy (MHT). METHODS: We analysed socio-demographic factors, reproductive history, gynaecological service utilization, and use of sex hormones in 2186 women aged 20-79 years. We used standard statistics and sex- and age group-specific weighting factors to reflect characteristics of the population of Western Pomerania. RESULTS: Approximately 43% of women reported surgical procedures. Participation in cancer screening at least once was reported by 78% of women (lifetime prevalence). Two-thirds of women stated ever use of OC, 28% (aged >40 years) ever use of MHT. CONCLUSIONS: Women in Western Pomerania reported a high life-time use of both OC and MHT. The use of cervical cancer screening exceeded the national average. Women had an almost 50% risk of undergoing gynaecological, breast or obstetric surgery. The high use of MHT and surgical procedures calls for efforts regarding continuing medical education and health care policy actions.

[Electrostimulation in therapy of postoperative urinary incontinence. Therapeutic value for quality of life]. / Die Elektrostimulation in der Therapie der postoperativen Harninkontinenz. Therapeutischer Nutzen unter Berücksichtigung der Lebensqualität.

Worldwide use of electrical stimulation for therapy of postoperative incontinence is based on a few prospective randomized controlled studies. We present a three-arm prospective randomized study evaluating physiotherapeutic pelvic floor training alone and in combination with transanal or perineal electrical stimulation. The study compared specific continence training (CT) and a combination of CT with transanal or perineal electrostimulation. The groups included 60 patients each and were analyzed with regard to self-assessment, objective characteristics of incontinence, standard quality of life questionnaire (QLQ-C 30), and recorded data of the stimulation device. The patients participated in a specific inpatient rehabilitation program and were assessed at the time of admittance, upon discharge, and again after 3 months. Significant improvement could be achieved in every group concerning urinary incontinence and quality of life. Additional use of electrical stimulation was significantly superior to physiotherapeutic training alone. However, these results could only be detected in a highly compliant subgroup. Analysis of device data indicated a high score of errors and lack of patient compliance. Perineal electrical stimulation was better accepted than transanal and showed less side effects and better outcome in the characteristics of incontinence. Improvement in the quality of life was mostly achieved during the weeks of inpatient rehabilitation. Electrical stimulation could not improve quality of life items. Electrical stimulation is an efficient instrument for treatment of postoperative high-grade incontinence, however, only with sufficient patient compliance.

Chromosome aberration analysis in peripheral lymphocytes of Gulf War and Balkans War veterans.

Chromosome aberrations and sister chromatid exchanges (SCEs) were determined in standard peripheral lymphocyte metaphase preparations of 13 British Gulf War veterans, two veterans of the recent war in the Balkans and one veteran of both wars. All 16 volunteers suspect exposures to depleted uranium (DU) while deployed at the two different theatres of war in 1990 and later on. The Bremen laboratory control served as a reference in this study. Compared with this control there was a statistically significant increase in the frequency of dicentric chromosomes (dic) and centric ring chromosomes (cR) in the veterans' group. indicating a previous exposure to ionising radiation. The statistically significant overdispersion of die and cR indicates non-uniform irradiation as would be expected after non-uniform exposure and/or exposure to radiation with a high linear energy transfer (LET). The frequency of SCEs was decreased when compared with the laboratory control.

High resolution emission spectra of TL materials.

High resolution emission spectra of several TL materials, that are commonly used in dosimetry, were measured using a low cost fibre optic spectrometer containing a 2048 pixel CCD array. The spectra were taken from 177 to 890 nm with a wavelength resolution of 1.3 nm. This allowed for line width discrimination and the resolution of transitions that have not been seen so far. For rare earth doped materials like CaF2:Tm (TLD-300) and CaF2:Dy (TLD-200) the spectral lines were compared to the energy levels measured by Dieke and Crosswhite leading to the identification of most of the transition lines.

Performance and use of current sheet antennae for RF-hyperthermia of a phantom monitored by 3 tesla MR-thermography.

Several MR-compatible current sheet antennae (CSA) of different height (h) (16 cm (l) x 8 cm (w) x 1-5 cm (h)) were built for simulated RF (96 MHz) hyperthermia of a medium-sized (12l) tissue-equivalent phantom inside a 3 tesla whole body tomograph. Prior to use, efficiencies of the CSA were determined by network analysis and by calorimetry. Depending on the height h of the CSA and on the thickness d(bolus) of the water bolus used for RF-coupling of the CSA to the lossy medium, their efficiency varied between 20-70% and the CSA with h = 3 cm was selected for simulated RF hyperthermia. During heating, spatial temperature distributions (20-42 degrees C) of five slices (voxel size 2 x 2 x 10mm(3)) were recorded intermittently within 4 s/slice by measuring the temperature dependent shift of the (1)H resonance frequency (125.32 MHz). A phased array consisting of two identical CSA produced distinctly different spatial temperature distributions at 0 and 180 degrees phase difference between both RF channels feeding the antennae. Within a one-dimensional heat diffusion model, the specific absorption rate (SAR) of the electromagnetic wave generated by a single antenna was deduced from the experimental data resulting in a penetration depth (1/e(2)) of approximately 4 cm.

[Epidemiology, social medicine, environmental medicine--a plea for a difficult but necessary integration]. / Epidemiologie, Sozialmedizin, Umweltmedizin--Plädoyer für eine schwierige, aber notwendige Integration.

The origins of environmental medicine date back more than 2000 years. The increasing incidence of environmental disease together with successful research into their etiology and pathogenesis have caused an impetus for this discipline in quantitative terms. A growing interest of patients, but also of politicians and parts of the industry in actual or suspected environmental risk factors for health have given rise to controversies--rendering the development of a rational, quality-oriented environmental medicine difficult, if not impossible. Given these controversies surrounding environmental health issues formal demarcations between the traditional disciplines (environmental) epidemiology, social medicine, occupational medicine, and environmental medicine become obsolete. Instead, a common agenda with respect to research, quality assurance, risk communication, and prevention as well as patient counselling and policy advising calls for a conceptual and institutional integration of these disciplines.

Measurement of the dose components of fast and thermal neutrons and photons from a 0.1 mg 252Cf source in water for brachytherapy treatment planning.

The use of 252Cf in brachytherapy is expected to be more effective with the therapy of bulky tumors than the conventional therapy with photons. For treatment planning a code developed for calculation of gamma dose was used to generate the dose distributions of fast and 10B enhanced thermal neutrons and photons. Dose distributions of these components measured with ionization chambers and a GM counter were fitted to analytical functions as required by the modified treatment planning program. A comparison of these experimental results and the treatment planning output indicate good agreement. Therefore, the program may be used to optimize the brachytherapy procedure considering all three dose components. A realistic case of a patient being treated with conventional brachytherapy has been used to calculate the dose distribution that would be obtained by use of the 252Cf source.

Microcystin-LR decreases hepatic and renal perfusion, and causes circulatory shock, severe hypoglycemia, and terminal hyperkalemia in intravascularly dosed swine.

Cross-bred, anesthetized female swine were given intravascularly a lethal (72 microg/kg; n = 6) or toxic-sublethal (25 microg/kg; n = 6) dose of microcystin-LR (MCLR), from Microcystis aeruginosa, or the vehicle (n = 4). At the high dose, from 12 to 18 min after administration, central venous pressure and hepatic perfusion were significantly lower, and shortly thereafter, portal venous pressure was significantly higher and aortic mean pressure was significantly lower than controls. By 45 min postdosing, serum bile acids, lactate, potassium, and total bilirubin, as well as blood pO2, were significantly higher, while hematocrit, platelet count, and blood bicarbonate, pCO2, and base excess were significantly lower than controls. By 90 min, serum arginase, urea nitrogen, inorganic phosphorus, and creatinine were significantly higher, while glucose and blood pH were significantly lower than in controls. By 150 min, serum alanine and aspartate aminotransferases, alkaline phosphatase, lactate dehydrogenase, and creatinine phosphokinase activities were significantly higher than controls. At the low dose, significant differences from controls occurred in hemodynamic, organ perfusion, and serum chemistry parameters, but such changes generally took longer to occur and were of a lesser magnitude than at the high dose. Livers of the high-dose swine were swollen and dark red-purple, and exuded excessive blood on the cut surface. Based on increases in liver weight and liver hemoglobin, 38% of the total blood volume was lost into the liver. Terminally, all high-dose swine experienced hyperkalemia, and most had severe hypoglycemia. Death due to acute MCLR toxicosis in intravascularly dosed swine appears to result from severe intrahepatic hemorrhage, partial obstruction of blood flow through the liver, circulatory shock, severe hypoglycemia, and/or terminal hyperkalemia.

Dietary ratio of (n-6)/(n-3) polyunsaturated fatty acids alters the fatty acid composition of bone compartments and biomarkers of bone formation in rats.

The effects of dietary polyunsaturated fatty acids (PUFA) on ex vivo bone prostaglandin E(2) (PGE(2)) production and bone formation rate were evaluated in rats. Weanling male Sprague-Dawley rats were fed AIN-93G diet containing 70 g/kg of added fat for 42 d. The dietary lipid treatments were formulated with safflower oil and menhaden oil to provide the following ratios of (n-6)/(n-3) fatty acids: 23.8 (SMI), 9.8 (SMII), 2.6 (SMIII), and 1.2 (SMIV). Ex vivo PGE(2) production in liver homogenates and bone organ cultures (right femur and tibia) were significantly lower in rats fed diets with a lower dietary ratio of (n-6)/(n-3) fatty acids than in those fed diets with a higher dietary ratio. Regression analysis revealed a significant positive correlation between bone PGE(2) and the ratio of arachidonic acid (AA)/eicosapentaenoic acid (EPA), but significant negative correlations between bone formation rate and either the ratio of AA/EPA or PGE(2) in bone. Activities of serum alkaline phosphatase isoenzymes, including the bone-specific isoenzyme (BALP), were greater in rats fed a diet high in (n-3) or a low ratio of (n-6)/(n-3), further supporting the positive action of (n-3) fatty acids on bone formation. These results demonstrated that the dietary ratio of (n-6)/(n-3) modulates bone PGE(2) production and the activity of serum BALP in growing rats.

[Effects of priming technique on onset profile of cisatracurium]. / Auswirkung der Priming-Technik auf die Anschlagszeit von Cisatracurium.

Compared to atracurium, cisatracurium releases less laudanosine and histamine, but it has a longer onset time. The primary objective of this study was a blinded, randomized comparison of intubation scores and onset times of a threefold ED 95 of cisatracurium using the priming technique with two priming substances cisatracurium itself and pancuronium. To test the effect of priming with cisatracurium or pancuronium on the onset of cisatracurium, 45 patients were anaesthetised with 0.15-0.25 mg/kg alfentanil, 0.25-0.3 mg/kg edomidate i.v. and O2/N2O, and were randomisely divided into one of three groups. After induction, 15 patients were primed with sodium chloride and thereafter received 0.15 mg/kg cisatracurium, 15 patients were primed with 0.01 mg/kg cisatracurium, another 15 patients were primed with 0.015 mg/kg pancuronium and the last two groups received 0.14 mg/kg cisatracurium three minutes later. Neuromuscular response was monitored by adductor pollicis electromyogram (EMG) by stimulating in a TOF pattern. Times for T1 reduction to 75%, 50%, 25% and 0% and T1 recovery to 25% were taken. Intubation was performed 120 seconds after the main relaxant dose and scored in four grades. The two priming groups showed a significantly faster onset of neuromuscular blockade than the control group (cisatracurium priming group: T1 = 0: 178.4 +/- 16.3 sec., pancuronium priming group 171.2 +/- 15.3 sec. vs. control group: T1 = 0: 205.5 +/- 18.9 sec.). Both primed groups showed no significantly better intubation scores, compared with the control group. Using the priming principle, cisatracurium will give good intubation scores 120 seconds after injection with a clinical duration profile comparable to an equipotent dose of atracurium.

13-cis retinoic acid in combination with interferon-alpha enhances radiation sensitivity of human squamous cell carcinoma cells of the oral cavity.

BACKGROUND: Preclinical and clinical trials demonstrated the antiproliferative and chemopreventive potential of 13-cis retinoic acid in combination with interferon-alpha. The present study was designed to determine the radiosensitizing potential of both drugs after single and combined treatment of human squamous-cell carcinoma cells of the oral cavity in vitro. MATERIAL AND METHODS: The study was performed using the human squamous-cell carcinoma cell line SCC4, which was originally established from a tumor of the oral cavity. Based on clonogenic assays, the inhibition of clonogenic activity and radiosensitizing potential of 13-cis retinoic acid and interferon-alpha after single or combined treatment without and with subsequent irradiation was determined. RESULTS: 13-cis retinoic acid (10 microM) and interferon-alpha (50 IU/ml) showed significant inhibition of clonogenic activity after single treatment. A combined treatment protocol resulted at least in a highly significant additive inhibition of clonogenicity. Treatment with both drugs (5 microM 13-cis retinoic acid, 25 IU/ml IFN-alpha) prior and post irradiation of the cells resulted in a pronounced enhancement of radiation toxicity resulting in significantly decreased SF2- and alpha-values. Combined treatment with both drugs was significantly more effective than single drug treatment. CONCLUSIONS: The data presented indicate that pre- and post-irradiation treatment with 13-cis retinoic acid and interferon-alpha significantly enhance the radiosensitivity of human squamous-cell carcinoma cells, SCC4, in vitro. Therefore, they support the initiation of clinical trials to test the radio-oncological value of such a treatment regime for squamous-cell carcinomas.

UFT plus calcium folinate plus radiotherapy for recurrent rectal cancer.

Uracil and tegafur (in a molar ratio of 4:1 [UFT]) plus calcium folinate comprise the components of the oral agent, Orzel, which appears to have activity comparable to intravenously administered 5-fluorouracil. This article describes the design of an open-label, disease-oriented, phase I trial of UFT plus calcium folinate in combination with simultaneous pelvic radiation for recurrent rectal cancer. This trial is designed to determine the maximum tolerated dose and dose-limiting toxicity of this regimen.

[Role of sodium selenite as an adjuvant in radiotherapy of rectal carcinoma]. / Zur Rolle von Natriumselenit als Adjuvans in der Strahlentherapie des Rektumkarzinoms.

BACKGROUND: In various epidemiologic studies an association of low selenium blood levels and reduced glutathione peroxidase with an increased risk of cancer incidence was described. The antitumoral therapy and a suboptimal nutrition could intensify this deficiency. Every reduction of disease related and therapeutic caused symptoms may improve life quality. APPLICATION: We report our preliminary experiences in the adjuvant radiochemotherapy of advanced rectal cancer (UICC II/III) corresponding to the NCl recommendation. An oral selenium supplementation was carried out with 2000 micrograms Na2SeO3 after every course of fluorouracil chemotherapy and daily 400 micrograms Na2SeO3 after irradiation of tumor region and lymph nodes. A weekly life quality assessment was explored with special interest in diarrhea, dysurie, pain, appetite, nausea and emesis. CONCLUSION: Damages to normal tissue specially to DNA enzymes and membranes caused by free radicals is one mechanism in tumorgenesis, tumor progression and therapeutic consequence. A radioprotective effect of selenium is verified by in vitro and in vivo data. Our data show that oral selenium intake in rectal cancer patients is easily tolerated with no side effects. Improving life quality and secondary cancer prevention with supplementation of selenium has to be proven in prospective randomized studies.

Molecular and cellular analysis of rP1.B in the rat hypothalamus: in situ hybridization and immunohistochemistry of a new P-domain neuropeptide.

P-domain peptides, a new family of secretory polypeptides, have been identified mainly in the gastroenteropancreatic tract of humans, rodents, and amphibians as well as in amphibian skin. In the present study, with PCR and RNA analysis a transcript has been discovered in rat brain termed rP1.B. The deduced polypeptide consists of a single P-domain and its amino acid sequence matches that of rat intestinal trefoil factor (rITF). Thus far, rP1.B is the only P-domain peptide expressed in neuronal cells of the CNS. Immunostained magnocellular perikarya were visible in the paraventricular, supraoptic and periventricular nuclei. Parvocellular rP1.B neurons were found in the arcuate nucleus. Additionally, specific hybridization signals with radiolabeled transcripts were observed in the same regions. rP1.B in the rat hypothalamus may be involved in the control of hypothalamo-hypophysial functions.

[Sequential parenteral and oral therapy with ofloxacin in urogenital infections]. / Sequentielle parenterale und orale Therapie mit Ofloxacin bei urogenitalen Infektionen.

125 hospitalized patients (56 men and 69 women) suffering from urinary tract infection (UTI) and 15 women with endometritis or pelvic inflammatory disease were treated with ofloxacin 6 mg/kg/d i.v. divided into 2 doses. Two thirds of the patients were switched to oral ofloxacin using the same dose regimen after 4 days. The median duration of treatment was 10 days. 98 patients were evaluable for efficacy: 45 had complicated lower UTI, 32 had upper UTI (75% of them with complications), 13 had endometritis and 8 an uncomplicated lower UTI. The most frequent complications of UTI were: obstruction (n = 27), indwelling catheters (n = 23), urinary concrements (n = 12), residual urine (n = 8) and a neurogenic bladder (n = 6). 22 patients had diabetes mellitus. A total of 103 pathogens was isolated from the urine of 85 patients, the most frequent being E. coli, Proteus spp. and Enterococcus faecalis. 98% of patients with UTI and 85% of patients with endometritis were clinically cured. Adverse drug events were observed in 6 patients.