Age at diagnosis of Type 2 diabetes in Germany: a nationwide analysis based on claims data from 69 million people.

AIM: For many European countries, including Germany, no valid estimates are available on age at diagnosis of Type 2 diabetes. Thus, we aimed to estimate the age at diagnosis in Germany. METHODS: Age at diagnosis of Type 2 diabetes in Germany was estimated based on Type 2 diabetes prevalence and incidence and the age distribution of the German population. Age- and sex-specific incidence and prevalence in 2014/2015, based on claims data from statutory health insurance (n= 69 000 000, ~85% of the German population), and the age pyramid for Germany in 2015 were used for the calculation. Age at Type 2 diabetes diagnosis was stratified by sex. CIs were estimated using bootstrap methods. In addition, the age range in which 50% of the population received a diagnosis of Type 2 diabetes was calculated (the interquartile range). RESULTS: The mean ± sd age at Type 2 diabetes diagnosis in 2015 was 61.0 ± 13.4 years (95% CI 60.9-61.0) in men. Women were diagnosed ~2 years later than men (mean age 63.4 ± 14.9 years; 95% CI 63.4-63.5). The age range in which 50% of the population was diagnosed with diabetes was 53-72 years for men and 54-76 years for women. CONCLUSIONS: The sex differences are mainly attributable to a higher incidence of Type 2 diabetes in men than women during middle age and the higher absolute number of women in the older ages. The early age at diabetes diagnosis compared to average life expectancy means that the risk of diabetes-related complications is increased.

A Behavioral Assay to Study Effects of Retinoid Pharmacology on Nervous System Development in a Marine Annelid.

Autonomous animal locomotion, such as swimming, is modulated by neuronal networks acting on cilia or muscles. Understanding how these networks are formed and coordinated is a complex scientific problem, which requires various technical approaches. Among others, behavioral studies of developing animals treated with exogenous substances have proven to be a successful approach for studying the functions of neuronal networks. One such substance crucial for the proper development of the nervous system is the vitamin A-derived morphogen retinoic acid (RA). In the larva of the marine annelid Platynereis dumerilii , for example, RA is involved in the specification and differentiation of individual neurons and responsible for orchestrating the swimming behavior of the developing larva. Here, we report a workflow to analyze the effects of RA on the locomotion of the P. dumerilii larva. We provide a protocol for both the treatment with RA and the recording of larval swimming behavior. Additionally, we present a pipeline for the analysis of the obtained data in terms of swimming speed and movement trajectory. This chapter thus summarizes the methodology for analyzing the effects of a specific drug treatment on larval swimming behavior. We expect this approach to be readily adaptable to a wide variety of pharmacological compounds and aquatic species.

Dorsal or ventral: similarities in fate maps and gastrulation patterns in annelids, arthropods and chordates.

The idea that chordates, during their evolution, have inverted their dorsoventral body axis has recently gained substantial support. It has been shown that various dorsoventral patterning genes that are evolutionarily conserved between insects and vertebrates are expressed dorsally in insects, and ventrally in vertebrates, or vice versa. The ventral body side of insects thus seems to correspond to the dorsal body side of vertebrates, and these are nerve cord-bearing, neural body sides in both groups. In order to exclude that the inverted polarity of gene patterning activity is purely accidental, we compare here vertebrate and invertebrate blastula fate maps and their gastrulation patterns in the framework of early gene expression. From this comparison it appears that the neural body sides, 'ventral' in annelids or arthropods, and 'dorsal' in chordates, develop at similar positions with respect to the initial egg asymmetry. In addition, the formation of the neural body sides involves similar movements during gastrulation. We further suggest that the deuterostome gastrulation seen in today's chordates can be derived from a more ancestral gastrulation pattern seen in today's annelids and arthropods, and that the ventral midline cells of insects correspond to the dorsal midline cells of vertebrates.

Rearranging gastrulation in the name of yolk: evolution of gastrulation in yolk-rich amniote eggs.

Gastrulating birds and mammals form a primitive streak in lieu of a circular blastopore, and a conspicuous underlying tissue layer, the hypoblast. In an attempt to understand the evolution of these amniote characteristics, pregastrula and gastrulation stages in selected amniotes are compared with the more ancestral situation in amphibians. At blastula/blastoderm stages, the overall fate maps and the arrangement of tissues around the organizer are rather similar, as is exemplified by a comparison of gene expression and fate maps in the frog and chick. Compared with amphibians, however, the eggs of reptiles, birds and monotreme mammals have a disproportionately large yolk that alters gastrulation morphology. During amphibian gastrulation, the organizer moves from anterior to posterior, to lay down the dorsal axis around the vegetal hemisphere (Arendt, D., Nübler-Jung, K., 1997. Dorsal or ventral: similarities in fate maps and gastrulation patterns in annelids, arthropods and chordates. Mech. Dev. 61, 1-15). In contrast, in amniote eggs, the large yolk impedes the organizer from moving around the entire vegetal hemisphere so that axis formation begins and ends at the same side of the egg. This has apparently provoked an evolutionary transformation of an amphibian-like blastopore, first into the 'blastoporal canal' of reptiles, and then into the birds' and mammals' primitive streak. The blastopore divides into two functionally divergent parts, one as the site of mesoderm internalization ('intraembryonic blastopore') and the other as the site of ectodermal epiboly ('extraembryonic blastopore'). The hypoblast is proposed to derive from the 'endodermal wedge' that is seen already in the amphibian gastrula. Hypoblast formation would then represent a special kind of gastrulation movement that also exists in the amphibians, and for which the term 'hypoboly' is introduced.

Daily fluctuation of cholestatic enzymes in bile and its relationship to the total bile salts concentration.

The activities of alkaline phosphatase (AP), gamma-glutamyl-transpeptidase and leucine aminopeptidase as well as the total bile salt concentration (Tbs) were measured in bile specimens collected spontaneously at 7 and 11 a.m. and 4 and 9 p.m. from the 3rd-9th postoperative day of 16 patients with T-tube insertion. The general trend for all cholestatic enzymes to increase or decrease was in some way related to the total bile salt concentration. The best correlation was found between AP and Tbs (r = 0.48). It is suggested that the enterohepatic circulation of bile salts may lead to the delivery of membrane-bound cholestatic enzymes into the bile canaliculi without damage to the hepatocyte.

Multiple radiopaque masses in the jaws.

In this report, the less common oral findings occurring in Gardner's syndrome are described, which occurred concurrently with colorectal polyposis. In addition, what clinically appeared as small intestinal polyps, microscopically represented nodular lymphoid hyperplasia, as reported in the literature. Review of the literature showed the oral findings reported here are not common and that enzyme assays can help detect polyps at an early stage of this complex syndrome.

Multiple radiolucent areas of the jaw.

A case of neurofibromatosis, or von Recklinghausen's disease, was presented. The skin manifestations include the development of numerous, variable sized, smooth-surfaced nodules (benign neural tumors) and asymmetric areas of hyperpigmentation called cafe-au-lait spots. Oral manifestations are not always apparent but, when they do occur, include multiple, discrete, nonulcerated mucosal nodules (typically benign neural tumors). Intraosseous tumors (usually neurofibromas) occasionally develop in the mandible as was reported in this patient. Clinicians should be aware of the characteristics of this hereditary disease, especially the possibility of malignant transformation of the neural tumors.

Exophytic mass of the floor of the mouth.

A tissue mass in the floor of the mouth was found to be an unusual, exophytic squamous cell carcinoma. The patient also had synchronous hepatic metastasis from an occult primary adenocarcinoma. The case is discussed from the standpoint of the differential diagnosis of lesions that may appear as masses of the floor of the mouth. Individuals with one primary cancer are at increased risk for developing second malignancies which may be in either the same anatomic area or in other organ systems. This case report emphasizes the need for the clinician to periodically follow-up any patient with a history of malignancy.

Rapidly expanding pigmented lesion of the buccal mucosa.

A case of oral melanoacanthoma was presented. The differential diagnosis of pigmented lesions of the oral mucous membrane includes a wide variety of categories of disease including local and systemic manifestations of hereditary and developmental conditions, reactive and inflammatory lesions, neoplasms, and metabolic diseases. For some of these lesions the histopathological pattern is diagnostic; for others, the tissue structure and organization are nonspecific and intelligent evaluation requires clinicopathological correlation. This discussion of oral mucosal pigmented lesions emphasizes the importance of the clinical parameters in the differential diagnosis of this group of lesions.

White plaque of the dorsal tongue.

A case of oral lichen planus has been discussed. The causes, associated conditions, laboratory tests, and treatment were addressed. The use of cyanoacrylate "super glue" may have acted as a contactant and promoted the patient's localized lichenoid process. No additional treatment was provided other than confirmation of clinical suspicions. The most important factor was ruling out the possibility of a dysplastic or a malignant process. Should the patient become symptomatic, the treatment would probably start out with kaolin and pectin (Kaopectate) lidocaine/benadryl rinses. Should supportive therapy fail, alternative regimens including topical to systemic corticosteroids would be considered.

Mixed density lesion of the anterior maxilla.

A case of COC which developed as a mixed lucent-opaque lesion in the anterior maxilla of a young person is discussed from the standpoint of clinical and radiographic differential diagnosis. Current concepts of the pathology of the COC and EOGCT are discussed.

Facial asymmetry.

A case of monostotic, mandibular fibrous dysplasia has been described in a 22-year-old Amerasian male, who had facial asymmetry of approximately 5 years' duration. Foci of ill-defined sclerotic, pagetoid calcifications were seen on routine film. The CT scans demonstrated bone facial and slight lingual expansion of bone with thinning of the cortex. A three-dimensional, enhanced CT film showed that this lesion was greater than 4 cm. The clinical, radiologic, and microscopic features of fibrous dysplasia have been described.

Role of the dental team in mass fatality incidents.

The process of dental identification for a mass fatality incident has unique aspects in comparison with that of a routine dental identification, outside of the obvious increase in the number of victims and responders. The dental team is a small part of a large effort to resolve the incident. Incident command structure applies to the dental team as a unit as well as to the entire organization of the response. Teamwork and planning are essential on all levels. Discussing the casework is limited to the public information officer; only the public information officer is authorized to talk to anyone outside the medical examiner's office. For the team, communication is essential between the team members and between the team and other morgue sections. Daily meetings not only update progress, but also identify and solve problems as they arise. Redundancy and cross-checking occur each step in each section. A core team of trained individuals provides a framework for the use of less experienced members. Use of a dental identification computer program is extremely beneficial, especially as the amount of fragmentation or number of victims increases. Because of the magnitude of the response, the physical and mental stresses require critical incident stress debriefing for all responders, regardless of their experience. The past and future service of the dental profession to the victims of mass fatality incidents and their families is an excellent example of the ideal of service on which the profession is based.

[The human being from the point of view of animals or, "Who knows whether the breath of men goes upwards?" (Ecclesiastes 3:21)]. / Der Mensch in animalischer Perspektive oder "Wer weiss, ob der Odem des Menschen aufwärts fahre?" (Koh. 3,21).

The question of whether animals have souls has been asked since as early as the Old Testament. Where this is believed to be true, fiction has provided interesting models in literature: The human being as seen by animals has been a popular subject since Apuleius' 'Asinus aureus' and how man appears from the perspective of a donkey or a beetle, that is to say the perspective from below, becomes controversial. Examples may be found in all languages and centuries in Jonathan Swift, Miguel Cervantes, E. T. A. Hoffmann, Ludwig Tieck, Heinrich Heine, Viktor von Scheffel, Franz Kafka and others. Résumé at the end: How does man answer this question or his own self-questioning?

Vasa unveils a common origin of germ cells and of somatic stem cells from the posterior growth zone in the polychaete Platynereis dumerilii.

To elucidate the evolution of germ cell specification in Metazoa, recent comparative studies focus on ancestral animal groups. Here, we followed the germline throughout the life cycle of the polychaete annelid Platynereis dumerilii, by examining mRNA and protein expression of vasa and other germline-specific factors in combination with lineage tracing experiments. In the fertilised egg, maternal Vasa protein localises to the yolk-free cytoplasm at the animal pole. It then asymmetrically segregates first into the micromeres, then into the founder cells of the mesodermal posterior growth zone (MPGZ). Vasa transcripts initially show ubiquitous distribution, but then become progressively restricted to the MPGZ. The cells of the MPGZ are highly proliferative, as evidenced by BrdU pulse labelling experiments. Besides vasa, they express nanos along with the stem cell-specific genes piwi, and PL10. At 4 days of development, four primordial germ cells are singled out from within the MPGZ, and migrate into the anterior segments to colonise a newly discovered "primary gonad". Our data suggest a common origin of germ cells and of somatic stem cells, similar to the situation found in planarians and cnidarians, which may constitute the ancestral mode of germ cell specification in Metazoa.

Reconstructing the eyes of Urbilateria.

The shared roles of Pax6 and Six homologues in the eye development of various bilaterians suggest that Urbilateria, the common ancestors of all Bilateria, already possessed some simple form of eyes. Here, we re-address the homology of bilaterian cerebral eyes at the level of eye anatomy, of eye-constituting cell types and of phototransductory molecules. The most widespread eye type found in Bilateria are the larval pigment-cup eyes located to the left and right of the apical organ in primary, ciliary larvae of Protostomia and Deuterostomia. They can be as simple as comprising a single pigment cell and a single photoreceptor cell in inverse orientation. Another more elaborate type of cerebral pigment-cup eyes with an everse arrangement of photoreceptor cells is found in adult Protostomia. Both inverse larval and everse adult eyes employ rhabdomeric photoreceptor cells and thus differ from the chordate cerebral eyes with ciliary photoreceptors. This is highly significant because on the molecular level we find that for phototransduction rhabdomeric versus ciliary photoreceptor cells employ divergent rhodopsins and non-orthologous G-proteins, rhodopsin kinases and arrestins. Our comparison supports homology of cerebral eyes in Protostomia; it challenges, however, homology of chordate and non-chordate cerebral eyes that employ photoreceptor cells with non-orthologous phototransductory cascades.