Prevalence and genotype distribution of human papillomavirus infections in Beijing, China between 2016 and 2020.

BACKGROUND: Certain types of human papillomavirus (HPV) induce long-lasting infections that cause cervical cancer. This study evaluated the prevalence of HPV infections and the distribution of their genotypes among clinic patients and healthy women in Beijing, China. METHODS: Cervical specimens were collected from 12,100 patients and 1176 subjects who underwent physical examinations at Dongzhimen Hospital, Beijing University of Chinese Medicine, between March 2016 and September 2020. HPV genotyping was performed using commercial kits designed to detect 15 high-risk and 2 low-risk HPV genotypes. RESULTS: There was a higher overall prevalence of HPV among the clinic patients (21.0%) than among the healthy women (11.9%). The most common HPV genotypes among the patients were: HPV-52 (5.4%), HPV-16 (3.4%), HPV-58 (3.2%), HPV-51 (2.6%), HPV-39 (2.0%), HPV-56 (2.0%), and HPV-66 (2.0%). Among the healthy women: HPV-52 (3.0%), HPV-51 (1.8%), HPV-58 (1.6%), HPV-66 (1.5%), HPV-16 (1.2%), HPV-56 (1.2%), and HPV-18 (1.1%). Multiple HPVs were detected in 29.1% of the gynecological outpatients and in 23.6% of the women receiving physical examinations. The most common pairs of HPV types detected were HPV-52 and HPV-16 in the clinic patients, and HPV-52 and HPV-56 in the healthy women. Age-specific HPV positivity and peak prevalence were observed among the individuals in both groups for women aged less than 25 years and those between 61 and 65 years of age. CONCLUSIONS: Our results provide current estimates of HPV prevalence and genotypes in the Beijing region. The epidemiological characteristics observed also provide a reference for the development of cervical cancer screening strategies and selection of HPV vaccine antigen targets for this region. A comparison of these HPV prevalence data with those from other regions suggests that regional vaccines may be an important direction for future research.

Art engagement and psychological well-being among community-dwelling older adults in Japan: an observational cross-sectional study.

OBJECTIVES: Art engagement, which includes individual art activities and museum and gallery visits, potentially contributes to improving psychological well-being. However, there is insufficient evidence of its effects on the older population, and few reports are from Asia, including Japan. This study examined the association between art engagement and psychological well-being among older adults in Japan. STUDY DESIGN: An observational cross-sectional study design was used. METHODS: Community-dwelling older adults aged ≥60 years were recruited from the visitors to public facilities (including community centres, sports centres and cultural centres) in Aichi, Japan, in 2022, and completed questionnaires. The psychological well-being assessment included five domains according to Seligman's PERMA framework: Positive emotion, Engagement, Relationship, Meaning and Accomplishment. Regarding art engagement, the frequencies of active art engagement (e.g. activities by individuals and participation in groups, such as music and painting) and receptive art engagement (e.g. visiting museums, galleries and the theatres) were assessed. RESULTS: A total of 522 participants were included in the analysis (mean age = 74.1 years; 78.0% females). Results from the multivariable linear regression analysis, which adjusted for demographic and socio-economic factors, revealed that higher frequencies of active art engagement were significantly associated with higher scores in all five PERMA domain scores. Higher frequencies of receptive art engagement were significantly associated with higher levels of Positive emotion, Engagement and Meaning domain scores, but were only marginally associated with the Accomplishment domain and were not associated with the Relationships domain. CONCLUSIONS: This study indicates that art engagement has the potential to enhance psychological well-being among older adults. National and local government strategies to increase accessibility to art and cultural activities for older adults are recommended.

Robust estimation of sediment sound speed from the group speed of the critical mode.

In the ocean waveguide, the sediment sound speed has a simple relationship with the group speed of the highest order mode that propagates close to the critical angle. The paper shows that robust estimates of the sound speed are obtained from estimates of the "critical" mode group speed determined from analysis of the energy distribution of the time-warped spectrum of a broadband signal. The method is applied to experimental data collected in the Yellow Sea of China. Estimated sound speeds agreed closely with expected values for clayey slit (1531 m/s) and sandy silt (1593 m/s) sediment at the sites.

How the thermocline affects the value of the waveguide invariant in a shallow-water waveguide.

On the basis of the principle of stationary phase, Chuprov [Ocean Acoustics: Current State (Nauka, Moscow, 1982)] proposed a scalar parameter-the waveguide invariant ß, to interpret the dispersive properties of underwater acoustic waveguide. It has been found that ß may be useful in many applications in underwater acoustics. A reasonable prediction of the value of ß is often necessary in such applications. It was known that ß has some "canonical" values for waveguides with simple sound speed profiles (SSP). When a thermocline exists, ß for refractive modes (with a turning point) is no longer constant and can even change its sign. In this paper, by dividing the SSP into the non-refractive part and the refractive part, a clear explanation of how the value of ß is affected by the thermocline is presented. The results show that ß can be positive and increase continually from around 1 to +∞; or negative from -∞ to about -3. An analytic criterion of the sign of ß is developed. This method can also be used to analyze the value of ß for any other kind of SSP.

Measurements of ocean bottom low-angle backscattering by single-mode reverberation.

The characteristics of scattering due to interface roughness are usually described by the backscattering matrix for reverberation modeling. The backscattering matrix based on the Bass perturbation theory has significant differences from that based on the empirical scattering rule (Lambert's rule), especially at low grazing angles. In a waveguide environment with a point source, it is very difficult to extract the quantitative characteristics of the backscattering matrix at low grazing angles from the experimental data because of the difficulties in acquiring low-grazing-angle scattering data and separating the scattering data between different modes (grazing angles). In contrast, the use of single-mode excitations as sources in shallow-water waveguides enables acquisition of good quality low-grazing-angle scattering data. In this paper, the characteristics of the backscattering matrix were obtained from different single-mode reverberation experiments in shallow-water. The experiments were carried out at different sites during different seasons off the coasts of China. Model-data comparisons were made and the results showed that at low grazing angles (2°-5°), the backscattering matrices based on the Bass perturbation theory were in good agreement with the experimental data, but the backscattering matrices based on Lambert's rule were not.

What determines the vote-seeking behavior of legislators in South Korea?

Pre-existing studies suggest that legislators in small districts tend to be more responsive to the electorate than those in large districts, as accountability is typically clearer in a smaller setting. However, it is not clear whether the relationship between district size and legislators' constituency-oriented spending holds in other electoral settings (e.g., South Korea), where pork barrel benefits tend to be determined at the administrative unit, not the electoral district. The present study hypothesizes that as the number of legislators in an administrative unit increases, they are less likely to try to appeal to the voters. Additionally, this study examines the moderating effects of partisan homogeneity and legislators' seniority. The results from the statistical analysis of data from Korean National Assembly members confirm our hypothesis: the number of legislators in an administrative unit turns out to be negatively associated with their vote-seeking behavior. Such a relationship tends to be strong in administrative units co-represented by multiple parties and weak among newly elected legislators.

Do political parties always prefer loyalists? Evidence from South Korea.

This paper examines the relationship between ideological polarization and party disloyalty, focusing on the moderating role of the status of a political party in the legislature, i.e., the ruling party or the opposition party. It hypothesizes that the ruling party is willing to endorse disloyal candidates whose issue positions are not close to their own party's platform, whereas the opposition party is likely to punish disloyal candidates to demonstrate party unity in the nomination process. The present study tests this hypothesis, using data from South Korea, where the nomination process for the parliamentary election is dominated by party leaders. The results are by and large consistent with the hypotheses. In line with previous studies, our results suggest that party loyalty is one of the driving forces of polarization in politics. In order to fully understand party polarization at the level of political elites, it is necessary to consider heterogeneous effects of party members' behavior on candidate selection, varying across the party's status, either the ruling party or the opposition party.

Relating waveguide invariant and bottom reflection phase-shift parameter P in a Pekeris waveguide.

The waveguide invariant ß is affected by the shallow-water environment. The effect due to bottom sediment on ß is investigated in this paper. It is found that the effect of sediment bottom can be concentrated on one parameter P-the bottom reflection phase-shift parameter. For a Pekeris waveguide, under Wentzel-Kramers-Brillouin (WKB) approximation, a very simple analytic relation is given: ß ≈ 1 + P/(k(0)H(eff)), where H(eff) is the "effective depth," and H(eff) = H + P/2 k(0). The value of ß related to different high-speed sediments (including layered sediment) ranges from 1.0 to 1.5. Some numerical examples including the layered sediment case are conducted to verify this result. Good agreement between the results calculated by KRAKEN and by WKB with parameter P has been found. Hence, the application of parameter P provides a model-free platform to investigate the bottom effect on the waveguide invariant ß in shallow-water.

Early supplementation of parenteral nutrition is capable of improving quality of life, chemotherapy-related toxicity and body composition in patients with advanced colorectal carcinoma undergoing palliative treatment: results from a prospective, randomized clinical trial.

AIM: Patients suffering from advanced colorectal cancer can experience unintended weight loss and/or treatment-induced gastrointestinal toxicity. Based on current evidence, the routine use of parenteral nutrition (PN) for patients with colorectal cancer is not recommended. This study evaluates the effect of PN supplementation on body composition, quality of life (QoL), chemotherapy-associated side effects and survival in patients with advanced colorectal cancer. METHOD: Eighty-two patients with advanced colorectal cancer receiving a palliative chemotherapy were prospectively randomized to either oral enteral nutrition supplement (PN-) or oral enteral nutrition supplement plus supplemental PN (PN+). Every 6 weeks body weight, body mass index (BMI), chemotherapy-associated side effects and caloric intake were assessed, haemoglobin and serum albumin were measured. Body composition was assessed by body impedance analysis, and QoL was evaluated by European Organization for Research and Treatment of Cancer (EORTC) QLQC30 questionnaire. RESULTS: No differences were evident at baseline between the groups for age, sex, diagnosis, weight, BMI or QoL. A difference in BMI was observed by week 36, whereas differences of the mean body cell mass could be observed from week 6, albumin dropped significantly in the PN- group in week 36 and QoL showed significant differences from week 18. Chemotherapy-associated side effects were higher in PN-. The survival rate was significantly greater in the PN+ group. CONCLUSION: A supplementation with PN slows weight loss, stabilizes body-composition and improves QoL in patients with advanced colorectal cancer. Furthermore, it can reduce chemotherapy-related side effects.

Results of sleeve gastrectomy-data from a nationwide survey on bariatric surgery in Germany.

BACKGROUND: Beginning January 1, 2005, the status and outcomes of bariatric surgery were examined in Germany. Data are registered in cooperation with the An-Institute of quality assurance in surgery at the Otto-von-Guericke-University Magdeburg. The objective of this study was to examine the morbidity and mortality rates secondary to sleeve gastrectomy (SG) in Germany since 2006. METHODS: Data collection occurred prospectively in an online data bank. All primary bariatric procedures performed were recorded as were all re-operations in patients that had already undergone a primary operation. Specific data compiled on the sleeve gastrectomy procedure were evaluated with a focus on operative details and complication rates. RESULTS: The total study cohort contains 3,122 patients. From January 2006 to December 2007, 144 sleeve gastrectomy procedures were performed in the 17 hospitals participating in the study. The mean body mass index (BMI) of all patients was 48.8 kg/m(2). The BMI of patients undergoing SG was 54.5 kg/m(2). In total, 73.8% of the patients were female and 26.2% of the patients were male. There were no significant differences between patients undergoing SG. The general complication rate after SG was 14.1%, and the surgical complication rate was 9.4%. The postoperative mortality rate was 1.4%. CONCLUSIONS: The complication rate during the first 2 years after SG in Germany is similar to that published in the literature. In order to improve the quality of bariatric surgery, an evaluation of data from a German multicenter trial is necessary to evaluate the position of SG in the bariatric algorithm.

A nationwide survey on bariatric surgery in Germany--results 2005-2007.

BACKGROUND: Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined since January 1st, 2005 with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany). METHODS: In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an Internet online data registry. In particular, perioperative characteristics, such as the spectrum of diagnostic measurements, type of surgical procedures, and short- and long-term outcomes, were investigated. RESULTS: During the study period, 629 surgical procedures were performed at 21 hospitals in 2005, 828 procedures at 32 hospitals in 2006, and 1,666 procedures at 35 hospitals in 2007. In 2005 and 2006, gastric banding was the most frequently performed operation, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean body mass index (BMI) was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients in 2005 and 2006; these data showed greater reduction of BMI after malabsorptive rather than restrictive bariatric procedures. The mortality was 0.1% (30 days) and 0.16% (overall). CONCLUSION: As indicated by the worldwide trend, there is an ongoing change from restrictive bariatric procedures to malabsorptive procedures and sleeve gastrectomy. Although the BMIs of German patients undergoing bariatric surgery appear to be substantially higher than those of patients from most other countries, there were no differences in intraoperative and short-term complications or in overall outcomes during follow-up when compared with published studies.

Evidence of thromboembolism prophylaxis in bariatric surgery-results of a quality assurance trial in bariatric surgery in Germany from 2005 to 2007 and review of the literature.

BACKGROUND: Since January 1st, 2005, the current situation for bariatric surgery has been examined by means of a voluntary quality assurance study in Germany with a multicenter design in which 38 hospitals and surgical departments participated. The data are registered in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany). METHODS: Data describing peri-interventional characteristics were prospectively documented in an internet online data registry. All primary bariatric procedures performed since January 1st, 2005, were registered. In addition, reoperations in patients who had previously undergone primary surgical intervention were included. As a representative excerpt from the overall prospective multicenter observational study on obesity surgery, data on the type, regimen, and time course of deep venous thrombosis (DVT) prophylaxis were documented. From the number and spectrum of complications, the incidences of clinically manifest DVT or pulmonary embolism (PE) were derived during the in-hospital course and follow-up in conjunction with the type of surgical procedure and body mass index (BMI). RESULTS: Overall, 3,122 bariatric procedures were performed at 38 German hospitals between January 2005 and December 2007. These procedures were subdivided into 2,869 primary operations and 253 revisions (sex ratio, male to female = 25.6:74.4%). The average BMI of all patients was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. In 2005 and 2006, gastric banding (GB) was the most commonly performed operation, followed by Roux-en-Y gastric bypass (RYGBP). In 2007, RYGBP was carried out in 42.1% of all bariatric procedures. Interestingly, the incidence of deep venous thrombosis (DVT) was only 0.06%, whereas PE occurred in 0.06% of patients only after hospital discharge. The DVT prophylaxis protocol used has been changed for the last 2 years: the majority of patients with a BMI above 50 kg/m(2) received low-molecular-weight heparin twice a day. CONCLUSION: In Germany, a trend from GB to sleeve gastrectomy (SG) and malabsorptive approach has been evaluated. This trend is associated with differences of the DVT prophylaxis regimen in the profile of bariatric surgical patients depending on BMI and the type of bariatric procedure. Despite the low incidence of DVT and pulmonary embolism (PE) detected, there is a lack of evidence on a reasonable regimen for sufficient DVT prophylaxis in bariatric surgery; instead, there are only recommendations from the guidelines and statements of a specific medical society. Therefore, prospective studies are necessary to determine the optimal DVT prophylaxis for bariatric surgical patients as well as obese patients undergoing surgery.

'Fast-track' colonic surgery in Austria and Germany--results from the survey on patterns in current perioperative practice.

OBJECTIVE: 'Fast-track' rehabilitation has been shown to accelerate recovery, reduce general morbidity and decrease hospital stay after elective colonic surgery. Despite this evidence, there is no information on the acceptance and utilization of these concepts among the entirety of Austrian and German surgeons. METHOD: In 2006, a questionnaire concerning perioperative routines in elective, open colonic resection was sent to the chief surgeons of 1270 German and 120 Austrian surgical centres. RESULTS: The response rate was 63% in Austria (76 centres) and 30% in Germany (385 centres). Mechanical bowel preparation is used by the majority (Austria, 91%; Germany, 94%); the vertical incision is the standard method of approach to the abdomen in Austria (79%) and Germany (83%), nasogastric decompression tubes are rarely used, one-third of the questioned surgeons in both countries use intra-abdominal drains. Half of the surgical centres allow the intake of clear fluids on the day of surgery and one-fifth offer solid food on that day. Epidural analgesia is used in three-fourths of the institutions. CONCLUSION: Although there is an evident benefit of fast-track management, the survey shows that they are not yet widely used as a routine in Austria and Germany.

Aging of the circadian system in zebrafish and the effects of melatonin on sleep and cognitive performance.

Aging is a complex process involving intracellular changes and, notably, modifications in intercellular communications, required for coordinated responses to internal and external events. One of the potential reasons for such changes is an age-dependent failure of the integrating systems, including the circadian clock. Here we demonstrate that aging in a diurnal vertebrate, zebrafish (Danio rerio), is associated with major but selective circadian alterations. By 3-5 years of age, zebrafish have reduced amplitude and increased fragmentation of entrained circadian rhythms of activity, with fast desynchronization of the rhythms in the absence of environmental time cues. Aging in zebrafish is also associated with a reduction in the overall duration of nighttime sleep, followed by lower activity levels and a higher arousal threshold during the day. The production of the principal circadian hormone, melatonin, progressively declines during zebrafish aging. However, the ability of melatonin to acutely promote sleep and entrain circadian rhythms of activity remains robust until at least 4-5 years of age, consistent with the preserved levels of mRNA expression for melatonin receptors. Aged zebrafish have altered expression of the circadian genes zBmal1 and zPer1 but not zClock1. A lack of circadian time cues alters cognitive performance in aged more than in young zebrafish and this can be partially attenuated by daily melatonin administration. The advantages of zebrafish as a diurnal, small, prolific and genetically well-characterized vertebrate model provide new opportunities to clarify the intrinsic circadian factors involved in human aging and promote the search for prophylactic and treatment strategies.

Virulent strain associated outer membrane proteins of Borrelia burgdorferi.

We have isolated and purified outer membrane vesicles (OMV) from Borrelia burgdorferi strain B31 based on methods developed for isolation of Treponema pallidum OMV. Purified OMV exhibited distinct porin activities with conductances of 0.6 and 12.6 nano-Siemen and had no detectable beta-NADH oxidase activity indicating their outer membrane origin and their lack of inner membrane contamination, respectively. Hydrophobic proteins were identified by phase partitioning with Triton X-114. Most of these hydrophobic membrane proteins were not acylated, suggesting that they are outer membrane-spanning proteins. Identification of palmitate-labeled lipoproteins revealed that several were enriched in the OMV, several were enriched in the protoplasmic cylinder inner membrane fraction, and others were found exclusively associated with the inner membrane. The protein composition of OMV changed significantly with successive in vitro cultivation of strain B31. Using antiserum with specificity for virulent strain B31, we identified OMV antigens on the surface of the spirochete and identified proteins whose presence in OMV could be correlated with virulence and protective immunity in the rabbit Lyme disease model. These virulent strain associated outer membrane-spanning proteins may provide new insight into the pathogenesis of Lyme disease.

[A survey of perioperative therapy for elective colon resection in Germany, 2006]. / Umfrage zur perioperativen Therapie bei elektiven Kolonresektionen in Deutschland 2006.

BACKGROUND: Despite the evidence that fast-track concepts in colon surgery lead to an enhanced recovery rate, there is no information on the prevalence and utilization of such programs in Germany. METHODS: Based on a conventional sigmoid resection, we asked 1,270 surgical departments in Germany to describe their standard surgical procedures in a questionnaire. RESULTS: The response rate was 385 (30.31%). A total of 96% use a bowel preparation, 83% a vertical incision, 10% use a nasogastric decompression for longer then 1 day, 34% avoid intra-abdominal drains, 51% allow clear fluids on the day of surgery, 13% offer solid food on the first day after surgery, 75% use epidural analgesia and 47% discharge the patients by the seventh day after surgery. CONCLUSION: Although there is an evident benefit using fast-track concepts, they are not yet in wide use as a standard procedure. Further efforts have to be made to ensure that the majority of patients will benefit from these concepts.

[Clinical efficacy and safety of vancomycin compared with linezolid for the treatment of neonatal gram-positive bacterial sepsis].

OBJECTIVE: To evaluate the clinical efficacy and safety of vancomycin and linezolid for the treatment of gram-positive neonatal bacterial sepsis. METHOD: The data of neonates diagnosed as gram-positive bacterial sepsis in neonatology department of Suzhou Municipal Hospital from June 2009 to December 2015 were retrospectively collected. These neonates were divided into vancomycin group and linezolid group. Propensity score matching (PSM) on baseline variables was used to balance the two groups by identifying a comparable group of neonates who received vancomycin and linezolid therapy. Clinical and microbiologic success rates were compared by chi-square test, and changes of laboratory parameters before and after treatment at the end of treatment were then directly compared by rank-sum test between the matched groups. In vancomycin group, correlation between trough concentration of vancomycin and clinical efficacy were evaluated. RESULT: Totally 108 and 209 cases were respectively selected in vancomycin and linezolid groups; 108 cases with well-matched baseline characteristics were included in matched linezolid group. The clinical success rates of vancomycin vs. linezolid therapy were 86.1%(93/108) and 88.9%(96/108)(P=0.681), and the microbiologic success rates were 91.7%(99/108) and 93.5%(101/108)(P=0.795). The average trough concentration of vancomycin was (12±8) mg/L. The rate of reaching the high trough concentration standard was only 33.3%(36/108). In 50 (46.3%) cases the dose was adjusted according to the initial concentration data. Compared to less than 10 mg/L, the clinical efficacy of trough concentration in 10-20 mg/L was much higher(93.9%(46/49) vs. 78.6%(33/42), P=0.031). Total bilirubin and platelet count had significant difference between the two-matched groups (34.1(14.9, 91.0)µmol/L vs. 53.0(27.0, 121.6)µmol/L, P=0.034; 301.0(198.8, 416.0)×10(9)/L vs. 195.5(94.0, 283.2)×10(9)/L, P=0.000). The incidence of linezolid related thrombocytopenia was 13.4%(28 cases). CONCLUSION: The clinical effect of vancomycin and linezolid on gram-positive bacterial sepsis in neonates is comparable. The rate of trough concentration of vancomycin reaching the high trough concentration standard is low, and the clinical efficacy is related to trough concentration. Linezolid have an effect on bilirubin and platelet count, the risk of thrombocytopenia should be monitored closely during linezolid treatment.

An European survey of structure and organisation of nutrition support teams in Germany, Austria and Switzerland.

BACKGROUND & AIMS: Nutritional support teams (NST) have been demonstrated to be an excellent mechanism for identifying patients in need of nutrition support, improving the efficacy of nutrition support in a variety of hospital environments. Focus of this study was the investigation of function, structure and organisation of NST in Germany (D), Austria (A) and Switzerland (CH). METHODS: Prospective investigation of the function, structure and organisation of NST in D, A and CH, using standardised questionnaires. RESULTS: From a total of 3071 hospitals in D, A and CH, NST have been established at 98 hospitals (3.2%). Their main activities were creating nutritional regimes (100%), education (87%) and monitoring nutrition therapy (92%). In general, the NST are not independently operating units but are affiliated to a special discipline. Seventy-one per cent of the physicians, 40% of the nurses and 69% of the dieticians in the NST held a nutrition-specific additional qualification. A total of 12% of the physicians, 37% of the nurses and 46% of the dieticians are exclusively responsible for the NST. A reduction of complications (88%) and cost saving (98%) were indicated since their establishment. The NST received in 32% funding support. CONCLUSION: In D, A, CH neither a uniform nor comprehensive patient care by NST existed in 2004. Standards of practice, development of guidelines in clinical nutrition and better documentation in NSTs are necessary. Special efforts should be aimed at education of NST members and financing of teams.

Advantages of endoscopic therapy of gastrojejunal dissociation in critical care patients.

OBJECTIVE: To evaluate the advantages of a new three-lumen tube (Trelumina) and a percutaneous endoscopic gastrostomy (EntriStar) with a jejunal insertion tube (PEGJ) as a safe method of early enteral nutrition and simultaneous gastric decompression as well as fast reduction of the high gastric reflux in critical care patients. DESIGN: Retrospective, descriptive case series. SETTING: Two anaesthesiological and one surgical intensive care unit (ICU) in a university hospital. PATIENTS: Sixty-five consecutive critically ill patients with gastrojejunal dissociation. The mean Acute Physiology and Chronic Health Evaluation Score (APACHE II) was 19. INTERVENTIONS: Placement of 46 Trelumina and 19 PEGJ under endoscopic control. MEASUREMENTS AND MAIN RESULTS: None of the known percutaneous endoscopic gastrostomy (PEG) complications like wound infection, bleeding or organ perforation were seen. One secondary dislocation of the jejunal insertion tube and four dislocations of the jejunal part of the Trelumina were found. The average gastric reflux of the Trelumina and the PEGJ amounted to 1700 +/- 230 ml/day. Forty-three patients showed a clear decrease in the gastric reflux to 450 +/- 200 ml/day within the first 24 h of tube placement. The average time of reduction to normal gastric reflux volumes (0-200 ml/day) amounted to 4 -/+ 2 days. Forty-three (71 %) of the patients showed improved intestinal passage as expressed by regular peristalsis and defaecation. The price for 1 day enteral feeding via Trelumina or PEGJ was 10 times lower than 1 day total parenteral nutrition. CONCLUSIONS: Placement of the Trelumina and the PEGJ is a safe, successful and inexpensive means of early enteral nutrition and simultaneous gastric reflux reduction in critical care patients.

Structure and organisation of 47 nutrition support teams in Germany: a prospective investigation in 2000 German hospitals in 1999.

OBJECTIVE: Evaluation. Contrary to the Anglo-American region, very little is known in Germany on the structure and organisation of nutrition support teams (NST). DESIGN: Prospective investigation of the structure and organisation of German NST, using standardised interview questionnaires. SETTINGS: Hospitals with more than 250 beds in Germany. SUBJECTS: German NST (n=47). INTERVENTIONS: Face-to-face interview in 1999, using a standardised questionnaire. RESULTS: From a total of 2000 German hospitals, NST have been established at 47 hospitals (2.3%). Most NST are affiliated to a large university hospital or an academic teaching hospital. In general, the NST are not independently operating units but are affiliated to a special discipline, and were in operation for an average of 8 y. The NST cared for a median of 65 outpatients annually. At the university hospitals in average, 477 in-patients were treated per year, at the teaching hospitals 400 and at all other hospitals 179. The work of the NST centred on enteral nutrition. A total of 47% of the physicians, 19% of the nurses and 19% of the dietitians in the NST held a nutrition-specific additional qualification. A total of 2% of the physicians, 68% of the nurses and 77% of the dietitians are exclusively responsible for the NST. More than 70% of the financing of the personnel was secured through third-party funds. CONCLUSION: In Germany, neither uniform nor comprehensive patient care by NST existed in 1999. More than 50% of all NST members do not hold a nutrition-specific additional qualification. Frequently, besides their tasks in the team, the NST staff also carries out other clinical functions. Contrary to the American NST, the German NST are not interdisciplinary operating units but are primarily financed through third-party funds of the industry.