Human cytomegalovirus seropositivity is associated with reduced patient survival during sepsis.

BACKGROUND: Sepsis is one of the leading causes of death. Treatment attempts targeting the immune response regularly fail in clinical trials. As HCMV latency can modulate the immune response and changes the immune cell composition, we hypothesized that HCMV serostatus affects mortality in sepsis patients. METHODS: We determined the HCMV serostatus (i.e., latency) of 410 prospectively enrolled patients of the multicenter SepsisDataNet.NRW study. Patients were recruited according to the SEPSIS-3 criteria and clinical data were recorded in an observational approach. We quantified 13 cytokines at Days 1, 4, and 8 after enrollment. Proteomics data were analyzed from the plasma samples of 171 patients. RESULTS: The 30-day mortality was higher in HCMV-seropositive patients than in seronegative sepsis patients (38% vs. 25%, respectively; p = 0.008; HR, 1.656; 95% CI 1.135-2.417). This effect was observed independent of age (p = 0.010; HR, 1.673; 95% CI 1.131-2.477). The predictive value on the outcome of the increased concentrations of IL-6 was present only in the seropositive cohort (30-day mortality, 63% vs. 24%; HR 3.250; 95% CI 2.075-5.090; p < 0.001) with no significant differences in serum concentrations of IL-6 between the two groups. Procalcitonin and IL-10 exhibited the same behavior and were predictive of the outcome only in HCMV-seropositive patients. CONCLUSION: We suggest that the predictive value of inflammation-associated biomarkers should be re-evaluated with regard to the HCMV serostatus. Targeting HCMV latency might open a new approach to selecting suitable patients for individualized treatment in sepsis.

The value of bronchoalveolar lavage for discrimination between healthy and diseased individuals.

BACKGROUND: Bronchoalveolar lavage (BAL) is standard diagnostic procedure. Procedural recommendations have been made by pneumological societies including normal values for interpretation of BAL cytology. These normal values derive from small studies in healthy volunteers and have never been analysed for their sensitivity and specificity. OBJECTIVES: This study aims to analyse sensitivity and specificity of these normal values by assessing lavage cell composition in healthy and diseased individuals. METHODS: More than 6000 BAL were retrospectively analysed for their cellular distribution including BALs of 250 healthy individuals. All BALs were obtained under similar conditions. RESULTS: Bronchoalveolar lavage cytology of healthy individuals mirrors data from previous studies with smoking being the most important manipulator of BAL cytology. Analyses of proposed normal values demonstrate specificity between 80% and 95%, whereas sensitivity ranges between 35% and 65%. Using different mathematical models, a value summing up the differences to ATS-proposed normal values of the cytological pattern was found to best discriminate between healthy and diseased individuals with a sensitivity of nearly 60% with a predefined specificity of 95%. CONCLUSION: In summary, our analysis confirmed prior results for healthy volunteers and enlarged these findings by analysing sensitivity and specificity of lavage results in an independent validation cohort of diseased individuals. Thereby, the study may influence the acceptance of BAL in the diagnostic workup of individuals with pulmonary diseases. Additionally, the study proposes a novel value that facilitates lavage interpretation and may therefore be useful in further studies.

[Psychosocial Stress, Stress Perception and Stress Management of Students of Social Work: a Quantitative Study]. / Psychosoziale Belastungen, Stressempfinden und Stressbewältigung von Studierenden der Sozialen Arbeit: Ergebnisse einer quantitativen Studie.

In this quantitative study, data on 746 students of social work were collected regarding their current sense of stress, experience of psychosocial drain as well as their use of specific coping strategies. The Perceived Stress Scale (PSS) and the Trier Inventory of Chronic Stress (TICS) were used. The results show that one out of 3 students suffer from a lot of to extreme stress. One-fourth of the students report feeling overworked and socially overburdened. More than half of the students are exposed to psychosocial drain as a consequence of past events in their biography (e. g. death or mental illness of a close relative). Despite these obvious burdens, only one-fourth made use of professional aid or counseling. Students who are primarily using functional coping strategies have a lower sensibility to stress and feel less overworked than students primarily using dysfunctional coping strategies. In the university setting, the theoretically and empirically sound knowledge based on this report can be used profitably: The increasing implementation of seminars on coping with stress at universities itself suggests that learning and utilizing functional coping strategies can contribute to a reduction of stress and strain among students.

[Sarcoidosis]. / Sarkoidose.

Sarcoidosis is a rare granulomatous disease mainly affecting lymph nodes and the lungs but joints, bones, muscles and other organs can also be affected. Sarcoidosis therefore represents an important differential diagnosis to various rheumatic diseases. For the diagnosis and differential diagnostic clarification, bronchoscopy including endobronchial ultrasound-guided fine needle aspiration of mediastinal and hilar lymph nodes represent the main procedures. Because of the high spontaneous remission rate initiating a therapy requires a therapeutic goal defined by sarcoidosis-associated functional organ impairment, especially for acute sarcoidosis. Cortisone represents the most commonly administered medication whereas methotrexate and azathioprine are well-established second-line medications. Antibodies which neutralize tumor necrosis factors (TNF) are a potential third-line therapy.

Multicentre study of abdominal aortic aneurysm measurement and enlargement.

BACKGROUND: No effective treatment is currently available to prevent progression of small and medium-sized abdominal aortic aneurysms (AAAs). Identification of drugs with sufficient promise to justify large expensive randomized trials remains challenging. One potentially useful strategy is to look for associations between commonly used drugs and AAA enlargement in appropriately adjusted observational studies. METHODS: Potential AAA measurements were identified from abdominal imaging reports in the electronic data files of three medical centres from 1995 to 2010. AAA measurements were extracted manually and patients with an aneurysm of 3 cm or larger, who had at least two measurements over an interval of at least 6 months, were identified. Other data were obtained from the electronic data files (demographics, co-morbidities, smoking status, drug use) to conduct a propensity analysis of the associations of drugs and other factors with AAA enlargement. RESULTS: From 52,962 abdominal imaging studies, 5362 patients with an AAA of 3 cm or more were identified, of whom 2428 had at least two measurements over at least 6 months. Mean AAA follow-up was 3.4 years and the mean AAA enlargement rate was 2.0 mm per year. Propensity analysis demonstrated no significant association of AAA enlargement with statins, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Diabetes was associated with a reduction in AAA enlargement of 1.2 mm per year (P = 0.008), and chronic obstructive pulmonary disease was associated with increased enlargement (0.5 mm per year; P = 0.050). Moderate AAA measurement variation and substantial terminal digit preference were also observed, but the digit preference became less pronounced after 2000. CONCLUSION: This study confirms the negative association of diabetes with AAA progression. There was no evidence that commonly used cardiovascular drugs affect AAA enlargement.

[Diagnosis and treatment of sarcoidosis. Current standards]. / Diagnostik und Therapie der Sarkoidose. Was ist gesichert?

Sarcoidosis is a granulomatous disease that mainly affects the lungs and intrathoracic lymph nodes; however, virtually any organ can be affected. As an orphan disease, recommendations are mainly based on observational or small randomized studies as well as experts' opinion. Diagnosing sarcoidosis requires proof of non-necrotizing granulomas in patients with a compatible symptomatic pattern and the exclusion of other granulomatous diseases. Granulomas can be detected best in the lungs or intrathoracic lymph nodes. Therefore, bronchoscopy and endobronchial ultrasound with biopsies of lymph nodes are the major tools to diagnose sarcoidosis. Frequently, close follow-up and symptomatic therapy are sufficient to allow for spontaneous resolution. In case of functional organ impairment, cardial or CNS involvement, or other complications, steroid therapy is necessary with a starting dose of 0.5 mg/kg body weight that should be tapered-off over 6-12 months. Steroid-refractory disease can be treated by adding methotrexate or azathioprine, two drugs long known in sarcoidosis treatment. Monoclonal antibodies against TNF and lung transplantation are further therapeutic options.

Pentacyclic triterpenes from Terminalia arjuna show multiple benefits on aged and dry skin.

BACKGROUND: Pentacyclic triterpenoids improve epidermal barrier function and induce collagen production. Here, their effects on cutaneous aging by means of objective instrumental measurements were elucidated. METHODS: Reconstituted human epidermis, cultivated keratinocytes and fibroblasts were incubated with Terminalia arjuna triterpenes (T. arjuna bark extract), and mRNA and protein expression of various genes was determined using microarray analysis, qRT-PCR and ELISA techniques. Clinical efficacy of T. arjuna bark extract versus vehicle control cream was elucidated in 30 patients and transepidermal water loss (TEWL), skin hydration and elasticity were measured. Another 30 female patients in their postmenopausal phase were treated with a similar regime, and skin sebum content, cutaneous blood microcirculation and skin density/echogenicity were assessed. RESULTS: Incubation with T. arjuna triterpenes increased FGF-2, TSP-1, TGF-ß and CTGF expression, and VEGF secretion in vitro. Elevated lactate dehydrogenase release upon sodium dodecyl sulphate challenge was reversed by the application of T. arjuna bark extract. T. arjuna bark extract decreased TEWL, improved skin moisturization, reduced scaliness and led to significantly improved skin elasticity. Also, increases in blood microflow and skin sebum content as well as improved skin thickness/echogenicity were noted on postmenopausal skin, resulting in visible reduction of sagging skin on the jowls as demonstrated by digital photography. CONCLUSION: T. arjuna bark extract appears as an innovative active ingredient that exerts versatile antiaging properties in vitro and in vivo.

Catheter length preference in wheelchair-using men who perform routine clean intermittent catheterization.

STUDY DESIGN: Prospective, unblinded, multicenter, randomized, controlled, cross-over study assessing user preference and ease of use characteristics of two gel intermittent catheters in 81 self-catheterizing wheelchair-using men. OBJECTIVES: To evaluate the male user's preference between a 30-cm and a 40-cm intermittent catheter (Apogee Intermittent Catheter, Hollister Incorporated, Libertyville, IL, USA) regarding the ease of insertion and removal, ability to control the catheter during insertion, bladder emptying confidence and ease of draining urine into a receptacle or connecting to a urine bag. SETTING: Multiple institutions in the United States. METHODS: Subjects were randomized to order of catheter use, using both 10 test catheters (30-cm) and 10 control catheters (40 cm). All catheters were 12 or 14 French and identical in design and composition, except length. Safety was assessed during the entire study period regarding adverse events (AE) and adverse device events (ADE). Subjects evaluated their ease of use characteristics after each catheter use and final catheter preference. RESULTS: Subjects preferred the Apogee 40-cm intermittent catheter (91.4%) over the 30-cm length (8.6%). The preference was due to subject confidence of complete bladder emptying (70%), more satisfactory length (74%) and easier to drain into a receptacle (58%) with a portable urinal being the most utilized (37%), followed by toilet (35%). The only AE/ADE reported was minor urethral bleeding in one subject and minor pain in another subject, both with the 30-cm catheter. None were reported with the 40-cm catheter. CONCLUSIONS: The Apogee 40-cm catheter was the preferred intermittent catheter due to subject confidence in bladder emptying, ease of catheter manipulation and the ease of draining urine into a receptacle.

[Prospective qualification requirements in nursing care. Results and conclusions of the BMBF research network FreQueNz]. / Zukünftiger Qualifikationsbedarf in der Pflege. Ergebnisse und Konsequenzen aus dem BMBF-Forschungsnetz FreQueNz.

Demographic change, advances in medicine, and innovative health care services are leading to changes in the professional qualification requirements for nursing and care staff. Detecting future trends in relation to these requirements was the focus of a Delphi study developed as part of the BMBF FreQueNz initiative. After qualitative expert interviews, data collection was organized in three consecutive steps, with 243 interviews realized in the second wave. It was found that home care will further diversify in the fields of supporting and counseling services as well as in palliative care, resulting in the necessary expansion of specific qualifications (e.g., intensive care). Moreover, there will be an increased need for interprofessional, intersectoral, and intercultural coordination and communication skills. As a consequence of the delegation of medical tasks, new duties for nonmedical professions in inpatient and outpatient care will also arise. For instance, qualifications need to be tailored to the new demands of assessment, diagnostics, therapy, and patient education and they should take into account evidence-based knowledge as well as clinical practice guidelines. Consequently, the system of care professionals will further diversify through advanced training programs and the continued academization of nursing.

Anatomic considerations of inflatable penile prosthetics: lessons gleaned from surgical body donor workshops.

Surgical implantation of an inflatable penile prosthesis (IPP) remains the gold-standard treatment for severe erectile dysfunction. The ideal surgical technique requires a thorough understanding of the relevant anatomy. This includes anatomic considerations related to, but not limited to, dissection and exposure of penoscrotal fasciae and tissues, corporal configuration, and abdominal structures. Insights obtained from pre-dissected anatomic specimens can obviate urethral injury, nerve damage, corporal perforation, inappropriate sizing, crossover, or implant malposition. We present penile implant-specific anatomic dissections and topographic landmarks identified over the last decade in the course of surgical training programs provided for IPP implantation.

X-ray absorption measurements on an ultrasonic spray aerosol.

Spray deposition of thin films and coatings is a widely used manufacturing process owing to its low cost, versatility and simple implementation. The objective of the presented experiments was to investigate whether X-ray absorption measurements on solutes carried by aerosols are possible, and what count rates can be achieved depending on solution flow through and the resulting mass density in the interrogation volume. The investigated prototypical spray aerosol was InCl(3) dissolved in water or ethanol dispersed via an ultrasonic nebulizer. InCl(3) spray is essential for the ion layer gas reaction process used for the deposition of In(2)S(3) buffer layers for highly efficient chalcopyrite solar cells. The discussed experiments demonstrate that measurements are possible, but that the achievement of good signal-to-noise ratios requires extended sampling times and concentrated solutions.

Fifty-kDa hyaluronic acid upregulates some epidermal genes without changing TNF-α expression in reconstituted epidermis.

BACKGROUND: Due to its strong water binding potential, hyaluronic acid (HA) is a well-known active ingredient for cosmetic applications. However, based on its varying molecular size, skin penetration of HA may be limited. Recent studies have demonstrated that low-molecular-weight HA (LMW HA) may show a certain proinflammatory activity. We thus aimed to characterize an LMW-sized HA molecule that combines strong anti-aging abilities with efficient skin penetration but lacks potential proinflammatory effects. METHODS: Total RNA and total protein were isolated from reconstituted human epidermis following incubation with HAs of various molecular weights (20, 50, 130, 300, 800 and 1,500 kDa). Tumor necrosis factor-α expression was determined using quantitative PCR. Genomic and proteomic expression of various junctional proteins was determined using Affymetrix and common Western blotting techniques. RESULTS: LMWHA of approximately 50 kDa did not significantly alter tumor necrosis factor-α expression compared to 20-kDa HA, but revealed significantly higher skin penetration rates than larger sized HA associated with increased expression of genes and proteins known to be involved in tight junction formation and keratinocyte cohesion. CONCLUSION: LMW HA of approximately 50 kDa shows better penetration abilities than larger-sized HA. In addition, LMW HA influences the expression of various genes including those contributing to keratinocyte differentiation and formation of intercellular tight junction complexes without showing proinflammatory activity. These observations contribute to current knowledge on the effects of LMW HA on keratinocyte biology and cutaneous physiology.

Assessment of trabecular and cortical architecture and mechanical competence of bone by high-resolution peripheral computed tomography: comparison with transiliac bone biopsy.

UNLABELLED: We compared microarchitecture and mechanical competence parameters measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) and finite-element analysis of radius and tibia to those measured by histomorphometry, micro-CT, and finite-element analysis of transiliac bone biopsies. Correlations were weak to moderate between parameters measured on biopsies and scans. INTRODUCTION: HR-pQCT is a new imaging technique that assesses trabecular and cortical bone microarchitecture of the radius and tibia in vivo. The purpose of this study was to determine the extent to which microarchitectural variables measured by HR-pQCT reflect those measured by the "gold standard," transiliac bone biopsy. METHODS: HR-pQCT scans (Xtreme CT, Scanco Medical AG) and iliac crest bone biopsies were performed in 54 subjects (aged 39 +/- 10 years). Biopsies were analyzed by 2D quantitative histomorphometry and 3D microcomputed tomography (microCT). Apparent Young's modulus, an estimate of mechanical competence or strength, was determined by micro-finite-element analysis (microFE) of biopsy microCT and HR-pQCT images. RESULTS: The strongest correlations observed were between trabecular parameters (bone volume fraction, number, separation) measured by microCT of biopsies and HR-pQCT of the radius (R 0.365-0.522; P < 0.01). Cortical width of biopsies correlated with cortical thickness by HR-pQCT, but only at the tibia (R = 0.360, P < 0.01). Apparent Young's modulus calculated by microFE of biopsies correlated with that calculated for both radius (R = 0.442; P < 0.001) and tibia (R = 0.380; P < 0.001) HR-pQCT scans. CONCLUSIONS: The associations between peripheral (HR-pQCT) and axial (transiliac biopsy) measures of microarchitecture and estimated mechanical competence are significant but modest.

[Recurrent synovial chondromatosis of the tarsometatarsal joint. Case report and review of literature]. / Rezidivierende synoviale Chondromatose im Tarsometatarsalgelenk. Fallbericht und Literaturübersicht.

Primary synovial chondromatosis is a rare and usually monoarticular metaplasia of the synovia. It may recur, but the tendency to malignant transformation is very low. The radiological and histopathological differentiation from low grade chondrosarcoma can be difficult. We present a case report of a 32-year-old male with synovial chondromatosis in the tarsometatarsal joint area, which is an uncommon localization.

Polycentric Exoprosthetic Knee Joints - Extent of Shortening During Swing Phase.

BACKGROUND: An often assumed advantage of polycentric knee joints compared to monocentric ones is the improved ground clearance during swing phase due to the geometric shortening of the lower leg segment (LLS). OBJECTIVE: To investigate whether polycentric knee joints considerably improve ground clearance and to evaluate the influence of prosthetic alignment on the extent of ground clearance. METHODOLOGY: 11 polycentric and 2 monocentric knee joints were attached to a rigid, stationary testing device. Shortening of the LLS and the resulting ground clearance during knee flexion were measured. Prosthetic components were mounted at the same height and the anterior-posterior position was in accordance with the manufacturer's alignment recommendations. FINDINGS: Shortening of up to 14.7 (SD=0.0) mm at the instance of minimal ground clearance during swing phase was measured. One knee joint elongated by 4.4 (SD=0.0) mm. Measurements of the ground clearance demonstrated differences up to 25.4 (SD=0.0) mm. One monocentric knee joint provided more ground clearance when compared to 8 of the polycentric knee joints investigated. CONCLUSION: Only some polycentric knee joints shorten appreciably during swing phase. With an optimized prosthetic alignment and a well-designed swing phase control, a monocentric knee joint may generate greater ground clearance compared to a polycentric knee joint.

[Determinants of workplace health promotion in the insurance sector: results of a complete survey of German insurance companies in 2006]. / Determinanten der betrieblichen Gesundheitsförderung in der Versicherungsbranche: Ergebnisse einer Vollerhebung bei deutschen Versicherungen im Jahr 2006.

OBJECTIVES: The present study is aimed to assess the current level of workplace health promotion (WHP) within the German insurance sector and to examine whether and to what extent internal and external factors play a role in implementing non-statutory health promotion measures. METHODS: Firstly, a telephone survey was conducted of German insurance companies fulfilling the inclusion criteria for the survey (n=258). It was enquired whether these companies wish to participate in a written survey on workplace health promotion. A written questionnaire was then sent to those companies meeting the criteria (n=140). The questionnaire contained questions on the company, number and type of workplace health promotion measures as well as the internal and external framework for workplace health promotion measures. In total, 68 questionnaires were filled in and returned. Linear regression analysis was applied to investigate how external and internal variables influence workplace health promotion. RESULTS: The response rate was 48.57%. Workplace health promotion measures undertaken by those insurance companies taking part in the written survey were largely dominated by behavioural and relational prevention measures. Also on offer were measures from areas such as further education and prevention that seek to improve communication and team work. By contrast, diagnostic activities were only of minor importance. Incorporation into workplace health management (beta=0.469; p<0.001), company size (beta=0.340; p<0.001) as well as implementation of management measures with regard to personnel development, organisational development and quality control (beta=0.243; p<0.01) have a significant influence on the number of non-statutory WHP measures implemented (R (2)=62%). CONCLUSIONS: To increase the effectiveness of their non-statutory health promotion measures insurance companies should increasingly incorporate such measures into specific health management programmes as well as general management measures with regard to personnel development, organisational development and quality control. Moreover, workplace health promotion measures should always be evaluated in terms of health and economic indicators. It should also be noted that small and medium-sized companies have the largest potential for improvement.