[Treatment mapping of prostate cancer in DVPZ prostate centers in Germany]. / Versorgungsabbild zum Prostatakarzinom in DVPZ-Prostatazentren in Deutschland.

BACKGROUND: In prostate centers of the Governing Body of German Prostate Centers (DVPZ, Dachverband der Prostatazentren Deutschlands e.V.) treatment data from 3 university clinics, 21 treatment clinics, 3 private clinics and 330 general practitioners incorporated under 22 certificates are collated, in order to document the quality and type of cross-sectoral and interdisciplinary treatment, in particular of prostate cancer (PCA) patients. METHODS: This analysis is based on the DVPZ UroCloud data sets from 20 July 2015. The UroCloud reflects the web-based chronological disease development and quality parameters. For the descriptive analysis of particular key figures, available complete data sets were selected. RESULTS: Of the centers 22 held a valid certificate and fulfilled all required case numbers and structural prerequisites at the primary certification or recertification. In three cases a reauditing led to requirements before certification. Since 2005 a total of 9650 PCA patients have been pseudonymized and followed up (41,247 follow-up forms, 4.3 forms per patient). In 2014 the median number of newly documented PCA patients was 61 per center (minimum 7 and maximum 295). Radical prostatectomy (RP) dominated with 4491 (56 %) cases followed by primary hormonal therapy (1210 cases, 15 %), irradiation (809, 10 %) and non-interventional therapy, such as active surveillance (AS) or watchful waiting (WW) in 760 cases (10 %). A prostate-specific antigen (PSA) reduction was documented in 50 % of the patients with a preoperative PSA value > 20, in 60 % of pT4 tumors and in 50 % of patients with a tumor Gleason score of 9-10. A positive incision margin (R+) was found in in 15 % of pT2 stages, 41 % of pT3 stages and 85 % of pT4 stages. A secondary intervention was documented in 6.5 % of RP. CONCLUSION: The DVPZ certificate reflects the complete spectrum of treatment of PCA patients. The strength of the certificate lies in the documentation of patient development and a simultaneous collation of quality parameters.

[Enhanced automatic collision notification system. First field experience]. / Automatische Unfallmelder. Erste Erfahrungen aus der Anwendung.

Motor vehicle accidents are the leading cause of severe injuries. Outcome of these victims is substantially influenced by rescue time and primary trauma centre care. Nowadays, automatic crash notification systems (ACN) are available offering the major possibility of immediate initiation of the rescue chain and thereby shortening rescue time up to 50%. According to the EU commission a nationwide equipping of motor vehicles with automatic crash notification systems could save up to 2,500 lives per year. Therefore, all new vehicles should be equipped with an automatic crash notification system by 2014. BMW is the first manufacturer to install an enhanced automatic crash notification system (eACN), which could optimize the rescue triage by estimating the risk for severe injuries (MAIS3+) based on telemetric transmitted accident data.

[Bulge of the scapholunate ligament: an arthro-CT sign of traumatic scapholunate instability]. / Un ligament scapholunaire bombé, signe arthrotomodensitométrique d'instabilité scapholunaire traumatique.

Tears of the scapholunate ligament are usually diagnosed during an arthro-CT or arthro-MRI examination. Typically, the contrast agent passes from one joint to the other. In certain cases, fibrous scar tissue devoid of any mechanical effect may block the passage and lead to an erroneous interpretation of the images. We reviewed retrospectively patients who underwent arthroscopic treatment for scapholunate tears and who had normal arthro-CT images. We searched for specific aspects suggestive of ligament injury. Analysis of the arthro-CT images demonstrated that a bulge of the scapholunate ligament could be noted in patients whose diagnosis of scapholunate ligament injury was established arthroscopically. We propose that appropriate lecture of wrist images can identify scapholunate ligament injury in patients wrongly considered to be free of wrist injury, but who actually have an occult injury to the scapholunate ligament.

Comparison of real world side impact/rollover collisions with and without thorax airbag/head protection system: a first field experience study.

After the introduction of the Thorax Airbag (TA) and the Head Protection System (HPS) by BMW there has been a significant reduction of injuries in real-world collisions. Comparison of similar collisions (in-depth collision analyses) of vehicles with and without HPS/TA indicates that the effectiveness of the system was credible. Minor injuries (AIS 1) increase while serious injuries (AIS 3+) are reduced. Based on the limited cases available, a proper statistical sampling could not be achieved at this time, however the results are to be understood as indicative of a trend.

Surfactant effects on cuticular penetration of neutral polar compounds: dependence on humidity and temperature.

Effects of poly(ethylene glycol) (PEG 400) and polydisperse fatty alcohol ethoxylates ("Genapols") on methylglucose penetration across cuticles of Pyrus communis were studied under different humidities and temperatures. All surfactants increased methylglucose penetration better than PEG 400. The efficacy was proportional to their own penetration. Genapol C-100 (C12.5E8.4; C, average number of carbon atoms in the alkyl chain; E, average number of ethoxy groups) effects were strongly concentration dependent (0.2-5 g/L). At 2 g/L distinct differences between surfactants were observed. Effects of Genapol C-050 (C12.5E5.8) did not depend on humidity (11-93% RH) and temperature (15-35 degrees C). They were maximal after application but decreased rapidly due to surfactant penetration. Genapol C-200 (C12.5E17) effects increased strongly with humidity and temperature both of which prevented its solidification. Genapol C-100 was superior under most conditions and never failed to increase penetration. There was no simple relationship between ethylene oxide content and surfactant effect.

A continuous fluorescence-based assay of human cytomegalovirus protease using a peptide substrate.

The 28-kDa protease from human cytomegalovirus (hCMV) has been successfully cloned, expressed, and purified to homogeneity. An internally quenched fluorescent substrate (4-4'-dimethylaminophenazo)benzoyl-Arg-Gly-Val-Val-Asn-Ala-Ser-Ser -Arg-Leu-Ala-5-[(2'-aminoethyl)-amino]-naphthalene-1-sulfonic acid; DABCYL-CMV-EDANS) based on the maturational cleavage site (M-site) junction was synthesized in an effort to develop a fluorescence-based assay. This substrate is cleaved specifically between the Ala-Ser peptide bond thereby liberating the C-terminal peptide-EDANS fragment from the proximity quenching effect of the DABCYL group. This results in greater than a 10-fold increase in fluorescence that is observed at the EDANS emission wavelength of 495 nm. Human CMV protease efficiently cleaved this synthetic substrate permitting continuous assay at peptide concentrations lower than 10 microM. At substrate concentrations greater than 10 microM, linearity was lost due to the "inner filter effect." This represents the first fluorescence-based assay for any of the herpes virus proteases. Additionally, a peptidyl inhibitor, H-Arg-Gly-Val-Val-Asn-Ala-psi[CH2NH]-Ser-Ser-Arg-Leu-Ala-OH, was prepared. This inhibitor was also based on the same M-site cleavage junction with a nonhydrolyzable reduced peptide bond incorporated at the cleavage site. Using the fluorescence-based assay, this reduced peptide bond analog was observed to be an inhibitor of hCMV protease with an inhibition constant of > 500 microM.

Hepatitis C-virus (HCV) antibodies in patients after kidney transplantation.

The hepatitis C-virus (HCV) is the main etiologic agent of posttransfusion hepatitis (PTH). Most patients depending on hemodialysis need transfusion of blood before kidney transplantation. Of 272 patients after kidney transplantation, 27 (10%) were found to be anti-HCV-ELISA-positive (HCV-Antibody-ELISA, Ortho Diagnostics). The antibodies could be neutralized by HCV C-100-3 antigen. Eight of 22 patients (36%) who had more than one kidney transplantation were classified anti-HCV positive [30% (8/27) of all anti-HCV positive patients]. The number of transfused blood units ranged from 0 to 99 BU. Receiving more than one kidney graft or the transfusion of more than 5 units of blood increased the risk for HCV infection 3.5 or 4.1 times, respectively, compared with one transplantation or less than 5 units of blood. No significant interactions were seen between these two variables. Of the anti-HCV positive patients, 48% were anti-HBc negative as well as HBs-antigen negative, 52% were anti-HBc positive.

[Hepatitis C virus antibodies (anti-HCV) prevalence rate in anti-HBc-negative blood donors]. / Hepatitis C-Virus-Antikörper (Anti-HCV) Prävalenzrate bei Anti-HBc-negativen Blutspendern.

Since 1986 only anti-HBc negative blood donors had been admitted for blood donations at the Heidelberg University Blood Bank. The maximum ALT-level for blood donors was set at less than or equal to 30 U/l. Four of 1514 blood donors (0.26%) were found to be anti-HCV positive. The routine screening of blood donors for anti-HBc in combination with an ALT-level less than or equal to 30 U/l leads to the observed lower prevalence compared to the rate found in German blood donors (0.26%/0.42% [1]).

[Hepatitis C virus antibodies in patients following blood transfusion and kidney transplantation]. / Hepatitis C-Virus (HCV) Antikörper bei Patienten nach Bluttransfusionen und Nierentransplantation.

The prevalence of anti-HCV in patients after kidney transplantation was tested by HCV-Antibody-ELISA (Ortho Diagnostics). In addition, reactive samples were tested by HCV-EIA (Abbott Laboratories), neutralization, anti-HBc (Corzyme, Abbott) and by HBs-Ag (Auszyme, Abbott). 27 of 271 patients (10%) were anti-HCV positive. Receiving more than one kidney graft (TPL) or the transfusion of more than four blood units (BU) increases the risk of HCV infection four times (OR: 4.1; p less than 0.01) or 2.5 times (OR: 2.5; p less than 0.05), respectively, compared with one TPL or less than 4 BU. Receiving more than one kidney graft and transfusion of more than four BU raises the risk of HCV infection 6.8 times. 52% of anti-HCV positive patients were anti-HBc positive, 48% were anti-HBc negative as well as HBs-Ag negative.

Epithelial mediated wound contraction in experimental wounds--the purse-string effect.

Wound contraction, a process whereby wound edges are drawn together, is thought to be mediated by the myofibroblast cell population. However, experimental wounds may close as much as 25% (surface area) before the onset of fibroplasia which is marked by the migration of fibroblasts and myofibroblasts into the wound bed 2 to 3 days after injury. This early phase of wound closure appears to be mediated by a contractile force produced by a circumferentially arranged band of fusiform-shaped epidermal cells situated in the wound margin. Cytoplasmic microfilaments in the epidermal cells, similar in size and configuration to actin filaments and/or tonofilaments, are found to be aligned with the long axis of the constitutive cells comprising the contractile band. The data suggest that contraction in experimental wounds is promoted by at least two distinct cell-mediated contractile events: an initial although brief phase effected by cells of the epidermis followed by an extended phase of soft connective tissue contraction produced vis à vis the myofibroblasts in the dermis.

Effect of tunicamycin, an inhibitor of protein glycosylation, on division of tumour cells in vitro.

We determined the effect tunicamycin (TM), an inhibitor of protein glycosylation, had on cells in vitro that were derived from solid and ascites variants of a chemically induced rat hepatoma. Using flow microfluorometry (FMF), labelling index (LI), and population-doubling time assays, we monitored the progression of cells through the cell cycle after treatment with TM. Cells in monolayer culture were first incubated in 0.05 or 0.10 micrograms TM/ml medium for 24 h then analysed or given fresh medium without TM and allowed to recover for 6-24 h. Exposing cells to 0.05-0.50 micrograms TM/ml medium did not affect the percentage of viable cells as determined using the Trypan Blue exclusion procedure. However, continuous exposure to 0.05 micrograms TM/ml medium did affect the population-doubling times of both the ascites and solid variants, and the ascites tumour cells were more sensitive than the solid tumour cells. TM reversibly inhibited hepatoma cells from entering S phase of the cell cycle. After exposure to TM for 24 h, the percentage of solid tumour cells in vitro in S phase decreased to 19%, as determined by autoradiography of tritiated-thymidine-labelled cells, and to 21% as determined by FMF; 49% of untreated solid tumour cells were in S phase. The percentage of ascites tumour cells in vitro decreased to 12% after exposure to TM for 24 h; 37% of untreated cells were in S phase. We concluded that TM can inhibit division of rat hepatoma cells in vitro by blocking them in G1 phase of the cell cycle.

The myofibroblast anchoring strand--the fibronectin connection in wound healing and the possible loci of collagen fibril assembly.

Myofibroblast anchoring strands (MAS) are extracellular structures that connect the termini of actin bundles within myofibroblasts to collagen fascicles in the extracellular space of wound healing tissues. The strands appear to be primarily comprised of microfibrils of fibronectin 2-5 nm in diameter. They also embody parallel arrays of intermediary sized filaments (ISF) and an amorphous matrix of collagen. The MAS effectively translate the cellular contractile forces required for cell motility into the collagen filament/fiber deformations required for wound contraction. However, the primary function of the strands appears to be the assembly of ISF into collagen fibrils.

A sample-grouping technique for paraffin embedments.

A technique is described which facilitates histological preparation of multiple tissue specimens for light microscopy. The procedure enables the investigator to separate and label identifiable subgroups from a larger number of specimens in one histological section. After standard fixation, murine esophagi were arranged longitudinally and secured within segments of murine intestine. Markers such as plant fibers and human hairs were threaded alongside the esophagi within each intestinal casing. After standard dehydration and infiltration, several segments of intestine were arranged parallel to each other and at right angles to the intended plane of sectioning and were embedded together in one paraffin block. This method made it possible to assemble onto one microscope slide cross sections of 42 individual esophagi in 6 identifiable subgroups, each containing 7 esophagi.

Bladder reconstruction in rabbits with glutaraldehyde-stabilized amniotic membranes.

Glutaraldehyde-treated human amniotic membranes were used to repair rabbit bladders after supratrigonal cystectomies. The membranes maintained the integrity of the bladders until healing and reepithelialization occurred. There was no significant loss of bladder capacity or decreased renal function postoperatively. Calcification did not occur on the membranes but was noted on chromic sutures retaining the membranes in 7 of 27 bladders. These findings suggest that glutaraldehyde-stabilized amnion is well tolerated by the urothelium and may serve as a suitable material for replacement of genitourinary tissues.

SEM of epithelial mediated wound in mice.

Wound edges are drawn together by a process known as wound contraction. Myofibroblasts are thought to mediate this contractile force. However, up to 25% of the surface area of a wound may close in the first few days, long before significant numbers of myofibroblasts appear in the wound bed. This suggests that another contractile force exists in the margins of the wound tissue. This force appears to be mediated by a band comprised of fusiform shaped epidermal cells. These cells are circumferentially distributed with respect to the wound margin. Microfilaments, similar in size to actin filaments and/or tonofilaments, can be observed in these cells. The filaments are aligned with the long axis of the epithelial cells that comprise the contractile band. Thus, wound contraction may in all likelihood be a biphasic phenomenon initially involving epidermal cells followed by the myofibroblasts.

Papillary necrosis in vitro: a scanning electron microscopic comparison of escherichia coli and Proteus mirabilis infection.

The effect of bacterial infection on excised renal papillae as a model for papillary necrosis and subsequent calcification was investigated. Sterile rat renal papillae were placed in 25 ml aliquots of filter sterilized human urine and then inoculated with one ml suspensions of sterilized human urine and then inoculated with one ml suspensions of sterile saline as a control, or 1 x 108/ml Escherichia coli or proteus mirabilis. After incubation at 37 degrees C for periods of 8 hr, 24 hr, 48 hr, 72 hr, 1 wk, 2 wk and 3 wk, urinary pH was measured, bacterial culture performed and the renal papillae were recovered and examined by scanning electron microscopy (SEM) and energy dispersive spectrophotometry (EDS). In the case of Proteus mirabilis, the sequence of events noted included bacterial-papillary interactions consisting of cell desquamation and strand formation, despite infrequent bacterial attachment. After 10 hr, a rapid, urease induced pH rise resulted in calcium salt deposition on the papillae surface. Organism death was apparent after 72 hr. Escherichia coli infected papillae demonstrated similar cell surface changes after a 8 hr as seen in P. mirabilis; however, frequent evidence of bacterial attachment and penetration was apparent. Bacterial attachment was a prominent feature throughout the incubation period with E. coli. After one week, rare areas of degenerating cells and bacteria with increased calcium levels as compared to surrounding areas were noted by EDS analysis. Urinary pH was stable throughout the incubation period. This study suggests varied roles for the organisms most associated with infection induced papillary necrosis (E coli) and papillary necrosis with subsequent stone formation (P. mirabilis). A role for bacterial calcification in the absence of bacterial urease activity by E. coli is also suggested.