In-hospital mortality after acute STEMI in patients undergoing primary PCI.

BACKGROUND: Acute myocardial infarction (AMI) is the main cause of global and in-hospital mortality in patients with cardiovascular diseases. We aimed to examine the association between the coronary artery involved and the in-hospital mortality in patients who underwent primary percutaneous coronary intervention (pPCI) after ST segment elevation myocardial infarction (STEMI). METHODS: The in-hospital mortality of STEMI patients who underwent pPCI was assessed at the Department of Cardiology, Harzklinik Goslar, Germany, which has no access to immediate mechanical circulatory support (MCS), between 2013 and 2017. RESULTS: We enrolled 312 STEMI patients, with a mean age of 67.1 ± 13.4 years, of whom 211 (68%) were male. In-hospital mortality was documented in 31 patients (10%). In-hospital mortality was associated with pre-hospital cardiopulmonary resuscitation (CPR; n = 39/12.5%), older age, lower systolic blood pressure, Killip class > 1, triple-vessel disease (each p < 0.0001), female gender (p = 0.0158), and with the localization of the treated culprit lesion in the left main coronary artery (LMCA; p = 0.0083) and in the ramus circumflexus (RCX; p = 0.0141). CONCLUSION: In this monocentric cohort, all-cause in-hospital mortality of STEMI patients after pPCI was significantly higher in those patients with culprit lesions in the LMCA and in the RCX, which may prove to be a substantial novel risk factor for STEMI-related mortality. Increasing age and female gender may be interdependent risk factors for mortality in this patient population. Furthermore, our data highlight the importance of the availability of MCS options in pPCI centers for patients after CPR.

Reduced O6-methylguanine repair in fibroblast cultures from patients with lung cancer.

The activity of O6-methylguanine-DNA methyltransferase was determined in fibroblast cultures from 45 patients with lung cancer, 39 patients with cutaneous malignant melanoma, and 29 healthy controls. This enzyme is a critical parameter for the capacity to repair O6-methylguanine (O6-mGua) adducts in DNA, and a decreased activity might therefore be responsible for an enhanced susceptibility to cancer. The assay was performed with 8 x 10(6) fibroblasts which were homogenized and incubated with a known amount of O6-mGua containing DNA. The remaining substrate was determined fluorimetrically after high performance liquid chromatographic separation. O6-mGua repair was significantly reduced in lung cancer patients [6.64 +/- 4.32 (SD) pmol O6-methylguanine repaired/8 x 10(6) cells] as compared to healthy controls [10.35 +/- 5.42, P less than 0.0022] or patients with cutaneous malignant melanoma [10.83 +/- 6.66]. The lowest mean values were detected in a subgroup of 16 lung cancer patients with a tumor manifestation below 46 years of age (5.06 +/- 3.89). Fibroblasts from 4 patients with lung cancer had no detectable repair. We conclude that a reduced capacity to remove O6-mGua adducts may represent a further mechanism of individually enhanced lung cancer risk.

Dendritic morphology of projection neurons in the cat pretectum.

The distribution and dendritic morphology of neurons in the cat pretectal nuclear complex were analyzed with respect to their projection to the ipsilateral dorsal lateral geniculate nucleus (LGNd) and the ipsilateral inferior olive (IO). Single and double retrograde tracing techniques were combined with intracellular injections of either horseradish peroxidase into electrophysiologically identified pretectal neurons or Lucifer Yellow into retrogradely labeled somata. Pretectal cells afferent to the LGNd were located in the nucleus of the optic tract (NOT), adjacent dorsal terminal nucleus of the accessory optic system (DTN), and posterior pretectal nucleus (NPP). Cells projecting to the IO were also distributed throughout the NOT-DTN and dorsal part of the NPP. Separate tracer injections (fluorogold and horseradish peroxidase [HRP] or granular blue) into the LGNd and the IO showed considerable overlap of labeled neurons in the NOT and dorsal NPP. Double-labeled neurons, however, were not observed after double tracer injections into LGNd and IO. Partial topographical segregation of the two populations was observed along the dorsoventral axis because LGNd-projecting neurons exhibited maximum density ventral to that of IO neurons. Pretectal cells to the LGNd had cell body diameters between 16 and 48 microns. Somatic shapes varied between fusiform and multipolar with considerable overlap between these two morphological appearances. Neurons projecting to the IO exhibited similar cell body sizes and their morphology also varied from fusiform to multipolar. Quantitative analysis of dendritic field size and orientation, number and order of dendritic arborizations, and symmetry of the dendritic tree revealed no statistically significant difference between the two neuronal populations. Hence, neurons of the two populations cannot be unequivocally identified just from the dendritic morphology. By contrast, dendritic morphology was correlated with the topographical location of either cell type within the pretectal nuclei rather than projection. Thus, the morphological appearance of neurons located dorsally predominantly was fusiform while neurons located ventrally mostly were multipolar.

Longitudinal study of neurotoxicity with occupational exposure to aluminum dust.

Two cross-sectional studies were conducted at a German aluminum (Al) powder plant to evaluate possible nervous system effects from occupational Al exposure. The investigation included biological monitoring, a neuropsychological test battery, and event-related P300 potentials. Neurophysiologic findings in workers chronically exposed to Al dust did not differ from non-Al-exposed controls from the same plant. The authors suggest that chronic exposure to Al dust, at the levels documented in this study, does not induce measurable cognitive decline.

Are snoring medical students at risk of failing their exams?

STUDY OBJECTIVES: To compare the examination results of self-reported snoring and nonsnoring medical students DESIGN: We studied the examination scores obtained by medical students answering a multiple-choice test forming part of their final examinations. The students were asked to classify themselves as "nonsnorers," "occasional snorers," or "frequent snorers," and to state their age, sex, height and weight. SETTING: University Hospital, Erlangen, Germany PARTICIPANTS: 201 medical students (61% males/39% females; mean age 24.6 +/- 2.1 years; BMI 22.4 +/- 2.5 kg/m2) taking their final examinations in internal medicine. MEASUREMENTS AND RESULTS: Seventy-eight students (38.8%) claimed to be nonsnorers, 99 (49.3%) occasional snorers and 24 (11.9%) frequent snorers. The mean examination scores (adjusted for age, sex, and BMI) were 69.6 +/- 9.9% for the nonsnorers, 65.3 +/- 10.0% for the occasional snorers and 62.0 +/- 8.2% for the frequent snorers (p < 0.0001). 12.8% of the nonsnorers failed the exam, compared with 22.2% of the occasional snorers and 41.7% of the frequent snorers (p < 0.001). Logistic regression analysis showed an association between failing the exam and snoring (p = 0.013), but not between failure and age, BMI, or sex (relative risk for snorers adjusted for age, sex and BMI: 1.26; 95%--CI 1.01-1.57). CONCLUSIONS: In medical students, snoring seems to be associated with an increased risk of failing exams in a dose-response manner, even after controlling for age, sex and BMI. For the present, the mechanisms underlying this association must remain a matter of speculation. Snoring-related sleep fragmentation ("upper airway resistance syndrome") might be a causal factor.

Significance of exposure to benzene and other toxic compounds through environmental tobacco smoke.

In order to assess the uptake of benzene from environmental tobacco smoke (ETS) and to estimate its contribution to the total body burden of benzene observed in non-smokers, two experimental studies have been conducted. Controlled exposure to high levels of ETS equivalent to 10 ppm CO for 9 h and 20 ppm for 8 h resulted in a nonsignificant increase in blood benzene levels and a significant increase in exhaled CO, COHb and cotinine in serum and urine. The slightly rising blood concentration of benzene following experimental ETS exposure was paralleled by an increased exhalation of benzene and aromatic hydrocarbons and in contrast to blood levels, this increase was significant. The blood levels of benzene obtained during exposure were comparable to those observed at the time of admission to the laboratory, when biomarkers of ETS uptake, e.g. cotinine in serum and urine, were at the limit of detection, thus demonstrating that these background levels were not from ETS exposure. No difference in the urinary excretion of phenol, the main metabolite of benzene, was found during the experimental periods. The background levels of urinary phenol in unexposed nonsmokers were rather high, demonstrating that phenol excreted in urine must be formed from several endogenous and exogenous precursors. In the light of our findings it is highly questionable whether exposure to benzene from ETS under real life conditions poses a cancerogenic risk to the general population, which is measurable today or in the future by toxicological or epidemiological methods.

A heated humidifier reduces upper airway dryness during continuous positive airway pressure therapy.

Upper airway dryness is a frequent side-effect of nasal continuous positive airway pressure (nCPAP) therapy in obstructive sleep apnoea (OSA). In this situation, heated humidification is often used. Alternatively, oily nose drops are frequently applied to relieve dryness. The present study aimed to investigate the efficacy of a heated humidifier in comparison with oily nose drops. Twenty-four OSA patients complaining of serious nCPAP-related upper airway dryness were randomized to 6 weeks of treatment either with heated humidification (HC 100, Fischer & Paykel, Inc., Auckland, New Zealand) or oily nose drops (Colda-Stop, Desitin, Inc., Germany). The patients completed questionnaires on the degree and frequency of upper airway dryness, compliance with nCPAP, intention to terminate nCPAP and comfort during the nCPAP therapy. All 12 patients treated with heated humidification improved in terms of the degree and frequency of upper airway dryness, and reported greater comfort when using the nCPAP device. All patients in the heated humidification group intending to terminate nCPAP therapy because of upper airway dryness persisted with nCPAP on addition of humidification. In contrast, only five out of 12 patients (42%) in the oily nose drops group reported their degree of upper airway dryness to be improved (P = 0.003), only three patients (25%) reported an improvement in the frequency of upper airway dryness (P < 0.001), and only five patients (42%) reported greater comfort when using the nCPAP device with oily nose drops (P < 0.001). In the group using oily nose drops none of the three patients who intended to terminate nCPAP therapy persisted with nCPAP. Heated humidification is highly effective and superior to oily nose drops in reducing the symptoms of upper airway dryness during nCPAP.

Current status of the external quality assurance programmes of the German Society for Occupational and Environmental Medicine.

Due to a technical rule issued by the Ministry of Labour, in Germany toxicological analysis in blood and urine for biological monitoring must be carried out under quality assurance. Since 1982 the German Society for Occupational and Environmental Medicine has offered 13 intercomparison programmes. The 1994 round robin considered 7 metals and 5 solvents in blood, 12 organochlorine compounds in plasma and 14 inorganic, as well as 11 organic, compounds in urine in the occupational and in the environmental exposure range. Reference values and tolerance ranges are established by reference laboratories. Successful participation was certified if the results for 2 concentration adjustments were in tolerance range (assigned value +/- 3 S.D.). In 1994 in 119 laboratories the percentage rate of accurate results was 59%. This mean success rate is in agreement with the last 12 round robins.

Use of bone mineral content determination by X-ray absorptiometry in the evaluation of osteodystrophy among workers exposed to aluminium powders.

Within the framework of a cross-sectional study, we investigated 61 employees in an aluminium powder factory to see if aluminium had an influence on bone mineral content using the non-invasive method of bone density measurement. Thirty-two workers had been employed for, on average, 151 months in the area of aluminium powder production. Twenty-nine employees in the same factory, who had not been engaged in the production of aluminium powder, served as controls. The groups differed significantly in the concentrations of aluminium in urine and plasma. The bone mineral content, which was determined in the lumbar spine by means of photon absorptiometry showed no significant difference between the groups. The bone density value amounted to 1.00 g/cm2 for those exposed and 1.02 g/cm2 for the control group (median values). No correlation could be determined between the values obtained from the biological monitoring of the plasma or the duration of exposure and the bone density values. To summarise, using osteodensitometry as the method of investigation here, no influence could be detected for an occupational exposure to aluminium powders on the mineral salt content of the skeletal system in the area of the lumbar spine.

[Cardiovascular diseases caused by unemployment? An analysis from the viewpoint of social medicine]. / Herz-Kreislauferkrankungen durch Arbeitslosigkeit? Eine Analyse aus Sicht der klinischen Sozialmedizin.

Unemployment has become a sociopolitical problem of great importance in the Western industrialised countries. Although negative effects on social life and psyche resulting from unemployment are regarded as scientifically accepted today, a possible causal relationship between job loss and somatic illnesses is still a matter of controversy. A possible target organ is the cardiovascular system. The aim of this study was, therefore, to check by means of extensive literature analysis to what extent unemployment can be seen to influence cardiovascular morbidity. Particular attention was paid to the method used and the clinical relevance of the results. Person-related epidemiological studies published since 1980 which investigated changes in cardiovascular risk factors associated with unemployment or prevalence rates of manifest disease influenced by unemployment, were included in the final evaluation. In some cases statistically significant associations were found between unemployment and the increase in cholesterol levels or systolic/diastolic blood pressure, but the clinical relevance of such slight changes is questionable. To consider unemployment as an independent, social, cardiovascular risk factor is at present unwarranted. An increase in the prevalence rates of coronary heart disease or arterial hypertonia causally linked in some studies with unemployment is scientifically questionable due to severe methodological shortcomings. On the basis of the currently available methodologically acceptable studies, the question of a qualitative contribution of unemployment to cardiovascular disease cannot be answered conclusively.

Genospecies and their influence on immunoblot results.

In Europe at least three human pathogenic species of Borrelia burgdorferi sensu lato are the causative agents of Lyme borreliosis. All three species have been isolated or detected by PCR from skin, CSF and synovial fluid of patients with skin lesions, neuroborreliosis and Lyme arthritis respectively. Studies using strains representing the three species as antigen for the immunoblot revealed that interpretation criteria depend strictly on the strain used as antigen. More than using certain species as antigen it is important to use strains (f.e. B. afzelii strain PKo) expressing certain immunodominant antigens like OspC and p17 which may not be expressed by other strains in vitro. Using strain PKo as antigen the two band criterium can be used without loss of too much sensitivity compared to using B. burgdorferi sensu stricto strain PKa2 and B. garinii strain PBi. The use of recombinant antigens allows selection of highly specific and combination of homologous antigens from different strains; however not all desirable antigens have been recombinantly expressed. Addition of p17 and p58 as antigens may improve the sensitivity of the hitherto described recombinant antigen immunoblots containing the antigens p83/100, p39, OspC and the p41 internal fragment.

Occupational health in Germany and other countries of the European Union.

Occupational medicine is affected to a much greater extent by national legal and social conditions than by clinical issues. The different preconditions specific to each country serve to restrict the scientific dialogue on issues of occupational medicine. Therefore, in this paper are described the organisation and the under- and postgraduate education of occupational medicine in Germany and other European countries (Austria, Belgium, Denmark, Italy, United Kingdom). In summary one can state that in many member states of the EU there is a lack of undergraduate training in occupational medicine for students and there are distinct systems for the postgraduate training and assessment of occupational physicians. The practice of occupational medicine in the EU countries probably has many similarities. The responsibilities of occupational physicians are rather comparable, though in some countries the approaches of occupational medical prevention and the interest in evaluating the structure, process and outcome of many of the activities of occupational medicine seem to recede something into the background.

Ear damage caused by leisure noise.

Noise is a health risk. Recent findings suggest that leisure noise is a substantial danger especially to children, teenagers and young adults. Epidemiological studies of teenagers with no occupational noise exposure show an increasing number with a substantial and measurable irreversible inner ear damage. This is basically due to the wide spread exposition to very loud toys (pistols and squibs), crackers and exposure to electronically amplified music, e.g. from personal cassette players (PCP), at discos or concerts etc. Protection against irreversible ear damage by leisure noise has an important impact in preventive medical care. Therefore the general public must be informed that loud leisure activities may cause damage to the ear. In order to protect children, young people and adults, the legislature ought to set limits for sound levels in discos, concert halls and for music equipment and toys by establishing the necessary standards and regulations.

The German external quality assessment scheme in occupational and environmental medicine.

According to a technical guideline for dangerous substances (TRGS 410) issued in 1979 by the Ministry of Labour of the Federal Republic of Germany, toxicological analyses in biological materials must be performed under conditions of "statistical quality control". The German Society for Occupational and Environmental Medicine is entrusted with the organization of the German external quality assessment scheme (EQAS). Since 1982 about 100 laboratories regularly take part in each run. Blood and urine samples spiked with two different concentrations (A, B) are distributed to the laboratories. Since 1991 additional samples with environmental exposure levels are also included in the EQAS. A laboratory is certified as successful if both its results (A, B) fall within the tolerance range given by the reference laboratories. The thirteenth (1994) external quality assessment exercise included blood and urine samples containing 21 inorganic and 29 organic substances, besides 8 inorganic and 14 organic analytes within the environmental concentration range.

[Medical habilitation. Accepted academic qualifications or outdated formalism?]. / Die medizinische Habilitation. Akzeptierter Qualifikationsnachweis oder unzeitgemässer Formalismus?

BACKGROUND: With the changes in the structure of education and society, in recent years also the medical habilitation (German postdoctoral lecturing qualification) has been called into question as an academic qualification. With this in mind, the aim of our study was to discover the current opinion of those who had successfully completed a habilitation on the prerequisites for a habilitation, the habilitation procedure and the status of a habilitation, and to document potential wishes for reform. COLLECTIVE AND METHODS: The target group of our survey were the 616 persons (female: 77, male 539) who successfully completed their habilitation in 1997 at one of the 36 German medical faculties. The database was formed by an anonymous questionnaire (23 items), which included questions on sociodemographic factors and occupational history (general part), and subjective opinions (specific part). Recruitment of the participants in the survey and passing on of the questionnaire were carried out by the office of the medical dean of the various universities, as the names of those who had completed a habilitation were not available to the investigators for reasons of protecting the individual's rights and identity. Evaluation of the returned questionnaires was carried out using descriptive statistics. Subgroups were formed according to sex, age and subject groups. RESULTS: The questionnaire was answered in a useable form by 389 persons (female: 46, male 343) from 35 medical faculties (return quota 63%). 95% of those who took part in the survey were registered doctors; 79% of these came from clinics, 16% from the field of theoretical medicine. 81% were specialist physicians. 5% had studied the natural sciences or humanities. The median age at the time of completing the habilitation was 38 years (minimum 30, maximum 54 years old). At present 93% were assistant professors, 5% were professors. The median interval between the doctoral thesis and habilitation was 10 years. 58% had carried out a period of research abroad. In 90% of cases the persons had written a postdoctoral thesis for their habilitation, 10% qualified cumulatively. 47% had improved their occupational rank within a period of 2 years after completing the habilitation, about 2/3 of these reached senior positions. Among the prerequisites for habilitation, "Humboldt's trias" (research, teaching and caring for patients) was accepted by the great majority. Other prerequisites regarded as important for habilitation were publications, holding talks, specialist status and experience abroad. Impact factors, however, should be regarded as important conditions for habilitation only in combination with other criteria. The value of a habilitation was not called into question; 89% would recommend completing one. 80% of those questioned, however, thought the procedure for completing a habilitation should be optimized. The general abolition of the medical habilitation was, however, not desired by the vast majority. CONCLUSION: The value of completing a medical habilitation is not a point for debate for most of those who successfully completed one. It remains the springboard for occupational advancement. The vast majority do not wish to see it abolished. Also the usual prerequisites for habilitation are accepted by the majority of persons. The procedure for completing a habilitation is, however, regarded as in need of improvement. There is a wide consensus of opinion regarding potential aims for reform.

[The medical dissertation. An assessment from the viewpoint of successful and unsuccessful candidates]. / Die medizinische Dissertation. Eine Bestandsaufnahme aus der Sicht erfolgreicher und gescheiterter Promovenden.

BACKGROUND: The actual value of medical dissertations is under current discussion. Studies concerning medical dissertation focused on successful candidates only. Therefore, data about physicians without "MD" are still lacking. PERSONS AND METHODS: We therefore performed a representative study of both, physicians with and without the "Dr. med." degree. Using an anonymous questionnaire we asked for reasons to perform a doctoral thesis. RESULTS: A total of 321 questionnaires could be evaluated (successful candidates n = 181; unsuccessful candidates n = 140). Nearly 96% have attempted to perform a medical dissertation at the beginning of their studies. Only 4% never had this intention. However, 67% answered that writing a medical dissertation has no relevance in clinical practice. For 80% of the successful physicians, it was the first attempted dissertation, they judged the supervision as very good or good. Physicians who did not write a medical dissertation stated that deficits in planning and supervising were the main reason for prematurely breaking off. 90% of the successful dissertationists thought that it had been personally meaningful and recommended the procedure to younger physicians. However, two-thirds of the practicing physicians without "MD" still intend to write a thesis. CONCLUSION: We conclude that the medical dissertation is highly rated in terms of personal and scientific value and should therefore remain a part of medical studies and science.