Prevalence of joint, entheseal, tendon, and bursal findings in young, healthy individuals by musculoskeletal ultrasound.

OBJECTIVE: The purpose of this study was to determine the prevalence of joint, enthesis, bursa, and tendon ultrasound findings in large and medium joints of young, healthy individuals. METHOD: Ultrasound assessment of large and medium joints, bursae, tendons, and entheses was performed in healthy individuals below the age of 30 years. Participants also underwent bioelectrical impedance analysis and conducted supervised weight training to determine maximum strength. The prevalence of ultrasound findings was calculated and a binary logistic regression model was applied to evaluate factors associated with the present findings. RESULTS: Fifty-one healthy individuals (52.9% female) with a mean age of 23.7 years were included in this study. Joint effusion in at least one joint was observed in 72.6% of the individuals (n = 37) and entheseal pathology in at least one enthesis was detected in 27.5% (n = 14). A binary logistic regression model indicated a significant association between reported hours of sports activity per week and the prevalence of effusion in the knee (p = 0.017). In addition, associations were observed between entheseal pathology in at least one entheseal site and body mass index (BMI) (p = 0.015) as well as fat mass index (p = 0.026). CONCLUSION: Joint effusion in large and medium joints, as well as entheseal hyperperfusion, bursal effusion, and tendon sheath effusion, are found in healthy individuals. Hours of sports activity per week, BMI and fat mass index showed significant associations with the findings in joints and entheses.

Farmers' valuation of incentives to produce genetically modified organism-free milk: Insights from a discrete choice experiment in Germany.

This paper investigates farmers' willingness to participate in a genetically modified organism (GMO)-free milk production scheme offered by some German dairy companies. The empirical analysis is based upon discrete choice experiments with 151 dairy farmers from 2 regions in Germany. A conditional logit estimation reveals a strong positive effect of the price premium on offer. Reliable feed monitoring and free technical support increase the likelihood of scheme adoption, the latter however only in farms that have been receiving technical support in other fields. By contrast, any interference with the entrepreneurial autonomy of farmers, through pre-arranged feed procurement or prescriptive advice on the part of the dairy company, lowers acceptance probabilities. Farmers' attitudes toward cultivation of genetically modified soy, their assessment of the market potential of GMO-free milk and future feed prices were found to be significant determinants of adoption, as are farmer age, educational status, and current feeding regimens. Respondents requested on average a mark-up of 0.80 eurocents per kilogram of milk to accept a contract. Comparison of the estimates for the 2 regions suggests that farmers in northern Germany are, on average, more likely to convert to genetically modified-free production; however, farmers in the south are, ceteris paribus, more responsive to an increase in the price premium offered. A latent class model reveals significant differences in the valuation of scheme attributes between 2 latent classes of adopters and nonadopters.

[Internet presence of psychiatrists in private practice. Status, chances and legal framework]. / Internetauftritte niedergelassener Psychiater. Status quo, Möglichkeiten und gesetzliche Vorgaben.

BACKGROUND: Physicians increasingly use home pages to call attention to their practice. Based on predefined criteria, this study examines the web presence of psychiatrists and medical psychotherapists in private practice. METHODS: All registered psychiatrists and psychotherapists of six northern German states were examined in May 2010 with regards to existence and quality of their web presence. Homepages were evaluated by means of a standardized criteria catalogue with 42 items. Statistical analysis comprised descriptive and analytic approaches (ANOVA, linear models). RESULTS: The analysis included 956 physicians, 168 of whom (17.6%) had a web presence. More physicians in city states had a web presence as compared to those in states with larger territories. However, there was no difference between eastern and western states. Male as compared to female physicians more often possessed an Internet presence. The average score was 19 (± 5.2) out of 42 items, with practices with more than one physician scoring higher than single physician practices. Websites often contained general information about the practice, medical services and diseases, and rarely online services, professional information about the physician, access for disabled, emergency services and holiday substitution. Legal requirements were not sufficiently considered by more than half of the physicians. CONCLUSION: Only a smaller number of psychiatrists and psychotherapists in private practice make use of their own web presence. The quality of information varies. The criteria catalogue used in this study may offer a guideline for development of a good quality Internet presence. A consensus Internet guideline with participation of physician chambers and medical societies would be of use to establish quality standards.

[Repeated measurement of memory with valenced test items: verbal memory, working memory and autobiographic memory]. / Messwiederholung von Gedächtnistests unter Berücksichtigung der Valenz des Testmaterials: verbales Gedächtnis, Arbeitsgedächtnis und autobiografisches Gedächtnis.

A large number of questions in clinical and/or experimental neuropsychology require the multiple repetition of memory tests at relatively short intervals. Studies on the impact of the associated exercise and interference effects on the validity of the test results are rare. Moreover, hardly any neuropsychological instruments exist to date to record the memory performance with several parallel versions in which the emotional valence of the test material is also taken into consideration. The aim of the present study was to test whether a working memory test (WST, a digit-span task with neutral or negative distraction stimuli) devised by our workgroup can be used with repeated measurements. This question was also examined in parallel versions of a wordlist learning paradigm and an autobiographical memory test (AMT). Both tests contained stimuli with neutral, positive and negative valence. Twenty-four participants completed the memory testing including the working memory test and three versions of a wordlist and the AMT at intervals of a week apiece (measuring points 1. - 3.). The results reveal consistent performances across the three measuring points in the working and autobiographical memory test. The valence of the stimulus material did not influence the memory performance. In the delayed recall of the wordlist an improvement in memory performance over time was seen. The tests on working memory presented and the parallel versions for the declarative and autobiographical memory constitute informal economic instruments within the scope of the measurement repeatability designs. While the WST and AMT are appropriate for study designs with repeated measurements at relatively short intervals, longer intervals might seem more favourable for the use of wordlist learning paradigms.

Role of antibiotic treatment after surgical debridement of superficial hand infections in 180 patients.

Considering the rising prevalence of antimicrobial resistance and the lack of recommendations on antibiotic treatment, the present study evaluated the necessity of local and systemic antibiotic therapy in addition to surgical debridement in superficial hand infections. Superficial hand infections were defined as not involving tendons, joints or bone. Data were analyzed for 180 patients, assigned to three study groups according to postoperative antimicrobial treatment. Patients in group I were treated with both systemic and local antibiotics; in group II antimicrobial therapy was limited to local antibiotics in the form of subcutaneous gentamicin bead chains; group III did not receive any antibiotic treatment after surgical debridement. Patients were followed up at two weeks and at three months. Immobilization time and length of stay were longer in group I, but there were no significant differences between the groups in terms of revision rate or recovery of hand function assessed by measurement of finger mobility, grip strength and the Disabilities of the Arm, Shoulder and Hand score at follow-up. Antibiotic treatment of hand infections should be considered carefully and reserved for specific indications: e.g., severe infections and selected patients such as those with diabetes or immunocompromising diseases.

Adrenal cancer: relevance of different grading systems and subtypes.

PURPOSE: The subclassification of adrenal cancers according to the WHO classification in ordinary, myxoid, oncocytic, and sarcomatoid as well as pediatric types is well established, but the criteria for each subtype are not sufficiently determined and the relative frequency of the different types of adrenal cancers has not been studied in large cohorts. Therefore, our large collection of surgically removed adrenal cancers should be reviewed o establish the criteria for the subtypes and to find out the frequency of the various types. METHODS: In our series of 521 adrenal cancers the scoring systems of Weiss et al., Hough et al., van Slooten et al. and the new Helsinki score system were used for the ordinary type of cancer (97% of our series) and the myxoid type (0.8%). For oncocytic carcinomas (2%), the scoring system of Bisceglia et al. was applied. RESULTS: Discrepancies between benign and malignant diagnoses from the first thee classical scoring systems are not rare (22% in our series) and could be resolved by the Helsinki score especially by Ki-67 index (more than 8% unequivocally malignant). Since all our cancer cases are positive in the Helsinki score, this system can replace the three elder systems. For identification of sarcomatoid cancer as rarest type in our series (0.2%), the scoring systems are not practical but additional immunostainings used for soft tissue tumors and in special cases molecular pathology are necessary to differentiate these cancers from adrenal sarcomas. According to the relative frequencies of the different subtypes of adrenal cancers the main type is the far most frequent (97%) followed by the oncocytic type (2%), the myxoid type (0.8%) and the very rare sarcomatoid type (0.2%). CONCLUSIONS: The Helsinki score is the best for differentiating adrenal carcinomas of the main, the oncocytic, and the myxoid type in routine work. Additional scoring systems for these carcinomas are generally not any longer necessary. Signs of proliferation (mitoses and Ki-67 index) and necroses are the most important criteria for diagnosis of malignancy.

Nitric acid trihydrate (NAT) in polar stratospheric clouds.

A comprehensive investigation of polar stratospheric clouds was performed on 25 January 2000 with instruments onboard a balloon gondola flown from Kiruna, Sweden. Cloud layers were repeatedly encountered at altitudes between 20 and 24 kilometers over a wide range of atmospheric temperatures (185 to 197 kelvin). Particle composition analysis showed that a large fraction of the cloud layers was composed of nitric acid trihydrate (NAT) particles, containing water and nitric acid at a molar ratio of 3:1; this confirmed that these long-sought solid crystals exist well above ice formation temperatures. The presence of NAT particles enhances the potential for chlorine activation with subsequent ozone destruction in polar regions, particularly in early and late winter.

Adrenal cancer: relevance of different grading systems and subtypes

Purpose The subclassification of adrenal cancers according to the WHO classification in ordinary, myxoid, oncocytic, and sarcomatoid as well as pediatric types is well established, but the criteria for each subtype are not sufficiently determined and the relative frequency of the different types of adrenal cancers has not been studied in large cohorts. Therefore, our large collection of surgically removed adrenal cancers should be reviewed o establish the criteria for the subtypes and to find out the frequency of the various types. Methods In our series of 521 adrenal cancers the scoring systems of Weiss et al., Hough et al., van Slooten et al. and the new Helsinki score system were used for the ordinary type of cancer (97% of our series) and the myxoid type (0.8%). For oncocytic carcinomas (2%), the scoring system of Bisceglia et al. was applied. Results Discrepancies between benign and malignant diagnoses from the first thee classical scoring systems are not rare (22% in our series) and could be resolved by the Helsinki score especially by Ki-67 index (more than 8% unequivocally malignant). Since all our cancer cases are positive in the Helsinki score, this system can replace the three elder systems. For identification of sarcomatoid cancer as rarest type in our series (0.2%), the scoring systems are not practical but additional immunostainings used for soft tissue tumors and in special cases molecular pathology are necessary to differentiate these cancers from adrenal sarcomas. According to the relative frequencies of the different subtypes of adrenal cancers the main type is the far most frequent (97%) followed by the oncocytic type (2%), the myxoid type (0.8%) and the very rare sarcomatoid type (0.2%). Conclusions The Helsinki score is the best for differentiating adrenal carcinomas of the main, the oncocytic, and the myxoid type in routine work (AU)

The characterization of radioaerosol deposition in the healthy lung by histogram distribution analysis.

Thirteen healthy nonsmoking volunteers inhaled an 8.1 micrometers (MMAD) radioaerosol on two occasions. Aerosol deposition pattern within the right lung, as recorded by a gamma camera, was expressed as the 3rd and 4th moments of the distribution histogram (skew and kurtosis) of radioactivity during the first ten minutes after aerosol inhalation. Deposition pattern was also expressed as the percentage of deposited activity retained within the lung at 24 hr (24 hr % retention) and found to be significantly correlated with measures of skew (P less than 0.001). Tests of pulmonary function (FEV1, FVC, and MMFR) were significantly correlated with skew. Correlations were also demonstrated for these pulmonary function tests with 24 hr % retention but at lower levels of significance. Results indicate that changes in measures of forced expiratory airflow in healthy human volunteers influence deposition pattern and that the skew of the distribution of inhaled radioactivity may provide an acceptable index of deposition pattern.

Monitoring immunocompetent cells in the peripheral blood of stomach cancer patients after splenectomy and gastrectomy.

The status of lymphocyte subpopulations in splenectomized (Sx) stomach cancer patients (SCa-patients), assessed by monoclonal antibodies, has not been evaluated so far. Therefore subsets of peripheral white blood cells were monitored prior to and following surgical treatment in gastrectomized (Gx) and Sx (n = 64) as well as in non-Sx patients (n = 39). Postoperative surgical complications were more frequent in the Sx group. However, the 2-year survival rate of this group was higher than in non-Sx patients. Lymphocytes were significantly decreased in both groups of patients during the early postoperative period. Monocytes and polymorphonuclear cells (PMN) increased correspondingly. A significant loss of lymphocytes and their subsets in Sx patients was observed during the 1st-3rd postoperative days as compared to the Gx only patients. The OKT4/OKT8 ratios did not differ in either group of patients, whereas the OKT3+anti-B-Ly2 ratio was significantly increased in Sx patients 1 to 3 days postoperatively.

Effect of timolol on aqueous humor protein concentration in the human eye.

We performed a double-masked, controlled study investigating the increase in the protein concentration in aqueous humor after topical timolol maleate administration. Forty patients scheduled to undergo intracapsular cataract surgery were included in the study. Either timolol ophthalmic solution or the vehicle of timolol alone (control) were applied topically in a randomized fashion, and aqueous humor was collected during surgery. Protein concentrations were determined by gel-filtration chromatography. The total protein concentration as well as the concentration of high and medium molecular weight proteins were significantly elevated in the timolol-treated group. The relation of the levels of the three different molecular weight classes did not differ significantly between the two groups, indicating that undisturbed protein filtration in the face of reduced aqueous humor production--and not a change in the permeability of the blood-aqueous barrier--is responsible for the increase in concentration.

Effect of diphenolic laxatives on Na+-K+-activated ATPase and cyclic nucleotide content of rat colon mucosa in vivo.

1. The effect of bisacodyl and oxyphenisation on the Na+-K+- and Mg2+-activated ATPase and on the mucosa levels of cAMP and cGMP was investigated in transporting ligated loops of the rat colon in acute studies and in chronic feeding experiments 2. The specific activity of the Na+-K+-ATPase was lowered in both types of experiments, concomitantly with a reduction in net sodium absorption. The specific activity of the Mg2+-activated ATPase was unaffected. 3. The cAMP content per mg protein was elevated and the cGMP content decreased in the acute experiments in which the effect on transport was most marked. The content of cyclic nucleotides returned to normal within 2 h whereas absorption, Na+-K+-ATPase specific activity and the mucosal potential difference were still significantly depressed at that time. In chronic experiments with bisacodyl, cAMP was not affected and cGMP was increased in colon loops exhibiting reduced absorption. 4. The results indicate that the inhibition of the Na+-K+-activated ATPase by diphenolic laxatives may play a role in the inhibition of intestinal fluid absorption caused by these compounds. The increase of cAMP in acute experiments could point to a cAMP-mediated stimulation of secretory processes under this condition.

Specific analysis of trace organics in water using gas chromatography and mass spectroscopy.

For the characterization of a broad range of compounds in water, various methods have been combined into a procedure. The reliability and limitations of this approach have been discussed in this paper. This combined procedure represents only a preliminary solution to the problem of organic materials in water. Future improvements will be possible as new columns, instruments, and software become available. Physico-chemical constants of trace organic compounds have been used to predict and interpret their extraction and pre-separation in an analytical scheme where purge/trap and solvent extraction methods are combined to measure a broad range of organic materials. This approach is limited by the scarcity of thermodynamic data; such data must be generated if predictive models of pollutant behavior in analytical as well as environmental systems are to be developed. In summary, the basic requirements for analyzing trace organic compounds in tertiary effluents and drinking waters include: The analysis must be based on a small sample size (up to 1 liter). Samples of one gallon or more are costly to ship and difficult to process and store. Samples of one liter or less can be shipped at moderate cost and stored in medium-sized refrigerators. The detection limit for most trace contaminants must be in the lower nanogram per liter range. At detection limits of 1 microgram/l and above, the removal (or formation) of many contaminants cannot be determined precisely. For conclusive results, variabilities of the procedure, the compound, and concentration at a sampling point have to be considered and investigated. Generally, approximately 30 samples are needed to establish a concentration distribution (1).

Analysis of aerosol deposition in the healthy human lung.

Wide variation in the pattern of deposition of inhaled aerosols has previously been described in both healthy and diseased humans. To investigate the factors responsible for such variation, the authors studied a group of 13 healthy nonsmoking subjects. One two occasions each subject inhaled a monodisperse 8.1 mm (mass median aerodynamic diameter) Fe2O3 aerosol labelled with 99mTc using a standardized breathing pattern. Pulmonary function was defined by tests of forced expiratory airflow. Total activity in the right lung at 0 hr and at 24 hr (24-hr percent retention) was measured using a gamma camera. Numerical indices of deposition pattern were derived in several ways from the initial gamma camera image of the right lung by comparing the ratio of activity within a mid- and peripheral lung region of interest, by analyzing the profile of radioactivity within a horizontal band across the right lung from the midline to the lung edge, and by analysis of a distribution histogram of activity within the whole lung (skew and kurtosis). The 24-hr percent retention of aerosol showed considerable intrasubject variability unlike the deposition indices. The various deposition indices were found to correlate with the 24-hr percent retention, FEV1.0, FEV1.0/FVC%, and MMFR at varying levels of significance. Results indicate that the pattern of aerosol deposition in healthy humans is influenced by mild degrees of obstruction to airflow, as reflected by tests of forced expiratory airflow, increasing airways obstruction being associated with more central deposition of the inhaled aerosol. Deposition indices derived from the initial pattern of aerosol distribution within the lung may prove to be more reliable and sensitive than measurements of 24-hr percent retention in defining aerosol deposition pattern.

[Treatment strategy and results in primary inoperable rectal cancer]. / Behandlungsstrategie und Ergebnisse beim primär inoperablen Rectumcarcinom.

The authors report their experience with laparotomy in patients with rectal carcinoma to identify those patients with locally non-resectable primary cancer of the rectum who may be treated initially by high-dose radiotherapy. The goal of this so-called "staging laparotomy" is to assess mobility and tumor size by means of bimanual palpation, to stage the abdominal cavity and to create total fecal diversion by performing an endcolostomy in order to condition these patients for maximum tolerance during the protracted radiotherapy course (greater than 50 Gy/5-6 weeks). The formation of an endcolostomy seems to avoid severe morbidity and even mortality of high-dose radiotherapy without delay of further surgery. Twenty-two patients with locally advanced rectal carcinoma were treated in this way. The tumor was resectable in 18 of the 20 patients who underwent relaparotomy after high-dose radiotherapy. Six out of the 13 patients with a radical resection died with evidence of disease during the follow-up (2 with local disease). One patient died with no evidence of disease after 5 years and 6 patients are still alive without disease after an average of 37 months (15-67 months).

Regional distribution of Na-K-ATPase specific activity in the large intestine of the rat and man.

Segmental heterogeneity of colonic electrolyte transport has been demonstrated in rat and man. We determined whether this is reflected by regional differences in Na-K-ATPase activity. In rats, Na-K-ATPase specific activity was significantly lower in the caecum than in the proximal colon, distal colon, and rectum. In man, biopsy specimens of macroscopically intact mucosa in 26 subjects showed no difference in Na-K-ATPase specific activity along the colon axis. We conclude that Na-K-ATPase distribution may contribute to electrolyte transport differences between rat caecum and colon but not between colonic segments in either rat or man. In an additional series of 11 patients with proximal intestinal resections colonic Na-K-ATPase specific activity was slightly but significantly higher than in controls, possibly representing an adaptive process.

Prediction of retarded adults' work performance through components of general ability.

A factor analysis was performed on a set of variables used to predict work performance, or industrial rate, for 127 mentally retarded adults. The results indicated that there is a general ability factor that can be partitioned into three components: cognitive, visual-motor, and work sample/sorting abilities. The latter two components were more closely related to industrial rate than was the former. Variables included subject characteristics, standardized tests, ratings, and work samples. As a group, the work samples were the best predictors of industrial rate; the subject characteristics were the poorest.

The left and gender relations -- criticism and self criticism -- what is the way forward?

PIP: This essay of the month discusses some of the lessons to be learned from the collapse of socialism in Eastern Europe and applied to the new opportunities in South Africa to undue patriarchal systems and transform gender relations. In South Africa socialism and equitable gender relations will be manifested in the care with which the Reconstruction and Development Program is implemented in gender sensitive ways. Economic transformations for women are of great importance, but so are political empowerment, state policy, and addressing social problems. Socialists must be aware of class relations and within that context gender relations. National liberation struggles offer a sense of direction in the integration of gender relations into development. Nicaraguan women have established Houses of Women, which provide legal, health, maternity, and day care services as a means of engaging women in a mass-driven approach. In Costa Rica the Vanguard Party recognizes the obstacles to the political engagement of women as husbands' attitudes, child care, and household responsibilities. Perestroika contributes new ideas about the social problems of family life. Gorbachev's address to the 27th Congress provides suggestions about shortening women's work day and granting paid maternity leave of 18 months. Paid sick leave for care of sick children would be increased for women. Special allowances would be given to low income families with children aged under 12 years of age. Preschool education would be expanded. In South Africa some of these proposals could be applied for men and women in the course of job creation while supporting within the political process the familial and social responsibility of men. Thus South Africa can avoid the problems of men loafing rather than helping relieve their wives of some of the burdensome tasks of infant care. Socialism in South Africa must specifically address the damage from apartheid, which particularly scarred youth and children. Community Life Centers should be established for psychological and social work counseling. Crime, violence, and social dislocation can be solved through addressing the personal in a political and organizational manner by political party policies, nongovernmental organizations, and government activities. Attention to socioeconomic issues and democratizing structures does not go far enough.^ieng