[Comparison of Patients and their Care in Urban and Rural Specialised Palliative Home Care - A Single Service Analysis]. / Retrospektive Datenanalyse von Patienten in der Spezialisierten Ambulanten Palliativversorgung (SAPV) - Vergleich zwischen Stadt und Landkreis.

BACKGROUND: Specialised outpatient palliative care teams (in Germany called SAPV) aim to ensure best possible end-of-life care for outpatients with complex needs. Information on the influence of living areas (rural vs. urban) on patient and care related aspects is rare. This study aims to explore differences between palliative care patients in urban and rural dwellings concerning their nursing and service characteristics. METHODS: A retrospective data analysis of documentary data for 502 patients supplied by SAPV team from December 2009 to June 2012 was conducted. Patients and care characteristics were investigated by frequency analysis and were compared for both groups of urban and rural dwelling patients (T test, Chi², Fisher's exact test p < 0.05). RESULTS: 387 complete data sets could be included. Urban (n=197) and rural (n=190) dwelling patients were almost equally sized groups. The mean age of the whole sample was 74.5 years, 55.3% were female. Most patients were diagnosed with cancer (76.8%). No significant differences in urban and rural dwelling patients concerning most demographics, care, disease and service related aspects of palliative home care could be detected. An exception is that the rate of re-admittance to hospital is higher for rural dwelling patients (Fisher's exact test p=0.022). CONCLUSIONS: Although predominantly presumed, the single service analysis shows - except for the re-admittance rate to hospital - no considerable differences between palliative care patients regarding their living area. Our findings indicate that patients cared for in rural and urban settings have similar needs and impose similar requirements on palliative care teams.

Review and experimental verification of x-ray dark-field signal interpretations with respect to quantitative isotropic and anisotropic dark-field computed tomography.

Talbot(-Lau) interferometric x-ray and neutron dark-field imaging has, over the past decade, gained substantial interest for its ability to provide insights into a sample's microstructure below the imaging resolution by means of ultra small angle scattering effects. Quantitative interpretations of such images depend on models of the signal origination process that relate the observable image contrast to underlying physical processes. A review of such models is given here and their relation to the wave optical derivations by Yashiro et al and Lynch et al as well as to small angle scattering is discussed. Fresnel scaling is introduced to explain the characteristic distance dependence observed in cone beam geometries. Moreover, a model describing the anisotropic signals of fibrous objects is derived. The Yashiro-Lynch model is experimentally verified both in radiographic and tomographic imaging in a monochromatic synchrotron setting, considering both the effects of material and positional dependence of the resulting dark-field contrast. The effect of varying sample-detector distance on the dark-field signal is shown to be non-negligible for tomographic imaging, yet can be largely compensated for by symmetric acquisition trajectories. The derived orientation dependence of the dark-field contrast of fibrous materials both with respect to variations in autocorrelation width and scattering cross section is experimentally validated using carbon fiber reinforced rods.

Relationship of polymorphisms in the renin-angiotensin system and in E-selectin of patients with early severe coronary heart disease.

Previous association studies between angiotensin-converting enzyme (ACE) and angiotensinogen (AGT) polymorphisms and several cardiovascular diseases have reported variable results. Therefore we examined the association of the DNA variants of ACE and AGT with early, severe coronary heart disease (CHD). In addition, we compared the genotypes of both polymorphisms and the recently discovered polymorphism in the E-selectin gene in both patients and an unselected population. This study included 113 patients with severe CHD (50 years old or less) and up to 197 control subjects. The frequencies of the ACE I/D variants were 48% I and 52% D in the controls and 46% I and 54% D in the patients. The frequencies of the AGT-M235T polymorphism were 60.8% M and 39.2% T in controls and 49.1% M and 50.9% T in the patients. The frequencies of the S128R polymorphism of the E-selectin were 91.3% S and 8.7% R in controls and 84.5% S and 15.5% R in the patients. In our studies the DD genotype of ACE was not associated with early severe CHD. We found a correlation between the M235T molecular variant of AGT and the S128R variant of E-selectin to early severe CHD.

Carrier detection in DMD families with point mutations, using PCR-SSCP and direct sequencing.

Non-isotopic single-strand conformation polymorphism (SSCP) and direct sequencing was used for carrier diagnosis in four families of DMD/BMD patients with previously characterized point mutations, leading to the identification of eight carriers and four non-carriers. When the mutation caused a distinctly altered migration pattern of the single strands, in principle, the SSCP-technique allowed determination of carrier status in the extended family of the probands without direct sequencing. However, because SSCP measures a function of not only the mutation, but of the entire sequence of the PCR product, it can lead to false negative and/or false positive diagnoses due to intronic and exonic sequence heterogeneity in the family. As we discovered this pitfall in one of the reported families, we concluded that for carrier testing the SSCP approach must be performed in essential conjunction with an independent assessment of the mutation site by direct sequencing.

seco-Cyclothialidines: new concise synthesis, inhibitory activity toward bacterial and human DNA topoisomerases, and antibacterial properties.

seco-Cyclothialidines are a promising class of bacterial DNA gyrase B subunit inhibitors. A new seco-cyclothialidine derivative containing a dioxazine moiety, BAY 50-7952, was synthesized through a new concise pathway. One key step of the synthesis is the straightforward formation of the 2-aminothiazole derivative of S-tritylcysteine. In biological tests, BAY 50-7952 and other known seco-cyclothialidines exhibited high and selective activity toward bacterial DNA gyrase and toward Gram-positive bacteria. The dioxazine moiety and other similar groups were found to be important for the ability of the seco-cyclothialidines to penetrate bacterial membranes. The opposite enantiomer ((S)-form) of BAY 50-7952 was also synthesized, and neither significant target activity nor in vitro antibacterial activity were found, suggesting a highly selective fit of the (R)-form. Despite promising in vitro activity, only poor activity was found in the murine infection model.

The determination of free and protein-bound haemoglobin in plasma using a combination of HPLC and absorption spectrometry.

The aim of the study was to develop a method for the determination of haemoglobin in plasma suitable for use to set target values for external quality assessment schemes for this analyte using commercially available test kits and equipment. In the early phase of the method development it became clear that the use of a single method, namely HPLC, would not be possible. However, by combining HPLC and absorption spectrophotometry, both qualitative and quantitative rapid determinations of protein-bound and free haemoglobin were able to be performed on equipment present in most routine clinical chemistry laboratories. The separation of protein-bound and free haemoglobin could be carried out using commercial HPLC equipment for the determination of haemoglobin A1c (HbA1c) without modification of the conditions used. Instead of haemolysed blood, the same volume of plasma (10 microl) was injected. The eluate was not discarded, but collected in 1-minute fractions so that the void volume (protein-bound Hb) and the haemoglobin peaks (free Hb) were available for the colorimetric determination of haemoglobin using the pseudoperoxidase activity of the haem moiety on hydrogen peroxide and a chromogen (3,3',5,5'-tetramethylbenzidine) in concentrated acetic acid and optimal determination at 600 nm. (In this publication at 578 nm due to the use of a spectrophotometer with Hg-discharge lamp and filter). The appearance of a blue colour in the reaction tube or cuvette indicated the presence of haemoglobin. The use of the above chromogen, with its absorption maximum around 600 nm excluded interference from serum components such as bilirubin, which may interfere in the conventional method often used to determine plasma haemoglobin. The method can be used quantitatively by including an aqueous human haemoglobin standard in the run. This elutes from the HPLC column only as free haemoglobin in the concentration range from 0.1 to 10 g/l. Addition of human haemoglobin to haemoglobin-free plasma resulted in the binding of all Hb to plasma proteins up to a concentration between 2 and 3 g/l (void-volume fraction). At higher concentrations free Hb appeared in the 3-5 minute fractions. These observations agree with published data on the scavenging capacity of plasma for Hb released from erythrocytes. The method is rapid, (HPLC-run maximally 6 min, quantitative colorimetric results 5-10 min) precise (inter-assay coefficients of variation < 8%) and suitable for answering the question as to whether the protein-binding (scavenging) system which prevents the nephro- and cerebrotoxic effects of haemoglobin has been saturated or not, an important question in patients with acute haemolysis problems. A qualitative result is obtainable within 10 minutes of injecting the sample into the HPLC-system. The use of this assay in controlling blood transfusion and haemolytic events arising from surgery, intravascular haemolytic bacteria or artificial heart valves can help in rapid corrective action, if needed.

[The pulmonary ligament (pulmo-diaphragmatic ligament) (author's transl)]. / Das Ligamentum pulmonale (bzw. Ligamentum pulmodiaphragmale) im Röntgenbild.

The paper considers the appearances of the contour of the diaphragm and of the normal irregularities of the diaphragm. The hitherto existing opinion of ill defined or tented diaphragmatic outlines always being the result of pleurodiaphragmatic implications in inflammatory or fibrotic processes in the basis of the lung needs to be corrected: In a great number of p.a. chest roentgenograms of healthy persons a more or less obvious ill definition or tenting of the medial part of the diaphragma can be found, caused by a variation of the pulmonary ligament characterized by its connection with the diaphragmatic pleura. Ill definition and tenting of the diaphragmatic outline caused by this variation of the pulmonary ligament are called physiological alterations, contrary to similar pathological (e.g. adhesive) ones. Only if this anatomical variation exists a pulmonary ligament can be roentgenologically visualized directly.

[Round atelectasis]. / Die Rundatelektasen.

a) For several reasons Sinner's paper calls for critical remarks: His term "Pleuroma" for a neither pleural nor tumorous but intrapulmonary and atelectatic mass lesion lacks any anatomical and histological basis and is misleading at that because it pretends a tumor of the pleura; his statement in the summary that atelectatic pseudotumors of the lung show a tumorcell-like cytoarchitecture is surprising without being further discussed by the author; he encourages risky invasive diagnostical procedures even in cases where the radiological diagnosis of round atelectasis is unmistakable; already known radiologic features of round atelectases are presented by him as hitherto undescribed; his conceptions of the formal development of round atelectases and of their most characteristic features can not be agreed with. b) The different forms of round atelectases and their residuals are presented with tomograms and with diagrams of their formal development from our point of view.

Design and evaluation of novel blood incubation systems for in vitro hemocompatibility assessment of planar solid surfaces.

Success in the development of hemocompatible biomaterials depends on adequate equipment and procedures for standardized analysis of blood-materials interactions in vitro. In view of the limited standard of knowledge on that important aspect, two novel incubation systems were designed, built, and evaluated for the in vitro assessment of the hemocompatibility of planar solid surfaces: A screening setup was introduced for the comparison of up to 12 different samples. A perfusion setup was developed to model the directed blood flow in the vascular system during incubation by a recirculation circuit, allowing the variation of the wall shear rate at the sample surface. The incubation procedures utilized freshly drawn, heparinized whole human blood. Hemocompatibility in terms of selected aspects of coagulation, thrombogenicity, and immune responses was quantified through plasma levels of characteristic molecules (immunoassays), cell counting, and analysis of adherent cells and fibrin formation (scanning electron microscopy), respectively. Prevention of blood-air contact and mechanical stress, constant temperature and blood pH during incubation, and the suitable choice of reference materials were found to be crucial for reliable testing. Considering those requirements, screening and perfusion system both provided sensitive discrimination between a given set of planar solid surfaces. In conclusion, the suggested methods for an in vitro hemocompatibility assessment permit versatile, sensitive, and efficient analysis of important blood-material interactions despite the unavoidable variability of blood characteristics in different experiments.

[The cattle breeding program of the Republic of Cuba]. / Zum Rinderzuchtprogramm der Republik Kuba.

The Cuban cattle breeding programme has remained unchanged over more than 20 years and aims at the genetic transformation of the indigenous population by means of crossbreeding within a high-performance cattle stock. Focus is on the breeds Holstein X Zebu in order to produce the crosses "Holstein Tropical" (7/8H 1/8Z), "Mambi" (3/4H 1/4Z), and "Siboney" (5/8H 3/8Z). Besides these, other new breeds are envisaged for milk and meat production. Representative parameters of the production and reproduction of the new genotypes are being reported and discussed.

Polymorphism in the human E-selectin gene detected by PCR-SSCP.

By using the non-isotopic single-strand conformation polymorphism (SSCP) technique to analyse products of the polymerase chain reaction (PCR), we detected a 561-adenine to cytosine substitution resulting in an amino acid exchange from serine to arginine at position 128 of the E-selectin gene. If this amino acid substitution has an effect on the adhesion of blood cells to the endothelium, the polymorphism could be of interest with respect to association studies in a number of pathological conditions, such as cardiovascular diseases.

[The leucocyte-migration-inhibition-test in the diagnostic of sarcoidosis (author's transl)]. / Der Leukocytenmigrations-Inhibitions-Test in der Diagnostik des Morbus Boeck

The positive diagnosis of a sarcoidosis is often difficult since reliable laboratory and radiological parameters are not available. It is therefore often necessary to make the diagnosis with invasive methods. The Kveim skin test has many disadvantages, so that there have been many trials to facilitate the diagnosis by in vitro systems. With a modified and easy handable leucocyte migration technique in agarose (Clausen technique), 30 patients with certified sarcoidosis were tested. As controls served healthy volunteers and patients with various diseases such as Hodkins disease, Crohn's disease, tuberculosis etc. As antigene a Kveim suspension typ I was prepared according to Chase and was used in a concentration of 100 mug/ml. It could be shown, that leucocytes from patients with sarcoidosis demonstrated a significant inhibition of their migration in presence of Kveim antigene. Besides patients with Crohn's disease in no other group there was a migration inhibition. Therefore this in vitro system allows diagnostic differentiation and helps to find the diagnose which compares well to the results obtained with the Kveim skin test. Since the test is easy to perform and the results are available after 24 h the test is of diagnostic value for the clinical routine.

[Use of sugar cane harvest residues in cattle fattening in the Republic of Cuba. 1. The physical and chemical composition of the residues and the effect of NaOH treatment on their in vitro and in vivo digestibility]. / Untersuchungen zum Einsatz von Ernterückständen des Zuckerrohrs in der Rinderfütterung der Republik Kuba. 1. Mitteilung. Physikalische und chemische Zusammensetzung der Rückstände und Einfluss einer NaOH-Behandlung auf ihre in vitro- und in-vivo-Verdaulichkeit.

The harvesting remains of sugar cane (crowns, leaves, sheaths, parts of stalks), which are rich in crude fibre, were investigated. The content of crude nutrients, their digestibility and the energy concentration of the harvesting remains largely correspond to the values of cereal straw. After the treatment with growing amounts of NaOH (0, 4, 6, 8, 10 g/ 100 g DM) a significantly increasing digestibility of the dry matter (31.9, 47.0, 56.1, 61.9, 67.6%) was ascertained in in-vitro experiments. In digestibility experiments with wethers an increased digestibility of the dry matter from 36.6 to 57.6% and of the energy from 39.3 to 56.2% after the treatment with 4 g NaOH/100 g DM could be ascertained in comparison with untreated harvesting remains. Energy concentration increased from 324 to 445 EFU cattle/kg DM and thus approached that of the hay of Bermuda grass (Cynodon dactylon), one of the most important fodder grasses of Cuba. After the feeding of harvesting remains treated with NaOH significant changes in the water and mineral metabolism could be ascertained.

[Gliadin-induced migration inhibition of peripheral leucocytes by the agarose-plate technique in patients with coeliac disease (author's transl)]. / Gliadin-induzierte Migrationshemmung peripherer Leukozyten in der Agaroseplattentechnik bei Patienten mit Coeliakie

Sensitisation to gliadin was studied--using a modified leucocyte-migration inhibtion test after Clausen--in patients with coeliac disease (10 patients), ulcerative colitis (9), terminal ileitis (9), bacterial diarrhoea (9), and other gastro-intestinal diseases (14). Only the group of patients with coeliac disease had such specific sensitisation. The migration index, at 0.72 +/- 0.06, was significantly lower in them than in other groups. This reaction is disease-specific and indicates that in coeliac disease cellular immune mechanisms also play a role. The specificity of the reaction can also be used diagnostically.

Prenatal diagnosis of the acute form of proximal spinal muscular atrophy: experience on the acceptance of linkage analyses by the families.

The acute form of proximal spinal muscular atrophy (SMA) is a severe autosomal recessive inherited neuromuscular disorder. It has been mapped to chromosome 5q 11.2-13.3. Using restriction fragment length polymorphisms (RFLPs) or (CA)n repeats of DNA probes in this region, prenatal diagnosis is, in principle, possible. Misdiagnosis can be due to incorrect diagnosis in the index patient, and crossing-over events. Using the DNA probes D5S6, D5S112, D5S39, and D5S78, we cover a region of 10.4 mega-base pairs (Mbp) of partially NotI-digested genomic DNA without overlap of fragments. The DNA probes D5S6 and D5S112, most likely flanking the SMA gene, cover a distance of about 6.6 Mbp. This corresponds to the genetic distance of 6 cM (Morrison et al., 1992; Daniels et al., 1992). But since the precise localization of the SMA gene is still unknown (Simard et al., 1992), a 10 per cent risk of misdiagnoses due to crossing-over events cannot be excluded. The acceptance of this 10 per cent risk for prenatal diagnoses differs in SMA families. We observed a case in which a woman accepted a 25 per cent risk because RFLPs and (CA)n repeats were both uninformative. In contrast, another family did not accept the minimal 10 per cent risk and the pregnancy was terminated. In two families, we performed prenatal diagnosis by linkage analysis. One child predicted to be healthy has been born in the meantime and has shown no indication of SMA during her first 8 months.

Point mutations at the carboxy terminus of the human dystrophin gene: implications for an association with mental retardation in DMD patients.

Duchenne and Becker muscular dystrophies (DMD/BMD) are caused by mutations in the human dystrophin gene. About two-thirds of DMD/BMD patients exhibit gross rearrangements in the gene whereas the mutations in the remaining one third are thought to be point mutations or minor structural lesions. By means of various progressive PCR-based techniques hitherto a number of point mutations has been described that in most cases should cause premature translational termination. These data indicate a particular functional importance for the C-terminal region of dystrophin and consequently for its gene products Dp 71 and Dp 116. To screen for microheterogeneities in this gene region we applied PCR-SSCP analysis to exons 60-79 of twenty-six DMD/BMD patients without detectable deletions. The study identified seven point mutations and one intron polymorphism. Six point mutations, found in DMD patients, should cause premature translational termination. One point mutation, identified in a BMD patient, results in an amino acid exchange. Five of the DMD patients bearing a point mutation are mentally retarded suggesting that a disruption of the translational reading frame in the C-terminal region is associated with this clinical finding in DMD cases. Therefore our data raise the possibility, that Dp 71 and/or Dp 116, the C-terminal translational products of dystrophin, may be causally involved in cases of mental retardation that are associated with DMD.

Use of cyanuric chloride-activated paper for detection of subpicogram quantities of specific DNA sequences and its application to linked restriction fragment length polymorphism analysis in a Duchenne muscular dystrophy affected family.

Conditions for the optimal use of cyanuric chloride-activated (CCA) paper in Southern transfer hybridization experiments of genomic DNA were investigated. They depend critically on pH and ionic strength during transfer and on the composition of the hybridization solution. Simplified hybridization conditions using a SSC/dextran sulfate system at 65 degrees C without sodium dodecyl sulfate and the complex Denhardt's solution are applied. CCA paper allows repeated use in hybridization experiments. Under optimized conditions CCA paper allows a more sensitive detection of single-copy gene sequences in the subpicogram range than do nylon membranes. Application of these transfer and hybridization conditions with our newly developed CCA paper to carrier determination and prediction of the healthy male haplotype demonstrates its usefulness for prenatal counseling of a Duchenne muscular dystrophy family.