Chemical marking of European glass eels Anguilla anguilla with alizarin red S and in combination with strontium: in situ evaluation of short-term salinity effects on survival and efficient mass-marking.

This study presents a new chemical double-marking technique for European glass eels Anguilla anguilla by combing alizarin red S (ARS) and strontium chloride hexahydrate (Sr). Marked eels (double marked with ARS and Sr, but also single marked with ARS) were exposed in situ to brackish water (15 g l-1 artificial sea salt) for 14 days and did not exhibit increased mortalities compared with unmarked eels. Indeed, no mortality occurred in a marked group during the experiments. Moreover, an efficient mass-marking approach with low handling effort for both single ARS and double ARS-Sr techniques is described and was proven to be practicable for large-scale stocking programmes.

Anthropogenic spreading of anguillid herpesvirus 1 by stocking of infected farmed European eels, Anguilla anguilla (L.), in the Schlei fjord in northern Germany.

The Schlei fjord in northern Germany is the recipient water of a comprehensive eel, Anguilla anguilla (L.), stocking programme. Since 2015, stocked eels become alizarin red S marked, but to date no control mechanism is implemented in this stock enhancement measure to prevent anthropogenic spreading of diseases. Consequentially, it was possible that farmed stocking cohorts of 2015 and 2016 (in total ca. 1040 kg) were subsequently tested positive for anguillid herpesvirus 1 (AngHV 1). For this study, 100 eels [total length (TL) 24.3-72.9 cm, age ca. 1-6 years] were caught in 2016 and investigated with regard to AngHV 1 infection, parasite load (Anguillicoloides crassus) and body conditions. 68% of the eels were found to be virus positive while larger specimens were more often infected. In addition, a fitted generalized linear model (area under the curve = 0.741) demonstrated that an increase in individual TL is accompanied with an increased risk of clinically relevant virus loads. Anguillicoloides crassus turned out to be an important stressor for eels, because parasite and virus load revealed a significant positive correlation. The results of this study evidently show the urgent need of a disease containment strategy for eel stocking programmes.

Psychological distress and adjustment to disease in patients before and after radical prostatectomy. Results of a prospective multi-centre study.

The aim of this prospective multi-centre study was to evaluate the level of psychological distress (PD) and adjustment to disease in patients who underwent radical prostatectomy. Furthermore, the impact of urinary incontinence and erectile dysfunction on PD was assessed. Anxiety, depression and PD were evaluated using the Hospital Anxiety and Depression Scale in 329 prostate cancer patients before surgery as well as 3, 6 and 12 months after surgery. These results were compared with those of a male German general population reference group. Adjustment to disease was assessed using the Perceived Adjustment to Chronic Illness Scale. Patients reported low levels of PD at all points of assessment similar to population norms of age-matched German men. Persistent PD was seen in about 8% of the patients and 20% had PD at least two of the measurement points. Relevant predictors for PD after surgery were urinary symptoms and baseline PD. Adjustment to disease was highest before surgery and had significantly reduced at 3 and 6 months after surgery. In general, men are resilient to the experience of localised prostate cancer and adjust well psychologically after surgery. However, between 8% and 20% of patients could possibly benefit from mental health support.

Preventing LVAD implantation by early short-term mechanical support and prolonged inodilator therapy : A case series with acute refractory cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation and optimised medical strategy.

Cardiogenic shock continues to be a life-threatening condition carrying a high mortality and morbidity, where the prognosis remains poor despite intensive modern treatment modalities. In recent years, mainly technical improvements have led to a more widespread use of short- and long-term mechanical circulatory support, such as veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and left ventricular assist devices (LVADs). Currently, LVADs are indispensable as 'bridge' to cardiac recovery, heart transplantation (HTX), and/or as destination therapy Importantly, both LVADs and HTX put a vast burden on financial resources, besides significant short- and long-term risks of morbidity and mortality. These considerations underscore the importance of optimal timing and appropriate patient selection for LVAD therapy, avoiding as much as possible an unfortunate and costly clinical path. In this report, we present a series of three cases with acute refractory cardiogenic shock ('crash and burn', INTERMACS profile 1) successfully treated by ECMO and early optimal medical therapy preventing a certain path towards LVAD and/or HTX, for which they were initially referred. This conservative approach in INTERMACS profile one patients warrants very early introduction of adequate medical heart failure therapy under the umbrella of a combination of short-term mechanical circulatory and inotropic support by phosphodiesterase inhibitors. Therefore, this novel combined medical-mechanical approach could have important clinical implications for this extremely challenging patient category, as it may avoid an unnecessary and costly clinical path towards LVAD and/or heart transplantation.

Migration behaviour of twaite shad Alosa fallax assessed by otolith Sr:Ca and Ba:Ca profiles.

Individual migration behaviour during the juvenile and adult life phase of the anadromous twaite shad Alosa fallax in the Elbe estuary was examined using otolith Sr:Ca and Ba:Ca profiles. Between hatching and the end of the first year of life, juveniles showed two migration patterns. Pattern one exhibited a single downstream migration from fresh water to the sea with no return into fresh water. In contrast, pattern two showed a first migration into the sea, then a return into fresh water and, finally, a second downstream migration into marine water. This first report of migration plasticity for A. fallax points to different exposure times to estuarine threats depending on the migration strategy. In adults, high Sr:Ca and low Ba:Ca in the majority of individuals confirmed prior reports of a primarily marine habitat use. Patterns reflecting spawning migrations were rarely observed on otoliths, possibly due to the short duration of visits to fresh water.

[Gallbladder polyps: prevalence and risk factors]. / Gallenblasenpolypen: Prävalenz und Risikofaktoren.

PURPOSE: The objective of the present study was to investigate the prevalence of gallbladder polyps and possible risk factors in a random population sample of an urban population. MATERIAL AND METHODS: A total of 2099 subjects (1072 women, 1027 men; aged 19 - 65 years, mean age 42.1 (SD ± 12.8 years) were prospectively examined using ultrasound, a standardized questionnaire and laboratory studies. RESULTS: Gallbladder polyps were identified in 6.1 % (128 / 2099) of all subjects (women: 6.1 % [63 / 1027]); men: 6.1 % [65 / 1072]). Solitary polyps were found in 52.4 % (65 / 124), two polyps in 16.1 % (20 / 124), three polyps in 6.5 % (8 / 124), several polyps in 22.6 % (28 / 124) and multiple polyps in 2.4 % (3 / 124) of subjects. The mean polyp diameter was 4.7 mm (SD ± 2.2; range 2 - 20 mm). The polyp diameter was ≤ 7 mm in 94.5 % of subjects. The polyps were described as pedunculate in 82.3 % (102 / 124). The polyps were broad-based in 11.3 % of subjects (14 / 124; men: 18 % women: 4.8 %). The polyps were homogeneously echogenic in 100 % of cases and with irregular contours in only one male subject. Multiple logistic regression failed to demonstrate an influence on the increased occurrence of gallbladder polyps for the risk factors of male sex, age, body-mass index (BMI), alcohol, nicotine or caffeine consumption or diabetes mellitus. CONCLUSION: The prevalence of gallbladder polyps reported in the present study (6.1 %) is higher than figures previously published for populations in Germany or Europe. The majority of polyps were pedunculate and solitary. A typical risk factor profile for gallbladder polyps could not be identified in the present population sample.

Care for the organ transplant recipient on the intensive care unit.

All transplant recipients receive tacrolimus, mycophenolate and glucocorticoids and these drugs have many side-effects and drug-drug interactions. Common complications include surgical complications, infections, rejection and acute kidney injury. Infections as CMV and PJP can be prevented with prophylactic treatment. Given the complexity of organ transplant recipients a multi-disciplinary team of intensivists, surgeons, pharmacists and transplant specialists is essential. After heart transplantation a temporary pacemaker is required until the conduction system recovers. Stiffening of the heart and increased cardiac markers indicate rejection. An endomyocardial biopsy is performed via the right jugular vein, necessitating its preservation. For lung transplant patients, early intervention for aspiration is warranted to prevent chronic rejection. Risk of any infection is high, requiring active surveillance and intensive treatment, mainly of fungal infections. The liver is immunotolerant requiring lower immunosuppression. Transplantation surgery is often accompanied by massive blood loss and coagulopathy. Other complications include portal vein or hepatic artery thrombosis and biliary leakage or stenosis. Kidney transplant recipients have a high risk of cardiovascular disease and posttransplant anemia should be treated liberally. After postmortal transplantation, delayed graft function is common and dialysis is continued. Ureteral anastomosis complications can be diagnosed with ultrasound.

Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn's disease.

The purposes of this study was to provide a retrospective comparison of semiquantitatively measured bowel wall vascularity by power Doppler sonography, endoscopic-histopathological biopsy findings, and disease activity in patients with confirmed Crohn's disease. Thirty-two out of 1,332 patients with histologically confirmed Crohn's disease (18 female, 14 male; mean age 38.8 years) met the inclusion criteria: ileocolonoscopy with biopsy and power Doppler sonographic determination of bowel wall vascularity with assessment of disease activity within a period of 5 days. Sonographic determination of bowel wall vascularity was based on a semiquantitative score. Endoscopic bowel wall biopsy specimens were assessed using a self-developed inflammation score and the disease activity was calculated using Crohn's disease activity index (CDAI). A significant association (p < 0.05) was shown for results of histology and bowel wall vascularity in the terminal ileum (kappa = 0.66; sensitivity 95%; specificity 69%). There was no observed association between CDAI and histology, although there was an association between CDAI and bowel wall vascularity (sensitivity 82%). Increased bowel wall vascularity in the terminal ileum measured by power Doppler ultrasound reflects inflammatory activity in histologically examined bowel wall. Power Doppler ultrasound may be able to monitor activity changes of the bowel wall determined by pharmaceutical treatment.

[Pathological Internet use--epidemiology, diagnostics, co-occurring disorders and treatment]. / Pathologischer Internetgebrauch--Epidemiologie, Diagnostik, komorbide Störungen und Behandlungsansätze.

In 2009, we can look back on a history of 40 years of internet use. While most consumers make use of the internet in a controlled fashion, a progressive loss of the ability to control the frequency and duration of internet activities emerges in some users. As a consequence, the excessive time devoted to internet use and the behavioural narrowing can lead to dramatic psychosocial outcomes. This phenomenon is referred to as "pathological internet use" (PIU). On behalf of the German ministry of health a systematic review of the literature since 1996 has been carried out. The main results will be presented in this review. Prevalence data on pathological internet use are limited by methodological difficulties concerning the diagnosis and the heterogeneity of diagnostical instruments. International prevalence rates range from 1.5 % to 8.2 %. Annual studies on representative samples of the German population describe their internet use and patterns of use, but information on the prevalence of PIU is missing. Diagnostical instruments are needed that show sufficient reliability and validity and allow international comparisons. Research on the Dutch "Compulsive Internet Use Scale" may close this gap. Cross-sectional studies on samples of patients report high comorbidity of PIU with psychiatric disorders, e. g. affective disorder and attention deficit hyperactivity disorder (ADHD). If PIU and these co-occurring disorders could be explained by shared risk factors or better as secondary disorders is largely unknown. The treatment currently is based on therapeutical interventions and strategies successful in the treatment of substance use disorders. Due to the lack of methodological sufficient research it is currently impossible to recommend any evidence-based treatment of PIU.

Estimating degradation-related settlement in two landfill-reclaimed soils by sand-salt analogues.

Landfill reclaimed soil here refers to largely degraded materials excavated from old landfill sites, which after processing can be reinstated as more competent fill, thereby restoring the former landfill space. The success of the process depends on the presence of remaining degradable particles and their influence on settlement. Tests on salt-sand mixtures, from which the salt is removed, have been used to quantify the impact of particle loss on settlement. Where the amount of particle loss is small, say 10% by mass or less, settlements are small and apparently independent of lost particle size. A conceptual model is presented to explain this behaviour in terms of nestling particles and strong force chains. At higher percentages of lost particles, greater rates of settlement together with some sensitivity to particle size were observed. The conceptual model was then applied to two landfill reclaimed soils, the long-term settlements of which were found to be consistent with the conceptual model suggesting that knowledge of particle content and relative size are sufficient to estimate the influence of degradable particles in landfill reclaimed soils.

Decreased insulin sensitivity of forearm muscle in myotonic dystrophy.

Previous studies of patients with myotonic dystrophy have demonstrated hyperinsulinism after glucose loading. This hyperinsulinism has been attributed by some investigators to tissue insulin resistance. We have directly studied insulin sensitivity of forearm muscle in patients having such hyperinsulinism. The effect of an intrabrachial arterial insulin infusion (100 mu U/kg per min) on glucose uptake was determined in six cases of myotonic dystrophy, six normal subjects, and in seven disease control subjects with myotonia or wasting from other disorders. There was no significant difference in insulin tolerance comparing myotonic dystrophy patients to the normal and disease control groups. Glucose tolerance and basal insulin levels were normal in the myotonic dystrophy patients, but hyperinsulinism occurred after glucose ingestion. After 25 min of intra-arterial insulin, the mean peak muscle glucose uptake in myotonic dystrophy was 2.54 +/- 0.54 mu mol/min per 100 ml forearm compared to 5.24 +/- 0.86 mu mol/min per 100 ml for disease controls (P is less than 0.05). Myotonic dystrophy patients showed a peak glucose uptake increment of only 2.6 +/- 0.2-fold over basal contrasted with the disease control value of 6.5 +/- 1.0-fold (P is less than 0.02) and the normal control value of 8.8 +/- 1.1-fold (P is less than 0.01). Thus, there was an absolute as well as a relative decrease in muscle insulin sensitivity in myotonic dystrophy patients compared to both control groups. The peak increments in arterio-superficial venous glucose concentration differences after insulin infusion were not significantly different comparing myotonic dystrophy and control groups. These data suggest that in myotonic dystrophy, there is insulin insensitivity of skeletal muscle.

Down syndrome and thyroid dysfunction: should nutritional support be the first-line treatment?

Individuals with Down syndrome (DS) not only have increased risk of hypothyroidism, they also tend to develop a relatively novel mild form of neonatal hypothyroidism. One problem that may predispose those with trisomy 21 to hypothyroidism is the overexpression of the gene DYRK1A, which may have an affect on the thyroid. While thyroxine supplementation (such as Synthroid) is increasingly being advised for those with DS, this treatment may have both positive and negative effects. Nutritional support for hypothyroidism offers some of the same benefits as drug therapy but without the likely negative long-term effects. Early 20th century practitioners used bovine glandulars for those with DS children, which were believed to help support thyroid function. Some doctors in more recent times have also included iodine, L-tyrosine, selenium, and zinc. As nutrition for those with DS has been safely used by some practitioners for many decades, it is suggested that nutritional thyroid support, and not necessarily thyroxine, should be considered for use as a first line treatment for those with trisomy 21. This paper also hypothesizes that nutritional interventions begun prenatally by the mother, may possibly also be of benefit.

[Extracorporeal life support in calcium antagonist intoxication]. / Extracorporele life support bij calciumblokkerintoxicatie.

BACKGROUND: Intoxication with calcium antagonists is associated with poor outcome. Even mild calcium antagonist overdose may be fatal. CASE DESCRIPTION: A 51-year-old woman and a 51-year-old man came to the Accident and Emergency Department in severe shock after they had taken a calcium antagonist overdose. After extensive medicinal therapy had failed, they both needed extracorporeal life support (ECLS) as a bridge to recovery. CONCLUSION: In severe calcium antagonist overdose, the combination of vasoplegia and cardiac failure leads to refractory shock. ECLS temporarily supports the circulation and maintains organ perfusion. In this way ECLS functions as a bridge to recovery and may possibly save lives. Timely consultation with and referral to an ECLS centre is recommended in patients with calcium antagonist overdose.

Might calcium disorders cause or contribute to myoclonic seizures in epileptics?

Although epilepsy is not rare, many epileptic conditions are considered to be idiopathic and the related seizures of unknown origin. It does appear that different types of seizures are caused by differing mechanisms. This paper discusses scattered case reports involving problems with calcium metabolism and the thyroid, and/or the parathyroid glands concurrent with seizures that support the position that calcium control mechanisms may have been involved in causing seizures in those patients. This paper hypothesizes that calcium levels can cause, or at least contribute to myoclonic (jerk) seizures, as well as to possibly infantile spasms. As these conditions are difficult to treat medically, this paper suggests that nutritional interventions, such as supplemental calcium, magnesium and/or vitamin D, might well be considered as an option as a first-line treatment in those with these types of epileptic disorders. The nutritional recommendations also would apply for those who have seizures concurrent with Down syndrome.

[Clinical pathways. Implementation in a urological department]. / Klinische Behandlungspfade. Einführung in einer urologischen Klinik.

BACKGROUND: Clinical pathways are directions for standardised treatment processes for different diseases or procedures in a hospital. These pathways are developed within a team of several professions and are used as order and procedure sheets. Experiences with this element of quality management are limited in Germany. METHODS: The development and the implementation process of 15 pathways in a urological department are described. A clinical pathway for female incontinence surgery (suburethral tape) is presented as an example. The effects of the pathways are evaluated on a routine basis. RESULTS: Seventy-two percent of the patients were treated according to a clinical pathway. The advantages of clinical pathways are a better structuring and transparency of medical processes, a reduction of documentation, improvements in medical education and savings in time, hospital stay of the patients and costs. Expenses for pharmaceuticals were significantly reduced in connection with development of the pathways. CONCLUSIONS: The implementation of clinical pathways is a complex but rewarding project. It can be expected that clinical pathways will be rapidly distributed in the near future and that they will contribute to improvements of health care quality.

[Female sexual function before and after treatment of urinary incontinence]. / Evaluación de la función sexual femenina antes y después de un procedimiento para la corrección de la incontinencia urinaria de esfuerzo.

The prevalence of urinary incontinence is around 20% of healthy middle-aged women. Incontinence causes a negative impact on the quality of life and sexuality. From August 2002 to January 2004, 30 patients (mean age 43 years) with stress urinary incontinence (59%), overactive bladder (15%) and mixed incontinence (26%) answered the ICIQ-SF(International Consultation on Incontinence Questionnarie-Short Form) and FSFI (Female Sexual Function Index) questionnaires before and after treatment for urinary incontinence. The follow-up ranged from 12 to 53 months. Mean ICIQ score was 17 and 7 before and after treatment respectivelly (p<0,001). Overactive bladder showed the worst scores in all domains. The patients who underwent surgery increased their scores of desire (p=0,02), satisfaction (p=0,05) and total score (p=0,02). Thirteen patients which ICIQ was zero increased: desire (p<0,01), satisfaction (p=0,05) and total score (p=0,01). Urinary incontinence significantly affects the quality of life. Therefore sexual evaluation in incontinence patients is recommended.

Identification of CYP2E1 in marmoset monkey.

CYP2E1 is the main enzyme responsible for chlorzoxazone 6-hydroxylase activity in human liver. Here, it is shown that marmoset monkey liver microsomal fraction catalyses this reaction at a similar rate and with a similar Km to human liver and that the activity is increased 4-fold in marmosets treated with isoniazid, a known inducer of CYP2E1. This indicates that CYP2E1 is present in marmoset liver. However conversely, an anti-peptide antibody targeted against the C-terminus of human and cynomolgus monkey CYP2E1 (Val-Ile-Pro-Arg-Ser) failed to bind to marmoset monkey hepatic microsomal fraction. To investigate if there is a difference in the C-terminus of CYP2E1 in these species, this region of marmoset CYP2E1 was sequenced following amplification of marmoset liver cDNA with primers selected according to conserved regions identified in human and cynomolgus monkey CYP2E1. It was found that the deduced amino acid sequence of marmoset CYP2E1 in this region is very similar to human CYP2E1, but due to two base differences in the marmoset nucleic acid sequence, the C-terminus of marmoset CYP2E1 is extended by 2 amino acids, i.e. Val-Ile-Pro-Arg-Ser-Ser-Val. This difference is sufficient to prevent the binding of an antibody raised against the C-terminus of human CYP2E1. The expression of CYP2E1 in the marmoset was confirmed by raising an antibody against the deduced C-terminus of marmoset CYP2E1 (Pro-Arg-Ser-Ser-Val). In immunoblotting, this antibody bound to a single protein of 54 kDa in marmoset liver microsomal fraction. The intensity of the band was increased in isoniazid-treated marmosets, consistent with induction of CYP2E1. The antibody did not recognise human or cynomolgus monkey CYP2E1. This was expected since the immunising peptide sequence does not occur in these enzymes. The results demonstrate the presence of CYP2E1 in marmoset liver and illustrate the importance of the C-terminus for the production of specific antibodies against P450 enzymes.

Assessment of P450 induction in the marmoset monkey using targeted anti-peptide antibodies.

The identity and expression of hepatic P450 enzymes in marmosets was investigated using a panel of anti-peptide antibodies originally targeted against human P450 enzymes. In immunoblotting, of 12 antibodies examined, 10 bound specifically to bands in marmoset liver microsomal fraction corresponding to P450 enzymes. It is proposed that these represent marmoset CYP1A1, CYP1A2, CYP2A, CYP2B, CYP2C forms (CYP2C-1 and CYP2C-2), CYP2D19, CYP3A21 and another CYP3A form (CYP3A-m). The antibodies, together with an anti-marmoset CYP2E1 antibody, were used to investigate the expression of 10 P450 enzymes in marmosets treated with P450-inducing chemicals. Treatment with phenobarbitone caused CYP2B, CYP2C-2 and CYP3A21 levels to increase, rifampicin caused increases in CYP2B and CYP2C-1 and a decrease in CYP3A21 levels, whereas dioxin caused CYP1A1 and CYP1A2 levels to increase and CYP2E1 levels to decrease. Clofibric acid did not induce any P450. P450 enzyme activities were assessed using 8 different substrates and increases were found after treatment with phenobarbitone, rifampicin, and dioxin. However, due to species differences in substrate selectivity, it proved difficult to ascribe these changes to individual P450 enzymes. Thus, the use of anti-peptide antibodies provides a more informative way of assessing the levels of specific P450 enzymes than enzyme activity measurements.

An improved method for the automated enumeration of fluorescently labelled bacteria in human faeces.

The study aimed to improve microscopy-based automated recognition of faecal bacterial cells labelled with 16S rRNA-targeted oligonucleotides and 4',6-diamidino-2-phenylindole (DAPI). Based on the software KS400 (Carl Zeiss Vision, Hallbergmoos, Germany), designed for automising microscopy-based image capture and image analysis, a routine was developed that affords the recognition of doubly stained bacteria and the rejection of artefacts. The accuracy of the automated enumeration was investigated by comparing the resulting data with those obtained by manual counting. The newly developed method was subsequently used to compare the total bacterial counts in human faecal samples using the domain specific probe Eub338 alone and a mixture of 5 domain-specific probes, respectively. Faecal samples from 90 healthy volunteers were analysed. The cell counts obtained with Eub338 were 10% lower than those obtained with the probe mixture. Since the cells detected with the probe mixture covered a wide range of signal intensities, a dynamic analysis routine was developed to effectively detect the whole range of bright to weak signals within the same image, while at the same time reliably rejecting artefacts.

Can cognitive deterioration associated with Down syndrome be reduced?

Individuals with Down syndrome have signs of possible brain damage prior to birth. In addition to slowed and reduced mental development, they are much more likely to have cognitive deterioration and develop dementia at an earlier age than individuals without Down syndrome. Some of the cognitive impairments are likely due to post-natal hydrogen peroxide-mediated oxidative stress caused by overexpression of the superoxide dismutase (SOD-1) gene, which is located on the triplicated 21st chromosome and known to be 50% overexpressed. However, some of this disability may also be due to early accumulation of advanced protein glycation end-products, which may play an adverse role in prenatal and postnatal brain development. This paper suggests that essential nutrients such as folate, vitamin B6, vitamin C, vitamin E, selenium, and zinc, as well as alpha-lipoic acid and carnosine may possibly be partially preventive. Acetyl-L-carnitine, aminoguanidine, cysteine, and N-acetylcysteine are also discussed, but have possible safety concerns for this population. This paper hypothesizes that nutritional factors begun prenatally, in early infancy, or later may prevent or delay the onset of dementia in the Down syndrome population. Further examination of these data may provide insights into nutritional, metabolic and pharmacological treatments for dementias of many kinds. As the Down syndrome population may be the largest identifiable group at increased risk for developing dementia, clinical research to verify the possible validity of the prophylactic use of anti-glycation nutrients should be performed. Such research might also help those with glycation complications associated with diabetes or Alzheimer's.