Showing papers in "Wiener Medizinische Wochenschrift in 2011"

Sex and gender differences in myocardial hypertrophy and heart failure.

Abstract: Cardiovascular disease is the most common cause of death in men and women worldwide. Men develop most, but not all, cardiovascular diseases at an earlier age while the number of affected women significantly increases with higher age. Heart failure (HF) is a common cause of cardiovascular death and carries a poor prognosis in both genders. Risk factors and myocardial adaptations in HF in men and women are different. Female hearts develop a more favorable physiological form of myocardial remodeling than male hearts. This may be related to sex hormones, estrogens and testosterone. A clinical study for gender differences in human aortic stenosis supports the hypotheses. HF management differs between both sexes, with underdiagnosis and undertreatment and less use of invasive therapies in women. Nevertheless, women frequently have better outcomes than men. Gender research will contribute directly to patient-oriented benefit by suggesting clinical protocols.

The role of nutrition in the prevention of sarcopenia.

Abstract: Nutrition is regarded as one important contributing factors in the complex etiology of sarcopenia. Associations between several nutritional factors and muscle mass, strength, function and physical performance were reported in a growing number of studies in recent years. Accordingly, the avoidance of weight loss is crucial to prevent the concomitant loss of muscle mass. Adequate amounts of high-quality protein are important for optimal stimulation of muscle protein synthesis. Vitamin D, antioxidants and ω 3-polyunsaturated fatty acids may also contribute to the preservation of muscle function. In order to ensure adequate intake in all elderly, nutritional problems like loss of appetite and weight loss should be recognized early by routine screening for malnutrition in the elderly. Underlying causes need to be identified and subsequently corrected. The importance of physical activity, specifically resistance training, is emphasized, not only in order to facilitate muscle protein anabolism but also to increase energy expenditure, appetite and food intake in elderly people at risk of malnutrition.

Physical activity, exercise, and sarcopenia – future challenges

Abstract: BACKGROUND: Numerous studies have demonstrated that the etiology of sarcopenia is multi-causal and very complex process. The degradation of muscle mass leads to a loss of strength, later on to a decreased functional status, impaired mobility, a higher risk of falls, and eventually an increased risk of mortality. Present guidelines state that physical inactivity or a decreased physical activity level is a part of the underlying mechanisms of sarcopenia and therefore physical activity can be seen as an important factor to reverse or modify the development of sarcopenia. TOPIC: Results in the area of physical activity and aging have not always been homogeneous. The inconsistent findings in this research area are related to the different understanding of terms and underlying constructs along with different population, type of intervention, or measurement methods. These aspects will be discussed in the paper. With regard to the formulated future role of physical activity this article will discuss in addition different barriers and challenges in the prevention and treatment of sarcopenia. A multitude of studies shows that structured exercise programs including progressive resistance or power training have positive effects on sarcopenia and sarcopenia-related outcomes but less or inconclusive information is available for the transfer to functional outcomes. CONCLUSIONS: Both physical activities and exercise have shown to decrease risk of sarcopenia and onset of functional limitations in older persons. Unfortunately the cohort of older persons is the one with the highest percentage of individuals classified as inactive or sedentary. Therefore motivating older persons to increase their physical activity level as well as providing safe access to exercise programs seems to be a mandatory task.

Actovegin®: a biological drug for more than 5 decades

Abstract: Actovegin® is a biological drug manufactured from a natural source: it is a calf blood hemodialysate. Its therapeutic benefits stem from a variety of pharmacodynamic actions that can be summarized to a common goal, i.e. the enhancement of cellular metabolism; this results from an insulin-like activity mediated by Inositol-phospho-oligosaccharides. Actovegin® results in beneficial effects in several pathophysiological clinical settings including malfunction of the blood circulation and trophic disturbances in the brain, impairment of peripheral blood circulation and associated diseases, dermal transplants and acute and chronic wounds. Here, we give an overview of the pharmacodynamic actions of calf-blood hemidialysate and its beneficial effects in a variety of clinical settings.

Sarcopenia - pathophysiology and clinical relevance.

Abstract: The causes of sarcopenia are multidimensional. The loss of fast-twitch muscle fibres exceeds the loss of slow-twitch muscle fibres and ends as a clinical relevant loss of muscle power. On a sub-cellular level, age associated changes in the mitochondria lead to functional decline of the muscle. The reduction of motor units causes muscle fibre atrophy and loss of muscle strength. Low levels of anabolic hormones and the imbalance of pro- and anti-inflammatory cytokines are responsible for changes in body composition of older adults. Reduced levels of physical activity, vitamin D and protein are highly associated with muscle loss. Sarcopenia causes loss of independence and high medical and nursing needs resulting in great economic healthcare burden.

Wireless communication fields and non-specific symptoms of ill health: a literature review.

Abstract: This is an update of a previous systematic review on the association between radiofrequency electromagnetic field (RF-EMF) exposure and health-related quality of life that included studies published before August 2007 [1]. Since then, nine randomized trials addressed short-term exposures from close-to-body RF-EMF sources such as mobile phones, and two observational studies investigated the effects of mobile phone use on health-related quality of life. Six randomized trials addressed short-term far-field exposure arising, for instance, from mobile phone base stations, and eight studies evaluated the effects of environmental far-field RF-EMF exposure. In most of the randomized trials, no exposure-response association was observed. The sporadically reported associations did not show a consistent pattern regarding the type of symptoms or the direction of the effects (increase/decrease). Similarly, most of the recent observational studies did not show associations between RF-EMF exposure and non-specific symptoms. However, the exposure gradients were small and possible exposure misclassification is a limitation of these studies. Longitudinal studies as well as studies in children and adolescents are scarce. In summary, recent research did not indicate health-related quality of life to be affected by RF-EMF exposure in our everyday environment. Furthermore, none of the studies showed that individuals with self-reported electromagnetic hypersensitivity (EHS) were more susceptible to RF-EMF than the rest of the population. Nevertheless, the rapid technological development and anticipated increase in exposure levels warrant the conduct of further longitudinal studies. Due to the widespread use of wireless communication technologies potential adverse health effects would have major public health consequences.

Integration of complementary and alternative medicine into medical schools in Austria, Germany and Switzerland--results of a cross-sectional study.

Abstract: BACKGROUND: The results of a survey of decision makers (directors of clinical departments, along with research and education institutes) at German medical schools in 1997 demonstrated that although most respondents were in favour of integrating complementary and alternative medicine (CAM) into medical school curricula, only a minority had implemented these into their medical schools. The aims of this study were to evaluate the current opinions on CAM from decision makers at medical schools in three German-speaking countries and the present extent to which it has been integrated. METHODS: In 2004 we sent a standardised questionnaire to 1,017 department directors at medical schools in Austria (A, n = 75), Germany (G, n = 873) and Switzerland (CH, n = 69). RESULTS: 487 questionnaires (overall response rate: 48%, country-specific response rate: A 39%; G 49%; S 42%) were returned. 40% of respondents had a positive opinion on CAM, whereas 28% had a neutral and 29% a negative opinion and 3% were unsure with a significant difference between Germany (44% positive opinion) in favour for CAM vs. Switzerland (22%; p = 0,021). The CAM therapies rated most positively were acupuncture (53%), osteopathy (52%) and naturopathy (38%) with no statistical differences between the countries. Naturopathy (39%) and herbal medicine (34%) were viewed more positively in Germany compared to Austria (4%, p = 0.001 and 8%, p = 0.01), but not to Switzerland (27%, p = 0.289 and 24%, p = 0.353). The majority of respondents favoured the integration of CAM into the medical system (research 85%, teaching 84% and treatment 60%). However, only 162 respondents (34%) indicated that CAM therapies had already been integrated into the curriculum at their medical schools (treatment 26%, research 19% and education 18%) with no significant differences between the countries. Respondents of Switzerland indicated lower activity of CAM integration (treatment 10% and research 10%) compared to Austria (28%, p = 0.016 and 28%, p = 0.016) and Germany (27%, p = 0.01 and 20%, p = 0.174). CONCLUSIONS: The majority of respondents favoured the integration of CAM into the medical system. However, this integration remains limited and does not reflect the high usage of CAM in the population.

Apoptogenic interactions of plasmalemmal type-1 VDAC and Aβ peptides via GxxxG motifs induce Alzheimer's disease – a basic model of apoptosis?*

Abstract: Human type-1 porin/VDAC (voltage-dependent anion channel) carries a GxxxG motif in its N-terminal part, traversing the β-barrel, while the Alzheimer's disease (AD) relevant amyloid peptides Aβ1-42 and Aβ1-40 show a series of corresponding motifs close to their C-terminus. GxxxG motifs are established as aggregation/membrane perturbation motifs. These peptide primary structure data support a proposal I recently made on the basis of a synopsis of recent literature. Accordingly, amyloid Aβ, cut from APP by beta-secretase BACE1 and gamma-secretase, has been insinuated to induce Alzheimer's disease via apoptosis by opening type-1 porin/VDAC in cell membranes of hypometabolic neuronal cells. Considering the ubiquitous expression modus of APP, beta- and gamma-secretases and type-1 VDAC/eukaryotic porin a basic model of apoptosis might be given.

Position of the mental foramen: an anatomical study.

Abstract: Knowledge of the position of the mental foramen is very important during all surgical procedures and it needs to be considered before all surgical procedures in the mandible region. The aim of this study was to determine the position of the mental foramen in the dissected human cadaver specimens. Four hundred hemimandible specimens from human cadavers were dissected and analyzed for the position of the mental foramen. The most common position of the mental foramen investigated – using anatomical dissection – was between the first and second mandibular premolars. These investigations provide relevant data for clinical anatomy, especially when planning oral operative treatment in the premolar area.

Children's health and RF EMF exposure. Views from a risk assessment and risk communication perspective.

Abstract: A review of the scientific literature published until August 2010, covering epidemiological studies on the effects of RF EMF exposure on the incidence of brain tumours and leukaemia in children as well as experimental studies on RF EMF effects on cognition and CNS in children, reveals no or only scant evidence for the assumption that RF EMF exposure poses a hazard to children. This result is at odds with public risk perceptions, i.e. prevailing concerns of (at least part of) the public about adverse health effect of RF EMF. Consequences for risk communication are discussed. A scientifically sound and easy-to-understand risk communication is especially exacerbated by the fact that current risk assessments cannot exclude that RF EMF might have adverse health effects due remaining knowledge gaps, but especially due to the impossibility to prove a non-effect.

The role of milrinone in children with cardiovascular compromise: review of the literature

Abstract: BACKGROUND: Cardiovascular instability is a common complication in children after cardiac surgery and in various forms of shock. METHODS: Systematic literature review. RESULTS: Four randomized controlled trials (RCTs) were included in this systematic literature review. In children after corrective surgery for congenital heart disease milrinone significantly reduced the risk of development of LCOS compared with placebo. In another study in children with high pulmonary vascular resistance and impaired oxygenation after Fontan operation, inhalation of NO with milrinone led to the most significant reduction of pulmonary vascular resistance and improvement of oxygenation. When only milrinone was given these changes were less pronounced. In non-hyperdynamic septic shock, CI, SVI, and DO2 significantly increased while SVRI significantly decreased after milrinone when compared to placebo. CONCLUSIONS: There are a limited number of RCTs in children that suggest a beneficial effect of milrinone in the optimization of cardiovascular function after cardiac surgery and in septic shock.

The role of vasopressin and terlipressin in catecholamine-resistant shock and cardio-circulatory arrest in children: Review of the literature

Abstract: INTRODUCTION: Arginine-vasopressin (AVP) and terlipressin (TP) are used as rescue drugs for states of shock and cardio-circulatory failure. METHODS: Review to assess AVP/TP as a rescue therapy in children with catecholamine-resistant shock or cardio-circulatory arrest. RESULTS: A total of 31 reports were included (428 patients); sixteen articles were case series, 10 case reports, 3 clinical evaluation studies, one study was a non-blind RCT while one study was a multicentre double-blind RCT. The most common indication for either drug was catecholamine-refractory septic shock (12 reports). Commonly reported responses following AVP/TP administration were a rapid increase in blood pressure, an increase in urine output, and a decrease in serum lactate. In most reports, AVP and TP led to the reduction of catecholamines. The cumulative mortality rate remained high (188/428; 43.9%) despite the use of AVP/TP. CONCLUSIONS: No firm recommendations on the use of AVP/TP in children with severe forms of cardio-circulatory failure can be issued.

Circulating retinol-binding protein 4 and metabolic syndrome in the elderly

Abstract: BACKGROUND: Retinol-binding protein (RBP) 4, a human adipokine that specifically binds to retinol, has been reported to provide a link between obesity and insulin resistance. Plasma RBP4 concentration may be under the influence of age and obesity, but only a few studies has investigated this link in elderly individuals. Consequently, we tested the correlation between RBP4 concentrations and type 2 diabetes/metabolic syndrome (MetS) components in a large population based cohort study (VITA) of elderly [1, 2]. Using a single birth cohort, this investigation could exclude the influence of age. METHODS: We evaluated the correlation of RBP4 with type 2 diabetes and MetS components including Body Mass Index (BMI), blood pressure, lipid parameters, fasting glucose insulin, homeostasis model assessment insulin resistance (HOMA-IR), and smoking in exclusively 75–76 year old participants (N = 232). RESULTS: In the present study, RBP4 concentrations were associated with type 2 diabetes and metabolic syndrome (MetS) components. Of all the individual components of metabolic syndrome that were associated with RBP4 concentrations, the correlations of RBP4 with serum triglycerides and a negative correlation with HDL were the strongest ones observed in our study cohort (p<0.0001). CONCLUSIONS: RBP4 plays a role in biological mechanisms that are responsible for insulin resistance and development of type 2 diabetes.

Nutrition and diabetes mellitus: an overview of the current evidence.

Abstract: Overwhelming evidence exists supporting the benefit of lifestyle and nutritional interventions to prevent or delay type 2 and gestational diabetes and improve glycemic control and co-morbidities in patients of all sub-types of diabetes mellitus. Therefore, nutritional therapy is an indispensable and fundamental treatment component, which has to be based on evidence-based recommendations, adapted for dietary intake and medication, and periodically adapted according to diagnosis and individual course of illness. This overview is based on the currently valid evidence-based nutritional recommendations of the European and American Diabetes Associations for the management of diabetes mellitus. It describes the quality and quantity of beneficial macronutrient (carbohydrates, fat, and protein) and micronutrient intake, alcohol consumption, and food groups. Moreover, the evidence for supplements and functional foods is summarized and the role of body weight and different weight loss diets are discussed.

Tick-borne encephalitis: new paradigms in a changing vaccination environment.

Abstract: The International Scientific Working Group on Tick-Borne Encephalitis (ISW TBE) held its 13th Annual Meeting in February 2011 to discuss epidemiological developments, news in TBE research, initiatives of the European Union, vaccination-immune response, clinical cases and TBE consequences, awareness of TBE prevention and the role of the ISW TBE to break vaccination fatigue TBE may be considered a complex system, characterized by an intricate interplay between tick biology and socioeconomic conditions The same may be said about vaccination behaviour Thus, although the facts are simple – vaccination is the best prevention – the socioeconomic conditions keep changing, and with them the ability or willingness of people to get vaccinated The ISW TBE is part of this complex system, and because the world keeps changing – so should the strategies

Training increases peroxiredoxin 2 contents in the erythrocytes of overweight/obese men suffering from type 2 diabetes

Abstract: Type 2 diabetes mellitus (T2DM) is associated with an increased release of free radicals which play an important role in the manifestation of diabetes and in the progression of diabetic complications. Peroxiredoxins are thought to be essential components of the erythrocyte antioxidative defense. Therefore, we compared peroxiredoxin isoform contents (PRDX1-6 immuno-histochemial stainings) in the erythrocytes of overweight/obese T2DM men (n = 6) and of BMI-matched non-diabetic male control subjects (n = 6). Only erythrocyte PRDX1 and PRDX2 proteins were detectable using immunohistochemical methods. PRDX1 was significantly increased in T2DM men relative to control subjects (+95.9%, P ≤ 0.05). Furthermore, we studied the influence of a 3-month endurance training program (3 times a week, cycling at 75% maximal heart rate) on erythrocyte PRDX1 and PRDX2 contents in overweight/obese T2DM men (n = 11). Training significantly increased PRDX2 at rest (+96%, P ≤ 0.05). The up-regulation of the peroxiredoxin system may help counteract free radicals in the erythrocytes of T2DM patients.

Biomechanical factors influencing the beginning and development of osteoarthritis in the hip joint.

Abstract: Osteoarthritis (OA) can be used as a common name for a group of overlapping pathological conditions when the balance between the processes of degradation and synthesis, in individual parts of the cartilage, is disturbed and leads to gradual cartilage destruction. A preventive approach toward OA helps with a timely diagnosis and subsequent treatment of this disease. One of the significant risk factors affecting development of hip joint OA is the mechanism and magnitude of mechanical loading on the joint. The main motivation for this work was to verify the hypothesis involving a pathologic cycle (overloading – change of locomotion – overloading) as contributory to the development of OA and whether it can be stopped, or at least partly decelerated, by a suitable change of movement stereotypes. Providing that there is a natural balance of muscular action, from the beginning of OA, the development of OA can be significantly decelerated. The return to a natural force balance can be achieved using suitable exercise and strengthening of muscular structures. In order to verify the hypothesis, we undertook experimental measurements of gait kinematics and a computational analysis of the hip joint using the Finite Element Method.

Time and motion study of anesthesiologists' workflow in German hospitals.

Abstract: BACKGROUND: The purpose of this study was to investigate anesthesiologists' workflow in real time METHODS: Anesthesiologists were observed for a total of 60 workdays All tasks performed during this time were recorded in real time RESULTS: The anesthesiologists were shadowed for a total of 517:16:36 hours The average workday lasted 08:37:17 hours Overall they spent 285% of each workday on indirect patient care, 147% on direct patient care and 188% on administrative work Communication took up 199% of anesthesiologists' time, breaks and disruptions 152% and other job tasks 29% CONCLUSIONS: The results comprise objective data about the workflow and working conditions in anesthesiology We found support of the large imbalance between the direct patient care and the heavy administrative workload reported by physicians These results may be useful in future efforts to improve anesthesiologists' working conditions and workflow optimization

Formen medizinischer Register – Definitionen, ausgewählte methodische Aspekte und Qualität der Forschung mit Registern

Abstract: Diese Arbeit prasentiert eine umfassende Liste von Definitionen von Registerformen mit weiter gefassten und engeren Definitionen. Im Vergleich dieser Registerformen zueinander lassen sich methodische Aspekte identifizieren, die in allen Registerformen verbreitet sind, sowie Aspekte, die besser einzelnen Registerformen zugeordnet werden konnen. In den Bemessungsinstrumenten fur die Qualitat von Registern spiegeln sich viele der dargestellten Methodenaspekte wieder. Generell, aber besonders bei Registern mit deskriptiver oder explorativer Forschungsdimension ist es fur die Beurteilung ihres wissenschaftlichen bzw. gesundheitspolitischen Nutzens von Bedeutung, die Register hinsichtlich der Erfullung ihrer Zweckbestimmung zu betrachten. Dazu gehort etwa, ob Zweck und die Methodik aufeinander abgestimmt sind. Ein Initiator sollte sich – ausgehend vom Zweck – von Beginn an uber die methodische Dimension des Registers im Klaren sein. Dies hilft, die richtige Registerform, die entsprechende Guidance und letztendlich auch die Argumente fur den Aufwand (Kosten-Nutzen-Relation) zu finden.

Thrombosis prophylaxis in critically ill patients

Abstract: Incidence of deep vein thrombosis in critically ill patients depends on the underlying disease but may be as high as 60%. The Surviving Sepsis Campaign clearly recommends administering anticoagulation in the absence of specific contraindications in patients with severe sepsis or septic shock. The article discusses risk factor for thromboembolic events in critical illness as well as means of non-pharmacologic and pharmacologic thrombosis prophylaxis. Peripheral vasoconstriction, edema, shock, and administration of catecholamines may reduce the bioavailability and efficacy of subcutaneous administration of low molecular weight heparin. This article further elaborates on the problem and pathophysiology of heparin resistance. Continuous intravenous administration of new anticoagulants may be a promising alternative to indirect anticoagulants. Severity of illness and SAPS II-score determine dosing of the direct thrombin inhibitor argatroban which needs to be about 10-times lower than in patients without critical illness.

Lipid lowering therapy in type 2 diabetes.

Abstract: The primary defect underlying abnormalities in lipoprotein transport in type 2 diabetes is insulin resistance, which leads to increased triglycerides in the fasting and postprandial states, preponderance of small, dense LDL and low concentrations of dysfunctional HDL. Concentrations of LDL-cholesterol (LDL-C) are most often not remarkably abnormal. Based on this lipoprotein profile, it seems somewhat counterintuitive to prioritize LDL-C lowering in type 2 diabetes. Nevertheless, ≈20 years of statins trials in >18,000 diabetic patients have unequivocally established this priority. Patients with type 2 diabetes without manifest atherosclerosis should reach an LDL-C goal <100 mg/dl or a Non-HDLcholesterol (NHDL-C) goal <130 mg/dl. If their baseline LDL-C is already between 70 and 100 mg/dl LDL-C should be lowered by 30 to 40%. Thus, the majority of these patients can be managed successfully with monotherapy using standard-intensity statins (e.g. simvastatin 40 mg/d). Patients with type 2 diabetes with manifest CHD should reach an LDL-C goal <70 mg/dl or an NHDL-C goal <100 mg/dl. A sizable fraction of these patients will require high-intensity statins (e.g. atorvastatin 80 mg/d or rosuvastatin 20-40 mg/d). If LDL-C goals are still not reached or high-intensity statins are not tolerated, combination of statins with ezetimibe is advisable. In patients with persistent pronounced dyslipidemic features, i.e. high TG/low HDL-C despite maximal lifestyle intervention and optimized statin dosage, pioglitazone should be incorporated in the antidiabetic management and combinations of statins with either niacin or fenofibrate should be considered. However, it has to be recognized that evidence supporting HDL-raising therapy is currently still much weaker than evidence supporting LDL lowering with statins.

Management of recurrent malignant glioma--neurosurgical strategies.

Abstract: There is currently no standard for neurosurgical interventions in patients with recurrent high grade gliomas. An individualized approach is recommended as well for decision-making as for planning an intervention with resection of the outmost possible amount of tumor tissue while preserving neurological function and thus quality of life. Recent technical developments of imaging and of neuronavigation and visualization of tumor tissue with in vivo fluorescence with 5-Ala have proved helpful in improving symptoms and prolonging survival times also for patients with recurrent malignant gliomas.

Successful therapy of sacroiliitis in SAPHO syndrome by etanercept

Abstract: Beim SAPHO-Syndrom stellen die aseptischen, schmerzhaften Osteitiden oft ein groses therapeutisches Problem dar. Wir stellen einen Patienten vor, der sowohl an einer Sakroileitis als auch an einer Akne conglobata im Rahmen eines SAPHO-Syndroms litt. Wahrend die Aknelasionen sehr gut auf eine Therapie mit Isotretinoin ansprachen, waren die durch die Sacroileitis verursachten Schmerzen mittels NSAR und Steroidapplikationen (lokal und systemisch) nicht anhaltend zu beeinflussen. Sie fuhrten zu einer massiven Beeintrachtigung seiner Mobilitat. Dieser Zustand anderte sich prompt nach Einleitung einer Therapie mit Etanercept. Innerhalb weniger Tage sistierten die Schmerzen, die Beweglichkeit kehrte zuruck. Der Patient war bis zu einem Etanercept-Auslassversuch, der 8 Monate nach Therapiebeginn unter DMARD-Schutz erfolgte, beschwerdefrei. Innerhalb weniger Tage rezidivierten die Beschwerden derart, dass Etanercept wieder begonnen werden musste. Unser Fall zeigt, ahnlich wie bisher in der Literatur in Einzelfallberichten beschrieben, dass die Gabe von TNF-Blockern zu einer schnellen und anhaltenden Besserung der osteoartikularen Beschwerden beim SAPHO-Syndrom fuhrt.

Gender and living donor kidney transplantation

Abstract: Renal transplantation is the first choice of treatment for end-stage renal disease (ESRD) patients. It offers a longer life span, a better quality of life, and lower health care costs as compared to long-term dialysis. In the past years, a constantly rising demand of kidneys on the one hand and a shortage of disposable organs on the other hand pose a growing challenge on transplant medicine. Donor and recipient gender may influence many aspects of kidney transplantation, but the nature of these interactions is still unclear. This article summarizes a part of our present knowledge in the field of gender-related kidney donation and kidney transplantation. Causes for gender disparity and its consequences will be discussed.

The role of osteoprotegerin (OPG) receptor activator for nuclear factor kappaB ligand (RANKL) in cardiovascular pathology – a review

Abstract: Initially described as key regulators in metabolic bone disease osteoprotegerin (OPG), receptor activator of nuclear factor kappa B (RANK) and RANK ligand (RANKL) have also been discriminated as regulators in immunologic function. Cardiovascular diseases (CVD) develop over many years in life and are often triggered by inflammatory processes within the vessel wall that lead to vascular remodeling. Recently some study groups have described OPG as a prognostic parameter for mortality and morbidity in cardiovascular patients.

Comparative health risk assessment of electromagnetic fields.

Abstract: Comparative health risk assessment of electromagnetic fields (EMFs) has been performed in their entire frequency range from static fields until ionizing radiation. Due to considerable change of physical and biologic interaction and the nature of potential adverse health effects comparison was based on the carcinogenic potential of environmental EMF exposure levels. There was a need for sophisticated discrimination of levels of evidence as well as the available database. Conclusions were based on a synoptic view to results of different scientific approaches such as theoretical and biologic interaction modeling, evidence for accumulative effects, in vitro and in vivo investigations and epidemiologic studies. The comparative assessment revealed significant differences of objective results and public risk perception, and puts EMF risks into perspective. It highlights the necessity for individual's responsible behavior in terms of prudent avoidance. The comparison indicates where risk awareness might merit priority. This is not restricted to the UV range but includes also other exposures such as to nocturnal light or within infrared cabins.

Cardiac fibrillation risk of TASER X-26 dart mode application

Abstract: In view of reported fatalities there are still controversial discussions on whether electronic stun law enforcement weapons can cause cardiac fibrillation. Experimental data are contradictory. Simplified theoretical estimations led to a negligible low risk of 8.10-7. With a detailed numerical-anatomical model of an adult man (NORMAN) cardiac exposure to Taser X26 high-tension pulses was quantitatively assessed and the fibrillation risk estimated by accounting for its dependence on excited volume based on 3D cardiac exposure patterns. For distance mode and worst case dart hits it could be demonstrated that cardiac exposure can reach the 30% fibrillation risk level. Risk reduces considerably if direct current flow across the heart is prevented. The overall fibrillation risk of Taser application is further reduced by the limited probability of critical hits. However, in agreement with experimental findings it is demonstrated that cardiac fibrillation risk of Taser X26 dart mode application is small, however, not negligible.

Monitoring of direct anticoagulants

Abstract: In recent years, new anticoagulants directly targeting individual components of the coagulation cascade have been developed. Although there is no need for routine coagulation monitoring with most of these agents, there are several clinical situations where a specific coagulation test should be available. Global coagulation tests react very sensitive to direct thrombin inhibitors or factor Xa inhibitors. However, with most agents, the effects on activated partial thromboplastin time (APTT) and prothrombin time (PT) are not linear and heterogeneous with respect to different reagents. In contrast, chromogenic assays show a good correlation to the pharmacokinetic of a specific agent.

Der palliative Behandlungsplan als Entscheidungsbasis zwischen palliativer und notfallmedizinischer Behandlung

Abstract: Krisenhafte Situationen am Ende des Lebens fuhren oft zur Einweisung ins Krankenhaus. Damit werden Betroffene aus der gewohnten Umgebung gerissen und die Sicherung der Betreuungskontinuitat wird bedeutend erschwert. In vielen Fallen ist dies mit einer hohen Belastung fur die PatientInnen verbunden, einer Aktivierung des Notarztsystems und einer Hospitalisierung, ohne dass sich daraus ein erkennbarer Nutzen feststellen lasst. Haufig leiten solche Krisen den Sterbeprozess ein. Vorausschauende Planung am Lebensende kann diesen Situationen in angemessener Weise vorbeugen und zu hoher Zufriedenheit bei PatientInnen, ihren Familien und den Betreuenden fuhren. Oft stellt sich die Frage: Steht in der gegebenen Situation die Belastung, die mit weiteren Krankenhausaufenthalten oder mit bestimmten medizinischen Masnahmen verbunden ist, in einem angemessenen Verhaltnis zum moglichen Nutzen dieser Masnahmen? Der "Palliative Behandlungsplan" kann als ein Instrument fur vorausschauende Planung am Lebensende an die komplexen Betreuungssituationen angepasst werden. Gemeinsam von Arzt/Arztin und Betreuungspersonen ausgefullt, kann er dazu beitragen, akut auftretende Probleme durch Masnahmen am Betreuungsort rasch und befriedigend zu losen. Wird trotzdem notarztliche Hilfe gebraucht, so kann sich das Notfallteam dank der schriftlich vorliegenden Informationen rasch ein Bild uber die aktuelle Lage verschaffen und an die Situation angepasst agieren. Das schliest mit ein, dass Notfallteams auch in der palliativen Therapie kompetent sein mussen. Damit kann der "Palliative Behandlungsplan" die Betreuenden darin unterstutzen, PatientInnen bis zuletzt in der gewohnten Umgebung gut zu versorgen.

An evaluation of applied biomechanics as an adjunct to systematic specific causation in forensic medicine.

Abstract: Biomechanical tests of post hoc probability have been proposed by prior authors as reliable tests of causation in forensic settings. Biomechanical assessment of injury kinetics and kinematics is a potentially important tool in forensic medicine, but there is also the potential for misapplication. The most reliable application is when biomechanical analysis is used to explain injury mechanisms, such as how an injury may have occurred. When a biomechanical analysis is used as a means of determining whether, rather than how an injury has resulted from a traumatic exposure, then a lack of reliability of the methodology limits its application in forensic medicine. Herein, we describe a systematic assessment of causation by adapting established general causation principles to specific causation scenarios, and how biomechanical analysis of injury mechanics is properly used to augment such an approach in conjunction with the principles of forensic epidemiology. An example calculation of relative risk associated with cervical spine injury is provided as a representative probabilistic metric for assessing causation. The statistical benefits and limitations of biomechanical analysis are discussed as an adjunct to forensic medicine.