Trends in bronchial hyperresponsiveness, respiratory symptoms and lung function among adults: West and East Germany. INGA Study Group. Indoor Factors and Genetics in Asthma

Previous studies have shown higher prevalences of bronchial hyperresponsiveness (BHR), respiratory symptoms and atopic sensitization among adults in Western Germany than in Eastern Germany. One of the aims of the joint project INGA (INdoor Factors and Genetics in Asthma) is to assess incidence, prevalence and trends for asthma, BHR and atopic diseases over a time period of 11 years (1990-2001) in the former West (Hamburg) and East Germany (Erfurt), with special reference to indoor exposure. INGA was designed as a case-control study following a cross-sectional study performed from 1990 to 1992 within the European Community Respiratory Health Survey (ECRHS). The database consisted of 1159 subjects in Hamburg and 731 subjects in Erfurt from the ECRHS (age 20-44). In 1995-1996, 107 cases (diagnosed asthma, positive specific serum IgE, positive skin prick or PD20FEV1< or =2.0 mg methacholine at ECRHS) and 106 controls (none of the previous findings) participated in Hamburg (115 cases and 109 controls in Erfurt). The methodology was identical to the ECRHS and dose-response slopes (DRS) of the methacholine challenge were calculated as an index of responsiveness. In the control group, median values of DRS were 0.028% mg(-1) (1990-1992) and 0.044 (1995-1996) (P<0.01) in Erfurt. Corresponding values for Hamburg were 0.028 and 0.022 (NS). Corresponding values within the case groups were 0.041 and 0.049 (NS) for Erfurt, and 0.069 and 0.052 (P<0.05) for Hamburg. Thus, 4 years after the first survey, we found an increased BHR in the Erfurt control group while the bronchial responsiveness remained unchanged for the Hamburg group. These trends in BHR, which indicate the expected converging tendency between East and West Germany, have to be confirmed within the next INGA-survey in 2000-2001.     

Zervikales CUP-Syndrom

Whenever the first diagnosis of a solid malignancy is found in lymphoid tissue and detection of the primary tumor during the initial diagnostic procedures is not successful, this syndrome is called CUP (cancer of unknown primary). When extensive diagnostic steps finally lead to detection of the primary, then an initial cup syndrome can be assumed in contrast to true CUP syndromes, where the primary tumor remains unrevealed. Most CUP metastases are adenocarcinomas, followed by poorly differentiated carcinomas, squamous cell carcinomas, and neuroendocrine tumors. Metastasis of unknown primaries occurring in lymph nodes of the neck region have a poor prognosis and is predominantly associated with worse prognosis than most other head and neck tumors, which however does depend on various factors. In this article, we introduce diagnostic steps with modern techniques like PET-CT/MRI, and review therapeutic options and prognosis in patients with cervical CUP syndrome.     

Der Video-Kopfimpulstest

Background

Side-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades.

Materials and methods

As clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome.

Results

A total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97?±?0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders.

Conclusions

By means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.     

Advance care planning conversations with palliative patients: looking through the GP’s eyes

Background

Although it is often recommended that general practitioners (GPs) initiate advance care planning (ACP), little is known about their experiences with ACP. This study aimed to identify GP experiences when conducting ACP conversations with palliative patients, and what factors influence these experiences.

Methods

Dutch GPs (N?=?17) who had participated in a training on timely ACP were interviewed. Data from these interviews were analysed using direct content analysis.

Results

Four themes were identified: ACP and society, the GP’s perceived role in ACP, initiating ACP and tailor-made ACP. ACP was regarded as a ‘hot topic’. At the same time, a tendency towards a society in which death is not a natural part of life was recognized, making it difficult to start ACP discussions. Interviewees perceived having ACP discussions as a typical GP task. They found initiating and timing ACP easier with proactive patients, e.g. who are anxious of losing capacity, and much more challenging when it concerned patients with COPD or heart failure. Patients still being treated in hospital posed another difficulty, because they often times are not open to discussion. Furthermore, interviewees emphasized that taking into account changing wishes and the fact that not everything can be anticipated, is of the utmost importance. Moreover, when patients are not open to ACP, at a certain point it should be granted that choosing not to know, for example about where things are going or what possible ways of care planning might be, is also a form of autonomy.

Conclusions

ACP currently is a hot topic, which has favourable as well as unfavourable effects. As GPs experience difficulties in initiating ACP if patients are being treated in the hospital, future research could focus on a multidisciplinary ACP approach and the role of medical specialists in ACP. Furthermore, when starting ACP with palliative patients, we recommend starting with current issues. In doing so, a start can be made with future issues kept in view. Although the tension between ACP’s focus on the patient’s direction and the right not to know can be difficult, ACP has to be tailored to each individual patient.

     

Evaluation of clinical safety and beneficial effects of a fish oil containing lipid emulsion (Lipoplus, MLF541): data from a prospective, randomized, multicenter trial

OBJECTIVE: To prove safety and effectiveness of a lipid emulsion enriched with n-3 fatty acids from fish oil (Lipoplus) within the setting of parenteral nutrition of patients after major abdominal surgery and to determine whether there are effects on outcome parameters. DESIGN: Prospective, randomized, double-blind, multicenter trial. SETTING: University and surgical teaching hospitals. PATIENTS: After obtaining informed consent, 256 patients undergoing major abdominal surgery were randomized. Parameters of safety, effectiveness, and outcome were routine laboratory parameters, complication rates, length of stay in the intensive care unit, and length of hospital stay. In addition we determined in patient subgroups of 30 patients each, the changes of the content of selected long-chain polyunsaturated fatty acids, the leukotriene synthetic capacity and the antioxidant alpha-tocopherol. INTERVENTIONS: Participating patients were randomized to receive either Lipoplus (group I; n = 127 patients) or Intralipid (group II; n = 129 patients). Parenteral nutrition was initiated immediately after surgery and ended on day 5 after surgery. MEASUREMENTS AND MAIN RESULTS: No significant differences between groups I and II were observed when comparing routine laboratory parameters during the perioperative period. Plasma levels of eicosapentaenoic acid, leukotriene B5, and antioxidant content were significantly increased in group I. Furthermore, there was a significantly shorter length of hospital stay of approximately 21% (17.2 vs. 21.9 days; p = .0061) in group I. CONCLUSIONS: Our findings indicate that the administration of Lipoplus in the postoperative period after major abdominal surgery is safe and results in a significantly shorter length of hospital stay. Administration of n-3 polyunsaturated fatty acids in the postoperative period can be considered a valuable choice for patients requiring parenteral nutrition after major abdominal surgery.     

Effect of naloxone on immune responses after hemorrhagic shock

OBJECTIVE: To determine whether naloxone administration after hemorrhagic shock has any beneficial or deleterious effect on immune responses. BACKGROUND DATA: Hemorrhagic shock is known to produce immunodepression in both humans and experimental animals. Although studies suggest that endogenous opioids play a role in immune regulation in adverse circulatory conditions, it remains controversial whether these opioids exert beneficial or detrimental effects on immunity after shock. Moreover, little information is available concerning the effects of opioid receptor blockade using naloxone on cell-mediated immunity and endocrine responses after shock. METHODS: Male C3H/HeN mice (25 g) were bled to and maintained at a mean arterial blood pressure of 35+/-5 mm Hg for 1 hr. The shed blood was then returned along with lactated Ringer's solution (two times the shed blood volume) to provide fluid resuscitation. The animals were randomized to receive either naloxone (1 mg/kg i.v.) or an equal volume of vehicle (saline) after the shed blood was returned, i.e., immediately before crystalloid resuscitation, and were killed at 2 hrs after resuscitation to obtain splenocytes, macrophages (peritoneal and splenic), and blood. MEASUREMENTS AND MAIN RESULTS: Bioassays revealed significantly decreased release of all studied interleukins (interleukins-1, -2, -3, and -6) by peritoneal and splenic macrophages as well as significantly decreased splenocyte proliferative capacity after shock in vehicle-treated mice. Naloxone administration after hemorrhage resulted in either similar or even more decreased levels of interleukin release compared with vehicle-treated hemorrhaged mice. Significantly increased plasma corticosterone concentrations were observed in vehicle-treated animals compared with control animals. Naloxone administration did not have any significant effects on corticosterone plasma concentrations after hemorrhage. CONCLUSIONS: These findings indicate the importance of the endogenous opioid system for the maintenance of immunity in adverse circulatory conditions, i.e., hemorrhage. Although additional studies involving different doses and/or times of naloxone administration may provide different results, the present findings raise the concern that naloxone administration in the traumatized host may have deleterious effects because it decreases peritoneal macrophage and splenic immune functions.     

Metabolic Profiling Reveals Distinct Variations Linked to Nicotine Consumption in Humans — First Results from the KORA Study

Exposure to nicotine during smoking causes a multitude of metabolic changes that are poorly understood. We quantified and analyzed 198 metabolites in 283 serum samples from the human cohort KORA (Cooperative Health Research in the Region of Augsburg). Multivariate analysis of metabolic profiles revealed that the group of smokers could be clearly differentiated from the groups of former smokers and non-smokers. Moreover, 23 lipid metabolites were identified as nicotine-dependent biomarkers. The levels of these biomarkers are all up-regulated in smokers compared to those in former and non-smokers, except for three acyl-alkyl-phosphatidylcholines (e.g. plasmalogens). Consistently significant results were further found for the ratios of plasmalogens to diacyl-phosphatidylcolines, which are reduced in smokers and regulated by the enzyme alkylglycerone phosphate synthase (alkyl-DHAP) in both ether lipid and glycerophospholipid pathways. Notably, our metabolite profiles are consistent with the strong down-regulation of the gene for alkyl-DHAP (AGPS) in smokers that has been found in a study analyzing gene expression in human lung tissues. Our data suggest that smoking is associated with plasmalogen-deficiency disorders, caused by reduced or lack of activity of the peroxisomal enzyme alkyl-DHAP. Our findings provide new insight into the pathophysiology of smoking addiction. Activation of the enzyme alkyl-DHAP by small molecules may provide novel routes for therapy.     

Accuracy of impression scanning compared with stone casts of implant impressions

Statement of problem

Accurate virtual implant models are a necessity for the fabrication of precisely fitting superstructures.