Long-term examinations of fundic mucosa in gastroduodenal ulcer after SpV and pyloroplasty (author's transl)

Morphological examinations of the fundic mucosa with quantitative analysis of the parietal, chief and mucous neck cells were carried out with duodenal ulcer cases before selective proximal vagotomy and pyloroplasty, and over a period of more than four years after the operation. In the material removed by forceps biopsy from 15 duodenal ulcer cases, an early post-operative parietal cell density reduction of 74.15% was found, and from 5 gastric ulcer cases a reduction of 73.77%. This result occurred over an examination period of four years. The post-operative displacement in the distribution of the parietal cell within the fundic gland was pointed out, as well as the increased post-operative inflammatory indurating changes in the fundic mucosa, which occur only in gastric ulcer cases. The thickness of the mucosa was measured with an ocular micrometer pre- and post-operatively in 8 cases, and a post-operative reduction of about 20% was found. The relationshiop between the degree of post-operative parietal cell reduction and the insulin-stimulated acid-secretion was checked and no significant difference between the absolutely insulin-negative and insulin-positive groups was found post-operatively. To supplement these findings, the reaction of the succinatdehydrogenase activity in the mitochondria of the parietal cell was analysed semiquantitatively and by absorption-photometer. Thus a post-operative reduction of enzyme-activity of 20.45% on average was found in duodenal ulcer cases. In gastric ulcer cases there was no evidence of any reduction.     

Maternal eating disorders influence sex ratio at birth

We explored sex ratio at birth, defined as the proportion of male live births, in women with anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified-purging type (EDNOS-P) relative to a referent group in a large population-based sample of 38,340 pregnant women in Norway. Poisson regressions were adjusted for mother's age, pre-pregnancy BMI, lifetime smoking status, maternal education, income, marital status, gestational age, and parity. Lower proportions of male live births were observed in the anorexia and bulimia groups, while binge eating disorder and EDNOS-P were associated with a higher proportion of male births. These data suggest that maternal eating disorders may influence offspring sex and that the direction of effect may vary by eating disorder subtype. If confirmed, this finding could provide evidence in formulating hypotheses regarding the consequences of eating disorders and determinants of sex ratio at birth.     

ANCA-associated vasculitides: Pathogenetic aspects and current evidence-based therapy

A lot of progress has been made regarding the therapy of ANCA-associated vasculitides in the past decades. Cyclophosphamide still is standard therapy for remission induction in generalized disease, however, duration and cumulative dose of cyclophosphamide have been curtailed successfully to reduce toxicity. MTX is a safe alternative for remission induction in early systemic disease and medications available for remission maintenance have been extended. Rituximab and TNFalpha-antagonists represent promising options for refractory disease. The current evidence of therapy of ANCA-associated vasculitides is summarized in this review.     

Häusliche Pflegeberatung für Geldleistungsbezieher in der Pflegeversicherung

Beneficiaries from the German long-term care insurance living at home have the option between cash payments and care-in-kind services. For those who opt for cash payments, there is an obligation to receive expert advice and ‘counseling visits’ by a professional nursing service at least twice a year. Although more than 2 million of these ‘counseling visits’ are conducted each year in Germany, hardly anything is known about these visits and whether they are useful for care recipients and their family caregivers. The purpose of this project was to gain insight into the ‘counseling visits’ in order to develop a useful approach for the performance of these visits. Data collection took place in two regions of Nordrhein-Westfalen (North Rhine-Westphalia). Data were collected using a questionnaire on the general performance of the visits, the perception of care recipients and their family members, and from the perspective of the nursing services. Additional qualitative interviews were conducted with family caregivers and nurse managers. Based on the findings, a family-oriented approach for home care counseling was developed and evaluated in 80 home care arrangements. The findings reveal that despite several efforts the usefulness and quality of the counseling visits basically occurs by chance. The family-oriented approach allowed for a better understanding of the home care arrangements and offered a solid ground on which to base recommendations and advice.     

Operational implications of varying ambient light levels and time-of-day effects on saccadic velocity and pupillary light reflex

Changes in maximal saccadic velocity (SV), initial pupil diameter (IPD), constriction latency (CL) and constriction amplitude (CA) determined by the pupillary light reflex have been found to be sensitive indicators of impairment as a result of drugs, sleepiness, and/or fatigue. Ambient illuminance and time of day are controlled when these indices are applied as repeated measures in fitness-for-duty determinations. The application of oculometrics in unrestricted operational environments, where ambient illuminance and time-of-day testing are not constant, requires understanding of, and potential compensation for, the effects of, and interactions among, these multiple uncontrolled variables. SV, IPD, CL, and CA were evaluated in the morning and evening on two consecutive days following adequate nightly sleep under one baseline ambient illuminance and seven test ambient illuminances. Sixteen healthy volunteers (21-38 years, eight females/eight males) participated. Within and across days, SV was unaffected by decreasing ambient light or time-of-day effects. With the increase of ambient light from 670 to 3300 lx, CL decreased by 1%, while IPD and CA decreased by 17% and 20%, respectively. IPD increased with time of day by 1-10% (IPD was smaller in the morning). The results show that SV and CL are essentially resistant to changes in ambient light and time-of-day effects, simplifying their application in uncontrolled operational environments.