Monitoring reproductive health in Europe: what are the best indicators of reproductive health? A need for evidence-based quality indicators of reproductive health care

Monitoring reproductive health by the Reprostat indicators in Europe will facilitate the transparency of reproductive health as well as comparisons over time and between countries. However, for the monitoring and improvement of reproductive health care, we suggest the systematic development of evidence-based quality indicators, especially process and structure indicators.     

Effects of bone marrow or mesenchymal stem cell transplantation on oral mucositis (mouse) induced by fractionated irradiation

Background and purpose

Oral mucositis is a severe and dose limiting early side effect of radiotherapy for head-and-neck tumors. This study was initiated to determine the effect of bone marrow- and mesenchymal stem cell transplantation on oral mucositis (mouse tongue model) induced by fractionated irradiation.

Material and methods

Daily fractionated irradiation (5?×?3 Gy/week) was given over 1 (days 0–4) or 3 weeks (days 0–4, 7–11, 14–18). Each protocol was terminated (day 7 or 21) by graded test doses (5 dose groups, 10 animals each) in order to generate complete dose–effect curves. The incidence of mucosal ulceration, corresponding to confluent mucositis grade 3 (RTOG/EORTC), was analyzed as the primary, clinically relevant endpoint. Bone marrow or mesenchymal stem cells were transplanted intravenously at various time points within these fractionation protocols.

Results

Transplantation of 6?×?10⁶, but not of 3?×?10⁶ bone marrow stem cells on day ??1, +?4, +?8, +?11 or +?15 significantly increased the ED₅₀ values (dose, at which an ulcer is expected in 50?% of the mice); transplantation on day +?2, in contrast, was ineffective. Mesenchymal stem cell transplantation on day ??1, 2 or +?8 significantly, and on day +?4 marginally increased the ED₅₀ values.

Conclusion

Transplantation of bone marrow or mesenchymal stem cells has the potential to modulate radiation-induced oral mucositis during fractionated radiotherapy. The effect is dependent on the timing of the transplantation. The mechanisms require further investigation.     

Development and testing of patient satisfaction measure for inpatient psychiatry care

Patient satisfaction is one of the most important indicators for service excellence. Investigations have been done with population-specific patient satisfaction tools for psychiatric patients; however, there are few published measures for evaluating inpatient care. We developed and tested a 15-item instrument to evaluate the interdisciplinary care model and therapeutic interventions. Results demonstrated reliability and validity of the tool.     

Differences between primary somatosensory cortex- and vertex-derived somatosensory-evoked potentials in the rat

The somatosensory-evoked potential (SEP) elicited by high-intensity stimulation potentially provides a reliable indicator of analgesic efficacy since it reflects the level of activation of the nociceptive system. In the present study, components in the 10-30-ms latency range of SEPs recorded over the primary somatosensory cortex (SI-SEPs) and vertex (Vx-SEP) in the rat were characterized and compared. SEPs were elicited by electrical tail-base stimulation, and SI-SEPs and Vx-SEPs were recorded simultaneously. Responses to increasing stimulus intensity and stimulus frequency while awake and responses to bolus injection of fentanyl, thiopental, and ketamine were investigated. The SI-SEP positive component (P) occurring at 12 ms after stimulation (P12) showed a significantly lower intensity threshold and was significantly less affected by increasing stimulus frequency and by administration of the different drugs when compared to the Vx-SEP P15. The fact that a single stimulus modality results in different signal characteristics dependent on the recording site supports the view that different neural mechanisms involved in primary processing of somatosensory information are responsible for the generation of the SI-SEP P12 and Vx-SEP P15, respectively. This differentiation between SI-SEPs and Vx-SEPs potentially has distinct consequences using the SEP to evaluate nociception and analgesia in the rat model.     

Arbeiten am Tumorascites der Maus

Ohne ZusammenfassungMit 1 TextabbildungDie Arbeit wurde mit Unterstützung der Deutschen Forschungsgemeinschaft durchgeführt.     

Effect of superior laryngeal nerve transection on pharyngeal muscle contraction timing and sequence of activity during eating and stimulation of the nucleus solitarius in dogs

The effect of unilateral or bilateral transection of the superior laryngeal nerve on the electromyographic activity in the hyopharyngeal, thyropharyngeal, and cricopharyngeal muscles was studied in 10 dogs during eating and during unilateral electrical stimulation of the solitary nucleus. In all groups of dogs, after unilateral or bilateral transection, there were some swallowing actions in which the sequence of activity in the pharyngeal muscles was disturbed during eating and during stimulation of the solitary nucleus. In the dogs in which the transection was unilateral, this fraction was 18% in the ipsilateral muscles during eating and 7% in the contralateral muscles. After bilateral transection it was 8% in the left muscles and 16% in the right muscles. The fractions were not significantly different when swallowing was evoked by stimulation of the solitary nucleus. Swallowing actions having a normal sequence of activity in these dogs were compared with those in a group of eight dogs in which the superior laryngeal nerves were intact. Contraction timing was not significantly different during eating, but during stimulation of the solitary nucleus the timing was significantly shorter than in the dogs with intact nerves. It was concluded that superior laryngeal nerve transection modulates the central pattern generator for pharyngeal swallowing in dogs.     

Correlation between circulating soluble ICAM-1 and prednisolone-induced amelioration of ulcerative colitis

BACKGROUND: A soluble form of intercellular adhesion molecule-1 (sICAM-1) shed from endothelial cells is present in the circulation. Whether the circulating molecules represent passive turnover of surface ICAM-1 or may have some active functions in the inflammatory process is unknown. Glucocorticoids (e.g. prednisolone) are cornerstones in the treatment of acute exacerbations of ulcerative colitis (UC), and influence of the leucocyte/endothelial interaction appears to be part of their mode of action. The aim of the present study was therefore to evaluate the ICAM-1-shedding through measurements of sICAM-1 concentrations during prednisolone treatment of UC patients. METHODS: Prednisolone (40 mg) was prescribed to 15 patients with severe disease activity. At inclusion, and after 2 weeks of treatment, plasma sICAM-1 levels were measured using the ELISA technique. RESULTS: The concentrations of sICAM-1 were significantly decreased during treatment from median 256.2 (ng/ml) (interquartile range 239.7-321.0 ng/ml) to 220.4 ng/ml (196.0-276.3 ng/ml) (P < 0.01). This reduction correlated with a decrease in disease activity (r(s) = 0.8; P < 0.003). CONCLUSIONS: sICAM-1 seems to be a poor diagnostic tool, but since plasma sICAM-1 concentrations decreased during the treatment period, it might prove to be applicable as an activity marker in the individual patient.     

Non-IBD and noninfectious colitis

A wide range of etiologies and pathogenic mechanisms underlie colitis. This Review provides an overview of the pathophysiology, epidemiology, histopathology, and clinical characteristics of noninfectious and non-IBD forms of colitis: microscopic colitis, Beh?et's syndrome, diversion colitis, diverticular colitis, eosinophilic colitis, ischemic colitis, and radiation colitis. These more recently characterized and rare forms of colitis occur as either primary conditions or complications of other diseases. Most of these diseases are uncommon; therefore, epidemiologic data and data from controlled trials are not readily available. Practical guidelines for the diagnosis and therapy of these more recently characterized and rarer forms of colitis are given where possible.