Guidelines on sodium lauryl sulfate (SLS) exposure tests. A report from the Standardization Group of the European Society of Contact Dermatitis

This report reviews the clinical and histopathological reactions caused by sodium lauryl sulfate (SLS), and the non-invasive methods that can characterize these reactions. Furthermore, SLS exposure techniques and factors that may influence the outcome of these exposures are discussed. Finally, guidelines are introduced for each exposure technique in order to have a uniform approach to SLS testing in man. Since different study aims warrant different testing conditions, we have proposed 2 categories, namely susceptibility testing and provocative testing, tailored to the aim with which the study is performed.     

Good clinical practice in patch testing: readings beyond day 2 are necessary: a confirmatory analysis. Members of the Information Network of Departments of Dermatology

BACKGROUND: Despite general recommendations, patch test readings are still sometimes terminated at day 2. OBJECTIVE: The consequences of failure to read patch tests after day 2 and the influence of exposure time to the patches is quantified. METHODS: Patch test data from 9,946 patients with at least one positive reaction at day 2 or later and readings at both days 2 and 3 (from 21,062 patients tested between January 1, 1990, and December 31, 1993) collected by the Information Network of Departments of Dermatology in Germany were analyzed. RESULTS: Comparing results at days 2 and 3, 34.5% of all positive reactions appeared at day 3 only, whereas 8.3% initially judged (weakly) positive were not considered allergic at day 3. Some standard allergens showed specific patterns. Additional positive reactions and an increasing percentage of diminishing reactions can be observed at day 4 (compared with day 3). CONCLUSION: The importance of late reading(s) is emphasized by the proportion of potentially false judgments based on readings at day 2 only.     

"Ultrahigh" dexamethasone in acute brain injury. Results from a prospective randomized double-blind multicenter trial (GUDHIS). German Ultrahigh Dexamethasone Head Injury Study Group

In a prospective randomized double-blind multicenter trial, the efficacy and safety of a 51-hour ultra-high intravenous dexamethasone dosing regimen was investigated in patients with moderate and severe head injury. 300 patients between 15 and 55 years of age were randomized to receive either placebo or dexamethasone: 500 mg intravenous infusion within 3 h after trauma initially, followed by 200 mg after 3 h, thereafter 8 times 200 mg at 6 hourly intervals, resulting in a total administered dose of 2,3 g in 51 hours. Primary end points for assessment of efficacy were: Modified Glasgow Coma Scale (grading 3-16) on Day 5, modified Glasgow Outcome Scale (grading 1-6) 10-14 months after injury, and the time interval until consciousness improved above a level of modified GCS > or = 8. Secondary endpoints were CT results and neurological and laboratory data. The two groups were well matched with respect to important prognostic variables, such as age, severity of trauma, and interval between trauma and application of the drug. 269 patients (89.7%) were available for final examination after 10-14 months. Results were surprisingly favourable in both groups: Lethality in the dexamethasone and placebo group was 14.3 and 15.4%, respectively, and 61.7 and 57.4%, respectively, achieved social and professional rehabilitation after 10-14 months (outcome scale 6). No statistical difference was seen between the dexamethasone and the placebo group in any of the primary end points of efficacy and safety (incidence of upper gastrointestinal bleeding, infection, and thrombosis).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of psychotherapy on the course of Crohn''s disease. Results of the German prospective multicenter psychotherapy treatment study on Crohn''s disease. German Study Group on Psychosocial Intervention in Crohn''s Disease

OBJECTIVES: To determine whether a combination of ciprofloxacin hydrochloride and metronidazole hydrochloride would be as effective or more effective than a combination of gentamicin sulfate and metronidazole hydrochloride for preventing infection in patients with penetrating abdominal trauma, to evaluate the factors associated with increased risk of infection, and to determine the serum peak and trough levels of gentamicin with the dosage regimen of 2.5 mg/kg every 12 hours. DESIGN: Randomized double-blind study. SETTING: Level I trauma center. PATIENTS: Eighty-four patients with penetrating intra-abdominal injuries (gunshot wound, 69; stab wound, 15) thought to require laparotomy. INTERVENTIONS: The patients were randomized during treatment in the emergency department to be given a combination of ciprofloxacin hydrochloride, 400 mg every 12 hours, and metronidazole hydrochloride, 500 mg every 6 hours, or a combination of gentamicin sulfate, 2.5 mg/kg every 12 hours, and metronidazole hydrochloride, 500 mg every 6 hours. RESULTS: Of 68 patients with intra-abdominal injuries who could be observed for at least 48 hours after laparotomy, posttraumatic infections developed in 12 (18%), and nosocomial infections developed in 6 (9%). The incidence of posttraumatic infections in patients who were given gentamicin and metronidazole (5/33 [15%]) was not significantly lower than the incidence in patients who were given ciprofloxacin and metronidazole (7 of 35 [20%]; P=.75). The presence of any infection increased the mean+/-SD length of hospital stay from 8.7+/-3.5 days to 23.3+/-10.9 days and increased the mean+/-SD hospital charges from $24 507+/-$9860 to $104920+/-$49083 (P<.001). Univariate analysis showed the factors most significantly associated with infection were as follows: (1) the use of blood transfusions (P<.001), (2) the penetrating abdominal trauma index of 35 or more (P<.002), (3) injury to the colon requiring a colostomy (P=.004), and (4) a trauma score of less than 12 (P<.02). Multivariate analysis showed the only significant factor was the receipt of blood transfusions (F=10.165; P<.005). CONCLUSIONS: Ciprofloxacin and gentamicin, each in combination with metronidazole, were equivalent in their ability to prevent infections after penetrating abdominal trauma; other factors, especially the receipt of blood transfusions, had much more effect on the incidence of infection. Infection greatly increases the length of hospital stay and hospital charges. The use of an increased dosing regimen of 2.5 mg/kg every 12 hours of gentamicin sulfate was effective at obtaining a therapeutic peak serum concentration.     

Radiotherapy of follicle center lymphoma. Results of a German multicenter and prospective study. Members of the Study Group "NHL-early stages"

PURPOSE: Follicle centre lymphoma grade I, II (REAL) or centroblastic-centrocytic lymphoma (Kiel classification) present a well defined clinical entity from a clinical point of view. These lymphomas are not curable by chemotherapy in early or advanced stages. They are treated by radiation therapy in early stages, but up to now the curative potency of radiotherapy has not been confirmed by prospective clinical trials. PATIENTS AND METHODS: Between January 1986 and August 1993 117 adults with follicle centre lymphoma were recruited from 24 institutions to enter the multicentric prospective, not randomised clinical trial. Patients with histologically proven nodal follicle centre lymphoma of stages I, II and limited III were included. They were treated by a standardised radiotherapy regimen, in stage I by extended field and in stages II and III by total nodal irradiation. Dose per fraction was 1.8 to 2.0 Gy, in the abdominal bath 1.5 Gy up to a total dose of 26 Gy in adjuvant situation and 36 Gy to enlarged lymphoma. RESULTS: All patients developed a complete remission at the end of radiotherapy. Median follow-up is 68 months. Overall survival of all patients in 86 +/- 3% at 5 and 8 years. Stage adjusted survival at 5 and 8 years was 89% for stage I, 86% for stage II and 81% for III. Patients in stages I and II < 60 years had survival rates of 94% at 5 and 8 years, patients > 60 years 63% (p < 0.0001). Recurrence free survival of all patients is 70% at 5 and 60 +/- 5% at 8 years. The number of recurrences is high with 29% at 5 and 41% at 8 years. All recurrences were seen within 7 years. The probability of localised nodal in-field recurrences is 11% and 22% at 5 and 8 years, respectively. Adverse prognostic factors were identified by multivariate analysis: age > 60 years, treatment breaks > or = 7 days and dose deviations > 20% from prescribed doses. Acute side effects of extended field irradiation were moderate. CONCLUSIONS: On the basis of these results radiotherapy is a potentially curative therapeutic approach in stages I, II and limited III of follicle centre lymphoma. The optimal technique is total lymphoid irradiation with doses of 30 Gy in the adjuvant situation and 40 to 44 Gy in enlarged lymphomas. The number of local recurrences leads to the assumption, that the extension of radiotherapy to the total lymphoid system might reduce their frequency.     

大型冶金企业网络核心的构建

文章对传统大型冶金企业网络信息系统的广泛应用前景,提出了实施企业核心网络构建,组建方式和模型.着重分析了环型核心网络构建和双星型核心网络构建的方法、连接方式和特点,以及在双星型核心构建时, 网络内、外网连接的配置技术要点.分析了大型冶金企业部门网络的三种现状,各自的互连接入方式和特点.结合实际,提出了大型冶金企业网络管理维护实行的原则:共享资源统管,自用资源分管.     

The effect of African-American acculturation on neuropsychological test performance in normal and HIV-positive individuals. The HIV Neurobehavioral Research Center (HNRC) Group

The development of a novel class of nonsteroidal human progesterone receptor (hPR) agonists, 5-aryl-1,2-dihydro-5H-chromeno[3,4-f]quinolines 2, is described. The introduction of a 5-aryl group into the 1,2-dihydrocoumarino[3,4-f]quinoline core 1 is the key for progestational activities. The structure-activity relationship (SAR) studies of the 5-aryl substituents generated a series of potent hPR agonists, which exhibited similar biological activity (EC50 = 8-30 nM) to the natural hormone progesterone (EC50 = 2.9 nM) in cell-based assays with efficacies ranging from 28% to 96%. Most of the analogues displayed similar or greater binding affinity (Ki = 0.41-3.6 nM) than progesterone (Ki = 3.5 nM). Three representative analogues (13, 15, and 24) demonstrated in vivo activities in mammary gland morphology/uterine wet weight assay in ovariectomized rats.     

Morphological and cytochemical findings in 150 cases of T-lineage acute lymphoblastic leukaemia in adults. German Multicentre ALL Study Group (GMALL)

During the process of endochondral ossification chondrocytes progress through stages of terminal differentiation culminating in apoptotic death. We have developed a serum-free suspension culture that allows terminal differentiation and facilitates the investigation of factors affecting chondrocyte apoptosis. We have found that chondrocytes not committed to terminal differentiation, i.e., those from the caudal region of chick embryo sterna, a region that remains cartilaginous for some months after the chick hatches, maintained high viability in serum-free suspension culture. A strong dependence of viability on culture density and sensitivity to induction of apoptosis with the protein kinase inhibitor, staurosporine, was consistent with the proposal that these chondrocytes, like nearly all cells, require intercellular communication for survival. Chondrocytes that were committed to terminal differentiation, i.e., those from the cephalic region of chick embryo sterna, a region that is replaced by bone before the chick hatches, expressed the hypertrophic phenotype but maintained their viability in culture for only approximately 6 days. Subsequent cell death was very consistent between cultures and shown to occur by an apoptotic process by analysis of DNA fragmentation and cell morphology. Short-term viability of hypertrophic chondrocytes was independent of culture density and relatively resistant to treatment with staurosporine. Induction of the hypertrophic phenotype in immature chondrocytes committed them to cell death and prevention of expression of the hypertrophic phenotype prevented cell death. We conclude that commitment of chondrocytes to terminal differentiation is associated with a commitment to apoptosis and apoptosis of hypertrophic chondrocytes in growth cartilage does not require initiation by external signals.     

Cognition and depression in a cohort of aging men: Results from the Western Collaborative Group Study.

Relationships between cognitive performance and self-ratings of depression on the Center for Epidemiologic Studies Depression scale (CES-D; L.S. Radloff, 1977) were examined for 1,217 older men. After controlling for demographic variables and both objective and subjective measures of health, significant associations were observed between several CES-D variables and measures of cognitive mental status, memory, and psychomotor speed. The Well-Being factor of the CES-D was the most robust predictor of cognitive scores. Therefore, for older adults with generally favorable health and socioeconomic resources, there may be a link between positive affect and maintenance of cognitive effectiveness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Direct and interaction effects among the dimensions of the Maslach Burnout Inventory: Results from two German longitudinal samples.

Inspired by the idea that the three dimensions of the Maslach Burnout Inventory (emotional exhaustion, depersonalization, and personal accomplishment) are causally related to each other, five models have been proposed in the literature to explain the main processes of burnout development. Latest empirical findings based on model comparisons suggest that emotional exhaustion exerts positive lagged effects on depersonalization and that depersonalization conceptualized as a coping strategy in turn leads to exhaustion and a low sense of personal accomplishment. The present study offers a more thorough test of various models of burnout development with longitudinal data from two German samples (total N = 643). The analyses, based on structural equation modeling, showed that exhaustion is longitudinally associated with depersonalization and that accomplishment is longitudinally predicted by depersonalization and exhaustion. Furthermore, and going beyond prior research, three moderator effects of depersonalization were identified in predicting all three burnout dimensions at a later point in time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Defense mechanisms in alcoholics attending outpatient treatment. Results from the MCT-test (Meta-Contrast Technique)

Defensive strategies were studied in 72 alcoholics participating in outpatient treatment by using, before the treatment started, the Meta-Contrast Technique, MCT, a percept-genetic method. Alcoholics had less often adaptive strategies than controls. A lack of adaptive defense strategies was related to a more impaired psychic status, more psychological benefits from drinking, and more psychiatric symptoms but not to severity of alcoholism or results of psychometric tests (intellectual level, field-dependence, spatial performance). It does not seem inconceivable that the MCT could be used as a diagnostic tool in treatment planning.     

Computed tomography in schizophrenic patients. Results from 15 patients. Review of the literature (author's transl)

The authors analyzed the scans of 15 chronic schizophrenic patients, apparently deteriorated, all of whom were long standing in-patients. They found 11 pathological cases (6 cortical atrophies and ventricular enlargement, 3 ventricular enlargement, 1 cortical atrophy, 1 cerebellar atrophy). With one exception all these atrophies were slight. The authors findings are comparable with those already reported in other studies. The article also summarizes the results of earlier studies of schizophrenics, by pneumoencephalography which are similar. Although no firm conclusions can be drawn, for such a limited sample, in particular due to the lack of any visible correlation between the pictures obtained and clinical diagnosis or prognosis, the consistent appearance of tomographic anomalies justifies continued research on these lines.     

The Thai version of the German Aachen Aphasia Test (AAT): description of the test and performance in normal subjects

The Aachen Aphasia Test (AAT), originally developed as a test for aphasia language disorders in Germany, consists of six spontaneous speech rating scales and five subtests: Token Test, Repetition, Written Language, Confronting Naming and Comprehension. The study aimed to describe the linguistic properties of the AAT Thai version and to investigate the test performances of the normal subjects. In this study some problems of linguistic changes in the construction of the Thai version were discussed. The results revealed that the normal subjects' performances on the test were independent of age, sex and education level. Therefore, the Thai version of AAT is applicable to the differential diagnosis of the communicative abilities of Thai aphasic patients.     

Usefulness of BTA Stat test (Bard) in the diagnosis of bladder cancer. Preliminary results and comparison with cytology and cystoscopy]

Risk factors associated with surgical infections are related to many events that modulate the immune system and affect the surgical procedure. The aim of this study was to determine the influence of low CD4+ lymphocyte counts in 24 patients with human immunodeficiency virus (HIV) undergoing abdominal surgery. Blood samples were obtained, and the lymphocyte population was evaluated perioperatively, as was the nutritional status of the patient. All the patients received selective antibiotic prophylaxis depending on the surgical procedure performed: (1) clean surgery: splenectomies (n = 8); (2) clean-contaminated: cholecystectomy and biliary tract surgery (n = 8); and (3) contaminated: appendectomy (n = 8). Depending on their CD4 count, two groups were formed: one with 200 to 500 cells/ml (n = 11) and the other with < 200 cells/ml (n = 13). When surgical infection was suspected, surgical drainage and microbiologic cultures were undertaken. For statistical evaluation of the groups ANOVA and the chi-square test were used; p < 0.05 was considered significant. Altogether 14 patients (58.3%) had a wound infection, and the mean (+/- SD) CD4 count in those patients was decreased (221.7 +/- 75.1) compared with that of the 10 patients in the uneventful group (386 +/- 81.2). Surgical infection rates were 50% for clean procedures, 62.5% for clean-contaminated procedures, and 62.5% for contaminated surgery. The group of patients with CD4 counts of < 200 cell/ml had an increased incidence of surgical infection, regardless of the type of surgery (p = 0.002). Thus the surgical infection rates with HIV patients undergoing abdominal surgery are dramatically increased. The CD4 and subsequently depressed neutrophil populations increase the risk of surgical infection during major procedures regardless of the type of surgery performed.     

Main results of the losartan versus amlodipine (LOA) study on drug tolerability and psychological general well-being. LOA Study Group

OBJECTIVE: To compare two losartan regimens (with and without hydrochlorothiazide) and amlodipine in treating mild-to-moderate hypertension regarding their blood-pressure-lowering effect, drug tolerability and quality of life. DESIGN: A 12-week, randomized, double-blind, parallel-group, multi-centre study. After 4 weeks of placebo, patients with a diastolic blood pressure (DBP) in the range 95-115 mmHg were allocated randomly to be administered 50 mg losartan (increased to 100 mg if the DBP was 90 mmHg or more after 6 weeks), 50 mg losartan (plus 12.5 mg hydrochlorothiazide under the above conditions), or 5 mg amlodipine (increased to 10 mg under the above condition). The tolerability of the treatment and the quality of life were evaluated by spontaneous reporting, active questioning and the Psychological General Well-Being (PGWB) index. STUDY POPULATION: In total 898 hypertensives, mainly referred from primary health care (mean age 57.8 years) of whom 52% were men. RESULTS: Administration of 50 mg losartan (plus 12.5 hydrochlorothiazide if necessary) and of 5 mg amlodipine (or 10 mg if necessary) lowered the blood pressure as well as or better than did 50 mg losartan (or 100 mg if necessary). The incidence of 'any discomfort' and 'swollen ankles' increased with amlodipine but not with losartan treatment. The opposite was found for 'dizziness upon standing'. The incidence of drug-related adverse events and the number of patients withdrawn from therapy were higher with amlodipine than they were with losartan treatment. The PGWB index at week 12 indicated that improvements from baseline had occurred in some domains for the losartan groups whereas it remained unchanged for the amlodipine group. CONCLUSION: Both losartan and amlodipine were effective in lowering the blood pressure and were tolerated well. Administration of 50 mg losartan (plus 12.5 mg hydrochlorothiazide if necessary) and of 5 mg amlodipine (or 10 mg if necessary) lowered the blood pressure equally well or better than did 50 mg losartan (or 100 mg if necessary). Drug-related adverse effects and withdrawal from the study were more common for the amlodipine group. The clinical significance of the improvements in the PGWB index with losartan needs to be studied further.     

Test for the efficacy of disinfectants at surfaces in test models. I. (communication:) Dependence of experimental results on the method of demonstration of surviving germs (swab and rinsing) (author's transl)

For the testing of disinfectants at surfaces, the germs having survived at the surface are demonstrated by means of swabs according to the guide-lines of the Deutsche Gesellschaft fur Hygiene und Mikrobiologie (DGHM): after the period of exposure to the disinfectant, the surfaces were rubbed off with a damp swab, and the frictional surface of the swab was plated out on nutrient agar. The effectiveness of this technique was compared with the effectiveness of a rinsing method in a test model. In the rinsing process, the objects to be tested for surviving germs were shaken together with a suspension and with glass beads. Then the content of germs in the suspension was quantitatively determined by means of dilution tests and pour plates. The findings were evaluated according to the guide-lines for evaluation of the DGHM (less than or equal to 10 surviving germs = adequate efficacy). For the findings obtained by rinsing, the average number of surviving germs was also determined. For maldehyde solutions were used as disinfectants for the test models (time of exposure: 4 hours; temperature 22 to 25 degrees C). These disinfecting experiments were performed on raw smoothed as well as on varnished beech-wood. The experimental results showed that the criterion "less than or equal to X surviving germs" in itself does not mean clear evidence of the efficacy of a disinfectant. The one and only decisive criterion is the frequency of the statement that a certain disinfectant or a corresponding dilution of this disinfectant has shown adequate efficacy. Therefore, one single test according to the guide-lines of the DGHM is insufficient. The frequency of the finding "adequate efficacy" is not only dependent on the concentration of the disinfectant but also on the technique used for the demonstration of surviving germs. The swab method (according to the guide-lines of the DGHM) occasionally resulted in the finding "adequate efficacy" already if 10(4) to 10(5) surviving germs were demonstrable by the rinsing method. The range of formaldehyde concentrations for which the finding of adequate efficacy were present with a frequency between 20% (minimum) and 80% (maximum) amounted to 0.2-0.5% (varnished surface) and 1.1-2.5% (raw surface), respectively for the swab method. The respective figures for the rinsing method were 0.8-1.3% and 4.8-6.5%, respectively. When using the swab method, there is a slower increase in the efficacy of the disinfectant with concentration as compared with the rinsing method. The rinsing method is, therefore, more representative of the efficacy of a disinfectant than the swab method. On account of the results of this study, it is recommended for model experiments to recover the surviving germs quantitatively by the rinsing method and to determine their number.