Potential biomarkers for early detection of pancreatic ductal adenocarcinoma.

Pancreatic cancer has the highest mortality amongst all major organ cancers. Early detection is key to reduce deaths related to pancreatic cancer. However, early detection has been challenged by the lack of non-invasive biomarkers with enough sensitivity and specificity to allow for screening. The gold standard is still carbohydrate antigen (CA 19-9), against which all new biomarkers must be evaluated. In this paper, we describe recent progress in the development of new pancreatic cancer biomarkers, focusing on proteins, metabolites, and genetic and epigenetic biomarkers. Although several promising biomarkers have been identified, they are all derived from retrospective studies and additional prospective studies are needed to confirm their clinical validity.

[Outcome Quality in Medical Rehabilitation: Relationship Between "Patient-Reported Outcomes" (PROs) and Social Security Contributions]. / Ergebnisqualität medizinischer Rehabilitation: Zum Zusammenhang zwischen "Patient Reported Outcomes" (PROs) und geleisteten Sozialversicherungsbeiträgen.

Aim of the Study The outcome quality of medical rehabilitation is evaluated often by "Patient Reported Outcomes" (PROs). It is examined to what extent these PROs are corresponding with "hard" or "objective" outcomes such as payments of contributions to social insurance. Methods The "rehabilitation QM outcome study" includes self-reports of patients as well as data from the Rehabilitation Statistics Database (RSD) of the German pension insurance Baden-Wurttemberg. The sample for the question posed includes N=2 947 insured who were treated in 2011 in 21 clinics of the "health quality network" and who were either employed or unemployed at the time of the rehabilitation application (e. g. the workforce or labour force group, response rate: 55%). The sample turned out widely representative for the population of the insured persons. Results PROs and payment of contributions to pension insurance clearly correspond. In the year after the rehabilitation improved vs. not improved rehabilitees differed clearly with regard to their payments of contributions. Conclusions The results support the validity of PROs. For a comprehensive depiction of the outcome quality of rehabilitation PROs and payments of contributions should be considered supplementary.

Healthcare transition challenges faced by young adults with autism spectrum disorder.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that impacts communicative interactions, with patterns of repetitive and restricted behaviors, interests, and cognitive rigidity. Recent incidence rate estimates for ASD are 1 in 68, and primarily male (4:1). A major epidemiological issue in ASD is transitioning to independence in adulthood, particularly navigating the healthcare system. This commentary will focus on approaches healthcare providers can use to not overlook and support individuals with ASD.

UV photoinitiated changes of humic fluorophores, influence of metal ions.

Fluorophore types and their photochemical stability have been tested in two samples of humic acids (HA) and four types of fulvic acids (FA) extracted from upper soil horizons (O and A horizons) in Norway spruce forest mountain ecosystems. Only one type of fluorophore occurred in all samples, with an excitation maximum at 310 nm for both HA and FA samples and emission maxima between 420-435 and 440-450 for HA and FA, respectively. HA weak native fluorescence increased significantly during irradiation in the first 12 h. Fluorophores in FA were uniformly degraded from the beginning of irradiation. Addition of metal (aluminium or ferric) ions did not affect the positions of fluorescence maxima in any of the studied samples; mild effects on fluorescence intensities were observed.

[Patient Questionnaire for Assessment of Rehabilitation Motivation (PAREMO-20) - psychometric evaluation and validation in a sample of cancer patients with different tumour sites]. / Patientenfragebogen zur Erfassung der Reha-Motivation (PAREMO-20) - Testtheoretische Uberprüfung und Validierung an einer Stichprobe von Krebspatienten unterschiedlicher Diagnosegruppen.

OBJECTIVES: A significant body of research suggests that patient motivation is related to better rehabilitation outcome with regard to psychosocial and physical well-being. Thus, patient motivation gains increasing attention with regard to the course of treatment and individual treatment planning in the practice and research in medical rehabilitation. This study aims to validate the PAREMO-20, a measure of rehabilitation motivation in a sample of cancer patients with different tumour sites. METHODS: 1193 cancer patients participated in a prospective study evaluating the medical and psychosocial effects of inpatient cancer rehabilitation. A set of various questionnaires was completed at the beginning and at the end of the rehabilitation measure as well as at one year follow-up (participation rate at follow-up: 78%). The PAREMO-20 was psychometrically examined on this sample. Validity was examined using a cancer-specific questionnaire for individual therapy goals, as well as the HADS-D and the SF-8. RESULTS: The original six factors were replicated. The factor solution emerging through PCA was tested with a confirmatory factor analysis. Maximum likelihood estimation of this model produced good fit statistics. Internal consistencies were high to satisfactory with Cronbach's Alpha=0.88 to Alpha=0.59. Psychological distress and physical impairments were positively associated with anxiety and depression, as well as with therapy goal dimensions. Moderate to high (negative) correlations were observed with health related quality of life, in particular with the mental-health dimension (r=-0.74, p=0.01). DISCUSSION: The PAREMO-20 is a reliable, valid and economic instrument, which can be recommended for use in clinical care.

[Questioning of relatives--potentials for the internal quality management in institutions caring for the elderly]. / Angehörigenbefragungen - Potenziale für das interne Qualitätsmanagement in Altenpflegeeinrichtungen.

The German care quality assurance law ("Pflege-Qualitätssicherungs-Gesetz", PQsG) calls for internal quality management in residential care facilities. Empirical surveys with residents, their relatives and employees are essential to get transparency and to assess the quality of service. Within the scope of the present study more than 1400 relatives of residents of 31 residential care institutions were surveyed. Therefore in preliminary studies a questionnaire for the relatives was developed, which collects data concerning quality aspects on various aspects (for example care, staff, medical care, cooperation with relatives). On the average, relatives judged the quality of the institutions as good. The overall mean of 2.2 (scale values between 1.8 ["administration/management"] and 2.5 ["care"]) reveals a positive aspect, but there is substantial variation between institutions. Empirical surveys are important tools for internal quality management. Among other things, their results can be used as input for specific quality circle work and thus for continuous improvement. Used continually in the sense of a routine-monitoring system, surveys can also serve to evaluate quality management procedures.

Real-time detection of L-ascorbic acid and hydrogen peroxide in crude food samples employing a reversed sequential differential measuring technique of the SIRE-technology based biosensor.

Detection of the common electrochemical interferents, ascorbic acid and hydrogen peroxide, using a SIRE (Sensors based on Injection of the Recognition Element) technology based biosensor in reverse mode operation is reported. The differential measuring principle employed in the SIRE biosensor during operation in reverse mode is such that the sample is measured first in the presence of enzyme (yielding matrix signal only), and then measured again in the absence of enzyme (yielding signal from matrix+analyte). Subtraction of the signal obtained in the presence of enzyme from the signal obtained in the absence of enzyme gives a specific signal for the analyte only and correlates directly to its concentration in solution. The linear range for the determination of ascorbic acid and hydrogen peroxide was 0-3 mM and 0-2 mM, respectively, with an enzyme concentration of 25 U ascorbate oxidase/ml and 1000 U catalase/ml. The reproducibility was 5% for ascorbic acid (R.S.D. n=15) and 10% for hydrogen peroxide (R.S.D. n=18). The cost per measurement was 0.28 USD for ascorbic acid analysis and 0.0008 USD for hydrogen peroxide analysis. The degradation of ascorbic acid in cereal was followed in real-time, as was the stabilization of low pH on the degradation process.

Advancements toward magneto immunoassays.

Recently, a magneto binding assay was conducted. The operational principle is based on a 'sandwich' mode of detection, where the target analyte (Concanavalin A) becomes bound nonselectively by protein adsorption between the solid support (silica carrier particles) and the ferromagnetic label (magneto markers). A magnetic transducer was employed for the detection. The binding assay gave a linear response in the dynamic range of 0-1.9 microM and proved to be sensitive by having a limit of detection at 250 nM. Furthermore, the relative standard deviation observed was 6.2% (n = 3). The demonstration of the 'sandwich' approach is a step toward achieving magneto immunoassays (MIA).

Flow-injection determination of trace hydrogen peroxide or glucose utilizing an amperometric biosensor based on glucose oxidase bound to a reticulated vitreous carbon electrode.

An electron transfer mediator, 8-dimethylamino-2,3-benzophenoxazine (Meldola Blue), dissolved in the carrier solution in a flow-injection system, was found to reduce the oxidation potential for hydrogen peroxide from 600-1200 mV without mediator to-100 mV vs. Ag/AgCl with the mediator present. The very low background current of reticulated vitreous carbon (RVC) at this potential makes it possible to detect very low levels of hydrogen peroxide or glucose. Glucose oxidase was covalently coupled with carbodiimide to RVC, and the RVC was formed into a column inserted in a flow-injection system. The calibration curve was linear from 30 nM to 10 microM glucose with 5 microM mediator. At higher mediator concentrations, the linear range was extended to 1000 microM, but with a much higher background current. The sample throughput was about 60 h(-1). The current response decreased to 50% of the original response after 20 days. The coulometric yield was high because the sample was pumped through the pores of the RVC. It was 16% and 55% at a flow rate of 1 ml min(-1) at mediator concentrations of 5 and 50 microM respectively.

Molecularly imprinted polymers for bioanalysis: chromatography, binding assays and biomimetic sensors.

The field of molecular imprinting has undergone rapid expansion in recent years, and applications have been demonstrated for imprinted materials in separations, analysis and catalysis. The range of compounds that has been imprinted has also expanded. Imprinted polymers have been used for the chromatographic separation of amino acids, sugars, drugs and nucleotides. Drugs have been measured using imprinted polymers as antibody substitutes in radioligand binding assays. Applications are being found for imprinted polymers in biomimetic sensing devices and sensors. Particularly interesting developments from the past year include ligand binding assays for morphine in aqueous buffers with similar specificity to antibody-based assays and the imprinting of cholesterol using a novel procedure in which the template is covalently bonded to the monomer during polymerization, but after cleavage, rebinds the polymer only by non-covalent interactions.

Magnetic permeability measurements in bioanalysis and biosensors.

A new transducer concept in bioanalysis and biosensors, utilizing measurements of magnetic permeability, is reported. A model system based on dextran ferrofluid, concanavalin A immobilized to a carrier (Sepharose), and glucose was used to demonstrate the feasibility of this approach. Direct ferromagnetic detection of the dextran ferrofluid was achieved by using a measuring coil (transducer) in a Maxwell bridge. A sensitivity of 21 µV/(µg Fe/mL) and a rsd value of 3.8% were obtained (n = 5). It was also demonstrated that a small, non-ferromagnetic metabolite (glucose) could be detected using a competitive approach. With an increasing concentration of glucose (20-40 mM), we observed a decrease in the response (0.59-0.11 mV). Reference measurements performed on Sepharose without the biorecognition element, concanavalin A, showed no significant response (0.01 mV). Some potential advantages and drawbacks of this novel type of magnetic transducer are discussed. The advantages include very low interference from the sample matrix, as the transducer is only sensitive to ferromagnetic substances, which rarely are present in samples. In addition, it is suggested that these transducers should be free from fouling. The new transducers are proposed to provide the basis for a new group of affinity biosensors suitable for in vivo and in vitro use.

Management of genital warts in women with human leukocyte interferon-alpha vs. podophyllotoxin in cream: a placebo-controlled, double-blind, comparative study.

The purpose of this double-blind, placebo-controlled, comparative study was to evaluate the specific clinical efficacy and tolerance of human leukocyte interferon-alpha (2 x 10(6) IU/g) and podophyllotoxin 0.5% incorporated in a hydrophilic cream to cure genital warts. Preselected Asian women (n = 60) aged 18-40 years (mean 22.9), with a clinical and biopsy-confirmed diagnosis of genital warts, harboring 322 lesions (mean 5.36) were randomly assigned to three parallel groups to receive one of the two test drugs or placebo. Each patient received a precoded tube (40 g) containing either human leukocyte interferon-alpha, podophyllotoxin, or identically appearing placebo cream for 3 days' usage. In addition to written instructions, each subject was shown how to apply a minimal amount of trial medication on their lesions thrice daily for 3 consecutive days per week (maximum nine topical applications per week). Patients were examined on a weekly basis, and a cure was considered to be a biopsy-confirmed, total elimination of a lesion. Moreover, patients cured during the study period were spared further therapy, and were requested to return in 16 weeks to monitor for the occurrence of a relapse. The remaining patients' empty tubes were collected, and similarly precoded replacement tubes were given to continue the treatment; a total of 214 tubes were used. The study was scheduled for 16 weeks with 4 weeks of active treatment. Individuals were excluded from the study due to pregnancy, breast feeding, or the receiving of any type of antiviral therapy during the 4 weeks preceding enrollment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Child abuse and neglect. II]. / Zlostavljanje i zanemarivanje djeteta (II).

In this review, published in two parts, the medical social and legal aspects of child abuse and neglect are assessed. The aim of this paper was to get all the physicians involved in the care of children more thoroughly acquainted with the extent, manifestations and management of abused and or neglected children. The necessity of an organised multidisciplinary approach to this serious medical and social problem iz also stressed.

[The status of care of abused and neglected children in Zagreb at the end of the 20th century]. / Stanje zastite djeteta od zlostavljanja i zanemarivanja u Zagrebu krajem XX. stoljeca.

In this paper, the data on some medical, social and legal aspects of abuse and/or neglect of children in Zagreb are presented which, at least, partially illustrate this societies' care of mistreated children at the end of the 20th century. We reviewed questionnaires that were administered to 44 health institutions involved in the childrens' health control and/or treatment and to 14 social work services and analyzed cases of child mistreatment reported to the Zagreb Public Prosecution Office and final court judgements for 1987 to 1988. We conclude that all these institutions encounter cases of child abuse and/or neglect but that medical institutions identify only 10% of cases detected by social work services and that judicial system sentences with imprisonment about 30% of abusers. Underdetection of child mistreatment in Zagreb, in addition to poor coordination of services, are the possible reasons for insufficient concern for these children. Up to now, only mass media and scientific publications have spoken more loudly about this problem. The authors emphasize the need and obligation of all those professionals concerned with children and of the entire community to undertake relevant measures to protect abused and/or neglected children.

[Child abuse and neglect. I]. / Zlostavljanje i zanemarivanje djece (I).

In this review, published in two parts, the medical social and legal aspects of child abuse and neglect are assessed. The aim of this paper was to get all the physicians involved in the care of children more thoroughly acquainted with the extent, manifestations and management of abused and/or neglected children. The necessity of an organized multidisciplinary approach to this serious medical and social problem is also stressed.