Protecting participants in health research: The South African Material Transfer Agreement.

The need to transfer human biological materials (HBMs) across national boundaries has become increasingly important in view of increased biobank and commercial activities globally. In light of South Africa (SA)'s history of colonisation and racial discrimination, coupled with well-known instances of exploitation of research participants in the developing world, it is critical that the management of HBMs from and to other jurisdictions is explored and regulated. Material transfer agreements (MTAs) represent an important point of departure in such a process. This article explores the need for a uniform MTA in SA and discusses some aspects of the recently gazetted national MTA, which provides a framework that can serve as a safeguard for cross-border transfer of HBMs in the absence of the National Health Act's chapter 8 regulations in this regard.

[Individualization of exercise load control for inpatient cardiac rehabilitation. Development and evaluation of a HRV-based intervention program for patients with ischemic heart failure]. / Individualisierung der Belastungssteuerung in der kardiologischen stationären Rehabilitation. Entwicklung und Evaluation eines HRV-gesteuerten Interventionsprogramms für Patienten mit ischämisch bedingter Herzinsuffizienz.

BACKGROUND: The effective use of rehabilitation programs is of primary importance in order to improve the physical performance of cardiac disease patients. A modular program has been developed which is intended to structure and individualize conventional, exercise-based rehabilitation programs according to the individual needs and physical condition of each patient. The individualization of the program is based on detailed diagnostics before patients enter the program and daily measurements of heart rate variability (HRV) during cardiac rehabilitation. METHODS: A total of 30 patients with ischemic heart disease were randomly assigned either to the intervention group (IG), completing the modular individualized rehabilitation program [n=15, mean age 54.4±4.2 years and mean left ventricular ejection fraction (LVEF) 28.53±6.25%) or to the control group (CG) taking part in the conventional rehabilitation program (n=15, mean age 56.4±4.4 years and mean LVEF 27.63±5.62). Before and after the intervention, cardiorespiratory fitness was assessed by measurement of maximal oxygen consumption (relative VO2max) during bicycle ergometry and the 6-minute walk test (6-MWT). Pre-post comparisons of cardiorespiratory fitness indicators were used to evaluate the effectiveness of the rehabilitation program. In addition to the results of the basic clinical investigations and the cardiorespiratory testing, results of standardized HRV measurements of 10 min at morning rest served as criteria for program individualization. RESULTS: The relative VO2max increased significantly (p<0.05) in the IG whereas no change was found in the CG. Similar results were found for maximum power output during bicycle ergometry (p<0.01) and for 6-MWT distance (p<0.001). Although patients in the IG completed less aerobic exercise sessions than those in the CG (p<0.001) the physical performance of the IG improved significantly. DISCUSSION: The results prove the effectiveness and efficacy of the modular individualized rehabilitation program. They further suggest the need for an individual program matrix instead of a maximum performance matrix in cardiac rehabilitation. Individualization should be based on clinical and performance diagnostics before and accompanying assessments of training condition, e.g. by HRV measurements, during rehabilitation programs. Each patient should only perform those intervention programs which match the results of the basic clinical investigation and additional analyses during rehabilitation.

Avoiding Plagiarism in Academic Writing: a Guide on What to Cite and How

This article defends the conventional view that plagiarism in academic writing is a form of publication misconduct. I emphasize that what constitutes plagiarism is presenting the intellectual product of another as if it is one's own. Common knowledge does not need to be cited; but verbatim text; data; results; distinctive arguments; organizational structures and ideas; do. What academic authors would like to have protected are their distinctive or novel contributions to their fields of knowledge; whatever form those take. Those who Plagiarize act unethically because they seek to obtain credit that is not due to them and they deny credit to those to whom it is due. Self-plagiarism is another form of academic misconduct that entails seeking to obtain credit for the same work more than once. As with plagiarism; it is seen as dishonest and fraudulent. Avoiding accusations of plagiarism can be easily achieved by following a few simple conventions of referencing and punctuation; and academic authors are advised to protect their own reputations by following these conventions

Putative cryptoendolithic life in Devonian pillow basalt, Rheinisches Schiefergebirge, Germany.

Middle Devonian (Givetian) pillow basalt and inter-pillow breccia from the Rheinisches Schiefergebirge in Germany were found to contain putative biogenic filaments that indicate that life once proliferated within these volcanic rocks. Mineralized filaments are found in carbonate amygdules (vesicles filled by carbonate cement) in the volcanic rock, where they started to form on the internal surface of the once water-filled vesicles. Biogenicity of the filaments is indicated by (1) their size and shape resembling modern microorganisms including a constant diameter along the length of curved filaments, (2) their independence of crystal faces or cleavage planes, (3) branching patterns reminiscent of modern microorganisms, and (4) their spatial clustering and preferential occurrence close to the margin of pillows and in the inter-pillow breccias. A time lag between the deposition of pillow basalt and the activity of endoliths is revealed by the sequence of carbonate cements filling the amygdules. The putative filamentous microorganisms thrived after the formation of early fibrous rim cement, but before later equant calcite spar filled most of the remaining porosity. Microbial clay authigenesis analogous to the encrustation of prokaryotes in modern iron-rich environments led to the preservation of filaments. The filaments predominantly consist of the clay minerals chamosite and illite. Having dwelled in water-filled vesicles, the Devonian basalt-hosted filaments apparently represent cryptoendoliths. This finding suggests that a previously unrecognized niche for life exists within volcanic rock.

Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure?

BACKGROUND: Adhesions can result in serious clinical complications and make ileostomy closure, which is relatively simple procedure into a complicated and prolonged one. The use of sodium hyaluronate and carboxymethyl cellulose membrane (Seprafilm) was proven to significantly reduce the postoperative adhesions at the site of application. The aim of this study was to assess the incidence and severity of adhesions around a loop ileostomy and to analyze the length of time and morbidity for mobilization at the time of ileostomy closure with and without the use of Seprafilm. METHODS: Twenty-nine surgeons from 15 institutions participated in this multicenter prospective randomized study. 191 patients with loop ileostomy construction were randomly assigned to either receive Seprafilm under the midline incision and around the stoma (Group I), only under the midline incision (Group II), or not to receive Seprafilm (Group III). At ileostomy closure, adhesions were quantified and graded; operative morbidity was also measured. RESULTS: All 3 groups were comparable relative to gender, mean age and number of patients with prior operations (26, 25 and 19, respectively). Group II patients were significantly more likely to have pre-existing adhesions than Group III patients (30.6% vs. 14.1%, p = 0.025). At stoma mobilization, significantly more patients in Group III than in Group I had adhesions around the stoma (95.2% vs. 82.3%, p = 0.021). Mean operative times were 27, 25, and 28 minutes, respectively (p = 0.38), with significant differences among sites. There was no significant difference in the number of patients needing myotomy or enterotomy (29, 27 and 24 patients, respectively), nor in the number of postoperative complications (7, 9 and 7 patients, respectively). CONCLUSIONS: When consistently applied, Seprafilm significantly decreased adhesion formation around the stoma but not operative times without any increase in the need for myotomy or enterotomy. These findings were not seen in the overall study population possibly due to the large number of surgeons using a variety of application techniques.

FeMo cofactor biosynthesis in a nifE- mutant of Rhodobacter capsulatus.

In all diazotrophic micro-organisms investigated so far, mutations in nifE, one of the genes involved in the biosynthesis of the FeMo cofactor (FeMoco), resulted in the accumulation of cofactorless inactive dinitrogenase. In this study, we have found that strains of the phototrophic non-sulfur purple bacterium Rhodobacter capsulatus with mutations in nifE, as well as in the operon harbouring the nifE gene, were capable of reducing acetylene and growing diazotrophically, although at distinctly lower rates than the wild-type strain. The diminished rates of substrate reduction were found to correlate with the decreased amounts of the dinitrogenase component (MoFe protein) expressed in R. capsulatus. The in vivo activity, as measured by the routine acetylene-reduction assay, was strictly Mo-dependent. Maximal activity was achieved under diazotrophic growth conditions and by supplementing the growth medium with molybdate (final concentration 20-50 microM). Moreover, in these strains a high proportion of ethane was produced from acetylene ( approximately 10% of ethylene) in vivo. However, in in vitro measurements with cell-free extracts as well as purified dinitrogenase, ethane production was always found to be less than 1%. The isolation and partial purification of the MoFe protein from the nifE mutant strain by Q-Sepharose chromatography and subsequent analysis by EPR spectroscopy and inductively coupled plasma MS revealed that FeMoco is actually incorporated into the protein (1.7 molecules of FeMoco per tetramer). On the basis of the results presented here, the role of NifNE in the biosynthetic pathway of the FeMoco demands reconsideration. It is shown for the first time that NifNE is not essential for biosynthesis of the cofactor, although its presence guarantees formation of a higher content of intact FeMoco-containing MoFe protein molecules. The implications of our findings for the biosynthesis of the FeMoco will be discussed.

[Laparoscopic palliative gastrointestinal operation in inoperable upper abdominal tumors with gastric outlet obstruction]. / Die laparoskopische GE-Palliativoperation bei inoperablen Oberbauchtumoren mit Magenausgangsstenose.

In the period from June 1994 to February 1997, a laparoscopic gastroenterostomy was carried out without intraoperative complications or mortality. In 12 out of 13 patients with gastric outlet obstruction due to inoperable tumor of the upper GI tract (gastric, gallbladder or pancreas carcinoma). From the above, a total of 4 patients had postoperative complications (30.7%), three of which could be treated without further operation. The average duration of the operation was 130 min (range 70-285 mins) followed by an approximal postoperative hospital stay of 17 days (8-41 days).

Geometric mismatch of the Gamma nail to the Chinese femur.

The geometric mismatch of the femoral component of the Gamma nail to the Chinese femora resulted in intraoperative complications. To provide scientific data for modification of the implant, 28 pairs of normal Chinese femora were studied with the 3-dimensional reconstruction from the computed tomography scan data. Measurements were taken from the reconstituted drawings, and the anthropometric data were applied in the modification of the implant. This study is the first report on the application of Chinese anthropometric data on the design of a trauma implant. It is hoped that a larger scale of the study will provide a more comprehensive data base for wider application to orthopaedic implant design in the future.

Effect of allergen provocation on inflammatory cell profile and endothelin-like immunoreactivity in guinea-pig airways.

The effect of allergen challenge on the number of leucocytes and the concentration of endothelin 1-like immunoreactivity (ET-LI) in bronchoalveolar lavage fluid (BALF) was investigated in guinea-pigs sensitized to Ascaris suum. The animals were twice exposed to allergen aerosol. All animals responded to the second challenge with bronchoconstriction. Twelve hours later, a significant increase in the number of eosinophilic granulocytes in BALF, compared to unsensitized and unprovoked control animals, was noted. Twenty-four hours after provocation, there was also an elevation of ET-LI concentration and content of neutrophils. During the first day post-challenge, the ET-LI values were moderately correlated to the eosinophil levels. One week after challenge, the ET-LI level and the neutrophil count did not differ from corresponding values in control animals whereas the number of eosinophils remained elevated. Pretreatment with dexamethasone before the second allergen challenge did not consistently affect the parameters studied during the first 24 h. Bronchoconstriction induced by carbachol aerosol affected significantly neither the ET-LI concentration nor the number of inflammatory cells in BALF. It is concluded that the allergen-induced inflammation in the guinea-pig airways causes an elevation in the ET-LI concentration in BALF and that this is moderately correlated to the influx of eosinophils during the first 24 h.

Evolution of the retrotransposons TRS/ingi and of the tubulin genes in trypanosomes.

The African trypanosomes have genomes of high plasticity, as demonstrated for instance by their ability to shuffle their genes around, coding for variant-specific surface glycoproteins (VSGs). Another indication of their genome plasticity is the presence of multiple retro-elements. The retrotransposon-like element TRS/ingi is present in many copies in the genome of trypanosomes. One particular derivative of TRS/ingi, called TUBIS, had previously been found to interrupt a tubulin gene in a particular strain of T. brucei. Here both TRS/ingi and TUBIS were studied by hybridizing genomic DNA of various strains and species of trypanosomes with suitable probes in order to elucidate the evolution of this family of retro-elements. The TSR/ingi elements are highly repeated and have very long open reading frames, while TUBIS clearly is a truncated, inactivated form of this element, found in only one particular chromosomal location. Both elements were shown to be present in several strains and species of the subgenus Trypanozoon, in particular in T. brucei brucei, T. gambiense, T. rhodesiense, T. equiperdum and T. evansi. They could not be detected in species of other subgenera, in particular in T. congolense and T. cruzi. These findings suggest that the retrotransposon TRS/ingi was acquired by trypanosomes only after divergence of present day subgenera. The TUBIS element was found in exactly the same chromosomal location (at the 3' end of the tubulin gene cluster) in many different strains and species of the subgenus Trypanozoon. This shows that the element was transposed to this location before speciation of the subgenus. Although, TRS/ingi is unlikely to be involved directly in VSG switching, it may have contributed to the genome plasticity of trypanosomes.

[Postpartum thyroid gland dysfunction--a prospective study]. / Postpartale Schilddrüsen-Dysfunktion--Eine prospektive Untersuchung.

In a prospective study the postpartum thyroid function was investigated in 120 healthy women in the department of obstetrics and gynecology of the Medical School Hannover. A physical examination was performed in the first week after delivery and two to five and five to eleven months later. Additionally blood was drawn for the determination of thyroid hormones, thyroid autoantibodies and thyroid-stimulating hormone. In 10% of the patients pathological titers for thyroid microsomal autoantibodies and thyroglobulin autoantibodies were found, in 2.5% pathological concentrations of thyroid hormones. In none of these patients clinical symptoms of thyroid dysfunction could be found. After delivery a immunologically mediated thyroid disease should be considered in patients with clinical symptoms. Then the thyroid function needs to be investigated.

Leydig cell mitoses in human testes bearing early germ cell tumors.

Numerous mitoses were noted in testicular tissue from adult men with early germ cell tumors. More than 15 Leydig cells undergoing mitosis were found in the interstitial compartment. The presence of specific crystalline intracytoplasmatic inclusions demonstrated for the first time that differentiated Leydig cells are capable of proliferation. Occasionally cells are difficult to discriminate during mitosis. To establish reference criteria, the light- and electron-microscopic features of the following mitotic cells were examined: Leydig cells, fibroblasts, perivascular cells, peritubular cells, and lymphocytes. Supplementary mitoses in germ cell tumors and in a case of Leydig cell tumor were investigated. In the literature, only single reports of mitoses in Leydig cells are available. The frequent incidence of Leydig cell mitosis in early germ cell tumors may be due to the presence of growth-promoting factors in the testicular tissue.

[Puerperal thyroid gland dysfunction in healthy patients]. / Postpartale Schilddrüsen-Dysfunktion bei gesunden Patientinnen.

Elevated thyroid antibodies (AB) have been described in clinically healthy women indicating a postpartum thyroid dysfunction. We evaluated the incidence of the postpartum thyroid dysfunction in Hannover, FRG. 121 women were examined 1-5 days pp and 2-4 months later; 76 were restudied 5-7 months pp. Every time T3, T4, TSH, TBG, microsomal AB and thyroglobulin AB were determined. Six patients showed increased TAB and 10 increased MAB titers. Severe clinical symptoms were not complained. In some patients these elevated titers turned to normal subsequently. Further studies must evaluate the prognosis of this disease.

[Clinical and histopathologic studies of primary glandular cancer of the uterine cervix. An analysis of 78 cases from 1972 to 1984]. / Klinische und histopathologische Untersuchungen an primären Drüsenkrebsen der Cervix uteri. Eine Analyse von 78 Fällen der Jahre 1972 bis 1984.

In the period between 1972 and 1984 716 cervical carcinomas, of which 78 were glandular cancers, were diagnosed at the University Hospital in Hamburg-Eppendorf. The incidence of invasive adenocarcinomas of the cervix is 10.9%. When compared with a study published in 1949 (19) the incidence of adenocarcinoma has risen from 3% to 10.9%. In the period of observation, i.e., from 1972 to 1984, no trend to an increase in incidence was observed. The average age of the patients, 62.6 years, is relatively high in comparison with other studies. An earlier onset of disease has not been observed. The available data do not provide any evidence of connection between the use of oral contraceptives and later development of an adenocarcinoma. The five-year survival rate for all stages taken together was 40.4%. The five-year survival rate, and thus the prognosis for glandular carcinomas of the cervical glands, depends primarily on the clinical stage of the disease, though also on the histological type and the degree of differentiation of the tumor.

[Comparison of Blount's sling and Kirschner wire fixation in the treatment of a dislocated supracondylar humeral fracture in childhood]. / Vergleich von Blountscher Schlinge und Kirschner-Drahtfixation zur Behandlung der dislozierten suprakondylären Humerusfraktur im Kindesalter.

From 1979 to 1982 we were treating 63 cases of displaced supracondylar fractures of the humerus. Patients underwent either closed reduction and fixation by collar and cuff immobilization (32 cases), or fixation by means of Kirschner wires following closed or (more often) open reduction (31 cases). Follow-up controls after an average time of three years clearly showed the more favourable results of the conservative method.

[Diagnosis and therapy of syphilitic changes of the skin and mucous membrane in the head and neck]. / Diagnostik und Therapie syphilitischer Haut- und Schleimhautveränderungen im Kopf- und Halsbereich.

Since the mid seventies the German Federal Board of Statistics has recorded a decrease in the incidence of the classical venereal diseases gonorrhoea and syphilis. This decrease is based only on a decline in the morbidity of gonorrhoea. Statistics on syphilis show an increase, from about 6000 to 8900 new cases each year, that is an increase of 48% between 1974 and 1978. Some cities such as Cologne, with a total of 401 new cases each year, show an increase, while numbers in rural regions remain unchanged or show a slight decline. Between 1978 and 1980 at the ENT and Dermatologic OPC of Cologne University many ulcers of uncertain aetiology in the head and neck region have been diagnosed as primary or secondary syphilis or as unusual presentations of this disease. In our Department a primary lesion of the head and neck was the presenting symptom in about 6% of all newly diagnosed cases. The differential diagnosis of early syphilitis lesions in the head and neck, the present position of serological diagnosis, and the current treatment of syphilis are illustrated by selected typical lesions.

[The management of congenital hip luxation with arthrographic control, an individual risk-reducing and time-saving method. I. Choice of method and risk assessment based on arthrographic findings]. / Die Einstellung der angeborenen Hüftluxation unter Arthrographiekontrolle, eine individuelle, risikoverringernde und zeitsparende Methode. Teil 1: Methodenwahl und Risikobeurteilung aufgrund des Arthrographiebefundes.

In 388 congenital hip dislocations arthrography was used to indicate the safest form of treatment. Immediate reduction in the squatting (human) position of plaster cast (Fettweis, Salter) was followed by 3.4% of avascular necrosis of the femoral head, while plaster casts after preliminary traction showed 14.8% necrosis and unsuccessful closed reductions preceeding open reductions 11.8%. Further investigations demonstrated the influence of mechanical factors. A higher percentage of avascular necrosis was found in a narrow capsular entrance between a deformed upper limbus (or acetabular bulge) and a protruding transverse ligament with insufficient reduction (lateral displacement greater than 5 mm) and abduction of more than 45 degrees. The percentage of avascular necrosis was also depending on the development of the epiphyseal nucleus, it was 0.9% in normal forms of nuclei, 4.5% when the nucleus had not appeared at the beginning of treatment, 4.7% in small and 12.5% in retarded nuclei. The rate of necrosis was increasing with age and the degree of dislocation. Critical arthrographic findings have been described. In sufficiently open joints and full reductions Pavliks harness or hip spicas in squatting (human) position are applied immediately. With moderate narrowing of the acetabular entrance and lateral displacement traction is used for 3-4 weeks with repeated arthrography. In severe soft tissue changes of the acetabulum and lateral displacement (greater than 5-7 mm) open reduction is safer than a forced closed reduction.

[Peripheral T-lymphocytes and delayed hypersensitivity in surgically and radiologically treated patients with early stages of larynx-carcinoma]. / Periphere T-Lymphozyten mit DNCB-Test nach operativer und radiologischer Behandlung von Plattenepithel-Karzinomen des Larynx im T-Stadium.

122 patients with squamous-cell-carcinoma of the larynx (T1-stage) were examined after surgical or radiological treatment. None of these patients showed evidence of tumor recurrence. Peripheral T-lymphocytes and delayed hypersensitivity were studied in all these patients. According to their treatment, the patients were allotted into three groups and compared with a control group, consisting of 20 patients with nonneoplastic head- and neck-disease. The main finding was a significant decrease in the peripheral T-lymphocytes in surgically- or radiologically-treated patients with a squamous-cell-carcinoma of the larynx (T1-stage). This reduction of T-cells must be interpreted as a congenital or acquired defect of the immunocompetent system. In about half of the control cases the DNCB-tests showed no evidence of delayed hypersensitivity. In view of these results and those reported in the literature, the test should be used critically. In contrast to our earlier findings, where patients received radiotherapy over large areas including big vessels, radiation over a smaller, localised area does not lead to a significant depression of peripheral T-lymphocytes.