[Patient orientation of websites of otorhinolaryngologists in private practice in Bavaria]. / Patientenorientierung von Websites niedergelassener Hals-Nasen-Ohren-Ärzte in Bayern.

OBJECTIVE: The internet plays an important role in the search for health-specific information. So far, only a few studies exist on the user-friendliness of medical websites. This study thus examines the web presence of otorhinolaryngologists in private practice in Bavaria. METHODS: All otorhinolaryngologists registered with statutory health insurance in Bavaria were evaluated using a standardized checklist. IBM SPSS version 25 (IBM Corp., Armonk, NY, USA) statistical software was used for the analysis. RESULTS: Among all otorhinolaryngologists (n = 448), 73.0% (n = 327) had their own functioning website. Only a minority of websites (1.5%) had options to adjust the font size. Regarding functional possibilities of the websites, 18.3% of the physicians offered an online appointment calendar and 3.7% the possibility of feedback. A liability disclaimer was missing on 21.6% of all websites. CONCLUSION: The results exhibit an inadequate use of criteria catalogues for web presence. A patient-oriented website configuration could help to improve customer acquisition and satisfaction, which is particularly relevant for cities with a high density of physicians.

Reliability and validity of the instrument for scoring clinical outcomes of research for epidermolysis bullosa (iscorEB).

BACKGROUND: Epidermolysis bullosa (EB) is a group of rare and currently incurable genetic blistering disorders. As more pathogenic-driven therapies are being developed, there is an important need for EB-specific validated outcomes measures designed for use in clinical trials. OBJECTIVES: To test the reliability and construct validity of an instrument for scoring clinical outcomes of research for EB (iscorEB), a new combined clinician- and patient-reported outcomes tool. METHODS: We conducted an observational study consisting of independent 1-day assessments (six assessors) at two academic hospitals. The assessments consisted of iscorEB clinician (iscorEB-c), Birmingham Epidermolysis Bullosa Severity (BEBS) and global severity assessment for physicians; and iscorEB patient (iscorEB-p), Quality of Life evaluation in Epidermolysis Bullosa and Children's Dermatology Life Quality Index for patients. Construct validity and intraclass correlation coefficients (ICCs) for interobserver, intraobserver and test-retest reliability were calculated. RESULTS: Overall, 31 patients with a mean age of 19·5 years (1·8-45·2) were included. Disease severity was mild in 42% of cases, moderate in 29% and severe in 29%. The interobserver ICC was 0·96 for both the clinician-reported section of iscorEB-c and BEBS. The ICC for intraobserver reliability was 0·91 and 0·70 for the skin and mucosal domains of iscorEB-c, respectively. Cronbach's alpha for iscorEB-c was 0·89. The test-retest reliability of iscorEB-p was 0·97 and Cronbach's alpha was 0·84. The clinical score differentiated between subjects with mild, moderate and severe disease, and both clinical and patient subscores discriminated between recessive dystrophic EB and other EB subtypes. CONCLUSIONS: iscorEB has robust reliability and construct validity, including strong ability to distinguish EB types and severities. Further studies are planned to test its responsiveness to change.

Patterns of bone mineral acquisition in children with epidermolysis bullosa: a longitudinal study.

BACKGROUND: Reduced bone mass and fractures are known complications of generalized forms of epidermolysis bullosa (EB). However, the aetiology - inadequate bone acquisition, premature bone loss, or a combination - is unclear. OBJECTIVES: To determine patterns of bone mineral acquisition in children with EB and to identify clinical and laboratory correlates of change in areal bone mineral density (aBMD). METHODS: Seventeen subjects ≥ 6 years of age with generalized EB were studied at two visits at least 12 months apart with clinical and laboratory evaluations and dual energy X-ray absorptiometry scans of the lumbar spine. Wilcoxon signed-rank tests were used to determine if changes from baseline to follow-up were significant. Wilcoxon rank-sum tests were used to compare subjects with gains in aBMD Z-score with those who experienced no change or decreases to determine if baseline laboratory or clinical characteristics differed between the two groups. RESULTS: Subjects gained height and weight at follow-up, but there was no significant improvement in mean Z-scores for height, weight or body mass index. Laboratory values did not change significantly. Mean bone mineral content and aBMD of the lumbar spine increased significantly at follow-up, but mean aBMD Z-scores remained static. No differences in clinical characteristics or laboratory values were seen between subjects with increased aBMD Z-scores vs. those whose scores decreased or did not change. CONCLUSIONS: Low bone mass in children with generalized EB is due primarily to inadequate gains in aBMD. Interventions to improve overall health and to help build bone mass in this patient population are warranted.

Lethal acantholytic epidermolysis bullosa due to a novel homozygous deletion in DSP: expanding the phenotype and implications for desmoplakin function in skin and heart.

Desmoplakin is the major linker in desmosomes in epithelia and myocardium, anchoring intermediate filaments by the C-terminus to plakoglobin and plakophilin in the desmosomal plaque. Mutations in the gene DSP encoding desmoplakin have been associated with various phenotypes affecting skin and/or heart. One of these phenotypes, lethal acantholytic epidermolysis bullosa (LAEB), is characterized by extensive postnatal shedding of epidermis leading to early demise and is caused by recessive mutations in the gene DSP resulting in truncation of the desmoplakin C-terminus. Here we describe two infants born to the same consanguinous parents who suffered extensive epidermal dislodgment and died shortly after birth. In addition, universal alopecia, anonychia, malformed ears and cardiomyopathy were observed. As the clinical diagnosis was LAEB, DSP mutation analysis was performed. A homozygous deletion (c.2874del5) abrogating the donor splice site of exon 20 was found. The deletion is predicted to cause read-through in intron 20 with subsequent recognition of a premature termination codon, resulting in desmoplakin lacking its rod domain and C-terminus (p.Lys959MetfsX5). Electron microscopic analysis of skin biopsies showed absence of the desmosomal inner dense plaque and lack of tonofilament insertion. This is the second report of LAEB. These findings suggest DSP mutations as the aetiology of LAEB and cardiomyopathy as part of the phenotype. Furthermore, they indicate that in addition to the desmoplakin C-terminus, the rod domain is dispensable for intrauterine development but is essential for the inner dense plaque of desmosomes.

Treatment decision-making for patients with the Herlitz subtype of junctional epidermolysis bullosa.

The Herlitz subtype of junctional epidermolysis bullosa (JEB-H) is a lethal genetic disorder characterized by recurrent and persistent erosions of the epithelial surfaces that heal with exuberant granulation tissue. In addition, respiratory distress, refractory anemia and failure to thrive are often seen. Mortality in the first year of life approaches 90%. JEB-H is caused by mutations in the genes that encode the protein laminin 5, a structural molecule involved in the adhesion of epidermis to dermis. There is currently no cure for JEB-H. Medical interventions treat complications but do not ultimately limit mortality. Ethical principles contend that offering comfort and company to the patient and family, not aggressive therapies, should comprise the mainstay of care for affected infants.

The recent decline of Montastraea annularis (complex) coral populations in western Curaçao: a cause for concern? / La reciente disminución de las poblaciones de coral Montastraea annularis (complejo) en el oeste de Curazao: ¿un motivo de preocupación?

Shallow leeward reefs off the western end of Curaçao are dominated by extensive populations of M. annularis (complex). These species are larger in size (mean= 66 cm diameter) than all other species, with few small colonies (<30 cm) and notable absence of recruits. In 1998, colonies of M. annularis (complex) accounted for more then 45% of all species >10 cm observed within transects, and most exhibited low levels of partial mortality (mean= 22.5%). These species were less abundant (38% of all colonies) in 2005. Partial mortality among live colonies of M. annularis and M. faveolata increased by 85% (mean = 42% partial mortality) and numerous dead colonies of M. faveolata and M. annularis were observed; M. franksi colonies were generally in excellent condition (14% partial tissue mortality). A high prevalence of coral diseases (3-30%) was documented among M. annularis and M. faveolata, while all other species were less frequently affected. Yellow band disease (YBD) emerged shortly after the 1995 bleaching event, and rapidly spread throughout all depths, with the highest prevalence between 1997-1999. YBD caused slow rates of mortality (=1 cm/month), but multiple focal lesions appeared on individual colonies, and these progressively radiated outward as they killed the colonies. By 2005, 44% of the tagged corals were dead; the remainder exhibited active YBD infections (21%) or were in remission (31.6%) but were missing on average >90% of their tissue. Although the incidence of YBD has declined since 2000, white plague (WP) prevalence was unusually high (4-12%) in 2001 and 2005, with affected colonies exhibiting recent mortality of up to 70%. Dead Montastraea spp. surfaces are being colonized by other corals, including poritids, agaricids, and other faviids, while recruits of M. annularis (complex) are absent. If diseases and other biotic stressors persist on these reefs, M. annularis and M. faveolata populations may undergo a decline similar to that observed in the 1980s among Caribbean acroporids. Rev. Biol. Trop. 54 (Suppl. 3): 45- 58. Epub 2007 Jan. 15.

Los arrecifes someros a sotavento del oeste de Curaçao están dominados por extensas poblaciones de Montastraea annularis (complejo). Estas especies son mayores en tamaño (promedio= 66 cm de diámetro) que las otras especies, con algunas colonias pequeñas (<30 cm) y una notable ausencia de reclutas. En 1998, las colonias de Montastraea annularis (complejo), representaban más del 45% de todas las especies de >10 cm observadas en transectos y la mayoría exhibió bajos niveles de mortalidad parcial (prom= 22.5%). En el 2005, fueron menos abundantes (38% de las colonias). La mortalidad parcial en colonias vivas de M. annularis y M. faveolata se incrementó en un 85% (promedio= 42% de mortalidad parcial) y se observaron numerosas colonias de M. annularis y M. faveolata muertas; las colonias de M. franski generalmente se encontraron en excelentes condiciones (14% de mortalidad parcial). Se documentó una alta prevalencia de enfermedades de coral (3-30%) en M. annularis y M. faveolata, mientras que las otras especies se vieron afectadas con menor frecuencia. La enfermedad de banda amarilla (BA) emergió poco después del blanqueamiento de 1995 y se dispersó rápidamente en todas las profundidades, alcanzando su mayor prevalencia entre 1997-1999. La BA causó mortalidades lentas (= 1cm/mes), con aparición de múltiples lesiones focales en colonias individuales; estas lesiones fueron creciendo progresivamente al tiempo que mataban las colonias. Para el año 2005, el 44% de los corales que se etiquetaron habían muerto; los restantes exhibían infecciones activas de BA (21%), o estaban en remisión (31.6%) pero habían perdido un promedio de >90% de su tejido. Aunque la incidencia de BA disminuyó a partir del 2000, la prevalencia de la plaga blanca (PB) fue inusualmente alta (4-12%) en el 2001 y 2005, provocando mortalidades recientes de hasta un 70% en las colonias afectadas. Las superficies muertas de Montastraea spp. han sido colonizadas por otros corales, incluyendo porítidos, agarícidos y otros fávidos, mientras que continúa la ausencia de reclutas de M. annularis (complejo). Si las enfermedades y otros estresores bióticos persisten en estos arrecifes, las poblaciones de M. annularis y M. faveolata podrían decaer de forma similar a como lo hicieron los acropóridos del Caribe durante la década de 1980.

The importance of the marine ornamental reef fish trade in the wider Caribbean

The marine ornamental fish trade began in the 1930s in Sri Lanka, spread to Hawaii and the Philippines in the 1950s, and expanded to a multi-million dollar industry in the 1970s with fisheries established throughout the tropical Pacific, Indian and Atlantic Oceans. Currently, 45 countries supply global markets an estimated 14-30 million fish annually, with an import value of US$28-44 million. The largest suppliers are Indonesia and the Philippines, followed by Brazil, Maldives, Vietnam, Sri Lanka and Hawaii. In the tropical Western Atlantic, 16 countries have export fisheries, including the U.S. (Florida and Puerto Rico). The U.S. is the world's largest buyer, followed by the European Union and Japan. The global trade consists of over 1400 species of reef fishes, of which only about 25 are captive bred on a commercial scale. Damselfish, anemonefish, and angelfish constitute over 50% of the global volume; butterflyfish, wrasses, blennies, gobies, triggerfish, filcfish, hawkfishes, groupers and basselets account for 31% of the trade, and the remaining 16% is represented by 33 families. The most important fishes from the Caribbean are angelfish (six species), seahorses (two species), royal gramma, jawfish, queen triggerfish, redlip blenny, puddingwife, bluehead wrasse, and blue chromis. The Caribbean currently supplies a small percentage of the global trade in marine ornamental species, but ornamental fisheries in this region represent important emerging industries. It is critical that effective ornamental fishery management plans and regulations are developed and enforced, and fishery-dependent and fishery-independent data are collected and utilized in decision making processes to ensure sustainable ornamental fisheries throughout the region

Active sites for NO reduction over Fe-ZSM-5 catalysts.

A study of Fe-ZSM-5 catalysts with variable amounts of isolated, oligomeric and heavily aggregated Fe3+ oxo sites (as evidenced by UV-Vis and EPR spectroscopic data) and their catalytic properties in the selective catalytic reduction of NO by isobutane or by NH3 is presented, which allows development of a unified concept of the active Fe sites in these reactions, according to which isolated Fe sites catalyse both SCR reactions while oligomeric sites, though also involved in the selective reduction path, limit the catalyst performance by causing the total oxidation of the reductant.

The importance of the marine ornamental reef fish trade in the wider Caribbean.

The marine ornamental fish trade began in the 1930s in Sri Lanka, spread to Hawaii and the Philippines in the 1950s, and expanded to a multi-million dollar industry in the 1970s with fisheries established throughout the tropical Pacific, Indian and Atlantic Oceans. Currently, 45 countries supply global markets an estimated 14-30 million fish annually, with an import value of US$28-44 million. The largest suppliers are Indonesia and the Philippines, followed by Brazil, Maldives, Vietnam, Sri Lanka and Hawaii. In the tropical Western Atlantic, 16 countries have export fisheries, including the U.S. (Florida and Puerto Rico). The U.S. is the world's largest buyer, followed by the European Union and Japan. The global trade consists of over 1400 species of reef fishes, of which only about 25 are captive bred on a commercial scale. Damselfish, anemonefish, and angelfish constitute over 50% of the global volume; butterflyfish, wrasses, blennies, gobies, triggerfish, filcfish, hawkfishes, groupers and basselets account for 31% of the trade, and the remaining 16% is represented by 33 families. The most important fishes from the Caribbean are angelfish (six species), seahorses (two species), royal gramma, jawfish, queen triggerfish, redlip blenny, puddingwife, bluehead wrasse, and blue chromis. The Caribbean currently supplies a small percentage of the global trade in marine ornamental species, but ornamental fisheries in this region represent important emerging industries. It is critical that effective ornamental fishery management plans and regulations are developed and enforced, and fishery-dependent and fishery-independent data are collected and utilized in decision making processes to ensure sustainable ornamental fisheries throughout the region.

Quantitative assessment of right ventricular volumes in severe chronic thromboembolic pulmonary hypertension using transthoracic three-dimensional echocardiography: changes due to pulmonary thromboendarterectomy.

AIMS: Evaluation of a three-dimensional reconstruction method to show the changes of right ventricular volume and systolic function when patients undergo pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. METHODS AND RESULTS: In the examination of 11 patients (four female, seven male; age 56+/-10 years) before and after pulmonary thromboendarterectomy, end-diastolic and end-systolic right ventricular volumes were determined as a sum total of the calculated volumes of derived parallel slices of the right ventricle. Using a Tomtec workstation and a Vingmed CFM 800 echocardiography device, the acquired data were ECG-and respiration-triggered in the course of transthoracic examination, using step intervals of 5 degrees. The ventricular outline was traced manually on 5mm slices from longitudinal cut planes. For subsequent correction, their area measurements were displayed and the volume cross-checked against the volume from orthogonal cut planes. End-diastolic and end-systolic volumes could be quantified in 11/11 cases before surgery, but data could only be attained for 9/11 patients after surgery, because a limited apical window rendered the postoperative three-dimensional reconstruction impossible in two cases. Before surgery, right ventricular size was larger than normal and systolic function was clearly impaired in all of the patients (end-diastolic volume: 121+/-37 ml; end-systolic volume 91+/-30 ml; ejection fraction 25+/-8%). The decrease in mean pulmonary artery pressure after surgery was significant (47+/-8 vs 26+/-8 mmHg; P<0.05). End-diastolic and end-systolic right ventricular volumes had been reduced (80+/-33 ml and 54+/-31 ml respectively), and the ejection fraction had increased (36+/-9%). CONCLUSIONS: Successfully performed pulmonary thromboendarterectomy leads to a significant reduction of right ventricular chamber size and improvement of systolic function, which can be determined with great precision and quite easily, using transthoracic three-dimensional echocardiography. Published by Elsevier Science Ltd. All rights reserved.

Allergic contact dermatitis in children: a practical approach to management.

Allergic contact dermatitis (ACD) may account for at least 20% of all childhood dermatitis. Clinically, its morphology is identical to other forms of dermatitis in acute, subacute and chronic forms. A persistent or unusual and localized pattern is often the key to diagnosis. Treatment has centered around the use of corticosteroids, with the adjunct of antihistamines, wet dressings, and emollients for alleviation of symptoms. The newer topical immunosuppressives, tacrolimus and pimecrolimus, may also hold promise as alternative therapies, although they have not been well-studied in this regard. Allergen identification, sometimes through patch testing and allergen avoidance are the keys to preventing recurrences of this disease.

Simultaneous combination of in situ-EPR/UV-VIS/on line GC: a novel setup for investigating transition metal oxide catalysts under working conditions.

In situ-EPR, in situ-UV-VIS spectroscopy and on line-GC have been for the first time simultaneously combined to follow the behaviour of lanthanum-doped CrOx/ZrO2 and CrOx/Al2O3 catalysts during the dehydrogenation of propane to propene.

Allergic contact dermatitis.

Allergic contact dermatitis (ACD) in children is underrecognized. It is often confused with antibody-mediated allergies such as urticaria or allergic rhinitis, but the mechanism in ACD involves T lymphocytes and not antibody. Surprisingly, sensitization to common allergens is likely to occur in infancy. All contact allergens are weak allergens requiring repeated exposure over long periods of time. Detection of specific allergens is by epicutaneous (patch) testing and will provide the basis for allergen avoidance therapeutic strategies.

Does sensitization to contact allergens begin in infancy?

OBJECTIVE: Because previous studies have found allergic contact sensitization common in children by 5 years of age, our aim was to determine the prevalence of positive epicutaneous test results in children <5 years of age and to determine whether sensitization to contact allergens was as common in infancy. METHODS: We recruited 95 asymptomatic children 6 months to 5 years of age from well-child visits at Denver area pediatric practices for epicutaneous patch testing using the T.R.U.E. Test system. Allergens were placed on the skin for 48 hours, and at a later follow-up visit, positive reactions were evaluated. RESULTS: A total of 85 patients completed the study. Of these, 20 (24.5%) had 1 or more positive reactions to the tested allergens. Positive reactors ranged from 6 to 65.5 months of age, with an average of 30.4 months of age. Of the children, 16 reacted to 1 allergen, and 4 reacted to 2. Eleven positive reactions were observed to nickel, followed by 8 to thimerosal. Other positive reactions were to neomycin, cobalt, and kathon CG. CONCLUSIONS: Children as young as 6 months of age may be sensitized to contact allergens. Within this pediatric population, the prevalence of sensitization is 24.5%. Sensitization to contact allergens may occur in infants.

Phase I clinical trials of aroA aroD and aroA aroD htrA attenuated S. typhi vaccines; effect of formulation on safety and immunogenicity.

PBCC211, an aroA aroD derivative of S. typhi strain CDC10-80, was tested in phase I trials as a single dose typhoid fever vaccine. Three different vaccine preparations, reconstituted lyophilized bacteria, freshly grown bacteria or lyophilized bacteria reconstituted from sachets, were orally administered to a total of 86 adult volunteers. An aroA aroD htrA strain, PBCC222, was also tested in 38 volunteers. Formulation impacted on the determination of a safe and immunogenic dose; reconstituted lyophilized cultures required higher doses than the broth cultures to stimulate seroconversion. In general, doses which seroconverted the majority of group members produced undesirable symptoms regardless of attenuation or formulation. The inability to separate the presence of symptoms from achieving significant immunogenicity in these aroA aroD or aroA aroD htrA strains precludes their use as single dose typhoid vaccines in the formulations tested. Multiple doses of these strains at a lower, safe level may be effective as vectors for foreign antigens.

Enantiomeric resolution of galanthamine and related drugs used in anti-Alzheimer therapy by means of capillary zone electrophoresis employing derivatized cyclodextrin selectors.

An analytical assay is presented for the determination of the enantiomeric composition of galanthamine and related synthetic and natural compounds. (-)-Galanthamine is isolated from Galanthus nivalis and is used in this optical pure form in the therapy of Alzheimer's disease. Recent efforts for a total synthesis of unichiral (-)-galanthamine is connected with the need for a fast and reliable assay for the determination of the optical purity of the end product, as well as for optimizing and controlling the final steps in total synthesis particularly the asymmetric transformation of narwedine. In this paper the enantiomeric resolution of these compounds is reported employing a capillary electrophoretic system with beta-cyclodextrin derived chiral selectors. With the proposed system a number of galanthamine and narwedine derived analogous compounds could be separated, including 1-bromo- and N-alkyl-substituted compounds.

Matrix-assisted laser desorption/ionization time-of-flight and nano-electrospray ionization ion trap mass spectrometric characterization of 1-cyano-2-substituted-benz[f]isoindole derivatives of peptides for fluorescence detection.

A series of hexa- to decapeptides (molecular mass range 800-1200) were labeled with naphthalene-2,3-dicarboxaldehyde, which preferentially reacts with the primary amino groups of a peptide. A highly stable peptide conjugate is formed, which allows selective analysis by fluorescence at excitation and emission wavelengths of 420 and 490 nm, respectively. After removal of unreacted compounds, the peptide conjugates were characterized by matrix-assisted laser desorption/ionization (MALDI) time-of-flight and nano-electrospray ionization (ESI) ion trap mass spectrometry. They readily form both [M + H]+ ions by MALDI and both [M + H]+ and [M + 2H]2+ ions by ESI. Furthermore, the fragmentation behavior of the N-terminally tagged peptides, exhibiting an uncharged N-terminus, was investigated applying post-source decay fragmentation with a curved field reflector and collision-induced dissociation with a quadrupole ion trap. Fragmentation is dominated in both cases by series of a-, b- and y-type ions and [M + H - HCN]+ ions. Peptide bonds adjacent to the fluorescence label were less susceptible to cleavage than the bonds of the non-derivatized peptide ions. In general, the resulting fragment ion patterns were less complex than those of the underivatized peptides.

Calculation of left ventricular outflow tract area using three-dimensional echocardiography. Influence on quantification of aortic valve stenosis.

In 23 patients with aortic valve stenosis (14 male, 9 female, mean age 66 +/- 21.5 years) left ventricular outflow tract cross-sectional area was determined in planimetric fashion using three-dimensional echocardiography. The 3-D data-set for each patient had been acquired in the course of a multiplane transesophageal examination. Aortic valve area was determined using the continuity equation. Results obtained were compared to those calculated by continuity equation using to the conventionally determined LVOT area (a = pi [d/2]2). As reference method the results were compared to invasive measurements. 3-D planimetric determination of LVOT cross-sectional area was possible in 20 of 23 patients. In three patients, this method failed due to artefacts. The mean difference to the conventionally calculated LVOT area amounted to 0.18 cm2 (SD = 0.46). The comparison of AVA determined by continuity equation and by invasive measurement showed a mean difference of -0.074 cm2 (SD = 0.21) for the conventionally calculated LVOT area; for the planimetrically determined LVOT area the mean difference of AVA amounted to -0.03 cm2 (SD = 0.14) (p < 0.05). Planimetric determination of LVOT area using 3-D echocardiography improves the agreement of the continuity equation with invasive measurement.