[Myofascial chronic pelvic pain in women : A retrospective evaluation of the effects of specific diagnostics and therapy]. / Myofaszial bedingte chronische Unterbauchschmerzen bei Frauen : Eine retrospektive Auswertung der Auswirkungen einer spezifischen Diagnostik und Therapie.

BACKGROUND: The prevalence of chronic pelvic pain of 11.8% in the general population underlines the importance of this disease. However, the specific diagnostics and therapy of the muscles of this region are not yet part of the standard examination. The following study examines the effects of specific diagnostics and therapy on myofascial chronic pelvic pain. OBJECTIVES: The effectiveness of targeted diagnostics and multimodal therapy in the context of chronic pelvic pain and the need for a complementary drug adjustment. MATERIALS AND METHODS: This study retrospectively evaluated the data of 59 patients, who were referred to a pain center for treatment-resistant chronic pelvic pain in the period from January 2012 to April 2017. The pain needed to be clearly identified as myofascial. A previous minimum duration of pain as well as previous operations or other treatment procedures did not constitute exclusion criteria. Previous traumatization was a reason for exclusion. Therapy components included manual therapeutic treatment, training in self-stretching exercises, medication with the active ingredients flupirtine or methocarbamol, as well as relaxation procedures. Therapy was evaluated on the basis of the German Pain Questionnaire. RESULTS: After the treatment interval, the following statistically significant improvements were recorded: The average pain intensity decreased by 29.95 points (standard deviation [SD] = 20.61). General quality of life (Marburg questionnaire on habitual well-being, MFHW) increased by 1.1 points (SD = 0.73). The depression and anxiety assessment decreased by 2.56 (SD = 3.99) and 2.63 points (SD = 5.21) respectively. CONCLUSION: A multimodal therapy concept with a manual therapeutic treatment focus can lead to an improvement in pain symptoms and quality of life in patients with myofascial chronic pelvic pain after a treatment period of 120 days. Myofascial syndromes of urogenital muscles must be considered in the assessment of the cause of chronic pelvic pain.

A versatile liquid-jet setup for the European XFEL.

The SPB/SFX instrument of the European XFEL provides unique possibilities for high-throughput serial femtosecond crystallography. This publication presents the liquid-jet sample delivery setup of this instrument. The setup is compatible with state-of-the-art gas dynamic virtual nozzle systems as well as high-viscosity extruders and provides space and flexibility for other liquid injection devices and future upgrades. The liquid jets are confined in a differentially pumped catcher assembly and can be replaced within a couple of minutes through a load-lock. A two-microscope imaging system allows visual control of the jets from two perspectives.

AXSIS: Exploring the frontiers in attosecond X-ray science, imaging and spectroscopy.

X-ray crystallography is one of the main methods to determine atomic-resolution 3D images of the whole spectrum of molecules ranging from small inorganic clusters to large protein complexes consisting of hundred-thousands of atoms that constitute the macromolecular machinery of life. Life is not static, and unravelling the structure and dynamics of the most important reactions in chemistry and biology is essential to uncover their mechanism. Many of these reactions, including photosynthesis which drives our biosphere, are light induced and occur on ultrafast timescales. These have been studied with high time resolution primarily by optical spectroscopy, enabled by ultrafast laser technology, but they reduce the vast complexity of the process to a few reaction coordinates. In the AXSIS project at CFEL in Hamburg, funded by the European Research Council, we develop the new method of attosecond serial X-ray crystallography and spectroscopy, to give a full description of ultrafast processes atomically resolved in real space and on the electronic energy landscape, from co-measurement of X-ray and optical spectra, and X-ray diffraction. This technique will revolutionize our understanding of structure and function at the atomic and molecular level and thereby unravel fundamental processes in chemistry and biology like energy conversion processes. For that purpose, we develop a compact, fully coherent, THz-driven atto-second X-ray source based on coherent inverse Compton scattering off a free-electron crystal, to outrun radiation damage effects due to the necessary high X-ray irradiance required to acquire diffraction signals. This highly synergistic project starts from a completely clean slate rather than conforming to the specifications of a large free-electron laser (FEL) user facility, to optimize the entire instrumentation towards fundamental measurements of the mechanism of light absorption and excitation energy transfer. A multidisciplinary team formed by laser-, accelerator,- X-ray scientists as well as spectroscopists and biochemists optimizes X-ray pulse parameters, in tandem with sample delivery, crystal size, and advanced X-ray detectors. Ultimately, the new capability, attosecond serial X-ray crystallography and spectroscopy, will be applied to one of the most important problems in structural biology, which is to elucidate the dynamics of light reactions, electron transfer and protein structure in photosynthesis.

[Visions about a new system of health care]. / Thesen für ein zukünftiges Versorgungskonzept.

The current demographic transition is leading to an ever-growing number of individuals needing assistance and physical care. The current health care system is not structured to manage these increasing demands. The elderly, as well as people with dementia or chronic diseases, will account for a large portion of the population. The new visionary system of health care delivery is a composite of local residents and professionals. This system recruits civic involvement within the society from the generation of the so-called third stage of life, thus making professional care affordable. The new system of care is most likely to be realized in regionally defined neighborhood areas, financed though regional budgets and organized by healthcare professionals.

[The new human mode of being demented]. / Die neue menschliche Seinsweise der Demenz.

Today, for the first time in the history of mankind, the number of demented people is so large that we are compelled to speak of a particular population group and a characteristic human mode of being. Ten perspectives describe which personal and societal changes will enable us to adjust to this new situation. Particular consideration is given to a new, more complete image of man.

Molybdenum balance studies in premature male infants.

UNLABELLED: Despite the fact that the trace element molybdenum (Mo) is essential, there is insufficient knowledge about the demands in infancy. Mo balances were therefore assessed under consideration of formula Mo concentrations ranging from 0.125 to 2.704 micromol/l. Sixteen premature male infants participated in the investigation. Their birth weights were between 1,500 and 1,990 g, the median (range) gestational age was 34 (32-36) weeks and the post-conceptual age at the time of study 37.4 (34.1-40.6) weeks. Twenty-four balance studies were performed and the materials analysed by atomic absorption spectroscopy. Infants with a "low" Mo intake received 0.024 (0.020-0.035) micromol/ kg per day, had a urinary excretion of 0.02 (0.008-0.045) and a retention of 0.0006 (-0.03 to 0.008) micromol/kg per day. Infants with a "high" intake received 0.284 (0.227-0.487) micromol/kg per day, had a urinary excretion of 0.243 (0.118-0.378) and a retention of 0.022 (-71.1 to 141.44) micromol/kg per day. Since the median urinary excretion exceeded 60% of the Mo intake at low and high intakes, sufficient resorption but minimal retention was assessed at low intakes of Mo. CONCLUSION: In view of the limited knowledge of long-term exposure to an elevated molybdenum intake and the substantial retention observed at higher intakes, upper limits should be set for molybdenum concentrations in preterm infant formulas.

Molybdenum metabolism: stable isotope studies in infancy.

The essential trace element molybdenum (Mo) is bound to and required for the function of molybdoenzymes, e.g. sulfite and xanthine oxidase. Dietary recommendations for early infancy are based on limited knowledge about its metabolism. 100Mo was used as an extrinsic tag to study the absorption and kinetics of excretion in infancy. 10 infants with a gestational age of 35 (30-39) weeks, a birth weight of 2.0 (0.9-2.3) kg and a post-natal age of 20 (10-54) days were studied. They received 25 microg 100Mo/kg with a feed of human milk or formula. Fractional urinary and fecal collections were conducted preceding the 100Mo intake and for 48-72 hours afterwards. The materials were analyzed by atomic absorption spectroscopy and inductively coupled plasma mass spectrometry. The median absorption of 100Mo intake was 97.5 (96.3 to 99.1) %. The retention of nutritive Mo intake and 100Mo in the study period was 11.2 (3.8-15.7) microg Mo/kg, equivalent to 35.7 (12.7-55.6) %. The Mo concentration increased to a peak value in urine within 8 (6-13) hours and in feces within 24 (7-48.5) hours. In addition, increases of copper in feces and urine were observed in 8 of 9 infants studied. Mo given orally is well resorbed in premature infants, and predominantly excreted in the urine. Dietary recommendations should prevent excessive intakes in infancy.

Evaluation of the Abbott Cell Dyn 4000 automated fluorescent reticulocyte measurements: comparison with manual, FACScan and Sysmex R1000 methods.

The Abbott Cell Dyn 4000 (CD4000) is the first haematology analyser in which fully-automated reticulocyte measurements can be routinely determined by fluorescence as part of the full blood count. This communication reports the first evaluation of this method which was undertaken by three independent reference laboratories in Belgium, Germany and Italy. A total of 695 different samples was entered into the study which was designed to compare CD4000 reticulocyte information (enumeration and qualitative maturational data) with results determined in parallel with the existing manual (supravital staining) reference procedure, and two semi-automated fluorescent assays (Becton Dickinson FACScan and Sysmex R1000 instruments). These studies revealed good agreement between the CD4000 and the manual procedure, with no inter-method bias. Comparison of CD4000 and FACScan reticulocyte measurements, however, indicated a distinct tendency for the FACScan to give higher reticulocyte estimates than the CD4000. Finally, the comparison of the CD4000 with the Sysmex R1000 showed excellent agreement in the range 0-6% reticulocytes, although there was some inter-method bias in the higher range (> 15%). Analysis of agreement levels between the methods using specific 'clinical decision points' confirmed the tendency for overestimation by the FACScan, in that 58% of the samples with a reticulocytopenia of < 0.5% as defined by the CD4000 gave FACScan results within the normal range (0.5-1.8%). In contrast, there was absolute agreement between the CD4000 and the Sysmex R1000 for all reticulocytopenias. Comparison (195 samples) of instrument fluorescent reticulocyte maturation profiles demonstrated an exponential relationship (r = 0.78) between CD4000 IRF and R1000 HFR (highly fluorescent reticulocyte fraction) values. The suggestion that the CD4000 IRF values includes some of the MFR as well the HFR reticulocyte fraction was confirmed as the correlation between the CD4000 IRF and the Sysmex R1000 MFR plus HFR percentages was linear (r = 0.82). This study confirms a high performance level for the CD4000 automated fluorescent reticulocyte method.

In vivo interference of heparin bolus injection with photometric continuous lipase determination.

The new photometric lipase determinations use diacylglycerols as substrates in a micellar solution, whereas the turbidimetric method is based on emulsified triacylglycerols degradation. Extrahepatic lipoprotein lipase, which is well known to be liberated by heparin from the capillar binding sites, may cleave triacylglycerols as well as diacylglycerols. When a heparin bolus injection is given to a patient, the released lipoprotein lipase renders high lipase activities in blood misleading for a pancreatic disorder.

Improved automated leucocyte counting and differential in newborns achieved by the haematology analyser CELL-DYN 3500.

Automated leucocyte counts in newborns generated by the impedance principle are artificially affected by the high osmotic resistance of some newborn RBC and possibly by the high normoblast numbers present during the neonatal period. Erroneously high WBC counts may result. The haematology analyser CELL-DYN 3500 (Abbott Diagnostika GmbH, Wiesbaden-Delkenheim, Germany) has two different channels for the WBC count, an electrical resistivity (impedance) channel and a laseroptical channel. In combination with facultative extended lysis of resistant RBC before WBC count, this instrument is claimed to be very suitable for newborn blood analysis. We measured the WBC count and differential of 165 blood samples from newborns and cord blood on the CELL-DYN 3500. Reticulocyte count and manual differential including normoblasts were determined. Furthermore, some technical aspects of neonatal blood analysis were evaluated: precision, cell stability, effect of incorrect blood-anticoagulant ratio of small blood collecting tubes. The internal decision making process of the CELL-DYN 3500 selects the result either from the optical channel (identifies and excludes normoblasts) or from the resistivity channel (eliminates resistant RBC). This instrument gives a reliable and accurate WBC count and differential of neonatal samples even in blood samples with normoblasts and lytic resistant RBC. The result given by the CELL-DYN 3500 can be confirmed by a subsequent run in extended lyse mode.

[Reference values for plasma amino acids in the course of pregnancy]. / Referenzwerte für Plasmaaminosäuren im Verlauf der Schwangerschaft.

Reference values for 26 plasma amino acids were determined by ion exchange chromatography in 29 healthy pregnant women (1st to 3rd trimenon). The results are given as P50 (P7-P93). In the course of pregnancy the concentrations of amino acids generally decrease. Threonine, however, shows a distinct, statistically significant increase. The interindividual concentration ranges are low and they show little change in the course of pregnancy. The data presented here are relevant for dietary treatment of metabolic disorders, e.g. maternal phenylketonuria in pregnants.

[Reference values for apolipoproteins and HDL-2/HDL-3 in childhood]. / Referenzwerte für Apolipoproteine und HDL-2/HDL-3 im Kindesalter.

It is known from epidemiological studies, that high apolipoprotein B or low HDL-2 concentrations in serum are correlated with an increased risk for premature cardiovascular diseases. It was the aim of this study to generate reference values for apolipoproteins and HDL-cholesterol fractions to accomplish early diagnosis and therapy. All concentrations are age depending, being low at birth and increasing during the first years of life. This rise is more pronounced in apolipoprotein B than in apolipoprotein AI and HDL-2. Apolipoprotein II and HDL-3 reach later childhood values as early as at the end of the first month of life. The ratio of B and AI, which is a very good indicator for an increased risk for premature cardiovascular diseases, moves also distinctively upward during the first year of life.

[Sodium and potassium metabolism in infancy]. / Natrium- und Kaliumbilanzen im Säuglingsalter.

BACKGROUND: Recommendations for the concentration of most nutrients in infant formulas are based on their concentration in human milk. Industry succeeded in adapting sodium and potassium content in infant formulas to concentration found in human milk. Whether this adaptation affects on infants' mineral balances was studied in breast-fed and artificially-fed infants. METHODS: Sodium and potassium balances were performed in 16 term male infants from their 3rd until their 17th week of life. The balances were performed at home and comprised up to five periods in intervals of three to four weeks. Each balance period consisted of subsequent three 24 h collections of milk, stool and urine samples. Ten infants were breast-fed, six received an adapted infant formula supplemented with copper, zinc and iron. RESULTS: The breast-fed infants got a mean intake of 1 mmol Na/kg b w x day and a mean intake of 1.8 mmol K/kg b w x day. Man retention was 0.4 mmol Na and 0.7 mmol K/kg b w x day. The formula-fed infants received 1.9 mmol Na/kg b w x day and 2.1 mmol K/kg b w x day. Na- and K-retention in this group was 0.5 and 0.6 mmol/kg b w x day respectively. Although sodium intake in the formula-fed infants was nearly twice as much as in the breast-fed infants the difference in sodium retention was only small (0.4 vs 0.5 mmol/kg b w x day). The formula-fed infants got more potassium than the breast-fed infants, but potassium retention was the same in both groups. CONCLUSIONS: With the adapted infant formula of this study the artificially fed infant was as well supplied with sodium and potassium as the breast-fed infant. A further reduction of the sodium concentration seems not to be useful.

Longitudinal zinc balances in breast-fed and formula-fed infants.

Longitudinal zinc (Zn) balance studies were performed under domestic conditions in term breast-fed (n = 10), term formula-fed (n = 5; Zn concentration in the formula: 4 mg/l) and preterm formula-fed (n = 3) infants during the first 17 weeks of life. Samples of milk, urine and feces were analyzed by atomic absorption spectrometry. The median daily Zn intake in breast-fed infants decreased from 0.592 (0.457-0.829) mg Zn/kg body weight to 0.151 (0.095-0.304) mg Zn/kg body weight in the first 17 weeks of life; comparable values for bottle-fed term infants were 0.58 (0.511-0.701) and 0.674 (0.529-0.731) mg Zn/kg body weight. The median percent retention of Zn intake was 27 (-60 to 81.4)% in breast-fed infants and 21.5 (-42 to 64)% in formula-fed infants. In view of the urinary and fecal Zn losses measured, a daily intake of 0.3-0.5 mg Zn/kg body weight is considered to be sufficient to ensure a Zn retention equivalent to breast-fed infants. This requires a Zn concentration of 2-3 mg/l of Zn depending on milk volume intake.