Influence of immunostimulant polysaccharides, nucleic acids, and Bacillus strains on the innate immune and acute stress response in turbots (Scophthalmus maximus) fed soy bean- and wheat-based diets.

Immunostimulants are widely applied in aquaculture practice and may have beneficial effects on the immune system and physical functions allowing higher tolerance to stress. In the current study, the impact of four (i-iv) dietary active ingredients on the immune and stress response of turbot was examined in two experiments (I and II). A basal low fish meal (FM; 32%) diet was formulated and supplemented with (i) yeast ß-glucan and mannan oligosaccharide (GM), (ii) alginic acid (AC), (iii) yeast nucleotides and RNA (NR), or (iv) Bacillus strains (BS). The basal diet (C-LF) and a high FM (59%) control (C-HF) were maintained. All six diets were fed to juvenile turbots for 84 days in experiment I and for additional 28 days prior to experiment II. Immunological and hematological parameters were determined in experiment I. In experiment II, physical stress response to a typical short-term (<1 day) aquaculture handling procedure (combination of capture, netting/transfer, and crowding) was investigated. For this, turbot blood was sampled before and at 0.5, 1, 4, and 24 h post stress. Plasma lysozyme activity, neutrophil reactive oxygen species (ROS) production, and total plasma protein levels did not significantly differ between treatment groups; however, plasma cholesterol increased significantly in fish fed GM, AC, NR, and C-HF compared to C-LF (I). A significant increase in plasma glucose and triglyceride was observed in GM and NR treatments, while glucose levels were significantly higher in C-HF compared to C-LF. Moreover, the immunostimulant-supplemented diets exhibited significantly lower cortisol levels compared to controls C-LF (at 0.5 h) and C-HF (at 1 h) post stress, respectively (II). According to our findings, FM substitution did not modulate the innate immune response but was associated with reduced levels of cholesterol. Dietary immunostimulants were not effective enough to boost the immune response, but we believe they might be helpful to trigger metabolic advantages during stressful handling events on fish farms.

[Infection rate in open fractures adjusted for the degree of exposure]. / Incidencia de infección en fracturas expuestas ajustada al grado de exposición.

UNLABELLED: Every year 50,000 open fractures occur in Mexico; the complication rate is 20%, and infection is the number one complication. The infection rate at the global level is 3%. The infection rate reported in Mexico is 4.4% (1999) overall for open fractures, with infection rates ranging from 0.8 to 15.6% according to the degree of exposure; however, no updated data are available. METHODS: A retrospective, longitudinal, descriptive, observational study was designed, that included a total of 273 cases. The degree of exposure of the fracture was identified in patients based on the Hospital de Traumatologia Victorio de la Fuente Narváez classification of open fractures and their course within 12 months was assessed identifying the cases with infection. The infection rate was measured according to the degree of exposure of the fracture with univariate analysis, and the association of the variables of interest was established using a bivariate analysis with the chi2 statistical test. RESULTS: The infection rate of open fractures was 8.05%, regardless of the degree of exposure. The latter resulted in an infection rate ranging from 0 to 16.66%. CONCLUSIONS: According to the world literature, open fractures result in a high infection rate, with a lower infection rate for open fractures adjusted for the degree of exposure compared to reports of world series and prior national figures. The degree of exposure was statistically significant (p = 0.04) for the presence of infection, according to the Hospital de Traumatología Victorio de la Fuente Narváez classification of open fractures.

First results from EBW emission diagnostics on COMPASS.

COMPASS tokamak shots at low magnetic field feature overdense plasmas during the extended current flat-top phase. The first harmonic of the electron cyclotron emission is completely cutoff for O and X modes and so the emission caused by electron Bernstein waves (EBWs) propagating obliquely with respect to the magnetic field and undergoing so called EBW-X-O conversion process can be observed. We perform an angular scan of the EBW emission during a set of comparable shots in order to determine the optimum antenna direction. A weak dependence of the radiative temperature on the antenna angles indicates an influence of multiple reflections from the vessel wall. The low temperature at the mode conversion region is responsible for the collisional damping of EBW, which can explain several times lower measured radiative temperature than the electron temperature measured by the Thomson scattering system.

Eficacia de la suplementación con L-arginina sobre la respuesta a la quimioterapia neoadyuvante en pacientes con cáncer de mama / Efficacy of L-arginine supplementation on response to neoadjuvant chemotherapy in patients with breast cancer

Introducción El cáncer de mama ocupa el primer lugar en mortalidad por neoplasias en la mujer en México. La quimioterapia neoadyuvante ha reportado una eficacia de alrededor 70%; sin embargo, aquellas pacientes que no responden adecuadamente deben someterse a métodos coadyuvantes que afectan su calidad de vida. El óxido nítrico, brevemente, en concentraciones altas es capaz de tener efectos citotóxicos y tumoricidas, favoreciendo una respuesta adecuada al tratamiento antineoplásico. La L-arginina es precursor del óxido nítrico, por lo que la suplementación puede influir en la síntesis y, por tanto, en su concentración.ObjetivosEvaluar la eficacia de la suplementación de L-arginina sobre la respuesta al tratamiento con quimioterapia neoadyuvante.Materiales y métodosEnsayo clínico de asignación aleatoria que administró un suplemento de 30g de L-arginina en cada ciclo de quimioterapia neoadyuvante. Se determinó la concentración de nitritos antes y después de ingerir el suplemento, así como el tamaño tumoral antes de iniciar el tratamiento y una vez concluido el mismo. Se realizó una prueba chi-cuadrado para evaluar la asociación entre la suplementación y una respuesta adecuada al tratamiento; los nitritos plasmáticos fueron evaluados mediante pruebas t-student.ResultadosSe evaluaron 45 pacientes. Veintiuno tuvieron una respuesta adecuada al tratamiento oncológico; sin embargo, no se encontró una asociación significativa entre la suplementación y dicha respuesta. La concentración de nitritos plasmáticos aumentó de manera significativa (p<0,05) en el grupo que recibió el suplemento con L-arginina.Conclusiones(..) (AU)

Background Breast cancer is the first cause of mortality from malignant neoplasms among women in Mexico. Neoadjuvant chemotherapy has a reported efficacy of approximately 70%; however, patients with inadequate response must undergo additional coadjuvant methods that negatively affect their quality of life. High concentrations of nitric oxide have shown cytotoxic and tumoricidal effects, thus favoring an adequate response to antineoplastic treatment. L-arginine is a nitric oxide precursor and therefore supplementation with this substance can augment nitric oxide synthesis and consequently its plasma concentration.ObjectivesTo evaluate the efficacy of L-arginine supplementation in response to neoadjuvant chemotherapeutic treatment.Materials and methodsWe conducted a randomized clinical trial in which 30g of L-arginine was administered in each neoadjuvant chemotherapy cycle. Plasma nitrite concentrations were determined before and after supplementation, as well as tumoral size before the start of antineoplastic treatment and after its completion. A chi-square test was performed to evaluate the association between the supplementation and adequate treatment response; plasma nitrites were evaluated by performing Student's T-tests.ResultsForty-five patients were assessed, of whom 21 had an adequate response to antineoplastic treatment. No statistically significant association was found between supplementation and adequate response. Nitrite concentrations in plasma were significantly increased (p<0.05) in patients receiving the supplement than in those who receiving placebo.Conclusions(..) (AU)

[Impact of family support over food intake and depressive status in cervical cancer patients during hospitalization]. / Impacto del acompañamiento familiar sobre la ingestión de alimentos y el estado depresivo en pacientes con cáncer cervicouterino hospitalizadas.

INTRODUCTION: Uterine cervical cancer represents a public health problem in Mexico; the patients suffer physical and psychological stress leading to depression and weight loss. Eating with a relative has positive effects in food ingestion and depressive status in hospitalized patients. In our society, food is the closest way that family members have to bring care and to show affection to the patient that has less appetite as disease goes on. OBJECTIVE: To establish the relationship between presence of the family during the meals and depresion, food intake, and weight variation during hospitalization. METHODOLOGY: 106 women admitted to the Oncology Department at the General Hospital of Mexico with a diagnosis of CUCA clinical stage II and III were studied in order to improve their condition. Weight and height, diet by means of 24 hour recalls were assessed both at hospital admission and discharge, and Beck's depression inventory was applied; the frequency with which the relatives escorted the patient was recorded. RESULTS: Patients were classified in two groups according to the frequency of family escorting; it was found that 43 patients (40.6%) were accompanied, and 63 patients (59.4%) were not. We did not find significant differences in age and days of hospital stay between the groups (p > 0.05). The escorted patients had more foods available during hospitalization (p < 0.05). Energy consumption (kcal) in escorted patients was higher by 12.7% as compared to non-escorted patients. 76.7% of the escorted patients were depressed, as compared to 55% in the non-escorted group. Significant differences were found with regards to clinical status and presence of depression (p < 0.05) between the study groups. CONCLUSIONS: Family escorting does not have an influence on the amount of foods consumed during hospitalization or body weight variation; however, it does have an influence on the presence of depression.

Impacto del acompañamiento familiar sobre la ingestión de alimentos y el estado depresivo en pacientes con cáncer cervicouterino hospitalizadas / Impact of family support over food intake and depressive status in cervical cancer patients during hospitalization

Introducción: El cáncer cérvico uterino constituye un problema de salud pública en México; las pacientes sufren estrés físico y psicológico que conlleva a depresión y pérdida de peso. El comer acompañado tiene efectos positivos en la ingestión de alimentos y en el estado depresivo de pacientes hospitalizados. En nuestra sociedad, la comida es el medio más cercano que la familia tiene para ofrecer cuidados, afecto y ayuda a su ser querido que se manifiesta cada vez más inapetente conforme progresa la enfermedad. Objetivo: Establecer la relación entre la presencia familiar durante las comidas sobre el estado anímico, ingestión de alimentos, y cambio de peso durante la hospitalización. Metodología: Se estudiaron 106 mujeres que ingresaron a hospitalización del servicio de oncología del Hospital General de México, con diagnóstico de CaCu EC II y III a fin de mejorar condiciones. Se evaluó peso y talla, la dieta mediante recordatorios de 24 horas, al ingreso como al egreso y se aplicó la escala de depresión de Beck; se registró la frecuencia con la que los familiares acompañaron a la paciente durante las comidas. Resultados: Para su análisis se clasificaron en dos grupos de acuerdo al acompañamiento familiar; se encontró que 43 pacientes (40,6%) tenían compañía, y 63 pacientes (59,4%) se encontraron sin compañía. No se observaron diferencias significativas en la edad, y días de estancia entre los grupos (p > 0,05). Las pacientes acompañadas, contaron con una mayor disponibilidad de alimentos durante su hospitalización (p < 0,05). El consumo de energía (kcal) en las mujeres acompañadas fue mayor en un 12,7% en relación a las mujeres sin compañía. De las pacientes acompañadas, el 76,7% se encontraba deprimidas; del grupo sin compañía el 55%. Se encontraron diferencias significativas en el estadio clínico, y la presencia de depresión (p < 0,05) entre los grupos de estudio. Conclusiones: La presencia familiar no influye en la cantidad de alimentos que se ingieren durante la hospitalización y el cambio de peso corporal, sin embargo si influye en la presencia de depresión (AU)

Introduction: Uterine cervical cancer represents a public health problem in Mexico; the patients suffer physical and psychological stress leading to depression and weight loss. Eating with a relative has positive effects in food ingestion and depressive status in hospitalized patients. In our society, food is the closest way that family members have to bring care and to show affection to the patient that has less appetite as diseasegoes on. Objective: To establish the relationship between presence of the family during the meals and depresion, food intake, and weight variation during hospitalization. Methodology: 106 women admitted to the Oncology Department at the General Hospital of Mexico with a diagnosis of CUCA clinical stage II and III were studied in order to improve their condition. Weight and height, diet by means of 24 hour recalls were assessed both at hospital admission and discharge, and Beck's depression inventory was applied; the frequency with which the relatives escorted the patient was recorded. Results: Patients were classified in two groups according to the frequency of family escorting; it was found that 43 patients (40.6%) were accompanied, and 63 patients (59.4%) were not. We did not find significant differences in age and days of hospital stay between the groups (p > 0.05). The escorted patients had more foods available during hospitalization (p < 0.05). Energy consumption (kcal) in escorted patients was higher by 12.7% as compared to non-escorted patients. 76.7% of the escorted patients were depressed, as compared to 55% in the non-escorted group. Significant differences were found with regards to clinical status and presence of depression (p < 0.05) between the study groups. Conclusions: Family escorting does not have an influence on the amount of foods consumed during hospitalization or body weight variation; however, it does have an influence on the presence of depression (AU)

[Nutritional status in hospitalized patients in a public hospital in Mexico City]. / Estado nutricio en pacientes internados en un hospital público de la ciudad de México.

OBJECTIVE: To determine the frequency of malnutrition among hospitalized patients and to relate nutrition status with body mass index, fasting time, adequacy intake of protein and energy during hospitalization and length of stay. METHODS (STUDY POPULATION, SUBJECTS, INTERVENTION): We evaluated weight loss in the last 6 months prior to admission, body mass index (BMI), ideal and usual body weight percentages, days of hospitalization, energy and protein intake adequacy, fasting days and cause in hospitalized patients at different wards at Hospital General de Mexico. Patients were divided into groups according to their nutritional status (at risk/with malnutrition or normal) and data was assessed descriptively and comparatively by t-tests to determine mean differences. RESULTS: We assessed 561 hospitalized patients. We found different frequencies of malnutrition according to various indicators: 21.17% according to BMI, 38.07% and 19.57% by percentages of habitual and ideal weights--respectively-- and a weight loss in 69.57% of the patients. Mean daily energy intake was found to be of 1,061+/-432.7 kcal, while mean protein intake was 42.1 + 22.7 g, representing only the 69.4% and 54.9% of the energy and protein requirements. We found statically significant differences among malnourished and normal patients in relation to BMI (p < 0.001), length of stay (p < 0.05), energy adequacy (p < 0.001) and protein intake (p < 0.05). CONCLUSION: Malnutrition is common in hospitalized patients. An important factor in hospital malnutrition is the lack of compliance in the patient's requirements, preventing a fast recovery and increasing their length of stay. Thus, it is important to make changes and improvements in the institutional health system so that there is trained personnel in order to provide and adequate nutrition care attention to the critically ill patient, improving their condition and general prognosis.

Estado nutricio en pacientes internados en un hospital público de la ciudad de México / Nutritional status in hospitalized patients in a public hospital in Mexico city

Objetivo: Determinar la frecuencia de desnutrición en los pacientes hospitalizados y relacionarla a su índice de masa corporal, ayuno, consumo de alimentos durante la estancia -nivel energético y proteico- y a los días de hospitalización. Métodos (población de estudio, sujetos, intervención): Se evaluó la pérdida de peso en los últimos seis meses, el índice de masa corporal (IMC), los porcentajes de peso ideal y habitual, días de hospitalización, porcentaje de adecuación de alimento consumido (en kilocalorías y gramos de proteína), los días y razones del ayuno según fuera el caso en pacientes hospitalizados en diferentes servicios del Hospital General de México. Los pacientes se dividieron en grupos de acuerdo a su estado nutricio (con/en riesgo de desnutrición o normal) y se llevó a cabo un análisis descriptivo, así como diversas pruebas t para estimar la diferencia entre medias y comparar los dos grupos. Resultados: Se evaluaron 561 pacientes. Se observaron diferentes frecuencias de desnutrición de acuerdo a varios indicadores: 21,17% de acuerdo al IMC, 38,07% y 19,57% por porcentaje de peso habitual e ideal respectivamente y una pérdida de peso en 69,57% de los pacientes. El promedio de consumo de alimentos diario fue de 1.061 ± 432,7 kcal y 42,1 + 22,7 g de proteína; cubriéndose únicamente el 69,4% de energía requerida y el 54,9% de demandas proteicas. Se encontró una diferencia significativa entre los pacientes desnutridos y aquéllos con un estado nutricio adecuado en cuanto al IMC (p < 0,001), días de hospitalización (p < 0,05), porcentaje de adecuación energético (p < 0,001) y consumo proteico (p < 0,05). Conclusión: La desnutrición es común en pacientes hospitalizados. Un factor importante en la desnutrición hospitalaria es la falta de cobertura de los requerimientos energético-proteicos del paciente, impidiendo la pronta recuperación y prolongado su estancia hospitalaria. Es importante realizar cambios y mejoras en el sistema institucional de salud, de manera que exista personal capacitado y un suministro dietético adecuado al paciente en estado crítico, de manera que se contribuya a la atención y cuidado recibido, mejorando su condición y pronóstico general (AU)

Objective: To determine the frequency of malnutrition among hospitalized patients and to relate nutrition status with body mass index, fasting time, adequacy intake of protein and energy during hospitalization and length of stay. Methods (study population, subjects, intervention): We evaluated weight loss in the last 6 months prior to admission, body mass index (BMI), ideal and usual body weight percentages, days of hospitalization, energy and protein intake adequacy, fasting days and cause in hospitalized patients at different wards at Hospital General de Mexico. Patients were divided into groups according to their nutritional status (at risk/with malnutrition or normal) and data was assessed descriptively and comparatively by t-tests to determine mean differences. Results: We assessed 561 hospitalized patients. We found different frequencies of malnutrition according to various indicators: 21.17% according to BMI, 38.07% and 19.57% by percentages of habitual and ideal weights-respectively- and a weight loss in 69.57% of the patients. Mean daily energy intake was found to be of 1,061 ± 432.7 kcal, while mean protein intake was 42.1 + 22.7 g, representing only the 69.4% and 54.9% of the energy and protein requirements. We found statically significant differences among malnourished and normal patients in relation to BMI (p < 0.001), length of stay (p < 0.05), energy adequacy (p < 0.001) and protein intake (p < 0.05). Conclusion: Malnutrition is common in hospitalized patients. An important factor in hospital malnutrition is the lack of compliance in the patient's requirements, preventing a fast recovery and increasing their length of stay. Thus, it is important to make changes and improvements in the institutional health system so that there is trained personnel in order to provide and adequate nutrition care attention to the critically ill patient, improving their condition and general prognosis (AU)

[Effect of an intensive nutritional treatment in nutritional status of head and neck cancer patients in stages III and IV]. / Evaluación del impacto de un tratamiento nutricional intensivo sobre el estado nutricional de pacientes con cáncer de cabeza y cuello en estadio III y IV.

OBJECTIVE: Malnutrition and accelerated weight loss are frequent secondary diagnosis in patients with cancer. Head and neck cancer (H & N Cancer) affects nutritional status because of the tumor type and localization. The aim of the study was to assess the effect of an intensive nutritional treatment (INT) on nutritional status of H & N cancer patients, stages III and IV and to compare that with a historical control whose nutritional treatment was conventional (CT). METHODS: All patients were nutritionally assessed before oncological treatment started (anthropometrical, biochemical, and dietetically). A nutritional feeding plan according to their nutritional personal need was calculated. In case it was impossible to cover all the nutritional requirements orally, a feeding tube was placed. Nutritional follow up was performed each 21 days, during their oncological treatment in four occasions. The results obtained were compared with those obtained from the patients who received the CT that consisted only in nutritional counseling by the attending physician; the statistical test used was Mann Whitney U test. RESULTS: The INT was associated with maintenance of the nutritional status along their oncological treatment. The statistical significant parameters were: weight 55 to 47 kg in the CT group vs 59 a 58 kg in the INT group (p < 0.0001), and hemoglobin: from 13 to 11 g/dl in the CT group vs 14 to 13 g/dl in the INT group (p < 0.002) as the most important ones. In the rest of the data we can observe a clear tendency of increasing the nutrition parameters in patients the INT group, while in the CT group, they showed a persistent decrease. CONCLUSION: We concluded that patients who received the INT as part of their oncological treatment deteriorated less their nutritional status than those who received a CT.

Evaluación del impacto de un tratamiento nutricional intensivo sobre el estado nutricional de pacientes con cáncer de cabeza y cuello en estadio III y IV / Effect of an intensive nutritional treatment in nutritional status of head and neck cancer patients in stages III and IV

Objetivo: La desnutrición y la pérdida acelerada de pesoson frecuentes en pacientes con cáncer. El cáncer de cabeza y cuello (cáncer de C y C) afecta el estado nutricional por la localización y estirpe del tumor. El objetivo fue evaluar el efecto de un tratamiento nutricional intensivo (TNI) sobre el estado nutricional en pacientes con cáncer de C y C en estadiosavanzados y compararlos con un grupo control históricocuyo tratamiento nutricional fue el convencional (TC).Métodos: A todos los pacientes se les realizó una evaluación del estado nutricional al ingreso (antropométrica, bioquímica y dietética). Se calculó un plan de alimentación que cubriera su requerimiento individual. En caso de que no fuera posible cubrir sus requerimientos vía oral se colocó una sonda para alimentación enteral. La evaluación del estado nutricional se realizó durante el tratamiento oncológicocada 21 días (cuatro evaluaciones). Los resultados secompararon el grupo del TC (25 pacientes) que consistió en orientación alimentaria general. El análisis de resultados se llevó a cabo con la prueba no paramétrica U de Mann Whitney. Resultados: El TNI (28 pacientes) se asoció con el mantenimiento del estado nutricional a lo largo del tratamiento oncológico. Los indicadores significativos fueron: cambio de peso 55 a 47 kg en TC contra 59 a 58 kg en TNI (p < 0,0001) y hemoglobina de 13 a 11 g/dl en TC versus 14 a 13,0 g/dl en TNI (p < 0,002) como los más importantes. En el resto de los indicadores se observó una clara tendencia aumentar poco a poco a lo largo del estudio en el grupo del TNI, mientras que en el TC la disminución de los indicadores fue constante.Conclusión:Los pacientes que se reciben un TNI como parteintegral de su tratamiento oncológico deterioraron menos su estado nutricional que aquellos que recibieron el TC

Objective: Malnutrition and accelerated weight loss arefrequent secondary diagnosis in patients with cancer.Head and neck cancer (H & N Cancer) affects nutritionalstatus because of the tumor type and localization. Theaim of the study was to assess the effect of an intensivenutritional treatment (INT) on nutritional status of H &N cancer patients, stages III and IV and to compare thatwith a historical control whose nutritional treatment wasconventional (CT).Methods: All patients were nutritionally assessed before oncological treatment started (anthropometrical,biochemical, and dietetically). A nutritionalfeeding plan according to their nutritional personalneed was calculated. In case it was impossible to cover all the nutritional requirements orally, a feeding tube was placed. Nutritional follow up was performed each 21days, during their oncological treatment in four occasions. The results obtained were compared with thoseobtained from the patients who received the CT that consisted only in nutritional counseling by the attending physician; the statistical test used was Mann Whitney U test.Results: The INT was associated with maintenance of thenutritional status along their oncological treatment. Thestatistical significant parameters were: weight 55 to 47 kg in the CT group vs 59 a 58 kg in the INT group (p <0.0001), and hemoglobin: from 13 to 11 g/dl in the CTgroup vs 14 to 13 g/dl in the INT group (p < 0.002) as the most important ones. In the rest of the data we canobserve a clear tendency of increasing the nutrition parameters in patients the INT group, while in the CT group, they showed a persistent decrease. Conclusion: We concluded that patients who received the INT as part of their oncological treatment deteriorated less their nutritional status than those who received a CT

[An efficient example of a Swiss pre-hospital chain of survival: the state of Vaud model]. / La chaîne des secours: le modèle vaudois.

The state of Vaud model of the pre-hospital chain of survival is an example of an efficient way to deal with pre-hospital emergencies. It revolves around a centrally located dispatch center managing emergencies according to specific key words, allowing dispatchers to send out resources among which we find general practitioners, ambulances, physician staffed fast response cars or physician staffed helicopters and specific equipment. The Vaud pre-hospital chain of survival has been tailored according to geographical, demographical and political necessities. It undergoes constant reassessment and needs continuous adaptations to the ever changing demographics and epidemiology of pre-hospital medicine.

Discharges in the JET tokamak where the safety factor profile is identified as the critical factor for triggering internal transport barriers.

Joint European Torus discharges which demonstrate the critical role the safety factor profile, q, can play in the formation of internal transport barriers (ITB) are examined. In these discharges, the target parameters, including the E x B flows, were kept virtually the same, except for the q profile. In a discharge with a nonmonotonic q, an ITB was triggered whereas a discharge with monotone q made no such transition. Thus, there is strong evidence that the q profile was the critical factor for the triggering of an ITB. Possible interpretations of this finding are discussed.

Physicians' views of the relative importance of thirty medical innovations.

In response to a mail survey, 225 leading general internists provided their opinions of the relative importance to patients of thirty medical innovations. They also provided information about themselves and their practices. Their responses yielded a mean score and a variability score for each innovation. Mean scores were significantly higher for innovations in procedures than in medications and for innovations to treat cardiovascular disease than for those to treat other diseases. The rankings were similar across subgroups of respondents, but the evaluations of a few innovations were significantly related to physicians' age. The greatest variability in response was usually related to the physician's patient mix.

[Experiences with the STT (scapho-trapezio-trapezoid) arthrodesis. A retrospective evaluation]. / Erfahrungen mit der STT-Arthrodese. Eine retrospektive Auswertung.

From 1992 until 1998, 98 fusions of the scapho-trapezio-trapezoid joint on 97 patients were performed in our clinic. The indications were dissociation of the scapho-lunate joint (n = 32), necrosis of the lunate stage III/IV (Lichtman classification) (n = 39), and idiopathic arthrosis of the scapho-trapezio-trapezoid joint (n = 27). 87 patients with 88 procedures were reviewed after an average follow-up period of three years. The review included a clinical examination with determination of a traditional wrist-score and a DASH questionnaire, X-rays of the wrist and CT of the carpal bones. The results in the wristscore were on average 74 of maximal 100 points. The DASH-score was on average 29. The best results were in the group with arthrosis of the scapho-trapezio-trapezoid joint. The results in the groups with scapho-lunate dissociation and necrosis of the lunate were also good. The rate of non-union was within an acceptable level with 7.7%. In the examined group, five patients underwent fusion of the wrist for persisting pain after scapho-trapezio-trapezoid arthrodesis. The examination of the radiological investigations in the reviewed group demonstrated, that CT shows arthritic degeneration in patients where the conventional X-ray does not. In conclusion, scapho-trapezio-trapezoid arthrodesis is a valid therapeutic method in the above mentioned indications. However, the question how early arthritic degeneration will affect long-term results remains unanswered for the moment.

Background for studies on the treatment of male osteoporosis: state of the art.

Male osteoporosis represents an important, although long underestimated, public health problem. Both in men and in women aging is accompanied by continuous bone loss and by an exponential increase in the incidence of osteoporotic fracture, with a female to male incidence ratio of about 2 to 3 to 1 in the elderly for hip and vertebral fractures. Morbidity after osteoporotic fractures appears to be more serious and mortality more common in men than in women. To date, no single treatment has been proved to be effective and safe in published prospective studies. The present report, based on a systematic search of the literature on male osteoporosis, summarises the state of the art on the clinical consequences of male osteoporosis and its risk factors, in relation to the present state of knowledge about female osteoporosis. This constitutes the background for the design of rational clinical development strategies for therapeutic interventions in male osteoporosis. From this review of the literature it is apparent that notwithstanding the existing sex differences in pathophysiology of osteoporosis and the difference in age-specific incidence of osteoporotic fractures, there are also important similarities between osteoporosis in women and men. The higher incidence of fracture in women than in men results from quantitative differences in risk factors rather than from different risk factors. Even though there are sex differences in bone geometry, incidence of fracture seems to be similar in men and women for a same absolute areal bone mineral density. However, the lack of data on the changes in fracture rates in men resulting from pharmacological intervention, leading to changes in bone mineral density or bone turnover, remains the main limitation for extrapolation of established treatment outcomes from women to men.

The future of health economics.

This paper discusses health economics as a behavioral science and as input into health policy and health services research. I illustrate the dual role with data on publications and citations of two leading health economics journals and three leading American health economists. Five important and relatively new topics in economics are commended to health economists who focus on economics as a behavioral science. This is followed by suggestions for health economists in their role of providing input to health policy and health services research. I discuss the strengths and weaknesses of economics, the role of values, and the potential for interdisciplinary and multidisciplinary research. The fourth section presents reasons why I believe the strong demand for health economics will continue, and the paper concludes with a sermon addressed primarily to recent entrants to the field.

Health care for the elderly: how much? Who will pay for it?

Health care expenditures on the elderly tend to grow about 4 percent per year more rapidly than the gross domestic product (GDP). This could plunge the nation into a severe economic and social crisis within two decades. This paper describes recent growth in age/sex-specific health care utilization by the elderly and discusses the important role of technology in that growth. It also explores the potential for the elderly to pay for additional care through increases in work and savings. Efforts to "save Medicare" will prove to be "too little, too late" unless they are embedded in broader policy initiatives that slow the rate of growth of health care spending and/or increase the income of the elderly.