[Costs of the influenza pandemic for the public health services - calculations based on the model of the metropolitan region Frankfurt am Main]. / Inkrementelle Kosten der A/H1N1-Pandemie für den Öffentlichen Gesundheitsdienst - Berechnungen am Beispiel der Metropole Frankfurt am Main.

The influenza pandemic of 2009 has been the biggest challenge to the public health services in post-war Germany. This study investigates the impact on the overall costs for the public health authorities of the metropolitan region Frankfurt am Main which arose in the context of the pandemic as well as the specific costs of the implementation and realisation of the vaccination campaign during the pandemic. In 2009 the incremental costs for the Health Protection Authority of the City of Frankfurt am Main for the prevention and logistics caused by this pandemic amounted to € 223,537.91, whereas costs which could be directly attributed to the vaccination campaign (vaccine not included amounted to only a fraction thereof (€â€Š45,401.48). The per-capita costs for vaccinated citizens were €â€Š10.66.  These results clearly demonstrate the importance of adequate financial resources for the public health authorities to cope with infectious disease outbreaks and future pandemics.

Secondary transmissions during the outbreak of Shiga toxin-producing Escherichia coli O104 in Hesse, Germany, 2011.

During the recent outbreak of Shiga toxin-producing Escherichia coli (STEC) O104:H4 in Germany most cases notified in the State of Hesse (6 million inhabitants) were linked to satellite clusters or had travelled to the outbreak area in northern Germany. Intensified surveillance was introduced to rapidly identify cases not linked to known clusters or cases and thus to obtain timely information on possible further contaminated vehicles distributed in Hesse, as well to describe the risk of secondary transmission among known cases. As of 2 August 2011* [corrected], 56 cases of haemolytic uraemic syndrome (HUS) including two fatal cases, and 124 cases of STEC gastroenteritis meeting the national case definitions have been reported in Hesse. Among the 55 HUS and 81 STEC gastroenteritis cases thatmet the outbreak case definition, one HUS case and eight STEC gastroenteritis cases may have acquired their infection through secondary transmission. They include six possible transmissions within the family, two possible nosocomial and one possible laboratory transmission. Our results do not suggest an increased transmissibility of the outbreak strain compared to what is already known about E. coli O157 and other STEC serotypes.

[Management of the influenza pandemic on a local health authority level]. / Management der Influenzapandemie auf kommunaler Ebene.

In most cities and districts, the influenza pandemic of 2009 could be handled without any restrictions in providing medical care or any disturbance in public life. Despite its relatively mild course, the local public health services reached their limits of capacity. Based on nationwide regulations, the local management determines the success of the measures. Evaluating the experience on the community level offers the chance of facing future pandemics more efficiently. Press conferences, press releases, and the internet are the most reliable tools to inform the public even in terms of personnel expenses. Telephone conferences and internet platforms help to reduce time-consuming meetings. An electronic database and logbook provide up-to-date information for all parties involved and allow quick, rational, coordinated, and transparent decision-making. Local evaluation of registration data, reports on cases of illness, and the availability of hospital beds on a daily basis allow intervention at an early stage to cope with the pandemic efficiently and helps save resources. Recruitment of external personnel, e.g., for the call center and the vaccination campaign, relieves the public health employees in charge with respect to their main tasks of directing and management functions.

How are women with SUI-symptoms treated with duloxetine in real life practice? - preliminary results from a large observational study in Germany.

BACKGROUND: Duloxetine was found safe and effective in the treatment of moderate to severe female stress urinary incontinence (SUI) in controlled clinical trials; complementary data from routine clinical practice are still wanted. OBJECTIVES: To explore the use of various initial duloxetine doses by physicians in the treatment of female SUI in routine clinical practice and its implications on drug safety and patients' subjective impression of effectiveness. METHODS: Adult women treated with duloxetine for SUI symptoms were documented as part of an ongoing large-scale observational study in Germany. Data collected at baseline, after 4 and 12 weeks, were evaluated by initial doses. Statistics were descriptive, 95% confidence intervals were calculated for adverse event (AE) rates. RESULTS: A total of 7888 adult women were treated with duloxetine; their mean age was 61.4 years, body mass index 27 kg/m(2), incontinence episode frequency (IEF) 14.0 per week. Previous SUI treatments were observed in 52.2%, comorbidities in 60.4% of the patients. A total of 90.7% reported reduced frequency of SUI-episodes, 12.1% any AE; nausea (5.7%) and vertigo (1.6%) were reported most frequently. In all, 52.2% of patients were initiated on a duloxetine dose of 40 mg/day. Only minor differences in patient characteristics, effectiveness and tolerability were associated with varying initial duloxetine doses. CONCLUSIONS: Many women received lower duloxetine doses than expected based on evidence-based dosing recommendations. Although SUI patients in this study had a higher health risk because of old age and multiple comorbidities than in previous controlled clinical trials, AE rates were lower, possibly because of the observational character of the study and/or the use of rather low doses. Similar AE rates for varying initial doses possibly reflect sensible dose-adjustment to individual needs.

[New surgical treatment procedures in fractures of the distal tibia (LCP, MIPO)]. / Neue Stabilisierungsverfahren bei distalen Tibiafrakturen (LCP, MIPO).

All along the operative treatment of distal tibial fractures is a difficult procedure. In most cases the clinical situation is characterized by small distal fragments in combination with crucial soft-tissue conditions. That's why complications as primary or secondary displacements, mal unions, delayed or non unions and as well as a high rate of deep wound infection are often seen. Thus internal fixations with traditional implants (standard screws and plates) could consider inevitable this crucial biology and biomechanics only insufficiently. The nowadays available internal fixators with optional angular-stable screws expand the possibilities of internal fixation in these severe situations. Their minimal invasive application (MIPO, Minimally Invasive Plate Osteosynthesis) takes care of the soft tissue and reduces the surgical trauma furthermore. With the variety of their possible applications (combination of angular stability with standard application) also the demands increase, however, both onto the surgeons, but also onto the general practitioners in the aftercare. The combination of most different tactics in one implant results in the consequence, that at the same bone simultaneously direct and indirect bone healing will be expected. The radiological differentiation between desired and unwanted healing processes becomes thus difficult. Pre- and perioperative procedures require from the trauma surgeon a huge infrastructure and a high measure of biomechanical and biological experience. In the postoperative management of these injuries an unlimited cooperation between traumatologists and general practitioners is indispensable for a further successful course.

VE-cadherin antibody accelerates neutrophil recruitment in vivo.

Neutrophils enter sites of inflammation by crossing the endothelial lining of the blood vessel wall. VE-cadherin is an endothelial specific, homophilic adhesion molecule located at the lateral cell surface. We have generated a monoclonal antibody against mouse VE-cadherin which inhibits electrical resistance of endothelial cell monolayers in vitro as well as aggregation of VE-cadherin transfected cells. In vivo, this antibody was found to increase vascular permeability and to accelerate the entry of neutrophils into chemically inflamed mouse peritoneum. Thus, VE-cadherin is essential for the integrity of the endothelial barrier in vivo. Our data suggest that opening of VE-cadherin mediated endothelial cell contacts may be a relevant step during neutrophil extravasation.

Molecular cloning and expression of murine vascular endothelial-cadherin in early stage development of cardiovascular system.

An early step in the formation of the extraembryonic and intraembryonic vasculature is endothelial cell differentiation and organization in blood islands and vascular structures. This involves the expression and function of specific adhesive molecules at cell-to-cell junctions. Previous work showed that endothelial cells express a cell-specific cadherin (vascular endothelial [VE]-cadherin, or 7B4/cadherin-5) that is organized at cell-to-cell contacts in cultured cells and is able to promote intercellular adhesion. In this study, we investigated whether VE-cadherin could be involved in early cardiovascular development in the mouse embryo. We first cloned and sequenced the mouse VE-cadherin cDNA. At the protein level, murine VE-cadherin presented 75% identity (90%, considering conservative amino acid substitutions) with the human homologue. Transfection of murine VE-cadherin cDNA in L cells induced Ca(++)-dependent cell-to-cell aggregation and reduced cell detachment from monolayers. In situ hybridization of adult tissues showed that the murine molecule is specifically expressed by endothelial cells. In mouse embryos, VE-cadherin transcripts were detected at the very earliest stages of vascular development (E7.5) in mesodermal cells of the yolk sac mesenchyme. At E9.5, expression of VE-cadherin was restricted to the peripheral cell layer of blood islands that gives rise to endothelial cells. Hematopoietic cells in the center of blood islands were not labeled. At later embryonic stages, VE-cadherin transcripts were detected in vascular structures of all organs examined, eg, in the ventricle of the heart, the inner cell lining of the atrium and the dorsal aorta, in intersomitic vessels, and in the capillaries of the developing brain. A comparison with flk-1 expression during brain angiogenesis revealed that brain capillaries expressed relatively low amounts of VE-cadherin. In the adult brain, the level of VE-cadherin transcript was further reduced. By immunohistochemistry, murine VE-cadherin protein was detected at cell-to-cell junctions of endothelial cells. Overall, these data demonstrate that VE-cadherin is an early, constitutive, and specific marker of endothelial cells. This distinguishes this molecule from other cadherins and suggests that its expression is associated with the early assembly of vascular structures.

Expression of P-selectin on endothelial cells is upregulated by LPS and TNF-alpha in vivo.

P-selectin is an endothelial cell adhesion molecule which mediates the binding of neutrophils and monocytes. Its appearance at the cell surface can be induced within minutes by histamine and thrombin which rapidly stimulate the transport of P-selectin from intracellular storage granules to the plasma membrane. We have recently found a second regulation mechanism for P-selectin on mouse endothelioma cells. Like E-selectin, P-selectin is also regulated at the level of transcription. Both selectins are induced by LPS or TNF-alpha with a maximal expression level at the cell surface 3-4 h after stimulation. Here, we report that this up-regulation of the synthesis of P-selectin also occurs in vivo in endothelium of the mouse. Analysing brain tissue, which is devoid of constitutive expression of P-selectin, we found that LPS and also TNF-alpha strongly induce the expression of P-selectin on all venular endothelial cells of the leptomeninges and, at a weaker level, on some blood vessels of the brain parenchyma. Induction of P-selectin expression could also be observed in tissues, such as the tongue, where P-selectin is constitutively expressed on small venules but only rarely on larger venules. Strong staining for P-selectin on endothelium of all large venules was observed in tissues of LPS and TNF-alpha treated animals and staining for this newly synthesized P-selectin was enriched at the luminal surface of these cells.(ABSTRACT TRUNCATED AT 250 WORDS)