[Patient reported outcome measurements in orthopedics and trauma surgery : Chances and risks for statutory quality assurance]. / "Patient reported outcome measurements" in Orthopädie und Unfallchirurgie : Chancen und Risiken für die gesetzliche Qualitätssicherung.

The routine use of patient reported outcome measurements (PROMs) can support the orientation of healthcare systems towards the value and usefulness for patients. The collation of patient reported experience measurements (PREMs) is suitable for bringing transparency to the patient orientation of healthcare processes and the experience gained. Both PREM and PROM will become an integral component of the assessment of medical quality in Germany when the guidelines for data-supported quality assurance across institutions (DeQS-RL) come into force. By means of newly developed patient surveys per medical service area, they will be used as additional sources for the legally binding quality assurance. Although this gives more weight to the evaluation of the quality of treatment by patients, special features must be taken into account in the development and implementation for orthopedics and trauma surgery in order to avoid misinterpretation of the results and subsequent misguidance in the healthcare system.

Study of gelatin supplemented diet on amino acid homeostasis in the horse.

REASONS FOR PERFORMING STUDY: Gelatin supplementation is a common measure in an attempt to assist cartilage repair, but little scientific evidence exists to support its efficacy. OBJECTIVES: To investigate the effects of gelatin administration on post prandial homeostasis. METHODS: Twelve Standardbred horses (mean 404 kg bwt) were fed a hay-concentrate diet supplemented by soy bean meal and oil (control [C], n = 6) or with the addition of 60 g gelatin/day (G, n = 6). The horses were trained by an alternate order of interval and prolonged exercise every second day. The velocities of the treadmill corresponding to 2 and 10 mmol lactate/l blood were derived from lactate curves during a standardised exercise test at the start and middle of the 64 day training period. Blood samples for amino acid analysis were obtained weekly at rest (2 h post prandial). In the second part of the training period, a post prandial sampling was conducted on a day without exercise (prior feeding up to 8 h post prandial). Plasma free amino acids (AA) were determined by HPLC. RESULTS: The change from pre- to the training diet induced an increase in many AA during the total training period. At rest free glycine and proline in blood increased with gelatin supplementation during 7 days after the start of supplementation. The AA in plasma showed a post prandial curve with peak concentrations 2-3 h after feeding. Significant post prandial effects of gelatin intake were detectable for glycine, proline and arginine. CONCLUSIONS: The AA from gelatin are absorbed quickly and become available for AA metabolism. POTENTIAL RELEVANCE: It is evident that in the horse, gelatin influences the homeostasis of those amino acids required for cartilage synthesis. Further research is needed to elucidate the utilisation of those amino acids for the prevention or repair of cartilage damage.

[Telematics and quality. Implementation of a telematic platform in Hamburg]. / Telematik und Qualität. Einführung einer Telematikplattform in Hamburg.

Since the end of the year 2000 a group of interested people has been working on the subject of quality improvement in breast cancer. Within this framework the project "improvement of breast cancer treatment by telemedicine" was started. Based on a workflow analysis and interviews with patients as well as health professionals, it turned out that there are gaps and flaws in the communication process. These problems occurred between health professionals involved in the treatment of patients and between health professionals and patients as well. As a result a telemedicine network has been developed which is based on MPLS technology. Within this network a central communication unit facilitates optimization of the workflow for the treatment of breast cancer. It will also be possible to set up groups for integrated care. Currently the system is being evaluated in specific breast centres in Hamburg. As the net is based on a positive business plan, it can be foreseen that a broad implementation will follow.

Secretion pores in human endothelial cells during acute hypoxia.

Weibel-Palade bodies (WPB) are endothelial vesicles that store von Willebrand factor (vWF), involved in the early phase of hemostasis. In the present study we investigated the morphodynamics of single WPB plasma membrane fusion events upon hypoxic stimulation by using atomic force microscopy (AFM). Simultaneously, we measured vWF release from endothelial cells to functionally confirm WPB exocytosis. Exposing human endothelial cells to hypoxia (pO2 = 5 mm Hg) we found an acute (within minutes) release of vWF. Despite acute vWF release, potential cellular modulators of secretion, such as intracellular pH and cell volume, remained unchanged. We only detected a slight instantaneous increase of cytosolic Ca2+ concentration. Although overall cell morphology remained virtually unchanged, high resolution AFM images of hypoxic endothelial cells disclosed secretion pores, most likely the loci of WPB exocytosis on luminal plasma membrane. We conclude that short-term hypoxia barely alters overall cell morphology and intracellular milieu. However, at nanometer scale, hypoxia instantaneously switches the smooth luminal plasma membrane to a rough activated cell surface, covered with secretion pores that release vWF to the luminal cell surface.

Purification and characterization of the preprotein translocase of the outer mitochondrial membrane from Arabidopsis. Identification of multiple forms of TOM20.

The translocase of the outer mitochondrial membrane (TOM) complex is a preprotein translocase that mediates transport of nuclear-encoded mitochondrial proteins across the outer mitochondrial membrane. Here we report the purification of this protein complex from Arabidopsis. On blue-native gels the Arabidopsis TOM complex runs at 230 kD and can be dissected into subunits of 34, 23, 21, 8, 7, and 6 kD. The identity of four subunits could be determined by immunoblotting and/or direct protein sequencing. The 21- and the 23-kD subunits exhibit significant sequence homology to the TOM20 preprotein receptor from other organisms. Analysis by two-dimensional isoelectric focusing/Tricine sodium dodecyl sulfide-polyacrylamide gel electrophoresis revealed the presence of further forms for Arabidopsis TOM20. All TOM20 proteins comprise a large cytoplasmically exposed hydrophilic domain, which is degraded upon trypsination of intact mitochondria. Clones encoding four different forms of Arabidopsis TOM20 were identified and sequenced. The deduced amino acid sequences are rather conserved in the N-terminal half and in the very C-terminal part, but include a highly variable glycine-rich region close to the C terminus. Implications on the function of plant TOM complexes are discussed. Based on peptide and nucleic acid sequence data, the primary structure for Arabidopsis TOM40 is presented.

Mucin and phospholipids determine viscosity of gallbladder bile in patients with gallstones.

AIM: An increased viscosity of gallbladder bile has been considered an important factor in the pathogenesis of gallstone disease. Besides lipids and proteins, mucin has been suggested to affect the viscosity of bile. To further clarify these issues we compared mucin, protein and the lipid componEnts of hepatic and gallbladder bile and its viscosity in patients with gallstones. METHODS: Viscosity of bile (mPa.s) was measured using rotation viscosimetry in regard to the non Newtonian property of bile at low shear rates. RESULTS: Biliary viscosity was markedly higher in gallbladder bile of patients with cholesterol (5.00 +/- 0.60 mPa.s, mean +/- SEM, r= 28) and mixed stones (3.50 +/- 0.68 mPa.s; r= 8) compared to hepatic bile (0.92 +/- 0.06 mPa.s, r= 6). A positive correlation between mucin and viscosity was found in gallbladder biles (r = 0.65; P < 0.001) but not in hepatic biles. The addition of physiologic and supraphysiologic amounts of mucin to gallbladder bile resulted in a dose dependent non linear increase of its viscosity. A positive correlation was determined between phospholipid concentration and viscosity (r = 0.34, P < 0.005) in gallbladder biles. However, no correlation was found between total protein or the other lipid concentrations and viscosity in both gallbladder and hepatic biles. CONCLUSION: The viscosity of gallbladder bile is markedly higher than that of hepatic bile in patients with gallstones. The concentration of mucin is the major determinant of biliary viscosity and may contribute by this mechanism to the role of mucin in the pathogenesis of gallstones.

Indomethacin decreases viscosity of gallbladder bile in patients with cholesterol gallstone disease.

There is experimental evidence that inhibition of cyclooxygenase with nonsteroidal anti-inflammatory drugs may decrease cholesterol gallstone formation and mitigate biliary pain in gallstone patients. The mechanisms by which NSAIDs exert these effect are unclear. In a prospective, controlled clinical trial we examined the effects of oral indomethacin on the composition of human gallbladder bile. The study included 28 patients with symptomatic cholesterol or mixed gallstones. Of these, 8 were treated with 3 x 25 mg indomethacin daily for 7 days prior to elective cholecystectomy while 20 received no treatment and served as controls. Bile and tissue samples from the gallbladder were obtained during cholecystectomy. Indomethacin tissue levels in the gallbladder mucosa, as assessed by HPLC, were 1.05 +/- 0.4 ng/mg wet weight, a concentration known to inhibit effectively cyclooxygenase activity. Nevertheless, no differences between the treated and untreated groups were found in the concentrations of biliary mucus glycoprotein (0.94 +/- 0.27 versus 0.93 +/- 0.32 mg/ml) or total protein (5.8 +/- 0.9 versus 6.4 +/- 1.3 mg/ml), cholesterol saturation (1.3 +/- 0.2 versus 1.5 +/- 0.2), or nucleation time (2.0 +/- 3.0 versus 1.5 +/- 2.0 days). However, biliary viscosity, measured using a low-shear rotation viscosimeter, was significantly lower in patients receiving indomethacin treatment (2.9 +/- 0.6 versus 5.6 +/- 1.2 mPa.s; P < 0.02). In conclusion, in man oral indomethacin decreases bile viscosity without alteration of bile lithogenicity or biliary mucus glycoprotein content.(ABSTRACT TRUNCATED AT 250 WORDS)