[Case numbers and revenues of main and affiliated ophthalmological departments: Developments since 2005]. / Fallzahlen und Erlöse in ophthalmologischen Haupt- und Belegabteilungen : Entwicklungen seit 2005.

BACKGROUND: Currently, very little data exist on the development of healthcare-related and financial parameters of both types of inpatient treatment: clinical units run by affiliated physicians and those run by hospital physicians. AIM: This study used a methodology based on published secondary data to estimate the annual number of cases and revenues for in inpatient ophthalmological treatment differentiated into clinical units run by affiliated physicians and those run by hospital physicians. MATERIAL AND METHODS: The case-based flat-rate catalogs and accompanying research data published annually by the Institute for the Hospital Remuneration System (Institut für Entgeltsysteme im Krankenhaus, InEK) served as a data source. The numbers of annual cases according to major diagnostic categories (MDC) and diagnosis-related groups (DRG), stratified by the unit type are reported for the period 2005-2012. The cumulative total revenues were calculated based on the number of ophthalmological cases, the effective DRG cost weighting, the length of stay and the national basic case values. RESULTS: Between 2005 and 2012 the units run by affiliated physicians showed a contrasting trend to those run by hospital physicians: the number of cases in units run by hospital physicians increased by 14 %, while those in units run by affiliated physicians decreased by 6 %. Up to 2012 the effective cost weighting for cases in units run by hospital physicians decreased to 0.60 (- 3 %) and increased to 0.43 (+ 5 %) for units run by affiliated physicians. In 2012 the corresponding effective case revenue accounted for 1767 euros and 1271 euros, respectively. Total revenue estimates for all inpatient ophthalmological treatment increased from 549 million euros in 2005 to 630 million euros in 2012, while the share of units run by affiliated physicians amounted to 10.6 % and 9.7 %, respectively. CONCLUSION: According to the indicators "number of cases" and "total revenue", the affiliated ophthalmologists lost ground compared with inpatient units run by hospital physicians over the period from 2005-2012.

Results of a long-term training program after acute myocardial infarction.

BACKGROUND: It is not well known what should be the benefits of a prolonged physical rehabilitation program after an acute myocardial infarction. METHODS: Our study is an open, randomized comparison of a long-term versus a standard rehabilitation program. Sixty-seven patients with acute myocardial infarction were included in an outpatient physical rehabilitation program of 6-8 weeks. Of these, 22 randomly selected patients continued the program until the 36th month (Group A). Twenty-five of the others were rechecked after 36 months, and represented the controls (Group B). For both groups, at the end of this period, a cycloergometer exercise test evaluated the exercise capacity of subjects and an echocardiogram was performed to determine left ventricular systolic and diastolic function. RESULTS: The maximal exercise capacity increased from 147 +/- 13.8 W to 178 +/- 16.4 W in Group A (p < 0.01), but it decreased from 144 +/- 13.2 to 132 +/- 12.8 W in group B. Functional aerobic impairment decreased from 29 +/- 2.7% to 22 +/- 2.1% in Group A, but it increased from 26 +/- 2.5% to 37 +/- 3.8% in Group B. The ejection fraction and diastolic function parameters were not significantly modified during the 36 months, for both groups. CONCLUSION: Long-term physical rehabilitation is useful in patients after an acute myocardial infarction to increase effort capacity, but left ventricular performance is not significantly changed.

Prodromal angina reduces infarcted mass less in interventionally reperfused than in thrombolysed myocardial infarction.

UNLABELLED: There is a lot of evidence that angina during the 24-48 h before a reperfused myocardial infarction improves the evolution of the patients. However, there are studies that failed to demonstrate this protective effect of preinfarction angina in an interventional reperfusion setting. OBJECTIVE: To compare the effect of preinfarction angina (PIA) on inhospital evolution of thrombolysis vs. interventionally reperfused acute myocardial infarction (AMI). MATERIAL AND METHOD: There were prospectively studied 133 consecutive AMI patients, eligible for reperfusion (thrombolysis or interventional). History of PIA under 48 hours was obtained. Evolution of AMI was evaluated considering the following end-points: the ratio between the number of ECG leads with final pathologic Q wave and the number of leads with initial ST elevation, CK-MB values, separate and composite incidence of death, heart failure, shock and incidence of serious arrhythmia (sustained VT or ventricular fibrillation). RESULTS: ECG ratio was lower in patients with PIA (0.511 +/- 0.281 vs. 0.646 +/- 0.274, p=0.02) in thrombolysed patients, but it was higher in interventionally reperfused patients (0.740 +/- 0.418 vs. 0.554 +/- 0.295 p=0.11). CK-MB values were lowered by PIA in thrombolysed AMI (122 +/- 74 vs. 190 +/- 89, p=0.0003), but they were not in the interventional group. Clinical end-points were slightly less frequent in patients with PIA, in both reperfusion groups, but not statistically significant. Major arrhythmia occurred less frequently in interventionally reperfused patients with PIA (9.5% vs. 31.6%, p=0.12). CONCLUSION: Preinfarction angina under 48 hours significantly reduces infarcted mass (measured by ECG and enzymes) in thrombolysed patients, but not in the interventional group. However, PIA reduced arrhythmic end-point in interventional setting.

The rehabilitation/school matrix: a model for accommodating the noncompliant child with severe burns.

Some children with severe burns may have difficulty following therapeutic recommendations after discharge from a burn center. Noncompliance may result in complications that affect function, surgical management, community reintegration, and successful reentry into school. We present a case study in which a child with significant compliance issues was managed in a coordinated interdisciplinary model. This model extended from acute recovery through reintegration into the classroom. A behavior-modification program was implemented across different levels of care. Educational reentry was facilitated by including a transitional period in a special-needs classroom in a freestanding special-needs school. Requirements for using educational resources to which some children are legally entitled are reviewed. Rehabilitation services that interface with the educational system for children with burns may improve outcomes as these children reintegrate into the community.

Ischemic preconditioning by repeated exercise tests involves nitric oxide up-regulation.

BACKGROUND: Animal studies show that nitric oxide is involved in delayed ischaemic preconditioning. OBJECTIVES: To determine whether plasma nitrates/nitrites (NOx-, as measure of nitric oxide) are modified by two consecutive effort tests and whether these changes translate into clinical improvement. METHODS: There were studied 22 patients with ischemic heart disease, who performed two effort tests at 24-hour interval. Plasma NOx- level was determined and compared before and after both stress tests. Peak effort, double product at peak effort and maximal ST segment depression were considered clinical end-points and were compared between the two tests. RESULTS: Plasma NOx- increased slightly after the first exercise test compared to pre-test value (17.05 +/- 1.6 vs. 15.38 +/- 1.4 micromol/ml). In turn, after the second test a significant rise of NOx- level (23.65 +/- 2.2 vs. 15.10 +/- 1.3 micromol/ml, p < 0.03) was noticed. The pre-test value was practically identical between the two tests. Peak effort and double product at peak effort remained unchanged between the two tests. Although the ischaemic stress was the same, ST depression was significantly lower (p < 0.01) at the second test (0.85 +/- 0.06 vs. 1.73 +/- 0.16 mm). CONCLUSION: Our study shows an increase of plasma NOx- level after the second of two consecutive exercise stress tests at 24 hour interval, along with a decrease of electrocardiographic consequences of approximately the same ischemic stress. These findings are consistent with experimental data in animals, which point to nitric oxide as both trigger and effector of ischaemic preconditioning.

Peroxynitrite causes endothelial cell monolayer barrier dysfunction.

Nitric oxide (.NO) attenuates hydrogen peroxide (H(2)O(2))-mediated barrier dysfunction in cultured porcine pulmonary artery endothelial cells (PAEC) (Gupta MP, Ober MD, Patterson C, Al-Hassani M, Natarajan V, and Hart, CM. Am J Physiol Lung Cell Mol Physiol 280: L116-L126, 2001). However,.NO rapidly combines with superoxide (O) to form the powerful oxidant peroxynitrite (ONOO(-)), which we hypothesized would cause PAEC monolayer barrier dysfunction. To test this hypothesis, we treated PAEC with ONOO(-) (500 microM) or 3-morpholinosydnonimine hydrochloride (SIN-1; 1-500 microM). SIN-1-mediated ONOO(-) formation was confirmed by monitoring the oxidation of dihydrorhodamine 123 to rhodamine. Both ONOO(-) and SIN-1 increased albumin clearance (P < 0.05) in the absence of cytotoxicity and altered the architecture of the cytoskeletal proteins actin and beta-catenin as detected by immunofluorescent confocal imaging. ONOO(-)-induced barrier dysfunction was partially reversible and was attenuated by cysteine. Both ONOO(-) and SIN-1 nitrated tyrosine residues, including those on beta-catenin and actin, and oxidized proteins in PAEC. The introduction of actin treated with ONOO(-) into PAEC monolayers via liposomes also resulted in barrier dysfunction. These results indicate that ONOO(-) directly alters endothelial cytoskeletal proteins, leading to barrier dysfunction.

Nitric oxide attenuates H(2)O(2)-induced endothelial barrier dysfunction: mechanisms of protection.

Nitric oxide (.NO) attenuates hydrogen peroxide (H(2)O(2))-mediated injury in porcine pulmonary artery endothelial cells (PAECs) and modulates intracellular levels of cGMP and cAMP. We hypothesized that.NO attenuates H(2)O(2)-induced PAEC monolayer barrier dysfunction through cyclic nucleotide-dependent signaling mechanisms. To examine this hypothesis, cultured PAEC monolayers were treated with H(2)O(2), and barrier function was measured as transmonolayer albumin clearance. H(2)O(2) caused significant PAEC barrier dysfunction that was attenuated by intracellular as well as extracellular.NO generation.NO increased PAEC cGMP and cAMP levels, but treatment with inhibitors of soluble guanylate cyclase or protein kinase G did not abrogate.NO-mediated barrier protection. In contrast, H(2)O(2) decreased protein kinase A activity, and inhibiting protein kinase A abrogated the protective effect of.NO. H(2)O(2)-induced barrier dysfunction was not associated with decreased levels of cGMP or cAMP. 3-Isobutyl-1-methylxanthine and the cGMP analog 8-bromo-cGMP had little effect on H(2)O(2)-mediated endothelial barrier dysfunction, whereas 8-bromo-cAMP plus 3-isobutyl-1-methylxanthine was protective. These results indicate that.NO modulates vascular endothelial barrier function through cAMP-dependent signaling mechanisms.

Posterior capsular opacification in phacotrabeculectomy : a long-term comparative study of silicone versus acrylic intraocular lens.

PURPOSE: To investigate the long-term outcomes of silicone versus acrylic intraocular lens (IOL) implantation in phacotrabeculectomy (PT) with special emphasis on posterior capsular opacification. DESIGN: Long-term follow-up on prior 1-year prospective, randomized study. PARTICIPANTS: A total of 200 eyes of 200 consecutive primary open-angle glaucoma patients who had undergone primary PT with capsular bag implantation of either a silicone IOL (102 eyes) or an acrylic IOL (98 eyes) according to the initial short-term prospective, randomized study protocol. INTERVENTION: The study eyes underwent primary trabeculectomy, phacoemulsification, and posterior chamber IOL implantation. Adjunctive mitomycin C was used selectively, primarily in patients with one or more risk factors for filtration failure. MAIN OUTCOME MEASURES: Incidence of posterior capsular opacification (PCO), best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of pressure-lowering medications, and filtration success rates, defined as maintenance of target IOP while on one (criteria 1) or zero (criteria 2) pressure-lowering medications without further surgical intervention. RESULTS: At 3-year follow-up, the PCO rate and BCVA did not differ significantly between the two groups (P: > 0.05 for both). In addition, there were no significant differences in IOP, number of medications, and filtration success rate between the two groups (P: > 0.05 for each). CONCLUSIONS: There were no significant long-term differences between the silicone and acrylic IOL groups in PCO, BCVA, IOP, number of medications, and success of filtration surgery after PT. Both groups attained significant improvement in BCVA and IOP control after surgery.

Structure and evolution of the alternatively spliced fast troponin T isoform gene.

The vertebrate fast skeletal muscle troponin T gene, TnTf, produces a complexity of isoforms through differential mRNA splicing. The mechanisms that regulate splicing and the physiological significance of TnTf isoforms are poorly understood. To investigate these questions, we have determined the complete sequence structure of the quail TnTf gene, and we have characterized the developmental expression of alternatively spliced TnTf mRNAs in quail embryonic muscles. We report the following: 1) the quail TnTf gene is significantly larger than the rat TnTf gene and has 8 non-homologous exons, including a pectoral muscle-specific set of alternatively spliced exons; 2) specific sequences are implicated in regulated exon splicing; 3) a 900-base pair sequence element, composed primarily of intron sequence flanking the pectoral muscle-specific exons, is tandemly repeated 4 times and once partially, providing direct evidence that the pectoral-specific TnT exon domain arose by intragenic duplications; 4) a chicken repeat 1 retrotransposon element resides upstream of this repeated intronic/pectoral exon sequence domain and is implicated in transposition of this element into an ancestral genome; and 5) a large set of novel isoforms, produced by regulated exon splicing, is expressed in quail muscles, providing insights into the developmental regulation, physiological function, and evolution of the vertebrate TnTf isoforms.

Attenuation of oxidant-mediated endothelial cell injury with docosahexaenoic acid: the role of intracellular iron.

Previous studies have demonstrated that altering the fatty acid composition of porcine pulmonary artery endothelial cells (PAEC) significantly modulates their susceptibility to oxidative stimuli, e.g. H2O2. Based on observations that fatty acids also function to transport iron, an important catalyst for H2O2-mediated hydroxyl radical generation, we hypothesized that fatty acid-induced alterations in PAEC iron metabolism contribute to modulation of PAEC oxidant susceptibility. To test this hypothesis, PAEC were treated with culture medium supplemented with 0.1 mM oleic (18:1), linolenic (18:3) or docosahexaenoic (22:6) acids or with an equivalent volume of ethanol vehicle for 3 h. After thorough washing and incubation in unsupplemented culture medium for 24 h, PAEC monolayers were subjected to additional studies. Supplementation with 22:6 attenuated lactate dehydrogenase (LDH) release from PAEC 2 h following treatment with 100 microM H2O2 for 30 min (% LDH release: ETOH-control = 7.9 +/- 1.6, 22:6-control = 5.9 +/- 0.9, ETOH-H2O2 = 26.4 +/- 4.2, 22:6-H2O2* = 16.2 +/- 2.9; *P < 0.05 vs ETOH-H2O2). In a non-cellular system, 18:1 and 18:3 were more effective than their methyl ester derivatives or 22:6 at translocating iron from aqueous to hydrophobic environments. In contrast, only supplementation with 22:6 significantly increased PAEC uptake of 57Fe and human umbilical vein endothelial cell (HUVEC) ferritin content, whereas none of the supplementation conditions altered PAEC catalytic iron measured with bleomycin. These novel observations indicate that specific fatty acids are capable of altering PAEC iron uptake and ferritin content thereby contributing to the understanding of the mechanisms by which fatty acids modulate the oxidant susceptibility of vascular endothelial cells.

Anticipatory postural adjustments before load pickup in a bi-manual whole body lifting task.

Balance regulation and movement control were examined in the context of bi-manual lifting. Subjects picked up a load (20% body mass) after several unloaded cycles using the leg-lift technique. The addition of the load to the body caused the system center of mass to shift forward and thus presented the subject with an expected perturbation of balance. To examine whether the disturbances to balance were counteracted by anticipatory postural adjustments, the last cycle, in which the barbell was grasped and lifted, was compared with the preceding unloaded cycle. Using a global mechanical analysis of the movement, we found that anticipatory postural adjustments were present before load pickup in bi-manual lifting. These anticipatory postural adjustments were characterized by a backward directed horizontal momentum, a backward directed horizontal component of the ground reaction force accompanied with a forward shift of the center of pressure, and a backward shift of the center of mass (CoM). These characteristics could all be understood from the mechanical consideration that adding a load in front of the body induces a forward shift of the CoM. However, major compensations of the position of the CoM were also observed after bar grasp. It is therefore proposed that commands giving rise to postural adjustments are closely tied to commands controlling the ongoing movement. On the basis of this insight the strict dichotomy in the control of posture and movement is being questioned.

Optimizing the determination of the body center of mass.

The position or trajectory of the body center of mass (COM) is often a parameter of interest when studying posture or movement. For instance, in balance control studies the body COM can be related to the ground reaction force or to the base of support. Since small displacements of the body COM are important in balance control studies, it is essential to obtain valid estimates of the body COM. The main source of error in the determination of the body COM is the estimation of the masses and centers of mass of the body segments. Especially the determination of the trunk COM is prone to error. In the current study five subjects maintained three postures, differing in trunk angle, during a few seconds. The relation between the center of pressure of the ground reaction force and the vertical projection of the body COM during the postures was used to optimize the trunk COM position. Additionally the subjects performed two lifting movements. The validity of the body COM trajectory estimation during the lifting movements, both with and without optimized trunk COM, was checked by relating the external moment of the ground reaction force with respect to the body COM to the rate of change of the angular momentum of the whole body. It was shown that the correspondence between the external moment and the rate of change of the angular momentum improved after optimization of the trunk COM. This suggests that the body COM trajectory estimation can be improved by the proposed optimization procedure.

Controllable dual-wavelength operation of a femtosecond neodymium fiber laser.

Simultaneous asynchronous mode locking of two wavelengths in a Nd(3+)-doped fiber laser is reported. The laser operates simultaneously at wavelengths of 1.060 and 1.100 microm where carrier-type passive mode locking is employed for the shorter wavelength and Kerr-type passive mode locking is used for the longer wavelength. The difference between the two repetition rates may be varied over a range from several megahertz to 500 Hz, limited by the onset of pulse interactions at small difference frequencies.

[Respiratory symptoms and function of coal miners presenting radiological pulmonary abnormalities]. / Symptômes et fonction respiratoires des mineurs de charbon présentant des anomalies radiologiques pulmonaires.

Respiratory symptoms and lung function of 80 coal workers suspected of pneumoconiosis (pulmonary X-rays classified 0/1 or 1/0 according to International Labour Organisation classification) who worked for at least 10 years at face work (Ts) were studied in comparison with two control groups matched by age (+/- 2 years), height (+/- 5 cm), weight (+/- 10 kg) and smoking habits: the Tn group constituted by 80 coal workers who worked for at least 10 years at face work with normal pulmonary X-rays, and the HTn group constituted by 80 underground miners who worked mainly out of face work with normal pulmonary X-rays. The frequencies of cough, expectoration, chronic bronchitis or dyspnoea were significantly higher in Ts group than in the two others. The one-second forced expiratory volume to vital capacity ratio (FEV1/VC) was lower, closing volume to vital capacity (CV/VC) or to total lung capacity ratios (CV/TLC) were higher in Ts group than in the control groups. Unexpectedly, vital capacity (VC), one-second forced expiratory volume (FEV1), total lung capacity (TLC), compliance, diffusing capacity (DLCO) referred to alveolar volume (VA) were higher. In Ts group, the small rounded opacities were noted in the top part of the lung (56.9%), the irregular ones were distributed on the entire lung (65.5%). There were no relation between the category of small opacities and respiratory symptoms or lung function.

42-fs pulse generation from a mode-locked fiber laser started with a moving mirror.

Passive mode locking initiated with a moving mirror is demonstrated in a neodymium fiber laser for what is to our knowledge the first time. Near-bandwidth-limited pulses with a width of 42 fs and energies as high as 1 nJ are generated.

Regenerative Nd:glass amplifier seeded with a Nd:fiber laser.

Wavelength tuning and broad-bandwidth operation of a passively mode-locked Nd:fiber laser is demonstrated at 1060 microm. The oscillator pulses are used to seed a bulk regenerative Nd:glass amplifier, and 300-fs transformlimited pulses with an energy of 10 microJ are obtained after 31 round trips at a repetition rate of 500 Hz.