[Nebulization of emergency medications in the south German rescue service]. / Vernebelung von Notfallmedikamenten im süddeutschen Rettungsdienst.

BACKGROUND: In German emergency rescue services, inhalation treatment is routinely carried out by qualified health personnel. Standard operating procedures (SOP) for nebulization are neither uniform throughout Germany nor available in all federal states. Standardized recommendations with respect to which nebulizer type should be used are missing. The aerosol output as well as the drug deposition rates of jet and mesh nebulizers, however, differ considerably. Mesh devices can achieve a threefold higher lung deposition. Their use in emergency departments has also been shown to be associated with a better patient outcome when compared to jet nebulizers. OBJECTIVE: This survey was designed to evaluate the type of nebulizer used in the south German rescue services. Special attention was paid to the influence of existing SOP on the decision to perform nebulization during emergency treatment. MATERIAL AND METHODS: A total of 4800 emergency paramedics working in Baden-Württemberg, Bavaria and Rhineland-Palatinate received a questionnaire with a total of 17 questions on the implementation of drug nebulization in the daily practice. RESULTS: Despite the existence of more efficient nebulizer types, the jet nebulizer was by far the most frequently used nebulizer in the south German rescue services. The deposition rates of both the jet and mesh nebulizers were considerably overestimated by most respondents; however, 77.5% of all respondents could not give any information about the deposition rates of the mesh nebulizer. Only two thirds of all respondents carried out nebulization treatment on the basis of SOP. The implementation of SOP, however, was pivotal to the application of nebulization during emergencies. If SOP were in place,76.9% of the responders used aerosol treatment compared to 23.1% when there were none. The perceived safety when using nebulization during emergencies was also significantly higher (p = 0.013) when SOP were implemented. CONCLUSION: The exclusive use of mesh nebulizers could standardize the treatment of emergency patients in the south German rescue services. The use of mesh devices might possibly improve patient outcomes, even if clinical studies are still lacking. Nebulizer treatment differs between the federal states. A comprehensive implementation of SOP for nebulization treatment might support this process and could increase the application frequency and the perceived safety of nebulization during emergencies. A better training of paramedic personnel could improve the knowledge of aerosols as a treatment option for emergency patients and help to classify the advantages and disadvantages of the different aerosol generators available.

[Relevant incidental findings and iatrogenic injuries : A retrospective analysis of 1165 resuscitation room patients]. / Relevante Zufallsbefunde und iatrogene Verletzungen : Eine retrospektive Analyse von 1165 Schockraumpatienten.

BACKGROUND: Whole-body computed tomography (CT) is increasingly being used as the diagnostic modality of choice in patients admitted to the resuscitation room. Beyond findings related to the suspected diagnosis it often additionally reveals incidental findings. The aim of this investigation was the evaluation of these findings in patients admitted via the emergency room after suffering potential major trauma or life-threatening medical conditions. Furthermore, the number of iatrogenic injuries as well as misplaced catheters and endotracheal tubes was investigated. METHODS: All patients admitted from 1 February 2012 to 31 January 2014 via the resuscitation area of the Mannheim University Medical Center, a tertiary care hospital and level 1 trauma center, were included in this study if they had undergone a whole-body CT scan at admission. Data from 1362 patients were collected retrospectively and 197 patients were excluded because of missing data so that the final cohort consisted of 1165 patients (1038 trauma and 127 internal neurological patients). Reports from the whole-body CT scans were screened for incidental findings. These findings were then classified as either clinically relevant or not. Furthermore, the reports were checked for iatrogenic injuries as well as misplaced catheters and endotracheal tubes. RESULTS: A total of 465 incidental findings were reported in 293 patients (25.1%) of the final cohort. In the synopsis of the radiological and clinical findings, 72 were rated as clinically relevant. In one patient two relevant incidental findings were reported and one patient presented with three incidental findings. In total, relevant incidental findings could be detected in 5.8% of the study patients (68/1165). In the discharge letters and/or the radiological report 16.2% of the incidental findings rated as clinically relevant were reported to be previously known, 66.2% were reported to be unknown and 17.6% could not be unequivocally classified as known or unknown due to missing references in the discharge letters. The group of internal neurological patients were clearly older than the trauma patients (61.6 years vs. 45.5 years). The rate of relevant incidental findings in the internal neurological group was more than twice as high as in the trauma group (11.0% vs. 5.2%); however, in the relatively young trauma group 1 in 20 patients showed an incidental finding classified as clinically relevant. In 43 (3.7%) patients a total of 46 iatrogenic injuries or misplaced catheters were reported. The most common finding was a too deeply placed endotracheal tube and five transurethral catheters placed in the emergency room were found to be blocked within the urethra. CONCLUSION: In addition to the main diagnosis, clinically relevant incidental findings were reported in nearly 25% of whole-body CT scans of patients admitted to the resuscitation room. Approximately 6% of patients had incidental findings rated as clinically relevant. In the internal neurological group of patients the rate of incidental findings was doubled compared to the trauma group; however, the latter were significantly younger. Whole-body CT was also useful for diagnosing iatrogenic injuries and misplaced catheters in approximately 4% of the study patients.

Diagnostic Performance of Contrast Enhanced Pulmonary Computed Tomography Angiography for the Detection of Angioinvasive Pulmonary Aspergillosis in Immunocompromised Patients.

Invasive pulmonary aspergillosis (IPA) is one of the major complications in immunocompromised patients. The mainstay of diagnostic imaging is non-enhanced chest-computed-tomography (CT), for which various non-specific signs for IPA have been described. However, contrast-enhanced CT pulmonary angiography (CTPA) has shown promising results, as the vessel occlusion sign (VOS) seems to be more sensitive and specific for IPA in hematologic patients. The aim of this study was to evaluate the diagnostic accuracy of CTPA in a larger cohort including non-hematologic immunocompromised patients. CTPA studies of 78 consecutive immunocompromised patients with proven/probable IPA were analyzed. 45 immunocompromised patients without IPA served as a control group. Diagnostic performance of CTPA-detected VOS and of radiological signs that do not require contrast-media were analyzed. Of 12 evaluable radiological signs, five were found to be significantly associated with IPA. The VOS showed the highest diagnostic performance with a sensitivity of 0.94, specificity of 0.71 and a diagnostic odds-ratio of 36.8. Regression analysis revealed the two strongest independent radiological predictors for IPA to be the VOS and the halo sign. The VOS is highly suggestive for IPA in immunocompromised patients in general. Thus, contrast-enhanced CTPA superior over non-contrast_enhanced chest-CT in patients with suspected IPA.

[Preclinical fibrinolysis in patients with ST-segment elevation myocardial infarction in a rural region]. / Präklinische Fibrinolyse bei Patienten mit ST-Hebungsinfarkt in einer ländlich geprägten Region.

BACKGROUND: In the current guidelines for the treatment of patients with ST-segment elevation myocardial infarction (STEMI), the European Society of Cardiology (ESC) recommends preclinical fibrinolysis as a reperfusion therapy if, due to long transportation times, no cardiac catheterisation is available within 90-120 min. However, there is little remaining in-depth expertise in this method because fibrinolysis is presently only rarely indicated. METHODS: In a rural area in southwestern Germany, where an emergency primary percutaneous coronary intervention was not routinely available within 90-120 min, 156 STEMI patients underwent fibrinolysis with the plasminogen activator reteplase, performed by trained emergency physicians. The practicality of the treatment, as well as complications and the mortality of the patients in the preclinical phase until arrival at the hospital, were retrospectively studied. RESULTS: The mean time from onset of the symptoms to first medical contact was 114 ± 116 min. The mean interval to the start of fibrinolysis of 13.5 ± 6.4 min was within the 30 min mandated by the ESC. Patients with inferior STEMI represented the largest subgroup. Occurring in 39 cases (25 %), complications due to infarction were relatively common during the prehospital phase, including 15 cases (9.6 %) of cardiogenic shock, but in all cases the complications were manageable. No patient died before arrival at the hospital. As lysis-associated adverse effects, merely two uncomplicated mucosal haemorrhages and one case of mild allergic skin reactions were seen. CONCLUSION: In emergency situations with long transportation times to the nearest suitable cardiac catheterisation laboratory, preclinical fibrinolysis in STEMI still represents a workable method. Success of this strategy requires particularly strong training of the emergency physicians in ECG and lysis therapy, and co-operation with nearby cardiac centres.

[Spectrum of missions for a rescue helicopter. Changes in a south German urban area over the last 25 years]. / Einsatzspektrum eines Rettungshubschraubers. Veränderung in einem süddeutschen Ballungsgebiet in den letzten 25 Jahren.

BACKGROUND: Over the past decade the number of air rescue missions has increased continuously. The reasons for this are still discussed at great length. In addition to the demographic changes to becoming an increasingly older and sicker society, the political reform in the healthcare system with a simultaneous reduction and concentration of hospitals and formation of centers is also under discussion. AIM: The key questions to be answered are, therefore, can the increasing demands on the emergency physician really be explained by an increasing number of severely ill and injured patients? Is a proportion of the missions really not indicated because they do not involve immediately life-threatening "acute medical" emergencies and are caused by a lack of alternative paramedical service infrastructures, unavailability of a general practitioner or the only temporary availability of medical on-call standby services? MATERIAL AND METHODS: This study therefore analyzed the alterations of a possible change with respect to the spectrum of missions and the utilization of air rescue services in the metropolitan area of Stuttgart. All primary missions of the rescue helicopter (RTH) "Christoph 41" (based in Leonberg) from 2006 to 2011 were included in the study and compared to the data from 1987 to 1992. RESULTS: The indications for missions and the spectrum of patients for the RTH Christoph 41 have changed over the last 25 years. The proportion of emergency trauma cases has significantly decreased and missions for non-trauma cases have increased. The proportion of patients with life-threatening conditions has increased. Despite the change in the spectrum of missions, emergency physicians are confronted with a greater number of patients with life-threatening conditions than 25 years ago. The patients treated were on average clearly older than the patients who were treated by the air rescue service 25 years ago. CONCLUSION: The changes in the spectrum of missions up to more emergencies involving non-trauma patients and older patients must be taken into consideration during training and advanced training.

Postpartum levels of 8-iso-prostaglandin F2α in plasma and milk phospholipid fractions as biomarker of oxidative stress in first-lactating dairy cows.

F2-isoprostanes such as 8-iso-prostaglandin F2 (8-iso-PGF2α) are formed by free radical-catalyzed mechanisms from membrane phospholipids and from low density lipoproteins through peroxidation of arachidonic acid. Esterified 8-iso-PGF2α is cleaved by phospholipases, circulates in blood and is excreted as putatively harmful oxidatively modified lipid via the kidney into urine. In this study we demonstrate that 8-iso-PGF2α concentrations in plasma samples from heifers are higher (p<0.005) compared to those from first-lactating dairy cows at 71 days postpartum. Furthermore, plasma 8-iso-PGF2α concentrations vary with ovarian activity and differ in response to luteolytic initiation as well as activation of the hypothalamic-pituitary-gonadal axis between heifers and first-lactating cows. Sustainable concentrations of 8-iso-PGF2α (50-150 pg/ml) are detectable in the phospholipid fraction of milk, suggesting milk as an additional excretion route for 8-isoprostanes. Plasma levels largely paralleled levels in milk (p<0.001). Plasma phospholipid 8-iso-PGF2α concentrations in cyclic cows decreased (p<0.05) from day 38 to day 71 postpartum, whereas milk phospholipid 8-iso-PGF2α rather increased (p<0.05). Cyclic cows tend to have higher 8-isoprostane levels compared to acyclic animals. In contrast to lipohydroperoxides, concentration of 8-iso-PGF2α were not correlated with milk yield (p>0.05). Our data indicate 8-iso-PGF2α may be a novel biomarker of oxidative stress in dairy cow, which is detectable in blood as well as in milk.

Inactivation of the LOX-1 pathway promotes the Golgi apparatus during cell differentiation of mural granulosa cells.

In female mammals, granulosa cells of the ovarian follicle differentiate into the corpus luteum after ovulation of the pregnable oocyte into the fallopian tube. During these differentiation processes several morphological alterations have to occur and the molecular basis is not fully understood. As an endpoint estradiol production from granulosa cells has to switch off in favor for progesterone production from the proceeding corpus luteum to sustain the developing embryo. Previously, we demonstrated that the multiligand receptor LOX-1 plays a critical role in steroid hormone synthesis of granulosa cells via intracellular calcium release from endoplasmic (ER)-dependent and ER-independent calcium pools. In the present study, we show that inhibition of LOX-1 leads to a rearrangement of ceramide from the basal membrane toward the Golgi apparatus. This activity is accomplished by a calcium-dependent phosphorylation of aromatase, the key step in estradiol production. Phosphorylated aromatase increased estradiol production in a dose-dependent manner. Our data indicate that the ceramide cascade is essential for proper granulosa cell function and ceramide redistribution serves as a first step in order to proceed with the prosperous differentiation into a corpus luteum.

LOX-1 regulates estrogenesis via intracellular calcium release from bovine granulosa cells.

Estradiol produced by ovarian granulosa cells triggers the luteinizing hormone surge which in turn initiates ovulation in female mammals. Disturbances in estradiol production from granulosa cells are a major reason for reproductive dysfunctions in dairy cows. Endogenous estradiol production might be altered by reactive oxygen species (ROS) such as oxidized low-density lipoprotein (ox-LDL). Inhibition of lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), a receptor of ox-LDL, leads to increased estrogenesis in granulosa cells. This activity is mediated by calcium release from endoplasmic reticulum (ER)-dependent and ER-independent calcium pools. Inhibition of the LOX-1 signal transduction pathway is followed by mitochondrial alterations. The membrane potential ΔΨ increases and the ROS production decreases in mitochondria after blocking LOX-1. Our data indicate that blocking the LOX-1 receptor signal pathway might be a promising way to improve steroid hormone concentrations in metabolically highly active female mammals and, therefore, to defend against reproductive dysfunctions in humans and animals.

Fuel feeds function: Energy balance and bovine peripheral blood mononuclear cell activation.

A general phenomenon in peripartum mammals is the breakdown of (acquired) immunity. The incidence of parasite load, disease and inflammation often rise during the specific energetically demanding time of pregnancy and lactation. In this period, blood leukocytes display decreased DNA synthesis in response to mitogens in vitro. Leukocyte activation, the phase of the cell cycle preceding the DNA synthetic phase has hardly been investigated, but the few studies suggest that leukocyte activation may also be impaired by the limited energy/nutrient availability. Leukocyte activation is characterized by manifold processes, thus, we used the cellular oxygen consumption rate (OCR) as a measure of ATP turnover to support all these processes. We hypothesized that the activation of peripheral blood mononuclear cells (PBMC) - in terms of oxygen consumed over basal levels after in vitro stimulation - is altered by energy balance around parturition. We studied peripartum high-yielding dairy cows because they undergo substantial fluctuations in energy intake, energy output and body fat mass. We established a fluorescence-based test strategy allowing for long-term (≥24h) quantification of O(2)-consumption and studied the peripartum period from 5 weeks ante partum to 5 weeks postpartum. In addition, we determined cellular lactate production, DNA/RNA synthesis and cell size and zoo-technical parameters such as animal energy intake and milk yield were assessed, as well as selected plasma parameters, e.g. glucose concentration. The basal OCR of PBMC from pregnant, non-lactating cows (n=6, -5 weeks ante partum) was 1.19±0.15 nmol min(-1) (10(7)cells)(-1) and increased to maximum levels of 2.54±0.49 nmol min(-1) (10(7)cells)(-1) in phytohemagglutinin (PHA)-stimulated PBMC. The basal OCR did not change over the peripartum period. Whereas the activation indices, herein defined as the PHA-induced 24h-increase of OCR above baseline, amounted to 1.1±0.3, 4.2±0.3, 4.1±1.1, 2.1±0.3, and 2.7±0.5 at weeks -5, -1, +1, +2, and +5 relative to parturition, respectively. Because the activation index was positively correlated to plasma glucose levels and to energy balance during late pregnancy (week -5/week -1) and transition to lactation (week -1/week +2), we conclude that PBMC activation is modulated by energy/nutrient availability. In future studies, the activation index should aid the identification of causal mechanisms of disparity in PBMC activation, such as attenuated ion transport or macromolecule synthesis.

Cellular conditions for intramuscular fat deposition in Japanese Black and Holstein steers.

The experiment was conducted to study the development of intramuscular fat in Japanese Black (JB) compared to Holstein (HS) steers and to find breed differences for fat depot development and distribution in the carcass under equal feeding conditions. Additional to slaughter samples, biopsy samples of longissimus muscle (LM) and subcutaneous fat, taken at 10, 14, 18, and 22 months of age, were used for histological and molecular investigations. Japanese Black steers stored about 14% more fat in the LM (P = 0.001), resulting in larger marbling flecks (P < 0.001). Muscle fibers and intramuscular adipocytes in both breeds responded to the high energy feeding with significant enlargement, which was faster in JB. Histograms of intramuscular adipocytes size showed a shift toward larger cells during growth, but also the abundance of small, developing adipocytes. This development was accompanied by a correlated up-regulation of adipogenic genes until 22 months of age.

A single exposure to social isolation in domestic piglets activates behavioural arousal, neuroendocrine stress hormones, and stress-related gene expression in the brain.

Stressful early life events can have short- and long-term effects on neuroendocrine and behavioural mechanisms of adaptation. Here, we investigated the effects of a single social isolation (4 h) of domestic piglets on both behavioural alterations in open-field tests and modifications in the expression of genes regulating glucocorticoid response in stress-related brain regions at 7, 21 or 35 days of age. The mRNAs of glucocorticoid receptor (GR), mineralocorticoid receptor (MR), 11ss-hydroxysteroid dehydrogenase 1 and 2 (11ss-HSD1 and 11ss-HSD2) and c-fos were analysed by real-time RT-PCR in the hypothalamus, hippocampus and amygdala. The social isolation caused both elevated stress hormone concentrations (e.g. cortisol) and open-field reactivity (e.g. locomotion, vocalisation) compared to control piglets. The enhanced behavioural and neuroendocrine activity was associated with distinct changes in gene expression in the limbic system. The hypothalamic GR, MR and 11ss-HSD1 mRNA expressions and the hippocampal 11ss-HSD1 mRNA was significantly higher in isolated piglets, whereas in the amygdala social isolation caused a significant decrease in MR mRNA expression. Isolated piglets also displayed significantly higher c-fos mRNA expression, an estimate of neuronal activation, in hypothalamus and amygdala. The mRNA alterations as well as the behavioural and hormonal pattern show an effect of social isolation on days 7 and 21, but no effect on day 35. In conclusion, a single social isolation in piglets caused age-dependent neuroendocrine and behavioural changes that indicate increased arousal and experienced distress. The present results also suggest that psychosocial stress effects should be considered for the assessment of livestock handling practices with respect to health and welfare.

Perilipin, C/EBPα, and C/EBPß mRNA abundance in longissimus muscle and different adipose tissues of Holstein and Charolais cattle.

Possible regulators of intramuscular fat deposition were investigated in longissimus muscle (LM) and adipose tissues of 18months old Holstein and Charolais bulls. The mRNA abundance of perilipin and transcription factors C/EBPα and C/EBPß was analyzed by real-time RT-PCR. Carcass traits and marbling traits were recorded and relationships among adipogenic genes and tissue traits were determined. Charolais cattle were heavier (P<0.001) and had less body fat (P<0.001). Holstein bulls accumulated more fat in the LM (P=0.02), but the number and size of marbling flecks did not differ (P>0.7) between breeds. Perilipin, C/EBPα, and C/EBPß mRNA abundance was influenced by tissue but not by breed. Relationships between mRNA abundance and marbling traits could not be confirmed, however relationships among adipogenic genes. The transcriptional activity of adipogenic genes in LM suggests that intramuscular adipose tissue is still developing and differentiation still occurs.

Nutritional level and energetic source are determinants of elevated circulatory lipohydroperoxide concentration.

Dietary energetic impact on oxidative stress is incompletely understood. Therefore, effects of diets on oxidative stress were studied using a crossover block design. In Expt 1, intake of metabolizable energy (ME) was restricted or ad libitum. In Expt 2, isoenergetic and isonitrogenic diets were fed, replacing carbohydrate energy by energy of fatty acids. Circulatory lipohydroperoxides (LOOH), markers of acute oxidative stress, were expressed absolutely and in terms of cholesterol or TAG levels. In Expt 1, plasma (jugularis vein) LOOH was assayed in combination with whole-body oxidative metabolism using gas exchange and heart rate (HR) during feeding periods and at rest. In Expt 2, LOOH was assayed in plasma from portal and a large udder vein and a mesenteric artery. In Expt 1, intake increased VO2, HR and LOOH following overnight fast with higher values (P < 0.05) when feeding ME ad libitum. Intake of ME ad libitum (3 weeks) increased cardiac protein of cytochrome oxidase and endothelial-type nitric oxide synthase (P < 0.05), indicating adaptation of the heart to higher activity. Transient HR responses evoked by an antidiabetic drug (levcromakalim) revealed a linear positive correlation with relative LOOH (r2 0.79), supporting the relationship between oxidative metabolic rate and lipoperoxidation. Evidence for exogenous lipids as LOOH source provided the vessel-specific rise in LOOH through replacing carbohydrate ME by lipid ME (Expt 2). Thus, dietary energy level and energetic source are important for circulatory LOOH with a role of vascular activity in production of oxidant.

Role of the platelet-activating factor and its receptor in the proliferative regulation of bovine ovarian granulosa cells.

UNLABELLED: Proliferation of granulosa cells and their withdrawal from the cell cycle may regulate follicular ovulation. Antagonists of platelet-activating factor (PAF) and its receptor (PAFr) inhibit follicle rupture. OBJECTIVES: Thus, PAF and PAFr may be involved in proliferative regulation of granulosa cells; however, expression of PAFr in these cells is unknown. MATERIALS AND METHODS: The aim of this study was to investigate the presence of PAFr and the effect of PAF on proliferation of cultured bovine granulosa cells using real-time polymerase chain reaction to assay steady-state level of mRNA, immunocytochemistry to quantify PAFr protein and proliferating cell nuclear antigen protein by flow cytometry. RESULTS: We found that granulosa cells express PAFr transcripts and protein. PAF presence did not change the concentration of PAFr mRNA or PAFr protein. Granulosa cells responded to PAF doses of 10 and 50 nm with increasing proportions of cells entering G0/G1 phase, as well as a significant expansion of total cell numbers. Rise in G0/G1-phase cells was accompanied by a decline in proliferating cell nuclear antigen protein expression, and these effects could be suspended by simultaneous PAFr blockage. The results provide clear evidence for expression of PAFr in bovine granulosa cells and its functional involvement in PAF/PAFr-mediated stimulation of cell recruitment. CONCLUSIONS: PAF antagonists are suggested to disturb this regulative activity of PAF and to contribute in this way to blockage of ovulation.

Prospective randomized comparison of the new Laryngeal Tube Suction LTS II and the LMA-ProSeal for elective surgical interventions.

BACKGROUND AND AIM: The Laryngeal Tube Suction (LTS) has recently undergone considerable changes in design. The new LTS II was compared with the LMA-ProSeal to determine device performance during general anaesthesia and controlled ventilation. METHODS: After Institutional Review Board approval, 100 elective surgical patients were randomized to be ventilated with LTS II or LMA-ProSeal. The number of attempts (maximum of two, and then other device tested) and time until first tidal volume were recorded. Ventilation was standardized (tidal volume, 7 ml/kg; respiratory rate, 12 breaths/min) and the resulting end-tidal CO(2) was recorded. The airway leak pressure (maximum of 40 cmH(2)O) was measured at cuff pressures of 60 cmH(2)O. The ease of gastric tube insertion was evaluated. The devices were inspected for traces of blood after removal. Patients were questioned regarding post-operative complaints. The Mann-Whitney U-test was used to compare the groups. RESULTS: The demographic data, American Society of Anesthesiologists' group, Mallampati score, and haemodynamic and respiratory variables were comparable for both groups of 50 patients. Insertion was successful in the first/second attempts in 44/4 patients for LTS II and in 43/6 patients for LMA-ProSeal. After two failed attempts, the other device was successfully used in one patient for LMA-ProSeal and in two patients for LTS II. The times until first tidal volume for LTS II and LMA-ProSeal were 25.0 +/- 10.1 and 25.5 +/- 11.5 s, respectively. The airway leak pressures were comparable: 33.1 (15-40) and 32.0 cmH(2)O (18-40 cmH(2)O) for LTS II and LMA-ProSeal, respectively. Gastric tube insertion failed in two patients in each group. Traces of blood were found in two patients with LTS II and in three patients with LMA-ProSeal. In both groups, post-operative complaints were mild and infrequent. CONCLUSION: In this prospective randomized trial, LMA-ProSeal and LTS II were comparable in all respects.

[Infrastructure of emergency medical services. Comparison of physician-staffed ambulance equipment in the state of Baden-Wuerttemberg in 2001 and 2005]. / Strukturqualität im Notarztdienst. Vergleich der Ausstattung arztbesetzter Rettungsmittel in Baden-Württemberg in den Jahren 2001 und 2005.

BACKGROUND: A survey amongst emergency physician bases in the federal state of Baden-Wuerttemberg in 2001 concerning equipment available for airway management and the treatment of acute coronary syndromes showed striking differences with respect to implementation of European norms and international recommendations. The survey was repeated in 2005 to evaluate the development of the equipment in physician-staffed ambulance systems. METHODS: A questionnaire was sent to all emergency physician bases (ground ambulance and helicopter) registered with the Ministry of Health in Baden-Wuerttemberg. Questions encompassed availability of options to verify correct tracheal tube position (e.g. capnometry), supraglottic airway devices as alternatives to mask ventilation and tracheal intubation, 12-lead ECG and fibrinolytic agents. RESULTS: In 2001, 116 out of 127 bases (91.3%) participated and in 2005, 107 out of 120 bases (89.2%) returned the questionnaire. With availability in 97.2% of bases, prevalence of supraglottic airway devices is almost state-wide (2001: 54.3%, p<0.001, Fisher's exact test). The topics verification of tracheal tube position (2005: 73.8%, 2001: 26.7%, p<0.001), 12-lead ECG (2005: 89.7%, 2001: 52.6%, p<0.001) and fibrinolytic therapy (2005: 59.8%, 2001: 12.9%, p<0.001) showed noticeable increases in the corresponding availability, however, distinct regional structural deficits were still present in 2005. CONCLUSIONS: A favourable trend could be found concerning the equipment of physician-staffed ambulances state-wide. Further efforts must be undertaken to ensure the complete implementation of legal requirements and international recommendations concerning provision of medical equipment.

Comparative study of cell cycle kinetics and induction of apoptosis or necrosis after exposure of human Mono Mac 6 cells to radiofrequency radiation.

The possible harmful effects of radiofrequency electromagnetic fields (RF EMFs) are controversial. We have used human Mono Mac 6 cells to investigate the influence of RF EMFs in vitro on cell cycle alterations and BrdU uptake, as well as the induction of apoptosis and necrosis in human Mono Mac 6 cells, using flow cytometry after exposure to a 1,800 MHz, 2 W/kg specific absorption rate (SAR), GSM-DTX signal for 12 h. No statistically significant differences in the induction of apoptosis or necrosis, cell cycle kinetics, or BrdU uptake were detected after RF EMF exposure compared to sham or incubator controls. However, in the positive control cells treated with gliotoxin and PMA (phorbol 12 myristate-13 acetate), a significant increase in apoptotic and necrotic cells was seen. Cell cycle analysis or BrdU incorporation for 72 h showed no differences between RF EMF- or sham-exposed cells, whereas PMA treatment induced a significant accumulation of cells in G(0)/G(1)-phase and a reduction in S-phase cells. RF EMF radiation did not induce cell cycle alterations or changes in BrdU incorporation or induce apoptosis and necrosis in Mono Mac 6 cells under the exposure conditions used.

Endocrine, morphological, and cytological effects of a depot GnRH agonist in bovine.

The present study was conducted to assess effects of the gonadotropin-releasing hormone agonist (GnRHa) triptorelin in dairy heifers. The peptide was released from a commercial 4-week depot formulation (Decapeptyl Depot) administered at animals' estrus (day 0). First experiment (EXP I, n=5), which was aimed to explore the availability of peptide, detected a maximum of triptorelin concentration between day 2 and 5 after depot injection, and the peptide remained detectable by RIA in peripheral blood for about 3 weeks. In further experiments, the peptide release was terminated on day 9 (EXP II, n=16) or day 21 (EXP III, n=47). Treatment effects were studied on follicular development, the characteristics of cumulus-oocyte complexes (COCs) (EXP II; EXP IIIa) and secretions of LH and progesterone (EXP IIIb). Results showed that the occurrence of the pre-ovulatory LH surge was more uniform in treated heifers than that in controls. The duration of ovulation periods was similar amongst the heifers of EXP II, but more compact amongst those of EXP III each compared with the respective controls. Post-ovulatory, the number of LH pulses was significantly reduced by treatment, whereas both basal LH and progesterone concentrations were elevated on a few days. Follicular growth was reduced only by the prolonged influence of the GnRHa. There were increased proportions of both degenerated COCs and immature oocytes from small follicles (<3mm in diameter), and meiotic configuration and quality of oocytes isolated from follicles 3-5mm were changed after the prolonged, 21-day treatment. These results indicate that a continuous influence of a GnRHa over more than 1 week may increasingly impair the development of bovine follicles and oocytes. This may have some significance for the development of novel GnRH-based techniques in regulating the reproductive function in cattle.

Polar phospholipids from bovine endogenously oxidized low density lipoprotein interfere with follicular thecal function.

The role of endogenously oxidized low density lipoprotein (oxLDL) in follicular steroidogenic regulation is unknown. Information may be important in order to elucidate ovulatory dysregulation in disordered lipid metabolism. To obtain specific data, we studied the effect of polar phospholipids (PL) isolated from oxLDL with different endogenous levels of lipohydroperoxides (LHP) on the thecal expression of mRNA encoding steroidogenic enzymes and cyclooxygenase 2 (COX-2), and on the thecal production of superoxide and progesterone. Large (preovulatory) bovine follicles were used and analyses of thecal fragments from single follicles were performed by radioimmunoassays, chemiluminescence assays and quantitative RT-PCR. Basal concentration of mRNA for several lipoprotein receptors exceeded by about 10-times the basal level of mRNA encoding steroidogenic enzymes, suggesting that preovulatory theca receptors may favour uptake of oxLDL. PL (5-11 pmol phosphorus/ml) decreased (up to 0.5-times the control) progesterone synthesis, production of superoxide and levels of P450 cholesterol side chain cleavage (P450 scc), 3beta-hydroxysteroid dehydrogenase and COX-2 mRNA. Abundance of COX-2 transcripts in thecal tissue incubated with forskolin depended on the progesterone/17beta-oestradiol ratio of the follicle fluid, i.e. the previous microenvironment in vivo. PL effects were mimicked by the platelet-activating factor (PAF). WEB 2086, a PAF receptor blocker, did not always abolish these responses, suggesting that the effects were not mediated solely by this receptor. PAF interfered dose-dependently with LH-induced responses, indicating interference with LH signalling. PL from mildly oxidized LDL (0.5 nmol/ml LHP) tended to exert greater effects than PL from oxLDL containing 1.5 nmol/ml LHP. In consideration of the known physiologic role of progesterone, COX-2 and possibly superoxide, these results provide evidence for a potential of PL from oxLDL to induce ovulatory dysregulation and suggest that the extent of the LDL oxidation seems to be important for interfering with thecal responses to the preovulatory LH surge.

Short communication: hydroperoxides in circulating lipids from dairy cows: implications for bioactivity of endogenous-oxidized lipids.

This study was conducted to investigate the potential for increased oxidative stress of high- vs. average-producing dairy cows. Two experiments were performed using 11 and 13 Holstein cows (53 +/- 2 d postpartum). Lipohydroperoxides (LHP) were determined in serum lipids (experiment 1) and low-density lipoprotein (experiment 2) via oxidation of ferrous to ferric ions through LHP using thiocyanate as chromogen. In experiment 1, differing milk yield and milk energy output corresponded to different concentrations of LHP. In experiment 2, analysis of regression resulted in a significant relationship between milk yield and LHP. Phospholipids isolated from lipids with 6.5 microM of LHP evoked in monocytic cells a transient increase in superoxide formation, indicating inflammatory potential. The results show that high milk productivity can associate with oxidative stress indicated by oxidative modifications of circulating lipids and their changed bioactivity.