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AIM: The objective of this pilot study was to determine the accuracy of point-of-care B-line lung ultrasound in comparison to NT Pro-BNP for screening acute heart failure. MATERIALS AND METHODS: An 8-zone lung ultrasound was performed by experienced sonographers in patients presenting with acute dyspnea in the ED. AHF was determined as the final diagnosis by 2 independent reviewers. RESULTS: Contrary to prior studies, B-line ultrasound in our study was highly specific, but moderately sensitive for identifying patients with AHF. There was a strong association between elevated NT-proBNP levels and an increased number of B-lines. CONCLUSION: In conclusion, point-of-care lung ultrasound is a helpful tool for ruling in or ruling out important differential diagnoses in ED patients with acute dyspnea.

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We present new data for the transverse target asymmetry T and the very first data for the beam-target asymmetry F in the γ[over →]p[over →]→ηp reaction up to a center-of-mass energy of W=1.9 GeV. The data were obtained with the Crystal-Ball/TAPS detector setup at the Glasgow tagged photon facility of the Mainz Microtron MAMI. All existing model predictions fail to reproduce the new data indicating a significant impact on our understanding of the underlying dynamics of η meson photoproduction. The peculiar nodal structure observed in existing T data close to threshold is not confirmed.

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A precision measurement of the differential cross sections dσ/dΩ and the linearly polarized photon asymmetry Σ≡(dσ⊥-dσ∥)/(dσ⊥+dσ∥) for the γp→π0p reaction in the near-threshold region has been performed with a tagged photon beam and almost 4π detector at the Mainz Microtron. The Glasgow-Mainz photon tagging facility along with the Crystal Ball/TAPS multiphoton detector system and a cryogenic liquid hydrogen target were used. These data allowed for a precise determination of the energy dependence of the real parts of the S- and all three P-wave amplitudes for the first time and provide the most stringent test to date of the predictions of chiral perturbation theory and its energy region of agreement with experiment.

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This paper presents the policy framework of contaminated site management in The Netherlands and the corresponding risk assessment tools, including innovations that have taken place since an overview was published in 1999. According to the Dutch Soil Protection Act assessment framework, soils are subdivided into three quality classes: clean, slightly contaminated and seriously contaminated. Historic cases of slightly contaminated soils are managed in a sustainable way by re-use of soil material within a region on the basis of risk-based and land use specific Maximal Values and Background Values. In case of serious soil contamination remediation is in principle necessary and the urgency of remediation has to be determined based on site-specific risks for human health, the ecosystem and groundwater. The major risk assessment tools in The Netherlands are the CSOIL exposure model (human health risks and food safety), Species Sensitivity Distributions and the Soil Quality Triad (ecological risks), along with a procedure to assess the risks due to contaminant spreading to and in the groundwater. Following the principle 'simple if possible, complex when necessary', tiered approaches are used. Contaminated site practices are supported with web-based decision support systems.

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OBJECTIVE: Mast cells are thought to participate in the pathogenesis of inflammatory bowel disease (IBD). In this study, urinary excretion of N-methylhistamine (UMH), a stable metabolite of the mast cell mediator histamine, was evaluated as an indicator of disease activity in patients with IBD. METHODS: Urinary excretion of UMH (microg/mmol creatinine x m2 body surface area) was measured by radioimmunoassay in 55 controls, 56 patients with Crohn's disease, and in 36 patients with ulcerative colitis. Excretion rates were correlated with clinical, serological, and endoscopic disease activity, disease extent, and location. RESULTS: Urinary excretion of UMH was found to be significantly elevated in IBD. Patients with active Crohn's disease (7.1 +/- 4.2, p = 0.002 vs controls) and active ulcerative colitis (8.1 +/- 4.8, p = 0.02 vs controls) had higher rates of UMH excretion than patients in remission (6.3 +/- 3.8 and 5.2 +/- 2.3, respectively) or controls (4.6 +/- 1.9). In Crohn's disease and ulcerative colitis, a significant correlation of UMH excretion with clinical disease activity was obtained (Crohn's Disease Activity Index r2 = 0.58, Clinical Activity Index r2 = 0.57, p < 0.0001). Serologically, orosomucoid showed the best positive correlation with disease activity (Crohn's Disease Activity Index r2 0.80, Clinical Activity Index r2 = 0.86, p < 0.0001), but UMH excretion was found to reflect disease activity more accurately than C-reactive protein (Crohn's Disease Activity Index r2 = 0.46, Clinical Activity Index r2 = 0.42, p < 0.0001). No association between UMH excretion and disease type or localization could be found in Crohn's disease. However, UMH excretion correlated strongly with endoscopic severity of inflammation in Crohn's disease (Crohn's Disease Endoscopic Index of Severity r2 = 0.70, p < 0.0001) or disease extent in ulcerative colitis. CONCLUSIONS: Urinary excretion of the histamine metabolite UMH is enhanced in IBD. It appears to represent an integrative parameter to monitor clinical and endoscopic disease activity in IBD, which appears to be influenced most likely by mediators released from histamine-containing cells, such as intestinal mast cell subtypes.

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PURPOSE: To assess the safety and efficacy of ultrasound guided puncture of the subclavian vein instead of blind puncture or surgical procedure. The advantages compared with implantation of brachial ports are demonstrated. PATIENTS AND METHODS: In 41 oncologic patients the subclavian vein was punctured by ultrasound guidance in order to implant a port (34 left side, 7 right side). The study included 21 women and 20 men (range 34 - 79, mean 61 years). Imaging of the subclavian vein was performed with a 7,5 MHz linear ultrasound probe in B-mode and in colour doppler mode. Puncture was performed under ultrasound control (18 G, 45 mm needle when skin-vessel distance was < 3 cm, 19 G, 75 mm needle when skin-vessel distance was > 3 cm). In 27 patients a Bardport was implanted, in 14 patients a Vitalport (Cook). In three patients surgical port implantation failed. One of these patients had a partial thrombosis of the subclavian vein. RESULTS: Technical success was 100 %. In one patient we first punctured the subclavian artery at the beginning of our series without any complication. All port systems could be implanted. There was one haematoma in the port pocket without any effect to the port function. In the three surgical patients subclavian vein puncture and portimplantation was successful. CONCLUSION: Ultrasound guided puncture of the subclavian vein and port implantation by radiologists is a save procedure. A low risk approach to the subclavian vein is possible at any location. The long approach through the cubital vein with brachial port implantation is not necessary.

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The effects of using several nicotine replacement treatments on self-reported withdrawal symptoms and side effects during 2-day periods of smoking cessation, with 5 days of ad lib smoking between cessation days, were evaluated. Participants (N = 18) experienced the following conditions: nicotine gum, 24-hr patch, 16-hr patch, 24-hr patch plus gum, double 24-hr patch, and no nicotine replacement. The present study found morning urge to smoke was greater during the 16-hr than during the 24-hr patch condition. Double-patch use resulted in significantly greater insomnia than the smoking baseline and 16-hr patch conditions. The no medication and gum alone conditions resulted in similar withdrawal symptoms, and both tended to result in greater reported withdrawal symptoms than the smoking baseline condition. There were no significant withdrawal symptom differences between the 24-hr, patch-gum, and double-patch conditions. The 24-hr and double-patch conditions were preferred by two thirds of the participants (6 each).

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Stride length, stance width and gait symmetry were measured as parameters of gait analysis in young (5 months) and old (28 months) Sprague-Dawley rats following 3 months of treadmill running as well as in sedentary controls. Stride length decreased significantly with age and increased significantly following training in both young and old rats. Means of stance width increased significantly with age, but were unaffected by training. Gait symmetry declined with age; however, treadmill running counteracted the decline of gait symmetry. It was concluded that treadmill running compensates for or prevents age-related changes in the neuromuscular function of rats, which lead to gait deterioration.

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The incidence of arthroses has a highly significant correlation with age. However, a clearly defined relationship from a causal basis does not yet exist. This association is not through the time-dependent accumulation derived from the mechanical "destruction-quantum" at a molecular level in the cartilage. Indicative for the transformation is progressive degeneration with considerations of disease values, norms, and biochemical parameters of the joint and associated indicators. We use the example of the knee joint to illustrate this point. The discrepancy over deficit in strength and regulatory mechanisms is also considered, as well as the passive chondroprotective shock-absorption of the subchondralia spongiosa, and, conversely, the apparent protective mechanism of osteoporosis preceding arthrosis. Epidemiologically, osteoporosis and arthroses have been proven incompatible; what remains to be elucidated is the well-known dichotomy in their courses of development.

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Basic metabolism generates energy by the anaerobic or aerobic metabolization of glucose. The articular cartilage obtains the substrate and oxygen from the synovial fluid. Their concentrations within the cartilage diminish with increasing proximity to the basal layer at the bone-cartilage boundary. The gradients depend upon the cell density and the consumption by the cells. The gradient of the partial oxygen pressure (PO2) could provide the conditions for the Pasteur effect, which, however, has not yet been clearly observed. Metabolic reactions of chondrocytes to positive or negative glucose gradient have not hitherto been examined, and are the object of the present study. The oxygen consumption (QO2) in the articular cartilage of pig femoral heads was measured manometrically (Warburg technique) in the absence of glucose and in its presence in concentrations of 1.25 to 10.0 mM. There was a close correlation between the QO2 and the concentration and consumption of glucose having the nature of a glucose-induced respiratory suppression (Crabtree effect). The consumption of glucose, which did not rise in proportion to its concentration, did not exceed 15.7 mumol/gdw/h. The maximum lactate production of 20 to 23 mumol/gdw/h was attained at 5 mM glucose and showed no further increase at higher substrate concentrations. This stoichiometric "lactate deficiency" means that the absorbed but not glycolyzed glucose is channeled into synthesizing and storage processes. In glucose-free incubation, despite aerobic conditions, lactate was utilized by the chondrocytes only at unphysiologically high concentrations greater than 10 mM. Potassium cyanide reduced the QO2 by only 80-90% as a sign of the activity of non-mitochondrial oxidases. With monoiodoacetate (MIA), respiration fell dramatically during the 4 h of substrate-free incubation. It can be concluded from the results that, under physiological conditions, the glucose level in the synovia reduces the consumption of oxygen in the well-glucose-supplied upper layer of the articular cartilage, thus allowing an oxidative compensation of the diminishing glycolysis in the basal zone. The Crabtree effect, which is demonstrated for the first time in chondrocytes, thus seems to have the role of an essential regulatory mechanism in the basic metabolism of the cartilage.

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Histological and histomorphometrical measurements were made on normal and on osteoporotic bone from the first lumbar vertebra and the iliac crest of 15 cases. A decrease in cancellous bone was found in both. This was accompanied by a reduction in haematopoietic marrow and a corresponding increase in fat cells. In addition, the numbers of arterial capillaries and sinuses per unit area were also reduced. There is a greater overall vascularization in the first lumbar vertebra than in the iliac crest, even though the amount of cancellous bone is normally less in the former. However, the arborization of the terminal vessels in the iliac crest is more extensive than that in the first lumbar vertebra. These observations provide support for the participation of a vascular component in the pathogenesis of osteoporosis.

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