Smartglass augmented reality-assisted targeted prostate biopsy using cognitive point-of-care fusion technology

INTRODUCTION

MRI-guided targeted biopsy has become standard of care for diagnosis of prostate cancer, with establishment of several biopsy techniques and platforms. Augmented reality smart glasses have emerged as novel technology to support image-guided interventions. We aimed to investigate its usage while prostate biopsy.

METHODS

MRI with PIRADS-lesions ≥3 was uploaded to smart glasses (Vuzix Blade^R ) and augmented reality smart glasses-assisted targeted biopsy (SMART-TB) of the prostate was performed using cognitive fusion technology at the point of care. Detection rates were compared to systematic biopsy. Feasibility for SMART-TB was assessed (10 domains from bad [1] to excellent [10]).

RESULTS

SMART-TB was performed for four patients. Prostate cancer detection was more likely for SMART-TB (46%; 13/28) than for systematic biopsy (27%; 13/48). Feasibility scores were high [8-10] for practicality, multitasking, execution speed, comfort and device weight and low [1-4] for handling, battery and image quality. Median execution time: 28 min; Investment cost smart glass: 1017 USD.

CONCLUSION

First description of SMART-TB demonstrated convenient feasibility. This novel technology might enhance diagnosis of prostate cancer in future.

IFN-γ and TNF Induce Senescence and a Distinct Senescence-Associated Secretory Phenotype in Melanoma

Immune checkpoint blockade (ICB) therapy is a central pillar of melanoma treatment leading to durable response rates. Important mechanisms of action of ICB therapy include disinhibition of CD4+ and CD8+ T cells. Stimulated CD4+ T helper 1 cells secrete the effector cytokines interferon-gamma (IFN-γ) and tumor necrosis factor alpha (TNF), which induce senescence in tumor cells. Besides being growth-arrested, senescent cells are metabolically active and secrete a large spectrum of factors, which are summarized as senescence-associated secretory phenotype (SASP). This secretome affects the tumor growth. Here, we compared the SASP of cytokine-induced senescent (CIS) cells with the SASP of therapy-induced senescent (TIS) cells. Therefore, we established in vitro models for CIS and TIS in melanoma. The human melanoma cell lines SK-MEL-28 and WM115 were treated with the cytokines IFN-γ and TNF as CIS, the chemotherapeutic agent doxorubicin, and the cell cycle inhibitor palbociclib as TIS. Then, we determined several senescence markers, i.e., growth arrest, p21 expression, and senescence-associated β-galactosidase (SA-β-gal) activity. For SASP analyses, we measured the regulation and secretion of several common SASP factors using qPCR arrays, protein arrays, and ELISA. Each treatment initiated a stable growth arrest, enhanced SA-β-gal activity, and—except palbociclib—increased the expression of p21. mRNA and protein analyses revealed that gene expression and secretion of SASP factors were severalfold stronger in CIS than in TIS. Finally, we showed that treatment with the conditioned media (CM) derived from cytokine- and palbociclib-treated cells induced senescence characteristics in melanoma cells. Thus, we conclude that senescence induction via cytokines may lead to self-sustaining senescence surveillance of melanoma.

The timing of initial imaging in testicular cancer: impact on radiological findings and clinical decision making

BACKGROUND

In testicular cancer determination of clinical stage and recommendation of therapeutic strategy after inguinal orchiectomy are based on primary imaging by CT-scan of the chest and CT- or MRI-abdomen. It has not been investigated so far whether the imaging should be performed before or after primary testicular surgery. Staging before surgery means exposing all patients to CT radiation irrespective of ensured histologic malignancy while postoperative staging could pose a risk in biased clinical decision making by increased presence of unspecific lymph node enlargement caused by postsurgical effects. Therefore, we aimed to investigate the association between the timing of initial staging and occurrence of unspecific lymph node enlargement and adjuvant therapies after inguinal orchiectomy.

METHODS

We retrospectively evaluated clinical and radiological data from 236 patients who had undergone inguinal orchiectomy for testicular cancer at our department. Statistical analysis was performed to determine whether the occurrence of unspecific lymph node enlargement or the rate of adjuvant therapies were influenced by timing of initial staging (preoperative vs. postoperative).

RESULTS

The postoperative imaging cohort showed significant more inguinal, pelvic and retroperitoneal unspecific lymph node enlargement than the preoperative imaging cohort. Simultaneous occurrence of inguinal or pelvic lymph node enlargement together with retroperitoneal enlargements could only be found in the postoperative imaging cohort. No difference regarding adjuvant therapies could be found.

CONCLUSIONS

Timing of imaging affects the detection rate of unspecific lymph node enlargements but does not show a significant effect on the rate of adjuvant therapies.

The timing of initial imaging in testicular cancer: impact on radiological findings and clinical decision making

BACKGROUND

In testicular cancer determination of clinical stage and recommendation of therapeutic strategy after inguinal orchiectomy are based on primary imaging by CT-scan of the chest and CT- or MRI- abdomen. It has not been investigated so far, whether the imaging should be performed before or after primary testicular surgery. Staging before surgery means exposing all patients to CT radiation irrespective of ensured histologic malignancy while postoperative staging could pose a risk in biased clinical decision making by increased presence of unspecific lymph node enlargement caused by postsurgical effects. Therefore, we aimed to investigate the association between the timing of initial staging and occurrence of unspecific lymph node enlargement and adjuvant therapies after inguinal orchiectomy.

METHODS

We retrospectively evaluated clinical and radiological data from 236 patients who had undergone inguinal orchiectomy for testicular cancer at our department. Statistical analysis was performed to determine whether the occurrence of unspecific lymph node enlargement or the rate of adjuvant therapies were influenced by timing of initial staging (preoperative vs. postoperative).

RESULTS

The postoperative imaging cohort showed significant more inguinal, pelvic and retroperitoneal unspecific lymph node enlargement than the preoperative imaging cohort. Simultaneous occurrence of inguinal or pelvic lymph node enlargement together with retroperitoneal enlargements could only be found in the postoperative imaging cohort. No difference regarding adjuvant therapies could be found.

CONCLUSIONS

Timing of imaging affects the detection rate of unspecific lymph node enlargements but does not show a significant effect on the rate of adjuvant therapies.

Global change of surgical and oncological clinical practice in urology during early COVID-19 pandemic

Objectives

While the coronavirus disease 2019 (COVID-19) pandemic captures healthcare resources worldwide, data on the impact of prioritization strategies in urology during pandemic are absent. We aimed to quantitatively assess the global change in surgical and oncological clinical practice in the early COVID-19 pandemic.

Methods

In this cross-sectional observational study, we designed a 12-item online survey on the global effects of the COVID-19 pandemic on clinical practice in urology. Demographic survey data, change of clinical practice, current performance of procedures, and current commencement of treatment for 5 conditions in medical urological oncology were evaluated.

Results

235 urologists from 44 countries responded. Out of them, 93% indicated a change of clinical practice due to COVID-19. In a 4-tiered surgery down-escalation scheme, 44% reported to make first cancellations, 23% secondary cancellations, 20% last cancellations and 13% emergency cases only. Oncological surgeries had low cancellation rates (%): transurethral resection of bladder tumor (27%), radical cystectomy (21–24%), nephroureterectomy (21%), radical nephrectomy (18%), and radical orchiectomy (8%). (Neo)adjuvant/palliative treatment is currently not started by more than half of the urologists. COVID-19 high-risk-countries had higher total cancellation rates for non-oncological procedures (78% vs. 68%, p = 0.01) and were performing oncological treatment for metastatic diseases at a lower rate (35% vs. 48%, p = 0.02).

Conclusion

The COVID-19 pandemic has affected clinical practice of 93% of urologists worldwide. The impact of implementing surgical prioritization protocols with moderate cancellation rates for oncological surgeries and delay or reduction in (neo)adjuvant/palliative treatment will have to be evaluated after the pandemic.

Electronic supplementary material

The online version of this article (10.1007/s00345-020-03333-6) contains supplementary material, which is available to authorized users.

Prognostic significance of PD-1 and PD-L1 positive tumor-infiltrating immune cells in ovarian carcinoma

INTRODUCTION

Ovarian carcinoma is associated with the highest mortality of all gynecologic malignancies. Even after optimal treatment, prognosis remains poor. There is no established biomarker to predict individual patient outcome.

OBJECTIVE

To evaluate the prognostic significance of PD-1 and PD-L1 expression in tumor tissues from patients with ovarian cancer.

METHODS

Tissue micro-arrays were prepared from routinely formalin-fixed, paraffin-embedded tumor tissues and examined immunohistochemically for the expression of programed cell death protein 1 (PD-1) and one of its ligands (PD-L1) on epithelial tumor cells, as well as on tumor- and stroma-infiltrating immune cells.

RESULTS

The presence of PD-1 positive tumor-infiltrating immune cells was significantly associated with prolonged overall survival. PD-1 and PD-L1 positive tumor-infiltrating immune cells were associated with the presence of lymph node metastases and higher tumor grade. Interestingly, the amount of PD-1/PD-L1 positive tumor- and stroma-infiltrating immune cells independent of PD-1 or PD-L1 expression did not show any significant correlation with prognostic variables.

CONCLUSION

Our results highlight the prognostic value of PD-1 and PD-L1 positive tumor-infiltrating immune cells in ovarian carcinoma. Their association with favorable prognosis supports the hypothesis that the expression of PD-1 and PD-L1 on tumor-infiltrating immune cells represents a strong immune response.

Nocturnal respiratory rate as a predictor of mortality in patients with acute coronary syndrome

Background

Patients with acute coronary syndrome (ACS) are at risk especially in the period shortly after the event. Alterations in respiratory control have been associated with adverse prognosis. The aim of our study was to assess if the nocturnal respiratory rate (NRR) is a predictor of mortality in patients with ACS presenting in the emergency department.

Methods

Clinically stable consecutive patients with ACS aged ≥ 18 years were prospectively enrolled. The Global Registry of Acute Coronary Events (GRACE) score and left ventricular ejection fraction (LVEF) were assessed for all patients. The average NRR over a period of 6  hours was determined by the records of the surveillance monitors in the first night after admission. Primary and secondary endpoints were intrahospital and 2  years all-cause mortality, respectively.

Results

Of the 860 patients with ACS, 21 (2.4%) died within the intrahospital phase and 108 patients (12.6%) died within the subsequent 2 years. The NRR was a significant predictor of both endpoints and was independent from the GRACE score and LVEF. Implementing the NRR into the GRACE risk model leads to a significant increase of the C-statistics especially for prediction of intrahospital mortality.

Conclusion

The NRR is an independent predictor of mortality in patients with ACS.

[Health promotion networks for children and youth on the local level : An overview of the status quo in Germany]

In recent years, more and more municipalities in Germany have started to establish cross-sectoral health promotion networks for children and teenagers. They are supported by several initiatives at the state and federal level. The aim of this article is to provide an overview of these initiatives and to describe the central barriers for the implementation of health promotion networks on the local level. For this purpose, the authors first outline the role of municipalities in health promotion in Germany in general, and then describe the initiatives in more detail. The authors identify four central obstacles for implementing health promotion networks on the local level: the tight financial situation of many municipalities, difficulties of the local public service in realizing intersectoral cooperation, the traditionally weak role of the local health service, and missing evidence for Germany regarding the effectiveness of networks and integrated strategies. In addition, the article presents two alternative solutions: Great Britain and Västerbotten, a county in Sweden.

[Implementation of the Preventive Health Care Act at the Level of The Federal States: An Analysis of the Framework Agreements]

BACKGROUND

The implementation of the Preventive Health Care Act 2015 requires framework agreements between social insurances and ministries on the state level (Länder).

GOALS

This article analyses the 15 agreements already concluded and provides an overview of similarities and differences between states.

METHODS

We conducted a qualitative content analysis for all 15 agreements. In a first step, we compared the agreements with the model agreement that had informed the negotiations in all states, and identified for each paragraph of the agreement divergent content. In a second step, we compared the divergent content and built subcategories. Third, we classified similarities and differences of each category. For this article, we selected 4 categories: goals and fields of action, committees and regulatory structures, cooperation requirements, cooperation with further actors.

RESULTS

All agreements refer to the nationally agreed health goals, some define further, state-specific goals. Furthermore, the agreements provide regulations regarding the goal definition process: some processes only include the subscribers of the agreement, while others involve all relevant stakeholders. New regulatory structures are created in almost all states, but their institutional design and mode of interaction vary highly between state. In 4 states the new structures aim at establishing a dialogue, in 3 states, the goal is to enable coordination, and in 7 states decision-making bodies are set up. Almost all agreements are missing concrete commitments regarding cooperation with other relevant actors on state and local level.

CONCLUSION

Most agreements are very general and their binding character is low. The agreements merely set the framework that now needs to be filled. Hence, evaluating the actual implementation of the agreements will only be possible in a few years.

In vivo assessment of retinal vessel pathology in amyotrophic lateral sclerosis

BACKGROUND

Changes in skin and muscle small blood vessels (SBVs) and microvascular structures of the brain have been reported in patients with amyotrophic lateral sclerosis (ALS). A direct assessment of brain SBVs in vivo is currently not feasible. Retinal vessels are considered a "mirror" of brain SBVs. In this study, we used optic coherence tomography (OCT)-based measurements to detect changes in retinal blood vessels of ALS patients compared to those of healthy controls.

METHODS

We analysed Spectralis-OCT images of 34 ALS patients and 20 HCs. The inner wall thickness (IWT), outer wall thickness (OWT), and lumen diameter (LD) of retinal vessels were assessed using intensity-based measurements. In addition, the different retinal layers were analysed using automated segmentation software. The correlations between the various retinal layers and clinical parameters [e.g., disease duration and revised ALS functional rating scale (ALS-FRS-R)] were examined.

RESULTS

The OWT of retinal vessels was higher in ALS patients than in HCs (p = 0.04). There were no differences in the IWT, LD. ALS patients showed a thinning of the outer nuclear layer (ONL) compared to HCs (median 1.63 vs. 1.77, p = 0.002). The whole retinal thickness negatively correlated with the ALS-FRS scale (r = 0.3, p = 0.03).

CONCLUSION

Our study reports retinal vessel pathology in ALS patients. These changes may be related to those observed in SBVs in skin and muscle biopsies. Furthermore, we report a thinning of the ONL in ALS, revealing a possible affection of rods and cones function in ALS.

Kommunale Gesundheitsförderung und Prävention

The article addresses the role of local government in health promotion and prevention in Germany. In a first step, it delineates the goals of health promotion and prevention policies in general and describes how these relate to the definition of prevention given in the editorial. The second part highlights the role of municipalities in health promotion and disease prevention. The third part describes five core elements of local health promotion and prevention policies: local health monitoring, the development of a coherent local health strategy, integration of local (health-related) administration, governance of relevant external actors, and securing participation at all process levels. Each of these five elements is illustrated with examples from North-Rhine Westphalian municipalities. The fourth part describes obstacles that health promoting and preventive policies encounter both in general and at the local level in particular. The author concludes that despite these obstacles, every small step towards more local action should be realized because of its potential to improve the health of the population.

Determination of leachate compounds relevant for landfill aftercare using FT-IR spectroscopy

Controlling and monitoring of emissions from municipal solid waste (MSW) landfills is important to reduce environmental damage and health risks. Therefore, simple and meaningful monitoring tools are required. This paper presents how Fourier Transform Infrared (FT-IR) Spectroscopy can be used to monitor leachate from various landfill sites. The composition of percolated leachate provides information about reactivity or stability of organic matter in landfills. Chemical compounds of investigated leachate are depicted by distinct spectral pattern. Partial least squares regression (PLS-R) models, a multivariate analysis tool, were developed based on infrared spectra to determine simultaneously conventional parameters such as ammonium, nitrate, sulfate, and dissolved organic carbon. The developed models are appropriate for application in waste management practice with respect to their excellent coefficients of determination, namely R(2)=0.99, 0.99, 0.98, and 0.98, their low errors of cross-validation and their high ratios of performance to deviation (RPD=9.3, 12.5, 6.5, 7.3). Thus, FT-IR spectroscopy turned out to be a reliable, time-saving tool to determine four parameters relevant for landfill aftercare monitoring by one single easy adaptable measurement.

Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany

Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, post-herpetic neuralgia (PHN). Currently, there is no effective treatment for HZ and PHN. The objective of this study was to assess the cost-effectiveness of a HZ vaccination program in Germany. An existing Markov Model was adapted to the German healthcare setting to compare a vaccination policy to no vaccination on a lifetime time-horizon, considering 2 scenarios: vaccinating people starting at the age of 50 or at the age of 60 years, from the perspective of the statutory health insurance (SHI) and the societal perspective. According to the perspective, vaccinating 20% of the 60+ German population resulted in 162,713 to 186,732 HZ and 31,657 to 35,793 PHN cases avoided. Corresponding incremental cost-effectiveness ratios (ICER) were 39,306 €/QALY from the SHI perspective and 37,417 €/QALY from a societal perspective. Results for the 50+ German population ranged from 336,468 to 394,575 HZ and from 48,637 to 56,087 PHN cases avoided from the societal perspective. Corresponding ICER were 39,782 €/QALY from a SHI perspective and 32,848 €/QALY from a societal perspective. Sensitivity analyses showed that results are mainly impacted by discount rates, utility values and use of alternative epidemiological data.The model indicated that a HZ vaccination policy in Germany leads to significant public health benefits and could be a cost-effective intervention. The results were robust and consistent with local and international existing literature.

Five types of OECD healthcare systems: empirical results of a deductive classification

This article classifies 30 OECD healthcare systems according to a deductively generated typology by Rothgang and Wendt [1]. This typology distinguishes three core dimensions of the healthcare system: regulation, financing, and service provision, and three types of actors: state, societal, and private actors. We argue that there is a hierarchical relationship between the three dimensions, led by regulation, followed by financing and finally service provision, where the superior dimension restricts the nature of the subordinate dimensions. This hierarchy rule limits the number of theoretically plausible types to ten. To test our argument, we classify 30 OECD healthcare systems, mainly using OECD Health Data and WHO country reports. The classification results in five system types: the National Health Service, the National Health Insurance, the Social Health Insurance, the Etatist Social Health Insurance, and the Private Health System. All five types belong to the group of healthcare system types considered theoretically plausible. Merely Slovenia does not comply with our assumption of a hierarchy among dimensions and typical actors due to its singular transformation history.

Risk assessment of an old landfill regarding the potential of gaseous emissions--a case study based on bioindication, FT-IR spectroscopy and thermal analysis

Risk assessment of two sections (I and II) of an old landfill (ALH) in Styria (Austria) in terms of reactivity of waste organic matter and the related potential of gaseous emissions was performed using conventional parameters and innovative tools to verify their effectiveness in practice. The ecological survey of the established vegetation at the landfill surface (plant sociological relevés) indicated no relevant emissions over a longer period of time. Statistical evaluation of conventional parameters reveals that dissolved organic carbon (DOC), respiration activity (RA(4)), loss of ignition (LOI) and total inorganic carbon (TIC) mostly influence the variability of the gas generation sum (GS(21)). According to Fourier Transform Infrared (FT-IR) spectral data and the results of the classification model the reactivity potential of the investigated sections is very low which is in accordance with the results of plant sociological relevés and biological tests. The interpretation of specific regions in the FT-IR spectra was changed and adapted to material characteristics. Contrary to mechanically-biologically treated (MBT) materials, where strong aliphatic methylene bands indicate reactivity, they are rather assigned to the C-H vibrations of plastics in old landfill materials. This assumption was confirmed by thermal analysis and the characteristic heat flow profile of plastics containing landfill samples. Therefore organic carbon contents are relatively high compared to other stable landfills as shown by a prediction model for TOC contents based on heat flow profiles and partial least squares regression (PLS-R). The stability of the landfill samples, expressed by the relation of CO(2) release and enthalpies, was compared to unreactive landfills, archeological samples, earthlike materials and hardly degradable organic matter. Due to the material composition and the aging process the landfill samples are located between hardly degradable, but easily combustible materials and thermally resistant materials with acquired stability.

Large scale study on measurement of respiration activity (AT(4)) by Sapromat and OxiTop

In the run-up for amending the Austrian landfill ordinance, parameters were developed to assess the stability/reactivity of mechanically-biologically pretreated residual wastes. The Landfill Ordinance 2008 regulates limit values for Respiration Activity (="Atmungsaktivität") RA(4) (AT(4))<7mgO(2)*(g dry matter (DM))(-1), Gas Generation Sum GS(21)<20Nl*kgDM(-1) and alternatively Gas Evolution (="Gasbildung") GB(21)<20Nl*kgDM(-1). Methods for analysing these parameters were established by the Austrian Standards Institute (2004). As laboratory practice shows, these methods also are used for the assessment of other wastes (sewage sludge, commercial waste, material from abandoned sites, biowaste compost). For measurement of respiration activity in Austria mainly two methods are used: the Sapromat®-method and the OxiTop®-method. Whether respectively to what extent these two methods give same results, is discussed in this paper. Since 2009 at ABF-BOKU 169 respiration activity tests of samples taken from different stages of MBT - as well as biowaste composting processes, materials from landfills as well as abandoned sites and residues from anaerobic treatment plants were analysed parallel by Sapromat® and OxiTop®. The results manifest very strong correlation between the Sapromat® and OxiTop® method. The correlation coefficient is 0.993. As a very clear tendency OxiTop® gives lower amounts than Sapromat®. In average the lower values of OxiTop® are around 88%.

How to enhance humification during composting of separately collected biowaste: impact of feedstock and processing

Conventional parameters (loss on ignition, total organic carbon, total nitrogen, C/N-ratio, respiration activity (RA₄), compost status (= 'Rottegrad'), NH₄-N and NO₃-N) are not correlated to humification. At best, they provide information on the biological stability (status of degradation) of composts. Humic substances which are a source of stable organic matter and nutrients are discussed as a parameter describing compost quality. Thus, in the present research project a photometric method evaluating humic acids was used to characterize the quality of 211 Austrian and foreign composts made from source-separated collected biowaste or sewage sludge. Furthermore, parameters influencing the formation of humic acids during the rotting process were investigated by implementing rotting experiments in the laboratory as well as in composting plants. The analysed composts showed humic acid contents between 2.5 and 47 %, calculated on a organic dry matter (oDM) basis. In addition to the duration of treatment the main influence on humification was the feedstock used. Stabilized sewage sludge, biowaste after intensive anaerobic pre-treatment or biowaste with low reactivity (RA₄) or uniform composition (e.g. mainly grass) showed a low formation of humic acids. For optimum humification the feedstock needed to contain components that are well balanced from scarcely to easily degradable compounds. Processing also influenced humification. Open windrow systems and reactor systems allow the same quality to be produced when operated well, but optimizing mineralization (e.g. very intensive aeration) showed negative effects. The positive condition required for humification is an unhurried (not too intense) degradation with long-lasting biological activity in which microbes have enough time to use the metabolic products of degradation for humification.

Scrutinizing compost properties and their impact on methane oxidation efficiency

Methane emissions from active or closed landfills can be reduced by means of microbial methane oxidation enhanced by properly designed landfill covers and engineered biocovers. Composts produced using different waste materials have already been proven to support methane oxidation, and may represent a low-cost alternative to other suitable substrates such as sandy or humic-rich soils, which are frequently not available in sufficient amounts or are too costly. In the present study a data set of 30 different compost materials (different age and input materials) and mixtures, as well as seven soils and mineral substrates were tested to assess methane oxidation rate under similar conditions in a laboratory column set-up. Multivariate data analysis (discriminant analysis) was applied to predict the influence of 21 different parameters (chemical, maturation and physical) on methane oxidation rate in a PLS-DA model. The results show that bulk density, total nutrient content (nitrogen and phosphorus), as well as the quantity and quality (with respect to maturity) of organic matter determined methane oxidation rate in this data set. The model explained 50% of the data variation, indicating how characterisation of oxidation rate by single, even diverse conventional parameters was limited. Thus for the first time, Fourier Transform Infrared (FTIR) spectroscopy was applied to a series of samples to better determine the characteristics of methane-oxidising materials. The initial data obtained in this study appear to be most promising. The prediction of specific methane oxidation rate of a potential biocover material from FTIR spectra and multivariate data analyses is a target to be focused on in the future.

Evaluation of old landfills--a thermoanalytical and spectroscopic approach

Abandoned landfills and dumps, where untreated waste materials were deposited in the past, are a main anthropogenic source of relevant gaseous emissions. The determination of stability is a crucial target in the context of landfill risk assessment. FTIR spectroscopy and simultaneous thermal analysis in association with multivariate statistical methods were applied to landfill materials in order to get information on the kind of waste and its reactivity. The spectral and thermal patterns are fingerprints of the material. Industrial waste and the material from a 5-year-old reactor landfill were distinguished from the defined classes of mechanically-biologically treated ("MBT") waste and 30 to 40-year-old stable landfills containing municipal solid waste and construction waste ("LF") by a classification model based on soft independent modeling of class analogy (SIMCA). Degradation experiments were carried out with the fresh material originating from one MBT plant that was subjected to aerobic and anaerobic conditions in lab-scale reactors. These samples were compared to samples of one reactor landfill and to the landfill fraction from the MBT plant to demonstrate the efficiency of the biological pretreatment before final disposal. Prediction models that are based on spectral or thermal characteristics and the corresponding reference analyses were calculated by means of a partial least squares regression (PLS-R). The developed models of the biological oxygen demand (BOD) and the dissolved organic carbon (DOC) were based on spectral data, the models of the total organic carbon (TOC) and total nitrogen (TN) were based on thermal data (heat flow profiles and mass spectra of combustion gases). Preliminary results are discussed. The enthalpy of the materials decreases with progressing mineralization, whereas the enthalpy of the remaining organic matter increases. The ratio of the enthalpies was used as an indicator of stability. Selected samples comprising old landfills, a recent reactor landfill, MBT landfills and MBT materials were classified according to the calculated ratios.

Investigations of biological processes in Austrian MBT plants

Mechanical biological treatment (MBT) of municipal solid waste (MSW) has become an important technology in waste management during the last decade. The paper compiles investigations of mechanical biological processes in Austrian MBT plants. Samples from all plants representing different stages of degradation were included in this study. The range of the relevant parameters characterizing the materials and their behavior, e.g. total organic carbon, total nitrogen, respiration activity and gas generation sum, was determined. The evolution of total carbon and nitrogen containing compounds was compared and related to process operation. The respiration activity decreases in most of the plants by about 90% of the initial values whereas the ammonium release is still ongoing at the end of the biological treatment. If the biogenic waste fraction is not separated, it favors humification in MBT materials that is not observed to such extent in MSW. The amount of organic carbon is about 15% dry matter at the end of the biological treatment.

Determination of MBT-waste reactivity - An infrared spectroscopic and multivariate statistical approach to identify and avoid failures of biological tests

The Austrian Landfill Ordinance provides limit values regarding the reactivity for the disposal of mechanically biologically treated (MBT) waste before landfilling. The potential reactivity determined by biological tests according to the Austrian Standards (OENORM S 2027 1-2) can be underestimated if the microbial community is affected by environmental conditions. New analytical tools have been developed as an alternative to error-prone and time-consuming biological tests. Fourier Transform Infrared (FT-IR) spectroscopy in association with Partial Least Squares Regression (PLS-R) was used to predict the reactivity parameters respiration activity (RA(4)) and gas generation sum (GS(21)) as well as to detect errors resulting from inhibiting effects on biological tests. For this purpose 250 MBT-waste samples from different Austrian MBT-plants were investigated using FT-IR spectroscopy in the mid (MIR) and near infrared (NIR) area and biological tests. Spectroscopic results were compared with those from biological tests. Arising problems caused by interferences of RA(4) and GS(21) are discussed. It is shown that FT-IR spectroscopy predicts RA(4) and GS(21) reliably to assess stability of MBT-waste materials and to detect errors.

[Information system of the Federal Health Monitoring System. An online database offering a wide range of health information]

The information system of the Federal Health Monitoring System (http://www.gbe-bund.de) offers as an online database a wide range of coordinated health information in words and figures. High-performance software tools allow the information to be researched, analyzed flexibly, and downloaded onto the user's own PC for subsequent processing. At present, the core of the information system represents more than 650 million data from more than 100 data sources, combined in sensible indicators. Clearly arranged diagrams, easy-to-understand texts, and precise definitions complete the offer. Documentations contain additional information on more than 200 data sources, features of surveys, methodological questions of surveys, and contact persons.

Der neue L�nderindikatorensatz f�r die Gesundheitsberichterstattung

In May 2003, the third revised version of the indicator set for health reporting activities was confirmed by the health ministries of all German States (Bundesländer). Modeled on the restructured indicator set which has been annotated with meta-data descriptions, most Bundesländer have now started to collect data for their specific health reporting activities. Thanks to the support provided by national data holders and the Federal Statistical Office, it has been possible to further enlarge the database and for the first time also ensure access via the Federal Statistical Office. In this contribution the authors describe the methodological and statistical principles of the indicator set. Another aspect is the benefit of the indicator set for the health reporting activities in the German States.

Neuronal apoptosis inhibitory protein (NAIP)-like immunoreactivity in brains of adult patients with Down syndrome

In Down syndrome (DS), enhanced apoptosis (programmed cell death) may play a role in the pathogenesis of characteristic early mental retardation and precocious neurodegeneration of Alzheimer-type. The human IAP (inhibitor of apoptosis proteins) genes (NAIP, c-IAP-2/HIAP-1, c-IAP-1/Hiap-2, XIAP, survivin) are an evolutionary conserved family of proteins which prevent cell death across species, implying that they act at a central, highly conserved point in the cell death cascade. Evidence for downregulation of NAIP-mRNA in fetal DS (23rd week of gestation), as found by subtractive hybridization technique challenged studies at the protein level in adult DS brain specimen. NAIP-like immunoreactivity was determined in four different regions of cerebral cortex and cerebellum in 9 adult DS patients with Alzheimer-like neuropathologic lesions, 9 Alzheimer disease (AD) patients as compared to 9 controls. For the first time, NAIP-IR could be demonstrated in different cortical regions of the human brain. Compared to control subjects, western blotting demonstrated significantly decreased levels in parietal and occipital cortex in DS and in frontal and occipital cortex in AD. While the mode of NAIP action is unknown, inhibition of certain caspases has already been demonstrated for other IAP-family members (c-IAP1, c-IAP2 and XIAP). Although decreased NAIP-IR of certain brain regions in DS and AD awaits further confirmation, the results suggest that alterations of apoptosis regulatory (inhibitory) proteins may be another feature of neurodegeneration in DS and AD.

Supercomputing in cancer research

Human Genome Analysis and Image Processing are part of the 'Grand Challenges' in High Performance Computing. The traditional mainframe has become insufficient for these applications in Biocomputing. Scalable parallel processor systems have entered the marketplace with superior price/performance. The evaluation process of such a system by an application-oriented benchmark test suite is described. Meanwhile a large system is integrated in the client/server structure of the Deutsches Krebsforschungszentrum where the traditional mainframe is completely replaced by scalable systems.

[Surgical correction of clubfoot in patients with myelomeningocele]

Between 1974 and 1991, 100 equinovarus deformities in 65 patients with myelomeningocele have been primary operated at the authors clinic. Aim of our treatment was a plantigrade position of the foot, to give the possibility of an orthetic supply. 75% of our patients reached this result after the first operation, 25% had to be operated once more. The incision was done in the way of Cincinnati. According to the level and type of paralysis the operative treatment had to be adapted. We could reach good results of treatment in group 1 (thoracal to L2) with 64% of plantigrade feed as well as in group 3 (L5 to sacral) with 61%. Group 2 (L4 to L5) was worse with 32%. Within all types of paralysis there was a better result while doing a tenotomy. Paralysed muscles should be cut, innervated muscles should be extended to keep the function. Important is the reconstruction of a balance of the muscles. While you have a forefoot varus, a plentiful medial release is necessary. After the operation a cast was given for 8 to 12 weeks, followed by special shoes and nightly storage in stales. Corresponding to the treatment of idiopathic equinovarus deformity the beginning of therapy should be started after birth and should be completed while the child begins to verticalize.

Experimental in vitro and in vivo studies of epithelium formation on biomaterials seeded with isolated respiratory cells

Extensive tracheal defects after intensive care medicine, trauma, or large resections in tumor surgery remain a major challenge in plastic and reconstructive surgery. Defects that cannot be satisfactorily treated by complicated and costly reconstructive techniques reveal a need for an alloplastic tracheal replacement. Recent experimental and clinical studies in the development of alloplastic tracheal prostheses proved that the lack of an epithelial lining on the luminal surfaces and inadequate biophysical properties and shapes of the prostheses were the main causes for failure of these prostheses. In this study a cell-seeding technique has been used. Adhesion, spreading, and differentiation of seeded mucosa cells on biomaterials in vitro were observed by scanning electron microscopy (SEM). Chemical properties and surface structure of the material influenced the differentiation process. Epithelium formation of incorporated tracheal prostheses was tested in animal experiments. Isolated respiratory cells were seeded into implanted tubular prostheses of porous polyurethane or expanded polytetrafluorethylene. Light microscopy and SEM showed the tendency of epithelium formation on the surface of the lumen. Vigorous cell layers, predominantly as multiple cell layers of squamous epithelium, were observed. Ciliated or mucus cells were not detected. It can be stated that the epithelium formation on incorporated porous implants is possible. Further studies of the stability and the differentiation process of the epithelium on such implants is needed before an introduction of tracheal replacements into the clinical practice can be considered.

Bilirubin phototoxicity to human cells by green light phototherapy in vitro

Phototherapy of newborn infants with blue or green light is the most common treatment of neonatal hyperbilirubinemia. Using bilirubin bound to human lymphoid and basal skin cells we obtained the green light dose dependency of the bilirubin phototoxicity to these cell types. Cells (3-5 x 10(6)/mL) were incubated with bilirubin complexed to human serum albumin (final concentrations 340 microM bilirubin, 150 microM albumin). Under these conditions all cells showed maximum binding of bilirubin. Irradiation with broadband green light (lambda max = 512 nm) over 24 h led to a light dose-dependent population of cells, which contained no bilirubin on the cell membrane as determined by Nomarski interference microscopy. The light-induced mechanism of the disappearance of bilirubin caused lethal membrane damage to the cells (trypan blue exclusion test). The cell kill rate increased with the irradiation dose and with the fraction of cells with no bilirubin. When 90% of lymphoid cells were bilirubin free, 46% of them were dead (using 480 J cm-1 green light). Similar results were obtained with basal skin cells. In addition, bilirubin-induced damage of cell membrane and nuclear membrane was also shown by transmission electron microscopy. Bilirubin (340 microM) in the dark led to 5% of the cells being killed. Basal skin cells bind 2.5 times more bilirubin molecules than lymphoid cells and showed a different bilirubin disappearance. Irradiation of bilirubin in carbon tetrachloride with 514.5 nm laser light showed generation of singlet oxygen via its luminescence at 1270 nm. These results demonstrate that green light phototherapy of hyperbilirubinemia may cause both skin and immune system damage.

[Copper-induced liver cirrhosis in a 13-month old boy]

A micronodular liver cirrhosis with a massive accumulation of copper in hepatocytes was found in a 13-months old boy. The causal factor was due to the increased copper concentration within the drinking water, which caused liver disease of the boy who had been completely weaned at the age of four weeks. The cooper concentration found in the drinking water exceeded 12 mg/l after a twelve hour stagnation time; after several days of stagnation the highest measured concentration was 28.6 mg/l. This increase is caused by the combined effect of copper pipes and acidulous well water.

High performance computing for the human genome project

Human Genome Analysis and Image Processing are part of the 'Grand Challenges' in High Performance Computing. The traditional mainframe has become insufficient for these applications in Biocomputing. New scalable parallel processor systems enter the marketplace with superior price/performance. The evaluation process of such a system by an application-oriented benchmark test suite is described. The system is integrated in the client/server structure of the Deutsches Krebsforschungszentrum where 'rightsizing' will eliminate the mainframe completely in the near future.

[Epithelialization of porous biomaterials with isolated respiratory epithelial cells in vivo]

Extensive tracheal defects after prolonged assisted ventilation, trauma or large resections in tumor surgery are a challenge in plastic and reconstructive surgery. Defects which cannot be satisfactorily repaired reguine near of an alloplastic tracheal replacement. Previous experimental and clinical experiences in the development of an alloplastic tracheal prosthesis have demonstrated that the main cause for failure is the lack of an epithelial lining of luminal surfaces and inadequate biophysical properties of the prosthesis. With the use of a cell-seeding technique tested in vitro on biomaterials epithelialization of tracheal prostheses can be tested in vivo. In animal experiments isolated respiratory cells were seeded into implanted tubular prostheses of porous polyurethane or expanded polytetrafluorethylene. Light and scanning microscopic investigations then showed the tendency of epithelialization to occur on the luminal surfaces. Vigorous squamous epithelium cell layers that were single and (predominantly) multiple layers were found. Differentiated cilated or mucous cells were not detected in any case. The present results have shown that epithelialization of incorporated porous implants is possible. The realization of usable tracheal replacement for clinical practice must still be tested in further experiments.

[Surgical treatment of the obliterated tympanic cavity with autologous mucous membrane cell suspension]

5 patients suffering from high-grade sound conduction deafness due to extensive adhesion process on both ears underwent tympanoplasty on one of the ears. The missing tympanic mucosa was replaced by an autologous cell suspension prepared from mucosa of the maxillary sinus. 6-12 months after re-epithelialisation of the tympanic cavity, reconstruction of the ossicular chain was performed using glasionomer cement prostheses (IONOS). 3 patients showed an improvement of hearing after transplantation of the isolated mucosal cells and following replacement of auditory ossicles. One patient had good improvement of hearing already after reconstruction of the tympanic cavity. In one case reobliteration of the tympanic cavity occurred. The clinical results confirm that using mucosal cell suspensions for reepithelisation of an obliterated tympanic cavity is yet another successful step forward in reconstructive surgery of the middle ear.