A high-fidelity prototype of a sterile information system for the perioperative area: OR-Pad

PURPOSE

Supporting the surgeon during surgery is one of the main goals of intelligent ORs. The OR-Pad project aims to optimize the information flow within the perioperative area. A shared information space should enable appropriate preparation and provision of relevant information at any time before, during, and after surgery.

METHODS

Based on previous work on an interaction concept and system architecture for the sterile OR-Pad system, we designed a user interface for mobile and intraoperative (stationary) use, focusing on the most important functionalities like clear information provision to reduce information overload. The concepts were transferred into a high-fidelity prototype for demonstration purposes. The prototype was evaluated from different perspectives, including a usability study.

RESULTS

The prototype's central element is a timeline displaying all available case information chronologically, like radiological images, labor findings, or notes. This information space can be adapted for individual purposes (e.g., highlighting a tumor, filtering for own material). With the mobile and intraoperative mode of the system, relevant information can be added, preselected, viewed, and extended during the perioperative process. Overall, the evaluation showed good results and confirmed the vision of the information system.

CONCLUSION

The high-fidelity prototype of the information system OR-Pad focuses on supporting the surgeon via a timeline making all available case information accessible before, during, and after surgery. The information space can be personalized to enable targeted support. Further development is reasonable to optimize the approach and address missing or insufficient aspects, like the holding arm and sterility concept or new desired features.

Contrast modes in a 3D ion transmission approach at keV energies

We present options for visualizing contrast maps in 3D ion transmission experiments. Simultaneous measurement of angular distributions and flight time of ions transmitted through self-supporting, single-crystalline silicon foils allows for mapping of intensity and different energy loss moments. The transmitted projectiles were detected mainly for random beam-sample orientation using pulsed beams of He ions and protons with incident energies 50 and 200 keV. Differences in contrast, observed when varying the projectile type and energy, can be attributed to sample nuclear and electronic structure and bear witness to impact parameter dependent energy loss processes. Our results provide a base for interpretation of data obtained in prospective transmission studies when for example using a helium ion microscope.

Disparate Energy Scaling of Trajectory-Dependent Electronic Excitations for Slow Protons and He Ions

We have simultaneously measured angular distributions and electronic energy loss of helium ions and protons directly transmitted through self-supporting, single-crystalline silicon foils. We have compared the energy loss along channeled and random trajectories for incident ion energies between 50 and 200 keV. For all studied cases the energy loss in channeling geometry is found lower than in random geometry. In the case of protons, this difference increases with initial ion energy. This behavior can be explained by the increasing contribution of excitations of core electrons, which are more likely to happen at small impact parameters accessible only in random geometry. For helium ions we observe a reverse trend-a decrease of the difference between channeled and random energy loss for increasing ion energy. Because of the inefficiency of core-electron excitations even at small impact parameters at such low energies, another mechanism has to be the cause for the observed difference. We provide evidence that the observation originates from reionization events induced by close collisions of helium ions occurring only along random trajectories.

[Implementation of the "Digital Pathology in Diagnostics" guideline : Support systems and their functionality]

BACKGROUND

The "Digital Pathology in Diagnostics - Assessment of Digital Images" guideline describes the technical and legal framework under which the use of this digital technology is justifiable for the individual pathologist. The focus is on conducting a validation study, defining minimum requirements for the generation and management of whole slide images, and ensuring the functionality and quality of the virtual microscopy solution used. By establishing a special web-based service, supportive services can be provided to assist the pathologist in the introduction of virtual microscopy and quality assurance.

AIM

Presentation of the Digitale-Pathologie.de server and description of its services in the context of the guideline.

RESULTS AND DISCUSSION

In the context of several scanner contests at the Charité in Berlin, as well as with the introduction of virtual microscopy in practice, many experiences were collected, which will be presented systematically. Essentially, this will provide support for the application of the guideline in practice. The following fields are discussed: implementation of the guideline recommendations, planning and evaluation of the validation study, and ensuring the correct color calibration of the slide scanner being used. Via the Digitale-Pathologie.de server, the possibility for self-monitoring and anonymously benchmarking will be offered. For example, errors in setup can be detected quickly and optimal settings can be identified.

Radiative Rotational Lifetimes and State-Resolved Relative Detachment Cross Sections from Photodetachment Thermometry of Molecular Anions in a Cryogenic Storage Ring

Photodetachment thermometry on a beam of OH^{-} in a cryogenic storage ring cooled to below 10 K is carried out using two-dimensional frequency- and time-dependent photodetachment spectroscopy over 20 min of ion storage. In equilibrium with the low-level blackbody field, we find an effective radiative temperature near 15 K with about 90% of all ions in the rotational ground state. We measure the J=1 natural lifetime (about 193 s) and determine the OH^{-} rotational transition dipole moment with 1.5% uncertainty. We also measure rotationally dependent relative near-threshold photodetachment cross sections for photodetachment thermometry.

The cryogenic storage ring CSR

An electrostatic cryogenic storage ring, CSR, for beams of anions and cations with up to 300 keV kinetic energy per unit charge has been designed, constructed, and put into operation. With a circumference of 35 m, the ion-beam vacuum chambers and all beam optics are in a cryostat and cooled by a closed-cycle liquid helium system. At temperatures as low as (5.5 ± 1) K inside the ring, storage time constants of several minutes up to almost an hour were observed for atomic and molecular, anion and cation beams at an energy of 60 keV. The ion-beam intensity, energy-dependent closed-orbit shifts (dispersion), and the focusing properties of the machine were studied by a system of capacitive pickups. The Schottky-noise spectrum of the stored ions revealed a broadening of the momentum distribution on a time scale of 1000 s. Photodetachment of stored anions was used in the beam lifetime measurements. The detachment rate by anion collisions with residual-gas molecules was found to be extremely low. A residual-gas density below 140 cm(-3) is derived, equivalent to a room-temperature pressure below 10(-14) mbar. Fast atomic, molecular, and cluster ion beams stored for long periods of time in a cryogenic environment will allow experiments on collision- and radiation-induced fragmentation processes of ions in known internal quantum states with merged and crossed photon and particle beams.

Photodissociation of an Internally Cold Beam of CH^{+} Ions in a Cryogenic Storage Ring

We have studied the photodissociation of CH^{+} in the Cryogenic Storage Ring at ambient temperatures below 10 K. Owing to the extremely high vacuum of the cryogenic environment, we were able to store CH^{+} beams with a kinetic energy of ∼60  keV for several minutes. Using a pulsed laser, we observed Feshbach-type near-threshold photodissociation resonances for the rotational levels J=0-2 of CH^{+}, exclusively. In comparison to updated, state-of-the-art calculations, we find excellent agreement in the relative intensities of the resonances for a given J, and we can extract time-dependent level populations. Thus, we can monitor the spontaneous relaxation of CH^{+} to its lowest rotational states and demonstrate the preparation of an internally cold beam of molecular ions.

Desflurane compared with propofol for postoperative sedation in the intensive care unit

BACKGROUND

We hypothesized that emergence from sedation in postoperative patients in the intensive care unit would be faster and more predictable after sedation with desflurane than with propofol.

METHODS

Sixty patients after major operations were allocated randomly to receive either desflurane or propofol. The target level of sedation was defined by a bispectral index(TM) (BIS(TM)) of 60. All patients were receiving mechanical ventilation of the lungs for 10.6 (SD 5.5) h depending on their clinical state. The study drugs were stopped abruptly in a calm atmosphere with the fresh gas flow set to 6 litres min(-1), and the time until the BIS increased above 75 was measured (t(BIS75), the main objective measure). After extubation of the trachea, when the patients could state their birth date, they were asked to memorize five words.

RESULTS

Emergence times were shorter (P<0.001) after desflurane than after propofol (25th, 50th and 75th percentiles): t(BIS75), 3.0, 4.5 and 5.8 vs 5.2, 7.7 and 10.3 min; time to first response, 3.7, 5.0 and 5.7 vs 6.9, 8.6 and 10.7 min; time to eyes open, 4.7, 5.7 and 8.0 vs 7.3, 10.5 and 20.8 min; time to squeeze hand, 5.1, 6.5 and 10.2 vs 9.2, 11.1 and 21.1 min; time to tracheal extubation, 5.8, 7.7 and 10.0 vs 9.7, 13.5 and 18.9 min; time to saying their birth date, 7.7, 10.5 and 15.5 vs 13.0, 19.4 and 31.8 min. Patients who received desflurane recalled significantly more of the five words. We did not observe major side-effects and there were no haemodynamic or laboratory changes except for a more marked increase in systolic blood pressure after stopping desflurane. Using a low fresh gas flow (air/oxygen 1 litre min(-1)), pure drug costs were lower for desflurane than for propofol (95 vs 171 Euros day(-1)).

CONCLUSIONS

We found shorter and more predictable emergence times and quicker mental recovery after short-term postoperative sedation with desflurane compared with propofol. Desflurane allows precise timing of extubation, shortening the time during which the patient needs very close attention.

Clustering of isochorismate synthase genes menF and entC and channeling of isochorismate in Escherichia coli

There are two isochorismate synthase genes entC and menF in Escherichia coli. They encode enzymes (isochorismate synthase, EC 5.4.99.6) which reversibly synthesize isochorismic acid from chorismic acid. The genes share a 24.2% identity but are differently regulated. Activity of the MenF isochorismate synthase is significantly increased under anaerobic conditions whereas the activity of the EntC isochorismate synthase is greatly stimulated during growth in an iron deficient medium. Isochorismic acid synthesized by EntC is mainly channeled into enterobactin synthesis whereas isochorismic acid synthesized by MenF is mainly channeled into menaquinone synthesis. When menF or entC were separately placed onto overexpression plasmids and the plasmids introduced into a menF(-)/entC(-) double mutant in two separate experiments, the isochorismate formed was fed into both, the menaquinone and the enterobactin pathway. Moreover, in spite of a high isochorismate synthase activity menaquinone and enterobactin formation were not fully restored, indicating that isochorismate was lost by diffusion. Thus, under these conditions channeling was not observed. We conclude that in E. coli the chromosomal position of both menF and entC in their respective clusters is a prerequisite for channeling of isochorismate in both pathways.

Properties and interaction of heterologously expressed glutamate decarboxylase isoenzymes GAD(65kDa) and GAD(67kDa) from human brain with ginkgotoxin and its 5'-phosphate

Two isoforms of glutamate decarboxylase (GAD(65kDa) and GAD(67kDa)) from human brain, which had previously been overexpressed in Escherichia coli as fusion proteins containing a glutathione-S-transferase domain, were purified by affinity chromatography on glutathione Sepharose 4B. Both isoforms were also expressed in Saccharomyces cerevisiae. After modification of a HPLC based assay, the enzymes were characterized with respect to their biochemical properties. Comparison of kinetic data, pH, and temperature optima as well as of the mode of interaction with pyridoxal phosphate as a cofactor revealed several significant differences between the two isoenzymes reflecting their somewhat different physiological and molecular features. Investigation of the influence of 4'-O-methylpyridoxine (ginkgotoxin) (1), a neurotoxin occurring in Ginkgo biloba L., on the different isoenzymes, indicates that the phosphorylated form of the toxin, 4'-O-methylpyridoxine-5'-phosphate (2), decreases GAD(65kDa) activity, although in unphysiologically high concentrations, whereas GAD(67kDa) activity seems to be hardly affected.

Dynamic deconvolution of a pre-equilibrated dynamic combinatorial library of acetylcholinesterase inhibitors

A dynamic combinatorial library composed of interconverting acylhydrazones has been generated and screened towards inhibition of acetylcholinesterase from the electric ray Torpedo marmorata. Starting from a small set (13) of initial hydrazide and aldehyde building blocks, a library containing possibly 66 different species was obtained in a single operation. Of all possible acylhydrazones formed, active compounds containing two terminal cationic recognition groups separated by an appropriate distance, permitting two-site binding, could be rapidly identified by using a dynamic deconvolution--screening procedure, based on the sequential removal of starting building blocks. A very potent bis-pyridinium inhibitor (K(i)=1.09 nM, alphaK(i)=2.80 nM) was selected from the process and the contribution of various structural features to inhibitory potency was evaluated.

Pulsed photothermal radiometry as a method for investigating blood vessel-like structures

Pulsed photothermal radiometry (PPTR) is known to be suitable for in vivo investigations of tissue optical properties. As a noncontact, nondestructive method it is a very attractive candidate for on-line dosimetry of laser treatments that rely on thermal laser-tissue interaction. In this article, we extend the one-dimensional (1D) analytical formalism that has widely been used to describe PPTR signals to a two-dimensional treatment of a simplified model of a blood vessel. This approach leads to quantitative description of a PPTR signal that, unlike in an 1D treatment, not only shows changes in time, but also varies in space. Using this approach, we are able to gain instructive understanding on how target characteristics of a blood vessel-like structure influence such a spatiotemporal PPTR signal. Likewise, the ability of extracting target features from those measurements is evaluated. Subsequently, we present experimental realization of the idealized model of a blood vessel as used in our theory. Comparison of actual PPTR measurements with theoretical predictions allow vessel localization laterally and in depth. Using our setup, we furthermore demonstrate the influence of flow inside the vessel on the measured signal.

CD83+ human dendritic cells transfected with tumor peptide cDNA by electroporation induce specific T-cell responses: A potential tool for gene immunotherapy

Dendritic cells (DC) are the most potent immunostimulatory cells, with the capacity to induce primary T-cell responses. Functional autologous DC can be generated from fetal calf serum-free peripheral blood mononuclear cells in the presence of interleukin-4 and granulocyte-macrophage colony-stimulating factor and are stimulated with a defined cytokine cocktail for terminal maturation. We were able to establish a nonviral transfection protocol for these DC by electroporation. Using enhanced green fluorescent protein as a reporter gene, we achieved transfection efficiencies of up to 10%. FACScan analyses revealed a stable phenotype, and the expression of major histocompatibility complex class II and CD83 was not affected by the transfection conditions used. Like their untransfected counterparts, DC that were functionally transfected with green fluorescent protein were potent inducers of allogeneic T cells. To assess whether cDNAs transfected into DC are functionally expressed, human tyrosinase cDNA was transfected into DC. Tyrosinase-transfected DC, but not controls, resulted in antigen-specific tumor necrosis factor-alpha release of the tyrosinase-specific cytolytic T-cell clone IVSB. Taken together, the data show that genuine (CD83+) mature DC can be transfected using a nonviral method, and that the DC retain their functionality. These DC are ideal candidates for immunotherapy (e.g., cancer therapy).

Direct evidence that FK506 inhibition of FcepsilonRI-mediated exocytosis from RBL mast cells involves calcineurin

FcepsilonRI-mediated exocytosis of preformed mediators from mast cells and basophils (e.g. histamine, serotonin, beta-hexosaminidase) is sensitive to the immunosuppressants cyclosporin A and FK506 (IC50 200 and 4 nM, respectively) but not rapamycin. The mechanism of inhibition does not appear to involve tyrosine phosphorylation, hydrolysis of inositol phosphates or calcium flux. Here we report experiments using a molecular approach to assess the role of calcineurin, a serine/threonine phosphatase thought to be the primary pharmacological target of these drugs. Calcineurin's activity requires association of its catalytic (A) subunit with an intrinsic regulatory (B) subunit. We hypothesized that calcineurin-sensitive signalling events should be affected by the depletion of calcineurin B subunits, thereby reducing the number of active A:B complexes. We therefore transfected rat basophilic leukemia (RBL) cells with an inhibitory (dominant negative) form of the calcineurin A subunit, which binds the calcineurin B subunit with high affinity but does not possess catalytic activity (B subunit knock-out, BKO). In these transfected cells, the dose-response curve for the inhibition of FcepsilonRI-mediated exocytosis by FK506 was shifted to the left, indicating an increased drug sensitivity of BKO-transfected cells. We conclude that FK506 inhibition of FcepsilonRI-mediated exocytosis in mast cells specifically targets calcineurin activity.

Down-regulation of the MHC class I antigen-processing machinery after oncogenic transformation of murine fibroblasts

Malignant transformation is often associated with genetic alterations providing tumor cells with mechanisms for escape from immune surveillance. Human and murine tumors of various origin as well as in vitro models of viral and oncogenic transformation express reduced levels of major histocompatibility complex (MHC) class I antigens resulting in decreased sensitivity to MHC class I-restricted cytotoxic T lymphocyte (CTL)-mediated lysis. We here investigate whether the suppressed MHC class I surface expression of ras-transformed fibroblasts is due to dysregulation of the genes of the antigen-processing machinery, the peptide transporters TAP-1 and TAP-2 and the proteasome subunits LMP-2 and LMP-7, and whether it can be restored by gene transfer. In comparison to parental NIH3T3 cells, the ras oncogenic transformants revealed reduced TAP and LMP mRNA expression and impaired function of these genes, leading to deficient peptide transport and peptide loading of MHC class I molecules resulting in instable expression of the MHC class I complex on the cell surface. Enhanced H-2 surface expression due to stabilization of the MHC class I complex could be achieved by culturing ras transformants at low, unphysiological temperature (26 degrees C) or by loading these cells with either exogenous human beta2-microglobulin or MHC class I-binding peptide alone or in combination. Furthermore, interferon-gamma treatment was capable to enhance the expression of TAP, LMP and MHC class I molecules in both parental as well as ras-transformed fibroblasts. Stable transfection of the human TAP-1 cDNA into ras transformants caused a partial reconstitution of the peptide transport and an enhancement of the MHC class I surface expression, whereas the level of MHC class I biosynthesis was not affected by TAP-1 overexpression in parental cells. Together these results point to the existence of an association between oncogenic transformation and deficiencies in the MHC class I antigen-restricted immunosurveillance, suggesting intervention strategies involving specific MHC class I-binding peptides or transfection of the LMP and/or TAP genes to overcome the expression of the immune escape phenotype.

Endogenous type II cGMP-dependent protein kinase exists as a dimer in membranes and can Be functionally distinguished from the type I isoforms

In mammalian tissues two types of cGMP-dependent protein kinase (cGK) have been identified. In contrast to the dimeric cGK I, cGK II purified from pig intestine was shown previously to behave as a monomer. However, recombinant rat cGK II was found to have hydrodynamic parameters indicative of a homodimer. Chemical cross-linking studies showed that pig cGK II in intestinal membranes has a dimeric structure as well. However, after purification, cGK II was found to be partly proteolyzed into C-terminal monomeric fragments. Phosphorylation studies in rat intestinal brush borders revealed that the potency of cGMP analogs to stimulate or inhibit native cGK II in vitro (i.e. 8-(4-chlorophenylthio)-cGMP > cGMP > beta-phenyl-1,N2-etheno-8-bromo-cGMP > beta-phenyl-1,N2-etheno-cGMP and Rp-8-(4-chlorophenylthio)-cGMPs > Rp-beta-phenyl-1, N2-etheno-8-bromo-cGMPs, respectively) correlated well with their potency to stimulate or inhibit cGK II-mediated Cl- secretion across intestinal epithelium but differed strikingly from their potency to affect cGK I activity. These data show that the N terminus of cGK II is involved in dimerization and that endogenous cGK II displays a distinct activation/inhibition profile with respect to cGMP analogs, which permits a pharmacological dissection between cGK II- and cGK I-mediated physiological processes.

Specific stabilization of the 4F7 molecule on dendritic cells by contact allergens

Our laboratory has recently developed the monoclonal antibody 4F7 which recognizes a molecule on dendritic cells in the dermis of mice that is upregulated after application of contact allergens in vivo. Furthermore, this antibody detects an antigen on dendritic cells in spleen, lymph nodes and colon. In order to study the influence of contact allergens on the surface expression of the 4F7 molecules on dendritic cells, FACScan analysis of splenic dendritic cells was carried out after in vitro application of contact allergens. Freshly isolated splenic dendritic cells were found to be positive for 4F7, 33D1, N418 (CD11c) and MHC class II. After overnight culture the expression of the dendritic cell-specific molecules 4F7 and 33D1 was decreased. This downregulation was not inhibited by the addition of the cytokines TNF-alpha or GM-CSF during in vitro culture. However, in vitro treatment of freshly isolated dendritic cells with the contact allergen 2,4-dinitrofluorobenzene prevented this downregulation of the 4F7 surface molecules. The same effect was observed after treatment with other contact allergens (1-chloro-2,4-dinitrobenzene or potassium dichromate). Treatment with the irritant substance sodium dodecyl sulphate, the lectins concanavalin and lipopolysaccharide or the phorbol ester PMA did not prevent the downregulation of 4F7 and 33D1. Moreover, the influence of contact allergens on the expression of the molecules 4F7 and 33D1 was not inhibited by the protein synthesis inhibitor cycloheximide. No effects of contact sensitizers were detectable on the expression of MHC class II molecules or the costimulatory molecules B7 and heat-stable antigen. Our results show a specific stabilizing effect of contact allergens on the dendritic cell-specific molecules 4F7 and 33D1 independent of de novo protein synthesis.

Epidermal cells enhance interleukin 4 and immunoglobulin E production after stimulation with protein allergen

Exposure to certain allergens via epithelial tissues is the primary route for the induction of immunoglobulin E-dependent allergies of the immediate type associated with atopic diseases. In order to address the question whether and how epithelial cells might contribute to the induction or increase of TH2-dependent IgE production, we performed co-culture experiments of syngeneic epidermal cells and cells from the associated lymphoid tissue or spleen (responder cells) of BALB/c mice primed with ovalbumin in vivo. In the presence of ovalbumin in vitro, immunoglobulin E but not immunoglobulin G2a production was significantly enhanced by the addition of epidermal cells, and separation of epidermal cells from responder cells by a membrane that prevented cellular contacts or addition of antibodies against intercellular adhesion molecule-1 reduced the enhancement of immunoglobulin E production induced by epidermal cells. Depletion of major histocompatibility complex class II+ antigen presenting Langerhans cells from the epidermal cells prior to co-culture also reduced the enhancement of immunoglobulin E production induced by epidermal cells. The enhanced immunoglobulin E production was dependent on the induction of TH2 cell-derived interleukin-4 detected in co-cultures because it was completely inhibited after addition of anti-interleukin-4 antibodies that also lead to increased immunoglobulin G2a production. Whereas interleukin-4 was not produced by epidermal cells, interleukin-10 seemed to be one important mediator contributed by epidermal cells. Interleukin-10 skewed the response toward a TH2-mediated IgE response because antibodies against interleukin-10 inhibited interleukin-4 and immunoglobulin E production, whereas they enhanced interferon-gamma and immunoglobulin G2a production.

Multiple levels of MHC class I down-regulation by ras oncogenes

A number of tumours and oncogene transformed cells displayed reduced MHC class I surface expression which seemed to enable their escape from immune surveillance. To test whether oncogenic activation is directly involved in suppressing MHC class I expression, a model of inducible oncogene expression was chosen. Mouse fibroblasts transfected with different oncogenes expressed under the control of the dexamethasone-inducible MMTV promoter were analysed in the presence and absence of hormone for the mRNA and protein expression of MHC class I molecules as well as the respective oncogenes. Immunofluorescence analyses demonstrated an inverse association of MHC class I and oncogene expression after dexamethasone stimulation, independent of the type of oncogene causing transformation. Hormone-mediated induction of oncogene expression caused down-regulation of all H-2 loci. Kinetic experiments using MMTV c-Ha-ras(A) transfectants revealed that down-regulation of MHC class I surface expression was preceded by a dexamethasone-induced change of morphology, anchorage-independent growth, and an increase of the ras protein p 21. Parallel monitoring of mRNA expression demonstrated a time-dependent up-regulation of ras specific transcripts, which was associated with differential regulation of MHC class I heavy and light chain transcripts. Beta2-microglobulin transcripts were transiently suppressed, whereas MHC class I heavy chain transcripts remained unaffected. To investigate the mechanisms of oncogene-mediated down-regulation of MHC class I expression, H-2 promoter transfections and a nuclear run on assays were performed. In MMTV c-Ha-ras(A) cells, neither alterations of the H-2 promoter activity nor of the transcriptional activity of H-2 antigens was observed in the presence of dexamethasone, whereas both could be up-regulated by interferon-gamma treatment. These data suggest that oncogene-mediated transformation is directly associated with MHC class I down-regulation, but that complex interactions affecting MHC class I heavy and light chain genes at the transcriptional and/or post-transcriptional level are involved in this process.

Adenosine 3',5'-monophosphate-dependent protein kinase and granulosa cell responsiveness to gonadotropins

The mechanisms by which estradiol enhances the actions of FSH (and cAMP), including the induction of LH receptors in rat ovarian granulosa cells, remain unclear. These studies were conducted to determine the extent to which changes in the activity, content, or intracellular distribution of the catalytic subunit of cAMP-dependent protein kinase might be altered in granulosa cells as a consequence of estradiol, FSH, and hCG administration in vivo. Dose-dependent stimulation of protein kinase activity (measured by histone phosphorylation in the presence of [gamma 32P]ATP and cAMP) demonstrated that the EC50 for cAMP was consistently 20 X 10(-8) M in cytosols prepared from granulosa cells of hypophysectomized rats before and after treatment with estradiol alone or estradiol and FSH. However, estradiol alone caused a 1.5 to 2.0-fold increase in the total amount of enzyme activity. When the cytosol content of the catalytic subunit (C) was quantitated directly, using immunoblotting procedures, the amount of C was 40 pmol/mg protein in all tissues, regardless of hormone treatments in vivo. When the content of RII, the regulatory subunit of type II cAMP-dependent protein kinase, was measured by similar immunoblotting procedures, a 10-fold increase was observed in granulosa cells exposed to both estradiol and FSH compared to that in cells exposed to estradiol alone. Greater than 80% of the intracellular content of both C and RII was present in the cytosol fraction (30,000 X g supernatant) rather than in the particulate nuclear fraction (30,000 X g pellet) of granulosa cells. This distribution of subunits was not altered by rapidly elevating intracellular concentrations of cAMP in vivo with 10 IU hCG, iv. We conclude that the catalytic subunit of protein kinase is a constitutive component of granulosa cells and that the sensitivity of the enzyme for cAMP is not affected by hormones or by a 10-fold increase in RII. Thus, the ability of estradiol to enhance FSH and cAMP action in granulosa cells appears to come primarily from the induction of specific substrates for the enzyme and a small increase in the catalytic activity but not from a change in the content of the catalytic subunit.

[Physical capacity of schizophrenic patients]

Reduced physical capacity in schizophrenic illness has been described in medical literature, but so far not been substantiated empirically. The findings of progressive bicycle ergometry confirm the assertion, with the following main results having been obtained: 1. As opposed to a matched comparison group of untrained healthy clients, the schizophrenically ill patients demonstrated significantly lower endurance levels in respect of the aerobic-anaerobic threshold. 2. Relative to the load maximum attainable highly significant differences existed between the groups. Particularly noteworthy had been early exercise termination already at submaximal loads by the schizophrenic patients. 3. The patients under study obtained values one third below standard compared to the maximum load target for untrained persons, with age and weight being taken into account. The findings are discussed as regards the possible causes of the performance reductions found as well as possibilities for improvement, demanding in particular that sports therapy programmes receive greater emphasis in the rehabilitation process. Also, the results obtained should be taken into consideration in the design of vocational rehabilitation measures.

[Social security for people in need of care -- proposals for the development and financing of aids for this group (author's transl)]

The article points out a serious deficiency in the social security system, i.e., that the old and infirm can only seldon obtain institutional care without calling on social assistance. It discusses possible solution of including the attendance allowances into the scope of social security benefits. The solutions are formulated in the amendment of the Association of German Cities and Towns (Deutscher Städtetag) to the insurance regulations of the earlier German Reich (Reichsversicherungsordnung). It is proposed that the Länder and communities as well as, to a small extent the Federal Government, assume the responsibility for investments, whereas the legal sickness insurance funds cover the costs for medical treatment and nursing and the patient pays an estimated rent value and the "hotel services".