[Stepwise occupational reintegration under the German pension insurance scheme--results of comprehensive routine data analyses and participants surveys]

This paper presents for the first time research results of a comprehensive analysis on stepwise occupational reintegration (SOR) provided under the German pension insurance scheme. SORs under the German pension insurance scheme directly after medical rehabilitation have recently become possible as legal changes came into force in April 2004; until then, they had been provided by the health insurance funds independent of earlier medical rehabilitation. Against the background of this amendment of the law, the present study was commissioned by Deutsche Rentenversicherung Bund to get information relative to indication, introduction, implementation and results of the new SOR procedure. Analysis of routine data from the German pension insurance scheme pertaining to more than 140 000 insured persons treated in more than 1 083 medical rehabilitation centres, as well as of more than 6 500 participant surveys, resulted in a so far unique database for investigating SOR. This database offers a comprehensive collection of data and experiences relative to the amount of SOR prescribed and realized, to participants, procedure and results of SOR under the pension insurance scheme. This amount of data has never before been available when SOR was provided by the health insurance funds. The data collected suggest pinpoint indication of SOR, a positive rating of participants and an effective contribution to reintegration into working life and prevention of premature retirement. According to the present data, medical rehabilitation centres and their recommendations have an important influence on SOR utilization. Findings suggest major differences in the recommendation behaviours of rehabilitation centres, the possibilities offered by SOR not made use of to the same degree everywhere.

Stufenweise Wiedereingliederung nach orthopädischer Rehabilitation - Teilnehmer, Durchführung, Wirksamkeit und Optimierungsbedarf

This paper presents research results on stepwise occupational reintegration in patients with orthopaedic diseases, predominantly back pain. A retrospective questionnaire study was performed from January to May 2003. We questioned 534 insurants of the LVA (statutory pension insurance institute) in Schleswig-Holstein who had completed orthopaedic rehabilitation between 1999 and 2001 and had been recommended for stepwise occupational reintegration. The participant rate was 47% (n = 250 completed questionnaires). The standardized survey included demographic as well as illness-, rehabilitation- and job-related information. Particularly, information about the beginning and implementation of the stepwise occupational reintegration programme, its evaluation by the insurants, and their reintegration into working life was gathered. Stepwise occupational reintegration was recommended for 4.5% of the rehabilitation patients; 57% of them acted on this suggestion. The results show a positive appraisal of the stepwise occupational reintegration programme in general and high rates of reintegration (more than 80%) at mid-term. However, the dropout rate of 15% is quite high. The results suggest a necessity for optimization especially regarding initiation of the stepwise occupational reintegration programme, patient motivation, and better support for patients during the programme. Thus, a close linkage of stepwise occupational reintegration with accompanying rehabilitation programmes offers promising perspectives for purposive occupation-orientated rehabilitation programmes.

[Outpatient rehabilitation as mirrored by the users--findings on the quality of outpatient orthopaedic rehabilitation provided by the Federal Insurance Institute for Employees, BfA]

This article presents the central results of a survey including all persons insured by the BfA (Bundesversicherungsanstalt für Angestellte, German Federal Insurance Institute for Employees) who had participated in outpatient orthopaedic rehabilitation between March and August of 2002. A total of 3838 insured persons were addressed, 69 % replied (n = 2660 questionnaires). The standardized survey included an appraisal of the outpatient rehabilitation measure, the care provided by physicians, psychologists and therapists, the organisation and performance of the rehabilitation measure, as well as of the stressors and general conditions specific to various outpatient measures. The assessment of treatment outcome, physical and psychosocial improvements, and the attainment of therapy goals were of particular importance. Overall, the results show a positive appraisal of outpatient rehabilitation but also indicate the necessity for optimisation--particularly with regard to resting rooms, physician and psychological care, as well as the suitability of the therapy for everyday life. Above all, however, the comparison of the rehabilitation centres shows a great variance in quality of care. Some rehabilitation centres show extraordinary results in many aspects of quality, whereas others reveal systematic deficits of quality.

[Subjective estimations of the treatment programmes offered in inpatient and outpatient orthopaedic rehabilitation]

The survey of psychosocial, somatic and economic outcomes is regarded as standard in establishing the effectiveness of various rehabilitative forms of medical care. Another important part is the patient's perspective for the subjective valuation of the entire measure or different facets of the rehabilitation measure. During a comparison of the effectiveness of different forms of care of orthopaedic rehabilitation (inpatient, outpatient in the hospital, outpatient) 1176 patients were questioned in writing at 4 different time points. The results concerning the general measurement of the satisfaction with the rehabilitation measure showed a high level and a high acceptance in all forms of medical care at the end of and after the measure. The result relating to the selection of the correct hospital for the specific troubles of the patient was positive as well. This can also be stated for the patients' estimation of the contacts between the doctors and the physiotherapists. At the end of measure, all the patients in every form of care viewed these contacts as being helpful. The outpatient offers were viewed a bit better by the patients concerning the contacts to doctors and physiotherapists. The extent of the care specific to the different occupational groups was estimated by almost all patients of all forms as being just about right. Additionally, the course organization and the work of the administration had a good evaluation - with slight advantages for the inpatient forms.

[Evaluation of outpatient rehabilitation: goals, conceptual framework and study design of a health and pension insurance joint research project]

In Germany the statutory health and pension insurance schemes are the main providers of medical rehabilitation, the majority of rehabilitation measures being given in an inpatient setting. Over the last few years, the health and pension insurance schemes have strengthened the extension of outpatient rehabilitation, and have funded a comprehensive evaluation study in this context. In this evaluation study outpatient rehabilitation in centres with different conceptual backgrounds is compared with inpatient rehabilitation in rehab clinics, indications considered being cardiology and orthopaedics. Overall, 14 rehab centres and more than 2000 patients were included in the project. The patients were interviewed and medically examined before and after the measure. A follow-up was done after six and twelve months. In addition to the rehabilitants themselves, the rehab centre physicians as well as the office-practice physicians were interviewed about the outcome of the rehab measure. One year after rehabilitation, data were collected from the relevant health and pension insurance funds concerning the benefits the patients had received. Due to the study's non-experimental design, validity of the results is confined to rehabilitants participating on an outpatient basis and who had been found medically suited for this type of rehabilitation, were capable of travelling to the rehab centre on their own within less than 45 minutes and had voluntarily opted for the outpatient setting. The findings of the study show that outpatient rehabilitants' motivation and expectations differ from those found in inpatient rehabilitation. The health economics analysis performed is restricted to the costs involved in the rehabilitation measure as such as well as the health-related benefits provided to the rehabilitants in the twelve-month study period. The issue of whether increasing outpatient rehab measures will lead to decreasing costs in the rehab system as a whole had not been considered in the framework of this project.

[Outpatient and inpatient orthopaedic rehabilitation--results of a study comparing outcome and costs]

This article presents main results of a study comparing outcome and costs of various all-day outpatient and inpatient orthopaedic rehabilitation forms. The results were obtained within the scope of a comprehensive evaluation programme commissioned by the federation of health (VdAK) and pension insurance institutes (VDR). The purpose of this evaluation was to examine the quality of different types of various rehabilitation care. The outcome comparison comprises a longitudinal follow-up of various somatic, psychosocial und occupational reintegration parameters up to one year after rehabilitation as well as outcome assessments from the perspective of patients and physicians in rehabilitation centres and general practice. The costs are estimated on the basis of data from health and pension insurance funds. The results show extensive corresponding of results und assessments in the different forms of rehabilitation care for comparable patient groups. There are no indications of poorer care quality in outpatient rehabilitation, while economic analyses show better cost effectiveness in outpatient treatment by comparability of treatment, patients, and results. Results suggest that outpatient care, offered in the same quality as in the examined rehabilitation centres, is an alternative or complement to inpatient care at least for those patients, who can be treated in both the outpatient and inpatient setting.

[Structural and procedural quality of different orthopaedic rehabilitation settings: A comparison]

In addition to outcome quality, the quality of structure and process is an essential parameter for health care. In the context of a study comparing the outcome and costs of inpatient and different outpatient rehabilitation settings, the structural and procedural quality of the participating rehabilitation facilities were examined as well. Data were collected using questionnaires, interviews, treatment plans and visitations of the rehabilitation facilities. The analyses show a great correspondence of structural and procedural quality between the different rehabilitation settings. Particularly the data gathered by questionnaires show few differences. Points of significant difference include the more extensive equipment and the more favorable personnel key with regard to physicians in the inpatient clinics and the outpatient settings within these clinics. The outpatient rehabilitation facilities outside of rehabilitation clinics are characterized by a stronger accentuation of functional therapy, in particular physiotherapy and sports therapy. Functional therapy is of greater importance in the self-concept of the outpatient rehabilitation facilities and is also applied there more often.

[Multiperspective estimates on the probability of patient return to work following orthopaedic rehabilitation: findings and predictive relevance]

This article analyses various methods of predicting whether patients in orthopaedic rehabilitation will return to work. In this regard, items of patients, physicians in charge of rehabilitation and general practitioners have been collected and compared to working time lost due to illness. In total, 72 % of patients had successfully returned to work after one year. The patients whose reintegration could not be achieved could be identified best by asking if they believed that they would be in a position to work until the statutory retirement age (96 % identified) on the one hand and on the other hand by the physicians' estimate as to the degree the last gainful activity might be resumed (90 % identified). In this context, the criteria have to be laid down very restrictively in order to sufficiently filter out patients not likely to return to work. The patients likely to return to work are identified best by means of the following characteristics: lack of intention to retire early (96 % identified), planning to return to work directly after rehabilitation (88 % identified), and little working time lost due to illness prior to rehab (86 % identified). In general, a major percentage of patients not likely to return to work can be identified by these statements of patients and physicians. The statements of general practitioners are clearly less valuable for prediction and show only weak correlation with the respective statements of the physicians in charge of rehabilitation.

[Are there class-specific disadvantages in utilization of medical rehabilitation?]

Many studies prove the fact that the risk for morbidity and mortality is increased in lower social classes. Most chronical diseases also accumulate in lower classes. However, data are missing as to whether this social disadvantage also affects the use of medical rehabilitation, which could supply support in dealing with the consequences of such diseases. On the basis of questionnaire data of 3021 insures of the LVA pension insurance fund for workers, it was examined whether there are class specific differences in the need for medical rehabilitation and in the intention of insures to apply for such a measure and which kind of class specific barriers and attitudes may hinder the application. The results first of all confirm that insured of lower social classes are specially health strained and have a particular demand for rehabilitative offers. The insured, however, quite rarely rate themselves as requiring rehabilitation, whereas there is no significant class specific difference in the intention to apply for rehabilitation. There are significant differences in the attitudes which influence application for medical rehabilitation. Above all, there are economic considerations and job-related fears which hinder lower class insurees to apply for medical rehabilitation. This calls for action regarding implementation of special screenings and counselling.

[Analysis of premature termination in inpatient psychosomatic rehabilitation based on epidemiologic data from two hospital companies]

Premature termination of inpatient psychotherapy can have multiple, mostly negative, effects for patients, therapists, clinics, insurance companies, and employers, but research regarding inpatient settings is still deficient. The analysis of two sets of data of four different rehabilitation clinics from two different hospital companies (2699 and 2215 patients, respectively), aimed at possible predictors and outcomes of premature termination. We found ratios of premature termination of 8.3% and 14.7%, respectively. Especially young patients under 30 years of age and patients with eating and personality disorders were more likely to terminate inpatient treatment prematurely. Treatment outcome as rated by therapists was in significantly fewer cases among premature terminators than among successful terminators improved. The results seem to indicate, that assignment to inpatient psychotherapy can be optimized. For a better understanding of the process of premature termination more theory guided prospective and followup studies are necessary.

[Current trends in medical rehabilitation and their significance for the field of psychosomatic rehabilitation]

At present the process of serious restructuring can be observed in the system of medical rehabilitation in Germany. This paper focuses on recently initiated innovations and their consequences for psychosomatic rehabilitation. The patient's access to a psychosomatic rehabilitation system is analysed and examined to what extent innovations increase early detection of patients with psychosomatic disorders. Regarding the structure of psychosomatic rehabilitative offers, the initiated innovations such as an increase of flexibility, better transition and improvement of inpatient rehabilitative offers are described and discussed. Finally, the development of quality improvement programs and rehabilitation research in the field of psychosomatic rehabilitation is presented. Although many changes have taken place up to now, further relevant modifications in psychosomatic rehabilitation are predicted by the authors.

[Differential indications for ambulatory and inpatient medical rehabilitation--results of an expert survey]

Medical rehabilitation in the Federal Republic of Germany has been provided in an almost exclusively inpatient setting up to now. However, in view of an intensified development of outpatient rehabilitation programs there are new challenges to confront. As to indication criteria, new preconditions and handling directives have to be defined in order to refer patients to those rehabilitation programs from which they can profit the most. Up to now, there has been a considerable lack of knowledge as to what kind of criteria must be considered in the transfer process. The present study represents results of expert interviews (Delphi method) regarding this topic. 50 experts from inpatient and outpatient rehabilitation facilities, from the Medical Services of health insurance funds and the pension insurance system, from rehabilitation agencies as well as rehabilitation research, have been questioned since they take important stands on these questions and since their assessment has a guiding quality. An additional study had been directed at the factors which determine present decision-making in terms of inpatient vs. outpatient rehabilitation. The results show that the experts stress the importance of a multitude of different aspects; however, there still is but little consensus concerning the criteria that should invariably be considered in making these rehabilitation decisions.

[How great is the need for ambulatory rehabilitation in the orthopedics field?--Results of a multi-perspective approach]

Despite the necessity to expand the outpatient rehabilitation system in Germany the development up to now must be described as quite reluctant. As yet there is a considerable lack of information about the demand for such care in Germany. On the basis of a complex study design insurants, applicants for medical rehabilitation, physicians in a rehabilitation hospital and general practitioners were asked how they estimated the demand for outpatient orthopedic rehabilitation care. Resulting data unanimously show a substantial demand in roughly one third of insurants who desire rehabilitation, clearly exceeding the already realized outpatient care. The investigation also illustrated that physicians often are uncertain as to their decisions and that depending on the respective point of view (insurants or different groups of physicians) there are different preferences as to the kind of rehabilitative care for the benefit of one specific patient. The results stress not only the fact that there is a demand for information of insurants and their referring physicians regarding the new outpatient rehabilitation offer, but also reveal the demand for a development of differential indication criteria for outpatient and inpatient rehabilitation, as well as for definite procedural regulations which should be harmonized among all insurers.

Ceramic coagulation tip for interstitial thermoablation of the prostate: first experiments

A direct electrically heated ceramic coagulation tip for interstitial thermoablation has been developed. Both the coagulation tip and a laser system (Medilas 4060) were tested in vitro to compare their efficacies. We have obtained coagulation necroses of similar sizes. The electrical coagulation tip as opposed to laser coagulation is a new therapeutic option for the therapy of high risk patients with symptomatic benign prostatic hyperplasia. Because of the materials used and the principle of heating involved, certain economic and safety advantages over the laser system are offered.

Hybridization characteristics of biomolecular adaptors, covalent DNA--streptavidin conjugates

Semisynthetic, covalent streptavidin-DNA adducts are versatile molecular connectors for the fabrication of both nano- and microstructured protein arrays by use of DNA hybridization. In this study, the hybridization characteristics of six adduct species, each containing a different DNA sequence of 21 or 24 bases, have been compared. First, the adducts were conjugated to biotinylated alkaline phosphatase, and their binding to immobilized oligomer complements of similar lengths was quantified in a microplate assay. The binding efficiency observed varied to a great extent with the specific sequence of the oligonucleotide attached, and could not be predicted from affiliated thermodynamic data of duplex stability. To further elucidate the hybridization properties, the hybridization rate constants of association and dissociation (kassn and kdissn) have been determined for both unconjugated oligonucleotides and protein adducts, using a surface plasmon resonance biosensor. The kassn values observed for the oligonucleotides are in the range of 9 x 10(3) to 2 x 10(5) M[-1] s(-1) and correlate with structural properties of the probe strands. Up to 3-fold decreased kassn values were obtained for the corresponding protein adducts. Likewise, values were observed for kdissn ranging from 1.4 x 10(-4) to 1.9 x 10(-5) s[-1] for the oligonucleotides. The dissociation of the analogous protein conjugates was reduced by up to 5-fold. The extent of this decrease correlates with the formation of homodimeric or intramolecular aggregation of probe strands. A mechanistic model for explaining these data is based on attractive intramolecular interaction between the nucleic acid and protein moiety.

Increase in C-reactive protein in the serum of piglets (pCRP) following ACTH or corticosteroid administration

A new isolation procedure for porcine C-reactive protein (pCRP) by affinity chromatography and ion-exchange chromatography is described. Antisera against this protein were raised in rabbits. Immunochemical methods indicate a close immunological relationship of pCRP to human CRP (hCRP). The molecular weight of one subunit of pCRP was determined to be 23,400 Da by SDS-PAGE. Measurements of serum concentration of pCRP by competitive ligand assay and radial immunodiffusion showed a good correlation. Normal values of healthy pigs, kept under good conditions, were 8.35 mg/l with a normal range up to 16.8 mg/l (3 x SD). ACTH or prednisolone were applicated to piglets daily for a period of 2 weeks and the pCRP concentration in serum was measured. There was a strong pCRP elevation during the application period in comparison to a control group. When the stimulus disappeared, the values declined to normal. In the absence of infections and inflammations, the pCRP appears to be a valuable parameter for following the effects of stress on animals.

Heparin inhibits leukocyte rolling in pial vessels and attenuates inflammatory changes in a rat model of experimental bacterial meningitis

Heparin is a natural proteoglycan that was first described in 1916. In addition to its well characterized effect on blood coagulation, it is becoming clear that heparin also modulates inflammatory processes on several levels, including the interference with leukocyte-endothelium interaction. Anecdotal observations suggest a better clinical outcome of heparin-treated patients with bacterial meningitis. The authors demonstrate that heparin, a glycosaminoglycan, inhibits significantly in the early phase of experimental pneumococcal meningitis the increase of 1) regional cerebral blood flow (125 +/- 18 versus 247 +/- 42%), 2) intracranial pressure (4.5 +/- 2.0 versus 12.1 +/- 2.2 mm Hg), 3) brain edema (brain water content: 78.23 +/- 0.33 versus 79.49 +/- 0.46%), and 4) influx of leukocytes (571 +/- 397 versus 2400 +/- 875 cells/microL) to the cerebrospinal fluid compared with untreated rats. To elucidate the possible mechanism of this observation, the authors investigated for the first time leukocyte rolling in an inflammatory model in brain venules by confocal laser scanning microscopy in vivo. Heparin significantly attenuates leukocyte rolling at 2, 3, and 4 hours (2.8 +/- 1.3 versus 7.9 +/- 3.2/100 microm/min), as well as leukocyte sticking at 4 hours (2.1 +/- 0.4 versus 3.5 +/- 1.0/100 microm/min) after meningitis induction compared with untreated animals. The authors conclude that heparin can modulate acute central nervous system inflammation and, in particular, leukocyte-endothelium interaction, a key process in the cascade of injury in bacterial meningitis. They propose to evaluate further the potential of heparin in central nervous system inflammation in basic and clinical studies.

Histamine (H1) receptor antagonist inhibits leukocyte rolling in pial vessels in the early phase of bacterial meningitis in rats

The present study tested the hypothesis whether a histamine dependent pathway is involved in leukocyte-endothel interaction in the early phase of bacterial meningitis. Using confocal laser scanning microscopy we investigated leukocyte rolling in brain venules in vivo during 4 h in experimental pneumococcal meningitis in the rat. Leukocyte rolling, but not firm adhesion induced by intracisternally (i.c.) injected pneumococcal cell wall components, was temporarily inhibited (2 h, 5.6 +/- 1.9 vs. 2.3 +/- 0.9; 3 h, 7.4 +/- 2.7 vs. 3.1 +/- 1.3/100 microm/min) by diphenhydramine, a histamine H1 receptor antagonist. Histamine, possibly released by activated mast cells, is known to initiate P-selectin upregulation and subsequent leukocyte rolling. This data suggest that histamine is a mediator of leukocyte rolling in the early phase of bacterial meningitis.

The trigeminal nerve and augmentation of regional cerebral blood flow during experimental bacterial meningitis

We investigated whether trigeminal nerve fibers contribute to enhanced regional cerebral blood flow (rCBF) in a rat model of experimental bacterial meningitis. rCBF was measured continuously for 6 h by laser Doppler flowmetry through thinned bone over the frontal cortex. Meningitis was induced with pneumococcal cell wall components and confirmed by a significant increase of (a) leukocytes within the cerebrospinal fluid, (b) brain water content, (c) intracranial pressure and (d) rCBF. The increase of rCBF was significantly attenuated (p < 0.05) at 3, 4, 5, and 6 h in animals after a chronic (200 +/- 21% versus 138 +/- 13% at 6 h on the intact and denervated sides, respectively) but not after an acute section of the nasociliary branch of the trigeminal nerve. We conclude that elevations in blood flow during the early phase of bacterial meningitis are mediated in part by the trigeminal nerve, probably by local perivascular release of neuropeptides from afferent axons innervating the meninges.

Pneumococcal cell wall components induce nitric oxide synthase and TNF-alpha in astroglial-enriched cultures

Astroglia and microglia, the most numerous cells in the central nervous system (CNS), have been shown to produce the inducible nitric oxide synthase (iNOS) and tumor necrosis factor-alpha (TNF-alpha) upon stimulation with the cytokines IFN-gamma, IL-1-beta, or bacterial lipopolysaccharides (LPS). However, it is not known whether gram-positive bacteria like Streptococcus pneumoniae cause astroglial cells to release nitric oxide (NO) and TNF-alpha. S. pneumoniae meningitis still has a high incidence and mortality in spite of antibiotic therapy. Cell wall components from S. pneumoniae (pneumococcal cell-wall components, PCW) and TNF-alpha have been shown to cause meningeal inflammation and cerebrovascular changes in experimental meningitis. Addition of PCW to cultured rat astroglial cells increased nitrite in the supernatant significantly after 24 h, from 17 +/- 21 to 133 +/- 62 nM/micrograms protein. Nitrite release was dose-dependent in a range shown to cause meningeal inflammation in vivo and was inhibited by the competitive NO synthase inhibitor NW-nitro-L-arginine (L-NA 10(-4 M)) and dexamethasone (10(-6 M)), with transcriptional and translational inhibition by actinomycin D and cycloheximide, respectively. PCW caused a significant increase in the release of TNF-alpha from astroglial cells after 4 h, from 2 +/- 3.5 pg/ml to 102 +/- 13.5 pg/ml, which was inhibited by dexamethasone (10(-6 M)). Our results suggest a role for astroglial-derived NO and TNF-alpha as mediators of vascular and inflammatory response in the early phase of experimental pneumococcal meningitis.

Anti ICAM-1 (CD 54) monoclonal antibody reduces inflammatory changes in experimental bacterial meningitis

We investigated whether monoclonal antibodies directed against intracellular adhesion molecule 1 (ICAM-1 mAb) inhibit brain edema, increase of intracranial pressure (ICP), regional cerebral blood flow (rCBF) and recruitment of white blood cells (WBC) into the cerebrospinal fluid (CSF) in the rat model of the early phase of bacterial meningitis. Brain edema was assessed by brain water content determinations. rCBF measured by laser Doppler flowmetry and ICP were recorded continuously for 6 h after intracisternal challenge. Meningitis was induced with pneumococcal cell walls (PCW). Increase of ICP and brain water content were significantly inhibited (P <0.05) by intravenous treatment with ICAM-1 mAb (TM-8, 1 mg/kg). Furthermore, ICAM-1 mAb treatment profoundly attenuated (P <0.05) rCBF increase and WBC invasion into the CSF. These results suggest that the ICAM-1 pathway is critically involved in the early phase of bacterial meningitis.

Fucoidin, a polysaccharide inhibiting leukocyte rolling, attenuates inflammatory responses in experimental pneumococcal meningitis in rats

It is presumed that adjuvant therapy rather than new antibiotics will improve the prognosis of pneumococcal meningitis. We investigated the effect of fucoidin, a polysaccharide inhibiting leukocyte rolling, on inflammatory changes in experimental meningitis in rats. After induction of meningitis by pneumococcal cell wall components, regional cerebral blood flow and intracranial pressure increased over the observation period of 6 h. At the end of the experiments, cerebrospinal fluid pleocytosis and brain water content were higher in animals with meningitis than without. Fucoidin treatment in the meningitis group reduced all inflammatory changes, whereas fucoidin treatment of animals without meningitis increased blood white cell count, but had no effect on any other parameter. Our results confirm that selectins are involved in the early phase of pneumococcal meningitis and possibly are a target for adjunctive therapy.

C-reactive protein--a characteristic feature of health control in swine

In this study 120 weaned female piglets were clinically examined and porcine C-reactive protein (CRP) concentration determined in blood serum by means of a competitive enzyme ligand assay. CRP values were put into relation to clinical (catarrh, diarrhoea, inflammation and fever) and pathomorphological findings. It was found, that CRP values are clearly elevated during infections with fever and inflammatory processes, but not in the case of catarrh and diarrhoea. The pathomorphological investigations of some animals with clinical findings revealed changes in lungs, bowels and liver. Special attention has to be paid to the fact that, as in man, CRP is an acute phase reactant, and therefore a sensitive, but non-specific indicator for infections and inflammation processes. Serum CRP screening seems to be a good means for the supervision of the general state of health in pigs.

The rat female protein, a pentraxin with lectinic properties

The C-reactive protein is the major acute phase protein (APP) in humans which binds lectin-like to different membraneous structures and exerts an important function in non-specific defense. Because of a pentameric molecular symmetry CRP as well as serum amyloid P component (SAP) and hamster female protein (FP) was merged into a special protein family named pentraxins. In rats a protein was found referred to as rat FP which was close related to hamster FP with respect to hormonal regulation and APP nature as well. Based on this conformity the molecular structure of rat FP was analyzed and as the results a pentameric structure could be demonstrated for rat FP, too. Furthermore, the response of rat CRP and FP on injection of adrenal hormones, agents being involved in acute phase reaction, was investigated. Epinephrine administration led to an increase in CRP and a decrease in FP serum concentration. Dexamethasone has the same effect in case of FP and changed the CRP concentration in a biphasic way with a maximum at about 0.01 mg/kg, a minimum at 0.6 mg/kg and a return to control values at 1.8 mg/kg. Thus, the results indicate a neuroendocrine control of CRP and FP but probably in a different way. Using FITC-labelled lectin the exposition of galactose-containing membraneous structures could be demonstrated in carbon tetrachloride-injured liver tissue in contrast to controls. These binding sites are in accordance with increased FP-binding shown by immunofluorescence histochemistry. Thus, lectin-like properties may be ascribed to rat FP comparable to CRP and SAP activity. The results are discussed with respect to findings from literature that also the acetylcholine receptor seems to have a pentameric structure.

Nonspecific action of glucocorticosteroids after high-dose pulse therapy?

The original view of glucocorticoid effects as being divided into physiological and pharmacological ones is no longer acceptable, i.e. all glucocorticoid effects are apparently mediated by receptor occupation which triggers RNA protein synthesis. The concentrations needed for receptor-mediated effects are low, e.g. the KD value for dexamethasone is in the nanomolar range. The high-dose pulse glucocorticoid therapy results in blood concentrations much higher than those necessary for receptor saturation. This makes sense only when nonspecific effects may be expected to occur which necessitate concentrations higher than 10(-6) mol.l-1. In this paper the question of nonspecific glucocorticoid effects in adjuvant arthritis and carrageenin paw edema of rats was investigated using the glucocorticoid receptor antagonist RU 38486 and by injecting the RNA/protein synthesis inhibitors actinomycin D or cycloheximide. We did not find convincing evidence for nonspecific glucocorticoid mechanisms.

Modulation of rat C-reactive protein serum level by dexamethasone and adrenaline--comparison with the response of alpha 2-acute phase globulin

The alpha-2-acute phase globulin (alpha 2-APG) of the rat is one of the best investigated acute phase proteins. Glucocorticoids as well as catecholamines could be characterized as potent modulators of alpha 2-APG concentration. The aim of this study was to investigate whether the C-reactive protein (CRP), another acute phase protein important in human medicine, is also influenced by adrenal hormones and if so whether the effects are receptor-mediated or not. Adrenaline and isoproterenol (a beta-agonist) increase the blood level of alpha 2-APG and CRP dose-dependently probably due to a mechanism involved in the sequence of an inflammatory process, too. Dexamethasone administration led to a sigmoidal dose-response curve in the case of alpha 2-APG whereas a biphasic sinusoidal-like dose-response curve was obtained for CRP. Doses around 0.01 mg/kg (2 X 10(-8) Mol/kg) increased while doses around 0.1 mg/kg (2 X 10(-7) Mol/kg) decreased the CRP serum level. By combination of the agonists (adrenaline, dexamethasone) with the respective antagonists (propranolol, a beta-blocking agent and RU 38486, a glucocorticoid antagonist) the agonist-induced changes in concentration of CRP and alpha 2-APG could be suppressed. Therefore it can be assumed that the hormone effects are receptor-mediated ones. The reactions of arthritic or inflamed rats pretreated with RU 38486 indicate a considerable influence of endogenous glucocorticoids on blood levels of acute phase proteins. Taken together, both alpha 2-APG and CRP are modulated by adrenal hormones.(ABSTRACT TRUNCATED AT 250 WORDS)

The rat C-reactive protein--isolation and response to experimental inflammation and tissue damage

A new isolation procedure of rat C-reactive protein (CRP) by affinity chromatography on amino-coupled phosphorylcolamine-Sepharose is described. CRP serum level of rats injured by turpentine injection or two different arthritis models was determined to test the potency of this protein as an marker of inflammation. The influence of repeated administration of carbon tetrachloride as a hepatotoxic agent was investigated in the same way. It was shown that CRP determination is a useful method to observe the course of experimental inflammations and other tissue injuries as well.

Hormonal regulation of a new female-specific serum protein (FP) of the laboratory rat

This paper reports evidence for a hormonal regulation of a new rat serum protein (female specific protein, FP) which is only demonstrable in female rats. Male and female rats were treated with testosterone and estrogen. The FP was assayed with immunological methods. The following results were obtained: 1. In testosterone-treated females the serum level of FP is reduced significantly 2. In estrogenized males the FP was distinctly demonstrable but not in the control males.

Quantitative examinations of some rat proteins by means of absorbed anti-pregnancy and anti-feto sera

This paper reports quantitative examinations of some rat serum proteins which occur only, or in rising concentrations in pregnant rats before and after birth. A new serum protein is described which is only demonstrable in female rats. In male rats this protein is found rarely and then in very small quantities.