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Biomedical subjects

J Michaelis

Publications and source records attributed to J Michaelis.

At least 73 records · Page 4Linked to original sources

Childhood malignancies in Germany--methods and results of a nationwide registry.

Since 1980, a nationwide registry of childhood malignancies has been established in the Federal Republic of Germany. The registry combines features of a population-based and a hospital-based registry. Basic registry data are complemented and validated by data from all ongoing clinical trials in paediatric oncology. Descriptive analyses are presented for the first 13 years of operation of the registry. In addition, time trends and regional variations of incidence within the Federal Republic of Germany are shown. A brief description of completed and ongoing registry-based epidemiological studies is given.

Adolescent↗

Is neuroblastoma screening evaluation needed and feasible?

Despite the five million children who have been screened for neuroblastoma in Japan through detection of catecholamine metabolites, it is still uncertain whether screening for this disease is beneficial. The Japanese study has clearly indicated that screening at 6 months or earlier leads to heavy overdiagnosis. It is shown in this paper that screening at a later age may give the same reduction in mortality with possibly less overdiagnosis. However, it is estimated that, even with two screens at 12 and 18 months, the reduction in mortality would not greatly exceed 25%, under realistic hypotheses on the length of the preclinical phase of the disease. The evaluation of the efficacy of this screening strategy would need the recruitment of half a million children per year over 5-7 years and the follow-up of an equal number of controls. Such a trial would improve our knowledge of the natural history of the disease and might help to answer some questions raised recently regarding its biological heterogeneity.

Age Factors↗

A new concept to ensure data privacy and data security in cancer registries.

In order to conform to the rigid German legislation on data privacy and security, a new concept of data flow and data storage for population-based cancer registries has been developed. This paper describes the basic principles of this approach and presents results from a pilot study in Rheinland-Pfalz. The cancer registry consists of two offices. The first office handles the notification of cases and communicates with the reporting physicians. It performs encryption of identifying data and passes encrypted records to the second office for permanent storage. Record linkage is performed with the encrypted data in the second office. This paper describes in detail how different encryption techniques are used for different purposes in order to ensure optimal security and the usability of the data. Our record linkage study shows that it is possible to keep both synonym and homonym error rates below 1%--acceptable both for routine performance of a registry and for scientific analyses. The methods described are not restricted to cancer registration and may therefore serve as a model for comparable MI applications.

Cohort Studies↗

Biopharmaceutical aspects of anti-infective therapy at the extremes of age.

Optimal anti-infective therapy at the extremes of age can be supported by the development of appropriate dosage forms. With regard to neonates, infants and children an oral liquid formulation appears to be superior compared with standard formulations such as tablets and capsules, since individualized dosing by body weight or body surface area is more easily achieved. Reformulation of marketed dosage forms, such as crunched tablets or opened capsules, by the hospital pharmacist may result in stability and bioavailability problems and therapeutic failures may be the consequence. With regard to the elderly a reduction in dosing frequency and individualized dosing are important in order to increase compliance. A reduction of dosing frequency can be achieved by oral controlled-release dosage forms, which are designed to release the drug in small amounts at predefined rates. However, to permit ease of swallowing they require a relative small daily dose together with excipients. In addition absorption must occur throughout the entire gastrointestinal tract; this is not the case for several antibiotics. Various advantages and disadvantages of oral liquid and oral controlled-release dosage forms are discussed. In the development of an oral formulation, in addition to a standard tablet a variety of information, such as physico-chemical characteristics, pharmacokinetics and pharmacodynamics must be available. Physico-chemical disadvantages can largely be solved by advanced pharmaceutical concepts, such as the pro-drug approach, complex formation or coprecipitation, which are discussed. Using ciprofloxacin with its long lasting and extremely bitter taste as an example, the pharmaceutical development of an oral liquid formulation and the pharmacokinetic investigations in healthy volunteers are described.

Administration, Oral↗

Immunohistochemical study of neutrophil- and fibroblast-type collagenases and stromelysin-1 in adult periodontitis.

Eight adult periodontitis (AP) patients were studied immunohistochemically to determine the presence of matrix metalloproteinases (MMPs) MMP-1, MMP-3, and MMP-8 in the marginal gingival and gingival granulation tissue specimens obtained from periodontal flap surgery after scaling and root planing. Clinically healthy gingival tissue specimens obtained from impacted third-molar extraction operations served as controls. MMP-type-specific antisera were applied by the avidin-biotin-peroxidase complex staining method. Moderate immunoreactivity for neutrophil collagenase (MMP-8) was found both in the AP patients' marginal gingival connective tissue and in gingival granulation tissue specimens. Immunoreactivity for fibroblast-type collagenase (MMP-1) and stromelysin-1 (MMP-3) was detected only in the AP patients' gingival granulation tissue specimens. In the control specimens, no immunoreactivity for the MMPs could be detected. For the first time, this finding demonstrates immunohistochemically the presence of MMP-8 in human inflamed gingiva in situ, and further highlights the importance of MMP-8 in periodontal tissue destruction, evidently during the acute phase(s) of the disease. However, our results confirm and extend previous studies indicating that other types of MMPs from resident gingival cell sources also seem to participate in the chronic and destructive course of periodontal inflammation.

Adult↗

Professional qualification of German physicians in medical informatics.

In addition to the medical education in the Federal Republic of Germany which includes a compulsory Medical Informatics course there exists a formal program for professional qualification of physicians in Medical Informatics. After two years of clinical practice and 1.5 years of professional training at an authorized institution, a physician may receive in addition to the medical degree a "supplement Medical Informatics". The qualification requirements are described in detail. Physicians with the additional Medical Informatics qualification perform responsible tasks in their medical domain and serve as partners for fully specialized Medical Informatics experts in the solution of practical Medical Informatics problems. The formal qualification is available for more than 10 years, has become increasingly attractive, and is expected to grow with respect to future Medical Informatics developments.

Education, Medical, Continuing↗

Mechanical methods of controlling ataxia.

Currently, the most effective and practical way of controlling ataxia which cannot be effectively treated with drugs, surgery or therapy is to use viscous damping. Devices are available commercially that have proved very effective in enabling people with ataxia to feed themselves and to use a computer, functions that they could otherwise not perform easily, if at all. For most people with severe ataxia this is very important. Being able to feed oneself is a very basic and important social and psychological function. Access to computers is extremely useful in this age, particularly for people with disabilities that prevent them from performing other functions. Provision of such devices can be one of the most effective ways of using resources to enrich the lives of people with ataxia.

Ataxia↗

Different effects of hypochlorous acid on human neutrophil metalloproteinases: activation of collagenase and inactivation of collagenase and gelatinase.

Human neutrophils stimulated with phorbol 12-myristate 13-acetate (PMA) produce the reactive oxidant hypochlorous acid (HOCl) and release the matrix metalloproteinases collagenase and gelatinase from secretory granules. We have investigated the stoichiometry of activation and inactivation of the two metalloproteinases with HOCl. HOCl activated purified neutrophil procollagenase at ratios between 10 and 40 mol of HOCl/mol enzyme, but caused inactivation at higher ratios. Maximum activation was about the same as that achieved by p-aminophenyl-mercuric acetate. However, less than a third of the total collagenase released from PMA-stimulated neutrophils was activated by coreleased HOCl and most of the activity was destroyed after 1 h of stimulation. These results indicate that the HOCl/enzyme ratio must fall within a narrow range for activation to occur. In contrast to collagenase, purified progelatinase underwent negligible activation (2.5 +/- 1.2%) at HOCl/enzyme molar ratios less than 30 and was destroyed at higher ratios. Likewise no active gelatinase could be detected in supernatant from PMA-stimulated cells and almost all of the proenzyme was destroyed by HOCl after 60 min stimulation. Our results illustrate that only collagenase can be activated by HOCl in vitro and that gelatinase is much more sensitive to inactivation. Since a precise HOCl/enzyme ratio is required for collagenase activation it is doubtful whether effective enzyme regulation by HOCl could occur in vivo where various HOCl scavengers are present.

Electrophoresis, Polyacrylamide Gel↗

Incidence of childhood malignancies in the vicinity of west German nuclear power plants.

The incidence of childhood malignancies in 20 areas surrounding major nuclear installations is compared with the incidence in matched control regions. The study is based on the registry of childhood malignancies in the Federal Republic of Germany and includes 1,610 cases which were diagnosed before 15 years of age from 1980 to 1990. The relative risk (RR) was 0.97 for all malignancies and 1.06 for acute leukemia in all regions within a 15 km radius of an installation. Increased RR was observed in subgroups for acute leukemia before five years of age and for lymphomas, especially in regions close to installations (less than 5 km) which started operation before 1970. Most of this increase was attributable to an unexpectedly low incidence in the control regions which could not be explained by analyzing possible confounding factors. Using the same control regions, a comparable and even more pronounced increase of RRs was observed in regions where nuclear power plants have been projected.

Adolescent↗

Risk assessment of future myocardial infarction from automated serial ECG analysis.

From 1980 to 1990 a cohort of 7,542 employees took part in the MARISK study. This study was designed in order to explore the utility of computerized electrocardiographic (ECG) measurements for predicting future myocardial infarction. After an initial period of annual examinations, follow-up information was collected by mailed questionnaires and obtained from 89.3% of all study participants with a median follow-up time of more than 7 years. Eighty-three participants suffered from myocardial infarction during the course of the study. Multivariate logistic regression analysis revealed that automated ECG measurements contribute significant additional information to risk estimates obtained from classical risk factors. Serial ECG analysis yields stronger risk indicators than single measurements. Results are represented via receiver operating characteristic (ROC) curves and regression coefficients, which can be used in independent applications. The results of this study indicate that it is useful to include automated serial ECG analysis in cardiovascular screening programs. It still has to be evaluated whether successful preventive measures may be based on such screening programs.

Cohort Studies↗

The 1989 Loma Prieta earthquake: impact on hospital patient care.

STUDY OBJECTIVE: To provide an overview of the Loma Prieta earthquake regarding patient care in affected hospitals. DESIGN: A retrospective review of medical records using International Classification of Disease, ninth revision (ICD-9) codes and a personal interview questionnaire. SETTING: Fifty-one hospitals in the six-county area most affected by the earthquake. TYPE OF PARTICIPANTS: Patients seeking care in emergency departments of study hospitals and supervising emergency physicians and ED nurses at the time of the earthquake. MEASUREMENTS: ED census data, complaint and diagnosis, disposition, and operative procedures for patients seen during the study period. MAIN RESULTS: Affected hospitals experienced a 15% increase in ED census during the study period. Minor trauma was the most common patient complaint. Open wound (870-897), contusion (920-924), and fracture (800-829) were the most common ICD-9 diagnostic categories. The percentage of patients presenting to EDs during the study period who were hospitalized increased slightly compared with baseline. Seventy-five percent of operative procedures were earthquake related; 63.7% of these were for fracture reduction. Physicians and nurses had somewhat conflicting opinions on adequacy of ED staffing. A small number of emergency physicians had difficulty in obtaining diagnostic tests on the night of the earthquake. Physicians noted no differences in diagnosis or treatment resulting from the earthquake. CONCLUSION: The Loma Prieta earthquake resulted in minimal negative impact on patient care in hospitals in the study area. The use of the ICD-9 classification deserves further consideration and study to improve the predictive value of disaster illness and injury reporting. The event has provided the stimulus for Bay Area hospitals to further improve plans for patient care during a disaster.

California↗

Latent collagenase and gelatinase from human neutrophils and their activation.

Procollagenase M(r) 85,000 (SDS-PAGE) was purified from buffy coat to homogeneity and represents a stable single polypeptide chain forming the entire proenzyme. The procollagenase can be activated by various proteinases, e.g. trypsin, chymotrypsin, cathepsin G, kallikrein and stromelysin and by different mercurial compounds. Proteolytic conversion of the latent enzyme to the active form by chymotrypsin is accompanied by a molecular weight reduction to an apparent M(r) 64,000. This active enzyme lacks the first 79 N-terminal residues. Activation by trypsin leads to a latent intermediate of apparent M(r) 70,000, lacking 48 N-terminal residues. The active enzyme is therefore generated upon prolonged incubation with trypsin by further cleavage of 22 N-terminal residues. Another latent intermediate form with apparent M(r) 69,000 is generated from the proenzyme upon incubation with leukocyte elastase by N-terminal cleavage of 53 or 64 residues, respectively. However, latent collagenase cannot be activated by plasmin. Activation by different mercurial compounds finally results in the formation of active collagenase with apparent M(r) 64,000. In contrast to the proenzyme, active collagenase can autolyse to give active M(r) 57,000 and 45,000 intermediates and two M(r) 28,000 fragments. Purification of latent leukocyte gelatinase yields three final products with apparent M(r) 98,000, 125,000 and 220,000 (SDS-PAGE; non reduced). Upon reduction, only the M(r) 98,000 form can be detected. The latent gelatinase can be activated in a similar manner as collagenase. Proteolytic activation by trypsin leads after N-terminal cleavage to an active gelatinase with sequence homology to leukocyte collagenase.

Amino Acid Sequence↗

Recommendations of the German Association for Medical Informatics, Biometry and Epidemiology for education and training in medical informatics.

In the fields of health care and medicine there is an immense demand for a systematic application of methods of information processing and for the use of computers. Obviously, to that end well-trained scientists and qualified personnel must be available. With the present recommendations on education and training in medical informatics the German Association for Medical Informatics, Biometry and Epidemiology (GMDS) proposes structure and contents of medical informatics curricula and courses. The recommendations describe a 2-dimensional educational framework with different education levels in one dimension and various types of educational needs and orientation in the other one. The recommendations comprise at the university level education as well specialized curricula covering the total spectrum of medical informatics as well as informatics curricula with medical informatics as integrated applied subject or subsidiary subject, respectively. Besides these informatics-oriented approaches medical-oriented programs of education in medical informatics are recommended, e.g., post-graduate education in medical informatics for physicians based on foundations in medical informatics as part of their initial training in medicine. At the level of polytechnical schools curricula of medical documentation and informatics and at the level of professional schools training in medical documentation are recommended. This report is a translation of its German original. Although considered by the GMDS as recommendations for the Federal Republic of Germany, the text may also contribute to the development of an international, especially European framework of training in medical informatics.

Germany↗