Aims Endoscopic vacuum therapy (EVT) has been proven to be an effective tool for closure of postoperative anastomotic leaks. We report a series of acute esophageal perforations treated with EVT successfully.

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EUS-Biopsienadeln mit speziellem Schliff (Franseen Schliff, Acquire® FNB Nadel) zielen auf histologisch auswertbare Gewebezylinder ab. Diese prospektive Studie untersucht als primären Zielparameter die histologische Qualität der gewonnen Proben und sekundär die diagnostische Genauigkeit.

In accordance with the 'refinement' component of the 3Rs, the primary aim of this study was to investigate and compare ketamine + medetomidine (KM) and s-ketamine + medetomidine (SKM) anaesthetic protocols in C57BL/6J mice (both sexes). We sought to determine whether s-ketamine could provide adequate surgical tolerance at a 50% dose relative to that of ketamine racemate and whether antagonism of medetomidine could be initiated 15 min earlier. The second aim was to investigate the potential improvement in analgesia for both anaesthetic protocols by adding butorphanol or metamizole. Analgesia was tested via the pedal withdrawal reaction (PWR) to a painful stimulus. During anaesthesia, respiratory frequency, pulse oximetry, body temperature and PWR were monitored. Among the 16 mice in each group, the PWR was lost in all the KM + metamizole (35:56 ± 6:07 min), KM + butorphanol (43:45 ± 2:14 min) and SKM + butorphanol (24:03 ± 5:50 min) mice, 15 of the non-premedicated KM (37:00 ± 8:11 min) mice, and 9 of the pure SKM (20:00 ± 4:19 min) mice; the latter group increased to 11 mice (17:16 ± 5:10 min) with premedication of metamizole. In contrast to the racemic combination, s-ketamine at the dose used here did not lead to sufficient loss of the PWR. However, earlier partial antagonism of SKM resulted in a slightly shorter and qualitatively better recovery than later partial antagonism of SKM. The addition of metamizole or butorphanol to KM or SKM anaesthesia positively influences the analgesic quality. However, when butorphanol is added, controlled ventilation may be necessary, especially for male mice.

The increasing prevalence of asthma, hay fever, and allergic sensitization in Western Germany after east-west division in 1949 and their rapid increase in East German children after re-unification in 1990 are strong indications for the role of life-style and/or environmental factors in the development of atopic diseases. Obviously, the perinatal period is crucial for priming the immune system. Therefore, explorations of determinants of atopic diseases need pregnancy or birth cohorts as the most appropriate epidemiological study designs. This review presents the design and selected results of the two German birth cohorts GINIplus and LISAplus. GINIplus and LISAplus recruited 5.991 and 3.097 healthy, term newborns, respectively, from Munich, Wesel, Leipzig, and Bad Honnef. Approximately 55% could be followed for the first 10 years. We analyzed the natural course of atopic diseases and the role of life-style, environmental, and genetic factors for disease onset, intermediate phenotypes, and genes involved in detoxification and oxidative stress. The results of these two large birth cohorts contributed substantially to the understanding of atopic diseases and their determinants.

Lifestyle-Gadget oder Hilfsmittel zum Rauchstopp? Fluch oder Segen? Sargnagel oder Rettungsanker? Kaum ein anderes Produkt ist unter Experten derzeit so heftig diskutiert wie die elektronische Zigarette [1–3]. Während die einen sie ob der chemischen Zusammensetzung ihrer Inhaltsstoffe als höchst gesundheitsgefährdend einstufen, betrachten andere sie als eine historische Chance, Millionen Menschenleben zu retten. Dabei ist das Ziel aller Wissenschaftler das gleiche – die enormen durch Zigarettenkonsum verursachten gesundheitlichen Schäden zu minimieren.

Purpose: The German maternity record (GMR, "Mutterpass") is the most important document for pregnant women and their health care providers during antenatal care. While the serological and ultrasound sections have been updated regularly, the document's catalogue of pre-existing factors has remained unaltered since 1986. We investigated whether a health-focused revision of the GMR would serve the needs of pregnant women and their care providers.Methods: A revised version of the Mutterpass was developed by a multidisciplinary panel of experts, focusing on health and salutogenesis. The new document highlights the uncomplicated pregnancy, and gives pregnant women the opportunity to make their own notes and to choose an appropriate place of birth after consultation with the doctor or midwife. These changes were developed within the requirements of the latest version of the German maternity guidelines (GMG) mandatory during the revision process. To test for user-friendliness and acceptance, 23 persons - 8 consultants, 7 midwives and 8 pregnant women - were asked to evaluate the revised GMR. Comments could be entered in the GMR itself and in an electronic survey. Notes in the GMR (n = 296 comments) were assigned to one of 7 categories (e.g. general comments, structural aspects) by 2 reviewers. After 6 weeks one of the reviewers repeated her evaluation.Results: 20 of the 23 persons approached wrote comments in the document, 19 participated in the electronic survey. Consultants and midwives predominantly stated that they would prefer to work with the revised GMR (92%). - Pregnant women appreciated the space for their own notes (83%). Most respondents (90%) had a good general impression. Inter-observer agreement was kappa = 0.43, intra-observer agreement - kappa = 0.55.Conclusions: This health-focused version of the German maternity record is a first step towards optimising maternity records in Germany. Future investigations should consider revisions going beyond the content of the mandatory guidelines.

Früher Beginn von Tabakkonsum erhöht die Suchtgefahr, damit das Risiko rauchassoziierter Folgeerkrankungen und reduziert maßgeblich die Lebenserwartung. Deshalb steht das Rauchverhalten Jugendlicher zunehmend im Blickwinkel des öffentlichen Interesses. Die in den Mikrozensus 2005 und 2009 erhobenen Daten zum Rauchverhalten Jugendlicher im Alter von 15 – 19 Jahren in Baden-Württemberg (BW) wurden nach Regierungsbezirken (RB) und Regionen (RG) ausgewertet und verglichen. Die Raucherprävalenz bei den 15 bis unter 20-jährigen lag in BW im Jahr 2005 mit 21,1% um 2,4% unter dem Bundesdurchschnitt. In 2009 war sie gegenüber 2005 um 5,1% auf 16,0% gesunken (Deutschland: 17,5%). Ein Vergleich der 4 RB innerhalb BW zeigte in 2005 im RB Karlsruhe und Freiburg eine Raucherprävalenz von jeweils 20,0%, im RB Tübingen von 21,6% und im RB Stuttgart von 22,1%. Deutlich Unterschiede zwischen den RB konnten beim Rückgang jugendlicher Raucher bis 2009 beobachtet werden (RB Freiburg -2,6%, RB Karlsruhe -4,3%, RB Tübingen -5,8%, RB Stuttgart -6,5%). In den einzelnen RG ist die Raucherprävalenz seit 2005 regional sehr unterschiedlich gesunken (von -0,5% in der RG Donau – Iller bis -7,8% in der RG Rhein-Neckar) und war 2009 in den RG Hochrhein-Bodensee und Neckar-Alb mit 18,9% am höchsten, in der Rhein-Neckar Region mit 11,8% deutlich am niedrigsten in BW. Die Reduktion des Tabakkonsums bei Jugendlichen in BW kann als Erfolg einer Kombination struktureller, verhaltenspräventiver und interventioneller Maßnahmen gewertet werden. Für die auffällig niedrige Raucherprävalenz mit 11,8% bei Jugendlichen in der Rhein-Neckar Region darf die Wirksamkeit des in dieser Region seit 13 Jahren etablierten primären Raucherpräventionsprogrammes für Schüler „ohne Kippe“ vermutet werden, an dem mittlerweile ca. 150.000 Schüler teilgenommen haben. Fazit: Strukturierte Präventionsprogramme für Schüler können die Raucherprävalenz bei Jugendlichen senken und sollten deutschlandweit etabliert werden.

Zusammenfassung Hintergrund: Die Thoraxklinik Heidelberg führt seit 2000 die Primärpräventionsmaßnahme „ohnekippe“ für 12- bis 14-jährige Schüler durch. Um die Wirksamkeit zu überprüfen, wurde die Maßnahme wissenschaftlich evaluiert. Methoden: Teilnehmende Schüler (n=1427) wurden zum Zeitpunkt der Intervention und nach einem Jahr zu ihrem Rauchverhalten befragt. Als Kontrollgruppe (n=1412) dienten Klassenstufen aus vergleichbaren Schulen ohne Präventionsveranstaltung. Anschließend erfolgte eine Adaptation des Programms in Zusammenarbeit mit den Schulen und es wurden Mikrozensusdaten von 2005 und 2009 zum Rauchverhalten Jugendlicher verglichen. Ergebnisse: Zu Beginn waren 187 (13,4 %) der Schüler der Interventionsgruppe und 215 Schüler (15,4 %) der Kontrollgruppe Raucher. Nach einem Jahr war der Anteil der Raucher von 11,2 % auf 21,2 % angestiegen mit nicht signifikantem Unterschied zwischen beiden Gruppen. Neben Alter und initialem Rauchstatus zeigte sich die „peer group“ als besonders wichtige Einflussgröße auf das Rauchverhalten. Nach anschließender Adaptation des Programms zeigte der Vergleich der Mikrozensusdaten eine mit 11,8 % um 4,2 % geringere Raucherprävalenz als im gesamten übrigen Baden-Württemberg (16,0 % Raucherprävalenz) und im restlichen Deutschland (17,5 % Raucherprävalenz). Der Anteil der Raucher in dieser Altersgruppe ist im genannten Einzugsgebiet von 2005 bis 2009 mit 7,8 % deutlich gesunken. Folgerungen: Raucherprimärpräventionsmaßnahmen für Schüler können bei entsprechender Konzeption wirksam sein. Allerdings kann der Raucherstatus von Schülern mit einer Veranstaltung alleine nicht nachhaltig beeinflusst werden. Unabdingbar ist daher eine intensive Vor- und Nachbereitung sowie die Einbindung der „peer group“. Das Primärpräventionsprogramm „ohnekippe“ wurde daher mit vielversprechendem Erfolg entsprechend modifiziert.

In the recently published 10-year follow-up of the German Infant Nutritional Intervention (GINI) study, it is reported that partially hydrolyzed whey formula (pHF-W) and extensively hydrolyzed casein formula (eHF-C), but not extensively hydrolyzed whey formula (eHF-W), prevent allergic disease compared with standard cow's milk formula.1von Berg A. Filipiak-Pittroff B. Krämer U. Hoffmann B. Link E. Beckmann C. et al.Allergies in high-risk schoolchildren after early intervention with cow's milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study.J Allergy Clin Immunol. 2013; 131: 1565-1573Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar These results suggest that both protein source and peptide size are important, and hence being able to identify studied formulas with marketed products and evaluating changes to formulations are crucial.2Scientific Committee on FoodReport of the Scientific Committee on Food on the revision of essential requirements of infant formulae and follow-on formulae. European Commission, Brussels2003Google Scholar In the case of the pHF-W and eHF-C used in the GINI study, some formulation changes since study enrollment ended in 1998 are noted, but it is reported that the “quality of the hydrolysates remained unchanged.”1von Berg A. Filipiak-Pittroff B. Krämer U. Hoffmann B. Link E. Beckmann C. et al.Allergies in high-risk schoolchildren after early intervention with cow's milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study.J Allergy Clin Immunol. 2013; 131: 1565-1573Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar No information is apparently available concerning eHF-W. Data reported for pHF-W in an earlier GINI study publication noted peptide sizes of 54% at less than 1500 Da and 18% at greater than 6000 Da.3von Berg A. Koletzko S. Grubl A. Filipiak-Pittroff B. Wichmann H.E. Bauer C.P. et al.The effect of hydrolyzed cow's milk formula for allergy prevention in the first year of life: the German Infant Nutritional Intervention Study, a randomized double-blind trial.J Allergy Clin Immunol. 2003; 111: 533-540Abstract Full Text Full Text PDF PubMed Scopus (391) Google Scholar With the ineffective eHF-W, the comparable reported figures were 84% at less than 1500 Da and 2% at greater than 6000 Da. The US Food and Drug Administration (FDA) recently reviewed information on pHF-W for a qualified health claim for the prevention of atopic dermatitis. In the manufacturer's submission to the FDA, the typical mean molecular weight of peptides in the hydrolysate, across 30 product batches, indicated approximately 2.5% of peptides at greater than 5000 Da.4Nestle Infant Nutrition/Gerber Products company qualified health claim petition for 100% whey-protein partially hydrolysed infant formula and reduced risk of atopic dermatitis. Section C: analytical data regarding the substance. Available at: http://www.regulations.gov/#!documentDetail;D=FDA-2009-Q-0301-0011. Accessed April 2, 2013.Google Scholar Potential differences in methodology between laboratories or changes over time, as well as differing peptide size cutoff points, make such comparisons with studied formulas difficult, and therefore directly comparable data are of particular interest. With the reduction in protein concentrations noted for pHF-W,1von Berg A. Filipiak-Pittroff B. Krämer U. Hoffmann B. Link E. Beckmann C. et al.Allergies in high-risk schoolchildren after early intervention with cow's milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study.J Allergy Clin Immunol. 2013; 131: 1565-1573Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar the new formulation was compared with the previous formulation.5Zeigler E.E. Jeter J.M. Drulis J.M. Nelson S.E. Haschke F. Steenhout P. et al.Formula with reduced content of improved, partially hydrolysed protein and probiotics: infant growth and health.Monatsschr Kinderheilkd. 2003; 151: S65-S71Crossref Scopus (29) Google Scholar The low-protein formulation used a different whey fraction, with less glycomacropeptide and more lactalbumin, than the high-protein formulation. The low-protein pHF-W also contained more small peptides (62.8% at <1000 Da) and fewer large peptides (1.8% at >5000 Da) than the original formulation. Clinical differences between the 2 pHF-W formulas in terms of stool characteristics were hypothesized to be due to differences in the degree of protein hydrolysis.5Zeigler E.E. Jeter J.M. Drulis J.M. Nelson S.E. Haschke F. Steenhout P. et al.Formula with reduced content of improved, partially hydrolysed protein and probiotics: infant growth and health.Monatsschr Kinderheilkd. 2003; 151: S65-S71Crossref Scopus (29) Google Scholar Separate to the protein component, the standard formula and the ineffective eHF-W in the GINI study contained 25% canola oil in the fat blend, whereas no canola oil was present in the effective pHF-W or eHF-C.6GRAS Associates, on behalf of Danone Trading PV. GRAS notification—canola oil use in infant formulas, 6 March 2012. GRAS Notice 000425. Available at: http://www.accessdata.fda.gov/scripts/fcn/gras_notices/GRN000425.pdf. Accessed April 4, 2013.Google Scholar Variations in fat blend can affect fatty acid profiles and might also introduce trace amounts of different proteins,7Poikonen S. Rance F. Puumailanen T.J. Le Manach G. Reunala T. Turjanmaa K. Sensitization and allergy to turnip rape: a comparison between the Finnish and French children with atopic dermatitis.Acta Paediatr. 2009; 98: 310-315Crossref PubMed Scopus (12) Google Scholar with an effect on allergy outcomes difficult to definitively rule out. In summary, the pHF-W and eHF-C used in the GINI study contained a different fat blend than the control formula and the ineffective eHF-W. The pHF-W has since been reformulated using a different whey fraction with a lower protein concentration and apparently a smaller peptide size distribution closer to that of the ineffective eHF-W. There appears to be less data in the public domain for the other studied hydrolyzed protein products. It would be desirable to vary only 1 component between the control and study formulas and to evaluate poststudy formulation changes to ensure efficacy is not affected. Allergies in high-risk schoolchildren after early intervention with cow's milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) studyJournal of Allergy and Clinical ImmunologyVol. 131Issue 6PreviewThe long-term effect of nutritional intervention with hydrolysate infant formulas on allergic manifestations in high-risk children is uncertain. Full-Text PDF ReplyJournal of Allergy and Clinical ImmunologyVol. 132Issue 3PreviewIn his correspondence J. V. Meaney1 expresses concern about the possible effects of the lipid composition of the study formulas used in the German Infant Nutritional Intervention (GINI) study and on poststudy changes in the protein components. We thank Mr Meaney for pointing out these issues and for giving us the chance to clarify. Full-Text PDF

There is evidence that environmental factors are important for the development of eczema. Different mechanisms have been discussed in the literature, the best known of which is the hygiene hypothesis. However, epidemiological data give reason for questioning this hypothesis with regard to childhood eczema. We present results from two German birth cohort studies (LISAplus and GINIplus) concerning regional prevalence patterns of eczema and the association of eczema with day care center attendance and older siblings. Our findings are not in line with the hygiene hypothesis and question its validity with regard to eczema. It seems reasonable to assume that the effect of environmental factors is somehow disease-specific.

BACKGROUND:The association between dietary fatty acid intake and the development of atopic diseases has been inconsistent. This could be due to inter-individual genetic differences in fatty acid metabolism.OBJECTIVE:The aim of the current study was to assess the influence of FADS1 FADS2 gene cluster polymorphisms on the association between dietary fatty acid intake and atopic diseases and allergic sensitization in 10-year-old children.METHODS:The analysis was based on data from two German prospective birth cohort studies. Data on margarine and fatty acid intake were collected using a food frequency questionnaire. Information on atopic diseases was collected using a questionnaire completed by the parents. Specific IgE against common food and inhalant allergens were measured. Six variants of the FADS1 FADS2 gene cluster (rs174545, rs174546, rs174556, rs174561, rs174575 and rs3834458) were tested. Logistic regression modelling, adjusted for gender, age, maternal education level and study centre, was used to analyse the association between fatty acid intake and atopic diseases stratified by genotype.RESULTS:No significant association was found between the six FADS single nucleotide polymorphisms (SNPs) and allergic diseases or atopic sensitization. The total n-3/total n-6 ratio was positive associated with an increased risk of hayfever in homozygous major allele carriers ranging from an adjusted odds ratios of 1.25 (95%-CI: 1.00-1.57) to 1.31 (95%-CI: 1.01-1.69) across the six tested SNPs although this association was not significant anymore after correcting for multiple testing. Daily margarine intake was significantly associated with asthma [1.17 (1.03-1.34) to 1.22 (1.06-1.40)] in individuals carrying the homozygous major allele. This association was also significant after correcting for multiple testing.CONCLUSIONS & CLINICAL RELEVANCE:The association between dietary intake of fatty acids and allergic diseases might be modulated by FADS gene variants in children.