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Biomedical subjects

G Winkler

Publications and source records attributed to G Winkler.

At least 19 recordsLinked to original sources
PubMed2006

[BeKi--an initiative for nutrition education in children: program description and evaluation].

OBJECTIVES: The State Initiative Be KI is carried out statewide by the Baden-Württemberg Ministry for Nutrition/Food and Rural Area since 1980. Be KI addresses all target groups involved in the upbringing and education of children from age 6 months up to the end of the 6th grade and provides factual, validated, and independent information on child nutrition and nutrition education. Recently a comprehensive evaluation was carried out to assess the public health impact. Program, design and results of the evaluation are presented. METHODS: According to the RE-AIM Model for health promotion programs the evaluation assesses the public health impact in regard of individual and institutional reach, efficacy, adoption, implementation, and maintenance by various methods (e. g. written surveys and interviews with experts of child nutrition, in day care facilities and primary schools supplemented by internal data of the Ministry). RESULTS: Be KI represents the nutrition education program for children in the German language area with the longest uninterrupted operation span. The number of assignments of the child nutrition experts has been increasing ever since Be KI's official inception in 1980. During the school year 2004/2005 the experts carried out 6090 assignments, predominantly in primary schools which accounted for 60% of the assignments. About a third of schools know Be KI. The majority of kindergarten and school teachers who know the experts of child nutrition or the compilation use these offers. Many teachers use Be KI-components without knowing that they belong to Be KI. As a result of Be KI some of the teachers noticed short-time changes: pupils eat healthier break-time snacks and change their attitude towards a more balanced diet. Concerning the frequency of nutrition education and teachers attitude there are hardly any differences between institutions with Be KI and without Be KI. CONCLUSION: Be KI meets the main requirements of effective nutrition education programs for children: it is creative, engaging, inexpensive an widely dissiminated. Contents and methods of the provided materials correspond to the development level of the target groups. But communication and networking with educational institutions as well as public relations should be intensified and teachers in day care facilities and school teachers should be motivated to work with the Be KI-materials on their own (empowerment). Room for improvement exists in regard of a permanent straightforward evaluation system and a more pronounced orientation of the prevention program towards the social environment would be helpful.

Attitude to Health↗
PubMed2006

Nephrotic syndrome with focal segmental glomerulosclerosis after an insect bite.

AIMS AND METHODS: Focal segmental glomerulosclerosis (FSGS) is a glomerular disease defined by a characteristic histologic pattern that occurs either as a primary kidney disease (primary FSGS) or as a result of a systemic illness (secondary FSGS). Proteinuria, often in the nephrotic range, is the hallmark of FSGS. The occurrence of nephrotic syndrome after an insect sting is rarely reported in the literature. We present a case of nephrotic syndrome with focal segmental glomerulosclerosis with a glomerular tip lesion developing after an insect bite. RESULTS: A 51-year-old Caucasian female was bitten by an insect on her left leg, which immediately became swollen. Generalized edema developed and she was admitted for further investigations. Urinary 24-h protein excretion was 7 g. Percutaneous renal biopsy was performed and showed focal segmental glomerulosclerosis of the tip variant. Nephrotic syndrome was steroid-resistant, and when we added cyclophosphamide for 8 weeks complete remission was achieved. There was no relapse of the disease during the 2-month follow-up. CONCLUSIONS: This report demonstrates the useful role of cyclophosphamide in the treatment of steroid-resistant nephrotic syndrome due to FSGS with glomerular tip lesion. A causal relationship between the insect bite and the nephrotic syndrome is suggested and an immune response could be responsible for the nephrotic syndrome.

Cyclophosphamide↗
PubMed2005

[Extraordinary cause of a self-induced focal epilepsy].

Epilepsies and psychiatric disorders such as psychoses are known to have reciprocal influence. There are problems in patient compliance and pharmacological interactions between the drugs used for treatment. We report an unusual, self-induced, focal, symptomatic epilepsy in a hitherto unrevealed schizophrenic psychosis. The interdisciplinary treatment of three different departments was necessary. The initial symptom of a diffuse frontal headache and the patient's penetration of his own skull in an attempt at self-treatment led to the development of a frontal abscess around a foreign body and the described focal epilepsy.

Adult↗
PubMed2005

Correlation between the activities of lipoprotein lipase and paraoxonase in type 2 diabetes mellitus.

UNLABELLED: In type 2 diabetes mellitus the decreased catabolism of triglyceride-rich lipoproteins as a consequence of mainly the decreased lipoprotein lipase activity results in hypertriglyceridaemia and other lipoprotein alterations promoting atherosclerosis. The high-density lipoprotein-associated enzyme, paraoxonase, prevents the oxidation of low-density lipoprotein, which is an antiatherogenic effect. AIM: to examine the relation between the activities of enzymes influencing HDL remodelling- LPL and PON- in type 2 diabetes mellitus. METHODS: 56 newly diagnosed type 2 diabetic patients and 39 healthy controls were involved in the study. The serum PON activity was measured spectrophotometrically using paraoxone as substrate. PON phenotype was determined by the dual substrate method, PON mass was measured by ELISA. The determination of lipoprotein lipase activity was performed using 3H-triolein. RESULTS: We noticed smaller PON activity decrease in our newly diagnosed diabetic subjects compared to the previous studies which investigated the alteration of enzyme activity after a longer duration of diabetes mellitus. The lipoprotein lipase activity showed a positive correlation with PON activity (r=0.43; P<0.02). Interestingly, the PON activity of the homozygous-low activity group did not correlate with the LPL activity, while in the heterozygous and homozygous-high activity groups there was a significantly positive correlation (r=0.51; P<0.05) between PON and LPL activity. CONCLUSION: Besides lipid alterations, the metabolic changes of type 2 diabetes mellitus influence the reduction of the antioxidant capacity of HDL by remodelling HDL and decreasing PON activity via modification of lipoprotein lipase activity, which might contribute to accelerated atherosclerosis.

Aryldialkylphosphatase↗
PubMed2004

Size-reduced lung transplantation: an advanced operative strategy to alleviate donor organ shortage.

BACKGROUND: The increasing need for donor lungs, especially for small and pediatric recipients, has not been matched by an adequate supply. This disparity has stimulated the development of new operative techniques, which allow downsizing of larger lungs for use in smaller recipients, thus potentially expanding the donor pool. This approach has recently gained more widespread use, especially for highly urgent recipients; however, is still not considered a standard procedure. PATIENTS AND METHODS: All primary size-reduced lung transplants performed from January 2001 to December 2003 were retrospectively reviewed. Downsizing was achieved by either split-lung transplantation, lobar transplantation, or by means of a peripheral wedge resection. Waiting list time, perioperative complications, and outcomes of those patients were compared to patients undergoing primary standard single or double lung transplantation during the observation period. RESULTS: Among 163 primary lung transplantations 51 (31.3%) were size-reduced procedures. Size reduction was achieved by lobar transplantation (n = 18), split-lung transplantation (n = 2), or peripheral segmental resection (n = 31). There was a slightly decreased waiting time among the size-reduced group (74 +/- 72 vs 98 +/- 90 days, P = .13). No statistically significant difference between the size-reduced and the standard lung transplantation group was evident with regard to the rate of bronchial healing problems (n = 3/9; P = .62) or the rate of revision due to postoperative bleeding (n = 6/15; P = .77). No other major thoracic surgical complications were observed. The 3-month survival rate was 86.3% in the size-reduced 92.0% in the standard group (P = .09). CONCLUSION: Size-reduced lung transplantations, including split-lung transplantation, lobar transplantation, and peripheral segmental resection, may be considered reliable procedures that provide results comparable to standard lung transplantation. It allows the use of oversized grafts for small and pediatric recipients and the use of single lobes if localized pathologies exist, thus enlarging the donor pool and potentially helping to reduce waiting times and waiting list mortality.

Cadaver↗
PubMed2004

Emergency management in the early phase.

An overview of response management in the early phase of an emergency at a nuclear installation is provided from a systems approach. This starts with the recognition of response goals, and using detailed analyses of threats, past experience, international law and principles, a response strategy is developed. The process is illustrated for the case of severe accidents at pressurized water reactors (PWRs) and identifies the need for and nature of: emergency classification based on plant conditions, notification, radiological monitoring and assessment strategies, operational criteria for implementing protective action decisions and management of public information. From the strategy detailed, functional and infrastructure requirements can be defined. The paper also presents some reflections on the key differences between response to emergencies arising from accidents and those arising from deliberate acts; on the preparedness and response capabilities of States, highlighting areas where generic improvements are needed and how best to achieve that.

Decision Support Systems, Management↗
PubMed2004

Food and fatty acid intake and atopic disease in adults.

The aim of the study was to assess the relationship between dietary intake of selected foods and fatty acids with atopic disease prevalence in adults. Data from the European Community Respiratory Health Survey in Erfurt, combined with a 3-day weighed records dietary survey, was used. Complete data was available from 469 males and 333 females aged 20-64 yrs. Multiple logistic regression was applied comparing the highest with the lowest quartile of dietary exposures and linear trends were tested stratified by sex. In males, margarine intake and a high ratio of omega-6 to omega-3 fatty acids were positively associated with hay fever. In females, a high intake of total fat, palmitoleic and oleic acids were positively associated with sensitisation. A high total fat, high monounsaturated fatty acid and high oleic acid consumption were positively associated with hay fever. Whilst an excessive intake of fat or imbalance in fat intake, particular of monounsaturated fatty acids, increased the risk for hay fever and allergic sensitisation in females, mostly no significant associations were found for males. Dietary factors were mostly not related with prevalence rates of bronchial hyperresponsiveness and atopic eczema either in males or in females.

Adult↗
PubMed2003

An adaptive algorithm for the detection of microcalcifications in simulated low-dose mammography.

This paper uses the task of microcalcification detection as a benchmark problem to assess the potential for dose reduction in x-ray mammography. We present the results of a newly developed algorithm for detection of microcalcifications as a case study for a typical commercial film-screen system (Kodak Min-R 2000/2190). The first part of the paper deals with the simulation of dose reduction for film-screen mammography based on a physical model of the imaging process. Use of a more sensitive film-screen system is expected to result in additional smoothing of the image. We introduce two different models of that behaviour, called moderate and strong smoothing. We then present an adaptive, model-based microcalcification detection algorithm. Comparing detection results with ground-truth images obtained under the supervision of an expert radiologist allows us to establish the soundness of the detection algorithm. We measure the performance on the dose-reduced images in order to assess the loss of information due to dose reduction. It turns out that the smoothing behaviour has a strong influence on detection rates. For moderate smoothing. a dose reduction by 25% has no serious influence on the detection results. whereas a dose reduction by 50% already entails a marked deterioration of the performance. Strong smoothing generally leads to an unacceptable loss of image quality. The test results emphasize the impact of the more sensitive film-screen system and its characteristics on the problem of assessing the potential for dose reduction in film-screen mammography. The general approach presented in the paper can be adapted to fully digital mammography.

Algorithms↗
PubMed2002

Role of tumour necrosis factor-alpha in insulin resistance during normal pregnancy.

OBJECTIVE: Role of tumour necrosis factor-alpha (TNF-alpha) was studied in insulin resistance during pregnancy. STUDY DESIGN: Serum TNF-alpha (ELISA) and fasting C-peptide (Cp) (RIA) concentrations were measured in 40 healthy pregnant women (15, 12 and 13 of them in the 1st, 2nd and 3rd trimesters, respectively) and in 25 healthy non-pregnant women in a case-control study. RESULTS: TNF-alpha (X+/-S.D.: 5.33+/-0.46 pg/ml) and Cp levels (3.37+/-1.30 ng/ml) were significantly higher in the 3rd trimester as compared with matched healthy controls (TNF: 4.07+/-0.26, Cp: 1.05+/-0.36) and to the pregnant women in 1st (TNF: 4.04+/-0.26, Cp: 1.34+/-0.59) and 2nd (TNF: 4.35+/-0.32, Cp: 1.11+/-0.35) trimesters. Significant positive linear correlation was calculated among TNF-alpha, Cp, Cp/blood glucose ratio (indirect parameters of insulin resistance) and body mass indexes (BMIs) of pregnant women (P<0.01). CONCLUSION: TNF-alpha may contribute to the insulin resistance during the course of normal pregnancy.

Adult↗
PubMed2002

Calcium-sensing receptor A986S polymorphism in human rectal cancer.

BACKGROUND AND AIMS: In vivo and in vitro experiments show the protective role of calcium ions (Ca2+) against colorectal cancer. The calcium-sensing receptor (CaSR) detects extracellular Ca2+ concentration. An association between the CaSR A986S polymorphism and serum calcium in healthy adults has been reported. Subjects with AA genotype had lower serum concentrations of Ca2+ than other genotypes. The expression of erbB-2, epidermal growth factor receptor (EGFR), p53, and ras in colorectal cancer has been suggested to have diagnostic and prognostic significance. PATIENTS AND METHODS: We investigated the relationship between the CaSR A986S polymorphism and the expression of erbB-2, EGFR, p53, and ras as well as the UICC stage in 56 patients with rectal cancer. RESULTS: The occurrence of the genotype AA was not different in cancer patients and in 112 controls. In the presence of the coexpression of major oncogenes, patients with genotype AA were in significantly higher UICC stages than in the case of AS genotype. During the follow-up period AA genotype showed a tendency for poor prognosis. CONCLUSIONS: Our observation raises the possibility that genetic alterations of CaSR influence the pathogenesis of rectal cancer.

Calcium↗
PubMed2002

The pathophysiological influence of leptin and the tumor necrosis factor system on maternal insulin resistance: negative correlation with anthropometric parameters of neonates in gestational diabetes.

The contribution of the tumor necrosis factor (TNF) system and leptin was studied in insulin resistance and neonatal development during the course of normal pregnancy and gestational diabetes mellitus (GDM). Thirty patients with GDM and their neonates (n = 30), 35 healthy pregnant women (15 in the first, nine in the second and 11 in the third trimester) and their neonates (n = 20), and 25 healthy matched non-pregnant women participated in the study. Significantly elevated levels of maternal TNF-alpha, sTNF receptor (R)-1 and R-2, leptin (detected by enzyme-linked immunosorbent assay) and fasting C-peptide (measured by radioimmunossay and raised body mass index (BMI) were found in GDM patients and in the third trimester of normal pregnancies. TNF-alpha, sTNFR-2, C-peptide, leptin concentrations and BMI positively correlated with each other in GDM. An inverse relationship between the body length, head circumference and body weight of the newborns, and maternal TNF-alpha, leptin and C-peptide concentrations was shown in GDM. In healthy pregnancies the maternal serum leptin level was in a negative linear correlation with the head circumference of the newborns. In conclusion, increased TNF-alpha and leptin levels may contribute to insulin resistance in GDM and in the third trimester of normal pregnancy and may negatively influence the anthropometric parameters of the newborns.

Adult↗
PubMed2001

[Changes in lipid profile and paraoxonase activity in obese patients as a result of orlistat treatment].

257 patients from 33 centres were involved in a six-month study, the aim of which was to assess the effect of orlistat together with a diet. The authors examined how the treatment effected the anthropometrical and lipid parameters, extending the study to the aspect of paraoxonase activity in case of 25 patients. 44 patients dropped out during the study period due to the lack of sufficient diet compliance, whereas 3 patients had to stop the therapy because of the adverse event of flatus with discharge. On the average, the body mass of the patients decreased from 100.8 +/- 18.9 to 91.3 +/- 18.6 kg, i.e. by 9.5 kgs, while their BMI was reduced from 36.1 +/- 5.6 to 32.5 +/- 5.2 kg/m2 and the circumference of the waist changing from 119.1 +/- 20 to 108.3 +/- 15.1 cm, i.e. by 10.8 cms. The blood sugar level significantly decreased from 5.7 to 5.4, while the cholesterol concentration significantly dropped from 5.9 to 5.5, the triglyceride level being reduced from 2.4 to 2.1 mmol/l and blood pressure falling significantly from 136.6/86.9 to 129.9/81.6. All the above changes showed a significant decrease. However, the HDL-cholesterol level did not change. The serum paraoxonase activity significantly increased (143 +/- 49 vs 166 +/- 43 UL) along with the standardised values for HDL (PON/HDL), even compared to the control diet group. From the above results it may be concluded that orlistat tends to have an antioxidant effect.

Abdomen↗
PubMed2001

[The pathogenesis of diabetic and hepatic neuropathies].

The pathomechanism of neuropathies associated with diabetes and chronic liver diseases are poorly understood. Both metabolic and vascular factors are involved in the pathogenesis of diabetic neuropathy. It seems likely, that microangiopathy on the one hand and changes of various metabolic pathways due to hyperglycaemia on the other hand are much more related to each other than it was suggested previously. Nitric oxide may be the link between the metabolic and vascular hypotheses of diabetic neuropathy. Both reduced endoneurinal blood flow and increased oxidative stress leads to reduced nitric oxide synthetase activity. There are widespread inter-relationships between the most relevant metabolic changes included polyol pathway hyperactivity, reduced myoinosit concentration, advanced glycation end products formation, increased oxidative stress and lipid peroxidation. Changes of hemorheological conditions and primary hemostasis leeds to hyperviscosity just as to increased activity of the coagulation system. Among patients with chronic alcoholic liver diseases the direct toxic effect of alcohol is of particular relevance, however, malabsorption, impairment of axoplasmatic transport, changes of intermedier metabolism as well as thiamine and pyridoxine deficiency are of importance as well. The role of decreased insulin sensitivity and various degrees of glucose intolerance related to chronic liver diseases are still underestimated. Impairment of proteoglycan metabolism as well as increased oxydative stress are thought to be important factors in the pathogenesis of both diabetic and hepatic neuropathies. Glucose autooxidation and enhanced lipid peroxidation contribute to increased oxidative stress in patients with diabetes and chronic liver diseases as well. Vitamin E deficiency, autoimmun processes, circulating immune complexes, cryoglobulinemia, just as changes of vascular responsiveness associated with nitric oxide activity plays a role in the development of neural damage of hepatic origin. Most likely, similarly to diabetes mellitus, vascular changes contribute to the development of neuropathy in patients with chronic liver diseases.

Chronic Disease↗
PubMed2001

Oestrogen and vitamin D receptor (VDR) genotypes and the expression of ErbB-2 and EGF receptor in human rectal cancers.

Oestrogen/oestrogen receptor (ER) and vitamin D/vitamin D receptor (VDR) systems have been implicated in the pathogenesis of colorectal cancers. The expression of erbB-2 and epidermal growth factor receptor (EGFR) in colorectal cancers has been suggested to have diagnostic and prognostic significance. In our study, XbaI and PvuII polymorphisms of the ER gene and the BsmI polymorphism of the VDR gene were studied in 56 Caucasian patients with rectal cancer. The relationship between the ER and VDR genotypes and the expression of oncogenes was also investigated. The presence of the x allele of ER gene significantly correlated with the overexpression of the erbB-2 and EGFR oncogenes. Significantly increased erbB-2 expression was observed in patients with the VDR B allele. The XXbb allelic combination of the ER/VDR genes was associated with a significantly lower erbB-2 expression, whereas in the other genotypes significantly higher oncogene expression was seen. Our data raise the possibility that ER/VDR gene polymorphisms accompanied by variable oncogene expression might influence the pathogenetic processes of colorectal cancers.

Adult↗
PubMed2001

Allergic sensitization and diet: ecological analysis in selected European cities.

It has been postulated that the prevalence of atopic diseases and their increase over time are associated with regional differences in diet and trends. The results of an ecological correlation study comparing the mean daily intake of selected dietary constituents and the prevalence of allergic sensitization in adults in Europe is presented. Prevalence data from the European Community Respiratory Health Survey (ECRHS) were used. For eight out of 37 ECRHS centres (including 3,872 subjects), comparable dietary data could be obtained. The effect for each dietary constituent was modelled using logistic regression analyses with a term for over dispersion. Inverse associations between the prevalence of allergic sensitization and the energy adjusted intake of fruit were found (odds ratio (OR) = 0.68, p = 0.034). Furthermore OR for energy adjusted intake of vitamin A (OR = 0.73, p = 0.057), vitamin C (OR = 0.83, p = 0.338) and riboflavin (OR = 0.72, p = 0.077) were consistently < 1, but confidence intervals were wider. Daily intake of monounsaturated fatty acids (energy adjusted) was positively associated with sensitization prevalence (OR = 1.59, p = 0.035). These results support the hypothesis that a high intake of monounsaturated fatty acids might promote the development of allergic sensitization.

Antioxidants↗
PubMed2001

2 Years' experience with inspiratory muscle training in patients with neuromuscular disorders.

PURPOSE: The aim of our study was to assess the long-term effects of specific inspiratory muscle training (IMT) in patients with neuromuscular disorders (NMDs) who have various degrees of respiratory impairment. PATIENTS AND METHODS: Twenty-seven patients with NMDs (Duchenne's muscular dystrophy, 18 patients; spinal muscular atrophy, 9 patients) underwent 24 months of IMT. Patients were divided into three groups according to their vital capacity (VC) values. VC was measured as the parameter for the respiratory system involvement of the disease. Maximal inspiratory pressure (PImax) was assessed as the parameter for respiratory muscle strength, and the results of the 12-s maximum voluntary ventilation test (12sMVV) were assessed as the parameter for respiratory muscle endurance. Pulmonary and inspiratory muscle function parameters were assessed 6 months before training, at the beginning of training, and then every 3 months. RESULTS: The PImax values improved in group A (VC, 27 to 50% predicted) from 51.45 to 87.00 cm H(2)O, in group B (VC, 51 to 70% predicted) from 59.38 to 94.4 cm H(2)O, and in group C (VC, 71 to 96% predicted) from 71.25 to 99.00 cm H(2)O. The 12sMVV values improved in group A from 52.69 to 69.50 L/min, in group B from 53.18 to 62.40 L/min, and in group C from 59.48 to 70.5 L/min. For all three groups, there was a significant improvement of PImax (p < 0.007) and 12sMVV (p < 0.015) until the 10th month when a plateau phase was reached with no decline in the following month until the end of training. CONCLUSION: With IMT, respiratory muscle function can be improved in the long term of up to 2 years.

Adolescent↗
PubMed2001

Vitamin D and estrogen receptor gene polymorphisms in type 2 diabetes mellitus and in android type obesity.

OBJECTIVE: We studied the significance of BsmI restriction enzyme polymorphism of the vitamin D receptor (VDR) gene and the XbaI and PvuII polymorphisms of the estrogen receptor (ER) gene in patients with type 2 diabetes (n=49), android type obesity with normal carbohydrate metabolism (n=29) and healthy controls (n=138). METHODS: The distribution of genotypes in the study groups, as well as their relationship to fasting and 1 h postprandial serum C-peptide levels were analyzed. RESULTS: Postprandial serum C-peptide levels of BB genotypes were significantly higher in the diabetes and obese groups (6.18+/-5.09 ng/ml) compared with other genotypes (2.71+/-2.45 vs. 1.72+/-1.97 ng/ml, respectively, P=0.05). Among patients with type 2 diabetes and obese subjects, the XX allelic variant of the ER gene was more frequent (P=0.00015). Postprandial C-peptide levels of subjects exhibiting XX genotype were significantly lower compared with those with Xx genotype (1.67+/-2.16 vs. 3.8+/-3.72 ng/ml, P=0.021). The BBXx allelic combination of the VDR/ER receptor genes was less frequent in diabetic patients than in healthy subjects or in obese patients. The BBXx genotype was associated with significantly elevated postprandial C-peptide levels in all subjects compared with other combinations (9.65+/-3.14 vs. 1.35+/-2.82 ng/ml, P=0.003). No difference was found in the distribution of the PvuII polymorphism of the ER gene or in the association with the C-peptide levels among study groups. CONCLUSION: Polymorphisms of the VDR/ER receptor genes might play a role in the pathogenesis of type 2 diabetes by influencing the secretory capacity of beta-cells.

Adult↗