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Biomedical subjects

J Bogner

Publications and source records attributed to J Bogner.

At least 19 recordsLinked to original sources

Methane mass balance at three landfill sites: what is the efficiency of capture by gas collection systems?

Many developed countries have targeted landfill methane recovery among greenhouse gas mitigation strategies, since methane is the second most important greenhouse gas after carbon dioxide. Major questions remain with respect to actual methane production rates in field settings and the relative mass of methane that is recovered, emitted, oxidized by methanotrophic bacteria, laterally migrated, or temporarily stored within the landfill volume. This paper presents the results of extensive field campaigns at three landfill sites to elucidate the total methane balance and provide field measurements to quantify these pathways. We assessed the overall methane mass balance in field cells with a variety of designs, cover materials, and gas management strategies. Sites included different cell configurations, including temporary clay cover, final clay cover, geosynthetic clay liners, and geomembrane composite covers, and cells with and without gas collection systems. Methane emission rates ranged from -2.2 to >10,000 mg CH(4) m(-2) d(-1). Total methane oxidation rates ranged from 4% to 50% of the methane flux through the cover at sites with positive emissions. Oxidation of atmospheric methane was occurring in vegetated soils above a geomembrane. The results of these studies were used as the basis for guidelines by the French environment agency (ADEME) for default values for percent recovery: 35% for an operating cell with an active landfill gas (LFG) recovery system, 65% for a temporary covered cell with an active LFG recovery system, 85% for a cell with clay final cover and active LFG recovery, and 90% for a cell with a geomembrane final cover and active LFG recovery.

Air Pollutants↗

Thyroid hypoechogenicity in patients with chronic hepatitis receiving interferon-alpha therapy: evaluation by standardized grey scale ultrasonography.

BACKGROUND: Recombinant human interferon-a therapy of chronic hepatitis B and C is associated with the induction of thyroid dysfunction in up to 15%. Little is known about morphological changes of the thyroid gland, especially about its tissue echogenicity under this immunomodulative drug treatment. METHODS: 116 patients with chronic hepatitis B or C were consecutively investigated. 53 patients qualified for treatment with interferon-a alone or in combination with ribavirin. Patients with normal serum aminotransferase levels, advanced liver cirrhosis, hepatocellular carcinoma, active intravenous drug or alcohol abusus and with focal thyroid lesions (nodes, cysts, calcifications) were excluded. Thyroid function was determined by measurements of FT4, TSH and thyroidal autoantibodies. Ultrasonography was performed before, during and after interferon-a therapy including volumetry and standardized grey scale analysis. The data were compared with values of 100 euthyroid volunteers as control group. RESULTS: After six months of therapy patients differed from controls by significant TSH elevation (12.8 +/- 9.34 vs. 2.8 +/- 1.1 microU/ml, p<0.02). Six patients (11%) developed overt hypothyroidism with detectable thyroidal autoantibodies. Thyroid volume in patients was similar (13.0 +/- 4.1 ml) to that in the control group (12.6 +/- 4.7 ml). However, thyroid echogenicity of the patients was significantly lower after 6 months of therapy (21.9 +/- 2.5 grey scales) compared to the status before (25.6 +/- 2.3 grey scales) and compared to the values of controls (25.4 +/- 2.1 grey scales, p <0.002). CONCLUSION: Beside of functional disorders interferon-alpha leads to thyroid hypoechogenicity suggesting relevant morphological changes of the organ.

Adult↗

Serum concentrations of fibroblast growth factor 2 are increased in HIV type 1-infected patients and inversely related to survival probability.

HIV-1-infected patients develop a generalized vasculopathy that is clinically most evident as Kaposi's sarcoma (KS), a multifocally appearing endothelial cell-derived tumor. Fibroblast growth factor 2 (FGF-2) is a potent autocrine and paracrine mitogen of endothelial cells and has been implicated in the cell proliferation and angiogenesis observed in KS. Here we determined by ELISA the FGF-2 serum concentrations in different clinical groups of HIV-1-infected patients. AIDS-KS patients (n = 53) and HIV-1-infected patients without KS (n = 39) revealed significantly increased FGF-2 serum concentrations (median, 4.5 and 4.6 pg/ml, respectively), as compared with the healthy control group (n = 22; median, 2.2 pg/ml; p < 0.01). FGF-2 concentrations were highest in untreated HIV-1-infected patients (median, 8.6 pg/ml) and were significantly decreased in patients undergoing antiretroviral therapy (AZT-median, 4.5 pg/ml; HAART-median, 2.5 pg/ml; p < 0.01). In addition, FGF-2 serum concentrations above 5.2 pg/ml were associated with a statistically significant higher risk of death in HIV-1-infected patients. Multivariate analysis showed that this effect is independent of CD4 levels, localization of KS (cutaneous or visceral), AIDS-defining opportunistic diseases, and therapy. Circulating FGF-2 may contribute to AIDS-associated vasculopathy and may be a sensitive and easily accessible surrogate marker to determine the survival time of HIV-1-infected patients and the efficacy of antiretroviral therapy.

Adult↗

Alterations of apolipoprotein B metabolism in HIV-infected patients with antiretroviral combination therapy.

BACKGROUND: Dyslipidemia (predominantly hypertriglyceridemia) is frequently seen in patients receiving antiretroviral combination therapy (ART). However, the underlying mechanisms and long-term risks (e.g., cardiovascular events) are still unclear. OBJECTIVES/METHODS: In 5 patients with ART-associated dyslipidemia, stable isotope labeled amino acid tracer (d3-Leu) kinetic analysis over 12 days was used to investigate the metabolism of apolipoprotein B-containing lipoproteins (very low density lipoproteins [VLDL]1, VLDL2, intermediate density lipoproteins [IDL] and low density lipoproteins [LDL]). Data were compared with those in 6 healthy normolipidemic controls. RESULTS: The patients under ART showed significantly increased fasting triglycerides (359 vs. 77 mg/dl) and VLDL (54 vs. 15 mg/dl), compared with controls. They had significantly higher total cholesterol (213 vs. 157 mg/dl) and there was a nonsignificant trend toward higher LDL (136 vs. 93 mg/dl), and toward lower HDL (26 vs. 46 mg/dl). The ratio of large, buoyant LDL1 over small, dense LDL2 was markedly reduced in patients under ART (0.80 vs. 2.00). Total apo B synthesis was significantly increased (25.5 vs. 14.5 mg/kg/d) and shifted toward triglyceride rich VLDL1 (18.5 vs. 8.7 mg/kg/d) in patients receiving ART. There was also a significantly reduced rate of apo B lipoprotein transfer from VLDL1 to VLDL2 (3.7 vs. 20.7 pools/d). In addition, all patients revealed insulin resistance. CONCLUSIONS: These data indicate that increased triglycerides in HIV-infected patients with ART are primary due to reduced rates of VLDL transfer into denser lipoproteins implying a lower rate of lipoprotein lipase-mediated delipidation. In addition, total apo B synthesis was increased and shifted toward triglyceride-rich VLDL1. Overall, this lipoprotein profile in patients with ART-associated dyslipidemia implies an increased risk for cardiovascular events.

Adult↗

A linac-based stereotactic irradiation technique of uveal melanoma.

PURPOSE: To describe a stereotactic irradiation technique for uveal melanomas performed at a linac, based on a non-invasive eye fixation and eye monitoring system. METHODS: For eye immobilization a light source system is integrated in a standard stereotactic mask system in front of the healthy eye: During treatment preparation (computed tomography/magnetic resonance imaging) as well as for treatment delivery, patients are instructed to gaze at the fixation light source. A mini-video camera monitors the pupil center position of the diseased eye. For treatment planning and beam delivery standard stereotactic radiotherapy equipment is used. If the pupil center deviation from a predefined 'zero-position' exceeds 1 mm (for more than 2 s), treatment delivery is interrupted. Between 1996 and 1999 60 patients with uveal melanomas, where (i) tumor height exceeded 7 mm, or (ii) tumor height was more than 3 mm, and the central tumor distance to the optic disc and/or the macula was less than 3 mm, have been treated. A total dose of 60 or 70 Gy has been given in 5 fractions within 10 days. RESULTS: The repositioning accuracy in the mask system is 0.47+/-0.36 mm in rostral-occipital direction, 0.75+/-0.52 mm laterally, and 1.12+/-0.96 mm in vertical direction. An eye movement analysis performed for 23 patients shows a pupil center deviation from the 'zero' position<1 mm in 91% of all cases investigated. In a theoretical analysis, pupil center deviations are correlated with GTV 'movements'. For a pupil center deviation of 1 mm (rotation of the globe of 5 degrees ) the GTV is still encompassed by the 80% isodose in 94%. CONCLUSION: For treatments of uveal melanomas, linac-based stereotactic radiotherapy combined with a non-invasive eye immobilization and monitoring system represents a feasible, accurate and reproducible method. Besides considerable technical requirements, the complexity of the treatment technique demands an interdisciplinary team continuously dedicated to this task.

Eye Movements↗

[Patient medication counseling--patient counseling about discharge medication].

BACKGROUND: With discharge from hospital, the correct use of his drugs is the responsibility of the patient. The patient's compliance mainly affects the success of therapy. An essential requirement for good compliance is informing the patient properly about the purpose and correct use of his drugs. In the first pilot study in Germany on this subject, we investigated how the additional patient medication counseling by a clinical pharmacist prior to discharge improves the patient's knowledge of his drugs. STUDY DESIGN: During a 10-week period, 37 patients were randomly assigned to either an intervention group or a control group. Patients of the intervention group were verbally and in writing informed about the purpose and correct use of their drugs. The effect of the additional counseling was determined in both groups by a questionnaire at the time of discharge and a telephone interview 2 weeks later. CONCLUSION: Patient medication counseling by a clinical pharmacist prior to discharge improves the patient's knowledge of his drugs as an essential requirement of good compliance. Taking into consideration the economical consequences of noncompliance and the financial problems of the public health system it is advisable to establish this service in German hospitals.

Adult↗

The biogeochemical controls of N2O production and emission in landfill cover soils: the role of methanotrophs in the nitrogen cycle.

Emissions of N2O from cover soils of both abandoned (> 30 years) and active landfills greatly exceed the maximum fluxes previously reported for tropical soils, suggesting high microbial activities for N2O production. Low soil matrix potentials (<-0.7 MPa) indicate that nitrification was the most likely mechanism of N2O formation during most of the time of sampling. Soil moisture had a strong influence on N2O emissions. The production of N2O was stimulated by as much as 20 times during laboratory incubations, when moisture was increased from -2.0 MPa to -0.6 MPa. Additional evidence from incubation experiments and delta13C analyses of fatty acids (18:1) diagnostic of methanotrophs suggests that N2O is formed in these soils by nitrification via methanotrophic bacteria. In a NH3(g)-amended landfill soil, the rate of N2O production was significantly increased when incubated with 100 ppmv methane compared with 1.8 ppmv (atmospheric) methane. Preincubation of a landfill soil with 1% CH4 for 2 weeks resulted in higher rates of N2O production when subsequently amended with NH3(g) relative to a control soil preincubated without CH4. At one location, at the soil depth (9-16 cm) of maximum methane consumption and N2O production, we observe elevated concentrations of organic carbon and nitrogen and distinct minima in delta15N (+1.0%) and delta13C (-33.8%) values for organic nitrogen and organic carbon respectively. A delta13C value of -39.3% was measured for 18:1 carbon fatty acids in this soil, diagnostic of type II methanotrophs. The low delta15N value for organic nitrogen is consistent with N2 fixation by type II methanotrophs. These observations all point to a methanotrophic origin for the organic matter at this depth. The results of this study corroborate previous reports of methanotrophic nitrification and N2O formation in aqueous and soil environments and suggest a predominance of type II rather than type I or type X methanotrophs in this landfill soil.

Euryarchaeota↗

Awareness of deficits: emotional implications for persons with brain injury and their significant others.

The relationship between emotional distress and differing perceptions of the extent of deficits was investigated with fifty individuals with brain injury and their significant others. Participants completed questionnaires assessing their perceptions of the individual's deficits in various areas (Patient Competency Rating Scale, PCRS). Difference scores were used as markers for awareness of deficits. Emotional distress of the individuals with brain injury and their significant others was assessed with the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Forty per cent of persons with brain injury and 34% of significant others reported symptoms suggestive of mild or greater depression, while 54% of persons with brain injury and 39% of significant others reported symptoms suggestive of experiencing mild or greater anxiety. Significant relationships were not found between the emotional distress of significant others and difference scores. Moderate-to-weak relationships were found between difference scores and the emotional distress of individuals with brain injury. The relationship between chronicity and awareness of deficits was in the opposite direction than predicted. The adjustment of significant others appears to be a function of the extent to which they perceive a resolution of deficits, time since injury, and other factors. Implications for rehabilitation and future research are discussed.

Adolescent↗

Conservative management of biliary obstruction due to Fasciola hepatica.

We report a case of temporary biliary obstruction due to fascioliasis. This case report shows that in Central Europe, fascioliasis is one of the differential diagnoses of abdominal pain, especially if it is associated with eosinophilia. Successful medical treatment is possible even with obstruction of the bile duct.

Adult↗

Infection with human immunodeficiency virus-1 increases expression of vascular endothelial cell growth factor in T cells: implications for acquired immunodeficiency syndrome-associated vasculopathy.

Alterations in the vascular system and the onset of angioproliferative lesions such as Kaposi's sarcoma (KS) are common traits of human immunodeficiency virus-1 (HIV-1)-infected patients. To investigate possible factors involved in acquired immunodeficiency syndrome (AIDS)-associated vasculopathy and vascular malfunction, expression of vascular endothelial cell growth factor-A (VEGF-A) was analyzed in HUT 78 T lymphocytes upon infection with HIV-1. VEGF-A was found to be increased in supernatants from infected cells as compared with uninfected cells. In addition, VEGF-A mRNA expression and protein secretion were significantly increased in HUT 78 cells incubated with conditioned medium (CM) derived from HIV-1 chronically infected HUT 78 cells (HIV-TCM) as compared with CM from uninfected cells (TCM). Increase of VEGF-A production in T cells was promoted by inflammatory cytokines (IC) present in HIV-TCM, including tumor necrosis factor alpha (TNFalpha), interferon gamma (IFNgamma), interleukin-1beta (IL-1beta), and IL-6. These IC that have been shown to be increased in sera of HIV-1-infected patients and to be increased by HIV-1 infection or cell activation in these individuals as well as HIV-TCM also increased VEGF-A expression in primary T lymphocytes. Consistent with this, VEGF-A concentrations were found to be higher in sera of HIV-1-infected patients with (mean, 357.1 +/- 197.9 pg/mL) and without KS (mean, 256.7 +/- 137.5 pg/mL) as compared with uninfected individuals (mean, 188.6 +/- 91.7 pg/mL). These data suggest that increased secretion of VEGF-A by T lymphocytes of HIV-1-infected individuals may induce vascular leakage and stimulate proliferation of vascular endothelial cells, which are hallmarks of AIDS-associated vasculopathy and especially of KS development.

Acquired Immunodeficiency Syndrome↗

Pneumocystis carinii pneumonia in the Federal Republic of Germany in the era of changing antiretroviral therapy - IDKF 13 -. German AIDS Study Group (GASG/IdKF).

BACKGROUND: Pneumocystis carinii pneumonia (PCP) is one of the most common AIDS defining diagnoses. METHODS: In a prospective observational trial all cases of Pneumocystis carinii pneumonia (PCP) were evaluated. Patients with and without PCP-prophylaxis were compared for symptoms, efficacy, side effects and mortality at week 4 and 26. RESULTS: 293 patients developed a PCP episode. Patients with no prophylaxis had a significant lower CD4 cell count and a more severe clinical status at time of diagnosis. This was pronounced in the group with first positive HIV test at time of diagnosis. There was no difference in the rate of successful treatment between both groups. At week four a tendency to a better survival in the group with prophylaxis was observed, however this changed to a trend to a better survival at week 26 for the group without prophylaxis. CONCLUSION: Even in the era of highly active antiretroviral treatment many patients present with PCP. Nearly 60% of patients presented without antiretroviral treatment or PCP-prophylaxis. Nearly 25% of all patients had their first HIV-test at time of PCP diagnosis.

AIDS-Related Opportunistic Infections↗

Cost-effectiveness analysis comparing liposomal anthracyclines in the treatment of AIDS-related Kaposi's sarcoma.

Liposomal formulations have been shown to alter the efficacy and toxicity profiles of anthracylines for patients with HIV-related advanced Kaposi's sarcoma (KS). Using decision-analysis models, the costs and cost-effectiveness of the two U.S. Food and Drug Administration (FDA)-approved liposomal formulations of these agents were estimated. Estimates of costs, effectiveness, and cost-effectiveness were derived from clinical trial data of separate, randomized phase III trials of pegylated liposomal doxorubicin (20 mg/m2 every 3 weeks) and liposomal daunorubicin (40 mg/m2 every 2 weeks). Clinical response rates were 59% for pegylated liposomal doxorubicin and 25% for liposomal daunorubicin. Despite higher acquisition costs for pegylated liposomal doxorubicin, total estimated costs of treatment for KS and chemotherapy-related hematologic toxicities were similar ($7,066 U.S. compared with $6,621 U.S. for liposomal daunorubicin). Cost-effectiveness profiles, defined as average costs per responder, favored pegylated liposomal doxorubicin ($11,976 U.S./responder versus $26,483 U.S./responder for liposomal daunorubicin), reflecting the higher reported response rate in the phase III trial. Sensitivity analyses suggested that the costs and cost-effectiveness results would not differ markedly when evaluated over a range of assumptions, including response rate, neutropenia rate, and dosage variations.

Acquired Immunodeficiency Syndrome↗

Lack of protection from HIV infection by the mutant HIV coreceptor CCR5 in intravenously HIV infected hemophilia patients.

The CCR5 chemokine receptor is an important coreceptor for macrophage-tropic HIV strains. Homozygous carriers of the mutated CCR5 receptor with a 32 bp deletion (delta 32-CCR5) are highly protected against HIV infection. A protective effect has also been described for heterozygous individuals carrying both mutated and wildtype CCR5 receptors. We compared the frequency of the mutated delta 32-CCR5 HIV coreceptor in HIV positive patients infected by sexual contact (N = 160) with intravenously HIV infected hemophilic patients (N = 84) and HIV negative individuals (N = 421). We found no protective effect of delta 32-CCR5 HIV coreceptor in hemophilic patients (p = 0.0134). If proteins of plasma concentrates would be responsible for facilitating the entry of HIV macrophages by upregulation of the CCR5 wildtype receptor it would be of therapeutical interest to identify the responsible plasma proteins.

Female↗

Primary caregivers of persons with brain injury: life change 1 year after injury.

The impact of a traumatic brain injury on the family of the injured person is just beginning to be explored. In the current study, 61 primary caregivers were contacted at 1 year following injury. They completed the Relative and Friend Support Index, Social Support Index, Trauma Complaints List and the Life Change Question. The majority of caregivers indicated at least mild negative life change following the brain injury. Greater social support was correlated with less life change and greater injury severity was correlated with negative life change. Neither of these relationships was found to be significant at the 0.05 level. A significant positive correlation was found between caregivers' perception of deficits and the degree of negative life change. Perceived deficits accounted for the greatest amount of variance in life change followed by relative and friend support when all variables were entered into a stepwise regression. Further analyses indicated that the most significant factor of the Trauma Complaints List in predicting life change may be problems with cognition, which accounted for a significant amount of the variance in life change. Implications for counselling and further research regarding caregivers of persons with brain injury are discussed.

Adolescent↗

[HIV-associated non-Hodgkin's lymphomas (HIV-NHL) in the area of the head-neck].

The life span of HIV-infected patients has increased because of anti-retroviral therapy and improved means for treating opportunistic infections. However, HIV infection and subsequent immunosuppression result in an increased risk of high-grade B-cell lymphomas. The purpose of this study was to determine the incidence, localization, clinical features, therapy and survival time of patients with HIV-related lymphomas of the head and neck. Between 1988 and 1995, 280 HIV-infected patients presented with otolaryngologic symptoms. Seventy-two (25.7%) were found to have a neoplastic disease. Fifty-six of these patients (20%) were diagnosed as having Kaposi's sarcoma and 12 (4.3%) had lymphomas. According to the Kiel classification, lymphomas were subdivided into Hodgkin's disease (2 cases) and B-cell lymphomas of high-grade malignancy (10 cases). These latter cases were centroblastic (n = 4), Burkitt's type (n = 4), anaplastic large cell (n = 1) and not classifiable (n = 1). All patients with HIV-related non-Hodgkin's lymphomas (NHL) were men and 8 were homosexuals. The mean age was 36.1 years. In addition to 7 nodal locations, high-grade B-cell lymphomas were found in the oropharynx (n = 2) and palate (n = 1). Four patients underwent chemotherapy, 1 patient underwent radiation therapy and 2 were treated with both methods. Two patients did not receive any treatment and 1 patient underwent laser therapy. The survival time depended on the previous diagnosis of AIDS, the patients' immune status and the karnofsky index. In 2 patients the lymphoma led to the diagnosis of HIV infection. Our findings show that any solitary or enlarging tumors or ulcerating lesions in the head and neck region of HIV patients must be examined histologically to exclude HIV-NHL. We also recommend that young patients with high-grade B-cell lymphomas should undergo HIV screening.

Adult↗

Determination of endothelin-1 immunoreactivity in plasma, cerebrospinal fluid and urine.

Endothelin-1 (ET-1) is a potent vasoconstrictor peptide apparently involved in a number of vascular diseases in man. Nonetheless, its determination in biological samples is difficult, and data on plasma or urine concentrations are controversial. We investigated different sample preparation procedures as well as different radioimmunoassays for their influence on ET-1 measurement. Recovery of ET-1 depended on the extraction procedure, the type and size of the extraction columns and on the biological matrix itself. Incomplete removal of matrix components by the extraction leads to the formation of particulate matter in the evaporated eluate. When dissolved in assay buffer, ET-1 was found to be absorbed to and only partly released from these particulates, so that it was not accessible for measurement in a radioimmunoassay. This was the case for all extraction procedures investigated except for that involving acetic acid. HPLC analysis of spiked samples revealed that ET-1 is in part degraded during extraction, most probably to Meth-sulphoxide ET-1. Dilution curves of synthetic pure ET-1 standards from different suppliers, prepared either in plasma with subsequent extraction or in assay buffer of the respective radioimmunoassay, resulted in considerable differences in the measured values for ET-1-immunoreactivity. Every radioimmunoassay tested had a specific pattern of recognizing different synthetic ET-1 standards. In conclusion, the measurement of ET-1-immunoreactivity is strongly influenced by the experimental conditions of sample preparation as well as by the radioimmunoassay employed.

Absorption↗

[Giant-cell arteritis limited to the femoral arteries].

A previously healthy 48-year-old woman developed, over several months, increasing pain in her hips, cervical and lumbar spine as well as the shoulders. In addition she developed intermittent claudication after walking 100-200 m. Erythrocyte sedimentation rate (ESR) was 35-43 mm in the first hour; the IgM concentration was raised to 610 mg/dl. Angiography demonstrated symmetrical occlusion of both superficial femoral arteries. An attempt at thrombolysis having failed, a biopsy of the femoral artery wall was obtained. This revealed a florid arteritis, in part as giant-cell arteritis with destruction of the elastic structures, while the adjacent muscle was unchanged. Subsequent biopsy of the temporal artery was normal. Treatment consisted at first of 60 mg prednisolone and 100 mg aspirin, both daily for 4 weeks. The ESR fell and the free-of-pain walking distance rose. There has been no recurrence of pain after stepwise reduction over one year of the steroid dosage until its discontinuation.

Aspirin↗

Music psychopathology. IV. The course of musical expression during music therapy with psychiatric inpatients.

The music therapeutic productions of 67 psychiatric inpatients were analyzed concerning a systematic variation in the course of therapy. The impairment of performance was not as regular as with customary music, nevertheless with growing remission it was reversible in all diagnostic subgroups. The change for the better of rhythmic and motor skills of endogenous-depressed patients was seen to the same extent as with traditional music. The polarity profile developed for the assessment of music proved meaningful in the characterization of music therapeutic utterances.

Adult↗