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S Schneider

Publications and source records attributed to S Schneider.

At least 19 recordsLinked to original sources

Synthesis and evaluation of a glibenclamide glucose-conjugate: a potential new lead compound for substituted glibenclamide derivatives as islet imaging agents.

The search for novel SUR1-ligands originates from the idea to influence the in vivo behaviour by adding new structural moieties to the glibenclamide structure while preserving its binding affinity. Important application of novel conjugates might be their use as radioactively labelled tracer probes in the non-invasive investigation of the islet mass. It is known that the imaging quality of a tracer could be improved by increasing its hydrophilicity, which leads to a reduced plasma protein binding and diminished the unspecific uptake by various organs. In this study the glucose molecule was chosen as a substitute of glibenclamide to enhance hydrophilicity. As expected glucose conjugation leads to a 12-fold increase of the hydrophilicity. In vitro evaluation showed that the conjugate binds with high affinity to SUR1. Interestingly, in vivo the hypoglycaemic action of the conjugate was of significant shorter duration compared to glibenclamide. In accordance, the conjugate was cleared much faster from the blood stream, due to a significant lower plasma protein binding. In conclusion, glycosylation proved to be a powerful tool for the development of a high affinity glibenclamide ligand with completely different pharmacodynamics. Therefore, the glucose-conjugate could be a potential lead compound for the design of substituted glibenclamide derivatives as islet imaging ligands.

ATP-Binding Cassette Transporters↗

The prognostic impact of successful cardioversion of atrial fibrillation in patients with organic heart disease.

The aim of the study was to evaluate the prognostic impact of successful cardioversion (CV) compared to failed CV in patients with atrial fibrillation (AF) and organic heart disease. A total of 471 consecutive patients with organic heart disease from the prospective single center anticoagulation registry ANTIK who underwent CV of AF or atrial flutter were analyzed. 417 patients (89%) could be successfully cardioverted. In 54 patients (11%) CV failed, these patients remained in AF. After 5 years there were 92 (24%) deaths among patients with restored sinus rhythm at index admission and 20 (38%) deaths among those who remained in AF after CV (unadjusted OR 1.9, 95% CI 1.1-3.6). After adjustment for age, gender and ejection fraction, successful CV was not associated with a beneficial effect on mortality (OR 0.72, 95% CI 0.43-1.21). Thus, successful CV is not an independent predictor of mortality on multivariate analysis. However, it remains a marker for a better prognosis in patients with organic heart disease as these patients have a lower unadjusted longterm mortality.

Aged↗

Epidemiology and risk factors of sports injuries--multivariate analyses using German national data.

Representative data on the incidence of sports injuries and the risk groups involved is extremely rare. The data generated by the "First National Health Survey for the Federal Republic of Germany", conducted between October 1997 and March 1999, included information on the incidence of sports injuries requiring medical care and the associated sick leave, fitness indicators, and potential risk factors. The data was collected on the basis of a standardised cross-sectional questionnaire. The net sample comprised 6687 subjects aged 18 to 79. 3.1 % of adult Germans sustained a sports-related injury within the foregoing year. The annual incidence of injury among those actively engaging in sports is 5.6 %. 62 % of all sports injuries result in sick leave. The period off work was longer than 30 days in only one out of five cases. Three out of four injured recreational athletes are male. The incidence declines significantly in the more senior population. These differences apply even if the specific sporting profile is factored in. Analysis of incidence rates on their own is misleading for some population groups. For instance, although individuals of normal weight and a good fitness display more than twice the average incidence of sports injuries, our study shows that these figures do not reflect the actual risk of injury, as bivariate calculation of incidence does not take account of the specific extent of sporting activity. When specific participation rates and the intensity of training are taken into account, no significant differences in the risk of injury are apparent. Our representative data also shows that future injury prevention strategies should focus on the highest risk group of young male recreational athletes.

Adolescent↗

[Smoke-free restaurants: opinions and acceptance in a representative sample of the German population].

BACKGROUND AND OBJECTIVE: Every year over 3,300 non-smokers in Germany die from diseases caused by passive smoking. It was the aim of this study to obtain country-wide representative opinions about a smoking ban in restaurants. MATERIAL AND METHODS: Data were obtained from a cross-sectional sample of the population, 2,008 men and women aged 16 years or over. Opinions on smoking ban in restaurants were analysed by bivariate and multivariate methods with regard to potential influencing factors such as smoking status and socio-demographic status. RESULTS: The majority of those questioned, namely 50% (95% confidence interval 57-61), wished for a smoking ban in restaurants. This represents an increase of 6% compared with the preceding year. While over 82% of never-smokers and 71% of previous smokers were in favor of a smoking ban, agreement for a ban among smokers averaged 25%, depending on the amount smoked. Agreement was especially common among women, the elderly and married persons. Three of four Germans said that they would continue to go to restaurants as frequently after smoking had been banned there. CONCLUSION: This is the first scientific study of opinions among the population on the smoking ban in restaurants of Germany. The current average approval rate for a ban was comparable to that among other nations. An overwhelming majority of the population would welcome a smoking ban and would, after its introduction, visit restaurants as often as previously.

Adolescent↗

["Are rich people healthier?"--Representative epidemiological data on socioeconomic group-specific disease prevalences among adults in Germany].

BACKGROUND AND OBJECTIVE: The aim of this study was to determine representative nationwide data on differences in the prevalence of specific diseases between socioeconomic groups. METHODS: The "First National Health Survey for the Federal Republic of Germany" was conducted from October 1997 to March 1999 in the form of a standardized cross-sectional questionnaire study. The data were elicited about the 35 most common diseases and socioeconomic status. The net sample was made up of a total of 7125 persons aged 18 to 79. RESULTS: A significantly higher prevalence in subjects of lower socioeconomic status was identified for typical orthopaedic diseases as well as for hypertension, chronic bronchitis, gastric and vascular disease. The most apparent socioeconomic difference to the detriment of socially deprived subjects was identified for addiction disease and diabetes. In contrast, numerous allergic diseases such as food allergies, urticaria, and allergic diseases of the respiratory tract and eyes were approximately twice as common among members of higher socioeconomic groups. Various gastrointestinal and renal diseases (hepatitis, gastritis, pyelonephritis) were also more common in higher socioeconomic groups. These socioeconomic differences were still apparent after adjustment for age and gender. CONCLUSION: This study provides representative socioeconomic group-specific prevalence data on a total of 35 clinical entities for the Federal Republic of Germany. Although the self-reporting involved in large epidemiological studies of this kind is associated with a certain amount of bias, it is nonetheless clear that the frequently cited "socioeconomic gradient", i. e., a higher disease prevalence among lower socioeconomic groups, seems not to apply for numerous disease entities; for which the association seems to be in the opposite direction. This phenomenon requires explanation.

Adult↗

Prevalence and correlates of inflammatory arthritis in Germany: data from the First National Health Survey.

The aim of this paper is to generate data on the prevalence of inflammatory arthritis in different subgroups of the population and to identify correlates on the basis of population-based cross-sectional data: the "First National Health Survey of the Federal Republic of Germany". This Survey investigated the prevalence of inflammatory arthritis, comorbidity and health-relevant behaviors on the basis of interviews with physicians and medical evaluations conducted in the period from October 1997 to March 1999. The study was based on a net sample comprising 6,461 subjects aged 18-79. Our data demonstrate an overall prevalence of 3.4% for inflammatory arthritis. The prevalence of inflammatory arthritis is significantly higher in women, the over-50, lower-income groups, and habitual smokers. Patients with inflammatory arthritis have a higher rate of numerous comorbidities such as osteoporosis, thyroid disease, chronic bronchial disease, hypertension, and elevated blood lipids versus healthy reference groups.

Adolescent↗

[Proximal fracture of the femur in elderly patients. The influence of surgical care and patient characteristics on post-operative mortality].

In a retrospective study, 1.173 fractures of the proximal femur, which had been treated surgically, were analysed in two periods from 1975 to 1991 and from 1992 to 2000. The influence on mortality of preoperative risk factors and primary treatment with total hip replacement (THR), even in cases of pertrochanteric fractures, was analysed by stepwise logistic regression. In the later period, mortality within 90 days was 13.1%, and within 1 year 22.2%. Rejection of hemiendoprosthesis in high-risk patients with intracapsular fractures increased the mortality rate from 6.3% to 11.8%. The introduction of dynamic hip screws instead of Ender nails led to a reduction of mortality from 16.5 to 7.1%. Higher mortality after THR (27.6%) compared to osteosynthesis (15.5%) in pertrochanteric femur and lateral neck fractures was due to higher age and increased risk factors. Although the influence of some risk factors could be reduced, age, sex and morbidity influenced the outcome more than surgical treatment. THP, even after pertrochanteric fractures, is reasonable if it guarantees a quick and enduring mobilisation of the patient. Bicentric bipolar prostheses are recommended for high risk patients.

Aged↗

[Is competitive running associated with osteoarthritis of the hip or the knee?].

BACKGROUND: The aim of the study was to find what degenerative changes were present in the hip and knee joints of former elite marathon runners and how these subjects' joints differ from those of control persons. METHODS: Twenty former elite German marathon runners (active careers 1972-86) underwent clinical (FFbH-OA [hip joint] and AKSS [knee joint]) and radiographic (hip and knee joints, Kellgren and Lawrence classification) examination. X-Rays of the hip joints were compared with those of controls matched for age, gender and BMI who did not engage in much sport. RESULTS: In the group of former elite marathon runners, 3 of the 38 knee joints for which comparison with control joints was possible were found to be affected by grade 2 osteoarthritis. In the same group, severe osteoarthritis (Kellgren and Lawrence grade 3) was documented in 1 and moderate osteoarthritis (grade 2) in 6 of the 28 hips for which direct comparison against the controls was possible, as against 1 hip affected by grade 2 osteoarthritis in the entire control group. The clinical evaluation showed high scores in all athletes. CONCLUSIONS: Osteoarthritis of the knee joint is rare in former elite marathon runners. The risk of osteoarthritis of the hip joint seems to be higher than in control subjects who do not engage in much sport.

Adult↗

Performance diagnostics in handbiking during competition.

STUDY DESIGN: Case study in handbiking under competition conditions. OBJECTIVE: To investigate exercise-induced, metabolic, pulmonary, cardiovascular and energetic reactions of a paraplegic athlete during a city marathon. SETTING: City marathon Cologne, Germany. SUBJECT: We tested a 27-year-old male athlete from the German national team. The handicap of the athlete was a complete traumatic spinal cord injury ASIA/IMSOP Grade A at the level of the fourth thoratic vertebra (Th4). METHOD: In the competition, the athlete used his own race handbike whose crank system had been exchanged for a power measurement system with registering option. For measuring ventilatory gas parameters during exercise, a portable spirometric system was used. The athlete managed to finish the marathon race in 1:48:54 h. RESULTS: The mean oxygen uptake (VO2) during the marathon was 1580 ml/min, with a maximum value of 2535 ml/min. The mean heart frequency was 137 bpm with a maximum of 157 bpm. During the race the mean energy consumption was 463 kcal/h with a maximum of 758 kcal/h. Prior to the race, the blood lactate value was 2.9 mmol/l; after 10 km 4.4 mmol/l; after 20 km 2.9 mmol/l, and after 30 km 2.9 mmol/l. CONCLUSION: Competition-oriented handbikers should concentrate on exercise units of long duration at low intensities--like marathon runners or cyclists--in order to improve their aerobic performance capacity. However, it has to be pointed out that paraplegic athletes develop relatively high metabolic intensities in competition and that the variability of their physiological parameters is considerably high.

Adult↗

[Oral antidiabetic therapy].

Consistent antihyperglycaemic treatment for preventing vascular complications in type 2 diabetes mellitus (2DM) often require the application of several measures. The basis of such treatment should be dietary changes and increased physical exercise. The target of antiglycemic treatment is the reduction of HbA1c to below 6.5%. Regular monitoring of HbA1c every 2-6 months is reasonable in order to recognize therapeutic failure early and adapt treatment accordingly. Metformin is the drug of first choice for the oral treatment of 2DM, once possible contraindications having been excluded. The advantage of glinides, compared with sulfonylureas, is mainly in allowing greater dietary flexibility. Although not finally decided, there are ever fewer objections against combined metformin and sulphonylurea treatment. The current guidelines of the (British)National Institute for Clinical Excellence (NICE) specifically recommend this combination treatment. There are pointers to glitazone having protective effects in 2DM beyond its blood-sugar lowering action. However, the clinical significance of these effects requires confirmation. If adequate blood-sugar reduction cannot be achieved with oral medication it is important to initiate insulin administration as soon as possible.

Administration, Oral↗

A prospective multicentre study on the safety of long-term intensive plasmapheresis in donors (SIPLA).

BACKGROUND AND OBJECTIVES: The safety of chronic intensive donor plasmapheresis has not been determined in large prospective studies examining dropout rates, dropout reasons and predictors of withdrawals. MATERIALS AND METHODS: Twenty-one plasma centres recruited 3783 donors who were switched from a moderate to an intensive plasmapheresis programme and observed over a 3-year period. Individuals weighing < 70 kg and > or = 70 kg donated 750 ml and 850 ml of plasma per session, respectively. The maximum of annual donations was limited to 60. Total serum protein (TSP) and haemoglobin (Hb) or haematocrit (Hct) were determined at each donation, and immunoglobulin G (IgG) at every fifth donation. Dropout rates, dropout reasons and potential predictors of withdrawal were analysed. RESULTS: Dropouts were predominantly due to socioeconomic (49.2% of all donors) or medical reasons not related to plasma donations (10.4% of all donors). Sixteen per cent of donors dropped out when IgG, TSP or Hb levels fell below threshold values. Severe clinical adverse events related to plasmapheresis were observed in five subjects. The incidence in severe cardiovascular diseases was lower in donors than in the general population. The risk factors that led to dropping out as a result of low IgG, TSP or Hb levels included younger age, female gender, low initial IgG levels and a high donation frequency. Neither body weight nor the amounts of plasma donated per kilogram of body weight per session were associated with ceasing due to medical reasons, whether related or unrelated to plasma donations. Females and males within the respective lowest body weight category were not at higher risk of dropping out. CONCLUSION: Long-term intensive donor plasmapheresis under conditions investigated in this study is safe. All donors weighing > or = 70 kg are safely able to donate 850 ml of plasma in each session up to 60 times per year, provided that they are carefully monitored.

Adult↗

Sports injuries: population based representative data on incidence, diagnosis, sequelae, and high risk groups.

OBJECTIVE: To generate national representative data on the incidence, diagnosis, severity, and nature of medically treated sports injuries and to identify high risk groups. METHODS: The first national health survey for the Federal Republic of Germany, conducted in the format of a standardised, written, cross sectional survey in the period October 1997 to March 1999, gathered data on the incidence of accident and injury and information on social demographics, injury related disability/time off work, and injury location/setting. The net sample comprised 7124 people aged 18-79. RESULTS: 3.1% of adult Germans said they sustained a sports injury during the previous year, corresponding to an annual injury rate of 5.6% among those engaging in regular recreational physical activity and ranking sports injuries as the second most common type of accident. About 62% of all sports injuries result in time taken off work. The period of occupational disability is 14 days or less in around two thirds of these cases. The occupational disability rate after occupational and traffic accidents is much higher by comparison. Dislocations, distortions, and/or torn ligaments make up 60% of all sports injuries, followed by fractures (18%), contusions, surface wounds, or open wounds (12%). Three out of four sports injury casualties are male. The incidence declines noticeably in higher age groups. CONCLUSIONS: Future injury prevention measures should focus on the high risk group of young male recreational athletes. The data indicate that the fear of damage to health and injury, believed to be significant internal psychological barriers to participation in sports, is largely unwarranted for the female population and/or older age groups. Sporting injuries are a marginal phenomenon among the female population and mobile seniors actively engaged in sports.

Adult↗

Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus.

We reviewed 39 patients with displaced three- and four-part fractures of the humerus. In 21 patients (group A) we had used an anatomical prosthesis for the humeral head and in 18 (group B) an implant designed for fractures. When followed up at a mean of 29.3 months after surgery the overall Constant score was 51.9 points; in group A it was 51.5 and in group B 52.4 points. The subjective satisfaction of the patients was assessed using a numerical rating scale and was similar in both groups. In group A complete healing of the tuberosities was found in 29% and 50% in group B. Partial integration was seen in 29% of group A and in only one patient in group B, while resorption was noted in 43% of group A and 44% of group B. The functional outcome was significantly better in patients with complete or partial healing of the tuberosities (p=0.022). The specific trauma prosthesis did not lead to better healing of the tuberosities. The difference in clinical outcome obtained by the two designs did not reach statistical significance.

Aged↗

Incidence of rotator cuff tears in shoulder dislocations and results of therapy in older patients.

INTRODUCTION: In older patients we documented the incidence of additional injuries in shoulder dislocations in a non-randomised, prospective study and compared the results of conservative and of operative therapy of rotator cuff tears. MATERIAL AND METHODS: Between 1993 and 1999 a total of 87 patients were prospectively enrolled. In the case of documented tears of the rotator cuff in combination with symptoms persisting after conservative therapy patients were free to decide between surgical and conservative treatment. Patients were monitored for function, subjective stability, and satisfaction over a minimum follow-up period of 1 year. RESULTS: In 54% of the patients enrolled a cuff tear was documented; the frequency increased with advancing age to 100% in patients over the age of 70. Surgical treatment of the cuff tears resulted in better function and satisfaction. There were three recurrences in the conservative treatment group, while no recurrences were documented in surgically treated patients. The significant benefit of cuff repair was confirmed by regression analysis. CONCLUSION: In this selected patient group, we believe surgical repair of the symptomatic rotator cuff tear should be discussed with the patient.

Adult↗

Unstable diaphyseal fractures of both bones of the forearm in children: plate fixation versus intramedullary nailing.

This retrospective study evaluated the results of plating versus intramedullary fixation in the management of unstable, diaphyseal fractures of both bones of the forearm in children. Of the 64 children included, 45 were treated with intramedullary fixation, 19 with plating. Only A3 forearm fractures of the middle third or the transition zones were included; Galeazzi, Monteggia, and Greenstick fractures were excluded. Full radiological follow-up to union was obtained in all cases and 60 patients returned for clinical evaluation 32.3 months (plating) and 20.6 months (intramedullary fixation) after injury. The functional outcome did not differ significantly. In the intramedullary fixation group, we found two major complications (refracture and non-union) and nine minor complications (two delayed unions, three thumb neuropathies, two rod migrations, two skin infections). In the plate group, there were two major complications (refractures) and one minor complication (thumb neuropathy). Plating resulted in significantly worse results for surgical approach, operating times, frequency and duration of hospitalisation, and cosmetic outcome. In conclusion, intramedullary fixation of an unstable forearm fracture in skeletally immature patients is a safe, child-friendly, minimally invasive technique that allows early functional treatment with an excellent functional and cosmetic outcome.

Adolescent↗

[The role of endoprostheses in the scope of hand surgery. Endoprostheses vs. traditional surgical procedures].

Alloarthroplasty has largely replaced traditional procedures in arthrosis of hip and knee joints. In contrast the role of alloarthroplasty in comparison to traditional procedures in hand surgery has been uncertain. To evaluate this question every registered hand surgery department (n=307) in Germany received a questionnaire requesting information on number and type of implanted prostheses and traditional procedures concerning the wrist joint, distal radioulnar joint (DRUJ), first carpometacarpal joint (CMC), metacarpal phalangeal joint (MP), interphalangeal joint (PIP), and preferred characteristics of the prostheses. Of the 307 hand surgery departments, 150 (57% of the hospitals and 42% of the visiting surgeons) participated in the inquiry. Per year, only 98 wrist prostheses were implanted (distributed among five different models) but 1534 traditional procedures were performed. The Sauve-Kapandji procedure was the most popular for the DRUJ and was performed 264 times per year. In comparison 24 hemiarthroplasties were implanted at the DRUJ. Trapezectomy remains the standard procedure for arthrosis of the first CMC joint (n=1399). The future importance of alloarthroplasty of the CMC joint is doubted by the majority of participating hand surgeons (90.3%). In contrast the majority (85.3/71.8%) is convinced that alloarthroplasty will be of importance for the MCP and PIP joints, respectively. Currently, the number of implanted prostheses is close to the number of traditional procedures performed at the MP joint. Irrespective of the joint involved, cementless anchorage is preferred as is the surface replacement anatomical design. The results confirm that alloarthroplasty in hand surgery is of minor importance. Thus, the role of alloarthroplasty differs depending on the joint involved. Traditional procedures except for the MP joint continue to be of major importance in hand surgery.

Arthroplasty, Replacement↗

[Prevalence and correlates of osteoarthritis in Germany. Representative data from the First National Health Survey].

BACKGROUND: The purpose of the paper was to generate up-to-date, representative osteoarthritis prevalence data for individual population subgroups and to identify potential risk factors. MATERIAL AND METHODS: A cross-sectional study, the "First National Health Survey", investigated the prevalence of osteoarthritis, comorbidity and health-relevant behaviours of the post-unification German population on the basis of interviews with physicians and medical evaluations conducted in the period from October 1997 to March 1990. The study was based on a net sample comprising 6205 subjects aged 18-79 years. RESULTS: The three main correlates for osteoarthritis are age, obesity and occupational stress factors. Osteoarthritis patients are more likely to have osteoporosis, thyroid disease, chronic bronchial disease, hypertension and elevated blood lipids, but do not tend to have a higher incidence of diabetes. CONCLUSION: Our data show the importance of preventive behavioural approaches such as weight management and workplaces designed to limit joint overuse.

Adolescent↗

[Garden I femoral neck fractures: conservative vs operative therapy].

INTRODUCTION: Treatment recommendations vary for Garden I fractures of the proximal femur. The aim of our retrospective study was to determine the results of functional treatment of these injuries. MATERIAL AND METHODS: A total of 54 consecutive patients were enrolled, and their data (age, comorbidities, treatment, complications, etc.) were ascertained and stored in a database. Initial treatment consisted in early mobilization and weight bearing in all patients. RESULTS: In 24 cases (44%) no complications at all were observed in the course of conservative treatment. In 28 cases (52%) surgical treatment was necessary due to early fracture dislocation. Analysis of the X-ray images showed that in 9 of these 28 cases the functional treatment had not been clearly indicated, i.e., incomplete impaction of the fragments. When these patients are excluded the success rate of conservative treatment was 53%, as two additional late complications occurred and were treated surgically (1x AVN, 1x nonunion). With reference to the survival rate, score, and patient satisfaction, there was no difference between conservative and operative treatment (p=0.478). The risk of a secondary dislocation increases with the number of risk factors (p=0.008). DISCUSSION: An attempt at functional treatment with close X-ray monitoring is appropriate in these fractures, since this makes it possible to avoid surgery in about half of the patients while achieving functional results comparable to those yielded by surgery.

Aged↗