From contrast media: gadolinium detected in beverages

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From contrast media

Researchers have found gadolinium from MRI contrast media in drinks from fast food restaurants.

BREMEN. Researchers led by Professor Michael Bau from Jacobs University Bremen have already detected gadolinium from contrast media in many rivers and drinking water in some German cities, and scientists have now found it in foods ( Science of the Total Environment 2019; 687: 1401-1408 ).

In cola drinks from fast food restaurants in Berlin, Dusseldorf, Essen, Karlsruhe, Munich and Dresden, they reported gadolinium. The substance is especially used in radiological MRI examinations.

Measured concentrations not hazardous to health

According to the current state of knowledge, the measured concentrations are not hazardous to health, but an indicator of the possible presence of other residues from the wastewater in the drinks, reports Jacobs University.

Contrast media have become indispensable in medical diagnostics, and the quantities of contrast media consumed increased from year to year. This also applies to MRI contrast agents based on gadolinium. Patients get rid of it in the hospital or at home, and the sewage goes to the local sewage treatment plants. These can not remove the contrast media from the water and introduce them into rivers and lakes.

Part of this gadolinium is taken into the sea by the rivers, where it already contaminates the North Sea, for example, while it also enters the groundwater with the infiltrating river water. Due to drinking water from groundwater and bank filtrate, the contrast agent gadolinium is ultimately also found in tap water.

In addition, recent data from the Berlin researchers in Berlin show that drinking water in individual districts in Berlin, such as samples from Bahnhof Zoo or Clay Allee, not only has the highest proportions (99 percent) of anthropogenic gadolinium measured in tap water in the world but that in recent years they have again increased significantly.

Gadolinium in drinking water

But also in the other cities studied, part of gadolinium in drinking water comes from MRI contrast media: 31 percent in Bremen, 34 percent in Karlsruhe, 63 percent in Dresden, 85 percent in Dusseldorf and 91 percent in Munich. And as the number of MRI examinations continues to increase, this trend toward higher contrast media concentrations in drinking water will continue to increase.

In the current study, cola drinks from branches of known fast-food chains were examined in the cities examined and compared with the tap water samples from the respective district. The result is clear: The drinks show almost the same levels of contrast agent gadolinium as the local tap water.

This is not surprising for the geochemist Bau: "In branches of fast-food restaurants, the cola syrup is mixed with tap water and CO ₂ . Although the restaurants state that this tap water will be additionally cleaned beforehand, this cleaning step is obviously unable to remove the residual contrast, "Bau is quoted in the Jacobs University Communication. (eb)

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With tablets and pull against penile curvature

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Peyronie

A small study suggests that Peyronie can be efficiently treated with a combination of oral medication and traction.

A taboo topic for men, when the penis does not have the optimal shape. With true penile curvature, medical help is possible.

© Staras / Getty Images / iStock

QUEBEC. Induratio penis plastica or Peyronie can be treated surgically, medically or by mechanical means.

A research group from Canada has now published data showing that combination of the previously established therapeutic agents pentoxifylline and / or colchicine with andropenic penile traction therapy (PTT) may be a good treatment option for inoperable patients ( Sex Med 2019; online August 21 ).

Between 2015 and 2018, prospective data from 46 patients receiving oral therapy for Peyronie (pentoxifylline and / or colchicine) were compared at baseline and at six months. The degree of curvature, plaque size and various Doppler ultrasound parameters in the penis were recorded. PTT was used by the patients over the six months for a total of one hour a day.

At the end of the study, the researchers noted a significant decrease in the degree of penile curvature (55.8º ± 20º vs 41.4º ± 20.8º) and a significantly reduced plaque size (5.42 ± 2.7 to 2.42 ± 1.71 cm ² ). Also, the peak systolic velocity increased significantly from 29.8 ± 10.02 to 38.2 ± 11 cm / sec.

The study authors conclude that pentoxifylline and colchicine with concomitant PTT are a cost effective and effective therapy for Peyronie. However, further prospective randomized trials are needed to better assess disease progression in patients with conservative management. (Mg)

Peyronie: What is typical for it?

    

The Peyronie (Induratio penis plastica, IPP – derived from latin induratio = hardening) is a connective tissue disease of the penis, which causes it to form fibrinous plaques
        comes in the area of ​​the inner shell layer of the penis (tunica albuginea) at the penis shaft
        – mostly on the penis top
        The tissue thickening pulls the penis together at this point, causing it to
        a curvature of the erect penis comes. This can sometimes be very painful
        and make intercourse difficult or even impossible.

    

Extends
        If the scar tissue on the corpora cavernosa (corpora cavernosa), one can
        Erectile dysfunction may be the result. The concrete cause of Peyronie is
        so far uncleared. (run)

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Research: How dangerous are nanoparticles?

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research

At least for a while, nanoparticles do not seem to damage cells, scientists have found.

Abstract Concept of Nanoparticles: How Harmful Are They?

© Mopic / stock.adobe.com

DÜSSELDORF. Carbon nanoparticles are indeed a promising tool for biomedical applications, such as targeted drug delivery in cells. An interdisciplinary team of researchers at the Heinrich Heine University of Düsseldorf (HHU) has now investigated whether these particles are potentially dangerous for the organism and how cells try to dispose of the particles ( Sci Rep 2019; online August 19 ).

Nanoparticles are particles smaller than five nanometers, the size of macromolecules, the HHU recalls in its communication. So small particles are absorbed very well into body cells and can thus be good vehicles to transport attached to targeted drugs in sick cells. But they can also harbor health risks that are discussed, for example, in the context of particulate matter.

Carbon Nanoparticles Encapsulated in Lysosomes

HHU researchers have now investigated what happens when body cells absorb such nanoparticles. The researchers used nanoparticles from graphene; this is a special form of carbon that consists of two-dimensional layers of carbon hexagon rings. They put them in stem cells of the blood-forming system, the CD34 + stem cells. Because of their lifelong ability to divide, these cells are particularly susceptible to damaging environmental influences. Nanoparticle damage, if any, is believed to be more severe in these cells than in the more robust other cell types.

The team was able to show that the carbon nanoparticles enter the cells and are encapsulated in the lysosomes. The lysosomes are known in the body as a sort of disposal unit in which foreign bodies are accumulated and then normally degraded by enzymes. However, researchers did not observe such a degradation process over the duration of the experiments – a few days.

Long-term statements are not possible due to the experiments

Comparing the active genes of stem cells with and without the addition of nanoparticles revealed that only one out of a total of 20,800 recorded gene expressions was altered; slight effects were found in 1171 additional gene expressions.

"The encapsulation of the nanoparticles in the lysosomes ensures that these particles, at least for a few days – as long as our investigations last – are safely stored and can not damage the cell. Thus, the viability of the cell is maintained without significant change in gene expression, "said Professor Thomas Heinzel of the Institute for Experimental Solid State Physics of the HHU quoted in the message. This finding is important if one wants to use nanoparticles as ferries for drugs in the cell.

However, long-term predictions, which can detect an increased probability of cell degeneration in the direction of carcinogenesis, are not possible in the experimental framework chosen here. (eb)

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Barmer: Doctor reservation for app use controversial

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Barmer

Doctors warn of an unthinking use of health apps in care. But a boss of the treasury sees exactly in it an important supplement.

By Anno Fricke

Health Care via Smartphone? This trend is increasingly developing momentum.

© vectorfusionart
    / stock.adobe.com

BERLIN. In the run-up to the parliamentary deliberations on Digitale Versorgungsgesetz (DVG), physicians and health insurances are taking precautionary positions. The planned apps on cash costs provide for discussion.

Neurologists and psychotherapists have warned against too much laissez-faire this week about introducing digital health applications.

"To protect patients, it must be ensured that health apps complement the medical therapeutic treatment plan and comply with regulated evidence-based quality criteria," states a statement from the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology.

The federations defend themselves against plans of Minister of Health Jens Spahn (CDU), to enable the employment of digital health applications without regulation by a physician or psychotherapist.

"At the expense of the solidarity community, there must be no economic development," says the paper. However, the fact that doctors and psychotherapists may prescribe apps in the future is met with approval from specialist associations.

Digital applications swiftly into supply

The stated goal of the grand coalition is to bring digital applications "quickly into the supply". This is what the Cabinet bill says, which will now go to the parliamentary deliberations.

However, the Kassenärztliche Bundesvereinigung (KBV) rejects a benefit claim of the insured on all digital applications. The claim should relate exclusively to medically-led, therapy-supporting or -begleitende applications, is called it in the opinion of the KBV to the bill.

The physicians receive protection at this point from the Federal Insurance Office (BVA), which is currently claiming medical treatment in the case of mental illness.

Criticism comes from Kassenseite: "The BVA was not always ready to take the momentum, which the Federal Government had taken up in their digital agenda, and to support us in the same courtesy and openness in these innovations in the direction of the insured on the Barmer leader Professor Christoph Straub said Wednesday in Berlin.

Straub: Doctors' Provisions Are Not Valid

For Straub, himself a doctor, the doctor's prescription is not valid. When validating apps, it was noted that there were groups of patients who did not go to the doctor or psychotherapist, but did use online products.

"Then it's difficult to say: You can do that, but only if the traditional system makes a diagnosis in advance," said the CEO of the country's second largest health insurance company. So you do not reach what the digital world makes possible, namely a target group that wants to use other offers.

The political debate over the digitization law does not restrain the process of digitalization. The Barmer presented a sickness tracker on Wednesday, which should be available to the insured from the late year. The question as to when sickness benefits go into the account is one of the "most time-sensitive benefits", said Straub.

View of processing status

Among other things, the app gives the insured an insight into the internal processing status of the sick pay application. The philosophy behind it is to filter out meaningful products from the immeasurably broad market and make them accessible to the insured.

"Only then will insured people say that Barmer now functions like a platform where I book flights, book hotels or order something," said Straub.

After some 15,000 out of 158,000 first-time claimants claim care services in the year around 130,000 at the Barmer and ask for help in completing the 14-page application, the Barmer has provided an electronic form, which, according to the responsible head of department Dr. med. Let Regina Vetters fill out in just a few minutes.

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The myth of the healthy sea air

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fine

The air on the coasts is far from being as healthy as widely believed. This is shown by the investigations of an atmospheric physicist at the Helmholtz Center.

By Gesa Coordes

A ferry leaves with thick exhaust cloud from the Baltic Sea resort of Rostock-Warnemünde.

© Bernd Wüstneck

GEESTHACHT. Atmosphere physicist Volker Matthias has a weakness for lighthouses and the North German coast. Often he travels with his wife from Hamburg to Nordfriesland, to relax in tranquil coastal villages. But he has a different view of the merchant ships passing by on the horizon.

The 53-year-old head of department at the Institute for Coastal Research at the Helmholtz Center, together with his team, has precisely calculated in an EU project the impact of the North Sea freighters on air quality. Conclusion: "Around a quarter of the nitrogen oxides on the North Sea coasts come from ship exhaust gases," says Matthias. For the fine dust, it is up to 20 percent.

But that's not all: the exhaust-laden sea air travels hundreds of kilometers far inland, as far as Hesse and Thuringia. And at the same time, the ship's exhaust gases react with other air pollutants – for example from agriculture -, which causes further fine dust to form. The result: According to the World Health Organization, more than 50,000 people die prematurely from ship emissions each year.

Three-Dimensional Computer Models

Volker Matthias has been involved with atmospheric measurements and air quality research ever since his doctoral thesis on measuring methods for aerosol particles. During his studies in physics in Hamburg and his time as a research assistant at the Max Planck Institute for Meteorology, he also traveled on research vessels in the Pacific and in the North Sea: "I'm getting seasick," he admits.

In 2003, he moved to the Helmholtz Center in Geesthacht, where he now heads the Department of Chemical Transport Modeling. Matthias does not investigate the ship's exhaust gases on site. The physicist works with three-dimensional computer models simulating the meteorological and chemical processes in the air. The basis of his calculations are the movement data of all commercially used merchant ships traveling in the North Sea.

Fuel Control by Satellite

Each freighter must have a satellite transmitter on board, which transmits the current position and speed around the clock to the traffic control centers. This allows us to calculate where and how fast each individual vessel is traveling, how high the fuel consumption is and what amounts of nitrogen oxides, particulate matter and other pollutants are expelled. With a so-called chemical transport model, the pollutant distributions in the coastal area are derived.

In 2010 Matthias started the investigations. At that time, the ship's emissions were still little in the eye, because cargo ship transport goods are considered climate-friendly: "There is no more effective way to transport containers," says the researchers. For each tonne and kilometer transported, trucks produce 15 times more carbon dioxide than ships.

The catch: In the case of air pollutants, shipping cuts off worse than any other means of transport. On the high seas, it burns heavy fuel oil, a residue that remains in oil processing at the refinery. Combustion produces large quantities of harmful sulfur and nitrogen oxides.

And even in the ports, ships are a "source of serious stress," says Matthias. Thus, the Port of Hamburg, which was examined by his department, contributed just under one third to the emissions of nitrogen oxides in the Hanseatic city. 70 percent of the exhaust fumes come from lying ships because freighters and crusaders also need energy for cooling or hotel operations in the port. And for that generators are used, which run with ship diesel without catalyst. In the port of Hamburg, therefore, more and more power is to be used by land.

For a research team with colleagues from Rostock, Gdansk, Riga and Gothenburg, Matthias also found high levels of nitrogen oxides in the Baltic Sea. It mainly affects southern Sweden, Denmark and the German Baltic Sea coast, with emissions drifting to Berlin.

Emission limits help

However, the simulations also show that polluting emissions can be effectively reduced by emission limits for ships. In the North Sea and the Baltic Sea, only freighters are now allowed to drive with fuels that contain a maximum of 0.1 percent sulfur. And from 2021 much stricter rules for the emission of nitrogen oxides apply.

From then on, all newly built ships in the North Sea and Baltic Sea have to be equipped with catalytic converters or run on LPG. And then – if you take into account the declining fuel consumption – the emissions by 2040 by about 80 percent, Matthias has calculated: "If the regulations are met, we are actually optimistic."

Burdens of shipping

• According to the World Health Organization (WHO), 50,000 people die prematurely from ship emissions every year.
• Nearly a third of the Port of Hamburg controls nitrogen oxide emissions
• Seventy percent of these emissions come from lying ships because freighters and crusaders also need energy for cooling or hotel operations in the harbor.

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"Female Breast Size Does Not Represent Foul Body State"

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LSG judgment

In the absence of glandular tissue, the health fund does not have to pay for breast implants. There is also no enforceable right to participate in the testing procedure for liposuction, according to the LSG Baden-Württemberg.

By Martin Wortmann

As there is no standard size for women in breasts, the health insurance fund does not have to pay any additional costs, according to the LSG in Stuttgart.

© Schulz-Design / Fotolia

STUTTGART. Women with genetic missing glandular tissue can claim from their statutory health insurance no Mammaaugmentation with silicone implants. Because the impaired body function would not be treated as the Landessozialgericht (LSG) of Baden-Württemberg in Stuttgart ruled in a recently published judgment. Furthermore, insured persons can not assert a claim to participation in the testing of liposuction against their health insurance.

The now 32-year-old plaintiff had lost 76 kilograms after a gastric bypass surgery in May 2013. Remaining skin excesses on the entire body led to disfigurement and restricted mobility, inflammation and pain. She also suffered from painful lipoedema.

The female breast size basically does not represent an irregular body condition, as there is no standard size; Therefore, there is basically no claim to enlargement or reduction of the size of the breast.

From the verdict of the LSG Baden-Württemberg

On the recommendation of the MDK, her health insurance fund approved a total of five operations for tightening and further interventions on the abdomen, breasts, upper arms and thighs. On the other hand, the insurance company refused to pay for a stationary liposuction and breast augmentation with silicone prostheses.

Woman wants to get paid for enlargement

The woman complained of this. Like the Social Court of Karlsruhe, the LSG also dismissed the lawsuit. For breast augmentation, the Stuttgart judges stressed that the health insurance companies must only occur in the presence of disease. This is "an irregular physical or mental condition that results in either a need for treatment or disability or both".

"Deviations from the morphologically ideal norm", such as small or asymmetrical breasts, were generally not included. An "extreme and unreasonable amount" that could justify an exception is not available here.

No claim to liposuction

There is no claim to liposuction either. The Federal Social Court (BSG) in Kassel have confirmed that this does not belong to the cash benefits.

In addition, the LSG decided that the woman could not enforce a possible claim to participation in the planned testing of the liposuction with a lawsuit against the health insurance. Because this is not involved in the selection of study participants. In detail, the Stuttgart judges refer to the procedure provided for this purpose. Thereafter, patients can report independently from October 1 to December 31 of this year and independently of any endorsement by the health insurance on the homepage " www.erprobung-liposuktion.de ".

Patients are then examined by a medical examiner. If there are more suitable candidates than places, the lot should decide. The health insurances have no influence on this entire process, the LSG emphasized.

LSG Baden-Württemberg

Az: L 5 KR 447/17

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High triglycerides: US experts recommend omega-3 fatty acids

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High triglycerides

Monotherapy with omega-3 fatty acids may be sufficient for patients with simple hypertriglyceridemia, according to new recommendations from the American cardiologist society.

By Robert Bublak

Benefits for the Heart through Fish Oil Capsules? Which dose is needed?

© morganka / Fotolia

DALLAS. Experts from the American Heart Association (AHA) have issued a scientific recommendation to prescribe omega-3 fatty acids to patients with hypertriglyceridemia ( Circulation 2019, online Aug. 19 ).

In their recommendation for the treatment of hypertriglyceridemia with the fish oils eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the AHA experts distinguish between simple (200-499 mg / dl) and markedly elevated triglyceride levels (≥ 500 mg / dl).

For patients with simple hypertriglyceridemia, even monotherapy with omega-3 fatty acids may be sufficient. On the other hand, patients with pronounced hypertriglyceridemia may need additional medications, such as statins, to come below the 500 mg / dl threshold and reduce the risk of pancreatitis. In addition, LDL cholesterol may rise under the combination therapy with fish oils.

As a dosage of omega-3 fatty acids, AHA practitioners report 4 g / day, either as a combination of EPA and DHA or as a pure EPA preparation.

Changing Lifestyles First!

A condition for the treatment with omega-3-fatty acids is that before all possible causes for the increase of the triglyceride concentration were addressed and dietetic as well as measures for the change of the lifestyle (alcohol renouncement!) Were taken.

The current guidelines of the European as well as the German society for Kardiologie consider it worth considering to use omega-3 fatty acids, if the therapy with statins and fibrates does not work sufficiently. That certainly does not sound so convincing, the data is considered inconclusive.

However, these guidelines are from 2016. The results of the REDUCE-IT study which were first presented last year, have not yet been evaluated.

Dosage in view

In REDUCE-IT, pure and high-dose eicosapentaenoic acid has been shown to significantly reduce the cardiovascular risk of patients with elevated triglyceride levels by 25 percent. It is also the results of REDUCE-IT that underpin the new AHA recommendations.

It is also important to keep an eye on the dosage. In the REDUCE-IT study, the subjects in the verum group had received a total of 4 g of eicosapentaenoic acid in pure form (icosapent-ethyl). In many negative studies, however, the doses of omega-3 fatty acids did not exceed 1 g / day.

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It does not matter to the time

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Heart attack

When treating heart attack patients, doctors probably do not have to take into account the time at which the infarction occurred.

MUNICH. Whether a heart attack occurs in the middle of the night or in broad daylight does not determine how severe its consequences are. The scientists of the German Center for Cardiovascular Research (DZHK) at the German Heart Center Munich ( Journal Transl Med 2019; 17: 180 ) report.

Previous studies on whether the time of day affects infarct size and survival rate have been contradictory, the DZHK said in a statement.

In their retrospective study of around 1,200 patients, the scientists studied under private lecturer Dr. med. Hendrik Sager the time at which the infarction occurred and whether this affected the consequences of the infarction. In all cases, ST elevation myocardial infarction (STEMI) was present and a closed coronary vessel.

Different time windows

Sager and his team initially divided the patients into four different time windows, depending on when the symptoms of STEMI had occurred: 0 to 6, 6 to 12, 12 to 18, and 18 to 24.

All patients had received a single photon emission computed tomography (SPECT), followed by primary percutaneous coronary intervention (PPCI).

SPECT was repeated in all participants 7-14 days after the PPCI to assess which areas of the previously non-perfused myocardium could be rescued by reopening the occluded coronary artery.

Factors were excluded

In addition, Sager and colleagues included in the study how many of the patients were still alive after five years. This allowed them to draw conclusions as to whether the time of day a heart attack occurred changed the long-term prognosis.

"Of course, there are many factors that determine how severe a heart attack is," Sager is quoted in the message. "About how long it takes for the vessel to reopen or which of the three coronary arteries is closed. We have calculated out these factors. "

The conclusion of the scientists concludes: It does not depend on the time of day, how a heart attack has a long-term effect. (eb / bae)

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Government against legalization of egg donation

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Bundestag

BERLIN. An amendment to the Embryo Protection Act is no longer planned in this legislature. This has been explained by the Federal Government to a parliamentary request of the FDP in the Bundestag.

Thus, a legalization of egg donation, which was the starting point of the FDP request, not tackled. In support of this, the government refers to the fundamental decision made in the Embryo Protection Act in 1991.

"In the interests of the best interests of the child, the ban aims to ensure the uniqueness of motherhood." She refers to the thesis, proclaimed for almost 30 years, that a "split motherhood" would complicate the child's "self-discovery."

Leopoldina contradicts

The National Academy of Sciences Leopoldina has objected to this assumption in a statement published in March of this year : "Contrary to the earlier expressed fears, children who are produced by egg donation, after birth to other children conceived by IVF no medical or psychosocial abnormalities, "it says.

Egg and sperm donation can not be compared, the government emphasizes the objection that both facts are treated unequally. The making available of eggs – unlike the sperm donation – is a "complicated process with considerable depth of involvement".

Here, too, the Leopoldina comes to another assessment: the egg cell production is now "performed much gentler, so that the health risks for the donors are low," the scientists.

Government does not know exact numbers

When asked how many couples from Germany annually make an egg donation in other EU countries, the government can contribute nothing – you have no knowledge.

The Leopoldina cites estimates according to which women from Germany went abroad "at several thousand treatment cycles" each year.

The number of women receiving egg donation in Europe is estimated at more than 56,000 in 2014 in research. Except in Germany, this procedure is prohibited only in Switzerland, Norway and Luxembourg. (FST)

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