A multicentre study for measuring skin hydration with 349 volunteers was carried out in six different laboratories. The purpose of the study was to investigate physical-, physiological- and product-dependent parameters of three test emulsions (base, base + moisturizer and base + moisturizer + lipids) in a double-blind study. A comparison between analogous and digital sensor technology of the Corneometer CM825 was examined. Here, a clear relationship between both sensor types could be highlighted. A vital point of the study was the division of the test subjects according to their skin type. To get more objective limits for three different skin types - very dry, dry and normal skin - visual expert evaluation, self-assessment and hydration measurements were analysed by means of statistical methods. The moisture-related skin types were determined as follows: very dry skin was characterized with corneometer units below 30, dry skin between 30 and 40 and normal skin higher than 40 a.u. (arbitrary units). The efficacy of the three test emulsions was examined in relation to the mentioned skin types. Analysing the measured data of all test centres, a clear dependency of skin physiology (skin type) and product efficacy became evident. The drier the skin, the higher the increase of hydration. The product performance of the three test emulsions compared to the untreated control resulted in a significant increase of skin hydration in all measuring centres. The evaluation of a product ranking showed a good differentiation between the basic emulsion and the two other products. An increase of efficacy by adding lipids could be observed in four of six centres. The important influence of the skin type of the volunteers on the degree of product performance, as demonstrated in this study, should be especially considered when drawing up guidelines for efficacy testing.

IntroductionRecent studies performed in our laboratory (Nissen et al. -1981) showed that the percentage composition of phospholipid-bound docosahexaenoic acid of human semen was distinctly lower in azoospermia and oligozoospermia than in astheno-or teratozoospermia. The fatty acid composition is important to provide the correct membrane fluidity and permeability (Chapman and Wallach -1968;Veerkamp et al. -1962). Therefore we continued our studies on a different and larger population and expanded it to include the absolute amounts of phospholipid-bound fatty acids from different andrological conditions. Materials and MethodsSemen: For the use of pooled samples has been arbitrary, we analysed the absolute fatty acid content in single ejaculates. Our studies were performed on the ejaculates from 100 donors. The semen specimens were obtained by masturbation after four to seven days of sexual continence from men aged 20-35 years.After liquefaction of the samples the sperm count and the percentage motility were determined by microscopic analysis. Chemicals: Silica gel 60 was purchased from E. Merck, Darmstadt, Germany.Applied Science Europe B.V. Oud-Beyerland, Holland. Boron trichloride-methanol reagent, malonaldehyde and thiobarbituric acid were purchased from Sigma Chemical Co, Munich. The glass capillary column was obtained from Machery and Nagel, Diiren, Germany. Lipid analysis: The lipids were extracted with chloroform-methanol (2:l v/v) (Folch et al.-1957). The extracted lipids were separated into neutral lipids and phospholipids by thinlayer chromatography on silica gel 60. Diethylether was used as developing solvent. The zones were scraped from the plate and eluted from silica with 1 : 1 chloroform-methanol mixture containing 5 mg/100 ml butylated hydroxytoluene (BHT) as antioxidant. To prevent degradation of plasmalogens all processes were conducted at 4" C. Fatty acid methylesters of phospholipids were prepared by transmethylation with boron trichloridemetha-no1 (Morrison and Smith -1964; Brian and Gardner -1967).The degradation and artifact formation which may occur with polyunsaturated fatty acids and boron trifluoride-methanol is minimal or absent when the boron trichloride reagent is used (Klopfenstein -1971, Brian et al. -1972. The methylesters were purified by Fatty acid methylesters were products of Sigma Chemical Co, Munich, Germany or of

BackgroundCase management has been suggested as an innovative strategy that facilitates the improvement of a patient's quality of life, reduction of hospital length of stay, optimization of self-care and improvement of satisfaction of patients and professionals involved. However, there is little evidence about the effectiveness of the patient advocacy case management model in clinical practice.Therefore, the objective of our study was to examine the effects of the Dutch patient advocacy case management model for severely disabled Multiple Sclerosis (MS) patients and their caregivers compared to usual care.Methods/designIn this randomized controlled trial the effectiveness of casemanagement on quality of life of patients and their caregivers, quality of care, service use and economic aspects were evaluated. The primary outcomes of this study were quality of life of MS-patients and caregiver burden of caregivers.Furthermore, we examined quality of life of caregivers, quality of care, service use and costs.DiscussionThis is a unique trial in which we examined the effectiveness of case management from a broad perspective. We meticulously prepared this study and applied important features and created important conditions for both intervention and research protocol to increase the likelihood of finding evidence for the effectiveness of patient advocacy case management. Concerning the intervention we anticipated to five important conditions: 1) the contrast between the case management intervention compared to the usual care seems to be large enough to detect intervention effects; 2) we included patients with complex care situations and/or were at risk for critical situations; 3) the case managers were familiar with disease specific health-problems and a broad spectrum of solutions; 4) case managers were competent and authorized to perform a medical neurological examination and worked closely with neurologists specialized in MS; and 5) the case managers had a regional network of professionals and health care organisations at their disposal, and were accepted as a coordinator of care. We also put a lot of effort on the selection of eligible patients, randomization and statistical methods, but also on power analysis, selection of reliable, validated and sensitive outcome measures, and (statistical) control of confounders.Trial registrationDutch Trial Register http://www.trialregister.nl. Trial ID: NTR762.

Amounts of Copper/zinc containing superoxide dismutase have been found in human seminal plasma. Superoxide dismutase inhibits the lipid peroxidation in the xanthine oxidase system. In seminal plasma of spermatozoa with a good motility the superoxide dismutase activity is higher than in those with a low motility.

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