Haemophilus influenzae Protein D antibody suppression in a multi-component vaccine formulation

Nontypeable Haemophilus influenzae (NTHi) has emerged as a dominant mucosal pathogen causing acute otitis media (AOM) in children, acute sinusitis in children and adults, and acute exacerbations of chronic bronchitis in adults. Consequently, there is an urgent need to develop a vaccine to protect against NTHi infection. A multi-component vaccine will be desirable to avoid emergence of strains expressing modified proteins allowing vaccine escape. Protein D (PD), outer membrane protein (OMP) 26, and Protein 6 (P6) are leading protein vaccine candidates against NTHi. In pre-clinical research using mouse models, we found that recombinantly expressed PD, OMP26, and P6 induce robust antibody responses after vaccination as individual vaccines, but when PD and OMP26 were combined into a single vaccine formulation, PD antibody levels were significantly lower. We postulated that PD and OMP26 physiochemically interacted to mask PD antigenic epitopes resulting in the observed effect on antibody response. However, column chromatography and mass spectrometry analysis did not support our hypothesis. We postulated that the effect might be in vivo through the mechanism of protein vaccine immunologic antigenic competition. We found when PD and OMP26 were injected into the same leg or separate legs of mice, so that antigens were immunologically processed at the same or different regional lymph nodes, respectively, antibody levels to PD were significantly lower with same leg vaccination. Different leg vaccination produced PD antibody levels quantitatively similar to vaccination with PD alone. We conclude that mixing PD and OMP26 into a single vaccine formulation requires further formulation studies.

Sexual behaviour, STI knowledge and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence in an asymptomatic cohort in Ruhr-area, Germany: PreYoungGo study

BACKGROUND AND OBJECTIVES

STIs present a significant threat to individual and public health, disproportionately affecting youth. The study aimed to evaluate (a) the prevalence of asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among youth using a rapid assay platform, (b) the participants' sexual behaviour and STI knowledge, (c) the utility of the rapid assay in reducing diagnosis-to-treatment time.

METHODS

In this study, 272 subjects (14-31 years) were included between 12/2016 and 7/2018. A questionnaire was used to collect sociodemographic data, sexual behaviour and STI knowledge. Prevalence of CT and NG infections were tested from oral, vaginal and anal swabs for women and oral, anal swabs and urine for men, using the Cepheid Xpert^® CT/NG assay. Time intervals between (i) test to the time the patient were informed of the result (turn around time - TAT) and (ii) test to therapy initiation was documented.

RESULTS

Of the 272 subjects (48.9% female, 48.9% male, undisclosed 2.2%), 56.6 % reported university education. 46.6% were men who have sex with men (MSM), and 47.4% of women and 63.1% of men had anal intercourse. 59.9% had previously been tested for HIV, while only 39.7% had for CT, 20.6% for NG. Among these asymptomatic youth 7.7% were positive for CT and 5.5% for NG. The localization of CT were 3.7% genital, 5.5% anal and 2.2% oral, while the corresponding localization of NG were 0.4%, 2.9%, 4.4% respectively. 91.8% of the participants were informed of a positive result within 24 h with a median TAT of 03:09 h. 73.3% initiated therapy within 24 h, with a median time from testing to therapy initiation being 06:50 h.

CONCLUSION

Asypmtomatic CT and NG infections are common and often not tested in persons at risk. The Cepheid Xpert^® CT/NG assay is an effective strategy as it reduces STI diagnosis-to-treatment time to less than a day.

Maternal health care provision for refugee women

Background

In the recent past, the number of forcibly displaced people increased worldwide. About 1/3 of the persons seeking asylum in Germany are female. The majority of all refugee women who are coming to Germany are currently of childbearing age. Refugee women are considered a highly vulnerable refugee subgroup, as they frequently experience physical strains and psychological burdens while fleeing their home countries and being pregnant at the same time. Moreover, pregnancy and the following period require specialized care and support in order to allow a transition to maternity without complications.

The aim of this project is to analyze maternal health care services for refugee women on the level of interaction with maternal health care professionals in Germany.

Methods

Maternal health care professionals in outpatient and clinical settings with experiences of caring for refugee women were recruited. Semi-structured interviews were conducted. The interviews were analyzed following the standards of qualitative thematic analysis.

Results

Maternal health care professionals face challenges in implementing and providing maternal health care concerning their professional practices and interventions. Due to a lack of resources (e.g. translators, time) and other conditions, gynaecologists and midwives are forced to find new solutions that maintain (medical care), adapt (vaginal examination) or miss out on (informed consent) ordinary professional practices.

Key messages

Maternal health care professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers and problems in relationship building. The identification of challenges and opportunities for professionals in maternal health care provision may contribute to improve maternal health (care) for refugee women.

A qualitative review of maternal health care provision for migrant and refugee women

Background

The number migrants increased worldwide. Pregnant migrant/refugee women are considered a vulnerable group. How do professionals manage their care? The aim was to summarize the current evidence regarding maternal health care provision for migrant/refugee women.

Methods

We conducted a systematic review and searched the databases PubMed (MEDLINE); CINAHL; PSYNDEX, PsycINFO and Cochrane Library. Studies were judged for eligibility: a study had to address maternal health care provision for migrant/refugee women who immigrated to an OECD member state. Publication date was restricted to 1990-2019, and language to English or German.

Results

16 primary (qualitative) studies were included. Heterogeneity of the included studies exists regarding e.g. origin of the women, migration background, receiving country. Nevertheless, synthesis can provide valuable information on challenges and how to deal with migrant/refugee women in maternal health care. Communication difficulties pose challenges on professionals (15 studies). Possibilities to deal with them: bridge-languages, non-verbal communication and interpreters. In addition, finding one's way in the unknown health care system is a barrier for women, which professionals can meet by informing the women and coordinating care (8 studies). The perceived diversity of women can lead to conflicts in care (10 studies). While some studies recommend 'cultural recipes', other authors emphasize the individuality of women and prefer a holistic care approach.

Conclusions

Professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers, coordinating care and handling women's diversity. Initiating and enhancing public health activities such as training courses for professionals that convey general principles such as woman-centered care, communication techniques are valuable opportunities to improve migrant/refugee women's maternal health care provision.

Key messages

Maternal health care professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers, coordinating care and handling women's diversity. Initiating and enhancing public health activities such as training courses for maternal health care professionals are valuable opportunities to improve migrant/refugee women’s maternal care.

Multi-channel Cochlear Implant Patients with Different Open Speech Understanding Show Some Similar Basic Psychophysical Results

A series of tests was recently undertaken on three multi-channel cochlear implant patients showing different degrees of open speech understanding in order to try to determine underlying differences in inner ear excitation. First we wanted to determine whether these patients showed notable differences in basic psychophysical tasks. This article reports a series of measures including absolute and differential thresholds, simultaneous and forward masking, and some polarity and phase perception. Absolute and differential sensitivities were found to be similar. In forward or simultaneous masking, the patients often showed no masking at all and in cases of masking, no frequency selectivity. In forward masking, their time constants were found to be longer than those in normal hearing. Multi-harmonic signals differing only in phase relations to produce large differences in peak amplitude did not seem to elicit different perceptions. In stimulating with very low-frequency square waves, only negative going fronts were perceived. The similarity of results for the 3 patients in this study suggest that individual differences lie in more complex stimulus processing and perhaps in qualitative aspects of perception.

The Impact of Refugee Women’s Accommodation on Maternal Health Care Provision

Background

About 1/3 of the persons seeking asylum in Germany are female. The majority of all refugee women in Germany are currently of childbearing age. The maternity period requires specialized care. Maternal health care professionals monitor the physiological processes of maternity and the psychosocial well-being in order to allow an uncomplicated transition to maternity. On arriving in Germany there are different types of accommodation for refugee women: 1) shared reception centers (e.g. tents, containerbuildings, gyms), 2) collective shelters for particularly vulnerable refugees and 3) private apartments. Depending on the woman’s accommodation maternal health care professionals are confronted with different situations and conditions in providing care for these women. The aim is to analyze the impact of refugee women’s accommodation on maternal health care provision and professional’s actions.

Methods

Structured expert interviews were conducted with maternal health care professionals. The interviews were analyzed following the standards of qualitative thematic analysis with a special focus on refugee women’s accommodation and its impact on maternal health care provision.

Results

The accommodation situation does impact the provision of maternal health care as well as the actions and doings of maternal health care professionals. On the one hand there is a change in tasks, which are no subject to original maternal health care, such as organizing transportation. On the other hand there are challenges in actually executing particular maternal health care actions, such as taking the medical history or performing examinations where there is no or little privacy.

Conclusions

Accommodation conditions impact maternal health care provision in various ways. Therefore an enhancement of housing for refugee women may improve maternal health care provision and therefore maternal health for refugee women.

Cascaded all-optical operations in a hybrid integrated 80-Gb/s logic circuit

We demonstrate logic functionalities in a high-speed all-optical logic circuit based on differential Mach-Zehnder interferometers with semiconductor optical amplifiers as the nonlinear optical elements. The circuit, implemented by hybrid integration of the semiconductor optical amplifiers on a planar lightwave circuit platform fabricated in silica glass, can be flexibly configured to realize a variety of Boolean logic gates. We present both simulations and experimental demonstrations of cascaded all-optical operations for 80-Gb/s on-off keyed data.

Trends in occupational exposure to styrene in the European glass fibre-reinforced plastics industry

Aim: This study presents temporal trends of styrene exposure for workers in the European glass fibre-reinforced plastics (GRP) industry during the period 1966–2002.

Methods: Data of personal styrene exposure measurements were retrieved from reports, databases and peer-reviewed papers. Only sources with descriptive statistics of personal measurements were accepted. The styrene exposure data cover personal air samples and biological monitoring data, that is, urinary styrene metabolites (mandelic acid and/or phenylglyoxylic acid) and styrene in blood. Means of series of measurements were categorized by year, country, production process, job and sampling strategy. Linear mixed models were used to identify temporal trends and factors affecting exposure levels.

Results: Personal exposure measurements were available from 60 reports providing data on 24145 1–8-h time-weighted average shift personal air samples. Available data of biological exposure indicators included measurements of mandelic acid in post-shift urine (6361 urine samples being analysed). Trend analyses of the available styrene exposure data showed that the average styrene concentration in the breathing zone of open-mould workers in the European GRP industry has decreased on average by 5.3% per year during the period 1966–1990 and by only 0.4% annually in the period after 1990. The highest exposures were measured in Southern Europe and the lowest exposures in Northern Europe with Central Europe in between. Biological indicators of styrene (mandelic acid in post-shift urine) showed a somewhat steeper decline (8.9%), most likely because urine samples were collected in companies that showed a stronger decrease of styrene exposure in air than GRP companies where no biological measurements were carried out.

Persistent supercurrent atom chip

Rubidium-87 atoms are trapped in an Ioffe-Pritchard potential generated with a persistent supercurrent that flows in a loop circuit patterned on a sapphire surface. The superconducting circuit is a closed loop made of a 100 microm wide molecular-beam epitaxy-grown MgB2 stripe carrying a supercurrent of 2.5 A. To control the supercurrent in the stripe, an on-chip thermal switch operated by a focused argon-ion laser is developed. The switch operates as an on/off switch of the supercurrent or as a device to set the current to a specific value with the aid of an external magnetic field. The current can be set even without an external source if the change is in the decreasing direction.

Endovaskuläre Therapie bei nicht-aneurysmatischer infrarenaler Aortenruptur

INTRODUCTION

Endovascular therapy is being used increasingly also to treat ruptured infrarenal aortic aneurysms. Non-traumatic rupture of non-aneurysmatic infrarenal aorta is an absolute rarity.

METHODS

The feasibility of endovascular repair of infrarenal aortic rupture is demonstrated with a case history and a literature review.

RESULTS

A 58-year-old male developed spontaneous rupture of his infrarenal aorta after successful chemotherapy resulting in regression of a periaortic tumor. The patient suffered from a sepsis for several days before aortic rupture was discovered during computed tomography for focus search. Immediate endovascular stent-graft repair was performed under emergency conditions. There is no recurrence and the patient is doing well with the stent-graft in place without any pathological finding after a follow-up of 24 months. So far only three further cases have been reported of endovascular repair for penetrating atherosclerotic ulcer with rupture of the infrarenal aorta.

DISCUSSION

This is the first report of endovascular repair of aortic rupture due to successful chemotherapy of a periaortic mesothelioma. Furthermore, this is the fourth case of successful stent-graft placement to treat non-aneurysmatic rupture of the infrarenal aorta. Minimally invasive endovascular therapy should become a standard treatment option for aortic rupture.

GNB3 C825T polymorphism and response to anti-retroviral combination therapy in HIV-1-infected patients--a pilot study

METHODS

Analyses were based on a cohort of 55 HIV infected patients whose treatment was changed due to therapy failure. Viral load, CD4+ and CD8+ cell counts were determined before therapy and after 8 weeks and 16-32 weeks, respectively. GNB3 genotyping was performed using Pyrosequencing. Chemotaxis of purified CD4+ cells was quantified in a Boyden chamber using stromal cell-derived factor 1alpha (SDF-1alpha) as a stimulus.

RESULTS

Age gender, route of infection, treatment, and baseline values for viral load and CD4+ and CD8+ cell counts were not associated with GNB3 genotypes (10 TT, 24 TC, 21CC). After 8 weeks of treatment viral load was lowest in TT genotypes (log copies/ml: TT: 1.88 +/- 0.32; TC: 2.49 +/- 0.24; CC: 3.06 +/- 0.22; p = 0.039) and this trend tended to persist until final visit. Unexpectedly, TT genotypes had lowest CD4+ cell counts at final visit (TT: 165.3 +/- 34.0; TC: 414.4 +/- 72.1; CC: 441.5 +/-70.9; p = 0.047). SDF-1alpha-stimulated chemotaxis was reduced in CD4+ cells from HIV-1-infected patients compared to healthy controls. Still cells from TT genotypes displayed strongest chemotaxis.

CONCLUSIONS

This pilot study suggests that the GNB3 C825T polymorphism is associated with short-term success of HAART treatment in HIV-1-infected patients.

10-fs pulse generation from a unidirectional Kerr-lens mode-locked Ti:sapphire ring laser

For the first time to our knowledge, nearly bandwidth-limited 10-fs laser pulses centered at 790 nm are generated in a Ti:sapphire ring resonator. Intracavity dispersion control is provided by dispersive dielectric mirrors together with the insertion of small amounts of intracavity glass path. Mode locking is self-starting without the use of an aperture.

[Traumatic pseudoaneurysm of the axillary artery after shoulder dislocation]

By means of a case report the diagnostic and therapeutic procedures and prognosis of a pseudo-aneurysm of the axillary artery after shoulder dislocation are demonstrated. The diagnosis of aneurysms of the axillary artery is difficult in some cases. It is important to mention a possible vascular injury in case of close reduction of the shoulder. Therefore in all patients with a penetrating or blunt trauma of the shoulder or the upper arm a thorough neurovascular examination is required. In patients with neurologic deficits or alteration of the pulse a duplex ultrasound examination should be performed and in dubious cases an additional arteriography is indicated.

[Long-term treatment of affective disorders]

The majority of depressive disorders may be viewed as a recurrent condition with the possibility of a deteriorative effect on the quality of life and productivity. The results of clinical investigations suggest that anti-depressant medication should be continued for a period of 4-6 months after the acute episode has been resolved (continuation therapy). What is more controversial, however, is the view that patients who have fully recovered should continue to receive medication in an attempt to prevent a future episode from taking place (maintenance therapy). Taking into account the results of empirical investigations which have shown that depressive disorders appear to become more severe and potentially refractory with each new episode, it is argued that patients at risk for recurrent episodes should receive a maintenance pharmacotherapy. The present study reviews the rationale and practical guidelines for the long-term treatment of affective disorders.

Electrically evoked auditory brainstem responses in cochlear implant patients

Electrically evoked auditory brainstem responses (EABR) were recorded in completely deaf patients implanted with Ineraid multichannel cochlear implants. Clear and reproducible EABR were obtained from all patients. Parametric differences with auditory brainstem responses (ABR) were demonstrated and can be explained by the different natures of both types of stimulations (electric versus acoustic). Evidence is given that other well-known properties of auditory evoked responses, like 'binaural interaction' or suppression of responses in a forward masking paradigm, can be observed in EABR of implanted patients.

Exploratory cochleotomy. Assessment of auditory nerve excitability and anatomical conditions in cochlear implant candidates

The exploratory cochleotomy is a new diagnostic procedure for the selection of cochlear implant candidates. We use this procedure to assess the excitability of the auditory nerve, the patency of the cochlea and to detect undesirable side effects of electrical stimulation, such as facial nerve activation. The exploratory cochleotomy is a limited surgical procedure performed under local anesthesia in adults and light sedation in children. It is combined with the recording of electrically evoked brainstem responses elicited by an intracochlear probe electrode.

Geneva experience with the Ineraid multichannel cochlear implant

Ineraid is a multichannel intracochlear implant of recent design that can provide high levels of speech recognition to totally deaf patients. We chose this device when it became available in 1985 because of our clinical and research interests. We had no commercial ties and could therefore critically assess the value of this implant in an array of patients, including congenital deafness, ossified cochleas and perilingual children.

Intraoperative electrically evoked vestibular potentials in humans

Electrically evoked short latency vestibular potentials were recorded in 9 patients during vestibular neurectomy. Patients were operated on because of intractable Meniere's disease. The VIIIth cranial nerve was exposed through a limited retrosigmoidal approach; the vestibular nerve was contacted in the cerebello-pontine angle with a bipolar platinum-iridium electrode and stimulated with biphasic current pulses (100 microseconds/phase, 0.75-1 mA p-p, 20/s). The responses were recorded over 12.8 ms between a forehead and an ipsilateral ear lobe electrode. Each recording consisted of 2 x 1,000 averaged responses. A systematically reproducible vertex-negative potential occurring at a latency of approximately 2 ms and having an amplitude of approximately 0.5 microV was recorded in all patients. This vertex-negative potential disappeared after selective vestibular neurectomy proximal to the stimulation site. Simultaneous continuous acoustic masking did not affect the response and no facial nerve response was observed on the facial nerve monitoring. These features strongly suggest that the characteristic vertex-negative potential constitutes a specifically evoked response of the vestibular system. Electrophysiological monitoring of the sectioning of the vestibular nerve during operation is one possible clinical application of intraoperative recording of electrically evoked vestibular potentials.

Indication of a relation between speech perception and temporal resolution for cochlear implantees

In order to better understand the reasons for success or failure of a cochlear implant system for various patients, it appears necessary to analyze the patients' basic psychophysical capacities in relation to speech perception. Five patients with intracochlear multichannel Ineraid implants were studied in terms of their performance on temporal analysis in relation to their perception of consonants. For temporal analysis we measured the detection of a silent gap in noise and of an interval between two clicks. For consonant perception we established a confusion matrix based on 12 consonants presented in a vowel-consonant-vowel context using the vowel /a/. The results showed a correlation between temporal resolution for two successive clicks at the most basal cochlear electrode used, and the perception of place of articulation of consonants. This finding indicates that delivering fine temporal coding can be crucial for the success of an implant and that for a given subject, optimal capacity for temporal resolution may serve as a criterion for choosing a basal electrode.

Intracochlear potential distribution with intracochlear and extracochlear electrical stimulation in humans

Intracochlear potential distributions were measured from subjects implanted with the Ineraid multichannel cochlear implant. The electrode array provided direct accessibility for obtaining measurements. Different modes of stimulation were used. The findings with intracochlear monopolar stimulation seem to confirm that significant low-resistance pathways, in which currents can flow into or out of the cochlea, are located in the basal turn. The results with extracochlear stimulation only show small intracochlear potential gradients. This finding suggests that no substantial currents flow along the auditory nerve fibers when extracochlear stimulation is used. These results concur with the electrically evoked auditory brain stem responses, in that intracochlear stimulation consistently elicited auditory brain stem responses, whereas responses elicited at or near the round window by extracochlear stimulation were weak or absent.

Bilateral electrical stimulation of a congenitally-deaf ear and of an acquired-deaf ear

Two identical multichannel intracochlear prostheses were implanted in the same patient. The first prosthesis, implanted in the congenitally-deaf right ear, elicited clear sound perception but no speech recognition. After 2 years, a second prosthesis, implanted in the acquired-deaf left ear, enabled the patient to understand speech without lip-reading. Brainstem and middle-latency evoked potentials were similar with electrical stimulation of both ears and resembled those evoked by acoustic stimuli in subjects with normal hearing. Cortical electric and magnetic responses differed for right- and left-sided electrical stimulation suggesting that stimulation of the congenitally-deaf ear elicited an abnormal activation of the auditory cortex. These results suggest that only cortical responses were affected by the different histories of deafness of the ears.

A case study of a 4-year-old perilingual deaf child implanted with an Ineraid multichannel cochlear implant

In August 1989, we implanted the first young (age 2-4) perilingual deaf child with the Ineraid multichannel cochlear implant. The child experienced sudden deafness at the age of 3 years 9 months. The time lapse between the onset of deafness and the implantation of the electrode array was only 4 months, but during that time the child completely stopped talking. Electrically evoked auditory brainstem responses were used for diagnosis and follow-up.

Binaural interaction in a cochlear implant patient

Binaural interaction was demonstrated in electrically evoked brainstem responses (EBRs) of a bilaterally implanted patient. A clear binaural difference waveform (BD), consisting of a negative peak near 3.6 ms followed by a positive peak near 4.4 ms, was found by subtracting the recordings with diotic stimulation from the sum of the recordings with monotic stimulation. These results are consistent with those reported for normal subjects and suggest that neural processing in this patient might resemble those ordinarily used in binaural hearing. They strengthen the argument that EBRs in cochlear implant patients do result from activity in auditory brainstem neurons and suggest a method for aligning the positions of the intracochlear electrodes.

[Fungal involvement of the penis in patients with penile condylomata acuminata]

In a study on 129 patients with penile condylomata acuminata we recognised an incidence of 32% penile yeast affection. Candida was found in 54%, Torulopsis in 30% and Rhodotorula in 17% of all cases. The high rate of yeasts not belonging to the candida species is remarkable. There was no correlation between our test results regarding the cell-mediated immunity against candida albicans and the local yeast infection.

Electrically evoked responses in Cochlear implant patients

Highly reproducible recordings of evoked responses elicited by electrical stimulation of the auditory nerve were obtained in a group of 4 totally deaf patients implanted with a multichannel intracochlear prosthesis. They were compared to auditory evoked responses obtained in a normal-hearing subject tested with the same equipment. The most striking observation drawn from these data is certainly the close resemblance, at all latencies, between evoked responses elicited by electrical stimulation and those elicited by acoustic stimulation. The remarkable correspondence of waveform morphology, waveform amplitude and interpeak latencies provides indirect evidence that the same sequence of events is triggered in the central auditory system in both cases. Those aspects of the responses which differ significantly are easily interpreted by the physical and physiological properties of the different types of stimulation.