Adjusting the RAPID score with 2 additional variables significantly increases its predictive value in patients with empyema

Pleural empyema is a serious condition leading to a significant burden on health care systems due to protracted hospitalisations. Treatment ranges from non-surgical interventions such as antibiotic therapy and chest tube placement to thoracoscopic or open surgery. Various risk factors which impact outcomes have been investigated. The RAPID (renal, age, purulence, infection source, and dietary factors) score is a clinical risk score which identifies patients at risk of death and may be used to formulate individual treatment strategies accordingly. All patients undergoing surgical interventions for empyema at a major tertiary medical centre in Germany from 2017 to 2020 were analysed. The aim was to identify perioperative risk factors which significantly impact treatment outcomes but are currently not included in the RAPID score. 245 patients with pleural empyema surgically treated at the Department of General, Visceral and Thoracic Surgery at the University Medical Centre, Hamburg, Germany (admitted from January 2017 to April 2020) were retrospectively analysed. All patients which received either minimally invasive or open thoracic surgery were included. Epidemiological as well as perioperative data was analysed to identify risk factors which impact long-term overall outcomes. 90-day mortality rate was the primary endpoint. The mean age was 59.4 years with a bimodal distribution. There was a male predominance across the cohort (71.4% compared to 28.6%), with no significant differences across ages below or above 60 years. 53 (21.6%) patients died within the first 90 days. Diabetes type 1 and 2, renal replacement therapy, immunosuppression, postoperative bleeding, intraoperative transfusion as well as microbiologically confirmed bacterial invasion of the pleura all led to higher mortality rates. Higher RAPID scores accurately predicted higher 90-day mortality rates. Modifying the RAPID score by adding the comorbidities diabetes and renal replacement therapy significantly increased the predictive value of the score. We demonstrated various perioperative and patient related risk-factors not included in the RAPID score which negatively impact postoperative outcome in patients receiving surgical treatment for pleural empyema. These should be taken into consideration when deciding on the best course of treatment. If confirmed in a prospective study including non-surgical patients with a significantly larger cohort, it may be worth considering expanding the RAPID score to include these.

UHECR results of combined analyses of TA and Auger experiments

The origin of ultra-high-energy cosmic rays (UHECRs) is still unknown. Their sources are believed to be within the local universe (a few hundred megaparsecs), but deflections by intergalactic and Galactic magnetic fields prevent us from straightforwardly associating UHECRs to their sources based on their arrival directions, making their angular distribution mostly isotropic. At higher energies, the number of potential source candidates and the magnetic deflections are both expected to be smaller, but so is the available amount of statistics. Hence, it is interesting to perform searches for anisotropies using several different energy thresholds. With a threshold of 8 EeV a dipole modulation has been discovered, and with higher thresholds evidence is mounting for correlations with certain nearby galaxies. Neither of the two main UHECR detectors, the Pierre Auger Observatory and the Telescope Array project, has full-sky coverage. Full-sky searches require combining the datasets of both, and a working group with members of both collaborations has been tasked with this. We present an overview of the challenges encountered in such analyses, recent results from the working group, possible ways of interpreting them, and an outlook for the near future.

Adamantiades-Behçet disease: from clinical heterogeneity to diagnosis during the COVID-19 pandemic

Adamantiades-Behçet Disease (ABD) is a systemic disease with vasculitis, characterised by recurrent oral aphthosis and ocular, cutaneous, articular, vascular, cardiopulmonary manifestations and it is mainly found in the territories of the antique "silk road. ABD pathogenesis remains unknown although genetic, infectious and environmental factors seem to be implicated in the development of the disease, which is considered an auto-inflammatory condition. COVID-19 infection can present some symptoms, in particular at the level of oral and pulmonary mucosa, which require a differential diagnosis with ABD. Furthermore, the immunological alterations of this disease, and the drugs used for its treatment could influence the infection by COVID-19, and its clinical evolution. Nevertheless, vaccination anti-COVID-19 is recommended in ABD patients. The most commonly used diagnostic criteria for ABD are those established in 2014 by the International Team for the Revision of the International Criteria for BD (ITR-ICBD). Furthermore, criteria for disease severity according to the Overall Damage Index of Behçet's syndrome (BODI) have recently been proposed in order to quantify the severity of the disease as well as the evolution during follow-up. In ABD patients it is mandatory to investigate on the presence of active/latent tuberculosis, because of the common organ involvement, such as eyes and bowel. ABD has a high morbidity and low mortality, sometimes linked to the rupture of an arterial aneurysm and/or neurological complications. This article is based on a general review on ABD ranging from the history of ABD to possible causes and clinical manifestations. A specific section has been dedicated to the COVID-19 pandemic.

A multicenter survey on endoscopic retrograde cholangiopancreatography during the COVID-19 pandemic in northern and central Italy

Background and study aims  COVID-19 has dramatically impacted endoscopy practice because upper endoscopy procedures can be aerosol-generating. Most elective procedures have been rescheduled. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed in emergency or urgent settings in which rescheduling is not possible. We evaluated the impact of the COVID-19 pandemic on ERCP in Italy during the SARS-CoV-2 lockdown, in areas with high incidence of COVID-19. Patients and methods  We performed a retrospective survey of centers performing ERCP in high COVID-19 prevalence areas in Italy to collect information regarding clinical data from patients undergoing ERCP, staff, case-volume and organization of endoscopy units from March 8, 2020 to April 30, 2020. Results  We collected data from 31 centers and 804 patients. All centers adopted a triage and/or screening protocol for SARS-CoV-2 and performed follow-up of patients 2 weeks after the procedure. ERCP case-volume was reduced by 44.1 % compared to the respective 2019 timeframe. Of the 804 patients undergoing ERCP, 22 (2.7 %) were positive for COVID-19. Adverse events occurred at a similar rate to previously published data. Of the patients, endoscopists, and nurses, 1.6 %, 11.7 %, and 4.9 %, respectively, tested positive for SARS-CoV-2 at follow up. Only 38.7 % of centers had access to a negative-pressure room for ERCP. Conclusion  The case-volume reduction for ERCP during lockdown was lower than for other gastrointestinal endoscopy procedures. No definitive conclusions can be drawn about the percentage of SARS-CoV-2-positive patients and healthcare workers observed after ERCP. Appropriate triage and screening of patients and adherence to society recommendations are paramount.

Electron irradiation of multilayer [Formula: see text] field effect transistors

Palladium diselenide ([Formula: see text]) is a recently isolated layered material that has attracted a lot of interest for its pentagonal structure, air stability and electrical properties that are largely tunable by the number of layers. In this work, multilayer [Formula: see text] is used as the channel of back-gate field-effect transistors, which are studied under repeated electron irradiations. Source-drain [Formula: see text] electrodes enable contacts with resistance below [Formula: see text]. The transistors exhibit a prevailing n-type conduction in high vacuum, which reversibly turns into ambipolar electric transport at atmospheric pressure. Irradiation by [Formula: see text] electrons suppresses the channel conductance and promptly transforms the device from n-type to p-type. An electron fluence as low as [Formula: see text] dramatically changes the transistor behavior, demonstrating a high sensitivity of [Formula: see text] to electron irradiation. The sensitivity is lost after a few exposures, with a saturation condition being reached for fluence higher than [Formula: see text]. The damage induced by high electron fluence is irreversible as the device persists in the radiation-modified state for several hours, if kept in vacuum and at room temperature. With the support of numerical simulation, we explain such a behavior by electron-induced Se atom vacancy formation and charge trapping in slow trap states at the [Formula: see text] interface.

Sequential therapy for first-line Helicobacter pylori eradication: 10- or 14-day regimen?

BACKGROUND AND AIM

Standard 10-day sequential therapy is advised as first-line therapy for Helicobacter pylori (H. pylori) eradication by current Italian guidelines. Some data suggested that a 14-day regimen may achieve higher eradication rates. This study compared the efficacy of sequential therapy administered for either 10- or 14-days.

METHODS

This prospective, multicenter, open-label study enrolled patients with H. pylori infection without previous treatment. Patients were receiving a sequential therapy for either 10 or 14 days with esomeprazole 40 mg and amoxicillin 1 g (5 or 7 days) followed by esomeprazole 40 mg, clarithromycin 500 mg and tinidazole 500 mg (5 or 7 days), all given twice daily. Bacterial eradication was checked using 13C-urea breath test. Eradication cure rates were calculated at both Intention-to-treat (ITT) and per-protocol (PP) analyses.

RESULTS

A total of 291 patients were enrolled, including 146 patients in 10-day and 145 in the 14-day regimen. The eradication rates were 87% (95% CI = 81.5-92.4) and 90.3% (95% CI = 85.5-95.1) at ITT analysis with the 10- and 14-day regimen, respectively, and 92.7% (95% CI = 88.3-97) and 97% (95% CI = 94.2-99.9) at PP analysis (p =0.37). Among patients, who earlier had interrupted therapy, bacterial eradication was achieved in 8 out of 9 who completed the first therapy phase and performed at least >/=3 days of triple therapy in the second phase.

CONCLUSION

This study found that both 10- and 14-day sequential therapies achieved a high eradication rate for first-line H. pylori therapy in clinical practice.

Short- and long-term efficacy of intragastric air-filled balloon (Heliosphere® BAG) among obese patients

BACKGROUND

Obesity is an increasing health problem worldwide. The intragastric balloon as a temporary endoscopic treatment of obesity can play an important role among the aforementioned group of obese individuals. It can also be used as a preoperative test before subjecting patients to restrictive bariatric surgery. Furthermore, the intragastric device may be applied to patients affected by severe obesity as a "bridge treatment" before they undergo major surgery in order to reduce chances of operation-related risks. To date, there are insufficient data in the literature on the long-term results of the intragastric balloon.

METHODS

Our study includes an analysis of our experience with Heliosphere® BAG from 2006 through to 2010, concerning early weight loss and weight loss maintenance over at least 18 months since the device's removal. The 32 patients who completed the 6-month treatment had recorded a mean weight loss of 12.66 kg and a mean overweight loss of 24.37 % (SD, 12.74).

RESULTS

A total of 16 patients are subjected to an 18-month follow-up. Their pretreatment and long-term body mass index (BMI) were calculated: 6 months later, when devices were removed, they showed a mean weight of 99.75 kg (SD, 17.90; p < 0.001) and a mean weight loss of 13.62 kg and 26.14 % (SD, 12.79). 18 months after removing Heliosphere® BAG, the 16 patients' mean BMI was 37.28 kg/m² (SD, 5.41; p = 0.004), with a mean weight of 103.56 kg (SD 17.25; p = 0.0125), and a mean weight loss of 9.8 kg or 18.2 % (SD, 12.07).

CONCLUSIONS

Heliosphere® BAG enables modest short-term weight loss with little side effects, although mid/long-term follow-up may entail partial weight gain. We believe it can be considered a useful bridge treatment in bariatric surgery in order to reduce chances of preoperative risks.

ELECTRICAL FACTORS INFLUENCING THE RATE OF FILTRATION OF AQUEOUS ELECTROLYTE SOLUTIONS THROUGH CELLOPHANE MEMBRANES

The mechanisms by which electrokinetic factors might influence the filtration rate of aqueous electrolyte solutions through membranes are discussed. The filtration rate of a thorium chloride solution in which the membrane is isoelectric is compared with those of other solutions. The maximum filtration rate is found at the isoelectric concentration, the rate falling as the electrokinetic potential increases. The results demonstrate an inverse relation between the electrokinetic potential and the filtration rate but do not permit the evaluation with any great exactitude of the respective rôles played by the two proposed mechanisms, namely, a stream potential-electroosmotic back-transport and a variation in effective pore diameter due to an orientation of water dipoles determined by electrical factors. Evidence is presented that Lepeschkin's membrane resistance is an artifact.

A COMPARISON OF THE ELECTROPHORETIC VELOCITIES OF CELLOPHANE AND COLLODION SUSPENSIONS WITH ELECTROOSMOTIC VELOCITIES THROUGH MEMBRANES OF THE SAME MATERIALS

It is demonstrated that the isoelectric concentration of ThCl₄ is much greater for electroosmosis in small-pored membranes (cellophane, collodion) than for electrophoresis of particles of the same material. An explanation for the difference is advanced, based on the influence of the small pores in preventing complete development of the electrical double layer.

Reconstruction of maxilla alveolus for application of dental implant in patients with cleft defect

The prospective study of dental implant application into the reconstructed maxilla alveolus of cleft patients was started in 2001. Its aims are to specify precisely the indications, conditions and techniques, as well as the factors justifying the assumption that the results will be successful. Indication was based on an examination by a multidisciplinary therapeutic team (plastic surgeon, dental surgeon, orthodontist, and prosthetist), with the proviso that the patient should have a positive approach. Successful orthodontic treatment of intergnathic relation and shape of the dental arches served as the basis. It was followed by a reconstruction of the defective alveolus using autologous cancellous bone grafts, harvested from an iliac crest. Dental implants were inserted 12-15 weeks after the transplantation and subsequently a prosthetic component was applied with a time delay of at least 2 months. After the orthodontic preparation, reconstruction of the alveolus has so far been performed in 38 patients. Their age was at least 14 years, i.e. the age when growth of the orofacial region was finalised or already complete. The crucial tasks at this stage are to form a stable, three-dimensional voluminous alveolar crest, and to cover the grafts with a sufficient amount of quality soft tissue. We needed an average amount of 3.7 ccm of cancellous bone graft for the reconstruction. This amount can be harvested only from an enchondral bone. For soft tissue shell the mucoperiosteal shift of flap from cleft segment was used. In more serious cases contralateral or even bilateral shift was performed. The relief of tissue tension was performed by double cut-back. Using the approach described we attained a 84.2% success rate. Our results and experience derived within this project show that the success rate of this procedure depends on the continuous flow of the alveolar arch with a good intergnathic relation, with a length of defect between crowns of border teeth of at least 8 mm. The original osseous walls of the defect must definitely be of suitable height. On-lay augmentation does not work in these cases. A subsequent pitfall lies in resorption of transplanted bone, which may be reduced due to an early load by a dental implant. During the three months after the reconstruction a spongy osseous graft matures enough to ensure the primary stability of a fixture. We emphasise the necessity of close co-operation of the therapeutic team in such cases.

The important role of residue F268 in ligand binding by LXRbeta

Liver X receptors (LXRs) are nuclear receptors that regulate the metabolism of cholesterol and bile acids. Despite information on the specificity of their natural ligands, oxysterols, relatively little is known about the ligand binding site in LXRs. The helix 3 region in the ligand binding domain (LBD) of peroxisome proliferator-activated receptors (PPARs) has been implicated in ligand entry. Sequence alignment of LXRs, farnesoid X receptor (FXR), and PPARs identified the corresponding helix 3 region in the LXRbeta LBD. Residues F268 and T272, which are conserved in all the aligned sequences and only in LXRs and FXR, respectively, were replaced with alanine. The effects of these mutations on ligand binding and receptor activation were examined using an in vitro ligand binding assay and a cell based reporter assay, respectively. The LXRbeta mutant F268A did not bind ligand. In contrast, conversion of T272 to alanine has no effect on ligand binding. By transiently expressing a chimeric receptor containing Escherichia coli tetracycline repressor (TetR) and LXRbeta LBD and a reporter with a TetR binding site, we show that mutant F268A lost the ability to activate transcription of the reporter, whereas mutant T272A still has an activity similar to that of the wild-type LXRbeta. These data, consistent with the findings in the in vitro ligand binding assay and our 3D modeling, are the first study that identifies a residue critical for ligand binding in LXRbeta.

Comparison of thrice weekly vs daily human leucocyte interferon-alpha therapy for chronic hepatitis C. TVVH Study Group

Standard treatment for chronic hepatitis C currently consists of 3-6 million units (MU) of interferon-alpha (IFN-alpha) given thrice weekly (t.i.w.) for 12 months, obtaining rates of sustained response (SR) that usually do not exceed 15-25%. Some recent reports have suggested that daily administration of IFN-alpha may be more efficacious. More than 7 years ago, when standard therapy for hepatitis C was usually given for 6 months, we conducted a randomized clinical trial comparing daily vs t.i.w. treatment. In this study, 149 patients with chronic hepatitis C were randomized to received 3 MU of IFN-alpha either t.i.w. for 6 months or daily for 3 months followed by t.i.w. for 3 months. All patients were treated with human leucocyte IFN-alpha and were followed-up for up to 72 months after inclusion. Overall, patients treated daily or t.i.w. had similar rates of virological response after 3 months of induction [24/49 (50%) vs 40/100 (40%)], at the end of therapy [15/49 (31%) vs 36/100 (36%)] and at the end of follow-up [6/49 (12%) vs 9/100 (9%)]. However, when patients infected with HCV types other than HCV-1 were studied, there was a trend favouring the daily schedule that was associated with a higher [5/20 (25%) vs 5/48 (10%)] rate of long-term SR. All patients with a virological response - hepatitis C virus (HCV) RNA negative in serum as determined using the polymerase chain reaction - at 6 months after therapy remained in biochemical and virological remission at long-term follow-up, while seven of eight subjects who had normal alanine aminotransferase (ALT) levels but were serum positive for HCV RNA at 6 months, relapsed later, indicating that serum HCV RNA is better than ALT at predicting long-term cure after IFN-alpha therapy in chronic hepatitis C.

Mouse oocyte maturation: the effect of modified nucleocytoplasmic ratio

Fully grown mouse oocytes isolated from large antral follicles and cultured in vitro complete their maturation up to the second metaphase with extrusion of the first polar body (1PB) with a 40/50 proportion (80%). When their cytoplasmic volume is, however, reduced before the onset of culture, the frequency of oocytes completing maturation gradually decreases. In the half oocytes, 66% (33/50) extruded 1PB, while in third oocytes the proportion was 57% (28/49) and in quarter oocytes no polar bodies were extruded. The time course of germinal vesicle breakdown was also delayed in comparison to the decreased cytoplasmic volume. Moreover, the isolated germinal vesicles surrounded with a thin cytoplasmic rim only remained intact after a prolonged culture. The full competence of complete maturation can be restored by fusion of an additional cytoplast to the manipulated nucleate parts. We postulate that a critical nucleocytoplasmic volume ratio is absolutely necessary for normal maturation in mammalian oocytes.

A composite reference section for terminal proterozoic strata of southern Namibia

Integrated sequence stratigraphic and chemostratigraphic data yield a framework for correlations of stratigraphic units in the terminal Proterozoic to Cambrian Witvlei and Nama Groups of Namibia. Coupled with precise U-Pb zircon age constraints, these correlations make it possible to construct a composite reference section for use in calibrating terminal Proterozoic chronostratigraphy. The Namibian reference section starts with two distinct glacial horizons and extends up to within 1 million years of the Proterozoic-Cambrian boundary. The two glacial horizons may represent each of two distinct Varanger-age glaciations better known from the North Atlantic region. From the higher of the two glacial horizons up, the composite stratigraphy preserves one of the thickest and most complete available records of carbon-isotope variability in post-Varanger terminal Proterozoic seawater. Four carbon-isotope chemostratigraphic intervals are recognized: (1) a postglacial negative delta 13C excursion (Npg interval); (2) a rising interval (Pr interval) of increasing positive delta 13C values; (3) a falling interval (Pf interval) characterized by decreasing positive delta 13C and culminating in near zero or negative values; and (4) an interval of moderately positive, relatively invariant delta 13C values (I interval) that extends up to the unconformity that contains the Proterozoic-Cambrian boundary. Each of these chemostratigraphic intervals can be recognized in widely separated correlative sections around the world. By comparing sediment accumulation rate in the radiometrically calibrated Namibian stratigraphy with sediment accumulation rates in correlative sections in Arctic Canada and Oman, a maximum age of 564 Ma is estimated for the end of the younger Varanger glaciation, 25 m.y. younger than previous estimates.

Chemically enucleated mouse oocytes: ultrastructure and kinetics of histone H1 kinase activity

The objective of the study was to characterize the ultrastructure changes and biochemical mechanisms underlying the expulsion of the entire chromosome complement in chemically enucleated mouse oocytes. The ultrastructural studies demonstrated that the morphology of cytoplasts produced by etoposide-cycloheximide treatment were indistinguishable from intact metaphase I and II oocytes. Moreover, polar bodies formed by chemical enucleation were in almost all cases completely separated from the parent cytoplast and differed from normal polar bodies only in their chromatin content morphology and because they contained a slightly higher number of cytoplasmic organelles. The mode of polar body formation, however, in normal and chemically enucleated oocytes differs substantially: spindle involvement is important for normal polar body extrusion but plays no part in the protracted expulsion of chromosomes during chemical enucleation. After etoposide-cycloheximide treatment, histone H1 kinase activity remains high for the ensuing 6-8 h before declining gradually to basal levels 14 h after treatment. The expulsion of the polar body occurred only after the slowly declining H1 kinase activity reached basal levels. The activity of this kinase rose sharply to reach maximal levels within 4 h when the enucleated oocytes were removed from the inhibitor-supplemented medium and placed in normal medium. The findings in this paper indicate that cytoplasts produced by chemical enucleation are morphologically normal, thus suggesting that these enucleated cells are suitable for cloning studies. Although effective in mouse oocytes, we postulate that certain modifications to the enucleation technology are necessary before a reliable non-invasive protocol for ungulate oocytes will be available.

Efficacy of a second cycle of interferon therapy in patients with chronic hepatitis C

BACKGROUND & AIMS

Approximately 75%-85% of patients with chronic hepatitis C virus (HCV) infection do not have a sustained response when treated with interferon (IFN). Limited information exists on the efficacy of retreatment with IFN alone in these patients. The aim of this study was to define the efficacy of IFN retreatment in chronic hepatitis C.

METHODS

Ninety-two patients with chronic hepatitis C who had shown transient or no response to recombinant IFN-alpha were randomly retreated with different schedules of lymphoblastoid IFN-alpha and followed up for 12 months after therapy to define biochemical and virological response.

RESULTS

None of 26 initial nonresponders obtained a sustained response with retreatment, independent of the schedule used. Thirteen of 66 patients (20%; 95% confidence interval [CI], 10.9-31.3) with transient response during the primary cycle developed a sustained biochemical and virological response when retreated, including 3 of 41 (7%; 95% CI, 1.5-9.9) of those receiving the same schedule and 10 of 25 (40%; 95% CI, 21.1-61.3; P < 0.004) of those retreated with a higher dosage and for a longer period. Shorter disease duration (P = 0.02), higher alanine aminotransferase (P = 0.002) and lower gamma-glutamyltransferase levels (P = 0.004), HCV genotype other than HCV-1 (P = 0.03), and a negative serum HCV-RNA test at the end of the primary cycle (P = 0.000) were associated with sustained response.

CONCLUSIONS

Patients with chronic hepatitis C who have a relapse after a complete response to a 6-month IFN-alpha treatment should be retreated for 12 months. Nonresponders should not be retreated with IFN alone.

Treatment of chronic hepatitis C with interferon-alpha by monitoring the response according to viraemia

In chronic hepatitis C (HCV) infection, treatment with interferon is associated with a rather low rate of sustained response and many treated patients do not achieve significant benefit. Efforts have therefore been made to identify non-responders as early as possible to avoid unjustified costs and side-effects. We treated 106 cases of HCV with an algorithm based on the results of sequential alanine aminotransferase (ALT) and HCV RNA determinations, using an initial dose of 6 MU thrice weekly for 4 months, and modified the subsequent treatment according to the biochemical and virological profile. Thirty-three out of 48 patients (68.7%) who were HCV RNA negative with normal ALT at 4 months after initiation of treatment were sustained responders when treated for an additional 4-month period with a reduced 3 MU dose, while sustained response was achieved in 12.5% of HCV RNA positive patients treated with a higher dosage and for a more prolonged period of time. Our findings indicate that HCV RNA monitoring during interferon therapy may be useful in modifying of the treatment schedule for the individual patient.

[History of the beginnings of Czech stomatology]

The authors present a brief account of the history of dental surgery--stomatology--in Bohemia and Moravia from the very beginnings to the period after the Second World War with indicators of the brisk development of the discipline in the new democratic state which occurred in particular after the foundation of the stomatological branch of medical faculties in 1950/51. The authors mention in more detail only the main personalities and representatives of the discipline who contributed most to the development, being aware that they collaborated with several tens of teachers and research workers of more than four generations who also deserve admiration and gratitude.

[Hyperplasia of the coronoid processes of the mandible--case-history]

Hyperplasia of the coronoid processes of the mandible in a 36-year-old man was associated, in addition to difficult opening of the mouth, with noises of apparently articular origin. The noise was due to the shifting of the coronoid processes along the inner surfaces of the temporal processes of the facial bones. On the X-ray picture also the elongated styloid processes were striking as well as symmetrial exostoses at the lower borderline of the mandible and condylar processes deformed without any apparent cause.