Testing quantum electrodynamics in extreme fields using helium-like uranium

Quantum electrodynamics (QED), the quantum field theory that describes the interaction between light and matter, is commonly regarded as the best-tested quantum theory in modern physics. However, this claim is mostly based on extremely precise studies performed in the domain of relatively low field strengths and light atoms and ions1-6. In the realm of very strong electromagnetic fields such as in the heaviest highly charged ions (with nuclear charge Z ≫ 1), QED calculations enter a qualitatively different, non-perturbative regime. Yet, the corresponding experimental studies are very challenging, and theoretical predictions are only partially tested. Here we present an experiment sensitive to higher-order QED effects and electron-electron interactions in the high-Z regime. This is achieved by using a multi-reference method based on Doppler-tuned X-ray emission from stored relativistic uranium ions with different charge states. The energy of the 1s1/22p3/2 J = 2 → 1s1/22s1/2 J = 1 intrashell transition in the heaviest two-electron ion (U90+) is obtained with an accuracy of 37 ppm. Furthermore, a comparison of uranium ions with different numbers of bound electrons enables us to disentangle and to test separately the one-electron higher-order QED effects and the bound electron-electron interaction terms without the uncertainty related to the nuclear radius. Moreover, our experimental result can discriminate between several state-of-the-art theoretical approaches and provides an important benchmark for calculations in the strong-field domain.

Toward the development of sensors for lung cancer: The adsorption of 1-propanol on hydrophobic zeolites

A healthy breath is mainly composed of water, carbon dioxide, molecular nitrogen, and oxygen and it contains many species, in small quantities, which are related to the ambient atmosphere and the metabolism. The breath of a person affected by lung cancer presents a concentration of 1-propanol higher than usual. In this context, the development of specific sensors to detect 1-propanol from breath is of high interest. The amount of propanol usually detected on the breath is of few ppb; this small quantity is a handicap for a reliable diagnostic. This limitation can be overcome if the sensor is equipped with a pre-concentrator. Our studies aim to provide an efficient material playing this role. This will contribute to the development of reliable and easy to use lung cancer detectors. For this, we investigate the properties of a few hydrophobic porous materials (chabazite, silicalite-1, and dealuminated faujasite). Hydrophobic structures are used to avoid saturation of materials by the water present in the exhaled breath. Our experimental and simulation results suggest that silicalite -1 (MFI) is the most suitable structure to be used as a pre-concentrator.

Stochastic epigenetic mutations as possible explanation for phenotypical discordance among twins with congenital hypothyroidism

PURPOSE

The elevated frequency of discordance for congenital hypothyroidism (CH) phenotype between monozygotic twins suggests the involvement of non-mendelian mechanisms. The aim of the study was to investigate the role of epigenetics in CH pathogenesis.

METHODS

A genome-wide DNA methylation analysis was performed on the peripheral blood of 23 twin pairs (10 monozygotic and 13 dizygotic), 4 concordant and 19 discordant pairs for CH at birth.

RESULTS

Differential methylation analysis did not show significant differences in methylation levels between CH cases and controls, but a different methylation status of several genes may explain the CH discordance of a monozygotic twin couple carrying a monoallelic nonsense mutation of DUOX2. In addition, the median number of hypo-methylated Stochastic Epigenetic Mutations (SEMs) resulted significantly increased in cases compared to controls. The prioritization analysis for CH performed on the genes epimutated exclusively in the cases identified SLC26A4, FOXI1, NKX2-5 and TSHB as the genes with the highest score. The analysis of significantly SEMs-enriched regions led to the identification of two genes (FAM50B and MEG8) that resulted epigenetically dysregulated in cases.

CONCLUSION

Epigenetic modifications may potentially account for CH pathogenesis and explain discordance among monozygotic twins.

Setting targets for population health improvements: Trends in perinatal health in Europe over the past five years

Background

The Euro-Peristat network documented disparities in perinatal outcomes between countries in Europe in its reports published every 5 years, but trend analyses were limited because data were not collected annually.

Methods

Using the Euro-Peristat PHIRI protocol, we estimated rates and assessed trends between 2015 and 2019 for preterm birth, stillbirth, neonatal mortality and caesarean delivery. Country-specific relative risks (RR) for year, modelled as a continuous variable, were estimated and random effects meta-analysis used to generate pooled RRs. Heterogeneity was measured with the I2 statistic (percentage of variability in estimates due to heterogeneity rather than sampling error).

Results

Stillbirth rates ≥24 weeks of gestational age (GA) varied in 2019 from <2.5 per 1000 births in Denmark, Estonia, Finland and Slovenia to over 4 per 1000 in Belgium, Cyprus, UK Wales and Lithuania. Preterm birth rates ranged from <6% in Lithuania, Finland, Latvia, Estonia and Denmark to 8% or more in Portugal, Belgium, UK Scotland and Cyprus. Fewer than 20% of births were by caesarean in Norway, the Netherlands, Finland, Estonia in comparison to one-third in Cyprus, Ireland, Italy, UK Scotland. Trends over time differed between countries and were not related to the level of the indicator: the pooled RR by year for preterm birth was 0.99 [0.99; 1.00] with five countries having significant decreases and three countries having increases. Caesarean section rates were stable overall (RR: 1.00 [0.99; 1.01]RR:1.00, 95% CI: 0.99-1.01), but with high heterogeneity (I2=99%); in six countries rates increased significantly, whereas in nine rates decreased between 2015 and 2019.

Conclusions

European countries have varying rates and trends of the principal perinatal health indicators. Investigation of policies in high-performing countries could provide guidance for improvement elsewhere.

Health status of people with intellectual disabilities: A systematic literature review

Background

People with intellectual disabilities (ID) have a right to the highest level of health and to non-discrimination in health care. There are an estimated 89,000 people with ID living in Austria. Little is known about their health status and about their health care. We carried out a systematic review with the aim to provide an overview of comparative studies on the health status and health behaviour of people with and without ID.

Methods

The systematic literature search was conducted in 3 electronic databases for the search period 2008 to March 2020, supplemented by a reference list check and a search of relevant websites. Abstracts and full texts were dually screened, data extraction was performed by one person and checked by a second. Bias risk was assessed by two people using the AXIS tool for cross-sectional studies. Results were summarised narratively.

Results

A total of 73 publications were included. The literature review reveals a very clear picture: people with ID have a shorter life expectancy, are more affected by illness and health problems, are more likely to have health-related limitations in daily living and are more likely to die from potentially preventable causes of death that could be avoided either through preventive measures or by high-quality medical care.

Conclusions

To better assess the health situation of people with ID in Austria, Austria-specific data is needed. Furthermore, systematic initiatives in the areas of prevention, health promotion and health care are necessary. People with ID should therefore be systematically considered in all strategies and processes in the health sector. In terms of health literacy, a stronger information policy towards people with ID and towards their relatives and health care professions would be indicated.

Key messages

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

BACKGROUND

The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.

METHODS

This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.

RESULTS

Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.

CONCLUSIONS

Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND

The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.

METHODS

Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups.

RESULTS

Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005).

CONCLUSION

Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.

Autoimmune polyendocrine syndrome type 1: an Italian survey on 158 patients

BACKGROUND

Autoimmune Polyglandular Syndrome type 1 (APS-1) is a rare recessive inherited disease, caused by AutoImmune Regulator (AIRE) gene mutations and characterized by three major manifestations: chronic mucocutaneous candidiasis (CMC), chronic hypoparathyroidism (CH) and Addison's disease (AD).

METHODS

Autoimmune conditions and associated autoantibodies (Abs) were analyzed in 158 Italian patients (103 females and 55 males; F/M 1.9/1) at the onset and during a follow-up of 23.7 ± 15.1 years. AIRE mutations were determined.

RESULTS

The prevalence of APS-1 was 2.6 cases/million (range 0.5-17 in different regions). At the onset 93% of patients presented with one or more components of the classical triad and 7% with other components. At the end of follow-up, 86.1% had CH, 77.2% AD, 74.7% CMC, 49.5% premature menopause, 29.7% autoimmune intestinal dysfunction, 27.8% autoimmune thyroid diseases, 25.9% autoimmune gastritis/pernicious anemia, 25.3% ectodermal dystrophy, 24% alopecia, 21.5% autoimmune hepatitis, 17% vitiligo, 13.3% cholelithiasis, 5.7% connective diseases, 4.4% asplenia, 2.5% celiac disease and 13.9% cancer. Overall, 991 diseases (6.3 diseases/patient) were found. Interferon-ω Abs (IFNωAbs) were positive in 91.1% of patients. Overall mortality was 14.6%. The AIRE mutation R139X was found in 21.3% of tested alleles, R257X in 11.8%, W78R in 11.4%, C322fsX372 in 8.8%, T16M in 6.2%, R203X in 4%, and A21V in 2.9%. Less frequent mutations were present in 12.9%, very rare in 9.6% while no mutations in 11% of the cases.

CONCLUSIONS

In Italy, APS-1 is a rare disorder presenting with the three major manifestations and associated with different AIRE gene mutations. IFNωAbs are markers of APS-1 and other organ-specific autoantibodies are markers of clinical, subclinical or potential autoimmune conditions.

The use of online video consultations in the aftercare of orthopedic patients: a prospective case-control study

Background

Video consultations have proven to be an efficient source of support for patient-doctor interactions and have become increasingly used in orthopedics, especially during the COVID-19 pandemic. This study analyzed both patients’ and doctors’ acceptance of an orthopedic telemedical consultation (OTC) and compared the results of OTC examinations to the results of live consultation (LC) to identify discrepancies.

Methods

The study was carried out in an orthopedic department of a German hospital between 2019 and 2020. After written informed consent was obtained, patients voluntarily presented for follow-up by OTC and LC. The experience with and attitudes toward OTC among both patients and doctors was evaluated (using Likert scale-scored and open questions, 26 to 28 items). The results of the OTC and LC examinations were compared using a 12-item checklist. The data were analyzed by quantitative and qualitative statistics.

Results

A total of 53 patients were included, each of whom completed an OTC and an LC. The OTC was rated as pleasant, and the experience was rated as very satisfying (average rating on a 5-point Likert scale, with 1 indicating strong agreement: doctors: 1.2; patients: 1.3). Various technical and organizational challenges were identified. Compared to LC, OTC showed no significant differences in patient history or in inspection, palpation, or active range of motion results. Only for the functional or passive joint assessment did LC show significantly higher suitability (p < 0.05) than OTC. Recommendations for further procedures did not differ significantly between OTC and LC.

Conclusions

Because of the high acceptance and the objective benefits of OTC and the similarity of clinical results with LC, OTC is recommendable for orthopedic follow-up examinations. To better assess joint functionality, meaningful digital alternatives for established examination methods should be further investigated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04653-3.

Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study

BACKGROUND

No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.

METHOD

This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).

RESULTS

Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC.

CONCLUSION

Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.

Comparison of short-term outcomes from the International Oesophago-Gastric Anastomosis Audit (OGAA), the Esophagectomy Complications Consensus Group (ECCG), and the Dutch Upper Gastrointestinal Cancer Audit (DUCA)

BACKGROUND

The Esophagectomy Complications Consensus Group (ECCG) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA) have set standards in reporting outcomes after oesophagectomy. Reporting outcomes from selected high-volume centres or centralized national cancer programmes may not, however, be reflective of the true global prevalence of complications. This study aimed to compare complication rates after oesophagectomy from these existing sources with those of an unselected international cohort from the Oesophago-Gastric Anastomosis Audit (OGAA).

METHODS

The OGAA was a prospective multicentre cohort study coordinated by the West Midlands Research Collaborative, and included patients undergoing oesophagectomy for oesophageal cancer between April and December 2018, with 90 days of follow-up.

RESULTS

The OGAA study included 2247 oesophagectomies across 137 hospitals in 41 countries. Comparisons with the ECCG and DUCA found differences in baseline demographics between the three cohorts, including age, ASA grade, and rates of chronic pulmonary disease. The OGAA had the lowest rates of neoadjuvant treatment (OGAA 75.1 per cent, ECCG 78.9 per cent, DUCA 93.5 per cent; P < 0.001). DUCA exhibited the highest rates of minimally invasive surgery (OGAA 57.2 per cent, ECCG 47.9 per cent, DUCA 85.8 per cent; P < 0.001). Overall complication rates were similar in the three cohorts (OGAA 63.6 per cent, ECCG 59.0 per cent, DUCA 62.2 per cent), with no statistically significant difference in Clavien-Dindo grades (P = 0.752). However, a significant difference in 30-day mortality was observed, with DUCA reporting the lowest rate (OGAA 3.2 per cent, ECCG 2.4 per cent, DUCA 1.7 per cent; P = 0.013).

CONCLUSION

Despite differences in rates of co-morbidities, oncological treatment strategies, and access to minimal-access surgery, overall complication rates were similar in the three cohorts.

On social psychiatry: Psychopathology of German justice on example of resident houses (RH)

Introduction

Social PSYCHIATRY is essential for solutions of RH-conflicts leading to immense psychic&medical problems-[2a-e,3]. Millions tenants in Europe: Germany-54.3%/Austria-30.2%/France-25.3%/GB-24.1%/Italy-12.9%/Slovenia-4.5%. German journals reflect catastrophic situation of tenant-lessor conflicts-[3].

Objectives

REFERENCES: [1a]-Luetge,Ch et-al(ed): Experimental Ethics, Basingstoke:Palgrave-Macmillan,2014. [1b]-Pegoraro,R (Chancellor Academy/Vatican-City) «Arzt und Christ» 38:3-55,1992; EACME-2017-Barcelona AB:p.129-130. [2]-Michailov,M.Ch, Neu,E, Welscher,U et-al: [2a]-Psychology: EFPA-2019-Moscow AB:p.1529,1530,1549. IUPsyS-2008-Berlin Int.J.Psychol. 43/3-4 p.154,248,615,799. [2b]-Psychiatry: EPA-2020-virtual/Madrid, Eur.Psychiatry 63S:EPP0834/5+EPV0581/1470; EPA-2019-Warsaw 56S:S689; EPA-2018-Nice 48/S1:S623&567&662. WPA-2019-Lisbon, E-Poster WCP19-2137/-1822/-1839: 2018-Mexico-City, Abs.-Book WCP18-0584/-0625/-0643/-0654. 2011-Buenos-Aires, AB:PO1.200. [2c]-Philosophy&Law: IVR-2019-Lucerne Progr.Book:p.114-116. FISP-2018-Peking Abstr.Book(AB)1348-50,1373-4,1420; -2013-Athens AB464-5/503-4/766. EACME-2017-Barcelona/MedEthics) AB73-74/125-126. [2d]-Psychosomatics: ICPM-2017-Peking AB:ID: 648493/648895/647749/648878; -2005-Kobe, JPsychosomRes 58: 85-86. [2e]-Physiology: DPG-2019 (German-Austrian-Suisse Soc.) Acta-Physiol., 227/S719, A03-3,A03-4,A03-9,A04-4,A05-1. IUPS-2017-Rio-de-Janeiro, AB:ID977; IUPS-2009-Kyoto, J.Physiol.Sci. Proc-IUPS-Vol.XXII/Springer,p.249. [3]-German-journals-“tz”-München, 14.02.2019, 15.02.17, 06.12.16/p.10, 18.10.16/p.10. Süddt.Zeitung-no172/p.30, 2017. Bild-14.12.2018/p.12. Mü.-Merkur-14./15.12.2019/no289/p.33.

Methods

Psychological-medical-social observations-[2a,e].

Results

Complex interaction of social-natural factors (micro-ecology/apartments) are demonstrated by conflicts tenants-lessors (RH-Munich). Conflicts conc. high-rents, luxurious repair, cause dangerous psychoneurological diseases: anxiety-neurosis-insomnia-depression,etc., esp. in patients/seniors with cardio-vascular pathology. Defect-doors&radiators&windows (air-currents) induce respiratory-diseases, defect-illumination causes accidents (neuro-orthopaedic diseases: commotio-cerebri,etc.). Examples for impossible situation in German-RH: After 47years annihilation of RH-contract (tenant-woman 74years); over 4.5years lessor tries to eliminate 2scientists from RH, living-working 40/50years (one invalid, other 86years, both with complex pathology) by justice-terror; RH-contracts of tenants 90years with dementia&blind-senior (90years) are annihilated. RH-conflict leads to lethal consequences of 73 year tenant-[3].

Conclusions

SOCIAL PSYCHIATRY could help millions of tenants injured by RH-conflicts-[2a-c,1a,b] by (a)-psychotherapy&education considering “total symptoms of mind-body, acc. to Emperor AKIHITO during ICPM-2005-Kobe-[2d], (b)-education of RH-administrators incl. philosophical/psychological/psychiatric-examination, (c)-foundation of „house-councils“ for „RH-industry“ counteracting psychopathological/-somatic diseases. This way will be supported UNO-Agenda21 for better health/education/ecology on global-level.

Disclosure

No significant relationships.

On psychiatry and psychology

Introduction

Psychiatry is fundamental interdisciplinary medical science with essential importance for enormous health-problems of humanity. Creation of integrative-psychiary in context of multidimensional&holistic medicine, founded by HIPPOCRATES-GALENUS-HUA T’UA-AVICENA-PARACELSUS is necessary to counteract disastrous human health-situation. Psychiatry needs new integrative therapy-models considering application of psychopharmacotherapy as well as practices of psycho-somatic (Th.v.UEXKÜLL) and somato-psychic theories (Y.IKEMI). Emperor AKIHITO during Opening-Ceremony of ICPM-2005-Kobe appointed to consider “total symptoms of mind-body, seeking ways of holistic care”.

Objectives

REFERENCES. PSYCHIATRY: EPA-2020-virtual/Madrid, Eur.Psychiatry 63S, EPP0834/5+EPV0581/1470; EPA-2019-Warsaw, Eur. Psychiatry 56S,S689; EPA-2018-Nice, Eur.Psychiatry 48/S1, S623&567&662. WPA-2019-Lisbon, E-Poster WCP19-2137, -1822, -1839; 2018-Mexico-City, Abs.-Book WCP18-0584/-0625/-0643/-0654. 2011-Buenos-Aires,AB:PO1.200. PSYCHOLOGY: EFPA-2019-Moscow, Abs.-Book 1529,1530,1549. IUPsyS-2012-Cape-Town, IntJPsychol 47:407; -2008-Berlin, 43/3-4:154, 248,615,799; -2004-Beijing, AB:49,587. PSYCHOSOMATICS: ICPM-2017-Beijing, AB:ID: 648493,648895,648749,648878; -2005-Kobe, J.Psychosom.Res. 58:85-86.

Methods

Evaluation of psychic-“polar-attitude-list”/physiological-parameters: heart-rate, blood-pressure,etc. from patients/probands after training by occidental/oriental practices (Music-/Yogatherapy/others) (ref.).

Results

Observations demonstrate strong positive influence after music[1], respiratory[2], hatha-yoga[3] therapies. Items of psycho-physiological (relaxed), emotional (tranquil/happy), cognitive (few/ordered thoughts), voluntary (active/spontaneous), social (open/assertive), consciousness (clear/sleepy) categories are significantly positive changed 25-50%. The 3-therapies have specific psychic-effects,e.g. items “relaxed/tranquil” after respiratory- (+45/50%) and music- (+20/5%), also item “open” after music-therapy (+25%) are positive, but negative after respiratory-therapy (-20%). Psychic-effects are correlated with positive physiological-ones,e.g. heart/respiratory-frequency decreased 25-30%, voluntary-apnoea prolonged 55%. Mountain-altitude (>2000-3000m), hypothermia (<20 to 0°C) influenced positively psychic/physiological-parameters,e.g. heart-rate/blood-pressure decrease (n=125,P<0.05-0.01).

Conclusions

Different methods of integrative psychiatric therapy are with preference,e.g. for depression is suitable respiratory/physical-training, also hypothermia&high-mountain therapy (activation-euphoria), for mania:music-therapy (inhibitory-effect). Systematically research about single/combined therapies is necessary,e.g. for epilepsy: Respiratory-therapy/hypothermia,etc. could help patients (hypo-/hypercapnia: inhibitory/excitatory effects on CNS-structures).

On social psychopathology: Example with German justice

Introduction

INTRODUCTION-OBJECTIVES. Similar to philosophy (regina-scientiarum) is psychiatry fundamental-discipline for all-medical&social sciences. Immanuel KANT: Primus inter pares of ARISTOTELES&PLATON considered over 200years ago physiological and pragmatic anthropology-[1]. Social physiology is given-[3-4]. Consideration of social-psychopathology in German-justice-[2].

Objectives

REFERENCES. [1]-Kant,I: BdXI,371-393, BdXII,399,625-638:Suhrkamp-TB-Wiss. [2]-Neu,E/Michailov, M.Ch/Welscher,U/et-al.: 2a.-FISP-2018-Beijing/Philos (1348-50,1373-4,1420); 2013-Athens Abstr.Book(AB):464-5/503-4/766; 2008-Seoul-ProcVol.4: 101-108/195-214/229-237; 2003-Istanbul:273-281; IVR-2019-Luzern (Law), Progr-Book p.116. 2b.-EPA-2020-Madrid, Eur.Psychiatry 63S, EPP0834/5+EPV0581/1470; EPA-2019-Warsaw, 56S,S689; EPA-2018-Nice, 48/S1, S623&567&662. 2c.-WPA-2021-Bangkok (in-press). 2019-Lisbon, E-Poster WCP19-2137/-1822/-1839. 2018-Mexico-City, Abs.-Book WCP18-0584/-0625/-0643/-0654. 2011-Buenos-Aires, AB:PO1.200. [3]-Glasachev,O: Sechenov Physiol.J 80/no5, 1994,p.139-143 (Russian), ref. in English. [4]-Seeley,T.D: Social-Physiology Honey-Bee, Book-1996.

Methods

[5]-Daily-journal-“tz”-München, esp. every Tuesday 2016-2019: reports on Res.-Houses,e.g. 14.02.2019, 15.02.17, 06.12.16/p.10, 18.10.16/p.10, 17.11.2020/p.6. Süddt.Zeitung-München no172/p.30,2017. Mü.-Merkur:16.11.2020/p.32; 19.11.2020/p.29. FAZ:20.10.2019/p.53; 16.11.2020/p.21. BUROW,P: Justiz am Abgrund&Ein Richter klagt an. GNISA,J, Präs.-Dt.Richterverein: „Ende der Gerechtigkeit“, Herder-2017. SCHLEIF,T/Amtsrichter: Buch „Urteil: ungerecht“, zeit-online 24.10.2019. Hans-Jochen&Liselotte VOGEL:„Mehr Gerechtigkeit“, 2019 „Wohn-Irrsinn“(Enteignungen). ZANTKE,S (Richter-Amtsgericht-Zwickau): TV-Programm„Auf einen Blick“ Nr.47,2018,S.24. [6]-Luetge,Ch et-al.(ed): Experimental-Ethics, Palgrave-Macmillan 2014. [7]-Pegoraro,R/Vatican: «Arzt&Christ» 38:3-55,1992.

Results

RESULTS Prominent German experts for justice: Patrick BUROW, Jens GNISA/President Law-Association/Germany, Torsten SCHLEIF/Amtsrichter, Hans-Jochen VOGEL/Ex-Minister, Stephan ZANTKE/Richter reflect in their books fundamental-criticism of German justice [5]. Inst.-Ecol.-Med./IUM investigated psychopathology of juridical-offices&law-court in Munich (Amtsgericht). Analysis suggests presence of symptoms for pseudologia-phantastica, psychopathy, cyclophrenia (esp.mania),etc. conc. observations on many persons (n>30).

Conclusions

CONCLUSION. Juridical situation in Germany demonstrates contradiction to human-rights (EU-CHARTA, art.1-8/25-26/33-35), ignoring moral-philosophy, related to human obligations/I.Kant-[1], experimental ethics/Ch.Luetge et-al.-[6], medical personnel/R.Pegoraro-[7]. Only paradigm change in law-policy incl. enlarged implication of moral philosophy-theology, psychiatry-psychology, social philosophy in juridical eduction & practices could counteract disastrous juridical situation in Germany and on global level, supporting UNO-AGENDA21 for better education-health-ecology-economy (see 2.).

Disclosure

No significant relationships.

The association between challenging behaviour and symptoms of post-traumatic stress disorder in people with intellectual disabilities: a Bayesian mediation analysis approach

BACKGROUND

A preponderance of behavioural symptoms is assumed to be the main difference in the manifestation of symptoms of post-traumatic stress disorder (PTSD) in people with intellectual disability (ID). However, no study so far has assessed the relationship between challenging behaviour (CB) and PTSD. The present study aims to explore this relationship by exploring whether CB is directly related to trauma exposure or whether this relationship is mediated through core symptoms of PTSD.

METHODS

Trauma exposure and current symptoms of PTSD were assessed in 43 adults with mild to moderate ID. Parallel versions were administered to 43 caregivers, including the Aberrant Behaviour Checklist to measure CB. Bayesian mediation analyses were conducted using self-rated and informant-rated data.

RESULTS

The self-report data showed no associations of CB with trauma exposure or PTSD symptoms. The association between informant-rated trauma exposure and irritability was mediated by severity and frequency of PTSD symptoms. The associations between informant-reported trauma exposure and the Aberrant Behaviour Checklist subscales hyperactivity and inappropriate speech were mediated by PTSD symptom severity.

CONCLUSIONS

The relationship between trauma exposure and CB was mediated by PTSD symptoms. PTSD core symptoms should be considered as underlying causes of CB, highlighting the necessity to explore trauma biography and symptoms of PTSD. The improvement of self-report assessment in people with ID is an important task for future studies.

"Block-and-replace" treatment in Graves' disease: experience in a cohort of pediatric patients

PURPOSE

The "block-and-replace" (BR) method involves the use of a high dose of antithyroid drugs (ATD) with levothyroxine (L-T4). Its use in the management of Graves' disease (GD) is still debated mainly because the frequency of side effects of ATD is dose dependent. We retrospectively studied the effect of medium dose of ATD with L-T4 versus monotherapy with ATD in pediatric patients with unstable GD.

METHODS

28 pediatric patients with GD with unstable response to ATD were treated with L-T4 and medium dose of ATD. We compared the rate of euthyroidism, hypothyroidism and hyperthyroidism episodes observed during treatment with methimazole alone with those observed during the BR approach. We evaluated the occurrence of side effects and the rate of remission in patients treated with ATD + L-T4 therapy and the efficacy of combination therapy to postpone a definitive treatment (radioiodine and thyroidectomy).

RESULTS

Patients showed a better control of thyroid function during the BR therapy, presenting fewer episodes of hyperthyroidism and hypothyroidism. No serious side effects during the BR approach were observed. Only one patient went into remission with the ATD + L-T4 therapy. Fifteen patients required a definitive therapy (4 radioiodine, 11 thyroidectomy). The use of BR method has delayed radioiodine treatment for 4.9 years and surgery for 2.9 years.

CONCLUSIONS

The BR method does not increase the remission rates. It may be useful to combine L-T4 with a medium dose of methimazole when GD is difficult to manage with methimazole alone. It may represent a therapeutic option to postpone definitive treatments to a suitable age.

Magma Degassing as a Source of Long-Term Seismicity at Volcanoes: The Ischia Island (Italy) Case

Transient seismicity at active volcanoes poses a significant risk in addition to eruptive activity. This risk is powered by the common belief that volcanic seismicity cannot be forecast, even on a long term. Here we investigate the nature of volcanic seismicity to try to improve our forecasting capacity. To this aim, we consider Ischia volcano (Italy), which suffered similar earthquakes along its uplifted resurgent block. We show that this seismicity marks an acceleration of decades-long subsidence of the resurgent block, driven by degassing of magma that previously produced the uplift, a process not observed at other volcanoes. Degassing will continue for hundreds to thousands of years, causing protracted seismicity and will likely be accompanied by moderate and damaging earthquakes. The possibility to constrain the future duration of seismicity at Ischia indicates that our capacity to forecast earthquakes might be enhanced when seismic activity results from long-term magmatic processes, such as degassing.

Soil solarization based on natural soil moisture: a practical approach for reducing the seed bank of invasive plants in wetlands

Soil solarization is a well-established method to disinfect soil for efficient weed control. However, the feasibility of applying this method in the restoration of invaded natural habitats is unclear. This is because soil moisture is necessary for the success of solarization, but pre-irrigation in natural ecosystems is often not applicable, or demands high labor investment, making it unsuitable for use in restoration. The present study was based on the idea that the relatively high soil moisture in wetlands might obviate the need for pre-irrigation, rendering this method much more applicable in natural habitats. We examined the efficacy of soil solarization using natural soil moisture to control the seed bank of the invasive plant, Acacia saligna, in a wetland, using large-scale experimental plots (0.38 ha each). An old, dense A. saligna grove was cut down and the roots were removed by a bulldozer. The plot was mulched with a transparent polyethylene sheet in early July and left on the soil for 14 weeks. Soil solarization significantly reduced the viability of seeds of A. saligna that had been experimentally buried. Additionally, viability of seeds in the natural seed bank was reduced, and seedling emergence was close to zero. Exposing seeds to soil temperature and soil moisture levels equivalent to those obtained during field soil solarization under controlled conditions significantly increased the release from dormancy of the seeds, suggesting that release from dormancy during the early stage of solarization is a critical stage leading to seed weakening or mortality in the soil. Soil solarization also decreased the cover and abundance of the natural vegetation; therefore, active revegetation is required to restore the natural vegetation and to conserve endangered and endemic species.

Rain-based soil solarization for reducing the persistent seed banks of invasive plants in natural ecosystems - Acacia saligna as a model

BACKGROUND

A large persistent seed bank of invasive plants is a significant obstacle to restoration programs. Soil solarization was demonstrated to be an effective method for reducing the seed bank of Australian acacias. However, use of this method in natural habitats might be limited due to the requirement to moisten the soil by irrigation. This study examined the possibility of replacing irrigation by trapping the soil moisture caused by the most recent rainfall, i.e. rain-based soil solarization (RBS).

RESULTS

Exposure of Acacia saligna seeds to 57 °C at 20% soil moisture for 68 h resulted in almost complete loss of seed viability. Similarly, RBS treatment significantly reduced the viability of A. saligna seeds buried at a soil depth of 1-19 cm as well as seed density in the natural seed bank, and almost completely eliminated seedling emergence from natural seed banks of A. saligna and other environmental weeds.

CONCLUSION

Our results indicate that RBS is an effective method for reducing the seed bank of invasive plants in natural habitats located in various climate regions characterized by different soil types. This is the first demonstration of a successful application of RBS for soil disinfestation. © 2018 Society of Chemical Industry.

X-linked hypophosphatemic rickets: an Italian experts' opinion survey

Background

X-linked hypophosphatemic rickets (XLH) is the first cause of inherited hypophosphatemia and is caused by mutation in the PHEX gene, resulting in excessive expression of the phosphaturic factor FGF23. Symptoms are mainly related to rickets in children and osteomalacia in adults and cause several complications that can be highly invalidating. Due to its rarity, XLH is poorly known and diagnosis is frequently delayed. Conventional treatment is based on oral phosphate salts supplementation and activated vitamin D analogs, which however, cannot cure the disease in most cases.

Objective

Due to the low prevalence of XLH, an experts’ opinion survey was conducted across Italian centers to collect data on XLH and on its management.

Methods

A questionnaire was developed by a group of experts to collect data on XLH epidemiology, diagnosis and treatment in Italy.

Results

Data from 10 Italian centers (nine of which pediatric) on 175 patients, followed between 1998 and 2017, were included in the survey. Most patients were followed since childhood and 63 children became adults during the investigated period. The diagnosis was made before the age of 1 and between 1 and 5 years in 11 and 50% of cases, respectively. Clinically apparent bone deformities were present in 95% of patients. These were ranked moderate/severe in 75% of subjects and caused growth stunting in 67% of patients. Other frequent complications included bone pain (40%), dental abscesses (33%), and dental malpositions (53%). Treatment protocols varied substantially among centers. Nephrocalcinosis was observed in 34% of patients. Tertiary hyperparathyroidism developed in 6% of patients.

Conclusions

XLH remains a severe condition with significant morbidities.

Wild boars as spore dispersal agents of ectomycorrhizal fungi: consequences for community composition at different habitat types

The success of dispersal events depend on the organism's ability to reach and establish in a new habitat. In symbiotic organisms, establishment also depends on the presence of their symbiont partner in the new habitat. For instance, the establishment of obligate ectomycorrhizal (EM) trees outside the forest is largely limited by the presence of EM fungi in soil. Wild boars (Sus scrofa) are important dispersal agents of EM fungal spores, particularly in the moderately dry Mediterranean region. The aim of this study was to explore how EM fungal spores dispersed by wild boars influence the EM fungal community associated with the roots of Pinus halepensis seedlings at different habitat types. Using a greenhouse bioassay, we grew pine seedlings in two soil types: old-field and forest soils mixed with either natural or autoclaved wild boar feces. In both soils, we observed a community dominated by a few EM fungal species. Geopora (85 %) and Suillus (68 %) species dominated the forest and old-field soils, respectively. The addition of natural wild boar feces increased the abundance of Tuber species in both EM fungal communities. However, this effect was more pronounced in pots with old-field soil, leading to a more even community, equally dominated by both Tuber and Suillus species. In forest soil, Geopora maintained dominance, but decreased in abundance (67 %), due to the addition of Tuber species. Our findings indicate that wild boar feces can be an important source for EM inoculum, especially in habitats poor in EM fungi such as old-fields.

A robust viologen and Mn-based porous coordination polymer with two types of Lewis acid sites providing high affinity for H2O, CO2 and NH3

A water stable PCP with two kinds of Lewis acid sites, open Mn²⁺ cations and viologen, shows high affinity for H₂O, CO₂ and NH₃.

Genetic and epigenetic alterations in the GNAS locus and clinical consequences in Pseudohypoparathyroidism: Italian common healthcare pathways adoption

BACKGROUND

Genetic and epigenetic alterations in the GNAS locus are responsible for the Gsα protein dysfunctions causing Pseudohypoparathyroidism (PHP) type Ia/c and Ib, respectively. For these heterogeneous diseases characterized by multiple hormone resistances and Albright's Hereditary Osteodystrophy (AHO) the current classification results inadequate because of the clinical overlap between molecular subtypes and a standard clinical approach is still missing. In the present paper several members of the Study Group Endocrine diseases due to altered function of Gsα protein of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED) have reviewed and updated the clinical-molecular data of the largest case series of (epi)/genetically characterized AHO/PHP patients; they then produced a common healthcare pathway for patients with these disorders.

METHODS

The molecular analysis of the GNAS gene and locus identified the causal alteration in 74 subjects (46 genetic and 28 epigenetic mutations). The clinical data at the diagnosis and their evolution during up to 15 years follow-up were collected using two different cards.

RESULTS

In patients with genetic mutations the growth impairment worsen during the time, while obesity prevalence decreases; subcutaneous ossifications seem specific for this group. Brachydactyly has been detected in half of the subjects with epigenetic alterations, in which the disease overts later in life, often with symptomatic hypocalcaemia, and also early TSH and GHRH resistances have been recorded.

CONCLUSIONS

A dedicated healthcare pathway addressing all these aspects in a systematic way would improve the clinical management, allowing an earlier recognition of some PHP features, the optimization of their medical treatment and a better clinical-oriented molecular analysis. Furthermore, standardized follow-up data would provide new insight into less known aspects.

Retroperitoneal "Mini" Approach for Aortoiliac Reconstructive Surgery

The large vertical midline or transverse transperitoneal approaches used in the conven tional aortoiliac reconstruction are accompanied with a relatively high postoperative morbidity and mortality rate (2% to 5%), even in patients who are good risks under going aortic surgery. The purpose of this study was develop a new technique for aorto bifemoral bypass operation to minimize the operative stress on these patients.

Methods: The recommended left paramedian or transmuscular retroperitoneal approach, using 5-6 cm skin incision and a special retractor with three-dimensional vision and with modified surgical instruments directly under eye control, offers the possibility of decreasing the operative stress significantly and of sufficiently controlling the serious bleeding that might occur. If necessary, this exposure can be immediately converted to a conventional approach by simple enlargement of the incision.

Results: In the authors' first cases the functional results were very good, and conse quently, hospitalization time and the convalescence period were short.

Conclusion: This minimal access approach appears to diminish the catabolic response, and it is hoped that it will be associated with accelerated recovery and virtual abolition of large wound-related complications. It could become the procedure of choice for selected patients with obstructive or aneurysmal aortoiliac disease.

t-Curves for n-Hexane

The adsorption and desorption isotherms of n-hexane on powdered alumina and silica have been studied at 25°C over a wide range of relative pressures. Two t-curves for pore structure analysis are proposed, one for alumina (C = 12) and the second for silica (3 ≤ C ≤ 9). The statistical thickness t of the adsorbed n-hexane layer has been drawn as a function of the relative pressure assuming a maximal thickness of 0.55 nm and a mean thickness of 0.42 nm for the monolayer. The results are discussed in relation to previous published data.

CdTe Timepix detectors for single-photon spectroscopy and linear polarimetry of high-flux hard x-ray radiation

Single-photon spectroscopy of pulsed, high-intensity sources of hard X-rays - such as laser-generated plasmas - is often hampered by the pileup of several photons absorbed by the unsegmented, large-volume sensors routinely used for the detection of high-energy radiation. Detectors based on the Timepix chip, with a segmentation pitch of 55 μm and the possibility to be equipped with high-Z sensor chips, constitute an attractive alternative to commonly used passive solutions such as image plates. In this report, we present energy calibration and characterization measurements of such devices. The achievable energy resolution is comparable to that of scintillators for γ spectroscopy. Moreover, we also introduce a simple two-detector Compton polarimeter setup with a polarimeter quality of (98 ± 1)%. Finally, a proof-of-principle polarimetry experiment is discussed, where we studied the linear polarization of bremsstrahlung emitted by a laser-driven plasma and found an indication of the X-ray polarization direction depending on the polarization state of the incident laser pulse.

Heterogeneous phenotype in children affected by non-autoimmune hypothyroidism: an update

BACKGROUND

In the last decades, a higher incidence of congenital hypothyroidism (CH) has been recorded in Italy (1:1940) and worldwide, mainly due to the shift to lower screening TSH cutoffs. Although CH can also be caused by dysgenetic defects, most CH cases have recently been found to be more frequently associated with functional defects of an in situ thyroid gland. Although the clinical phenotype is milder with high prevalence of transient forms, some cases eventually prove to be permanent.

RESULTS

Possible explanations of the raised incidence of CH are ethnic modifications of the screened population and the increasing incidence of preterm birth and multiple pregnancies. These findings are important in terms of public health and standardization of screening programmes for special at-risk categories such as preterms, acutely ill term neonates, low birth weight and very low birth weight infants, and newborns with specific drug exposure. Other environmental factors have contributed to the increased incidence of hypothyroidism, including thyroid disrupting chemicals, iodine supply (excess/deficiency), and drugs interfering with thyroid function. Finally, an increased prevalence of hypothyroidism has been documented in obese children and patients with syndromic forms (Williams, Down, Turner, pseudohypoparathyroidism). The clinical and molecular phenotype of patients with CH will be better defined thanks to novel genetic approach based on the systematic analysis of a panel of genes (TSHR, DUOX2, DUOXA, TPO, PDS, TG, NKX2.1, JAG1, GLIS3, FOXE1, PAX-8).

CONCLUSIONS

This review summarizes significant advances in the epidemiology and aetiology of non-autoimmune hypothyroidism, with a focus on thyroid dysfunction in preterm infants.

Risk factors for and impact of carbapenem-resistant Acinetobacter baumannii colonization and infection: matched case-control study

The objective of this investigation was to identify risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) and its association with mortality. A population-based matched case-control study using the computerized database of Clalit Health Services (CHS) in the period between 2007 and 2012 was conducted. Hospitalized patients with CRAB colonization or infection were compared to hospitalized patients without evidence of A. baumannii, matched by age, ward of hospitalization, season, Charlson score, and length of hospitalization. Risk factors for CRAB isolation were searched for using multivariate analysis. Association of CRAB and other risk factors with mortality were assessed in the cohort. A total of 1190 patients with CRAB were matched to 1190 patients without CRAB. Low socioeconomic status was independently associated with CRAB isolation and CRAB bacteremia [odds ratio 2.18, 95% confidence interval (CI) 1.02-5]. Other risk factors were invasive procedures and bacteremia with other pathogens prior to CRAB isolation, and various comorbidities. Among all patients, CRAB isolation was independently associated with increased mortality (hazard ratio 2.33, 95% CI 2.08-2.6). Socioeconomic status is associated with health outcomes. Our population-based study revealed an almost doubled risk for CRAB in patients at lower socioeconomic status and an association with healthcare exposure. CRAB was associated with mortality and might become a risk indicator for complex morbidity and mortality.

Key enzymes and tumor cell heterogeneity

Tumor heterogeneity is reflected in many aspects of cancer cells, including morphology, biology, drug responsiveness and biochemistry. The basis of the transformation- and progression-linked biochemical imbalance in cancer cells was revealed to be due to an imbalance in the activity, amount and isozyme pattern of key enzymes. The key enzymes, particularly those in the biosynthetic pathways of purine and pyrimidine metabolism, were identified as sensitive targets of experimental and clinical anticancer drugs. The concept of key enzymes as regulatory elements and targets of chemotherapy led to the design of enzyme-pattern-targeted anticancer chemotherapy approaches.

[Lung hernia provoked by a cough fit]

Lung hernias are rare and their pathogenesis is few described. They are defined as the protrusion of lung parenchyma through the chest wall: intercostal space, inter-costo-clavicular, supra-clavicular or diaphragmatic hiatus. Lung hernias are classically divided into congenital and acquired hernias. Those are usually post-traumatic or post-surgical but can be provoked by cough. Clinical diagnosis is often evident but is confirmed by chest radiograph and especially computed tomography. Major risks are lung incarceration and necrosis but also ventilatory distress due to paradoxical respiration, in case of large defect. Treatment is first and foremost surgical but debated and should consider the localization, the size, the length of evolution and the possible infectious context. We report the case of a right basi-thoracic lung hernia induced by a cough fit, in a patient with chronic bronchitis.