Postoperative adjuvant radiochemotherapy with cisplatin versus adjuvant radiochemotherapy with cisplatin and pembrolizumab in locally advanced head and neck squamous cell carcinoma- the study protocol of the Adrisk trial

Most of the patients with head and neck squamous cell carcinoma (HNSCC) are diagnosed with locally advanced disease. Standards of care for curative-intent treatment of this patient group are either surgery and adjuvant radio(chemo)therapy (aRCT) or definitive chemoradiation. Despite these treatments, especially pathologically intermediate and high-risk HNSCC often recur. The ADRISK trial investigates in locally advanced HNSCC and intermediate and high risk after up-front surgery if the addition of pembrolizumab to aRCT with cisplatin improves event-free sur-vival compared to aRCT alone. ADRISK is a prospective, randomized controlled investiga-tor-initiated (IIT)-phase II multicenter trial within the German Interdisciplinary Study Group of German Cancer Society (IAG-KHT). Patients with primary resectable stage III and IV HNSCC of the oral cavity, oropharynx, hypopharynx and larynx with pathologic high (R1, extracapsular nodal extension) or intermediate risk (R0 <5 mm; N≥2) after surgery will be eligible. Two hun-dred forty patients will be randomly assigned (1:1) to either standard aRCT with cisplatin (standard arm) or aRCT with cisplatin + pembrolizumab (200 mg iv, in 3-week cycle, max. 12 months) (interventional arm). Endpoints are event-free and overall survival. Recruitment started in August 2018 and is ongoing.

Impaired Cardioprotection by HDL in CAD and Diabetes in Ischemia/Reperfusion Injury: role of S1P and SR-BI

Background

HDL dysfunction rather than HDL-cholesterol concentration is involved in the pathogenesis of coronary artery disease (CAD) and type-2 diabetes (T2DM). While causes and consequences of HDL dysfunction are manifold, reduced concentrations of HDL-sphingosine-1-phsophate (S1P) are partially responsible for impaired vasodilation and suppression of inflammation by CAD-HDL. Administration of healthy human HDL prior to coronary ischemia/reperfusion (I/R) in mice reduced infarct size (IS) due to HDL-S1P. The role of major HDL receptor SR-BI is unexplored in this context.

Purpose

In this study, we, a) investigated the cardioprotective properties of healthy versus CAD-HDL and T2DM-HDL in a murine model of acute myocardial infarction (AMI), b) tested the effect of S1P loading of CAD-HDL in cardioprotection, and c) detected the relevant HDL receptor of this cardioprotection.

Methods

HDL were isolated from plasma of healthy volunteers, CAD, and T2DM patients by density ultra-centrifugation and injected (43 mg HDL protein/KG) in the tail vein of C57Bl/6J mice 5 minutes prior to 30 minutes of ischemia. Cardiac function was assessed after 24 hours of reperfusion by echocardiography. IS was analyzed by TTC staining and S1P concentration measured by LC-MS/MS, respectively.

Results

Administration of human healthy HDL reduced IS by 23% and increased ejection fraction (EF) by 22% 24 hours after I/R (IS: Control 43.8±6.9% [n=17] vs. healthy HDL 32.9±3.6% [n=9]; EF: Control 34.5±5.7% vs. healthy HDL 41.9±4.1%). In contrast, CAD-HDL in the same dosage had no protective effect (IS: 40.1±5.7% [n=12]; EF: 31.9±8.4%). As HDL-S1P concentrations were 33% lower in CAD-HDL compared to healthy HDL, we tested whether S1P-loading may correct CAD-HDL's defective cardioprotection. Indeed, S1P-loading (38 μg S1P/kg in 43 mg HDL protein/KG) completely restored CAD-HDL cardioprotection to levels achieved by healthy HDL. S1P-loading of healthy HDL had no additional benefit. Administration of T2DM-HDL prior to I/R led to 28% larger IS and 22% worse EF compared to healthy HDL (IS: healthy HDL 33.0±4.3% [n=6] vs. T2DM-HDL 42.4±8.9% [n=13]; EF: healthy HDL 38.5±5.8% [n=6] vs. T2DM-HDL 33.1±.4.0%). Compared to healthy HDL, T2DM-HDL exhibited a 19% decrease in S1P content. We thus tested whether the major HDL receptor SR-BI is involved in HDL-S1P mediated cardioprotection using global SR-BI deficient mice (Scarb1−/−). Remarkably, cardioprotection by HDL administration was completely absent in Scarb1−/− mice but intact in wild type controls. (IS Scarb1++: Vehicle 38.6±8.3% [n=12] vs. HDL 29.9±8.5% [n=11], Scarb1−/−: Vehicle 31.4±5.6% [n=12] vs. HDL 31.1±6.9% [n=17])

Conclusion

We have identified: (a) impaired cardioprotection after I/R as new characteristic of HDL dysfunction in CAD and T2DM; (b) low HDL-S1P as its cause and the possibility of its therapeutic correction by S1P loading, and (c) SR-BI as the HDL receptor responsible for HDL-S1P-mediated cardioprotection.

Funding Acknowledgement

Type of funding sources: None.

The LEGACy study: a European and Latin American consortium to identify risk factors and molecular phenotypes in gastric cancer to improve prevention strategies and personalized clinical decision making globally

BACKGROUND

Gastric Cancer (GC) is the fourth most deadly cancer worldwide. Enhanced understanding of its key epidemiological and molecular drivers is urgently needed to lower the incidence and improve outcomes. Furthermore, tumor biology in European (EU) and Latin American (LATAM) countries is understudied. The LEGACy study is a Horizon 2020 funded multi-institutional research approach to 1) detail the epidemiological features including risk factors of GC in current time and 2) develop cost-effective methods to identify and integrate biological biomarkers needed to guide diagnostic and therapeutic approaches with the aim of filling the knowledge gap on GC in these areas.

METHODS

This observational study has three parts that are conducted in parallel during 2019-2023 across recruiting centers from four EU and four LATAM countries: Part 1) A case-control study (800 cases and 800 controls) using questionnaires on candidate risk factors for GC, which will be correlated with clinical, demographic and epidemiological parameters. Part 2) A case-control tissue sampling study (400 cases and 400 controls) using proteome, genome, microbiome and immune analyses to characterize advanced (stage III and IV) GC. Patients in this part of the study will be followed over time to observe clinical outcomes. The first half of samples will be used as training cohort to identify the most relevant risk factors and biomarkers, which will be selected to propose cost-effective diagnostic and predictive methods that will be validated with the second half of samples. Part 3) An educational study, as part of our prevention strategy (subjects recruited from the general public) to test and disseminate knowledge on GC risk factors and symptoms by a questionnaire and informative video. Patients could be recruited for more than one of the three LEGACy studies.

DISCUSSION

The LEGACy study aims to generate novel, in-depth knowledge on the tumor biological characteristics through integrating epidemiological, multi-omics and clinical data from GC patients at an EU-LATAM partnership. During the study, cost-effective panels with potential use in clinical decision making will be developed and validated.

TRIAL REGISTRATION

ClinicalTrials.gov Identifiers: Part 1: NCT03957031 . Part 2: NCT04015466 . Part 3: NCT04019808 .

Impact of molecular alterations on quality of life and prognostic understanding over time in patients with incurable lung cancer: a multicenter, longitudinal, prospective cohort study

PURPOSE

The purpose of this study is to investigate changes over time in quality of life (QoL) in incurable lung cancer patients and the impact of determinants like molecular alterations (MA).

METHODS

In a prospective, longitudinal, multicentric study, we assessed QoL, symptom burden, psychological distress, unmet needs, and prognostic understanding of patients diagnosed with incurable lung cancer at the time of the diagnosis (T0) and after 3 (T1), 6 (T2) and 12 months (T3) using validated questionnaires like FACT-L, National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT), PHQ-4, SCNS-SF-34, and SEIQoL.

RESULTS

Two hundred seventeen patients were enrolled, 22 (10%) with reported MA. QoL scores improved over time, with a significant trend for DT, PHQ-4, and SCNS-SF-34. Significant determinants for stable or improving scores over time were survival > 6 months, performance status at the time of diagnosis, and presence of MA. Patients with MA showed better QoL scores (FACT-L at T1 104.4 vs 86.3; at T2 107.5 vs 90.0; at T3 100.9 vs 92.8) and lower psychological distress (NCCN DT at T1 3.3 vs 5; at T2 2.7 vs 4.5; at T3 3.7 vs 4.5; PHQ-4 at T1 2.3 vs 4.1; at T2 1.7 vs 3.6; at T3 2.2 vs 3.6), but also a worsening of the scores at 1 year and a higher percentage of inaccurate prognostic understanding (27 vs 17%) compared to patients without MA.

CONCLUSION

Patients with tumors harboring MA are at risk of QoL deterioration during the course of the disease. Physicians should adapt their communication strategies in order to maintain or improve QoL.

Symptom Burden and Palliative Care Needs of Patients with Incurable Cancer at Diagnosis and During the Disease Course

Background

Although current guidelines advocate early integration of palliative care, symptom burden and palliative care needs of patients at diagnosis of incurable cancer and along the disease trajectory are understudied.

Material and Methods

We assessed distress, symptom burden, quality of life, and supportive care needs in patients with newly diagnosed incurable cancer in a prospective longitudinal observational multicenter study. Patients were evaluated using validated self‐report measures (National Comprehensive Cancer Network Distress Thermometer [DT], Functional Assessment of Cancer Therapy [FACT], Schedule for the Evaluation of Individual Quality of Life [SEIQoL‐Q], Patients Health Questionnaire‐4 [PHQ‐4], modified Supportive Care Needs Survey [SCNS‐SF‐34]) at baseline (T0) and at 3 (T1), 6 (T2), and 12 months (T3) follow‐up.

Results

From October 2014 to October 2016, 500 patients (219 women, 281 men; mean age 64.2 years) were recruited at 20 study sites in Germany following diagnosis of incurable metastatic, locally advanced, or recurrent lung (217), gastrointestinal (156), head and neck (55), gynecological (57), and skin (15) cancer. Patients reported significant distress (DT score ≥ 5) after diagnosis, which significantly decreased over time (T0: 67.2%, T1: 51.7%, T2: 47.9%, T3: 48.7%). The spectrum of reported symptoms was broad, with considerable variety between and within the cancer groups. Anxiety and depressiveness were most prevalent early in the disease course (T0: 30.8%, T1: 20.1%, T2: 14.7%, T3: 16.9%). The number of patients reporting unmet supportive care needs decreased over time (T0: 71.8 %, T1: 61.6%, T2: 58.1%, T3: 55.3%).

Conclusion

Our study confirms a variable and mostly high symptom burden at the time of diagnosis of incurable cancer, suggesting early screening by using standardized tools and underlining the usefulness of early palliative care.

Implications for Practice

A better understanding of symptom burden and palliative care needs of patients with newly diagnosed incurable cancer may guide clinical practice and help to improve the quality of palliative care services. The results of this study provide important information for establishing palliative care programs and related guidelines. Distress, symptom burden, and the need for support vary and are often high at the time of diagnosis. These findings underscore the need for implementation of symptom screening as well as early palliative care services, starting at the time of diagnosis of incurable cancer and tailored according to patients’ needs.

Guidelines recommend early integration of palliative care in the treatment of patients with advanced cancer. This study assessed distress, symptom burden, quality of life, and supportive care needs in patients with newly diagnosed incurable cancer to facilitate future implementation of more effective palliative care services.

Integration of antimicrobial substances in 3-D printed plastics

The risk of healthcare associated infections (HAI) is rising with the utilization of more complex medical devices. Cleaning and disinfecting measures of such devices are often insufficient leading to an increased microbiological contamination on these devices. Recent studies imply that antimicrobial coatings could present a solution for this topic. In this work a novel approach for the introduction of an antimicrobial technology into plastic granulate was tested. After 3-D printing the antimicrobial activity of the test samples was analysed. Our results show that the integration of an antimicrobial substance to ABS plastic is feasible only with sophisticated plastic processing technologies. Simple heating or mixing of the substance did not allow integration of the antimicrobial substance into the 3-D printed sample, but it was possible to integrate the antimicrobial ingredient into the raw material by compounding. The printed test samples showed strong antimicrobial activity in the standardized test procedures.

Self-Organized Nanorod Arrays for Large-Area Surface-Enhanced Infrared Absorption

Capabilities of highly sensitive surface-enhanced infrared absorption (SEIRA) spectroscopy are demonstrated by exploiting large-area templates (cm²) based on self-organized (SO) nanorod antennas. We engineered highly dense arrays of gold nanorod antennas featuring polarization-sensitive localized plasmon resonances, tunable over a broadband near- and mid-infrared (IR) spectrum, in overlap with the so-called "functional group" window. We demonstrate polarization-sensitive SEIRA activity, homogeneous over macroscopic areas and stable in time, by exploiting prototype self-assembled monolayers of IR-active octadecanthiol (ODT) molecules. The strong coupling between the plasmonic excitation and molecular stretching modes gives rise to characteristic Fano resonances in SEIRA. The SO engineering of the active hotspots in the arrays allows us to achieve signal amplitude improved up to 5.7%. This figure is competitive to the response of lithographic nanoantennas and is stable when the optical excitation spot varies from the micro- to macroscale, thus enabling highly sensitive SEIRA spectroscopy with cost-effective nanosensor devices.

Symptoms and Needs of Patients with Advanced Lung Cancer: Early Prevalence Assessment

BACKGROUND

Little is known on symptom burden, psychosocial needs, and perception of prognosis in advanced lung cancer patients at the time of diagnosis, although early assessment is strongly recommended within the setting of daily routine care.

METHODS

Twelve study sites cross-sectionally assessed symptoms and psychosocial needs of patients suffering from newly diagnosed incurable lung cancer. Assessment comprised NCCN distress thermometer, FACT-L, SEIQoL-Q, PHQ-4, and shortened and modified SCNS-SF-34 questionnaires. Additional prognostic information from both patients and physicians were collected.

RESULTS

A total of 208 patients were evaluated. Mean age was 63.6 years, 58% were male, 84% suffered from stage IV lung cancer, and 71% had an ECOG performance status of 0-1. Mean distress level was 5.4 (SD 2.5), FACT-L total score was 86 (21.5), and TOI 50.5 (14.9). PHQ-4 was 4.6 (3.3), and shortened and modified SCNS-SF-34 showed 9 (8.7) unmet needs per patient. According to their physicians' perspective, 98.1% of patients were reflecting on and 85.2% were accepting incurability, while 26.5% of patients considered the treatment to be of curative intent.

CONCLUSION

Our findings emphasize substantial domains of symptom burden seen in newly diagnosed, incurable lung cancer patients. Oncologists should be aware of these features and address prognostic issues early in the disease trajectory to facilitate opportunities to improve coping, advance care planning, and appropriate integration of palliative care, thus improving quality of life.

Automated scoring of the Rey-Osterrieth Complex Figure Test using a deep-learning algorithm

Objective

To validate a fully automated scoring algorithm for the Rey-Osterrieth Complex Figure Test (ROCFT) by comparing the scoring results of the algorithm to the results of human raters.

Method

The algorithm consisted of a cascade of deep neural networks which were trained on human rater scores to extract the 18 segments of the figure, and to quantify the patient’s performance. Algorithm results were compared to six expert raters for 303 drawings. We tested whether the average correlation between algorithm scores and scores by all human raters was equivalent to the average inter-rater correlation (with equality bound Δr < .05). The immediate and delayed recall trial were used; the copy trial showed a strong ceiling effect.

Results

The mean Pearson correlation between raters was .94 (SD = 0.01). The correlation between to algorithm and the raters was .88 (SD = 0.02). A two-one-sided t-tests (TOST) equivalence test showed that these correlations were not strictly equivalent, t(5) = 4.02, p = .995, 95% CI [0.35, 0.52].

Conclusions

Although not strictly equivalent to human ratings, the algorithm’s performance is high, approaching a level of reliability found among human raters. We expect that improved individual segment detection will bring the algorithm scoring accuracy on par with that of human raters. Algorithmic scoring of the ROCFT will likely save valuable time and lead to higher levels of standardization in clinical practice.

Cardiac resynchronisation therapy

Aim: Cardiac resynchronisation therapy (CRT) has been shown to improve haemodynamics and clinical symptoms in heart failure patients. The present study evaluated the effects of a 4-month CRT on myocardial blood flow (MBF) at rest, after vasodilation and on myocardial oxygen consumption (MVO2). Patients, Methods: We studied 16 patients with idiopathic dilated cardiomyopathy prior to and during CRT performed as biventricular pacing. Resting MBF and MVO2 were determined from an 11C-acetate PET study and vasodilator MBF from a 13N-ammonia study. Results: MBF at rest (0.55 ± 0.10 ml/min/g), after vasodilation (1.20 ± 0.45 ml/min/g), and MVO2 (0.082 ± 0.014/min) did not change by mid-term CRT at a global level (0.57 ± 0.11 ml/min/g; 1.32 ± 0.49 ml/min/g; 0.085 ± 0.018/min), whereas the rate pressure product (RPP) normalised MVO2 decreased from 0.104 ± 0.024 to 0.086 ± 0.018/min (p = 0.02). At baseline, the regional analysis revealed significantly higher values for all parameters in the lateral wall than for those in the other walls. Under CRT the regional differences between the resting parameters equalised and all parameters showed significant lower coefficients of variation. Conclusion: Effects of mid-term CRT on resting MBF, vasodilator MBF and MVO2 occur at a regional level. The resynchronisation is associated with a more homogenous distribution pattern of these parameters among the myocardial walls. Substantial alterations to global MBF at rest, after vasodilation or to MVO2 are not detectable. Regarding the RPP normalised MVO2, there is evidence of improved ventricular efficiency through CRT.

Dysregulation of lysophosphatidic acids in multiple sclerosis and autoimmune encephalomyelitis

Abstract

Bioactive lipids contribute to the pathophysiology of multiple sclerosis. Here, we show that lysophosphatidic acids (LPAs) are dysregulated in multiple sclerosis (MS) and are functionally relevant in this disease. LPAs and autotaxin, the major enzyme producing extracellular LPAs, were analyzed in serum and cerebrospinal fluid in a cross-sectional population of MS patients and were compared with respective data from mice in the experimental autoimmune encephalomyelitis (EAE) model, spontaneous EAE in TCR¹⁶⁴⁰ mice, and EAE in Lpar2^-/- mice. Serum LPAs were reduced in MS and EAE whereas spinal cord LPAs in TCR¹⁶⁴⁰ mice increased during the ‘symptom-free’ intervals, i.e. on resolution of inflammation during recovery hence possibly pointing to positive effects of brain LPAs during remyelination as suggested in previous studies. Peripheral LPAs mildly re-raised during relapses but further dropped in refractory relapses. The peripheral loss led to a redistribution of immune cells from the spleen to the spinal cord, suggesting defects of lymphocyte homing. In support, LPAR2 positive T-cells were reduced in EAE and the disease was intensified in Lpar2 deficient mice. Further, treatment with an LPAR2 agonist reduced clinical signs of relapsing-remitting EAE suggesting that the LPAR2 agonist partially compensated the endogenous loss of LPAs and implicating LPA signaling as a novel treatment approach.

Graphical abstract

Graphical summary of lysophosphatidic signaling in multiple sclerosis

Electronic supplementary material

The online version of this article (doi:10.1186/s40478-017-0446-4) contains supplementary material, which is available to authorized users.

Symptoms and Needs of Head and Neck Cancer Patients at Diagnosis of Incurability - Prevalences, Clinical Implications, and Feasibility of a Prospective Longitudinal Multicenter Cohort Study

BACKGROUND

Little is known about the physical symptoms and psychosocial burden of patients at the time of diagnosis of an incurable situation, although cancer treatment guidelines demand early assessment and integration of palliative care concepts, beginning from the diagnosis of incurability.

METHODS

Therefore, we initiated a prospective longitudinal multicenter cohort study assessing the symptoms and needs of patients suffering from incurable cancer (various entities), from the time of diagnosing incurability (i.e., before palliative anticancer treatment was initiated) and in 3-monthly intervals thereafter, by using validated self-reporting tools. Here, we focus on patients with head and neck cancer and present preliminary results on symptoms and need prevalences, on clinical implications, and on the feasibility of a methodologically complex assessment procedure in a particularly vulnerable study population.

RESULTS

22 patients completed the first visit. The Eastern Cooperative Oncology Group (ECOG) performance scores and most physical symptoms and psychosocial items varied between the extremes, from a virtually uncompromised condition to extremely perceived symptoms and needs. If intense face-to-face study support was provided, the study concept proved to be feasible, despite the complexity of assessment, problems in interdisciplinary and patient communication, comorbidities, and early death from complications.

CONCLUSIONS

The striking variability in the perceived symptom and need intensities requires a highly individualized approach. For clinical purposes, a less complex screening procedure would be desirable, in order to enable a routine, early and comprehensive support, including palliative care services.

Spatial patterns of European droughts under a moderate emission scenario

Abstract. Meteorological drought is generally defined as a prolonged deficiency of precipitation and is considered one of the most relevant natural hazards as the related impacts can involve many different sectors. In this study, we investigated the spatial patterns of European droughts for the periods 1981–2010, 2041–2070, and 2071–2100, focusing on the projections under a moderate emissions scenario. To do that, we used the outputs of the KNMI-RACMO2 model, which belongs to the A1B family and whose spatial resolution is 0.25° × 0.25°. By means of monthly precipitation and potential evapotranspiration (PET), we computed the Standardized Precipitation Index (SPI) and the Standardized Precipitation Evapotranspiration Index (SPEI) at the 12-month accumulation scale. Thereafter, we separately obtained drought frequency, duration, severity, and intensity for the whole of Europe, excluding Iceland. According to both indicators, the spatial drought patterns are projected to follow what recently characterized Europe: southern Europe, who experienced many severe drought events in the last decades, is likely to be involved by longer, more frequent, severe, and intense droughts in the near future (2041–2070) and even more in the far future (2071–2100). This tendency is more evident using the SPEI, which also depends on temperature and consequently reflects the expected warming that will be highest for the Mediterranean area in Europe. On the other side, less severe and fewer drought events are likely to occur in northern Europe. This tendency is more evident using the SPI, because the precipitation increase is projected to outbalance the temperature (and PET) rise in particular in Scandinavia. Regarding the mid-latitudes, the SPEI-based analyses point at more frequent drought events, while the SPI-based ones point at less frequent events in these regions.

Study of the negative magneto-resistance of single proton-implanted lithium-doped ZnO microwires

The magneto-transport properties of single proton-implanted ZnO and of Li(7%)-doped ZnO microwires have been studied. The as-grown microwires were highly insulating and not magnetic. After proton implantation the Li(7%) doped ZnO microwires showed a non-monotonous behavior of the negative magneto-resistance (MR) at temperature above 150 K. This is in contrast to the monotonous NMR observed below 50 K for proton-implanted ZnO. The observed difference in the transport properties of the wires is related to the amount of stable Zn vacancies created at the near surface region by the proton implantation and Li doping. The magnetic field dependence of the resistance might be explained by the formation of a magnetic/non-magnetic heterostructure in the wire after proton implantation.

Large-scale discovery of novel genetic causes of developmental disorders

Despite three decades of successful, predominantly phenotype-driven discovery of the genetic causes of monogenic disorders, up to half of children with severe developmental disorders of probable genetic origin remain without a genetic diagnosis. Particularly challenging are those disorders rare enough to have eluded recognition as a discrete clinical entity, those with highly variable clinical manifestations, and those that are difficult to distinguish from other, very similar, disorders. Here we demonstrate the power of using an unbiased genotype-driven approach to identify subsets of patients with similar disorders. By studying 1,133 children with severe, undiagnosed developmental disorders, and their parents, using a combination of exome sequencing and array-based detection of chromosomal rearrangements, we discovered 12 novel genes associated with developmental disorders. These newly implicated genes increase by 10% (from 28% to 31%) the proportion of children that could be diagnosed. Clustering of missense mutations in six of these newly implicated genes suggests that normal development is being perturbed by an activating or dominant-negative mechanism. Our findings demonstrate the value of adopting a comprehensive strategy, both genome-wide and nationwide, to elucidate the underlying causes of rare genetic disorders.

Kinetic model of acetate metabolism in healthy and hyperinsulinaemic humans

Background/objectives

The short chain fatty acid acetate (AC), may play a role in increasing insulin sensitivity, thus lowering risk for obesity and type 2 diabetes mellitus. It is unclear if AC kinetics is similar in normal and hyperinsulinaemic participants. Therefore, we studied AC absorption from the distal colon in participants with normal (<40 pmol/L, NI) and high (≥40 pmol/L, HI) plasma-insulin. This work was part of a series of studies conceived to compute a kinetic model for acetate. Kinetic parameters such as estimates of rate of entry into peripheral blood, hepatic uptake and endogenous/exogenous production were compared in the groups.

Subjects/methods

Overnight fasted NI (n = 9) and HI (n = 8) participants were given rectal infusions containing sodium acetate (90 mmol/L). The solutions were retained for 40 min, then voided for AC measurement. Total amount of AC infused was 27 mmols.

Results

Acetate absorption from the distal colon (279±103 vs 322±91 μmol/min, P = 0.76) and hepatic uptake of AC (155±101 vs 146±85 μmol/min, P = 0.94) were similar in the groups. Endogenous and exogenous AC production was significantly higher in NI than HI participants. Plasma AC was inversely proportional to plasma insulin concentrations in the entire cohort (y=k/x, where k = 1813).

Conclusions

There was low power to detect differences in AC absorption rate and hepatic AC uptake in NI vs HI. The rate of entry of AC into peripheral blood was similar in NI and HI participants. However, hyperinsulinaemia may alter endogenous and exogenous AC metabolism.

Sulfide-inhibition of mitochondrial respiration at very low oxygen concentrations

Our aim was to study the ability of an immortalized cell line (AMJ2-C11) to sustain aerobic cell respiration at decreasing oxygen concentrations under continuous sulfide exposure. We assumed that the rate of elimination of sulfide through the pathway linked to the mitochondrial respiratory chain and therefore operating under aerobic conditions, should decrease with limiting oxygen concentrations. Thus, sulfide's inhibition of cellular respiration would occur faster under continuous sulfide exposure when the oxygen concentration is in the very low range. The experiments were performed with an O2K-oxygraph (Oroboros Instruments) by suspending 0.5-1×10(6) cells in 2 ml of continuously stirred respiration medium at 37 °C and calculating the oxygen flux (JO2) as the negative derivative of the oxygen concentration in the medium. The cells were studied in two different metabolic states, namely under normal physiologic respiration (1) and after uncoupling of mitochondrial respiration (2). Oxygen concentration was controlled by means of a titration-injection pump, resulting in average concentration values of 0.73±0.05 μM, 3.1±0.2 μM, and 6.2±0.2 μM. Simultaneously we injected a 2 mM Na2S solution at a continuous rate of 10 μl/s in order to quantify the titration-time required to reduce the JO2 to 50% of the initial respiratory activity. Under the lowest oxygen concentration this effect was achieved after 3.5 [0.3;3.5] and 11.7 [6.2;21.2]min in the uncoupled and coupled state, respectively. This time was statistically significantly shorter when compared to the intermediate and the highest O2 concentrations tested, which yielded values of 24.6 [15.5;28.1]min (coupled) and 35.9 [27.4;59.2]min (uncoupled), as well as 42.4 [27.5;42.4]min (coupled) and 51.5 [46.4;51.7]min (uncoupled). All data are medians [25%, and 75% percentiles]. Our results confirm that the onset of inhibition of cell respiration by sulfide occurs earlier under a continuous exposure when approaching the anoxic condition. This property may contribute to the physiological role of sulfide as an oxygen sensor.

An overview of drought events in the Carpathian Region in 1961–2010

Abstract. The Carpathians and their rich biosphere are considered to be highly vulnerable to climate change. Drought is one of the major climate-related damaging natural phenomena and in Europe it has been occurring with increasing frequency, intensity, and duration in the last decades. Due to climate change, land cover changes, and intensive land use, the Carpathian Region is one of the areas at highest drought risk in Europe. In order to analyze the drought events over the last 50 yr in the area, we used a 1961–2010 daily gridded temperature and precipitation dataset. From this, monthly 0.1° × 0.1° grids of four drought indicators (Standardized Precipitation-Evapotranspiration Index (SPEI), Standardized Precipitation Index (SPI), Reconnaissance Drought Indicator (RDI), and Palfai Aridity/Drought Index (PADI)) have been calculated. SPI, SPEI, and RDI have been computed at different time scales (3, 6, and 12 months), whilst PADI has been computed on an annual basis. The dataset used in this paper has been constructed in the framework of the CARPATCLIM project, run by a consortium of institutions from 9 countries (Austria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, and Ukraine) with scientific support by the Joint Research Centre (JRC) of the European Commission. Temperature and precipitation station data have been collected, quality-checked, completed, homogenized, and interpolated on the 0.1° × 0.1° grid, and drought indicators have been consequently calculated on the grid itself. Monthly and annual series of the cited indicators are presented, together with high-resolution maps and statistical analysis of their correlation. A list of drought events between 1961 and 2010, based on the agreement of the indicators, is presented. We also discuss three case studies: drought in 1990, 2000, and 2003. The drought indicators have been compared both on spatial and temporal scales: it resulted that SPI, SPEI, and RDI are highly comparable, especially over a 12-month accumulation period. SPEI, which includes PET (Potential Evapo-Transpiration) as RDI does, proved to perform best if drought is caused by heat waves, whilst SPI performed best if drought is mainly driven by a rainfall deficit, because SPEI and RDI can be extreme in dry periods. According to PADI, the Carpathian Region has a sufficient natural water supply on average, with some spots that fall into the ''mild dry'' class, and this is also confirmed by the FAO-UNEP aridity index and the Köppen-Geiger climate classification.

Prosthesis-User-in-the-Loop: a user-specific biomechanical modeling and simulation environment

In this paper, a novel biomechanical modeling and simulation environment with an emphasis on user-specific customization is presented. A modular modeling approach for multi-body systems allows a flexible extension by specific biomechanical modeling elements and enables an efficient application in dynamic simulation and optimization problems. A functional distribution of model description and model parameter data in combination with standardized interfaces enables a simple and reliable replacement or modification of specific functional components. The user-specific customization comprises the identification of anthropometric model parameters as well as the generation of a virtual three-dimensional character. The modeling and simulation environment is associated with Prosthesis-User-in-the-Loop, a hardware simulator concept for the design and optimization of lower limb prosthetic devices based on user experience and assessment. For a demonstration of the flexibility and capability of the modeling and simulation environment, an exemplary application in context of the hardware simulator is given.

Prosthesis-user-in-the-loop: user-centered design parameters and visual simulation

After an amputation, processes of change in the body image as well as a change in body scheme have direct influences on the quality of living in every patient. Within this paper, a paradigm of experimental induced body illusion (the Rubber Hand Illusion, RHI) is integrated in a prosthetic hardware simulator concept. This concept combines biodynamical and visual feedback to enhance the quality of rehabilitation and to integrate patients' needs into the development of prostheses aiming on user-centered solutions. Therefore, user-centered design parameters are deducted. Furthermore, the basic concept of the visual simulation is presented and a possibility for its implementation is given. Finally, issues and conclusions for future work are described.

In vivo corrosion and corrosion protection of magnesium alloy LAE442

The aim of this study was to investigate whether the extruded magnesium alloy LAE442 reacts in vivo with an appropriate host response and to investigate how an additional magnesium fluoride (MgF(2)) coating influences the in vivo corrosion rate. Forty cylinders were machined from extruded LAE442 and 20 of these were coated additionally with MgF(2) and implanted into the medial femur condyle of adult rabbits. Synchrotron-radiation-based X-ray computed micro-tomography (SRmicroCT) was used to quantitatively analyse corrosion non-destructively in vivo and comparisons were made to magnesium degradation rates based on area measurements of the remaining metal on uncalcified sections. Blood concentrations of the alloying elements were measured below toxicological limits. The MgF(2) layer was no longer detected after 4 weeks of implantation by particle-induced gamma emission, and the MgF(2) coating reduced the blood content of alloying elements during the first 6 weeks of implantation with no elevated fluoride concentration in the adjacent bone. Histopathological examinations of liver showed in 9 out of 40 cases minimal infiltrations of heterophil granulocytes of unknown origin (5 LAE442, 4 LAE442+MgF(2)). The kidneys were mainly regular in structure. The synovial tissue showed a granular cell infiltration as a temporary observation in the LAE442+MgF(2) group after 2 weeks. No subcutaneous gas cavities were observed clinically and on postoperative X-rays in all animals. All specimens were scanned by SRmicroCT at 2, 4, 6 and 12 weeks postoperatively before uncalcified sections were performed. All magnesium implants have been observed in direct bone contact and without a fibrous capsule. Localized pitting corrosion occurred in coated and uncoated magnesium implants. This study shows that the extruded magnesium alloy LAE442 provides low corrosion rates and reacts in vivo with an acceptable host response. The in vivo corrosion rate can be further reduced by additional MgF(2) coating.

Serum concentrations of matrix metalloproteinase-9, tissue inhibitor of matrix metalloproteinase-1 and alpha2-macroglobulin in healthy subjects after supplementation with different doses of marine n-3 fatty acids

OBJECTIVE

Extracellular matrix modification by matrix metalloproteinase-9 (MMP-9), tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) and alpha2-macroglobulin may affect the stability of atherosclerotic plaques. Marine n-3 polyunsaturated fatty acids (n-3 PUFA) may protect against plaque rupture. The aim was to investigate the effect of marine n-3 PUFA supplementation on serum levels of MMP-9, TIMP-1, and alpha2-macroglobulin.

METHODS

Healthy volunteers were randomized to receive capsules contributing either 6.6 g marine n-3 PUFA/day, 2.0 g marine n-3 PUFA/day or 6.6 g of olive oil (control). Serum MMP-9, TIMP-1 and alpha2-macroglobulin was measured at baseline and after 12 weeks of supplementation. One way ANOVA or Kruskal-Wallis test was used to compare groups.

RESULTS

60 healthy volunteers were enrolled and no subjects dropped out of the 12 week study. There were no statistically significant changes in serum levels of MMP-9, TIMP-1, and alpha2-macroglobulin in any of the three treatment groups (P=0.85, P=0.23 and P=0.87, respectively).

CONCLUSION

Supplementation with marine n-3 PUFA had no effect on serum levels of MMP-9, TIMP-1 and alpha2-macroglobulin in healthy subjects. The possible protection offered by marine n-3 PUFA against plaque rupture is therefore unlikely to be mediated through a change in serum levels of MMP-9, TIMP-1 and alpha2-macroglobulin.

The effect of N-3 fatty acids on plasma myeloperoxidase levels in healthy adults

OBJECTIVE

To examine the effect of marine n-3 polyunsaturated fatty acids (PUFA) supplementation in a low to moderate and a high dose on plasma levels of myeloperoxidase (MPO) in healthy individuals.

BACKGROUND

Atherosclerosis is a chronic inflammatory disease and MPO, which is secreted primarily from activated neutrophils and monocytes, has pro-inflammatory properties and has been linked with both initiation and propagation of atherosclerosis. Marine n-3 PUFA have anti-inflammatory properties, but whether n-3 PUFA affect plasma levels of MPO is largely unknown.

METHODS

Sixty healthy adults were randomized to three groups receiving either 6.6 g PUFA/day, 2.0 g PUFA/day or a control oil (olive oil) for 12 weeks. Blood samples were drawn at baseline and after exposure. Plasma levels of MPO were measured using a MPO ELISA-kit (from Mercodia, Uppsala, Sweden) with specific mouse monoclonal antibodies.

RESULTS

Plasma MPO concentrations (microg/L) at baseline were 36.9 +/- 9.4; 36.2 +/- 7.1 and 35.4 +/- 11.3 (for high dose-, low dose- and control-group, respectively). After 12 weeks of supplementation we found no significant changes in plasma MPO in any of the groups nor between groups, with values after intervention of 36.1 +/- 8.6; 37.0 +/- 8.2 and 34.4 +/- 11.1, respectively.

CONCLUSION

Supplementation with n-3 PUFA has no effect on plasma levels of MPO in healthy adults with low baseline levels of MPO.

Physisorption of Small Molecules on Single Crystal Alkali Halide Surfaces: CO and N2 Adsorbed on KCl(100)

The adsorption of CO and N2 on KCl(100) single crystal cleavage planes has been investigated by means of low energy electron diffraction (LEED) at primary currents in the nA range as well as polarization infrared spectroscopy (PIRS) in transmittance geometry. These isoelectronic adsorbates behave very similarly, and three different adsorption phases can be distinguished as a function of surface coverage for both of them. Initially a (1×1) structure is observed and assigned to a commensurate monolayer with one molecule per KCl ion pair. The CO infrared spectrum of this ‘phase I’ is characterized by a doublet absorption of the CO stretching vibration, which is discussed in the context of a correlation field splitting. The lack of superstructure diffraction peaks is attributed to a high degree of orientational disorder in this phase. From LEED adsorption isotherms the isosteric heat of adsorption of N2 has been determined to be 11±3 kJ mol−1. Upon increase in coverage by 50% ‘phase II’ is formed which exhibits a large number of additional diffraction spots. It is assigned to a bilayer in which the second layer is only half filled. Based on the LEED experiments a structure model is proposed in which the second layer is characterized by growth in rows along the [210] direction and a high degree of roughness in the perpendicular direction. This model can explain all experimentally observed main features. Finally upon further exposure formation of three-dimensional solid is observed, which proceeds via Stransky–Krastanov growth of crystalline 3D clusters with the structure of the low-temperature cubic α-phase. A simulation of the CO cluster infrared spectra within the dipole–dipole coupling approach can reproduce all major observed vibrational features.

Germline mutation in DOK7 associated with fetal akinesia deformation sequence

BACKGROUND

Fetal akinesia deformation sequence syndrome (FADS) is a heterogeneous disorder characterised by fetal akinesia and developmental defects including, in some case, pterygia. Multiple pterygium syndromes (MPS) are traditionally divided into prenatally lethal and non-lethal (such as Escobar) types. Previously, we and others reported that homozygous mutations in the fetal acetylcholine receptor gamma subunit (CHRNG) can cause both lethal and non-lethal MPS, demonstrating that pterygia resulted from fetal akinesia, and that mutations in the acetylcholine receptor subunits CHRNA1, CHRND, and Rapsyn (RAPSN) can also result in a MPS/FADS phenotype.

METHODS

We hypothesised that mutations in other acetylcholine receptor related genes may interfere with neurotransmission at the neuromuscular junction and so we analysed 14 cases of lethal MPS/FADS without CHRNG, CHRNA1, CHRNB1, CHRND, or RAPSN mutations for mutations in DOK7.

RESULTS

A homozygous DOK7 splice site mutation, c.331+1G>T, was identified in a family with three children affected with lethal FADS. Previously DOK7 mutations have been reported to underlie a congenital myaesthenic syndrome with a characteristic "limb girdle" pattern of muscle weakness.

CONCLUSION

This finding is consistent with the hypothesis that whereas incomplete loss of DOK7 function may cause congenital myasthenia, more severe loss of function can result in a lethal fetal akinesia phenotype.

Metabolic effects of vasoactive agents

After adequate volume resuscitation, the mainstay of therapy in critically ill patients with shock is treatment with vasoactive substances to restore haemodynamics or to improve regional perfusion. These agents include adrenoceptor agonists with inotropic combined with either vasoconstricting or vasodilating effects, and predominantly vasodilating drugs such as prostacyclin and related compounds. However, vasoactive agents not only affect the cardiovascular system, but also have profound metabolic effects. The interdependence of vasoactive drugs with metabolism may be relevant regarding adequate oxygen and substrate delivery to cover actual organ needs. Therefore, the profiles of these metabolic effects have to be considered during their therapeutic administration.

Regurgitation of the Atrioventricular Valves after Corrective Surgery for Complete Atrioventricular Septal Defects - Comparison of Different Surgical Techniques

OBJECTIVE

Different surgical approaches have been used to repair complete atrioventricular septal defects (AVSD). Regurgitant atrioventricular valves (AV-valves) are common after surgery. We compared different surgical techniques with respect to long-term postoperative AV-valve regurgitation.

METHODS

In 69 patients with complete AVSD, three different surgical techniques were applied: Single-patch, two-patch, and modified techniques. The left-sided AV-valve cleft was surgically closed in all patients.

RESULTS

A comparison of the results of the different techniques showed no difference in the degree of AV-valve regurgitation on either the right or the left side. The average degree was mild on both sides. Only one patient needed reoperation for severe left-sided AV-valve regurgitation.

CONCLUSION

The different surgical techniques used for the correction of AVSD do not have a major bearing on the degree of AV-valve regurgitation.