Generation of LexA enhancer-trap lines in Drosophila by an international scholastic network

Conditional gene regulation in Drosophila through binary expression systems like the LexA-LexAop system provides a superb tool for investigating gene and tissue function. To increase the availability of defined LexA enhancer trap insertions, we present molecular, genetic, and tissue expression studies of 301 novel Stan-X LexA enhancer traps derived from mobilization of the index SX4 line. This includes insertions into distinct loci on the X, II, and III chromosomes that were not previously associated with enhancer traps or targeted LexA constructs, an insertion into ptc, and seventeen insertions into natural transposons. A subset of enhancer traps was expressed in CNS neurons known to produce and secrete insulin, an essential regulator of growth, development, and metabolism. Fly lines described here were generated and characterized through studies by students and teachers in an international network of genetics classes at public, independent high schools, and universities serving a diversity of students, including those underrepresented in science. Thus, a unique partnership between secondary schools and university-based programs has produced and characterized novel resources in Drosophila, establishing instructional paradigms devoted to unscripted experimental science.

Shorter and sweeter: the 16-item version of the SRS questionnaire shows better structural validity than the 20-item version in young patients with spinal deformity

PURPOSE

In patients with adult spinal deformity, it was previously shown that 16 of the non-management items of the SRS-instrument showed a better fit to the theoretical four-factor model (pain, function, self-image, mental health) than did all 20 items. Whether the same phenomenon is observed in data from younger (< 20y) patients, for whom the questionnaire was originally designed, is not currently known.

METHODS

Confirmatory factor analysis was used to evaluate the factor structure of the 20 non-management items of the SRS-instrument completed by 3618 young patients with spinal deformity (75.5% female; mean age, 15.0 ± 2.0 years) and of its equivalence across language versions (2713 English-speaking, 270 Spanish, 264 German, 223 Italian, and 148 French). The root mean square error of approximation (RMSEA) and comparative fit index (CFI) indicated model fit.

RESULTS

Compared with the 20-item version, the 16-item solution significantly increased the fit (p < 0.001) across all language versions, to achieve good model fit (CFI = 0.96, RMSEA = 0.06). For both 16-item and 20-item models, equivalence across languages was not reached, with some items showing weaker item-loading for some languages, in particular German and French.

CONCLUSION

In patients with adolescent idiopathic scoliosis, the shorter 16-item version showed a better fit to the intended 4-factor structure of the SRS-instrument. The wording of some of the items, and/or their equivalence across language versions, may need to be addressed. Questionnaire completion can be a burden for patients; if a shorter, more structurally valid version is available, its use should be encouraged.

The aspects of sex, age and nationality in winter swimming performance

OBJECTIVE

Winter swimming is a new sport discipline. Very little is known, however, about the sex differences, origin, participation and performance of the world's best winter swimmers. Therefore, the study aimed to investigate sex differences in performance and age. Furthermore, it should be determined which country has the fastest swimmers, the highest numbers of participants and the most successful age group athletes in winter swimming.

SUBJECTS AND METHODS

A total of 6,477 results from the 25 m events of the IWSA (International Winter Swimming Association) World Cups from 2016-2020 was collected from the official website of IWSA. Data were analyzed using a generalized linear model (GLM) with a gamma probability distribution and identity link function. The 25 m events were carried out in head-up breaststroke style, freestyle and butterfly. The nationalities were grouped into six groups, the five nationalities with the highest number of participants in the 25 m competitions and one group with the other nationalities. The mean time of 25 m races by sex and country of the total sample was compared. For the top 10 comparisons, the best ten athletes from the six groups were selected. The mean time of each top 10 groups was compared by sex and nationality.

RESULTS

Men were faster than women for all categories. Swimmers in age group 15-29 years were the fastest, where females were the fastest in age group 15-19 years and males in age group 20-29 years. Women from both Russia and Estonia and men from both Russia and China were the fastest. Both Russian and Chinese males were the fastest in all water categories in the top 10 section in the 25 m events.

CONCLUSIONS

In summary, males were faster than females in the IWSA World Cups between 2016 and 2020. The age group of 15-29 years old athletes was the most successful while females had their age of peak performance earlier than males. Russian and Estonian males and Russian females were the overall fastest in the 25 m events in all water categories. Future studies should investigate the optimal anthropometric characteristics of male and female winter swimming sprint athletes and whether there are distinct areas in Russia, Estonia and China, where many international winter swimming athletes originate.

Comparison of clinical outcomes of edoxaban versus apixaban, dabigatran, rivaroxaban, and vitamin K antagonists in patients with atrial fibrillation in Germany: A real-world cohort study

BACKGROUND

The aim of the study was to compare the real-world effectiveness and safety in atrial fibrillation (AF) patients treated with edoxaban versus other oral anticoagulants (OACs) (apixaban, dabigatran, rivaroxaban, and vitamin K antagonists [VKA]) in Germany.

METHODS AND RESULTS

Using a representative database of 3.5 million statutory health-insured lives in Germany, a retrospective cohort study was conducted to examine ischemic stroke (IS) or systemic embolism (SE) and major bleeding in AF patients initiating anticoagulant therapy from January 2014 through June 2017. Inverse probability of treatment weighting using propensity score was applied for baseline covariate adjustment. Cox proportional hazards models were used to estimate the adjusted risk (hazard ratio [HR]) of each outcome comparing edoxaban versus other OACs. Among 21,038 patients treated with OACs, 1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA patients were included. The adjusted combined risks of IS or SE were lower (p < 0.05) for each edoxaban pairwise comparison with other OACs (HR: 0.83 vs. apixaban, 0.60 vs. dabigatran, 0.72 vs. rivaroxaban, 0.64 vs. VKA). Edoxaban favored lower risks of major bleeding compared with rivaroxaban (HR: 0.74) and VKA (HR: 0.47). No differences in the risk of major bleeding were found between edoxaban and apixaban (p = 0.33), and between edoxaban and dabigatran (p = 0.06).

CONCLUSIONS

Edoxaban was associated with better effectiveness compared with other OACs in AF patients from Germany. Edoxaban also demonstrated a favorable safety profile.

Improved adherence to anticoagulant therapy with once-daily regimen: a real-world study in patients with atrial fibrillation in Germany

Background

Adherence and persistence to non-VKA oral anticoagulants (NOACs) are important to achieve optimal clinical outcomes in patients with atrial fibrillation (AF). Dosing frequency may play a role in adherence and persistence to NOAC therapy. Among the NOACs that are currently available, edoxaban and rivaroxaban are given once daily (QD) while dabigatran and apixaban are given twice daily (BID).

Purpose

The objective of the study was to compare the adherence and persistence in AF patients receiving QD versus BID NOAC regimens in Germany.

Methods

Using an administrative database from our institution (Deutsche Analysedatenbank für Evaluation und Versorgungsforschung) between January 2013 and December 2017, a retrospective cohort study was conducted to compare the 6-month adherence in NOAC-naïve AF patients who initiated anticoagulant therapy. Continuous enrolment for 12 months before anticoagulant initiation was required to assess baseline characteristics. Adherence was measured using proportion of days covered (PDC) and medication possession ratio (MPR). Proportions of patients with PDC ≥80% and MPR ≥80% were also measured. Treatment discontinuation was defined as a prescription supply gap of ≥90 days. Inverse probability treatment weighting using propensity score was applied to control for differences in baseline characteristics.

Results

A total of 8249 (1236 edoxaban, 7013 rivaroxaban) and 7359 (6053 apixaban, 1306 dabigatran) patients who received QD and BID regimens were included. The two regimen groups were well balanced after weighting. Patients who received QD regimens had a significantly higher mean PDC at 6 months compared to those who received BID regimens (0.78 vs. 0.72, p&lt;0.05). The proportion of patients with PDC ≥80% was significantly higher for QD versus BID regimens (65.3% vs. 49.6%, p&lt;0.05). Similarly, the mean MPR was higher for QD versus BID regimens (0.81 vs. 0.74, p&lt;0.05), with more QD patients having MPR ≥80% than BID patients (69.5% vs. 53.3%, p&lt;0.05). Six-month persistence rates were comparable between the two regimen groups (73.4% vs. 74.2%, p=0.13).

Conclusions

Adherence to once-daily regimens of NOAC was significantly higher compared to adherence to twice-daily NOAC regimens. Future research is needed to examine the relationship between adherence to NOAC treatment and clinical outcomes in AF patients, and factors affecting persistence.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): This study was sponsored by Daiichi Sankyo Inc

Comparison of clinical outcomes with edoxaban versus apixaban, dabigatran, rivaroxaban, and vitamin K antagonist in patients with atrial fibrillation in Germany: a real-world cohort study

Background

Vitamin K antagonists (VKA) and non-VKA oral anticoagulants (NOACs) are used to prevent thromboembolic conditions in patients with atrial fibrillation (AF). Unlike VKA, NOACs have fixed dosage schemes, do not require regular laboratory tests, and have fewer drug and food interactions. The use of NOACs has increased substantially in recent years in Germany. However, there is limited evidence on the comparative effectiveness and safety between different NOACs and VKA in real-world settings.

Purpose

The objective of the study was to compare the clinical outcomes, including systemic embolism (SE), ischemic stroke (IS), and major bleeding, of edoxaban with other NOACs (apixaban, dabigatran, rivaroxaban) and VKA in AF patients in Germany.

Methods

Using an administrative database from our institution (Deutsche Analysedatenbank für Evaluation und Versorgungsforschung) between January 2013 and December 2017, a retrospective cohort study was conducted to compare the effectiveness (risk of SE or IS) and safety (risk of major bleeding) in NOAC-naïve AF patients who initiated anticoagulant therapy. Continuous enrolment for 12 months before anticoagulant initiation was required to assess baseline characteristics. Patients were followed up until (1) the first outcome event (SE, IS, or major bleeding), (2) disenrollment from health plans, or (3) discontinuation of the index NOAC or VKA or therapy switch, whichever occurred first. Inverse probability treatment weighting (IPTW) using propensity score was applied to control for differences in baseline characteristics. Cox proportional hazards models were used to estimate the hazard ratios (HR) for each outcome comparing edoxaban versus other NOACs and VKA. Sensitivity analyses were conducted with follow-up period cut-off at 1 year.

Results

A total of 1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA patients were included. Patient cohorts were well balanced after weighting. The adjusted risks of SE or IS were lower for edoxaban compared to apixaban (HR 0.83, 95% CI 0.69–0.99), dabigatran (HR 0.54, 95% CI 0.40–0.74), rivaroxaban (HR 0.72, 95% CI 0.60–0.87), and VKA (HR 0.65, 95% CI 0.53–0.78) (all p&lt;0.05). Edoxaban was associated with a significantly lower risk of major bleeding compared to dabigatran (HR 0.73, 95% CI 0.55–0.98), rivaroxaban (HR 0.74, 95% CI 0.63–0.87), and VKA (HR 0.47, 95% CI 0.40–0.55) (all p&lt;0.05). The risk of major bleeding was comparable between edoxaban and apixaban (HR 1.09, 95% CI 0.92–1.30, p=0.33). Results were consistent in the sensitivity analyses.

Conclusions

Edoxaban was associated with a significantly lower risk of SE or IS compared to other NOACs and VKA, indicating improved effectiveness. Edoxaban also had a favourable safety profile with a significantly lower risk of major bleeding compared to dabigatran, rivaroxaban, and VKA.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): This study was sponsored by Daiichi Sankyo Inc.

Einfluss von Teamarbeit auf Wohlbefinden und emotionale Erschöpfung von Mitarbeitern in der medizinischen Rehabilitation

Ziel der Studie: Emotionale Erschöpfung und Wohlbefinden von Mitarbeitern sind Indikatoren, welche im Zusammenhang mit der hohen Prävalenz psychischer und psychosomatischer Erkrankungen bei Mitarbeitern im Gesundheitswesen von Bedeutung sind. Teamarbeit kann das Wohlbefinden der Mitarbeiter positiv beeinflussen. Dies ist jedoch im Bereich der Rehabilitation noch unzureichend belegt. Ziel der vorliegenden Studie war es, Aspekte von Teamarbeit als Prädiktoren für Wohlbefinden und emotionale Erschöpfung bei Mitarbeitern in deutschen Rehabilitationskliniken zu untersuchen.

Methodik: Die Daten wurden in insgesamt 10 Rehabilitationskliniken in Südwestdeutschland erhoben, davon wurden die Mitarbeiterfragebogen aus 9 Kliniken (n=306, 70% weiblich, 68% zwischen 40 und 59 Jahre alt) mittels multipler linearer Regression ausgewertet.

Ergebnisse: Die Mitarbeiter berichteten moderate Maße an emotionaler Erschöpfung und hohes Wohlbefinden. Die Ergebnisse der Regressionsanalysen zeigen, dass Zusammenhalt (β=0,27, p<0,001), Teamorganisation (β=0,19, p<0,01) und Alter (β=0,13, p<0,05) der Mitarbeiter einen bedeutsamen Teil der Varianz von Wohlbefinden aufklären konnten (F[3, 244]=19,38, p<0,05). Durch das Kriterium Zusammenhalt (β=− 0.37, p<0,001) konnte die emotionale Erschöpfung der Mitarbeiter bedeutsam vorhergesagt werden (F[1, 244]=39,19, p<0,001).

Schlussfolgerung: Diskutiert werden die Auswirkungen der interpersonellen und strukturellen Aspekte von Teamarbeit, sowie die potentielle Relevanz von Interventionsmaßnahmen zur Verbesserung der Teamarbeit, um eine Steigerung des psychischen Wohlbefindens der Mitarbeiter zu erreichen.

[Facilitators and barriers to interprofessional collaboration in rehabilitation clinics--a survey of clinical executive managers]

PURPOSE

Interprofessional collaboration is an essential feature of quality and success in medical rehabilitation, a field which is influenced by a variety of factors. It is the objective of this study to identify beneficial factors that may promote team collaboration as well as barriers which may hinder it.

METHODS

The facilitators and barriers of team collaboration were identified in a cross-sectional study. We conducted guided expert interviews with 18 managers aged between 36 and 62 years (M = 49.2) in a total of 5 inpatient rehabilitation clinics. Among the surveyed managers were 5 senior physicians and 13 department head managers of the health professionals (4 head nurses,6 head therapists and 3 heads of psychological departments). The qualitative analysis of interview transcripts was carried out according to Mayring’s structured content analysis approach.

RESULTS

From a total of 480 coded statements,337 are concerned with factors supporting interprofessional collaboration and 143 relate to barriers.The most common statements concerning supporting factors relate to the main category “Interprofessional Coordination of Treatment”.Here, for example, the existence of an overall rehabilitation concept and planning of care services with rehabilitation goals in mind are regarded as facilitating. Variables such as interactive information exchange, multilateral communication,transparent team roles, defined tasks of the entire team or of individual team members play significant roles in this context. Hindering factors and barriers to interprofessional collaboration are mentioned in particular in relation to the organization.In terms of organization, heavy workload(time pressure, high treatment frequencies,altered severity of rehabilitation needs, considerable administration costs), inadequate pay Inter and insufficient time corridors to consult within the interprofessional team are rated as limiting factors.

CONCLUSION

Influencing factors on interprofessional collaboration identified in our study are similar to those named in other studies. Facilitators and barriers of interprofessional collaboration should be taken into account when guiding and managing teams.

Expectations and requests regarding team training interventions to promote interdisciplinary collaboration in medical rehabilitation--A qualitative study

BACKGROUND

Interdisciplinary teamwork and team interventions are highly valued in the rehabilitation sector because they can improve outcomes of care for persons with complex health problems. However, little is known about expectations and requests regarding team interventions, especially in medical rehabilitation. This study aimed to explore how clinical managers and health professionals within multidisciplinary rehabilitation teams describe their expectations and requests regarding team-training interventions in the field of medical rehabilitation.

METHODS

Considering the methodology of qualitative research, data were collected using semi-structured interviews and focus groups at five rehabilitation clinics in Germany. We conducted face-to-face interviews with 5 clinical managers and 13 department heads of health care teams as well as five focus groups with a total of 35 members of interdisciplinary rehabilitation teams. Afterwards, the data were analyzed through qualitative content analysis encompassing data coding and using inductive thematic analysis.

RESULTS

The exploration of team members' and clinical managers' descriptions showed that, to them, interdisciplinary team training programs should include a wide array of training contents. Seven common core themes emerged from the interviews, including participation of employees, leadership, communication, team meetings, team composition, coordination, and equal esteem. Additionally, 13 themes were identified by either managers or team members. The body of expectations regarding team training content in healthcare spans the continuum of changes on the team and organizational levels. On the organizational level, a number of structural factors were mentioned (e.g. improving the general conditions for team meetings, organized workshops to exchange interdisciplinary experiences, and leadership training), and on the team level, changes in procedural factors were listed (e.g. optimizing the consecutive planning and coordination of patient treatments, clarity with regard to roles and responsibilities of team members, and mutual esteem and appreciation between different professions).

CONCLUSIONS

The synthesis underscores that there is meaningful heterogeneity in team training needs; training interventions should be locally adapted for each clinic in terms of training content and training strategies. Tailored team interventions are important for rehabilitation clinics. Future work should evaluate employed team training concepts over time as well as training contents, implementation strategies, and learning outcomes. This includes using robust study designs and evaluating team-training effects.

LGI Proteins and Epilepsy in Human and Animals

Leucine‐rich glioma‐inactivated (LGI) protein was first thought to have a suppressor effect in the formation of some cancers. Developments in physiology and medicine made it possible to characterize the function of the LGI protein family and its crucial role in different conditions more precisely. These proteins play an important role in synaptic transmission, and dysfunction may cause hyperexcitability. Genetic mutation of LGI1was confirmed to be the cause of autosomal dominant lateral temporal lobe epilepsy in humans. The LGI2 mutation was identified in benign familial juvenile epilepsy in Lagotto Romagnolo (LR) dogs. Cats with familial spontaneous temporal lobe epilepsy have been reported, and the etiology might be associated with LGI protein family dysfunction. In addition, an autoimmune reaction against LGI1 was detected in humans and cats with limbic encephalitis. These advances prompted a review of LGI protein function and its role in different seizure disorders.

Fabrication and experimental demonstration of the first 160 Gb/s hybrid silicon-on-insulator integrated all-optical wavelength converter

We present a hybrid integrated photonic circuit on a silicon-on-insulator substrate that performs ultra high-speed all-optical wavelength conversion. The chip incorporates a 1.25 mm non-linear SOA mounted on the SOI board using gold-tin bumps as small as 14 μm. Τhe device performs chirp filtering and signal polarity inversion with two multi-mode interference (MMI) - based cascaded delay interferometers (DIs) monolithically integrated on the same SOI substrate. Full free spectral range (FSR) tuning of the DIs is accomplished by two independently tuneable on-chip thermal heaters. We demonstrate 160Gb/s all-optical wavelength conversion with power penalties of less than 4.6dB.

[Patients as customers? The term "customer" in the perception of medical students at the end of their university training]

In the preceding decades a new perspective on the role of patients in the health-care system has gained ground, considering patients not merely as "suffering persons" but additionally as "customers". Physicians, however, tend to disagree with this approach because of the economic connotation of the term customer. Until now, there is only poor evidence of whether students of medicine - who are going to work as physicians in the future - agree or disagree with that approach and whether they are ready to accept patients as customers. In the following study students of medicine were interviewed on their perspectives towards that approach, in particular on their attitudes towards the idea of "the patient as customer", the appropriateness of the term consumer in different clinical settings and sectors of health care, the implementation of consumer orientation in clinical routine, and their favoured model of physician-patient relationship.As the study could not build upon data of prior similar studies, a quantitative and qualitative cross-sectional study with a descriptive-explorative design was conducted. Using a semi-standardised questionnaire, 313 medical students (response rate: 95%) were interviewed in Spring 2010. At the time of the survey, the students were enrolled at the faculty of medicine at Freiburg University, Germany, and were in their last semester which immediately preceded their exam.The future physicians do not consider patients primarily as customers. More than 80% of the respondents "absolutely" or "largely" supported the idea that patients are considerably more than customers. The analysis of the qualitative data of the study shows different results. Here, more statements were made that patients could equally be seen as customers (449 students supported this idea, 298 did not). Statements contradicting the customer approach referred mostly to the asymmetry of the physician-patient relationship and the special role of the patient. The highest level of acceptance of the customer approach was found in classical service settings such as pharmacies, the lowest level in emergency medical aid. According to medical students, a consumer orientation has been realised in different health service areas in correspondingly different degrees: On top of the list are plastic surgery clinics, followed by private health insurances and homeopathic clinics. A minority of medical students predict the implementation of consumer orientation in the emergency medical aid. Future physicians consider their relationship to patients largely as a relationship between a healing person and a person seeking help rather than a relationship between a service provider and a customer.Considering recent developments in the organisation of medical services and health services in general, it becomes increasingly important to know what kind of 'service behaviour' patients expect from their doctors and other health providers. Obviously, it is not self-evident for medical students to perceive their future patients as customers and to act as customer-oriented 'service providers'. In view of this, the faculties of medicine at universities - which provide professional training to students of medicine - should be aware of the challenge to 'socialise' their students so that they can keep up with patients' expectations.

Advanced diagnostic imaging in colonic disease

Advanced colonic imaging refers to the use of techniques such as high definition white light, standard white light with chromoendoscopy, virtual chromoendoscopy (narrow band imaging), autofluorescence imaging and endomicroscopy to evaluate the colonic mucosa. The main aims of both advanced colonic imaging are to enhance the mucosal detail and to allow a detailed view of the submucosal capillary pattern, thus potentially improving the detection of more pathological lesions. The mucosal surface of neoplastic and non-neoplastic growths develops into specific mucosal convolutions, also called "pit pattern". Neoplasia also leads to angiogenesis with its resulting vessel proliferation and disarray. Because both the pit pattern and the submucosal capillary network are disarranged in the presence of neoplasia it is compelling to hypothesize that advanced imaging methods will allow the endoscopist a better interrogation of lesions with a resulting increase in diagnostic sensitivity and specificity (i.e. differentiation of lesions). However, the current literature dealing with advanced endoscopic imaging of the colon is fraught with many controversial findings, with few experts vehemently supporting the use of most of these methods in routine clinical practice, whereas most practicing endoscopists still effuse to accept that this methods aid in the clinical routine. This review describes the concept of advanced endoscopic imaging. We conclude that advanced endoscopic imaging of the colon holds many promises, but with the exception of high definition white light endoscopy, at the present stage, there is no solid evidence to support the implementation of most advanced endoscopic methods in routine clinical practice.

Tolerability of sorafenib in the treatment of hepatocellular carcinoma (HCC) in patients with Child A and B liver cirrhosis

e15593

Background: Sorafenib (S) is the only drug that prolongs overall survival in patients (pts) with advanced HCC by nearly 3 months in pts with Child A liver cirrhosis (LC). This study aims to evaluate tolerability of S in pts with Child B LC. Methods: Pts with HCC not suitable for curative therapy were treated with S since it became available for clinical use. 50 of 139 consecutive patients diagnosed with HCC were treated with S (8 f, 42 m; median age 67 (18–86) yrs). Initial dose was 400 mg/day and increased in case of good tolerability stepwise up to 800mg/day. Pts were stratified according to the stage of LC and analyzed for treatment toxicity based on the National Cancer Institute Common Toxicity System. Results: 41 pts with HCC had LC, 17 in Child A and 24 in Child B stadium. Due to side effects a dose escalation to 800mg was possible in 9 pts (22.0%) only, 3 with Child A and 6 with Child B LC. Grade 1/2 toxicity was observed in 15 pts with initial Child A (88.2%) and in 11 pts with initial Child B LC (45.8%), grade 3/4 toxicity occurred in 2 pts with Child A (11.8%) and 3 pts with Child B LC (12.5%). After 12 weeks of follow-up, 12 pts with Child A (70.6%) and 10 pts with Child B LC (41.7%) at entry were still under treatment. A deterioration of liver function from Child A to Child B was observed in 5 of 17 pts (29.4%) and from Child B to Child C in 1 patient (4.2%). In 5 pts (29.4%) with Child A LC and 14 pts with Child B LC at entry treatment had been discontinued in advance. Survival in patients with LC Child A was better than in patients with LC Child B (median overall survival 327 (60–495) vs 138 (10–560) days resp., ns). Conclusions: Systemic therapy of advanced HCC with S appears to be a safe treatment option in pts with Child B LC. However, tolerability is an important limitation in the use of S independently of the stage of LC. Whether pts with advanced HCC benefit from a systemic treatment with smaller doses than 800mg/day needs to be addressed in further studies.

[Table: see text]

Neonatal procedural pain exposure and pain management in ventilated preterm infants during the first 14 days of life

OBJECTIVES

Ventilated preterm infants are at high risk for procedural pain exposure. In Switzerland there is a lack of knowledge about the pain management in this highly vulnerable patient population. The aims of this study were to describe the type and frequency of procedures and to determine the amount of analgesia given to this patient group in two Swiss neonatal intensive care units.

METHOD

A retrospective cohort study was performed examining procedural exposure and pain management of a convenience sample of 120 ventilated preterm infants (mean age = 29.7 weeks of gestation) during the first 14 days of life after delivery and born between May 1st 2004 and March 31st 2006.

RESULTS

The total number of procedures all the infants underwent was 38,626 indicating a mean of 22.9 general procedures performed per child and day. Overall, 75.6% of these procedures are considered to be painful. The most frequently performed procedure is manipulation on the CPAP prongs. Pain measurements were performed four to seven times per day. In all, 99.2% of the infants received either non-pharmacological and/or pharmacological agents and 70.8% received orally administered glucose as pre-emptive analgesia. Morphine was the most commonly used pharmacological agent.

DISCUSSION

The number of procedures ventilated preterm infants are exposed to is disconcerting. Iatrogenic pain is a serious problem, particularly in preterm infants of low gestational age. The fact that nurses assessed pain on average four to seven times daily per infant indicates a commitment to exploring a painful state in a highly vulnerable patient population. In general, pharmacological pain management and the administration of oral glucose as a non-pharmacological pain relieving intervention appear to be adequate, but there may be deficiencies, particularly for extremely low birth weight infants born <28 weeks of gestation.

Outbreaks of infectious keratoconjunctivitis in alpine chamois and ibex in Switzerland between 2001 and 2003

Five outbreaks of infectious keratoconjunctivitis (ikc) affecting alpine chamois and ibex in the western and central Swiss Alps were recorded in 2001 to 2003. Mycoplasma conjunctivae was identified from conjunctival swabs by means of a nested pcr in 27 of the 28 chamois tested. The outbreaks occurred in an area covering 1590 km(2). Deep valleys acted as a barrier to the spread of the disease. A total of 409 chamois and 33 ibex with clinical signs of ikc were reported. Most of the chamois were shot, primarily because they were blind or in poor general body condition. Almost a quarter were observed alive, and 16.9 per cent died as a result of ikc. Many of the affected animals were juveniles, and more females than males died of ikc. The disease was more common during the summer and autumn. The chamois affected by ikc were found at altitudes between 550 and 3200 m. The estimated overall mortality was less than 5 per cent, but more than 20 per cent may have died locally. Ibex affected by ikc were recorded in only two outbreaks. In six places, ibex with clinical signs of ikc were found before the first affected chamois appeared in the same area.

Modeling tree water deficit from microclimate: an approach to quantifying drought stress

Tree water deficit estimated by measuring water-related changes in stem radius (DeltaW) was compared with tree water deficit estimated from the output of a simple, physiologically reasonable model (DeltaWE), with soil water potential (Psisoil) and atmospheric vapor pressure deficit (VPD) as inputs. Values of DeltaW were determined by monitoring stem radius changes with dendrometers and detrending the results for growth. We followed changes in DeltaW and DeltaWE in Pinus sylvestris L. and Quercus pubescens Willd. over 2 years at a dry site (2001-2002; Salgesch, Wallis) and in Picea abies (L.) Karst. for 1 year at a wet site (1998; Davos, Graubuenden) in the Swiss Alps. The seasonal courses of DeltaW in deciduous species and in conifers at the same site were similar and could be largely explained by variation in DeltaWE. This finding strongly suggests that DeltaW, despite the known species-specific differences in stomatal response to microclimate, is mainly explained by a combination of atmospheric and soil conditions. Consequently, we concluded that trees are unable to maintain any particular DeltaW. Either Psisoil or VPD alone provided poorer estimates of DeltaW than a model incorporating both factors. As a first approximation of DeltaWE, Psisoil can be weighted so that the negative mean Psisoil reaches 65 to 75% of the positive mean daytime VPD over a season (Q. pubescens: approximately 65%, P. abies: approximately 70%, P. sylvestris: approximately 75%). The differences in DeltaW among species can be partially explained by a different weighting of Psisoil against VPD. The DeltaW of P. sylvestris was more dependent on Psisoil than that of Q. pubescens, but less than that of P. abies, and was less dependent on VPD than that of P. abies and Q. pubescens. The model worked well for P. abies at the wet site and for Q. pubescens and P. sylvestris at the dry site, and may be useful for estimating water deficit in other tree species.

Does low phosphorus supply limit seedling establishment and tree growth in groves of ectomycorrhizal trees in a central African rainforest?

•  In a forest grove at Korup dominated by the ectomycorrhizal species Microberlinia bisulcata , an experiment tested whether phosphorus (P) was a limiting nutrient. •  P-fertilization of seven subplots 1995-97 was compared with seven controls. It led to large increases in soil P concentrations. Trees were measured in 1995 and 2000. M. bisulcata and four other species were transplanted into the treatments, and a wild cohort of M. bisulcata seedlings was followed in both. Leaf litter fall from trees and seedlings were analysed for nutrients. •  Growth of trees was not affected by added P. Transplanted seedlings survived better in the controls than added-P subplots: they did not grow better with added-P. M. bisulcata wildlings survived slightly better in the added-P subplots in yr 1 but not later. Litter fall and transplanted survivors had much higher concentrations of P (not N) in the added-P than control subplots. •  Under current conditions, it appears that P does not limit growth of trees or hinder seedling establishment, especially of M. bisculcata , in these low-P grove soils.

Monoclonal antibodies recognizing epitopes of calretinins: dependence on Ca2+-binding status and differences in antigen accessibility in colon cancer cells

Monoclonal antibodies are very helpful tools to investigate the localization and sometimes even the function of specific proteins in cells and tissues. By generating monoclonal antibodies against calretinin-22k (CR-22k), a C-terminally truncated isoform of calretinin (CR) as a result of alternative splicing of the CR mRNA, we envisaged that screening multiple monoclonal antibodies would allow the identification of CR-22k as well as CR. Both proteins share the first 178 amino acids, but have different C-termini. All three antibodies 10C10, 6B3 and 2H4 recognize recombinant CR-22k and the specificity to also recognize CR was demonstrated in brain extracts of different species and human tumour cells, which express CR. All monoclonal antibodies did not crossreact with the closely related protein calbindin D-28k. Antibody binding was depending on the Ca2+-binding status of both forms of calretinin. Generally, the Ca2+-bound form was better recognized than the Ca2+-free form. Carboxy- and amino-terminally truncated CR proteins were expressed in E. coli in order to characterize the epitopes recognized by the three antibodies. Additionally, tryptic and cyanogen bromide fragments were produced to further narrow down the sequences recognized by the three antibodies. 10C10 recognizes an epitope consisting of the linker region between EF-hand domains I and II and the N-terminal part of EF-hand II, while the others (6B3, 2H4) bind to a region including the linker between EF-hand domains III and IV. These antibodies are valuable tools to further investigate the distribution and eventually the specific function of these two proteins in the nervous tissue and under pathological conditions, e.g. in colon tumours and mesotheliomas.

Embolization treatment of bleeding complications in pancreatitis

Pseudoaneurysm following chronic pancreatitis is a severe complication that can lead to massive gastrointestinal bleeding. Surgical treatment means high risk for the patient. We report on two patients in whom the bleeding was managed by percutaneous transvascular embolization, a relatively non-invasive and successful method with low risk. The goal was either the definitive arrest of bleeding or stabilization of the patient to enable a surgical procedure. Embolization coils are the material most utilized for vessel occlusion. In patients with bleeding complication following pancreatitis, if sonography or computed tomography demonstrates a pseudoaneurysm, we recommend angiographic visualization and immediate subsequent embolization.

[In vitro peroxidation of plasma and erythrocyte lipids during WR-1339 induced hyperlipidemia in Wistar rats]

The inhibition of lipoprotein catabolism after triton WR-1339 intravenous administration is associated with an impressive modification in the balance between plasma peroxidable substrates and antioxidants. Treated rat plasma and membrane lipids become peroxiaable when they are incubated with phenylhydrazine in standardized conditions and the production of thiobarbituric acid-reactive substances (lipoperoxidation markers) significantly increases. An accumulation of native lipoproteins which present a decreased alpha-tocopherol on triglycerid ratio and a modification in the plasmatic balance between alpha-tocopherol and ascorbate could explain these observations.

Resistance to oxidation of native lipoproteins and erythrocyte membrane lipids in rats with iron overload

Iron plays a promoting role in lipid oxidation through several mechanisms. Therefore, hepatic iron deposits in the rat may lead to peroxidative damage and to alterations in the lipoprotein formation. In this report we observed that an iron overload in rats strongly reduced the hepatic lipoprotein secretion but did not affect oxidation resistance of native lipoproteins and erythrocyte lipids in spite of tocopherol and ascorbate deficiencies. Since oxidation resistance depends on the substrate to antioxidant vitamin molar ratio, our results show that an iron overload probably alters the lipoprotein lipid fatty acid composition in rats.

Lead effect on the oxidation resistance of erythrocyte membrane in rat triton-induced hyperlipidemia

The anemia observed in severe chronic lead poisoning is in part attributable to alterations in the erythrocyte physicochemical properties. Since they are partly related to the membrane lipid composition, the aim of the present study was to determine the effects of a triton-induced hyperlipidemia on the resistance to oxidation of erythrocyte membranes in lead-treated Wistar rats. Our results showed that triton administration to lead-treated rats induced an increase in erythrocyte choline phospholipid levels together with a significant decrease in the erythrocyte membrane lipid resistance to oxidation. These results led us to suggest that anemia in lead poisoning is linked to interactions between lead present in the membrane and plasma phospholipids. Their increase in rat hyperlipidemia induced by triton resulted in a decrease in the membrane resistance to oxidation and finally in an erythrocyte fragility leading to their destruction.