A novel method for the accurate quantification of two isomeric mercapturic acids of 1,3-dichlorobenzene in human urine using isotope dilution online-SPE-LC-MS/MS

1,3-dichlorobenzene (1,3-DCB) is an aromatic solvent that might be formed during thermal decomposition of bis(2,4-dichlorobenzoyl)peroxide used as initiator in silicone rubber production with many workers exposed worldwide. During metabolism of 1,3-DCB, two isomeric mercapturic acids can be formed from ring oxidation of 1,3-DCB in the liver, namely 2,4-dichlorophenylmercapturic acid (24CPhMA) and 3,5-dichlorophenylmercapturic acid (35CPhMA). These urinary mercapturic acids might serve as biomarkers of the toxicologically relevant absorbed dose of 1,3-DCB and have not been determined so far. Thus, we were aimed to develop an analytical method for quantification of these biomarkers. Authentic standards of both mercapturic acids as well as deuterium-labelled analogues were self-synthesized. A method for the quantification of both CPhMAs in human urine using online-SPE LC/MS/MS was developed and validated with an LOQ of 0.1 ng mL-1 for both CPhMAs. The analytes were extracted from urine by online-SPE on a restricted access material phase, transferred to the analytical column and quantified by tandem mass spectrometry. Interday (n = 6) and Intraday (n = 10) precision for both CPhMAs ranged from 1.7 to 4.3 % with accuracies between 99.4 and 109.9 % at concentrations of 0.6 and 3 ng mL-1. We applied the method on post-shift urine samples of 16 workers of the silicone rubber industry with occupational exposure to 1,3-DCB. Both CPhMAs were above LOQ in 15 of 16 urine samples with median levels (range) for 24CPhMA and 35CPhMA of 1.64 ng mL-1 (<0.1 - 8.2 ng mL-1) and 3.98 ng mL-1 (0.36 - 24.1 ng mL-1), respectively. This is the first report on specific urinary mercapturic acids of 1,3-DCB in humans. Our results show that ring oxidation of 1,3-DCB is considered to be a toxicologically relevant metabolic pathway in humans. This might improve risk assessment of 1,3-DCB-emissions in silicone rubber industry.

Model-predicted geometry variations to compensate material variability in the design of classical guitars

Musical instrument making is often considered a mysterious form of art, its secrets still escaping scientific quantification. There is not yet a formula to make a good instrument, so historical examples are regarded as the pinnacle of the craft. This is the case of Stradivari's violins or Torres guitars that serve as both models and examples to follow. Geometric copies of these instruments are still the preferred way of building new ones, yet reliably making acoustic copies of them remains elusive. One reason for this is that the variability of the wood used for instruments makes for a significant source of uncertainty-no two pieces of wood are the same. In this article, using state-of-the-art methodologies, we show a method for matching the vibrational response of two guitar top plates made with slightly different materials. To validate our method, we build two guitar soundboards: one serving as a reference and the second acting as a copy to which we apply model-predicted geometry variations. The results are twofold. Firstly, we can experimentally validate the predictive capabilities of our numerical model regarding geometry changes. Secondly, we can significantly reduce the deviation between the two plates by these precisely predicted geometry variations. Although applied to guitars here, the methodology can be extended to other instruments, e.g. violins, in a similar fashion. The implications of such a methodology for the craft could be far-reaching by turning instrument-making more into a science than artistic craftsmanship and paving the way to accurately copy historical instruments of a high value.

Excretion kinetics of 1,3-dichlorobenzene and its urinary metabolites after controlled airborne exposure in human volunteers

The solvent 1,3-dichlorobenzene (1,3-DCB) is formed during thermal decomposition of the initiator 2,4-dichlorobenzoylperoxide in the production of silicone rubber with potential exposure of production workers as shown in previous works. Despite a threshold limit value (MAK value) of 2 ppm in air, there are currently no data about the corresponding internal exposure that would allow for the derivation of a biological limit value. In the present study, we have investigated the absorption of 1,3-DCB and urinary kinetics of its metabolites in 10 human volunteers after controlled inhalative exposure. Due to the strong odour of 1,3-DCB, a subjective evaluation of odour nuisance was also performed. Ten male human volunteers (23-36 yrs.) were exposed 6 h/day to a concentration of 0.7 ppm and 1.5 ppm in the Aachen workplace simulation laboratory (AWSL) with one week between each experiment. In order to investigate potential dermal absorption, the volunteers were exposed to 1.5 ppm wearing a suitable filter mask that prevented inhalative exposure in a third exposure. 1,3-DCB in blood was measured after 3 and 6 h exposure and the urinary metabolites 3,5-dichlorocatechol (3,5-DCC), 2,4-dichlorophenol (2,4-DCP) and 3,5-dichlorophenol (3,5-DCP) were measured over 24 h after exposure via LC/MS/MS. There were clear dose-response relations for all investigated parameters. The maximum excretion of the metabolites was reached at the end of exposure and corresponded to 5.2 ± 0.7 mg/g crea, 1.5 ± 0.35 mg/g crea and 0.07 ± 0.011 mg/g crea at 0.7 ppm and to 12.0 ± 3 mg/g crea, 3.5 ± 1.1 mg/g crea and 0.17 ± 0.05 mg/g crea at 1.5 ppm for 3,5-DCC, 2,4-DCP and 3,5-DCP, respectively. The use of filter masks decreased the internal exposure for about 85-90%, indicating substantial dermal absorption. Odour perception did not show a dose-response, probably due to fast olfactory adaption. The human study presented here provides an excellent basis for deriving a biological limit value for 1,3-DCB.

Lower heart rates and beta-blockers are associated with new-onset atrial fibrillation

Background

Lower heart rates (HRs) prolong diastole, thereby raising filling pressures and wall stress (1,2), slowing myocardial relaxation (3), and increasing central blood pressure via superposition of reflected peripheral pressure waves onto systole (2,4). As a result, lower HRs may be associated with higher brain natriuretic peptide (BNP) levels and incident atrial fibrillation (AF). Beta-blockers (BBs) may thereby increase the risk for AF.

Purpose

Examine the relationships of HR, BNP, BB use and new-onset AF in the REVEAL-AF and SPRINT cohort of subjects at risk for developing AF.

Methods

In REVEAL-AF, 383 subjects (52% male, mean age 71.5±9.8 years) without a history of AF and a mean CHA2DS2VASC score of 4.4±1.3 received an insertable cardiac monitor and were followed up to 30 months. Baseline HRs were averaged between 8AM and 8PM for the first week post-implantation. Adjudicated AF lasting ≥6 minutes was defined as new-onset AF.

In SPRINT, 7595 patients (64% male, mean age 67.5±9.2 years) without prior history of AF and a mean CHA2DS2VASC score of 2.3±1.2 were followed for up to 60 months. Baseline average HR was derived from three seated measurements taken at the initial clinical visit. 12-lead ECG at baseline, 2 years, 4 years and close-out visit were used to determine presence of AF. Based on longitudinal medication inventories BB use was categorized into “on BB” vs “never on BB” for the duration of the trial.

Results

The median daytime HR in the REVEAL-AF cohort was 75bpm [interquartile range, IQR 68–83]. Subjects with below median HRs had 2.4-fold higher BNP levels when compared to subjects with above median HRs (median BNP [IQR]: 62pg/dl [37–112] vs. 26pg/dl [13–53], p&lt;0.001). Below median HRs were associated with a higher incidence of AF: 37% vs. 27%, p=0.047. This was validated in the SPRINT cohort after adjusting for AF risk factors (age, HR, sex, body mass index, coronary artery disease, intensive vs standard blood pressure therapy, chronic kidney disease). Both a HR&lt;75bpm and BB use were independently associated with a higher rate of AF: 1.9 vs 0.7%, p&lt;0.001 and 2.5% vs. 0.6%, p&lt;0.001, respectively. The hazard ratio for patients on BB to develop AF was 3.72 [CI 2.32, 5.96], p&lt;0.001.

Conclusion

Lower HRs and BB use are associated with higher BNP levels and incident AF, supporting the hypothesis that lower HRs mimic and/or exacerbate the hemodynamic effects of diastolic dysfunction and promote atrial myopathy. The effects of BBs on clinical outcomes in patient populations outside the context of heart failure with reduced ejection fraction will need to be reassessed.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health

An entirely reverse-engineered finite element model of a classical guitar in comparison with experimental data

The classical guitar is a popular string instrument in which the sound results from a coupled mechanical process. The oscillation of the plucked strings is transferred through the bridge to the body, which acts as an amplifier to radiate the sound. In this contribution, a procedure to create a numerical finite element (FE) model of a classical guitar with the help of experimental data is presented. The geometry of the guitar is reverse-engineered from computed tomography scans to a very high level of detail, and care is taken in including all necessary physical influences. All of the five different types of wood used in the guitar are modeled with their corresponding orthotropic material characteristics, and the fluid-structure interaction between the guitar body and the enclosed air is taken into account by discretizing the air volume inside the guitar with FEs in addition to the discretization of the structural parts. Besides the numerical model, an experimental setup is proposed to identify the modal parameters of a guitar. The procedure concludes with determining reasonable material properties for the numerical model using experimental data. The quality of the resulting model is demonstrated by comparing the numerically calculated and experimentally identified modal parameters.

Combining ACL Reconstruction and Refixation: the Single Anteromedial Bundle Biological Augmentation and Refixation (SAMBBAR) Technique

PURPOSE OF THE STUDY Anterior cruciate ligament (ACL) preservation surgical techniques have been rising lately. In the acute setting, proximal ACL tears and femoral avulsions of the ACL are good indications for primary repair of the ACL. However, literature shows a wide range of failure rates. An intact synovial membrane seems to be a predicational factor for the outcome of primary ACL repair. Disruption of the synovial membrane is associated with higher failure rates. We describe a surgical technique repairing the ACL in combination with a semitendinosus augmentation for proximal ACL tears with or without disruption of the synovial membrane. MATERIAL AND METHODS The procedure preserves as much of the original anatomy as possible by repairing the synovial membrane and ACL remnant to the femoral origin. To accomplish this, we have built on the so-called "Single Anteromedial Bundle Biological Augmentation (SAMBBA) technique" and developed it further to the "Single Anteromedial Bundle Biological Augmentation and Refixation (SAMBBAR) technique", which we firstly describe here. RESULTS All three patients treated with the SAMBBAR technique showed very good short-term clinical outcomes comparable with successful standard ACL reconstruction. There were no complications. Twelve months postoperatively, patients had no pain. They had normal range of motion in the affected knee without any signs of instability. DISCUSSION The SAMBBAR technique seems to be an adequate procedure to preserve as much proprioceptive native tissue as possible, while at the same time ensuring high tissue strength in order to reduce failure rates. Prospective randomized controlled trials are needed to compare the new SAMBBAR technique with standard ACL reconstruction, with the original SAMBBA technique, and with techniques of ACL refixation. CONCLUSIONS With the presented surgical procedure, it is possible to perform a standard ACL reconstruction using an autologous semitendinosus graft and at the same time preserving the tissue remnant of the ACL in all proximal tear patterns. This might contribute to improved proprioception and rehabilitation without sacrificing stability. Key words: anterior cruciate ligament, Lachman test, Ligamys, knee instability, semitendinosus tendon.

Metabolic activation and toxicological evaluation of polychlorinated biphenyls in Drosophila melanogaster

Degradation of polychlorinated biphenyls (PCBs) is initiated by cytochrome P450 (CYP) enzymes and includes PCB oxidation to OH-metabolites, which often display a higher toxicity than their parental compounds. In search of an animal model reflecting PCB metabolism and toxicity, we tested Drosophila melanogaster, a well-known model system for genetics and human disease. Feeding Drosophila with lower chlorinated (LC) PCB congeners 28, 52 or 101 resulted in the detection of a human-like pattern of respective OH-metabolites in fly lysates. Feeding flies high PCB 28 concentrations caused lethality. Thus we silenced selected CYPs via RNA interference and analyzed the effect on PCB 28-derived metabolite formation by assaying 3-OH-2',4,4'-trichlorobiphenyl (3-OHCB 28) and 3'-OH-4',4,6'-trichlorobiphenyl (3'-OHCB 28) in fly lysates. We identified several drosophila CYPs (dCYPs) whose knockdown reduced PCB 28-derived OH-metabolites and suppressed PCB 28 induced lethality including dCYP1A2. Following in vitro analysis using a liver-like CYP-cocktail, containing human orthologues of dCYP1A2, we confirm human CYP1A2 as a PCB 28 metabolizing enzyme. PCB 28-induced mortality in flies was accompanied by locomotor impairment, a common phenotype of neurodegenerative disorders. Along this line, we show PCB 28-initiated caspase activation in differentiated fly neurons. This suggested the loss of neurons through apoptosis. Our findings in flies are congruent with observation in human exposed to high PCB levels. In plasma samples of PCB exposed humans, levels of the neurofilament light chain increase after LC-PCB exposure, indicating neuronal damage. In summary our findings demonstrate parallels between Drosophila and the human systems with respect to CYP mediated metabolism and PCB mediated neurotoxicity.

Are all CHA2DS2-VASc risk factors created equal? An assessment of stroke risk among 34,470 patients with CHA2DS2-VASc scores of 1 or 2

Introduction

The CHA2DS2-VASc score is commonly used to assess ischemic stroke risk in patients with documented atrial fibrillation (AF). Whether each combination of CHA2DS2-VASc score 1 or 2 confers a similar stroke risk is poorly understood.

Methods

A de-identified database of aggregated electronic health record (EHR) data from 2007–2017 was used to identify patients not on oral anticoagulation (OAC) who had documented AF and CHA2DS2-VASc scores of 1 or 2. CHA2DS2-VASc=1 groups included patients with only heart failure, hypertension, age 65–74, diabetes, vascular disease or female gender. The 17 possible permutations of CHA2DS2-VASc =2 scores were consolidated into 6 groups: prior stroke/TIA, age &gt;75, 2 co-morbidities, 1 co-morbidity + age 65–74, 1 co-morbidity + female gender, or age 65–74 + female gender. Stroke risk hazard ratios were computed for each of these groups.

Results

A total of 34,470 patients (61.0±12.0 years, 67.3% male) not on OAC with a documented history of AF and CHA2DS2-VASc scores of 1 (n=16,572) or 2 (n=17,898) were identified. The annual risks of ischemic stroke among CHA2DS2-VASc 1 and 2 patients were 0.22% [0.18–0.26] and 0.38% [0.33–0.43], respectively. For CHA2DS2-VASc =1 patients, age 65–74 conferred a greater risk of stroke while female gender conferred a lower risk. For CHA2DS2-VASc =2 patients, prior stroke/TIA conferred a greater risk of stroke while 1 co-morbidity + female gender conferred a lower risk [Figure].

Conclusion

Ischemic stroke risk varies significantly across specific risk factors in patients with CHA2DS2-VASc scores =1 or 2. Therefore, OAC decisions in these patients should consider individual risk factors rather than the aggregate score alone.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Medtronic

Zehn Jahre Hautkrebsscreening in Deutschland – Leuchtturmfunktion, Probleme und Verbesserungsansätze – Daten einer großen Hautarztpraxis

Von 2008 – 2018 wurden ca. 40 000 Hautkrebsscreenings durchgeführt und die Daten analysiert.

Es zeigte sich zum einen eine hochsignifikant steigende Zunahme von epithelialen malignen Tumoren um mehr als das Doppelte zwischen 2009 – 2018. Bei Patienten des gesetzlichen Hautkrebsscreenings konnte bei jedem 10. Patienten „weißer Hautkrebs“ diagnostiziert werden, 1,2 % der Patienten litten unter einem malignen Melanom, wobei 50 % davon in situ waren. Eine statistische Analyse der dysplastischen Nävi erbrachte eine höchst signifikante Differenz zwischen Patienten des gesetzlichen Screenings (54,2 Jahre) und Patienten unter 35 Jahren (23,4 Jahre). Die jüngere Patientengruppe (< 35 Jahre) wies fast doppelt so häufig histologisch nachgewiesene dysplastische Nävi als die Patienten des gesetzlichen Screenings (> 35 Jahre) auf. Dies könnte ein früheres Screening ab 20 Jahren befürworten, um mögliche Risikogruppen rechtzeitig zu identifizieren. Die Senkung der Melanommortalität als einziger Erfolgsparameter ist allerdings kritisch zu hinterfragen.

Trends in fracture development of the upper extremity in Germany-a population-based description of the past 15 years

Background

Recent studies investigating fracture development in Germany are not available especially with regard to demographic change. The primary aim of this study was to report trends in fracture development of the upper extremity in Germany between 2002 and 2017 and to evaluate changes over time.

Methods

Evaluating inpatient data from the German National Hospital Discharge Registry (International Classification of Diseases, ICD-10) between 2002 and 2017. Total count, incidences and percentage changes of the following fracture localizations were analysed: proximal humerus, distal humerus, proximal ulna, proximal radius, ulna diaphysis (including Monteggia lesion) and distal radius. Ten age groups for men and women were formed: 35–44, 45–54, 55–64, 65–74; 75–84; 85–90, and > 90 (years).

Results

The total count of proximal humeral fractures increased from 40,839 (2002, men/women 9967/30,872) to 59,545 (2017, men/women 14,484/45,061). Distal humeral fractures increased from 5912 (2002, men/women 1559/4353) to 6493 (2017, men/women1840/4653). The total count of forearm fractures increased from 68,636 (2002, men/women 17,186/51,450) to 89,040 (2017, men/women 20,185/68,855). Women were affected in 70–75% of all cases with rising incidences among nearly every age group in female patients.

Conclusion

Total count of nearly every evaluated fracture increased. Also, incidences increased especially in the older female age groups. Fracture development already seems to reflect demographic changes in Germany.

Sporting activity is reduced following medial reefing performed for patellar dislocation : A retrospective case series of 144 patients with a minimum follow-up of 24 months

Background

Patellar dislocation is common in young and active patients. The purpose of this study was to determine sporting activity following the medial reefing of patellar dislocation.

Methods

One hundred forty-four patients with objective patellar dislocation were treated between 2004 and 2013. Three groups were analyzed retrospectively with a minimum follow-up of 24 months: (1) primary dislocation that was treated with medial reefing without a recurrent dislocation until the day of follow-up (n = 74), (2) primary dislocation that was initially treated with medial reefing but with a recurrent dislocation until the day of follow-up (n = 44), and (3) medial reefing after failed conservative treatment (n = 26). Sporting activity was assessed using a widely-used sporting activity questionnaire and the Tegner score prior to the injury and at the follow-up (58.7 ± 22.6 months after the injury). Clinical outcomes were assessed using IKDC and Kujala score.

Results

The Kujala score was 94.7 ± 9.3 for Group 1, 84.1 ± 16.6 for Group 2 and 93.4 ± 9.7 for Group 3. IKDC at the time of follow-up was 97.2 ± 9.3 for Group 1, 86.1 ± 14.6 for Group 2 and 95.1 ± 11.1 for Group 3. 91.9% of Group 1 and 92.3% of Group 3 were active in sports prior to their injuries and at the time of the follow-up. In Group 2, sporting activity reduced from 81.8 to 75.0%. In all groups, a shift from high performance to recreational sports was found.

Conclusions

Despite good clinical results, sporting activity was reduced following patellar dislocation treated with medial reefing. Also, a shift from engagement in high- to low-impact sports among the participants was noted.

Spatio-temporal dynamics in maturation and spawning of Patagonian toothfish Dissostichus eleginoides on the sub-Antarctic Kerguelen Plateau

This study investigated maturation and spawning of Patagonian toothfish Dissostichus eleginoides in the Heard Island and McDonald Islands (HIMI) fishery on the Kerguelen Plateau in the Indian Sector of the Southern Ocean based on gonads and otoliths collected between 2004 and 2015 and using histological analyses and calibration of macroscopic staging criteria. Dissostichus eleginoides at HIMI spawn throughout the austral late autumn and winter months of May-August and spawning activity is concentrated on slopes along the west and south of the plateau around HIMI at depths of 1500-1900 m. Comparison between histological analyses and macroscopic gonad staging indicated that many fish that had spawned, as indicated by the presence of post-ovulatory follicles, returned to a resting stage which was macroscopically indistinguishable from maturing fish. Furthermore, the occurrence of females of all size classes with low gonado-somatic index and low macroscopic gonad stage during the spawning season suggested that a proportion of mature females did not spawn every year. Age-at-maturity estimates, based on the assumption that fish of macroscopic stages ≥2 were mature, decreased between the 2004-2009 and 2010-2015 periods for both sexes. The magnitude of this temporal variation in age at maturity, however, varied between gear types and fishing depths and variable sampling regimes probably influenced these variations. This study highlights the importance of correct interpretation of macroscopic gonad stages and understanding the influence of fishery operations on estimations of life-history parameters.

[Retrospective Analysis of Diabetics with Regard to Treatment Duration and Costs]

Background: The increasing incidence of diabetes mellitus is also reflected in the patient population of a trauma and orthopaedic centre. Diabetics also exhibit more comorbidities than non-diabetics. In addition to surgical problems in these patients, hospitalisation is often accompanied by complications, which can prolong treatment and increase costs. The aim of this retrospective study is to analyse hospitalisation of diabetics compared to non-diabetics, as well as differences in treatment costs, depending on associated age and comorbidities. Patients/Material and Methods: 17,185 patients were treated at a transregional trauma and orthopaedic centre and were included in this retrospective analysis between 2012 and 2015. Comorbidities and hospitalisation of diabetics and non-diabetics were recorded. All costs charged by DRG were evaluated to calculate the cost per day and per patient, on the basis of the specific case rate. In this calculation, patient-related case rates were divided by the average residence time and the means of the calculated daily rates were calculated. Inclusion criteria were treatment within the various departments and a minimum hospitalisation of one day. Statistical analysis was performed with the SPSS program (version 22.0, SPSS Inc., Chicago, USA). Results: In comparison to non-diabetics (ND), diabetics (D) exhibited significantly more comorbidities, including: obesity, arterial hypertension, coronary heart disease, myocardial infarction (in the history), peripheral arterial disease, chronic kidney disease and hyperlipidaemia. Pneumonia in hospital was considerably commoner in diabetics (2.45 % [D] vs. 1.02 % [ND], p < 0.001). Time in hospital was significantly longer in diabetics (endoprosthetics 13.52 days [D] vs. 12.54 days [ND], p < 0.001; septic surgery 18.62 days [D] vs. 16.31 days [ND], p = 0.007; traumatology 9.82 days [D] vs. 7.07 days [ND], p < 0.001). For patients aged under 60 years, time in hospital was significantly longer for diabetics than for non-diabetics (9.98 days [D] vs. 6.43 days [ND] p < 0.001). Because of the longer time in hospital, treatment costs were higher by € 1,932,929.42 during the investigated time period. Conclusion: Because of their comorbidities, diabetics need to be categorised at an early stage as high-risk patients in traumatological and orthopaedic departments. Hospitalisation and the associated increased treatment costs, as well as postoperative complications, could be minimised in patients with diabetes by implementing an interdisciplinary treatment concept.

[Malnutrition in Elderly Trauma Patients - Comparison of Two Assessment Tools]

Background: The prevalence of malnutrition in hospitalised patients is reported to be between 16 and 55 % across disciplines. Within hospital care, screening for malnutrition is required. However, in orthopaedics and trauma surgery, there is still no generally accepted recommendation for the methods for such a data survey. In the present study, the following aspects are to be investigated with the help of two established scores: (1) the prevalence of malnutrition in the patient population of geriatric trauma care, and (2) the correlation between methods of data survey. Material and Methods: Between June 2014 and June 2015, a consecutive series of hospitalised trauma patients were studied prospectively with two validated screening instruments to record nutritional status. The study was carried out at a municipal trauma surgery hospital, which is a first level interregional trauma centre as well as a university hospital. The Nutritional Risk Screening (NRS) and the Mini Nutritional Assessment (MNA Short and Long Form) were used. All patients were divided into three age groups: < 65 years, 65-80 years, and > 80 years. The prevalence of malnutrition in geriatric trauma patients and the correlation between the screening instruments were determined. For a better comparison, prescreening and main assessment were applied to all patients. For statistical evaluation, both quantitative and semi-quantitative parameters were used. Furthermore, the Kolmogorov-Smirnov test, Spearman's correlation analysis and the chi-square test were applied. These tests were two-sided and had a level of significance of 5 %. The present study was partially funded by the Oskar-Helene-Heim Foundation. Results: 521 patients (43.8 % women, 56.2 % men), with a mean age of 53.96 ± 18.13 years, were statistically evaluated within the present study. Depending on the method of the data survey, malnutrition (NRS≥3) in geriatric trauma patients varied from 31.3 % (65-80 years) to 60 % (> 80 years). With MNA, 28.8 and 54.3 % of patients were at risk of malnutrition (MNA 17-23.5), while the fractions of patients already suffering from malnutrition (MNA < 17) were 5.4 and 8.6 %, respectively. The correlation between the NRS and MNA total scores increases with the age of the patients. The correlation coefficient for patients under 65 years is r = - 0.380, while among patients aged between 65 and 80, it is r = - 0.481, and for patients over 80 years, there is a medium to strong correlation of r = - 0.638 (each with a Spearman correlation of p < 0.001). For the total population as well as the different age groups, statistically significant correlations were recorded between the categorised scores (chi-square test for linear trend, p < 0.001). Summary: The present study demonstrates high prevalence of malnutrition among the geriatric trauma patients. Because of its easy and rapid application, the NRS has an advantage in clinical use. It was shown that the two methods of data survey were highly correlated.

Relative in vitro growth rates of duckweeds (Lemnaceae) - the most rapidly growing higher plants

Relative growth rates (RGR), doubling times (DT) and relative weekly yields (RY) of 39 clones (ecotypes) from 13 species representing all five genera of duckweeds were determined under standardised cultivation conditions. RGR ranged overall from 0.153 to 0.519 day(-1) , DT from 1.34 to 4.54 days and RY from 2.9 to 37.8 week(-1) . The RGR and RY data can be compared directly to other published findings to only a limited extent on account of missing clonal designations for and limited accessibility to previously investigated clones, as well as the use of different data denominators. However, they are consistent with the published results of other comparative duckweed studies of similar scope in showing that RGR does not vary primarily at the level of the genus or species, but rather reflects the adaptation of individual clones to specific local conditions. The RGR data support the widely held assumption that duckweeds can grow faster than other higher plants and that they can thus surpass land-based agricultural crops in productivity. Duckweeds are highly promising for the production of biomass for nutrition and energy, but extensive clonal comparison will be required to identify the most suitable isolates for this purpose.

Low-molecular weight carbohydrates modulate dormancy and are required for post-germination growth in turions of Spirodela polyrhiza

The aquatic duckweed Spirodela polyrhiza propagates itself vegetatively by forming turions - bud-like perennation organs - in the autumn, which spend the winter on the bottom of ponds and then germinate in the following spring and proliferate on the water surface. Newly formed turions usually require a period of cold after-ripening and light to germinate effectively, but an ample supply of exogenous sugar can lead to germination even in the dark and independent of after-ripening. The results of the present study indicate that the availability of readily metabolised carbohydrates is a determining factor for turion germination. Freshly harvested turions do not contain soluble, low-molecular weight carbohydrates at a level sufficient to allow germination to take place, but after-ripened turions do. Augmentation of the soluble carbohydrate content during after-ripening derives from gradual breakdown of reserve starch of the turions. The long time required for any germination to be observed in turions incubated in darkness and the limited frequency of germination in the dark (about 50% of turion population), even with an ample external sugar, supply emphasise that both after-ripening and light are essential for ensuring rapid germination and subsequent frond proliferation at an ecologically appropriate time. The carbohydrate supply required for rapid proliferation of the fronds produced at germination is provided by the rapid light-induced breakdown of turion reserve starch.

Smartphone-assisted guide for the placement of ventricular catheters

OBJECTIVE

Freehand placement of ventricular catheters (VC) is reported to be inaccurate in 10-40 %. Endoscopy, ultrasound, or neuronavigation are used in selected cases with significant technical and time-consuming efforts. We suggest a smartphone-assisted guiding tool for the placement of VC.

METHODS

Measurements of relevant parameters in 3D-MRI datasets in a patient cohort with narrow ventricles for a frontal precoronal VC placement were performed. In this context, a guiding tool was developed to apply the respective measures for VC placement. The guiding tool was tested in a phantom followed by CT imaging to quantify placement precision. A smartphone application was designed to assist the relevant measurements. The guide was applied in 35 patients for VC placement.

RESULTS

MRI measurements revealed the rectangular approach in the sagittal plane and the individual angle towards the tangent in the coronal section as relevant parameter for a frontal approach. The latter angle ranged from medial (91.96° ± 2.75°) to lateral margins (99.56° ± 4.14°) of the ventricle, which was similar in laterally shifted (±5 mm) entry points. The subsequently developed guiding tool revealed precision measurements in an agarose model with 1.1° ± 0.7° angle deviation. Using the smartphone-assisted guide in patients with narrow ventricles (frontal occipital horn ratio, 0.38 ± 0.05), a primary puncture of the ventricles was possible in all cases. No VC failure was observed during follow-up (9.1 ± 5.3 months).

CONCLUSIONS

VC placement in narrow ventricles requires accurate placement with simple means in an every-case routine. The suggested smartphone-assisted guide meets these criteria. Further data are planned to be collected in a prospective randomized study.

Phosphoproteomic identification of a PDX-1/14-3-3ε interaction in pancreatic beta cells

Glucose-dependent activation of the homeodomain transcription factor PDX-1 leads to its phosphorylation, to an increase in DNA binding capacity, and to NLS dependent translocation into the nucleus. To uncover unknown mediators of PDX-1 activation, PDX-1 interacting proteins were analysed by pull-down from (32)P-labelled, glucose-stimulated MIN6 cells. Recovered proteins were analysed by 2D gel electrophoresis and mass spectrometry. We identified 14-3-3ε as a novel PDX-1 binding protein and confirmed the interaction in vivo by Fluorescence Resonance Energy Transfer (FRET) analysis. We propose that 14-3-3ε interacts directly with PDX-1 to regulate its cellular distribution in pancreatic beta cells.

Spatial distribution of risk factors for Cryptosporidium spp. transport in an Irish catchment

Cryptosporidium spp. has become a major public health concern in many parts of the globe, including Ireland, as a result of recent reported waterborne outbreaks of Cryptosporidiosis. Continuous monitoring of Cryptosporidium spp. in water supplies is not feasible, so a risk-forecasting approach is required. This study reports a globally applicable approach for evaluating the spatial variation in relative risk of contaminating surface water by Cryptosporidium spp. based on a risk potential index (RPI) as an indicator of the potential pollution of surface water. The RPI is predicted by readily available data on land use, rainfall, soil type, slope, soil moisture deficit, and distance from water course. A small catchment in County Meath, Ireland, was chosen to illustrate the analysis of the approach. Data for the study area were digitized and rectified using surveyed ground control points to capture each of the RPI factors, field boundaries, and land use. The six parameters were classified and assigned a relative risk score out of 5. A Geographic Information Systems overlay analysis then was used to calculate a cumulative relative risk score for each month of the year. The analysis indicated that April and June experienced a relatively low risk of Cryptosporidium spp. transport compared with other months of the year. June had the least risk, because more than 98% of the catchment was estimated to be of low or moderate risk (RPI ranges = 0 to 2). December had the highest risk of Cryptosporidium spp. transport, because approximately 20% of the catchment area had a moderately high to very high risk (RPI ranges = 2 to 5). The study also made an attempt to reduce the risk of contaminating surface water by alternative land-use practice and relocating the field boundaries. The study demonstrated a semi-quantitative and readily implemented method for using spatial risk assessment for planning land management to reduce the risk of surface water contamination by Cryptosporidium spp. from agricultural sources. The approach could be used in any catchment with similar hydrological characteristics subject to a surface water pathogen contamination risk from grazing livestock.

Human T cell development and HIV infection in human hemato-lymphoid system mice

Advances in generation of mice that on human hematopoietic stem and progenitor cell transplantation develop and maintain human hemato-lymphoid cells have fueled an already thriving field of research. We focus here on human T cell development and HIV infection in Rag2 -/- gamma(c) -/- mice transplanted as newborns with human CD34+ cord blood hematopoietic stem and progenitor cells.

Crystal structure of pentabismuth heptaoxide nitrate, Bi5O7NO3

Bi5NO10, monoclinic, P121/c1 (no. 14), a = 8.5846(6) Å, b = 23.385(2) Å, c = 5.5422(4) Å, β = 108.103(8)°, V = 1057.5 Å3, Z = 4, Rgt(F) = 0.029, wRref(F2) = 0.074, T = 210 K.

Predictors of children's body mass index: a longitudinal study of diet and growth in children aged 2–8 y

OBJECTIVE

To identify longitudinal variables related to children's body mass index (BMI) (kg/m(2)) at age 8 y.

DESIGN

A longitudinal design, with nine interviews per child from ages 2 to 8 y.

SUBJECTS

In all, 70 white children (37 males, 33 females) who were continuous participants since infancy in the longitudinal study. Families were primarily middle and upper socioeconomic status.

MEASUREMENTS

At each interview, children's height and weight were measured, and mothers provided 3 days of the child's intake data (a 24-h recall and 2 days of food records).

ANALYSES

Analyses used were means+/-s.d., correlations, repeated measures analysis of variance, and forward stepwise regression. BMI at each interview was calculated and age of adiposity rebound was determined.

RESULTS

Children's BMI at 8 y was negatively predicted by age of adiposity rebound and positively predicted by their BMI at 2 y. Additionally, each model included one longitudinal dietary variable; mean protein and fat intakes recorded between 2 and 8 y were positive predictors of BMI at 8 y; mean carbohydrate intake over the same time period was negatively related to BMI at 8 y. R(2) values indicated that these three-variable models predicted 41-43% of the variability in BMI among children. BMI of 23% of the children exceeded the 85th CDC percentile.

CONCLUSIONS

The results of this study show that factors in early life are associated with children's BMI at age 8 y.