Terbium-149 production: a focus on yield and quality improvement towards preclinical application

Terbium-149 (T1/2 = 4.1 h, Eα = 3.98 MeV (16.7%), 28 µm range in tissue) is a radionuclide with potential for targeted alpha therapy. Due to the negligible emission of α-emitting daughter nuclides, toxicity to healthy tissue may be reduced in comparison with other α-particle emitters. In this study, terbium-149 was produced via 1.4 GeV proton irradiation of a tantalum target at the CERN-ISOLDE facility. The spallation products were mass separated and implanted on zinc-coated foils and, later, radiochemically processed. Terbium-149 was separated from the co-produced isobaric radioisotopes and the zinc coating from the implantation foil, using cation-exchange and extraction chromatographic techniques, respectively. At the end of separation, up to 260 MBq terbium-149 were obtained with > 99% radionuclidic purity. Radiolabeling experiments were performed with DOTATATE, achieving 50 MBq/nmol apparent molar activity with radiochemical purity > 99%. The chemical purity was determined by inductively coupled plasma-mass spectrometry measurements, which showed lead, copper, iron and zinc only at ppb level. The radiolabeling of the somatostatin analogue DOTATATE with [149Tb]TbCl3 and the subsequent in vivo PET/CT scans conducted in xenografted mice, showing good tumor uptake, further demonstrated product quality and its ability to be used in a preclinical setting.

How short-range adhesion slows down crack closure and contact formation

While viscoelastic, adhesive contact rupture of simple indenters is well studied, contact formation has received much less attention. Here, we present simulations of the formation of contact between various power law indenters and an adhesive, viscoelastic foundation. For all investigated indenters, we find that the macroscopic relaxation time τ scales approximately with 1/ρ1.8, where ρ is the range of adhesion. The prolongation of contact formation with Tabor parameter is rationalized by the increased dissipation that short-range adhesion causes on a moving crack.

Chemodiversity in flowers of Tanacetum vulgare has consequences on a florivorous beetle

The chemical composition of plant individuals can vary, leading to high intraspecific chemodiversity. Diversity of floral chemistry may impact the responses of flower-feeding insects. Tanacetum vulgare plants vary significantly in their leaf terpenoid composition, forming distinct chemotypes. We investigated the composition of terpenoids and nutrients of flower heads and pollen in plants belonging to three chemotypes - dominated either by β-thujone (BThu), artemisia ketone (Keto) or a mixture of (Z)-myroxide, santolina triene, and artemisyl acetate (Myrox) - using different analytical platforms. We tested the effects of these differences on preferences, weight gain and performance of adults of the shining flower beetle, Olibrus aeneus. The terpenoid composition and diversity of flower heads and pollen significantly differed among individuals belonging to the above chemotypes, while total concentrations of pollen terpenoids, sugars, amino acids, and lipids did not differ. Beetles preferred BThu over the Myrox chemotype in both olfactory and contact choice assays, while the Keto chemotype was marginally repellent according to olfactory assays. The beetles gained the least weight within 48 h and their initial mortality was highest when feeding exclusively on floral tissues of the Myrox chemotype. Short-term weight gain and long-term performance were highest when feeding on the BThu chemotype. In conclusion, the beetles showed chemotype-specific responses towards different T. vulgare chemotypes, which may be attributed to the terpenoid composition in flower heads and pollen rather than to differences in nutrient profiles. Both richness and overall diversity are important factors when determining chemodiversity of individual plants and their consequences on interacting insects.

The effect of mycophenolate mofetil on podocytes in nephrotoxic serum nephritis

Mycophenolate mofetil (MMF) is applied in proteinuric kidney diseases, but the exact mechanism of its effect on podocytes is still unknown. Our previous in vitro experiments suggested that MMF can ameliorate podocyte damage via restoration of the Ca2+-actin cytoskeleton axis. The goal of this study was to characterize podocyte biology during MMF treatment in nephrotoxic serum (NTS) nephritis (NTN). NTN was induced in three-week old wild-type mice. On day 3, half of the mice were treated with MMF (100 mg/kgBW/d p.o.) for one week. On day 10, we performed proteomic analysis of glomeruli as well as super-resolution imaging of the slit diaphragm. For multiphoton imaging of Ca2+ concentration ([Ca2+]i), the experimental design was repeated in mice expressing podocyte-specific Ca2+ sensor. MMF ameliorated the proteinuria and crescent formation induced by NTS. We identified significant changes in the abundance of proteins involved in Ca2+ signaling and actin cytoskeleton regulation, which was further confirmed by direct [Ca2+]i imaging in podocytes showing decreased Ca2+ levels after MMF treatment. This was associated with a tendency to restoration of podocyte foot process structure. Here, we provide evidence that MPA has a substantial direct effect on podocytes. MMF contributes to improvement of [Ca2+]i and amelioration of the disorganized actin cytoskeleton in podocytes. These data extend the knowledge of direct effects of immunosuppressants on podocytes that may contribute to a more effective treatment of proteinuric glomerulopathies with the least possible side effects.

C/EBPβ-LIP mediated activation of the malate-aspartate shuttle sensitizes cells to glycolysis inhibition

OBJECTIVE

Cancer cells use glycolysis for generation of metabolic intermediates and ATP needed for cell growth and proliferation. The transcription factor C/EBPβ-LIP stimulates glycolysis and mitochondrial respiration in cancer cells. We initially observed that high expression of C/EBPβ-LIP makes cells vulnerable to treatment with the glycolysis inhibitor 2-deoxyglucose. The aim of the study was to uncover the involved mechanisms of C/EBPβ-LIP induced sensitivity to glycolysis inhibition.

METHODS

We used genetically engineered cell lines to examine the effect of C/EBPβ-LIP and -LAP protein isoforms on glycolysis and NADH/NAD⁺ metabolism in mouse embryonic fibroblasts (MEFs), and triple negative breast cancer (TNBC) cells that endogenously express high levels of C/EBPβ-LIP. Analyses included assays of cell proliferation, cell survival and metabolic flux (OCR and ECAR by Seahorse XF96). Small molecule inhibitors were used to identify underlying metabolic pathways that mediate sensitivity to glycolysis inhibition induced by C/EBPβ-LIP.

RESULTS

The transcription factor C/EBPβ-LIP stimulates both glycolysis and the malate-aspartate shuttle (MAS) and increases the sensitivity to glycolysis inhibition (2-deoxyglucose) in fibroblasts and breast cancer cells. Inhibition of glycolysis with ongoing C/EBPβ-LIP-induced MAS activity results in NADH depletion and apoptosis that can be rescued by inhibiting either the MAS or other NAD⁺-regenerating processes.

CONCLUSION

This study indicates that a low NADH/NAD+ ratio is an essential mediator of 2-deoxyglucose toxicity in cells with high cytoplasmic NAD⁺-regeneration capacity and that simultaneous inhibition of glycolysis and lowering of the NADH/NAD⁺ ratio may be considered to treat cancer.

Noncovalent Interactions in Halogenated Pyridinium Salts of the Weakly Coordinating Anion [Al(OTeF5 )4 ]. Chemistry 2023;29:e202202749. [PMID: 36268910 PMCID: PMC10107151 DOI: 10.1002/chem.202202749]

The synthesis and the first structural characterization of the halogenated pyridinium salts [C₅ F₅ NH]⁺ , [C₅ F₄ ClNH]⁺ , [(C₅ F₅ N)₂ H]⁺ , [(C₅ Cl₅ N)₂ H]⁺ of the weakly coordinating anion (WCA) [Al(OTeF₅ )₄ ]^- , showing noncovalent interactions in the solid state, are presented. The salts were characterized by the multinuclear NMR and IR spectroscopy as well as X-ray diffraction. Hirshfeld surface analysis and solid state structures reveal various intermolecular anion-π and σ-hole interactions between the corresponding halogenated pyridinium cations and the anion [Al(OTeF₅ )₄ ]^- .

Co-application of biochar and compost with decreased N fertilizer reduced annual ammonia emissions in wetland rice

Ammonia (NH3) emission from rice fields is a dominant nitrogen (N) loss pathway causing negative impacts on farm profitability and the environment. Reducing N fertilizer application to compensate for N inputs in organic amendments was evaluated for effects on N loss via volatilization, rice yields and post-harvest soil properties in an annual irrigated rice (Boro) – pre-monsoon rice (Aus) – monsoon (Aman) rice sequence. That experiment was conducted using the integrated plant nutrition system (IPNS; nutrient contents in organic amendments were subtracted from the full recommended fertilizer dose i.e., RD of chemical fertilizers) where six treatments with four replications were applied in each season: (T1) no fertilizer (control), (T2) RD, (T3) poultry manure biochar (3 t ha−1; pyrolyzed at 450°C) + decreased dose of recommended fertilizer (DRD), (T4) rice husk ash (3 t ha−1) + DRD, (T5) compost (3 t ha−1) + DRD, and (T6) compost (1.5 t ha−1)+ biochar (1.5 t ha−1) + DRD. The N loss via volatilization varied twofold among seasons being 16% in irrigated rice and 29% in the pre-monsoon rice crop. In irrigated rice, T6 had significantly lower NH3 emissions than all other treatments, except the control while in pre-monsoon and monsoon seasons, T6 and T3 were alike. Pooling the three seasons together, biochar (T3) or biochar plus compost (T6) reduced NH3 loss via volatilization by 36-37% while compost alone (T5) reduced NH3 loss by 23% relative to RD. Biochar (T3) and biochar plus compost mixture (T6) reduced yield-scaled NH3 emissions by 40 and 47% relative to the RD of chemical fertilizer (T2). The organic amendments with IPNS reduced the quantity of N fertilizer application by 65, 7, 24, and 45% in T3, T4, T5, and T6 treatments, respectively, while rice yields and soil chemical properties in all seasons were similar to the RD. This study suggests that incorporation of biochar alone or co-applied with compost and decrease of N fertilizer on an IPNS basis in rice-based cropping systems can reduce N application rates and NH3 emissions without harming yield or soil quality.

Newbornscreening SMA - From Pilot Project to Nationwide Screening in Germany

Now that targeted therapies for spinal muscular atrophy are available, attempts are being made worldwide to include screening for spinal muscular atrophy in general newborn screening. In Germany, after pilot projects from 2018-2021, it was included in the general newborn screening from October 2021. To ensure a smooth transition, criteria for follow-up were developed together with key stakeholders. At the beginning of the transition to nationwide screening, false positive findings were reported in 3 patients. After optimization of the screening method in the laboratories concerned, all findings have been subsequently confirmed. On average, the first presentation to a neuromuscular center occurred on day 12 of life, and in patients with 2 or 3 SMN2 copies, therapy started on day 26 of life. Compared with the pilot project, there was no significant delay in timing.

Usage of a graph database for the selection of sterile items in the OR

Purpose

In this work, we present a subsystem of a robotic circulating nurse, that produces recommendations for the next supplied sterile item based on incomplete requests from the sterile OR staff, the current situation, predefined knowledge and experience from previous surgeries. We describe a structure to store and query the underlying information in terms of entities and their relationships of varying strength.

Methods

For the implementation, the graph database Neo4j is used as a core component together with its querying language Cypher. We outline a specific structure of nodes and relationships, i.e., a graph. Primarily, it allows to represent entities like surgeons, surgery types and items, as well as their complex interconnectivity. In addition, it enables to match given situations and partial requests in the OR with corresponding subgraphs. The subgraphs provide suitable sterile items and allow to prioritize them according to their utilization frequency.

Results

The graph database was populated with existing data from 854 surgeries describing the intraoperative use of sterile items. A test scenario is evaluated in which a request for “Prolene” is made during a cholecystectomy. The software identifies a specific “Prolene” suture material as the most probable requested sterile item, because of its utilization frequency from over 95%. Other “Prolene” suture materials were used in less than 15% of the cholecystectomies.

Conclusion

We have proposed a graph database for the selection of sterile items in the operating room. The example shows how the partial information from different sources can be easily integrated in a query, leading to an unique result. Eventually, we propose possible enhancements to further improve the quality of the recommendations. In the next step, the recommendations of the software will be evaluated in real time during surgeries.

Determinants influencing municipal decision-makers in Germany regarding community health promotion

Background

Community health promotion should be based on theoretical behavioural and environmental approaches. Especially changes in the physical environment require administrative and political decisions. This study aims to identify determinants that influence decision-makers from local politics and administrations on decisions so that health promotion can be placed on the agenda of communities as a prerequisite of intervention implementation.

Methods

We used the methods of qualitative guided interviews and a quantitative survey. First, decision-makers from local politics and administrations in both urban and rural areas in Germany were interviewed in the period from July to November 2020. The interviews were analysed using qualitative content analysis according to Kuckartz and MAXQDA. Second, a nationwide online survey was conducted using Limesurvey. We used descriptive analyses. In both surveys, decision-makers reported the determinants for decision-making processes and their decision-making behaviour.

Results

22 interviews were conducted (women n = 7), and 415 participants (women n = 118) responded to the online survey. The decision-making behaviour of local decision-makers can be differentiated on different levels, following socio-ecological models: individual, socio-cultural, institutional, municipal and political. Each of these levels comprises a multitude of determinants that are essential for successful persuasion toward community health promotion. At the individual level, we identified determinants like attitudes, outcome expectations or emotions towards a topic.

Conclusions

The identification and understanding of determinants for local decision-making are essential for a tailored and theory-based intervention approach to place health promotion on the agenda of communities and to implement interventions. Further research is needed to replicate the importance of potential determinants and to develop effective intervention methods and techniques.

Key messages

Statistik zwischen Data Science, Artificial Intelligence und Big Data: Beiträge aus dem Kolloquium „Make Statistics great again“

Die Statistik als fachliche Disziplin muss sich in einem rasch wandelnden Umfeld behaupten, das durch den Aufstieg der Data Science, den Bedeutungszuwachs der künstlichen Intelligenz sowie neue Datenstrukturen charakterisiert wird. Wie kann sich die Statistik hier behaupten oder verlorenes Terrain wiedergewinnen? Unter dem provokanten Motto „Make Statistics great again“ wurden aus verschiedenen Blickwinkeln Entwicklungen, Strategien und positive Beispiele skizziert, wie sich das Fach Statistik an der Universität, im Wissenschaftsbetrieb und auf dem Arbeitsmarkt positionieren sollte. Willi Seidel schaut aus dem Blickwinkel eines Hochschulpräsidenten auf den Ressourcenkampf der Fächer. Christine Müller berichtet über die Initiativen der Dachorganisation DAGStat die vielen Teildisziplinen der Statistik wirkungsvoll im Wissenschaftsbetrieb und in der Öffentlichkeit zu positionieren. Florian Meinfelder dokumentiert den Aufstieg des Masterstudiengangs in Survey Statistik zu einem der nachgefragtesten Studiengänge der Uni Bamberg. Jürgen Chlumsky und Markus Zwick beleuchten die historische Wahrnehmung der Amtsstatistik bei Pflichterhebungen und die Entwicklung der Forschungsdatenzentren sowie moderner Zugänge zu neuen Datenquellen. Joachim Wagner schildert das Verhältnis von Datenproduzenten und Datennutzern aus der Sicht eines unzufriedenen Datennutzers. Schließlich geht es um die Position der Statistik in der Datenwissenschaft. Ist „Data Science“ nur ein neumodisches Wort für Statistik? Ein Konzeptionspapier der Gesellschaft für Informatik (GI) hat zu Positionspapieren der DStatG und der DAGStat geführt, die von Ulrich Rendtel vorgestellt werden.

Das Kolloquium fand anlässlich der Abschiedsvorlesung von Ulrich Rendtel im Juni 2019 am Fachbereich Wirtschaftswissenschaft der Freien Universität statt.

Enhanced C/EBPβ function promotes hypertrophic versus hyperplastic fat tissue growth and prevents steatosis in response to high-fat diet feeding

Chronic obesity is correlated with severe metabolic and cardiovascular diseases as well as with an increased risk for developing cancers. Obesity is usually characterized by fat accumulation in enlarged – hypertrophic – adipocytes that are a source of inflammatory mediators, which promote the development and progression of metabolic disorders. Yet, in certain healthy obese individuals, fat is stored in metabolically more favorable hyperplastic fat tissue that contains an increased number of smaller adipocytes that are less inflamed. In a previous study, we demonstrated that loss of the inhibitory protein-isoform C/EBPβ-LIP and the resulting augmented function of the transactivating isoform C/EBPβ-LAP promotes fat metabolism under normal feeding conditions and expands health- and lifespan in mice. Here, we show that in mice on a high-fat diet, LIP-deficiency results in adipocyte hyperplasia associated with reduced inflammation and metabolic improvements. Furthermore, fat storage in subcutaneous depots is significantly enhanced specifically in LIP-deficient male mice. Our data identify C/EBPβ as a regulator of adipocyte fate in response to increased fat intake, which has major implications for metabolic health and aging.

Herbivore-induced plant volatiles, not natural enemies, mediate a positive indirect interaction between insect herbivores

Many insect herbivores engage in apparent competition whereby two species interact through shared natural enemies. Upon insect attack, plants release volatile blends that attract natural enemies, but whether these volatiles mediate apparent competition between herbivores is not yet known. We investigate the role of volatiles that are emitted by bean plants upon infestation by Acyrthosiphon pisum aphids on the population dynamics and fitness of Sitobion avenae aphids, and on wheat phloem sap metabolites. In a field experiment, the dynamics of S. avenae aphids on wheat were studied by crossing two treatments: exposure of aphid colonies to A. pisum-induced bean volatiles and exclusion of natural enemies. Glasshouse experiments and analyses of primary metabolites in wheat phloem exudates were performed to better understand the results from the field experiment. In the field, bean volatiles did not affect S. avenae dynamics or survival when aphids were exposed to natural enemies. When protected from them, however, volatiles led to larger aphid colonies. In agreement with this observation, in glasshouse experiments, aphid-induced bean volatiles increased the survival of S. avenae aphids on wheat plants, but not on an artificial diet. This suggests that volatiles may benefit S. avenae colonies via metabolic changes in wheat plants, although we did not find any effect on wheat phloem exudate composition. We report a potential case of associational susceptibility whereby plant volatiles weaken the defences of receiving plants, thus leading to increased herbivore performance.

A neuronal mechanism for motivational control of behavior

Acting to achieve goals depends on the ability to motivate specific behaviors based on their predicted consequences given an individual’s internal state. However, the underlying neuronal mechanisms that encode and maintain such specific motivational control of behavior are poorly understood. Here, we used Ca²⁺ imaging and optogenetic manipulations in the basolateral amygdala of freely moving mice performing noncued, self-paced instrumental goal-directed actions to receive and consume rewards. We found that distinct neuronal activity patterns sequentially represent the entire action-consumption behavioral sequence. Whereas action-associated patterns integrated the identity, value, and expectancy of pursued goals, consumption-associated patterns reflected the identity and value of experienced outcomes. Thus, the interplay between these patterns allows the maintenance of specific motivational states necessary to adaptively direct behavior toward prospective rewards.

Jumping Mechanography is a Suitable Complementary Method to Assess Motor Function in Ambulatory Boys with Duchenne Muscular Dystrophy

OBJECTIVE

The number of clinical trials for Duchenne muscular dystrophy (DMD) has increased substantially lately, therefore appropriate clinical instruments are needed to measure disease progression and drug efficacy. Jumping mechanography is a medical diagnostic method for motion analysis, which allows to quantify physical parameters. In this study, we compared mechanography with timed function tests (TFTs).

METHODS

41 ambulatory DMD patients performed a total of 95 chair rising tests (CRT) and a total of 76 single two-legged jumps (S2LJ) on a mechanography ground reaction force platform. The results were correlated with a 6-minute walk test (6MWT) and the time required to run 10 meters, stand up from a supine position, and climb four stairs, all performed in the same setting.

RESULTS

Our measurements show a high correlation between mechanography and the TFTs: S2LJ/10-m run, r = 0.62; CRT/10-m run, r = 0.61; S2LJ/standing up from supine, r = 0.48; CRT/standing up from supine, r = 0.58; S2LJ/climb four stairs, r = 0.55; CRT/climb four stairs, r = 0.51. The correlation between mechanography and the 6MWT was only moderate with r = 0.38 for S2LJ/6MWT and r = 0.39 for CRT/6MWT.

INTERPRETATION

Jumping mechanography is a reliable additional method, which can be used for physical endpoint measurements in clinical trials. We confirmed our assumption, that the method provides additional information concerning performance at movement with higher power output. We suggest using the S2LJ as a first-choice tandem tool combined with the 6MWT. In patients with higher disability, the CRT is an alternative measuring method, because with the progression of the disease this is longer feasible.

Cyclotron production and radiochemical purification of terbium-155 for SPECT imaging

Background

Terbium-155 [T_1/2 = 5.32 d, Eγ = 87 keV (32%) 105 keV (25%)] is an interesting radionuclide suitable for single photon emission computed tomography (SPECT) imaging with potential application in the diagnosis of oncological disease. It shows similar decay characteristics to the clinically established indium-111 and would be a useful substitute for the diagnosis and prospective dosimetry with biomolecules that are afterwards labeled with therapeutic radiolanthanides and pseudo-radiolanthanides, such as lutetium-177 and yttrium-90. Moreover, terbium-155 could form part of the perfect “matched pair” with the therapeutic radionuclide terbium-161, making the concept of true radiotheragnostics a reality. The aim of this study was the investigation of the production of terbium-155 via the ¹⁵⁵Gd(p,n)¹⁵⁵Tb and ¹⁵⁶Gd(p,2n)¹⁵⁵Tb nuclear reactions and its subsequent purification, in order to obtain a final product in quantity and quality sufficient for preclinical application. The ¹⁵⁶Gd(p,2n)¹⁵⁵Tb nuclear reaction was performed with 72 MeV protons (degraded to ~ 23 MeV), while the ¹⁵⁵Gd(p,n)¹⁵⁵Tb reaction was degraded further to ~ 10 MeV, as well as performed at an 18 MeV medical cyclotron, to demonstrate its feasibility of production.

Result

The ¹⁵⁶Gd(p,2n)¹⁵⁵Tb nuclear reaction demonstrated higher production yields of up to 1.7 GBq, however, lower radionuclidic purity when compared to the final product (~ 200 MBq) of the ¹⁵⁵Gd(p,n)¹⁵⁵Tb nuclear reaction. In particular, other radioisotopes of terbium were produced as side products. The radiochemical purification of terbium-155 from the target material was developed to provide up to 1.0 GBq product in a small volume (~ 1 mL 0.05 M HCl), suitable for radiolabeling purposes. The high chemical purity of terbium-155 was proven by radiolabeling experiments at molar activities up to 100 MBq/nmol. SPECT/CT experiments were performed in tumor-bearing mice using [¹⁵⁵Tb]Tb-DOTATOC.

Conclusion

This study demonstrated two possible production routes for high activities of terbium-155 using a cyclotron, indicating that the radionuclide is more accessible than the exclusive mass-separated method previously demonstrated. The developed radiochemical purification of terbium-155 from the target material yielded [¹⁵⁵Tb]TbCl₃ in high chemical purity. As a result, initial cell uptake investigations, as well as SPECT/CT in vivo studies with [¹⁵⁵Tb]Tb-DOTATOC, were successfully performed, indicating that the chemical separation produced a product with suitable quality for preclinical studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41181-021-00153-w.

[Patient transport and networks for use of extracorporeal life support]

Neue Technologien und die kontinuierliche Weiterentwicklung extrakorporaler Unterstützungssysteme haben das Anwendungsspektrum des Extracorporeal Life Support (ECLS) in den letzten Jahren erweitert. Neben dem Einsatz im kardiogenen Schock oder unter Reanimation nehmen die Anfragen zur Übernahme instabiler Patienten aus peripheren Krankenhäusern zu. Durch organisatorische Herausforderungen wie die Etablierung von Netzwerken und ein strukturiertes Teamtraining aller Beteiligten ergibt sich eine rasche Verfügbarkeit des ECLS-Teams, um schnell beim zu versorgenden Patienten einzutreffen.

Obesity and its impact on COVID-19

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has proven a challenge to healthcare systems since its first appearance in late 2019. The global spread and devastating effects of coronavirus disease 2019 (COVID-19) on patients have resulted in countless studies on risk factors and disease progression. Overweight and obesity emerged as one of the major risk factors for developing severe COVID-19. Here we review the biology of coronavirus infections in relation to obesity. In particular, we review literature about the impact of adiposity-related systemic inflammation on the COVID-19 disease severity, involving cytokine, chemokine, leptin, and growth hormone signaling, and we discuss the involvement of hyperactivation of the renin-angiotensin-aldosterone system (RAAS). Due to the sheer number of publications on COVID-19, we cannot be completed, and therefore, we apologize for all the publications that we do not cite.

Primary tumor side is associated with prognosis of colorectal cancer patients with brain metastases

Background

Brain metastases (BM) are a rare complication in colorectal cancer (CRC) patients and associated with an unfavorable survival prognosis. Primary tumor side (PTS) was shown to act as a prognostic and predictive biomarker in several trials including metastatic CRC (mCRC) patients. Here, we aim to investigate whether PTS is also associated with the outcome of CRC patients with BM.

Methods

Patients treated for CRC BM between 1988 and 2017 at an academic care center were included. Right-sided CRC was defined as located in the appendix, cecum and ascending colon and left-sided CRC was defined as located in the descending colon, sigma and rectum.

Results

Two hundred and eighty-one CRC BM patients were available for this analysis with 239/281 patients (85.1%) presenting with a left-sided and 42/281 patients (14.9%) with a right-sided primary CRC. BM-free survival (BMFS) was significantly longer in left-sided compared with right-sided CRC patients (33 versus 20 months, P = 0.009). Overall survival from CRC diagnosis as well as from diagnosis of BM was significantly longer in patients with a left-sided primary (42 versus 25 months, P = 0.002 and 5 versus 4 months, P = 0.005, respectively). In a multivariate analysis including graded prognostic assessment, PTS remained significantly associated with prognosis after BM (hazard ratio 0.65; 95% confidence interval: 0.46-0.92 months, P = 0.0016).

Conclusions

PTS was associated with survival times after the rare event of BM development in CRC patients. Therefore, its prognostic value remains significant even thereafter.

•

Primary tumor side is a relevant and independent prognostic factor in mCRC.

•

Left-sided CRC was associated with a significantly longer BMFS compared with right-sided CRC.

•

OS from initial diagnosis of CRC as well as from BM was significantly longer in patients with left-sided primaries.

[Active hearing implants in chronic otitis media]

In patients with inadequate hearing improvement after tympanoplasty and failure of conventional hearing aid fitting, active hearing implants provide an alternative treatment option. Active middle ear implants function as a vibromechanical bypass of the stiffness and damping effect of a poorly oscillating tympanic membrane and the (reconstructed) ossicular chain. The selection of the hearing system depends on the maximum output levels of the hearing system and the anatomical conditions in mostly multiply operated ears. The development of variable coupling elements for active middle ear implants led to an extension of the indications to include not only purely sensorineural hearing loss but also mixed and conductive hearing loss in patients, as the transducer can now be coupled to the (mobile) stapes or the round window membrane. The article provides an overview of current clinical study results and recommendations on the indications for active hearing implants in patients with chronic otitis media.

Teaching breast ultrasound skills including core-needle biopsies on a phantom enhances undergraduate student's knowledge and learning satisfaction

Purpose

To investigate whether a training program on breast ultrasound skills including core-needle biopsies to undergraduate students can improve medical knowledge and learning satisfaction.

Methods

Medical students attending mandatory classes at the Medical School of the University of Saarland received a supplemental theoretical and hands-on training program on ultrasound (US) breast screening and on US-guided core-needle biopsy using an agar–agar phantom. Experienced breast specialists and ultrasound examiners served as trainers applying Peyton’s 4-step training approach. The students’ theoretical knowledge and hands-on skills were tested before and after the training program, using a multiple-choice questionnaire (MCQ), the Objective Structured Clinical Examination (OSCE) and a student curriculum evaluation.

Results

The MCQ results showed a significant increase of the student’s theoretical knowledge (50.2–75.2%, p < 0.001). After the course, the OSCE showed a mean total of 17.3/20 points (86.5%), confirming the practical implementation of the new skills. The student curriculum evaluation in general was very positive. A total of 16/20 questions were rated between 1.2 and 1.7 (very good) and 3 questions were rated as 2.1 (good).

Conclusion

Undergraduate student’s medical education can be enhanced by teaching breast US skills.

Ultrahigh vacuum packaging and surface cleaning for quantum devices

We describe design, implementation, and performance of an ultra-high vacuum (UHV) package for superconducting qubit chips or other surface sensitive quantum devices. The UHV loading procedure allows for annealing, ultra-violet light irradiation, ion milling, and surface passivation of quantum devices before sealing them into a measurement package. The package retains vacuum during the transfer to cryogenic temperatures by active pumping with a titanium getter layer. We characterize the treatment capabilities of the system and present measurements of flux tunable qubits with an average T₁ = 84 µs and T₂ ^echo=134μs after vacuum-loading these samples into a bottom loading dilution refrigerator in the UHV-package.

Ammonia fluxes and emission factors under an intensively managed wetland rice ecosystem

Nitrogen (N) loss from rice production systems in the form of ammonia (NH₃) can be a significant N loss pathway causing significant economic and environmental costs. Yet, data on NH₃ fluxes in wetland rice ecosystems are still very scarce which limits the accuracy of national and global NH₃ budgets. We measured the NH₃ fluxes in situ in a wetland rice field and estimated emission factors (EF) under two soil management systems (i.e. conventional tillage, CT and strip tillage, ST); two residue retention levels (i.e. 15%, LR and 40% crop residue by height, HR); and three N fertilization rates (i.e. 108, 144 and 180 kg N ha^-1) in two consecutive years (2019 and 2020). The highest NH₃ peaks were observed within the first 3 days after urea application. The mean and cumulative NH₃ fluxes significantly increased with the increases in N fertilization rates and were 18.5% and 18.6% higher in ST than in CT in 2020 but not in 2019. Overall, the highest mean NH₃ fluxes were in 180 kg N ha^-1 coupled with either HR or LR and ST or CT. In 2019, the NH₃ EF was unchanged by any treatments. In 2020, the lower EF was in CT coupled with LR (15%) than all other treatment combinations, where ST with HR showed the highest EF (20%). Likewise, the lowest N rate (108 kg N ha^-1) in ST had the highest NH₃ EF (20%) that was similar to higher N rates (144 and 180 kg N ha^-1) in the same tillage treatment and to 180 kg N ha^-1 in CT. Our results highlight that NH₃ fluxes in rice field particularly the effects of ST correlated with higher soil pH and NH₄⁺ content and lower redox potential. Our results highlight that NH₃ fluxes are a potentially large N loss pathway in wetland rice under conventional and decreased soil disturbance regimes.

Allogeneic expanded adipose-derived stem cells in the treatment of rectovaginal fistulas in Crohn's disease

AIM

Crohn's disease (CD)-related rectovaginal fistulas (RVFs) are rare, challenging to treat and associated with a high morbidity. Due to a significant lack of data, we aimed to analyse the safety and feasibility of allogeneic adipose-derived stem cells (ASCs) in the treatment of CD-related RVF.

METHOD

Four consecutive patients with CD-related RVF underwent treatment with expanded allogeneic ASCs extracted from a healthy donor in a tertiary referral centre in 2019. None of the patients had an intestinal diversion at the time of the treatment. Follow-up was performed 6 months postoperatively.

RESULTS

The median operation time was 45 min with a median hospital stay of 3 days. No intra-operative complications occurred. Three patients (75%) developed recurrent RVF after a median follow-up of 19 days. Two patients required surgical treatment including loose seton drainage due to discharge and pain. One patient developed recurrence of symptoms after 10 days, but refused further surgical therapy. Only one patient (25%) showed healing of the RVF, with re-epithelialization of both the vaginal and rectal opening and absence of clinical symptoms.

CONCLUSION

Expanded allogeneic ASC therapy represents a novel safe treatment option for CD-associated RVF. Although efficacy appears limited, further controlled studies are required to draw robust conclusions.

Infants Diagnosed with Spinal Muscular Atrophy and 4 SMN2 Copies through Newborn Screening - Opportunity or Burden?

Although the value of newborn screening (NBS) for early detection and treatment opportunity in SMA patients is generally accepted, there is still an ongoing discussion about the best strategy in children with 4 and more copies of the SMN2 gene. This gene is known to be the most important but not the only disease modifier.

In our SMA-NBS pilot project in Germany comprising 278,970 infants screened between January 2018 and November 2019 were 38 positive cases with a homozygous SMN1 deletion. 40% of them had 4 or more SMN2 copies. The incidence for homozygous SMN1 deletion was 1 : 7350, which is within the known range of SMA incidence in Germany.

Of the 15 SMA children with 4 SMN2 copies, one child developed physical signs of SMA by the age of 8 months. Reanalysis of the SMN2 copy number by a different test method revealed 3 copies. Two children had affected siblings with SMA Type III, who were diagnosed only after detection of the index patient in the NBS. One had a positive family history with an affected aunt (onset of disease at the age of 3 years). Three families were lost to medical follow up; two because of socioeconomic reasons and one to avoid the psychological stress associated with the appointments.

Decisions on how to handle patients with 4 SMN2 copies are discussed in the light of the experience gathered from our NBS pilot SMA program.

Is Exercise-Induced Fatigue a Problem in Children with Duchenne Muscular Dystrophy?

OBJECTIVE

Duchenne muscular dystrophy (DMD) is a devastating X-linked muscular disorder. The number of studies investigating new therapeutic approaches is substantially increasing. This study aims to investigate the impact and diagnostic value of exercise-induced fatigue in DMD, which has been proposed as a suitable outcome parameter in other conditions like spinal muscular atrophy.

PATIENTS AND METHODS

A cohort of 55 DMD patients (49 of them treated with steroids and 9 with ataluren) underwent a total of 241 6MWT (mean 4.4 tests/patient) which were retrospectively analyzed. Exercise-induced fatigue was assessed by the ratio between the distance achieved in the sixth minute and the distance in the second minute of the 6MWT. In previous studies a quotient above 1 was defined as a sign of fatigue.

RESULTS

The average fatigue quotient in the whole cohort of patients was 1.0. In a further analysis no impact of age, steroid therapy, ataluren therapy, overall disability, and distance in the 6-minute walk test (6MWT) on fatigue in DMD patients could be shown.

CONCLUSION

Our data show that fatigue does not play a relevant role in DMD. Analysis of fatigue is not a useful outcome parameter in DMD studies. For this reason we suggest the 2MWT, which is better accepted by the patients, as an alternative to the commonly 6MWT.

Application of 15N tracing for estimating nitrogen cycle processes in soils of a constructed wetland

Integrated Constructed Wetlands (ICW) area technology for the attenuation of contaminants such as organic carbon (C), nitrogen (N), phosphorous (P) and sulphur (S) in water coming from point or diffuse sources. Currently there is a lack of knowledge on the rates of gross N transformations in soils of the ICW bed leading to losses of reactive N to the environment. In addition, the kinetics of these processes need to be studied thoroughly for the sustainable use of ICW for removal of excessive N in the treatment of waste waters. Gross N transformation processes were quantified at two soil depths (0-15 and 30-45 cm) in the bed of a surface flow ICW using a ¹⁵N tracing approach. The ICW, located in Dunhill village at Waterford in Southeastern Ireland, receives 500 person equivalent waste waters containing large quantities of organic pollutants (ca. mean annual C, N, P and S contents of 240, 60, 5 and 73 mg L^-1). Soil was removed from these depths in December 2014 and incubated anaerobically in the laboratory, with either ¹⁵N labeled ammonium (NH₄⁺) or nitrate (NO₃^-), differentially labeled with ¹⁴NH₄¹⁵NO₃ and ¹⁵NH₄¹⁴NO₃ in parallel setups, enriched to 50 atm% ¹⁵N. Results showed that at both soil depths, NO₃^- production rates were small, which may have resulted in lower NO₃^- reduction by either denitrification or dissimilatory NO₃^- reduction to ammonium (DNRA). However, despite being low, the DNRA rates were greater than denitrification rates. Direct transformation of organic N to NO₃^-, without mineralization to NH₄⁺, was a prevalent pathway of NO₃^- production accounting for 28-33% of the total NO₃^- production. Relative contribution of this process to the total N mineralization was negligible at depth 1 (0.01%) but dominant at depth 2 (99.7%). Total NO₃^-production to total immobilization of NH₄⁺ and NO₃^- was very small (<0.50%) suggesting that ICW soils are not a source of NO₃^-. Despite a large potential of N immobilization existed at both the layers, relative N immobilization to the total N conversion was higher at depth 2 (ca. 2.2) than at depth 1 (ca. 1.5). The NH₄⁺ desorption rate at 30-45 cm was high. However, immobilization in the recalcitrant and labile organic N pools was higher. Mineralization and immobilization of NH₄⁺ processes showed that recalcitrant organic N was the predominant source in ICW soils whereas the labile organic N was comparatively small. Source apportionment of N₂O production showed that the majority of the N₂O produced through denitrification (ca. 92.5%) followed by heterotrophic nitrification (ca. 5.5%), co-denitrification (ca. 1.90%) and nitrification (0.20%). These results revealed that application of a detailed ¹⁵N tracing method can provide insights on the underlying processes of ecosystem based abundances of reactive N. A key finding of this study was that both investigated ICW layers were characterised by large N immobilization which restricts production of NO₃^- and further gaseous N losses.

Qualitative and quantitative muscle ultrasound in patients with Duchenne muscular dystrophy: Where do sonographic changes begin?

OBJECTIVE

The number of studies investigating and understanding the disease mechanisms of Duchenne muscular dystrophy (DMD) in human clinical trials have increased substantially over the last decade. Suitable clinical instruments for the measurement of disease progress and drug efficiency are mandatory, but currently not available, especially in the youngest patients. The aim of this study was to detect a reproducible pattern of muscle involvement in early stages potentially preceding evidence of motor regression.

MATERIAL AND METHODS

A cohort of 25 DMD patients aged 1-6 years at the first presentation were examined at multiple timepoints and compared with age-matched healthy controls. Muscle ultrasound was quantified using computer-analyzed gray scale levels (GSL) and blinded visual rating, using a modified Heckmatt scale.

RESULTS

Changes in muscle echogenicity in DMD patients occurred very early, clearly preceding motor regression and in some cases, even before the motor plateau phase was reached. Visual rating and GSL identified the earliest changes in the proximal adductor magnus muscle.

CONCLUSION

Muscle ultrasound can be used as an additional method to assess the disease progression and for decision-making in paucisymptomatic DMD patients. Sonographic changes in the ad-ductor magnus muscle seem to be the first detectable changes with a recognisable pattern.

An app-based quick assessment tool for childcare PA environments and practices

Background

Childcare centers are settings with a huge impact on children's health and health behavior and should therefore be encouraged to implement policies and practices to promote physical activity (PA). The project “QueB 2 - developing quality with and through physical activity” aims at exploring how stakeholders can be involved to identify childcare centers with need for action. For this purpose, an app-based quick assessment tool is developed.

Methods

We conducted two group discussions with stakeholders working with childcare centers (consultants, supervisors) about requirements in terms of applicability and criteria that are important and easily verifiable. Based on the results of the discussions and building on scientific evidence and existing frameworks, a quick assessment checklist was created and developed as a web app. The tool is tested by stakeholders and evaluated in further group discussions.

Results

Stakeholders require a simple assessment tool that can be used in counseling with small expenditure and is combined with information material. The developed app-based assessment tool consists of 20 items in 7 categories (indoor space, outdoor space, play equipment, activities, childcare center culture, professional development, network). It incorporates a simple scoring system with a total score ranging from 0 to 126. Based on the score, the tool shows a feedback window stating whether there is little, some or much need for action and providing additional information.

Conclusions

Stakeholders can be involved to sensitize childcare centers to the issue of physical activity environments and practices with the help of an app-based quick assessment tool. This is an important step before possible interventions can be implemented in childcare centers.

Key messages

An app-based assessment tool for childcare physical activity environments and practices is developed. It will enable stakeholders to identify childcare centers with need for action and offer support.