[Measurement of IgG concentration in bovine colostrum by immunoturbidimetric assay in comparison to ELISA-based assessment]

OBJECTIVE

The aim of the presented study was to compare the results of IgG measurements using a turbidimetric immunoassay (TIA), a newly developed laboratory-independent method for direct immunoglobulin determination in colostrum, with measurements obtained via enzyme-linked immunosorbent assay (ELISA).

MATERIAL AND METHODS

In colostrum samples from 59 cows, IgG concentration was measured using TIA and ELISA.

RESULTS

Correlation analysis according to Pearson revealed a correlation coefficient of r = 0.74 (p < 0.0001) between the 2 methods. The Bland-Altman analysis showed that measurement by TIA resulted in significantly lower mean IgG levels than the ELISA-based quantification. This difference was more pronounced in high IgG concentration ranges. By means of a double-logarithmized data transformation it was calculated that the TIA-determined IgG-values on average amounted to 66.4 % of the IgG-values measured by ELISA. Although colostrum with low IgG concentration could be quantified with satisfactory reliability (sensitivity 100 %), high-quality colostrum was not sufficiently assessed in the TIA-based IgG measurements (specificity 40.4 %).

CONCLUSION AND CLINICAL RELEVANCE

Based on the results of the presented study, IgG measurement by TIA cannot be recommended. In comparison to ELISA-based assessment, this technique does not exhibit higher correlations than established indirect rapid evaluation methods (density and viscosity determination).

Quantitative assessment of German Holstein dairy cattle colostrum and impact of thermal treatment on quality of colostrum viscosity and immunoglobulins

OBJECTIVE

This study aimed to determine the color, fat, viscosity, IgG concentration, %Brix and refractive index of fresh postpartum colostrum of German Holstein dairy cattle and assess the impact of different thermal treatments on the visual and dynamic viscosity, in association to IgG concentration, of colostrum that can be used for pasteurization process.

RESULTS

Of the total 40 fresh postpartum colostrum, the color of colostrum (ranging from white-pale yellow to yellow and dark-yellowish), fat (1.4-8.2 100 g^-1), IgG (4-116 mg mL^-1), %Brix (8.5-35.4%), refractive index (1.3454-1.3905 nD), visual (ranging from watery to liquid and thick) and dynamic (4.9-219 cp) viscosity, were recorded. Statistical analysis between visual and dynamic viscosity of fresh colostrum showed significant correlation coefficients (r_s = 634). Moreover, a significant correlation between viscosity and three IgG concentrations was also observed. Heat-treated colostrum showed dynamic viscosity ranged from 25 to 3066 cP, where dynamic viscosity of colostrum before- and after heat-treatment showed no significant correlation. Treated colostrum at 60 °C/60 min and 63.5 °C/30 min containing IgG concentration ≤ 80 mg mL^-1 and ≤ 68 mg mL^-1 showed no significant change in the viscosity and can successfully be applied for pasteurization of first postpartum colostrum.

The Cofactors of Nitrogenases

In biological nitrogen fixation, the enzyme nitrogenase mediates the reductive cleavage of the stable triple bond of gaseous N2at ambient conditions, driven by the hydrolysis of ATP, to yield bioavailable ammonium (NH4+). At the core of nitrogenase is a complex, ironsulfur based cofactor that in most variants of the enzyme contains an additional, apical heterometal (Mo or V), an organic homocitrate ligand coordinated to this heterometal, and a unique, interstitial carbide. Recent years have witnessed fundamental advances in our understanding of the atomic and electronic structure of the nitrogenase cofactor. Spectroscopic studies have succeeded in trapping and identifying reaction intermediates and several inhibitor- or intermediate- bound structures of the cofactors were characterized by high-resolution X-ray crystallography. Here we summarize the current state of understanding of the cofactors of the nitrogenase enzymes, their interplay in electron transfer and in the six-electron reduction of nitrogen to ammonium and the actual theoretical and experimental conclusion on how this challenging chemistry is achieved.

[Is the discipline associated with self-confidence in handling rational antibiotic prescription? : Results from the MR2 study in German hospitals]

BACKGROUND

Besides public awareness and specialist knowledge and training of physicians, their self-confidence plays a key role for clinical decision-making in the respective area.

OBJECTIVE

This exploratory study investigated the influence of the discipline on differences in self-confidence in dealing with antibiotics and in the self-rated knowledge.

METHODS

In 2015 the multi-institutional reconnaissance of practice with multiresistant bacteria (MR2) questionnaire containing items on antibiotic prescription and multiresistant pathogens was sent out to 1061 physicians working in departments for internal medicine, general surgery, gynecology and obstetrics and urology. In 2017 a similar MR2 survey was sent to 1268 specialist and assistant physicians in anesthesiology in Germany. Besides demographic data 4 items on self-confidence in the use of antibiotic treatment and 11 items concerning self-rated knowledge about rational antibiotic therapy and multiresistant pathogens were included in the present analysis. Logistic regression analysis, the χ²-test and the Kruskal-Wallis test were used for statistical analysis of the influence of the discipline on these items.

RESULTS

The response rates were 43% (456 out of 1061) from the non-anesthetists and 56% (705 out of 1268) from the anesthetists. Of the non-anesthetists 44% and 57% of the anesthetists had had no advanced training on antibiotic stewardship during the year before the study. In the overall analysis anesthetists (mean±SD: 2.53±0.54) were significantly less self-confident about antibiotics than colleagues from other departments (internal medicine: 3.10±0.50, general surgery: 2.97±0.44, gynecology and obstetrics: 3.12±0.42 and urology: 3.15±0.44) in the unadjusted (all p<0.001) and adjusted comparison. The analysis of self-rated knowledge about rational antibiotic prescription showed similar results. Senior consultant status and advanced training in infectiology were significantly associated with self-confidence and self-rated knowledge about antibiotics.

CONCLUSION

Anesthetists showed significantly less self-confidence in dealing with antibiotics than colleagues from other disciplines. Advanced training on a rational prescription of antibiotics was associated with a greater self-confidence, so that the implementation of compulsory courses on rational antibiotic stewardship in the respective residency curriculum needs to be considered.

Neoadjuvant immunotherapy with combined ipilimumab and nivolumab in patients with melanoma with primary or in transit disease

The introduction of new therapeutic agents has revolutionized the treatment of metastatic melanoma. The approval of adjuvant anti-programmed death-1 monotherapy with nivolumab or pembrolizumab, and dabrafenib plus trametinib has recently set a new landmark in the treatment of stage III melanoma. Now, clinical trials have shown that immune checkpoint blockade can be performed in a neoadjuvant setting, an approach established as a standard therapeutic approach for other tumour entities such as breast cancer. Recent studies suggest that a pathological response achieved by neoadjuvant immunotherapy is associated with long-term tumour control and that short neoadjuvant application of checkpoint inhibitors may be superior to adjuvant therapy. Most recently, neoadjuvant ipilimumab plus nivolumab in stage III melanoma was reported. With two courses of dose-optimized ipilimumab (1 mg kg^-1 ) combined with nivolumab (3 mg kg^-1 ), pathological responses were observed in 77% of patients, while only 20% of patients experienced grade 3 or 4 adverse events. However, the neoadjuvant trials employing combined immune checkpoint blockade conducted so far have excluded patients with in transit metastases, a common finding in stage III melanoma. Here we report four patients with in transit metastases or an advanced primary tumour who have been treated with neoadjuvant ipilimumab plus nivolumab according to the OpACIN-neo trial scheme (arm B). All patients achieved radiological disease control and a pathological response. None of the patients has relapsed so far. Linked Comment: Blankenstein and van Akkooi. Br J Dermatol 2020; 183:421-422.

The Comprehensive Community Engagement Framework for Health and Well-being

Background

Community engagement (CE) and empowerment are required to support the sustainability and effectiveness of actions to reach Agenda 2030. There is a need to guide CE for health and well-being to take action on important societal challenges such as the growing burden of non-communicable diseases (NCDs) and health inequities. The framework proposed in this study has been designed to assist professionals, practitioners and communities to effectively engage.

Methods

A narrative review of existing grey literature, policy papers and models related to CE was performed. This guided the development of a systematic search strategy, performed by two researchers, which reviewed CE approaches and key influencing factors. The search strategy captured different terms used for CE.

Results

A total of 27 studies of different types, from around the world, were identified for inclusion into the review. The study compiled a set of widely-used theories and approaches to CE. Key factors such as governance, trust, accessibility and sociocultural contextualisation were also identified as important for the success of CE initiatives. Subsequently, the Comprehensive Community Engagement Framework (CCEF) was developed. It combines theoretical and empirical principles, proven participatory actions and key factors to produce evidence-based health and well-being outcomes across different sectors and levels of society.

Conclusions

This study has formed the basis of a forthcoming WHO report on CE. The CCEF enables the operationalisation of CE to guide for possible practical approaches to planning, initiating, sustaining and evaluating CE processes alongside the community. It can be used by the health sector as well as the non-health sectors to address health, well-being and broader societal challenges.

Key messages

The CCEF can be used to engage health and non-health stakeholders to tailor CE processes, increase impact of interventions and policies, building capacity and empowering communities. The proposed framework provides the first comprehensive guidance to conduct community engagement.

[Quality Assessment of Bovine and Equine Colostrum - An Overview]

INTRODUCTION

Good quality colostrum intake is essential for passive immunity in neonatal calf and foals. The quality of colostrum depends on its IgG content. Since in practice the possibilities for a direct determination of these parameter are limited, an estimation of colostrum quality is often based on its biophysical properties. The simple methodology allows to perform measurements directly on site and immediately after birth. The biophysical properties included in the current review are density, refractive index, relative density, viscosity, pH, and color. The determination of the density of bovine colostrum is a common method for the evaluation of the IgG content in practice since it correlates with IgG. Density of bovine colostrum should be 1047 g/l. Different colostrometers are available for the measurement. This method is also used in the horses. Density of equine colostrum should be 1060 g/l. Refractive index or the relative density by refractometer has been proven to correlate with the IgG and is an established method in cattle and horses. Good bovine colostrum should have an index of 22% brix and equine colostrum 23% brix. Although not yet established in practice an additional methodology would be the determination viscosity of bovine colostrum. Viscosity could be measured with an outlet cup. A relationship between viscosity and IgG has demonstrated. Sufficient data for this method is missing for equine colostrum. Color and pH are not suitable for estimating the IgG content.

SpraySyn-A standardized burner configuration for nanoparticle synthesis in spray flames

In many scientific communities, the definition of standardized experiments has enabled major progress in process understanding. The investigation of the spray-flame synthesis of nanoparticles at a well-defined standard burner by experiment and simulation makes it possible to produce a comprehensive data set with various established and novel measuring methods. In this work, we introduce the design of the SpraySyn burner as a new standard for a free-jet type burner that offers well-defined and simulation-friendly boundary conditions and geometries as well as accessibility for optical diagnostics. A combustible precursor solution is fed through a centrally located capillary and aerosolized with an oxygen dispersion gas flow. The spray flame is stabilized by a premixed flat methane/oxygen pilot flame fed via a porous bronze matrix surrounded by a stabilizing nitrogen coflow emanating through the same porous matrix, providing easy-to-calculate boundary conditions for simulations. This burner design enables the use of a wide choice of solvents, precursors, and precursor combinations. Best-practice operating instructions and parameters are given, and large-eddy simulations are performed demonstrating the suitability of the SpraySyn burner for computational fluid dynamics simulations. For ensuring reproducible operation across labs, we define a consumer-camera-based flame characterization scheme for the quantitative assessment of the flame geometry such as flame length, diameter, tilt angle, and photometric distribution of visible chemiluminescence along the center axis. These parameters can be used for benchmarking the pilot and spray flame by each user of the SpraySyn burner with the reference flames.

Patient blood management: A solution for South Africa

For more than 70 years the default therapy for anaemia and blood loss was mostly transfusion. Accumulating evidence demonstrates a significant dose-dependent relationship between transfusion and adverse outcomes. This and other transfusion-related challenges led the way to a new paradigm. Patient blood management (PBM) is the application of evidence-based practices to optimise patient outcomes by managing and preserving the patient's own blood. 'Real-world' studies have shown that PBM improves patient outcomes and saves money. The prevalence of anaemia in adult South Africans is 31% in females and 17% in males. Improving the management of anaemia will firstly improve public health, secondly relieve the pressure on the blood supply, and thirdly improve the productivity of the nation's workforce. While high-income countries are increasingly implementing PBM, many middle- and low-income countries are still trying to upscale their transfusion services. The implementation of PBM will improve South Africa's health status while saving costs.

Options for Fertility Treatments for Trans Women in Germany

Fertility preservation in trans women is a crucial but thus far neglected component in the gender confirming treatment in Germany. It is difficult for trans women to access reproductive health care because centers offering treatment, psychological guidance, gender confirming surgery, as well as reproductive health services are scarce in Germany. Legal, social, or financial issues as well as individual patient comorbidities prevent trans women from receiving appropriate counselling. This review provides an overview on options of fertility preservation in trans women. We consider recent publications on testicular regression at the time of gender confirming surgery demonstrating presence of sperm or at least spermatogonia in the majority of tissues. This may open options for cryopreservation of sperm or testicular stem cells in trans women even at the final stage of transition. Hence, standardized urological procedures (i.e., sperm cryopreservation after masturbation or sperm extraction from the testicular tissue) and experimental approaches (cryopreservation of testicular tissue with undifferentiated spermatogonia) can be offered best at the initiation but also during the gender confirming process. However, counselling early in the gender confirming process increases the chances of fertility preservation because gender confirming hormone therapy has an impact on spermatogenesis.

Auswirkungen von Chlamydien auf Rinderspermien

Eckert T, Goericke-Pesch S, Heydel C et al. Interaction of different Chlamydiae species with bovine spermatozoa. BMC Microbiol 2019; 19: 23

Bei der Frau spielt die Chlamydieninfektion im Rahmen von Fruchtbarkeitsstörungen eine wichtige Rolle. Auch beim weiblichen Nutztier werden Reproduktionsstörungen mit Chlamydieninfektionen in Zusammenhang gebracht. Erkenntnisse über die Beeinflussung der Fortpflanzung durch diese Erreger beim männlichen Tier gibt es kaum. Die Studie untersuchte daher die Auswirkung einer Chlamydieninfektion auf Rindersperma in vitro.

Cumulative cortisol exposure in the third trimester correlates with postpartum mothers' neural response to emotional interference

Prolonged stress affects the central nervous system, rendering individuals vulnerable to a wide range of mental health disorders. 76 healthy postpartum mothers were studied by means of functional magnetic resonance imaging within 6 days of childbirth. The subjects were required to perform the emotional Stroop task involving happy and anxious word-face combinations. Hair samples were collected to determine cumulative hair cortisol concentration (HCC) in the third trimester. HCC was found to be negatively correlated with the recruitment of the dorsal anterior cingulate cortex (ACC) and the midcingulate cortex (MCC). In response to the emotional interference of only anxious target faces, a negative correlation was seen between HCC and the bilateral orbitofrontal cortex, extending to the rostral ACC and the MCC. Women with lower HCC recruited brain areas relevant to emotional cognitive control, indicating that lower HCC helps preserve conflict monitoring and resolution capacities and thus benefits mental health in pregnancy.

[Use of social media by psychiatric in-patients : Case report and further perspectives]

Communication by means of social networks and messenger programs as well as the use of smartphones have rapidly increased during recent years and are constantly present in everyday life. We report about a 25-year-old patient with a diagnosis of borderline personality disorder who posted photographs of acute self-injuries to a group of fellow patients by means of a messenger app while on weekend leave during psychiatric hospital treatment. The implications about possible effects of the use of social media by psychiatric in-patients on treatment and group dynamics are discussed. Furthermore, social media communication by patients is focused on in general and potential consequences for psychiatric, psychotherapeutic and psychosomatic treatment are discussed.

Gastroresistant gelatin films prepared by addition of cellulose acetate phthalate

Gastroresistant capsules are obtained mostly by using modified-release fill in hard capsules, or by coating the gelatin shell with acid-resistant polymers. Modification of the material used at the stage when the capsule shell is produced would reduce the complexity and cost of introducing new products to the market. Gastroresistant gelatin films were obtained by using commercial cellulose acetate phthalate (aqueous dispersion Aquacoat® CPD). Only films casted from non-alkalized mixtures showed no visible disintegration at pH from 1.2 (simulated gastric fluid) to 4.5 (phosphate buffer). Elasticity of the dry films was comparable with the one determined for non-modified gelatin films, however tear resistance was 2-fold smaller, but still acceptable for practical application.

Linear and non-linear heart rate metrics for the assessment of anaesthetists' workload during general anaesthesia

BACKGROUND

Excessive workload may impact the anaesthetists' ability to adequately process information during clinical practice in the operation room and may result in inaccurate situational awareness and performance. This exploratory study investigated heart rate (HR), linear and non-linear heart rate variability (HRV) metrics and subjective ratings scales for the assessment of workload associated with the anaesthesia stages induction, maintenance and emergence.

METHODS

HR and HRV metrics were calculated based on five min segments from each of the three anaesthesia stages. The area under the receiver operating characteristics curve (AUC) of the investigated metrics was calculated to assess their ability to discriminate between the stages of anaesthesia. Additionally, a multiparametric approach based on logistic regression models was performed to further evaluate whether linear or non-linear heart rate metrics are suitable for the assessment of workload.

RESULTS

Mean HR and several linear and non-linear HRV metrics including subjective workload ratings differed significantly between stages of anaesthesia. Permutation Entropy (PeEn, AUC=0.828) and mean HR (AUC=0.826) discriminated best between the anaesthesia stages induction and maintenance. In the multiparametric approach using logistic regression models, the model based on non-linear heart rate metrics provided a higher AUC compared with the models based on linear metrics.

CONCLUSIONS

In this exploratory study based on short ECG segment analysis, PeEn and HR seem to be promising to separate workload levels between different stages of anaesthesia. The multiparametric analysis of the regression models favours non-linear heart rate metrics over linear metrics.