Self-generated surface magnetic fields inhibit laser-driven sheath acceleration of high-energy protons

High-intensity lasers interacting with solid foils produce copious numbers of relativistic electrons, which in turn create strong sheath electric fields around the target. The proton beams accelerated in such fields have remarkable properties, enabling ultrafast radiography of plasma phenomena or isochoric heating of dense materials. In view of longer-term multidisciplinary purposes (e.g., spallation neutron sources or cancer therapy), the current challenge is to achieve proton energies well in excess of 100 MeV, which is commonly thought to be possible by raising the on-target laser intensity. Here we present experimental and numerical results demonstrating that magnetostatic fields self-generated on the target surface may pose a fundamental limit to sheath-driven ion acceleration for high enough laser intensities. Those fields can be strong enough (~10⁵ T at laser intensities ~10²¹ W cm^–2) to magnetize the sheath electrons and deflect protons off the accelerating region, hence degrading the maximum energy the latter can acquire.

Laser-generated ion acceleration has received increasing attention due to recent progress in super-intense lasers. Here the authors demonstrate the role of the self-generated magnetic field on the ion acceleration and limitations on the energy scaling with laser intensity.

Granulocytic myeloid-derived suppressor cells (GR-MDSC) accumulate in cord blood of preterm infants and remain elevated during the neonatal period

Preterm delivery is the leading cause of perinatal morbidity and mortality. Among the most important complications in preterm infants are peri- or postnatal infections. Myeloid-derived suppressor cells (MDSC) are myeloid cells with suppressive activity on other immune cells. Emerging evidence suggests that granulocytic MDSC (GR-MDSC) play a pivotal role in mediating maternal-fetal tolerance. The role of MDSC for postnatal immune-regulation in neonates is incompletely understood. Until the present time, nothing was known about expression of MDSC in preterm infants. In the present pilot study, we quantified GR-MDSC counts in cord blood and peripheral blood of preterm infants born between 23 + 0 and 36 + 6 weeks of gestation (WOG) during the first 3 months of life and analysed the effect of perinatal infections. We show that GR-MDSC are increased in cord blood independent of gestational age and remain elevated in peripheral blood of preterm infants during the neonatal period. After day 28 they drop to nearly adult levels. In case of perinatal or postnatal infection, GR-MDSC accumulate further and correlate with inflammatory markers C-reactive protein (CRP) and white blood cell counts (WBC). Our results point towards a role of GR-MDSC for immune-regulation in preterm infants and render them as a potential target for cell-based therapy of infections in these patients.

Seafood pathogens and information on antimicrobial resistance: A review

Seafood-borne diseases are a major public health hazard in the United States and worldwide. Per capita, seafood consumption has increased globally during recent decades. Seafood importation and domestic aquaculture farming has also increased. Moreover, several recent outbreaks of human gastroenteritis have been linked to the consumption of contaminated seafood. Investigation of seafood-borne illnesses caused by norovirus, and Vibrio, and other bacteria and viruses require a concrete knowledge about the pathogenicity and virulence properties of the etiologic agents. This review explores pathogens that have been associated with seafood and resulting outbreaks in the U.S. and other countries as well as the presence of antimicrobial resistance in the reviewed pathogens. The spectrum of such resistance is widening due to the overuse, misuse, and sub-therapeutic application of antimicrobials in humans and animals.

Combination of micellar casein with calcium and vitamins D2 and K2 improves bone status of ovariectomized mice

Nutritional approaches may help to preserve bone quality. The purpose of our study was to demonstrate the efficiency of an innovative bone health product (BHP) including micellar casein rich in calcium, vitamin D2 and vitamin K2, to improve bone mineral density.

INTRODUCTION

The aim of postmenopausal osteoporosis treatment is to decrease bone resorption and/or increase bone formation. Because of the slow bone turnover, osteoporosis prevention and therapies are long-lasting, implying great costs and poor compliance. Even if the effects of nutrition on bone are not as marked as that of pharmaceutical agents, it can be of great help. The purpose of our study was to demonstrate the efficiency of an innovative bone health product (BHP) containing micellar casein rich in calcium, vitamin D2 and vitamin K2, for the improvement of bone mineral density (BMD).

METHODS

An ovariectomized mice model was used to study the effect of different concentrations of the ingredient on BMD and microarchitectural parameters. Blood concentrations of C-terminal telopeptide of type I collagen (CTX), N-terminal propeptide of type 1 procollagene (PINP), alkaline phosphatase (ALP), osteocalcin (OC) and RANKL were also measured to evaluate bone remodelling, To evaluate the efficiency of the product to modulate osteoblast and osteoclast growth and differentiation, primary murine bone cells were used.

RESULTS

In vivo studies showed that BMD and microarchitectural parameters were dose-dependently improved after ingestion of the supplement for 3 months. We also report increased osteoblast activity as shown by increased OC activity and decreased osteoclastogenesis as shown by reduced CTX activity. In vitro studies support that BHPs stimulate osteoblast differentiation and mineralization and inhibit osteoclast resorption activity.

CONCLUSION

Our results show that, when chronically ingested, BHPs improve BMD of ovariectomized mice. This work supports that providing an ingredient including micellar casein rich in calcium, vitamin D2 and vitamin K2 is more efficient than the control diet to maintain bone quality.

An automatic device to measure time spent upright

Objective measurements of time spent standing or walking would be of benefit in assessing response to therapy. We have tested a device consisting of a mercury tilt switch attached to an electronic counter to measure time spent upright. Eleven subjects, six male and five female age 67-88 years (mean 76 years) undergoing rehabilitation were studied. Diagnoses included: Parkinson's disease, dementia, stroke and femoral fracture. The device was fitted with the tilt switch on the lateral aspect of thigh. Measurements compared stopwatch readings made by an observer and the device. Study periods were of one to three hours. There was excellent correlation between stopwatch and device measurements of time spent standing (t = 0.994; p < 0.001). The device functioned well during physiotherapy and ward activities although measurements were inaccurate when subjects used an exercise bicycle or climbed steps greater than 20 cm in height. The device should prove useful for monitoring activity and response to mobilization therapy.

[Bouveret syndrome: a case report and literature review]

Bouveret syndrome is a gastric outlet obstruction caused by impaction of a gallstone that passes through a cholecystoduodenal or cholecystogastric fistula. It is a rare disease, most common in elderly women with multiple comorbidities and high surgical risk. The diagnosis can be made either radiologically or endoscopically. Endoscopic extraction is the preferred therapeutic option. Surgical intervention is indicated when endoscopic methods fail. We describe a case of Bouveret syndrome in a 79 years old woman. The report is followed by a review of literature on the diagnostics and treatment of this rare syndrome.

KEY WORDS

gallstones bilioenteric fistula gallstone ileus duodenal obstruction Bouveret syndrome.

Markers of oxidative damage of nucleic acids and proteins among workers exposed to TiO2 (nano) particles

OBJECTIVE

The use of nanotechnology is growing enormously and occupational physicians have an increasing interest in evaluating potential hazards and finding biomarkers of effect in workers exposed to nanoparticles.

METHODS

A study was carried out with 36 workers exposed to (nano)TiO2 pigment and 45 controls. Condensate (EBC) titanium and markers of oxidation of nucleic acids (including 8-hydroxy-2-deoxyguanosine (8-OHdG), 8-hydroxyguanosine (8-OHG), 5-hydroxymethyl uracil (5-OHMeU)) and proteins (such as o-tyrosine (o-Tyr), 3-chlorotyrosine (3-ClTyr) and 3-nitrotyrosine (3-NOTyr)) were analysed from samples of their exhaled breath.

RESULTS

In the production workshops, the median total mass 2012 and 2013 TiO2 concentrations were 0.65 and 0.40 mg/m(3), respectively. The median numbers of concentrations measured by the scanning mobility particle sizer (SMPS) and aerodynamic particle sizer (APS) were 1.98 × 10(4) and 2.32 × 10(4) particles/cm(3), respectively; and about 80% of those particles were smaller than 100 nm in diameter. In the research workspace, lower aerosol concentrations (0.16 mg/m(3) and 1.32 × 10(4) particles/cm(3)) were found. Titanium in the EBC was significantly higher in production workers (p<0.001) than in research workers and unexposed controls. Accordingly, most EBC oxidative stress markers, including in the preshift samples, were higher in production workers than in the two other groups. Multiple regression analysis confirmed an association between the production of TiO2 and the levels of studied biomarkers.

CONCLUSIONS

The concentration of titanium in EBC may serve as a direct exposure marker in workers producing TiO2 pigment; the markers of oxidative stress reflect the local biological effect of (nano)TiO2 in the respiratory tract of the exposed workers.

[Treatment of Chronic Lymphocytic Leukemia with TP53 Aberrations]

Patients with chronic lymphocytic leukemia with deletion of the short arm of chromosome 17 (17p -) or mutation of the TP53 gene have significantly worse prognosis with a higher risk of progression to symptomatic disease, worse and shorter responses to chemo immunotherapy, and more frequent occurrence of Richters syndrome. TP53 deletion/ mutation is currently the only genetic abnormality that independently predicts response to treatment and also affects the choice of therapeutic approach in chronic lymphocytic leukemia. This work summarizes treatment options available for this poor prognosis variant of chronic lymphocytic leukemia. Traditional chemo immunotherapy (e. g. FCR) does not offer longterm disease control, and patients with TP53 deletion/ mutation were usually considered to undergo allogeneic bone marrow transplantation. New molecules from the group of BCR inhibitors or BCL2 antagonists achieve excellent efficacy in chronic lymphocytic leukemia with del17p even in relapsed/ refractory (R/ R) cases, with a higher percentage of responses and prolonged survival without progression. Clinical trials are ongoing to determine optimal therapeutic approach and to induce longterm remission of the disease. The new molecules change algorithms for treatment of patients with TP53 aberration, including indication for allogeneic transplantation. Especially younger patients should be consulted in centers of intensive hematological care to consider their inclusion into clinical trials testing new molecules or to indicate allogeneic transplantation at the optimal time.

Atmospheric station Křešín u Pacova, Czech Republic – a Central European research infrastructure for studying greenhouse gases, aerosols and air quality

Abstract. Long-lasting research infrastructures covering the research areas of atmospheric chemistry, meteorology and climatology are of highest importance. The Atmospheric Station (AS) Křešín u Pacova, central Czech Republic, is focused on monitoring of the occurence and long-range transport of greenhouse gases, atmospheric aerosols, selected gaseous atmospheric pollutants and basic meteorological characteristics. The AS and its 250 m tall tower was built according to the recommendations of the Integrated Carbon Observation System (ICOS) and cooperates with numerous national and international projects and monitoring programmes. First measurements conducted at ground started in 2012, vertical profile measurements were added in 2013. A seasonal variability with slightly higher autumn and winter concentrations of elemental and organic carbon was revealed. The suitability of the doubly left-censored Weibull distribution for modelling and interpretation of elemental carbon concentrations, which are often lower than instrumental quantification limits, was verified. Initial data analysis also suggests that in summer, the tower top at 250 m is frequently above the nocturnal surface inversions, thus being decoupled from local influences.

The ribB FMN riboswitch from Escherichia coli operates at the transcriptional and translational level and regulates riboflavin biosynthesis

FMN riboswitches are genetic elements that, in many bacteria, control genes responsible for biosynthesis and/or transport of riboflavin (vitamin B2 ). We report that the Escherichia coli ribB FMN riboswitch controls expression of the essential gene ribB coding for the riboflavin biosynthetic enzyme 3,4-dihydroxy-2-butanone-4-phosphate synthase (RibB; EC 4.1.99.12). Our data show that the E. coli ribB FMN riboswitch is unusual because it operates at the transcriptional and also at the translational level. Expression of ribB is negatively affected by FMN and by the FMN analog roseoflavin mononucleotide, which is synthesized enzymatically from roseoflavin and ATP. Consequently, in addition to flavoenzymes, the E. coli ribB FMN riboswitch constitutes a target for the antibiotic roseoflavin produced by Streptomyces davawensis.

A novel device for target controlled administration and reflection of desflurane--the Mirus™

The Anaconda™ system is used to deliver inhalational sedation in the intensive care unit in mainland Europe. The new Mirus™ system also uses a reflector like the Anaconda; however, it also identifies end-tidal concentrations from the gas flow, injects anaesthetics during early inspiration, controls anaesthetic concentrations automatically, and can be used with desflurane, which is not possible using the Anaconda. We tested the Mirus with desflurane in the laboratory. Compared with an external gas monitor, the bias (two standard deviations) of the end-tidal concentration was 0.11 (0.29)% volume. In addition, automatic control was reasonable and maximum concentration delivered was 10.2%, which was deemed to be sufficient for clinical use. Efficiency was > 80% and was also deemed to be acceptable, but only when delivering a low concentration of desflurane (≤ 1.8%). By modifying the reflector, we improved efficiency up to a concentration of 3.6%. The Mirus appears to be a promising new device for long-term sedation with desflurane on the intensive care unit, but efficiency must be improved before routine clinical use becomes affordable.

Natural riboflavin analogs

Riboflavin analogs have a good potential to serve as basic structures for the development of novel anti-infectives. Riboflavin analogs have multiple cellular targets, since riboflavin (as a precursor to flavin cofactors) is active at more than one site in the cell. As a result, the frequency of developing resistance to antimicrobials based on riboflavin analogs is expected to be significantly lower. The only known natural riboflavin analog with antibiotic function is roseoflavin from the bacterium Streptomyces davawensis. This antibiotic negatively affects flavoenzymes and FMN riboswitches. Another roseoflavin producer, Streptomyces cinnabarinus, was recently identified. Possibly, flavin analogs with antibiotic activity are more widespread than anticipated. The same could be true for flavin analogs yet to be discovered, which could constitute tools for cellular chemistry, thus allowing a further extension of the catalytic spectrum of flavoenzymes.

Riboflavin analogs as antiinfectives: occurrence, mode of action, metabolism and resistance

Antimetabolites are molecules, which are structurally similar to molecules needed to carry out primary metabolic reactions.The inhibitory activity of an antimetabolite depends on its successful competition with the natural substrate, ligand, modulator or cofactor of a given biomolecule. Antimetabolites are indispensable as molecular tools in order to understand biological processes. Beyond that,antimetabolites have a large variety of applications in the pharmaceutical and food industries. The identification of the structural riboflavin(vitamin B2) analog roseoflavin in Streptomyces davawensis demonstrates that anti-vitamins/cofactor analogs may serve as lead structures for the development of novel antibiotics. The latter is supported by the recent finding that roseoflavin had a profound inhibiting effect on the growth and infectivity of the human bacterial pathogen Listeria monocytogenes at very low concentrations. Roseoflavin is studied in our laboratory as a model compound. We investigate the biosynthesis, the possible large-scale production, the metabolization,the mechanism of action and the resistance mechanism of the producer organism in order to pave the way for the structured analysis of other vitamin analogs yet to be discovered. These compounds hopefully will help to replenish the arsenal of antimicrobials urgently needed to fight multiresistant bacterial pathogens.

[The effectiveness of anagrelide treatment in patients with Ph negative myeloproliferative diseases: influence on the incidence of thrombosis in the data from the Registry of patients with essential thrombocythemia and thrombocythemia associated with other myeloproliferative diseases treated with Thromboreductin® to the end of 2012]

In the Czech Republic, anagrelide (Thromboreductin®) [29] is used according to the recommendations of the Czech Working Group on Myeloproliferative Disorders (CZEMP) for treatment of thrombocythemia associated with Ph negative myeloproliferative disorders (MPDs). The patient data are collected in the Registry of patients with essential thrombocythemia (ET) and thrombocythemia associated with other MPDs treated with Thromboreductin®. At the end of 2012, the Registry contained data on 1,161 patients. Out of these, 1,159 patients with the dia-gnosis of a Ph negative MPD were evaluated. In 844 patients, precise WHO based dia-gnosis was known at start of therapy: 442 (52.4%) had ET, 108 (12.8%) had polycythaemia vera (PV) and 243 had primary myelofibrosis (PMF). The median age was 51 years at the time of diagnosis. At the time of the evaluation of the population, the median was 59 years. Every year, the proportion of patients newly treated with anagrelide as a firstline treatment in accordance with the CZEMP guidelines has been increasing. A growing proportion of patients has been treated with an additional cytoreducing drug, such as hydroxyurea and interferon. The majority of the patients received also an antiaggregant (or anticoagulant). More than a half of patients harbors the JAK2 mutation. A prompt decrease of platelet counts (as the response to Thromboreductin® treatment) was documented in most of the patients. After one year, 86.9% of patients had a full or partial response. In poorer responders, combination cytoreductive treatment was administered rather then the escalation of the Thromboreductin® dosage. There were 461 thrombotic manifestations in 363 patients and 61 haemorrhagic events in 57 patients recorded in the patients history. In the course of treatment (followup; F U), thrombosis was diagnosed only 179-times in 136 patients. There were more haemorrhagic events during F U: 109 events in 83 patients. Upon comparison of the number of events during F U to their numbers in history, we found a twofold decrease in arterial thrombosis, an almost twofold decrease in microvascular thrombosis and even a 6.6- fold decrease in venous thromboembolism events. Bleeding episodes increased 1.8-fold during F U. However, the vast majority of these hemorrhagic events were clinically insignificant. In conclusion, the treatment strategy according to the CZEMP guidelines incorporating anagrelide is highly effective in reducing the platelet counts, strongly prevents venous events, reduces arterial events, and leads to an increase of minor hemorrhages.

[Clinical results of surgically treated paediatric fractures of the medial humeral epicondyle]

OBJECTIVES

Fractures of the medial humeral epicondyle represent approximately 10 % of all paediatric elbow fractures. material and methods: Surgically treated paediatric fractures of the medial humeral epicondyle were analysed retrospectively for their epidemiological, clinical and surgical parameters. Re-evaluation included clinical function, satisfaction, pain level and MAYO elbow performance score (MEPS).

RESULTS

22 children could be included. A re-evaluation of 91 % of our patients after a follow-up of ∅ 4 years (range: 1-9 years; median: 4 years) after initial surgery was possible. Subjective outcome and objective function were good with moderate limitations. 85 % of our patients showed good to excellent results in the MEPS.

CONCLUSION

Regarding our own good clinical results and potentially lower rates of pseudarthrosis - in comparison to conservatively treated patients - by trend we recommend internal fixation in paediatric fractures of the medial humeral epicondyle. However, operative or conservative treatment must be indicated individually together with the patient and his/her parents.

[Results of surgically treated paediatric supracondylar humeral fractures]

BACKGROUND

About 80 % of all paediatric distal humerus fractures are supracondylar fractures.

PATIENTS AND METHODS

Surgically treated children with supracondylar humeral fractures between 2000-2008 were analysed retrospectively and re-evaluated for function, satisfaction, pain level and with the MAYO elbow performance score (MEPS).

RESULTS

46 patients were included. Open fractures (2 %) and vessel (0 %) or nerve (4 %) lacerations were rare, additional forearm fractures frequent (15 %). Surgery was done by closed/open reduction and crossed K-wire pinning. Main complications were movement restriction and K-wire migration. All fractures healed. 72 % of patients could be re-evaluated Ø 51 months after surgery. The mean differences between non-affected and affected elbows showed 8° for flexion, 1° for extension, 1° for pronation and 0° for supination. In 88 % excellent or good results could be measured with the MEPS.

CONCLUSION

Regarding bony healing in all patients, well manageable complications, mostly excellent or good results in the MEPS and good function, crossed K-wire pinning after closed/open reduction is a safe standard surgical procedure for this type of fracture.

Analgesic drug use associated with statin prescription--a cross-sectional study in primary care settings

BACKGROUND

To investigate whether features of muscular complaints (MC) differ between receivers of a statin prescription and non-receivers. To analyze the relationship between analgesics prescription, statin prescription and/or musculoskeletal disorders.

METHODS

Cross-sectional study. Consecutive patients in offices of family practitioners were interviewed using a standardized questionnaire. Target variables: Rates of features of MC in patients with or without a statin prescription and rates of analgesic drug prescription in patients with or without statin prescription and/or musculoskeletal disorders. Odds ratios (adjusted for age, sex, and socio-economic status) were calculated using logistic regression analysis.

RESULTS

1135 patients in 26 general practitioners' offices were asked to participate, and 1031 patients agreed. Features of MC did not differ between the two groups of patients. Analgesic prescription was found to be associated with statin prescription in patients without musculoskeletal disorders (OR 2.2, CI 1.1-4.7 without statin, OR 2.5, CI 0.9-6.9 with statin) and particularly in those with musculoskeletal disorders (OR 5.2, CI 2.9-9.3 without statin, OR 9.3, CI 4.5-19.1 with statin).

CONCLUSIONS

Analgesic prescriptions are probably positively associated with statin prescription. Assuming that analgesics attenuate MC, an even stronger association between MC and statin use seems likely. The results generate the hypothesis that statin use contributes to analgesic use in primary care patients.

Mass and chemically speciated size distribution of Prague aerosol using an aerosol dryer--the influence of air mass origin

Ambient aerosol particles dried using a diffusional aerosol dryer were sampled using a 7-stage modified Berner low pressure impactor with a back-up filter during the heating and non-heating season campaigns in 2008. The samples were analyzed for water-soluble ions and water-soluble organic carbon. Because of the drying, the aerosol size distribution was not influenced by the daily variability of ambient relative humidity. The results summarize the observations from campaigns in both the heating (11 sampling days) and non-heating (10 sampling days) seasons. The aerosols sampled on individual days were classified based on the connected air mass back trajectories into three classes: sea-influenced aerosol (SIA), continental aerosol (CA) and mixed aerosol (MA) for samples of intermediate origin. The differences between CA and SIA were substantial both when looking at the normalized mass size distributions of the particulate matter (PM) and of the individual species and when taking into account the absolute concentrations in the fine and coarse size fractions. The main differences were found in the normalized mass size distributions of the PM and of the sea-salt related ions.

F8 haplotype and inhibitor risk: results from the Hemophilia Inhibitor Genetics Study (HIGS) Combined Cohort

Ancestral background, specifically African descent, confers higher risk for development of inhibitory antibodies to factor VIII (FVIII) in haemophilia A. It has been suggested that differences in the distribution of FVIII gene (F8) haplotypes, and mismatch between endogenous F8 haplotypes and those comprising products used for treatment could contribute to risk. Data from the Hemophilia Inhibitor Genetics Study (HIGS) Combined Cohort were used to determine the association between F8 haplotype 3 (H3) vs. haplotypes 1 and 2 (H1 + H2) and inhibitor risk among individuals of genetically determined African descent. Other variables known to affect inhibitor risk including type of F8 mutation and human leucocyte antigen (HLA) were included in the analysis. A second research question regarding risk related to mismatch in endogenous F8 haplotype and recombinant FVIII products used for treatment was addressed. Haplotype 3 was associated with higher inhibitor risk among those genetically identified (N = 49) as of African ancestry, but the association did not remain significant after adjustment for F8 mutation type and the HLA variables. Among subjects of all racial ancestries enrolled in HIGS who reported early use of recombinant products (N = 223), mismatch in endogenous haplotype and the FVIII proteins constituting the products used did not confer greater risk for inhibitor development. Haplotype 3 was not an independent predictor of inhibitor risk. Furthermore, our findings did not support a higher risk of inhibitors in the presence of a haplotype mismatch between the FVIII molecule infused and that of the individual.

Comparison of particulate number concentrations in three Central European capital cities

Number size distributions of atmospheric aerosol particles in the mobility diameter range from 10 to 1000 nm were determined in Budapest, Prague and Vienna for a one-year-long period. Particle number concentrations in various size fractions, their diurnal and seasonal variations, mean size distributions and some properties of new particle formation events were derived and compared. Yearly median particle number concentrations for Budapest, Prague and Vienna were 10.6×10(3), 7.3×10(3) and 8.0×10(3) cm(-3). Differences were linked to the different pollution levels of the cities, and to diverse measurement environments and local conditions. Mean contributions of ultrafine particles (particles with a mobility diameter <100 nm) to the total number concentration were 80%, 84% and 74% for Budapest, Prague and Vienna, thus these particles represent an overwhelming share of all particles in each city. Seasonal variation of particle number concentrations was not obvious. Diurnal variations of particles with a diameter between 100 and 1000 nm (N(100-1000)) exhibited similar shape for the cities, which was related to the time-activity pattern of inhabitants and regional influences. The structure of the diurnal variation for ultrafine particles was also similar. It contained a huge morning peak in each city which was explained by emissions from vehicular traffic. The second peak was shifted from afternoon rush hours to late evenings as a result of the daily cycling in meteorological parameters. The character of the measurement site also influenced the diurnal variation. Diurnal variation of the mean ratio of ultrafine particles to N(100-1000) clearly revealed the presence and importance of new particle formation and subsequent growth in urban environments. Nucleation frequencies in Budapest and Prague were 27% and 23%, respectively on a yearly time scale. They showed a minimum in winter for both places, while the largest nucleation activity was observed in spring for Budapest, and in summer for Prague.

Depression in Parkinson's disease

Among the recently well appreciated non-motor symptoms in Parkinson's disease (PD), depression plays a prominent role due to its frequency and impact on quality of life. However, depression may be confounded by motor symptoms, especially akinesia and other non-motor symptoms such as apathy, anxiety and dementia. Data on specific diagnostic tools or treatment for depressive symptoms in PD patients are still sparse. Here we summarize an expert opinion based on available data and clinical experience.

Sorption of Sulfonamide Antibiotics to Soil Organic Sorbents: Batch Experiments with Model Compounds and Computational Chemistry

Sorption of the sulfonamide antibiotics sulfanilamide, sulfadimethoxine, and sulfapyridine to model soil organic matter was investigated. Therefore, Fluka humic acid and an enzymatically reacted vanillin oligomer were used in batch experiments at pH 4.5, 6.0, and 7.5. Sorption of the amphoteric sulfonamides was nonlinear and pH dependent. At pH 4.5 and 6.0 sorption to both humic acid and oligomer increased in the order sulfanilamide < sulfapyridine < sulfadimethoxine. This was primarily attributed to the sulfonamides' H-bond donor/acceptor properties. Sorption to the oligomer indicated that in addition to π-π interactions with aromatics phenolic, aldehyde and methoxyl moieties of the oligomer are specific binding sites. Stronger sorption to humic acid than to the oligomer was related to the more complex structure and functional group diversity of humic acid. At pH 7.5 sorption sequence was changed to sulfadimethoxine < sulfanilamide < sulfapyridine, indicating a changed sorption behavior due to different sulfonamide speciation. In part sorption non-reversibility was strong. This was attributed to surface complexation, rate-limiting intra-particle diffusion processes and entrapment of sulfonamides in voids of organic matter. Molecular mechanics (MM+) computational modeling using a DOM-trimer model confirmed that H-bonding and dipole-dipole interactions are crucial for entrapment of sulfonamides in voids of organic matter.

Small cause - big effect: improvement in interface design results in improved data quality - a multicenter crossover study

In Germany the core data set for anesthesia version 3.0 was recently introduced for external quality assurance, which includes five surgical tracer procedures. We found a low rate of correctly documented tracers when compared to procedure data (OPS-Codes) documented separately. Examination revealed that the graphical user interface (GUI) contravened the dialogue principles as defined in EN ISO 9241-110. We worked with the manufacturer to implement small improvements and roll out the software. A crossover study was conducted at a university hospital and a municipal hospital chain with five hospitals. All study sites and surgical tracer procedures combined, we found an improvement from 42% to 65% (p<0.001; N=34,610) correctly documented anesthesias. We also saw improvements for most of the observed surgical tracer procedures at all hospitals. Our results show the big effect small changes to the GUI can have on data quality. They also raise the question, if highly flexible and parameterized clinical documentation systems are suited to achieve high usability. Finding the right balance between GUIs designed by usability experts and the flexibility of parameterization by administrators will be a difficult task for the future and subject to further research.

TAPP - Stuttgart technique and result of a large single center series

Laparoscopic hernioplasty is assessed as a difficult operation. Operative technique determines the frequency of complications, the time of recovery and the rate of recurrences. A proper technique is absolutely necessary to achieve results that are superior to open hernia surgery.

[Minimal node affection in gastric carcinoma--pilote multicentric study results]

INTRODUCTION

Lymphadenectomy is an essential part of surgical treatment of gastric cancer. In the part of hematoxylin-eosin negative nodes, small foci of tumour cells (micrometastastasis and isolated tumour cells) can be found using immunostaing or RT-PCR. The aim of this study is to asses clinical and prognostic relevance of these findings.

MATERIAL AND METHODS

Multicenter, prospective, non-randomised clinical trial running in four Czech centres. All lymphatic nodes from patients after radical resection are stained using standard hematoxylin-eosin technique, all negative nodes are further processed with immunostaining employing cytokeratin antibody.

RESULTS

In the period of two years (1st January 2009 - 31st December 2010), 73 patients (100%) were included into the study from four Czech centers. All patients underwent radical resection for gastric cancer. Subtotal resection was performed in 33 patients (45%), total gastrectomy in the remaining 40 patients (55%). Total number of acquired lymphatic nodes (LN) reached 1245, average number of nodes per one patient was 17.3. H-E metastasis were disclosed in 364 LN (29%). All H-E negative nodes were further processed using immunohistochemical staining. Lymph node micrometastasis (MM) were discovered in 35 LN (3%), isolated tumour cells (ITC) in another 72 LN (6%). Clinical and prognostic relevance of lymph node MM and ITC was assessed based on the patients' survival data.

CONCLUSION

Preliminary results of this study indicate that presence of the lymph node MM and ITC in gastric cancer patients is not linked to worse oncological outcome. Based on our results we can conclude, that expensive, time consuming and technically demanding immunostaining technique could not yet be recommended as a routine part of histological investigation of lymphatic nodes.