Persistent organic pollutants in shallow percolated water of the Alps Karst system (Zugspitze summit, Germany)

In the German Calcareous Alps at the Zugspitze, percolated water close to a permafrost bedrock in a tunnel system was monitored long-term for polychlorinated dibenzo-p-dioxins (PCDD), polychlorinated dibenzofurans (PCDF), polychlorinated biphenyls (PCB), polycyclic aromatic hydrocarbons (PAH), and 28 organochlorine pesticides (OCP). Semi-permeable membrane devices (SPMD) were deployed in a temporary surface water system at the Zugspitze plateau and analysed for PCB, PAH, and OCP. The high-volume water sampling was successfully implemented and all compounds were identified in the water percolated through the Karst system. However, the percentage distribution of contaminants in the percolated water differed significantly from that found in surface waters. The highest chlorinated PCDD homologues were the predominant compounds of the PCDD/F family, whereas percentages of PCB #52 increased in percolated water. Toxic equivalent values (TEQ) of samples ranged from 2.0 to 4.2pgTEQ/m³ and from 0.017 to 0.069pgTEQ/m³ for PCDD/F and PCB, respectively. Low and intermediate molecular weight PAH were the prevailing compounds in the samples. Endosulfan sulfate, endrin, and cis-heptachlor epoxide were enhanced after water percolation through the Karst system in comparison with the surface waters (wet deposition). The relative enrichment on these pesticides was related to the environmental bedrock conditions and glacier melting sources. In summary, the Karst system highly influenced the fate of organic persistent pollutants generating different chemical patterns in their percolated waters than those found at the surface systems.

[Intralymphatic immunotherapy: An effective and safe alternative route for canine atopic dermatitis]

INTRODUCTION

Allergen-specific immunotherapy (ASIT) is the only etiologic treatment of atopic dermatitis in dogs. In humans it has been shown that intralymphatic immunotherapy (ILIT) enhanced efficacy and patient compliance and reduced treatment time from 3 years to 8 weeks. As only safety data have been published yet, the aim of this study was to evaluate the clinical efficacy of ILIT in dogs. 20 atopic dogs underwent ILIT with alum-precipitated allergens administered every 4 weeks for 3 to 7 times in the popliteal lymph node. Pruritus (Hill score), CADESI (canine atopic dermatitis severety index), concurrent medications and adverse reactions were recorded initially and every 4 weeks for a total period of 24 weeks. The observed clinical response was good in 12/20 (60%) patients and improvement could be seen in some dogs already after 4 weeks. The median number of injections was 5.6. All dogs tolerated the procedure well and no adverse effects were recognized during or after ILIT. Therefore ILIT should be regarded as a safe alternative to subucaneous ASIT, enabling a faster clinical improvement with the same response rate.

VINCIA for hadron colliders

We present the first public implementation of antenna-based QCD initial- and final-state showers. The shower kernels are [Formula: see text] antenna functions, which capture not only the collinear dynamics but also the leading soft (coherent) singularities of QCD matrix elements. We define the evolution measure to be inversely proportional to the leading poles, hence gluon emissions are evolved in a [Formula: see text] measure inversely proportional to the eikonal, while processes that only contain a single pole (e.g., [Formula: see text]) are evolved in virtuality. Non-ordered emissions are allowed, suppressed by an additional power of [Formula: see text]. Recoils and kinematics are governed by exact on-shell [Formula: see text] phase-space factorisations. This first implementation is limited to massless QCD partons and colourless resonances. Tree-level matrix-element corrections are included for QCD up to [Formula: see text] (4 jets), and for Drell-Yan and Higgs production up to [Formula: see text] (V / H + 3 jets). The resulting algorithm has been made publicly available in Vincia  2.0.

Severe motor aphasia after reinfusion of cryopreserved autologous stem cells after myeloablative conditioning

BACKGROUND

Autologous peripheral blood stem cells (PBSCs) are usually cryopreserved before high-dose chemotherapy (HDCT) and autologous peripheral blood stem cell transplantation (PBSCT). The freezing process requires the addition of cryoprotectants such as dimethyl sulfoxide (DMSO), which is vital for cell viability in frozen aliquots. DMSO has a number of well-described side effects. However, severe neurologic side effects assigned to DMSO are exceedingly rare.

CASE REPORT

A 64-year-old female underwent HDCT followed by PBSCT as consolidation therapy in relapsed high-grade (Grade 3B) Stage IIIA follicular lymphoma. PBSCs were mobilized using granulocyte-colony stimulating factor and plerixafor after the second cycle of R-DHAP (rituximab, dexamethasone, high-dose Ara-C, cisplatin) salvage chemotherapy. A total of 7.18 × 10⁶ /kg body weight CD34+ cells were cryopreserved using 10% DMSO. HDCT was administered some weeks later followed by reinfusion of two bags of PBSCs, each containing 98 mL with 1.6 × 10⁶ /kg body weight CD34+ cells. Within a few minutes the patient developed a motor aphasia and became very agitated. Brain imaging did not reveal any pathologic finding. After being transferred to the intensive care unit the patient's condition steadily improved and the motor aphasia resolved completely within 6 hours after its onset.

CONCLUSION

This is, to our knowledge, the first report to describe an episode of severe motor aphasia during PBSCT. Given the close timely correlation with PBSCT, this episode appears to be caused by dimethyl sulfoxide (DMSO) and might possibly have been prevented by use of lower concentrations of DMSO.

Neurodevelopmental Outcomes Following Extensive Cardiopulmonary Resuscitation in the Delivery Room for Infants Born <29 Weeks’ Gestational Age

BACKGROUND: Neurodevelopmental outcomes of preterm infants who receive extensive CPR (ECPR), defined as chest compression with or without epinephrine in the delivery room, remain unclear.

OBJECTIVES: To compare the neurodevelopmental outcomes of preterm infants admitted to Canadian NICUs requiring ECPR versus those who did not require ECPR in the delivery room.

DESIGN/METHODS: Preterm infants born at <29 weeks GA between January 1, 2010 and September 30, 2011 and evaluated at CNFUN centers were retrospectively evaluated. The primary outcome was a composite of death or neurodevelopmental impairment (NDI) at 18-21 months CA defined as presence of any one or more of the following: definitive cerebral palsy or Bayley- III cognitive, language, motor scores <85 on any one of the components or hearing impairment or visual impairment. Demographic factors, neurodevelopmental status including Bayley III cognitive, language and motor scores and sensory impairments were compared between the ECPR and the no ECPR group using univariate and multivariate analyses. RESULTS: Of 2488 eligible infants, 197 (7.9%) received ECPR. 83% of surviving infants had follow-up data. Demographic and outcomes data are summarized below in Table 1 and 2 respectively.

Bendamustine and rituximab in combination with lenalidomide in patients with chronic lymphocytic leukemia

PURPOSE

A phase I/II trial to assess safety and efficacy of the combination bendamustine, rituximab, and lenalidomide (BRL) in patients with chronic lymphocytic leukemia (CLL).

PATIENTS AND METHODS

Seventeen relapsed or refractory (R/R) and five previously untreated (FL) CLL patients were enrolled in the trial. In the R/R cohort, four different dose levels of lenalidomide (maximum 15 mg/d) were used. In the FL cohort, lenalidomide was dose escalated from 5 mg/d to 15 mg/d. Bendamustine was used at doses of 50 or 90 mg/m(2) for R/R or FL treatment, respectively. 375 mg/m(2) Rituximab were used for the first and 500 mg/m(2) for subsequent treatment courses. Treatment consisted of up to six courses of 28 d.

RESULTS

The maximal tolerable dose of lenalidomide was 5 mg/d. The response rate was 47.1% in R/R and 60% in FL patients. Median progression-free survival was 8.0 months. Median overall survival was 22.9 and 12.3 months, respectively, in R/R and FL patients. Grade 3/4 hematological toxicity was observed in 71.4%, and severe infections in 47.6% of patients. Due to high toxicity and low response rate of BRL, the trial was closed prematurely.

CONCLUSION

BRL was associated with a high toxicity rate, a high number of treatment interruptions, and a low remission rate. Therefore, BRL cannot be considered an appropriate treatment option for patients with CLL.

A qualitative exploration of the experiences of children with spina bifida and their parents around incontinence and social participation

BACKGROUND

Urinary incontinence is frequently experienced by children with spina bifida, putting them at increased risk for low self-esteem and impacting upon participation in home, school and leisure activities. However, little is known about children's experiences of these continence issues.

OBJECTIVE

This study explored the experiences of children and young people with spina bifida around continence issues, social participation and peer relationships, in order to identify potential areas of support healthcare professionals can provide.

METHODS

Children and youth aged 6-18 years with diagnoses of spina bifida and neurogenic bladder and their parents were invited to participate in semi-structured interviews. Descriptive thematic analysis was employed.

RESULTS

Eleven children (with a range of mobility levels, types of spina bifida and degrees of bladder control) and their parents participated in the study. Three broad themes were identified, which encompassed the following: (1) normal versus different; (2) independence, ownership and the road to continence; and (3) peer relationships and acceptance.

DISCUSSION

The experiences discussed by the children and parents in this study ranged from minimal impact of incontinence on their day-to-day living to significant social isolation and rejection. The stigma of incontinence was apparent in all interviews. Children and youth who were able to control their bladder with minimal accidents had greater independence and more opportunities for social participation. Healthcare professionals need to take into account that parents and their children may differ in attitudes and desires about the management of incontinence.

Tropheryma whipplei in children with diarrhoea in rural Ghana

Tropheryma whipplei has been hypothesized to be able to cause diarrhoea, but data from young children are scarce. In this hospital-based case-control study 534 stool samples of children aged between 2 months and 15 years from rural Ghana were analysed for the presence of T. whipplei. Overall stool prevalence of T. whipplei was high (27.5%). Although there was no difference in T. whipplei carriage overall between cases and controls, cases aged between 0 and 12 months carried T. whipplei in their stool twice as often as controls without diarrhoea. The results from this study may support the hypothesis that T. whipplei can cause diarrhoea in first-time infection.

Radiologic and functional evaluation of electrode dislocation from the scala tympani to the scala vestibuli in patients with cochlear implants

BACKGROUND AND PURPOSE

Localization of the electrode after cochlear implantation seems to have an impact on auditory outcome, and conebeam CT has emerged as a reliable method for visualizing the electrode array position within the cochlea. The aim of this retrospective study was to evaluate the frequency and clinical impact of scalar dislocation of various electrodes and surgical approaches and to evaluate its influence on auditory outcome.

MATERIALS AND METHODS

This retrospective single-center study analyzed a consecutive series of 63 cochlear implantations with various straight electrodes. The placement of the electrode array was evaluated by using multiplanar reconstructed conebeam CT images. For the auditory outcome, we compared the aided hearing thresholds and the charge units of maximum comfortable loudness level at weeks 6, 12, and 24 after implantation.

RESULTS

In 7.9% of the cases, the electrode array showed scalar dislocation. In all cases, the electrode array penetrated the basal membrane within 45° of the electrode insertion. All 3 cases of cochleostomy were dislocated in the first 45° segment. No hearing differences were noted, but the charge units of maximum comfortable loudness level seemed to increase with time in patients with dislocations.

CONCLUSIONS

The intracochlear dislocation rate of various straight electrodes detected by conebeam CT images is relatively low. Scalar dislocation may not negatively influence the hearing threshold but may require an increase of the necessary stimulus charge and should be reported by the radiologist.