Managing incidental findings and disclosure of results in a paediatric research cohort - the LIFE Child Study cohort

OBJECTIVE

To assess the frequency of incidental findings (IFs) in the population-based "Leipzig Research Centre for Civilization Diseases (LIFE) Child Study" within 1 year.

METHODS

From July 2011 to June 2012, 969 children participated in the study. The IFs were analysed with respect to age, gender, type of examination and clinical action taken.

RESULTS

The IFs were detected in 63 participants (6.5%), including five children who presented with two IFs simultaneously. Eleven children received a new, hence previously unknown, clinical diagnosis. Alternatively, 18 IFs could not be confirmed or were of a transient and self-limiting condition. The frequency of IFs varied widely depending on the type of examination, but did not differ by gender.

CONCLUSION

Although IFs were common events, there was no finding with a profound clinical impact on the subject's life. Our current IF management protocol may be useful in creating management plans for other cohort studies.

Monitoring and engineering reactor microbiomes of denitrifying bioelectrochemical systems

Elucidating the structure–function relationship of a denitrifying biocathodes.

Management of patients with Cushing's disease: a Canadian cost of illness analysis

BACKGROUND

Cushing's disease (CD) is a rare disorder caused by increased pituitary secretion of adrenocorticotropic hormone (ACTH) resulting in elevated production of cortisol. It is associated with multiple adverse cardiovascular, metabolic, musculoskeletal and mental consequences. Patients with CD require substantial health care resources both in terms of treatments with a curative intent and control of disease related co-morbidities. In this study, a cost of illness analysis was conducted to estimate the direct cost of CD care in Canada.

METHODS

This was a retrospective cohort study of 86 CD patients. Data collection included patient demographic and disease related information, existing comorbidities, treatments received and all clinical outcomes. In addition, healthcare resource utilization to manage CD was also collected. Once the mean cost per patient was determined, the overall disease prevalence was used to estimate the total direct cost of illness in Canada.

RESULTS

The sample included 86 CD patients, with a mean age of 43 years at diagnosis, 72% were female. All received a first line intervention consisting of transsphenoidal pituitary surgery (78%), bilateral adrenalectomy (5%), radiation therapy (5%) or medical therapy ± radiation (13%). In addition, 18 and 14 patients subsequently received a second and third line intervention, respectively. The mean cost was $85,946 per patient over the first three lines of therapy. Combining this estimate with the reported disease prevalence (5.5 patients per 100,000 [95%CI: 4.2 to 6.8]), the total direct cost of CD in Canada was estimated to be approximately $80.6 million (95%CI: $61.5 to $99.6 million) over the first 3 lines of therapy.

CONCLUSIONS

CD is a debilitating condition that is associated with substantial health care costs. Strategies that provide clinical cure or long term disease control need to be identified to reduce patient morbidity and to save health care costs in patients who remain uncontrolled.

Registered Replication Report: Schooler and Engstler-Schooler (1990)

Trying to remember something now typically improves your ability to remember it later. However, after watching a video of a simulated bank robbery, participants who verbally described the robber were 25% worse at identifying the robber in a lineup than were participants who instead listed U.S. states and capitals-this has been termed the "verbal overshadowing" effect (Schooler & Engstler-Schooler, 1990). More recent studies suggested that this effect might be substantially smaller than first reported. Given uncertainty about the effect size, the influence of this finding in the memory literature, and its practical importance for police procedures, we conducted two collections of preregistered direct replications (RRR1 and RRR2) that differed only in the order of the description task and a filler task. In RRR1, when the description task immediately followed the robbery, participants who provided a description were 4% less likely to select the robber than were those in the control condition. In RRR2, when the description was delayed by 20 min, they were 16% less likely to select the robber. These findings reveal a robust verbal overshadowing effect that is strongly influenced by the relative timing of the tasks. The discussion considers further implications of these replications for our understanding of verbal overshadowing.

An erosion sensor based on a quartz crystal microbalance for quantitative determination of the cleaning efficiency in an ultrasonic vessel

The efficiency of ultrasonic cleaning vessels cannot be measured directly in an easy way. In the presented work, a sensor is developed which quantitatively measures the ablation of a test layer. The sensor element is a quartz crystal which is coated with a sacrificial layer. Small changes in mass of this layer can be measured by a frequency shift of the crystal oscillation. For measurements, a 10 MHz AT-cut quartz crystal was used in a cleaning vessel working at 44.9 kHz. To determine the frequency shift by the ablation of the test layer, the quartz crystal was driven by a frequency generator sweeping the frequency in the range of the resonance frequency and a characteristic frequency was determined. The test layer which was applied to the quartz crystal consisted of silica microparticles suspended in varnish. In a preliminary experiment using a commercial cleaner it could be shown that significant changes in resonance frequency by cavitation effect could be detected. The initial frequency shift of the sacrificial layer is reproducible within 10%. The test layer can be adapted to the conditions of the cleaning vessel. By changing the electrical input power of the vessel, a threshold in the cavitation erosion was found.

The development of diet-induced obesity and glucose intolerance in C57BL/6 mice on a high-fat diet consists of distinct phases

High-fat (HF) diet-induced obesity and insulin insensitivity are associated with inflammation, particularly in white adipose tissue (WAT). However, insulin insensitivity is apparent within days of HF feeding when gains in adiposity and changes in markers of inflammation are relatively minor. To investigate further the effects of HF diet, C57Bl/6J mice were fed either a low (LF) or HF diet for 3 days to 16 weeks, or fed the HF-diet matched to the caloric intake of the LF diet (PF) for 3 days or 1 week, with the time course of glucose tolerance and inflammatory gene expression measured in liver, muscle and WAT. HF fed mice gained adiposity and liver lipid steadily over 16 weeks, but developed glucose intolerance, assessed by intraperitoneal glucose tolerance tests (IPGTT), in two phases. The first phase, after 3 days, resulted in a 50% increase in area under the curve (AUC) for HF and PF mice, which improved to 30% after 1 week and remained stable until 12 weeks. Between 12 and 16 weeks the difference in AUC increased to 60%, when gene markers of inflammation appeared in WAT and muscle but not in liver. Plasma proteomics were used to reveal an acute phase response at day 3. Data from PF mice reveals that glucose intolerance and the acute phase response are the result of the HF composition of the diet and increased caloric intake respectively. Thus, the initial increase in glucose intolerance due to a HF diet occurs concurrently with an acute phase response but these effects are caused by different properties of the diet. The second increase in glucose intolerance occurs between 12-16 weeks of HF diet and is correlated with WAT and muscle inflammation. Between these times glucose tolerance remains stable and markers of inflammation are undetectable.

[The relationship between the temperature increase caused by phacoemulsification and the damage to the corneal endothelium]

PURPOSE

Endothelial cell damage can be found after a phacoemulsification. The reason for this cell damage is not yet known. The temperature rise inside the anterior chamber during the emulsification of the lens is considered as a potential damage mechanism. The aim of this study was to investigate the relationship between the temperature increase and the cell damage.

MATERIALS AND METHODS

This study was performed with 86 enucleated porcine eyes, which were divided into six groups A-F. Group A served as control group. Phacoemulsification was simulated in the groups B-E with different surgically relevant system settings. The temperature change was measured simultaneously with temperature sensors inside the anterior chamber. Inside the eyes of group F, the instruments were positioned and irrigation and aspiration were activated, but no ultrasound was applied. For all 86 corneas, the endothelial cell damage was quantified with a standardised evaluation protocol using scanning electron microscopy (SEM). A potential correlation was checked between the observed cell damage and the measured temperature rise.

RESULTS

The highest temperature increase in group E with an obstructed aspiration line and an output power setting of 50 % was 17.77 °C. The temperature increase in group D with an output power setting of 100 % and unblocked fluid flow was significantly lower (p = 0.006). The highest temperature increase in group D was 8.89 °C. In contrast, the cells in group D were rated with a significantly lower score value than the cells in group E (p < 0.001). No significant correlation between the temperature rise and the cell damage could be obtained in due consideration of all measured data. However, an increase of the output power setting was connected with a non-linear increase of the cell loss.

CONCLUSION

The temperature rise was not the main reason for the endothelial cell damage in the performed experiments. Therefore, there seems to be no causal relationship between the temperature increase inside the anterior chamber during a common phacoemulsification and the endothelial cell damage. Due to the strong dependence between the output power setting and the cell damage, the lowest output power setting should be used during surgery which ensures the emulsification of the nucleus.

Temporal structure coding with and without awareness

In order to interpret a constantly changing environment, visual events far apart in space and time must be integrated into a unified percept. While spatial properties of invisible signals are known to be encoded without awareness, the fate of temporal properties remains largely unknown. Here, we probed temporal integration for two distinct motion stimuli that were either visible or rendered invisible using continuous flash suppression. We found that when invisible, both the direction of apparent motion and the gender of point-light walkers were processed only when defined across short time periods (i.e., respectively 100 ms and 1000 ms). This limitation was not observed under full visibility. These similar findings at two different hierarchical levels of processing suggest that temporal integration windows shrink in the absence of perceptual awareness. We discuss this phenomenon as a key prediction of the global neuronal workspace and the information integration theories of consciousness.

The mitochondrial Atp8 mutation induces mitochondrial ROS generation, secretory dysfunction, and β-cell mass adaptation in conplastic B6-mtFVB mice

Mutations in mitochondrial DNA (mtDNA) cause a variety of pathologic phenotypes. In this study, we used conplastic mouse strains to characterize the impact of a mtDNA mutation in the Atp8 gene on β-cell function, reactive oxygen species (ROS) generation, β-cell mass, and glucose metabolism in response to high-fat diet (HFD). In comparison with B6-mt(AKR) controls, the B6-mt(FVB) strain carries a point mutation of the mtDNA-coded Atp8 gene (ATP synthase), leading to a fragmentated mitochondrial phenotype. Isolated pancreatic islets from 3-month-old B6-mt(FVB) mice showed increased mitochondrial generation of ROS, reduced cellular ATP levels, reduced glucose-induced insulin secretion, higher susceptibility to palmitate stress, and pathological morphology of mitochondria. ROS generation in β-cells was not affected by changes of the ambient glucose concentrations. Feeding a HFD for 3 months resulted in impaired glucose tolerance in B6-mt(FVB) mice but not in B6-mt(AKR) controls. In B6-mt(FVB) animals, glucose intolerance positively correlated with gain of body weight. Serum insulin levels and β-cell mass significantly increased in B6-mt(FVB) mice after a 3-month HFD. The data indicate that the mutation in the Atp8 gene induces mitochondrial dysfunction in β-cells with concomitant impairment of secretory responsiveness. This mitochondrial dysfunction induced a higher susceptibility to metabolic stressors, although this effect appeared not strictly linked to nutrient-induced ROS generation. The Atp8 gene mutation caused mitochondrial dysfunction, apparently stimulating an adaptive increase of β-cell mass in response to HFD, whereas mitochondrial ROS might have had an supportive role.

[Near-infrared spectroscopy in sepsis therapy : predictor of a low central venous oxygen saturation]

BACKGROUND

Early goal-directed hemodynamic optimization has become a cornerstone of sepsis therapy. One major defined goal is to achieve adequate central venous oxygen saturation (SO(2)). This study aimed to investigate the correlation between central venous SO(2) and frontal cerebral near-infrared spectroscopy (NIRS) measurement in patients with severe sepsis and septic shock. The NIRS method provides non-invasive measurement of regional oxygen saturation (rSO(2)) in tissues approximately 2 cm below the optical NIRS sensors which depends on arterial, capillary and venous blood. Thus this system gives site-specific real-time data about the balance of oxygen supply and demand.

METHODS

This was a secondary analysis from a prospective study of surgical intensive care (ICU) patients in the early phase of severe sepsis or septic shock. Bilateral cerebral rSO(2), central venous SO(2), arterial oxygen saturation (S(a)O(2)) and other surrogate parameters of oxygen supply, such as hemoglobin, partial pressure of oxygen and oxygen content in arterial blood were recorded.

RESULTS

A total of 16 ICU patients (4 women, median age 65.5 years) were included in the study. As sepsis focus an intra-abdominal infection was detected in 62.5 % of patients, severe pneumonia was determined in 31.3 % and skin and soft tissue infections were recognized in 12.5 %. At study inclusion 50 % of patients had septic shock, the median sequential organ failure assessment (SOFA) score was 10.2 (interquartile range 5.25-8.75) and the median acute physiology and chronic health evaluation II (APACHE II) score was 26 (range 23.25-29.75). Mortality at day 28 was 37.5 %. Minimum rSO(2) (median 58) and right-sided rSO(2) (median 58) values showed a significant correlation in the analysis of receiver operating characteristics (area under the curve 0.844, p= 0.045). A central venous SO(2)< 70 % was indicated by rSO(2)< 56.5 with sensitivity and specificity of 75 % and 100 %, respectively.

CONCLUSIONS

Cerebral NIRS could provide a fast and easily available side effect-free monitoring that could be used in addition to established procedures for goal-directed treatment in the early phase of sepsis. Further studies should be made in a larger population to verify the correlation found and to investigate the impact of NIRS-directed resuscitation treatment in early sepsis.

How do patients' preferences compare to the present spectrum of diabetes research?

OBJECTIVE

To compare patients' preferences in diabetes research to the current scientific research spectrum as presented during annual meetings of the European Association for the Study of Diabetes (EASD).

METHODS

After dividing all scientific activities in diabetes research into 9 main fields, a questionnaire was published in a popular German weekly news magazine, inviting diabetic patients to express their research preferences. Thereafter, all abstracts accepted for publication at 2 recent EASD meetings were allocated to one of these research fields.

RESULTS

In May and July 2011 the questionnaire was answered by 652 patients with diabetes, 205 relatives and 61 other persons interested. The most important research fields were "development, pathophysiology and prevention of diabetes" (25.6%), "transplantation and cell therapy" (19.4%) and "blood glucose measurement and artificial pancreas" (16.5%). The most often covered topic of the 2,645 EASD abstracts was "development, pathophysiology and prevention" (46.3%), followed by "diabetes complications in man" (17.5%) and "special situations, training, psychology, treatment- and care structures" (10.5%).

CONCLUSION

Views of diabetic patients and their relatives regarding their preferred research fields may differ when compared to current scientific activity in diabetology. Diabetic patients and their relatives should be involved in the weighting and selection of research topics more often.

Clonal re-introduction of endangered plant species: the case of German False Tamarisk in pre-alpine rivers

The scope of re-introduction as a measure for plant species protection is increasing, but as long as no standardized methods are available, species-specific assessments are necessary to determine whether seeds, adult plants or plant fragments should be used. The endangered German False Tamarisk (Myricaria germanica), which occurs on gravel bars along pre-alpine rivers, is difficult to grow from seeds. Thus, propagation of stem cuttings was investigated as an alternative method. Experiments were conducted in a greenhouse and a field site with three treatments: cutting length 5 or 10 cm, vertical burial 5 or 10 cm, and water level low or high. Plants grown in the greenhouse were transplanted to the River Isar to test establishment of rooted cuttings on gravel bars. The cuttings in the greenhouse showed high survival (34-96 %). Survival and biomass production were greatest for 10-cm cuttings buried at 10-cm depth, while only one of the 5-cm cuttings survived at this depth, and no significant effect of variation in water level was observed. None of the cuttings transplanted to field sites survived, most likely because of drought stress and competition. We conclude that for re-introduction of Myricaria germanica rooted cuttings can be easily produced in large quantities, while transplantation to near-natural environments has to be improved to reduce mortality.

Image Signature: Highlighting Sparse Salient Regions

We introduce a simple image descriptor referred to as the image signature. We show, within the theoretical framework of sparse signal mixing, that this quantity spatially approximates the foreground of an image. We experimentally investigate whether this approximate foreground overlaps with visually conspicuous image locations by developing a saliency algorithm based on the image signature. This saliency algorithm predicts human fixation points best among competitors on the Bruce and Tsotsos [1] benchmark data set and does so in much shorter running time. In a related experiment, we demonstrate with a change blindness data set that the distance between images induced by the image signature is closer to human perceptual distance than can be achieved using other saliency algorithms, pixel-wise, or GIST [2] descriptor methods.

[Intrathoracic esophageal perforation of unknown cause in four horses]

Three horses (age 17 - 23 years) were referred to the equine clinic of the University of Berne due to colic, fever, tachycardia and tachypnea. All horses showed pleural effusion. Clinical findings in 2 of the horses were highly suggestive of an intra-thoracic esophageal perforation. Severe septic pleuropneumonia without suspicion of an esophageal lesion was diagnosed in the 3rd horse. In addition, an 11 year old stallion was referred to the equine clinic for treatment of a presumptive large colon impaction. The horse was given laxatives after nasogastric intubation. Subsequent dramatic clinical deterioration and signs consistent with severe pleuropneumonia suggest that esophageal perforation had occurred when passing the nasogastric tube. All 4 horses were euthanized due to a poor prognosis. Esophageal perforation was diagnosed or confirmed post mortem in all cases. A hypertrophy of the tunica muscularis of the intra-thoracic esophagus was found in 3 of 4 horses.

The life cycle of the amoeboid alga Synchroma grande (Synchromophyceae, Heterokontophyta)--highly adapted yet equally equipped for rapid diversification in benthic habitats

Synchroma grande (Synchromophyceae, Heterokontophyta) is a marine amoeboid alga, which was isolated from a benthic habitat. This species has sessile cell stages (amoeboid cells with lorica and cysts) and non-sessile cell stages (migrating and floating amoebae) during its life cycle. The different cell types and their transitions within the life cycle are described, as are their putative functions. Cell proliferation was observed only in cells attached to the substrate but not in free-floating or migrating cells. We also characterised the phagotrophy of the meroplasmodium in comparison to other amoeboid algae and the formation of the lorica. The functional adaptations of S. grande during its life cycle were compared to the cell stages of other amoeboid algae of the red and green chloroplast lineages. S. grande was found to be highly adapted to the benthic habitat. One sexual and two asexual reproductive strategies (haplo-diploid life cycle) support the ability of this species to achieve rapid diversification and high adaptivity in its natural habitat.

Novel assays to assess the functional capacity of the classical, the alternative and the lectin pathways of the complement system

Deficiencies in many of the complement proteins and their regulatory molecules have been described and a variety of diseases, such as recurrent infections, systemic lupus erythematosus (SLE) and renal diseases, may be linked to deficiency in the complement system. Screening for complement defects is therefore of great importance. In this study, we present novel improved enzyme-linked immunosorbent assays for the functional assessment of the three individual pathways of the complement system. The method is applicable at high serum concentrations and we demonstrate that it minimizes both false negative as well as false positive results. In particular, for the functional mannose-binding lectin activity it represents an improvement on the existing assays. In this respect, the present assays represent novel improved diagnostic protocols for patients with suspected immunodeficiencies related to the complement system.