Invasion windows for a global legume invader are revealed after joint examination of abiotic and biotic filters

Successful alien plant invasion is influenced by both climate change and plant-plant interactions. We estimate the single and interactive effects of competition and extreme weather events on the performance of the global legume invader Lupinus polyphyllus (Lindl.). In three experimental studies we assessed (i) the stress tolerance of seedling and adult L. polyphyllus plants against extreme weather events (drought, fluctuating precipitation, late frost), (ii) the competitive effects of L. polyphyllus on native grassland species and vice versa, and (iii) the interactive effects of extreme weather events and competition on the performance of L. polyphyllus. Drought reduced growth and led to early senescence of L. polyphyllus but did not reduce adult survival. Fluctuating precipitation events and late frost reduced the length of inflorescences. Under control conditions, interspecific competition reduced photosynthetic activity and growth of L. polyphyllus. When subjected to competition during drought, L. polyphyllus conserved water while simultaneously maintaining high assimilation rates, demonstrating increased water use efficiency. Meanwhile, native species had reduced performance under drought. In summary, the invader gained an advantage under drought conditions through a smaller reduction in performance relative to its native competitors but was competitively inferior under control conditions. This provides evidence for a possible invasion window for this species. While regions of high elevation or latitude with regular severe late frost events might remain inaccessible for L. polyphyllus, further spread across Europe seems probable as the predicted increase in drought events may favour this non-native legume over native species.

[Pain and poverty]

BACKGROUND

Poverty is an important problem in Germany. The health effects of poverty can lead to a higher risk of disease and the arising of chronic affections. On the other hand chronic illness may support the development and continuance of poverty. The context of chronic pain and poverty has not been analyzed so far.

OBJECTIVES

We investigated the correlation between chronic pain and poverty.

MATERIALS AND METHODS

In a prospective manner we interviewed 20 patients with pain syndromes during our consultation hour regarding their household income. Further, data from the German Federal Statistical Office were analyzed with respect to the correlation between the incidence of a chronic pain diagnosis and household income.

RESULTS

At 1546 €, the average household income of the patients studied was below the poverty level. The analyzed data showed that women suffered from chronic pain more often than men did and also had a lower income. Another economic inequality was found between Eastern and Western Germany. There was a statistically significant correlation between income and the incidence of the diagnostic codes for chronic pain (R52.1, 2, 9) for men.

CONCLUSION

Our investigation showed the correlation between chronic pain and poverty. A commitment and cooperation of German medical associations and federal politics is necessary to overcome this sociopolitical issue.

Intraoperative point-of-care assessment of an inflammatory biomarker in chronic subdural hematomas: Technical note

OBJECTIVE

Inflammatory processes have been associated with the development and recurrence of chronic subdural hematomas (cSDH). Elevated levels of presepsin, a truncated N-terminal fragment of soluble CD14, occur in various inflammatory conditions of bacterial and non-bacterial origin. Here we report on our initial experiences with the intraoperative point-of-care (POC) assessment of presepsin in patients treated for cSDH.

PATIENTS AND METHODS

The POC analyser Pathfast® was used in 21 patients treated for cSDH at our institution. Prior to surgery, levels of C-reactive protein (CRP) and white blood cells (WBC) were assessed. After burr hole trephination and dura incision, samples of subdural fluid and whole blood were collected and immediately assessed with the POC analyser. Values of presepin were compared between samples of the subdural compartment and whole blood.

RESULTS

Presepsin levels were assessed within 13 min in all patients and no technical difficulties occurred. Compared to the reported normal range values of presepsin (55-184 pg/mL), mean levels of presepsin in samples of the subdural compartiment was increased more than 5-fold (821 ± 110.1 pg/mL). Furthermore, mean presepsin values in samples of the subdural compartiment were significantly higher than in samples of whole blood (154.8 ± 19.2 pg/mL; p < 0.0001).

CONCLUSION

POC assessment of the inflammatory biomarker presepsin is feasible within minutes during surgical treatment of cSDH. Corresponding to previous studies, presepsin levels were highly elevated in the subdural fluid, indicating processes of inflammation. Whether results of intraoperative POC assessment of inflammatory biomarkers is associated with outcome parameters in patients treated for cSDH has to be addressed in further studies. In our view, there is a role for this promising technique in improving future treatment strategies in respective patients.

Abstract PD6-03: Pilot project assessing the impact of self-care techniques on post-surgical pain, fatigue, and inflammation

More than one third of women diagnosed with breast cancer experience significant emotional distress, which may then effect pain perception, wound healing, quality of life (QOL), and return to physical function. Several studies have shown that physical and cognitive relaxation strategies may relieve perioperative anxiety, leading to improved postoperative pain and QOL.

One hundred women from Brooke Army Medical Center with non-metastatic breast cancer, planning to undergo surgery as initial treatment, were randomly assigned using an intention-to-treat model to either the treatment as usual group (TAU; n = 49) or TAU plus a self-care toolkit (SCT; n=51). The SCT included audio-recordings of guided mind-body techniques (breathing, progressive muscle relaxation, meditation, guided imagery, and self-hypnosis), an acupressure anti-nausea wristband, and a workbook with instructions for use of the tools plus a section to journal the cancer experience.

Pain, anxiety, nausea, sleep, fatigue, global health, and QOL were assessed using the Defense and Veterans Pain Rating Scale (DVPRS), the 10-cm Visual Analog Scale (VAS), and the NIH PROMIS-57 subscales. Data was collected at baseline (T1), immediately prior to surgery (T2), within 10 hours post-operatively (T3), and approximately two weeks post-surgery (T4). Two inflammatory blood markers (ESR and CRP) were measured at T1, T2, and T4. Due to diurnal variability of ESR and CRP, laboratory draws were generally collected prior to 10:00 AM. Categorical variables and frequency counts were analyzed using Chi-Squared or Fisher's Exact tests, whichever was most appropriate. Means and standard deviations were used as summary statistics for continuous variables and analyzed using Student's t-test, ANOVA, and/or Wilcoxon's Test. For data measured at two time points, the delta change in values was calculated to detect within-group differences in SCT and TAU using Wilcoxon's rank sum test or paired t-test. For factors measured at more than two time points, a two-way repeated measures ANOVA was implemented with a Bonferroni corrected post-hoc analysis to determine between-group differences at each time point.

Between T1 and T4, there were significant between group differences in PROMIS-57 scores of Pain Interference, Fatigue, and Satisfaction With Social Roles, favoring the SCT group compared to TAU (p=0.005, p=0.023, and p=0.021, respectively). There was a significant mean change in DVPRS scores from T2 to T3, with the SCT group having significantly smaller increases in post-operative pain (p=0.008) and in post-operative ESR (p=0.0197) compared with the TAU group. Clinically significant reductions in anxiety occurred in the SCT group during the main intervention period. These results suggest that using the SCT in the perioperative period decreased pain perceptions, fatigue, and inflammatory cytokine secretion.

The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force and Department of Defense or the U.S. Government.

Citation Format: Setlik RF, Inman A, Peacock K, Aden J, Paat C, Stoerkel E, Bellanti D, Walter J. Pilot project assessing the impact of self-care techniques on post-surgical pain, fatigue, and inflammation [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-03.

[Not Available]

Traumatische Verletzungen des zentralen Nervensystems stellen die Folge einer äußeren Gewalteinwirkung auf Gehirn oder Rückenmark dar. Sowohl das Schädel-Hirn-Trauma als auch das spinale Trauma sind dynamische Krankheitsbilder, die besondere Anforderungen an Diagnostik und Therapie stellen und somit in spezialisierten Zentren versorgt werden sollten.

[Traumatic Injuries of the Central Nervous System]

The term "traumatic injuries of the central nervous system" (CNS) refers to both traumatic brain injury (TBI) as well as traumatic spinal cord injury (SCI). Both types of injuries substantially contribute to morbidity and mortality in developed as well as developing countries. The underlying pathophysiological processes are very complex and despite extensive research efforts they are still not completely understood. Therefore, traumatic injuries to the CNS pose special challenges for preclinical and clinical management. Thus, in order to treat these conditions effectively an interdisciplinary treatment approach consisting of intensive conservative as well as operative treatment options in specialized centers experienced in the treatment of patients with traumatic injuries of the CNS is necessary. This review summarizes the epidemiology, pathophysiology, diagnostic approaches as well as current preclinical and clinical treatment options based on current guidelines and literature. Finally, the prognosis for both conditions is outlined.

Evaluation of the statutory surveillance system for invasive MRSA infections in Germany, 2016-2017

BACKGROUND

Mandatory notification of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections was introduced for laboratories in Germany in 2009. The aims were to support local health authorities (LHAs) in their mandate to prevent and control infections in hospitals and to improve population-based nationwide surveillance of healthcare associated infections. We evaluated the MRSA surveillance system to assess whether its aims were met and to identify areas for improvement.

METHODS

Using the updated guidelines for evaluating public health surveillance systems by the Centers for Disease Control and Prevention we assessed the attributes simplicity, timeliness, data quality, acceptability, and usefulness. In 2016/2017 we interviewed staff in LHAs, state health authorities (SHAs), and laboratories and analyzed surveillance data of cases notified between 2009 and 2016.

RESULTS

We interviewed 10% of LHAs (n = 38), 63% of SHAs (n = 10), 5 selected laboratories and analyzed information on 27,706 notified MRSA cases. LHAs reported that on receiving notifications from laboratories they contacted hospitals for clinical information, which was time-consuming and complicated as physicians were hard to reach or refused to answer questions, citing doctor-patient confidentiality. LHAs suggested reducing the amount of information collected as some clinical information was unnecessary for implementing control measures. LHAs stated that they received notifications on time, however surveillance data analysis showed some delay. Data completeness exceeded 90% for most variables, however it was only 68% and 80% for dates of disease onset and hospital admission respectively making it impossible to discriminate between hospital and community acquired infections in half of the cases. The surveillance system was well accepted by half of the interviewees. A third however stated that the benefits of the surveillance system were outweighed by the work associated with it. The majority rated the system to be useful for recognizing trends in the MRSA incidence and the ability to check up on infection control measures in hospitals.

CONCLUSIONS

The surveillance system proved to be useful by fulfilling its aims. It was timely, acceptable and provided complete data for most variables. However, the system was complicated; ensuring that only relevant variables are reported could simplify the system without losing any of its usefulness.

Clival Chondrosarcoma Associated With an Intra-Axial Cystic Medullary Lesion Responsive to Steroids

Introduction: Here we present a 75-year-old patient who was admitted with acute-onset right-sided hemiparesis, dysphagia, dysarthria and nystagmus. Repeated MRI scans showed two lesions with contact to one another: one solid stationary extra-axial lesion at the caudal part of the clivus and a rapidly growing intra-axial cystic lesion at the level of the medulla oblongata. Biopsy of the solid lesion demonstrated a low-grade chondrosarcoma, while no tissue sample of the cystic lesion could be retrieved. After initiation of dexamethasone therapy the cystic lesion markedly regressed.

Background: A literature search on published cases with the same combination of a stationary solid extra-axial mass at the caudal part of the clivus and a growing intra-axial cystic mass in the medulla oblongata was negative, indicating that the case described here is both unique and novel.

Discussion: Considering the rapid progression of symptoms and growth on MR-imaging in combination with the marked response to steroids, an inflammatory response linked to the chondrosarcoma is most likely. At the same time other possible explanations as a second neoplasm, an abscess or an ischemic lesion seem unlikely.

Concluding remarks: This case underlines an unusual complication of a rare brainstem tumor and outlines both the differential diagnosis and potential treatment options. For such cystic lesions in combination with chondrosarcoma, a treatment course with steroids should be considered along with surgical exploration necessary to obtain the diagnosis and for potential reduction of mass-effect on the medulla oblongata.

Six Novel and Three Recurrent Mutations in Nine Austrian Patients with Hemophilia B

In this report we describe the molecular basis of the factor IX (FIX) deficiency in nine patients with severe (n = 6), moderate (n = 1) or mild (n = 2) hemophilia B. The following genetic defects were identified by enzymatic amplification with the polymerase chain reaction (PCR) and subsequent direct sequencing of all exons and exon-intron-junctions: patient B.B. (FIX “Vienna I”): deletion of nucleotides 6343 to 6362; patient M.H. and W. J. (FIX “Vienna II”): nucleotide 17704 (C to G), Gin 97 to Glu; patient L. K. (FIX “Vienna III”): nucleotide 17761 (C to T), Arg 116 to stop; patient U. A. (FIX “Vienna IV”): nucleotide 10415 (C to G), Pro 55 to Ala; patient H.G. (FIX “Vienna V”): nucleotide 6488 (C to T), Thr 38 to lie; patient H. M. (FIX “Vienna VI”): nucleotide 31276 (G to C), Trp 385 to Cys; patient L. C. (FIX “Vienna VII”): deletion of nucleotide 6700; patient S.F. (FIX “Vienna VIII”): nucleotide 10392 (A to T), Asp 47 to Val. The causative mutation was detected in the FIX gene in each of the nine patients with hemophilia B. There was one small deletion, one point deletion and seven point mutations. The latter include six missense mutations and one nonsense mutation. The mutations in Vienna III, IV and V have already been described in previous studies. The two deletions, Vienna I and Vienna VII have not been reported previously. The genetic defects observed in Vienna II, VI and VIII are novel missense mutations which result in amino acid changes at residues 97,47 and 385, respectively.

Ionomer and protein size analysis by analytical ultracentrifugation and electrospray scanning mobility particle sizer

By combining analytical ultracentrifugation (AUC) in liquid phase and scanning mobility particle sizer (SMPS) in the gas phase, additional information on the particle size and morphology has been obtained for rigid particles. In this paper, we transfer this concept to soft particles, allowing us to analyze the size and molar mass of the short side chain perfluorosulfonic acid ionomer Aquivion^® in a dilute aqueous suspension. The determination of the primary size and exact molar mass of this class of polymers is challenging since they are optically transparent and due to the formation of different aggregate structures depending on the concentration and solvent properties. First, validation of AUC and SMPS measurements was carried out using the well-defined biopolymers bovine serum albumin (BSA) and lysozyme (LYZ) to confirm the reliability of the results of the two unique and independent classifying methods. Then, the ionomer Aquivion^® was studied using both techniques. From the mean molar mass of 185 ± 14 kDa obtained by AUC, a mean hydrodynamic diameter of 7.6 ± 0.5 nm was calculated. The particle size obtained from SMPS (7.1 nm) agrees very well with the results from AUC showing that the molecule was transferred into the gas phase without significantly changing its structure. In conclusion, the Aquivion^® is molecularly dispersed in the used aqueous buffer solution without any aggregate formation in the investigated concentration range (< 2 g l^-1).

Lethal Ultra-Early Subarachnoid Hemorrhage Due to Rupture of De Novo Aneurysm 5 Months After Primary Aneurysmatic Subarachnoid Hemorrhage

BACKGROUND

Approximately 1% of all patients surviving rupture of a cerebral aneurysm suffer from a second aneurysmatic subarachnoid hemorrhage later in their lives, 61% of which are caused by rupture of a de novo aneurysm. Latency between bleedings is usually many years, and younger patients tend to achieve better outcomes from a second subarachnoid hemorrhage.

CASE DESCRIPTION

We report an unusual case of lethal ultra-early rupture of a de novo aneurysm of the anterior communicating artery only 5 months after the initial subarachnoid hemorrhage and complete coiling in a young, healthy male patient.

CONCLUSION

Despite complete aneurysm obliteration, young age, and good recovery, patients may be subjected to secondary subarachnoid hemorrhages from de novo aneurysms after only a few months of the initial bleeding. Early-control magnetic resonance angiography might hence be advisable.

2D analysis of polydisperse core-shell nanoparticles using analytical ultracentrifugation

Accurate knowledge of the size, density and composition of nanoparticles (NPs) is of major importance for their applications. In this work the hydrodynamic characterization of polydisperse core-shell NPs by means of analytical ultracentrifugation (AUC) is addressed. AUC is one of the most accurate techniques for the characterization of NPs in the liquid phase because it can resolve particle size distributions (PSDs) with unrivaled resolution and detail. Small NPs have to be considered as core-shell systems when dispersed in a liquid since a solvation layer and a stabilizer shell will significantly contribute to the particle's hydrodynamic diameter and effective density. AUC measures the sedimentation and diffusion transport of the analytes, which are affected by the core-shell compositional properties. This work demonstrates that polydisperse and thus widely distributed NPs pose significant challenges for current state-of-the-art data evaluation methods. The existing methods either have insufficient resolution or do not correctly reproduce the core-shell properties. First, we investigate the performance of different data evaluation models by means of simulated data. Then, we propose a new methodology to address the core-shell properties of NPs. This method is based on the parametrically constrained spectrum analysis and offers complete access to the size and effective density of polydisperse NPs. Our study is complemented using experimental data derived for ZnO and CuInS₂ NPs, which do not have a monodisperse PSD. For the first time, the size and effective density of such structures could be resolved with high resolution by means of a two-dimensional AUC analysis approach.

Comparison of eosin-thiazin and Papanicolaou-Shorr staining for endometrial cytologies of broodmares

Introduction: Exfoliative endometrial cytology is an easy and valuable diagnostic tool for the detection of inflammatory processes of the uterus that correlates well to culture results. The practical use of this procedure is limited due to the time-consuming Papanicolaou-Shorr staining technique. In this study the suitability of the rapid eosin-thiazin staining for endometrial smears was investigated. Material and methods: Sample collection was carried out with a guarded culture swab (Knudsen-catheter) in 27 broodmares during routine gynaecological examination. Two smears were prepared from each collection. One was stained according to Papanicolaou-Shorr and the second using the eosin-thiazin method (Hemacolor®, Merck). Specimens with more than 0.5% neutrophil granulocytes were classified as positive for endometritis. The presentability of polymorphonuclear neutrophils (PMN), proportion of positive/negative samples, as well as the PMN contents were compared between the two staining methods. Results: PMN were easily identifiable in both specimens. In Papanicolaou-Shorr stained smears 10 samples showed > 0.5% neutrophil granulocytes (37%), whereas in the eosin-thiazin staining 12 samples were positive (44%). Thus results corresponded in 25 mares (95%). Conclusion: Eosin-thiazin staining is a suitable staining method for endometrial smears of broodmares, which surpassed Papanicolaou-Shorr method in two cases. Clinical relevance: The use of eosin-thiazin staining provides a considerable gain of time and renders endometrial cytology more attractive for routine stud farm practice.