Recycling and Reusing of Graphite from Retired Lithium-ion Batteries: A Review

The proliferation of rechargeable lithium-ion batteries (LIBs) over the past decade has led to a significant increase in the number of electric vehicles (EVs) powered by these batteries reaching the end of their lifespan. With retired EVs becoming more prevalent, recycling and reusing their components, particularly graphite, has become imperative as the world transitions toward electric mobility. Graphite constitutes ≈20% of LIBs by weight, making it a valuable resource to be conserved. This review presents an in-depth analysis of the current global graphite mining landscape and explores potential opportunities for the "second life" of graphitefrom depleted LIBs. Various recycling and reactivation technologies in both industry and academia are discussed, along with potential applications for recycled graphite forming a vital aspect of the waste management hierarchy. Furthermore, this review addresses the future challenges faced by the recycling industry in dealing with expired LIBs, encompassing environmental, economic, legal, and regulatory considerations. In conclusion, this review provides a comprehensive overview of the developments in recycling and reusing graphite from retired LIBs, offering valuable insights for forthcoming large-scale recycling efforts.

P11.15.B First multicentric real-life experience with the combination of lomustine and temozolomide in newly diagnosedMGMT promoter methylatedIDH wildtype glioblastoma

Background

The CeTeG/NOA-09 trial assessed in a randomized phase 3 setting, whether combined treatment of lomustine together with temozolomide was superior to temozolomide treatment alone in newly diagnosed MGMT (O(6)-methylguanine-DNA-methyltransferase) promoter methylated glioblastoma patients. Survival was significantly improved from 31.4 months with temozolomide alone to 48.1 months with the combination of lomustine plus temozolomide. In view of this encouraging data - suggesting this combination could have a significant impact on the survival of newly diagnosed glioblastoma patients - we were curious to assess safety and efficacy of this regimen under real-life conditions.

Material and Methods

We collected clinical and radiographic data from adult newly diagnosed MGMT promoter methylated IDH (isocitrate dehydrogenase) wildtype glioblastoma patients treated at five neuro-oncology centers in Germany. As a requirement for inclusion, first-line treatment with lomustine plus temozolomide had to be performed for at least six weeks (one course). The available radiographic data was independently reviewed by an experienced board-certified neuro-radiologist.

Results

In total, 70 patients were included. Median progression-free survival of the full cohort was 14.4 months and median overall survival was 36.0 months. Patients who received TTFields (Tumor Treating Fields) treatment for eight weeks or longer together with the combination of lomustine plus temozolomide (n=22, 31%) had a prolonged progression-free survival compared to those patients who received TTFields treatment less than eight weeks or did not receive treatment with TTFields (n=48, 69%) (21.5 months versus 11.2 months; HR: 2.118, 95% CI: 1.245-3.605; p=0.0105). In a multivariable Cox regression analysis the use of TTFields for eight weeks or longer together with the combination of lomustine plus temozolomide as well as the application of at least five courses of CeTeG therapy emerged as independent prognostic factors for progression-free survival and overall survival. Pseudoprogression occurred in n=16 (33%) of the patients. We observed no treatment related deaths and high-grade hematotoxicity in n=31 (44%) of the patients.

Conclusion

The results from this multicentric trial that investigated newly diagnosed MGMT promoter methylated IDH wildtype glioblastoma under real-life conditions indicate toxicity and survival estimates comparable to the CeTeG/NOA-09 trial. The use of TTFields for at least eight weeks in combination with this regimen was independently associated with extended progression-free and overall survival.

Oncology clinical trial disruption during the COVID-19 pandemic: a COVID-19 and cancer outcomes study

Background

COVID-19 disproportionately impacted patients with cancer as a result of direct infection, and delays in diagnosis and therapy. Oncological clinical trials are resource-intensive endeavors that could be particularly susceptible to disruption by the pandemic, but few studies have evaluated the impact of the pandemic on clinical trial conduct.

Patients and methods

This prospective, multicenter study assesses the impact of the pandemic on therapeutic clinical trials at two large academic centers in the Northeastern United States between December 2019 and June 2021. The primary objective was to assess the enrollment on, accrual to, and activation of oncology therapeutic clinical trials during the pandemic using an institution-wide cohort of (i) new patient accruals to oncological trials, (ii) a manually curated cohort of patients with cancer, and (ii) a dataset of new trial activations.

Results

The institution-wide cohort included 4756 new patients enrolled to clinical trials from December 2019 to June 2021. A major decrease in the numbers of new patient accruals (−46%) was seen early in the pandemic, followed by a progressive recovery and return to higher-than-normal levels (+2.6%). A similar pattern (from −23.6% to +30.4%) was observed among 467 newly activated trials from June 2019 to June 2021. A more pronounced decline in new accruals was seen among academically sponsored trials (versus industry sponsored trials) (P < 0.05). In the manually curated cohort, which included 2361 patients with cancer, non-white patients tended to be more likely taken off trial in the early pandemic period (adjusted odds ratio: 2.60; 95% confidence interval 1.00-6.63), and substantial pandemic-related deviations were recorded.

Conclusions

Substantial disruptions in clinical trial activities were observed early during the pandemic, with a gradual recovery during ensuing time periods, both from an enrollment and an activation standpoint. The observed decline was more prominent among academically sponsored trials, and racial disparities were seen among people taken off trial.

Population-wide shifts in herbivore resistance strategies over succession

As a strategic cost-saving alternative to constitutive resistance, induction of resistance against herbivores in plants can be especially beneficial when enemies are scarce or variable in abundance. Although probably describing the two ends of a continuum, constitutive and induced resistance strategies have long been observed to trade off within species. Examining these traits among populations along a successional gradient can help explain how temporally variable environments can maintain genetic variation and how ecosystem processes are affected by shifting plant resistance trait expression over time. Here we leverage large experimental plots that represent a chronosequence of succession up to 15 yr in combination with common garden experiments to examine changes in the selective environment and genetic differences in tall goldenrod's (Solidago altissima) constitutive and induced resistance. We show that resistance against a specialist herbivore Trirhabda virgata was inducible in the plants originating from midsuccession, which coincides with the largest loads of herbivores. The flavonoid compound content of the leaves varied with successional stage of the population of origin, which is indicative of constitutive differences in secondary metabolite production. Finally, there was a clear trade-off between constitutive and induced resistance. Our study indicates that selection for resistance traits within a population can be highly variable over time and likely result in genetically determined shifts of resistance strategies over relatively short time periods via genotype sorting.

3D Printing in Dentistry-State of the Art

Three-dimensional (3D) printing is a rapidly developing technology that has gained widespread acceptance in dentistry. Compared to conventional (lost-wax technique) and subtractive computer numeric controlled methods, 3D printing offers process engineering advantages. Materials such as plastics, metals, and ceramics can be manufactured using various techniques. 3D printing was introduced over three decades ago. Today, it is experiencing rapid development due to the expiration of many patents and is often described as the key technology of the next industrial revolution. The transition to its clinical application in dentistry is highly dependent on the available materials, which must not only provide the required accuracy but also the necessary biological and physical properties. The aim of this work is to provide an up-to-date overview of the different printing techniques: stereolithography, digital light processing, photopolymer jetting, material jetting, binder jetting, selective laser sintering, selective laser melting, and fused filament fabrication. Additionally, particular attention is paid to the materials used in dentistry and their clinical application.

Effect of a Pulmonary Rehabilitation Program on the levels of anxiety and depression and on the quality of life of patients with chronic obstructive pulmonary disease

OBJECTIVE

To analyze the effect of a Pulmonary Rehabilitation Program (PRP) on the levels of anxiety and depression and the quality of life of patients with chronic obstructive pulmonary disease.

METHOD

Patients with chronic obstructive pulmonary disease (COPD) who completed the PRP of 3 weekly sessions of 60 min duration for 12 weeks, a total of 36 sessions, were assessed using Beck Inventory (BAI and BDI) and Saint George's Respiratory Questionnaire (SGRQ).

RESULTS

A total of 125 individuals, with an average age of 63.7 ± 8.8 years, FEV1: 1.17 ± 0.57L (43.18 ± 18.79% predicted), 61.6% male and 38.4% female, were analyzed. The BAI and BDI before and after PRP were, respectively, 10.15 ± 6.32 vs. 7.67 ± 7.21; p=0.0041 and 12.60 ± 7.99 vs. 8.96 ± 7.29; p=0.00016. The results of the SGRQ domains were, respectively, Before and After symptoms (48.53 ± 20.41 vs. 32.58 ± 18.95), Activity (69.15 ± 20.79 vs. 52.42 ± 23.70), Impact (32.92 ± 18.29 vs. 20.27 ± 16.70), Total (46.69 ± 16.90 vs. 32.07 ± 16.96). When correlating the BDI to the domains of the SGRQ, weak correlations were observed (Symptoms r=0.22; p=0.01; Activity r=0.28; p=0.001; Impact r=0.52; p=2.72; Total r=0.44; p=0.17). In the same way, weak correlations were observed when correlating the BAI to the SGRQ (Symptoms r=0.28; p=0.0009; Activity r=0.32; p=0.0005; Impact r=0.42; p=7.33; Total r=0.43; p=0.74).

CONCLUSION

Although the PRP improves levels of depression and anxiety as well as the quality of life in patients with COPD, no significant correlation of these analyzed variables was observed.

Discriminant construct validity of ImPACT™: a companion study

In a previous analysis of ImPACT scores relative to traditional neuropsychological tests (NP) and experimental tasks (Maerlender et al., 2010 ) we demonstrated convergent construct validity for the primary ImPACT test-score composites. A complete analysis of discriminant validity was not undertaken at that time. Here, test scores from the 54 collegiate football and hockey players were re-analyzed to specifically address the discriminant validity of the ImPACT™ composite scores using a multiply operationalized correlation matrix of multi-trait multi-method data. In the method used here, discriminant validity is determined by obtaining non-significant correlations between a target score when correlated with the average of the other trait measurements (multiply-operationalized multi-trait-mono-method analysis). Results showed that the ImPACT™ Verbal Memory (p = .044), Visual Memory (p = .006), and Visual Motor Speed (p = .000) scores were highly correlated with composites of the other scores, while the Reaction Time composite demonstrated adequate discriminant validity (p = .145). In comparison all of the NP composites showed good discrimination (all p-values >.05, except for Reaction Time p = .05). Thus the apparent lack of discriminability between three of four composite scores in this sample raises questions about using ImPACT™ composite scores to support specific construct-oriented interpretations. Taken together, the discriminant and convergent construct validity properties of ImPACT™ indicate construct sensitivity, but limited construct specificity.

Examination of the construct validity of ImPACT™ computerized test, traditional, and experimental neuropsychological measures

Although computerized neuropsychological screening is becoming a standard for sports concussion identification and management, convergent validity studies are limited. Such studies are important for several reasons: reference to established measures is needed to establish validity; examination of the computerized battery relative to a more traditional comprehensive battery will help understand the strengths and limitations of the computer battery; and such an examination will help inform the output of the computerized battery. We compared scores on the ImPACT™ battery to a comprehensive battery of traditional neuropsychological measures and several experimental measures used in the assessment of sports-related concussion in 54 healthy male athletes. Convergent validity was demonstrated for four of the five ImPACT™ domain scores. Two cognitive domains often compromised as a result of mild TBI were not directly identified by the ImPACT™ battery: sustained attention and auditory working memory. Affective symptoms correlated with performance on measures of attention and working memory. In this healthy sample the correlations between the domains covered by ImPACT™ and the neuropsychological battery supports ImPACT™ as a useful screening tool for assessing many of the cognitive factors related to mTBI. However, the data suggest other sources of data need to be considered when identifying and managing concussions.

The endoscopic Draf II frontal sinusotomy: non-navigated approach

OBJECTIVE

Endoscopic endonasal Draf II frontal sinusotomy is indicated for a variety of pathologies such as mucocele and non-responsive chronic frontal sinusitis. However, this approach is challenged and controversial. The objectives were to evaluate the advantages, disadvantages, indications, and rate of complications of this approach, without the use of a navigation system.

METHODS

The files and computed tomography (CT) scans of 25 patients who underwent endoscopic endonasal Draf II sinusotomy at Assaf Harofeh Medical Center between 1999 and 2002 were reviewed.

RESULTS

Thirty-one frontal sinuses were operated on and follow-up was between 18 and 62 months (average 30.3). Twenty-two sinuses (71%) had previous surgery. The Draf II procedure was used in 3.7% of all cases during the survey period. The most frequent indication for surgery was inflammation (48%) followed by mucocele (28%). In all but 2 sinuses (93%), the frontal floor between the lamina papyracea and the middle concha was drilled out. Twenty-four patients (96%) were successfully ventilated. No major complications were noted.

CONCLUSIONS

The Draf II approach can be used safely and successfully without a navigation system, including cases of revision endoscopic sinus surgery. Correct interpretation of the surgical field and a CT scan are crucial for success. Careful patient selection is essential for this procedure.

Clinical characteristics of patients with ischemic ocular nerve palsies and lacunar brain infarcts: a retrospective comparative study

BACKGROUND

Ischemic ocular motor nerve palsies (IOMP) and lacunar brain infarcts share a similar pathological mechanism. The clinical characteristics of patients as well as the protective role of aspirin should therefore be similar in both conditions.

METHODS

The medical records of 107 consecutive patients with IOMP and 160 patients with lacunar cerebrovascular accidents (CVA) were reviewed and analyzed with respect to patient characteristics, vascular risk factors, and aspirin intake. The data on patients with and without aspirin were compared within each group as well as between both groups.

RESULTS

Hyperlipidemia, smoking, high carotid stenosis (>70%) and the presence of more than one vascular risk factor in an individual patient were found to be more common in patients with lacunar brain infarcts regardless of aspirin intake. Absence of vascular risk factors was encountered more in IOMP patients. The recurrence of lacunar CVA was significantly higher than recurrence of IOMP. A history of Bell's palsy was more common in IOMP patients than in patients with lacunar CVA. Within the IOMP group, the prevalence of vascular risk factors did not differ between the aspirin and non-aspirin group. Ischemic heart disease (IHD), CVA and recurrence were found more often in the aspirin group. Within the CVA group hypertension, IHD, cardiac arrhythmia and recurrence rate were more common in the aspirin group whereas smoking was found to be more common in the non-aspirin group of patients.

CONCLUSIONS

Arteriosclerosis is the main cause of lacunar CVA and IOMP. However, IOMP depends less on the presence of vascular risk factors than does lacunar CVA. Furthermore, aspirin - at least at low doses - does not seem to have a protective effect on either of these conditions, but more extensive prospective studies of homogeneous groups of patients are needed to clarify the preventive role of antiplatelet agents in IOMP.

Omental infarction: an unusual cause of acute abdomen in children

Acute abdomen is caused by a wide variety of etiologies, many of which require surgical intervention. Two boys were hospitalized for acute abdominal pain and low-grade fever. Physical examination revealed epigastric and right upper abdominal fullness, and laboratory studies showed elevated erythrocyte sedimentation rates, with normal leukocyte counts and coagulation profiles. Abdominal ultrasound and computerized tomography revealed pseudotumor in both cases. Symptomatic treatment and cefazolin were administered, and pain and fever subsided after 6 to 10 days. Pseudotumor due to omental infarction can present as acute abdomen in children. A high index of suspicion and the use of both ultrasonography and computerized tomography will help avoid unnecessary surgical intervention in such cases.

Inner ear damage in children due to noise exposure from toy cap pistols and firecrackers: a retrospective review of 53 cases

This retrospective study presents the findings of inner ear damage documented in 53 children exposed to impulsive sound emitted by toy weapons and firecrackers. There were 49 boys and four girls aged between four and fourteen years. Thirty-nine children were affected unilaterally while fourteen had bilateral hearing loss (total of 67 ears). Most of the hearing loss (>70%) was sensorineural high frequency hearing loss, while only nine out of the 67 injured ears had sensorineural mid frequency hearing loss. Seven children sustained a traumatic ear drum perforation. Dizziness or tinnitus was reported by twenty children, with pathological ENG findings in four of them. This paper re-emphasizes the possibility of inner ear damage in children from exposure to noisy toys.

Remarkable morphological diversity of viruses and virus-like particles in hot terrestrial environments

Electron microscopic studies of the viruses in two hot springs (85 degrees C, pH 1.5-2.0, and 75-93 degrees C, pH 6.5) in Yellowstone National Park revealed particles with twelve different morphotypes. This diversity encompassed known viruses of hyperthermophilic archaea, filamentous Lipothrixviridae, rod-shaped Rudiviridae, and spindle-shaped Fuselloviridae, and novel morphotypes previously not observed in nature. Two virus types resembled head-and-tail bacteriophages from the families Siphoviridae and Podoviridae, and constituted the first observation of these viruses in a hydrothermal environment. Viral hosts in the acidic spring were members of the hyperthermophilic archaeal genus Acidianus.

Serum leptin level in women with idiopathic intracranial hypertension

Leptin is a protein secreted by adipose cells which influences regulation of energy balance and body weight. Idiopathic intracranial hypertension (IIH) is recognised as a neurological disorder mainly affecting obese females. The aim of this study was to evaluate the association between IIH and serum leptin level in 15 obese patients and compare the results with those for 16 obese and 15 non-obese women. A significantly higher serum leptin level was found in patients with IIH than in controls (p<0.0001), and this did not correlate with body mass index (BMI). Serum leptin levels were significantly associated with BMI in both control groups (p<0.0006). Additional factors must therefore be involved in the phenomenon of serum leptin increase beyond weight gain. The cause can only be hypothesised, but it seems that the origin is central, probably hypothalamic.

[Hearing disorders in children with Down's syndrome]

Among 4947 children in an outpatients unit for hearing disorders 102 children with Down's syndrome were seen and checked for hearing disorders. 57 had hearing deficiencies, 50 (88 %) conductive hearing loss, 4 (7 %) combined and 3 (5 %) a sensory neural hearing loss. Compared to other publications the number of very young children was very high. 32 patients under two years of age had a hearing disorder. The results underline the necessity of early diagnosis and follow up also in children with normal reactions during the first presentation. Early diagnosis enables early treatment, conservative, surgical or fitting with hearing aids, especially important in the rehabilitation of these children. Hearing aids may be given temporarily imploring communication during the development of the child.

Merging molecular and ecological approaches in plant-insect interactions

The singer-song-writer Paul Simon sang about the '50 ways to leave your lover'; plants have at least as many ways of coping with their insect herbivores. Recent research has elucidated the mechanisms of direct and indirect plant defenses, and has provided the first proof of a protective function for indirect defenses in nature. Insect attack elicits a large transcriptional reorganization that differs from that elicited by mechanical wounding. Elicitors in herbivore oral secretions can account for herbivore-specific responses. Patterns of transcriptional changes point to the existence of central herbivore-activated regulators of metabolism.

Thyroglossal duct cyst: is thyroid scanning necessary in the preoperative evaluation?

BACKGROUND

Evaluation of thyroglossal duct cysts before surgical excision traditionally includes hormonal evaluation, ultrasound of the neck, and thyroid scanning.

OBJECTIVE

To evaluate the need for thyroid scanning in cases of thyroglossal duct cysts scheduled for operation.

METHODS

A retrospective chart review of 100 cases of thyroglossal duct cyst between 1988 and 1995 was carried out.

RESULTS

No cases of ectopic thyroid were detected.

CONCLUSION

Our goal was to document the presence of normal thyroid tissue by non-invasive tools such as ultrasound, rather than to rule out the existence of ectopic thyroid tissue by radionuclide scanning. Radionuclide scanning is justified in cases of lingual thyroid and where a normally located thyroid gland cannot be detected.

Renal multigated spectral Doppler imaging before and after captopril challenge

RATIONALE AND OBJECTIVES

A new method of measurement, simultaneous multigated spectral Doppler imaging (MSDI), was used to quantify the hemodynamic changes in kidneys after administration of captopril.

METHODS

Forty kidneys in 22 hypertensive patients were included in the study. All underwent MSDI and scintigraphy before and after administration of captopril.

RESULTS

With scintigraphy used as the gold standard for diagnosing renal artery stenosis (RAS), three kidneys were found to be positive for RAS. Multigated spectral Doppler imaging detected a decrease in the resistive index after administration of captopril in all patients with RAS and correctly excluded RAS in one patient who was diagnosed as having RAS on scintigraphy. The resistive index was increased after captopril administration in normally functioning kidneys and was unchanged in kidneys with impaired function.

CONCLUSIONS

With further supportive evidence, MSDI may prove to be a powerful tool for the acquisition of resistive index information and may increase the value of the resistive index as a physiological hemodynamic parameter in the evaluation of normal and abnormal conditions.

Defensive function of herbivore-induced plant volatile emissions in nature

Herbivore attack is known to increase the emission of volatiles, which attract predators to herbivore-damaged plants in the laboratory and agricultural systems. We quantified volatile emissions from Nicotiana attenuata plants growing in natural populations during attack by three species of leaf-feeding herbivores and mimicked the release of five commonly emitted volatiles individually. Three compounds (cis-3-hexen-1-ol, linalool, and cis-alpha-bergamotene) increased egg predation rates by a generalist predator; linalool and the complete blend decreased lepidopteran oviposition rates. As a consequence, a plant could reduce the number of herbivores by more than 90% by releasing volatiles. These results confirm that indirect defenses can operate in nature.

Non-neoplastic intratesticular lesions mimicking tumour on ultrasound

It has recently been emphasized that the incidence of benign testicular lesions is much higher than previously suspected. Sonography is reported to have a high sensitivity but poor specificity in the evaluation of intratesticular abnormalities. This report reviews the common and unusual lesions that can mimic testicular tumour on ultrasound, and discusses the clinical and sonographic features that may help to narrow the differential diagnosis and guide management.

Diversification of cardiac insulin signaling involves the p85 alpha/beta subunits of phosphatidylinositol 3-kinase

Ventricular cardiomyocytes and cardiac tissue of lean and genetically obese (fa/fa) Zucker rats were used 1) to study the role of the p85 regulatory subunit isoforms p85 alpha and p85 beta for insulin signaling through the phosphatidylinositol (PI) 3-kinase pathway, and 2) to elucidate the implications of these mechanisms for cardiac insulin resistance. Western blot analysis of cardiomyocyte lysates revealed expression of p85 alpha and p85 beta but no detectable amounts of the splice variants of p85 alpha. Essentially no p85 alpha subunit of PI 3-kinase was found to be associated with insulin receptor substrate (IRS)-1 or IRS-2 in basal and insulin-stimulated (5 min) cardiomyocytes. Instead, insulin produced a twofold increase in p85 beta associated with IRS-1, leading to a three- to fourfold increase in p85 beta-associated PI 3-kinase activity. This response was significantly reduced in obese animals. Comparable results were obtained in the intact heart after in vivo stimulation. In GLUT-4-containing vesicles, an increased abundance (3.7 +/- 0.7-fold over basal) of p85 alpha was observed after insulin stimulation of lean animals, with no significant effect in the obese group. No p85 beta could be detected in GLUT-4-containing vesicles. Recruitment of the p110 catalytic subunit of PI 3-kinase and a twofold increase in enzyme activity in GLUT-4-containing vesicles by insulin was observed only in lean rats. We conclude that, in the heart, p85 alpha recruits PI 3-kinase activity to GLUT-4 vesicles, whereas p85 beta represents the main regulator of IRS-1- and IRS-2-mediated PI 3-kinase activation. Furthermore, multiple defects of PI 3-kinase activation, involving both the p85 alpha and the p85 beta adaptor subunits, may contribute to cardiac insulin resistance.

Nasal obstruction in the adult: is CT scan of the sinuses necessary?

OBJECTIVE

To determine whether CT (computerized tomography) scan of the paranasal sinuses is essential in the diagnosis and medical/surgical management of nasal obstruction.

DESIGN

One hundred thirteen adult patients with nasal obstruction but without signs of sinusitis who underwent CT examination prior to surgery, were included in the study.

RESULTS

Fifty seven percent of the CT scans revealed a variety of abnormal findings. Of the patients with an abnormal CT scan, surgical planning had to be altered in 16 patients due to significant abnormalities found on the CT scans.

CONCLUSIONS

We conclude that CT scan of the nose and paranasal sinuses is an effective presurgical planning tool in patients with nasal obstruction.

Rab11 is associated with GLUT4-containing vesicles and redistributes in response to insulin

AIMS/HYPOTHESIS

To identify a GTPase of 24,000 M(r) which we recently found to co-localize with GLUT4 in cardiac muscle.

METHODS

A 24,000 M(r)-GTP-binding fraction was purified from pig heart by a three-step chromatographic procedure, followed by two-dimensional electrophoresis and electrospray ionization-mass spectrometry. Subcellular distribution of the GTPase was assessed by western blotting. Co-localization with GLUT4 was assessed by continuous sucrose density gradient fractionation and immunoadsorption of GLUT4-containing vesicles.

RESULTS

The Rab11 protein was identified as a major component of the GTP-binding fraction and its expression in rat cardiac muscle was confirmed. In vivo insulin treatment resulted in the recruitment of Rab11 from the microsomal fraction to the plasma membrane. Subcellular fractionation indicated two immunoreactive GLUT4 pools. Most of the intracellular pool of Rab11 overlapped with the high-density GLUT4 pool and most of the transferrin receptor pool. The Rab11 protein also co-sedimented with the low-density, non-endosomal GLUT4 pool and substantially increased in this fraction after insulin treatment. It was specifically present in GLUT4-containing vesicles and insulin increased its abundance in these vesicles 2.2-fold relative to the amount of GLUT4. These vesicles also containend Rab4 and Akt-2, the latter being only associated after insulin stimulation. Insulin was unable to alter the cellular localization of Rab11 in insulin-resistant obese Zucker rats.

CONCLUSION/INTERPRETATION

These results support the hypothesis that at least two GTPases of the Rab family participate in GLUT4-vesicle trafficking. We suggest that Rab11 is involved in the endosomal recycling, sorting and exocytotic movement of the glucose transporter.

[Bilateral acoustic trauma after air bag inflation]

Airbag inflation is associated with a loud noise. This very short noise has a peak amplitude of 170 dB sound pressure level and can make otologic injuries. We report a case of acoustic trauma after airbag inflation. The 24-year-old man has hearing loss both side in the 3000- to 6000-Hz range and in the deep-frequency. The possibility of acoustic trauma from airbag noise are probably much more common and need more attention in the clinic.