Frequency of an intrathecal IgM synthesis and MRZ reaction in children with MS

BACKGROUND

Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of the CNS. An intrathecal IgM synthesis is associated with a more rapid progression of MS and the intrathecal immune response to measles -, rubella -and varicella zoster virus (MRZR) which, if present, increases the likelihood of a diagnosis of MS in adults.

OBJECTIVE

To evaluate the frequency of an intrathecal IgM synthesis and MRZR in children with MS. MethodsChildren with MS and a data set including clinical and treatment history, MRI at onset, in addition to a CSF analysis, and determination of antibody index (AI) of measles, rubella, and zoster antibodies, were eligible. The presence of an intrathecal IgM synthesis and/or a positive MRZ reaction were compared to biomarkers of a more progressive disease course.

RESULTS

In 75 children with MS, OCBs were present in 93.3 %). 49,2 % experienced their first relapse within 6 months. 50.7 % had a total lesion load of more than 10 lesions in the first brain MRI. Spinal lesions were identified in 64 %. 23.5 % had a positive MRZR and 40.3 % an intrathecal IgM synthesis. No significant associations were detected between the presence of an intrathecal IgM synthesis and MRZR and parameters including the relapse rate in the first two years.

CONCLUSION

An intrathecal IgM synthesis and a positive MRZR are found in a subset of MS children but are not associated with markers associated with a poor prognosis.

Surgical phase and instrument recognition: how to identify appropriate dataset splits

PURPOSE

Machine learning approaches can only be reliably evaluated if training, validation, and test data splits are representative and not affected by the absence of classes. Surgical workflow and instrument recognition are two tasks that are complicated in this manner, because of heavy data imbalances resulting from different length of phases and their potential erratic occurrences. Furthermore, sub-properties like instrument (co-)occurrence are usually not particularly considered when defining the split.

METHODS

We present a publicly available data visualization tool that enables interactive exploration of dataset partitions for surgical phase and instrument recognition. The application focuses on the visualization of the occurrence of phases, phase transitions, instruments, and instrument combinations across sets. Particularly, it facilitates assessment of dataset splits, especially regarding identification of sub-optimal dataset splits.

RESULTS

We performed analysis of the datasets Cholec80, CATARACTS, CaDIS, M2CAI-workflow, and M2CAI-tool using the proposed application. We were able to uncover phase transitions, individual instruments, and combinations of surgical instruments that were not represented in one of the sets. Addressing these issues, we identify possible improvements in the splits using our tool. A user study with ten participants demonstrated that the participants were able to successfully solve a selection of data exploration tasks.

CONCLUSION

In highly unbalanced class distributions, special care should be taken with respect to the selection of an appropriate dataset split because it can greatly influence the assessments of machine learning approaches. Our interactive tool allows for determination of better splits to improve current practices in the field. The live application is available at https://cardio-ai.github.io/endovis-ml/ .

Exploring complications following cranioplasty after decompressive hemicraniectomy: A retrospective bicenter assessment of autologous, PMMA and CAD implants

Cranioplasty (CP) after decompressive hemicraniectomy (DHC) is a common neurosurgical procedure with a high complication rate. The best material for the repair of large cranial defects is unclear. The aim of this study was to evaluate different implant materials regarding surgery related complications after CP. Type of materials include the autologous bone flap (ABF), polymethylmethacrylate (PMMA), calcium phosphate reinforced with titanium mesh (CaP-Ti), polyetheretherketone (PEEK) and hydroxyapatite (HA). A retrospective, descriptive, observational bicenter study was performed, medical data of all patients who underwent CP after DHC between January 1st, 2016 and December 31st, 2022 were analyzed. Follow-up was until December 31st, 2023. 139 consecutive patients with a median age of 54 years who received either PMMA (56/139; 40.3%), PEEK (35/139; 25.2%), CaP-Ti (21/139; 15.1%), ABF (25/139; 18.0%) or HA (2/139; 1.4%) cranial implant after DHC were included in the study. Median time from DHC to CP was 117 days and median follow-up period was 43 months. Surgical site infection was the most frequent surgery-related complication (13.7%; 19/139). PEEK implants were mostly affected (28.6%; 10/35), followed by ABF (20%; 5/25), CaP-Ti implants (9.5%; 2/21) and PMMA implants (1.7%, 1/56). Explantation was necessary for 9 PEEK implants (25.7%; 9/35), 6 ABFs (24.0%; 6/25), 3 CaP-Ti implants (14.3%; 3/21) and 4 PMMA implants (7.1%; 4/56). Besides infection, a postoperative hematoma was the most common cause. Median surgical time was 106 min, neither longer surgical time nor use of anticoagulation were significantly related to higher infection rates (p = 0.547; p = 0.152 respectively). Ventriculoperitoneal shunt implantation prior to CP was noted in 33.8% (47/139) and not significantly associated with surgical related complications. Perioperative lumbar drainage, due to bulging brain, inserted in 38 patients (27.3%; 38/139) before surgery was protective when it comes to explantation of the implant (p = 0.035). Based on our results, CP is still related to a relatively high number of infections and further complications. Implant material seems to have a high effect on postoperative infections, since surgical time, anticoagulation therapy and hydrocephalus did not show a statistically significant effect on postoperative complications in this study. PEEK implants and ABFs seem to possess higher risk of postoperative infection. More biocompatible implants such as CaP-Ti might be beneficial. Further, prospective studies are necessary to answer this question.

Mepolizumab improves sense of smell in severe chronic rhinosinusitis with nasal polyps: SYNAPSE

BACKGROUND

Loss of smell is one of the most bothersome and difficult-to-treat symptoms in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP).

METHODOLOGY

SYNAPSE was a 52-week Phase III study of 4-weekly mepolizumab (100 mg subcutaneously) plus standard of care in adults with severe bilateral CRSwNP. This post hoc analysis assessed changes from baseline to study end in loss of smell visual analogue scale (VAS) symptom score, in patients stratified by several baseline clinical characteristics. SinoNasal Outcomes Test (SNOT)-22 sense of smell/taste item and University of Pennsylvania Smell Identification Test (UPSIT) scores were also assessed.

RESULTS

SYNAPSE enrolled 407 patients (mepolizumab=206; placebo=201) with impaired sense of smell at baseline. Improvements from baseline to study end in loss of smell VAS score were greater with mepolizumab versus placebo (treatment difference: -0.37) and most notable in patients with fewer or more recent prior surgeries (treatment difference: 1 vs 2 vs >2 prior surgeries,-1.29 vs -0.23 vs -0.07.

Mepolizumab improves sense of smell in severe chronic rhinosinusitis with nasal polyps: SYNAPSE

BACKGROUND

Loss of smell is one of the most bothersome and difficult-to-treat symptoms in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP).

METHODOLOGY

SYNAPSE was a 52-week Phase III study of 4-weekly mepolizumab (100 mg subcutaneously) plus standard of care in adults with severe bilateral CRSwNP. This post hoc analysis assessed changes from baseline to study end in loss of smell visual analogue scale (VAS) symptom score, in patients stratified by several baseline clinical characteristics. SinoNasal Outcomes Test (SNOT)-22 sense of smell/taste item and University of Pennsylvania Smell Identification Test (UPSIT) scores were also assessed.

RESULTS

SYNAPSE enrolled 407 patients (mepolizumab=206; placebo=201) with impaired sense of smell at baseline. Improvements from baseline to study end in loss of smell VAS score were greater with mepolizumab versus placebo (treatment difference: −0.37) and most notable in patients with fewer or more recent prior surgeries (treatment difference: 1 vs 2 vs more than 2 prior surgeries,−1.29 vs −0.23 vs −0.07; =3 years since last surgery, −0.89 vs 0.22). Approximately 25% of patients had baseline UPSIT scoresavailable; among those scoring =19 by study end. The SNOT-22 sense of smell/taste item score improved with mepolizumab versus placebo.

CONCLUSIONS

Mepolizumab treatment improved patients' perceived sense of smell, as measured by loss of smell VAS score and SNOT-22 sense of smell/taste item score in patients with severe refractory CRSwNP.

Trauma treatment using Narrative Exposure Therapy adapted to persons with intellectual disabilities or severe chronic mental disorders - a randomised controlled pilot study with an embedded observational study

BACKGROUND

Despite an increased likelihood of experiencing traumatic events and increased vulnerability, there are only few publications on trauma therapy for persons with intellectual disabilities (IDs). This pilot study for the first time investigates the feasibility and effectiveness of Narrative Exposure Therapy (NET) within this target group modified by Plain Language.

METHODS

A group of n = 10 participants with ID dual diagnoses and another group of n = 5 participants with severe and chronic mental disorders were separately stratified and randomised, then forming together an intervention group (n = 7) and a waiting list control group (n = 8). All participants were treated with NET attuned to their communication abilities by using Plain Language. Primary outcome was the post-traumatic stress measured with the Post-Traumatic Symptom Scale-10 before and after the intervention. In addition, the Adverse Childhood Experience Index was used for diagnostic purposes. Data were analysed using t-test for repeated measures and analysis of covariance.

RESULTS

Narrative Exposure Therapy and the randomised controlled trial study proved to be successfully conductible with participants with IDs in a congregated residential service. Although the corresponding effect size was high (partial eta square = 0.188), the between-group difference was not significant (P = 0.12). Analysis of the observational study resulted in a highly significant improvement for participants with IDs (P < 0.001; Hedges' g = 2.36) and in a significant improvement in participants with severe and chronic mental disorders (P < 0.013; Hedges' g = 1.52). Additionally, the participants with IDs show a significantly better reduction of symptom burden (P = 0.03; partial eta square = 0.327).

CONCLUSIONS

The results provide a first evidence for a possible and successful implementation of NET modified in Plain Language for persons with IDs and complex mental health support needs. Completeness in responding to the items of Post-Traumatic Symptom Scale-10 and Adverse Childhood Experience Index indicates the suitability of these instruments for both groups of participants. Although the group difference in the randomised controlled trial failed to achieve statistical significance mainly due to the small sample size, the results of the embedded observational study are promising for the conduct of further studies with the modified NET.

Evaluating treatment response to mepolizumab in patients with severe CRSwNP

BACKGROUND

The SYNAPSE study (NCT03085797) demonstrated that mepolizumab decreased nasal polyp (NP) size and nasal obstruction in patients with chronic rhinosinusitis with NP (CRSwNP).

METHODS

SYNAPSE, a randomized, double-blind study, included patients with recurrent, refractory, severe CRSwNP, eligible for repeated surgery despite receiving standard of care (SoC). Patients received 4-weekly mepolizumab 100 mg or placebo subcutaneously plus SoC for 52 weeks. This post hoc analysis further characterized treatment responses and association with patient characteristics. The proportion of patients meeting any and each of five response criteria indicating improvement in disease-specific quality of life, NP size, nasal obstruction, loss of smell, and overall symptoms at Weeks 24 and 52, were assessed in subgroups: 1) no surgery; 2) neither surgery nor systemic corticosteroids (SCS).

RESULTS

Of 407 patients in the intention-to-treat population, 381 and 343 patients had no sinus surgery by Weeks 24 and 52, respectively. More mepolizumab- versus placebo-treated patients without surgery by Weeks 24 and 52 met each response criteria. Of the mepolizumab-treated patients without surgery by Week 24, 109 (55%) responded across ≥ 3 criteria, increasing to 126 (67%) by Week 52. Similar response trends were seen for patients with neither surgery nor SCS by Weeks 24 and 52. At either timepoint, there were no major differences in baseline characteristics between mepolizumab-treated full- (5/5 categories) and non-responders (0/5 categories).

CONCLUSIONS

Most patients who completed SYNAPSE required neither surgery nor SCS use and in addition achieved a progressive and sustained clinical response to mepolizumab underscoring the therapeutic benefits of mepolizumab in severe CRSwNP.

Comparison of transcatheter edge-to-edge and surgical repair in patients with functional mitral regurgitation using a meta-analytic approach

Background

Evidence regarding favorable treatment of patients with functional mitral regurgitation (FMR) using transcatheter edge-to-edge repair (TEER) is constantly growing. However, there is only few data directly comparing TEER and surgical mitral valve repair (SMVr).

Aims

To compare baseline characteristics, short-term and 1-year outcomes in FMR patients undergoing mitral valve (MV) TEER or SMVr using a meta-analytic approach.

Methods

Systematic database search identified 1,703 studies reporting on TEER or SMVr for treatment of FMR between January 2010 and December 2020. A meta-analytic approach was used to compare outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI). Statistical significance was assumed if CIs did not overlap. A total of 21 TEER and 37 SMVr studies comprising 4,304 and 3,983 patients were included.

Results

Patients in the TEER cohort presented with higher age (72.0 ± 1.7 vs. 64.7 ± 4.7 years, p < 0.001), greater burden of comorbidities like hypertension (p < 0.001), atrial fibrillation (p < 0.001), lung disease (p < 0.001) and chronic renal disease (p = 0.005) as well as poorer left ventricular ejection fraction (30.9 ± 5.7 vs. 36.6 ± 5.3%, p < 0.001). In-hospital mortality was significantly lower with TEER [3% (95%-CI 0.02-0.03) vs. 5% (95%-CI 0.04-0.07)] and 1-year mortality did not differ significantly [18% (95%-CI 0.15-0.21) vs. 11% (0.07-0.18)]. NYHA [1.06 (95%-CI 0.87-1.26) vs. 1.15 (0.74-1.56)] and MR reduction [1.74 (95%-CI 1.52-1.97) vs. 2.08 (1.57-2.59)] were comparable between both cohorts.

Conclusion

Despite considerably higher age and comorbidity burden, in-hospital mortality was significantly lower in FMR patients treated with TEER, whereas a tendency toward increased 1-year mortality was observed in this high-risk population. In terms of functional status and MR grade reduction, comparable 1-year results were achieved.

Interactive visual exploration of surgical process data

PURPOSE

Integrated operating rooms provide rich sources of temporal information about surgical procedures, which has led to the emergence of surgical data science. However, little emphasis has been put on interactive visualization of such temporal datasets to gain further insights. Our goal is to put heterogeneous data sequences in relation to better understand the workflows of individual procedures as well as selected subsets, e.g., with respect to different surgical phase distributions and surgical instrument usage patterns.

METHODS

We developed a reusable web-based application design to analyze data derived from surgical procedure recordings. It consists of aggregated, synchronized visualizations for the original temporal data as well as for derived information, and includes tailored interaction techniques for selection and filtering. To enable reproducibility, we evaluated it across four types of surgeries from two openly available datasets (HeiCo and Cholec80). User evaluation has been conducted with twelve students and practitioners with surgical and technical background.

RESULTS

The evaluation showed that the application has the complexity of an expert tool (System Usability Score of 57.73) but allowed the participants to solve various analysis tasks correctly (78.8% on average) and to come up with novel hypotheses regarding the data.

CONCLUSION

The novel application supports postoperative expert-driven analysis, improving the understanding of surgical workflows and the underlying datasets. It facilitates analysis across multiple synchronized views representing information from different data sources and, thereby, advances the field of surgical data science.

Erratum - Tri-Lineage Differentiation of NTERA2 Clone D1 Cells towards Neural, Hepatic and Osteogenic Lineages in Vitro

The images in Fig. 4 were not presented correctly. The correct version of Fig. 4: see the last page of pdf. The original article was published in Folia Biologica (Praha) Volume 67, No. 5-6 (2021), 174-182. https://doi.org/10.14712/fb2021067050174.

Hemolytic anemia following intravenous immunoglobulins in children with PIMS-TS: Two case reports

This is the first case report on two children presenting with immediate and severe hemolytic anemia following the administration of high-dose intravenous immunoglobulins (IVIGs) in the context of pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Hemolytic anemia was described as a significant decrease in hemoglobin and an increase in lactate dehydrogenase after the second administration of high-dose IVIGs was performed. Both patients were found to have AB blood group. One of our patients showed massive pallor, weakness, and inability to walk in association with hemolysis. However, in both cases, the anemia was self-limiting and transfusion of red blood cells was not required: both patients recovered without persistent impact. Nonetheless, we aim to draw attention to this widely unknown adverse effect of IVIG, especially in the context of PIMS-TS. We suggest determining the patient's blood group prior to high-dose IVIG infusion and replacing the second IVIG through high-dose steroids or anticytokine therapy. Using IVIGs containing lower titers of specifically anti-A or anti-B antibodies to avoid isoagglutinin-caused hemolytic anemia is desirable; however, the information is not routinely available.

Morphometric analyses in patients treated with subthreshold laser photocoagulation for central serous chorioretinopathy

BACKGROUND AND OBJECTIVE

To analyze changes in selected parameters in optical coherence tomography (OCT) after subthreshold laser coagulation (ST-LP) in patients with central serous chorioretinopathy (CSCR).

MATERIALS AND METHODS

Fifty-four eyes of 49 patients with CSCR were included in the study. Each patient underwent therapy with ST-LP with a frequency-doubled Neodym-YAG Laser and OCT imaging. In OCT the thickness of the central subfield, cube volume, average cube thickness, volume under the ETDRS grid, and average thickness under the ETDRS grid were collected.

RESULTS

Decreases in total OCT volume and central retinal subfield thickness were statistically significant (p < 0.05). Possible correlations were observed between visual acuity at V3 (3 months after ST-LP) and Baseline and between central retinal subfield thickness at V1 (4 weeks after ST-LP) and visual acuity at BL.

CONCLUSION

A decrease in retinal thickness and retinal volume could be shown after ST-LP. Central retinal subfield thickness measured by OCT could be a more sensitive measure than mean retinal thickness or macular volume for early detection of disease recurrence occurring in some patients 3 months after ST-LP.

A-33 Criteria For Determining Clinical Recovery From Concussion: A Preliminary Survey Of Sports Neuropsychologists

Purpose: To arrive at a consensus of best practices currently employed by sports neuropsychologists regarding specific criteria for determining concussion recovery. Methods: A survey was sent to 120 sports neuropsychologists listed in a public membership directory of the Sports Neuropsychology Society. The survey included demographic, Likert-style, and multiple-choice questions regarding the importance of given criteria in determining concussion recovery for youth (up to age 18) or adult (18+ years). Results: A sample of 22 participants (95% White, 59% male, 68% working with youth and adults, 45% seeing ≥50 patients yearly, 86% ≥10 years of experience) was obtained. The two highest rated criteria for youth and adults were: 1) symptom-free with exercise, and 2) back to work/school without symptoms or accommodations. The two lowest rated criteria were: 1) physician exam without concerns, and 2) opinions from another healthcare professional. Of those who treat adults, 71% reported 1 week symptom free is sufficient. For youth, 63% rated ≥1 week, 31% rated 2–3 weeks, and 6% rated ≥1 month is preferred. Conclusions: Most respondents have worked with youth and adult athletes for at least 10 years. Responses were mostly consistent regarding importance of the various surveyed criteria. There may be a tendency to wait for longer symptom-free periods for youth. Interestingly, the opinions of another health care professional or physician were less important than all other criteria in the survey. The two most important criteria appear to be resolution of symptoms during physical exertion and return to functional activities without symptoms or accommodations.

[Potential effect of the stimulus threshold level of the nociceptive flexion reflex (NFRT) on mortality and delirium incidence in the critically ill patient: a retrospective cohort analysis]

BACKGROUND

Mortality and delirium in critically ill patients are affected by the provided analgesics and sedatives. The deeper the sedation and the higher the dose of analgesics applied, the more difficult it is to assess pain and the depth of sedation. Therefore, instrumental measurement methods, such as the measurement of the stimulus threshold of the nociceptive flexion reflex (NFRT), are becoming increasingly more important.

OBJECTIVE

The aim of the present study is to investigate a potential association between the level of the nociceptive flexion reflex, mortality, and the occurrence of delirium.

MATERIAL AND METHODS

By retrospectively analyzing a pilot data set of 57 ICU patients from the interdisciplinary surgical ICU of Ulm University Hospital surveyed between 11/2018 and 03/2020, a possible association between the NFRT, mortality, and the occurrence of delirium was calculated in an adjusted logistic regression model. Depending on the cut-off value, the stimulus threshold corridors result in the following comparison pairs: < 20 mA vs. 20-40 mA/20-50 mA/20-60 mA, > 40 mA vs. 20-40 mA, > 50 mA vs. 20-50 mA and > 60 mA vs. 20-60 mA. Results are presented as odds ratios (OR) adjusted for age, sex, height, TISS-28, SAPS II, RASS, BPS, and applied analgesics. Pain assessment was performed, in addition to the Behavioral Pain scale, ≥ 3 times daily by measuring NFRT.

RESULTS

A statistically nonsignificant tendency for an increase in mortality incidence occurred with an NFRT > 50 mA, versus a stimulus threshold corridor of 20-50 mA (OR 3.3, CI: 0.89-12.43, p = 0.07). A trend toward a reduction in delirium incidence occurred at an NFRT < 20 mA, versus a stimulus threshold corridor of 20-40 mA (OR 0.40, CI: 0.18-0.92, p = 0.03).

CONCLUSION

Based on the level of the NFRT, no recommendation can be made at this point to adjust the analgesic regimen of critically ill patients, who are unable to communicate. The observation of a tendency towards an increase in mortality at high stimulus thresholds or a reduction in the occurrence of delirium at low stimulus thresholds of the NFRT must be verified in standardized studies.

A comparative study of pre-alpha islands in the entorhinal cortex from selected primates and in lissencephaly

The entorhinal cortex (EC) is the main interface between the sensory association areas of the neocortex and the hippocampus. It is crucial for the evaluation and processing of sensory data for long-term memory consolidation, and shows damage in many brain diseases, e.g., neurodegenerative diseases, such as Alzheimer's disease and developmental disorders. The pre-alpha layer of the EC in humans (layer II) displays a remarkable distribution of neurons in islands. These cellular islands give rise to a portion of the perforant path - the major reciprocal data stream for neocortical information into the hippocampal formation. However, the functional relevance of the morphological appearance of the pre-alpha layer in cellular islands and the precise timing of their initial appearance during primate evolution are largely unknown. Here, we conducted a comparative study of the EC from 38 non-human primates and Homo sapiens and found a strong relationship between gyrification index (GI) and the presence of the pre-alpha cellular islands. The formation of cellular islands also correlated wih brain and body weight as well as neopallial volume. In the two human lissencephalic cases, the cellular islands in the pre-alpha layer were lacking. These findings emphasize the relationship between cortical folding and island formation in the entorhinal cortex from an evolutionary perspective, and suggest a role in the pathomechanism of developmental brain disorders. This article is protected by copyright. All rights reserved.

Tri-Lineage Differentiation of NTERA2 Clone D1 Cells towards Neural, Hepatic and Osteogenic Lineages in Vitro

Over the past decades, the in vitro use of pluripotent cell lines gained a crucial role in toxicology, preclinical drug testing and developmental biology. NTERA2 clone D1 cells were identified as pluripotent cells with high potential for neural differentiation. Although they are commonly used cellular sources in neuropharmacology and neurodevelopmental studies, their endodermal and mesodermal differentiation potential awaits further characterization. Here, we devised improved protocols for hepatogenic and osteogenic differentiation of NTERA2 clone D1 cells. Our in vitro differentiation assays showed significant up-regulation of multiple hepatogenic markers. We also observed robust mineralization and osteogenic marker expression of NTERA2 clone D1 cells upon in vitro osteogenic induction. These results suggest that NTERA2 clone D1 cells may be utilized as an in vitro model system to study various aspects of liver biology and osteogenesis. In addition, tri-lineage differentiation of NTERA2 clone D1 cells may serve as a simple experimental control system when validating pluripotency of other cell types.

Haploinsufficiency of TANK-binding kinase 1 prepones age-associated neuroinflammatory changes without causing motor neuron degeneration in aged mice

Loss-of-function mutations in TANK-binding kinase 1 cause genetic amyotrophic lateral sclerosis and frontotemporal dementia. Consistent with incomplete penetrance in humans, haploinsufficiency of TANK-binding kinase 1 did not cause motor symptoms in mice up to 7 months of age in a previous study. Ageing is the strongest risk factor for neurodegenerative diseases. Hypothesizing that age-dependent processes together with haploinsufficiency of TANK-binding kinase 1 could create a double hit situation that may trigger neurodegeneration, we examined mice with hemizygous deletion of Tbk1 (Tbk1 ^+/- mice) and wild-type siblings up to 22 months. Compared to 4-month old mice, aged, 22-month old mice showed glial activation, deposition of motoneuronal p62 aggregates, muscular denervation and profound transcriptomic alterations in a set of 800 immune-related genes upon ageing. However, we did not observe differences regarding these measures between aged Tbk1 ^+/- and wild-type siblings. High age did also not precipitate TAR DNA-binding protein 43 aggregation, neurodegeneration or a neurological phenotype in Tbk1^{+/ -} mice. In young Tbk1^{+/ -} mice, however, we found the CNS immune gene expression pattern shifted towards the age-dependent immune system dysregulation observed in old mice. Conclusively, ageing is not sufficient to precipitate an amyotrophic lateral sclerosis or frontotemporal dementia phenotype or spinal or cortical neurodegeneration in a model of Tbk1 haploinsufficiency. We hypothesize that the consequences of Tbk1 haploinsufficiency may be highly context-dependent and require a specific synergistic stress stimulus to be uncovered.

Optical coherence tomography-based assessment of retinal vascular pathology in cerebral small vessel disease

Background

Cerebral small vessel disease (CSVD) is a disorder of brain vasculature that causes various structural changes in the brain parenchyma, and is associated with various clinical symptoms such as cognitive impairment and gait disorders. Structural changes of brain arterioles cannot be visualized with routine imaging techniques in vivo. However, optical coherence tomography (OCT) is thought to be a “window to the brain”. Thus, retinal vessel parameters may correlate with CSVD characteristic brain lesions and cerebrospinal fluid biomarkers (CSF) of the neuropathological processes in CSVD like endothelial damage, microglial activation and neuroaxonal damage.

Methods

We applied OCT-based assessment of retinal vessels, magnetic resonance imaging (MRI), and CSF biomarker analysis in a monocentric prospective cohort of 24 patients with sporadic CSVD related stroke and cognitive impairment. MRI lesions were defined according to the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE). Biomarkers were assessed using commercially available ELISA kits. Owing to the unavailability of an age-matched control-group lacking MRI-characteristics of CSVD, we compared the retinal vessel parameters in CSVD patients (73.8 ± 8.5 years) with a younger group of healthy controls (51.0 ± 16.0 years) by using an age- and sex-adjusted multiple linear regression analysis model.

Results

Among the parameters measured with OCT, the Wall to Lumen Ratio (WLR) but not Mean Wall Thickness (MWT) of the superior branch of the retinal artery correlated significantly with the volume of white matter hyperintensities on MRI (r_s = − 0.5) and with CSF-levels of Chitinase 3 like 1 protein (r_s = − 0.6), zona occludens 1 protein (r_s = − 0.5) and GFAP (r_s = − 0.4). MWT and WLR were higher in CSVD than in controls (28.9 μm vs. 23.9 μm, p = 0.001 and 0.32 vs. 0.25, p = 0.001).

Conclusions

In this exploratory study, WLR correlated with the volume of white matter hyperintensities, and markers of vascular integrity, microglial activation, and neuroaxonal damage in CSVD. Further prospective studies should clarify whether retinal vessel parameters and CSF biomarkers may serve to monitor the natural course and treatment effects in clinical studies on CSVD.

Tracing nitrate sources with a combined isotope approach (δ15NNO3, δ18ONO3 and δ11B) in a large mixed-use watershed in southern Alberta, Canada

Rapid population growth and land-use intensification over the last century have resulted in a substantial increase in nutrient loads degrading marine and freshwater ecosystems worldwide. In mixed-use watersheds, elevated nitrogen loads from wastewater treatment plant (WWTP) effluent or agricultural runoff often drive the eutrophication of waterways. Accordingly, the objective of this research was to identify sources of riverine nitrate (NO₃), a deleterious dissolved species of nitrogen, with a combined isotopic tracing technique in the Bow River and the Oldman River in Alberta, Canada. Riverine NO₃ and boron (B) concentrations, mean daily flux and δ¹⁵N_NO3, δ¹⁸O_NO3, and δ¹¹B values were determined at 17 mainstem sites during high and low discharge periods in 2014 and 2015. The data for mainstem sites were then compared to results for effluent from seven WWTPs, eight synthetic fertilizers, cow manure, and three predominantly agricultural tributary sites to estimate point and non-point NO₃ sources. The NO₃ flux, δ¹⁵N_NO3 and δ¹⁸O_NO3 values indicated the city of Calgary's Bonnybrook WWTP effluent accounts for the majority of the NO₃ flux in the Bow River downstream of Calgary. δ¹⁵N_NO3 and δ¹¹B values in the Bow River highlighted an increase in agricultural NO₃ loading downstream of irrigation return-flows. A three-fold decrease in the NO₃:B flux ratio indicated NO₃-removal processes are active in the lower reaches of the Bow River. For the Oldman River, δ¹¹B values revealed elevated nutrient loading from the Lethbridge WWTP effluent (10% of downstream B flux). Furthermore, the agricultural tributaries contributed 25% of the local B flux to the Oldman River. Overall, δ¹¹B was proven to be an effective co-tracer for discriminating between urban and agricultural sources of NO₃ in these large mixed-use watersheds. This combined isotope tracing approach has significant potential to identify point and non-point NO₃ sources driving eutrophication around the world.

Geochemical and sulfate isotopic evolution of flowback and produced waters reveals water-rock interactions following hydraulic fracturing of a tight hydrocarbon reservoir

Although multistage hydraulic fracturing is routinely performed for the extraction of hydrocarbon resources from low permeability reservoirs, the downhole geochemical processes linked to the interaction of fracturing fluids with formation brine and reservoir mineralogy remain poorly understood. We present a geochemical dataset of flowback and produced water samples from a hydraulically fractured reservoir in the Montney Formation, Canada, analyzed for major and trace elements and stable isotopes. The dataset consists in 25 samples of flowback and produced waters from a single well, as well as produced water samples from 16 other different producing wells collected in the same field. Additionally, persulfate breaker samples as well as anhydrite and pyrite from cores were also analyzed. The objectives of this study were to understand the geochemical interactions between formation and fracturing fluids and their consequences in the context of tight gas exploitation. The analysis of this dataset allowed for a comprehensive understanding of the coupled downhole geochemical processes, linked in particular to the action of the oxidative breaker. Flowback fluid chemistries were determined to be the result of mixing of formation brine with the hydraulic fracturing fluids as well as coupled geochemical reactions with the reservoir rock such as dissolution of anhydrite and dolomite; pyrite and organic matter oxidation; and calcite, barite, celestite, iron oxides and possibly calcium sulfate scaling. In particular, excess sulfate in the collected samples was found to be mainly derived from anhydrite dissolution, and not from persulfate breaker or pyrite oxidation. The release of heavy metals from the oxidation activity of the breaker was detectable but concentrations of heavy metals in produced fluids remained below the World Health Organization guidelines for drinking water and are therefore of no concern. This is due in part to the co-precipitation of heavy metals with iron oxides and possibly sulfate minerals.

A Critical Review of State-of-the-Art and Emerging Approaches to Identify Fracking-Derived Gases and Associated Contaminants in Aquifers

High-volume, hydraulic fracturing (HVHF) is widely applied for natural gas and oil production from shales, coals, or tight sandstone formations in the United States, Canada, and Australia, and is being widely considered by other countries with similar unconventional energy resources. Secure retention of fluids (natural gas, saline formation waters, oil, HVHF fluids) during and after well stimulation is important to prevent unintended environmental contamination, and release of greenhouse gases to the atmosphere. Here, we critically review state-of-the-art techniques and promising new approaches for identifying oil and gas production from unconventional reservoirs to resolve whether they are the source of fugitive methane and associated contaminants into shallow aquifers. We highlight future research needs and propose a phased program, from generic baseline to highly specific analyses, to inform HVHF and unconventional oil and gas production and impact assessment studies. These approaches may also be applied to broader subsurface exploration and development issues (e.g., groundwater resources), or new frontiers of low-carbon energy alternatives (e.g., subsurface H₂ storage, nuclear waste isolation, geologic CO₂ sequestration).

Water and sediment as sources of phosphate in aquatic ecosystems: The Detroit River and its role in the Laurentian Great Lakes

Eutrophication of freshwater ecosystems and harmful algal blooms (HABs) are an ongoing concern affecting water quality in the Great Lakes watershed of North America. Despite binational management efforts, Lake Erie has been at the center of dissolved reactive phosphate driven eutrophication research due to its repeated cycles of algae blooms. We investigated the Detroit River, the largest source of water entering Lake Erie, with the objectives to (1) characterize Detroit River phosphate levels within water and sediment, and (2) use multiple chemical and isotopic tracers to identify nutrient sources in the Detroit River. Riverine water and sediment samples were collected at 23 locations across 8 transects of the Detroit River. The bulk δ¹⁵N values from sediments were enriched compared the δ¹⁵N values of nitrate from water samples, consistent with biogeochemical cycling in the sediment. Principle component analysis of multiple chemical tracers from water samples found spatial variation consistent with multiple sources including synthetic and manure-derived fertilizers and wastewater effluent. The concentrations of phosphate dissolved in water were within regulatory guidelines; however, sediments had elevated concentrations of both water- and acid-extractable phosphate. Sediment-sequestered legacy phosphorus historically deposited in the Detroit River may be transported into Lake Erie and, if mobilized into the water column, be an unrecognized internal-load that contributes to algal bloom events. Globally, freshwater ecosystems are impacted by numerous non-point source phosphorus inputs contributing to eutrophication and the use of multiple tracer approaches will increase our ability to effectively manage aquatic ecosystems.

[Duodenum-preserving pancreatic head resection in chronic pancreatitis : Limitations of the Heidelberg multicenter ChroPac study]

The data published in Der Chirurg and The Lancet on the results of the multicenter ChroPac study comparing results of 115 patients in the duodenum-preserving pancreatic head resection (DPPHR) group with 111 patients in the pancreaticoduodenectomy (PD) group, recommend partial PD as the first line procedure for chronic pancreatitis (CP). This is based on the significantly higher frequency of rehospitalization assigned to CP in the DPPHR group and data derived from post hoc meta-analysis about higher frequency of reoperations in the DPPHR group. Based on the presented data of the intention-to-treat analysis it is difficult to support the authors' recommendation of PD as the first line procedure for CP. The critical points are substantial heterogeneity of the different surgical procedures in the DPPHR group (20%) and PD group (13.5%) and a heterogeneity with respect to the number of patients with very advanced CP in the DPPHR group but not in the PD group. The data on the new onset of diabetes and endocrine insufficiency after surgery are not the result of measuring the preoperative and postoperative status of glucose metabolism and degree of exocrine dysfunction but are based on patient records. The advantages and/or disadvantages of the local parenchyma-sparing pancreatic head resection for CP compared to PD results of the published monocentric randomized controlled studies (RCT) more closely verify the clinical evidence than those of the ChroPac trial.

Die limitierte Aussagekraft formaler Fallzahlplanung im Rahmen von Tierversuchen der medizinischen Grundlagenforschung

Für die medizinische Grundlagenforschung sind Tierversuche von großer Bedeutung, wenngleich deren Einsatz in der Öffentlichkeit kontrovers diskutiert wird. Eine aus biometrischer Sicht optimale Fallzahl für diese Projekte ist demnach anzustreben. Die statistische Fallzahlabschätzung stellt üblicherweise eine angemessene Methodik der Planung in Projekten der medizinischen Forschung dar. Die dafür notwendige Vorinformation ist jedoch im Rahmen eines Tierversuchs oftmals nicht valide oder verfügbar. In diesem Beitrag soll daher die Aussagekraft einer formalen Fallzahlplanung für Tierversuche kritisch diskutiert werden. Im Rahmen der Diskussion werden entsprechende Forderungen formuliert, um den Prozess der Fallzahlbestimmung für Tierversuche grundlegend zu regeln.

Cardioprotective effects of 5-hydroxymethylfurfural mediated by inhibition of L-type Ca2+ currents

BACKGROUND AND PURPOSE

The antioxidant 5-hydroxymethylfurfural (5-HMF) exerts documented beneficial effects in several experimental pathologies and is currently tested as an antisickling drug in clinical trials. In the present study, we examined the cardiovascular effects of 5-HMF and elucidated the mode of action of the drug.

EXPERIMENTAL APPROACH

The cardiovascular effects of 5-HMF were studied with pre-contracted porcine coronary arteries and rat isolated normoxic-perfused hearts. Isolated hearts subjected to ischaemia/reperfusion (I/R) injury were used to test for potential cardioprotective effects of the drug. The effects of 5-HMF on action potential and L-type Ca²⁺ current (I_Ca,L ) were studied by patch-clamping guinea pig isolated ventricular cardiomyocytes.

KEY RESULTS

5-HMF relaxed coronary arteries in a concentration-dependent manner and exerted negative inotropic, lusitropic and chronotropic effects in rat isolated perfused hearts. On the other hand, 5-HMF improved recovery of inotropic and lusitropic parameters in isolated hearts subjected to I/R. Patch clamp experiments revealed that 5-HMF inhibits L-type Ca²⁺ channels. Reduced I_Ca,L density, shift of I_Ca,L steady-state inactivation curves toward negative membrane potentials and slower recovery of I_Ca,L from inactivation in response to 5-HMF accounted for the observed cardiovascular effects.

CONCLUSIONS AND IMPLICATIONS

Our data revealed a cardioprotective effect of 5-HMF in I/R that is mediated by inhibition of L-type Ca²⁺ channels. Thus, 5-HMF is suggested as a beneficial additive to cardioplegic solutions, but adverse effects and contraindications of Ca²⁺ channel blockers have to be considered in therapeutic application of the drug.

Characterization of a low expression haplotype in canine glutathione S-transferase (GSTT1) and its prevalence in golden retrievers

Glutathione S-transferase-theta (GSTT1) is a carcinogen detoxification enzyme, and low activity variants are associated with lymphoma in humans. We recently found a variant in the 3' untranslated region (UTR) of canine GSTT1, *101_102insT, which was predicted to change miRNA binding and was found in 5 of 17 golden retriever (GR) dogs with lymphoma but none of 14 healthy GRs. The aim of this study was to determine whether this variant led to decreased GSTT1 expression and was a discernible risk factor for lymphoma within the GR breed. On resequencing, *101_102insT appeared to be in complete linkage disequilibrium with 3 additional 3'UTR variants, leading to the inferred haplotype *3T>C; *101_102insT; *190C>A; *203T>C. In canine livers that were heterozygous for this variant haplotype, GSTT1 protein expression was significantly lower compared to the reference haplotype (densitometry .40 vs .64, P = .022), and GSTT1 transcript levels by qPCR were also significantly lower (fold difference .52, P = .012), without evidence of substantial allelic expression imbalance. The variant haplotype led to >50% decrease in expression in vitro (.31 ± .07 vs .64 ± .19; P = .019). We found no significant difference in minor allele frequencies between 71 GR dogs with lymphoma (MAF .162) and 33 healthy age-matched controls (MAF .136, P = .69). Our results indicate that the variant GSTT1 3'UTR haplotype containing *101_102insT reduces gene expression, which could lead to impaired carcinogen detoxification, but was not a detectable risk factor for lymphoma in GR dogs.

Long-term mutual phase locking of picosecond pulse pairs generated by a semiconductor nanowire laser

The ability to generate phase-stabilized trains of ultrafast laser pulses by mode-locking underpins photonics research in fields, such as precision metrology and spectroscopy. However, the complexity of conventional mode-locked laser systems has hindered their realization at the nanoscale. Here we demonstrate that GaAs-AlGaAs nanowire lasers are capable of emitting pairs of phase-locked picosecond laser pulses with a repetition frequency up to 200 GHz when subject to incoherent pulsed optical excitation. By probing the two-pulse interference spectra, we show that pulse pairs remain mutually coherent over timescales extending to 30 ps, much longer than the emitted laser pulse duration (≤3 ps). Simulations performed by solving the optical Bloch equations produce good quantitative agreement with experiments, revealing how the phase information is stored in the gain medium close to transparency. Our results open the way to phase locking of nanowires integrated onto photonic circuits, optical injection locking and applications, such as on-chip Ramsey comb spectroscopy.

Although nanolasers have been an active field of research for over a decade, mode-locking on the nanoscale has not been achieved yet. Here, Mayer et al. show that semiconductor nanowire lasers can emit pairs of phase-locked picosecond pulses when the nanowires are incoherently pumped.

A unique LAMB3 splice-site mutation with founder effect from the Balkans causes lethal epidermolysis bullosa in several European countries

BACKGROUND

We have encountered repeated cases of recessive lethal generalized severe (Herlitz-type) junctional epidermolysis bullosa (JEB gen sev) in infants born to Hungarian Roma parents residing in a small region of Hungary.

OBJECTIVES

To identify the disease-causing mutation and to investigate the genetic background of its unique carrier group.

METHODS

The LAMB3 gene was analysed in peripheral-blood genomic DNA samples, and the pathological consequences of the lethal defect were confirmed by cutaneous LAMB3cDNA sequencing. A median joining haplotype network within the Y chromosome H1a-M82 haplogroup of individuals from the community was constructed, and LAMB3 single-nucleotide polymorphism (SNP) patterns were also determined.

RESULTS

An unconventional intronic splice-site mutation (LAMB3, c.1133-22G>A) was identified. Thirty of 64 voluntarily screened Roma from the closed community carried the mutation, but none of the 306 Roma from other regions of the country did. The age of the mutation was estimated to be 548 ± 222 years. Within the last year, more patients with JEB gen sev carrying the same unusual mutation have been identified in three unrelated families, all immigrants from the Balkans. Two were compound heterozygous newborns, in Germany and Italy, and one homozygous newborn died in France. Only the French family recognized their Roma background. LAMB3SNP haplotyping confirmed the link between the apparently unrelated Hungarian, German and Italian male cases, but could not verify the same background in the female newborn from France.

CONCLUSIONS

The estimated age of the mutation corresponds to the time period when Roma were wandering in the Balkans.

Occurrence and origin of methane in groundwater in Alberta (Canada): Gas geochemical and isotopic approaches

To assess potential future impacts on shallow aquifers by leakage of natural gas from unconventional energy resource development it is essential to establish a reliable baseline. Occurrence of methane in shallow groundwater in Alberta between 2006 and 2014 was assessed and was ubiquitous in 186 sampled monitoring wells. Free and dissolved gas sampling and measurement approaches yielded comparable results with low methane concentrations in shallow groundwater, but in 28 samples from 21 wells methane exceeded 10mg/L in dissolved gas and 300,000 ppmv in free gas. Methane concentrations in free and dissolved gas samples were found to increase with well depth and were especially elevated in groundwater obtained from aquifers containing coal seams and shale units. Carbon isotope ratios of methane averaged -69.7 ± 11.1‰ (n=63) in free gas and -65.6 ± 8.9‰ (n=26) in dissolved gas. δ(13)C values were not found to vary with well depth or lithology indicating that methane in Alberta groundwater was derived from a similar source. The low δ(13)C values in concert with average δ(2)HCH4 values of -289 ± 44‰ (n=45) suggest that most methane was of biogenic origin predominantly generated via CO2 reduction. This interpretation is confirmed by dryness parameters typically >500 due to only small amounts of ethane and a lack of propane in most samples. Comparison with mud gas profile carbon isotope data revealed that methane in the investigated shallow groundwater in Alberta is isotopically similar to hydrocarbon gases found in 100-250 meter depths in the WCSB and is currently not sourced from thermogenic hydrocarbon occurrences in deeper portions of the basin. The chemical and isotopic data for methane gas samples obtained from Alberta groundwater provide an excellent baseline against which potential future impact of deeper stray gases on shallow aquifers can be assessed.

Monolithically Integrated High-β Nanowire Lasers on Silicon

Reliable technologies for the monolithic integration of lasers onto silicon represent the holy grail for chip-level optical interconnects. In this context, nanowires (NWs) fabricated using III-V semiconductors are of strong interest since they can be grown site-selectively on silicon using conventional epitaxial approaches. Their unique one-dimensional structure and high refractive index naturally facilitate low loss optical waveguiding and optical recirculation in the active NW-core region. However, lasing from NWs on silicon has not been achieved to date, due to the poor modal reflectivity at the NW-silicon interface. We demonstrate how, by inserting a tailored dielectric interlayer at the NW-Si interface, low-threshold single mode lasing can be achieved in vertical-cavity GaAs-AlGaAs core-shell NW lasers on silicon as measured at low temperature. By exploring the output characteristics along a detection direction parallel to the NW-axis, we measure very high spontaneous emission factors comparable to nanocavity lasers (β = 0.2) and achieve ultralow threshold pump energies ≤11 pJ/pulse. Analysis of the input-output characteristics of the NW lasers and the power dependence of the lasing emission line width demonstrate the potential for high pulsation rates ≥250 GHz. Such highly efficient nanolasers grown monolithically on silicon are highly promising for the realization of chip-level optical interconnects.

Limited surgery for benign tumours of the pancreas: a systematic review

BACKGROUND

Limited surgical procedures for benign cystic neoplasms and endocrine tumours of the pancreas have the potential advantage of pancreatic tissue sparing compared to standard oncological resections.

METHODS

Searching PubMed/MedLine, Embase and Cochrane Library identified 86 full papers: 25 reporting on enucleation (EN), 38 on central pancreatectomy (CP) and 23 on duodenum-preserving total/partial pancreatic head resection (DPPHRt/p). The results are based on analysis of data of 838, 912 and 431 patients for EN, CP and DPPHRt/s, respectively.

RESULTS

The indication for EN for cystic neoplasms and neuro-endocrine tumours to EN was 20.5 and 73 %; for CP 62.9 and 31 %; and for DPPHRt/p 69.6 and 10.2%, respectively. The estimated mean tumour sizes were in EN-group 2.4 cm, in CP-group 2.9 cm and in DPPHRt/p-group 3.1 cm (DPPHRt/p vs EN, p = 0.035). Postoperative severe complications developed after EN, CP and DPPHRt/p in 9.6, 16.8 and 11.5% of patients; pancreatic fistula in 36.7, 35.2 and 20.1%; and reoperation was required in 4.7, 6.5 and 1.8 %, respectively. Hospital mortality after EN was 0.95 %; after CP 0.72%; and after DPPHRt/p 0.49%. Compared to EN and CP, DPPHRt/p exhibited significant lower frequency of reoperation (p = 0.029, p < 0.001) and lower rate of fistula (p < 0.001; p = 0.001).

CONCLUSION

EN, CP and DPPHRt/p applied for benign tumours are associated with low surgery-related early postoperative morbidity, a very low hospital mortality and the advantages of conservation of pancreatic functions. However, the level of evidence for EN and CP compared to standard oncological resections appears presently low. There is a high level of evidence from prospective controlled trials regarding the significant maintenance of exocrine and endocrine pancreatic functions after DPPHRt/p compared to pancreato-duodenectomy.

Eating disorder professionals' perceptions of oral health knowledge

OBJECTIVE

The aim of this study was to assess the oral health knowledge among professionals who specialize in treating eating disorders, and identify to what extent their education, and training addresses oral health care delivery, and recommendations for individuals with eating disorders.

METHOD

Participants for this study were licensed behavioural and medical providers specializing in eating disorder treatment (n = 107), and recruited through professional eating disorder organizations. Participants completed an anonymous, online questionnaire (33 items) assessing level of oral health-related education, knowledge and treatment recommendations within the participant's respective eating disorder discipline.

RESULTS

The majority of respondents (85%) were formally trained in eating disorders, and of those trained, 64.4% were not satisfied with the level of oral health education during formal education, and 19.5% report no oral health education. Respondents consider their knowledge of risk of oral disease for their clients/patients as average or above (84%), and ranked tooth erosion as the greatest reason for oral care (63%) while dry mouth led in the rankings for least significant reason for oral care (33%). Referral for oral care was found to be more common after reports of complication (55%).

DISCUSSION

According to these findings, eating disorder professionals regard oral health care for their clients as significant, and may be unaware of associated oral risk factors, current oral care standards and long-term oral effects of disordered eating apart from enamel erosion.

Frequence, spectrum and prognostic impact of additional malignancies in patients with gastrointestinal stromal tumors

Currently available data on prognostic implication of additional neoplasms in GIST miss comprehensive information on patient outcome with regard to overall or disease specific and disease free survival. Registry data of GIST patients with and without additional neoplasm were compared in retrospective case series. We investigated a total of 836 patients from the multi-center Ulmer GIST registry. Additionally, a second cohort encompassing 143 consecutively recruited patients of a single oncology center were analyzed. The frequency of additional malignant neoplasms in GIST patients was 31.9% and 42.0% in both cohorts with a mean follow-up time of 54 and 65 months (median 48 and 60 months), respectively. The spectrum of additional neoplasms in both cohorts encompasses gastrointestinal tumors (43.5%), uro-genital and breast cancers (34.1%), hematological malignancies (7.3%), skin cancer (7.3%) and others. Additional neoplasms have had a significant impact on patient outcome. The five year overall survival in GIST with additional malignant neoplasms (n = 267) was 62.8% compared to 83.4% in patients without other tumors (n = 569) (P < .001, HR=0.397, 95% CI: 0.298-0.530). Five-year disease specific survival was not different between both groups (90.8% versus 90.9%). 34.2% of all deaths (n = 66 of n = 193) were GIST-related. The presented data suggest a close association between the duration of follow-up and the rate of additional malignancies in GIST patients. Moreover the data indicate a strong impact of additional malignant neoplasms in GIST on patient outcome. A comprehensive follow-up strategy of GIST patients appears to be warranted.

[Prevention of Occupational Injuries Related to Hands: Calculation of Subsequent Injury Costs for the Austrian Social Occupational Insurance Institution (AUVA)]

MOTIVATION

Occupational injuries cause short-term, direct costs as well as long-term follow-up costs over the lifetime of the casualties. Due to shrinking budgets accident insurance companies focus on cost reduction programmes and prevention measures. For this reason, a decision support system for consequential cost calculation of occupational injuries was developed for the main Austrian social occupational insurance institution (AUVA) during three projects.

METHODS

This so-called cost calculation tool combines the traditional instruments of accounting with quantitative methods such as micro-simulation. The cost data are derived from AUVA-internal as well as external economic data sources. Based on direct and indirect costs, the subsequent occupational accident costs from the time of an accident and, if applicable, beyond the death of the individual casualty are predicted for the AUVA, the companies in which the casualties are working, and the other economic sectors.

RESULTS

By using this cost calculation tool, the AUVA classifies risk groups and derives related prevention campaigns. In the past, the AUVA concentrated on falling, accidents at construction sites and in agriculture/forestry, as well as commuting accidents. Currently, among others, a focus on hand injuries is given and first prevention programmes have been initiated. Hand injuries represent about 38% of all casualties with average costs of about 7,851 Euro/case. Main causes of these accidents are cutting injuries in production, agriculture, and forestry. Beside a low, but costly, number of amputations with average costs of more than 100,000 Euro/case, bone fractures and strains burden the AUVA-budget with about 17,500 and 10,500 € per case, respectively.

CONCLUSION

Decision support systems such as this cost calculation tool represent necessary instruments to identify risk groups and their injured body parts, causes of accidents, and economic activities, which highly burden the budget of an injury company, and help derive countermeasures to avoid injuries. Target-group specific, suitable prevention measures for hand injuries can reduce accidents in a cost-effective way and lower their consequences.

Tolerance to nitroglycerin through proteasomal down-regulation of aldehyde dehydrogenase-2 in a genetic mouse model of ascorbate deficiency

Background and Purpose

L-gulonolactone oxidase-deficient (Gulo^(-/-)) mice were used to study the effects of ascorbate deficiency on aortic relaxation by nitroglycerin (GTN) with focus on changes in the expression and activity of vascular aldehyde dehydrogenase-2 (ALDH2), which catalyses GTN bioactivation.

Experimental Approach

Ascorbate deficiency was induced in Gulo^(-/-) mice by ascorbate deprivation for 4 weeks. Some of the animals were concomitantly treated with the proteasome inhibitor bortezomib and effects compared with ascorbate-supplemented Gulo^(-/-), untreated or nitrate-tolerant wild-type mice. Aortic relaxation of the experimental groups to GTN, ACh and a NO donor was studied. Changes in mRNA and protein expression of vascular ALDH2 were quantified by qPCR and immunoblotting, respectively, and aortic GTN denitration rates determined.

Key Results

Like GTN treatment, ascorbate deprivation induced vascular tolerance to GTN that was associated with markedly decreased rates of GTN denitration. Ascorbate deficiency did not affect ALDH2 mRNA levels, but reduced ALDH2 protein expression and the total amount of ubiquitinated proteins to about 40% of wild-type controls. These effects were largely prevented by ascorbate supplementation or treating Gulo^(-/-) mice with the 26S proteasome inhibitor bortezomib.

Conclusions and Implications

Our data indicate that ascorbate deficiency results in vascular tolerance to GTN via proteasomal degradation of ALDH2. The results support the view that impaired ALDH2-catalysed metabolism of GTN contributes significantly to the development of vascular nitrate tolerance and reveal a hitherto unrecognized protective effect of ascorbate in the vasculature.