[Medication reconciliation and hospital-community transition securisation: Survey of community pharmacists]

OBJECTIVE

To collect the community pharmacists' perception on their role in the medication reconciliation's process.

METHODS

We did an observational transverse study thanks to a survey of community pharmacists working in France, conducted in 2020. A digital questionnaire was submitted to Parisian community pharmacists before being shared on two Facebook groups. The responses were analysed with Microsoft Excel® software. We calculated percentages, used Chi2 or Fisher's exact tests and did qualitative analyses.

RESULTS

We collected the perception of 135 community pharmacists, the majority was women (80%), relatively young (69.6% of 40 years old or less). They were 63.7% to claim knowing the medication reconciliation, but they could not define it properly. The subject's knowledge was statistically related to age (P-value<0.001) and previous contacts of the health care facilities (P-value<0.001). The majority of interviewed pharmacist considered the transmission of information to those health facilities as relevant and feasible and they expressed their willingness to get involved. However, they were limited by some obstacles such as the non-exhaustiveness of the medicinal record, the unsecured mail and the lack of feedbacks.

CONCLUSIONS

Although the community pharmacists expressed interest for the medication reconciliation process and willingness to get involved, their role remained limited. Therefore, this process needs an improvement of its organisation and a generalisation of its practice to really benefit the hospital-community transition's safety.

[Update on collaborative autopsy-based research in German pathology, neuropathology, and forensic medicine]

BACKGROUND

Autopsies are a valuable tool for understanding disease, including COVID-19.

MATERIALS AND METHODS

The German Registry of COVID-19 Autopsies (DeRegCOVID), established in April 2020, serves as the electronic backbone of the National Autopsy Network (NATON), launched in early 2022 following DEFEAT PANDEMIcs.

RESULTS

The NATON consortium's interconnected, collaborative autopsy research is enabled by an unprecedented collaboration of 138 individuals at more than 35 German university and non-university autopsy centers through which pathology, neuropathology, and forensic medicine autopsy data including data on biomaterials are collected in DeRegCOVID and tissue-based research and methods development are conducted. More than 145 publications have now emerged from participating autopsy centers, highlighting various basic science and clinical aspects of COVID-19, such as thromboembolic events, organ tropism, SARS-CoV‑2 detection methods, and infectivity of SARS-CoV-2 at autopsy.

CONCLUSIONS

Participating centers have demonstrated the high value of autopsy and autopsy-derived data and biomaterials to modern medicine. The planned long-term continuation and further development of the registry and network, as well as the open and participatory design, will allow the involvement of all interested partners.

COSMOS next generation - A public knowledge base leveraging chemical and biological data to support the regulatory assessment of chemicals

The COSMOS Database (DB) was originally established to provide reliable data for cosmetics-related chemicals within the COSMOS Project funded as part of the SEURAT-1 Research Initiative. The database has subsequently been maintained and developed further into COSMOS Next Generation (NG), a combination of database and in silico tools, essential components of a knowledge base. COSMOS DB provided a cosmetics inventory as well as other regulatory inventories, accompanied by assessment results and in vitro and in vivo toxicity data. In addition to data content curation, much effort was dedicated to data governance - data authorisation, characterisation of quality, documentation of meta information, and control of data use. Through this effort, COSMOS DB was able to merge and fuse data of various types from different sources. Building on the previous effort, the COSMOS Minimum Inclusion (MINIS) criteria for a toxicity database were further expanded to quantify the reliability of studies. COSMOS NG features multiple fingerprints for analysing structure similarity, and new tools to calculate molecular properties and screen chemicals with endpoint-related public profilers, such as DNA and protein binders, liver alerts and genotoxic alerts. The publicly available COSMOS NG enables users to compile information and execute analyses such as category formation and read-across. This paper provides a step-by-step guided workflow for a simple read-across case, starting from a target structure and culminating in an estimation of a NOAEL confidence interval. Given its strong technical foundation, inclusion of quality-reviewed data, and provision of tools designed to facilitate communication between users, COSMOS NG is a first step towards building a toxicological knowledge hub leveraging many public data systems for chemical safety evaluation. We continue to monitor the feedback from the user community at support@mn-am.com.

[Microvascular changes in COVID-19]

BACKGROUND

Clinically, coronavirus disease 2019 (COVID-19) is associated with a wide range of symptoms, which can range from mild complaints of an upper respiratory infection to life-threatening hypoxic respiratory insufficiency and multiorgan failure.

OBJECTIVE

The initially identified pulmonary damage patterns, such as diffuse alveolar damage in acute lung failure, are accompanied by new findings that draw a more complex scenario. These include microvascular involvement and a wide range of associated pathologies of multiple organ systems. A back-scaling of microstructural vascular changes is possible via targeted correlation of pathological autopsy results with radiological imaging.

MATERIAL AND METHODS

Radiological and pathological correlation as well as microradiological imaging to investigate microvascular involvement in fatal COVID-19.

RESULTS

The cases of two COVID-19 patients are presented. Patient 1 showed a relative hypoperfusion in lung regions that did not have typical COVID-19 infiltrates; the targeted post-mortem correlation also showed subtle signs of microvascular damage even in these lung sections. Patient 2 showed both radiologically and pathologically advanced typical COVID-19 destruction of lung structures and the case illustrates the damage patterns of the blood-air barrier. The perfusion deficit of the intestinal wall shown in computed tomography of patient 2 could not ultimately clearly be microscopically attributed to intestinal microvascular damage.

CONCLUSION

In addition to microvascular thrombosis, our results indicate a functional pulmonary vasodysregulation as part of the pathophysiology during the vascular phase of COVID-19. The clinical relevance of autopsies and the integration of radiological imaging findings into histopathological injury patterns must be emphasized for a better understanding of COVID-19.

[Elder fallers: A group at risk of readmission?]

OBJECTIVES

To describe older patients hospitalized for falls, at risk of readmission and priority for interventions to reduce this risk.

METHODS

We conducted an observational, monocentric, prospective study (from April to June 2019). The inclusion criteria were: patients aged 75 and over, admitted to the Emergency Department for falls, consenting to the study. For patients subsequently hospitalized, the geriatric scores were determined (risk of readmission [ISAR score], state of frailty, degree of autonomy [Katz score]), and when appropriate, medication treatments were listed and compliance of patients was assessed (Girerd score).

RESULTS

In three months, 154 patients were included (median age 86 years [min 75-max 103], sex ratio 0.44), of which 73 patients were hospitalized. Among these patients, 63% presented a high risk of readmission; 45.2% are likely to become frail; 72.6% were dependent. Finally, 53 of the 73 patients (72.6%) had a treatment in primary care and presented a 71.7% non-compliance or low-compliance rate. Fifty height patients (79.5%) had at least 1 drug associated with fall [min 1-max 7].

CONCLUSIONS

Older patients presenting at hospital with a fall were numerous, often likely to become frail and dependent for the majority of them. As the readmission risk is also very high in this population, future studies aiming at reducing the risk of hospital readmission are needed.

Bulk and grain boundary Li-diffusion in dense LiMn2O4 pellets by means of isotope exchange and ToF-SIMS analysis

Lithium diffusion in LiMn₂O₄ pellets is studied by means of isotope exchange and Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS). A ⁶Li-enriched film deposited by Pulsed Laser Deposition (PLD) on a dense LiMn₂O₄ pellet with natural abundance of lithium isotopes is used to study the tracer diffusion of lithium. The measured profiles are analyzed by numerical models describing the ⁶Li tracer diffusion from the film into the pellet. Experiments in the Harrison type B regime of diffusion kinetics allow for the distinction and simultaneous determination of bulk and grain boundary diffusion coefficients. Changing the experimental conditions to reach Harrison type A behavior yields effective diffusion coefficients for lithium tracer diffusion in LiMn₂O₄. Activation energies for bulk and grain boundary diffusion were obtained from experiments at different temperatures. Our values are critically compared to previous studies.

P981Predictor factors and the prognostic role of persistent pulmonary veins isolation in patients with arrhythmia recurrence necessitating a second ablation procedure

Aims

Pulmonary vein isolation (PVI) is the treatment of choice in patients (pts) with symptomatic atrial fibrillation. Durable pulmonary veins isolation (PVI) seems to be associated with a lower risk of AF recurrence, but the predictor factors of persistent PVI are still uncertain. We aimed to determinate the predictor factors and the prognostic role of persistent pulmonary veins isolation in pts with arrhythmia recurrence necessitating a second ablation procedure.

Methods and results

Our Study included 102 pts (65.7% male, 65±8 years old, 75.5% persistent AF) with arrhythmia recurrence, whom underwent a Redo-PVI between October 2016 and Mars 2018. Patients were divided into two groups regarding the persistence of PVI. Group 1 included 20 pts with persistent PVI and Group 2 included 82 pts with reconnection of at least one PV. The clinical profile, ablation data and three months arrhythmia recurrence were analyzed.

There were no statistical differences in terms of clinical profile between the two groups of pts (age; p=0.513, gender; p=0.299, BMI; p=0.077, diabetes mellitus; p=0.621, coronary artery disease; p=0.787; arterial hypertension; p=0.732; left ventricle ejection fraction; p=0.323 and left atrial diameter; p=0.5). Patients in group 1 presented more often with atrial tachycardia compared to group 2 Patients (30% versus 7.3%; p=0.014). Regarding the ablation data, there were no differences between the two groups in terms of procedure time (p=0.710) but the ablation time was longer in group 2 patients (29.1±13.7 versus 20.8±10.5 min. p=0.031). Low voltage areas (LVA) acquired by bipolar electroanatomical mapping were more often and diffuse in group 1 patients (70% versus 40.3%; p=0.050). The three months arrhythmia recurrence after Redo-Ablation was the same between the two groups (p=1.000).

Conclusion

The type of arrhythmia recurrence and low voltage areas are predictor factors of persistent pulmonary veins isolation in patients with arrhythmia recurrence necessitating a second ablation procedure. This fact can help in planning the second ablation procedure. Persistent PVI seems to have no prognostic role regarding the three months arrhythmia recurrence after Redo-Ablation.

Interactions between plant-derived oestrogenic substances and the mycoestrogen zearalenone in a bioassay with MCF-7 cells

Human and animal diets may contain several non-steroidal oestrogenic compounds which originate either from plants (phytoestrogens) or from fungi that infect plants (mycoestrogens such as zearalenone (ZEN)). Phytoestrogens may compete with ZEN in binding to the oestrogen receptor β and thereby may counteract the oestrogenic activity of ZEN. Using a modified version of the E-screen assay, plant-derived oestrogenic substances were tested for their proliferative or anti-proliferative effect on oestrogen-dependent MCF-7 cells. The samples were additionally tested for their ability to influence the oestrogenic activity of ZEN (1 μM). Among the individual substances tested, 8-prenylnaringenin had the strongest effect, as cell proliferation was increased by 78% at the lowest concentration (0.23 μM), and by 167% at the highest concentration (29.4 μM). Coumestrol (5.83 μM) increased cell proliferation by 39%, and genistein (370 μM) by 61%, respectively. Xanthohumol and enterolactone did not stimulate cell proliferation significantly. In the co-incubation experiments with ZEN, none of the single substances was able to decrease the oestrogenic activity of ZEN. Only for 8-prenylnaringenin (14.7 and 29.4 μM) was a trend towards an increase in the ZEN-induced cell proliferation up to 72% observed. In conclusion, with the exception of 8-prenylnaringenin, no substantial interaction between phytoestrogens and the mycotoxin ZEN could be detected using a bioassays with MCF-7 cells.

Effects of a lower extremity exercise program on gait biomechanics and clinical outcomes in children and adolescents with obesity: A randomized controlled trial

BACKGROUND

Research highlights the detrimental effects of obesity on gait biomechanics and the accompanied risk of lower-extremity skeletal malalignments, increased joint stress, pain and discomfort. Individuals with obesity typically show increased knee valgus angles combined with an increased step width. Accompanying muscular dysfunctions impede their ability to compensate for these alterations, especially in the frontal plane. To date, no studies are available, which evaluated the potential effects of an exercise program (EP) in reducing these unfavorable biomechanical changes.

RESEARCH QUESTIONS

Is a 12-week EP, which includes hip abductor and knee extensor strength exercises and fosters dynamic knee alignment, effective in positively altering gait biomechanics in children and adolescents with obesity?

METHODS

This study was a randomized controlled trial having children and adolescents with obesity assigned to an EP (n = 19) or control (n = 16) group. Pain, self-rated knee function, muscle strength and 3D gait analysis during walking and stair climbing were evaluated.

RESULTS

Results indicate that the EP was able to increase muscular strength especially in the hip abductors. In addition, children from the EP group walked with less maximum hip adduction and reduced pelvic drop during weight acceptance at follow-up. No changes were present in self-rated knee function, pain or discomfort.

SIGNIFICANCE

Even though effects were small, results indicate that an EP is an effective short-term possibility to counteract the progressive development of biomechanical malalignments of the lower extremity. Clinical parameters indicated that the program was feasible. Nonetheless, low adherence highlights the need to develop more attractive programs. CLINICAL TRIALS REG. NO: clinicaltrials.gov (NCT02545764).

Reliability of joint kinematic calculations based on direct kinematic and inverse kinematic models in obese children

BACKGROUND

In recent years, the reliability of inverse (IK) and direct kinematic (DK) models in gait analysis have been assessed intensively, but mainly for lean populations. However, obesity is a growing issue. So far, the sparse results available for the reliability of clinical gait analysis in obese populations are limited to direct kinematic models. Reliability error-margins for inverse kinematic models in obese populations have not been reported yet.

RESEARCH QUESTIONS

Is there a difference in the reliability of IK models compared with a DK model in obese children? Are there any differences in the joint kinematic output between IK and DK models?

METHODS

A test-retest study was conducted using three-dimensional gait analysis data from two obese female and eight obese male participants from an earlier study. Data were analyzed using a DK model and two OpenSim-based IK models. Test-retest reliability was compared by calculating the Standard Error of Measurement (SEM) along with similar absolute reliability measures. A Friedman Test was used to assess whether there were any significant differences in the reliability between the models. Kinematic output of the models was compared by using Statistical Parametric Mapping (SPM).

RESULTS

No significant differences were found in the reliability between the DK and IK models. The SPM analysis indicated several significant differences between both IK models and the DK approach. Most of these differences were continuous offsets.

SIGNIFICANCE

Reliability values showed clinically acceptable error-margins and were comparable between all models. Therefore, our results support the careful use of IK models in overweight or obese populations, e.g. for musculoskeletal modelling studies. The inconsistent kinematic output can mainly be explained by different model conventions and anatomical segment coordinate frame definitions.

Iatrogenic risk factors associated with hospital readmission of elderly patients: A matched case-control study using a clinical data warehouse

WHAT IS KNOWN

Hospital readmission within 30 days of patient discharge has become a standard to judge the quality of hospitalizations. It is estimated that 14% of the elderly, people over 75 years old or those over 65 with comorbidities, are at risk of readmission, of which 23% are avoidable. It may be possible to identify elderly patients at risk of readmission and implement steps to reduce avoidable readmissions.

OBJECTIVE

The aim of this study was to identify iatrogenic risk factors for readmission. The secondary objective was to evaluate the rate of drug-related readmissions (DRRs) among all readmissions and compare it to the rate of readmissions for other reasons.

METHODS

We conducted a retrospective, matched, case-control study to identify non-demographic risk factors for avoidable readmission, specifically DRRs. The study included patients hospitalized between 1 September 2014 and 31 October 2015 in an 800-bed university hospital. We included patients aged 75 and over. Cases consisted of patients readmitted to the emergency department within 30 days of initial discharge. Controls did not return to the emergency department within 30 days. Cases and controls were matched on sex and age because they are known as readmissions risk factors. After comparison of the mean or percentage between cases and controls for each variable, we conducted a conditional logistic regression.

RESULTS

The risk factors identified were an emergency admission at the index hospitalization, returning home after discharge, a history of unplanned readmissions and prescription of nervous system drugs. Otherwise, 11.4% of the readmissions were DRRs, of which 30% were caused by an overdose of antihypertensive. The number of drugs at readmission was higher, and potentially inappropriate medications were more widely prescribed for DRRs than for readmissions for other reasons.

WHAT IS NEW AND CONCLUSION

In this matched case-control retrospective study, after controlling for gender and age, we identified the typical profile of elderly patients at risk of readmission. These patients had an unplanned admission at the index hospitalization and prescribed nervous system drugs at discharge from the index admission; they have a history of unplanned readmission within 30 days and return home after discharge.

Modal noise in an integrated photonic lantern fed diffraction-limited spectrograph

In an attempt to develop a streamlined astrophotonic instrument, we demonstrate the realization of an all-photonic device capable of both multimode to single mode conversion and spectral dispersion on an 8-m class telescope with efficient coupling. The device was a monolithic photonic spectrograph which combined an integrated photonic lantern and an efficient arrayed waveguide grating device. During on-sky testing, we discovered a previously unreported type of noise that made spectral extraction and calibration extremely difficult. The source of the noise was traced to a wavelength-dependent loss mechanism between the feed fiber's multimode near-field pattern and the modal acceptance profile of the integrated photonic lantern. Extensive modeling of the photonic components replicates the wavelength-dependent loss, and demonstrates an identical effect on the final spectral output. We outline that this could be mitigated by directly injecting into the integrated photonic lantern.

Demonstration of an efficient, photonic-based astronomical spectrograph on an 8-m telescope

We demonstrate for the first time an efficient, photonic-based astronomical spectrograph on the 8-m Subaru Telescope. An extreme adaptive optics system is combined with pupil apodiziation optics to efficiently inject light directly into a single-mode fiber, which feeds a compact cross-dispersed spectrograph based on array waveguide grating technology. The instrument currently offers a throughput of 5% from sky-to-detector which we outline could easily be upgraded to ∼ 13% (assuming a coupling efficiency of 50%). The isolated spectrograph throughput from the single-mode fiber to detector was 42% at 1550 nm. The coupling efficiency into the single-mode fiber was limited by the achievable Strehl ratio on a given night. A coupling efficiency of 47% has been achieved with ∼ 60% Strehl ratio on-sky to date. Improvements to the adaptive optics system will enable 90% Strehl ratio and a coupling of up to 67% eventually. This work demonstrates that the unique combination of advanced technologies enables the realization of a compact and highly efficient spectrograph, setting a precedent for future instrument design on very-large and extremely-large telescopes.

The effects of instrumental color and extractable lipid content on sensory characteristics of pork loin chops cooked to a medium-rare degree of doneness

Boneless loins ( = 286) were selected from a population of pigs of a common genetic line and management strategy to be used in an experiment to determine the effects of instrumental color and extractable lipid content on sensory traits of boneless pork chops cooked to an end point internal temperature of 63°C. Loins were cut into 2.54-cm-thick chops and aged until 14 d postmortem. Chop L* values ranged from 57.60 (light) to 43.11 (dark) and extractable lipid ranged from 0.80 to 5.52%. Using these values, chops were assigned to 5 color and 6 marbling categories using National Pork Producers Council (NPPC) standards, resulting in a 5 × 6 factorial arrangement of treatments. Chops were also assigned a quality grade using a proposed grading system. Low-quality loins ( = 56) had marbling scores < 1.5, regardless of color, or had color scores ≤ 2.5 and marbling scores ≤ 2.0. Medium-quality loins ( = 180) had color scores of 2.0 to 3.5 and marbling scores ≥ 2.5 or loins with color scores of 3.0 through 3.5 and marbling scores ≥ 2.0. High-quality loins ( = 50) had color scores > 4.0 and marbling scores ≥ 2.0. Chops were cooked to a medium-rare degree of doneness (63°C) and evaluated for tenderness, juiciness, and pork flavor by trained panelists. Slice shear force (SSF) and cooking loss were also evaluated. Data were analyzed using the MIXED procedure of SAS as a 1-way ANOVA with the fixed effect of quality grade and using the REG procedure of SAS. Individually, extractable lipid content and instrumental color accounted for no more than 2% ( ≤ 0.02) of the variation in tenderness, juiciness, or pork flavor. High-quality chops had 6.5 and 11.2% less SSF ( ≤ 0.04) than medium- and low-quality chops, respectively, and medium-quality chops had 5.6% less SSF ( < 0.04) than low-quality chops. Trained sensory panelists did not detect differences in tenderness ( = 0.09) or juiciness ( = 0.48) among quality grades, but low- and medium-quality chops were more flavorful ( < 0.01) than high-quality chops. Cooking loss tended ( = 0.06) to decrease from 16.57% to 15.32% as quality grade increased. Neither color nor marbling alone was predictive of sensory quality. But when these were used together, as they were in the proposed grading system, pork sensory flavor ratings were greater for low-quality chops than for high- and medium-quality chops. Also, the proposed grading system was able to discern differences in SSF but not sensory tenderness among the quality grades.

A phase I/II trial of AT9283, a selective inhibitor of aurora kinase in children with relapsed or refractory acute leukemia: challenges to run early phase clinical trials for children with leukemia

Aurora kinases regulate mitosis and are commonly overexpressed in leukemia. This phase I/IIa study of AT9283, a multikinase inhibitor, was designed to identify maximal tolerated doses, safety, pharmacokinetics, and pharmacodynamic activity in children with relapsed/refractory acute leukemia. The trial suffered from poor recruitment and terminated early, therefore failing to identify its primary endpoints. AT9283 caused tolerable toxicity, but failed to show clinical responses. Future trials should be based on robust preclinical data that provide an indication of which patients may benefit from the experimental agent, and recruitment should be improved through international collaborations and early combination with established treatment strategies.

Predicting pork loin chop yield using carcass and loin characteristics

The objective was to determine the predictive ability of carcass length for the number of equal-thickness chops obtained from a boneless pork loin. Longer pork carcasses are assumed to yield longer loins and, therefore, an increased number of chops. Loins were collected from pigs (1,238 total) raised under commercial conditions and marketed when the mean pig weight in a pen reached 138 kg. Pigs were slaughtered over 7 wk in a commercial facility. Carcass length was measured at 1 d postmortem on the left side of each carcass from the anterior edge of the symphysis pubis bone to the anterior edge of the first rib. Carcasses were fabricated, and boneless loins (North American Meat Processors number 414) were vacuum packaged and transported to the University of Illinois Meat Science Laboratory. Loins were stored at 4°C for 14 d. At the end of the aging period, loins were weighed, measured for stretched length (stretched to maximum length without distortion) and compressed length (compressed to minimum length without distortion), and sliced into 2.54-cm-thick chops. Boneless chops were counted and weighed. Carcass length ranged from a minimum of 78.2 cm to a maximum of 96.5 cm and the number of boneless chops ranged from a minimum of 13 to a maximum of 20 chops. Data were analyzed using the regression procedure of SAS. The dependent variable was the number of boneless chops. Coefficient of determination () was calculated for carcass length, boneless loin weight, compressed loin length, and stretched loin length. Carcass length explained 15% ( < 0.0001) of the variation in the number of loin chops. Loin weight explained 33% ( < 0.0001) of the variation in the number of loin chops. Compressed loin length and stretched loin length explained 28 and 8% ( < 0.0001), respectively, of the variation in the number of loin chops. Multiple linear regression was used to determine a predictive equation for the number of loin chops using the stepwise selection option of all independent variables. The combination of boneless loin weight, compressed loin length, 10th-rib carcass fat depth, and carcass length explained 45% of the variation ( < 0.0001; C(p) = 16.76) in the number of loin chops using a required statistic at the SLENTRY and SLSTAY level = 0.15. Overall, carcass length is a poor predictor of the number of equal-thickness loin chops that can be derived from a boneless pork loin.

Outcome in children with Down's syndrome and acute lymphoblastic leukemia: role of IKZF1 deletions and CRLF2 aberrations

Children with Down's syndrome (DS) have an increased risk of developing acute lymphoblastic leukemia (ALL) and have a low frequency of established genetic aberrations. We aimed to determine which genetic abnormalities are involved in DS ALL. We studied the frequency and prognostic value of deletions in B-cell development genes and aberrations of janus kinase 2 (JAK2) and cytokine receptor-like factor 2 (CRLF2) using array-comparative genomic hybridization, and multiplex ligation-dependent probe amplification in a population-based cohort of 34 Dutch Childhood Oncology Group DS ALL samples. A population-based cohort of 88 DS samples from the UK trials was used to validate survival estimates for IKZF1 and CRLF2 abnormalities. In total, 50% of DS ALL patients had ≥1 deletion in the B-cell development genes: PAX5 (12%), VPREB1 (18%) and IKZF1 (35%). JAK2 was mutated in 15% of patients, genomic CRLF2 rearrangements in 62%. Outcome was significantly worse in patients with IKZF1 deletions (6-year event-free survival (EFS) 45 ± 16% vs 95 ± 4%; P=0.002), which was confirmed in the validation cohort (6-year EFS 21 ± 12% vs 58 ± 11%; P=0.002). This IKZF1 deletion was a strong independent predictor for outcome (hazard ratio EFS 3.05; P=0.001). Neither CRLF2 nor JAK2 were predictors for worse prognosis. If confirmed in prospective series, IKZF1 deletions may be used for risk-group stratification in DS ALL.

Converging perturbed microvasculature and microglial clusters characterize Alzheimer disease brain

We have investigated physical properties of microvasculature and vessel association with microglial clusters in cortical tissue from Alzheimer disease individuals, classified as severe (ADsev) or mild (ADmild), and nondemented controls (ND). Immunostaining with laminin or von Willerbrand factor demonstrated numbers of microvessels and microvascular density were significantly higher in ADsev cases compared with levels in ADmild or ND cases suggesting proangiogenic activity in ADsev brain. Evidence for extravascular laminin immunoreactivity was found in ADsev tissue and was largely absent in ADmild and ND cases suggesting vascular remodeling in ADsev brain included abnormalities in blood vessels. Microgliosis was progressively increased from ND to ADmild to ADsev with the latter demonstrating areas of clustered microglia (groupings of three or more cells) rarely observed in ADmild or ND cases. Microglial clusters in ADsev brain were in close proximity with extravascular laminin and also plasma protein, fibrinogen, implicating vascular perturbation as a component of inflammatory reactivity. ADsev brain also exhibited elevated levels of the pro-inflammatory/angiogenic factors tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) in association, relative to non-association, with microglial clusters. The presence of extravascular laminin and fibrinogen and the vascular modifying factors, TNF-α and VEGF in localization with clusters of activated microglia, is consistent with microglial-induced vascular remodeling in ADsev brain. Microglial-vascular reciprocal interactions could serve a critical role in the amplification and perpetuation of inflammatory reactivity in AD brain.

Complications of a buried penis in an extremely obese patient

The buried penis syndrome in adults is a rare condition of different aetiologies. Today extreme obesity is considered as a major contributor. We present a case of a 30-year-old extremely obese patient (BMI 65 kg/m(2)) with purulent infection of the penile cavity, a phlegmon of the mons pubis and urinary retention due to a buried penis. Whereas acute complications of a buried penis in obese patients include local infection and urinary retention, chronic problems are undirected voiding, disturbed vaginal penetration and erectile dysfunction. Even though several surgical techniques are described, weight reduction should be primarily preferred.

Structure and Metastabiltty of Muonium Centers in Semiconductors and their Simulation of Isolated Hydrogen Centers

The study of isolated hydrogen in semiconductors is difficult because of the tendency for hydrogen to form complexes. An alternative to direct studies of hydrogen is the study of tnuonium in semiconductors. In such experiments the muon is essentially an isotope of hydrogen with th the mass of the proton. Twenty isolated muonium centers have been observed in tetrahedrally-coordinated crystals ranging from Si to the cuprous halides. Muon level-crossing resonance has provided detailed information on neutral interstitial muonium located at a bond center in Si (the analog of the hydrogen center seen by EPR) and very near a bond center in CaP and GaAs. This paper reviews these measurements and discusses the structures and their metastabilities. Comparison is made to EPR for Si and to theoretical studies. Recent results on the metastable and stable muonium centers in CuCl are discussed.

[Peyronie's disease-often a disabling disease for sexually active men]

Peyronie's disease is an acquired penile condition characterized by fibrous plaques between the tunica albuginea and the subtunical tissue of the corpora cavernosa. Plaques are considered responsible for the main symptoms: penile pain and deviation. Even though several risk factors and associations with other diseases are known its exact aetiology remains unclear. Most commonly discussed hypotheses are micro traumata, inflammatory and/or ischemic processes. Currently different treatment forms exist raging form systemic or local medical treatment, to physical applications and surgery. All treatment forms are symptom based and evidence based treatment remains difficult to establish. Because conservative treatment is of limited success in many patients especially with severe deviations surgery becomes necessary.

Als2-deficient mice exhibit disturbances in endosome trafficking associated with motor behavioral abnormalities

ALS2 is an autosomal recessive form of spastic paraparesis (motor neuron disease) with juvenile onset and slow progression caused by loss of function of alsin, an activator of Rac1 and Rab5 small GTPases. To establish an animal model of ALS2 and derive insights into the pathogenesis of this illness, we have generated alsin-null mice. Cytosol from brains of Als2(-/-) mice shows marked diminution of Rab5-dependent endosome fusion activity. Furthermore, primary neurons from Als2(-/-) mice show a disturbance in endosomal transport of insulin-like growth factor 1 (IGF1) and BDNF receptors, whereas neuronal viability and endocytosis of transferrin and dextran seem unaltered. There is a significant decrease in the size of cortical motor neurons, and Als2(-/-) mice are mildly hypoactive. Altered trophic receptor trafficking in neurons of Als2(-/-) mice may underlie the histopathological and behavioral changes observed and the pathogenesis of ALS2.

Role of ICAM-1 in persisting inflammation in Parkinson disease and MPTP monkeys

It has been established that neuroinflammation is present in the substantia nigra (SN) of Parkinson disease (PD) cases but the factors responsible are as yet unknown. One contributing protein may be the intercellular adhesion molecule-1 (ICAM-1, CD54). ICAM-1 with its counter receptor, the lymphocyte function-associated antigen 1 (LFA-1) is known to play a key role in inflammatory processes and in T-cell mediated host defense mechanisms. We detected large numbers of ICAM-1-positive reactive astrocytes in the SN of a series of 14 patients with neuropathologically confirmed PD, including 3 of familial origin, compared with 11 age-matched controls. In PD SN, these ICAM-1-positive reactive astrocytes were particularly concentrated around many residual neurons in areas of heavy neuronal loss and extracellular melanin accumulation. LFA-1-positive reactive microglia gathered in areas of intense ICAM-1 expression, and LFA-1-positive leukocytes were identified infiltrating the tissue. Double immunostaining for ICAM-1 and LFA-1 revealed aggregates of reactive microglia embedded in areas of diffuse ICAM-1. Leukocyte counts were 5 fold higher in PD SN compared to controls (P < 0.001). Similar over-expression of ICAM-1 was found in monkeys that had been exposed to MPTP from 5.5 to 14 years previously compared with control monkeys. The presence of ICAM-1-positive reactive astrocytes in Parkinson disease and MPTP-treated monkeys is indicative of a sustained inflammatory process and suggests that antiinflammatory agents may have a place in PD therapy.

Cytotoxic effects of the herbicide 2,4-dichlorophenoxyacetic acid in HepG2 cells

2,4-Dichlorophenoxyacetic acid (2,4-D) and its derivatives are herbicides widely used to control the growth of broadleaf and woody plants. Although 2,4-D is well known to be moderately toxic, little information is available on the mechanisms of its toxicity. Results on carcinogenicity, genotoxicity and mutagenicity are contradictory, but neurotoxic, immunosuppressive and hepatotoxic effects have been defined. The aim of the present study was to investigate the cytotoxic effects of 2,4-D on a human hepatoma cell line. HepG2 cells were treated with different concentrations of 2,4-D, and cell viability, induction of apoptosis/necrosis and cell cycle phases were determined. Apoptosis was detected in flow cytometric light scatter histograms, the annexin V assay, the determination of DNA strand breaks with the TUNEL assay and the occurrence of a sub G(0) peak after propidium iodide (PI) staining. The induction of apoptosis by 2,4-D was accompanied by a disruption of the mitochondrial membrane potential as verified by staining with the cationic JC-1 probe. In addition, 2,4-D affected the cell cycle in a concentration-dependent manner. Our investigation suggested that 2,4-D exerts its cytotoxic effects by the induction of apoptosis via a direct effect on the mitochondrial membrane potential.