Laser Excitation of the Th-229 Nucleus

The 8.4 eV nuclear isomer state in Th-229 is resonantly excited in Th-doped CaF_{2} crystals using a tabletop tunable laser system. A resonance fluorescence signal is observed in two crystals with different Th-229 dopant concentrations, while it is absent in a control experiment using Th-232. The nuclear resonance for the Th^{4+} ions in Th:CaF_{2} is measured at the wavelength 148.3821(5) nm, frequency 2020.409(7) THz, and the fluorescence lifetime in the crystal is 630(15) s, corresponding to an isomer half-life of 1740(50) s for a nucleus isolated in vacuum. These results pave the way toward Th-229 nuclear laser spectroscopy and realizing optical nuclear clocks.

Impact of long-range attraction on desorption kinetics

Desorption of molecules from surfaces is widespread both in nature and technology. Despite its omnipresence and conceptual simplicity, fundamental details can be surprisingly complex and are often poorly understood. In many cases, first-order kinetics is assumed, which implies that the adsorbates do not interact with each other and desorption is the rate-limiting process. While this might be a good approximation in some cases, it is far from reality in the case of adsorbates that form ordered structures. Here, we study the desorption of a submonolayer film of 3-nitrophenol from the natural cleavage plane of calcite kept in ultrahigh vacuum. Interestingly, two distinctly different desorption regimes are observed during isothermal desorption monitored by dynamic atomic force microscopy. Initially, at high coverages, the coverage decreases almost linearly in time, indicating a constant desorption rate. Beyond this linear regime, at low coverages, a drastic increase in desorption rate is observed until the surface is completely empty. The transition between these two regimes is associated with a critical island width. We propose an existence of a long-range attractive interaction between the molecules as a possible explanation for the sudden increase in the desorption rate when a critical island width is reached. The herein observed phenomenon of two different desorption regimes is expected to be of general nature when interactions beyond next-neighbour attraction are present.

Healthcare‑associated infections in intensive care unit patients with and without COVID-19: a single center prospective surveillance study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic led to a global increase in healthcare-associated infections (HAI) among intensive care unit (ICU) patients. Whether this increase is directly attributable to COVID-19 or whether the pandemic indirectly (via staff shortages or breaches in infection prevention measures) led to this increase, remains unclear. The objectives of this study were to assess HAI incidence and to identify independent risk factors for HAI in COVID-19 and non-COVID-19 ICU patients.

METHODS

We established a monocentric prospective HAI surveillance in the medical ICU of our tertiary care center from September 1st 2021 until August 31st 2022, during circulation of the SARS-CoV-2 delta and omicron variants. We consecutively included patients ≥ 18 years of age with an ICU length of stay of > 2 calendar days. HAI were defined according to the European Centre for Disease Prevention and Control definitions. HAI rate was calculated per 1,000 patient-days or device-days; risk ratios (RR) and corresponding 95% confidence intervals (CI) for COVID-19 versus non-COVID-19 patients were calculated. We used multivariable Cox regression to identify independent risk factors for HAI. As a proxy for institutional COVID-19 burden, weekly COVID-19 density (i.e. percentage of COVID-19 patients among all ICU patients) was included in the model as time-dependent co-variable.

RESULTS

We included 254 patients, 64 (25.1%) COVID-19 and 190 (74.9%) non-COVID-19 patients; 83 HAI in 72 patients were recorded, thereof 45 ventilator-associated lower respiratory tract infections (VA-LRTI) (54.2%) and 18 blood stream infections (BSI) (21.6%). HAI incidence rate was 49.1/1,000 patient-days in COVID-19 and 22.5/1,000 patient-days in non-COVID-19 patients (RR 2.2, 95%-CI 1.4-3.4). This result was mainly due to different VA-LRTI rates (40.3 vs. 11.7/1,000 ventilator days, p < 0.001), whereas BSI rates were not statistically different (9.4 vs. 5.6/1,000 patient days, p = 0.27). Multivariable analysis identified COVID-19 as main risk factor for HAI development, whereas age, mechanical ventilation and COVID-19 density were not significant.

CONCLUSIONS

These data from the fourth and fifth wave of the pandemic show a higher HAI incidence in COVID-19 than in non-COVID-19 ICU patients, mainly due to an increase in pulmonary infections. A diagnosis of COVID-19 was independently associated with HAI development, whereas institutional COVID-19 burden was not.

An Investigation of the Suitability of Viscosity Detection in Estimating IgG Content in Mare Colostrum

An adequate supply of colostrum is important for the prevention of hypogammaglobulinaemia in foals. In addition to the quantity of colostrum consumed and the time of consumption, the quality of the colostrum, the immunoglobulin (Ig) G concentration, is crucial. The aim of this study was to determine whether the viscosity of equine colostrum was a suitable estimate of IgG concentration. IgG content of colostrum was measured by ELISA and viscosity directly measured with a cone plate viscometer and indirectly assessed with a funnel. Analysis of 56 colostrum samples obtained from 40 mares at different postpartum time points was conducted to assess colostrum samples with varying levels of quality. The range of IgG concentrations determined by ELISA was 0.83 to 245.5 mg/mL (30.69 ± 41.92 mg/mL). The range of viscosity values determined by the cone plate method was 1.84 to 110.00 cP (7.86 ± 17.48 cP) at a shear rate of 3 rpm. Colostrum drainage from the funnel (drainage time), varied between 7.9 and 30.0 s, with an average of 9.96 ± 4.48 s. As the data were not normally distributed, Spearman's rank correlation analyses were calculated and significant correlation found between viscosity and IgG content (ρ = 0.71, P < .001), as well as between drainage time and IgG content (ρ = 0.75, P < .001). These correlations indicate that determining the viscosity of equine colostrum by cone plate or drainage time, may be an effective proxy measurement of IgG content.

A new approach to estimate soil organic carbon content targets in European croplands topsoils

Adopting land management practices that increase the stock of soil organic carbon (SOC) in croplands is widely promoted as a win-win strategy to enhance soil health and mitigate climate change. In this context, the definition of reference SOC content and stock values is needed to provide reliable targets to farmers, policymakers, and stakeholders. In this study, we used the LUCAS dataset to compare different methods for evaluating reference SOC content and stock values in European croplands topsoils (0-20 cm depth). Methods gave generally similar estimates although being built on very different assumptions. In the absence of an objective criterion to establish which approach is the most suitable to determine SOC reference values, we propose an ensemble modelling approach that consists in extracting the estimates using different relevant methods and retaining the median value among them. Interestingly, this approach led us to select values from the three different approaches with similar frequencies. Using estimated bulk density values, we obtained a first rough estimate of 3.5 Gt C of SOC storage potential in the cropland topsoils that we interpret as a long-term aspirational target that would be reachable only under extreme changes in agricultural practices. The use of additional methods in the ensemble modelling approach and more valid statistical spatial estimates may further refine our approach designed for the estimation of SOC reference values for croplands.

Competition and moral behavior: A meta-analysis of forty-five crowd-sourced experimental designs

Does competition affect moral behavior? This fundamental question has been debated among leading scholars for centuries, and more recently, it has been tested in experimental studies yielding a body of rather inconclusive empirical evidence. A potential source of ambivalent empirical results on the same hypothesis is design heterogeneity-variation in true effect sizes across various reasonable experimental research protocols. To provide further evidence on whether competition affects moral behavior and to examine whether the generalizability of a single experimental study is jeopardized by design heterogeneity, we invited independent research teams to contribute experimental designs to a crowd-sourced project. In a large-scale online data collection, 18,123 experimental participants were randomly allocated to 45 randomly selected experimental designs out of 95 submitted designs. We find a small adverse effect of competition on moral behavior in a meta-analysis of the pooled data. The crowd-sourced design of our study allows for a clean identification and estimation of the variation in effect sizes above and beyond what could be expected due to sampling variance. We find substantial design heterogeneity-estimated to be about 1.6 times as large as the average standard error of effect size estimates of the 45 research designs-indicating that the informativeness and generalizability of results based on a single experimental design are limited. Drawing strong conclusions about the underlying hypotheses in the presence of substantive design heterogeneity requires moving toward much larger data collections on various experimental designs testing the same hypothesis.

New perspectives on fertility in transwomen with regard to spermatogonial stem cells

Objective

Germ cells of transwomen are affected by gender-affirming hormone therapy (GAHT). Fertility will be lost after surgical intervention; thereby, fertility preservation becomes an increasingly imortant topic. This study investigated if the absolute number of spermatogonia in transwomen is comparable at the time of gender-affirming surgery (GAS) to that in pre-pubertal boys.

Methods

We carried out a retrospective study of testicular tissues from 25 selected subjects, which had undergone a comparable sex hormone therapy regimen using cyproterone acetate (10 or 12.5 mg) and estrogens. As controls, testicular biopsies of five cisgender adult men (aged 35-48 years) and five pre-/pubertal boys (5-14 years) were included. Testicular tissues were immunohistochemically stained for MAGE A4-positive cells, the most advanced germ cell type. The number of spermatogonia per area was assessed. Clinical values and serum hormone values for FSH, LH, testosterone, free testosterone, estradiol and prolactin were determined on the day of GAS for correlation analyses.

Results

Round spermatids were the most advanced germ cell type in 3 subjects, 5 had an arrest at spermatocyte stage, while 17 showed a spermatogonial arrest. On average, testicular tissues of transwomen contained 25.15 spermatogonia/mm3, a number that was significantly reduced compared to the two control groups (P < 0.01, adult 80.65 spermatogonia/mm3 and pre-/pubertal boys 78.55 spermatogonia/mm3). Linear regression analysis revealed that testes with higher weight and high LH contained more spermatogonia.

Conclusion

Irrespective of treatment dose or duration, spermatogenesis was impaired. Spermatogonial numbers were significantly reduced in transwomen compared to the control groups.

Lay summary

When transwomen go through treatment to confirm their gender, their germ cells are affected. They lose their fertility after surgery, so fertility preservation becomes an important topic. We carried out a study looking at tissue from testes of 25 people who had been through the same sex hormone therapy until surgery. Blood samples were also taken. As controls, samples were taken from the testes of cisgender boys and adult men. On average, the samples from the testes of transwomen contained a smaller number of early sperm cells compared to the two control groups. Regardless of the dose or length of hormone treatment, the fertility of transwomen was significantly reduced so that counseling about fertility preservation should be offered before hormone therapy.

Diffusion and interaction dynamics of the cytosolic peroxisomal import receptor PEX5

Cellular functions rely on proper actions of organelles such as peroxisomes. These organelles rely on the import of proteins from the cytosol. The peroxisomal import receptor PEX5 takes up target proteins in the cytosol and transports them to the peroxisomal matrix. However, its cytosolic molecular interactions have so far not directly been disclosed. Here, we combined advanced optical microscopy and spectroscopy techniques such as fluorescence correlation spectroscopy and stimulated emission depletion microscopy with biochemical tools to present a detailed characterization of the cytosolic diffusion and interaction dynamics of PEX5. Among other features, we highlight a slow diffusion of PEX5, independent of aggregation or target binding, but associated with cytosolic interaction partners via its N-terminal domain. This sheds new light on the functionality of the receptor in the cytosol as well as highlighting the potential of using complementary microscopy tools to decipher molecular interactions in the cytosol by studying their diffusion dynamics.

Predicting ecosystem responses by data-driven reciprocal modelling

Treatment effects are traditionally quantified in controlled experiments. However, experimental control is often achieved at the expense of representativeness. Here, we present a data-driven reciprocal modelling framework to quantify the individual effects of environmental treatments under field conditions. The framework requires a representative survey data set describing the treatment (A or B), its responding target variable and other environmental properties that cause variability of the target within the region or population studied. A machine learning model is trained to predict the target only based on observations in group A. This model is then applied to group B, with predictions restricted to the model's space of applicability. The resulting residuals represent case-specific effect size estimates and thus provide a quantification of treatment effects. This paper illustrates the new concept of such data-driven reciprocal modelling to estimate spatially explicit effects of land-use change on organic carbon stocks in European agricultural soils. For many environmental treatments, the proposed concept can provide accurate effect size estimates that are more representative than could feasibly ever be achieved with controlled experiments.

Roots are key to increasing the mean residence time of organic carbon entering temperate agricultural soils

The ratio of soil organic carbon stock (SOC) to annual carbon input gives an estimate of the mean residence time of organic carbon that enters the soil (MRT_OC ). It indicates how efficiently biomass can be transformed into SOC, which is of particular relevance for mitigating climate change by means of SOC storage. There have been few comprehensive studies of MRT_OC and their drivers, and these have mainly been restricted to the global scale, on which climatic drivers dominate. This study used the unique combination of regional-scale cropland and grassland topsoil (0-30 cm) SOC stock data and average site-specific OC input data derived from the German Agricultural Soil Inventory to elucidate the main drivers of MRT_OC . Explanatory variables related to OC input composition and other soil-forming factors were used to explain the variability in MRT_OC by means of a machine-learning approach. On average, OC entering German agricultural topsoils had an MRT of 21.5 ± 11.6 years, with grasslands (29.0 ± 11.2 years, n = 465) having significantly higher MRT_OC than croplands (19.4 ± 10.7, n = 1635). This was explained by the higher proportion of root-derived OC inputs in grassland soils, which was the most important variable for explaining MRT_OC variability at a regional scale. Soil properties such as clay content, soil group, C:N ratio and groundwater level were also important, indicating that MRT_OC is driven by a combination of site properties and OC input composition. However, the great importance of root-derived OC inputs indicated that MRT_OC can be actively managed, with maximization of root biomass input to the soil being a straightforward means to extend the time that assimilated C remains in the soil and consequently also increase SOC stocks.

Sustainable Development Goals and livestock systems

Within the framework of the Sustainable Development Goals (SDGs) of the United Nations, particularly those that livestock impact most significantly (SDGs 1, 2, 3, 5, 8, 12, 13, 15 and 17), this paper provides an overview of the livestock sector's impact on food system sustainability and opportunities for building solutions through sustainable livestock options that are supported by robust animal health services. The discourse is shaped by the experiences of the Global Agenda for Sustainable Livestock, a multi-stakeholder partnership which facilitates policy dialogue and action among diverse stakeholders to make livestock systems more sustainable. The Global Agenda for Sustainable Livestock adopted the aforementioned SDGs as the reference framework for its actions, which are organised under four domains (food and nutrition security, animal health and welfare, livelihoods and economic growth, and climate and natural resources). These domains are used to highlight the complexity and diversity of the livestock sector, its positive and negative relationships to development, the integral roles of animal health systems and the opportunities for livestock sector contributions towards a sustainable future.

The effect of potent CYP2D6 inhibition on the pharmacokinetics and safety of deutetrabenazine in healthy volunteers

Purpose

Deutetrabenazine is a deuterated form of tetrabenazine with a confirmed lower rate of CYP2D6 metabolism of the active metabolites, α- and β-HTBZ. In this study, we assessed the effect of paroxetine, a potent CYP2D6 inhibitor, on the pharmacokinetics and safety of deutetrabenazine and its metabolites.

Methods

In this open-label sequential drug-drug-interaction study, 24 healthy adults who were CYP2D6 extensive or intermediate metabolizers received a single deutetrabenazine 22.5-mg oral dose on days 1 and 11 and a single paroxetine 20-mg oral daily dose on days 4–12. Pharmacokinetics of deutetrabenazine and its metabolites were assessed on days 1–4 and 11–14. Paroxetine trough concentrations were obtained pre-dose on days 9–13. Safety examinations occurred throughout the study.

Results

Paroxetine administered under steady-state conditions, increased exposure of the deuterated active metabolites, α-HTBZ (1.2-fold C_max and 1.8-fold AUC_0–∞) and β-HTBZ (2.1-fold C_max and 5.6-fold AUC_0–∞), and correspondingly, 1.6-fold C_max and threefold AUC_0–∞ for total (α + β)-HTBZ. Sixteen subjects reported 45 adverse events and most were mild. Headache was the most common AE reported 8 times by 7 subjects (5 following paroxetine alone; 2 following deutetrabenazine + paroxetine).

Conclusions

Paroxetine-induced increases in exposure to the active deutetrabenazine metabolites were less than those previously reported for tetrabenazine, a finding expected to reduce the burden of drug interaction. In addition, single doses of 22.5 mg deutetrabenazine, when given alone or in the presence of steady-state paroxetine (20 mg daily), were safe.

Supplementary information

The online version contains supplementary material available at 10.1007/s00228-021-03202-0.

Performance evaluation of a staggered three-layer DOI PET detector using a 1 mm LYSO pitch with PETsys TOFPET2 ASIC: comparison of HAMAMATSU and KETEK SiPMs

In this study, we propose a staggered three-layer depth-of-interaction (DOI) detector with a 1 mm crystal pitch and 19.8 mm total crystal thickness for a high-resolution and high-sensitivity small animal in-beam PET scanner. A three-layered stacked LYSO scintillation array (0.9 × 0.9 × 6.6 mm³crystals, 23 × 22 mm²surface area) read out by a SiPM array (8 × 8 channels, 3 × 3 mm²active area/channel and 50μm microcell size) with data acquisition, signal processing and digitization performed using the PETsys Electronics Evaluations kit (based on the TOFPET v2c ASIC) builds a DOI LYSO detector block. The performance of the DOI detector was evaluated in terms of crystal resolvability, energy resolution, and coincidence resolving time (CRT). A comparative performance evaluation of the staggered three-layer LYSO block was conducted with two different SiPM arrays from KETEK and HAMAMATSU. 100% (KETEK) and 99.8% (HAMAMATSU) of the crystals were identified, by using a flood irradiation the front- and back-side. The average energy resolutions for the 1st, 2nd, and 3rd layers were 16.5 (±2.3)%, 20.9(±4.0)%, and 32.7 (±21.0)% (KETEK) and 19.3 (±3.5)%, 21.2 (±4.1)%, and 26.6 (±10.3)% (HAMAMATSU) for the used SiPM arrays. The measured CRTs (FWHM) for the 1st, 2nd, and 3rd layers were 532 (±111) ps, 463 (±108) ps, and 447 (±111) ps (KETEK) and 402 (±46) ps, 392 (±54) ps, and 408 (±196) ps (HAMAMATSU). In conclusion, the performance of the staggered three-layer DOI detector with 1 mm LYSO pitch and 19.8 mm total crystal thickness was fully characterized. The feasibility of a highly performing readout of a high resolution DOI PET detector via SiPM arrays from KETEK and HAMAMATSU employing the PETsys TOFPET v2c ASIC could be demonstrated.

Serum and intratesticular inhibin B, AMH, and spermatogonial numbers in trans women at gender-confirming surgery: An observational study

BACKGROUND

Anti-Müllerian hormone and inhibin B are produced by Sertoli cells. Anti-Müllerian hormone secretion indicates an immature Sertoli cell state. Inhibin B serves as a marker of male fertility. Identification of markers reflecting the presence of germ cells is of particular relevance in trans persons undergoing gender-affirming hormone therapy in order to offer individualized fertility preservation methods.

OBJECTIVES

Serum and intratesticular inhibin B and anti-Müllerian hormone values were assessed and related to clinical features, laboratory values, and germ cell numbers.

MATERIALS AND METHODS

Twenty-two trans women from three clinics were included. As gender-affirming hormone therapy, 10-12.5 mg of cyproterone acetate plus estrogens were administered. Height, weight, age, medication, and treatment duration were inquired by questionnaires. Serum luteinizing hormone, follicle-stimulating hormone, testosterone, and estradiol were measured by immuno-assays. Serum and intratesticular inhibin B and anti-Müllerian hormone were measured by commercially available ELISAs. Spermatogonia were quantified as spermatogonia per cubic millimeter testicular tissue applying a morphometric analysis of two independent testicular cross-sections per individual after MAGEA4 immunostaining.

RESULTS

Patients with high inhibin B levels presented with a higher number of spermatogonia (*p < 0.05). Furthermore, mean serum inhibin B was associated with low age (*p < 0.05), low follicle-stimulating hormone (*p < 0.05), and low testosterone (*p < 0.05). Serum anti-Müllerian hormone, however, was not related to spermatogonial numbers. It correlated with high testosterone (*p < 0.05) and high follicle-stimulating hormone (*p < 0.05) only. High intratesticular inhibin B was accompanied by high luteinizing hormone (*p < 0.05), high follicle-stimulating hormone (**p < 0.01), and high testosterone levels (**p < 0.01). Higher the intratesticular anti-Müllerian hormone levels, the longer gender-affirming hormone therapy was administered (*p < 0.05).

DISCUSSION AND CONCLUSION

Serum inhibin B levels indicate the presence of spermatogonia, whereas anti-Müllerian hormone seems not to be a reliable marker concerning germ cell abundance.

A short-term musical training affects implicit emotion regulation only in behaviour but not in brain activity

Background

In everyday life, negative emotions can be implicitly regulated by positive stimuli, without any conscious cognitive engagement; however, the effects of such implicit regulation on mood and related neuro-mechanisms, remain poorly investigated in literature. Yet, improving implicit emotional regulation could reduce psychological burden and therefore be clinically relevant for treating psychiatric disorders with strong affective symptomatology.

Results

Music training reduced the negative emotional state elicited by negative odours. However, such change was not reflected at the brain level.

Conclusions

In a context of affective rivalry a musical training enhances implicit regulatory processes. Our findings offer a first base for future studies on implicit emotion regulation in clinical populations.

Modelling the productivity of Siberian larch forests from Landsat NDVI time series in fragmented forest stands of the Mongolian forest-steppe

The monitoring of the spatial and temporal dynamics of vegetation productivity is important in the context of carbon sequestration by terrestrial ecosystems from the atmosphere. The accessibility of the full archive of medium-resolution earth observation data for multiple decades dramatically improved the potential of remote sensing to support global climate change and terrestrial carbon cycle studies. We investigated a dense time series of multi-sensor Landsat Normalized Difference Vegetation Index (NDVI) data at the southern fringe of the boreal forests in the Mongolian forest-steppe with regard to the ability to capture the annual variability in radial stemwood increment and thus forest productivity. Forest productivity was assessed from dendrochronological series of Siberian larch (Larix sibirica) from 15 plots in forest patches of different ages and stand sizes. The results revealed a strong correlation between the maximum growing season NDVI of forest sites and tree ring width over an observation period of 20 years. This relationship was independent of the forest stand size and of the landscape's forest-to-grassland ratio. We conclude from the consistent findings of our case study that the maximum growing season NDVI can be used for retrospective modelling of forest productivity over larger areas. The usefulness of grassland NDVI as a proxy for forest NDVI to monitor forest productivity in semi-arid areas could only partially be confirmed. Spatial and temporal inconsistencies between forest and grassland NDVI are a consequence of different physiological and ecological vegetation properties. Due to coarse spatial resolution of available satellite data, previous studies were not able to account for small-scaled land-cover patches like fragmented forest in the forest-steppe. Landsat satellite-time series were able to separate those effects and thus may contribute to a better understanding of the impact of global climate change on natural ecosystems.

South African Society of Anaesthesiologists Perioperative Patient Blood Management Guidelines 2020

Anaesthesiologists regularly request and administer blood components to their patients, a potentially life-saving intervention. All anaesthesiologists must be familiar with the indications and appropriate use of blood and blood components and their alternatives, but close liaison with haematologists and their local haematology blood sciences laboratory is encouraged. In the last decade, there have been considerable changes in approaches to optimal use of blood components, together with the use of alternative products, with a need to update previous guidelines and adapt them for anaesthesiologists working throughout the hospital system.

Prognostic value of O-(2-[18F]-fluoroethyl)-L-tyrosine PET in relapsing oligodendroglioma

PURPOSE

To assess the relationship between F-18-fluoro-ethyl-tyrosine positron emission tomography (FET-PET) parameters of relapsing oligodendroglioma and progression-free survival.

MATERIAL AND METHODS

The relationship of clinical parameters, FET-PET parameters (SUV_max, TBR_max, BTV_, time-activity curves) and progression-free survival was analyzed using univariate and multivariate analysis in 42 adult patients with relapsing oligodendroglioma. Kaplan-Meier analysis was used to assess survival.

RESULTS

Patients who did not undergo surgical resection of their relapsing tumor had significantly lower PFS if the tumor exhibited an SUV_max above 3.40 than those with an SUV_max below 3.40 (13.1 ± 2.3 months vs. 47.3 ± 6.0 months, respectively, p < .001). Patients who underwent surgery had similar PFS as the aforementioned non-operated patients with low SUV_max (53.6 ± 6.7 months, p = .948). The same was true for TBR_max using a threshold of 3.03 (PFS 12.5 ± 2.4 months vs. 44.0 ± 6.3 months / 53.6 ± 6.7 months, respectively; p < .001 / p = .825). Also, subjects with BTV below 10 cm³ that did not undergo surgery had a similar PFS as subjects who underwent surgery (40.2 ± 6.0 months vs. 52.4 ± 8.9 months, respectively, p = .587). Subjects with BTV above 10 cm³ and without surgery had a significantly worse PFS (13.8 ± 3.3 months, p < .001). Multivariate analysis showed that the prognostication by clinical parameters is improved by adding TBR_max to the model (AUC 0.945 (95% CI: 0.881-1.000), true classification rate 88.1%).

CONCLUSION

FET-PET may provide added value for the prognostication of relapsing oligodendroglioma in addition to clinical parameters.

Cognitive and emotional empathy in individuals at clinical high risk of psychosis

BACKGROUND

Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive.

METHODS

Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined.

RESULTS

Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms.

CONCLUSION

Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored.

[Measurement of IgG concentration in bovine colostrum by immunoturbidimetric assay in comparison to ELISA-based assessment]

OBJECTIVE

The aim of the presented study was to compare the results of IgG measurements using a turbidimetric immunoassay (TIA), a newly developed laboratory-independent method for direct immunoglobulin determination in colostrum, with measurements obtained via enzyme-linked immunosorbent assay (ELISA).

MATERIAL AND METHODS

In colostrum samples from 59 cows, IgG concentration was measured using TIA and ELISA.

RESULTS

Correlation analysis according to Pearson revealed a correlation coefficient of r = 0.74 (p < 0.0001) between the 2 methods. The Bland-Altman analysis showed that measurement by TIA resulted in significantly lower mean IgG levels than the ELISA-based quantification. This difference was more pronounced in high IgG concentration ranges. By means of a double-logarithmized data transformation it was calculated that the TIA-determined IgG-values on average amounted to 66.4 % of the IgG-values measured by ELISA. Although colostrum with low IgG concentration could be quantified with satisfactory reliability (sensitivity 100 %), high-quality colostrum was not sufficiently assessed in the TIA-based IgG measurements (specificity 40.4 %).

CONCLUSION AND CLINICAL RELEVANCE

Based on the results of the presented study, IgG measurement by TIA cannot be recommended. In comparison to ELISA-based assessment, this technique does not exhibit higher correlations than established indirect rapid evaluation methods (density and viscosity determination).

Quantitative assessment of German Holstein dairy cattle colostrum and impact of thermal treatment on quality of colostrum viscosity and immunoglobulins

OBJECTIVE

This study aimed to determine the color, fat, viscosity, IgG concentration, %Brix and refractive index of fresh postpartum colostrum of German Holstein dairy cattle and assess the impact of different thermal treatments on the visual and dynamic viscosity, in association to IgG concentration, of colostrum that can be used for pasteurization process.

RESULTS

Of the total 40 fresh postpartum colostrum, the color of colostrum (ranging from white-pale yellow to yellow and dark-yellowish), fat (1.4-8.2 100 g^-1), IgG (4-116 mg mL^-1), %Brix (8.5-35.4%), refractive index (1.3454-1.3905 nD), visual (ranging from watery to liquid and thick) and dynamic (4.9-219 cp) viscosity, were recorded. Statistical analysis between visual and dynamic viscosity of fresh colostrum showed significant correlation coefficients (r_s = 634). Moreover, a significant correlation between viscosity and three IgG concentrations was also observed. Heat-treated colostrum showed dynamic viscosity ranged from 25 to 3066 cP, where dynamic viscosity of colostrum before- and after heat-treatment showed no significant correlation. Treated colostrum at 60 °C/60 min and 63.5 °C/30 min containing IgG concentration ≤ 80 mg mL^-1 and ≤ 68 mg mL^-1 showed no significant change in the viscosity and can successfully be applied for pasteurization of first postpartum colostrum.

The Cofactors of Nitrogenases

In biological nitrogen fixation, the enzyme nitrogenase mediates the reductive cleavage of the stable triple bond of gaseous N2at ambient conditions, driven by the hydrolysis of ATP, to yield bioavailable ammonium (NH4+). At the core of nitrogenase is a complex, ironsulfur based cofactor that in most variants of the enzyme contains an additional, apical heterometal (Mo or V), an organic homocitrate ligand coordinated to this heterometal, and a unique, interstitial carbide. Recent years have witnessed fundamental advances in our understanding of the atomic and electronic structure of the nitrogenase cofactor. Spectroscopic studies have succeeded in trapping and identifying reaction intermediates and several inhibitor- or intermediate- bound structures of the cofactors were characterized by high-resolution X-ray crystallography. Here we summarize the current state of understanding of the cofactors of the nitrogenase enzymes, their interplay in electron transfer and in the six-electron reduction of nitrogen to ammonium and the actual theoretical and experimental conclusion on how this challenging chemistry is achieved.

[Is the discipline associated with self-confidence in handling rational antibiotic prescription? : Results from the MR2 study in German hospitals]

BACKGROUND

Besides public awareness and specialist knowledge and training of physicians, their self-confidence plays a key role for clinical decision-making in the respective area.

OBJECTIVE

This exploratory study investigated the influence of the discipline on differences in self-confidence in dealing with antibiotics and in the self-rated knowledge.

METHODS

In 2015 the multi-institutional reconnaissance of practice with multiresistant bacteria (MR2) questionnaire containing items on antibiotic prescription and multiresistant pathogens was sent out to 1061 physicians working in departments for internal medicine, general surgery, gynecology and obstetrics and urology. In 2017 a similar MR2 survey was sent to 1268 specialist and assistant physicians in anesthesiology in Germany. Besides demographic data 4 items on self-confidence in the use of antibiotic treatment and 11 items concerning self-rated knowledge about rational antibiotic therapy and multiresistant pathogens were included in the present analysis. Logistic regression analysis, the χ²-test and the Kruskal-Wallis test were used for statistical analysis of the influence of the discipline on these items.

RESULTS

The response rates were 43% (456 out of 1061) from the non-anesthetists and 56% (705 out of 1268) from the anesthetists. Of the non-anesthetists 44% and 57% of the anesthetists had had no advanced training on antibiotic stewardship during the year before the study. In the overall analysis anesthetists (mean±SD: 2.53±0.54) were significantly less self-confident about antibiotics than colleagues from other departments (internal medicine: 3.10±0.50, general surgery: 2.97±0.44, gynecology and obstetrics: 3.12±0.42 and urology: 3.15±0.44) in the unadjusted (all p<0.001) and adjusted comparison. The analysis of self-rated knowledge about rational antibiotic prescription showed similar results. Senior consultant status and advanced training in infectiology were significantly associated with self-confidence and self-rated knowledge about antibiotics.

CONCLUSION

Anesthetists showed significantly less self-confidence in dealing with antibiotics than colleagues from other disciplines. Advanced training on a rational prescription of antibiotics was associated with a greater self-confidence, so that the implementation of compulsory courses on rational antibiotic stewardship in the respective residency curriculum needs to be considered.

Neoadjuvant immunotherapy with combined ipilimumab and nivolumab in patients with melanoma with primary or in transit disease

The introduction of new therapeutic agents has revolutionized the treatment of metastatic melanoma. The approval of adjuvant anti-programmed death-1 monotherapy with nivolumab or pembrolizumab, and dabrafenib plus trametinib has recently set a new landmark in the treatment of stage III melanoma. Now, clinical trials have shown that immune checkpoint blockade can be performed in a neoadjuvant setting, an approach established as a standard therapeutic approach for other tumour entities such as breast cancer. Recent studies suggest that a pathological response achieved by neoadjuvant immunotherapy is associated with long-term tumour control and that short neoadjuvant application of checkpoint inhibitors may be superior to adjuvant therapy. Most recently, neoadjuvant ipilimumab plus nivolumab in stage III melanoma was reported. With two courses of dose-optimized ipilimumab (1 mg kg^-1 ) combined with nivolumab (3 mg kg^-1 ), pathological responses were observed in 77% of patients, while only 20% of patients experienced grade 3 or 4 adverse events. However, the neoadjuvant trials employing combined immune checkpoint blockade conducted so far have excluded patients with in transit metastases, a common finding in stage III melanoma. Here we report four patients with in transit metastases or an advanced primary tumour who have been treated with neoadjuvant ipilimumab plus nivolumab according to the OpACIN-neo trial scheme (arm B). All patients achieved radiological disease control and a pathological response. None of the patients has relapsed so far. Linked Comment: Blankenstein and van Akkooi. Br J Dermatol 2020; 183:421-422.

The Comprehensive Community Engagement Framework for Health and Well-being

Background

Community engagement (CE) and empowerment are required to support the sustainability and effectiveness of actions to reach Agenda 2030. There is a need to guide CE for health and well-being to take action on important societal challenges such as the growing burden of non-communicable diseases (NCDs) and health inequities. The framework proposed in this study has been designed to assist professionals, practitioners and communities to effectively engage.

Methods

A narrative review of existing grey literature, policy papers and models related to CE was performed. This guided the development of a systematic search strategy, performed by two researchers, which reviewed CE approaches and key influencing factors. The search strategy captured different terms used for CE.

Results

A total of 27 studies of different types, from around the world, were identified for inclusion into the review. The study compiled a set of widely-used theories and approaches to CE. Key factors such as governance, trust, accessibility and sociocultural contextualisation were also identified as important for the success of CE initiatives. Subsequently, the Comprehensive Community Engagement Framework (CCEF) was developed. It combines theoretical and empirical principles, proven participatory actions and key factors to produce evidence-based health and well-being outcomes across different sectors and levels of society.

Conclusions

This study has formed the basis of a forthcoming WHO report on CE. The CCEF enables the operationalisation of CE to guide for possible practical approaches to planning, initiating, sustaining and evaluating CE processes alongside the community. It can be used by the health sector as well as the non-health sectors to address health, well-being and broader societal challenges.

Key messages

The CCEF can be used to engage health and non-health stakeholders to tailor CE processes, increase impact of interventions and policies, building capacity and empowering communities. The proposed framework provides the first comprehensive guidance to conduct community engagement.

[Quality Assessment of Bovine and Equine Colostrum - An Overview]

INTRODUCTION

Good quality colostrum intake is essential for passive immunity in neonatal calf and foals. The quality of colostrum depends on its IgG content. Since in practice the possibilities for a direct determination of these parameter are limited, an estimation of colostrum quality is often based on its biophysical properties. The simple methodology allows to perform measurements directly on site and immediately after birth. The biophysical properties included in the current review are density, refractive index, relative density, viscosity, pH, and color. The determination of the density of bovine colostrum is a common method for the evaluation of the IgG content in practice since it correlates with IgG. Density of bovine colostrum should be 1047 g/l. Different colostrometers are available for the measurement. This method is also used in the horses. Density of equine colostrum should be 1060 g/l. Refractive index or the relative density by refractometer has been proven to correlate with the IgG and is an established method in cattle and horses. Good bovine colostrum should have an index of 22% brix and equine colostrum 23% brix. Although not yet established in practice an additional methodology would be the determination viscosity of bovine colostrum. Viscosity could be measured with an outlet cup. A relationship between viscosity and IgG has demonstrated. Sufficient data for this method is missing for equine colostrum. Color and pH are not suitable for estimating the IgG content.

SpraySyn-A standardized burner configuration for nanoparticle synthesis in spray flames

In many scientific communities, the definition of standardized experiments has enabled major progress in process understanding. The investigation of the spray-flame synthesis of nanoparticles at a well-defined standard burner by experiment and simulation makes it possible to produce a comprehensive data set with various established and novel measuring methods. In this work, we introduce the design of the SpraySyn burner as a new standard for a free-jet type burner that offers well-defined and simulation-friendly boundary conditions and geometries as well as accessibility for optical diagnostics. A combustible precursor solution is fed through a centrally located capillary and aerosolized with an oxygen dispersion gas flow. The spray flame is stabilized by a premixed flat methane/oxygen pilot flame fed via a porous bronze matrix surrounded by a stabilizing nitrogen coflow emanating through the same porous matrix, providing easy-to-calculate boundary conditions for simulations. This burner design enables the use of a wide choice of solvents, precursors, and precursor combinations. Best-practice operating instructions and parameters are given, and large-eddy simulations are performed demonstrating the suitability of the SpraySyn burner for computational fluid dynamics simulations. For ensuring reproducible operation across labs, we define a consumer-camera-based flame characterization scheme for the quantitative assessment of the flame geometry such as flame length, diameter, tilt angle, and photometric distribution of visible chemiluminescence along the center axis. These parameters can be used for benchmarking the pilot and spray flame by each user of the SpraySyn burner with the reference flames.

Patient blood management: A solution for South Africa

For more than 70 years the default therapy for anaemia and blood loss was mostly transfusion. Accumulating evidence demonstrates a significant dose-dependent relationship between transfusion and adverse outcomes. This and other transfusion-related challenges led the way to a new paradigm. Patient blood management (PBM) is the application of evidence-based practices to optimise patient outcomes by managing and preserving the patient's own blood. 'Real-world' studies have shown that PBM improves patient outcomes and saves money. The prevalence of anaemia in adult South Africans is 31% in females and 17% in males. Improving the management of anaemia will firstly improve public health, secondly relieve the pressure on the blood supply, and thirdly improve the productivity of the nation's workforce. While high-income countries are increasingly implementing PBM, many middle- and low-income countries are still trying to upscale their transfusion services. The implementation of PBM will improve South Africa's health status while saving costs.

Options for Fertility Treatments for Trans Women in Germany

Fertility preservation in trans women is a crucial but thus far neglected component in the gender confirming treatment in Germany. It is difficult for trans women to access reproductive health care because centers offering treatment, psychological guidance, gender confirming surgery, as well as reproductive health services are scarce in Germany. Legal, social, or financial issues as well as individual patient comorbidities prevent trans women from receiving appropriate counselling. This review provides an overview on options of fertility preservation in trans women. We consider recent publications on testicular regression at the time of gender confirming surgery demonstrating presence of sperm or at least spermatogonia in the majority of tissues. This may open options for cryopreservation of sperm or testicular stem cells in trans women even at the final stage of transition. Hence, standardized urological procedures (i.e., sperm cryopreservation after masturbation or sperm extraction from the testicular tissue) and experimental approaches (cryopreservation of testicular tissue with undifferentiated spermatogonia) can be offered best at the initiation but also during the gender confirming process. However, counselling early in the gender confirming process increases the chances of fertility preservation because gender confirming hormone therapy has an impact on spermatogenesis.

Auswirkungen von Chlamydien auf Rinderspermien

Eckert T, Goericke-Pesch S, Heydel C et al. Interaction of different Chlamydiae species with bovine spermatozoa. BMC Microbiol 2019; 19: 23

Bei der Frau spielt die Chlamydieninfektion im Rahmen von Fruchtbarkeitsstörungen eine wichtige Rolle. Auch beim weiblichen Nutztier werden Reproduktionsstörungen mit Chlamydieninfektionen in Zusammenhang gebracht. Erkenntnisse über die Beeinflussung der Fortpflanzung durch diese Erreger beim männlichen Tier gibt es kaum. Die Studie untersuchte daher die Auswirkung einer Chlamydieninfektion auf Rindersperma in vitro.

Cumulative cortisol exposure in the third trimester correlates with postpartum mothers' neural response to emotional interference

Prolonged stress affects the central nervous system, rendering individuals vulnerable to a wide range of mental health disorders. 76 healthy postpartum mothers were studied by means of functional magnetic resonance imaging within 6 days of childbirth. The subjects were required to perform the emotional Stroop task involving happy and anxious word-face combinations. Hair samples were collected to determine cumulative hair cortisol concentration (HCC) in the third trimester. HCC was found to be negatively correlated with the recruitment of the dorsal anterior cingulate cortex (ACC) and the midcingulate cortex (MCC). In response to the emotional interference of only anxious target faces, a negative correlation was seen between HCC and the bilateral orbitofrontal cortex, extending to the rostral ACC and the MCC. Women with lower HCC recruited brain areas relevant to emotional cognitive control, indicating that lower HCC helps preserve conflict monitoring and resolution capacities and thus benefits mental health in pregnancy.

[Use of social media by psychiatric in-patients : Case report and further perspectives]

Communication by means of social networks and messenger programs as well as the use of smartphones have rapidly increased during recent years and are constantly present in everyday life. We report about a 25-year-old patient with a diagnosis of borderline personality disorder who posted photographs of acute self-injuries to a group of fellow patients by means of a messenger app while on weekend leave during psychiatric hospital treatment. The implications about possible effects of the use of social media by psychiatric in-patients on treatment and group dynamics are discussed. Furthermore, social media communication by patients is focused on in general and potential consequences for psychiatric, psychotherapeutic and psychosomatic treatment are discussed.

Gastroresistant gelatin films prepared by addition of cellulose acetate phthalate

Gastroresistant capsules are obtained mostly by using modified-release fill in hard capsules, or by coating the gelatin shell with acid-resistant polymers. Modification of the material used at the stage when the capsule shell is produced would reduce the complexity and cost of introducing new products to the market. Gastroresistant gelatin films were obtained by using commercial cellulose acetate phthalate (aqueous dispersion Aquacoat® CPD). Only films casted from non-alkalized mixtures showed no visible disintegration at pH from 1.2 (simulated gastric fluid) to 4.5 (phosphate buffer). Elasticity of the dry films was comparable with the one determined for non-modified gelatin films, however tear resistance was 2-fold smaller, but still acceptable for practical application.

Linear and non-linear heart rate metrics for the assessment of anaesthetists' workload during general anaesthesia

BACKGROUND

Excessive workload may impact the anaesthetists' ability to adequately process information during clinical practice in the operation room and may result in inaccurate situational awareness and performance. This exploratory study investigated heart rate (HR), linear and non-linear heart rate variability (HRV) metrics and subjective ratings scales for the assessment of workload associated with the anaesthesia stages induction, maintenance and emergence.

METHODS

HR and HRV metrics were calculated based on five min segments from each of the three anaesthesia stages. The area under the receiver operating characteristics curve (AUC) of the investigated metrics was calculated to assess their ability to discriminate between the stages of anaesthesia. Additionally, a multiparametric approach based on logistic regression models was performed to further evaluate whether linear or non-linear heart rate metrics are suitable for the assessment of workload.

RESULTS

Mean HR and several linear and non-linear HRV metrics including subjective workload ratings differed significantly between stages of anaesthesia. Permutation Entropy (PeEn, AUC=0.828) and mean HR (AUC=0.826) discriminated best between the anaesthesia stages induction and maintenance. In the multiparametric approach using logistic regression models, the model based on non-linear heart rate metrics provided a higher AUC compared with the models based on linear metrics.

CONCLUSIONS

In this exploratory study based on short ECG segment analysis, PeEn and HR seem to be promising to separate workload levels between different stages of anaesthesia. The multiparametric analysis of the regression models favours non-linear heart rate metrics over linear metrics.