Trauma-associated extracellular histones mediate inflammation via a MYD88-IRAK1-ERK signaling axis and induce lytic cell death in human adipocytes

Despite advances in the treatment and care of severe physical injuries, trauma remains one of the main reasons for disability-adjusted life years worldwide. Trauma patients often suffer from disturbances in energy utilization and metabolic dysfunction, including hyperglycemia and increased insulin resistance. White adipose tissue plays an essential role in the regulation of energy homeostasis and is frequently implicated in traumatic injury due to its ubiquitous body distribution but remains poorly studied. Initial triggers of the trauma response are mainly damage-associated molecular patterns (DAMPs) such as histones. We hypothesized that DAMP-induced adipose tissue inflammation contributes to metabolic dysfunction in trauma patients. Therefore, we investigated whether histone release during traumatic injury affects adipose tissue. Making use of a murine polytrauma model with hemorrhagic shock, we found increased serum levels of histones accompanied by an inflammatory response in white adipose tissue. In vitro, extracellular histones induced an inflammatory response in human adipocytes. On the molecular level, this inflammatory response was mediated via a MYD88-IRAK1-ERK signaling axis as demonstrated by pharmacological and genetic inhibition. Histones also induced lytic cell death executed independently of caspases and RIPK1 activity. Importantly, we detected increased histone levels in the bloodstream of patients after polytrauma. Such patients might benefit from a therapy consisting of activated protein C and the FDA-approved ERK inhibitor trametinib, as this combination effectively prevented histone-mediated effects on both, inflammatory gene activation and cell death in adipocytes. Preventing adipose tissue inflammation and adipocyte death in patients with polytrauma could help minimize posttraumatic metabolic dysfunction.

Rare Antagonistic Leptin Variants and Severe, Early-Onset Obesity

Hormone absence or inactivity is common in congenital disease, but hormone antagonism remains controversial. Here, we characterize two novel homozygous leptin variants that yielded antagonistic proteins in two unrelated children with intense hyperphagia, severe obesity, and high circulating levels of leptin. Both variants bind to the leptin receptor but trigger marginal, if any, signaling. In the presence of nonvariant leptin, the variants act as competitive antagonists. Thus, treatment with recombinant leptin was initiated at high doses, which were gradually lowered. Both patients eventually attained near-normal weight. Antidrug antibodies developed in the patients, although they had no apparent effect on efficacy. No severe adverse events were observed. (Funded by the German Research Foundation and others.).

Oncostatin M promotes lipolysis in white adipocytes

Oncostatin M (OSM) is a member of the glycoprotein 130 cytokine family that is involved in chronic inflammation and increased in adipose tissue under obesity and insulin resistance. OSM was shown to inhibit adipogenesis, suppress browning, and contribute to insulin resistance in cultured white adipocytes. In contrast, OSM may have a metabolically favourable role on adipocytes in mouse models of obesity and insulin resistance. However, a putative role of OSM in modulating lipolysis has not been investigated in detail to date. To address this, cultured white adipocytes of mouse or human origin were exposed to 10 or 100 ng/ml of OSM for various time periods. In murine 3T3-L1 cells, OSM stimulation directly activated hormone-sensitive lipase (HSL) and other players of the lipolytic machinery, and dose-dependently increased free fatty acid and glycerol release. In parallel, OSM attenuated insulin-mediated suppression of lipolysis and induced phosphorylation of serine-residues on the insulin receptor substrate-1 (IRS1) protein. Key experiments were verified in a second murine and a human adipocyte cell line. Inhibiton of extracellular signal-regulated kinase (ERK)-1/2 activation, abolished OSM-mediated HSL phosphorylation and lipolysis. In conclusion, OSM signalling directly promotes lipolysis in white adipocytes in an ERK1/2-dependent manner.

Adipose tissue: a neglected organ in the response to severe trauma?

Despite the manifold recent efforts to improve patient outcomes, trauma still is a clinical and socioeconomical issue of major relevance especially in younger people. The systemic immune reaction after severe injury is characterized by a strong pro- and anti-inflammatory response. Besides its functions as energy storage depot and organ-protective cushion, adipose tissue regulates vital processes via its secretion products. However, there is little awareness of the important role of adipose tissue in regulating the posttraumatic inflammatory response. In this review, we delineate the local and systemic role of adipose tissue in trauma and outline different aspects of adipose tissue as an immunologically active modifier of inflammation and as an immune target of injured remote organs after severe trauma.

microRNA-27a-3p but Not -5p Is a Crucial Mediator of Human Adipogenesis

MicroRNAs (miRNAs), a class of small, non-coding RNA molecules, play an important role in the posttranscriptional regulation of gene expression, thereby influencing important cellular functions. In adipocytes, miRNAs show import regulatory features and are described to influence differentiation as well as metabolic, endocrine, and inflammatory functions. We previously identified miR-27a being upregulated under inflammatory conditions in human adipocytes and aimed to elucidate its function in adipocyte biology. Both strands of miR-27a, miR-27a-3p and -5p, were downregulated during the adipogenic differentiation of Simpson–Golabi–Behmel syndrome (SGBS) cells, human multipotent adipose-derived stem cells (hMADS), and human primary adipose-derived stromal cells (hASCs). Using miRNA-mimic transfection, we observed that miR-27a-3p is a crucial regulator of adipogenesis, while miR-27a-5p did not alter the differentiation capacity in SGBS cells. In silico screening predicted lipoprotein lipase (LPL) and peroxisome proliferator activated receptor γ (PPARγ) as potential targets of miR-27a-3p. The downregulation of both genes was verified in vitro, and the interaction of miR-27-3p with target sites in the 3′ UTRs of both genes was confirmed via a miRNA-reporter-gene assay. Here, the knockdown of LPL did not interfere with adipogenic differentiation, while PPARγ knockdown decreased adipogenesis significantly, suggesting that miR-27-3p exerts its inhibitory effect on adipogenesis by repressing PPARγ. Taken together, we identified and validated a crucial role for miR-27a-3p in human adipogenesis played by targeting the essential adipogenic transcription factor PPARγ. Though we confirmed LPL as an additional target of miR-27a-3p, it does not appear to be involved in regulating human adipogenesis. Thereby, our findings call the conclusions drawn from previous studies, which identified LPL as a crucial regulator for murine and human adipogenesis, into question.

Latent TGFβ-binding proteins regulate UCP1 expression and function via TGFβ2

Objective

Activation of brown adipose tissue (BAT) in humans has been proposed as a new treatment approach for combating obesity and its associated diseases, as BAT participates in the regulation of energy homeostasis as well as glucose and lipid metabolism. Genetic contributors driving brown adipogenesis in humans have not been fully understood.

Methods

Profiling the gene expression of progenitor cells from subcutaneous and deep neck adipose tissue, we discovered new secreted factors with potential regulatory roles in white and brown adipogenesis. Among these, members of the latent transforming growth factor beta-binding protein (LTBP) family were highly expressed in brown compared to white adipocyte progenitor cells, suggesting that these proteins are capable of promoting brown adipogenesis. To investigate this potential, we used CRISPR/Cas9 to generate LTBP-deficient human preadipocytes.

Results

We demonstrate that LTBP2 and LTBP3 deficiency does not affect adipogenic differentiation, but diminishes UCP1 expression and function in the obtained mature adipocytes. We further show that these effects are dependent on TGFβ2 but not TGFβ1 signaling: TGFβ2 deficiency decreases adipocyte UCP1 expression, whereas TGFβ2 treatment increases it. The activity of the LTBP3–TGFβ2 axis that we delineate herein also significantly correlates with UCP1 expression in human white adipose tissue (WAT), suggesting an important role in regulating WAT browning as well.

Conclusions

These results provide evidence that LTBP3, via TGFβ2, plays an important role in promoting brown adipogenesis by modulating UCP1 expression and mitochondrial oxygen consumption.

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Inhibition of LTBP2 and LTBP3 reduces secretion of TGFβ2.

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Both knockout of LTBP2/3 or TGFβ2 inhibit UCP1 expression and mitochondrial respiration in human adipocytes.

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Expression of TGFβ2 correlates with UCP1 expression in human adipose tissue.

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Treatment with TGFβ2 rescues inhibition of UCP1 by LTBP knockout during adipogenesis.

Coil embolization of a thoracic aorta hematoma with branch artery pseudoaneurysm - case report

Background

A thoracic aorta hematoma with branch artery pseudonaneurysm is a very rare complication of thoraric blunt trauma. The standard treatment of this type of injury is aortic endograft placement.

Case presentation

We present a case in which a thoracic aorta hematoma with branch artery pseudoaneurysm was treated with coil embolization instead of endografting.

Conclusions

Coil embolization of aortic injuries may be a safe and definitive treatment alternative in selected cases. This technique has the potential to reduce the risk of procedure-related complications.

Triplex doppler ultrasonography to describe the uterine arteries during diestrus and progesterone profile in pregnant and non-pregnant bitches of different sizes

Hemodynamics of uterine vascularization is modified throughout pregnancy to meet the increasing demand of the growing fetuses and triplex doppler ultrasonography is widely used in human medicine to study the uterine arteries and assess the fetal and placental conditions. The aim of our study was to confirm this observation in the bitch, to evaluate differences between bitches of different sizes and to study abnormal pregnancies. Forty-four bitches were monitored during the estrous period to determine ovulation and every 10 days from ovulation to 50 days post-ovulation: the resistivity (RI) and pulsatility (PI) indexes of the right uterine artery were measured as well as usual assessment of fetal development and follow up of the luteal function. Thirty-three out of forty-four bitches were pregnant, including 6 abnormal pregnancies (resorption of more than 10% of the embryos). We also divided them in four weight categories: 8 were small (<10 kg), 13 medium (10-25 kg), 13 large (>25-40 kg) and 10 were giant breeds (>40 kg). We observed that RI and PI decreased over time and were significantly lower for pregnant bitches compared to non-pregnant ones from 30 days post-ovulation. In contrast, RI and PI did not significantly vary with the size of the bitches and we could not determine a significant impact of abnormal pregnancies either. In conclusion, we found no significant difference related to the size of bitches in the RI and PI. The only significant difference between pregnant and non-pregnant bitches was observed from 30 days post-ovulation.

Improvement after two sessions of electroconvulsive therapy predicts final remission in in-patients with major depression

OBJECTIVE

To investigate whether early improvement, measured after two electroconvulsive therapy (ECT) sessions, is a good predictor of eventual remission in severely depressed in-patients receiving ECT.

METHOD

A prospective cohort study was performed that included 89 major depressive disorder in-patients treated with bilateral ECT. Sensitivity, specificity, and predictive values were computed for various definitions of early improvement (15%, 20%, 25%, and 30% reduction on the Montgomery Asberg depression rating scale (MADRS) score) after 1 week (i.e. two sessions) of ECT regarding prediction of remission (final MADRS score ≤ 9).

RESULTS

A 15% reduction in MADRS score appeared to be the best definition of early improvement, with modest sensitivity (51%) and relatively good specificity (79%). Kaplan-Meier analysis showed a more than 2-week shorter time to remission in patients with early improvement compared with patients lacking early improvement.

CONCLUSION

Early improvement during an ECT course may be assessed after two ECT sessions. Such improvement, defined as a 15% reduction in the MADRS score, is a moderately sensitive predictor for eventual remission in an in-patient population with severe major depression.

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

BACKGROUND

The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.

METHODS

ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.

RESULTS

The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.

CONCLUSIONS

This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

CLINICAL TRIAL REGISTRATION

NCT03044899.

Interlaboratory Oral Anticoagulant Quality Assessment by the Netherlands Federation of Thrombosis Services

The 50 laboratories of the Netherlands Federation of Thrombosis Services, covering a population of 9 million and responsible for the laboratory control of approximately 150,000 patients under oral anticoagulation, have participated since 1974 in a voluntary external and internal quality control program. The external program comprises a monthly distribution to the member laboratories of a series of artificially prepared control blood samples, two of which are identical. The overall variation of the coagulation times found were 10% (CV) in 1974 and 8% (CV) in 1975. Performance improved rather abruptly at the beginning of 1975, after the application of a tight methodological standardization and improvement by the manufacturer of the thromboplastin preparation (Thrombotest) used by the great majority of the laboratories involved. The main source of variation was found to be random error in the Thrombotest determination, approximating 6%. Interbatch variation of Thrombotest and inter-aliquot variation of control blood samples both do amount to approximately 3% (CV). In terms of rabbit tissue thromboplastins, which have a lower sensitivity than Thrombotest (i. e., a flatter slope of the correlation between the PT and the anticoagulant effect), the total variation in the performance of the Dutch laboratories is 2.2-5.6% (CV), which is unusually low. The main reason for this is the fact that the laboratories can rely not only on the services of the manufacturer but also on a central information office and a reference laboratory responsible for the preparation of the control blood as well as the standardization (calibration) of thromboplastin.

Progressive Antithrombin and Fibrinogen The Antithrombin Time According to Innerfield and its Relation to Acute Pancreatitis

Innerfield’s method of determining antithrombin III using plasma “defibrinated” by thrombin is submitted to criticsm. This method proves to involve insufficient defibrination: the higher the fibrinogen concentration of the plasma to be tested, the larger the fibrinogen remnant after “defibrination”. The residual fibrinogen interferes in the determinations of antithrombin III, as fibrin (antithrombin I) adsorbes thrombin; an increase in antithrombin III activity is suggested. This becomes manifest in all conditions associated with hyperfibrinogenaemia, including acute pancreatitis.

A “New” Family with Stuart-Prower Deficiency

A description is given of the coagulation disturbances in six patients with a haemorrhagic diathesis due to Stuart-Prower deficiency. Relatives of these patients, if heterozygous for this deficiency, showed no significant haemorrhagic diathesis; in the laboratory, their one-stage “prothrombin” times showed only a slight prolongation. Thromboplastin formation in these relatives was sufficient, but determination of the Stuart-Prower factor revealed lower values. The relatives in question were incapable of giving the same correction of the thromboplastin generation test in their bleeder relatives as normal serum does.

The relation between Stuart-Prower deficiency and Christmas factor is discussed.

One patient is described who combined heterozygotism for Stuart-Prower deficiency with alcaptonuria.

The mode of inheritance of the Stuart-Prower deficiency is discussed.

Blood Coagulation as a Continuous Process

In order to study the phenomenon of spontaneous hemorrhages in cases of diminished clotting power, we performed an investigation with the aid of the electron-microscope by means of a replica technique, on the aspect of aorta endothelium in two groups of rabbits, the first with a normal clotting power, the second with a hypocoagulability. Comparison of these two groups revealed two points of discrepancy. In the first place, in all the preparations of normal rabbits we saw fibres lying perpendicular to the borderlines of endothelial cells. These fibres were hardly seen under conditions of hypocoagulability, which is one of the arguments for equating these filaments with fibrin. In the second place, the nuclei of endothelial cells were less prominent into the vascular lumen in hypocoagulability than in cases of normal clotting power. From these observations and from some theoretical arguments we came to the hypothesis that blood coagulation is a continuous process which lays down fibrin fibres on the endothelium and which influences the swelling of the cytoplasm of endothelial cells. We could not get more information concerning the problem of how erythrocytes can penetrate endothelium in cases of hypocoagulability by studying the aspect of the blood-urine barrier in the glomeruli in the same two groups of rabbits.

Two years' experience with inspiration breath-hold in liver SBRT

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The workflow of inspiration breath-hold SBRT for liver metastases is described.

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Inspiration breath-hold in liver SBRT is feasible for 95% of the patients.

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An individual margin recipe for inspiration breath-hold liver SBRT is explained.

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Margin reduction of 10 mm using inspiration breath-hold compared to free breathing.

A computational biology approach of a genome-wide screen connected miRNAs to obesity and type 2 diabetes

OBJECTIVE

Obesity and type 2 diabetes (T2D) arise from the interplay between genetic, epigenetic, and environmental factors. The aim of this study was to combine bioinformatics and functional studies to identify miRNAs that contribute to obesity and T2D.

METHODS

A computational framework (miR-QTL-Scan) was applied by combining QTL, miRNA prediction, and transcriptomics in order to enhance the power for the discovery of miRNAs as regulative elements. Expression of several miRNAs was analyzed in human adipose tissue and blood cells and miR-31 was manipulated in a human fat cell line.

RESULTS

In 17 partially overlapping QTL for obesity and T2D 170 miRNAs were identified. Four miRNAs (miR-15b, miR-30b, miR-31, miR-744) were recognized in gWAT (gonadal white adipose tissue) and six (miR-491, miR-455, miR-423-5p, miR-132-3p, miR-365-3p, miR-30b) in BAT (brown adipose tissue). To provide direct functional evidence for the achievement of the miR-QTL-Scan, miR-31 located in the obesity QTL Nob6 was experimentally analyzed. Its expression was higher in gWAT of obese and diabetic mice and humans than of lean controls. Accordingly, 10 potential target genes involved in insulin signaling and adipogenesis were suppressed. Manipulation of miR-31 in human SGBS adipocytes affected the expression of GLUT4, PPARγ, IRS1, and ACACA. In human peripheral blood mononuclear cells (PBMC) miR-15b levels were correlated to baseline blood glucose concentrations and might be an indicator for diabetes.

CONCLUSION

Thus, miR-QTL-Scan allowed the identification of novel miRNAs relevant for obesity and T2D.

Circulating levels of miR-122 and nonalcoholic fatty liver disease in pre-pubertal obese children

OBJECTIVES

The liver-specific miR-122 was proposed as biomarker for NAFLD in adults. Here, we investigated the relationship between miR-122 levels, parameters of liver metabolism and NAFLD in pre-pubertal obese children.

METHODS

Parameters of liver metabolism (ALT, AST and GGT) of three European cohorts were included (German cohort [n = 71; age: 11.53 ± 1.29 years; BMI z-score: 2.96 ± 0.64], Italian cohort [n = 45; age: 9.60 ± 2.11 years; BMI z-score: 3.57 ± 1.16], Slovenian cohort [n = 31; age: 7.53 ± 1.47 years; BMI z-score: 3.66 ± 0.88]). MiR-122 levels and CK18 concentrations were measured in fasting blood samples. In the German and Italian cohort, the diagnosis of NAFLD and grading of NAFLD was assessed by ultrasound.

RESULTS

NAFLD was diagnosed in n = 50 patients of the German cohort (29.6%) and in n = 29 patients (72.5%) of the Italian cohort. In all three cohorts, miR-122 was positively correlated with ALT and AST as well as with CK18 concentrations. MiR-122 levels were higher in children with NAFLD compared with healthy controls.

CONCLUSIONS

MiR-122 levels in pre-pubertal obese children could be a potential biomarker for paediatric NAFLD.

Trail (TNF-related apoptosis-inducing ligand) induces an inflammatory response in human adipocytes

High serum concentrations of TNF-related apoptosis-inducing ligand (TRAIL), a member of the tumor necrosis factor protein family, are found in patients with increased BMI and serum lipid levels. In a model of murine obesity, both the expression of TRAIL and its receptor (TRAIL-R) is elevated in adipose tissue. Accordingly, TRAIL has been proposed as an important mediator of adipose tissue inflammation and obesity-associated diseases. The aim of this study was to investigate if TRAIL regulates inflammatory processes at the level of the adipocyte. Using human Simpson-Golabi-Behmel syndrome (SGBS) cells as a model system, we found that TRAIL induces an inflammatory response in both preadipocytes and adipocytes. It stimulates the expression of interleukin 6 (IL-6), interleukin 8 (IL-8) as well as the chemokines monocyte chemoattractant protein-1 (MCP-1) and chemokine C-C motif ligand 20 (CCL-20) in a time- and dose-dependent manner. By using small molecule inhibitors, we found that both the NFκB and the ERK1/2 pathway are crucial for mediating the effect of TRAIL. Taken together, we identified a novel pro-inflammatory function of TRAIL in human adipocytes. Our findings suggest that targeting the TRAIL/TRAIL-R system might be a useful strategy to tackle obesity-associated adipose tissue inflammation.

Functional Significance and Predictive Value of MicroRNAs in Pediatric Obesity: Tiny Molecules with Huge Impact?

Obesity is a major health concern. While some children develop comorbidities such as insulin resistance and low-grade systemic inflammation upon weight gain, others stay metabolically healthy. There is an urgent need for clinically relevant markers with prognostic value related to disease development and intervention success. MicroRNAs (miRNAs) are established biomarkers for several disease states. Herein, we give a brief overview of miRNA biogenesis and function and the potential role of circulating miRNA in the context of pediatric obesity.

miR-146a-mediated suppression of the inflammatory response in human adipocytes

The obesity-associated inflammation of white adipose tissue (WAT) is one of the factors leading to the development of related diseases such as insulin resistance and liver steatosis. Recently, microRNAs (miRNAs) were identified as important regulators of WAT functions. Herein, we cultured human Simpson-Golabi-Behmel syndrome (SGBS) adipocytes with macrophage-conditioned medium (MacCM) and performed an Affimetrix miRNA array to identify miRNAs differentially expressed under inflammatory conditions. We identified 24 miRNAs differentially expressed upon inflammation in human adipocytes and miR-146a was the most up-regulated miRNA species. In subcutaneous WAT, miR-146a was elevated in both human and murine obesity. Transfection of miR-146a mimics prevented the MacCM-induced inflammatory response in SGBS adipocytes as seen by reduced levels of IL-8 and MCP-1 mRNA and protein. We identified IRAK1 and TRAF6 as targets of miR-146a in human adipocytes and detected a reduced inflammation-induced activation of JNK and p38 upon miR-146a transfection. Taken together, we could show that miR-146a reduces the inflammatory response in human adipocytes. In a negative feedback loop miR-146a might contribute to the regulation of inflammatory processes in WAT and possibly prevent an overwhelming inflammatory response.

A case of small-bowel obstruction after insertion of a percutaneous endoscopic gastrostomy tube due to mesenteric penetration

A case of small-bowel obstruction after insertion of a percutaneous endoscopic gastrostomy (PEG) tube is described. At laparotomy, the PEG tube was found to have penetrated the jejunal mesentery at two points, thereby acting as a focus for a volvulus. Direct injury and obstruction to the small bowel have been described but volvulus due to mesenteric penetration has not.

Tin doping speeds up hole transfer during light-driven water oxidation at hematite photoanodes

Numerous studies have shown that the performance of hematite photoanodes for light-driven water splitting is improved substantially by doping with various metals, including tin. Although the enhanced performance has commonly been attributed to bulk effects such as increased conductivity, recent studies have noted an impact of doping on the efficiency of the interfacial transfer of holes involved in the oxygen evolution reaction. However, the methods used were not able to elucidate the origin of this improved efficiency, which could originate from passivation of surface electron-hole recombination or catalysis of the oxygen evolution reaction. The present study used intensity-modulated photocurrent spectroscopy (IMPS), which is a powerful small amplitude perturbation technique that can de-convolute the rate constants for charge transfer and recombination at illuminated semiconductor electrodes. The method was applied to examine the kinetics of water oxidation on thin solution-processed hematite model photoanodes, which can be Sn-doped without morphological change. We observed a significant increase in photocurrent upon Sn-doping, which is attributed to a higher transfer efficiency. The kinetic data obtained using IMPS show that Sn-doping brings about a more than tenfold increase in the rate constant for water oxidation by photogenerated holes. This result provides the first demonstration that Sn-doping speeds up water oxidation on hematite by increasing the rate constant for hole transfer.

Unusual Mn coordination and redox chemistry in the high capacity borate cathode Li7Mn(BO3)3

The recently discovered lithium-rich cathode material Li₇Mn(BO₃)₃ has a high theoretical capacity and an unusual tetrahedral Mn²⁺ coordination.

Absence of orbital currents in superconducting YBa2Cu4O8 using a zeeman-perturbed nuclear-quadrupole-resonance technique

Zeeman perturbed nuclear quadrupole resonance was applied to evaluate weak magnetic fields in the context of orbital currents in cuprate superconductors. The magnetic environment of the barium atom in c-axis oriented powder samples of YBa(2)Cu(4)O(8) was investigated in the pseudogap phase at 90 K. No evidence for orbital currents was found: any static and dynamic field must be less than 0.07 and 0.7 mT, respectively.

Lack of evidence for orbital-current effects in the high-temperature Y2Ba4Cu7O15-delta superconductor using 89Y nuclear magnetic resonance

We have performed NMR measurements at the Y site on a c-axis-oriented powder sample of the cuprate superconductor Y2Ba4Cu7O15-delta to search for the possible orbital-current phase. The temperature dependence of the Y linewidth and relaxation behavior in the normal-conducting phase were studied down to 100 K. These measurements give upper limits for a static magnetic field and the amplitude of a fluctuating magnetic field at the Y site of < or approximately 0.15 and < or approximately 0.7 mT, respectively. These values provide significant constraints on possible static or quasistatic orbital currents.

Mechanical thrombo-embolectomy in acute ischaemic stroke: a local experience

Large-vessel ischaemic strokes have a very poor natural history. Thombolysis is indicated for the treatment of ischaemic stroke but in practice is given to less than 10% of stroke sufferers, and its efficacy in large-vessel occlusion is poor. Mechanical embolectomy is a new therapy that allows attempted revascularisation up to eight hours after stroke onset. With its improved efficacy, it therefore offers some hope to patients admitted with this devastating condition.

Should human chondrocytes fly? The impact of electromagnetic irradiation on chondrocyte viability and implications for their use in tissue engineering

A significant logistic factor as to the successful clinical application of the autologous tissue engineering concept is efficient transportation: the donor cells need to be delivered to tissue processing facilities which in most cases requires air transportation. This study was designed to evaluate how human chondrocytes react to X-ray exposure. Primary cell cultures were established, cultured, incubated and exposed to different doses and time periods of radiation. Subsequently, quantitative cell proliferation assays were done and qualitative evaluation of cellular protein production were performed. Our results show that after irradiation of chondrocytes with different doses, no significant differences in terms of cellular viability occurred compared with the control group. These results were obtained when chondrocytes were exposed to luggage transillumination doses as well as exposure to clinically used radiation doses. Any damage affecting cell growth or quality was not observed in our study. However, information about damage of cellular DNA remains incomplete.

[Osteofluorosis caused by excess use of toothpaste]

BACKGROUND

Osteofluorosis is caused by chronic fluoride intoxication. Fluoride is used in toothpaste for the prevention of dental caries, and dental fluorosis has often been reported among children and attributed to ingestion of fluoride toothpaste. We report a case of chronic fluoride intoxication caused by excess use of toothpaste in an adult.

CASE

A 45-year-old woman consulted a rheumatologist for painful swelling of the fingers, phalangeal rather than articular. She also had brown staining on her teeth. Radiography of the hands showed periosteal apposition on the phalanges. Further work-up ruled out tumoral or thyroid causes. Laboratory tests showed elevated fluoride levels in the blood (50.9 micromol/L, normal<1.5 micromol/L) and in the urine (721 micromol/L, normal<46 micromol/L). On questioning, we found only one cause for chronic fluoride intoxication: excess and unusual use of toothpaste. The patient brushed her teeth 18 times a day and swallowed the toothpaste, because she liked the taste. She consumed a tube of toothpaste every 2 days, thereby swallowing 68.5 mg of fluoride every day. Suspecting fluorosis from toothpaste, we asked the patient to use a toothpaste without fluoride. Sixteen weeks later, the pain had ceased, and laboratory tests showed massively reduced but still elevated fluoride levels in the blood (6.9 micromol/L) and urine (92.7 micromol/L).

CONCLUSION

In this rare case of fluoride intoxication, misuse of a normally innocuous product caused osteofluorosis.

[Application of multislice spiral CT (MSCT) in multiple injured patients and its effect on diagnostic and therapeutic algorithms]

The initial diagnostic work-up of trauma victims with multiple injuries is currently a combination of conventional radiography (CR), ultrasound (US), and computed tomography (CT). This article reviews the diagnostic quality of the different imaging modalities regarding detection and classification of injuries. CT performs better than US in detecting traumatic lesions of abdominal parenchymal organs. Furthermore, CT is better than CR in detecting therapeutically relevant chest and bone injuries. MSCT may replace CR and US under the condition that it is faster than or at least as fast as the conventional approach to diagnose life threatening injuries. This can be achieved only by changing the work-flow for the entire trauma team including radiologist. Furthermore, certain prerequisites must be fulfilled including integration of a MSCT scanner into the emergency room. An optimized whole body CT protocol for the assessment of trauma victims using MSCT as well as a two-step algorithm for reporting the imaging findings depending on their clinical significance is presented.

Direct observation of the oxygen isotope effect on the in-plane magnetic field penetration depth in optimally doped YBa2Cu3O7-delta

We report the first direct observation of the oxygen-isotope ((16)O/(18)O) effect on the in-plane penetration depth lambda(ab) in a nearly optimally doped YBa(2)Cu(3)O(7-delta) film using the novel low-energy muon-spin rotation technique. Spin-polarized low-energy muons are implanted in the film at a known depth z beneath the surface and process in the local magnetic field B(z). This feature allows us to measure directly the profile B(z) of the magnetic field inside the superconducting film in the Meissner state and to make a straightforward determination of lambda(ab). A substantial isotope shift Delta lambda(ab)/lambda(ab)=2.8(1.0)% at 4 K is observed, implying that the in-plane effective supercarrier mass m*(ab) is oxygen-isotope dependent with Delta m*(ab)/m*(ab)=5.5(2.0)%. These results are in good agreement with magnetization measurements on powder samples.

[Initial examination for school attendance in Mannheim: language development at initial school entry level]

INTRODUCTION

In autumn 2001 the initial examination for school attendance in Mannheim has been fundamentally reorganised. The individual examination elements had been widely standardized, the results can be evaluated by regions and a diagnosis for the early detection of legasthenia has been developed.

METHODS

The testing involved repeating sentences, numbers and artificial words. This has been developed by the Pedagogical University Heidelberg. In pre-examinations in Heidelberg the results relate significantly to the subsequent results in reading and writing.

PROBANDS

A total of 2,744 children (46.1% girls, 53.9% boys) aged of 5 to 7 years was seen. 71.5% of the children were German nationality. Most non-German nationalities were Turkish (15.4%) and Italian (3.6%) children. Besides the nationality the mother tongue has been also recorded. More than 96% of the children had been attending a kindergarten. For judgement of the social strata the frequency of social welfare receivers has been recorded.

RESULTS

The testing results are significantly influenced by the native language and the social strata of the children. The results of children with German as native language are above those of non-Germans. Within the migrant children there are significant differences between the several nationalities. Children from a lower social strata achieved lower results. A positive effect to the language development is attributed to the attendance of a kindergarten.

CONCLUSION

These results are the basis for language- and general health supporting projects in Mannheim. For the examination for school attendance in the current year the diagnostic for language development has been extended by some more aspects.