Ammonia emissions from a dairy housing and wastewater treatment plant quantified with an inverse dispersion method accounting for deposition loss

Ammonia (NH3) emissions negatively impact air, soil, and water quality, hence human health and biodiversity. Significant emissions, including the largest sources, originate from single or multiple structures, such as livestock facilities and wastewater treatment plants (WWTPs). The inverse dispersion method (IDM) is effective in measuring total emissions from such sources, although depositional loss between the source and point of measurement is often not accounted for. We applied IDM with a deposition correction to determine total emissions from a representative dairy housing and WWTP during several months in autumn and winter in Switzerland. Total emissions were 1.19 ± 0.48 and 2.27 ± 1.53 kg NH3 d-1 for the dairy housing and WWTP, respectively, which compared well with literature values, despite the paucity of WWTP data. A concurrent comparison with an inhouse tracer ratio method at the dairy housing indicated an offset of the IDM emissions by < 20%. Diurnal emission patterns were evident at both sites mostly driven by changes in air temperature with potential lag effects such as following sludge agitation. Modeled deposition corrections to adjust the concentration loss detected at the measurement point with the associated footprint were 22-28% of the total emissions and the cumulative fraction of deposition to emission modeled with distance from the source was between 7% and 12% for the measurement distances (60-150 m). Although estimates of depositional loss were plausible, the approach is still connected with substantial uncertainty, which calls for future validation measurements. Longer measurement periods encompassing more management activities and environmental conditions are required to assess predictor variable importance on emission dynamics. Combined, IDM with deposition correction will allow the determination of emission factors at reduced efforts and costs, thereby supporting the development and assessment of emission reducing methods and expand the data availability for emission inventories.Implications: Ammonia emissions must be measured to determine emission factors and reporting national inventories. Measurements from structures like farms and industrial plants are complex due to the many different emitting surfaces and the building configuration leading to a poor data availability. Micrometeorological methods provide high resolution emission data from the entire structure, but suffer from uncertainties, as the instruments must be placed at a distance from the structure resulting in a greater loss of the emitted ammonia via dry deposition before it reaches the measurement. This study constrains such emission measurements from a dairy housing and wastewater treatment plant by applying a simple correction to account for the deposition loss and compares the results to other methods.

Direct isolation of small extracellular vesicles from human blood using viscoelastic microfluidics

Small extracellular vesicles (sEVs; <200 nm) that contain lipids, nucleic acids, and proteins are considered promising biomarkers for a wide variety of diseases. Conventional methods for sEV isolation from blood are incompatible with routine clinical workflows, significantly hampering the utilization of blood-derived sEVs in clinical settings. Here, we present a simple, viscoelastic-based microfluidic platform for label-free isolation of sEVs from human blood. The separation performance of the device is assessed by isolating fluorescent sEVs from whole blood, demonstrating purities and recovery rates of over 97 and 87%, respectively. Significantly, our viscoelastic-based microfluidic method also provides for a remarkable increase in sEV yield compared to gold-standard ultracentrifugation, with proteomic profiles of blood-derived sEVs purified by both methods showing similar protein compositions. To demonstrate the clinical utility of the approach, we isolate sEVs from blood samples of 20 patients with cancer and 20 healthy donors, demonstrating that elevated sEV concentrations can be observed in blood derived from patients with cancer.

Targeted delivery of tumor necrosis factor in combination with CCNU induces a T cell-dependent regression of glioblastoma

Glioblastoma is the most aggressive primary brain tumor with an unmet need for more effective therapies. Here, we investigated combination therapies based on L19TNF, an antibody-cytokine fusion protein based on tumor necrosis factor that selectively localizes to cancer neovasculature. Using immunocompetent orthotopic glioma mouse models, we identified strong anti-glioma activity of L19TNF in combination with the alkylating agent CCNU, which cured the majority of tumor-bearing mice, whereas monotherapies only had limited efficacy. In situ and ex vivo immunophenotypic and molecular profiling in the mouse models revealed that L19TNF and CCNU induced tumor DNA damage and treatment-associated tumor necrosis. In addition, this combination also up-regulated tumor endothelial cell adhesion molecules, promoted the infiltration of immune cells into the tumor, induced immunostimulatory pathways, and decreased immunosuppression pathways. MHC immunopeptidomics demonstrated that L19TNF and CCNU increased antigen presentation on MHC class I molecules. The antitumor activity was T cell dependent and completely abrogated in immunodeficient mouse models. On the basis of these encouraging results, we translated this treatment combination to patients with glioblastoma. The clinical translation is ongoing but already shows objective responses in three of five patients in the first recurrent glioblastoma patient cohort treated with L19TNF in combination with CCNU (NCT04573192).

A Rare Case of Classical Hodgkin Lymphoma Diagnosed 10 Years after Liver Transplant

Posttransplant lymphoproliferative disorders (PTLD) represent a rare and potentially life-threatening complication after liver transplantation. Classical Hodgkin lymphoma (cHL), with an incidence of approximately 1.8-3.4% of all PTLD cases, represents a minority of PTLD, mainly presenting as a late transplant complication. The main risk factors for the development of PTLD are Epstein-Barr virus (EBV) infection and intensive immunosuppression. However, other risk factors like hepatitis C virus may, together with EBV infection, contribute to the development of PTLD. Here we present a case of late-onset EBV-positive cHL that occurred 10 years after an unrelated donor liver transplantation. To our knowledge, this is the first report of cHL occurring with such a long interval after liver transplantation. Given the low incidence of cHL PTLD, there is little information regarding pathology, clinical characteristics, and management of this disease. The development of individual, risk-adapted treatments may improve the long-term outcome of cHL PTLD.

[Classification of haematogenous and post-traumatic osteomyelitis]

A classification of osteomyelitis must reflect the complexity of the disease and, moreover, provide conclusions for the treatment. The classification is based on the following eight parameters: source of infection (OM [osteomyelitis]/OT [post-traumatic OM]), anatomic region, stability of affected bone (continuity of bone), foreign material (internal fixation, prosthesis), range of infection (involved structures), activity of infection (acute, chronic, quiescent), causative microbes (unspecific and specific bacteria, fungi) and comorbidity (immunosuppressive diseases, general and local). In the long version of the classification, which was designed for scientific studies, the parameters are named by capital letters and specified by Arabic numbers, e.g., an acute, haematogenous osteomyelitis of a femur in an adolescent with diabetes mellitus, caused by Staphylococcus aureus, multi-sensible is coded as: OM2 Lo33 S1a M1 In1d Aa1 Ba2a K2a. The letters and numbers can be found in clearly arranged tables or calculated by a freely available grouper on the internet (www.osteomyelitis.exquit.net). An equally composed compact version of the classification for clinical use includes all eight parameters, but without further specification. The above-mentioned example in the compact version is: OM 3 S a Ba2 K2. The short version of the classification uses only the first six parameters and excludes causative microbes and comorbidity. The above mentioned example in the short version is: OM 3 S a. The long version of the classification describes an osteomyelitis in every detail. The complexity of the patient's disease is clearly reproducible and can be used for scientific comparisons. The for clinical use suggested compact and short versions of the classification include all important characteristics of an osteomyelitis, can be composed quickly and distinctly with the help of tables and provide conclusions for the individual treatment. The freely available grouper (www.osteomyelitis.exquit.net) creates all three versions of the classification in one step.

[Definition of the Diagnosis Osteomyelitis-Osteomyelitis Diagnosis Score (ODS)]

AIM

The disease "osteomyelitis" is characterised by different symptoms and parameters. Decisive roles in the development of the disease are played by the causative bacteria, the route of infection and the individual defense mechanisms of the host. The diagnosis is based on different symptoms and findings from the clinical history, clinical symptoms, laboratory results, diagnostic imaging, microbiological and histopathological analyses. While different osteomyelitis classifications have been published, there is to the best of our knowledge no score that gives information how sure the diagnosis "osteomyelitis" is in general.

METHOD

For any scientific study of a disease a valid definition is essential. We have developed a special osteomyelitis diagnosis score for the reliable classification of clinical, laboratory and technical findings. The score is based on five diagnostic procedures: 1) clinical history and risk factors, 2) clinical examination and laboratory results, 3) diagnostic imaging (ultrasound, radiology, CT, MRI, nuclear medicine and hybrid methods), 4) microbiology, and 5) histopathology.

RESULTS

Each diagnostic procedure is related to many individual findings, which are weighted by a score system, in order to achieve a relevant value for each assessment. If the sum of the five diagnostic criteria is 18 or more points, the diagnosis of osteomyelitis can be viewed as "safe" (diagnosis class A). Between 8-17 points the diagnosis is "probable" (diagnosis class B). Less than 8 points means that the diagnosis is "possible, but unlikely" (class C diagnosis). Since each parameter can score six points at a maximum, a reliable diagnosis can only be achieved if at least 3 parameters are scored with 6 points.

CONCLUSION

The osteomyelitis diagnosis score should help to avoid the false description of a clinical presentation as "osteomyelitis". A safe diagnosis is essential for the aetiology, treatment and outcome studies of osteomyelitis.

[Two-stage procedure to exchange septic total hip arthroplasties with late periprosthetic infection. Early results after implantation of a reverse modular hybrid endoprosthesis]

BACKGROUND

Between January 2001 and January 2005 we performed the exchange of infected total hip arthroplasties in 40 cases.

MATERIAL AND METHODS

We applied a two-stage procedure when implant salvage was not possible. Our treatment algorithm included complete removal of the infected material, thorough débridement, and repeated revisions until cultures were negative. We then implanted a cemented acetabular polyethylene cup with specific antibiotic addition and a cementless modular stem (reverse modular hybrid endoprosthesis). Appropriate intravenous and oral antibiotic therapy was prescribed.

RESULTS

A total of 18 women and 22 men (age 48-86 years) were followed up for 4-48 months (mean: 12 months). Up to now 38 have remained infection free; in two cases the treatment failed and a resection arthroplasty had to be performed. There were eight complications intraoperatively (shaft fractures); four of them were treated conservatively and four needed additional stabilization. The mean hip score improved from 21 points initially to 81 points at the last examination. All details are listed in table form. Two-stage revision hip arthroplasty for infection using the inverse modular hybrid technique seems to be a safe and reliable method. Further investigation and a larger number of patients are necessary to confirm these preliminary results.

Studies on the mechanism of RNAi-dependent heterochromatin assembly

Assembly of heterochromatin at centromeric DNA regions in the fission yeast Schizosaccharomyces pombe involves an intimate interplay between chromatin modifying complexes and components of the RNAi pathway. The RNA-induced transcriptional silencing (RITS) complex, containing Chp1, Ago1, Tas3, and centromeric siRNAs, localizes to centromeric DNA repeats and is required for the assembly and maintenance of heterochromatin. RITS brings together two types of molecular recognition modules: a chromodomain protein, which binds to lysine 9 methylated histone H3 (H3K9), and Argonaute, which binds to specific sequences by siRNA-directed base-pairing interactions. The RNA-directed RNA polymerase complex (RDRC), composed of Rdp1, the Hrr1 helicase, and the Cid12 Poly(A) polymerase family member, synthesizes double-stranded RNA and creates the substrate for Dicer to generate siRNAs. RDRC physically associates with RITS, and both complexes localize to noncoding centromeric RNAs and centromeric DNA repeats, suggesting that recognition of nascent RNA transcripts may be involved in localization of these complexes to specific chromosome regions. In support of this possibility, tethering of the RITS complex to the transcript of the normally euchromatic ura4 (+) gene results in siRNA generation and RNAi- and heterochromatin-dependent silencing of the ura4 (+) gene. Finally, silencing of a subset of endogenous and transgene promoters within heterochromatic DNA domains occurs by RNAi-dependent degradation of nascent transcripts by a mechanism that we have termed co-transcriptional gene silencing (CTGS).

Gene-gene effects on central processing of aversive stimuli

Emotional reactivity and regulation are fundamental to human behavior. As inter-individual behavioral variation is affected by a multitude of different genes, there is intense interest to investigate gene-gene effects. Functional sequence variation at two genes has been associated with response and resiliency to emotionally unpleasant stimuli. These genes are the catechol-O-methyltransferase gene (COMT Val158Met) and the regulatory region (5-HTTLPR) of the serotonin transporter gene. Recently, it has been proposed that 5-HTT expression is not only affected by the common S/L variant of 5-HTTLPR but also by an A to G substitution. Using functional magnetic resonance imaging, we assessed the effects of COMT Val(158)Met and both 5-HTT genotypes on brain activation by standardized affective visual stimuli (unpleasant, pleasant, and neutral) in 48 healthy subjects. Based on previous studies, the analysis of genotype effects was restricted to limbic brain areas. To determine allele-dose effects, the number of COMT Met158 alleles (i.e., lower activity of COMT) and the number of 5-HTT low expressing alleles (S and G) was correlated with the blood oxygen level-dependent (BOLD) response to pleasant or unpleasant stimuli compared to neutral stimuli. We observed an additive effect of COMT and both 5-HTT polymorphisms, accounting for 40% of the inter-individual variance in the averaged BOLD response of amygdala, hippocampal and limbic cortical regions elicited by unpleasant stimuli. Effects of 5-HTT and COMT genotypes did not affect brain processing of pleasant stimuli. These data indicate that functional brain imaging may be used to assess the interaction of multiple genes on the function of neuronal networks.

Das Aneurysma spurium der A.�genus superior lateralis

Arterial complications after total knee arthroplasty are rare. If the formation of a false aneurysm does occur, it usually affects the popliteal artery. We report the case of an 77 year old female with a false aneurysm of the lateral superior genicular artery. The patient was suffering from gonarthrosis and received a duocondylar knee replacement without resurfacing of the patella. Postoperatively, she reported anterior knee pain and a revision of the joint with lateral release was carried out. In the third postoperative week, a painful swelling in the lateral and superior aspect of the knee occurred. A scintigraphic investigation with enrichment in the early period was misinterpreted as infection. Ultrasonographic and angiographic investigations gave the right diagnosis of a false aneurysm. In the same angiographic investigation, the aneurysm could be cured by coil embolisation. The interval between the operation leading to the problem and the formation of the aneurysm, as well as the low incidence of this complication, made it hard to diagnose. Ultrasonographic and angiographic examinations allow for proper diagnosis in cases of unclear painful swellings. When dealing with an arterial complication following total knee arthroplasty, a specialized radiologist or vascular surgeon should be consulted immediately.

Osteoid osteoma: technique of computed tomography-controlled percutaneous resection using standard equipment available in most orthopaedic operating rooms

Symptoms of osteoid osteoma are cured by removing the nidus. 'En-bloc' resection is often not successful because the nidus is hard to find and remove totally. Recently, minimally invasive procedures have been advocated for the resection of osteoid osteoma. Preceding investigators have used a set of special instruments. The nidus is best localized with computed tomography (CT). Surgery under CT control is only possible with minimal invasive procedures. A technique using standard equipment usually available in the operating room can be used successfully for CT-guided removal of the nidus. We report our preliminary results with 17 patients (12 men, 5 women) with an average age of 22 years (range 6-57 years). All patients were pain-free immediately after the operation. The average follow-up was 8.4 months (range 1-22 months) and the average operating time 75 min (range 50-130 min). Ten patients could be treated as outpatients. The average time in hospital after surgery was 1.5 days (range 1-3 days). There were two complications, one superficial wound infection and one change of operative technique to an open procedure due to a technical problem. The diagnosis could be confirmed histologically.

The epidemiology of fractures of the distal femur

Between 1980 and 1989, reports on 2,165 fractures of the distal part of the femur (1,051 women and 1,114 men) were collected by AO Documentation and are analyzed in the present paper. The number of fractures showed a bimodal pattern with a marked variation in the number of fractures in relation to gender and age. A larger prevalence of fractures was observed either in young men (about 20 years old, traffic or sport) and in old women (about 70, fall at home, osteoporosis).

The epidemiology of fractures of the proximal femur

Between 1980 and 1989, reports on 21,145 fractures of the proximal part of the femur (15,428 women and 5,717 men) were collected by AO Documentation and are analysed in the present paper. The number of fractures increases exponentially with age for women and for men. Up to 50, the number of fractures is higher for men than for women and vice versa after 55 years. The exponential increase in the number of fractures with age appears for all the types A1 to B3 for both women and men. No special increase has been identified for women after 50 (expected age of menopause).

The epidemiology of diaphyseal fractures of the tibia

AO Documentation collected reports of nearly five thousand diaphyseal tibial fractures occurring in the 1980s. The following conclusions can be drawn: i. The number of fractures affecting men is twice that affecting women. ii. These fractures occurred mainly in younger people (under 40 years of age) and no increase occurred in elderly people. iii. Most bending fractures occurred in young men (20-30 yrs) and the torsion fractures affected men and women of about 40 equally. iv. The number of simple fractures (type A) is about the same as for fractures with one fragment (type B).

Novel dialysis cannulas: are they worth the higher price tag?

Accessory hemodialysis equipment, including dialysis cannulas, usually lack controlled and independent testing before being introduced onto the market. The aim of this study is a prospective comparison of a newly designed curved-tip dialysis cannula with a standard dialysis cannula of the same size from the same manufacturer. Fifteen chronic dialysis patients were enrolled onto a prospective 4-month crossover study. All patients had arteriovenous fistulas, except for two patients with polytetrafluoroethylene grafts. The routinely used standard cannulas were replaced by either a curved-tip 15G cannula or a new standard 15G cannula from the same manufacturer. The two cannulas were compared with respect to puncture-related pain and/or problems and bleeding complications, as well as blood-flow dynamics. Venous and arterial access pressures were recorded at blood-flow rates of 100 to 400 mL/min. Linear regression analyses of arterial and venous pressure profiles showed the same regression lines for the standard and curved-tip cannulas. Plasma haptoglobulin levels and occlusion times necessary to stop bleeding after removal of the cannulas did not differ between the two cannulas. Both patients and nurses independently reported equal puncture-related pain and/or problems for both cannulas on visual analogue scales. No correlation was found between puncture problems reported by nurses and puncture pain reported by patients. The curved-tip cannula does not offer an advantage compared with the less expensive standard cannula. Controlled testing of advertised advantages by manufacturers of accessory equipment should be a prerequisite before introduction into routine clinical treatment.

Longitudinal monthly body measurements from 1 to 12 months of age: a study by practitioners for practitioners. Zurich Association of Practicing Paediatricians

A longitudinal growth study with monthly measurements during the 1st year of life was conducted by nine paediatricians working in private practice in Zurich. Of 92 children, none was lost to the study and only 32 of 1104 planned visits were missed; the quality of the measurements was comparable to that of a specialised university clinic. Compared to the Zurich Longitudinal Growth Studies, children of this study were considerably heavier and taller. In 92% of the subjects, growth velocity was at least once outside the reference range (3rd 97th percentile). For weight increments, the corresponding proportion was 87%.

CONCLUSIONS

The data indicate that current standards for the 1st year of life for the Zurich area might no longer be appropriate and need to be updated. The currently used velocity percentiles based on 3-monthly measurements are not suitable to assess individual height and weight increments calculated from monthly measurements.

Transjugular intrahepatic portosystemic shunting (TIPS) with balloon-expandable and self-expanding stents: technical and clinical aspects after 3 1/2 years' experience

PURPOSE

To evaluate prospectively our experience with transjugular intrahepatic portosystemic shunt (TIPS) using four different metallic stents.

METHODS

Between November 1991 and April 1995, 57 patients (41 men and 16 women; age 35-72 years, mean 54 years) underwent the TIPS procedure. Techniques for portal vein localization before and during TIPS were fluoroscopy, computed tomography (CT) studies, wedged hepatic venography, arterial portography, and ultrasound. After predilation we deployed balloon-expandable (n = 48) and self-expanding (n = 45) metallic stents. Fifteen patients underwent variceal embolization. Initial follow-up angiograms (mean 6.9 months, range 3-24 months) were obtained in 39 of these patients.

RESULTS

Fifty-three patients (93%) had successful TIPS placement. The mean decrease in portal pressure was 42.7%. Besides fluoroscopy, the most helpful techniques for portal vein localization were venography and CT. Residual stenosis (n = 1) and late shortening (n = 4) of Wallstents resulted in shunt dysfunction. The technical problems encountered with the Palmaz stent resulted from its lack of flexibility. We combined balloon-expandable and self-expanding stents in 12 patients. The 30-day and late follow-up (mean 11.9 months) percutaneous reintervention rates were 11.3% and 64.2%, respectively. There were no clinically significant complications related to the TIPS insertions.

CONCLUSION

An ideal stent does not exist for TIPS, and the authors recommend combining a Palmaz stent with a flexible self-expanding stent.

Mechanism of the antiischemic effect of mibefradil, a selective T calcium channel blocker in dogs: comparison with amlodipine

Calcium channel blockers are active in variant angina principally by preventing coronary vasospasm. However, a direct antiischemic effect may also occur. In open-chest dogs, an attack of variant angina was mimicked by a 2-min critical coronary stenosis, and the following reversible myocardial ischemia was assessed by measuring the decrease of segmental shortening. We compared the antiischemic mechanism of mibefradil, a T and L calcium channel blocker, with that of amlodipine, a pure L channel blocker. Both drugs showed a similar relationship between the decrease of the rate-pressure product and the antiischemic effect, but only mibefradil reduced heart rate. Amlodipine and mibefradil at the highest doses tested (20 and 70 micrograms/kg/min, respectively) restored 68 +/- 8 and 76 +/- 5% of segmental shortening in the ischemic area, respectively, as compared with preischemic values. Matching blood pressure (by intraaortic balloon) or heart rate (by atrial pacing) to predrug values showed that the antiischemic effect was mainly afterload-dependent for amlodipine and heart rate-dependent for mibefradil. We conclude that in variant angina, in addition to their antivasospastic effects, calcium channel blockers may be antiischemic by a direct myocardial effect associated with a decrease of the rate pressure product. Blockade of the T channel does not seem to participate in the direct antiischemic effect of mibefradil but could explain the decrease of heart rate.

[Simultaneous measumrement of the renal excretion of 131I-hippuran and 99mTc-MAG3]

This study describes methods of measuring simultaneously the renal excretion of two radiopharmaceuticals and of evaluating their different kinetics. For quantification of the dynamic contributions of scattered radiation in a double-radionuclide study a high-resolution pure germanium detector was used. The geometry of the arrangement was a semi-shielded whole-body counter according to E. Oberhausen. An intra-individual comparison of the renal elimination of 99mTc-MAG3 and 131I-Hippuran shows a systemic difference between both tracers depending on the time after injection, its average being around 11% between the 10th and 20th min. The inter-individual comparison shows deviations from the mean between -29 and +20%.

[Clinical results with the limited contact DCP plate of titanium--a prospective study of 504 cases]

From the beginning of 1988 to July 1991, ten Swiss and German clinics undertook to document all cases of internal fixation using the titanium LC-DCP as part of a prospective multicenter study. The follow-up period was 14.2 months on average. The clinical results of 504 fixations were convincing. The follow-up rate was 72%. Of these, 95% healed without complication. The most frequent complication was delayed healing which occurred in 2.5% of cases. The infection rate was low (1.1%). A separate comparison of DCP fixations on the tibial shaft in 1984-1988 demonstrated the obvious biological compatibility of the new plate and shows that excellent results can be obtained using plate fixation.

Simultane Messung der renalen Ausscheidung von 131J-Hippuran und 99mTc-MAG3

In der vorliegenden Arbeit werden methodische Ansätze für einen simultanen Vergleich zweier nierengängiger Radiopharmaka dargestellt. Zur Quantifizierung der bei Doppelisotopenuntersuchungen auftretenden dynamischen Streuanteile wurde ein hochauflösender Reinst-Germanium-Detektor eingesetzt. Die Meßgeometrie entsprach der von Oberhausen beschriebenen Methode des teilabgeschirmten Ganzkörperzählers. Damit wurde erstmals ein Vergleich von MAG3 mit Hippuran durchgeführt, der 1. unter idealen meßtechnischen Bedingungen erfolgte und 2. bei simultaner Anwendung der Radiodiagnostika mögliche biologische Schwankungen bei der renalen Elimination ausschloß. Ein intraindividueller Vergleich der renalen Elimination von 99mTc-IVIAG3 und 131J-Hippuran läßt zeitabhängige systematische Differenzen zwischen beiden Tracern erkennen, die zwischen der ca. 10. und 20. Minute nach Untersuchungsbeginn im Mittel etwa 11% betrugen. Ein interindividueller Vergleich hingegen zeigte im Extrem Abweichungen vom Mittelwert zwischen -29 und +20%.

Documentation

In the period from 1. January to 31. December 1992, the new pinless external fixator was applied in eight European and North American clinics as part of a prospective multicentric study run by the AO/ASIF Documentation Centre. The aim of this study was to determine the indications, handling, and clinical results with the new fixator. The new pinless fixator was used 77 times on a total of 75 patients. The main indications were fresh tibial shaft fractures for which immediate definitive treatment was impossible. The majority of cases were secondarily stabilized with an unreamed tibial nail once the local and/or general condition of the patient had improved. In the remaining cases the pinless fixator was used for calcaneal and tibial head traction, segment transport and temporary stabilization in cases of tibial infection. Only after long-term application of the fixator was local infection at the pin site observed. There were no other complications. The new pinless fixator is a valuable addition in the treatment of fresh tibial fractures, in particular, in those cases which cannot be primarily treated due to contributing factors whether local or general.

[Classification of proximal femoral fractures]

Based on the AO Classification of Fractures, the classification of fractures of the proximal femur will be explained. Especially the sub- and pertrochanteric fractures, as well as the fractures of the femoral neck will be considered. During the period from 1980-1989 26,126 fractures of the proximal femur were documented in the AO/ASIF Documentation Center. These fractures will be discussed regarding following aspects: dispersion of age and fractures, pre-existing systemic illnesses, general and local postoperative complications, choice of implant.

[The decentralized documentation system '90' of the Study Group for Osteosynthesis Problems (AO)]

The new decentralized documentation system '90' of the "Arbeitsgemeinschaft für Osteosynthesefragen" (Association for the Study of Internal Fixation to ASIF) will be introduced. This system is used for gathering clinical data of operatively treated fractures and their clinical outcome.

[Soft tissue infection--osteitis--osteomyelitis]

Statistically the posttraumatic osteitis shows a clear tendency to decrease from 1972-76 in comparison with 1982-86 (AO/ASIF-documentation). The incidence of infection varies considerably according to the different anatomical location of fractures. More recently atypical manifestations became of more importance and ask for differentiated bacteriological examinations. A close postoperative follow-up and exact wound-observations enable an immediate and adequate therapy in case of an infection.

[Nosocomial infections in a university hospital. Results of a prospective study of infections in a medical and surgical ward and a surgical intensive care unit]

The results of an 11-month pilot study of surveillance of nosocomial infections are reported. Prospective surveillance was performed by daily examination of the microbiology reports and daily visits by the infection control nurse to the ward for the review of charts and Kardex of all patients for detection of "infection clues". Work sheets were used to collect all data during the daily rounds. Infection rates were calculated by dividing the the total number of hospital-acquired infections by the total number of discharges during the surveillance period. Active surveillance was performed for 6 months in the surgical intensive care unit (SCIU), 5 months in the surgical ward (SW) and 9 months in the medical ward (MW). Of 1527 patients discharged from these wards, nosocomial infections developed in 158 patients (10.4%). The overall infection rate was 14% (214 nosocomial infections). The infection rate varied greatly from ward to ward due to different patient populations, invasive procedures and severity of underlying diseases. Incidence infection rates were 42.5% for the SICU, 19.6% for the SW and 4.1% for the MW. The major sites affected were surgical wounds (42%), urinary tract (23%), respiratory tract (19%) and bloodstream (8%). The major etiologic agents associated with these nosocomial infections were E. coli, Pseudomonas aeruginosa, enterococci and Staphylococcus aureus. Conclusions drawn from the results of surveillance are discussed. The major benefits of an effective surveillance program for nosocomial infections are (a) estimates of the endemic levels of nosocomial infection, (b) identification of the nosocomial pathogens commonly encountered within a given institution, (c) identification of risk factors and (d) prompt recognition of epidemics. These data provide the necessary basis for an effective infection control program.

On the kinetics and mechanism of enoate reductase

Enoate reductases from Clostridium spec. La 1 and Clostridium kluyveri show a rather broad substrate specificity i.e. many alpha,beta-unsaturated carboxylates are reduced in a NADH-dependent reaction. The relative rates for different substrates are different for both reductases. The Km value of NADH for the reductase from C. spec. La 1 is about 12 muM. The transhydrogenase activity (reduction of N-acetylpyridine adenine dinucleotide) with NADH shows a maximum at pH 8 which is about 2 units higher than that for the reduction of enoates. Results of initial rate studies can be best explained by a Bi Bi ping pong mechanism. No back reaction and no proton exchange from 2(-3)H-labelled acylates could be demonstrated. NAD+ is a mixed-type inhibitor. The product inhibition constant Ki = 0.84mM and the dissociation constant for the dead-end inhibition complex 4.8mM. Aliphatic acylates show no measurable inhibition when they are applied in concentrations at the 100-fold Km values of the corresponding enoates. Measurable inhibitions can be observed with phenyl group-containing acylates. 3-Phenylpropionate (38mM) shows about 86% inhibition. Fumarate which is not a substrate inhibits the reduction of enoates by NADH as well as by reduced methylviologen. However, the reduction of NAD+ by reduced methylviologen as well that of acetylpyridine adenine dinucleotide by NADH is not inhibited by fumarate. On the other hand inhibitors such as morin or dicoumarol which probably bind to the flavin domain do not impair the reduction of enoates by reduced methylviologen however, all reductions with NADH are inhibited. These results are indicative for three binding domains: one for NADH which can be blocked by dicoumarol or morin, another for enoates which can be occupied by fumarate and a third one for reduced methylviologen. Enoate reductase splits off exclusively the (4S)-hydrogen atom from NADH. There is no direct hydrogen transfer from NADH to the products. Depending on the substrate concentration the isotope effect of the reduction of (E)-2-methyl-2-butenoate with (4S)-[4(-3)H]NADH varies from 6.8 to 1.3. The presence of NAD+ decreases the isotope effect.

Rhein as an electron acceptor for various flavoproteins and for electron transport particles

Rhein (4,5-dihydroxyanthraquinone-2-carboxylic acid) which has been previously employed as an inhibitor for electron transport particles, NADH dehydrogenase, and other flavoproteins is reducible under physiological conditions. Soluble hydrogenase from Alcaligenes eutrophus H 16, several flavoproteins, and electron transport particles from baker's yeast and from beef heart were found to catalyse NADH oxidation with 9 micrometers to 2mM rhein as the electron acceptor. Dithionite or enzymatically reduced rhein (lambda max = 408 nm) is immediately reoxidized to rhein lambda max = 437 nm) by oxygen. Cyclovoltagrams reveal the midpoint redox potentials --0.240 V, -0.270 V, -0.280 V, -0.335 V at pH 6.0, 7.0, 7.7, 9.2, respectively. Due to its redox behaviour, caution should be exercised using rhein as a flavin-site-directed inhibitor for biological electron transfer systems.

[Quantitative whole-body bone scintigraphy. II. Pharmacokinetics of osteotropic radiopharmaceuticals (author's transl)]

85Sr, 99mTc-Sn-pyrophosphate and 99mTc-Sn-methylene-diphosphonate, the most important agents for skeletal imaging, are compared with each other by calculation of the plasma clearance and the urinary excretion and by a series of quantitative whole-body scans. 85Sr the distribution volume in equilibrium is the largest, shifting of activity is demonstrable for several days after injection. 99mTc-Sn-MDP is excreted most quickly, equilibrium is reached early. There is no significant difference in skeletal uptake between the phosphate complexes. The distribution however is different: 85Sr is localized to a greater extent in the extremities, the phosphate complexes more in the trunk, 99mTc-Sn-MDP and 85Sr nearer the joints than 99mTc-Sn-pyrophosphate.