Laser-irradiating infrared attenuated total reflection spectroscopy of articular cartilage: Potential and challenges for diagnosing osteoarthritis

Objective

A prototype infrared attenuated total reflection (IR-ATR) laser spectroscopic system designed for in vivo classification of human cartilage tissue according to its histological health status during arthroscopic surgery is presented. Prior to real-world in vivo applications, this so-called osteoarthritis (OA) scanner has been tested at in vitro conditions revealing the challenges associated with complex sample matrices and the accordingly obtained sparse spectral datasets.

Methods

In vitro studies on human knee cartilage samples at different contact pressures (i.e., 0.2-0.5 ​MPa) allowed recording cartilage degeneration characteristic IR signatures comparable to in vivo conditions with high temporal resolution. Afterwards, the cartilage samples were assessed based on the clinically acknowledged osteoarthritis cartilage histopathology assessment (OARSI) system and correlated with the obtained sparse IR data.

Results

Amide and carbohydrate signal behavior was observed to be almost identical between the obtained sparse IR data and previously measured FTIR data used for sparse partial least squares discriminant analysis (SPLSDA) to identify the spectral regions relevant to cartilage condition. Contact pressures between 0.3 and 0.4 ​MPa seem to provide the best sparse IR spectra for cylindrical (d ​= ​3 ​mm) probe tips.

Conclusion

Laser-irradiating IR-ATR spectroscopy is a promising analytical technique for future arthroscopic applications to differentiate healthy and osteoarthritic cartilage tissue. However, this study also revealed that the flexible connection between the laser-based analyzer and the arthroscopic ATR-probe via IR-transparent fiberoptic cables may affect the robustness of the obtained IR data and requires further improvements.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

An adaptive framework to differentiate receiving water quality impacts on a multi-scale level

The paradigm shift in recent years towards sustainable and coherent water resources management on a river basin scale has changed the subject of investigations to a multi-scale problem representing a great challenge for all actors participating in the management process. In this regard, planning engineers often face an inherent conflict to provide reliable decision support for complex questions with a minimum of effort. This trend inevitably increases the risk to base decisions upon uncertain and unverified conclusions. This paper proposes an adaptive framework for integral planning that combines several concepts (flow balancing, water quality monitoring, process modelling, multi-objective assessment) to systematically evaluate management strategies for water quality improvement. As key element, an S/P matrix is introduced to structure the differentiation of relevant 'pressures' in affected regions, i.e. 'spatial units', which helps in handling complexity. The framework is applied to a small, but typical, catchment in Flanders, Belgium. The application to the real-life case shows: (1) the proposed approach is adaptive, covers problems of different spatial and temporal scale, efficiently reduces complexity and finally leads to a transparent solution; and (2) water quality and emission-based performance evaluation must be done jointly as an emission-based performance improvement does not necessarily lead to an improved water quality status, and an assessment solely focusing on water quality criteria may mask non-compliance with emission-based standards. Recommendations derived from the theoretical analysis have been put into practice.

Attributiveness of a mass flow analysis model for integrated water resources assessment under data-scarce conditions

Nutrients in river systems originate from multiple emission sources, follow various pathways, and are subject to processes of conversion and fate. One approach to tackle this complexity is to apply balance-oriented models. Although these models operate on a coarse temporal and spatial scale, they are capable of assessing the significance of the different emission sources and their results can be the basis for developing integrated water quality management schemes. In this paper we propose and apply a methodology to evaluate the attributiveness of such model results with regard to the modelled emission pathways. The MONERIS (MOdelling Nutrient Emissions in RIver Systems) model is set up, assuming plausible ranges of emission levels from four principal sources. The sensitivity of model performance is computed and related to the contribution from the pathways. The approach is applied for a case study in the upper Western Bug catchment (Ukraine). Coefficient of determination (R(2)) is found insensitive against the model assumptions, at levels around 0.65 for nitrogen and 0.55 for phosphorous emissions. Relative mean absolute error is minimized around 0.2 for both nutrients, but with equifinal combinations of the varied emission pathways. Model performance is constrained by the ranges of the emission assumptions to a limited extent only.

IWRM decision support with material flow analysis: consideration of urban system input

A review of material flow analysis (MFA) tools, comparison of case studies and analysis of approximately 20 MFA tools (static, semi-empirical models) are performed. The evaluation of the quantification procedures revealed several deficits in the approaches. The following principal complications for a reliable quantification of inputs from the urban water system are identified: (1) frequently insufficient data for urban system model validation (e.g. combined sewer overflow (CSO) discharges); (2) the necessity for additionally quantifying diffuse sources in order to verify modelling results at basin scale, where both input pathways occur, and (3) the contradictions arising when describing the highly dynamic urban system with the help of static MFA models. However, a wise selection of appropriate calculation procedures with regard to the concrete systems characteristics and available data can minimize the model deviations significantly. Criteria and suggestions for designing adapted quantification procedures are given.

Element patterns for particulate matter in stormwater effluent

Particulate matter in stormwater deteriorates the quality of receiving water and sediment. Characterization of stormwater particulate matter by means of its particle-associated element pattern provides an aid to determining its impact on receiving surface waters. During a 6 month measurement campaign, we determined particle-associated concentrations of major pollutants and rare earths for three combined water/stormwater outlets in the town of Stassfurt. We differentiated the particle-associated constituents on the basis of a hierarchical cluster analysis. Repeating the cluster analysis on random subsets, we gained information about the variability of the element patterns between and within the sites. In general, constituents associated with sewage and sewer sediment behave differently compared with constituents associated with runoff. The degree to which associations can be established for element patterns from site to site is limited by the variability encountered within sample sets taken from individual sites. The latter variability depends on the complexity of the catchment.

Extreme value statistics for river quality simulations

Various methods have been proposed to assess intermittent pollution loads and impacts on rivers in urban areas. Although the variables to describe the impact are mainly the same, the standards show significant differences in the assessment of permitted concentration level, duration and return period. The probability of an event is derived using either frequencies of occurrence or predefined extreme value distributions. Both methods have drawbacks. To bypass these, an a posteriori estimation of the statistical distribution of data based on the peak-over-threshold method is proposed. The method is exemplarily demonstrated using a semi-virtual case study.

Model-based comparison of two ways to enhance WWTP capacity under stormwater conditions

Two different approaches to increase the fraction of combined water treated in the wastewater treatment plant (WWTP) which would otherwise contribute to combined sewer overflows (CSO) are presented and compared based on modelling results with regard to their efficiencies during various rain events. The first option is to generally increase the WWTP inflow according to its actual capacity rather than pre-setting a maximum that applies to worst case loading. In the second option the WWTP inflow is also increased, however, the extra inflow of combined water is bypassing the activated sludge tank and directly discharged to the secondary clarifier. Both approaches have their advantages. For the simulated time series with various rain events, the reduction of total COD load from CSOs and WWTP effluent discharged to the receiving water was up to 20% for both approaches. The total ammonia load reduction was between 6% for the bypass and 11% for inflow increase. A combination of both approaches minimises the adverse effects and the overall emission to the receiving water.

Towards a better understanding of sewer exfiltration

This paper gives a full review of the importance of sewer leakage, which has received increased attention throughout the last decades. Despite the intensive interdisciplinary research that has been invested, its magnitude is still unclear and a comprehensive solution for the assessment of sewer exfiltration does not seem to be at hand. However, given that mechanisms of exfiltration and the factors influencing its extent are similar all over the world, it seems possible to develop a generic leakage approach. Several methods for modelling sewer leakage are reviewed and the available measuring techniques are critically evaluated. Based on this evaluation, we suggest a unifying framework to facilitate focused model building. Specifically, we identify open research questions and propose to (i) standardise measurement results to enable better understanding, (ii) perform more long-term experiments under realistic field conditions, and (iii) assess the uncertainty of measurement and model results so that findings are not over-interpreted.

Modelling of enhanced CSO treatment in secondary clarifiers with a modified Activated Sludge Model no. 3

An alternative approach for combined water treatment as opposed to its CSO discharge into receiving water is its bypass to the inlet of secondary clarifiers (SC). To analyse the processes and to evaluate the performance of this approach, experiments and numerical modelling were carried out. In batch and pilot scale experiments major effects were identified and quantified. The Activated Sludge Model No. 3 (ASM3) was modified to simulate the batch and pilot scale experiments for implementation of the bypass-specific processes and thus to set up an overall balance of the relevant compounds. With some modifications of ASM3, good agreement of the modelling results with measurements of COD, nitrogen and phosphorus were achieved.

Dynamic optimisation of WWTP inflow to reduce total emission

A prerequisite for an integrated control of sewer and wastewater treatment plant (WWTP) is a capacity driven inflow control to WWTP. This requires reliable information about the current status of WWTP operation and its behaviour on varying hydraulic, COD and nutrient loads. So far most of the proposed control strategies are based on hypothetical modelling studies. In this paper the behaviour of three large WWTPs on increased storm water loads is analysed based on online measurements of several years. In all cases the main limiting factors for an increase of load were the sedimentation processes in the secondary clarifier and the nitrification capacity. In one case study predictive control strategies have been developed observing these processes which are backboned by effluent control. Tests using an integrated model of sewer and WWTP demonstrate that inflow control on emission load varies significantly with rain intensity.

One-photon photodetachment of I− in glycerol: Spectra and yield of solvated electrons in the temperature range 329⩽T⩽536K

Solvated electrons in glycerol were generated via a resonant one-photon photodetachment of the charge-transfer-to-solvent (CTTS) band of I- in glycerol (Gl) after irradiation with a 248 nm excimer laser. Optical absorption spectra of solvated electrons (esolv-) in Gl were recorded as a function of temperature (381<or=T<or=505 K). The observed redshift of the absorption maximum, homegamax, yields a temperature coefficient d(homegamax)/dT=-(2.67+/-0.07)x10(-3) eV K-1. For solutions with a concentration c(I-) approximately 10(-3)M, the absorbance of esolv- at homegamax increases by a factor of about 65 when the temperature is raised from 329 to 536 K. This effect can be partially explained by a temperature-dependent redshift of the CTTS spectrum of I- in Gl with respect to the laser wavelength. The main contribution to the increasing yield of esolv- is determined by diffusion controlled escape dynamics of the electron in the contact pair (I:e-)solv which is formed very fast during the detachment process. At room temperature no absorption of esolv- (absorbance<1.0x10(-3)) could be observed which is probably a result of an extremely small self-diffusion coefficient of Gl (a factor of 1250 lower than that of water at 298 K). The results are compared with a previous study of I- in ethylene glycol.

Statistical methods towards more efficient infiltration measurements

A comprehensive knowledge about the infiltration situation in a catchment is required for operation and maintenance. Due to the high expenditures, an optimisation of necessary measurement campaigns is essential. Methods based on multivariate statistics were developed to improve the information yield of measurements by identifying appropriate gauge locations. The methods have a high degree of freedom against data needs. They were successfully tested on real and artificial data. For suitable catchments, it is estimated that the optimisation potential amounts up to 30% accuracy improvement compared to nonoptimised gauge distributions. Beside this, a correlation between independent reach parameters and dependent infiltration rates could be identified, which is not dominated by the groundwater head.

Quantification of sewer leakage: a review

One of the goals of the APUSS project (assessing infiltration and exfiltration on the performance of urban sewer systems) is to assess sewer exfiltration, in order to support cities and operators to define problem-oriented rehabilitation strategies. In this paper, we review various methods currently used for the estimation of exfiltration and discuss data needs and applicability for rehabilitation planning. Although each approach has its individual advantages and drawbacks, we identified pressure tests and tracer methods to have the highest potential for decision support in rehabilitation planning. With regard to future challenges (e.g., micropollutants) such methods might play a key role in integrated sewer management.

Application of a leakage model to assess exfiltration from sewers

The exfiltration of wastewater from sewer systems in urban areas causes a deterioration of soil and possibly groundwater quality. Beside the simulation of transport and degradation processes in the unsaturated zone and in the aquifer the analysis of the potential impact requires the estimation of quantity and temporal variation of wastewater exfiltration. Exfiltration can be assessed by the application of a leakage model. The hydrological approach was originally developed to simulate the interactions between the groundwater and surface water, it was adapted to allow for modelling of interactions between groundwater and sewer system. In order to approximate the exfiltration specific model parameters infiltration specific parameters were used as a basis. Scenario analysis of the exfiltration in the City of Dresden from 1997 to 1999 and during the flood event in August 2002 shows the variation and the extent of exfiltration rates.

ArcEGMO-URBAN--hydrological model for point sources in river basins

The new model ArcEGMO-URBAN aims at deterministic and spatiotemporal modelling of water, nitrogen and phosphorus fluxes from all urbanised areas of a river basin considering all potential sources. Pollution loads are calculated for discrete urban patches and balanced on the level of hydrological subbasins. Modelling results can be defined by the user of any level of spatial and/or temporal aggregation, e.g. matter balances for river basins or river sections and years or months, respectively. To process spatial data, a Geographic Information System is linked to the model. Information on urban land use and general characteristics of river basins is based on digital coverages, partly generated from remote-sensing data. Moreover, statistical data, e.g. on population, sewer systems, wastewater treatment plants etc. are included. Stormwater runoff from impervious surfaces is calculated as one input to the sewer network. Wastewater is considered with its main sewer system, pumping stations and treatment plants. Finally, the discharge is balanced for discrete river sections. Modelling results attest ArcEGMO-URBAN its ability to realistically quantify matter fluxes and major pollution sources as well as their seasonal variation. This makes the model an applicable tool for the analysis of scenarios with e.g. varying population distribution or climatic and technological conditions.

Identification of overall degradation in sewer systems from long-term measurements and consequences for WWTP simulations

In-sewer transformation processes affect significantly design and operation of large wastewater treatment plants. Especially for long-term simulations the degradation has to be considered in order to avoid over- and underestimation. In this paper a method is presented to derive the overall degradation from available operation data. The application of the results in a long-term simulation of a WWTP shows the relevance of the degradation for design and operation of an activated sludge plant.

Dynamics of rain-induced pollutographs of solubles in sewers

When looking at acute receiving water impacts due to combined sewer overflows the characteristics of the background diurnal sewage flux variation may influence the peak loads from combined sewer overflows (CSO) and wastewater treatment plant (WWTP) effluent significantly. In this paper, effects on the dynamic compounds transported in the sewer, on CSO discharges and WWTP loading are evaluated by means of hydrodynamic simulations. The simulations are based on different scenarios for diurnal dry-weather flow variations induced by different infiltration rates.

Integrated operation of sewer system and WWTP by simulation-based control of the WWTP inflow

In recent years numerical modelling became a standard procedure to optimise urban wastewater systems design and operation by integration. For dynamic control of the wastewater teatment plant (WWTP) inflow, a model-based predictive concept is introduced aiming at improving the receiving water quality. An on-line simulator running parallel to the real WWTP operation reflects the actual state of operation and provides this model information to a prognosis tool which determines the best option for the WWTP inflow. The investigations showed that it is possible to reduce the NH4-N peak concentrations in the receiving water by dynamic WWTP inflow control based on predictive scenario analysis.

Systems analysis of urban wastewater systems--two systematic approaches to analyse a complex system

This work was aimed at performing an analysis of the integrated urban wastewater system (catchment area, sewer, WWTP, receiving water). It focused on analysing the substance fluxes going through the system to identify critical pathways of pollution, as well as assessing the effectiveness of energy consumption and operational/capital costs. Two different approaches were adopted in the study to analyse urban wastewater systems of diverse characteristics. In the first approach a wide ranged analysis of a system at river basin scale is applied. The Nete river basin in Belgium, a tributary of the Schelde, was analysed through the 29 sewer catchments constituting the basin. In the second approach a more detailed methodology was developed to separately analyse two urban wastewater systems situated within the Ruhr basin (Germany) on a river stretch scale. The paper mainly focuses on the description of the method applied. Only the most important results are presented. The main outcomes of these studies are: the identification of stressors on the receiving water bodies, an extensive benchmarking of wastewater systems, and the evidence of the scale dependency of results in such studies.

Integrated modelling for the evaluation of infiltration effects

The objective of the present study is the estimation of the potential benefits of sewer pipe rehabilitation for the performance of the drainage system and the wastewater treatment plant (WWTP) as well as for the receiving water quality. The relation of sewer system status and the infiltration rate is assessed based on statistical analysis of 470 km of CCTV (Closed Circuit Television) inspected sewers of the city of Dresden. The potential reduction of infiltration rates and the consequent performance improvements of the urban wastewater system are simulated as a function of rehabilitation activities in the network. The integrated model is applied to an artificial system with input from a real sewer network. In this paper, the general design of the integrated model and its data requirements are presented. For an exemplary study, the consequences of the simulations are discussed with respect to the prioritisation of rehabilitation activities in the network.

Phase I Dose Escalation Study of Carboplatin to a Fixed Dose of Irinotecan as First-Line Treatment of Small Cell Lung Cancer

BACKGROUND

Superiority of irinotecan (CPT-11) plus cisplatin over etoposide plus cisplatin in small cell lung cancer (SCLC) has recently been demonstrated. This study determines dose-limiting toxicity (DLT) and maximum tolerated dose (MTD) of escalating doses of carboplatin to a fixed dose of irinotecan in Caucasians with small cell lung cancer.

PATIENTS AND METHODS

Patients with extensive small cell lung cancer received 50 mg/m(2) irinotecan on day 1, 8, and 15. Dose escalation of carboplatin on day 1 started in dose level 1 at an AUC of 5 mg x min/ml and was escalated to AUC 6 in level 2. Cycles were repeated on day 29. Dose escalation was evaluated after 3 consecutive patients. If no grade IV neutropenia lasting for > or =7 days or thrombopenia or non-hematologic toxicity > or = grade III occurred, treatment was continued in the next dose level.

RESULTS

16 patients were treated. DLT was reached in dose level 2 with 2 grade IV neutropenias and 1 grade IV thrombopenia and diarrhea. Toxicity was further investigated at dose level 1 in a total of 10 patients, which revealed 2 grade III neutropenias and 1 grade III diarrhea. Of 15 evaluable patients, 10 had a partial response, 3 had disease stabilization and 2 progressed.

CONCLUSION

Dose level 1 was found to be MTD, this dose is currently compared to the combination of etoposide plus carboplatin within a randomised phase II/III trial.

Integral and unified model for the sewer and wastewater treatment plant focusing on transformations

The urban drainage cycle is a very complex system with many interacting processes. Models are a great help to test different scenarios and improve the understanding of this system. At present, good models exist for the hydrodynamics of the sewer systems, for the biological conversions in the wastewater treatment plant (ASM 1 to 3) and for the receiving water (RWOM1). However, the traditional transport and conversion models for the sewer system are incompatible with the ASM definitions, making it difficult to link the models to come an integral and unified urban drainage model. In this work, a new sewer system model that is based on ASM3 has been coupled to an advanced nutrient removal model for the wastewater treatment plant. As both models are based on ASM3, they are unified in their definitions of the state variables and processes. This new combination has been used to test different scenarios and to test the influence of the sewer system on the treatment plant.

[Surgical angioplasty of the left main coronary artery. Evaluation and postoperative follow-up with intravascular ultrasound]

We report the case of a 45 year old man presenting to our emergency ward with acute onset of typical chest pain. The ECG showed ST-segment depression in the postero-lateral leads without elevation of any cardiac enzymes. The coronary angiogram showed a three-vessel disease with a subtotal, short stenosis of the right coronary artery and a severe ostial stenosis of the left main coronary artery. An operative revascularization with a venous graft to the right coronary artery and a angioplasty with an autologous vein patch of the left main coronary artery were performed. No peri- or postoperative complications occurred. Because of the importance of the left main coronary artery, the patient underwent an early post-operative coronary angiogram with intravascular ultrasound (IVUS) to confirm the patency of the patch angioplasty. We discuss the historical development, the indications and the main advantages of the patch angioplasty in comparison to conventional CABG procedures. The main issue of the presentation is the special value of IVUS in the pre- and postoperative assessment of the left main coronary artery. Within the last few years, IVUS has emerged from a pure research tool to the gold standard of coronary imaging. It is playing a more and more important role in the assessment of angiographically unclear lesions, mainly in the left main stem and its bifurcation. In addition, IVUS has a large influence in clinical decision making, e.g., reverral to CABG or PCI. It is also a powerful tool for optimizing the operative setting and provides the best possible postoperative control.

Integrated modelling as an analytical and optimisation tool for urban watershed management

In recent years numerical modelling has become a standard procedure to optimise urban wastewater systems design and operation. Since the models were developed for the subsystems independently, they did not support an integrated view to the operation of the sewer system, the wastewater treatment plant (WWTP) and the receiving water. After pointing out the benefits of an integrated approach and the possible synergy effects that may arise from analysing the interactions across the interfaces, three examples of modelling case studies carried out in Germany are introduced. With these examples we intend to demonstrate the potential of integrated models, though their development cannot be considered completed. They are set up with different combinations of self-developed and commercially available software. The aim is to analyse fluxes through the total wastewater system or to integrate pollution-based control in the upstream direction, that is e.g. managing the combined water retention tanks as a function of state variables in the WWTP or the receiving water. Furthermore the interface between the sewer and the WWTP can be optimised by predictive simulations such that the combined water flow can be maximised according to the time- and dynamics-dependent state of the treatment processes.

Deterministic modelling of integrated urban drainage systems

Today, the main concepts required for describing the dynamics of drainage in an entire urban area are known and models are available that can reasonably simulate the behaviour of the urban water system. Still, such integrated modelling is a complex exercise not only due to the sheer size of the model, but also due to the different modelling approaches that reflect the history of the sub-models used and of the purpose they were built for. The paper reviews the state of the art in deterministic modelling, outlines experiences and discusses problems and future developments.

Numerical modelling of dynamic sludge blanket behaviour in secondary clarifiers

New developments in numerical modelling of turbulent and density-affected flow in secondary clarifiers are reported. The sludge blanket is included in the computation domain which allows us to account for sedimentation and resuspension of sludge as well as the growth and diminution of the sludge blanket and at the same time respecting mass conservation. It is shown how strongly the prediction of the sludge-blanket height depends on the approaches to describe the settling behaviour of the sludge and the rheological properties within the sludge blanket. Further, an example of dynamic simulation is presented and discussed. This demonstrates how the sludge blanket behaves during load variation and that instabilities may occur at the interface of sludge blanket and supernatant, potentially resulting in sludge wash-off during transient phases, which is not only during load increase but also during load decrease.

Urban drainage redefined: from stormwater removal to integrated management

Even though urban drainage has been practised for more than 5000 years, many challenges arising from growing demands on drainage still remain with respect to runoff quantity and quality; landscape aesthetics, ecology and beneficial uses; and operation of existing urban wastewater systems. Further advances can be achieved by adopting an integrated approach, optimal operation of the existing infrastructure, advanced pollution and runoff source controls, improved resilience of receiving waters, and adaptive water management. The specific research needs include new technologies and strategies for stormwater management, advanced treatment of urban wet-weather effluents, and tools for analysis and operation of drainage systems. High diversity of demands on, and region/site specific conditions of, urban drainage shapes the role of urban drainage experts--as mediators among the many stakeholders and fields involved.

Pleomorphic lobular carcinoma: morphology, immunohistochemistry, and molecular analysis

Infiltrating pleomorphic lobular carcinoma (PLC) is an aggressive variant of infiltrating lobular carcinoma. Recently, in situ changes identical to PLC (PLCIS) have been described. The role of prognostic markers and their correlation with therapeutics, clinical outcome, and genetic changes is not well established in PLC. The authors examined 38 cases of this entity to understand better this tumor's biology. Immunohistochemical (IHC) analysis was performed in 21 specimens for estrogen and progesterone steroid receptors, p53, Her 2 (p185), and GCDFP-15. Genomic deoxyribonucleic acid was obtained from microdissected tumor as well as normal control cells, and loss of heterozygosity was investigated at the ESR (16q24), p53 (TP53 17p), Her 2 (17q 11-12), and BRCA 1 (17q12-25) loci. In this series, the average patient age was 57.5 years (age range, 24-92 years). Twenty-seven women were postmenopausal. Tumor size ranged from 1.2 to 25 cm. Six patients were a pathologic stage I; 19, stage II; 12, stage III; and one, stage IV. Histologically, multifocal nodular aggregates of discohesive pleomorphic tumor cells were seen interspersed in dense and fibrotic breast parenchyma. Twenty-nine percent of the specimens demonstrated associated signet ring cells. The remainder had dishesive, globoid, plasmacytoid cells with high-grade nuclear features. PLCIS was identified in 17 of 38 patients (45%), and lobular carcinoma in situ (LCIS) was noted in 8 patients (21%). IHC analysis showed estrogen immunoreactivity in 81%, progesterone in 67%, GCDFP-15 in 71%, and Her 2 in 81% (2+ to 3+ membranous staining) of specimens. Antibodies to p53 stained the tumor cell nuclei in 48% of the tumors. Loss of heterozygosity was identified in 52% of the specimens at the p53 locus, 18% at the ESR locus, 19% to 24% at the Her 2 loci, and 27% to 32% at the BRCA 1 locus. Follow-up was available in 19 patients and ranged from 12 months to 15 years (mean, 73 months). Seven patients had no evidence of disease at last examination (range, 1-15 years), three patients were alive with disease (range, 2-14 years), and nine patients were dead of disease (range, 2 months-9 years). Six patients had subsequent diagnoses of tumor in the contralateral breast. Analysis shows that PLC tends to appear in older postmenopausal women who present with locally advanced disease. PLCIS was found to be associated with PLC 45% of the time. The aggressive clinical course of patients with PLC is supported by tumor immunoreactivity with unfavorable markers Her 2 and p53. Overexpression of Her 2 in PLC may be therapeutically relevant, enabling the use of novel chemotherapeutic drugs like Herceptin. Interestingly, tumors that were Her 2 immunoreactive also maintained estrogen hormone immunoreactivity.

FISH studies in 45 patients with Rubinstein-Taybi syndrome: deletions associated with polysplenia, hypoplastic left heart and death in infancy

Rubinstein-Taybi syndrome (RTS) is a dominant Mendelian disorder characterised by mental retardation, a typical facies, broad thumbs and short stature. Previous reports indicated that 4-25% of RTS patients have a submicroscopic 16p13.3 deletion of the CBP gene. Using FISH and cosmid probes RT100, RT191 and RT203 we studied 45 RTS patients from Germany, the Czech Republic, Austria and Turkey and found four deletions (8.9%, pooled data including other studies: 11%). All deletions were interstitial; three spanned the CBP gene (RT100-RT203) and one was smaller (RT100 only). Previous studies reported no phenotype-genotype correlation between RTS patients with or without a deletion. Our findings suggest a more severe phenotype. The mean age at presentation was 0.96 years in patients with a deletion as against 11.12 years in those without. Patients A and B with a deletion died in infancy which is rare in RTS and was not observed among the other patients. Patients A and D had accessory spleens, Patient A with hypoplastic left heart, abnormal pulmonary lobulation and renal agenesis. This is the second report of hypoplastic left heart and the first report of polysplenia with RTS. The signs suggest a developmental field defect (disturbance of laterality) either as a newly recognised pattern of RTS, or alternatively a novel contiguous gene syndrome.

Frequency of CFTR gene mutations in males participating in an ICSI programme

A higher prevalence of cystic fibrosis transmembrane regulator (CFTR) gene mutations has been suggested both in men affected by congenital aplasia of the vas deferens, and in individuals presenting with reduced sperm quality. In this case, an increased risk for offspring being affected by cystic fibrosis (CF) can be expected in couples who are planning to undergo intracytoplasmic sperm injection (ICSI), since most of the male partners suffer from infertility. In order to determine the risk for these couples more precisely, we offered them a test for the most frequent CF mutations prevalent in the German population. The frequency of mutations within the CFTR gene in the female group was in the same range as expected for the general population (six out of 150). In 10 out of 207 males tested, infertility could be explained by exogenous factors not related to CFTR. Among the remaining 197 males with idiopathic infertility, we detected 13 heterozygotes for a mutation within the CFTR gene. This slightly, but significantly (P = 0.014), elevated rate could indicate that infertile males have, compared with the general population, an increased risk of being a carrier of a CFTR gene mutation.

Mosaic tetrasomy 9p in a girl with multiple congenital anomalies: cytogenetic and molecular-cytogenetic studies

We report on a 16-year-old girl with tetrasomy 9p mosaicism. Clinical investigations disclosed a malformation syndrome with craniofacial abnormalities, dysplasia of the right clavicle, short neck with cervical ribs, patella dislocation, Dandy-Walker malformation, mental retardation and blindness. Karyotype analysis of blood lymphocytes indicated an additional marker in the size of a C-group chromosome with a large heterochromatic block in 88% of the investigated metaphases. The origin and structure of this additional marker could not be determined by chromosome banding. Application of fluorescence in situ hybridisation and comparative genomic hybridisation identified the origin of the marker chromosome, demonstrating the effectiveness of molecular-cytogenetic investigations in the diagnosis of structural and numerical chromosome abnormalities.