D-Transposition of the great arteries with restrictive foramen ovale in the fetus: the dilemma of predicting the need for postnatal urgent balloon atrial septostomy

OBJECTIVE

Restrictive foramen ovale (FO) in dextro-transposition of the great arteries (d-TGA) with intact ventricular septum may lead to severe life-threatening hypoxia within the first hours of life, making urgent balloon atrial septostomy (BAS) inevitable. Reliable prenatal prediction of restrictive FO is crucial in these cases. However, current prenatal echocardiographic markers show low predictive value, and prenatal prediction often fails with fatal consequences for a subset of newborns. In this study, we described our experience and aimed to identify reliable predictive markers for BAS.

METHODS

We included 45 fetuses with isolated d-TGA that were diagnosed and delivered between 2010 and 2022 in two large German tertiary referral centers. Inclusion criteria were the availability of former prenatal ultrasound reports, of stored echocardiographic videos and still images, which had to be obtained within the last 14 days prior to delivery and that were of sufficient quality for retrospective re-analysis. Cardiac parameters were retrospectively assessed and their predictive value was evaluated.

RESULTS

Among the 45 included fetuses with d-TGA, 22 neonates had restrictive FO postnatally and required urgent BAS within the first 24 h of life. In contrast, 23 neonates had normal FO anatomy, but 4 of them unexpectedly showed inadequate interatrial mixing despite their normal FO anatomy, rapidly developed hypoxia and also required urgent BAS ('bad mixer'). Overall, 26 (58%) neonates required urgent BAS, whereas 19 (42%) achieved good O2 saturation and did not undergo urgent BAS. In the former prenatal ultrasound reports, restrictive FO with subsequent urgent BAS was correctly predicted in 11 of 22 cases (50% sensitivity), whereas a normal FO anatomy was correctly predicted in 19 of 23 cases (83% specificity). After current re-analysis of the stored videos and images, we identified three highly significant markers for restrictive FO: a FO diameter < 7 mm (p < 0.01), a fixed (p = 0.035) and a hypermobile (p = 0.014) FO flap. The maximum systolic flow velocities in the pulmonary veins were also significantly increased in restrictive FO (p = 0.021), but no cut-off value to reliably predict restrictive FO could be identified. If the above markers are applied, all 22 cases with restrictive FO and all 23 cases with normal FO anatomy could correctly be predicted (100% positive predictive value). Correct prediction of urgent BAS also succeeded in all 22 cases with restrictive FO (100% PPV), but naturally failed in 4 of the 23 cases with correctly predicted normal FO ('bad mixer') (82.6% negative predictive value).

CONCLUSION

Precise assessment of FO size and FO flap motility allows a reliable prenatal prediction of both restrictive and normal FO anatomy postnatally. Prediction of likelihood of urgent BAS also succeeds reliably in all fetuses with restrictive FO, but identification of the small subset of fetuses that also requires urgent BAS despite their normal FO anatomy fails, because the ability of sufficient postnatal interatrial mixing cannot be predicted prenatally. Therefore, all fetuses with prenatally diagnosed d-TGA should always be delivered in a tertiary center with cardiac catheter stand-by, allowing BAS within the first 24 h after birth, regardless of their predicted FO anatomy.

[Multilocular hepatic masses due to Enterobius vermicularis]

Infestation with Enterobius vermicularis involving extraintestinal manifestation is rare. In a 50-year-old man with lower abdominal pain, computed tomography led to a suspected diagnosis of sigmoid carcinoma with liver metastasis. After ruling out colon cancer by endoscopy, laparoscopic resection of one suspected tumor nodule in the liver was performed. Histopathological examination revealed parasitic granulomas containing pinworms. Hematogenous migration was postulated in the setting of phlebitis with thrombosis of the inferior mesenteric vein.

Whole-body [18F]-FDG-PET/MRI for staging of pediatric non-Hodgkin lymphoma: first results from a single-center evaluation

Aim

In 2015, the revised International Pediatric Non-Hodgkin Lymphoma Staging System was published. It mentions [¹⁸F]-FDG-PET/MRI as the latest method to perform whole-body imaging. However, supporting data are pending. Our aim was to investigate the performance of whole-body [¹⁸F]-FDG-PET/MRI in pediatric non-Hodgkin lymphoma patients by using a limited number of MRI sequences.

Materials and methods

Ten pediatric patients with histologically proven non-Hodgkin lymphoma underwent whole-body [¹⁸F]-FDG-PET/MRI at staging. The retrospective analysis included three steps: First, [¹⁸F]-FDG-PET and MR scans were evaluated separately by a nuclear medicine physician and a pediatric radiologist. Nineteen nodal and two extranodal regions as well as six organs were checked for involvement. Second, discrepant findings were reviewed together in order to reach consensus. Third, [¹⁸F]-FDG-PET/MRI findings were correlated with the results of other clinical investigations.

Results

Of the 190 lymph node regions evaluated, four were rated controversial. Consensus was reached by considering metabolic, functional and morphologic information combined. Concordantly, [¹⁸F]-FDG-PET and MRI detected Waldeyer’s ring involvement in two patients whose Waldeyer’s ring was negative on clinical assessment. In four patients MRI showed pleural effusion. However, in only two of them an increased glucose metabolism as a reliable sign of pleural involvement was detectable. In six patients [¹⁸F]-FDG-PET and MRI detected skeletal lesions although bone marrow biopsy was positive in only one of them.

Conclusion

Despite the small number of cases evaluated, whole-body [¹⁸F]-FDG-PET turned out to be a valuable tool for staging of pediatric non-Hodgkin lymphoma.

[Antibiotic stewardship (ABS). Part 1: Basics]

Against the background of increasing antimicrobial resistance, antibiotic stewardship (ABS) is an important measure to counteract the spread of resistant pathogens and multidrug resistance. For Germany and Austria, a comprehensive S3 guideline is available, which was last updated in 2018. The control of antibiotic or anti-infective use in hospitals should be guided by specialized ABS teams. At the hospital level, ABS also includes a structured ongoing analysis of local antibiotic use and resistance data. Recommendations for locally adapted therapy regimens should be derived and implemented from this data analysis. ABS consists of regular ward rounds ("ABS visits"), during which members of the ABS team review the indication, dosage, route of administration and duration of antimicrobial therapy at the bedside. Here, the key challenge is to save antibiotics without compromising the individual patient. Digitalization and artificial intelligence offer new options for ABS, while the adaption of inpatient concepts to outpatient care is also important.

[Antibiotic stewardship (ABS). Part 2: Application]

Antibiotic stewardship (ABS) is an important measure to counteract the spread of resistant pathogens and multidrug resistance. The most important ABS tools include the implementation of local guidelines, the development of a house-related list of anti-infective agents, regular ABS visits and practice-oriented internal training events. Effective strategies for therapy optimization include indication testing and therapy evaluation, dose optimization as well as determining an appropriate duration of therapy. Oralization of anti-infectives (sequence therapy) should be supported by consistent clinical criteria in in-house guidelines. The incidence of Clostridioides difficile infections (CDI) can be more than halved by restricting the so-called "4C antibiotics". Point-of-care tests help to minimize the use of antibiotics in the outpatient setting. Vaccination reduces the need for antibiotic therapy.

Step edge structures on the anatase TiO2 (001) surface studied by atomic-resolution TEM and STM

Atomic arrangements in oxide surfaces can be uncovered by combining side view imaging using transmission electron microscopy and top view imaging using scanning tunnelling microscopy.

Role of steps in the dissociative adsorption of water on rutile TiO2(110)

The water-TiO(2) interaction is of paramount importance for many processes occurring on TiO(2), and the rutile TiO(2)(110)-(1×1) surface has often been considered as a test case. Yet, no consensus has been reached whether the well-studied surface O vacancies on the terraces are the only active sites for water dissociation on rutile TiO(2)(110)-(1 × 1), or whether another channel for the creation of H adatoms exists. Here we use high-resolution scanning tunneling microscopy and density functional theory calculations to tackle this long-standing question. Evidence is presented that a second water dissociation channel exists on the surfaces of vacuum-annealed TiO(2)(110) crystals that is associated with the ⟨111⟩ step edges. This second water dissociation channel can be suppressed by blocking of the ⟨111⟩ step edges using ethanol.

Reduced step edges on rutile TiO2(110) as competing defects to oxygen vacancies on the terraces and reactive sites for ethanol dissociation

The rutile TiO2(110) surface is the most studied surface of titania and considered as a prototype of transition metal oxide surfaces. Reactions on flat TiO2(110)-(1×1) surfaces are well studied, but the processes occurring on the step edges have barely been considered. Based on scanning tunneling microscopy studies, we here present experimental evidence for the existence of O vacancies along the [11¯1](R) step edges (O(S) vac.'s) on rutile TiO(2)(110). Both the distribution of bridging O vacancies on the terraces and temperature-programed reaction experiments of ethanol-covered TiO(2)(110) point to the existence of the O(S) vac.'s. Based on experiments and density functional theory calculations, we show that O(S) vac.'s are reactive sites for ethanol dissociation via O-H bond scission. Implications of these findings are discussed.

Packing defects into ordered structures: strands on TiO2

We have studied vicinal TiO2(110) surfaces by high-resolution scanning tunneling microscopy and density functional theory calculations. On TiO2 surfaces characterized by a high density of <111> steps, scanning tunneling microscopy reveals a high density of oxygen-deficient strandlike adstructures. With the help of density functional theory calculations we develop a complete structural model for the entire strand and demonstrate these adstructures to be more stable than an equivalent amount of bulk defects such as Ti interstitials. We argue that strands can form particularly easy on stepped surfaces because building material is available at step sites. The strands on TiO2(110) represent point defects that are densely packed into ordered adstructures.

[Percutaneous tracheostomy with use of a laryngeal mask]

The percutaneous tracheostomy is a conventional procedure in patients undergoing long term ventilation on ICU. It both facilitates weaning and reduces the ventilation and tracheal tube associated risks.Usually the tracheostomy is accomplished via the tracheal tube. The alternative implies extubation and reinsertion of a laryngeal mask. This method itself affords a better overview for the bronchoscoping person accompanied by a lower risk for cuff or bronchoscope lesions. An accidental extubation as well as an injuring of the vocal cords (because of the inflated cuff during accidental extubation) appears impossible in this method.This paper gives a general survey on indication, contraindication, advantages and disadvantages of the percutaneous tracheostomy via laryngeal mask. We also described the procedure itself, step by step.

Direct evidence for ethanol dissociation on rutile TiO2(110)

We have studied the interaction of ethanol with reduced TiO(2)(110)-(1 × 1) by high-resolution scanning tunneling microscopy (STM) measurements and density functional theory calculations. The STM data revealed direct evidence for the coexistence of molecularly and dissociatively adsorbed ethanol species on surface Ti sites. In addition, we found evidence for dissociation of ethanol at bridge-bonded O vacancies. The density functional theory calculations support these findings and rationalize the distinct diffusion behaviors of molecularly and dissociatively adsorbed ethanol species, as revealed in time-lapsed STM images.

Formation and diffusion of water dimers on rutile TiO2(110)

From an interplay of time-lapsed high resolution scanning tunneling microscopy and density functional theory calculations we reveal the formation and diffusion of water dimers on hydrated rutile TiO2(110)-(1x1) surfaces, i.e., surfaces containing OH_{br} groups. At temperatures between approximately 150 and approximately 210 K water monomers diffusing along the Ti troughs were found to form stable water dimers that diffuse faster than the water monomers. An H bond mediated rollover mechanism operating for the water dimers explains the experimental findings.

Enhanced Bonding of Gold Nanoparticles on Oxidized TiO2(110)

We studied the nucleation of gold clusters on TiO2(110) surfaces in three different oxidation states by high-resolution scanning tunneling microscopy. The three TiO2(110) supports chosen were (i) reduced (having bridging oxygen vacancies), (ii) hydrated (having bridging hydroxyl groups), and (iii) oxidized (having oxygen adatoms). At room temperature, gold nanoclusters nucleate homogeneously on the terraces of the reduced and oxidized supports, whereas on the hydrated TiO2(110) surface, clusters form preferentially at the step edges. From interplay with density functional theory calculations, we identified two different gold-TiO2(110) adhesion mechanisms for the reduced and oxidized supports. The adhesion of gold clusters is strongest on the oxidized support, and the implications of this finding for catalytic applications are discussed.

Enzyme replacement therapy with agalsidase alfa in children with Fabry disease

AIM

To assess the effects of enzyme replacement therapy (ERT) in children with Fabry disease.

METHODS

Safety and efficacy of ERT with agalsidase alfa, 0.2 mg/kg infused over 40 minutes every 2 weeks for 23 weeks, were studied in a multicentre open-label trial in nine boys and four girls. Median age at the start of the study was 11.0 years (range 3.5-18 years).

RESULTS

Fifty-four adverse events were reported in 11 patients. No serious adverse events related to ERT were reported. Twelve of the 54 adverse events were considered possibly or probably related to ERT. Infusion reactions (8 mild, 3 moderate) occurred in four boys, in seven infusions. One boy developed IgG antibodies, although he continued to make good clinical progress. At the end of the study, two of the four boys and the one girl on regular pain medication at baseline had stopped taking analgesics. Brief Pain Inventory (BPI) scores decreased in most patients by week 12 and were sustained until the end of the study. This change was greater in the boys, who had higher (worse) BPI scores at baseline. Pain-related quality of life (QoL) scores also decreased during the study. Plasma globotriaosylceramide concentrations and urinary globotriaosylceramide:sphingomyelin ratios decreased after 12 and 23 weeks of therapy, particularly in the boys. Increases in sweat volume were recorded in three out of five of the boys and in one of two girls tested after 23 weeks of treatment.

CONCLUSION

ERT with agalsidase alfa in children with Fabry disease is well tolerated and, in the short term, appears to decrease pain and to improve pain-related QoL.

Formation and splitting of paired hydroxyl groups on reduced TiO2(110)

A combination of high-resolution scanning tunneling microscopy and density functional theory is utilized to study the interaction of water with the reduced TiO2(110)-(1 x 1) surface. As the direct product of water dissociation in oxygen vacancies, paired hydroxyl groups are formed. These pairs are immobile and stable unless they interact with adsorbed water molecules. As a result of these interactions, protons are transferred to adjacent oxygen rows, thereby forming single hydroxyl groups. Additionally, we show that hydroxyl groups facilitate the diffusion of water molecules over the oxygen rows.

Susceptibility of different eukaryotic cell lines to SARS-coronavirus

In order to define and characterize target cells of SARS-coronavirus (SARS-CoV) we studied the susceptibility of 23 different permanent and primary eukaryotic cell lines to SARS-coronavirus. Beneath Vero E6 cells SARS- Coronavirus infection could also be demonstrated in two pig cell lines (POEK, PS) and one human cell line (Huh-7) using the indirect immunofluorescence assay and a newly established quantitative real-time PCR. In all susceptible cell lines mRNA of the Angiotensin-converting enzyme 2 (ACE2), the functional receptor for SARS-CoV infection, could be detected by RT-PCR. Our results show that there is a correlation between the abundance of ACE2 mRNA and SARS-CoV susceptibility.

Successful pregnancy outcome in a patient with Fabry disease receiving enzyme replacement therapy with agalsidase alfa

Fabry disease is an inherited lysosomal storage disease caused by deficiency of alpha-galactosidase A. Enzyme replacement therapy for this multisystem progressive disease has been available only since 2001. We here report the first known successful pregnancy of a female patient receiving such therapy.

The influence of stocking rate on transmission of helminth parasites in pigs on permanent pasture during two consecutive summers

This study was made to elucidate the transmission of nematode infections in outdoor pigs at different stocking rates during two consecutive seasons. Five pigs (Group 1A) inoculated with low doses of Oesophagostomum dentatum, Ascaris suum, and Trichuris suis and five helminth-naïve pigs (Group 1B) were turned out together in June 1996 on each of four pastures at stocking rates of 100, 240 (two pastures) and 576m(2) per pig, respectively. The pigs were slaughtered in early October, and pasture infectivity was subsequently measured using helminth-naïve tracer pigs (Tracer). In 1997, 10 helminth-naïve pigs were turned out on each pasture in May (Group 2) and again in August (Group 3), and allowed to graze for 12 weeks. The percentage of grass cover was reduced considerably at the high stocking rate in comparison to the other stocking rates. Transmission of all three helminths was observed on all pastures. In 1996, the O. dentatum faecal egg counts and worm burdens were significantly higher in pigs at the high stocking rate compared to pigs at the other stocking rates. O. dentatum did not survive the winter and pigs of Group 2 were inoculated with 3000 larvae each to reintroduce this parasite. Ascaris suum ELISA values and worm counts were highest at the high stocking rate in 1997 (Group 3). Transmission of T. suis was not significantly influenced by stocking rate. The results indicate that transmission of O. dentatum, and to some extent A. suum is influenced by stocking rate. However, both A. suum and T. suis eggs are still expected to constitute a high risk of infection on intensively used pastures where eggs may accumulate for years. The relationship between host density and helminth transmission seems more complex for grazing/rooting pigs than for grazing ruminants. This may be due to the differences in behaviour of the animals and the resulting differences in microclimate of the developing eggs/larvae.

Facilitation of artificial retinal detachment for macular translocation surgery tested in rabbit

PURPOSE

For macular translocation surgery, the native attached retina has to be detached either locally or completely. Although different surgical techniques are used, there is a general search for supporting procedures that facilitate and accelerate the retinal detachment.

METHODS

Pars plana vitrectomies were performed in pigmented rabbits. In all experimental groups, a local retinal detachment was created by infusing the test solution with a thin glass micropipette attached to a glass syringe. In control animals a standard balanced salt solution was used at room temperature, in combination with a standard vitrectomy light source. In two test groups, a calcium- and magnesium-free solution was used for the vitrectomy, under illumination by a standard light source in group I (solution at room temperature) and group II (solution heated up to body temperature). In group III the rabbits were dark-adapted for half an hour, and then, during surgery, a red filter was used in front of the light source (standard balanced salt solution at room temperature). After the rabbits were killed at the end of surgery, the adherence of the retinal pigment epithelium (RPE) to the neural retina in the detachment area was quantified microscopically, and the morphologic integrity of the detached retinal tissue was examined by light and electron microscopy. No electrophysiology was performed.

RESULTS

In all four groups, it was possible to detach the retina. The maximum adherence of the RPE cells to the neural retina was observed in the control group. Virtually no decrease in adherence was found in test group II (36 degrees C solution without calcium and magnesium), whereas a significant decrease was seen in both group I (calcium- and magnesium-free solution at room temperature) and group III (dark adaptation-red light technique; standard balanced salt solution at room temperature). In none of the experimental groups was any obvious damage of the retinal structure observed, even after exposure to the test solutions for 60 minutes.

CONCLUSIONS

Both dark adaptation (red illumination) and the use of a calcium chloride- and magnesium chloride-free solution (at room temperature) can facilitate retinal detachment in macular translocation surgery. Both techniques are proposed as a gentle support for the operation, because they protect an intact RPE cell layer and do not cause retinal damage at the ultrastructural level.

Retinal pigment epithelium melanin granules are phagocytozed by Müller glial cells in experimental retinal detachment

The ability of retinal Müller glial cells to perform phagocytosis in vivo is studied in a rabbit model of experimental retinal detachment where pigment epithelial cells are occasionally detached together with the neural retina. While macrophages and/or microglial cells phagocytoze most of the cellular debris at the sclerad surface of the detached retinae, some Müller cells accumulate melanin granules. The granules are virtually intact at the ultrastructural level, and are surrounded by a membrane. They are often located close to the sclerad end of the cells, but some are distributed throughout the outer stem process up to the soma. It is concluded that rabbit Müller cells in vivo are capable of phagocytosis and of transporting the phagocytozed material within their cytoplasm.

Neustrukturierung des Sonderarbeitsmarkts für Menschen mit Behinderung durch die Reform des Reha-Rechts - Folgen für die Werkstatt für Behinderte

The legal basis for employment of people with disabilities in sheltered Workshops for the Disabled (Werkstätten für Behinderte, WfB) had hitherto been shaped by the 1961 Federal Social Assistance Act, the 1969 Employment Promotion Act, the 1974 Severely Disabled Persons Act with the related Workshop Ordinances of 1980 and 1996. The Act on Combating Unemployment of Severely Disabled Persons, effective as of Oct. 1, 2000 has now created a new legal foundation, which also is aimed at enhancing Workshop employees' horizontal mobility into the general job market, inter alia providing for access to Supported Employment arrangements and for availability of selective placement and support services (Integrationsfachdienste, IFD) throughout Germany. These Services also are intended as points of contact in the counselling of severely disabled school leavers in relation to placement opportunities in competitive jobs and/or integration projects or firms. Discussed from a legal perspective are the differences in sociolegal respects between such projects for severely disabled persons and employment in Workshops for the Disabled, as well as implications for the Workshops' own economic activity, also making reference to the forthcoming Book 9 of the Social Code.

Mitochondrial creatine kinase in contact sites: interaction with porin and adenine nucleotide translocase, role in permeability transition and sensitivity to oxidative damage

The creatine/phosphocreatine circuit provides an efficient energy buffering and transport system in a variety of cells with high and fluctuating energy requirements. It connects sites of energy production (mitochondria, glycolysis) with sites of energy consumption (various cellular ATPases). The cellular creatine/phosphocreatine pool is linked to the ATP/ADP pool by the action of different isoforms of creatine kinase located at distinct subcellular compartments. Octameric mitochondrial creatine kinase (MtCK), together with porin and adenine nucleotide translocase, forms a microcompartment at contact sites between inner and outer mitochondrial membranes and facilitates the production and export into the cytosol of phosphocreatine. MtCK is probably in direct protein-protein contact with outer membrane porin, whereas interaction with inner membrane adenine nucleotide translocase is rather mediated by acidic phopholipids (like cardiolipin) present in significant amounts in the inner membrane. Octamer-dimer transitions of MtCK as well as different creatine kinase substrates have a profound influence on controlling mitochondrial permeability transition (MPT). Inactivation by reactive oxygen species of MtCK and destabilization of its octameric structure are factors that contribute to impairment of energy homeostasis and facilitated opening of the MPT pore, which eventually lead to tissue damage during periods of ischemia/reperfusion.

Atomic-scale structure and catalytic reactivity of the RuO(2)(110) surface

The structure of RuO(2)(110) and the mechanism for catalytic carbon monoxide oxidation on this surface were studied by low-energy electron diffraction, scanning tunneling microscopy, and density-functional calculations. The RuO(2)(110) surface exposes bridging oxygen atoms and ruthenium atoms not capped by oxygen. The latter act as coordinatively unsaturated sites-a hypothesis introduced long ago to account for the catalytic activity of oxide surfaces-onto which carbon monoxide can chemisorb and from where it can react with neighboring lattice-oxygen to carbon dioxide. Under steady-state conditions, the consumed lattice-oxygen is continuously restored by oxygen uptake from the gas phase. The results provide atomic-scale verification of a general mechanism originally proposed by Mars and van Krevelen in 1954 and are likely to be of general relevance for the mechanism of catalytic reactions at oxide surfaces.

Nose-rings and transmission of helminth parasites in outdoor pigs

Five growing pigs experimentally infected with low doses of Oesophagostomum dentatum, Ascaris suum, and Trichuris suis were turned out with 5 helminth-naïve pigs on each of 3 pastures in June 1996 (Group 1). On one pasture all pigs received nose-rings. After slaughter of Group 1 in October, pasture infectivity was monitored using helminth-naïve, unringed tracer pigs. In 1997, helminth-naïve young pigs were turned out on the contaminated pastures in May (Group 2) and again in August (Group 3). Again all pigs on one pasture received nose-rings. All pigs and pastures were followed parasitologically and reduction in grass cover was monitored. Based on the acquisition of infection by the naïve pigs in Group 1, the estimated minimal embryonation times for eggs deposited on pasture were 23-25 days for O. dentatum, 5-6 weeks for A. suum and 9-10 weeks for T. suis. Results from tracer pigs and grass/soil samples indicated that pasture infectivity was light both years. Free-living stages of O. dentatum did not survive the winter. The nose-rings reduced rooting considerably, resulting in three-fold more grass cover on the nose-ring pasture compared to the control pastures by the end of the experiment. Nevertheless, the nose-rings did not significantly influence parasite transmission.

Free radical-induced inactivation of creatine kinase: influence on the octameric and dimeric states of the mitochondrial enzyme (Mib-CK)

Free radicals of X-ray-induced water radiolysis, either directly or indirectly via their reaction products, reduce the activity of both dimeric cytoplasmic muscle-type creatine kinase (MM-CK) and octameric mitochondrial creatine kinase (Mi-CK) to virtually zero. Similarly values of the characteristic D(37)-dose of enzyme inactivation (dose required to reduce enzyme activity to 37%) were found for the two isoenzymes of CK under identical conditions. Octamer stability was not significantly affected within the dose range considered. However, both the dissociation of octamers into dimers by a transition-state analogue complex (TSAC), and the reassociation of the dimers into octamers, showed dose-dependent reduction. Binding of the TSAC to the active centre was found to protect the enzyme against inactivation by free radicals. No protection was observed for the radiation-induced decrease of the endogenous tryptophan fluorescence. The experimental results are in line with the following interpretation: (i) the reduction of Mi(b)-CK dimer association is due to free radical-induced modification of Trp-264, situated at the dimer/dimer interface; (ii) the active-site Trp-223 is not a prime target for free radicals and is not involved in the inactivation of the enzyme; (iii) the inhibition of TSAC-induced dissociation of Mi(b)-CK, like enzyme inactivation, is primarily due to a modification of the active-site Cys-278.