Household dishwashing detergents efficiently inactivate HSV-1, but not the non-enveloped viruses HAV and MNV, while all viruses were removed from glass by manual scrubbing

This study investigated the stability of herpes simplex virus 1 (HSV-1), hepatitis A virus (HAV) and murine norovirus (MNV) on glass, their inactivation by three household dishwashing detergents and during a glass rinsing process. After drying on glass and storage in darkness, virus titers decreased by 4.7, 5.5 and 4.5 log10 plaque forming units (PFU) in 21, 28 and 14 days for HSV-1, HAV and MNV, respectively. Daylight storage resulted in shorter survival times. While HAV and MNV titers were not significantly affected by 60 s incubation in dishwashing detergents at up to 43 °C, HSV-1 titer decreased significantly by > 4 log10 PFU/mL at the same conditions with each detergent used. After cleaning artificially contaminated drinking glasses with a manual glass scrubbing device, HSV-1, HAV and MNV titers decreased significantly by 4.4 ± 0.1 to 5.3 ± 0.0 log10 PFU. Our study shows, that all tested viruses can remain infectious after drying on glass up to several weeks. Household dishwashing detergents efficiently inactivate the enveloped virus HSV-1, but not the non-enveloped viruses HAV and MNV. The applied manual glass rinsing procedure efficiently removed all three viruses from drinking glasses, probably due to the combination of chemical and mechanical treatments.

Environmental factors associated with the prevalence of ESBL/AmpC-producing Escherichia coli in wild boar (Sus scrofa)

Antimicrobial resistances (AMR) in bacteria, such as ESBL/AmpC-producing E. coli, are a burden to human and animal health. This burden is mainly driven by the consumption and release of antimicrobial substances into the environment. The pollution and contamination of habitats by AMR in bacteria and antimicrobial substances can lead to the transmission of bacterial AMR to wildlife. Therefore, it is necessary to understand the transmission cycle of antibiotics and resistant bacteria between humans, and animals as well as their occurrences in the environment. Environmental factors associated with the occurrence of bacterial AMR in wildlife can lead to a better understanding of the distribution of bacterial AMR in humans and animals using One Health approaches. Here, we analyzed data gathered in the framework of the German zoonoses monitoring program in 2016 and 2020 using spatiotemporal statistics to identify relevant environmental factors (e.g., livestock density, climatic variables, and human density) in association with the spatial distribution of ESBL/AmpC-producing E. coli. For this purpose, we developed a generic data integration and analysis pipeline to link spatially explicit environmental factors to the monitoring data. Finally, we built a binomial generalized linear mixed model (GLMM) to determine the factors associated with the spatial distribution of ESBL/AmpC-producing E. coli. In 2016 and 2020, 807 fecal samples from hunted wild boar (Sus scrofa L.) were randomly taken in 13 federal states and selectively analyzed for ESBL/AmpC-producing E. coli. Forty-eight isolates were identified in 12 German federal states, with an overall prevalence of 6%. We observed an almost three times higher probability of ESBL/AmpC-producing E. coli isolates in wild boar in counties with high cattle densities (OR = 2.57, p ≤ 0.01). Furthermore, we identified a seasonal effect in areas with high precipitation during the off-hunting seasons (OR = 2.78, p = 0.025) and low precipitation throughout the years (OR = 0.42, p = 0.025). However, due to the low amount of identified isolates, confidence intervals were wide, indicating a high level of uncertainty. This suggests that further studies on smaller scales need to be conducted with multiannual data and improved metadata, e.g., on the location, the hunting procedure, and species characteristics to be collected during field sampling.

One Health Consensus Report Annotation Checklist (OH-CRAC): A cross-sector checklist to support harmonized annotation of surveillance data in reports

To facilitate cross-sector integration of surveillance data it is necessary to improve and harmonize the meta-information provided in surveillance data reports. Cross-sector integration of surveillance results in sector-specific reports is frequently difficult as reports with a focus on a single sector often lack aspects of the relevant meta-information necessary to clarify the surveillance context. Such reporting deficiencies reduce the value of surveillance reports to the One Health community. The One Health Consensus Report Annotation Checklist (OH-CRAC), described in this paper along with potential application scenarios, was developed to improve the current practice of annotating data presented in surveillance data reports. It aims to provide guidance to researchers and reporting officers on what meta-information should be collected and provided to improve the completeness and transparency of surveillance data reports. The OH-CRAC can be adopted by all One Health-related sectors and due to its cross-sector design, it supports the mutual mapping of surveillance meta-information from sector-specific surveillance reports on federal, national and international levels. To facilitate the checklist completion, OH-CRAC is also available as an online resource that allows the collection of surveillance meta-information in an easy and user-friendly manner. Completed OH-CRAC checklists can be attached as annexes to the corresponding surveillance data reports or even to individual data files regardless of the data source. In this way, reports and data become better interpretable, usable and comparable to information from other sectors, improving their value for all surveillance actors and providing a better foundation for advice to risk managers.

Stability of Hepatitis E Virus After Drying on Different Surfaces

The hepatitis E virus (HEV) causes acute and chronic hepatitis in humans. The zoonotic HEV genotype 3 is mainly transmitted by consumption of contaminated food produced from infected animals. However, transmission via contaminated surfaces has also to be considered. Here, the genotype 3c strain 47832c was dried on steel, wood, plastics and ceramics, stored at 23 °C or 3 °C for up to 8 weeks and remaining infectivity was titrated on cell culture. During the drying process, only a mean 0.2 log₁₀ decrease of HEV infectivity was observed. At 23 °C, remaining infectious virus was detected until week 4 on most surfaces, but HEV was completely inactivated (> 4 log₁₀ decrease) after 8 weeks. At 3 °C, HEV was detectable up to 8 weeks on most surfaces, with an average 2.3 log₁₀ decrease. HEV showed the highest stability on plastics, which was lower on ceramics and steel, and lowest on wood. The addition of bovine serum albumin mimicking high protein load had only a slight stabilizing effect. In conclusion, HEV shows a high stability against drying and subsequent storage on different surfaces. Strict application of hygienic measures during food production is therefore crucial in order to prevent HEV persistence on surfaces and subsequent cross-contamination.

A one health glossary to support communication and information exchange between the human health, animal health and food safety sectors

Collaboration across sectors, disciplines and countries is a key concept to achieve the overarching One Health (OH) objective for better human, animal and environmental health. Differences in terminology and interpretation of terms are still a significant hurdle for cross-sectoral information exchange and collaboration within the area of OH including One Health Surveillance (OHS). The development of the here described glossary is a collaborative effort of three projects funded within the One Health European Joint Programme (OHEJP). We describe the infrastructure of the OHEJP Glossary, as well as the methodology to create such a cross-sectoral web resource in a collaborative manner. The new OHEJP Glossary allows OH actors to identify terms with different or shared interpretation across sectors. Being aware of such differences in terminology will help overcome communication hurdles in the future and consequently support collaboration and a more inclusive development of OHS. The OHEJP Glossary was implemented as a web-based, user-friendly and searchable infrastructure that complies with the Findable, Accessible, Interoperable, Reusable (FAIR) data principles. Maintenance, enrichment and quality control of the OHEJP Glossary is supported through a flexible and updatable curation infrastructure. This increases the uptake potential and exploitation of the OHEJP Glossary by other OH initiatives or tools and services.

The Glossaryfication Web Service: an automated glossary creation tool to support the One Health community

In many interdisciplinary research domains, the creation of a shared understanding of relevant terms is considered the foundation for efficient cross-sector communication and interpretation of data and information. This is also true for the domain of One Health (OH) where many One Health Surveillance (OHS) documents rarely contain glossaries with a list of terms for which their specific meaning in the context of the given document is defined (Cornelia et al. 2018, Buschhardt et al. 2021). The absence of glossaries within these documents may lead to misinterpretation of surveillance results due to the wrong interpretation of terminology specifically when term definitions differ across OH sectors. Under the One Health EJP project ORION, the OHEJP Glossary was recently created. The OHEJP Glossary is a tool to improve communication and collaboration amongst OH sectors by providing an easy-to-use online resource that lists relevant OH terms and sector-specific definitions. To improve the accessibility of content from the OHEJP Glossary and support the creation of integrative glossaries in future OHS-related documents, the OHEJP Glossaryfication Web Service was created. This service can support the practical use of the OHEJP Glossary and other relevant online glossaries by OH professionals.

The Glossaryfication Web Service (GWS) is an application that automatically identifies terms in any uploaded text-based document and creates a document-specific list of matching definitions in selected online glossaries. This auto-generated document-specific glossary can easily be adjusted by the user, for example, by selecting the desired definition in case multiple definitions were found for a specific term. The document-specific glossary could then be downloaded, manually adjusted and finally included into the original document where it supports the correct interpretation of terminology used. Especially in sector-specific reports, such as from animal health or public health authorities, this can be beneficial to ensure the correct interpretation by other OH sectors in the future. The GWS was developed with the open-source desktop software KNIME Analytics Platform and runs as a web service on a KNIME Web Server infrastructure. The core data processing functionality in the GWS is based on KNIME’s Text Processing extension. KNIME's JavaScript nodes provided the basis for an interactive user interface where users can easily upload their files and select between different reference glossaries, such as the OHEJP Glossary, the CDC Glossary, the WHO Glossary or the EFSA Glossary. After retrieval of the user input settings, the GWS tags words within the provided document and maps these tagged words with matching entries in the selected glossaries. As the main output, the user receives a downloadable list of matching terms with their corresponding definitions, sectorial assignments and references, which can then be added by the user to the original document. The GWS is freely accessible via this link as well as the underlying KNIME workflow.

Effect of Sodium Chloride, Sodium Nitrite and Sodium Nitrate on the Infectivity of Hepatitis E Virus

Hepatitis E virus (HEV) infection can cause acute and chronic hepatitis in humans. The zoonotic HEV genotype 3, which is highly prevalent in Europe, is mainly transmitted by consumption of raw meat and raw meat products produced from infected pigs or wild boars. High salt concentrations represent an important measure to preserve meat products and to inactivate foodborne pathogens. Here, an HEV preparation in phosphate-buffered saline (PBS) was subjected to different salt concentrations and the remaining infectivity was measured in a cell culture assay. Treatments with up to 20% sodium chloride for 24 h at 23 °C, with and without addition of 0.015% sodium nitrite or 0.03% sodium nitrate, did not lead to virus inactivation as compared to PBS only. Conditions usually applied for short-term and long-term fermented raw sausages were simulated by incubation at 22 °C for up to 6 days and at 16 °C for up to 8 weeks, respectively. Only 2% sodium chloride with 0.015% sodium nitrite showed a weak (< 1 log₁₀), but significant, infectivity reduction after 2 and 4 days as compared to PBS only. Addition of 2% sodium chloride and 0.03% sodium nitrate showed a slight, but not significant, decrease in infectivity after 2 and 8 weeks as compared to PBS only. In conclusion, HEV is highly stable at high salt concentrations and at salt conditions usually applied to preserve raw meat products.

STEM: An Open Source Tool for Disease Modeling

The Spatiotemporal Epidemiologic Modeler (STEM) is an open source software project supported by the Eclipse Foundation and used by a global community of researchers and public health officials working to track and, when possible, control outbreaks of infectious disease in human and animal populations. STEM is not a model or a tool designed for a specific disease; it is a flexible, modular framework supporting exchange and integration of community models, reusable plug-in components, and denominator data, available to researchers worldwide at www.eclipse.org/stem. A review of multiple projects illustrates its capabilities. STEM has been used to study variations in transmission of seasonal influenza in Israel by strains; evaluate social distancing measures taken to curb the H1N1 epidemic in Mexico City; study measles outbreaks in part of London and inform local policy on immunization; and gain insights into H7N9 avian influenza transmission in China. A multistrain dengue fever model explored the roles of the mosquito vector, cross-strain immunity, and antibody response in the frequency of dengue outbreaks. STEM has also been used to study the impact of variations in climate on malaria incidence. During the Ebola epidemic, a weekly conference call supported the global modeling community; subsequent work modeled the impact of behavioral change and tested disease reintroduction via animal reservoirs. Work in Germany tracked salmonella in pork from farm to fork; and a recent doctoral dissertation used the air travel feature to compare the potential threats posed by weaponizing infectious diseases. Current projects include work in Great Britain to evaluate control strategies for parasitic disease in sheep, and in Germany and Hungary, to validate the model and inform policy decisions for African swine fever. STEM Version 4.0.0, released in early 2019, includes tools used in these projects and updates technical aspects of the framework to ease its use and re-use.

The Spatiotemporal Epidemiologic Modeler (STEM) is an open source software project supported by the Eclipse Foundation and used by a global community of researchers and public health officials working to track and, when possible, control outbreaks of infectious disease in human and animal populations. STEM is not a model or a tool designed for a specific disease; it is a flexible, modular framework supporting exchange and integration of community models, reusable plug‐in components, and denominator data, available to researchers worldwide.

Stability of hepatitis E virus at different pH values

Infection with the hepatitis E virus (HEV) can cause acute and chronic hepatitis in humans. The zoonotic HEV genotype 3 is mainly transmitted by consumption of raw and fermented meat products prepared from infected pigs or wild boars. Lowering of pH during fermentation is one of the microbiological hurdles considered to inhibit growth of certain pathogens. However, no data are currently available on pH stability of HEV. As a reliable and reproducible measurement of HEV infectivity in meat products is not established so far, the stability of the cell culture-adapted HEV genotype 3 strain 47832c was analyzed here in phosphate-buffered saline (PBS) at different pH values. Only a minimal decrease of infectivity (up to 0.6 log₁₀ focus forming units) was found after treatment at pH 2 to 9 for 3 h at room temperature. At pH 10, a decrease of about 3 log₁₀ was evident, whereas no remaining virus (>3.5 log₁₀ decrease) was detected at pH 1. The conditions usually achieved during curing of raw sausages were simulated using D/L-lactic acid added to PBS resulting in pH 4.5 to 6.5. After incubation at 4 °C for 7 days at these conditions, no significant differences as compared to a standard PBS solution at pH 7.7 were evident. At room temperature, a 0.8 log₁₀ decrease was found at pH 4.7 after 7 days incubation compared to pH 7.7, but less at the other pH values. In conclusion, only minimal inactivating effects were found at pH conditions commonly occurring during food processing. Therefore, remaining infectious virus might be present in fermented meat products if HEV-contaminated starting material was used. Additional effects of other factors like high salt concentrations and low a_w values should be investigated in future studies.

[Guideline conform diagnostics for dysphagia : A representative survey of speech therapists at certified stroke units in Germany]

BACKGROUND

Almost 260,000 people in Germany suffer from a stroke each year. As a consequence, for more than 60% this leads to dysphagia. In order to prevent secondary diseases, such as pneumonia, malnutrition and dehydration, a differentiated diagnosis by a multiprofessional team in a stroke unit is required. The guidelines in 2015 for diagnosing neurologic dysphagia by the German Society of Neurology recommend a detailed anamnesis, a standardized screening, a clinical swallowing examination and additional instrumental diagnostics.

OBJECTIVE

This study examined whether dysphagia is diagnosed by speech therapists at certified stroke units according to the recommended guidelines.

MATERIAL AND METHODS

An online questionnaire was compiled and sent to 1 speech therapist at each of the 195 certified stoke units and 112 participants responded to the questionnaire. The questionnaire consisted of questions about anamnesis, clinical swallowing diagnostics and the instrumental diagnostics. Of the speech therapists working on a stroke unit 57% participated in this study.

RESULTS

The results show that 50% of the participants elaborated a detailed and differentiated anamnesis, 64% used a standardized screening (Daniels test) and 66% implemented a guideline conform swallowing test. As technical instruments, 35% of the respondents used video fluoroscopy and 71% of the respondents a fiber endoscopy.

CONCLUSION

The implementation of a detailed and differentiated anamnesis, standardized screening, and a clinical swallowing examination with testing of different food consistencies suggests a high quality of the dysphagia diagnostics at stroke units in Germany. The increasing availability of technical instruments, especially fiber endoscopy, substantiates this view.

[Tricuspid valve regurgitation : Indications and operative techniques]

Functional tricuspid valve (TV) regurgitation secondary to left heart disease (e.g. mitral insufficiency and stenosis) is observed in 75% of the patients with TV regurgitation and is thus the most common etiology; therefore, the majority of patients who require TV surgery, undergo concomitant mitral and/or aortic valve surgery. Uncorrected moderate and severe TV regurgitation may persist or even worsen after mitral valve surgery, leading to progressive heart failure and death. Patients with moderate to severe TV regurgitation show a 3-year survival rate of 40%. Surgery is indicated in patients with severe TV regurgitation undergoing left-sided valve surgery and in patients with severe isolated primary regurgitation without severe right ventricular (RV) dysfunction. For patients requiring mitral valve surgery, tricuspid valve annuloplasty should be considered even in the absence of significant regurgitation, when severe annular dilatation (≥40 mm or >21 mm/m²) is present. Functional TV regurgitation is primarily treated with valve reconstruction which carries a lower perioperative risk than valve replacement. Valve replacement is rarely required. Tricuspid valve repair with ring annuloplasty is associated with better survival and a lower reoperation rate than suture annuloplasty. Long-term results are not available. The severity of the heart insufficiency and comorbidities (e.g. renal failure and liver dysfunction) are the essential determinants of operative mortality and long-term survival. Tricuspid valve reoperations are rarely necessary and associated with a considerable mortality.

Automatic control of the effluent turbidity from a chemically enhanced primary treatment with microsieving

For chemically enhanced primary treatment (CEPT) with microsieving, a feedback proportional integral controller combined with a feedforward compensator was used in large pilot scale to control effluent water turbidity to desired set points. The effluent water turbidity from the microsieve was maintained at various set points in the range 12-80 NTU basically independent for a number of studied variations in influent flow rate and influent wastewater compositions. Effluent turbidity was highly correlated with effluent chemical oxygen demand (COD). Thus, for CEPT based on microsieving, controlling the removal of COD was possible. Thereby incoming carbon can be optimally distributed between biological nitrogen removal and anaerobic digestion for biogas production. The presented method is based on common automation and control strategies; therefore fine tuning and optimization for specific requirements are simplified compared to model-based dosing control.

The mitogenome of a 35,000-year-old Homo sapiens from Europe supports a Palaeolithic back-migration to Africa

After the dispersal of modern humans (Homo sapiens) Out of Africa, hominins with a similar morphology to that of present-day humans initiated the gradual demographic expansion into Eurasia. The mitogenome (33-fold coverage) of the Peştera Muierii 1 individual (PM1) from Romania (35 ky cal BP) we present in this article corresponds fully to Homo sapiens, whilst exhibiting a mosaic of morphological features related to both modern humans and Neandertals. We have identified the PM1 mitogenome as a basal haplogroup U6*, not previously found in any ancient or present-day humans. The derived U6 haplotypes are predominantly found in present-day North-Western African populations. Concomitantly, those found in Europe have been attributed to recent gene-flow from North Africa. The presence of the basal haplogroup U6* in South East Europe (Romania) at 35 ky BP confirms a Eurasian origin of the U6 mitochondrial lineage. Consequently, we propose that the PM1 lineage is an offshoot to South East Europe that can be traced to the Early Upper Paleolithic back migration from Western Asia to North Africa, during which the U6 lineage diversified, until the emergence of the present-day U6 African lineages.

DEVELOPMENT OF AN ANNOTATION SCHEME FOR STANDARDIZED DESCRIPTION OF MATHEMATICAL MODELS IN THE FIELD OF PLANT PROTECTION

Mathematical models on properties and behavior of harmful organisms in the food chain are an increas- ingly relevant approach of the agriculture and food industry. As a consequence, there are many efforts to develop biological models in science, economics and risk assessment nowadays. However, there is a lack of international harmonized standards on model annotation and model formats, which would be neces- sary to set up efficient tools supporting broad model application and information exchange. There are some established standards in the field of systems biology, but there is currently no corresponding provi- sion in the area of plant protection. This work therefore aimed at the development of an annotation scheme using domain-specific metadata. The proposed scheme has been validated in a prototype implementation of a web-database model repository. This prototypic community resource currently contains models on aflatoxin secreting fungal Aspergillus flavus in maize, as these models have a high relevance to food safety and economic impact. Specifically, models describing biological processes of the fungus (growth, Aflatoxin secreting), as well as dose-response- and carry over models were included. Furthermore, phenological models for maize were integrated as well. The developed annotation scheme is based on the well-established data exchange format SBML, which is broadly applied in the field of systems biology. The identified example models were annotated according to the developed scheme and entered into a Web-table (Google Sheets), which was transferred to a web based demonstrator available at https://sites.google.com/site/test782726372685/. By implementation of a software demonstrator it became clear that the proposed annotation scheme can be applied to models on plant pathogens and that broad adoption within the domain could promote communication and application of mathematical models.

Influence of the geomembrane on time-lapse ERT measurements for leachate injection monitoring

Leachate recirculation is a key process in the operation of municipal waste landfills as bioreactors. To quantify the water content and to evaluate the leachate injection system, in situ methods are required to obtain spatially distributed information, usually electrical resistivity tomography (ERT). However, this method can present false variations in the observations due to several parameters. This study investigates the impact of the geomembrane on ERT measurements. Indeed, the geomembrane tends to be ignored in the inversion process in most previously conducted studies. The presence of the geomembrane can change the boundary conditions of the inversion models, which have classically infinite boundary conditions. Using a numerical modelling approach, the authors demonstrate that a minimum distance is required between the electrode line and the geomembrane to satisfy the good conditions of use of the classical inversion tools. This distance is a function of the electrode line length (i.e. of the unit electrode spacing) used, the array type and the orientation of the electrode line. Moreover, this study shows that if this criterion on the minimum distance is not satisfied, it is possible to significantly improve the inversion process by introducing the complex geometry and the geomembrane location into the inversion tools. These results are finally validated on a field data set gathered on a small municipal solid waste landfill cell where this minimum distance criterion cannot be satisfied.

Improvement of electrical resistivity tomography for leachate injection monitoring

Leachate recirculation is a key process in the scope of operating municipal waste landfills as bioreactors, which aims to increase the moisture content to optimize the biodegradation in landfills. Given that liquid flows exhibit a complex behaviour in very heterogeneous porous media, in situ monitoring methods are required. Surface time-lapse electrical resistivity tomography (ERT) is usually proposed. Using numerical modelling with typical 2D and 3D injection plume patterns and 2D and 3D inversion codes, we show that wrong changes of resistivity can be calculated at depth if standard parameters are used for time-lapse ERT inversion. Major artefacts typically exhibit significant increases of resistivity (more than +30%) which can be misinterpreted as gas migration within the waste. In order to eliminate these artefacts, we tested an advanced time-lapse ERT procedure that includes (i) two advanced inversion tools and (ii) two alternative array geometries. The first advanced tool uses invariant regions in the model. The second advanced tool uses an inversion with a "minimum length" constraint. The alternative arrays focus on (i) a pole-dipole array (2D case), and (ii) a star array (3D case). The results show that these two advanced inversion tools and the two alternative arrays remove almost completely the artefacts within +/-5% both for 2D and 3D situations. As a field application, time-lapse ERT is applied using the star array during a 3D leachate injection in a non-hazardous municipal waste landfill. To evaluate the robustness of the two advanced tools, a synthetic model including both true decrease and increase of resistivity is built. The advanced time-lapse ERT procedure eliminates unwanted artefacts, while keeping a satisfactory image of true resistivity variations. This study demonstrates that significant and robust improvements can be obtained for time-lapse ERT monitoring of leachate recirculation in waste landfills.

Late outcome of surgical treatment of the non-specific neurogenic thoracic outlet syndrome

OBJECTIVE

Despite the relatively high incidence of the thoracic outlet syndrome, diagnostic criteria, role of surgery and optimal operative approach remain controversial. The main goal of the current study is to determine the long-term outcome of operative treatment of a series of patients with non-specific neurogenic thoracic outlet syndrome.

METHODS

A retrospective study of a consecutive group of patients with thoracic outlet syndrome was carried out. The indications for surgery relied on clinical examination. Patients with diffuse pain were excluded. In all cases, the supraclavicular approach was used. Main outcome measures were neurological status and subjective complains.

RESULTS

Nineteen patients have been operated over a period of 5 years. Total number of surgeries was 23. Pain and paresthesia on exertion were the leading symptoms in all cases. The causes of thoracic outlet syndrome were fibromuscular compression in 43.5%, cervical rib alone or in combination with a fibromuscular component in 30.4% and the first rib in 26.1%. The average follow-up was 36.3 months. In 91.7%, improvement of at least 50% was observed; 20.8% of the patients were completely symptom-free, and in 25%, the improvement was 90%. Recovery of the pre-operative motor weakness was recorded in 66.6%. The mortality and the permanent morbidity rates of the procedure were 0%.

DISCUSSION

Operative decompression of the brachial plexus via the supraclavicular approach in patients with non-specific neurogenic thoracic outlet syndrome is a safe procedure that leads to a significant neurological improvement and amelioration of complains. The indication for surgery should be based chiefly on the neurological and clinical findings.

APC mutation spectrum in ileoanal pouch polyps resembles that of colorectal polyps

BACKGROUND

Ileoanal pouch polyps commonly develop following restorative proctocolectomy in patients with familial adenomatous polyposis (FAP). In FAP adenomas, the relationship between germline and somatic adenomatous polyposis coli (APC) mutations is determined by 'just right' beta-catenin signalling in tumour cells, with respect to the 20-amino acid beta-catenin-binding/degradation repeats (20AARs) in the APC protein. However, the relationship varies, with upper gastrointestinal polyps typically retaining three to four 20AARs and colonic polyps retaining one or two. The aim of this study was to establish the mutational spectrum in ileoanal pouch polyps, to ascertain whether polyp development resembled that typical of small or large bowel.

METHODS

Some 151 pouch adenomas were screened from 46 patients with known germline APC mutations for 'second hits' acquired through loss of heterozygosity and truncating mutations. The number of 20AARs remaining after the 'second hit' was calculated.

RESULTS

Loss of heterozygosity was rare in pouch polyps except when the germline mutation left one 20AAR. Overall, the combined alleles left two to three 20AARs in 40 of 51 polyps with an identified 'second hit'. This was significantly fewer than in upper gastrointestinal polyps, and more than in colorectal adenomas.

CONCLUSION

Tissue environment appears to influence the position of the 'second hit' in pouch polyps and the mutations resemble those of large bowel polyps.

Attentional functions in children and adolescents with attention-deficit/hyperactivity disorder with and without comorbid tic disorder

Although the coexistence of attention-deficit/hyperactivity disorder (ADHD) and tic disorder (TD) is common, the nature of association is yet not fully understood. Thus, the aim of the present study was to explore attentional dysfunction in children with pure ADHD compared to children with comorbid ADHD + TD. Three groups of 20 children each, aged 8-15 years with either ADHD, ADHD + chronic tic disorder or Tourette syndrome (ADHD + TD) and a healthy control group were compared in their performance on three computerized attention tasks. Tasks of sustained attention, selective attention and interference control were employed. In addition, parental ratings of ADHD symptom severity and behaviour problems were obtained. Both clinical groups were rated as equally inattentive, however, externalising symptoms were more severe in the ADHD group. Objective measures of attentional performance revealed differences between the groups: whereas the ADHD group was markedly impaired in sustaining attention and selective attention/inhibitory control, the ADHD + TD group only showed marginal deficits in selective attention/inhibitory control. Possible explanations for the superior performance of the comorbid group are discussed: In particular, the results may indicate that in some patients, the tic disorder produces behavioural symptoms of ADHD, but not the broad neurocognitive deficits that usually are associated with ADHD. Alternatively, compensatory neural mechanisms of TD patients may result in a better neuropsychological performance of comorbid patients relative to patients suffering from pure ADHD.

Concentration, compartmentation and metabolic function of intracellular free Mg2+

Intracellular total Mg2+ and free Mg2+ are compartmentalized between cell organelles and within the cytosol. Different values of [Mg2+]i in the cytosol of the same cell type were measured by various investigators. A main reason for the differences is the uncertainty of the dissociation constants used for the Mg furaptra complex in the fluorescence method and for MgATP when 31P NMR was employed. The more realistic KD values of Mg furaptra and MgATP measured under in situ conditions are higher than the KDs used by most investigators. The [Mg2+]is obtained and the KDs used by various authors were presented. The role of intracellular Mg2, in metabolic functions and the action of various effectors on [Mg2+]i and [Ca2+] was reviewed. Intracellular Mg2+ may have a permissive role supporting the effector-induced mechanisms that are mediated by Ca2+ as a second messenger.

Mechanisms, regulation and pathologic significance of Mg2+ efflux from erythrocytes

Mg2+ efflux from erythrocytes can be performed by the Na+/Mg2+ antiport and by Na+-independent Mg2+ efflux. Na+-independent Mg2+ efflux functions via the unspecific choline exchanger as choline/Mg2+ or K+/Mg2+ antiport and as Mg2+ efflux accompanied by intracellular Cl- for charge compensation, as found for example in sucrose medium. Na+/Mg2+ antiport in erythrocytes exchanges 2 extracellular Na+ for 1 intracellular Mg2+. Driving forces are the Na+ and Mg2+ gradients. By reversing these gradients, the Na+/Mg2+ antiporter can mediate Mg2+ influx. The Na+/Mg2+ antiporter can exchange 24Mg2+ for 28Mg2+ and other divalent cations for intracellular Mg2+. In the exchange mechanism, extra- and intracellular Na+ can compete with Mg2+. Na+/Mg2+ antiport is inhibited by amiloride, quinidine and imipramine. Na+/Mg2+ antiport is drastically activated by intracellular Mg2+ due to an allosteric transition. The affinity of intracellular Mg2+ to the Na+/Mg2+ antiporter is dependent on intracellular ATP due to phosphorylation. Besides this mechanism, in non Mg2+-loaded erythrocytes, the activity of Na+/Mg2+ antiport is regulated by phosphorylation-dephosphorylation and by intracellular Cl-. The drastically Mg2+-activated Na+/Mg2+ antiporter is not further stimulated by phosphorylation and intracellular Cl-. Na+-independent Mg2+ efflux via the choline exchanger is also inhibited by amiloride, quinidine and imipramine, and can also be regulated by phosphorylation-dephosphorylation. Na+/Mg2+ antiport of erythrocytes is altered in various pathologic conditions.

Stimulation of choline/Mg2+ antiport in rat erythrocytes by mefloquine

In non Mg(2+)-loaded and non malaria-infected rat erythrocytes, mefloquine (100 micromol x l (-1)) stimulated choline/Mg2+ antiport without affecting the Na+/Mg2+ antiport. The stimulation of the choline/Mg2+ antiport by mefloquine, found in this study, and by trifluoperazine and fluvoxamine, reported previously [Ebel et al. Biochim Biophys Acta 2004; 1167: 132-40], was associated with CF3 groups attached to the quinoline or benzene ring. The effect of mefloquine on choline/Mg2+ antiport in vitro was not related to the antimalarial action of mefloquine in vivo. In rat erythrocytes, the choline/Mg2+ antiport can be differentiated from the Na+/Mg2+ antiport through the use of cinchonine that inhibited the choline/Mg2+ antiport [Ebel et al. Biochim Biophys Acta 2002; 1559: 135-44], and mefloquine that stimulated the choline/Mg2+ antiport, whereby the Na+/Mg2+ antiport was not affected by either drug at proper concentrations. The Na+/Mg2+ antiport and choline/Mg2+ antiports behave as different molecular entities.

Surgical removal of a rhabdomyoma in a neonate as rescue therapy

Primary cardiac and mediastinal tumors are rare at all ages. We report on a rescue therapy in a neonate due to a severely obstructed left ventricular outflow tract.

[PMMA pulmonary embolism and post interventional associated fractures after percutaneous vertebroplasty]

A 78-year old woman with osteoporotic collapse of the Th12 and L4 vertebrae was treated by percutaneous vertebroplasty (pVp) with PMMA (polymethylmethacrylate). Postoperatively, the Th11 and L1 vertebrae collapsed so that a second vertebroplasty was performed. Postoperatively, the patient developed a severe pulmonary embolism which was treated conservatively. In this report, the complications of pulmonary embolism, perivertebral leakage of PMMA and of additional vertebral collapses after pVp are discussed.

Na+/Mg2+ antiport in erythrocytes of spontaneously hypertensive rats: role of Mg2+ in the pathogenesis of hypertension

Total Mg2+ content in plasma and erythrocytes did not significantly differ between WKY and SHR. Mg2+ efflux via Na+/Mg2+ antiport was 10% lower in non Mg(2+)-loaded erythrocytes of SHR than in WKY, and 16% lower in Mg(2+)-loaded erythrocytes of SHR. The activation of Na+/Mg2+ antiport in erythrocytes by Cl-, as tested by substitution of Cl- with SCN-, and the regulation of Na+/Mg2+ antiport by protein kinases, as tested by PMA and staurosporine, showed no differences between WKY and SHR. The reduction of Na+/Mg2+ antiport was explained by a reduction in the number of Na+/Mg2+ antiporter molecules in SHR erythrocytes. Mg2+ efflux in KCl medium by K+/Mg2+ antiport via the unspecific choline exchanger was not significantly reduced in SHR and was equally affected by PMA and staurosporine in WKY and SHR. An explanation for some controversial results, unchanged or reduced concentration of Mg2+ in serum, total Mg2+ and free Mg2+ in erythrocytes of SHR and patients with essential hypertension was proposed. The role of Na+/Mg2+ antiport and [Mg2+]i in the pathogenesis of experimental and clinical hypertension was discussed.

Differential effect of imipramine and related compounds on Mg2+ efflux from rat erythrocytes

The effect of imipramine on Mg2+ efflux in NaCl medium (Na+/Mg2+ antiport), on Mg2+ efflux in choline.Cl medium (choline/Mg2+ antiport) and on Mg2+ efflux in sucrose medium (Cl- -coupled Mg2+ efflux) was investigated in rat erythrocytes. In non-Mg2+-loaded rat erythrocytes, imipramine stimulated Na+/Mg2+ antiport but inhibited choline/Mg2+ antiport and Cl- -coupled Mg2+ efflux. The same effect could be obtained by several other compounds structurally related to imipramine. These drugs contain a cyclic hydrophobic ring structure to which a four-membered secondary or tertiary amine side chain is attached. At a physiological pH, the amine side chain expresses a cationic choline-like structure. The inhibitory effect on choline/Mg2+ antiport is lost when the amine side chain is modified or abandoned, pointing to competition of the choline-like side chain with choline or another cation at the unspecific choline antiporter or at the Cl- -coupled Mg2+ efflux. Other related drugs either stimulated Na+/Mg2+ antiport and choline/Mg2+ antiport, or they were ineffective. For stimulation of Na+/Mg2+ antiport and choline/Mg2+ antiport, there is no specific common structural motif of the drugs tested. The effects of imipramine on Na+/Mg2+ antiport and choline/Mg2+ antiport are not mediated by PKCalpha but are caused by a direct reaction of imipramine with these transporters. By increasing the intracellular Mg2+ concentration, the stimulation of Na+/Mg2+ antiport at a physiological intracellular Mg2+ concentration changed to an inhibition of Na+/Mg2+ antiport. This effect can be explained by the hypothesis that Mg2+ loading induced an allosteric transition of the Mg2+/Mg2+ exchanger with low Na+/Mg2+ antiport capacity to the Na+/Mg2+ antiporter with high Na+/Mg2+ antiport capacity. Both forms of the Mg2+ exchanger may be differently affected by imipramine.

Changes in negative symptoms and EEG in schizophrenic patients after repetitive transcranial magnetic stimulation (rTMS): an open-label pilot study

The effects of repetitive transcranial magnetic stimulation (rTMS) on schizophrenic negative symptoms (NS) and EEG topography were investigated in this pilot study. 10 patients with predominant NS were treated with 10 Hz rTMS over the left dorsolateral prefrontal cortex for 5 days. For NS ratings, the Scale for the Assessment of Negative Symptoms (SANS) was used. Both ratings and EEG recordings were obtained pre- and post-rTMS. Electrical activity changes were computed by Low Resolution Brain Electromagnetic Tomography. SANS showed an improvement after rTMS, from 49.0 (SD: 10.7) to 44.7 (SD: 11.8) (means). EEG frequency bands were changed fronto-temporally (right) and were mainly decreases in delta- and beta- and increases in alpha1-activity, as well as decreases in beta-activity in the temporal and parieto-occipital regions (left). Although we are aware of the limitations of this study, we assume a slight improvement in NS. The EEG findings refer to a possible neurophysiologic correlate of their improvement after rTMS.

Regulation of Na+/Mg2+ antiport in rat erythrocytes

In rat erythrocytes, the regulation of Na+/Mg2+ antiport by protein kinases (PKs), protein phosphatases (PPs), intracellular Mg2+, ATP and Cl- was investigated. In untreated erythrocytes, Na+/Mg2+ antiport was slightly inhibited by the PK inhibitor staurosporine, slightly stimulated by the PP inhibitor calyculin A and strongly stimulated by vanadate. PMA stimulated Na+/Mg2+ antiport. This effect was completely inhibited by staurosporine and partially inhibited by the PKC inhibitors Ro-31-8425 and BIM I. Participation of other PKs such as PKA, the MAPK cascade, PTK, CK I, CK II, CAM II-K, PI 3-K, and MLCK was excluded by use of inhibitors. Na+/Mg2+ antiport in rat erythrocytes can thus be stimulated by PKCalpha. In non-Mg2+ -loaded erythrocytes, ATP depletion reduced Mg2+ efflux and PMA stimulation in NaCl medium. A drastic activation of Na+/Mg2+ antiport was induced by Mg2+ loading which was not further stimulated by PMA. Staurosporine, Ro-31-8425, BIM I and calyculin A did not inhibit Na+/Mg2+ antiport of Mg2+ -loaded cells. Obviously, at high [Mg2+]i Na+/Mg2+ antiport is maximally stimulated. PKCalpha or PPs are not involved in stimulation by intracellular Mg2+. ATP depletion of Mg2+ -loaded erythrocytes reduced Mg2+ efflux and the affinity of Mg2+ binding sites of the Na+/Mg2+ antiporter to Mg2+. In non-Mg2+ -loaded erythrocytes Na+/Mg2+ antiport essentially depends on Cl-. Mg2+ -loaded erythrocytes were less sensitive to the activation of Na+/Mg2+ antiport by [Cl-]i.

Age-dependent neuropsychological deficits and effects of methylphenidate in children with attention-deficit/hyperactivity disorder: a comparison of pre- and grade-school children

OBJECTIVE

Pre-school and grade-school children diagnosed with attention-deficit/hyperactivity disorder (ADHD) were compared in their performance on computerized attention tasks. Depending on the nature of the specified attention deficit, subjects were assigned to groups of cognitive subtypes. The effects of methylphenidate (MPH) were analysed depending on age and cognitive subtype.

METHOD

The preschool group comprised 45 children aged 5-7 years; the grade-school group comprised 54 children aged 8-12 years. Children were tested on placebo and on MPH (mean dose: 0.25-0.3 mg/kg body weight) employing tasks of alertness, sustained attention, focused attention, divided attention, and a cognitive conflict task.

RESULTS

Both groups showed measurable attention deficits. While preschoolers were especially impaired in supervisory attention functions, grade-schoolers most frequently exhibited deficits in attention intensity and selectivity. Positive MPH effects were documented for sustained attention in both age-groups. Analysis of MPH effects in dependence on the type of attention impairment (supervisory functions vs. attention intensity/selectivity) revealed a positive relation between deficits in a specific attention domain and MPH effects.

CONCLUSIONS

Age-dependent differences in attention dysfunctions might be due to brain maturational processes. Performance on computerized attention tasks was particularly improved by MPH in children with objectified attention deficits suggesting that neuropsychological diagnostics can be useful to optimise treatment outcome.