Flemish network on rare connective tissue diseases (CTD): patient pathways in systemic sclerosis. First steps taken

Despite the low prevalence of each rare disease, the total burden is high. Patients with rare diseases encounter numerous barriers, including delayed diagnosis and limited access to high-quality treatments. In order to tackle these challenges, the European Commission launched the European Reference Networks (ERNs), cross-border networks of healthcare providers and patients representatives. In parallel, the aims and structure of these ERNs were translated at the federal and regional levels, resulting in the creation of the Flemish Network of Rare Diseases. In line with the mission of the ERNs and to ensure equal access to care, we describe as first patient pathways for systemic sclerosis (SSc), as a pilot model for other rare connective and musculoskeletal diseases. Consensus was reached on following key messages: 1. Patients with SSc should have multidisciplinary clinical and investigational evaluations in a tertiary reference expert centre at baseline, and subsequently every three to 5 years. Intermediately, a yearly clinical evaluation should be provided in the reference centre, whilst SSc technical evaluations are permissionably executed in a centre that follows SSc-specific clinical practice guidelines. In between, monitoring can take place in secondary care units, under the condition that qualitative examinations and care including interactive multidisciplinary consultations can be provided. 2. Patients with early diffuse cutaneous SSc, (progressive) interstitial lung disease and/or pulmonary arterial hypertension should undergo regular evaluations in specialised tertiary care reference institutions. 3. Monitoring of patients with progressive interstitial lung disease and/or pulmonary (arterial) hypertension will be done in agreement with experts of ERN LUNG.

AB0761 HISTOPATHOLOGY OF CHECKPOINT INHIBITORS INDUCED ARTHRITIS: RETROSPECTIVE ANALYSIS OF 3 CASES

Background:

Induced arthritis (IA) is a rare immune related adverse event occurring in 0.5 to 2% of patients exposed to Immune (irAEs) Checkpoint Inhibitors (CPI). In some patients, this condition may be severe and long lasting even after CPI cessation. Cross-reactivity between tumor- and self-antigens was considered in the etiology of several cases of irAEs but disease mechanisms in IA remain elusive.

We systematically collect synovial tissue of patients with IA (Ethical Committee B403201942386).

Objectives:

Here, we report the histopathological findings from ultrasound guided (USG) synovial biopsies from the 3 first patients of our cohort. The immune cell infiltration in CPI IA patients is compared to the histopathological findings in rheumatoid arthritis.

Methods:

Patients were referred through their oncologist after the onset of an arthritis in the context of a CPI therapy. The diagnostic of arthritis was confirmed by a rheumatologist and by ultrasound assessment. USG biopsies were performed before initiation of specific therapies.

Pathological and immunohistochemical analyses include semi quantitative scoring of the following: synovial hyperplasia, fibrinoid necrosis, chorion cellular infiltrate, vascular hyperplasia, CD3-, CD20-, CD68- and CD138-positive cells.

All patients gave written informed consent.

Results:

Three patients went through the USG biopsy procedure: 2 males and 1 female. No adverse events were recorded.

All patients had metastatic neoplasms and time-to-arthritis was on average 6.7 months after CPI initiation. The USG biopsies were performed from 1 week after the onset of the IA to 16 months. The target joints displayed strong synovial thickening on ultrasound. Histological and immunohistochemistry studies showed light to moderate synovial hyperplasia and inflammatory cell infiltration of the sublining by macrophages and T cells, but no or little B cells (Table 1).

Table 1.

Clinical Characteristics and histopathological analyses on synovial biopsies.

Patient 1Patient 2Patient 3CanceruterusbladderlungsBiopsied jointfirst metatarsophalangial jointwristkneeTime-to-synovial biopsy1 week2 months16 monthsGrey scale on ultrasound3/33/33/3Hematoxylin-eosin staining:synovial hyperplasiafibrinoid necrosischorion cellular infiltratevascular hyperplasia++++0+++++++00/+++Immunochemistry staining:CD3CD20CD68CD138++++000/+++0/+++000/+

Conclusion:

USG synovial biopsies have been safely performed and the histopathological analysis have confirmed the synovitis with mainly a macrophage infiltrate (myeloid pattern). IA synovitis is characterized by synovial hyperplasia and macrophage and T cell infiltration of the sublining. Increased collaboration between oncologists and rheumatologists is needed to create opportunities for referral of patients between the two specialties and optimize treatment. Further analyses (such as global or single-cell RNA sequencing) are needed to learn more about IA physiopathology.

References:

[1]Humby F, Lewis M, Ramamoorthi N & al. Synovial cellular and molecular signatures stratify clinical response to csDMARD therapy and predict radiographic progression in early rheumatoid arthritis patients. Ann Rheum Dis. 2019 Jun;78(6):761-772. doi: 10.1136/annrheumdis-2018-214539.

[2]Postow MA, Sidlow R, Hellmann MD. Immune-Related Adverse Events Associated with Immune Checkpoint Blockade. N Engl J Med. 2018 Jan 11;378(2):158-168. doi: 10.1056/NEJMra1703481. PMID: 29320654.

Disclosure of Interests:

Meric de Bellefon Laurent: None declared, Aspeslagh Sandrone: None declared, Di Romana Silvana: None declared, Cornelis Frank: None declared, Poncin Renaud: None declared, Christine Galant: None declared, Bernard Lauwerys Employee of: Bernard Lauwerys is currently employed at UCB Biopharma, Patrick Durez: None declared

Outcome measurement in trauma surgery with a fracture database and clinical and patient-reported outcome measures (PROMs)

Objective

Patient-Reported Outcome Measures (PROMs) gain growing attention. The Food and Drug Administration suggested in 2009 to have PROMs for every new treatment and technology. The use of PROMs was further promoted by the Patient Protection and Affordable Care Act of 2010 in the USA. Recommendations from other national and international organizations include the OECD's Project of Patient-Reported Indicator Surveys (PaRIS) and the International Consortium for Health Outcomes Measurement (ICHOM). Our development and initiation of a Fracture Database started early in 2018. We orientated our database on the role model of the Swedish Fracture Registry.

Methods

REDCap (Research Electronic Data Capture) is a web interface for a SQL (Structured Query Language)-Database. We used it to program the Fracture Registry. We collect data about demographics, diagnosis, treatment, adverse events, clinical outcomes, and PROMs. The PROMS are recorded with the Software 'Heartbeat ONE' vs. 6.15.4. Inclusion criteria are all patients with fractures of the upper and lower extremity, including the pelvis and multiple injuries, treated surgically. Excluded are all patients with fractures of the hand as monotrauma and non-surgical treatment. We established questionnaire sets for each anatomical region. Every hospitalized patient is screened for inclusion criteria to get the baseline PROMs. Follow-up PROMs are collected at 3-months and 12-months in our outpatient clinic.

Results

In five months of collecting PROMs, we have evaluated 599 patients, 521 fulfilling the inclusion criteria. 329 (63%) questionnaire sets were completed. The mean time for answering the questions was 11-20 minutes. The input rate of 63% for PROMs accounts for the start of the process, with 22 (4%) patients being dismissed before answering the questionnaires. 93 (18%) patients denied participation. 52 (10%) patients were not able to participate (dementia, delirium). Other causes for missing data were language barriers (n = 28; 5%), medical reasons like polytraumatized patients (n = 4; 0.8%), and deceased patients (n = 15; 2.9%).

Conclusion

Most Orthopaedic Trauma centers publish data about PROMs from surgically treated patients. Starting in the first quarter of 2021, we will include non-surgically treated patients. We have optimized the process of including patients. Our aim is a response rate of more than 80% within this year to get representing data.

Hybrid triad provides fracture plane stability in a computational model of a Pauwels Type III hip fracture

The study utilized finite element method to determine displacements and stresses in a set of Pauwels Type III femoral neck fractures repaired using 3 techniques (cannulated screws (Triad), sliding hip screw (SHS), and a Hybrid (SHS + cannulated screws). The research found that shear displacement doubled between the 65° and 75° fracture angles regardless of fixation construct. The SHS alone was the least stable construct, with highest construct stresses and shear displacement along the fracture plane. The stability of the Hybrid and Triad constructs were similar, but stress in the Hybrid was lower suggesting it would provide a higher load to failure than the Triad.

A-19 Inhibition in Metabolic Syndrome and its Relationship to Orbitofrontal Cortex Activation During Sucrose Evaluation

Objective

Metabolic syndrome(MetS) is associated with disinhibited eating,executive dysfunction,and increased risk of dementia. The orbitofrontal cortex(OFC) has been implicated in literature as an area involved with decision making and reward. Decreased OFC volume has been linked to disinhibited eating and poorer executive functioning skills.However,research examining executive functioning in individuals with MetS fails to address the role of inhibition as it pertains to consumption and risk of developing MetS. We examined the relationship between neuropsychological performance and OFC activation after receiving and rating a sucrose stimulus to determine if OFC activation is associated with executive functioning deficits that may lead to developing MetS.

Method

Participants were categorized by MetS status(n = 46) and Control(n = 34) with mean age of 49.13±20.29years. During an fMRI session, the Blood-Oxygenation-Level-Dependent(BOLD) response of OFC was recorded while participants rated the pleasantness of an aqueous sucrose solution. Participants were administered the Color-Word Interference Test outside the scanner. Partial Correlation analyses controlling for age examined the relationship between OFC activation during hedonic ratings of sucrose and cognitive performance.

Results

There was a significant negative relationship between left OFC activity and Color-Word Interference:Inhibition performance for Controls(r(42) = -.365, p = .015) as compared to MetS(r(30) = .141,p > .05).

Conclusions

Less activity in the OFC during sucrose hedonic rating was associated with better performance on the Inhibition condition for Controls. We speculate that decreased activation in the OFC after sucrose consumption reflects intact executive functioning and perhaps even a preventative factor to developing MetS. Alternatively, it could indicate that Controls are actively inhibiting hedonic responses to sucrose which improves their ability on a test of inhibition.

[Parameters influencing the preclinical application of cervical collars]

BACKGROUND

The application of cervical collars is a standard procedure in emergency care of trauma patients. It is often observed that the application of cervical collars is performed incorrectly, which may lead to reduced immobilization of the cervical spine.

OBJECTIVES

The objective of this study was to analyze the practical skills of professional emergency care providers concerning the application of cervical collars.

MATERIALS AND METHODS

Emergency care professionals (n = 104) were asked to apply a cervical collar to a training doll. Each performance step was assessed separately. Furthermore, personal and occupational data of all study participants were collected using a questionnaire.

RESULTS

The study participants included professional rescue personnel and emergency physicians. The average occupational experience of all study participants in out-of-hospital emergency care was 11.1 ± 8.9 years. Most participants had already received training on trauma care (61 %) and felt "very confident" in handling a cervical collar (84 %). The application of the cervical collar was performed correctly in 11 % of the performances. The most common error was incorrect size adjustment of the cervical collar (66 %). No association was found between the correct application of the cervical collar and possible parameters of influence, such as working experience in emergency care or participation in trauma courses.

CONCLUSIONS

Despite pronounced subjective confidence regarding the application of cervical collars, this study shows that there are general deficits in the practical skills of applying cervical collars. Therefore, a critical assessment of the current training contents on the subject of trauma care must be demanded.

[Ocriplasmin as a treatment option for symptomatic vitreomacular traction with and without macular hole. First clinical experiences]

PURPOSE

To evaluate the resolution rate in patients with symptomatic vitreomacular traction (≤ 1500 μm) with or without macular holes (≤ 400 μm) after therapy with intravitreal ocriplasmin (Jetrea®) injection in a clinical setting.

METHODS

Until now we have prospectively examined 21 eyes of 21 consecutive patients with symptomatic vitreomacular traction with or without macular holes who underwent intravitreal operative injection of 0.1 ml ocriplasmin. The best corrected visual acuity and high-resolution optical coherence tomography (SD-OCT) ultrastructural parameters were measured before injection and again 1, 3 and 4 months after treatment. The numbers of resolved vitreomacular traction and closed macular holes were documented.

RESULTS

Vitreomacular traction was resolved in 15 out of 21 (71 %) eyes. Of the five eyes which initially presented with vitreomacular traction with macular holes, all showed resolution of vitreomacular traction but only two of the macular holes were closed. The average best corrected visual acuity was 0.38 logMAR (± 0.23) at baseline and 0.43 logMAR (± 0.28), 0.38 logMAR (± 0.27) and 0.36 logMAR (± 0.24) 1, 3 and 4 months after injection, respectively. The average foveal thickness was 355.95 μm (± 114.53 μm) at baseline, reducing to 304.61 μm (± 100.91 μm), 308.00 μm (±76.17 μm) and 277.50 μm (± 26.24 μm) after 1, 3 and 4 months, respectively.

CONCLUSION

In this ongoing study there was a high percentage of resolution of vitreomacular traction (71 %) 1 month after intravitreal operative injection of Jetrea® and closure of two out of five macular holes. This was further associated with stabilization of visual acuity and reduction of foveal thickness. Further investigations are necessary to document the effectiveness of the pharmacological vitreolysis in a clinical setting.

[Therapeutic Options in Vitreomacular Traction With or Without a Macular Hole]

Treatment is usually indicated for symptomatic vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) and without spontaneous resolution. Ultrastructural parameters are evaluated by SD-OCT, in order to classify the vitreoretinal interface and to estimate the success rate of treatment. The resolution rate after therapy with intravitreal Jetrea® (Ocriplasmin) is high (up to 70 %) in patients with symptomatic focal vitreomacular traction (≤ 1500 µm) with or without a macular hole (≤ 250 µm) and with no epiretinal membrane (ERM), but depends on the exact baseline analysis. All other patients with idiopathic traction retinopathy should be treated by minimal invasive pars plana vitrectomy (MIVI). Vitreoretinal surgery effectively removes traction and gives a high closure rate of a full thickness macular hole (FTMH, 90 to 100 %). It is now a very safe procedure with few side effects. Despite a low risk profile (cataract, retinal tear etc.) the indication for surgery needs to take the safety profile into account. Therefore vitrectomy is only indicated in symptomatic patients complaining of blurred vision, VA reduction and metamorphopsia. Vitrectomy is also indicated in patients whose treatment by pharmacologic vitreolysis has failed.

Adverse events in nursing: A retrospective study of reports of patient and relative experiences

BACKGROUND

Patient safety is an important global issue. While it is well known that patients can suffer from adverse events in nursing care, there is a lack of knowledge as to how they experience them.

AIM

To examine adverse events in nursing care as they are experienced by patients and relatives.

METHODS

This was a retrospective study taking both a qualitative and a quantitative approach. It was based on data regarding 242 adverse events in nursing care, as reported by patients and relatives to Sweden's Medical Responsibility Board, content analysis was used to analyse the reports.

RESULTS

Patients' and relatives' experiences were analysed into four categories of adverse events, as concerning participation, clinical judgement, nursing intervention and the essentials of care.

LIMITATIONS

The reports were classified by the Medical Responsibility Board, without a standardized system. The adverse events reported were few in number and were reported by patients and relatives only.

CONCLUSION

Lack of participation has negative consequences and contributes to adverse events. Adverse events occur through missed care as well as through carer errors.

IMPLICATIONS ON NURSING AND HEALTH PRACTICE

Nurses need to improve their skills that support patient participation. Patient participation needs to be incorporated into nurses' duties.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Resources for patients to participate in their own care needs to be a priority underpinning policy-making in health systems. Nursing education systems need to teach students about the value and benefits of involving patients in their care.

Genetic or pharmacologic disruption of the calcineurin-nuclear factor of activated T-cells axis prevents social stress-induced voiding dysfunction in a murine model

OBJECTIVE

Social stress can suppress the voiding reflex, with resultant diminished voiding frequency and increased volumes. The calcineurin-NFAT (nuclear factor of activated T cells) pathway is important in memory development. It was hypothesized that interruption of the calcineurin-NFAT pathway might prevent social stress-induced voiding dysfunction.

METHODS

Mice were subjected to social stress in an established resident-intruder model for 1 h, followed by 23 h of barrier separation. NFATc3, NFATc4 knockout (KO) and wild-type (WT) mice were studied. At two weeks, voiding patterns were collected; this was followed by sacrifice. Corticotropin-releasing factor (CRF) mRNA expression in Barrington's nucleus (BN) was determined by in-situ hybridization.

RESULTS

Social stress decreased voiding frequency and increased voided volumes in WT strains. At baseline, NFATc3 KO mice showed decreased voids and increased volumes, while the NFATc4 KO mice resisted social stress. However, CRF mRNA increased in WT mice following social stress and was increased at baseline in NFATc3 KO mice. It was found that CRF mRNA did not increase following social stress in NFATc4 KO mice. The administration of CsA to WT mice normalized voiding patterns following social stress, albeit with no effect on CRF mRNA in BN.

CONCLUSION

Disrupting the calcineurin-NFAT axis by either genetic or pharmacologic approaches confers resistance to the development of social stress-induced voiding and dysfunction.

Results of surveillance for infections with Shiga toxin-producing Escherichia coli (STEC) of serotype O104:H4 after the large outbreak in Germany, July to December 2011

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Autochthonous dengue virus infection in Japan imported into Germany, September 2013

In September 2013, dengue virus (DENV) infection was diagnosed in a German traveller returning from Japan. DENV-specific IgM and IgG and DENV NS1 antigen were detected in the patient’s blood, as were DENV serotype 2-specific antibodies. Public health authorities should be aware that autochthonous transmission of this emerging virus may occur in Japan. Our findings also highlight the importance of taking a full travel history, even from travellers not returning from tropical countries, to assess potential infection risks of patients.

An outbreak of Salmonella Newport associated with mung bean sprouts in Germany and the Netherlands, October to November 2011

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[The 2011 HUS epidemic in Germany. Challenges for disease control: what should be improved?]

From May to July 2011 [corrected] the world's largest outbreak of hemolytic uremic syndrome (HUS) occurred in northern Germany with dramatic consequences for the population, the health care system and the food industry. In the following we examine the detection of the outbreak, epidemic management and related public communication aspects based on scientific publications, media reports as well as own and new data analyses. The subsequent 17 recommendations concern issues such as participation in and implementation of existing and new surveillance systems particularly with respect to physicians, broad application of finely tuned microbiological typing, improved personnel capacity and crisis management structures within the public health service and evidence-based communication by administrations and scientific associations. Outbreaks of similar dimensions can inevitably occur again and result in costs which will far exceed investments needed for early detection and control. This societal balance should be taken into account in spite of limited resources in the public health sector.

DISC1-ATF4 transcriptional repression complex: dual regulation of the cAMP-PDE4 cascade by DISC1

Disrupted-In-Schizophrenia 1 (DISC1), a risk factor for major mental illnesses, has been studied extensively in the context of neurodevelopment. However, the role of DISC1 in neuronal signaling, particularly in conjunction with intracellular cascades that occur in response to dopamine, a neurotransmitter implicated in numerous psychiatric disorders, remains elusive. Previous data suggest that DISC1 interacts with numerous proteins that impact neuronal function, including activating transcription factor 4 (ATF4). In this study, we identify a novel DISC1 and ATF4 binding region in the genomic locus of phosphodiesterase 4D (PDE4D), a gene implicated in psychiatric disorders. We found that the loss of function of either DISC1 or ATF4 increases PDE4D9 transcription, and that the association of DISC1 with the PDE4D9 locus requires ATF4. We also show that PDE4D9 is increased by D1-type dopamine receptor dopaminergic stimulation. We demonstrate that the mechanism for this increase is due to DISC1 dissociation from the PDE4D locus in mouse brain. We further characterize the interaction of DISC1 with ATF4 to show that it is regulated via protein kinase A-mediated phosphorylation of DISC1 serine-58. Our results suggest that the release of DISC1-mediated transcriptional repression of PDE4D9 acts as feedback inhibition to regulate dopaminergic signaling. Furthermore, as DISC1 loss-of-function leads to a specific increase in PDE4D9, PDE4D9 itself may represent an attractive target for therapeutic approaches in psychiatric disorders.

Evidence for kinetically limited thickness dependent phase separation in organic thin film blends

We present depth-resolved grazing incidence x-ray diffraction, grazing incidence small angle scattering and x-ray reflectivity studies on the structure of mixed C(60) and diindinoperylene (DIP) films as a function of the mixing ratio. We observe enhanced out-of-plane order and smoothing of the mixed films compared to pure films upon coevaporation of DIP:C(60) thin films (in different mixing ratio) which otherwise phase separate. The mixing ratio of molecules can be tuned to alter the in-plane crystallite size as well as the interisland distances of the mixing molecules. Real-time in situ grazing incidence x-ray diffraction measurements show the kinetics and thickness dependence of phase separation, which appears to proceed only after a certain thickness. The crystallite grain size of the individual phase separated components is significantly larger at the top of the film than at the bottom with implications for the understanding of devices.

Increase in hepatitis A in tourists from Denmark, England, Germany, the Netherlands, Norway and Sweden returning from Egypt, November 2012 to March 2013

Since November 2012, there has been an increase in reported cases of hepatitis A in tourists returning from Egypt in several European countries. As of 24 April, 80 HAV cases in travellers with symptom onset after 1 November 2012 visiting different areas in Egypt have been reported. Four cases from Norway, six cases from the Netherlands and five cases from England share an identical hepatitis A viral RNA sequence. This increase in cases suggests that vaccination recommendations for travellers to hepatitis A endemic countries should be reinforced.

More reasons to dread rain on vacation? Dengue fever in 42 German and United Kingdom Madeira tourists during autumn 2012

In October and November 2012 residents and tourists in the Autonomous Region of Madeira, Portugal, were affected by dengue fever. The outbreak waned during the unusually dry winter. Using a Monte Carlo test we investigated the hypothesis that rainy weather conveyed increased risk of dengue virus infection among tourists. Results confirmed the hypothesis. As it is unclear whether the outbreak is over, upkeep and emphasis on mosquito avoidance on rainy days may help residents and tourists reduce infection risk.

Puumala virus outbreak in Western Thuringia, Germany, 2010: epidemiology and strain identification

In 2010, the highest annual number of human Puumala virus (PUUV) infections was reported in Germany since hantavirus surveillance started in 2001. The increase in annual case numbers was especially marked in western Thuringia. We combined results of case-based hantavirus surveillance in humans and serological and molecular investigations in the rodent reservoir to describe the epidemiological situation and to identify the putative outbreak strain. A 5-fold increase in notified hantavirus cases compared to the previous annual maximum was observed in western Thuringia in 2010. Disease incidence varied tremendously within a small geographical area with case patients' places of residence clustering around beech-dominated broad leaf forest patches. Investigations in the rodent reservoir revealed a novel Puumala virus (PUUV) subtype, which is clearly distinct from strains collected in other PUUV endemic regions of Germany. It can be assumed that in regions in western Thuringia where hantavirus cases occurred in 2010 or previous outbreak years, PUUV has been present in the environment for a long time. Further studies are needed to elucidate the population dynamics and hantavirus prevalence of the rodent reservoir and driving ecological factors.

Comparative effectiveness of alternative clinical pathways for primary hip and knee joint replacement patients: a pragmatic randomized, controlled trial

OBJECTIVE

Total hip replacement (THR) and total knee replacement (TKR) (arthroplasty) surgery for end-stage osteoarthritis (OA) are ideal candidates for optimization through an algorithmic care pathway. Using a comparative effectiveness study design, we compared the effectiveness of a new clinical pathway (NCP) featuring central intake clinics, dedicated inpatient resources, care guidelines and efficiency benchmarks vs. the standard of care (SOC) for THR or TKR.

METHODS

We compared patients undergoing primary THR and TKR who received surgery in NCP vs. SOC in a randomised controlled trial within the trial timeframe. 1,570 patients (1,066 SOC and 504 NCP patients) that underwent surgery within the study timeframe from urban and rural practice settings were included. The primary endpoint was improvement in Western Ontario and McMaster University osteoarthritis index (WOMAC) overall score over 12 months post-surgery. Secondary endpoints were improvements in the physical function (PF) and bodily pain (BP) domains of the Short Form 36 (SF-36).

RESULTS

NCP patients had significantly greater improvements from baseline WOMAC scores compared to SOC patients after adjusting for covariates (treatment effect=2.56; 95% confidence interval (CI) [1.10-4.01]). SF-36 BP scores were significantly improved for both hip and knee patients in the NCP (treatment effect=3.01, 95% CI [0.70-5.32]), but SF-36 PF scores were not. Effects of the NCP were more pronounced in knee patients.

CONCLUSION

While effect sizes were small compared with major effects of the surgery itself, an evidence-informed clinical pathway can improve health related quality of life (HRQoL) of hip and knee arthroplasty patients with degenerative joint disorder in routine clinical practice for up to 12 months post-operatively. CLINICALTRIALS.GOV IDENTIFIER: NCT00277186.

Structure and morphology of coevaporated pentacene-perfluoropentacene thin films

The structural properties of coevaporated thin films of pentacene (PEN) and perfluoropentacene (PFP) on SiO(2) were studied using x-ray reflectivity and grazing incidence x-ray diffraction. Reciprocal space maps of the coevaporated thin films with different volume fractions reveal the coexistence of two different molecular mixed PEN-PFP phases together with the pure PEN and PFP crystallites. The crystal structure of PEN:PFP blends does not change continuously with volume fraction, instead the proportion of the appropriate phases changes, as seen from the diffraction analysis. Additional temperature dependent experiments reveal that the fraction of the two mixed PEN-PFP phases varies with growth temperature. The λ-phase (molecular plane parallel to the substrate) is metastable and induced by low growth temperature. The σ-phase (molecular plane nearly perpendicular to the substrate) is thermally stable and nucleates predominantly at high growth temperatures.

Outbreak of Salmonella Montevideo associated with a dietary food supplement flagged in the Rapid Alert System for Food and Feed (RASFF) in Germany, 2010

In March 2010 the Rapid Alert System for Food and Feed (RASFF) was used to inform about Salmonella Montevideo in a herbal food supplement, formulated in capsules, distributed under a Dutch label in Germany. Simultaneous to the first RASFF notice, in the last two weeks of March 2010 an unusual number of 15 infections with S. Montevideo was notified within the electronic reporting system for infectious diseases at the Robert Koch Institute. Adult women (median age: 43, range: 1-90 years) were mainly affected. An outbreak was suspected and the food supplement hypothesised to be its vehicle. Cases were notified from six federal states throughout Germany, which required efficient coordination of information and activities. A case-control study (n=55) among adult women showed an association between consumption of the specific food supplement and the disease (odds ratio (OR): 27.5, 95% confidence interval (CI): 3.1-infinity, p-value=0.002). Restricting the case-control study to the period when the outbreak peaked (between 29 March and 11 April 2010) resulted in an OR of 43.5 (95% CI: 4.8-infinity, p-value=0.001). Trace-back of the supplement's main ingredient, hemp seed flour, and subsequent microbiological testing by pulsed-field gel electrophoresis supported its likely role in transmission. This outbreak investigation illustrates that information from RASFF may aid in hypothesis generation in outbreak investigations, though likely late in the outbreak.

Outbreak of Salmonella Montevideo associated with a dietary food supplement flagged in the Rapid Alert System for Food and Feed (RASFF) in Germany, 2010

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Extinction of care-induced vocalizations by a desensitization routine on a palliative care unit

Vocalizations during care occur frequently in patients with dementia, and are not uncommon in the palliative setting. Underlying trigger factors may include pain during movement, fear of being turned, startle reflex, attempts at verbal communication, environmental factors such as cold water, and other possible etiologies. A case of a 92 year old female who screamed and called out during bathing is presented. This patient with comorbid dementia and brain lesions did not respond to pre-event pain medication, and became somnolent due to opioid administration for presumed incident pain. A non-pharmacological approach, with a patient-centered focus rather than task orientation, succeeded in extinguishing the vocalizations after a period of six weeks.

Enhanced surveillance during a large outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/verotoxin-producing Escherichia coli in Germany, May to June 2011

Germany has a well established broad statutory surveillance system for infectious diseases. In the context of the current outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/ verotoxin-producing Escherichia coli in Germany it became clear that the provisions of the routine surveillance system were not sufficient for an adequate response. This article describes the timeline and concepts of the enhanced surveillance implemented during this public health emergency.

Update on the ongoing outbreak of haemolytic uraemic syndrome due to Shiga toxin-producing Escherichia coli (STEC) serotype O104, Germany, May 2011

Since early May 2011, a large outbreak of haemolytic uraemic syndrome (HUS) and bloody diarrhoea related to infections with Shiga toxin-producing Escherichia coli (STEC) has been observed in Germany. The outbreak is focused in the north, but cases have been reported from all German states and other countries. Since our report last week, the number of HUS cases has increased to 470 and STEC serotype O104 has been confirmed in many cases.

Large and ongoing outbreak of haemolytic uraemic syndrome, Germany, May 2011

Since early May 2011, an increased incidence of haemolytic uraemic syndrome (HUS) and bloody diarrhoea related to infections with Shiga toxin-producing Escherichia coli (STEC) has been observed in Germany, with most cases in the north of the country. Cases reported from other European countries had travelled to this area. First results of a case–control study conducted in Hamburg suggest an association between the occurrence of disease and the consumption of raw tomatoes, cucumber and leaf salad.

Large and ongoing outbreak of haemolytic uraemic syndrome, Germany, May 2011

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An outbreak of Salmonella Typhimurium traced back to salami, Denmark, April to June 2010

Between April and June 2010, a small national outbreak of Salmonella Typhimurium with a particular multilocus variable-number tandem repeat analysis (MLVA) type was identified in Denmark through laboratory-based surveillance. The outbreak involved twenty cases, primarily living within the greater Copenhagen area. Half of the cases were children aged ten years or younger and 12 were male; three cases were hospitalised.A matched case-control study showed a strong link between illness and eating a particular salami product containing pork and venison, matched odds ratio(mOR):150, confidence interval (CI): 19–1,600. The salami had been produced in Germany. Microbiological confirmation in food samples was sought but not obtained. Danish consumers were notified that they should return or dispose of any packages from the suspected salami batch. Because the salami product had potentially been sold in other European countries, the European Centre for Disease Prevention and Control urgent enquiry and Rapid Alert System for Food and Feed systems were used to highlight the possibility of outbreaks in these countries. Case-control studies area strong tool in some outbreak investigations and evidence from such studies may give sufficient information to recall a food product.

An outbreak of Salmonella Typhimurium traced back to salami, Denmark, April to June 2010

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The proof of the pudding is in the eating: an outbreak of emetic syndrome after a kindergarten excursion, Berlin, Germany, December 2007

An outbreak of food poisoning (emetic syndrome) occurred in three kindergartens (A, B and C) in Berlin, Germany, on 3 December 2007 after an excursion during which food was served. We conducted a retrospective cohort study among the kindergarten children and personnel who participated in the trip. The overall attack rate among the 155 participants was 30%. It was 31% among the 137 children (aged two to six years) and 17% among adults (n=18). The consumption of rice pudding was significantly associated with disease. Among those who ate rice pudding, the attack rate was 36%, compared with 0% for non-eaters (relative risk: infinite, p<0.001, aetiological fraction: 100%), but differed significantly between kindergartens A (43%), B (61%) and C (3%), probably because groups were served from different pots. Bacillus cereus sensu stricto was identified from one vomit sample. The clinical and epidemiological characteristics suggest that B. cereus emetic toxin (cereulide) was the causative agent, although it could not be proven in the single vomit isolate. Inadequate food handling most probably led to the outbreak. Single-portion ready-to-eat rice pudding was recommended for subsequent excursions and no further cases of food poisoning occurred.

The proof of the pudding is in the eating: an outbreak of emetic syndrome after a kindergarten excursion, Berlin, Germany, December 2007

An outbreak of food poisoning (emetic syndrome) occurred in three kindergartens (A, B and C) in Berlin, Germany, on 3 December 2007 after an excursion during which food was served. We conducted a retrospective cohort study among the kindergarten children and personnel who participated in the trip. The overall attack rate among the 155 participants was 30%. It was 31% among the 137 children (aged two to six years) and 17% among adults (n=18). The consumption of rice pudding was significantly associated with disease. Among those who ate rice pudding, the attack rate was 36%, compared with 0% for non-eaters (relative risk: infinite, p<0.001, aetiological fraction: 100%), but differed significantly between kindergartens A (43%), B (61%) and C (3%), probably because groups were served from different pots. Bacillus cereus sensu stricto was identified from one vomit sample. The clinical and epidemiological characteristics suggest that B. cereus emetic toxin (cereulide) was the causative agent, although it could not be proven in the single vomit isolate. Inadequate food handling most probably led to the outbreak. Single-portion ready-to-eat rice pudding was recommended for subsequent excursions and no further cases of food poisoning occurred.

High Surface Area Substrates for DNA Arrays

High-density, spatially addressable arrays of DNA probes offer a high-throughput approach to DNA sequence analysis that is likely to have a major impact on biological and genetic research. These arrays are comprised of short strands of immobilized DNA (“probe”) sequences prepared synthetically on a planar glass support. Samples of unknown, fluorescentlylabeled strands of “target' DNA can be analyzed by sequence-specific binding (“hybridization”) to the arrays in order to extract detailed sequence information. The detection sensitivity of these arrays is dependent on quantity and density of immobilized probe molecules on the surface, as well as the thermodynamics of nucleic acid hybridization. In this report, substrates with a porous, “3-dimensional” surface layer were investigated as a means of increasing the number of available probes, and therefore the amount of detectable bound target per unit area. Two methods for creating porous silica layers were investigated - a “subtractive” method and an “additive” method. For the systems investigated, the additive method, sol-gel processing, offered the most promising route for high density DNA arrays.

Dengue virus infection in a traveller returning from Croatia to Germany

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[Emergency response management near the tracks of the public railway network: special aspects of missions connected with the German national railway system]

Emergency response management and rescue operations concerning the railway network in Germany need special attention and implementation in several ways. The emergency response concerning the German national railway network managed by Deutsche Bahn AG is subject to various rules and regulations which have to be followed precisely. Only by following these rules and procedures is the safety of all emergency staff at the scene ensured. The German national railway network (Deutsche Bahn AG) provides its own emergency response control center, which specializes in managing its response to emergencies and dispatches an emergency response manager to the scene. This person serves as the primary Deutsche Bahn AG representative at the scene and is the only person who is allowed to earth the railway electrical power lines. This article will discuss different emergency situations concerning railway accidents and the emergency medical response to them based on a near collision with a high speed train during a rescue mission close to the railway track. Injury to personnel could only be avoided by chance and luck. The dangers and risks for rescue staff are specified. Furthermore, the article details practical guidelines for rescue operations around the German national railway track system.