Predictive preoperative clinical score for patients with liver-only oligometastatic colorectal cancer

Background

Resection of liver metastases from colorectal cancer (CRC) in the oligometastatic stage improves survival and is a potentially curative treatment. Thus, predictive scores that reliably identify those patients who especially benefit from surgery are essential.

Patients and methods

In this multicenter analysis, 512 patients had undergone surgery for liver metastases from CRC. We investigated distinct cancer-specific risk factors that are routinely available in clinical practice and developed a predictive preoperative score using a training cohort (TC), which was thereafter tested in a validation cohort (VC).

Results

Inflammatory response to the tumor, a right-sided primary tumor, multiple liver metastases, and node-positive primary tumor were significant adverse variables for overall survival (OS). Patients were stratified in five groups according to the cumulative score given by the presence of these risk factors. Median OS for patients without risk factors was 133.8 months [95% confidence interval (CI) 81.2-not reached (nr)] in the TC and was not reached in the VC. OS decreased significantly for each subsequent group with increasing number of risk factors. Median OS was significantly shorter (P < 0.0001) for patients presenting all four risk factors: 14.3 months (95% CI 10.5 months-nr) in the TC and 16.6 months (95% CI 14.6 months-nr) in the VC.

Conclusions

Including easily obtainable variables, this preoperative score identifies oligometastatic CRC patients with prolonged survival rates that may be cured, and harbors potential to be implemented in daily clinical practice.

•

We identified four variables of adverse outcome for patients treated with surgical resection of liver metastases from CRC.

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Adverse variables were inflammatory response to the tumor, multiple metastases, right-sided primary tumor, node-positive primary tumor.

•

We developed a preoperative clinical score according to the number of risk factors present.

•

Using easily obtainable variables, this score identified patients with oligometastatic CRC with good prognosis.

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Patients without risk factors should strongly be considered for surgical resection of their metastases.

Potentials and current shortcomings in the cooperation between German centers for rare diseases and primary care physicians: results from the project TRANSLATE-NAMSE

Background

The TRANSLATE-NAMSE project with the strengthening of the centers for rare diseases with their affiliation to the European Reference Networks was a major step towards the implementation of the German National Plan of Action for People with Rare Diseases establishing better care structures. As primary care physicians, general practitioners and pediatricians play a central role in the diagnosis of patients with rare disease, as it is usually them referring to specialists and rare disease centers. Therefore, the interface management between primary care physicians and the centers for rare diseases is of particular importance.

Methods

In a mixed-method-approach an anonymous postal survey of 1,500 randomly selected primary care physicians in Germany was conducted with focus on (1) knowledge about a center for rare diseases and how it works, (2) in case of cooperation, satisfaction with the services provided by centers, and (3) expectations and needs they have with regard to the centers. In addition, in-depth telephone interviews were conducted with physicians who had already referred patients to a center.

Results

In total, 248 physicians responded to the survey, and 15 primary care physicians were interviewed. We observed a wide lack of knowledge about the existence of (45.6% confirmed to know at least one center) about how to access rare disease centers (50.4% of those who know a center confirmed knowledge) and what the center specializes in. In case of cooperation the evaluation was mostly positive.

Conclusion

To improve medical care, the interplay between primary care physicians and rare disease centers needs to be strengthened. (1) To improve the communication, the objectives and functioning of the rare disease centers should become more visible. (2) Other projects dealing with the analysis and improvement of interface management between centers and primary care physicians, as described in the National Plan of Action for People with Rare Diseases, need to be implemented immediately. (3) If the project is evaluated positively, the structures of TRANSLATE-NAMSE should be introduced nationwide into the German health care system to ensure comprehensive, quality-assured care for people with rare diseases with special consideration of the key role of primary care physicians—also taking into account the financial expenditures of this new care model.

Analysis of the lipid extraction performance in a cascade process for Scenedesmus almeriensis biorefinery

BACKGROUND

Microalgae have attracted considerable interest due to their ability to produce a wide range of valuable compounds. Pulsed Electric Fields (PEF) has been demonstrated to effectively disrupt the microalgae cells and facilitate intracellular extraction. To increase the commercial viability of microalgae, the entire biomass should be exploited with different products extracted and valorized according to the biorefinery scheme. However, demonstrations of multiple component extraction in series are very limited in literature. This study aimed to develop an effective lipid extraction protocol from wet Scenedesmus almeriensis after PEF-treatment with 1.5 MJ·kgDW-1. A cascade process, i.e., the valorization of several products in row, was tested with firstly the collection of the released carbohydrates in the water fraction, then protein enzymatic hydrolysis and finally lipid extraction. Biomass processed with high pressure homogenization (HPH) on parallel, served as benchmark.

RESULTS

Lipid extraction with ethanol:hexane (1:0.41 vol/vol) offered the highest yields from the different protocols tested. PEF-treatment promoted extraction with almost 70% of total lipids extracted against 43% from untreated biomass. An incubation step after PEF-treatment, further improved the yields, up to 83% of total lipids. Increasing the solvent volume by factor 2 offered no improvement. In comparison, extraction with two other systems utilizing only ethanol at room temperature or elevated at 60 °C were ineffective with less than 30% of total lipids extracted. Regarding cascade extraction, carbohydrate release after PEF was detected albeit in low concentrations. PEF-treated samples displayed slightly better kinetics during the enzymatic protein hydrolysis compared to untreated or HPH-treated biomass. The yields from a subsequent lipid extraction were not affected after PEF but were significantly increased for untreated samples (66% of total lipids), while HPH displayed the lowest yields (~ 49% of total lipids).

CONCLUSIONS

PEF-treatment successfully promoted lipid extraction from S. almeriensis but only in combination with a polar:neutral co-solvent (ethanol:hexane). After enzymatic protein hydrolysis in cascade processing; however, untreated biomass displayed equal lipid yields due to the disruptive effect of the proteolytic enzymes. Therefore, the positive impact of PEF in this scheme is limited on the improved reaction kinetics exhibited during the enzymatic hydrolysis step.

Advanced field emission measurement techniques for research on modern cold cathode materials and their applications for transmission-type x-ray sources

We report on the functional capabilities of our field emission (FE) measurement systems. The samples are prepared and inserted under clean room conditions and can be precisely xyz-positioned, heat-treated, and investigated in different vacuum environments and temperatures. The FE scanning microscope is a unique microscope being used for the localization of FE sites with high lateral resolution by means of extraction voltage U(x, y) or emission current I(x, y) maps over the cathode area of 25 × 25 mm² and measuring the FE properties of localized emission sites or individual emitters. In contrast, the integral measurement system with the luminescent screen provides real-time integral information about the distribution of emission sites over the whole cathode during long- and short-term current stability measurements, thus allowing us to investigate the properties of various materials and their applications. Commissioning results with the upgraded systems using a silicon emitter array and a point-type graphene emitter will be given to demonstrate that both FE measurement techniques are very useful for an improved understanding and tailoring of materials for applications. The results showed that point-type graphene emitters are more preferable for practical applications. Using simulation software, a suitable triode configuration for point emitters was designed, and a current transmission ratio of ∼100% was obtained. The FE current stability of graphene emitters at pressures >10^-3 Pa can be improved by heating the cathode at 100 °C-300 °C for 1 min-30 min. Finally, point-type graphene film emitters were used for transmission-type x-ray sources, and their applications in imaging and fluorescence spectroscopy are presented.

[The Respiratory Syncytial Virus (RSV) in Adults]

RSV induces an acute viral disease with involvement of the respiratory tract. It can be notably life-threatening for infants but also for older adults. New RSV-subtypes are constantly evolving globally. The knowledge about epidemiology, hygiene measures, diagnostics and clinical feature is essential not only for the paediatrician. Vaccines or specific therapeutics are still missing. This article gives an overview with focus on RSV in adults. In addition, molecular pathological characteristics of the virus are explained, research approaches concerning vaccines and therapeutics are mentioned and current problems in management are discussed.

Cytokine expression and lymphocyte proliferative capacity in diseased harbor porpoises (Phocoena phocoena) - Biomarkers for health assessment in wildlife cetaceans

Harbor porpoises (Phocoena phocoena) in the North and Baltic Seas are exposed to anthropogenic influences including acoustic stress and environmental contaminants. In order to evaluate immune responses in healthy and diseased harbor porpoise cells, cytokine expression analyses and lymphocyte proliferation assays, together with toxicological analyses were performed in stranded and bycaught animals as well as in animals kept in permanent human care. Severely diseased harbor porpoises showed a reduced proliferative capacity of peripheral blood lymphocytes together with diminished transcription of transforming growth factor-β and tumor necrosis factor-α compared to healthy controls. Toxicological analyses revealed accumulation of polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene (DDE), and dichlorodiphenyltrichloroethane (DDT) in harbor porpoise blood samples. Correlation analyses between blood organochlorine levels and immune parameters revealed no direct effects of xenobiotics upon lymphocyte proliferation or cytokine transcription, respectively. Results reveal an impaired function of peripheral blood leukocytes in severely diseased harbor porpoises, indicating immune exhaustion and increased disease susceptibility.

Age, burnout and physical and psychological work ability among nurses

Background

The ageing of the US labour force highlights the need to examine older adults' physical and psychological ability to work, under varying levels of occupational burnout.

Aims

To examine how age and burnout interact in predicting physical and psychological work ability.

Methods

Using a cohort of actively working nurses, we assessed factors on the Work Ability Index at 12-month follow-up and determined how these were related to age and exhaustion-related burnout at baseline.

Results

The study group consisted of 402 nurses aged 25-67 (mean = 41.7). Results indicated age by burnout interactions in which decrements in physical work ability with greater age were observed at all but the lowest level of burnout (1.5 SD below mean: β = -0.14, 95% CI -0.36, 0.07; 1 SD below: β = -0.23, 95% CI -0.39, -0.06; mean: β = -0.39, 95% CI -0.50, -0.29; 1 SD above: β = -0.56, 95% CI -0.70, -0.42; 1.5 SD above: β = -0.64, 95% CI -0.83, -0.46). In contrast, we observed decrements in psychological work ability with age at higher levels of burnout only (1 SD above: β = -0.20, 95% CI -0.35, -0.05; 1.5 SD above: β = -0.30, 95% CI -0.49, -0.11); at lower levels of burnout, older age was associated with improvements in this (1 SD below: β = 0.19, 95% CI 0.03, 0.35; 1.5 SD below: β = 0.29, 95% CI 0.08, 0.50).

Conclusions

Findings indicated physical and psychological dimensions of work ability that differed by age and occupational burnout. This emphasizes the need for interventions to reduce burnout and to address age-related strengths and vulnerabilities relating to physical and psychological work ability.

Ein Gentest für die GM1-Gangliosidose beim Alaskan Husky

Gegenstand und Ziel: Die GM1-Gangliosidose der Alaskan Huskies ist eine angeborene Erkrankung, die durch einen autosomal rezessiv vererbten Defekt des Gens für die saure β-Galaktosidase (GLB1) hervorgerufen wird. Klinisch zeigen die Tiere Minderwuchs sowie, beginnend im Alter von sechs bis acht Wochen, neurologische Ausfallerscheinungen wie Ataxie und Dysmetrie. Zur gezielten Vermeidung dieser Erkrankung ist es für Zuchtentscheidungen wichtig, Anlageträger für den Defekt sicher identifizieren zu können. Material und Methode: Die Spezifität und Sensitivität eines kürzlich beschriebenen Gentests zum direkten Nachweis des genetischen Defekts bei der GM1-Gangliosidose des Alaskan Husky wurde mit der biochemischen Bestimmung der enzymatischen Aktivität der β-Galaktosidase aus isolierten Hautfibroblasten, klinischen und pathologischen Befunden sowie einer Stammbaumanalyse verglichen. Ergebnisse: Die β-Galaktosidase-Enzymaktivitäten von Anlageträgern lagen im Durchschnitt niedriger als die Enzymaktivitäten homozygot gesunder Hunde. Da sich jedoch die Werte der beiden Gruppen überlappten, war eine sichere Identifizierung von Anlageträgern mit der biochemischen Analyse nicht möglich. Demgegenüber erlaubte der Gentest eine eindeutige Unterscheidung zwischen homozygot gesunden Tieren und Anlageträgern. Schlussfolgerung: Der Gentest ist der biochemischen Diagnostik überlegen. Klinische Relevanz: Mithilfe des Gentests können die phänotypisch unauffälligen Anlageträger sicher identifiziert werden. Damit lassen sich Anpaarungen von zwei Anlageträgern verhindern und das Auftreten der GM1-Gangliosidose kann zukünftig vermieden werden.

[Outcome Quality in Medical Rehabilitation: Relationship Between "Patient-Reported Outcomes" (PROs) and Social Security Contributions]

Aim of the Study The outcome quality of medical rehabilitation is evaluated often by "Patient Reported Outcomes" (PROs). It is examined to what extent these PROs are corresponding with "hard" or "objective" outcomes such as payments of contributions to social insurance. Methods The "rehabilitation QM outcome study" includes self-reports of patients as well as data from the Rehabilitation Statistics Database (RSD) of the German pension insurance Baden-Wurttemberg. The sample for the question posed includes N=2 947 insured who were treated in 2011 in 21 clinics of the "health quality network" and who were either employed or unemployed at the time of the rehabilitation application (e. g. the workforce or labour force group, response rate: 55%). The sample turned out widely representative for the population of the insured persons. Results PROs and payment of contributions to pension insurance clearly correspond. In the year after the rehabilitation improved vs. not improved rehabilitees differed clearly with regard to their payments of contributions. Conclusions The results support the validity of PROs. For a comprehensive depiction of the outcome quality of rehabilitation PROs and payments of contributions should be considered supplementary.

Testing Hadronic Interactions at Ultrahigh Energies with Air Showers Measured by the Pierre Auger Observatory

Ultrahigh energy cosmic ray air showers probe particle physics at energies beyond the reach of accelerators. Here we introduce a new method to test hadronic interaction models without relying on the absolute energy calibration, and apply it to events with primary energy 6-16 EeV (E_{CM}=110-170  TeV), whose longitudinal development and lateral distribution were simultaneously measured by the Pierre Auger Observatory. The average hadronic shower is 1.33±0.16 (1.61±0.21) times larger than predicted using the leading LHC-tuned models EPOS-LHC (QGSJetII-04), with a corresponding excess of muons.

[Effects of a Combined Orthopedic and Psychosomatic Rehabilitation Concept]

Objective: Effects of a combined orthopedic and psychosomatic rehabilitation (VOP) concept are evaluated in contrast to psychosomatic and orthopedic rehabilitation. Therefore both mental and physical health of rehabilitants are compared. Methods: A prospective case-control study was performed in order to gather psychic strain and bodily constitution. Covariance analysis was conducted to expose significant differences between groups. Results: An equal clinically relevant reduction of psychological distress could be achieved with psychosomatic rehabilitation (N=322) and VOP (N=511). Moreover, bodily constitution could be increased by the same amount through VOP and orthopedic rehabilitation (N=135). In conclusion the therapy concept is successful in patients with both somatic and psychic problems.

[Posttraumatic deformities of the knee joint : Intra-articular osteotomy after malreduction of tibial head fractures]

Malreduction of tibial head fractures often leads to malalignment of the lower extremity, pain, limited range of motion and instability. The extent of the complaints and the degree of deformity requires an exact analysis and a standardized approach. True ligamentous instability should be distinguished from pseudoinstability of the joint. Also extra- and intra-articular deformities have to be differentiated. In intra-articular deformities the extent of articular surface displacement, defects and clefts must be accurately evaluated. A specific surgical approach is necessary, which allows adequate visualization, correct osteotomy and refixation of the fractured area of the tibial head. In the long-term course good clinical results are described for intra-articular osteotomies. If the joint is damaged to such an extent that it cannot be reconstructed or in cases of advanced posttraumatic osteoarthritis, total knee arthroplasty may be necessary; however, whenever possible and reasonable, anatomical reconstruction and preservation of the joint should be attempted.

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8±0.7(stat)±6.7(syst)  MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principles calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.

Cutaneous form of maculopapular mastocytosis in a foal

BACKGROUND

Cutaneous mastocytosis is a rare benign disease occurring in domestic animals and humans. In previous reports, dermal findings in foals were accompanied by systemic mast cell infiltrations, whereas lesions in human cutaneous mastocytosis, including urticaria pigmentosa and solitary mastocytoma, are usually restricted to the skin.

OBJECTIVES

To describe a new variant of equine cutaneous maculopapular mastocytosis lacking systemic involvement.

ANIMALS

A 2.5-month-old warmblood foal with multiple skin nodules since birth.

METHODS

Clinical examination (including haematology, fine needle biopsy and thoracic radiographs), postmortem examination, histopathology and immunohistochemistry.

RESULTS

Clinical examination showed 41 skin nodules that contained numerous mast cells as detected by cytology. Macroscopic examination at postmortem examination revealed intradermal circumscribed lesions ranging from 2 to 5 cm in diameter. Histologically, they were composed of well differentiated mast cells with metachromatic granules stained with toluidine blue accompanied by many eosinophils. Immunohistochemically, mast cells had mast cell growth factor receptor c-KIT predominating at the cell surface and intracytoplasmic expression of tryptase. In other organs similar mast cell infiltrations were not detected.

CONCLUSIONS AND CLINICAL IMPORTANCE

The case presented here fulfils the criteria of equine cutaneous maculopapular mastocytosis (ECMM), representing a rare entity in foals that is reported to be associated with spontaneous regression, although the long-term prognosis is not known. Unlike in previous reports, lesions described here were restricted to the skin. This may imply that ECMM is primarily a dermal disease sharing similarities with urticaria pigmentosa in young children.

Feather mites of Calidris fuscicollis (Aves: Scolopacidae) in Brazil

During the period 2010-2012, eighty individuals of Calidris fuscicollis (Vieillot, 1819) were collected on the southern coast of Rio Grande do Sul, Brazil, with the objective of determining the presence of feather mites. Of the 80 birds examined, 32.5% were infested by mites, identified as Avenzoaria calidridis (Oudemans, 1904) (Avenzoariidae) (31.25%), Montchadskiana securicata (Megnin & Trouessart 1884) (Pterolichidae) (22.5%) and Alloptes limosae (Dubinin, 1951) (Alloptidae) (6.25%). This is the first report of feather mites on Calidris fuscicollis in Brazil.