Exploring bacterial diversity and antimicrobial resistance gene on a southern Brazilian swine farm

The bacterial composition of and the circulation of antimicrobial resistance genes (ARGs) in waste from Brazilian swine farms are still poorly understood. Considering that antimicrobial resistance (AMR) is one of the main threats to human, animal, and environmental health, the need to accurately assess the load of ARGs released into the environment is urgent. Therefore, this study aimed to characterize the microbiota in a swine farm in southern Brazil and the resistome in swine farm wastewater treated in a series of waste stabilization ponds (WSPs). Samples were collected from farm facilities and the surrounding environment, representing all levels of swine manure within the treatment system. Total metagenomic sequencing was performed on samples from WSPs, and 16S-rDNA sequencing was performed on all the collected samples. The results showed increased bacterial diversity in WSPs, characterized by the presence of Caldatribacteriota, Cloacimonadota, Desulfobacterota, Spirochaetota, Synergistota, and Verrucomicrobiota. Furthermore, resistance genes to tetracyclines, lincosamides, macrolides, rifamycin, phenicol, and genes conferring multidrug resistance were detected in WSPs samples. Interestingly, the most abundant ARG was linG, which confers resistance to the lincosamides. Notably, genes conferring macrolide (mphG and mefC) and rifamycin (rpoB_RIF) resistance appeared in greater numbers in the late WSPs. These drugs are among the high-priority antibiotic classes for human health. Moreover, certain mobile genetic elements (MGEs) were identified in the samples, notably tnpA, which was found in high abundance. These elements are of particular concern due to their potential to facilitate the dissemination of ARGs among bacteria. In summary, the results indicate that, in the studied farm, the swine manure treatment system could not eliminate ARGs and MGEs. Our results validate concerns about Brazil's swine production system. The misuse and overuse of antimicrobials during animal production must be avoided to mitigate AMR.

The MAPSTROKE project: A computational strategy to improve access to acute stroke care

BACKGROUND

Global access to acute stroke treatment is variable worldwide, with notable gaps in low and middle-income countries (LMIC), especially in rural areas. Ensuring a standardized method for pinpointing the existing regional coverage and proposing potential sites for new stroke centers is essential to change this scenario.

AIMS

To create and apply computational strategies (CSs) to determine optimal locations for new acute stroke centers (ASCs), with a pilot application in nine Latin American regions/countries.

METHODS

Hospitals treating acute ischemic stroke (AIS) with intravenous thrombolysis (IVT) and meeting the minimum infrastructure requirements per structured protocols were categorized as ASCs. Hospitals with emergency departments, noncontrast computed tomography (NCCT) scanners, and 24/7 laboratories were identified as potential acute stroke centers (PASCs). Hospital geolocation data were collected and mapped using the OpenStreetMap data set. A 45-min drive radius was considered the ideal coverage area for each hospital based on the drive speeds from the OpenRouteService database. Population data, including demographic density, were obtained from the Kontur Population data sets. The proposed CS assessed the population covered by ASCs and proposed new ASCs or artificial points (APs) settled in densely populated areas to achieve a target population coverage (TPC) of 95%.

RESULTS

The observed coverage in the region presented significant disparities, ranging from 0% in the Bahamas to 73.92% in Trinidad and Tobago. No country/region reached the 95% TPC using only its current ASCs or PASCs, leading to the proposal of APs. For example, in Rio Grande do Sul, Brazil, the introduction of 132 new centers was suggested. Furthermore, it was observed that most ASCs were in major urban hubs or university hospitals, leaving rural areas largely underserved.

CONCLUSIONS

The MAPSTROKE project has the potential to provide a systematic approach to identify areas with limited access to stroke centers and propose solutions for increasing access to AIS treatment.

DATA ACCESS STATEMENT

Data used for this publication are available from the authors upon reasonable request.

Assessment of Kaistella jeonii esterase conformational dynamics in response to poly(ethylene terephthalate) binding

The pervasive presence of plastic in the environment has reached a concerning scale, being identified in many ecosystems. Bioremediation is the cheapest and most eco-friendly alternative to remove this polymer from affected areas. Recent work described that a novel cold-active esterase enzyme extracted from the bacteria Kaistella jeonii could promiscuously degrade PET. Compared to the well-known PETase from Ideonella sakaiensis, this novel esterase presents a low sequence identity yet has a remarkably similar folding. However, enzymatic assays demonstrated a lower catalytic efficiency. In this work, we employed a strict computational approach to investigate the binding mechanism between the esterase and PET. Understanding the underlying mechanism of binding can shed light on the evolutive mechanism of how enzymes have been evolving to degrade these artificial molecules and help develop rational engineering approaches to improve PETase-like enzymes. Our results indicate that this esterase misses a disulfide bridge, keeping the catalytic residues closer and possibly influencing its catalytic efficiency. Moreover, we describe the structural response to the interaction between enzyme and PET, indicating local and global effects. Our results aid in deepening the knowledge behind the mechanism of biological catalysis of PET degradation and as a base for the engineering of novel PETases.

CBCovid19EC: A dataset complete blood count and PCR test for COVID-19 detection in Ecuadorian population

In this work, we present the complete blood count data and PCR test results of a population of Ecuadorians from different provinces, primarily residing in the Andean region, especially in Quito. PCR was the standard test to detect Covid-19 during the pandemic since 2020. The data were obtained between March 1st and August 12th, 2021. Segurilab and Previne Salud laboratories performed the tests. The dataset contains about 400 clinical cases. Each patient agreed to participate in the study by sharing the results of their PCR (reverse transcription polymerase chain reaction) tests and CBC (complete blood count). CBC test measured several components and features of the blood, including red blood cells, white blood cells, hemoglobin, hematocrit, and platelets. The shared data are intended to provide researchers with input to analyze various events associated with the diagnosis of Covid-19 linked to potential diseases identified in the components measured in the CBC test. These data are helpful for pattern analysis of blood components in modeling prediction and clustering problems. The components measured in the complete blood count and CRP together can be helpful for the analysis of different medical conditions using machine learning algorithms.

Comparison of machine learning techniques to handle imbalanced COVID-19 CBC datasets

The Coronavirus pandemic caused by the novel SARS-CoV-2 has significantly impacted human health and the economy, especially in countries struggling with financial resources for medical testing and treatment, such as Brazil's case, the third most affected country by the pandemic. In this scenario, machine learning techniques have been heavily employed to analyze different types of medical data, and aid decision making, offering a low-cost alternative. Due to the urgency to fight the pandemic, a massive amount of works are applying machine learning approaches to clinical data, including complete blood count (CBC) tests, which are among the most widely available medical tests. In this work, we review the most employed machine learning classifiers for CBC data, together with popular sampling methods to deal with the class imbalance. Additionally, we describe and critically analyze three publicly available Brazilian COVID-19 CBC datasets and evaluate the performance of eight classifiers and five sampling techniques on the selected datasets. Our work provides a panorama of which classifier and sampling methods provide the best results for different relevant metrics and discuss their impact on future analyses. The metrics and algorithms are introduced in a way to aid newcomers to the field. Finally, the panorama discussed here can significantly benefit the comparison of the results of new ML algorithms.

Evaluation of drug repositioning by molecular docking of pharmaceutical resources available in the Brazilian healthcare system against SARS-CoV-2

In 2020 SARS-CoV-2 reached pandemic status, reaching Brazil in mid-February. As of now, no specific drugs for treating the disease are available. In this work, the possibility of interaction between SARS-CoV-2 viral proteins (open and closed spike protein, isolate spike protein RBD, NSP 10, NSP 16, main protease, and RdRp polymerase) and multiple molecules is addressed through the repositioning of drugs available for the treatment of other diseases that are approved by the FDA and covered by SUS, the Brazilian Public Health System. Three different docking software were used, followed by a unification of the results by independent evaluation. Afterwards, the chemical interactions of the compounds with the targets were inspected via molecular dynamics and analyzed. The results point to a potential effectiveness of Penciclovir, Ribavirin, and Zanamivir, from a set of 48 potential candidates. They may also be multi-target drugs, showing high affinity with more than one viral protein. Further in vitro and in vivo validation is required to assess the suitability of repositioning the proposed drugs for COVID-19.

Multi-Approach Bioinformatics Analysis of Curated Omics Data Provides a Gene Expression Panorama for Multiple Cancer Types

Studies describing the expression patterns and biomarkers for the tumoral process increase in number every year. The availability of new datasets, although essential, also creates a confusing landscape where common or critical mechanisms are obscured amidst the divergent and heterogeneous nature of such results. In this work, we manually curated the Gene Expression Omnibus using rigorous filtering criteria to select the most homogeneous and highest quality microarray and RNA-seq datasets from multiple types of cancer. By applying systems biology approaches, combined with machine learning analysis, we investigated possible frequently deregulated molecular mechanisms underlying the tumoral process. Our multi-approach analysis of 99 curated datasets, composed of 5,406 samples, revealed 47 differentially expressed genes in all analyzed cancer types, which were all in agreement with the validation using TCGA data. Results suggest that the tumoral process is more related to the overexpression of core deregulated machinery than the underexpression of a given gene set. Additionally, we identified gene expression similarities between different cancer types not described before and performed an overall survival analysis using 20 cancer types. Finally, we were able to suggest a core regulatory mechanism that could be frequently deregulated.

ConfID: an analytical method for conformational characterization of small molecules using molecular dynamics trajectories

MOTIVATION

The conformational space of small molecules can be vast and difficult to assess. Molecular dynamics (MD) simulations of free ligands in solution have been applied to predict conformational populations, but their characterization is often based on clustering algorithms or manual efforts.

RESULTS

Here, we introduce ConfID, an analytical tool for conformational characterization of small molecules using MD trajectories. The evolution of conformational sampling and population frequencies throughout trajectories is calculated to check for sampling convergence while allowing to map relevant conformational transitions. The tool is designed to track conformational transition events and calculate time-dependent properties for each conformational population detected.

AVAILABILITY AND IMPLEMENTATION

Toolkit and documentation are freely available at http://sbcb.inf.ufrgs.br/confid.

CONTACT

marcelo.poleto@ufv.br or bigrisci@inf.ufrgs.br.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Hemogram data as a tool for decision-making in COVID-19 management: applications to resource scarcity scenarios

Background

COVID-19 pandemics has challenged emergency response systems worldwide, with widespread reports of essential services breakdown and collapse of health care structure. A critical element involves essential workforce management since current protocols recommend release from duty for symptomatic individuals, including essential personnel. Testing capacity is also problematic in several countries, where diagnosis demand outnumbers available local testing capacity.

Purpose

This work describes a machine learning model derived from hemogram exam data performed in symptomatic patients and how they can be used to predict qRT-PCR test results.

Methods

Hemogram exams data from 510 symptomatic patients (73 positives and 437 negatives) were used to model and predict qRT-PCR results through Naïve-Bayes algorithms. Different scarcity scenarios were simulated, including symptomatic essential workforce management and absence of diagnostic tests. Adjusts in assumed prior probabilities allow fine-tuning of the model, according to actual prediction context.

Results

Proposed models can predict COVID-19 qRT-PCR results in symptomatic individuals with high accuracy, sensitivity and specificity, yielding a 100% sensitivity and 22.6% specificity with a prior of 0.9999; 76.7% for both sensitivity and specificity with a prior of 0.2933; and 0% sensitivity and 100% specificity with a prior of 0.001. Regarding background scarcity context, resources allocation can be significantly improved when model-based patient selection is observed, compared to random choice.

Conclusions

Machine learning models can be derived from widely available, quick, and inexpensive exam data in order to predict qRT-PCR results used in COVID-19 diagnosis. These models can be used to assist strategic decision-making in resource scarcity scenarios, including personnel shortage, lack of medical resources, and testing insufficiency.

Evaluation of a self-management patient education programme for fibromyalgia-results of a cluster-RCT in inpatient rehabilitation

The objective was to evaluate the effectiveness of a self-management patient education programme for fibromyalgia syndrome (FMS) as compared with usual care education in inpatient rehabilitation. In a multicentre cluster-randomized controlled trial, 583 inpatients in 3 rehabilitation centres received an advanced self-management patient education programme or usual care education. Patients completed questionnaires at admission, discharge and after 6 and 12 months. Primary outcomes were disease- and treatment-specific knowledge at discharge, and self-management-competencies after 6 months. Secondary outcomes included satisfaction, attitudes, coping competencies, psychological distress and health impairment. We found a medium-sized effect on disease- and treatment-specific knowledge at discharge (P < 0.05, Cohen's d = 0.45, 95% CI = 0.27-0.63), and small effects for subjective knowledge, pain-related control, self-monitoring and insight, communication about disease, action planning for physical activity and treatment satisfaction (all P < 0.05). Only the effect on knowledge persisted for 6 and 12 months. This advanced education programme seemed to be more effective in the short term than usual education. However, intermediate- and long-term effects did not emerge. While superior long-term effects on knowledge as well as short-term effects on self-management skills may suggest implementation, additional long-term effects on other patient-relevant outcomes would be desirable. Trial registration: German Clinical Trials Register, DRKS00008782, Registered 8 July 2015.

Illness representations, pain and physical function in patients with rheumatic disorders: between- and within-person associations

OBJECTIVES

Rehabilitation for patients with rheumatic diseases improves both illness representations (IR) and clinical outcomes such as pain and physical functioning (PF). However, it is unclear whether IR may affect and, in turn, are affected by pain and PF. In this study, we examined both between-person associations and within-person associations between IR and pain/PF over time on three measurement occasions. Furthermore, cross-lagged relationships were examined.

DESIGN AND MAIN OUTCOME MEASURES

This secondary analysis is based on data from N = 186 patients with rheumatic diseases. Data on pain, PF and IR were assessed using self-report questionnaires at the beginning, the end and three months after a 3-week inpatient rehabilitation.

METHODS

To separate between- and within-person level, data were analysed using random-intercept cross-lagged panel models.

RESULTS

On both the between-person level (r = |0.21| - |0.44|) and the within-person level (r = |0.15| - |0.46|), pain and PF were related to cognitive and emotional IR. In addition, we found within-person bidirectional cross-lagged effects between emotional IR and PF.

CONCLUSION

IR show complex relationships with pain and PF. Improving PF might improve subsequent illness-related emotional distress and vice versa.

A multi-objective gene clustering algorithm guided by apriori biological knowledge with intensification and diversification strategies

BACKGROUND

Biologists aim to understand the genetic background of diseases, metabolic disorders or any other genetic condition. Microarrays are one of the main high-throughput technologies for collecting information about the behaviour of genetic information on different conditions. In order to analyse this data, clustering arises as one of the main techniques used, and it aims at finding groups of genes that have some criterion in common, like similar expression profile. However, the problem of finding groups is normally multi dimensional, making necessary to approach the clustering as a multi-objective problem where various cluster validity indexes are simultaneously optimised. They are usually based on criteria like compactness and separation, which may not be sufficient since they can not guarantee the generation of clusters that have both similar expression patterns and biological coherence.

METHOD

We propose a Multi-Objective Clustering algorithm Guided by a-Priori Biological Knowledge (MOC-GaPBK) to find clusters of genes with high levels of co-expression, biological coherence, and also good compactness and separation. Cluster quality indexes are used to optimise simultaneously gene relationships at expression level and biological functionality. Our proposal also includes intensification and diversification strategies to improve the search process.

RESULTS

The effectiveness of the proposed algorithm is demonstrated on four publicly available datasets. Comparative studies of the use of different objective functions and other widely used microarray clustering techniques are reported. Statistical, visual and biological significance tests are carried out to show the superiority of the proposed algorithm.

CONCLUSIONS

Integrating a-priori biological knowledge into a multi-objective approach and using intensification and diversification strategies allow the proposed algorithm to find solutions with higher quality than other microarray clustering techniques available in the literature in terms of co-expression, biological coherence, compactness and separation.

A Memetic Algorithm for 3-D Protein Structure Prediction Problem

Memetic Algorithms are population-based metaheuristics intrinsically concerned with exploiting all available knowledge about the problem under study. The incorporation of problem domain knowledge is not an optional mechanism, but a fundamental feature of the Memetic Algorithms. In this paper, we present a Memetic Algorithm to tackle the three-dimensional protein structure prediction problem. The method uses a structured population and incorporates a Simulated Annealing algorithm as a local search strategy, as well as ad-hoc crossover and mutation operators to deal with the problem. It takes advantage of structural knowledge stored in the Protein Data Bank, by using an Angle Probability List that helps to reduce the search space and to guide the search strategy. The proposed algorithm was tested on nineteen protein sequences of amino acid residues, and the results show the ability of the algorithm to find native-like protein structures. Experimental results have revealed that the proposed algorithm can find good solutions regarding root-mean-square deviation and global distance total score test in comparison with the experimental protein structures. We also show that our results are comparable in terms of folding organization with state-of-the-art prediction methods, corroborating the effectiveness of our proposal.

Aromatic Rings Commonly Used in Medicinal Chemistry: Force Fields Comparison and Interactions With Water Toward the Design of New Chemical Entities

The identification of lead compounds usually includes a step of chemical diversity generation. Its rationale may be supported by both qualitative (SAR) and quantitative (QSAR) approaches, offering models of the putative ligand-receptor interactions. In both scenarios, our understanding of which interactions functional groups can perform is mostly based on their chemical nature (such as electronegativity, volume, melting point, lipophilicity etc.) instead of their dynamics in aqueous, biological solutions (solvent accessibility, lifetime of hydrogen bonds, solvent structure etc.). As a consequence, it is challenging to predict from 2D structures which functional groups will be able to perform interactions with the target receptor, at which intensity and relative abundance in the biological environment, all of which will contribute to ligand potency and intrinsic activity. With this in mind, the aim of this work is to assess properties of aromatic rings, commonly used for drug design, in aqueous solution through molecular dynamics simulations in order to characterize their chemical features and infer their impact in complexation dynamics. For this, common aromatic and heteroaromatic rings were selected and received new atomic charge set based on the direction and module of the dipole moment from MP2/6-31G^* calculations, while other topological terms were taken from GROMOS53A6 force field. Afterwards, liquid physicochemical properties were simulated for a calibration set composed by nearly 40 molecules and compared to their respective experimental data, in order to validate each topology. Based on the reliance of the employed strategy, we expanded the dataset to more than 100 aromatic rings. Properties in aqueous solution such as solvent accessible surface area, H-bonds availability, H-bonds residence time, and water structure around heteroatoms were calculated for each ring, creating a database of potential interactions, shedding light on features of drugs in biological solutions, on the structural basis for bioisosterism and on the enthalpic/entropic costs for ligand-receptor complexation dynamics.

[Work-related medical rehabilitation for patients with rheumatic diseases]

In recent years work-related rehabilitation has been intensified. Several studies have shown the effectiveness of work-related interventions in medical rehabilitation by improving participation in the work force and reducing sick leave. The German pension insurance fund has developed standardized requirements for medical work-related rehabilitation which include diagnostic procedures to identify patients with specific occupational problems and vocation-related interventions. These requirements address patients across different indications and diagnoses. Rehabilitation centers are assigned to different levels of work-related interventions depending on the intensity and specificity of the profile. Centers providing the complete range of work-related interventions offer differentiated work-related diagnostics, job training and occupational groups in addition to general social advice. In this article four case studies with different priorities regarding vocational interventions are presented.

["Vocational perspective"--short-term efficacy of a group treatment for patients with extensive work-related problems during medical rehabilitation]

AIM OF THE STUDY

To analyze the short-term efficacy of the Vocational Perspective programme for patients identified as having extensive work-related problems during rheumatology or orthopaedic inpatient rehabilitation. The primary objectives of the programme on patient level are to convey information about the legal provisions regarding earning incapacity and occupational reintegration, to suggest strategies for dealing with one's own occupational situation, and to strengthen the motivation to stay employed. The programme is explicitly designed for patients who wish to retire or have applied for a pension. On the systemic level, the main goals are to facilitate doctor-patient communication and to increase rehabilitation teams' awareness of occupational problems.

METHODS

In a controlled quasi-experimental design, 359 subjects were consecutively assigned to either the control group (CG, n=177) or the intervention group (IG, n=182). The control group received standard care only, whereas the intervention group additionally participated in the 5-part Vocational Perspective programme. Evaluation criteria were assessed by questionnaire at the beginning (t1) and at end of rehabilitation (t2). Survey participation was 92.2% at t2. The socio-medically relevant knowledge status was objectively documented using a specially designed knowledge questionnaire. Aspects of treatment satisfaction were evaluated using individual items, and the subjective prognosis of gainful employment was assessed using the Subjective Prognosis of Gainful Employment (SPE) scale. Facilitation of communication between doctor and patient was operationalized at patient level in terms of patient satisfaction with medical care, and increased awareness of the rehabilitation team was operationalized in terms of the rate of recommendations to apply for vocational reintegration (LTA) services at discharge. Emotional and functional parameters were exploratively analyzed (anxiety and depression using the IRES 3.1 scales, and subjectively experienced pain-related impairment using the Pain Disability Index).

RESULTS

Scores for subjective satisfaction with job-related information, medical care, socio-medical assessment, and the overall benefits of rehabilitation were significantly higher in the intervention group than in the control group. IG subjects moreover were better able to use the rehabilitation measure to clarify their occupational situation and exhibited significantly greater improvement of socio-medically relevant knowledge. Age proved to be an important predictor of change in a patient's subjective prognosis for gainful employment (SPE): A positive change in SPE was observed in both groups in subjects under 50, in those aged 50 and older, however, only in the intervention group. No differences between the two groups were observed in terms of functional and emotional parameters (e. g., disability through pain, anxiety, and depression). A total of 60% of the subjects received a recommendation at discharge to apply for vocational reintegration services, the proportion however was significantly higher in the IG.

CONCLUSIONS

The Vocational Perspective programme met the patients' high demand for information on relevant socio-medical facilities and services regarding career change and facilitated communication between the doctor and patient by creating greater transparency. The improvement of subjective prognosis for gainful employment observed in the subgroup of older patients indicates that specialized interventions are needed in precisely this disadvantaged group in order to improve their own vocational expectations and thus to improve their chances of reintegration into work life. The high rate of recommendations to apply for vocational reintegration services suggests that rehabilitation teams already have a high awareness of job-related problems even under “usual care” conditions.

Replication of single macromolecules with graphene

The electronic properties of graphenes depend sensitively on their deformation, and therefore strain engineered graphene electronics is envisioned. In order to deform graphenes locally, we have mechanically exfoliated single and few layer graphenes onto atomically flat mica surfaces covered with isolated double stranded plasmid DNA rings. Using scanning force microscopy in both contact and intermittent contact modes, we find that the graphenes replicate the topography of the underlying DNA with high precision. The availability of macromolecules of different topologies, e.g., programmable DNA patterns, render this approach promising for new graphene based device designs. On the other hand, the encapsulation of single macromolecules offers new prospects for analytical scanning probe microscopy techniques.

["Vocational perspective" - concept and acceptance of a group treatment for patients with extensive work-related problems]

BACKGROUND

The treatment programme "Vocational Perspective" was developed for patients with health-related social problems, e. g. long-term sick leave, job loss due to disability, job insecurity and psychosocial disabilities. It intends the patient-oriented imparting of information referring to social system, legal rights, earning capacity and occupational reintegration as well as an early feedback of the sociomedical assessment by the physicians. Participants during in-patient rehabilitation are supported to deal with their occupational situation; motivation to stay employed is strengthened. The group programme contains five psychoeducative modules and an additional sociomedical "ward round". The aim of the study was to examine the acceptance of the newly developed sociomedical vocational therapy module.

METHOD

A total of 179 patients participated in 21 "vocational perspective" seminars within the scope of a controlled quasi-experimental trial. In the experimental group the data on acceptance of the treatment was assessed by questionnaire at the end of the intervention. Experiences with implementation of the programme are described in order to complete the patient-related perspective.

RESULTS

The identification of a demand for work-related interventions in medical rehabilitation seemed successful: Sociodemographic and socioeconomical parameters of the sample proved high risk in view of the social-medical perspective (poor education, high unemployment rates and long-term sick leave). Self-estimations revealed high suffering of the participants, e. g. due to the occupational situation, anxiety and depression, and confirmed high interest in work-related issues. The patients showed quite high acceptance of the programme (regarding importance of seminar, comprehensibility, usefulness of information, atmosphere of the group, mode and extent of the programme). 82.7% of the participants would recommend the programme to other people with work-related problems. Altogether, the experiences during the implementation of the programme can be described as positive. Nevertheless, organizing took much effort and the treatment was very demanding for the therapists. Finally, it is also necessary that the physicians agree to realize high transparency in the process of sociomedical assessment.

CONCLUSION

The sociomedical programme "Vocational Perspective" helps patients to deal with relevant information referring to social system and occupational reintegration. Problematical sociomedical issues can be handled in a therapeutic way during rehabilitation process. Therefore, the programme can be used as meaningful supplement in regular medical rehabilitation. For final conclusions, the results of short-term and follow-up evaluations described elsewhere have to be considered.

High-protein nutrition during pregnancy and lactation programs blood pressure, food efficiency, and body weight of the offspring in a sex-dependent manner

Maternal low-protein diet during pregnancy is a risk factor for cardiovascular disease of the offspring in later life. The impact of high-protein diet during pregnancy on the cardiovascular phenotype of the offspring, however, is still unknown. We examined the influence of a high-protein diet during pregnancy and lactation on the renal, hemodynamic, and metabolic phenotype of the F1 generation. Female Wistar rats were either fed a normal protein diet (20% protein: NP) or an isocaloric high-protein diet (40% protein: HP) throughout pregnancy and lactation. At weaning, the offspring were fed with standard diet, and they were allocated according to sex and maternal diet to four groups: normal-protein male (NPm, n = 25), normal-protein female (NPf, n = 19), high-protein male (HPm, n = 24), high-protein female (HPf, n = 29). During the experiment (22 wk), the animals were characterized by repeated measurement of body weight, food intake, blood pressure, glucose tolerance, energy expenditure, and kidney function. At the end of the study period histomorphological analyses of the kidneys and weight measurement of reproductive fat pads were conducted. There were no differences in birth weight between the study groups. No influence of maternal diet on energy expenditure, glucose tolerance, and plasma lipid levels was detected. Blood pressure and glomerulosclerosis were elevated in male offspring only, whereas female offspring were characterized by an increased food efficiency, higher body weight, and increased fat pads. Our study demonstrates that a high-protein diet during pregnancy and lactation in rats programs blood pressure, food efficiency, and body weight of the offspring in a sex-dependent manner.

[Long term change in quality of life after adenotonsillectomy for pediatric obstructive sleep disorders]

BACKGROUND

To study short-term and long-term changes in quality of life (QOL) in children before and after adenotonsillectomy (T and A) for obstructive sleep disorders (OSDs).

MATERIALS AND METHODS

Prospective study of 20 children underwent T and A for OSDs at the University hospital of Ulm/Germany. Caregivers were asked to complete the Brouillette-Score (BS) and OSA-18 survey, validated instruments for detecting symptoms and QOL change in children with OSDs, at the initial office visit prior to surgery (BS/1 and OSA-18/1) within 7.5 +/- 1.14 weeks after surgery (BS/2 and OSA-18/2), and 14.8 +/- 1.98 months after surgery (BS/3 and OSA-18/3). The BS comprises 3 items including: difficulty breathing during sleep, apnea observed by the caregivers and snoring. The OSA-18 survey comprises 18 items in 5 domains of sleep disturbance, physical suffering, emotional distress, daytime problems, and caregiver concerns. Scores from the preoperative and postoperative surveys were compared using the paired T-test and SPEARMAN-RANK test.

RESULTS

13 children were male (65 %). The mean age at the time of inclusion in the study was 6.2 +/- 1.63 years, mean preoperative body mass index (BMI) was 17.4 +/- 1.24 kg/m(2). Brouillette-Score: The mean Brouillette-Score before T and A (2.72) was significantly higher ( P = or < .001) than in the short-term (- 2.19) and in the long-term. (- 3.54). OSA-18 SURVEY: The mean total score for OSA-18/1 (83.4) was significantly higher ( P = or < .001) than the mean total score for OSA-18/2 (29.8) and OSA-18/3 (25.6). The overall correlation between BS and OSA-18 was R = .887 ( P = or < .001).

CONCLUSION

Children with suspicious OSDs demonstrate significant short term and long-term improvement in the Brouillette-Score and OSA-18 survey. Caregivers perceive a long-term improvement for a minimum of one year in QOL after T and A for OSDs, although these improvements are not uniform across all domains of the OSA-18 survey. Use of the Brouillette-Score and the OSA-18 survey should decrease the need for polysomnographic monitoring and facilitate selection of children for T and A, whereas the OSA-18 questionnaire permits the more differentiated finding.

Depth profile of uncompensated spins in an exchange bias system

We have used the unique spatial sensitivity of polarized neutron and soft x-ray beams in reflection geometry to measure the depth dependence of magnetization across the interface between a ferromagnet and an antiferromagnet. The net uncompensated magnetization near the interface responds to applied field, while uncompensated spins in the antiferromagnet bulk are pinned, thus providing a means to establish exchange bias.

[Controlled clinical testing of an antidiarrheal]

AIM

To identify the efficacy and tolerance of activated charcoal in acute, nonspecific diarrhea.

METHOD

Randomized, double-blind study on 100 adults with nonspecific diarrhea, performed in two general practices. 94 were included in the final analysis, 6 patients - all from the placebo group abandoned treatment because of the absence of an effect.

RESULTS

The major outcome parameters - reduction of stool frequency and curtailment of the duration of the diarrhea - were unequivocally achieved. Differences between the agent and placebo were great. Stool frequency decreased significantly from the third day in the drug group, and highly significantly from the fourth day. The superiority of the antidiarrheal was also clearly evident in terms of the numbers of days with diarrhea, the clinical findings tympania, nature of the stool and of eight individual symptoms, the summed score of which was improved highly significantly by the test substance.

CONCLUSION

The substance tested proved rapidly and reliably effective in the treatment of nonspecific diarrhea, and was well tolerated. Activated charcoal, together with oral rehydration, can therefore be recommended as an initial measure for treating diarrhea with the aim of rapidly and effectively preventing loss of fluid and electrolytes and relieving symptoms.

[Tolerance and effectiveness of oxymetazoline and xylometazoline in treatment of acute rhinitis]

BACKGROUND

Local alpha-sympathomimetics in hydrous solution are well known in the therapy of acute rhinitis and sinusitis. However, added preservatives like benzalkonium chloride have a negative effect on compatibility.

PATIENTS AND METHOD

A total of 307 patients with acute rhinitis entered the study. The treatment with oxymetazoline with preservative, oxymetazoline without preservative and xylometazoline with preservative was evaluated.

RESULTS

This randomised, double-blind, multi-centered, verum-controlled tolerance study confirmed that the local sympathomimetics oxymetazoline and xylometazoline are well tolerated in the treatment of acute rhinitis. When evaluated according to the parameters "feeling of dryness in nasal mucosa" and "burning sensation", the Nasivin sanft 0.05% spray, which contains the active agent oxymetazoline without preservatives, proved to be considerably superior to preparations containing the preservative benzalkonium chloride.

CONCLUSION

Preparations without preservatives should be the preferred choice of treatment for acute rhinitis.

[Postoperative management following rhinosurgery interventions in severe obstructive sleep apnea. A pilot study]

BACKGROUND

Patients with severe obstructive sleep apnea (OSA) treated by nasal continuous positive airway pressure (CPAP) often undergo rhinosurgery to improve nasal ventilation and comply with CPAP therapy. The use of nasal packing postoperatively may worsen the severity of their sleep-related breathing disorders, even leading to death. For this reason, postoperative surveillance with CPAP ventilation is recommended. An oral connection piece offers the possibility to continue CPAP therapy.

PATIENTS AND METHOD

Five patients with OSA were enrolled in this pilot study. All patients underwent a septorhinoplasty with nasal packing for 2 days. CPAP ventilation was guaranteed postoperatively by using an oral connection piece. The object of the study was to evaluate the feasibility, effectiveness, and acceptance of CPAP ventilation with this oral connection piece in patients with nasal packing. Therefore, the blood oxygenation of the patients was observed by pulse oximetry pre- and postoperatively.

RESULTS

None of the patients with nasal packing showed apneas or hypopneas with arterial blood oxygen saturation below 92%. Application of oxygen was not necessary. Cardiorespiratory or neurological complications were not observed.

CONCLUSION

The oral connection piece offers a feasible and effective opportunity to continue CPAP ventilation therapy after rhinosurgery in patients with OSA. The acceptance of the method is satisfactory.

[Efficacy and tolerability of Baldrian versus oxazepam in non-organic and non-psychiatric insomniacs: a randomised, double-blind, clinical, comparative study]

OBJECTIVE

To show better improvement of sleep quality when treating non-organic insomniacs with extractum Valerianae radix siccum instead of oxazepam.

DESIGN

Randomised, double blind, comparative study.

SETTING

Out-patients of 8 general practitioners.

PATIENTS

Non-organic and non-psychiatric insomniacs aged between 18 and 70 years were included into the trial. Persons with known hypersensitivity to valerian or benzodiazepines, other psychotropic drugs and various contraindications/limitations for benzodiazepines were excluded.

INTERVENTION

75 patients were randomly allocated either to the index group (2 x 300 mg extractum Valerianae radix siccum dragées LI 156) or control group (2 x 5 mg oxazepam dragées). The patients took study medication daily over a period of 28 days 30 min before going to bed.

OUTCOMES

The factor sleep quality of the SF-B was defined as primary outcome. Secondary outcomes were other sleep characteristics of the SF-B, well-being (Bf-S) and anxiety (HAMA). Controls were performed before treatment as well as after 1, 2 and 4 weeks. Vital and laboratory parameters as well as unexpected events were assessed for safety and tolerability.

STATISTICS

For all outcomes effect sizes between groups were calculated. For the main outcome criteria significance was tested by repeated-measures ANOVA considering all cases for which data of at least one follow-up existed (n = 70).

RESULTS

Baseline characteristics were well balanced. 70% (54/75) of the patients were females, over 53% (40/75) reported insomnia for more than 1 year. Mean age was 52 +/- 12 years. In both groups sleep quality improved significantly (p <0.001), but no statistically significant difference could be found between groups (p = 0.70). Effect sizes between groups varied between 0.02 and 0.25. Five persons withdrew due to possibly adverse drug reactions (2 ( valerian, 3 ( oxazepam). No serious adverse events happened.

CONCLUSIONS

The study showed no differences in the efficacy for valerian and oxazepam. Because of the more favourable adverse effect profile of valerian compared to oxazepam, this hypothesis should be analysed confirmatorily in an equivalence study.

Inversion errors in Arabic number reading: is there a nonsemantic route?

This article reports on a mildly aphasic patient with major disorders in reading, writing, and number processing. His predominant error type in reading aloud Arabic numbers and in matching heard numerals with Arabic numbers was the violation of the inversion rule of the German Arabic number reading system. According to this rule most of the two-digit numbers or numbers in the final and prefinal position of longer digit strings have to be read beginning with the final digit (e.g. 26-->sechsundzwanzig (literally translated: six-and-twenty)). It is argued that AT's inversion errors (e.g., 26-->zweiundsechzig (literally translated: two-and-sixty)) are not consistent with the predictions of single route models of Arabic number reading but are in agreement with proposals of a visually based asemantic reading routine in addition to a semantically mediated reading routine.

Congenital multiple plaquelike glomus tumors

We encountered two patients with congenital multiple plaquelike glomus tumors. These lesions were present at birth and enlarged with body growth, attaining a diameter of up to 13 cm. The diagnosis was confirmed by histologic and electron-microscopic examination, which revealed the typical changes of glomus tumors. Immunocytochemistry findings demonstrated the tumor cells to be vimentin- and alpha-smooth muscle-actin-positive and desmin-negative. On ultrastructural examination, typical dense bodies and attachment plaques were easily found within the tumor cells. Glomus cells were coated by a thick basal lamina.

[Cooperation between dentists, teachers and parents in effective prevention of oral diseases in pupils in lower classes]

The oral conditions of pupils on three schools with different levels of teachers public relation to the problems of dental service and oral health education were observed before and after a program of dental care and education for 6 months. The best results were reached in the school with highest standard of cooperation and communication between dentists and teachers.

[Photosensitizing properties of nonsteroidal antirheumatic drugs in the photopatch test]

The non-steroidal anti-inflammatory drugs, aspirin, carprofen, diclofenac, ketoprofen, piroxicam, and tiaprofenic acid, were tested in a standard photopatch test series. The routine irradiation dose was 15 J/cm2 UV-A; in most patients additional test series were exposed to non-erythematogenic doses of UV-B and a combination of UV-B and UV-A. In the photopatch test, there were reactions to tiaprofenic acid in 43 of 175 (24.6%), to carprofen in 21 of 86 (24.4%), to aspirin in 7 of 76 (9.2%), to piroxicam in 7 of 84 (8.3%), to diclofenac in 5 of 75 (6.7%), and to ketoprofen in 2 of 53 (3.8%). In 16 patients positive photopatch test results did not start to develop until after the 3rd test day (between day 7 and day 34). In some cases there were positive reactions within the non-irradiated control series. Most of the positive photopatch test reactions could be elicited by UV-A alone; in some cases, however, combined irradiation with UV-B plus UV-A was necessary to yield positive results; only rarely did positive reactions occur exclusively with UV-B. The high incidence of positive photopatch test reactions to non-steroidal anti-inflammatory drugs is a possible indication of a phototoxic action. However, in some cases a photoallergic pathomechanism seems probable with regard to the development of reactions after the 3rd test day, a high UV-sensitivity in the photopatch threshold test, and the results of the histological evaluation of test reactions in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)