Long-span fiber composite truss made by coreless filament winding for large-scale satellite structural systems demonstrated on a planetary sunshade concept

Climate change necessitates exploring innovative geoengineering solutions to mitigate its effects-one such solution is deploying planetary sunshade satellites at Sun-Earth Lagrange point 1 to regulate solar radiation on Earth directly. However, such long-span space structures present unique technical challenges, particularly structural scalability, on-orbit manufacturing, and in-situ resource utilization. This paper proposes a structural concept for the sunshade's foil support system and derives from that a component-level modular system for long-span fiber composite lightweight trusses using coreless filament winding. Within a laboratory-scale case study, the component scalability, as well as the manufacturing and material impacts, were experimentally investigated by bending deflection testing. Based on these experimental results, FE models of the proposed structural concept were calibrated to estimate the maximum displacement and mass of the foil support structure, while comparing the influences of foil edge length, orbital load case, and material selection.

Management of respiratory failure in immune checkpoint inhibitors-induced overlap syndrome: a case series and review of the literature

BACKGROUND

Checkpoint inhibitor-induced overlap syndrome ([OS] myocarditis, and myositis with or without myasthenia gravis) is rare but life-threatening.

CASES PRESENTATION

Here we present a case series of four cancer patients that developed OS. High troponinemia raised the concern for myocarditis in all the cases. However, the predominant clinical feature differed among the cases. Two patients showed marked myocarditis with a shorter hospital stay. The other two patients had a prolonged ICU stay due to severe neuromuscular involvement secondary to myositis and myasthenia gravis. Treatment was based on steroids, plasmapheresis, intravenous immunoglobulin, and immunosuppressive biological agents.

CONCLUSION

The management of respiratory failure is challenging, particularly in those patients with predominant MG. Along with intensive clinical monitoring, bedside respiratory mechanics can guide the decision-making process of selecting a respiratory support method, the timing of elective intubation and extubation.

Types of colourants used in tattoo and permanent make-up techniques, legal regulations, health, and psychological aspects of tattooing

Background

It is estimated that more than 60 million people in Europe, that is, around 12% of the European population, have at least one tattoo. However, there is still little information on the long-term effects of tattoos. Inks used for tattooing are a mixture of chemicals, with pigments being the main components responsible for the visual effect. The pigments used are not produced specifically as ingredients for tattooing, but mainly/primarily for the needs of industry, where lower purity requirements and quality standards are acceptable. It is therefore necessary to understand the risks associated with tattoos, but also to implement appropriate legal regulations. The aim of this article was to collect and summarise the results of research conducted so far on the type of colourants used in tattoo ink and to analyze the impact of these on human health. In addition, as part of this work, the current legal acts regulating the concentration limits and composition of inks used in tattooing as well as the psychological aspects of tattooing were collected and presented.

Methods

Scientific reports and articles from renowned journals from 1994 to 2022, relevant review and research publications in PubMed, and Google Scholar were analyzed. To analyze the available research literature, the Web of Science, Scopus, PubMed databases were used. The following keywords were used to search for publications: tattoos, colourants used in tattoos, side effects of tattoos, legal acts, psychological aspects of tattoos.

Results

The result of the literature analysis indicates a risk to health and side effects associated with tattooing the body. There are still no standardised test methods to analyze tattoo inks and assess their safety. Although the art of tattooing has been known for millennia, European legal authorities have not yet implemented effective regulations. Currently, tattoo products in Europe are covered by the general REACH regulation (Resolution ResAP, 2008; EU regulation 2020/2081, 2020). on product safety. The new amendment in force since January 4, 2022 introduces concentration limits for certain substances used in tattoo and permanent makeup inks. However, these provisions do not sufficiently protect either the consumer or the tattoo industry.

Conclusions

The results of the research indicate a potentially harmful effect on skin health. A more stringent safety assessment of the colourants used for tattooing is recommended, supported by studies and applicable legislation.

Clinical Characteristics and Cause of Death Among Hospitalized Decedents With Cancer and COVID-19

There is scant information on the clinical progression, end-of-life decisions, and cause of death of patients with cancer diagnosed with COVID-19. Therefore, we conducted a case series of patients admitted to a comprehensive cancer center who did not survive their hospitalization. To determine the cause of death, 3 board-certified intensivists reviewed the electronic medical records. Concordance regarding cause of death was calculated. Discrepancies were resolved through a joint case-by-case review and discussion among the 3 reviewers. During the study period, 551 patients with cancer and COVID-19 were admitted to a dedicated specialty unit; among them, 61 (11.6%) were nonsurvivors. Among nonsurvivors, 31 (51%) patients had hematologic cancers, and 29 (48%) had undergone cancer-directed chemotherapy within 3 months before admission. The median time to death was 15 days (95% confidence interval [CI], 11.8 to 18.2). There were no differences in time to death by cancer category or cancer treatment intent. The majority of decedents (84%) had full code status at admission; however, 53 (87%) had do-not-resuscitate orders at the time of death. Most deaths were deemed to be COVID-19 related (88.5%). The concordance between the reviewers for the cause of death was 78.7%. In contrast to the belief that COVID-19 decedents die because of their comorbidities, in our study only 1 of every 10 patients died of cancer-related causes. Full-scale interventions were offered to all patients irrespective of oncologic treatment intent. However, most decedents in this population preferred care with nonresuscitative measures rather than full support at the end of life.

Intraoperative Anesthesiology Management and Patient Outcomes for Surgical Revascularization for Moyamoya Disease: A Review and Clinical Experience

Background Moyamoya disease (MMD) is a rare cerebrovascular condition, often presenting as a headache or stroke in adults. Anesthetic management of this illness may challenge providers because it can affect the long-term neurologic outcome and hospital length of stay (LOS) in patients with MMD.

Materials and Methods A literature search was conducted to assess etiology and epidemiology, as well as existing reports of intraoperative management of MMD. Due to sparse findings, the search was expanded to include studies of the use of intraoperative anesthetic agents during other neurosurgical procedures. We also retrospectively reviewed all MMD cases from January 1, 2009, to December 31, 2015, at Memorial Hermann Hospital-Texas Medical Center, where intraoperative management involved craniotomy and surgical revascularization. Data were collected primarily on the use of several anesthetic agents. The LOS and any adverse events were also recorded for each case. The data were divided into two equivalent case cohorts: (1) January 1, 2009, to February 18, 2013, and (2) February 19, 2013, to December 31, 2015.

Results Remifentanil use notably increased between the first and second time periods while fentanyl use decreased. Desflurane usage also demonstrated an observed increase when our two cohorts were compared. Additionally, there was a decrease in the mean LOS between the first and second periods of 3.9 and 3.3 days, respectively.

Conclusion Increasing use of remifentanil in MMD cases could be attributed to its ability to provide more stable hemodynamics during induction, maintenance, and emergence of anesthesia when compared with fentanyl. Lower systolic pressures, diastolic pressures, and heart rates were reported in patients receiving remifentanil over fentanyl.

In-Hospital Mortality with Use of Percutaneous Endoscopic Gastrostomy in Traumatic Brain Injury Patients: Results of a Nationwide Population-Based Study

BACKGROUND

Percutaneous endoscopic gastrostomy (PEG) is a frequently performed invasive procedure that has been associated with high short-term mortality. Its use of special interest in traumatic brain injury (TBI) patients as nutrition support constitutes important issues in intensive care of this group. We used a national database to determine the incidence of, and factors associated with, in-hospital mortality among TBI patients undergoing PEG.

METHODS

We conducted a retrospective study using the US nationwide inpatient sample to analyze data from all hospitalizations in 2008 with International Classification of Diseases, Ninth Revision, diagnostic and procedure codes identifying patients with TBI and hemorrhagic stroke who received PEG. Bivariate and multivariate logistic regression analyses were performed using demographic and clinical variables to identify predictors of in-hospital mortality in this patient population. Patients who did not undergo PEG were used as control.

RESULTS

In-hospital mortality after PEG was 6% (95% CI, 0.05-0.76%) among the TBI population with 0.2% occurring in the first 7 days and 2% occurring in the first 14 days. These patients had a higher incidence of other trauma-related comorbidities and were classified as high-risk stratification based on SRRi score compared to the non-PEG group. Factors strongly predictive of in-hospital mortality were age >51 years, not receiving a PEG, and having a high comorbidity burden of >2.

CONCLUSION

Understanding the rate of mortality associated with PEG in this patient population and identifying factors that increase and decrease the risk of death will improve patient selection for those most likely to benefit from this procedure.

Evaluating the Adjuvant Effect of Dexamethasone to Ropivacaine in Transversus Abdominis Plane Block for Inguinal Hernia Repair and Spermatocelectomy: A Randomized Controlled Trial

BACKGROUND

The transversus abdominis plane (TAP) block is a relatively straightforward regional technique used for postoperative analgesia in patients undergoing abdominal surgeries. Various adjuvants have been used in past to prolong the duration of action of analgesia in peripheral nerve blocks. Several studies investigating the analgesic efficacy of dexamethasone added to local anesthetic agents, such as bupivacaine, have shown promising results. However, there are few studies comparing the efficacy of dexamethasone with ropivacaine.

OBJECTIVES

To determine if the addition of dexamethasone 8 mg to ropivacaine 0.2% in a TAP block would prolong the analgesic effect when compared with ropivacaine 0.2% alone after inguinal hernia repair and spermatocelectomy.

STUDY DESIGN

A randomized, double blinded, placebo-controlled, prospective study.

SETTING

Teaching hospital.

METHODS

A total of 82 patients undergoing inguinal hernia repair or spermatocelectomy were enrolled in the study, of which 41 patients received TAP block with ropivacaine with saline, and the other 41 received ropivacaine with dexamethasone immediately following surgery. Both the proceduralist (resident) and the patient were blinded to the solution used. Visual analog pain scores (0 - 10) were obtained pre-block and immediately post block. Our primary endpoint was visual analog pain score at 12 hours, with 24 and 48-hour pain scores as the secondary endpoints.

RESULTS

The averaged pre-block pain score was 7.6 ± 1.7 in the saline group and 7.7 ± 2.2 in the dexamethasone group. There was an improvement in the pain scores from the baseline, at 12 hours after the administration of the block in both the groups. Although the dexamethasone group had a greater change in pain score (-3.2) than the saline group (-2.2), the difference between the 2 groups was not statistically significant (0.08). We did not observe significant differences in change from baseline at 24 hours and 48 hours between the 2 groups (P value = 0.74 and 0.44, respectively).

LIMITATIONS

We did not assess the total dose of analgesics used during the surgery with the assumption that the effect of intraoperative analgesics should wear off by the time we collect the 12-hour pain score. We did not control for the expertise of the provider that performed the block, as some of the providers may have been junior residents with limited experience and expertise in the area. Additionally, we were unable to include postoperative opioid consumption due to concerns of inconsistencies during patient reporting and data quality.

CONCLUSIONS

In conclusion, we could not show a statistically significant prolongation of analgesia for TAP blocks with ropivacaine when dexamethasone was added, though there was a one point drop in pain score at 12 hours post block when dexamethasone was added to the block solution. This decrease in pain scores at 12 hours may still be beneficial to patient satisfaction given the low side effect profile of dexamethasone. As ropivacaine has a lower pH than other local anesthetic agents, further well designed studies are needed to investigate the combination of this drug with more alkaline drugs like corticosteroids.

KEY WORDS

Regional anesthesia, transversus abdominis plane, dexamethasone, ropivacaine.

Gastrointestinal Complications After Cardiac Surgery: A Nationwide Population-Based Analysis of Morbidity and Mortality Predictors

OBJECTIVE

The authors aimed to evaluate the incidence, risk factors, and outcomes of gastrointestinal (GI) complications in cardiac and aortic surgery using recent versions of the National (Nationwide) Inpatient Sample (NIS) to provide clinicians with a better understanding of these uncommon but potentially serious complications.

DESIGN

Population-based study.

SETTING

NIS database 2010-2012.

PARTICIPANTS

Patients undergoing cardiac and aortic aneurysm repair surgeries.

INTERVENTIONS

Not applicable.

MEASUREMENTS AND MAIN RESULTS

The most common GI complication was postoperative ileus, which also had the lowest mortality, followed by GI hemorrhage. Mesenteric ischemia demonstrated the highest mortality, followed by intestinal perforation. Mortality was highest in those with infective endocarditis (16.02%), followed by myocardial infarction (12.48%). GI complications were highest in patients undergoing repair of abdominal aortic aneurysm, followed by off-pump coronary artery bypass grafting.

CONCLUSION

In conclusion, this study demonstrated that GI complications after cardiac surgery occurred at a rate of 4.17%, which is similar to that reported in the NIS database from 1998 to 2002 in coronary artery bypass grafting patients, but higher than that previously described in single-center studies. GI complications after cardiac surgery increased inpatient mortality 3-fold and more than doubled length of stay. Improved recognition and understanding of the predisposing risk factors and complications elucidated in this study could serve to increase the necessity for timely diagnosis and treatment of patients at high risk for GI complications after cardiac surgery.

Completing the picture for the smallest eigenvalue of real Wishart matrices

Rectangular real N×(N+ν) matrices W with a Gaussian distribution appear very frequently in data analysis, condensed matter physics, and quantum field theory. A central question concerns the correlations encoded in the spectral statistics of WW^{T}. The extreme eigenvalues of WW^{T} are of particular interest. We explicitly compute the distribution and the gap probability of the smallest nonzero eigenvalue in this ensemble, both for arbitrary fixed N and ν, and in the universal large N limit with ν fixed. We uncover an integrable Pfaffian structure valid for all even values of ν≥0. This extends previous results for odd ν at infinite N and recursive results for finite N and for all ν. Our mathematical results include the computation of expectation values of half-integer powers of characteristic polynomials.

Eugenia 'negativa', psiquiatria e catolicismo: embates em torno da esterilização eugênica no Brasil

Analisa o diálogo do eugenista Renato Kehl com um grupo de psiquiatras brasileiros que, no início da década de 1930, aproximaram-se da chamada eugenia negativa. Entusiasmados com as pesquisas e a aplicação de medidas eugênicas em países como os EUA e a Alemanha, autores como Ernani Lopes, Ignácio da Cunha Lopes, Alberto Farani e Antonio Carlos Pacheco e Silva elegeram a religião católica como empecilho para que o Brasil pudesse seguir caminho semelhante, especialmente quanto à resistência à implantação da esterilização dos ditos 'degenerados' que passara a vigorar na Alemanha em 1934. O artigo mapeia as diferentes estratégias propostas pelos autores para dialogar com a Igreja católica.

Burnout syndrome in seafarers in the merchant marine service

PURPOSE

As seafarers face a wide range of psychosocial stressors on board, they may be endangered to develop burnout syndrome. This study aims to investigate respective indicators.

METHODS

In a cross-sectional study, 251 seafarers were asked about demographic data and job-related stressors. Particularly, the subscale emotional exhaustion (EE) of the Maslach Burnout Inventory and the Epworth Sleepiness Scale were used to assess the respective risks of job-related burnout and daytime sleepiness among seafarers. The statistical analysis was carried out using multiple logistic regression.

RESULTS

Within the whole study group, the EE score was elevated in 10.8 %. A higher EE score was found in 10.7 % of officers, in 4.5 % of lower crew ranks and in 25.0 % of the galley staff (p = 0.05). Furthermore, long working days were associated with an elevated EE score [OR 3.83 (CI 1.46-10.03)]. Emotional exhaustion was associated with a subjective perception of enough sleep on board [OR 3.33 (CI 1.17-9.46)], lack of care taken by the shipboard superiors and/or the shipping company [OR 1.19 (CI 1.04-1.36)], with high responsibility for work organisation of those involved in leadership [OR 1.46 (CI 1.20-1.78)] and with social problems due to the long periods of separation from their families [OR 1.19 (CI 1.02-1.39)], taking into account relevant demographic parameters.

CONCLUSIONS

Compared with the majority of on-shore occupations, the burnout risk in seafaring seems to be moderate. To reduce the EE among seafarers, it is recommended to extend the sleeping time, to avoid long working hours, to improve the superiors' communication and leadership skills, to diminish the superiors' stress load caused by organisational duties and to support low-price telecommunication possibilities at home.

Forty-eight new cases with infertility due to balanced chromosomal rearrangements: detailed molecular cytogenetic analysis of the 90 involved breakpoints

A molecular cytogenetic study was performed on 48 infertile patients who were identified as carriers of balanced translocations (40 cases), inversions (6 cases) or insertions (2 cases) by means of banding cytogenetics. Cases with a Robertsonian translocation or pericentric inversion 2 or 9 were not included. In summary, 100 break-events occurred in these patients, and 90 different chromosomal regions were involved. Thus, this study confirmed the presence of abnormal karyotypes in a subgroup of patients seeking infertility treatment. Breaks were demonstrated to appear preferentially in GTG-light bands in these patients. Furthermore, the observed breakpoints were associated with genomic regions prone to instability due to the presence of segmental duplications. Nonetheless, further detailed molecular analysis will be necessary in the future to characterize the mechanisms and genetic basis for this phenomenon.

Biomonitoring results and cytogenetic markers among harbour workers with potential exposure to river silt aerosols

BACKGROUND

Workers on dredgers and lighters on rivers are potentially exposed to a variety of substances.

AIMS

To determine the internal load of heavy metals and arsenic as well as levels of cytogenetic markers in workers exposed to river silt aerosols.

METHODS

One hundred exposed workers were examined up to eight times within three years. Additionally, 100 control workers were studied once. Blood samples were analysed for lead, mercury, and cadmium. Additionally, micronuclei frequency and sister chromatid exchange (SCE) rates were determined. Urinary samples were analysed for cadmium, mercury, nickel, chromium, and arsenic. Information on potential confounders, such as smoking habits and consumption of fish were assessed.

RESULTS

Apart from some increased concentrations of mercury in blood (maximum 14.6 microg/l) and arsenic in urine (maximum 356.5 microg/l) all measurements were within reference values. None of the exposure and effect markers were found to be significantly increased in exposed workers compared to non-exposed controls. In multiple linear regression models, mercury levels in blood as well as the concentration of arsenic in urine were strongly related to fish consumption. Cadmium levels in blood as well as urinary cadmium concentrations were strongly related to smoking habits. After adjusting for smoking habits, SCE rates were associated with cadmium levels in blood.

CONCLUSION

Increased exposure levels or enhanced levels of cytogenetic markers were not found in workers exposed to river silt aerosols. However, cadmium exposure in blood was related to SCE frequency.

[Books from the Arco do Cego in colonial Brazil]

Between 1799 and 1801, the friar José Mariano da Conceição Veloso, a Minas Gerais native, headed Lisbon's Casa Literária do Arco do Cego, which in a brief three-year span published at least eighty works on topics that included agriculture, navigation, and medicine. This editorial project must be understood within the context of Dom Rodrigo de Souza Coutinho's enlightened government program. Meant to modernize the Empire, it included dissemination of technical and practical knowledge in lands under Portuguese dominion, especially in the Americas. As a contribution to an understanding of the Enlightenment in Brazil , this article presents elements form my research on the development of the project and how it was received.

[Asthma due to grain dust]

The actual literature as well as two case reports described in detail show that grain dust induces asthmatic reactions and ODTS which are obviously not of allergic origin. For diagnosis occupational-type exposure tests are decisive whereas allergological testing usually is not. Endotoxins which are present in the grain dust samples in high concentrations have to be regarded as the major causative components. To avoid irreversible lung function impairment a comprehensive early diagnosis is necessary. Generally, a remarkable reduction of exposure to dust with high levels of airborne endotoxin in agriculture has to be achieved since in many workplaces corresponding exposures are still rather high.

Copper(II) complexes of aminocarbohydrate beta-ketoenaminic ligands: efficient catalysts in catechol oxidation

Copper(II) complexes of tridentate dianionic beta-ketoenaminic ligands derived from differently functionalized amino-deoxyglucoses were synthesized and characterized with respect to their structural, spectroscopic, and catalytic properties. The (probably dimeric) complex [1,2-O-isopropylidene-6-N-(3-acetyl-2-oxobut-3-enyl)amino-6-deoxyglucofuranoso)copper(II) Cu(3a) was a highly efficient catalyst for the catechol-oxidase-like oxidation of 3,5-di-tert-butylcatechol (dtbc) into 3,5-ditert-butylquinone (dtbq) by molecular oxygen (kcat=2.63s(-1)). In contrast to this magnetically "normal" complex Cu(3a), the analogous dinuclear complex [[Cu(2a)]2], derived from the isomeric amino sugar 5-amino-5-deoxyglucofuranose, forms six-membered chelate rings with the sugar moiety and has very strong antiferromagnetic-coupled copper atoms (resulting in a diamagnetic ground state). It has a rather insignificant activity (kcat < 10(-3)s(-1)). The ligand H2 1a, derived from a (protected) 6-amino-6-deoxyglucopyranose, forms a trinuclear complex [[Cu(1a)]]2.Cu(OAc)2] in which two basic formula units are bridged by one copper acetate. This compound and the complex derived from an (isomeric) aminodeoxyglucopyranose ([Cu(4a)]: kcat approximately equals 0.03 s(-1)) show moderate activity. All complexes with a peripheral ethoxycarbonyl group instead of the acetyl substituent R2, Cu(1b)-Cu(3b) and Cu(4c), are inactive. The complexes derived from 2-hydroxocyclohexylamine, Cu(5a) and Cu(5c), which were used as models of the active complex Cu(3a), have the typical "cubane-like" tetranuclear structure known from many copper complexes with derivatives of saturated 2-aminoalcohols. They are inactive with respect to the activation of dioxygen.

Lung function decline in 4-monthly repeated spirometric measurements: due to silt aerosol exposure or decreasing effort?

BACKGROUND

Workers on dredgers and lighters on rivers are exposed to the inhalation of aerosols and dusts.

OBJECTIVE

The aim of this study was to investigate effects of river silt aerosol and dust exposure on the respiratory health of dredging employees.

METHODS

Six examinations were performed over a period of 2 years at 4-monthly intervals in 54 seamen with higher silt aerosol exposure and 36 controls of the same employer.

RESULTS

No significant differences could be observed between the groups at any time of the study but there was an unexpected significant decrease in the age-corrected expiratory vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)) and midexpiratory flow rate (MMEF(25/75)) over the six series in both groups. This may indicate a loss of effort of the participants in re-examinations since biological and technical influences were highly unlikely to be the cause of these findings.

CONCLUSIONS

Ignoring this possible decline of effort in frequently repeated measurements may result in overestimating potential effects of occupational exposure.

Lung function, biological monitoring, and biological effect monitoring of gemstone cutters exposed to beryls

OBJECTIVES

Gemstone cutters are potentially exposed to various carcinogenic and fibrogenic metals such as chromium, nickel, aluminium, and beryllium, as well as to lead. Increased beryllium concentrations had been reported in the air of workplaces of beryl cutters in Idar-Oberstein, Germany. The aim of the survey was to study the excretion of beryllium in cutters and grinders with occupational exposure to beryls--for example, aquamarines and emeralds--to examine the prevalence of beryllium sensitisation with the beryllium lymphocyte transformation test (BeLT), to examine the prevalence of lung disease induced by beryllium, to describe the internal load of the respective metals relative to work process, and to screen for genotoxic effects in this particular profession.

METHODS

In a cross sectional investigation, 57 out of 100 gemstone cutters working in 12 factories in Idar-Oberstein with occupational exposure to beryls underwent medical examinations, a chest radiograph, lung function testing (spirometry, airway resistance with the interrupter technique), and biological monitoring, including measurements of aluminium, chromium, and nickel in urine as well as lead in blood. Beryllium in urine was measured with a newly developed direct electrothermal atomic absorption spectroscopy technique with a measurement limit of 0.06 microgram/l. Also, cytogenetic tests (rates of micronuclei and sister chromatid exchange), and a BeLT were performed. Airborne concentrations of beryllium were measured in three factories. As no adequate local control group was available, the cutters were categorised into those with an exposure to beryls of > 4 hours/week (group A) and < or = 4 hours/week (group B).

RESULTS

Clinical, radiological, or spirometric abnormalities indicating pneumoconiosis were detected in none of the gemstone cutters. Metal concentrations in biological material were far below the respective biological limit values, and beryllium in urine was only measurable in subjects of group A. Cytogenetic investigations showed normal values which were independent of the duration of beryllium exposure. In one subject, the BeLT was positive. Beryllium stimulation indices were significantly higher in subjects with detectable beryllium in the urine than in those with beryllium concentrations below the detection limit (p < 0.05). In one factory, two out of four measurements of airborne beryllium concentrations were well above the German threshold limit value of 2 micrograms/m3 (twofold and 10-fold), and all gemstone cutters working in this factory had measurable beryllium concentrations in urine.

CONCLUSION

No adverse clinical health effects were found in this cross sectional investigation of gemstone cutters working with beryls. However, an improvement in workplace hygiene is recommended, accompanied by biological monitoring of beryllium in urine.

Combined partial trisomy 3p/monosomy 5p resulting in sonographic abnormalities

We report here a case of partial trisomy of the short arm of chromosome 3 combined with partial monosomy 5p due to malsegregation of a balanced maternal translocation t(3;5). The newborn demonstrated esophageal atresia and complex cerebral malformations. Conspicuous sonographic findings offering the chance of prenatal detection included polyhydramnios without visualization of the stomach, as well as a single umbilical artery. The child died 8 days postpartum.

Does pulsed-Doppler ultrasound have mutagenic effects? Application of the Ames mutagenicity assay to test pulsed-Doppler equipment

Measurement of fetal blood flow has been accepted using pulsed-Doppler ultrasound. Until recently, there has been a lack of investigations concerning the potential risks of this method. The possible mutagenic effect of a pulsed-Doppler system was examined in vitro by applying the Ames test. Tester strains of Salmonella typhimurium indicating point mutations were irradiated (TA 98, TA 100, TA 102, TA 1535, TA 1537, TA 1538). A commercially available duplex system was applied in the experiments emitting an ultrasound beam with a spatial-peak temporal-average of 5.2 mW/cm2 and a spatial-peak temporal-peak of 117 mW/cm2 at a frequency of 2 MHz. The tester strains were sonicated up to 60 minutes, the bacterial suspension being in direct contact with the transducer surface. The ultrasound-exposed bacterial suspensions were compared with nonexposed samples. Reference mutagens were used for checking the sensitivity of the system. The results do not indicate any mutagenic effects.

Increased genetic risk of hypertension in glomerulonephritis?

The present study was carried out to test the hypothesis that the familial risk of hypertension is elevated in individuals with glomerulonephritis. Sixty-three parents of 39 consecutive patients below the age of 50 years who were admitted with biopsy-confirmed primary glomerulonephritis (excluding familial glomerulonephritis) were examined. Of these parents, 57% had blood pressure greater than or equal to 160/95 mmHg and/or were taking antihypertensive medication (81% of hypertensives). In 138 parents of 87 controls (age- and sex-matched patients admitted to a surgical ward for trauma), hypertension was found in 32.6% (of whom 73% were on antihypertensive medication). Age, sex ratio and body mass index were comparable in both groups of parents. A similar proportion of parents of patients with glomerulonephritis (27%) and parents of controls (25%) had already died. There was no evidence of excess cardiovascular or renal mortality in either group of parents. Urinary abnormalities were found in a similar proportion of the parents of patients with glomerulonephritis (5%) and controls (8%). Although the effects of a shared environment are not formally excluded, the data are consistent with a possible increased genetic risk of hypertension in patients with primary chronic glomerulonephritis.

[Comparison of the effect of 2 therapy concepts in the treatment of Pneumocystis carinii pneumonia. Cotrimoxazole for 21 days versus sequential therapy with cotrimoxazole followed by pentamidine inhalation]

Standard therapy of pneumocystis carinii pneumonia with cotrimoxazole and intravenous pentamidine second line therapy both have a response rate of 75 to 90%. As severe side effects, myelotoxicity and skin reaction have been observed which may occur from treatment day 7 on. In order to prevent such side effects as well as reduce hospitalization times, an open, randomized pilot study was designed. Object of this study was the comparison of efficacy and safety of two different treatment schemes: standard therapy versus sequential treatment. Twelve patients were treated according to study design: five patients with cotrimoxazole only, and seven patients with sequential therapy consisting of cotrimoxazole followed by pentamidine aerosol. All patients were treated for 21 days. Four out of five patients with cotrimoxazole, and two out of seven patients with sequential therapy, were successfully treated and had no pneumocystis carinii pneumonia relapses within four weeks after termination of treatment. Each group had one treatment failure. Four patients under sequential treatment were not evaluable. - In spite of the rather unfavourable preliminary results, the study should be continued. However, patients with secondary opportunistic infections respectively other severe diseases should not be included into the study.