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Nutrition status plays a critical role in pressure injury (PI) healing and yet the available literature, especially in pediatric patients, is limited. Critically ill pediatric patients are at an increased risk of skin integrity compromise and PI development. Adequate nutritional intake can often be challenging to achieve in this population and immobility and illness present additional obstacles to maintaining skin integrity in this vulnerable population. Despite the unique nutritional challenges and needs of this group, there is no standardized approach to macro- and micronutrient management and monitoring. Here, several key vitamins and minerals believed to play a role in PI healing are discussed and an approach to nutritional management and monitoring for PI healing in pediatric patients is proposed. Registered dietitians (RD) are essential to assess individual patient macro and micronutrient requirements, to identify gaps and make recommendations to optimize nutritional therapy that may exist and impact wound healing. We used a scoping review to focus on the interplay of nutrition and PI healing and inform a multidisciplinary approach to PI identification and management. Through this review, we propose a strategy for the nutritional management of pediatric patients

The historical phylogeography of Ostrea edulis was successfully depicted in its native range for the first time using ancient DNA methods on dry shells from museum collections. This research reconstructed the historical population structure of the European flat oyster across Europe in the 1870s—including the now extinct population in the Wadden Sea. In total, four haplogroups were identified with one haplogroup having a patchy distribution from the North Sea to the Atlantic coast of France. This irregular distribution could be the result of translocations. The other three haplogroups are restricted to narrow geographic ranges, which may indicate adaptation to local environmental conditions or geographical barriers to gene flow. The phylogenetic reconstruction of the four haplogroups suggests the signatures of glacial refugia and postglacial expansion. The comparison with present-day O. edulis populations revealed a temporally stable population genetic pattern over the past 150 years despite large-scale translocations. This historical phylogeographic reconstruction was able to discover an autochthonous population in the German and Danish Wadden Sea in the late nineteenth century, where O. edulis is extinct today. The genetic distinctiveness of a now-extinct population hints at a connection between the genetic background of O. edulis in the Wadden Sea and for its absence until today.

Background: Systemic therapy is a widespread evidence-based psychotherapy approach. Its main goal revolves around the concept of viewing mental symptoms within the context of social systems (e.g., families, couples). Systematic reviews and meta-analyses have confirmed that systemic therapy significantly reduces symptom severity of DSM- or ICD-diagnosed patients. This meta-analysis aims to investigate the differential efficacy of systemic therapy, taking into account moderators (e.g., allegiance, adherence) and outcomes (system functioning) not considered in previous meta-analytical investigations.Methods: To conduct a comprehensive literature search, we will optimize search strategies from previous systematic reviews on systemic therapy. The search strategy presented in this protocol has improved the precision and sensitivity by using an iterative validation and optimization process. We will conduct the literature search in multiple electronic databases (PsycInfo, Pubmed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)). We will include all randomized controlled trials that report quantitative outcomes for symptom change and/or system functioning. For the calculations, we will conduct a Bayesian meta-analysis for the outcomes based on a random-effects model, a Bayesian meta-regression for the moderators, and Bayesian subgroup analysis for disorder-specific differences.Discussion: Understanding the differential efficacy of systemic therapy is essential for the conceptualization, performance, and analysis of future research and therapeutic practice. This meta-analysis faces potential limitations associated with the definition of systemic therapy, as well as methodological problems in systemic therapy research.

Aspergillus can cause a wide variety of diseases ranging from hypersensitivity diseases to invasive infection. Invasive disease most commonly occurs in severely immunocompromised patients such as chemotherapy-induced neutropenia and transplantation. It is a less well-recognized complication in critically ill patients without traditional risk factors. We describe a case of invasive aspergillosis complicating influenza and diabetic ketoacidosis that disseminated to the central nervous system and led to demise despite high-intensity antifungal therapy. Keywords: Aspergillus, Influenza, DKA, Disseminated, Immunocompetent

Zusammenfassung Hintergrund Erwerbsminderungsrenten (EM-Renten) stellen einen Großteil der indirekten Krankheitskosten von chronischen Rückenschmerzen dar. Methodik Auf Basis von Sekundärdaten einer gesetzlichen Krankenkasse und der gesetzlichen Rentenversicherung wurde die Dauer bis zum Eintritt einer EM-Berentung bei Erwerbstätigen mit chronischen Rückenschmerzen untersucht. Dabei wurde neben soziodemografischen Faktoren und Behandlungsmerkmalen insbesondere der Effekt einer erfolgten Rehabilitation als potentielle Einflussfaktoren untersucht. Ergebnisse Bei Rehabilitanden begann die EM-Rente im Mittel 7,1 Monate später als bei Nicht-Rehabilitanden. Daraus resultieren 8 432,60 € höhere Beitragszahlungen zugunsten der gesetzlichen Krankenkasse (GKV) und der Deutschen Rentenversicherung (DRV) pro Rehabilitand. Bezogen auf die Gesamtzahl von 21 262 EM-Rentnern mit orthopädischer Indikation können dadurch 180,7 Mio. € eingespart werden. Der Zeitpunkt der EM-Berentung wurde vom Alter und vom Krankengeldbezug im vorherigen Monat signifikant beeinflusst. Einsparungen durch die Vermeidung des Eintritts in die EM-Rente wurden dabei in diesem Modell noch nicht berücksichtigt. Schlussfolgerung Rehabilitanden beziehen später EM-Renten, wodurch länger Beitragszahlungen an die GKV und DRV geleistet werden können. Dies deutet darauf hin, dass die medizinische Rehabilitation eine kosteneffektive und wirksame Maßnahme sein kann.

OBJECTIVE Placenta accreta spectrum (PAS) is associated with significant maternal morbidity mainly related to blood loss. Pre-operative planning is aided by antenatal ultrasound and magnetic resonance imaging. We sought to assess whether three-dimensional (3D) models from MR images were accurate when compared with surgical and pathological findings. METHODS Digital Imaging and Communications in Medicine files containing MR images with varying severity of PAS (n = 4) were modeled using 3D Slicer. Placenta, bladder, and myometrial defects were modeled. Myometrial defects at three different uterine locations were included-anterior, lateral and inferior. 3D models were used to identify the relationship between the myometrial defect and the internal cervical os. Findings were validated in a larger series of PAS cases (n = 14) where patterns of invasion were compared with estimated blood loss and distance from defect to the internal os. RESULTS The defect illustrated in the four 3D models correlates to both surgical and pathological findings in terms of depth and pattern of invasion, location of defect, bladder involvement. Blood loss and topography of the defect from 3D modeling were examined in 14 further cases. Inferior defects were associated with increased blood loss compared with anterior defects. Increased distance from cervix was associated with reduced blood loss (R2 = 0.352, P = 0.01). CONCLUSION Three-dimensional models of PAS provide an accurate preoperative description of placental invasion and should be investigated as a tool for selecting patients for uterine-conserving surgery. Accurate 3D models of placenta accreta spectrum are achievable and may provide additional information, such as distance of the defect from the internal os.

In the Middle Ages, European settlements of all sizes were repeatedly affected by outbreaks of infectious diseases. Some of the outbreaks reached epidemic proportions, the second plague pandemic being the most notorious of all. A Late Medieval mass-burial site next to the Heiligen-Geist-Hospital (HGH) in Lubeck, a city of the Hanseatic League, contained the skeletal remains of more than 800 individuals assumed to have died of an infectious disease, most probably of the plague. However, Lubeck was ravaged by at least six pestilences in the 14 th century alone. We investigated ancient DNA extracts of 92 individuals from the HGH site to determine whether viral or bacterial pathogenic DNA was present that would help identify the cause of death. Metagenomic screening revealed evidence of an infection with Mi>Salmonella enterica subsp. enterica serovar Paratyphi C, suggesting an epidemic outbreak of enteric paratyphoid fever. A full reconstruction was possible for three S. Paratyphi C genomes that showed a close similarity to another strain from 1200 CE Norway. Based on radiocarbon dates, we determined the enteric paratyphoid fever outbreak in Lubeck to have occurred between 1360 and 1400 CE, historical records indicating the year 1367 CE as the most probable date. Our results also showed that the disease victims were people of northern and eastern European descent, confirming that Hanseatic Lubeck was an important trading centre for the Baltic region.

New capability for observing conditions in the upper atmosphere comes with the implementation of global ultraviolet (UV) imaging from geosynchronous orbit. Observed by the NASA GOLD mission, the emissions of atomic oxygen (OI) and molecular nitrogen (N2) in the 133&ndash, 168-nm range can be used to characterize the behavior of these major constituents of the thermosphere. Observations in the ultraviolet from the first 200 days of 2019 indicate that the oxygen emission at 135.6 nm varies much differently than the broader Lyman-Birge-Hopfield (LBH) emission of N2. This is determined from monitoring the average instrument response from two roughly 1000 km2 areas, well separated from one another, at the same time of each day. Variations in the GOLD response to UV emissions in the monitored regions are determined, both in absolute terms and relative to a running 7-day average of GOLD measurements. We find that variations in N2 emissions in the two separate regions are significantly correlated, while oxygen emissions, observed in the same fixed geographic regions at the same universal time each day, exhibit a much lower correlation, and exhibit no correlation with the N2 emissions in the same regions. This indicates that oxygen densities in the airglow-originating altitude range of 150&ndash, 200 km vary independently from the variations in nitrogen, which are so well correlated across the dayside to suggest a direct connection to variation in solar extreme-UV flux. The relation of the atomic oxygen variations to solar and geomagnetic activity is also shown to be low, suggesting the existence of a regional source that modifies the production of atomic oxygen in the thermosphere.

Summary A 5,000-year-old Yersinia pestis genome (RV 2039) is reconstructed from a hunter-fisher-gatherer (5300–5050 cal BP) buried at Riņņukalns, Latvia. RV 2039 is the first in a series of ancient strains that evolved shortly after the split of Y. pestis from its antecessor Y. pseudotuberculosis ∼7,000 years ago. The genomic and phylogenetic characteristics of RV 2039 are consistent with the hypothesis that this very early Y. pestis form was most likely less transmissible and maybe even less virulent than later strains. Our data do not support the scenario of a prehistoric pneumonic plague pandemic, as suggested previously for the Neolithic decline. The geographical and temporal distribution of the few prehistoric Y. pestis cases reported so far is more in agreement with single zoonotic events.

Las altas prevalencias de problemas de salud mental en personas LGBT han sido explicadas desde el modelo de estrés de minorías. La homolesbobitransfobia y la internalización del estigma, constituyen procesos de estrés que impactan la salud mental. Por su parte, la internalización e hipervigilancia del estigma y, el ocultamiento de la identidad sexual diversa, pueden constituir barreras para la provisión de una atención de calidad. Con el objetivo de identificar aspectos que constituyen barreras y facilitadores para la ayuda en salud mental, se re-analizaron 30 entrevistas de un estudio previo con adolescentes y jóvenes LGBT sobrevivientes de procesos de suicidio. Se empleó la codificación focalizada de la Teoría Fundamentada, desarrollando tres categorías centrales: La hipervigilancia en la ayuda psicológica, La necesidad de ayuda en el estigma internalizado, y el lugar de la orientación sexual y la identidad de género en la ayuda psicológica. Del análisis emergió el fenómeno “Tan cerca pero tan lejos”, que engloba las barreras para la provisión de ayuda psicológica y psicoterapéutica sensible a las necesidades de adolescentes y jóvenes LGBT.

The hepatitis B virus (HBV) is one of the most widespread human pathogens known today, yet its origin and evolutionary history are still unclear and controversial. Here, we report the analysis of three ancient HBV genomes recovered from human skeletons found at three different archaeological sites in Germany. We reconstructed two Neolithic and one medieval HBV genomes byde novoassembly from shotgun DNA sequencing data. Additionally, we observed HBV-specific peptides using paleo-proteomics. Our results show that HBV circulates in the European population for at least 7000 years. The Neolithic HBV genomes show a high genomic similarity to each other. In a phylogenetic network, they do not group with any human-associated HBV genome and are most closely related to those infecting African non-human primates. These ancient virus forms appear to represent distinct lineages that have no close relatives today and went possibly extinct. Our results reveal the great potential of ancient DNA from human skeletons in order to study the long-time evolution of blood borne viruses.

Background: Data concerning the effects of afternoon snacking on ingestive behavior, mood, and cognition are limited. Objective: The purpose of this study was to compare 1088 kJ of high-protein (HP) or high-fat (HF) afternoon snacks vs. no snacking on appetite, food intake, mood, and cognition in adolescents. Methods: Thirty-one healthy adolescents (age: 17 ± 1 y) consumed the following afternoon snacks (in randomized order) for 3 d: HP snack (26 g of protein/6 g of fat per 27 g of carbohydrates), HF snack (4 g of protein/12 g of fat per 32 g of carbohydrates), and no snack (NoS). On day 4 of each treatment, the participants completed an 8-h testing day containing pre- and postsnack appetite questionnaires, food cue-stimulated functional MRI brain scans, mood, cognitive function, and eating initiation. Ad libitum dinner and evening snacks were provided and assessed. Results: HP, but not HF, delayed eating initiation vs. NoS (P < 0.05). Both snacks reduced appetite vs. NoS (P < 0.001) with HP eliciting greater reductions than HF (P < 0.05). Only HF led to reductions in corticolimbic activation in brain regions controlling food motivation/reward vs. NoS (P < 0.01). Although no treatment differences in daily energy intake were detected, HP led to greater protein consumption than NoS (P < 0.05) and greater protein and lower fat consumption than HF (both, P < 0.05). HP led to fewer HF/high-sugar evening snacks than NoS (P < 0.01) and HF (P = 0.09). Although no treatment effects were detected for mood and cognition, HP tended to reduce confusion-bewilderment (P = 0.07) and increase cognitive flexibility (P = 0.09), whereas NoS reduced tension-anxiety (P < 0.05) and vigor-activity (P < 0.05). Conclusion: Afternoon snacking, particularly on HP soy foods, improves appetite, satiety, and diet quality in adolescents, while beneficially influencing aspects of mood and cognition. This trial was registered at clinicaltrials.gov as NCT01781286.

Chemokines are involved in both the negative and positive regulation of inflammatory processes, angiogenesis and cancer/cancer stem cell proliferation as well as the chemoattraction of tumor cells to metastatic sites. The aim of this study was to measure the mRNA expression levels of three chemokines, CCL2, CCL7 and CX3CL1, in soft tissue sarcomas (STSs) and to assess the correlations between these levels as well as their correlations with clinicopathological data and the disease-specific survival of STS patients. The mRNA levels of CCL2, CCL7 and CX3CL1 were analyzed in tumor tissues from 126 STS patients using qPCR. Low mRNA expression of CCL2 and CX3CL1 was significantly correlated with a worse prognosis (RR = 1.98; p = 0.019 and RR = 2.10; p = 0.014; multivariate Cox's regression analysis). A combined low expression of CCL2 and CX3CL1 was associated with a significantly increased risk of tumor-related death as compared to patients with high expression levels of both chemokines (RR = 3.08; p = 0.003). A gender-specific multivariate analysis revealed that female STS patients with low CX3CL1 mRNA expression had a 3.46-fold increased risk of death (p = 0.004). Low expression of both CCL2 and CX3CL1 mRNAs resulted in an additive 5.37-fold increased risk of tumor-related death (p = 0.003) as compared to those with high expression of both parameters in female patients. In conclusion, this is the first study to show a significant correlation between combined low expression of CCL2 and CX3CL1 and a poor prognosis for STS patients, particularly in female patients.

Respiration-related movement of organs is a complication in a range of diagnostic and interventional procedures. The development and validation of techniques to compensate for such movement requires appropriate models. Human cadavers embalmed with the Thiel method remain flexible and could provide a suitable model. In this study liver displacement during ventilation was assessed in eight Thiel embalmed cadavers, all of which showed thoracic and abdominal motion. Four cadavers displayed realistic lung behaviour, one showed some signs of pneumothorax after prolonged ventilation, one had limited filling of the lungs, and two displayed significant leakage of air into the thorax. A coronal slice containing the largest section through the liver was imaged with a real-time Fast Gradient Echo (FGR) MRI sequence: Craniocaudal displacement of the liver was then determined from a time-series of slices. The maximum liver displacement observed in the cadavers ranged from 7 to 35 mm. The ventilation applied was comparable to tidal breathing at rest and the results found for liver displacement are similar to values in the literature for respiratory motion of the liver under similar conditions. This indicates that Thiel embalmed cadavers have potential as a model for research and training in minimally invasive procedures.

Symptoms of posttraumatic stress disorder (PTSD), depression, and physical health outcomes are three of the most common health outcomes evaluated for trauma survivors and several lines of empirical and meta-analytic research have demonstrated many risk factors for PTSD. Further, examining trauma survivors’ responses through a resilience orientation has grown increasingly popular over the past decade. However, the resilience orientation has little support among adult trauma survivor populations and none when evaluating physical health as part of an integrated health index (combining PTSD, depression, and physical health outcomes). Through examination of residential fire survivors, the current project evaluates the predictive validity of protective factors of PTSD as they relate to this integrated health index. Participants were assessed via self-report and semi-structured interviews approximately 4 months post-fire. Through evaluation of the integrated health index, peritraumatic emotionality and resource loss were found to significantly predict a resilient group of residential fire survivors 4 months post-fire. The present study suggests lower sustained resource loss and lower peritraumatic emotionality are significant protective factors for resiliency from residential fire.

CCL2 is a chemokine known to recruit monocytes/macrophages to sites of inflammation. CCL2 is also associated with tumor progression in several cancer types. Recently, we showed that the N-terminus of CCL2 is modified to a pyroglutamate (pE)-residue by both glutaminyl cyclases (QC (QPCT)) and its isoenzyme (isoQC (QPCTL)). The pE-residue increases stability against N-terminal degradation by aminopeptidases. Here, we report an upregulation ofQPCTexpression in tissues of patients with thyroid carcinomas compared with goiter tissues, whereasQPCTLwas not regulated. In thyroid carcinoma cell lines,QPCTgene expression correlates with the mRNA levels of its substrateCCL2. BothQPCTandCCL2are regulated in a NF-κB-dependent pathway shown by stimulation with TNFa and IL1b as well as by inhibition with the IKK2 inhibitor and RNAi ofp50. In the culture supernatant of thyroid carcinoma cells, equal amounts of pECCL2 and total CCL2 were detected by two ELISAs discriminating between total CCL2 and pECCL2, concluding that all CCL2 is secreted as pECCL2. Activation of the CCL2/CCR2 pathway by recombinant CCL2 increased tumor cell migration of FTC238 cells in scratch assays as well as thyroid carcinoma cell-derived CCL2-induced migration of monocytic THP1 cells. Suppression of CCL2 signaling by CCR2 antagonist, IKK2 inhibitor, andQPCTRNAi reduced FTC238 cell growth measured by WST8 proliferation assays. Our results reveal new evidence for a novel role of QC in thyroid carcinomas and provide an intriguing rationale for the use of QC inhibitors as a means of blocking pECCL2 formation and preventing thyroid cancer metastasis.

The time course and cellular localization of myostatin expression following musculoskeletal injury are not well understood; therefore, the authors evaluated the temporal and spatial localization of myostatin during muscle and bone repair following deep penetrant injury in a mouse model. They then used hydrogel delivery of exogenous myostatin in the same injury model to determine the effects of myostatin exposure on muscle and bone healing. Results showed that a “pool” of intense myostatin staining was observed among injured skeletal muscle fibers 12–24 hr postsurgery and that myostatin was also expressed in the soft callus chondrocytes 4 days following osteotomy. Hydrogel delivery of 10 or 100 µg/ml recombinant myostatin decreased fracture callus cartilage area relative to total callus area in a dose-dependent manner by 41% and 80% ( p

Recent studies suggest that whole-body vibration (WBV) can improve measures of bone health for certain clinical conditions and ages. In the elderly, there also is particular interest in assessing the ability of physical interventions such as WBV to improve coordination, strength, and movement speed, which help prevent falls and fractures and maintain ambulation for independent living. The current study evaluated the efficacy of WBV in an aging mouse model. Two levels of vibration--0.5 and 1.5g--were applied at 32Hz to CB57BL/6 male mice (n=9 each) beginning at age 18 months and continuing for 12 weeks, 30 min/day, in a novel pivoting vibration device. Previous reports indicate that bone parameters in these mice begin to decrease substantially at 18 months, equivalent to mid-fifties for humans. Micro-computed tomography (micro-CT) and biomechanical assessments were made in the femur, radius, and lumbar vertebra to determine the effect of these WBV magnitudes and durations in the aging model. Sera also were collected for analysis of bone formation and breakdown markers. Mineralizing surface and cell counts were determined histologically. Bone volume in four regions of the femur did not change significantly, but there was a consistent shift toward higher mean density in the bone density spectrum (BDS), with the two vibration levels producing similar results. This new parameter represents an integral of the conventional density histogram. The amount of high density bone statistically improved in the head, neck, and diaphysis. Biomechanically, there was a trend toward greater stiffness in the 1.5 g group (p=0.139 vs. controls in the radius), and no change in strength. In the lumbar spine, no differences were seen due to vibration. Both vibration groups significantly reduced pyridinoline crosslinks, a collagen breakdown marker. They also significantly increased dynamic mineralization, MS/BS. Furthermore, osteoclasts were most numerous in the 1.5 g group (p≤ 0.05). These findings suggest that some benefits of WBV found in previous studies of young and mature rodent models may extend to an aging population. Density parameters indicated 0.5 g was more effective than 1.5 g. Serological markers, by contrast, favored 1.5 g, while biomechanically and histologically the results were mixed. Although the purported anabolic effect of WBV on bone homeostasis may depend on location and the parameter of interest, this emerging therapy at a minimum does not appear to compromise bone health by the measures studied here.

Myostatin (GDF-8) is known as a potent inhibitor of muscle growth and development, and myostatin is also expressed early in the fracture healing process. The purpose of this study was to test the hypothesis that a new myostatin inhibitor, a recombinant myostatin propeptide, can enhance the repair and regeneration of both muscle and bone in cases of deep penetrant injury.We used a fibula osteotomy model with associated damage to lateral compartment muscles (fibularis longus and brevis) in mice to test the hypothesis that blocking active myostatin with systemic injections of a recombinant myostatin propeptide would improve muscle and bone repair. Mice were assigned to two treatment groups after undergoing a fibula osteotomy: those receiving either vehicle (saline) or recombinant myostatin propeptide (20 mg/kg). Mice received one injection on the day of surgery, another injection 5 days after surgery, and a third injection 10 days after surgery. Mice were killed 15 days after the osteotomy procedure. Bone repair was assessed using microcomputed tomography (micro-CT) and histologic evaluation of the fracture callus. Muscle healing was assessed using Masson trichrome staining of the injury site, and image analysis was used to quantify the degree of fibrosis and muscle regeneration.Three propeptide injections over a period of 15 days increased body mass by 7% and increased muscle mass by almost 20% (p0.001). Micro-CT analysis of the osteotomy site shows that by 15 days postosteotomy, bony callus tissue was observed bridging the osteotomy gap in 80% of the propeptide-treated mice but only 40% of the control (vehicle)-treated mice (p0.01). Micro-CT quantification shows that bone volume of the fracture callus was increased by ∼ 30% (p0.05) with propeptide treatment, and the increase in bone volume was accompanied by a significant increase in cartilage area (p = 0.01). Propeptide treatment significantly decreased the fraction of fibrous tissue in the wound site and increased the fraction of muscle relative to fibrous tissue by 20% (p0.01).Blocking myostatin signaling in the injured limb improves fracture healing and enhances muscle regeneration. These data suggest that myostatin inhibitors may be effective for improving wound repair in cases of orthopaedic trauma and extremity injury.

Zusammenfassung Bei einer 34-jahrigen Frau entwickelte sich 5 Tage nach Sturz auf beide Kniee am linken Knie eine oberflachliche Dermatomykose, die zunachst als oberflachliche Trichophytie diagnostiziert wurde. Da in der Pilzkultur Mikrosporum gypseum nachgewiesen wurde, muste die Diagnose in „oberflachliche Mikrosporie” revidiert werden. Auf Grund der Bestimmungen des Bundesseuchengesetzes wurde die Erkrankung dem zustandigen Gesundheitsamt gemeldet. Unter Behandlung mit Griseofulvin heilte die oberflachliche Mikrosporie vollstandig aus, nachdem durch Tonoftal® bereits eine eindeutige Besserung erzielt war. Die oberflachliche Gypseum-Mikrosporie ist charakterisiert durch die ausgesprochen scharfe Begrenzung der geroteten, gelegentlich starker infiltrierten Herde mit einem papulosen, teilweise auch vesikulosen oder pustulosen Randsaum. Die Infektion kommt im allgemeinen durch Kontakt mit dem Erdboden zustande; die Inkubationszeit betragt 4–5 Tage. Der Infektionsmodus sollte Veranlassung zur Uberprufung der strengen Bestimmungen des Bundesseuchengesetzes fur Erkrankungen durch Mikrosporum gypseum und seine nahen Verwandten geben.

Artificial heart valves comprising metal can cause significant MR image artifacts due to the material (susceptibility artifact) and/or electromagnetic characteristics (RF artifact). The purpose of our study was to examine current commercially available heart valve prostheses, integrate resonant circuits and to produce a prototype self-expanding heart valve for MRI-guided placement. Different types of commercially available heart valves were tested in MRI. Freshly excised porcine heart valves were sutured with 6-0 prolene into a 21 mm Nitinol stent. Resonant circuits were integrated into the heart valves and tuned to the Larmor frequency of the MRI (42.58 MHz for 1.0 T and about 64 MHz for 1.5 T and 128 MHz for 3T). The artifacts caused by the non-ferromagnetic heart valves and the Nitinol stent could be overcome. MRI signal could be enhanced using low flip angles

Myostatin (GDF-8) is a negative regulator of skeletal muscle growth and mice lacking myostatin show increased muscle mass. We have previously shown that myostatin deficiency increases bone strength and biomineralization throughout the skeleton, and others have demonstrated that myostatin is expressed during the earliest phase of fracture repair. In order to determine the role of myostatin in fracture callus morphogenesis, we studied fracture healing in mice lacking myostatin. Adult wild-type mice (+/+), mice heterozygous for the myostatin mutation (+/−), and mice homozygous for the disrupted myostatin sequence (−/−) were included for study at two- and four-weeks following osteotomy of the fibula. Expression of Sox-5 and BMP-2 were significantly upregulated in the fracture callus of myostatin-deficent (−/−) mice compared to wild-type (+/+) mice at two-weeks following osteotomy. Fracture callus size was significantly increased in mice lacking myostatin at both two- and four-weeks following osteotomy, and total osseous tissue area and callus strength in three-point bending were significantly greater in myostatin −/− mice compared to myostatin +/+ mice at four weeks post-osteotomy. Our data suggest that myostatin functions to regulate fracture callus size by inhibiting the recruitment and proliferation of progenitor cells in the fracture blastema. Myostatin deficiency increases blastema size during the early inflammatory phase of fracture repair, ultimately producing an ossified callus having greater bone volume and greater callus strength. While myostatin is most well known for its effects on muscle development, it is also clear that myostatin plays a significant, direct role in bone formation and regeneration.

This article will serve as a forum for two graduate students enrolled in Virginia Tech's clinical psychology doctoral program to discuss their experiences on the day of the shootings of April 16, 2007, describing both their personal reactions to the events as well as the playing out of their professional roles immediately following the shootings. Topics discussed include therapeutic clinical work carried out with survivors and family members of the victims on the day of the shootings, clinical work with ongoing patients affected by the shootings, the gathering and developing of training materials for clinicians, teaching courses in the wake of the shootings, and completing assessments of members of the Virginia Tech community for the University's needs-based assessment. The article concludes with a discussion of lessons learned and recommendations for future community disaster relief. Language: en

The receptor for advanced glycation end products (RAGE) is a member of the immunoglobulin superfamily that has multiple ligands and is implicated in the pathogenesis of various diseases, including diabetic complications, neurodegenerative disorders, and inflammatory responses. However, the role of RAGE in normal physiology is largely undefined. Here, we present evidence for a role of RAGE in osteoclast maturation and function, which has consequences for bone remodeling. Mice lacking RAGE had increased bone mass and bone mineral density and decreased bone resorptive activity in vivo. In vitro–differentiated RAGE-deficient osteoclasts exhibited disrupted actin ring and sealing zone structures, impaired maturation, and reduced bone resorptive activity. Impaired signaling downstream of αvβ3 integrin was observed in RAGE−/− bone marrow macrophages and precursors of OCs. These results demonstrate a role for RAGE in osteoclast actin cytoskeletal reorganization, adhesion, and function, and suggest that the osteosclerotic-like phenotype observed in RAGE knockout mice is due to a defect in osteoclast function.

The [URE3] yeast prion is a self-propagating inactive form of the Ure2 protein. Ure2p is composed of two domains, residues 1-93, the prion-forming domain, and the remaining C-terminal part of the protein, which forms the functional domain involved in nitrogen catabolite repression. In vitro, Ure2p forms amyloid filaments that have been proposed to be the aggregated prion form found in vivo. Here we showed that the biochemical characteristics of these two species differ. Protease digestions of Ure2p filaments and soluble Ure2p are comparable when analyzed by Coomassie staining as by Western blot. However, this finding does not explain the pattern specifically observed in [URE3] strains. Antibodies raised against the C-terminal part of Ure2p revealed the existence of proteolysis sites efficiently cleaved when [URE3], but not wild-type crude extracts, were submitted to limited proteolysis. The same antibodies lead to an equivalent digestion pattern when recombinant Ure2p (either soluble or amyloid) was analyzed in the same way. These results strongly suggest that aggregated Ure2p in [URE3] yeast cells is different from the amyloid filaments generated in vitro.

Direct imaging of the magnetosphere by instruments on the IMAGE spacecraft is supplemented by simultaneous observations of the global aurora in three far ultraviolet (FUV) wavelength bands. The purpose of the multi-wavelength imaging is to study the global auroral particle and energy input from the magnetosphere into the atmosphere. This paper describes the method for quantitative interpretation of FUV measurements. The Wide-Band Imaging Camera (WIC) provides broad band ultraviolet images of the aurora with maximum spatial resolution by imaging the nitrogen lines and bands between 140 and 180 nm wavelength. The Spectrographic Imager (SI), a dual wavelength monochromatic instrument, images both Doppler-shifted Lyman-α emissions produced by precipitating protons, in the SI-12 channel and OI 135.6 nm emissions in the SI-13 channel. From the SI-12 Doppler shifted Lyman-α images it is possible to obtain the precipitating proton flux provided assumptions are made regarding the mean energy of the protons. Knowledge of the proton (flux and energy) component allows the calculation of the contribution produced by protons in the WIC and SI-13 instruments. Comparison of the corrected WIC and SI-13 signals provides a measure of the electron mean energy, which can then be used to determine the electron energy flux. To accomplish this, reliable emission modeling and instrument calibrations are required. In-flight calibration using early-type stars was used to validate the pre-flight laboratory calibrations and determine long-term trends in sensitivity. In general, very reasonable agreement is found between in-situ measurements and remote quantitative determinations.

Background Periodontitis is a chronic inflammatory disease triggered by the host immune response. Epigenetic modifications also affect the immune response. We assessed CpG methylation in 22 inflammatory candidate genes (ATF2, CCL25, CXCL14, CXCL3, CXCL5, CXCL6, FADD, GATA3, IL10RA, IL12A, IL12B, IL13, IL13RA1, IL15, IL17C, IL17RA, IL4R, IL6R, IL6ST, IL7, INHA, and TYK2) with respect to the occurrence of aggressive periodontitis (AgP). Patients and methods In this study 15 AgP patients (53.3% males, 41.4 ± 10.5 years) and 10 controls (40.0% males, 36.9 ± 17.5 years) were included. The methylation patterns of gingival biopsies were quantified using EpiTect® Methyl Signature PCR Array Human Inflammatory Response. Results In gingival biopsies taken from patients with AgP, CpG methylation of CCL25 (1.73% vs. 2.59%, p = 0.015) and IL17C (6.89% vs. 19.27%, p = 0.002) was significantly reduced as compared with periodontally healthy tissues. Discussion We showed for the first time a differential methylation pattern for CCL25 and IL17C in periodontitis. CCL25 plays an important role in T-cell development, whereas IL17C regulates innate epithelial immune responses. The decrease in CpG methylation is presumably accompanied by an increase in gene expression. This could lead to a greater availability of CCL25 and interleukin 17C and support periodontal loss of attachment.

16 pages; International audience; Large-scale production and incorporation of titanium dioxide nanoparticles (NP-TiO2 ) in consumer products leads to their potential release into the environment and raises the question of their toxicity. The bactericidal mechanism of NP-TiO2 under UV light is known to involve oxidative stress due to the generation of reactive oxygen species. In the dark, several studies revealed that NP-TiO2 can exert toxicological effects. However, the mode of action of these nanoparticles is still controversial. In the present study, we used a combination of fluorescent probes to show that NP-TiO2 causes Escherichia coli membrane depolarization and loss of integrity, leading to higher cell permeability. Using both transcriptomic and proteomic global approaches we showed that this phenomenon translates into a cellular response to osmotic stress, metabolism of cell envelope components and uptake/metabolism of endogenous and exogenous compounds. This primary mechanism of bacterial NP-TiO2 toxicity is supported by the observed massive cell leakage of K(+) /Mg(2+) concomitant with the entrance of extracellular Na(+) , and by the depletion of intracellular ATP level.

A methodological framework is introduced to assess and compare a conventional fluoroscopy protocol for peripheral angioplasty with a new magnetic resonant imaging (MRI)-guided protocol. Different scenarios were considered during interventions on a perfused arterial phantom with regard to time-based and cognitive task analysis, user experience and ergonomics. Three clinicians with different expertise performed a total of 43 simulated common iliac angioplasties (9 fluoroscopic, 34 MRI-guided) in two blocks of sessions. Six different configurations for MRI guidance were tested in the first block. Four of them were evaluated in the second block and compared to the fluoroscopy protocol. Relevant stages’ durations were collected, and interventions were audio-visually recorded from different perspectives. A cued retrospective protocol analysis (CRPA) was undertaken, including personal interviews. In addition, ergonomic constraints in the MRI suite were evaluated. Significant differences were found when comparing the performance between MRI configurations versus fluoroscopy. Two configurations [with times of 8.56 (0.64) and 9.48 (1.13) min] led to reduce procedure time for MRI guidance, comparable to fluoroscopy [8.49 (0.75) min]. The CRPA pointed out the main influential factors for clinical procedure performance. The ergonomic analysis quantified musculoskeletal risks for interventional radiologists when utilising MRI. Several alternatives were suggested to prevent potential low-back injuries. This work presents a step towards the implementation of efficient operational protocols for MRI-guided procedures based on an integral and multidisciplinary framework, applicable to the assessment of current vascular protocols. The use of first-user perspective raises the possibility of establishing new forms of clinical training and education.

Essential Tremor (ET) is the most common movement disorder among adults. This paper presents a device to induce the effects of ET in the wrists and hands of otherwise healthy research participants for use in inclusive design studies. The device, called “The HandShake,” reproduces the functional impairment of ET sufferers on design study participants. Existing solutions can require complex or expensive equipment. The HandShake uses a novel low-cost system based around a single RC servo. Users of the device in validation testing were found to be impaired in a manner similar to ET sufferers. This tool is intended to aid future inclusive design research regarding upper extremity disabilities. We present results regarding the validity of the simulated tremors versus data from those suffering with ET.Copyright © 2014 by ASME

Background Transfusion-associated circulatory overload (TACO) is the second leading cause of reported transfusion-related fatalities in the United States. While its occurrence has been previously investigated after red cell and plasma transfusion, no data are available regarding its association with platelet transfusion. Our goal was to determine the rate of platelet-associated TACO at our university medical centre. Study Design and Methods This study had retrospective and prospective analyses. The 13-year retrospective analysis served to determine the historical rate of platelet-associated TACO by passive reporting. The 30-day prospective analysis included active surveillance of all non-emergently issued and non-operative platelet recipients ≥16 years old with no transfusions in the previous 6 h determined by analysis of blood bank product issue records. Data collected included demographics, vital signs pre- and posttransfusion, fluid balances, supplemental oxygen use, reports of dyspnoea, and infusion rates. For the prospective analysis, all variables were collected within 24 h of transfusion from the medical record and, when necessary, interviews with care providers and/or patients. Results In the retrospective analysis, 366 reactions were reported, of which 6 (1·6%) were TACO. The historical rate of TACO was 1:5997 transfused platelet units. During the prospective analysis, 225 eligible patients received a total of 334 units of platelets. The average platelet transfusion volume was 261 ± 26 ml, and the average infusion rate was 391 ± 198 ml/h. Two unreported TACO reactions were discovered and characterized by new-onset hypertension, crackles on lung auscultation, dyspnoea, hypoxia and supplemental oxygen requirements which resolved completely with diuresis. The rate of TACO during this prospective analysis was 1:167 transfused platelet units. Conclusion Platelet-associated TACO is greatly underestimated by passive reporting in the adult patient population.

Following the Interpol standard is one of the primary methods to identify unknown persons the forensic molecular analysis of samples taken from the victims. In many cases of the routine case work these persons were found in a stadium of high decomposition after a long time. Following the recommendations of the ISFG bone samples have to investigate.

Heart transplantation has become an established procedure for the treatment of terminal heart failure. However, due to a shortage of donor organs, the waiting period for a donor organ is increasing. Cross-sectional and retrospective studies have indicated that there is tremendous psychological distress during this waiting period. The aim of this study was to assess this phase systematically and longitudinally. At the beginning of their waiting period, 62 patients at the Heidelberg Transplantation Centre were examined with regard to their physical complaints, quality of life, and level of depression. Four months later the remaining 42 patients were re-examined. The sample showed a significant increase (p

There is evidence that activation of coagulation by influencing tumour biology may have impact on clinical course of lung cancer.We measured the activation markers thrombin-antithrombin complex (TAT) and prothrombin fragment F1 + 2 in 99 lung cancer patients immediately after diagnosis, before antineoplastic treatment. Outcome was assessed at the end of appropriate standard primary therapy (four to six courses of chemotherapy, surgery or radiation).The activation markers (means +/- SEM) were lower in the 33 responders (RSP; complete or partial remission) than in the 66 non-responders (NRSP): TAT 3.96 +/- 0.48 vs. 9.69 +/- 1.57 micrograms/l (P0.001), and F1 + 2 1.09 +/- 0.09 vs. 1.64 +/- 0.25 nmol/l (P0.05). TAT levels were6 micrograms/l in 30 of 66 (45%) NRSP, but only 4 of 33 (12%) RSP. 88% of patients with TATor = 6 micrograms/l achieved remission, and 45% with TAT6 micrograms/l (P = 0.0014). In the subgroup of 46 patients with advanced disease, the six RSP showed lower TAT than the 40 NRSP: 4.65 +/- 0.94 vs. 11.92 +/- 2.49 micrograms/l (P0.01); one of six (17%) RSP, but 21 of 40 (53%) NRSP showed TAT6 micrograms/l. These data suggest that in lung cancer the activation of coagulation is an independent prognostic factor, since TAT levels were different between RSP and NRSP, also within the homogeneously unfavourable metastatic subgroup. It should be further studied, whether TAT can identify patients, whose prognosis could be improved by anticoagulation as an adjunct to standard antineoplastic therapy.

Auto anti-N is infrequently encountered and, in most reported cases, does not cause clinical hemolysis. This case reports an auto anti-N associated with severe hemolytic anemia (Hb = 2.7 g/dL) in a 6-year-old Caucasian girl with a history of vomiting, fever, and abdominal pain. Upon admission, she was found to have a metabolic acidosis, secondary to her severe anemia, with abnormal liver function tests. As in three other case reports, the autoimmune hemolytic anemia resolved, with disappearance of the auto anti-N, after corticosteroid therapy. Immunohematology 2005, 21:63–65.

HumTH01 is reported to be associated with arterial hypertension (HT). As forensic polymorphisms must not reveal information about the personality of the tested individual in Germany, this finding is a potential obstacle for applying this locus to casework. We thus tested whether HumTH01 is associated with myocardial hypertrophy or with increased incidence of blood pressure (BP)-related diseases such as myocardial infarction. As we found no influence, it is argued that the use of TH01 for forensic purposes is legitimate.

Lung cancer is associated with an increased incidence of thrombosis. An activation of coagulation is demonstrable in lung cancer patients by sensitive activation markers, as well as a stimulation of neutrophil granulocytes, which are known to interfere with hemostasis, e.g., by degrading inhibitory proteins. We assessed antigen level, amidolytic activity, and clotting activity of the plasma anticoagulant protein C and the activation markers thrombin-antithrobin complex (TAT) and neutrophil elastase-α1-antitrypsin complex (EAT) in 67 lung cancer patients before antineoplastic treatment was begun. The protein C clotting activity was lower (p = 0.010) in the patients with extensive than in those with limited disease. However, the median levels remained within the normal range in both groups (91 vs. 108% of normal). The median amidolytic activity levels (110 vs. 117% of normal ; NS) were higher than the protein C antigen levels (82 vs. 77% of normal; NS) in- both groups. There was no significant correlation of protein C measurements with TAT levels, but there were significant negative correlations between EAT and protein C clotting activity and antigen level. The data suggest that in patients with lung cancer, there may be an alteration of the protein C molecule, which reduces antigen level and impairs clotting activity without affecting amidolytic activity. The negative correlation with EAT levels might point to limited degradation of protein C by neutrophil enzymes, leading to partial loss of epitopes detected by the immunologic determination and of structures necessary for the biologic effect of protein C upon clotting time. Further studies should clarify whether such a modification of protein C could contribute to the increased incidence of thrombosis in lung cancer patients. Key Words: Lung cancer-Neutrophil elastase-Protein C.

Proteolytic enzymes by polymorphonuclear leukocytes such as elastase may contribute to the pathogenesis of acute cerebral ischemia. We measured elastase α1-protease inhibitor complexes (EIC

There was an error in the funding statement. The correct funding statement is: The research was supported by the National Science Foundation (Grant no. 0347960 to LRG). MGS was funded in part by the European Community's Seventh Framework Programme (FP7/2007-2013; http://cordis.europa.eu/fp7) [^] under grant agreement n° 235897 and the Spanish Ministry of Science and Innovation (CGL2009-07301-BOS). The authors are grateful for a grant provided to CHC from Consejo Nacional de Ciencia y Tecnologia (Scholarship No. 95802). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.