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The COVID 19 pandemic was declared on the 9th of March 2020. The health crisis affected the whole world with a very high and unexpected number of infected people. The situation forced the declaration of lockdown and a worldwide health system reorganization. Surprisingly, the social distancing laws caused a reduction of urgent hospital activities not COVID 19 related. The aim of this manuscript is to analyze the reasons why fewer emergencies were described during the 2020 Italian lockdown. The Data reporting urgent Emergency Room (ER) activity, during the first three weeks of the Italian lockdown (Group 1), were analyzed and compared with the same period in 2019 (Group 2). During the study period in 2020, there was a 46,5% reduction in ER activity compared to that in 2019. Nevertheless, the hospitalization rate was higher in the 2020 then in 2019 (p

Background: Delayed gastric emptying (DGE) is a common complication after esophagectomy with gastric tube reconstruction. It is still unclear whether a pyloric drainage procedure might reduce the r...

Social belonging is an important human drive that influences mood and behavior. Neural responses to social exclusion are well-characterized, but the specificity of these responses to processing rejection-related affective distress is unknown. The present study compares neural responses to exclusion and over-inclusion, a condition that similarly violates fairness expectations but does not involve rejection, with a focus on implications for models of dorsal anterior cingulate cortex (dACC) and anterior insula (AI) function. In an fMRI adaptation of the Cyberball paradigm with adolescents 11.1-17.7 years of age (N=69), we employed parametric modulators to examine scaling of neural signal with cumulative exclusion and inclusion events, an approach that overcomes arbitrary definitions of condition onsets/offsets imposed on fluid, continuous gameplay. We identified positive scaling of dACC and posterior insula response with cumulative exclusion events, but these same regions exhibited trending signal decreases with cumulative inclusion events. Furthermore, areas within the dACC and insula also responded to context incongruency (throws to the participant in the exclusion run; throws between computer players in the over-inclusion run). Taken together, these findings caution against interpretations that responses in these regions uniquely reflect aspects of affective distress within social rejection paradigms. We further identified that the left ventrolateral PFC, rostromedial PFC, and left intraparietal sulcus responded similarly to cumulative exclusion and inclusion. These findings shed light on which neural regions exhibit patterns of differential sensitivity to exclusion or over-inclusion, as well as those that are more broadly engaged by both types of social interaction.

Background Although pathological complete response (pCR) after multimodal treatment for esophageal cancer is associated to the best prognosis, recurrence may occur in 20–40% of cases. The present study investigated the recurrence pattern and predictive factors of recurrence after pCR in patients with esophageal cancer. Methods In this study, 427 patients received preoperative treatment for either esophageal squamous cell carcinoma (SCC) or adenocarcinoma at Verona University Hospital between 2000 and 2018. Of these, 145 patients (34%) achieved a pCR. Long-term prognosis, recurrence pattern, and risk factors for relapse in pCR patients were analysed. Results During a median follow-up of 52 months, 37 relapses (25.5%) occurred, mostly at distant level (n = 28). Nearly all locoregional relapses (8/9) were detected in SCC cases. The 5-year overall survival and cancer-related survival were 71.7% (95% confidence interval [CI] 62.6–78.9%) and 77.5% (95% CI 68.5–84.2%) respectively. Male sex, higher body mass index, and cT4 were significant risk factors for recurrence at univariate analysis. The multivariate analysis confirmed the role of cT4 as predictor of recurrence only in SCCs. Conclusions Esophageal cancer recurs in about one-fourth of pCR cases. A fair number of local recurrences occurs in SCCs, but the main problem is the systemic disease control. According to our analysis, SCCs patients with cT4 stage have an increased risk to recur, so they should be managed differently by a personalized approach in terms of adjuvant treatment and follow-up.

Surgery is the cornerstone of the treatment for esophageal cancer, either alone or as a part of a multimodal approach including chemotherapy and radiotherapy. Despite the improvements in surgical techniques, esophagectomy remains a high-risk surgical procedure. In the last few decades, a large body of evidence has suggested the relationship between high surgical volume and better clinical outcomes, with lower mortality and morbidity rates. Experience of the surgeon and all care providers plays an important role during operation and perioperative period. For instance, an expert surgeon is more confident in promptly recognizing and treating postoperative complications, also involving several care processes. Additionally, a multidisciplinary board is more frequently present in a high-volume center and its evaluation is mandatory to define an appropriate oncological pathway. Despite this evidence, the centralization of esophageal surgery has actually taken place in only few healthcare systems and a clear threshold for high volume is not yet widely defined. In Italy the absence of a formal centralization policy has resulted in a heterogeneous situation and the only efforts towards centralization come from the initiative of the single regions, as in the case of the diagnostic, therapeutic and care pathways (PDTA) available in the Veneto Region.

Background Boerhaave’s syndrome (BS) is a rare life-threating condition with poor prognosis. Unfortunately, due to its very low incidence, no clear evidences or definitive guidelines are currently available: in detail, surgical strategy is still a matter of debate. Most of the case series reports thoracic approach as the most widely used; conversely, transhiatal abdominal management is just described in sporadic case reports. In our center, the laparoscopic approach has been adopted for years: in the present study, we aim to show his feasibility by reporting the outcomes of the largest clinical series available to date. Methods Clinical records of patients admitted for BS to the General and Upper GI Surgery Division of Verona from February 2014 to December 2019 were retrospectively collected. Clinico-pathological characteristics, preoperative workup, surgical management, and outcomes were analyzed. Results Seven patients were admitted; epigastric/thoracic pain and vomiting were the most frequent symptoms at diagnosis. Laboratory findings were not specific; conversely, radiological imaging always revealed abnormal findings: particularly, CT had excellent sensitivity in detecting signs of esophageal perforation. All but one case had diagnostic workup and received surgery within 24 h. Every patient had laparoscopic transhiatal direct suture and gastric valve; 2 patients (28.6%) also needed a thoracoscopic toilette. Postoperative complications occurred in 4 patients (57%), but in only two of them (29%), the complication was severe according to Clavien-Dindo classification (both received thoracentesis or thoracic drainage for pleural effusion). Of note, no cases of postoperative esophageal leak were recorded. Postoperative mortality was 14% due to one patient who died for cardiovascular complications. Most of the patients (71.4%) were admitted to ICU after surgery (average length, 8.8 days); mean hospital stay was 14.7 days. No patients had readmissions. Conclusions To our knowledge, this is the largest case series reporting laparoscopic management of BS. We show that laparoscopy is a safe and feasible approach associated with a shorter length of hospital stay when compared with clinical series in which thoracic approach had been chosen. Of note, laparoscopic management would be easily adopted by surgical centers treating benign gastro-esophageal junction entailing a proper management more widely.

Enhanced recovery protocols (ERP) have demonstrated their efficacy after esophagectomy and gastrectomy but little is known about their feasibility and safety in elderly patients. Patients submitted to Ivor-Lewis esophagectomy or gastrectomy for cancer between January 2016 and June 2019 were divided into three age groups: young-age group, YG (≤ 65 years, n = 130); middle-age group, MG (66–74 years, n = 101); old-age group, OG (≥ 75 years, n = 74). The groups were compared for adherence to our ERP, morbidity and mortality rates. After esophagectomy, adherence to ERP was comparable between the three groups, overall morbidity was higher in OG, without statistically significant difference, while the incidence of cardiac complications was significantly higher in OG (p = 0.02). After gastrectomy, OG presented a lower adherence to urinary catheter removal and to early mobilization. No difference in overall morbidity rate was observed (p = 0.13). The median length of stay was comparable both after esophagectomy (p = 0.075) and gastrectomy (p = 0.07). Multivariable analysis showed that age ≥ 75 years was not associated with a higher risk of ERP failure either after esophagectomy (p = 0.59) or after gastrectomy (p = 0.83). After esophagectomy, the risk of failure of the ERP program was higher for patients with ASA grade 3–4 (p = 0.03) and for those with postoperative complications (p

Background Chyle leak is a rare but life-threatening complication after esophagectomy. In Literature is reported a mortality rate up to 40% in case chyle leak after esophageal surgery. In case of re-operation, ligature of the chyle duct is mandatory. However, chyle duct identification can be difficult. To our knowledge, in Literature are reported only two cases of chyle duct identification through ICG visualization. We present the case of a 66 years old male patient who underwent to a totally mini-invasive McKeown esophagectomy for a locally advanced esophageal adenocarcinoma, after neoadjuvant chemo-radiotherapy. In 2nd post-operative day (POD) we observed a chylous debt from the thoracic drain, sign of chyle leak. A first conservative approach was tempted, with a nihil-per-os regimen and total parenteral nutrition, with a significant reduction in drain output. However, at the resumption of oral intake, we observed a new increase of drain output. We therefore decided to re-operate the patient to seal the leak. On POD 15 the patient was submitted to a new thoracoscopy, with previous inguinal green indocyanine infiltration. During the thoracoscopy, the ICG allowed to safely identify the chyle duct and to proceed to its selective ligation. During the following days the patient’s clinical state progressively improved, allowing to restore oral feeding in POD3. No chyle debt was attested from the drainage, removed in POD 5. The patients was dismissed the next day. In our opinion, this is a promising application for the ICG technique.

Background In dedicated centres ERAS (Enhanced Recovery After Surgery) programs have been successfully applied after esophageal surgery. However, some concerns have been raised about the feasibility of these protocols in elderly patients. Methods We retrospective reviewed 72 patients submitted to Ivor-Lewis esophagectomy in our Institution, during the period 2015-2017. We divided the patients into two groups: 47 patients (65,3%) were Results The two groups were not different in terms of overall morbidity rate (53,2% in YG vs 60,0% in EG p= 0,6) and pulmonary complications rate (70,2% in YG vs 72,0% in EG, p= 1). EG showed a higher cardiac complications rate (3,5% in YG vs 26,7% in EG, p=0,001). We did not report 90-days mortality. We did not observe differences in adherence to the following ERAS steps: pre-operative carbohydrate load administration (78,7% in YG vs 76,0% in EG, p=0,7), ward transfer on POD 0 (61,7% in YG vs 48,0% in EG, p=0,32), removal of naso-gastric tube on POD 1 (87,2% in YG vs 96,0% in EG, p=0,4), resume of liquid diet on POD 1 (55,3% in YG vs 56,0% in EG, p=1), urinary catheter removal on POD 2 (61,7% in YG vs 48,0% in EG, p=0,3), fully mobilization on POD 3 (63,8% in YG vs 52,0% in EG, p=0,4), resume of soft diet on POD 4 (72,3% in YG vs 68,0% in EG, p=0,7), discharge on POD 7 (48,9% in YG vs 40,0% in EG, p=0,6). Median day of discharge was POD 8 for both groups (p= 0,8). Conclusions In high-volume centres ERAS protocols can be safely applied to elderly patients undergoing esophagectomy.

Aim investigate factors influencing the choice of neoadjuvant treatment type in the real world, analyzing our single high-volume center experience. Background & Methods The neoadjuvant chemoradiotherapy is the standard of care for esophageal cancer [1-2]. This consensus stems from the results of CCT performed on highly selected patients. However, the best treatment for non-selected patients remains unclear. In our clinical practice the treatment considered the goal standard is a TCF with 50GyRT [3-4-5], which showed an R0 resection rate of 88% and 5 y OS of 43%, better than CROSS trial. Despite these results, since 2012 not all patients underwent the same ideal treatment. We analyzed a real life patients group, that from the oncological point of view, they would be treated with our protocol in an intention to treat setting. Results From 2012 to 2017, 244 patients were treated. Analyzing retrospectively our data, it emerges that we have chosen the therapeutic strategy based on patient's characteristics: those aged over 75 yrs or with severe comorbidities were addressed to a “weakened” treatment: 37 with chemotherapy, 24 with radiotherapy and 55 with concomitant chemoradiotherapy different from our protocol. 125 with our protocol. Further selection involved lymph node status and patients with lymph node involvement (>N2 were referred to chemotherapy. The results confirmed that the protocol achieves better results in pathological response (pT0N0 in protocol 40,8% vs 18.2% in standard chemoradiotherapy – p value Conclusion Chemoradiotherapy is currently the gold standard of treatment but it cannot be consider the only treatment, especially for real life patients, less ideal but still requiring treatment. Clinical trials are certainly useful in providing information on highly selected patients, but clinical practice must consider patients whose conditions require tailored treatment.

Background Although studies suggest that most patients use healthcare professionals as the main source of health information, the ease of Internet access has resulted in a growing number of people who seek health information from other sources. Health information-seeking skills and patterns may influence follow-through with treatment recommendations. Purpose The purpose of this study was to explore the health information-seeking behaviors (HISBs) of urgent care (UC) patients and the association to adherence to discharge instructions. Methods A HISB questionnaire was administered to adults presenting for care at a UC clinic. A repeated measure of HISB and the Medical Outcomes Study General Adherence Scale were administered 10-14 days after UC visit. Descriptive and bivariate analyses determined HISB and their association with discharge instruction adherence. Results Two hundred ten patients completed all surveys. Family and friends were the most common health information source used both before and after an UC visit. Seeking health information through family/friends after the visit was negatively associated with adherence (covariate adjusted p value, .0003). Implications for practice At times of episodic illness, patients tend to seek health information from family and friends with greater frequency than traditional medical, online, or paper sources. Nurse practitioners working in UC or emergent care settings should include family and friends at the time of discharge teaching because patients may use these sources for additional health information, which may affect instruction adherence.

Anastomotic leakage (AL) is a deadly complication after Ivor-Lewis esophagectomy. The use of an anastomotic drainage (AD), to diagnose and to potentially treat the leakage, is still a widespread practice. At present, scientific literature is lacking in this topic and its use is based on each center experience. We performed a retrospective analysis of 239 consecutive patients who underwent an Ivor-Lewis esophagectomy in our Department from 01/01/2006 to 31/12/2017. Until 28/02/2014, a transthoracic anastomotic drainage was routinely placed in 119 patients (anastomotic-drain group). Drainage removal was planned on POD 5 after the resume of oral intake. In the remaining 120 cases, no drainage was placed (no anastomotic-drain group). We compared the two groups to assess whether the anastomotic drainage had an impact on the timing of the anastomotic leakage diagnosis and treatment. In our series, we observed 9 anastomotic leaks in the first group (7.6%) and 3 in the second one (2.5%). In the anastomotic-drain group, median time for leak diagnosis was 10 days, and notably, in seven cases, the anastomotic drainage was already removed. Considering all the patients who experienced an AL, a re-operation was mandatory in one case, while endoscopic treatment was chosen for five cases and conservative treatment was adopted in three cases. The median hospital length of stay in these patients was 31 days. In the no anastomotic-drain group, one patient with anastomotic leakage was treated conservatively and discharged after 34 days. The other two cases were re-operated and an esophageal prosthesis was placed in both cases, and these patients were discharged, respectively, on POD 28 and POD 38. Concluding, the role of the anastomotic drain in Ivor-Lewis esophagectomy is still unclear. There is a shortage of the literature on this topic and our experience shows that the anastomotic drain has a limited sensibility in AL diagnosis and cannot replace the clinical signs and symptoms. Moreover, the drain it is often removed before the leakage becomes visible. In selected patients with a less severe leak, the anastomotic drain can be an effective treatment, but often a percutaneous drainage, it is an effective alternative choice. In severe dehiscence with sepsis, a reoperation remains the mainstay to control the mediastinal contamination and to eventually treat the leakage.

Background:Rheumatoid arthritis (RA) affects 0.4-1.3% of general population (1). It can affect lungs in different ways, with interstitial lung disease (ILD) as the most severe. Clinically evident ILD has been reported in 10-42% of patients, with a great impact in prognosis (2).Objectives:Toidentify the prevalence of lung involvement in early rheumatoid arthritis patients (ERA) without previous known lung disease and describe the association between high resolution computed tomography (HRCT), lung functional tests (LFT) and clinical findings.Methods:Cross sectional multicentric study. We included ERA patients (1 year or less since diagnose) consecutively. Patients with previous RA related lung disease or biologic/targeted synthetic Dmard treatment were excluded. HRCT, immunological tests (rheumatoid factor, anti-CCP, ANA), LFT and clinical evaluation were performed.Results:We included 74 patients, 63 (85,1%) woman, mean (SD) of 47 (17,7) years. Thirty-seven patients (50%) were current or former smokers. Abnormal findings in HRCT were found in 62 patients (88,6%): ILD in 6 (8,6%), airway involvement in 40 (70%) and emphysema in 7 (10%). Ten patients (13,5%) had abnormal auscultation (2 sibilances, 2 roncus, and 6 crackles). Six patients (8,1%) had digital clubbing. Regarding immunological tests, 54/61 (88,5%) patients were positive for Anti CCP, and 53/61 (86,9%) were positive for FR. We compared features of patients with findings related to RA in HRCT (interstitial and/or airway) with those without them. We found no differences in the mean (SD) of DAS-28 [4,74 (1,38) vs 4,32 (1,39); p= 0,27]. The prevalence of anti- CCP was not higher in patients with abnormal HRCT [38/44 (86,3%) vs 16/17 (94,1%); p=0,39]. Patients with abnormal HRCT were older [median (IQR) 50,5 years (44,5-59,5) vs 43 years (32-51); p=0,008) and showed higher VSG values [mean (SD) 39,09 (24,03) vs 27,38 (17,6); p= 0,043]. Abnormal physical examination or dyspnea (class 2 mMRC or higher) was significantly associated with HRCT abnormalities [26 (50%) vs 3 (13,6%); p=0.003) and the presence of ILD on HRCT was significantly associated with crackles on the auscultation [4/68(6,25%) vs 2/6 (33,33%); p 0,023].Conclusion:This study shows a high prevalence of lung involvement in ERA patients of less 1 year from diagnosis. Also, we showed a significant association between HRCT and physical examination findings. This data highlights the importance of the clinical examination in Rheumatoid Arthritis patients. More studies with bigger samples and longitudinal follow up are needed to confirm and complete our results.References:[1]Rooney BK, Silman AJ. Epidemiology of the rheumatic diseases. Curr Opin Rheumatol [Internet]. 1999 Mar [cited 2016 Jul 19];11(2):91–7. Available from:http://www.ncbi.nlm.nih.gov/pubmed/10319210.[2]Antin-Ozerkis D, Evans J, Rubinowitz A, Homer RJ, Matthay RA. Pulmonary Manifestations of Rheumatoid Arthritis. Clin Chest Med [Internet]. 2010;31(3):451–78. Available from:http://dx.doi.org/10.1016/j.ccm.2010.04.003.Disclosure of Interests:None declared

SUMMARY Application of enhanced recovery protocols (ERP) in esophageal surgery seems to lead an advantage in terms of length of hospital staying and outcomes, but only few data exist on its cost effectiveness. Previous literature analyzed pre- and post-ERP groups, finding a cost reduction with the introduction of the pathway. We aimed to study the influence on costs of accumulating experience and compliance in an ERP group. Seventy-one patients have been treated at our institution from January 2014 to June 2017 with our ERP for Ivor–Lewis esophagectomy. Direct costs were divided into subcategories and were analyzed as a function of calendar year and compliance. Factor affecting costs were searched. Univariable analysis highlighted a significant reduction in costs over time. Increase in compliance led to a progressive cost reduction for each ERP item completed (€14 852–€11 045). While age was not found to significantly influence the cost (p = 0.341), complications seemed to nullify the effect of experience: the median was €11 507 in uncomplicated patients, and increased to €13 791 in Clavien–Dindo 3–4 (CD3–4) patients. Compliance and CD3–4 remained significant also in multivariable analysis, accomplished by quantile regression, while year of surgery lost its significance. Our results evidence how accumulating experience in ERP led to a cost reduction over time, which was mainly mediated by an increase in compliance. Indeed, compliance was the main factor in reducing ERP cost while CD3–4 complications were the most important factor in cost increasing, nullifying the benefit of compliance.

Background The use of ERAS (Enhanced Recovery After Surgery) protocols, to reduce morbidity and accelerate recovery is spreading in general surgery. In dedicated centres these programs have been successfully applied after oesophageal surgery. However, some concerns have been raised about the feasibility of these protocols in elderly patients. Methods We retrospective reviewed 72 patients submitted to Ivor-Lewis esophagectomy in our Institution, in the period 2015–2017. We divided the patients into two groups: 47 patients (65,3%) were Results The two groups were not different in terms of overall morbidity rate (53,2% in YG vs 60,0% in EG P = 0,6) and pulmonary complications rate (70,2% in YG vs 72,0% in EG, P = 1). We did not reporte 90-days mortality. We did not observe differences in adherence to ERAS step: pre-operative carbohydrate load administration (78,7% in YG vs 76,0% in EG, P = 0,7), peri-dural catheter for analgesia placement (89,3% in YG vs 88,0% in EG, P = 1), ward transfer on POD 0 (61,7% in YG vs 48,0% in EG, P = 0,32), removal of naso-gastric tube on POD 1 (87,2% in YG vs 96,0% in EG, P = 0,4), resume of liquid diet on POD 1 (55,3% in YG vs 56,0% in EG, P = 1), urinary catheter removal on POD 2 (61,7% in YG vs 48,0% in EG, P = 0,3), fully mobilization on POD 3 (63,8% in YG vs 52,0% in EG, P = 0,4), resume of soft diet on POD 4 (72,3% in YG vs 68,0% in EG, P = 0,7), discharge on POD 7 (48,9% in YG vs 40,0% in EG, P = 0,6). Median day of discharge was POD 8 for both groups (P = 0,8). Conclusion In high-volume centres ERAS protocols can be safely applied to elderly patients undergoing esophagectomy. An experienced team is needed to achieve this results. Disclosure All authors have declared no conflicts of interest.

Background An increasing number of Americans are using urgent care (UC) clinics due to: improved health insurance coverage, the need to decrease cost, primary care offices with limited appointment availability, and a desire for convenient care. Patients are treated by providers they may not know for episodic illness or injuries while in pain or not feeling well. Treatment instructions and follow-up directions are provided quickly. Purpose To examine health literacy in the adult UC population and identify patient characteristics associated with health literacy risk. Methods As part of a larger cross-sectional study, UC patients seen between October 2013 and January 2014 completed a demographic questionnaire and the Newest Vital Sign. Descriptive, nonparametric analyses, and a multinomial logistic regression were done to assess health literacy, associated and predictive factors. Results A total of 57.5% of 285 participants had adequate health literacy. The likelihood of limited health literacy was associated with increased age (p < .001), less education (p < .001), and lower income (p = .006). Conclusions/implications Limited health literacy is common in a suburban UC setting, increasing the risk that consumers may not understand vital health information. Clear provider communication and confirmation of comprehension of discharge instructions for self-management is essential to optimize outcomes for UC patients.

Background Conversion surgery is a surgical treatment aiming R0 resection after chemotherapy of tumors that were originally regarded as technically or oncologically unresectable or only marginally resectable. Performing surgery in such patients may result in a long-term survival. The current experience concerns stage IV gastric cancer patients with marginally resectable metastasis, while the evidence concerning cardia tumors are poor. We report a case of primary cardia cancer with potentially unresectable metastasis, successfully treated by a multidisplinary approach including chemotherapy and surgery. Methods We report a case about a 65-year-old man affected by EGJ adenocarcinoma (Siewert II) with multiple hepatic metastases and para-aortic adenopathy (cT3N + M1 according to UICC 7th edition). He received intensive chemotherapy with Taxotere, Cisplatin and 5 FU. After therapy, primary tumor and liver lesions had markedly regressed according to CT, using RECIST guidelines. The endoscopy confirmed the reduction in the cardia lesion with negative biopsies. For that reason, the patient was addressed to follow up. Results After 6 years of follow up, endoscopy indicated a local relapse with a pathological diagnosis of adenocarcinoma. CT scan showed a clinical stage was cT3N + M0. The patient was treated with neoadjuvant concurrent chemoradiotherapy. After treatment the exams showed a partial response. The patient was eligible for conversion surgery and we proceeded to laparotomy total gastrectomy with D2 lymphadenectomy. We performed also exeresis of a liver nodule, which resulted fibrous. The surgical procedure was radical (R0). According to histological examination, the postoperative stage was ypT0N0. Treatment-induced response at the primary tumor site, evaluated according to SPR classification and TRG classification, was SPR 1 and TRG 1. Conclusion Despite limited evidence in literature about conversion surgery in cardia carcinoma, this case shows that intensive chemotherapy allows for conversion of unresectable cardia cancer to resectable cancer, resulting in long-term survival. The following surgical resection provided a R0 resection, leaving no macroscopic residual tumor. This result indicates a potential strategy for patients affected by unresectable cardia cancer. Clearly this strategy requires further analysis to be confirmed. However, based on our case report, the conversion surgery seems safe and feasible, associated with R0 resection. Disclosure All authors have declared no conflicts of interest.

Mutated huntingtin (htt) is ubiquitously expressed in tissues of Huntington's disease (HD) patients. In the brain, the mutated protein leads to neuronal cell dysfunction and death, associated with formation of htt-positive inclusions. Given increasing evidence of abnormalities in HD skeletal muscle, we extensively analyzed primary muscle cell cultures from seven HD subjects (including two unaffected mutation carriers). Myoblasts from presymptomatic and symptomatic HD subjects showed cellular abnormalities in vitro, namely mitochondrial depolarization, cytochrome c release, increased caspase-3, -8, and -9 activities, and defective cell differentiation. Another notable feature was the formation of htt inclusions in differentiated myotubes. This study helps to advance current knowledge about the downstream effects of the htt mutation in human tissues. Further applications may include drug screening using this human cellular model.

HNPCC families are characterized by a genetic predisposition for colorectal and other cancers. In Dusseldorf we pursue an interdisciplinary counselling approach (geneticists, psychologists and surgeons). Apart from the genetic counselling itself, special emphasis is placed on the benefits of surveillance and screening recommendations. In this pilot study we were interested in investigating if the counselled women had understood the increased risk of gynecological cancers and correspondingly underwent the intensified screening modalities. We selected the approach of a telefone interview and encountered broad acceptance for contacting persons this way. Affected women are better compliant to screening recommendations than women at risk. Both groups consider colonoscopy more strainful than gynecological surveillance. A regular transvaginal ultrasound is not performed in some 40 % of at risk women although 2/3 of them see their gynecologist in regular intervals. Given the support of gynecologists a higher rate of transvaginal ultrasound in women at risk should be achievable.

The aim of this work was to obtain a freeze-dried kit for direct99mTc-labeling of human polyclonal IgG. The labeling procedure was carried out by Schwarz's method. The best yields of99mTc-IgG were obtained by using sodium pyrophosphate decahydrate as a weak chelating agent. Performed tests showed the stability of the radiopharmaceutical up to 24 hours. Plasma clearance in rats was fitted to a biexponential curve withT1/2α=(0.1 ±0.9) h andT1/2β=(10±3) h. The organs with higher uptake of radiopharmaceutical were lung, kidneys and blood. In a rabbit model the abscess target/background ratio was 3–6 according to time of the scintigraphic images. Thirty patients with musculoskeletal infection were studied. Twenty-one lesions were detected and confirmed by culture/biopsy.

Im Rahmen eines Liaisonkonzeptes zwischen den Abteilungen der Hautklinik und der Abteilung der Psychosomatik/Psychotherapie des Universitatsklinikums Dusseldorf wurden 187 Patienten der Hautklinik psychosomatisch und testpsychologisch untersucht. Die Verteilung von Hauterkrankungen und psychosomatischen Diagnosen nach ICD 10 werden dargestellt. Es zeigte sich, das Patienten- (Symptom-Check-Liste-90-R) und Untersuchereinschatzung (Beeintrachtigungsschwere-Score) positiv korrelieren. Es wird fur eine dermatologisch-psychosomatische Simultanbehandlung pladiert, um das primar organische Beziehungsangebot des Patienten in ein personelles zu ubersetzen, was wiederum in poststationare simultane Behandlungen einmunden konnte und so zu einer sinnvollen Weiterentwicklung des stationar erreichten Behandlungsergebnisses fuhren kann.

We describe a new sensory response in the enteric bacterium Serratia marcescens. When grown in liquid media, the bacteria were short rods with one to two flagella and displayed classical swimming behavior. Upon transfer to a solid surface (0.7 to 0.8T% agar medium), the bacteria underwent a dramatic change of form. They ceased septation, elongated, and expressed numerous (10 to 100) flagella that covered the lateral sides of the cells. The bacteria now displayed a different form of locomotion--swarming--which allowed them to rapidly move over the top of the solid surface. The differentiation to either swimmer or swarmer cells could be reversed by growth on solid or liquid medium, respectively. To identify conditions that influence this differentiation, the growth environment of S. marcescens was manipulated extensively. The swarming response was monitored by visual and microscopic observation of cell movement on solid surfaces, by immunofluorescent labeling followed by microscopic observation for the presence of elongated, profusely flagellated cells, as well as by estimation of induction of flagellin protein, using Western immunoblot analysis. Conditions that imposed a physical constraint on bacterial movement, such as solid or viscous media, were the most efficient at inducing the swarming response. No chemical constituent of the medium that might contribute to the response could be identified, although the existence of such a component cannot be ruled out. Both swimmer and swarmer cells had flagellin proteins of identical molecular weight, which produced similar proteolysis patterns upon digestion with trypsin.

BACKGROUND: Leptin, the product of the ob gene, could have a significant role in the pathogenesis of obesity and non-insulin-dependent diabetes mellitus. However, it is still debated whether different degrees of glucose tolerance may affect plasma leptin concentrations in obese patients. OBJECTIVE: To investigate whether diabetes might influence leptin concentrations in obese patients. METHODS: We evaluated clinical parameters, anthropometric measures, and sex hormones, fasting plasma leptin, glucose and insulin concentrations in 100 elderly obese diabetic patients and 100 obese non-diabetic control individuals matched for age and sex. RESULTS: After adjustment for age and fat mass, plasma leptin concentrations did not differ between diabetic and non-diabetic obese individuals, in both men and women. In all patients leptin was significantly related to body mass index, fat mass and the homeostasis model insulin resistance index; moreover we observed a significant relationship with fasting plasma glucose and age in diabetic obese women, and with blood pressure values and testosterone concentrations in diabetic obese men. Multiple regression analysis revealed age and fasting plasma glucose to be the only independent determinants of fasting plasma leptin in diabetic obese women. CONCLUSIONS: These data suggest that leptin concentrations do not differ between obese diabetic and obese non-diabetic elderly patients. Among correlates of the metabolic syndrome, systolic pressure seems to be related to leptin only in men. In the postmenopausal or andropausal status, sex hormones are related to leptin concentrations only in diabetic men; in diabetic women, however, high glucose seems to be relevant in maintaining the same leptin concentrations as in non-diabetic women with similar degree of obesity.

Background: The treatment of mental disorders in Germany is mainly done by primary care physicians. Several studies have shown that primary care physicians have difficulty in diagnosing these disorders. Recently, several self-report questionnaires have been developed that can be used as screening instruments to identify psychopathology in primary care settings and in the community. The aim of this paper was to investigate the screening properties of the General Health Questionnaire (GHQ-12) and the Symptom Check-List (SCL-90-R) in a primary care setting in Germany. Method: A randomly selected sample (n = 408) of adult outpatients from 18 primary care offices in Dusseldorf was screened using the German versions of the GHQ-12 and the SCL-90-R. A structured diagnostic interview (SCID) and an impairment rating (IS) were used as a gold standard to which both questionnaires were compared. Test performance was evaluated by receiver operating characteristic (ROC) analysis. Results: We found no difference in the performance of the general scores of the two questionnaires. Both instruments were able to detect cases. Complex scoring methods offered no advantages over simpler ones for the GHQ-12. ROC analysis confirmed that the SCL-90-R subscales “anxiety” and “depression” showed acceptable concurrent validity for the diagnostic groups anxiety and depression (according to DSM-III-R). Conclusions: GHQ-12 and SCL-90-R appeared to be useful tools for identifying mental disorders in primary care practice and research. The use of GHQ-12 or SCL-90-R, employed as a first step, supplemented by a second-stage interview, may enhance the detection rate of mental disorder in primary care settings.

Huntington's disease (HD) is a neurodegenerative disorder characterized by progressive neuronal death in the basal ganglia and cortex. Although increasing evidence supports a pivotal role of mitochondrial dysfunction in the death of patients' neurons, the molecular bases for mitochondrial impairment have not been elucidated. We provide the first evidence of an abnormal activation of the Bcl-2/adenovirus E1B 19-kDa interacting protein 3 (BNip3) in cells expressing mutant Huntingtin. In this study, we show an abnormal accumulation and dimerization of BNip3 in the mitochondria extracted from human HD muscle cells, HD model cell cultures and brain tissues from HD model mice. Importantly, we have shown that blocking BNip3 expression and dimerization restores normal mitochondrial potential in human HD muscle cells. Our data shed light on the molecular mechanisms underlying mitochondrial dysfunction in HD and point to BNip3 as a new potential target for neuroprotective therapy in HD.

The effects of febarbamat and pipamperon on agitational and aggressive states of patients with diffuse psycho-organic syndrome were compared in a double-blind study on patients over 60 years of age requiring nursing care. Such disorders, particularly in the field of psychiatric gerontology, represent an increasing problem. The neuroleptic agents hitherto prescribed for such agitational states are not only beset with serious side-effects (predyskinesia, drug-induced Parkinson syndrome, sedentary restlessness, postdyskinesia), but particularly with an unwanted suppression of the patients' reactions. It was therefore of particular interest to find out if febarbamat showed an equally good therapeutic effect on aggressive and agitational states, without causing these side-effects (especially suppression of cognitive performance). This could have a positive effect on social and other therapeutic activities. The test substances were therapeutically comparable in their effect on agitational and aggressive states. On the psychological level, febarbamat showed superiority in the cognitive performance parameters.

8 women and 8 men took Cattell's IPAT-anxiety questionnaire and later McFarland's test of ability to perceive heart activity. The second test involved subjects' tracking their own heart rates, then they enrolled in an EKG biofeedback session to evaluate ability to increase and decrease heart rate from subjects' resting baselines. At the end of the session each subject completed Blanchard, et al.'s questionnaire to specify the cognitive strategies used for heart-rate control. Heart rate, abdominal respiration rate, respiration amplitude, EEG percent power in theta, alpha, and beta bands were evaluated. Success of heart-rate decrease seemed to depend mainly on activity levels: the subjects who achieved high scores on the activity test decreased heart rate significantly better than did low scorers. The relationship between scores for perception of heart and increases in heart rate was nonsignificant: increased heart-rate seemed to depend on differences in respiration between the rest and periods of increase. The significant, negative correlation between trait anxiety and perceptions of heart activity suggested that anxiety affected subjects' ability to perceive heart rate. The theta EEG power of the right hemisphere was significantly higher in subjects scoring high than for those low in perception of heart activity. During heart-rate increase tasks subjects mainly reported use of ‘arousal responses,’ similarly during heart-rate decrease tasks they reported use of relaxation responses.

Plasma glucose has been regarded as a risk factor for macrovascular complications in diabetes, but less is known about its role in the development of cardiac impairment other than coronary heart disease (CHD). The aim of our study was to determine the relationship between basal and post-OGTT (Oral Glucose Tolerance Test) plasma glucose levels and some ECG parameters in a group of elderly women with normal or impaired glucose tolerance (IGT). One-hundred and one women with normal fasting glucose (

In Reply.— Floraquin was introduced in 1936 based on data that were appropriate at the time. However, at the time of the more recent National Academy of Sciences and National Research Council reviews, Floraquin was classified as only "possibly effective," due to the lack of well-controlled clinical studies supporting it. In view of the limited sales of Floraquin, Searle did not elect to undertake the clinical-trials program that would have been necessary to maintain it on the market. As a consequence, FDA approval of Floraquin was withdrawn and marketing was discontinued on July 7, 1975, with all supplies being recalled down to the retail level. The same FDA directive that caused the demise of Floraquin also caused a number of other topical preparations for the treatment of trichomonal vaginitis to be withdrawn from the market. The reasons for this directive were set forth in a letter from the FDA to

Seventy‐two half‐hour conversations—the interactions of 36 female dyads on two successive occasions—were automatically analyzed for instances of simultaneous speech (SS), defined as speech uttered by the participant who does not have the floor while the participant who does is talking. On the basis of outcome, SS segments were divided into two categories: nonencompassed SS(NSS) culminates in a change of which speaker has the floor while encompassed SS(ESS) does not. Duration frequencies of ESS and NSS segments were distributed exponentially over subjects. Comparing ESS and NSS occurrence frequencies in the first and second halves of the conversations yielded consistency estimates of 0.77 and 0.61 for occasion 1 and 0.72 and 0.54 for occasion 2. Comparing the occurrence frequencies of both occasions yielded stability estimates of 0.54 for ESS and 0.50 for NSS. However, comparing ESS and NSS frequencies over subjects and occasions yielded an r of 0.36, indicating the two categories share only about 13% of their variance. The results suggest that the frequencies with which speakers engage in ESS and NSS represent different but equally reliable aspects of their conversational styles, and provide a basis for examining lexical and psychological correlates of SS outcome.