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Zusammenfassung Hintergrund Die primäre synoviale Chondromatose (SC) ist eine seltene Erkrankung der Synovialmembran unklarer Ätiologie. Der aktuelle Wissensstand zu dieser Erkrankung soll in einer kurzen Übersicht dargestellt werden. Methoden Übersichtsarbeiten und rezente Fallberichte zur SC wurden systematisch ausgewertet und mit Daten eigener Fälle in Kontext gesetzt. Ergebnisse Auf Grund neuer genomischer Daten wird die SC als benigne Neoplasie eingestuft. In 60 % der Fälle liegen Mutationen im Fibronektin-1-Gen (FN1) und/oder im Gen für den Activin-A-Typ-II-Rezeptor (ACVR2A) vor. Diagnoseweisend ist die Magnetresonanztomographie (MRT) und die meist arthroskopische Biopsie der Synovia. An einem Fallbeispiel soll gezeigt werden, dass die Knorpelaggregate der SC radiologisch nicht immer schattengebend sein müssen. Differenzialdiagnostisch kommen Monarthritiden anderer Ursachen, andere Gelenk- und Muskelerkrankungen mit Mineralisierung sowie weitere von der Synovialmembran ausgehende Erkrankungen in Betracht. Die Entartungsrate liegt bei 2–4 %. Therapeutisch hat sich in den letzten Jahren das arthroskopische Vorgehen durchgesetzt, das an die Ausdehnung der Erkrankung adaptiert wird. Schlussfolgerung Genomische Untersuchungen sowie Fallserien und Fallberichte aus jüngerer Zeit werfen ein neues Licht auf die SC. Therapeutisch wird in jüngeren Arbeiten überwiegend arthroskopisch vorgegangen.

BACKGROUND: The prevalence of atrial fibrillation(AF) and diabetes mellitus is rising to epidemic proportions. We aimed to assess the impact of diabetes on the management and outcomes of patients with AF.METHODS: The EORP-AF General Long-Term Registry is a prospective, observational registry from 250 centres across 27 European countries. Outcomes of interest were as follows: i)rhythm control interventions; ii)quality of life; iii)healthcare resource utilisation; and iv)major adverse events.RESULTS: Of 11,028 patients with AF, the median age was 71 (63-77) years and 2537 (23.0%) had diabetes. Median follow-up was 24 months. Diabetes was related to increased use of anticoagulation but less rhythm control interventions. Using multivariable analysis, at 2-year follow-up, patients with diabetes were associated with greater levels of anxiety (p = 0.038) compared to those without diabetes. Overall, diabetes was associated with worse health during follow-up, as indicated by Health Utility Score and Visual Analogue Scale. Healthcare resource utilisation was greater with diabetes in terms of length of hospital stay (8.1 (±8.2) vs. 6.1 (±6.7) days); cardiology and internal medicine/general practitioner visits; and emergency room admissions. Diabetes was an independent risk factor of major adverse cardiovascular event (MACE; HR 1.26 [95% CI, 1.04-1.52]), all-cause mortality (HR 1.28 [95% CI, 1.08-1.52]), and cardiovascular mortality (HR 1.41 [95% CI, 1.09-1.83]).CONCLUSION: In this contemporary AF cohort, diabetes was present in 1 in 4 patients and it served as an independent risk factor for reduced quality of life, greater healthcare resource utilisation and excess MACE, all-cause mortality and cardiovascular mortality. There was increased use of anticoagulation therapy in diabetes but with less rhythm control interventions.

Water-logging and the inability to take up sufficient iron (Fe), causing iron deficiency chlorosis (IDC) in soybean (Glycine max, L. Merr.), can be major yield reducing factors in certain soils in the northern USA and Manitoba, Canada, soybean growing regions. The objective of this research was to evaluate soybean IDC, biomass production, and yield with seeding on raised beds and seed application of the Fe-chelate compound ortho-ortho-Fe-EDDHA. In six environments, soybean were seeded on raised beds and conventionally prepared seedbeds (flat) and with a factorial arrangement of five cultivars (within adapted maturity group 0.1 to 0.9 and variable IDC tolerance) and seed applied Fe-EDDHA using rates of 0 kg·ha−1 and 3.36 kg·ha−1. There were no significant interactions between the factors tested. The plant population was 27% higher on the raised beds compared with flat, and yield was 6.3% higher (2893 kg·ha−1 vs. 2722 kg·ha−1). Total dry plant biomass on raised beds was 9.8% greater compared with flat. The plant population with seed applied Fe-EDDHA was 10.6% lower compared with no application. However, the IDC score was significantly lower 2.2 vs 2.4 (1 = green, 5 = dead) for Fe-EDDHA seed application. Yield and plant biomass were not significantly different between Fe treatments. Raised beds offer an opportunity for soybean growers to reduce the negative influence of excessive water. Further research is needed to determine the long-term effect of raised beds on plant development, IDC expression, and yield. The application of Fe-EDDHA remains a partial solution and should therefore be combined with other methods to reduce IDC. Further research should study other Fe-EDDHA application rates and methods.

BACKGROUND: Cardiac troponins (cTn) have been reported to be predictors for adverse outcomes in atrial fibrillation (AF), patients, but their actual use is still unclear.AIM: To assess the factors associated with cTn testing in routine practice and evaluate the association with outcomes.METHODS: Patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry were stratified into 3 groups according to cTn levels as (i) cTn not tested, (ii) cTn in range (≤99th percentile), (iii) cTn elevated (>99th percentile). The composite outcome of any thromboembolism /any acute coronary syndrome/cardiovascular (CV) death, defined as Major Adverse Cardiovascular Events (MACE) and all-cause death were the main endpoints.RESULTS: Among 10 445 AF patients (median age 71 years, 40.3% females) cTn were tested in 2834 (27.1%). cTn was elevated in 904/2834 (31.9%) and in-range in 1930/2834 (68.1%) patients. Female sex, in-hospital enrollment, first-detected AF, CV risk factors, history of coronary artery disease, and atypical AF symptoms were independently associated with cTn testing. Elevated cTn were independently associated with a higher risk for MACE (Model 1, hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.40-2.16, Model 2, HR 1.62, 95% CI 1.28-2.05; Model 3 HR 1.76, 95% CI 1.37-2.26) and all-cause death (Model 1, HR 1.45, 95% CI 1.21-1.74; Model 2, HR 1.36, 95% CI 1.12-1.66; Model 3, HR 1.38, 95% CI 1.12-1.71).CONCLUSIONS: Elevated cTn levels were associated with an increased risk of all-cause mortality and adverse CV events. Clinical factors that might enhance the need to rule out CAD were associated with cTn testing.

We searched for an isotropic stochastic gravitational wave background in the second data release of the International Pulsar Timing Array, a global collaboration synthesizing decadal-length pulsar-timing campaigns in North America, Europe, and Australia. In our reference search for a power law strain spectrum of the form $h_c = A(f/1\,\mathrm{yr}^{-1})^{\alpha}$, we found strong evidence for a spectrally-similar low-frequency stochastic process of amplitude $A = 3.8^{+6.3}_{-2.5}\times10^{-15}$ and spectral index $\alpha = -0.5 \pm 0.5$, where the uncertainties represent 95\% credible regions, using information from the auto- and cross-correlation terms between the pulsars in the array. For a spectral index of $\alpha = -2/3$, as expected from a population of inspiralling supermassive black hole binaries, the recovered amplitude is $A = 2.8^{+1.2}_{-0.8}\times10^{-15}$. Nonetheless, no significant evidence of the Hellings-Downs correlations that would indicate a gravitational-wave origin was found. We also analyzed the constituent data from the individual pulsar timing arrays in a consistent way, and clearly demonstrate that the combined international data set is more sensitive. Furthermore, we demonstrate that this combined data set produces comparable constraints to recent single-array data sets which have more data than the constituent parts of the combination. Future international data releases will deliver increased sensitivity to gravitational wave radiation, and significantly increase the detection probability., 17 pages, 12 figures, accepted in MNRAS

Zusammenfassung Hintergrund In der Neonatologie sind peripher eingeführte zentrale Katheter ein häufiger Zugangsweg zur parenteralen Ernährung und Verabreichung von Medikamenten und Flüssigkeit. Die Vorteile stehen den Risiken wie Infektion, Thrombose und Fehllage gegenüber. Fragestellung Welche Charakteristika und klinischen Zeichen weisen auf das Vorliegen einer katheterassoziierten Thrombose hin? Material und Methoden In einer retrospektiven Betrachung aus dem Zeitraum 2010–2016 wurden alle Fälle von katheterassoziierten Thrombosen untersucht. Identifiziert wurden 10 Frühgeborene, deren Indikation zur Katheteranlage, Zugangsweg, Lage der Katheterspitze, Liegedauer, klinische Symptome und Krankheitsverlauf analysiert wurden. Ergebnisse Bei 10 Frühgeborenen mit einem Gestationsalter von 23 + 4 bis 34 + 5 SSW wurden 11 Thromboseereignisse beobachtet. Zehn der 11 Thromboseereignisse betrafen die V. cava inferior nach Katheteranlage an der unteren Extremität. Die Indikation zur Katheteranlage waren parenterale Ernährung und chirurgische Eingriffe. Bei 9 Patienten traten perinatale Komplikationen auf. Bei allen Patienten bestand während der Liegedauer der Katheter der Verdacht auf eine Infektion. Das Auftreten der Thrombose wurde nach 3 bis 27 Tagen sonographisch dokumentiert. In 8 Thromboseereignissen war eine Thrombozytopenie, in 4 Fällen eine Beinschwellung auffällig. Diskussion Das Patientenkollektiv zeigt Gemeinsamkeiten im klinischen Verlauf und bei den Symptomen, welche auf das Vorliegen einer Thrombose deuten. Auffällig ist außerdem, dass die meisten Thromboseereignisse das Stromgebiet der V. cava inferior betrafen.

Predicting soybean [Glycine max (L.) Merr.] seed yield is of interest for crop producers to make important agronomic and economic decisions. Evaluating the soybean canopy across a range of common agronomic practices, using canopy measurements, provides a large inference for soybean producers. The individual and synergistic relationships between fractional green canopy cover (FGCC), photosynthetically active radiation (PAR) interception, and a normalized difference vegetative index (NDVI) measurements taken throughout the growing season to predict soybean seed yield in North Dakota, USA, were investigated in 12 environments. Canopy measurements were evaluated across early and late planting dates, 407,000 and 457,000 seeds ha−1 seeding rates, 0.5 and 0.8 relative maturities, and 30.5 and 61 cm row spacings. The single best yield predictor was an NDVI measurement at R5 (beginning of seed development) with a coefficient of determination of 0.65 followed by an FGCC measurement at R5 (R2 = 0.52). Stepwise and Lasso multiple regression methods were used to select the best prediction models using the canopy measurements explaining 69% and 67% of the variation in yield, respectively. Including plant density, which can be easily measured by a producer, with an individual canopy measurement did not improve the explanation in yield. Using FGCC to estimate yield across the growing season explained a range of 49% to 56% of yield variation, and a single FGCC measurement at R5 (R2 = 0.52) being the most efficient and practical method for a soybean producer to estimate yield.

We study the explosive production of gauge fields during axion inflation in a novel gradient expansion formalism that describes the time evolution of a set of bilinear electromagnetic functions in position space. Based on this formalism, we are able to simultaneously account for two important effects that have thus far been mostly treated in isolation: (i) the backreaction of the produced gauge fields on the evolution of the inflaton field and (ii) the Schwinger pair production of charged particles in the strong gauge-field background. This allows us to show that the suppression of the gauge-field production due to the Schwinger effect can prevent the backreaction in scenarios in which it would otherwise be relevant. Moreover, we point out that the induced current, $\boldsymbol{J} = \sigma \boldsymbol{E}$, also dampens the Bunch-Davies vacuum fluctuations deep inside the Hubble horizon. We describe this suppression by a new parameter $\Delta$ that is related to the time integral over the conductivity $\sigma$ which hence renders the description of the entire system inherently nonlocal in time. Finally, we demonstrate how our formalism can be used to construct highly accurate solutions for the mode functions of the gauge field in Fourier space, which serves as a starting point for a wealth of further phenomenological applications, including the phenomenology of primordial perturbations and baryogenesis., Comment: 24 pages, 7 figures

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Agronomic practices, such as planting date, seeding rate, and genotype, commonly influence hard red spring wheat (HRSW, Triticum aestivum L. emend. Thell.) production. Determining the agronomic optimum seeding rate (AOSR) of newly developed hybrids is needed as they respond to seeding rates differently from inbred cultivars. The objectives of this research were to determine the AOSR of new HRSW hybrids, how seeding rate alters their various yield components, and whether hybrids offer increased end-use quality, compared to conventional cultivars. The performance of two cultivars (inbreds) and five hybrids was evaluated in nine North Dakota environments at five seeding rates in 2019−2020. Responses to seeding rate for yield and protein yield differed among the genotypes. The AOSR ranged from 3.60 to 5.19 million seeds ha−1 and 2.22 to 3.89 million seeds ha−1 for yield and protein yield, respectively. The average AOSR for yield for the hybrids was similar to that of conventional cultivars. However, the maximum protein yield of the hybrids was achieved at 0.50 million seeds ha−1 less than that of the cultivars tested. The yield component that explained the greatest proportion of differences in yield as seeding rates varied was kernels spike−1 (r = 0.17 to 0.43). The end-use quality of the hybrids tested was not superior to that of the conventional cultivars, indicating that yield will likely be the determinant of the economic feasibility of any future released hybrids.

While genetic advances have successfully defined part of the complexity in Parkinson’s disease (PD), the clinical characterization of phenotypes remains challenging. Therapeutic trials and cohort studies typically include patients with earlier disease stages and exclude comorbidities, thus ignoring a substantial part of the real-world PD population. To account for these limitations, we implemented the Luxembourg PD study as a comprehensive clinical, molecular and device-based approach including patients with typical PD and atypical parkinsonism, irrespective of their disease stage, age, comorbidities, or linguistic background. To provide a large, longitudinally followed, and deeply phenotyped set of patients and controls for clinical and fundamental research on PD, we implemented an open-source digital platform that can be harmonized with international PD cohort studies. Our interests also reflect Luxembourg-specific areas of PD research, including vision, gait, and cognition. This effort is flanked by comprehensive biosampling efforts assuring high quality and sustained availability of body liquids and tissue biopsies. We provide evidence for the feasibility of such a cohort program with deep phenotyping and high quality biosampling on parkinsonism in an environment with structural specificities and alert the international research community to our willingness to collaborate with other centers. The combination of advanced clinical phenotyping approaches including device-based assessment will create a comprehensive assessment of the disease and its variants, its interaction with comorbidities and its progression. We envision the Luxembourg Parkinson’s study as an important research platform for defining early diagnosis and progression markers that translate into stratified treatment approaches.

Background Elderly patients are vulnerable to adverse drug reactions (ADRs). Drug-related readmissions (DRRs) can be a major consequence of ADR. Therefore, this study aimed to investigate the effects of a ward-based, comprehensive pharmaceutical care service on the occurrence of DRRs as the endpoint in dependent-living elderly patients. Methods A randomized, controlled trial was performed at a German University Hospital. Patients fulfilling the following criteria were eligible: admission to a cooperating ward, existing drug therapy at admission, 65 years of age and older, home-care or nursing home residents in ambulatory care, and a minimum hospital stay of three days. Patients received either standard care (control group) or pharmaceutical care (intervention group). Follow-up consultations were conducted for each patient at 1, 8, 26, and 52 weeks after discharge. The time to DRR was defined as the primary outcome measure and was analysed using the log-rank test. The Cox-proportional hazard model was used for risk factor analysis. Results Sixty patients (n = 31 intervention group, n = 29 control group) participated in the study. For patients in the intervention group, the median time to DRR was prolonged; however, the level of statistical significance was not reached (log-rank test P = 0.068; HR = 3.28, P = 0.086). When the risk factors ‘age’ or ‘length of stay on the ward’ were added to the Cox proportional hazard model, patients in the control group exhibited a significantly higher risk of experiencing a DRR than patients of the intervention group (HR = 4.62; P = 0.028 including age and HR = 5.76; P = 0.033 including length of stay on the ward). Conclusions Our findings demonstrate the successful implementation of ward-based, comprehensive pharmaceutical care for dependent-living elderly. Despite a low participation rate, which led to an underpowered study, the results provide a preliminary efficacy signal and effect size estimates to power a definitive trial. Trial registration Clinicaltrials.gov identifier: NCT01578525, prospectively registered April 13, 2012.

Background Emergency department (ED) triage is performed to prioritize care for patients with critical and time-sensitive illness. Triage errors create opportunity for increased morbidity and mortality. Here, we sought to measure the frequency of under- and over-triage of patients by nurses using the Emergency Severity Index (ESI) in Brazil and to identify factors independently associated with each. Methods This was a single-center retrospective cohort study. The accuracy of initial ESI score assignment was determined by comparison with a score entered at the close of each ED encounter by treating physicians with full knowledge of actual resource utilization, disposition, and acute outcomes. Chi-square analysis was used to validate this surrogate gold standard, via comparison of associations with disposition and clinical outcomes. Independent predictors of under- and over-triage were identified by multivariate logistic regression. Results Initial ESI-determined triage score was classified as inaccurate for 16,426 of 96,071 patient encounters. Under-triage was associated with a significantly higher rate of admission and critical outcome, while over-triage was associated with a lower rate of both. A number of factors identifiable at time of presentation including advanced age, bradycardia, tachycardia, hypoxia, hyperthermia, and several specific chief complaints (i.e., neurologic complaints, chest pain, shortness of breath) were identified as independent predictors of under-triage, while other chief complaints (i.e., hypertension and allergic complaints) were independent predictors of over-triage. Conclusions Despite rigorous and ongoing training of ESI users, a large number of patients in this cohort were under- or over-triaged. Advanced age, vital sign derangements, and specific chief complaints—all subject to limited guidance by the ESI algorithm—were particularly under-appreciated.

International audience; This paper describes the standalone magnet cold testing of the high temperature superconducting (HTS) magnet Feather-M2.1-2. This magnet was constructed within the European funded FP7-EUCARD2 collaboration to test a Roebel type HTS cable, and is one of the first high temperature superconducting dipole magnets in the world. The magnet was operated in forced flow helium gas with temperatures ranging between 5 and 85 K. During the tests a magnetic dipole field of 3.1 T was reached inside the aperture at a current of 6.5 kA and a temperature of 5.7 K. These values are in agreement with the self-field critical current of the used SuperOx cable assembled with Sunam tapes (low-performance batch), thereby confirming that no degradation occurred during winding, impregnation, assembly and cool-down of the magnet. The magnet was quenched many tens of times by ramping over the critical current and no degradation nor training was evident. During the tests the voltage over the coil was monitored in the microvolt range. An inductive cancellation wire was used to remove the inductive component, thereby significantly reducing noise levels. Close to the quench current, drift was detected both in temperature and voltage over the coil. This drifting happens in a time scale of minutes and is a clear indication that the magnet has reached its limit. All quenches happened approximately at the same average electric field and thus none of the quenches occurred unexpectedly.

Objective: To identify the genetic cause of pontocerebellar hypoplasia type III (PCH3). Methods: We studied the original reported pedigree of PCH3 and performed genetic analysis including genome-wide single nucleotide polymorphism genotyping, linkage analysis, whole-exome sequencing, and Sanger sequencing. Human fetal brain RNA sequencing data were then analyzed for the identified candidate gene. Results: The affected individuals presented with severe global developmental delay and seizures starting in the first year of life. Brain MRI of an affected individual showed diffuse atrophy of the cerebrum, cerebellum, and brainstem. Genome-wide single nucleotide polymorphism analysis confirmed the linkage to chromosome 7q we previously reported, and showed no other genomic areas of linkage. Whole-exome sequencing of 2 affected individuals identified a shared homozygous, nonsense variant in the PCLO (piccolo) gene. This variant segregated with the disease phenotype in the pedigree was rare in the population and was predicted to eliminate the PDZ and C2 domains in the C-terminus of the protein. RNA sequencing data of human fetal brain showed that PCLO was moderately expressed in the developing cerebral cortex. Conclusions: Here, we show that a homozygous, nonsense PCLO mutation underlies the autosomal recessive neurodegenerative disorder, PCH3. PCLO is a component of the presynaptic cytoskeletal matrix, and is thought to be involved in regulation of presynaptic proteins and synaptic vesicles. Our findings suggest that PCLO is crucial for the development and survival of a wide range of neuronal types in the human brain.

Mesenchymale Tumoren stellen aufgrund ihrer Morphologie fur den Pathologen oft eine diagnostische Herausforderung dar. Von diagnostischem Nutzen kann daher der Nachweis tumorspezifischer Mutationen oder chromosomaler Aberrationen, wie Translokationen und Fusionen, Amplifikationen oder Deletionen sein. Die Methode der Wahl fur die Routinediagnostik ist derzeit bei den meisten Veranderungen die Fluoreszenz-in-situ-Hybridisierung. Daneben kommen auch die reverse Transkriptase-Polymerasekettenreaktion (PCR), Sequenzierungen sowie spezifische immunhistochemische Assays zum Einsatz. „Next generation sequencing“ hat zur Identifizierung bislang unbekannter Aberrationen beigetragen. Hauptsachlich dient die Molekularpathologie bei Sarkomen der differenzialdiagnostischen Abgrenzung verschiedener Entitaten. Auch im Hinblick auf eine personalisierte Therapie kann die Molekularpathologie zum Nachweis pradiktiver Marker genutzt werden.

Objective Corticotropin-releasing hormone (CRH) and pro-opiomelanocortin (POMC) axis activation leads to the production of hormones, such as adrenocorticotrophic hormone (ACTH) and the α-melanocyte stimulating hormone (α-MSH). Data regarding the role of these hormones in systemic lupus erythematosus (SLE) are scarce. In the present study we aim to evaluate the participation of this axis in the cutaneous involvement of SLE. Methods Seventeen SLE patients were clinically evaluated, and biopsies from affected and unaffected skin of these patients were compared with 17 healthy control individuals. Immunohistochemical analyses for CRH, ACTH, α-MSH, and MC-1R were performed, and the serum levels of α-MSH, IL-1, IL-1ra, IL-6, IL-10, IL-12p70, IL-17, TNF-α, and IFN-γ were measured. Results The affected skin of the SLE patients exhibited higher CRH expression in the deep dermis compared to the skin of the controls ( p = 0.024), whereas the tissue expression of ACTH, cortisol, α-MSH and its receptor MC-1R were comparable in SLE patients and controls. Higher serum levels of IFN-γ ( p = 0.041), TNF-α ( p = 0.001) and IL-6 ( p = 0.049) were observed in SLE patients compared with controls, while α-MSH levels were similar in both groups. Conclusion The novel finding of elevated CRH expression solely in the affected skin deep dermis supports the notion of a cutaneous local dysfunction of the CRH-POMC axis in the pathogenesis of cutaneous SLE lesions.

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Seit Juli 2010 ist Ozurdex® in Deutschland fur die Behandlung des Makulaodems (MO) von venosen retinalen Gefasverschlussen (RVV) zugelassen. In dieser klinischen Fallserie sollen die klinischen Erfahrungen zu Komplikationen und Nebenwirkungen der intravitrealen Applikation von Dexamethason systematisch zusammengefasst und analysiert werden. In einer retrospektiven, multizentrischen Studie an 10 Zentren wurden 342 Augen mit RVV mit intravitrealer Dexamethason-Therapie (Ozurdex®, Allergan) behandelt und uber einen Zeitraum von 8 Monaten nachkontrolliert. Dabei wurden intra-, peri- und postoperative Besonderheiten und Komplikationen (wie z. B. Augeninnendruckanstieg, Luxation des Implantats) systematisch erfasst. Infektionen, Endophthalmitiden oder perioperative Hypotonien traten ebenso wie intraoperative Linsenverletzungen oder Netzhautablosungen nicht auf. Tensioanstiege waren mit nahezu 20% die haufigste Komplikation. Bei 9% der Patienten stieg der Augeninnendruck um mehr als 10 mmHg zum Ausgangswert, bei 6 Patienten auf > 35 mmHg. Bei vorbekanntem Glaukom stieg der Augeninnendruck nicht signifikant haufiger an als bei Nicht-Glaukompatienten. Eine Progression der Linsentrubung fuhrte in 4 Fallen zu einer Phakoemulsifikation. Zwei Transplantatdislokationen in die Vorderkammer erforderten eine operative Reposition in den Glaskorperraum. In 2 Fallen trat postinterventionell ein Makulaforamen auf. Die Ozurdex-Therapie zeigt sich auch in der klinischen Routine als nebenwirkungsarmes Therapieverfahren. Als haufigste Nebenwirkung der Ozurdex-Implantation sind Tensioanstiege zu beobachten, die in der Regel aber keiner operativen Intervention bedurften. Vorsicht ist bei Patienten mit einer Vorderkammerlinse und Iridektomie geboten. Makulaforamina als seltene Komplikation konnten Folge der Glaskorpertraktion bei der Implantation sein. In der klinischen Routineanwendung von Ozurdex zeigt sich keine hohere Komplikationsrate als in den Zulassungsstudien.

Positional information, independent of neuronal activity, regulates presynaptic strength, with the strongest presynaptic terminals closest to the soma., Different regulatory principles influence synaptic coupling between neurons, including positional principles. In dendrites of pyramidal neurons, postsynaptic sensitivity depends on synapse location, with distal synapses having the highest gain. In this paper, we investigate whether similar rules exist for presynaptic terminals in mixed networks of pyramidal and dentate gyrus (DG) neurons. Unexpectedly, distal synapses had the lowest staining intensities for vesicular proteins vGlut, vGAT, Synaptotagmin, and VAMP and for many nonvesicular proteins, including Bassoon, Munc18, and Syntaxin. Concomitantly, distal synapses displayed less vesicle release upon stimulation. This dependence of presynaptic strength on dendritic position persisted after chronically blocking action potential firing and postsynaptic receptors but was markedly reduced on DG dendrites compared with pyramidal dendrites. These data reveal a novel rule, independent of neuronal activity, which regulates presynaptic strength according to dendritic position, with the strongest terminals closest to the soma. This gradient is opposite to postsynaptic gradients observed in pyramidal dendrites, and different cell types apply this rule to a different extent.

Legumes carry out special biochemical functions, e.g. the fixation of molecular nitrogen based on a symbiosis with proteobacteria. At the cellular level, this symbiosis has to be implemented into the energy metabolism of the host cell. To provide a basis for future analyses, we have characterized the protein complement of mitochondria of the model legume Medicago truncatula using two-dimensional isoelectric focussing (IEF) and blue-native (BN)-SDS-PAGE. While the IEF reference map resulted mainly in resolution of those proteins associated with the mitochondrial matrix, the BN proteomic map allowed separation of protein subunits from the respiratory chain protein complexes, which are located in the organelle's inner membrane. The M. truncatula mitochondrial BN reference map revealed some striking similarities to the one from Arabidopsis thaliana but at the same time exhibited also some special features: complex II is of increased abundance and additionally represented by a low molecular mass form not reported for Arabidopsis. Furthermore three highly abundant forms of prohibitin complexes are present in the mitochondrial proteome of M. truncatula. Special features with respect to mitochondrial protein complexes might reflect adaptations of legumes to elevated cellular energy requirements enabling them to develop symbiotic interactions with rhizobial bacteria.

Study objective We assess accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. In accordance with previous reports and clinical observation, we hypothesize low accuracy and high variability across all sites. Methods This cross-sectional multicenter study enrolled 87 ESI-trained nurses from EDs in Brazil, the United Arab Emirates, and the United States. Standardized triage scenarios published by the Agency for Healthcare Research and Quality (AHRQ) were used. Accuracy was defined by concordance with the AHRQ key and calculated as percentages. Accuracy comparisons were made with one-way ANOVA and paired t test. Interrater reliability was measured with Krippendorff's α. Subanalyses based on nursing experience and triage scenario type were also performed. Results Mean accuracy pooled across all sites and scenarios was 59.2% (95% confidence interval [CI] 56.4% to 62.0%) and interrater reliability was modest (α=.730; 95% CI .692 to .767). There was no difference in overall accuracy between sites or according to nurse experience. Medium-acuity scenarios were scored with greater accuracy (76.4%; 95% CI 72.6% to 80.3%) than high- or low-acuity cases (44.1%, 95% CI 39.3% to 49.0% and 54%, 95% CI 49.9% to 58.2%), and adult scenarios were scored with greater accuracy than pediatric ones (66.2%, 95% CI 62.9% to 69.7% versus 46.9%, 95% CI 43.4% to 50.3%). Conclusion In this multinational study, concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, our findings point to a need for more reliable ED triage tools.

Systolic blood pressure rises continually with increasing age. Side by side the diastolic blood pressure also rises up to an age of approximately 50 and begins to drop from the age of 60. Pathophysiologically, this course of the blood pressure is due to a loss of elasticity of the proximal aorta with advancing age. Whereas an isolated diastolic hypertonia (IDH) is most frequent in younger patients while at middle age a combined systolic and diastolic hypertonia occurs most often. The generalizing phrase ”systolic pressure is all that matters” ignores the many patients with an isolated diastolic blood pressure increase, the diagnosis and treatment of which remains essential. It may be difficult to reduce especially the systolic pressure. Hypertonic intervention studies have shown that normalization of diastolic pressure has been achieved almost always (

Bulbusverletzungen fuhren haufig zu einer dauerhaften Beeintrachtigung des Sehvermogens. Insbesondere bei Bulbusrupturen ist die Chance, einen Visus >0,1 zu erreichen 50-mal geringer als nach Bulbuskontusion. Neben Netzhaut- und Aderhauttrauma kommt dem Iris-Linsendiaphragma (ca. 10% Irisdefekte und 1% Aniridie nach stumpfer Verletzung) bei der visuellen Rehabilitation eine haufig unterschatzte Rolle zu. Vor diesem Hintergrund wurden die operativen Ergebnisse nach Implantation von Aniridie-Intraokularlinsen untersucht. 11 Patienten (41,9±19,6 Jahre) mit Z. n. Bulbustrauma (3-mal Bulbusruptur, 8-mal penetrierende Bulbusverletzung mit Iris-Linsenbeteiligung) wurden mit einem Aniridie-Implantat versorgt. Die Implantation der Aniridie-IOL erfolgte im Mittel 1,0±0,6 Jahre (Spanne 0,4–2,3 Jahre) nach der primaren Wundversorgung. Bei 10 Augen wurde eine Aniridie-IOL Modell HMK ANI 2 (Ophtec/Polytech), bei 1 Auge eine Aniridie-IOL Modell 67 (Morcher) implantiert. Die postoperative Patientenzufriedenheit war hoch (korrigierter Visus im Mittel 0,48; 0,05–1,0). 63% der operierten Augen erreichten einen Visus ≥0,4. Alle Patienten erfuhren eine Reduktion der praoperativ bestandenen Blendungsempfindlichkeit. Die Inzidenz von Sekundarglaukomen wurde durch die Sekundarimplantation nicht erhoht. Ein Patient erlitt 3 Monate nach Implantation eine Netzhautablosung, die durch ppV und Gastamponade behoben werden konnte. Bei Trauma-Augen mit partieller oder vollstandiger Aniridie und gleichzeitig bestehender Aphakie erscheint die Implantation von Aniridie-IOLs als eine therapeutische Option mit z. T. guter visueller Rehabilitation. Bei der postoperativen Verlaufskontrolle ist auf ausreichende Tensionseinstellung und Ablatioprodromi zu achten.

OBJECTIVES. Our goal was to assess the degree of pediatric preparedness of emergency departments in the United States.METHODS. A closed-response survey based on the American Academy of Pediatrics/American College of Emergency Physicians joint policy statement, “Care of Children in the Emergency Department: Guidelines for Preparedness,” was mailed to 5144 emergency department medical and nursing directors. A weighted preparedness score (scale of 0–100) was calculated for each emergency department.RESULTS. A total of 1489 useable surveys (29%) were received, with 62% completed by emergency department medical directors. Eighty-nine percent of pediatric (age: 0–14 years) emergency department visits occur in non–children's hospitals, 26% of visits occur in rural or remote facilities, and 75% of responding emergency departments see CONCLUSION. Pediatric preparedness of hospital emergency departments demonstrates opportunities for improvement.

One great challenge for OEMs is to manage the complex supply processes. In order to reduce this complexity, they could integrate large suppliers into so-called Automotive Supplier Parks. In the end, large suppliers would have many small one-to-one plants in Supplier Parks with low economies of scale and high costs. This paper illustrates the key problems of traditional Supplier Parks and presents a new solution: the concept of Extended Multi-Customer Supplier Parks (MCSP+). Requirements, logistic processes and structures will be explained. Furthermore, the paper will present an approach to integrate suppliers in an MCSP+ that are not located in a Supplier Park.

Soft tissue tumors are often challenging for pathologists on the basis of morphology alone; therefore, tumor-specific chromosomal aberrations, such as translocations and fusions, amplifications or deletions can be diagnostically useful. Fluorescence in situ hybridization is widely used for the detection of most aberrations in routine diagnostics. Furthermore, reverse transcriptase PCR, sequencing and specific immunohistochemical assays are also applied. Next generation sequencing has already contributed to the identification of hitherto unknown aberrations. Molecular pathology is mainly used in sarcomas to discriminate between different tumor entities. In terms of personalized therapy and targeted treatment, molecular pathology can be utilized to detect predictive markers.

Continuing medical education (CME) is plagued by outdated ideas about how physicians should use information in treating their patients. To maintain relevance, CME programs must develop a new approach to teaching that acknowledges the realities of twenty-first century health care and offers physicians a better way to learn.

Bone is a critical organ for the accumulation of 90Sr but also of other “bone-seeking” radionuclides such as Ra, Pb, Th, U and Pu. That's why a simple radiochemical procedure to separate 90Sr, 210Pb, 226Ra, Thnat. Unat., 238Pu and 239/240Pu from bone and teeth was developed. The separation scheme is based on extraction chromatography. Deciduous teeth, extracted from children born in 1982-1991 were collected in various regions of Germany and in Northwest Ukraine and analyzed for 90Sr concentrations with regard to the Chernobyl accident in 1986. The teeth were grouped into samples according to the year of birth and the residence of the donors. The 90Sr content in teeth from the Ukraine (mean = 63.8 mBq/g Ca) averaged more than twice as much as that found in teeth from Germany (mean = 28.4 mBq/g Ca). The obvious explanation for this effect is that the concentration of 90Sr decreased with increasing distance from the damaged Chernobyl nuclear power plant. The measured levels of 90Sr concentrations, however, were much lower than 90Sr concentrations determined in the mid-60s and mid-70s.