ABSTRACT
The cyanogenic glucoside, dhurrin, present in Sorghum bicolor is thought to have multiple functions, including in defence against herbivory. The hormone methyl jasmonate (MeJA) is also induced by herbivory and is key to instigating defence processes in plants. To investigate whether dhurrin is induced in response to herbivore attack and also to the associated presence of MeJA, sorghum plants were either wounded or exogenous MeJA was applied. We show that specific wounding (pin board and perforation) and the application of MeJA increases dhurrin concentration in leaves and sheath tissue 12 h after treatment. Quantitative PCR shows that the expression of two genes, SbCYP79A1 and SbUGT85B1, involved in the synthesis of dhurrin are significantly induced by exogenous MeJA and by wounding. Analysis of 2 kb of sequence upstream of the start codon of SbCYP79A1 identifies several cis-acting elements that have been linked to MeJA induction. A promoter deletion series, coupled to GFP, and transiently expressed in Nicotiana benthamiana suggests that there are potentially three sequence motifs (~-925 to -976) involved in the binding of transcription factors that result in increased expression of SbCYP79A1 and the synthesis of dhurrin in response to MeJA.
Subject(s)
Sorghum , Sorghum/genetics , Sorghum/metabolism , Up-Regulation , Plants , Cyclopentanes/pharmacology , Cyclopentanes/metabolism , Oxylipins/pharmacology , Oxylipins/metabolism , Glucosides , Acetates/pharmacologyABSTRACT
Anthropologists have long emphasized the social significance of foods and the contexts in which they are consumed. Expanding on this idea, we define the context of consumption as the non-eating behaviors that surround eating, such as the manner of food preparation, food sharing, and dietary patterns. In this study, we used cultural consensus analysis to assess whether there exist consistently shared, normative ideas about preferable context of food consumption in three diverse research sites: urban Ethiopia, rural Brazil, and rural Haiti. Our analysis demonstrates that in all three communities, there are distinct sets of behaviors that people identified as non-preferable because they reliably associate them with poverty and food insecurity, and behaviors that people identify as preferable because they reliably associate them with wealth and food security. Across the settings, there was little variation in agreement about behaviors across household composition, age, gender, and food security status. These findings suggest that people do indeed share culturally specific ideas about the context in which foods should be prepared and consumed, beyond the actual content of one's diet. Exploring these cultural models elucidates the social consequences of food insecurity, enabling researchers to better examine the relationship between food insecurity, social context, and well-being.
Subject(s)
Food Supply , Rural Population , Diet , Food Security , Humans , PovertyABSTRACT
Spatial optical Fourier filtering is a widespread technique for in situ image or light field processing. However, conventional fixed absorbing patterns or mechanical irises only allow an inflexible, very restricted control. Thus, we present two electrochromic spatial filters with ring-shaped or directional segments, which can be individually addressed and continuously tuned in transmission resulting in up to 512 different filtering states. For realization of the electrochromic devices, we overcome technical obstacles to realize seamless, gap-free electrochromic segments. We describe this novel fabrication process and demonstrate the successful application in an optical Fourier transform set-up.
ABSTRACT
Tidal disruption and subsequent accretion of planetesimals by white dwarfs can reveal the elemental abundances of rocky bodies in exoplanetary systems. Those abundances provide information on the composition of the nebula from which the systems formed, which is analogous to how meteorite abundances inform our understanding of the early Solar System. We report the detection of lithium, sodium, potassium, and calcium in the atmosphere of the white dwarf Gaia DR2 4353607450860305024, which we ascribe to the accretion of a planetesimal. Using model atmospheres, we determine abundance ratios of these elements, and, with the exception of lithium, they are consistent with meteoritic values in the Solar System. We compare the measured lithium abundance with measurements in old stars and with expectations from Big Bang nucleosynthesis.
ABSTRACT
BACKGROUND: The Boko Haram insurgency has brought turmoil and instability to Nigeria, generating a large number of internally displaced people and adding to the country's 17.5 million orphans and vulnerable children. Recently, steps have been taken to improve the mental healthcare infrastructure in Nigeria, including revamping national policies and initiating training of primary care providers in mental healthcare. In order for these efforts to succeed, they require means for community-based detection and linkage to care. A major gap preventing such efforts is the shortage of culturally appropriate, valid screening tools for identifying emotional and behavioral disorders among adolescents. In particular, studies have not conducted simultaneous validation of screening tools in multiple languages, to support screening and detection efforts in linguistically diverse populations. We aim to culturally adapt screening tools for emotional and behavioral disorders for use among adolescents in Nigeria, in order to facilitate future validation studies. METHODS: We used a rigorous mixed-method process to culturally adapt the Depression Self Rating Scale, Child PTSD Symptom Scale, and Disruptive Behavior Disorders Rating Scale. We employed expert translations, focus group discussions (N = 24), and piloting with cognitive interviewing (N = 24) to achieve semantic, content, technical, and criterion equivalence of screening tool items. RESULTS: We identified and adapted items that were conceptually difficult for adolescents to understand, conceptually non-equivalent across languages, considered unacceptable to discuss, or stigmatizing. Findings regarding problematic items largely align with existing literature regarding cross-cultural adaptation. CONCLUSIONS: Culturally adapting screening tools represents a vital first step toward improving community case detection.
ABSTRACT
BACKGROUND: Psychiatric diagnostic manuals recognise the importance of local expressions of distress in culturally diverse settings [i.e. idioms/cultural concepts of distress (CCDs)], yet there is a lack of consensus on how these should be incorporated into mental health related research. AIMS: To perform a narrative synthesis and critical review of research exploring how idioms/CCDs have been integrated into assessment measures and interventions. METHOD: A systematic review was conducted in accordance with PRISMA guidelines. An adapted version of the COSMIN checklist was used to assess the quality of the linguistic translation of the idioms/CCDs. RESULTS: Twenty-nine papers were included in the final review. Primary qualitative research was the most common method of gathering information about idioms/CCDs. The majority of studies described integrating idioms/CCDs into assessment measures as opposed to interventions. Some studies used information relating to idioms/CCDs to develop novel assessment measures, while others adapted pre-existing assessment measures. The measures generated moderate to high levels of validity. Information relating to the linguistic translation conducted in the completion of the studies tended to be inadequately reported. CONCLUSIONS: Integrating information about idioms/CCDs into assessment measures can enhance the validity of these assessments. Allocating greater research attention to idioms/CCDs can also promote more equitable exchanges of knowledge about mental health and wellbeing between the Global North and the Global South.
ABSTRACT
GALAXIES is an in-vacuum undulator hard X-ray micro-focused beamline dedicated to the study of the electronic structure of materials with high energy resolution using both photoelectron spectroscopy and inelastic X-ray scattering and under both non-resonant (NR-IXS) and resonant (RIXS) conditions. Due to the penetrating power of hard X-rays and the `photon-in/photon-out' technique, the sample environment is not a limitation. Materials under extreme conditions, for example in diamond anvil cells or catalysis chambers, thus constitute a major research direction. Here, the design and performance of the inelastic X-ray scattering end-station that operates in the energy range from â¼4â keV up to 12â keV is reported, and its capabilities are highlighted using a selection of data taken from recently performed experiments. The ability to scan `on the fly' the incident and scattered/emitted X-ray energies, and the sample position enables fast data collection and high experimental throughput. A diamond X-ray transmission phase retarder, which can be used to generate circularly polarized light, will also be discussed in the light of the recent RIXS-MCD approach.
ABSTRACT
AIMS: We evaluated the effects of Bacillus anthracis surrogates, low surface concentrations, surface materials and assay methods on false-negative rate (FNR) and limit of detection (LOD95 ) for recovering Bacillus spores using a macrofoam-swab sampling procedure. METHODS AND RESULTS: Bacillus anthracis Sterne or Bacillus atrophaeus Nakamura spores were deposited over a range of low target concentrations (2-500 per coupon) onto glass, stainless steel, vinyl tile and plastic. Samples were assayed using a modified Rapid Viability-PCR (mRV-PCR) method and the traditional plate culture method to obtain FNR and LOD95 results. CONCLUSIONS: Mean FNRs tended to be lower for mRV-PCR compared to culturing, and increased as spore concentration decreased for all surface materials. Surface material, but not B. anthracis surrogate, influenced FNRs with the mRV-PCR method. The mRV-PCR LOD95 was lowest for glass and highest for vinyl tile. LOD95 values overall were lower for mRV-PCR than for the culture method. SIGNIFICANCE AND IMPACT OF STUDY: This study adds to the limited data on FNR and LOD95 for mRV-PCR and culturing methods with low concentrations of B. anthracis sampled from various surface materials by the CDC macrofoam-swab method. These are key inputs for planning characterization and clearance studies for low contamination levels of B. anthracis.
Subject(s)
Bacillus anthracis/isolation & purification , Polymerase Chain Reaction , Bacillus/genetics , Bacillus/isolation & purification , Bacillus anthracis/genetics , Bacteriological Techniques , Limit of Detection , Spores, Bacterial/genetics , Spores, Bacterial/isolation & purificationABSTRACT
The process of sporulation is vital for the stability and infectious cycle of Bacillus anthracis. The spore is the infectious form of the organism and therefore relevant to biodefense. While the morphological and molecular events occurring during sporulation have been well studied, the influence of growth medium and temperature on the proteins expressed in sporulated cultures is not well understood. Understanding the features of B. anthracis sporulation specific to natural vs. laboratory production will address an important question in microbial forensics. In an effort to bridge this knowledge gap, a system for sporulation on two types of agar-immobilized soils was used for comparison to cultures sporulated on two common types of solid laboratory media, and one liquid sporulation medium. The total number of proteins identified as well as their identity differed between samples generated in each medium and growth temperature, demonstrating that sporulation environment significantly impacts the protein content of the spore. In addition, a subset of proteins common in all of the soil-cultivated samples was distinct from the expression profiles in laboratory medium (and vice versa). These differences included proteins involved in thiamine and phosphate metabolism in the sporulated cultures produced on soils with a notable increase in expression of ATP binding cassette (ABC) transporters annotated to be for phosphate and antimicrobial peptides. A distinct set of ABC transporters for amino acids, sugars and oligopeptides were found in cultures produced on laboratory media as well as increases in carbon and amino acid metabolism-related proteins. These protein expression changes indicate that the sporulation environment impacts the protein profiles in specific ways that are reflected in the metabolic and membrane transporter proteins present in sporulated cultures.
Subject(s)
Bacillus anthracis/chemistry , Bacillus anthracis/physiology , Proteomics , Soil , Spores, Bacterial/chemistry , Culture Media , Spores, Bacterial/physiologyABSTRACT
The electrocardiogram is a simple and useful clinical tool; nevertheless, few studies have evaluated the prevalence of electrocardiographic abnormalities in the Latin American population. This study aims to evaluate the major electrocardiographic abnormalities according to the Minnesota coding system in Brazilian adults, stratified by gender, age, race, and cardiovascular risk factors. Data from 14,424 adults (45.8% men, age 35 to 74 years) were obtained at baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), according to standardized protocol. The electrocardiogram were obtained with the Burdick Atria 6100 machine, stored on Pyramis System, automatically coded according to the Minnesota coding system by the Glasgow University software and then manually revised. Major abnormalities were more prevalent in men than women (11.3% and 7.9%, p <0.001). These differences were consistent through the different age groups, race, and number of cardiovascular risk factors. Electrocardiographic major abnormalities were more prevalent in black participants for both men (black: 15.1%, mixed: 10.4%, white: 11.1%, p = 0.001) and women (black: 10%, mixed: 7.6%, white: 7.2%, p = 0.004). In conclusion, in this large sample of Brazilian adults, the prevalence of major electrocardiographic abnormalities was higher among men, the elderly, black, and among people with more cardiovascular risk factors.
Subject(s)
Cardiovascular Diseases/physiopathology , Electrocardiography , Heart Conduction System/physiopathology , Risk Assessment/methods , Urban Population , Adult , Age Factors , Aged , Brazil/epidemiology , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cross-Sectional Studies , Female , Humans , Incidence , Male , Middle Aged , Prevalence , Risk Factors , Sex FactorsABSTRACT
AIMS: We sought to evaluate the effects of Bacillus species, low surface concentrations, and surface material on recovery efficiency (RE), false-negative rate (FNR) and limit of detection for recovering Bacillus spores using a validated macrofoam-swab sampling procedure. METHODS AND RESULTS: The performance of a macrofoam-swab sampling method was evaluated using Bacillus anthracis Sterne (BAS) and Bacillus atrophaeus Nakamura (BG) spores applied at nine low target surface concentrations (2 to 500 CFU per plate or coupon) to positive-control plates and test coupons (25·8064 cm(2) ) of four surface materials (glass, stainless steel, vinyl tile and plastic). The Bacillus species and surface material had statistically significant effects on RE, but surface concentration did not. Mean REs were the lowest for vinyl tile (50·8% with BAS and 40·2% with BG) and the highest for glass (92·8% with BAS and 71·4% with BG). FNR values (which ranged from 0 to 0·833 for BAS and from 0 to 0·806 for BG) increased as surface concentration decreased in the range tested. Surface material also had a statistically significant effect on FNR, with FNR the lowest for glass and highest for vinyl tile. Finally, FNR tended to be higher for BG than for BAS at lower surface concentrations, especially for glass. CONCLUSIONS: Concentration and surface material had significant effects on FNR, with Bacillus species having a small effect. Species and surface material had significant effects on RE, with surface concentration having a nonsignificant effect. SIGNIFICANCE AND IMPACT OF THE STUDY: The results provide valuable information on the performance of the macrofoam-swab method for low surface concentrations of Bacillus spores, which can be adapted to assess the likelihood that there is no contamination when all macrofoam-swab samples fail to detect B. anthracis.
Subject(s)
Bacillus anthracis/isolation & purification , Bacillus/isolation & purification , Microbiological Techniques/methods , Spores, Bacterial/isolation & purification , Bacillus/classification , Bacillus anthracis/growth & development , Limit of Detection , Microbiological Techniques/instrumentation , Microbiological Techniques/standards , Spores, Bacterial/growth & development , Stainless Steel/analysisABSTRACT
Antiretrovirals are a significant cost driver for HIV programmes. Current first-line regimens have performed well in real-life programmes, but have a low barrier to virological resistance and still carry toxicity that limits adherence. New drug developments may mean that we have access to safer, more robust and cheaper regimens, but only if the appropriate clinical trials are conducted. We briefly discuss these trials, and demonstrate the large cost savings to the South African HIV programme if these are successful.
Subject(s)
Anti-HIV Agents/economics , Antiretroviral Therapy, Highly Active/economics , Cost Savings , Drug Costs , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active/methods , Clinical Trials as Topic , Drug Discovery , Humans , South AfricaABSTRACT
Among factors affecting the accuracy of flow simulations with Reynolds-Averaged Navier-Stokes turbulence models is modeling turbulent diffusion processes. With the use of the Gram-Charlier series expansions, the turbulent diffusion in fourth-order one-point statistical closures of the Reynolds-Averaged Navier-Stokes equations can be modeled without introducing unknown model coefficients and without assuming turbulence being Gaussian. Terms representing turbulent diffusion processes in transport equations for second- and third-order velocity correlations do not require any modeling in such closures. In this regard, fourth-order closures are a more accurate alternative to lower-order closures where turbulent diffusion is modeled on semi-empirical or Gaussian turbulence assumptions. In the current paper, the accuracy of the closing procedure based on the Gram-Charlier series expansions is evaluated using data of direct numerical simulations in an incompressible zero-pressure-gradient turbulent boundary layer over a flat plate. One-point third-, fourth-, and fifth-order velocity moments were extracted for this purpose from the dataset collected by the Fluid Dynamics Group at the Universidad Politécnica de Madrid at two streamwise locations Reθ= 4101 and 5200 that correspond to channels and pipes at δ+= 1331 and 1626. Results demonstrate that the truncated Gram-Charlier series expansions are an accurate approximation of the fifth-order velocity moments in the considered flow.
ABSTRACT
The GALAXIES beamline at the SOLEIL synchrotron is dedicated to inelastic X-ray scattering (IXS) and photoelectron spectroscopy (HAXPES) in the 2.3-12 keV hard X-ray range. These two techniques offer powerful complementary methods of characterization of materials with bulk sensitivity, chemical and orbital selectivity, resonant enhancement and high resolving power. After a description of the beamline components and endstations, the beamline capabilities are demonstrated through a selection of recent works both in the solid and gas phases and using either IXS or HAXPES approaches. Prospects for studies on liquids are discussed.
ABSTRACT
A photovoltaic tandem cell made of amorphous silicon (a-Si) and microcrystalline silicon (µc-Si) was investigated as a photocathode for hydrogen evolution in a photoelectrochemical device. The electronic and electrochemical properties of the samples were characterized using X-ray photoemission spectroscopy (XPS) and cyclic voltammetry (CV), whereas the morphology of the surface in contact with the electrolyte was investigated by scanning electron microscopy (SEM). The electric efficiency of the tandem cell was determined to be 5.2% in a photoelectrochemical (PEC) setup in acidic solution which is only about half of the photovoltaic efficiency of the tandem cell. A significant improvement in efficiency was achieved with platinum as a catalyst which was deposited by physical vapour deposition (PVD) under ultra-high vacuum (UHV) conditions.
ABSTRACT
BACKGROUND: School vaccination programs against human papilloma virus (HPV) have been implemented in most Western countries. Only a few studies have investigated socio-economic factors related to school-based vaccination. METHOD: A cross-sectional study was conducted using the vaccination cards of 1158 randomized girls aged 13 to 14 years enrolled in the public schools of the canton of Geneva. Several other socio-economic variables (nationality, socio-professional category and marital status of the parents) were collected. RESULTS: Immunization coverage for three doses of HPV vaccine was 56%. After having controlled the covariates, Portuguese adolescents (adjusted OR [95% CI]: 4.18 [1.76-9.92]), adolescents whose mothers were workers (adjusted OR [95% CI]: 1.91 [1.38-2.65]) or married (adjusted OR [95% CI]: 1.44 [1.06-1.98]) showed significantly higher immunization rates than Swiss adolescents or those whose mothers' socio-professional category was senior manager or executive. CONCLUSION: This study shows that the HPV vaccine coverage is not yet optimal in Geneva and varies significantly according to the socio-economic status, thus better promotion of HPV vaccination for certain target groups must be implemented.
Subject(s)
Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/administration & dosage , Uterine Cervical Neoplasms/prevention & control , Vaccination/statistics & numerical data , Adolescent , Cities/epidemiology , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Humans , Papillomavirus Infections/epidemiology , Patient Acceptance of Health Care/statistics & numerical data , Schools/statistics & numerical data , Socioeconomic Factors , Switzerland/epidemiology , Uterine Cervical Neoplasms/epidemiologyABSTRACT
During the last years the indications of Cardiac Magnetic Resonance Imaging (CMRI) have been continuously expanded. However, the acceptance of the method by cardiologists and radiologists does not correlate with respect to the diagnostic potential. Several factors, such as expensive equipment, relatively long examination times, high technical know how and lack of remuneration, limit the application of CMRI in everyday clinical practice. Furthermore, doctors tend to apply more conventional, well established diagnostic procedures, the access to the method is still limited and there exist difficulties in the interdisciplinary collaboration. The interdisciplinary Austrian approach to Cardiac Imaging is aimed to improve the aforementioned problems and to support the implementation of CMRI in the diagnostic tree of cardiac diseases thus enabling a cost efficient management of patients in cardiology.
Subject(s)
Cooperative Behavior , Heart Diseases/diagnosis , Image Interpretation, Computer-Assisted/methods , Interdisciplinary Communication , Magnetic Resonance Imaging/methods , Coronary Disease/diagnosis , Humans , Image Enhancement/methods , Magnetic Resonance Angiography/methods , Myocardial Perfusion Imaging/methods , Sensitivity and SpecificityABSTRACT
PURPOSE: To assess the effect of abiraterone acetate plus prednisone on the pharmacokinetics of dextromethorphan HBr (CYP2D6 substrate) and theophylline (CYP1A2 substrate) in patients with metastatic castration-resistant prostate cancer (mCRPC). METHODS: Men with progressive metastatic mCRPC who failed gonadotropin-releasing hormone therapy and ≥1 lines of chemotherapy were enrolled. Patients received two doses of dextromethorphan HBr-30 mg (n = 18; group A) or theophylline-100 mg (n = 16; group B) under fasting conditions; one dose on cycle 1, day -8, and the other dose on cycle 1, day 8. Only patients with extensive CYP2D6 metabolizing status were assigned to group A. All patients received continuous daily oral abiraterone acetate (1,000 mg) plus prednisone (10 mg) starting on cycle 1, day 1. RESULTS: Coadministration of abiraterone acetate plus prednisone increased the systemic exposure of dextromethorphan by approximately 100%. Ratios of geometric means for maximum plasma concentration (C(max)) (275.36%) and area under plasma concentration-time curves from time 0 to 24 h (AUC(24h)) (268.14%) of dextromethorphan were outside the bioequivalence limit. The pharmacokinetics of theophylline was unaltered following coadministration of abiraterone acetate plus prednisone. Ratios of geometric means [C(max); 102.36% and AUC(24h); 108.03%] of theophylline exposure parameters were within the bioequivalence limit. The safety profile of abiraterone acetate was consistent with reported toxicities. CONCLUSION: Abiraterone acetate plus prednisone increased the exposure of dextromethorphan, suggesting a need for caution when coadministrating with known CYP2D6 substrates. The pharmacokinetics of theophylline was unaffected when coadministered with abiraterone acetate plus prednisone.
Subject(s)
Androstadienes/pharmacology , Dextromethorphan/pharmacokinetics , Prednisone/pharmacology , Prostatic Neoplasms/drug therapy , Theophylline/pharmacokinetics , Abiraterone Acetate , Androstadienes/administration & dosage , Androstadienes/adverse effects , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Area Under Curve , Cytochrome P-450 CYP1A2/drug effects , Cytochrome P-450 CYP1A2/metabolism , Cytochrome P-450 CYP2D6/drug effects , Cytochrome P-450 CYP2D6/metabolism , Dextromethorphan/administration & dosage , Drug Interactions , Follow-Up Studies , Humans , Male , Neoplasm Metastasis , Prednisone/administration & dosage , Prostatic Neoplasms/pathology , Theophylline/administration & dosageABSTRACT
OBJECTIVE: This study characterized artificially ventilated patients in a neurological intensive care unit (NICU) between 2006-2008 in a purely neurological clinic and a so-called stand-alone situation. In addition the long-term prognoses as well as the quality of life of surviving patients were investigated. METHODS: All ventilated patients from October 2006 to December 2008 were enrolled in this descriptive, retrospective study. The duration of stay in intensive care was analyzed and the current quality of life was prospectively assessed based on the patient records. Final diagnoses, duration of intensive care unit and ventilation as well as the highest score in SAPS II (simplified acute physiology score) and complications during hospitalization were determined. The patients were divided into groups based on the diagnoses as vascular, inflammatory, neurodegenerative, hereditary, epileptogenic and others. Additionally patients were contacted and asked to respond by completing questionnaires on the Barthel index (BI) and the modified Rankin scale (mRS). RESULTS: During the study period a total of 512 patients were treated in the NICU of whom 201 required artificial respiration. Cerebrovascular diseases were the main reason for therapy in the NICU in 96 out of 201 cases (47.8%), followed by inflammatory diseases in 46 (22.8%) and epileptogenic diseases in 26 patients (13%). The median duration of artificial respiration was 9 days with a mean treatment duration of 16 days (range 1-57 days). Of the patients 31 (15.4%) died in the NICU and an additional 32 patients (18.8%) died within a median of 2 months after discharge. Outcome data were available from 67 out of 170 sent questionnaires and rehabilitation reports of 86 patients, which enabled the outcome of 121 surviving patients to be analyzed (71.2%). Of these 42.2% showed no or mild impairment in everyday life. However, the remaining 38% had severe impairments according to the BI. The evaluation of the mRS showed that 49.6% of the patients still had severe symptoms. CONCLUSIONS: More than one third of the patients treated in the NICU required artificial ventilation with an emphasis on cerebrovascular diseases, which illustrates the overlap between stroke unit and NICU care. Despite a lengthy duration of ventilation and a long stay in the intensive care unit more than one third of surviving patients showed no or only mild impairment. However, an additional third suffered from severe disability up to nursing care dependency. The study data differ little from the few publications in this field despite the stand alone situation of the NICU. The case mix index per day averaged around 0.3 and underlines the economic importance with respect to other forms of neurological treatment.
Subject(s)
Cerebrovascular Disorders/mortality , Cerebrovascular Disorders/rehabilitation , Intensive Care Units/statistics & numerical data , Neurology/statistics & numerical data , Quality of Life , Respiration, Artificial/mortality , Adult , Aged , Aged, 80 and over , Female , Germany/epidemiology , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Assessment , Survival Analysis , Survival Rate , Treatment OutcomeABSTRACT
OBJECTIVES: To determine factors associated with diagnostic yield of ENB. METHODS: In 112 consecutive patients referred to our department between March 2010 and December 2010 the diagnostic work-up for solitary pulmonary lesions included a FDG-PET-CT scan, and ENB in combination with ROSE. The final diagnosis was confirmed by histopathological evaluation of specimen obtained either by ENB, or - if ENB was not diagnostic - by CT-guided fine needle aspiration or surgery. RESULTS: Thirty-seven (33%) subjects were female, mean age was 66.7 (±1.04) years. The mean diameter of lesions was 27mm (range: 6-46mm). In 83.9% the combination of PET-CT, ENB, and ROSE established a correct diagnosis, as defined by the definite histopathological result. 15.2% (17/112) of lesions were benign, and 84.8% (95/112) were malignant. For 112 procedures we observed a steep learning curve with a diagnostic yield of 80% and 87.5% for the first 30 and last 30 procedures, respectively. The diagnostic yield in lesions ≤20mm and >20mm in diameter was 75.6% and 89.6% (p=0.06), respectively. No significant difference in diagnostic yield was seen depending on lung function, and the localization of the lesions. Two cases (1.8%) of pneumothorax were seen during and up to 24h after bronchoscopy, none of them required a chest tube. CONCLUSION: Diagnostic yield increased with experience but was independent from the size of the lesion, the localisation in the lungs, and lung function. The diagnostic yield of ENB can be as high as for CT-guided transthoracic biopsies but carries a significantly lower complication rate.