[Successful lipid rescue therapy in a case of severe amitriptyline/quetiapine intoxication]. / Erfolgreiche "Lipidrescuetherapie" bei Amitriptylin-Quetiapin-Mischintoxikation in mehrfach letaler Dosis.

A 25-year-old patient was admitted urgently due to mixed amitriptyline/quetiapine intoxication at a potentially lethal dose. Alongside severe anticholinergic toxidrome, she presented with antiadrenergic and quinidin-like cardiotoxic findings, including ventricular tachycardia. In the present case, arrhythmia and circulatory shock responded neither to alkalization and elevated sodium levels after infusion of sodium bicarbonate, nor to any other established therapies. Following the lipid rescue paradigm, bolus infusion of a 20% lipid emulsion led to rapid stabilization and continued reversal of all intoxication features.

Different yet similar? Prisoners versus psychiatric patients - A comparison of their mental health.

BACKGROUND: Previous research indicates that prisoners have severe psychological distress. To assess their distress level and potential need for treatment, the present study compared the subjective psychological distress of long- and short-term prisoners with that of psychiatric and forensic patients. METHODS: Long- (n=98) and short-term prisoners (n=94) and forensic (n=102) and psychiatric (n=199) patients completed the German versions of the Symptom Checklist Revised (SCL-90-R) and Brief Symptom Inventory (BSI). RESULTS: In general, long-term prisoners showed the same level of mental distress as psychiatric patients and more than that reported by forensic patients. Short-term prisoners reported the least level of distress. Long- but not short-term prisoners showed clinically significant results on the scales for depression, paranoid ideation, and psychosis. CONCLUSIONS: The improvements in psychiatric treatment for inmates demanded by many stakeholders need to differentiate between long- and short-term prisoners. Because depression seems to cause the most psychological distress among inmates, suicide prevention seems to be an important issue in prisons.

[Questionnaire for Investigating Therapeutic Alliance in Forensic Setting (FTBF): Results of a Pilot Study]. / Fragebogen zur therapeutischen Beziehung in der Forensik (FTBF): Ergebnisse einer Pilotstudie.

The relation between patient and therapist has a substantial effect on the success of psychotherapy. So far, in German-speaking regions questionnaires translated from English have been used, particularly for studying outpatients. Studies investigating and concerned with specialised features of hospitalised forensic psychiatry patients are sparse. The preliminary results of this study evaluating a recently developed questionnaire aimed to investigate the quality of the therapeutic relationship in forensic psychiatry ("Fragebogen zur therapeutischen Beziehung in der Forensik, FTBF") are reported. The data were collected both in general and forensic psychiatry departments. Factor analyses yielded two essential factors, namely "positive emotional aspects" (12 items, main features trust, respect, helpfulness, harmony, and sympathy; Cronbach's α = .933) and "negative emotional aspects" (4 items, main features power divide and punishment; Cronbach's α = .805). Forensic patients experienced power divide and punishment tendencies more intensively than general psychiatry patients (p < 0.001). Our questionnaire therefore demonstrates not only excellent reliabilities but also differential validity, enabling a differentiation between general and forensic psychiatry patients. Studies with larger samples would enable conclusions about the impact of the therapists' perspective, specific diagnostic subgroups and different psychotherapeutic orientations, on the patient-therapist relationship in forensic psychiatry.

[Convergent validity of SCID-II and TCI: categorical vs. dimensional diagnostics of personality disorders using the example of short-term prisoners]. / Konvergente Validität von SKID-II und TCI: Kategoriale vs. dimensionale Diagnostik von Persönlichkeitsstörungen am Beispiel von Gefangenen mit Kurzzeitstrafe.

In order to objectify the diagnostics of personality disorders, questionnaires and structured interviews are used. Nevertheless, due to different methodological approaches even those instruments arrive at different results very often. Therefore, this study aimed to check the convergent validity of two frequently used instruments - the Structured Clinical Interview for DSM IV Axis II Disorders (SCID-II) and the Temperament and Character Inventory (TCI) - the first one representing the categorical and the latter one the dimensional approach for diagnosing personality disorders. The diagnostic concordances were statistically described with Cohen's Kappa, Yule's Y, and correlations. The results indicate that there are striking differences in diagnoses and that the SCID-II rather tends to diagnose a personality disorder earlier than the TCI.

Investigating recurrent neural networks for OCT A-scan based tissue analysis.

OBJECTIVES: Optical Coherence Tomography (OCT) has been proposed as a high resolution image modality to guide transbronchial biopsies. In this study we address the question, whether individual A-scans obtained in needle direction can contribute to the identification of pulmonary nodules. METHODS: OCT A-scans from freshly resected human lung tissue specimen were recorded through a customized needle with an embedded optical fiber. Bidirectional Long Short Term Memory networks (BLSTMs) were trained on randomly distributed training and test sets of the acquired A-scans. Patient specific training and different pre-processing steps were evaluated. RESULTS: Classification rates from 67.5% up to 76% were archived for different training scenarios. Sensitivity and specificity were highest for a patient specific training with 0.87 and 0.85. Low pass filtering decreased the accuracy from 73.2% on a reference distribution to 62.2% for higher cutoff frequencies and to 56% for lower cutoff frequencies. CONCLUSION: The results indicate that a grey value based classification is feasible and may provide additional information for diagnosis and navigation. Furthermore, the experiments show patient specific signal properties and indicate that the lower and upper parts of the frequency spectrum contribute to the classification.

Sexual behaviour and Chlamydia trachomatis infections in German female urban adolescents, 2004.

This ad-hoc observational study, conducted in the metropolitan area of Berlin during 2004, revealed that the prevalence of Chlamydia trachomatis (CT) infections in female urban adolescents self-presenting at their gynaecologist without (n=397) or with (n=124) symptoms of CT infection was 5.5% (95% CI 3.7-8.2%) and 9.7% (95% CI 5.6-16.2%), respectively. The prevalence of CT infection was significantly dependent on the number of lifetime sexual partners. Condom use was inconsistent, and lack of knowledge about CT infections and associated health risks predominated in this cohort. The data indicated a need for health education concerning CT to be targeted at female adolescents.

Elective cryopreservation of all pronuclear oocytes after GnRH agonist triggering of final oocyte maturation in patients at risk of developing OHSS: a prospective, observational proof-of-concept study.

BACKGROUND: A bolus dose of GnRH agonist can substitute for hCG as a trigger for the resumption of meiosis in ovarian stimulation with GnRH antagonists, which has been suggested to reduce the risk of ovarian hyperstimulation syndrome (OHSS). As the efficacy of this measure in fresh embryo transfer (ET) cycles is unclear, we evaluated a new clinical concept of GnRH-agonist triggering. METHODS: In this prospective, observational proof-of-concept study, 20 patients considered at increased risk of developing OHSS (> or = 20 follicles > or = 10 mm or estradiol > or = 4000 pg/ml, or a history of cycle cancellation due to OHSS risk or the development of severe OHSS in a previous cycle) after ovarian stimulation and concomitant GnRH-antagonist administration had final oocyte maturation triggered with 0.2 mg triptorelin s.c. All two pronucleate (2 PN) oocytes were cryopreserved by vitrification, and frozen-thawed ETs (FT-ETs) were performed in an artificial cycle. Main outcome measures were the cumulative ongoing pregnancy rate per patient and the ongoing pregnancy rate per first ET. Secondary outcomes included the incidence of moderate-to-severe OHSS. RESULTS: Of the 20 patients triggered with GnRH agonist, 19 patients underwent 24 FT-ETs in the observational period. The cumulative ongoing pregnancy rate was 36.8% (95% confidence interval: 19.1-59.0%). The ongoing pregnancy rate per first FT-ET was 31.6% (15.4-54.0%). No cases of moderate or severe OHSS were observed. CONCLUSIONS: The present study is the proof of the concept that GnRH-agonist triggering of final oocyte maturation in combination with elective cryopreservation of 2 PN oocytes offers OHSS risk patients a good chance of pregnancy achievement, while reducing the risk of moderate and severe OHSS.

[Structural femoral head allografts in revision surgery of loosened acetabular cups]. / Strukturelle Femurkopfallografts in der Revisionschirugie von gelockerten Hüftendoprothesenpfannen.

BACKGROUND: Treatment of acetabular bone defects presents a great challenge in revision total hip arthroplasty (THA). Many methods of acetabular reconstruction have been described. The purpose of this study was to evaluate the midterm results of structural femoral head allografts for acetabular reconstruction. METHODS: Thirty-six patients (33 females and 3 males) with acetabular defects ranging from type 2C to type 3B according to Paprosky's classification were included in the study. In all cases acetabular defects were closed using allografts from femoral heads. In 13 cases an uncemented press-fit cup, in 17 cases a cemented polyethylene socket, and in 6 cases a Burch-Schneider antiprotrusion cage was implanted. The mean follow-up period was 84.2 months (range: 5-147). RESULTS: Four acetabular components failed. All 36 grafts were osseointegrated radiographically and formed a mechanically stable construction. The mean Harris Hip Score at the most recent follow-up was 79.8 points. The distance from the obturator line to the prosthesis head center was 3.73 cm (1.17-5.80 cm) preoperatively and 2.79 cm (0.85-4.8 cm) postoperatively (p<0.05). The distance from the teardrop figure to the prosthesis head center was 3.02 cm (1.0-5.8 cm) preoperatively and 3.25 cm (1.6-4.8 cm) postoperatively (p<0.001). CONCLUSIONS: Closure of acetabular defects of types 2C to 3B according to Paprosky's classification can be satisfactorily accomplished using femoral head allografts. These allografts may facilitate future revision surgery. Femoral heads are readily available due to widespread primary total hip replacement surgery. However, the use of structural femoral head allografts for acetabular reconstruction is cost intensive. Individual patient-related aspects, such as the function of revision arthroplasty, have to be considered when planning revision arthroplasty using femoral head allografts.

Reinforcement of deficient femur with inlay strut grafts in revision hip arthroplasty: a small series.

Failure of the femoral component due to severe loss of femoral bone is an important long-term complication of total hip arthroplasty. We treated four patients with a type IV femoral defect (Paprosky classification) because of aseptic and septic loosening. To enhance bone stock and create a stable prosthetic reconstruction we used femoral allografts as inlay strut grafts alone or combined with onlay strut grafts and impaction grafting. At a mean follow-up of 11 years all four patients presented good or excellent results with Harris Hip Score between 86 and 95 points. Radiologically, no migration of the stems were found and the struts showed signs of incorporation. Inlay strut grafts are a reliable method for bone reconstruction of deficient femoral bone stock in failed total hip replacement.

Complete conversion of nitrate into dinitrogen gas in co-cultures of denitrifying bacteria.

In the past 10 years many molecular aspects of microbial nitrate reduction have been elucidated, but the ecophysiology of this process is hardly understood. In this contribution, our efforts to study the complex microbial communities and interactions involved in the reduction of nitrate to dinitrogen gas are summarized. The initial work concentrated on emission of the greenhouse gas nitrous oxide during incomplete denitrification by Alcaligenes faecalis. As more research methods became available, the fitness of A. faecalis could be tested in mixed cultures with other denitrifying bacteria, most notably with the nitrate-reducing bacterium Pseudomonas G9. Finally, the advancement of molecular diagnostic tools made it possible to survey complex microbial communities using specific primer sets for/and antibodies raised against the various NO(x) reductases. Given the enormous complexity of substrates and environmental conditions, it is evident that mixed cultures rather than single species are responsible for denitrification in man-made and natural ecosystems. However, it is surprising that even for the breakdown of a single compound, such as acetate, mixed cultures are responsible, and that the consecutive denitrification steps are commonly performed by mutualistic co-operating species. Our observations also indicate that we seldom know the identity of the major key players in the nitrogen cycle of these ecosystems.

Recombinant luteinizing hormone supplementation to recombinant follicle-stimulating hormone induced ovarian hyperstimulation in the GnRH-antagonist multiple-dose protocol.

BACKGROUND: Suppression of endogenous LH production by mid-follicular phase GnRH-antagonist administration in controlled ovarian hyperstimulation protocol using recombinant (rec) FSH preparations void of LH activity may potentially affect ovarian response and the outcome of IVF treatment. The present study prospectively assessed the effect of using a combination of recFSH and recLH on ovarian stimulation parameters and treatment outcome in a fixed GnRH-antagonist multiple dose protocol. METHODS: 127 infertile patients with an indication for IVF or ICSI were recruited and randomized (using sealed envelopes) to receive a starting dose of either 150 IU recFSH (follitropin alpha) or 150 IU recFSH plus 75 IU recLH (lutropin alpha) for ovarian hyperstimulation. GnRH-antagonist (Cetrorelix) 0.25 mg was administered daily from stimulation day 6 onwards up to and including the day of the administration of recombinant HCG (chorion gonadotropin alpha). Gonadotropin dose adjustments were allowed from stimulation day 6 onwards, HCG was administered as soon as three follicles > or =18 mm were present. The primary outcome parameter was treatment duration until administration of HCG. RESULTS: Exogenous LH did not shorten the time necessary to reach ovulation induction criteria. Serum estradiol (E(2)) and LH levels were significantly higher on the day of HCG administration in the recLH-supplemented group (1924.7 +/- 1256.4 vs 1488.3 +/- 824.0 pg/ml, P < 0.03), and 2.1 +/- 1.4 vs 1.4 +/- 1.5 IU/l, P < 0.01, respectively). CONCLUSIONS: Except for higher E(2) and LH levels on the day of HCG administration, no positive trend in favour of additional LH was found as defined by treatment outcome parameters.

Enhanced oestradiol secretion briefly after embryo transfer in conception cycles from IVF.

The hypothesis was tested that conception cycles (CC) resulting from IVF can be distinguished from non-conception cycles (NC) by differences in corpora lutea function that are detectable at the earliest stage of embryo implantation. Luteal oestradiol secretion was analysed retrospectively in 409 ovarian stimulation cycles of 296 patients from the day of embryo transfer until 14 days after embryo transfer (ET+14) in IVF/intracytoplasmic sperm injection (ICSI) cycles. Human chorionic gonadotrophin (HCG) was administered in 330 of 409 cycles in addition to vaginal progesterone in all cycles. Differences in serum oestradiol concentrations between CC and NC increased from day ET+1 onward and became statistically significant on days ET+4 through ET+14, with higher oestradiol concentrations in CC compared with NC. Even though exogenous HCG administration prevented the fall in luteal oestradiol concentrations after ET+4 both in CC and NC, increasing differences in oestradiol concentrations between CC and NC after embryo transfer were observed in both groups of HCG-supplemented and non-supplemented cycles. It is concluded that luteal oestradiol secretion is affected at the earliest stage of embryo implantation. The putative early signal to the corpus luteum associated with embryo attachment and early implantation appears to be superimposed onto the effect of exogenous luteal HCG administration and is clearly distinguishable as early as 4 days after embryo transfer in conception cycles.

Formation of semicarbazide (SEM) in food by hypochlorite treatment: is SEM a specific marker for nitrofurazone abuse?

Semicarbazide (SEM) is considered to be a characteristic protein-bound side-chain metabolite of the banned veterinary drug nitrofurazone. It is therefore used as a marker for nitrofurazone abuse. Recently, there has been concern about other sources of SEM in tissue samples, which are not linked to the illegal use of nitrofurazone. The present studies have shown that SEM can occur naturally, e.g. in algae, shrimps and eggs, and is formed from natural substances, e.g. arginine and creatine. A significant formation of SEM was observed in samples treated with hypochlorite commonly used in food processing for disinfection or bleaching. SEM was formed in different kinds of nitrogen compound-containing samples (0.3-20 microg kg(-1)) after treatment with 1% active chlorine. It was detected in the mg kg(-1) range after hypochlorite treatment (0.015% active chlorine) of creatine. Lower levels were also formed from creatinine, arginine and urea. SEM present in hypochlorite-treated carrageenan proved mostly to occur in the tissue-bound form. Therefore, differentiation between SEM from nitrofurazone abuse and SEM originating from natural constituents (due to hypochlorite treatment) seems not to be unambiguously possible.

[Synovial chondromatosis as an unusual cause for subacromial impingement in a tennisplayer]. / Subakromiales Impingement bei einem Tennisspieler verursacht durch eine synoviale Chondromatose.

On the one hand synovial chondromatosis is a rare disorder and usually involves the knee and hip but rarely the shoulder joint. On the other hand bursal causes of impingement are rare too. We report a case of synovial osteochondromatosis presenting as chronic impingement syndrome in a 44 year old hobby tennis player. In the course of four years impingement problems and a "tumorous" growth on the outer surface attacked attraction to the patient. An MRI presented several nodular structures with sclerosis in the anteriomedial region of the shoulder joint. The mass was completely removed by operative treatment. The histological result showed a synovial chondromatosis with chronical synovitis. After the operative exstirpation of the calcified bodies the patient had no discomfort for 15 months and is now able to play tennis again.

Erv41p and Erv46p: new components of COPII vesicles involved in transport between the ER and Golgi complex.

Proteins contained on purified COPII vesicles were analyzed by matrix-assisted laser desorption ionization mass spectrometry combined with database searching. We identified four known vesicle proteins (Erv14p, Bet1p, Emp24p, and Erv25p) and an additional nine species (Yip3p, Rer1p, Erp1p, Erp2p, Erv29p, Yif1p, Erv41p, Erv46p, and Emp47p) that had not been localized to ER vesicles. Using antibodies, we demonstrate that these proteins are selectively and efficiently packaged into COPII vesicles. Three of the newly identified vesicle proteins (Erv29p, Erv41p, and Erv46p) represent uncharacterized integral membrane proteins that are conserved across species. Erv41p and Erv46p were further characterized. These proteins colocalized to ER and Golgi membranes and exist in a detergent-soluble complex that was isolated by immunoprecipitation. Yeast strains lacking Erv41p and/or Erv46p are viable but display cold sensitivity. The expression levels of Erv41p and Erv46p are interdependent such that Erv46p was reduced in an erv41Delta strain, and Erv41p was not detected in an erv46Delta strain. When the erv41Delta or ev46Delta alleles were combined with other mutations in the early secretory pathway, altered growth phenotypes were observed in some of the double mutant strains. A cell-free assay that reproduces transport between the ER and Golgi indicates that deletion of the Erv41p-Erv46p complex influences the membrane fusion stage of transport.

The mtl genes and the mannitol-1-phosphate dehydrogenase from Klebsiella pneumoniae KAY2026.

The mtl operon of Klebsiella pneumoniae KAY2026 (formerly Aerobacter aerogenes 1033-5P14) was shown to contain as the promoter-proximal gene mtlA, encoding a D-mannitol-specific enzyme II transporter (IICBA(Mtl)). This gene is followed by mtlD, coding for a mannitol-1-phosphate dehydrogenase (MtlD, 382 amino acid residues), and mtlR (MtlR, 195 amino acid residues) coding for a putative repressor, gene mtlR overlaps the termination codon of mtlD. The DNA and protein sequences are highly similar to the corresponding genes (81% identical bp) and proteins (79-85% identical amino acids) of Escherichia coli K-12. A truncated form of MtlD lacking the 162 C-terminal amino acid residues still shows 10% dehydrogenase activity which may explain the controversy in the literature concerning the properties of mannitol-phosphate and other medium-length dehydrogenases.

NUCB1, the Drosophila melanogaster homolog of the mammalian EF-hand proteins NEFA and nucleobindin.

Mammalian NEFA and nucleobindin are calcium-binding proteins containing a signal peptide, two EF-hand motifs, acidic and basic regions and a leucine-zipper motif. Although they have been discussed to be involved in autoimmunity, apoptosis and calcium homeostasis in the Golgi apparatus and bone matrix, their exact role remains unknown. Here we report the cloning of their Drosophila homolog, nucb1, as well as the analysis of its expression pattern during embryogenesis and the subcellular localization of the NUCB1 protein. The nucb1 mRNA and the NUCB1 protein were found to be expressed maternally and zygotically, and they accumulate ubiquitously at low levels during all embryonic stages due to a maternal component. From stage 11 onward, high levels of zygotic expression can be detected specifically in the salivary glands and their placodes. In contrast to the known mammalian family members, the NUCB1 protein localizes in a subpattern of cytoplasmic substructures, probably the Golgi apparatus.

Nitrogen, carbon, and sulfur metabolism in natural thioploca samples

Filamentous sulfur bacteria of the genus Thioploca occur as dense mats on the continental shelf off the coast of Chile and Peru. Since little is known about their nitrogen, sulfur, and carbon metabolism, this study was undertaken to investigate their (eco)physiology. Thioploca is able to store internally high concentrations of sulfur globules and nitrate. It has been previously hypothesized that these large vacuolated bacteria can oxidize sulfide by reducing their internally stored nitrate. We examined this nitrate reduction by incubation experiments of washed Thioploca sheaths with trichomes in combination with 15N compounds and mass spectrometry and found that these Thioploca samples produce ammonium at a rate of 1 nmol min-1 mg of protein-1. Controls showed no significant activity. Sulfate was shown to be the end product of sulfide oxidation and was observed at a rate of 2 to 3 nmol min-1 mg of protein-1. The ammonium and sulfate production rates were not influenced by the addition of sulfide, suggesting that sulfide is first oxidized to elemental sulfur, and in a second independent step elemental sulfur is oxidized to sulfate. The average sulfide oxidation rate measured was 5 nmol min-1 mg of protein-1 and could be increased to 10.7 nmol min-1 mg of protein-1 after the trichomes were starved for 45 h. Incorporation of 14CO2 was at a rate of 0.4 to 0.8 nmol min-1 mg of protein-1, which is half the rate calculated from sulfide oxidation. [2-14C]acetate incorporation was 0.4 nmol min-1 mg of protein-1, which is equal to the CO2 fixation rate, and no 14CO2 production was detected. These results suggest that Thioploca species are facultative chemolithoautotrophs capable of mixotrophic growth. Microautoradiography confirmed that Thioploca cells assimilated the majority of the radiocarbon from [2-14C]acetate, with only a minor contribution by epibiontic bacteria present in the samples.