Rahnella spp. are commonly isolated from onion (Allium cepa) bulbs and are weakly pathogenic.

AIMS: Bacterial decays of onion bulbs have serious economic consequences for growers, but the aetiologies of these diseases are often unclear. We aimed to determine the role of Rahnella, which we commonly isolated from bulbs in the United States and Norway, in onion disease. METHODS AND RESULTS: Isolated bacteria were identified by sequencing of housekeeping genes and/or fatty acid methyl ester analysis. A subset of Rahnella spp. strains was also assessed by multilocus sequence analysis (MLSA); most onion strains belonged to two clades that appear closely related to R. aquatilis. All tested strains from both countries caused mild symptoms in onion bulbs but not leaves. Polymerase chain reaction primers were designed and tested against strains from known species of Rahnella. Amplicons were produced from strains of R. aquatilis, R. victoriana, R. variigena, R. inusitata and R. bruchi, and from one of the two strains of R. woolbedingensis. CONCLUSIONS: Based on binational testing, strains of Rahnella are commonly associated with onions, and they are capable of causing mild symptoms in bulbs. SIGNIFICANCE AND IMPACT OF THE STUDY: While Rahnella strains are commonly found within field-grown onions and they are able to cause mild symptoms, the economic impact of Rahnella-associated symptoms remains unclear.

Early cryoprecipitate for major haemorrhage in trauma: a randomised controlled feasibility trial.

BACKGROUND: Low fibrinogen (Fg) concentrations in trauma haemorrhage are associated with poorer outcomes. Cryoprecipitate is the standard source for Fg administration in the UK and USA and is often given in the later stages of transfusion therapy. It is not known whether early cryoprecipitate therapy improves clinical outcomes. The primary aim of this feasibility study was to determine whether it was possible to administer cryoprecipitate, within 90 min of admission to hospital. Secondary aims were to evaluate laboratory measures of Fg and clinical outcomes including thrombotic events, organ failure, length of hospital stay and mortality. METHODS: This was an unblinded RCT, conducted at two civilian UK major trauma centres of adult trauma patients (age ≥16 yrs), with active bleeding and requiring activation of the major haemorrhage protocol. Participants were randomised to standard major haemorrhage therapy (STANDARD) (n=22), or to standard haemorrhage therapy plus two early pools of cryoprecipitate (CRYO) (n=21). RESULTS: 85% (95% CI: 69-100%) CRYO participants received cryoprecipitate within 90 min, median time 60 min (IQR: 57-76) compared with 108 min (67-147), CRYO and STANDARD arms respectively (P=0.002). Fg concentrations were higher in the CRYO arm and were maintained above 1.8 g litre(-1) at all time-points during active haemorrhage. All-cause mortality at 28 days was not significantly different (P=0.14). CONCLUSIONS: Early Fg supplementation using cryoprecipitate is feasible in trauma patients. This study supports the need for a definitive RCT to determine the effect of early Fg supplementation on mortality and other clinical outcomes. TRIAL REGISTRY NUMBER: ISRCTN55509212.

[Acute pancreatitis: guideline-based diagnosis and treatment]. / Akute Pankreatitis: Leitlinienbasierte Diagnostik und Therapie.

Acute pancreatitis is most frequently of biliary or alcoholic origin and less frequently due to iatrogenic (ERCP, medication) or metabolic causes. Diagnosis is usually based on abdominal pain and elevation of serum lipase to more than three-times the normal limit. Acute pancreatitis can either resolve quickly following an oedematous swelling or present as a severe necrotizing form. A major risk is the systemic inflammatory response syndrome (SIRS), which can cause multi-organ failure. Prediction of disease course is initially difficult, thus necessitating immediate therapy and regular re-evaluation. In order to prove or exclude biliary genesis, abdominal ultrasonography should first be performed and endoscopic ultrasound may also be required. Primary therapy includes rapid and correctly dosed fluid substitution. Biliary pancreatitis requires causal treatment. In the case of cholangitis, stone extraction must be performed immediately; in the absence of cholangitis, it might be advisable to wait for spontaneous stone clearance. Timely cholecystectomy is necessary in all cases of biliary pancreatitis.

HopX1 in Erwinia amylovora functions as an avirulence protein in apple and is regulated by HrpL.

Fire blight is a devastating disease of rosaceous plants caused by the Gram-negative bacterium Erwinia amylovora. This pathogen delivers virulence proteins into host cells utilizing the type III secretion system (T3SS). Expression of the T3SS and of translocated and secreted substrates is activated by the alternative sigma factor HrpL, which recognizes hrp box promoters upstream of regulated genes. A collection of hidden Markov model (HMM) profiles was used to identify putative hrp boxes in the genome sequence of Ea273, a highly virulent strain of E. amylovora. Among potential virulence factors preceded by putative hrp boxes, two genes previously known as Eop3 and Eop2 were characterized. The presence of functionally active hrp boxes upstream of these two genes was confirmed by ß-glucuronidase (GUS) assays. Deletion mutants of the latter candidate genes, renamed hopX1(Ea) and hopAK1(Ea), respectively, did not differ in virulence from the wild-type strain when assayed in pear fruit and apple shoots. The hopX1(Ea) deletion mutant of Ea273, complemented with a plasmid overexpressing hopX1(E)(a), suppressed the development of the hypersensitivity response (HR) when inoculated into Nicotiana benthamiana; however, it contributed to HR in Nicotiana tabacum and significantly reduced the progress of disease in apple shoots, suggesting that HopX1(Ea) may act as an avirulence protein in apple shoots.

Extra-articular fractures of the proximal phalanges of the fingers: a comparison of 2 methods of functional, conservative treatment.

PURPOSE: For nonsurgical treatment of fractures of the proximal phalanges of the triphalangeal fingers, different dynamic casts have been described. The main principle behind these casts is advancement and tightening of the extensor hood, caused by a combination of blocking the metacarpophalangeal joints in flexion and actively flexing the proximal interphalangeal joints. In contrast to established treatment protocols using functional forearm casts, the Lucerne cast allows for free mobilization of the wrist joint. The purpose of the current multicenter study was to compare the results of conservative, functional treatment using 2 different methods, either a forearm cast or a Lucerne cast. METHODS: Over a 2-year-period, a prospective, randomized, multicenter study was conducted at 4 hospitals in Switzerland. Clinical and radiological results of 66 consecutive patients having 75 extra-articular fractures of the proximal phalanges were recorded through a minimum follow-up of 3 months. Intra-articular and physeal fractures, pathological fractures, open fractures, concomitant injuries of the tendons or collateral ligaments, and accidents more than 7 days before presentation were excluded from the study. RESULTS: Radiographically, there were no statistically significant differences between the 2 groups in terms of palmar apex angulation and radial or ulnar angulation. There were no differences in total active range of finger motion. Wrist joint motion at the time of cast removal was statistically superior in patients treated with Lucerne cast. However, there were no significant differences in wrist joint motion at 12 weeks of follow-up. CONCLUSIONS: The clinical and radiological results achieved with the Lucerne cast are comparable to those of established treatment. Well-reduced, minimally angulated, or nonangulated fractures of the proximal phalanges of the fingers can be effectively treated using functional casts without immobilizing the wrist. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Eop1 from a Rubus strain of Erwinia amylovora functions as a host-range limiting factor.

Strains of Erwinia amylovora, the bacterium causing the disease fire blight of rosaceous plants, are separated into two groups based on host range: Spiraeoideae and Rubus strains. Spiraeoideae strains have wide host ranges, infecting plants in many rosaceous genera, including apple and pear. In the field, Rubus strains infect the genus Rubus exclusively, which includes raspberry and blackberry. Based on comparisons of limited sequence data from a Rubus and a Spiraeoideae strain, the gene eop1 was identified as unusually divergent, and it was selected as a possible host specificity factor. To test this, eop1 genes from a Rubus strain and a Spiraeoideae strain were cloned and mutated. Expression of the Rubus-strain eop1 reduced the virulence of E. amylovora in immature pear fruit and in apple shoots. Sequencing the orfA-eop1 regions of several strains of E. amylovora confirmed that forms of eop1 are conserved among strains with similar host ranges. This work provides evidence that eop1 from a Rubus-specific strain can function as a determinant of host specificity in E. amylovora.

Beam position stabilization for a confocal multiphoton microscope.

The influence of beam-pointing on scanning confocal microscopy is investigated. The beam displacement is measured using a quadrant photodiode, and the apparent movement of a sub-micron-sized particle observed by second-harmonic microscopy is linked to the beam displacement. A simple beam-pointing stabilization is implemented, and improvement of beam stability by three orders of magnitude on long time scales is achieved.

First Report of Enterobacter Bulb Decay of Onions Caused by Enterobacter cloacae in New York.

During the summer of 2010, onions (Allium cepa L.) of several cultivars growing in muck-land soils in Orange, Genesee, Orleans, and Oswego counties of New York exhibited leaf dieback and bulb decay consistent with disease symptoms caused by Enterobacter cloacae as described previously (1,3,4). Isolations of bacteria from symptomatic tissues and muck soil were made using onion extract medium (OEM), which contains extracts of autoclaved onions, salts, and inhibitors of fungi and gram-positive bacteria. Some presumptive strains of E. cloacae were isolated; 5 from symptomatic onions growing in Genesee County, 2 from muck-land soil, and 27 from bulbs stored for ~2.5 months in a farm storage facility in Oswego County. Tentative identification was based on colony morphology (convex, cream-color colonies, 2 to 3 mm in diameter following incubation at 28°C for 1 day on OEM), which was similar to the morphology of reference strains of E. cloacae ATCC 23355, ATCC 13047, and strain 310 (gift of H. F. Schwartz, which was derived from reference 4; personal communication). Strains were gram-negative rods, negative for oxidase and indole, positive for nitrate reductase and catalase; produced acid from glucose aerobically and anaerobically. Also, all strains produced PCR products from the 16S-23S internal transcribed spacer (ITS) DNA region of the predicted sizes using primers T5A and T3B designed for identification of E. cloacae (2). The growth of eight of the isolated strains and strains ATTC 23355 and 310 were evaluated on several carbon sources with RapiD 20E test strips (bio Mérieux, Inc, Durham, NC). All strains were positive for ß-d-galactosidase, ornithine decarboxylase, utilization of citrate and malonate, and production of acetoin. Hydrolysis of esculin by ß-glucosidase differed among the eight. All strains were negative for lysine decarboxylase, urease, para-phenylalanine deaminase, indole, and oxidase. All produced acid from arabinose, xylose, rhamnose, cellobiose, melibiose, saccharose, trehalose, raffinose, and glucose; no strains produced acid from adonitol. These characteristics are consistent with published data for E. cloacae. Surface-disinfested onion bulbs and sets were inoculated with 50 to 100 µl of bacterial suspensions containing ~108 CFU/ml, injected with hypodermic needles and syringes, and incubated at 37°C for 2 weeks. Bisected onions revealed dry brown discoloration in each of the four bulbs and sets that had been inoculated with each presumptive strain. Symptoms were indistinguishable from those apparent in onions inoculated with the authentic strains mentioned. Strains recovered on OEM were identified as E. cloacae based on the stated biochemical properties and analysis of the 16S rRNA gene amplified by PCR as above. The sequence of the amplicon from the isolated strains was identical to that of reference strains ATCC 23355 and 310. Amplicon sequences of the 16S rRNA gene of New York strains Ecl3, Ecl6, and Ecl7 were deposited in GenBank as JF832951, JF832952, and JF832953, respectively. The strains were accessioned as ATCC BAA-2271, ATCC BAA-2272, and ATCC BAA-2273, respectively. To our knowledge, this is the first published report of E. cloacae causing Enterobacter bulb decay of onion in New York. References: (1) A. L. Bishop and R. M. Davis. Plant Dis. 74:692, 1990. (2) M. M. Clementino et al. J. Clin. Microbiol. 39:3865, 2004. (3) B. K. Schroeder and L. J. du Toit. Plant Dis. 93:323, 2009. (4) H. F. Schwartz and K. Otto. Plant Dis. 84:808, 2000.

[Approaches to developing a procedure for mapping water basin regions, by using the parasitological criteria].

The structure of a parasite system is formed and its functioning takes place in qualitatively different environments. The aquatic environment serves as a source of new elements and modules, energy, and information for parasite systems. And the parasite systems, for their part, affect the physical and biological parameters of the environment. Many intestinal infections caused by pathogenic microorganisms generally characterized by an acute disease course are related to a water factor. Such are typhus, typhoids, dysentery, cholera, salmonellosis, virus hepatitis, and others. Many parasitic diseases caused by pathogenic intestinal protistae (lambliasis, amebiasis, balantidiasis), blood parasite protistae (malaria), helminthes (opisthorchiasis, fascioliasis, diphyllobothriasis, cercariosis, pseudoamphistomosis) are also closely related to a water factor. Ascaridiasis, hymenolepiasis, trichocephalosis, and echinococcosis have a less close but still self-evident relationship to a water factor. The clbse relationships of many parasitic diseases to a water factor are also determined by the fact that the life cycles of many parasites necessarily include various intermediate hosts and parasite vectors, such as fishes, mollusks, crustaceans, and insects, which are aquatic organisms at some stages of their life. The results of continuous exposure of people to parasitic diseases are quite similar to the suppressive effects of the environment in the ecologically troublesome regions. The most prognostically useful information is formed while mapping by medical and ecological regions, by employing a combination of current mathematical and cartographical methods. The former include cluster analysis, quartering method, informational logical analysis, which are all described in this article and others. Regional mapping using the parasitological criteria should achieve at least two goals: 1) a scientific one that aids in finding causative connections and to prognosticate a situation; 2) a practical one that assists in developing regional programs for disease control and prevention. It is necessary to use the recommendations described in detail in the article in order to have the maximum results during medical and ecological mapping by the regions with a future goal of obtaining useful prognostic information.

Complete genome sequence of the plant pathogen Erwinia amylovora strain ATCC 49946.

Erwinia amylovora causes the economically important disease fire blight that affects rosaceous plants, especially pear and apple. Here we report the complete genome sequence and annotation of strain ATCC 49946. The analysis of the sequence and its comparison with sequenced genomes of closely related enterobacteria revealed signs of pathoadaptation to rosaceous hosts.

Low bone mineral density is not associated with angiographically determined coronary atherosclerosis in men.

UNLABELLED: This study for the first time investigates the association of bone mineral density (BMD) with angiographically determined coronary atherosclerosis in men. Our data show that the prevalence of low BMD is very high in men undergoing coronary angiography. However, neither osteopenia nor osteoporosis is associated with an increased prevalence of angiographically determined coronary atherosclerosis. INTRODUCTION: The association of low BMD with angiographically determined coronary atherosclerosis in men is unknown. METHODS: We enrolled 623 consecutive men undergoing coronary angiography for the evaluation of established or suspected coronary artery disease (CAD). BMD was assessed by dual X-ray absorptiometry. CAD was diagnosed in the presence of any coronary artery lumen narrowing at angiography; coronary stenoses with lumen narrowing > or =50% were considered significant. RESULTS: From the total study cohort (mean age of 64 +/- 11 years), 207 patients (33.2%) had osteopenia and 65 (10.4%) had osteoporosis; at angiography, CAD was diagnosed in 558 patients (89.6%) and 403 (64.7%) had significant coronary stenoses. In multivariate logistic regression analysis neither osteopenia nor osteoporosis was associated with an increased prevalence of CAD (adjusted odds ratios (ORs) = 0.71 [95% confidence interval 0.40-1.23]; p = 0.222 and 1.03 [0.38-2.80]; p = 0.955, respectively) or with significant coronary stenoses (OR 0.74 [0.52-1.07], p = 0.112 and 0.72 [0.41-1.26]; p = 0.251, respectively). Also, as a continuous variable, BMD was not associated with angiographically diagnosed CAD. CONCLUSIONS: The prevalence of low BMD is very high in men undergoing coronary angiography. However, low BMD is not associated with angiographically determined coronary atherosclerosis in men.

Factors influencing the health related quality of life in patients with systemic lupus erythematosus: long-term results (2001--2005) of patients in the German Lupus Erythematosus Self-Help Organization (LULA Study).

The aim of this longitudinal study was to determine disease-specific and individual factors associated with health-related quality of life (HRQOL) in a cohort of patients with systemic lupus erythematosus (SLE) organized in the German Lupus Erythematosus Self-Help Organization. Three hundred and seventeen patients aged between 11 and 77 years participated annually in five surveys carried out between 2001 and 2005. Regression analyses were carried out for physical and mental HRQOL as dependent variables. Factors influencing HRQOL were the respective HRQOL scores of the previous year, SLE activity as measured by the Systemic Lupus Activity Questionnaire (SLAQ), and impairments in everyday life. Social support indicated by living in marriage or in a marriage-like partnership had a positive influence on both mental and physical HRQOL, whereas individual factors such as education seemed to be of minor importance.

First Report of Bulb Disease of Onion Caused by Pantoea ananatis in New York.

In winter 2007, disease symptoms were observed in stored yellow onion bulbs (Allium cepa) grown in New York (NY) in 2006. Similar symptoms were observed in bulbs produced in 2007, 2008, and 2009. Symptoms were associated with one to three bulb scales near the midsection. Infected scales were light brown to brown, not macerated, and lacking foul odors typical of onion bulbs infected with Burkholderia cepacia. Onion grower-packers located in Orange County, NY were concerned that onion lots were rejected following grading by inspectors who cut bulbs to check market quality. Extent of the problem statewide is not currently clear. Isolation attempts were made from symptomatic tissues onto nutrient agar plates (3), with incubation for 24 h at 26 to 28°C, and PA-20 (2), a semiselective medium for the isolation of Pantoea ananatis, with similar incubation for 4 to 6 days. Most strains that grew on PA-20 were gram negative and yellow pigmented with dark centers. Isolated strains were tentatively identified as P. ananatis on the basis of growth on PA-20, a positive indole and negative oxidase test, positive tests for catalase, fermentation of glucose, Voges-Proskauer, and citrate utilization; negative for phenylalanine deaminase, urease, nitrate reductase, methyl red tests, and hypersensitive response induction in tobacco. The BIOLOG (Hayward, CA) system indicated that all presumptive strains of P. ananatis utilized d-mannose, d-cellobiose, d-melibiose, l-inositol, d-arabinose, cellulose, glycerol, d-arabitol, and sucrose, but not glycogen, N-acetyl-d-galactosamine, malonic acid, l-fucose, or xylitol. Strains of P. ananatis recovered from diseased onions in Georgia (GA) (1) were included in all tests as positive controls. We used PCR primers suggested by R. D. Gitaitis (University of Georgia): PanITS1 (5'-GTC TGA TAG AAA GAT AAA GAC-3') and AS2b (5'-TTC ATA TCA CCT TAC CGG CGC-3'). Together, they amplify the 16S-23S rDNA internal transcribed spacer region of 398 bp; the nucleotide sequences of six NY and three GA strains are identical to each other and 99.3% identical to P. ananatis LMG 20103 (GenBank CP001875) and 93.3% identical to P. stewartii (AJ311838). Pathogenicity tests were done in onion leaves. For inoculation, strains were grown on nutrient agar for 24 h and bacterial suspensions of ~108 CFU/ml were prepared in sterile water. Tips of healthy, greenhouse-grown onion leaves were cut and inoculum was applied to the cut surfaces with cotton swabs. Plants were incubated in a greenhouse for up to 2 weeks. Plants mock inoculated with water were symptomless. Bacteria were recovered from all lesions induced by artificial inoculation with the presumptive strains of P. ananatis. Recovered bacteria had characteristics of P. ananatis. Pathogenic strains from NY and GA produced off-white lesions that extended the length of the leaf, which was consistent with previous studies of the pathogenicity of P. ananatis (1). On the basis of microbiological and molecular analyses and pathogenicity tests, 14 NY strains, each isolated from a different diseased bulb, were identified as P. ananatis. To our knowledge, this is the first published report of P. ananatis causing a disease of onion in New York. References: (1) R. D. Gitaitis et al. USA Crop Prot. 21:983, 2002. (2) T. Goszczynska et al. J. Microbiol. Methods. 64:22, 2006. (3) N. W. Shaad et al, eds. Laboratory Guide for Identification of Plant Pathogenic Bacteria. 3rd ed. The American Phytopathological Society, St. Paul, MN, 2000.

[Polymorphism of the cox1 gene in bird schistosome cercaria isolates (Trematoda, Schistosomatidae) from ponds of Moscow and Moscow oblast].

Polymorphism of a 8 10-bp mitochondrial cox1 gene region was studied in 16 cercaria isolates of bird schistosomes (family Schistosomatidae), which were collected in water bodies of Moscow and Moscow oblast and represented three species: Trichobilharzia szidati, T. franki, and T. regenti. A substantial predominance of AT (65.4%) was characteristic of the cox1 sequences in all three species. Rare single nucleotide substitutions determined low (0.2-0.9%) intraspecific nucleotide and amino acid sequence diversity. Haplotype diversity h was high (80-100%) in all three species, suggesting a unique character for almost all cox1 sequences in the sample. Phylogenetic trees based on the nucleotide and amino acid sequence variations were constructed to study the relationships of the three schistosome species. A high support was observed for the main branching node that reflects differentiation of the monophyletic group Trichobilharzia and species of the genera Bilharziella (B. polonica), Dendritobilharzia (D. pulverulenta), and Gigantobilharzia (G. huronensis). Based on the nucleotide substitutions and amino acid polymorphisms, two groups of isolates, which infect Lymnaea stagnalis (T. szidati) and snails of the group Radix (T. franki and T. regenti) respectively, were isolated in the genus Trichobilharzia. The time of divergence between the two schistosome groups infecting snails of the genera Radix and Lymnaea was calculated from the cox1 nucleotide substitution rate, which is known for Asian and Indian blood flukes from the genus Schistosoma and is 2-3% per million years on average. Divergence of the three bird schistosome species under study and divergence of the Asian species of mammalian schistosome were almost concurrent, dating back to 2.5-3.8 Myr ago. Factors responsible for the lack of intraspecific subdivision with respect to the cox1 gene in bird schistosomes and the lack of separation between two species (T. franki and T. regenti) are discussed.

[Phylogenetic relationships among schistosomatidae].

According updates on molecular genetics, the development of human schistosomes in Asia with subsequent migration to the African continent is considered to be the most probable course of events. Generally, there are 2 hypotheses of the genus Schistoma. A hypothesis of Gondvana origin was based on snail host phylogeny and paleonthology and considered first schistosomes to originate on this continent to and appear in Asia from the Indian subcontinent platform 70-150 million years ago and in South America before Gondvana's split 60-120 million years ago. The recent data of molecular genetics show a high similarity between ITS2 sequences of S.bovis and S.intercalatum, with slightly lesser one between S.bovis and S.matthei. The similar pattern with slightly fewer differences can be seen in variability of cytochrome C subunit 1. Webster et al. 2006 noted a generally high similarity among species of the African group of schistosomes and considered it to originate from interspecies hybridization inside this group. Such hydridization occurring in both nature and a laboratory can make uncertain the determination of schistosome species based on a certain single gene marker.

Harpin, elicitor of the hypersensitive response produced by the plant pathogen Erwinia amylovora.

A proteinaceous elicitor of the plant defense reaction known as the hypersensitive response was isolated from Erwinia amylovora, the bacterium that causes fire blight of pear, apple, and other rosaceous plants. The elicitor, named harpin, is an acidic, heat-stable, cell-envelope-associated protein with an apparent molecular weight of 44 kilodaltons. Harpin caused tobacco leaf lamina to collapse and caused an increase in the pH of bathing solutions of suspension-cultured tobacco cells. The gene encoding harpin (hrpN) was located in the 40-kilobase hrp gene cluster of E. amylovora, sequenced, and mutated with Tn5tac1. The hrpN mutants were not pathogenic to pear, did not elicit the hypersensitive response, and did not produce harpin.

The acute wheezy adult with airways disease in the emergency department: a retrospective case-note review of exacerbations of COPD.

Introduction: There has been an increase in interest in the peripheral blood eosinophil count as a biomarker in COPD. Few studies have examined the eosinophil count in patients attending the emergency department (ED) with acute exacerbations of COPD (AECOPD). We investigated the relationship between the blood eosinophil and other variables collected routinely at ED presentation and outcomes. Methods: Retrospective case note review of patients attending the ED with an AECOPD over 18 months. Demographic, clinical and pharmacological data were analyzed at the time of presentation, and clinical outcomes relating to hospital admission, length of hospital stay and mortality were investigated. Results: There were 743 AECOPD index events in 537 patients. Over half (57%) of all attendees were admitted to hospital. They were older, reported an increased number of exacerbations and higher levels of total leukocytes and neutrophils. Length of stay was shorter in patients with a blood eosinophil count ≥2% compared to <2% (median (IQR) 3 days (1-7) vs 4 days (2-8) respectively, p<0.05). Length of stay correlated with peripheral blood neutrophils (r=0.12, p=0.021), peripheral blood absolute and relative eosinophils (r=-0.12, p=0.024 and r=-0.11, p=0.035, respectively) and CRP (r=0.16, p=0.027). Non-eosinophilic AECOPD were associated with an increased risk of mortality during an exacerbation (χ2 5.9, OR 3.08, 95% CI 1.19-7.96, p=0.015). Conclusion: In exacerbations of COPD presenting to ED, a higher blood eosinophil count is associated with a shorter length of stay and reduced mortality.

Ulnar Variance in Scaphoid Fractures: Retrospective Analysis of 182 Cases.

BACKGROUND: Literature provides little and controversial evidence regarding the influence of ulnar variance (UV) on the incidence of scaphoid fractures. The aim of this retrospective study was to assess UV in a large number of patients with acute scaphoid fracture in comparison to a control group of the same population. METHODS: During a two year period, 182 patients with acute scaphoid fractures (fracture group) and 182 ethnicity-, gender- and age-matched patients with wrist contusions (control group) were treated in three non-university hospitals. Using standardized digital wrist radiographs, UV values were measured by means of the method of perpendiculars by two independent examiners. The UV values of the fracture group were then compared to the UV values of the control group. RESULTS: Analyses of the agreement between the two raters resulted in a good to excellent inter-item correlation of 0.89, with a high intra-class coefficient of 0.93 (95% confidence interval: 0.87-0.95). Mean (SD) UV value was -0.82 mm (1.77) in the fracture group and 0.27 mm (1.44) in the control group. Paired sample t-test showed a significant difference between the two groups (p < 0.0001). CONCLUSIONS: According to this study, patients with scaphoid fractures are significantly more likely to show a negative UV than matched patients with wrist contusions.

[Results after simple trapeziectomy and capsular fixation for osteoarthritis of the trapeziometacarpal joint]. / Ergebnisse nach alleiniger Trapezektomie und Kapselraffung bei der Behandlung der Rhizarthrose.

BACKGROUND: Resection arthroplasty of the carpometacarpal joint of the thumb is considered to be the most frequently used surgical treatment for osteoarthritis of the trapeziometacarpal joint. Although simple trapeziectomy and fixation of the capsular tissue have been found to be an easy, successful treatment, the ligament reconstruction and tendon interposition in different techniques is still widely used. We evaluate the results of our patients after simple trapeziectomy. PATIENTS AND METHODS: Thirty-four thumbs were treated by simple trapeziectomy and fixation of the dorsal capsular tissue. If the dorsal capsular tissue seemed to be weak, it was fixed with a mitek anchor (Minilok Quickanchor, De Puy Mitek, Raynham, USA) to the distal scaphoid pole. Assessment included patient satisfaction, pain measurement, range of motion and tip, key and grip strength. RESULTS: After a mean follow-up of 26.9 (8-61) months, 91% were satisfied with the outcome, 94.1% would undergo the procedure again. 41% of the patients reported complete pain relief, 44% had pain only with large mechanical load. At follow-up, the mean DASH score was 29.2 (+/-21.7). We noticed in 29% paraesthesia at the back of the thumb, suggesting damage to branches of the superficial radial nerve. Furthermore, we tried two easy functional tests: 91% of the patients could hold a cup of coffee without any pain, 76.4% could hold a one-litre bottle without pain. CONCLUSION: The collected data confirm that the simple trapeziectomy is a safe and relative simple procedure for treatment of carpometacarpal osteoarthritis of the thumb.