Influence of segmental body composition and adiposity hormones on resting metabolic rate and substrate utilization in overweight and obese adults.

PURPOSE: Low resting metabolic rate (RMR) and high carbohydrate reliance at rest are associated with weight gain, but are highly variable in obese individuals. This study determined the relationship of total and segmental body composition and adiposity hormones with RMR and respiratory exchange ratio (RER) in overweight and obese adults. METHODS: In 49 men (n = 23) and premenopausal women (n = 26) [mean ± SD; age = 35.0 ± 8.9 years; body mass index (BMI) = 33.6 ± 5.2 kg·m-2; percent body fat (%fat) = 40.0 ± 8.0%], RMR and RER were evaluated using indirect calorimetry. Total and segmental body composition [fat mass (FM), percent fat (%fat), lean mass (LM), visceral adipose tissue (VAT)] were estimated using dual-energy X-ray absorptiometry. Fasted blood and saliva samples were analyzed for insulin, leptin, estradiol, and cortisol. RESULTS: In men (M) and women (W), RMR significantly correlated (p < 0.05) with FM (M: R = 0.535; W: R = 0.784) and LM (M: R = 0.645; W: R = 0.867). Of the segmental measures, trunk LM (M: R = 0.593; W: R = 0.879; p < 0.05) and leg LM (M: R = 0.664; W: R = 0.821; p < 0.05) had the strongest correlations with RMR. In men, but not women, RER significantly correlated with FM (R = 0.449; p = 0.032), trunk FM (R = 0.501; p = 0.015), and VAT (R = 0.456; p = 0.029). In men, RMR positively correlated with cortisol (R = 0.430, p = 0.040) and estradiol (R = 0.649, p = 0.001) and RER positively correlated with insulin (R = 0.525, p = 0.010). In women, RMR positively correlated with insulin (R = 0.570, p = 0.006), but RER was not significantly correlated with hormones (p > 0.05). CONCLUSIONS: Segmental evaluation of body composition, specifically in the lower extremities and abdomen, may be an effective and efficient way to evaluate metabolic status. Sex-specific evaluations are also imperative.

Multi-Center Study of Diffusion-Weighted Imaging in Coma After Cardiac Arrest.

BACKGROUND: The ability to predict outcomes in acutely comatose cardiac arrest survivors is limited. Brain diffusion-weighted magnetic resonance imaging (DWI MRI) has been shown in initial studies to be a simple and effective prognostic tool. This study aimed to determine the predictive value of previously defined DWI MRI thresholds in a multi-center cohort. METHODS: DWI MRIs of comatose post-cardiac arrest patients were analyzed in this multi-center retrospective observational study. Poor outcome was defined as failure to regain consciousness within 14 days and/or death during the hospitalization. The apparent diffusion coefficient (ADC) value of each brain voxel was determined. ADC thresholds and brain volumes below each threshold were analyzed for their correlation with outcome. RESULTS: 125 patients were included in the analysis. 33 patients (26%) had a good outcome. An ADC value of less than 650 × 10(-6) mm(2)/s in ≥10% of brain volume was highly specific [91% (95% CI 75-98)] and had a good sensitivity [72% (95% CI 61-80)] for predicting poor outcome. This threshold remained an independent predictor of poor outcome in multivariable analysis (p = 0.002). An ADC value of less than 650 × 10(-6) mm(2)/s in >22% of brain volume was needed to achieve 100% specificity for poor outcome. CONCLUSIONS: In patients who remain comatose after cardiac arrest, quantitative DWI MRI findings correlate with early recovery of consciousness. A DWI MRI threshold of 650 × 10(-6) mm(2)/s in ≥10% of brain volume can differentiate patients with good versus poor outcome, though in this patient population the threshold was not 100% specific for poor outcome.

Factors influencing sleep quality among nursing staff: Results of a cross sectional study.

PURPOSE: Given the intense physical and mental demands placed on nurses and other caregivers, getting sufficient sleep is essential to maintaining both individual health and professional performance. The goal of our study is to describe and analyze the self-reported sleep quality of nursing staff and identify which factors have an influence on it. METHODS: The sample was comprised of 153 female nurses over the age of 20 years who completed written surveys regarding their health status and health behavior. Their responses were subjected to ANOVA analysis with post hoc follow-up tests and logit regression was used. RESULTS: 33% of female nursing staff reported poor quality sleep. Lower quality of life, tachycardia and unequal distribution of work load were most strongly associated with poor sleep quality. CONCLUSION: Our study indicates that reducing workplace stress is a good place to start in developing a proactive strategy. A comprehensive prevention strategy should include both behavioral and situational prevention elements. Future studies should focus on identifying causal factors and developing prevention strategies.

Magnetic moments of chromium-doped gold clusters: the Anderson impurity model in finite systems.

The magnetic moment of a single impurity atom in a finite free electron gas is studied in a combined x-ray magnetic circular dichroism spectroscopy, charge transfer multiplet calculation, and density functional theory study of size-selected free chromium-doped gold clusters. The observed size dependence of the local magnetic moment can be understood as a transition from a local moment to a mixed valence regime. This shows that the Anderson impurity model essentially describes finite systems even though the discrete density of states introduces a significant deviation from a bulk metal, and the free electron gas is only formed by less than 10 electrons. Electronic shell closure in the gold host minimizes the interaction of localized impurity states with the confined free electron gas and preserves the magnetic moment of 5 µ_{B} fully in CrAu_{2}^{+} and almost fully in CrAu_{6}^{+}. Even for open-shell species, large local moments are observed that scale with the energy gap of the gold cluster. This indicates that an energy gap in the free electron gas stabilizes the local magnetic moment of the impurity atom.

Electronic ground states of Fe2(+) and Co2(+) as determined by x-ray absorption and x-ray magnetic circular dichroism spectroscopy.

The (6)Π electronic ground state of the Co2 (+) diatomic molecular cation has been assigned experimentally by x-ray absorption and x-ray magnetic circular dichroism spectroscopy in a cryogenic ion trap. Three candidates, (6)Φ, (8)Φ, and (8)Γ, for the electronic ground state of Fe2 (+) have been identified. These states carry sizable orbital angular momenta that disagree with theoretical predictions from multireference configuration interaction and density functional theory. Our results show that the ground states of neutral and cationic diatomic molecules of 3d transition elements cannot generally be assumed to be connected by a one-electron process.

Direct observation of high-spin states in manganese dimer and trimer cations by x-ray magnetic circular dichroism spectroscopy in an ion trap.

The electronic structure and magnetic moments of free Mn2 (+) and Mn3 (+) are characterized by 2p x-ray absorption and x-ray magnetic circular dichroism spectroscopy in a cryogenic ion trap that is coupled to a synchrotron radiation beamline. Our results directly show that localized magnetic moments of 5 µB are created by 3d(5)((6)S) states at each ionic core, which are coupled ferromagnetically to form molecular high-spin states via indirect exchange that is mediated in both cases by a delocalized valence electron in a singly occupied 4s derived antibonding molecular orbital with an unpaired spin. This leads to total magnetic moments of 11 µB for Mn2 (+) and 16 µB for Mn3 (+), with no contribution of orbital angular momentum.

Body Composition, Muscle Quality and Scoliosis in Female Collegiate Gymnasts: A Pilot Study.

Research has demonstrated an elevated prevalence of body weight concerns and scoliosis among female gymnasts. The purpose of the current pilot study was to evaluate the utility of ultrasonography and dual-energy X-ray absorptiometry (DXA) as practical imaging modalities to measure body composition and spinal curvature variables that may correlate with performance in female collegiate gymnasts (n=15). DXA was used to evaluate body composition and lateral spinal curvature, utilizing a modified Ferguson method. Echo intensity (EI) and cross-sectional area (CSA) of the vastus lateralis were determined from a panoramic cross-sectional ultrasound image. For returning athletes (n=9), performance scores from the previous season were averaged to quantify performance. The average performance score was correlated with lean mass of the arms (R=0.714; P=0.03) and right leg (R=0.680; P=0.04). Performance was not correlated with total mass, fat mass or body fat percentage (P>0.10). Scoliosis was identified in 3 of 15 scans (20%). Echo intensity and CSA of the vastus lateralis were inversely correlated with each other (R=-0.637, P=0.01), but not with other measures of body composition or performance. Results suggest that limb LBM may be a determinant of gymnastics performance, and DXA may provide important health and performance-related information for female collegiate gymnasts.

[Sexual risk behaviour of nursing students. A cross-sectional study at nursing schools in Saxony-Anhalt]. / Das sexuelle Risikoverhalten von Auszubildenden der Gesundheits- und Krankenpflege. Eine Querschnittstudie an Krankenpflegeschulen in Sachsen-Anhalt.

AIM: This work describes the sexual risk behaviour of nursing students. METHODS: 22 of 23 state-approved nursing schools in Saxony-Anhalt, Germany, participated in this cross-sectional study (study period 7/2005-5/2006). Participation was voluntarily and anonymous. RESULTS: More male than female students (59.6% vs. 44.8%) used condoms to prevent STIs. More female students (58.9% vs. 43.4%) reported constant partnership with just one partner as an STI prevention method (chi² test, p<0.005). 29.6% of the nursing students reported >1 sexual partner in the past 12 months. 3.9% of the students demanded an HIV test from the partner, 69.3% had never tested themselves for HIV. 10.2% used no prevention against STIs. CONCLUSIONS: Nursing students should be sensitised for sexual risk behaviour and STIs. This should be included in the content of teaching throughout the education, not least since nursing students are multiplicators and have an influence on health behaviour of the patients.

Spin coupling and orbital angular momentum quenching in free iron clusters.

Magnetic spin and orbital moments of size-selected free iron cluster ions Fe{n}{+} (n=3-20) have been determined via x-ray magnetic circular dichroism spectroscopy. Iron atoms within the clusters exhibit ferromagnetic coupling except for Fe{13}{+}, where the central atom is coupled antiferromagnetically to the atoms in the surrounding shell. Even in very small clusters, the orbital magnetic moment is strongly quenched and reduced to 5%-25% of its atomic value while the spin magnetic moment remains at 60%-90%. This demonstrates that the formation of bonds quenches orbital angular momenta in homonuclear iron clusters already for coordination numbers much smaller than those of the bulk.

Abuse of tropicamide eye drops: review of clinical data.

Over the past 15 years, the increasing nonmedical use of tropicamide ophthalmic drops has been reported in Europe, coinciding with an increase in opioid addiction and drug-related mortality. Although tropicamide is generally known as a cheap alternative to heroin in Eastern Europe, it still appears to be a relatively new phenomenon that has arisen over the last decade. A narrative review was conducted of all the relevant sources published in more than five countries between January 1, 1975 and January 10, 2021. For bibliographic accuracy, the materials published in Russian and Italian were professionally translated to English. During the preparation of this report, we were able to interview five Russian-speaking patients who injected tropicamide in the past and we discuss another case of intravenous tropicamide use. This review was acknowledged by the institutional review board of the University of Missouri-Kansas City. All patients interviewed at the Unica Medical Center consented for their clinical information to be reported in a medical publication. We analyzed data from 50+ various sources and covered a variety of drug-related issues, including information on the extent, patterns, and trends in tropicamide use, its health consequences, and other clinical findings. The information provided in this article may help providers better detect tropicamide abuse and incorporate new rehabilitation strategies into the management of these patients.

Low doses of the novel caspase-inhibitor GS-9450 leads to lower caspase-3 and -8 expression on peripheral CD4+ and CD8+ T-cells.

Chronic hepatitis C virus (HCV) infection is characterized by increased rates of apoptotic hepatocytes and activated caspases have been shown in HCV-infected patients. GS-9450, a novel caspase-inhibitor has demonstrated hepatoprotective activity in fibrosis/apoptosis animal models. This study evaluated the effects of GS-9450 on peripheral T-cell apoptosis in chronic HCV-infected patients. As sub study of the GS-US-227-0102, a double-blind, placebo-controlled phase 2a trial evaluating the safety and tolerability of GS-9450, apoptosis of peripheral CD4+ and CD8+ T-cells was measured using activated caspase-3, activated caspase-8 and CD95 (Fas). Blood samples were drawn at baseline, day 14 after therapy and at 5 weeks off-treatment follow-up in the first cohort of 10 mg. In contrast to the placebo-treated patients, GS-9450 caused a median of 46% decrease in ALT-values from baseline to day 14 in all treated patients (median of 118-64 U/l) rising again to a median of 140 U/l (19%) at 5 weeks off-treatment follow-up. In GS9450-treated patients, during treatment and follow-up, percentages of activated caspase-3+ and caspase-8 expression tended to decrease, in contrast to placebo-treated patients. Interestingly, compared to healthy controls, higher percentages of caspase-3 and caspase-8 positive CD4+ and CD8+ T-cells were demonstrated in HCV-infected patients at baseline. Decreased ALT-values were observed in all HCV-infected patients during treatment with low dose of the caspase-inhibitor GS-9450 accompanied by a lower expression of caspase-3 and -8 on peripheral T-cells. Furthermore, at baseline percentages of activated caspase-3, activated caspase-8 and CD95+ T-cells were higher in chronic HCV-infected patients compared to healthy controls.

Communication: Highest occupied molecular orbital-lowest unoccupied molecular orbital gaps of doped silicon clusters from core level spectroscopy.

A method to determine band gaps of size-selected and isolated nanoparticles by combination of valence band and core-level photoionization spectroscopy is presented. This approach is widely applicable and provides a convenient alternative to current standard techniques for the determination of band gaps by optical or photoelectron spectroscopy. A first application to vanadium doped silicon clusters confirms a striking size-dependence of their highest occupied-lowest unoccupied molecular orbital gaps.

Herpes in the Heart: A Case of Widely Disseminated Intrauterine Herpes Simplex Virus Infection Involving Neonatal Myocardium in a 23-Week Gestationally Aged Neonate.

We report a rare case of disseminated herpes simplex virus (HSV) infection in an extremely preterm neonate. Herpes Simplex Virus-2 (HSV-2) is the leading cause of genital ulcer disease in adults and is the most common cause of neonatal herpes, a rare infection associated with long-term neurologic impairment and high mortality. HSV-2 can be transmitted perinatally via direct mucosal or skin contact. Most neonates are infected intrapartum. However, intrauterine transmission does occur, though rarely. The pattern of dissemination described in our patient differs from previous case reports. Most reports indicate that intrauterine HSV infections have a typical triad of cutaneous manifestations, ophthalmologic findings, and neurologic involvement. However, we report the first case of intrauterine disseminated HSV infection in the heart.

Upper jurassic dinosaur egg from utah.

The Upper Jurassic egg described here is the first known egg from the 100-million-year gap in the fossil record between Lower Jurassic (South Africa) and upper Lower Cretaceous (Utah). The discovery of the egg, which was found mixed in with thousands of dinosaur bones rather than in a nest, the pathological multilayering of the eggshell as found in modern and fossil reptilians, and the pliable condition of the eggshell at the time of burial indicate an oviducal retention of the egg at the time of burial.

Vasopressors for acute myocardial infarction complicated by cardiogenic shock.

Several international evidence-based guidelines reveal the lack of evidence on the treatment of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) for all recommended therapies. We included 6 studies with 842 eligible patients and one ongoing study. Three different adrenergic agents (norepinephrine, dopamine, epinephrine), vasopressin and the NOS inhibitor tilarginine were compared in 4 different combinations. On the small basis of all available evidence we can state that there is no evidence to use tilarginene, some evidence to avoid dopamine due to increased rates of arrhythmias, but some evidence, which suggests to prefer norepinephrine in comparison to epinephrine as vasopressor.

Megaprepuce: presentation of a modified surgical technique with excellent cosmetic and functional results.

OBJECTIVE: Congenital megaprepuce is a malformation consisting of a great redundancy of the inner preputial skin over a penis with normal shaft and glans and is combined with a severe phimosis. Patients suffer from difficulties in voiding because the urine is trapped in the large dome-shaped megaprepuce. We describe a modification of the surgical technique of reconstructing a megaprepuce initially presented by Leao et al. PATIENTS AND METHODS: We retrospectively reviewed 7 patients aged 6-53 months (mean age 17 months, 6 were younger than 18 months) who underwent congenital megaprepuce repair between 02/2014 and 05/2018 in our institution. All these otherwise healthy children suffering from difficulties in voiding and reporting genital ballooning during micturition and urinary retention were referred to our hospital. In all cases, parents needed to express the trapped urine. Four of these patients additionally showed a glanular hypospadias, another one a distal penile hypospadias. In addition to the repair of the megaprepuce, six patients needed correction of a penile curvature, five of whom needed correction of the chordee and one a corporoplasty (Schröder-Essed). The patient showing the distal penile hypospadias additionally underwent hypospadias repair. During the follow-up, we evaluated the cosmetic result and complications such as secondary concealed penis, difficulties in voiding, urinary retention, and urinary infections. RESULTS: Mean follow-up was 18 months. All patients following surgery showed normal voiding without urinary retention or urinary infections and good cosmetic results resembling a circumcised penis in appearance without reconcealment. No intraoperative complications occurred. One patient had a scrotal hematoma postoperatively. Mild transient edema of the penis was seen in all patients, which disappeared spontaneously within one week after surgery. CONCLUSION: Our surgical approach is a safe and relatively simple procedure with a low rate of complications, good cosmetic results, and functional outcome. Whether the hypospadias associated with ventral curvature was a coincidence or part of the disease pattern remains unclear but will probably be the object of further investigations.

The prognostic value of quantitative diffusion-weighted MRI after pediatric cardiopulmonary arrest.

OBJECTIVES: The prognostic value of quantitative diffusion-weighted magnetic resonance imaging (DWI MRI) in predicting neurologic outcomes after pediatric cardiopulmonary arrest (CPA) has not been determined. The aim of this study was to identify a DWI MRI threshold for brain volume percent that correlates with neurologic outcome in children who remain comatose or display significant neurologic deficits immediately after resuscitation from CPA. METHODS: This single-center retrospective study analyzed DWI MRIs of pediatric patients who remained neurologically impaired after CPA. Any MRI obtained within 2 weeks after CPA was analyzed. The apparent diffusion coefficient (ADC) value of each voxel within the brain was determined. Percentage brain volume with voxels below each ADC threshold between 300 and 1200 × 10-6 mm2/s with a step of 50 were calculated. Area under the receiver operating characteristics curve (AUC) was used to identify optimal DWI MRI thresholds for brain volume percent most predictive of poor neurologic outcome. The primary outcome measure was neurologic outcome 6-months after CPA based on Pediatric Cerebral Performance Category (PCPC) score. Poor neurologic outcome was defined as PCPC score of 3-6, or a worsening from baseline score ≥1 if baseline PCPC score was ≥3. RESULTS: Twenty-six patients were included in this study. The median age was 8.5 years (2.2-14) and median time from CPA to MRI was 4 days (2-7). Two ADC thresholds for brain volume percent had the largest AUC for predicting poor neurologic outcome. An ADC threshold of <600 × 10-6 mm2/s in ≥7% of brain volume; and <650 × 10-6 mm2/s in ≥11% of brain volume both demonstrated a specificity of 1.0 (0.76-1.0, 95% CI) and a sensitivity of 0.8 (0.44-0.96, 95% CI) for poor outcome. CONCLUSIONS: In pediatric patients who remain comatose or have significant neurologic deficits after CPA, quantitative DWI MRI correlates with neurologic outcome. Both an ADC threshold of <600 × 10-6 mm2/s in ≥7% of brain volume and <650 × 10-6 mm2/s in ≥11% of brain volume are highly specific for predicting poor neurologic outcome. A prospective trial to validate these thresholds is needed.

Spin-current-mediated rapid magnon localisation and coalescence after ultrafast optical pumping of ferrimagnetic alloys.

Sub-picosecond magnetisation manipulation via femtosecond optical pumping has attracted wide attention ever since its original discovery in 1996. However, the spatial evolution of the magnetisation is not yet well understood, in part due to the difficulty in experimentally probing such rapid dynamics. Here, we find evidence of a universal rapid magnetic order recovery in ferrimagnets with perpendicular magnetic anisotropy via nonlinear magnon processes. We identify magnon localisation and coalescence processes, whereby localised magnetic textures nucleate and subsequently interact and grow in accordance with a power law formalism. A hydrodynamic representation of the numerical simulations indicates that the appearance of noncollinear magnetisation via optical pumping establishes exchange-mediated spin currents with an equivalent 100% spin polarised charge current density of 107 A cm-2. Such large spin currents precipitate rapid recovery of magnetic order after optical pumping. The magnon processes discussed here provide new insights for the stabilization of desired meta-stable states.

[Renal transplantation: Opportunities and risks for medical refugees]. / Nierentransplantation: Chancen und Risiken bei medizinischen Flüchtlingen.

BACKGROUND: Families with children and adolescents with end-stage renal disease came to Germany from the former Eastern Bloc countries before the wave of refugees in 2015, in order to enable their children to survive with adequate kidney replacement therapy and in the best case a kidney transplant. METHODS: In a case study, medical records of 4 childen and adolescents were retrospectively analyzed. These patients who fled to Germany for the treatment of terminal renal failure applied for asylum and were successfully transplanted after the usual waiting period. RESULTS: Four of the eight children and adolescents who came to Erlangen for treatment of terminal renal failure between 2003 and 2013 received a functioning kidney transplant (deceased donor kidney) after dialysis therapy was difficult due to lack of compliance to drug and dietary recommendations such as fluid restriction. Since children and adolescents are treated with chronic dialysis only with the aim of kidney transplantation, a living donation was discussed but was not possible for medical reasons. 3 recipients are symptom-free with a functional graft. DISCUSSION: The case study demonstrates that children and adolescents fleeing to Germany due to their end stage renal disease are better integrated after kidney transplantation, have better chances of obtaining a good education and can be expected to live independently with their own income in the future.