Preparative refolding of small monomeric outer membrane proteins.

The outer membrane of gram-negative bacteria constitutes an important hurdle for the transport of hydrophobic molecules into the cell. Mass flux is often facilitated by various outer membrane proteins. These proteins are of biotechnological importance because they could help to improve the performance of whole-cell biocatalysts or be incorporated into artificial cell-like systems. The characterization and understanding of their transport properties greatly benefits from the possibility to express and purify these proteins. We investigated folding parameters for the refolding of four small monomeric outer membrane proteins from Escherichia coli (OmpW) and different pseudomonads (AlkL, OprG and TodX). To this aim we screened a number of inexpensive detergents and detergent concentrations, folding additives as well as protein concentrations. Interestingly, detergents with a C12 chain were most effective in promoting the folding reaction, particularly the negatively charged N-Lauroylsarcosine for OmpW, OprG and TodX as well as the zwitterionic N,N-Dimethyl-n-dodecylamine N-oxide (LDAO) for AlkL. The addition of 1 M urea (AlkL, OmpW), 0.1 M glutamate (OprG) or 0.1 M glycine (TodX) could further improve the folding efficiency. In order to be able to reproducibly produce larger amounts of the proteins, we then established the folding in a miniaturized stirred-tank reactor system combined with a liquid handler. This approach led to a near-complete refolding of OprG (96%), a very good folding of AlkL (84%) and OmpW (71%), only TodX folding was more variable with a final folding efficiency of 52%, all obtained at a final protein concentration of 0.5 g/L.

Ablative or Surgical Treatment for Small Renal Masses (T1a): A Single-Center Comparison of Perioperative Morbidity and Complications.

The purpose of this study is to evaluate the treatment safety of thermal ablation compared to surgical treatment of T1a tumors (small renal masses) at a high-volume center. We conducted an observational single-center study based on data collected form the National Swedish Kidney Cancer Register (NSKCR) between 2015 and 2021. In total, 444 treatments of T1a tumors were included. Patients underwent surgery (partial or total nephrectomy) or ablative treatment-radiofrequency ablation (RFA) or microwave ablation (MWA). Patient characteristics were retrieved from patient records, and tumor complexity was estimated from pre-interventional CT scans. The odds ratio (OR) of suffering from a severe surgical complication following ablative treatment was estimated using a logistic regression model adjusted for age, BMI, ASA physical status classification, smoking status and RENAL nephrometry score. The frequency of severe surgical complications was 6.3% (16/256 treatments) after surgical intervention and 2.1% (4/188 treatments) following ablative treatment. Our primary hypothesis that ablative treatment is associated with a lower risk of severe surgical complications is supported by the results (OR 0.39; 0.19-0.79; p = 0.013). When adjusting for age, smoking status, ASA score, BMI score and RENAL nephrometry score, we see an even greater difference between the two groups (OR 0.34; 0.17-0.68; p = 0.002). Our study was limited by the differences in patient and tumor characteristics between the two compared groups and the study design. If oncological outcomes are found to be comparable, ablative treatment should be considered as a first-line treatment for all small renal masses.

[Study of the functional capacity and health status of patients with hip as well as knee osteoarthritis]. / A csípo-, valamint térdízületi arthrosisos betegek funkcióképességének és egészségi állapotának vizsgálata.

INTRODUCTION: Hip as well as knee osteoarthritis are common diseases. There are numerous therapeutic possibilities to address the problem. OBJECTIVE: To study the effectiveness of the complex conservative treatment in patients with hip as well as knee osteoarthritis. METHOD: In addition to a self-made questionnaire, we applied the visual analogue scale, the Functional Independence Measure, the Barthel Index and the Medical Outcomes Study (MOS) - 36-Item Short-Form Health Survey. Apart from these, joint range of motion was measured. The members of the examined group had different physiotherapy treatments (thermal water, physiotherapy, classic Swedish massage, Bemer treatment, wraps, physiotherapy). RESULTS: The results of the visual analogue scale and the Barthel Index were significantly different between the two measurements. Regarding the Functional Independence Measure, we did not find significant difference between the two groups. As for measuring the study group's health condition, we observed improvement in the case of both the physical and mental health dimensions. During the examination of joint range of motion in the study group, after analyzing the participants' data, we detected improvement, except for the passive extension of the left knee. CONCLUSION: The 3-week complex conservative therapy can be an appropriate form of treatment to improve the functionality and the health condition in the case of hip as well as knee osteoarthritis. Orv Hetil. 2022; 163(48): 1917-1922.

Rate of incisional hernia after minimally invasive and open surgery for renal cell carcinoma: a nationwide population-based study.

OBJECTIVES: To determine the rate of incisional hernia after surgery for renal cell carcinoma, to compare the rate after open vs minimally invasive surgery and radical nephrectomy vs partial nephrectomy and to identify risk factors for incisional hernia. MATERIALS AND METHODS: From the Renal Cell Cancer Database Sweden we identified all patients (n = 9,638) diagnosed with renal cell carcinoma in Sweden between January 2005 and November 2015. Of these, 6,417 were included in the analyses to determine comorbidity and subsequent diagnosis of or surgery for incisional hernia. RESULTS: In all, 6,417 patients underwent surgery for renal cell carcinoma between January 2005 and November 2015, of these 5,216 (81%) underwent open surgery and 1,201 (19%) underwent minimally invasive surgery. Altogether 140 patients were diagnosed with incisional hernia. The cumulative rate of incisional hernia after 5 years was 5.2% (95% confidence interval [CI] = 4.0-6.4%) after open surgery and 2.4% (95% CI = 1.0-3.4%) after minimally invasive surgery (p < 0.05). In Cox proportional hazard analysis, age and left-sided surgery were associated with incisional hernia in the open surgery group (both p < 0.05), whereas in the minimally invasive group, no statistically significant risk factors for incisional hernia were found. CONCLUSIONS: Open surgery for renal cell carcinoma is associated with a significantly higher risk for developing incisional hernia. If open surgery is the only option, care should be taken when choosing the approach and closing the wound. More studies are needed to find strategies to reduce the risk of abdominal wall complications following open kidney surgery.

Androgen Deprivation Therapy and the Risk for Inguinal Hernia: An Observational Nested Case Control Study.

It has been suggested that hypogonadism increases the risk for inguinal hernia (IH). The aim of this study was to investigate any association between androgen deprivation therapy (ADT) for prostate cancer and increased risk for IH. The study population in this population-based nested case-control study was based on data from the Prostate Cancer Database Sweden. The cohort included all men with prostate cancer who had not received curative treatment. Men who had been diagnosed or had undergone IH repair (n = 1,324) were cases and controls, where not diagnosed, nor operated on for IH, matched only on birth year (n = 13,240). Conditional multivariate logistic regression models were used to assess any temporal association between ADT and IH, adjusting for marital status, education level, prostate cancer risk category, Charlson Comorbidity Index, ADT, time since prostate cancer diagnosis, and primary prostate cancer treatment. Odds ratio (OR) for diagnosis/repair of IH 0 to 1 year from start of ADT was 0.5 (95% confidence interval [CI] = [0.38, 0.68]); between 1 and 3 years after, the OR was 0.35 (95% CI = [0.26, 0.47]); between 3 and 5 years after, the OR was 0.39 (95% CI = [0.26, 0.56]); between 5 and 7 years after, the OR was 0.6 (95% CI = [0.41, 0.97]); and >9 years after, the OR was 3.68 (95% CI = [2.45, 5.53]). The marked increase in OR for IH after 9 years of ADT supports the hypothesis that low testosterone levels increase the risk for IH. The low risk for IH during the first 8 years on ADT is likely caused by selection of men with advanced cancer unlikely to be diagnosed or treated for IH.

Isobutanol Production by Autotrophic Acetogenic Bacteria.

Two different isobutanol synthesis pathways were cloned into and expressed in the two model acetogenic bacteria Acetobacterium woodii and Clostridium ljungdahlii. A. woodii is specialized on using CO2 + H2 gas mixtures for growth and depends on sodium ions for ATP generation by a respective ATPase and Rnf system. On the other hand, C. ljungdahlii grows well on syngas (CO + H2 + CO2 mixture) and depends on protons for energy conservation. The first pathway consisted of ketoisovalerate ferredoxin oxidoreductase (Kor) from Clostridium thermocellum and bifunctional aldehyde/alcohol dehydrogenase (AdhE2) from C. acetobutylicum. Three different kor gene clusters are annotated in C. thermocellum and were all tested. Only in recombinant A. woodii strains, traces of isobutanol could be detected. Additional feeding of ketoisovalerate increased isobutanol production to 2.9 mM under heterotrophic conditions using kor3 and to 1.8 mM under autotrophic conditions using kor2. In C. ljungdahlii, isobutanol could only be detected upon additional ketoisovalerate feeding under autotrophic conditions. kor3 proved to be the best suited gene cluster. The second pathway consisted of ketoisovalerate decarboxylase from Lactococcus lactis and alcohol dehydrogenase from Corynebacterium glutamicum. For increasing the carbon flux to ketoisovalerate, genes encoding ketol-acid reductoisomerase, dihydroxy-acid dehydratase, and acetolactate synthase from C. ljungdahlii were subcloned downstream of adhA. Under heterotrophic conditions, A. woodii produced 0.2 mM isobutanol and 0.4 mM upon additional ketoisovalerate feeding. Under autotrophic conditions, no isobutanol formation could be detected. Only upon additional ketoisovalerate feeding, recombinant A. woodii produced 1.5 mM isobutanol. With C. ljungdahlii, no isobutanol was formed under heterotrophic conditions and only 0.1 mM under autotrophic conditions. Additional feeding of ketoisovalerate increased these values to 1.5 mM and 0.6 mM, respectively. A further increase to 2.4 mM and 1 mM, respectively, could be achieved upon inactivation of the ilvE gene in the recombinant C. ljungdahlii strain. Engineering the coenzyme specificity of IlvC of C. ljungdahlii from NADPH to NADH did not result in improved isobutanol production.

Identifying and Engineering Bottlenecks of Autotrophic Isobutanol Formation in Recombinant C. ljungdahlii by Systemic Analysis.

Clostridium ljungdahlii (C. ljungdahlii, CLJU) is natively endowed producing acetic acid, 2,3-butandiol, and ethanol consuming gas mixtures of CO2, CO, and H2 (syngas). Here, we present the syngas-based isobutanol formation using C. ljungdahlii harboring the recombinant amplification of the "Ehrlich" pathway that converts intracellular KIV to isobutanol. Autotrophic isobutanol production was studied analyzing two different strains in 3-L gassed and stirred bioreactors. Physiological characterization was thoroughly applied together with metabolic profiling and flux balance analysis. Thereof, KIV and pyruvate supply were identified as key "bottlenecking" precursors limiting preliminary isobutanol formation in CLJU[KAIA] to 0.02 g L-1. Additional blocking of valine synthesis in CLJU[KAIA]:ilvE increased isobutanol production by factor 6.5 finally reaching 0.13 g L-1. Future metabolic engineering should focus on debottlenecking NADPH availability, whereas NADH supply is already equilibrated in the current generation of strains.

Electron availability in CO2 , CO and H2 mixtures constrains flux distribution, energy management and product formation in Clostridium ljungdahlii.

Acetogens such as Clostridium ljungdahlii can play a crucial role reducing the human CO2 footprint by converting industrial emissions containing CO2 , CO and H2 into valuable products such as organic acids or alcohols. The quantitative understanding of cellular metabolism is a prerequisite to exploit the bacterial endowments and to fine-tune the cells by applying metabolic engineering tools. Studying the three gas mixtures CO2  + H2 , CO and CO + CO2  + H2 (syngas) by continuously gassed batch cultivation experiments and applying flux balance analysis, we identified CO as the preferred carbon and electron source for growth and producing alcohols. However, the total yield of moles of carbon (mol-C) per electrons consumed was almost identical in all setups which underlines electron availability as the main factor influencing product formation. The Wood-Ljungdahl pathway (WLP) showed high flexibility by serving as the key NAD+ provider for CO2  + H2, whereas this function was strongly compensated by the transhydrogenase-like Nfn complex when CO was metabolized. Availability of reduced ferredoxin (Fdred ) can be considered as a key determinant of metabolic control. Oxidation of CO via carbon monoxide dehydrogenase (CODH) is the main route of Fdred formation when CO is used as substrate, whereas Fdred is mainly regenerated via the methyl branch of WLP and the Nfn complex utilizing CO2  + H2 . Consequently, doubled growth rates, highest ATP formation rates and highest amounts of reduced products (ethanol, 2,3-butanediol) were observed when CO was the sole carbon and electron source.

Incidence of incisional hernia after minimally invasive and open radical prostatectomy: a population-based nationwide study.

OBJECTIVE: Minimally invasive techniques (laparoscopic or robot-assisted laparoscopic) are gradually becoming the methods of choice for surgical treatment of prostate cancer. However, the impact of these techniques on the risk of developing incisional hernia has yet to be fully evaluated. The aim of this study was to compare the risk of incisional hernia after open radical prostatectomy (ORP) and minimally invasive radical prostatectomy (MIRP). MATERIALS AND METHODS: From the National Prostate Cancer Register of Sweden, all men who underwent radical prostatectomy for prostate cancer between 2004 and 2013 were identified. These data were linked with the National Patient Register to determine comorbidity and subsequent diagnosis of incisional hernia or surgery for incisional hernia. The endpoint was diagnosis of or surgery for incisional hernia. Multivariate proportional Cox hazard regression analyses were performed to analyze risk factors. RESULTS: In total, 19,743 men underwent radical prostatectomy during the study period. The cumulative incidence of incisional hernia was 1.4% [95% confidence interval (CI) 1.2-1.7%] and 2.3% (CI 1.9-2.7%) 5 years after ORP and MIRP, respectively (p < .05). For men undergoing ORP, age above the median was associated with increased risk of incisional hernia (p < .001). For men undergoing MIRP, age above the median, prostate volume above the median and lymph-node dissection were associated with increased risk of incisional hernia (p < .05). CONCLUSION: MIRP is associated with a significantly higher risk of developing an incisional hernia compared to ORP. Awareness of appropriate surgical technique may reduce this risk.

[Position statement of the National Nursing Assessment Group of Germany: regarding the basic "nutrition and fluid requirements" policy of the elderly by the MDS (Medical Service of the Central Associations of the Health Insurance Companies), July 2003]. / Positionspapier der Nationalen Pflegeassessmentgruppe Deutschland: zur Grundsatzstellungnahme "Ernährung und Flüssigkeitsversorgung älterer Menschen", Abschlussbericht Projektgruppe P 39 des Medizinischen Dienstes der Spitzenverbände der Krankenkassen (MDS), Juli 2003.

Assessing the nutritional state of old and dependent people demands a distinctive consideration of all aspects which might influence the individual's nutritional habits. An isolated consideration of the body mass index (BMI) does not serve the needs of elderly, because the BMI seems not to be a valid indicator for their nutrtional state. In order to prove the risk of malnutrition, also the individual life conditions as well as social, religious, cultural and economic circumstances besides the amount of energy and nu triments are to be taken into account.

A Rare Case of Male-to-Eunuch Gender Dysphoria.

The aim of this case report is to improve the awareness of this gender dysphoria both for the single patient interest as well as for the community. This is a single-patient case report. Literature search and Internet browsing for forum concerning this subject were performed. Healthcare professionals must be aware of this group of patients as they have a greater risk of self-harm in order to self-castrate, which could be acute and life threatening if not performed in the right way. Hermann M and Thorstenson A. A rare case of male-to-eunuch gender dysphoria. Sex Med 2015;3:331-333.

A surge of flu-associated adult respiratory distress syndrome in an Austrian tertiary care hospital during the 2009/2010 Influenza A H1N1v pandemic.

We report on 17 patients with influenza A H1N1v-associated Adult Respiratory Distress Syndrome who were admitted to the intensive care unit (ICU) between June 11th 2009 and August 10th 2010 (f/m: 8/9; age: median 39 (IQR 29-54) years; SAPS II: 35 (29-48)). Body mass index was 26 (24-35), 24% were overweight and 29% obese. The Charlson Comorbidity Index was 1 (0-2) and all but one patient had comorbid conditions. The median time between onset of the first symptom and admission to the ICU was 5 days (range 0-14). None of the patients had received vaccination against H1N1v. Nine patients received oseltamivir, only two of them within 48 hours of symptom onset. All patients developed severe ARDS (PaO(2)/FiO(2)-Ratio 60 (55-92); lung injury score 3.8 (3.3-4.0)), were mechanically ventilated and on vasopressor support. Fourteen patients received corticosteroids, 7 patients underwent hemofiltration, and 10 patients needed extracorporeal membrane-oxygenation (ECMO; 8 patients veno-venous, 2 patients veno-arterial), three patients Interventional Lung Assist (ILA) and two patients pump driven extracorporeal low-flow CO(2)-elimination (ECCO(2)-R). Seven of 17 patients (41%) died in the ICU (4 patients due to bleeding, 3 patients due to multi-organ failure), while all other patients survived the hospital (59%). ECMO mortality was 50%. The median ICU length-of-stay was 26 (19-44) vs. 21 (17-25) days (survivors vs. nonsurvivors), days on the ventilator were 18 (14-35) vs. 20 (17-24), and ECMO duration was 10 (8-25) vs. 13 (11-16) days, respectively (all p = n.s.). Compared to a control group of 241 adult intensive care unit patients without H1N1v, length of stay in the ICU, rate of mechanical ventilation, days on the ventilator, and TISS 28 scores were significantly higher in patients with H1N1v. The ICU survival tended to be higher in control patients (79 vs. 59%; p = 0.06). Patients with H1N1v admitted to either of our ICUs were young, overproportionally obese and almost all with existing comorbidities. All patients developed severe ARDS, which could only be treated with extracorporeal gas exchange in an unexpectedly high proportion. Patients with H1N1v had more complicated courses compared to control patients.