Pentraxin-3 level at admission is a strong predictor of short-term mortality in a community-based hospital setting.

BACKGROUND: The pattern recognition molecule pentraxin-3 (PTX3) is a novel potential marker of prognosis, as elevated levels are associated with both disease severity and mortality in patients with a wide range of conditions. However, the usefulness of PTX3 as a prognostic biomarker in a general hospital setting is unknown. PATIENTS AND METHODS: The study cohort consisted of 1326 unselected, consecutive patients (age >40 years) admitted to a community hospital in Copenhagen, Denmark. Patients were followed until death or for a median of 11.5 years after admission. The main outcome measure was all-cause mortality. Serum samples collected from patients at admission and from 192 healthy control subjects were quantified for PTX3 level by enzyme-linked immunosorbent assay. RESULTS: PTX3 was elevated in patients (median 3.7 ng mL(-1) , range 0.5-209.8) compared with healthy nonhospitalized subjects (median 3.5 ng mL(-1) , range 0.0-8.3; P = 0.0003). Elevated PTX3 levels, defined as above the 95th percentile of the concentration in healthy subjects, were associated with increased overall mortality during the study (P < 0.0001). This increase in mortality was greatest in the short term, with an unadjusted hazard ratio (HR) of 6.4 [95% confidence interval (CI) 3.8-11.0] at 28 days after admission, compared to 1.7 (95% CI 1.4-2.0) at the end of follow-up. These results were still significant after adjustment for age, gender and glomerular filtration rate: adjusted HR of 5.0 (95% CI 2.9-8.8) and 1.4 (95% CI 1.2-1.8), respectively. CONCLUSION: These results suggest that PTX3 could be a widely applicable marker of short-term mortality in hospitalized patients and may be useful in the initial risk stratification.

Single event time series analysis in a binary karst catchment evaluated using a groundwater model (Lurbach system, Austria).

The Lurbach karst system (Styria, Austria) is drained by two major springs and replenished by both autogenic recharge from the karst massif itself and a sinking stream that originates in low permeable schists (allogenic recharge). Detailed data from two events recorded during a tracer experiment in 2008 demonstrate that an overflow from one of the sub-catchments to the other is activated if the discharge of the main spring exceeds a certain threshold. Time series analysis (autocorrelation and cross-correlation) was applied to examine to what extent the various available methods support the identification of the transient inter-catchment flow observed in this binary karst system. As inter-catchment flow is found to be intermittent, the evaluation was focused on single events. In order to support the interpretation of the results from the time series analysis a simplified groundwater flow model was built using MODFLOW. The groundwater model is based on the current conceptual understanding of the karst system and represents a synthetic karst aquifer for which the same methods were applied. Using the wetting capability package of MODFLOW, the model simulated an overflow similar to what has been observed during the tracer experiment. Various intensities of allogenic recharge were employed to generate synthetic discharge data for the time series analysis. In addition, geometric and hydraulic properties of the karst system were varied in several model scenarios. This approach helps to identify effects of allogenic recharge and aquifer properties in the results from the time series analysis. Comparing the results from the time series analysis of the observed data with those of the synthetic data a good agreement was found. For instance, the cross-correlograms show similar patterns with respect to time lags and maximum cross-correlation coefficients if appropriate hydraulic parameters are assigned to the groundwater model. The comparable behaviors of the real and the synthetic system allow to deduce that similar aquifer properties are relevant in both systems. In particular, the heterogeneity of aquifer parameters appears to be a controlling factor. Moreover, the location of the overflow connecting the sub-catchments of the two springs is found to be of primary importance, regarding the occurrence of inter-catchment flow. This further supports our current understanding of an overflow zone located in the upper part of the Lurbach karst aquifer. Thus, time series analysis of single events can potentially be used to characterize transient inter-catchment flow behavior of karst systems.

Multiple stressor effects on benthic macroinvertebrates in very large European rivers - A typology-based evaluation of faunal responses as a basis for future bioassessment.

Two factors complicate the ecological status classification of very large rivers in Europe according to the EU Water Framework Directive: First, current assessment methods do not fully consider the specific ecology of very large rivers (such as lateral connectivity and the role of floodplains for ecological status). Second, most of Europe's very large rivers have been severely altered by human activities such as flood protection, damming and navigation. The aim of our study is to develop an assessment method for very large rivers by identifying suitable biological metrics as the basis for multi-metric bioassessment using benthic invertebrates. Based on the pan-European typology of very large rivers by Borgwardt et al. (2019), we established a river type-specific assessment approach using invertebrate samples from 25 European countries and 94 very large rivers. The frequency and intensity of eight pressures jointly acting on the sampling sites were described, and a selection of suitable invertebrate community metrics were correlated with the pressure intensities to establish pressure-response relationships. The very large river types differ in terms of relevant pressures and pressure combinations, with the invertebrate communities distinctly responding to these pressure patterns. Neozoa dominance correlated strongly with 'navigation', being a major pressure at very large rivers, which entails severe hydro-morphological alterations such as channelization, riparian vegetation alteration and impoundment. Under combined pressures, a critical community turnover became evident in terms of neozoa outnumbering EPT taxa and the ratio of hemilimnic invertebrates decreasing. We propose ten bioassessment metrics, including measures of biological diversity as well as newly generated indicators, for the development of a European type-specific assessment method for very large rivers.

A guideline to frame stressor effects in freshwater ecosystems.

Environmental policies fall short in protecting freshwater ecosystems, which are heavily threatened by human pressures and their associated stressors. One reason is that stressor effects depend on the context in which they occur and it is difficult to extrapolate patterns to predict the effect of stressors without these being contextualized in a general frame. This study aims at improving existing decision-making frameworks such as the DPSIR approach (Driver-Pressure-State-Impact-Response) or ERA (Environmental Risk Assessment) in the context of stressors. Here, we delve into stressor-impact relationships in freshwater ecosystems and develop a guideline which includes key characteristics such as stressor type, stressor duration, location, the natural levels of environmental variables to which each ecosystem is used to, among others. This guideline is intended to be useful in a wide range of ecosystem conditions and stressors. Incorporating these guidelines may favor the comparability of scientific results and may lead to a substantial advancement in the efficacy of diagnosis and predictive approaches of impacts.

Effect of adrenomedullin on the cerebral circulation: relevance to primary headache disorders.

Adrenomedullin (ADM) is closely related to calcitonin gene-related peptide, which has a known causative role in migraine. Animal studies have strongly suggested that ADM has a vasodilatory effect within the cerebral circulation. For these reasons, ADM is also likely to be involved in migraine. However, the hypothetical migraine-inducing property and effect on human cerebral circulation of ADM have not previously been investigated. Human ADM (0.08 microg kg(-1) min(-1)) or placebo (saline 0.9%) was administered as a 20-min intravenous infusion to 12 patients suffering from migraine without aura in a crossover double-blind study. The occurrence of headache and associated symptoms were registered regularly 24 h post infusion. Cerebral blood flow (CBF) was measured by (133)Xenon single-photon emission computed tomography, mean blood flow velocity in the middle cerebral artery (V(MCA)) by transcranial Doppler and the diameter of peripheral arteries by transdermal ultrasound (C-scan). ADM did not induce significantly more headache or migraine compared with placebo (P = 0.58). CBF was unaffected by ADM infusion (global CBF, P = 0.32 and rCBF(MCA), P = 0.38) and the same applied for the V(MCA) (P = 0.18). The superficial temporal artery dilated compared with placebo (P < 0.001), and facial flushing was seen after ADM administration (P = 0.001). In conclusion, intravenous ADM is not a mediator of migraine headache and does not dilate intracranial arteries.

[Dislocation of voice prostheses. Interdisciplinary management of diagnostics and treatment]. / Dislokation von Stimmprothesen. Interdisziplinäres Vorgehen bei Diagnostik und Therapie.

Tracheoesophageal voice prostheses after total laryngectomy are infrequently the cause of severe complications. We report on a patient with threefold dislocation of a Provox prosthesis, each with suspected oesophageal loss. The patient came to our hospital with acute dyspnoea. An urgent bronchoscopy showed two prostheses in the right and one in the left main bronchus, which had caused inflammation with extensive occlusion of the bronchus. All three prostheses could be recovered.

Catchment properties and the photosynthetic trait composition of freshwater plant communities.

Unlike in land plants, photosynthesis in many aquatic plants relies on bicarbonate in addition to carbon dioxide (CO2) to compensate for the low diffusivity and potential depletion of CO2 in water. Concentrations of bicarbonate and CO2 vary greatly with catchment geology. In this study, we investigate whether there is a link between these concentrations and the frequency of freshwater plants possessing the bicarbonate use trait. We show, globally, that the frequency of plant species with this trait increases with bicarbonate concentration. Regionally, however, the frequency of bicarbonate use is reduced at sites where the CO2 concentration is substantially above the air equilibrium, consistent with this trait being an adaptation to carbon limitation. Future anthropogenic changes of bicarbonate and CO2 concentrations may alter the species compositions of freshwater plant communities.

Bernese periacetabular osteotomy through a double approach : Simplification of a surgical technique.

OBJECTIVE: Reorientation of the acetabulum to normalize load transfer or avert femoroacetabular pincer impingement to prevent osteoarthritis of the hip. INDICATIONS: Persisting acetabular dysplasia after closure of growth plates or acetabular malrotation. CONTRAINDICATIONS: High dislocation of hip, secondary acetabulum, increased misalignment on functional X­ray, high-grade mobility restriction. Relative: degenerative changes, advanced age. SURGICAL TECHNIQUE: Bernese periacetabular osteotomy through two incisions; all bone cuts are carried out under direct vision. The osteotomies are equivalent to the classic Ganz method. In a slightly tilted forward lateral decubitus position, a posterior incision is applied for the ischium osteotomy and the caudal portion of the retroacetabular osteotomy. The pubis and ilium osteotomies are performed in a supine position through an anterior approach with subsequent reorientation and screw fixation. The rectus femoris is not dissected unless joint exposure is required. POSTOPERATIVE MANAGEMENT: Partial weight bearing with 20 kg for the first 6 weeks postoperatively, followed by stepwise transition to full loads after radiological control. RESULTS: In total, 34 patients (37 hips) were followed up for 20.4 ± 10.3 months. Tönnis osteoarthritis scale levels remained constant. The center-edge angle of Wiberg increased from 13.2 ± 7.5° to 26.5 ± 6.7°, the Tönnis angle (acetabular index) changed from 13.8 ± 6.5° to 3.4 ± 4.4°. At follow-up, the Merle d'Aubigné and Postel score was 16.5 ± 1.4; the modified Harris hip score 87.6 ± 13.9 and the International hip outcome tool (iHOT)-12 78.2 ± 20.3 points. The mean surgical time was 213 ± 29 min. Severe complications were not observed.

The effects of two years of mestranol treatment on carbohydrate metabolism.

Twenty-nine menstrual age women who had a hysterectomy and oophorectomy were treated cyclically with 80 micrograms of mestranol per day for 2 yr. Their carbohydrate metabolism was evaluated prospectively by doing a 3 hr oral glucose tolerance test after a 100 g glucose load and measuring both blood glucose and plasma insulin levels. The tests were performed before drug treatment and after 2 yr of drug use. Those women that had a "normal" predrug test had some carbohydrate metabolism changes at the 2 yr test with significant elevations of the fasting, 1 and 2 hr blood glucose values, and also significant elevations of the 2 and 3 hr plasma insulin values. Those women with a "borderline abnormal" predrug test had no significant change in either parameter of carbohydrate metabolism however a trend toward similar changes was noted.

PIP: 29 menstrual age women who had hysterectomy and oophorectomy were treated cyclically with 80 mcg of mestranol/day for 2 years. Their carbohydrate metabolism was evaluated prospectively by doing a 3 hour oral glucose tolerance test after a 100 g glucose load and measuring both blood glucose and plasma insulin levels. Tests were performed before a drug treatment and after 2 years of drug usage. Those women who had normal predrug tests had some carbohydrate metabolism changes at the 2 year test with significant elevations of the fasting, 1, and 2 hour blood glucose values, and also significant elevations of the 2 and 3 hour plasma insulin values. Those women with a borderline abnormal predrug test had no significant change in either parameter of carbohydrate metabolism; however, a trend toward similar changes was noted.

Human placental lactogen levels in multiple pregnancies.

Serum human placental lactogen (hPL) levels were measured in duplicate with a radioimmunoassay in 206 serum samples at 30 and 36 weeks' gestation from women with normal singleton pregnancies (75) or pregnancies with twins (37). One triplet pregnancy was also studied. The results show a significant elevation of hPL in the women with twin pregnancies at both the 30th (7.0 vs 6.0 microgram/ml) and the 36th (9.2 vs 7.4 microgram/ml) weeks. One-third of the twin pregnancies had values of hPL in excess of 8.0 microgram/ml at 30 weeks and more than half had values in excess of 9.0 microgram/ml at 36 weeks. The triplet pregnancy had an hPL value of 11.0 microgram/ml at 36 weeks' gestation. These data support the potential usefulness of serum hPL measurements in the screening profile for the detection of high-risk pregnancies.

Carbohydrate metabolism in women with a twin pregnancy.

Carbohydrate metabolism was evaluated in 24 women with a twin pregnancy and 24 women with a singleton pregnancy. The groups were of similar age, parity, weight, and gestational age. In each woman an intravenous glucose tolerance test was done using a 25-g glucose load in the last half of gestation. Both blood glucose and plasma insulin levels were measured and statistically compared. The plasma human placental lactogen levels were significantly higher in the women with the twin gestation (7.3 +/- 0.7 versus 4.7 +/- 0.3 microgram/ml). Although the glucose disappearance rates (K) were not different, there was a significantly lower fasting as well as 5- and 15-minute blood glucose value in the twin pregnancy group. There was also a significantly lower 15-minute insulin level in the twin group. The importance of these findings to the clinical management of twin pregnancies and to the understanding of the metabolic changes in pregnancy is discussed.

Effects of diuril and dilantin on blood glucose and insulin levels in late pregnancy.

In order to evaluate the carbohydrate metabolic effects of certain drug therapies used in treating the toxemia syndrome, 75 term pregnant women were studied with two intravenous glucose tolerance tests performed 1 week apart. During the 2-hour tests, both blood glucose and plasma insulin were measured. The women were randomly assigned to three treatment groups, and during the week between tests they received:a) no drugs (control or C group);b) Diuril, 500 mg/day (Dgroup); or c)Dilantin, 100 mg, t.i.d. (DL group). Each group was of similar age, weight, and gestational age. There were no significant changes in any of the glucose curves. Both drug-treated groups demonstrated insulin changes. In contrast to the C group, the D group showed an elevation of the plasma insulin values during the second test, and the DL group had a lowering of plasma insulin levels in the second test. Thus, both drugs had minor effects on carbohydrate metabolism during short-term use. However, a more marked metabolic effect of these drugs must be considered when using them at higher dosages or for a longer duration.

Human placental lactogen and intrauterine growth retardation.

Serum human placental lactogen levels were measured after 36 weeks' gestation in 264 serum samples from 109 women with normal pregnancies and in 137 serum samples from 70 women with pregnancies complicated by fetal intrauterine growth retardation (IGR). The fetal and placental weights were significantly lower in the IGR groups while the maternal ages were not different. There was a significantly lower hPL value at each week from 36 to 41 (except for the 39th) in the IGR group. Sixty percent of the women with IGR had hPL values less than 6 mug/ml, and 18.6% were less than 4 mug/ml. It is suggested that a low serum hPL value obtained during the last month of pregnancy should alert the physician to the possibility of intrauterine problems, including IGR.

Effects of norethindrone on carbohydrate and lipid metabolism.

A prospective study was undertaken to investigate the carbohydrate and lipid metabolic effects of the oral contraceptive norethindrone. An oral glucose tolerance test was performed before and 1 year after the daily oral administration of 0.35 mg of norethindrome to 31 women. Measurements were made of glucose, insulin, cholesterol, and triglycerides. During the year there was no significant weight change in the women, and the fasting cholesterol values were unaffected by the steroid. The fasting triglycerides decreased as normally occurs in the late postpartum period. There was no change in the blood glucose curve, but there was a statistically significant elevation produced in all of the plasma insulin values. These data suggest that this 19-nor progestogen steroid can affect the peripheral activity of insulin and thus require higher blood levels in order to obtain the same glucose homeostasis.

Amniotic fluid L/S ratio in twin gestation.

Transabdominal amniocenteses were performed on both sacs of 14 sets of twins. In each instance one sac was marked with methylene blue to correctly identify the fluids. The lecithin/sphingomyelin ratio was determined on each fluid, and the correlation coefficient between the two sets of fluids was 0.86. There was no significant difference in the fluids' L/S ratios. The importance of this in terms of understanding the variables affecting fetal lung maturation and in clinically managing twin pregnancies is stressed.

Treatment of premature labor with ritodrine: a randomized controlled study.

Twenty-nine women with premature labor were randomly assigned to a ritodrine (N = 14) or placebo (N = 15) drug group. The 2 groups were of similar age, parity, weight, gestational age, and cervical change at the onset of treatment. They were treated sequentially with intravenous, intramuscular, and oral drugs and monitored carefully during therapy. There was a significant increase in both the maternal and fetal heart rates during ritodrine treatment, and also a significant decrease in maternal blood pressure. Ritodrine-treated women often complained of palpatations. There was no significant difference in the extension of pregnancy, birth weight, or infant survival for the ritodrine group. Although the 1-minute Apgar scores in the ritodrine group were higher, the 5-minute scores were similar in both groups.

Comparison of fetal maturity evaluation with ultrasonic biparietal diameter and amniotic fluid lecithin-sphingomyelin ratio.

Fetal head biparietal (BP) measurements by ultrasonic techniques and amniotic fluid lecithin-sphingomyelin (L/S) ratios were simultaneously determined (within 2 days) on 84 occasions in 72 women. Using the criteria for maturity of an L/S ratio of 2.0 or more or a BP measurement of 9.0 cm or more, there was agreement between these test results in 66.7% of the cases. The BP incorrectly predicted the L/S ratio 33.3% of the time, with a false positive rate of 27.3% and a false negative rate of 6.0%. If an L/S ratio of 1.5 were used as the critical determinant, the BP false positive rate remained high (9.5%). A high false negative error (21.4%) occurred if a BP value of 9.3 cm was used. These results suggest that ultrasonic BP measurements should not be used as the only criteria of fetal maturity in the management of high-risk pregnancies.

Influence of HLA types on carbohydrate effects of a low-estrogen oral contraceptive.

The lymphocyte HLA types were determined for 13 women, who were then separated into a subgroup of those having a "high" risk for insulin-dependent diabetes mellitus (B8, B15, AW30) and a "low-risk" subgroup (B7, BW35). A 3-hour oral glucose tolerance test was conducted on each woman before starting on oral contraceptives (OC) and then 6 months after using them. Both blood glucose and plasma insulin levels were measured. The OC contained 0.035 mg of ethinylestradiol and 0.4 mg of norethindrone. There was a significantly higher 0.5-hour glucose value in the control test in the "high risk" group. There was a significant elevation of the 1-hour plasma insulin value in the 6-month test for the "high-risk" group. The usefulness of the HLA prescreening of women prior to use of OC needs more study.

PIP: Metabolic alterations often accompany the use of OCs (oral contraceptives), especially blood glucose and plasma insulin. Persons at risk have been identified by blood HLA typing and this paper discusses effects of HLA type on carbohydrate metabolic changes accompanying the use of low-dose OCs. The lymphocyte HLA types were determined for the 13 women who were then divided into 2 groups: those at high-risk for insulin-dependent diabetes mellitus (HLA type of B8, B15, AW30; N=6) and those at low-risk (HLA type of B7 or BW35; N=7). Each woman underwent a 3-hour glucose tolerance test before beginning OCs (0.035 mg ethinylestradiol and 0.4 mg norethindrone) and then 6 months following their introduction, with both blood glucose and plasma insulin levels being measured. The high-risk group showed a significantly higher 0.5 hour glucose value and a significant elevation of the 1-hour plasma insulin value in the 6-month test following OC administration. Further study is necessary to determine whether separation of patients into high-risk and low-risk HLA types is important and whether HLA typing to preselect women for certain OC treatment programs is cost-effective.

Stimulated plasma prolactin levels in women using medroxyprogesterone acetate or an intrauterine device for contraception.

PIP: Pituitary prolactin has been implicated in the etiology of breast tumors. This study examines the effects of MPA (medroxyprogesterone acetate) on prolactin secretion by measuring both basal and phenothiazine-stimulated plasma prolactin levels in women using MPA (n=12) and IUD (control group, n=9). The MPA group was slightly older (mean, 33.3 years) and had a higher parity (mean, 4.5) than the IUD group (26.4 years, 1.5 parity). Blood samples were collected and assayed using a double antibody radioimmunoassay technqiue. After determination of basal hormone levels, each woman received an intramuscular injection of chlorpromazine. No significant differences in either basal or stimulated blood prolactin concentration between the 2 groups were observed. Further research should still be done on the posssibility of MPA use being associated with increased incidence of breast tumors in humans.^ieng