A compact high resolution electrospray ionization ion mobility spectrometer.

Electrospray is a commonly used ionization method for the analysis of liquids. An electrospray is a dispersed nebular of charged droplets produced under the influence of a strong electrical field. Subsequently, ions are produced in a complex process initiated by evaporation of neutral solvent molecules from these droplets. We coupled an electrospray ionization source to our previously described high resolution ion mobility spectrometer with 75 mm drift tube length and a drift voltage of 5 kV. When using a tritium source for chemical gas phase ionization, a resolving power of R=100 was reported for this setup. We replaced the tritium source and the field switching shutter by an electrospray needle, a desolvation region with variable length and a three-grid shutter for injecting ions into the drift region. Preliminary measurements with tetraalkylammonium halides show that the current configuration with the electrospray ionization source maintains the resolving power of R=100. In this work, we present the characterization of our setup. One major advantage of our setup is that the desolvation region can be heated separately from the drift region so that the temperature in the drift region stays at room temperature even up to desolvation region temperatures of 100 °C. We perform parametric studies for the investigation of the influence of temperature on solvent evaporation with different ratios of water and methanol in the solvent for different analyte substances. Furthermore, the setup is operated in negative mode and spectra of bentazon with different solvents are presented.

Local B cells and IgE production in the oesophageal mucosa in eosinophilic oesophagitis.

BACKGROUND: Eosinophilic oesophagitis (EO) is an emerging yet increasingly prevalent disorder characterised by a dense and selective eosinophilic infiltration of the oesophageal wall. While EO is considered an atopic disease primarily triggered by food antigens, disparities between standard allergen testing and clinical responses to exclusion diets suggest the participation of distinct antigen-specific immunoglobulin E (IgE) in the pathophysiology of EO. AIM: To find evidence for a local IgE response. METHODS: Endoscopic biopsies of the distal oesophagus of atopic and non-atopic EO and control individuals (CTL) were processed for immunohistochemistry and immunofluorescence to assess the presence of B cells, mast cells, and IgE-bearing cells. Oesophageal RNA was analysed for the expression of genes involved in B cell activation, class switch recombination to IgE and IgE production, including germline transcripts (GLTs), activation-induced cytidine deaminase (AID), IgE heavy chain (Cepsilon) and mature IgE mRNA using polymerase chain reaction and microarray analysis. RESULTS: Regardless of atopy, EO showed increased density of B cells (p<0.05) and of IgE-bounded mast cells compared to CTL. Both EO and CTL expressed muGLT, epsilonGLT, gamma4GLT, AID, Cepsilon and IgE mRNA. However, the frequency of expression of total GLTs (p = 0.002), epsilonGLT (p = 0.024), and Cepsilon (p = 0.0003) was significantly higher in EO than in CTL, independent of the atopic status. CONCLUSION: These results support the heretofore unproven occurrence of both local immunoglobulin class switching to IgE and IgE production in the oesophageal mucosa of EO patients. Sensitisation and activation of mast cells involving local IgE may therefore critically contribute to disease pathogenesis.

Does vaginal bleeding influence first-trimester markers for Down syndrome?

OBJECTIVES: To examine the effect of early vaginal bleeding on first-trimester screening markers for Down syndrome. METHODS: A retrospective study was conducted on 1755 normal singleton fetuses that underwent first-trimester combined screening for Down syndrome on the basis of ultrasound and maternal serum markers. Fetal delta-nuchal translucency (NT), maternal serum pregnancy-associated plasma protein A (PAPP-A) and free beta-hCG were compared between pregnancies with (n = 252) and without (n = 1503) an episode of vaginal bleeding. Subgroup analysis for the intensity of bleeding (spotting n = 191; light n = 32; heavy n = 29) was performed. RESULTS: The median +/- SD (log(10)) for delta-NT, multiple of medians (MoM) PAPP-A and MoM free beta-hCG (corrected for maternal weight, smoking and ethnicity) was - 0.17 +/- 0.62, 1.10 +/- 0.28, 1.1 +/- 0.28 and - 0.15 +/- 0.51, 0.98 +/- 0.26, 0.94 +/- 0.3 in pregnancies with and without a history of early vaginal bleeding, which were not significantly different. Exclusion of patients with spotting from the vaginal bleeding group revealed significantly higher maternal serum free beta-hCG MoM values (median +/- SD (log(10))) compared to patients without bleeding, 1.29 +/- 0.27 vs 0.96 +/- 0.3(p = 0.011). Screen-positive (cut off of 1:350) rate after combined first-trimester screening was 28.1% in patients with light vaginal bleeding and 8.4% in patients without bleeding (p = 0.001). CONCLUSIONS: Light vaginal bleeding before first-trimester combined screening for Down syndrome leads to a higher screen-positive rate after combined first trimester screening, without a significant difference in serum levels of the screening markers.

An environmentalist's vision of operationalizing the precautionary principle in the management of chemicals.

In Europe and elsewhere, there is compelling evidence that humans, wildlife, and the environment are being damaged by man-made chemicals. Recognizing that regulatory initiatives are needed to try to prevent harm before it occurs in the future, the precautionary principle has become a focus of attention on both sides of the Atlantic. The authors suggest a way to implement the precautionary principle in the management of chemicals, outlining how this guiding principle can be given a practical relevance within regulatory initiatives to reduce the risks posed by chemicals currently traded in the European Union and elsewhere.

Rapid simultaneous comparison system for subjective grading scales grading scales for facial paralysis.

OBJECTIVE: The senior authors developed a computer-assisted rapid, simultaneous comparison system for nine international grading scales for facial paralysis. The purpose of this study is to present the system and to compare the agreement of hand-performed House-Brackmann and Sunnybrook scales, two frequently used scales herein taken as the concurrent criterion test standards, with those like scales done simultaneously in the computed system. STUDY DESIGN: The study design was a prospective concurrent criterion validity study. Test-retest reliability and interobserver agreement were assessed using the kappa statistic (k) for ordinal data and the intraclass correlation coefficient (ICC) for semidimensional data. SETTING: The study was conducted at a university practice. PATIENTS: Ten consecutive consenting subjects with varying degrees of facial paralysis were studied. INTERVENTION: Each subject was measured, in random order, twice by each method by each of two independent observers. MAIN OUTCOME MEASURES: House-Brackmann score, Sunnybrook score, and like-scale scores done simultaneously in the computed system were measured. RESULTS: Agreement between the computed system and hand-performed criterion standards was equal to each scale compared against itself; for the House-Brackmann, agreement was moderate (k = 0.554); for the Sunnybrook, agreement was excellent (ICC = 0.976). CONCLUSIONS: The computed system has the advantage of allowing an examiner to view a rapid, simultaneous display of multiple grading scale scores at a keystroke from one clinical assessment input, obviating the labor of repeating measures by hand.

Prospective determination of the hormonal response after cessation of luteinizing hormone-releasing hormone agonist treatment in patients with prostate cancer.

OBJECTIVES: To determine the hormonal (luteinizing hormone [LH] and testosterone) and biochemical (serum prostate-specific antigen [PSA]) response to withdrawal of luteinizing hormone-releasing hormone (LHRH) agonists in patients who received more than 2 years of LHRH therapy for advanced prostate cancer. METHODS: Fourteen patients with clinical Stage T3 or higher prostate cancer and no evidence of clinical or biochemical progression, who had received 2 years or more of LHRH therapy, were enrolled at the time of their scheduled 3-month depot injection. Patients underwent history, physical examination, and measurement of serum PSA, LH, and testosterone at baseline, monthly for 3 months, and then every 3 months for 1 year following LHRH withdrawal. RESULTS: The mean age of patients was 70.3 years (range 56 to 84). Patients previously received LHRH agonist for a mean of 38.6 months (range 25 to 82). All patients had castrate levels of testosterone (median 10.0 ng/dL) and suppressed LH levels (median 0.1 mIU/mL) at baseline. Median baseline PSA was 0.15 ng/mL. On multiple groupwise comparison, there was no significant change (compared with baseline) in LH or testosterone until 6 months after withdrawal and no change in PSA throughout the duration of the study (median PSA at 1 2 months 0.30 ng/mL). Despite significant increases in LH and testosterone when compared with baseline beginning at 6 months, both LH and testosterone remained markedly suppressed, with median testosterone remaining in the castrate range at both 6 and 9 months and significantly below the lower limit of normal at 12 months (median 111.0 ng/dL). Despite no statistically significant change for the entire cohort in serum PSA, a rising PSA was noted in 4 patients between 3 and 9 months, and LHRH therapy was reinitiated. The remaining patients continued to have suppressed LH and testosterone, with 4 patients remaining in the castrate range at 12 months. CONCLUSIONS: The recovery of function of the hypothalamic-pituitary-testicular axis after prolonged LHRH administration is variable. Castrate levels of testosterone and suppressed LH may persist even up to 1 year after discontinuing LHRH. These results have significant implications regarding the interpretation of clinical trials incorporating neoadjuvant and adjuvant hormonal therapy. Further studies are needed to expand on these preliminary observations and should also address the feasibility of incorporating LHRH withdrawal into clinical practice.

Effect of scrambling on the short-term reliability of the American Urological Association Symptom Index.

OBJECTIVES: To determine the degree of attention patients pay to the wording of symptom scoring instruments and to determine the short-term reliability of the American Urological Association Symptom Index (AUA SI). METHODS: The AUA SI was administered to 111 volunteers with a mean age+/-SD of 50.8+/-16.4 years (range 23 to 83) in the standard formatting. Without debriefing, the same volunteers were given the AUA SI a second time within 2 weeks. By sequential assignment, 65 of the subjects were given the AUA SI in the same standard format, and for the remaining 46, the sequence of the questions was scrambled and the order of the answers reversed for the second administration. In addition, the Benign Prostatic Hyperplasia Impact Index (BPH II) and the quality of life (QOL) question were answered and urinary flow rates were performed on both occasions to compare the short-term variability between the "subjective" symptom score and the "objective" flow rate recordings. RESULTS: In this group of volunteers with a mean age of 50.8 years, the mean AUA SI was 11.7 points. The mean values in the unscrambled group were 12.4 and 12.9 (NS) and in the scrambled group 10.5 and 10.2 (NS) for the two administrations. Cumulative frequency distribution of differences were nearly identical. Similarly, there were no differences in the mean values for the two administrations in either group for the BPH II, the QOL question, or the peak flow rate. The reproducibility was excellent for each of the individual seven questions in both groups. There was no effect of age (younger or older than 50 years) on the reproducibility, although in general the variability of the scores was higher in older men, presumably due to a higher score in the first assessment. CONCLUSIONS: Subjects pay relatively close attention to the questions of symptom score questionnaires. The reproducibility for each individual question, as well as for the entire score, was very high in the original unscrambled and in the scrambled version. In addition, the short-term variability of the AUA SI is comparable to that of the flow rate recording. These observations should give confidence to those using such scores in clinical practice and clinical research.

Are emotions frightening? II: An analogue study of fear of emotion, interpersonal conflict, and panic onset.

Two studies with college students were conducted to further explore the reliability and construct validity of fear of emotion, as assessed by the Affective Control Scale (ACS), a measure of fear of anxiety, depressed mood, anger, and strong positive emotion. The ACS fared well in tests of internal consistency and of convergent and divergent validity. In an analogue study of panic onset with college students with no history of panic, the predictive and incremental validity of the ACS was demonstrated: the ACS predicted students' fear of induced panic-like bodily sensations even once trait and state anxiety were statistically controlled. A second aspect of the investigation was an analogue test of the hypothesis that stress from interpersonal conflict (induced via remembrance of conflictual interactions with an important person) would moderate the ACS's effects on anxiety and fear of induced bodily sensations. This hypothesis was not confirmed.

Are emotions frightening? An extension of the fear of fear construct.

Proposed in this paper is an expansion of the concept of fear of fear to include fear of other emotions (anger, depression, and positive emotions). In Study 1, initial evidence of the reliability and validity of a questionnaire designed to measure this construct, the Affective Control Scale, is provided. In Study 2, an analogue experiment of susceptibility to panic disorder was conducted. The ability of fear of anger, depression, and positive emotions to predict fear of laboratory-induced bodily sensations in a population with no history of panic attacks was demonstrated.

Integrated disability management: taking a coordinated approach to managing employee disabilities.

1. Disability management provides opportunities to control costs and improve employee benefits through three levels of prevention: primary prevention of disabilities (work and non-work related); secondary minimization of disability costs; and tertiary facilitation of rehabilitation and early return to work. 2. A totally integrated disability management program has many components, all of which must be effectively coordinated. Management of these components will result in lower disability related costs, increased employee productivity and job satisfaction, and less employee turnover. 3. All employees receive individualized services designed to assist them in returning to work and emphasizing their contributions to the company's overall dedication to global leadership, continuous growth, and success.

Discriminant validity of the Inventory to Diagnose Depression.

Measures of depression and anxiety correlate highly with one another. It has been hypothesized that this shared variance partly reflects poor discriminant validity, which could be improved by linking item content more closely to diagnostic criteria. We tested this speculation by comparing the Inventory to Diagnose Depression (Zimmerman, Coryell, Corenthal, & Wilson, 1986), developed to correspond with diagnostic criteria for major depression, with the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979) in terms of discriminant validity. These measures correlated more strongly with each other than with anxiety but did not differ in their relations with anxiety.

[Anaerobic infections in the head and neck area. Current status of knowledge]. / Anaerobierinfektionen im Kopf-/Halsbereich. Aktueller Wissensstand.

The classification of anaerobic infections and the most common organisms affecting the head and neck, pathogenesis diagnosis and current therapy are reported. Certain types of infections are particularly important for anaerobic bacteria and include actinomycosis, infectious complications of chronic otitis media or sinusitis, phlegmon of the floor of the mouth, peritonsillar abscess, retro-(para-)pharyngeal abscess, neck space infections, mediastinitis, wound infections following head and neck surgery and septic complications.

Attributional style in children of substance abusers.

This study examined attributional style in children of substance abusers. We hypothesized that children of substance abusers are more likely to develop a depressogenic attributional style. Forty children between the ages of 8 and 14 participated in the study. Twenty children were from families with a history of substance abuse and 20 were from families without such a history. Each child completed self-report measures of depression and attributional style. After controlling for depression and other factors, the results revealed that children of substance abusers had a more depressogenic attributional style than did children without such a family history. Implications of the results for children of substance abusers and for hopelessness theory are discussed.

Depression and pessimism for the future: biased use of statistically relevant information in predictions for self versus others.

The cognitive theories of depression emphasize the role of pessimism about the future in the etiology and maintenance of depression. The present research was designed for two reasons: to provide a clear demonstration that depressed individuals' predictions of the likelihood of future outcomes are more pessimistic than those of nondepressed individuals given identical information with which to make forecasts and identical conditions for forecasting, and to test two additional hypotheses regarding possible mechanisms underlying depressives' relative pessimism in forecasting: a social-comparison and a differential attributional-style hypothesis. We used a modification of the cue-use paradigm developed by Ajzen (1977, Experiment 1) and examined depressed and nondepressed people's predictions of the likelihood of future positive and negative outcomes for themselves and for others. The results provided strong support for pessimism on the part of depressed individuals relative to nondepressed individuals in forecasts for both self and others. In addition, whereas nondepressives exhibited a self-enhancing bias in which they overestimated their probability of success and underestimated their probability of failure relative to that of similar others, depressives did not succumb to either positive or negative social comparison biases in prediction. Finally, in line with the attributional-style hypothesis, depressed-nondepressed differences in subjects' cue-use patterns were obtained, especially in forecasts for self. The findings are discussed with respect to the mechanisms underlying predictive optimism and pessimism and the possible functions and implications of these predictive biases.