Epidemiology and outcome of penetrating injuries in a Western European urban region.

PURPOSE: Severe life-threatening injuries in Western Europe are mostly caused by blunt trauma. However, penetrating trauma might be more common in urban regions, but their characteristics have not been fully elucidated. METHODS: Retrospective analysis of data from patients admitted to our urban university level I trauma center between 2008 and 2013 with suspicion of severe multiple injuries. Collection of data was performed prospectively using a PC-supported online documentation program including epidemiological, clinical and outcome parameters. RESULTS: Out of 2095 trauma room patients admitted over the 6-year time period 194 (9.3 %) suffered from penetrating trauma. The mean Injury Severity Score (ISS) was 12.3 ± 14.1 points. In 62.4 % (n = 121) the penetrating injuries were caused by interpersonal violence or attempted suicide, 98 of these by stabbing and 23 by firearms. We observed a widespread injury pattern where mainly head, thorax and abdomen were afflicted. Subgroup analysis for self-inflicted injuries showed higher ISS (19.8 ± 21.8 points) than for blunt trauma (15.5 ± 14.6 points). In 82.5 % of all penetrating trauma a surgical treatment was performed, 43.8 % of the patients received intensive care unit treatment with mean duration of 7.4 ± 9.3 days. Immediate emergency surgical treatment had to be performed in 8.0 vs. 2.3 % in blunt trauma (p < 0.001). Infectious complications of the penetrating wounds were observed in 7.8 %. CONCLUSIONS: Specific characteristics of penetrating trauma in urban regions can be identified. Compared to nationwide data, penetrating trauma was more frequent in our collective (9.3 vs. 5.0 %), which may be due to higher crime rates in urban areas. Especially, self-inflicted penetrating trauma often results in most severe injuries.

Self-heating, bistability, and thermal switching in organic semiconductors.

We demonstrate electric bistability induced by the positive feedback of self-heating onto the thermally activated conductivity in a two-terminal device based on the organic semiconductor C(60). The central undoped layer with a thickness of 300 nm is embedded between thinner n-doped layers adjacent to the contacts, minimizing injection barriers. The observed current-voltage characteristics follow the general theory for thermistors described by an Arrhenius-like conductivity law. Our findings include hysteresis phenomena and are of general relevance for the entire material class since most organic semiconductors can be described by a thermally activated conductivity.

Validation of food-grade salts of organic acids as ingredients to control Listeria monocytogenes on pork scrapple during extended refrigerated storage.

This study was conducted to investigate control of Listeria monocytogenes on pork scrapple during storage at 4°C. In phase I, scrapple was formulated, with or without citrate-diacetate (0.64%), by a commercial processor to contain various solutions or blends of the following antimicrobials: (i) lactate-diacetate (3.0 or 4.0%), (ii) lactate-diacetate-propionate (2.0 or 2.5%), and (iii) levulinate (2.0 or 2.5%). Regardless of whether citrate-diacetate was included in the formulation, without the subsequent addition of the targeted antimicrobials pathogen levels increased ca. 6.4 log CFU/g within the 50-day storage period. In the absence of citrate-diacetate but when the targeted antimicrobials were included in the formulation, pathogen numbers increased by ca. 1.3 to 5.2 log CFU/g, whereas when citrate-diacetate was included with these antimicrobials, pathogen numbers increased only by ca. 0.7 to 2.3 log CFU/g. In phase II, in the absence of citrate-diacetate, when the pH of the lactate-diacetate-propionate blend (2.5%) was adjusted to pH 5.0 or 5.5 pathogen numbers remained unchanged (≤0.5 log CFU/g increase) over 50 days, whereas when citrate-diacetate was included with the lactate-diacetate-propionate blend adjusted to pH 5.0 or 5.5, pathogen numbers decreased by 0.3 to 0.8 log CFU/g. In phase III, when lower concentrations of the lactate-diacetate-propionate blend (1.5 or 1.94%) were adjusted to pH 5.5, pathogen numbers increased by ca. 6.0 and 4.7 log CFU/g, respectively, whereas when the mixture was adjusted to pH 5.0, pathogen numbers increased by ≤0.62 log CFU/g. Thus, scrapple formulated with lactate-diacetate-propionate (1.5 and 1.94% at pH 5.0) is an unfavorable environment for outgrowth of L. monocytogenes.

Effect of storage and subsequent reheating on viability of Listeria monocytogenes on pork scrapple.

We evaluated the fate of Listeria monocytogenes on commercial pork scrapple, a regionally popular, ready-to-eat (RTE) meat. We also conducted an informal survey to address consumer practices for storing and reheating scrapple. Of the 129 consumers who responded to at least one of the eight questions posed in the survey, about half (46.4%; 52 of 112) considered scrapple RTE, the majority (69.7%; 76 of 109) stored it in the refrigerator, and all (100%; 112 of 112) preferred to reheat it prior to consumption. Most respondents (83.9%; 94 of 112) reheated the scrapple by pan frying for 1 to 10 min at medium to high temperature. To study pathogen behavior, slices of pork scrapple were surface inoculated with a five-strain cocktail of L. monocytogenes (ca. 2.0 log CFU/g), vacuum sealed, and stored for up to 60 days. Pathogen levels increased to 8.9, 9.5, and 9.9 log CFU/g after 44 (4 degrees C), 21 (10 degrees C), and 5 (21 degrees C) days, respectively. When slices 1.3 cm (ca. 55 g) and 1.9 cm (ca. 85 g) thick were surface inoculated with L. monocytogenes (ca. 7.0 log CFU/g) and then reheated in a skillet (191 degrees C) for 0.5 to 4 min per side or to target instantaneous internal temperatures of 48.9 to 71.1 degrees C, it was possible to achieve pathogen reductions ranging from ca. 2.2 to 6.5 log CFU/g. These data confirm that in the unlikely event of postprocessing contamination of pork scrapple by L. monocytogenes, proper reheating can appreciably reduce levels of the pathogen before consumption.

Pharmacokinetics of orally administered tetrahydrobiopterin in patients with phenylalanine hydroxylase deficiency.

The oral loading test with tetrahydrobiopterin (BH(4)) is used to discriminate between variants of hyperphenylalaninaemia and to detect BH(4)-responsive patients. The outcome of the loading test depends on the genotype, dosage of BH(4), and BH(4) pharmacokinetics. A total of 71 patients with hyperphenylalaninaemia (mild to classic) were challenged with BH(4) (20 mg/kg) according to different protocols (1 x 20 mg or 2 x 20 mg) and blood BH(4) concentrations were measured in dried blood spots at different time points (T(0), T(2), T(4), T(8), T(12), T(24), T(32) and T(48 h)). Maximal BH(4) concentrations (median 22.69 nmol/g Hb) were measured 4 h after BH(4) administration in 63 out of 71 patients. Eight patients presented with maximal BH(4) concentrations approximately 44% higher at 8 h than at 4 h. After 24 h, BH(4) blood concentrations dropped to 11% of maximal values. This profile was similar using different protocols. The following pharmacokinetic parameters were calculated for BH(4) in blood: t (max) = 4 h, AUC (T(0-32)) = 370 nmol x h/g Hb, and t (1/2) for absorption (1.1 h), distribution (2.5 h), and elimination (46.0 h) phases. Maximal BH(4) blood concentrations were not significantly lower in non-responders and there was no correlation between blood concentrations and responsiveness. Of mild PKU patients, 97% responded to BH(4) administration, while one was found to be a non-responder. Only 10/19 patients (53%) with Phe concentrations of 600-1200 mumol/L responded to BH(4) administration, and of the patients with the severe classical phenotype (blood Phe > 1200 mumol/L) only 4 out of 17 patient responded. An additional 36 patients with mild hyperphenylalaninaemia (HPA) who underwent the combined loading test with Phe+BH(4) were all responders. Slow responders and non-responders were found in all groups of HPA.

WKY/Ztm-ter: a new rat inbred strain on the WKY/Ztm genetic background with congenital teratomas.

We describe a new rat model for teratomas (WKY/Ztm-ter) which arose through a spontaneous mutation in the inbred WKY/Ztm rat strain. When the tumours of the gonads became clinically apparent, affected males were 14 to 224 days of age, whereas the females only developed tumours between days 21 and 63. Tumour incidence is not gender-dependent. However, almost all females develop bilateral tumours, while 50% of the males show unilateral tumours. Histologically, all examined tumours (n = 65) represent partially undifferentiated teratocarcinomas.

Effects of cage enrichment on territorial aggression and stress physiology in male laboratory mice.

The activation of different neuroendocrine subsystems depends on the individual perception and coping with the challenging situation, the formulation of these relations by J.P. Henry represents a most useful concept also for the assessment of welfare consequences of particular caging variables. We investigated effects of cage enrichment on behaviour and neuroendocrine activations of male laboratory mice. Mice in enriched cages behaved more aggressive, lacked stable dominance hierarchies and exhibited neuroendocrine alterations depending on their individual social position. Subdominant passive mice were characterized by an augmented adrenal capacity to synthesize epinephrine despite low activities of the tyrosine hydroxylase. Dominant mice showed elevated circulating corticosterone concentrations despite high tyrosine hydroxylase-activities. Findings showed a dissociation of neurosympathetic and adrenomedullary components in subdominant passive mice and a simultaneous activation of sympathetic adrenomedullary and hypothalamo-adrenocortical components in dominant mice. Within the conceptual framework of the Henry model this would suggest different deteriorations of welfare in dominant and subdominant passive mice. In the situation of intensified aggression in the enriched cages the increased epinephrine synthesis in subdominant mice reflect their more frequent receipt of attacks and the elevated corticosterone secretion in dominant mice reflect their hindered ability to control the dominant position.

[Dorsal recumbency in dogs--a circulatory risk during surgical treatment?]. / Rückenlage des Hundes--ein Kreislaufrisiko bei operativen Eingriffen?

In this study, changes in hemodynamic, blood gas, and metabolic variables recorded during right lateral and dorsal recumbency in beagles anaesthetised with thiopental are presented. Other than reported in human beings, dorsal recumbency in these dogs resulted in an increase (33%) in heart rate, decrease (30%) in systolic, diastolic, and mean systemic arterial pressure, a decrease (17%) in systemic vascular resistance, and a decrease in both right (31%) and left (39%) ventricular work in comparison with lateral recumbency. Furthermore, mixed-venous PO2, oxygen saturation and respiratory quotient were lower in dorsal than in lateral recumbency while O2 consumption and lipolysis were increased in the former. The changes presented may have been caused by beta-adrenergic stimulation in dorsal recumbency. It needs to be studied if capillary perfusion can be maintained adequately during surgery in dorsal recumbency or if this predisposes to cardiovascular shock.

Dissociation between adrenal tyrosinehydroxylase and phenylethanolamine N-methyltransferase activities following repeated experience of defeats in individually housed male DBA/2J mice.

Adrenal activities of tyrosinehydroxylase (TH) and phenylethanolamine N-methyltransferase (PNMT) were compared between individually housed defeated intruders and socially housed residents (SR) (Experiment 1), and between individually housed defeated intruders and individually housed victor residents (Experiment 2). In addition, corticosterone titers were determined and dominance status of SR (dominant, subdominant active, and subdominant passive) considered. Defeats were induced twice a week for 6 consecutive weeks in short resident-intruder encounters. The main findings were: 1) within the groups of SR, TH and PNMT activities were high in dominant and low in subdominant-passive mice; 2) in Experiment 1, TH activities of individually housed defeated intruders were low like those of subdominant-passive SR whereas their PNMT activities were high like those of dominant SR; 3) in Experiment 2, TH activities were low in both categories of individually kept mice whereas PNMT activities were significantly elevated in the defeated intruders; 4) in both experiments, PNMT activities of intruders correlated significantly with the accumulated number of attacks they had received throughout all resident-intruder tests. Findings show separate effects of permanent social stimulation and of episodic experience of defeats on adrenal catecholamine synthesis. Lack of permanent social stimulation decreased adrenal TH and PNMT activities whereas repeated episodic experience of defeats specifically increased PNMT but not TH activities in individually housed mice.

Changes in pulmonary calcitonin gene-related peptide and protein gene product 9.5 innervation in rats infected with Mycoplasma pulmonis.

Changes in the expression of calcitonin gene-related peptide (CGRP) and polyneural protein gene product 9.5 (PGP) in hilar peribronchial innervation was investigated by immunohistochemistry in specific pathogen-free rats chronically infected with Mycoplasma pulmonis. Image analysis of immunostained sections revealed a reduction of approximately 62% in the amount of CGRP- and PGP-immunoreactive innervation of the peribronchial area in the infected animals. The portion of the total bronchial perimeter occupied by bronchus-associated lymphoid tissue was increased six-fold. The decrease in the CGRP-immunoreactive area could be the result either of an enhanced CGRP release or of a loss of nerve fibres. The decrease in the PGP-immunoreactive fibres indicates a degenerative loss of nerves. Increased bronchus-associated lymphoid tissue and decreased bronchial innervation by neurons releasing the immunomodulatory neuropeptide CGRP might both contribute to the pathophysiology and symptoms of mycoplasmosis in the rat.

Response of rat colonic mucosa to a high fiber diet.

Secreting lubricating mucins, colonic crypt goblet cells, contribute to the intestinal protection against mechanical challenge. After feeding germ-free (GF) and specific pathogen-free (SPF) AS/Ztm rats for 6 weeks, the proliferative response of colonic goblet to a commercial bulky diet (37.1% fiber) was compared to that of a standard diet. (4.4% fiber). An increased uptake of the high fiber diet by GF rats significantly augmented the capacity for mucin secretion as indicated by the amount and length of crypts, crypt cells and mature goblet cells. The response of SPF rats was limited to a crypt elongation, generated by more crypt cells. In both study groups, the goblet cell replication activity was similar to their controls. The increase in the mucin-secreting capacity, induced by a constant mechanical challenge, highly suggests an improved intestinal protection.

Clinical infections in the noninstitutionalized geriatric age group: methods utilized and incidence of infections. The Pittsburgh Good Health Study.

Because noninstitutionalized senior citizens comprise over 95% of the population 65 years of age and older, their health needs are a major concern. Data regarding infections in this population including the epidemiology, morbidity, and mortality are lacking. The authors recruited a study population of 417 free-living persons, all 65 years of age or older, from two neighborhoods in Pittsburgh, Pennsylvania. After the collection of self-reported baseline information from these persons, they were monitored for all clinical infections for 2 years, beginning July 1986 and through June 1988, using clinic visits, hospitalizations, or phone calls when needed. The baseline information showed the study population of 417 persons to be comparable with a neighborhood comparison group and with established populations for epidemiologic studies of the elderly in three other states. The 24 months of infection surveillance yielded 494 diagnosed infections in 224 or 54% of the subjects. Respiratory infections were most frequent with 259 or 52% of the total, followed by genitourinary infections with 24%, skin infections with 18%, gastrointestinal infections with 4%, and other types of infection with 2%. By comparing 22 self-reported baseline conditions with the occurrence of infection, 10 historic factors were univariately significant for infection. Of these 10 factors, only history of a lung problem (relative risk = 1.7, 95% confidence interval (CI) 1.1-2.9) and history of difficulty controlling urination (relative risk = 2.7, 95% CI 1.3-4.9) were statistically significant in multivariate analysis. To our knowledge, this study represents the first prospective data on infections in the noninstitutionalized elderly. The data demonstrate the wide variety of infections that occurred in this population and suggest that persons with a history of any one of several medical problems were possibly at greater risk for infection.

Effects of environmental enrichment on aggressive behavior, dominance hierarchies, and endocrine states in male DBA/2J mice.

Adult male mice (DBA/2J) siblings were housed three per cage for 6 wk, either in standard cages (SC) or in enriched cages (EC). Both attacks among group members and attacks against strange intruders were monitored once a week within each of 22 experimental groups. According to its attacking behavior, each mouse was categorized into one of three dominance categories: dominant, subdominant active, subdominant passive. Aggressive behavior and social organization were compared between the two types of housing conditions, and the effects of housing condition and dominance category on endocrinological and some organometrical parameters were analysed. The main findings were: (a) Mice in EC attacked intruders significantly more frequently compared to mice in SC; (b) In EC groups the position of the dominant male was less stable than in SC groups; (c) Plasma corticosterone titers (PCT) were significantly elevated in EC. Activities of tyrosinehydroxylase (TH) and phenylethanolamine-N-methyltransferase (PNMT) did not differ significantly between the housing conditions; (d) TH and PNMT activity were significantly enhanced in the dominant males of SC groups compared to subdominant passive males. Intermediate activities for both enzymes were determined for subdominant active males; and (e) PCT were significantly elevated in dominant males of the EC groups compared to subdominant active and subdominant passive males and also compared to the dominant males in the SC groups. Findings suggest that keeping adult male mice in structured cages can result in increased aggression towards intruders, a change in the social organization, and altered endocrine states, depending on the individual dominance position.

The cage design affects intermale aggression in small groups of male laboratory mice: strain specific consequences on social organization, and endocrine activations in two inbred strains (DBA/2J and CBA/J).

Effects of the enrichment of conventional laboratory housing cages with an additional labyrinth on intermale aggression, social organization, and activations of the pituitary-adrenocortical and sympathetic-adrenomedullary neuroendocrine subsystems are compared between adult male DBA/2J and CBA/J mice, differing genetically in their intermale aggression. Mice of both strains were kept three per cage for six weeks either in standard laboratory cages (SC) or in enriched cages (EC). Intermale aggression against a strange intruder and between cagemates was monitored once a week within each group. Dominance relations were derived from the distribution of attacks within a group. Plasma corticosterone titers (PCT) and activities of the tyrosinehydroxylase (TH) and phenylethanolamine N-methyltransferase (PNMT) were determined for each mouse at the end of the study. The main findings were: 1. Intermale aggression increased in both strains in groups kept in EC. 2. In the more aggressive DBA/2J the pattern of social organization shifted from groups with a single permanent dominant mouse in SC to groups with a frequently changing dominant mouse in EC. 3. In CBA interchanges of the dominant mouse was prevailing and did not differ between the two housing conditions. 4. In DBA/2J mice PCT were significantly elevated in EC. 5. In CBA/J mice activities of TH and PNMT were significantly elevated in EC. 6. Body weight gain was significantly delayed in mice kept in EC in both strains. Findings revealed strainspecific environmental effects on both social organization and endocrine states. The PCT increase obtained only in DBA/2J indicate that alterations of the social relations between cagemates are more likely to induce states of stress than an increase in intermale aggression alone.

Mechanical challenge causes alterations of rat colonic mucosa and released mucins. Alterations of mucosa and mucins.

The effect of intraluminal challenge on rat colonic mucin producing cells and the amount and composition of released mucins was investigated. Germfree rats (GF) were maintained on a commercial high fiber (HF) diet (37% of undigestable fiber, Altromin 1640 p), in order to increase volume, dry weight and abrasive effect of the ingesta. GF control rats were fed a standard (ST) laboratory diet with 4.5% fiber (Altromin 1314 f). In the HF diet group, histological sections of the proximal and distal colon revealed a significantly increased number of mucin secreting goblet cells and an elevated goblet cell replication activity, as determined by 5'-bromo-deoxyuridine incorporation. The total amount of colonic mucins, isolated by gel filtration, was increased versus the control group. According to the results of ion exchange chromatography, carbohydrate and amino acid analysis, mucins from rats, given the HF diet, had an elevated content of acidic mucin constituents with alterations in the carbohydrate and amino acid composition. In a parallel study with specified pathogen free rats (SPF), the additional influence of the microflora on mucin secreting cells and isolated mucins was determined. An increased number of mucin secreting cells predominantly was observed in rats given the standard diet. Due to bacterial degradation, significantly less mucin was isolated from both dietary groups. The increase of acidic mucin constituents was less pronounced than in GF rat mucin, coinciding with losses of terminally linked monosaccharides. Alterations of the core protein, accompanying the presence of the microflora, were not detected.

Social isolation modifies the response of mice to experimental Mengo virus infection.

To investigate the effects of social isolation on host resistance male mice were housed either individually (IH) or in groups of four or five (GH). All animals were infected with MengoM,L virus. Incubation time (INCUB), duration of illness (ILL), death rate (DR), histopathological changes, and serum corticosterone levels (CORT) were recorded. First, the effect of IH starting 4 days prior to infection was studied in 5 different inbred strains. Next, the effect of different IH length was examined, and the role of T-cells was investigated by comparing euthymic (+/+) and athymic (nu/nu) NMRI mice. Finally, the effects of the infection on CORT in IH and GH mice were compared in C57BL/6 mice. The major findings were: 1. IH significantly increased ILL in all but the DBA/2 strain, whereas DR was not affected except in C57BL/6. 2. Longer IH (starting 35 [DBA/2] or 10 [NMRI] days prior to virus inoculation) significantly shortened INCUB and prolonged ILL, but IH starting on the day of virus inoculation [DBA/2] significantly prolonged INCUB and shortened ILL. 3. NMRI nude mice exhibited an unaltered DR accompanied by a tremendously prolonged INCUB. 4. Investigations in C57BL/6 mice revealed a significant rise of CORT after infection. This increase was higher in IH compared to GH mice. It is suggested that IH attenuates T-cell mediated inflammatory processes and/or increases macrophage activation, which in turn results in a prolonged course of the disease.

Impact of a needleless intravenous system in a university hospital.

Needlestick injuries are a serious, but preventable problem in the healthcare industry. Industry has developed better devices to protect the healthcare worker. This study evaluates the impact of a "needleless" intravenous system on needlestick exposures and whether the increased cost of this new system could be justified. Exposures were defined and injury reports analyzed retrospectively and following introduction of the needleless IV system. This study indicates that the introduction of a needleless IV system can significantly reduce the number of IV-related injuries that occur in an institution, and is economically feasible. Other categories of exposure (needle-related, related to other sharps, and trash-related) also showed a drop, whereas exposure from the disposal of sharp devices into needle boxes showed a significant increase. This seems to support other findings that in-room needle-box containers have not thus far reduced the number of injuries related to sharps disposal.

[Physiologic hypothermia of newborn kittens up to 6 weeks old]. / Physiologische Hypothermie der Katzenwelpen bis zur 6. Lebenswoche.

Kittens showed a physiological hypothermia until they were 6 weeks of age. In the first 3 weeks of age rectal temperature was constantly low (37.6 +/- 0.3 degrees C). A linear increase of rectal temperature followed from the fourth to the sixth week of age inclusively and from the seventh week on rectal temperature reached the final temperature level (38.4 +/- 0.3 degrees C). This finding has to be considered in clinical assessment of kittens' body temperature.

Examinations on differential mortality.

PIP: Mortality differentials by sex, age, and marital status in the former Federal Republic of Germany are examined for the period 1950-1989. Some comparative data for the former German Democratic Republic are included.^ieng

Changes in colonic mucins of germfree rats in response to the introduction of a "normal" rat microbial flora. Rat colonic mucin.

In order to determine the influence of bacterial colonization on amount and composition of colonic mucins, germfree male AS/Ztm rats were colonized with a rat specific intestinal flora for different times (2, 7, 14, 21, 28, 35, 120 days). The amount of colonic mucins was determined by gel filtration on Sepharose CL-4B; the relative amount of acidic mucins was calculated after ion exchange chromatography. In addition, cecal weight and dry matter of feces were monitored. While germfree and SPF rats revealed similar amounts of colonic mucins (7.0 vs. 7.2 mg mucin/300 g body weight), the initial phase of association was characterized by considerably decreasing values. After four weeks of association, the total amount of colonic mucins had almost equalized in the two groups. The amount of acidic mucins, having decreased during the first three weeks of colonization, rendered values comparable to the SPF mucins after four months of adaptation. Cecomegaly in germfree rats disappeared within the first two days, while solidification of the intestinal content occurred within four months. Mucin losses during initial phase of association are attributed 1. to the disappearance of the cecal mucin pool, and 2. to the mucin degrading activity of some bacterial strains known to be present in the intestinal flora. Further development is conducted by a stimulation of mucin secretion, described to follow the colonization. The initially increased secretion of neutral mucins is attributed to a pronounced release of immature mucin glycoproteins, while the shift to more acidic mucins is considered to result from stimulated secretion as well as from a selective bacterial degradation of neutral mucin components.