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Background: Screening for atrial fibrillation (AF) may reveal incidental arrhythmias of relevance. The aim of this study was to describe incidental arrhythmias detected during screening for AF in the STAR-FIB (Predicting SilenT AtRial FIBrillation in Patients at High Thrombembolic Risk) cohort study., Methods and Results: In the STAR-FIB cohort study, we screened hospitalized patients for AF with 3 repeat 7-day Holter ECGs. We analyzed all Holter ECGs for the presence of the following incidental arrhythmias: (1) sinus node dysfunction, defined as sinus pause of ≥3 seconds' duration; (2) second-degree (including Wenckebach) or higher-degree atrioventricular block (AVB); (3) sustained supraventricular tachycardia of ≥30 seconds' duration; and (4) sustained ventricular tachycardia of ≥30 seconds' duration. We furthermore report treatment decisions because of incidental arrhythmias. A total of 2077 Holter ECGs were performed in 794 patients (mean age, 74.7 years; 49% women), resulting in a mean cumulative duration of analyzable ECG signal of 414±136 hours/patient. We found incidental arrhythmias in 94 patients (11.8%). Among these were sinus node dysfunction in 14 patients (1.8%), AVB in 41 (5.2%), supraventricular tachycardia in 42 (5.3%), and ventricular tachycardia in 2 (0.3%). Second-degree AVB was found in 23 patients (2.9%), 2:1 AVB in 10 (1.3%), and complete AVB in 8 (1%). Subsequently, 8 patients underwent pacemaker implantation, 1 for sinus node dysfunction (post-AF conversion pause of 9 seconds) and 7 for advanced AVB. One patient had an implantable cardioverter-defibrillator implanted for syncopal ventricular tachycardia., Conclusions: Incidental arrhythmias were frequently detected during screening for AF in the STAR-FIB study and resulted in device therapy in 1.1% of our cohort patients.

The global monitoring plan (GMP) established under the Stockholm Convention on Persistent Organic Pollutants (POPs) had defined ambient air, human milk or blood, and water as core matrices to be analyzed and assessed for spatial and temporal distribution. Within projects coordinated by the United Nations Environment Programme (UNEP), developing countries were offered to have other matrices analyzed for dioxin-like POPs (dl-POPs) in experienced laboratories. Subsequently, 185 samples from 27 countries located in Africa, Asia, and Latin America were collected during 2018-2019 and analyzed for polychlorinated dibenzodioxins (PCDD), dibenzofurans (PCDF), and biphenyls (PCB). Using the WHO 2005 toxic equivalency approach (TEQ), the amounts of dl-POPs found were low (<1 pg TEQ/g); however, singular samples had higher values; e.g., egg from Morocco, fish from Argentina or Tunisia; soil and sediment samples. Results showed that the matrix, abiotic or biota, had more impact on the TEQ pattern than the geographic location. Independent of the location and across all samples, dl-PCB in (shell)fish and beef samples had a contribution of 75% to the total TEQ; milk (63%), chicken (52%), and butter (50.2%) more than 50%. Sediment (57% and 32%) and soil (40% and 36%)) samples were dominated by PCDD and PCDF, respectively; therein, dl-PCB had shares of 11% and 24%. Egg samples (N = 27) did not follow the general biota pattern and had 21% of the TEQ from the PCDD, 45% from PCDF, and 34% from dl-PCB; thus, indicating that abiotic matrices such as soil or other material may have an impact., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Rhinoviruses (RVs) constitute a substantial public health burden. To evaluate their abundance and genetic diversity in pediatric patients, RV RNA in respiratory samples was assessed using real-time RT-PCR and partial nucleic acid sequencing of viral genomes. Additionally, clinical data were retrieved from patient charts to determine the clinical significance of pediatric RV infections. In total, the respiratory specimens of 776 patients (<18 years), collected from 2013 to 2017, were analyzed. Infections occurred throughout the entire year, with peaks occurring in fall and winter, and showed remarkably high intra- and interseasonal diversity for RV genotypes. RV species were detected in the following frequencies: 49.1% RV-A, 5.9% RV-B, and 43.6% RV-C. RV-C was found to be more frequently associated with asthma (p = 0.04) and bronchiolitis (p < 0.001), while RV-A was more frequently associated with fever (p = 0.001) and pneumonia (p = 0.002). Additionally, 35.3% of the patients had co-infections with other pathogens, which were associated with a longer hospital stay (p < 0.001), need for ventilation (p < 0.001), and pneumonia (p < 0.001). Taken together, this study shows pronounced RV genetic diversity in pediatric patients and indicates differences in RV-associated pathologies, as well as an important role for co-infections.

Against the background of the changes in the collective bargaining agreement-for municipal hospitals in the version of January 1, 2021, and for university hospitals in the version of March 7, 2020-this article deals with the legal consequences of chronic violations of the German Working Hours Act in medicine, but especially in surgical specialties such as urology. It includes an overview of current law and sanctions for violations and highlights responsibilities as well as exceptions. It is important to clarify the distribution of responsibilities with regard to working hours in the institution concerned in order to avoid fines and, in the worst case, imprisonment. It should also be clear who is liable in specific cases for persistent working time violations. When changing duty models, it is important to bear in mind that this can lead to a considerable deterioration in the opportunities for further training and education of physicians, meaning that in the long term the compatibility of further training in line with working hours can only be achieved with sufficient staffing of the hospitals. In some cases, this is diametrically opposed to economic interests in the health care system and thus presents an almost insoluble dilemma. In the view of the working group, structural changes in the diagnosis-related group (DRG)-based inpatient sector are needed in the near future., (© 2022. The Author(s).)

Background: Leadless pacemakers (PMs) capable of atrioventricular (AV) synchronous pacing have recently been introduced. Initial feasibility studies were promising but limited to just a few minutes of AV synchronous pacing. Real-world, long-term data on AV synchrony and programming adjustments affecting AV synchrony in outpatients are lacking., Objective: The purpose of this study was to investigate AV synchrony and influences of PM programming adjustments in outpatients with leadless VDD PMs., Methods: All patients who received a leadless VDD PM (Micra™ AV, Medtronic) between July 2020 and May 2021 at our center were included in this observational study. AV synchrony was assessed repeatedly postoperatively and during follow-up using Holter electrocardiographic (ECG) recordings. AV synchrony was defined as a QRS complex preceded by a p wave within 300 ms. The impact of programming changes during follow-up on AV synchrony was studied., Results: A total of 816 hours of Holter ECG from 20 outpatients were analyzed. During predominantly paced episodes (≥80% ventricular pacing), median AV synchrony was 91% [interquartile range (IQR) 34%-100%] when patients had sinus rates 50-80/min. Median AV synchrony was lower when patients had sinus rates >80/min [33% (29%-46%); P <.001]. During a stepwise optimization protocol, AV synchrony could be improved (P <.038). Multivariate analysis showed that a shorter maximum A3 window end (P <.001), lower A3 threshold (P = .046), and minimum A4 threshold (P <.001) improved AV synchrony., Conclusion: Successful VDD pacing in the outpatient setting during higher sinus rates is more difficult to achieve than can be presumed based on initial feasibility studies. The devices often require multiple reprogramming to maximize AV sequential pacing., (Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

MEG and EEG source analysis is frequently used for the presurgical evaluation of pharmacoresistant epilepsy patients. The source localization of the epileptogenic zone depends, among other aspects, on the selected inverse and forward approaches and their respective parameter choices. In this validation study, we compare the standard dipole scanning method with two beamformer approaches for the inverse problem, and we investigate the influence of the covariance estimation method and the strength of regularization on the localization performance for EEG, MEG, and combined EEG and MEG. For forward modelling, we investigate the difference between calibrated six-compartment and standard three-compartment head modelling. In a retrospective study, two patients with focal epilepsy due to focal cortical dysplasia type IIb and seizure freedom following lesionectomy or radiofrequency-guided thermocoagulation (RFTC) used the distance of the localization of interictal epileptic spikes to the resection cavity resp. RFTC lesion as reference for good localization. We found that beamformer localization can be sensitive to the choice of the regularization parameter, which has to be individually optimized. Estimation of the covariance matrix with averaged spike data yielded more robust results across the modalities. MEG was the dominant modality and provided a good localization in one case, while it was EEG for the other. When combining the modalities, the good results of the dominant modality were mostly not spoiled by the weaker modality. For appropriate regularization parameter choices, the beamformer localized better than the standard dipole scan. Compared to the importance of an appropriate regularization, the sensitivity of the localization to the head modelling was smaller, due to similar skull conductivity modelling and the fixed source space without orientation constraint.

This study concerns reconstructing brain activity at various depths based on non-invasive EEG (electroencephalography) scalp measurements. We aimed at demonstrating the potential of the RAMUS (randomized multiresolution scanning) technique in localizing weakly distinguishable far-field sources in combination with coinciding cortical activity. As we have shown earlier theoretically and through simulations, RAMUS is a novel mathematical method that by employing the multigrid concept, allows marginalizing noise and depth bias effects and thus enables the recovery of both cortical and subcortical brain activity. To show this capability with experimental data, we examined the 14-30 ms post-stimulus somatosensory evoked potential (SEP) responses of human median nerve stimulation in three healthy adult subjects. We aim at reconstructing the different response components by evaluating a RAMUS-based estimate for the primary current density in the nervous tissue. We present source reconstructions obtained with RAMUS and compare them with the literature knowledge of the SEP components and the outcome of the unit-noise gain beamformer (UGNB) and standardized low-resolution brain electromagnetic tomography (sLORETA). We also analyzed the effect of the iterative alternating sequential technique, the optimization technique of RAMUS, compared to the classical minimum norm estimation (MNE) technique. Matching with our previous numerical studies, the current results suggest that RAMUS could have the potential to enhance the detection of simultaneous deep and cortical components and the distinction between the evoked sulcal and gyral activity., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

The historical air pollution with halogenated flame retardants (HFRs) in Germany was assessed by investigating tree leaf and shoot samples which have been archived in the German environmental specimen bank. Samples covered the period from 1985 to 2016. 43 HFRs comprising polybrominated diphenyl ethers as well as emerging brominated and chlorinated compounds such as Dechlorane Plus, DBDPE, or DPTE, were analysed in 115 samples from ten sub sites originating from six areas characterised by different land uses, including urban as well as a background site. HFRs were observed in each sample showing the widespread distribution of HFRs in Germany in tree leaves and shoots as bioindicators of past and present atmospheric pollution. Analytes observed at elevated concentrations were BDE 209, DBDPE and DPTE. Observed HFR-levels differed between analytes as well as sampling locations, particularly prior to the year 2000. They were typically highest at conurbation areas. Concentrations at the background site often belonged to the lowest ones observed, however, lowest values were not exclusively found there. The quantification frequencies appeared to decrease from the past to most recent samples. With few exceptions, atmospheric pollution of both, legacy and emerging HFRs, decreased significantly., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

This paper evaluates the impact of announcements of Covid-19 related monetary and fiscal policy measures by the European Central Bank and the European Commission. Applying an event study, we find that the announcements predominantly affect the government bond yields of more solvent countries such as Germany and the Netherlands. Since this finding mainly holds for the announcements of fiscal measures, we conclude that the investors are primarily concerned about the future fiscal burden that has to be shouldered by those solvent countries within the euro area., (© 2020 Elsevier Inc. All rights reserved.)

Background: Many hospitals seek to increase patient safety through interprofessional team-trainings. Accordingly, these trainings aim to strengthen important key aspects such as safety culture and communication. This study was designed to investigate if an interprofessional team-training, administered to a relatively small group of nurses and physicians would promote a change in healthcare professionals' perceptions on safety culture and communication practices throughout the hospital. We further sought to understand which safety culture aspects foster the transfer of trained communication practices into clinical practice., Methods: We conducted a pre-post survey study using six scales to measure participants' perceptions of safety culture and communication practices. Mean values were compared according to profession and participation in training. Using multiple regression models, the relationship between safety culture and communication practices was determined., Results: Before and after the training, we found high mean values for all scales. A significant, positive effect was found for the communication practices of the physicians. Participation in the training sessions played a variably relevant role in the communication practices. In addition, the multiple regression analyses showed that specific safety culture aspects have a cross-professional influence on communication practices in the hospital., Conclusions: This study suggest that interprofessional team-trainings of a small group of professionals can successfully be transferred into clinical practice and indicates the importance of safety culture aspects for such transfer processes. Thus, we recommend the consideration of safety culture aspects before starting a training intervention.

Renal Monomorphology in COVID-19 with Acute Renal Insufficiency Abstract. A 78-year-old ventilator-dependent COVID-19 patient developed severe renal failure with an estimated glomerular filtration rate of 20 ml/min per 1.73 m2 and nephrotic proteinuria. Sonography showed echo-dense and enlarged kidneys with high resistance indices (>0.8). Echocontrast sonography showed a delayed renal perfusion. In the further course of the disease renal function recovered, kidney size decreased and the renal perfusion normalized. An acute COVID-19-associated interstitial nephritis is postulated.

Current meat production places high costs on the environment. However, only a small portion of consumers are willing to opt for meat substitutes or a vegetarian diet. Cultured meat may contribute to solve this dilemma. In this journal, Bryant and Barnett recently reviewed current attitude research and summarized objections perceived by consumers concerning cultured meat. However, no research from Germany was available. Thus, we conducted a survey of German participants, including attitudes previously found to be important in the literature. With a panel sample of 713 consumers, attitudes were found to structure in three dimensions: ethics (e.g., animal welfare, ecological) was the strongest positive driver and depended on pre-knowledge available for 38% of participants; emotional objections (e.g., unnatural) were the second strongest predictor but unrelated to pre-knowledge and demographics; and the third attitudinal dimension expresses concern over the global diffusion of cultured meat. A path model summarizes the results. In conclusion, Germany shows itself to be only moderately prepared to accept cultured meat., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interests., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Ultrasound Course in Ifakara (Tanzania) with Case Studies Abstract. Presentation of two practical cases from the ultrasound course in Ifakara, Tanzania. Case 1 shows the diagnostic value of abdominal and thorax ultrasound in a polytraumatized patient with splenic rupture. In case 2 the sonographic signs of pulmonary and extrapulmonary tuberculosis are presented.

To get an overview about distribution, levels and temporal trends of polybrominated diphenyl ethers (PBDE) and halogenated flame retardants (HFR) of emerging concern, different types of environmental samples archived in the German Environment Specimen Bank as well as fish filet samples from the Arctic (n = 13) and Antarctica (n = 5) were analysed for 43 substances (24 PBDE, 19 HFR) using a multi-column clean-up and GC-API-MS/MS or GC-MS. Sample types were herring gull egg (n = 3), blue mussel (n = 3) and eelpout filet (n = 3) from the German North- and Baltic Sea, bream filet (n = 7), zebra mussel (n = 6) and suspended particulate matter (SPM, n = 7) from German freshwater ecosystems as well as tree leaves (n = 9)/shoots (n = 10), soil (n = 4), earthworm (n = 4) and deer liver (n = 7) as representatives of German terrestrial ecosystems. PBDE and emerging HFR were present in each investigated matrices from Germany and Polar regions showing their widespread distribution. The presence in Arctic and Antarctic fish samples confirms their long-range transport potential. Average concentrations of total emerging HFR were highest in SPM (26 ng g -1 dry weight (dw)), zebra mussel (10 ng g -1 dw) and herring gull egg (2.6 ng g -1 dw). Lowest levels were measured in fish filet samples from Antarctica (0.02 ng g -1 dw). Average total PBDE concentrations were highest in bream filet (154 ng g -1 ), herring gull egg (61 ng g -1 dw), SPM (21 ng g -1 dw), and zebra mussel 18 (ng g -1 ) and lowest in deer liver (0.04 ng g -1 dw). The patterns of non-fauna terrestrial samples (leaves, shoots, soil) as well as SPM were dominated by DBDPE and BDE209. Elevated proportions of DPTE and in most cases the absence of DBDPE characterized all fauna samples with the exception of Polar samples. Overall, emerging HFR appeared to be less bioaccumulative than PBDE. Temporal trends were generally decreasing with few exceptions such as DBDPE., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Point-of-Care Ultrasound: Teaching and Learning in Ifakara, Tanzania Abstract. Presentation of two practical cases from the point-of-care ultrasound class in Ifakara, Tanzania. The first case shows the sonographic findings of tuberculosis with findings in the lungs, heart, abdominal lymph nodes and spleen. In the second case, detection of an enterobiliary fistula by sonographic live imaging of air passing from the intestine into the gall bladder and causing non-iatrogenic pneumobilia.

Coniferous shoots and deciduous tree leaf samples from 10 sites in Germany were taken in 2015 or 2016 within the German Environmental Specimen Bank sampling program and analysed for 24 polybrominated biphenyl ethers (PBDEs) and 19 additional halogenated flame retardants (HFRs). At one site, additional historic samples dating back till 2003 were also investigated. Samples were Soxhlet-extracted, cleaned-up by a non-destructive multi-step procedure involving gel permeation chromatography, and detected by GC-API-MS/MS as well as GC-MS. Besides PBDEs as classical HFRs, emerging HFRs such as Dechlorane Plus, DPTE, DBDPE, or ATE were region-wide observed demonstrating their widespread occurrence in the atmosphere. Highest concentrations in recent samples were found for DBDPE (<230-2760 pg g -1 dry weight (dw)) followed by DPTE (91-1540 pg g -1 dw), BDE209 (<156-461 pg g -1 dw), and BDE47 (<27-505 pg g -1 dw) or DP (31-122 pg g -1 dw). The overall uniform and widespread distribution as well as similar HFR levels and composition profiles observed in recent conifer shoots and corresponding deciduous tree leaves from the same area indicate a prolonged medium to long-range transport as sources. Furthermore, it is demonstrated that both tree types are generally suitable bioindicators for atmospheric pollution with HFRs, although accumulation may vary depending on HFR properties and accumulation period. The historic samples showed decreasing PBDE levels whereas no clear trend could be observed for other investigated HFRs at this site., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The extensive application of halogenated flame retardants has led to their widespread distribution in the environment. Recently, concerns emerged regarding their potential persistence, (bio)accumulation, and/or toxicity. Particularly halogenated flame retardants based on norbornene structures, like Dechlorane Plus as well as other brominated PBDE replacements, generically called emerging, novel, or alternative flame retardants, are in the focus of interest. A comprehensive analytical method for the determination of 21 halogenated flame retardants (HFRs) of different substance classes (dechloranes, brominated aromates, brominated ethers, cyclic BFR) in a broad variety of matrices (tree leaves, fish fillet, birds eggs, suspended particles) was developed in order to assess their environmental levels as well as temporal trends, especially for the use within environmental specimen banks (ESBs). In addition to the alternative HFRs, a set of 24 PBDEs were measured in the same samples, however using GC-EI-MS for detection. Samples were extracted using accelerated solvent extraction (ASE) with dichloromethane:hexane (exception: soxhlet extraction for suspended particles) followed by a multi column clean-up. Quantification was performed by API-GC-MS/MS as a modern, gentle, and sensitive technique for simultaneous detection of compounds throughout a wide range of masses and fragmentation characteristics (exception: PBDE detection using GC-EI-MS). With the exception of BDE 209, instrumental precisions of target compounds ranged from 1% to 16 % (at levels of 2 pg injection -1 for HFR, 20 pg injection -1 for DBDPE, 7-36 pg injection -1 for PBDEs). Interday precisions of the entire analytical method including extraction and clean-up were mostly below 25% for all validation matrices at spiked levels of 100 pg sample -1 for HFR (DBDPE: 1000 pg sample -1 ) and 1200-6000 pg sample -1 for PBDEs. The majority of analytes were investigated with expanded measurement uncertainties of less than 50%. Graphical abstract A new approach to HFR analysis in multiple environmental matrices.

Beamformers are a widely-used tool in brain analysis with magnetoencephalography (MEG) and electroencephalography (EEG). For the construction of the beamformer filters realistic head volume conductor modeling is necessary for accurately computing the EEG and MEG leadfields, i.e., for solving the EEG and MEG forward problem. In this work, we investigate the influence of including realistic head tissue compartments into a finite element method (FEM) model on the beamformer's localization ability. Specifically, we investigate the effect of including cerebrospinal fluid, gray matter, and white matter distinction, as well as segmenting the skull bone into compacta and spongiosa, and modeling white matter anisotropy. We simulate an interictal epileptic measurement with white sensor noise. Beamformer filters are constructed with unit gain, unit array gain, and unit noise gain constraint. Beamformer source positions are determined by evaluating power and excess sample kurtosis (g 2 ) of the source-waveforms at all source space nodes. For both modalities, we see a strong effect of modeling the cerebrospinal fluid and white and gray matter. Depending on the source position, both effects can each be in the magnitude of centimeters, rendering their modeling necessary for successful localization. Precise skull modeling mainly effected the EEG up to a few millimeters, while both modalities could profit from modeling white matter anisotropy to a smaller extent of 5-10 mm. The unit noise gain or neural activity index beamformer behaves similarly to the array gain beamformer when noise strength is sufficiently high. Variance localization seems more robust against modeling errors than kurtosis.

Polychlorinated biphenyls (PCBs) are a substance group of 209 theoretically possible compounds. The human body burden of PCBs is commonly calculated based on so-called indicator congeners such as PCB 138, PCB 153 and PCB 180, which are analyzed in human blood. The German "Human Biomonitoring (HBM) Commission" assumes that the sum of these indicator congeners multiplied by a factor of 2 represents the total PCB burden. This norm is based on data obtained from exposure studies after dietary intake. Data from indoor air shows a different congener pattern, which might lead to a relatively higher intake of lower chlorinated PCBs by inhalation. In two independent studies with adult participants from two regions in Germany, we measured all 209 PCB congeners in 44 whole blood and 42 plasma samples. Participants from the whole blood study group had additional exposure to PCBs via indoor air. With our analytical method, 141 individual PCB congeners, 27 coeluted pairs of PCB congeners and 2 records of 3 and 4 coeluted PCBs could be determined. Thus, 172 analysis results were reported per sample. In the whole blood samples, 50 congeners showed values below the limit of quantification (LOQ), whereas 94 congeners could not be detected in any of plasma samples. Total PCB concentrations (Σ 209 PCB congeners, incl. ½ LOQ) in the whole blood samples ranged from 99 to 2152ng PCB/g lipid (Median: 454ng/g lipid; 95th Percentile: 1404ng/g lipid). The sum of all 209 measured PCB (incl. ½ LOQ) in plasma samples showed levels between 52 and 933ng PCB/g lipid (Median: 226ng/g lipid; 95th Percentile: 642ng/g lipid). Our results show that the burden of PCBs on the human body is caused mainly by the three highly chlorinated indicator congeners PCB 138, PCB 153 and PCB 180. In median approximately 50% of the total PCB content in human whole blood or plasma samples can be attributed to these congeners. Total PCB, calculated by multiplying the sum of the three indicator congeners by 2, showed a strong and highly significant correlation to the sum of all 209 measured congeners for each sample. A slightly stronger correlation in the whole blood samples could be achieved by choosing six indicator congeners, including the lower chlorinated congeners (PCB 28, 52 and 101) into the calculation. Although this difference is very small, it must be considered that higher PCB levels in indoor air than those measured in the present study might be associated with a higher burden of indoor-air-related congeners in exposed individuals. For precautionary reasons, it could therefore be recommended that the assessment of individuals exposed to PCB via indoor air should be carried out based on the sum of the 6 indicator congeners PCB 28, PCB 52, PCB 101, PCB 138, PCB 153 and PCB 180 multiplied by a factor of 2., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

As a marine mammal species that inhabits shallow nearshore waters, humpback dolphins are likely exposed to a wide range of pollutants from adjacent land-based activities. Increased mortality rates of Australian humpback dolphins (Sousa sahulensis) in waters off a major urbanised centre triggered investigations into the threats to these species, including their contaminant exposure. The present study utilised archived tissues from 6 stranded animals to screen for a range of pollutants (PCDD/Fs, PBDEs, PCBs, organochlorine pesticides, PAHs, organotins, essential and non-essential elements) to inform future biopsy based biomonitoring strategies. Concentrations of PCBs and DDXs in blubber of some of these animals were remarkably high, at levels near or above toxicological thresholds associated with immune- and reproductive toxicity or population declines in other marine mammals. PBDEs, PAHs, HCB, organotins, 'drins' as well as other organic pesticides were not detected, or present at relatively low concentrations. Profiles of elements were similar in epidermis compared to other tissues, and apart from some exceptions (e.g. Fe, Cr, Co, Cu) their concentrations fell within 25th-75th percentiles of cetacean baselines in four of the five animals. Non-essential elements (Al, V, Pb, Ba, Ni, Cd) were notably elevated in one specimen which may have experienced poor health or nutritional status. These data provide a first insight into the contaminant status of a rare and poorly studied population inhabiting an urbanised area. The results highlight a need for future biomonitoring of live populations, and inform on priorities in the typically limited blubber and skin sample volumes obtained through biopsies., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Aim: The introduction of quality management systems might be promoted by use of recognised certification programmes. Over the years, in health care organisations the certification model named KTQ has gained more and more importance. The aim of this study is to evaluate intra-organisational effects in a clinic after introduction of quality management on the basis of KTQ., Methods: The evaluation was performed using a 2-step approach: first, before starting the implementation process of KTQ in the year 2008, and second, after the implementation process had become successful. Data were obtained by a systematic questionnaire survey. Hospital staff (physicians, nurses, and others like administration staff, technical and medical assistants) were asked to appraise the quality management, to give own preferences, and rate their overall satisfaction with the process., Results: Response rates were 56% in the year 2008 and 50% in the year 2010. Subjects regarding the working atmosphere, leading of superiors, organisational issues, and pervasion of quality management predominantly were found to be improved, almost with high statistical significance. At the same time, higher satisfaction values could be determined., Conclusions: There might be high acceptance to the undergone changes from the staff members' point of view. It appears that the implementation process has led to higher satisfaction values. Moreover it can be concluded that certification programmes might be able to promote the needed pervasion of quality management throughout the institution., (© Georg Thieme Verlag KG Stuttgart · New York.)

Chronic inflammation in hemodialysis (HD) patients is associated with cardiovascular complications and mortality. Circulating immune active proteins in the molecular range 15-45 kD that cannot be efficiently cleared by high-flux (HF) dialysis may be causally involved. We intended to test the feasibility of using a high cutoff (HCO) dialyzer in chronic HD patients and its influence on inflammation and monocyte activation. The Gambro HCO1100 dialyzer was compared to a conventional HF membrane in a randomized double-blind crossover trial in 19 chronic HD patients selected for the presence of elevated serum C-reactive protein levels. Patients were treated for six consecutive dialysis sessions (2 weeks) with each membrane. Safety analysis recorded adverse events and albumin losses through the protein-leaking membranes. Efficacy analysis observed reductions in the number of proinflammatory (CD14+CD16+) monocyte subpopulations in circulating blood. Treatment with the HCO membrane was well tolerated, although the number of adverse events was slightly higher. Despite significant serum albumin loss (from 34.1 ± 2.7 to 29.6 ± 3.0 g/L; P < 0.01), there was no need to supplement albumin, and rising activity of cholinesterase during HCO treatment indicated compensation by enhanced hepatic synthesis. The HCO membrane cleared high amounts of proinflammatory cytokines, but did not reduce predialysis inflammatory monocytes and markers. Although the time of HD session was extended, the study was hampered by a lower Kt/V in the HCO compared to the HF period. Treatment of chronic HD patients with this HCO dialyzer for 2 weeks is tolerable in terms of albumin loss and able to clear proinflammatory cytokines; however, this was not sufficient to decrease monocyte activation. Therefore, a more selective, less albumin-leaking membrane is desirable to allow prolonged high-efficient dialysis with more effective cytokine clearance., (© 2012, Copyright the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

An extraordinary plan of official control was carried out in 2008 in Campania (Italy) with the aim to monitor polychlorinated dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (dl-PCBs) levels in buffalo milk and to detect the contaminated farms, most of which are located in Caserta province. For these companies has been ordered seizure and execution of additional analyses has been requested in farms falling in the nearness, within a distance of 3km, for a total of 304 farms examined. Moreover, all non-compliant farms were subjected to a periodic sampling in order to monitor trends in the levels of contamination. In this paper the distribution and the concentrations of 17 PCDD/Fs and 12 dioxin-like PCBs in 460 samples of buffalo milk collected in the province of Caserta (Italy) are presented. The range of WHO-TEQ values for the PCDD/Fs in milk was 0.17pgTEQg(-1)fat and 87.0pgTEQg(-1)fat with a mean value 3.63pgTEQg(-1)fat and medium value 2.25pgTEQg(-1)fat. The concentrations of dioxin-like PCBs in the analysed samples ranged from 0.21pgTEQg(-1)fat to 15.9pgTEQg(-1)fat and the WHO-TEQ values of sum of PCDDs, PCDFs and dl-PCBs ranged from 0.45pgTEQg(-1)fat to 103.0pgTEQg(-1)fat. The geo-referencing analysis allowed to individuate a restricted area of the region object of the present study where is located the majority of the non-compliant farms. The study of the congeners distribution has finally suggested that the likely cause of contamination is to be attributed to the illegal burning of waste., (2010 Elsevier Ltd. All rights reserved.)

Hippocampal long-term potentiation (LTP) is considered as a cellular model of memory formation. Specific, electrical weak tetanization of distinct afferents such as the medial perforant path results in a short-lasting, protein synthesis-independent early-LTP (up to 4 h) within the dentate gyrus. A stronger tetanization leads to late-LTP (>4 h), which is protein synthesis-dependent and requires heterosynaptic activation during its induction, the latter of which can be provided by afferents from cortical brain regions or subcortical nuclei during memory formation in the behaving animal. In particular, noradrenaline (NA) is required for late-LTP in the dentate gyrus and dopamine for late-LTP in the apical CA1-dendrites. However, little is known about the concentrations and temporal dynamics of such neuromodulators like NA, serotonin (5-HT) and dopamine (DA) during LTP. We now implemented the microdialysis method to study this topic after stimulating the dentate gyrus in more detail. A weak tetanus of the perforant path, which normally leads to early-LTP, transiently but significantly decreased the concentration of NA (3 h) and increased the concentration of 5-HT (about 2 h) and DA (about 1 h) in the hippocampus. A strong tetanus, normally resulting in late-LTP, increased concentrations of NA and DA significantly and long-lasting (for about 5 h), whereas 5-HT concentration was increased with a delay (after about 30 min) and only for a short time (30 min). Thus different stimulation protocols resulted in different release patterns of neuromodulators, that may support discriminative processing of incoming information in the hippocampus.

Four laboratories participated in a collaborative study to determine differences in analytical results generated according to two different compliance methods, US EPA Method 1613b and European Union Method EN 1948 for the determination of chlorinated dibenzo-p-dioxins and dibenzofurans (CDD/CDFs). Various sample matrices containing the analytes at levels ranging from parts-per-quadrillion (ppq) to parts-per-billion (ppb) were used to illustrate differences and similarities between the two analytical methods. The choice of the sample matrices analyzed in this study was made to mirror many of the real-world samples that are of interest to Dow and also to test the laboratories on many different, complex matrices. For this reason, commercially available performance evaluation samples were not used. The study results indicate that the 1613b requirement for confirmation of analyte identity and concentration on a second, polar gas chromatographic column for 2378-tetrachlorodibenzofuran (TCDF) only may lead to quantitative results which are biased high compared to EN 1948 which additionally requires confirmation for all 2378-substituted tetra--through hexachlorodibenzo-p-dioxins and dibenzofurans.

Background: Adequate peripheral venous access is crucial for successful extracorporeal photopheresis (ECP). As this approach is not always feasible in older patients and patients with graft-versus-host disease, central venous catheters play an increasing role in providing long-term vascular access for ECP.However, not all catheters are able to deliver the minimum flow rate of 7 ml/min for ECP., Patients and Methods: Eight different permanent subcutaneous right atrial catheters were connected in vitro to the UVAR-XTS photopheresis system and median flow rates were determined. In addition, in vivo flow rates of patients who received ECP, using either peripheral or central venous access, were determined., Results: Hemodialysis catheters with an internal diameter of 2.0 or 1.5 x 3.5 mm and a length up to 48 cm provided in vitro flow rates of 27-28 ml/min, almost identical to a peripheral access needle. Central venous catheters with a length of over 90 cm reached flow rates below 7 ml/min and are impractical for ECP. The analysis of 308 ECP collection cycles with peripheral vascular access revealed an average flow rate of 31.5 +/- 6.4 ml/min. Only permanent subcutaneous right atrial catheters made for hemodialysis provided similar flow rates (Quinton PermCath Dual Lumen) (33.7 +/- 4.7 ml/min, n = 198)., Conclusions: Permanent subcutaneous hemodialysis catheters with a length of maximally 48 cm achieve optimal flow rates for ECP. They represent therefore the central venous access of choice in patients with inadequate peripheral vascular access.

Purpose: To evaluate the use of magnetic resonance imaging (MRI) compared with arthrography and arthro-CT (AG/ACT) in patients with wrist pain., Methods: MRI and arthrography/arthro-CT (AG/ACT) of the wrist joint were retrospectively evaluated in 346 patients over a three-year period. Imaging findings were correlated to surgical results (n = 78) or clinical course in an at least 6-month follow-up., Results: For tears of the triangular fibrocartilage, arthrography, arthro-CT, and MRI demonstrated a sensitivity and specificity of more than 0.96. Only the positive predictive value was superior for arthrography/arthro-CT (0.99 and 0.98, respectively) compared with MRI (0.94). Arthrography was superior for functional diagnosis of scapho-lunate ligament tears (n = 25). Ulno-lunate and ulno-triquetral ligament defects were demonstrated more exactly by arthrography. Traumatic osseous defects, particularly scaphoid fractures (n = 33) and avascular necrosis (n = 17), were better diagnosed using MRI., Conclusion: For suspected lesions of the triangular fibrocartilage complex, AG/ACT is slightly more reliable than MRI. However, MRI was found to be highly accurate in diagnosing TFC tears, and is superior to AG/ACT in detecting traumatic and vascular lesions of the wrist.

Objective: To assess baseline concentrations of a number of metals and organic compounds in blood and urine of 28 workers employed at a new hazardous waste incinerator (HWI), before operation of the plant., Methods: Plasma analyses of hexachlorobenzene (HCB), polychlorinated biphenyls (PCB 28, 52, 101, 138, 153 and 180), benzene, toluene, ethylbenzene, m-xylene, and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) were carried out. The urinary levels of 2,4- and 2,5-dichlorophenol (DCPs), 2,4,5- and 2,4,6-trichlorophenol (TCPs) and pentachlorophenol (PCP), as well as those of 1-hydroxypyrene (1-HP) were also measured. Beryllium (Be), manganese (Mn), mercury (Hg) and lead (Pb) concentrations were determined in total blood, while the levels of arsenic (As), cadmium (Cd), chromium (Cr), nickel (Ni) and vanadium (V) were measured in urine., Results: The levels of benzene, toluene, ethylbenzene and m-xylene were under their respective detection limits. The concentrations of HCB, PCBs and PCDD/Fs in plasma of the HWI workers, chlorophenols (CLPs) and 1-HP urinary concentrations, as well as those of metals in blood and urine are shown. PCDD/F concentrations in plasma of the new HWI workers ranged between 13.4 and 84.0 pg international toxic equivalents (I-TEQ)/g lipid, with a geometric mean value of 24.4 pg I-TEQ/g lipid., Discussion: PCDD/F levels, as well as the concentrations of PCBs were of the same order of magnitude as those recently obtained for non-occupationally exposed populations of Catalonia (Spain). No significant gender differences were found for the levels of HCB, PCBs and PCDD/Fs. Although the present results showed a notable variability in the levels of CLPs, geometric mean values of these compounds were similar or even lower than those considered as potential reference values. Metal concentrations in blood and urine were also of the same order of magnitude than previously reported metal levels in the same area., Conclusion: The present results should be useful in future surveys in which internal exposure of the HWI workers will be determined.

The purpose of this study was to identify firstly the extent of contamination both of the aquatic biota and of sediments and secondly any regional differences in the concentrations of these compounds. In 1996, polychlorinated biphenyls (PCBs, including their coplanar congeners) were measured in 58 eel and 50 sediment samples. Furthermore, the veterinary pharmacetical bromocyclene and the nitro musks were determined in 84 (1995) and 122 (1996) eel samples. Polycyclic musk fragrances were additionally determined in analyses carried out in 1996. The mean values obtained during the two measurement periods (1995 and 1996) were 24 and 12 micrograms/kg fw. for musk xylene, 41 and 39 micrograms/kg fw. for musk ketone, 14 and 7 micrograms/kg fw. for bromocyclene and, in 1996, 592 micrograms/kg fw. for HHCB (maximum: 4131 micrograms/kg fw.). Decreasing contamination levels are seen for musk xylene and bromocylene but not for musk ketone. This tendency, and the high amounts of polycyclic musk fragrances in the edible parts of eel show that these musks are widely being used in place of nitro musks and that they reach the aquatic system via waste waters, especially those of sewage treatment plants. The mean levels of PCBs in the biota samples of a highly polluted area were 1227 micrograms/kg fw. or 119 pgTEQ/g (sediment: 203 micrograms/kg dw.) and of a slightly polluted area 340 micrograms/kg fw. or 49 TEQ/g (sediment: 47 micrograms/kg dw.).

Pyruvate formate-lyase (acetyl-CoA:formate C-acetyltransferase, EC 2.3.1.54) from anaerobic Escherichia coli cells converts pyruvate to acetyl-CoA and formate by a unique homolytic mechanism that involves a free radical harbored in the protein structure. By EPR spectroscopy of selectively 13C-labeled enzyme, the radical (g = 2.0037) has been assigned to carbon-2 of a glycine residue. Estimated hyperfine coupling constants to the central 13C nucleus (A parallel = 4.9 mT and A perpendicular = 0.1 mT) and to 13C nuclei in alpha and beta positions agree with literature data for glycine radical models. N-coupling was verified through uniform 15N-labeling. The large 1H hyperfine splitting (1.5 mT) dominating the EPR spectrum was assigned to the alpha proton, which in the enzyme radical is readily solvent-exchangeable. Oxygen destruction of the radical produced two unique fragments (82 and 3 kDa) of the constituent polypeptide chain. The N-terminal block on the small fragment was identified by mass spectrometry as an oxalyl residue that derives from Gly-734, thus assigning the primary structural glycyl radical position. The carbon-centered radical is probably resonance-stabilized through the adjacent carboxamide groups in the polypeptide main chain and could be comparable energetically with other known protein radicals carrying the unpaired electron in tyrosine or tryptophan residues.

The large zero-field splitting of rigid biradicals makes them important candidates for spin probes of phospholipid membranes. Here we develop an electron spin resonance line-shape model for such probes on the basis of the stochastic Liouville equation. Particular emphasis is given to the slow-diffusional regime, characteristic of bilayers in the gel phase. The theory is employed to study the line shapes of bis(verdazyl) biradicals, incorporated into oriented multibilayers of dimyristoylphosphatidylcholine. Computer simulations of the angular-dependent spectra provide the orientational distribution functions and rotational correlation times of the spin probes. They occupy two different sites in bilayer membrane. The orientational distribution of the spin probes is related to the structure of the phospholipid phases. In the L beta' phase the hydrocarbon chains are uniformly tilted by delta = 23 degrees with respect to the bilayer normal. For the P beta' phase we observe a random distribution of tilt angles from delta = 0 degree to delta = 19 degrees, indicating that the chains orient perpendicular to the local (rippled) bilayer surfaces. This structure has not been established previously. In agreement with other studies we find no tilt for the L alpha phase. The order parameters of the hydrocarbon chains increase with decreasing temperature, jumping from S less than or equal to 0.6 to S greater than or equal to 0.8 at the main transition. From the rotational correlation times of the spin probes, intrinsic bilayer viscosities of 0.08 P less than or equal to eta less than or equal to 20 P (50 degrees C greater than or equal to T greater than or equal to 1 degree C) are determined. An Arrhenius plot provides activation energies of the viscous flow. The values increase from Evisc approximately 10 kcal/mol in the L alpha phase to Evisc approximately 18 kcal/mol in the L beta' phase.

The first-derivative EPR spectrum of the active form of Escherichia coli pyruvate formate-lyase shows an asymmetric doublet with partially resolved hyperfine splittings (g = 2.0037). Isotope substitution studies demonstrated couplings of a carbon-centered unpaired electron to a solvent-exchangeable proton (a = 1.5 mT) and to further hydrogen nuclei (a = 0.36 and 0.57 mT). By selective incorporation of unlabelled tyrosine into 2H-labelled enzyme protein, a tyrosyl radical structure has been ruled out. Circumstantial evidence indicates that the organic free radical, which also displays an ultraviolet absorption signal at 365 nm, is located on a standard amino acid residue of the polypeptide chain. EPR signal quantification found a stoichiometry of 1 spin per active site. The formate analogue hypophosphite has been characterized as a specific kcat inhibitor of pyruvate formate-lyase which destroys the enzyme radical. Protein-linked 1-hydroxyethylphosphonate was previously described as the dead-end product after reaction of the analogue with the intermediary acetyl-enzyme form of the catalytic cycle [W. Plaga et al. (1988) Eur. J. Biochem. 178, 445-450]. EPR spectroscopy of this system has now identified the corresponding alpha-phosphoryl radical as a reaction intermediate [g = 2.0032; a(P) = 2.72 mT, a(3H) = 1.96 mT]; it showed a half-life of about 20 min at 0 degrees C. This finding proves that the enzyme radical is a hydrogen-atom-transferring coenzymic element.

Pyruvate formate-lyase (formate acetyltransferase; EC 2.3.1.54) of Escherichia coli cells is post-translationally interconverted between inactive and active forms. Conversion of the inactive to the active form is catalyzed by an Fe2+-dependent activating enzyme and requires adenosylmethionine and dihydroflavodoxin. This process is shown here to introduce a paramagnetic moiety into the structure of pyruvate formate-lyase. It displays an EPR signal at g = 2 with a doublet splitting of 1.5 mT and could comprise an organic free radical located on an amino acid residue of the polypeptide chain. Hypophosphite was discovered as a specific reagent that destroys both the enzyme radical and the enzyme activity; it becomes covalently bound to the protein. The enzymatic generation of the radical, which is linked to adenosylmethionine cleavage into 5'-deoxyadenosine and methionine, possibly occurs through an Fe-adenosyl complex. These results suggest a radical mechanism for the catalytic cycle of pyruvate formate-lyase.