Search

In two studies (“App-based infection assessment in RESIST (iAR)” and “Digital infection monitoring in persons living with immunodeficiency (DIMI)” ), we monitor health related items, as vaccination against SARS-CoV-2 and conduct syndromic surveillance of acute respiratory infections in high-risk populations, i.e. elderly persons and persons living with HIV, respectively. In a third very similar study (“Sensors for measuring aerosols and reactive gases to deduce health effects (SMARAGD)”) mainly healthy adults participate. To record incident or recurring transient health events, risk factors and further health data in real-time, we developed the eResearch system “PIA - Prospective Monitoring and Management App”. Recruitment for RESIST, SMARAGD and DIMI started in March 2021 and is ongoing. The questionnaire was presented in April 2022. Preliminary results include 86 participants from the three cohorts. In total, one indicated to be not vaccinated, none were vaccinated once, three (3.5%) twice, 63 (73.3%) three times and 19 (22.1%) four times. Participants reported the following adverse events after immunization (AEFI): after 40 applied doses with Vaxzevria® 24 AEFI (60%); after 158 doses of Comirnaty® 41 AEFI (26%); after 62 doses of Spikevax® 19 AEFI (30.7%); and after three doses of Janssen®, one AEFI (33.3%). In these cohorts, 20 (23.36%) participants stated having had a SARS-CoV-2 infection, of these 16 (80%) after the last vaccination dose, three (15%) before the first dose and one (5%) in between doses. Most participants were vaccinated three times, with Comirnaty being the most applied vaccine, as in officially reported numbers. AEFI varied according to vaccine and were higher than in the German surveillance system (1.64/1000 doses). Most infections were indicated to have been diagnosed after the booster vaccination. The results are limited by the small sample size and possible bias through self-reporting and social desirability regarding vaccination status. Key messages • Overall, most participants were vaccinated with Comirnaty and had three doses of vaccine. Of the participants with a diagnosed SARS-CoV-2-infection, most got infected after the booster vaccine. • The number of reported AEFI was higher than in the official surveillance in Germany.

Korperliche Aktivitat kann durch eine Reihe von Faktoren zur Pravention gastrointestinaler Karzinome beitragen. Zu diesen zahlt ein gunstiger Einfluss von korperlicher Aktivitat auf Korperfett, Insulinresistenz, Darmflora, Geschlechtshormone, Wachstumsfaktoren, chronische Inflammation und oxidativen Stress. Auserdem kann korperliche Aktivitat vor anderen gastrointestinalen Erkrankungen schutzen, die selbst als Risikofaktoren fur gastrointestinale Karzinome gelten, wie vor der gastroosophagealen Refluxerkrankung, der entzundlichen Darmerkrankung, dem Kolonadenom, der nichtalkoholischen Steatohepatitis und der Pankreatitis. Prospektive epidemiologische Studien zeigen, dass korperliche Aktivitat statistisch signifikant invers mit dem Adenokarzinom des Osophagus und der Kardia, dem kolorektalen Karzinom, dem intrahepatischen hepatozellularen Karzinom und dem Pankreaskarzinom assoziiert ist. Die Beziehungen von korperlicher Aktivitat zum Plattenepithelkarzinom des Osophagus, zum Nichtkardiakarzinom, zum Dunndarmkarzinom und zum intra- und extrahepatischen Cholangiokarzinom mussen hingegen noch anhand weiterer prospektiver Studien geklart werden.

BACKGROUND Occasionally specimen containers are received in the dermatopathology laboratory without an accompanying specimen. The consequences in this scenario can range from delay in care and inconvenience to patients to increased morbidity and even mortality. Data regarding incidence and associated characteristics of missing specimens are scant. METHODS Over a 10-year period (7 January 2010 to 7 January 2020) all cases with a missing specimen in a single academic dermatopathology laboratory and a single dermatopathology practice embedded within a dermatology practice were reviewed. RESULTS Out of 270,754 specimens received, 83 empty specimen containers were identified for an incidence of 0.031%. There were 14 (0.005%) cases in which patients had a separate procedure and a second container with both specimens in it accompanying the empty container. The most common missing specimen-generating procedures were shave biopsies (51%) with most common clinical diagnosis being unspecified (30%). The most common specimen location from the 97 total specimen bottles containing either zero or two specimens was head/neck (53%). Although no further procedures were performed after the specimen was lost for 48% of cases, re-biopsy occurred for 28%. CONCLUSIONS Failure to insert specimens into the correct container is rare, but represents a potential significant negative event where vigilance and improvement is required.

Objective Facilities that process and package meat for consumer sale and consumption (meatpacking plants) were early sites of coronavirus disease 2019 (COVID‐19) outbreaks. The aim of this study was to characterize the association between meatpacking plant exposure and clinical outcomes among emergency department (ED) patients with COVID‐19 symptoms. Methods This was a retrospective cohort study of patients presenting to a single ED, from March 1 to May 31, 2020, who had: 1) symptoms consistent with COVID‐19 and 2) a COVID‐19 test performed. The primary outcome was COVID‐19 positivity, and secondary outcomes included hospital admission from the ED, ventilator use, intensive care unit (ICU) admission, hospital length of stay (LOS

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field.

The ocean surface is a boundary layer between atmosphere and ocean. It is highly relevant for the exchange of momentum, radiation, gas and water molecules. To get a better understanding of the exchange processes through the ocean surface APMOS, an autonomous profiling measurement system for the ocean surface boundary layer, was developed. APMOS profiles the undisturbed water column aside from a research vessel and consists of a floating body as well as a profiler. Both bodies are connected through a cable and drifting passively with the water current. System parameters of the profiler like depth, position and inclination can be recorded wirelessly and the user can configure the dive depth in real time. The profiler is equipped with a CTD (Conductivity, Temperature, and Depth) sensor and due to its modular design other sensors can also be mounted. To achieve positive or negative buoyancy the profiler is equipped with two piston tanks. The APMOS was successfully tested in the Jade Bay (southern North Sea). The profiler descends with 0,2 m/s and rises with 0,1 m/s in a relative stable position with a maximum tilt of 10 degrees. Compared with other common measurement systems these rates are slower thus preventing from mixing through platform movement. The CTD sensor is installed as upward looking and performs measurements even through the ocean surface. Overall the system is inexpensive, weighs 20 kg and can be easily handled by one person. Data shown represent novel results from the first testing phase.

The goal of this study was to understand how immune reconstitution through ART in HIV-1 infected patients affects CD4(+) recent thymic emigrants (identified as CD31(+) naïve T cells). We performed FACS analysis of CD4(+) CD31(+) naïve T cells from PBMCs in a cross-sectional age-matched cohort, including 25 healthy controls (HC), 18 untreated HIV-1 infected viremic progressors (VP), 10 untreated HIV-1 infected viral controllers (VC), and 24 HIV-1 infected immune responders (IR) following ART. Our data reveal that 37.5% of IR failed to restore their CD4(+) CD31(+) naïve T cell counts. In addition, significantly higher expressions of Ki67, CD57, and CD95 were observed in CD4(+) CD31(+) naïve T cells of both VP and IR comparing to HC and VC. The significantly elevated CD57 and CD95 expressions are observed in IR with low CD4(+) CD31(+) naïve T cell counts. Therefore, our data indicate an incomplete immune reconstitution of CD4(+) CD31(+) naïve T cells in more than one third of IR, which is associated with HIV-1 driven immunological phenotypic alterations.

HISTORY AND CLINICAL FINDINGS A 51-year-old man infected with HIV-1 presented with weight loss, weakness, fever, agitation, tachycardia and tremor first occurring three year after initiation of antiretroviral therapy. INVESTIGATIONS The electrocardiogram showed atrial fibrillation. Laboratory findings revealed hyperthyroidism with fully suppressed thyroid stimulating hormone (TSH). Antibodies against thyroid globulin and TSH-receptor were markedly increased. Both alpha-fodrin antibodies and antinuclear antibodies were abnormal. Retrospective analysis revealed an association of hyperthyroidism and the presence of autoantibodies with a sudden immune reconstitution under HIV-therapy. DIAGNOSIS, TREATMENT AND COURSE An immune reconstitution inflammatory syndrome (IRIS) presenting as Graves's disease was diagnosed and treated with radioiodide. The patient recovered to clinical euthyroidism while antiretroviral treatment remained unchanged. CONCLUSION IRIS against infectious or self-antigens during HIV treatment results from local or systemic inflammatory imbalances. IRIS with autoimmune manifestations may occur even years after initiation of an effective antiretroviral therapy.

Efficacy and durability are particularly important when choosing highly active antiretroviral therapy (HAART) for treatment-naive patients with HIV, alongside long-term safety and tolerability, special circumstances (such as pregnancy) and risk of cardiovascular disease. Regimens containing non-nucleoside reverse transcriptase inhibitors (NNRTIs), including nevirapine (NVP), are as effective as efavirenz, and avoiding NVP in patients with CD4 cell counts >250 cells/mL (women) or >400 cells/mL (men) can prevent hepatotoxicity. In women who become pregnant while already on HAART, the current regimen should be maintained unless it involves potentially teratogenic drugs. Pregnancy is not an independent risk factor for developing liver enzyme elevations or rash with NVP. High levels of low-density lipoprotein (LDL) cholesterol should be controlled to a target, with HAART modified if it is suspected to be increasing the LDL. The European AIDS Clinical Society rate NVP as the drug with the lowest metabolic impact among the NNRTIs and other classes of antiretroviral therapy.

Thyroid cancer incidence has increased rapidly over time, as has obesity prevalence. A link between the two appears plausible, but the relation of adiposity to thyroid cancer remains incompletely understood. We performed a meta-analysis of adiposity measures and thyroid cancer using studies identified through October 2014. Twenty-one articles yielded data on 12,199 thyroid cancer cases. We found a statistically significant 25% greater risk of thyroid cancer in overweight individuals and a 55% greater thyroid cancer risk in obese individuals as compared with their normal-weight peers. Each 5-unit increase in body mass index (BMI), 5 kg increase in weight, 5 cm increase in waist or hip circumference and 0.1-unit increase in waist-to-hip ratio were associated with 30%, 5%, 5% and 14% greater risks of thyroid cancer, respectively. When evaluated by histologic type, obesity was significantly positively related to papillary, follicular and anaplastic thyroid cancers, whereas it revealed an inverse association with medullary thyroid cancer. Both general and abdominal adiposity are positively associated with thyroid cancer. However, relations with BMI vary importantly by tumour histologic type.

The incidence of HIV-related non-Hodgkin lymphoma (NHL) but not that of Hodgkin lymphoma (HL) has been declining. The aim of the study was to compare HIV-infected patients with NHL and HL with respect to antiretroviral therapy (ART) exposure at the time of lymphoma diagnosis.HIV-infected patients with NHL and HL included in a prospective multicentre cohort study since January 2005 were compared with respect to ART exposure and viral load at the time of lymphoma diagnosis.As of 31 December 2012, data for 329 patients with NHL and 86 patients with HL from 31 participating centres were available. Patients with HL were more likely to be on ART (73.5% vs. 39.1%, respectively; P 0.001) and more frequently had a viral load below the detection limit (57.3% vs. 27.9%, respectively; P 0.001) than patients with NHL. The proportion of patients with HL was 8.0% in ART-naïve patients, 34.8% in patients with current HIV RNA 50 HIV-1 RNA copies/mL, and 50.0% in patients with both HIV RNA 50 copies/mL for 12 months and a CD4 cell count of 200 cells/μL. Of note, 45.8% of all patients with NHL were not currently on ART and had a CD4 count of 350 cells/μL.This prospective cohort study shows that HL was as common as NHL in patients with sustained viral suppression and limited immune deficiency. In contrast to NHL, the majority of patients with HL were on effective ART, suggesting that ART provides insufficient protection from developing HL. The high proportion of untreated patients with NHL suggests missed opportunities for earlier initiation of ART.

Long-term effects of brief in utero exposure to diethylstilboestrol (DES) during a foetal period known to be critical for gonadal development were evaluated. Rats were exposed to DES (100 μg/kg body-weight) from day 17 to 19 of pregnancy. All of the DES-treated pregnant rats (11/11) ate parts or whole of their offspring during the first day after birth (p = 0.03). Surviving male offspring were examined on day 63 post-partum. DES induced a reduction in weight of the testis (p = 0.06) and ventral prostate (p = 0.07), even after this short exposure. DES tended to reduce the number of Sertoli cells (p = 0.13). Our findings indicate that even a short in utero exposure of rats to DES during a critical period for gonadal development results in cannibalism and reduced testis and ventral prostate weight.

To avoid the well-known shortcomings of phenotyping granulocytes for the NA antigens using NA-specific human sera, a DNA-based method to determine the NA genotype was developed. Genomic DNA was isolated from blood cells or serum, amplified by polymerase chain reaction (PCR), immobilized on nylon membrane and genotyped using digoxigenin-labeled, sequence-specific oligonucleotides (SSO). The genotyping results of whole blood samples from 54 and of serum from 20 individuals correlated perfectly with our phenotyping using the antigen capture assay MAIGA. In three cases with the phenotype “NA-null” no hybridization of the NA-specific oligonucleotides occurred. These data show that SSO is a reliable method for NA genotyping especially if only small volumes of blood or even only serum probes are available.

The neutrophil-specific antigen NC1 is defined by an antibody in the serum of a mother who gave birth to a child with alloimmune neonatal neutropenia. NC1 has been reported to be associated with the neutrophil-specific antigen NA2, but the precise relation of NC1 and NA2 remained unclear. Therefore, we investigated the serum using the antigen capture assay MAIGA and the granulocyte (GIFT) and lymphocyte (LIFT) immunofluorescence tests. In GIFT, no NA association was observed. In LIFT, serum antibodies bound preferably to lymphocytes with the HLA antigens HLA-B7 and cross-reacting antigens. In MAIGA, an antibody specific for the NA2 variant of the granulocyte Fc gamma-receptor III was observed. The NA2 specificity was confirmed by testing granulocytes from 40 further different donors. This indicates that the NC1 and NA2 antigens are identical. A positive GIFT result but a negative one in LIFT using cells of an NA2-negative typed individual suggest the presence of an additional, non-NA2-specific granulocyte antibody.

Workforce effectiveness relies on two critical characteristics: competence and readiness. This technical note describes the Competency Lifecycle Roadmap (CLR), a preliminary roadmap for understanding and building workforce readiness developed by the Computer Security Incident Response Team (CSIRT) Development and Training team at the CERT Program, part of Carnegie Mellon University's Software Engineering Institute. This note provides an early look at the roadmap, highlights some of its uses to date, and discusses potential next steps in its development and transition.

Background: Inappropriate prescriptions of proton pump inhibitors (PPI) in hospital and primary care have been widely reported. Recommendations from hospital have been implicated as one reason for inappropriate prescriptions of PPI in primary care. Objective: To quantify the amount of appropriate PPI recommendations in hospital discharge letters and the influence of these recommendations on general practitioners' (GPs') PPI-prescriptions. Materials and Methods: This is an observational study in 31 primary care practices. We identified patients discharged from hospital with PPI recommendation between 2006 and 2007 and assessed practice records and PPI prescription six months prior and after hospital admission. Hospital recommendation for continuous PPI-treatment and continuation by GPs was classified as appropriate, inappropriate or uncertain. Logistic regression analysis was used to calculate factors associated with indicated and non-indicated PPI continuation. Results: In 263 (58%) out of 506 patients discharged from 35 hospitals with a PPI recommendation no indication could be found. Non-indicated PPIs were continued by GPs in 58% for at least 1 month. Indicated PPIs were discontinued in 33%. Two thirds of non-indicated PPIs were initiated in hospital. The strongest factor associated with non-indicated continuation was a PPI-prescription prior to hospital admission [OR: 3.0; 95% confidence interval (CI): 1.7-5.4]. This was also the strongest factor for continuation of an indicated PPI medication (OR: 3.2; 95% CI: 1.4-7.5). Conclusions: We found a strong influence of hospital recommendations and previous prescriptions on PPI prescriptions after discharge. Hospitals should critically review their practice of recommending PPI and document indications. GPs should carefully assess hospital recommendations and their medication prior to admission to avoid over- and under-prescribing.

Laser-induced changes in the refractive index are used to create superimposed transient population gratings and permanent structural gratings in Eu(3+) doped silicate and phosphate glasses. Potential uses for these laser-induced gratings (LIGs) are investigated. First, the structural gratings are shown to be permanent at room temperature and their use as a holographic storage medium is discussed. Second, a permanent LIG of this type is used to demultiplex multifrequency laser beams, demonstrating its use as a tunable line filter. Third, the transient LIG is used to modulate the amplitude of a laser beam which is passed through the sample and scatters off the permanent LIG. This results in information being transferred from one beam to another beam. It was found that thermal lensing plays an important role in the formation of this type of permanent LIG and a procedure for determining the tilt angle of the fringes of the LIG is discussed.

A 51-year-old man infected with HIV-1 presented with weight loss, weakness, fever, agitation, tachycardia and tremor first occurring three year after initiation of antiretroviral therapy.The electrocardiogram showed atrial fibrillation. Laboratory findings revealed hyperthyroidism with fully suppressed thyroid stimulating hormone (TSH). Antibodies against thyroid globulin and TSH-receptor were markedly increased. Both alpha-fodrin antibodies and antinuclear antibodies were abnormal. Retrospective analysis revealed an association of hyperthyroidism and the presence of autoantibodies with a sudden immune reconstitution under HIV-therapy.An immune reconstitution inflammatory syndrome (IRIS) presenting as Graves's disease was diagnosed and treated with radioiodide. The patient recovered to clinical euthyroidism while antiretroviral treatment remained unchanged.IRIS against infectious or self-antigens during HIV treatment results from local or systemic inflammatory imbalances. IRIS with autoimmune manifestations may occur even years after initiation of an effective antiretroviral therapy.

Zusammenfassung In der vorliegenden Untersuchung wurde der Einflus eines alimentaren Zn-Mangels auf die Zn-Verteilung im Vollblut sowie das Phospholipid- und das Fettsaurenmuster der Erythrocytenmembran wachsender Ratten gepruft. Dazu erhielten 100 g schwere mannliche Wistar Ratten uber einen Zeitraum von 28 Tagen eine Eiklarprotein-Diat mit einem nativen Zn-Gehalt < 1 mg/kg ad libitum verabreicht (-ZnAl). Den Kontrolltieren wurde dieselbe, jedoch auf 50 mg Zn/kg supplementierte Diat entweder ad libitum (+ ZnAl) oder restriktiv (+ ZnPF) zugeteilt. Die Zn-Depletion hatte das parallele Absinken von Plasma- und Erythrocytenmembran-Zn bei konstantem Cytosolzinkgehalt zur Folge. Im Phospholipidmuster der depletierten Erythrocytenmembranen konnten keine Veranderungen nachgewiesen werden, der Membrancholesteringehalt ging zuruck. Das Fettsaurenmuster der Mangelgruppe unterschied sich nur punktuell von dem der Kontrollgruppen. Eine Zunahme des Docosahexaensaureanteils (C 22:6) im Phosphatidylcholin und -ethanolamin sowie der Lignocerinsaure (C 24:0) im Sphingomyelin bei gleichzeitiger Abnahme des Palmitinsauregehaltes (C 16:0) im Phosphatidylcholin war bei den Mangeltieren zu verzeichnen. Die aus Phospholipid- und Cholesterinverteilung sowie Fettsaurenmuster berechneten Parameter der Erythrocytenmembranfluiditat liesen keinen gerichteten Einflus des alimentaren Zn-Mangels erkennen. Der membranprotektive Mechanismus des Zn scheint deshalb von einer direkten Einwirkung des Kations auf die Membranoberflache herzuruhren.

The characteristics of four-wave mixing signals were studied in Eu(3+)-doped glasses. When the Eu(3+) ions were resonantly excited, two types of laser-induced grating were formed: a transient population grating associated with the excited Eu(3+) ions and a holographic grating, which was permanent at room temperature but could be erased either thermally or optically.

The lasing properties of chromium-aluminum-doped forsterite were investigated using a tunable alexandrite laser as the pump source. Results of measurements of the lasing threshold, slope efficiency, spectral and temporal profiles of the laser pulse, and the time delay between the alexandrite pump pulse and the laser emission are presented for pump wavelengths of 770, 746, and 730 nm and different pump beam energies. Laser rate equations are developed to model the lasing center as a four-level system and applied to the case of 746-nm pumping. >

A design by Ohmori et al. (1983) of a short-backfire antenna used in the Green Bank Telescope at the National Radio Astronomy Observatory is the basis for the design presented in this paper. The current design shows small variation in beamwidth as a function of frequency, good circular symmetry of the beam and return loss better than -13 dB over the entire 30% band. A concept of a dual-band version of the SBA at 342/800 MHz has been tested. Such a feed would facilitate pulsar observations at the two bands simultaneously.

The recommendations made in this review are based on the current clinical knowledge with regard to the origin and therapy of lipodystrophy. They should be regarded as provisional and will change with expanding knowledge. The recommendations for treating dyslipidaemia in particular are oriented closely on the American recommendations of the National Cholesterol Education Program (NCEP III), and may be regarded both by HIV practitioners and patients as excessive and too rigid. The therapeutic goals of the NCEP in the first intervention studies in HIV-positive individuals were only achieved for a small proportion of the HIV patients. In addition, preliminary results suggest a potentially higher risk of adverse events in HIV-patients under statins or fibrates. The clinical efficacy of interventions with lipid lowering drugs has not been validated in HIV-seropositive patients. However, therapeutic decisions so far have been based on data obtained in non-HIV cardiovascular intervention studies. With more and more results becoming available from the HIV patient population a revision of these recommendations will be required.

Some results on the numerical simulation of blood flow in phantoms for the study of vascular stenoses and aneurysms are presented in this paper. A commercially available CFD solver “FLUENT” is employed in the numerical simulations to compare with the PC-MRI results. Comparisons of PC-MRI and FLUENT output data show qualitative agreement in streamline patterns and good quantitative agreement for pressure drop across the stenosis and aneurysm.

There is accumulating evidence that human immunodeficiency virus type 1 (HIV-1) protease inhibitors (PIs) can induce hyperlipidaemia. To evaluate the frequency and type of hyperlipidaemia in PI-treated patients, 98 outpatients were prospectively analysed for their lipoprotein characteristics at the Medizinische Hochschule in Hannover, Germany. Fifty-seven percent of the patients studied presented with hyperlipidaemia. Both hypertrigylceridaemia (type IV and V hyperlipoproteinaemia, 33%) and hypercholesterolaemia (type IIa hyperlipoproteinaemia, 6%) were detectable. The remaining 18% had a type IIb hyperlipoproteinaemia. Increased lipid levels were highly statistically significant compared to a control group of PI-naive HIV-1-infected patients [low-density lipoprotein (LDL) 146 mg/dl (range, 53-274 mg/dl) versus 105 mg/dl (range, 22-188 mg/dl; P=0.0006); very-low-density lipoprotein (VLDL) 35.5 mg/dl (5-253 mg/dl) versus 18 mg/dl (range, 3-94 mg/dl; P=0.0002)]. All PIs used (saquinavir, indinavir, nelfinavir and ritonavir) were associated with this variable form of hyperlipidaemia according to the Fredrickson classification. There was no significant correlation of any determined lipid value with the duration of treatment. A higher frequency of the apolipoprotein E2 allele and E4 allele was observed in the hyperlipidaemic subjects. Patients with excessive hypertriglyceridaemia showed a reduced lipoprotein lipase activity. Lipodystrophy was observed especially in hyperlipidaemic patients and to a lesser extent in normolipidaemic subjects. The frequency of hyperlipidaemic risk factors was surprisingly high in the group studied, which in turn may explain the proposed increased risk of atherogenesis in HIV-1 PI-treated patients. Therefore, PI-treated subjects should also be evaluated for their lipoprotein pattern, which may require antihyperlipidaemic interventions.

The cochlear nucleus (CN) receives descending input from a variety of auditory nuclei. Descending inputs from the superior olive in particular have been well described, especially those of olivocochlear neurons, which terminate ultimately in the cochlea. It has been demonstrated that olivocochlear neurons receive serotonergic and noradrenergic inputs and thus form a route by which the aminergic system may modulate cochlear mechanisms. Since olivocochlear neurons send collaterals into the CN, it is possible that they also from a route by which the aminergic systems modulate CN processes. The goal of the current study was to determine if neurons in the superior olive that projected to the CN received serotonergic or noradrenergic inputs. The retrograde tracer WGAapoHRP-Au was injected into the CN of cats. The brainstems were silver-enhanced to visualize the tracer and then immunohistochemically processed with antibodies raised against serotonin or dopamine-beta-hydroxylase (DBH) to label serotonergic or noradrenergic fibers, respectively. The sections were viewed with high power light microscopy to determine if the retrogradely labeled neurons were contacted by serotonin- or DBH-immunoreactive varicosities. Retrogradely labeled cells were observed in auditory brainstem nuclei known to project to the CN including the superior olivary complex and inferior colliculus bilaterally and the opposite CN. In these regions, retrogradely labeled neurons were closely associated with serotonin- and/or DBH-immunoreactive varicosities. Assuming a synaptic relationship between the projection neurons and varicosities, these results indicate that the serotonergic and noradrenergic systems innervate the descending pathways to the CN. Since the serotonergic and noradrenergic systems modulate their targets based on level of arousal, these results support the theory that descending systems are involved in selective attention.

The disadvantage of most devices presently available for cardiac rhythm event monitoring is that they require either permanently attached electrodes or the subcutaneous implantation of the device. The aim of the study was to evaluate the feasibility and diagnostic yield of a hand-held, portable electrocardiograph for the evaluation of infrequent episodes of palpitations. In contrast to other devices, this electrocardiograph records and stores the electrocardiograms with integral electrodes, which makes long-term attached electrodes not unnecessary.The study included 55 consecutive patients with palpitations less than once a week. The patients received the electrocardiograph Miniscope MS-3 with integral tripod electrodes (Schiller AG, Switzerland) to record a one-channel electrocardiogram during a recurrent episode. The frequency of device activation and the atrial rhythm during an episode was assessed.Forty-one (75%) patients had at least one episode within 38 +/- 22 days. The first episode occurred within the first week in 18 cases, during the 2nd in 9, during the 3rd in 9, during the 4th in 2 patients, and in 3 patients between the 4th and 12th week. All episodes could be properly analyzed: Twenty-three patients had sinus rhythm, 7 paroxysmal atrial fibrillation, 7 paroxysmal atrial flutter, and 4 an AV node reentry tachycardia. Eleven of the 23 patients with sinus rhythm additionally had premature atrial or ventricular contractions. Mean heart rate was 111 +/- 45 bpm. A second episode was recorded in 22 and a third episode in 12 patients. All patients had during the subsequent episode the same cardiac rhythm as during their first episode.Patients evaluated for their infrequent palpitations had during event monitoring a recurrent episode in 75% that occurred in 88% within the first 4 weeks. All patients were able to activate the electrocardiograph and could store an electrocardiogram with the integral electrodes. Patient-activated event monitoring reliably identified patients with an atrial arrhythmia who need further invasive evaluation and treatment, and ruled out patients with sinus rhythm and premature contractions.

The single application of estradiol in postmenopausal women with symptomatic coronary heart disease has an antiischemic effect, which seems to be mainly related to the relaxation of the vascular smooth muscle. Longterm replacement with estrogen in postmenopausal women reduces their increased sympathetic activity. The aim of the double-blinded study was to assess whether a single transdermal estradiol administration also has an effect on the sympathovagal balance and may additionally explain the acute effects of estradiol. Methods Fifteen women with symptomatic and angiographically proven coronary artery disease were cross-over randomized to two 100-microgram patches of estradiol or identical placebo. After one week the women received the opposite treatment. One day after patch application a 24-hour Holter-ECG recording was performed to assess the mean heart rate over 24 hours as well as time domain and frequency domain indices of the heart rate variability. Results The estradiol plasma concentration rose significantly from 354 +/- 176 pmol/l after placebo to 800 +/- 260 pmol/l after estradiol application. Heart rate during placebo was 74 +/- 15 bpm and during therapy 74 +/- 15 bpm. Heart rate variability was not different for time domain indices such as SDNN (estradiol: 64 +/- 31 ms; placebo: 65 +/- 33 ms) or for frequency domain indices such as LF (estradiol: 15.8 +/- 8.0 ms; placebo: 15.3 +/- 9.4 ms) and HF (estradiol: 12.1 +/- 8.5 ms; placebo: 12.9 +/- 9.9 ms). Conclusion A single transdermal application of estradiol did not modify heart rate or heart rate variability of women with coronary artery disease. The modulation of the autonomic tone does not seem to be a relevant mechanism of short-term estradiol effects.

Osteonecrosis is a rare complication of HIV infection. The presumptive cause of the aseptic osteonecrosis is a disturbed blood supply to the bone. Most cases of osteonecrosis are associated with numerous risk factors, such as use of steroids, alcohol abuse, coagulopathies or metabolic derangements. Since conventional X-rays appear unremarkable, early forms often go unrecognized or are diagnosed late. Methods of establishing the diagnosis are NMR and three-phase skeletal scintigraphy. The pathogenesis of osteonecrosis in HIV infection is unclear. So far, about 30 cases have been reported in the literature. Since a number of these cases had no classical risk factors, it is assumed that the HIV infection itself is the causative agent. In other patients anticardiolipin antibodies, which are considered to be a risk factor, are found. Other HIV patients with aseptic osteonecrosis have elevated blood lipids; changes in blood fats have long been established as a risk factor in osteonecrosis. Furthermore, an association of osteonecrosis with proteinase inhibitor-induced metabolic lipid disorders was reported. Whether the risk for osteonecrosis in treatment with proteinase inhibitors actually is raised, or whether the association is a coincidence needs further investigation. We would recommend that in HIV patients with typical symptoms--in particular when classical risk factors are present--osteonecrosis be included in the differential diagnostic considerations.

Die HIV-1 Protease besteht aus zwei 99 Aminosauren Untereinheiten, die ein Homodimer bilden und Aspartylprotease-Aktivitat besitzen. HIV-1 Proteaseinhibitoren binden mit hoher Affinitat an die katalytische Domane der HIV-1 Protease und verhindern so die Spaltung von HIV-Proteinen in infizierten Zellen. Durch die Reifungshemmung des Virus fallt die Virusmenge von HIV im Blut und in den Lymphknoten unter der Behandlung mit Proteaseinhibitoren rasch ab. Die vier zur Zeit zugelassenen Proteaseinhibitoren (Saquinavir, Indinavir, Ritonavir, Nelfinavir) sind strukturell verwandte Substanzen, die die Spaltung von Vorlauferproteinen kompetetiv hemmen [9].

Der Einsatz der intensivierten antiretroviralen Therapie bei Patienten mit fortgeschrittener HIV-1 Infektion hat zu einem deutlichen Ruckgang der Morbiditat und Mortalitat von AIDS-Patienten gefuhrt [17, 20]. Durch Kombination von nukleosidalen Reverse-Trans-kriptase-Inhibitoren (NRTI) und Protease-Inhibitoren (PI) ist eine Reduzierung der HIV- RNA, gemessen als Viruskopien im Plasma, und ein Anstieg der CD4+ Lymphozyten zu erreichen. Diese Kombinationstherapien werden daher fur die Behandlung der HIV- Infektion empfohlen.

Eine HIV-1 infektion kann mit verschiedenen autoimmun-rheumatologischen Manifestationen einhergehen. Es sind eine Reihe von ahnlichen immunologischen Veranderungen bei HIV-1 Infektion und Autoimmunerkrankungen wie z.B. demsystemische Lupus erythematodes (SLE) beschrieben [10,11]. Schon seit langem werden Mechanismen von Autoimmunitat bei der HIV-1 Infektion diskutiert. Verschiedene Autoantikorper, wie Antinukleare Antikorper (ANA), Doppelstrang-Dna-Antikorper (ds-DNA-Ak), Anticardiolipin-Antikorper (aCL) sowie thrombozytare und leukozytare Antikorper sind im Serum von Patienten mit HIV-1 infektion nachgewiesen worden [4].

During 1990 we surveyed the southern sky using a multi-beam receiver at frequencies of 4850 and 843 MHz. The half-power beamwidths were 4 and 25 arcmin respectively. The finished surveys cover the declination range between +10 and −90 degrees declination, essentially complete in right ascension, an area of 7.30 steradians. Preliminary analysis of the 4850 MHz data indicates that we will achieve a five sigma flux density limit of about 30 mJy. We estimate that we will find between 80 000 and 90 000 new sources above this limit. This is a revised version of the paper presented at the Regional Meeting by the first four authors; the surveys now have been completed.

The purpose of this document is to describe the state of the practice in information assurance and security curriculum and certification. The scope is not exhaustive, but rather illustrative of the types of activity occurring today within various organizations, including government, universities and research centers, professional societies, and the business community. Although individual courses are available, there apparently is no systematic agreement on the knowledge, skills, and abilities required to formulate a curriculum for information security professionals that enjoys broad-based support across organizations. As a result of Presidential Decision Directive 63 and the charge to protect the nation's critical infrastructures, the pressure is increasing to provide some minimum level of competence for system and network administrators working in the field of information assurance. Presently, several professional organizations offer certified professional designations. What is needed is a comprehensive framework for curriculum and certification in information assurance and security. Currently the thrust for training focuses primarily on the technologies of information infrastructures. However, long-term solutions for the protection of critical information assets will require a more comprehensive approach in which senior executives and managers, as well as technical staff, develop strong and diverse skills that allow them to advance an organization's mission in a dynamic and increasingly hostile networked environment.

This report summarizes the results of characterization studies of plutonium-bearing wastes produced at the US Department of Energy weapons production facilities. Several different solid wastes were characterized, including incinerator ash and ash heels from Rocky Flats Plant and Los Alamos National Laboratory; sand, stag, and crucible waste from Hanford; and LECO crucibles from the Savannah River Site. These materials were characterized by chemical analysis and analytical electron microscopy. The results showed the presence of discrete PuO{sub 2}PuO{sub 2{minus}x}, and Pu{sub 4}O{sub 7} phases, of about 1{mu}m or less in size, in all of the samples examined. In addition, a number of amorphous phases were present that contained plutonium. In all the ash and ash heel samples examined, plutonium phases were found that were completely surrounded by silicate matrices. Consequently, to achieve optimum plutonium recovery in any chemical extraction process, extraction would have to be coupled with ultrafine grinding to average particle sizes of less than 1 {mu}m to liberate the plutonium from the surrounding inert matrix.

An in vitro study showed that it is possible to alter the surface morphology of root canals with a Nd-YAG Laser. S.E.M. and dye penetration photographs showed these changes in the canal surface morphology. In our opinion when an energy level of 15 IPS/1,5 W is used, the resulting changes are useful and of benefit in root canal treatment.