Use of biomarkers or echocardiography in pulmonary embolism: the Swiss Venous Thromboembolism Registry

Cardiac biomarkers and echocardiography for assessing right ventricular function are recommended to risk stratify patients with acute non-massive pulmonary embolism (PE), but it remains unclear if these tests are performed systematically in daily practice. Design and methods: Overall, 587 patients with acute non-massive PE from 18 hospitals were enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER): 178 (30%) neither had a biomarker test nor an echocardiographic evaluation, 196 (34%) had a biomarker test only, 47 (8%) had an echocardiogram only and 166 (28%) had both tests.

Isotope fractionation of selenium by biomethylation in microcosm incubations of soil

The natural abundance of stable Se isotopes in methylselenides reflects sources and formation conditions of methylselenides. We tested the effects of (i) different inorganic Se species spiked to soils and (ii) different soil samples on the extent of fungal biomethylation of Se and the Se isotope ratios (δ82/76Se) in methylselenides. Furthermore, we assessed the decrease of dissolved, bioavailable Se during three days of equilibration of the soils with Se-enriched solutions. We conducted closed microcosm experiments containing soil spiked with Se(IV) or Se(VI), a growth medium, and the fungus species Alternaria alternata for 11 d. The concentrations and isotope ratios of Se were determined in all components of the microcosm with multicollector ICP-MS. The equilibration of the spiked Se(IV) and Se(VI) for 3 d resulted in a decrease of dissolved, bioavailable Se concentrations by 32 to 44% and 8 to 14%, respectively. Very little isotope fractionation occurred during this phase, and it can be attributed to mixing of the added Se with the pre-existing Se in the soils and minor Se(IV) reduction in one experiment. In two of the incubated soils – moderately acidic roadside and garden soils – between 9.1 and 30% of the supplied Se(IV) and 1.7% of the supplied Se(VI) were methylated while in a strongly acidic forest soil no Se methylation occurred. The methylselenides derived from Se(IV) were strongly depleted in 82Se (δ82/76Se = − 3.3 to − 4.5‰) compared with the soil (0.16–0.45‰) and the added Se(IV) (0.20‰). The methylselenide yield of the incubations with Se(VI) was too small for isotope measurements. Our results demonstrate that Se source species and soil properties influence the extent of Se biomethylation and that the produced methylselenides contain isotopically light Se.

Use of quality assessment tools in systematic reviews was varied and inconsistent

OBJECTIVES To assess the use of quality assessment tools among a cross-section of systematic reviews (SRs) and to further evaluate whether quality was used as a parameter in the decision to include primary studies within subsequent meta-analysis. STUDY DESIGN AND SETTING We searched PubMed for SRs (interventional, observational, and diagnostic) published in Core Clinical Journals between January 1 and March 31, 2014. RESULTS Three hundred nine SRs were identified. Quality assessment was undertaken in 222 (71.8%) with isolated use of the Cochrane risk of bias tool (26.1%, n = 58) and the Newcastle-Ottawa Scale (15.3%, n = 34) most common. A threshold level of primary study quality for subsequent meta-analysis was used in 12.9% (40 of 309) of reviews. Overall, fifty-four combinations of quality assessment tools were identified with a similar preponderance of tools used among observational and interventional reviews. Multiple tools were used in 11.7% (n = 36) of SRs overall. CONCLUSION We found that quality assessment tools were used in a majority of SRs; however, a threshold level of quality for meta-analysis was stipulated in just 12.9% (n = 40). This cross-sectional analysis provides further evidence of the need for more active or intuitive editorial processes to enhance the reporting of SRs.

The inhibition of NF-kappaB activation pathways and the induction of apoptosis by dithiocarbamates in T cells are blocked by the glutathione precursor N-acetyl-L-cysteine

Nuclear factor-kappaB regulates genes that control immune and inflammatory responses and are involved in the pathogenesis of several diseases, including AIDS and cancer. It has been proposed that reactive oxygen intermediates participate in NF-kappaB activation pathways, and compounds with putative antioxidant activity such as N-acetyl-L-cysteine (NAC) and pyrrolidine dithiocarbamate (PDTC) have been used interchangeably to demonstrate this point. We examined their effects, separately and combined, on different stages of the NF-kappaB activation pathway, in primary and in transformed T cells. We show that NAC, contrary to its reported role as an NF-kappaB inhibitor, can actually enhance rather than inhibit IkappaB degradation and, most importantly, show that in all cases NAC exerts a dominant antagonistic effect on PDTC-mediated NF-kappaB inhibition. This was observed at the level of IkappaB degradation, NF-kappaB DNA binding, and HIV-LTR-driven reporter gene expression. NAC also counteracted growth arrest and apoptosis induced by dithiocarbamates. Antagonistic effects were further observed at the level of jun-NH2-terminal kinase, p38 and ATF-2 activation. Our findings argue against the widely accepted assumption that NAC inhibits all NF-kappaB activation pathways and shows that two compounds, previously thought to function through a common inhibitory mechanism, can also have antagonistic effects.

Transferrin immunoextraction for determination of carbohydrate-deficient transferrin in human serum by capillary zone electrophoresis

CZE-based assays for carbohydrate-deficient transferrin (CDT) in which serum is mixed with an Fe(III) ion-containing solution prior to analysis are effective approaches for the determination of CDT in patient samples. Sera of patients with progressed diseases, however, are prone to interferences comigrating with transferrin (Tf) that prevent the proper determination of CDT by CZE in these samples. The need of a simple and economic approach to immunoextract Tf from human serum prompted us to investigate the use of a laboratory-made anti-Tf spin column containing polyclonal rabbit anti-human Tf antibodies linked to Sepharose 4 Fast Flow beads. This article reports extraction column manufacturing and column characterization with sera having normal and elevated CDT levels. The developed procedure was applied to a number of relevant hepatology and dialysis patient samples and could thereby be shown to represent an effective method for extraction and concentration of all Tf isoforms. Furthermore, lipemic sera were delipidated using a mixture of diisopropyl ether and butanol prior to immunoextraction. CDT could unambiguously be determined in all pretreated samples.

Regionalist Protest through Shared Rule? Peripherality and the Use of Cantonal Initiatives in Switzerland

In this article, we are interested in the extent to which federalism is able to deal with peripheral protest through shared rule channels. Shared rule as a key dimension of federal states has not thus far received adequate academic attention. Empirically, we analyse the use of all cantonal initiatives in Switzerland over the past 25 years as a particular instrument of shared rule, subsequently focusing on two peripheral regions with successful regionalist parties, Ticino and Geneva. We find that regionalist parties contribute towards radicalizing peripheral demands in search of attention from the centre. This leads to the mainstreaming of peripheral demands by pulling other parties along. We conclude that shared rule properly designed gives even the most peripheral regions a voice in national decisions, but that regionalist parties may also use shared rule instruments to mobilize their electorate at home to fight their non-regionalist competitors.

Off-label use of misoprostol for labor induction: a nation-wide survey in Switzerland

Off-label use of drugs is frequent in obstetrical practice. No data however are available about nation-wide off-label use in obstetrics regarding frequency and patient information. The objective of our study was to assess the clinical practice of off-label use of misoprostol for labor induction.

Use of linezolid in neonatal and pediatric inpatient facilities-results of a retrospective multicenter survey

The purpose of this investigation was to describe the use of linezolid in pediatric inpatient facilities. A retrospective multicenter survey including data from nine participating tertiary care pediatric inpatient facilities in Germany and Austria was undertaken. Data on 126 off-label linezolid treatment courses administered to 108 patients were documented. The survey comprises linezolid treatment in a broad spectrum of clinical indications to children of all age groups; the median age was 6.8 years (interquartile range 0.6-15.5 years; range 0.1-21.2 years; ten patients were older than 18 years of age but were treated in pediatric inpatient units). Of the 126 treatment courses, 27 (21%) were administered to preterm infants, 64 (51%) to pediatric oncology patients, and 5% to patients soon after liver transplantation. In 25%, the infection was related to a medical device. Linezolid iv treatment was started after intensive pre-treatment (up to 11 other antibiotics for a median duration of 14 days) and changed to enteral administration in only 4% of all iv courses. In 39 (53%) of 74 courses administered to children older than 1 week and younger than 12 years of age, the dose was not adjusted to age-related pharmacokinetic parameters. In only 17 courses (13%) was a pediatric infectious disease consultant involved in the clinical decision algorithm. Linezolid seemed to have contributed to a favorable outcome in 70% of all treatment courses in this survey. Although retrospective, this survey generates interesting data on the off-label use of linezolid and highlights several important clinical aspects in which the use of this rescue antibiotic in children might be improved.

Predictors of optimal viral suppression in patients switched to abacavir, lamivudine, and zidovudine: the Swiss HIV Cohort Study

OBJECTIVE: To investigate predictors of continued HIV RNA viral load suppression in individuals switched to abacavir (ABC), lamivudine (3TC) and zidovudine (ZDV) after successful previous treatment with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination antiretroviral therapy. DESIGN AND METHODS: An observational cohort study, which included individuals in the Swiss HIV Cohort Study switching to ABC/3TC/ZDV following successful suppression of viral load. The primary endpoint was time to treatment failure defined as the first of the following events: two consecutiveviral load measurements > 400 copies/ml under ABC/3TC/ZDV, one viral load measurement > 400 copies/ml and subsequent discontinuation of ABC/3TC/ZDV within 3 months, AIDS or death. RESULTS: We included 495 individuals; 47 experienced treatment failure in 1459 person-years of follow-up [rate = 3.22 events/100 person-years; 95% confidence interval (95% CI), 2.30-4.14]. Of all failures, 62% occurred in the first year after switching to ABC/3TC/ZDV. In a Cox regression analysis, treatment failure was independently associated with earlier exposure to nucleoside reverse transcriptase inhibitor (NRTI) mono or dual therapy [hazard ratio (HR), 8.02; 95% CI, 4.19-15.35) and low CD4 cell count at the time of the switch (HR, 0.66; 95% CI, 0.51-0.87 by +100 cells/microl up to 500 cells/microl). In patients without earlier exposure to mono or dual therapy, AIDS prior to switch to simplified maintenance therapy was an additional risk factor. CONCLUSIONS: The failure rate was low in patients with suppressed viral load and switch to ABC/3TC/ZDV treatment. Patients with earlier exposure to mono or dual NRTI therapy, low CD4 cell count at time of switch, or AIDS are at increased risk of treatment failure, limiting the use of ABC/3TC/ZDV in these patient groups.

The social perception of heroes and murders: Effects of gender-inclusive language in media reports

The way media depict women and men can reinforce or diminish gender stereotyping. Which part does language play in this context? Are roles perceived as more gender-balanced when feminine role nouns are used in addition to masculine ones? Research on gender-inclusive language shows that the use of feminine-masculine word pairs tends to increase the visibility of women in various social roles. For example, when speakers of German were asked to name their favorite "heroine or hero in a novel," they listed more female characters than when asked to name their favorite "hero in a novel." The research reported in this article examines how the use of gender-inclusive language in news reports affects readers' own usage of such forms as well as their mental representation of women and men in the respective roles. In the main experiment, German participants (N = 256) read short reports about heroes or murderers which contained either masculine generics or gender-inclusive forms (feminine-masculine word pairs). Gender-inclusive forms enhanced participants' own usage of gender-inclusive language and this resulted in more gender-balanced mental representations of these roles. Reading about "heroines and heroes" made participants assume a higher percentage of women among persons performing heroic acts than reading about "heroes" only, but there was no such effect for murderers. A post-test suggested that this might be due to a higher accessibility of female exemplars in the category heroes than in the category murderers. Importantly, the influence of gender-inclusive language on the perceived percentage of women in a role was mediated by speakers' own usage of inclusive forms. This suggests that people who encounter gender-inclusive forms and are given an opportunity to use them, use them more themselves and in turn have more gender-balanced mental representations of social roles.

Solute losses from various shoot parts of field-grown wheat by leakage in the rain

Leakage from field-grown wheat was investigated during two seasons differing considerably in their rainfall patterns. For all solutes analyzed, these losses were low from non-senescing plant parts, increased after the onset of senescence and became maximal in fully senesced (dry, brown) organs. The cumulative losses of potassium by leakage in the rain were 65% of the content at anthesis for the flag leaf and 95% for the third leaf from the top, while these relative values were lower for magnesium (50 to 80%) and calcium (around 55%) and extremely low for sodium (<10%). The differences between potassium and sodium may be due to a different compartmentation on the tissue level or on the subcellular level. It became evident that for certain nutrients (e.g. potassium or magnesium) leakage in the rain may represent a major loss from senescing leaves and can be a relevant flux in maturing wheat.

Magnetization exchange with water and T(1) relaxation of the downfield resonances in human brain spectra at 3.0 T

The use of water suppression for in vivo proton MR spectroscopy diminishes the signal intensities from resonances that undergo magnetization exchange with water, particularly those downfield of water. To investigate these exchangeable resonances, an inversion transfer experiment was performed using the metabolite cycling technique for non-water-suppressed MR spectroscopy from a large brain voxel in 11 healthy volunteers at 3.0 T. The exchange rates of the most prominent peaks downfield of water were found to range from 0.5 to 8.9 s(-1), while the T(1) relaxation times in absence of exchange were found to range from 175 to 525 ms. These findings may help toward the assignments of the downfield resonances and a better understanding of the sources of contrast in chemical exchange saturation transfer imaging.