Fattori di rischio biomeccanico e valori limite di esposizione (TLV-ACGIH®) nell’ambito dello studio di coorte della sindrome del tunnel carpale occupazionale

OBIETTIVI: Per esplorare il contributo dei fattori di rischio biomeccanico, ripetitività (hand activity level – HAL) e forza manuale (peak force - PF), nell’insorgenza della sindrome del tunnel carpale (STC), abbiamo studiato un’ampia coorte di lavoratori dell’industria, utilizzando come riferimento il valore limite di soglia (TLV©) dell’American Conference of Governmental Industrial Hygienists (ACGIH). METODI: La coorte è stata osservata dal 2000 al 2011. Abbiamo classificato l’esposizione professionale rispetto al limite di azione (AL) e al TLV dell’ACGIH in: “accettabile” (sotto AL), “intermedia” (tra AL e TLV) e “inaccettabile” (sopra TLV). Abbiamo considerato due definizioni di caso: 1) sintomi di STC; 2) sintomi e positività allo studio di conduzione nervosa (SCN). Abbiamo applicato modelli di regressione di Poisson aggiustati per sesso, età, indice di massa corporea e presenza di patologie predisponenti la malattia. RISULTATI: Nell’intera coorte (1710 lavoratori) abbiamo trovato un tasso di incidenza (IR) di sintomi di STC di 4.1 per 100 anni-persona; un IR di STC confermata dallo SCN di 1.3 per 100 anni-persona. Gli esposti “sopra TLV” presentano un rischio di sviluppare sintomi di STC di 1.76 rispetto agli esposti “sotto AL”. Un andamento simile è emerso per la seconda definizione di caso [incidence rate ratios (IRR) “sopra TLV”, 1.37 (intervallo di confidenza al 95% (IC95%) 0.84–2.23)]. Gli esposti a “carico intermedio” risultano a maggior rischio per la STC [IRR per i sintomi, 3.31 (IC95% 2.39–4.59); IRR per sintomi e SCN positivo, 2.56 (IC95% 1.47–4.43)]. Abbiamo osservato una maggior forza di associazione tra HAL e la STC. CONCLUSIONI: Abbiamo trovato un aumento di rischio di sviluppare la STC all’aumentare del carico biomeccanico: l’aumento di rischio osservato già per gli esposti a “carico intermedio” suggerisce che gli attuali valori limite potrebbero non essere sufficientemente protettivi per alcuni lavoratori. Interventi di prevenzione vanno orientati verso attività manuali ripetitive.

La navigazione nella chirurgia oncologica ortopedica: Applicazione ed implementazione di nuove tecnologie per il trattamento chirurgico dei tumori dell'apparato muscolo-scheletrico, studio pilota

Nel presente progetto di ricerca, da novembre 2011 a novembre 2013 , sono stati trattati chirurgicamente, con l’assistenza del navigatore , pazienti con tumori ossei primitivi degli arti, del bacino e del sacro, analizzando i risultati degli esami istologici dei margini di resezione del tumore e i risultati clinici e radiografici. Materiali e metodi : Abbiamo analizzato 16 pazienti 9 maschi e 7 femmine , con un'età media di 31 anni (range 12-55 ). Di tutti i pazienti valutati 8 avevano una localizzazione agli arti inferiori , 4 al bacino e 4 all'osso sacro . Solo quelli con osteosarcoma parostale , Cordoma e Condrosarcoma non sono stati sottoposti a terapia antiblastica . Solo un paziente è stato sottoposto a radioterapia postoperatoria per una recidiva locale . Tutti gli altri pazienti non sono stati trattati con la radioterapia per l’ adeguatezza dei margini di resezione . Non ci sono state complicanze intraoperatorie . Nel periodo postoperatorio abbiamo osservato una vescica neurologica , una paresi sciatica, due casi di infezione di cui una superficiale e una profonda, tutti e quattro i pazienti con sarcoma sacrale sviluppati hanno avuto ritardato della guarigione della ferita e di questi tre hanno avuto incontinenza sfinterica. In tutti i casi si è ottenuta una eccellente risultato clinico e radiografico , con soddisfazione del paziente , corretto contatto tra l'osteotomia e l'impianto che apparivano stabili ai primi controlli ambulatoriali ( FU 19 mesi). Risultati: La chirurgia assistita da calcolatore ha permesso di migliorare l’esecuzione delle resezioni ossee prevista dal navigatore. Questa tecnologia è valida e utile per la cure dei tumori dell’apparato scheletrico, soprattutto nelle sedi anatomiche più complesse da trattare come la pelvi, il sacro e nelle resezioni intercalari difficoltose nell’ottenere un margine di resezione ampio e quindi di salvare l’articolazione e l’arto stesso.

Massenspektrometrische Wasserdampfmessung in der oberen Troposphäre und unteren Stratosphäre

Diese Arbeit beschreibt die Entwicklung des flugzeuggetragenen Atmosphärischen Ionisations-Massenspektrometers AIMS-H2O zur Messung von Wasserdampf in der oberen Troposphäre und unteren Stratosphäre (UTLS) und erste Flugzeugmessungen mit dem Instrument. Wasserdampf beeinflusst das Klima in der UTLS aufgrund seiner Strahlungseigenschaften und agiert als wichtiger Parameter bei der Bildung von Zirruswolken und Kondensstreifen. Deshalb sind genaue Wasserdampfmessungen für das Verständnis vieler atmosphärischer Prozesse unerlässlich. Instrumentenvergleiche wie sie im SPARC Report No. 2 und dem Bericht der AUQAVIT Kampagne zusammengefasst sind, haben gezeigt, dass große Abweichungen zwischen einzelnen Methoden und Instrumenten bestehen. Diese Unsicherheiten limitieren das Verständnis des Einflusses von Wasserdampf auf die Dynamik und die Strahlungseigenschaften in der UTLS. Die in dieser Arbeit vorgestellte Entwicklung einer neuen Messmethode für Wasserdampf mit dem Massenspektrometer AIMS-H2O ist deshalb auf die genaue Messung niedriger Wasserdampfkonzentrationen in der UTLS fokussiert. Mit AIMS H2O wird Umgebungsluft in einer neu entwickelten Gasentladungsquelle ionisiert. Durch eine Reihe von Ionen-Molekül-Reaktionen entstehen H3O+(H2O) und H3O+(H2O)2 Ionen. Diese Ionen werden genutzt, um die Wasserdampfkonzentration in der Atmosphäre zu bestimmen. Um die erforderliche hohe Genauigkeit zu erzielen, wird AIMS H2O im Flug kalibriert. In dem zu diesem Zweck aufgebauten Kalibrationsmodul wird die katalytische Reaktion von Wasserstoff und Sauerstoff auf einer Platinoberfläche genutzt, um definierte Wasserdampfkonzentrationen für die Kalibration im Flug zu erzeugen. Bei ersten Messungen auf der Falcon während der Kampagne CONCERT 2011 konnte dabei eine Genauigkeit von 8 bis 15% für die Messung der Wasserdampfkonzentration in einem Messbereich von 0,5 bis 250 ppmv erreicht werden. Die Messfrequenz betrug 4 Hz, was einer räumlichen Auflösung von etwa 50 m entspricht. Der Vergleich der Messung des Massenspektrometers mit dem Laserhygrometer Waran zeigt eine sehr gute Übereinstimmung im Rahmen der Unsicherheiten. Anhand zweier Fallstudien werden die Messungen von AIMS H2O während CONCERT 2011 detailliert analysiert. In der ersten Studie werden zwei Flüge in eine stratosphärische Intrusion über Nordeuropa untersucht. In dieser Situation wurde stratosphärische Luft bis hinunter auf 6 km Höhe transportiert und war dadurch mit der Falcon erreichbar. Es konnte gezeigt werden, dass AIMS-H2O sehr gut für die genaue Messung niedriger Wasserdampfkonzentrationen, in diesem Fall bis etwa 3,5 ppmv, geeignet ist. Der Vergleich der Messung mit Analysen des ECMWF Integrated Forecast Systems zeigt eine gute Übereinstimmung der gemessenen Wasserdampfstrukturen mit der dynamischen Tropopause. Unterschiede tauchen dagegen beim Vergleich der Wasserdampfkonzentrationen in der unteren Stratosphäre auf. Hier prognostiziert das Modell deutlich höhere Feuchten. Die zweite Fallstudie beschäftigt sich mit der Verteilung der relativen Feuchte in jungen Kondensstreifen im Vergleich zu ihrer direkten Umgebung. Dabei wurde für drei Messsequenzen im Abgasstrahl von Flugzeugen beobachtet, dass die relative Feuchte innerhalb des Kondensstreifens im Vergleich zur Umgebung sowohl bei unter- als auch übersättigten Umgebungsbedingungen in Richtung Sättigung verschoben ist. Die hohe Anzahl an Eispartikeln und die damit verbundene große Eisoberfläche in jungen Kondensstreifen führt also zu einer schnellen Relaxation von Gasphase und Eis in Richtung Gleichgewicht. In der Zukunft soll AIMS-H2O auch auf HALO für die genaue Messung von Wasserdampf bei ML-CIRRUS und weiteren Kampagnen eingesetzt werden.

Haematopoietic stem cell transplantation: activity in Switzerland compared with surrounding European countries

Haematopoietic stem cell transplantation (HSCT) is a highly specialised procedure used to treat malignancies of the lymphohaematopoietic system as well as some acquired and inherited disorders of the blood. This analysis by the Swiss Blood Stem Cell Transplantation Group, based on data from 2008-2011, describes, treatment rates in Switzerland for specific indications and compares this with data from Germany, France, Italy and the Netherlands, corrected for the size of the population. Differences in transplant rates, in rates for particular indications, and in the use of specific transplant technologies such as use of unrelated donors, use of cord blood or mismatched family donors are described. These data are put in correlation with donor availability from international registries and with number of transplant teams and number of procedures per team all corrected for population size.

Heikinpäivä in Hancock

Each January in Hancock, Michigan, the Heikinpäivä Midwinter Festival offers local residents three weeks of activities highlighting the continuing role Finnish culture has in the area. Utilizing a set of fading Finnish midwinter traditions surrounding the day of Heikki, or Henrik, this festival has grown from a brief day-long gathering to a long period of activity incorporating films, craft and cooking classes, religious services, and more traditional festival events such as a parade, games, feasting, music, and dancing. This festival has complex origins in more commonplace agricultural traditions brought from Finland by immigrants, which are often no longer commonly remembered in Finland to this day. In this paper, I will examine the complex history of this festival both through its Finnish origins and through its current incarnation in Michigan. Through this festival, we can see the role Finnish heritage has as a simultaneous marker of cultural pride and deprecation. The place Finnish heritage has as a tool in community and economic development in the City of Hancock and the wider region will also be explored. Finally, the function of the festival as a means of maintaining traditions seemingly doomed to fade with time will also be explored.

SPRING DISCHARGE MONITORING IN LOW-RESOURCE SETTINGS: A CASE STUDY OF CONCEPCIÓN CHIQUIRICHAPA, GUATEMALA

Water springs are the principal source of water for many localities in Central America, including the municipality of Concepción Chiquirichapa in the Western Highlands of Guatemala. Long-term monitoring records are critical for informed water management as well as resource forecasting, though data are scarce and monitoring in low-resource settings presents special challenges. Spring discharge was monitored monthly in six municipal springs during the author’s Peace Corps assignment, from May 2011 to March 2012, and water level height was monitored in two spring boxes over the same time period using automated water-level loggers. The intention of this approach was to circumvent the need for frequent and time-intensive manual measurement by identifying a fixed relationship between discharge and water level. No such relationship was identified, but the water level record reveals that spring yield increased for four months following Tropical Depression 12E in October 2011. This suggests that the relationship between extreme precipitation events and long-term water spring yields in Concepción should be examined further. These limited discharge data also indicate that aquifer baseflow recession and catchment water balance could be successfully characterized if a long-term discharge record were established. This study also presents technical and social considerations for selecting a methodology for spring discharge measurement and highlights the importance of local interest in conducting successful community-based research in intercultural low-resource settings.

One-year evaluation of a neonatal screening program for cystic fibrosis in Switzerland

BACKGROUND From January 2011 onward, the Swiss newborn screening (NBS) program has included a test for cystic fibrosis (CF). In this study, we evaluate the first year of implementation of the CF-NBS program. METHODS The CF-NBS program consists of testing in two steps: a heel prick sample is drawn (= Guthrie test) for measurement of immunoreactive trypsinogen (IRT) and for DNA screening. All children with a positive screening test are referred to a CF center for further diagnostic testing (sweat test and genetic analysis). After assessment in the CF center, the parents are given a questionnaire. All the results of the screening process and the parent questionnaires were centrally collected and evaluated. RESULTS In 2011, 83 198 neonates were screened, 84 of whom (0.1%) had a positive screening result and were referred to a CF center. 30 of these 84 infants were finally diagnosed with CF (positive predictive value: 35.7%). There was an additional infant with CF and meconium ileus whose IRT value was normal. The 31 diagnosed children with CF correspond to an incidence of 1 : 2683. The average time from birth to genetically confirmed diagnosis was 34 days (range: 13-135). 91% of the parents were satisfied that their child had undergone screening. All infants receiving a diagnosis of CF went on to receive further professional care in a CF center. CONCLUSION The suggested procedure for CF-NBS has been found effective in practice; there were no major problems with its implementation. It reached high acceptance among physicians and parents.

Swiss prospective study on spider bites

Knowledge of spider bites in Central Europe derives mainly from anecdotal case presentations; therefore we aimed to collect cases systematically. From June 2011 to November 2012 we prospectively collected 17 cases of alleged spider bites, and together with two spontaneous notifications later on, our database totaled 19 cases. Among them, eight cases could be verified. The causative species were: Cheiracanthium punctorium (3), Zoropsis spinimana (2), Amaurobius ferox, Tegenaria atrica and Malthonica ferruginea (1 each). Clinical presentation was generally mild, with the exception of Cheiracanthium punctorium, and patients recovered fully without sequelae. In Switzerland, spider bites generally have a benign clinical course, which is characterised by minor effects, with rapid and complete recovery. Since only verified spider bites can be regarded as spider bites, in the case of clinically important arachnidism, the spider should be sent to an expert for identification. Our study may help to diminish spider fear and reassure people who have experienced a bite. The study was registered at ClinicalTrials.gov (NCT01355744).

Prevalence and Clinical Significance of DSM-5-Attenuated Psychosis Syndrome in Adolescents and Young Adults in the General Population: The Bern Epidemiological At-Risk (BEAR) Study

Objective: Section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists attenuated psychosis syndrome as a condition for further study. One important question is its prevalence and clinical significance in the general population. Method: Analyses involved 1229 participants (age 16-40 years) from the general population of Canton Bern, Switzerland, enrolled from June 2011 to July 2012. "Symptom," "onset/worsening," "frequency," and "distress/disability" criteria of attenuated psychosis syndrome were assessed using the structured interview for psychosis-risk syndromes. Furthermore, help-seeking, psychosocial functioning, and current nonpsychotic axis I disorders were surveyed. Well-trained psychologists performed assessments using the computer-assisted telephone interviewing technique. Results: The symptom criterion was met by 12.9% of participants, onset/worsening by 1.1%, frequency by 3.8%, and distress/disability by 7.0%. Symptom, frequency, and distress/disability were met by 3.2%. Excluding trait-like attenuated psychotic symptoms (APS) decreased the prevalence to 2.6%, while adding onset/worsening reduced it to 0.3%. APS were associated with functional impairments, current mental disorders, and help-seeking although they were not a reason for help-seeking. These associations were weaker for attenuated psychosis syndrome. Conclusions: At the population level, only 0.3% met current attenuated psychosis syndrome criteria. Particularly, the onset/worsening criterion, originally included to increase the likelihood of progression to psychosis, lowered its prevalence. Because progression is not required for a self-contained syndrome, a revision of the restrictive onset criterion is proposed to avoid the exclusion of 2.3% of persons who experience and are distressed by APS from mental health care. Secondary analyses suggest that a revised syndrome would also possess higher clinical significance than the current syndrome.

Short-term clinical outcomes among patients undergoing transcatheter aortic valve implantation in Switzerland: the Swiss TAVI registry

Aims: To evaluate short-term clinical outcomes following transcatheter aortic valve implantation (TAVI) using CE-mark approved devices in Switzerland. Methods and results: The Swiss TAVI registry is a national, prospective, multicentre, monitored cohort study evaluating clinical outcomes in consecutive patients undergoing TAVI at cardiovascular centres in Switzerland. From February 2011 to March 2013, a total of 697 patients underwent TAVI for native aortic valve stenosis (98.1%), degenerative aortic bioprosthesis (1.6%) or severe aortic regurgitation (0.3%). Patients were elderly (82.4±6 years), 52% were females, and the majority highly symptomatic (73.1% NYHA III/IV). Patients with severe aortic stenosis (mean gradient 44.8±17 mmHg, aortic valve area 0.7±0.3 cm2) were either deemed inoperable or at high risk for conventional surgery (STS 8.2%±7). The transfemoral access was the most frequently used (79.1%), followed by transapical (18.1%), direct aortic (1.7%) and subclavian access (1.1%). At 30 days, rates of all-cause mortality, cerebrovascular events and myocardial infarction were 4.8%, 3.3% and 0.4%, respectively. The most frequently observed adverse events were access-related complications (11.8%), permanent pacemaker implantation (20.5%) and bleeding complications (16.6%). The Swiss TAVI registry is registered at ClinicalTrials.gov (NCT01368250). Conclusions: The Swiss TAVI registry is a national cohort study evaluating consecutive TAVI procedures in Switzerland. This first outcome report provides favourable short-term clinical outcomes in unselected TAVI patients.

CD8/CD45RO T-cell infiltration in endoscopic biopsies of colorectal cancer predicts nodal metastasis and survival

BACKGROUND AND AIMS: Reliable prognostic markers based on biopsy specimens of colorectal cancer (CRC) are currently missing. We hypothesize that assessment of T-cell infiltration in biopsies of CRC may predict patient survival and TNM-stage before surgery. METHODS: Pre-operative biopsies and matched resection specimens from 130 CRC patients treated from 2002-2011 were included in this study. Whole tissue sections of biopsy material and primary tumors were immunostained for pancytokeratin and CD8 or CD45RO. Stromal (s) and intraepithelial (i) T-cell infiltrates were analyzed for prediction of patient survival as well as clinical and pathological TNM-stage of the primary tumor. RESULTS: CD8 T-cell infiltration in the preoperative biopsy was significantly associated with favorable overall survival (CD8i p = 0.0026; CD8s p = 0.0053) in patients with primary CRC independently of TNM-stage and postoperative therapy (HR [CD8i] = 0.55 (95% CI: 0.36-0.82), p = 0.0038; HR [CD8s] = 0.72 (95% CI: 0.57-0.9), p = 0.0049). High numbers of CD8i in the biopsy predicted earlier pT-stage (p < 0.0001) as well as absence of nodal metastasis (p = 0.0015), tumor deposits (p = 0.0117), lymphatic (p = 0.008) and venous invasion (p = 0.0433) in the primary tumor. Infiltration by CD45ROs cells was independently associated with longer survival (HR = 0.76 (95% CI: 0.61-0.96), p = 0.0231) and predicted absence of venous invasion (p = 0.0025). CD8 counts were positively correlated between biopsies and the primary tumor (r = 0.42; p < 0.0001) and were reproducible between observers (ICC [CD8i] = 0.95, ICC [CD8s] = 0.75). For CD45RO, reproducibility was poor to moderate (ICC [CD45i] = 0.16, ICC [CD45s] = 0.49) and correlation with immune infiltration in the primary tumor was fair and non-significant (r[CD45s] = 0.16; p = 0.2864). For both markers, no significant relationship was observed with radiographic T-stage, N-stage or M-stage, indicating that assessment of T-cells in biopsy material can add additional information to clinical staging in the pre-operative setting. CONCLUSIONS: T-cell infiltration in pre-operative biopsy specimens of CRC is an independent favorable prognostic factor and strongly correlates with absence of nodal metastasis in the resection specimen. Quantification of CD8i is highly reproducible and allows superior prediction of clinicopathological features as compared to CD45RO. The assessment of CD8i infiltration in biopsies is recommended for prospective investigation.

Major challenges in clinical management of TB/HIV co-infected patients in Eastern Europe compared with Western Europe and Latin America.

INTRODUCTION Rates of both TB/HIV co-infection and multi-drug-resistant (MDR) TB are increasing in Eastern Europe (EE). Data on the clinical management of TB/HIV co-infected patients are scarce. Our aim was to study the clinical characteristics of TB/HIV patients in Europe and Latin America (LA) at TB diagnosis, identify factors associated with MDR-TB and assess the activity of initial TB treatment regimens given the results of drug-susceptibility tests (DST). MATERIAL AND METHODS We enrolled 1413 TB/HIV patients from 62 clinics in 19 countries in EE, Western Europe (WE), Southern Europe (SE) and LA from January 2011 to December 2013. Among patients who completed DST within the first month of TB therapy, we linked initial TB treatment regimens to the DST results and calculated the distribution of patients receiving 0, 1, 2, 3 and ≥4 active drugs in each region. Risk factors for MDR-TB were identified in logistic regression models. RESULTS Significant differences were observed between EE (n=844), WE (n=152), SE (n=164) and LA (n=253) for use of combination antiretroviral therapy (cART) at TB diagnosis (17%, 40%, 44% and 35%, p<0.0001), a definite TB diagnosis (culture and/or PCR positive for Mycobacterium tuberculosis; 47%, 71%, 72% and 40%, p<0.0001) and MDR-TB prevalence (34%, 3%, 3% and 11%, p <0.0001 among those with DST results). The history of injecting drug use [adjusted OR (aOR) = 2.03, (95% CI 1.00-4.09)], prior TB treatment (aOR = 3.42, 95% CI 1.88-6.22) and living in EE (aOR = 7.19, 95% CI 3.28-15.78) were associated with MDR-TB. For 569 patients with available DST, the initial TB treatment contained ≥3 active drugs in 64% of patients in EE compared with 90-94% of patients in other regions (Figure 1a). Had the patients received initial therapy with standard therapy [Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (RHZE)], the corresponding proportions would have been 64% vs. 86-97%, respectively (Figure 1b). CONCLUSIONS In EE, TB/HIV patients had poorer exposure to cART, less often a definitive TB diagnosis and more often MDR-TB compared to other parts of Europe and LA. Initial TB therapy in EE was sub-optimal, with less than two-thirds of patients receiving at least three active drugs, and improved compliance with standard RHZE treatment does not seem to be the solution. Improved management of TB/HIV patients requires routine use of DST, initial TB therapy according to prevailing resistance patterns and more widespread use of cART.

Alleviation of chronic venous leg ulcers with a hand-held dielectric barrier discharge plasma generator (PlasmaDerm(®) VU-2010): results of a monocentric, two-armed, open, prospective, randomized and controlled trial (NCT01415622).

BACKGROUND Cold atmospheric plasma (CAP, i.e. ionized air) is an innovating promising tool in reducing bacteria. OBJECTIVE We conducted the first clinical trial with the novel PlasmaDerm(®) VU-2010 device to assess safety and, as secondary endpoints, efficacy and applicability of 45 s/cm(2) cold atmospheric plasma as add-on therapy against chronic venous leg ulcers. METHODS From April 2011 to April 2012, 14 patients were randomized to receive standardized modern wound care (n = 7) or plasma in addition to standard care (n = 7) 3× per week for 8 weeks. The ulcer size was determined weekly (Visitrak(®) , photodocumentation). Bacterial load (bacterial swabs, contact agar plates) and pain during and between treatments (visual analogue scales) were assessed. Patients and doctors rated the applicability of plasma (questionnaires). RESULTS The plasma treatment was safe with 2 SAEs and 77 AEs approximately equally distributed among both groups (P = 0.77 and P = 1.0, Fisher's exact test). Two AEs probably related to plasma. Plasma treatment resulted in a significant reduction in lesional bacterial load (P = 0.04, Wilcoxon signed-rank test). A more than 50% ulcer size reduction was noted in 5/7 and 4/7 patients in the standard and plasma groups, respectively, and a greater size reduction occurred in the plasma group (plasma -5.3 cm(2) , standard: -3.4 cm(2) ) (non-significant, P = 0.42, log-rank test). The only ulcer that closed after 7 weeks received plasma. Patients in the plasma group quoted less pain compared to the control group. The plasma applicability was not rated inferior to standard wound care (P = 0.94, Wilcoxon-Mann-Whitney test). Physicians would recommend (P = 0.06, Wilcoxon-Mann-Whitney test) or repeat (P = 0.08, Wilcoxon-Mann-Whitney test) plasma treatment by trend. CONCLUSION Cold atmospheric plasma displays favourable antibacterial effects. We demonstrated that plasma treatment with the PlasmaDerm(®) VU-2010 device is safe and effective in patients with chronic venous leg ulcers. Thus, larger controlled trials and the development of devices with larger application surfaces are warranted.

An inter-regional assessment of concentrations and δ13C values of methane and dissolved inorganic carbon in small European lakes

Methane (CH4) and carbon dioxide emissions from lakes are relevant for assessing the greenhouse gas output of wetlands. However, only few standardized datasets describe concentrations of these gases in lakes across different geographical regions. We studied concentrations and stable carbon isotopic composition (δ13C) of CH4 and dissolved inorganic carbon (DIC) in 32 small lakes from Finland, Sweden, Germany, the Netherlands, and Switzerland in late summer. Higher concentrations and δ13C values of DIC were observed in calcareous lakes than in lakes on non-calcareous areas. In stratified lakes, δ13C values of DIC were generally lower in the hypolimnion due to the degradation of organic matter (OM). Unexpectedly, increased δ13C values of DIC were registered above the sediment in several lakes. This may reflect carbonate dissolution in calcareous lakes or methanogenesis in deepwater layers or in the sediments. Surface water CH4 concentrations were generally higher in western and central European lakes than in Fennoscandian lakes, possibly due to higher CH4 production in the littoral sediments and lateral transport, whereas CH4 concentrations in the hypolimnion did not differ significantly between the regions. The δ13C values of CH4 in the sediment suggest that δ13C values of biogenic CH4 are not necessarily linked to δ13C values of sedimentary OM but may be strongly influenced by OM quality and methanogenic pathway. Our study suggests that CH4 and DIC cycling in small lakes differ between geographical regions and that this should be taken into account when regional studies on greenhouse gas emissions are upscaled to inter-regional scales.

Besnoitia besnoiti lytic cycle in vitro and differences in invasion and intracellular proliferation among isolates

Background Bovine besnoitiosis, caused by the protozoan Besnoitia besnoiti, reduces productivity and fertility of affected herds. Besnoitiosis continues to expand in Europe and no effective control tools are currently available. Experimental models are urgently needed. Herein, we describe for the first time the kinetics of standardised in vitro models for the B. besnoiti lytic cycle. This will aid to study the pathogenesis of the disease, in the screening for vaccine targets and drugs potentially useful for the treatment of besnoitiosis. Methods We compared invasion and proliferation of one B. tarandi (from Finland) and seven B. besnoiti isolates (Bb-Spain1, Bb-Spain2, Bb-Israel, Bb-Evora03, Bb-Ger1, Bb-France, Bb-Italy2) in MARC-145 cell culture. Host cell invasion was studied at 4, 6, 8 and 24 h post infection (hpi), and proliferation characteristics were compared at 24, 48, 72, 96, 120, and 144 hpi. Results In Besnoitia spp., the key parameters that determine the sequential adhesion-invasion, proliferation and egress steps are clearly distinct from those in the related apicomplexans Toxoplasma gondii and Neospora caninum. Besnoitia spp. host cell invasion is a rather slow process, since only 50 % of parasites were found intracellular after 3–6 h of exposure to host cells, and invasion still took place after 24 h. Invasion efficacy was significantly higher for Bb-France, Bb-Evora03 and Bb-Israel. In addition, the time span for endodyogeny to take place was as long as 18–35 h. Bb-Israel and B. tarandi isolates were most prolific, as determined by the tachyzoite yield at 72 hpi. The total tachyzoite yield could not be predicted neither by invasion-related parameters (velocity and half time invasion) nor by proliferation parameters (lag phase and doubling time (dT)). The lytic cycle of Besnoitia was asynchronous as evidenced by the presence of three different plaque-forming tachyzoite categories (lysis plaques, large and small parasitophorous vacuoles). Conclusions This study provides first insights into the lytic cycle of B. besnoiti isolates and a standardised in vitro model that allows screening of drug candidates for the treatment of besnoitiosis.