Opening Comments Before Master Conservationist Presentations

It is a real pleasure to participate in this recognition program honoring the 2004 Master-Conservationists. We are grateful for the partnership with the Omaha World Herald in this unique program. In an effort to keep the program in tune with current developments in soil and waster conservation, a special committee is considering the idea of including conservation easements in the 2005 program. Some members of the committee are in the audience tonight. We appreciate the efforts of members of the Omaha World Herald, Natural Resources Districts, the USDA Natural-Resources Conservation Service and the Institute of Agriculture and Natural Resources in carrying out this program.

COMMENSAL RODENT CONTROL

SUMMARY: Federal Urban Rat Control Program grants were awarded to cities in different areas of the United States. Severe problems of rat infestations have been detected in many of the cities by the Environmental Health Service. Approximately 20% of 3.8 million people in the project areas were occupying homes infested with rats. Control operations are now in effect in all cities, and the living conditions of the people have been substantially improved. An increase in interest in rodent control also is evident in countries outside of the United States. The Technical Development Laboratories of the National Communicable Disease Center are participating in the World Health Organization program of research on new rodenticides. The evaluation program involves five steps which carry a candidate toxi¬cant from laboratory phase through field testing. Acceptability and suitable concentrations of both acute and accumulative rodenticides are determined. Observations are made on the hazard of the compound to pets and to other nontarget vertebrates. Laboratory and field studies have been completed on a new, promising stabilized scilliroside glycoside which has given excellent control of the Norway rat in 16 out of 19 premises. Another new coded compound has shown a unique specificity for roof rats as compared to Norway rats. Although anticoagulant resistant rat populations have occurred in several countries in Europe, as yet no evidence has been noted of such resistance in rats in the United States.

Dentomaxillofacial manifestations of Gaucher's disease: preliminary clinical and radiographic findings

Objectives: A wide variety of manifestations is presented in patients with Gaucher's disease (GD), including bone, haematology and visceral disturbances. This study was conducted to ascertain the main maxillofacial abnormalities by means of clinical survey, panoramic and cone beam CT (CBCT); to compare the patient's group with an age-sex matched control group; and to correlate clinical and radiological data. Methods: Ten patients previously diagnosed with GD were submitted to clinical and radiological surveys (CBCT and panoramic radiographs). The examination consisted of anamnesis, extra- and intraoral examinations and analyses of each patient's records. Imaging data were collected from the point of view of 3 observers, and the results compared with a healthy group (20 individuals) by means of statistical analysis (Fisher's exact test). Results: Gaucher patients had significantly more manifestations than otherwise healthy carriers. The most prevalent findings were enlarged marrow spaces, generalized osteopenia and effacement of jaw structures (mandibular canal, lamina dura and mental foramen). Here we describe a case in which thickening of the maxillary sinus mucosa was observed on CBCT rather than opacification of the sinus as seen on panoramic radiographs. Pathological fractures, root resorption and delay on tooth eruption were not observed. Conclusions: A poor relationship could be observed between clinical and radiological data. Patients showed important bone manifestations, which require careful diagnostic and surgical planning whenever necessary. Although panoramic radiographs have shown significant differences, CBCT is more effective in pointing out differences between patients and a control group, thus showing it as an important tool for evaluation of Gaucher patients. Dentomaxillofacial Radiology (2012) 41, 541-547. doi: 10.1259/dmfr/143023353

Mitochondrial localization and structure-based phosphate activation mechanism of Glutaminase C with implications for cancer metabolism

Glutamine is an essential nutrient for cancer cell proliferation, especially in the context of citric acid cycle anaplerosis. In this manuscript we present results that collectively demonstrate that, of the three major mammalian glutaminases identified to date, the lesser studied splice variant of the gene gls, known as Glutaminase C (GAC), is important for tumor metabolism. We show that, although levels of both the kidney-type isoforms are elevated in tumor vs. normal tissues, GAC is distinctly mitochondrial. GAC is also most responsive to the activator inorganic phosphate, the content of which is supposedly higher in mitochondria subject to hypoxia. Analysis of X-ray crystal structures of GAC in different bound states suggests a mechanism that introduces the tetramerization-induced lifting of a "gating loop" as essential for the phosphate-dependent activation process. Surprisingly, phosphate binds inside the catalytic pocket rather than at the oligomerization interface. Phosphate also mediates substrate entry by competing with glutamate. A greater tendency to oligomerize differentiates GAC from its alternatively spliced isoform and the cycling of phosphate in and out of the active site distinguishes it from the liver-type isozyme, which is known to be less dependent on this ion.

Associação de variáveis ambientais à ocorrência de leptospirose canina e humana na cidade de São Paulo

Foi realizada uma análise espacial da ocorrência de leptospirose humana e canina na Supervisão de Vigilância em Saúde do Butantã, situada no município de São Paulo, no ano de 2007, associada a variáveis ambientais de risco, tais como: focos de enchente e áreas de desratização. Foram encontrados aglomerados espaciais de pontos de alagamentos em 12 setores censitários e de casos de leptospirose humana em quatro setores censitários, sem correlação entre ambos. Não foram encontrados agrupamentos de casos em cães, possivelmente devido à subnotificação. As proporções casos humanos de leptospirose : população humana dentro e fora da área de desratização foram 7:199.600 e 9:257.980, respectivamente. Conclui-se que medidas de controle de roedores como a desratização foram responsáveis pela minimização dos efeitos dos fatores de risco para a transmissão de leptospirose para humanos.

Performance and radial distribution profiles of a variable flow rate sprinkler developed for precision irrigation

Variable rate sprinklers (VRS) have been developed to promote localized water application of irrigated areas. In Precision Irrigation, VRS permits better control of flow adjustment and, at the same time, provides satisfactory radial distribution profiles for various pressures and flow rates are really necessary. The objective of this work was to evaluate the performance and radial distribution profiles of a developed VRS which varies the nozzle cross sectional area by moving a pin in or out using a stepper motor. Field tests were performed under different conditions of service pressure, rotation angles imposed on the pin and flow rate which resulted in maximal water throw radiuses ranging from 7.30 to 10.38 m. In the experiments in which the service pressure remained constant, the maximal throw radius varied from 7.96 to 8.91 m. Averages were used of repetitions performed under conditions without wind or with winds less than 1.3 m s-1. The VRS with the four stream deflector resulted in greater water application throw radius compared to the six stream deflector. However, the six stream deflector had greater precipitation intensities, as well as better distribution. Thus, selection of the deflector to be utilized should be based on project requirements, respecting the difference in the obtained results. With a small opening of the nozzle, the VRS produced small water droplets that visually presented applicability for foliar chemigation. Regarding the comparison between the estimated and observed flow rates, the stepper motor produced excellent results.

Expression profiling und rationale Expressionsoptimierung am Beispiel eines prokaryontischen Wirt-,Vektor-Systems

Durch globale Expressionsprofil-Analysen auf Transkriptom-, Proteom- oder Metabolom-Ebene können biotechnologische Produktionsprozesse besser verstanden und die Erkenntnisse für die zielgerichtete, rationale Optimierung von Expressionssystemen genutzt werden. In der vorliegenden Arbeit wurde die Überexpression einer Glukose-Dehydrogenase (EC 1.1.5.2), die von der Roche Diagnostics GmbH für die diagnostische Anwendung optimiert worden war, in Escherichia coli untersucht. Die Enzymvariante unterscheidet sich in sieben ihrer 455 Aminosäuren vom Wildtyp-Enzym und wird im sonst isogenen Wirt-/Vektor-System in signifikant geringeren Mengen (Faktor 5) gebildet. Das prokaryontische Expressionssystem wurde auf Proteom-Ebene charakterisiert. Die 2-dimensionale differenzielle Gelelektrophorese (DIGE) wurde zuvor unter statistischen Aspekten untersucht. Unter Berücksichtigung von technischen und biologischen Variationen, falsch-positiven (α-) und falsch-negativen (β-) Fehlern sowie einem daraus abgeleiteten Versuchsdesign konnten Expressionsunterschiede als signifikant quantifiziert werden, wenn sie um den Faktor ≥ 1,4 differierten. Durch eine Hauptkomponenten-Analyse wurde gezeigt, dass die DIGE-Technologie für die Expressionsprofil-Analyse des Modellsystems geeignet ist. Der Expressionsstamm für die Enzymvariante zeichnete sich durch eine höhere Variabilität an Enzymen für den Zuckerabbau und die Nukleinsäure-Synthese aus. Im Expressionssystem für das Wildtyp-Enzym wurde eine unerwartet erhöhte Plasmidkopienzahl nachgewiesen. Als potenzieller Engpass in der Expression der rekombinanten Glukose-Dehydrogenase wurde die Löslichkeitsvermittlung identifiziert. Im Expressionsstamm für das Wildtyp-Enzym wurden viele Proteine für die Biogenese der äußeren Membran verstärkt exprimiert. Als Folge dessen wurde ein sog. envelope stress ausgelöst und die Zellen gingen in die stationäre Wuchsphase über. Die Ergebnisse der Proteomanalyse wurden weiterführend dazu genutzt, die Produktionsleistung für die Enzymvariante zu verbessern. Durch den Austausch des Replikationsursprungs im Expressionsvektor wurde die Plasmidkopienzahl erhöht und die zelluläre Expressionsleistung für die diagnostisch interessantere Enzymvariante um Faktor 7 - 9 gesteigert. Um die Löslichkeitsvermittlung während der Expression zu verbessern, wurde die Plasmidkopienzahl gesenkt und die Coexpression von Chaperonen initiiert. Die Ausbeuten aktiver Glukose-Dehydrogenase wurden durch die Renaturierung inaktiven Produkts aus dem optimierten Expressionssystem insgesamt um einen Faktor von 4,5 erhöht. Somit führte im Rahmen dieser Arbeit eine proteombasierte Expressionsprofil-Analyse zur zielgerichteten, rationalen Expressionsoptimierung eines prokaryontischen Modellsystems.

Elastizität porenüberspannender Membranen: eine kraftmikroskopische Studie

Membranen spielen eine essentielle Rolle bei vielen wichtigen zellulären Prozessen. Sie ermöglichen die Erzeugung von chemischen Gradienten zwischen dem Zellinneren und der Umgebung. Die Zellmembran übernimmt wesentliche Aufgaben bei der intra- und extrazellulären Signalweiterleitung und der Adhäsion an Oberflächen. Durch Prozesse wie Endozytose und Exozytose werden Stoffe in oder aus der Zelle transportiert, eingehüllt in Vesikel, welche aus der Zellmembran geformt werden. Zusätzlich bietet sie auch Schutz für das Zellinnere. Der Hauptbestandteil einer Zellmembran ist die Lipiddoppelschicht, eine zweidimensionale fluide Matrix mit einer heterogenen Zusammensetzung aus unterschiedlichen Lipiden. In dieser Matrix befinden sich weitere Bausteine, wie z.B. Proteine. An der Innenseite der Zelle ist die Membran über Ankerproteine an das Zytoskelett gekoppelt. Dieses Polymernetzwerk erhöht unter anderem die Stabilität, beeinflusst die Form der Zelle und übernimmt Funktionenrnbei der Zellbewegung. Zellmembranen sind keine homogenen Strukturen, je nach Funktion sind unterschiedliche Lipide und Proteine in mikrsokopischen Domänen angereichert.Um die grundlegenden mechanischen Eigenschaften der Zellmembran zu verstehen wurde im Rahmen dieser Arbeit das Modellsystem der porenüberspannenden Membranen verwendet.Die Entwicklung der porenüberspannenden Membranen ermöglicht die Untersuchung von mechanischen Eigenschaften von Membranen im mikro- bis nanoskopischen Bereich mit rasterkraftmikroskopischen Methoden. Hierbei bestimmen Porosität und Porengröße des Substrates die räumliche Auflösung, mit welcher die mechanischen Parameter untersucht werdenrnkönnen. Porenüberspannende Lipiddoppelschichten und Zellmembranen auf neuartigen porösen Siliziumsubstraten mit Porenradien von 225 nm bis 600 nm und Porositäten bis zu 30% wurden untersucht. Es wird ein Weg zu einer umfassenden theoretischen Modellierung der lokalen Indentationsexperimente und der Bestimmung der dominierenden energetischen Beiträge in der Mechanik von porenüberspannenden Membranen aufgezeigt. Porenüberspannende Membranen zeigen eine linear ansteigende Kraft mit zunehmender Indentationstiefe. Durch Untersuchung verschiedener Oberflächen, Porengrößen und Membranen unterschiedlicher Zusammensetzung war es für freistehende Lipiddoppelschichten möglich, den Einfluss der Oberflächeneigenschaften und Geometrie des Substrates, sowie der Membranphase und des Lösungsmittels auf die mechanischen Eigenschaften zu bestimmen. Es ist möglich, die experimentellen Daten mit einem theoretischen Modell zu beschreiben. Hierbei werden Parameter wie die laterale Spannung und das Biegemodul der Membran bestimmt. In Abhängigkeit der Substrateigenschaften wurden für freitragende Lipiddoppelschichten laterale Spannungen von 150 μN/m bis zu 31 mN/m gefunden für Biegemodulde zwischen 10^(−19) J bis 10^(−18) J. Durch Kraft-Indentations-Experimente an porenüberspannenden Zellmembranen wurde ein Vergleich zwischen dem Modell der freistehenden Lipiddoppelschichten und nativen Membranen herbeigeführt. Die lateralen Spannungen für native freitragende Membranen wurden zu 50 μN/m bestimmt. Weiterhin konnte der Einfluss des Zytoskeletts und der extrazellulä-rnren Matrix auf die mechanischen Eigenschaften bestimmt und innerhalb eines basolateralen Zellmembranfragments kartiert werden, wobei die Periodizität und der Porendurchmesser des Substrates das räumliche Auflösungsvermögen bestimmen. Durch Fixierung der freistehenden Zellmembran wurde das Biegemodul der Membran um bis zu einem Faktor 10 erhöht. Diese Arbeit zeigt wie lokal aufgelöste, mechanische Eigenschaften mittels des Modellsystems der porenüberspannenden Membranen gemessen und quantifiziert werden können. Weiterhin werden die dominierenden energetischen Einflüsse diskutiert, und eine Vergleichbarkeit zurnnatürlichen Membranen hergestellt.rn

Forme atipiche di malattia mani-piedi-bocca: La nostra esperienza

Introduzione: La malattia mani-piedi-bocca è una patologia infettiva tipica della prima infanzia causata dagli enterovirus, in particolare i sierotipi Coxsackievirus A16 ed Enterovirus 71. A partire dal 2008, ne è stata descritta un’epidemia da Coxsackievirus A6, in genere accompagnata da febbre elevata e che si distingue per lo sviluppo di piccole vescicole che progrediscono a lesioni vescicolo-bollose e a bolle vere e proprie. Inoltre, nei pazienti affetti da dermatite atopica, le lesioni tendono a localizzarsi sulle aree eczematose. Abbiamo quindi svolto uno studio osservazionale prospettico per descrivere le caratteristiche cliniche delle forme atipiche di malattia mani-piedi-bocca. Metodi: Sono stati arruolati i pazienti affetti da una forma atipica di malattia mani-piedi-bocca giunti consecutivamente presso l’Ambulatorio di Dermatologia Pediatrica del Policlinico S.Orsola-Malpighi di Bologna tra gennaio 2012 e febbraio 2014. Abbiamo valutato distribuzione, tipologia ed estensione delle lesioni. In un gruppo di pazienti è stata inoltre eseguita l’identificazione virale sul fluido vescicolare. Risultati: Abbiamo arruolato 47 pazienti (68% maschi) con un’età mediana di 22 mesi. Sono stati individuati 3 aspetti clinici principali: 1) forma acrale (distribuzione delle lesioni prevalentemente acrale), nel 62% dei soggetti; 2) eczema coxsackium (lesioni localizzate su aree eczematose), nel 23% dei soggetti; 3) forma diffusa (estensione delle lesioni al tronco), nel 15% dei soggetti. Inoltre, nell’80% circa dei pazienti si riscontravano macule purpuriche acrali, circa la metà dei pazienti aveva lesioni con aspetto purpurico e il 72% un interessamento dei glutei. In 9 su 11 soggetti genotipizzati è stato isolato il Coxsackievirus A6. Conclusioni: Questo studio ha permesso di descrivere tre fenotipi di malattia mani-piedi-bocca atipica, che deve essere correttamente identificata al fine di non porre diagnosi errate quali varicella, eczema herpeticum, vasculiti, impetigine, e di potere così procedere ad una gestione appropriata della patologia.

Tracer diffusion at water-oil interfaces studied by fluorescence correlation spectroscopy

The adsorption of particles and surfactants at water-oil interfaces has attracted continuous attention because of its emulsion stabilizing effect and the possibility to form two-dimensional materials. Herein, I studied the interfacial diffusion of single molecules and nanoparticles at water-oil interfaces using fluorescence correlation spectroscopy. rnrnFluorescence correlation spectroscopy (FCS) is a promising technique to study diffusion of fluorescent tracers in diverse conditions. This technique monitors and analyzes the fluorescence fluctuation caused by single fluorescent tracers coming in and out of a diffraction-limited observation volume “one at a time”. Thus, this technique allows a combination of high precision, high spatial resolution and low tracer concentration. rnrnIn chapter 1, I discussed some controversial questions regarding the properties of water-hydrophobic interfaces and also introduced the current progress on the stability and dynamic of single nanoparticles at water-oil interfaces. The materials and setups I used in this thesis were summarized in chapter 2. rnrnIn chapter 3, I presented a new strategy to study the properties of water-oil interfaces. The two-dimensional diffusion of isolated molecular tracers at water/n-alkane interfaces was measured using fluorescence correlation spectroscopy. The diffusion coefficients of larger tracers with a hydrodynamic radius of 4.0 nm agreed well with the values calculated from the macroscopic viscosities of the two bulk phases. However, for small molecule tracers with hydrodynamic radii of only 1.0 and 0.6 nm, notable deviations were observed, indicating the existence of an interfacial region with a reduced effective viscosity. rnrnIn chapter 4, the interfacial diffusion of nanoparticles at water-oil interfaces was investigated using FCS. In stark contrast to the interfacial diffusion of molecular tracers, that of nanoparticles at any conditions is slower than the values calculated in accordance to the surrounding viscosity. The diffusion of nanoparticles at water-oil interfaces depended on the interfacial tension of liquid-liquid interfaces, the surface properties of nanoparticles, the particle sizes and the viscosities of surrounding liquid phases. In addition, the interfacial diffusion of nanoparticles with Janus motif is even slower than that of their symmetric counterparts. Based on the experimental results I obtained, I drew some possibilities to describe the origin of nanoparticle slowdown at water-oil interfaces.

Meccanizzazione dei vigneti allevati a doppia cortina e a cordone libero

La ricerca svolta ha voluto approfondire le possibilità offerte dai sistemi di allevamento dei vigneti a Doppia Cortina (GDC) e a Cordone Libero nei riguardi della meccanizzazione. La ricerca ha considerato gli interventi di potatura invernale, di gestione della chioma (spollonatura, cimatura, defogliazione e pettinatura della doppia cortina) e di vendemmia. Un’operazione particolarmente seguita è stata la potatura invernale realizzando differenti livelli di meccanizzazione. Tutti gli interventi sono stati eseguiti sia manualmente che meccanicamente, confrontando i tempi d’impiego, la qualità del lavoro svolto e gli impegni di manodopera. I risultati sono stati sintetizzati in una valutazione economica, ipotizzando differenti livelli di costo della manodopera impiegata, per ottenere giudizi di convenienza per i singoli interventi e per costruire una valutazione completa e più organica della linea di lavoro proposta. Nelle due forme d’allevamento la meccanizzazione della potatura invernale e della gestione della chioma hanno rispettato pienamente gli obbiettivi tecnici prefissati, dimostrando di essere un valido mezzo per ridurre tempi e costi di gestione. Per questi interventi l’acquisto delle macchine risulta conveniente anche per vigneti di piccola dimensione. Ancor più evidenti in queste due forme d’allevamento sono i vantaggi economici offerti dalla vendemmia meccanica, realizzata con pochi maltrattamenti e perdite di prodotto. La tendenza a meccanizzare integralmente gli interventi di gestione del ciclo colturale della vite, può essere nei prossimi anni un motivo di interesse e di scelta nella realizzazione di nuovi impianti con queste due forme di allevamento, che hanno dimostrato di essere un’espressione completa di sinergia tra macchina e pianta.

Zielvereinbarungsgespräch und Leitungsaufgabe von katholischen Priestern

Die großen christlichen Kirchen in Deutschland befinden sich in einem strukturellen Umbruch, der sich zunehmend auf die Pastoral der örtlichen Pfarreien und Kirchengemeinden auswirkt. Durch die Einführung von Verfahren aus dem New Public Management erhoffen sich Kirchenleitungen beider Konfessionen eine innerkirchliche Personalentwicklung, die vor allem das hauptberufliche Seelsorgepersonal neu motivieren soll. Insbesondere in der katholischen Kirche soll so - in Verbindung mit einem möglichst missionarisch wirksamen Neuaufbruch - die Transformation der ehemals volkskirchlich geprägten Pfarrgemeinden in eine sich neu abzeichnende Sozialgestalt von Kirche als Netzwerk größerer pastoraler Einheiten unterstützt werden. Die vorliegende Arbeit untersucht an der interdisziplinären Schnittstelle von Organisationforschung und praktischer Theologie, inwieweit die Einführung von Zielvereinbarungsgesprächen (ZVG) führungsverantwortliche Priester in der Wahrnehmung ihrer Leitungsaufgabe stärkt. Über 300 leitende Priester aus den Erzbistümern Freiburg und Paderborn hatten an der empirischen Studie mit zwei Messzeitpunkten teilgenommen. 73 Priester waren an beiden Messzeitpunkten A (2007) und B (2008) beteiligt. Unmittelbar nach dem Zeitpunkt A besuchten die befragten Priester der Erzdiözese Freiburg eine ZVG-Einführungsschulung, der sich eine einjährige Gesprächspraxis anschloss. Die in der Erzdiözese Paderborn befragten Priester bildeten die Vergleichsgruppe (ohne entsprechendes Treatment).rn rnWesentliches Ergebnis der Studie sind empirische Hinweise auf signifikante Zusammenhänge zwischen dem priesterlichem Leitungsselbstverständnis, der ZVG-Umsetzung und der Einschätzung der eigenen Führungsqualität.rnrnIn den Selbsteinschätzungen der leitenden Priester (z.B. im Hinblick auf Leitungszufriedenheit, Bedeutung bzw. Gelingen von einzelnen Leitungs- und Gesprächsaspekten, etc.) zeigten sich zum Zeitpunkt A im Vergleich zwischen beiden Diözesen nur geringe Unterschiede. Dies gilt auch für die in A erfolgte Auswertung offener Fragen zum priesterlichen Selbstverständnis, welches als leitungs-amtliche Handlungs- und Objektorientierung in beiden Diözesen am wenigsten stark ausgeprägt war.Zum Zeitpunkt B verdeutlichte die Untersuchung des Tätigkeitsfelds Gemeindeleitung, dass dessen Bedeutung in Freiburg größer war als in Paderborn. Der hierfür erbrachte Kraft- bzw. Zeitaufwand war in Freiburg jedoch niedriger als in Paderborn, was als eine Frucht der verbindlichen ZVG-Einführung in Freiburg interpretiert werden kann. Deutlich wird auch, dass Priester, die der ZVG-Einführung eine hohe Bedeutung beimessen, mit ihren Mitarbeitern viele Gespräche planen. Weil Folgegespräche zum Zeitpunkt B im gleichen Umfang wie schon zum Zeitpunkt A geplant wurden, müssen die konkreten Gesprächserfahrungen in der A-Phase hinreichend positiv gewesen sein. Die Umsetzung zum Zeitpunkt B war jedoch nicht in dem zum Zeitpunkt A geplanten Maß erfolgt, was sich mit Prioritätsverschiebungen erklären lässt. Interessanterweise korreliert die Anzahl der geführten Zielvereinbarungsgespräche mit dem Dienst- und Lebensalter der Priester. Erfahrene Priester, die sich auf eine Mitarbeiterführung durch Zielvereinbarung einlassen, machen demnach gute Erfahrungen mit diesem Personalentwicklungsinstrument. rnrnInsgesamt können die Ergebnisse der Studie zu einer weiteren Kultivierung der Zielvereinbarungsgespräche im kirchlichen Dienst ermutigen. Bistümern, die noch keine Zielvereinbarungsgespräche eingeführt haben, kann eine Implementierung angeraten werden. rn

Aesthetic outcome and oncological safety of nipple-areola complex replantation after mastectomy and immediate breast reconstruction

Immediate breast reconstruction (IBR) has become an established procedure for women necessitating mastectomy. Traditionally, the nipple-areola complex (NAC) is resected during this procedure. The NAC, in turn, is a principal factor determining aesthetic outcome after breast reconstruction, and due to its particular texture and shape, a natural-looking NAC can barely be reconstructed with other tissues. The aim of this study was to assess the oncological safety as well as morbidity and aesthetic outcome after replantation of the NAC some days after IBR. Retrospective analysis of 85 patients receiving 88 mastectomies and IBR between 1998 and 2007 was conducted. NAC (n=29) or the nipple alone (n=23) were replanted 7 days (median, range 2-10 days) after IBR in 49 patients, provided the subareolar tissue was histologically negative for tumour infiltration. Local recurrence rate was assessed after 49 months (median, range 6-120 months). Aesthetic outcome was evaluated by clinical assessment during routine follow-up at least 12 months after the last intervention. Malignant involvement of the subareolar tissue was found in eight cases (9.1%). Patients qualifying for NAC replantation were in stage 0 in 29%, stage I in 15%, stage IIa in 31%, stage IIb in 17% and stage III in 8%. Total or partial necrosis occurred in 69% and 26% if the entire NAC or only the nipple were replanted, respectively (P<0.01). Depigmentation was seen in 52% and corrective surgery was done in 11 out of 52 NAC or nipple replantations. Local recurrence and isolated regional lymph node metastasis were observed in one single case each. Another 5.8% of the patients showed distant metastases. We conclude that the replantation of the NAC in IBR is oncologically safe, provided the subareolar tissue is free of tumour. However, the long-term aesthetic outcome of NAC replantation is not satisfying, which advocates replanting the nipple alone.

Oncocytic ependymoma: a new morphological variant of high-grade ependymal neoplasm composed of mitochondrion-rich epithelioid cells

Oncocytomas are defined as tumors containing in excess of 50% large mitochondrion-rich cells, irrespective of histogenesis and dignity. Along the central neuraxis, oncocytomas are distinctly uncommon but relevant to the differential diagnosis of neoplasia marked by prominent cytoplasmic granularity. We describe an anaplastic ependymoma (WHO grade III) with a prevailing oncocytic component that was surgically resected from the right fronto-insular region of a 43-year-old female. Preoperative imaging showed a fairly circumscribed, partly cystic, contrast-enhancing mass of 2 cm × 2 cm × 1.7 cm. Histology revealed a biphasic neoplasm wherein conventional ependymal features coexisted with plump epithelioid cells replete with brightly eosinophilic granules. Whereas both components displayed an overtly ependymal immunophenotype, including positivity for S100 protein and GFAP, as well as "dot-like" staining for EMA, the oncocytic population also tended to intensely react with the antimitochondrial antibody 113-1. Conversely, failure to bind CD68 indicated absence of significant lysosomal storage. Negative reactions for both pan-cytokeratin (MNF 116) and low molecular weight cytokeratin (CAM 5.2), as well as synaptophysin and thyroglobulin, further assisted in ruling out metastatic carcinoma. In addition to confirming the presence of "zipper-like" intercellular junctions and microvillus-bearing cytoplasmic microlumina, electron microscopy allowed for the pervasive accumulation of mitochondria in tumor cells to be directly visualized. A previously not documented variant, oncocytic ependymoma, is felt to add a reasonably relevant novel item to the differential diagnosis of granule-bearing central nervous system neoplasia, in particular oncocytic meningioma, granular cell astrocytoma, as well as metastatic deposits by oncocytic malignancies from extracranial sites.

Ultrasonographic guided axillary plexus blocks with low volumes of local anaesthetics: a crossover volunteer study

Our study group recently evaluated an ED(95) local anaesthetic volume of 0.11 ml.mm(-2) cross-sectional nerve area for the ulnar nerve. This prospective, randomised, double-blind crossover study investigated whether this volume is sufficient for brachial plexus blocks at the axillary level. Ten volunteers received an ultrasonographic guided axillary brachial plexus block either with 0.11 ('low' volume) or 0.4 ('high' volume) ml.mm(-2) cross-sectional nerve area with mepivacaine 1%. The mean (SD) volume was in the low volume group 4.0 (1.0) and 14.8 (3.8) ml in the high volume group. The success rate for the individual nerve blocks was 27 out of 30 in the low volume group (90%) and 30 out of 30 in the high volume group (100%), resulting in 8 out of 10 (80%) vs 10 out of 10 (100%) complete blocks in the low vs the high volume groups, respectively (NS). The mean (SD) sensory onset time was 25.0 (14.8) min in the low volume group and 15.8 (6.8) min in the high volume group (p < 0.01). The mean (SD) duration of sensory block was 125 (38) min in the low volume group and 152 (70) min in the high volume group (NS). This study confirms our previous published ED(95) volume for mepivacaine 1% to block peripheral nerves. The volume of local anaesthetic has some influence on the sensory onset time.