Estimated incidence and number of outpatient visits for seasonal influenza in 2015-2016 in Beijing, China.

Information on morbidity burden of seasonal influenza in China is limited. A multiplier model was used to estimate the incidence and number of outpatient visits for seasonal influenza by age group for the 2015-2016 season in Beijing, the capital of China, based on reported numbers of influenza-like illness consultations and proportions of positive cases from influenza surveillance systems in Beijing, general consultation rates and other parameters from previous studies, surveys and surveillance systems. An estimated total of 1 190 200 (95% confidence interval (CI) 830 400-1 549 900) cases of influenza virus infections occurred in Beijing, 2015-2016 season, with an attack rate of 5·5% (95% CI 3·9-7·2%). These infections resulted in an estimated 468 280 (95% CI 70 700-606 800) outpatient visits, with an attack rate of 2·2% (95% CI 0·3-2·8%). The attack rate of influenza virus infections was highest among children aged 0-4 years (31·9% (95% CI 21·9-41·9%)), followed by children aged 5-14 years (18·7% (95% CI 12·9-24·5%)). Our study demonstrated a substantial influenza-related morbidity in Beijing, China, especially among the preschool- and school-aged children. This suggests that development or modification of seasonal influenza targeted vaccination strategies need to recognize that incidence is highest in children.

A concept for routine emergency-care data-based syndromic surveillance in Europe.

We developed a syndromic surveillance (SyS) concept using emergency dispatch, ambulance and emergency-department data from different European countries. Based on an inventory of sub-national emergency data availability in 12 countries, we propose framework definitions for specific syndromes and a SyS system design. We tested the concept by retrospectively applying cumulative sum and spatio-temporal cluster analyses for the detection of local gastrointestinal outbreaks in four countries and comparing the results with notifiable disease reporting. Routine emergency data was available daily and electronically in 11 regions, following a common structure. We identified two gastrointestinal outbreaks in two countries; one was confirmed as a norovirus outbreak. We detected 1/147 notified outbreaks. Emergency-care data-based SyS can supplement local surveillance with near real-time information on gastrointestinal patients, especially in special circumstances, e.g. foreign tourists. It most likely cannot detect the majority of local gastrointestinal outbreaks with few, mild or dispersed cases.

Local implementation of a syndromic influenza surveillance system using emergency department data in Santander, Spain.

BACKGROUND: We assessed the local implementation of syndromic surveillance (SyS) as part of the European project 'System for Information on, Detection and Analysis of Risks and Threats to Health' in Santander, Spain. METHODS: We applied a cumulative sum algorithm on emergency department (ED) chief complaints for influenza-like illness in the seasons 2010-11 and 2011-12. We fine tuned the algorithm using a receiver operating characteristic analysis to identify the optimal trade-off of sensitivity and specificity and defined alert criteria. We assessed the timeliness of the SyS system to detect the onset of the influenza season. RESULTS: The ED data correlated with the sentinel data. With the best algorithm settings we achieved 70/63% sensitivity and 89/95% specificity for 2010-11/2011-12. At least 2 consecutive days of signals defined an alert. In 2010-11 the SyS system alerted 1 week before the sentinel system and in 2011-12 in the same week. The data from the ED is available on a daily basis providing an advantage in timeliness compared with the weekly sentinel data. CONCLUSIONS: ED-based SyS in Santander complements sentinel influenza surveillance by providing timely information. Local fine tuning and definition of alert criteria are recommended to enhance validity.

Quality of alveolar bone--Structure-dependent material properties and design of a novel measurement technique.

The evidence for the efficiency of clinical methods used to assess the quality of alveolar bone in terms of a density measure prior to and during dental implant surgery is limited. The aim of this paper is to describe the biomechanical background which can be used as a basis for determining the bone quality by measuring the elastic properties of the bone and to design a novel device for the determination of the bone quality during dental implant surgery. Applying material mechanical equations for porous and cellular structured models, the elastic material properties (modulus of elasticity) of cellular and cortical bone as porous structures were approximated over the whole range of relative bone mineral density of trabecular and cortical bone. Based on a circular disc with a central hole reflecting a horizontal cross-section of an implant socket, the mechanical effects of expanding the central hole were studied. Subsequently, the clinical situation of a socket prepared for the placement of a dental implant (depth: 10 mm; diameter 3.5 mm) was simulated using three-dimensional (3D) finite element analysis. A loading device (thickness: 3.5 mm) was placed in the trabecular part of the socket and expanded, while the resulting pressure was recorded and used for the calculation of an elastic modulus. Finite element analysis revealed that it was possible to estimate the bone quality by applying the measurement technique proposed. Maximum deviations of 6% of the experimentally determined elastic modulus from the setpoint elastic modulus were found. Measuring the internal pressure in a drill hole, e.g., in an implant socket caused by a defined expansion of a rotational symmetric loading device, could be used for establishing a clinically meaningful test system for the objective classification of alveolar bone.

[Comparison of the emergency medical services systems of Birmingham and Bonn: process efficacy and cost effectiveness]. / Effektivitäts- und Effizienzvergleich der Rettungsdienstsysteme in Birmingham (UK) und Bonn (D).

OBJECTIVE: Due to rising health care costs there is a need to verify that the treatment by Emergency Medical Services (EMS) systems is efficient and cost effective. The integration of emergency physicians is inherent part of out-of-hospital emergency care and regulated by law in Germany but not in England and the United States of America. Aim of this study therefore was to conduct a cost performance analysis by evaluating the underlying structure, the costs incurred and the achieved performance in two EMS systems with paramedics or emergency physicians on scene. METHODS: The study was carried out in West-Birmingham, a part of the West-Midlands-Ambulance-Service (WMAS), and the EMS of Bonn. Pre defined questionnaires, EMS protocols, calculations of purchasing power parity and recent publications concerning out-of-hospital resuscitation (CPR) were used to evaluate the operating costs, to describe the structure and to measure the quality of performance. Significance was assumed at p < 0.01 for CHI(2)- or t-test, respectively. RESULTS: Birmingham used state of the art technology for dispatch and logistics whereas Bonn trusted in high qualified personnel. In the 1st quarter 1997 the Mainz-Emergency-Evaluation Score could be achieved before (MEES A) and after preclinical treatment (MEES B) in 3502 and 3422 patients in Birmingham and Bonn, respectively. In Birmingham 7.5 % and in Bonn 17 % of all patients could be improved by the EMS treatment, respectively (p < 0.01). Looking at severely ill patients (MEES A < 22) the EMS in West-Birmingham achieved an improvement in 27.9 % of these patients with an averaged change in MEES of 0.9 +/- 1.7 points in all of them. In contrast the Bonn EMS improved the status in 47.8 % of these patients and MEES A could be improved considerably by 2.3 +/- 3.4 points (p < 0.01). Pharmacological treatment was less frequently used in Birmingham than in Bonn (12.9 % vs. 32.4 %, respectively; p < 0.01). At equal incidences of CPR attempts discharge rate after CPR was only 4 % in WMAS compared to 14.7 % in Bonn-North (p < 0.01). Per inhabitant and year total costs amounted to 10.43 euro for the EMS system in Birmingham, which is 42 % less than in Bonn. Unit hour utilisation reached 0.6 in Birmingham and only 0.33 in Bonn. In severely ill patients the improvement of MEES A by 0.1 points cost per inhabitant and year 1.16 euro in Birmingham and only 0.65 euro in Bonn. The survival of one patient after CPR was calculated to 0.7 euro in Birmingham and 0.17 euro in Bonn. CONCLUSIONS: The provider of the EMS in West-Birmingham--WMAS--organised a reliable system with high efficiency concerning unit hour utilisation and response time reliability. In the EMS of Bonn, in contrast, the complex therapy by the emergency physicians improved MEES considerably and increased probability of survival after CPR at a higher level of efficiency. Further investigations however are necessary to evaluate the presented parameter of efficiency.

[Use of emergency medical service and sociodemographic factors]. / Frecuentación del servicio de urgencias y factores sociodemográficos.

OBJECTIVES: Health resources utilization is related to health conditions and to the population's sociodemographic characteristics. Low socioeconomic groups show increased utilization of certain resources. Emergency department utilization could also be affected by socioeconomic factors. The aim of this study was to identify differences in emergency department utilization among different socioeconomic groups. MATERIAL AND METHODS: A population-based study was performed. Census sections of the city of Santander in Spain were grouped according to sociodemographic variables (age, educational and professional attinment). Areas of the city with similar socioeconomic characteristics were established by cluster analysis. The place of residence of patients visiting the emergency department of th Hospital Marqués de Valdecilla was identified and the utilization rate was calculated for each cluster. RESULTS: Cluster analysis was able to identify four different groups, each with different socioeconomic characteristics, which were closely related to the districts of Santander. Comparison of clusters 1 and 4 showed that increased emergency department utilization was found amongst groups with lowest socioeconomic status and higher mean age, with an odds ratio of 1.91 (95% CI: 1.73-2.1). Patients from higher socioeconomic groups were more likely to be admitted to hospital while those from lower socioeconomic groups made more repeat visits to the emergency department. CONCLUSION: Emergency department utilization is affected by the sociodemographic characteristics of patients' area of residence. Patients with lower socioeconomic status show greater use of the emergency department.

Frecuentación del servicio de urgencias y factores sociodemográficos / Use of emergency medical service and sociodemographic factors

Objetivos: La utilización por parte de la población de los recursos sanitarios se encuentra relacionada con los niveles de salud y con factores socioeconómicos. Los grupos de población con menor nivel socioeconómico tienen una mayor utilización de determinados recursos sanitarios; los servicios de urgencia podrían presentar un uso diferencial entre los distintos grupos de población. El presente estudio pretende identificar diferencias en el uso de los recursos de atención urgente entre grupos con diferentes características socioeconómicas. Material y métodos: Se realiza un estudio poblacional, en el que mediante el agrupamiento de las secciones censales de la ciudad de Santander, según variables sociodemográficas (edad, nivel de formación y nivel de empleo), se establecen áreas de la ciudad con similares características, mediante análisis de clusters. Se identifica el origen de los pacientes que consultan en el Servicio de (..) (AU)

Objectives: Health resources utilization is related to health conditions and to the population's sociodemographic characteristics. Low socioeconomic groups show increased utilization of certain resources. Emergency department utilization could also be affected by socioeconomic factors. The aim of this study was to identify differences in emergency department utilization among different socioeconomic groups. Material and methods: A population-based study was performed. Census sections of the city of Santander in Spain were grouped according to sociodemographic variables (age, educational and professional attinment). Areas of the city with similar socioeconomic characteristics were established by cluster analysis. The place of residence of patients visiting the emergency (..) (AU)

Cloning and sequencing of the genes encoding the periplasmic-cytochrome B-containing selenate reductase of Thauera selenatis.

The periplasmic selenate reductase (Ser) of Thauera selennatis is a component of the electron transport chain catalyzing selenate reduction with acetate as the electron donor (i.e., selenate respiration). The purified enzyme consists of three subunits (SerA, SerB and SerC). Using transposon (i.e., Tn5) mutagenesis selenate reductase mutants were isolated. Junction fragments of DNA adjacent to the integrated Tn5 were used, together with oligonucleotides derived from the N-termini of SerA and SerB, to clone from a gene bank a DNA fragment that contained the corresponding genes. After sequencing, serA, serB and serC were identified by sequence comparison with the N-termini of the three subunits. The genes are arranged in the order serA, serB, serC; a fourth open reading frame (serD) in between, but overlapping serB and serC, is also present. The serA gene product contains an apparent leader peptide with a twin-arginine motif. The remainder of the translated amino acid sequence is similar to that of a number of prokaryotic molybdenum-containing enzymes (e.g., nitrate reductases and formate dehydrogenases of Escherichia coli). The serB gene product contains four cysteine clusters and is similar to various iron-sulfur protein subunits. The serC gene product contains a putative Sec-dependent leader peptide, but there are no similarities between the remainder of the translated protein and other protein subunits. The SerC contains two histidine and four methionine residues, and these may noncovalently bind heme b--which is a component of the active selenate reductase. The serD gene product encodes a putative protein that shows no significant sequence similarities to other proteins. However, the location of the serD within the other ser genes is similar to that of narJ within the E. coli narGHJI operon (nitrate reductase A); thus suggesting that the role of SerD may be similar to that of NarJ, which is a system-specific chaperone protein.

Mutational analysis of the follicle-stimulating hormone (FSH) receptor in normal and infertile men: identification and characterization of two discrete FSH receptor isoforms.

In a search for pathophysiological causes of idiopathic male infertility we investigated the occurrence of mutations of the FSH receptor in 48 men with this disorder. The entire FSH receptor gene was analyzed by single stranded conformation polymorphism analysis (SSCP). A heterozygous point mutation without functional consequences, exchanging Val to Ala in codon 341, was found in one patient. SSCP analysis led to the identification of 2 polymorphisms in exon 10 associated in 2 discrete FSH receptor allelic variants, i.e. Thr307-Asn680 and Ala307-Ser680. The frequency and distribution of the two allelic variants was further analyzed in 86 proven fathers and 75 infertile men by SSCP (codon 307) and restriction fragment length polymorphism (codon 680). The 2 receptor isoforms showed similar Mendelian distribution in proven fathers and in infertile men. Serum FSH, inhibin B, and combined testicular volume did not differ between subjects with different receptor isoforms. Binding studies in transiently transfected COS-7 cells showed similar binding affinity for the two receptor variants. Moreover, the Ala307-Ser680 and the Thr307-Asn680 FSH receptors responded in vitro to FSH with comparable cAMP production. These data suggest that different isoforms of the FSH receptor with similar functional properties exist in normal and infertile men. We conclude that mutations of the FSH receptor or the FSH receptor genotype do not play a pathogenic role in male idiopathic infertility. The possibility that different FSH isoforms might interact differently with the 2 receptor variants remains to be investigated.

Purification and characterization of the respiratory arsenate reductase of Chrysiogenes arsenatis.

Chrysiogenes arsenatis is the only bacterium known that respires anaerobically using arsenate as the terminal electron acceptor and the respiratory substrate acetate as the electron donor. During growth, the arsenate is reduced to arsenite; the reduction is catalyzed by an arsenate reductase. This study describes the purification and characterization of a respiratory arsenate reductase (Arr). The enzyme consists of two subunits with molecular masses of 87 kDa (ArrA) and 29 kDa (ArrB), and is a heterodimer alpha1beta1 with a native molecular mass of 123 kDa. The arsenate reductase contains molybdenum, iron, acid-labile sulfur and zinc as cofactor constituents. The Km of the enzyme for arsenate is 0.3 mM and the Vmax is 7013 micromol arsenate reduced x min(-1) x mg protein(-1). Nitrate, sulfate, selenate and fumarate cannot serve as alternative electron acceptors for the arsenate reductase. Synthesis of the protein is regulated, as arsenate must be present during growth for the enzyme to be fully induced. The N-terminus of ArrA is similar to a number of procaryotic molybdenum-containing polypeptides (e.g. the formate dehydrogenases H and N of Escherichia coli). The N-terminus of ArrB is similar to iron-sulfur proteins. The respiratory arsenate reductase of C. arsenatis is different from the non-respiratory arsenate reductases of E. coli and Staphylococcus aureus.

Purification and characterization of the selenate reductase from Thauera selenatis.

Thauera selenatis is one of two isolated bacterial species that can obtain energy by respiring anaerobically with selenate as the terminal electron acceptor. The reduction of selenate to selenite is catalyzed by a selenate reductase, previously shown to be located in the periplasmic space of the cell. This study describes the purification of the enzyme from T. selenatis grown anaerobically with selenate. The enzyme is a trimeric alphabetagamma complex with an apparent Mr of 180,000. The alpha, beta, and gamma subunits are 96 kDa, 40 kDa, and 23 kDa, respectively, in size. The selenate reductase contains molybdenum, iron, and acid-labile sulfur as prosthetic group constituents. UV-visible absorption spectroscopy also revealed the presence of one cytochrome b per alphabetagamma complex. The Km for selenate was determined to be 16 microM, and the Vmax was 40 micromol/min/mg of protein. The enzyme is specific for the reduction of selenate; nitrate, nitrite, chlorate, and sulfate were not reduced at detectable rates. These studies constitute the first description of a selenate reductase, which represents a new class of enzymes. The significance of this enzyme in relation to cell growth and energy generation is discussed.

Properties of a Wolinella succinogenes mutant lacking periplasmic sulfide dehydrogenase (Sud).

A delta sud deletion mutant of Wolinella succinogenes that lacked the periplasmic sulfide dehydrogenase (Sud) was constructed using homologous recombination. The mutant grew with sulfide and fumarate, indicating that Sud was not a component of the electron transport chain that catalyzed fumarate respiration with sulfide as an electron donor. Likewise, growth with formate and either polysulfide or sulfur was not affected by the deletion. Removal of Sud from wild-type W. succinogenes by spheroplast formation did not decrease the activity of electron transport to polysulfide. The delta psr deletion mutant that lacks polysulfide reductase (Psr) grew by fumarate respiration with sulfide as an electron donor, indicating that Psr is not required for this activity.

The function of Wolinella succinogenes psr genes in electron transport with polysulphide as the terminal electron acceptor.

The membrane-integrated polysulphide reductase (Psr) of Wolinella succinogenes is part of the electron transport chain catalyzing polysulphide reduction by formate or hydrogen. The isolated enzyme catalyzes sulphide oxidation by dimethylnaphthoquinone. The two hydrophilic subunits, PsrA and PsrB of the enzyme, are encoded by genes that form an apparent operon psrABC together with a third gene. Using homologous recombination, three deletion mutants of W. succinogenes were constructed that lack psrC, psrBC or the whole psr operon. The mutants grown with formate and fumarate were fractionated, and the cell fractions were analyzed for the presence of PsrA and enzyme activity. It was concluded that: (a) polysulphide reductase is a constituent of the wild-type chain catalyzing electron transport from formate to polysulphide; (b) the gene psrC encodes a subunit that anchors the enzyme in the membrane and is required for electron transport; (c) PsrA which probably carries the substrate site, is exposed to the bacterial periplasm; (d) PsrA and PsrB are required for the activity of sulphide oxidation with 2,3-dimethyl-1,4-naphthoquinone. Surprisingly, the delta psrABC mutant could grow with formate and polysulphide. The membrane fraction of the mutant grown under these conditions contained an enzyme that replaced polysulphide reductase in electron transport, and catalyzed sulphide oxidation with 2,3-dimethyl-1,4-naphthoquinone.

Abrasion of surface components in endosseous implants depending on their shape and coating.

To investigate titanium surface abrasion of dental implants by mere insertion into the bone, we tested 20 implants of different shape, surface, and length. Under in vitro conditions, it could be proved that longer implants had more abrasion than cylindric implants, that screw implants had more abrasion than cylindric implants, that carved threads caused less abrasion than uncarved ones, and that plasma-flame-coated implants had more abrasion than implants with polished surfaces. Possible causes of the metal abrasion are discussed.

Clinical investigation into the incidence of direct damage to the lingual nerve caused by local anaesthesia.

The aim of this study was to investigate the amount of damage to the lingual nerve by mandibular block anaesthesia alone. For this purpose the records of 12,104 patients in whom mandibular block anaesthesia was administered without any type of surgery were reviewed. The reason for treatment in those patients was, in 72.4% fillings and crown preparations, in 27.13% periodontal procedures and in 0.30% other treatment. The records showed a lingual sensory disturbance in 18 out of 12,104 patients (0.15%). In 17 out of these 18 patients the tongue sensation recovered after a period of 6 months. Only in one patient (0.008%) was there a slight sensory diminution of the tongue, even after one year.

[Xenogenic cartilage as a transplant for reconstruction of the facial skull]. / Xenogener Knorpel als Transplantat zur Rekonstruktion des Gesichtsschädels.

90 patients were followed-up, in whom 110 cartilage grafts of bovine origin (Chondroplast) had been inserted. Nose and orbit (46 and/or 32 cartilage grafts) were the most frequent implantation sites. In three out of those 90 patients incorporation of the grafts was eventful. In two out of those three complication finally resulted in a loss of the graft. When following-up in 57 patients whether the grafts had kept their shape we found out that the cartilage grafts had still kept their shape quite well after three and a half years in 50 patients.

Experience with midazolam as sedative in the dental treatment of uncooperative children.

Shortage of capacity, and the limited range of therapies available for dental treatment of uncooperative children involve obvious problems which have given rise to new developments in treatment. Over the last two years, 83 children have been treated in 181 sessions after sedation with Midazolam. Rectal application is clearly superior to giving the drug orally. The results, and the good amnestic effect of Midazolam show that sedation employing this drug, while not a substitute for general anaesthesia in every case, does constitute an important alternative in the treatment of uncooperative children.