Quality of life of patients with 3D-printed arm prostheses in a rural area of Sierra Leone.

INTRODUCTION: In Sierra Leone, access to prostheses is limited due to absence of practical knowledge, materials, trained staff, and high cost. This paper investigates the impact of a 3D printed prosthesis on the health-related quality of life (HRQoL) in prosthesis recipients. METHODS: Patients with upper extremity amputations were included in this case study from December 2018 until July 2019. Data on the HRQoL was gathered until April 2020 in Masanga Hospital, central rural Sierra Leone. At two follow-up moments the HRQoL was assessed by applying the standard EQ-5D-5L questionnaire. These two follow-up moments varied between one week and just over a year after receiving the prosthesis. A second patient questionnaire was used to assess prosthesis satisfaction. RESULTS: Seven patients were included. The results of the EQ-5D-5L questionnaire show no deterioration of the HRQoL in any patient and the overall HRQoL increased by almost 20% compared to the null measurement. One patient was lost to follow up after the first re-visit. The responses to the second questionnaire indicated that patients are satisfied with the prosthesis and use it in various situations. Patients often mentioned they feel more included in society when wearing the prosthesis. One patient says wearing the prosthesis helped in accepting the amputation. As a result, enough self-confidence was experienced without the prosthesis and the patients stopped wearing the prosthesis. DISCUSSION: The overall HRQoL in patients wearing a 3D-printed prosthesis increases compared to not wearing one. Assessing the HRQoL at regular intervals is important for the long-term follow-up and to safeguard sustainability and long-term success of this project. Nevertheless, defining the HRQoL is challenging due to cultural differences and misunderstandings. Therefore, the use of alternative questionnaires to define the HRQoL should be investigated. To improve and warrant long-term success, identifying long-term problems is important, and the second questionnaire accounts for this need.

Hydrocephalus and hypothalamic involvement in pediatric patients with craniopharyngioma or cysts of Rathke's pouch: impact on long-term prognosis.

OBJECTIVE: Pediatric patients with sellar masses such as craniopharyngioma (CP) or cyst of Rathke's pouch (CRP) frequently suffer disease- and treatment-related sequelae. We analyzed the impact and prognostic relevance of initial hydrocephalus (HY) and hypothalamic involvement (HI) on long-term survival and functional capacity (FC) in children with CP or CRP. SUBJECTS AND METHODS: Using retrospective analysis of patient records, presence of initial HY or HI was assessed in 177 pediatric patients (163 CP and 14 CRP). Twenty-year overall survival (OS) and progression-free survival (PFS), FC, and BMI were analyzed with regard to initial HY, degree of resection, or HI. RESULTS: Of the 177 patients, 105 patients (103/163 CP and 2/14 CRP) presented with initial HY and 96 presented with HI. HY at diagnosis was associated (P=0.000) with papilledema, neurological deficits, and higher BMI at diagnosis and during follow-up. OS, PFS, and FC were not affected by HY at initial diagnosis. HI at diagnosis (96/177) had major negative impact on long-term prognosis. Sellar masses with HI were associated with lower OS (0.84±0.04; P=0.021), lower FC (P=0.003), and higher BMI at diagnosis and last follow-up (P=0.000) when compared with sellar masses without HI (OS: 0.94±0.05). PFS was not affected by HI or degree of resection. CONCLUSIONS: Initial HY has no impact on outcome in patients with sellar masses. OS and FC are impaired in survivors presenting with initial HI. PFS is not affected by HY, HI, or degree of resection. Accordingly, gross-total resection is not recommended in sellar masses with initial HI to prevent further hypothalamic damage.

[Childhood craniopharyngioma with hypothalamic obesity - no long-term weight reduction due to rehabilitation programs]. / Kraniopharyngeom mit hypothalamischer Adipositas - Stationäre Rehabilitation ohne Einfluss auf die Gewichtszunahme bei Kindern und Jugendlichen.

BACKGROUND: Severe obesity due to hypothalamic involvement has major impact on prognosis in long-term survivors of childhood craniopharyngioma. The long-term effects of rehabilitation efforts on weight development and obesity in these patients are not analyzed up to now. PATIENTS AND METHODS: 108 patients with childhood craniopharyngioma recruited in HIT Endo before 2001 were included in the study. Long-term weight development (BMI SDS after >10 yrs follow-up) was analyzed in regard to rehabilitation, which was performed in 31 of 108 (29%) patients (one rehabilitation in 4 patients (13%), more than one in 21 patients (68%), 6 patients unknown) in 13 German rehabilitation -clinics. RESULTS: 84% of patients underwent rehabilitation in order to reduce hypothalamic obesity (BMI>+ 2 SD), whereas 12% of patients were normal weight. Childhood craniopharyngioma pa-tients with rehabilitation presented with higher BMI at diagnosis (median BMI: +1.32 SD; range: -1.08 to + 7.00 SD) and at last evaluation (median BMI: +4.93 SD; range: -0.20 to + 13.13 SD) when compared with patients without rehabilitation (median BMI at diagnosis: +0.24 SD; range: -2.67 to + 6.98 SD; BMI at evaluation: +2.09 SD; range: -1.48 to + 10.23 SD). A long-term weight reducing effect of rehabilitation was no detectable regardless of degree of obesity, frequency of rehabilitation, and hospital of rehabilitation. CONCLUSION: Treatment options for hypothalamic obesity in terms of rehabilitation are limited. Accordingly, strategies for prevention of hypothalamic lesions and psychosocial effects of rehabilitation are currently in focus for improvement of prognosis in childhood craniopharyngioma patients.

The association between iliac fixation and proximal stent-graft migration during EVAR follow-up: mid-term results of 154 Talent devices.

OBJECTIVE: This study investigated the importance of iliac fixation to secure endograft fixation. MATERIALS AND METHODS: Computed tomography (CT) scans of patients who underwent endovascular aneurysm repair with an endoprosthesis of great columnar strength (Talent stent graft) were analysed retrospectively. Patients were enrolled consecutively between June 2000 and January 2007 and prospectively followed up with serial CT imaging. The superior mesenteric artery was used as a reference point to determine endograft migration (centerline endograft displacement of >or=10mm). Proximal and distal fixation lengths were defined as the length of the endograft that was in full apposition to the aortic neck or common iliac arteries, respectively. RESULTS: Proximal endograft migration occurred in 32 of 154 patients (21%) at a follow-up duration of 32+/-14 months; 13 migrations required treatment (8%). Migration was more frequent in patients treated with aorto-uniiliac devices than bifurcation devices (p<0.008). The migrator and non-migrator groups had similar demographic and abdominal aortic aneurysm (AAA) characteristics. The migrator group had significantly shorter proximal (30+/-12 mm vs. 41+/-13 mm, P<0.001) and distal endograft fixation lengths (31+/-18 mm vs. 47+/-15 mm, P<0.001). By multivariate regression analysis, proximal and distal endograft fixations were significant predictors for endograft migration at follow-up (P<0.001). CONCLUSION: Iliac endograft fixation, along with proximal fixation, is a significant predictor for endograft migration.

Properties of the Cell Walls of Lactococcus lactis subsp. cremoris SK110 and SK112 and Their Relation to Bacteriophage Resistance.

Resistance of Lactococcus lactis subsp. cremoris SK110 to bacteriophage sk11G, encoded on the plasmid pSK112, is due to poor phage adsorption. Its phage-sensitive variant SK112, cured of pSK112, adsorbs phages effectively. Incubation of SK112 with concanavalin A remarkably reduced phage adsorption to this strain. This treatment also caused agglutination of SK112 that was not found with SK110, indicating different concanavalin A adsorption characteristics of cell walls of both strains. The differences between the two strains were reduced by a mild alkali treatment of cells. This resulted in a positive agglutination with concanavalin A for both strains and in parallel adsorption of phage sk11G to both. Moreover, isolated cell walls of the two strains were investigated, and both bound phage sk11G. These observations suggest the presence of phage receptor material in SK112 as well as in SK110. SK110 contained a relatively high level of bound galactose when compared with the phage-sensitive SK112. After the mild alkali treatment, however, the galactose content of SK110 was diminished such that it became comparable with that of SK112. It is hypothesized that the alkali treatment liberates a galactose-containing component from the cell wall and causes phage sensitivity in L. lactis subsp. cremoris SK110.

Loss of phage resistance encoded by plasmid pSK112 in chemostat cultures of Lactococcus lactis ssp. cremoris SK110.

In cultures of L. lactis ssp. cremoris SK110, phage SK11G-resistant through the presence of pSK112, phage-sensitive variants segregated spontaneously that lacked the plasmid. In overnight batch culture these comprised up to 1% of the total population. Upon prolonged incubation in chemostat culture, a further loss of resistance was observed after a lag period. At high growth rates (0.7 h-1) this period amounted to approximately 35 generations, whereas cultures grown at rates of 0.4 and 0.1 h-1 remained resistant for 55 and 70 generations, respectively. At average-to-high growth rate, characteristics of the partially mixed populations that evolved were comparable to those of pure cultures of L. lactis ssp. cremoris SK110. However, in the culture fluid of the mixed populations that occurred at growth rate 0.1 h-1, higher acetate and formate concentrations were found than in the fluid of pure cultures of L. lactis ssp. cremoris SK110. This indicated that the former metabolized lactose more efficiently. Competition experiments between the resistant strain and a cured, sensitive derivative, L. lactis ssp. cremoris SK112, gave stable mixed populations. It is concluded that at average-to-high growth rates, loss of resistance from cultures of L. lactis ssp. cremoris SK110 had occurred due to instability of the plasmid and not to a competitive disadvantage of the resistant strain towards emerging sensitive variants.

Phenotypic variations in cell envelope proteins of Klebsiella aerogenes.

The structure and functioning of the cell envelope of Klebsiella aerogenes vary phenotypically with changes in the culture environment. These variations involve, in particular, the proteinaceous components. This contribution discusses results obtained in recent studies directed towards analysing the influence of growth conditions on membrane protein composition in this organism.

Influence of nutrient limitation and growth rate on the outer membrane proteins of Klebsiella aerogenes NCTC 418.

Four major proteins with molecular weights of 78 000, 37 000, 34 000 and 20 000 were present in the envelope of Klebsiella aerogenes when cultured at a high specific growth rate. However, at lower growth rates, the protein content and composition of the envelope depended on the imposed nutrient limitation. Under potassium-, carbon-, sulphur- and phosphorus-limited conditions, derepression of synthesis of limitation-specific proteins was observed, their apparent molecular weights being 90 000, 48 000, 41 000 and 36 000, respectively. Nitrogen-limited cells had no additional proteins. For a particular limiting nutrient, expression of the limitation-specific proteins was independent of the chemical or physical form in which the nutrient was supplied. Under potassium or sulphur limitation the specific proteins were present maximally at the lowest imposed growth rate, whereas under carbon limitation a maximum expression of these proteins was found at moderate growth rates. It is concluded that limitation-specific proteins which are associated with the outer membrane function in the uptake of limiting nutrients or, possibly, limitation-releasing compounds.

Expression and loss of the pBR322 plasmid in Klebsiella aerogenes NCTC 418, grown in chemostat culture.

Klebsiella aerogenes harbouring the plasmid pBR322 was grown in continuous culture at various growth rates under glucose, phosphate or ammonia limitation. With tetracycline in the medium, the maximum culture beta-lactamase activity was found at the higher growth rates. When tetracycline was absent, loss of resistance to the drug occurred. Concomitant with the occurrence of drug-sensitive cells, the culture beta-lactamase activity decreased. At the higher growth rates the enzyme activity decreased at a slightly higher rate than did the resistance to tetracycline. From this it was concluded that the beta-lactamase activity per mg cellular dry weight of the drug-resistant fraction of the population was still decreasing during the appearance of drug-sensitive cells. At the higher growth rates, this decrease was independent of the nutrient that was growth-limiting.

Phenotypic variability of the sensitivity to cycloserine of Klebsiella aerogenes NCTC 418, growing in chemostat culture.

The susceptibility of Klebsiella aerogenes to cycloserine varied according to the growth conditions. In batch culture, cells were less susceptible to the antibiotic when glycine was present in the medium, presumably due to competition between glycine and cycloserine for the uptake system by which glycine, D-alanine and cycloserine are transported into the cell. In the chemostat at average dilution rates, ammonia-limited cultures were more susceptible to the antibiotic than were glucose-limited cultures. Under phosphate-limiting conditions cultures were at least ten times less susceptible. Under ammonia and phosphate limitation the susceptibility increased with increasing growth rate. The sensitivity of glucose-limited cells was independent of the growth rate. A high-affinity uptake system for cycloserine (as measured by D-alanine transport) was present in ammonia- and glucose-limited cells, but not in phosphate-limited cells. Thus, the phenotypically defined alterations in the susceptibility of the bacterium to cycloserine could be correlated with variations in its uptake system for the antibiotic.

Influence of specific growth limitation and dilution rate on the phosphorylation efficiency and cytochrome content of mitochondria of Candida utilis NCYC 321.

With Candida utilis cells that had been removed directly from a 61 chemostat culture, in steady state, well-coupled mitochondria generally could be isolated. This requires a modified snail-gut enzyme procedure that allowed the total processing time to be decreased to 3 h, or less. Examination of these mitochondria in an oxygraph showed the presence of 3 sites of energy conservation when the cells were grown at various dilution rates between 0.1 and 0.45 h-1 in environments that were, successively, glucose-, ammonia-, magnesium-, phosphate- and sulphate-limited. Potassium-limited cells also apparently possessed 3 sites of oxidative phosphorylation when growing at dilution rates greater than 0.2 h-1, but only 2 sites when growing at lower dilution rates. Analysis of cytochrome spectra obtained with these intact mitochondria revealed large quantitative (but not qualitative) differences, depending on the environmental conditions under which the yeast had been cultured. In particular, comparison of the ratio of cytochrome b to cytochrome a showed a pattern of change with dilution rate in mitochondria from potassium-limited cells that was distinctly different from those evident in mitochondria from cells that had been limited in their growth by the availability of other nutrients.