Studies of an insecticidal inhibitor of acetyl-CoA carboxylase in the nematode C. elegans.

We have studied the mode of action of the insecticide spirotetramat in the nematode Caenorhabditis elegans. A combination of symptomology, forward genetics and genome editing show that spirotetramat acts on acetyl-CoA carboxylase (ACC) in C. elegans, as it does in insects. We found C. elegans embryos exposed to spirotetramat show a cell division defect which closely resembles the phenotype of loss-of-function mutations in the gene pod-2, which encodes ACC. We then identified two mutations in the carboxyl transferase domain of pod-2 (ACC) which confer resistance and were confirmed using CRISPR/Cas9. One of these mutations substitutes an invertebrate-specific amino acid with one ubiquitous in other taxa; this residue may, therefore, be a determinant of the selectivity of spirotetramat for invertebrates. Such a mutation may also be the target of selection for resistance in the field. Our study is a further demonstration of the utility of C. elegans in studying bioactive chemicals.

The ELFIN Mission.

The Electron Loss and Fields Investigation with a Spatio-Temporal Ambiguity-Resolving option (ELFIN-STAR, or heretoforth simply: ELFIN) mission comprises two identical 3-Unit (3U) CubeSats on a polar (∼93∘ inclination), nearly circular, low-Earth (∼450 km altitude) orbit. Launched on September 15, 2018, ELFIN is expected to have a >2.5 year lifetime. Its primary science objective is to resolve the mechanism of storm-time relativistic electron precipitation, for which electromagnetic ion cyclotron (EMIC) waves are a prime candidate. From its ionospheric vantage point, ELFIN uses its unique pitch-angle-resolving capability to determine whether measured relativistic electron pitch-angle and energy spectra within the loss cone bear the characteristic signatures of scattering by EMIC waves or whether such scattering may be due to other processes. Pairing identical ELFIN satellites with slowly-variable along-track separation allows disambiguation of spatial and temporal evolution of the precipitation over minutes-to-tens-of-minutes timescales, faster than the orbit period of a single low-altitude satellite (Torbit ∼ 90 min). Each satellite carries an energetic particle detector for electrons (EPDE) that measures 50 keV to 5 MeV electrons with Δ E/E < 40% and a fluxgate magnetometer (FGM) on a ∼72 cm boom that measures magnetic field waves (e.g., EMIC waves) in the range from DC to 5 Hz Nyquist (nominally) with <0.3 nT/sqrt(Hz) noise at 1 Hz. The spinning satellites (Tspin ∼ 3 s) are equipped with magnetorquers (air coils) that permit spin-up or -down and reorientation maneuvers. Using those, the spin axis is placed normal to the orbit plane (nominally), allowing full pitch-angle resolution twice per spin. An energetic particle detector for ions (EPDI) measures 250 keV - 5 MeV ions, addressing secondary science. Funded initially by CalSpace and the University Nanosat Program, ELFIN was selected for flight with joint support from NSF and NASA between 2014 and 2018 and launched by the ELaNa XVIII program on a Delta II rocket (with IceSatII as the primary). Mission operations are currently funded by NASA. Working under experienced UCLA mentors, with advice from The Aerospace Corporation and NASA personnel, more than 250 undergraduates have matured the ELFIN implementation strategy; developed the instruments, satellite, and ground systems and operate the two satellites. ELFIN's already high potential for cutting-edge science return is compounded by concurrent equatorial Heliophysics missions (THEMIS, Arase, Van Allen Probes, MMS) and ground stations. ELFIN's integrated data analysis approach, rapid dissemination strategies via the SPace Environment Data Analysis System (SPEDAS), and data coordination with the Heliophysics/Geospace System Observatory (H/GSO) optimize science yield, enabling the widest community benefits. Several storm-time events have already been captured and are presented herein to demonstrate ELFIN's data analysis methods and potential. These form the basis of on-going studies to resolve the primary mission science objective. Broad energy precipitation events, precipitation bands, and microbursts, clearly seen both at dawn and dusk, extend from tens of keV to >1 MeV. This broad energy range of precipitation indicates that multiple waves are providing scattering concurrently. Many observed events show significant backscattered fluxes, which in the past were hard to resolve by equatorial spacecraft or non-pitch-angle-resolving ionospheric missions. These observations suggest that the ionosphere plays a significant role in modifying magnetospheric electron fluxes and wave-particle interactions. Routine data captures starting in February 2020 and lasting for at least another year, approximately the remainder of the mission lifetime, are expected to provide a very rich dataset to address questions even beyond the primary mission science objective.

RDL A301S alone does not confer high levels of resistance to cyclodiene organochlorine or phenyl pyrazole insecticides in Plutella xylostella.

Mutations in the GABA-gated chloride channel are associated with resistance to cyclodiene organochlorine and phenyl pyrazole insecticides. The best characterised of these is A301S, which was initially identified in a Dieldrin resistant strain of Drosophila melanogaster. The orthologous mutation has been found in a variety of different crop pests including the diamond back moth Plutella xylostella. However, the contribution of this mutation to resistance in this species remains unclear. We have used the CRISPR/Cas9 system in order to edit Plutella xylostella PxGABARalpha1 to Serine at the 301 orthologous position (282 in PxGABARalpha1) in an insecticide sensitive strain isolated from Vero Beach (VB) USA. In this edited line, no high level of resistance is conferred to Dieldrin, Endosulfan or Fipronil, rather only a subtle shift in sensitivity which could not confer commercially important resistance. We conclude that the high level of commercial resistance to cyclodiene organochlorine and phenyl pyrazole insecticides observed in some field isolates of Plutella xylostella cannot arise from A282S in PxGABARalpha1 alone.

Engineering plant membranes using droplet interface bilayers.

Droplet interface bilayers (DIBs) have become widely recognised as a robust platform for constructing model membranes and are emerging as a key technology for the bottom-up assembly of synthetic cell-like and tissue-like structures. DIBs are formed when lipid-monolayer coated water droplets are brought together inside a well of oil, which is excluded from the interface as the DIB forms. The unique features of the system, compared to traditional approaches (e.g., supported lipid bilayers, black lipid membranes, and liposomes), is the ability to engineer multi-layered bilayer networks by connecting multiple droplets together in 3D, and the capability to impart bilayer asymmetry freely within these droplet architectures by supplying droplets with different lipids. Yet despite these achievements, one potential limitation of the technology is that DIBs formed from biologically relevant components have not been well studied. This could limit the reach of the platform to biological systems where bilayer composition and asymmetry are understood to play a key role. Herein, we address this issue by reporting the assembly of asymmetric DIBs designed to replicate the plasma membrane compositions of three different plant species; Arabidopsis thaliana, tobacco, and oats, by engineering vesicles with different amounts of plant phospholipids, sterols and cerebrosides for the first time. We show that vesicles made from our plant lipid formulations are stable and can be used to assemble asymmetric plant DIBs. We verify this using a bilayer permeation assay, from which we extract values for absolute effective bilayer permeation and bilayer stability. Our results confirm that stable DIBs can be assembled from our plant membrane mimics and could lead to new approaches for assembling model systems to study membrane translocation and to screen new agrochemicals in plants.

[Care concepts in mass casualty incidents and disasters. Concept for primary care clinic]. / Versorgungskonzepte im Großschadens- und Katastrophenfall. Das Konzept der Erstversorgungsklinik.

BACKGROUND: Patient care in mass casualty incidents and disaster strongly demand a joint approach of all preclinical and clinical forces. OBJECTIVE: Special emphasis must be placed on immediate triage, establishment and preservation of transportability of high-risk patients and their clinical treatment as soon as possible. During limited mass casualties, the preclinical rescue station additionally serves as a buffer for patients, whereby in case of disaster, the focus on transportation of high-risk patients is imperative. DISCUSSION AND CONCLUSION: Primary care hospitals are a decisive part in the chain of medical supply and are confronted with great challenges, which demand detailed emergency plans and also repeated exercises. In planning and exercises, special attention should be given to the cooperation with the fire department and other medical services.

[The hospital emergency plan]. / Der Notfallplan des Krankenhauses.

STRUCTURE: The hospital emergency plan consists of a basic plan and an appendix. The basic plan deals with the general aspects of emergency operation and the special aspects of external and internal emergencies. The appendix contains special instructions, e.g., emergency action orders, staff alert lists, material lists, and situation plans. CONTENT AND IMPLEMENTATION: External emergencies (e.g., mass casualty incidents) and internal emergencies (e.g., fire and other environmental threats) should be regarded. Once a defined experienced physician decides to activate the emergency plan, the hospital changes from routine to emergency service. Due to its security significance, the emergency plan should be regarded as confidential. MANDATORY REQUIREMENTS: A two-tier chain of command is implemented: the hospital staff deals with administrational and organizational aspects, whereas the subsequent medical staff is in charge of immediate patient care. Repeated updating and exercises are necessary. Furthermore, a basic logistic autonomy of the hospital is essential.

[Interhospital transport of intensive care patients in Lower Saxony : statewide need-based and effective management]. / Intensivverlegung in Niedersachsen : Landesweite bedarfsgerechte und effektive Sicherstellung.

BACKGROUND: Since 2007 interhospital transport of intensive care patients in Lower Saxony appertains to the performance requirements of emergency medical services. Against this background the Working Group for Evaluation of Intensive Care Transport (Arbeitsgemeinschaft Evaluation Intensivverlegung) was established. This group formulated standardized definitions for the requirements of intensive care transport vehicles and a federal statewide monitoring of intensive care transport was implemented to analyze if simultaneously on-call intensive care transport systems (intensive care helicopter and ground based mobile intensive care units) can be deployed need-based and efficiently. METHODS: A prospective follow-up study and evaluation of intensive care transport in Lower Saxony between April 1(st) 2008 and July 31(st) 2010 was carried out. RESULTS: A total of 6,779 data records were evaluated in this study of which 4,941 (72.9%) missions were located in Lower Saxony, 2,928 (43.2%) missions were carried out by helicopters and 3,851 (56.8%) by ground based mobile intensive care units. The mean duration of a mission was 3 h 59min±2 h 25 min, 4 h 39 min±2 h 23 min by ground based mobile intensive care units and 2 h 21 in±30 min by helicopter units. All systems proved to be feasible for intensive care transport. The degree of urgency was estimated correctly in 94.8% of the evaluated missions and 58.0% of the transfers could not be deployed. In 76.8% patients were transferred to hospitals with a higher level of medical care, 51.7% of patients were transferred for intensive care therapy and 40.4% for an operation/intervention. Of the patients 38.2% required mechanical ventilation and in 48.3% invasive monitoring was carried out. CONCLUSION: Interhospital transfer of intensive care patients can be carried out need-based with a limited number of intensive care transport vehicles if the missions are deployed effectively by standardized disposition in accordance with performance requirements.

Ulnar nerve palsy after open carpal tunnel decompression: Case report and review of the literature.

Open carpal tunnel release is the commonest surgical treatment of median nerve compression at the wrist. Although successful in most cases, there are well described complications. We report a case of laceration of the deep motor branch of the ulnar nerve at the level of the hook of hamate following a complicated carpal tunnel decompression. Good surgical technique and knowledge of wrist anatomy are essential for performing this apparently simple procedure safely.

[Wandering spleen]. / Vandremilt.

The spleen is well fixed below the left side of the diaphragm. Wandering spleen is a rare condition of unknown pathogenesis. The wandering spleen is most often localized in the lower abdomen or pelvis. The diagnosis may be difficult if wandering spleen is not suspected. Often a wandering spleen can be palpated in the lower abdomen. In the rare cases of torsion of the splenic vascular pedicle, wandering spleen becomes symptomatic, and splenectomy should be performed. We report a case of a 20-year-old female treated with splenectomy because of torsion of the vascular pedicle.

[Diagnosis and treatment of complications during cholecystectomy]. / Diagnostik og behandling af komplikationer ved kolecystektomi.

The incidence of bile duct injury after laparoscopic cholecystectomy has been reduced to 0.6%. One factor contributing to such injuries is misidentification of the bile duct anatomy. During laparoscopic cholecystectomy the surgeon should follow the criteria for dissection of the triangle of Calot and dealing with bleeding. Immediate reconstruction over a T-tube may be possible, or a baby-feeding tube should be inserted into the proximal part of the bile duct and the patient should be transferred to a center with experience in bile duct reconstruction.

[Analgesia, sedation and anaesthesia in emergency service]. / Analgesie, Sedierung und Anästhesie im Rettungsdienst.

Skilful analgesia is self-explanatory and needs no justification. In contrast to this, preclinical general anaesthesia is of relative value and depends, in part, on the professional qualities of the emergency physician. Analgesic and anaesthestic drugs should be administered via a safe intravenous line. In contrast to rapid sequence induction of general anaesthesia, analgesic drugs should be titrated. The patient has to be monitored by the vigilance of the physician and adequate technical equipment. Metamizol is used for treatment of minor and medium pain, while morphine is indicated for treatment of major pain, especially in internal patients. Fentanyl is mainly used for total intravenous anaesthesia with controlled ventilation. (S)-ketamine is indicated for analgesia, analgosedation and anaesthesia in trauma patients, except isolated or dominating craniocerebral trauma, and in special internal cases. Midazolam is used for sedation or, in combination with (S)-ketamine or fentanyl, total intravenous anaesthesia. Etomidate is especially useful for induction of emergency patients with sufficient cardiovascular stability. Suxamethonium is the standard relaxant for endotracheal intubation during rapid sequence induction. If longer muscle relaxation is necessary, vecuronium should be used due to its simple storage and general lack of untoward effects. Butylscopolamin is used in colic pain, either alone or in combination with analgesic drugs. Haloperidol is indicated in acute psychotic syndromes as well as psychomotoric and alcohol-dependent excitation. On the whole, profound pharmacological and practical knowledge is necessary, although restricting oneself to just a few drugs increases the depth of one's personal experience.

[Ultrasound-guided radiofrequency ablation of malignant liver tumors]. / UL-vejledt radiofrekvensbehandling af maligne levertumorer.

INTRODUCTION: Radio frequency ablation (RFA) of malignant tumours is a new and promising treatment modality. The aim of this study was to evaluate the method in patients with non-resectable liver tumours. MATERIAL AND METHODS: RFA was performed under the guidance of ultrasonography and general anaesthesia in 37 patients from December 1998 to November 2001. Six patients had primary liver cancers, and 31 metastases from other cancer, often colorectal cancer. RESULTS: Eight patients could not be evaluated because of the short follow-up time. Twenty-four of 29 patients (83%) achieved a complete tumour response. Twelve patients (41%) are alive after 3-28 (median 16) months, without recurrence. Twelve patients (41%) are alive after 1-34 (median 14) months, with recurrence. Five patients (14%) died after 4-26 (median 11) months, because of recurrence in the liver and/or other organs. Four patients had minor complications and one a major complication. There was no postoperative mortality. DISCUSSION: RFA can be offered to patients with non-resectable liver tumours when it is technically possible. The treatment can be performed with few complications, requires only a short hospital stay, and is cheaper than other treatments. Prolonged survival is attained in 40-50% cent of the patients.

Subungual pilonidal sinus of the hand in a dog groomer.

Interdigital pilonidal sinus of the hand is an occupational hazard in barbers, sheep shearers and cow milkers. We present a case of a subungual pilonidal sinus of the thumb of a dog groomer, complicated by the development of osteomyelitis in the distal phalanx.