Habitat complexity affects how young of the year Atlantic cod Gadus morhua perceive predation threat from older conspecifics.

The response of age 0+ year juvenile Atlantic cod Gadus morhua to the presence of age 1+ and age 3+ year conspecifics was measured with and without cover available. Juveniles reacted by aggregating more closely and maintaining distance from older conspecifics in an experimental setting without cover but only to age 3+ year conspecifics when cover was available. The results indicate that prior residence of older juveniles can affect age 0+ year juveniles during benthic settlement and highlights the conservation value of structurally complex nursery habitats.

Revalidation and update of the TASH-Score: a scoring system to predict the probability for massive transfusion as a surrogate for life-threatening haemorrhage after severe injury.

BACKGROUND: The Trauma Associated Severe Haemorrhage (TASH)-Score has been recognized as an easy-to-calculate scoring system to predict the probability for massive transfusion (MT) as a surrogate for life-threatening haemorrhage after injury. Changes with respect to management and outcome of these patients over time prompted a revalidation and an update of the TASH-Score. METHODS: The performance of the TASH-Score developed from the 1993-2003 TR-DGU database (Trauma Registry Deutsche Gesellschaft für Unfallchirurgie/German Trauma Society) was revalidated on 5834 datasets from the 2004-2007 TR-DGU database with respect to discrimination, precision and calibration. The performance of the TASH-Score applied onto the 2004-2007 TR-DGU database was compared to its initial performance, and the logistic function to calculate the probability for MT was modified for score adjustment. RESULTS/CONCLUSIONS: When the original TASH-Score was applied onto the 2004-2007 TR-DGU database, a slight increase in discrimination was observed while precision was considerably lower. The predicted rate for MT within the development dataset was 13·9% while the observed incidence was 14·1%. In contrast, the predicted rate for MT within the revalidation dataset was 11·7%, while the observed rate was 8·4%. The logistic function to calculate MT probability was modified, and the TASH-Score was again evaluated against the most recent TR-DGU 2004-2007 database. The high performance of the score was not only restored but enhanced reflected by an increased ROC/AUC of 0·905. The score can be calculated quickly upon arrival of the patient in the emergency department and may be supportive to correct coagulopathy, to activate logistics and for research.

Clinical profile of assault burned victims: a 16-year review.

OBJECTIVE: Assaults by burning occur infrequently and are related to the social circumstances and demographics of each population. We aimed to explore the mechanisms, complications, morbidity and mortality associated with assault burn injuries admitted to the Burns Intensive Care Unit of Merheim University Hospital in Cologne. METHODS: A retrospective data analysis of a consecutive series of 1 243 burn patients between 1989 and 2004. The cohort was divided into two groups: AG (assault group) and CG (control group). Analyses were controlled for clinical data, treatment and outcome of all patients involved. RESULTS: Forty-one patients with assault burn injuries were identified during the study period. Compared with the general burn population (CG), the AG had a significantly larger size of third-degree burns (p=0.047), a higher incidence of inhalation injury (p<0.001) and a longer intubation period (p=0.047). Patients in the AG were also more likely to undergo escharotomy (p=0.013) and to receive antibiotics on admission (p=0.016). The mortality rate was higher in the AG than in the CG (26.8% v. 19.9%), but this difference was not significant. CONCLUSIONS: Burned patients who were victims of assault tend to have more severe injuries than the general burn population. These injuries are not only physical, and their management requires a multidisciplinary approach to improve outcome.

Cologne burn centre experience with assault burn injuries.

OBJECTIVE: To evaluate demographic and socioeconomic factors associated with assault burn injuries. BACKGROUND: Assault by burning demonstrates a rare but severe public health issue and accounts for unique injury characteristics in the burn intensive care unit (BICU). METHODS: We conducted a retrospective cohort study involving patients with thermal injuries admitted to the BICU of a university hospital. The patient cohort was divided into two groups (ABI group: patients with assault burns, n=41; CONTROL GROUP: population of all other burned patients admitted to the BICU, n=1202). Bivariate and multivariate analyses including demographic and socioeconomic data were used to identify factors associated with assault burns. RESULTS: Forty-one assault-related burn victims were identified in the study period. This represents 3.3% of all significant burns admitted. Comparing battery victims with the control population, assault patients were more likely to be young (mean age 36.2 years vs. 42.2 years) and immigrants (41.5% vs. 15.1%). Furthermore, marital status (65.9% vs. 40.8% singles), employment status (36.6% vs. 9.7% unemployed) and insurance status (41.5% vs. 12.3% social insurance) were significantly different in the bivariate analysis. Logistic regression evaluation identified three variables that were independently associated with assault burns: younger age (< or =25 years) (odds ratio, 2.54 [95% confidence interval, 1.29-5.02]; p=0.007), ethnic minority (odds ratio, 3.71 [95% confidence interval, 1.91-7.20]; p<0.001) and unemployment (odds ratio, 4.02 [95% confidence interval, 2.03-7.97]; p<0.001). CONCLUSIONS: The high incidence of youngsters, unemployment and the great proportion of immigrants in victims of assault might provide several opportunities for community-based psychosocial and occupational programs. A multidisciplinary approach targeting issues specific to the violent nature of the injury and the socioeconomic background of the victims may be of benefit to improve their perspectives for rehabilitation.

Acalculous cholecystitis in severely burned patients: incidence and predisposing factors.

OBJECTIVE: To investigate the incidence and predisposing factors of acalculous cholecystitis (AAC) in severely burned patients. BACKGROUND DATA: Although some studies report on AAC in critically ill patients, very little is known about AAC after severe burns. METHODS: We conducted a retrospective cohort study involving patients with burns admitted to the burn intensive care unit (BICU) of a university hospital. The patient cohort was divided into two groups (AAC group: burned patients with histological proven acalculous cholecystitis, n=15; CONTROL GROUP: population of all other burned patients admitted to the BICU, n=1225). Univariate and multivariate analyses were used to identify predisposing factors for the development of AAC. RESULTS: Fifteen patients with acalculous cholecystitis were identified in the study period. This represents 1.2% of all significant burns admitted. Comparing the AAC group with the Control population the following patients' characteristics, therapeutic measures and outcome parameters were significantly different in the univariate analysis: mean age (54.0 years vs. 42.0 years), BMI (28.9 kg/m(2) vs. 25.6 kg/m(2)), abbreviated burn severity index (8.3 vs. 6.4), total body surface area burn deep partial thickness (12.0% vs. 6.2%) and full thickness (10.2% vs. 6.8%), concomitant inhalation injury (80.0% vs. 28.9%), sepsis (46.7% vs. 14.9%), catecholamine (100% vs. 30.4%) and antibiotic requirement (100% vs. 58.2%), non-biliary tract operations (4.9 vs. 1.5), BICU length of stay (63.4 days vs. 21.0 days), ventilator days (50.3 vs. 11.9), packed red blood cells (PRBCs) administration (70.0 units vs.13.0 units) and mortality (53.3% vs. 19.7%). In the multivariate analysis however, only age, the number of administered units of PRBCs and the duration of mechanical ventilation turned out to be independent predictors for the occurrence of AAC. CONCLUSION: AAC is a rare complication of severely burned patients and may reflect the severity of the patient's general conditions. Predisposing factors for AAC are advanced age, the need of blood transfusions and prolonged mechanical ventilation. In the presence of these predisposing factors, early monitoring may help to detect AAC earlier and to initiate appropriate intervention.

[Reconstruction of the oral commissure in microstomia patients with deep dermal facial burns: a modified technique]. / Rekonstruktion der oralen Kommissur bei Mikrostomie nach tief dermaler Verbrennung - eine modifizierte Technik.

BACKGROUND: Deep thermal dermal wounds of the oral region with subsequent microstomia are a rare and complex indication for surgical reconstruction of the oral commissure. Apart from functional and mimic aspects, aesthetic expectations are high. Based on converse technique, we performed a reconstruction of the oral commissure in 17 patients. 8 of these needed surgical re-operation due to recurrence and insufficient results. This high rate of complications led to a modification of the surgical procedure. PATIENTS: We present a modified technique which gave good results in our clinic. Based on Fairbank's technique, we altered the technique by covering the soft tissue defect of the lateral lip with an additional rotation flap raised from the mucosa of the enoral lower lip. Resulting scars were thereby shifted to the enoral side of the lower lip which caused less contracture in the region of the oral commissure. RESULTS: Using this modified technique, we were able to achieve a lasting displacement of the oral commissure to the lateral side. Long-term follow-up showed good functional results with no need for additional procedures.

In vitro engineering of heart muscle: artificial myocardial tissue.

INTRODUCTION: Myocardial infarction followed by heart failure represents one of the major causes of morbidity and mortality, particularly in industrialized countries. Engineering and subsequent transplantation of contractile artificial myocardial tissue and, consequently, the replacement of ischemic and infarcted areas of the heart provides a potential therapeutic alternative to whole organ transplantation. METHODS: Artificial myocardial tissue samples were engineered by seeding neonatal rat cardiomyocytes with a commercially available 3-dimensional collagen matrix. The cellular engraftment within the artificial myocardial tissues was examined microscopically. Force development was analyzed in spontaneously beating artificial myocardial tissues, after stretching, and after pharmacologic stimulation. Moreover, electrocardiograms were recorded. RESULTS: Artificial myocardial tissues showed continuous, rhythmic, and synchronized contractions for up to 13 weeks. Embedded cardiomyocytes were distributed equally within the 3-dimensional matrix. Application of Ca(2+) and epinephrine, as well as electrical stimulation or stretching, resulted in enhanced force development. Electrocardiographic recording was possible on spontaneously beating artificial myocardial tissue samples and revealed physiologic patterns. CONCLUSIONS: Using a clinically well-established collagen matrix, contractile myocardial tissue can be engineered in vitro successfully. Mechanical and biologic properties of artificial myocardial tissue resemble native cardiac tissue. Use of artificial myocardial tissues might be a promising approach to reconstitute degenerated or failing cardiac tissue in many disease states and therefore provide a reasonable alternative to whole organ transplantation.

Serum concentrations of some metals and steroids in patients with chronic fatigue syndrome with reference to neurological and cognitive abnormalities.

Chronic fatigue syndrome is defined by the Atlanta Centers for Disease Control (Atlanta, GA, USA) as debilitating fatigue lasting for longer than 6 months. Symptoms include disturbances of cognition. Certain factors have in the past been shown to influence cognition, including metals such as aluminum, iron, and zinc; and steroids such as dehydroepiandrosterone. In the present study, concentrations of these factors were determined in the serum and plasma of patients and their age- and gender-matched healthy controls (10 women and 5 men in each group). In addition, copper, dehydroepiandrosterone sulphate, cortisol, cholesterol, hemoglobin, ferritin and transferrin concentrations, as well as transferrin genetic subtypes were determined in both groups. The results indicate that patients had significantly increased serum aluminum and decreased iron compared to controls. In the females, serum iron and dehydroepiandrosterone sulphate were significantly decreased and correlated. Total cholesterol was significantly increased, and significantly negatively correlated with dehydroepiandrosterone sulphate. There were no differences in zinc, copper, cortisol, hemoglobin, transferrin and ferritin concentrations, or in transferrin genetic subtypes.

Aluminium uptake and excretion in potroom workers of a new primary aluminium smelter during the construction stage.

The aim of this study was to define bio-accumulation and excretion patterns of aluminium in newly employed potroom workers as well as changes in ambient aluminium levels in the potrooms of a modern aluminium smelter during the plant construction stage and one year into full production. A study was carried out on 115 newly employed volunteer potroom workers at various intervals, over a total period of 36 months. Before commencement of employment a structured questionnaire was completed by all study participants and the first collection of blood and urine specimens took place. As none of the subjects had ever worked in the aluminium industry before, they also served as their own controls. Atomic absorption spectroscopy was used to measure the aluminium content in the biological fluids and the content of the metal in the ambient air of the potrooms. Significantly, the study found an early and marked biological response to inhalation of very low levels of airborne aluminium. After only 12 months, the mean concentration of aluminium in serum had almost doubled; thereafter it levelled off. A mixed model analysis did not find any differences in the concentrations of aluminium in the serum of the subjects since the variation between subjects at any given time was much smaller than the variation within subjects. This may be an indication of the pronounced effect of aluminium inhalation on the kinetics of this metal in the human body. Furthermore, urinary excretion of aluminium by the potroom workers showed a linear increase reaching a concentration of only 49 microg l(-1) at the 36 month stage, suggesting a slow rate of elimination.

Repair of congenital H-type vestibuloanorectal fistula through the posterior midsagittal approach: case report.

The posterior midsagittal approach was successfully used for the repair of congenital H-type vestibuloanorectal fistula in a patient 1.5 months old. Technical details of the operation which consisted of two main parts are described. Identification and dissection of the fistulous tract started following midsagittal division of the sphincters and the posterior half of the rectum with the patient in a knee-chest position. The dissected part of the fistulous tract was inverted per vagina. Completion of dissection and excision of the fistulous tract were accomplished with the patient in the lithotomy position. The main advantage of the procedure was the ability to completely excise the fistula under direct vision.

Biological indicators of exposure to total and respirable aluminium dust fractions in a primary aluminium smelter.

OBJECTIVES: The study attempts to define biological indicators of aluminium uptake and excretion in workers exposed to airborne aluminium compounds in a primary aluminium smelter. Also, this study defines the total and respirable aluminium dust fractions in two different potrooms, and correlates their concentrations with biological indicators in this group of workers. METHODS: Air was sampled at defined work sites. Non-destructive and conventional techniques were used to find total and respirable aluminium content of the dust. Blood and urine was collected from 84 volunteers employed at various work stations throughout the smelter and from two different cohorts of controls matched for sex, age, and socioeconomic status. Aluminium in serum samples and urine specimens was measured by flameless atomic absorption with a PE 4100 ZL spectrometer. RESULTS: The correlation of aluminium concentrations in serum and urine samples with the degree of exposure was assessed for three arbitrary exposure categories; low (0.036 mg Al/m3), medium (0.35 mg Al/m3) and high (1.47 mg Al/m3) as found in different areas of the smelter. At medium and high exposure, the ratio of respirable to total aluminium in the dust samples varied significantly. At high exposure, serum aluminium, although significantly raised, was still within the normal range of an unexposed population. The workers with low exposure excreted aluminium in urine at levels significantly higher than the controls, but still within the normal range of the population. However, potroom workers with medium and high exposure had significantly higher urinary aluminium than the normal range. CONCLUSIONS: It is concluded that only urinary aluminium constitutes a practical index of occupational exposure at or above 0.35 mg Al/m3, and that the respirable fraction of the dust may play a major role in the biological response to exposure to aluminium in a smelter environment.

Deposition of aluminium in tissues of rabbits exposed to inhalation of low concentrations of Al2O3 dust.

With strong evidence coming to light for the toxicity of aluminium (Al), especially to the brain, investigation into the effects of inhalation of low concentrations of Al dust in animal models has become important. This study follows up previous observations on the effects of Al on the concentrations of essential metals in serum of workers exposed to inhalation of low concentrations of Al dust, with a study of the concentrations of Al in tissues of rabbits exposed to Al dust at one twentieth of the threshold limit value (TLV). Even at this low concentration, the amount of Al in the brains of these animals was nearly two and a half times as high as that of the control animals. The concentrations in other tissues were similar to normal. At the same time, the concentrations of Al in the serum was only slightly raised, indicating that this variable is a poor marker for the effects of Al on the body. It is suggested that an extensive study is needed to determine a more correct TLV and health based permissible concentration for occupational exposure to Al.

The effect of exposure to aluminium on concentrations of essential metals in serum of foundry workers.

The concentrations of aluminium (Al) in serum and urine of 33 volunteers exposed to inhalation of Al2O3 dust at a concentration in the air of less than 1 mg Al/m3 were measured. These were compared with results from 20 normal subjects not exposed. The concentrations of copper (Cu), zinc (Zn), and total iron (Fe) in serum were also measured. The Al concentration in serum was significantly raised in the subjects exposed to dust, but Al concentrations in urine showed no significant difference from controls. This suggests a possible change in distribution of metals in the body tissues due to the presence of Al, with incomplete excretion of Al in the urine. This redistribution was selective, as the serum concentrations of Cu were conclusively decreased whereas the serum concentrations of Zn were conclusively increased. The serum concentration of Fe did not change significantly.