Six-grade Scale Research Articles

Decompression strain in parachute jumpmasters during simulated high-altitude missions: a special reference to preoxygenation strategies

PurposeMilitary parachute operations are often executed at high altitude, from an unpressurized aircraft compartment. Parachute jumpmasters (JM) are thus regularly exposed to 29,500 ft for 60 min. The aim was to investigate the decompression strain during a simulated JM mission at high altitude and to compare two strategies of preoxygenation, conducted either at sea-level or below 10,000 ft, during ascent to mission altitude.MethodsTen JM completed, on separate occasions, a 45-min preoxygenation either at sea-level (normobaric: N) or 8200ft (hypobaric: H), followed by exposure to 28,000 ft for 60 min, whilst laying supine and breathing 100% oxygen. At min 45 of the exposure to 28,000 ft, the JM performed 10 weighted squats. Decompression strain was determined from ultrasound assessment of venous gas emboli (VGE) during supine rest (5-min intervals), after three unloaded knee-bends (15-min intervals) and immediately following the weighted squats. The VGE were scored using a six-graded scale (0–5).ResultsIn condition H, two JM experienced decompression sickness (DCS), whereas no DCS incidents were reported in condition N. The prevalence of VGE was higher in the H than the N condition, at rest [median(range), 3(0–4) vs 0(0–3); p = 0.017], after unloaded knee-bends [3(0–4) vs 0(0–3); p = 0.014] and after the 10 weighted squats [3(0–4) vs 0(0–3); p = 0.014]. VGE were detected earlier in the H (28 ± 20 min, p = 0.018) than the N condition (50 ± 19 min).ConclusionsA preoxygenation/altitude procedure commonly used by JM, with a 60-min exposure to 28,000 ft after pre-oxygenation for 45 min at 8200 ft is associated with high risk of DCS. The decompression strain can be reduced by preoxygenating at sea level.

Impact of COVID-19 and COVID-19 vaccination on high-risk patients with antiphospholipid syndrome: a nationwide survey.

ObjectivesPatients with antiphospholipid syndrome (APS) and triple-positive for antiphospholipid antibodies (aPL) are at high-risk of recurrent events. As COVID-19 and COVID-19 vaccination may induce thrombotic complications, the objective of the study was to assess the course of COVID-19 and adverse events after vaccination in these patients.MethodsThis is a nationwide multicentre survey conducted in nine APS referral centres by means of a questionnaire. Included patients are thrombotic APS with triple-positive aPL confirmed 12 weeks apart. Reference specialist physicians used a four-graded scale of severity for COVID-19 [from 0 (asymptomatic) to 3 (hospitalization in intensive care unit)] and a six-graded scale for adverse reactions to vaccination [from 0 (transient local injection site sign/symptoms) to 5 (potentially life-threatening reactions)]. Outcomes were considered within a 30-days period.ResultsOut of 161 patients interviewed, 18 (11%) had COVID-19. All of them fully recovered without any progression to severe disease nor thromboembolic event. One-hundred-forty-six patients received the first (92%) and 129 (80%) the second dose of vaccine; side effects were minimal and, in most cases, (83% after the first and 68% after the second shot) limited to a sore arm. Fifteen patients (9%) were unvaccinated. Most of them raised doubts on the need for vaccination, complained for poor safety and in general were reluctant on COVID-19 vaccination.ConclusionPatients with triple-positive thrombotic APS did not suffer from severe COVID-19 outcomes. Importantly, COVID-19 vaccination was well tolerated. These data may reassure patients and physicians and contribute in reducing hesitancy in unvaccinated patients.

Capacity of Zlatitsa Municipality (Western Bulgaria) to provide ecosystem services

The present research aims at estimating the capacity of the ecosystems in Zlatitsa Municipality to provide certain types of ecosystem services. The case study area is located in the western parts of Bulgaria, and it is a part of Sofia Province. The basis of the study is the CORINE Land Cover (CLC) classification (2018) upon which the Maes typology has been built. Fourteen (14) CLC Classes were distinguished in Zlatitsa Municipality, as well as five (5) ecosystem types. The capacity of the latter to provide ecosystem services was evaluated, based on a six-grade scale. The results of the study include maps of the provisioning, regulating, and cultural service capacity of the area, as well as an overall map of all of them. The research outcomes provided successful results, focusing on the importance of the provision of ecosystem services. They can be applied as a framework for similar studies in the neighboring municipalities.

Pathways for horizontal gene transfer in bacteria revealed by a global map of their plasmids

Plasmids can mediate horizontal gene transfer of antibiotic resistance, virulence genes, and other adaptive factors across bacterial populations. Here, we analyze genomic composition and pairwise sequence identity for over 10,000 reference plasmids to obtain a global map of the prokaryotic plasmidome. Plasmids in this map organize into discrete clusters, which we call plasmid taxonomic units (PTUs), with high average nucleotide identity between its members. We identify 83 PTUs in the order Enterobacterales, 28 of them corresponding to previously described archetypes. Furthermore, we develop an automated algorithm for PTU identification, and validate its performance using stochastic blockmodeling. The algorithm reveals a total of 276 PTUs in the bacterial domain. Each PTU exhibits a characteristic host distribution, organized into a six-grade scale (I–VI), ranging from plasmids restricted to a single host species (grade I) to plasmids able to colonize species from different phyla (grade VI). More than 60% of the plasmids in the global map are in groups with host ranges beyond the species barrier.

Analysis of Symptom Development in Relation to Quantity of Rice stripe virus in Rice (Oryza sativa) to Simplify Evaluation of Resistance.

Rice stripe virus (RSV) is one of the most devastating pathogens of rice (Oryza sativa) in rice-growing regions of East Asia. We analyzed the increase in RSV accumulation in infected rice plants over time and evaluated the association between disease severity and RSV accumulation with the aim of establishing an experimental system for accurate and efficient evaluation of RSV resistance in rice. As an index of RSV accumulation in plants, relative concentration of RNA corresponding to the coat protein gene region was measured using reverse-transcription quantitative polymerase chain reaction. Actin and elongation factor 1a were used as the host reference genes. RSV concentrations tended to increase with time from 7 to 28 days after inoculation, and a strong positive correlation was observed between the log RSV concentrations in the midsections of the uppermost leaves and in the stems at the first leaf sheath position. We analyzed RSV concentrations at these two locations 21 days after inoculation with RSV and assessed severity of disease symptoms based on a commonly used scale (Washio's six-grade scale) rated as A (most severe), B, Bt, C, Cr, or D (mild symptoms). RSV concentrations at both locations were high in plants graded A, B, or Bt, with no significant difference in concentration of RSV among the three grades, but concentrations were significantly higher in the three grades compared with that in the plants in grade D. RSV concentrations were highly variable among plants in grades C and Cr. On the basis of these data, we propose a new formula to estimate the range of disease severities with greater ease and practical value. The values calculated by the new formula corresponded well to those based on Washio's six-grade scale.

Treatment of facial lipoatrophy, morphological asymmetry, or debilitating scars with the hyaluronic acid dermal filler Princess® FILLER.

PurposeThe aim of this study was to evaluate the effectiveness and safety of hyaluronic acid (HA) dermal filler when used in the face for medical reconstructive purposes.Patients and methodsAdult patients with moderately severe facial lipoatrophy (FLA), morphological asymmetry (MA) of the face, or debilitating scars (DS) on the face were included in a prospective, noncomparative, multicenter, postmarket clinical follow-up study. All patients were treated with an HA filler (Princess® FILLER), which was injected intradermally on study Day 1, with optional touch-up 2 weeks later. The effectiveness of the treatment was evaluated at Weeks 4 and 24, using a six-grade scale ranging from “excellent” to “worsening”. The assessments were conducted by both the investigator and the patient and, at Week 4, by the independent photography reviewer as well. Adverse events were collected at each visit.ResultsFifty-three patients were included in the study (FLA 23, MA 17, and DS 13), and 46 patients completed a 6-month follow-up (FLA 20, MA 15, and DS 11). At Week 4 (primary endpoint), the overall treatment success rate was 100% (FLA), 100% (MA), and 94% (DS), based on assessments made by the investigator, patients, and the independent reviewer, respectively. In most patients (~95%), the effect was sustained over 6 months. Treatment-related adverse events were reported in five patients (9%) and included injection site hematoma, injection site pain, and headache.ConclusionDermal filling with HA gel is a viable treatment option for the correction of various deformities of the face resulting from FLA, MA, or DS.

A Model of Continuous Improvement of Data Quality in Modelling and Simulation

Accurate, reliable and adaptive data form the foundation stone of large-scale simulation system and data quality becomes one of the most important measures weighing the reliability of simulation system. This paper firstly establishes an index system of data quality evaluation for large-scale simulation system which uses the six-grade scale method to mark and calculate weights of indexes, then draws out the curve between investments and quality index values by Pearl forecasting model, and lastly gets the optimized outlay distribution based on GA upon the condition of fixed total investment, realizing the continuous improvement of data quality and helping to the promotion of reliability for large-scale simulation system.

PD-L1 immunohistochemistry in clinical diagnostics: Inter-pathologist variability is as high as assay variability.

e20637 Background: Several checkpoint inhibitors targeting the PD1 axis are now approved for the treatment of non-small cell lung cancer (NSCLC). The best predictor for therapy response is PD-L1 expression on tumor cells assessed by immunohistochemistry (IHC). However, the PD-L1 assays have been developed independently for each available drugs. In this study, we evaluated the different assays to determine the comparability between the assays and the concordance between pathologists under conditions reflecting the clinical situation. Methods: We tested four IHC assays (28-8, 22C3, SP263 and SP142) and one in-house protocol (28-8 on the Ventana system) on a tissue microarray (TMA) including 55 resected tissue specimens of NSCLC patients. The TMAs were independently annotated by seven pathologists with regard to the percentage of tumor cell membrane staining using a six-grade scale ( < 1%; 1-≤5%; 5%-≤10%; 10-≤25%; 25-≤50%; ≥50%). Results: The staining scores were comparable for the three assays with clones 28-8, 22C3 and SP263 as well as the in-house 28-8 protocol (κ-value: 0.75-0.91). The use of the SP142 clone resulted in a lower percentage of positive tumor cells and positive cases (κ: 0.44-0.63). When a reference score was defined based on the majority of scores, the proportion of positive cases (≥1%) were 38% for 28-8, 29% for 22C3, 42% for SP263, 37% for 28-8 in-house and 16% for SP142%. With ≥1% cut-off 3-8 of the 55 cases (5-15%) were differently classified as positive or negative when comparing any two assays excluding SP142. Analysing the scoring of the seven pathologists a clear inter-rater variability (κ: 0.71-0.96) was observed independent from the assay. With a ≥1% cut-off, 20% of cases were annotated differently by at least one pathologist. Conclusions: The concordance between the three antibody clones 28-8, 22C3 and SP263 was acceptable and was in the similar range as inter-rater variability of different pathologists. The results suggest that assessment of tumor cell staining for Nivolumab, Pembrolizumab and Durvalumab might be performed with only one of these assays. The assessment of the pathologist presents an intrinsic source of error that should be considered especially at low PD-L1 scores.

Skin microtopography as a measure of photoaging and risk of squamous cell carcinoma of the skin in a US population.

Skin microtopography as a measure of photoaging is a noninvasive approach to measuring chronic ultraviolet radiation exposure and reflects the degree of dermal elastosis in populations of European descent in the subtropics. Less is known about the utility of this approach in populations at different latitudes, and whether it relates to skin cancer risk. A population-based case-control study of 342 squamous cell carcinoma (SCC) cases and 331 age- and gender-matched controls were evaluated for histologic evidence of solar damage and severity of photoaging based on microtopography on a six-grade scale. Odds ratios (OR) for SCC associated with degree of photoaging were estimated using logistic regression analysis adjusted for potentially confounding factors. After adjustment for known risk factors, SCC was associated with increasing photoaging grade (OR=1.7, 95% CI=0.9-3.0 for severe photoaging; OR=2.8, 95% CI=1.6-5.0 for very severe photoaging). Associations remained among those with actinic keratosis (OR=3.4, 95% CI=0.9-12.4 for severe photoaging, OR=5.7, 95% CI=1.7-19.6 for very severe photoaging). There was limited statistical power, particularly for subgroup analyses. Our findings provide further evidence of microtopography as an independent, objective indicator of risk of SCC.

Pattern and Management of Vaginal Bleeding Complications, Especially Hypermenorrhea, with Direct Oral Anticoagulants - Results of the Prospective Dresden Noac Registry (NCT01588119)

Background: Bleeding is a common complication of oral anticoagulation (OAC). In anticoagulated women of child-bearing potential (WOCBP), increase of menstrual bleeding may be discomforting and severe cases of menorrhagia may require dedicated treatment or even discontinuation of OAC. Since hypermenorrhea seems to be more frequent in patients receiving direct oral anticoagulants (DOAC) compared to classic OAC with vitamin-K antagonists, patterns of menorrhagia need to be studied in daily care cohorts.Patients and methods: Using data from the prospective, non-interventional Dresden NOAC registry and phase-III DOAC trial patients at our site, we evaluated rates, severity and management of vaginal bleeding complications in WOCBP (defined as age ≤55 years and without sterilizing procedures or age >55 years with documented menstrual bleeding).All bleeding complications were centrally adjudicated and classified according to ISTH definition. Annualized rates of vaginal bleeding and hypermenorrhea were calculated as number of bleeding events divided by cumulative days of DOAC exposure divided by 365 days.OAC treatment satisfaction was assessed in all registry patients at every follow-up visit by a simple six-graded scale (ranging from 1=very satisfied to 6=very unsatisfied). To assess impact of vaginal bleeding on quality of live, the first available score after a vaginal bleeding was compared with the last available score of WOCBPs without vaginal bleeding.Results: Until March 31th 2015, 1343 women were enrolled, of which 154 were WOCBPs (mean age 39±12 years; range 14-56). In these patients, OAC consisted of dabigatran (1.3%), rivaroxaban (92.2%), apixaban (5.8%) or edoxaban (0.6%).During follow-up (mean FU duration 24.6 months), 85 female patients reported 107 vaginal bleeding complications, of which 68 occurred in 53 WOCBPs (53 cases of hypermenorrhea and 15 bleedings unrelated to cycle).Table 1 indicates severity of hypermenorrhea and vaginal bleedings unrelated to cycle.According to ISTH definition, 37/68 (54.4%) of the vaginal bleeding in WOCBPs were minor, 25/68 (36.8%) were non-major, clinically relevant (NMCR) and 6/68 (8.8%) major bleeding (classified as "major" due to drop of hemoglobin ≥2g/l in 5 cases and/or transfusion of ≥2 units of red blood cells in 5 cases).In relation to all exposed WOCBPs, the rate of vaginal bleeding events was found to be 0.41 events per exposure year and the rate of hypermenorrhea was found to be 0.32 events per exposure year (median exposure time 243d; 25th/75th percentile 105/674d and median time to first hypermenorrhea 26d; 25th/75th percentile 10/46d).Of the 53 WOCBPs that described vaginal bleeding complications (including hypermenorrhea and cycle-unrelated bleeding), 12/53 (22.6%) experienced a 2nd and 3/53 (5.7%) a 3rd event (figure 1). While bleeding intensity remained stable in most recurrent events, bleeding intensity increased in 6 cases with a 2nd bleeding episode while bleeding intensity remained stable or decreased in all 3 cases with a third episode.In only 16 of the 53 hypermenorrhea events, anatomical causes could be established and 3 of these cases progressed to major bleeding (necessity of at ≥2 units of red blood cells). In contrast, in the 34 hypermenorrhea events without anatomical causes, bleeding intensity was less severe (table 1).Surgical or interventional treatment was necessary in 6/68 (8.8%) vaginal bleeding events. The remaining 62 (91.2%) events were treated conservatively (start or change of hormone therapy, tranexamic acid, OAC dose reduction or temporary interruption).Overall, OAC treatment satisfaction in WOCBP was good (mean score 1.6; 25th/75th percentile 1/2 with data available for 98/154 WOCBPs) and not different in patients with and without vaginal bleeding complications (1.6; 25th/75th percentile 1/2 vs. 1.5; 1/2; p=0.548).Conclusion: Vaginal bleeding and especially hypermenorrhea is a common complication in WOCBPs receiving oral anticoagulation. Only a small proportion of affected patients have underlying anatomical causes for bleeding but these patients often develop more severe bleeding. The majority of cases can be conservatively managed and bleeding intensity rarely increases over time. Overall, the impact of vaginal bleeding complications on treatment satisfaction seems small. [Display omitted] [Display omitted] DisclosuresMarten:Bayer HealthCare: Honoraria. Beyer-Westendorf:Pfizer: Honoraria, Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; Boehringer Ingelheim: Honoraria, Research Funding; Bayer HealthCare: Honoraria, Research Funding.

Changes in the expression of epidermal differentiation markers at sites where cultured epithelial autografts were transplanted onto wounds from burn scar excision.

This study investigated the recovery process during which grafted cultured epithelium formed normal epidermis. The subjects were 18 patients whose burn scars were excised at a depth not exposing the fat layer and who subsequently received cultured epithelial autografts. A total of 24 samples were obtained from the grafted sites: 6 samples within 6 weeks (stage 1), 5 samples after 6 weeks and within 6 months (stage 2), 6 samples after 6 months and within 18 months (stage 3) and 7 samples beyond 18 months (stage 4) after transplantation. These samples were stained for monoclonal antibodies against filaggrin, transglutaminase (TG), cytokeratin 6 and involucrin. Their expressions were examined in the epidermis. The expression patterns were classified using a six-grade scale. The grades of filaggrin and TG were significantly higher at stage 3 and 4 compared with stage 1. There was a marginally significant increase in the grade of cytokeratin 6 at stage 3 and it was significantly higher at stage 4 compared with stage 1. These results showed that wound healing continued at a molecular level until the end of stage 3. The recovery of involucrin was delayed compared with that of other markers. TG and involucrin are thought to be regulated independently at the grafted sites.

The Consequences of Industrialization: Evidence from Water Pollution and Digestive Cancers in China

China's rapid industrialization has led to a severe deterioration in water quality in the country's lakes and rivers. By exploiting variation in pollution across China's river basins, I estimate that a deterioration of water quality by a single grade (on a six-grade scale) increases the digestive cancer death rate by 9.7%. The analysis rules out other potential explanations such as smoking rates, dietary patterns, and air pollution. I estimate that doubling China's levy rates for wastewater dumping would save roughly 17,000 lives per year but require an additional [dollar]500 million in annual spending on wastewater treatment.

Photoaging of the chest analyzed by capacitance imaging

Capacitance imaging is a new technique using sensors based on silicon technology developed to record fingerprints for security reasons. Applying such a sensor onto the skin surface gives the capacitance (hydration) map of the skin surface with a two-dimensional resolution of 50 microm. This method was used to characterize skin of the chests of 64 women with various grades of skin photoaging. The severity of photoaging of the chest skin of 64 women was clinically assessed according to a six-grade scale. Capacitance images of the skin were recorded and analyzed in terms of mean capacitance, homogeneity of gray levels and density of microrelief lines. Capacitance images of the adjacent unexposed area (upper part of the breast) were also recorded and analyzed for comparison. Pictures of the different areas were recorded. Microrelief line density decreases with the age of the volunteers but is independent of the severity of photoaging. Mean hydration of the skin surface is found to be independent of both photoaging severity and age. Evenness of hydration is a parameter markedly linked to the severity of photoaging independent of age. Uneven hydration is related to the juxtaposition of both hydrated and dry areas corresponding to some hyperpigmented and hyperkeratosic areas. Moreover, capacitance images reveal that some of the hyperpigmented areas may exhibit under- or over-hydrated conditions depending on the nature of the lesion. Irregular skin surface hydration is an important characteristic of skin photoaging. It is related to skin pigmentation but does not parallel its unevenness of pigmentation.

Low levels of physical activity in back pain patients are associated with high levels of fear‐avoidance beliefs and pain catastrophizing

Fear-avoidance beliefs are important determinants for disability in patients with non-specific low-back pain (LBP). The association with self-reported level of physical activity is less known. The aim of the present study was to describe the level of physical activity in patients with chronic non-specific LBP and its relation to fear-avoidance beliefs and pain catastrophizing. A cross-sectional study on 64 patients with chronic non-specific LBP in primary healthcare. The variables measured and the questionnaires used were: level of physical activity (six-graded scale); activity limitations (Roland Morris Disability Questionnare (RDQ)); fear-avoidance beliefs (Tampa Scale of Kinesiophobia (TSK) 13-item and sub-scales 'activity avoidance' and 'somatic focus'); and pain catastrophizing (Pain Catastrophizing Scale (PCS)). The level of physical activity was dichotomised into low and high physical activity. Individual median scores on the TSKandPCSscales were used to group the patients into different levels offear-avoidance beliefs and pain catastrophizing. Univariate logistic regressions were used to calculate odds ratios for having low physical activity. Patients with low physical activity had significantly higher scores in fear-avoidance beliefs and pain catastrophizing (p < 0.05). Odds ratios for low level of physical activity were between 4 and 8 (p < 0.05) for patients with high fear-avoidance beliefs or medium/high pain catastrophizing. This study indicates that it seems important for physiotherapists in primary care to measure levels of fear-avoidance beliefs or pain catastrophizing. In particular, the two subscales of the TSK could be of real value for clinicians when making treatment decisions concerning physical exercise therapy for patients with chronic LBP.

Management of air leak after pulmonary resection.

We prospectively evaluated the efficacy of water seal in the management of air leak after pulmonary resection. Eighty-seven patients who underwent lobectomy were enrolled. Air leak was qualitatively described on each postoperative day using a six-grade scale. All chest tubes were continuously suctioned at a negative pressure of 12 cm H2O until the morning of postoperative day (POD) 1. Switch was made to water seal if the air leak was graded as "minor at expiration" or lower. This procedure is referred to as "the water seal challenge". On POD 1, 58 patients had air leaks. The water seal challenge was attempted on POD 1.6+/-1.0. While 45 patients (78%) continued to receive the water seal, the remaining 13 patients were switched to suctioning at -5 cm H2O followed by the successful second water seal challenge within 3 days from the first challenge. The air leak stopped 3.1+/-3.0 days after the application of the water seal in the 58 patients. None of the following correlated with the duration of air leak: preoperative pulmonary function tests, type of lobectomy, age, and gender. Only the leak grade on POD 0 correlated significantly with the duration of air leaks (p<0.0001). These results show that water seal is a safe and effective management option for air leak during the early postoperative period.

On categorization and quantification of women's sexual dysfunctions: an epidemiological approach.

The objectives of this study are to compare the two definitions of female sexual dysfunction, namely dysfunction per se (A category) and personal distress caused by dysfunction (B category), and to gauge their associations with some sociodemographic aspects and level of sexual well-being. The subjects were a nationally representative sample of sexually active Swedish women (n: 1056) aged 18-65 y, who participated in a combined structured interview/questionnaire investigation. The functions analysed were: self-reported sexual desire, interest, lubrication, orgasm, genital pain and vaginism, which were subclassified for the A and B categories into no, mild (sporadically occurring) and manifest dysfunction. Sexual well-being was reported along a six-grade scale ranging from very satisfied to very dissatisfied. The sociodemographic items registered were: education, occupation, financial situation, social group, immigrant status, location of domicile and church-going. Aggregated mild and manifest dysfunction per se of sexual interest, orgasm and vaginal lubrication were reported by about 60-90%. More than one-third had dyspareunia, but few reported vaginism. Mild dysfunctions were clearly more common than manifest dysfunctions. Not fully 45% of those with manifest low interest and orgasm perceived these dysfunctions as manifestly distressing, while in 60-70% lubricational insufficiency of dyspareunia led to manifest distress. Age and the included sociodemographic variables had marginal or no influence on sexual functions. A four-factor sexual function pattern was identified, closely linking A and B categories in a pairwise manner. Three factors, labelled sexual desire, orgasm and genital function were powerful classifiers (discriminant analysis) of level of sexual well-being. Hence, it is a matter of taste whether to use the A or the B category. Together, they can explain the gross level of satisfaction with sexual life to an adequate extent.

Evaluation of the predictive value of Her-2/neu gene expression on osteosarcoma therapy in laser-microdissected paraffin-embedded tissue

Histologic response to chemotherapy is currently the strongest prognostic factor in high-grade osteosarcoma, but it can only be assessed after several weeks of therapy. Thus, detection of chemosensitivity at the time of diagnosis would be of great clinical importance. The expression of the proto-oncogene Her-2/neu has been shown to be of predictive value in breast cancer and has also been considered as prognostic marker for osteosarcomas, but reports of mainly immunohistochemical studies are controversial. Therefore, the aim of this study was to investigate Her-2/neu gene expression in laser-microdissected osteosarcoma cells. Laser microdissection enables the precise isolation of morphological defined cells from archival tissue specimens and is in combination with the highly sensitive real-time RT-PCR technique a valuable tool for cell-specific analysis of gene expression. Through optimization of current protocols, we could show that this technique can be successfully applied on formalin-fixed, paraffin-embedded and decalcified osteosarcoma tissue with high sensitivity and reproducibility. In all 17 osteosarcoma biopsies analyzed, we could detect Her-2/neu gene expression. Expression correlated significantly with the response to preoperative chemotherapy, which was assessed histologically according to the six-grade scale of Salzer-Kuntschik. Risk assessment on the basis of increased Her-2/neu gene expression matched the histologic findings in 16 out of 17 cases (94%). These data demonstrate the reliability of laser microdissection in the analysis of gene expression and suggest a possible role of Her-2/neu as prognostic marker for therapy outcome in osteosarcomas.

Variation in bill colour among Greylag Geese Anser anser breeding in south-west Scania

The anser subspecies of the Greylag Goose Anser anser was earlier distributed over most of Europe, between the ranges of sylvestris in the west and rubirostris in the east. Its bill colour was orange. I examined the bill colour of 97 trapped breeding adults from the province of Scania in 1995—1998. I used a six-grade scale from orange (I) to pink (VI). Most birds were intermediate (III), a few had pink bills (V–VI), but none had an orange one (I). Two explanations are examined: fauna falsification by introduction of rubirostris birds, which is known to have taken place several times, and inclusion of rubirostris genes into the small 20th century population of anser birds by rubirostris individuals that have reached the anser range naturally; a few such winter visitors are known. I conclude that the most likely explanation is the deliberate introduction of rubirostris but the other alternative cannot yet be ruled out.

Life satisfaction several years after severe multiple trauma--a retrospective investigation.

To describe the prevalence of self-reported changes in life satisfaction after multiple trauma, to analyse associations between satisfaction with life as a whole and with domains in life, and to identify important contributors for satisfaction with life. Retrospective follow-up study. Rehabilitation hospital three years after multiple trauma. Sixty-nine subjects with severe multiple trauma (ISS > or = 16). Clinical examinations to reveal prevalences of impairments and disabilities. Questionnaires about satisfaction with life as a whole and eight domains of life, both for the time before trauma, and for the actual situation; sense of coherence (SOC-13); social network. A total of 87% experienced a decrease in at least one of the nine life satisfaction items from before to after trauma (six-graded scale). After trauma significantly fewer subjects reported to be satisfied with life as a whole, as well as the domains sexual life, ADL, contact with friends, leisure, vocational and financial situation. Satisfaction with family life and partner relationship did not decrease significantly. The most important domains after trauma were satisfaction with leisure, family life and vocation. Vocational and leisure disability after trauma were important determinants for satisfaction with life as a whole. A strong sense of coherence and sufficient social network quality had significant impact on satisfaction with life as a whole and some of the domain-specific satisfactions. Both personal resources (a strong sense of coherence) and the presence of a qualitatively sufficient social network can buffer the negative influence of disabilities on life satisfaction after trauma.

Delayed facial palsy after vestibular schwannoma resection: clinical data and prognosis.

The object of the present study was to review a series of surgically removed vestibular schwannoma tumours to establish the incidence of delayed facial palsy and to evaluate the course of recovery according to the possible etiology (surgical postoperative edema or viral reactivation) with reference to the time of onset. The study group was composed of 98 patients with vestibular schwannoma. Sex, age, location, and extent of tumour and postoperative complications were all taken into consideration in the final evaluation. The course of each patient's postoperative facial function was graded according to House and Brackmann's six-grade scale. The incidence and the time of onset of the delayed facial palsy were also evaluated. The deterioration in the facial function was found to be delayed in 25 of the 98 patients (26%); of these, it occurred in the first 5 days after surgery in 11 cases, between 6 and 13 days in 10 cases, and after 15 days in 14 patients. The incidence rate of the delayed facial dysfunction was not influenced by age, sex, or the size of the tumour. The prognosis of the facial dysfunction was favourable in the majority of cases, and, in fact, there were only five grade III to IV cases 1 year later. Facial dysfunction was over grade III in the majority of the latter five cases, and the period of recovery was long. Eighty percent of our patients with delayed facial palsy following vestibular schwannoma resection were classified as having excellent or good function. In the remaining patients who had a less favourable recovery, the palsy was more severe, and the onset occurred after some time. This seems to agree with those who are of the opinion that the complication is due to viral reactivation. In these patients, it is advisable to start aggressive medical therapy with antiviral agents such as acyclovir as soon as possible.