Molecular basis for complement recognition by integrin αXβ2

Integrin α(X)β(2) functions as complement receptor for iC3b and mediates recognition and phagocytosis of pathogens. We used negative-stain EM to examine the α(X)β(2) interaction with iC3b. EM class averages of α(X)β(2) in complex with iC3b define the binding sites on both the integrin and iC3b. iC3b contains C3c and thioester domain moieties linked by a long flexible linker. The binding site is on the key ring of the C3c moiety, at the interface between the MG3 and MG4 domains. Similar complexes are seen between α(X)β(2) and the C3c fragment. α(X)β(2) binds through the α(X) αI domain, on the face known to bear the metal ion-dependent adhesion site, at the opposite end of the αI domain from its site of insertion in the β-propeller domain.     

Orbital floor reconstruction with resorbable polydioxanone implants

Many different materials are proposed for reconstruction of traumatic orbital floor defects. Donor-site morbidity of autologous transplants and infections or extrusions of nonresorbable implants lead to a widespread use of resorbable, alloplastic materials such as polydioxanone (PDS). The goal of this study was to evaluate the prevalence of orbital floor fracture-related problems after surgical treatment using PDS. Ophthalmologic and clinical examinations were performed at 194 patients before orbital floor reconstruction, 14 days and 6 months after surgery (approximate defect sizes: <1 cm2, n=50; 1-2 cm2, n=97; >2 cm2, n=47). Clinical findings including the ocular motility, the sensibility of the infraorbital nerve, and the position of the globe were evaluated. For statistical analysis of categorical data, confidence intervals of percentages were determined. Linear relationships between 2 variables were assessed with Pearson correlation analysis. A reduced ocular motility was diagnosed in 60 patients (31%) before surgery; in 14 patients (7%), 2 weeks; and in 10 patients (5%), 6 months after surgery. Infraorbital hypesthesia was found in 120 patients (62%) before surgery; in 47 patients (24%), 2 weeks; and in 35 patients (18%), 6 months after surgery. An enophthalmos was present in 10 patients (5%) before surgery, and in 4 patients (2%), 6 months after surgery. Our data suggest that PDS is a suitable implant for orbital floor reconstruction with acceptable low rates of infraorbital hypesthesia, bulbus motility disturbances, and enophthalmos. Polydioxanone can also be used for orbital floor defects exceeding 2 cm2.     

Sequence and structure relationships within von Willebrand factor

In the present study, we re-annotated von Willebrand factor (VWF), assigned its entire sequence to specific modules, and related these modules to structure using electron microscopy (EM). The D domains are assemblies of smaller modules visible as lobes in EM. Modules in the D-domain assemblies include von Willebrand D, 8-cysteine, trypsin inhibitor-like, E or fibronectin type 1-like domains, and a unique D4N module in D4. The D1-D2 prodomain shows 2 large connected assemblies, each containing smaller lobes. The previous B and C regions of VWF are re-annotated as 6 tandem von Willebrand C (VWC) and VWC-like domains. These 6 VWC domains correspond to 6 elongated domains that associate in pairs at acidic pH in the stem region of VWF dimeric bouquets. This correspondence is demonstrated by binding of integrin α(IIb)β(3) to the fourth module seen in EM, VWC4, which bears the VWF Arg-Gly-Asp motif. The C-terminal cystine knot domain dimerizes end-to-end in a manner predicted by homology to TGF-β and orients approximately perpendicular to the VWC domains in dimeric bouquets. Homologies of domains in VWF to domains in other proteins allow many disulfide bonds to be tentatively assigned, which may have functional implications.     

Influence of resection extent on morbidity in surgery for squamous cell cancer at the pharyngoesophageal junction

Purpose

Squamous cell cancer (SCC) of the pharyngoesophageal junction area has a poor prognosis mainly due to late symptom manifestation and diagnosis. Treatment of choice is still pharyngolaryngoesophagectomy, substantially affecting quality of life. Limited surgical procedures have been adopted as well. The aim of this retrospective study was to evaluate whether the extent of resection influences postoperative safety and mortality.

Methods

From 1984 to 2006, 66 patients were operated at a single tertiary referral center. Nineteen patients (28.8 %) had SCC of the hypopharynx and 47 patients (71.2 %) had SCC of the cervical and cervicothoracic esophagus. Thirty-five patients (53.0 %) underwent cervical esophageal resection (CE) and 31 underwent total esophagectomy (TE). In 39 patients (59.1 %), the larynx was preserved. Thirteen patients (19.7 %) underwent multimodal treatment.

Results

Overall postoperative morbidity was 69.7 % and reoperation rate reached 28.8 %. TE (P?=?0.03) and larynx preservation (P?=?0.02) were followed by a higher rate of non-lung infections compared with CE and pharyngolaryngectomy, respectively. Pulmonary complications have been observed more frequently after larynx preservation (P?=?0.02). Hospital mortality was 9.1 %. Four patients died after TE (12.9 %) and two patients died after CE (5.7 %). In all of them, the larynx had been preserved (15.4 %). Overall, 53 patients (80.3 %) died until follow-up. One-year and 5-year survival in patients with the major tumor burden at the cervicothoracic site was 35.7 and 0 %.

Conclusions

CE can be recommended as long as R0 resection is warranted. The advantage of larynx preservation is gained by higher morbidity and mortality rates and may not be recommended as standard procedure. Surgery may not be appropriate for advanced SCC in the cervicothoracic region.     

How efficacious is pace-therapy when ‘language systematic training’ is incorporated?

Abstract

The traditional PACE approach was compared with a modified PACE approach, which incorporated a semantic classification task for the training of lexical-semantic difficulties. In a cross-over design, four patients were treated over a period of five weeks. The modified PACE approach was found to have a more effective impact on the improvement of both verbal naming and general communicative behaviour.     

Der Stellenwert von Muttermilch für die gesunde Entwicklung Frühgeborener – aktuelle Übersicht und praktische Aspekte

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - In den letzten Jahren konnte der immense Vorteil der Muttermilchernährung für Frühgeborene belegt werden: in Bezug...     

Work‐related injuries in the Alaska logging industry, 1991‐2014

Background

Although loggers in Alaska are at high risk for occupational injury, no comprehensive review of such injuries has been performed since the mid‐1990s. We investigated work‐related injuries in the Alaska logging industry during 1991‐2014.

Methods

Using data from the Alaska Trauma Registry and the Alaska Occupational Injury Surveillance System, we described fatal and nonfatal injuries by factors including worker sex and age, timing and geographic location of injuries, and four injury characteristics. Annual injury rates and associated 5‐year simple moving averages were calculated.

Results

We identified an increase in the 5‐year simple moving averages of fatal injury rates beginning around 2005. While injury characteristics were largely consistent between the first 14 and most recent 10 years of the investigation, the size of logging companies declined significantly between these periods.

Conclusions

Factors associated with declines in the size of Alaska logging companies might have contributed to the observed increase in fatal injury rates.

     

Gesichtsästhetik Teil 1: Die Bedeutung der Symmetrieebene des Gesichts

When humans observe a face, the eyes, mouth and nose regions are the preferred targets of the centre of gaze, with the outlines of eye position recordings approximating a triangle with vertices located in the centre of the eyes and mouth [31]. We studied the significance of cutaneous asymmetries inside and outside the Yarbus triangle on the basis of the assessment of digitally-manipulated images by 201 independent judges. We show that certain facial variations (such as naevi) are more attractive when asymmetrical than symmetrical (p<?0,001). They appear more attractive when located laterally rather than medially, particularly so when located outside the Yarbus triangle as compared to inside it (p<?0,001). The significance of facial symmetry increases significantly when approaching the Yarbus triangle or the midline, respectively.