Laboratory diagnosis of Lyme neuroborreliosis: a comparison of three CSF anti-Borrelia antibody assays

The diagnosis of Lyme neuroborreliosis (LNB) requires the detection of intrathecal synthesis of Borrelia-specific antibodies, but in very early disease, the sensitivity may be low. We compared the performance of the second-generation IDEIA Lyme Neuroborreliosis test (Oxoid), based on purified native flagellum antigen, with two newly developed tests based on several recombinant antigens for the diagnosis of LNB. Patients investigated for LNB during 2003 through 2007 were included (n = 175); 52 with definite LNB, four with possible LNB and 119 non-LNB patients. Serum and cerebrospinal fluid (CSF) were analysed with the IDEIA Lyme Neuroborreliosis (Oxoid), VIDAS Lyme IgG (bioMérieux) and recomBead Borrelia IgM and IgG (Mikrogen) assays. Intrathecal antibody indices (AIs) were calculated according to the manufacturers’ protocols. The IDEIA test performed with an overall sensitivity (IgM and IgG AIs taken together) of 88 % and a specificity of 99 %. The VIDAS test showed a sensitivity of 86 % and a specificity of 97 %. An overall sensitivity of 100 % and a specificity of 97 % were achieved by the recomBead test. We conclude that the three assays performed equally well regarding specificity, but our data suggest an improved diagnostic sensitivity with the recomBead Borrelia test

Acupuncture fails to reduce but increases anaesthetic gas required to prevent movement in response to surgical incision.

Background: Acupuncture is used for clinical pain relief but has not been evaluated under clinical anaesthesia. This study was designed to compare movement in response to surgical incision in anaesthetized patients subjected to electro-acupuncture (EA) or sham procedures. Our hypothesis was that EA stimulation would reduce the requirements for anaesthetic gas. Methods: Forty-six healthy women, scheduled for laparoscopic sterilization at a Swedish county hospital, were randomized to have either the electro-acupuncture (n = 23) or sham (n = 23) procedure between the induction of general anaesthesia and the start of surgery. The minimal alveolar concentration (MAC) of sevoflurane required to prevent neck or major limb movements in response to surgical incision was determined in each group of patients. Results: The MAC for sevoflurane was found to be higher in the group given acupuncture than in the control group (2.1 ± 0.3% vs. 1.8 ± 0.4%; P = 0.008). Conclusion: Electro-acupuncture given during general anaesthesia with sevoflurane failed to reduce but instead increased the clinical need for anaesthetic gas, possibly by reducing the anaesthetic effect of sevoflurane and/or by facilitating nociceptive transmission and/or reflex activity

Naming the pain in requirements engineering : Contemporary problems, causes, and effects in practice

Requirements Engineering (RE) has received much attention in research and practice due to its importance to software project success. Its interdisciplinary nature, the dependency to the customer, and its inherent uncertainty still render the discipline difficult to investigate. This results in a lack of empirical data. These are necessary, however, to demonstrate which practically relevant RE problems exist and to what extent they matter. Motivated by this situation, we initiated the Naming the Pain in Requirements Engineering (NaPiRE) initiative which constitutes a globally distributed, bi-yearly replicated family of surveys on the status quo and problems in practical RE. In this article, we report on the qualitative analysis of data obtained from 228 companies working in 10 countries in various domains and we reveal which contemporary problems practitioners encounter. To this end, we analyse 21 problems derived from the literature with respect to their relevance and criticality in dependency to their context, and we complement this picture with a cause-effect analysis showing the causes and effects surrounding the most critical problems. Our results give us a better understanding of which problems exist and how they manifest themselves in practical environments. Thus, we provide a first step to ground contributions to RE on empirical observations which, until now, were dominated by conventional wisdom only.Peer reviewe

Immune cell contexture in the bone marrow tumor microenvironment impacts therapy response in CML

Increasing evidence suggests that the immune system affects prognosis of chronic myeloid leukemia (CML), but the detailed immunological composition of the leukemia bone marrow (BM) microenvironment is unknown. We aimed to characterize the immune landscape of the CML BM and predict the current treatment goal of tyrosine kinase inhibitor (TKI) therapy, molecular remission 4.0 (MR4.0). Using multiplex immunohistochemistry (mIHC) and automated image analysis, we studied BM tissues of CML patients (n = 56) and controls (n = 14) with a total of 30 immunophenotype markers essential in cancer immunology. CML patients' CD4+ and CD8+ T-cells expressed higher levels of putative exhaustion markers PD1, TIM3, and CTLA4 when compared to control. PD1 expression was higher in BM compared to paired peripheral blood (PB) samples, and decreased during TKI therapy. By combining clinical parameters and immune profiles, low CD4+ T-cell proportion, high proportion of PD1+ TIM3-CD8+ T cells, and high PB neutrophil count were most predictive of lower MR4.0 likelihood. Low CD4+ T-cell proportion and high PB neutrophil counts predicted MR4.0 also in a validation cohort (n = 52) analyzed with flow cytometry. In summary, the CML BM is characterized by immune suppression and immune biomarkers predicted MR4.0, thus warranting further testing of immunomodulatory drugs in CML treatment.Peer reviewe

A novel planar optical sensor for simultaneous monitoring of oxygen, carbon dioxide, pH and temperature

The first quadruple luminescent sensor is presented which enables simultaneous detection of three chemical parameters and temperature. A multi-layer material is realized and combines two spectrally independent dually sensing systems. The first layer employs ethylcellulose containing the carbon dioxide sensing chemistry (fluorescent pH indicator 8-hydroxy-pyrene-1,3,6-trisulfonate (HPTS) and a lipophilic tetraalkylammonium base). The cross-linked polymeric beads stained with a phosphorescent iridium(III) complex are also dispersed in ethylcellulose and serve both for oxygen sensing and as a reference for HPTS. The second (pH/temperature) dually sensing system relies on the use of a pH-sensitive lipophilic seminaphthorhodafluor derivative and luminescent chromium(III)-activated yttrium aluminum borate particles (simultaneously acting as a temperature probe and as a reference for the pH indicator) which are embedded in polyurethane hydrogel layer. A silicone layer is used to spatially separate both dually sensing systems and to insure permeation selectivity for the CO2/O2 layer. The CO2/O2 and the pH/temperature layers are excitable with a blue and a red LED, respectively, and the emissions are isolated with help of optical filters. The measurements are performed at two modulation frequencies for each sensing system and the modified Dual Lifetime Referencing method is used to access the analytical information. The feasibility of the simultaneous four-parameter sensing is demonstrated. However, the practical applicability of the material may be compromised by its high complexity and by the performance of individual indicators

Rifting in heterogeneous lithosphere inferences from numerical modeling of the northern North Sea and the Oslo Graben.

Permian rifting and magmatism are widely documented across NW Europe. The different Permian basins often display contrasting structural styles and evolved in lithospheric domains with contrasting past evolution and contrasting thermotectonic ages. In particular, the Oslo Graben and the northern North Sea rift initiated in close areas of northern Europe. The Oslo Graben evolved in the cold and stable Precambrian lithosphere of Fennoscandia, whereas the northern North Sea rift took birth in freshly reworked Caledonian lithosphere. Huge volumes of magmatic rocks characterize the relatively narrow Oslo Graben. In contrast, little magmatism is documented for the wide northern North Sea rift. Differences in timing between both rifts are inferred but still debated. We present numerical thermomechanical models along a lithospheric E-W section that involves both the Oslo Graben and the northern North Sea area. Because the modeled section crosses the boundary between Caledonian and Proterozoic provinces, thermal and compositional heterogeneities are considered. As is suggested by various geophysical data sets, we also consider lithospheric thickness heterogeneities in the Precambrian lithosphere. Modeling results suggest that the northern North Sea was on top of "weak" lithosphere very sensitive to far-field stresses. Consequently, we suggest that rifting in the northern North Sea began as early as regional extension was effective (i.e., Late Carboniferous-Early Permian) and does not postdate the Oslo Graben as it is commonly assumed. Rifting in the "strong" Precambrian lithosphere is unexpected. Modeling results suggest that a pre-existing lithospheric thickness contrast within the Fennoscandian lithosphere favored rifting in the Oslo Graben

Technological Change in Economic Models of Environmental Policy: A Survey

This paper provides an overview of the treatment of technological change in economic models of environmental policy. Numerous economic modeling studies have confirmed the sensitivity of mid- and long-run climate change mitigation cost and benefit projections to assumptions about technology costs. In general, technical progress is considered to be a noneconomic, exogenous variable in global climate change modeling. However, there is overwhelming evidence that technological change is not an exogenous variable but to an important degree endogenous, induced by needs and pressures. Hence, some environmenteconomy models treat technological change as endogenous, responding to socio-economic variables. Three main elements in models of technological innovation are: (i) corporate investment in research and development, (ii) spillovers from R&D, and (iii) technology learning, especially learning-by-doing. The incorporation of induced technological change in different types of environmental-economic models tends to reduce the costs of environmental policy, accelerates abatement and may lead to positive spillover and negative leakage