Intended healthcare utilisation in cases of severe COVID-19 and inflammatory gastrointestinal disease: results of a population survey with vignettes

Objectives: To examine variations in intended healthcare utilisation in severe cases of COVID-19 and inflammatory gastrointestinal disease (IGD).Design Representative cross-sectional telephone survey. Setting and participants 1207 randomly drawn adults of the city of Hamburg, Germany, between November 2020 and January 2021. Outcome measures: Different vignettes with severe symptoms were presented varying in sex, age (child, middle-aged person, older person), daytime (Tuesday morning or Tuesday evening) and disease (COVID-19 or IGD), while the degree of urgency was equivalent for all cases. The respondents were asked for the intended healthcare utilisation resulting in three different alternatives: general practitioner (GP)/paediatrician, medical on-call service ('116117') and emergency care (accident and emergency department, emergency practice, rescue service). In multivariate analyses, associations of characteristics of the vignettes and participants (sex, age, education, migration background) with intended healthcare utilisation were tested. In a further step, analyses were conducted separately for IGD and COVID-19. Results: Regarding the vignettes' characteristics, intended utilisation of GP/paediatrician is associated with female sex, higher age, daytime (morning) and COVID-19 symptoms, the medical on-call service with male sex, daytime (evening) and COVID-19 symptoms and the emergency medicine with younger age, daytime (evening) and IGD. Women chose more often the GP/paediatrician, men preferred emergency medicine. Only in case of IGD, higher educated persons more often chose the medical on-call service while people with a migration background decided less often for medical on-call service and emergency medicine. Conclusions: Despite comparable urgency, the findings suggest variations of intended healthcare utilisation depending on various characteristics of the vignettes and respondents. Depending on the type of disease inequalities vary. Overall, information about healthcare alternatives in severe cases has to be improved and clear pathways to facilitate healthcare utilisation has to be further developed.Data are available on reasonable request

Large Herbivores and Their Interaction with Arctic Soil Carbon Storage

Permafrost degradation and organic matter decomposition in the terrestrial Arctic are strongly depending on soil temperatures. A factor that affects these temperatures is grazing and snow trampling by large herbivorous animals, as well as animal-induced changes in vegetation cover. We analysed samples taken from adjacent areas with different grazing intensities, both in a permafrost environment (Siberia) and seasonally frozen ground (norther Finland) for TOC, C/N ratio, d13C, bulk density and radiocarbon age. While in permafrost there was a strong increase in soil carbon storage with high grazing intensity, this effect is not visible in seasonally frozen ground. However, in both areas we observed massive changes in vegetation composition and structure, following the grazing gradient. We conclude that seasonally frozen ground allows for more intensive carbon relocation and mixing, which outweighs the effects animals have in the permafrost region but state that on permafrost, animals might efficiently be utilized to stabilise permafrost temperatures and reduce organic material decomposition

Nitrogen isotopic inventory of the Lena River Delta

Permafrost-affected soils around the Arctic Ocean contain a large reservoir of organic matter including nitrogen, which partly reach the river after thawing, degradation and erosion of permafrost. After mobilization, reactive remineralised nitrogen is either used for primary production, microbial processing or is simply transported to coastal waters. We have analyzed soil, suspended matter and dissolved inorganic and organic nitrogen for their contents and 15N stable isotope composition to create a baseline for a nitrogen inventory of the Lena River Delta in 2019/2020. We used samples from two transect cruises through the delta in March and August 2019, a monitoring program at Samoylov Island in the central delta (2019/2020), and different soil type samples from Samoylov Island. Our data shows that the nitrogen transported from the delta to the Laptev Sea were dominated by dissolved organic nitrogen (DON) and nitrate, which occur in similar amounts of approx. 10 μmol/L. DON was available during the whole year. Nitrate showed a clear seasonal pattern: increase from late summer until the spring flood, during summer the nitrate concentration are close to zero. During the spring flood the nitrogen concentration are higher with up to 100 μmol/L. The nitrogen stable isotope values of the different nitrogen components ranges mainly between 0.5 and 4.5‰, and were subsequently enriched from the soils via suspended particulate matter (SPM)/sediment and DON to nitrate. During the spring flood, the stable isotope signature of nitrate suggested a strong source of atmospheric deposition. The 15N values are depleted with appox. -8‰ and the 18O values are enriched up to 60‰. Our data provides a baseline for isoscape analysis and can be used as an endmember signal for modeling approaches

More than carbon: Frozen element inventories in ice-rich Yedoma permafrost

Soils of the permafrost zone store globally relevant reservoirs of frozen matter, such as organic matter, mineral elements as well as other biogeochemical relevant compounds like contaminants. Besides well-studied organic carbon (OC), other compounds can become available in active biological and hydrological element cycling as global climate change is warming northern permafrost regions nearly four times faster than the global average. Current heating in Siberia is unprecedented during the past seven millennia, triggering widespread permafrost degradation and collapse. This is especially relevant for our study region, the Yedoma domain. In this region, a large amount of belowground ice is present and the ground can become unstable with warming, allowing the mobilisation of previously frozen sediments with their geochemical element contents. With this presentation, we want to synthesise recent studies, which have improved the understanding of various frozen stocks. Here, we estimated that the Yedoma domain contains 41.2 Gt of nitrogen, which increases the previous estimate for the circumpolar permafrost zone by ~46%. The highest element stock within the Yedoma domain is estimated for r Si (2739 Gt), followed by Al, Fe, K, Ca, Ti, Mn, Zr, Sr, and Zn. The stocks of Al and Fe (598 and 288 Gt) are in the same order of magnitude as OC (327–466 Gt). Concerning contaminants, we focused on mercury. Using the ratio of mercury to OC (RHgC, our found value: 2.57 μg Hg g C−1) and the OC levels from various studies for a first rough estimation of the Hg reservoir, we estimate the Yedoma mercury pool to be ~542000 tons. In conclusion, we find that deep thaw of the Yedoma permafrost domain and its degradation will bear the potential to change the availability of various elements in active biogeochemical and hydrological cycles, which will have the potential to change crucial ecosystem variables and services

Methanbildungspotenziale verschiedener Pflanzenarten aus Energiefruchtfolgen

Das Methanbildungspotenzial ist ein entscheidendes Qualitätsmerkmal von Biomassen bei ihrer Nutzung als Einsatzstoff für die Biogasproduktion. Von 769 unter einheitlichen Bedingungen silierten Erntegütern aus Energiefruchtfolgen wurden mittels Batch-Gärtests in zwei verschiedenen Versuchsanlagen spezifische Methanausbeuten ermittelt. Daraus konnten Richtwerte für mittlere Methanausbeuten je Fruchtart und Fruchtfolgestellung, Schnitt bzw. Trockenmassebereich oder Entwicklungsstadium zur Ernte für 93 verschiedene pflanzliche Biomassen abgeleitet werden. Die Ergebnisse stellen eine umfassende Datengrundlage dar, die in Verbindung mit Biomasseerträgen für die Abschätzung von Methanhektarerträgen zur ökonomischen und ökologischen Bewertung von Energiefruchtfolgen, zur Planung und Auslegung von Biogasanlagen sowie zur Entscheidung hinsichtlich des Anbaus alternativer pflanzlicher Kosubstrate und der Konzeption nachhaltiger Biogasfruchtfolgen genutzt werden können.The methane production potential represents an essential quality parameter of biomass if used as feedstock for biogas production. 769 harvested crop materials from crop rotations were ensiled at standardized conditions and were analyzed regarding their specific methane yields by applying two different experimental setups of batch anaerobic digestion tests. Based on this analysis, reference values for average methane yields per crop species and position within the crop rotation, cutting regime, range of dry matter content, or stage of growth at harvest have been deduced for 93 different crop biomasses. Results provide a comprehensive dataset that can be used in combination with biomass yields for the estimation of methane hectare yields, for economic and ecological evaluation of energy crop rotations, for planning and structural design of biogas plants as well as for decisions regarding the cultivation of alternative co-substrates and the design of sustainable biogas crop rotations

Promoter elements of rice susceptibility genes are bound and activated by specific TAL effectors from the bacterial blight pathogen, Xanthomonas oryzae pv. oryzae.

Summary • Plant pathogenic bacteria of the genus Xanthomonas inject transcription activator-like effector (TALe) proteins that bind to and activate host promoters, thereby promoting disease or inducing plant defense. TALes bind to corresponding UPT (up-regulated by TALe) promoter boxes via tandemly arranged 34 ⁄ 35-amino acid repeats. Recent studies uncovered the TALe code in which two amino acid residues of each repeat define specific pairing to UPT boxes. • Here we employed the TALe code to predict potential UPT boxes in TALeinduced host promoters and analyzed these via b-glucuronidase (GUS) reporter and electrophoretic mobility shift assays (EMSA). • We demonstrate that the Xa13, OsTFX1 and Os11N3 promoters from rice are induced directly by the Xanthomonas oryzae pv. oryzae TALes PthXo1, PthXo6 and AvrXa7, respectively. We identified and functionally validated a UPT box in the corresponding rice target promoter for each TALe and show that box mutations suppress TALe-mediated promoter activation. Finally, EMSA demonstrate that code-predicted UPT boxes interact specifically with corresponding TALes. • Our findings show that variations in the UPT boxes of different rice accessions correlate with susceptibility or resistance of these accessions to the bacterial blight pathogen

Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas-A Retrospective Multicenter Analysis of the German Pancreatitis Study Group

Background Necrotising pancreatitis, and particularly infected necrosis, are still associated with high morbidity and mortality. Since 2011, a step-up approach with lower morbidity rates compared to initial open necrosectomy has been established. However, mortality and complication rates of this complex treatment are hardly studied thereafter. Methods The German Pancreatitis Study Group performed a multicenter, retrospective study including 220 patients with necrotising pancreatitis requiring intervention, treated at 10 hospitals in Germany between January 2008 and June 2014. Data were analysed for the primary endpoints "severe complications" and "mortality" as well as secondary endpoints including "length of hospital stay", "follow up", and predisposing or prognostic factors. Results Of all patients 13.6% were treated primarily with surgery and 86.4% underwent a step-up approach. More men (71.8%) required intervention for necrotising pancreatitis. The most frequent etiology was biliary (41.4%) followed by alcohol (29.1%). Compared to open necrosectomy, the step-up approach was associated with a lower number of severe complications (primary composite endpoint including sepsis, persistent multiorgan dysfunction syndrome (MODS) and erosion bleeding: 44.7% vs. 73.3%), lower mortality (10.5% vs. 33.3%) and lower rates of diabetes mellitus type 3c (4.7% vs. 33.3%). Low hematocrit and low blood urea nitrogen at admission as well as a history of acute pancreatitis were prognostic for less complications in necrotising pancreatitis. A combination of drainage with endoscopic necrosectomy resulted in the lowest rate of severe complications. Conclusion A step-up approach starting with minimal invasive drainage techniques and endoscopic necrosectomy results in a significant reduction of morbidity and mortality in necrotising pancreatitis compared to a primarily surgical intervention

Synthesis and functionalization of protease-activated nanoparticles with tissue plasminogen activator peptides as targeting moiety and diagnostic tool for pancreatic cancer

Background: Functionalized nanoparticles (NPs) are one promising tool for detecting specific molecular targets and combine molecular biology and nanotechnology aiming at modern imaging. We aimed at ligand-directed delivery with a suitable target-biomarker to detect early pancreatic ductal adenocarcinoma (PDAC). Promising targets are galectins (Gal), due to their strong expression in and on PDAC-cells and occurrence at early stages in cancer precursor lesions, but not in adjacent normal tissues. Results: Molecular probes (10-29 AA long peptides) derived from human tissue plasminogen activator (t-PA) were selected as binding partners to galectins. Affinity constants between the synthesized t-PA peptides and Gal were determined by microscale thermophoresis. The 29 AA-long t-PA-peptide-1 with a lactose-functionalized serine revealed the strongest binding properties to Gal-1 which was 25-fold higher in comparison with the native t-PA protein and showed additional strong binding to Gal-3 and Gal-4, both also over-expressed in PDAC. t-PA-peptide-1 was selected as vector moiety and linked covalently onto the surface of biodegradable iron oxide nanoparticles (NPs). In particular, CAN-doped maghemite NPs (CAN-Mag), promising as contrast agent for magnetic resonance imaging (MRI), were selected as magnetic core and coated with different biocompatible polymers, such as chitosan (CAN-Mag-Chitosan NPs) or polylactic co glycolic acid (PLGA) obtaining polymeric nanoparticles (CAN-Mag@PNPs), already approved for drug delivery applications. The binding efficacy of t-PA-vectorized NPs determined by exposure to different pancreatic cell lines was up to 90%, as assessed by flow cytometry. The in vivo targeting and imaging efficacy of the vectorized NPs were evaluated by applying murine pancreatic tumor models and assessed by 1.5 T magnetic resonance imaging (MRI). The t-PA-vectorized NPs as well as the protease-activated NPs with outer shell decoration (CAN-Mag@PNPs-PEG-REGAcp-PEG/tPA-pep1Lac) showed clearly detectable drop of subcutaneous and orthotopic tumor staining-intensity indicating a considerable uptake of the injected NPs. Post mortem NP deposition in tumors and organs was confirmed by Fe staining of histopathology tissue sections. Conclusions: The targeted NPs indicate a fast and enhanced deposition of NPs in the murine tumor models. The CAN-Mag@PNPs-PEG-REGAcp-PEG/tPA-pep1Lac interlocking steps strategy of NPs delivery and deposition in pancreatic tumor is promising