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The Fourier harmonics,$$v_2$$v 2 and$$v_3$$v 3 of negative pions are measured at center-of-mass energy per nucleon pair of$$\\sqrt{s_{\\textrm{NN}}}$$s NN = 17.3 GeV around midrapidity by the CERES/NA45 experiment at the CERN SPS in 0–30% central PbAu collisions with a mean centrality of 5.5%. The analysis is performed in two centrality bins as a function of the transverse momentum$$\\mathrm {p_{\\textrm{T}}}$$p T from 0.05 GeV/ c to more than 2 GeV/ c . This is the first measurement of the$$v^{1/3}_{3}/v^{1/2}_{2}$$v 3 1 / 3 / v 2 1 / 2 ratio as a function of transverse momentum at SPS energies, that reveals, independently of the hydrodynamic models, hydrodynamic behavior of the formed system. For$$\\mathrm {p_{\\textrm{T}}}$$p T above 0.5 GeV/ c , the ratio is nearly flat in accordance with the hydrodynamic prediction and as previously observed by the ATLAS and ALICE experiments at the much higher LHC energies. The results are also compared with the SMASH-vHLLE hybrid model predictions, as well as with the SMASH model applied alone.

Background:The severity of hepatic encephalopathy is currently graded clinically using West Haven criteria and psychometric tests.Objective:To assess the discriminative power of the bispectral index (BIS) monitor to classify the degree and progression of hepatic encephalopathy.Design:A consecutive, multicentre, observer blinded validation study.Setting:Medical University of Graz (Graz, Austria), Zhejiang University First Affiliated Hospital (Hang Zhou, China), and Cairo University (Cairo, Egypt).Patients:28 consecutive patients with hepatic encephalopathy were first enrolled at Medical University of Graz as a test set. The estimated BIS cut off values were subsequently tested in a validation set of 31 patients at Zhejiang University First Affiliated Hospital and 26 patients at Cairo University; 18 patients were reassessed later in a longitudinal study. Fifteen of 85 patients (18%) were excluded from the final analysis (11 became too agitated with high electromyographic activity; four fell asleep during the recording).Results:Applying the Austrian BIS cut off values of 85, 70, and 55 for discriminating West Haven grades 1 to 4 yielded agreement between BIS classification and West Haven grades in 40 of the 46 validation patients (87%), and in 16 of the 18 follow up patients (89%). Mean (SD) BIS values differed significantly between patients with West Haven grade 1 (90.2 (2.5)), grade 2 (78.4 (6.6)), grade 3 (63.2 (4.8)), and grade 4 (45.4 (5.0)).Conclusions:BIS is a useful measure for grading and monitoring the degree of involvement of the central nervous system in patients with chronic liver disease.

Poststroke depression is a frequent psychiatric complication after stroke that may have strong negative impact on rehabilitation therapy and functional recovery. This study was conducted to show the efficacy and safety of early treatment with the selective serotonin reuptake inhibitor fluoxetine in post-stroke depressed patients. This double-blind, randomized placebo-controlled study was of patients within two weeks after stroke. Moderate to severe depressed patients (determined by Hamilton Depression Scale (HDS) > 15, the Beck Depression Inventory (BDI) and the Clinical Global Impression (CGI) Scale) were randomized to receive either 20 mg/d fluoxetine or placebo for 3 months. Beside the psychiatric assessment, patients were evaluated by use of the Scandinavian Stroke Scale (SSS), the Mini-Mental-State-Examination (MMSE) and the Barthel-Index (BI). An open-label long-term follow up was done 18 months after the initial assessment. 54 depressed patients of an inpatient population of 242 consecutive stroke patients aged 25 to 85 years entered the trial within the first two weeks post-stroke. 50 patients completed the trial per-protocol. The initial severity of depression was comparable in the two groups (mean baseline HDS score 32.8 in the fluoxetine vs. 30.3 in the placebo group), as were neurological symptom severity and demographic parameters. Significant improvement was seen in both groups within 4 weeks of treatment, whereas no advantages of fluoxetine could be observed at this time. This indicates a high degree of spontaneous recovery during early rehabilitation therapy. BDI scores of patients treated with fluoxetine further decreased until the follow-up at 12 weeks, whereas the scores increased again in the placebo group. This depressive relapse of the placebo patients after the end of most rehabilitation efforts was evident at a long-term follow-up 18 months after inclusion, when patients who had been treated with fluoxetine were significantly less depressed. No side effects of fluoxetine treatment were detected. The advantages of fluoxetine were obvious at the follow-up 18 months after inclusion, but could not be demonstrated within the first three months of controlled treatment. The multitude of therapeutic efforts that take place in the early phase of rehabilitation might have facilitated spontaneous recovery from depression and might have hindered benefits of antidepressant treatment to become obvious. Fluoxetine treatment was well tolerated and safe.

Aims: The insulin-like growth factor (IGF) system has been implicated in tumour development and progression. This study was designed to analyse the expression of the IGF-I receptor (IGF-IR) and its ligands (IGF-I, IGF-II) in gallbladder cancer. Methods: IGF-I, IGF-II, and IGF-IR immunoreactivity was investigated in 57 gallbladder carcinomas and corresponding lymph node (n  =  11) and hepatic (n  =  7) metastases using a tissue microarray technique and correlated with tumour stage, grade, and patient outcome. Results: Cancer tissue allowing a reliable evaluation of IGF-I, IGF-II, and IGF-IR was present in 55 of 57 primary tumours and 17 of 18 metastases. IGF-I and IGF-II immunoreactivity was seen in 25 and 14 of the 55 primary tumours, in addition to six and three of the 17 metastases, respectively. No associations with tumour stage, grade, or prognosis were detected. IGF-IR was expressed in 52 of 55 primary tumours and all 17 metastases. IGF-IR staining intensity decreased with tumour cell dedifferentiation. Moreover, IGF-IR expression in less than 50% of cancer cells was an independent marker of poor prognosis in multivariate analysis (risk ratio, 4.0; 95% confidence interval, 1.4 to 11.2; p  =  0.01). Conclusions: The expression of IGF-IR and its ligands provides evidence for the existence of an auto/paracrine loop of tumour cell stimulation in gallbladder cancer and makes this type of cancer a candidate for therapeutic strategies aimed at interfering with the IGF pathway. The recognition of IGF-IR as a new independent prognostic biomarker may help to identify patients who might benefit from adjuvant treatment.

The biological significance of squamous and glandular differentiation and different patterns of invasion in upper urinary tract urothelial carcinoma is unclear. We reviewed 268 cases of consecutive upper urinary tract carcinomas with respect to the presence of squamous and/or glandular differentiation and different patterns of invasion (nodular, trabecular, and infiltrative) and correlated data with patient outcome. Squamous or glandular differentiation occurred in 47/268 (18%) tumors and its presence correlated with high tumor stage (P<0.001) and grade (P<0.001). Invasive patterns were nodular in 49/227 (22%), trabecular in 95/227 (42%), and infiltrative in 83/227 (37%) tumors. The nodular pattern prevailed in low stage (P<0.001) and low-grade (P<0.001) tumors, whereas the infiltrative pattern prevailed in high stage (P<0.001) and high-grade (P<0.001) tumors. Multivariate analysis proved that tumor stage (P<0.001) and the infiltrative pattern (P<0.001) are independent predictors of metastasis-free survival, whereas tumor grade and squamous and glandular differentiation lacked independent influence on patient outcome. In conclusion, the infiltrative pattern of invasion significantly correlated with advanced disease and poor patient outcome. In contrast, the presence of squamous and/or glandular invasion did not prove independent influence on patient outcome. The pattern of invasion should be commented upon separately in the pathology report.

Aims: To assess whether heterogeneity of epidermal growth factor receptor (EGFR) immunoreactivity in renal cell carcinoma (RCC) is related to non-standardised criteria for staining evaluation. Methods: EGFR expression was investigated in 132 primary and 55 metastatic conventional RCCs using a tissue microarray technique. Results: Overall, membranous and/or cytoplasmic EGFR immunostaining was present in 123 of 132 (93%) primary and 49 of 53 (92%) metastatic RCCs, with extensive immunoreactivity (> 50% of tumour cells) in 110 of 132 (83%) primary tumours and 39 of 53 (73%) metastases. Cytoplasmic staining was associated with high tumour stage and high tumour grade. In addition, strong membranous staining (score 3+) prevailed in high grade RCCs. Cytoplasmic immunostaining was associated with an unfavourable prognosis, whereas overall (cytoplasmic and membranous) immunoreactivity and intensity of membranous staining were not. Conclusions: Different methods of immunohistochemical evaluation led to different results, strengthening the need for standardisation, especially against a background of rapidly evolving EGFR targeted cancer treatment strategies.

Regaining consciousness 8 h postoperatively was reflected in an increase in higher 8-9 Hz α activity. [...]intraoperative EEG monitoring gave an early indication that restoration of hepatic function also restored cerebral activity. 2 Whereas examining postoperative EEG changes in 14 OLT patients 3 showed that pre- to post-transplantation improvement in liver function was associated with similar improvement in EEG findings manifesting as an increase in occipital α-θ power ratio, decrease in θ power, increase in α and β power over all cerebral regions, all confirming the reversibility of bioelectric brain dysfunction with restoration of liver function. 3 However, when using repeated measures ANOVA, we found no significant difference over time between the LDLT and OLT groups in mean BIS values, despite the fact that intraoperative ALT and AST values were higher (p<0.001) in OLT patients than in LDLT patients.

BackgroundRange of motion is a crucial measure of outcome after total knee arthroplasty. In order for maximum flexion to occur, the femur must progressively shift posteriorly on the tibia, a movement that is known as femoral rollback. Mobile bearings with free anterior-posterior translation could improve knee flexion by allowing such motion. The purpose of the present study was to determine the influence of an anterior-posterior gliding mobile bearing on the postoperative range of knee motion in patients with an intact posterior cruciate ligament.MethodsWe performed a prospective, randomized clinical trial of fifty consecutive total knee arthroplasties that were performed with use of the LCS-Universal prosthesis. Participants were randomized to receive either a deep-dish rotating platform or a mobile bearing that allowed additional anterior-posterior translation, the latter of which requires an intact posterior cruciate ligament. The ranges of motion of the knees were assessed to detect a 15° difference in the active non-weight-bearing range of motion with a power (1 – β) of 20% and with the level of significance (α) set at 0.05. The translation of the mobile bearing was measured with use of a standardized ultrasound technique and was correlated with maximum knee flexion. The participants and the assessor were blinded throughout the study.ResultsAt the time of the one-year follow-up evaluation, forty-eight knees were available for an intention-to-treat analysis. The mean active non-weight-bearing range of motion at one year was 113° (95% confidence interval, 108° to 118°) in the twenty-six knees that had received a rotating platform and 111° (95% confidence interval, 115° to 125°) in the twenty-two knees that had received an anterior-posterior gliding bearing (p = 0.57). In the latter group, a continuous rollback occurred in two knees. There was no significant correlation between knee flexion and anterior-posterior translation (r = 0.015).ConclusionsThe use of a mobile bearing that allowed free anterior-posterior translation did not regularly restore femoral rollback and did not improve range of motion after total knee arthroplasty compared with the findings seen in association with the use of a rotating platform.Level of EvidenceTherapeutic study, Level I-1b (randomized controlled trial [no significant difference but narrow confidence intervals]). See Instructions to Authors for a complete description of levels of evidence.

Procalcitonin (PCT), interleukin-6 (IL-6), tumour necrosis factor α (TNFα), and interleukin-1β (IL-1β) are important clinical prognostic markers in ICU septic patients. The goal of the study was to determine whether continuous venovenous haemofiltration (CVVH), using an AN69 haemofilter, leads to elimination of PCT, TNFα, IL-6 and IL-1βin 13 septic patients with multi-organ failure. At the start of haemofiltration (0), 6 and 12 hours the mean afferent plasma concentration ±SD of PCT (10.1±9.1, 7±6, 5.9±5.7 ng/ml), IL-6 (804.6±847.6, 611.7±528.4, 575.2±539.2 pg/ml), and that of TNFα (4.5±2.6, 4±3.1, 3.8±2.9 pg/ml) significantly declined during CVVH. The efferent plasma concentrations were significantly lower than the corresponding afferent concentrations. PCT, IL-6 and TNFαwere detectable in the ultra-filtrate of all patients. IL-1βwas only detectable in the plasma of eight patients and the ultrafiltrate of five patients. The plasma clearance of PCT, IL-6 and TNFαsignificantly decreased after 12 hours as a result of a decline in the adsorptive elimination of the mediators due to progressive membrane saturation. We demonstrated that if PCT, IL-6 and TNFα are used as clinical prognostic markers in septic patients who are treated with CVVH using an AN69 membrane, one should be aware that their plasma level could be modified by the therapy. In addition CVVH could represent an appropriate tool to remove a broad spectrum of proinflammatory mediators, if such removal is required in septic patients.

The Fourier harmonics, v 2 and v 3 of negative pions are measured at center-of-mass energy per nucleon pair of s NN = 17.3 GeV around midrapidity by the CERES/NA45 experiment at the CERN SPS in 0–30% central PbAu collisions with a mean centrality of 5.5%. The analysis is performed in two centrality bins as a function of the transverse momentum p T from 0.05 GeV/ c to more than 2 GeV/ c . This is the first measurement of the v 3 1 / 3 / v 2 1 / 2 ratio as a function of transverse momentum at SPS energies, that reveals, independently of the hydrodynamic models, hydrodynamic behavior of the formed system. For p T above 0.5 GeV/ c , the ratio is nearly flat in accordance with the hydrodynamic prediction and as previously observed by the ATLAS and ALICE experiments at the much higher LHC energies. The results are also compared with the SMASH-vHLLE hybrid model predictions, as well as with the SMASH model applied alone.