Butyric acid fermentation from pretreated and hydrolysed wheat straw by an adapted Clostridium tyrobutyricum strain

Butyric acid is a valuable building-block for the production of chemicals and materials and nowadays it is produced exclusively from petroleum. The aim of this study was to develop a suitable and robust strain of Clostridium tyrobutyricum that produces butyric acid at a high yield and selectivity from lignocellulosic biomasses. Pretreated (by wet explosion) and enzymatically hydrolysed wheat straw (PHWS), rich in C6 and C5 sugars (71.6 and 55.4 g l⁻¹ of glucose and xylose respectively), was used as substrate. After one year of serial selections, an adapted strain of C. tyrobutyricum was developed. The adapted strain was able to grow in 80% (v v⁻¹) PHWS without addition of yeast extract compared with an initial tolerance to less than 10% PHWS and was able to ferment both glucose and xylose. It is noticeable that the adapted C. tyrobutyricum strain was characterized by a high yield and selectivity to butyric acid. Specifically, the butyric acid yield at 60–80% PHWS lie between 0.37 and 0.46 g g⁻¹ of sugar, while the selectivity for butyric acid was as high as 0.9–1.0 g g⁻¹ of acid. Moreover, the strain exhibited a robust response in regards to growth and product profile at pH 6 and 7.

Outcomes of mismatched and unrelated donor hematopoietic stem cell transplantation in Fanconi anemia conditioned with chemotherapy only

Fanconi anemia (FA) is a genomic instability syndrome associated with bone marrow failure, myelodysplastic syndrome (MDS), and/or acute myeloid leukemia (AML) requiring hematopoietic stem cell transplantation (HSCT) to restore normal hematopoiesis. Although low-intensity fludarabine-based preparative regimens without radiation confer excellent outcomes in FA HSCTs with HLA-matched sibling donors, outcomes for FA patients with alternative donors are less encouraging, albeit improving. We present our experience with 17 FA patients who completed mismatched related or unrelated donor HSCT using a non-radiation fludarabine-based preparative regimen at Charité University Medicine Berlin. All patients engrafted; however, one patient had unstable chimerism in the setting of multi-viral infections that necessitated a stem cell boost to revert to full donor chimerism. Forty-seven percent of patients developed grade I acute graft-verus-host disease (aGVHD). No grade II-IV aGVHD or chronic graft-versus-host disease of any severity occurred. At a median follow-up of 30 months, 88 % of patients are alive with normal hematopoiesis. Two patients died of infections 4 months post-transplantation. These results demonstrate that short-term outcomes for FA patients with mismatched and unrelated donor HSCTs can be excellent using chemotherapy only conditioning. Viral reactivation, however, was a major treatment-related complication.

[Development and validation of the Tonsillectomy Outcome Inventory 14]

BACKGROUND

Until now, no validated instrument to measure disease-specific, health-related quality of life (HR-QOL) in adults with chronic tonsillitis (CTO) exists.

MATERIAL AND METHODS

After an item reduction of the alpha-version of the Tonsillectomy Outcome Inventory (TOI), the TOI-14 resulted. In addition to the total score, it includes the subscales throat problems, overall health, resources, and social-psychological restrictions. In phase 2, the TOI-14 was prospectively validated on 108 adults with CTO, who had undergone a tonsillectomy.

RESULTS

The TOI-14 had, on average, good reliability. It included all important aspects of the HR-QOL. Patients with CTO can be distinguished with high sensitivity from healthy subjects. All scores showed moderate to good correlation with the subjective limitation in quality of life. The sensitivity of the questionnaire demonstrated major effects postoperatively.

CONCLUSION

The TOI-14 constitutes the first worldwide-validated, disease-specific instrument to measure HR-QOL in adults with CTO. Due to its ease of use, it can be utilized both in the outcome research and in clinical routine.

[Differential diagnosis of headaches in otorhinolaryngology]

Facial pain and headaches are heterogeneous, therefore, a differential diagnosis, interdisciplinary survey and mapping of the pain symptoms are essential for determination of treatment concepts. This requires an otorhinolaryngology (ENT) adapted zoning of the various pains in the head and neck in line with the classification of the International Headache Society (IHS). In this review, idiopathic, symptomatic and neuralgic facial pain and headaches will be differentiated and classified according to their location from the ENT medical point of view. This provides otolaryngologists with a simplified, targeted diagnosis and subsequent indication for therapy.

[Microsurgical middle ear operations : Variability of the audiometric results from frequency variations]

INTRODUCTION

The audiometric results after reconstructive tympanic surgery on 504 patients carried out between October 2005 and October 2007, including 190 cases of tympanoplasty type I and 314 cases of tympanoplasty type III according to Wullstein, were retrospectively analyzed at the Department of Otolaryngology, Ruprecht-Karls-University in Heidelberg.

PATIENTS AND METHODS

To investigate the influence of the frequencies used to compare the outcome, the pure tone average air-bone gaps (PTA-ABG) of the preoperative and postoperative audiograms of tympanoplasties type I and III were analyzed. The frequencies covered the ranges of 0.5 kHz, 1 kHz, 2 kHz, 4 kHz and 6 kHz. In each case the 3-frequency, 4-frequency and 5-frequency analyses were calculated for the different surgical groups.

RESULTS

The 3-frequency analysis (0.5 kHz, 1 kHz and 2 kHz) of the type 1tympanoplasties were 18.8 ± 11.8 dB preoperative and 12.3 ± 11.8 dB postoperative. In 58.9% of cases the PTA-ABG ≤ 10 dB and in 86.7% it was ≤ 20 dB. The 3-frequency analysis showed that the tympanoplasties type III had a PTA-ABG of 30.6 ± 15.3 dB preoperatively and 21.8 ± 15.1 dB postoperatively. In 30.4% of cases the PTA-ABG was ≤ 10 dB and ≤ 20 dB for 56%.

DISCUSSION

The detailed itemization of frequencies in this study and the consequent opportunity to modify the frequency range, allowed the impact of this selection on the PTA-ABG to be illustrated and various comparisons with other studies could be carried out. In this article, the exclusion criteria were dealt with liberally and risk patients were also included and data from patients who displayed prognostic risks regarding the successful surgery in terms of the audiometric reports were integrated. These prognostic risks were due to the poor aeration of the tympanum and recent (sometimes diverse), pre-surgery as well as chronic inflammatory processes. This study has proved that all surgery collectives showed significant improvements of the PTA-ABG. Therefore, all surgery collectives (measured against the audiometric evaluation) benefited from the surgery.

Comparison of different approaches for assessment of HER2 expression on protein and mRNA level: prediction of chemotherapy response in the neoadjuvant GeparTrio trial (NCT00544765)

Human epidermal growth factor receptor 2 (HER2) testing is an essential part of pathological assessment in breast cancer patients, as HER2 provides not only prognostic but also predictive information on response to targeted therapy. So far, HER2 test accuracy of immunohistochemistry/in situ-hybridization techniques is still under debate, and more reliable and robust technologies are needed. To address this issue and to evaluate the predictive value of HER2 on chemotherapy, we investigated a cohort of 278 patients from the GeparTrio trial, a prospective neoadjuvant anthracycline/taxane-based multicenter study. In the GeparTrio trial, patients were not treated with any anti-HER2 therapy, as this was not standard therapy at this time. The HER2 status was analyzed by three different approaches: local and central evaluation using immunohistochemistry combined with in situ-hybridization as well as evaluation of HER2 mRNA expression using kinetic RT-PCR from formalin-fixed, paraffin-embedded (FFPE) tissue samples using a predefined cutoff. HER2 overexpression/amplification was observed in 37.3% (91/244) and 17.9% (41/229) of the informative samples in the local and central evaluations, respectively. Positive HER2 mRNA levels were found in 19.8% (55/278). We observed a highly significant correlation between central HER2 expression and HER2 status measured by kinetic RT-PCR (r = 0.856, P < 0.0001) and an overall agreement of 95.6% (κ statistic, 0.862, CI 0.77-0.94). Further, central HER2 as well as HER2 mRNA expression were predictors for a pathological complete response after neoadjuvant anthracycline/taxane-based primary chemotherapy in a univariate binary logistic regression analysis (OR 3.29, P = 0.002; OR 2.65, P = 0.004). The predictive value could be confirmed for the central HER2 status by multivariate analysis (OR 3.04, P = 0.027). The locally assessed HER2 status was not predictive of response to chemotherapy. Our results suggest that standardized methods are preferable for evaluation of HER2 status. The kinetic RT-PCR from FFPE tissue might be an additional approach for assessment of this important prognostic and predictive parameter but has to be confirmed by other studies.

[Septoplasty update]

Septoplasty is one of the most frequently performed otorhinolaryngological procedures which might be very challenging for the surgeon. An accurate preoperative diagnosis of pathologies of the septum in the context of the nasal cavity is essential for the success of surgery. Intraoperative visualization through microscope or endoscope is very helpful for the surgeon and for the training of the residents. The modern technique of septoplasty with the phases of approach, mobilization, resection/repositioning and reconstruction/fixation is presented. Furthermore, the extracorporeal septoplasty in extreme deviations of the septum and alternative techniques for use in cases with limited pathologies as well as aspects of septoplasty in children are discussed. As particularly pathologies of the caudal septum are responsible for failures of septal surgery, some special problems of this region such as the vertical fracture of the caudal septum, the lack of caudal septum or anterior convexities of the cartilaginous septum are argued. Finally, advices for the management of intra-and postoperative complications are given.

[Quality of life before and after septoplasty and rhinoplasty]

Subjective assessment of quality of life (QOL) as an important aspect of outcomes research has received increasing importance during the past decades. QOL is measured with standardized questionnaires which had been tested with regard to reliability, validity, and sensitivity. Surgical procedures of the nasal septum (septoplasty) and the external nose (rhinoplasty) are frequently performed. Since many years subjectively assessed results of these operations have been reported in the literature. Nevertheless, validated QOL instruments were applied only for one decade. Beforehand, measurements were performed using retrospective assessment of contentment or visual analogue scales. Prospective application of validated disease-specific and general measuring instruments has to be demanded for future studies.Most of the septoplasty patients as well as most of the rhinoplasty patients evaluate the operation being successful. Nevertheless, a relevant number of patients is not satisfied with the result of surgery. In this context, QOL instruments have the potential to identify further factors influencing the outcome. Especially in rhinoplasty patients, special attention has to be drawn on potential psychosocial effects of the operation.

[Development of a grading scale for the Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV)]

INTRODUCTION

Quality of life measurements with the Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV) in chronic rhinosinusitis (CRS) patients require normative values measured in a comparison group taken from the normal population. These will make it possible to reach conclusions on correlations between scores and severity of symptoms and also on how close such patients' scores can get to those scores recorded in healthy subjects after surgical treatment.

PATIENTS AND METHODS

We collected SNOT-20 GAV data and data on the presence of CRS from 778 subjects via a web-based survey of employees of the University Hospital in Heidelberg. For comparison we used data collected before surgery and at 3 months and 1 year after surgery from 163 CRS patients who had undergone endonasal sinus surgery (ESS).

RESULTS

Gender and age had no clinically significant impact on the SNOT-20 GAV scores. We defined an assessment scale with four classes of symptom intensity. Surgically treated patients with CRS showed a persisting small disadvantage in the scales of the SNOT-20 GAV compared with the reference subgroup without CRS. When surgically treated CRS patients were compared with the entire reference group these disadvantages were only obvious in the Primary Nasal Symptoms (PNS) scale and not in the other scales measuring quality of life.

CONCLUSION

Patients with CRS benefit from ESS and subsequently reach scores similar to those recorded in the reference group. The newly developed four-level assessment scale is easy to use and gives the attending physician additional information about the severity of the patients' illness and its effects on their subjective wellbeing.

[Chronic rhinosinusitis. Subjective assessment of benefit 1 year after functional endonasal sinus surgery]

BACKGROUND

Against the background of constantly intensifying economic pressure in the healthcare sector, in the future confirmation of subjective and economic benefit of different forms of therapy will be the criterion applied by the health insurance companies to decide whether to reimburse the costs they involve. The aim of this study was to provide confirmation that patients with chronic rhinosinusitis (CRS) do benefit from functional endonasal sinus surgery (FESS).

PATIENTS AND METHODS

One year after undergoing FESS for the treatment of CRS, 82 patients completed various questionnaires. The Glasgow Benefit Inventory (GBI) was used, as it is a validated instrument for the assessment of benefit. In addition, the patients were asked to complete questionnaires relating to pre- and postoperative use of resources (use of antibiotics, visits to their doctors and time unfit for work) and also to give an overall rating of their satisfaction with the outcome, the difference in their symptoms after FESS and the likelihood that they would recommend this treatment to friends or relatives.

RESULTS

Three out of four GBI scales [total score (+22.6), general benefit (+26.8), physical functioning (+23.7)] indicated that patients experienced significant benefit. The frequency of visiting their doctors, their intake of antibiotics and the amount of time off work were all significantly reduced. The vast majority of patients were satisfied with the overall result and the level of symptom relief achieved and would recommend FESS to friends and relatives.

CONCLUSION

The vast majority of these patients with CRS experienced FESS as highly beneficial. A significant reduction of resource usage was reported after the operation.

Reduced intensity conditioning in unrelated donor transplantation for refractory cytopenia in childhood

Myelodysplastic syndromes (MDS) are a heterogenous group of acquired hematopoietic stem cell disorders. Refractory cytopenia (RC) is the most common subtype of childhood MDS and hematopoietic stem cell transplantation (HSCT) is the only curative treatment. HSCT following a myeloablative preparative regimen is associated with a low probability of relapse and considerable transplant-related mortality. In the present European Working Groups of MDS pilot study, we investigated whether a reduced intensity conditioning regimen (RIC) is able to offer reduced toxicity without increased rates of graft failure or relapse. Nineteen children with RC were transplanted from an unrelated donor following RIC consisting of fludarabine, thiotepa and anti-thymocyte globulin. Three patients experienced graft failure. Neutrophil and platelet engraftment occurred at a median time of 23 and 30 days, respectively. Cumulative incidence of grade II-IV and grade III and IV acute graft-versus-host disease (GVHD) was 0.48 and 0.13, respectively; three patients developed extensive chronic GVHD. Although infections were the predominant complications, only one patient with extensive chronic GVHD died from infectious complications. Overall and event-free survival at 3 years were 0.84 and 0.74, respectively. In conclusion, our results were comparable to those of patients treated with myeloablative HSCT. Long-term follow-up is needed to demonstrate the expected reduction in long-term sequelae.