Assessing the potential spread and maintenance of foot-and-mouth disease virus infection in wild ungulates: general principles and application to a specific scenario in Thrace

Foot-and-mouth disease (FMD), due to infection with serotype O virus, occurred in wild boar and within eleven outbreaks in domestic livestock in the south-east of Bulgaria, Thrace region, in 2011. Hence, the issue of the potential for the spread and maintenance of FMD virus (FMDV) infection in a population of wild ungulates became important. This assessment focused on the spread and maintenance of FMDV infection within a hypothetical wild boar and deer population in an environment, which is characterized by a climate transitional between Mediterranean and continental and variable wildlife population densities. The assessment was based on three aspects: (i) a systematic review of the literature focusing on experimental infection studies to identify the parameters describing the duration of FMDV infection in deer and wild boar, as well as observational studies assessing the occurrence of FMDV infection in wild deer and wild boar populations, (ii) prevalence survey data of wild boar and deer in Bulgaria and Turkey and (iii) an epidemiological model, simulating the host-to-host spread of FMDV infections. It is concluded, based on all three aspects, that the wildlife population in Thrace, and so wildlife populations in similar ecological settings, are probably not able to maintain FMD in the long term in the absence of FMDV infection in the domestic host population. However, limited spread of FMDV infection in time and space in the wildlife populations can occur. If there is a continued cross-over of FMDV between domestic and wildlife populations or a higher population density, virus circulation may be prolonged.

[Anesthesiological aspects of deep brain stimulation : special features of implementation and dealing with brain pacemaker carriers]

Deep brain stimulation (DBS) provides a very effective treatment for a number of neurological diseases including Parkinson's disease, movement disorders and epilepsy. In DBS microelectrodes are positioned in defined cerebral target areas and connected to a pacemaker. It is most often performed as an awake craniotomy with intraoperative testing. Various anesthesiological regimes are used to protect the patient from surgical stress on the one hand and to achieve ideal test conditions on the other. They include local anesthesia or scalp blocks, intermittent general anesthesia or analgosedation with or without airway protection; however, anesthetic agents interfere with hemodynamic stability and ventilation, with vigilance and cooperation and in addition with the symptoms and microelectrode recording. Guidance and communication have a pivotal impact on patient needs for pharmacological interventions. With increasing numbers of DBS procedures, anesthesiologists are more often faced with patients carrying brain pacemakers. For anesthesia the characteristics of the disease as well as the respective long-term medication have to be considered. In addition, the rules for handling patients with pacemakers need to be followed to avoid both dysfunction of the generator and tissue damage due to overheating of the electrodes.

[The first wave of the German Health Interview and Examination Survey for Adults (DEGS1): sample design, response, weighting and representativeness]

The "German Health Interview and Examination Survey for Adults" (DEGS) is part of the health monitoring program of the Robert Koch Institute (RKI) and is designed as a combined cross-sectional and longitudinal survey. The first wave (DEGS1; 2008-2011) comprised interviews and physical examinations. The target population were 18- to 79-year olds living in Germany. The mixed design consisted of a new sample randomly chosen from local population registries which was supplemented by participants from the "German National Health Interview and Examination Survey 1998" (GNHIES98). In total, 8,152 persons took part, among them 4,193 newly invited (response 42%) and 3,959 who had previously taken part in GNHIES98 (response 62%). 7,238 participants visited one of the 180 local study centres, 914 took part in the interview-only programme. The comparison of the net sample with the group of non-participants and with the resident population of Germany suggests a high representativeness regarding various attributes. To account for certain aspects of the population structure cross-sectional, trend and longitudinal analyses are corrected by weighting factors. Furthermore, different participation probabilities of the former participants of GNHIES98 are compensated for. An English full-text version of this article is available at SpringerLink as supplemental.

The Materials Science beamline upgrade at the Swiss Light Source

The Materials Science beamline at the Swiss Light Source has been operational since 2001. In late 2010, the original wiggler source was replaced with a novel insertion device, which allows unprecedented access to high photon energies from an undulator installed in a medium-energy storage ring. In order to best exploit the increased brilliance of this new source, the entire front-end and optics had to be redesigned. In this work, the upgrade of the beamline is described in detail. The tone is didactic, from which it is hoped the reader can adapt the concepts and ideas to his or her needs.

The ADHD-susceptibility gene lphn3.1 modulates dopaminergic neuron formation and locomotor activity during zebrafish development

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, increased impulsivity and emotion dysregulation. Linkage analysis followed by fine-mapping identified variation in the gene coding for Latrophilin 3 (LPHN3), a putative adhesion-G protein-coupled receptor, as a risk factor for ADHD. In order to validate the link between LPHN3 and ADHD, and to understand the function of LPHN3 in the etiology of the disease, we examined its ortholog lphn3.1 during zebrafish development. Loss of lphn3.1 function causes a reduction and misplacement of dopamine-positive neurons in the ventral diencephalon and a hyperactive/impulsive motor phenotype. The behavioral phenotype can be rescued by the ADHD treatment drugs methylphenidate and atomoxetine. Together, our results implicate decreased Lphn3 activity in eliciting ADHD-like behavior, and demonstrate its correlated contribution to the development of the brain dopaminergic circuitry.

[Who doesn't benefit from psychosomatic rehabilitation?]

BACKGROUND

The aim of this study was to examine how far treatment success in psychosomatic rehabilitation can be predicted by patients' characteristics, therapy motivation and disorder.

METHODS

Data of 307 patients with psychosomatic disease were included. External and self-evaluations were operationalized as criterion for success. Data were collected using the Brief Symptom Inventory (BSI), Patients' Questionnaire of Therapy Motivation (PAREMO-20) and Disorder Severity Score (BSS). Hierarchical linear regression analysis was used for data analysis.

RESULTS AND CONCLUSIONS

A sceptical attitude, low education and long time of incapacity for work prior to rehabilitation can predict a lower treatment success. High levels of readiness for change and 6-8 working hours daily seem to favourably impact coping with disease in the framework of inpatient psychosomatic rehabilitation.

Disease severity declines over time after a wild boar population has been affected by classical swine fever--legend or actual epidemiological process?

Classical swine fever (CSF) is a severe multi-systemic disease that can affect both domestic pigs and wild boar. Past outbreaks in European wild boar involved high-virulent CSF virus (CSFV) strains and were mostly self-limiting. In these cases, morbidity and mortality rates were high in the affected regions. In contrast, endemic infections have been observed in several European wild boar populations in recent decades. Morbidity and mortality rates were much lower despite the fact that outbreaks were still detected via diseased or fallen animals. The virus strains involved were mostly classified as genotype 2.3 strains of moderate virulence causing age-dependent disease outcomes. The mechanisms leading to the establishment and perpetuation of endemicity are still not fully understood, but the factor "moderate virulence" seems to be of considerable importance. In this study, we aim to clarify whether the perception of declined 'CSF severity' could hypothetically reflect the adaptation of an initially high-virulent virus or whether this might be better explained as a misinterpretation of observations. A mechanistic eco-epidemiological model was employed to follow up a highly virulent strain of CSFV introduced into large connected wild boar populations. In the model, the virulence of the CSF virus is represented by case mortality and life expectancy after lethal infection. Allowing for small stochastic variation, these two characteristics of the virus are passed on with every new simulated infection that occurs. Model analysis revealed a decrease from high to moderate case mortality within a few years of simulated perpetuation of the virus. The resulting mortality corresponded to the level where the population average of the infectious period and the basic reproduction number of the disease were maximal. This shift in virulence was sufficient to prolong virus circulation considerably beyond the epidemic phase of the simulated outbreaks. Alternative mechanistic explanations for the decrease in disease severity in a CSF-affected wild boar population were evaluated in the light of the simulation experiments and the available epidemiological or virological evidence. In conclusion, the current virus isolates of subgroup 2.3 might be the ideally adapted variants of the CSF virus for long-term perpetuation in wildlife and indeed may have evolved (once) during past outbreaks in large populations. A repeated perception of a declining severity of disease pattern during the course of a CSF outbreak, however, favours the explanation based on monitoring and detection biases rather than repeated observation of selection against highly virulent virus during the time of virus perpetuation.

Desflurane-induced post-conditioning against myocardial infarction is mediated by calcium-activated potassium channels: role of the mitochondrial permeability transition pore

BACKGROUND

Desflurane (DES)-induced preconditioning is mediated by large-conductance calcium-activated potassium channels (BK(Ca)). Whether BK(Ca) are involved in anaesthetic-induced post-conditioning is unknown. We tested the hypothesis that DES-induced post-conditioning is mediated by BK(Ca) upstream of the mitochondrial permeability transition pore (mPTP).

METHODS

Pentobarbital-anaesthetized male C57Black/6 mice were subjected to 45 min coronary artery occlusion (CAO) and 3 h reperfusion. Animals received either no intervention or dimethylsulphoxide (DMSO, 10 µl g(-1)). DES (1.0 MAC, 7.5 vol%) was administered for 18 min, starting 3 min before the end of CAO. The following agents were given either alone or in combination with DES: the BK(Ca) activator NS1619 (1 µg g(-1)), the BK(Ca) inhibitor iberiotoxin (IbTx, 0.05 µg g(-1)), the mPTP opener atractyloside (ATRA, 25 µg g(-1)), and the mPTP inhibitor cyclosporine A (CYC A, 10 µg g(-1)). Infarct size (IS) was determined with triphenyltetrazolium chloride and the area at risk with Evans Blue, respectively.

RESULTS

IS in control animals was 48(6)%. Neither DMSO, IbTx nor ATRA affected myocardial IS. DES alone or NS1619 alone or the combination reduced IS (P<0.05), CYC A alone or in combination with IbTx or DES also reduced IS (P<0.05). DES-induced reduction of myocardial IS was completely abolished by IbTx and was partially blocked by ATRA and ATRA partially blocked IS reduction by NS1619.

CONCLUSIONS

These data suggest that DES-induced post-conditioning against myocardial infarction is mediated by BK(Ca) and mPTP. Cardioprotection by BK(Ca) activator NS1619 might occur, at least in part, independently of mPTP.

Association of psoriasis with the VEGF gene polymorphism in the northern Polish population

BACKGROUND

Neovascularization plays an important role in pathogenesis of psoriasis and vascular endothelial growth factor (VEGF) seems to be the main angiogenic factor involved in this disease. Published studies which analysed the role of VEGF gene polymorphism in psoriasis were limited and they received controversial results. Objective The aim of our study was to evaluate the association between -1154 G/A, -460 T/C and +405 G/C polymorphisms and the psoriasis susceptibility and to determine whether this genetic variation influence levels of VEGF protein expression.

MATERIALS AND METHODS

One hundred and eighty-nine patients with psoriasis and 215 ethnically matched controls were genotyped using ARMS-PCR and PCR-RFLP methods. VEGF serum levels were assessed in 47 patients and 40 controls using ELISA test.

RESULTS

We noted that an increased risk of Type I psoriasis is associated with -1154 G allele (OR = 1.9; P = 0.04), +405 CC (OR = 2.86; P = 0.03) and -460 TT (OR = 1.56; P = 0.05) genotypes and demonstrated that a significantly increased risk of developing disease is related to presence of haplotype GTC among all patients (OR = 1.97; P = 0.001), patients with Type I (OR = 1.87; P = 0.005) and Type II psoriasis (OR = 2.37, P = 0.01). We have found significantly increased serum levels of VEGF in patients with psoriasis compared with those in healthy controls (P = 0.008). Serum levels of VEGF significantly correlated with PASI: r = 0.72, P < 0.00001. Patients with elevated levels of VEGF in the serum showed more frequently: GC genotype (P = 0.04), C allele (P = 0.02) at the locus +405 and TT genotype (P = 0.03) at the locus -460.

CONCLUSION

Our results strongly support the role of VEGF gene polymorphism in the pathogenesis of psoriasis.

Levetiracetam compared to phenytoin for the prevention of postoperative seizures after craniotomy for intracranial tumours in patients without epilepsy

Anticonvulsant drugs are frequently given after craniotomy. Phenytoin (PHT) is the most commonly used agent; levetiracetam (LEV) is a new anticonvulsant drug with fewer side effects. To compare the incidence of seizures in patients receiving either prophylactic PHT or LEV perioperatively, 971 patients undergoing a craniotomy were analysed retrospectively during a 2-year period. PHT was used routinely and LEV was administered when PHT was contraindicated. Seizures documented during the first 7 days after craniotomy were considered. A total of 235 patients were treated with an antiepileptic drug: 81 patients received LEV, and 154 patients, PHT. Two patients receiving LEV (2.5%) and seven receiving PHT (4.5%) had a seizure despite this treatment. No patient had a documented side effect or drug interaction. The data show that LEV may be an alternative option in patients with contraindications to PHT.

Diffuse cutaneous mastocytosis: analysis of 10 cases and a brief review of the literature

BACKGROUND

Diffuse cutaneous mastocytosis (DCM) is an extremely rare disease characterized by mast cell (MCs) infiltration of the entire skin. Little is known about the natural course of DCM.

OBJECTIVES

We decided to characterize clinical manifestations, the frequency of MCs mediator-related symptoms and anaphylaxis, risk of systemic mastocytosis (SM) and prognosis, based on 10 cases of DCM, the largest series published to date.

METHODS

Diffuse cutaneous mastocytosis, DCM was confirmed by histopathological examination of skin samples in all cases. SCORing Mastocytosis (SCORMA) Index was used to assess the intensity of DCM. The analysis of clinical symptoms and laboratory tests, including serum tryptase levels was performed. Bone marrow biopsy was done only in selected cases.

RESULTS

Large haemorrhagic bullous variant of DCM (five cases) and infiltrative small vesicular variant (five cases) were identified. The skin symptoms appeared in age-dependent manner; blistering predominated in infancy, whereas grain-leather appearance of the skin and pseudoxanthomatous presentation developed with time. SM was not recognized in any of the patients. Mast cell mediator-related symptoms were present in all cases. Anaphylactic shock occurred in three patients. Follow-up performed in seven cases revealed slight improvement of skin symptoms, reflected by decrease of SCORMA Index in all of them. Serum tryptase levels declined with time in six cases.

CONCLUSIONS

Diffuse cutaneous mastocytosis, DCM is a heterogeneous, severe, cutaneous disease, associated with mediator-related symptoms and risk of anaphylactic shock. Although our results suggest generally favourable prognosis, the review of the literature indicate that SM may occur. Therefore, more guarded prognosis should be given in DCM patients.

Structure and stability of the negative hydrogen molecular ion

We present the results of a Coulomb explosion experiment that allows for the imaging of the rovibrational wave function of the metastable H2- ion. Our measurements confirm the predicted large internuclear separation of 6 a.u., and they show that the ion decays by autodetachment rather than by spontaneous dissociation. Imaging of the resulting H2 products reveals a large angular momentum of J = 25 ± 2, quantifying the rotation that leads to the metastability of this most fundamental molecular anion.

[Breast feeding during methadon- and buprenorphin therapy]

The number of opiate addicted patients treated with opioid replacement therapy is continuously increasing. In Germany, 57.7% of these patients are treated with methadone and 18.6% with buprenorphine. This maintenance therapy provides several advantages while addicted pregnant women and their foetus have a high benefit from appropriate replacement therapy. However, the recommendations concerning breast feeding during an opioid replacement therapy are discussed controversially, because methadone as well as buprenorphine accumulate in breast milk. This accumulation might cause damages to the newborn's health; so, child benefits of breast feeding have to be balanced with possible health risks.This review provides an overview of a selective literature search based on the PubMed-database and german consensus recommendations. Used search terms included: (methadone*) AND (breastfeeding OR lactation), (methadone*) AND (human milk), (buprenorphine*) AND (breastfeeding OR lactation) and (buprenorphine*) AND (human milk).According to the available literature, addicted women, substinated with methadone or buprenorphine are allowed to breast feed their newborns. The advantages of breast feeding prevail the risks of an infant opiate intoxication caused by methadone or buprenorphine.

[Effects of a cognitive-behavioral patient education on fibromyalgia: a controlled efficacy study]

BACKGROUND

The efficacy of a cognitive-behavioral patient education program was compared with the efficacy of treatment based solely on patient education. Both forms of treatment were integrated into the inpatient rehabilitation program. For therapy of fibromyalgia a multimodal therapy has been shown to be effective. Stress management, pain management and relaxation techniques enhance the ability to cope with the disease.

MATERIALS AND METHODS

Various questionnaires including the Hospital Anxiety and Depression Scale (HADS-D), the questionnaire for assessment of level of coping with pain (FESV) and the patient questionnaire IRES-24 were distributed to 3,541 fibromyalgia patients within the framework of a pre, post and 6-month follow-up study design. Multivariate variance models were used for data analysis.

RESULTS

Both interventions showed positive effects on psychological impairment, coping with pain and state of health. Only the paired comparison showed different results. However, cognitive-behavioral patient education showed better effects on independent coping with the disease. These patients showed an improved ability to cope with pain and a better state of health at the end of the rehabilitation program.

CONCLUSIONS

Multimodal inpatient rehabilitation programs can have a strong positive impact on the course of the disease for patients with fibromyalgia. A cognitive-behavioral treatment appears to strongly influence coping with the disease.

Fatigue, quality of life, and cognitive functions in metastatic kidney cancer patients with antiangiogenic treatment

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Background: Fatigue is commonly reported by patients under anti-angiogenic therapies, with sometimes cognitive complains. However, few studies have explored these problems. A longitudinal multicentric prospective study is ongoing in France on fatigue, cognitive functions, quality of life (QoL), anxiety and depression among metastatic kidney cancer patients receiving anti-angiogenic therapies. Objectives: The main objective is to assess fatigue. Secondary objectives are to assess cognitive functions, QoL, anxiety, and depression.

Methods: Assessments are made at baseline, at 3 and 6 months. Evaluations were made by: autoquestionnaire MFI-20 to assess fatigue, FACT-G and FKSI to assess QoL, Spielberger's and Beck's questionnaires to assess respectively anxiety and depression. Cognitive functions were assessed by a neuropsychologist with the Working Memory Index (WAIS-III), Grober and Buschke test, Rey Complexe Figure test, verbal fluency and Trail Making test, exploring respectively working memory, episodic memory and executive functions. Preliminary results are presented.

Results: 35 patients were enrolled, and 20 of them had the second assessment at 3 months. Most of patients received sunitinib (51%), others received bevacizumab and interferon, or sorafenib. At baseline, 45% of patients expressed general fatigue and 50% at 3 months (p=0.04). Other domains of fatigue (physical, mental, reduced activity and motivation) did not change over time. At baseline, few patients had cognitive disorders (working memory 6%; executive functions 0%; episodic memory 11%), with no decline at 3 months. However, there was an impairment of QoL in FKSI score (p=0.01) and of FACT-G physical well-being (p=0.01). No differences were found in social, emotional or functional well-being. There was no difference on depression nor on anxiety over time.

Conclusions: Fatigue significantly increased during the first 3 months of anti-angiogenic treatment, with no impact on cognitive functions but a decline of QoL. These preliminary findings need to be confirmed by further follow-up and more patients. Final results will be provided with 120 patients.

No significant financial relationships to disclose.

Vasopressin in sepsis and septic shock

Arginine vasopressin (AVP) and its synthetic, long-acting analog terlipressin (TP) are potent alternative vasoconstrictors in the treatment of septic patients with catecholamine-refractive vasodilatatory shock. The results from one large randomized clinical trial suggest that AVP plus norepinephrine (NE) infusion is as safe and effective as treatment with NE alone in patients with septic shock. Because the desired effects of vasopressin analogs are basically related to their vasopressinergic effects via the V1a receptor, more selective V1 agonists, such as TP, may be more potent in reversing sepsis-related arterial hypotension. In this regard, recent evidence from small-scale studies suggests that continuous low-dose infusion rather than intermittent bolus injection of TP is associated with fewer side effects, such as depression of cardiac output and rebound arterial hypotension. However, because clinical data on the administration of TP in patients with sepsis are limited, it should not currently be used beyond the scope of controlled trials. The optimal time point for the initiation of therapy with vasopressin analogs has yet to be determined. While AVP and TP are commonly used as last-resort therapies in severe septic shock, some evidence supports the initiation of treatment in a less severe state of the disease.

A cryogenic electrostatic trap for long-time storage of keV ion beams

We report on the realization and operation of a fast ion beam trap of the linear electrostatic type employing liquid helium cooling to reach extremely low blackbody radiation temperature and residual gas density and, hence, long storage times of more than 5 min which are unprecedented for keV ion beams. Inside a beam pipe that can be cooled to temperatures <15 K, with 1.8 K reached in some locations, an ion beam pulse can be stored at kinetic energies of 2-20 keV between two electrostatic mirrors. Along with an overview of the cryogenic trap design, we present a measurement of the residual gas density inside the trap resulting in only 2 x 10(3) cm(-3), which for a room temperature environment corresponds to a pressure in the 10(-14) mbar range. The device, called the cryogenic trap for fast ion beams, is now being used to investigate molecules and clusters at low temperatures, but has also served as a design prototype for the cryogenic heavy-ion storage ring currently under construction at the Max-Planck Institute for Nuclear Physics.

Aprotinin-associated risks in off-pump coronary artery bypass grafting

BACKGROUND

Little data is available regarding the safety of using the serine protease inhibitor aprotinin in off-pump cardiac surgery. We retrospectively assessed the risks of administering the drug to adult patients undergoing off-pump coronary artery bypass grafting (OPCABG).

METHODS

Aprotinin was administered as a bolus of 1 or 2 million kallikrein inhibiting units to 391 patients following median sternotomy; 370 control patients underwent surgery during the same time period without receiving aprotinin. No other antifibrinolytic agents were administered.

RESULTS

Preoperative characteristics, length of ICU and hospital stay were similar between the mostly medium-risk aprotinin and the control patients. Postoperative cardiac, renal, neurological, and respiratory complications and hospital mortality occurred with comparable frequencies in both groups. Levels of myocardial enzymes during the first 72 h after surgery also did not differ significantly.

CONCLUSION

Use of aprotinin in OPCABG was not associated with a higher incidence of hospital mortality, cardiovascular, renal, or other complications. Given the good safety profile in this large patient population we suggest that aprotinin could still be a valid antifibrinolytic treatment option in OPCABG.