Occurrence of subtilase cytotoxin and relation with other virulence factors in verocytotoxigenic Escherichia coli isolated from food and cattle in Argentina

We investigated the presence of the gene of subtilase cytotoxin (SubAB), described in certain highly virulent verocytotoxigenic E. coli strains, in isolates from Argentina and its relation with other virulence factors. The gene subA was present in eae-negative strains mostly associated with saa, vt2 and ehxA genes.

The sandflies (Diptera: Psychodidae, Phlebotominae) in military camps in northern Afghanistan (2007-2009), as identified by morphology and DNA 'barcoding'

As part of a continuous, standardized programme of monitoring the Leishmania vectors in German military camps in northern Afghanistan between 2007 and 2009, a detailed taxonomic analysis of the endemic sandfly fauna, as sampled using light and odour-baited traps, was conducted. Of the 10 sandfly species that were recorded, six may serve as enzootic and/or zooanthroponotic vectors of parasites causing human leishmaniasis. The use of a simple DNA-'barcoding' technique based on the mitochondrial cyt b gene, to identify the collected sandflies to species level, revealed (1) a clear discrimination between the potential vector species, (2) clustering of species within most subgenera, and (3) particularly high heterogeneity within the subgenus Paraphlebotomus (Phlebotomus alexandri being grouped with Ph. papatasi rather than with other Paraphlebotomus species). The data also indicate a high level of genetic heterogeneity within the subgenus Sergentomyia but close similarity between Sergentomyia sintoni and Sergentomyia murgabiensis. The morphological similarity of many medically important sandflies can make species identification difficult, if not impossible. The new DNA-barcoding techniques may provide powerful discriminatory tools in the future.

Surgical dislocation of the hip for the fixation of acetabular fractures

Surgical dislocation of the hip in the treatment of acetabular fractures allows the femoral head to be safely displaced from the acetabulum. This permits full intra-articular acetabular and femoral inspection for the evaluation and potential treatment of cartilage lesions of the labrum and femoral head, reduction of the fracture under direct vision and avoidance of intra-articular penetration with hardware. We report 60 patients with selected types of acetabular fracture who were treated using this approach. Six were lost to follow-up and the remaining 54 were available for clinical and radiological review at a mean follow-up of 4.4 years (2 to 9).

Substantial damage to the intra-articular cartilage was found in the anteromedial portion of the femoral head and the posterosuperior aspect of the acetabulum. Labral lesions were predominantly seen in the posterior acetabular area. Anatomical reduction was achieved in 50 hips (93%) which was considerably higher than that seen in previous reports. There were no cases of avascular necrosis. Four patients subsequently required total hip replacement. Good or excellent results were achieved in 44 hips (81.5%). The cumulative eight-year survivorship was 89.0% (95% confidence interval 84.5 to 94.1). Significant predictors of poor outcome were involvement of the acetabular dome and lesions of the femoral cartilage greater than grade 2. The functional mid-term results were better than those of previous reports.

Surgical dislocation of the hip allows accurate reduction and a predictable mid-term outcome in the management of these difficult injuries without the risk of the development of avascular necrosis.

[Two-photon microscopy of the cornea using intrinsic contrast]

BACKGROUND

Three-dimensional imaging of the cornea under physiological conditions is best performed with intrinsic contrast mechanisms for the visualisation of cells and extracellular matrix. However, the unique transparency of the cornea goes along with a lack of contrast for the extracellular matrix (ECM) in reflective mode microscopy and optical coherence tomography.

METHODS

Femtosecond laser-based non-linear microscopy provides novel contrast mechanisms for the visualisation of ECM. The confinement of the non-linear contrast to the focus volume provides an intrinsic sectioning property for 3D imaging. Further advantages of the infrared light are lower phototoxicity and higher penetration depth into the tissue. For the visualisation of the cornea and its layered substructures two non-linear contrast mechanisms are of main interest: Two-photon excited autofluorescence of NAD(P)H in the cytoplasma and second harmonic generation (SHG) in the collagen-I fibres of the stroma. Ex-vivo corneas of the rabbit were imaged to demonstrate the abilities of non-linear microscopy.

RESULTS

Using the autofluorescence of NAD(P)H the corneal epithelium with squamous cells, wing cells and basal cells is visualised in three dimensions without additional exogenoeus staining. Stromal keratocytes are also imaged using the NAD(P)H autofluoresecence. The layered structure of lamella in the stroma is visible after virtual resclicing of the 3D volume data. The en-face SHG images detected through the transparent cornea in forward direction show areas of parallel streaks, which increase in size and periodically alter in orientation (90 degrees , 45 degrees) with increasing depth from anterior to posterior. These streaks are not visible in the backward SHG signal. First results on rabbit corneas, which were cross-linked with Rivoflavin and UV application showed a signature of treatment five weeks post treatment. There were zones in the stroma totally lacking NAD(P)H autofluorescence and the abundance of keratocytes was less homogeneous than in control corneas.

CONCLUSION

These results and current reports on applications in the literature show that femtosecond laser-based non-linear microscopy is an emerging imaging modality which provides dye-free imaging of the corneal ECM and therefore complements scattering imaging modalities such as optical coherence tomography and confocal laser scanning microscopy in the reflective mode.

[Virtual endoscopy of the nose and paranasal sinuses in real-time. Surgical planning system "Sinus endoscopy" (SPS-SE)]

PROBLEM

The aim of this study was the development and clinical evaluation of a new method for virtual endoscopy of the nose and paranasal sinuses.

MATERIAL AND METHODS

The surgical planning system "sinus endoscopy" (SPS-SE) was completely newly developed. The surfaces of the CT images are represented with direct volume rendering (raycasting) which allows a sufficiently high image repetition frequency with the movement of the virtual endoscopy and material effects for a natural appearance were added. Detail accuracy of the virtual illustrations was examined with the help of a picture-statistic comparison between optical and the virtual endoscopy. The evaluation of the system by the patients and physicians was made with a validated questionnaire.

RESULTS

The deviations from defined landmarks of virtual in comparison to optical endoscopy are between 1.4 mm and 11.1 mm. Manoeuvering the virtual endoscope was found to be better than with the optical endoscope but the important parameters for visualization were similar. The accuracy of volume rendering, the high variability of scaling of the anatomical borders and orientation were judged to be negative factors. Altogether there was a balanced opinion from the ENT surgeons but without exception patients judged the system positively.

DISCUSSION

This investigation proved the efficiency of SPS-SE for three-dimensional real time reconstruction of high-resolution CT data of the nose and paranasal sinuses. However, some modifications are necessary before introduction into routine use.

[Teaching non-technical skills for critical incidents: Crisis resource management training for medical students]

BACKGROUND

Physicians have to demonstrate non-technical skills, such as communication and team leading skills, while coping with critical incidents. These skills are not taught during medical education. A crisis resource management (CRM) training was established for 4th to 6th year medical students using a full-scale simulator mannikin (Emergency Care Simulator, ECS, METI).

PATIENTS AND METHODS

The learning objectives of the course were defined according to the key points of Gaba's CRM concept. The training consisted of theoretical and practical parts (3 simulation scenarios with debriefing). Students' self-assessment before and after the training provided the data for evaluation of the training outcome.

RESULTS

A total of 65 students took part in the training. The course was well received in terms of overall course quality, debriefings and didactic presentation, the mean overall mark being 1.4 (1: best, 6: worst). After the course students felt significantly more confident when facing incidents in clinical practice. The main learning objectives were achieved.

CONCLUSION

The effectiveness of applying the widely used ECS full-scale simulator in interdisciplinary teaching has been demonstrated. The training exposes students to crisis resource management issues and motivates them to develop non-technical skills.

Independent measurement of the total active 8B solar neutrino flux using an array of 3He proportional counters at the Sudbury Neutrino Observatory

The Sudbury Neutrino Observatory (SNO) used an array of 3He proportional counters to measure the rate of neutral-current interactions in heavy water and precisely determined the total active (nu_x) 8B solar neutrino flux. This technique is independent of previous methods employed by SNO. The total flux is found to be 5.54_-0.31;+0.33(stat)-0.34+0.36(syst)x10(6) cm(-2) s(-1), in agreement with previous measurements and standard solar models. A global analysis of solar and reactor neutrino results yields Deltam2=7.59_-0.21;+0.19x10(-5) eV2 and theta=34.4_-1.2;+1.3 degrees. The uncertainty on the mixing angle has been reduced from SNO's previous results.

Reduced tumour cell proliferation and delayed development of high-grade mammary carcinomas in cathepsin B-deficient mice

Expression levels of the papain-like cysteine protease cathepsin B (Ctsb) have been positively correlated with mammary tumour progression and metastasis; however, its roles in the hallmark processes of malignant growth remain poorly defined. Using Ctsb-deficient mice we investigated tumour cell differentiation, proliferation and apoptosis in the Tg(MMTV-PyMT) mouse mammary cancer model. Absence of Ctsb significantly impaired development of high-grade invasive ductal carcinomas and reduced the metastatic burden in the lungs. Mice lacking Ctsb exhibited reduced cell proliferation in mammary carcinomas and their lung metastases. Notably, intravenous injection of primarily isolated, Ctsb-expressing tumour cells into congenic Ctsb-deficient mice revealed impaired cell proliferation in the resulting experimental lung metastases, providing evidence for the involvement of Ctsb in paracrine regulation of cancer cell proliferation. No Ctsb genotype-dependent difference in tumour cell death was observed in vivo or by treatment of isolated PyMT cancer cells with tumour necrosis factor-alpha. However, cancer cells lacking Ctsb exhibited significantly higher resistance to apoptosis induction by the lysosomotropic agent Leu-Leu-OMe. Thus, our results indicate an in vivo role for Ctsb in promoting cellular anaplasia in mammary cancers and proliferation in lung metastases.

Evaluation of vt2-subtyping methods for identifying vt2g in verotoxigenic Escherichia coli

Verotoxin-producing Escherichia coli (VTEC) are important pathogens that can cause severe human disease, including haemorrhagic colitis and haemolytic-uraemic syndrome. A new variant of verotoxin, vt2g, has recently been described. It was possible to find this variant for the first time in Argentina among VTEC isolated from cattle. The present study evaluated the identification of this gene with three conventional methods used for subtyping the vt2 gene. The results show that it is possible to screen VTEC strains for the presence of vt2g without the implementation of new protocols.

[Anti-metastatic effects of serine protease inhibitors: animal models for analysis]

To date, no effective adjuvant drug preventing the aggressive spread of tumour cells in late stages of cancer disease or at the time-point of primary tumour removal is available. Although proteases, including members of the large serine protease family, were shown to be promising targets for an anti-metastatic cancer therapy, synthetic protease inhibitors (SPIs) have so far failed to be introduced into the clinic. In addition to considerations in the design of classical in vivo -tests of SPIs as cancer therapy agents, we here review our findings with a straightforward, highly sensitive and very fast in vivo metastasis model and its implications in the development of efficient anti-metastatic SPIs. The lacZ-tagging of tumour cells of this very aggressive T-cell lymphoma model allowed highly sensitive and reproducible detection of metastases within seven days after tumour cell inoculation by X-gal staining of whole organs, allowing cost-effective and material-saving side-by-side screening of a series of SPIs with different specificities for different serine proteases. By establishment of specificity/antimetastatic efficacy correlations we identified coagulation factor Xa as one important target of anti-metastatic SPIs and could use this information for the subsequent design and optimization of factor Xa-specific lead structures.

CONCLUSION

We exemplify the usefulness of high-throughput in vivo analysis to direct optimization of lead structures and how this may allow unexpected insight into the molecular biology of metastasis.

Sterol composition of freshwater algivorous ciliates does not resemble dietary composition

Algivorous ciliates represent an important link in freshwater food webs, as they transfer energy and biochemical matter from their algal prey to mesozooplankton predators. However, it is still unknown how dietary composition influences the biochemical composition of ciliates. We analyzed the sterol composition of the algivorous ciliates Balanion planctonicum and Urotricha farcta and compared it to the sterol composition of their diet--the cryptomonad Cryptomonas phaseolus. The sterol composition of the ciliates did not resemble that of their algal diet. Ergosterol [(22E)-ergosta-5,7,22-trien-3beta-ol] was the sterol in highest concentration in C. phaseolus, whereas stigmasterol [(24S)-24-ethylcholesta-5,22E-dien-3beta-ol] was dominant in both B. planctonicum and U. farcta. Moreover, the occasionally higher sterol concentrations in the ciliates than in their algal diet suggest sterol accumulation by the ciliates. We conclude that dietary sterol composition influences the composition of the two algivorous ciliates studied, but species-specific differences in metabolism probably determine the ultimate sterol composition of the ciliates.

Antimetastatische Effizienz synthetischer Serinproteaseinhibitoren

Es gibt kein wirksames adjuvantes Therapeutikum, das die aggressive Ausbreitung von Tumorzellen in fortgeschrittenen Tumorstadien oder bei chirurgischer Entfernung des Primärtumors verhindert. Obwohl Proteasen einschließlich der Serinproteasen als vielversprechende Zielstrukturen für eine antimetastatische Krebstherapie ausgewiesen wurden, schlug die klinische Einführung synthetischer Proteaseinhibitoren (SPIs) fehl. Zusätzlich zu Überlegungen zu klassischen Herangehensweisen bei der Prüfung von SPIs als Krebstherapeutika in vivo, beleuchten wir hier unsere Ergebnisse mit einem einfach handhabbaren, hochsensitiven und schnellen In-vivo-Metastasierungsmodell und seine Bedeutung für die Entwicklung effizienter, antimetastatisch wirksamer SPIs. Die lacZ-Markierung sehr aggressiver T-Zell-Lymphomzellen ermöglicht die hochsensitive und reproduzierbare Detektion von Metastasen innerhalb von sieben Tagen nach Tumorzellinokulation, durch X-Gal-Färbung ganzer Organe. Dieses Modell erlaubt ein kostengünstiges und materialsparendes paralleles Screening einer Serie von SPIs mit unterschiedlichen Spezifitäten für verschiedene Serinproteasen. Durch Korrelationen zwischen Spezifität und antimetastatischer Effizienz identifizierten wir den Gerinnungsfaktor Xa als wichtige Zielstruktur antimetastatischer SPIs und konnten diese Information für das weitere Design und die Optimierung von Faktor-Xaspezifischen Leitstrukturen verwenden. Schlussfolgerung: Wir können exemplarisch zeigen, dass In-vivo-Analysen mit hohem Durchsatz die Optimierung von Leitstrukturen dirigieren können und darüber hinaus zu unerwarteten, neuen Einblicken in die Molekularbiologie der Metastasierung führen.

Cementless hemiarthroplasty in femoral neck fractures: evaluation of clinical results and measurement of migration by EBRA-FCA

Aim of the present study was to evaluate migration rates of cementless primary hemiarthroplasty in acute femoral neck fractures. In a longitudinal, prospective study 46 patients were treated by cementless hemiarthroplasty. Clinical follow up was correlated with the EBRA-FCA method. In 30% of all patients stem migration amounted to more than 2 mm; further, these patients were seen to have a high level of activity. A high degree of migration in more than 30% of all patients requires critical scepticism toward further use of the investigated cementless stem as hemiarthroplasty. According to literature, migration of more than 2 mm suggests a high probability of early aseptic loosening. In patients with a low degree of activity good results could be observed; nevertheless, in patients with a high level of activity the combination of the investigated cementless stem with a solid fracture head cannot be recommended.

Intraserotype diversity among Argentinian verocytotoxigenic Escherichia coli detected by random amplified polymorphic DNA analysis

Most cases of diarrhoea-associated haemolytic uraemic syndrome (HUS) are caused by verocytotoxin-producing Escherichia coli (VTEC). Argentina has the highest worldwide incidence of HUS, but with a lower incidence of VTEC O157 : H7 serotype than non-Latin American countries. A large number of VTEC serotypes have been isolated from cattle and cattle-derived food products in Argentina. The aim of this work was to study intraserotype genetic diversity among these VTEC strains by random amplification of polymorphic DNA (RAPD). Strains were selected that belonged to the same serotype, but had been isolated from different sources (cattle and meat). Intraserotype genetic diversity was detected among strains belonging to O20 : H19, O113 : H21, O117 : H7, O157 : H7, O171 : H2 and O174 : H21, but only one RAPD profile corresponded to strains belonging to O91 : H21, although these isolates were from different sources.