Expression of monocyte human leukocyte antigen-DR in relation with sepsis severity and plasma mediators

AIM

After an initial septic hit, the immune response to a new antigen changes as time progresses, with an unpredictable efficiency. The aim of this study was to characterize the monocyte functional phenotype by HLA-DR expression in septic patients at the onset of sepsis and during recovery in relation to organ failure and plasma mediators.

METHODS

Twenty-six patients were analyzed as either single organ failure at worst (SOF) or multiple organ failure (MOF) over 14 days. Twelve patients received immunosuppressive (IS) drugs before sepsis. We measured: 1) monocyte HLA-DR expression (mHLA-DR); 2) plasma pro-inflammatory mediators (IL-12p40, macrophage Migration Inhibitory Factor [MIF]); 3) plasma anti-inflammatory mediators (IL-10, cortisol); and 4) in vitro lipopolysaccharide (LPS) stimulated mHLA-DR in 6-hour whole blood culture or after plasma replacement with standard milieu.

RESULTS

mHLA-DR expression was equally decreased in patients who were treated with IS drugs as those who were not. Despite the difference in severity, SOF patients showed a similar profound mHLA-DR downregulation as MOF patients at day 0, but tended to recover earlier. MOF patients presented higher plasma IL-10 and cortisol levels than SOF patients but similar plasma IL-12p40 and MIF levels. In vitro LPS stimulation showed an impaired mHLA-DR response in both groups. Plasma replacement by milieu elicited a slight improvement in the response to LPS in SOF but not MOF patients.

CONCLUSIONS

At the onset of sepsis, an initial low mHLA-DR was not related to any prior IS drug regimen, the severity of the sepsis or the outcome. The duration of mHLA-DR downregulation could be related to plasma factors in SOF, while other mechanisms may be implicated in MOF evolution.

Detection and elimination of cyanobacteria from frescoes: the case of the St. Brizio Chapel (Orvieto Cathedral, Italy)

A rosy discoloration partly masking the Luca Signorelli frescoes in St. Brizio Chapel (Orvieto Cathedral, Italy) for many years proved to be a biological alteration, so the present research focused on investigating biodeteriogens and selecting an appropriate biocide to treat them. Optical epifluorescence and electronic microscopic observations of the rosy powder revealed a prevalent autofluorescent coccoid form with a diameter bigger than 5 microm. Chlorophylls a and b were extracted, suggesting the presence of cyanobacteria, a thesis subsequently confirmed by flow cytometry. Cultural media were inoculated with the rosy powder, and microorganisms grew as a green patina in phototrophic conditions and as a rosy patina when organic compounds were added to the mineral medium. The rosy discoloration was most likely caused by the presence of phycoerythrin. The sequencing of the cyanobacteria-specific polymerase chain reaction (PCR)-DGGE bands matched, with a similarity percentage >94, uncultured cyanobacteria, and the sequences were deposited in the GenBank under EU874241, EU874242, EU874243, EU874244, EU874245, EU874246, and EU874247. Finally, the efficiency of the two biocides Neo Desogen and Metatin 5810-101, both based on benzalkonium chloride, was evaluated using adenosine triphosphate measurements and PCR-based detection of cyanobacteria. Metatin, used in situ at 2% of the trade product, proved to be the better biocide, no cyanobacteria being detected after the Metatin treatment.

Genetic alteration in hereditary colorectal cancer

Colorectal cancer is a major cause of morbidity and mortality. Both genetic and environmental factors contribute to cancer aetiology. About 15-20% of all colorectal cancers are familial. Approximately 6% of colorectal cancers can be attributed to recognizable heritable germline mutations. The discovery of genes responsible for inherited forms of colorectal cancer have the potential to improve cancer risk assessment and counselling. Genetic testing for hereditary forms of colorectal cancer can confirm or reject diagnoses at the molecular level, determine surveillance intervals for at-risk persons, decrease the cost of surveillance by risk stratification, aid in surgical and chemoprevention decision-making, and help patients in family and career planning. This paper reviews the genetics behind genes and molecular study of the hereditary colorectal cancer. This may help the medical professionals especially internists, gastroenterologists, and oncologists to update their knowledge in this field.

The application of sentinel lymph node mapping in colon cancer

Lymph node status is the most important prognostic factor for colorectal carcinoma. Complete lymph node dissection has historically been an integral part of the surgical treatment of these diseases. Sentinel lymph node mapping is a newer technology that allows selective removal of the first node draining a tumor. Sentinel node mapping is well accepted for the management of breast carcinoma and cutaneous melanoma, and has resulted in reduced morbidity without adversely affecting survival. Sentinel node mapping is currently being investigated for treatment of colorectal cancers. Recent studies show promise for incorporating the sentinel node mapping technique for treatment of several gastrointestinal malignancies.

Primary colorectal lymphomas: review of the literature

Primary colorectal lymphoma is an infrequent disease of unknown origin and with a growing incidence. Primary colorectal lymphoma accounts for only about 0.2% of large intestinal malignancies. The aim of this study is to review, identify and underline risk factors, presentation, treatment and prognosis of primary colorectal lymphoma, using the three most important studies made in the last years: the Chung-Wei Fan study from the division of colon and rectal surgery, in Taipei [Fan CW, Changchien CR, Wang JY. Primary colorectal lymphoma. Disease of the Colon and Rectum 2000;43:1277-82]; the Wong and Eu [Primary colorectal lymphomas. Colorectal Diseases 2006;8:586-91] study from the Department of colorectal surgery in Singapore and the study of Doolabh et al. [Primary colon lymphoma. Journal of Surgical Oncology 2000;74:257-62] University of Texas Southwestern Medical School, Dallas, Texas.

Perioperative management of four anaemic female Jehovah’s Witnesses undergoing urgent complex cardiac surgery

Previous studies have demonstrated that preoperative haemoglobin concentration and female gender are related to an increased need for perioperative allogeneic transfusions in cardiac surgery. Hence, urgent cardiac surgery presents a dilemma for female patients who are Jehovah's Witnesses, because of their refusal of allogeneic transfusion. This report describes the management of four high-risk anaemic female patients undergoing urgent complex cardiac surgery. In these Jehovah's Witness patients, strict application of a comprehensive blood-sparing protocol permitted safe avoidance of allogeneic transfusions. The protocol involved intraoperative acute normovolaemic haemodilution, intraoperative administration of tranexamic acid, intra- and postoperative use of a cell-saver system, postoperative administration of erythropoietin, iron and folic acid, and a careful surgical technique to avoid perioperative bleeding.

Intelligent databases assist transparent and sound economic valuation of ecosystem services

Assessment and economic valuation of services provided by ecosystems to humans has become a crucial phase in environmental management and policy-making. As primary valuation studies are out of the reach of many institutions, secondary valuation or benefit transfer, where the results of previous studies are transferred to the geographical, environmental, social, and economic context of interest, is becoming increasingly common. This has brought to light the importance of environmental valuation databases, which provide reliable valuation data to inform secondary valuation with enough detail to enable the transfer of values across contexts. This paper describes the role of next-generation, intelligent databases (IDBs) in assisting the activity of valuation. Such databases employ artificial intelligence to inform the transfer of values across contexts, enforcing comparability of values and allowing users to generate custom valuation portfolios that synthesize previous studies and provide aggregated value estimates to use as a base for secondary valuation. After a general introduction, we introduce the Ecosystem Services Database, the first IDB for environmental valuation to be made available to the public, describe its functionalities and the lessons learned from its usage, and outline the remaining needs and expected future developments in the field.

Use of the Given Patency System for the screening of patients at high risk for capsule retention

BACKGROUND

Capsule enteroscopy is a non-invasive diagnostic tool for the study of the small bowel. Due to the risk of capsule retention, capsule enteroscopy is contraindicated in patients with suspected small bowel strictures. The Given Patency Capsule is a disintegration time-controlled capsule developed to identify patients with strictures that may cause capsule enteroscopy retention. The presence of the patency capsule within the patient's body can be detected by a radio-frequency scanner.

AIM OF THE STUDY

To evaluate safety and usefulness of the patency capsule in preventing capsule retention in patients at high risk.

PATIENTS AND METHODS

Thirty-two patients were studied. Indications for patency capsule were: (A) Crohn's disease (18), (B) previous intestinal surgery (7), (C) previous obstruction (1), A+B (3), A+C (1), B+C (2). Patients were evaluated with the scanner at 72 h from ingestion.

RESULTS

At 72 h, 24 patients had already excreted the intact capsule in the stool. Of these, two experienced abdominal pain during capsule passage. In the other eight patients, the scanner detected the presence of the patency capsule. Four of them excreted the capsule intact in the stool after 72-96 h, the remaining four never found the capsule in the stool. The 26 patients who excreted the patency capsule intact without experiencing abdominal pain were deemed eligible for the capsule enteroscopy procedure, which was performed uneventfully in the 25 who agreed to undergo the examination.

CONCLUSIONS

The patency capsule is useful to identify, among patients at high risk, those who can be submitted to capsule enteroscopy without risks of capsule retention.

Metal toxicity in municipal wastewater activated sludge investigated by multivariate analysis and in situ hybridization

The toxicity of three heavy metals (copper, zinc and nickel) on an activated sludge biomass was studied by measuring several parameters of microbiological activity and the dynamics of microbial community composition. The effects on the microflora in the activated-sludge tank were evaluated by dosing the tank with different metal concentrations and a non-inhibiting concentration of copper for a 2-week period. The relationship between biological effects and chemical measurements was elucidated by principal component analysis (PCA). The biochemical data suggested a higher sensitivity of nitrifiers to these metals than heterotrophs. This was confirmed by fluorescent in situ hybridization (FISH) analysis on the microbial community. The impact of copper was displayed by biomass deflocculating phenomena (pin-point) and a decrease in the beta-proteo bacteria component. In addition, the zone settling velocity (ZSV) was shown not to be a good indicator of chronic toxicity phenomena. Finally, the sequence of biomass metal accumulation capability was assessed, and corresponds to Cu>Ni>Zn.

The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices: a prospective three-center pilot study

BACKGROUND AND STUDY AIMS

Variceal bleeding is a major complication of cirrhosis, and is associated with a 20 % mortality at 6 weeks. Current international guidelines recommend that patients with cirrhosis are screened by conventional upper endoscopy (esophagogastroduodenoscopy, EGD) in order to detect esophageal varices. The recently developed PillCam ESO esophageal capsule endoscope has been shown to be an accurate diagnostic tool in the investigation of patients with gastroesophageal reflux and Barrett's esophagus. We compared the PillCam ESO capsule endoscope with EGD for the detection of esophagogastric varices and portal hypertensive gastropathy in patients with cirrhosis.

PATIENTS AND METHODS

A pilot trial was conducted at three sites. Patients with cirrhosis who were undergoing clinically indicated EGD for screening or surveillance for esophageal varices underwent a PillCam ESO study followed by an EGD within 48 hours. Capsule videos were assessed by an investigator who was blinded to the patient's medical history and EGD findings.

RESULTS

A total of 23 of the 32 enrolled patients were found to have esophageal varices at both EGD and PillCam ESO endoscopy. In one patient PillCam ESO detected small varices that were not seen at EGD. The overall concordance between PillCam ESO and EGD was 96.9 % for the diagnosis of esophageal varices and 90.6 % for the diagnosis of portal hypertensive gastropathy. There were no adverse events related to PillCam ESO endoscopy.

CONCLUSIONS

In a high-prevalence population, PillCam ESO may represent an accurate noninvasive alternative to EGD for the detection of esophageal varices and portal hypertensive gastropathy. A large-scale trial is underway to validate and expand these findings.

Sensitivity and specificity of the suspected blood identification system in video capsule enteroscopy

BACKGROUND AND STUDY AIMS

Capsule enteroscopy has become a standard tool for the evaluation of obscure gastrointestinal bleeding. Reviewing the video recordings of capsule examinations is time-consuming and requires prolonged attention. Recently, software that can recognize the frames containing "red spots", the Suspected Blood Identification system (SBIS), has been developed with the aim of assisting in the analysis of video recordings. We assessed the sensitivity and specificity of the SBIS in patients undergoing capsule enteroscopy.

PATIENTS AND METHODS

100 consecutive patients underwent capsule enteroscopy at our tertiary referral center, for the following indications: obscure gastrointestinal bleeding (75 patients), metastatic carcinoid (7 patients) known or suspected Crohn's disease (5 patients), miscellaneous (13 patients). Capsule endoscopy was carried out by the standard method. Four gastroenterologists, experienced in capsule endoscopy, reviewed the recordings.

RESULTS

Small-bowel visualization was obtained in 95 cases. The physicians identified 209 "red spots", 54 of which (25.8%) were also identified by the SBIS. The overall sensitivity, specificity, and positive and negative predictive values of the SBIS, calculated on the number of true-positive, true-negative, false-positive and false-negative results, were 40.9%, 70.7%, 69.2% and 42.6%, respectively. Sensitivity was higher for the identification of red blood (60.9%) than for nonbleeding "red" lesions such as arteriovenous malformations (25.8%).

CONCLUSIONS

The SBIS has low sensitivity and specificity. It can be used as a complementary and rapid screening tool, but complete review of the recordings is still necessary.

A simple HPLC-UV method for the assay of ginkgolic acids in Ginkgo biloba extracts

Extracts from the leaves of Ginkgo biloba are among the most widely used phytotherapeutics. Some alkylphenols (ginkgolic acids, cardanols and cardols) have been described as potentially hazardous constituents in Ginkgo extracts. Accordingly, a requirement for a maximum concentration of ginkgolic acids has been proposed in the UE and US pharmacopoeias Ginkgo monographs establishing a limit value of 5 ppm. A novel HPLC-UV method, developed by the use of HPLC-APCI-MS HPLC-DAD techniques and allowing the identification of ginkgolic acids and related phenols, is described. The new analytical method, not requiring enrichment procedures, can be used for the quantification of ginkgolic acids in Ginkgo extracts.

Drf1, a novel regulatory subunit for human Cdc7 kinase

Studies in model organisms have contributed to elucidate multiple levels at which regulation of eukaryotic DNA replication occurs. Cdc7, an evolutionarily conserved serine-threonine kinase, plays a pivotal role in linking cell cycle regulation to genome duplication, being essential for the firing of DNA replication origins. Binding of the cell cycle-regulated subunit Dbf4 to Cdc7 is necessary for in vitro kinase activity. This binding is also thought to be the key regulatory event that controls Cdc7 activity in cells. Here, we describe a novel human protein, Drf1, related to both human and yeast Dbf4. Drf1 is a nuclear cell cycle-regulated protein, it binds to Cdc7 and activates the kinase. Therefore, human Cdc7, like cyclin-dependent kinases, can be activated by alternative regulatory subunits. Since the Drf1 gene is either absent or not yet identified in the genome of model organisms such as yeast and Drosophila, these findings introduce a new level of complexity in the regulation of DNA replication of the human genome.

Photonic crystal sensor based on surface waves for thin-film characterization

A new sensor based on optical surface waves in truncated one-dimensional photonic crystals is proposed for use in determining the optical properties of metallic or dielectric thin films and bulk media. Specifically, the method of optical characterization takes into account the changes that the surface waves of a layered structure undergo when either a thin film of arbitrary material is added at the surface or the optical properties of transmission medium change. For the surface-wave excitation the Kretschmann configuration used in attenuated total reflectance is employed.

Environmental vulnerability indicators for environmental planning and decision-making: guidelines and applications

Environmental decision-making and policy-making at all levels refers necessarily to synthetic, approximate quantification of environmental properties such as vulnerability, conservation status, and ability to recover after perturbation. Knowledge of such properties is essential to informed decision-making, but their definition is controversial and their precise characterization requires investments in research, modeling, and data collection that are only possible in the most developed countries. Environmental agencies and governments worldwide have increasingly requested numerical quantification or semiquantitative ranking of such attributes at the ecosystem, landscape, and country level. We do not have a theory to guide their calculation, in general or specific contexts, particularly with the amount of resources usually available in such cases. As a result, these measures are often calculated with little scientific justification and high subjectivity, and such doubtful approximations are used for critical decision-making. This problem applies particularly to countries with weak economies, such as small island states, where the most precious environmental resources are often concentrated. This paper discusses frameworks for a "least disappointing," approximate quantification of environmental vulnerability. After a review of recent research and recent attempts to quantify environmental vulnerability, we discuss models and theoretical frameworks for obtaining an approximate, standardizable vulnerability indicator of minimal subjectivity and maximum generality. We also discuss issues of empirical testing and comparability between indicators developed for different environments. To assess the state of the art, we describe an independent ongoing project developed in the South Pacific area and aimed to the comparative evaluation of the vulnerability of arbitrary countries.