[Nutrition and acute respiratory failure]

Acute respiratory distress syndrome (ARDS) is characterized by the formation of a protein-rich alveolar edema caused by increased permeability of the alveolocapillary membrane. The key clinical feature is refractory arterial hypoxemia, which in severe cases necessitates the application of extracorporeal membrane oxygenation. Besides lung-protective ventilation as a confirmed therapeutic option, supportive therapy is an integral part of ARDS management. In this context, modern and individualized nutritional regimens are of special importance; however, their prognostic impact, especially of immunonutrition, for ARDS patients is controversial. In this review, basic features of nutrition in intensive care medicine and ARDS-specific aspects (e.g., immunonutrition) are presented and discussed.

[Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia. S-3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy]

Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However infections on general wards are also increasing. A central issue are infections with multi drug resistant (MDR) pathogens which are difficult to treat particularly in the empirical setting potentially leading to inappropriate use of antimicrobial therapy. This guideline was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and therapy of HAP on the basis of quality of evidence and benefit/risk ratio. The guideline has two parts. First an update on epidemiology, spectrum of pathogens and antiinfectives is provided. In the second part recommendations for the management of diagnosis and treatment are given. Proper microbiologic work up is emphasized for knowledge of the local patterns of microbiology and drug susceptibility. Moreover this is the optimal basis for deescalation in the individual patient. The intensity of antimicrobial therapy is guided by the risk of infections with MDR. Structured deescalation concepts and strict limitation of treatment duration should lead to reduced selection pressure.

Integrating cereal genomics to support innovation in the Triticeae

The genomic resources of small grain cereals that include some of the most important crop species such as wheat, barley, and rye are attaining a level of completion that now is contributing to new structural and functional studies as well as refining molecular marker development and mapping strategies for increasing the efficiency of breeding processes. The integration of new efforts to obtain reference sequences in bread wheat and barley, in particular, is accelerating the acquisition and interpretation of genome-level analyses in both of these major crops.

[Nutrition in intensive care medicine]

Nutrition of intensive care patients is challenging due to complex metabolic changes. For this reason nutritional support adapted to the metabolic state is the only effective option to avoid hyperalimentation or hypoalimentation and thus has a direct influence on the prognosis. The analysis of the calorific requirement and the mode of administration are of key importance. An early enteral nutrition should be established, whereas in practice often a supplementary parenteral support is required to provide adequate calorie supply. Nowadays, most commercially available standard solutions are optimized concerning composition of nutrients; however, metabolic and gastrointestinal monitoring is recommended. In a selected group of patients the administration of immunomodulatory substances may be indicated but due to insufficient or conflicting study data an uncritical use of these supplements cannot be recommended.

Integrating cereal genomics to support innovation in the Triticeae

The genomic resources of small grain cereals that include some of the most important crop species such as wheat, barley, and rye are attaining a level of completion that now is contributing to new structural and functional studies as well as refining molecular marker development and mapping strategies for increasing the efficiency of breeding processes. The integration of new efforts to obtain reference sequences in bread wheat and barley, in particular, is accelerating the acquisition and interpretation of genome-level analyses in both of these major crops.

[Recommendations for the husbandry and welfare of sheep and goats by the German Small Ruminant Veterinary Association. Part 1]

Recommendations for the different forms of sheep and goat husbandry based on the legal regulations are summarized. These are given in particular respect to transhumance, tending, alpine farming, and indoor housing. The requirements for pasture, housing, supply of water and food, lambing, rearing of lambs, and health management are intensively discussed. The general requirements of the extensive as well as of the intensive husbandry of sheep and goats are defined. Examples of species-specific capabilities for adaption, the limits of adaption, and signs of decompensation are provided. Compliance with these recommendations should accord the animals entrusted to our care the "five freedoms (13)": 1. Freedom from hunger and thirst, 2. freedom from discomfort, 3. freedom from pain, injury, or disease, 4. freedom to express normal behaviour, and 5. freedom from fear and distress.

Functional assessment of TSC2 variants identified in individuals with tuberous sclerosis complex

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder caused by mutations in the TSC1 or TSC2 genes. The TSC1 and TSC2 gene products, TSC1 and TSC2, form a complex that inhibits the mammalian target of rapamycin (mTOR) complex 1 (TORC1). Here, we investigate the effects of 78 TSC2 variants identified in individuals suspected of TSC, on the function of the TSC1-TSC2 complex. According to our functional assessment, 40 variants disrupted the TSC1-TSC2-dependent inhibition of TORC1. We classified 34 of these as pathogenic, three as probably pathogenic and three as possibly pathogenic. In one case, a likely effect on splicing as well as an effect on function was noted. In 15 cases, our functional assessment did not agree with the predictions of the SIFT amino acid substitution analysis software. Our data support the notion that different, nonterminating TSC2 mutations can have distinct effects on TSC1-TSC2 function, and therefore, on TSC pathology.

An essential cis-acting element of the lck-3' promoter regulates the expression of p56(lck) in metastatic colorectal-cancer cells

Detection of lck-specific transcripts has been discussed as a marker for metastasis of epithelial tumor cells. Since it is known that lck expression is regulated post-transcriptionally, it was fundamental to us to identify lck in human colorectal cancer cell lines also at the protein level. Subsequently, RT-PCR was used to confirm that lck-producing colorectal cancer cell lines contain mature transcripts initiated exclusively from the 3' promoter element. When transcriptional activity of the two different lck promoter elements was characterized in the colon cancer cell lines, we found the 3' promoter preferentially activated. Based on the results obtained from truncating this promoter element at its 5' end, we were able to define the major transcriptional activity of the downstream promoter to be regulated within a small region of only 90 bp upstream from the start site for lck type I transcripts. This finding will contribute to the identification of lymphocyte-specific transcription factors involved in the activation of the lck gene in metastatic colorectal carcinoma cells.

[Acute respiratory distress syndrome]

Acute respiratory distress syndrome (ARDS) is the clinical manifestation of an acute lung injury caused by a variety of direct and indirect injuries to the lung. The cardinal clinical feature of ARDS, refractory arterial hypoxemia, is the result of protein-rich alveolar edema with impaired surfactant function, due to vascular leakage and dysfunction with consequently impaired matching of ventilation to perfusion. Better understanding of the pathophysiology of ARDS has led to the development of novel therapies, pharmacological strategies, and advances in mechanical ventilation. However, protective ventilation is the only confirmed option in ARDS management improving survival, and few other therapies have translated into improved oxygenation or reduced ventilation time. The development of innovative therapy options, such as extracorporeal membrane oxygenation, have the potential to further improve survival of this devastating disease.

[Update: studies in intensive care medicine. Results of the last 12 months]

Die Intensivmedizin spielt eine bedeutende Rolle sowohl für den medizinischen als auch den ökonomischen Erfolg eines Krankenhauses. Eine qualitativ hochwertige Intensivmedizin setzt die Kenntnis und die Umsetzung relevanter neuer klinischer Studien voraus. Die vorliegende Arbeit gibt einen Überblick über die wichtigsten intensivmedizinischen Publikationen des Jahres 2010 und der ersten Jahreshälfte von 2011 und ordnet diese im Hinblick auf die jeweilige klinische Relevanz ein. In den Jahren 2010 und 2011 sind zahlreiche randomisierte Studien veröffentlicht worden. Schwerpunkte waren die Therapie des Lungenversagens, die Analgosedierung und die Sepsistherapie.

Richter syndrome and brain involvement: low-grade lymphoma relapsing as cerebral high-grade lymphoma

Richter syndrome (RS) describes the development of high-grade non-Hodgkin's lymphoma (NHL) from low-grade NHL. RS isolated to the brain is very rare and has a poor prognosis. We describe the cases of high-grade large B-cell diffuse NHL in a 56-year-old male with chronic lymphocytic leukemia and in a 71-year-old female with previously unknown low-grade NHL, both with initial appearance of neurological symptoms. This report extends the literature of central nervous system RS and particularly highlights the importance of a thorough diagnostic evaluation of patients with low-grade NHL presenting with neurological symptoms.

Empfehlung für die Haltung von Schafen und Ziegen der Deutschen Gesellschaft für die Krankheiten der kleinen Wiederkäuer, Fachgruppe der DVG

Der zweite Teil der Haltungsempfehlungen beschäftigt sich mit der Gesundheitsvorsorge sowie den gesetzlichen Rahmenbedingungen für die Haltung von Schafen und Ziegen, den Transport und die Eingriffe an Schafen und Ziegen. Das vorgeschlagene Konzept der Gesundheitsvorsorge zielt auf die Entwicklung eines für jede Herde individuellen Gesundheitsplans ab, in dem neben der Abwehr von anzeige- und meldepflichtigen Krankheiten gerade auch die chronischen, sich langsam entwickelnden Erkrankungen und ein regelmäßiges Parasitenmonitoring Berücksichtigung finden. Dabei liegt der Schwerpunkt auf dem frühen Erkennen und der Prophylaxe von Erkrankungen. In diesem Zusammenhang wird auf den Umgang mit Lahmheiten, die Schur, Tierzukauf und Quarantäne sowie die Reinigung und Desinfektion in Schaf- und Ziegenherden intensiver eingegangen. Zum Transport von Tieren und zu Eingriffen bei Tieren liegen mit der Tierschutztransportverordnung und entsprechenden europäischen Regelungen detaillierte Vorschriften zu diesen Komplexen vor. Die gesetzlichen Bestimmungen und die praktische Durchführung werden übersichtlich dargestellt.