Antibiotic failure in a renal transplant patient with Rhodococcus equi infection: an indication for surgical lobectomy

Rhodococcus equi is an animal pathogen that causes infrequent but challenging infections in immunocompromised individuals, few of which have been described in solid organ transplant recipients. Common clinical presentations include indolent cough, fever, and dyspnea, with necrotizing pneumonia and cavitation. We report a case of a dense right upper lung pneumonia with resultant R. equi bacteremia in a renal transplant recipient. Our patient initially responded to antibiotic treatment with resolution of bacteremia and clinical recovery, followed by interval progression in her right upper lobe consolidation on follow-up computed tomography scans. She underwent lobectomy for definitive therapy with resolution of symptoms. Lobectomy can be utilized in isolated infection after antibiotic failure with excellent clinical outcomes.

Correlation of the volume of ectopic pregnancy and MTX therapy outcome: a retrospective cohort study

OBJECTIVE

To investigate a possible correlation between the volume of the tubal ectopic pregnancy (EP) measured by vaginal-ultrasound (VUS) and methotrexate (MTX) therapy outcome.

STUDY DESIGN

Data of EP volume measured by one expert-sonographer, viability, clinical symptoms, previous IVF/insemination, follow-up of β-hCG and progesterone levels, and treatment of EP was collected of 100 patients with sonographically diagnosed EP, who attended the Department of Obstetrics and Gynecology of the Medical University Vienna between March 2008 and September 2011.

RESULTS

The mean volume of EP (mVol.) in the group with successful MTX therapy (n = 38) was 5.11 ml, 95%CI [2.4; 7.8] with a median 3.2 ml, IQR [5.0], in the group with unsuccessful MTX treatment (n = 11) it was 15.24 ml, 95%CI [-2.6; 33.1], with a median 4.4 ml, IQR [11.4]. We could observe a trend towards a lower mVol. in the successful MTX group (5.11 ml vs. 15.24 ml). We could not show a significant correlation (u-test p = 0.208).

CONCLUSION

A clear tendency was observed towards a lower mVol. in the successful MTX therapy group, but we could not verify a statistically significant correlation of volume of EP and MTX therapy outcome most likely due to the small sample size. This was the first study investigating the correlation of volume of EP and MTX therapy outcome as principal question.

Cost-efficient delay generator for fast terahertz imaging

We present a fast and low-cost delay generator for terahertz (THz) waves that transfers a rotational motion of a transparent dielectric cube into an effective THz delay. The device is easily implemented in the THz beam path and allows for coherent sampling over 40 ps with a scan rate of hundreds of hertz. Furthermore, we show that our approach is particularly suitable for fast THz imaging.

Successful clinical and organisational change in endodontic practice: a qualitative study

The aim of this study was to explicate and describe the qualitative meaning of successful clinical and organizational change in endodontic practice, following a comprehensive implementation program, including the integration of the nickel-titanium-rotary-technique. After an educational intervention in the Public Dental Service in a Swedish county, thematic in-depth interviews were conducted, with special reference to the participants' experience of the successful change. Interviews with four participants, were purposively selected on the basis of occupation (dentist, dental assistant, receptionist, clinical manager), for a phenomenological human scientific analysis. Four constituents were identified as necessary for the invariant, general structure of the phenomenon: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator. The perceived requirements for achieving successful clinical and organizational change in endodontic practice were clinical relevance, an atmosphere which facilitated discussion and allowance for individual learning patterns. The qualities required in the educator were acknowledged competence with respect to scientific knowledge and clinical expertise, as well as familiarity with conditions at the dental clinics. The results indicate a complex interelationship among various aspects of the successful change process.

Molecular and cellular regulation of hypothalamic melanocortin neurons controlling food intake and energy metabolism

The brain receives and integrates environmental and metabolic information, transforms these signals into adequate neuronal circuit activities, and generates physiological behaviors to promote energy homeostasis. The responsible neuronal circuitries show lifetime plasticity and guaranty metabolic health and survival. However, this highly evolved organization has become challenged nowadays by chronic overload with nutrients and reduced physical activity, which results in an ever-increasing number of obese individuals worldwide. Research within the last two decades has aimed to decipher the responsible molecular and cellular mechanisms for regulation of the hypothalamic melanocortin neurons, which have a key role in the control of food intake and energy metabolism. This review maps the central connections of the melanocortin system and highlights its global position and divergent character in physiological and pathological metabolic events. Moreover, recently uncovered molecular and cellular processes in hypothalamic neurons and glial cells that drive plastic morphological and physiological changes in these cells, and account for regulation of food intake and energy metabolism, are brought into focus. Finally, potential functional interactions between metabolic disorders and psychiatric diseases are discussed.

Untersuchungen über die Abhängigkeit optischer Eigenschaften der Desoxyribonukleinsäure (DNS) von ihrem Salzgehalt

Es wurden Schmelzkurven sowie ORD- und ZD-Spektren von DNS-Lösungen verschiedenen Salzgehaltes gemessen. In Übereinstimmung mit den aus der Literatur bekannten Daten wurde mit abnehmendem Salzgehalt eine Destabilisierung der DNS-Doppelhelix gefunden, die Doppelstrangstruktur und die Basenaufstockung bleiben jedoch weitgehend erhalten. Die Doppelstrangstruktur wird bei niedrigen Ionenstärken erst nach thermischer oder Säuredenaturierung zerstört. Die Basenaufstockung wird dabei ebenfalls reduziert. Hohe Salzkonzentrationen (4,5 ᴍ NaCl) bewirken Strangtrennungen und ungeordnete Basendesorientierungen. Ein Vergleich der Absorptions-, ORD- und ZD-Daten zeigt, daß die Art der Konformationsänderungen von der Art der äußeren Einwirkungen abhängt

On the Insertion Reactions of CH2(ã1A1) in to Some Element-Hydrogen Bonds

Absolute values for the removal rates of CH2(ã1A1) by NH3, CH3NH2, CH3OH, HCl, and HF have been determined in the gas phase at low pressures and room temperature. CH2(ã1A1) was generated by pulsed laser photolysis of CH2CO. The measurements were carried out by observing the laser induced fluorescence of 1CH2 after excitation by a pulsed laser as a function of the time delay between the photolysis and analysis pulses. The overall rate constants were found to be 2.4, 2.4, 2.3, 1.6 and 0.13 · 1014 cm3/mol s, respectively.

NH2 was shown by LIF detection to be a primary product of the reaction of 1CH2 with NH3. The intersystem crossing channel of 1CH2 was investigated by monitoring the formation of CH2(X̃3B1) with laser magnetic resonance. LMR absorption intensities of 3CH2 resulting from quenching of 1CH2 in the presence and absence of the reactant R were compared under otherwise identical conditions. The branching ratios of quenching versus total removal of 1CH2, turned out to be 0.30, 0.13 and 0.98 for NH3, CH3OH, and HF, respectively.

Randomized clinical trial of stapler versus clamp-crushing transection in elective liver resection

BACKGROUND

Various devices have been developed to facilitate liver transection and reduce blood loss in liver resections. None of these has proven superiority compared with the classical clamp-crushing technique. This randomized clinical trial compared the effectiveness and safety of stapler transection with that of clamp-crushing during open liver resection.

METHODS

Patients admitted for elective open liver resection between January 2010 and October 2011 were assigned randomly to stapler transection or the clamp-crushing technique. The primary endpoint was the total amount of intraoperative blood loss. Secondary endpoints included transection time, duration of operation, complication rates and resection margins.

RESULTS

A total of 130 patients were enrolled, 65 to clamp-crushing and 65 to stapler transection. There was no difference between groups in total intraoperative blood loss: median (i.q.r.) 1050 (525-1650) versus 925 (450-1425) ml respectively (P = 0·279). The difference in total intraoperative blood loss normalized to the transection surface area was not statistically significant (P = 0·092). Blood loss during parenchymal transection was significantly lower in the stapler transection group (P = 0·002), as were the parenchymal transection time (mean(s.d.) 30(21) versus 9(7) min for clamp-crushing and stapler transection groups respectively; P < 0·001) and total duration of operation (mean(s.d.) 221(86) versus 190(85) min; P = 0·047). There were no significant differences in postoperative morbidity (P = 0·863) or mortality (P = 0·684) between groups.

CONCLUSION

Stapler transection is a safe technique but does not reduce intraoperative blood loss in elective liver resection compared with the clamp-crushing technique.

REGISTRATION NUMBER

NCT01049607 (http://www.clinicaltrials.gov).

Preparation of 13C-labelled cis-zearalenone and its application as internal standard in stable isotope dilution analysis

Pure U-[13C18]-labelled cis-zearalenone (cis-ZEA) has been prepared and characterised as internal standard (ISTD) for a reliable quantification of cis-ZEA in contaminated food and feed products. The cis-isomer of the naturally trans-configurated Fusarium mycotoxin zearalenone is often neglected. However, isomerisation easily occurs by exposure of ZEA to (UV-)light. Thus, the applicability of the new cis-ZEA ISTD was demonstrated in a long-term isomerisation study comparing naturally trans-ZEA-contaminated edible oil with spiked edible oil. To estimate the benefits of the newly prepared cis-ZEA ISTD, various approaches to quantify cis-ZEA by high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) were compared. As a result, a significant bias was revealed if no appropriate cis-ZEA standards are used. Furthermore, the new ISTD was applied to the analysis of 15 edible oils by stable isotope dilution analysis in combination with HPLC-electrospray ionisation-MS/MS. One of the maize germ oils showed the presence of cis-ZEA above LOD (≯0.3 μg/kg), whereas two out of 15 maize germ oils were found to be contaminated with trans-ZEA (range 17.0-31.0 μg/kg).

The tumor suppressor gastrokine-1 is expressed in placenta and contributes to the regulation of trophoblast migration

INTRODUCTION

Gastrokine-1 (GKN1) is a secreted auto-/paracrine protein, described to be expressed in the gastric mucosa. In gastric cancers GKN1 expression is commonly down-regulated. While current research focusses on the exploration of tumor-suppressive properties of GKN1 with regard to its potential clinical use in the treatment of gastroenterologic tumor disease, nothing is known about GKN1 expression and function in other organ systems. We investigated GKN1 expression in placental tissue and cells.

MATERIALS AND METHODS

GKN1 was localized using immunohistochemistry in first and third trimester placental tissue, hydatidiform moles and various gestational trophoblastic neoplasias. We determined the expression of GKN1 in immunomagnetic bead-separated term placental cells and in choriocarcinoma cell lines. The role of GKN1 for JEG-3 migration was studied using live cell imaging. E-cadherin, MMP-2 and -9, TIMP-1 and -2, as well as urokinase (uPA) expression levels were determined.

RESULTS

GKN1 is expressed in healthy third trimester placentas. Its expression is specifically limited to the extravillous trophoblast (EVT). GKN1 expression is significantly reduced in choriocarcinoma cell lines and gestational trophoblastic neoplasias. GKN1 attenuates the migration of JEG-3 choriocarcinoma cells in vitro, possibly via AKT-mediated induction of E-cadherin. GKN1 treatment reduced MMP-9 expression in JEG-3.

DISCUSSION

Besides its role in gastric physiology our results clearly indicate regulatory functions of GKN1 in the EVT at the feto-maternal interface during pregnancy. Based on our findings in the JEG-3 choriocarcinoma cell line, an auto-/paracrine role of GKN1 for EVT motility and villous anchorage at the basal plate is conceivable. Thus, the tumor suppressor GKN1 is expressed in placental EVT and might contribute to the regulation of EVT migration/invasion.

Isogeneic MSC application in a rat model of acute renal allograft rejection modulates immune response but does not prolong allograft survival

Application of mesenchymal stromal cells (MSCs) has been proposed for solid organ transplantation based on their potent immuno-modulatory effects in vitro and in vivo. We investigated the potential of MSCs to improve acceptance of kidney transplants in an MHC-incompatible rat model including isogeneic kidney transplantation (RTx) as control. MSCs were administered i.v. or i.a. at time of transplantation. No immunosuppression was applied. Renal function was monitored by serum-creatinine, histopathology, immunochemistry for graft infiltrating cells and expressions of inflammatory genes. We demonstrated the short-term beneficial effects of MSC injection. In the long term, however, MSC-related life-threatening/shortening events (thrombotic microangiopathy, infarctions, infections) were evident despite decreased T- and B-cell infiltration, lower interstitial inflammation and downregulated inflammatory genes particularly after i.a. MSC injection. We conclude that i.a. MSC administration provides efficient immunomodulation after allogeneic RTx, although timing and co-treatment strategies need further fine-tuning to develop the full potential of powerful cell therapy in solid organ transplantation.

Terahertz plastic compound lenses

We present terahertz (THz) lenses made of highly refracting polymeric compounds which provide a better focusing performance and an increased functionality in comparison to conventional THz lenses. Using mixtures consisting of polypropylene (PP) and alumina as well as PP and zinc sulfide allows a significant increase of the refractive index while simultaneously keeping a low extinction and dispersion. With these new material combinations, lenses with an increased focusing capability are realized. This is evaluated by focal plane measurements using a fiber coupled THz time-domain spectrometer.