Recommendations for stereotactic body radiation therapy for spine and non-spine bone metastases. A GETUG (French society of urological radiation oncolgists) consensus using a national two-round modified Delphi survey

Background and purpose

The relevance of metastasis-directed stereotactic body radiation therapy (SBRT) remains to be demonstrated through phase III trials. Multiple SBRT procedures have been published potentially resulting in a disparity of practices. Therefore, the french society of urological radiation oncolgists (GETUG) recognized the need for joint expert consensus guidelines for metastasis-directed SBRT in order to standardize practice in trials carried out by the group.

Materials and methods

After a comprehensive literature review, 97 recommendation statements were created regarding planning and delivery of spine bone (SBM) and non-spine bone metastases (NSBM) SBRT. These statements were then submitted to a national online two-round modified Delphi survey among main GETUG investigators. Consensus was achieved if a statement received ≥ 75 % agreements, a trend to consensus being defined as 65-74 % agreements. Any statement without consensus at round one was re-submitted in round two.

Results

Twenty-one out of 29 (72.4%) surveyed experts responded to both rounds. Seventy-five statements achieved consensus at round one leaving 22 statements needing a revote of which 16 achieved consensus and 5 a trend to consensus. The final rate of consensus was 91/97 (93.8%). Statements with no consensus concerned patient selection (3/19), dose and fractionation (1/11), prescription and dose objectives (1/9) and organs at risk delineation (1/15). The voting resulted in the writing of step-by-step consensus guidelines.

Conclusion

Consensus guidelines for SBM and NSBM SBRT were agreed upon using a validated modified Delphi approach. These guidelines will be used as per-protocole recommendations in ongoing and further GETUG clinical trials.

The state of the art in beyond 5G distributed massive multiple-input multiple-output communication system solutions

Beyond fifth generation (5G) communication systems aim towards data rates in the tera bits per second range, with improved and flexible coverage options, introducing many new technological challenges in the fields of network architecture, signal pro- cessing, and radio frequency front-ends. One option is to move towards cell-free, or distributed massive Multiple-Input Multiple-Output (MIMO) network architectures and highly integrated front-end solutions. This paper presents an outlook on be- yond 5G distributed massive MIMO communication systems, the signal processing, characterisation and simulation challenges, and an overview of the state of the art in millimetre wave antennas and electronics.

Exploratory real-time kinetic analysis of the cytotoxicity induced by maize silage mycotoxins in a calf intestinal epithelial cell line

In a temperate climate, the mycotoxins deoxynivalenol (DON), nivalenol (NIV), enniatin B (ENN B), mycophenolic acid (MPA), roquefortine C (ROC) and zearalenone (ZEN) are often found in maize silage. Although rumen microbiota are able to degrade some mycotoxins (e.g. DON), others are known to stay mainly intact (e.g. ROC). In addition, mycotoxin degradation can be hampered by a low ruminal pH or decrease in rumen microbial activity. Hence, these mycotoxins can reach the small intestine and exert a cytotoxic effect on intestinal epithelial cells. In this study, a real-time kinetic analysis of the cytotoxicity of these six mycotoxins and some of their metabolites (α- and β-zearalenol, α- and β-ZOL) was performed in a calf small intestinal epithelial cell line (CIEB). Confluency as well as the cell death parameters apoptosis and necrosis were determined to evaluate the mycotoxin-induced cytotoxicity. A combination of Annexin-V green and Cytotox red staining was used to determine early and late apoptosis as well as necrosis. Six different concentrations were tested ranging from 0.78 to 12.5 μM. Compared to cells not exposed to mycotoxins, DON and NIV exert a fast toxic effect with DON being more toxic than NIV within the first hours of incubation, whereas the inverse was observed at 16 h of incubation. On the other hand, MPA and ZEN induced increased Annexin V green positive cells within several hours of incubation with higher toxicity over time. Increased Annexin V green and Cytotox red positive cells were seen for ROC only at the highest concentration tested. For ENN B, increased Annexin V green positive cells were observed only after 12 h and α- and β-ZOL did not show cytotoxic effects. Hence, mycotoxin exposure causes either severe (DON and NIV) or more limited (ZEN, ROC, MPA, and ENN B) risk of bovine intestinal epithelial damage.

Bidirectional reflectance measurement of tungsten samples to assess reflection model in WEST tokamak

This paper presents the measurement of the bidirectional reflectance distribution function of tungsten (W) samples and the resulting reflection models in the nuclear fusion device WEST (tokamak). For this, an experimental gonio-spectrophotometer was developed to fully characterize the material's optical and thermal-radiative properties of metallic samples with different roughnesses. Ray-tracing photonic simulation was then carried out to predict the photon behavior in a fully metallic environment as a function of reflectance measurement. Low emissivity (0.1 at 4 μm) and highly specular reflectance (fitting with a Gaussian distribution around the specular direction with a small width lower than 10°) are found for W samples. These measurements have been used as input for the photonic simulation, and the resulting synthetic image reproduced the reflection features well on the upper divertor, detected in WEST infrared experimental images.

Detection of osteoarthritis in dogs by metabolic, pro-inflammatory and degenerative synovial fluid biomarkers and traditional radiographic screening: A pilot study

Secondary osteoarthritis (OA) is a slow progressive, common disorder of synovial joints in dogs. It is characterized by a loss of balance between the synthesis and degeneration of articular cartilage components. Its diagnosis is currently based on the presence of clear radiographic changes, which only occur in the later stages of the disease. Hence, early diagnosis of OA remains a major problem. Therefore, interest in synovial fluid (SF) biomarkers has emerged. Besides pro-inflammatory and degenerative markers, i.e. tumor necrosis factor alpha (TNF-alpha), interleukin-1beta (IL-1beta), tenascin-c (TN-C) and matrix metalloproteinase-2 (MMP-2), metabolic parameters, i.e. pH, glucose and lactate, can potentially be used to detect OA. The current study demonstrated statistically significant differences in the SF levels of pH, glucose and lactate between OA-affected and normal joints. In addition, the in-house validated immuno-assays for TNF-alpha, IL-1beta, TN-C and MMP-2 allowed to demonstrate also statistically significant differences in the SF concentrations for all these biomarkers - except TNF-alpha - between OA-affected and normal joints. However, no correlation was found between any of these biomarkers and the currently used radiographic scoring system for OA in dogs. Future research is warranted to explore the potential of these biomarkers in the early detection of OA and in the severity characterization of this disease.

Serum hyaluronic acid, a marker for improved liver perfusion after gradual surgical attenuation of extrahepatic portosystemic shunt closure in dogs

Current liver function tests used in dogs do not consistently normalise after successful surgical attenuation of portosystemic shunts (PSS). Serum hyaluronic acid (sHA) concentrations in dogs with PSS are reported to be higher at diagnosis than in healthy dogs. The objective of this study was to assess sHA as a marker of liver perfusion by measuring sHA concentrations in dogs before and after gradual surgical attenuation of extrahepatic (EH)PSS and by determining whether sHA concentrations could differentiate closed EHPSS from persistent shunting. Specificity of sHA was assessed by comparing sHA concentrations in dogs with EHPSS to those in dogs with other liver diseases. Twenty dogs with EHPSS had sHA concentrations measured at diagnosis, 1, 3, and 6 months postoperatively. In addition, sHA concentrations were determined in 10 dogs with other liver diseases. At EHPSS diagnosis, median sHA concentration was 335.6 ng/mL (43.0-790.7 ng/mL). All dogs had a significant decrease in sHA concentrations from 1 month postoperatively onwards (P < 0.05), regardless of surgical outcome. At all postoperative follow-up visits, there was a significant difference between the median sHA concentration in dogs with closed EHPSS vs. those with persistent shunting (P < 0.05). Median sHA concentration in dogs with other liver diseases was 89.8 ng/mL (22.9-160.0 ng/mL), which was significantly lower than dogs with EHPSS at diagnosis (P < 0.001). In conclusion, sHA is a promising non-invasive biomarker that can help to determine liver perfusion after surgical attenuation of EHPSS. In addition, sHA could potentially be used to differentiate dogs with EHPSS from dogs with other liver diseases.

Motivational Interviewing for the control of type 2 diabetes mellitus and arterial hypertension

Background

Motivational Interviewing (MI) has been effective in promoting positive changes in various health-related behaviors, including chronic disease management. The main goal of this study was evaluating the effectiveness of this care technology in individual nursing consultations for the control of type 2 Diabetes Mellitus (2DM) and Arterial Hypertension (AH) in primary healthcare.

Methods

Double-blind, controlled, parallel randomized clinical trial conducted in Porto Alegre, Rio Grande do Sul - Brazil, from June 2018 to July 2019. The study subjects suffered from 2DM with associated diagnosis of AH and were randomized individually to the Test/MI Group and Control Group. The Test Group was subjected to an MI-based nursing consultation intervention with a professional who had been trained for 20 hours, while the Control Group received conventional nursing consultation. The variables were collected in order to measure the main glycated hemoglobin and blood pressure outcomes, and for the secondary adherence outcome.

Results

After an average follow-up of 6 months, 175 patients completed the study. There was a significant difference between the groups with improvement in the Test/MI group for the outcomes Systolic Blood Pressure - SBP (p &lt; 0.01), Diastolic Blood Pressure - DBP (p &lt; 0.01), Total Adherence Score in Martín-Bayarre-Grau Questionnaire (p = 0.011) and their dimensions 'Treatment compliance' and 'Personal implication' (p = 0.033; p = 0.031). The blood pressure levels of the patients who received the Motivational Interviewing Intervention showed a significant mean reduction of 15.2 mmHg in SBP and 6.4 mmHg in DBP, compared to the control group. The Test group also showed a significant average intragroup reduction of 0.5% in HbA1c at the completion of the study (p &lt; 0.01).

Conclusions

It is concluded that the MI-based nursing consultation was effective in improving clinical control and adherence in diabetic and hypertensive patients in primary healthcare.

Key messages

MI-based nursing consultation is effective in reducing pressure and glycemic levels in primary healthcare. The MI improves adherence levels in diabetic and hypertensive patients.

Effect of subinhibitory exposure to quaternary ammonium compounds on the ciprofloxacin susceptibility of Escherichia coli strains in animal husbandry

BACKGROUND

Quaternary ammonium compound based disinfectants are commonly used in pig and poultry husbandry to maintain farm hygiene. However, studies have shown that subinhibitory concentrations of these disinfectants may increase antibiotic resistance. Investigation of antibiotic susceptibility is usually assessed via the microbroth dilution method, although this conventional culture-based technique only provides information on the bacteriostatic activity of an antimicrobial agent. Therefore, experiments were performed to investigate the effect of prior benzalkonium chloride (BKC) exposure on the viability of subsequent ciprofloxacin (CIP) treated Escherichia coli.

RESULTS

Following CIP treatment, bacterial cell counts were significantly higher after exposure to a subinhibitory BKC concentration than without BKC exposure. The flow cytometric results suggested a BKC-dependent onset of membrane damage and loss of membrane potential.

CONCLUSION

Our results indicate a lower bactericidal effect of CIP treatment on BKC-exposed E. coli isolates compared to unexposed E. coli isolates.

Repeated disinfectant use in broiler houses and pig nursery units does not affect disinfectant and antibiotic susceptibility in Escherichia coli field isolates

BACKGROUND

Disinfectants are frequently used in animal production to reduce or eliminate the load of infectious agents and parasites in buildings and equipment associated with the housing or transportation of animals. There are growing concerns that the use of disinfectants would select for resistance to antibiotics and disinfectants. The aim of this study was to determine the effect of repeated use of different disinfectants on the disinfectant and antibiotic susceptibility under practical conditions in a broiler and pig pilot farm. Therefore, the susceptibility of Escherichia coli (E. coli) to 14 antibiotics and 4 disinfectants was monitored over a one-year period.

RESULTS

High (20-50%) to very high (> 50%) resistance levels for ampicillin, sulfamethoxazole, trimethoprim and tetracycline were observed in both animal production types. Disinfectant susceptibility did not change over time and did not depend on the used disinfection product. Compared to in-use concentrations of formaldehyde, benzalkoniumchloride and a peracetic acid - hydrogen peroxide formulation, all E. coli strains remained susceptible indicating that the use of disinfectants did not select for disinfectant resistance. Moreover, no association could be found between the use of disinfectants and antibiotic resistance.

CONCLUSIONS

These findings suggest that repeated use of disinfectants in agricultural environments does not select for antibiotic resistance nor does it reduce disinfectant susceptibility.

Evaluation of acute kidney injury in dogs with complicated or uncomplicated Babesia rossi infection

Dogs with babesiosis can present with multiple complications, including acute kidney injury (AKI). The objective of this study was to characterize AKI in dogs with babesiosis caused by Babesia rossi at presentation and after treatment. Thirty-five client-owned dogs with B. rossi infection and 10 control dogs were included in this prospective observational study. Blood and urine were collected in Babesia-infected dogs at presentation (T₀, n = 35), after 24 h (T_24h, n = 11), and after 1 month (T_1m, n = 9). The following urinary kidney injury biomarkers were assessed: urinary protein to creatinine ratio (UPC), urinary glomerular injury biomarkers (immunoglobulin G (uIgG) and C-reactive protein (uCRP)), and urinary tubular injury biomarkers (retinol-binding protein (uRBP) and neutrophil gelatinase-associated lipocalin (uNGAL)). Serum functional renal biomarkers were creatinine (sCr) and symmetric dimethylarginine (sSDMA). Post-mortem kidney biopsies were analyzed by light and transmission electron microscopy. At T₀, all kidney injury biomarkers were significantly higher in Babesia-infected dogs compared to healthy controls (P < 0.001), while functional renal biomarkers were not significantly different (P > 0.05). At T_24h, all urinary tubular injury biomarkers and UPC decreased significantly (P < 0.01), while glomerular injury biomarkers did not (P = 0.084). At T_1m, all urinary kidney injury biomarkers decreased to values not significantly different from healthy controls (P > 0.5). Significant changes in functional renal biomarkers were not seen after treatment (P > 0.05). Dogs with complicated babesiosis had significantly higher glomerular injury biomarkers, UPC, and sSDMA compared to uncomplicated cases (P < 0.05), while all tubular injury biomarkers and sCr were not significantly different (P > 0.1). Dogs with babesiosis caused by B. rossi showed transient kidney injury, which was detected by all kidney injury biomarkers, but remained undetected by functional biomarkers. All infected dogs, irrespective of disease severity, suffered comparable kidney injury based on tubular injury biomarker concentrations, while loss of function was seen more often in dogs with complicated babesiosis based on sSDMA results.

139 Heat stress has a deleterious effect on bull semen quality and subsequent embryo development

High ambient temperature induces an increase in bovine body temperature above the physiological homeothermic point, leading to impaired reproductive performance. Belgian Blue bulls are more susceptible to heat stress compared with most other cattle breeds. Therefore, the aim of this study was to investigate whether high ambient temperature affected bull semen quality and subsequent embryo development. For this purpose, semen samples were collected from six Belgian Blue bulls during August (14-28 days after three consecutive warm days with temperature-humidity index between 63.8 and 83.7) and March 2016 (temperature-humidity index between 35.9 and 47.4). After semen collection, volume, sperm concentration, and motility of fresh semen were assessed. Furthermore, frozen sperm samples were used to assess the motion parameters and morphological abnormalities using computer-assisted sperm analysis, viability and reactive oxygen species (hydrogen peroxide and superoxide) production using flow cytometry, and acrosome integrity and chromatin condensation using fluorescence microscopy. Afterward, blastocysts were produced (r=4) by conventional invitro methods for assessment of embryo development (Wydooghe et al. 2014 Reprod. Fertil. Dev. 26, 717-724; https://doi.org/10.1071/RD13043). Cleavage rate was determined 48h after fertilisation, and the blastocyst rates were determined on Days 7 and 8 postinsemination. Moreover, Day 8 blastocysts underwent differential staining in order to determine the numbers of the inner cell mass, trophectoderm, total cell number, and apoptotic cells ratio. The data set was analysed using the GLM procedure of SAS (SAS Institute Inc.). Normal distribution was checked using the UNIVARIATE procedure, and the Shapiro-Wilk test and arcsine square root transformation were used when required. Furthermore, Duncan's test was applied to determine the significant differences (P=0.05). In fresh semen, samples from the non-heat-stressed (NHS) group showed a higher sperm concentration compared with samples from the heat-stressed (HS) group (P=0.05), whereas semen volume and motility were not affected by heat stress (P&gt;0.05). In frozen-thawed semen, total and progressive motility and straight-line velocity were lower in the HS group compared with the NHS group (P=0.05), whereas the generation of H2O2, percentages of aberrant chromatin condensation, total morphological abnormality, spermatozoa with bent tails, and distal protoplasmic droplets were higher in the HS group compared with the NHS group (P=0.05). The cleavage rate and blastocyst rates on Days 7 and 8 were higher (P=0.05) in the NHS group (70.4±1.13, 25.4±1.84, and 40.3±1.15, respectively) compared with the HS group (62.8±1.49, 15.4±1.56, and 23.3±1.84, respectively). However, there were no significant differences in hatched or hatching rate of two treatments (P&gt;0.05). The total cell number and trophectoderm were higher in NHS-derived blastocysts than in HS-derived blastocysts (P=0.05), whereas the apoptotic cells ratio was lower (P&lt;0.001) in NHS blastocysts (2.16±0.48% vs. 5.21±0.52%). In conclusion, these findings show that elevated ambient temperature during summer as a consequence of climate change can lead to decreased quality of fresh and frozen-thawed bull spermatozoa and subsequent embryo development.

Mechanical dissipation via image potential states on a topological insulator surface

Joule energy loss due to resistive heating is omnipresent in today's electronic devices whereas quantum-mechanical dissipation is largely unexplored. Here, we experimentally observe a suppression of the Joule dissipation in Bi₂Te₃ due to topologically protected surface states. Instead, a different type of dissipation mechanism is observed by pendulum atomic force microscopy, which is related to single-electron tunnelling resonances into image potential states that are slightly above the Bi₂Te₃ surface. The application of a magnetic field leads to the breakdown of the topological protection of the surface states and restores the expected Joule dissipation process. Nanomechanical energy dissipation experienced by the cantilever of the pendulum atomic force microscope provides a rich source of information on the dissipative nature of the quantum-tunnelling phenomena on the topological insulator surface, with implications for coupling a mechanical oscillator to the generic quantum material.

A Langevin equation that governs the irregular stick-slip nano-scale friction

Friction force at the nanoscale, as measured from the lateral deflection of the tip of an atomic force microscope, usually shows a regular stick-slip behavior superimposed by a stochastic part (fluctuations). Previous studies showed the overall fluctuations to be correlated and multi-fractal, and thus not describable simply by e.g. a white noise. In the present study, we investigate whether one can extract an equation to describe nano-friction fluctuations directly from experimental data. Analysing the raw data acquired by a silicon tip scanning the NaCl(001) surface (of lattice constant 5.6 Å) at room temperature and in ultra-high vacuum, we found that the fluctuations possess a Markovian behavior for length scales greater than 0.7 Å. Above this characteristic length, the Kramers-Moyal approach applies. However, the fourth-order KM coefficient turns out to be negligible compared to the second order coefficients, such that the KM expansion reduces to the Langevin equation. The drift and diffusion terms of the Langevin equation show linear and quadratic trends with respect to the fluctuations, respectively. The slope 0.61 ± 0.02 of the drift term, being identical to the Hurst exponent, expresses a degree of correlation among the fluctuations. Moreover, the quadratic trend in the diffusion term causes the scaling exponents to become nonlinear, which indicates multifractality in the fluctuations. These findings propose the practical way to correct the prior models that consider the fluctuations as a white noise.

Exposure of ciprofloxacin-resistant Escherichia coli broiler isolates to subinhibitory concentrations of a quaternary ammonium compound does not increase antibiotic resistance gene transfer

Resistance to antibiotics threatens to become a worldwide health problem. An important attributing phenomenon in this context is that pathogens can acquire antibiotic resistance genes through conjugative transfer of plasmids. To prevent bacterial infections in agricultural settings, the use of veterinary hygiene products, such as disinfectants, has gained popularity and questions have been raised about their contribution to such spreading of antibiotic resistance. Therefore, this study investigated the effect of subinhibitory concentrations of benzalkoniumchloride (BKC), a quaternary ammonium compound (QAC), on the conjugative transfer of antibiotic resistance genes. Five Escherichia coli field strains originating from broiler chickens and with known transferable plasmid-mediated ciprofloxacin resistance were exposed to subinhibitory BKC concentrations: 1/3, 1/10 and 1/30 of the minimum bactericidal concentration. Antibiotic resistance transfer was assessed by liquid mating for 4 h at 25°C using E. coli K12 MG1655 as recipient strain. The transfer ratio was calculated as the number of transconjugants divided by the number of recipients. Without exposure to BKC, the strains showed a ciprofloxacin resistance transfer ratio ranging from 10-4 to 10-7. No significant effect of exposure to subinhibitory concentrations of BKC was observed on this transfer ratio.

Correction to: Spectrum of movement disorders and neurotransmitter abnormalities in paediatric POLG disease

Due to a typesetting error the wrong Table 2 was used. The correct Table 2 is shown here.

Spectrum of movement disorders and neurotransmitter abnormalities in paediatric POLG disease

OBJECTIVES

To describe the spectrum of movement disorders and cerebrospinal fluid (CSF) neurotransmitter profiles in paediatric patients with POLG disease.

METHODS

We identified children with genetically confirmed POLG disease, in whom CSF neurotransmitter analysis had been undertaken. Clinical data were collected retrospectively. CSF neurotransmitter levels were compared to both standardised age-related reference ranges and to non-POLG patients presenting with status epilepticus.

RESULTS

Forty-one patients with POLG disease were identified. Almost 50% of the patients had documented evidence of a movement disorder, including non-epileptic myoclonus, choreoathetosis and ataxia. CSF neurotransmitter analysis was undertaken in 15 cases and abnormalities were seen in the majority (87%) of cases tested. In many patients, distinctive patterns were evident, including raised neopterin, homovanillic acid and 5-hydroxyindoleacetic acid levels.

CONCLUSIONS

Children with POLG mutations can manifest with a wide spectrum of abnormal movements, which are often prominent features of the clinical syndrome. Underlying pathophysiology is probably multifactorial, and aberrant monoamine metabolism is likely to play a role.

Assessment of acute kidney injury in canine parvovirus infection: Comparison of kidney injury biomarkers with routine renal functional parameters

Dogs with naturally occurring canine parvovirus (CPV) infection are at risk of developing acute kidney injury (AKI) due to several factors, including severe dehydration, hypotension and sepsis. Serum creatinine (sCr) and serum urea are insensitive markers for the assessment of early kidney injury. Therefore, the aim of this study was to investigate potential kidney injury in dogs with CPV infection using both routine renal functional parameters and several kidney injury biomarkers. Twenty-two dogs with CPV infection were prospectively enrolled and compared with eight clinically healthy control dogs. Urinary immunoglobulin G (uIgG) and C-reactive protein (uCRP) were measured to document glomerular injury, whereas urinary retinol-binding protein (uRBP) and neutrophil gelatinase-associated lipocalin (uNGAL) served as markers for tubular injury. These biomarkers were compared to routine renal functional parameters, including sCr, serum urea, urinary protein:creatinine ratio (UPC) and urine specific gravity (USG). Dogs with CPV infection had significantly higher concentrations of uIgG, uCRP, uRBP and uNGAL compared to healthy dogs. In contrast, sCr was significantly lower in dogs with CPV infection compared to controls, while serum urea was not significantly different. UPC and USG were both significantly higher in CPV-infected dogs. This study demonstrated that dogs with CPV infection had evidence of AKI, which remained undetected by the routine functional markers sCr and serum urea, but was revealed by UPC, uIgG, uCRP, uRBP and uNGAL. These results emphasize the added value of novel urinary kidney injury biomarkers to detect canine patients at risk of developing AKI.

Variability of serum concentrations of cystatin C and urinary retinol-binding protein, neutrophil gelatinase-associated lipocalin, immunoglobulin G, and C-reactive protein in dogs

Background

Markers of kidney dysfunction and damage have potential to detect chronic kidney disease (CKD) in early stages. However, data on long‐term variation of these markers in healthy dogs is lacking and is crucial for the interpretation of results.

Hypothesis/Objectives

To determine temporal variations of serum cystatin C (sCysC) and urinary retinol‐binding protein (uRBP), neutrophil gelatinase‐associated lipocalin (uNGAL), immunoglobulin G (uIgG), and C‐reactive protein (uCRP) in healthy dogs.

Animals

Eight clinically healthy adult Beagles were evaluated.

Methods

Longitudinal observational study. Serum cystatin C was determined by particle‐enhanced nephelometric immunoassay. Urinary retinol‐binding protein, uNGAL, uIgG and uCRP were determined by ELISA and concentrations were indexed to urinary creatinine. Within‐ and between‐dog variance components (VC) and within‐dog coefficients of variation (CV) were determined from blood and urine collected at eight time points over 1.5 years.

Results

Urinary C‐reactive protein (uCRP) concentrations were consistently below the detection limit (5.28 ng/mL). Mean ± within‐dog standard deviation for sCysC, uRBP/c, uNGAL/c and uIgG/c was 0.15 ± 0.01 mg/L, 0.09 ± 0.03 mg/g, 2.32 ± 2.03 μg/g and 12.47 ± 10.98 mg/g, respectively. Within‐dog CV for sCysC, uRBP/c, uNGAL/c and uIgG/c was 8.1%, 33.7%, 87.2% and 88.1%, respectively.

Conclusions and clinical importance

Serum cystatin C, uRBP/c, uNGAL/c and uIgG/c exhibit a wide range of long‐term within‐dog variability. Researchers and veterinarians might need to take this into account when interpreting their results. To assess their diagnostic and predictive ability, future studies need to establish reference ranges for healthy dogs and dogs with CKD.

Potential therapeutic application of bacteriophages and phage-derived endolysins as alternative treatment of bovine mastitis

The increase in bacterial drug resistance causes major difficulties in the clinical treatment of a growing number of bacterial infections worldwide. Consequently, there is an urgent need to develop novel anti-bacterial agents to control these resistant pathogens and to complement the currently used antibiotics. Mastitis is the most prevalent disease impacting dairy cattle, and therefore one of the costliest diseases in the global dairy industry. The excessive use of curative as well as preventive antibiotics in this sector entails a real risk for the emergence of antimicrobial resistance. Moreover, these traditional antimicrobial agents are often ineffective and lead to residues in the milk, which can affect dairy product consumers. As an alternative therapeutic approach, bacteriophages and phage-encoded endolysins have been proposed and are currently (re)investigated as potential antibacterial agents against mastitis.

Evaluation of the hygienogram scores and related data obtained after cleaning and disinfection of poultry houses in Flanders during the period 2007 to 2014

Cleaning and disinfection (C&D) of poultry houses is an essential aspect in farm hygiene management. Adequate performance of the different steps of a C&D protocol and the use of suitable products are key to prevent and control zoonoses and animal diseases. Hygiene monitoring on total aerobic flora through sampling with agar contact plates at different locations of the poultry house results in a hygienogram score that is used to evaluate the proper execution of C&D.This study analyzed the hygienogram scores of 19,739 poultry flocks in Flanders after C&D. Data relating to the C&D protocol, i.e., year, season, husbandry system, production type, cleaning product, sampler, active components of the disinfectant, disinfection time, disinfection temperature, and disinfection responsible, were collected.The average hygienogram score decreased significantly over time, suggesting a general improvement between 2007 and 2014. Differences in scores were found among the husbandry systems, with the barn/aviary system having a significantly better hygienogram score compared to the floor house, furnished cage, and battery. Significantly better scores also were found when a cleaning product was used in the C&D protocol. Disinfection with a peracetic acid and hydrogen peroxide combination or formaldehyde gave the best scores. In addition, C&D protocols using ≥2 different disinfectants showed improved results compared to the use of one single disinfectant. Finally, disinfection applied by a specialist contractor resulted in a better score compared to disinfection by the farmer.In conclusion, analysis of the hygienogram scores and related data allowed identifying several factors, resulting in an improvement, which may reduce the total bacterial load in poultry stables and, consequently, the number of zoonotic and pathogenic micro-organisms.

Multiscaling behavior of atomic-scale friction

The scaling behavior of friction between rough surfaces is a well-known phenomenon. It might be asked whether such a scaling feature also exists for friction at an atomic scale despite the absence of roughness on atomically flat surfaces. Indeed, other types of fluctuations, e.g., thermal and instrumental fluctuations, become appreciable at this length scale and can lead to scaling behavior of the measured atomic-scale friction. We investigate this using the lateral force exerted on the tip of an atomic force microscope (AFM) when the tip is dragged over the clean NaCl (001) surface in ultra-high vacuum at room temperature. Here the focus is on the fluctuations of the lateral force profile rather than its saw-tooth trend; we first eliminate the trend using the singular value decomposition technique and then explore the scaling behavior of the detrended data, which contains only fluctuations, using the multifractal detrended fluctuation analysis. The results demonstrate a scaling behavior for the friction data ranging from 0.2 to 2 nm with the Hurst exponent H=0.61±0.02 at a 1σ confidence interval. Moreover, the dependence of the generalized Hurst exponent, h(q), on the index variable q confirms the multifractal or multiscaling behavior of the nanofriction data. These results prove that fluctuation of nanofriction empirical data has a multifractal behavior which deviates from white noise.

Evaluation of Cystatin C for the Detection of Chronic Kidney Disease in Cats

BACKGROUND

Serum cystatin C (sCysC) and urinary cystatin C (uCysC) are potential biomarkers for early detection of chronic kidney disease (CKD) in cats. An in-depth clinical validation is required.

OBJECTIVES

To evaluate CysC as a marker for CKD in cats and to compare assay performance of the turbidimetric assay (PETIA) with the previously validated nephelometric assay (PENIA).

ANIMALS

Ninety cats were included: 49 CKD and 41 healthy cats.

METHODS

Serum CysC and uCysC concentrations were prospectively evaluated in cats with CKD and healthy cats. Based on plasma exo-iohexol clearance test (PexICT), sCysC was evaluated to distinguish normal, borderline, and low GFR. Sensitivity and specificity to detect PexICT < 1.7 mL/min/kg were calculated. Serum CysC results of PENIA and PETIA were correlated with GFR. Statistical analysis was performed using general linear modeling.

RESULTS

Cats with CKD had significantly higher mean ± SD sCysC (1.4 ± 0.5 mg/L) (P < .001) and uCysC/urinary creatinine (uCr) (291 ± 411 mg/mol) (P < .001) compared to healthy cats (sCysC 1.0 ± 0.3 and uCysC/uCr 0.32 ± 0.97). UCysC was detected in 35/49 CKD cats. R(2) values between GFR and sCysC or sCr were 0.39 and 0.71, respectively (sCysC or sCr = μ + GFR + ε). Sensitivity and specificity were 22 and 100% for sCysC and 83 and 93% for sCr. Serum CysC could not distinguish healthy from CKD cats, nor normal from borderline or low GFR, in contrast with sCr.

CONCLUSION

Serum CysC is not a reliable marker of reduced GFR in cats and uCysC could not be detected in all CKD cats.

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

Introduction

In the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute.

Materials and methods

A structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library). The grading of recommendations in relation to their evidence is according to the AWMF Guidance Manual and Rules for Guideline Development.

Conclusion

The guideline provides the grounds for rational use of antibiotics in hospital to counteract antimicrobial resistance and to improve the quality of care of patients with infections by maximising clinical outcomes while minimising toxicity. Requirements for a successful implementation of ABS programmes as well as core and supplemental ABS strategies are outlined. The German version of the guideline was published by the German Association of the Scientific Medical Societies (AWMF) in December 2013.

[What future for chest x-ray against ultra-low-dose computed tomography?]

Technological improvements, with iterative reconstruction at the foreground, have lowered the radiation dose of a chest CT close to that of a PA and lateral chest x-ray. This ultra-low dose chest CT (ULD-CT) has an image quality that is degraded on purpose, yet remains diagnostic in many clinical indications. Thus, its effectiveness is already validated for the detection and the monitoring of solid parenchymal nodules, for the diagnosis and monitoring of infectious lung diseases and for the screening of pleural lesions secondary to asbestos exposure. Its limitations are the analysis of the mediastinal structures, the severe obesity (BMI>35) and the detection of interstitial lesions. If it can replace the standard chest CT in these indications, all the more in situations where radiation dose is a major problem (young patients, repeated exams, screening), it progressively emerges as a first line alternative for chest radiograph, providing more data at a similar radiation cost.

Cleaning of first mirrors in ITER by means of radio frequency discharges

First mirrors of optical diagnostics in ITER are subject to charge exchange fluxes of Be, W, and potentially other elements. This may degrade the optical performance significantly via erosion or deposition. In order to restore reflectivity, cleaning by applying radio frequency (RF) power to the mirror itself and thus creating a discharge in front of the mirror will be used. The plasma generated in front of the mirror surface sputters off deposition, restoring its reflectivity. Although the functionality of such a mirror cleaning technique is proven in laboratory experiments, the technical implementation in ITER revealed obstacles which needs to be overcome: Since the discharge as an RF load in general is not very well matched to the power generator and transmission line, power reflections will occur leading to a thermal load of the cable. Its implementation for ITER requires additional R&D. This includes the design of mirrors as RF electrodes, as well as feeders and matching networks inside the vacuum vessel. Mitigation solutions will be evaluated and discussed. Furthermore, technical obstacles (i.e., cooling water pipes for the mirrors) need to be solved. Since cooling water lines are usually on ground potential at the feed through of the vacuum vessel, a solution to decouple the ground potential from the mirror would be a major simplification. Such a solution will be presented.

Ruxolitinib in corticosteroid-refractory graft-versus-host disease after allogeneic stem cell transplantation: a multicenter survey

Despite major improvements in allogeneic hematopoietic cell transplantation over the past decades, corticosteroid-refractory (SR) acute (a) and chronic (c) graft-versus-host disease (GVHD) cause high mortality. Preclinical evidence indicates the potent anti-inflammatory properties of the JAK1/2 inhibitor ruxolitinib. In this retrospective survey, 19 stem cell transplant centers in Europe and the United States reported outcome data from 95 patients who had received ruxolitinib as salvage therapy for SR-GVHD. Patients were classified as having SR-aGVHD (n=54, all grades III or IV) or SR-cGVHD (n=41, all moderate or severe). The median number of previous GVHD-therapies was 3 for both SR-aGVHD (1-7) and SR-cGVHD (1-10). The overall response rate was 81.5% (44/54) in SR-aGVHD including 25 complete responses (46.3%), while for SR-cGVHD the ORR was 85.4% (35/41). Of those patients responding to ruxolitinib, the rate of GVHD-relapse was 6.8% (3/44) and 5.7% (2/35) for SR-aGVHD and SR-cGVHD, respectively. The 6-month-survival was 79% (67.3-90.7%, 95% confidence interval (CI)) and 97.4% (92.3-100%, 95% CI) for SR-aGVHD and SR-cGVHD, respectively. Cytopenia and cytomegalovirus-reactivation were observed during ruxolitinib treatment in both SR-aGVHD (30/54, 55.6% and 18/54, 33.3%) and SR-cGVHD (7/41, 17.1% and 6/41, 14.6%) patients. Ruxolitinib may constitute a promising new treatment option for SR-aGVHD and SR-cGVHD that should be validated in a prospective trial.