The genetic interaction of REVOLUTA and WRKY53 links plant development, senescence, and immune responses

In annual plants, tight coordination of successive developmental events is of primary importance to optimize performance under fluctuating environmental conditions. The recent finding of the genetic interaction of WRKY53, a key senescence-related gene with REVOLUTA, a master regulator of early leaf patterning, raises the question of how early and late developmental events are connected. Here, we investigated the developmental and metabolic consequences of an alteration of the REVOLUTA and WRKY53 gene expression, from seedling to fruiting. Our results show that REVOLUTA critically controls late developmental phases and reproduction while inversely WRKY53 determines vegetative growth at early developmental stages. We further show that these regulators of distinct developmental phases frequently, but not continuously, interact throughout ontogeny and demonstrated that their genetic interaction is mediated by the salicylic acid (SA). Moreover, we showed that REVOLUTA and WRKY53 are keys regulatory nodes of development and plant immunity thought their role in SA metabolic pathways, which also highlights the role of REV in pathogen defence. Together, our findings demonstrate how late and early developmental events are tightly intertwined by molecular hubs. These hubs interact with each other throughout ontogeny, and participate in the interplay between plant development and immunity.

A bioactive molecule made by unusual salvage of radical SAM enzyme byproduct 5-deoxyadenosine blurs the boundary of primary and secondary metabolism

5-Deoxyadenosine (5dAdo) is the byproduct of many radical S-adenosyl-l-methionine enzyme reactions in all domains of life. 5dAdo is also an inhibitor of the radical S-adenosyl-l-methionine enzymes themselves, making it necessary for cells to construct pathways to recycle or dispose of this toxic metabolite. However, the specific pathways involved have long remained unexplored. Recent research demonstrated a growth advantage in certain organisms by using 5dAdo or intermediates as a sole carbon source and elucidated the corresponding salvage pathway. We now provide evidence using supernatant analysis by GC-MS for another 5dAdo recycling route. Specifically, in the unicellular cyanobacterium Synechococcus elongatus PCC 7942 (S. elongatus), the activity of promiscuous enzymes leads to the synthesis and excretion first of 5-deoxyribose and subsequently of 7-deoxysedoheptulose. 7-Deoxysedoheptulose is an unusual deoxy-sugar, which acts as an antimetabolite of the shikimate pathway, thereby exhibiting antimicrobial and herbicidal activity. This strategy enables organisms with small genomes and lacking canonical gene clusters for the synthesis of secondary metabolites, like S. elongatus, to produce antimicrobial compounds from primary metabolism and enzymatic promiscuity. Our findings challenge the view of bioactive molecules as sole products of secondary metabolite gene clusters and expand the range of compounds that microorganisms can deploy to compete for their ecological niche.

The BIR2/BIR3-Associated Phospholipase Dγ1 Negatively Regulates Plant Immunity

Plants have evolved effective strategies to defend themselves against pathogen invasion. Starting from the plasma membrane with the recognition of microbe-associated molecular patterns (MAMPs) via pattern recognition receptors, internal cellular signaling pathways are induced to ultimately fend off the attack. Phospholipase D (PLD) hydrolyzes membrane phospholipids to produce phosphatidic acid (PA), which has been proposed to play a second messenger role in immunity. The Arabidopsis (Arabidopsis thaliana) PLD family consists of 12 members, and for some of these, a specific function in resistance toward a subset of pathogens has been shown. We demonstrate here that Arabidopsis PLDγ1, but not its close homologs PLDγ2 and PLDγ3, is specifically involved in plant immunity. Genetic inactivation of PLDγ1 resulted in increased resistance toward the virulent bacterium Pseudomonas syringae pv. tomato DC3000 and the necrotrophic fungus Botrytis cinerea As pldγ1 mutant plants responded with elevated levels of reactive oxygen species to MAMP treatment, a negative regulatory function for this PLD isoform is proposed. Importantly, PA levels in pldγ1 mutants were not affected compared to stressed wild-type plants, suggesting that alterations in PA levels are not likely the cause for the enhanced immunity in the pldγ1 line. Instead, the plasma-membrane-attached PLDγ1 protein colocalized and associated with the BAK1-INTERACTING RECEPTOR-LIKE KINASES BIR2 and BIR3, which are known negative regulators of pattern-triggered immunity. Moreover, complex formation of PLDγ1 and BIR2 was further promoted upon MAMP treatment. Hence, we propose that PLDγ1 acts as a negative regulator of plant immune responses in complex with immunity-related proteins BIR2 and BIR3.

Cell Death Triggered by the YUCCA-like Bs3 Protein Coincides with Accumulation of Salicylic Acid and Pipecolic Acid But Not of Indole-3-Acetic Acid

The pepper (Capsicum annuum) resistance gene bacterial spot3 (Bs3) is transcriptionally activated by the matching Xanthomonas euvesicatoria transcription-activator-like effector (TALE) AvrBs3. AvrBs3-induced Bs3 expression triggers a rapid and local cell death reaction, the hypersensitive response (HR). Bs3 is most closely related to plant flavin monooxygenases of the YUCCA (YUC) family, which catalyze the final step in auxin biosynthesis. Targeted mutagenesis of predicted NADPH- and FAD-cofactor sites resulted in Bs3 derivatives that no longer trigger HR, thereby suggesting that the enzymatic activity of Bs3 is crucial to Bs3-triggered HR. Domain swap experiments between pepper Bs3 and Arabidopsis (Arabidopsis thaliana) YUC8 uncovered functionally exchangeable and functionally distinct regions in both proteins, which is in agreement with a model whereby Bs3 evolved from an ancestral YUC gene. Mass spectrometric measurements revealed that expression of YUCs, but not expression of Bs3, coincides with an increase in auxin levels, suggesting that Bs3 and YUCs, despite their sequence similarity, catalyze distinct enzymatic reactions. Finally, we found that expression of Bs3 coincides with increased levels of the salicylic acid and pipecolic acid, two compounds that are involved in systemic acquired resistance.

Comparing Arabidopsis receptor kinase and receptor protein-mediated immune signaling reveals BIK1-dependent differences

Pattern recognition receptors (PRRs) sense microbial patterns and activate innate immunity against attempted microbial invasions. The leucine-rich repeat receptor kinases (LRR-RK) FLS2 and EFR, and the LRR receptor protein (LRR-RP) receptors RLP23 and RLP42, respectively, represent prototypical members of these two prominent and closely related PRR families. We conducted a survey of Arabidopsis thaliana immune signaling mediated by these receptors to address the question of commonalities and differences between LRR-RK and LRR-RP signaling. Quantitative differences in timing and amplitude were observed for several early immune responses, with RP-mediated responses typically being slower and more prolonged than those mediated by RKs. Activation of RLP23, but not FLS2, induced the production of camalexin. Transcriptomic analysis revealed that RLP23-regulated genes represent only a fraction of those genes differentially expressed upon FLS2 activation. Several positive and negative regulators of FLS2-signaling play similar roles in RLP23 signaling. Intriguingly, the cytoplasmic receptor kinase BIK1, a positive regulator of RK signaling, acts as a negative regulator of RP-type immune receptors in a manner dependent on BIK1 kinase activity. Our study unveiled unexpected differences in two closely related receptor systems and reports a new negative role of BIK1 in plant immunity.

The Arabidopsis GAGA-Binding Factor BASIC PENTACYSTEINE6 Recruits the POLYCOMB-REPRESSIVE COMPLEX1 Component LIKE HETEROCHROMATIN PROTEIN1 to GAGA DNA Motifs

Polycomb-repressive complexes (PRCs) play key roles in development by repressing a large number of genes involved in various functions. Much, however, remains to be discovered about PRC-silencing mechanisms as well as their targeting to specific genomic regions. Besides other mechanisms, GAGA-binding factors in animals can guide PRC members in a sequence-specific manner to Polycomb-responsive DNA elements. Here, we show that the Arabidopsis (Arabidopsis thaliana) GAGA-motif binding factor protein basic pentacysteine6 (BPC6) interacts with like heterochromatin protein1 (LHP1), a PRC1 component, and associates with vernalization2 (VRN2), a PRC2 component, in vivo. By using a modified DNA-protein interaction enzyme-linked immunosorbant assay, we could show that BPC6 was required and sufficient to recruit LHP1 to GAGA motif-containing DNA probes in vitro. We also found that LHP1 interacts with VRN2 and, therefore, can function as a possible scaffold between BPC6 and VRN2. The lhp1-4 bpc4 bpc6 triple mutant displayed a pleiotropic phenotype, extreme dwarfism and early flowering, which disclosed synergistic functions of LHP1 and group II plant BPC members. Transcriptome analyses supported this synergy and suggested a possible function in the concerted repression of homeotic genes, probably through histone H3 lysine-27 trimethylation. Hence, our findings suggest striking similarities between animal and plant GAGA-binding factors in the recruitment of PRC1 and PRC2 components to Polycomb-responsive DNA element-like GAGA motifs, which must have evolved through convergent evolution.

Cell type-specific transcriptome analysis in the early Arabidopsis thaliana embryo

In multicellular organisms, cellular differences in gene activity are a prerequisite for differentiation and establishment of cell types. In order to study transcriptome profiles, specific cell types have to be isolated from a given tissue or even the whole organism. However, whole-transcriptome analysis of early embryos in flowering plants has been hampered by their size and inaccessibility. Here, we describe the purification of nuclear RNA from early stage Arabidopsis thaliana embryos using fluorescence-activated nuclear sorting (FANS) to generate expression profiles of early stages of the whole embryo, the proembryo and the suspensor. We validated our datasets of differentially expressed candidate genes by promoter-reporter gene fusions and in situ hybridization. Our study revealed that different classes of genes with respect to biological processes and molecular functions are preferentially expressed either in the proembryo or in the suspensor. This method can be used especially for tissues with a limited cell population and inaccessible tissue types. Furthermore, we provide a valuable resource for research on Arabidopsis early embryogenesis.

Plant core environmental stress response genes are systemically coordinated during abiotic stresses

Studying plant stress responses is an important issue in a world threatened by global warming. Unfortunately, comparative analyses are hampered by varying experimental setups. In contrast, the AtGenExpress abiotic stress experiment displays intercomparability. Importantly, six of the nine stresses (wounding, genotoxic, oxidative, UV-B light, osmotic and salt) can be examined for their capacity to generate systemic signals between the shoot and root, which might be essential to regain homeostasis in Arabidopsis thaliana. We classified the systemic responses into two groups: genes that are regulated in the non-treated tissue only are defined as type I responsive and, accordingly, genes that react in both tissues are termed type II responsive. Analysis of type I and II systemic responses suggest distinct functionalities, but also significant overlap between different stresses. Comparison with salicylic acid (SA) and methyl-jasmonate (MeJA) responsive genes implies that MeJA is involved in the systemic stress response. Certain genes are predominantly responding in only one of the categories, e.g., WRKY genes respond mainly non-systemically. Instead, genes of the plant core environmental stress response (PCESR), e.g., ZAT10, ZAT12, ERD9 or MES9, are part of different response types. Moreover, several PCESR genes switch between the categories in a stress-specific manner.

Bioinformatic cis-element analyses performed in Arabidopsis and rice disclose bZIP- and MYB-related binding sites as potential AuxRE-coupling elements in auxin-mediated transcription

BACKGROUND

In higher plants, a diverse array of developmental and growth-related processes is regulated by the plant hormone auxin. Recent publications have proposed that besides the well-characterized Auxin Response Factors (ARFs) that bind Auxin Response Elements (AuxREs), also members of the bZIP- and MYB-transcription factor (TF) families participate in transcriptional control of auxin-regulated genes via bZIP Response Elements (ZREs) or Myb Response Elements (MREs), respectively.

RESULTS

Applying a novel bioinformatic algorithm, we demonstrate on a genome-wide scale that singular motifs or composite modules of AuxREs, ZREs, MREs but also of MYC2 related elements are significantly enriched in promoters of auxin-inducible genes. Despite considerable, species-specific differences in the genome structure in terms of the GC content, this enrichment is generally conserved in dicot (Arabidopsis thaliana) and monocot (Oryza sativa) model plants. Moreover, an enrichment of defined composite modules has been observed in selected auxin-related gene families. Consistently, a bipartite module, which encompasses a bZIP-associated G-box Related Element (GRE) and an AuxRE motif, has been found to be highly enriched. Making use of transient reporter studies in protoplasts, these findings were experimentally confirmed, demonstrating that GREs functionally interact with AuxREs in regulating auxin-mediated transcription.

CONCLUSIONS

Using genome-wide bioinformatic analyses, evolutionary conserved motifs have been defined which potentially function as AuxRE-dependent coupling elements to establish auxin-specific expression patterns. Based on these findings, experimental approaches can be designed to broaden our understanding of combinatorial, auxin-controlled gene regulation.

Volatiles of two growth-inhibiting rhizobacteria commonly engage AtWRKY18 function

Interactions with the (a)biotic environment play key roles in a plant's fitness and vitality. In addition to direct surface-to-surface contact, volatile chemicals can also affect the physiology of organism. Volatiles of Serratia plymuthica and Stenotrophomonas maltophilia significantly inhibited growth and induced H(2) O(2) production in Arabidopsis in dual culture. Within 1 day, transcriptional changes were observed by promoter-GUS assays using a stress-inducible W-box-containing 4xGST1 construct. Expression studies performed at 6, 12 and 24 h revealed altered transcript levels for 889 genes and 655 genes in response to Se. plymuthica or St. maltophilia volatiles, respectively. Expression of 162 genes was altered in both treatments. Meta-analysis revealed that specifically volatile-responsive genes were significantly overlapping with those affected by abiotic stress. We use the term mVAMP (microbial volatile-associated molecular pattern) to describe these volatile-specific responses. Genes responsive to both treatments were enriched for W-box motifs in their promoters, and were significantly enriched for transcription factors (ERF2, ZAT10, MYB73 and WRKY18). The susceptibility of wrky18 mutant lines to volatiles was significantly delayed, suggesting an indispensable role for WRKY18 in bacterial volatile responses.

The SCO2 protein disulphide isomerase is required for thylakoid biogenesis and interacts with LHCB1 chlorophyll a/b binding proteins which affects chlorophyll biosynthesis in Arabidopsis seedlings

The process of chloroplast biogenesis requires a multitude of pathways and processes to establish chloroplast function. In cotyledons of seedlings, chloroplasts develop either directly from proplastids (also named eoplasts) or, if germinated in the dark, via etioplasts, whereas in leaves chloroplasts derive from proplastids in the apical meristem and are then multiplied by division. The snowy cotyledon 2, sco2, mutations specifically disrupt chloroplast biogenesis in cotyledons. SCO2 encodes a chloroplast-localized protein disulphide isomerase, hypothesized to be involved in protein folding. Analysis of co-expressed genes with SCO2 revealed that genes with similar expression patterns encode chloroplast proteins involved in protein translation and in chlorophyll biosynthesis. Indeed, sco2-1 accumulates increased levels of the chlorophyll precursor, protochlorophyllide, in both dark grown cotyledons and leaves. Yeast two-hybrid analyses demonstrated that SCO2 directly interacts with the chlorophyll-binding LHCB1 proteins, being confirmed in planta using bimolecular fluorescence complementation (BIFC). Furthermore, ultrastructural analysis of sco2-1 chloroplasts revealed that formation and movement of transport vesicles from the inner envelope to the thylakoids is perturbed. SCO2 does not interact with the signal recognition particle proteins SRP54 and FtsY, which were shown to be involved in targeting of LHCB1 to the thylakoids. We hypothesize that SCO2 provides an alternative targeting pathway for light-harvesting chlorophyll binding (LHCB) proteins to the thylakoids via transport vesicles predominantly in cotyledons, with the signal recognition particle (SRP) pathway predominant in rosette leaves. Therefore, we propose that SCO2 is involved in the integration of LHCB1 proteins into the thylakoids that feeds back on the regulation of the tetrapyrrole biosynthetic pathway and nuclear gene expression.

Prerequisites, performance and profits of transcriptional profiling the abiotic stress response

During the last decade, microarrays became a routine tool for the analysis of transcripts in the model plant Arabidopsis thaliana and the crop plant species rice, poplar or barley. The overwhelming amount of data generated by gene expression studies is a valuable resource for every scientist. Here, we summarize the most important findings about the abiotic stress responses in plants. Interestingly, conserved patterns of gene expression responses have been found that are common between different abiotic stresses or that are conserved between different plant species. However, the individual histories of each plant affect the inter-comparability between experiments already before the onset of the actual stress treatment. This review outlines multiple aspects of microarray technology and highlights some of the benefits, limitations and also pitfalls of the technique. This article is part of a Special Issue entitled: Plant gene regulation in response to abiotic stress.

The activation of the Arabidopsis P-ATPase 1 by the brassinosteroid receptor BRI1 is independent of threonine 948 phosphorylation

The plasma membrane-spanning receptor brassinosteroid insenstive 1 (BRI1) rapidly induces plant cell wall expansion in response to brassinosteroids such as brassinolide (BL). Wall expansion is accompanied by a rapid hyperpolarisation of the plasma membrane which is recordable by measuring the fluorescence lifetime (FLT) of the green fluorescent protein (GFP) fused to BRI1. For the BL induction of hyperpolarisation and wall expansion, the activation of the plasma membrane P-type H+-ATPase is necessary. Furthermore, the activation of the P-ATPase requires BRI1 kinase activity and appears to be mediated by a BL-modulated association of BRI1 with the proton pump. Here, we show that BRI1 also associates with a mutant version of the Arabidopsis P-ATPase 1 (AHA1) characterized by an exchange of a well-known regulatory threonine for a non-phosphorylatable residue in the auto-inhibitory C-terminal domain. Even more important, BRI1 is still able to activate this AHA1 mutant in response to BL. This suggests a novel mechanism for the enzymatic activation of the P-ATPase by BRI1 in the plasma membrane. Furthermore, we demonstrate that the FLT of BRI1-GFP can be used as a non-invasive probe to analyse long-distance BL signaling in Arabidopsis seedlings.

Designability of Graphitic Cones

We show that, with topologically flexible seeds which are allowed to explore different growth modes, graphitic cones are inherently more “designable” than flat graphitic disks. The designability of a structure is the number of seed topologies encoding that structure.

We illustrate designability with a simple model, where graphite grows onto Cn (5≤n≤30) ring seeds. For a wide range of ring sizes, cones are the most likely topological outcome. Results from the model agree well with data from special cone-rich carbon black samples.

The concept of designability allows entropy to be incorporated into the “pentagon road” model of the formation of curved graphitic structures.

Transcriptome analysis of high-temperature stress in developing barley caryopses: early stress responses and effects on storage compound biosynthesis

High-temperature stress, like any abiotic stress, impairs the physiology and development of plants, including the stages of seed setting and ripening. We used the Affymetrix 22K Barley1 GeneChip microarray to investigate the response of developing barley (Hordeum vulgare) seeds, termed caryopses, after 0.5, 3, and 6 h of heat stress exposure; 958 induced and 1122 repressed genes exhibited spatial and temporal expression patterns that provide a detailed insight into the caryopses' early heat stress responses. Down-regulation of genes related to storage compound biosynthesis and cell growth provides evidence for a rapid impairment of the caryopsis' development. Increased levels of sugars and amino acids were indicative for both production of compatible solutes and feedback-induced accumulation of substrates for storage compound biosynthesis. Metadata analysis identified embryo and endosperm as primary locations of heat stress responses, indicating a strong impact of short-term heat stress on central developmental functions of the caryopsis. A comparison with heat stress responses in Arabidopsis shoots and drought stress responses in barley caryopses identified both conserved and presumably heat- and caryopsis-specific stress-responsive genes. Summarized, our data provide an important basis for further investigation of gene functions in order to aid an improved heat tolerance and reduced losses of yield in barley as a model for cereal crops.

Significance of light, sugar, and amino acid supply for diurnal gene regulation in developing barley caryopses

The caryopses of barley (Hordeum vulgare), as of all cereals, are complex sink organs optimized for starch accumulation and embryo development. While their early to late development has been studied in great detail, processes underlying the caryopses' diurnal adaptation to changes in light, temperature, and the fluctuations in phloem-supplied carbon and nitrogen have remained unknown. In an attempt to identify diurnally affected processes in developing caryopses at the early maturation phase, we monitored global changes of both gene expression and metabolite levels. We applied the 22 K Barley1 GeneChip microarray and identified 2,091 differentially expressed (DE) genes that were assigned to six major diurnal expression clusters. Principal component analysis and other global analyses demonstrated that the variability within the data set relates to genes involved in circadian regulation, storage compound accumulation, embryo development, response to abiotic stress, and photosynthesis. The correlation of amino acid and sugar profiles with expression trajectories led to the identification of several hundred potentially metabolite-regulated DE genes. A comparative analysis of our data set and publicly available microarray data disclosed suborgan-specific expression of almost all diurnal DE genes, with more than 350 genes specifically expressed in the pericarp, endosperm, or embryo tissues. Our data reveal a tight linkage between day/night cycles, changes in light, and the supply of carbon and nitrogen. We present a model that suggests several phases of diurnal gene expression in developing barley caryopses, summarized as starvation and priming, energy collection and carbon fixation, light protection and chaperone activity, storage and growth, and embryo development.

Phylogenetic and comparative gene expression analysis of barley (Hordeum vulgare) WRKY transcription factor family reveals putatively retained functions between monocots and dicots

Background

WRKY proteins belong to the WRKY-GCM1 superfamily of zinc finger transcription factors that have been subject to a large plant-specific diversification. For the cereal crop barley (Hordeum vulgare), three different WRKY proteins have been characterized so far as regulators in sucrose signaling, pathogen defense, and in response to cold and drought. However, their phylogenetic relationship remained unresolved.

Results

In this study, we used available sequence information to identify a minimum number of 45 barley WRKY transcription factor (HvWRKY) genes. According to their structural features, the HvWRKY factors were classified into the previously defined polyphyletic WRKY subgroups 1 to 3. Furthermore, we could assign putative orthologs of the HvWRKY proteins in Arabidopsis and rice. While in most cases clades of orthologous proteins were formed within each group or subgroup, other clades were composed of paralogous proteins for the grasses and Arabidopsis only, which is indicative of specific gene radiation events. To gain insight into their putative functions, we examined expression profiles of WRKY genes from publicly available microarray data resources and found group specific expression patterns. While putative orthologs of the HvWRKY transcription factors have been inferred from phylogenetic sequence analysis, we performed a comparative expression analysis of WRKY genes in Arabidopsis and barley. Indeed, highly correlative expression profiles were found between some of the putative orthologs.

Conclusion

HvWRKY genes have not only undergone radiation in monocot or dicot species, but exhibit evolutionary traits specific to grasses. HvWRKY proteins exhibited not only sequence similarities between orthologs with Arabidopsis, but also relatedness in their expression patterns. This correlative expression is indicative for a putative conserved function of related WRKY proteins in monocot and dicot species.

The AtGenExpress global stress expression data set: protocols, evaluation and model data analysis of UV-B light, drought and cold stress responses

The tolerance responses of plants to many abiotic stresses are conjectured to be controlled by complex gene networks. In the frame of the AtGenExpress project a comprehensive Arabidopsis thaliana genome transcript expression study was performed using the Affymetrix ATH1 microarray in order to understand these regulatory networks in detail. In contrast to earlier studies, we subjected, side-by-side and in a high-resolution kinetic series, Arabidopsis plants, of identical genotype grown under identical conditions, to different environmental stresses comprising heat, cold, drought, salt, high osmolarity, UV-B light and wounding. Furthermore, the harvesting of tissue and RNA isolation were performed in parallel at the same location using identical experimental protocols. Here we describe the technical performance of the experiments. We also present a general overview of environmental abiotic stress-induced gene expression patterns and the results of a model bioinformatics analysis of gene expression in response to UV-B light, drought and cold stress. Our results suggest that the initial transcriptional stress reaction of Arabidopsis might comprise a set of core environmental stress response genes which, by adjustment of the energy balance, could have a crucial function in various stress responses. In addition, there are indications that systemic signals generated by the tissue exposed to stress play a major role in the coordination and execution of stress responses. In summary, the information reported provides a prime reference point and source for the subsequent exploitation of this important resource for research into plant abiotic stress.

A Two-Step Clustering for 3-D Gene Expression Data Reveals the Main Features of the Arabidopsis Stress Response

We developed an integrative approach for discovering gene modules, i.e. genes that are tightly correlated under several experimental conditions and applied it to a threedimensional Arabidopsis thaliana microarray dataset. The dataset consists of approximately 23000 genes responding to 9 abiotic stress conditions at 6-9 different points in time. Our approach aims at finding relatively small and dense modules lending themselves to a specific biological interpretation. In order to detect gene modules within this dataset, we employ a two-step clustering process. In the first step, a k-means clustering on one condition is performed, which is subsequently used in the second step as a seed for the clustering of the remaining conditions. To validate the significance of the obtained modules, we performed a permutation analysis and determined a null hypothesis to compare the module scores against, providing a p-value for each module. Significant modules were mapped to the Gene Ontology (GO) in order to determine the participating biological processes.

As a result, we isolated modules showing high significance with respect to the p-values obtained by permutation analysis and GO mapping. In these modules we identified a number of genes that are either part of a general stress response with similar characteristics under different conditions (coherent modules), or part of a more specific stress response to a single stress condition (single response modules). We also found genes clustering within several conditions, which are, however, not part of a coherent module. These genes have a distinct temporal response under each condition. We call the modules they are contained in individual response modules (IR).

PNPase activity determines the efficiency of mRNA 3'-end processing, the degradation of tRNA and the extent of polyadenylation in chloroplasts

The exoribonuclease polynucleotide phosphorylase (PNPase) has been implicated in mRNA processing and degradation in bacteria as well as in chloroplasts of higher plants. Here, we report the first comprehensive in vivo study of chloroplast PNPase function. Modulation of PNPase activity in Arabidopsis chloroplasts by a reverse genetic approach revealed that, although this enzyme is essential for efficient 3'-end processing of mRNAs, it is insufficient to mediate transcript degradation. Surprisingly, we identified PNPase as also being indispensable for 3'-end maturation of 23S rRNA transcripts. Analysis of tRNA amounts in transgenic Arabidopsis plants suggests a direct correlation of PNPase activity and tRNA levels, indicating an additional function of this exoribo nuclease in tRNA decay. Moreover, the extent of polyadenylated mRNAs in chloroplasts is negatively correlated with PNPase activity. Together, our results attribute novel functions to PNPase in the metabolism of all major classes of plastid RNAs and suggest an unexpectedly complex role for PNPase in RNA processing and decay.

Determination of blood flow and endothelial shear stress in human coronary artery in vivo

This paper describes a system that permits, for the first time, the in vivo determination of local velocity and endothelial shear stress in the major human coronary arteries. The purpose of the system is to facilitate the study of plaque growth and the relationships between local hemodynamic factors and atherogenesis and restenosis. The three-dimensional anatomy of a segment of the right coronary artery was determined immediately after directional atherectomy via a combination of intracoronary ultrasound and biplane angiography. The highly irregular geometry of the segment was then represented in curvilinear coordinates and a computational fluid dynamics technique was used to investigate the detailed, intravascular velocity profile and shear stress distribution. We found minor flow reversals, significant swirling and a large variation of local velocity and shear stress, both axially and circumferentially, within the artery, even in the absence of significant luminal obstruction. The flow phenomena exhibit characteristics consistent with the focal nature of atherogenesis and restenosis. It is concluded that the technology now exists to determine luminal geometry and local variations in flow fields and endothelial shear stress, in vivo.

[The effect of low droperidol dosages on postoperative anxiety, internal tension, general mood and PONV]

BACKGROUND

Droperidol even in low doses such as 0.5 mg to 1.25 mg can increase postoperative anxiety and state of tension. The aim of this study was to determine whether these side effects occur frequently following low-dose droperidol and to see whether these are dose related.

METHODS

184 female in- and outpatients ASA grade 1 and 2 undergoing gynaecological laparoscopy were recruited to this prospective, double-blind study. General anaesthesia was standardized (induction with thiopentone, fentanyl 2 micrograms/kg and vecuronium 0.1 mg/kg, tracheal intubation, maintainance with enflurane in N2O/O2). Patients were randomly allocated to receive saline (n = 45), 0.625 mg (n = 46), 1.25 mg (n = 47) or 2.5 mg (n = 46) droperidol i.v. 10 minutes before the end of surgery. 1,3,6, and 24 hours postoperatively, the patients' anxiety, state of tension and overall mood was evaluated using two psychological questionnaires which had been tested for the perioperative period (Erlanger anxiety and tension-scale/BSKE-EWL-test). Sedation was evaluated by the staff of the recovery room. In addition, postoperative nausea and vomiting (PONV) was assessed using a 100 mm visual analogue scale and by counting the episodes of retching or vomiting. PONV was then rated over the whole observation period as none, mild, moderate or severe using a fixed scoring algorithm. Statistical analysis was performed using the ANOVA and the chi2-test.

RESULTS

The patients did not differ with regard to biometric data, duration of surgery and anaesthesia. The postoperative scores for anxiety, state of tension and overall mood were not different between the groups at any observation time (Fig. 1: anxiety and tension: P = 0.5687; figure 2: overall mood: P = 0.0647). Quality of sleep in the first night after surgery was the same in all groups (Table 2 and 3). Sedation was not significantly different (Table 4; P = 0.0704). Furthermore, duration of stay in the recovery room did not differ (P = 0.4353). On the other hand, three patients from the 2.5 mg droperidol group had to stay unexpectedly on the ward overnight, because they had been too much sedated to be discharged at home. This was not the case with any patient from the other groups. Compared to placebo, PONV over the whole 24 h observation period was significantly reduced by droperidol (Fig. 3; P = 0.0338): completely free from PONV: placebo: 41.3%, 0.625 mg droperidol: 67.4%, 1.25 mg droperidol: 53.2%, 2.5 mg droperidol: 71.7%. Also the severity of PONV was reduced.

CONCLUSION

In gynaecological laparoscopy under general anaesthesia with tracheal intubation, we recommend droperidol 0.625 mg in the prevention of PONV, as it reduces PONV as well as 2.5 mg with no severe sedation in this dosage. Psychological side effects did not occur more frequently after droperidol compared to placebo in any of the investigated dosages.

[The effect of total intravenous anesthesia with propofol, alfentanil and vecuronium (TIVA) on bronchial mucosal transport]

PURPOSE

The mucociliary escalator of the lung is an important protective transport system by means of which inhaled particles and microorganisms are removed from the tracheobronchial system. In the present prospective study the effect of total intravenous anaesthesia with propofol, alfentanil, vecuronium, and oxygen-air ventilation on bronchial mucus transport velocity (BTV) was investigated.

METHOD

10 patients undergoing major abdominal surgery were included in the study. In all patients anaesthesia was induced and maintained with propofol, alfentanil, and vecuronium. Ventilation was assisted with a mixture of air and oxygen (FiO2:0.35). The BTV was measured preoperatively in the conscious patients one day before surgery while they received local anaesthesia with 10 ml of 1 percent lidocaine and after the end of the operation during intubation anaesthesia. BTV was determined with a small volume of albumin microspheres labelled with technetium -99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronches via a catheter placed in the inner channel of a fibre-optic bronchoscope [7]. The study was approved by the ethics committee of our hospital.

RESULTS

The administered dose of propofol was 3.0 g (1.8-5.5), of alfentanil 26 mg (20-50), and of vecuronium 20 mg (16-34) (median with range). The duration of mechanical ventilation up to the time of measurement was 5 h (3.0-9.5). TIVA produced a decrease of BTV in the right (9.7 vs 4.9 mm/min) and left main bronchus (11.3 mm/min vs 5.3 mm/min).

CONCLUSIONS

Total intravenous anaesthesia with propofol, alfentanil, and vecuronium depressed mucociliary flow in patients with healthy lungs. The period for recovery of mucociliary clearance and the possible disadvantage in patients with increased pulmonary risk (e.g. patients with chronic bronchitis and abdominal surgery) should be clarified in further studies.

[Diagnosis of urethral stricture--what is necessary?]

For therapy of strictures of the urethra several procedures are available. The choice of the adequate strategy requires a rational diagnostic, answering questions about localisation, length, shape and functional effect of the stricture. The most important method is the miction-cyst-urethrography (MCU). Statements about the dimensions of scarred alterations in the corpus spongiosum urethrae are to receive from urethral ultrasonic. In addition you can perform the retrograde urethrography. The functional effects of the urethral stricture should be investigated by uroflowmetry and examinations of the upper urinary tract (ultrasonic/urography).

[Combination anesthesia and bronchial tranport velocity. Effects of anesthesia with isoflurane, fentanyl, vecuronium and oxygen-nitrous oxide breathing on bronchial mucus transport]

The mucociliary escalator of the lung is an important protective transport system by means of which inhaled particles and microorganisms are removed from the tracheobronchial system. In general, it is assumed that anaesthetics inhibit mucociliary clearance [3,5,6,19,27]. In the present prospective study the effect of combination anaesthesia with isoflurane, fentanyl, vecuronium, and nitrous oxide-oxygen mixture on bronchial mucus transport velocity (BTV) was investigated.

PATIENTS AND METHODS

10 patients undergoing major abdominal surgery were included in the study. The study was approved by the ethics committee of our hospital. In all patients anaesthesia was induced with propofol (1-2 mg/kg), fentanyl (0.2-0.3 mg/kg) and vecuronium (0.1 mg/kg). After intubation anaesthesia was maintained with 1.5 MAC isoflurane and repeated doses of fentanyl (0.1-0.2 mg) and vecuronium. Ventilation was assisted with a 2:1 mixture of nitrous oxide and oxygen. The BTV was measured preoperatively in the conscious patients one day before surgery while they received local anaesthesia with 10 ml of 1 percent lidocaine and postoperatively while they received intubation anaesthesia. BTV was determined with a small volume of albumin microspheres labeled with technetium-99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronchi via a catheter placed in the inner channel of a fibre-optic bronchoscope [15].

RESULTS

Table 1 provides information about age, application of anaesthetics and duration of mechanical ventilation of the patients. The preoperative and postoperative BTV values showed no significant differences (Fig. 1).

CONCLUSIONS

Combination anaesthesia with isoflurane, fentanyl, vecuronium, and O2:N2O does not influence BTV in patients with healthy lungs.

Secure spread spectrum watermarking for multimedia

This paper presents a secure (tamper-resistant) algorithm for watermarking images, and a methodology for digital watermarking that may be generalized to audio, video, and multimedia data. We advocate that a watermark should be constructed as an independent and identically distributed (i.i.d.) Gaussian random vector that is imperceptibly inserted in a spread-spectrum-like fashion into the perceptually most significant spectral components of the data. We argue that insertion of a watermark under this regime makes the watermark robust to signal processing operations (such as lossy compression, filtering, digital-analog and analog-digital conversion, requantization, etc.), and common geometric transformations (such as cropping, scaling, translation, and rotation) provided that the original image is available and that it can be successfully registered against the transformed watermarked image. In these cases, the watermark detector unambiguously identifies the owner. Further, the use of Gaussian noise, ensures strong resilience to multiple-document, or collusional, attacks. Experimental results are provided to support these claims, along with an exposition of pending open problems.

[The application of n-acetylcysteine as an antioxidant and mucolytic in mechanical ventilation in intensive care patients. A prospective, randomized, placebo-controlled, double-blind study]

Oxygen radicals and oxygen radial mediators are thought to be important components in the development of acute lung injury, sepsis, and multiple organ failure. Injured patients, patients with pulmonary diseases, and multiple trauma patients also showed an elevated lipid peroxidation, indicating increased oxidant stress. N-Acetylcysteine (NAC) has been used as an antioxidant in a wide variety of experiments. NAC has been suggested to act by raising concentrations of cysteine, and hence glutathione, and by scavenging of oxidant species [1, 11, 17, 29]. The present study was designed to investigate whether the application of NAC in intubated patients has an effect on concentrations of reduced glutathione in plasma and bronchoalveolar lavage fluid (BAL) and on the lipid peroxidation products malondialdehyde and conjugated dienes. Because NAC has been widely used as a mucolytic drug for the treatment of lung diseases, the influence on tracheobronchial mucus was studied, too. METHODS. In a randomized, double-blind, placebo-controlled study, a total of 38 long-term ventilated patients of a surgical intensive care unit were investigated. Patients were treated for 5 days with either 3 g NAC/day or placebo. The plasma concentration of reduced glutathione, malondialdehyde, and conjugated dienes were measured on admission and on the 3rd and 5th days of treatment [8, 34, 48]. Additionally, the numbers of tracheobronchial suctionings were registered and chest radiographs were evaluated. A fibre-bronchoscopy was performed on admission and on the 3rd day of treatment. The amount and viscidity of tracheobronchial secretions were examined semiquantitatively, and glutathione levels were measured in the unconcentrated BAL. The study was approved by the ethics committee of the University of Ulm. RESULTS. The two groups were comparable with respect to age, sex, APACHE II score and diagnosis (Table 1). We found no significant differences in reduced glutathione levels in the plasma or in the BAL (Figs. 1, 2). Plasma concentrations of malondialdehyde were similar (Fig. 3). Only the levels of conjugated dienes were significantly higher on the 5th treatment day in the placebo group (Fig. 4). The organ function of the lung (FiO2, PEEP, PaO2), liver (SGOT, bilirubin), and kidney (creatinine) and coagulation parameters (PTT, prothrombin time, platelet count) were similar in the two groups during the time of investigation. We observed no clinically relevant differences in the tracheobronchial mucus (Table 2). CONCLUSION. The present data do not support routine use of NAC in ventilated patients, either as an antioxidant or as a mucolytic agent. Intravenous administration of 3 g NAC/day had no clinically relevant effect on glutathione levels, lipid peroxidation products, tracheobronchial mucus, and clinical condition.

[The effect of theophylline on the mucociliary clearance function in ventilated intensive care patients]

Mucociliary clearance represents an important protective mechanism of the upper and lower respiratory tracts whereby inhaled particles and micro-organisms are removed from the tracheobronchial system. In incubated intensive care unit (ICU) patients, impaired ciliary function and mucus transport are associated with pulmonary complications [9]. Some authors have shown that theophylline increases mucus transport in healthy subjects and patients with chronic bronchitis [8, 16, 31, 36]. However, other investigators have found unconvincing or conflicting results [4, 20, 25]. Therefore, we studied the influence of theophylline on bronchial mucus transport velocity (BTV) in ventilated ICU patients. METHODS. The study was approved by the ethnics committee of our hospital. In a placebo-controlled double-blind study, the effect of therapeutic serum concentrations (10-20 micrograms/ml) of theophylline on BTV in ventilated patients in a surgical ICU was investigated. Group 1 (n = 10) served as controls and received placebo. The patients of group 2 (n = 10) were given intravenous infusions of 5 mg/kg body weight theophylline over 20 min, followed by 1 mg/kg per hour. Before administration of theophylline and 1 h after starting the infusion BTV, serum theophylline concentrations, and arterial blood gases were measured. Heart rate and blood pressure were registered every 5 min. In an additional study, the effect of theophylline on BTV at subtherapeutic serum concentrations (5 micrograms/ml) was investigated. BTV was measured with a small volume (0.05-0.08 ml) of albumin microspheres labeled with technetium-99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronchi via a catheter placed in the inner channel of a fibre-optic bronchoscope. The movement of the microspheres towards the trachea was visualised and recorded using a scintillation camera [10]. RESULTS. The theophylline treatment induced a significant improvement in BTV from 3.8 to 7.6 mm/min in the left main bronchus and from 0.5 to 5.4 mm/min in the right, while placebo was inactive. The increase in BTV, however, was associated with an increase in heart rate; in 3 patients the theophylline infusion had to be stopped because of severe tachycardia. Blood gases and blood pressures did not change. Theophylline at subtherapeutic concentrations had no effect on either BTV or heart rate. CONCLUSIONS. Theophylline at therapeutic concentrations improves bronchial mucus transport in intubated ICU patients. The increase in BTV may be associated with severe tachycardia, and therefore routine application cannot be recommended.

Adrenaline: relationship between infusion rate, plasma concentration, metabolic and haemodynamic effects in volunteers

The present study investigated the relationship between supraphysiological plasma concentrations of adrenaline and the resulting haemodynamic and metabolic effects. Adrenaline was administered at five infusion rates (0.01-0.2 micrograms kg-1 min-1) in an escalating sequence to eight volunteers. The arterial plasma concentration of adrenaline increased from 53 +/- 44 to 4349 +/- 818 ng litre-1 during the highest infusion rate. Typical haemodynamic responses, such as increase in blood pressure and heart rate, were seen. The plasma concentrations of glucose and lactate increased from 5.2 +/- 0.4 to 13.7 +/- 1.3 mmol litre-1 and from 0.9 +/- 0.3 to 4.7 +/- 2.6 mmol litre-1, respectively, during the highest infusion rate without a significant increase in insulin concentration. Non-esterified fatty acids increased from 379 +/- 97 to 1114 +/- 331 mumol litre-1 during the 0.06 microgram kg-1 min-1 infusion rate. Adrenaline had no selective haemodynamic effect. If similar metabolic effects occur in patients during treatment with adrenaline or other sympathomimetics, they may further increase breakdown of energy stores in a situation of increased catabolism, and impair utilization of parenteral nutrition.

[The value of criteria for pneumonia in the diagnosis of a ventilated pneumonia]

Reliable diagnosis of pneumonia in ventilated patients is frequently difficult, since there is no single specific criterion. In the present study, the following diagnostic criteria for pneumonia were checked in 25 ventilated patients: 1. temperature over 38.5 degrees C, 2. leukocytosis over 12,000/mm3, infiltration in the x-ray, 4. positive auscultatory findings, 5. purulent tracheal secretion (TS), 6. positive bacteriological findings (TS). Diagnosis of bacterial pneumonia was assumed if in the bronchoalveolar lavage (BAL) the concentration of a plausible causative organism was greater than or equal to 10(4)/ml and the "Bacterial Index" (BI) was greater than or equal to 6 (16). 15 patients fulfilled more than four criteria for pneumonia. In all patients the concentration of bacteria in the BAL was greater than or equal to 10(4)/ml (median 10(6)/ml, BI: 10). 10 patients fulfilled less than or equal to 4 criteria of pneumonia. In three of the patients, BAL was sterile, in four cases organisms less than 10(4) were isolated; none of these patients received antibiotics and diagnosis of pneumonia was not confirmed in the further course of illness. In three patients, bacteria greater than or equal to 10(4)/ml were isolated (BI 9, 10, 13); they improved under adequate antibiotic therapy. We conclude from these results that "as a rule" more than four of the criteria of pneumonia specified above should be present for diagnosis of pneumonia in ventilated patients in a surgical intensive-care ward. If there is any doubt, BAL should be performed to confirm the diagnosis.

[In vitro drug interactions and their importance in anesthesiologic practice]

The potential for in vitro drug interactions is great in anaesthesiology because of routine intravenous comedication. When the drug is applied directly into (via) the injection port of the cannula most of these interactions are overlooked, whereas others show no visible signs. Chemical interactions depend on pH changes, formation of insoluble salts, oxidation and reduction, complex formation, or hydrolysis. Physical interactions are caused by changing of solvent system polarity, salting out, emulsion cracking or sorption. Solving the problem requires information (1) and precautions in respect of the mode of application (2). (1) Anaesthesiologists should know the most frequent mechanisms. Glucose infusions cannot be considered as safe carrier solutions for admixtures. Pharmacological databases should offer as much information as possible on incompatibility. (2) Injections into a separate line or lumen with a sodium chloride infusion are safe. Admixture is recommended only if compatibility is known.

[The "preoxygenation" special function in mechanical ventilators. Medically necessary and an ergonomic plus?]

Hypoxia-related cardiovascular complications and unnecessary monitor and ventilator alarms are well-known problems during tracheobronchial suctioning. Preoxygenation together with temporary muting of acoustic alarms for tracheobronchial suctioning are provided by a single operational control of the ventilator "Evita", software release 9 (Drägerwerk AG). This integrated function was evaluated in medical and ergonomic respects. METHODS. Thirty tracheobronchial suctioning procedures each, with or without preoxygenation, were evaluated. The subjects were patients in our anesthesiological intensive care unit who were under continuous positive-pressure ventilation with FIO2 between 0.25 and 0.6. They ranged in age from 18 months to 72 years. Each patient served as her/his own control after about 1-h delays. Depending on the preference of the nurse, the procedures were either both on-ventilator (via the catheter port) or both off-ventilator suctionings. Arterial samples for blood gas analyses as well as arterial oxygen saturation (SaO2) determinations were taken before preoxygenation, at the moment of disconnection or opening of the catheter port, at reconnection or closure of the port, and 5 min later. Moreover, the number of changes in position of the performing nurse, the number of acoustic ventilator alarms, and the duration of the procedure were recorded. Finally, assessments of the integrated ventilator feature by the 28 participating nurses were collected both as a score from 1 ("most useful and innovative") to 5 ("completely superfluous and distracting") and as detailed statements. RESULTS. Arterial blood gas results and SaO2 courses differentiated as to procedures with or without preoxygenation as well as on-ventilator and off-ventilator suctioning are shown in Table 1 (values are mean +/- standard deviation). Without preoxygenation, most patients did not exhibit threatening drops in SaO2 (values fell from 98.2%) to 97.0% on the average). Nevertheless, preoxygenation provided an additional safety margin (100% saturation throughout the procedure in all patients). Under certain conditions, e.g., low functional residual capacity as in small children or patients with adult respiratory distress syndrome (in 1 of these cases we observed a SaO2 drop to 87%), it is mandatory. Although occurring far less frequently, unnecessary acoustic alarms were not completely excluded by the integrated function because the ventilator would not recognize the insertion of the suction catheter via the catheter port as the expected disconnection. Thus, coughing was able to trigger the "high airway pressure" alarm. As expressed by an average score of 2.8, approval of the integrated ventilator function prevailed among the involved nursing staff.

[Risk factors in nosocomial pneumonia in intensive care patients. A prospective study to identify high-risk patients]

Sixteen risk factors for nosocomial pneumonia were prospectively studied in 582 intubated patients in a surgical intensive care unit (ICU) to identify patients at particularly high risk. Overall, pneumonias developed in 94 of the patients (16%). Significant risk factors for pneumonia were mechanical ventilation for more than 72 h, impaired consciousness or co-operation, specific therapeutic interventions as a marker of severe underlying diseases (dopamine/dobutamine greater than or equal to 5 micrograms/kg.min, barbiturate therapy for treatment of elevated intracranial pressure, continuous i.v. antiarrhythmic or antihypertensive drugs), and pre-existing pulmonary abnormalities (P less than 0.001). The acquisition of postoperative pneumonia was further associated with male sex, ASA class IV and a history of smoking, but statistical significance was lost after stepwise logistic regression. Longer operative procedures, thoracic or upper abdominal surgery, longer preoperative hospital stay, low serum albumin concentration on admission, prior antibiotics, old age, obesity, low weight, malignant disease, and steroid treatment did not influence the incidence of pneumonia. In this study we were able to identify a subpopulation of intensive care patients at particularly high risk for pneumonia.

[Pneumonia prevention in long-term mechanically ventilated patients: selective skin decontamination according to Stoutenbeek or prevention of colonization according to Unertl? A prospective randomized comparison of both treatments]

In a prospective randomised study, the effects of two different colonisation prophylaxis techniques on colonisation and pulmonary infection were investigated in 40 critically ill patients with long-term ventilatory support (greater than or equal to 4 days). 20 patients were selectively decontaminated with 4 x 100 g polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and with an antimicrobial sticky paste in the oropharynx (group I). 20 patients received 50 mg of polymyxin B and 80 mg of gentamicin dissolved in 10 ml of 0.9% saline at 6 h intervals into nose, oropharynx and stomach as well as 300 mg of amphotericin B in the oropharynx only (group II). All patients received cefotaxime systemically in the first 3 days. In group I gram-negative aerobic bacteria in the pharynx decreased from 35% to 0%, in group II from 40% to 10% and in the rectum from 80% to 61% (10% in the second week) in Group I and from 100% to 73% (33% in the second week) in group II. The decrease in gram-negative microorganisms was accompanied by an increase in the frequency of Staphylococcus epidermidis. In group I, two patients developed pneumonia and two patients urinary tract infections, in group II two patients suffered from pneumonia and 3 patients urinary tract infections. Both regimes are effective methods of prophylaxis for lowering colonisation with gram-negative aerobic bacteria and the frequency of pneumonia in patients requiring long-term mechanical ventilation. A possible selection of gram-positive bacteria must be appropriately monitored.

[Causes of death in intensive care surgical patients. A prospective study]

Infection and sepsis are generally considered as causally related to death in intensive care unit (ICU) patients, but in several studies a decrease in infection rates was not associated with lower mortality. We therefore investigated the causes of death in surgical ICU patients, with special regard to the relationship between infection and mortality. MATERIAL AND METHODS. During the investigation period of 6 months, 502 patients were treated in the ICU (cardiac surgery: 222, thoracoabdominal surgery: 125, vascular surgery: 84, others: 14). In all patients each antibiotic therapy and infection was documented, as was the sepsis score. Definitions of infection and bacteriological monitoring were described in detail previously. In all deaths, attention was paid to an infection that was causally related to or contributed to death. In unclear cases a postmortem examination was performed. RESULTS. Forty-two patients died (8.4%). During the first 4 days 23 patients died, 11 within 24 h, because of severe trauma with severe underlying disease (main reason for death: cardiac 30%, cerebral 32%). Infections were not significant in these patients. Nineteen patients suffered from 1 or more infections (total 30). They died after a median of 16 days. The leading cause of death was multiple organ failure. In 7 of these patients a life-threatening infection was the reason for admission and, later, death. In 8 patients a nosocomial infection was causally related to or contributed to death. In the 4 other patients a postmortem examination excluded an infection as being responsible for death. DISCUSSION. More than one-half of the deaths were caused by severe trauma or severe underlying disease. Nosocomial infections could only be related to death in 1.6% of the 502 treated ICU patients. The influence of new therapeutic regimens on infection and mortality can therefore only be investigated in multicenter trials.

[The provision and perioperative transfusion of erythrocyte concentrates]

A previously used order schedule for procuring blood concentrates was reviewed, as the need for blood had changed due to the application of blood saving methods. Furthermore, the indication to blood transfusion has been reduced as a result of the potential danger of infection with AIDS. In 1035 patients, we compared the number of preoperatively ordered with the number of perioperatively transfused units of blood. In addition, we documented the factors which lead to increased blood ordering. The relation between ordered and transfused units of blood in total was 596/97 (Urology: 392/78, Gynaecology: 179/18, ENT and Ophthalmology: 25/1). Anticoagulation, anaemia, secondary illnesses and specific surgical problems have been identified as factors leading to increased blood ordering. As to many units of blood are being crossmatched without being transfused, we developed a revised blood ordering schedule. According to this schedule for certain surgical procedures typing and screening only should be done rather than crossmatching.

Investigation by scintigraphic methods of neutrophil kinetics under normal and septic shock conditions in the experimental baboon model

The purpose of this study was the correlation of neutrophil kinetics with the pathogenic course of septic shock in the baboon model. Radioactively labelled neutrophils were traced in vivo in normal baboons (n = 6) and in Escherichia coli-infected baboons, which were reinjected with labelled autologous neutrophils either 2 h after the onset of the E. coli infusion (procedure A) (n = 3) or simultaneously with the infusion (procedure B) (n = 3). Cell isolation was done according to a method developed in this laboratory. The cells were labelled with tropolonate In 111, resuspended in 1-2 ml plasma and reinjected. One-minute images were taken every 5th min and then hourly for 4 h with a gamma camera and analysed with a data processor. Time-activity curves were obtained for neutrophil washout from the lungs and neutrophil accumulation in the liver and spleen. These curves were compared for normal baboons and for those treated according to procedures A and B. A significant retention of neutrophils in the lungs of baboons with E. coli-induced septic shock was noted as well as an abnormally slow rate of accumulation in the liver and spleen. It also seems that any lung injury which could be attributed to changes in neutrophil behaviour should be traced back to events during the early exposure of neutrophils to bacterial infection.

[Routine throat swabs in artificially ventilated patients: meaningful bacteriologic monitoring or a needless procedure?]

Organisms colonizing the oropharynx of patients in the intensive care unit (ICU) play an important role in the development of nosocomial infection. Thus, routine throat swab specimens of ICU patients are recommended to screen for potential pathogens [20]. This investigation was designed to clarify the value of throat swabs taken in addition to tracheal aspirates, urine cultures, and wound swabs with regard to antibiotic therapy in patients with pneumonia and other infections. MATERIALS AND METHODS. A total 627 intubated patients were examined in a surgical ICU during a 12 month period. Pharyngeal swabs, tracheal aspirates, urine cultures, and-if necessary-swabs from wounds and drains were taken immediately after admission to the ICU and routinely thereafter three times each week.

DEFINITIONS

Early onset pneumonia: pneumonia occurring within 4 days; late onset pneumonia: pneumonia occurring after the 4th day. Intra-abdominal infection: diffuse or localized peritonitis or abdominal abscess. Wound infection: soft-tissue or bone infection. Corresponding organisms: the same species of bacteria with the same sensitivity pattern (Table 1). RESULTS. Sixty-eight of the patients developed pneumonia. 37 had early onset pneumonia. In 22 of these patients, throat and tracheal specimens had been obtained 2-3 days before the pneumonia was diagnosed. In these specimens, the causative organisms for the subsequent pneumonia were isolated in the throat in 60% of cases and in tracheal secretions in 40% (Table 3). In 35 patients with late onset pneumonia, the causative bacteria were found in 66% of the cases in the throat swabs obtained 2-3 days before the diagnosis was made, in tracheal aspirates in 74% (Table 4). Throat swabs obtained at admission to the ICU from already infected patients or from patients who developed an infection were significantly more colonized with potentially pathogenic micro-organisms (Fig. 1). In 4 patients with early onset pneumonia the results of the throat swab cultures influenced antibiotic therapy, but none of the throat culture results influenced the therapy of the patients with late onset pneumonia or other infections (intra-abdominal infection, wound infection, urinary tract infection). CONCLUSIONS. The throat swab taken at admission may indicate patients at risk for infection. However, throat cultures taken routinely thereafter, parallel with tracheal aspirate cultures, do not provide additional information that is diagnostically or therapeutically helpful. Therefore, throat swab cultures are not necessary for routine bacteriological monitoring. For the prevention of colonization by local administration of antimicrobial agents, regular throat cultures are mandatory.