Pathogenic pathways of renal damage in Fabry nephropathy: interplay between immune cell infiltration, apoptosis and fibrosis

BACKGROUND

Fabry nephropathy is a consequence of the deposition of globotriaosylceramide, caused by deficient GLA enzyme activity in all types of kidney cells. These deposits are perceived as damage signals leading to activation of inflammation resulting in renal fibrosis. There are few studies related to immunophenotype characterization of the renal infiltrate in kidneys in patients with Fabry disease and its relationship to mechanisms of fibrosis. This work aims to quantify TGF-β1 and active caspase 3 expression and to analyze the profile of cells in inflammatory infiltration in kidney biopsies from Fabry naïve-patients, and to investigate correlations with clinical parameters.

METHODS

Renal biopsies from 15 treatment-naïve Fabry patients were included in this study. Immunostaining was performed to analyze active caspase 3, TGF-β1, TNF-α, CD3, CD20, CD68 and CD163. Clinical data were retrospectively gathered at time of kidney biopsy.

RESULTS

Our results suggest the production of TNFα and TGFβ1 by tubular cells, in Fabry patients. Active caspase 3 staining revealed that tubular cells are in apoptosis, and apoptotic levels correlated with clinical signs of chronic kidney disease, proteinuria, and inversely with glomerular filtration rate. The cell infiltrates consisted of macrophages, T and B cells. CD163 macrophages were found in biopsy specimens and their number correlates with TGFβ1 and active caspase 3 tubular expression.

CONCLUSIONS

These results suggest that CD163+ cells could be relevant mediators of fibrosis in Fabry nephropathy, playing a role in the induction of TGFβ1 and apoptotic cell death by tubular cells. These cells may represent a new player in the pathogenic mechanisms of Fabry nephropathy.

Major cardiovascular adverse events in Fabry disease patients receiving agalsidase alfa

Cardiovascular mortality (CVM) has become the major contributor to overall Fabry disease (FD) mortality in the enzyme replacement therapy (ERT) era. Our objectives were to describe causes and potential predictors of mortality in FD adult patients in Argentina, and to assess risk of major adverse cardiovascular events (MACE) in the ERT era. We retrospectively studied 93 consecutive patients treated with alphagalactosidase A (median follow up: 9.5 years from start of ERT). Mean age at ERT starting was 35 ± 16.3 years. Prevalence of cardiomyopathy and renal disease reached 47% and 41%, respectively. Eleven subjects (11.8%, 95% CI: 5-18%) died during follow up (1.24/100 patient-years). Mean overall survival was 71 years (95% CI: 66-75 years). Seven cases were considered as CVM; main causes were sudden death and stroke. Risk of MACE was 14% (95% CI: 6.9-21.1%; 1.47 events/100 patient-years from start of ERT). All but 2 subjects had at least one comorbid cardiovascular risk factor; however, 86% of patients remained free of MACE during follow-up. CVM remained low and our study was underpowered for detection of predictors of mortality, but it is worth noting that age at diagnosis and ERT starting, left ventricular mass index and renal disease trended to correlate with CVM. Prevalence of hypertension, diabetes and dyslipidemia were lower in FD patients when compared to population level data. As in the Argentinean general population, CVM was the leading cause of mortality among this cohort of consecutive FD patients treated with agalsidase alfa.

Dicer regulates Nosema ceranae proliferation in honeybees

Nosema ceranae is a microsporidian parasite that infects the honeybee midgut epithelium. The protein-coding gene Dicer is lost in most microsporidian genomes but is present in N. ceranae. By feeding infected honeybees with small interfering RNA targeting the N. ceranae gene coding Dicer (siRNA-Dicer), we found that N. ceranae spore loads were significantly reduced. In addition, over 10% of total parasite protein-coding genes showed significantly divergent expression profiles after siRNA-Dicer treatment. Parasite genes for cell proliferation, ABC transporters and hexokinase were downregulated at 3 days postinfection, a key point in the middle of parasite replication cycles. In addition, genes involved in metabolic pathways of honeybees and N. ceranae showed significant co-expression. Furthermore, the siRNA-Dicer treatment partly reversed the expression patterns of honeybee genes. The honeybee gene mucin-2-like showed significantly upregulation in the siRNA-Dicer group compared with the infection group continually at 4, 5 and 6 days postinfection, suggesting that the siRNA-Dicer feeding promoted the strength of the mucus barrier resulted from interrupted parasite proliferation. As the gene Dicer broadly regulates N. ceranae proliferation and honeybee metabolism, our data suggest the RNA interference pathway is an important infection strategy for N. ceranae.

Nanoscale Spin Manipulation with Pulsed Magnetic Gradient Fields from a Hard Disc Drive Writer

The individual and coherent control of solid-state based electron spins is important covering fields from quantum information processing and quantum metrology to material research and medical imaging. Especially for the control of individual spins in nanoscale networks, the generation of strong, fast, and localized magnetic fields is crucial. Highly engineered devices that demonstrate most of the desired features are found in nanometer size magnetic writers of hard disk drives (HDD). Currently, however, their nanoscale operation in particular comes at the cost of excessive magnetic noise. Here, we present HDD writers as a tool for the efficient manipulation of single as well as multiple spins. We show that their tunable gradients of up to 100 μT/nm can be used to spectrally address individual spins on the nanoscale. Their gigahertz bandwidth allows one to switch control fields within nanoseconds, faster than characteristic time scales such as Rabi and Larmor periods, spin-spin couplings, or optical transitions, thus extending the set of feasible spin manipulations. We used the fields to drive spin transitions through nonadiabatic fast passages or to enable the optical readout of spin states in strong misaligned fields. Building on these techniques, we further apply the large magnetic field gradients for microwave selective addressing of single spins and show its use for the nanoscale optical colocalization of two emitters.

Microwave-Assisted Cross-Polarization of Nuclear Spin Ensembles from Optically Pumped Nitrogen-Vacancy Centers in Diamond

The ability to optically initialize the electronic spin of the nitrogen-vacancy (NV) center in diamond has long been considered a valuable resource to enhance the polarization of neighboring nuclei, but efficient polarization transfer to spin species outside the diamond crystal has proven challenging. Here we demonstrate variable-magnetic-field, microwave-enabled cross-polarization from the NV electronic spin to protons in a model viscous fluid in contact with the diamond surface. Further, slight changes in the cross-relaxation rate as a function of the wait time between successive repetitions of the transfer protocol suggest slower molecular dynamics near the diamond surface compared to that in bulk. This observation is consistent with present models of the microscopic structure of a fluid and can be exploited to estimate the diffusion coefficient near a solid-liquid interface, of importance in colloid science.

Fatty Acid Metabolism in Symptomatic Patients with Mitral Valve Prolapse but without Coronary Artery Disease - Comparison with 201 Tl Myocardial Perfusion Scintigraphy

Using 123l-ω-heptadecanoic acid (HDA) and 201TI, respectively, myocardial fatty acid metabolism and perfusion were studied in 51 symptomatic patients with mitral valve prolapse (MVP) as diagnosed by ventriculography, and no evidence of coronary artery disease. Twelve subjects with normal coronary arteries and normal ventriculogram served as a control group for the evaluation of elimination kinetics of HDA. In the control group, the mean elimination halflife was 26.1 ± 3.6 min, whereas the patients with MVP had a mean value of ± 6.4 min. In patients with MVP, a high incidence concerning abnormalities of accumulation and/or elimination of HDA occurred, namely accumulation defects in 31 % and both prolonged and shortened elimination half-lives in 16% and 29%, respectively. Myocardial perfusion scintigraphy using 201TI showed abnormalities in 76%. Correlations were found between decreased uptake of HDA and prolonged elimination half-life as well as defects by 201TI, presumably due to ischemia based on small-vessel disease or abnormalities of cellular metabolism.

[Noninvasive Mechanical Ventilation in Acute Respiratory Failure]

The non-invasive ventilation (NIV) is widespread in the clinical medicine and has attained meanwhile a high value in the clinical daily routine. The application of NIV reduces the length of ICU stay and hospitalization as well as mortality of patients with hypercapnic acute respiratory failure. Patients with acute respiratory failure in context of a cardiopulmonary edema should be treated in addition to necessary cardiological interventions with continuous positive airway pressure (CPAP) or NIV. In case of other forms of acute hypoxaemic respiratory failure it is recommended the application of NIV to be limited to mild forms of ARDS as the application of NIV in severe forms of ARDS is associated with higher rates of treatment failure and mortality. In weaning process from invasive ventilation the NIV reduces the risk of reintubation essentially in hypercapnic patients. A delayed intubation of patients with NIV failure leads to an increase of mortality and should therefore be avoided. With appropriate monitoring in intensive care NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency. Furthermore NIV can be useful within palliative care for reduction of dyspnea and improving quality of life. The aim of the guideline update is, taking into account the growing scientific evidence, to outline the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.

High-precision nanoscale temperature sensing using single defects in diamond

Measuring local temperature with a spatial resolution on the order of a few nanometers has a wide range of applications in the semiconductor industry and in material and life sciences. For example, probing temperature on the nanoscale with high precision can potentially be used to detect small, local temperature changes like those caused by chemical reactions or biochemical processes. However, precise nanoscale temperature measurements have not been realized so far owing to the lack of adequate probes. Here we experimentally demonstrate a novel nanoscale temperature sensing technique based on optically detected electron spin resonance in single atomic defects in diamonds. These diamond sensor sizes range from a micrometer down to a few tens of nanometers. We achieve a temperature noise floor of 5 mK/Hz(1/2) for single defects in bulk sensors. Using doped nanodiamonds as sensors the temperature noise floor is 130 mK/Hz(1/2) and accuracies down to 1 mK for nanocrystal sizes and therefore length scales of a few tens of nanometers. This combination of precision and position resolution, combined with the outstanding sensor photostability, should allow the measurement of the heat produced by chemical interactions involving a few or single molecules even in heterogeneous environments like cells.

[Guidelines for diagnosis, monitoring and treatment of Fabry disease]

Fabry disease is an X-linked hereditary lysosomal storage disorder caused by deficiency of the enzyme alpha-galactosidase A. Knowledge about this disease, and its medical management, has made remarkable progress in the last decade, including the development of its specific treatment. This guide was developed by medical professionals from various specialties involved in the care of patients with Fabry disease. The discussion and analysis of the available scientific evidence, coupled with the experience of each of the participants, has allowed us to develop the concepts included in this guide in order to provide a useful tool for all professionals who care for patients with Fabry disease.

High-dynamic-range magnetometry with a single nuclear spin in diamond

Sensors based on the nitrogen-vacancy defect in diamond are being developed to measure weak magnetic and electric fields at the nanoscale. However, such sensors rely on measurements of a shift in the Lamor frequency of the defect, so an accumulation of quantum phase causes the measurement signal to exhibit a periodic modulation. This means that the measurement time is either restricted to half of one oscillation period, which limits accuracy, or that the magnetic field range must be known in advance. Moreover, the precision increases only slowly (as T(-0.5)) with measurement time T (ref. 3). Here, we implement a quantum phase estimation algorithm on a single nuclear spin in diamond to combine both high sensitivity and high dynamic range. By achieving a scaling of the precision with time to T(-0.85), we improve the sensitivity by a factor of 7.4 for an accessible field range of 16 mT, or, alternatively, we improve the dynamic range by a factor of 130 for a sensitivity of 2.5 µT Hz(-1/2). Quantum phase estimation algorithms have also recently been implemented using a single electron spin in a nitrogen-vacancy centre. These methods are applicable to a variety of field detection schemes, and do not require quantum entanglement.

The use of the Foley Airway Stylet Tool® to guide tracheal intubations through an intubating laryngeal mask airway

BACKGROUND

Blind insertion of endotracheal tubes through the intubating laryngeal mask airway (ILMA) is unsuccessful in almost 50% of cases on the first attempt, with an overall success rate of approximately 90%. We used a portable fiber optic device (Foley Airway Stylet Tool® FAST) to detect the reasons for failed intubations and tested its use in facilitating endotracheal tube placement.

METHODS

Thirty patients without anticipated intubation difficulties participated in the study. The fiber optic device was fastened with its tip at the end of the endotracheal tube, and both instruments were advanced through the previously inserted ILMA past the lifting bar. The view was scored in the following manner: I, full view of laryngeal inlet; II, partial vocal cords, arytenoids, epiglottis; III, epiglottis; IV, no laryngeal structures identifiable. The ILMA was adjusted for the best obtainable view, which was scored, and the endotracheal tube was inserted.

RESULTS

The initial laryngeal view was I in four patients, II in eighteen patients, III in one patient and IV in seven patients. The best view after corrective maneuvers was I in twenty-seven patients, II in two patients and IV in one patient. First attempt tracheal intubations were successful in twenty-seven (90%) patients; two patients required a second attempt.

CONCLUSION

A grade II view or worse indicated misalignment of the ILMA with the glottis. An endotracheal tube inserted blindly through the misaligned ILMA will impinge on and potentially damage laryngeal structures. The use of a portable fiber optic device can help reduce the failure rate of endotracheal intubations by utilizing ILMA in emergent situations.

Violation of a temporal bell inequality for single spins in a diamond defect center

Quantum nonlocality has been experimentally investigated by testing different forms of Bell's inequality, yet a loophole-free realization has not been achieved up to now. Much less explored are temporal Bell inequalities, which are not subject to the locality assumption, but impose a constraint on the system's time correlations. In this Letter, we report on the experimental violation of a temporal Bell's inequality using a nitrogen-vacancy (NV) defect in diamond and provide a novel quantitative test of quantum coherence. Such a test requires strong control over the system, and we present a new technique to initialize the electronic state of the NV with high fidelity, a necessary requirement also for reliable quantum information processing and/or the implementation of protocols for quantum metrology.

Dark states of single nitrogen-vacancy centers in diamond unraveled by single shot NMR

The nitrogen-vacancy (NV) center in diamond is supposed to be a building block for quantum computing and nanometer-scale metrology at ambient conditions. Therefore, precise knowledge of its quantum states is crucial. Here, we experimentally show that under usual operating conditions the NV exists in an equilibrium of two charge states [70% in the expected negative (NV-) and 30% in the neutral one (NV0)]. Projective quantum nondemolition measurement of the nitrogen nuclear spin enables the detection even of the additional, optically inactive state. The nuclear spin can be coherently driven also in NV0 (T1≈90  ms and T2≈6  μs).

Influence of preparation form, luting space setting and cement type on the marginal and internal fit of CAD/CAM crown copings

PURPOSE

To evaluate the influence of two different tooth preparation forms, two luting space settings and two cement types on the marginal and internal adaptation of all-ceramic crown copings produced using Cerec3 CAD/CAM system.

MATERIALS AND METHODS

Forty working stone dies were made from two metal master casts (1. Tooth 36: with anatomic occlusal reduction, 2. Tooth 36: with flat occlusal reduction). Forty crown copings were milled using Vita In-Ceram 2000 YZ: 20 with an luting space settings of 0 = 100 microm and 20 with -50 = 50 microm. Copings were cemented using two cements (zinc phosphate cement, P21: Panavia21), then embedded and sectioned bucco-lingually and mesio-distally. Widths of marginal and internal gaps were measured using a light microscope at magnification of 40X. Data were submitted to one-way ANOVA, and statistical significance was set at p < 0.05.

RESULTS

Copings with flat occlusal reduction and luting space settings of 100 pm had a better internal and marginal fit compared with copings with anatomic occlusal reduction and luting space settings of 50 microm, regardless of the cement used. P21 showed a significantly better fit compared with zinc phosphate cement.

CONCLUSION

The presented Cerec3 CAD/CAM system can provide a marginal and internal adaptation which is comparable to that of conventional cast and conventional all-ceramic crowns.

Reproductive division of labour and thelytoky result in sympatric barriers to gene flow in honeybees (Apis mellifera L.)

Determining the extent and causes of barriers to gene flow is essential for understanding sympatric speciation, but the practical difficulties of quantifying reproductive isolation remain an obstacle to analysing this process. Social parasites are common in eusocial insects and tend to be close phylogenetic relatives of their hosts (= Emery's rule). Sympatric speciation caused by reproductive isolation between host and parasite is a possible evolutionary pathway. Socially parasitic workers of the Cape honeybee, Apis mellifera capensis, produce female clonal offspring parthenogenetically and invade colonies of the neighbouring subspecies A. m. scutellata. In the host colony, socially parasitic workers can become pseudoqueens, an intermediate caste with queenlike pheromone secretion. Here, we show that over an area of approximately 275.000 km², all parasitic workers bear the genetic signature of a clone founded by a single ancestral worker genotype. Any gene flow from the host to the parasite is impossible because honeybee workers cannot mate. Gene flow from the parasite to the host is possible, as parasitic larvae can develop into queens. However, we show that despite sympatric coexistence for more than a decade, gene flow between host and social parasite (F(st) = 0.32) and hybridizations (0.71%) are rare, resulting in reproductive isolation. Our data suggest a new barrier to gene flow in sympatry, which is not based on assortative matings but on thelytoky and reproductive division of labour in eusocial insects, thereby suggesting a new potential pathway to Emery's rule.

Novel approaches to incorporating pharmacoeconomic studies into phase III clinical trials for Alzheimer's disease

The societal and individual costs of Alzheimer's disease are significant, worldwide. As the world ages, these costs are increasing rapidly, while health systems face finite budgets. As a result, many regulators and payers will require or at least consider phase III cost-effectiveness data (in addition to safety and efficacy data) for drug approval and reimbursement, increasing the risks and costs of drug development. Incorporating pharmacoeconomic studies in phase III clinical trials for Alzheimer's disease presents a number of challenges. We propose several specific suggestions to improve the design of pharmacoeconomic studies in phase III clinical trials. We propose that acute episodes of care are key outcome measures for pharmacoeconomic studies. To improve the possibility of detecting a pharmacoeconomic impact in phase III, we suggest several strategies including; study designs for enrichment of pharmacoeconomic outcomes that include co-morbidity of patients; reducing variability of care that can affect pharmacoeconomic outcomes through standardized care management; employing administrative claims data to better capture meaningful pharmacoeconomic data; and extending clinical trials in open label follow-up periods in which pharmacoeconomic data are captured electronically by administrative claims. Specific aspects of power analysis for pharmacoeconomic studies are presented. The particular pharmacoeconomic challenges caused by the use of biomarkers in clinical trials, the increasing use of multinational studies, and the pharmacoeconomic challenges presented by biologicals in development for Alzheimer's disease are discussed. In summary, since we are entering an era in which pharmacoeconomic studies will be essential in drug development for supporting regulatory approval, payor reimbursement and integration of new therapies into clinical care, we must consider the design and incorporation of pharmacoeconomic studies in phase III clinical trials more seriously and more creatively.

Misdiagnosis in Fabry disease

OBJECTIVE

To evaluate the most frequent diagnostic errors in patients with Fabry disease and the types of specialists most often consulted before diagnosis.

STUDY DESIGN

We evaluated 45 consecutive symptomatic patients with Fabry disease confirmed by enzymatic tests in males and genetic studies in females. We interviewed the patients, their mothers, or both regarding symptoms, age at onset, medical consultations, and recommended treatments.

RESULTS

Neuropathic pain was the most frequent initial complaint, and rheumatic fever was the most common diagnosis. Seven patients were treated with penicillin for many years. Ten patients sought medical consultation because of abdominal pain and were diagnosed with food intoxication or nonspecific pain. Six patients sought consultation because of anhidrosis, considered of unclear cause, and angiokeratomas diagnosed as petechiae. Internists and pediatricians were the most frequently consulted specialists. The correct diagnosis was obtained after a mean of 19.7 years.

CONCLUSIONS

Pediatricians as well as internists commonly misdiagnose Fabry disease. Neuropathic pain, hypohidrosis, and recurrent abdominal pain in childhood or adolescence should include Fabry disease in the differential diagnosis to facilitate earlier diagnosis and treatment of these patients.

High sensitivity magnetic imaging using an array of spins in diamond

We present a solid state magnetic field imaging technique using a two-dimensional array of spins in diamond. The magnetic sensing spin array is made of nitrogen vacancy (NV) centers created at shallow depths. Their optical response is used for measuring external magnetic fields in close proximity. Optically detected magnetic resonance is read out from a 60 x 60 microm(2) field of view in a multiplexed manner using a charge coupled device camera. We experimentally demonstrate full two-dimensional vector imaging of the magnetic field produced by a pair of current carrying microwires. The presented wide-field NV magnetometer offers, in addition to its high magnetic sensitivity and vector reconstruction, an unprecedented spatiotemporal resolution and functionality at room temperature.

Susceptibility of Aethina tumida (Coleoptera: Nitidulidae) larvae and pupae to entomopathogenic nematodes

In this study, we evaluated the potential use of entomopathogenic nematodes as a control for the beetle Aethina tumida Murray (Coleoptera: Nitidulidae). In particular, we conducted 1) four screening bioassays to determine nematode (seven species, 10 total strains tested) and application level effects on A. tumida larvae and pupae, 2) a generational persistence bioassay to determine whether single inoculations with nematodes would control multiple generations of A. tumida larvae in treated soil, and 3) a field bioassay to determine whether the nematodes would remain efficacious in the field. In the screening bioassays, nematode efficacy varied significantly by tested nematode and the infective juvenile (IJ) level at which they were applied. Although nematode virulence was moderate in screening bioassays 1-3 (0-68% A. tumida mortality), A. tumida mortality approached higher levels in screening bioassay 4 (nearly 100% after 39 d) that suggest suitable applicability of some of the test nematodes as field controls for A. tumida. In the generational persistence bioassay, Steinernema riobrave Cabanillas, Poinar & Raulston 7-12 strain and Heterorhabditis indica Poinar, Karunaka & David provided adequate A. tumida control for 19 wk after a single soil inoculation (76-94% mortality in A. tumida pupae). In the field bioassay, the same two nematode species also showed high virulence toward pupating A. tumida (88-100%) mortality. Our data suggest that nematode use may be an integral component of an integrated pest management scheme aimed at reducing A. tumida populations in bee colonies to tolerable levels.

New approaches to catheter navigation for interventional radiology simulation

For over 20 years, interventional methods have improved the outcomes of patients with cardiovascular disease. However, these procedures require an intricate combination of visual and tactile feedback and extensive training. In this paper, we describe a series of novel approaches that have led to the development of a high-fidelity simulation system for interventional neuroradiology. In particular, we focus on a new approach for real-time deformation of devices such as catheters and guidewires during navigation inside complex vascular networks. This approach combines a real-time incremental Finite Element Model (FEM), an optimization strategy based on substructure decomposition, and a new method for handling collision response in situations where the number of contact points is very large. We also briefly describe other aspects of the simulation system, from patient-specific segmentation to the simulation of contrast agent propagation and fast volume-rendering techniques for generating synthetic X-ray images in real time. Although currently targeted at stroke therapy, our results are applicable to the simulation of any interventional radiology procedure.

A survey of U.S. and Canadian oncologists’ attitudes toward the cost, cost-effectiveness (CE), and reimbursement of cancer drugs

9502

Background: Drug costs and reimbursement issues offer significant challenges to U.S. and Canadian oncologists even though they practice in substantially different health care systems. However, little is known about the attitudes of American and Canadian oncologists towards these issues. Methods: We surveyed 1,379 U.S. and 356 Cdn oncologists to assess their attitudes to cancer drug costs, CE and reimbursement policies. Results: Response rate was 57% in the U.S. and 48% in Canada. Oncologists in both countries stated that patients' “out-of-pocket” drug costs influenced their treatment recommendations (84% U.S., 80% Cdn respondents). Most respondents felt that every patient should have access to effective cancer treatments regardless of cost (66% US; 54% Cdn), while 59% of U.S. and 72% of Cdn and respondents believed that patients should only have access to effective cancer treatments that provided “good value for money.” 70% of U.S. and 64% Cdn respondents felt that <$100,000 per life year gained was a reasonable definition of “good value for money” but less than half of respondents (42% US, 49% Cdn) felt well prepared to interpret and use CE information in their treatment decisions. A majority of respondents (57% US, 69% Cdn) felt government price controls for cancer drugs are needed while a minority felt that more cost-sharing by patients was needed (29% US, 37% Cdn). Most oncologists felt that evaluating whether a drug provides “good value” should be overseen by an independent non-profit agency (57% US, 71% Cdn) or physicians (61% US and Cdn); in contrast, few believed that government (21% US, 33% Cdn), patients (36% US, 37% Cdn) or insurance companies (6% US, 10% Cdn) should determine “good value”. 79% of U.S. and 69% of Cdn respondents felt more use of CE data in coverage and reimbursement decisions is needed. Conclusions: Oncologists in the U.S. and Canada share many similar attitudes to cancer drug costs, CE, and reimbursement policies despite differences in their health care systems. In both countries, oncologists favor more use of CE information.

No significant financial relationships to disclose.

Low temperature studies of the excited-state structure of negatively charged nitrogen-vacancy color centers in diamond

We report a study of the 3E excited-state structure of single negatively charged nitrogen-vacancy (NV) defects in diamond, combining resonant excitation at cryogenic temperatures and optically detected magnetic resonance. A theoretical model is developed and shows excellent agreement with experimental observations. In addition, we show that the two orbital branches associated with the 3E excited state are averaged when operating at room temperature. This study leads to an improved physical understanding of the NV defect electronic structure, which is invaluable for the development of diamond-based quantum information processing.

[Problematic of intra-abdominal pressure measurement]

Intra-abdominal hypertension (intra-abdominal pressure, IAP>12 mmHg) is observed in more than 30% of critically ill patients and is of major prognostic relevance. Unfortunately, clinical examination alone does not allow the IAP to be estimated with sufficient accuracy. Consequently, IAP monitoring should be considered if risk factors for intra-abdominal hypertension are present in order to enable early therapeutic intervention. A technically simple estimation of IAP is possible by intravesical pressure measurements. Alternatively, intragastric pressure can be measured continuously and IAP changes can be detected rapidly. In addition the development of IAP values over time can be appreciated more comprehensively compared to single snapshot-like measurements. The goal of IAP monitoring is not to keep the IAP below a certain threshold, but rather to establish a sufficient abdominal perfusion pressure [APP=mean arterial pressure (MAP)-IAP] of 50-60 mmHg. However, no data have yet been provided showing that the routine use of IAP monitoring and APP targeted therapy is able to improve the prognosis of critically ill patients.

Response to Comment on "Multipartite Entanglement Among Single Spins in Diamond"

Our study reported entanglement among single spins in diamond. Lovett and Benjamin argue that three of six described entangled states were not achieved. Here, we explain our choice of entangled states and discuss their importance for quantum information processing. We also show that the eigenstates discussed by Lovett and Benjamin, although formally entangled and routinely generated in our experiments, cannot be used to detect nonlocal correlations.

[Non-invasive ventilation as treatment for acute respiratory insufficiency. Essentials from the new S3 guidelines]

BACKGROUND

Scientific evidence is accumulating that non-invasive ventilation (NIV) may be beneficial for different patient groups with acute respiratory insufficiency (ARI). The aim of the new S3 guidelines is to propagate evidence-based knowledge about the indications and limitations of NIV in clinical practice.

METHODS

A total of 28 experts from 12 German medical societies were involved in the process of development of the present guidelines. These experts systematically analyzed approximately 2,900 publications. Finally, the recommendations were discussed and approved in two consensus conferences.

RESULTS

In hypercapnic ARI, NIV reduces the length of stay and mortality during intensive care treatment [grade A recommendation (A)]. Patients with cardiopulmonary edema should be treated with continuous positive airway pressure (CPAP) or NIV (A). For immunocompromized patients with ARI, NIV reduces the mortality (A). In patients with postextubation respiratory failure and during weaning from mechanical ventilation, NIV reduces the risk of reintubation (A). For patients who decline to be ventilated invasively, NIV may be an acceptable alternative (B). Non-invasive ventilation can also successfully be used in pediatric patients with ARI caused by different reasons (C). In acute respiratory distress syndrome (ARDS) NIV cannot generally be recommended because the failure rate is relatively high.

CONCLUSION

Non-invasive ventilation is still not as widely implemented in clinical medicine as would be expected on the basis of the scientific literature. The aim of the present guidelines is to further propagate NIV for the treatment of ARI.

Dynamic polarization of single nuclear spins by optical pumping of nitrogen-vacancy color centers in diamond at room temperature

We report a versatile method to polarize single nuclear spins in diamond, based on optical pumping of a single nitrogen-vacancy (NV) defect and mediated by a level anticrossing in its excited state. A nuclear-spin polarization higher than 98% is achieved at room temperature for the 15N nuclear spin associated with the NV center, corresponding to microK effective nuclear-spin temperature. We then show simultaneous initialization of two nuclear spins in the vicinity of a NV defect. Such robust control of nuclear-spin states is a key ingredient for further scaling up of nuclear-spin based quantum registers in diamond.

Temporal coherence of photons emitted by single nitrogen-vacancy defect centers in diamond using optical Rabi-oscillations

Photon interference among distant quantum emitters is a promising method to generate large scale quantum networks. Interference is best achieved when photons show long coherence times. For the nitrogen-vacancy defect center in diamond we measure the coherence times of photons via optically induced Rabi oscillations. Experiments reveal a close to Fourier-transform (i.e., lifetime) limited width of photons emitted even when averaged over minutes. The projected contrast of two-photon interference (0.8) is high enough to envisage applications in quantum information processing. We report 12 and 7.8 ns excited state lifetimes depending on the spin state of the defect.

[Nutrition and exercise of schoolchildren. Results of a cross-sectional study at the Lessing Gymnasium (secondary) school in Mannheim, Germany]

BACKGROUND AND OBJECTIVES

During the last few years there have been many articles in various newspapers about the unhealthy nutrition of children. It was the aim of this study to find out about the state of nutrition and exercise among the children at our school, a Gymnasium (secondary or grammar school) in Mannheim, Germany.

METHODS

We distributed questionnaires to 729 fellow pupils at the school to get some data/information about their exercise, nutrition and leisure activities. We developed a point-based system to record the quality of the food eaten; the time spent on sports, playing musical instruments; looking at television (TV) etc. or using the computer; and other leisure activities (e.g. reading, meeting friends, playing games).

RESULTS

84% of completed questionnaires were returned (98% of those sent to pupils in the lower forms). Food served at our school was reasonably good, but could have been improved by having a proper dining room or cafeteria. The situation regarding exercise tended to get worse in the younger pupils, because the school day has been lengthened. We found gender-related differences between school marks and other parameters. There was a positive relationship between good marks and a low [normal?] body mass index (BMI) and a negative effect on nutrition/exercise of hours spent watching TV or on the computer (PC). We also found a strong correlation in girls between school marks and their leisure. The number of points for wholesome meals, how much time the pupils spent on sports and music led to better school marks. Pupils of the lower grades exercised much less than older ones.

CONCLUSION

Body weight index and their TV/computer time had similar effects in girls and boys. A low BMI correlated with better school marks, while high TV/PC time worsened them At our school relatively few pupils were overweight. Good nutrition and good amounts of exercise correlated positively with good marks. The amount of exercise taken by the pupils decreased as they advanced to the higher grades.

Pheromonal dominance and the selection of a socially parasitic honeybee worker lineage (Apis mellifera capensis Esch.)

The recent invasion by self-replicating socially parasitic Cape honeybee workers, Apis mellifera capensis, of colonies of the neighbouring African subspecies Apis mellifera scutellata represents an opportunity to study evolution of intraspecific parasitism in real time. As honeybee workers compete pheromonally for reproductive dominance, and as A. m. capensis workers readily produce queen-like pheromones, we hypothesized that these semiochemicals promoted the evolution of intraspecific social parasitism. Remarkably, the offspring of a single worker became established as a parasite in A. m. scutellata's range. This could have resulted from extreme selection among different clonal parasitic worker lineages. Using pheromonal contest experiments, we show that the selected parasitic lineage dominates in the production of mandibular gland pheromones over all other competitors to which it is exposed. Our results suggest that mandibular gland pheromones played a key role in the evolution of intraspecific social parasitism in the honeybee and in the selection of a single genotype of parasitic workers.

Bee-hawking by the wasp, Vespa velutina, on the honeybees Apis cerana and A. mellifera

The vespine wasps, Vespa velutina, specialise in hawking honeybee foragers returning to their nests. We studied their behaviour in China using native Apis cerana and introduced A. mellifera colonies. When the wasps are hawking, A. cerana recruits threefold more guard bees to stave off predation than A. mellifera. The former also utilises wing shimmering as a visual pattern disruption mechanism, which is not shown by A. mellifera. A. cerana foragers halve the time of normal flight needed to dart into the nest entrance, while A. mellifera actually slows down in sashaying flight manoeuvres. V. velutina preferentially hawks A. mellifera foragers when both A. mellifera and A. cerana occur in the same apiary. The pace of wasp-hawking was highest in mid-summer but the frequency of hawking wasps was three times higher at A. mellifera colonies than at the A. cerana colonies. The wasps were taking A. mellifera foragers at a frequency eightfold greater than A. cerana foragers. The final hawking success rates of the wasps were about three times higher for A. mellifera foragers than for A. cerana. The relative success of native A. cerana over European A. mellifera in thwarting predation by the wasp V. velutina is interpreted as the result of co-evolution between the Asian wasp and honeybee, respectively.

Das Serotoninsyndrom

The serotonin syndrome is caused by a drug-induced increase of the intrasynaptic serotonin concentration. Milder forms of the syndrome may be difficult to diagnose because of the variability of symptoms. Severe forms often rapidly turn into a life-threatening situation, therefore the serotonin syndrome may be a challenge for physicians. We describe the pathophysiology and therapeutic options of the serotonin syndrome and report about a 42-year-old female patient who ingested large amounts of moclobemide, a monoamine oxidase inhibitor, and citalopram, a selective serotonin reuptake inhibitor, for attempted suicide. Within a few hours the patient developed a lethal serotonin syndrome although ICU therapy was initiated immediately.