Effect of a Potential Probiotic Candidate Enterococcus faecalis-1 on Growth Performance, Intestinal Microbiota, and Immune Response of Commercial Broiler Chickens

The probiotic effect of Enterococcus faecalis-1 (isolated from healthy chickens) on growth performance, immune response, and modulation of the intestinal microbiota of broilers was assessed with a total of 100-day-old commercial Cobb chicks. The chicks were randomly divided into two equal groups. The control group received a basal diet, while the test group received a basal diet and was orally supplied with E. faecalis at a dose of 10⁸ CFU/bird/day. Results showed that E. faecalis-1 supplement significantly (P < 0.05) improved the body weight and feed conversion ratio of treated broilers compared with the control ones. The mortality percentage was reduced in E. faecalis-1-supplemented group. The total IgY serum level was significantly (P < 0.05) increased in broilers receiving E. faecalis-1 supplement (7.1 ± 0.39) compared with the control group (5.8 ± 0.3), while the serum avidin level was significantly (P < 0.05) decreased in E. faecalis-1-supplemented broilers (76 ± 11.1). There was no significant change in the immune response towards avian influenza and Newcastle vaccines in both groups. The total Lactobacillus and Enterococcus counts were significantly (P < 0.05) higher in the cecal contents of broilers given E. faecalis-1 than those that received the control treatment. E. faecalis-1 supplement enhanced the enzyme activities, antioxidant system, and liver functions of treated broilers compared with those in the control group. Collectively, these results showed that E. faecalis-1 could promote growth performance and immunological status and convey beneficial modulation of the cecal microbiota in broilers.

Similar precipitated withdrawal effects on intracranial self-stimulation during chronic infusion of an e-cigarette liquid or nicotine alone

The FDA recently extended their regulatory authority to electronic cigarettes (ECs). Because the abuse liability of ECs is a leading concern of the FDA, animal models are urgently needed to identify factors that influence the relative abuse liability of these products. The ability of tobacco products to induce nicotine dependence, defined by the emergence of anhedonia and other symptoms of nicotine withdrawal following cessation of their use, contributes to tobacco abuse liability. The present study compared the severity of precipitated withdrawal during chronic infusion of nicotine alone or nicotine-dose equivalent concentrations of three different EC refill liquids in rats, as indicated by elevations in intracranial self-stimulation (ICSS) thresholds (anhedonia-like behavior). Because these EC liquids contain constituents that may enhance their abuse liability (e.g., minor alkaloids), we hypothesized that they would be associated with greater withdrawal effects than nicotine alone. Results indicated that the nicotinic acetylcholine receptor antagonist mecamylamine precipitated elevations in ICSS thresholds in rats receiving a chronic infusion of nicotine alone or EC liquids (3.2mg/kg/day, via osmotic pump). Magnitude of this effect did not differ between formulations. Our findings indicate that nicotine alone is the primary CNS determinant of the ability of ECs to engender dependence. Combined with our previous findings that nicotine alone and these EC liquids do not differ in other preclinical addiction models, these data suggest that product standards set by the FDA to reduce EC abuse liability should primarily target nicotine, other constituents with peripheral sensory effects (e.g. flavorants), and factors that influence product appeal (e.g., marketing).

Vasoproliferative process resembling pulmonary capillary hemangiomatosis in a cat

BACKGROUND

Pulmonary capillary hemangiomatosis is a rare, vascular obstructive disorder that uniformly causes pulmonary arterial hypertension. Clinically, pulmonary capillary hemangiomatosis is indistinguishable from primary pulmonary arterial hypertension and histology is required for definitive diagnosis. The distinctive histologic feature of pulmonary capillary hemangiomatosis is non-malignant extensive proliferation of capillaries in the alveolar septae. Vasodilator treatment of humans with primary arterial hypertension due to pulmonary capillary hemangiomatosis can result in fatal acute pulmonary edema. Computed tomography is thus critical to discern pulmonary capillary hemangiomatosis from other causes of pulmonary arterial hypertension prior to vasodilator therapy. This is the first report of a vasoproliferative process resembling pulmonary capillary hemangiomatosis in the feline species.

CASE PRESENTATION

A 15-year-old, male castrated, domestic shorthair cat presented for persistent labored breathing presumptively due to congestive heart failure despite treatment with diuretics for 7 days. Echocardiography showed evidence of hypertrophic cardiomyopathy with severe pulmonary hypertension; however, a normal sized left atrium was not consistent with congestive heart failure. Thoracic computed tomography was performed and showed evidence of diffuse ill-defined nodular ground glass opacities, enlarged pulmonary arteries, and filling defects consistent with pulmonary thromboembolism. The cat acutely decompensated after a single dose of sildenafil and was euthanized. Histopathology of the lungs showed severe multifocal alveolar capillary proliferation with respiratory bronchiolar infiltration, marked type II pneumocyte hyperplasia and multifocal pulmonary arterial thrombosis.

CONCLUSION

This is the first description in a cat of a vasoproliferative disorder resembling pulmonary capillary hemangiomatosis complicated by multifocal pulmonary arterial thrombosis. Inspiratory and expiratory ventilator-driven breath holds with angiography revealed lesions predominantly characterized by ground glass opacification and vascular filling defects with absence of air trapping. The results from this report suggest that, as in humans, the cat can develop a pulmonary capillary hemangiomatosis-like disease in which vasodilator therapy to address pulmonary hypertension may lead to fatal pulmonary edema.

Exposure to a combination of heat and hyperoxia during cycling at submaximal intensity does not alter thermoregulatory responses

In this study, we tested the hypothesis that breathing hyperoxic air (F_inO₂ = 0.40) while exercising in a hot environment exerts negative effects on the total tissue level of haemoglobin concentration (tHb); core (T_core) and skin (T_skin) temperatures; muscle activity; heart rate; blood concentration of lactate; pH; partial pressure of oxygen (P_aO₂) and carbon dioxide; arterial oxygen saturation (S_aO₂); and perceptual responses. Ten well-trained male athletes cycled at submaximal intensity at 21°C or 33°C in randomized order: first for 20 min while breathing normal air (F_inO₂ = 0.21) and then 10 min with F_inO₂ = 0.40 (HOX). At both temperatures, S_aO₂ and P_aO₂, but not tHb, were increased by HOX. Tskin and perception of exertion and thermal discomfort were higher at 33°C than 21°C (p < 0.01), but independent of F_inO₂. T_core and muscle activity were the same under all conditions (p > 0.07). Blood lactate and heart rate were higher at 33°C than 21°C. In conclusion, during 30 min of submaximal cycling at 21°C or 33°C, T_core, T_skin and T_body, tHb, muscle activity and ratings of perceived exertion and thermal discomfort were the same under normoxic and hyperoxic conditions. Accordingly, breathing hyperoxic air (F_inO₂ = 0.40) did not affect thermoregulation under these conditions.

Identification of RIP1 as a critical mediator of Smac mimetic-mediated sensitization of glioblastoma cells for Drozitumab-induced apoptosis

This study aims at evaluating the combination of the tumor-necrosis-factor-related apoptosis-inducing ligand (TRAIL)-receptor 2 (TRAIL-R2)-specific antibody Drozitumab and the Smac mimetic BV6 in preclinical glioblastoma models. To this end, the effect of BV6 and/or Drozitumab on apoptosis induction and signaling pathways was analyzed in glioblastoma cell lines, primary glioblastoma cultures and glioblastoma stem-like cells. Here, we report that BV6 and Drozitumab synergistically induce apoptosis and reduce colony formation in several glioblastoma cell lines (combination index<0.1). Also, BV6 profoundly enhances Drozitumab-induced apoptosis in primary glioblastoma cultures and glioblastoma stem-like cells. Importantly, BV6 cooperates with Drozitumab to suppress tumor growth in two glioblastoma in vivo models including an orthotopic, intracranial mouse model, underlining the clinical relevance of these findings. Mechanistic studies reveal that BV6 and Drozitumab act in concert to trigger the formation of a cytosolic receptor-interacting protein (RIP) 1/Fas-associated via death domain (FADD)/caspase-8-containing complex and subsequent activation of caspase-8 and -3. BV6- and Drozitumab-induced apoptosis is blocked by the caspase inhibitor zVAD.fmk, pointing to caspase-dependent apoptosis. RNA interference-mediated silencing of RIP1 almost completely abolishes the BV6-conferred sensitization to Drozitumab-induced apoptosis, indicating that the synergism critically depends on RIP1 expression. In contrast, both necrostatin-1, a RIP1 kinase inhibitor, and Enbrel, a TNFα-blocking antibody, do not interfere with BV6/Drozitumab-induced apoptosis, demonstrating that apoptosis occurs independently of RIP1 kinase activity or an autocrine TNFα loop. In conclusion, the rational combination of BV6 and Drozitumab presents a promising approach to trigger apoptosis in glioblastoma, which warrants further investigation.

Cardiorespiratory, metabolic and hormonal responses during open-wheel indoor kart racing

AIM

This study aimed to quantify the cardiorespiratory, metabolic and hormonal responses of elite open-wheel indoor kart racers.

METHODS

Ten male racers (age: 21±3 yrs; height: 1.92±0.06 m, body mass: 76.0±5.9 kg) participated in a racing tournament. Their peak oxygen uptake and heart rate were assessed by a ramp test (100 W, increase 30 W·min-1) in the laboratory. During the racing itself, the cardio-respiratory and accelerometer values were recorded and pre- and post-race levels of blood lactate and salivary cortisol were determined.

RESULTS

The average peak values for all of the drivers with respect to oxygen uptake and heart rate were 4.5±0.8 L·min-1 (56.7±7.9 mL·min-1·kg-1) and 193±5 beats·min-1, respectively. Overall, 28.3±3.3 laps were completed during 30-min of racing. Acceleration forces for the entire test averaged 1.20±0.51 G (maximum: 3.30 G), declining from the first 10 min until the end of racing (P<0.03). The oxygen uptake (~20 mL·min-1·kg-1), heart rate (~133 beats·min-1), respiratory exchange ratio (~0.96) and ventilation (~70 L·min-1) observed indicated moderate cardio-respiratory responses. Blood lactate concentration was significantly higher after the race than before but remained at <2 mmol·L-1 (P<0.01; effect size: 1.62).

CONCLUSION

There were no differences between salivary cortisol levels before and after the race (P<0.06; effect size: 0.49). Directly after the race, the drivers rated their perceived exertion on Borg's scale as 11.1±1.3. The present data revealed that the psycho-physical exertion associated with a 30-min open-wheel indoor kart race is moderate.

Endothelial barrier antigen-immunoreactivity is conversely associated with blood-brain barrier dysfunction after embolic stroke in rats

While the concept of the Neurovascular Unit (NVU) is increasingly recognized for exploring mechanisms of tissue damage in ischemic stroke, immunohistochemical analyses are of interest to specifically visualize constituents like the endothelium. Changes in immunoreactivity have also been discussed to reflect functional aspects, e.g., the integrity of the blood-brain barrier (BBB). This study aimed to characterize the endothelial barrier antigen (EBA) as addressed by the antibody SMI-71 in a rat model of embolic stroke, considering FITC-albumin as BBB leakage marker and serum levels of BBB-associated matrix metalloproteinases (MMPs) to explore its functional significance. Five and 25 h after ischemia onset, regions with decreased BBB integrity exhibited a reduction in number and area of EBA-immunopositive vessels, while the stained area per vessel was not affected. Surprisingly, EBA content of remaining vessels tended to be increased in areas of BBB dysfunction. Analyses addressing this interrelation resulted in a significant and inverse correlation between the vessels' EBA content and degree of BBB permeability. In conclusion, these data provide evidence for a functional relationship between EBA-immunoreactivity and BBB dysfunction in experimental ischemic stroke. Further studies are required to explore the underlying mechanisms of altered EBA-immunoreactivity, which might help to identify novel neuroprotective strategies.

The heidelberg sports activity score - a new instrument to evaluate sports activity

Objective:

An appropriate measuring instrument for assessing if sports activity changes after a surgical treatment is not available yet. We hypothesised that the Heidelberg Sport Activity Score is a valid and adequate instrument for measuring sport activity in patients before and after operative treatment.

Design:

This retrospective study presents a new score (Heidelberg Sports Activity Score - HAS) for measuring the sport activity in 11 selected sports. Validity, sensitivity and test-retest-reliability have been assessed.

Setting:

The score includes importance of the sports for patients, impairment of the corresponding joint, and frequency and duration of the sporting activities undertaken. The HAS was validated using 3 criteria: external validation, internal comparison of groups and correlation with the Tegner Score.

Patients:

A total of 655 patients were recruited for this study. The inclusion criterion was a planned or already received reconstruction (such as a high tibial osteotomy or implantation of a hip or knee prosthesis). The sport activity of these patients was evaluated before and after treatment.

Main Outcome Measurement:

The mean HAS was 32.1 points preoperatively and 37.0 postoperatively (p=0.017).

Results:

A high correlation was found between the HAS and the Tegner Score (TS) (r=0.729; p=0.010). The Test-Retest- Reliability was performed within a time interval of 2 weeks and a significant correlation of r=0.752 was found (p<0.01). Sensitivity was analysed using a sample of patients before and after high tibial osteotomy.

Conclusions:

The HAS is a new, easy to use, effective and valid measuring instrument for the assessment of sports activity in patients before and after operative treatment.

Polymorphisms of interleukin 18 in the genetics of preterm birth and bronchopulmonary dysplasia

Interleukin 18 (IL-18) is an important cytokine and involved in the pathogenesis and genetics of many diseases. The authors studied two different populations of preterm infants to test whether polymorphisms within IL-18 are in association with prematurity itself or with typical pulmonary disease or measurements seen in preterm infants, such as bronchopulmonary dysplasia, pneumothoraces and application of surfactant, inhalation or mechanical ventilation. Whereas the first population of 228 preterm infants showed strong association of IL-18 with preterm birth (p<0.001), this was not confirmed in the second population of 346 preterm infants. In addition, no association with any lung condition of prematurity was observed. The authors conclude that IL-18 does not play an important role in the genetics of preterm birth nor in the development of bronchopulmonary dysplasia and other lung complications in preterm infants. Caution must be taken in the interpretation of the results of genetic association studies performed in one population.

Ergogenic effect of hyperoxic recovery in elite swimmers performing high-intensity intervals

This investigation tested the hypothesis that breathing oxygen-enriched air (F(i)O(2) =1.00) during recovery enhances peak (P(peak)) and mean power (P(mean)) output during repeated high-intensity exercise. Twelve elite male swimmers (21 ± 3 years, 192.1 ± 5.9 cm, 79.1 ± 8.2 kg) inhaled either hyperoxic (HOX) or normoxic (NOX) air during 6-min recovery periods between five repetitions of high-intensity bench swimming, each involving 40 maximal armstrokes. Oxygen partial pressure (pO(2)) and saturation (SO(2)), [H(+)], pH, base excess and blood lactate concentration were measured before and after all intervals. The production of the reactive oxygen species (ROS) hydrogen peroxide was measured before, directly after and 15 min after the test. P(peak) and P(mean) with HOX recovery were significantly higher than with NOX throughout the third, fourth and fifth intervals (P<0.001-0.04). With HOX, electromyography activity was lower during the third, fourth and fifth intervals than during the first (P=0.05-0.001), with no such changes in NOX (P=0.99). There were no differences in blood lactate, pH, [H(+)] or base excess and ROS production at any time point with either HOX or NOX recovery. These findings demonstrate that the P(peak) and P(mean) of elite swimmers performing high-intensity intervals can be improved by exposure to oxygen-enriched air during recovery.

Micro-rheology on (polymer-grafted) colloids using optical tweezers

Optical tweezers are experimental tools with extraordinary resolution in positioning (± 1 nm) a micron-sized colloid and in the measurement of forces (± 50 fN) acting on it-without any mechanical contact. This enables one to carry out a multitude of novel experiments in nano- and microfluidics, of which the following will be presented in this review: (i) forces within single pairs of colloids in media of varying concentration and valency of the surrounding ionic solution, (ii) measurements of the electrophoretic mobility of single colloids in different solvents (concentration, valency of the ionic solution and pH), (iii) similar experiments as in (i) with DNA-grafted colloids, (iv) the nonlinear response of single DNA-grafted colloids in shear flow and (v) the drag force on single colloids pulled through a polymer solution. The experiments will be described in detail and their analysis discussed.

Genetic polymorphisms of adhesion molecules in children with severe RSV-associated diseases

Adhesion molecules are involved in the pathophysiology of respiratory syncytial virus (RSV)-associated diseases. By testing polymorphisms within ICAM-1, VCAM-1 and E-selectin, we found no evidence for association of any polymorphism with severe RSV infections. Thus, we conclude that these genes do not predispose to severe RSV-associated diseases.

ICAM1 amino-acid variant K469E is associated with paediatric bronchial asthma and elevated sICAM1 levels

Intercellular adhesion molecule-1 (ICAM1) acts as ligand for beta2-integrin molecules and mediates leucocyte trafficking to the site of inflammation. Intercellular adhesion molecule-1-deficient mice show impaired lymphocyte recruitment to the lung, less airway hyper-responsiveness and less lung inflammation than healthy controls. Thus, the aim of the study was to test common ICAM1 polymorphisms for association with paediatric asthma. Furthermore, we were interested in whether soluble ICAM1 (sICAM1) serum levels were in correlation with genotypes. The following polymorphisms in ICAM1 were genotyped on 352 children with asthma and 270 controls: rs5491 (resulting in the amino-acid exchange K56M), rs5493 (G241S), rs5498 (K469E), rs5030400 (R478W) and rs885743 in the 3'-untranslated region. In addition, sICAM1 serum levels were measured. Only K469E and rs885743 were present in our populations. K469E showed association with asthma (P = 0.0037 with Armitage's trend test). Haplotype analysis by FAMHAP using both polymorphisms revealed association with asthma by P < 0.000001. In addition, serum sICAM1 levels were correlated with K469E genotypes (P = 0.009 by Kruskal-Wallis test). We conclude from our data that K469KE is associated with paediatric asthma in the German population. Furthermore, the same polymorphism is correlated with serum levels of sICAM1. Functional analyses have to further clarify the pathophysiological mechanism conferred by the polymorphisms.

Thrombolytic therapy of acute ischemic stroke during pregnancy

The authors report eight pregnant women with acute ischemic stroke treated with thrombolysis (rt-PA [recombinant human tissue plasminogen activator] or urokinase). Seven women recovered. Two extracranial and two asymptomatic intracranial hemorrhages complicated treatment; one woman died of arterial dissection complicating angiography. Three patients had therapeutic abortions, two fetuses were miscarried, and two babies were delivered healthy. Although pregnant women may be treated safely with thrombolytics, risks and benefits to mother and fetus must be carefully weighed.

Escherichia coli Strain Nissle 1917: Significant Reduction of Neonatal Calf Diarrhea

Inappropriate daily use of antimicrobial drugs for the treatment of intestinal diseases is associated with an increased risk of antibiotic resistance. Thus, the establishment of new forms of therapy is still needed. Our objective was to examine the effect of the nonpathogenic Escherichia coli strain Nissle 1917 on the prophylaxis and treatment of neonatal calf diarrhea in a hypothesis-generating study (study I) and a subsequent confirmatory clinical study (study II) under field conditions. Both trials were designed as consecutive, placebo-controlled, single-blind comparisons of 2 groups of animals. Immediately after birth, healthy calves were assigned to either the E. coli Nissle 1917 or the placebo group. The study medication was administered orally 1/d before the first feeding. The treatment was continued for the first 10 to 12 d of life. For each animal, the studies ended on d 20 to 22 of life. In both trials, the number of calves developing diarrhea was defined as the primary target criterion. A total of 335 newborn calves were included in the studies (study I: n = 172; study II: n = 163). Study I showed that the incidence of diarrhea was 65.2% under placebo and 26.5% under E. coli Nissle 1917. In study II, the corresponding figures were 63.0% under placebo and 12.2% under E. coli Nissle 1917. It can be concluded that the administration of viable E. coli bacteria, strain Nissle 1917, has a clear beneficial effect on the prophylaxis and treatment of neonatal calf diarrhea.

C-Reactive Protein and Antibacterial Activity in Blood Plasma of Colostrum-Fed Calves and the Effect of Lactulose

Several milk proteins are very important for immunological defense and can be absorbed in the intestine of calves in the first hours after birth. The influence of colostrum intake and the effect of additional lactulose application on the concentration of C-reactive protein (CRP) in blood were investigated. The CRP is known as a mediator of innate immunity. Results were compared to the bovine acute phase protein haptoglobin, and to lactalbumin, lactoferrin, and immunoglobulins in plasma from calves. After colostrum intake, the concentration of most proteins were strongly increased. The data show, for the first time, a significant increase of CRP in the blood of calves 1 d after colostrum intake (nonlactulose group, n = 10), and an even more significant increase in CRP concentration (1 d postpartum) was measured in the group of animals with additional application of lactulose (lactulose group, n = 10) when compared to the nonlactulose group. In an in vitro assay with the plasma of these animals, an increased bactericidal activity was detected against Morganella morganii (1 d postpartum) in both groups, but again a higher activity occurred in the lactulose group. The results of these investigations emphasize the importance of colostrum intake during the first hours after birth for the defense potential of newborn calves. In addition, lactulose may have a positive effect in the period of passive transfer of colostrum proteins and in the immune defense.

Effects of lactulose on the intestinal microflora of periparturient sows and their piglets

The periparturient period of animals (and humans) is very stressful and influenced by the microecosystem of the gastrointestinal tract (GIT). Performance and productivity of animal husbandry depend on the health of animal mothers and their offspring. We investigated the influence of prebiotic amounts of lactulose in sows and their piglets. Two experimental trial sows received daily 30 ml lactulose, 71 field trial sows received daily 45 ml lactulose during their periparturient period (10 days before until 10 days after parturison). The weaners of trial sows received 15 ml lactulose per 1 kg baby food 10 days before and 10 days after weaning.The effect of lactulose was recorded by performance parameters like number of piglet born alive, losses until weaning, body mass of piglets, daily weight gain of weaners until 35 days after weaning. The effect of lactulose on GIT microflora was estimated by bacterial counts of faeces of sows (total aerobic bacteria, Gram-negative bacteria, Clostridium (C.) perfringens). In order to show a previously unknown effect of lactulose we investigated the levels of antibodies to phospholipase C (PLC) of C. perfringens in plasma of experimental sows and in colostral and ripe milk of field sows. Lactulose influenced the performance parameters of sows in a non-significant way. In case of weaners we recorded significant daily weight gains. Lactulose significantly influenced total aerobic bacterial counts, C. perfringens counts in faeces of sows 20 days after parturison. Under experimental conditions it was shown that trial sows and their piglets had higher IgG-antibody levels to C. perfringens PLCs than the control animals. Similar results were found under field conditions. Trial sows had significant higher IgG-anti LPS (J5) antibodies in milk 10 days after birth.

Taxonomic studies of predatory bdellovibrios based on 16S rRNA analysis, ribotyping and the hit locus and characterization of isolates from the gut of animals

The aim of our study was to obtain data for the molecular characterization of bdellovibrio bacteria, which were recently split into the genus Bdellovibrio and the newly designated genus Bacteriovorax. We determined the 16S rDNA sequences of five reference strains and performed a phylogenetic analysis including published 16S rRNA sequences of bdellovibrios. A comparison of the secondary structure showed significant differences in two regions of the 16S rRNAs of the species Bdellovibrio bacteriovorus, Bacteriovorax starrii, and Bacteriovorax stolpii. In addition, ribotyping techniques gave specific hybridization patterns and revealed that two rRNA operons are present in the investigated strains. A hybridization probe derived from the genetic locus hit, associated with the host independent (HI) phenotype of B. bacteriovorus, was found to be specific for this species. Sequence comparison of the hit locus revealed few base pair changes between host independent (HI) and host dependent (HD) strains. Ribotyping and hybridization experiments using the hit probe were applied to characterize bdellovibrio strains isolated from the gut of animals and humans and one isolate from sewage.

A novel acute phase marker in cattle: lipopolysaccharide binding protein (LBP)

The host response to infection, the "acute phase response" is a highly conserved series of physiological reactions including marked changes in concentrations of plasma proteins. These proteins have been shown to participate in the immune response to infections. Several recent studies have elevated the role of acute phase proteins (APPs) as predictive markers in infection. APPs such as serum amyloid A and haptoglobin but not C-reactive protein (CRP) have been identified as markers of inflammation in cattle. In humans, lipopolysaccharide (LPS) binding protein (LBP) has certain biological functions in host defence and participates in acute phase reactions. We measured plasma levels of LBP in a group of 20 calves experimentally infected with Gram-negative Mannheimia haemolytica (Pasteurella) in comparison to haptoglobin, the most widely studied APP in cattle. In infected calves, LBP levels rose significantly 6 h after infection, reaching a maximum at 24 h. Haptoglobin concentrations significantly rose after 12 h, and peak responses were measured 48 h after infection. Thus, LBP may prove to be a diagnostic marker in cattle infection and is faster than haptoglobin in detecting sepsis.

Floating thrombus on an ASD occluder device in a patient with hemophilia A

The case presented is that of a 29-year-old man with a history of hemophilia A who was admitted with recurrent onsets of transient cerebrovascular ischemia; he had undergone a transvenous closure of an atrial septal defects with an occluder device (Cardioseal Starflex) two months ago. Due to a factor-VIII deficiency, no further anticoagulation therapy was initiated. On admission, transesophageal echocardiography revealed a floating thrombus on the left atrial side of the umbrella. The device was explanted via a right minithoracotomy, and the atrial septal defect was closed. The patient had an uneventful recovery.

Cord blood levels of interleukin-6 and interleukin-8 for the immediate diagnosis of early-onset infection in premature infants

BACKGROUND

Cytokine plasma levels are suggested to be sensitive indicators of neonatal sepsis, but conventional assays are time consuming. This study aimed at evaluating the significance of cord blood levels of interleukin (IL)-6 and IL-8 determined by a fully automated random access assay within 90 min of admission to predict systemic bacterial infection.

PATIENTS AND METHODS

Cord blood levels of IL-6 and IL-8 were determined in 71 mature and 100 premature infants by a chemiluminescence assay (Immulite). Patients were divided into four groups according to a clinical and laboratory scoring system. Group A: documented early-onset infection; group B: infection possible; group C: infection unlikely, and group D: healthy newborns.

RESULTS

Median IL-6 levels in the subgroup of premature newborns were as follows: group A, 1,920 pg/ml (5-95% confidence interval 308-4,660 pg/ml); group B, 50 (15-102) pg/ml; group C, 21 (12-71) pg/ml, and group D, 8 (6-11) pg/ml. For IL-8, median levels for groups A-D were 289 (226-514) pg/ml, 87 (40-107) pg/ml, 44 (33-98) pg/ml and 21 (16-25) pg/ml, respectively. The difference between group A and the other groups was highly significant (IL-6 p < 0.0001, IL-8 p < 0.001). At a cut-off of 80 pg/ml, the sensitivity of IL-6 for the diagnosis of sepsis was 96% (specificity 95%). For IL-8 (cut-off 90 pg/ml), the sensitivity was 87% (specificity 94%).

CONCLUSION

In premature infants, the diagnosis of an early-onset infection can be established or ruled out with a high level of confidence by measuring IL-6 or IL-8 levels from cord blood using a random access chemiluminescence assay.

Descriptions of self: an exploratory study of adolescents with ADHD

PROBLEM

How do adolescents experience attention deficit hyperactivity disorder (ADHD), and how are those experiences shaped and managed?

METHODS

A qualitative exploratory design to investigate how adolescents with ADHD (N = 11; 8 males, 3 females) experience, perceive, and manage ADHD. Findings are based on a subset of data from a large grounded theory study of the experiences of living in a family when a child or adolescent has ADHD. The constant comparative method was used to analyze both individual and focus group interview data.

FINDINGS

The primary finding, presented as a hypothesis, suggests that an ADHD adolescent's sense of self is distorted and that the development of self has been disrupted due to the neurobiology of ADHD and environmental factors associated with the difficulties of parenting a difficult child, social role expectations, and modeling.

CONCLUSIONS

Therapeutic attention to how the self functions is important in stabilizing and ordering an adolescent's sense of self. Intrapsychic psychotherapy may be an important therapeutic approach in helping adolescents with ADHD develop personal responsibility and increased capacity for empathy.

Pharmacokinetics of oral talinolol following a single dose and during steady state in patients with chronic renal failure and healthy volunteers

OBJECTIVE

The objective of this study was to investigate the effect of renal impairment on the pharmacokinetics of the selective beta1-receptor antagonist talinolol.

METHODS

Pharmacokinetic data were obtained in 12 healthy volunteers, 12 patients with renal impairment and 8 patients with terminal renal insufficiency after the oral administration of 100 mg talinolol and under steady state conditions (100 mg talinolol daily). Concentrations of talinolol in plasma, urine and dialysate during hemodialysis were measured with a validated HPLC-method.

RESULTS

Talinolol is absorbed quite rapidly from the gastrointestinal tract (tmax 2.5-4 h). Steady state conditions were reached within 3-4 days depending on renal function. The calculated mean elimination half-life (t(1/2z)) in healthy volunteers (11 male, 1 female) was about 12 h. After an oral dose of 100 mg, about 55% of the bioavailable talinolol is eliminated unchanged in the urine. This fraction is reduced to 25% in patients with moderate to severe renal failure. A strong correlation was found between the renal elimination of talinolol and creatinine clearance. In patients with renal failure, the delayed elimination leads to an increase in t(1/2z) and to a decrease in the apparent total body clearance. Steady state trough levels (c(min)ss) in these patients are about 2.2-fold higher than in volunteers. The hemodialysability of talinolol was low.

CONCLUSION

The disposition of talinolol shows a strong dependence on the renal function. On the basis of the kinetic data for talinolol, dose reductions of 30-50% are recommended in subjects with moderate to severe renal impairment.

Synthetic aperture-based beam compression for intravascular ultrasound imaging

In this paper, intravascular ultrasound (IVUS) images acquired with a 64-element array transducer using a multistatic acquisition scheme are presented. The images are reconstructed from a collection of pulse-echo measurements using a synthetic aperture array imaging technique. The main limitations of IVUS imaging are a poor lateral resolution and elevated grating lobes caused by the imaging geometry. We propose a Synthetic Aperture Focusing Technique (SAFT), which uses a limited number of A-scan signals. The focusing process, which is performed in the Fourier domain, requires far less computation time than conventional delay-and-sum methods. Two different reconstruction kernel functions have been derived and are compared for the processing of experimental data.

Treatment of respiratory failure with inhaled nitric oxide and high- frequency ventilation in an infant with respiratory syncytial virus pneumonia and bronchopulmonary dysplasia

In a 7-month-old infant with bronchopulmonary dysplasia and respiratory syncytial virus (RSV) pneumonia, we have shown an additive effect of high-frequency ventilation (HFV) and inhaled nitric oxide (iNO) in terms of improved oxygenation and the avoidance of extracorporeal membrane oxygenation. Apparently, the combined therapy of HFV and iNO is superior to either therapeutic modality alone in the treatment of hypoxemic respiratory failure due to RSV pneumonia. The mechanism of increased lung expansion and alveolar recruitment appears to be responsible for a favorable clinical outcome. We conclude that the combined therapy of HFV and iNO should be considered in hypoxemic respiratory failure in pediatric patients.

A time-efficient and accurate strain estimation concept for ultrasonic elastography using iterative phase zero estimation

In ultrasonic elastography, the exact estimation of temporal displacements between two signals is the key to estimating strain. An algorithm was previously proposed that estimates these displacements using phase differences of the corresponding base-band signals. A major advantage of these algorithms compared with correlation techniques is the computational efficiency. In this paper, an extension of the algorithm is presented that iteratively takes into account the time shifts of the signals to overcome the problems of aliasing and accuracy in the estimation of the phase shift. Thus, it can be proven that the algorithm is equivalent to the search of the maximum of the correlation function. Furthermore, a robust logarithmic compression is proposed that only compresses the envelope of the signal. This compression does not introduce systematic errors and significantly reduces decorrelation noise. The resulting algorithm is a computationally simple and very fast alternative to conventional correlation techniques, and the accuracy of strain images is improved.

Cranial computed tomography interpretation in acute stroke: physician accuracy in determining eligibility for thrombolytic therapy

CONTEXT

Intracranial hemorrhage must be excluded prior to administration of thrombolytic agents in acute stroke.

OBJECTIVE

To evaluate physician accuracy in cranial computed tomography scan interpretation for determining eligibility for thrombolytic therapy in acute stroke.

DESIGN

Administration of randomly selected, randomly ordered series of 15 computed tomography scans from a pool of 54 scans that demonstrated intracerebral hemorrhage, acute infarction, intracerebral calcifications (impostor for hemorrhage), old cerebral infarction (impostor for acute infarction), and normal findings.

PARTICIPANTS

A convenience sample of 38 emergency physicians, 29 neurologists, and 36 general radiologists.

MAIN OUTCOME MEASURES

Physician determination of eligibility for thrombolytic therapy based on computed tomography scan interpretation.

RESULTS

Average correct score by all physicians on all computed tomography scans was 77% (95% confidence interval, 74%-80%). Of 569 computed tomography readings by emergency physicians, 67% were correct; of 435 readings by neurologists, 83% were correct; and of 540 readings by radiologists, 83% were correct. Overall sensitivity for detecting hemorrhage was 82% (95% confidence interval, 78%-85%); 17% of emergency physicians, 40% of neurologists, and 52% of radiologists achieved 100% sensitivity for identification of hemorrhage.

CONCLUSION

Physicians in this study did not uniformly achieve a level of sensitivity for identification of intracerebral hemorrhage sufficient to permit safe selection of candidates for thrombolytic therapy.

Deformability and stability of erythrocytes in high-frequency electric fields down to subzero temperatures

High-frequency electric fields can be used to induce deformation of red blood cells. In the temperature domain T = 0 degrees to -15 degrees C (supercooled suspension) and for 25 degrees C this paper examines for human erythrocytes (discocytes, young cell population suspended in a low ionic strength solution with conductivity sigma(25 degrees) = 154 microS/cm) in a sinusoidal electric field (nu = 1 MHz, E0 = 0-18 kV/cm) the following properties and effects as a function of field strength and temperature: 1) viscoelastic response, 2) (shear) deformation (steady-state value obtained from the viscoelastic response time), 3) stability (by experimentally observed breakdown of cell polarization and hemolysis), 4) electrical membrane breakdown and field-induced hemolysis (theoretical calculations for ellipsoidal particles), and 5) mechanical hemolysis. The items 2-4 were also examined for the frequency nu = 100 kHz and for a nonionic solution of very low conductivity (sigma(25 degrees) = 10 microS/cm) to support our interpretations of the results for 1 MHz. Below 0 degrees C with decreasing temperature the viscoelastic response time tau(res)(T) for the cells to reach steady-state deformation values d(infinity,E) increases and the deformation d(infinity,E)(T) decreases strongly. Both effects are especially high for low field strengths. The longest response time of approximately 30 s was obtained for -15 degrees C and small deformations. For 1 MHz the cells can be highly elongated up to 2.3 times their initial diameter a0 for 25 degrees and 0 degrees C, 2.1a0 for -10 degrees C and still 1.95a0 for -15 degrees C. For T > or = 0 degrees C the deformation is limited by hemolysis of the cells, which sets in for E0(lysis)(25 degrees) approximately 8 kV/cm and E0(lysis)(0 degrees) approximately 14 kV/cm. These values are approximately three times higher than the corresponding calculated critical field strengths for electrically induced pore formation. Nevertheless, the observed depolarization and hemolysis of the cells is provoked by electrical membrane breakdown rather than by mechanical forces due to the high deformation. For the nonionic solution, where no electrical breakdown is expected in the whole range for E0, the cells can indeed be deformed to even higher values with a low hemolytic rate. Below 0 degrees C we observe no hemolysis at all, not even for the frequency 100 kHz, where the cells hemolyze at 25 degrees C for the much lower field strength E0(lysis) approximately 2.5 kV/cm. Obviously, pore formation and growth are weak for subzero temperatures.