[Perioperative antibiotic prophylaxis for pancreas resections with and without preoperative bile drainage : Is there room for improvement?] / Perioperative Antibiotikaprophylaxe bei Pankreasresektionen mit und ohne präoperative Galleableitung : Gibt es Verbesserungspotenzial?

BACKGROUND: Whether an immediate surgical treatment or preoperative bile drainage (PBD) should be performed in cases of obstructive jaundice caused by a pancreatic carcinoma has been a matter of controversy for decades. The aim of this study based on in-house patient data was to evaluate both the influence of PBD on septic complications and to analyze intraoperative bile samples in patients with PBD in order to formulate current recommendations for antibiotic treatment. MATERIAL AND METHODS: Relevant data from all pancreatic resections performed in this hospital from January 2013 to December 2017 were collected in a prospective database and were retrospectively analyzed. Depending on the presence of a PBD the collected data were checked for postoperative complications. In addition, the spectrum of bacteria on bile duct swabs was analyzed in patients with PBD and the sensitivity to ampicillin-sulbactam was tested according to the resistogram. Subsequently, an antibiotics recommendation for the practice was compiled. RESULTS: Within the period under consideration 197 pancreas resections were performed in this hospital, 122 of which were duodenopancreatectomies and 20 total pancreatectomies (n = 142). A PBD was performed in 28.2% (40/142) of the patients. There were no significant differences in mortality, intra-abdominal abscesses, post-pancreatectomy hemorrhages (PPH) or postoperative pancreatic fistulas (POPF) depending on a PBD. On the other hand, a significantly higher rate of postoperative wound infections was found in patients with PBD (+PBD 18/40, 45.0% vs. -PBD 13/102, 12.7%, P < 0.0001). Bacteriobilia was found in 86.8% (33/38) of patients with PBD. In 47.4% (18/38) of patients with PBD at least 1 detected bacterium of the bile duct culture was not sensitive to ampicillin-sulbactam. Regarding the antibiotics piperacillin-tazobactam 8 patients (21%) and ciprofloxacin or imipenem 4 patients each (10.5%) showed a bacterium with resistance. CONCLUSION: In general, the indications for a PBD should be strictly applied. If a PBD needs to be performed, perioperative antibiosis should be optimized to minimize subsequent complications. A hospital adjusted perioperative antibiotic prophylaxis should be developed and preoperatively obtained swab results, e. g. within endoscopic retrograde cholangiopancreatography (ERCP) can be used to increase the effectiveness of perioperative antibiotics. Based on an internal analysis of intraoperative bile duct swabs, ciprofloxacin is used in this hospital for the perioperative antibiotic treatment of patients with PBD.

Microbial community structure and activity in trace element-contaminated soils phytomanaged by Gentle Remediation Options (GRO).

Gentle remediation options (GRO) are based on the combined use of plants, associated microorganisms and soil amendments, which can potentially restore soil functions and quality. We studied the effects of three GRO (aided-phytostabilisation, in situ stabilisation and phytoexclusion, and aided-phytoextraction) on the soil microbial biomass and respiration, the activities of hydrolase enzymes involved in the biogeochemical cycles of C, N, P, and S, and bacterial community structure of trace element contaminated soils (TECS) from six field trials across Europe. Community structure was studied using denaturing gradient gel electrophoresis (DGGE) fingerprinting of Bacteria, α- and ß-Proteobacteria, Actinobacteria and Streptomycetaceae, and sequencing of DGGE bands characteristic of specific treatments. The number of copies of genes involved in ammonia oxidation and denitrification were determined by qPCR. Phytomanagement increased soil microbial biomass at three sites and respiration at the Biogeco site (France). Enzyme activities were consistently higher in treated soils compared to untreated soils at the Biogeco site. At this site, microbial biomass increased from 696 to 2352 mg ATP kg-1 soil, respiration increased from 7.4 to 40.1 mg C-CO2 kg-1 soil d-1, and enzyme activities were 2-11-fold higher in treated soils compared to untreated soil. Phytomanagement induced shifts in the bacterial community structure at both, the total community and functional group levels, and generally increased the number of copies of genes involved in the N cycle (nirK, nirS, nosZ, and amoA). The influence of the main soil physico-chemical properties and trace element availability were assessed and eventual site-specific effects elucidated. Overall, our results demonstrate that phytomanagement of TECS influences soil biological activity in the long term.

Kinetic and economic analysis of reactive capture of dilute carbon dioxide with Grignard reagents.

Carbon Dioxide Utilisation (CDU) processes face significant challenges, especially in the energetic cost of carbon capture from flue gas and the uphill energy gradient for CO2 reduction. Both of these stumbling blocks can be addressed by using alkaline earth metal compounds, such as Grignard reagents, as sacrificial capture agents. We have investigated the performance of these reagents in their ability to both capture and activate CO2 directly from dried flue gas (essentially avoiding the costly capture process entirely) at room temperature and ambient pressures with high yield and selectivity. Naturally, to make the process sustainable, these reagents must then be recycled and regenerated. This would potentially be carried out using existing industrial processes and renewable electricity. This offers the possibility of creating a closed loop system whereby alcohols and certain hydrocarbons may be carboxylated with CO2 and renewable electricity to create higher-value products containing captured carbon. A preliminary Techno-Economic Analysis (TEA) of an example looped process has been carried out to identify the electrical and raw material supply demands and hence determine production costs. These have compared broadly favourably with existing market values.

Characterization of different courses of atopic dermatitis in adolescent and adult patients.

BACKGROUND: Atopic dermatitis (AD) starts most often during the first years of life and goes into remission in a high proportion of cases during childhood. However, in severe cases, AD persists until adulthood or starts and relapses later in life. So far, studies investigating the natural course of AD during adolescence and adulthood are rare. The aim of our study was to classify different courses of AD and to correlate these with specific risk factors for severe variants of AD. METHODS: A detailed clinical examination and retrospective evaluation of the history of the disease were performed in a collective of 725 adolescent and adult patients with AD. Laboratory data including total and specific IgE were evaluated. RESULTS: Six hundred and seven patients of 725 patients could be classified into course types. Of these 607 patients 85.7% could be classified into five main different course types of all 31 course types recorded. The highest differences in the number of sensitizations, total immunoglobulin E serum levels and predilection of the skin lesions were observed between patients with an early type of onset of AD and a chronic persisting course until adulthood and patients with a late type of onset of AD, that is, after the 20th year of life. CONCLUSION: Our data show that the natural course of AD can be divided into subgroups that display different clinical features. The data support the assumption of a broad heterogeneity of AD in adolescence and adulthood and emphasize the future need for careful stratification of patients with AD.

[Value of routine preoperative oesophagogastroduodenoscopy before elective cholecystectomy]. / Stellenwert der routinemäßigen präoperativen Ösophagogastroduodenoskopie vor elektiver Cholezystektomie.

BACKGROUND: Symptomatic gallstones and inflammatory diseases of the gastroduodenum are common causes of upper abdominal pain. PATIENTS / MATERIAL AND METHODS: We evaluated the data of 766  patients who underwent pre-operative oesophagogastroduodenoscopy before elective surgical treatment of cholelithiasis between January  1, 2003 and March 31, 2008. RESULTS: Pathological findings of an inflammatory nature were seen in 43.1 % (330 / 766), 25.2 % (197 / 766) of the patients had a chronic gastritis, 14.9 % (114 / 766) an acute gastritis and 3 % (54 / 766) a gastroduodenal ulcer. Non-specific upper abdominal pain was not significantly related to an inflammatory gastroduodenal dis-ease (p = 0.0755). Independent of the history (p = 0.1065), the therapy concept had to be -changed in favour of a primary non-surgical therapy in 16.3 % (125 / 766) of the examined patients due to relevant gastroscopic findings. CONCLUSIONS: The case history is not sufficient for identifying gastroduodenal disease requiring treatment in patients with symptomatic gall-stones. Therefore, contrary to the current leading concepts, preoperative oesophagogastroduodenoscopy should be discussed as a matter of -routine in patients undergoing elective cholecystectomy in order to treat pathological gastroduodenal findings.

Landfill leachate treatment with willows and poplars--efficiency and plant response.

Irrigation of willow and poplar short-rotation coppice with landfill leachate is an increasingly interesting treatment option. Minimal leaching to groundwater and disturbance to plant growth must be ensured, but in such systems, where various site-specific factors interact, a case-specific approach is needed to determine potential hazards. This paper compares the effect of leachate irrigation on willow grown in clay lysimeters and poplar grown in sand lysimeters. Leachate irrigation increased willow biomass production, but not that of poplar. Near-zero nitrate-N concentrations were found in drainage water for both species after 2 years of irrigation. Ability to retain total N and P, and TOC was relatively high for willow, taking into account the large amounts supplied, and better than for poplar. To reduce environmental risks the irrigation load should be reduced, but if leachate concentrations are reduced, the irrigation load can be as high as 6mm/day.

Fate of heavy metals after application of sewage sludge and wood-ash mixtures to short-rotation willow coppice.

Short-rotation willow coppice (SRWC), grown on farmland in Sweden for energy-biomass production, was fertilised with sewage sludge and wood-ash mixtures on the basis of the permitted annual phosphorus supply. Two identical experiments were conducted in central Sweden, on two newly harvested commercial SRWC fields. The maximum legally permitted amount of the sludge-ash mixture, sludge only, ash only, and twice the maximum permitted sludge-ash amount, were applied. The aim was to assess the effect of pH changes following treatment, on the ability of SRWC to take up large amounts of Cd and other metals. The remediation effect of SRWC was also studied. Under the experimental conditions applied, uptake by SRWC was unaffected by pH changes. The differences between the amounts of metals experimentally applied, less the uptake by SRWC after a potential harvest, were broadly within the permitted limits. For Cd, a reduction of total amounts in soil was observed.

CD40 on salivary gland epithelial cells: high constitutive expression by cultured cells from Sjögren's syndrome patients indicating their intrinsic activation.

CD40 has been identified in an expanding list of haematopoietic and non-haematopoietic cells and has received an increased interest based on its role in a variety of cell-mediated responses and its potential to participate in the pathogenesis of chronic inflammatory disorders. Sjögren's syndrome (SS) is an autoimmune exocrinopathy, which is characterized by chronic lymphocytic infiltration of exocrine glands and aberrant activation of epithelial tissues. We studied the expression of CD40 protein in cultured non-neoplastic salivary gland epithelial cell (SGEC) lines as well as in minor SG biopsies obtained from 17 SS patients and 12 controls. Immunocytochemical and flow cytometric analyses had revealed the occurrence of constitutively expressed CD40 molecules on the surface of long-term cultured SGEC lines, which could be further induced by interferon-gamma (IFN-gamma) and IL-1beta cytokines, but not tumour necrosis factor-alpha (TNF-alpha), IL-4, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF) or IFN-alpha. Triggering of SGEC through CD40 enhanced the surface expression of the adhesion molecule intercellular adhesion molecule-1 (ICAM-1)/CD54, but not MHC class I and class II (HLA-DR) molecules. Spontaneous CD40 expression was significantly higher in SGEC lines derived from SS patients, compared with controls (P < 0.001), which is suggestive of their intrinsically activated status. In SG biopsies, CD40 was constitutively expressed by lymphocytes, ductal epithelial cells and endothelial cells but not by other glandular cell types, such as acinar cells, myoepithelial cells and fibroblasts. In addition, CD40L staining was also detected in 30--50% of the infiltrating lymphocytes in the biopsies of SS patients. Our findings indicate the immunoregulatory potential of SGEC and lend further support to a model of intrinsic activation in salivary epithelia in SS, whereby these cells actively participate in the induction and maintenance of lymphocytic infiltrates of patients.

Induction of salivary gland epithelial cell injury in Sjogren's syndrome: in vitro assessment of T cell-derived cytokines and Fas protein expression.

Sjogren's syndrome (SS) is an exocrinopathy characterized by T cell infiltrates, salivary gland epithelial cell (SGEC) apoptosis and high Fas and FasL expression. To address the participation of T cell-derived cytokines and of Fas apoptotic pathway in SS glandular lesions, we utilized non-neoplastic SGEC lines established from SS patients and controls. Possibly attesting to their intrinsic activation, cell lines derived from SS patients displayed significantly higher constitutive Fas and FasL than controls. Surface co-expression of Fas and FasL was not associated with spontaneous fratricide apoptosis. SGEC were resistant to anti-Fas-mediated apoptosis (possibly owing to the constitutive expression of anti-apoptotic proteins cFLIP and Bcl-2), but became sensitive after protein or RNA synthesis inhibition. IFN-gamma and TNF-alpha were able to upregulate surface Fas and FasL, whereas IL-1beta downregulated surface FasL. IFN-gamma (but not several other cytokines) reduced the survival of SGEC in a dose- and time-dependent manner and induced Fas/FasL-mediated apoptosis, directly and via anoikia. Dexamethasone inhibited the upregulation of Fas and FasL by IFN-gamma and the induction of SGEC apoptosis and detachment by anti-Fas mAb or IFN-gamma. Our findings indicate the injurious role of IFN-gamma for the salivary epithelia of SS patients through the induction of Fas-mediated apoptosis and anoikia.

Activation of epithelial and myoepithelial cells in the salivary glands of patients with Sjögren's syndrome: high expression of intercellular adhesion molecule-1 (ICAM.1) in biopsy specimens and cultured cells.

ICAM.1 (CD54) is a surface protein expressed on epithelial and other nonhematopoietic cells upon activation and is known to play an important role in the stimulation of T cells by the provision of cellular adhesion and costimulatory support. Sjogren's syndrome (SS) is an autoimmune exocrinopathy, which is characterized by chronic lymphocytic infiltration of exocrine glands and aberrant activation of epithelial tissues. To address the contribution of ICAM.1 in the pathogenesis of SS, the expression of this protein was studied by immunohistochemistry and flow cytometry in minor salivary gland (SG) biopsies as well as in cultured SG epithelial cell (SGEC) lines obtained from 18 SS patients and 16 controls. In biopsies from SS patients (but not controls), strong ICAM.1 was expressed by infiltrating mononuclear cells (52%) and by a significant proportion of periacinar myoepithelial cells (18%). In addition, a patchy pattern of moderate ICAM.1 expression was detected in 31% of ductal epithelia of SS patients. These ICAM.1-expressing epithelial and myoepithelial cells were observed throughout glandular tissues and were not confined in areas proximal to lymphoid infiltrates. In support to an intrinsic activation profile of SGEC in SS, long-term cultured non-neoplastic SGEC lines derived from SS patients displayed significantly upregulated spontaneous expression of ICAM.1, compared to controls (P < 0.05). The high expression of ICAM.1 protein by the salivary epithelium of SS patients is likely suggestive of its important role in the pathogenesis of the disorder. Further, our results support a model of intrinsic activation of salivary epithelial and myoepithelial cells in SS, whereby these cells actively participate in the induction and maintenance of lymphocytic infiltrates of patients.

Expression of B7 costimulatory molecules by salivary gland epithelial cells in patients with Sjögren's syndrome.

OBJECTIVE: To investigate the expression of B7 costimulatory molecules in the lymphoepithelial lesions of salivary gland (SG) biopsy tissues and in SG epithelial cell lines derived from patients with Sjögren's syndrome (SS). METHODS: B7.1 and B7.2 protein expression was studied by immunohistochemistry in minor SGs obtained from 11 patients with SS and 10 disease control patients with nonspecific sialadenitis and in cultured SG epithelial cell lines obtained from minor SGs from 15 SS patients and 15 control patients. B7.1 and B7.2 messenger RNA (mRNA) expression by SG epithelial cell lines was examined by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: In biopsy tissues from SS patients, but not control patients, ductal and acinar epithelial cells showed increased expression of both B7.1 and B7.2. Intense spontaneous B7.1 protein expression (as well as HLA-ABC, but not B7.2 or HLA-DR) was also found in 73% of SG epithelial cell lines from SS patients versus 13% of those from control patients (P < 0.01). Interferon-y treatment induced, or up-regulated, B7.1, B7.2, and HLA-DR expression in all SG epithelial cell lines tested. B7.1 and B7.2 expression by SG epithelial cell lines was also verified at the mRNA level by RT-PCR. CONCLUSION: Human SG epithelia are intrinsically capable of expressing B7 proteins upon activation. In SS patients, the expression of B7 molecules by SG epithelial tissues and by SG epithelial cell lines indicates the activated status of SG epithelial cells in this disorder and, possibly, their capacity for presenting antigens to T cells.

Safety and efficacy of recombinant gamma interferon in the treatment of systemic sclerosis.

OBJECTIVE: To evaluate the safety and efficacy of recombinant gamma interferon (rIFN gamma) in the treatment of patients with systemic sclerosis. METHODS: Sixteen patients with systemic sclerosis were treated with r-IFN gamma, 60 micrograms m-2 (low dose, n = 10) and 150 micrograms m-2 (high dose, n = 6), three times weekly in an open phase I/II trial of eight months duration. The patients were stratified in low and high dose according to the severity and the extent of scleroderma; the two groups were comparable. RESULTS: The treatment was well tolerated. The most common side effects, almost certainly related to r-IFN gamma, were fever, chills, dizziness, headache, and severe flu-like syndrome with decreasing intensity with the time of treatment. Severe aphthous stomatitis (n = 1), ventricular tachycardia (n = 1), severe oesophageal ulcers due to gastro-oesophageal reflux (n = 1), disease exacerbation alone with frank arthritis and slight pericardial effusion (n = 1), and inability to conform to the requirements of the study (n = 1) were the reasons for discontinuing treatment. Side effects and degree of response were evident during the first five months of treatment. A significant decrease in mean skin thickness score was observed and was higher in the high dose group. Reactive oxygen species of peripheral neutrophils and soluble interleukin-2 receptor serum concentrations were higher than those of normal individuals at study entry and decreased in parallel with clinical improvement. CONCLUSIONS: Treatment of systemic sclerosis patients with r-IFN gamma was relatively safe and well tolerated for doses as high as 150 micrograms m-2 three times weekly. Side effects and the degree of response can be seen during the first months of therapy and can be used as predictors of ultimate toxicity or response. The drug seems to be effective in treating cutaneous scleroderma.

[Experimental study of the inducing action of streptococcal pathogenic factors on immunity and cellular autoimmunity]. / Etude expérimentale sur l'action inductrice d'immunité et d'auto-immunité cellulaires des facteurs de pathogénie streptococciques.

Rabbits issued from a closed colony which was genetically homogenous were used to investigate the capacity of streptolysin O and streptococcal M-protein to induce both cellular immune and autoimmune responses with respect to autologous cardiac tissue. The presence of immune response was indicated by positive responses of two tests of cellular immunity: blastogenesis of splenic T lymphocytes and inhibition of splenic macrophage migration. By thing into account that a nonspecific direct effect is produced by certain components of the streptococcal cell wall (lipoteichoic acid) but not by streptolysin O or M-protein on splenic lymphocytes, and according to the data on the modifications of lymphocyte populations during the autoimmune processes, it was possible to presume that anti-cardiac autoimmunity was as much due to a modification of cardiac tissue towards "non-self" status caused by experimental inductive factors as to he presence of a functional imbalance of the immunomodulatory lymphocyte system due to a predominance of auxiliary T lymphocytes.