Electroencephalographic study showing that tactile stimulation by fabrics of different qualities elicit graded event-related potentials.

BACKGROUND/PURPOSE: Neurophysiologic data on reactions of the human brain towards tactile stimuli evoked by fabrics moved on the skin are scarce. Furthermore, evaluation of fabrics' pleasantness using questionnaires suffers subjective biases. That is why we used a 64-channel electroencephalography (EEG) to objectively evaluate real-time brain reactions to fabric-skin interactions. METHODS: Tactile stimuli were triggered by selected fabrics of different qualities, i.e. modal/polyamide single jersey, cotton double rib and a jute fabric, applied hidden to either the palm or forearm of 24 subjects via a custom-made fabric-to-skin applicator called SOFIA. One-way anova analysis was carried out to verify the EEG data. RESULTS: The modal/polyamide fabric applied to the forearm and palm led to slightly stronger emotional valence scores in the brain than the conventional or baseline fabric. Furthermore, the single jersey elicits significant higher event-related potential (ERP) signals in all subjects when applied to the forearm, suggesting less distraction and better cognitive resources during the fabric/skin interaction. The brain thus reacts with instantaneous ERP to tactile stimulation of fabrics and is able to discriminate different qualities via implicit preferences. CONCLUSION: The test procedure described here may be a tool to evaluate the fabric feel with the exclusion of subjective biases.

Adipogenic differentiation of scaffold-bound human adipose tissue-derived stem cells (hASC) for soft tissue engineering.

Adipose tissue engineering, instead of tissue substitution, often uses autologous adipose tissue-derived stem cells (hASC). These cells are known to improve graft integration and to support neovascularization of scaffolds when seeded onto biomaterials. In this study we thought to engineer adipose tissue using scaffold-bound hASC, since they can be differentiated into the adipocyte cell lineage and used for soft tissue regeneration. We show here by microscopy and gene expression of the peroxysome proliferator-activated receptor gene (PPARγ2) that hASC growing on polypropylene fibrous scaffolds as well as on three-dimensional nonwoven scaffolds can be turned into adipose tissue within 19 days. Freshly isolated hASC displayed a higher differentiation potential than hASC cultured for eight passages. In addition, we proved a modified alginate microcapsule to directly induce adipogenic differentiation of incorporated hASC. The results may help to improve long-term success of adipose tissue regeneration, especially for large-scale soft tissue defects, and support the development of cell-scaffold combinations which can be shaped individually and directly induce the adipogenic differentiation of incorporated hASC at the site of implantation.

A model of the transmission of micro-organisms in a public setting and its correlation to pathogen infection risks.

AIM: Gastro-intestinal infections are widespread in the community and have considerable economic consequences. In this study, we followed chains of infection from a public toilet scenario, looking at infection risks by correlating the transmission of bacteria, fungi and viruses to our current knowledge of infectious doses. METHODS AND RESULTS: Transmission of Escherichia coli, Bacillus atrophaeus spores, Candida albicans and bacteriophage MS2 from hands to surfaces was examined in a transmission model, that is toilet brush, door handle to water tap. The load of viable pathogens was significantly reduced during transfer from hands to objects. Nevertheless, it was shown that pathogens were successfully transferred to other people in contagious doses by contact with contaminated surfaces. CONCLUSIONS: Our results suggest that infection risks are mainly dependent on current infectious doses of pathogens. For enteritic viruses or bacteria, for example Norovirus or EHEC, only a few particles or cells are sufficient for infection in public lavatories, thus bearing a high risk of infection for other persons. However, there seems to be only a low probability of becoming infected with pathogens that have a high infectious dose whilst sharing the same bathroom. SIGNIFICANCE AND IMPACT OF THE STUDY: The transmission model for micro-organisms enables a risk assessment of gastro-intestinal infections on the basis of a practical approach.

Multistate outbreak of Escherichia coli O157:H7 infections associated with a national fast-food chain, 2006: a study incorporating epidemiological and food source traceback results.

A multistate outbreak of Escherichia coli O157:H7 infections occurred in the USA in November-December 2006 in patrons of restaurant chain A. We identified 77 cases with chain A exposure in four states - Delaware, New Jersey, New York, and Pennsylvania. Fifty-one (66%) patients were hospitalized, and seven (9%) developed haemolytic uraemic syndrome; none died. In a matched analysis controlling for age in 31 cases and 55 controls, illness was associated with consumption of shredded iceberg lettuce [matched odds ratio (mOR) 8·0, 95% confidence interval (CI) 1·1-348·1] and shredded cheddar cheese (mOR 6·2, CI 1·7-33·7). Lettuce, an uncooked ingredient, was more commonly consumed (97% of patients) than cheddar cheese (84%) and a single source supplied all affected restaurants. A single source of cheese could not explain the regional distribution of outbreak cases. The outbreak highlights challenges in conducting rapid multistate investigations and the importance of incorporating epidemiological study results with other investigative findings.

Caspofungin-resistant Aspergillus flavus after heart transplantation and mechanical circulatory support: a case report.

Invasive aspergillosis (IA) is a severe complication in the post-transplant period in recipients of solid organs. Therefore, early diagnosis and specific therapy of fungal infections in these patients are indispensable. We report the case of a 49-year-old patient, who suffered from IA after cardiac transplantation, which was complicated by post-transplant right heart failure requiring mechanical circulatory support using veno-arterial extracorporeal membrane oxygenation and a right ventricular assist device. Despite antifungal treatment, the patient died 3 weeks after transplantation because of multi-organ failure secondary to IA. The isolated Aspergillus strains exhibited in vitro resistance to caspofungin.

Electromechanical synchronization of the heterotopic and native heart by dual atrial stimulation following heart transplantation.

After heterotopic heart transplantation, a 59-year-old woman presented with remarkable symptoms of breathlessness and fatigue, despite excellent donor heart function. Asynchrony of donor and native heart provoked haemodynamic instability. Dual atrial pacemaker implantation lead to linkage and synchronization of atrial and ventricular contraction in both the donor and native heart with the faster organ executing the synchronization. Remarkable relief of symptoms has been evident during the long-term follow-up.

Successful management of recurrent Epstein-Barr virus-associated multilocular leiomyosarcoma after cardiac transplantation.

BACKGROUND: In contrast to Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disorders (PTLD), EBV-associated leiomyomatous tumors have thus far only rarely been described. CASE REPORT: Two years after heart transplantation with ATG induction, cyclosporine (CsA; trough levels of 250 ng/mL)-based triple drug immunosuppression), a 23-year-old patient developed a small round lesion within the left lateral liver segment. The patient underwent ultrasound-guided biopsy followed by liver resection. Histological and immunohistological examination showed a leiomyosarcoma. In situ hybridization using EBV-specific EB endoplasmic reticulum-RNA showed an intensive signal in almost all tumor cells. The tumor stained for EB nuclear antigen (EBNA)-2-protein. Immunosuppression was drastically reduced, namely, CsA levels <100 ng/dL, prednisolone 5 mg, azathioprine withdrawn, and antiviral chemotherapy initiated with 10 days of IV gancyclovir and acyclovir followed by oral famcyclovir. During the follow-up, anti-EBV-IgM, anti-early antigen antibodies, and anti-EBNA antibodies were continuously monitored excluding significant EBV replication. Eighteen months post-liver resection, and high-resolution computed tomography scan demonstrated two paravertebral tumors. These lesions and a small nodule at the left ankle were resected revealing identical leiomyosarcomata. Immunosuppression was further reduced (CsA levels 75 ng/dL) and famcyclovir maintenance therapy started. Nevertheless, 2 years later the patient again developed tumor recurrence (perirectal, liver, and right adrenal gland); the tumors were surgically removed. The therapy was switched to Rapamycin and famcyclovir was continued. Three years after the last surgical intervention, the patient is well and recurrence-free. CONCLUSION: Long-term survival in patients with posttransplant EBV-associated leiomyosarcoma can be achieved by combined surgical intervention, reduction of immunosuppression, switch to Sirolimus, and antiviral chemotherapy.

Kaposi sarcoma in solid organ transplant recipients: a single center report.

BACKGROUND: Human herpes virus (HHV8) is associated with Castleman's disease, primary effusion lymphoma, and the Kaposi's sarcoma (KS). PATIENTS AND METHODS: Among 3815 solid organ transplants performed at our center between 1977 and 2003, five patients (0.1%) were identified with KS. RESULTS: There were one cardiac, one liver, and three renal allograft recipients of median age of 52 (range 38 to 60) years, three of whom were females. Three patients were of Italian and one of Turkish descent; only one patient was a native Austrian. The onset of the disease was 2.0, 7.5, 7.8, 9.4 months, and 22 years posttransplant. Diagnosis of KS was based in all cases on histology. The heart recipient developed a tumor on the planta pedis; one renal recipient, on both legs. The liver and the two remaining renal recipients presented with disseminated disease. Treatment in all cases consisted of reduction in immunosuppression, together with surgery (n = 1), chemotherapy (n = 1), or irradiation (n = 2). Furthermore, immunosuppression was switched in two cases from Tacrolimus to Sirolimus. In the liver recipient a complete response was achieved; he died, however, due to noncompliance followed by graft failure. One renal recipient died without evidence of recurrent disease from myocardial infarction. The cardiac and two renal recipients are alive between 4 months and 17 years with well-functioning grafts and no evidence of recurrent disease. DISCUSSION: HHV8-associated lesions seem to be extremely rare in the Central European transplant population. Nevertheless, awareness of KS is important for early diagnosis and optimal treatment.

Complete detachment of an aortic valve prosthesis 10 years after implantation.

A 47-year-old male patient died unexpectedly 10 years after replacement of the aortic valve with a Carbomedics heart valve prosthesis required for post-endocarditic valve stenosis. The man was in regular medical attendance by his general practitioner and in hospital. Clinical data and examinations did not suggest the reoccurrence of endocarditis. Three months before his death a haemolytic anaemia of unknown genesis was diagnosed. One afternoon, while lifting a heavy object, the man suffered acute chest pain and collapsed. Resuscitation failed and the patient died in hospital. Autopsy revealed the completely detached valve prosthesis within the ascending aorta. Histological examination confirmed a chronic endocarditis at the site of the valve implantation.

Off pump coronary artery bypass grafting in EuroSCORE high and low risk patients.

OBJECTIVE: Off pump coronary artery bypass grafting (OPCAB) is claimed to reduce the operative morbidity and mortality in high risk patients. It was the aim of the study to compare the outcome of OPCAB patients classified as high- and low risk according to the EuroSCORE. METHODS: Medical records of patients undergoing off pump coronary artery bypass grafting (n=126) at our institution between 1998 and 2001 were retrospectively reviewed. We classified them into two subgroups: low risk (EuroSCORE < or = 5, n=72, male 58 (81%), female 14 (19%), age 61 (37-78) years) and high risk (EuroSCORE >5, n=54, male 32 (59%), female 22 (41%), age 73 (42-83) years). RESULTS: EuroSCORE high risk patients showed significantly higher rates of blood transfusion (70 vs 31%; P<0.0001), intraaortic balloon pump insertion (16 vs 3%; P=0.013), atrial fibrillation (43 vs 22%; P=0.014), and renal failure (13 vs 3%; P=0.028). ICU length of stay was significantly longer in the high risk group (25 vs 22 h; P=0.002). There was also a higher perioperative mortality in the high risk group (9 vs 0%; P=0.008). CONCLUSION: From these data we conclude that using off pump coronary artery bypass grafting results as predicted by the EuroSCORE can be achieved. OPCAB is safe for low risk patients. Major complications seem to occur preferentially in the high risk group.

Network of vascular-associated dendritic cells in intima of healthy young individuals.

In earlier studies, our group has established a new "immunological" hypothesis for atherogenesis supported by experimental and clinical studies showing that inflammatory immunological reactions against heat shock protein 60 initiate the development of atherosclerosis. In the present study, we describe the discovery of a so-far-unknown network of dendritic cells in the innermost layer of arteries, the intima, but not veins of healthy humans and rabbits. The number of these dendritic cells is comparable to that of Langerhans cells in the skin, and dendritic cells show a similar phenotype (CD1a(+) S-100(+) lag(+) CD31(-) CD83(-) CD86(-) and no staining for von Willebrand factor or smooth muscle cell myosin). These vascular-associated dendritic cells accumulate most densely in those arterial regions that are subjected to major hemodynamic stress by turbulent flow conditions and are known to be predisposed for the later development of atherosclerosis. These results open new perspectives for the activation of the immune system within the arterial wall.

Bereavement counseling for gay individuals.

This article is intended to sensitize therapists to the particular concerns of the gay bereaved. Clinicians need to be aware of and accept homosexual and lesbian lifestyles as well as knowledgeable about grieving procedures before engaging in a therapeutic relationship with gay bereaved individuals. If the therapist has minimal information about either of these areas, the patient should be referred to another clinician who is more informed. The therapist and patient together should explore the possible mechanisms for a bereaved lesbian or gay man to cope with within his or her social environment. While it is now less of a problem than in the recent past, there is still little awareness of the specific problems homosexuals encounter and society has few structures to deal with them. Homosexual and lesbian couples who mourn their mates need to be seen and see themselves as worthy of support.