Evidence for the existence of a new genus Chlamydiifrater gen. nov. inside the family Chlamydiaceae with two new species isolated from flamingo (Phoenicopterus roseus): Chlamydiifrater phoenicopteri sp. nov. and Chlamydiifrater volucris sp. nov.

The family Chlamydiaceae currently comprises a single genus Chlamydia, with 11 validly published species and seven more taxa. It includes the human pathogens Chlamydia (C.) trachomatis, C. pneumoniae and C. psittaci, a zoonotic agent causing avian chlamydiosis and human psittacosis, as well as other proven or potential pathogens in ruminants, birds, snakes, reptiles and turtles. During routine testing of 15 apparently healthy captive flamingos in a zoo in 2011, an atypical strain of Chlamydiaceae was detected by real-time PCR of cloacal swab samples. Sequence analysis of the 16S rRNA gene revealed high similarity to the uncultured Chlamydiales bacterium clone 122, which previously had been found in gulls. As more samples were collected during annual campaigns of the flamingo ringing program in southern France from 2012 to 2015, Chlamydiaceae-specific DNA was detected by PCR in 30.9% of wild birds. From these samples, three strains were successfully grown in cell culture. Ultrastructural analysis, comparison of 16S and 23S rRNA gene sequences, whole-genome analysis based on de novo hybrid-assembled sequences of the new strains as well as subsequent calculation of taxonomic parameters revealed that the relatedness of the flamingo isolates to established members of the family Chlamydiaceae was sufficiently distant to indicate that the three strains belong to two distinct species within a new genus. Based on these data, we propose the introduction of Chlamydiifrater gen. nov., as a new genus, and Chlamydiifrater phoenicopteri sp. nov. and Chlamydiifrater volucris sp. nov., as two new species of the genus.

Spirituality and mood pathology in severe skin conditions: a prospective observational study.

Although the association between spirituality and parameters of psychological health and disease has been investigated extensively, little evidence is available for its potential role in dermatology. In a single-centre observational prospective study, 149 outpatients (107 women) with systemic sclerosis (SSc; n = 44), lupus erythematosus (LE; n = 48), or early stage malignant melanoma (MM; n = 57) were investigated using the multidimensional inventory for religious/spiritual well-being together with the Brief Symptom Inventory for psychiatric symptoms (BSI-18). SSc patients reported the highest amount of Somatization in comparison with LE and MM patients (p < 0.05). Furthermore, in line with the previous research, spiritual dimensions, such as Hope for a better future (p < 0.01) or Hope for a better afterlife (p < 0.01), proved to be especially negatively predictive for the global amount of psychiatric symptom burden in these dermatological patient groups. Our findings suggest that greater attention should be given to spiritual issues, such as encouraging patients, imbuing them with optimism, and offering interventions that address spiritual well-being.

Urinary levoglucosan levels in Austrian communities differing in agrarian quota.

Levoglucosan is a sugar anhydride produced by combustion of carbohydrates. In ambient monitoring it serves as an indicator for wood smoke. Its use in human biomonitoring, however, is not yet widespread. This study investigated whether levoglucosan in urine is a suitable biomarker for regional differences in wood smoke exposure in the winter season. Within the first Austrian biomonitoring survey, pooled urine samples from mothers as well as children of five communities of different size (two-stage random stratified sampling) were analysed by HPLC. As an indicator of exposure to polycyclic aromatic hydrocarbons (PAH) that are also prevalent in wood smoke, 1-hydroxypyrene was determined. In each town levoglucosan was found in higher levels in the pooled children's samples than in the pooled mothers' samples. It correlated well with the agrarian quota. 1-Hydroxypyrene concentrations were higher in areas with higher population density. Correlation of urinary levoglucosan concentrations with the agrarian quota may be explained by higher wood smoke exposure in communities with higher agrarian quota. To our knowledge this study is the first investigation on this issue in Europe. It indicates that human biomonitoring of levoglucosan may be suitable to detect differences in regional exposure to wood smoke.

Occurrence of polycyclic musks in wastewater and receiving water bodies and fate during wastewater treatment.

The occurrence of cashmerane (DPMI), celestolide, phantolide, traesolide (ATII), galaxolide (HHCB) and tonalide (AHTN) in sewage and surface waters and their fate during wastewater treatment and anaerobic sludge digestion is investigated. AHTN and HHCB are the most important representatives and influent concentrations of 0.41-1.8 and 0.9-13 µgL(-1) are observed. DPMI is detected in influent and effluent samples but in notably lower concentrations than AHTN and HHCB. Major sources of polycyclic musks are households, whereas industrial emitters seem to be of minor importance. This conclusion is supported by the analysis of selected industrial wastewaters (metal, textile and paper industry). Specific emissions of 0.36 ± 0.19 and 1.6 ± 1.0 mg cap(-1)d(-1) for AHTN and HHCB are calculated. Overall removal efficiencies between approx 50% and more than 95% are observed during biological wastewater treatment and removal with the excess sludge is the major removal pathway. Log K(D) values of 3.73-4.3 for AHTN, 3.87-4.34 for HHCB and 2.42-3.22 for DPMI are observed in secondary sludge. During sludge digestion no or only slight removal occurred. Mean polycyclic musk concentrations in digested sludge amounted to 1.9 ± 0.9 (AHTN), 14.2 ± 5.8 (HHCB), 0.8 ± 0.4 (ATII) and 0.2 ± 0.09 (DPMI) mgkg(-1) dry matter. In the receiving water systems a comparable distribution as during wastewater treatment is observed. AHTN, HHCB and DPMI are detected in surface waters (ND (not detected) - <0.04, ND - 0.32 and ND - 0.02 µg L(-1)) as well as AHTN and HHCB in sediments (ND - 20, ND - 120 µg kg(-1)). For HHCB an apparent K(OC) value of 4.1-4.4 is calculated for sediments. Major source for polycyclic musks in surface waters are discharges from wastewater treatment plants. For HHCB and DPMI 100% of the load observed in the sampled surface waters derive from discharges of treated wastewater.

Legionella pneumophila-induced IκBζ-dependent expression of interleukin-6 in lung epithelium.

Severe community- and hospital-acquired pneumonia is caused by Legionella pneumophila. Lung airway and alveolar epithelial cells comprise an important sentinel system in airborne infections. Although interleukin (IL)-6 is known as a central regulator of the immune response in pneumonia, its regulation in the lung is widely unknown. Herein, we demonstrate that different L. pneumophila strains induce delayed expression of IL-6 in comparison with IL-8 by human lung epithelial cells. IL-6 expression depended, at early time points, on flagellin recognition by Toll-like receptor (TLR)5, activity of mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK)1 and p38 mitogen-activated protein (MAP) kinase, and, at later time points, on the type-IV secretion system. In the same manner, but more rapidly, the recently described transcription factor IκBζ was induced by Legionella infection and, binding to the nuclear factor (NF)-κB subunit p50 - recruited to the il6 promoter together with CCAAT-enhancer-binding protein ß and phosphorylated activator protein-1 subunit cJun. Similarly, histone modifications and NF-κB subunit p65/RelA appeared at the iκbζ and subsequently at the il6 gene promoter, thereby initiating gene expression. Gene silencing of IκBζ reduced Legionella-related IL-6 expression by 41%. Overall, these data indicate a sequence of flagellin/TLR5- and type IV-dependent IκBζ expression, recruitment of IκBζ/p50 to the il6 promoter, chromatin remodelling and subsequent IL-6 transcription in L. pneumophila-infected lung epithelial cells.

Comparing pulmonary resistance measured with an esophageal balloon to resistance measurements with an airflow perturbation device.

The airflow perturbation device (APD) perturbs flow and mouth pressure during regular breathing. Ratios of mouth pressure perturbation magnitudes to flow perturbation magnitudes were used to calculate inspiratory, expiratory and average respiratory resistances. Resistance measurements with the APD were compared to pulmonary resistances directly measured with an esophageal balloon. Six healthy subjects were tested during tidal breathing when known external resistances were added during inspiration, during expiration and during both inspiration and expiration. When the baseline averaged balloon measured pulmonary resistance was subtracted from the baseline averaged APD measured resistance, the difference between them was 0.92 +/- 1.25 (mean +/- SD) cmH(2)O L(-1) s(-1). Compared to the magnitude of the known increase in the added resistance, the APD measured resistance increased by 79%, whereas directly measured pulmonary resistance increased only by 56%. During addition of external resistances to both inspiration and expiration, the changes in inspiratory and expiratory pulmonary resistance were only 36% and 62% of the added resistance, respectively. On the other hand, the APD inhalation and exhalation resistance measured between 82% and 76% of the added resistance. We conclude that the APD detects changes in external resistance at least as well as, and probably better than, classical measurements of pulmonary resistance.

High levels of xenoestrogens in patients with low-grade endometrial stromal sarcoma--report of two cases.

BACKGROUND: Endometrial stromal sarcomas (ESS) are rare uterine tumors with unknown etiological risk factors, but estrogen-dependent growth promotion. CASES: We present two patients with advanced ESS, who had increased levels of p,p-DDE; hexachlorobenzene; PCB 28; PCB 52; PCB 101; PCB 138; PCB 153 and PCB 180 in abdominal adipose tissue. Other xenoestrogens were within expected limits for the non-exposed European population. CONCLUSION: Increased levels of xenoestrogens in patients with ESS may be involved in the pathogenesis of ESS. Chronic exposure to xenoestrogens may be a risk factor for tumor progression.

A novel chronic social stress paradigm in female mice.

Major depression is one of the most prevalent stress-related psychiatric diseases. Next to environmental influences such as chronic social stress, gender is among the strongest risk factors for major depression, with women having a twice as high risk to develop the disease compared to men. While there is abundant literature on the effects of chronic social stress in male rodents, there is a serious lack of information on gender-specific effects. Especially in mice, which due to the wide availability of transgenic lines offer a unique opportunity to study gene x environment interactions, there is no existing model of chronic social stress that is applicable to both sexes. We here describe the effects of chronic social stress based on the disruption of the social network in a group-housed situation in female mice, a model that was recently described and validated for male mice. In this model, the group composition of the mice is changed twice per week for a period of 7 weeks, covering the adolescent and early adulthood period. We observed that housing in an unpredictable social environment resulted in chronic stress in female mice. The observed effects, which included increased adrenal weight, decreased thymus weight, increased corticosterone levels, and increased anxiety-like behavior, were very similar to the described effects of this paradigm in male mice. In addition, we observed a distinct expression of stress system-related genes in female mice following chronic stress exposure. Our results validate this model as a suitable approach to study chronic social stress in female mice and open up the opportunity to use this model with transgenic or knockout mouse lines.

High susceptibility to chronic social stress is associated with a depression-like phenotype.

Chronic stress is a key risk factor for a variety of diseases, including depression. There is a large degree of individual variation in the ability to recover successfully from a chronic stress exposure, but the determinants of this individual stress susceptibility are still poorly understood. We recently developed a novel mouse paradigm for chronic social stress during adolescence, which closely mimics the human condition of chronic social stress in respect to construct, face and predictive validity. By applying this chronic stress model to a large number of animals we aimed at identifying individuals that are either resilient or vulnerable to the persistent effects of chronic social stress exposure. Animals showing markedly elevated basal corticosterone levels 5 weeks following the end of the stress paradigm were considered "vulnerable", whereas individuals recovering quickly and being indistinguishable from controls were classified as "resilient". Stress vulnerability was associated with an increased level of corticotropin-releasing hormone in the paraventricular nucleus, decreased hippocampal mineralocorticoid receptor expression as well as increased anxiety- and depression-like behavior compared to resilient and control animals. In summary, we show that by using a large cohort of animals it is possible to select individuals that are vulnerable or resilient to the lasting effects of chronic social stress. The vulnerable phenotype mimics many aspects of stress-related human affective disorders and this may be used as a novel approach to study depression in an animal model, ultimately contributing to a better understanding and treatment of stress-related disorders.

Asthma as a predictor of obstructive sleep apnea in urban African-American children.

BACKGROUND: Asthma is a known co-morbid factor in childhood obstructive sleep apnea (OSA); however, little is known about the effects that asthma might have on the severity of OSA. We hypothesize that children with concomitant asthma and OSA have more severe OSA. METHODS: We conducted a prospective study of 50 children with OSA diagnosed by polysomnography referred for tonsillectomy and adenoidectomy (T&A). The presence of concomitant asthma was determined by ISAAC questionnaire and spirometry. Atopy to common allergens was determined by skin prick testing. Due to the relatively small sample size, we limited hypothesis testing to cross tabulations with Fisher's Exact Test and t testing. We also employed a parsimonious ordinary least squares (OLS) regression assuming a large effect size. RESULTS: Subjects (n = 50) included 32 males and 41 African-Americans. Age at T&A was 9.3 +/- 3.4 years (mean +/- S.D). Thirty-two subjects reported a history of asthma during their lifetimes, but the ISAAC questionnaire detected only 30 subjects. Twenty-two subjects reported current asthma. Atopy was found in 27 subjects. Apnea-hypopnea index (AHI) was lower in the current asthma group than in the lifetime asthma group but did not reach statistical significance. However, AHI was significantly higher in subjects with poorly controlled asthma. Further, in a parsimonious OLS model controlling for sleep efficiency and age, a history of lifetime asthma increased the AHI by 8.8 (p < 0.05). DISCUSSION: In urban African-American children referred for T&A to treat OSA, a history of poorly controlled asthma is associated with more severe OSA.

Perfluorinated alkylated substances in the aquatic environment: an Austrian case study.

Perfluorinated alkylated substances (PFAS) are of global interest due to their occurrence and persistency in the environment. This study includes surface waters and sediments for the analysis of eleven PFAS. The PFAS studied can be grouped in perfluoroalkyl carboxylates (PFCAs), perfluoroalkyl sulfonates (PFS) and perfluoroalkyl sulfonamides (PFSA). The two most important compounds are perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS). These two substances showed the most significant values for surface water samples with maximum concentrations of 21 ng l(-1) for PFOA and 37 ng l(-1) for PFOS. Sediment samples from seven Austrian lakes and the river Danube were studied. Whereas PFSA and PFS were not detected in any sediment sample PFCAs were detected in most of the lake samples in concentrations up to 1.7 microg kg(-1) dry wt. PFOA, perfluorohexanoic acid (PFHxA) and perfluoroheptanoic acid (PFHpA) were detected in all Danube river sediment samples in concentrations varying from 0.1 up to 5.1 microg kg(-1) dry wt. For the various sampling points the proportional mass flows deriving from wastewater discharges were calculated. Whereas only up to 10% of the average flow is discharged wastewater up to more than 50% of the PFAS mass flows in the rivers can be attributed to wastewater discharges. Besides wastewater different other pathways as emissions from point sources, further degradation of precursor products, runoff from contaminated sites or surface runoff as well as dry and wet deposition have to be considered as relevant sources for PFAS contamination in surface waters.

PKC(alpha) and PKC(epsilon) differentially regulate Legionella pneumophila-induced GM-CSF.

Legionella pneumophila is an important causative agent of severe pneumonia in humans. The human alveolar epithelium is an effective barrier for inhaled microorganisms and actively participates in the initiation of innate host defense. Although secretion of granulocyte-macrophage colony-stimulating factor (GM-CSF) is essential for the elimination of invading Legionella spp., mechanisms of Legionella pneumophila-induced release of this cytokine are widely unknown. In this study, we have demonstrated a toll-like receptor (TLR)2- and TLR5-dependent release of GM-CSF in L. pneumophila-infected human alveolar epithelial cells. GM-CSF secretion was not dependent on the bacteria type II or type IV secretion system. Furthermore, an increase in protein kinase C (PKC) activity, particularly PKC(alpha) and PKC(epsilon), was noted. Blocking of PKC(alpha) and PKC(epsilon) activity or expression, but not of PKC(beta), PKC(delta), PKC(eta), PKC(theta), and PKC(zeta), significantly reduced the synthesis of GM-CSF in infected cells. While PKC(alpha) was critical for the initiation of a nuclear factor-kappaB-mediated GM-CSF expression, PKC(epsilon) regulated GM-CSF production via activator protein 1. Thus, differential regulation of GM-CSF, production by PKC isoforms, contributes to the host response in Legionnaires' disease.

Opioid-associated central sleep apnea: a case series.

INTRODUCTION: Subjects on methadone maintenance for drug addiction have been reported to have central sleep apnea (CSA). However, there are few reports of disordered breathing in patients receiving opioids for chronic pain. MATERIALS AND METHODS: We report on six patients (ages 41-68, two females, body mass index 27-34, morphine equivalent doses 120-420 mg/day, Epworth Scales 7-21) referred to our sleep center receiving sustained release opioids for more than 6 months with excessive daytime sleepiness. CSA was defined as apnea-hypopnea index (AHI) more than 5 per hour with > or =50% central events. Bilevel (BLV) titration was done to determine settings and all patients were followed for at least 6 months on nocturnal BLV. AHI ranged 28.4-106 per hour. Time less than 90% O(2) saturation ranged 1.8 min to 6.4 h. Four of the patients were treated with chronic BLV ventilation with settings ranging 12-16 cm H(2)O (inspiratory positive airway pressure)/4-8 cm H(2)O (expiratory positive airway pressure) with backup rate of 12-16. Among the four patients who used BLV treatment for at least 6 months, Epworth scores improved (by 4, 12, 5, and 9, respectively). CONCLUSION: Treatment of opioid-associated CSA with BLV corrected nocturnal hypoxemia and reduced sleep fragmentation. Randomized controlled trials, with objective measures of daytime function, are recommended in opioid-induced CSA patients.

Emissions of perfluorinated alkylated substances (PFAS) from point sources--identification of relevant branches.

Effluents of wastewater treatment plants are relevant point sources for the emission of hazardous xenobiotic substances to the aquatic environment. One group of substances, which recently entered scientific and political discussions, is the group of the perfluorinated alkylated substances (PFAS). The most studied compounds from this group are perfluorooctanoic acid (PFOA) and perfluorooctane sulphonate (PFOS), which are the most important degradation products of PFAS. These two substances are known to be persistent, bioaccumulative and toxic (PBT). In the present study, eleven PFAS were investigated in effluents of municipal wastewater treatment plants (WWTP) and in industrial wastewaters. PFOS and PFOA proved to be the dominant compounds in all sampled wastewaters. Concentrations of up to 340 ng/L of PFOS and up to 220 ng/L of PFOA were observed. Besides these two compounds, perfluorohexanoic acid (PFHxA) was also present in nearly all effluents and maximum concentrations of up to 280 ng/L were measured. Only N-ethylperfluorooctane sulphonamide (N-EtPFOSA) and its degradation/metabolisation product perfluorooctane sulphonamide (PFOSA) were either detected below the limit of quantification or were not even detected at all. Beside the effluents of the municipal WWTPs, nine industrial wastewaters from six different industrial branches were also investigated. Significantly, the highest emissions or PFOS were observed from metal industry whereas paper industry showed the highest PFOA emission. Several PFAS, especially perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluorododecanoic acid (PFDoA) and PFOS are predominantly emitted from industrial sources, with concentrations being a factor of 10 higher than those observed in the municipal WWTP effluents. Perfluorodecane sulphonate (PFDS), N-Et-PFOSA and PFOSA were not detected in any of the sampled industrial point sources.

Is there any role for computed tomography measurements of medial temporal lobe atrophy in dementia? A review of the literature and case series from a memory clinic.

Neuroimaging in dementia has focused on documenting any burden of vascular disease or excluding any reversible intracranial pathology. We review the use of computed tomography to examine for medial temporal lobe atrophy in dementia and compare this with a case series of such measurements from our memory clinic. Measures of medial temporal lobe atrophy were used to separate patients with Alzheimer's disease from those with normal cognition, mood disorders or other forms of early dementia.

What do healthcare workers think? A survey of facial protection equipment user preferences.

Data on healthcare workers'(HCWs) self-reported knowledge regarding selection of facial protection equipment, usage preferences and compliance are limited. We used a questionnaire on the use of facial protection equipment at a 700-bed adult tertiary care hospital employing approximately 7000 HCWs. Clinical areas targeted were those with frequent users of N95 respirators: intensive care unit, emergency room, respiratory services, and internal medicine. Respiratory therapists were also invited. In all, 137 questionnaires (68.5%) were returned. Most (72.8%) reported that training on the use of facial protection equipment was 'sufficient' to 'excellent'. The PFR95 and 3M 1860 Cone were used most frequently (56%) followed by the 3M 1870 Pocket (42%). While 95% reported having been fit-tested, only 60% were tested annually. PRF95 use exceeded the number of HCWs fit-tested for the item. Overall comfort and compliance scores were 13.6/20 and 21.5/25, respectively, for respirators and 7.7/10 and 18.5/25 for protective eyewear. No relationship between comfort and years of use of either respirators or protective eyewear was found. The results highlight potential failures in effectiveness in the use of personal protective equipment that could compromise HCW safety, and support observations that compliance in the workplace is usually less than in the research setting.

Occurrence of selected surfactants in untreated and treated sewage.

Several surfactants were monitored in treated and untreated sewage in nine municipal wastewater treatment plants (WWTPs) in western Austria. The nine sampled WWTPs cover a wide variety referring to size and applied treatment technology. The investigation focused on linear alkylbenzene sulphonate (LAS), quaternary ammonia compounds (QAC), nonylphenol (NP), octylphenol (OP), nonylphenolmono- (NP(1)EO) and -diethoxylates (NP(2)EO). Whereas LAS, NP, OP and NP(1,2)EO were analysed separately in the liquid phase and in the solid phase, the QACs were measured in the total sample. Total influent concentrations of LAS varied between 2.4 mg l(-1) up to 6.7 mg l(-1) whereas total effluent concentrations were in the lower microg l(-1) range (11-50 microg l(-1)). Whichever the type of treatment, a clear removal during treatment was observed. Solid liquid distribution coefficients K(d) were calculated for untreated sewage. The calculated K(d) values varied between 1300 and 3900 l kg(-1). OP was of minor importance with total influent concentrations below 1microg l(-1). NP and NP(1,2)EO were present in all analysed influents in concentrations between 1 and 35microg l(-1). Effluent concentrations were notably lower than the measured influent concentrations. K(d) values for NP varied between 500 and 6600 l kg(-1), for NP(1)EO between 800 and 2700 l kg(-1) and for NP(2)EO between 100 and 1800 l kg(-1). From the QACs several alkyl benzyl (BAC), dialkyl (DDAC) and trialkyl (ATAC) ammonium chlorides with varying alkyl chain lengths were analysed. Highest total concentrations in the influents to the WWTPs were observed for the BAC-C12 and the ATAC-C16 homologues. Effluent concentrations were notably lower compared to influent concentrations, indicating removal by adsorption and/or biodegradation. The influence of the removal by adsorption increased with increasing alkyl chain length.

Mass antibiotic treatment to stop an outbreak of meningococcal disease: a molecular analysis.

The occurrence of three cases of meningococcal disease among children in a small community, two of whom attended the same day-care centre, prompted a programme of mass antibiotic prophylaxis. Nasopharyngeal and throat swabs were obtained on three occasions from all children registered at the day-care centre. Serogroup B Neisseria meningitidis was isolated from 13 of 61 children before prophylaxis, from three children after 2 weeks, and from 19 children after 3 months. Repetitive extragenic palindromic PCR analysis identified several meningococcal strains before treatment, one of which became predominant after 3 months. Mass antibiotic prophylaxis initially suppressed meningococcal carriage, but the carriage rate subsequently rebounded.

Estimating pulmonary artery pressures by echocardiography in patients with emphysema.

In patients with emphysema being evaluated for lung volume reduction surgery, Doppler echocardiography has been used to screen for pulmonary hypertension as an indicator of increased peri-operative risk. To determine the accuracy of this test, the present authors compared the results of right heart catheterisations and Doppler echocardiograms in 163 patients participating in the cardiovascular substudy of the National Emphysema Treatment Trial. Substudy patients had both catheterisation and Doppler echocardiography performed before and after randomisation. In 74 paired catheterisations and echocardiograms carried out on 63 patients, the mean values of invasively measured pulmonary artery systolic pressures and the estimated right ventricular systolic pressures were similar. However, using the World Health Organization's definitions of pulmonary hypertension, echocardiography had a sensitivity of 60%, specificity of 74%, positive predictive value of 68% and a negative predictive value of 67% compared with the invasive measurement. Bland-Altman analysis revealed a bias of 0.37 kPa with 95% limits of agreement from -2.5-3.2 kPa. In patients with severe emphysema, echocardiographic estimates of pulmonary artery pressures correlate very weakly with right heart catheterisations, and the test characteristics (e.g. sensitivity, specificity, etc.) of echocardiographic assessments are poor.