Hernia repair and simultaneous continuous ambulatory peritoneal dialysis (CAPD) catheter implantation: feasibility and outcome.

BACKGROUND: Occurrence of abdominal wall hernias during and before peritoneal dialysis constitutes a pivotal role in treatment discontinuation, failure, and exclusion from this dialysis method. We herein present a single-center experience regarding a one-stage surgical strategy, including hernia repair and simultaneous peritoneal dialysis catheter implantation. PATIENTS AND METHODS: Over a 4-year period, 123 patients underwent peritoneal dialysis catheter implantation and 23 patients (19%) had concomitant abdominal wall hernias and were enrolled in this monocentric prospective study. Data collection included recurrent and new-onset hernias, surgical site infection, 1-year and 2-year catheter survival. RESULTS: In 23 patients, 27 hernia repairs combined with peritoneal dialysis catheter implantation were performed. Median age was 52 years (range, 30-85 years) and 18/23 (78%) patients were male. There were no recurrent hernias and no early surgical site infections. Daily flushing was regularly started on the 1st to 3rd postoperative day. Five patients (22%) developed hernias on other anatomical sites, which required hernia repair and perioperative discontinuation of peritoneal dialysis. After a median follow-up of 37 months (range, 28-87 months), 96% of all implanted catheters were still working. CONCLUSION: Hernia repair and simultaneous peritoneal dialysis catheter implantation are associated with no recurrent hernias, an early start of peritoneal dialysis, a very low postoperative morbidity and very high 1-year and 2-year catheter survival.

Giant crystals inside mitochondria of equine chondrocytes.

The present study reports for the first time the presence of giant crystals in mitochondria of equine chondrocytes. These structures show dark contrast in TEM images as well as a granular substructure of regularly aligned 1-2 nm small units. Different zone axes of the crystalline structure were analysed by means of Fourier transformation of lattice-resolution TEM images proving the crystalline nature of the structure. Elemental analysis reveals a high content of nitrogen referring to protein. The outer shape of the crystals is geometrical with an up to hexagonal profile in cross sections. It is elongated, spanning a length of several micrometres through the whole cell. In some chondrocytes, several crystals were found, sometimes combined in a single mitochondrion. Crystals were preferentially aligned along the long axis of the cells, thus appearing in the same orientation as the chondrocytes in the tissue. Although no similar structures have been found in the cartilage of any other species investigated, they have been found in cartilage repair tissue formed within a mechanically stimulated equine chondrocyte construct. Crystals were mainly located in superficial regions of cartilage, especially in joint regions of well-developed superficial layers, more often in yearlings than in adult horses. These results indicate that intramitochondrial crystals are related to the high mechanical stress in the horse joint and potentially also to the increased metabolic activity of immature individuals.

Hepatitis B and C in pregnancy: a review and recommendations for care.

Our objective was to provide a comprehensive review of the current knowledge regarding pregnancy and hepatitis B virus (HBV) or hepatitis C virus (HCV) infection as well as recent efforts to reduce the rate of mother-to-child transmission (MTCT). Maternal infection with either HBV or HCV has been linked to adverse pregnancy and birth outcomes, including MTCT. MTCT for HBV has been reduced to approximately 5% overall in countries including the US that have instituted postpartum neonatal HBV vaccination and immunoprophylaxis with hepatitis B immune globulin. However, the rate of transmission of HBV to newborns is nearly 30% when maternal HBV levels are greater than 200 000 IU ml(-1) (>6 log10 copies ml(-1)). For these patients, new guidelines from the European Association for the Study of the Liver (EASL) and the Asian Pacific Association for the Study of the Liver (APASL) indicate that, in addition to neonatal vaccination and immunoprophylaxis, treating with antiviral agents such as tenofovir disoproxil fumarate or telbivudine during pregnancy beginning at 32 weeks of gestation is safe and effective in preventing MTCT. In contrast to HBV, no therapeutic agents are yet available or recommended to further decrease the risk of MTCT of HCV, which remains 3 to 10%. HCV MTCT can be minimized by avoiding fetal scalp electrodes and birth trauma whenever possible. Young women with HCV should be referred for treatment post delivery, and neonates should be closely followed to rule out infection. New, better-tolerated treatment regimens for HCV are now available, which should improve outcomes for all infected individuals.

How much oxidative stress exists without the liver?

BACKGROUND: Oxidative stress (OS) represents an important pathogenetic factor of acute liver failure and chronic liver diseases. To elucidate whether the liver itself is a major source of OS, the present study was performed to assess OS and antioxidant status in an anhepatic porcine model. METHODS: Six pigs underwent a total hepatectomy, five pigs were sham operated. OS and antioxidant status were evaluated by measuring plasma concentrations of malondialdehyde (MDA), xanthine oxidase (XO), superoxide dismutase (SOD) and the ferric reducing ability of plasma (FRAP). They were sampled at the start of the experiment, immediately after surgery, and then at 8 and 16 hours post hepatectomy. RESULTS: Increased concentrations of MDA were observed in anhepatic pigs postoperatively (p < 0.02) and 8 hours after hepatectomy (p < 0.003) compared to controls. XO activity increased soon after hepatectomy (22.6 ±â€Š5.4 mU/L versus 3.3 ±â€Š2.1 mU/L in sham animals, p < 0.03) but returned to normal values in the further course. SOD levels did not change during the observational period in both groups. FRAP values rose significantly in the anhepatic animals compared to control (p < 0.015). A significant positive correlation was observed between MDA levels and FRAP levels (Spearman's ρ = 0.62; p < 0.0001). CONCLUSIONS: These findings show that hepatectomy does not completely prevent the occurrence of OS because the production and regulation of OS are also located outside the liver.

Mesoscopic properties of interfacial ordering in amorphous germanium on Si(111) determined by quantitative digital image series matching.

For the quantitative characterization of atomic ordering in the transition region between crystalline and amorphous materials we have previously described a method based on averaging HREM images along the interface, simulation of averaged images with the use of the averaged projected potential approximation and determination of the atom arrangement by means of an iterative matching procedure for high-resolution focus series. In order to study mesoscopic properties of crystal induced ordering a fully quantitative procedure is developed in this work. For this purpose, the width of the averaging region is defined as a compromise providing necessary accuracy of calculations and desirable locality of characterization of the atom distribution. Fluctuations of the obtained atom distribution on the amorphous side of the interface are estimated by means a of special Monte-Carlo simulation technique. As a result, distribution functions obtained from different regions can be quantitatively compared and statistically significant differences can be identified and related to the atomic structure. The method is applied to investigate the near interfacial atom order at the interface between atomically flat crystalline Si(111) and amorphous Ge. It is shown that significant variations in the atomic density distribution occur on a 5-10nm scale for germanium atoms in the second and third atomic layer lying parallel to the interface.

Synthesis of stable AuAg bimetallic nanoparticles encapsulated by diblock copolymer micelles.

We present a facile method for the preparation of bimetallic AuAg nanoparticles (NPs) with controlled size and composition rendering them ideally suitable for optical and catalytic applications. In analogy to methods for the generation of monometallic Au and Ag NPs, AuAg NPs were prepared inside polystyrene-b-poly(4-vinylpyridine) (PS-b-P4VP) block-copolymer micelles formed in toluene, by loading the P4VP cores of the micelles first with AgNO(3) and then with HAuCl(4). In contrast to the reverse sequence of loading, homogenously bimetallic AuAg particle arrays were achieved after reduction carried out in solution with hydrazine monohydrate as the reducing agent. TEM reveals that stable and spherical NPs can be prepared well separated from one another and with a narrow size distribution with diameters of ∼3 nm. The bimetallic NP composition was confirmed by energy-dispersive X-ray spectroscopy (EDX) of single NPs. The atomic ratio of Ag and Au contained in single particles is in good agreement with the relative concentrations of both metals used in the synthesis which was confirmed by atomic absorption spectroscopy. The atomic ratio Au : Ag was systematically varied between 3 : 1 and 1 : 3. For all ratios UV-vis spectra showed a single plasmon band. Its wavelength varied from 430 for Au : Ag = 1 : 3 to 515 nm for Au : Ag = 3 : 1, showing a linear dependence on the relative amount of gold within the range of plasmon wavelengths from monometallic gold (538 nm) to silver (415 nm).

Nicotine-induced plasma corticosterone is attenuated by social interactions in male and female adolescent rats.

Most smokers begin smoking during adolescence, a period during which social reward is highly influential. Initial exposure to nicotine can produce anxiogenic effects that may be influenced by social context. This study examined play behavior and plasma corticosterone following nicotine administration (0.6 mg/kg, s.c.) in both male and female adolescent (PND39) Sprague-Dawley rats in either isolate or social contexts. In blood samples collected immediately following the 15-min test session, nicotine increased plasma corticosterone relative to saline in both male and female isolate rats, but failed to do so in both males and females placed together in same-sex pairs. Nicotine also attenuated several indices of play behavior including nape attacks, pins and social contact. In isolate rats, nicotine selectively increased locomotor activity in females; however, when administered to social pairs, nicotine decreased locomotion in both sexes. These findings suggest that the presence of a social partner may decrease the initial negative, stress-activating effects of nicotine, perhaps leading to increased nicotine reward.

A reproducible porcine model of acute liver failure induced by intrajejunal acetaminophen administration.

BACKGROUND AND AIMS: Severe intoxication following acetaminophen overdose is the most common cause of acute liver failure (ALF) in many Western European and North American countries. A reproducible large animal model of acetaminophen intoxication has not been successfully evaluated previously. METHODS: Eight male pigs underwent acetaminophen intoxication receiving an initial enteric bolus of 250 mg/kg body weight acetaminophen followed by an acetaminophen plasma level (300-450 mg/l) adapted enteric maintenance dose of 1,000-3,000 mg/h to the onset of ALF (prothrombin time value <30%). Vital and ventilation parameters were continuously recorded until death. Saline, hydroxyethyl starch, fresh frozen plasma and erythrocyte units were used for volume substitution, and norepinephrine to prevent severe hypotension. RESULTS: All animals developed ALF after 25 ± 3 h, which was confirmed by laboratory values, the clinical course and histological examinations. All animals died due to ALF after a further 21 ± 5 h, precipitated by cerebral edema. CONCLUSIONS: Using an initial enteric acetaminophen bolus, followed by body weight-adapted acetaminophen plasma level intoxication, it was possible to establish a reproducible, clinically relevant porcine model which may be used for the investigation of novel therapeutic approaches in this life-threatening condition.

Performance of commercial enzyme-linked immunosorbent assays for detection of antibodies to Bordetella pertussis.

Measuring antibodies to Bordetella pertussis antigens is mostly done by enzyme-linked immunosorbent assays (ELISAs). We compared the performance of ELISA kits that were commercially available in Germany. Eleven measured IgG antibodies, and nine measured IgA antibodies. An in-house ELISA with purified antigens served as a reference method. Samples included two WHO reference preparations, the former Food and Drug Administration (FDA)/Center for Biologics Evaluation and Research (CBER) reference preparations, serum samples from patients with clinically suspected pertussis, and serum samples from patients having received a combined tetanus, diphtheria, and pertussis (Tdap) vaccination. Kits using pertussis toxin (PT) as an antigen showed linearity compared to the WHO Reference preparation (r2 between 0.82 and 0.99), and these kits could quantify antibodies according to the reference preparation. ELISA kits using mixed antigens showed no linear correlation to the reference preparations. Patient results were compared to results of in-house ELISAs using a dual cutoff of either ≥100 IU/ml anti-PT IgG or ≥40 IU/ml anti-PT IgG together with ≥12 IU/ml anti-PT IgA. The sensitivities of kits measuring IgG antibodies ranged between 0.84 and 1.00. The specificities of kits using PT as an antigen were between 0.81 and 0.93. The specificities of kits using mixed antigens were between 0.51 and 0.59 and were thus not acceptable. The sensitivities of kits measuring IgA antibodies ranged between 0.53 and 0.73, and the specificities were between 0.67 and 0.94, indicating that IgA antibodies may be of limited diagnostic value. Our data suggest that ELISAs should use purified PT as an antigen and be standardized to the 1st International Reference preparation.

Environmental living conditions introduced during forced abstinence alter cocaine-seeking behavior and Fos protein expression.

Environmental enrichment (EE) introduced during abstinence from cocaine self-administration is protective in reducing cue-elicited incentive motivation for cocaine in rats. This study examined neural activation associated with this protective effect of EE using Fos protein expression as a marker. Rats were trained to press a lever reinforced by cocaine (0.75 mg/kg/0.1 mL infusion) and light and tone cues across 15 consecutive days during which they were all housed in isolated conditions (IC). Rats were then assigned to either remain in IC, or to live in pair-housed conditions (PC) or EE for 30 days of forced abstinence from cocaine. Subsequently, cocaine-seeking behavior (lever presses without cocaine reinforcement) elicited by response-contingent cue presentations was assessed for 90 min, after which the rats' brains were immediately harvested for Fos protein immunohistochemistry. EE attenuated, whereas IC enhanced, cue-elicited cocaine-seeking behavior relative to PC. Also, within the prelimbic and orbitofrontal cortices and basolateral amygdala, IC enhanced, whereas EE reduced, Fos expression relative to PC. Furthermore, EE attenuated Fos expression in the infralimbic and anterior cingulate cortices, the nucleus accumbens (core and shell), bed nucleus of the stria terminalis, and ventral tegmental area, evident as a reduction relative to both PC and IC. In contrast, IC enhanced Fos expression in the dorsal caudate putamen, substantia nigra, and central amygdala, evident as an increase relative to both PC and EE. These results suggest that EE blunts neural activation throughout the mesocorticolimbic circuitry involved in cue-elicited incentive motivation for cocaine, whereas IC enhances activation primarily within the nigrostriatal dopamine pathway. These findings have important implications for understanding and treating drug-conditioned craving in humans.

Flt3 ligand promotes the generation of a distinct CD34(+) human natural killer cell progenitor that responds to interleukin-15.

Interleukin-15 (IL-15) is produced by human bone marrow (BM) stromal cells and can induce CD34(+) hematopoietic progenitor cells (HPCs) to differentiate into CD56(+)CD3(-) natural killer (NK) cells in the absence of stromal cells. IL-15 mediates its effects by signaling through the beta and gammac chains of the IL-2/15 receptor (R). The c-kit ligand (KL), also produced by stromal cells, enhances the expansion of NK cells from CD34(+) HPCs in the presence of IL-15, but alone has no ability to differentiate NK cells. Mice deficient in KL do not appear to have a quantitative deficiency in NK cells, suggesting that other stromal cell factors may contribute to NK cell expansion. Flt3 ligand (FL) is also produced by BM stromal cells and has homology with KL. Furthermore, mice with a targeted disruption of the FL gene have reduced numbers of NK cells. We evaluated here the effects of FL on human NK cell development and expansion from CD34(+) HPCs. Like KL, FL significantly enhanced the expansion of NK cells from CD34(+) HPCs in the presence of IL-15, compared with IL-15 alone. However, FL alone had no effect on NK cell differentiation. We therefore explored the mechanism by which FL promotes IL-15-mediated NK cell development. FL was found to induce IL-2/15Rbeta (CD122) expression on CD34(bright) HPCs. The CD34(bright) CD122(+) cell coexpressed CD38, but lacked expression of CD7, CD56, NK cell receptors (NKRs), or cytotoxic activity in the absence of IL-15. Using limiting dilution analysis in the presence of IL-15 alone, we demonstrated that the FL-induced CD34(bright)CD122(+) HPCs had an NK cell precursor frequency 20- to 60-fold higher than the CD34(dim/neg)CD122(-) HPCs and 65- to 235-fold higher than fresh CD34(+) HPCs. KL had similar effects as FL, but induced a significantly lower percentage of CD34(bright)CD122(+) cells (P

Adolescent pregnancy and early intervention programs benefit from case management.

Case Management methods are being adapted to effectively serve two vulnerable populations: pregnant and parenting adolescents, and infants and toddlers with disabilities of developmental delay and their families. This article describes the case management model developed by California's Adolescent Family Life program and discusses issues related to providing family-centered, community-based case management in early intervention programs.

A service tracking and referral form to monitor the receipt of services in a case management program.

Too often, systematic recording procedures are not developed which describe and assess the delivery of social work--and, more specifically, case management--services. The authors report on the Service Tracking and Referral Form developed by California's Adolescent Family Life Evaluation Project to document the receipt of services by pregnant adolescent clients as a result of case management intervention. The rationale and process underlying the development and use of the project's Service Tracking and Referral Form are discussed. Data are presented to illustrate the kinds of information which can be generated from the form. Finally, the authors discuss the form's utility and the possible uses of these types of data for case management, supervisory, administrative, and evaluative purposes.

[Biocompatibility of various surgical drainage materials in the cytotoxicity and implantation test]. / Untersuchungen zur Biokompatibilität verschiedener chirurgischer Drainagematerialien im Zytotoxizitäts- und Implantationstest.

The biocompatibility of 10 materials used for surgical drainage was evaluated in a cytotoxicity test and in rat subcutaneous tissue implantation test. All rubber materials and silikolatex were found to be cytotoxic. There was no correspondence of the results of the cytotoxicity test with those of the implantation test. Therefore various procedures for biocompatibility-testing should be used.

Loss of tumorigenicity following in vitro MuLV infection is associated with induction of peritoneal natural killer cell activity.

Infection by an attenuated replication-competent murine retrovirus (Friend leukemia virus-FLV4), but not other non-transforming retroviruses, stimulated rejection of transplantable thymomas (RL-cell line) and subsequent tumor immunity in syngeneic mouse recipients. FLV-infected RL-cells (RL-FLV) were unaltered in their in vitro growth, and grew progressively to kill sublethally irradiated animals and nude mice. Primary RL-FLV rejection was due to induction of increased natural killer (NK)-cell activity limited to peritoneal sites of tumor inoculation with a minor cytolytic macrophage population. Syngeneic mutant beige (NK-deficient) mice similarly rejected RL-FLV cells with increased peritoneal NK-cell activity and acquired immunity to the parental RL-tumor. While RL-FLV stimulated far greater peritoneal NK activity than did other tested retrovirus-infected RL-cells, the inherent susceptibility of these cells to lysis by normal NK cells was not altered by virus. RL-FLV induced NK effectors showed an indiscriminate lysis pattern that was independent of target cell type and retrovirus expression.

[Biological effects of coordinated compounds of transitional metals. 7. Antiviral activity of 4-methyl-2-aminopyridine palladium chloride against herpes simplex virus type 1 and type 2 in vitro and in vivo]. / Uber biologische Wirkungen von Koordinationsverbindungen der Ubergangsmetalle. 7. Zur antiviralen Wirksamkeit von 4-Methyl-2-amino-pyridinpalladiumchlorid gegenüber Herpes simplex-Virus Typ 1 und Typ 2 in vitro und in vivo.

4-Methyl-2-amino-pyridine-palladium chloride (MAP) showed an antiviral activity against herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in a serum-free medium under in vitro conditions. The replication of these viruses on primary rabbit testes cells was completely suppressed by 10(-5) M/l MAP. In animal tests using ABD2-mice the course of HSV-1 and HSV-2 encephalitis was not influenced by MAP indicated by mean survival time and lethality.

[(E)-5-(2-bromovinyl)-2'-desoxyuridine--a new nucleoside analog with selective inhibitory action against herpesviruses. Studies in cell culture and animal experiments]. / (E)-5-(2-Bromvinyl)-2'-desoxyuridin--ein neues Nucleosidanalogon mit selektiver Hemmwirkung gegenüber Herpesviren. Untersuchungen in der Zellkultur und im Tierexperiment.

(E)-5-(2-Bromovinyl)-2'-deoxyuridine (1; BrVUdR) inhibits the replication of herpes simplex virus type 1 (HSV-1) and of varicella-zoster virus (VZV) in vitro at concentrations of 0.01 to 0.23 mumol/l, whereas herpes simplex virus type 2 (HSV-2) is influenced only at 5.5 to 27 mumol/l. In comparison to some classical and newly developed antiherpetics, i. e. 5-iodo-2'-desoxyuridine (2; idoxuridine, IDU), 9-beta-D-arabinofuranosyladenine (4; vidarabine Ara-A), 9-(2-hydroxyethoxymethyl) guanine (5; acyclovir, ACV) and 2'-fluoro-5-iodo-1-beta-D-aracytosine (6;FIAC) the following order of decreasing activity was found:1 greater than 6 greater than 5 greater than 2 greater than 4 (against HSV-1) and 6 greater than 2 greater than 5 greater than 1 greater than 4 (against HSV-2). The high selectivity of the antiviral effect of BrVUdR towards HSV-1 and TZV is based on the fact, that proliferation of different mammalian cell lines is inhibited by 50% only at concentrations as high as 90 to 170 mumol/l, resulting in a therapeutical index of 1000 to 10,000. Successful treatment of an HSV-1 encephalitis in mice as well as an HSV-1 keratitis of rabbits confirmed the efficiency of 1 in experimental animal infections. No toxic side effects in both local and systemic applications were observed. Promising data from cell culture and animal experiments recommend 1 as a potential candidate for the local and systemic treatment of HSV-1 and VZV infections in man.