Intestinal glucose absorption in calves as affected by different carbohydrate sources.

From numerous recent studies, it has been demonstrated that the development of the forestomach system in ruminants and thus microbial carbohydrate fermentation do not exclude the potential of the small intestines for enzymatic carbohydrate digestion and subsequent monosaccharide absorption. However, the role of regulatory nutritional factors is still under discussion. Therefore, we investigated the kinetic parameters of intestinal Na(+) -dependent glucose absorption and SGLT1 expression using isolated brush border membrane vesicles (BBMV) from the jejunum of 10-week-old calves kept on either hay, concentrate or corn silage-based diets in addition to milk replacer. While the maximal transport capacity was significantly higher for concentrate and corn silage-fed animals, SGLT1 protein expression was highest in BBMV isolated from hay-fed animals. This observation differs from the prevalent conception that induction of Na(+) -dependent glucose uptake via SGLT1 is based on an increased number of transporters at the brush border membrane.

[The TraumaRegister DGU® as the basis of medical quality management. Ten years experience of a national trauma centre exemplified by emergency room treatment]. / Das TraumaRegister DGU® als Basis eines medizinischen Qualitätsmanagements. 10 Jahre Erfahrung eines überregionalen Traumazentrums am Beispiel der Schockraumversorgung.

BACKGROUND: The trauma register of the German Society of Trauma Surgery (TraumaRegister DGU®/TR-DGU) has been proven to be a valuable tool for external assessment of quality in the treatment of patients with major trauma. This publication shows for the first time how the quality of trauma treatment in a level I trauma centre could be improved over a period of almost ten years with the help of continuous quality management, i.e. recognizing a problem, developing a solution and evaluating its effect. MATERIALS AND METHODS: Tracer parameters and indicators of quality are presented in four periods over a total study period from 1st January 1989 to 31st March 2007. The division into four periods is due to major changes in the trauma treatment algorithms or structural changes in the trauma room. The results are displayed for all patients treated in the trauma room and for those patients with an injury severity score (ISS)≥16. RESULTS: Over all four periods a total number of n=2,239 patients were admitted to the trauma room. Based on the results of the trauma register a number of changes were made, not only structural changes, such as the introduction of point-of-care diagnostics, initially conventional X-ray, then digital X-ray and finally multislice computed tomography (CT) scanning in the trauma room but also changes in the way personnel participating in the trauma treatment are trained. Advanced trauma life support (ATLS®) has become the standard training for doctors and prehospital trauma life support (PHTLS®) for nurses. Time efficient treatment algorithms were introduced. All measures led to changes in several parameters which are chosen as indicators for good treatment quality. It was for instance possible to reduce the average total trauma treatment time for patients with an ISS≥16 from initially 90.9±48.6 min to 37.4±18.  min in the final study period. CONCLUSIONS: The external quality management performed by the TR-DGU has proved to be a constant source of inspiration. The effects of the changes made can be scientifically proven. It is to be discussed to what extent a sole external quality management can be useful.

[Standardized documentation in emergency departments with the core dataset of the DIVI]. / Standardisierte Dokumentation im Schockraum mit dem Kerndatensatz "Notaufnahme" der DIVI.

In Germany the documentation of every prehospital emergency medical treatment has been standardized since 1997 based on the core data-set MIND (minimal emergency physician data-set). Against this background it is very surprising that there is still no standardized data-set implemented for the documentation of early inhospital emergency care. In order to create such a data-set the current state of documentation in many different hospitals all over the country was scrutinized. In addition existing registries and international requirements were taken into consideration. Finally, a modular data-set was created using a Delphi process. This data-set was tested, clinically validated and finally ratified by the executive committee of the DIVI (German Interdisciplinary Association of Critical Care Medicine). The modular data-set was designed in such a way that a basic module forms the foundation for every patient. Process-oriented modules (e.g. surveillance) and symptom-oriented modules (e.g. trauma, neurology) were added if necessary. Along with this data-set a set of six modules was created for graphical representation when required. This high level of standardization not only allows an internal and external quality assessment but also provides a sophisticated documentation system especially to the trauma team in the emergency department. In terms of content major parameters of interhospital quality management are recorded and important factors of process management, such as MTS (Manchester triage system), ATLS (advanced trauma life support) and EWS (early warning score) have been implemented. The data-set includes all necessary information for transfers between physicians and non-academic staff as well as between physicians and could also be used as a fundamental discharge letter. Moreover, this new core data-set is the implementation of items required by existing registries into the daily routine documentation in order to reduce unnecessarily time-consuming and error-prone secondary data acquisition. For example, all items of the preclinical and emergency room documentation for the TraumaRegister DGU® (documentation phase S, A and B of the standard and QM form) have been included. This is sufficient for participation as a TraumaNetzwerk DGU® member as far as the early clinical treatment of multiple injured patients is concerned.

The effect of association of aspirin and omega 3 in rat temporomandibular joint with induced arthritis.

This study aimed to evaluate the effects of omega-3 (ω3) polyunsaturated fatty acids, in association with aspirin (AA), on the morphology of cytokine release in the temporomandibular joint (TMJ) of rats induced with rheumatoid arthritis (IR) by injecting 100 µL of complete Freund's adjuvant with bovine type II collagen at the tail base. Thirty-two adult male rats were divided into treatment groups: Sham, treated with 0.9% sodium chloride (NaCl) p.o.; IR-control, treated with 0.9% NaCl p.o.; IR-ω3 treated with ω3 PUFAS (85 mg/kg/day p.o.); and IR-ω3 + AA treated with ω3 (85 mg/kg/day p.o.) + AA (20 mg/kg/day i.p.). After maintained treatment for seven days, the animals were euthanized. Bilateral TMJs from each rat were removed and one was subjected to histological immunoassays and enzyme-linked immunosorbent assays to assess interleukin (IL)-1ß, tumor necrosis factor-α, and IL-10 levels. Data analysis was performed using the Kruskal-Wallis and Dunn tests. In the IR-ω3 and IR-ω3 + AA groups, the TMJ was greater than in the IR-control group (P < 0.0001). The addition of AA did not improve the effects of ω3 (P = 0.0698). Similarly, the addition of AA conferred no additional effects on the cytokine levels (P > 0.05); however, it increased the proteoglycan density, compared with ω3 alone. We found that ω3 exhibited anti-inflammatory activity in arthritic rats, and the addition of AA increased proteoglycan density, but did not affect cytokine expression.

Magnetic resonance imaging in the presence of projectiles and projectile fragments: Artefacts, image quality, rotation and movement.

BACKGROUND AND PURPOSE: Gunshot injuries have been considered a contraindication for MRI because of the risk of secondary dislodgement of retained metallic foreign bodies. The objective of our study was to provide a systematic overview of the behaviour of projectiles and fragments in order to aid decision-making regarding the use of MRI in clinical practice. MATERIALS AND METHODS: Ferromagnetic (n = 2) and non-ferromagnetic (n = 5) projectiles and fragments that were lodged in soft tissue (porcine masseter muscles) were examined using standard protocols at 1, 1.5 and 3 T, to simulate clinical situations as realistically as possible. CT was performed before and after every MRI to assess rotation and movement. Artefacts and image quality were analysed using Likert-type scales. RESULTS: Ferromagnetic projectiles were of poorer quality and showed larger artefacts and did not provide benefit for clinical practice compared to images of non-ferromagnetic material. Image quality of non-ferromagnetic projectiles varied widely (from very good to moderate) depending on the composition of the projectiles. Field strength (1 T to 3 T) had no relevant influence on image quality. CONCLUSIONS: Non-ferromagnetic projectiles are not a contraindication for MR imaging since there is no potential risk of secondary dislodgement. Image quality and the extent of artefacts, however, strongly depend on the type of ammunition used. The presence of ferromagnetic projectiles in or near vital anatomic structures is a contraindication for MRI because these objects may exhibit movement in response to magnetic fields. Knowledge of the type of projectile used appears to be important in order to guide patient management before an examination is performed. So, the production and use of projectiles suitable for MRI should be favored in the future, knowing that this will be hard to fulfil.

Influence of 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 on expression of P-glycoprotein and cytochrome P450 3A in sheep.

In order to improve calcium and phosphorus balance, beef cattle and dairy cows can be supplemented with vitamin D. However, different vitamin D metabolites have been shown to increase expression of P-glycoprotein (P-gp, MDR1, ABCB1) and cytochrome P450 3A (CYP3A) in rodents as well as in cell culture systems. As such interferences might have an impact on pharmacokinetics of some drugs widely-used in veterinary medicine, we investigated the expression of P-gp, CYP3A, vitamin D receptor (VDR), pregnane X receptor (PXR) and retinoid X receptor α (RXRα) in sheep either treated orally with 6µg/kg body weight (BW) 25-hydroxyvitamin D3 (OHD3) for ten days before sacrifice or 12h after intravenous injection of 0.5µg/kg BW 1,25-dihydroxyvitamin D3 (1,25- (OH)2D3). Down-regulation of ruminal, jejunal and hepatic, but not renal P-gp could be found with 25-OHD3 supplementation. Interestingly, this effect on P-gp was not observed in tissues from 1,25-(OH)2D3-treated sheep. In contrast, 1,25-(OH)2D3 induced a significant up-regulation of renal and jejunal CYP3A expression, while 25-OHD3 had no impact. Renal expression of VDR and PXR was also increased by treatment with 1,25-(OH)2D3, while jejunal PXR expression was only stimulated in sheep supplemented with 25-OHD3. Either treatments increased renal, but not ruminal, jejunal or hepatic expression of RXRα. These results demonstrate that the impact of large doses of vitamin D metabolites on different target organs and potential interactions with other medications should be further investigated in vitro and in vivo to understand the effects of vitamin D metabolites on metabolism and excretion pathways in livestock.

Combined Campylobacter jejuni and Campylobacter coli Rapid Testing and Molecular Epidemiology in Conventional Broiler Flocks.

Campylobacter spp. are important causes of bacterial zoonosis, most often transmitted by contaminated poultry meat. From an epidemiological and risk assessment perspective, further knowledge should be obtained on Campylobacter prevalence and genotype distribution in primary production. Consequently, 15 Austrian broiler flocks were surveyed in summer for their thermophilic Campylobacter spp. contamination status. Chicken droppings, dust and drinking water samples were collected from each flock at three separate sampling periods. Isolates were confirmed by PCR and subtyped. We also compared three alternative methods (culture-based enrichment in Bolton broth, culture-independent real-time PCR and a lateral-flow test) for their applicability in chicken droppings. Twelve flocks were found to be positive for thermophilic Campylobacter spp. during the entire sampling period. Seven flocks (46.6%) were contaminated with both, C. jejuni and C. coli, five flocks harboured solely one species. We observed to a majority flock-specific C. jejuni and C. coli genotypes, which dominated the respective flock. Flocks within a distance <2 km shared the same C. jejuni genotypes indicating a cross-contamination event via the environment or personnel vectors. Multilocus sequence typing (MLST) of C. jejuni revealed that the majority of isolates were assigned to globally distributed clonal complexes or had a strong link to the human interface (CC ST-446 and ST4373). The combination of techniques poses an advantage over risk assessment studies based on cultures alone, as, in the case of Campylobacter, occurrence of a high variety of genotypes might be present among a broiler flock. We suggest applying the lateral-flow test under field conditions to identify 'high-shedding' broiler flocks at the farm level. Consequently, poultry farmers and veterinarians could improve hygiene measurements and direct sanitation activities, especially during the thinning period. Ultimately, real-time PCR could be applied to quantify Campylobacter spp. directly from chicken droppings and avoid non-interpretable results achieved by culture-dependent methods.

[Organ donation in Switzerland]. / Organspende in der Schweiz.

Since 1985 Swisstransplant coordinates all allocations for organ transplantations in Switzerland. During these 20 years the number of deceased donors decreased, while the number of living donors increased. In the same period the number of patients on a waiting list for organ transplantation increased significantly, up to more than 1000 at the end of2004. During the year 2004 412 patients were transplanted, 43 (4%) died while waiting on the list. In comparison to other European countries the frequency of organ donation from deceased donors is relatively low in Switzerland, only 13 per million inhabitants. In order to treat the high number of patients needing organ transplantation, additional efforts have to be undertaken in future. The measures include the development of alternative therapies preventing or treating organ failure, the amelioration of legal conditions of organ transplantation with the new law, an increase of resources and knowledge to improve donor evaluation and donor pools in the donor hospitals, a further improvement of the allocation process, the enhancement of information and motivation of the population by the patient organisations, the medical staff, Swisstransplant and eventually public means.

[Contrast-enhanced MR angiography (CEMRA) in peripheral arterial occlusive disease (PAOD): conventional moving table technique versus hybrid technique]. / Kontrastverstärkte MR-Angiographie (CEMRA) bei peripherer AVK (pAVK): konventionelle Tischverschiebetechnik versus Hybrid-Technik.

PURPOSE: In peripheral arterial occlusive disease (PAOD), angiographic evaluation of the entire aortopedal arterial system is mandatory. In a randomized study, two different protocols of CEMRA were evaluated prospectively to compare their diagnostic quality and clinical usefulness. PATIENTS AND METHODS: 80 patients (males n = 60, females n = 20, median age = 70 years, diabetics n = 27) with PAOD were examined with a 1.5 T system (40 mT/m) using a dedicated phased array peripheral vascular coil. Protocol A consisted of a single injection of Gd-BOPTA with consecutive craniocaudal image acquisition and protocol B of two injections, with the first injection of Gd-BOPTA followed by image acquisition of the popliteocrural and pedal segments and the second injection followed by acquiring the aortoiliac and femoral segments (hybrid technique). The evaluation of the arterial system was directed to the iliac, femoral, popliteocrural and pedal arteries. RESULTS: The visualization of the entire aortopedal vascular system was of diagnostically good or satisfactory quality in 16 of 40 patients using protocol A and in 29 of 40 patients using protocol B (iliac 40 vs. 37, femoral 40 vs. 40, popliteocrural 35 vs. 37, pedal 16 vs. 29); without the pedal station the number increased to 35 of 40 patients for both protocols. The reason of diagnostic limitations was an arteriovenous overlap in 24 of 80 cases, with 19 of 40 cases for protocol A and 5 of 40 for protocol B, located exclusively in the cruropedal region. CONCLUSION: Moving table hybrid CEMRA is superior to conventional technique in craniocaudal direction by producing less venous overlap of arteries and is especially more suitable for the diagnostic evaluation of the cruropedal region.

Blood characteristics of white-tailed deer from northeastern Kansas.

Blood samples were collected from 118 white-tailed deer (Odocoileus virginianus) shot on the Fort Riley Military Installation in northeastern Kansas. Values for these deer for hematocrit, glucose, alkaline phosphatase, uric acid, total protein, albumin, and calcium were within the ranges reported in previous studies for undrugged white-tailed deer. Abnormally high concentrations of serum glutamic oxaloacetate transaminase (SGOT) and lactic dehydrogenase (LDH) were attributed to general trauma and tissue damage caused by shooting the deer. Fawns had higher concentrations of alkaline phosphatase than adults and had lower concentrations in winter than at other times of the year. Serum urea nitrogen (SUN) concentrations fluctuated seasonally. Elevated concentrations of SUN in adult males killed in December were attributed to an increased catabolism of muscle protein caused by low dietary intake and high energy requirements during the rut. Cholesterol concentrations varied seasonally without regard to age or sex.

L. monocytogenes in a cheese processing facility: Learning from contamination scenarios over three years of sampling.

The aim of this study was to analyze the changing patterns of Listeria monocytogenes contamination in a cheese processing facility manufacturing a wide range of ready-to-eat products. Characterization of L. monocytogenes isolates included genotyping by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Disinfectant-susceptibility tests and the assessment of L. monocytogenes survival in fresh cheese were also conducted. During the sampling period between 2010 and 2013, a total of 1284 environmental samples were investigated. Overall occurrence rates of Listeria spp. and L. monocytogenes were 21.9% and 19.5%, respectively. Identical L. monocytogenes genotypes were found in the food processing environment (FPE), raw materials and in products. Interventions after the sampling events changed contamination scenarios substantially. The high diversity of globally, widely distributed L. monocytogenes genotypes was reduced by identifying the major sources of contamination. Although susceptible to a broad range of disinfectants and cleaners, one dominant L. monocytogenes sequence type (ST) 5 could not be eradicated from drains and floors. Significantly, intense humidity and steam could be observed in all rooms and water residues were visible on floors due to increased cleaning strategies. This could explain the high L. monocytogenes contamination of the FPE (drains, shoes and floors) throughout the study (15.8%). The outcome of a challenge experiment in fresh cheese showed that L. monocytogenes could survive after 14days of storage at insufficient cooling temperatures (8 and 16°C). All efforts to reduce L. monocytogenes environmental contamination eventually led to a transition from dynamic to stable contamination scenarios. Consequently, implementation of systematic environmental monitoring via in-house systems should either aim for total avoidance of FPE colonization, or emphasize a first reduction of L. monocytogenes to sites where contamination of the processed product is unlikely. Drying of surfaces after cleaning is highly recommended to facilitate the L. monocytogenes eradication.

[Sex differences in morphologic aging processes]. / Geschlechtsunterschiede morphologischer Alternsprozesse.

According to Max Bürger (2) it is justified to speak of sexual divergence of biomorphosis. Morphometrical investigations have proved the existence of such sexual differences. The following results were obtained: The first example concerns the increase of fatty tissue in parathyroid glands which we measured on histological slides of 135 human samples by means of the point counting method. The fatty tissue of males was shown to increase continuously with statistic significance, whereas this process stops in females during their generative phase between the 2nd and 5th decade. Evidence for the sexual divergence was also obtained by investigating the fatty tissue between the bundles of muscle fibers of the tongue, however, without being able to statistically verify these results. We found the same sexual differences by measuring the muscle cell regression and connective tissue proliferation in the ciliary muscle of human eyes and tunica muscularis of the small intestine as well. All findings prove that the female is able to stay biologically younger during her generative activity compared to males. After menopause the aging processes speed up in female tissues without making up for the "age lead" of males. It is also worth mentioning that macroscopic anthropometric features do confirm the same fact, e.g., length and breadth of human auricles, ranging in age from 18 to 51 years.