Low-dose antibiotic prophylaxis has no significant impact on the stability of the intestinal microbiome in children with urogenital tract malformations under 1 year of age.

INTRODUCTION: Accumulating data point at potentially lasting effects of early childhood therapeutic antibiotic exposure on the intestinal microbial. Little is known on the impact of low-dose longterm antibiotic prophylaxis on the developing intestinal microbiota in children during their first year of life. OBJECTIVE: To investigate compositional changes of the intestinal microbiota by next generation sequencing based microbiome analysis and bacterial metabolites in longitudinally collected fecal samples. STUDY DESIGN: Twelve patients were analyzed in this prospective, longitudinal pilot study during a period of 70 days (sampling on days 0,7,14,30,70). Only transvaginally and term born babies, breastfed with no prior antibiotic exposure with urogenital malformation (vesicoureteral reflux and/or upper urinary tract dilatation) were included into the study. Seven patients received antibiotic longterm prophylaxis with a second-generation cephalosporin and five did not. Sequencing of bacterial 16 S rRNA allowed for an analysis of the microbiome composition. The Principal coordinate analysis was performed for the evaluation of compositional profile. Furthermore, quantitative measurement of short chain fatty acids served as a proxy for the metabolic activity of the individual microbiome over the study time. RESULTS: Analysis of observed species, Shannon Index and weighted Unifrac distances between timepoints revealed neither significant difference comparing the prophylaxis group versus the control group over the study period, nor significant changes within the groups over time. Principal coordinate analysis (PCoA) was performed for the evaluation of compositional profile. Also, no differences regarding the fecal SCFA content were found between the two groups (>0.05 at each tested point, Mann-Whitney Test). DISCUSSION: Although there were interindividual compositional differences of the microbiome (cluster of bacterial composition) at the beginning of the observation, we did not observe significant longitudinal changes regarding both bacterial diversity and SCFAs in neither group. Over the study period, the patient's microbiome remained stable and resilient to the antibiotic exposure in terms of bacterial abundance and metabolism. Limitations to the study are the low number of patients included and the use of one single antibiotic (cefaclor). CONCLUSION: This is the first pilot study to demonstrate that long term low-dose antibiotic administration in children under one year of age does neither seem to influence the composition of the intestinal microbiota nor the quantities of bacterial fermentation products compared to untreated controls.

Management of ureteropelvic junction obstruction in children-a roundtable discussion.

The investigation, management and follow-up of paediatric ureteropelvic junction obstruction is not standardized. The Young Pediatric Urology Committee of the European Society of Pediatric Urology interviewed five experts in the field on various aspects of management and compared this with published literature.

Benefit of F-15 protocols in equivocal F + 20 MAG3 renography in children with upper tract dilatation and symmetric split function: Results and outcomes.

PURPOSE: In children with upper tract dilatation, diuretic renography, which includes application of mercaptoacetyltriglicin-99 mTc (MAG3), is the standard examination. Ordinarily, furosemide is applied 20 min after tracer injection (F + 20). In children with persistent hydronephrosis and preserved split function, this protocol may lead to further examinations with repeatedly equivocal washout curves. The present study evaluated the potential of MAG3 (F-15) scans in this subgroup of children to achieve a conclusive result avoiding additional equivocal MAG3 (F + 20) scans. OBJECTIVE: To evaluate whether the washout curve using the F-15 protocol is a helpful criterion with which to clarify results in patients with equivocal patterns in the F + 20 protocol. PATIENTS: 31 children (male/female 22/9, median age at time of examination 42 months, mean anterioposterior diameter 2.1 cm, left/right 14/18) underwent MAG3 F-15 renography at the present department because of upper urinary tract dilatation and (repeatedly n ≥ 2 F + 20 = 28) equivocal results in MAG3 F + 20 examinations. RESULTS: In 10/31 children (32.2%), MAG3 F-15 revealed an obstructive pattern, indicating a pyeloplasty in 9/10 of them (90%). In 16/31 children (51%), the F-15 protocol showed a non-obstructive curve, leading to further uneventful follow-up in 15/16 of them (93.7%). In 5/31 children (16%), MAG3 F-15 led to equivocal results, resulting in no pyeloplasty and further uneventful follow-up in all the children (mean follow-up 1.46 years). DISCUSSION: In children with persistent high-grade hydronephrosis on ultrasound and preserved split function, multiple scans were prompted and further management was sometimes difficult. Although there was proven evidence that the F-15 protocol reduced the frequency of equivocal pattern, there was no indication for primary F-15 investigation, due to the risk of over diagnosis of obstruction. The F-15 scan was considered to be a stress test of the upper tract leading to a diuretic challenge without any opportunity to investigate normal washout curve. In these cases, partial obstruction could lead to false positive obstructive results. A stepwise approach, in which the traditional F + 20 technique allows observation of the rate of washout of radiopharmaceuticals before forced diuresis followed by a F-15 protocol, could reduce the child's additional radiation burden and stress. CONCLUSION: After equivocal results in MAG3 F + 20 protocols, performing a MAG3 F-15 exam lead to a conclusive result in 80.6% (25/31 patients) of the cases. Thus, performing a MAG3 (F-15) exam can be recommended in children with persistent hydronephrosis and preserved split function after equivocal results on MAG3 (F + 20) scans.

Evidence for superconductivity in Li-decorated monolayer graphene.

Monolayer graphene exhibits many spectacular electronic properties, with superconductivity being arguably the most notable exception. It was theoretically proposed that superconductivity might be induced by enhancing the electron-phonon coupling through the decoration of graphene with an alkali adatom superlattice [Profeta G, Calandra M, Mauri F (2012) Nat Phys 8(2):131-134]. Although experiments have shown an adatom-induced enhancement of the electron-phonon coupling, superconductivity has never been observed. Using angle-resolved photoemission spectroscopy (ARPES), we show that lithium deposited on graphene at low temperature strongly modifies the phonon density of states, leading to an enhancement of the electron-phonon coupling of up to λ ≃ 0.58. On part of the graphene-derived π*-band Fermi surface, we then observe the opening of a Δ ≃ 0.9-meV temperature-dependent pairing gap. This result suggests for the first time, to our knowledge, that Li-decorated monolayer graphene is indeed superconducting, with Tc ≃ 5.9 K.

Long- versus Short-Range Scattering in Doped Epitaxial Graphene.

Tuning the electronic properties of graphene by adatom deposition unavoidably introduces disorder into the system, which directly affects the single-particle excitations and electrodynamics. Using angle-resolved photoemission spectroscopy (ARPES) we trace the evolution of disorder in graphene by thallium adatom deposition and probe its effect on the electronic structure. We show that the signatures of quasiparticle scattering in the photoemission spectral function can be used to identify thallium adatoms, although charged, as efficient short-range scattering centers. Employing a self-energy model for short-range scattering, we are able to extract a δ-like scattering potential δ = -3.2 ± 1 eV. Therefore, isolated charged scattering centers do not necessarily act just as good long-range (Coulomb) scatterers but can also act as efficient short-range (δ-like) scatterers; in the case of thallium, this happens with almost equal contributions from both mechanisms.

The effect of normovolemic modified ultrafiltration on inflammatory mediators, endotoxins, terminal complement complexes and clinical outcome in high-risk cardiac surgery patients.

OBJECTIVE: The clinical benefit of normovolemic modified ultrafiltration (N-MUF) after cardiac surgery is still debated. As we have shown in a previous publication, there is a significant improvement in platelet function, so we were interested in whether ultrafiltration can reduce plasma levels of endotoxins, terminal complement complexes and cytokines after cardiopulmonary bypass (CPB) in adults with increased risk profiles. METHODS: In this single-center, prospective, randomized trial, fifty high-risk patients (mean logistic EuroSCORE II: 17.5%) who underwent cardiac surgery were randomized. After CPB, Group 1 (n = 25) served as the control and in, Group 2 (n= 25), an N-MUF of 3000 ml was performed, using a BC140plus filter after weaning from CPB. Blood samples were taken after the induction of anesthesia, before CPB, before CPB weaning, 30 minutes after CPB and at 6, 24 and 48 hours postoperatively. Primary outcomes were plasma levels of lipopolysaccharide-binding protein (LBP), terminal complement complex (C5b9) and cytokines (IL-6, IL-10, IL-1beta, TNF-α). Secondary outcomes focused on differences in the clinical outcome. RESULTS: A significant reduction in LBP concentration (preoperatively: 23.8±8.4 pg/ml, postoperatively: 14.2±12.9 pg/ml) and C5b9 (preoperatively: 4.18±2.6 pg/ml, postoperatively: 3.05±2.39 pg/ml) were detected 6 hours after N-MUF. In the N-MUF group, significantly lower concentrations of lactate could be detected in the early postoperative period. Furthermore, postoperative chest tube blood loss was significantly lower in the N-MUF group at 24 and 48 hours. CONCLUSIONS: N-MUF leads to a significant reduction of lipopolysaccharide-binding protein and terminal complement complex and was associated with reduced blood loss and postoperative lactate concentrations shortly after surgery.

Opportunistic cytomegalovirus infection causing colonic perforation in a patient with systemic lupus erythematosus.

We present the case of a 58-year-old woman with a long-standing history of systemic lupus erythematosus (SLE) who developed a cytomegalovirus (CMV) infection with colonic perforation and subsequent purulent peritonitis whilst using combined immunosuppressive therapy. The pathogenesis and the clinical presentation of this unique case is discussed in detail. Opportunistic infection should always be kept in mind in SLE patients presenting with fever. Viral serology should be routinely performed in these patients, especially when immunosuppressive therapy is given, to avoid delay in instituting adequate management and therapy.

Competitive bulk liquid membrane transport of some metal ions using RC(S)NHP(S)(OiPr)(2) as ionophores. Unusual supramolecular "honeycomb" aggregate of the polynuclear copper(I) complex of H(2)NC(S)NHP(S)(OiPr)(2).

Competitive transport experiments involving metal ions from an aqueous source phase through a chloroform membrane into an aqueous receiving phase have been carried out using a series of N-(thio)phosphorylated (thio)amide and thiourea ligands as ionophores in the organic phase. The source phase contained equimolar concentrations of Co(II), Ni(II), Cu(II), Zn(II), Ag(I), Cd(II) and Pb(II) with the source and receiving phases being buffered at different pH. Good transport properties were observed for Ag(I) in the case of (13). The best extraction properties have been shown by (3)L(1), (3)L(8), (2)L(7), (3)L(9) and (3)L(11) which contain an unsubstituted nitrogen atom at the C[double bond, length as m-dash]S groups ((3)L(1) and (3)L(9)), or a third nitrogen atom, capable of participating in additional coordination ((3)L(8), (2)L(7) and (3)L(11)). Reaction of Cu(NO(3))(2).6H(2)O with the potassium salt of the N-thiophosphorylated thiourea NH(2)C(S)NHP(S)(OiPr)(2) formed a new supramolecular Cu(I) complex, [{Cu(6)((2)L(1))(6)}{Cu(3)((2)L(1))(3)}.4Me(2)CO] that contains both trinuclear and hexanuclear forms in its solid state structure, and in solution.

DEK is a poly(ADP-ribose) acceptor in apoptosis and mediates resistance to genotoxic stress.

DEK is a nuclear phosphoprotein implicated in oncogenesis and autoimmunity and a major component of metazoan chromatin. The intracellular cues that control the binding of DEK to DNA and its pleiotropic functions in DNA- and RNA-dependent processes have remained mainly elusive so far. Our recent finding that the phosphorylation status of DEK is altered during death receptor-mediated apoptosis suggested a potential involvement of DEK in stress signaling. In this study, we show that in cells committed to die, a portion of the cellular DEK pool is extensively posttranslationally modified by phosphorylation and poly(ADP-ribosyl)ation. Through interference with DEK expression, we further show that DEK promotes the repair of DNA lesions and protects cells from genotoxic agents that typically trigger poly(ADP-ribose) polymerase activation. The posttranslational modification of DEK during apoptosis is accompanied by the removal of the protein from chromatin and its release into the extracellular space. Released modified DEK is recognized by autoantibodies present in the synovial fluids of patients affected by juvenile rheumatoid arthritis/juvenile idiopathic arthritis. These findings point to a crucial role of poly(ADP-ribosyl)ation in shaping DEK's autoantigenic properties and in its function as a promoter of cell survival.

Influence of histamine release on postoperative vomiting (POV) following gynaecological laparoscopic surgery.

OBJECTIVE: The mechanisms leading to the high incidence of postoperative vomiting (POV) after gynaecological laparoscopic surgery are still unknown. The effectiveness of POV-prophylaxis using H1 + H2-receptor antagonists has been demonstrated, suggesting a role for histamine in the pathogenesis of POV. However, histamine levels were not measured in these studies. The aim of this study was to investigate the incidence of plasma histamine release and its association with POV after gynaecological laparoscopic surgery. MATERIAL OR SUBJECTS: Twenty-two female patients, aged 20-56 y, classified ASA physical status I or II, undergoing elective gynaecological laparoscopic surgery were enrolled in the study. Blood samples for plasma histamine measurements were drawn at defined time points perioperatively. Emetic symptoms were recorded within the first 24 h after operation. A standardized balanced anaesthesia without any prophylactic antiemetic medication was applied. Formal causality analysis for histamine as a determinant for POV was performed. RESULTS: The overall incidence of POV was 40.9% (9 out of 22 patients). Twelve out of 22 patients (54.5%) demonstrated a histamine release reaction during the whole observation period. Six out of 9 patients with POV (66.7%) had a histamine release. There was no difference in mean plasma histamine levels between POV-positive and POV-negative patients. The conditional probability for POV with histamine release was 6/12 = 0.5, in contrast to 3/10 = 0.3 for POV without histamine release. CONCLUSIONS: A high incidence of plasma histamine release was demonstrated in most but not all patients with POV. The probability of POV with histamine release (0.5) was higher than without histamine release (0.3), thus histamine release was shown to be one of the contributory determinants for POV in this clinical study. Thus, patients at risk for POV may benefit from a H1 + H2-receptor antagonists prophylaxis alone or in combination with other antiemetic strategies.

Inflammatory bowel disease-specific autoantibodies in HLA-B27-associated spondyloarthropathies: increased prevalence of ASCA and pANCA.

AIMS: An association between inflammatory bowel disease (IBD) and spondyloarthropathies (SpA) has repeatedly been reported. The aim of the present study was to investigate whether serologic markers of IBD, e.g. antibodies against Saccharomyces cerevisiae (ASCA), antibodies against exocrine pancreas (PAB) and perinuclear antineutrophil cytoplasmic antibodies (pANCA) are present in HLA-B27-associated SpA. METHODS: 87 patients with HLA-B27-positive SpA and 145 controls were tested for ASCA, PAB and pANCA employing ELISA or indirect immunofluorescence, respectively. Antibody-positive patients were interviewed regarding IBD-related symptoms using a standardized questionnaire. RESULTS/CONCLUSION: When compared to the controls, ASCA IgA but not ASCA IgG levels were significantly increased in patients with SpA, in particular in ankylosing spondylitis (AS) and undifferentiated SpA (uSpA). pANCA were found in increased frequency in patients with SpA whereas PAB were not detected. The existence of autoantibodies was not associated with gastrointestinal symptoms but sustains the presence of a pathophysiological link between bowel inflammation and SpA.

[Vomiting after gynecologic laparoscopy and under general anesthesia is associated with changes in excretion of serotonin metabolites]. / Erbrechen nach gynäkologischen Laparoskopien in Allgemeinanästhesie ist assoziiert mit Veränderungen der Serotoninmetabolitenausscheidung.

INTRODUCTION: The efficacy of 5-HT(3)-receptor antagonists suggests a role of serotonin in the pathogenesis of postoperative nausea and vomiting (PONV). However, studies investigating the relationship between the turnover of serotonin and PONV were contradictory. Therefore we carried out a pilot study in order to find out whether results can be obtained that would justify further studies on a larger scale. METHODS: A total of 22 patients scheduled for elective gynaecological laparoscopy were enrolled. A balanced anaesthesia using sufentanil, etomidate, cisatracurium, isoflurane and nitrous oxide was administered and 5-hydroxyindoleaceticacid (5-HIAA) concentrations in the urine were measured within the 24 h after surgery. RESULTS: Only the patients that vomited postoperatively had a significant change in the concentrations of 5-HIAA over the time course investigated. However, comparison of urinary 5-HIAA concentrations of the group comprising patients that vomited with those that had no PONV did not reveal a significant difference. CONCLUSIONS: Results of this study support further investigation of the relationship between serotonin and PONV and suggest that there may in fact be an association between PONV and increased serotonin turnover.

[Clinical outcome of a cohort of 63 patients with hepatocellular carcinoma treated with octreotide].

Unresectable hepatocellular carcinoma (HCC) are associated with a poor prognosis. Recently, one controlled study reported a strikingly prolonged survival of patients with HCC who were treated with octreotide. Until other randomised controlled trials become available, this multicentric retrospective study therefore assesses the outcome of HCC-patients who received octreotide treatment. 63 patients (53 males, 10 females) who had been treated with octreotide at 13 participating German centres were included in the analysis. In 54 cases liver cirrhosis was present (25 Child-Pugh A, 20 Child-Pugh B, 7 Child-Pugh C, 2 unknown). The liver disease was associated with alcohol abuse in 19 patients, alcohol and viral hepatitis in four patients, while 12 patients had only markers of past or present hepatitis B infection, 11 patients suffered of chronic hepatitis C infection, and four patients were seropositive for both hepatitis B and hepatitis C markers. The Okuda stage was stage I in 23, stage II in 33, and stage III in 7 patients. The patients initially received octreotide as a long-acting release formula (20-30 mg/month) in 43 cases or through subcutaneous injection (dose 3 x 50-3 x 300 ug/day) in the remaining cases. 11 of the patients receiving subcutaneous treatment were later converted to the long-acting release form of the drug. At three months, a partial remission was achieved in two patients, while 22 tumours showed no change and 26 tumours progressed. At six months, 11 tumours showed no change, while 15 tumours progressed. The patients' median survival was 9 months (Okuda stage I 16 months, stage II 9 months, stage III 4 months). In conclusion, octreotide treatment did not result in markedly prolonged survival in this retrospective series of 63 patients.

The visual function of professional baseball players.

PURPOSE: To measure the visual acuity, stereoacuity, and contrast sensitivity of professional baseball players. METHODS: Three hundred eighty-seven professional baseball players underwent several tests of visual function including distance visual acuity. Stereoacuity was evaluated at near by the Randot test and at distance by both contour and random dot targets. Distance stereoacuity was also tested under timed and untimed conditions. Contrast sensitivity was evaluated by the Vision Contrast Test System, Contrast Sensitivity Viewer, and Binocular Visual Acuity Tester. RESULTS: Visual acuity (measured with players' regular distance correction) in 774 eyes ranged from 20/8.89 to 20/100. Near stereoacuity ranged from 23 to 37 seconds of arc, mean untimed distance contour stereoacuity from 55 to 35 seconds of arc, and mean untimed distance random dot stereoacuity from 98 to 76 seconds of arc. The results under timed conditions were 86 to 65 seconds of arc (timed distance contour stereoacuity) and 104 to 83 seconds of arc (timed distance random dot stereoacuity). Statistically significant differences were found between major and minor league players on tests of untimed distance contour and random dot stereopsis, and on contrast sensitivity testing with the 3.0- and 6.0-cpd gratings using the Contrast Sensitivity Viewer. CONCLUSIONS: Professional baseball players have excellent visual skills. Mean visual acuity, distance stereoacuity, and contrast sensitivity are significantly better than those of the general population.

[Contribution and limitations of peroperative radiotherapy combined with excision-curettage in the treatment of gastric cancers]. / Apports et limites de la radiothérapie peropératoire associée à l'exérèse-curage dans le traitement des cancers gastriques.

Macro- or microscopic residual tumor after surgery is the dominating prognostic factor in the treatment of gastric cancer. The majority of patients die of local recurrence and peritoneal spread. Therefore, in addition to gastrectomy and extended lymphadectomy (compartments 1 & 2) in some centers a adjuvant intraoperative radiotherapy is performed. Recent results of adjuvant intraoperative radiotherapy for gastric cancer revealed a lower local recurrence but there was no improvement in the survival rate for advanced tumor stages. These results are confirmed by our prospective study including 36 patients till now: in the group of 21 survivors there is no sign of a local recurrence. In 15 patients which died meanwhile there was only one case of local recurrence (median follow-up: 9 months, range 1-30 months). Peritoneal spread and liver metastasis were observed as the most frequent cause of death (tumor stage IIIB and IV only).

[Thyroid function after thyroidectomy for benign goiter. 200 cases explored by ultrasensitive TSH]. / Fonction thyroïdienne après thyroïdectomie pour goître bénin. A propos de 200 cas explorés par TSH ultrasensible.

Based on a retrospective study of a series of 200 thyroidectomies for benign goitre and a mean follow up period of 12 Months, the authors analysed post-operative thyroid function and correlated it with the degree of surgical excision (47 unilateral lobectomies, 91 classical subtotal bilateral lobectomies and 62 extended bilateral subtotal lobectomies). After a presentation of the results in comparison with data from the literature, the timing and threshold for the institution of replacement therapy are examined and the need for prolonged clinical and laboratory monitoring is also stressed. In terms of changes in laboratory criteria only monitoring of spontaneous changes in US TSH allows opotherapy to be avoided or conversely to accurately define the conditions for institution of definitive replacement therapy. The justification of total thyroidectomy in the treatment of multihetoronodular goitres almost totally involving the glandular parenchyma is acknowledged.

Preadsorption of polymers on glass and silica to reduce fibrinogen adsorption.

Glass and silica beads were precoated with various polymers to obtain steric exclusion chromatography (SEC) supports which are nonadsorbant for hydrophilic macromolecules. The efficiency of this treatment was estimated by subsequent radiolabeled fibrinogen adsorption. The result obtained with a block copolymer was better than with various hydrophilic homopolymers. This ABA type block copolymer, where A is a poly(N-acetylethyleneimine) (PAEI) sequence and B a polyethylene oxide (PEO) sequence was preadsorbed at pH 4.5 and 25 degrees C; the fibrinogen adsorption was reduced to less than 5% of the value observed on untreated solid surfaces. Thus the hemocompatibility of solid supports should be increased by precoating with this block copolymer. Results for nonporous glass beads and porous silica particles were in good correlation.