Cardiovascular magnetic resonance assessment of acute cardiovascular effects of voluntary apnoea in elite divers.

BACKGROUND: Prolonged breath holding results in hypoxemia and hypercapnia. Compensatory mechanisms help maintain adequate oxygen supply to hypoxia sensitive organs, but burden the cardiovascular system. The aim was to investigate human compensatory mechanisms and their effects on the cardiovascular system with regard to cardiac function and morphology, blood flow redistribution, serum biomarkers of the adrenergic system and myocardial injury markers following prolonged apnoea. METHODS: Seventeen elite apnoea divers performed maximal breath-hold during cardiovascular magnetic resonance imaging (CMR). Two breath-hold sessions were performed to assess (1) cardiac function, myocardial tissue properties and (2) blood flow. In between CMR sessions, a head MRI was performed for the assessment of signs of silent brain ischemia. Urine and blood samples were analysed prior to and up to 4 h after the first breath-hold. RESULTS: Mean breath-hold time was 297 ± 52 s. Left ventricular (LV) end-systolic, end-diastolic, and stroke volume increased significantly (p < 0.05). Peripheral oxygen saturation, LV ejection fraction, LV fractional shortening, and heart rate decreased significantly (p < 0.05). Blood distribution was diverted to cerebral regions with no significant changes in the descending aorta. Catecholamine levels, high-sensitivity cardiac troponin, and NT-pro-BNP levels increased significantly, but did not reach pathological levels. CONCLUSION: Compensatory effects of prolonged apnoea substantially burden the cardiovascular system. CMR tissue characterisation did not reveal acute myocardial injury, indicating that the resulting cardiovascular stress does not exceed compensatory physiological limits in healthy subjects. However, these compensatory mechanisms could overly tax those limits in subjects with pre-existing cardiac disease. For divers interested in competetive apnoea diving, a comprehensive medical exam with a special focus on the cardiovascular system may be warranted. TRIAL REGISTRATION: This prospective single-centre study was approved by the institutional ethics committee review board. It was retrospectively registered under ClinicalTrials.gov (Trial registration: NCT02280226 . Registered 29 October 2014).

[Increase in genetically determined anemia as a result of migration in Germany]. / Zunahme genetisch determinierter Anämien durch Migration in Deutschland.

BACKGROUND: Due to the increasing numbers of migrants and asylum seekers, hemoglobinopathies and glucose-6-phosphate dehydrogenase deficiency are no longer rare diseases in Germany. As a result of the current migration movements these genetically determined diseases will gain in importance. METHODS: Following a literature search the prevalence of the original endemic regions was compiled and compared to the population composition based on statistical data on migrants, foreign residents and asylum seekers in Germany. RESULTS: In the endemic regions a prevalence of 40 % and sometimes higher have been found for glucose-6-phosphate dehydrogenase deficiency and hemoglobinopathies. The number of people arriving in Germany from these endemic regions is rapidly increasing. CONCLUSION: Due to the high number of asylum seekers arriving from Asian and African regions, genetic erythrocyte defects will gain importance in the differential diagnosis of anemia; therefore, medical education and training must incorporate heightened awareness of risks, diagnostics and therapy of these disease patterns.

Oxygen saturation in pulse oximetry in hemoglobin anomalies.

Pulse oximetry is an essential diagnostic method in pediatric emergency medicine and pediatric intensive care. However, if undetected hemoglobin anomalies are the underlying cause measurements of low oxygen saturation can be interpreted incorrectly or may lead to unnecessary examinations. In 2 recently discovered hemoglobin anomalies, Hb Bonn and Hb Venusberg, this resulted in extensive and repeat cardiopulmonary examinations. This review aims to provide an overview of hemoglobin anomalies causing low oxygen saturation.We describe the methods required for differential diagnosis of hemoglobin anomalies, such as hemoglobin electrophoresis, High Performance Liquid Chromatography, hemoglobin gene sequencing and spectral photometry, and the difficulties with the interpretation of results. Furthermore, with a review of the literature we provide an extensive overview of hemoglobin anomalies which result in low oxygen saturation measurement in pulse oximetry. With the examples of Hb Bonn, a novel hemoglobin mutation of the proximal α1-globin, which results in false low pulse oximetry measurements of oxygen saturation, and Hb Venusberg, a low oxygen-affine hemoglobin mutation of the ß-globin, we highlight the difficulties arising from the respective case histories.In pediatric medicine, hemoglobin anomalies must be included in the diagnosis as a possible underlying cause of low oxygen saturation in case of ambiguous or conflicting pulse oximetry findings.

Effects of an active immunization on the immune response of laying Japanese quail (Coturnix coturnix japonica) fed with or without genetically modified Bacillus thuringiensis-maize.

Potentially adverse effects of diets containing transgenic plants are a concern for many consumers, particularly in Europe. For Bacillus thuringiensis-maize, several studies in livestock and poultry showed that the zootechnical data provide no indication for such adverse effects. These studies were all done in homeostatic situations; it remained open whether a deflection of the regulatory physiological systems might yield divergent dynamic responses in B. thuringiensis-maize-fed animals. We therefore tested the effect of an active immunization using BSA as antigen in a feeding regimen with or without B. thuringiensis-maize using quail as a model organism. Newly hatched Japanese quail were randomly allocated to 2 groups (n=120 per group) fed with diets containing either B. thuringiensis-maize or isogenic maize of the same cultivar. The diets did not differ in concentrations of the mycotoxins deoxynivalenol and zearalenone, which were both far below guidance values. After 16 wk on the experimental diets, one-half of each group was immunized against BSA. The remaining birds were injected with saline. Thirty-six hours after the injection, half of the BSA-injected subgroup (n=30) and half of the saline subgroup (n=30) from B. thuringiensis-maize- and isogenic-fed birds were killed and blood samples were collected and analyzed for serum zinc levels, indicative for acute phase response. For determining IgY-mediated immune responses, eggs were collected every other week for 6 wk after the injections from the remaining birds and total IgY concentrations and BSA-specific IgY titers were measured in egg yolk. The BSA injections did not elicit significant decreases of serum zinc concentrations. The serum zinc levels were significantly higher in B. thuringiensis-maize-fed quail. Expectedly, total IgY as well as BSA-specific IgY titers increased with time in the BSA-immunized quail. The response of both variables to the BSA injection did not differ between the feeding groups. Our results indicate that feeding of B. thuringiensis-maize does not impair the immune system of Japanese quail and thus gives no indication for respective concerns.

Evaluation of 2 hematology analyzers in body fluid mode versus flow cytometry immunophenotyping of mainly neurosurgical cerebrospinal fluid samples.

BACKGROUND: For CSF analysis, exact knowledge of the type and amount of cells is essential, especially for detection of infection or bleeding. The chamber count has been the current reference method to date, yet it is problematic due to its subjectivity depending on the examiner's skill and experience. Therefore, as a reference method, we used an impulse cytophotometric measurement with Epics XL owing to its improved objectify ability and compared this method to the measurement of CSF samples performed with the ADVIA 2120 and XE-5000. MATERIAL AND METHODS: 101 CSF samples were measured with the ADVIA 2120, XE-5000, and Epics XL. For impulse cytophotometric measurement, CD235a was used for identification of erythrocytes; CD45 for the entire leukocyte population; CD56, CD16 and CD14 for monocytes; CD3, CD4 and CD19 for lymphocytes;and CD13, CD15 and CD33 for neutrophile granulocytes. RESULTS: Regarding leukocyte measurements, a strong correlation was obtained between Epics XL and XE-5000 (r = 0.990), with the correlation between Epics XL and ADVIA 2120 not as strong (r = 0.538). This finding is due to the fact that with blood-stained CSF samples (erythrocytes >1,500/µl), no valid results were produced by the ADVIA 2120. In measurements of blood-free CSF samples, correlations between Epics XL, XE-5000, and ADVIA 2120 were almost identical (r = 0.985 and r = 0.964). The same applies to the correlation between polymorphonuclear and mononuclear cells (range 0.920-0.972). In erythrocyte measurements, the correlation between XE-5000 and ADVIA 2120 was excellent (r = 0.945). Impulse cytophotometric measurement of erythrocytes with CD 238 antibodies did not appear to be functional. CONCLUSION: In the measurement of leukocytes in CSF with the ADVIA 2120, no valid results could be obtained in blood-stained CSF samples (erythrocytes >1,500/µl). In blood-free CSF samples (erythrocytes <1,500/µl), measurements of leukocytes, and polymorphonuclear and mononuclear cells performed with the ADVIA 2120 and XE-5000 produced almost identical good results. Determination of CSF cells with the XE-5000 is presently the best automated method for counting leukocytes of blood-stained CSF.

Gelatin-based sprayable foam as a skin substitute.

Physical and antimicrobial properties of a newly developed gelatin based spray-on foam bandage for use on skin wounds have been evaluated. The aqueous foam is sprayed from aerosol containers and effectively covers and washes uneven wound surfaces. The foam dries to form an adherent and stable three-dimensional matrix which diminishes evaporative water losses. The foam possesses antimicrobial activity against gram-positive, gram-negative, and fungal contaminants.

Comparative responses of lactating cows to total mixed rations or computerized individual concentrates feeding.

A trial was conducted in a commercial dairy herd in which the concentrate part of the ration was fed individually to a group of cows through computerized self-feeders. Performance results were compared with those of a group fed TMR of 65 to 67% concentrates. Rationing of individual concentrates was according to parity, milk yield, milk yield potential, BW changes, and bunk feed-stuffs. Mean intake of concentrates per cow was about 1 kg/d lower in the individually supplemented cows. This was partly compensated for by a higher intake of bunk feedstuffs. Overall daily milk yield per cow was similar to those receiving a TMR in first parity cows, higher in second parity cows, and lower in third and greater parity cows. The higher performance of the second parity cows was achieved in all milk yield potential classes, and the lower yield in subsequent lactations was due to lower performance in low and high potential classes. The individually supplemented cows gained less BW than those in the TMR group. Milk yield per unit of BW was better than milk yield as a variable to refine individual cow supplementation strategy for allocation of concentrates. Results also suggest that the same criteria used for supplementation of concentrates can be beneficial to cows' assignments and movements among different TMR groups. Computerized dispensing of concentrates, when applied properly, can economize on consumption of concentrates when grouping and feeding different TMR are impossible.

Autoimmune hepatitis in a genetically susceptible patient: is it triggered by acute viral hepatitis A?

The pathogenic mechanisms for autoimmune hepatitis (AIH) are not completely known. Susceptibility to AIH is associated with the human leukocyte antigens (HLA) class II: DR3 and DR4. Nevertheless, AIH does not have a strong genetic predisposition, suggesting that other factors are involved. Perhaps the strongest evidence of a viral cause for AIH exists for hepatitis C virus. AIH has been reported to develop rarely after acute infection with hepatitis A virus. We report on a 55-year-old woman in whom AIH developed during the convalescence period of serologically proven acute viral hepatitis type A. HLA class II DRB1*0401, which was reported to be associated with AIH with a moderate coarse and late appearance in life, was found in this patient. Steroid therapy was followed by a complete clinical remission. Our case supports the possibility that acute hepatitis A may trigger the development of AIH in a genetically susceptible subject.