Endoscopic projection of the gastroduodenal artery: Anatomical implications for bleeding management.

INTRODUCTION: Peptic ulcers account for 50% of upper gastrointestinal bleeding incidents. Bleedings from large vessels, such as the gastroduodenal artery, are associated with increased mortality. Ulcers located on the posterior wall of the duodenum show the highest risk for erosion of the gastroduodenal artery. Endoscopic management is challenging and rebleeding rates are high due to internal and external confounding factors such as anatomical variability and gastric insufflation. We aimed to correlate macroscopic and endoscopic anatomy for assessment of implications for clinical management. MATERIAL AND METHODS: The gastroduodenal artery was dissected in 10 anatomical specimens. The points of contact of the artery with the posterior wall of the duodenum were marked with needles. The endoluminal position of the needles was recorded by standardized gastroscopy and a 3-dimensional virtual reconstruction was carried out for visualization of the artery's course. RESULTS: The artery's proximal and distal points of contact with the duodenum were 27.2mm (range 15-30mm; SD 6.7mm) and 15mm (range 10-20mm; SD 3.5mm), respectively, from the pylorus. The gastroduodenal artery branches from the common hepatic artery within the omentum minus running adjacent to the duodenal wall to the head of the pancreas. From endoscopic perspective, the gastroduodenal artery's course was directed towards the tip of the gastroscope. CONCLUSION: Due to the peculiar extraluminal course of the gastroduodenal artery the arterial blood flow projects into the direction of the gastroscope during endoscopic intervention. Measures for bleeding control might have to be applied aboral from the bleeding site.

[Psychological care in the intensive care unit : Task areas, responsibilities, requirements, and infrastructure]. / Psychologische Versorgung auf der Intensivstation : Tätigkeitsbereiche, Aufgaben, Anforderungen und Ausstattung.

The relatively high rates of mental stress among critically ill patients and their relatives implies the necessity of conceptually and financially embedded psychological care in intensive care units (ICUs). Professional associations also recommend the involvement of psychological professionals and screening of mental symptoms in critically ill patients. Intensive care medicine psychologists and psychotherapists take this as an opportunity to describe the content and goals of psychological care. Task areas are care for patients and relatives as well as staff support. Goals of psychological support in the ICU are detection of mental symptoms in patients and their treatment, psychological first aid for relatives in crisis situations, and support of the staff in terms of communication with patients and relatives as well as regarding development and maintenance of an adaptive coping style for dealing with emotionally challenging situations. Psychological care in the ICU is offered by psychologists, psychotherapists, or physicians with a psychotherapeutic qualification. The psychologist is integrated into the ICU team and has a proactive, resource-oriented, and supportive orientation. Psychological support can be an enrichment and a relief, both in the interdisciplinary treatment of patients as well as in the care of relatives, and also represent a resource for the team.

CB2 receptors regulate natural killer cells that limit allergic airway inflammation in a murine model of asthma.

BACKGROUND: Allergic asthma is a chronic airway inflammatory disease involving the complementary actions of innate and adaptive immune responses. Endogenously generated cannabinoids acting via CB2 receptors play important roles in both homeostatic and inflammatory processes. However, the contribution of CB2-acting eicosanoids to the innate events preceding sensitization to the common house dust mite (HDM) allergen remains to be elucidated. We investigated the role of CB2 activation during allergen-induced pulmonary inflammation and natural killer (NK) cell effector function. METHODS: Lung mucosal responses in CB2-deficient (CB2-/- ) mice were examined and compared with wild-type (WT) littermates following intranasal exposure to HDM allergen. RESULTS: Mice lacking CB2 receptors exhibited elevated numbers of pulmonary NK cells yet were resistant to the induction of allergic inflammation exemplified by diminished airway eosinophilia, type 2 cytokine production and mucus secretion after allergen inhalation. This phenomenon was corroborated when WT mice were treated with a CB2-specific antagonist that caused a pronounced inhibition of HDM-induced airway inflammation and goblet cell hyperplasia. Unexpectedly, the preponderance of NK cells in the lungs of CB2-/- mice correlated with reduced numbers of group 2 innate lymphoid cells (ILC2s). Depletion of NK cells restored the allergen responsiveness in the lungs and was associated with elevated ILC2 numbers. CONCLUSIONS: Collectively, these results reveal that CB2 activation is crucial in regulating pulmonary NK cell function, and suggest that NK cells serve to limit ILC2 activation and subsequent allergic airway inflammation. CB2 inhibition may present an important target to modulate NK cell response during pulmonary inflammation.

Current management of upper gastrointestinal bleeding.

Despite the introduction of proton pump inhibitors and modern flexible endoscopy techniques, upper gastrointestinal bleeding is still a common and serious condition. Once considered the domain of surgery, it is now uncommon to treat endoscopically controllable bleeding surgically. Therefore, most surgically treated cases are complicated and associated with a high mortality rate. This article presents the current management of upper gastrointestinal bleeding. Besides the description of current endoscopic treatment, medical prophylaxis and treatment, as well as radiological intervention, the article describes the indication and the surgical procedure.

Sequoiatones C-f, constituents of the redwood endophyte Aspergillus parasiticus.

Aspergillus parasiticus, a fungal isolate from a coast redwood tree (Sequoia sempervirens), has been shown to produce four new compounds, sequoiatones C-F (1-4). The structures of these compounds, all of which are cytotoxic to brine shrimp, were deduced by spectral analysis.

Dihydroramulosin from Botrytis sp.

Botrytis sp., isolated from the inner bark of the Pacific yew, Taxus brevifolia, was shown to produce ramulosin (1), 6-hydroxyramulosin (2), and the new compound 8-dihydroramulosin (3). The structure of dihydroramulosin was deduced from the NMR spectra and confirmed by chemical conversion from ramulosin.

New phomopsolides from a Penicillium sp.

Investigation of the bioactive compounds from a Penicillium sp. isolated from the inner bark of the Pacific yew, Taxus brevifolia, led to the isolation of the known furanone 1, and a series of phomopsolides. The phomopsolide fractions contained phomopsolides A and B, which have previously been described, and three new phomopsolides. The structures of the new phomopsolides were deduced by comparison of their NMR spectra to those of the known compounds.

The search for a taxol-producing microorganism among the endophytic fungi of the Pacific yew, Taxus brevifolia.

Endophytic microbes associated with the Pacific yew tree, Taxus brevifolia, were examined as potential sources of the anticancer drug taxol [1], a secondary metabolite of the host organism. The first promising organism found was the novel fungus, Taxomyces andreanae, which was isolated from the inner bark of a yew tree growing in northwestern Montana. It appears to produce taxol and other taxanes in de novo fashion when grown in semi-synthetic liquid media. The presence of 1 in the fungal extract was confirmed by mass spectrometry, comparative chromatographic behavior with "yew" taxol, reactivity with taxol-specific monoclonal antibodies, and 9KB cytotoxicity studies. Both acetate-1-14C and phenylalanine UL-14C served as precursors of taxol-14C in fungal culture labeling studies, confirming the de novo synthesis of 1 by the fungus. Immunoassay techniques are currently being used to screen extracts of Taxomyces andreanae for new taxanes, and to determine if other endophytic fungi are taxol producers.

Taxol and taxane production by Taxomyces andreanae, an endophytic fungus of Pacific yew.

Taxomyces andreanae, a fungal endophyte, was isolated from the phloem (inner bark) of the Pacific yew, Taxus brevifolia. The fungus is hyphomyceteous and, when grown in a semi-synthetic liquid medium, produced taxol and related compounds. Taxol was identified by mass spectrometry, chromatography, and reactivity with monoclonal antibodies specific for taxol. Both [1-14C]acetic acid and L-[U-14C]phenylalanine served as precursors of [14C]taxol in fungal cultures. No taxol was detected in zero-time cultures or in the small agar plugs used to inoculate the culture flasks.

Antimicrobial N-methylpyridinium salts related to the xestamines from the Caribbean sponge Calyx podatypa.

Two antimicrobial fractions were obtained from the sponge Calyx podatypa from the Bahamas. The less polar fraction contained the known compounds xestamines A [1] and B [2] and three new metabolites called xestamines D [3], E [4], and F [5]. The more polar fraction consisted of a mixture of xestamines G [6] and H [7].