Long-term monitoring of a Coxiella burnetii-infected sheep flock after vaccination and antibiotic treatment under field conditions

The purpose of this study was to pursue the development of a sheep flock for a period of 18 months after a Q fever outbreak. In a flock with approximately 250 ewes losses of 18% were caused by abortions and weak offspring. Q fever was diagnosed in April 2009 after detection of Coxiella (C.) burnetii in one placenta and two aborted fetuses by PCR. Shortly afterwards Q fever was diagnosed in humans. Between July 2009 and December 2010 the sheep were sampled regularly. Six weeks before lambing the flock was initially immunised with Coxevac. Moreover, pregnant ewes were treated with oxytetracyclines during late gestation until lambing. Seroprevalence increased from 39% before vaccination up to 98% afterwards. After these measures bacteraemia and shedding of C burnetii decreased significantly, indicating that during an acute outbreak the vaccination with Coxevac can reduce the shedding of C burnetii effectively, although vaccination is performed without medical approval for sheep and in late pregnancy. Both measures should be taken into consideration in acute Q fever outbreaks to reduce or even avoid transmission to humans.

Traps in spinal MR imaging

There are many traps in spinal MRI in part related to the technique but also due to the existence of anatomical variations, lesions which are difficult to confirm because of non-specific signs, and sometimes rare conditions.

Investigations concerning the prevalence of Coxiella burnetii and Chlamydia abortus in sheep in correlation with management systems and abortion rate in Lower Saxony in 2004

The intracellular bacteria Coxiella (C) burnetii and Chlamydia (Chl) abortus induce abortion in sheep and also affect humans. While Chl. abortus only infrequently infects humans, C burnetii is the aetiological agent of numerous Q fever outbreaks during the last decades. There is only limited knowledge about the prevalence of both pathogens in sheep, although sheep are involved in almost all Q fever outbreaks in Germany. The aim of our study was to investigate the prevalence of both pathogens in flocks located in Lower Saxony, Germany, in correlation to the management form and abortion rate. Serum samples of 1714 sheep from 95 flocks located in Lower Saxony were investigated by ELISA. 2.7% of these samples were positive, 1.3% showed inconclusive results in the C. burnetii-ELISA. Elevated intra-flock seroprevalences were only detected in three migrating flocks. Chlamydia-specific antibodies could be detected in 15.1% serum samples of mainly shepherded and migrating flocks. In one of these flocks with a high intra-flock seroprevalence for C burnetii (27%) and Chlamydia (44.9%), C burnetii was detected in 21.6% of the placenta samples of normal births and in 12.5% of the colostrum samples by PCR. Aborted fetuses and the corresponding placentas were negative in C burnetii-PCR, but in most of them and also in many other placenta samples Chl. abortus could be detected by PCR and DNA microarray. This survey shows a low overall prevalence of C. burnetii in sheep in Lower Saxony in the year 2004. However, three migrating flocks with a high intra-flock prevalence are localized in the southern parts of Lower Saxony. Spreading of C burnetii could occur, because of the large radius of grazing of all three flocks.

The tremor network targeted by successful VIM deep brain stimulation in humans

OBJECTIVE

Deep brain stimulation (DBS) of the ventral intermediate nucleus of thalamus (VIM) is a treatment option in medically intractable tremor, such as essential tremor or tremor-dominant Parkinson disease (PD). Although functional studies demonstrated modulation of remote regions, the structural network supporting this is as yet unknown. In this observational study, we analyzed the network mediating clinical tremor modulation.

METHODS

We studied 12 patients undergoing VIM stimulation for debilitating tremor. We initiated noninvasive diffusion tractography from tremor-suppressive VIM electrode contacts. Moreover, we tested for the contribution of primary motor projections in this structural correlate of a functional tremor network, comparing the connectivity of effective DBS contacts with those of adjacent, but clinically ineffective, stimulation sites.

RESULTS

VIM stimulation resulted in decrease of tremor and improvement in quality of life. Tractography initiated from the effective stimulation site reconstructed a highly reproducible network of structural connectivity comprising motor cortical, subcortical, and cerebellar sites and the brainstem, forming the anatomic basis for remote effects of VIM stimulation. This network is congruent with functional imaging studies in humans and with thalamic projections found in the animal literature. Connectivity to the primary motor cortex seemed to play a key role in successful stimulation.

CONCLUSIONS

Patients undergoing DBS provide a unique opportunity to assess an electrophysiologically defined seed region in human thalamus, a technique that is usually restricted to animal research. In the future, preoperative tractography could aid with stereotactic planning of individual subcortical target points for stimulation in tremor and in other disease entities.

Magnetic resonance imaging in patellar lateral femoral friction syndrome (PLFFS): prospective case-control study

OBJECTIVES

To describe morphologic abnormalities and signs of patellar lateral femoral friction syndrome (PLFFS) detected by magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Prospective study of 56 knees (21 patients and 30 controls) studied by 3Tesla MRI. Comparative analysis of clinical data, quantitative and qualitative imaging criteria in a population of patients with anterior knee pain associated with an abnormal MRI signal along the lateral alar folds of the infrapatellar fat pad, a characteristic sign of PLFFS, and a control population with no anterior knee pain or abnormal signal from the infrapatellar fat pad.

RESULTS

Patients with PLFFS have anterior and/or lateral knee pain. Their knee has anatomical predispositions for instability, primarily with patella alta (P<0.0001), patellar tilt more than 13.5° (P<0.0001), a patellar nose length less than 9 mm (P=0.0037), a patellar nose ratio less than 0.25 (P<0.0001), a TT-TG distance more than 10 mm (P<0.0001), and a trochlear prominence more than 4 mm (P=0.0056). In 35% of patients, patellar chondropathy is visible, and 48% of patients have patellar or trochlear subchondral abnormalities.

CONCLUSION

Anterior, lateral, and medial knee pain may be related to PLFFS. Anatomical predispositions contributing to instability are found in these patients. There may be associated chondropathies and osteochondropathies.

Additive impact of alfacalcidol on bone mineral density and bone strength in alendronate treated postmenopausal women with reduced bone mass

OBJECTIVES

Assessment of additive impact of alfacalcidol 1 μg daily (Alfa) on bone mineral density (BMD) and on bone strength in postmenopausal women treated with alendronate 70 mg weekly + 500 mg calcium daily.

SUBJECTS AND METHODS

In a randomized, double-blind, placebo controlled study, 279 postmenopausal women with osteoporosis or osteopenia participated (intention to treat analysis [ITT]; aged 73.6∓4.7 years) and were treated with 70 mg alendronate (ALN) weekly and 500 mg calcium daily for 36 months. In addition, these patients received either 1 μg alfacalcidol (Alfa) or placebo (PLC) daily. BMD was measured with Dual-Energy-X-ray-Absorptiometry (DXA) at the lumbar spine and proximal femur and at forearm and tibia with peripheral quantitative computed tomography (pQCT) at regular intervals for 36 months.

RESULTS

DXA-BMD of lumbar spine (L1-4) increased after 36 months, by 6.65% (p<0.0001) in the Alfa/ALN group versus 4.17% (p<0.0001) in the PLC/ALN group. Group difference was significant after 3 years (p=0.026). At the end of the study, significant differences were found in favor of the Alfa/ALN group in trabecular density (tibia) (p=0.002), cortical density (midshaft tibia) (p=0.043), and bone strength (p=0.001). The remaining parameters showed no differences between the treatment arms, apart cortical bone density at midshaft radius.

CONCLUSIONS

Alfacalcidol significantly increases the efficacy of alendronate treatment in osteopenic/osteoporotic postmenopausal women on spinal DXA-BMD, cortical and trabecular BMD of the tibia and also bending stiffness of the tibia.

Effect of a six-month therapy with alfacalcidol on muscle power and balance and the number of fallers and falls

PURPOSE

In an open observational prospective multicentered study on a cohort of patients with a creatinine clearance of < or = 65 ml/min and diagnosed with the "Esslinger Fall Risk Assessment" to be at an increased risk for falls the effect of daily treatment with 1 microg alfacalcidol (CAS 41294-56-8; Alpha-D3) on muscle power, balance and number of fallers and falls was investigated.

METHODS

In this open prospective study on 237 participants recruited in Germany, 16.9% men and 83.1% women with a mean age of 75.9 years and a mean body mass index (BMI) of 26.3 kg/m2 underwent at the beginning and after 3 and 6 months different muscle strength and balance tests such as the Timed-up and Go Test (TUG), the Tandem Stand Test (TST) and the Chair Rising Test (CRT). A successful performance in these tests has been associated with a significantly lower risk for falls and non-vertebral fractures in elderly patients (successful test performance: TUG < 12 s, TST > 10 s, CRT < 10 s).

RESULTS

Controlled for age, gender and BMI, treatment with alfacalcidol was associated with a significantly increased performance in all three muscle and balance tests already after 3 months. This effect increased after six months of therapy and a significant increase in the number of participants who were able to successfully perform the different tests was observed: plus 74.9% for the TUG (p < .0001), plus 112% for the TST (p < .0001) and plus 108% for the CRT (p < .0001). After six months the mean time used for the TUG was decreased by 2.01 s, by 2.29 s for the CRT, and increased by 2.02 s for the TST. Controlled for age, gender, BMI and CrCI, treatment with alfacalcidol for six moths resulted in a significant 48.1% (p _< or = .0001) decrease in the absolute number of fallers and a significant 51.3% (p .0001) decrease in the absolute number of falls, compared to the 6 months prior to alfacalcidol therapy.

CONCLUSIONS

Treatment with alfacalcidol increases muscle power and balance as measured with three different muscle power and balance tests and leads to a highly significant decrease in the number of fallers and falls.

Independent from muscle power and balance performance, a creatinine clearance below 65 ml/min is a significant and independent risk factor for falls and fall-related fractures in elderly men and women diagnosed with osteoporosis

We assessed in a cross-sectional study in elderly men and women with osteoporosis, the association between the creatinine clearance (CrCl) and the performance in different balance and muscle power and function tests and found that a decreasing creatinine clearance was significantly associated with lower balance and muscle power.

INTRODUCTION

To determine if a creatinine clearance of <65 ml/min is significantly associated with decreasing muscle power and balance and an increased risk for falls and fractures.

METHODS

We assessed in a cross-sectional-study in 1781 German osteoporotic patients, the association between the CrCl, the physical performance, and the number of falls and fractures.

RESULTS

Controlling for age, gender, BMI, and osteoporosis treatment (fracture analysis only), a decreasing CrCl was associated with lower physical performance in the timed-up-and-go test (corr -0.2337, P < 0.0001), chair-rising test (corr -0.1706, P < 0.001), and tandem-stand test (corr 0.2193, P < 0.0001), and a CrCl of <65 ml/min was associated with a significantly higher risk for falls (47.7% vs. 36.2%, P = 0.0008) and fall-related fractures (33.1% vs. 22.9%, P = 0.0003) compared with a CrCl of >or=65 ml/min.

CONCLUSIONS

In this study, we found a significant gender-independent correlation between decreasing CrCl and lower performance in balance and muscle power tests. Reduced muscle power and balance may therefore be involved in the low creatinine clearance associated increased risk for falls and fall-related fractures. Furthermore, we found that a CrCl <65 ml/min., independent from the performance in muscle power, muscle function, and balance tests, is a significant risk factor for falls and fractures.

Jugular venous pooling during lowering of the head affects blood pressure of the anesthetized giraffe

How blood flow and pressure to the giraffe's brain are regulated when drinking remains debated. We measured simultaneous blood flow, pressure, and cross-sectional area in the carotid artery and jugular vein of five anesthetized and spontaneously breathing giraffes. The giraffes were suspended in the upright position so that we could lower the head. In the upright position, mean arterial pressure (MAP) was 193 ± 11 mmHg (mean ± SE), carotid flow was 0.7 ± 0.2 l/min, and carotid cross-sectional area was 0.85 ± 0.04 cm2. Central venous pressure (CVP) was 4 ± 2 mmHg, jugular flow was 0.7 ± 0.2 l/min, and jugular cross-sectional area was 0.14 ± 0.04 cm2 ( n = 4). Carotid arterial and jugular venous pressures at head level were 118 ± 9 and −7 ± 4 mmHg, respectively. When the head was lowered, MAP decreased to 131 ± 13 mmHg, while carotid cross-sectional area and flow remained unchanged. Cardiac output was reduced by 30%, CVP decreased to −1 ± 2 mmHg ( P < 0.01), and jugular flow ceased as the jugular cross-sectional area increased to 3.2 ± 0.6 cm2 ( P < 0.01), corresponding to accumulation of ∼1.2 l of blood in the veins. When the head was raised, the jugular veins collapsed and blood was returned to the central circulation, and CVP and cardiac output were restored. The results demonstrate that in the upright-positioned, anesthetized giraffe cerebral blood flow is governed by arterial pressure without support of a siphon mechanism and that when the head is lowered, blood accumulates in the vein, affecting MAP.

[Composting of poultry carcasses as an alternative method for disposal in case of an outbreak of an epizootic disease: first results]

Composting of poultry carcasses represents an alternative method for disposal in case of an outbreak of an epizootic disease. Two composting experiments, each with a different construction of the compost pile, were carried out in a stable. In the first experiment two layers of turkey carcasses were formed. This compost pile covered with straw was directly built on the ground. In the second experiment no layers of carcasses were formed, and it was assembled on straw bales covered with plastic foil. One part of this compost pile was covered with straw, the other one was additionally covered with plastic foil. In the first experiment in the upper layers of the compost pile temperatures of up to 54.9 degrees C were reached and the decomposition of carcasses was very advanced with no soft tissues remaining after 30 days. In contrast temperatures of only 45.2 degrees C were reached in the lower layers and decomposition was far less advanced. This difference in decomposition was most likely caused by the temperature difference observed. In the second experiment the near complete decomposition seen in the upper layers of the compost pile at the first trial, was not achieved. Decomposition was more advanced in the straw covered part of this compost pile than in the part covered with straw and plastic foil. On the other hand, higher temperatures of up to 48.4 degrees C were measured in the lower layers of this compost pile most likely as a result of the increased heat insulation in particular to the ground.

La kyphoplastie par ballonnets : nouvelle technique dans le traitement percutané des tassements vertébraux

Balloon assisted kyphoplasty and vertebroplasty are minimally invasive procedures with established value in the management of osteoporotic and neoplastic vertebral compression fractures. Kyphoplasty, a variation of vertebroplasty, is a technique with indications and therapeutic particularities that require validation.

Rapid detection of urinary tract infection – evaluation of flow cytometry

AIMS

Urogenital tract infection (UTI) due to bacteria is not only a common infection but also a complication during hospitalization. Therefore, the identification and quantification of bacteria in urine samples are routinely performed methods in microbiological laboratories. To differentiate between infection and contamination it is also important to quantify the leukocyte count. In this study, we suggest a screening procedure using the flow cytometer analyzer BACSYS-40i as tool for the diagnosis of UTI.

MATERIAL AND METHODS

Each urine sample was inoculated onto agar plates (MacConkey agar, sheep blood agar and enterococcosel agar (Bio Merieux, Nütingen, Germany)) within 4 hours after collection. After 24 up to 48 hours incubation at 37 degrees C, bacteria were quantified by evaluation of colony-forming units (CFU) according to the criteria given by the German recommendation [MIQ 1997]. Additionally, each sample was submitted to the BACSYS-40i analyzer. The technological principle is a fluorescence flow cytometer with a laser and a fluorescent dye to identify bacteria and leukocytes with high analytical sensitivity.

RESULTS

Coefficients of variation (CV) for examination of within-run reproducibility ranged from 1.7 - 9.0% for leukocytes and from 6.2 - 24.6% for bacteria. Linearity was found to be very good, with coefficients of determination of r = 0.9998 for leukocytes, and r = 0.9994 for bacteria. Carry-over was calculated and found to be extremely low, ranging up to 0.03% for leukocytes and up to 0.002% for bacteria. The correlation coefficient for leukocyte counting is 0.979, regression y = 1.0 x + 1.0. The number of bacteria determined with the BACSYS-40i (total cell count) is higher than the number determined by culture (viable cell count). If the cut-offs of the analyzer were fixed at > or = 10(6) and < 10(5) bacteria/microl for positive, respectively negative results, 39 out of 42 patients (93%) showing unambiguous predominant clinical signs of UTI and in addition growth of bacteria involved in UTI were recognized. Six samples were questionable.

CONCLUSIONS

Results obtained by the BACSYS-40i can be reported after a few minutes. Urine samples from all 57 patients with predominant clinical signs and in addition growth of bacteria isolated from urine and known as pathogens of UTI had positive results with the analyzer (100%) for elevated bacteria and leukocyte counts. Furthermore, all patients without symptoms for UTI were negative after analysis with the BACSYS-40i (44/44; 100%).

Determinants of musculoskeletal frailty and the risk of falls in old age

Neuromuscular parameters that describe locomotion are indispensable variables for the diagnosis and treatment of frailty, fall risk and osteoporosis. A scientifically-based standardized locomotor assessment should be an essential part of medical examinations in research and clinical practice. There has been no previous consensus regarding which test procedures should be included in a locomotor assessment. The goal of this article is to provide a rationale for the selection of appropriate locomotor tests in a comprehensive locomotor assessment for elderly patients. We propose that a locomotor assessment should comprise the parameters that have been proven predictive for both falls and impending disability. The parameters should be measured in the standard units of physics. Therefore, we propose the following tests for a standardized locomotor assessment: (1) Self-selected gait velocity as the single best measure of general locomotor status and a good predictor of age-related adverse events; (2) Chair rise test (timed 5 chair rises) which measures power on vertical movement and the hip surrounding muscles as the most important neuromuscular risk factor for falls and fall-related fractures; (3) Tandem standing and tandem walking to measure postural capacity (balance) to the side; (4) Timed up and go test as a global screening procedure; (5) Clinical gait analysis with special focus on regularity; and (6) At least on a research level, movement must be measured referring to the terms of physics by mechanography. Mechanography (Leonardo force plate system, Novotec Pforzheim, Germany) records the time course of ground reaction forces, velocity of the vertical movements of the center of mass and power during unrestricted physiological movements. In the mechanogram the eccentric and concentric phases of movements can be differentiated and the storage of energy in the elastic elements of the body can be examined. The kinetics of human movement is explained by mechanograms of a two-legged jump. The ground reaction forces resulting from a jump down from a height of 0,46 m are demonstrated as a performance that is representative for human coordination. One goal of this text is to underline the insights that arise if the rules of physics are applied to human movement. A deeper understanding enables us to create more effective treatments for disorders of the muscle-bone unit. Bringing physics and cybernetics into the field of osteoporosis is a great heritage of Harold Frost.

[Detection of Coxiella burnetii in the air of a sheep barn during shearing]

Local epidemics of Q fever occur sporadically in Germany, mainly in rural residential communities. There is increasing evidence that these outbreaks, which are caused by Coxiella burnetii, are related particularly to the lambing season and shearing periods of nearby sheep holdings. It is assumed that this zoonotic agent is massively emitted from the placenta of infected ewes at birth and during shearing of wool contaminated with infected faeces of ticks. However, little is known about the airborne transmission and travel distance of this infectious agent, and only few attempts have been made to isolate it directly from the air. This paper describes for the first time the isolation and detection of C. burnetii in the air of an enclosed sheep barn during shearing of a herd which had tested positive for C. burnetii serologically and by PCR. Samples of inhalable dust samples were taken using I.O.M. samplers with glass fibre and polycarbonate filters at a flow rate of 2.5 l/min. The sampling time was nearly 4.5 h. Two sampling positions were set up on both sides of the shearing place at a distance of 3 m and 1.5 m above the ground. A third position with the same sampling equipment was not activated and served as a sampling and transport control. In the laboratory, the glass fibre filters were used to determine the dust concentration. The polycarbonate filters were treated in a specific breakdown procedure which inactivates PCR inhibitors, followed by amplification and sequencing of a specific DNA section of C. burnetii, which was found in the dust from both active sampling positions. The investigation clearly shows that the sampling and detection methods used in this small field study are suitable for the detection of C. burnetii in the air of sheep barns. The results confirm experimentally the high risk of airborne transmission of C. burnetii from sero-positive sheep herds during shearing. However, little is known about the effective travel distance of infective airborne C. burnetii particles. There is an urgent need for more detailed investigations on the emission and airborne dispersion of infectious C. burnetii particles in order to improve our understanding of the health risks caused by this zoonotic agent originating from sheep herds.