Streptococcus mitis and Gemella haemolysans were simultaneously found in atherosclerotic and oral plaques of elderly without periodontitis-a pilot study

OBJECTIVES

Local infections may contribute to the initiation and progression of several clinical diseases in humans. Atherosclerotic plaques of subjects suffering from periodontitis are colonized by periopathogens; however, the presence of bacteria in atherosclerotic plaques in patients without severe forms of periodontitis is of high relevance for the general population.

MATERIALS AND METHODS

Patients who were electively treated for atherosclerotic lesions of the carotid artery and without clinical signs of periodontitis were eligible for the study. Oral and atherosclerotic plaques were sampled, processed, and analyzed for their microbial composition by 454-sequencing.

RESULTS

Seventeen patients were included in the analyses, and 76 % of all atherosclerotic plaque specimens were positive for bacterial DNA. In the oral plaques, 76,532 sequences were identified representing 1 phylum, 17 classes, 112 families, and 263 genera. In atherosclerotic plaques, 6112 sequences representing 1 phylum, 4 classes, 8 families, and 36 genera were found. The bacterial DNAs of the species Gemella haemolysans and Streptococcus mitis were simultaneously found in atherosclerotic as well as oral plaque samples of 3 patients.

CONCLUSIONS

These results indicated that in subjects without periodontitis, the transmission of oral bacteria to atherosclerotic plaques of the carotid artery is a feasible event.

CLINICAL RELEVANCE

The prevention of transient bacteremia from the oral cavity requires high levels of oral health.

[Fax Survey to Elucidate the Information Needs of General Practitioners in Lower Saxony Regarding the Topic of Medical Implants]

Background: Medial implants help a multitude of patients to gain more health, mobility and thus, quality of life. In collaboration with a still growing expectation of life especially, i.e., within Western industrial countries, this has led to an increasing use of implants over the last years. However, although biomechanical characteristics of modern implant materials have improved considerably, one big challenge still exists - the implant-associated infection. Early diagnostic and therapeutic interventions could clearly mitigate this issue, but are general practitioners sufficiently informed regarding this topic? Material and Methods: In March 2013 and in close cooperation with the Lower Saxony association of general practitioners, we initiated a survey to elucidate the information demands of general practitioners regarding the topic of medical implants. A total of 939 members of the association were contacted via fax and 101 (10.8 %) responded. Based on the obtained data, we then evaluated which topics are most interesting for this group of medical professionals. Results: The survey clearly indicates that general practitioners request more general implant-related data, e.g., type and specification of an implant as well as its location within the individual patient and contact addresses of the implanting hospital, but also want more specific information regarding diagnostic and therapeutic strategies in the case of implant-associated complications. Conclusion: The present article reports in detail on the conducted fax survey and shows some initial strategies as to how the identified challenges might be faced.

Kidney pericytes: a novel therapeutic target in interstitial fibrosis

Chronic Kidney Disease affects approximately 8% of the population and contributes considerably to premature morbidity and mortality. Recently reported studies have highlighted an important role for resident microvascular pericytes in the pathogenesis of kidney fibrosis. Pericytes are emerging as the predominant source of the activated, matrix depositing, stromal cell population seen in progressive fibrosis. Further, pericyte activation leads to their detachment from the vasculature, triggers unstable microvasculature and leads to rarefaction. Strategies to modulate pericyte function in these processes are therefore therapeutically attractive. In this review we will first describe our current understanding of the structure and function of the pericyte and the role these cells play in angiogenesis and the pathogenesis of renal fibrosis. Novel therapeutic approaches targeting pericytes in murine models of renal disease will then be considered.

A recombinant anti-ICAM-1 Fab fragment is as effective as the complete IgG antibody in treatment of burns in rabbits

The purpose of this study was to examine the efficiency of an Anti-ICAM-1-Fab fragment in the treatment of burns. Blocking ICAM-1 using murine IgG with the purpose to prevent further damage to the zone of stasis has proven its effectiveness in animal models as well as in humans. The use of murine Antibodies has some disadvantages including allergic reactions and complement activation. For the first time we examined an industry produced Fab-fragment blocking ICAM-1 and compared it to the corresponding IgG antibody. We showed in a standardised rabbit burn model that an Fab-fragment is capable of blocking ICAM-1 and therefore improving the reaction of the skin to trauma in the zone of stasis.

Endothelial thrombomodulin (CD 141) in a rabbit burn model

Thrombomodulin (CD 141) is an endothelial surface transmembrane glycoprotein. It is involved in the activation of protein C in the inactivation of thrombin. In severe sepsis CD 141 is shed from the endothelial surface. This leads to disseminated intravascular coagulation (DIC), disturbed organ functions and multi organ failure (MOF). In this study, we investigated if endothelial bound thrombomodulin is shed in thermal injuries.

MATERIAL AND METHODS

In 10 New Zealand white rabbits full thickness and superficial partial thickness burns were produced. Dermal blood flow was analyzed by measuring the fluorescence of intravenously injected indocyanine green. Skin-biopsies were taken from the burn wounds from the zones of stasis between full thickness burns and from unburned skin 72 h post burn. Specimens were processed for immunoperoxidase staining using a specific monoclonal antibody against CD 141.

RESULTS

Dermal blood flow was reduced in burned skin areas and in the zones of stasis. Thrombomodulin was only detectable on the surface of capillary endothelial cells in specimens taken from unburned skin areas. No thrombomodulin was detectable in specimens taken from burn wounds or from the zones of stasis. Thus, shedding of thrombomodulin was detectable in areas with reduced dermal blood flow.

CONCLUSION

Thermal injuries affect the dermal endothelial surfaces resulting in a shedding of thrombomodulin. This mechanism might be involved in the development of progressive skin damage in the zone of stasis. Disseminated intravascular coagulation following inactivation of thrombomodulin might lead to multiple organ dysfunctions in severe burn injuries.

Extensive thrombus formation in the right ventricle due to a rare combination of arrhythmogenic right ventricular cardiomyopathy and heterozygous prothrombin gene mutation G20210 A

Arrhythmogenic right ventricular cardiomyopathy is a rare heart muscle disease characterized by right and often left ventricular myocardial atrophy and fibrofatty replacement. Heart failure, arrhythmias and sudden death are characteristic complications. We observed a female in whom arrhythmogenic right ventricular cardiomyopathy was diagnosed due to presyncopes and dyspnea on exertion. A left ventricular thrombus was found echocardiographically, which disappeared with oral anticoagulation. Subsequently, however, extensive thrombus formation in the dilated akinetic right ventricle occurred which was resistant to combined treatment with heparin and oral anticoagulation. Thrombophilia screening showed a mutant prothrombin 20210A allele which is an inherited coagulopathy associated with increased plasma levels of prothrombin and increased risks of mainly venous thrombosis. The patient developed endstage biventricular heart failure and underwent heart transplantation within 3 months after thrombus formation in the right ventricle was diagnosed. In the explanted heart, the thrombus in the right ventricle was impressively large and calcified. In patients with unusual thrombus formation in the heart, coagulopathy may be associated and should be excluded.