Insight into the herbicide resistance patterns in Lolium rigidum populations in Tunisian and Moroccan wheat regions

Rigid ryegrass (Lolium rigidum Gaud.) is one of the most troublesome weeds in Moroccan and Tunisian cereal crop fields. In total, 19 rigid ryegrass field populations were randomly selected in northern wheat crop areas of Morocco and Tunisia to examine the patterns of herbicide resistance to acetolactate synthase (ALS)- and acetyl-CoA carboxylase (ACCase)-inhibiting herbicides. Greenhouse experiments confirmed reduced sensitivity to ALS- and/or ACCase-inhibiting herbicides in all L. rigidum populations. The occurrence of target-site resistance (TSR) was tested using high-throughput genotyping. The advent of next-generation sequencing (NGS) has enabled easy identification of causal mutations and confirmed the presence of ALS and ACCase mutations at specific codons conferring TSR. Thirteen populations showed resistance to ALS-inhibiting herbicides associated with point mutations in positions Pro-197-Thr, Pro-197-Ser, Pro-197-Leu, Pro-197-Gln and Trp-574-Leu, while resistance to ACCase-inhibiting herbicides was detected in 18 populations in positions Asp-2078-Val, Trp-2027-Cys, Ile-1781-Leu, Gly-2096-Ala, and Ile-2041-Asn of the enzymes conferring TSR. Additionally, dose-response experiments with pyroxsulam applied after the inhibition of cytochrome P450 monooxygenase by malathion showed an increase in sensitivity in two out of seven highly resistant (HR) rigid ryegrass populations. This demonstrates the presence of non-target-site resistance (NTSR) in some ryegrass populations. Further evidence of NTSR was investigated in dose-response experiments with pyroxsulam, following pretreatment with the glutathione S-transferase (GST) inhibitor 4-chloro-7-nitrobenzoxadiazole (NBD-Cl), which partially reversed resistance in only a few individuals of two L. rigidum populations. Hence, our study confirms the existence of multiple and cross-resistance to ALS- and ACCase-inhibiting herbicides in L. rigidum from Morocco and Tunisia with both TSR and NTSR mechanisms. These results emphasize local resistance management as an important tool to detect and mitigate gene flow from rigid ryegrass populations where resistance has evolved.

Comprehensive insights into herbicide resistance mechanisms in weeds: a synergistic integration of transcriptomic and metabolomic analyses

Omics techniques, including genomics, transcriptomics, proteomics, and metabolomics have smoothed the researcher's ability to generate hypotheses and discover various agronomically relevant functions and mechanisms, as well as their implications and associations. With a significant increase in the number of cases with resistance to multiple herbicide modes of action, studies on herbicide resistance are currently one of the predominant areas of research within the field of weed science. High-throughput technologies have already started revolutionizing the current molecular weed biology studies. The evolution of herbicide resistance in weeds (particularly via non-target site resistance mechanism) is a perfect example of a complex, multi-pathway integration-induced response. To date, functional genomics, including transcriptomic and metabolomic studies have been used separately in herbicide resistance research, however there is a substantial lack of integrated approach. Hence, despite the ability of omics technologies to provide significant insights into the molecular functioning of weeds, using a single omics can sometimes be misleading. This mini-review will aim to discuss the current progress of transcriptome-based and metabolome-based approaches in herbicide resistance research, along with their systematic integration.

Calcium signalling in weeds under herbicide stress: An outlook

The continuous use of herbicides for controlling weeds has led to the evolution of resistance to all major herbicidal modes of action globally. Every year, new cases of herbicide resistance are reported. Resistance is still in progress in many species, which must be stopped before it becomes a worldwide concern. Several herbicides are known to cause stressful conditions that resemble plant abiotic stresses. Variation in intracellular calcium (Ca²⁺) concentration is a primary event in a wide range of biological processes in plants, including adaptation to various biotic and abiotic stresses. Ca²⁺ acts as a secondary messenger, connecting various environmental stimuli to different biological processes, especially during stress rejoindering in plants. Even though many studies involving Ca²⁺ signalling in plants have been published, there have been no studies on the roles of Ca²⁺ signalling in herbicide stress response. Hence, this mini-review will highlight the possible sensing and molecular communication via Ca²⁺ signals in weeds under herbicide stress. It will also discuss some critical points regarding integrating the sensing mechanisms of multiple stress conditions and subsequent molecular communication. These signalling responses must be addressed in the future, enabling researchers to discover new herbicidal targets.

[Acute Traumatic Intervertebral Disc Herniation]

Acute traumatic intervertebral disc herniation of the thoracic spine is a rather rare injury with only a few reported cases to date. In this manuscript, we present a case of a 58-year-old male patient who sustained a car accident-related high-energy trauma, resulting in a disc herniation of the thoracic spine. Furthermore, we also discuss the possible implications of late diagnosis of such condition. The patient was initially referred from the Emergency Department as a case of head contusion with a left upper limb paresis. Due to only minimal bony trauma visible on the initial spine CT scan, the neurological deficit was attributed to the cranial trauma. The diagnosis of a traumatic disc herniation was therefore established only after the rapid onset of paraparesis, which gradually progressed into paraplegia, and a following spine MRI scan. Despite the subsequent urgent spinal decompression, the neurological functions of the lower limbs were not restored. This manuscript addresses the indications for performing MRI scans in polytrauma patients with a CT-verified spine trauma. Although it may be complicated to perform routine MRI scans in all such patients in daily practice, it can certainly help diagnose such injuries earlier and thus prevent potential permanent neurological damage to the patients. Key word: spine injury, traumatic disc herniation, thoracic spine, spine surgery.

Herbicide resistance in grass weeds: Epigenetic regulation matters too

Although herbicides have been successfully used for controlling weeds, their continuous use has developed in the evolution of resistance to all major herbicide modes of action worldwide. Reports suggest that the members of Poaceae family are more prone to developing herbicide resistance than other families. In plants, epigenetic mechanisms play critical roles by increasing their stress-adaptive potential in a rapidly changing environment. Epigenetic mechanisms involve alteration of the expression of genetic elements, but without any changes in the DNA sequence. Although the possible roles of epigenetic mechanisms in contributing to survival and fitness under various stresses are well documented in model plants and crops, their contribution to herbicide resistance in weeds is still in its infancy. A few studies with herbicides have shown differential expression of DNA methyltransferases, histone methyltransferases and DNA demethylases in response to the herbicides; however, no further studies were conducted. In the case of herbicide stress, exploring how these epigenetic processes affect the gene expression pattern in individual plants subjected to recurrent selection would be exciting. Hence, our mini-review will focus on the potential contributions of epigenetic mechanisms to the adaptive responses of grass-weedy species to herbicide stress. A better understanding of these epigenetic changes will add novel perceptions to our knowledge of herbicide resistance evolution in weeds enabling the development of herbicides with novel targets.

Vertical Oscillation of Railway Vehicle Chassis with Asymmetry Effect Consideration

This paper deals with the problem of vertical oscillation of rail and road vehicles under symmetrical and asymmetrical loading and symmetrical and asymmetrical kinematic excitation. The term asymmetry is understood as the asymmetric distribution of vehicle mass and elastic and dissipative elements with respect to the axes of geometric symmetry, including asymmetric kinematic excitation. The various models used (spatial, planar, quarter-plane) are discussed and their analytical solutions are outlined. The theory of the spatial model is applied to the chassis of a model railway vehicle. The basic relations for the calculation of the equations of motion of this vehicle are given. In the next section, the experimental solution of a four-axle platform rail car is described and the measurements of vertical displacement and accelerations when crossing wedges (representing unevenness) are given.

A patient with severe metformin-associated lactic acidosis complicated by acute coronary syndrome: a case report

Introduction

Metformin-associated lactic acidosis (MALA) is a rare but life-threatening condition. Here, we report the outcome of a patient with MALA complicated by acute coronary syndrome.

Case presentation

A 47-year-old obese woman of Caucasian ethnicity was admitted for syncope and tachypnea with Kussmaul breathing. She had a type-2 diabetes and was on oral antidiabetic therapy. Hemoglobin A1c was 6.6%. On admission, a severe acute kidney injury (serum creatinine: 1251 µmol/L) with hyperkalemia (7.5 mmol/L) and severe lactic acidosis (ph:7.042, bicarbonate: 9.9 mmol/L, partial pressure of carbon dioxide: 21.8 mmHg, lactate: 20.0 mmol/L) was found. Despite bicarbonate therapy, ph further decreased. Within 2.5 h of admission, a temporary hemodialysis catheter was placed, and one session of a high-efficiency hemodialysis was performed. 8 h after admission, a continuous venovenous hemodiafiltration was initiated and maintained for 2 days. The metformin therapy was stopped. Supplemental oxygen, intravenous catecholamines (4 days) and antibiotic therapy (7 days) were applied. During this therapy of lactic acidosis, an acute coronary syndrome evolved by day 2 after admission and resolved by day 5 in hospital. After recovery, the patient was transferred to a general ward on day 7 and left the hospital on day 11. By discharge, both the acute kidney injury and the acute coronary syndrome were reversible.

Conclusion

In the patient with MALA complicated by acute coronary syndrome, the combination of a high-efficiency hemodialysis and, consecutively, continuous venovenous hemodiafiltration led to a favorable outcome.

Pulse-shape discrimination against low-energy Ar-39 beta decays in liquid argon with 4.5 tonne-years of DEAP-3600 data

The DEAP-3600 detector searches for the scintillation signal from dark matter particles scattering on a 3.3 tonne liquid argon target. The largest background comes from 39 Ar beta decays and is suppressed using pulse-shape discrimination (PSD). We use two types of PSD estimator: the prompt-fraction, which considers the fraction of the scintillation signal in a narrow and a wide time window around the event peak, and the log-likelihood-ratio, which compares the observed photon arrival times to a signal and a background model. We furthermore use two algorithms to determine the number of photons detected at a given time: (1) simply dividing the charge of each PMT pulse by the mean single-photoelectron charge, and (2) a likelihood analysis that considers the probability to detect a certain number of photons at a given time, based on a model for the scintillation pulse shape and for afterpulsing in the light detectors. The prompt-fraction performs approximately as well as the log-likelihood-ratio PSD algorithm if the photon detection times are not biased by detector effects. We explain this result using a model for the information carried by scintillation photons as a function of the time when they are detected.

Enhanced metabolism and target gene overexpression confer resistance against acetolactate synthase-inhibiting herbicides in Bromus sterilis

BACKGROUND

Intensive application of acetolactate synthase (ALS)-inhibiting herbicides has resulted in herbicide-resistance in many weeds, including Bromus sterilis. The present study was conducted to identify the mechanisms conferring resistance to ALS-inhibiting herbicides in a Bromus sterilis biotype.

RESULTS

Dose-response studies revealed the resistant biotype to be 288 times less sensitive to pyroxsulam than the susceptible biotype. Furthermore, experiment with a single-dose, proved this biotype was also cross-resistant to propoxycarbazone, iodosulfuron plus mesosulfuron and sulfosulfuron. Prior treatment with malathion, a known inhibitor of cytochrome P450s, reduced the level of resistance to pyroxsulam. No mutations were detected from the partial ALS gene sequencing. Flow cytometry and chromosome counting rejected ploidy level variation between the susceptible and resistant biotypes. Relative copy number variation ruled out gene amplification. Quantitative real-time polymerase chain reaction (PCR) detected a significant difference in ALS gene expression between the susceptible and resistant biotypes.

CONCLUSIONS

Target gene overexpression and enhanced metabolism by cytochrome P450s are likely mechanisms of resistance to pyroxsulam in Bromus sterilis. The current findings highlight the need to monitor additional brome populations for herbicide resistance in Europe and endorse the need for alternate herbicides in integrated weed management to delay the possible evolution of herbicide resistance in these species. © 2020 Society of Chemical Industry.

A standardised diagnostic approach to pituitary neuroendocrine tumours (PitNETs): a European Pituitary Pathology Group (EPPG) proposal

The 2017 World Health Organization (WHO) classification proposes to type and subtype primary adenohypophyseal tumours according to their cell lineages with the aim to establish more uniform tumour groups. The definition of atypical adenoma was removed in favour of high-risk adenoma, and the assessment of proliferative activity and invasion was recommended to diagnose aggressive tumours. Recently, the International Pituitary Pathology Club proposed to replace adenoma with the term of pituitary neuroendocrine tumour (PitNET) to better reflect the similarities between adenohypophyseal and neuroendocrine tumours of other organs. The European Pituitary Pathology Group (EPPG) endorses this terminology and develops practical recommendations for standardised reports of PitNETs that are addressed to histo- and neuropathologists. This brief report presents the results of EPPG's consensus for the reporting of PitNETs and proposes a diagnostic algorithm.

The effect of fatty acid profile on the stability of non-traditional and traditional plant oils

The effect of fatty acid composition on the autoxidation of selected plant oils (rapeseed (canola) oil, corn oil, frying oil, grapeseed oil, pomace olive oil, rice bran oil, sunflower oil and high oleic sunflower oil) during their storage was studied. Oils were purchased in retail food stores. Oxidative stability of plant oils was monitored during the storage under the Schaal test conditions at 60 °C in 100 mL beakers and the dark for 40 days. The weight changes, the peroxide and acid values were analysed during the storage. Changes in the composition of fatty acids were analyzed by the gas chromatography-mass spectrometry. The results obtained by monitoring the weight changes of oils correlated with their peroxide values. The induction period in case of grapeseed and sunflower oils was 27 and 28 days respectively. The induction period for frying and rapeseed oils were around 35 days. The remaining four oils had induction periods over 40 days. The acid values at the end of experiment correspond to both the relative weight gain and the the peroxide values. The stability of oils depended mainly on the degree of fatty acids unsaturation. A strong negative correlation between oleic acid content and oil stability expressed as the peroxide value was found. The significant positive correlation was found in case of linoleic acid. The relative content of polyunsaturated fatty acids decreased during the storage while the content of saturated and monounsaturated fatty acids increased. The highest relative increase in oleic acid was found at the least stable oils, grapeseed and sunflower oils, by 37.5% and 25.3% respectively. The initial content of free fatty acids monitored by the acid value did not affect the oxidation rate. With consideration to all monitored parameters the grapeseed and the sunflower oils were the least stable. The most stable ones were olive pomace and high oleic sunflower oils.

First Results from the DEAP-3600 Dark Matter Search with Argon at SNOLAB

This Letter reports the first results of a direct dark matter search with the DEAP-3600 single-phase liquid argon (LAr) detector. The experiment was performed 2 km underground at SNOLAB (Sudbury, Canada) utilizing a large target mass, with the LAr target contained in a spherical acrylic vessel of 3600 kg capacity. The LAr is viewed by an array of PMTs, which would register scintillation light produced by rare nuclear recoil signals induced by dark matter particle scattering. An analysis of 4.44 live days (fiducial exposure of 9.87 ton day) of data taken during the initial filling phase demonstrates the best electronic recoil rejection using pulse-shape discrimination in argon, with leakage <1.2×10^{-7} (90% C.L.) between 15 and 31  keV_{ee}. No candidate signal events are observed, which results in the leading limit on weakly interacting massive particle (WIMP)-nucleon spin-independent cross section on argon, <1.2×10^{-44}  cm^{2} for a 100  GeV/c^{2} WIMP mass (90% C.L.).

[Non-Hodgkin´s B-lymphoma of the ovaries with an unfavourable prognosis - incidental finding during caesarean section]

OBJECTIVE

Presentation of a rare finding non-Hodgkin´s B-lymphoma of the ovary in a patient during caesarean section.

DESIGN

Case report.

SETTINGS

Department of Obstetrics and Gynaecology, Regional Hospital Liberec, a.s.; First Internal Clinic - Clinic of Hematology, First Faculty of Medicine and General University Hospital, Charles University in Prague; Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University in Praque and Motol University Hospital.

RESULTS

Pregnant woman, 31-years old, primiparous, with a history of caesarean section was examinated in our department due to nonspecific abdominal pain during her pregnancy. During the caesarean section of fetal indication we found bilateral ovarian tumours. We performed unilateral adnexectomy. Preliminary diagnosis from frozen section was thecoma, but final diagnosis (after definitive histology, imunohistochemistry and molecular investigation) was high-grade B-cell non-Hodgkin´s lymphoma with c-myc and bcl-6 gene rearrangement (double-hit lymphoma) resulting in an unfavourable prognosis. The patient consequently completed 6 cycles of chemotherapy with a biological treatment, and achieved a complete remission. However, after 6 months, an early generalisation to the CNS appeared, leading to intracranial hypertension refractory to anithypertensive and anti-oedematous therapy, consequently leading to death.

CONCLUSION

Non-Hodgkin´s lymphoma of the ovary in pregnancy is a rare adnexal tumour whose treatment requires interdisciplinary cooperation.

Effect of a non-woven fabric covering on the residual activity of pendimethalin in lettuce and soil

BACKGROUND

Lettuce (Lactuca sativa L.) is a crop that is very sensitive to herbicide contamination owing to its short growing season. The use of long-residual herbicides and non-woven fabric coverings could therefore influence pendimethalin concentrations in soil and lettuce.

RESULTS

The pendimethalin half-life in soil ranged between 18 and 85 days and was mainly affected by season (i.e. weather), and especially by soil moisture. Pendimethalin degradation in soil was slowest under dry conditions. A longer pendimethalin half-life was observed under the non-woven fabric treatment, but the effect of varying application rate was not significant. Pendimethalin residue concentrations in lettuce heads were significantly influenced by pendimethalin application rate and by non-woven fabric cover, especially at the lettuce's early growth stages. The highest pendimethalin concentration at final harvest was determined in lettuce grown on uncovered plots treated with pendimethalin at an application rate of 1200 g ha-1 (7-38 µg kg-1 ). Depending on growing season duration and weather conditions, pendimethalin concentrations in lettuce grown under non-woven fabric ranged from 0 to 21 µg kg-1 .

CONCLUSION

Use of transparent non-woven fabric cover with lettuce can help to reduce application rates of soil herbicides and diminish the risk of herbicide contamination in the harvested vegetables. © 2016 Society of Chemical Industry.

Etiology and clinical relevance of elevated platelet count in ICU patients : A retrospective analysis

BACKGROUND

Thrombocytosis is a common phenomenon in critically ill patients. Although thrombocytosis is an independent risk factor for complications, it does not seem to influence mortality in intensive care (ICU) patients.

OBJECTIVES

Our investigation aimed to evaluate the etiological and clinical relevance of a platelet count greater than 450 × 10⁹/l in ICU patients.

MATERIALS AND METHODS

Patients admitted for a minimum of 4 days to an interdisciplinary ICU during a 45-month period were enrolled in this retrospective observational study. Thrombocytopenic patients (platelet count <150 × 10⁹/l in at least one measurement) were excluded. The study patients were divided into two groups: thrombocytosis group (thrombocytes >450 × 10⁹/l in at least one measurement) and control group (thrombocytes = 150 - 450 × 10⁹/l during ICU stay). Univariate and multiple regression analysis were used to determine the influence of severe co-morbidities on the development of thrombocytosis and the association of elevated platelet count with thrombotic embolism, length of stay (LOS) in ICU, and mortality.

RESULTS

A total of 307 patients were analyzed, of whom thrombocytosis was observed in 119 cases. Independent risk factors for the development of thrombocytosis included SIRS, mechanical ventilation, and acute bleeding. Increasing age reduced the risk of thrombocytosis. Thromboembolism occurred in 16 patients (13.4%) with an elevated platelet count and only in nine patients (4.7%) with physiological platelet values (OR: 3.1; 95% CI: 1.3-7.2; p = 0.009). Mean duration of LOS was significantly longer in patients with thrombocytosis (25.2 vs.11.7 days, p < 0.0001). Elevated platelet count showed a negative correlation with ICU mortality (OR: 0.32; 95%-CI: 0.12-0.83; p = 0.019).

CONCLUSION

In our retrospective analysis the occurrence of thrombocytosis in a cohort of interdisciplinary ICU patients was associated with a higher rate of complications and longer LOS in the ICU. Despite these findings, thrombocytosis seems to reduce mortality in critical ill patients.

Drought stress impact on vegetable crop yields in the Elbe River lowland between 1961 and 2014

The study is focused on drought stress that is detrimental to yield formation of field-grown vegetables in the lowland regions of the Czech Republic. Extensive vegetable yield losses are attributed to drought, often in combination with heat or other stresses. The objective of this research was to investigate, under field conditions, the effect of drought stress quantified by the Standardized Precipitation Evapotranspiration Index (SPEI) on yield variability of key vegetable crops growing in the Elbe River lowland, representing central European agriculture conditions. Additionally, we also tried to determine the period of crop with the highest sensitivity to drought (PCSD) of vegetable crops over the Elbe River lowland. Historical climate datasets for a regular gridded network with a high horizontal resolution of 10 km (CZGRIDS) and 305 climatological stations from the Czech Hydrometeorological Institute were applied. The SPEI at 1-, 3-, and 6-month lags was calculated for the period 1961-2014 based on precipitation and input dataset for the reference evapotranspiration (ETr) by the Penman-Monteith (PM) method. Moreover, the difference between daily precipitation and crop evapotranspiration (ETc) has been used to calculate the mean crop water balance (D) per main growth stages, as an indicator of plant stress. This improvement increased the applicability of the SPEI in agriculture drought impact on rainfed and/or irrigated field crops grown under various agronomic management systems. To understand how the SPEI, over the period 1989-2014, controlled the yield variation, we calculated the percentage of yield losses and gains for each crop. When the value of SPEI at 3-month lag–as a measure of the balance between the water availability and the atmospheric water demand–for PCSD was between -1.49 and 0.99, the yield moderately increased for Fruiting vegetables (e.g. tomatoes, cucumber). Conversely, when the SPEI-3 in the key development stage dropped below -3.0, the yield losses were about -30% and a negative influence is apparent from threshold of the SPEI≤-1.5. The effect of the SPEI on yield formation of vegetable cultivars grown under filed conditions was achieved up to 62% in the study region.

Mechanisms of resistance to acetolactate synthase-inhibiting herbicides in populations of Apera spica-venti from the Czech Republic

BACKGROUND

This study investigates the mechanisms of resistance to acetolactate synthase-inhibiting herbicides in populations of Apera spica-venti (L.) P.B. from the Czech Republic.

RESULTS

The proportion of resistance due to mutant acetolactate synthase (ALS) alleles was estimated by genotyping individuals from each of three populations for the eight ALS mutations known to confer resistance. Four resistance-conferring ALS mutations were identified: Pro-197-Ala, Pro-197-Thr, Trp-574-Leu and previously unreported Trp-574-Met substitution. Two populations (R1, R3) have amino acid substitution at positions Pro-197 and Trp-574. Individuals from the R3 population had two different resistance alleles. In the R2 population, only the resistant Trp-574-Met substitution was detected. Ten other single point mutations were identified, but these were not related to resistance. The cytochrome malathion decreased chlorsulfuron resistance in the resistant populations that were examined. Although malathion increased mortality, the GR50 values were too high to conclude that non-target-based mechanism was the main one for the resistance in Apera spica-venti populations tested in this study.

CONCLUSIONS

Individuals of Apera spica-venti populations tested in this study possess the target-site ALS resistance mutation and an additional so far unknown resistance mechanism(s).

[Histiocytic necrotizing lymphadenitis / Kikuchi-Fujimoto disease (HNL/K-F) and its differential diagnosis: analysis of 19 patients]

Histiocytic necrotizing lymphadenitis / Kikuchi-Fujimoto disease (HNL/K-F) is being recognized with an increasing frequency not only in the East Asia but also on the American continents and in the Europe. Still the diagnostics of HNL/K-F is not easy and difficulties with its proper classification persist. In a group of 19 patients diagnosed primarily or as consults at our department there were 12 woman and 7 men. An average age at diagnosis was 28 years, median 25 years. Cervical lymph nodes were involved in 18 patients. Bilateral lymphadenopathy was present in one patient, the remaining 17 were unilateral. Inguinal lymph node was affected in one patient. In one other patient there were enlarged retroperitoneal lymph nodes simultaneously with a cervical lymphadenopathy. The size of the lymph nodes varied between 5 mm to 32 mm. The subclassification showed the necrotizing type in 14 patients, in one there was a predominant xanthomatous tissue reaction around the necrotic areas (xanthomatous type), and in 4 patients the disease was recognized as the proliferative type without necrosis (in two with a variously intense apoptosis of the proliferating lymphocytes). Of 10 consult cases the tumor was primarily evaluated as B cell lymphoma not otherwise specified (1x), peripheral T cell lymphoma (1x), classical Hodgkin lymphoma of mixed cellularity (1x); two patients were submitted with a differential diagnosis between peripheral T cell lymphoma and HNL/K-F; in one diagnosis of probable EBV lymphadenitis and in one diagnosis HNL/K-F was made. There were no data submitted in the remaining three cases. The authors stress diagnostic features which should lead to the diagnosis of the disease and should prevent unnecessary oncological staging investigations and potential chemotherapy for a lymphoma. Among diagnostic features of HNL/K-F identification of the proliferating cells - CD8 activated lymphocytes with apoptotic decay prevail, there are frequent plasmacytoid monocytes and a striking reaction of macrophages which are CD68/myeloperoxidase positive. There are virtually no neutrophil granulocytes and there is a miminal participation of plasma cells. In case of necrotizing and xanthomatous type infectious causes are to be ruled out as well. In case we still need to distinguish HNL/K-F from a lymphoma PCR analysis of a rearrangement of the immunoreceptor gene in T cell population should be investigated.

[Sedation concepts with volatile anaesthetics in intensive care: practical use and current experiences with the AnaConDa system]

The use of volatile anaesthetics in intensive care medicine has so far been limited by the lack of equipment suitable for daily routine use and the need for an anaesthetic machine. The new Anaesthetic Conserving Device (AnaConDa) enables the routine use of volatile anaesthetics for long-term sedation via intensive care ventilators. The Anaesthetic Conserving Device replaces the common heat and moisture exchanger in the ventilation circuit. The volatile anaesthetic is continuously applied in liquid status via a syringe pump to a form of mini-vaporiser where the anaesthetic agent is vaporised. The expired anaesthetic gas is stored in the carbon filter and approximately 90% of the gas is resupplied into the breathing cycle. The current experiences suggest that volatile anaesthetics present an alternative for long-term sedation in intensive care units, providing optimised pathways, from a medical as well as from an economical point of view. It must, however, be emphasized that the use of volatile anaesthetics for longer periods of time is an off-label use and should only undertaken by medical professionals at their own risk.

Temperature gradient between brain tissue and arterial blood mirrors the flow-metabolism relationship in uninjured brain: an experimental study

BACKGROUND

The purpose of the present experimental study was to determine the feasibility and usefulness of brain temperature measurement (T(br)) and the calculated difference between brain temperature and arterial blood temperature (DeltaT(br-a)) in uninjured brain during variations of cerebral perfusion pressure (CPP) and concomitant changes of the regional cerebral blood flow (rCBF).

METHODS

Nine anaesthetized pigs were subjected to controlled CPP decrease to assess the lower cerebral autoregulation threshold. A parenchymal intracranial pressure (ICP) sensor combined with a microthermistor for temperature measurement, a miniaturized Clark-type electrode measuring brain tissue oxygenation (p(ti)O(2)), a small flexible intraparenchymal thermodilution probe for measuring rCBF and cerebral microdialysis were inserted carefully in the frontal white matter.

RESULTS

Analysing the p(ti)O(2) during controlled CPP decrease, we found significant breakpoints of p(ti)O(2) at a CPP of 40 mmHg and 20 mmHg, related to an rCBF of 20 ml/100 g/min and approximately 10 ml/100 g/min. Similarly, the relationship between DeltaT(br-a), and CPP or rCBF revealed a characteristic increase of DeltaT(br-a) in the negative direction up to more than -0.30 degrees C assuming a strong flow dependency.

CONCLUSION

The temperature difference between brain tissue and arterial blood DeltaT(br-a) mainly reflects the cerebral blood flow-brain tissue oxygenation-metabolism relationship as far as the estimation of the individual lower cerebral autoregulation threshold.

Use of catheters with the AgION antimicrobial system in kidney transplant recipients to reduce infection risk

Microbial blood infection represents a high risk for immuno-suppressed patients. Of all catheter-related infections in the bloodstream, 90% result from the use of central venous catheters, the main cause being microbial colonization at the catheter's insertion point or the catheter hub. Between January 2003 and December 2004, 102 patients received a renal transplant including 57 who received a triple-lumen central venous catheter (CVC) during the procedure. Two catheters were used: a standard polyurethane catheter placed in the jugular veina or the subclavian veina for group I, and polyurethane catheters with the AgION antimicrobial system always placed in the subclavian veina for group II. Care and maintenance of the CVCs was standardized in both groups. After catheter removal, the tips were analyzed microbiologically. Of 57 (43.9%) CVCs, 25 were found to be contaminated. In the first group 24 out of 41 CVCs (58.5%) showed bacterial growth, whereas in group II only one catheter (6.6%) had a biofilm. The most common contaminant (18 out of 25, 72%) was Staphylococcus epidermidis. In group II, two patients had positive blood cultures yet a microbiologically sterile CVC. None of the catheters with the AgION antimicrobial system had to be removed owing to local infection or intolerance. The continuous release of silver ions increases the protection against bacteria and fungi during the entire time of catheterization. Use of catheters with the AgION antimicrobial system lead to a marked reduction in catheter-associated infections of the bloodstream.

Local and systemic hemorheological effects of cerebral hyper- and hypoperfusion in a porcine model

Using a well defined pig model, we investigated whether cerebral hypertension and hypotension influence hemorheological factors. After surgical preparation and stabilization, periods of hyperventilation, controlled periods of cerebral perfusion pressure increases and decreases were utilized. After each period, blood samples were collected from the cannulated femoral artery and vein, and from the superior sagittal sinus. Erythrocyte deformability, whole blood and plasma viscosity and hematological parameters were determined. Erythrocyte deformability significantly worsened in arterial samples after hypertension and hypotension, and in sinus samples it was impaired after hypotension period. Hematocrit significantly increased in arterial and sinus samples during hypertensive period, accompanied by similar alterations in whole blood viscosity. We conclude that hemodynamic changes caused by hyperventilation, hyper- or hypotension can influence hemorheological factors, and suggest that the rheological alterations can affect local hemodynamic and metabolic conditions.

[Molecular diagnosis of malignant B-cell lymphoma: detection of clonality and a brief review of problems with our results]

BACKGROUND

Diagnostic approach to non-Hodgkin's lymphomas requires a combination of laboratory methods. Methods used in morphology constitute the basis of the diagnostics; in many instances it is necessary to combine them with methods of molecular genetics. The latter method plays a key role in the detection of B cell clonality using identification of the rearrangement of IGH and/or IGK genes and in detection of the chromosomal translocations specific for some lymphomas.

METHODS AND RESULTS

Using PCR we investigated 113 patients with malignant B cell lymphomas of different types (follicular--FL, mantle cell--MCL, small cell--CLL/SLL, diffuse large cell--DLBCL). We established the IGH gene clonal rearrangement in 85% of the cases (96/113), and the clonal rearrangement of the IGK gene in 58.3% patients (42/72). Combination of both approaches (IGH and IGK) revealed a positive result in 90.3% (102/113). The highest yield was rendered in patients with CLL/SLL and with MCL (100%), and it was 86 and 87% in cases with FL and DLBCL.

CONCLUSIONS

The detection of clonality in lymphomas helps to distinguish a malignant disease from polyclonal hyperplastic and lymphoproliferative disorders of B cells. The recognition of clonal rearrangements of the IGH and IGK genes serves for a long term monitoring of the disease activity in cases in which there are no other molecular markers available. The demonstration of lymphoma characteristic translocations is relatively specific and useful but at present its usefulness is reduced in cases with variable breakpoint regions.

Ethanol fixation of lymphoma samples as an alternative approach for preservation of the nucleic acids

Molecular methods play an important role in diagnostic pathology of lymphomas. PCR based demonstration of clonality or detection of a specific chromosomal translocation may determine the exact classification of the lymphoma. Hence the final diagnosis may depend on the quality of preserved nucleic acids in the bioptic specimen. The integrity of DNA and RNA may be damaged by formalin fixation, which destroys the nucleic acids by fragmentation. Therefore, a portion of each lymphoma sample should be frozen. To substitute freezing techniques we utilized ethanol as a fixative, which preserves nucleic acids. We compared PCR and RT-PCR products from lymphoma samples, which were differently pre-treated by ethanol fixation, formalin fixation and freezing. The ethanol fixed samples retained a high quality of both DNA and RNA and provided reproducible PCR products similar to frozen samples and significantly better then those extracted from formalin fixed samples. We may recommend ethanol as a complementary fixative for all pathology laboratories where deep freezing in not routinely available.

[Atraumatic retroperitoneal hemorrhage--interdisciplinary and differential diagnostic considerations based on a case report]

The differential-diagnostic strategy and the order of precedence of most diverse radiologic diagnostic procedures are discussed based on a case of retroperitoneal bleeding. Apart from iatrogen-caused bleedings, the therapeutic anticoagulant therapy in the context of the patient's disease, haemodialysis or a rare, spontaneously-occurring retroperitoneal bleeding play a substantial role. In the order of precedence of radiologic diagnostic procedures for fast diagnosis of a retroperitoneal haematoma, the abdomen CT-scan is the preferred method.

[New aspects of MALT lymphomas of the stomach]

The knowledge about MALT lymphomas has dramatically changed in the last few years. The genesis of MALT lymphomas has become clearer, and new tools in modern diagnostics are available. This article, as a concise review, summarises the latest data and the clinical and morphological characteristics with the aspect of routine diagnostics. The characteristic translocation t(11;18) and its chimeric transcript API2-MALT1 with antiapoptotic function is emphasised.

[Follicular lymphomas: molecular diagnosis using t(14;18)(q32;q21)--fluorescence in situ hybridization, qualitative and quantitative PCR]

Diagnosis of follicular lymphoma (FL) is based on histology and immunohistochemical profile (CD20+, CD79alfa+, CD10+, BCL-2+, CD5-). A chromosomal marker--translocation t(14;18)(q32;q21) supporting the tumor diagnosis and useful for monitoring bone marrow or peripheral blood infiltration by the tumor cells is also used. The BCL2 gene (18q21) is controlled by an enhancer of the IGH gene (14q32) resulting in BCL-2 protein overexpression. The translocation is present in the majority of patients with FL. The aim of the study was to introduce the quantitative PCR (RQ-PCR, real-time quantification) method for the assessment of the quantity of cells bearing the translocation t(14;18) in patients with FL. The fluorescence in situ hybridization on interphasic nuclei (I-FISH) in histologic sections was used for screening of patients with the t(14;18). A search for the break of the BCL2 gene at the major breakpoint region (mbr) was performed by means of qualitative PCR. We determined the relative number of the tumor cells bearing t(14;18) translocation (mbr) in patients with FL by the RQ-PCR. The relative quantity of these cells was significantly higher in the lymph nodes than in the bone marrow or peripheral blood. The RQ-PCR is a tool of choice to monitor the activity of the disease in individual patients, and to detect an early disease relapse before its manifestation at the level diagnosed by morphology.

[Large-cell diffuse B-cell lymphoma: heterogenous origin and prognosis from the aspect of modern diagnosis]

BACKGROUND

Diffuse large B-cell lymphomas represent a heterogeneous group of tumors with a different origin, morphological findings and a variable clinical prognosis. These tumors have been recently classified into two prognostically relevant subgroups differing in the gene expression. The key genes suitable for routine diagnostics of DLBCL have not been yet identified. The aim of this work was to study changes and expression of several genes and proteins participating in the genesis of DLBCL.

METHODS AND RESULTS

We analysed a group of 31 patients with diffuse large B-cell lymphomas. Basic clinical data including follow-up of the patients were available. Tumors were examined by a panel of immunohistochemical reactions with antibodies against CD20, CD79a, BCL-2, BCL-6, CD10, Ki-67 and TP53. FISH was used to detect a translocation t(14;18)(q32;q21) and/or a break in BCL6 region (3q27) suggestive of a translocation with a variable translocation partner t(3;?). PCR was utilized to detect the translocation t(14;18) and a clonal rearrangement of heavy and/or kappa chain of the immunoglobin genes.

CONCLUSIONS

The expression of BCL-2 protein appeared to correlate with a higher mortality rate. The expression of other proteins examined in the study did not correspond significantly with the clinical development of the disease. Tumors with follicular lymphoma as a component had significantly higher mortality rate than the tumors developing de novo. Moreover, higher mortality was evident in cases with higher values of the International Prognostic Index (IPI).

Brain tissue oxygen monitoring for assessment of autoregulation: preliminary results suggest a new hypothesis

Brain tissue oxygen monitoring (P(ti)O2 (Neurotrend, Codman, Germany) was employed in addition to standard intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring in seven patients with severe neuronal damage of heterogeneous etiology. The correlation between P(ti)O2 changes and CPP fluctuations during periods of 30 minutes were analyzed, when CPP was above 70 mmHg and lower than 100 mmHg. A new ratio, the CPP-oxygen-reactivity (COR) index was calculated as COR=delta p(ti)O2 %/delta CPP%. The patient COR values were compared to those found in the brain of six noninjured anesthetized piglets. The analysis was performed to determine the significance of synchronous fluctuations of CPP and P(ti)O2, when CPP is above the lower threshold of autoregulation. The correlation between CPP variations and p(ti)O2 variations was found to be strong (R(mean)) = 0.74 +/- 0.17) in the patients and was weak in the uninjured animals (R(mean)) =0.38 +/- 0.43). The COR (mean) was 2.05 +/- 0.57 in patients and 0.78 +/- 0.6 in the animals. In the injured brain of our patients, we observed an unexpectedly close correlation between P(ti)O2 and CPP variations when CPP levels were within a therapeutically targeted range (70 to 100 mmHg). In a porcine model, we could not find this relationship in the noninjured brain. We speculate that an increased COR might be indicative for an impaired local pressure autoregulation. The preliminary data suggest that COR values above "1" might be pathologic. However, the reported sample sizes are too small to provide sufficient statistical power to justify inferential statistical analyses. As such, results are presented with descriptive statistics only, and should be regarded as a hypothesis.

[Ulcerating Herpes simplex infections in intensive care patients]

Herpes simplex infections are potentially a life-threatening situation for immunocompromised as well as critically ill patients. The correct diagnosis is made more difficult in comatose patients by the fact that the characteristic symptom of extreme pain cannot be registered. The clinical dermatological findings (polycyclic configuration, easily bleeding ulcers) are thus especially important in patients under intensive care conditions. As examples, the cases of 3 critically ill patients (subarachnoid bleeding or head injury) developing therapy-resistant, flat sacral or perioral skin ulcers with peripheral blisters are presented. Herpes simplex virus was confirmed immunohistologically and in the smear test. All patients subsequently died. These cases emphasize that patients in the intensive care unit are in danger of developing a chronic persistent Herpes simplex infection due to latent immunosuppression. Chronic persistent Herpes infections may be underrated in intensive therapy, and must always be ruled out in case of therapy-resistant erosions or ulcerations.

[Lymphoma of the small intestine]

The authors analyze on a case-history the problem of lymphomas of the gastrointestinal tract. The patient was a female who was operated on account of a suspected perforation. On operation multiple perforations of the small intestine were found. A resection was performed. According to the histological results it was a giant-cell B-lymphoma of the small intestine. The postoperative course was without major complications. The patient was referred to the oncological department without further treatment.

Parity violation in proton-proton scattering at 221 MeV

The parity-violating longitudinal analyzing power, A(z), has been measured in pvectorp elastic scattering at an incident proton energy of 221 MeV. The result obtained is A(z) = [0.84+/-0.29(stat)+/-0.17(syst)]x10(-7). This experiment is unique in that it selects a single parity violating transition amplitude (3P2 - 1D2) and consequently directly constrains the weak meson-nucleon coupling constant h(pp)(rho). When this result is taken together with the existing pvectorp parity violation data, the weak meson-nucleon coupling constants h(pp)(rho) and h(pp)(omega) can, for the first time, both be determined.

Aleukemic granulocytic sarcoma with AML1/ETO fusion gene expression and clonal T cell populations

We report a unique case of aleukemic granulocytic sarcoma of the neck, originally misdiagnosed as non-Hodgkin's lymphoma (NHL), though chloroma was also suspected due to a greenish macroscopic appearance and the presence of myeloid chloroacetate esterase (CAE)+ cells. The proof of clonal T cell receptor gamma chain (TcRgamma) gene rearrangements in the recurring tumor was deemed to confirm the initial diagnosis of T cell NHL. Altogether five distinct types of clonal TcRgamma gene rearrangements were found in the tumor, bone marrow and peripheral blood. Only retrospectively, using RT-PCR, did we detect the acute myeloid leukemia subset-specific fusion gene AML1/ETO in the frozen samples of the relapsed tumor, as well as in the otherwise unaffected bone marrow and peripheral blood (representing 'minimal initial disease' in the latter two samples). Simultaneous staining verified that the neoplastic CAE+ cells and CD45RO+ T cells were different populations.

[Cerebral oxygen reactivity determination--a simple test with potential prognostic relevance]

Brain tissue oximetry (ptiO2) using flexible micro-polarographic electrodes is a loco-regional approach to monitor oxygen supply to the injured brain, after neuronal damage. In patients after severe head injury (SHI), disturbances of CBF and CO2 related vasoconstriction have been demonstrated. CO2 reactivity testing may assist to determine outcome in these patients. Not much information is available on the preservation of vasoreactivity to arterial hyperoxia after neuronal damage. Therefore, we studied the response of ptiO2 in 7 piglets and in 14 patients on day one after trauma to 100% FiO2 ventilation (O2rea) and analyzed the 3 month outcome using the Glasgow-Outcome-Score (GOS). In the animal study, we placed a Paratrend 7 (P7) sensor for ptiO2 measurements in the non injured frontal white matter. The animals were anesthetized and mechanically ventilated. FiO2 was increased from 30 (+/- 5)% to 100% over a period of 5 minutes. In patients, we placed the P7 probe in the frontal lobe. FiO2 was increased from 35 (+/- 5)% to 100% over a period of 6 hours. O2rea was tested by calculating the percentage change of ptiO2 during 100% FiO2 ventilation, compared to the baseline value of 35% FiO2. By analyzing the patient outcome, we were able to define two patient populations according to the GOS at three month (Group I: favorable outcome [GOS 0-2]; Group II: poor outcome [GOS 3-4]). For the non-injured brain tissue in animals were revealed an O2rea = 0.21 (+/- 0.12).

PATIENTS

Group I: O2rea = 0.4 (+/- 0.16); Group II: 0.9 (+/- 0.6). Group I and II were statistical significant different (p < 0.05; unpaired t-test). Oxygen reactivity in severely head patients is a simple test with prognostic value using ptiO2 measurement. These results may be explained by the close relationship of CBF disturbances to oxygen vasoreactivity after traumatic brain injury. The O2rea in animals without neuronal damage is smaller than in patients after SHI. We speculate, the animal data could be considered as normal value of O2rea in non injured brain tissue.

Experiences with continuous intra-arterial blood gas monitoring

Management of critically ill patients requires frequent arterial blood gas analyses for assessing the pulmonary situation and adjusting ventilator settings and circulatory therapeutic measures. Continuous arterial blood gas analysis is a real-time monitoring tool, which reliably detects the onset of adverse pulmonary effects. It gives rapid confirmation of ventilator setting changes and resuscitation and helps to ensure precise adjustment of therapy. In this study a newly available fiber optic sensor system has been employed for continuous intraarterial blood gas monitoring. The measurement performance was compared with a bench top blood gas analyzer. A prospective study was performed enrolling 20 patients undergoing surgery. A comparison between intermittent blood gas analyses (ABL Radiometer 610) and the results of continuous blood gas monitoring (Paratrend 7+, Agilent Technol.) was performed by simultaneous measurements. Statistical analysis in agreement with the method of "Bland and Altman" was employed. Two case reports are provided of patients with Acute Adult Respiratory Distress Syndrome and rapid changes in ventilator settings. Over a range of arterial oxygenation from 10 to 50 kPa the bias for pO2-measurement was 0.2 (limits of agreement 4), R2 = 0.9. If the arterial pO2 was higher than 50 kPa the bias was -7 (10) kPa. PCO2-measurement showed a bias of 0.25 (limits of agreement 0.45), R2 = 0.7. pH bias was -0.02 (limits of agreement 0.04), R2 = 0.7. The Paratrend 7+ sensor proved to be clinical feasible and showed an improved precision in terms of clinical situations with an arterial pO2 smaller than 50 kPa. However, the results are not much different regarding the findings with older systems consisting of hybrid technology combining optodes and electrochemical oxygen measurement. The advantages might be seen if the sensor is used for a period over several days in patients on ICU as demonstrated by the two case reports.

Preferences for cardiopulmonary resuscitation

PURPOSE

To examine nurse-patient communication about preferences for cardiopulmonary resuscitation (CPR).

DESIGN

Prospective cohort. Sampled were patients and nurses caring for patients enrolled in SUPPORT (1989-91), a multicenter study of seriously-ill hospitalized adults at four U.S. hospitals.

METHODS

Information about patient preferences was obtained by interviews with patients and their designated surrogates. For selected patients, nurses were interviewed prospectively about their understanding of patients' preferences and whether they discussed these preferences with their patients. Nurse demographic information was obtained by questionnaire. Additional patient data were obtained by interview and chart review. Logistic regression was used to identify independent correlates of nurse-patient communication and nurses' understanding of patients' preferences.

FINDINGS

For 1,763 study patients, 1,427 nurse interviews (response rate 81%) were obtained. The median age of interviewed nurses was 29 years; 96% were women, 68% had a bachelor's or master's degree, and 62% had worked for 5 years or more as a nurse. Nurses reported discussions about CPR with 13% of their patients, and these discussions were more likely if the nurse thought the patient did not want CPR (adjusted odds ratio [AOR] 2.68; 95% CI 1.84 to 3.90), if the nurse had spent more time with the patient (AOR 1.05; 95% CI 1.02 to 1.08) per 5 additional days, if the patient had metastatic cancer (AOR 3.56; 95% CI 1.86 to 6.78), or if the patient was in an intensive care unit at the time of study entry (AOR 2.08; 95% CI 1.26 to 3.42). Diagnosis and study site were also associated with nurses' reports of discussions with patients. Of 551 patients with available data, 58% (n = 317) wanted CPR and 30% (n = 164) did not. Nurses understood patients' CPR preferences correctly for 74% of the patients. Nurses were more likely to understand patients' preferences to forego CPR if the patient was 75 years of age or older (AOR 6.6; 95% CI 2.0 to 22.0) or if the nurse and patient had discussed the patient's preferences (AOR 25.3; 95% CI 6.5 to 98.6) or if the patient had cancer (AOR 10.9; 95% CI 2.3 to 50.1). Nurses' understanding of patients' preferences for CPR was no better than that of physicians or patients' surrogate decision-makers.

CONCLUSIONS

In this sample of seriously ill hospitalized adults, discussions between patients and nurses about CPR were infrequent. Nurses' understanding of patients' preferences for care was similar to that of physicians and patients' surrogate decision-makers. Educational interventions should focus on increasing the frequency of nurse-patient discussions about end-of-life care and improving nurses' understanding of patients' preferences for care.

[Continuous recording of cardiac output volume with the OptiQ system--experiences with clinical application]

This report discusses initial experiences with the clinical application of continuous cardiac output measurement (OptiQ SvO2/CCO-System). The system was used in 9 intensive care patients suffering either global cardiac insufficiency or systemic inflammatory response syndrome. Continuous cardiac output measurement was recorded during a period of stable blood pressure conditions and compared with the results of the conventional thermodilution method (bolus technique) in these patients. Regression analyses yielded r = 0.523 (r2 = 0.274) for the "urgent" mode, r = 0.943 (r2 = 0.889) for the "fast" mode, r = 0.953 (r2 = 0.907) for the "fast filter" mode and r = 0.990 (r2 = 0.980) for the "normal" mode. Mean differences between the continuous and the bolus technique were calculated as -0.13 +/- 1.81 l/min for the "urgent" mode, -0.42 +/- 0.51 l/min for the "fast" mode, -0.14 +/- 0.48 l/min for the "fast filter" mode and -0.08 +/- 0.19 l/min for the "normal" mode. After a period of two days, the costs of the conventional bolus technique significantly exceeded those of continuous measurement. The expenses for the conventional thermodilution technique are largely determined by the frequency of application and, hence, by the personnel and laboratory costs. In our experience, easy component handling and stable measuring properties make this new method of continuous cardiac output monitoring a valuable method in the diagnose and care of patients who are critically ill.

The use of complementary and alternative therapies to treat anxiety and depression in the United States

OBJECTIVE

This study presents data on the use of complementary and alternative therapies to treat anxiety and depression in the United States.

METHOD

The data came from a nationally representative survey of 2,055 respondents (1997-1998) that obtained information on the use of 24 complementary and alternative therapies for the treatment of specific chronic conditions.

RESULTS

A total of 9.4% of the respondents reported suffering from "anxiety attacks" in the past 12 months; 7.2% reported "severe depression." A total of 56.7% of those with anxiety attacks and 53.6% of those with severe depression reported using complementary and alternative therapies to treat these conditions during the past 12 months. Only 20.0% of those with anxiety attacks and 19.3% of those with severe depression visited a complementary or alternative therapist. A total of 65.9% of the respondents seen by a conventional provider for anxiety attacks and 66.7% of those seen by a conventional provider for severe depression also used complementary and alternative therapies to treat these conditions. The perceived helpfulness of these therapies in treating anxiety and depression was similar to that of conventional therapies.

CONCLUSIONS

Complementary and alternative therapies are used more than conventional therapies by people with self-defined anxiety attacks and severe depression. Most patients visiting conventional mental health providers for these problems also use complementary and alternative therapies. Use of these therapies will likely increase as insurance coverage expands. Asking patients about their use could prevent adverse effects and maximize the usefulness of therapies subsequently proven to be effective.

Association between airway hyperreactivity and bronchial macrophage dysfunction in individuals with mild asthma

Little is known about the functional capabilities of bronchial macrophages (BMs) and their relationship to airway disease such as asthma. We hypothesize that BMs from asthmatics may be modulated in their function compared with similar cells from healthy individuals. BMs obtained by induced sputum from mild asthmatics (n = 20) and healthy individuals (n = 20) were analyzed using flow cytometry for CD16, CD64, CD11b, CD14, and human leukocyte antigen-DR expression, phagocytosis of IgG opsonized yeast, and oxidant production. Asthma status was assessed by lung function [percent predicted forced vital capacity and forced expiratory volume in 1 s (FEV(1))], percent sputum eosinophils, and nonspecific airway responsiveness [provocative concentration that produces a 20% fall in FEV(1) (PC(20,FEV1))]. Asthmatics with >5% airway eosinophils (AEo+) had decreased BM CD64 expression and phagocytosis compared with asthmatics with <5% eosinophils (AEo-). Among asthmatics, a significant correlation was found between CD64 expression and BM phagocytosis (R = 0.7, P < 0.009). Phagocytosis was also correlated with PC(20,FEV1) (R = 0.6, P < 0.007), lung function (%predicted FEV(1), R = 0.7, P < 0.002) and percent eosinophils (R = -0.6, P < 0.01). In conclusion, BM from asthmatics are functionally modulated, possibly by Th2 cytokines involved in asthma pathology.

Sputum phagocytes from healthy individuals are functional and activated: a flow cytometric comparison with cells in bronchoalveolar lavage and peripheral blood

Cells in the bronchial airways of healthy individuals are continuously exposed to inhaled particulates in the size range 2-5 microm, which preferentially deposit in the bronchial rather than the alveolar lung. Induced sputum obtains cells primarily from the surfaces of bronchial airways. Using flow cytometry, we investigated whether sputum phagocytes demonstrate phenotypes indicative of increased functional activation and inflammation compared to phagocytes from the alveolar airways and peripheral blood (PB) in healthy subjects (N = 17). Sputum macrophages demonstrated increased levels of CD11b, increased oxidative burst, and greater phagocytosis than autologous alveolar macrophages. Expression of CD11b, CD64, and HLA-DR in sputum monocytes was upregulated compared to that in PB monocytes. Sputum neutrophils showed increased expression of CD11b, CD64, CD14, and HLA-DR and were more phagocytic than PB neutrophils. In conclusion sputum/bronchial phagocytes from healthy individuals express an inflammatory phenotype and are functionally more active than phagocytes from the alveolar airways and peripheral blood.

[Epidemiologic problems in hantavirus infections]

The objective of the submitted paper was to present some information pertaining to epidemiological problems of hantavirus infection. In the Czech Republic the prevalence of these infections is not alarming but in the world cases of haemorrhagic fever with renal syndrome (HFRS) as well as hantavirus pulmonary syndrome (HPS) are reported. On the territory of the Czech Republic there are foci of hantaviruses and in conjunction with summer tourism or working activities abroad the import of this infection cannot be ruled out. With regard to the serious character of some forms of the disease it is essential to follow up this problem systematically.