Intra-uterine fetal demise caused by amniotic band syndrome after standard amniocentesis

The amniotic band syndrome represents a prime example of exogenous disruption of an otherwise normal feta I development. It may be a sequel of invasive diagnostic procedures such as amniocentesis or fetal blood sampling. A 38-year-old gravida II, para II delivered a morphologically normal male stillborn at term. The pregnancy history had been unremarkable but for an early 2nd-trimester amniocentesis. Cause of the intra-uterine fetal demise was noted to be an amniotic band constricting the umbilical cord, An amniotic band is a rare but potentially fatal condition which may be induced by, e.g., invasive prenatal procedures. Such bands are not usually diagnosed prenatally; however, selected patients with augmented risk may profit from intensive ultrasound evaluation including Doppler studies. Copyright (C) 2000 S. Karger AG, Basel

Pregnancy-associated breast cancer - Special features in diagnosis and treatment

For obvious psychological reasons it is difficult to associate pregnancy - a life-giving period of our existence with life-threatening malignancies. Symptoms pointing to malignancy are often ignored by both patients and physicians, and this, together with the greater difficulty of diagnostic imaging, probably results in the proven delay in the detection of breast cancers during pregnancy. The diagnosis and treatment of breast cancer are becoming more and more important, as the fulfillment of the desire to have children is increasingly postponed until a later age associated with a higher risk of carcinoma, and improved cure rates of solid tumors no longer exclude subsequent pregnancies. The following article summarizes the special features of the diagnosis and primary therapy of pregnancy-associated breast cancer with particular consideration of cytostatic therapy

Cross-sectional study: prevalence of oedema disease Escherichia coli (EDEC) in weaned piglets in Germany at pen and farm levels

Background Escherichia coli bacteria capable of producing the toxin Stx2e and possessing F18-fimbriae (edema disease E. coli, EDEC) are considered causative agents of porcine oedema disease. This disease, which usually occurs in piglets shortly after weaning, has a high lethality in affected animals and can lead to high economic losses in piglet rearing. The aim of this cross-sectional field study was to determine the prevalence of EDEC in weaned piglets in Germany at pen and farm levels. Results Ninety-nine farms with unknown history of infections with shigatoxin-producing E. coli (STEC) and oedema disease were sampled. On each farm, up to five pens were selected for sampling (n = 481). The piglets in these pens were at an age 1–3 weeks after weaning. Single faecal samples (n = 2405) and boot swabs (n = 479) were collected from the floor. On 50 farms, cotton ropes were additionally used to collect oral fluid samples (n = 185) and rope wash out samples (n = 231) from the selected pens. All samples were analyzed by bacterial culture combined with a duplex PCR for the presence of the corresponding genes stx2e and fedA (major subunit protein of F18 fimbriae). In addition, whole DNA specimens extracted from boot swabs, oral fluid samples, and rope wash out samples were directly examined by duplex PCR for DNA of stx2e and fedA. A pen was classified as positive if at least one of the samples, regardless of the technique, yielded a positive result in the PCR, and farms were considered positive if at least one pen was classified as positive. Overall, genes stx2e and fedA were found simultaneously in 24.9% (95% CI 22.1–29.1%) of sampled pens and in 37.4% (95% CI 27.9–47.7%) of sampled farms. Regardless of the presence of F18-fimbriae, Escherichia coli encoding for Stx2e (STEC-2e) were found in 35.1% (95% CI 31.0–39.1%) of the pens and 53.5% (95% CI 44.4–63.6%) of the farms sampled. Conclusions Escherichia coli strains considered capable to cause oedema disease in swine (EDEC) are highly prevalent in the surveyed pig producing farms in Germany. Due to intermittent shedding of EDEC and a potentially low within-farm prevalence, we recommend a combination of different sampling techniques for EDEC monitoring at pen and farm levels. Further studies are needed to understand which STEC-2e strains really pose the risk of causing severe porcine disease

Follow-up for breast cancer - the patients' view

Background: International and national guidelines (S3 guideline) for the surveillance of post-treatment breast cancer patients recommend a clinical follow-up including routine history and physical examination and regular mammograms. The practice of a clinical follow-up has been often discussed, but has been proven not to be inferior when compared to an intensified follow-up in randomized trials. Patients and Methods: The present manuscript reports the patients' view on the basis of a survey including 2000 patients with a history of breast cancer. Results: A total of 452 patients (22.6%) answered the questionnaire. The median age was 62 years (range 23-85 years). More than 80% of the patients were disease-free at the time of the survey. The need for surveillance was affirmed by the majority of patients (>95%), and one third stated that there was a need for more technical efforts during follow-up. In contrast to the follow-up guidelines, the results of the present survey indicated that most of the regularly scheduled follow-up visits were expanded using extensive laboratory and imaging procedures. Conclusion: This survey shows that the majority of physicians obviously do not accept the present follow-up guidelines. A new surveillance study investigating the efficacy of an intensified surveillance based on the improved possibilities of modern diagnostics and endocrine, immunotherapeutic, chemotherapeutic and interventional treatment options is warranted

HAUSGARTEN: Multidisciplinary investigations at a deep-sea, long-term observatory in the Arctic Ocean

The marine Arctic has played an essential role in the history of our planet over the past 130 million years and contributes considerably to the present functioning of Earth and its life. The global cycles of a variety of materials fundamental to atmospheric conditions and thus to life depend to a signifi cant extent on Arctic marine processes (Aargaard et al., 1999). The past decades have seen remarkable changes in key Arctic variables. The decrease of sea-ice extent and sea-ice thickness in the past decade is statistically signifi - cant (Cavalieri et al., 1997; Parkinson et al., 1999; Walsh and Chapman, 2001; Partington et al., 2003; Johannessen et al., 2004). There have also been large changes in the upper and intermediate layers of the ocean, which have environmental implications. For instance, the deep Greenland Sea has continued its decadal trend towards warmer and saltier conditions, with a corresponding decrease in oxygen content, refl ecting the lack of effective local convection and ventilation (Dickson et al., 1996; Boenisch et al., 1997). Changes in temperature and salinity and associated shifts in nutrient distributions will directly affect the marine biota on multiple scales from communities and populations to individuals, consequently altering food-web structures and ecosystem functioning (Benson and Trites, 2002; Moore, 2003; Schumacher et al., 2003; Wiltshire and Manly, 2004; Perry et al., 2005). Today, we do not know whether the severe alterations in abiotic parameters represent perturbations due to human impacts, natural long-term trends, or new equilibriums (Bengtson et al., 2004). Because Arctic organisms are highly adapted to extreme environmental conditions with strong seasonal forcing, the accelerating rate of recent climate change challenges the resilience of Arctic life (Hassol, 2004). The entire system is likely to be severely affected by changing ice and water conditions, varying primary production and food availability to faunal communities, an increase in contaminants, and possibly increased UV irradiance. The stability of a number of Arctic populations and ecosystems is probably not strong enough to withstand the sum of these factors, which might lead to a collapse of subsystems. To detect and track the impact of large-scale environmental changes in the transition zone between the northern North Atlantic and the central Arctic Ocean, and to determine experimentally the factors controlling deep-sea biodiversity, the German Alfred Wegener Institute for Polar and Marine Research (AWI) established the deepsea, long-term observatory HAUSGARTEN, representing the fi rst, and by now only, open-ocean, long-term station in a polar region

Interannual variability (2000–2013) of mesopelagic and bathypelagic particle fluxes in relation to variable sea ice cover in the eastern Fram Strait

The Fram Strait connects the Atlantic and Arctic Oceans and is a key conduit for sea ice advected southward by the Transpolar Drift and northward inflow of warm Atlantic Waters. Continued sea ice decline and “Atlantification” are expected to influence pelagic–benthic coupling in the Fram Strait and Arctic as a whole. However, interannual variability and the impact of changing ice conditions on deepwater particle fluxes in the Arctic remain poorly characterized. Here, we present long-term sediment trap records (2000–2013) from mesopelagic (200 m) and bathypelagic (2,300 m) depths at two locations (HGIV and HGN) in the Fram Strait subjected to variable ice conditions. Sediment trap catchment areas were estimated and combined with remote sensing data and a high-resolution model to determine the ice cover, chlorophyll concentration, and prevailing stratification regimes. Surface chlorophyll increased between 2000 and 2013, but there was no corresponding increase in POC flux, suggesting a shift in the efficiency of the biological carbon pump. A decrease in particulate biogenic Si flux, %opal, Si:POC, and Si:PIC at mesopelagic depths indicates a shift away from diatom-dominated export as a feasible explanation. Biogenic components accounted for 72% ± 16% of mass flux at 200 m, but were reduced to 34% ± 11% at 2,300 m, substituted by a residual (lithogenic) material. Total mass fluxes of biogenic components, including POC, were higher in the bathypelagic. Biomarkers and ∂13C values suggest both lateral advection and ice-rafted material contribute to benthic carbon input, although constraining their precise contribution remains challenging. The decadal time series was used to describe two end-members of catchment area conditions representing the maximum temperatures of Atlantic inflow water in 2005 at HGIV and high ice coverage and a meltwater stratification regime at HGN in 2007. Despite similar chlorophyll concentrations, bathypelagic POC flux, Si flux, Si:POC, and Si:PIC were higher and POC:PIC was lower in the high-ice/meltwater regime. Our findings suggest that ice concentration and associated meltwater regimes cause higher diatom flux. It is possible this will increase in the future Arctic as meltwater regimes increase, but it is likely to be a transient feature that will disappear when no ice remains

Varicella zoster virus glycoprotein C increases chemokine-mediated leukocyte migration

Varicella zoster virus (VZV) is a highly prevalent human pathogen that establishes latency in neurons of the peripheral nervous system. Primary infection causes varicella whereas reactivation results in zoster, which is often followed by chronic pain in adults. Following infection of epithelial cells in the respiratory tract, VZV spreads within the host by hijacking leukocytes, including T cells, in the tonsils and other regional lymph nodes, and modifying their activity. In spite of its importance in pathogenesis, the mechanism of dissemination remains poorly understood. Here we addressed the influence of VZV on leukocyte migration and found that the purified recombinant soluble ectodomain of VZV glycoprotein C (rSgC) binds chemokines with high affinity. Functional experiments show that VZV rSgC potentiates chemokine activity, enhancing the migration of monocyte and T cell lines and, most importantly, human tonsillar leukocytes at low chemokine concentrations. Binding and potentiation of chemokine activity occurs through the C-terminal part of gC ectodomain, containing predicted immunoglobulin-like domains. The mechanism of action of VZV rSgC requires interaction with the chemokine and signalling through the chemokine receptor. Finally, we show that VZV viral particles enhance chemokine-dependent T cell migration and that gC is partially required for this activity. We propose that VZV gC activity facilitates the recruitment and subsequent infection of leukocytes and thereby enhances VZ

Defective removal of ribonucleotides from DNA promotes systemic autoimmunity

Genome integrity is continuously challenged by the DNA damage that arises during normal cell metabolism. Biallelic mutations in the genes encoding the genome surveillance enzyme ribonuclease H2 (RNase H2) cause Aicardi-Goutières syndrome (AGS), a pediatric disorder that shares features with the autoimmune disease systemic lupus erythematosus (SLE). Here we determined that heterozygous parents of AGS patients exhibit an intermediate autoimmune phenotype and demonstrated a genetic association between rare RNASEH2 sequence variants and SLE. Evaluation of patient cells revealed that SLE- and AGS-associated mutations impair RNase H2 function and result in accumulation of ribonucleotides in genomic DNA. The ensuing chronic low level of DNA damage triggered a DNA damage response characterized by constitutive p53 phosphorylation and senescence. Patient fibroblasts exhibited constitutive upregulation of IFN-stimulated genes and an enhanced type I IFN response to the immunostimulatory nucleic acid polyinosinic:polycytidylic acid and UV light irradiation, linking RNase H2 deficiency to potentiation of innate immune signaling. Moreover, UV-induced cyclobutane pyrimidine dimer formation was markedly enhanced in ribonucleotide-containing DNA, providing a mechanism for photosensitivity in RNase H2-associated SLE. Collectively, our findings implicate RNase H2 in the pathogenesis of SLE and suggest a role of DNA damage-associated pathways in the initiation of autoimmunity

Dominantly inherited micro-satellite instable cancer - the four Lynch syndromes - an EHTG, PLSD position statement

The recognition of dominantly inherited micro-satellite instable (MSI) cancers caused by pathogenic variants in one of the four mismatch repair (MMR) genes MSH2, MLH1, MSH6 and PMS2 has modified our understanding of carcinogenesis. Inherited loss of function variants in each of these MMR genes cause four dominantly inherited cancer syndromes with different penetrance and expressivities: the four Lynch syndromes. No person has an "average sex "or a pathogenic variant in an "average Lynch syndrome gene" and results that are not stratified by gene and sex will be valid for no one. Carcinogenesis may be a linear process from increased cellular division to localized cancer to metastasis. In addition, in the Lynch syndromes (LS) we now recognize a dynamic balance between two stochastic processes: MSI producing abnormal cells, and the host's adaptive immune system's ability to remove them. The latter may explain why colonoscopy surveillance does not reduce the incidence of colorectal cancer in LS, while it may improve the prognosis. Most early onset colon, endometrial and ovarian cancers in LS are now cured and most cancer related deaths are after subsequent cancers in other organs. Aspirin reduces the incidence of colorectal and other cancers in LS. Immunotherapy increases the host immune system's capability to destroy MSI cancers. Colonoscopy surveillance, aspirin prevention and immunotherapy represent major steps forward in personalized precision medicine to prevent and cure inherited MSI cancer

The Effects of Larval Nutrition on Reproductive Performance in a Food-Limited Adult Environment

It is often assumed that larval food stress reduces lifetime fitness regardless of the conditions subsequently faced by adults. However, according to the environment-matching hypothesis, a plastic developmental response to poor nutrition results in an adult phenotype that is better adapted to restricted food conditions than one having developed in high food conditions. Such a strategy might evolve when current conditions are a reliable predictor of future conditions. To test this hypothesis, we assessed the effects of larval food conditions (low, improving and high food) on reproductive fitness in both low and high food adults environments. Contrary to this hypothesis, we found no evidence that food restriction in larval ladybird beetles produced adults that were better suited to continuing food stress. In fact, reproductive rate was invariably lower in females that were reared at low food, regardless of whether adults were well fed or food stressed. Juveniles that encountered improving conditions during the larval stage compensated for delayed growth by accelerating subsequent growth, and thus showed no evidence of a reduced reproductive rate. However, these same individuals lost more mass during the period of starvation in adults, which indicates that accelerated growth results in an increased risk of starvation during subsequent periods of food stress