Sialic Acid in Human Serum and Cerebrospinal Fluid. Comparison of methods and reference values

Peer Reviewe

Complement activated granulocytes can cause autologous tissue destruction in man

Activation of polymorphonuclear granulocytes (PMNs) by C5a is thought to be important in the pathogenesis of multiple organ failure during sepsis and after trauma. In our experiment exposure of human PMNs to autologous zymosan activated plasma (ZAP) leads to a rapid increase in chemiluminescence. Heating the ZAP at 56°C for 30 min did not alter the changes, while untreated plasma induced only baseline activity. The respiratory burst could be completely abolished by decomplementation and preincubation with rabbit antihuman C5a antibodies. Observation of human omentum using electron microscopy showed intravascular aggregation of PMNs, with capillary thrombosis and diapedesis of the cells through endothelial junctions 90 s after exposure to ZAP. PMNs caused disruption of connections between the mesothelial cells. After 4 min the mesothelium was completely destroyed, and connective tissue and fat cells exposed. Native plasma and minimum essential medium did not induce any morphological changes. These data support the concept that C5a activated PMNs can cause endothelial and mesothelial damage in man. Even though a causal relationship between anaphylatoxins and organ failure cannot be proved by these experiments C5a seems to be an important mediator in the pathogenesis of changes induced by severe sepsis and trauma in man

Reprocessing of Instruments for Minimal Invasive Surgery - State of the Art and Prospects

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich.This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.Die Weiterentwicklung des Instrumentariums der minimal-invasiven Chirurgie (MIC) vollzieht sich in Richtung einer Miniaturisierung mechanischer Komponenten, einer Kombination mehrerer Funktionen in einem Gerät und der Einführung neuer Techniken, insbesondere zur blutungsarmen und thermisch schonenden Durchtrennung von Blutgefäßen. Diese Entwicklungstendenzen haben Auswirkungen auf die Aufbereitungsfähigkeit der Geräte. Sie wirken sich in der Regel erschwerend aus. Hierbei stellt insbesondere die Reinigung, also die Entfernung der Anschmutzungen aus kleinen Lumina, filigranen Gelenken, von der Waschflotte schwer erreichbaren Toträumen etc. besonders hohe Anforderungen. Hinzu kommt, daß der Nachweis des Reinigungserfolges schwer zu führen ist und bisher kein in der Routine praktikables, allgemein akzeptiertes Standardnachweisverfahren eingeführt werden konnte. Es werden ein Überblick über die im Zusammenhang mit der Aufbereitung von Instrumenten der MIC auftretenden Problemstellungen gegeben und Lösungsansätze diskutiert.The development of instruments for minimal invasive surgery (MIS) is moving in the direction of the miniaturization of mechanical components, a combination of multiple functions in a single instrument, and the introduction of new techniques, in particular those reducing bleeding and thermal damage when cutting blood vessels. These tendencies have consequences for the reprocessability of the instruments, usually making reprocessing more difficult. In particular cleaning the removal of contaminations from tiny lumina, joints, etc., is highly demanding. In addition, proof of successful cleaning is difficult, and no standardised method of doing this in practice is currently available. An overview of the problems associated with the reprocessing of instruments for minimal invasive surgery is given, and a numbers of possible solutions are discussed

Flood hazard risk forecasting index (FHRFI) for urban areas: the Hurricane Harvey case study

Hurricane Harvey caused at least 70 confirmed deaths, with estimated losses in the Houston urban area of Texas reaching above US$150 billion, making it one of the costliest natural disasters ever in the United States. The study tests two types of forecast index to provide surface flooding (inundation) warning over the Houston area: a meteorological index based on a global numerical weather prediction (NWP) system, and a new combined meteorological and land surface index, the flood hazard risk forecasting index (FHRFI), where land surface is used to condition the meteorological forecast. Both indices use the total precipitation extreme forecast index (EFI) and shift of tails (SoT) products from the European Centre for Medium‐Range Weather Forecasts (ECMWF) medium‐range ensemble forecasting system (ENS). Forecasts at the medium range (3–14 days ahead) were assessed against 153 observed National Weather Service (NWS) urban flood reports over the Houston urban area between August 26 and 29, 2017. It is shown that the method provides skilful forecasts up to four days ahead using both approaches. Moreover, the FHRFI combined index has a hit ratio of up to 74% at 72 hr lead time, with a false‐alarm ratio of only 45%. This amounts to a statistically significant 20% increase in performance compared with the meteorological indices. This first study demonstrates the importance of including land‐surface information to improve the quality of the flood forecasts over meteorological indices only, and that skilful flood warning in urban areas can be obtained from the NWP using the FHRFI

From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance

Background: Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Methods: Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. Conclusion: The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed