Treating critically ill patients with probiotics: Beneficial or dangerous?

Probiotic bacteria are live microorganisms which confer to health benefits of the host. They help to maintain the integrity of the intestinal barrier function by modulating the mucosal and systemic immune response of the host. These bacteria have proven their beneficial effect in several conditions of ulcerative colitis. More recently probiotics/synbiotics have been included in the treatment of critically ill patients. However to date it remains uncertain whether probiotics/synbiotics are beneficial or even dangerous to the clinical outcome of this patient group. This article reviews the current evidence of the use of bacteria in critically ill patients in intensive care settings

Effect of El Niño on the mesosphere/lower thermosphere winds over Collm (51.3°N, 13°E)

Mesosphere/lower thermosphere (MLT) zonal winds measured by a VHF meteor radar at Collm, Germany (51.3°N, 13.0°E) during late winter 2015/2016 show very strong westerly winds above about 90 km, but not below that height. This anomaly appears during a very strong El Niño event. The comparison of Niño3 equatorial sea surface temperature index and the Collm MLT wind time series starting in 2004 shows that in January and especially in February zonal winds are positively correlated with the Niño3 index. The signal is strong for the upper altitudes (above 90 km) accessible to the radar observations, but weakens with decreasing height. This reflects the fact that during El Niño years the westerly winter middle atmosphere wind jet is weaker on an average, and this is also the case with the easterly lower thermospheric jet. The El Niño effect on the meridional wind is weak. The experimental results can be qualitatively reproduced by numerical experiments using the MUAM mechanistic global circulation model with prescribed tropospheric temperatures and latent heat release for El Niño and La Niña conditions.Der Zonalwind in der oberen Mesosphäre/unteren Thermosphäre über Collm (51.3°N, 13.0°E) in der zweiten Hälfte des Winter 2015/2016 weist eine besonders starke westliche Komponente oberhalb von etwa 90 km auf. Diese Anomalie erfolgte während eines sehr starken El Niño-Ereignisses. Der Vergleich von Collmer Zonalwinden seit 2004 und dem Niño3-index zeigt im Januar und besonders Februar eine positive Korrelation. Diese ist stark oberhalb von 90 km, nimmt aber nach unten hin ab. Dies spiegelt die Tatsache wider, dass während El Niño-Jahren im Mittel der stratosphärische/mesosphärische Westwindjet schwächer ist. Dieses Signal kehrt aber in der oberen Mesosphäre um, so dass der thermosphärische Ostwindjet ebenfalls schwächer ist. Der Effekt auf den meridionalen Wind ist schwächer. Die Beobachtungen können mit Modellexperimenten qualitativ reproduziert werden

Taurolidine reduces the tumor stimulating cytokine interleukin-1beta in patients with resectable gastrointestinal cancer: a multicentre prospective randomized trial

Background The effect of additional treatment strategies with antineoplastic agents on intraperitoneal tumor stimulating interleukin levels are unclear. Taurolidine and Povidone-iodine have been mainly used for abdominal lavage in Germany and Europe. Methods In the settings of a multicentre (three University Hospitals) prospective randomized controlled trial 120 patients were randomly allocated to receive either 0.5% taurolidine/2,500 IU heparin (TRD) or 0.25% povidone-iodine (control) intraperitoneally for resectable colorectal, gastric or pancreatic cancers. Due to the fact that IL-1beta (produced by macrophages) is preoperatively indifferent in various gastrointestinal cancer types our major outcome criterion was the perioperative (overall) level of IL-1beta in peritoneal fluid. Results Cytokine values were significantly lower after TRD lavage for IL-1beta, IL-6, and IL-10. Perioperative complications did not differ. The median follow-up was 50.0 months. The overall mortality rate (28 vs. 25, p = 0.36), the cancer-related death rate (17 vs. 19, p = .2), the local recurrence rate (7 vs. 12, p = .16), the distant metastasis rate (13 vs. 18, p = 0.2) as well as the time to relapse were not statistically significant different. Conclusion Reduced cytokine levels might explain a short term antitumorigenic intraperitoneal effect of TRD. But, this study analyzed different types of cancer. Therefore, we set up a multicentre randomized trial in patients undergoing curative colorectal cancer resection. Trial registration : ISRCTN6647853

Modeling the Southern Hemisphere winter circulation using realistic zonal mean gravity wave information in the lower atmosphere

A mechanistic global circulation model is used to simulate the mesospheric and lower thermospheric circulation during austral winter. The model includes a gravity wave (GW) parameterization that is initiated by prescribed GW parameters in the troposphere. In standard configuration, these waves are described by a simple distribution with large amplitudes in the winter hemisphere and small ones in summer. Here we replace this distribution by a more realistic one, which is based on observations of potential GW energy using GPS radio occultations, but which is normalized to the same global mean amplitude. The model experiment shows that this new gravity wave distribution leads to weaker zonal winds in the mesosphere, a downward shift of the meridional poleward mesospheric wind jet, enhanced downwelling in the mid-to-high-latitude winter mesosphere and warming of the polar stratopause.Ein globales mechanistisches Zirkulationsmodell wird verwendet um die Dynamik der Mesosphäre und unteren Thermosphäre im Südwinter zu simulieren. Das Modell beinhaltet eine Schwerewellenparametrisierung die durch eine vorgeschriebene Schwerewellenverteilung in der oberen Troposphäre angetrieben wird. In der Standardkonfiguration besteht diese aus einer einfachen zonal gemittelten Verteilung mit größeren Amplituden im Winter als im Sommer. Wir ersetzen diese Verteilung durch eine realistischere, die auf der beobachteten globalen Verteilung der potentiellen Energie von Schwerewellen basiert und auf die gleiche global gemittelte Amplitude normiert wird. Das Modellexperiment zeigt, dass die neue Schwerewellenverteilung zu schwächeren zonalen Winden in der Mesosphäre, einer Verschiebung des meridionalen Jets nach unten, verstärkten Abwinden in der Mesosphäre mittlerer und höherer Breiten im Winter, und einer Erwärmung der polaren Winterstratopause führt

The influence of NCEP-data assimilated into COMMA-LIM on the 16-day wave

The general circulation model COMMA-LIM solves the primitive equations on a sphere using gridpoints. The relative large interval between adjacent gridpoints (5° × 5.6° latitude versus longitude) causes an incorrect meridional temperature gradient in the coarsly resolved troposphere that leads to too weak winds there, particularly in the lower winter stratosphere above the polar region. By using the technique of nudging 11-year averaged NCEP zonal mean temperature data were assimilated into COMMA-LIM. This means that longitudinal dependent processes as calculated by the model still influence the atmosphere. The nudging method has improved not only the lower atmosphere, but also the middle atmospheric jets show a more realistic behaviour. A numerical experiment by forcing the 16-day wave was carried out in order to investigate the influence of an improved background circulation on the vertical propagation of planetary waves.Das globale Zirkulationsmodell COMMA-LIM berechnet die primitiven Gleichungen auf einem Kugelgitter. Der relativ große Gitterabstand von 5°× 5.6° in Breite und Länge und die grobe vertikale Auflösung führen zu einem inkorrekten meridionalen Temperaturgradienten in der Troposphäre, so dass die troposphärischen Jets und der polare Winterwirbel zu schwach ausgeprägt sind. Mit Hilfe der Methode des Nudging wurden in den unteren 30 km der Atmosphäre 11-Jahres gemittelte NCEP Reanalysedaten des Temperaturfeldes assimiliert. Dabei wurde nur der zonale Mittelwert der berechneten Temperatur an die Reanalysedaten relaxiert, so dass die Antriebsterme, die von COMMA-LIM berechnet werden, erhalten bleiben. Durch diese Methode wurden Wind- und Temperaturfeld sowohl in der Troposphäre als auch in der mittleren Atmosphäre verbessert. Ein Experiment zur Ausbreitung der 16-Tage Welle wurde unter den neuen Bedingungen durchgeführt, und der Einfluß der veränderten Atmosphäre auf die vertikale Wellenausbreitung wurde untersucht

Microbe sampling by mucosal dendritic cells is a discrete, MyD88-independent stepin ΔinvG S. Typhimurium colitis

Intestinal dendritic cells (DCs) are believed to sample and present commensal bacteria to the gut-associated immune system to maintain immune homeostasis. How antigen sampling pathways handle intestinal pathogens remains elusive. We present a murine colitogenic Salmonella infection model that is highly dependent on DCs. Conditional DC depletion experiments revealed that intestinal virulence of S. Typhimurium SL1344 ΔinvG mutant lacking a functional type 3 secretion system-1 (ΔinvG)critically required DCs for invasion across the epithelium. The DC-dependency was limited to the early phase of infection when bacteria colocalized with CD11c+CX3CR1+ mucosal DCs. At later stages, the bacteria became associated with other (CD11c−CX3CR1−) lamina propria cells, DC depletion no longer attenuated the pathology, and a MyD88-dependent mucosal inflammation was initiated. Using bone marrow chimeric mice, we showed that the MyD88 signaling within hematopoietic cells, which are distinct from DCs, was required and sufficient for induction of the colitis. Moreover, MyD88-deficient DCs supported transepithelial uptake of the bacteria and the induction of MyD88-dependent colitis. These results establish that pathogen sampling by DCs is a discrete, and MyD88-independent, step during the initiation of a mucosal innate immune response to bacterial infection in vivo

Retroperitoneal Castleman's tumor and paraneoplastic pemphigus: report of a case and review of the literature

BACKGROUND: Castleman's disease is a rare lymphoproliferative syndrome. Its etiology and pathogenesis are unclear. The disease can be occasionally associated with a paraneoplastic pemphigus (PNP), an autoimmune mucocutaneous disorder commonly seen in neoplasms of lymphocytic origin. CASE PRESENTATION: We present a case of a 63-year old male patient who was referred for surgical treatment of a lately diagnosed retroperitoneal pelvic mass. The patient had been already treated for two years due to progressive diffuse cutaneous lesions histologically consistent with lichen ruber verucosus and pemphigus vulgaris. Intraoperatively a highly vascularized solid mass occupying the small pelvis was resected after meticulous vascular ligation and hemostasis. After surgery and following immunosuppressive treatment a clear remission of the skin lesions was observed. CONCLUSION: Castleman's tumor should be always suspected when a retroperitoneal mass is combined with PNP. In a review of the literature we found 37 additional cases. Complete surgical resection of the tumor can be curative in most of the cases

Noninvasive monitoring of myocardial function after surgical and cytostatic therapy in a peritoneal metastasis rat model: assessment with tissue Doppler and non-Doppler 2D strain echocardiography

<p>Abstract</p> <p>Objective</p> <p>We sought to evaluate the impact of different antineoplastic treatment methods on systolic and diastolic myocardial function, and the feasibility estimation of regional deformation parameters with non-Doppler 2D echocardiography in rats.</p> <p>Background</p> <p>The optimal method for quantitative assessment of global and regional ventricular function in rats and the impact of complex oncological multimodal therapy on left- and right-ventricular function in rats remains unclear.</p> <p>Methods</p> <p>90 rats after subperitoneal implantation of syngenetic colonic carcinoma cells underwent different onclogical treatment methods and were diveded into one control group and five treatment groups (with 15 rats in each group): group 1 = control group (without operation and without medication), group 2 = operation group without additional therapy, group 3 = combination of operation and photodynamic therapy, group 4 = operation in combination with hyperthermic intraoperative peritoneal chemotherapy with mitomycine, and group 5 = operation in combination with hyperthermic intraoperative peritoneal chemotherapy with gemcitabine, group 6 = operation in combination with taurolidin i.p. instillation. Echocardiographic examination with estimation of wall thickness, diameters, left ventricular fractional shortening, ejection fraction, early and late diastolic transmitral and myocardial velocities, radial and circumferential strain were performed 3–4 days after therapy.</p> <p>Results</p> <p>There was an increase of LVEDD and LVESD in all groups after the follow-up period (P = 0.0037). Other LV dimensions, FS and EF as well as diastolic mitral filling parameters measured by echocardiography were not significantly affected by the different treatments. Values for right ventricular dimensions and function remained unchanged, whereas circumferential 2D strain of the inferior wall was slightly, but significantly reduced under the treatment (-18.1 ± 2.5 before and -16.2 ± 2.9 % after treatment; P = 0.001) without differences between the single treatment groups.</p> <p>Conclusion</p> <p>It is feasible to assess dimensions, global function, and regional contractility with echocardiography in rats under different oncological therapy. The deformation was decreased under overall treatment without influence by one specific therapy. Therefore, deformation assessment with non-Doppler 2D strain echocardiography is more sensitive than conventional echocardiography for assessing myocardial dysfunction in rats under oncological treatment.</p

Stratospheric contraction caused by increasing greenhouse gases

Rising emissions of anthropogenic greenhouse gases (GHG) have led to tropospheric warming and stratospheric cooling over recent decades. As a thermodynamic consequence, the troposphere has expanded and the rise of the tropopause, the boundary between the troposphere and stratosphere, has been suggested as one of the most robust fingerprints of anthropogenic climate change. Conversely, at altitudes above ∼55 km (in the mesosphere and thermosphere) observational and modeling evidence indicates a downward shift of the height of pressure levels or decreasing density at fixed altitudes. The layer in between, the stratosphere, has not been studied extensively with respect to changes of its global structure. Here we show that this atmospheric layer has contracted substantially over the last decades, and that the main driver for this are increasing concentrations of GHG. Using data from coupled chemistry-climate models we show that this trend will continue and the mean climatological thickness of the stratosphere will decrease by 1.3 km following representative concentration pathway 6.0 by 2080. We also demonstrate that the stratospheric contraction is not only a response to cooling, as changes in both tropopause and stratopause pressure contribute. Moreover, its short emergence time (less than 15 years) makes it a novel and independent indicator of GHG induced climate change