Aetiology of community-acquired, acute gastroenteritis in hospitalised adults: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>The aetiology of severe gastroenteritis leading to hospitalisation in adults frequently remains unclear. Our objective was to study the causes and characteristics of community-acquired, acute gastroenteritis in adult hospitalized patients to support the clinical management of these patients.</p> <p>Methods</p> <p>From August 2005 to August 2007, we conducted a prospective cohort study among patients ≥18 y hospitalized with community-acquired gastroenteritis in a university hospital in Berlin, Germany. Stool specimens were examined for 26 gastrointestinal pathogens, supplemented by serologic tests for antibodies to <it>Campylobacter spp.</it>, <it>Yersinia spp.</it>, and <it>Entamoeba histolytica</it>. Patient data on demographics and clinical presentation were recorded and analyzed. Coexisting medical conditions were assessed using the Charlson Comorbidity Index score.</p> <p>Results</p> <p>Of 132 patients presenting with acute community-acquired gastroenteritis, 104 were included in the study. A non-infectious aetiology was diagnosed in 8 patients (8%). In 79 (82%) of the remaining 96 patients at least one microorganism was identified. <it>Campylobacter spp. </it>(35%) was detected most frequently, followed by norovirus (23%), <it>Salmonella spp. </it>(20%), and rotavirus (15%). In 46% of the patients with <it>Campylobacter spp. </it>infection, the diagnosis was made solely by serology. More than one pathogen was found in seventeen (22%) patients. Simultaneous infection was significantly more likely in patients with rotavirus and salmonella infections (RR 3.6; 95% CI: 1.8–7.4; RR 2.5; 95%CI: 1.2–5.5). Length of hospital stay (median: 5.5 days) was independent of the pathogen, but was associated with coexisting medical conditions (OR 4,8; 95%CI:2,0–11,6).</p> <p>Conclusion</p> <p>Known enteric pathogens were detected in 82% of adult patients who were hospitalized with acute gastroenteritis. We found that currently used culture-based methods may miss a substantial proportion of <it>Campylobacter </it>infections, and additional serological testing for <it>Campylobacter </it>should be considered. Viral infections emerged as an important cause of severe gastroenteritis in adults, and viral-bacterial co-infections in adults are probably underrecognized so far. The presence of coexisting medical conditions – but not the etiological agent – was a predictor for the duration of the hospital stay.</p

Radiation enhancement and "temperature" in the collapse regime of gravitational scattering

We generalize the semiclassical treatment of graviton radiation to gravitational scattering at very large energies $\sqrt{s}\gg m_P$ and finite scattering angles $\Theta_s$, so as to approach the collapse regime of impact parameters $b \simeq b_c \sim R\equiv 2G\sqrt{s}$. Our basic tool is the extension of the recently proposed, unified form of radiation to the ACV reduced-action model and to its resummed-eikonal exchange. By superimposing that radiation all-over eikonal scattering, we are able to derive the corresponding (unitary) coherent-state operator. The resulting graviton spectrum, tuned on the gravitational radius $R$, fully agrees with previous calculations for small angles $\Theta_s\ll 1$ but, for sizeable angles $\Theta_s(b)\leq \Theta_c = O(1)$ acquires an exponential cutoff of the large $\omega R$ region, due to energy conservation, so as to emit a finite fraction of the total energy. In the approach-to-collapse regime of $b\to b_c^+$ we find a radiation enhancement due to large tidal forces, so that the whole energy is radiated off, with a large multiplicity $\langle N \rangle\sim Gs \gg 1$ and a well-defined frequency cutoff of order $R^{-1}$. The latter corresponds to the Hawking temperature for a black hole of mass notably smaller than $\sqrt{s}$.Comment: 5 pages, 2 figures, talk presented at the European Physical Society Conference on High Energy Physics, 5-12 July, Venice, Ital

Thermal (n, γ) cross section and resonance integral of 171Tm

Background: About 50% of the heavy elements are produced in stars during the slow neutron capture process. The analysis of branching points allows us to set constraints on the temperature and the neutron density in the interior of stars. Purpose: The temperature dependence of the branch point 171Tm is weak. Hence, the 171Tm neutron capture cross section can be used to constrain the neutron density during the main component of the s process in thermally pulsing asymptotic giant branch (TP-AGB) stars. Methods: A 171Tm sample produced at the ILL was activated with thermal and epithermal neutrons at the TRIGA research reactor at the Johannes Gutenberg-Universität Mainz. Results: The thermal neutron capture cross section and the resonance integral have been measured for the first time to be σth = 9.9 ± 0.9 b and σRI = 193 ± 14 b. Conclusions: Based on our results, new estimations of the direct capture components’ impact on the Maxwellian-nAveraged cross sections (MACS) are possible.European Unions’s Seventh Framework Programme (FP/2007-2013

5,5'-Azoxytetrazolates - a new nitrogen-rich dianion and its comparison to 5,5'-azotetrazolate

A modification of the synthesis of sodium 5,5'-azotetrazolate pentahydrate, described by Thiele in 1898, yields the unknown and unexpected corresponding 5N-oxido derivative sodium 5,5'-azoxybistetrazolate pentahydrate (Na(2)zTO center dot 5H(2)O, 1). Purification was achieved by recrystallization based on the better solubility of Na(2)zTO center dot 5H(2)O in water. Different nitrogen-rich salts, such as the diammonium (3), the dihydroxylammonium (4), the bis-diaminoguanidinium (5), the bis-triaminoguanidinium (6) and the diaminouronium salt (7), have been prepared using metathesis reactions starting from barium 5,5'azoxybistetrazolate pentahydrate (2) and ammonium, hydroxylammonium, diaminoguanidinium or diaminouronium sulfate and triaminoguanidinium chloride, respectively. The nitrogen rich azoxyderivatives 3-7 were characterized using NMR, IR and Raman spectroscopy, mass spectrometry and elemental analysis. Additionally the solid state structures of 3, 4, 5 and 7 were determined by single crystal X-ray diffraction. The heats of formation of 3 and 4 and their corresponding azo-tetrazolate derivatives were calculated by the atomization method based on CBS-4M enthalpies. With these values and the crystal densities, several detonation parameters such as the detonation velocity, detonation pressure and specific impulse were calculated (EXPLO5) and compared. The sensitivities towards shock (BAM drophammer), friction (BAM friction tester) and electrostatic discharge of the described compounds were determined

E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy

Background Posthepatectomy liver failure (PHLF) contributes significantly to morbidity and mortality after liver surgery. Standardized assessment of preoperative liver function is crucial to identify patients at risk. These European consensus guidelines provide guidance for preoperative patient assessment. Methods A modified Delphi approach was used to achieve consensus. The expert panel consisted of hepatobiliary surgeons, radiologists, nuclear medicine specialists, and hepatologists. The guideline process was supervised by a methodologist and reviewed by a patient representative. A systematic literature search was performed in PubMed/MEDLINE, the Cochrane library, and the WHO International Clinical Trials Registry. Evidence assessment and statement development followed Scottish Intercollegiate Guidelines Network methodology. Results Based on 271 publications covering 4 key areas, 21 statements (at least 85 per cent agreement) were produced (median level of evidence 2− to 2+). Only a few systematic reviews (2++) and one RCT (1+) were identified. Preoperative liver function assessment should be considered before complex resections, and in patients with suspected or known underlying liver disease, or chemotherapy-associated or drug-induced liver injury. Clinical assessment and blood-based scores reflecting liver function or portal hypertension (for example albumin/bilirubin, platelet count) aid in identifying risk of PHLF. Volumetry of the future liver remnant represents the foundation for assessment, and can be combined with indocyanine green clearance or LiMAx® according to local expertise and availability. Functional MRI and liver scintigraphy are alternatives, combining FLR volume and function in one examination. Conclusion These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research.publishedVersio

Preventive Antibacterial Therapy in Acute Ischemic Stroke: A Randomized Controlled Trial

BACKGROUND: Pneumonia is a major risk factor of death after acute stroke. In a mouse model, preventive antibacterial therapy with moxifloxacin not only prevents the development of post-stroke infections, it also reduces mortality, and improves neurological outcome significantly. In this study we investigate whether this approach is effective in stroke patients. METHODS: Preventive ANtibacterial THERapy in acute Ischemic Stroke (PANTHERIS) is a randomized, double-blind, placebo-controlled trial in 80 patients with severe, non-lacunar, ischemic stroke (NIHSS>11) in the middle cerebral artery (MCA) territory. Patients received either intravenous moxifloxacin (400 mg daily) or placebo for 5 days starting within 36 hours after stroke onset. Primary endpoint was infection within 11 days. Secondary endpoints included neurological outcome, survival, development of stroke-induced immunodepression, and induction of bacterial resistance. FINDINGS: On intention-to treat analysis (79 patients), the infection rate at day 11 in the moxifloxacin treated group was 15.4% compared to 32.5% in the placebo treated group (p = 0.114). On per protocol analysis (n = 66), moxifloxacin significantly reduced infection rate from 41.9% to 17.1% (p = 0.032). Stroke associated infections were associated with a lower survival rate. In this study, neurological outcome and survival were not significantly influenced by treatment with moxifloxacin. Frequency of fluoroquinolone resistance in both treatment groups did not differ. On logistic regression analysis, treatment arm as well as the interaction between treatment arm and monocytic HLA-DR expression (a marker for immunodepression) at day 1 after stroke onset was independently and highly predictive for post-stroke infections. INTERPRETATION: PANTHERIS suggests that preventive administration of moxifloxacin is superior in reducing infections after severe non-lacunar ischemic stroke compared to placebo. In addition, the results emphasize the pivotal role of immunodepression in developing post-stroke infections. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN74386719

A bio-psycho-social exercise program (RÜCKGEWINN) for chronic low back pain in rehabilitation aftercare - Study protocol for a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>There is strong, internationally confirmed evidence for the short-term effectiveness of multimodal interdisciplinary specific treatment programs for chronic back pain. However, the verification of long-term sustainability of achieved effects is missing so far. For long-term improvement of pain and functional ability high intervention intensity or high volume seems to be necessary (> 100 therapy hours). Especially in chronic back pain rehabilitation, purposefully refined aftercare treatments offer the possibility to intensify positive effects or to increase their sustainability. However, quality assured goal-conscious specific aftercare programs for the rehabilitation of chronic back pain are absent.</p> <p>Methods/Design</p> <p>This study aims to examine the efficacy of a specially developed bio-psycho-social chronic back pain specific aftercare intervention (RÜCKGEWINN) in comparison to the current usual aftercare (IRENA) and a control group that is given an educational booklet addressing pain-conditioned functional ability and back pain episodes. Overall rehabilitation effects as well as predictors for compliance to the aftercare programs are analysed. Therefore, a multicenter prospective 3-armed randomised controlled trial is conducted. 456 participants will be consecutively enrolled in inpatient and outpatient rehabilitation and assigned to either one of the three study arms. Outcomes are measured before and after rehabilitation. Aftercare programs are assessed at ten month follow up after dismissal form rehabilitation.</p> <p>Discussion</p> <p>Special methodological and logistic challenges are to be mastered in this trial, which accrue from the interconnection of aftercare interventions to their residential district and the fact that the proportion of patients who take part in aftercare programs is low. The usability of the aftercare program is based on the transference into the routine care and is also reinforced by developed manuals with structured contents, media and material for organisation assistance as well as training manuals for therapists in the aftercare.</p> <p>Trial Registration</p> <p>Trial Registration number: NCT01070849</p

Les droits disciplinaires des fonctions publiques : « unification », « harmonisation » ou « distanciation ». A propos de la loi du 26 avril 2016 relative à la déontologie et aux droits et obligations des fonctionnaires

The production of tt‾ , W+bb‾ and W+cc‾ is studied in the forward region of proton–proton collisions collected at a centre-of-mass energy of 8 TeV by the LHCb experiment, corresponding to an integrated luminosity of 1.98±0.02 fb−1 . The W bosons are reconstructed in the decays W→ℓν , where ℓ denotes muon or electron, while the b and c quarks are reconstructed as jets. All measured cross-sections are in agreement with next-to-leading-order Standard Model predictions.The production of $t\overline{t}$, $W+b\overline{b}$ and $W+c\overline{c}$ is studied in the forward region of proton-proton collisions collected at a centre-of-mass energy of 8 TeV by the LHCb experiment, corresponding to an integrated luminosity of 1.98 $\pm$ 0.02 \mbox{fb}^{-1}. The $W$ bosons are reconstructed in the decays $W\rightarrow\ell\nu$, where $\ell$ denotes muon or electron, while the $b$ and $c$ quarks are reconstructed as jets. All measured cross-sections are in agreement with next-to-leading-order Standard Model predictions