Non-operative management of a splenic laceration in a patient with the Proteus syndrome

An adult patient with the Proteus syndrome sustained a grade III splenic laceration after falling off a horse. Clinical features of this rare disorder include subcutaneous and visceral hamartomatous tumours. The patient also suffered from chronic intravascular coagulation associated with extensive haemangiomatosis (Kasabach-Merritt syndrome). Considering the visceral anomalies and abnormal coagulation, a non-operative approach was preferred despite considerable transfusion requirement, and the patient successfully underwent embolisation of the splenic artery. This is the first reported case of splenic injury in a patient with Proteus syndrome

Coregulation of the cyclic lipopeptides orfamide and sessilin in the biocontrol strain Pseudomonas sp. CMR12a

Cyclic lipopeptides (CLPs) are synthesized by nonribosomal peptide synthetases (NRPS), which are often flanked by LuxR-type transcriptional regulators. Pseudomonas sp. CMR12a, an effective biocontrol strain, produces two different classes of CLPs namely sessilins and orfamides. The orfamide biosynthesis gene cluster is flanked up- and downstream by LuxR-type regulatory genes designated ofaR1 and ofaR2, respectively, whereas the sessilin biosynthesis gene cluster has one LuxR-type regulatory gene which is situated upstream of the cluster and is designated sesR. Our study investigated the role of these three regulators in the biosynthesis of orfamides and sessilins. Phylogenetic analyses positioned OfaR1 and OfaR2 with LuxR regulatory proteins of similar orfamide-producing Pseudomonas strains and the SesR with that of the tolaasin producer, Pseudomonas tolaasii. LC-ESI-MS analyses revealed that sessilins and orfamides are coproduced and that production starts in the late exponential phase. However, sessilins are secreted earlier and in large amounts, while orfamides are predominantly retained in the cell. Deletion mutants in ofaR1 and ofaR2 lost the capacity to produce both orfamides and sessilins, whereas the sesR mutant showed no clear phenotype. Additionally, RT-PCR analysis showed that in the sessilin cluster, a mutation in either ofaR1 or ofaR2 led to weaker transcripts of the biosynthesis genes, sesABC, and putative transporter genes, macA1B1. In the orfamide cluster, mainly the biosynthesis genes ofaBC were affected, while the first biosynthesis gene ofaA and putative macA2B2 transport genes were still transcribed. A mutation in either ofaR1, ofaR2, or sesR genes did not abolish the transcription of any of the other two

Experimental and numerical analysis of deformation patterns in notched heterogeneous welds

Standardized weld flaw assessment techniques assume the weld region to be homogeneous which is a strong idealisation of reality. Characterising the effects of heterogeneous properties of welds through the analysis of deformation patterns and slip lines is the major concern of this research. It is the goal to investigate which effects these variations in properties within the weld material have on the propagation of cracks within the weld material. Performed experiments are SENT tests on strongly heterogeneous welded connections. The same material is also simulated with a weld heterogenisation model in ABAQUS®. Results from both experiments and simulations are discussed and compared. It is shown that slip lines tend to avoid zones of high hardness in a way that a path of least resistance is found. Related to this, it is seen that the slip line angles deviate from the theoretical 45° for homogeneous material. Obtained results validate the numerical model used

High natural killer cell number might identify stroke patients at risk of developing infections

Objective: To investigate early changes in leukocyte subsets and autonomic function as predictors of the development of poststroke infections. Methods: We assessed the time course of leukocyte subsets in the blood of 59 patients with acute ischemic stroke. We divided the patients into 2 groups: those who developed infections during the first 7 days after stroke onset and those who did not. We measured urinary norepinephrine and epinephrine concentrations and pulse rate variability indices within 24 hours of admission. Results: We found that the number of circulating natural killer (NK) cells within the first hours after stroke was higher in stroke patients who developed infections (mean 435 cells/mL; 95% confidence interval [CI] 321-588) than in stroke patients who did not develop infections (mean 236 cells/mL; 95% CI 186-300; p = 0.001). This was followed by a decrease in all lymphocyte subsets from admission to day 1, varying between 22% and 40%, which was not seen in patients without poststroke infection (mean increase varied between 2% and 23%; all p <0.005). In the group that developed infections, pulse rate variability revealed a decreased high frequency component. These findings all remained significant after adjustment for age and stroke volume. Conclusions: High circulating NK cell count within the first hours after ischemic stroke onset followed by a drop in all lymphocyte subsets identified patients who developed infections and may be caused by a sympathovagal imbalance with sympathetic overweight. These findings need to be validated in larger studies

Clinical controversies in abdominal sepsis : insights for critical care settings

International audienc

Direct intra-abdominal pressure monitoring via piezoresistive pressure measurement: a technical note

<p>Abstract</p> <p>Background</p> <p>Piezoresistive pressure measurement technique (PRM) has previously been applied for direct IAP measurement in a porcine model using two different devices. Aim of this clinical study was to assess both devices regarding complications, reliability and agreement with IVP in patients undergoing elective abdominal surgery.</p> <p>Methods</p> <p>A prospective cohort study was performed in 20 patients randomly scheduled to receive PRM either by a Coach^®-probe or an Accurate++^®-probe (both MIPM, Mammendorf, Germany). Probes were placed on the greater omentum and passed through the abdominal wall paralleling routine drainages. PRM was compared with IVP measurement by t-testing and by calculating mean difference as well as limits of agreement (LA).</p> <p>Results</p> <p>There were no probe related complications. Due to technical limitations, data could be collected in 3/10 patients with Coach^®and in 7/10 patients with Accurate++^®. Analysis was carried out only for Accurate++^®. Mean values did not differ to mean IVP values. Mean difference to IVP was 0.1 ± 2.8 mmHg (LA: -5.5 to 5.6 mmHg).</p> <p>Conclusion</p> <p>Direct IAP measurement was clinically uneventful. Although results of Accurate++^®were comparable to IVP, the device might be too fragile for IAP measurements in the clinical setting. Local ethical committee trial registration: EK2024</p

Migration of culture-expanded human mesenchymal stem cells through bone marrow endothelium is regulated by matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-3

Background and Objectives Mesenchymal stem cells (MSC) are adult stem cells that can be expanded many fold in vitro and have the therapeutic potential to restore the bone marrow microenvironment and support hematopoietic recovery after myeloablative conditioning for hematopoietic stem cell transplantation. Successful homing to the target tissue, such as bone marrow, implies that MSC are able to extravasate after systemic administration. However, the extravasation capacity of MSC and the underlying mechanisms are poorly understood to date. We studied in vitro the capacity of MSC to migrate through bone marrow endothelium.Design and Methods In vitro invasion and transendothelial migration assays were performed. The expression of matrix metalloproteinase (MMP) was analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) and zymography. Migration of cells cultured at high or low confluence was compared and differential gene expression in these conditions was analyzed with microarray and real-time RT-PCR. The functional involvement in MSC migration was assessed using neutralizing anti-MMP-2 antibody, MMP-2 short interfering RNA or recombinant tissue inhibitor of metalloproteinase (TIMP-3).Results We demonstrated that MSC can invade reconstituted basement membrane and that bone marrow endothelial cells stimulate this process. We also showed that the transendothelial migration of MSC is at least partially regulated by MMP-2. High culture confluence was found to increase production of the natural MMP-inhibitor TIMP-3 and decrease transendothelial migration of MSC.Interpretation and Conclusions We show that MSC have the potential to migrate through bone marrow endothelium and that this process involves MMP-2. Moreover, the migration of MSC is significantly influenced by the level of culture confluence. Increased culture confluence impairs migration and is related to an upregulation of TIMP-3. The therapeutic use of MSC would benefit from a selection of culture conditions that allow optimal extravasation of these cells

An international survey of adherence to Surviving Sepsis Campaign Guidelines 2016 regarding fluid resuscitation and vasopressors in the initial management of septic shock

BACKGROUND: Our survey aimed to evaluate adherence to Surviving Sepsis Campaign (SSC) Guidelines 2016 among intensive care practitioners and to identify issues that remain controversial or lack clarity. METHODS: Members of the European Society of Intensive Care Medicine (ESICM) were surveyed using an anonymous web-based survey written by an international group of experts. The primary outcome measure was the rate of adherence to specific recommendations. Secondary outcomes were to describe areas of controversy and lack of data and to associate specific practices with clinician characteristics. RESULTS: Overall 820 questionnaires were completed. The SCC recommendations 2016 most adhered to were the choice of norepinephrine as first-line vasoactive drug (96.5%), vasopressor prescription based on therapeutic goal rather than dose (83.4%), targeting a specific mean arterial blood pressure during vasopressor use (77.9%), monitoring of blood pressure invasively (62.8%) and adding vasopressin or epinephrine as a second vasoactive agent (83.4%). We identified an internal conflict with regards to parallel versus sequential administration of fluids and vasoactive drugs and regional differences in practice that may be related to drug availabilities. CONCLUSION: The use of vasopressors and fluid use in septic shock is largely compliant with current guidelines but several controversies should be addressed in future guideline iterations

Light-driven Pickering interfacial catalysis for the oxidation of alkenes at near-room temperature †

In this study, we have developed an emulsion system combining plasmonic Au-loaded amphiphilic silica nanoparticles (Au/SiO2–C3) and tri(dodecyltrimethylammonium) phosphotungstate ([C12]3[PW12O40]) nanoparticles acting as an on-site photoassisted heater/activator and a catalyst, respectively, at the water/oil interface. The system exhibits a 5-fold increase of activity compared to the thermal reaction for the near-room temperature oxidation of alkenes with H2O2. The nanoparticles show excellent recyclability and structural stability. This study opens an avenue to design multiphase photoreactors for oxidation reactions at mild temperature, with a potential energy saving of 74% compared to that of thermally heated reactors at isoconversion