Hemophagocytic macrophages constitute a major compartment of heme oxygenase expression in sepsis

Schaer DJ, Schaer CA, Schoedon G, Imhof A, Kurrer MO. Hemophagocytic macrophages constitute a major compartment of heme oxygenase expression in sepsis. Objectives: Uncontrolled macrophage activation with hemophagocytosis is a distinctive feature of hemophagocytic syndromes (HPS). We examined whether lympho-histiocytic infiltration of the bone marrow and liver, as well as hemo-/erythrophagocytosis also occurs during sepsis and whether this process could account for the increased production of anti-inflammatory heme-oxygenase (HO-1) products observed during sepsis. Methods: Hemophagocytosis and expression of CD163, HO-1, ferritin as well as CD8 and granzyme-B were examined in post-mortem bone marrow samples from 28 patients with sepsis and from eight control patients. Results: Comparison of samples from non-septic patients with samples from patients with fatal sepsis revealed that the latter group displayed dense lympho-histiocytic bone marrow infiltration with CD163(+)/HO-1(+)/ferritin(+) macrophages as well as with CD8(+) and granzyme-B(+) T-cells. Hemophagocytosis with prominent phagocytosis of erythroid cells was readily apparent in septic patients, implying that this process is a likely stimulus for the up-regulation of macrophage HO-1 expression. Conclusions: Lympho-histiocytic activation with hemophagocytosis is a shared pathophysiologic mechanism in HPS and sepsis. Furthermore, the association of hemophagocytosis with an increase in HO-1 expression may indicate a novel role for this apparently futile process as a negative regulator of inflammation

Strategieanalyse des deutschen Naturkostfachhandels

Der deutsche Naturkostfachhandel verzeichnete seit einigen Geschäftsquartalen ein stagnierendes oder rückläufiges Wachstum, während der konventionelle Lebensmitteleinzelhandel seine Rolle als führender Anbieter von ökologischen Lebensmitteln weiter ausbaute. Ziel des vorliegenden Beitrags war es, die aktuelle Strategie des Naturkostfachhandels zu analysieren und Empfehlungen für seine zukünftige Ausrichtung abzuleiten. Dazu wurden 15 qualitative Interviews mit Experten des deutschen Öko-Marktes nach der Delphi-Methode durchgeführt. Die Experten identifizierten vor allem Schwächen des Naturkostfachhandels, eine klare strategische Positionierung fehle aus ihrer Sicht. Anstatt sich auf eine Niedrigpreis zentrierte Politik zu konzentrieren, sollte der Naturkostfachhandel eine Qualitätsstrategie verfolgen, ein originelles, werthaltiges Sortiment anbieten und kompetente und motivierte Mitarbeiter beschäftigen. Insbesondere Themen wie regionale Bezugsquellen müssen stärker in Angriff genommen werden. Zusätzlich müssen die Werte und die praktischen Leistungen des Naturkostfachhandels Öko-Konsumenten wirkungsvoll vermittelt werden, um langfristig wieder stärker vom Wachstum des Öko-Markts profitieren zu können

A liquid sulfur dioxide battery

A liquid sulfur dioxide battery, such as K/KCl SbCl₅ (0.25 molar) + IBr₃ (15 %wt) + SO₂ (1)/carbon matrix is shown to have an open circuit voltage greater than 3.70 volts and an initial voltage of 3.15 volts, decreasing to 2.40 volts in 10 minutes at a current density of 20 ma./sq. cm. at a temperature of 20°C. The anode and cathode are in a parallel arrangement and are separated by a distance of 0.15 cm. thus simulating the actual conditions in a wafer type battery. The battery cell is tested at four temperatures in the range 20°C to -44°C. The performance decreases at the lower temperatures. The individual types of polarization, such as activation, concentration, and IR drop are isolated. Activation polarization is evaluated for the Br°-Br⁻ cathode and the Zn⁰-Zn⁺⁺ anode by the double pulse galvanostatic method. The rate constant, k[subscript s], for the Br⁰-Br⁻ reaction is evaluated to be 0.23 cm./sec. at -20°C. Concentration polarization is mathematically shown to be very small at the current densities studied (less than 100 millivolts at 20 ma./sq. cm.). The IR drop in the electrolyte contributes appreciably to the total polarization of the cell. However, the largest single factor in the total polarization of the cell is the corrosion film formed on the anode surface by the reaction of the anode with the liquid sulfur dioxide electrolyte. Oxidizing agents, such as water, anhydrous ferric chloride, and anhydrous antimony pentachloride appear to alleviate this polarization. somewhat. Polarization data are tabulated for the dissolution of zinc, magnesium, calcium, lithium, sodium, and potassium. Data are also tabulated for the reduction of IBr₃ on porous stainless steel, flat stainless steel, and a porous carbon matrix

Ermittlung von derzeitigen und absehbaren Vermarktungsproblemen entlang der Wertschöpfungskette differenziert nach Produktgruppen (Probleme hinsichtlich z.B. Mengen, Preise, Qualitäten, Logistik etc.) Teilbereich: Produktgruppe Rindfleisch

Die Studie zur Ermittlung von derzeitigen und absehbaren Vermarktungsproblemen im Markt für ökologisch erzeugtes Rindfleisch wurde mit der Forschungsmethode einer „mehrstufigen Befragung nach dem Delphi-Prinzip“ bearbeitet. Den Befragungen war eine umfassende Analyse der Veröffentlichungen über den Markt für ökologisch erzeugtes Rindfleisch vorausgegangen. Die Ergebnisse zeigen, dass die Branche sich in einem strukturellen Engpass befindet. Das individualistische Agieren zahlreicher kleiner Akteure stößt im größer werdenden Markt und angesichts zunehmender Komplexität an Grenzen. Es gibt Ansätze von verstärkter Kooperation, die auch mit Erfolg am Markt belohnt werden. Die Darstellung der Probleme im Ergebnisteil hat gezeigt, dass viele Probleme wie uneinheitliche Verbraucheransprache und fehlende Qualifikationen durch die Struktur des Ökomarktes allgemein entstanden sind. Andere Probleme wie Marktrisiken und Richtlinien liegen außerhalb des Einflussbereichs der Marktteilnehmer. Als ein zentrales Ergebnis, das sich wie ein roter Faden durch die Studie zieht, ist der Mangel an Kommunikation innerhalb der Branche und damit verbunden eine genereller Informationsmangel. Die vorgeschlagene Lösung, die als Schlüssel für einige angesprochene Schwierigkeiten gelten kann, ist der horizontale und vertikale Zusammenschluss von Partnern mit ähnlichen Interessen. Ein weiteres zentrales Problem könnte mit dem Begriff „Rechtsunsicherheit“ umrissen werden. Die Marktteilnehmer fühlen sich angesichts der Mängel der so genannten „EU-Öko-Verordnung“ (abweichende Produktions- und Kontrollstandards innerhalb benachbarter Märkte) stark verunsichert. Die Schwächen des bestehenden Kontrollsystems, das als zu schwerfällig, als zu ineffizient, als zu uneinheitlich innerhalb Europas aber auch innerhalb Deutschlands betrachtet wird, verstärken diese Unsicherheit

Predictors for early mortality and arrhythmic events in patients with cardiac resynchronization therapy with defibrillator: A two center cohort study

Background: Guidelines of heart failure therapy include cardiac resynchronization as standard ofcare in patients with severely depressed left ventricular function and wide QRS complex. It has beenshown that patients benefit regarding mortality and morbidity. However, early mortality precludes longtermbenefits from the device. The aim of the study was to identify predictors for early occurrence ofboth death and first-ever implantable cardioverter-defibrillator (ICD) therapy using a large combineddatabase of patients with cardiac resynchronization therapy with defibrillator (CRT-D).Methods: From two registries (tertiary care centers) 904 patients were identified, no single patient wasexcluded. Early death was defined as death occurring within the 3 years after implantation whereasearly ICD therapy as such occurring within the first year. 33 baseline parameters were compared usinguni- and multivariate analysis with the Cox model and binary logistic regression.Results: The population was predominantly male (77%), with mean age of 63 ± 11 years and primaryprevention indication in 80%. Mean follow-up was 55 ± 38 months. 256 (28%) patients hadICD therapies whereof the first-ever event occurred early in 52%. 270 (30%) patients died after 41 ±± 31 months, mostly from advancing heart failure (41%), 141 (52%) patients of them early. Independentpredictors for early ICD therapy were secondary prevention and renal failure. Independent predictors forearly mortality were a history of percutaneous coronary intervention and of peripheral vascular disease.Conclusions: Predictors for early mortality after CRT-D implantation were a history of percutaneouscoronary intervention and peripheral vascular disease, present in only a minority of patients, thus limitingtheir use in clinical practice

Phrenic nerve palsy during ablation of atrial fibrillation using a 28-mm cryoballoon catheter: predictors and prevention

Purpose: The purposes of this study were to determine whether predictors of phrenic nerve palsy (PNP) exist and to test whether a standardized ablation protocol may prevent PNP during cryoballoon (CB) ablation using the 28mm CB. Methods: Three-dimensional (3D) geometry of the pulmonary veins (PV) and their relationship to the superior vena cava (SVC) was analyzed. Phrenic nerve (PN) stimulation was performed during ablation of the right-sided PVs with a 28-mm CB. The freezing cycle was immediately terminated in case of loss of PN capture. Results: Sixty-five patients (age, 58 ± 11years; ejection fraction, 0.59 ± 0.06; left atrial size, 40 ± 5mm) with paroxysmal atrial fibrillation were included. No persistent PNP was observed. Transient PNP occurred in 4 of 65 patients (6%). PN function normalized within 24h in all four patients. A short distance between the right superior PV and the SVC was significantly associated with PNP, but left atrial and 3D PV anatomy were not. Low temperature early during the freezing cycle (<−41°C at 30s) predicted PNP with a sensitivity and a specificity of 100 and 98%, respectively. Conclusion: The anatomical relationship between the right superior PV and the SVC is a preprocedural predictor for the development of transient PNP, and low temperature early during ablation at the right superior PV is a sensitive warning sign of impending PNP. Despite the use of the 28mm CB, transient PNP occurred in 6% of patients undergoing CB ablatio

High-sensitivity cardiac Troponin T delta concentration after repeat pulmonary vein isolation

Introduction: Difference between high-sensitivity cardiac troponin T concentrations (hs-cTnT) before and after ablation procedure (delta concentration) reflects the amount of myocardial injury. The aim of the study was to investigate hs-cTnT prognostic power for predicting atrial fibrillation (AF) recurrence after repeat pulmonary vein isolation (PVI) procedure. Materials and methods: Consecutive patients with paroxysmal AF undergoing repeat PVI using a focal radiofrequency catheter were included in the study. Hs-cTnT was measured before and 18-24 hours after the procedure. Standardized 3, 6 and 12-month follow-up was performed. Cox-regression analysis was used to identify predictors of AF recurrence. Results: A total of 105 patients undergoing repeat PVI were analysed (24% female, median age 61 years). Median (interquartile range) hs-cTnT delta after repeat PVI was 283 (127 - 489) ng/L. After a median follow-up of 12 months, AF recurred in 24 (23%) patients. A weak linear relationship between the total radiofrequency energy delivery time and delta hs-cTnT was observed (Pearson R2 = 0.31, P = 0.030). Delta Hs-cTnT was not identified as a significant long-term predictor of AF recurrence after repeated PVI (P = 0.920). Conclusion: This was the first study evaluating the prognostic power of delta hs-cTnT in predicting AF recurrence after repeat PVI. Delta hs-cTnT does not predict AF recurrence after repeat PVI procedures. Systematic measurement of hs-cTnT after repeat PVI does not add information relevant to outcome

Effective reduction of fluoroscopy duration by using an advanced electroanatomic-mapping system and a standardized procedural protocol for ablation of atrial fibrillation: ‘the unleaded study'

Aims It is recommended to keep exposure to ionizing radiation as low as reasonably achievable. The aim of this study was to determine whether fluoroscopy-free mapping and ablation using a standardized procedural protocol is feasible in patients undergoing pulmonary vein isolation (PVI). Methods and results Sixty consecutive patients were analysed: Thirty consecutive patients undergoing PVI using Carto3 were treated using a standardized procedural fluoroscopy protocol with X-ray being disabled after transseptal puncture (Group 1) and compared with a set of previous 30 consecutive patients undergoing PVI without a specific recommendation regarding the use of fluoroscopy (Group 2). The main outcome measures were the feasibility of fluoroscopy-free mapping and ablation, total fluoroscopy time, total dose area product (DAP), and procedure time. Sixty patients (age 60 ± 10 years, 73% male, ejection fraction 0.55 ± 0.09, left atrium 42 ± 8 mm) were included. In Group 1, total fluoroscopy time was 4.2 (2.6-5.6) min and mapping and ablation during PVI without using fluoroscopy was feasible in 29 of 30 patients (97%). In Group 2, total fluoroscopy time was 9.3 (6.4-13.9) min (P < 0.001). Total DAP was 13.2 (6.2-22.2) Gy*cm2 in Group 1 compared with 17.5 (11.7-29.7) Gy*cm2 in Group 2 (P = 0.036). Total procedure time did not differ between Groups 1 (133 ± 37 min) and 2 (134 ± 37 min, P = 0.884). Conclusion Performing mapping and ablation guided by an electroanatomic-mapping system during PVI without using fluoroscopy after transseptal puncture using a standardized procedural protocol is feasible in almost all patients and is associated with markedly decreased total fluoroscopy duration and DA