Risk of dissemination of relevant phytopathogens of potato with agricultural use of sewage sludge

Klärschlamm stellt einen bedeutsamen Sekundärrohstoffdünger dar, der grundsätzlich für eine Verwendung in der Landwirtschaft geeignet ist. Abhängig von der Herkunft des Klärschlammes, kann dieser mit verschiedenen Tier-, Human- und Pflanzenpathogenen belastet sein. Anhand von Literaturangaben erfolgte eine Bewertung verschiedener Klärschlammbehandlungsverfahren hinsichtlich der Wirkung auf relevante Schadorganismen der Kartoffel und das damit verbundene Risiko der Verbreitung solcher Schadorganismen mit Klärschlamm bei landwirtschaftlicher Verwertung. Entsprechend der vorliegenden Literatur muss davon ausgegangen werden, dass eine vollständige Abtötung widerstandsfähiger Schadorganismen durch übliche Klärschlammbehandlungsverfahren nicht gesichert ist. Dies betrifft vor allem eine mögliche Kontamination mit den in der Richtlinie 2000/29/EG gelisteten Schadorganismen der Kartoffel, vor allem mit Synchytrium endobioticum, dem Erreger des Kartoffelkrebses. Um eine Verbreitung solcher Schadorganismen auszuschließen, sollte auf eine Einleitung risikoreicher Abwässer, z.B. aus der Kartoffelverarbeitung, in kommunale Kläranlagen, bzw. eine Verwendung von Klärschlamm in der Landwirtschaft nach Einleitung risikoreicher Abwässer verzichtet werden. DOI: 10.5073/JfK.2014.12.01, https://doi.org/10.5073/JfK.2014.12.01Sewage sludge is a significant fertilizer that is generally suitable for usage in agriculture. Depending on the origin of the sewage sludge, it can be contaminated with various animal, human or plant pathogens. Based on literature data, current sewage sludge treatments were analyzed regarding their effectiveness on the inactivation of relevant pathogens of potatoes and the associated risk of their dissemination when sewage sludge is used in agriculture. According to the available literature it has to be concluded, that treatments usually applied in Germany will not be sufficient for complete inactivation of robust phytopathogens. This refers mainly to pathogens of po­tato that are listed in Directive 2000/29/EC, especially Synchytrium endobioticum, the agent for potato wart disease. Therefore, risky waste waters, e.g. from potato processing industries, should not be introduced in municipal waste waters or sewage sludge produced from such risky waste water should not be used in agriculture, to avoid the possible dissemination of such phytopathogens. DOI: 10.5073/JfK.2014.12.01, https://doi.org/10.5073/JfK.2014.12.0

Image quality and radiation dose comparison of prospectively triggered low-dose CCTA: 128-slice dual-source high-pitch spiral versus 64-slice single-source sequential acquisition

Currently 64-multislice computed tomography (MSCT) scanners are the most widely used devices allowing low radiation dose coronary CT angiography (CCTA) with prospective ECG triggering. Latest 128-slice dual-source CT (DSCT) scanners offer prospective high-pitch spiral acquisition covering the heart during one single beat. We compared radiation dose and image quality from prospective 64-MSCT versus high-pitch spiral 128-slice DSCT scanning, as such data is lacking. CCTA of 50 consecutive patients undergoing 128-DSCT (2×64×0.6mm collimation, 0.28s rotation time, 3.4 pitch, 100-120kV tube voltage and 320mAs tube current-time product) were compared to CCTA of 50 heart rate (HR) and BMI matched patients undergoing 64-MSCT (64×0.625mm collimation, 0.35s rotation time, 100-120kV tube voltage and 400-650mA tube current). Image quality was rated on a 4-point scale by two independent cardiac imaging physicians (1=excellent to 4=non-diagnostic). Of 710 coronary segments assessed on 128-DSCT, 216 (30.4%) achieved an image quality score 1 excellent, 400 (56.3%) score 2, 76 (10.7%) score 3 and 18 (2.6%) score 4 (non-diagnostic). Of 737 coronary segments evaluated on 64-MSCT 271 (36.8%) had an image quality score of 1, 327 (44.4%) 2, 110 (14.9%) score 3, and 29 (3.9%) segments score 4. Average image quality score for both scanners was similar (P=0.641). The mean heart rate during scanning was 58.7±5.6bpm on 128-DSCT and 59.0±5.6bpm on 64-MSCT, respectively. Mean effective radiation dose was 1.0±0.2mSv for 128-DSCT and 1.7±0.6mSv for 64-MSCT (P<0.001). 128-DSCT with high-pitch spiral mode allows CCTA acquisition with reduced radiation dose at maintained image quality compared to 64-MSC

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection

Eine perioperative thorakale Periduralanalgesie mit Lokalanästhetika und Opiaten führt nach kolorektalen Eingriffen im Vergleich zu einer patientenkontrollierten Analgesie mit Opioiden zu einer effizienteren Analgesiekontrolle. Durch den Einsatz periduraler Lokalanästhetika nach konventionellen kolorektalen Resektionen wird durch eine Sympathikolyse der viszeralen Efferenzen eine Verkürzung der postoperativen gastrointestinalen Atoniedauer erreicht . Minimal- invasive kolorektale Resektionen zeigen im Vergleich zur konventionellen Operationstechnik eine schnellere Rekonvaleszenz und reduzieren ebenso die gastrointestinale Atoniedauer. Zum Einfluss der Periduralanalgesie bei laparoskopischen kolorektalen Resektionen auf die frühe postoperative Phase lagen bisher nur Daten aus nicht- kontrollierten Studien vor. In der Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité Campus Mitte, wurde in einer kontrollierten randomisierten Studie untersucht, ob durch den Einsatz einer perioperativen kontinuierlichen Periduralanalgesie mit Lokalanästhetika eine Verkürzung der postoperativen gastrointestinalen Atoniedauer nach laparoskopischen Sigmaresektionen erreicht werden kann. 20 Patienten konnten unter Beachtung der Ein- und Ausschlusskriterien in die Studie aufgenommen werden und wurden entweder in die Gruppe mit Periduralanalgesie (Gruppe A n= 10) oder ohne Periduralanalgesie (Gruppe B n= 10) randomisiert. Die beiden Gruppen wiesen hinsichtlich des Alters, Geschlechtes, ASA– Klassifikation und Body- Mass- Index keine Unterschiede auf. In der Gruppe mit Periduralanalgesie war am Operationstag und vom 1. bis 2- postoperativen Tag der Morphinverbrauch im Median niedriger. Dieser lag in Gruppe A bei 12,37 mg/kg/KG (3,61-20,11), in Gruppe B bei 20,17 mg/kg/KG (5,19-46,55) (p= 0,21). Eine Signifikanz lag nicht vor. Die Analgesiequalität gemessen mit dem visuellen Analogscore in Ruhe und während des Hustens war jedoch in beiden Gruppen vergleichbar. Die Ergebnisse der Datenanalyse zeigten eine Verkürzung des Intervalls vom Operationsende bis zum ersten Flatus für die Gruppe mit Periduralanalgesie, das im Median bei 30 Stunden (Range: 18- 41 Stunden) lag im Vergleich zur Kontrollgruppe mit 46,5 Stunden (Range 29- 80 Stunden). Das Zeitintervall zum ersten Stuhlgang lag bei den Patienten mit Periduralanalgesie im Median bei 54 Stunden (Range: 32- 127 Stunden) im Vergleich zu 77 Stunden (Range: 31-99 Stunden) in der Kontrollgruppe. Eine Verkürzung der postoperativen gastrointestinalen Atoniedauer durch eine Periduralanalgesie konnte somit nicht bestätigt werden. Innerhalb von 3 Tagen wurde bei den Patienten ein Kostaufbau mit einer Schonkost erreicht (Gruppe mit Periduralanalgesie: nach median 48 Stunden (Range: 40-64 Stunden) und in der Kontrollgruppe nach median 56 Stunden (Range: 48-64 Stunden). Somit führte der zusätzliche Aufwand einer perioperativen thorakalen Periduralanalgesie bei der laparoskopischen Sigmaresektionen zu keinen wesentlichen klinisch relevanten Vorteilen. Der Einfluss der Periduralanalgesie auf die postoperative gastrointestinale Atoniedauer bei laparoskopischen Kolonresektionen sollte weiterhin in randomisierten, kontrollierten Studien untersucht werden.A perioperative thoracic epidural analgesia with local anaesthetics and opioids after colorectal surgery leads in comparison with a patient- controlled analgesia (PCA) with opioids to a more efficient pain control. Several randomised studies have shown that epidural local anaesthetics reduce the duration of postoperative ileus after conventional abdominal surgery by blocking nociceptive afferent nerves and by blocking thoracolumbar sympathetic efferent nerves. Laparoscopic compared with conventional colorectal resections shorten the duration of postoperative ileus and thus accelerate recovery. At the department of General, Visceral, Vascular and Thoracic Surgery, Humboldt University of Berlin, Charité Campus Mitte was carried out this randomised clinical trial to evaluate whether perioperative epidural analgesia with the local anaesthetic Ropivacain had any effect on the duration of postoperative ileus after laparoscopic sigmoid resection. Twenty patients were randomised to surgery either with (group A; n=10) or without thoracic epidural analgesia (group B n=10). The major endpoint of the study was the time to the first postoperative bowel movement. Secondary endpoints war the interval until oral feeding was tolerated, incidence of postoperative vomiting, postoperative analgesic consumption use of patient- controlled analgesia until the fourth day after operation, subjective pain perception and the incidence of epidural- related side- effects. Age, sex and American Society of Anesthesiologists classification were similar in the two groups. The first bowel movement was documented after a median of 54 (95 per cent confidence interval 32- 127) h in group 1 and 77 (31- 99) h in group 2 (p=0,8). A reduction of postoperative ileus could not be proofed by the use of epidural analgesia. Oral feeding without additional parenteral therapy was tolerated in between 3 days in both groups without any significant difference. Postoperative vomiting occurred in two patients from each group. During epidural therapiy the cumulative dosage of patient- controlled analgesia with morphine from postoperative day 1 till 2 was lower in group A with 12,37 mg/kg/KG (3,61-20,11) in comparison to group B with 20,17 mg/kg/KG (5,19-46,55) group A with 12,37 mg/kg/KG (3,61-20,11) in comparison to group B with 20,17 mg/kg/KG (5,19-46,55) (p=0,21). But no statistical difference had been shown. Postoperative pain perception during rest and while coughing was similar in both groups. Three patients experienced reversible side effects of epidural therapy. The additional effort of a perioperative thoracic epidural analgesia with the local anaesthetic Ropivacain did not have a clinical relevant effect on the duration of postoperative ileus after sigmoid resection. Further investigations should be undertaken to evaluate this issue

A Specific Pattern of Routine Cerebrospinal Fluid Parameters Might Help to Identify Cases of West Nile Virus Neuroinvasive Disease

Background: Viral meningitis/encephalitis (ME) is a rare but potentially harmful disease. The prompt identification of the respective virus is important to guide not only treatment but also potential public health countermeasures. However, in about 40% of cases, no virus is identified despite an extensive diagnostic workup. The aim of the present study was to analyze demographic, seasonal, and routine cerebrospinal fluid (CSF) parameters in cases of viral ME and assess their utility for the prediction of the causative virus. Methods: Demographic data, season, and routine CSF parameters (total leucocytes, CSF cell differentiation, age-adjusted CSF/serum albumin ratio, and total immunoglobulin ratios) were retrospectively assessed in cases of viral ME. Results: In total, 156 cases of acute viral ME (74 female, median age 40.0 years) were treated at a tertiary-care hospital in Germany. Specific viral infections were detected in 93 (59.6%) cases. Of these, 14 (9.0%) cases were caused by herpes simplex virus (HSV), 36 (23.1%) by varicella-zoster virus (VZV), 27 (17.3%) by enteroviruses, 9 (5.8%) by West Nile virus (WNV), and 7 (4.5%) by other specific viruses. Additionally, 64 (41.0%) cases of ME of unknown viral etiology were diagnosed. Cases of WNV ME were older, predominantly male, showed a severe disruption of the blood–CSF–barrier, a high proportion of neutrophils in CSF, and an intrathecal total immunoglobulin M synthesis in the first CSF sample. In a multinominal logistic regression analysis, the accuracy of these CSF parameters together with age and seasonality was best for the prediction of WNV (87.5%), followed by unknown viral etiology (66.7%), VZV (61.8%), and enteroviruses (51.9%). Conclusions: Cases with WNV ME showed a specific pattern of routine CSF parameters and demographic data that allowed for their identification with good accuracy. These findings might help to guide the diagnostic workup in cases with viral ME, in particular allowing the timely identification of cases with ME due to WNV

Image quality and radiation dose comparison of prospectively triggered low-dose CCTA: 128-slice dual-source high-pitch spiral versus 64-slice single-source sequential acquisition

Currently 64-multislice computed tomography (MSCT) scanners are the most widely used devices allowing low radiation dose coronary CT angiography (CCTA) with prospective ECG triggering. Latest 128-slice dual-source CT (DSCT) scanners offer prospective high-pitch spiral acquisition covering the heart during one single beat. We compared radiation dose and image quality from prospective 64-MSCT versus high-pitch spiral 128-slice DSCT scanning, as such data is lacking. CCTA of 50 consecutive patients undergoing 128-DSCT (2 × 64 × 0.6 mm collimation, 0.28 s rotation time, 3.4 pitch, 100-120 kV tube voltage and 320 mAs tube current-time product) were compared to CCTA of 50 heart rate (HR) and BMI matched patients undergoing 64-MSCT (64 × 0.625 mm collimation, 0.35 s rotation time, 100-120 kV tube voltage and 400-650 mA tube current). Image quality was rated on a 4-point scale by two independent cardiac imaging physicians (1 = excellent to 4 = non-diagnostic). Of 710 coronary segments assessed on 128-DSCT, 216 (30.4%) achieved an image quality score 1 excellent, 400 (56.3%) score 2, 76 (10.7%) score 3 and 18 (2.6%) score 4 (non-diagnostic). Of 737 coronary segments evaluated on 64-MSCT 271 (36.8%) had an image quality score of 1, 327 (44.4%) 2, 110 (14.9%) score 3, and 29 (3.9%) segments score 4. Average image quality score for both scanners was similar (P = 0.641). The mean heart rate during scanning was 58.7 ± 5.6 bpm on 128-DSCT and 59.0 ± 5.6 bpm on 64-MSCT, respectively. Mean effective radiation dose was 1.0 ± 0.2 mSv for 128-DSCT and 1.7 ± 0.6 mSv for 64-MSCT (P < 0.001). 128-DSCT with high-pitch spiral mode allows CCTA acquisition with reduced radiation dose at maintained image quality compared to 64-MSCT