Effectiveness of a procalcitonin algorithm to guide antibiotic therapy in respiratory tract infections outside of study conditions: a post-study survey

All published evidence on procalcitonin (PCT)-guided antibiotic therapy was obtained in trials where physicians knew that they were being monitored, possibly resulting in higher adherence to the PCT algorithm. This study investigates the effectiveness of PCT guidance in an observational quality control survey. We monitored antibiotic therapy and algorithm adherence in consecutive patients with respiratory tract infections admitted to the Kantonsspital Aarau, Switzerland, between May 2008 and February 2009. The results were compared to the site-specific results of the former ProHOSP study. Overall and more pronounced for patients with community-acquired pneumonia, the median duration of antibiotic treatment in this survey was shorter than the ProHOSP control patients (6 vs. 7days, P = 0.048 and 7 vs. 9days, P < 0.001). In 72.5% of patients, antibiotics were administered according to the prespecified PCT algorithm. No significant differences concerning adverse medical outcome could be detected. This study mirrors the use of PCT-guided antibiotic therapy in clinical practice, outside of trial conditions. If algorithm adherence is reinforced, antibiotic exposure can be markedly reduced with subsequent reduction of antibiotic-associated side effects and antibiotic resistance. The integration of the PCT algorithm into daily practice requires ongoing reinforcement and involves a learning process of the prescribing physician

THE PREVALENCE OF PALPABLE FINGER JOINT NODULES IN DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH). A CONTROLLED STUDY

The presence of clinically palpable finger joint nodules a(Heberden's and Bouchard's nodes) was documented in 123 consecutive cases with diffuse idiopathic skeletal hyperostosis (DISH) of the thoracic spine and 191 matched DISH negative controls. The prevalence of palpable finger joint nodules was almost twice as frequent in cases with spinal DISH compared to controls (46% versus 31%, X2 = 7.67, P<0.01; multivariate adjusted odds ratio OR = 1.84; 95% CI: 1.14-2.98). This increase was most marked at the proximal interphalangeal joint, in males and in patients up to the age of 65 years. In addition and independent of other variables such as hyperostotic features, age and sex, the prevalence of palpable finger joint nodules was about twice as high in probands with a history of physically heavy work compared to those without (43% ver sus 26%, X = 9.18, P<0.005; multivariate adjusted odds ratio OR = 2.10; 95% CI: 1.26-3.52). From these results we con clude that DISH should be considered as an independent risk factor in the development of finger joint nodule

Two-point function of strangeness-carrying vector-currents in two-loop Chiral Perturbation Theory

We calculate the correlator between two external vector-currents having the quantum-numbers of a charged kaon. We give the renormalized expression to two loops in standard chiral perturbation theory in the isospin limit, which, as a physical result, is finite and scale-independent. Applications include a low energy theorem, valid at two loop order, of a flavor breaking combination of vector current correlators as well as a determination of the phenomenologically relevant finite $O(p^6)$-counterterm combination $Q_V$ by means of inverse moment finite energy sum rules. This determination is less sensitive to isospin-breaking effects than previous attempts.Comment: 24 pages, revtex, 4 figures, 2 tables, revised version, one ref. adde

Virtual Compton Scattering off the Pseudoscalar Meson Octet

We present a calculation of the virtual Compton scattering amplitude for the pseudoscalar meson octet in the framework of chiral perturbation theory at ${\cal O}(p^4)$. We calculate the electromagnetic generalized polarizabilities and compare the results in the real Compton scattering limit to available experimental values. Finally, we give predictions for the differential cross section of electron-meson bremsstrahlung.Comment: 9 pages, Latex, uses cjp3.sty (included), 4 eps figures, to be published in the proceedings of the 13th Indian-Summer School "Understanding the Structure of Hadrons," August 28 - September 1, 2000, Prague, Czech Republi

DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH) OF THE SHOULDER: A CAUSE OF SHOULDER PAIN?

Shoulder pain is a common complaint and shoulder hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the clinical relevance of shoulder hyperostosis we performed a controlled, blind study of 99 hospitalized probands with and without thoracospinal hyperostosis on lateral chest X-rays. The study included grading of the shoulder hyperostosis on the basis of three bilateral standard radiographs, assessing shoulder pain in a standardized way by an interviewer and recording extraskeletal causes of shoulder pain. The prevalence of shoulder hyperostosis was doubled in probands with thoracospinal hyperostosis compared to controls (X2= 5.90, F>0.025, n = 99). Shoulder hyperostosis, irrespective of thoracospinal hyperostosis, predisposed to shoulder pain (40% versus 18%, x2 = 4.06, F>0.05, n = 74). Shoulder hyperostosis in combination with thoracospinal hyperostosis (shoulder DISH) predisposed to shoulder pain to an even greater extent (46% versus 12%, x2 = 6.64, P>0.01, n = 47). We conclude that shoulder hyperostosis is a radiological finding of potential clinical relevanc

The periodicity of phytoplankton in Lake Constance (Bodensee) in comparison to other deep lakes of central Europe

Phytoplankton periodicity has been fairly regular during the years 1979 to 1982 in Lake Constance. Algal mass growth starts with the vernal onset of stratification; Cryptophyceae and small centric diatoms are the dominant algae of the spring bloom. In June grazing by zooplankton leads to a lsquoclear-water phasersquo dominated by Cryptophyceae. Algal summer growth starts under nutrient-saturated conditions with a dominance of Cryptomonas spp. and Pandorina morum. Depletion of soluble reactive phosphorus is followed by a dominance of pennate and filamentous centric diatoms, which are replaced by Ceratium hirundinella when dissolved silicate becomes depleted. Under calm conditions there is a diverse late-summer plankton dominated by Cyanophyceae and Dinobryon spp.; more turbulent conditions and silicon resupply enable a second summer diatom growth phase in August. The autumnal development leads from a Mougeotia — desmid assemblage to a diatom plankton in late autumn and winter. Inter-lake comparison of algal seasonality includes in ascending order of P-richness Königsee, Attersee, Walensee, Lake Lucerne, Lago Maggiore, Ammersee, Lake Zürich, Lake Geneva, Lake Constance. The oligotrophic lakes have one or two annual maxima of biomass; after the vernal maximum there is a slowly developing summer depression and sometimes a second maximum in autumn. The more eutrophic lakes have an additional maximum in summer. The number of floristically determined successional stages increases with increasing eutrophy, from three in Königsee and Attersee to eight in Lake Geneva and Lake Constance

Inheritance of porcine receptors for enterotoxigenic Escherichia coli with fimbriae F4ad and their relation to other F4 receptors

Enteric Escherichia coli infections are a highly relevant cause of disease and death in young pigs. Breeding genetically resistant pigs is an economical and sustainable method of prevention. Resistant pigs are protected against colonization of the intestine through the absence of receptors for the bacterial fimbriae, which mediate adhesion to the intestinal surface. The present work aimed at elucidation of the mode of inheritance of the F4ad receptor which according to former investigations appeared quite confusing. Intestines of 489 pigs of an experimental herd were examined by a microscopic adhesion test modified in such a manner that four small intestinal sites instead of one were tested for adhesion of the fimbrial variant F4ad. Segregation analysis revealed that the mixed inheritance model explained our data best. The heritability of the F4ad phenotype was estimated to be 0.7±0.1. There are no relations to the strong receptors for variants F4ab and F4ac. Targeted matings allowed the discrimination between two F4ad receptors, that is, a fully adhesive receptor (F4adRFA) expressed on all enterocytes and at all small intestinal sites, and a partially adhesive receptor (F4adRPA) variably expressed at different sites and often leading to partial bacterial adhesion. In pigs with both F4ad receptors, the F4adRPA receptor is masked by the F4adRFA. The hypothesis that F4adRFA must be encoded by at least two complementary or epistatic dominant genes is supported by the Hardy-Weinberg equilibrium statistics. The F4adRPA receptor is inherited as a monogenetic dominant trait. A comparable partially adhesive receptor for variant F4ab (F4abRPA) was also observed but the limited data did not allow a prediction of the mode of inheritance. Pigs were therefore classified into one of eight receptor phenotypes: A1 (F4abRFA/F4acR+/F4adRFA); A2 (F4abRFA/F4acR+/F4adRPA); B (F4abRFA/F4acR+/F4adR−); C1 (F4abRPA/F4acR−/F4adRFA); C2 (F4abRPA/F4acR−/F4adRPA); D1 (F4abR−/F4acR−/F4adRFA); D2 (F4abR−/F4acR−/F4adRPA); E (F4abR−/F4acR−/F4adR−