Paenibacillus brasilensis sp nov., a novel nitrogen-fixing species isolated from the maize rhizosphere in Brazil

Sixteen nitrogen-fixing strains isolated from the rhizosphere of maize planted in Cerrado soil, Brazil, which showed morphological and biochemical characteristics similar to the gas-forming Paenibacillus spp., were phenotypically and genetically characterized. Their identification as members of the genus Paenibacillus was confirmed by using specific primers based on the 16S rRNA gene. SDS-PAGE of whole-cell proteins, API 50CH, morphological and biochemical tests, amplified rDNA-restriction analysis (ARDRA), DNA-relatedness analyses, denaturing-gradient gel electrophoresis (DGGE) and 16S rRNA gene sequence determinations were performed to characterize the novel isolates and to compare them to strains of other nitrogen-fixing Paenibacillus spp. Phenotypic analyses showed that the 16 strains were very homogeneous and shared a high level of relatedness with Paenibacillus polymyxa and Paenibacillus peoriae. However, none of the novel isolates was able to ferment glycerol (positive test for P. polymyxa), L-arabinose or D-xylose (positive tests for P. polymyxa and P. peoriae) or utilize succinate (positive test for P. peoriae). Genetic approaches also indicated a high level of similarity among the novel isolates and P. polymyxa and P. peoriae, but the novel strains clearly could not be assigned to either of these two recognized species. On the basis of the features presented in this study, the 16 novel isolates were considered to represent members of a novel species within the genus Paenibacillus, for which the name Paenibacillus brasilensis is proposed. The type strain is PB172(T) (=ATCC BAA-413(T)=DSM 14914(T)

Adult life after surviving lymphoma in childhood

Introduction: Almost all pediatric lymphomas are malignant, high-grade tumors. The combined incidence of Hodgkin's disease (HD) and non-Hodgkin lymphoma (NHL) reaches 10 to 12 new cases a year per million children under the age of 16years, representing about 10% of all pediatric cancers. HD makes up to 40% and NHL 60% of pediatric lymphomas. During the last 20years, cure rates raised dramatically so that currently over 90% of children and adolescents with HD and about 80% of those with NHL can be cured. As cure can be achieved in a large majority of patients, long-term effects and quality of life of the survivors are nowadays the principal challenges to pediatric oncologists. Discussion: Like survivors from acute lymphoblastic leukemia, young adults cured from NHL may present with neurocognitive deficits, especially if treated at a young age and with cranial irradiation. Intrathecal or high-dose intravenous chemotherapy with methotrexate may induce the same problems, although in a lesser extent and severity. Large enough prospective cohort studies like the CCSS in the USA were able to show an increased risk of second malignant neoplasms, especially brain tumors in patients formerly treated with cranial irradiation. Reduced fertility can follow exposure to cyclophosphamide, especially in the male. Cardiac function must be serially evaluated over the long to very long-term because of potential cardiomyopathy after high anthracycline doses and/or mediastinal irradiation. Survivors from HD are at high risk of late complications. Radiation therapy to the neck and mediastinum (mantle field) induces a 50% risk of developing hypothyroidism and a 20% risk of developing thyroid nodules at 20years. The risk of thyroid cancer is 18 times higher the expected rate for the general population. Secondary aggressive breast cancer shows a cumulative risk of 30% at 30years after radiotherapy. Other structures affected by mediastinal irradiation are the heart (pericardial, myocardial and endocardial structures), the great arteries (fibrosis, stenosis, aneurysms) and the central portion of the lungs (diffusion troubles, restrictive pneumopathy). Cardiac toxicity can be enhanced by the concomitant therapy with adriamycin and lung toxicity by bleomycin. Radiotherapy to the paraaortic and iliacal lymph nodes can affect gonadal function both in males and females; concomitant chemotherapy with alkylating agents like cyclophosphamide and especially procarbazine have a synergistic action and can lead to premature menopause as well as infertility. Although the vast majority of survivors from pediatric lymphomas fare well, a minority present with extreme symptoms of depression and psychosomatic distress; female sex, low socio-economic status and treatment with intensive chemotherapy are important risk factors for a poor psychosocial outcome. Conclusion: It is therefore crucial, but not always easy, to inform patients and families about potential late effects and organize follow-up after the pediatric age. A well functioning network of pediatric oncologists, GP's, adult oncologists and other specialists of adult medicine must be developed in order to prevent, early detect and treat expected long-term toxicitie

Performance-based payment of contract physicians in hospitals : an activity-based costing approach using the example of varicose vein patients

In welchem Umfang ein Ärztemangel in Deutschland vorliegt ist Gegenstand zahlreicher Diskussionen. Unbestritten ist, dass ländliche Regionen insbesondere in der ambulanten Versorgung einer teilweise dramatischen Unterversorgung gegenüberstehen, während in urbanen Regionen das Kontingent an Praxissitzen ausgeschöpft ist. Ein vergleichbarer Trend lässt sich auch im stationären Sektor erkennen, weswegen Krankenhäuser neben dem klassischen Angestelltenverhältnis neue Beschäftigungs-formen bzw. Kooperationsverhältnisse mit bereits niedergelassenen Fachärzten ausloten, um Nachfragespitzen zu decken und Fachkompetenz einzukaufen. Dabei stellen sich zahlreiche Fragen - von rechtlichen Rahmenbedingungen bis hin zur leistungsorientieren Vergütung - die in der vorliegenden Arbeit aufgegriffen und anhand eines realen Fallbeispiels diskutiert werden. Im Mittelpunkt der Arbeit steht eine exemplarische Prozesskostenrechnung, mit deren Hilfe die Ertragsanteile eines im Krankenhaus tätigen Honorararztes an der DRG-Fallpauschale aufwandsgemäß ermittelt werden können. Dies ist für die Kalkulation einer honorarärztlichen Vergütung unerlässlich. Im Ergebnis zeigt sich, dass Kooperationen auf Honorarbasis sowohl für das Krankenhaus als auch für den niedergelassenen Facharzt als profitabel eingestuft werden können. Vor diesem Hintergrund scheint es möglich, dass Kooperationsverhältnisse zukünftig zunehmen. Dies könnte helfen, die Sektorengrenzen zwischen ambulanter und stationärer Versorgung zu überwinden, indem die doppelte Facharztversorgung in Krankenhäusern und Praxen verringert wird. Online-Version im Universitätsverlag der TU Berlin (www.univerlag.tu-berlin.de) erschienenA great deal of discussion has taken place about the extent to which Germany is currently experiencing a shortage of physicians. The undersupply of health professionals in rural areas, however, is undisputed and, in some cases, dramatic. This stands in stark contrast to the oversupply of physicians in private practice in urban areas of this country. A similar trend is observable in hospitals across Germany, and has led to the implementation of various models testing new forms of employment and cooperation with contract physicians. Common to all of these models is their aim to purchase medical expertise and cover peaks in demand. This situation raises numerous questions, ranging from the appropriateness of different legal frameworks to the feasibility of introducing performance-based reimbursement. The present paper discusses these questions based on a real case study and employing an activity-based accounting approach. This makes it possible to calculate which share of a given case-fee payment a contract physician should receive to reflect accurately the work he or she has performed. Our findings show that contract-based employment can be profitable for both hospitals and contract physicians. It appears likely that these forms of cooperation will become increasingly common, potentially bridging the gap between ambulatory and hospital care that has characterized the health system in Germany for the better part of a century. Online-Version published by Universitätsverlag der TU Berlin (www.univerlag.tu-berlin.de

Late effects in long-term survivors of ALL in childhood: experiences from the SPOG late effects study.

With the use of more intensive regimens including prophylactic CNS treatment, the prognosis of children with ALL has dramatically improved over the last three decades. The aim of this cross-sectional, nationwide study was to comprehensively assess long-term toxicity in ALL survivors, with special attention given to neuropsychological morbidity, and to look for possible differences in cognitive outcome between children having received prophylactic cranial irradiation and those not having received it. Between 1994 and 1996, long-term survivors of ALL were assessed in a multi-center setting according to a standardized protocol which included, besides usual clinical and laboratory investigations, a comprehensive endocrine work-up. Additionally, children having received anthracyclines were checked for possible late cardio-toxicity with echocardiography and ECG. Intellectual performance was evaluated with standardized neuropsychological tests (age-adapted versions of the Wechsler test). One-hundred and fifty patients were eligible for the study. The median age at diagnosis was 5 years and at evaluation 16 years, for a median follow-up of 10 years. Thirty-five patients had cranial irradiation as part of the prophylactic CNS treatment. One-hundred and forty (93%) of the 150 eligible patients were completely evaluated in terms of global long-term toxicity: 117 (83%) long-term survivors had no (n = 61) or only minimal (n = 56) late toxicity; 19 (14%) suffered from moderate impairments; 4 (3%) showed severe somatic or neuropsychological sequelae. Intellectual performance could be assessed in 147 (98%) of the 150 eligible patients. The mean global, verbal and non-verbal IQs (103, 105 and 101 respectively) of the ALL survivors as a group were comparable with those found in the general population. The results of the comparison between children having and those not having received prophylactic cranial irradiation showed: 1) significantly higher scores in chemotherapy-only treated patients, both for the global and the verbal performances; 2) significantly poorer results in specific items of the Wechsler test (short-term verbal memory, arithmetics, concentration/speed of processing) in irradiated children. These findings which show the deleterious role of cranial irradiation correlate well with many other reports found in the literature. However, they could have been influenced by the significantly longer time interval observed between therapy and evaluation in our irradiated patients. Prospective studies are needed to further characterize the potential neuropsychological hazards of chemotherapy and their evolution over time

Agroecologia: condição para a segurança alimentar

Este artigo discute o agronegócio brasileiro e de como o formato adotado de agricultura pelo governo não está garantindo a segurança alimentar. Evidencia a agroecologia e de como essa forma de agricultura permite responder estruturalmente aos graves problemas de abastecimento alimentar, aos problemas econômicos, sociais e ambientais