Comparison of the Antimicrobial Activity of Deactivated Human Macrophages Challenged with Aspergillus fumigatus and Listeria monocytogenes

The anticonidial activity of human monocytes deactivated by cytokines interleukin (IL)-4 and IL-10 and the hormone dexamethasone was studied and compared with antilisterial activity. Dexamethasone had the largest effect on the anticonidial activity and suppressed germination-inhibiting activity and elimination of ingested spores by macrophages more than the cytokines did. Maximally active concentrations of IL-10 had a similar but significantly smaller deactivating effect. IL-4, in contrast to IL-10 and dexamethasone, did not reduce anticonidial activity. However, IL-4 and IL-10 were equally potent in deactivating human macrophages against Listeria monocytogenes, whereas dexamethasone was significantly less potent in the Listeria model. These observations indicate that all three mediators lessen antimicrobial activity but that this effect depends on the test organism studied and is apparently mediated through regulation of different antimicrobial systems operating against a particular microorganis

Nitric Oxide Synthase Is Not a Constituent of the Antimicrobial Armature of Human Mononuclear Phagocytes

Nitric oxide synthase (NOS) has received immense interest as an antimicrobial and antitumoral effector system of mononuclear phagocytes from rodents. Because there is increasing doubt that an analogous system exists in human macrophages, NOS was reexamined in these cells. Under tightly controlled conditions, with murine macrophages as positive controls, human macrophages failed to secrete nitric oxide <0.1µmol/106 cells/24 h), even after activation with endotoxin, intcrferon-γ, granulocyte-macrophage colony-stimulating factor, tumor necrosis factor- a, bacteria, or proliferating lymphocytes. The discrepancy between murine and human macrophages depended on neither the anatomic source (blood, peritoneum), the agent used for activation, nor the duration of activation. NOS activity was paralleled by metabolization of L-arginine to L-citrulline. Exogenous tetrahydrobiopterin, an essential cofactor of NOS not synthesized by human macrophages, did not support NOS activity in human macrophages. Also, no NOS activity was found in cellular subfractions of human macrophages. It appears that in humans, the inducible high-output NOS is not conserved as an antimicrobial system of macrophage

Negligible impact of highly patient-specific decision support for potassium-increasing drug-drug interactions – a cluster-randomised controlled trial

BACKGROUND AND OBJECTIVE: Clinical decision support (CDS) might improve management of potassium-increasing drug-drug interactions (DDI). We studied CDS with five features intended to increase effectiveness: (i) focus on serious DDIs, (ii) fewer notifications, (iii) presentation of current laboratory results, (iv) timing (when adverse event becomes likelier), (v) removal of notification when appropriate. METHODS: We conducted a 1-year, hospital-wide, cluster- randomised controlled trial in the inpatient setting at a large tertiary-care academic medical centre. Three CDS types were implemented: monitoring reminders (unknown potassium, no monitoring ordered), elevated potassium warnings (≥4.9 mEq/l), and hyperkalaemia alerts (≥5.5 mEq/l). The primary endpoint was the frequency of potassium- monitoring intervals >72 h. RESULTS: We analysed 15,272 and 18,981 stays with 2804 and 2057 potassium-increasing DDIs in the intervention and control groups, respectively. Patient-specific notifications: displayed were 869 reminders (1 per 3.2 potassium- increasing DDIs), 356 warnings (1:7.9), and 62 alerts (1:45.2). Nevertheless, insufficiently monitored DDIs were not reduced (intervention 451 of 9686 intervals >72 h [4.66%]; control 249 of 6140 [4.06%]). The only secondary outcome improved was the length of potassium monitoring intervals (intervention group mean 22.9 h, control 23.7 h; p <0.001). However, in the intervention group, during 50 of 2804 observed potassium-increasing DDI periods (1.78%) one or more serum potassium values ≥ 5.5mEq/ l were measured, in the control group, during 27 of 2057 (1.31%; p = 0.20). CONCLUSIONS: A highly patient-specific CDS feature combination had a negligible impact on the management of potentially serious potassium-increasing DDIs and was unable to improve safety among hospitalised patients. Trial registration number: The study was registered at ClinicalTrials.gov (NCT02020317). Keywords: drug interactions, hyperkalaemia, potassium, medical order entry systems, electronic health records, clinical decision support systems, computer-assissted drug therapy, patient safety, drug monitorin

Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug-drug interactions

Purpose: Hyperkalaemia due to potassium-increasing drug-drug interactions (DDIs) is a clinically important adverse drug event. The purpose of this study was to identify patient- and physician-related risk factors for the development of hyperkalaemia. Methods: The risk for adult patients hospitalised in the University Hospital Zurich between 1 December 2009 and 31 December 2011 of developing hyperkalaemia was correlated with patient characteristics, number, type and duration of potassium-increasing DDIs and frequency of serum potassium monitoring. Results: The 76,467 patients included in this study were prescribed 8,413 potentially severe potassium-increasing DDIs. Patient-related characteristics associated with the development of hyperkalaemia were pulmonary allograft [relative risk (RR) 5.1; p 48h: RR 1.6; p < 0.01). Conclusion: Strategies for reducing the risk of hyperkalaemia during potassium-increasing DDIs should consider both patient- and physician-related risk factors

Crucial Role of Interferon Consensus Sequence Binding Protein, but neither of Interferon Regulatory Factor 1 nor of Nitric Oxide Synthesis for Protection Against Murine Listeriosis

Listeria monocytogenes is widely used as a model to study immune responses against intracellular bacteria. It has been shown that neutrophils and macrophages play an important role to restrict bacterial replication in the early phase of primary infection in mice, and that the cytokines interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) are essential for protection. However, the involved signaling pathways and effector mechanisms are still poorly understood. This study investigated mouse strains deficient for the IFN-dependent transcription factors interferon consensus sequence binding protein (ICSBP), interferon regulatory factor (IRF)1 or 2 for their capacity to eliminate Listeria in vivo and in vitro and for production of inducible reactive nitrogen intermediates (RNI) or reactive oxygen intermediates (ROI) in macrophages. ICSBP−/− and to a lesser degree also IRF2−/− mice were highly susceptible to Listeria infection. This correlated with impaired elimination of Listeria from infected peritoneal macrophage (PEM) cultures stimulated with IFN-γ in vitro; in addition these cultures showed reduced and delayed oxidative burst upon IFN-γ stimulation, whereas nitric oxide production was normal. In contrast, mice deficient for IRF1 were not able to produce nitric oxide, but they efficiently controlled Listeria in vivo and in vitro. These results indicate that (a) the ICSBP/IRF2 complex is essential for IFN-γ–mediated protection against Listeria and that (b) ROI together with additional still unknown effector mechanisms may be responsible for the anti-Listeria activity of macrophages, whereas IRF1-induced RNI are not limiting

Junctional Adhesion Molecule, a Novel Member of the Immunoglobulin Superfamily That Distributes at Intercellular Junctions and Modulates Monocyte Transmigration

Tight junctions are the most apical components of endothelial and epithelial intercellular cleft. In the endothelium these structures play an important role in the control of paracellular permeability to circulating cells and solutes. The only known integral membrane protein localized at sites of membrane–membrane interaction of tight junctions is occludin, which is linked inside the cells to a complex network of cytoskeletal and signaling proteins. We report here the identification of a novel protein (junctional adhesion molecule [JAM]) that is selectively concentrated at intercellular junctions of endothelial and epithelial cells of different origins. Confocal and immunoelectron microscopy shows that JAM codistributes with tight junction components at the apical region of the intercellular cleft. A cDNA clone encoding JAM defines a novel immunoglobulin gene superfamily member that consists of two V-type Ig domains. An mAb directed to JAM (BV11) was found to inhibit spontaneous and chemokine-induced monocyte transmigration through an endothelial cell monolayer in vitro. Systemic treatment of mice with BV11 mAb blocked monocyte infiltration upon chemokine administration in subcutaneous air pouches. Thus, JAM is a new component of endothelial and epithelial junctions that play a role in regulating monocyte transmigration

Triptans and troponin: a case report

This case report describes for the first time acute coronary syndrome in a 67-year old patient after oral intake of naratriptan for migraine. So far in the literature, only sumatriptan, zolmitriptan and frovatriptan have been described to cause acute coronary syndromes

Mittelfristprognose: Arbeitsmarktdynamik bis 2025

Die in diesem Bericht erstmalig vorgestellte Mittelfristprognose (Prognosezeitraum: 5 Jahre) schließt die Lücke zwischen der Engpassanalyse der Bundesagentur für Arbeit zur aktuellen Fachkräftesituation und den bisherigen Langfristprognosen für den Zeitraum von 10 bis 20 Jahren des Fachkräftemonitorings. In der Mittelfristprognose sind Bevölkerungs- und Konjunkturprojektionen aktueller als in der zu letzt veröffentlichten Langfristprojektion "Digitalisierte Arbeitswelt", dennoch geht diese vom selben langfristen Entwicklungspfad und zueinander konsistenten Annahmen aus. Neben einer neu entwickelten QuBe-Indikatorik zur Identifikation von Berufen mit potentiellen Handlungsbedarfen (Fokusberufen) wird in diesem Bericht der Gender Employment Gap als Indikator zur Identifikation von Frauen- bzw. Männerberufen erstmals vorgestellt.The medium-term forecast presented in this report for the first time (forecast period: 5 years) closes the gap between the Engpassanalyse (tool to identify skills shortages by occupationA) of the Federal Employment Agency (Bundesagentur für Arbeit) for the current situation and the previous long-term forecasts for the next 10 to 20 years of the Skilled Lobour Monitoring. In the medium-term forecast, population and economic projections are more up-to-date than in the long-term projection "Digitized world of work", yet the first assumes the same long-term development path and mutually consistent assumptions. In addition to a newly developed QuBe indicator for identifying occupations with potential mismatches (focus occupations), the Gender Employment Gap is presented for the first time in this report as an indicator for identifying female and male occupations

Die Auswirkungen der Klimaschutzmaßnahmen auf den Arbeitsmarkt und die Wirtschaft

In diesem Bericht werden die Auswirkungen des Klimaschutzprogramms 2030, des Klimaschutz Sofortprogramms 2022 und der Aufstockung Bundesförderung energieeffiziente Gebäude (BEG) vom 22.09.2021 für Arbeitsmarkt und Wirtschaft für den Zeitraum bis 2025 abgeschätzt. Ob die Maßnahmen geeignet sind, die Treibhausgasemissionen bis 2030 um 65 Prozent zu mindern, wird im Rahmen dieses Berichts nicht untersucht.This report estimates the effects of the Climate Protection Program 2030, the Climate Protection Immediate Action Program 2022 and the increase in federal funding for energy-efficient buildings of September 22, 2021 on the labor market and the economy for the period 2021 to 2025. This report does not examine whether the measures are likely to reduce greenhouse gas emissions by 65 percent by 2030