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Background: The diagnostic significance of the atopy patch test for the management of dermatitis possibly triggered by aeroallergens is still controversial. However, sufficiently large studies with routinely tested standardized aeroallergen patch test preparations in dermatitis patients are lacking. Objective: To evaluate the reaction frequency and the reaction profiles of 10 until mid‐2015 commercially available, standardized aeroallergen patch test preparations of the 'Stallerpatch' test series (Stallergenes, Antony Cedex, France) in a large multicentre patient cohort. Methods: A retrospective data analysis of patients with suspected aeroallergen‐dependent eczematous skin lesions was performed, who were patch tested in 15 Information Network of Departments of Dermatology‐associated clinics between 2000 and 2015. Patients were stratified according to their atopic dermatitis (AD) status. Results: The study group included 3676 patients (median age 41 years, 34.8% males, 54.5% AD). The most common aeroallergens causing positive patch test reactions were Dermatophagoides pteronyssinus (19.6%), Dermatophagoides farinae (16.9%), birch (6.2%), timothy grass (6.0%), cat dander (5.4%), mugwort (4.9%) and dog dander (4.6%). Reactions to other pollen allergen preparations, that is 5 grasses (3.2%), cocksfoot (2.1%) and plantain (1.6%), were less common. Positive patch test reactions to aeroallergens were consistently more frequent in patients with AD. These patients showed proportionally less dubious, follicular, irritant and weak positive reactions. Independent of AD status, a patient history of past or present allergic rhinitis was associated with an increased chance of a positive aeroallergen patch test reaction to pollen allergens. Conclusion: The aeroallergen patch test is a useful add‐on tool in clinical routine, especially in patients with AD and/or respiratory allergy. A patch test series comprising Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, timothy grass, cat dander and mugwort seems to be suitable. Controlled studies with specific provocation and elimination procedures are required to further evaluate the diagnostic significance of the proposed screening series. [ABSTRACT FROM AUTHOR]

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Background Psoriasis has a negative impact on health-related quality of life ( HRQoL) and may favour mental comorbidity. Objective To investigate the contribution of chronic stress and burnout experience to HRQoL and how mental health influences the efficacy of an inpatient rehabilitation measure in psoriasis patients. Methods Eighty-four psoriasis patients taking part in a 3-week inpatient rehabilitation measure participated in the study. Severity of psoriasis was assessed with the Psoriasis Area and Severity Index ( PASI) and by patients' self-evaluation at the beginning and end of treatment. The following aspects of mental health were explored using validated questionnaires. Symptoms of chronic stress and burnout experience: Trier Inventory for the Assessment of Chronic Stress ( TICS) and Shirom Melamed Burnout Measure ( SMBM). Symptoms of depression: depression scale of the Patient Health Questionnaire in the German version ( PHQ-D). HRQoL: Dermatology Life Quality Index ( DLQI) and Short Form Health Survey-8 ( SF-8). Results Linear regression analyses revealed that chronic stress, burnout experience and perceived symptom severity but not clinician-assessed severity of psoriasis had independent negative effects on HRQoL. Patients who achieved a PASI reduction of <75% at discharge from the rehabilitation measure had lower baseline QoL and showed more symptoms of depression, chronic stress and burnout than patients who achieved a PASI improvement of ≥75. Conclusion Chronic stress and burnout have appreciable influence on HRQoL and may adversely affect treatment success in psoriasis patients. Our data underscore the importance of a multidimensional approach in the management of psoriasis. [ABSTRACT FROM AUTHOR]

Background Occupational hand eczema ( OHE) is associated with impaired health-related quality of life (QoL) and mental distress. Interdisciplinary inpatient rehabilitation measures in the framework of tertiary individual prevention ( TIP) offered by the German employers' liability insurance associations include dermatological treatment, education and psychological interventions. Objective To investigate the effects of interdisciplinary inpatient rehabilitation in the framework of TIP on mental health in patients with severe OHE and the relationships between recovery of OHE and improvement of mental health and QoL. Methods A total of 122 patients participated in the study. A test battery consisting of the German versions of the Hospital Anxiety and Depression Scale ( HADS-D), the Dermatology Life Quality Index ( DLQI), the Short Form Health Survey-36 ( SF-36) and the Trier Inventory for the Assessment of Chronic Stress ( TICS) was applied at the time of admission (T1) and 3 weeks after dismissal (T2). Severity of hand eczema was assessed with the Osnabrueck Hand Eczema Severity Index ( OHSI). Results All parameters improved significantly from T1 to T2. A relationship was established between the improvement of QoL and recovery of OHE, while there was no such relationship between the improvement of mental distress and improvement of OHE. Nonresponders had significantly more cumulative days of sickness at T1. Conclusions Our data underscore the importance of psychological interventions in addition to dermatological treatment in the framework of prevention measures for OHE. These measures should be applied at an early stage of OHE prior to the occurrence of sick leave. [ABSTRACT FROM AUTHOR]

Background Aluminium tubes for pharmaceutical use are internally lacquered with epoxy resins ( ER) based on bisphenol A diglycidyl ether ( BADGE). Recently, it was shown that remnants of ER polymerization like BADGE are extractable from epoxy-based coatings of commercially available tubes and may leach into semi-solid drug preparations. We aimed to evaluate the safety of BADGE-contaminated macrogol ointments in individuals sensitized to ER based on BADGE by use tests. Methods Repeated open application testing ( ROAT) in 11 patients sensitized to ER based on BADGE with BADGE in macrogol ointments (3 mg/kg; 30 mg/kg, equivalent to BADGE concentration determined in macrogol ointment after storage in a commercially available tube; 300 mg/kg). Results The 30 mg/kg BADGE ointment elicited reactions in three patients, and another three patients reacted to 300 mg/kg BADGE ointment. No reactions to the vehicle control and 3 mg/kg BADGE were observed. Conclusions Elevated BADGE concentrations in ER-coated aluminium tubes pose a risk of developing contact dermatitis to patients sensitized to ER based on BADGE. Quality standards are deemed necessary for the production of ER-coated aluminium tubes intended for pharmaceutical use and should consider the results of the present ROAT study. [ABSTRACT FROM AUTHOR]

Background Stress is known to activate or exacerbate dermatoses, but the relationships between chronic stress, job-related stress and sickness absence among occupational hand eczema (OHE) patients are inadequately understood. Aims To see whether chronic stress or burnout symptoms were associated with cumulative sickness absence in patients with OHE and to determine which factors predicted sickness absence in a model including measures of job-related and chronic stress. Methods We investigated correlations of these factors in employed adult inpatients with a history of sickness absence due to OHE in a retrospective cross-sectional explorative study, which assessed chronic stress (Trier Inventory for the Assessment of Chronic Stress), burnout (Shirom Melamed Burnout Measure), clinical symptom severity (Osnabrück Hand Eczema Severity Index), perceived symptom severity, demographic characteristics and cumulative days of sickness absence. Results The study group consisted of 122 patients. OHE symptoms were not more severe among patients experiencing greater stress and burnout. Women reported higher levels of chronic stress on some measures. Cumulative days of sickness absence correlated with individual dimensions of job-related stress and, in multiple regression analysis, with an overall measure of chronic stress. Conclusions Chronic stress is an additional factor predicting cumulative sickness absence among severely affected OHE patients. Other relevant factors for this study sample included the ‘cognitive weariness’ subscale of the Shirom Melamed Burnout Measure and the physical component summary score of the SF-36, a measure of health-related life quality. Prevention and rehabilitation should take job stress into consideration in multidisciplinary treatment strategies for severely affected OHE patients. [ABSTRACT FROM AUTHOR]

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Background Staphylococcus aureus (S. aureus) is a well-known trigger factor of atopic dermatitis (AD). Besides staphylococcal superantigens, α-toxin may influence cutaneous inflammation via induction of T-cell proliferation and cytokine secretion. Objectives To investigate the association between sensitization to inhalant allergens and skin colonization with α-toxin-producing S. aureus in AD. Patients and methods We investigated 127 patients with AD, aged 14–65 years, who were on standard anti-inflammatory and antiseptic treatment before investigation. We evaluated skin colonization, medical history, severity of AD and sensitization to inhalant allergens. Results Forty-eight of 127 patients were colonized with S. aureus, suffered from more severe AD, had asthma more often and showed higher sensitization levels to inhalant allergens. Thirty of 48 patients with S. aureus skin-colonizing strains produced α-toxin and had higher total IgE and specific IgE to birch pollen and timothy grass pollen. Conclusions Under topical treatment with antiseptic and anti-inflammatory agents the colonization of lesional skin with S. aureus was clearly lower than commonly found in untreated patients with AD. Colonization with S. aureus was associated with a higher severity of AD, higher degree of sensitization, and a higher frequency of asthma. The proportion of patients whose skin was colonized with α-toxin-producing S. aureus was higher than expected from a former study. Cutaneous colonization with α-toxin-producing S. aureus was associated with a higher sensitization level to birch pollen allergen in AD. This may point to a higher susceptibility of patients with higher T-helper 2 polarization towards α-toxin-producing S. aureus. [ABSTRACT FROM AUTHOR]

Synovial fluid is a semidilute hyaluronate (HA) polymer solution, the rheology of which depends on HA-protein interactions, and lubricin is a HA-binding protein found in synovial fluid and at cartilage surfaces, where it contributes to boundary lubrication under load. Individuals with genetic deficiency of lubricin develop precocious joint failure. The role of lubricin in synovial fluid rheology is not known. We used a multiple-particle-tracking microrheology technique to study the molecular interactions between lubricin and HA in synovial fluid. Particles (200 nm mean diameter) embedded in normal and lubricin-deficient synovial fluid samples were tracked separately by using multiple-particle-tracking microrheology. The time-dependent ensemble-averaged mean-squared displacements of all of the particles were measured over a range of physiologically relevant frequencies. The mean-squared displacement correlation with time lag had slopes with values of unity for simple HA solutions and for synovial fluid from an individual who genetically lacked lubricin, in contrast to slopes with values less than unity (α ≈ 0.6) for normal synovial fluid. These data correlated with bulk rheology studies of the same samples. We found that the subdiffusive and elastic behavior of synovial fluid, at physiological shear rates, was absent in fluid from a patient who lacks lubricin. We conclude that lubricin provides synovial fluid with an ability to dissipate strain energy induced by mammalian locomotion, which is a chondroprotective feature that is distinct from boundary lubrication. [ABSTRACT FROM AUTHOR]

Increased efforts have been undertaken by manufacturers to reveal the secrets of material odors, the structure of the odorants responsible, with regard to finding out the source(s) of odor and possible starting points for odor reduction, and therewith product improvement, increased consumer satisfaction and improved indoor air quality. The identification of odor-active compounds in materials by means of gas chromatography–olfactometry (GC-O, also called GC-sniffing), performed at the Fraunhofer Institute for Building Physics (IBP) during the previous years, showed surprising similarities between certain odorants found in materials and those previously identified in certain kinds of food. Examples of important odorants found in different material samples and similarities with food odorants were analyzed. Odorant sources are indicated as regards materials, and possible conditions and mechanisms of formation suggested to show starting points for odor reduction and odor improvement in material development. Practical Implications If technical materials are planned to be used indoors and if they spread a distinct odor, the analysis of the compounds contained and emitted by this material using gas chromatography–olfactometry is a means to help reveal the compounds being responsible for that odor. The exact knowledge of the structure of the odorants is the prerequisite for drawing conclusions on possible sources and formation mechanisms and to reveal starting points for odor reduction and product improvement, e.g. by changing ingredients or production conditions. This contributes to an improvement of indoor air quality. Furthermore, quite often the concentrations of certain single odorants found in materials can be very low and the same odorants can be part of other well-known food flavors. This information might be useful to reduce consumers’ fears of a possible impairment of their health in the future. [ABSTRACT FROM AUTHOR]

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Background Epidemiological studies indicate environmental pollutants to be involved in the increase in the prevalence of allergic diseases. In human exposure studies, volatile organic compounds (VOCs) have been shown to cause exacerbations of allergic asthma whereas, no data concerning atopic eczema (AE) are available. Objective We investigated the effect of airborne VOCs on the skin of patients with AE and controls in the presence or absence of house dust mite allergen, Der p 1. Methods In a double-blind crossover study, 12 adults with AE and 12 matched healthy volunteers were exposed on their forearms to Der p 1 and subsequently to a mixture of 22 VOCs (M22, 5 mg/m3) in a total body exposure chamber for 4 h. Transepidermal water loss (TEWL) and skin blood flow were measured in all subjects before, during and after exposure. Additionally, an atopy patch test (APT) with Der p 1 was applied to the skin after exposure. Results A significant increase in transepidermal water loss was observed 48 h after exposure to VOCs as compared with exposure with filtered air in all individuals (mean difference: +34%; 95% Confidence Interval: 7–69%). Prior Der p 1 exposure resulted in a significant rise of dermal blood flow after 48 h in patients with AE but not in controls. Six out of seven patients showed enhanced atopy patch test (APT) reactions to HDM allergen after previous exposure to VOCs. Conclusion Our results show that exposure to VOCs – at concentrations commonly found in indoor environments – can damage the epidermal barrier and enhance the adverse effect of Der p 1 on sensitized subjects with AE. These findings may contribute to a better understanding of the mechanisms underlying the increase in prevalence and exacerbation of AE. [ABSTRACT FROM AUTHOR]

Background: The effect of specific immunotherapy (SIT) on eczema in atopic dermatitis is not known. Therefore, a multi-centre, randomized dose–response trial, double-blind with respect to the efficacy of a biologically standardized depot house dust mite preparation was performed. Methods: Eighty-nine adults with a chronic course of atopic dermatitis, SCORAD ≥40 and allergic sensitization to house dust mites [CAP-FEIA ≥3] were included, of whom 51 completed the study. Subcutaneous SIT with a house dust mite preparation ( Dermatophagoides pteronyssinus/ D. farinae) applying maintenance doses of 20, 2000 and 20 000 SQ-U in weekly intervals for 1 year. The main outcome measures addressed the change of the SCORAD as average of the values after 9 and 12 months of SIT in comparison with the value at baseline. Results: The SCORAD declined in the three dose groups in a dose-dependent manner ( P = 0.0368, Jonckheere–Terpstra test) and was significantly lower in the two high-dose groups (2000, 20000 SQ-U) compared with the low-dose group of 20 SQ-U ( P = 0.0379, U-test) after 1 year of SIT. The use of topical corticosteroids was significantly reduced with higher doses ( P = 0.0007, Mantel–Haenszel chi-square test). Conclusions: Allergen-SIT for 1 year with a house dust mite preparation is able to improve the eczema in patients with atopic dermatitis who are sensitized to house dust mite allergens and reduces the need for topical corticosteroids. SIT may be valuable in the treatment of this chronic skin disease. [ABSTRACT FROM AUTHOR]

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Staphylococcus aureus is a well known trigger factor of atopic dermatitis (AD). Besides the superantigens, further exotoxins are produced by S. aureus and may have an influence on the eczema. To explore the impact of staphylococcal α-toxin on human T cells, as those represent the majority of skin infiltrating cells in AD. Adult patients with AD were screened for cutaneous colonization with α-toxin producing S. aureus. As α-toxin may induce necrosis, CD4+ T cells were incubated with sublytic α-toxin concentrations. Proliferation and up-regulation of IFN-γ on the mRNA and the protein level were assessed. The induction of t-bet translocation in CD4+ T cells was detected with the Electrophoretic Mobility Shift Assay. Thirty-four percent of the patients were colonized with α-toxin producing S. aureus and α-toxin was detected in lesional skin of these patients by immunohistochemistry. Sublytic α-toxin concentrations induced a marked proliferation of isolated CD4+ T cells. Microarray analysis indicated that α-toxin induced particularly high amounts of IFN-γ transcripts. Up-regulation of IFN-γ was confirmed both on the mRNA and the protein level. Stimulation of CD4+ T cells with α-toxin resulted in DNA binding of t-bet, known as a key transcription factor involved into primary T helper type 1 (Th1) commitment. α-toxin is produced by S. aureus isolated from patients with AD. We show here for the first time that sublytic α-toxin concentrations activate T cells in the absence of antigen-presenting cells. Our results indicate that α-toxin is relevant for the induction of a Th1 like cytokine response. In AD, this facilitates the development of Th1 cell dominated chronic eczema. [ABSTRACT FROM AUTHOR]

Noninfectious granulomatous skin diseases are inflammatory disorders of unknown aetiology which are often recalcitrant to common anti-inflammatory treatment regimens. Recently, in several case reports, fumaric acid esters (FAE) have proved beneficial in granulomatous skin diseases, but studies on a larger collection of consecutive patients have not yet been performed.To investigate the therapeutic efficacy of FAE for the treatment of granulomatous skin diseases.The therapeutic efficacy and side-effects of FAE were analysed retrospectively in 32 patients with disseminated granuloma annulare (n = 13), annular elastolytic giant cell granuloma (n = 3), sarcoidosis (n = 11), necrobiosis lipoidica (n = 4), or granulomatous cheilitis (n = 1).Three patients discontinued treatment within 4 weeks because of side-effects. Of the remaining 29 patients, 18 patients responded to treatment with FAE. Marked improvement or complete clearance was seen in seven patients. We observed a slight to moderate improvement in 11 patients, and 11 patients did not respond. In patients showing a complete remission, the maximum effect was observed after 8·5 months (SD±6 months, range 3–20 months). In two patients with systemic sarcoidosis, the pulmonary changes improved in parallel with the skin. Side-effects were usually mild and resolved spontaneously upon dose reduction or discontinuation of the therapy.The data presented here indicate that FAE may be considered for the treatment of recalcitrant granulomatous skin disease. [ABSTRACT FROM AUTHOR]

Approximately 5% of pigs slaughtered in the UK have been tail-bitten, leading to welfare and production issues. Tail biting is sporadic and not all pigs tail bite. The aim of this study was to identify factors that are common in pigs that perform tail-biting behaviour, and that might be used in a predictive way to identify such animals. The behaviour of 159 pigs was observed in the post-weaning period. Pigs were weaned at 4 weeks of age. In the week prior to weaning and at 6 weeks of age each pig was individually tested in a tail chew test (tail chew test 1 and 2, respectively). The tail chew test involved recording the pig's behaviour directed towards two ropes, one of which had been soaked in saline solution and the other not. The production performance of the pigs was recorded from birth to 7 weeks of age. Time spent performing tail-biting behaviour correlated positively with time in contact with the rope in tail chew test 2 (r = 0·224, P<0·05), and time spent ear biting correlated positively with time spent in rope directed behaviour in tail chew test 1 (r = 0·248, P<0·01). Pigs that spent as much as 1·5% of their time of more performing tail-biting behaviour were lighter at weaning (26 days) and tended to be lighter at 7 weeks of age compared with pigs that spent less than 1·5% of their time performing tail-biting behaviour (weaning weight : ≥1·5% tail biting 8·96 kg, < 1·5% tail biting 9·67 kg, P<0·05; 7-week weight : ≥1·5% tail biting 15·75 kg, < 1·5% tail biting 17·09 kg, P<0·08). There was no significant difference in birth weight between pigs that spent ≥ or < 1·5% of their time performing tail-biting behaviour. Pigs that spent 1·5% of their time or more performing tail-biting behaviour showed significantly lower growth rates between birth and weaning (≥ 1·5% tail biting 260 g/day, < 1·5% tail biting 285 g/day, P<0·05) but not between weaning and 7 weeks of age ( ≥ 1·5% tail biting 343 g/day, < 1·5% tail biting 365 g/day, P>0·05). The results suggest that pigs that tail bite have some nutritional deficiency that results in performance of foraging behaviour that is expressed in intensive housing as ear/tail biting. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a common chronic inflammatory skin disease often accompanied by cutaneousStaphylococcus aureuscolonization and, in this regard, especially complicated by the presence of superantigen-producing strains. Because IgG antibodies comprise an important defence mechanism of the adaptive immune system against bacteria, it was investigated whether AD patients have an abnormal pattern or distribution of superantigen-specific IgG subclass antibodies in association with disease severity and activity.Staphylococcal enterotoxin B (SEB) and staphylococcal enterotoxin C1 (SEC1) specific IgG antibody subclasses were assessed inn=89 adult AD patients with mild to severe disease activity as determined by the SCORAD score and inn=28 healthy age-matched controls. Results were correlated with the current status of bacterial skin colonization and severity score.Thirty-eight per cent of the AD patients showed a selective deficiency in IgG2 antibodies against SEC1 compared with only 14% in the control group. The absence of these antibodies was found in both currently colonized and non-colonized AD patients and was associated with a severe phenotype (SCORAD more than 40 points in two-thirds of the deficient patients). However, these patients had normal production levels of IgG2 antibodies againstpneumococcal capsular polysaccharide(PCP) and SEB, but higher IgG1 and IgG4 titres against SEC1. Except for elevated total IgG1, total IgG subclass levels were normal in this AD subgroup. Yet, peripheral blood mononuclear cells (PBMCs) derived from these patients clearly produced IL-4 and IL-5 upon SEC1 re-stimulation whereas PBMCs from those providing SEC1-specific IgG2 antibodies failed in the production of these cytokines.A subgroup of AD patients suffers from a selective deficiency to produce anti-SEC1 IgG2 antibodies. This patient group is characterized by a severe AD phenotype. [ABSTRACT FROM AUTHOR]

Food allergy to cow's milk or hen's egg is a common problem in children with atopic eczema/dermatitis syndrome (AEDS) but the role of birch pollen-related food for the induction of allergic symptoms is still not clear. Twelve children (median age 5 years) with AEDS underwent an oral challenge with those birch pollen-related foods which were reported to induce no immediate symptoms, but were consumed on a regular basis. Total IgE and specific IgE to birch pollen, Bet v 1/2 and various birch pollen-related foods were determined. Seven of 12 children showed immediate and/or late eczematous reactions upon ingestion of birch pollen-related foodstuff. Four children showed a worsening of eczema 24 h upon oral challenge with a significant difference in SCORAD before and after challenge. There were no differences in terms of total IgE or birch pollen-specific IgE between children with a late eczematous response and non-reacting children. Birch pollen-related food may induce allergic symptoms in children with AEDS who exhibit a sensitization to birch pollen. Oral challenge tests should be performed in those children who suffer from severe AEDS and who are highly sensitized to birch pollen allergens even in the absence of a history suggestive of food allergy. [ABSTRACT FROM AUTHOR]

Food allergy is a common problem in patients with atopic dermatitis (AD), particularly in children. While immediate reactions to food are well characterized, the importance of food as a provocation factor for late eczematous reactions has been a subject of debate for several decades. To investigate the importance of food for the induction of late eczematous reactions in children with AD and to correlate the clinical outcome to the results of specific IgE determinations and atopy patch tests (APTs). One hundred and six double-blind placebo-controlled food challenges (DBPCFCs) to cow's milk, hen's egg, wheat and soy in 64 children with AD (median age 2 years) were analysed retrospectively. Total and food-specific IgE were determined by CAP RAST FEIA and APTs with native foodstuff were performed. The diagnostic values of specific IgE and APT results were calculated. Forty-nine (46%) of the challenges were related to a clinical reaction. An exacerbation of AD (late eczematous reaction) commonly occurred 24 h after the ingestion of food. Isolated late eczematous reactions were seen in 12% of all positive challenges. Forty-five percent of the positive challenges were associated with late eczematous responses, which followed immediate-type reactions. The sensitivity of food-specific IgE and the APT was 76% and 70%, respectively. Specific IgE and APT were often false positive, which resulted in low positive predictive values (64% and 45%, respectively). Late eczematous reactions may often be observed upon food challenge in children with AD. Due to the poor reliability of food-specific IgE and APT results DBPCFCs have still to be regarded as the gold standard for the appropriate diagnosis of food responsive eczema in children with AD. [ABSTRACT FROM AUTHOR]

Because of its potential use as fertilizer, urine ("yellow water") is a resource originating from sanitation. Its separate collection in no-mix toilets is a beneficial aspect of ecological (source control) sanitation. In order to avoid dilution of the fertilizing nutrients with toilet flush water, the utilization of yellow water as toilet flush liquid seems to be advantageous. To be accepted for this purpose, urine has to be decolorized (and also deodorized). In this study activated carbon adsorption, irradiation with UV light of different wavelengths, the advanced oxidation processes ultrasound, UV/H2O2, and photocatalytic oxidation have failed to decolorize urine. Biological treatment caused brown colour of the treated urine. Only ozonation was successful in colour removal, although it did not affect TOC. In spite of darkening of yellow water during biological treatment (generation of humic substances), smaller ozone doses were required for decolorizing the biologically pre-treated urine than for original urine. Photocatalytic oxidation of biologically treated urine also removed brown colour, but the original yellow colour remained. In ozonated urine, yellow colour was reconstituted unless hydrogen peroxide was added. In addition to colour removal, ozone contributed to deodorization as a consequence of ammonia stripping and probably of phenol oxidation. [ABSTRACT FROM AUTHOR]

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Background The skin of up to 100% of patients with atopic dermatitis (AD) is colonized with Staphylococcus aureus. Of all S. aureus strains isolated from lesional skin, up to 65% have been shown to produce exotoxins with superantigenic properties. Patients colonized with S. aureus have been treated with antibiotics in several open and double-blind placebo-controlled studies, with conflicting results. These studies did not consider the anterior nares as a reservoir of S. aureus, or the possibility of transmission between patients and their contacts. Moreover, adult patients have not so far been investigated. Objectives To investigate the colonizing features of S. aureus in adults with AD and in their contacts, and the effect of an antimicrobial treatment of the patients and their partners. Methods Swabs were taken from the skin and anterior nares of 66 adults with AD. S. aureus strains were screened for the production of exotoxins in 32 patients. Ten patients (two with toxigenic strains, eight with non-toxigenic strains) were treated orally with cefalexin, chlorhexidine ointment was applied to the skin, and the anterior nares were treated with mupirocin ointment. A bath containing potassium permanganate was taken daily. In addition, their partners were treated topically. Results Sixty-two of 66 patients (94%) were carriers of S. aureus, and mostly harboured the bacteria on both skin and anterior nares. Ten of 32 (31%) patients were colonized with toxigenic strains. The Severity Scoring in AD (SCORAD) score decreased in nine of 10 patients who received antimicrobial treatment (P < 0.001), and this effect was more pronounced in patients with a baseline SCORAD > 50. Conclusions S. aureus may play an important role as an aggravating factor in adults with AD, as antimicrobial treatment leads to a significant improvement of AD in patients who are colonized with the bacterium. [ABSTRACT FROM AUTHOR]

A prospective, randomized, controlled monocentric trial was performed to evaluate the efficacy and safety of once daily ceftriaxone 2 g plus gentamicin 5 mg/kg in comparison to cefepime 2 g t.i.d. plus gentamicin 5 mg/kg q.d. in the treatment of neutropenic fever. In case of fever (oral temperature ≥38.5°C on one occasion or ≥38.0°C twice within 24 h) and a granulocytopenia (neutrophil count below 500 or below 1000/µl when expected to fall below 500 within 72 h), patients with hematological malignancies or solid tumors were assigned to ceftriaxone or cefepime, each with gentamicin. The primary endpoint was defined as defervescence on day 4–6 followed by at least 7 afebrile days. Secondary endpoints were overall response, defined as defervescence on day 28 and toxicity. Two hundred eleven episodes were included. Fever of unknown origin (FUO) accounted for 124 episodes (58.8%), microbiologically defined infection (MDI) for 39 (18.5%), clinically defined infection (CDI) for 25 (11.8%), and both clinically and microbiologically defined infection (CMDI) for 19 episodes (9%). On an intent-to-treat basis 207 episodes were evaluable for the primary endpoint. Ceftriaxone plus gentamicin and cefepime plus gentamicin were successful in 49.5% and 51%, respectively. Overall response was achieved on study day 28 in 92.5% and 91%, respectively. Diarrhea was more frequent with ceftriaxone/gentamicin (6.5% vs 17%), while nausea/vomiting was less (12.1% vs 5%). Once-daily ceftriaxone plus gentamicin was not inferior to cefepime t.i.d. plus gentamicin q.d. in the empirical treatment of neutropenic fever. [ABSTRACT FROM AUTHOR]

Evaluates the cause of complications of atopic dermatitis (AD). Definition and origin of AD; Characterization of AD compared to chronic lesions; Identification of environmental allergen and food allergen as common cause of AD complication.

Background: Eosinophils are important effector cells in several atopic diseases. The levels of eosinophil granule-derived mediators (ECP, EPX) in serum and body fluids have been proven to be correlated with disease activity in atopic respiratory diseases and atopic dermatitis. The study aimed to demonstrate an interrelationship between urine EPX and disease activity in adult patients with atopic dermatitis. Methods: We determined urine EPX concentration, serum ECP concentration, and peripheral blood eosinophil count in 40 adult patients with mild to severe atopic dermatitis and compared it with the disease activity as assessed with the SCORAD index. Results: Urine EPX and serum ECP concentrations were significantly higher in patients with severe atopic dermatitis than in patients with mild or moderate disease (median values 123.5 vs 78.3 µg/mmol creatinine, P<0.0001; 25.4 vs 14.9 µg/l, P<0.0001, respectively). We found a significant correlation between urine EPX levels, serum ECP levels, and the SCORAD (r=0.36, P<0.0001 and 0.34, P<0.0001, respectively). Conclusions: Urine EPX is a useful in vitro parameter of inflammation in atopic dermatitis of the adult age. [ABSTRACT FROM AUTHOR]

Background: Staphylococcus aureus has been identified as a possible trigger factor in atopic dermatitis (AD). Some 30–60% of S. aureus strains isolated from patients with AD are able to produce exotoxins with superantigenic properties, mostly staphylococcal enterotoxins A, B, C, and D (SEA–D) and toxic shock syndrome toxin-1 (TSST-1). Recently, it was demonstrated that the presence of IgE antibodies to SEA and SEB is correlated with the severity of skin lesions in children with AD. To determine the relevance of staphylococcal enterotoxins in adult patients with AD, we investigated the relationship between the severity of skin lesions and sensitization to SEA and SEB. Methods: Clinical severity was determined by the SCORAD index. Circulating IgE antibodies to SEA and SEB, serum eosinophil cationic protein (ECP) levels, and urine eosinophil protein X (EPX) levels were measured. Results: The skin condition was significantly worse in patients sensitized to SEB than in unsensitized patients. Serum ECP and urine EPX levels were found to be significantly higher in SEB-sensitized patients, confirming the higher degree of cutaneous inflammation. Conclusions: Our results demonstrate a relationship between severity of skin lesions and sensitization to SEB in adult patients with AD, but a relationship between disease activity and sensitization to SEA could not be shown. [ABSTRACT FROM AUTHOR]

Three different species of Sphagnum mosses originating from a bog ('Hochmoor') were examined with respect to their behaviour of accumulation of heavy metal ions lead and cadmium. A strong bond of double charged Pb could be found independent of the Sphagnum species. When competitive reactions were performed in test solutions, with two ions (Pb and one alkali or one earthalkali ion) or three (Pb and one earthalkali and one alkali ion) Pb was always accumulated too. This leads to a suppression of exchange of the other ions. Cadmium is by far less strongly bound than lead. Cadmium was tested in combination with two or three ions as was done for lead. The behaviour of cadmium adsorption is similar to that of calcium. For a number of ions typical tendencies were observed, which give insight in the quantity and strength of their binding to the exchanging material. The following series of accumulation was found: Pb>Cd≥Ca>Mg>K>Na≥NH. (Accumulation was determined in test solutions containing each ion in the concentration 0.01N.) Differences in this series selectivity could not be found within the three Sphagnum species. But there exist typical differences in the total amount of adsorbed ions per unit dry weight. This species specific value corresponds with total capacities for ion exchange of the three species. Furthermore acid strength as well as pH-dependence of the ion exchanging Sphagnum material were investigated. Its physico-chemical behaviour may be described as that of a weak acid polyelectrolyte with variable charge, depending on ionic strength. [ABSTRACT FROM AUTHOR]

Chemical equilibrium of ion exchange reactions of Sphagnum mosses was investigated for four different combinations of ions. These combinations were: Pb/Ca; Cd/Ca; Pb/K; Cd/K. Based on the law of mass action one can find mathematical descriptions of ion exchange reactions which permit one to calculate a state of equilibrium. As a measure of ion selectivity a rational coefficient of selectivity can be used. For culture experiments three different species of Sphagnum originating from a bog ('Hochmoor') in southern Bavaria were used. With these species coefficients of selectivity of the mentioned heavy metals were determined in solutions of different total ion content. Furthermore for each test solution of fixed total concentration the portions of the ions were altered. The Sphagnum material shows the behaviour of a relative ideal ion exchanger, whose states of equilibrium can be well described by the mathematical equations. The coefficients of selectivity are independent of Sphagnum species. In all cases they reflect the preferred binding of lead to the exchanger. Cadmium and calcium are adsorbed in approximately equivalent amounts. Representative limit isotherms permit an estimation of the errors caused by variation of the rational coefficients of selectivity. The applicability of the determined interactions and regularities on heavy metal monitoring programs is discussed. [ABSTRACT FROM AUTHOR]

The Navier-Stokes equations for circular pipe flow are integrated using direct numerical simulation for the case of transitional Reynolds number. Previous work on linear disturbances (reported in Part I) is exploited for the simulation of low to moderate amplitude disturbances where it is found that the transient growth mechanism persists in the nonlinear development with the evolution attributable to the linear mechanism remaining of considerable significance. A hypothesis of Trefethen et al. [Science 261, 578 (1993)] concerning the role of nonlinearity in the transition process and ultimately in turbulence is elucidated and given support. It is suggested that nonlinearity is essential in continually perturbing the eigenmodes of the flow in such a way that each mode is never permitted to relax to its least stable eigenstate (damped in the subcritical case). In this way, the linear growth mechanism can be regarded as an underpinning component of the general nonlinear feedback insofar as it is the only part which can extract energy from the mean flow and thus yield a net increase in disturbance energy. The physical aspects of the flow simulations are consistent with puff formation where, using a pair of helical waves as initial data, a sharp trailing front is formed naturally; axisymmetric ring vortices are generated and the general flow characteristics are in broad agreement with experiment. [ABSTRACT FROM AUTHOR]

The behavior of very low-amplitude disturbances in a circular pipe is considered. Direct simulation of the Navier-Stokes equations is used to compute the evolution of two- and three-dimensional waves and the results are found to be in good agreement with solutions to the Orr-Sommerfeld equation for Hagen-Poiseuille flow. Transient growth mechanisms are also investigated computationally, in which case it is found that the growth of disturbances with large but finite streamwise wavelength exhibits a very rich structure of temporal evolution depending on the particular initial condition chosen. Comparison with recent results reported by Bergstriim on optimal disturbances is also given. In Part II of this study these findings will be extended to the nonlinear development of like disturbances. [ABSTRACT FROM AUTHOR]

We present a measurement technique designed to accurately measure small flow rates near atmospheric pressure, and demonstrate the ability to measure flows on the order of 10-10 mol/sec. The technique is based upon a modification of a constant-volume mass accumulation scheme where the flow rate is measured by monitoring the change in pressure of a known volume of gas. We identify two phenomena, thermally-induced fluctuations and thermodynamically-induced fluctuations, which will affect the resolution and dynamic range of the instrumentation and discuss how the problems associated with them can be mitigated. We estimate the resolution to be approximately 2.0×10-13 mol/s, and the maximum measurable flow rate to be to the order 2×10-9 mol/s. [ABSTRACT FROM AUTHOR]

The calibration of high-bandwidth sensors is typically carried out in an steady environment or at least a well-controlled unsteady flow. A simple technique for calibration of sensors in flow fields with arbitrary unsteadiness (such as a turbulent field) is described. Although the method requires a DC reference measurement at each calibration point, the resulting calibration is accurate for both average and unsteady measurements up to the full bandwidth of the sensor. Applications and limitations of the technique are also discussed. [ABSTRACT FROM AUTHOR]