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Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Changes in ACTH challenge test characteristics in dairy cows changing their physiological status at different lactational stages and different feeding levels were not investigated in terms of repeatability yet. In 23 multiparous Holstein cows (10 cows fed a sole fresh herbage diet without concentrate, 13 cows fed with concentrate), three ACTH challenge tests were performed: once during pregnancy shortly prior to drying off ( T1), and in week 3 ( T2) and 8 ( T3) after parturition. Test characteristics were correlated to performance and metabolic parameters: DMI, BW, energy balance ( EB), plasma concentrations of free fatty acids ( NEFA) and beta-hydroxybutyrate ( BHB). Basal plasma cortisol concentrations were higher at T1 compared with T2 and T3 ( p < .05). The adrenal cortex sensitivity (expressed as total AUC ( AUCt) of cortisol response after ACTH application) was lowest at T2 compared with T1 and T3 ( p < .05). Ranking of the individual animals' responses was not repeatable between time points of the ACTH tests. Enhancing the energy deficiency during early lactation by omission of concentrate did not affect baseline cortisol concentrations in plasma, but decreased peak height at T2 ( p < .05). Baseline plasma cortisol concentrations were positively correlated with cortisol peak values after ACTH application, previous lactation performance, milk yield and BW ( p < .05). The AUCt was positively correlated with baseline cortisol concentrations, EB and DMI. Cortisol release after ACTH injection was lower in animals with high plasma concentrations of NEFA, BHB and with higher contents of fat and free fatty acids in milk ( p < .05). Cortisol peak height after ACTH administration was higher in cows with a more positive EB, higher DMI and lower plasma concentrations of NEFA and BHB. In summary, cortisol responses to ACTH challenges in this study were not repeatable in dairy cows changing their physiological status. [ABSTRACT FROM AUTHOR]

Herbage feeding with only little input of concentrates plays an important role in milk production in grassland dominated countries like Switzerland. The objective was to investigate the effects of a solely herbage-based diet and level of milk production on performance, and variables related to the metabolic, endocrine and inflammatory status to estimate the stress imposed on dairy cows. Twenty-five multiparous Holstein cows were divided into a control (C+, n = 13) and a treatment group (C−, n = 12), according to their previous lactation yield (4679-10 808 kg) from week 3 ante partum until week 8 post-partum (p.p.). While C+ received fresh herbage plus additional concentrate, no concentrate was fed to C− throughout the experiment. Within C+ and C−, the median of the preceding lactation yields (7752 kg) was used to split cows into a high ( HYC+, HYC−)- and low-yielding ( LYC+, LYC−) groups. Throughout the study, HYC+ had a higher milk yield (35.9 kg/d) compared to the other subgroups (27.2-31.7 kg/d, p < 0.05). Plasma glucose (3.51 vs. 3.72 mmol/l) and IGF-1 (66.0 vs. 78.9ng/ mL) concentrations were lower in HYC−/ LYC− compared to HYC+/ LYC+ cows (p < 0.05). Plasma FFA and BHBA concentrations were dramatically elevated in HYC− (1.1 and 1.6 mmol/l) compared to all other subgroups (mean values: 0.5 and 0.6 mmol/l, p < 0.05). Saliva cortisol, plasma concentrations of serum amyloid A ( SAA), haptoglobin (Hp), beta-endorphin ( BE) and activity of alkaline phosphatase ( AP) were not different between C+ and C−. In conclusion, herbage-fed high-yielding cows without supplementary concentrate experienced a high metabolic load resulting in a reduced performance compared to cows of similar potential fed accordingly. Low-yielding cows performed well without concentrate supplementation. Interestingly, the selected markers for inflammation and stress such as cortisol, Hp, SAA, BE and AP gave no indication for the metabolic load being translated into compromised well-being. [ABSTRACT FROM AUTHOR]

Background: The isolation of Propionibacterium acnes in blood cultures is often considered a contaminant. On rare occasions, P. acnes can cause severe infections, including endocarditis and intravascular prosthesis-associated infections. To evaluate the discrimination between a contaminant and a clinically relevant infection we used an Ouchterlony test system to quantify the antibody response to P. acnes in a patient with a proven P. acnes endocarditis. Case Presentation: We report on a 64-year-old Caucasian man who developed P. acnes endocarditis four years following a composite valve-graft conduit replacement of the aortic root. Bacterial growth in blood cultures was detected after an incubation period of 6 days. However, the antibody titer to P. acnes was 1:8 at the time of diagnosis and declined slowly thereafter over 2½ years. The patient's response to the antibiotic treatment was excellent, and no surgical re-intervention was necessary. Conclusion: The working hypothesis of infective endocarditis can be substantiated by serologic testing, which, if positive, provides one additional minor criterion. Moreover, quantification of the antibody response to P. acnes, though not specific, may assist in the differentiation between contaminants and an infection. This quantification may have implications for the patient management, e.g. indication for and choice of the antibiotic therapy. [ABSTRACT FROM AUTHOR]

The HAMSTRAD (H2O Antarctica Microwave Stratospheric and Tropospheric Radiometers) instrument is a microwave radiometer installed at Dome C (Antarctica, 75°06'S, 123°21'E, 3233 m a.m.s.l.) dedicated to the tropospheric measurements of temperature, absolute humidity and integrated water vapour (IWV). The aim of the present paper is to review the entire HAMSTRAD dataset from 2009 to 2014 with a 7-minute integration time from 0 to 10 km by comparison with coincident radiosondes launched at 12h00 UTC at Dome C. Based upon an extensive evaluation of biases and time correlation coefficients (r), we can state: i) IWV is of excellent quality (r>0.98) and can be used without retrieving significant bias, ii) temperature is suitable for scientific analyses over 0–10 km with a high time correlation with radiosondes (r>0.80) and iii) absolute humidity is suitable for scientific analyses over 0–4 km with a moderate time correlation against radiosondes (r>0.70). The vertical distribution of temperature (0–10 km) and absolute humidity (0–4 km) is subject to biases that need to be removed if the analyses require the use of vertical profiling. The HAMSTRAD dataset is provided in open access to the scientific community. [ABSTRACT FROM AUTHOR]

The space and time variabilities of methane (CH4) total column and upper tropospheric mixing ratios are analyzed above the Mediterranean Basin (MB) as part of the Chemical and Aerosol Mediterranean Experiment (ChArMEx) programme. Spaceborne measurements from the Thermal And Near infrared Sensor for carbon Observations-Fourier Transform Spectrometer (TANSO-FTS) instrument on the Greenhouse gases Observing SATellite (GOSAT) satellite, the Atmospheric InfraRed Spectrometer (AIRS) on the AURA platform and the Infrared Atmospheric Sounder Interferometer (IASI) instrument aboard the MetOp-A platform are used in conjunction with model results from the Chemical Transport Model (CTM) MOCAGE, and the Chemical Climate Models CCMs) CNRM-AOCCM and LMDz-OR-INCA (according to different emission scenarios). In order to minimize systematic errors in the spaceborne measurements, we have only considered maritime pixels over the MB. The period under interest spans from 2008 to 2011 considering satellite and MOCAGE data and, regarding the CCMs, from 2001 to 2010. An East-West gradient in CH4 is observed and modelled whatever the season considered. In winter, air masses mainly originating from Atlantic Ocean and Europe tend to favour an elevated amount of mid-to-upper tropospheric CH4 in the West vs. the East of the MB, with a general upward transport above the MB. In summer, the meteorological state of the MB is changed, favouring air from Northern Africa and Middle East together with Atlantic Ocean and Europe, with a general downward motion above the MB. The Asian Monsoon traps and uplifts high amounts of CH4 that are transported towards North Africa and Middle East by the Asian Monsoon Anticyclone to finally reach and descent in the East of the MB. Consequently, the mid-to-upper tropospheric CH4 is much greater in the East than in the West of the MB. The seasonal variation of the difference in CH4 between the East and the West MB does show a maximum in summer for pressures from 500 to 100 hPa considering both spaceborne measurements and model results whatever the emission scenarios used. From this study, we can conclude that CH4 in the mid-to-upper troposphere over the MB is mainly affected by long-range transport, particularly intense in summer from Asia. In the low-to-mid troposphere, the local sources of emission in the vicinity of the MB mainly affect the CH4 variability. [ABSTRACT FROM AUTHOR]

The objective of this paper is to deliver the most accurate ozone (O3) and carbon monoxide (CO) climatology for the pure troposphere only, i.e. exclusively from the ground to the dynamical tropopause on an individual profile basis. The results (profiles and columns) are derived solely from the Measurements of OZone and water vapour by in-service AIrbus airCraft programme (MOZAIC) over 15 years (1994-2009). The study, focused on the northern midlatitudes [24-50° N] and [119°W-140° E], includes more than 40 000 profiles over 11 sites to give a quasi-global zonal picture. Considering all the sites, the pure tropospheric column peak-to-peak seasonal cycle ranges are 23.7-43.2DU for O3 and 1.7-6.9×1018 moleculescm-2 for CO. The maxima of the seasonal cycles are not in phase, occurring in February-April for CO and May-July for O3. The phase shift is related to the photochemistry and OH removal efficiencies. The purely tropospheric seasonal profiles are characterized by a typical autumn-winter/spring-summer O3 dichotomy (except in Los Angeles, Eastmed - a cluster of Cairo and Tel Aviv - and the regions impacted by the summer monsoon) and a summer-autumn/winter-spring CO dichotomy. We revisit the boundary-layer, mid-tropospheric (MT) and uppertropospheric (UT) partial columns using a new monthly varying MT ceiling. Interestingly, the seasonal cycle maximum of the UT partial columns is shifted from summer to spring for O3 and to very early spring for CO. Conversely, the MT maximum is shifted from spring to summer and is associated with a summer (winter) MT thickening (thinning). Lastly, the pure tropospheric seasonal cycles derived from our analysis are consistent with the cycles derived from spaceborne measurements, the correlation coefficients being r = 0.6-0.9 for O3 and r > 0.9 for CO. The cycles observed from space are nevertheless greater than MOZAIC for O3 (by 9-18 DU) and smaller for CO (up to 1×1018 moleculescm-2). The larger winter O3 difference between the two data sets suggests probable stratospheric contamination in satellite data due to the tropopause position. The study underlines the importance of rigorously discriminating between the stratospheric and tropospheric reservoirs and avoiding use of a monthly averaged tropopause position without this strict discrimination in order to assess the pure O3 and CO tropospheric trends. [ABSTRACT FROM AUTHOR]

The influence of stratospheric ozone on the interannual variability and trends in tropospheric ozone is evaluated between 30 and 90 N from 1990-2009 using ozone measurements and a global chemical transport model, the Community Atmospheric Model with chemistry (CAM-chem). Long-term measurements from ozonesondes, at 150 and 500 hPa, and the Measurements of OZone and water vapour by in-service Airbus aircraft programme (MOZAIC), at 500 hPa, are analyzed over Japan, Canada, the Eastern US and Northern and Central Europe. The measurements generally emphasize northern latitudes, although the simulation suggests that measurements over the Canadian, Northern and Central European regions are representative of the large-scale interannual ozone variability from 30 to 90 N at 500 hPa. CAM-chem is run with input meteorology from the National Center for Environmental Prediction; a tagging methodology is used to identify the stratospheric contribution to tropospheric ozone concentrations. A variant of the synthetic ozone tracer (synoz) is used to represent stratospheric ozone. Both the model and measurements indicate that on large spatial scales stratospheric interannual ozone variability drives significant tropospheric variability at 500 hPa and the surface. In particular, the simulation and the measurements suggest large stratospheric influence at the surface sites of Mace Head (Ireland) and Jungfraujoch (Switzerland) as well as many 500 hPa measurement locations. Both the measurements and simulation suggest the stratosphere has contributed to tropospheric ozone trends. In many locations between 30-90 N 500 hPa ozone significantly increased from 1990-2000, but has leveled off since (from 2000-2009). The simulated global ozone budget suggests global stratosphere-troposphere exchange increased in 1998-1999 in association with a global ozone anomaly. Discrepancies between the simulated and measured ozone budget include a large underestimation of measured ozone variability and discrepancies in long-term stratospheric ozone trends. This suggests the need for more sophisticated simulations including better representations of stratospheric chemistry and circulation. [ABSTRACT FROM AUTHOR]

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The aim of this quality control study was to assess the time to initial diagnostic procedures and the time to the first dose of antibiotics in patients with pneumococcal bacteremia, and to investigate whether the timeliness of these interventions influenced outcome. Methods: We retrospectively studied patient characteristics, chronological sequence of diagnostic and therapeutic steps, and the course of disease of all patients with pneumococcal bacteremia at a Swiss university hospital between 2003 and 2009, and we analyzed associations between these factors and the length of hospital stay (LOS) and mortality. Results: A total of 102 episodes of pneumococcal bacteremia in 98 patients were analyzed, of whom 15.7% died during hospitalization. The median time (interquartile range [IQR]) to the first antibiotic dose was 4.0 (2.0-5.9) h, and the median times (IQR]) to blood cultures, chest radiograph, lumbar puncture, and brain computed tomography (CT) scan or magnetic resonance imaging (MRI) were 1.4 (0.5-3.3), 2.5 (1.2-4.2), 4.2 (2.7-7.2), and 2.3 (0.6-6.2) h, respectively. The time to diagnostic procedures and therapy were not associated with LOS or death. Risk factors for death in the univariable analysis were: Charlson comorbidity index [odds ratio [OR] (95% confidence interval) per unit increase, 1.3 (1.1-1.6)], neutropenia [OR 10.1 (2.0-51.0)], human immunodeficiency virus (HIV) infection [OR 3.9 (1.1-13.8)], chronic respiratory disease [OR 4.4 (1.2-16.0)], chronic liver disease [OR 3.2 (1.0-9.7)], smoking [OR 3.8 (1.1-13.5)], injection drug use [OR 9.7 (1.5-63.7)], and antibiotic therapy within 6 months before admission [OR 4.0 (1.3-12.5)]. The multivariable analysis revealed age >60 years ( P = 0.048) and alcoholism ( P = 0.009) as risks for prolonged LOS. Conclusions: The outcome of pneumococcal bacteremia may be more influenced by patient characteristics than by minor differences in the timeliness of initial diagnostic and therapeutic measures within the first several hours after hospital admission. [ABSTRACT FROM AUTHOR]

Background: Extended-spectrum β-lactamases (ESBLs) are an increasing challenge in the treatment of urinary tract infections (UTIs), and also in the community. We aimed to investigate the characteristics of patients with UTIs due to ESBL-producing Escherichia coli and to assess the risk factors for ESBLs in community-acquired isolates. Methods: We performed a retrospective study from January 1, 2007 to December 31, 2009 at a tertiary care teaching hospital in Switzerland, comparing patients with community-acquired versus healthcare-associated UTIs due to ESBL-producing E. coli. Additionally, we investigated the antimicrobial susceptibility of these isolates. Results: A total of 123 patients were studied, of whom 79 (64%) had community-acquired and 44 (36%) had healthcare-associated UTIs. Community-acquired isolates were associated with acute uncomplicated UTIs (odds ratio [OR] 6.62, 95% confidence interval [CI] 1.83-36.5, P < 0.001). Risk factors were recurrent UTI (OR 3.04, 95% CI 1.14-9.14, P = 0.022) and female sex (OR 2.46, 95% CI 1.01-6.08). Community-acquired ESBL-producing E. coli urinary isolates showed high resistance rates to most of the currently used oral antimicrobial agents, including β-lactam antibiotics (amoxicillin-clavulanic acid, 69.6% resistance), quinolones (ciprofloxacin, 84.8% resistance; norfloxacin, 83.9% resistance), and trimethoprim-sulfamethoxazole (75.9% resistance), except for nitrofurantoin (15% resistance) and fosfomycin (0% resistance). Conclusion: UTI due to ESBL-producing E. coli are emerging, and also in a country with low antibiotic use. Because of increasing antibiotic resistance rates of E. coli to current standard therapy and because of the resistance patterns of ESBL-producing E. coli, guidelines for the management of UTIs must be revised. Fosfomycin or nitrofurantoin are recommended for the first-line empirical oral treatment of community-acquired uncomplicated UTIs. [ABSTRACT FROM AUTHOR]

Background: Extended-spectrum β-lactamases (ESBLs) are an increasing challenge in the treatment of urinary tract infections (UTIs), and also in the community. We aimed to investigate the characteristics of patients with UTIs due to ESBL-producing Escherichia coli and to assess the risk factors for ESBLs in community-acquired isolates. Methods: We performed a retrospective study from January 1, 2007 to December 31, 2009 at a tertiary care teaching hospital in Switzerland, comparing patients with community-acquired versus healthcare-associated UTIs due to ESBL-producing E. coli. Additionally, we investigated the antimicrobial susceptibility of these isolates. Results: A total of 123 patients were studied, of whom 79 (64%) had community-acquired and 44 (36%) had healthcare-associated UTIs. Community-acquired isolates were associated with acute uncomplicated UTIs (odds ratio [OR] 6.62, 95% confidence interval [CI] 1.83-36.5, P < 0.001). Risk factors were recurrent UTI (OR 3.04, 95% CI 1.14-9.14, P = 0.022) and female sex (OR 2.46, 95% CI 1.01-6.08). Community-acquired ESBL-producing E. coli urinary isolates showed high resistance rates to most of the currently used oral antimicrobial agents, including β-lactam antibiotics (amoxicillin-clavulanic acid, 69.6% resistance), quinolones (ciprofloxacin, 84.8% resistance; norfloxacin, 83.9% resistance), and trimethoprim-sulfamethoxazole (75.9% resistance), except for nitrofurantoin (15% resistance) and fosfomycin (0% resistance). Conclusion: UTI due to ESBL-producing E. coli are emerging, and also in a country with low antibiotic use. Because of increasing antibiotic resistance rates of E. coli to current standard therapy and because of the resistance patterns of ESBL-producing E. coli, guidelines for the management of UTIs must be revised. Fosfomycin or nitrofurantoin are recommended for the first-line empirical oral treatment of community-acquired uncomplicated UTIs. [ABSTRACT FROM AUTHOR]

We evaluate the influence of stratospheric ozone on the interannual variability and trends in tropospheric ozone from 30-90° N between 1990 and 2009 using ozone measurements and a global chemical transport model (the Community Atmospheric Model with chemistry) with input meteorology from the National Center for Environmental Prediction. The model simulation uses constant interannual emissions. Both the model and measurements indicate that on large spatial scales stratospheric interannual ozone variability drives significant tropospheric variability and contributes to long-term tropospheric ozone trends. To diagnose the measured variability we utilized measurements from ozonesondes and the Measurements of OZone and water vapour by in-service Airbus airCraft programme (MOZAIC) north of 30° N. We identify a regionally robust 150 hPa ozone signal from measurements over Canadian, Northern European and Central European regions and at 500 hPa over Canadian, Northern European and Eastern US regions. Averaged over these regions, the 150 hPa interannual ozone variability explains 69% of the interannual variability at 500 hPa. The simulated stratospheric signal explains 81% of the simulated variability over these same regions. Simulated and measured ozone are significantly correlated over these regions and the simulation suggests that the ozone record over these regions is representative of the overall hemispheric 500 hPa ozone record from 30-90° N. The measured 500 hPa trends averaged over these three regions between 1990 and 2000 and 1990 and 2009 are 0.73 (±0.51) ppbv yr-1 and 0.27 (±0.19) ppbv yr-1, respectively. The simulated trends in 1990-2000 and 1990-2009 are 0.29±0.10 ppbv yr-1 and 0.13±0.05 ppbv yr-1, respectively; however, these trends are substantially larger when the model is sampled for missing data exactly as the measurements are. Simulated stratospheric ozone accounts for 79% of the simulated 500 hPa trend between 1990 and 2000 and 100% of the simulated trend between 1990 and 2009. Due to the importance of local meteorology and emissions at the surface it is difficult to isolate the stratospheric component of measured surface ozone variability. Overall when averaged between 30-90° N simulated surface interannual ozone trends are 0.18 ppbv yr-1 and 0.07 ppbv yr-1 between 1990 and 1999, and between 1990 and 2009, respectively. We have identified a number of surface sites where the measured interannual ozone variability is correlated with the 150 hPa ozone signal. Most notably these sites include the high mountain sites over Europe and Macehead, Ireland. Over Macehead the measured 150 hPa ozone signal explains 40% of the interannual variability of the unfiltered measured ozone record. The simulated and measured ozone are highly correlated over Macehead. The Macehead measured and simulated unfiltered ozone trends between 1990 and 2000 are 0.28 (±0.33) and 0.17 (±0.13) ppbv yr-1 respectively; between 1990 and 2009 the measured and simulated trends are 0.18 (±0.11) and 0.08 (±0.06) ppbv yr-1, respectively. Increases in the simulated stratospheric ozone component accounts for 53% and 75% of the overall modeled trend for the two periods at Macehead. [ABSTRACT FROM AUTHOR]

There are considerable geographical differencesin the occurrence of extended-spectrum beta-lactamase(ESBL)-producing bacteria, both in the community and in thehospital setting. Our aim was to assess risk factors forbloodstream, urinary tract, and vascular catheter-associatedinfections with ESBL-producing Escherichia coli and Klebsiellapneumoniae at a tertiary care hospital in a low-prevalencecountry. We performed a case-control study comparing 58patients with infections due to ESBL-producing E. coli or K. pneumoniae vs 116 controls with infections due to non-ESBL producing organisms at the University Hospital Zurich,Switzerland, between 1 July 2005 and 30 June 2007. Cases included 15 outpatients and 43 inpatients.Multivariable analyses found three risk factors for ESBL-producingisolates: begin of symptoms or recent antibioticpre-treatment in a foreign country (odds ratio [OR] 27.01,95% confidence interval [CI] 2.38–1,733.28], p = 0.042),antibiotic therapy within the year preceding the isolation ofthe ESBL-producing strain (OR 2.88, 95% CI 1.13–8.49,p = 0.025), and mechanical ventilation (OR 10.56, 95% CI1.06–579.10, p = 0.042). The major risk factors for infections due toESBL-producing bacteria were travel in high-prevalencecountries, prior antibiotic use, and mechanical ventilationduring a stay in the intensive care unit. Community-acquiredinfections were documented in 17% of the patients.An early identification of risk factors is crucial to providingthe patients an optimal empiric antibiotic therapy and tokeep the use of carbapenems to a minimum. [ABSTRACT FROM AUTHOR]

A periodic survey of methicillin-resistant Staphylococcus aureus (MRSA) in Zurich in 2004 and 2006 revealed a consistently low prevalence of MRSA. SCC mec and ccr typing showed fluctuations in the proportions of SCC mec types and in the carriage of mobile virulence determinants. Together with the presence of variant SCC mecs these findings suggest a high clonal diversity and level of SCC mec recombination. The prevalence of a local “drug clone", associated with low-level methicillin resistance and rapid growth, significantly decreased. This clone had spread among intraveneous drug users, steadily increasing from 1994 to 2001 and was dominant in 2001. Apparently, changes in the management of the Zurich drug scene have restricted the spread of this clone. [ABSTRACT FROM AUTHOR]

Staphylococcus lugdunensis endocarditis has been associated with an aggressive course. The aim of this study was to determine factors associated with the development of endocarditis in patients with S. lugdunensis bacteremia. A retrospective analysis of all patients with S. lugdunensis bacteremia in three tertiary care centers in Switzerland was performed. Data regarding medical history, symptoms, and susceptibility of S. lugdunensis isolates were collected. Our results were reviewed in the context of the current literature. A total of 28 patients with S. lugdunensis bacteremia were identified. Of the 13 patients with endocarditis, all were community acquired. Cardiac surgery was performed in 85% of these patients; mortality was 23%, reflecting the aggressive course of this disease. In contrast, in the 15 patients without endocarditis, no complications associated with S. lugdunensis bacteremia were observed. In 73%, a probable source was identified in the form of a venous catheter or other foreign device. Only three of these episodes were community acquired. No difference was observed in susceptibility of the S. lugdunensis isolates to penicillin, which was 77% in endocarditis isolates, and 87% in isolates of bacteremia without endocarditis, respectively. S. lugdunensis bacteremia is associated with endocarditis in up to 50% of patients. Every patient with community-acquired S. lugdunensis bacteremia should be carefully examined for signs of endocarditis. Once S. lugdunensis endocarditis is diagnosed, close monitoring is essential and surgical treatment should be considered early. In the nosocomial setting, endocarditis is far less frequent, and S. lugdunensis bacteremia is usually associated with a catheter or other foreign materials. [ABSTRACT FROM AUTHOR]

This study presents an analysis of both MOZAIC profiles above Frankfurt and Lagrangian dispersion model simulations for the 2003 European heat wave. The comparison of MOZAIC measurements in summer 2003 with the 11-year MOZAIC climatology reflects strong temperature anomalies (exceeding 4°C) throughout the lower troposphere. Higher positive anomalies of temperature and negative anomalies of both wind speed and relative humidity are found for the period defined here as the heat wave (2–14 August 2003), compared to the periods before (16–31 July 2003) and after (16–31 August 2003) the heat wave. In addition, Lagrangian model simulations in backward mode indicate the suppressed long-range transport in the mid- to lower troposphere and the enhanced southern origin of air masses for all tropospheric levels during the heat wave. Ozone and carbon monoxide also present strong anomalies (both ∼+40 ppbv) during the heat wave, with a maximum vertical extension reaching 6 km altitude around 11 August 2003. Pollution in the planetary boundary layer (PBL) is enhanced during the day, with ozone mixing ratios two times higher than climatological values. This is due to a combination of factors, such as high temperature and radiation, stagnation of air masses and weak dry deposition, which favour the accumulation of ozone precursors and the build-up of ozone. A negligible role of a stratospheric-origin ozone tracer has been found for the lower troposphere in this study. From 29 July to 15 August 2003 forest fires burnt around 0.3×106 ha in Portugal and added to atmospheric pollution in Europe. Layers with enhanced CO and NOy mixing ratios, advected from Portugal, were crossed by the MOZAIC aircraft in the free troposphere over Frankfurt. A series of forward and backward Lagrangian model simulations have been performed to investigate the origin of anomalies during the whole heat wave. European anthropogenic emissions present the strongest contribution to the measured CO levels in the lower troposphere (near 30%). This source is followed by Portuguese forest fires which affect the lower troposphere after 6 August 2003 and even the PBL around 10 August 2003. The averaged biomass burning contribution reaches 35% during the affected period. Anthropogenic CO of North American origin only marginally influences CO levels over Europe during that period. [ABSTRACT FROM AUTHOR]

Continuous CO measurements performed at 3 high-altitude stations in France are analyzed for the first time. Data are provided by the new PAES (Pollution Atmospherique à l'Echelle Synoptique) network since 2002 for the Puy de Dôme and 2004 for the Pic du Midi and the Donon. CO measurements of 5 another European stations have been analysed to put the PAES stations in an European perspective. The January 2002-April 2005 CO mean levels of surface stations capture the stratification revealed by climatological CO profiles from the airborne observation system MOZAIC (Measurement of OZone and water vapour by Airbus In-service Aircraft). The deviation between the free tropospheric reference MOZAIC and surface data above 2000m is less than 10% and this deviation can be explained in term of spatial variability, as evidenced by MOPITT CO retrievals at 700 hPa. This suggests that, averaged at a seasonal time scale (4 months), surface data at stations above 2000m are representative of background CO concentration. This paper focuses then on trends since the 1980s-1990s. The comparison between old (1982-1983) and recent CO mixing ratio (2005) at the Pic du Midi leads to a 10% decrease, consistent with the continuous data series at Zugspitze (ZSP) from 1991 to 2004. This decrease was found to be mainly due to a negative trend of January-April mean levels. The decrease in CO sources over France and Europe appears to be responsible for that trend. The stable values of June-September mean levels suggest that the summertime oxidizing capacity of the atmosphere related to OH radicals is important enough to counterbalance any CO inputs into the troposphere. Our study shows a recent change in CO evolution since 2000 over Western Europe, with a slowed down decrease in CO concentration. Studying specifically the interactions between CO, CH4 and OH turns out to be needed, however, to find definitive explanations to those observations. [ABSTRACT FROM AUTHOR]

The PAES (French acronym for synoptic scale atmospheric pollution) network focuses on the chemical composition (ozone, CO, NOx/y and aerosols) of the lower troposphere (0-3000 m). Its high-altitude surface stations located in different mountainous areas in France complete the low-altitude rural MERA stations (the French contribution to the european program EMEP, European Monitoring and Evaluation Program). They are representative of pollution at the scale of the French territory because they are away from any major source of pollution. This study deals with ozone observations between 2001 and 2004 at 11 stations from PAES and MERA, in addition to 16 elevated stations located in mountainous areas of Switzerland, Germany, Austria, Italy and Spain. The set of stations covers a range of altitudes between 115 and 3550 m. The comparison between recent ozone mixing ratios to those of the last decade at Pic du Midi (2877 m), as well as trends calculated over 14-year data series at three high-altitude sites in the Alps (Jungfraujoch, Sonnblick and Zugspitze) reveal that ozone is still increasing but at a slower rate than in the 1980s and 1990s. The 2001-2004 mean levels of ozone from surface stations capture the ozone stratification revealed by climatological profiles from the airborne observation system MOZAIC (Measurement of OZone and water vapour by Airbus In-service airCraft) and from ozone soundings above Payerne (Switzerland). In particular all data evidence a clear transition at about 1000-1200ma.s.l. between a sharp gradient below (of the order of +30 ppb/km) and a gentler gradient (+3 ppb/km) above. The same altitude (1200 m) is also found to be a threshold regarding how well the ozone levels at the surface stations agree with the free-tropospheric reference (MOZAIC or soundings). Below the departure can be as large as 40%, but suddenly drops within 15% above. For stations above 2000 m, the departure is even less than 8%. Ozone variability also reveals a clear transition between boundary-layer and free-tropospheric regimes around 1000ma.s.l. Below, diurnal photochemistry accounts for about the third of the variability in summer, but less than 20% above -- and at all levels in winter -- where ozone variability is mostly due to day-to-day changes (linked to weather conditions or synoptic transport). In summary, the altitude range 1000-1200m clearly turns out in our study to be an upper limit below which specific surface effects dominate the ozone content. Monthly-mean ozone mixing-ratios show at all levels a minimum in winter and the classical summer broad maximum in spring and summer -- which is actually the superposition of the tropospheric spring maximum (April-May) and regional pollution episodes linked to persistent anticyclonic conditions that may occur from June to September. To complement this classical result it is shown that summer maxima are associated with considerably more variability than the spring maximum. This ensemble of findings support the relevance of mountain station networks such as PAES for the long-term observation of free-tropospheric ozone over Europe. [ABSTRACT FROM AUTHOR]

The PAES (French acronym for synoptic scale atmospheric pollution) network focuses on the chemical composition (ozone, CO, NOx/y and aerosols) of the lower troposphere (0-3000 m). Its high-altitude surface stations located in different mountainous areas in France complete the low-altitude rural MERA stations (the French contribution to the european program EMEP, European Monitoring and Evaluation Program). They are representative of pollution at the scale of the French territory because they are away from any major source of pollution. This study deals with ozone observations between 2001 and 2004 at 11 stations from PAES and MERA, in addition to 16 elevated stations located in mountainous areas of Switzerland, Germany, Austria, Italy and Spain. The set of stations covers a range of altitudes between 115 and 3550 m. The comparison between recent ozone mixing ratios with those of the last decade found in the literature for two high-elevation sites (Pic du Midi, 2877m and Jungfraujoch, 3580 m) leads to a trend that has slowed down compared to old trends but remains positive. This could be attribuable to the reduction of ozone precursors at European scale, that however do not compensate an ozone increase at the global scale. Averaged levels of ozone increase with elevation in good agreement with data provided by the airborne observation system MOZAIC (Measurement of OZone and water vapour by Airbus In-service airCraft), showing a highly stratified ozone field in the lower troposphere, with a transition at about 1000m asl between a sharp gradient (30 ppb/km) below but a gentler gradient (3 ppb/km) above. Ozone variability also reveals a clear transition between boundary-layer and free-tropospheric regimes at the same altitude. Below, diurnal photochemistry accounts for about the third of the variability in summer, but less than 20% above -- and at all levels in winter--where ozone variability is mostly due to day-to-day changes (linked to weather conditions or synoptic transport). Monthly-mean ozone mixing-ratios show at all levels a minimum in winter and the classical summer broad maximum in spring and summer--which is actually the superposition of the tropospheric spring maximum (April-May) and regional pollution episodes linked to persistent anticyclonic conditions that may occur from June to September. To complement this classical result it is shown that summer maxima are associated with considerably more variability than the spring maximum. This ensemble of findings support the relevance of mountain station networks such as PAES for the long-term observation of free-tropospheric ozone over Europe. [ABSTRACT FROM AUTHOR]

We present a case study of interleaving in the free troposphere of 4 layers of nontropospheric origin, with emphasis on their residence time in the troposphere. Two layers are stratospheric intrusions at 4.7 and 2.2 km altitude with residence times of about 2 and 6.5 days, respectively. The two other layers at 7 and 3km altitude were extracted from the maritime planetary boundary layer by warm conveyor belts associated with two extratropical lows and have residence times of about 2 and 5.75 days, respectively. The event took place over Frankfurt (Germany) in February 2002 and was observed by a commercial airliner from the MOZAIC programme with measurements of ozone, carbon monoxide and water vapour. Origins and residence times in the troposphere of these layers are documented with a trajectory and particle dispersion model. The combination of forward and backward simulations of the Lagrangian model allows the period of time during which the residence time can be assessed to be longer, as shown by the capture of the stratospheric-origin signature of the lowest tropopause fold just about to be completely mixed above the planetary boundary layer. This case study is of interest for atmospheric chemistry because it emphasizes the importance of coherent airstreams that produce laminae in the free troposphere and that contribute to the average tropospheric ozone. The interleaving of these 4 layers also provides the conditions for a valuable case study for the validation of global chemistry transport models used to perform tropospheric ozone budgets. [ABSTRACT FROM AUTHOR]

Background: Successful treatment of allograft infections by the temporary implantation of an antibiotic-loaded polymethylmethacrylate cement spacer depends on the diffusion of antibiotics out of the cement and inhibition of bacterial growth in the surrounding tissue. We investigated with an in vitro model how long antibiotics are released by the cement and if gentamicin-resistant coagulase-negative staphylococci (CNS) are inhibited by vancomycin mixed with the gentamicin-loaded cement. Materials and Methods: Four formulations of antibiotic-loaded cement disks, i.e. gentamicin, tobramycin, vancomycin and tobramycin combined with vancomycin, respectively, were used to test the inhibition of eight isolates of Staphylococcus epidermidis and two reference strains of Staphylococcus aureus by an agar diffusion test on Mueller-Hinton (MH) agar similar to the routine laboratory disk diffusion method. Moreover, cement spacer cylinders loaded with gentamicin alone or combined with vancomycin were submerged in MH agar for weeks and the capacity to inhibit five different isolates of S. epidermidis was measured. Results: The size of the inhibition zones around the antibiotic-loaded cement disks correlated with the minimal inhibitory concentration (MIC) of the antibiotics against the tested strains. All five strains of S. epidermidis were inhibited by vancomycin-loaded cement spacers for at least 30 days. However, two gentamicin-resistant S. epidermidis strains with MICs of 4 mg/l and 16 mg/l could not be inhibited longer than 3 days by the gentamicin-loaded cement spacer. Conclusion: The in vitro data suggest that antibiotic-loaded cement spacers inhibit susceptible bacteria for 4-6 weeks. The addition of vancomycin to commercial aminoglycoside-loaded cements might be helpful in allograft infections in tumor patients to inhibit a broad range of bacteria including gentamicin-resistant CNS very commonly found in such infections. [ABSTRACT FROM AUTHOR]

Brevibacterium spp. were considered apathogenic until a few reports of infections in immunocompromised patients were published. Herein, we present a case of a catheter-related septicemia with Brevibacterium casei in an immunocompetent patient receiving continuous iloprost infusion for pulmonary arterial hypertension and review the clinical presentation of this mainly emerging opportunistic pathogen. [ABSTRACT FROM AUTHOR]

The MOZAIC programme collects ozone and water vapour data using automatic equipment installed on board five long-range Airbus A340 aircraft flying regularly all over the world since August 1994. Those measurements made between September 1994 and August 1996 allowed the first accurate ozone climatology at 9-12 km altitude to be generated. The seasonal variability of the tropopause height has always provided a problem when constructing climatologies in this region. To remove any signal from the seasonal and synoptic scale variability in tropopause height we have chosen in this further study of these and subsequent data to reference our climatology to the altitude of the tropopause. We de- fine the tropopause as a mixing zone 30 hPa thick across the 2 pvu potential vorticity surface. A new ozone climatology is now available for levels characteristic of the upper troposphere (UT) and the lower stratosphere (LS) regardless of the seasonal variations of the tropopause over the period 1994-2003. Moreover, this new presentation has allowed an estimation of the monthly mean climatological ozone concentration at the tropopause showing a sine seasonal variation with a maximum in May (120 ppbv) and a minimum in November (65 ppbv). Besides, we present a first assessment of the inter-annual variability of ozone in this particular critical region. The overall increase in the UTLS is about 1%/yr for the 9 years sampled. However, enhanced concentrations about 10-15 % higher than the other years were recorded in 1998 and 1999 in both the UT and the LS. This so-called "1998-1999 anomaly" may be attributed to a combination of different processes involving large scale modes of atmospheric variability, circulation features and local or global pollution, but the most dominant one seems to involve the variability of the North Atlantic Oscillation (NAO) as we find a strong positive correlation (above 0.60) between ozone recorded in the upper troposphere and the NAO index. A strong anti-correlation is also found between ozone and the extremes of the Northern Annular Mode (NAM) index, attributing the lower stratospheric variability to dynamical anomalies. Finally this analysis highlights the coupling between the troposphere, at least the upper one, and the stratosphere, at least the lower one. [ABSTRACT FROM AUTHOR]

Several thousands of ozone vertical profiles collected in the course of the MOZAIC programme (Measurements of Ozone, Water Vapour, Carbon Monoxide and Nitrogen Oxides by In-Service Airbus Aircraft) from August 1994 to February 2002 are investigated to bring out climatological and interannual variability aspects. The study is centred on the most frequently visited MOZAIC airports, i.e. Frankfurt (Germany), Paris (France), New York (USA) and the cluster of Tokyo, Nagoya and Osaka (Japan). The analysis focuses on the vertical integration of ozone from the ground to the dynamical tropopause and the vertical integration of stratospheric-origin ozone throughout the troposphere. The characteristics of the MOZAIC profiles: frequency of flights, accuracy, precision, and depth of the troposphere observed, are presented. The climatological analysis shows that the Tropospheric Ozone Column (TOC) seasonal cycle ranges from a wintertime minimum at all four stations to a spring-summer maximum in Frankfurt, Paris, and New York. Over Japan, the maximum occurs in spring presumably because of the earlier springtime sun. The incursion of monsoon air masses into the boundary layer and into the mid troposphere then steeply diminishes the summertime value. Boundary layer contributions to the TOC are 10% higher in New York than in Frankfurt and Paris during spring and summer, and are 10% higher in Japan than in New York, Frankfurt and Paris during autumn and early spring. Local and remote anthropogenic emissions, and biomass burning over upstream regions of Asia may be responsible for the larger low- and mid-tropospheric contributions to the tropospheric ozone column over Japan throughout the year except during the summer-monsoon season. A simple Lagrangian analysis has shown that a minimum of 10% of the TOC is of stratospheric-origin throughout the year. Investigation of the short-term trends of the TOC over the period 1995-2001 shows a linear increase 0.7%/year in Frankfurt, 0.8%/year in Japan, 1.1%/year in New York and 1.6%/year in Paris for the reduced 1995-1999 period. Dominant ingredients of these positive short-term trends are the continuous increase of wintertime tropospheric ozone columns from 1996 to 1999 and the positive contributions of the mid troposphere whatever the season. [ABSTRACT FROM AUTHOR]

Objectives: To determine the influence of diabetes mellitus on coronary collateral flow by accurate means of collateral flow measurement in a large population with variable degrees of coronary artery disease. Methods: 200 patients (mean (SD) age 64(9) years; 100 diabetic and 100 non-diabetic) were enrolled in the study. Coronary collateral How was assessed in 174 steriotic and in 26 angiographically normal vessels with a pressure guidewire (n = 131), Doppler guidewire (n = 36), or both (n = 33) to calculate pressure or How velocity derived collateral How index (CFI). Diabetic patients were perfectly matched with a non-diabetic control group for clinical, haemodynamic, and angiographic parameters. Results: CFI did not differ between the diabetic and the non-diabetic patients (0.21 (0.12) v 0.19 (0.13), not significant). Likewise, CFI did not differ when only angiographically normal vessels (0.20 (0.09) v 0.15 (0.08), not significant) or chronic total coronary occlusions (0.30 (0.14) v 0.30 (0.17), not significant) were compared. Fewer patients in the diabetic group tended to have angina pectoris during the one minute vessel occlusion (60 diabetic v 69 non-diabetic patients, p = 0.15). Conclusion: Quantitatively measured coronary CFI did not differ between diabetic and non-diabetic patients with stable coronary artery disease. [ABSTRACT FROM AUTHOR]

Several thousands ozone vertical profiles collected in the course of the MOZAIC program (Measurements of Ozone, Water Vapour, Carbon Monoxide and Nitrogen Oxides by In-Service Airbus Aircraft) from August 1994 to February 2002 are investigated to bring out climatological and interannual variability aspects. The study is centred on the most frequently visited MOZAIC airports, i.e. Frankfurt (Germany), Paris (France), New York (USA) and the cluster of Tokyo, Nagoya and Osaka (Japan). The analysis focuses on the vertical integration of ozone from the ground to the dynamical tropopause and the vertical integration of stratospheric-origin ozone throughout the troposphere. The characteristics of the MOZAIC profiles, frequency of flights, accuracy, precision, and depth of the troposphere observed, are presented. The climatological analysis shows that the Tropospheric Ozone Column (TOC) seasonal cycle ranges from a minimum wintertime at all four stations to a spring-summer maximum in Frankfurt, Paris, and New York. Over Japan, the maximum occurs in spring because of the earlier springtime sun. The invasion of monsoon air masses in the boundary layer and in the mid-troposphere then steeply diminishes the summertime value. Boundary layer contributions to the TOC are 10% higher in New York compare to Frankfurt and Paris during spring and summer, and are 10% higher in Japan compare to New York, Frankfurt and Paris during autumn and early spring. Local and remote anthropogenic emissions as well as biomass burning over upstream regions of Asia may be responsible of larger low- and mid-tropospheric contributions to the tropospheric ozone column over Japan throughout the year except during the summer-monsoon season. A simple Lagrangian analysis has shown that a minimum range of 10% of the TOC is of stratospheric-origin throughout the year. The investigation on the short-term trends of the TOC over the period 1995-2001 shows a linear increase of 0.7%/year in Frankfurt, 0.8%/year in Japan, 0.9%/year in Paris, and 1.1%/year in New York. Essential ingredients to these positive short-term trends are the continuous increase of wintertime tropospheric ozone columns from 1996 to 1999 and the positive contributions of the mid-troposphere whatever the season. [ABSTRACT FROM AUTHOR]

The MOZAIC programme collects ozone and water vapour data using automatic equipment installed on board five long-range Airbus A340 aircraft flying regularly all over the world since August 1994. Those measurements made between September 1994 and August 1996 allowed the first accurate ozone climatology at 9-12 km altitude to be generated. The seasonal variability of the tropopause height has always provided a problem when constructing climatologies in this region. To remove any signal from the seasonal and synoptic scale variability in tropopause height we have chosen in this further study of these and subsequent data to reference our climatology to the altitude of the tropopause. We define the tropopause as a mixing zone 30 hPa thick across the 2 pvu potential vorticity surface. A new ozone climatology is now available for levels characteristic of the upper troposphere (UT) and the lower stratosphere (LS) regardless of the seasonal variations of the tropopause over the period 1994-2003. More over, this new presentation has allowed an estimation of the monthly mean climatological ozone concentration at the tropopause showing a sine seasonal variation with a maximum in May (120 ppbv) and a minimum in November (65 ppbv). Besides, we present a first assessment of the inter-annual variability of ozone in this particular critical region. The overall increase in the UTLS is about 1%/yr for the 9 years sampled. However, enhanced concentrations about 10-15% higher than the other years were recorded in 1998 and 1999 in both the UT and the LS. This so-called "1998-1999 anomaly" may be attributed to a combination of different processes involving large scale modes of atmospheric variability, circulation features and local or global pollution, but the most dominant one seems to involve the variability of the North Atlantic Oscillation (NAO) as we find a strong positive correlation (above 0.60) between ozone recorded in the upper troposphere and the NAO index. A strong anti-correlation is also found between ozone and the Northern Annular Mode (NAM) index, attributing the lower stratospheric variability to dynamical anomalies. Finally this analysis highlights the coupling between the troposphere, at least the upper one, and the stratosphere, at least the lower one. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance of Helicobacter pylori is the main reason for eradication failure. We have studied the feasibility of a commercial transport medium for cultural recovery and subsequent drug susceptibility testing. Patients and Methods: From March to December 2000, 79 consecutive gastric biopsies, positive in a rapid urease test, were transferred into a commercial transport medium and sent within 24 hours from the district hospital to the microbiological laboratory for culture and susceptibility testing. A commercial agar plate and an in-house Wilkins-Chalgren agar plate were used for culture. Susceptibility data were compared with data collected from 1992 to 2003 in the University Hospital of Zurich. Results: Cultural recovery and susceptibility testing of H. pylori was successful in 55 of 79 patients. In 17 cases cultural recovery failed because of technical problems (n = 14), long transport time (n = 1) and unknown reason (n = 2). Failure of susceptibility testing (n = 7) was mainly due to fungal overgrowth. Resistance to metronidazole and clarithromycin was found in 15 (27%) and in 12 patients (22%), respectively; resistance to amoxicillin was not observed. Five patients (9%) showed resistance both to metronidazole and to clarithromycin. Eradication therapy failed in all patients with macrolide resistance. Resistance rates were higher in females than in males; 30% vs 12% for clarithromycin and 33% vs 20% for metronidazole. Resistance to metronidazole was significantly lower in Swiss patients (15%) than in non-Swiss patients (39%). Conclusion: Antimicrobial resistance data can reliably be obtained by sending the biopsy specimen in a commercial transport medium to a microbiological laboratory. This is especially important after eradication failure. Resistance to metronidazole and clarithromycin is highly prevalent and more common in women and non-Swiss patients. [ABSTRACT FROM AUTHOR]

The aim of this prospective study was to observe immunophenotypic patterns in the ejaculate of patients with noninflammatory chronic pelvic pain syndrome (Cat IIIB CPPS) and to test for a possible autoimmune aetiology. Thirty-five patients of a total of 88 patients with chronic prostatitis Cat IIIB were consecutively selected. Monthly ejaculate testing was carried out for IgG, IgA, IgM, IL-1 α, sIL-2R and IL-6. The control group for ejaculate analysis was composed of 96 normal ejaculates (according to the WHO criteria). Immunohistochemical detection of CD3 cells (T lymphocytes) and CD20 cells (B lymphocytes) was performed in 71 biopsy cylinders of Cat IIIB CPPS patients and in 25 prostate biopsy cylinders of subjects without symptoms or obstruction. Intra-acinar T-lymphocytic infiltrates were dominated by T-cytotoxic cells ( P = 0.05). Ejaculate IL-6 and ejaculate IgA increased significantly and dropped again, correlating with a release of clinical symptoms. Inflammatory ejaculate interleukin concentrations correlated with the immunohistochemical findings with presence of large numbers of T cells (all P-values ≤ 0.01). Immunomodulation was performed in a pilot series of three patients by five monthly cycles of IgG (Sandoglobulin®), 1 g kg−1 body weight. Immunomodulation with IgG decreased pain moderately and did not change ejaculate interleukin and immunoglobulin concentrations. In summary, interleukin and immunoglobulin determinations in the ejaculate revealed an inflammatory process even in Cat IIIB CPPS. The findings of intra-acinar T-cell rich infiltrates and the associated inflammatory reaction may indicate a possible autoimmune component in the aetiology of CPPS. Exact origin and role of interleukin changes in the ejaculate of CPPS patients need to be further evaluated. Unfortunately, pilot series with immunomodulation with IgG do not seem to provide clear clinical benefit. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain syndrome is still an important clinical problem. The NIH prostatitis classification introduced in 1998 for diagnosis and treatment measures is based on extended microbiological analysis of urine and expressed prostate secretion (4-glass test). In 1997 J.C. Nickel proved that the culture and microscopic examination of urine before and after prostatic massage leads to the same results as the 4-glass test. In our prospective study on 143 patients with a diagnosis of chronic prostatitis, we analyzed this statement and came to the same results. We therefore recommend replacing the expensive and time-consuming 4-glass test by a simple preprostatic and postprostatic massage urine culture. Further examinations should only be performed in special cases. [ABSTRACT FROM AUTHOR]

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In order to assess the performance of two detection methods, a set of 93 recent clinical isolates of Staphylococcus aureus, including a large number of strains that demonstrated low-level methicillin-resistance were evaluated using the MRSA-Screen (Denka Seiken, Japan), a commercial latex agglutination test to detect penicillin-binding protein 2′ (PBP2′), and a polymerase chain reaction assay using the LightCycler Instrument (Roche Diagnostics, Switzerland). The results show that the latex agglutination test is highly sensitive if performed after induction by cefoxitin. Inconclusive results can be rapidly confirmed on the same day by real-time polymerase chain reaction used to detect mecA and femA genes. [ABSTRACT FROM AUTHOR]

Three cases, one each of native valve, prosthetic valve and composite graft endocarditis caused by Rothia dentocariosa are described. The first patient presented with multiple brain abscesses and severe congestive heart failure due to destructive endocarditis with large vegetations on the mitral valve. He died shortly after emergency valve replacement. Gram-positive coccoid rods were identified in the vegetations of the excised mitral valve. The second patient had a R. dentocariosa endocarditis of a prosthetic aortic valve that was treated empirically with netilmicin and teicoplanin, due to an allergy to penicillin. Both antibiotics were replaced according to susceptibility testing in vitro with rifampin and ciprofloxacin, and the endocarditis was cured within 9 weeks. The third patient presented with a circular root abscess of an aortic composite graft that was successfully treated with rifampin and ceftriaxone without surgery. All patients had extensive periodontal disease which was thought to be responsible for hematogenic spread and seeding of the microorganism. The microbiological identification and antibiotic resistance pattern of the isolates, as well as therapeutic implications are discussed. [ABSTRACT FROM AUTHOR]

The diagnostic value of IgM to Bartonella henselae was evaluated in 20 children with cat-scratch disease (CSD) and controls consisting of 20 blood donors and 20 children with enlarged lymph nodes without CSD by two indirect immunofluorescence assays (IFA). One was based on B. henselae cocultivated with Vero cells (host cell-associated IFA), and the other on B. henselae grown on agar (host cell-free IFA). With the host cell-associated IFA, 18 of 20 children with CSD revealed IgM, whereas only 14 did so with the host cell-free IFA. Sera of two blood donors as well as sera from three children with enlarged lymph nodes without CSD showed also positive IgM to cell-associated B. henselae. This study reveals that the IFA applied had sensitivities of 70 – 90% and specificities of 87.5 – 100% for detecting IgM to B. henselae. Additionally, 20 patients with IgM to Epstein-Barr virus (EBV) capsid antigen were tested for IgM to B. henselae. Sera of 16 and 9 of these patients revealed IgM to B. henselae with the host cell-associated and the host cell-free IFA, respectively. Using Western blot these sera were demonstrated to react against linearized proteins of Vero cells and of B. henselae. Thus, since acute EBV infection may substantially reduce the specificity of B. henselae-specific IgM tests, we conclude that diagnosis of CSD should be confirmed by a significant IgG titer to B. henselae or by detection of this pathogen. [ABSTRACT FROM AUTHOR]

Four commercial slides were compared with in-house slides for the detection of immunoglobulin G (IgG) against Bartonella henselae in 58 healthy persons from a rural region by an indirect immunofluorescence assay. MRL-BA slides (MRL Diagnostics, USA) and Virion slides (Virion, Switzerland) with agar-derived Bartonella henselae showed IgG titers of ≥ 1∶256 in 44.8% and 51.7%, respectively, whereas Bion slides (Bios, Germany), MRL-Vero slides (MRL Diagnostics), and in-house slides with cell-associated Bartonella henselae showed such titers in 3.4%, 5.1% and 3.4%, respectively. The MRL-Vero slides ( Bartonella IgG substrate slides, MRL Diagnostics) were further evaluated with 26 patients with cat scratch disease, 20 patients with lymphadenopathy not due to cat scratch disease, 100 blood donors from an urban area, and 120 blood donors from a mixed urban/rural area. In our mixed urban/rural population the IgG titer of 1∶256 had a sensitivity of 84.6% and a specificity of 93.4% for the serodiagnosis of cat scratch disease. Seroprevalence was higher in blood donors from the mixed area (50.8%) than from the urban area (37%). MRL-Vero slides were considered useful for the serodiagnosis of cat scratch disease by indirect immunofluorescence and have replaced our in-house system. However, patients with low IgG titers should be retested three to four weeks after initial sampling to demonstrate a possible rise of IgG titers in paired sera. [ABSTRACT FROM AUTHOR]

Transient left ventricular apical ballooning syndrome is characterized by transient akinesis of the left ventricular apex with basal wall hyperkinesis; this is also known as Takotsubo cardiomyopathy. There are three distinct contractile LV patterns described in the literature: apical, midventricular, and basal ballooning. The apical ballooning pattern is the most frequent pattern. We describe the case of a transient anterolateral left ventricular ballooning fulfilling the definition of Takotsubo cardiomyopathy except for the contractile LV pattern. The diagnosis was supported by cardiac magnetic resonance imaging and by the fact that the anterolateral ballooning resolved completely after 6 weeks. [ABSTRACT FROM AUTHOR]

The article reflects on the benefits of cell-based therapy for myocardial repair. Several improvements were observed in patients that received cell therapy for ischaemic heart disease, where cardiac myocytes are terminally differentiated and irreplaceable. Clinical trials show that cell therapy is faster and more prolific in treating myocardial infarction and demonstrates beneficial effect of injecting autologous bone marrow cells.

The article reports the case of a 54-year-old patient with bacteremia and meningitis after a dog bite, in which the etiologic diagnosis was difficult to establish. Retrospective Gram stain of the gram-negative bacteria colonies that grew in both the CSF culture media and in an aerobic blood-culture flask showed gram-negative rods with fusiform shapes suggestive of a Capnocytophaga sp. The patient's condition improved rapidly after administration of ceftriaxone therapy for 13 days. He was discharged 1 day after treatment ended.

A 71-year-oId female patient was hospitalized with membranous Iaryngopharyngitis typical of classical diphtheria. A toxigenic strain of Corynebacterium ulcerans was isolated from the throat. The patient was treated for 6 days with amoxicillin-clavulanic acid and recovered without complications. This second reported case of diphtheric laryngopharyngitis caused by C. ulcerans in Switzerland is a reminder that C. ulcerans should be included as a possible agent in patients with classical diphtheria symptoms. [ABSTRACT FROM AUTHOR]

We report a case of a retroperitoneal abscess due to Mycoplasma hominis in a young polytraumatized man who developed septicemia under treatment with rifampin and flucloxacillin M. hominis was recovered from blood cultures as well as from the abscess near the left iliac spine. After 10 days of therapy with clindamycin the patient improved, and intraoperatively taken swabs were culturenegative but still positive by PCR. [ABSTRACT FROM AUTHOR]

Two cases of Aerococcus urinae endocarditis are reported. The organism is not included in any database of commercial identification systems at this time. Formation of tetrades and positive reactions for leucine arylamidase and beta-glucuronidase pointed strongly to A. urinae. The cellular fatty acid pattern was similar to that of Aerococcus viridans, with predominantly C16∶0, C18∶1ω9c and C18∶0; the presence of C18∶1ω7t differentiated our isolates from A. viridans and can support the diagnosis of A. urinae. Furthermore, susceptibility to penicillin but resistance to cotrimoxazole represents a pattern opposite to that of A. viridans. Minimal inhibition concentrations of gentamicin and netilmicin were≤64 mg/l but those of tobramycin were≥256 mg/l. Penicillin combined with either gentamicin or netilmicin showed distinct synergy in killing kinetics. These combinations seem to be the appropriate regimen to treat A. urinae endocarditis. [ABSTRACT FROM AUTHOR]