Is It Useful to Measure Efficiency Indices of a Deceased-Donor Kidney Transplant Program in One Intensive Care Unit?

BACKGROUND: Before 2010, donor detection rate and donor conversion rate at our tertiary level care institution were low. To assess the effectiveness of the implemented organizational changes, an analysis of organizational indicators with the use of the DOPKI (Improving the Knowledge and Practices in Organ Donation) project was conducted. METHODS: Three groups of DOPKI indicators were used: indicators of the potential for deceased organ donation, indicators on areas for improvement in the deceased donation process, and indicators of program effectiveness. We compared the 3-year period before instituting organizational measures with the 3-year period after the changes. RESULTS: Significant differences in almost all DOPKI indicators were found. Most importantly, the number of actual donors has increased significantly, pointing to the effectiveness of the organizational measures that we put in place in 2010. In addition, the study highlights the value of the use of DOPKI indicators in one intensive care unit to improve the transplant program on a hospital level. CONCLUSIONS: We conclude by arguing that despite the lack of a uniform national database, DOPKI indicators could still be useful for improving the quality of donor programs.

Dynamics of oxidative/nitrosative stress in mice with methionine-choline-deficient diet-induced nonalcoholic fatty liver disease.

Insulin resistance, oxidative stress, and proinflammatory cytokines play a key role in pathogenesis of nonalcoholic fatty liver disease (NAFLD). The aim of our study was to investigate the dynamics of oxidative/nitrosative stress in methionine-choline-deficient (MCD) diet -induced NAFLD in mice. Male C57BL/6 mice were divided into following groups: group 1: control group on standard diet; group 2: MCD diet for 2, 4, and 6 weeks (MCD2, MCD4, and MCD6, respectively). After treatment, liver and blood samples were taken for histopathology, alanine- and aspartate aminotransferase, acute phase reactants, and oxidative/nitrosative stress parameters. Liver malondialdehyde level was higher in all MCD-fed groups versus control group (p < 0.01), while nitrites + nitrates level showed a progressive increase. The activity of total superoxide dismutase and its isoenzymes was significantly lower in all MCD-fed groups (p < 0.01). Although catalase activity was significantly lower in MCD-fed animals at all intervals (p < 0.01), the lowest activity of this enzyme was evident in MCD4 group. Liver content of glutathione was lower in MCD4 (p < 0.05) and MCD6 group (p < 0.01) versus control. : Ferritin and C-reactive protein serum concentration were significantly higher only in MCD6 group. Our study suggests that MCD diet induces a progressive rise in nitrosative stress in the liver. Additionally, the most prominent decrease in liver antioxidative capacity is in the fourth week, which implies that application of antioxidants would be most suitable in this period, in order to prevent nonalcoholic steatohepatitis but not the initial NAFLD phase.

Clinical consequences of aspirin and clopidogrel resistance: an overview.

The aim of this review is to introduce the concept of personalized medicine in secondary stroke prevention with antiplatelet medication. In the last years, many studies have been conducted regarding aspirin resistance and genotyping of clopidogrel metabolism. A review of the currently published data on this issue emphasizes the importance of focusing on the individualizing approach in antiplatelet therapy to achieve maximal therapeutic beneficial effect. However, many authors suggest that, before new information from ongoing trials become available, good clinical practice should dictate the use of low dose of aspirin that was shown to be effective in the prevention of stroke and death in patients with ischemic cerebrovascular disease, because higher doses do not have significantly better efficacy than lower doses in secondary stroke prevention, but lower-dose aspirin is associated with less side effects. On the other hand, many factors are associated with clopidogrel resistance, and recent genetic studies showed that the CYP2C19*2 genotype (loss-of-function allele) is related to poor metabolism of clopidogrel, but larger studies are needed to definitively confirm or rule out the clinical significance of this genetic effect. The aim of personalized approach in secondary stroke prevention is to take the most appropriate medicine in the right dose in accordance with the clinical condition of the patient and associated risk factors.

Phages of Pseudomonas aeruginosa: response to environmental factors and in vitro ability to inhibit bacterial growth and biofilm formation.

AIMS: To examine effects of various environmental factors on adsorption and inactivation of Pseudomonas aeruginosa-specific phages: δ (family Podoviridae), J-1, σ-1 and 001A (family Siphoviridae) and their ability to inhibit bacterial growth and biofilm formation. METHODS AND RESULTS: The phages examined in the study were clonally different, as revealed by RFLP. The temperature in the range 7-44°C had no influence on the adsorption of Podoviridae, but did affect Siphoviridae adsorption, particularly 001A. All phages were significantly stable at pH 5-9, and phages δ and 001A even at pH 3. Most of the examined carbohydrates and exopolysaccharides of the original host efficiently inactivated phage δ, while phages σ-1 and J-1 were inactivated considerably only by the amino acid alanine. Silver nitrate efficiently inactivated all the phages, while Siphoviridae were more resistant to povidone-iodine. Serum of nonimmunized rats had no influence on phage inactivation and adsorption. Only phage δ showed ability to effectively inhibit in vitro bacterial growth and biofilm formation. CONCLUSIONS: The examined environmental parameters can significantly influence the adsorption and viability of Ps. aeruginosa-specific phages. The phage δ is a good candidate for biocontrol of Ps. aeruginosa. SIGNIFICANCE AND IMPACT OF THE STUDY: The study provides important data on Ps. aeruginosa-specific phage adsorption, inactivation and in vitro lytic efficacy.

Antibiotic resistance of Shigella strains isolated in the Federal Republic of Germany 1989-1990.

A great many reports have been published about the multiresistance to strains of antibiotics in countries with a high incidence of shigellosis. In order to obtain better information about the situation in Germany, we tested 255 Shigella strains to 28 antibiotics during the 1989-1990 period. 153 (60%) of isolates originated from imported cases of infection (Middle and Far East, West and North Africa, Central America), whereas no history of infection in foreign countries was available for the remaining 102 strains. 207 (81.2%) of these strains were resistant to one or more antibiotics. They were divided into 6 phaenotypes according to their resistant pattern. The phaenotypes with the resistance patterns AMP, CMP, SM, SSS, TET as well as SM, SSS, TET in combination with SXT (38.6%) were most frequently isolated, followed by phaenotypes with the resistance pattern AMP, CMP, SM, SSS, or SM, SSS, combined with or without SXT (27.5%), and the phaenotypes AMP, CMP, SM, TET and CMP, SM, SSS, TET (15%). The incidence of resistance was significantly higher in strains from imported cases (93.5%) than in isolates from domestic infections (62.7%; p < 0.001). The similarity of the resistance patterns of strains acquired abroad and those acquired in Germany suggested that such strains might have been introduced from abroad. All strains were sensitive to the quinolones examined (ofloxacin and enoxacin) as well as to cephalosporines of the second and third generations.

Incidence of sporadic infections due to enterotoxigenic Escherichia coli (ETEC) in the population of Hamburg, north Germany.

In two studies (1982 and 1985/86), the presence of enterotoxigenic E. coli (ETEC) and other enteropathogenic bacteria was investigated in 779 stool specimens from children and adults with and without diarrhoeal disease. ETEC was isolated from 2% of diseased children and 1.6% of adult patients, but also from 0.5% of asymptomatic persons. Mixed infections with two different ETEC strains or with other enteropathogenic bacteria were identified in 4 of 9 infected persons. The ETEC strains belonged to 10 different serovars, eight of which produced only heat-stable enterotoxin. One infection had been contracted in a tropical country. After Salmonella and Campylobacter, ETEC was more frequently isolated than Yersinia and Shigella; the difference of ETEC infections in diseased and asymptomatic persons was, however, not statistically significant (p greater than 0.05). Analysis of the isolated serovars suggests that most ETEC strains implicated in sporadic cases of diarrhoea in Hamburg are unrelated to those which are widely spread in the developing world.

Occurrence and clinical importance of the pathogenic serogroup O: 5, 27 of Yersinia enterocolitica in the Federal Republic of Germany and methods for its serological and bacteriological identification.

Despite its world-wide distribution, the pathogenic serogroup O: 5, 27 of Yersinia enterocolitica (Y. e.) has scarcely been considered in the Federal Republic of Germany. In the 1980 to 1986 period, a total of 74 strains from patients was identified at the National Reference Centre for Salmonella, Hamburg. The clinical manifestations of the cases was not different from those associated with Y. e. O: 3 and O: 9 infections. Six out of 8 patients from whom serum samples were available, developed moderate agglutination titres (1:80-1:1280). Only 8 of the 74 strains were negative in in vitro virulence tests. A list of biochemical tests is given which permit a differentiation of the pathogenic serogroup O: 5, 27 from the apathogenic Y. e. O: 5 which is widely distributed in the environment. Serological studies revealed different H antigens in both serogroups. The O antigen factor 27, and a subfactor O: 5(2) which is typical of Y. e. serogroup O: 5, are further differential markers; the production of both factor sera is described. Besides serogroups O: 3 and O: 9, Y. e. O: 5, 27 must be considered as an aetiological agent of human yersiniosis in the Federal Republic of Germany.

Seasonal distribution of facultatively enteropathogenic vibrios (Vibrio cholerae, Vibrio mimicus, Vibrio parahaemolyticus) in the freshwater of the Elbe River at Hamburg.

Between June 1981 and December 1982 the incidence of Vibrio cholerae, V. mimicus and V. parahaemolyticus was determined at two sampling sites on the Elbe River at Hamburg. A total of 183 strains was isolated from 147 water samples. Of these, 107 belonged to non-01 V. cholerae (ten strains producing a cholera-like enterotoxin); 33 were identified as V. mimicus, including two enterotoxin producers; 42 strains were Kanagawa-negative cultures of V. parahaemolyticus; and one was V. fluvialis. The highest incidence was observed from June to September with about 10(2) organisms/l. Halophilic vibrios, less than five organisms/l, were detectable during the period June/July to October. The vibrio incidence was not influenced by the numbers of aerobic heterotrophic bacteria, coliforms or faecal bacteria. In general water temperature correlated with the seasonal variation. Thus, a temperature rise over 10 degrees to 20 degrees C was followed by a distinct increase in vibrio numbers. Of 14 chemical parameters only chloride concentration might have had an influence on the seasonal variation. It is concluded that the three Vibrio species are indigenous organisms of the Elbe River.

Pathogenicity tests with strains of Edwardsiella tarda: detection of a heat-stable enterotoxin.

A total of 25 strains of Edwardsiella tarda isolated from various sources in different parts of the world between 1968 and 1982 was subjected to enteropathogenicity tests. A heat-stable enterotoxin was detected in three strains (12%). Whereas culture filtrates gave doubtful results, concentration of toxin by ultrafiltration led to net fluid accumulation in the suckling mouse test and the rabbit ligated ileal loop assay. The enterotoxin resisted heating to 60 degrees C (30 min) and 100 degrees C (15 min). Neither cell elongation nor cytotoxic effect were observed in the Chinese hamster ovary cell assay. No strain caused keratoconjunctivitis in the guinea pig eye model. There was no correlation of enterotoxigenic strains and a typical pathology. With regard to the usual clinical pattern of E. tarda enteritis, which primarily appears to be invasive, it is suggested that enterotoxin production might be of secondary pathogenetical importance, comparable to toxin production in salmonellosis, shigellosis, and Yersinia enterocolitica infection.

Seventeen new Salmonella serovars of the subgenera I, II, III and IV.

In this paper seventeen Salmonella serovars are described which were identified in the period 1979 to 1981 at the Salmonella Reference Centre of Hamburg. In addition to the Supplements Nos. XXIII (1979) to XXVI (1982) further serological, biochemical and epidemiological data of each serovar are given. S. aarhus 18:z4,z23:z64; S. 4,12:j:-; S. ogbete 43:z:1,5; S. olten 9,46:d:e,n,z15; S. tema 1,42:z35:z6; S. waedenswil 9,46:e,h:1,5; S. II 1,9,12,(46),27:z10:e,n,x; S. II 13,23:k:z41; S. II 48:d:1,2; S. II 9,12,(46),27:g,t:e,n,x; S. II 44:g,t:z42; S. II 58:d:z6; S. II 6,8:d:z6:z42; S. II 13,22:m,t:z39:z42; S. III arizonae 6,7,14:z39:1,2 = Arizona 27:45:30; S. III arizonae 38:k:e,n,x,z15 = Arizona 16:29:28; S. IV 44:z4z23:-.

Five new Salmonella serovars of subgenera I, II and III, and three serological variants.

Description of five new serovars of Salmonella subgenera I, II and III and of three serological variants, which have been isolated from stool specimens, intestinal content of reptiles and foodstuff: S. thayngen 1,4,12,27:Z41:1,(2),5; S. potosi 6,14:Z36:1,5; S. jalisco 11:y:1,7; S. ohlstedt var. 15+ 3,15:y:e,n,x; S. II 6,7:z:z39; S., II constantia var. monophasic 17:l,w:-; S. III arizonae 47:r:1,5,7; S. III arizonae var. triphasic 57:c:z:z60.

[Four new Salmonella species and three serological variants of subgenus III (Arizona) (author's transl)]. / Vier neue Salmonella-Species und drei serologische Varianten des Subgenus III (Arizona).

Four new strains of Salmonella and three serological variants described in this paper were isolated from free living snakes (Vipera berus L. and Natrix natrix L.) of Northern Germany. All strains belong to the subgenus III of the genus Salmonella. For the first time a representative of subgenus III in the Salmonella group M with the serological formula S. arizonae 28:Z10:Z57 was isolated. 1) S. (6),14:1,v:z (Ar. 7 a,7c:23-31) 2) S. 17:Z10:e,n,X,Z15:Z56 (Ar. 12:27-28-38) 3) S. 21:1,v:Z57 (Ar. 22:23-40a,40c) 4) S. 28:Z10:Z57 (Ar. 35:27-40a,40c) 5) S. 38:(k):Z35:Z56 (Ar. 16:22-21-38) 6) S. 43:1,v:Z56 (Ar. 21:23-38) 7) S. 50:Z10:Z:Z56 (Ar. 9a,9c:27-31-38)

Three new Salmonella serotypes of subgenera I, II and III and four serological variants.

Description of three new Salmonella serotypes of the subgenera I, II and III, and four serological variants which have been isolated and diagnosed in 1977-1978 at the National Reference Centre for Salmonella, Institute of Hygiene, Hamburg. The strains are as follows: S. blitta 47:y:e,n,x; S. II 1, 40:Z42:1,5,7; S. III arizonae 52:k:Z53 (Arizona 31:29:25); S. infantis with phase 2 R antigen 6,7:r:1,11; S. stuivenberg var. Z13-1,3,19:1,Z28:1,5; S. III arizonae 35:k:Z53 (Arizona 20:29:25) var. fimbriae+ (O-inagglutinable); S. III arizonae 38:Z10:Z53 (Arizona 16:27:25) var. fimbriae+ (O-inagglutinable).

[Purification and physico-chemical analysis of the fimbrial antigen in two different genera of Enterobacteriacea: Salmonella enteritidis and Yersinia enterocolitica (author's transl)]. / Reindarstellung und physikalisch-chemische Analyse des Fimbrien-Antigens bei zwei verschiedenen Enterobacteriaceae: Salmonella enteritidis und Yersinia enterocolitica.

Chemical, physical and immunological properties of the fimbrial antigen of two different genera of Enterobacteriaceae, namely Salmonella (S. enteritidis) and Yersinia (Y. enterocolitica) were analysed. Only a few strains of these two bacterial genera possess a fimbrial antigen which proved to be identical in all tests. Purified fimbriae are unstable in buffer solutions. They tend to form aggregates, patterns of which are between 240000 and 270000. Submitted to solubility testing by various methods these aggregates easily dissociate into particles of different molecular size. Treatment with 1% sodium dodecyl sulphate (SDS) in 1% mercaptoaethanol at 37 degrees C for 60 minutes gave constant reproducible results. The fimbrial protein prepared by this method proved to be an antigenically active unit with a molecular weight of 23450 for S. enteritidis and 23350 for Y. enterocolitica. The electron microscope revealed that purified fimbriae of these two genera consist of extremely thin filaments (1.5 to 2.7 nm), covering the bacterial cell as an envelope. They are supposed to be composed of no more than 2 to 3 peptid chains. The presence of the amino acids tyrosine, phenylalanine and tryptophane may be responsible of the particular behaviour of the fimbriae which according to different external conditions react with different states of dissociation. Probably the filaments are not stable in a solution as single filaments but tend to form oligomer, secondary and tertiary structures. Experiments of isoelectric focusing revealed that both antigens consist of a pure protein component (composed of 17 amino acids) which appears at pH 3.9.

Salmonella 38:g,z51:-, a new Salmonella of sub-genus IV: a serological study on the complex H-antigen g,z51 which can be divided into three sub-genus specific factors.

A new Salmonella of sub-genus IV with the antigen formula 38:g,z51:- has been isolated from a boa. Comparative studies of the H:g,z51 revealed that this phase only occurs in the sub-genera I, III and IV but not in sub-genus II. Furthermore it became evident that there exist typical serological differences between the g,z51 phases of Salmonella sub-genus I, III and IV which are of significance for the differential diagnosis.

[Eight new Arizona serotypes with emphasis on 2 O-antigens previously only found in Salmonella (author's transl)]. / Acht neue Arizona-Serotypen unter besonderer Berücksichtigung von zwei bisher nur bei Salmonella nachgewiesenen O-Antigenen

Description of eight new Arizona serotypes isolated from snakes and lizards (exception: Arizona 7a, 7c:23-21) in various countries and submitted to the National Salmonella Centre Hamburg for identification. No. 4-36/70 Arizona 10a, 10b:29-25 = S. arizonae 40(1), 40(2):k:z53 No. 159-36/70 Arizona 7a, c..:26-21 (with a new O-antigen) = S. arizonae 1, 6, 14, 25:z53:z35 No. 160-36/70 Arizona 30:32-31 = S. arizonae 65:c:z No. 162-36/70 Arizona 10a, 10b, (10c):23-31 (with a new O-antigen) = S. arizonae 40(1), 40(2):1, v:z No. 167-36/70 Arizona 25:23-31-41 = S. arizonae 16:1, v:z:z61 No. 2-36/71 Arizona 20:33-21 = S. arizonae 35:i:z35 No. 227-36/72 Arizona 26a, 26b:26-21 = S. arizonae 61(1), 61(2):z52:z35 No. 305-36/72 Arizona 7a, 7c:23-21 = S. arizonae (6), 14:1, v:z35 The two new Arizona O-antiges traced in strains nos. 159-36/70 and 162-36/70 testify the close relationship between Arizona and Salmonella justifying the inclusion of all Arizona serotypes with their corresponding Salmonella-formulae in the Kauffmann-White-Schema. The O-antigen of strain no. 159-36/70 was verified only by using Salmonella O-antisera, the O-antigen of no. 162-36/70 by serological comparative tests with a certain Salmonella-species = S. bukavu. Strain no. 167-36/70: it is pointed out that phase 3 could probably be a so-called R-phase.