Deep vein thrombosis - the role of ultrasound in the diagnosis and follow-up of patients.

Deep vein thrombosis still represents a challenge regarding the diagnostics, treatment and follow-up. All this steps are often performed in the internal medicine ambulatory centers and such clinics therefore need to be aable to manage the whole process. Its key part is vascular sonography, which is needed to establish the diagnosis, the form of thrombosis and proper treatment course. There are two types of vascular sonography - Point of Care a expert sonography, being performed in two different regimes (diagnostic and follow up sonography). There are different demands for each of these two types, and each type is performed by physicians with different level of expertise. There are well defined criteria for performance a conclusions made for each type, and their precise fulfillment leads to establishment of diagnosis of DVT, early treatment initiation and setting of optimal strategy following the baseline treatment period.

Utility of fatty acid profile and in vitro immune cell activation for chemical and biological standardization of Arthrospira/Limnospira.

Commercially cultivated Limnospira (species formerly classified to genus Arthrospira) is a popular food/supplement consumed by millions of people worldwide for health benefits. The objective of the current research was to advance the standardization technology for Limnospira. Quantitative methods were established to detect fatty acids as potential chemical markers and immune-enhancing activity. Analysis of 20 different batches of biomass obtained from one commercial grower demonstrated that there was a statistically significant relationship between the sum of two fatty acids (linoleic and γ-linolenic) and Toll-like receptor (TLR)2/TLR1-dependent activation (R2 = 0.48, p = 0.0007). Investigation of 12 biomass samples sourced from growers in 10 different countries demonstrated that fatty acid content was again significantly correlated with biological activity (R2 = 0.72, p = 0.0005) and the content of fatty acids varied by twofold and activity by 12.5-fold. This large variation between different samples confirms the need to use the present standardization methods to ensure consistent and properly characterized biomass for consumers and for future scientific research.

Operating a modern performance-oriented internal medicine outpatient unit.

Outpatient internal medicine clinics as a key providers of health care are not in their best shape and are facing up to range of economical as well as staffing issues. If current status does not change, outpatient internal medicine can become marginal field of medicine. Article offers analysis of current situation and possible means of change.

Thainema gen. nov. (Leptolyngbyaceae, Synechococcales): A new genus of simple trichal cyanobacteria isolated from a solar saltern environment in Thailand.

Simple trichal types constitute a group of cyanobacteria with an abundance of novel, often cryptic taxa. Here, we investigated material collected from wet surface-soil in a saline environment in Petchaburi Province, central Thailand. A morphological comparison of the isolated strain with similar known species, as well as its phylogenetic and species delimitation analyses based on the combined datasets of other related organisms, especially simple trichal cyanobacteria, revealed that the material of this study represented an independent taxon. Using a multifaceted method, we propose that this material represents a new genus, Thainema gen. nov., belonging to the family Leptolyngbyaceae, with the type species Thainema salinarum sp. nov. This novel taxon shares similar ecological habitats with strains previously placed in the same lineage.

Tenebriella gen. nov. - The dark twin of Oscillatoria.

Oscillatoria has long been known to be polyphyletic. After recent resequencing of the reference strain for this genus, many Oscillatoria-like groups phylogenetically distant from the type species O. princeps remained unresolved. Here we describe one of these groups as a new genus Tenebriella. Most of the studied strains originate from Central Europe, where they are able to form prominent microbial mats. Despite the overall Oscillatoria-like morphology, Tenebriella can be distinguished by darker trichomes and forms a separate monophyletic clade in phylogenies inferred from the 16S rRNA gene and two additional loci (rpoC1, rbcLX). Within Tenebriella we recognize two new species differing from each other by morphological and ecological characteristics. First species does not fit any known taxon description, and thus is described as a new species T. amphibia. The latter one corresponds with the information available for Oscillatoria curviceps Agardh ex Gomont, and thus new combination T. curviceps is proposed. The phylogenetic analyses of the 16S-23S ITS region together with the comparison of the hypothetical secondary structures confirmed recognition of these two species and additionally revealed presence of a morphologically cryptic species Tenebriella sp. The results corroborate frequent recurrence of convergent morphotypes in the evolution of cyanobacteria and justify further exploration even of the intensively studied European freshwaters using molecular phylogenetics to discover new and ecologically relevant taxa.

Taxonomic resolution of the genus Cyanothece (Chroococcales, Cyanobacteria), with a treatment on Gloeothece and three new genera, Crocosphaera, Rippkaea, and Zehria.

The systematics of single-celled cyanobacteria represents a major challenge due to morphological convergence and application of various taxonomic concepts. The genus Cyanothece is one of the most problematic cases, as the name has been applied to oval-shaped coccoid cyanobacteria lacking sheaths with little regard to their phylogenetic position and details of morphology and ultrastructure. Hereby we analyze an extensive set of complementary genetic and phenotypic evidence to disentangle the relationships among these cyanobacteria. We provide diagnostic characters to separate the known genera Cyanothece, Gloeothece, and Aphanothece, and provide a valid description for Crocosphaera gen. nov. We describe two new genera, Rippkaea and Zehria, to characterize two distinct phylogenetic lineages outside the previously known genera. We further describe 13 new species in total including Cyanothece svehlovae, Gloeothece aequatorialis, G. aurea, G. bryophila, G. citriformis, G. reniformis, Gloeothece tonkinensis, G. verrucosa, Crocosphaera watsonii, C. subtropica, C. chwakensis, Rippkaea orientalis, and Zehria floridana to recognize the intrageneric diversity as rendered by polyphasic analysis. We discuss the close relationship of free-living cyanobacteria from the Crocosphaera lineage to nitrogen-fixing endosymbionts of marine algae. The current study includes several experimental strains (Crocosphaera and "Cyanothece") important for the study of diazotrophy and the global oceanic nitrogen cycle, and provides evidence suggesting ancestral N2 -fixing capability in the chroococcalean lineage.

Detailed characterization of the Arthrospira type species separating commercially grown taxa into the new genus Limnospira (Cyanobacteria).

The genus Arthrospira has a long history of being used as a food source in different parts of the world. Its mass cultivation for production of food supplements and additives has contributed to a more detailed study of several species of this genus. In contrast, the type species of the genus (A. jenneri), has scarcely been studied. This work adopts a polyphasic approach to thoroughly investigate environmental samples of A. jenneri, whose persistent bloom was noticed in an urban reservoir in Poland, Central Europe. The obtained results were compared with strains designated as A. platensis, A. maxima, and A. fusiformis from several culture collections and other Arthrospira records from GenBank. The comparison has shown that A. jenneri differs from popular species that are massively utilized commercially with regard to its cell morphology, ultrastructure and ecology, as well as its 16S rRNA gene sequence. Based on our findings, we propose the establishment of a new genus, Limnospira, which currently encompasses three species including the massively produced L. (A.) fusiformis and L. (A.) maxima with the type species Limnospira fusiformis.

226Ra, 238U and Cd adsorption kinetics and binding capacity of two cyanobacterial strains isolated from highly radioactive springs and optimal conditions for maximal removal effects in contaminated water.

Biomass-based decontamination methods are among the most interesting water treatment techniques. In this study, 2 cyanobacterial strains, Nostoc punctiforme A.S/S4 and Chroococcidiopsis thermalis S.M/S9, isolated from hot springs containing high concentrations of radium (226Ra), were studied to be associated with removal of radionuclides (238U and 226Ra) and heavy metal cadmium (Cd) from aqueous solutions. The adsorption equilibrium data was described by Langmuir and Freundlich isotherm models. Kinetic studies indicated that the sorption of 3 metals followed pseudo-second-order kinetics. Effects of biomass concentration, pH, contact time, and initial metal concentration on adsorption were also investigated. Fourier-transform infrared spectroscopy revealed active binding sites on the cyanobacterial biomass. The obtained maximum biosorption capacities were 630 mg g-1 and 37 kBq g-1 for 238U and 226Ra for N. punctiforme and 730 mg g-1 and 55 kBq g-1 for C. thermalis. These 2 strains showed maximum binding capacity 160 and 225 mg g-1, respectively for Cd adsorption. These results suggest that radioactivity resistant cyanobacteria could be employed as an efficient adsorbent for decontamination of multi-component, radioactive and industrial wastewater.

Highly divergent 16S rRNA sequences in ribosomal operons of Scytonema hyalinum (Cyanobacteria).

A highly divergent 16S rRNA gene was found in one of the five ribosomal operons present in a species complex currently circumscribed as Scytonema hyalinum (Nostocales, Cyanobacteria) using clone libraries. If 16S rRNA sequence macroheterogeneity among ribosomal operons due to insertions, deletions or truncation is excluded, the sequence heterogeneity observed in S. hyalinum was the highest observed in any prokaryotic species thus far (7.3-9.0%). The secondary structure of the 16S rRNA molecules encoded by the two divergent operons was nearly identical, indicating possible functionality. The 23S rRNA gene was examined for a few strains in this complex, and it was also found to be highly divergent from the gene in Type 2 operons (8.7%), and likewise had nearly identical secondary structure between the Type 1 and Type 2 operons. Furthermore, the 16S-23S ITS showed marked differences consistent between operons among numerous strains. Both operons have promoter sequences that satisfy consensus requirements for functional prokaryotic transcription initiation. Horizontal gene transfer from another unknown heterocytous cyanobacterium is considered the most likely explanation for the origin of this molecule, but does not explain the ultimate origin of this sequence, which is very divergent from all 16S rRNA sequences found thus far in cyanobacteria. The divergent sequence is highly conserved among numerous strains of S. hyalinum, suggesting adaptive advantage and selective constraint of the divergent sequence.

Real-life experience with the specific reversal agent idarucizumab for the management of emergency situations in dabigatran-treated patients: a series of 11 cases.

Non-vitamin K antagonist oral anticoagulants (NOACs) have a favorable benefit-risk profile compared with vitamin K antagonists. However, the lack of specific reversal agents has made the management of some patients receiving long-term treatment with NOACs problematic in emergency situations such as major bleeding events or urgent procedures. Idarucizumab, a fully humanized Fab antibody fragment that binds specifically and with high affinity to dabigatran, was recently approved for use in adult patients treated with dabigatran when rapid reversal of its anticoagulant effect is required. Clinical experience with idarucizumab is currently limited. We report 11 real-life clinical cases in which idarucizumab was used after multidisciplinary consultation in a variety of emergency situations including severe postoperative bleeding, emergency high-bleeding-risk surgery (hip/spine surgery and neurosurgery), invasive diagnostic testing (lumbar puncture), intracranial bleeding (pre-pontine subarachnoid hemorrhage and lobar intracerebral hemorrhage) and thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke. This case series illustrates the role of idarucizumab in improving patient safety in rare emergency situations requiring rapid reversal of the anticoagulant effect of dabigatran, while highlighting the importance of information and education about the availability and appropriate use of this recently approved specific reversal agent.

Some Like it High! Phylogenetic Diversity of High-Elevation Cyanobacterial Community from Biological Soil Crusts of Western Himalaya.

The environment of high-altitudinal cold deserts of Western Himalaya is characterized by extensive development of biological soil crusts, with cyanobacteria as dominant component. The knowledge of their taxonomic composition and dependency on soil chemistry and elevation is still fragmentary. We studied the abundance and the phylogenetic diversity of the culturable cyanobacteria and eukaryotic microalgae in soil crusts along altitudinal gradients (4600-5900 m) at two sites in the dry mountains of Ladakh (SW Tibetan Plateau and Eastern Karakoram), using both microscopic and molecular approaches. The effects of environmental factors (altitude, mountain range, and soil physico-chemical parameters) on the composition and biovolume of phototrophs were tested by multivariate redundancy analysis and variance partitioning. Both phylogenetic diversity and composition of morphotypes were similar between Karakorum and Tibetan Plateau. Phylogenetic analysis of 16S rRNA gene revealed strains belonging to at least five genera. Besides clusters of common soil genera, e.g., Microcoleus, Nodosilinea, or Nostoc, two distinct clades of simple trichal taxa were newly discovered. The most abundant cyanobacterial orders were Oscillatoriales and Nostacales, whose biovolume increased with increasing elevation, while that of Chroococales decreased. Cyanobacterial species richness was low in that only 15 morphotypes were detected. The environmental factors accounted for 52 % of the total variability in microbial data, 38.7 % of which was explained solely by soil chemical properties, 14.5 % by altitude, and 8.4 % by mountain range. The elevation, soil phosphate, and magnesium were the most important predictors of soil phototrophic communities in both mountain ranges despite their different bedrocks and origin. The present investigation represents a first record on phylogenetic diversity of the cyanobacterial community of biological soil crusts from Western Himalayas and first record from altitudes over 5000 m.

Main photoautotrophic components of biofilms in natural draft cooling towers.

While photoautotrophic organisms are an important component of biofilms that live in certain regions of natural draft cooling towers, little is known about these communities. We therefore examined 18 towers at nine sites to identify the general patterns of community assembly in three distinct tower parts, and we examined how community structures differ depending on geography. We also compared the newly acquired data with previously published data. The bottom sections of draft cooling towers are mainly settled by large filamentous algae, primarily Cladophora glomerata. The central portions of towers host a small amount of planktic algae biomass originating in the cooling water. The upper fourths of towers are colonized by biofilms primarily dominated by cyanobacteria, e.g., members of the genera Gloeocapsa and Scytonema. A total of 41 taxa of phototrophic microorganisms were identified. Species composition of the upper fourth of all towers was significantly affected by cardinal position. There was different species composition at positions facing north compared to positions facing south. West- and east-facing positions were transitory and highly similar to each other in terms of species composition. Biofilms contribute to the degradation of paint coatings inside towers.

Phylogenetic analysis of cultivation-resistant terrestrial cyanobacteria with massive sheaths (Stigonema spp. and Petalonema alatum, Nostocales, Cyanobacteria) using single-cell and filament sequencing of environmental samples.

Molecular assessment of a large portion of traditional cyanobacterial taxa has been hindered by the failure to isolate and grow them in culture. In this study, we developed an optimized protocol for single cell/filament isolation and 16S rRNA gene sequencing of terrestrial cyanobacteria with large mucilaginous sheaths, and applied it to determine the phylogenetic position of typical members of the genera Petalonema and Stigonema. A methodology based on a glass-capillary isolation technique and a semi-nested PCR protocol enabled reliable sequencing of the 16S rRNA gene from all samples analyzed. Ten samples covering seven species of Stigonema from Europe, North and Central America, and Hawaii, and the type species of Petalonema from Slovakia were sequenced. Contrary to some previous studies, which proposed a relationship with heteropolar nostocalean cyanobacteria, Petalonema appeared to belong to the family Scytonemataceae. Analysis of Stigonema specimens recovered a unique coherent phylogenetic cluster, substantially broadening our knowledge of the molecular diversity within this genus. Neither the uni- to biseriate species nor the multiseriate species formed monophyletic subclusters within the genus. Typical multiseriate species of Stigonema clustered in a phylogenetic branch derived from uni- to biseriate S. ocellatum Thuret ex Bornet & Flahault in our analysis, suggesting that species with more complex thalli may have evolved from the more simple ones. We propose the technique tested in this study as a promising tool for a future revision of the molecular taxonomy in cyanobacteria.

Reassessment of the cyanobacterial family Microchaetaceae and establishment of new families Tolypothrichaceae and Godleyaceae.

The family Microchaetaceae is a large group of heterocytous cyanobacteria, whose members bear typical morphological features of uniseriate heteropolar filaments never terminated by thin hairs and with simple false branching. However, phylogenetic analyses of the gene for 16S rRNA showed that members of this traditionally morphologically delimited family form several distant groups and therefore the current concept is hereafter indefensible. In this study, we provide reassessment of the status of the family Microchaetaceae based on morphology, ecology, biogeography, and phylogeny of 16S rRNA gene. Thorough examination of strains of the nominate genus Microchaete revealed their affiliation to two groups, Nostocaceae and Rivulariaceae, and their distant position to other traditional members of Microchaetaceae such as Tolypothrix, Hassallia, and Coleodesmium. To reflect the phylogenetic relationships and to accommodate members of the traditional family Microchaetaceae that are clearly not related to any of the Microchaete representatives, we propose establishment of two new families, Tolypothrichaceae and Godleyaceae. Based on both molecular and morphological evidence, we also provide a description of three new species of the genus Fortiea.