Molecular basis of human body odour formation: insights deduced from corynebacterial genome sequences.

During the past few decades, there has been an increased interest in the essential role of commensal skin bacteria in human body odour formation. It is now generally accepted that skin bacteria cause body odour by biotransformation of sweat components secreted in the human axillae. Especially, aerobic corynebacteria have been shown to contribute strongly to axillary malodour, whereas other human skin residents seem to have little influence. Analysis of odoriferous sweat components has shown that the major odour-causing substances in human sweat include steroid derivatives, short volatile branched-chain fatty acids and sulphanylalkanols. In this mini-review, we describe the molecular basis of the four most extensively studied routes of human body odour formation, while focusing on the underlying enzymatic processes. Considering the previously reported role of ß-oxidation in odour formation, we analysed the genetic repertoire of eight Corynebacterium species concerning fatty acid metabolism. We particularly focused on the metabolic abilities of the lipophilic axillary isolate Corynebacterium jeikeium K411.

Transcriptional regulation of catabolic pathways for aromatic compounds in Corynebacterium glutamicum.

Corynebacterium glutamicum is a gram-positive soil microorganism able to utilize a large variety of aromatic compounds as the sole carbon source. The corresponding catabolic routes are associated with multiple ring-fission dioxygenases and among other channeling reactions, include the gentisate pathway, the protocatechuate and catechol branches of the beta-ketoadipate pathway and two potential hydroxyquinol pathways. Genes encoding the enzymatic machinery for the bioconversion of aromatic compounds are organized in several clusters in the C. glutamicum genome. Expression of the gene clusters is under specific transcriptional control, apparently including eight DNA-binding proteins belonging to the AraC, IclR, LuxR, PadR, and TetR families of transcriptional regulators. Expression of the gentisate pathway involved in the utilization of 3-hydroxybenzoate and gentisate is positively regulated by an IclR-type activator. The metabolic channeling of ferulate, vanillin and vanillate into the protocatechuate branch of the beta-ketoadipate pathway is controlled by a PadR-like repressor. Regulatory proteins of the IclR and LuxR families participate in transcriptional regulation of the branches of the beta-ketoadipate pathway that are involved in the utilization of benzoate, 4-hydroxybenzoate and protocatechuate. The channeling of phenol into this pathway may be under positive transcriptional control by an AraC-type activator. One of the potential hydroxyquinol pathways of C. glutamicum is apparently repressed by a TetR-type regulator. This global analysis revealed that transcriptional regulation of aromatic compound utilization is mainly controlled by single regulatory proteins sensing the presence of aromatic compounds, thus representing single input motifs within the transcriptional regulatory network of C. glutamicum.

Transcriptional regulation of catabolic pathways for aromatic compounds in Corynebacterium glutamicum

Corynebacterium glutamicum is a gram-positive soil microorganism able to utilize a large variety of aromatic compounds as the sole carbon source. The corresponding catabolic routes are associated with multiple ring-fission dioxygenases and among other channeling reactions, include the gentisate pathway, the protocatechuate and catechol branches of the beta-ketoadipate pathway and two potential hydroxyquinol pathways. Genes encoding the enzymatic machinery for the bioconversion of aromatic compounds are organized in several clusters in the C. glutamicum genome. Expression of the gene clusters is under specific transcriptional control, apparently including eight DNA-binding proteins belonging to the AraC, IclR, LuxR, PadR, and TetR families of transcriptional regulators. Expression of the gentisate pathway involved in the utilization of 3-hydroxybenzoate and gentisate is positively regulated by an IclR-type activator. The metabolic channeling of ferulate, vanillin and vanillate into the protocatechuate branch of the beta-ketoadipate pathway is controlled by a PadR-like repressor. Regulatory proteins of the IclR and LuxR families participate in transcriptional regulation of the branches of the beta-ketoadipate pathway that are involved in the utilization of benzoate, 4-hydroxybenzoate and protocatechuate. The channeling of phenol into this pathway may be under positive transcriptional control by an AraC-type activator. One of the potential hydroxyquinol pathways of C. glutamicum is apparently repressed by a TetR-type regulator. This global analysis revealed that transcriptional regulation of aromatic compound utilization is mainly controlled by single regulatory proteins sensing the presence of aromatic compounds, thus representing single input motifs within the transcriptional regulatory network of C. glutamicum.

Downregulation of T helper type 1 immune response and altered pro-inflammatory and anti-inflammatory T cell cytokine balance following conventional but not laparoscopic surgery.

BACKGROUND: The clinical advantages of laparoscopic procedures result from a minimized surgical trauma. The present study was performed to investigate immunosupression following laparoscopic operations as compared with open surgery. Our analysis focused on the T cell secretion of cytokines that regulate the critical balance of either T helper type-1 (Th1)- and Th2-mediated immune responses on pro- and antiinflammatory activities. METHODS: In a prospective study, immunological data of 26 patients submitted to laparoscopic cholecystectomy (LCE) and 17 patients undergoing conventional cholecystectomy (CCE) for symptomatic cholecystolithiasis were compared. Patients with acute cholecystitis and patients developing postoperative complications or receiving immunosuppressive medication were excluded. Production of interferon (IFN)-gamma, interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)-alpha, and IL-10 by isolated T cells stimulated by cross-linking of CD3 and CD28 was evaluated preoperatively as well as on postoperative days 1 and 6 or 7. Cytokines were measured by immunoenzymometric assay. RESULTS: IFN-gamma, TNF-alpha, and IL-2 production by T cells decreased significantly by 48.3%, 36.6%, and 36.8%, respectively, on postoperative day 1 after CCE, but not after LCE. These results indicate severe suppression of Th1-type and proinflammatory cytokines after the open operation. In contrast, IL-4 and IL-10 did not show significant changes in either group suggesting that Th2 cell response and anti-inflammatory activity remained normal. CONCLUSIONS: The present study shows that open, but not laparoscopic cholecystectomy is associated with a marked suppression of T lymphocytes functions as indicated by deregulation of both the Th1/Th2 and the pro-/anti-inflammatory cytokine balance. The results therefore suggest that downregulation of Th1 cell-mediated immune response and pro-inflammatory activity of T cells is a hallmark of open, but not laparoscopic surgery.

Normal T lymphocyte and monocyte function after minimally invasive surgery.

BACKGROUND: The aim of this study was to evaluate immune defense mechanisms after laparoscopic (LCHE) and open cholecystectomy (CHE), particularly with regard to monocyte and T-lymphocyte function. METHODS: In a prospective study, we evaluated the following immunological data from 27 patients (21 women, six men; mean age, 47.2 years) submitted to elective LCHE and 14 patients (seven women, seven men; mean age, 60.8 years) undergoing elective CHE: T-lymphocyte proliferation (stimulated by SEA, SEB, TSST-1 with antigen presentation by patient monocytes), expression of cell surface molecules on monocytes (HLA-DR, CD80, L-Selectin), CD4+ T lymphocytes (HLA-DR, CD25, ICAM-1, L-Selectin), and granulocytes (L-Selectin). Blood samples were collected preoperatively and on postoperative days 1 and 6-7. Statistical analysis was performed using the Mann-Whitney U test for paired samples. RESULTS: HLA-DR on monocytes significantly decreased after LCHE during the early postoperative course but returned to preoperative levels within 1 week. After CHE, significant downregulation of HLA-DR expression persisted throughout the whole observation period. This decrease, however, did not alter the antigen-presenting capacity of monocytes in both groups. Moreover, the APC-independent proliferative capacity of T lymphocytes was unimpaired. CD25 expression was significantly increased on postoperative day 1 after CHE but not after LCHE. Expression of HLA-DR, ICAM1, and L-Selection on CD4+ T cells was not altered in either group. CD80 on monocytes and L-Selection on monocytes and granulocytes remained unchanged after both procedures. CONCLUSIONS: HLA-DR surface molecules on monocytes that are required for antigen presentation were significantly decreased in both groups; they returned to normal within 1 week after LCHE but not after CHE. However, the antigen-presenting capacity for monocytes remained normal in both groups. T-cell stimulation, reflected by an increase of CD25 expression, was observed only after CHE, not after LCHE. We therefore conclude that LCHE interferes less with immune defense than CHE; however, the clinical relevance of the changes noted after the open operation remains to be determined.

Laparoscopic gastrojejunostomy and endoscopic biliary stent placement for palliation of incurable gastric outlet obstruction with cholestasis.

BACKGROUND: For patients with incurable malignant gastric outlet obstruction and cholestasis, laparoscopic gastrojejunostomy combined with endoscopic biliary stent placement seems to offer a minimally invasive palliation. METHODS: We retrospectively analyzed the data of 16 patients submitted to laparoscopic gastrojejunostomy. Laparoscopic gastroenterostomy was performed as an antecolic, side-to-side gastrojejunostomy with enteroenterostomy. In 12 patients cholestasis was relieved preoperatively by stent placement via endoscopy (n = 6, 37.5%), percutaneous access (n = 5, 31%) or bilioenteric anastomosis (n = 1, 6.25%). One patient needed a percutaneous Yamakawa prosthesis postoperatively. RESULTS: Mean operative time was 126 min. There were no intraoperative complications. In one patient conversion to open surgery became necessary because of extensive adhesions. The only postoperative complication was bleeding from a trocar site requiring reintervention; there was no mortality. Median postoperative hospital stay was 7 days. Delayed gastric emptying was observed in 3 (18.7%) patients. Median survival was 87 days after the operation. All patients died from their primary disease but could maintain oral intake during the remaining survival time. CONCLUSIONS: We conclude that laparoscopic gastrojejunostomy and endoscopic or percutaneous biliary stenting provide a good functional result while impairing the quality of life only to a minimal extent.

[Problems of laparoscopy using captoperitoneum: controlled ventilation, circulation, blood gas and body temperature]. / Probleme bei der Laparoskopie unter Kapnoperitoneum: kontrollierte Beatmung, Kreislauf, Blutgase und Körpertemperatur.

More and more veterinarians are going to perform laparoscopic diagnosis and surgery those days. But the technique using capnoperitoneum implicates several alterations of different physiological parameters, which, without proper monitoring, are often realized to late. Pathophysiology under CO2 insufflated abdomen as well as counter measures to keep or reestablish physiological situations are described. Within experimental studies, 27 pigs received partial colon resection using the laparoscopic technique, another six after laparotomy. They were compared concerning controlled ventilation, cardiovascular and blood gas parameters as well as the body temperature. Monitoring of the end-exspiratory CO2-gas tension as well as controlled ventilation seems to be essential. Blood gas analyses are proposed additionally. Under the described laparoscopic conditions blood circulation and body temperature seem to be influenced positively.

[Early elective surgery of acute diverticulitis of the colon]. / Frühelektive Chirurgie der akuten Diverticulitis des Colons.

The aim of surgery for acute diverticulitis is the removal of the inflammatory focus, i.e. resection of the diseased bowel segment. With the aid of modern surgical technique, intensive care medicine, and interventional radiology surgery for acute diverticulitis is increasingly performed under elective conditions. This has led to a decrease in two- or three-staged resections in favor of primary resection and anastomosis even in advanced stages of diverticulitis.

[Mucinous cystadenomas and cystadenocarcinomas of the pancreas--the pancreaticoscopy as a new device for endoscopic and histological diagnosis]. / Muzinöse Zystadenome und Zystadenokarzinome des Pankreas--die Pankreatikoskopie als neues Instrument der endoskopischen und feingeweblichen Diagnosesicherung.

Recent advances in diagnostic imaging procedures offer the opportunity for detection of rare cystic neoplasms of the pancreas. Cystadenomas of the pancreas have been reported to represent 10% of cystic pancreatic lesions. Serous microcystic cystadenoma, megacystic mucinous and duct-ectatic mucinous cystadenoma were distinguished. While the serous cystadenoma is benign, in general the megacystic and the duct-ectatic mucinous cystadenoma have a significant malignant potential. With pancreatoscopy, a rather new endoscopic technique, five cases of mucinous megacystic cystadenoma were diagnosed preoperatively by macroscopic and microscopic means. In one case, development of malignant neoplasm was diagnosed, one patient did not undergo surgery because of her age. Three patients were operated (total pancreatectomy in one case, duodeno-hemipancreatectomy in two cases) and are without any further signs of recurrence and free of symptoms in a one year to four year clinical follow-up.

Complications after laparoscopic and conventional cholecystectomy: a comparative study.

The growing popularity of laparoscopic cholecystectomy (LC) has made extensive series comparing laparoscopic and conventional cholecystectomy in a prospective, randomized way nearly impossible. To evaluate LC we compared retrospectively 800 laparoscopic with 748 conventional cholecystectomies (CC). Of the 800 LC, 10 (1.2%) were converted to laparotomy. 6 conversions were related to aberrant anatomical features or features making dissection very difficult, 4 conversions were due to complications. There were 5 (0.6%) intraoperative complications during LC and 4 (0.5%) during CC. Postoperative morbidity was 2.1% (n = 17) after LC and 3.7% (n = 28) after CC. Particularly the incidence of wound problems was only 0.5% (n = 4) after LC while it was 1.3% (n = 10) after CC. Overall morbidity was 2.7% (n = 22) for LC and 4.2% (n = 32) for CC. Mortality rate after CC was 0.4% (n = 3), there were no deaths after LC. Common bile duct-injury rate was 0.2% (n = 2) for both groups. Complication rates after LC have been rapidly decreasing with growing experience. Laparoscopic cholecystectomy can safely be performed by appropriately trained surgeons in more than 90% of patients suffering from gallbladder disease. The low morbidity and mortality together with the significant advantages to patient recovery makes laparoscopic cholecystectomy the treatment of choice for symptomatic cholecystolithiasis.

[Laparoscopic side-to-side gastrojejunostomy]. / Laparoskopische Seit-zu-Seit-Gastro-Jejunostomie.

Development of laparoscopic stapling devices and growing experience with the new method made resective and reconstructive operations on the digestive system accessible to laparoscopy. After extensively testing the method on pigs, we now report on laparoscopic gastro-jejunostomies performed in two patients for gastric stenosis due to inoperable carcinoma of the pancreas. The technique is described. It requires expensive instruments and a very skilled surgeon. While being a safe procedure in the hands of a well-trained surgeon, it presents a high degree of difficulty. Therefore, in order to avoid complications, it should not be advised for a large scale application before results of a greater number of cases can be presented.

[Laparoscopic sigmoid resection]. / Laparoskopische Sigmaresektion.

Laparoscopic appendectomy and cholecystectomy have become routine operations in many hospitals by now. The high acceptance among patients and surgeons together with the development of performing laparoscopic instruments made the laparoscopic approach of colon resections possible. The technique of laparoscopic resection of the sigmoid colon is described. By a surgeon possessing experience in laparoscopic surgery, it can be done without problems. The advantage for the patient lies in less postoperative pain and a shorter hospital stay, but the method still needs to be perfectionated and tested before being advised for a large scale application.

Lupus cardiomyopathy: cardiac mechanics, hemodynamics, and coronary blood flow in uncomplicated systemic lupus erythematosus.

Right and left heart pressures, left ventricular volumes, indices of contractility, myocardial wall stiffness, and coronary blood flow were determined in five young women with systemic lupus erythematosus (SLE) during diagnostic right and left heart catheterization. Examinations revealed (1) increases of right and left ventricular enddiastolic pressures; (2) decreases of cardiac output, stroke volume, ejection fraction, contractility indices, diastolic left ventricular volume inflow; (3) decreases of pharmacologically induced coronary vasodilation in SLE. The results demonstrate impaired pump function, reduced contractility, increased myocardial wall stiffness, and decreased coronary vascular reserve in SLE. It is concluded that lupus cardiomyopathy associated with an impairment of left ventricular function may be apparent in young women with SLE who have no clinical signs of cardiac dysfunction.

[Cardiomyopathy in uncomplicated systemic lupus erythematosus (author's transl)]. / Lupus-Kardiomyopathie bei unkompliziertem Lupus erythematodes disseminatus

Haemodynamic functions, myocardial contractility, and coronary blood flow were measured in five young women with systemic lupus erythematosus. There had been no signs of cardiac involvement. Left and right heart catherterisation excluded abnormal pressure gradients and valvar regurgitation. But left ventricular end-diastolic pressures were considerably raised while cardiac output, stroke volume, ejection fraction, and left ventricular compliance were decreased. Isovolumic indices of myocardial contractility were altered, corresponding to a decreased contractile state of the myocardium. Coronary blood flow was moderately increased at rest, but pharmacologically induced coronary vascular reserve was markedly reduced. It is concluded that in young women with this disease there may be, in the absence of clinical signs of cardiac involvement, haemodynamic abnormalities which must be ascribed to the consequences of a lupus cardiomyopathy.