Schwere Infektionen

The sepsis syndrome has only recently been defined as a clinical syndrome but despite its unspecific definition it has evolved rapidly into an important concept. Although specific therapeutic interventions targeting the inflammatory pathway have not yet been effective in treating sepsis, a better understanding of mechanisms leading to organ dysfunction has led to better management of patients with sepsis. Clinical signs of systemic inflammatory response syndrome (SIRS) or sepsis are hallmarks for the definition of severe infections. Current guidelines are presented for the management of a number of severe infectious syndromes.     

Application of Maastricht 2-2000 guidelines for the management of Helicobacter pylori among specialists and primary care physicians in israel: are we missing the malignant potential of Helicobacter pylori?

BACKGROUND: The Maastricht 2-2000 guidelines on the current management of Helicobacter pylori infection were recently adopted by the Israeli Gastroenterological Association. GOAL: To determine the impact of these clinical guidelines on the current knowledge, attitudes, and management of H. pylori among primary care physicians, hospital internists, and gastroenterologists in Israel. STUDY: Self-administered, voluntary, anonymous questionnaires were given personally to 229 physicians, 73 primary care physicians, 71 internists, and 85 gastroenterologists. The questions evaluated 4 main issues in the management of H. pylori: (1). the optimal diagnostic test, (2). indications for eradication, (3). combination and duration of triple therapy, and (4). the need for confirmation following eradication. RESULTS: There were significant variations in the adherence of those recommendations among gastroenterologists, internists, and primary care physicians. Specifically, 94.1% of gastroenterologists and 88.9% of internists consider the urea breath test the test of choice for H. pylori diagnosis compared with 60.0% of the primary care physicians. Significant differences in the eradication indications for mucosa-associated lymphoid tissue (MALT) lymphoma, first-degree relatives of gastric cancer patients, atrophic gastritis, functional dyspepsia, and concomitant use of nonsteroidal antiinflammatory drugs were demonstrated among gastroenterologists and the other groups. CONCLUSIONS: Primary care physicians may not be aware of important indications for diagnosis and eradication of H. pylori related to the risk of gastric malignancy or concomitant use of nonsteroidal antiinflammatory drugs. Public health agencies may need to increase penetration of the Maastricht 2000 recommendations to primary care physicians.     

Fibre supplementation for the prevention of type 2 diabetes and improvement of glucose metabolism: the randomised controlled Optimal Fibre Trial (OptiFiT)

Aims/hypothesis

Insoluble cereal fibres have been shown in large prospective cohort studies to be highly effective in preventing type 2 diabetes, but there is a lack of interventional data. Our 2 year randomised double-blind prospective intervention study compared the effect of an insoluble oat fibre extract with that of placebo on glucose metabolism and incidence of diabetes.

Methods

A total of 180 participants with impaired glucose tolerance underwent a modified version of the 1 year lifestyle training programme PREvention of DIAbetes Self-management (PREDIAS) and were randomised to receive a fibre supplement (n?=?89; 7.5 g of insoluble fibre per serving) or placebo (n?=?91; 0.8 g of insoluble fibre per serving) twice daily for 2 years. Eligible participants were men and women, were at least 18 years old and did not report corticosteroid or other intensive anti-inflammatory treatment, fibre intolerance or any of the following disorders: overt diabetes, chronic or malignant disease, or severe cardiopulmonary, endocrine, psychiatric, gastrointestinal, autoimmune or eating disorder. Participants were recruited at two clinical wards in Berlin and Nuthetal. The allocation was blinded to participants and study caregivers (physicians, dietitians, study nurses). Randomisation was conducted by non-clinical staff, providing neutrally numbered supplement tins. Both supplements were similar in their visual, olfactory and gustatory appearance. Intention-to-treat analysis was applied to all individuals.

Results

After 1 year, 2 h OGTT levels decreased significantly in both groups but without a significant difference between the groups (fibre ?0.78?±?1.88 mmol/l [p?≤ 0.001] vs placebo ?0.46?±?1.80 mmol/l [p?=?0.020]; total difference 0.32?±?0.29 mmol/l; not significant). The 2 year incidence of diabetes was 9/89 (fibre group) compared with 16/91 (placebo group; difference not significant). As secondary outcomes, the change in HbA_1c level was significantly different between the two groups (?0.2?±?4.6 mmol/mol [?0.0?±?0.0%; not significant] vs +1.2?±?5.2 mmol/mol [+0.1?±?0.0%; not significant]; total difference 1.4?±?0.7 mmol/mol [0.1?+?0.0%]); p?=?0.018); insulin sensitivity and hepatic insulin clearance increased in both groups. After 2 years, improved insulin sensitivity was still present in both groups, although the effect size had diminished. Separate analysis of the sexes revealed a significantly greater reduction in 2 h glucose levels for women in the fibre group (?0.88?±?1.59 mmol/l [p?≤ 0.001] vs ?0.22?±?1.52 mmol/l [p?=?0.311]; total difference 0.67?±?0.31 mmol/l; p?=?0.015). Levels of fasting glucose, adipokines and inflammatory markers remained unchanged in the two groups. Significantly increased fibre intake was restricted to the fibre group, despite dietary counselling for both groups. No severe side effects occurred.

Conclusions/interpretation

We cannot currently provide strong evidence for a beneficial effect of insoluble cereal fibre on glycaemic metabolism, although further studies may support minor effects of fibre supplementation in reducing glucose levels, insulin resistance and the incidence of type 2 diabetes.Trial registration: clinicaltrials.gov NCT01681173Funding: German Diabetes Foundation (grant no. 232/11/08)

     

Malignant transformation of normal enterocytes following downregulation of Bak expression

Bak is a pro-apoptotic gene, which plays an important role in the multi-step process of gastrointestinal tumorigenesis. We hypothesized that downregulation of Bak expression in normal enterocytes will result in a transformed phenotype. The nontumorigenic intestinal epithelial cell line (IEC18) was transfected with the vector pMV12-AS-bak (encoding anti-sense bak). Three clones, with Bak protein levels similar to those seen in colon cancer cell lines and significantly lower than those found in the parental cells, were further evaluated. The three clones proliferated faster, demonstrated anchorage-independent growth in soft agar and a higher saturation density and plating efficiency. Furthermore, when injected into nude mice, these cells generated tumors after approximately 2-3 weeks. The cells were more resistant to the induction of apoptosis by sulindac sulfide and sulindac sulfone but more sensitive to COX 2 inhibitors (celecoxib and nimesulide). The levels of p16, cyclin D1 and COX 2 were higher in the three transformed clones. In summary,downregulation of Bak expression in normal enterocytes contributes to abnormal growth and tumorigenesis. COX 2 inhibitors may serve as important agents in the prevention and treatment of CRC as they only inhibit the growth of malignant cells.     

Materner Metabolismus und fetale Entwicklung

Die Diabetologie - Schon intrauterin wird die menschliche Entwicklung von äußeren Faktoren beeinflusst. In dieser sensiblen Phase liegen entwicklungsbedingte Ursprünge von Gesundheit...     

Fetal response to vibratory acoustic stimulation in periods of low heart rate reactivity and low activity

The fetal response to vibratory acoustic stimulation during periods of low fetal activity and low fetal heart rate reactivity was studied in 10 healthy pregnant women at term. In each case, two periods of low reactivity were studied. Consecutive cases alternated: The vibratory acoustic stimulus was applied 10 minutes after the first nonreactive period in half of the cases; the remainder were stimulated during the second nonreactive period. The unstimulated period served as a control. After vibratory acoustic stimulation the baseline fetal heart rate, the mean number of fetal heart rate accelerations, and, the number of fetal movements were significantly increased with values in the control nonstimulated periods (p less than 0.0001). This consistent response to vibratory acoustic stimulation may prove to be clinically useful in altering periods of low reactivity observed during nonstress testing of normal fetuses.     

Der intraperitoneale Keimabbau bei galliger Peritonitis Eine experimentelle Studie an der Ratte

Zusammenfassung Bei 60 Lewis-Ratten wird der intraperitoneale Keimabbau mit Hilfe des Uriculttestes untersucht. Während die Bauchhöhle 24 h nach Keiminjektion bei Ringer-Lösung nahezu steril ist, wird der Keimabbau in Abhängigkeit der Gallekonzentration verlangsamt oder aufgehoben. Diese Wirkung beruht teils auf der bekannten Phagocytosehemmung durch Gallensäuren, teils durch Bilirubinwirkung, deren Einfluß verzögert nach 6 h einsetzt und wahrscheinlich auf einer Unterdrückung der Chemotaxis für Granulocyten beruht.

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Intraperitoneal germ reduction in biliary peritonitis An experimental study in rat

Summary In 60 Lewis rats the intraperitoneal germ reduction was studied by means of the Uricult method. 24 h after inoculation with germs in ringer's solution the peritoneum was nearly sterile, whereas germ reduction due to bile concentration slows down or stops totally. This results from blocked phagocytosis by bile acids and delayed effect of bilirubin, probably by suppression of chemotaxis of granulocytes.