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Introduction In this pilot study, we aimed to determine qualitative and quantitative microbiological changes after the implementation of orthodontic appliances. Methods A total of 10 healthy patients aged 12-15 years were recruited who needed to undergo orthodontic treatment with buccal fixed appliances. Gingival conditions were assessed by the Gingival Index, Periodontal Screening Index, and Sulcus Bleeding Index. Microbiological samples were collected before and 1 week after the start of therapy at premolars and molars of the right upper quadrant. Bacterial species were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Results The total number of bacteria increased. Six bacterial species were identified that are involved in the development of caries and other infectious processes. The bacteria selectively adapted more efficiently to the new oral milieu compared with the general oral microbial background. There was a significant increase in Streptococcus spp at the premolars and molars. In all individuals, symptoms of inflammation and gingivitis were detected as a response to the bacterial challenge. Conclusions Orthodontic treatment induces significant changes in the oral microbial flora associated with gingivitis and an enhanced risk for cariogenic reactions within the first days of orthodontic treatment. To prevent or reduce infectious side effects, oral hygiene instructions and control of patients are necessary before and during the beginning of the therapy.

Die rechtlichen Rahmenbedingungen fur Prognosen im Strafverfahren haben sich seit Vorlage der „Mindestanforderungen fur Prognosegutachten“ im Jahre 2006 erheblich weiterentwickelt. Der Gesetzgeber hat die bestehenden Prognosetatbestande weithin uberarbeitet und zusatzliche Tatbestande mit teilweise neuartigen Fragestellungen geschaffen. Auch die begleitenden verfahrensrechtlichen Regelungen sind in Teilen uberarbeitet worden. Zugleich stellen die Obergerichte zunehmend strengere Anforderungen an die Begrundung von Prognoseentscheidungen. Der nachfolgende Beitrag vollzieht diese Entwicklungen nach und bringt die Rahmenbedingungen fur Prognosen im Strafverfahren auf den aktuellen Stand. Die Darstellung differenziert dabei nach Verfahrensrecht und materiellem Recht und hier weiter nach Erkenntnisverfahren und Vollstreckungsverfahren sowie nach den verschiedenen Sanktionen.

ZUSAMMENFASSUNGEine 55-jährige Patientin stellte sich zur Abklärung eines generalisierten epileptischen Anfalls in der zentralen Notaufnahme unseres Universitätsklinikums vor. Im Rahmen der weiteren Untersuchungen fielen kognitive Einschränkungen und eine axonal-demyelisierende Polyneuropathie auf. Laborchemisch war initial lediglich eine leichte Pleozytose in der Liquoruntersuchung auffällig. Im Rahmen der weiteren Abklärung der klinischen Beschwerden und der Liquorpleozytose konnte bei der Patientin infektionsserologisch eine chronisch-persistierende Treponema-pallidum-Infektion gesichert werden. Die gleiche Diagnose konnte anschließend auch bei dem Lebenspartner der Patientin gestellt werden. Bei generalisierten epileptischen Anfällen, zunehmenden kognitiven Einschränkungen und axonal-demyelinisierender Polyneuropathie unklarer Genese sollte eine Neurolues differenzialdiagnostisch erwogen und eine Liquoruntersuchung durchgeführt werden.

MALDI-TOF mass spectrometry (MS) may be used as a rapid typing method for nosocomial pathogens. Here, we evaluated MALDI-TOF MS for discrimination of hospital outbreak-related clusters of Serratia marcescens and carbapenemase-producing Citrobacter freundii. Thirty-three S. marcescens isolates collected from neonatal intensive care unit (NICU) patients, and 23 C. freundii isolates including VIM-positive isolates from a hospital colonization outbreak were measured by Vitek MS. Consensus spectra of each isolate were clustered using SARAMIS software. Genotyping was performed by whole-genome sequencing (WGS). First, a set of 21 S. marcescens isolates from 2014 with seven genotypes including three monoclonal clusters was used for the evaluation of MALDI-TOF typing. MS clustering was largely in agreement with genotyping results when the similarity cut-off for clonal identity was set on 90%. MALDI-TOF cluster analysis was then investigated for the surveillance of S. marcescens in the NICU in 2017 and demonstrated the introduction of new strains into the hospital and nosocomial transmissions. MS analysis of the C. freundii outbreak in 2016 revealed a monoclonal cluster of VIM-positive isolates and the separation of epidemiologically non-related VIM-positive and negative isolates. Two additional VIM-positive Citrobacter isolates from food samples were closely related to the large monoclonal cluster. WGS confirmed the MS results. MALDI-TOF MS may be used as a first-line typing tool for S. marcescens and C. freundii to detect transmission events in the hospital because isolates of an identical WGS type were grouped into the same MS cluster.

Interest in the application of cold atmospheric plasma (CAP) in the medical field has been increasing. Indications in dentistry are surface modifications and antimicrobial interventions. The antimicrobial effect of CAP is mainly attributed to the generation of reactive oxygen and reactive nitrogen species. The aim of this article is to systematically review the available evidence from in-vitro studies on the antimicrobial effect of CAP on dental pathogens. A database search was performed (PubMed, Embase, Scopus). Data concerning the device parameters, experimental set-ups and microbial cultivation were extracted. The quality of the studies was evaluated using a newly designed assessment tool. 55 studies were included (quality score 31–92%). The reduction factors varied strongly among the publications although clusters could be identified between groups of set pathogen, working gases, and treatment time intervals. A time-dependent increase of the antimicrobial effect was observed throughout the studies. CAP may be a promising alternative for antimicrobial treatment in a clinically feasible application time. The introduced standardized protocol is able to compare the outcome and quality of in-vitro studies. Further studies, including multi-species biofilm models, are needed to specify the application parameters of CAP before CAP should be tested in randomized clinical trials.

(1) Background: Antimicrobial agents such as chlorhexidine (CHX) are commonly used in oral plaque control. However, sometimes those agents lack antimicrobial efficiency or cause undesired side effects. To identify alternative anti-infective agents, the present study investigated the antibacterial activity of all-fruit juices derived from blackcurrant, redcurrant, cranberry and raspberry on common oral pathogenic gram-positive and gram-negative bacteria (Streptococcus mutans, Streptococcus gordonii, Streptococcus sobrinus, Actinomyces naeslundii, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Enterococcus faecalis). (2) Methods: Antibacterial efficiency was evaluated by agar diffusion assay and in direct contact with bacteria in planktonic culture. Furthermore, cytotoxicity on human gingival fibroblasts was determined. (3) Results: Blackcurrant juice was most efficient at suppressing bacteria, followed by the activity of redcurrant and cranberry juice. Raspberry juice only suppressed P. gingivalis significantly. Only high-concentrated blackcurrant juice showed minimal cytotoxic effects which were significantly less compared to the action of CHX. (4) Conclusion: Extracts from natural berry juices might be used for safe and efficient suppression of oral pathogenic bacterial species.

The spread of antimicrobial resistance challenges the empirical treatment of urinary tract infections (UTIs). Among others, nitrofurantoin is recommended for first-line treatment, but acceptance among clinicians is limited due to chronic nitrofurantoin-induced lung toxicity and insufficient coverage of Enterobacteriaceae other than Escherichia coli. Nitroxoline appears to be an alternative to nitrofurantoin owing to its favourable safety profile, however data on its current in vitro susceptibility are sparse. In this study, susceptibility to nitroxoline was tested against 3012 urinary clinical isolates (including multidrug-resistant bacteria and Candida spp.) by disk diffusion test and/or broth microdilution. At least 91% of all Gram-negatives (n = 2000), Gram-positives (n = 403) and yeasts (n = 132) had inhibition zone diameters for nitroxoline ≥18 mm. Except for Pseudomonas aeruginosa, nitroxoline MIC90 values were ≤16 mg/L and were 2- to >16-fold lower compared with nitrofurantoin. In extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus (MRSA), MIC90 values of nitroxoline were two-fold higher compared with non-ESBL-producing enterobacteria and methicillin-susceptible S. aureus (MSSA). The in vitro efficacies of nitroxoline and nitrofurantoin against ATCC strains of E. coli, Enterococcus faecalis and Proteus mirabilis were compared by time-kill curves in Mueller-Hinton broth and artificial urine. Nitroxoline was non-inferior against E. coli, P. mirabilis and E. faecalis in artificial urine. In conclusion, nitroxoline showed a broad antimicrobial spectrum, with inhibition zone diameters and MICs of nitroxoline well below the EUCAST breakpoint for E. coli for most organisms, and thus may also be a target for therapy of uncomplicated UTIs.

Pflegeheimbewohner und altere Krankenhauspatienten haben ein deutlich erhohtes Risiko an einer nosokomialen Infektion (NI) zu erkranken. Offen ist bis jetzt, ob und in welchem Ausmas NI das Ziel der Aufrechterhaltung bzw. Verbesserung der Selbsthilfefahigkeit gefahrden. In einer retrospektiven Beobachtungsstudie wurde das Auftreten NI wahrend des Aufenthalts in der stationaren akutgeriatrischen Versorgung der Klinik fur Geriatrie am Universitatsklinikum Jena anhand von Patientenakten erfasst. Fur die Studie wurden die Daten von 555 Patienten im Zeitraum vom 01.08.2011 bis zum 31.08.2012 eingeschlossen. Es wurden Patienten ohne Akutkomplikationen eingeschlossen und Patienten, welche fruhestens am dritten Tag ihres stationaren Aufenthalts eine NI entwickelten. Jeder dritte Patient, was ca. 18 Patienten/1000 Tage Krankenhausaufenthalt entspricht, erkrankte neu an einer NI. Diese Zahl liegt deutlich uber dem Bundesdurchschnitt. Die haufigsten NI waren Harnwegsinfektionen, Gastroenteritiden und Infektionen der unteren Atemwege. Niedriger Aufnahme-Barthel-Index, hoher Multimorbiditatsindex und kunstliche Harnableitung begunstigten die Entstehung NI. Der Zugewinn an Selbsthilfefahigkeit, beurteilt durch die Mittelwerte (MW) der Barthel-Index-Differenz, war bei Patienten, welche eine NI entwickelten, signifikant geringer (MW 14,5 ± 16,3 Punkte) als bei Patienten, die im Verlauf keine NI erlitten (MW 18,1 ± 14,8). Nosokomiale Infektionen stellen einen relevanten Faktor fur negative Auswirkungen auf den Barthel-Index dar. Nosokomiale Infektionen, insbesondere das Vorliegen mehrerer NI, gefahrdeten eine Verbesserung der Selbsthilfefahigkeit. Dies galt besonders fur Infektionen der unteren Atemwege und Gastroenteritiden.

Die Unterbringung in einem psychiatrischen Krankenhaus (§ 63 StGB) ist wegen ihrer zeitlichen Unbegrenztheit neben der Sicherungsverwahrung die schwerste Sanktion des deutschen Strafrechts. Steigende Belegungszahlen in den Masregelvollzugskliniken haben den Gesetzgeber veranlasst, die Vorschriften uber Anordnung und Fortdauer der Unterbringung mit dem Ziel zu verandern, den Grundsatz der Verhaltnismasigkeit starker in den Fokus zu rucken und eine schnellere Entlassung der weniger gefahrlichen Untergebrachten zu ermoglichen. Der Beitrag beschreibt, was sich in den Vorschriften uber die Anordnung der Masregel, deren Vollstreckung und deren Beendigung sowie uber das dabei anzuwendende Verfahren geandert hat. Dabei erweisen sich die Anderungen inhaltlich nur z. T. als „neu“, da der Gesetzgeber an mehreren Stellen lediglich gesetzlich festgeschrieben hat, was nach der standigen Rechtsprechung der Obergerichte schon seit Langem als Auslegung des bisherigen Rechts gegolten hatte. Abschliesend wird die Bedeutung der Novelle fur die praktische Arbeit der Gutachter untersucht.

The use of molecular assays to rapidly identify pathogens and resistance genes directly from positive blood cultures (BCs) contribute to shortening the time required for the diagnosis of bloodstream infections. In this work, loop-mediated isothermal amplification (LAMP) assays have been examined for their potential use in BC diagnosis. Three different assays were applied. The commercially available eazyplex® MRSA test detects Staphylococcus aureus, S. epidermidis, mecA, and mecC. Two in-house assays [Gram-positive (GP) and Gram-negative (GN)] have been developed for the detection of streptococci, enterococci, vanA, vanB, Pseudomonas spp., Enterobacteriaceae, and the bla CTX-M family. A total of 370 positive BCs were analyzed. LAMP test results were obtained within 30 min, including sample preparation. Amplification was measured by real-time fluorescence detection. The threshold time for fluorescence intensity values ranged from 6.25 to 13.75 min. The specificity and sensitivity of the assays varied depending on the target. Overall, from 87.7% of BCs, true-positive results were obtained, compared to routine standard diagnosis. Twenty-one tests were true-negative because of the lack of an appropriate target (5.7%). The concordance of positive test results for resistance genes with subsequent antibiotic susceptibility testing was 100%. From 15 BC bottles with mixed cultures, eazyplex® assays produced correct results in 73% of the cases. This study shows that LAMP assays are fast and cost-saving tools for rapid BC testing in order to expedite the diagnostic report and improve the antibiotic stewardship for sepsis patients.

Introduction: Accurate and fast microbiological diagnosis of infective endocarditis (IE) is of vital importance for patient outcome. Material & Methods: Forty culture-negative heart valves were evaluated with a new POCT multiplex-PCR cartridge (Unyvero™, Curetis AG, Holzgerlingen, Germany), advertised to detect several Gram positive/­negative bacteria and fungi, together with several antibiotic resistance genes. Those POCT results were compared to conventional 16S rDNA PCR/sequencing results. Results: POCT multiplex-PCR was positive in 13 cases [Staphylococcus aureus (n=5), Enterococcus spp. / E. faecalis (n=5), ConS (n=1), Granulicatella adjacens (n=1), Abiotrophia adjacens (n=1)]. Antibiotic resistances were found in 44 specimens, from which 2 specimens were without any pathogen identification. 16S rDNA PCR was positive in 20 cases. Consecutive sequencing identified those as Staphylococcus spp. (n=6), Enterococcus faecalis (n=4), Streptococcus spp. (n=4), Leifsonia shinshuensis (n=1), Granulicatella elegans / G. adjacens (n=2), Abiotrophia adjacens (n=1). One case was positive in 16S PCR without any reliable signal in sequencing. When comparing both methods, identification was consistent in 9 cases and divergent in other 9 cases. Discussion: This POCT cartridge is easy to integrate into the daily microbiology laboratory work flow, and is less laborious than 16S sequencing PCR. For the application in routine IE diagnosis, the system needs to be optimized to include targets for viridans streptococci and HACEK group. In addition, problems with invalid resistance and pathogen target detection need to be fixed by the producer. Conclusion: The analyzed POCT system might be a future diagnostic tool for IE detection following assay optimization.

Rapid diagnosis of bloodstream infections remains a challenge for the early targeting of an antibiotic therapy in sepsis patients. In recent studies, the reliability of the Nanosphere Verigene Gram-positive and Gram-negative blood culture (BC-GP and BC-GN) assays for the rapid identification of bacteria and resistance genes directly from positive BCs has been demonstrated. In this work, we have developed a model to define treatment recommendations by combining Verigene test results with knowledge on local antibiotic resistance patterns of bacterial pathogens. The data of 275 positive BCs were analyzed. Two hundred sixty-three isolates (95.6%) were included in the Verigene assay panels, and 257 isolates (93.5%) were correctly identified. The agreement of the detection of resistance genes with subsequent phenotypic susceptibility testing was 100%. The hospital antibiogram was used to develop a treatment algorithm on the basis of Verigene results that may contribute to a faster patient management.

Streptococcus (S.) pneumoniae is a major cause of secondary bacterial pneumonia during influenza epidemics. Neuraminidase (NA) is a virulence factor of both pneumococci and influenza viruses. Bacterial neuraminidases (NAs) are structurally related to viral NA and susceptible to oseltamivir, an inhibitor designed to target viral NA. This prompted us to evaluate the antipneumococcal potential of two NA inhibiting natural compounds, the diarylheptanoid katsumadain A and the isoprenylated flavone artocarpin. Chemiluminescence, fluorescence-, and hemagglutination-based enzyme assays were applied to determine the inhibitory efficiency (IC(50) value) of the tested compounds towards pneumococcal NAs. The mechanism of inhibition was studied via enzyme kinetics with recombinant NanA NA. Unlike oseltamivir, which competes with the natural substrate of NA, artocarpin exhibits a mixed-type inhibition with a Ki value of 9.70 μM. Remarkably, artocarpin was the only NA inhibitor (NAI) for which an inhibitory effect on pneumococcal growth (MIC: 0.99-5.75 μM) and biofilm formation (MBIC: 1.15-2.97 μM) was observable. In addition, we discovered that the bactericidal effect of artocarpin can reduce the viability of pneumococci by a factor of >1000, without obvious harm to lung epithelial cells. This renders artocarpin a promising natural product for further investigations.

The identification of pathogens in ascitic fluid is standardly performed by ascitic fluid culture, but this standard procedure often needs several days. Additionally, more than half of the ascitic fluid cultures are negative in case of suspected spontaneous bacterial peritonitis (SBP). It is therefore important to identify and characterize the causing pathogens since not all of them are covered by the empirical antimicrobial therapy. The aim of this study is to show that pathogen identification in ascitic fluid is possible by means of Raman microspectroscopy and chemometrical evaluation with the advantage of strongly increased speed. Therefore, a Raman database containing more than 10000 single-cell Raman spectra of 34 bacterial strains out of 13 different species was built up. The performance of the used statistical model was validated with independent bacterial strains, which were grown in ascitic fluid.

Introduction. Identification of non-O157 Shiga-toxin-producing Escherichia coli (STEC) infections may be underestimated in microbiological diagnosis. Case presentation. A 58-year-old woman developed diarrhoea with watery and subsequently mucous stool. Initial multiplex PCR testing revealed a positive result for stx2. Culture isolation of a STEC was successful only after repeated inoculation of chromogenic E. coli media. Molecular characterization was performed and identified the isolate as stx 2e-positive STEC of serotype O8 : H19. The strain harboured lpfA, but not eae. Conclusion. This case highlights the usefulness of initial multiplex PCR for diagnosis of non-O157 STEC infection.

Nursing home residents and older hospitalized patients have a significantly higher risk to suffer from nosocomial infections (NI). It is still an unanswered question whether patients suffering from NI are at greater risk for deterioration of activities of daily living.In a retrospective observational study, we evaluated the prevalence of NI during hospitalization of acute geriatric inpatients of the geriatric department at Jena University Hospital by patient records. The study included data from 555 patients, hospitalized from 1 August 2011 to 31 August 2012. We included patients without acute complications and those who developed NI after the second day of hospitalization.Every third patient developed a NI during the observation period. Consequently, the incidence of NI was approximately 18 patients with NI per 1000 days of hospitalization. This rate was considerably higher than the national average. The most frequent NIs were urinary tract infection, gastroenteritis and infections of the lower respiratory tract. A low value of Barthel index at admission, high multimorbidity index and transurethral indwelling catheters promoted the development of NI. An improvement in activities of daily living, assessed by mean values of the difference in the Barthel index, was significantly lower in patients who developed NI (mean value14.5 ± 16.3) than in patients who did not (mean value 18.1 ± 14.8).Nosocomial infections were a relevant factor for deterioration of the Barthel Index, at least temporarily and NIs, in particular the combination of several NIs, jeopardized an improvement in the activities of daily living. This was particularly true for infections of the lower respiratory tract and gastroenteritis.

In times of rising antibiotic resistances, there is a high need for fast, sensitive and specific methods to determine antibiotic susceptibilities of bacterial pathogens. Here, we present an integrated microfluidic device in which bacteria from diluted suspensions are captured in well-defined regions using on-chip dielectrophoresis and further analyzed in a label-free and non-destructive manner using Raman spectroscopy. Minimal sample preparation and automated sample processing ensure safe handling of infectious material with minimal hands-on time for the operator. Clinical applicability of the presented device is demonstrated by antibiotic susceptibility testing of Escherichia coli towards the commonly prescribed second generation fluoroquinolone ciprofloxacin. Ciprofloxacin resistant E. coli were differentiated from sensitive E. coli with high accuracy within roughly three hours total analysis time paving the way for future point-of-care devices. Spectral changes leading to the discrimination between sensitive and resistant bacteria are in excellent agreement with expected metabolic changes in the bacteria due to the mode of action of the drug. The robustness of the method was confirmed with experiments involving different chip devices with different designs, both electrode as well as microfluidics design, and material. Furthermore, general applicability was demonstrated with different operators over an extended time period of half a year.

OBJECTIVE A controlled clinical trial was conducted to evaluate the effects of oral prophylaxis on halitosis-associated, immunological and microbiological parameters. METHODS Thirty subjects were included in this controlled clinical trial (patients with generalized chronic periodontitis and controls without clinical attachment loss; each n = 15). Before oral prophylaxis and 14 days after (including tongue cleaning) volatile sulphur compounds (VSC), organoleptic scores and a tongue coating index were evaluated. The levels of IL-1β, IL-8, IL-10 and MMP-8 were measured in GCF, and also major periodontal pathogens were detected. Data were statistically analysed using anova and paired t-test. RESULTS Supragingival plaque and calculus removal with combined tongue cleaning was able to reduce significantly (P < 0.05) the VSC values in both groups (no significant differences between both groups). Two weeks after periodontal debridement, the VSC values were observed in the periodontitis group, but not in the control group, similar to the baseline values. The difference between the groups was statistically significant (P < 0.05). Only a repeated prophylaxis session in the periodontitis group was able to reduce VSC values significantly in comparison with baseline (P < 0.05). Organoleptic scores (10 and 30 cm) were significantly different (P < 0.05) between both groups before and after the treatment. Periodontal pathogens and host-derived markers were not significantly affected by a single prophylaxis session. CONCLUSIONS Oral prophylaxis may result in a significant decrease in VSC values. However, in periodontal diseases, a more complex treatment seems to be necessary.

Ausgehend von Zweck und Aufgabe des Strafprozesses wird die gesetzlich zulassige Form einer Verstandigung zwischen Gericht, Staatsanwaltschaft und Angeklagtem uber das Ergebnis eines Strafverfahrens beschrieben und gegenuber dem ungesetzlichen „Deal“ abgegrenzt. Sodann wird festgelegt, was in diesem Zusammenhang als Fehlurteil verstanden werden muss. Darauf aufbauend wird dargelegt, welche Risiken fur Fehlurteile mit dem „Deal“ verbunden sind, die sich durch eine strikte Beachtung der gesetzlichen Vorgaben fur eine Verstandigung beherrschen lassen.

INTRODUCTION To ensure root canal treatment success, endodontic microbiota should be efficiently reduced. The in vitro bactericidal effects of a hydrodynamic system and a passive ultrasonic irrigation system were compared. METHODS Single-rooted extracted teeth (n = 250) were contaminated with suspensions of Enterococcus faecalis ATCC 29212, mixed aerobic cultures, or mixed anaerobic cultures. First, the antibacterial effects of the hydrodynamic system (RinsEndo), a passive ultrasonic irrigation system (Piezo smart), and manual rinsing with 0.9% NaCl (the control) were compared. Colony-forming units were counted. Second, the 2 systems were used with 1.5% sodium hypochlorite (NaOCl) alone or NaOCl + 0.2% chlorhexidine (CHX). The colony-forming units in the treated and untreated roots were determined during a period of 5 days. RESULTS Both irrigation systems reduced bacterial numbers more effectively than manual rinsing (P < .001). With NaCl, ultrasonic activated irrigation reduced bacterial counts significantly better than hydrodynamic irrigation (P = .042). The NaOCl + CHX combination was more effective than NaOCl alone for both systems (P < .001), but hydrodynamic irrigation was more effective with NaOCl + CHX than the passive ultrasonic irrigation system. CONCLUSIONS Both irrigation systems, when combined with NaOCl + CHX, removed bacteria from root canals.

In cystic fibrosis (CF) patients' airways, inflammatory processes decisively contribute to remodeling and pulmonary destruction. The aims of this study were to compare upper airway (UAW) inflammation in the context of Staphylococcus aureus and Pseudomonas aeruginosa colonization in a longitudinal setting, and to examine further factors influencing UAW inflammation. Therefore, we analyzed soluble inflammatory mediators in noninvasively obtained nasal lavage (NL) of CF patients together with microbiology, medication, and relevant clinical parameters. NL, applying 10 mL of isotonic saline per nostril, was serially performed in 74 CF patients (326 samples). Concentrations of the inflammatory mediators' interleukin (IL)-1β, IL-6, IL-8, matrix metalloproteinase (MMP)-9, and its anti-protease TIMP-1 were quantified by bead-based multiplexed assay, neutrophil elastase (NE) via ELISA. Culture-based microbiology of the upper and lower airways (LAW), as well as serological and clinical findings, were compiled. Our results indicate that UAW colonization with S. aureus significantly impacts the concentration of all measured inflammatory mediators in NL fluid except TIMP-1, whereas these effects were not significant for P. aeruginosa. Patients with S. aureus colonization of both the UAW and LAW showed significantly increased concentrations of IL-1β, IL-6, IL-8, MMP-9, and slightly elevated concentrations of NE in NL fluid compared to non-colonized patients. This work elaborates a survey on S. aureus' virulence factors that may contribute to this underestimated pathology. Serial assessment of epithelial lining fluid by NL reveals that colonization of the UAW with S. aureus contributes more to CF airway inflammatory processes than hitherto expected.

Bei der Verwendung elektrischer Heizsysteme werden diese vom selben Energietraeger wie der Fahrantrieb bedient. Dadurch reduzieren sich allerdings die Reichweiten - je nach Waermebedarf und Betriebsart um bis zu 50 Prozent. Deshalb wird an einer Vielzahl von Alternativen zur Beheizung von E-Fahrzeugen gearbeitet, die zum Teil eine Kombination bekannter Loesungen darstellen. Es werden jedoch auch ganz neue Loesungsansaetze zur Diskussion gestellt, die beispielsweise nur den Nahbereich der Fahrzeuginsassen temperieren. Eberspaecher hat bioethanolfaehige Geraete entwickelt, die eine CO2-freundliche und effiziente Loesung zur Beheizung von Elektrofahrzeugen darstellen. Sicherheit und Komfort koennen in gleicher Weise realisiert werden, ohne die Nutzung des Fahrzeugs zu beeinflussen.

Background and Objectives Immunoglobulin (Ig) G1 plays an important role in the adaptive immune response. Kgp, a lysine-specific cysteine protease from Porphyromonas gingivalis, specifically hydrolyses IgG1 heavy chains. The purpose of this study was to examine whether cleavage of IgG1 occurs in gingival crevicular fluid (GCF) in vivo, and whether there is any association with the presence of Porphyromonas gingivalis and other periodontopathogens. Material and Methods GCF was obtained from nine patients with aggressive periodontitis, nine with chronic periodontitis and five periodontally healthy individuals. The bacterial loads of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Treponema denticola, Prevotella intermedia and Tannerella forsythia were analysed by real-time polymerase chain reaction, and the presence and cleavage of IgG1 and IgG2 were determined using Western blotting. Kgp levels were measured by ELISA. Results Cleaved IgG1 was identified in the GCF from 67% of patients with aggressive periodontitis and in 44% of patients with chronic periodontitis. By contrast, no cleaved IgG1 was detectable in healthy controls. No degradation of IgG2 was detected in any of the samples, regardless of health status. Porphyromonas gingivalis was found in high numbers in all samples in which cleavage of IgG1 was detected (P

Introduction: We report an unusual case of Campylobacter jejuni bacteraemia in a patient with Philadelphia chromosome-positive, BCR-ABL-positive chronic myelogenous leukaemia in complete cytogenetic and major molecular remission after dasatinib/IFN therapy. Case presentation: On admission, the patient presented with fever and acute haemorrhagic diarrhoea. Initial empiric antibiotics consisted of ceftriaxone and metronidazole. Stool and blood culture samples were collected and submitted for evaluation; these specimens were processed as per laboratory protocol. Several Gram-negative, spiral rods could be identified microscopically in Gram-stained slides from bottled blood and stool cultures. Isolate identification was performed on the Vitek 2 system using a GN identification card and API Campy strips and by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Discrepant identification was obtained between the Vitek versus the API Campy test and MALDI-TOF. Erythromycin susceptibility testing was done using an Etest, whereas all other susceptibility testing and breakpoint analysis was done following the EUCAST procedure. Initial empiric antibiotic treatment was switched from ceftriaxone to ciprofloxacin according to antibiotic susceptibility testing (AST) and Etest (ciprofloxacin MIC of 0.094 μg ml− 1) results. C. jejuni bacteraemia was successfully eradicated after 1 week of ciprofloxacin therapy. Conclusion: This case describes the rare event of a Campylobacter bacteraemia, which could have been falsely interpreted because of non-specific colony morphology and the initial Vitek result. Only the combination of microscopy, MALDI-TOF and an API Campy test was able to rapidly identify this bacterium as C. jejuni. This case also shows the importance of immediate AST- and MIC-adapted antibiotic treatment in immunocompromised febrile patients suffering from Campylobacter-induced bloody diarrhoea.

In periodontitis, an effective host-response is primarily related to neutrophils loaded with serine proteases, including elastase (NE) and protease 3 (PR3), the extracellular activity of which is tightly controlled by endogenous inhibitors. In vitro these inhibitors are degraded by gingipains, cysteine proteases produced by Porphyromonas gingivalis. The purpose of this study was to determine the level of selected protease inhibitors in gingival crevicular fluid (GCF) in relation to periodontal infection. The GCF collected from 31 subjects (nine healthy controls, seven with gingivitis, five with aggressive periodontitis and 10 with chronic periodontitis) was analyzed for the levels of elafin and secretory leukocyte protease inhibitor (SLPI), two main tissue-derived inhibitors of neutrophil serine proteases. In parallel, activity of NE, PR3 and arginine-specific gingipains (Rgps) in GCF was measured. Finally loads of P. gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia and Treponema denticola were determined. The highest values of elafin were found in aggressive periodontitis and the lowest in controls. The quantity of elafin correlated positively with the load of P. gingivalis, Ta. forsythia and Tr. denticola, as well as with Rgps activity. In addition, NE activity was positively associated with the counts of those bacterial species, but not with the amount of elafin. In contrast, the highest concentrations of SLPI were found in periodontally healthy subjects whereas amounts of this inhibitor were significantly decreased in patients infected with P. gingivalis. Periodontopathogenic bacteria stimulate the release of NE and PR3, which activities escape the control through degradation of locally produced inhibitors (SLPI and elafin) by host-derived and bacteria-derived proteases.

Der Autor beschreibt kritisch die Masnahmen zur Ausweitung der Sicherungsverwahrung in den letzten Jahren. Er verweist auf den Kontrast zur tatsachlichen Entwicklung der Kriminalitat. Dabei scheint die Rechtspolitik nicht mehr auf die reale, sondern die medial produzierte Gefahrdungslage zu reagieren. Sicherungsverwahrung wandelt sich tendenziell von einer Ultima Ratio zu einem Bestrafungsstandard und gerat nicht zuletzt dadurch in Konflikt mit der Europaischen Menschenrechtskonvention.

The impact of a semiquantitative commercially available test based on DNA-strip technology (microIDent®, Hain Lifescience, Nehren, Germany) on diagnosis and treatment of severe chronic periodontitis of 25 periodontitis patients was evaluated in comparison with a quantitative in-house real-time PCR. Subgingival plaque samples were collected at baseline as well as at 3, 6, and 12 months later. After extracting DNA, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and several other periodontopathogens were determined by both methods. The results obtained by DNA-strip technology were analyzed semiquantitatively and additionally quantitatively by densitometry. The results for the 4 major periodontopathogenic bacterial species correlated significantly between the 2 methods. Samples detecting a high bacterial load by one method and negative by the other were always found in less than 2% of the total samples. Both technologies showed the impact of treatment on microflora. Especially the semiquantitative DNA-strip technology clearly analyzed the different loads of periodontopathogens after therapy and is useful in microbial diagnostics for patients in dental practices.

Objectives Presence of residual blood is a common problem in cerebrospinal fluid (CSF) diagnostics of ventriculitis. We hypothesised that neutrophil granulocytes in infected, blood-containing CSF lose CD62L expression. Therefore CD62L expression on neutrophils may present a complementary marker to distinguish between patients with residual blood and infection. Designs and methods Evaluation was performed in 64 ventricular CSF samples sent to the laboratory for diagnostic investigation. Cell count, microbiological culture, total protein and flow cytometric analysis of CSF were performed. Results Cell counts and CD62L expression were significantly different between the culture positive and negative group. ROC-analysis revealed a significant predictive value for cell count and CD62L expression. Optimal cut-offs were calculated and a decision tree was established to predict a positive culture. Conclusions Cell count and CD62L expression were predictive for a positive culture and the combination helped to increase specificity and sensitivity for the detection of ventriculitis in blood-containing CSF.

Background: Lactic acid concentrations (LA) are an established marker of bacterial infection in cerebrospinal fluid (CSF). However, use of LA for the detection of infection in CSF with residual blood has not been fully evaluated. Methods: Analysis of LA and total protein, cell count and bacterial culture were performed in 90 lumbar and ventricular CSF samples contaminated with blood. Results: Bacterial culture was positive in six CSF samples. The diagnostic value of the cell count was significantly higher than that of LA for the prediction of a positive culture, even if all culture positive and all likely infected samples were included in the analysis. There was no significant difference in LA concentrations between positive or likely positive ventricular CSF samples and all negative, ventricular samples. Conclusions: Although LA concentrations in CSF are evidently a predictor of bacterial infection, its diagnostic value for the detection of bacterial infection in ventricular CSF with residual blood is limited. Clin Chem Lab Med 2010;48:1777–80.

Background: The purpose of this study is to clinically and microbiologically evaluate the effect of photodynamic therapy (PDT) as a full-mouth procedure in Fusobacterium nucleatum–infected patients with periodontitis. Methods: In the present study, PDT is administered adjuvantly after scaling and root planing (SRP) to patients with localized chronic periodontitis (LCP). Twenty-four patients, in whom only F. nucleatum was detected by baseline polymerase chain reaction (PCR) after SRP, were randomly assigned to PDT and control groups. PDT was carried out once as a full-mouth disinfection in the test group. The control group was treated with the photosensitizer solution, but without laser irradiation. In all subjects, the clinical parameters plaque index, reddening, bleeding on probing (BOP), probing depth (PD), gingival recession, and clinical attachment level (CAL) were determined at the baseline examination and at 1, 4, and 12 weeks after PDT. Quantitative analysis of the F. nucleatum DNA concentration was performed by competitive PCR. All clinical indices were calculated for each test and control subject as were the median and interquartile range of each group. Results: In patients with LCP who received PDT treatment, significant reductions in reddening, BOP, and mean PD and CAL were observed during the observation period and with respect to controls. Four and 12 weeks after PDT, the mean PD and CAL showed significant differences from baseline values and from those of the control group. In the PDT group, 12 weeks after treatment, the F. nucleatum DNA concentration was found to be significantly reduced compared to the baseline level. Conclusion: The results of this study show that the adjuvant application of the described PDT method is appropriate to reduce periodontal inflammatory symptoms and to successfully treat infection with F. nucleatum. J Periodontol 2010;81:975-981.

Guentsch A, Ronnebeck M, Puklo M, Preshaw PM, Pfister W, Eick S. Influence of serum on interaction of Porphyromonas gingivalis ATCC 33277 and Aggregatibacter actinomycetemcomitans Y4 with an epithelial cell line. J Periodont Res 2009; doi: 10.1111/j.1600-0765.2009.01224.x. © 2009 John Wiley & Sons A/S Background and Objective: The purpose of this study was to investigate the influence of serum on the interaction of periodontal pathogens with epithelial cells using an epithelial cell line (KB cells). This is important because serum is a key component of gingival crevicular fluid and may influence inflammatory responses in epithelial cells exposed to periodontal pathogens. Material and Methods: Porphyromonas gingivalis ATCC 33277 and Aggregatibacter actinomycetemcomitans Y4 were co-cultured with KB cells either with or without the addition of up to 10% human serum or 50 mg/mL human serum albumin. The numbers of free-floating, adherent and intracellular bacteria were determined up to 18 h after exposure of the epithelial cells to the pathogens. Additionally, the concentrations of interleukin (IL)-6 and IL-8 produced by the epithelial cells in response to exposure to the bacteria were determined. Results: Serum and human serum albumin reduced the number of internalized A. actinomycetemcomitans Y4 organisms in the epithelial cells, increased the levels of IL-6 and IL-8 in the supernatants of infected cells (those with internalized A. actinomycetemcomitans) and influenced non-infected epithelial cells. Increased IL-6 and IL-8 concentrations were also detected in the supernatants of KB cells infected with P. gingivalis ATCC 33277. Interleukin-6 and IL-8 were detectable after addition of serum, probably as a result of inhibition of the activity of P. gingivalis cysteine proteinases by serum. Conclusion: Serum promotes the release of the cytokines IL-6 and IL-8 by epithelial cells. This mechanism is influenced by periodontal pathogens and may maintain clinical periodontal inflammation.

Drogenkonsum ist ein kriminogener Faktor. Nahezu jeder unerlaubte Umgang mit Betaubungsmitteln ist in Deutschland unter Strafe gestellt. Konsumenten und Handler beschaftigen die Justiz deshalb in erheblichem Mas. Diese ist dabei nicht selten auf die Hilfe von psychowissenschaftlichen Sachverstandigen angewiesen. Ihnen gilt dieser Beitrag. Er vermittelt die Grundzuge des Betaubungsmittelstrafrechts und beschreibt, welche Bedeutung der Drogenkonsum bei der Beurteilung der Schuldfahigkeit von Straftatern sowie bei der Anordnung von Masregeln der Besserung und Sicherung aus der Sicht der Rechtsprechung hat. Auserdem befasst er sich mit den rechtlichen Konsequenzen einer Teilnahme am Strasenverkehr unter Drogeneinfluss. Daruber hinaus werden Anforderungen an das Sachverstandigengutachten bei der strafrechtlichen Beurteilung von Drogenabhangigen formuliert.

Lower airway (LAW) infection with Pseudomonas aeruginosa and Staphylococcus aureus is the leading cause of morbidity in cystic fibrosis (CF). The upper airways (UAW) were shown to be a gateway for acquisition of opportunistic bacteria and to act as a reservoir for them. Therefore, tools for UAW assessment within CF routine care require evaluation.The aims of the study were non-invasive assessment of UAW and LAW microbial colonisation, and genotyping of P aeruginosa and S aureus strains from both segments.182 patients with CF were evaluated (age 0.4-68 years, median 17 years). LAW specimens were preferably sampled as expectorated sputum and UAW specimens by nasal lavage. P aeruginosa and S aureus isolates were typed by informative single nucleotide polymorphisms (SNPs) or by spa typing, respectively.Of the typable S aureus and P aeruginosa isolates from concomitant UAW- and LAW-positive specimens, 31 of 36 patients were carrying identical S aureus spa types and 23 of 24 patients identical P aeruginosa SNP genotypes in both compartments. Detection of S aureus or P aeruginosa in LAW specimens was associated with a 15- or 88-fold higher likelihood also to identify S aureus or P aeruginosa in a UAW specimen from the same patient.The presence of identical genotypes in UAW and LAW suggests that the UAW play a role as a reservoir of S aureus and P aeruginosa in CF. Nasal lavage appears to be suitable for non-invasive UAW sampling, but further longitudinal analyses and comparison with invasive methods are required. While UAW bacterial colonisation is typically not assessed in regular CF care, the data challenge the need to discuss diagnostic and therapeutic standards for this airway compartment.NCT00266474.