title: Thermal investigation on whole plants and plant tissues

text: In recent years, plant calorimetry has finished its sleeping beauty dormancy that lasted more or less continuously since the beginning of last century and realizes quite a number of scientifically attractive princes around it. They appeared with new armours and weapons and are eager to dedicate their life to her beauty. New sophisticated calorimeter allow investigations that were excluded before, combination with other highly specific instruments renders more information than gathered earlier by calorimetry alone, rigid and flexible light guides illuminate the otherwise dark vessels and open the field to photosynthesis experiments, infrared thermography provides a means to determine temperature distributions without injuring or even only touching the object. Imagination and technical skill are asked for further developments in plant calorimetry that will for sure come. A special issue of Thermochimica Acta in 2004 will be dedicated to the outcomes of the XIII(th) Conference of the International Society for Biological Calorimetry Energetics of Adaptation and Development — From Molecular Mechanisms to Clinical Practice that took place in Würzburg / Germany 2003. Many contributions deal with photocalorimetry and its application to plant systems as well as with conventional heat flow and combustion calorimetry for plant cells. Among other, topics like A new calorespirometric instrument, Calorespirometric ratios and metabolic efficiency, Energy processes in model plant cells, Heat production and respiration of wheat roots, Calorimetric studies of vegetable tissue wounding, Life zones for key plant species can be predicted with calorespirometry and temperature measurements; Photo-Bio-Calorimetry of Chlorella vulgaris growth, Energetic evaluation of forest formations by bomb calorimetry will be approached. This issue is recommended for further information.


docid: cpdpinsv

title: Lymphocyte trafficking and chemokine receptors during pulmonary disease


Disease Surveillance in Georgia: Benefits of International Cooperation


title: An Evaluation of China’s Influenza A (H1N1) Emergency Response Measures

text: In order to stay up to date on epidemic trends and monitor possible mutations of the virus in the wake of an outbreak, China invested nearly 400 million RMB on testing large amounts of specimens and expanding the influenza monitoring network to include 411 influenza monitoring network laboratories and 556 sentinel hospitals - a network which covered all prefectural-level cities and some priority districts and counties. All of these laboratories and hospitals were in operation by September, 2009 (see Fig. 5.1).


title: Bioinformatics

text: Why is sequence, structure, and biological pathway information relevant to medicine? Where on the Internet should you look for a DNA sequence, a protein sequence, or a protein structure? What are two problems encountered in analyzing biological sequence, structure, and function? How has the age of genomics changed the landscape of bioinformatics? What two changes should we anticipate in the medical record as a result of these new information sources? What are two computational challenges in bioinformatics for the future?


title: Pneumonia

text: This chapter describes the imaging patterns of pneumonia (lobar, lobular, interstitial, round) and its complications (abscess, empyema, pneumatocele); bacterial, fungal, and viral infections; and the many manifestations of pulmonary tuberculosis. ELECTRONIC SUPPLEMENTARY MATERIAL : The online version of this chapter (10.1007/978-3-030-16826-1_6) contains supplementary material, which is available to authorized users.


docid: wodhiywa

title: Endogenous DAMPs, Category I: Constitutively Expressed, Native Molecules (Cat. I DAMPs)

text: This chapter provides the reader with a collection of endogenous DAMPs in terms of constitutively expressed native molecules. The first class of this category refers to DAMPs, which are passively released from necrotic cells, and includes the most prominent subclasses of high mobility group box I and heat shock proteins. Further subclasses of DAMPs that are passively released from necrotic cells include S100 proteins, nucleic acids, histones, pro-forms of interleukin-1-family members, mitochondria-derived N-formylated peptides, F-actin, and heme. A particular subclass of these passively released DAMPs are molecules, which indirectly activate the inflammasome, including adenosine-5′-triphosphate, monosodium urate crystals, cholesterol crystals, some lipolytic species, and beta-amyloid. All these passively released DAMPs are characterized by their capability to promote necroinflammatory responses. The second class of this Category I refers to molecules, which are exposed on the surface of stressed cells. They include the subclass of phagocytosis-facilitating molecules such as calreticulin, as well as the subclass of MHC-I-related molecules such as MHC-I-related molecule A and B. These DAMPs are capable of inducing the activation of innate lymphoid cells and unconventional T cells. One of these DAMPs, the major histocompatibility complex I-related molecule A, is shown to act as a bona fide transplantation antigen. In sum, the endogenous constitutively expressed native molecules represent an impressive category of DAMPs with extraordinary properties, which play a critical role in the pathogenesis of many human diseases.


docid: pmoerehn

title: Birds, Pigs, and People: The Rise of Pandemic Flus

text: In early April 2009, a ten-year-old boy in San Diego County, California, showed up at an outpatient clinic with fever, severe cough, and vomiting. Suspecting flu, the health worker took a routine throat swab and sent it to the county laboratory.


title: Global Stability Analysis of HIV+ Model

text: We developed and studied a mathematical model of HIV+. Two equilibriums points were found, disease free and endemic equilibrium, and basic reproduction ratio [Formula: see text] was also calculated by the use of next generation matrix. Global stability analysis of the equilibria was carried out by the use of Lyapunov function, and it was shown that the stability of the equilibria depends on the magnitude of the basic reproduction ratio. When [Formula: see text] , the disease free equilibrium is globally asymptotically stable, and disease dies out. On the other hand if [Formula: see text] , the endemic equilibrium is globally asymptotically stable and epidemics occurs. Reported cases of 13646 HIV-1 positive were obtained in the year 2016 from Ministry of Health, Turkey (MOH). This data is used to present the numerical simulations, which supports the analytic result. [Formula: see text] was found to be 1.98998, which is bigger than 1, this shows the threat posed by HIV in Turkey.


title: Human and Animal Viruses in Food (Including Taxonomy of Enteric Viruses)

text: In recent years, there has been an increase in the incidence of foodborne diseases worldwide, with viruses now being recognized as a major cause of these illnesses. The most common viruses implicated in foodborne disease are enteric viruses, which are found in the human gastrointestinal tract, excreted in human feces and transmitted by the fecal-oral route. Many different viruses are found in the gastrointestinal tract but not all are recognized as foodborne pathogens. The diseases caused by enteric viruses fall into three main types: gastroenteritis, enterically transmitted hepatitis, and illnesses that can affect other parts of the body such as the eye, the respiratory system and the central nervous system leading to conjunctivitis, poliomyelitis, meningitis and encephalitis. Viral pathogens excreted in human feces include noroviruses, sapoviruses, enteroviruses, adenoviruses, hepatitis A virus (HAV), hepatitis E virus (HEV), rotaviruses, and astroviruses. Most of these viruses have been associated with foodborne disease outbreaks. Noroviruses and HAV are commonly identified as foodborne causes of gastroenteritis and acute hepatitis, respectively.


title: Infektionsverlauf und Pathogenität

text: Die Ausbreitung eines Virus im Organismus ist je nach Virus verschieden. Es gibt akute, persistierende und latente Virusinfektionen. Die pathogenen Eigenschaften eines Virus können durch das Virus direkt ausgelöste Schäden in den infizierten Zellen sowie indirekt durch die Auswirkungen der Immunantwort auf die Virusinfektion bedingt sein. Bei erstmaligem Kontakt mit einem Virus lösen Mechanismen der angeborenen Immunität (Basisabwehr) eine Entzündung aus, welche die adaptive Immunität anregt; gemeinsam blockieren sie die weitere Replikation und Ausbreitung. Bei einer Zweitinfektion reagiert die adaptive Immunität blitzschnell (»Gedächtnis«) fast ohne Entzündungen. Polymorphismen des Wirtes oder des Virus beeinflussen den Ablauf der Infektion.


title: Case Study – France

text: Emerging health risks, weapons of mass destruction, and terrorism – including biological weapons and bioterrorism – are identified in the 2008 White Paper on defence and national security as threats for France and its citizens. Since the beginning of the century, the 2001 anthrax attacks in the USA and subsequent hoaxes as well as the global SARS outbreak and influenza pandemic threats have all contributed to raise public awareness about health emergencies, leading authorities to adapt and improve planning for such events. This chapter focuses on natural and intentional public health threats and on biopreparedness from a French perspective, describing legal and organizational frameworks, plans and guidelines.


title: Infektionen des ZNS

text: Die Involvierung des Zentralnervensystems (ZNS) ist grundsätzlich eher eine seltene Manifestation einer viralen Infektion, wesentlich häufiger als das Hirngewebe werden die Meningen betroffen. Obwohl eine spezifische Therapie nur bei wenigen Viren, die eine Enzephalitis verursachen, verfügbar ist, ist eine frühestmögliche Diagnose und die daraus sich eventuell ableitende antivirale Therapie sowie eine maximale supportive/symptomatische Therapie essenziell, um die bestmögliche Prognose zu erreichen.


title: Thrombotic Microangiopathy Syndrome in the ICU

text: Major studies designed to improve our understanding of the pathophysiology of TMA have been conducted over recent years. This improved knowledge opens up new perspectives for more targeted treatment. However, until these innovative treatments become available, early diagnosis of these diseases is essential in order to rapidly initiate specific treatment, as the interval between diagnosis and initiation of plasma exchange is a decisive element in the prognosis of TTP. Treatment must not be stopped too early or too rapidly and must take into account the various associated factors, especially the presence of infection.


title: Study of Sentiment Analysis Using Hadoop

text: In the current world of Internet people express themselves, present their views and feelings about specific topics or entities using various social media application. These posts from users present a huge opportunity for the organizations to increase their market value by analyzing the posts and using information in decision making. These posts can be studied using various machine learning and lexicon-based approaches for extracting its sentiments. With more and more people moving to internet, huge data is being produced every second and challenge is to store this large data and process it efficiently in real time to infer knowledge from this data. This paper presents different approaches for real-time and scalable ways of performing sentiment analysis using Hadoop in a time efficient manner. Hadoop and its component tools like MapReduce, Mahout, and Hive are being surveyed in different scholar articles for this paper.


High-Frequency Oscillatory Ventilation


title: Transgenic Farm Animals: Current Status and Perspectives for Agriculture and Biomedicine

text: The first transgenic livestock were produced in 1985 by microinjection of foreign DNA into zygotic pronuclei. This was the method of choice for more than 20 years, but more efficient protocols are now available, based on somatic cell nuclear transfer (SCNT) which permits targeted genetic modifications. Although the efficiency of transgenic animal production by microinjection technology is low, many animals with agriculturally important transgenic traits were produced. Typical applications included improved carcass composition, lactational performance, and wool production as well as enhanced disease resistance and reduced environmental impact. Transgenic animal production for biomedical applications has found broad acceptance. In 2006 the European Medicines Agency (EMEA) approved the commercialization of the first recombinant protein drug produced by transgenic animals. Recombinant antithrombin III, produced in the mammary gland of transgenic goats, was launched as ATryn® for prophylactic treatment of patients with congenital antithrombin deficiency. Pigs expressing human immunomodulatory genes have contributed to significant progress in xenotransplantation research with survival periods of non-human primates receiving transgenic porcine hearts or kidneys approaching six months. Lentiviral vectors and small interfering ribonucleic acid (siRNA) technology are also emerging as important tools for transgenesis. As the genome sequencing projects for various farm animal species progress, it has become increasingly practical to target the removal or modification of individual genes. We anticipate that this approach to animal breeding will be instrumental in meeting global challenges in agricultural production in the future and will open new horizons in biomedicine.


title: Next-Generation Sequencing and Its Application: Empowering in Public Health Beyond Reality

text: Next-generation sequencing has the ability to revolutionize almost all fields of biological science. It has drastically reduced the cost of sequencing. This allows us to study the whole genome or part of the genome to understand how the cellular functions are governed by the genetic code. The data obtained in huge quantity from sequencing upon analysis gives an insight to understand the mechanism of pathogen biology, virulence, and phenomenon of bacterial resistance, which helps in investigating the outbreak. This ultimately helps in the development of therapies for public health welfare against human pathogen and diagnostic reagents for the screening. This chapter includes the basic of Sanger’s method of DNA sequencing and next-generation sequencing, different available platforms for sequencing with their advantages, and limitations and their chemistry with an overview of downstream data analysis. Furthermore, the breadth of applications of high-throughput NGS technology for human health has been discussed.


title: Etiquette with Chinese Characteristics

text: As China modernizes, it imports more and more Western culture and etiquette. The pace at which this is happening is at least as fast as the economy is growing. Over time, Western etiquette has been skillfully assimilated into the Chinese mainstream. It now looks and feels Chinese.


title: Insect Biotechnology

text: For the purpose of this work, insect biotechnology, which is also known as yellow biotechnology, is the use of insects as well as insect-derived cells or molecules in medical (red biotechnology), agricultural (green biotechnology), and industrial (white) biotechnology. It is based on the application of biotechnological techniques on insects or their cells to develop products or services for human use. Such products are then applied in agriculture, medicine, and industrial biotechnology. Insect biotechnology has proven to be a useful resource in diverse industries, especially for the production of industrial enzymes including chitinases and cellulases, pharmaceuticals, microbial insecticides, insect genes, and many other substances. Insect cells (ICs), and particularly lepidopteran cells, constitute a competitive strategy to mammalian cells for the manufacturing of biotechnology products. Among the wide range of methods and expression hosts available for the production of biotech products, ICs are ideal for the production of complex proteins requiring extensive posttranslational modification. The progress so far made in insect biotechnology essentially derives from scientific breakthroughs in molecular biology, especially with the advances in techniques that allow genetic manipulation of organisms and cells. Insect biotechnology has grown tremendously in the last 30 years.


title: Norovirus Infection

text: Norovirus (NoV) was first reported as causative agent of gastroenteritis in 1972, when students and staff of an elementary school located in Norwalk, Ohio, USA, presented vomitus and diarrhoea. After this, a number of studies definitively associated the NoV infection with outbreaks of acute gastroenteritis. Nowadays, NoV is considered the leading cause of nonbacterial gastroenteritis outbreaks and severe childhood diarrhoea worldwide, including water- and food-borne outbreaks. In animals, NoV infections have been reported in swine, bovine, ovine, canine, feline, and murine. The pathogenic role of NoV infection and its impact in animal health are not completely clear. Most of the epidemiological studies detected NoV in asymptomatic animal hosts worldwide. However, there are studies that associated the NoV infection with disease, especially enteritis, in swine, bovine, canine, and feline. This chapter presents the NoV properties and describes the pathogenesis, epidemiology, and available techniques for diagnosis of the virus infection. Additionally, the NoV infection management and prophylaxis measures for livestock animal species are approached.


title: Why This Book? An Introduction

text: For the sake of simplicity, let us start by naming an infectious agent a “germ.” There are countless germs that can infect human, animal, and plant hosts. Germs can be transmitted directly between hosts via respiratory air droplets or bodily fluids (e.g., saliva, blood, or secretions from sexual organs). Germs can also be transmitted indirectly through an intermediary source, for instance via mosquitoes, ticks, rodents, environmental particles (e.g., contaminated water and food) or contaminated blood products. Germs evolve and transform while new germs emerge regularly, implying their supply can be considered infinite. A broad distinction is often made between microscopically small germs with relatively short life spans, which replicate within their hosts (often called microparasites such as viruses, bacteria, and fungi), and much larger germs with relatively longer life spans (often called macroparasites such as parasitic worms). Many germs live inside or on the surface of their hosts’ bodies without causing illness or even discomfort.


title: Introduction: Infectious Animals and Epidemic Blame

text: The Introduction to the edited volume summarises the chapters of the volume and discusses their contribution in the context of current historical and anthropological studies of zoonotic and vector-borne disease, with a particular focus on how epidemic blame is articulated in different historical, social and political contexts.


title: Photo-Generation of Carbohydrate Microarrays

text: The unparalleled structural diversity of carbohydrates among biological molecules has been recognized for decades. Recent studies have highlighted carbohydrate signaling roles in many important biological processes, such as fertilization, embryonic development, cell differentiation and cellȁ4cell communication, blood coagulation, inflammation, chemotaxis, as well as host recognition and immune responses to microbial pathogens. In this chapter, we summarize recent progress in the establishment of carbohydrate-based microarrays and the application of these technologies in exploring the biological information content in carbohydrates. A newly established photochemical platform of carbohydrate microarrays serves as a model for a focused discussion.


title: Towards Real Time Epidemiology: Data Assimilation, Modeling and Anomaly Detection of Health Surveillance Data Streams

text: An integrated quantitative approach to data assimilation, prediction and anomaly detection over real-time public health surveillance data streams is introduced. The importance of creating dynamical probabilistic models of disease dynamics capable of predicting future new cases from past and present disease incidence data is emphasized. Methods for real-time data assimilation, which rely on probabilistic formulations and on Bayes’ theorem to translate between probability densities for new cases and for model parameters are developed. This formulation creates future outlook with quantified uncertainty, and leads to natural anomaly detection schemes that quantify and detect disease evolution or population structure changes. Finally, the implementation of these methods and accompanying intervention tools in real time public health situations is realized through their embedding in state of the art information technology and interactive visualization environments.


Infektionskrankheiten


title: A Writer’s Attic

text: This chapter presents a miscellany of facts about writing: America’s first and oldest medical journal; the most remarkable feat of medical writing in more or less modern times; and the change in focus in medical journals. The chapter describes “authorisms,” neosyndromes, and classic gaffes in the medical literature. There is advice about what to think about when invited to edit a clinical reference book. There are also tales of retracted scientific articles and fake medical journals, and advice for aspiring medical writers, including books and websites to consult.


title: Metabolische Störungen

text: Bei fortgeschrittenem Organversagen von Niere, Herz, Leber oder Lunge stellt eine Organtransplantation meist das einzige kurative Therapieverfahren dar. Daneben ist die allogene bzw. in Sonderfällen auch die autologe Knochenmarktransplantation eine Therpieoption bei Leukämien, Lymphomen, myelodysplastischen Syndromen, angeborenen Stoff wechsel- und Immundefekten sowie auch in seltenen Fällen bei schweren Autoimmunerkrankungen.


title: Community-Acquired Pneumonia and Health Care-Associated Pneumonia Clinical Guidelines

text: The Infectious Disease Society of America (IDSA) produced clinical guidelines on the care of community-acquired pneumonia (CAP) in immunocompetent adults in 2000 and 2003 (1,2). Throughout the guidelines, a grading system is used to categorize the strength of evidence behind various recommendations (3), as listed in Table 1.


title: Towards Identifying and Predicting Spatial Epidemics on Complex Meta-population Networks

text: In the past decade, the network science community has witnessed huge advances in the threshold theory, prediction and control of epidemic dynamics on complex networks. While along with the understanding of spatial epidemics on meta-population networks achieved so far, more challenges have opened the door to identify, retrospect, and predict the epidemic invasion process. This chapter reviews the recent progress towards identifying susceptible-infected compartment parameters and spatial invasion pathways on a meta-population network as well as the minimal case of two-subpopulation version, which may also extend to the prediction of spatial epidemics as well. The artificial and empirical meta-population networks verify the effectiveness of our proposed solutions to the concerned problems. Finally, the whole chapter concludes with the outlook of future research.


title: Plasmofluidics for Biosensing and Medical Diagnostics

text: Plasmofluidics, an extension of optofluidics into the nanoscale regime, merges plasmonics and micro-/nanofluidics for highly integrated and multifunctional lab on a chip. In this chapter, we focus on the applications of plasmofluidics in the versatile manipulation and sensing of biological cell, organelles, molecules, and nanoparticles, which underpin advanced biomedical diagnostics.


title: Alveolar Lung Diseases

text: Alveolar lung diseases (ALD) are group of disorders characterized by pathological insult involving mainly the alveoli. The alveoli can be imagined as an empty cup, and alveolar diseases are classified according to the content of this cup. Alveolar diseases are characterized by filling of the alveoli with materials that impede its normal physiological function (ventilation). Alveolar diseases can be localized (focal) or diffuse. Names of the conditions depend upon the content of the material filling the alveoli.


title: Hygiene auf der IMC-Station

text: Laut Aussage des Bundesgesundheitsministeriums im Juli 2011 erkranken in Deutschland jährlich 400.000–600.000 Menschen an einer Krankenhausinfektion. Schätzungsweise zwischen 7.500 und 15.000 Menschen sterben jährlich an einer Krankenhausinfektion. 20–30% der Infektionen könnten durch die Einhaltung von Hygienemaßnahmen vermieden werden (BMG 2012).


title: Optische und Elektronenmikroskopische Detektion – Erregerschnelldiagnostik, hochauflösende Lichtmikroskopie und Live-Cell-Imaging

text: Die Kombination aus Zellbiologie und Mikrobiologie hat mit der Zellulären Mikrobiologie eine neue Disziplin geschaffen, deren primäres Ziel die Erforschung des Zusammenspiels von Wirt und Erregern auf der Ebene des Gewebes, der Zelle und letztlich von einzelnen Molekülen ist. Die Entschlüsselung dieser dynamischen Interaktionen erlaubt ein tiefgreifendes Verständnis von Infektionsmechanismen sowie zellulärer Logistik und bereitet damit den Weg für die Entwicklung wirkungsvoller Therapeutika.


title: Characterization of Synonymous Codon Usage in the Newly Identified Duck Plague Virus UL16 Gene

text: A comparative analysis of the codon usage bias in the newly identified UL16 gene(GenBank accession no.EU195095) of DPV and the UL16 gene of 22 reference herpesviruses was performed. In this study, the synonymous codon usage bias of UL16 gene in the 23 herpesviruses have been analyzed and the results showed obvious differences by the CAI, RSCU, ENC and GC(3s). The results revealed that the synonymous codons with A and T at the third codon positon have widely usage in the codon of UL16 gene of DPV. The ENC-GC(3s) plot revealed that the genetic heterogeneity in UL16 gene of herpesviruses was constrained by G+C content at the third codon position. The phylogenetic analysis suggested that DPV was evolutionarily closer to herpesviruses which further clustered into Alphaherpesvirinae. Furthermore the ORF of DPV UL16 gene has sequential rare codons. There were 21 codons showing distinct usage differences between DPV with Escherichia coli, 19 codons showing distinct usage differences between DPV with yeast, and 20 between DPV and Human. Therefore the Escherichia coli, Yeast and Human expression system were suitable for the expression of DPV UL16 gene if some codons could be optimized.


title: What Is a Virus?

text: Viruses are built from short sequences of nucleic acid, either DNA or RNA wrapped in a protein shell. Until the invention of the electron microscope, it was impossible to visualize a virus. The first viruses to be visualized were bacteriophage, which appeared to have a head and tail-like structure. Only the nucleic acid entered the bacterial cell through the tail. Animal viruses were described as spherical or rod-shaped; they were bound to receptors and were taken up by the cell. After the crystallization of the tobacco mosaic virus, there was much discussion as to whether viruses were “living” organisms; the controversy continues to this day. Although viruses were defined in part on the basis of size and filterability, viruses much larger than the traditional viruses have recently been isolated. Studies of viral replication indicate that most viruses self-assemble as a result of interactions between the viral proteins to form a viral capsid that interacts with the nucleic acid to form the whole. The viral replication cycle and synthesis is presented in this chapter. Viral classification into a Linnaean scheme has been proposed, but newer methods using nucleic acid homologies are changing classification. Viruses are spread in the human population by various means, including airborne particles, fecal-oral contact, clothing, insects, and contact with other animals (zoonosis).


title: Vaccines

text: Vaccines are predominantly used for prevention; that means they should establish a protection in immunized people or animals which will protect them from a possible infection and the subsequent illness when they come into contact with the respective pathogens. Fundamentally, there are two kinds of immunization: active and passive. The latter is based on the administration of immunoglobulin preparations that can neutralize a specific virus. Therefore, passive vaccination is applied only in special cases, such as when the person to be protected recently had verifiable contact with a specific virus (postexposure prophylaxis), or if the risk of exposure to pathogens cannot be ruled out in the following weeks and an active vaccination is not possible, as in short-term planned trips to Third World countries (exposure prophylaxis). An example is the administration of antibodies specific for hepatitis B virus in cases of contamination with blood from people who have an acute or chronically persistent infection with this virus, and thus have high concentrations of infectious particles in the blood. Such accidents occur primarily in medical personnel by needlestick injury (10.1007/978-3-642-20718-1_19). In certain cases, the administration is performed in combination with an active vaccination (active–passive immunization). Specific immunoglobulin preparations are also administered when people have been bitten by animals that may be infected with the rabies virus (10.1007/978-3-642-20718-1_15). In the case of early application (together with an active vaccination), the antibodies can neutralize the virus, and impede its spread in the body. Since the time between contact with the virus and its spread in the organism is often very short, passive immunization is limited to a period shortly before or after exposure to the infective agent (usually within 4 days). Therefore, it is reserved for cases in which the contact with the potential pathogen is well documented and the type of infection is known, and when an appropriate immunoglobulin preparation is available. The protection afforded by antibody preparations lasts just a few weeks, as immunoglobulins are rapidly degraded in the organism. Therefore, postexposure administration of active vaccines is increasingly preferred, e.g. in the context of outbreak-control vaccination. In veterinary medicine, passive immunization is employed occasionally in young animals which were born in a flock with high infection pressure. This approach is applied, for example, in kennels when infections occur with canine parvovirus (10.1007/978-3-642-20718-1_20). However, its value is controversial, as the immunoglobulins administered hinder the more advantageous active immunization.


Survival and Transport of Enteric Viruses in the Environment


title: Gastroenterologie

text: Die Gastroenterologie umfasst neben den klassischen Erkrankungen des Magen-Darm-Trakts (wie z .B. Ösophagitis, Hiatushernien, Gastritis, gastroduodenale Ulkuskrankheit, Malassimilationssyndrome, M. Crohn, Colitis ulcerosa, kolorektales Karzinom etc.) auch die pathologischen Veränderungen an Pankreas (Bauchspeicheldrüsenentzündung und Pankreaskarzinom), Leber (Hepatitis, Zirrhose, Leberversagen etc.) und Gallenblase bzw. -wege (PSC, PBC, Cholelithiasis, maligne Entartungen). Darüber hinaus werden in diesem Kapitel auch die neuroendokrinen Tumoren (NET) behandelt.


title: MMPs, inflammation and pulmonary arterial hypertension

text: Pulmonary arterial hypertension (PAH) is characterised by remodelling of small pulmonary arteries leading to a progressive increase in pulmonary vascular resistance and right ventricular failure [1]. PAH can be idiopathic, familial, or associated with a number of conditions or diseases, such as connective tissue disease. Its prognosis is poor, less than 3 yr from diagnosis. The aetiology of severe unexplained pulmonary hypertension remained largely unknown until a few years ago. The gene underlying familial PAH was identified in 2000, the BMPR-2 gene. However its mutations are not always present, and it probably does not explained the full scope of the disease. PAH is associated with structural alterations in pulmonary arteries including intimal fibrosis, medial hypertrophy and adventitial changes, pointing towards extracellular matrix remodelling which have raised the question of involvement of the matrix degrading enzymes. Among them, serine proteases, such as plasmina and endogenous vascular elastase (EVE), and matrix metalloproteases have been studied. In experimental models, the three of them are increased. Accordingly, their inhibition has preventing and in some cases therapeutic effects. However it should be stressed that opposite consequence of protease inhibition on PAH can be observed depending on the experimental model, either chronic hypoxia-induced PAH (deleterious) or toxic moncrotalin-induced PAH (positive). In humans, only sparse reports exist, that found increase in the MMP inhibitor, TIMP-1, and MMP-2 expression and decreased collagenase (MMP-1). Inflammation is part of the PAH, and accordingly, protease production is a well known part of the inflammatory response. Answering the question whether protease inhibition might represent a therapeutic option in human PAH is however certainly too early.


title: A Case of Fever and Rash After a Tick Bite

text: A 55-year-old man who lived in rural Indiana with a history of diabetes mellitus type 2 presented to the Emergency Department in May with 5 days of headache, fever to 104 °F, diffuse myalgias, and generalized weakness. He frequently performed yardwork. He had noticed a tick on his arm 10 days before that he removed with tweezers. He reported that it was not engorged. Three weeks prior to presentation, he went camping in the forest and slept in a cabin. He had frequent contact with his 3-year-old granddaughter who had a recent febrile upper respiratory illness.


title: The Human Clone Market

text: Imagine the following scenario. A few years from now, those who can afford it will contract cloning labs to grow clones to supply duplicate organs or replace body parts. Clones will be genetically matched to clients so they can be used in transplants without being attacked by the client’s immune system. To side-step the ethical argument of what is considered human, the client’s clones will be grown as headless embryos, without a brain or a central nervous system. Destined never to leave the lab, these cloned embryos will develop all the necessary body parts, including a heart, a circulatory system, lungs, and a digestive system. For those without deep pockets, the cloning labs will offer economy clones featuring one or more specific organs. Using embryo cloning techniques developed in Britain in the late 1990s, the cloning labs will grow these headless clones to match each stage of a child’s or adult’s development, so that organs will be available throughout the client’s life.


title: Platelets and Airway Diseases

text: The role of platelets as inflammatory cells is now well established. Given the peculiar characteristics of the lung circulation, with a broad capillary bed, platelets are especially involved with the physiology of the lungs and play a key role in a number of inflammatory lung disorders. The platelet precursors, megakaryocytes, are detected in the lung microcirculation; moreover platelets with their endothelium-protective and vascular reparative activities contribute to the lung capillary blood barrier integrity. Given the function of the lungs as first wall against pathogen invasion, platelets participate in immune defence of the normal lung. On the other hand, platelets may turn into effectors of the inflammatory reaction of the lungs to allergens, to infectious agents, to chemical agents and may contribute strongly to the perpetuation of chronic inflammatory reactions, largely by their ability to interact with other inflammatory cells and the endothelium. In this chapter we provide an overview of the role of platelets in several inflammatory lung disorders discussing the pathophysiologic bases of platelet involvement in these conditions and the experimental and clinical evidence for a role of platelets in lung diseases.


title: Spread of Epidemics and Rumours with Mobile Agents

text: We propose a simple model of infection that enables to study the coincidence time of two random walkers on an arbitrary graph. By studying the coincidence time of a susceptible and an infected individual both moving in the graph we obtain estimates of the infection probability. The main result of this paper is to pinpoint the impact of the network topology on the infection probability.


Gastroenterologie


title: Noninvasive Oxygen Therapies in Oncologic Patients

text: Acute hypoxemic respiratory failure (ARF) is the most common cause of critical illness in oncologic patients. Despite significant advancements in survival of oncologic patients who develop critical illness, mortality rates in those requiring invasive mechanical ventilation have improved but remain high. Avoiding intubation is paramount to the management of oncologic patients with ARF. There are important differences between the oncologic patient with ARF compared to the general ICU population that likely underlie the increased mortality once intubated. Noninvasive oxygen modalities have been recognized as an important therapeutic approach to prevent intubation. Continuous low-flow oxygen therapy, noninvasive ventilation, and high-flow nasal cannula are the most commonly used noninvasive oxygen therapies in recent years. They have unique physiologic properties. The data surrounding their efficacy in the general ICU population and oncologic population has evolved over time reflecting the changes in the oncologic population. This chapter reviews the three different noninvasive oxygen modalities, their physiologic impact, and evidence surrounding their effectiveness.


title: Essentials of the Production of Safe and Efficacious State-of-the-Art Polyclonal IgG Concentrates

text: Severe noninfectious adverse events (AEs) and transmission of pathogens by plasma-derived protein concentrates from the very beginning of their clinical use were threats for recipients (see Chap. 10.1007/978-3-319-68038-5_11 for additional information). “Standard IgG” preparations were the first available for clinical use. They were produced by the cold-ethanol fractionation methods and did not make an exception. Noninfectious severe AEs occurred while infectious AEs were rarely reported. Indeed, prior to the introduction of mass screening for infection markers of plasma donations, inadvertent transmission of HIV to recipients of factor VIII and factor IX concentrates did occur, while IgG concentrates obtained from the same plasma pool did rarely transmit HIV (Morgenthaler 2001). Rare transmissions were restricted to products not exposed to low pH. The very few incidences of HIV and some incidences of HCV transmission by IgG concentrates in the early 1990s together with many cases of coagulation factor concentrates transmitted viral disease clearly demonstrated the need to establish standardized measures to render plasma products pathogen safe. In the second half of the 1990s, authorities shifted regulatory emphasis from a scientific review of the processes to a focus on compliance to current good manufacturing practice (cGMP). The focus on cGMP compliance was applied to all aspects of plasma fractionation and the clinical use of plasma products. Court injunctions and warning letters were the consequences of this paradigm shift by authorities. This in turn resulted in a paradigm shift how the modern plasma industry operates (Steinhardt 1998).


title: Molecular Inhibitors of Growth Signals

text: Signal transduction associated with growth factor receptors typically mediates the activation of cell cycle promoting gene products or the inactivation of cell cycle checkpoints. These signals are frequently transduced through G-Protein pathways, kinase receptor pathways, or nuclear receptor pathways (Fig. 4.1), are dependent on proto-oncogenic transcription factors, and lead to the expression of Cyclins and Cyclin-Dependent Kinases (CDKs), which are drivers of the cell cycle (Fig. 4.2). Physiologically, growth signals are transient and entirely depend on the engagement of a growth factor receptor by its cognate ligand. Upon termination of this interaction, the growth signal ceases. Gain-of-function mutations in cancer keep the growth signal active, regardless of the presence of the transient growth factor-receptor interaction. Such deregulated signaling cascades are appropriate drug targets in the treatment of cancer.


title: What Went Wrong? The World Health Organization from Swine Flu to Ebola

text: Since 2001, the World Health Organization (WHO) has been actively promoting its ability to manage global health security. Recent events such as the 2009 H1N1 influenza pandemic and the 2014 Ebola outbreak have, however, led to questions being raised about the WHO’s abilities and extensive calls for the organisation’s reform. This chapter examines a series of mistakes and the structural, cultural, political and epidemiological factors that contributed to the WHO’s mishandling of the first pandemic of the twenty-first century and the world’s largest ever outbreak of Ebola. The chapter then concludes by examining the reforms currently being implemented to strengthen the WHO’s global health security capabilities and what these signify for the future.


title: Care of the Critically Ill Pediatric Sickle Cell Patient

text: Sickle cell disease is the most common inherited disease in the United States. Through the effects of hemolysis and vaso-occlusion, it has the potential to incite critical illness involving multiple organ systems. Children with sickle cell disease are at risk of multiple types of shock resulting in a need for ICU care. Our youngest patients with sickle cell disease are at highest risk of infection due to lack of splenic function, and this can present with septic shock. Hypovolemic shock can occur secondary to severe acute anemia as seen with splenic sequestration or a delayed transfusion reaction. As one ages, the risk of cardiac dysfunction – diastolic and systolic dysfunction as well as pulmonary hypertension – can result in cardiogenic shock. In addition to shock, patients with sickle cell disease are at risk for respiratory failure from acute chest syndrome as well as acute neurologic deterioration from stroke. For these reasons, critical care physicians must be familiar with the unique management of sickle cell complications in order to provide the best possible care for this vulnerable population.


title: The ‘Next People’: And the Zombies Shall Inherit the Earth

text: On Halloween night 2014 I stood with thousands of others along the side of a large boulevard in Amsterdam. There was an excited buzz rippling through the crowd and young children zipped in and out, threading their way around their parents and friends, vying for the best viewing locations. Their cries and laughter filled the air alongside the adult conversation and the sound of phones ringing as people attempted to find each other in the crowd. We were all waiting with mounting excitement for the annual Halloween Parade. It was running late. Heads turned down the street, cameras and phones at the ready, watching for any sign that the parade was arriving. Expectation hung in the air. Finally … music. And then a truck disguised as a giant metal dragon belching smoke and music lurched into view, followed by a slow moving phalanx of participants, all in Halloween costumes. Some of the walkers were waving at the crowd, others were ignoring us, while still others lunged at unsuspecting individuals with threatening roars and grimaces. An armada of decorated vehicles, flanked by phalanxes of monsters and ghouls moved slowly along the street.


title: Risk, Media and Japanese Young People

text: Theories of risk in society have defined and extrapolated on risk in multiple ways depending on the object of study and types of claims made by the author. Zinn (2008b) lists six main traditions, including risk society, cultural turn, and governmentality. One of the central problems that more recent work on risk has focused on is how risk varies according to the fabric of particular everyday lives in particular societies and under various types of social arrangements (Tulloch and Lupton, 2003; Tulloch, 2004). In this chapter I explore this problem of risk theory by looking at the views Japanese young people have about risk in Japanese society.


title: Hochsicherheitslabor

text: Das Planen, Bauen und Betreiben eines Hochsicherheitslabors muss sehr gut vorbereitet werden. Nutzer, spätere Anlagenbetreiber (Technik und Bau) und die Genehmigungsbehörde sollten rechtzeitig in das Verfahren eingebunden werden. Umfangreiche technische Kenntnisse, insbesondere das Zusammenspiel gewerksübergreifender Funktionen, sind notwendig. Dabei steht die Sicherheit an oberster Stelle. Dieses Kapitel gibt einen fundierten Überblick über die rechtlichen Grundlagen und Sicherheitsaspekte, die bei der Planung, der Errichtung und dem Betrieb von Hochsicherheitslaboren beachtet werden müssen.


title: Care of the Surgical ICU Patient with Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension

text: Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease characterized by airflow limitation that is frequently progressive and associated with respiratory impairment. As the fourth leading cause of death in the United States and Europe, COPD results in a substantial and ever increasing economic and social burden [1]. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are frequently encountered in the intensive care unit (ICU). Although there is no standardized definition, AECOPD are characterized by a significant change in patient symptoms from baseline accompanied by overall increased airway resistance [2]. These exacerbations carry a significant risk to patients, with 10 % in-hospital mortality and 1-year and 2-year all-cause mortality rates of 43 % and 49 %, respectively, in patients with hypercapnic exacerbations [3]. Other studies note in-hospital mortality rates as high as 30 % with worse outcomes associated with older age, severity of respiratory and non-respiratory organ dysfunction, and hospital length of stay [4]. Given that patients transferred to the ICU with AECOPD are at high risk for complications and adverse outcomes, early diagnosis and management are critical to improve patient outcomes and survival in this population.


title: Zoonotic Viruses and Conservation of Bats

text: Many of the recently emerging highly virulent zoonotic diseases have a likely bat origin, for example Hendra, Nipah, Ebola and diseases caused by coronaviruses. Presumably because of their long history of coevolution, most of these viruses remain subclinical in bats, but have the potential to cause severe illnesses in domestic and wildlife animals and also humans. Spillovers from bats to humans either happen directly (via contact with infected bats) or indirectly (via intermediate hosts such as domestic or wildlife animals, by consuming food items contaminated by saliva, faeces or urine of bats, or via other environmental sources). Increasing numbers of breakouts of zoonotic viral diseases among humans and livestock have mainly been accounted to human encroachment into natural habitat, as well as agricultural intensification, deforestation and bushmeat consumption. Persecution of bats, including the destruction of their roosts and culling of whole colonies, has led not only to declines of protected bat species, but also to an increase in virus prevalence in some of these populations. Educational efforts are needed in order to prevent future spillovers of bat-borne viruses to humans and livestock, and to further protect bats from unnecessary and counterproductive culling.


title: Mechanisms of symptoms of common cold and flu

text: It is the familiar symptoms of sore throat, runny nose, sneezing, and nasal congestion, muscle aches, chilliness and fever, etc., that define the common cold and flu syndromes as self-diagnosed illnesses. Although there is much information about the molecular biology of the viruses that cause the common cold and flu syndromes, there is relatively little research on the immunological, physiological and pathophysiological mechanisms involved in generating the symptoms. This chapter studies the mechanisms that cause local symptoms associated with local inflammation of the airway (sore throat, sneezing, rhinorrhoea and purulent nasal discharge, nasal congestion, sinus pain, watery eyes and cough), and the mechanisms that cause systemic symptoms associated with release of cytokines from leukocytes (headache, chilliness and fever, psychological effects, malaise and mood changes, loss of appetite, and muscle aches and pains).


title: Immunorecognition of Biological Agents: An Introduction to Immunology

text: The main mechanims and concepts regulating the functioning of the human immune system are illustrated, with the general aims of improving disease prevention and ecosystem dynamics knowledge. These concepts must be known for the best management of infectious diseases and in the paramount view of ecology and parasitism, which are at the basis of stage-sharing of the environment by different species of life, each defending its own uniqueness and biological existence. Man is only one of the many living species sharing the stage of the planet. These considerations are fundamental in the fields of infectious diseases and of bioterrorism which have to be efficiently contrasted.


title: Porcine Coronaviruses

text: Transmissible gastroenteritis virus (TGEV), porcine epidemic diarrhoea virus (PEDV), and porcine deltacoronavirus (PDCoV) are enteropathogenic coronaviruses (CoVs) of swine. TGEV appearance in 1946 preceded identification of PEDV (1971) and PDCoV (2009) that are considered as emerging CoVs. A spike deletion mutant of TGEV associated with respiratory tract infection in piglets appeared in 1984 in pigs in Belgium and was designated porcine respiratory coronavirus (PRCV). PRCV is considered non-pathogenic because the infection is very mild or subclinical. Since PRCV emergence and rapid spread, most pigs have become immune to both PRCV and TGEV, which has significantly reduced the clinical and economic importance of TGEV. In contrast, PDCoV and PEDV are currently expanding their geographic distribution, and there are reports on the circulation of TGEV-PEDV recombinants that cause a disease clinically indistinguishable from that associated with the parent viruses. TGEV, PEDV and PDCoV cause acute gastroenteritis in pigs (most severe in neonatal piglets) and matches in their clinical signs and pathogenesis. Necrosis of the infected intestinal epithelial cells causes villous atrophy and malabsorptive diarrhoea. Profuse diarrhoea frequently combined with vomiting results in dehydration, which can lead to the death of piglets. Strong immune responses following natural infection protect against subsequent homologous challenge; however, these viruses display no cross-protection. Adoption of advance biosecurity measures and effective vaccines control and prevent the occurrence of diseases due to these porcine-associated CoVs. Recombination and reversion to virulence are the risks associated with generally highly effective attenuated vaccines necessitating further research on alternative vaccines to ensure their safe application in the field.


title: Deubiquitinating Enzymes as Novel Targets for Cancer Therapies

text: Most ubiquitinated proteins can be recognized and degraded by the 26S proteasome. In the meantime, protein deubiquitination by various deubiquitinating enzymes (DUBs) regulates protein stability within cells, and it can counterbalance intracellular homeostasis mediated by ubiquitination. Numerous reports have demonstrated that an aberrant process of the ubiquitin-proteasome pathway (UPP) regulated by the ubiquitination and deubiquitination systems results in failure of balancing between protein stability and degradation, and this failure can lead to tumorigenesis in various organs and tissues of mammals. The identification of molecular properties for various DUBs is very critical to understand cancer development and tumorigenesis. Therefore, knowledge of DUBs and their association with cancer and diseases is indispensible for developing effective inhibitors for DUBs. This chapter describes various features and functions of cancer-related DUBs. In addition, we summarize several inhibitors that specifically target certain DUBs in cancer and suggest that DUBs may be one of the most ideal and attractive therapeutic targets.


title: Viral Proliferation and Replication

text: As obligate cellular parasites, viruses do not have their own metabolism; therefore, they must infect cells for reproduction. The virus particles must be able to recognize specific receptor molecules on the cytoplasmic membrane of the host cell and to bind to them. This process is known as attachment. In enveloped viruses, this interaction is mediated by proteins that are embedded within the viral envelope. This is the case in influenza viruses as well as retroviruses and herpesviruses. Binding of viral envelope proteins to cellular surface structures is to some extent very specific: this is the case for the interaction between the surface protein gp120 of human immunodeficiency virus (HIV) and the CD4 receptor, a polypeptide that occurs almost exclusively in the cytoplasmic membrane of T-helper cells and macrophages (Sect. 10.1007/978-3-642-20718-1_18). In other cases, viral proteins bind to cellular structures that are found on many cell types. One example is the binding of haemagglutinin of influenza viruses (Sect. 10.1007/978-3-642-20718-1_16) to terminal N-acetylneuraminic acid residues of complex oligosaccharides, which are found as protein and lipid modifications on the membrane surface of various cells.


title: Isolierungsmaßnahmen

text: Die Kenntnis des infektionsspezifischen Übertragungsweges einer Erkrankung ist die entscheidende Voraussetzung zur Festlegung sinnvoller, d. h. effektiver Präventionsmaßnahmen, zu denen auch heute noch die räumliche Isolierung von Patienten gehört. Die in der Vergangenheit empfohlenen pauschalen Maßnahmen, die weder den Übertragungsweg noch die Virulenz eines Infektionserregers angemessen berücksichtigten, führten oftmals zu erkennbarer Überisolierung, mit der Folge, dass in der täglichen Praxis notwendige Isolierungsmaßnahmen eher nachlässig gehandhabt wurden. Die Konsequenzen waren vermeidbare Kontaktinfektionen in Kliniken. Andererseits birgt die Unterbringung in einem Isolierzimmer die Gefahr einer schlechteren medizinischen wie pflegerischen Versorgung und damit einer Gefährdung des Patienten. Erreger- und maßnahmenbezogene Isolierkriterien mit disziplinierter Befolgung erforderlicher Verhaltensregeln seitens aller Beschäftigten, der isolierten Patienten und ihrer Besucher sind die Voraussetzung einer erfolgreichen Vermeidung von Infektionsübertragungen. Die Vermeidung unnötiger Isolierungsmaßnahmen spart erhebliche Kosten, reduziert die Belastung von Ärzten wie Pflegekräften und damit die Gefahr der Noncompliance bei essenziellen Präventionsmaßnahmen wie Händedesinfektion und andere Maßnahmen der Basishygiene.


title: Big Data and Biodefense: Prospects and Pitfalls

text: This chapter will provide an overview of how “big data” and “big data” analytics can be brought to bear on the pressing biodefense challenges of: (1) threat awareness; and (2) surveillance and detection. The chapter will also discuss potential problems that can arise by relying exclusively on “big data” approaches, which have properties and limitations inherent in their composition that may not be initially recognized but which may lead to erroneous results. The chapter will conclude by discussing how multi-disciplinary teams of researchers using hybrid systems, involving “big data” and “small data,” could more effectively and accurately contribute to understanding biodefense problems.


title: Basic Knowledge and Developing Tendencies in Epidemic Dynamics

text: Infectious diseases have been a ferocious enemy since time immemorial. To prevent and control the spread of infectious diseases, epidemic dynamics has played an important role on investigating the transmission of infectious diseases, predicting the developing tendencies, estimating the key parameters from data published by health departments, understanding the transmission characteristics, and implementing the measures for prevention and control. In this chapter, some basic ideas of modelling the spread of infectious diseases, the main concepts of epidemic dynamics, and some developing tendencies in the study of epidemic dynamics are introduced, and some results with respect to the spread of SARS in China are given.


The technology of pharming


Genome organization and structural aspects of the SARS-related virus


Lung


title: Allgemeine Notfälle

text: Sie werden als Notarzt zu einem 54 Jahre alten Mann gerufen, der über Schmerzen in der Brust klagt, die seit etwa 45 min bestehen. Eine koronare Herzkrankheit ist anamnestisch bekannt. Der Blutdruck ist 150/90 mmHg, die Herzfrequenz 110/min. Der Patient ist kaltschweißig und klagt über Übelkeit. Das 12-Kanal-EKG zeigt einen Linkslagetyp mit normalem Sinusrhythmus, Zeichen einer akuten Ischämie (ST-Hebungen) sind nicht zu sehen.


title: Adenoviren

text: Adenoviren verursachen akute Erkältungskrankheiten, Pharyngitis, Konjunktivitis, Keratokonjunktivitis, Gastroenteritis, hämorrhagische Zystitis, Pneumonien, Meningitis und Enzephalitis. Sie interferieren mit dem Angriff des Immunsystems auf infizierte Zellen und persistieren mehrere Jahre in den Tonsillen (»Adenoiden«). Bei Immunsuppression können sie reaktiviert werden und dann lebensbedrohlich disseminieren. Das Virus wurde erstmals 1953 in Explantaten von Tonsillengewebe anhand seines zytopathischen Effekts in vitro nachgewiesen. 1956 erhielten die Isolate die Bezeichnung »Adenoviren«. Typ 12 war das erste humanpathogene Virus, bei dem man Onkogenität im Versuchstier beobachtete. Eine ursächliche Beteiligung von Adenoviren bei menschlichen Neoplasien ist aber nicht gesichert.


title: Gold Nanoparticles for DNA/RNA-Based Diagnostics

text: The remarkable physicochemical properties of gold nanoparticles (AuNPs) have prompted development in exploring biomolecular interactions with AuNPs-containing systems, pursuing biomedical applications in diagnostics. Among these applications, AuNPs have been remarkably useful for the development of DNA/RNA detection and characterization systems for diagnostics, including systems suitable for point of need. Here, emphasis will be on available molecular detection schemes of relevant pathogens and their molecular characterization, genomic sequences associated with medical conditions (including cancer), mutation and polymorphism identification, and the quantification of gene expression.


title: The Role of Animal Models In Influenza Vaccine Research

text: A major challenge for research on influenza vaccines is the selection of an appropriate animal model that accurately reflects the disease and the protective immune response to influenza infection in humans. Vaccines for seasonal influenza have been available for decades and there is a wealth of data available on the immune response to these vaccines in humans, with well-established correlates of protection for inactivated influenza virus vaccines. Many of the seminal studies on vaccines for epidemic influenza have been conducted in human subjects. Studies in humans are performed less frequently now than they were in the past. Therefore, as the quest for improved influenza vaccines continues, it is important to consider the use of animal models for the evaluation of influenza vaccines, and a major challenge is the selection of an appropriate animal model that accurately reflects the disease and the protective immune response to influenza infection in humans. The emergence of highly pathogenic H5N1 avian influenza (AI) viruses and the threat of a pandemic caused by AI viruses of this or another subtype has resulted in a resurgence of interest in influenza vaccine research. The development of vaccines for pandemic influenza presents a unique set of obstacles, not the least of which is that the demonstration of efficacy in humans is not possible. As the correlates of protection from pandemic influenza are not known, we rely on extrapolation of the lessons from seasonal influenza vaccines and on data from the evaluation of pandemic influenza vaccines in animal models to guide our decisions on vaccines for use in humans. The features and contributions of commonly used animal models for influenza vaccine research are discussed. The recent emergence of the pandemic 2009 H1N1 influenza virus underscores the unpredictable nature of influenza viruses and the importance of pandemic preparedness.


title: Bispecific Antibodies for Diagnostic Applications

text: Bispecific monoclonal antibodies (BsMAb) are unique engineered macromolecules that have two different pre-determined binding specificities. Their ability to simultaneously bind to a specific antigen and a given detection moiety enables them to function as excellent bifunctional immunoprobes in diagnostic assays. BsMAb are being exploited for the development of simple, rapid, and highly sensitive immunoassays for diagnosis of bacterial and viral infectious diseases. This chapter describes the use of BsMAb for the detection of Mycobacterium tuberculosis, Escherichia coli O157:H7, Bordetella pertussis, Severe Acute Respiratory Syndrome coronavirus, and Dengue virus. Further, BsMAb have been utilized for diagnosis of various types of cancers. The use of BsMAb in detection of prostate cancer and in cancer diagnostic imaging is also discussed.


title: Intensivtherapie der HIV-Infektion

text: Bei HIV-infizierten Patienten hat sich durch die Einführung der antiretroviralen Kombinationstherapie die Langzeitprognose erheblich verbessert und das Spektrum der zum Intensivaufenthalt führenden Erkrankungen verschoben.


docid: viagxmqs

title: Super-Gau: Ausrottung der Menschheit durch Krieg und Naturkatastrophen

text: Die Vernichtung der Menschheit durch Krieg oder Naturkatastrophen weist in ihren Konsequenzen große Überschneidungen auf, weshalb ich sie auch zu einem übergeordneten Typus „Super-Gau – Ausrottung der Menschheit“ zusammengefasst habe. Im Prinzip lehren uns die dystopischen Filme generell, dass die Menschheit stets selbst an ihrem Unheil schuld ist. Dies unterscheidet auch die von Giddens als high-consequence risks bezeichneten modernen Risiken von früheren Katastrophen wie Sintfluten, Dürren oder Epidemien, die der Mensch nicht beeinfl ussen konnte. Wenn man jedoch genauer hinsieht, dann ist die Zuschreibung der Verantwortlichkeit des Menschen für das, was in der Umwelt passiert, keine moderne Erfindung.


docid: qgvrnrwq

title: Cell Polarity: A Key Defence Mechanism Against Infection and Cancer Cell Invasion?

text: It is now emerging that a number of cellular targets of pathogens are involved in the establishment and/or maintenance of epithelial cell polarity. Increasing evidence also suggests that cancer-causing pathogens such as Helicobacter pylori (H. pylori) and human papilloma virus (HPV) may induce oncogenesis by disrupting cell polarity. This is mainly achieved through their ability to deregulate the function of cell polarity components and/or regulators. Hence cell polarity represents the first line of defence against infection. Interestingly, EGFR/RAS oncogenic signals also induce cancer cell invasion by inducing epithelial to mesenchymal transition (EMT). Since the loss of cell polarity is a prerequisition of EMT, cell polarity also represents the last line of defence against cancer cell invasion. As such we argue that cell polarity may be a key defence mechanism against infection and cancer cell invasion. The potential role of cell polarity as a gatekeeper against cancer through its ability to regulate asymmetric cell division and tumour suppression has been discussed in a number of recent reviews. In this review we will focus on the role of cell polarity as a potential target of infection and cancer cell invasion.


title: Vitamin D and respiratory infections in infants and toddlers: a nutri-shine perspective

text: There is compelling evidence of a global problem of poor vitamin D status in expecting mothers and postnatal life; and even more critical, is the evidence showing the association of vitamin D deficiency with increased morbidity and mortality risks from respiratory infections. Viral and bacterial pneumonia kills more children than any other illness, accounting for 19 % of all deaths in children less than five years of age worldwide; and under-nutrition, which includes vitamin D insufficiency/deficiency, has been implicated in 53 % of all these deaths. Poor vitamin D status is a result of insufficient sunlight exposure and/or poor dietary intake. Greater understanding of the role of vitamin D deficiency in precipitating lung infections grew from the use of rodent models and observational and intervention studies in infants and toddlers. Vitamin D adequacy is important to maintaining the key protective mechanism of developing lungs since it mediates the synthesis of antimicrobial peptides, the lungs strongest defense against viral and bacterial pathogens. If vitamin D intervention currently under study in several clinical trials is proven successful, then implementation of new fortification practices, revised guidelines for healthy sun exposure and public health programs for vitamin D supplementation of pregnant/lactating women and their infants may be effective strategies to aide in preventing neonates and children under five from developing pneumonia. Globally, there is potential to save more than a million young lives with preventive treatment, a compelling reason why the efficacy of optimizing vitamin D mediated defense against respiratory pathogens in infants and children merits further study.


title: Influenza vaccines have a short but illustrious history

text: Isolation of the causative virus of influenza in 1933, followed by the discovery of embryonated hen eggs as a substrate, quickly led to the formulation of vaccines. Virus-containing allantoic fluid was inactivated with formalin. The phenomenon of antigenic drift of the virus HA was soon recognized and, as WHO began to coordinate the world influenza surveillance, it became easier for manufacturers to select an up-to-date virus. Influenza vaccines remain unique in that the virus strain composition is reviewed yearly but modern attempts are being made to free manufacturers from this yolk by investigating internal virus proteins including M2e and NP as “universal” vaccines covering all virus sub types. Recent technical innovations have been the use of Vero and MDCK cells as the virus cell substrate, the testing of two new adjuvants and the exploration of new presentations to the nose or epidermal layers as DNA or antigen mixtures. The international investment into public health measures for a global human outbreak of avian H5N1 influenza is leading to enhanced production of conventional vaccine and to a new research searchlight on T cell epitope vaccines, viral live attenuated carriers of influenza proteins and even more innovative substrates to cultivate virus, including plant cells.


title: Super Refractory Status Epilepticus

text: Earlier definitions of status epilepticus (SE) were based on the duration of seizures, but newer definitions rely more on a pragmatic staging based on treatment failures (Table 23.1). Refractory status epilepticus (RSE) is defined as SE that continues despite administration of both benzodiazepines and an appropriately dosed second-line antiseizure drug. Depending on the semiology of the seizures and comorbidities of the patient, this stage may be treated with further antiseizure drugs or anesthesia. When seizures recur upon weaning the anesthetic agent, typically after 24 h of seizure suppression, or in the rare cases where seizure control cannot be achieved with anesthesia, status epilepticus is considered to be super refractory (SRSE). The incidence of status epilepticus has been increasing, from 3.5 to 12.5/100,000 population between 1979 and 2010. During this time hospital mortality has not changed [1].


title: Befunde der Untersuchung

text: Die Fallstudien und die Befragung dieser Studie bieten viele Antworten auf die Fragen nach den Eigenschaften von Patentpools und den Einflussfaktoren, die auf die Teilnahmebereitschaft der Akteure wirken. Im Folgenden wird anhand der Fallstudien in der IKT und den Life Sciences aufgezeigt, wie Patentpools gestaltet sind und welche Eigenschaften von Patentpools besonders wichtig sind, um zu verstehen, warum diese Form der Patentübereinkunft von Patentinhabern genutzt wird. Anhand der Fallstudien werden auch die Anreize und Motive der Akteure beleuchtet, Patentpools zu gründen oder sich anderweitig an ihnen zu beteiligen. Die Schlüsselfaktoren der einzelnen Fälle werden in der Fallstudiensynthese für einen Vergleich zusammengeführt.


title: The Accuracy of Mean-Field Approximation for Susceptible-Infected-Susceptible Epidemic Spreading with Heterogeneous Infection Rates

text: The epidemic spreading over a network has been studied for years by applying the mean-field approach in both homogeneous case, where each node may get infected by an infected neighbor with the same rate, and heterogeneous case, where the infection rates between different pairs of nodes are also different. Researchers have discussed whether the mean-field approaches could accurately describe the epidemic spreading for the homogeneous cases but not for the heterogeneous cases. In this paper, we explore if and under what conditions the mean-field approach could perform well when the infection rates are heterogeneous. In particular, we employ the Susceptible-Infected-Susceptible (SIS) model and compare the average fraction of infected nodes in the metastable state, where the fraction of infected nodes remains stable for a long time, obtained by the continuous-time simulation and the mean-field approximation. We concentrate on an individual-based mean-field approximation called the N-intertwined Mean Field Approximation (NIMFA), which is an advanced approach considered the underlying network topology. Moreover, for the heterogeneity of the infection rates, we consider not only the independent and identically distributed (i.i.d.) infection rate but also the infection rate correlated with the degree of the two end nodes. We conclude that NIMFA is generally more accurate when the prevalence of the epidemic is higher. Given the same effective infection rate, NIMFA is less accurate when the variance of the i.i.d. infection rate or the correlation between the infection rate and the nodal degree leads to a lower prevalence. Moreover, given the same actual prevalence, NIMFA performs better in the cases: 1) when the variance of the i.i.d. infection rates is smaller (while the average is unchanged); 2) when the correlation between the infection rate and the nodal degree is positive. Our work suggests the conditions when the mean-field approach, in particular NIMFA, is more accurate in the approximation of the SIS epidemic with heterogeneous infection rates.


title: What Has Been Learned from Postmortem Studies?

text: Infectious and noninfectious pulmonary diseases are commonly found on postmortem autopsy studies in patients with hematological malignancy. Despite the technological advances in diagnostic testing and imaging modalities, obtaining an accurate clinical diagnosis remains difficult and often not possible until autopsy. Major diagnostic discrepancies between clinical premortem diagnoses and postmortem autopsy findings have been reported in these patients. The most common missed diagnoses are due to opportunistic infections and cardiopulmonary complications. These findings underscore the importance of enhanced surveillance, monitoring and treatment of infections and cardiopulmonary disorders in these patients. Autopsies remain important in determining an accurate cause of death and for improved understanding of diagnostic deficiencies, as well as for medical education and quality assurance.


title: Carcinogenic Effect of Wireless Communication Radiation in Rodents

text: The potential health effects of radio frequency (RF) radiation associated with cellular mobile telephones and related wireless devices remain a focus of concern. Although our knowledge regarding the health effects of RF radiation has increased considerably, the scientific evidence on biological effects of RF radiation associated with these wireless devices is still tentative. The uncertainties persist, in part, because of the limited number and scope of studies that have been conducted. Aside from the lack of a scientific consensus on experimental studies that provide clear evidence either refuting or supporting the cancer induction or promotion potential of RF radiation from cell phones, there is a concern that an established effect from wireless radiation, however small, could have a considerable impact in terms of public health. This chapter provides an updated review on recent research results on cancer induction and promotion in normal and transgenic mice and rats subjected to prolonged or life-long exposure to modulation schemes such as GSM, TDMA, CDMA, UMTS, and others. A majority of the laboratory mouse and rat studies did not exhibit a significant difference in carcinogenic incidences between exposed and sham-exposed animals. Although this observation may be comforting from the perspective of safety evaluation, most of the studies are one-of-a-kind investigations – only three mouse and perhaps four rat studies were designed as replication or confirmation studies. It is noteworthy that the findings of these studies have not been consistent, making it difficult to arrive at a definitive conclusion. It could be a major flaw that in a majority of the investigations, cage-control animals were not part of the investigation or were not included in the data analyses. Moreover, restraining the experimental animals during exposure could have introduced a stress factor, which further complicates interpretation of the results since stress has often been associated with cancer induction in these animals.


Evidence-Based Medicine in the Intensive Care Unit


title: Acute Pneumonia and Importance of Atypical Bacteria

text: The diagnosis of pulmonary infection caused by Mycoplasma and Chlamydia pneumoniae, Coxiella burnetii, and different species of Legionella, is often long and challenging although they are the major etiologic agents of pneumonia. For this reason, the treatment of these infections remains probabilistic. Advances in new diagnostic techniques, such as PCR sequencing, show the relative predominance of atypical organisms and serves to identify emerging pathogenic agents. Moreover, these techniques should clarify the correlation between common and atypical pathogens.


title: China’s Institutional Mechanisms for Influenza A (H1N1) Prevention and Control

text: Innovation in institutional mechanisms is a fundamental issue in effectively dealing with public health emergencies. In the wake of the 2003 SARS Epidemic, China initially established a public health emergency management system and an emergency organization and management network, placing emphasis on “government leading, unified command, local management, responsibility on all levels, management by classifications, and inter-departmental coordination,” which strengthened the existing health emergency preparation system.


title: Sapelovirus

text: Sapelovirus (SPV), an emerging virus in the family Picornaviridae, is detected in several animal and bird species irrespective of their age. Amid all SPVs, porcine sapeloviruses (PSVs) are more ubiquitously present all over the world in porcine population. These viruses are highly stable in different environmental conditions and spread easily within the susceptible animals mainly through faeco-oral route. Usually, PSVs cause asymptomatic infections but are also clinically associated with encephalomyelitis, respiratory distress, fertility disorders and skin lesions. PSV-associated outbreaks have been reported where death occurs due to polioencephalitis and respiratory paralysis. Till date, PSVs have been detected from several European and Asian countries with moderate-to-high prevalence and clinical course. Viral capsid proteins are immunogenic and mutations in these proteins are responsible for the diverse nature of the viruses. Further, genomic analysis shows the varied evolutionary patterns and the presence of recombination within PSV strains. These viruses also exist as concurrent infections with several enteric bacterial, viral and parasitic pathogens. Classical to modern biotechnological assays are in use to detect PSV involving virus isolation in cell culture, immunohistochemistry, conventional nucleic acid amplification techniques, quantitative real-time amplification assays and isothermal amplification molecular techniques. Till date, there is no vaccine available against PSVs.


title: Challenges, Opportunities and Theoretical Epidemiology

text: Lessons learned from the HIV pandemic, SARS in 2003, the 2009 H1N1 influenza pandemic, the 2014 Ebola outbreak in West Africa, and the ongoing Zika outbreaks in the Americas can be framed under a public health policy model that responds after the fact. Responses often come through reallocation of resources from one disease control effort to a new pressing need. The operating models of preparedness and response are ill-equipped to prevent or ameliorate disease emergence or reemergence at global scales. Epidemiological challenges that are a threat to the economic stability of many regions of the world, particularly those depending on travel and trade, remain at the forefront of the Global Commons. Consequently, efforts to quantify the impact of mobility and trade on disease dynamics have dominated the interests of theoreticians for some time. Our experience includes an H1N1 influenza pandemic crisscrossing the world during 2009 and 2010, the 2014 Ebola outbreaks, limited to regions of West Africa lacking appropriate medical facilities, health infrastructure, and sufficient levels of preparedness and education, and the expanding Zika outbreaks, moving expeditiously across habitats suitable for Aedes aegypti. These provide opportunities to quantify the impact of disease emergence or reemergence on the decisions that individuals take in response to real or perceived disease risks. The case of SARS 2003 in 2003, the efforts to reduce the burden of H1N1 influenza cases in 2009, and the challenges faced in reducing the number of Ebola cases in 2014 are the three recent scenarios that required a timely global response. Studies addressing the impact of centralized sources of information, the impact of information along social connections, or the role of past disease outbreak experiences on the risk-aversion decisions that individuals undertake may help identify and quantify the role of human responses to disease dynamics while recognizing the importance of assessing the timing of disease emergence and reemergence. The co-evolving human responses to disease dynamics are prototypical of the feedbacks that define complex adaptive systems. In short, we live in a socioepisphere being reshaped by ecoepidemiology in the “Era of Information.”


title: Alveolar Disease

text: Diffuse alveolar damage (DAD) is the histopathological substrate for most patients diagnosed clinically with the acute respiratory distress syndrome. The two terms are not synonymous, however, as some patients presenting with acute unexplained respiratory failure will be found to have a more specific disease. The benchmark for DAD is the hyaline membrane. Some authors have used the term acute interstitial pneumonitis for cases where the etiology of the DAD is unknown, and restricted the term DAD to cases where the etiology is known. The disease, when usually sampled, is subacute (weeks), principally alveolar rather than interstitial (alveoli filled by myxoid fibrosis), and not a pneumonitis (principally fibrosis rather than inflammation).


title: Infectious Diseases

text: Infect Dis Clin North Am 2007;21:4


title: An Overview of What Global Health Is

text: There have been significant improvements in the state of health in the world over the decades: the average global life expectancy since 1960 has increased from just over 50 to over 71; smallpox has been wiped out and the number of deaths from measles, 871,000 in 1999, rapidly fell to an estimated figure of 12,000 in 2012 (thanks to vaccination). However, though there are more than 7 billion people in the world, only 1 billion can expect to lead a long and healthy life. Unlike in the past, health problems are no longer confined within the individual countries. The SARS epidemic, which started in China in 2002, rapidly spread to 29 different countries in 8 months. The emissions of CO(2) in the United States and China may be causing an increase in floods in Bangladesh, as we show in the book. Global health has been defined by the United States Institute of Medicine as all those “health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by co-operative actions and solutions.” The concept of global health is connected with another important phenomenon, that of the epidemiological transition, or the continuous process according to which some diseases decline (many infectious diseases and those caused by malnutrition) and others spread (chronic “ non-communicable” diseases). According to many indicators, including health, there is a general convergence of the countries in the world but also great internal inequalities in each country. In this chapter addresses the new health issues raised by globalisation, including the impact of economic and technological changes. In doing so, it tells three exemplary stories of globalisation and health: Nauru (a very early example of the impact of globalisation), Greece (the consequences of the economic crisis) and Bangladesh (one of the countries currently most exposed to the effects of climate change).


title: A Pairwise Alignment Algorithm for Long Sequences of High Similarity

text: Alignment algorithms are important in bioinformatics for comparing the similarity among sequences. The algorithm of Needleman–Wunsch is well known for globally aligning two sequences. However, this algorithm is unsuitable for sequences of long length. Many heuristic algorithms are proposed, such as BLAST and FASTA. However, they are still unsuitable for long sequences. In this paper, we study the alignment problem on highly similar sequences. By taking SARS viruses as an example, our result shows that our algorithm runs faster than Clustalx for aligning two SARS viruses. It implies that our algorithm is suitable for viruses of high similarity.


title: Viral Infections

text: Although influenza remains indisputably the most significant viral pathogen in adults, other viruses such as respiratory syncytial virus, parainfluenza viruses, and human metapneumovirus are now recognized as significant pathogens in older populations. Oseltamivir and zanamivir are antiviral agents that are effective for the treatment and prophylaxis of influenza A and B. For treatment and for optimal effect, therapy should be initiated within 48 h of symptom onset. Infection with hepatitis viruses may be more severe in older adults with more fulminate disease as observed with acute hepatitis A and a more rapid progression to cirrhosis with hepatitis C. Outbreaks of viral gastroenteritis are common in long-term care facilities, and infection may lead to death due to dehydration and oliguria. The incidence of herpes zoster increases with advancing age and carries with it a significant risk of post herpetic neuralgia. The use of antiviral medications and corticosteroids may reduce the incidence and severity of chronic pain.


title: Platelet-Derived Inhibitors of Platelet Activation

text: Negative regulators of platelet activation are a relatively unexplored aspect of platelet physiology yet have an important role in tempering thrombus development by contributing much needed negative regulation to a process that is amplified by several positive feedback mechanisms. Some negative regulators, such as RASA3 and JAM-A, act as gatekeepers that modulate key mediators of activation and provide barriers that must be deactivated to permit full activation and stable thrombus formation. Other negative regulators, such as PECAM-1 and other proteins that signal through ITIMs, come into play once platelets are activated and provide restraining, negative feedback for activatory pathways. Many platelet-derived inhibitors have been identified but not fully characterised and so questions remain regarding the mechanisms that underlie the effects on platelet activity following their activation, inhibition or genetic disruption. However, dysregulation of inhibitory signals is believed to contribute to enhanced risk of thrombosis in diseases such as diabetes and other pathological conditions. In this chapter we have described platelet-derived inhibitors of platelet function that are secreted by or expressed within platelets themselves to provide inhibition or negative regulation to the processes that underpin activation.


title: Tag 2: Infektionskrankheiten

text: Das Kapitel gibt einen Überblick über die außergewöhnliche Bedeutung von Infektionskrankheiten aufgrund der schnelle Übertragbarkeit und der Entwicklung von Antibiotikaresistenzen. Nach der Darstellung von Übertragungswegen und den Prinzipien der Diagnostik und Therapie werden die wichtigsten Krankheitsbilder systematisch behandelt. Dazu gehören Sepsis, Meningitis, Pneumonie, Osteomyelitis, Harnwegsinfektionen und Gastroenteritis. Die erregerbezogene Systematik mit typischen klinischen Manifestationen wird unterteilt in besonders relevante Bakterien (Streptokokken und Staphylokokken), Viren (Masern-, Mumps-, Röteln- und Herpesviren), Pilze, Würmer und Arthropoden. Ein weiterer Fokus ist die Infektionsprophylaxe durch aktive und passive Impfungen.


title: Acronyms and Abbreviations in Surgery and Medicine

text: The patient went from the ER to the OR and then to the ICU.” It is an irrefutable fact that doctors' speech is full of abbreviations. Healthcare professionals in general and surgeons in particular use at least ten abbreviations per minute (this is just a guesstimate; please don't quote us). This high prevalence has led us to consider medical abbreviations an important challenge.


title: Exam 1 Questions

text: 1. Which of the following is the most common form of incomplete spinal cord injury? A. Central cord syndrome. B. Cauda equina syndrome. C. Anterior spinal cord syndrome. D. Posterior spinal cord syndrome. E. Brown-Sequard lesion. 2. A 64-year-old male with a history of chronic alcohol abuse and congestive heart failure is currently recovering from excision of a large right shoulder lesion suspicious for melanoma. Postoperatively, he is experiencing bleeding and oozing from his surgical site that has persisted despite suture repair and direct pressure for an extended period of time. His labs are drawn, and are as follows: platelets 141 × 10(3)/mL, INR 1.2, fibrinogen 90 mg/dL. Which of the following blood products should be administered next? A. Fresh frozen plasma. B. Cryoprecipitate. C. Prothrombin complex concentrate. D. Recombinant activated factor VII. E. Aminocaproic acid. 3. A 75-year-old, 90 kg male with a history of peripheral vascular disease, coronary artery disease, and epilepsy following a recent cerebral infarction presents to the emergency department after having three witnessed seizures at home. He was intubated at the scene by the paramedics, and received 8 mg of intravenous lorazepam and 1 g of phenytoin. While you are evaluating him, he has another generalized tonic-clonic seizure, and the nurse asks if you would like to initiate a continuous propofol infusion. His blood pressure is 94/42 mmHg, and he is having numerous premature ventricular contractions (PVCs) on the electrocardiographic monitor. He has no history of platelet or liver dysfunction. Which of the following should be performed next? A. Complete the phenytoin load to attain 20 mg/kg, then start propofol infusion. B. Complete the phenytoin load to attain 20 mg/kg only C. Administer valproate, 30 mg/kg over 10 min, as well as midazolam 0.2 mg/kg. D. Start immediate midazolam infusion at 2 mg/kg/h. E. Give a 1 L normal saline bolus, and start a norepinephrine infusion to normalize blood pressure. 4. A 38-year-old male is brought to the emergency department after a motor vehicle accident. He is found to have significant ecchymoses on his chest and face, with multiple apparent rib fractures. He is in mild respiratory distress, with an oxygen saturation of 89% on room air, and hypotensive, with a systolic blood pressure of 88 mmHg. He has absent breath sounds on the right side. There is currently a delay in obtain a bedside portable chest x-ray. Which of the following should be performed next? A. 28-French chest tube placement. B. 16-French chest tube placement. C. Obtain computed tomography (CT) of the chest. D. Administer 30 cc/kg crystalloid. E. Obtain urgent cardiothoracic surgery consult. 5. Stress ulcer prophylaxis is often undertaken to prevent clinically important upper gastrointestinal (GI) bleeding. Which of the following factors puts patients at highest risk for such bleeding episodes? A. Respiratory failure. B. History of alcohol abuse. C. NPO status. D. Diverticulitis. E. All of the above. 6. In an intact heart, the Frank-Starling mechanism describes contractility increases in responses to: A. Decreased preload. B. Increased afterload. C. Decreased left ventricular end-diastolic pressure. D. Increased left ventricular end-diastolic volume. E. Increased pulmonary vascular resistance. 7. A 68-year-old female with a history of hyperlipidemia, hypothyroidism, and gastric cancer on total parenteral nutrition is currently in the ICU following a small traumatic subdural hemorrhage. On hospital day 5, the patient begins to spike fevers that persist despite broad spectrum antibiotic coverage with vancomycin and piperacillin-tazobactam. She is otherwise hemodynamically stable. The lab calls you to notify you that multiple sets of blood cultures display budding yeast forms and pseudohyphae. Which of the following should be administered next? A. Fluconazole. B. Posaconazole. C. Anidulafungin. D. Caspofungin. E. Amphotericin B. 8. A 56-year-old male with a past medical history of hypertension, hyperlipidemia, and morbid obesity is currently intubated in the ICU following a left middle cerebral artery infarct. The respiratory therapist alerts you the fact that the patient has become markedly dysynchronous with the ventilator, including breath holding episodes, breath stacking, and resisting ventilator-delivered breaths. A variety of pressure- and volume-regulated ventilator modes have been attempted without improvement, as well as boluses of both fentanyl and midazolam. The most recent arterial blood gas is as follows: pH 7.19, PaCO(2) 78 mmHg, PaO(2) A. Prone the patient. B. Administer nitric oxide at 10 parts per million. C. Administer 10 mg of cisatracurium. D. Administer a mixture of 60% helium/40% oxygen. E. Administer a continuous infusion of phenobarbital. 9. Compared to lactulose for the treatment of hepatic encephalopathy, polyethylene glycol (PEG) has been shown to: A. Decrease in-hospital mortality. B. More rapidly improve symptoms. C. Increase the rate of gastrointestinal complications. D. Increase the incidence of major electrolyte abnormalities. E. None of the above. 10. Which of the following neurologic insults is the least likely to cause central (non-infectious) fever in the ICU? A. Intracranial neoplasm. B. Intraventricular hemorrhage. C. Normal pressure hydrocephalus. D. Subarachnoid hemorrhage. E. Traumatic brain injury. 11. A 57-year-old male with a history of epilepsy and medication noncompliance is admitted to a small community hospital after a brief tonic-clonic seizure. A non-contrast head CT on admission is normal. On the second hospital day, the patient begins to complain of severe substernal chest pressure, and an urgent bedside EKG shows evidence of an acute inferior myocardial infarction (MI). The nearest percutaneous coronary intervention (PCI) capable center is approximately 150 min away by the fastest transport method available. Which of the following is the most appropriate next step in this patient’s care? A. Arrange for transport to the closest PCI center with anticipated balloon time within 30 min of arrival. B. Prepare to administer fibrinolytic therapy. C. Consult cardiothoracic surgery for possible coronary artery bypass grafting (CABG). D. Place the patient on a continuous nitroglycerine infusion and administer aspirin, clopidogrel, and heparin. E. Await serum cardiac biomarkers and repeat EKG in 1 h. 12. A 62-year-old male with unknown past medical history who recently immigrated from El Salvador is currently in the stroke unit after suffering from an acute left middle cerebral artery infarction. The patient is aphasic; his wife states that he been in his usual state of health lately, and denies any recent weakness, dizziness, chest pain, cough, shortness of breath, or fevers. On reviewing this patient’s belongings, the nurse discovers a bottle of isoniazid, as well as paperwork demonstrating a positive quantiferon gold test performed at a local clinic approximately 3 weeks ago. He does not appear to be on any other medications. A bedside portable chest x-ray is performed, which preliminarily appears normal. Which of the following should be performed next? A. Move the patient to a negative pressure isolation room, continue isoniazid. B. Isolate the patient, continue isoniazid, add rifampin. C. Isolate the patient, continue isoniazid, add rifampin and pyrazinamide. D. Isolate the patient, continue isoniazid, add rifampin, pyrazinamide and ethambutol. E. None of the above. 13. A 56-year-old, 70 kg female patient in oliguric renal failure would be expected to have a daily urine output of: A. No more than 50 mL. B. No more than 400 mL. C. No more than 800 mL. D. Less than 70 mL/h. E. Less than 35 mL/h. 14. A 37-year-old female with a history of epilepsy is admitted to the ICU with status epilepticus. She required several doses of lorazepam in the emergency department in addition to fosphenytoin, intubation, and a continuous propofol infusion. There was concern for aspiration in the prehospital setting. Approximately 3 days after being admitted to the hospital, her respiratory status has worsened; she is increasingly hypoxic, and her chest x-ray demonstrates diffuse bilateral interstitial infiltrates. The patient is afebrile with minimal secretions. Her most recent arterial blood gas is as follows: pH 7.21, PaO(2) 107 mmHg, PCO(2) 55 mmHg, 100% FiO(2), and a positive end-expiratory pressure (PEEP) of 8 cm H(2)O. According to the Berlin criteria, how would you categorize this patient’s acute respiratory distress syndrome (ARDS)? A. Acute lung injury (ALI). B. Mild ARDS. C. Moderate ARDS. D. Severe ARDS. E. None of the above. 15. An 80-year-old male presents to the emergency department with multiple episodes of bright red blood per rectum. He is on aspirin and clopidogrel for a history of coronary artery disease and a previous transient ischemic attack. He underwent aortic graft surgery for repair of an abdominal aortic aneurysm 2 years ago. A complete blood count and coagulation profile are all within normal limits. His vital signs are as follows: blood pressure 102/58 mmHg, heart rate 98 beats/min, respiratory rate 18 breaths/min, oxygen saturation 98% on room air, and temperature 98.3 °F. Which of the following is the next best step in the care of this patient? A. Transfuse platelets, fresh frozen plasma, and recombinant factor VIIa. B. Consult gastroenterology for emergent upper endoscopy. C. Consult gastroenterology for emergent colonoscopy. D. CT angiogram of the abdomen and pelvis. E. Expectant management with fluids and blood transfusions. 16. A thrombus in which of the following veins would not be considered a deep vein thrombosis (DVT)? A. Popliteal vein. B. Soleal vein. C. Femoral vein. D. Gastrocnemius vein. E. Greater saphenous vein. 17. After partial resection of the pituitary stalk, secretion of which of the following hormones will be most affected? A. Oxytocin. B. Adrenocorticotrophic hormone. C. Melanocyte-stimulating hormone. D. Thyroid-stimulating hormone. E. All will be equally affected. 18. A 58-year-old female with a history of hypertension, rheumatoid arthritis, metastatic ovarian cancer, and bilateral deep venous thrombosis status post recent inferior vena cava filter placement presents to the emergency department with right flank pain. She states the pain began approximately 1 h ago when bending down to pick something off the floor, and that it is constant and severe in nature. She denies dysuria or hematuria. Her vital signs are as follows: blood pressure 108/62 mmHg, heart rate 121 beats/min, respiratory rate 20 breaths/min, oxygen saturation 99% on room air, and temperature 99.6 °F. A CT scan of the abdomen is obtained (see Image 1). Which of the following is the next best step in this patient’s management? A. Administer vancomycin and cefepime, and draw two sets of blood cultures. B. Urgent vascular surgery consult. C. Immediately place the patient on her left side. D. Rapid sequence intubation with mechanical ventilation. E. Perform bedside diagnostic peritoneal lavage;