title: Infectious Diseases

text: The chapter describes bacerial, viral, parasitic and fungal infections commonly detected in pet birds. The chapter includes history, etiology, susceptible hosts, transmission, pathogenesis, clinical symptoms, lesion, diagnosis, zoonosis, Treatment and control strategy of Tuberculosis, Salmonellosis, Chlamydiosis, Campylobacteriosis, Lyme disease, other bacterial infection, Newcastle disease, Avian Influenza infection, West Nile Virus infection, Usutu virus infection, Avian Borna Virus infection, Beak and feather disease, other viral infection, Toxoplasmosis, Giardiasis, Cryptosporidiosis, other parasitic infection, Cryptococcosis, Aspergillosis, Other fungal infections.


title: Zur Rolle der Marktforschung in der Konsumgesellschaft

text: „Nun, sehen Sie, Miss Ford, wir leben in einer komplizierten Gesellschaft, die es vorzieht, dem Wettbewerb alle Risiken zu entziehen. Deshalb gibt es auch mehr Meinungsforschungsinstitute als ein normaler Sterblicher zu zählen vermag. Bevor wir ein Produkt auf den Markt bringen, wollen wir erfahren, wer es kaufen wird, wie oft und was man dafür anlegen will; welche Gründe fur Bekenntnisse maβgebend sind; welche Chancen Gouverneur Stone hat, wieder gewählt zu werden; welche Waren besonders viel verlangt werden; ob Tante Bessie in der nächsten Modesaison blau oder rosa vorzieht.“ (Daniel F. Galouye, Simulacron 3, 1965)


title: Infectious Diseases

text: The number of infectious complications encountered in the intensive care unit (ICU) continues to increase. Patients who otherwise would have not survived in the past are now improving due to new technical advancements. However, the length of stay, as well as the large number of devices employed for this purpose, predisposes patients to difficult and often fatal infections. Clinical characteristics of patients who are treated in the ICU have evolved in recent years. Those who are immunocompromised, post-transplant, and the geriatric population are now regularly treated in the ICU with the consequent increase in morbidity, mortality, and cost.


title: Society, Differentiation and Globalisation

text: First, theories of globalisation and their implications for the analysis of health issues are discussed. Emphasis is on: (1) globalisation as embodied, something often overlooked by sociologists working outside of the field of health and (2) health vulnerabilities that arise from the heightened mobility and connectivities that characterise globalisation, taking migration and health as an illustration. Second, differentiation is considered by highlighting disparities in health vulnerability and the capacity of social groups to protect their health. This is illustrated by reference to the securitisation of health and the health consequences of violent conflict and the special vulnerabilities of children and of women. Third, the influence of interconnectedness of various national healthcare systems and implications for the delivery of effective healthcare are considered.


Schwärzepilze


title: Elektronenmikroskopie in der Erregerdiagnostik

text: Visualisierung als diagnostisches Prinzip Mit der Studie „Die Ätiologie der Milzbrand-Krankheit, begründet auf die Entwicklungsgeschichte des Bacillus Anthracis“ legte Robert Koch (1843–1910) 1876 das Fundament der wissenschaftlichen Infektiologie. Unter Anwendung der später als Koch’sche Postulate bezeichneten experimentellen Strategie beschrieben er und seine Schüler in kurzer Folge Bakterien als die Erreger einer Reihe gefürchteter Seuchen (Tuberkulose 1882; Diphtherie Loeffler, 1883; Cholera 1884; Typhus Gaflky, 1884; Tetanus Kitasato, 1889). Die Ätiologie einer Infektion galt als gesichert, wenn ein morphologisch, durch Form und Anfärbbarkeit definierter Keim (1.) konstant im erkrankten Gewebe nachgewiesen wurde, (2.) wenn er in Reinkultur isoliert werden konnte, und wenn (3.), das Isolat im Versuchstier die ursprüngliche Krankheit wieder auslöste. Wesentliche Voraussetzung zur Begründung der ätiologischen Rolle von Bakterien war die Einführung von Nährböden für ihre Anzucht und Isolierung — kombiniert mit einer sehr fortschrittlichen, über Ölimmersion, Mikrophotographie und Temperierkammer verfügenden Lichtmikroskopie und dem Einsatz von Laboratoriumstieren.


title: PIRO: The Key to Success?

text: Sepsis continues to represent a major problem in intensive care units worldwide. Diagnosis and management are often complex due in part to the remarkably diverse nature of the septic patient. Indeed, sepsis can range in severity from mild systemic inflammation of little clinical importance through to a widespread severe inflammatory response with multiple organ failure and a mortality rate in excess of 50%. Sepsis can affect individuals of any age group, with no or multiple co-morbidities, and with many different ongoing diagnoses. It can occur as the result of infection by one or more of a multitude of microbial pathogens impacting on any of numerous different sites within the body. Given the huge complexity of sepsis and the diverse populations of patients it affects, simple definitions are of relatively little use and a more detailed framework which can be used to better characterize patients with sepsis has been proposed, much as the TNM classification (tumor size, nodal spread, metastases) has been successfully used in clinical oncology. In this chapter, we discuss the development of this PIRO system, and suggest how it may be used in the future to aid diagnosis, guide therapy, and improve prognostication.


title: Selected Disorders of the Respiratory System

text: Respiration and gas exchange require coordination between the chest wall, lungs, central nervous system, and pulmonary circulation. A disruption within any one of these systems or a change in the relationship between systems can result in impairments of ventilation, perfusion, or gas exchange. These disruptions can result in debilitating acute and chronic respiratory disorders. This chapter discusses the etiology, epidemiology, clinical presentation, diagnostic criteria, management, and notable public health implications of respiratory system disorders not addressed in prior chapters. Topic areas covered include acute respiratory distress syndrome (ARDS), pulmonary hypertension, pneumothorax, pleural effusion, interstitial lung disease, bronchiectasis, atelectasis, and pulmonary sarcoidosis.


The Role of Autoimmunity in Multiple Sclerosis


title: Virologie

text: Noch im 20. Jahrhundert verstarben mehr als 300 Millionen Menschen an den Pocken. Nach dem ersten Weltkrieg tötete die Spanische grippe viele Millionen Menschen. Und heute? Heute müssen sich die FachärztInnen für Virologie neuen Herausforderungen stellen, wie etwa HIV, SARS oder der Vogelgrippe. Denn es treten immer neue Viren in Erscheinung - und deren Erforschung und Bekämpfung steht im Mittelpunkt der Arbeit der VirologInnen.


title: Distribution of present-day biodiversity

text: Biodiversity is unevenly distributed across the planet. A range of factors contribute to this distribution, including the global climatic gradient, the current and historical distribution of land masses, and geographical barriers, such as mountains.


title: Inflammatory Bowel Disease at the Intersection of Autophagy and Immunity: Insights from Human Genetics

text: Studies using human genetics have identified more than 160 loci that affect the risk of developing inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). Several of these genes have been found to play key roles in the process of autophagy, a lysosome-based degradation pathway. Although historically considered to be a relatively nonselective process of degradation of cytosolic contents, autophagy has recently been revealed to have several selective and immune-specific functions that are relevant to the maintenance of intestinal homeostasis, including xenophagy, mitophagy, antigen presentation, secretion, and inflammasome regulation. In this chapter, we review the evidence that links autophagy-related genes, their immune-specific functions, and possible mechanisms of IBD pathogenesis. We summarize the basic molecular events underlying general and selective autophagy and present evidence suggesting possible pathogenic mechanisms revealed by studies of IBD-associated risk alleles of ATG16L1 and IRGM. Finally, we review chemical biology-based experimental approaches for identifying autophagy regulatory pathways that may have implications for the development of therapeutics.


title: Algorithm Combination for Improved Performance in Biosurveillance: Univariate Monitoring

text: This chapter proposes an enhancement to currently used algorithms for monitoring daily counts of pre-diagnostic data. Rather than use a single algorithm or apply multiple algorithms simultaneously, our approach is based on ensembles of algorithms. The ensembles lead to better performance in terms of higher true alert rates for a given false alert rate. Combinations can be employed at the data preprocessing step and/or at the monitoring step. We discuss the advantages of such an approach and illustrate its usefulness using authentic modern biosurveillance data.


title: Nutrition Monitoring in the PICU

text: The ideal set of variables for nutritional monitoring that may correlate with patient outcomes has not been identified. This is particularly difficult in the PICU patient because many of the standard modes of nutritional monitoring, although well described and available, are fraught with difficulties. Thus, repeated anthropometric and laboratory markers must be jointly analyzed but individually interpreted according to disease and metabolic changes, in order to modify and monitor the nutritional treatment. In addition, isotope techniques are neither clinically feasible nor compatible with the multiple measurements needed to follow progression. On the other hand, indirect alternatives exist but may have pitfalls, of which the clinician must be aware. Risks exist for both overfeeding and underfeeding of PICU patients so that an accurate monitoring of energy expenditure, using targeted indirect calorimetry, is necessary to avoid either extreme. This is very important, since the monitoring of the nutritional status of the critically ill child serves as a guide to early and effective nutritional intervention.


title: Basic Mechanisms Mediating Cardiomyopathy and Heart Failure in Aging

text: Biological aging represents the major risk factor for the development of heart failure (HF), malignancies, and neurodegenerative diseases. While risk factors such as lifestyle patterns, genetic traits, blood lipid levels, and diabetes can contribute to its development, advancing age remains the most determinant predictor of cardiac disease. Several parameters of left ventricular function may be affected with aging, including increased duration of systole, decreased sympathetic stimulation, and increased left ventricle ejection time, while compliance decreases. In addition, changes in cardiac phenotype with diastolic dysfunction, reduced contractility, left ventricular hypertrophy, and HF, all increase in incidence with age. Given the limited capacity that the heart has for regeneration, reversing or slowing the progression of these abnormalities poses a major challenge. In this chapter, we present a discussion on the molecular and cellular mechanisms involved in the pathogenesis of cardiomyopathies and HF in aging and the potential involvement of specific genes identified as primary mediators of these diseases.


title: Transportation of Patients in a Bioemergency

text: Serious recurrent and emerging communicable diseases, such as novel influenza strains, highly pathogenic viral hemorrhagic fevers, and novel coronaviruses in an era of increased globalization and travel, necessitate heightened vigilance and preparedness. Last year over four billion persons traveled by air. Systems and processes need to be in place to not just recognize and treat individuals, who harbor a serious pathogen, but also to manage and transport them safely while minimizing the risk of transmission to healthcare workers and others in the community. In this chapter, environmental and administrative controls, work practices, and personal protective equipment necessary to prevent transmission are described for the management and transportation of patients in both the out-of-hospital and hospital settings.


title: Diversity of Coronavirus Spikes: Relationship to Pathogen Entry and Dissemination

text: Coronaviruses are widespread in the environment, infecting humans, domesticated and wild mammals, and birds. Infections cause a variety of diseases including bronchitis, gastroenteritis, hepatitis, and encephalitis, with symptoms ranging from being nearly undetectable to rapidly fatal. A combination of interacting variables determine the pattern and severity of coronavirus-induced disease, including the infecting virus strain, its transmission strategy, and the age and immune status of the infected host. Coronavirus pathogenesis is best understood by discerning how each of these variables dictates clinical outcomes. This chapter focuses on variabilities amongst the spike (S) proteins of infecting virus strains. Diversity of coronavirus surface proteins likely contributes to epidemic disease, an important and timely topic given the recent emergence of the human SARS coronavirus.


title: Surface Nano-patterning of Polymers for Mass-Sensitive Biodetection

text: The crafting of sensor material of desired features has always remained a challenging task in the field of material designing and predominantly becomes more interesting when analyte belongs to biospecies. Label-free detection of different bioanalytes such as enzymes, viruses, microorganisms, and blood groups through mass-sensitive transducers has gained considerable importance in the development of modern biosensors. Analyte molecules interact with the surface of sensitive layer coated on these devices and as a result of this interaction, the frequency change is determined, which provides quantitative information about the mass of analyte. One of the most vital elements of these detection systems is to design selective sensor coatings through control surface structuring at nanoscale. Molecular imprinting has proven to be a highly suitable technique to generate selective surfaces that are capable of detecting different analytes, quantitatively and qualitatively as well. The tailor-made synthetic antibody cavities are rigid and stable, which are not immediately collapsed upon analyte interaction; moreover, the different bioanalytes do not undergo any phase change and maintain their original identity during analysis. This chapter will discuss the contribution of imprinting methods to design optimized surfaces for mass-sensitive detection of diverse biological species.


title: Disaster Preparedness and Social Capital

text: The first decade of the 21st century has pushed the field of disaster preparedness to the forefront of public health. In a few short years, the world has witnessed the far–ranging ramifications of 9/11 and anthrax (2001), SARS (2003), the Indian Ocean tsunami (2004), Hurricane Katrina (2005) and the looming threat of pandemic influenza. Societies everywhere are responding to these developments with new policies that commit added resources for protection against future disasters.


title: Monitoring Immune Dysfunction in Septic Patients: Toward Tailored Immunotherapy

text: Septic syndromes represent a major although largely under-recognized healthcare problem worldwide accounting for thousands of deaths every year [1–3]. Mortality remains high ranging from 20 % for sepsis to over 50 % for septic shock despite almost 20 years of anti-inflammatory clinical trials [1–3]. The inability of these therapies to mitigate the devastating effects of this condition indicates that the initial hypotheses for sepsis pathophysiology may have been misconstrued or inadequately addressed. Two major explanations have been proposed: 1) Septic patients have mainly been treated as a group despite the extreme heterogeneity characterizing this population [1]; 2) The postulate that death after sepsis is solely due to an overwhelming pro-inflammatory immune response may actually be inaccurate [1, 3]. Indeed, several lines of evidence have now established that death from septic shock is probably due to the effect of distinct mechanisms over time [1–3]. Early in the course of the disease, a massive release of inflammatory mediators (normally designed to trigger an immune response against pathogens) is occurring that may be responsible for organ dysfunction and hypoperfusion [1, 3]. Concomitantly, the body develops compensatory mechanisms to prevent overwhelming inflammation and dampen an overzealous anti-infectious response [1–3]. These negative feedback mechanisms, although having protective effects during the first initial hours, may paradoxically become deleterious as they persist over time leading to immune paralysis (Fig. 1) [1, 3]. Indeed, considerable clinical and experimental evidence indicates that patients rapidly present with numerous compromised immune functions [1, 3].


title: Studying Future Disasters and Crises: A Heuristic Approach

text: Over time, new types of crises and disasters have emerged. We argue that new types of adversity will continue to emerge. In this chapter, we offer a framework to study and interpret new forms of crises and disasters. This framework is informed by historical insights on societal interpretations of crises and disasters. We are particularly focused here on the rise of transboundary crises – those crises that traverse boundaries between countries and policy systems. We identify the characteristics of these transboundary disruptions, sketch a few scenarios and explore the societal vulnerabilities to this type of threat. We end by discussing some possible implications for planning and preparation practices.


title: Feline Coronavirus RT-PCR Assays for Feline Infectious Peritonitis Diagnosis

text: Feline infectious peritonitis (FIP) is a highly fatal systemic disease in cats, caused by feline coronavirus (FCoV) infection. FCoV usually has little clinical significance; however, a mutation of this avirulent virus (feline enteric coronavirus) to a virulent type (FIP virus) can lead to FIP incidence. It is difficult to diagnose FIP, since the viruses cannot be distinguished using serological or virological methods. Recently, genetic techniques, such as RT-PCR, have been conducted for FIP diagnosis. In this chapter, the reliability of RT-PCR and procedures used to determine FCoV infection as part of antemortem FIP diagnosis is described.


title: Current and Future Novel Targets of Gene Therapy for Hypertension

text: Traditional therapeutic approaches for the treatment and control of hypertension are effective in normalizing blood pressure (BP) in less than a third of patients with hypertension. These pharmacological approaches may have reached a plateau in their effectiveness and newer strategies need to be investigated to not only increase the number of patients achieving BP control, but to find ways to cure the disease instead of just manage it. Since completion of the Human Genome Project and the continuous advancement of gene delivery systems, it is now possible to investigate genetic means for the treatment and possible cure for hypertension. In this review, we discuss potential genetic targeting for treatment of hypertension. There are two generalized gene transfer approaches that have been used successfully for hypertension. One is an induction approach where genes that lower blood pressure are overexpressed. A second method is a reduction approach where products of genes that are known to increase blood pressure are decreased. There are a variety of methods that have been utilized to meet these objectives, such as “knockout” and “ knock-in” animal models, and the use of sense and antisense (AS) technology. This review will focus on the sense and antisense applications, and how this technique is becoming more refined and precise through the targeting of specific tissues, the regulation and induction of components of the system, and use of other newer technologies, such as short interfering RNA (siRNA). Our lab has generally focused on the reduction approach, specifically in the genetic manipulation of components of the renin-angiotensin system (RAS). This system not only modulates BP, but has also been implicated in cardiac hypertrophy and morphology and in insulin resistance, which is highly correlated with hypertension. We will also discuss how new genes can be identified and subsequently serve as targets for the treatment of human hypertension.


title: Large-Scale Phylogenetic Analysis of Emerging Infectious Diseases

text: Microorganisms that cause infectious diseases present critical issues of national security, public health, and economic welfare. For example, in recent years, highly pathogenic strains of avian influenza have emerged in Asia, spread through Eastern Europe, and threaten to become pandemic. As demonstrated by the coordinated response to Severe Acute Respiratory Syndrome (SARS) and influenza, agents of infectious disease are being addressed via large-scale genomic sequencing. The goal of genomic sequencing projects are to rapidly put large amounts of data in the public domain to accelerate research on disease surveillance, treatment, and prevention. However, our ability to derive information from large comparative genomic datasets lags far behind acquisition. Here we review the computational challenges of comparative genomic analyses, specifically sequence alignment and reconstruction of phylogenetic trees. We present novel analytical results on two important infectious diseases, Severe Acute Respiratory Syndrome (SARS) and influenza. SARS and influenza have similarities and important differences both as biological and comparative genomic analysis problems. Influenza viruses (Orthymxyoviridae) are RNA based. Current evidence indicates that influenza viruses originate in aquatic birds from wild populations. Influenza has been studied for decades via well-coordinated international efforts. These efforts center on surveillance via antibody characterization of the hemagglutinin (HA) and neuraminidase (N) proteins of the circulating strains to inform vaccine design. However, we still do not have a clear understanding of (1) various transmission pathways such as the role of intermediate hosts like swine and domestic birds and (2) the key mutation and genomic recombination events that underlie periodic pandemics of influenza. In the past 30 years, sequence data from HA and N loci has become an important data type. In the past year, full genomic data has become prominent. These data present exciting opportunities to address unanswered questions in influenza pandemics. SARS is caused by a previously unrecognized lineage of coronavirus, SARS-CoV, which like influenza has an RNA based genome. Although SARS-CoV is widely believed to have originated in animals, there remains disagreement over the candidate animal source that lead to the original outbreak of SARS. In contrast to the long history of the study of influenza, SARS was only recognized in late 2002 and the virus that causes SARS has been documented primarily by genomic sequencing. In the past, most studies of influenza were performed on a limited number of isolates and genes suited to a particular problem. Major goals in science today are to understand emerging diseases in broad geographic, environmental, societal, biological, and genomic contexts. Synthesizing diverse information brought together by various researchers is important to find out what can be done to prevent future outbreaks [JON03]. Thus comprehensive means to organize and analyze large amounts of diverse information are critical. For example, the relationships of isolates and patterns of genomic change observed in large datasets might not be consistent with hypotheses formed on partial data. Moreover when researchers rely on partial datasets, they restrict the range of possible discoveries. Phylogenetics is well suited to the complex task of understanding emerging infectious disease. Phylogenetic analyses can test many hypotheses by comparing diverse isolates collected from various hosts, environments, and points in time and organizing these data into various evolutionary scenarios. The products of a phylogenetic analysis are a graphical tree of ancestor–descendent relationships and an inferred summary of mutations, recombination events, host shifts, geographic, and temporal spread of the viruses. However, this synthesis comes at a price. The cost of computation of phylogenetic analysis expands combinatorially as the number of isolates considered increases. Thus, large datasets like those currently produced are commonly considered intractable. We address this problem with synergistic development of heuristics tree search strategies and parallel computing.


title: Role of Heat Shock Proteins in Viral Infection

text: One of the most intriguing and less known aspects of the interaction between viruses and their host is the impact of the viral infection on the heat shock response (HSR). While both a positive and a negative role of different heat shock proteins (HSP) in the control of virus replication has been hypothesized, HSP function during the virus replication cycle is still not well understood. This chapter describes different aspects of the interactions between viruses and heat shock proteins during infection of mammalian cells: the first part focuses on the modulation of the heat shock response by human viral pathogens; the second describes the interactions of HSP and other chaperones with viral components, and their function during different steps of the virus replication cycle; the last part summarizes our knowledge on the effect of hyperthermia and HSR modulators on virus replication.


title: Eosinophilic Pneumonia

text: Eosinophilic pneumonia may manifest as chronic or transient infiltrates with mild symptoms, chronic idiopathic eosinophilic pneumonia, or the frequently severe acute eosinophilic pneumonia that may be secondary to a variety of causes (drug intake, new onset of tobacco smoking, infection) and that may necessitate mechanical ventilation. When present, blood eosinophilia greater than 1 × 10(9) eosinophils/L (and preferably greater than 1.5 × 10(9)/L) is of considerable help for suggesting the diagnosis, however it may be absent, as in the early phase of idiopathic acute eosinophilic pneumonia or when patients are already taking corticosteroids. On bronchoalveolar lavage, high eosinophilia (>25 %, and preferably >40 % of differential cell count) is considered diagnostic of eosinophilic pneumonia in a compatible setting, obviating the need of video-assisted thoracic surgical lung biopsy, which is now performed only on very rare occasions with inconsistency between clinical, biological, and imaging features. Inquiry as to drug intake must be meticulous (www.pneumotox.com) and any suspected drug should be withdrawn. Laboratory investigations for parasitic causes must take into account the travel history or residence and the epidemiology of parasites. In patients with associated extrathoracic manifestations, the diagnosis of eosinophilic granulomatosis with polyangiitis or of the hypereosinophilic syndromes should be raised. Presence of airflow obstruction can be found in hypereosinophilic asthma, allergic bronchopulmonary aspergillosis, idiopathic chronic eosinophilic pneumonia, eosinophilic granulomatosis with polyangiitis, or in the recently identified syndrome of hyperosinophilic obliterative bronchiolitis. Corticosteroids remain the cornerstone of symptomatic treatment for eosinophilic pneumonias, with a generally dramatic response. Relapses are common when tapering the doses or after stopping treatment especially in idiopathic chronic eosinophilic pneumonia. Cyclophosphamide is necessary only in patients with eosinophilic granulomatosis with polyangiitis and poor-prognostic factors. Imatinib is very effective in the treatment of the myeloproliferative variant of hypereosinophilic syndromes. Anti-interleukin-5 monoclonal antibodies are promising in the spectrum of eosinophilic disorders.


title: Application of MultiBac System to Large Complexes

text: Multisubunit protein complexes regulate numerous biologically important processes. Elucidation of their functional mechanisms based on their three-dimensional structures allows us to understand biological events at the molecular level. Crystallography and electron microscopy are powerful tools for analyzing the structures of biological macromolecules. However, both techniques require large-scale preparation of pure and structurally homogenous samples, which is usually challenging for large multisubunit complexes, particularly from eukaryotes. In this chapter, we describe the principles and methods of producing multisubunit complexes in insect cells using the MultiBac system.


title: Single Sign-on(SSO) to Cloud based Services and Legacy Applications “Hitting the IAM wall”

text: Single Sign-On (SSO) projects are a special case of Identity and Access Management (IAM) projects. They are usually undertaken with the aim of increasing the user friendliness of Corporate IT systems’ user log-on processes. This should result in abolishing the use of multiple username and password combinations the user has to remember and change at different intervals. The SSO aim should be achieved without jeopardizing information security in any way. Increasing user convenience in such a manner will increase user satisfaction with the IT department along with general productivity levels. Cost control related to IT help desks resetting forgotten passwords should follow. SSO can also help organizations address information security compliance requirements, through the central logging (and audit facilities) of all access attempts and authorization decisions granted in relation to the organization’s restricted information resources. Sometimes compliance objectives are in fact the major business driver for SSO. In the consumer space customer loyalty and retention rates are often cited as an important commercial driver for SSO projects. With the advent of the de-perimeterized organization and increased scepticism around ‘Cloud Security’ is SSO still a viable worthwhile goal for organisations? This paper takes a closer look at special security issues arising when an organization attempts to create an Enterprise Single Sign-On (ESSO) solution that includes both legacy applications hosted within traditional organizational firewalls and a new breed of ‘Cloud Based’ solutions that are following the Software as Service (SaaS) model and therefore can be hosted with any number of Service Providers (SP) ‘in the cloud’.


title: Evaluating Tests in Medical Diagnosis: Combining Machine Learning with Game-Theoretical Concepts

text: In medical diagnosis, information about the health state of a patient can often be obtained through different tests, which may perhaps be combined into an overall decision rule. Practically, this leads to several important questions. For example, which test or which subset of tests should be selected, taking into account the effectiveness of individual tests, synergies and redundancies between them, as well as their cost. How to produce an optimal decision rule on the basis of the data given, which typically consists of test results for patients with or without confirmed health condition. To address questions of this kind, we develop an approach that combines (semi-supervised) machine learning methodology with concepts from (cooperative) game theory. Roughly speaking, while the former is responsible for optimally combining single tests into decision rules, the latter is used to judge the influence and importance of individual tests as well as the interaction between them. Our approach is motivated and illustrated by a concrete case study in veterinary medicine, namely the diagnosis of a disease in cats called feline infectious peritonitis.


title: Use of MAR Elements to Increase the Production of Recombinant Proteins

text: The biopharmaceutical industry continues to face the challenge of producing large amount of recombinant proteins for use as therapeutics, and eighty percent of protein therapeutics in clinical development are produced in mammalian cell systems. Approaches to increase production addressing growth conditions, such as the improvement of media composition and process control, or transcription of the recombinant gene via the use of strong promoters/enhancers and amplification of gene copy number, have increased the yields obtained from mammalian cells considerably over the past decades. However these processes remain laborious, and extensive screening of clones is often required, as stable cell line and/or protein production is not always obtained. Unstable or variable expression is linked to the location of transgene integration site, the regulation of gene expression, the silencing of genes, and the loss of gene copies. Genetic elements that may remodel chromatin to maintain the transgene in an active configuration are now being employed increasingly to improve protein production using mammalian cells. Here we will review how one type of such elements, the MARs, may increase transgene integration into the cell genome and decrease silencing effects to reduce expression variability. We also illustrate how inclusion of these elements in expression vectors leads to increased specific productivities ranging from 20 to 100 picograms per cell and per day (p/c/d), resulting in protein titers above 5 g/l.


title: Innate Immune Responses in Ventilator-Associated Pneumonia

text: Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation, resulting in substantial morbidity, mortality, and health care cost. Early upper airway colonization by pathogenic bacteria and microaspiration are the primary pathogenic events leading to VAP. Patients at risk for VAP have defects in structural/mechanical defenses of the respiratory tract. In addition, critical illness, including sepsis, trauma, and postoperative states, is associated with profound defects in both innate and acquired antibacterial immunity, influencing antimicrobial effector functions of both leukocytes and structural/parenchymal cells. Factors present within the lung microenvironment, including alveolar stretch, cyclical atelectasis, changes in oxygen tension, and respiratory tract microbiota, substantially impact antibacterial host responses. Mechanisms accounting for dysregulated immune homeostasis are incompletely understood, but likely involve: (1) alterations in the balance of pro- and anti-inflammatory cytokines; (2) changes in pathogen recognition receptor and G-protein coupled receptor expression and downstream signaling cascades; and (3) dysregulated cell death responses. Antibiotics and preventive strategies are the mainstay of therapy in patients with VAP. However, novel approaches are needed to reverse immunological reprogramming that occurs during critical illness and/or mechanical ventilation, and to identify patients who are most likely to benefit from immunomodulatory therapy.


title: Nonhuman Primate Models of Immunosenescence

text: Due to a dramatic increase in life expectancy, the number of individuals aged 65 and older is rapidly rising. This presents considerable challenges to our health care system since advanced age is associated with a higher susceptibility to infectious diseases due to immune senescence. However, the mechanisms underlying age-associated dysregulated immunity are still incompletely understood. Advancement in our comprehension of mechanisms of immune senescence and development of interventions to improve health span requires animal models that closely recapitulate the physiological changes that occur with aging in humans. Nonhuman primates (NHPs) are invaluable preclinical models to study the underlying causal mechanism of pathogenesis due to their outbred nature, high degree of genetic and physiological similarity to humans, and their susceptibility to human pathogens. In this chapter, we review NHP models available for biogerontology research, advantages and challenges they present, and advances they facilitated. Furthermore, we emphasize the utility of NHPs in characterizing immune senescence, evaluating interventions to reverse aging of the immune system, and development of vaccine strategies that are better suited for this vulnerable population.


title: Real-Time Reverse Transcription Polymerase Chain Reaction for Rapid Detection of Transmissible Gastroenteritis Virus

text: Transmissible gastroenteritis (TGE) is a highly contagious disease of pigs caused by the TGE virus (TGEV). Rapid detection of the virus in the affected pigs’ feces is critical for controlling the disease outbreaks. The real-time RT-PCR assay described in this chapter can quickly detect the presence of TGEV in fecal samples with high sensitivity and specificity.


title: Paramyxoviruses: Respiratory Syncytial Virus and Human Metapneumovirus

text: Human respiratory syncytial virus (RSV) and human metapneumovirus (MPV) are members of the family Paramyxoviridae of the Mononegavirales order, comprising the nonsegmented negative-strand RNA viruses. Paramyxoviridae has two subfamilies: Paramyxovirinae, which includes the parainfluenza viruses 1–4 and measles and mumps viruses, and Pneumovirinae, which includes RSV and MPV. Pneumovirinae has two genera: Pneumovirus, which includes human RSV, bovine respiratory syncytial virus, and pneumonia virus of mice, and Metapneumovirus, which includes human MPV and avian metapneumovirus, sometimes called avian pneumovirus.


title: Intelligence Tasking and Coordination

text: This chapter explains the complexities involved in understanding how intelligence is tasked or coordinated by decision-makers in the bio-threat and risk context. It argues that compared to other threat and risk categories (conventional terrorism, cyber and high volume crime), the political leadership of most ‘Five Eyes’ countries do not see bio-threats and risks as high intelligence priorities. This impacts on the intelligence communities in a number of ways that are not helpful to gaining greater understanding of these issues. Nonetheless, the chapter argues that the intelligence communities themselves can play a more proactive role to improve tasking and coordination of bio-threat and risk intelligence.


title: Return to Play in Asthma and Pulmonary Conditions

text: In football (soccer), an athlete’s cardiopulmonary system consistently operates in a sinusoidal manner with numerous episodes of low- and high-intensity surges. This demand requires an athlete to have the most ideal function to perform at a high level. Multiple pulmonary processes can influence an athlete’s ability to perform by interfering with the pulmonary system’s primary function of ventilation and perfusion to try to optimize gas exchange. In this chapter, we will discuss some of the more common pathology that can affect this delicate balance. Some of the more common, but important, conditions such as asthma, exercise-induced bronchoconstriction (EIB), pneumothorax, and pulmonary infections will be addressed, as each are readily seen, by sports medicine teams, caring for the football players. The discussion will begin with how those conditions are diagnosed through history and advanced testing and will be followed by treatment with environmental trigger modification, pharmacologic interventions, and lastly return to play criteria.


Workplace Health Promotion Interventions ConcerningWomenWorkers' Occupational Hazards


title: Production of Antibody Fab Fragments in Escherichia coli

text: A phage-display library is the most broadly used platform for preparation of recombinant human monoclonal antibody Fab fragments. Panning is effective for the selection of immunoglobulin genes from naïve and immune libraries. However, it is possible to bypass the phage display system if human peripheral lymphocytes are obtained from seropositive patients with infectious diseases as a source of immunoglobulin genes. Direct screening of bacterial colonies producing Fab fragments by colony blotting using filter membranes is practical for the isolation of human Fab fragments to major antigens of pathogens. An oligoclonal culture can also be used, and is a partial application of Epstein-Barr virus transformation of peripheral lymphocytes. Using these procedures, neutralizing antibody Fab fragments to various antigens can be obtained with a sufficient level of cloning efficacy. Chain shuffling and site-directed mutagenesis are also useful ways to improve the quality of the cloned antibody Fab fragments.


title: Liver

text: The discovery that renin–angiotensin system (RAS) components are locally expressed in the liver tissue, pointed out to a role for this system in the pathogenesis of hepatic fibrosis and cirrhosis. The RAS counter-regulatory axis composed by the angiotensin converting enzyme 2 (ACE2), angiotensin-(1-7) [Ang-(1-7)] and Mas receptor mediates pro-inflammatory, pro-thrombotic, and pro-fibrotic processes, frequently opposing the classical RAS arm (ACE-Ang II-AT(1) receptor) actions. Therefore, the balance between both RAS axes most likely affects the clinical and histopathological expression of liver diseases. It is worth noticing that liver diseases are major causes of morbidity and mortality worldwide. Without proper treatment, all types of chronic hepatitis will progress to end-stage liver diseases, including cirrhosis, liver failure, and hepatocellular carcinoma, which ultimately lead to death. In this context, to better comprehend the role of RAS components in liver failure might pave the way for the search of potential predictive biomarkers as well as the development of novel therapeutic approaches. Valuable data have been generated from preclinical and clinical studies. Herein, we summarize the current evidence, mainly focusing in the ACE2-Ang-(1-7)-Mas receptor arm, regarding the role of RAS in liver diseases. The therapeutic potential of the modulation of RAS molecules in liver diseases is also discussed.


title: Healthcare-Associated Viral Infections: Considerations for Nosocomial Transmission and Infection Control

text: Nosocomial and healthcare-associated viral infections are major contributors to patient morbidity and mortality, prolonged hospitalization, and increased healthcare costs in all pediatric age groups. Healthcare workers are also at risk of acquiring nosocomial viral infections, affecting their own health, as well as facilitating spread of the infection to other patients, their family, and the community. Healthcare-associated viral infections may occur in a variety of healthcare settings, including clinics, emergency centers, urgent care centers, procedure suites, operating rooms, hospital wards, nurseries, and intensive care units. In addition, non-patient care areas, such as the cafeteria, waiting areas, and playrooms may also be a source of viral infections that can spread in the healthcare setting. These infections may be device-related or transmitted via blood products or organ donation and respiratory droplets, through food including human milk, person to person, or via air ducts, fomites, and surfaces. They most commonly involve the respiratory and gastrointestinal tracts; however, all organ systems may potentially be involved. Both DNA and RNA viruses, either common or exotic, may contribute to healthcare-associated viral infections. Advances in molecular viral diagnostics have enabled rapid detection and routine surveillance for viral infections and now allow early identification of viruses. Prompt identification allows timely containment measures to minimize transmission to other patients or healthcare workers and avoids hospital, community, and global outbreaks.


title: Antiviral Activity of Phytochemicals: A Current Perspective

text: A wide variety of active phytochemicals have been found to have therapeutic applications against genetically and functionally diverse viruses. The antiviral mechanism of these agents may be explained on the basis of their antioxidant activities, scavenging capacities, the inhibition of DNA, RNA synthesis, or the blocking of viral reproduction, etc. Numerous epidemiological and experimental studies have revealed that a large number of phytochemicals have promising antiviral activities. Especially in the last decade, a number of promising leads have been identified by a combination of in vitro and in vivo studies using diverse biological assays.


title: Learning Nature of Science Through Socioscientific Issues

text: A series of reforms in science education in Hong Kong started at the turn of the twenty-first century. In line with international trends, science education in Hong Kong has undergone considerable changes in the last decade since the implementation of the revised junior secondary science curriculum (grades 7–9) (Curriculum Development Council [CDC], 1998). The new curriculum encourages teachers to conduct scientific investigations in their classes, advocates scientific investigation as a desired means of learning scientific knowledge, and highlights the development of inquiry practices and generic skills such as collaboration and communication. Most importantly, it was the first local science curriculum that embraced understanding of nature of science (NOS), for example, being “able to appreciate and understand the evolutionary nature of scientific knowledge” (CDC, 1998, p. 3) was stated as one of its broad curriculum aims. In the first topic, “What is science?”, teachers are expected to discuss with students some features about science, for example, its scope and limitations, some typical features about scientific investigations, for example, fair testing, control of variables, predictions, hypothesis, inferences, and conclusions. Such an emphasis on NOS was further supported in the revised secondary 4 and 5 (grade 10 and 11) physics, chemistry, and biology curricula (CDC, 2002). Scientific investigation continued to be an important component while the scope of NOS was slightly extended to include recognition of the usefulness and limitations of science as well as the interactions between science, technology, and society (STS).


title: Acute Respiratory Failure Before ICU Admission: A Practical Approach

text: Acute respiratory failure (ARF) is a common and life-threatening event in cancer patients. It is the leading cause of admission to ICU among the patients with hematologic and solid malignancies and is often associated with poor outcome. Timely identification of the cause of ARF and the initiation of the appropriate therapy may improve the survival. Pulmonary infections represent the leading cause of ARF in those patients, and unless proven otherwise, ARF must be considered as an infectious emergency. Noninfectious causes of ARF include cardiogenic and noncardiogenic pulmonary edema, acute pulmonary embolism, and complications related both to the underlying malignancy and the toxic effects of chemotherapy. This chapter reviews the most common causes of ARF in oncologic patients and discusses the diagnostic and therapeutic approach before ICU admission.


Part I Dictionary


title: Pro-resolution of Inflammation: New Hints to Manage Sepsis?

text: Sepsis is newly defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The pathophysiological mechanism of sepsis is highly complex, and the mortality of in-patients suffering from sepsis is more than 10%. Severe unmanaged inflammation and inappropriate immune response characterize sepsis. Anti-inflammation therapies alone are not successful for the reason that disbalance of anti-inflammatory and pro-resolving agents. In the recent researches, the host responses during the course of self-resolving infections are found to have the involvements of specialized pro-resolution mediators (SPMs), namely, lipoxins, resolvins, protectins and maresins. These endogenous lipid metabolites are core signal molecules in the resolution of inflammation, playing a key role in regulating the inflammation and promoting return to homeostasis. Besides, heme oxygenase-1 (HO-1, a sensitive marker for oxidative stress) is also known for upregulation in inflammation profiling. Carbon monoxide, synthesized by HO-1, performs multiple stances of anti-inflammation and pro-resolution along with the SPMs. If the potentially beneficial effects of these mediators would be well evaluated in clinical trials, they present encouraging new hints in managing infectious maladies especially sepsis.


title: On Sci-Fi’s Good China, Bad China: Maureen F. McHugh and Chang-Rae Lee

text: In this chapter, “On Sci-Fi’s Good China, Bad China,” examines China Mountain Zhang (1992) and On Such a Full Sea (2014). In both works, the universal duality of “good cop, bad cop,” utopia and dystopia, sinophilia and sinophobia, is attributed to the rise of China as the world power and the scourge of the world. In Maureen F. McHugh’s and Chang-rae Lee’s sci-fi novels, they trade the police badge of justice and violence for the Chinese face—a countenance of beauty and bastardy, awesome “China Mountain” that somehow infects with the suggestive C-illness in Lee.


title: Neutral Evolution

text: Neutral evolution is the default process of genomic changes. This is because our world is finite, and the randomness, indispensable for neutral evolution, is important when we consider the history of a finite world. The random nature of DNA propagation is discussed using branching process, coalescent process, Markov process, and diffusion process. Expected evolutionary patterns under neutrality are then discussed on fixation probability, rate of evolution, and amount of DNA variation kept in population. We then discuss various features of neutral evolution starting from evolutionary rates, synonymous and nonsynonymous substitutions, junk DNA, and pseudogenes.


title: Prediction of Transmembrane Proteins from Their Primary Sequence by Support Vector Machine Approach

text: Prediction of transmembrane (TM) proteins from their sequence facilitates functional study of genomes and the search of potential membrane-associated therapeutic targets. Computational methods for predicting TM sequences have been developed. These methods achieve high prediction accuracy for many TM proteins but some of these methods are less effective for specific class of TM proteins. Moreover, their performance has been tested by using a relatively small set of TM and non-membrane (NM) proteins. Thus it is useful to evaluate TM protein prediction methods by using a more diverse set of proteins and by testing their performance on specific classes of TM proteins. This work extensively evaluated the capability of support vector machine (SVM) classification systems for the prediction of TM proteins and those of several TM classes. These SVM systems were trained and tested by using 14962 TM and 12168 NM proteins from Pfam protein families. An independent set of 3389 TM and 6063 NM proteins from curated Pfam families were used to further evaluate the performance of these SVM systems. 90.1% and 86.7% of TM and NM proteins were correctly predicted respectively, which are comparable to those from other studies. The prediction accuracies for proteins of specific TM classes are 95.6%, 90.0%, 92.7% and 73.9% for G-protein coupled receptors, envelope proteins, outer membrane proteins, and transporters/channels respectively; and 98.1%, 99.5%, 86.4%, and 98.6% for non-G-protein coupled receptors, non-envelope proteins, non-outer membrane proteins, and non-transporters/non-channels respectively. Tested by using a significantly larger number and more diverse range of proteins than in previous studies, SVM systems appear to be capable of prediction of TM proteins and proteins of specific TM classes at accuracies comparable to those from previous studies. Our SVM systems – SVMProt, can be accessed at http://jing.cz3.nus.edu.sg/cgi-bin/svmprot.cgi.


title: Asthma and COPD

text: Asthma and chronic obstructive pulmonary disease (COPD) are clinically important in older adults because like heart failure, they are common causes of chronic shortness of breath, which reduces the quality of life by limiting an individual’s activity. In developed countries, about 4% of older adults have been diagnosed with asthma and another 4% have been diagnosed with COPD, but the prevalence is doubled for each of these chronic respiratory diseases when objective tests are performed. COPD has become the fourth leading cause of death in some developed countries. COPD onset occurs almost exclusively in older age due to the cumulative effects of cigarette smoking in genetically-susceptible individuals. An upper respiratory viral infection commonly leads to the initial diagnosis of asthma at any age. About half of older adults with asthma have allergic triggers, compared to about 90% of asthmatic children. Exacerbations with dyspnea, wheezing and cough are the major morbidity of asthma and COPD, which limits activity, reduces quality of life and increases health care utilization and costs. In older adults as in younger adults, the most effective prevention for both asthma and COPD is smoking cessation.


title: Human Health Threats and Implications for Regional Security in Southeast Asia

text: Health security issues like infectious diseases, natural and man-made disasters and environmental degradation represent daunting, non-traditional regional and global security challenges. This chapter examines these major threats to human health, individually and as elements of a complex health security system, and relates them to human security in Southeast Asia and to the global security situation. Loss of confidence in government’s ability to protect its citizens makes people vulnerable to extremists who promise near-term solutions, leading to civil unrest and political violence, refugee migrations into neighboring states, insurgencies and disruption of regional security. Case studies are included to show how governmental failure to respond effectively to health challenges can compromise national and regional security. Additional case studies demonstrate best practices in preventing and mitigating negative health effects on human security and regional stability. Finally, this chapter posits that multilateral collaboration and cross-sectoral interagency cooperation are essential for sustainable regional health security solutions.


title: Pharyngitis

text: A 40-year-old woman presents to her primary care physician complaining of fever, malaise, and sore throat for the last 3 days. The patient has a past medical history significant for hypothyroidism. She takes only levothyroxine pills and recent thyroid tests have been normal. The patient denied nausea, vomiting, diarrhea, cough, chest pain, and shortness of breath. She is a nursery school teacher who reports having taken care of multiple children with “colds” in the recent week. She drinks one glass of wine every week and denied smoking or other drug use. The patient is married and lives with her husband, who has not been sick.


title: Managing Uncertainty Through Participation

text: Participation enjoys a very special status in health promotion discourse. Conceptualised both as a process and a valued outcome, it is often viewed as a defining feature and a key principle of health promotion (Robertson & Minkler, 1994; Rootman, Goodstadt, Potvin & Springett, 2001). Taking advantage of an undisputable position as a cardinal value, the role of participation has rarely been critically examined in relation to health promotion practice and its contribution to public health. The questions regarding the role of participation and how, in practice, practitioners can facilitate and support its emergence, have not been given satisfactory answers. Answers to these crucial questions can only result from a theoretical understanding of what participation entails in terms of action in the social situations of health promotion interventions. Theorizing on the role of participation in health promotion and on the social processes at play when it occurs is a prerequisite to reframing participation as a professional practice rather than as an ideology (see Pelikan, Chapter 6), and to develop appropriate procedures that can foster the conditions for effective participation.


title: Blut und Blutprodukte

text: die Blutgruppe richtet sich nach der Antigeneigenschaft der Erythrozyten; die Blutgruppenantigene A und B des AB0-Systems befinden sich an der Ery throzytenoberfläche. Das Antigen 0 gibt es nicht, man spricht allenfalls vom Merkmal H; die Blutgruppe A lässt sich in A(1) und A(2) unterteilen. Der Hauptunterschied zwischen den Untergruppen besteht darin, dass die Agglutination von A(1)-Erythrozyten bei Kontakt mit Anti-A-Serum wesentlich stärker und rascher verläuft. Für die Transfusion ist diese Unterteilung nicht von Bedeutung, da Antigen-Antikörper-Reaktionen zwischen A(1) und A(2) sehr selten auft reten und nur sehr schwach sind (Verteilung: A(1) ≈ 20%, A(2) ≈ 80%);


title: Human Subjects Research in Bioemergencies

text: Bioemergencies present unique ethical and operational challenges to performing clinical research with human subjects. Patient care, public health protection, and responder safety are paramount in these situations, which often involve high biosafety level pathogens and containment conditions. While working to halt the spread of disease, research is necessary to understand the ongoing outbreak as well as increase response capabilities in the face of future threats. Research in bioemergencies has novel and unexpected challenges that vary greatly depending on the type of studies being conducted and data being collected. This chapter will provide an understanding of basic principles, challenges, and regulatory components of human subjects research during bioemergencies, as well as ongoing practical components of these studies.


title: Prediction of RNA Secondary Structure Including Kissing Hairpin Motifs

text: We present three heuristic strategies for folding RNA sequences into secondary structures including kissing hairpin motifs. The new idea is to construct a kissing hairpin motif from an overlay of two simple canonical pseudoknots. The difficulty is that the overlay does not satisfy Bellman’s Principle of Optimality, and the kissing hairpin cannot simply be built from optimal pseudoknots. Our strategies have time/space complexities of O(n (4)) / O(n (2)), O(n (4)) / O(n (3)), and O(n (5)) / O(n (2)). All strategies have been implemented in the program pKiss and were evaluated against known structures. Surprisingly, our simplest strategy performs best. As it has the same complexity as the previous algorithm for simple pseudoknots, the overlay idea opens a way to construct a variety of practically useful algorithms for pseudoknots of higher topological complexity within O(n (4)) time and O(n (2)) space.


title: Pneumonie

text: nach dem ursächlichem Agens (virale, bakterielle, mykotische oder atypische); nach klinischem Verlauf (akut, chronisch); nach dem Ort, an dem die Infektion erworben wurde: 1. ambulant, außerhalb des Krankenhauses erworbene Pneumonie („community acquired pneumonia“; CAP); 2. nosokomial erworbene Pneumonie („hospital acquired pneumonia“; HAP); hierzu zählen die: beatmungsassoziierte Pneumonie („ventilator associated pneumonia“; VAP ) und die. Pneumonie bei Patienten, welche aus dem Alten- oder Pflegeheim stammen („health care acquired pneumonia“; HCAP): 3. Pneumonien bei immunsupprimierten Patienten; • primäre und sekundäre Pneumonien (als Folge bestimmter Grunderkrankungen, Bronchiektasien, Aspiration, Inhalationsintoxikation, Lungeninfarkt etc.);


title: The Importance of Animal Models in the Development of Vaccines

text: Efficient translation of basic vaccine research into clinical therapies greatly depends upon the availability of appropriate animal models. Testing novel vaccine candidates in animal models is a critical step in the development of modern vaccines. Animal models are being used to assess the quality and quantity of the immune response, to identify the optimal route of delivery and formulation, to determine protection from infection and disease transmission, and to evaluate the safety and toxicity of the vaccine formulation. Animal models help to make the translation from basic research to clinical application, and they often allow prediction of the vaccine potential, which helps in predicting the financial risks for vaccine manufacturers. Choosing an appropriate animal model has become increasingly important for the field, as each model has its own advantages and disadvantages. In this review, the criteria for selecting the right animal model, the advantages and disadvantages of various animal models, as well as the future needs for animal models are being discussed.


title: Respiratory System

text: The following chapter will focus on the respiratory system. Pertinent questions, answers, and rationale will be reviewed. Answers for this chapter can be found beginning on page 101.


title: Glyco3D: A Suite of Interlinked Databases of 3D Structures of Complex Carbohydrates, Lectins, Antibodies, and Glycosyltransferases

text: Glyco3D is a portal for structural glycobiology of several interlinked databases that is covering the three-dimensional features of monosaccharides, disaccharides, oligosaccharides, polysaccharides, glycosyltransferases, lectins, monoclonal antibodies, and glycosaminoglycan-binding proteins. Collection of annotated NMR data of bioactive oligosaccharides is also available. A common nomenclature has been adopted for the structural encoding of the carbohydrates. Each individual database stands by itself as it covers a particular family of either complex carbohydrates or carbohydrate-binding proteins. A unique search engine is available that scans the full content of all the databases for queries related to sequential information of the carbohydrates. The interconnection of these databases provides a unique opportunity to characterize the three-dimensional features that a given oligosaccharide molecule can take in different environments, i.e., vacuum, crystalline state, or interacting with different proteins having different biological function. The databases, which have been manually curated, were developed with nonproprietary software. They are web-based platform and are freely available to the scientific community at http://glyco3d.cermav.cnrs.fr.


title: A Novel Efficient Simulated Annealing Algorithm for the RNA Secondary Structure Predicting with Pseudoknots

text: The pseudoknot structure of RNA molecular plays an important role in cell function. However, existing algorithms cannot predict pseudoknots structure efficiently. In this paper, we propose a novel simulated annealing algorithm to predict nucleic acid secondary structure with pseudoknots. Firstly, all possible maximum successive complementary base pairs would be identified and maintained. Secondary, the new neighboring state could be generated by choosing one of these successive base pairs randomly. Thirdly, the annealing schedule is selected to systematically decrease the temperature as the algorithm proceeds, the final solution is the structure with minimum free energy. Furthermore, the performance of our algorithm is evaluated by the instances from PseudoBase database, and compared with state-of-the-art algorithms. The comparison results show that our algorithm is more accurate and competitive with higher sensitivity and specificity indicators.


title: Adjunctive and Supportive Measures for Community-Acquired Pneumonia

text: The widespread introduction of penicillin in the 1940s resulted in a substantial reduction in mortality from community-acquired pneumonia (CAP). However, despite significant advances in medical science, only a small improvement has occurred since, particularly in patients with bacteremic pneumococcal pneumonia [1, 2]. Even modern intensive care has only made a small difference to the mortality in patients with severe pneumonia [3, 4]. While the aging population, increased number of patients with severe co-morbid illnesses, and the human immunodeficiency virus (HIV) epidemic have certainly contributed to the persistently high mortality rate [2, 5, 6], apparently healthy, immunocompetent patients continue to die from CAP. Disturbingly, a recent British Thoracic Society study concluded that no available therapy could substantially reduce the mortality rate from severe CAP in young adults [7].


title: Acute Myelogenous Leukemia and Febrile Neutropenia

text: Aggressive chemotherapy has a deleterious effect on all components of the defense system of the human body. The resulting neutropenia as well as injury to the pulmonary and gastrointestinal mucosa allow pathogenic micro-organisms easy access to the body. The symptoms of an incipient infection are usually subtle and limited to unexplained fever due to the absence of granulocytes. This is the reason why prompt administration of antimicrobial agents while waiting for the results of the blood cultures, the so-called empirical approach, became an undisputed standard of care. Gram-negative pathogens remain the principal concern because their virulence accounts for serious morbidity and a high early mortality rate. Three basic intravenous antibiotic regimens have evolved: initial therapy with a single antipseudomonal β-lactam, the so-called monotherapy; a combination of two drugs: a β-lactam with an aminoglycoside, a second β-lactam or a quinolone; and, thirdly, a glycopeptide in addition to β-lactam monotherapy or combination. As there is no single consistently superior empirical regimen, one should consider the local antibiotic susceptibility of bacterial isolates in the selection of the initial antibiotic regimen. Not all febrile neutropenic patients carry the same risk as those with fever only generally respond rapidly, whereas those with a clinically or microbiologically documented infection show a much slower reaction and less favorable response rate. Once an empirical antibiotic therapy has been started, the patient must be monitored continuously for nonresponse, emergence of secondary infections, adverse effects, and the development of drug-resistant organisms. The averageduration of fever in serious infections in eventually successfully treated neutropenic patients is 4–5 days. Adaptations of an antibiotic regimen in a patient who is clearly not responding is relatively straightforward when a micro-organism has been isolated; the results of the cultures, supplemented by susceptibility testing, will assist in selecting the proper antibiotics. The management of febrile patients with pulmonary infiltrates is complex. Bronchoscopy and a high resolution computer-assisted tomographic scan represent the cornerstones of all diagnostic procedures, supplemented by serological tests for relevant viral pathogens and for aspergillosis. Fungi have been found to be responsible for two thirds of all superinfections that may surface during broad-spectrum antibiotic treatment of neutropenic patients. Antibiotic treatment is usually continued for a minimum of 7 days or until culture results indicate that the causative organism has been eradicated and the patient is free of major signs and symptoms. If a persistently neutropenic patient has no complaints and displays no evidence of infection, early watchful cessation of antibiotic therapy or a change to the oral regimen should be considered.


title: Secondary Hemophagocytic Lymphohistiocytosis, Macrophage Activation Syndrome, and Hyperferritinemic Sepsis-Induced Multiple-Organ Dysfunction Syndrome in the Pediatric ICU

text: Children with secondary hemophagocytic lymphohistiocytosis present diagnostic and therapeutic challenges to the intensivist. Management of this condition can be facilitated with a collaborative approach among a team of intensivists, immunologists, rheumatologists, hematologists, and infectious disease specialists. Controversy over management approach commonly centers on incomplete understanding at the time of clinical presentation regarding individual patient differences in inflammation pathobiology that require different therapies. This review provides the clinician with the rationale for personalizing care for these critically ill children.


title: 2 Secondary assessment

text: Een (dreigend) agressieve of gewelddadige patiënt managen is een complexe uitdaging. Diverse factoren spelen een rol: vroege herkenning van een potentieel agressieve patiënt, diagnose en behandeling, interventietechnieken, veiligheid voor patiënt en omgeving, en medicolegale aspecten. Een goede training van het personeel in de omgang met agressieve patiënten is essentieel.


title: Pädiatrie

text: Was wir essen, wie viel, wie, mit wem, wann und wo ist ein Ausdruck von unseren frühesten Erfahrungen und entscheidet wesentlich über unser späteres Leben, unseren Ernährungszustand und unsere Gesundheit. Die Ernährung des Säuglings und Kindes hat zum Ziel, das Kind in den ersten Lebensjahren an eine ausgewogene Kost und den gemeinsamen Familientisch zu bringen. Essen ist dabei nicht nur ein physiologischer Vorgang, sondern wird von verschiedensten Einflussfaktoren (familiäre Strukturen, kulturelle Zusammenhänge, Mythen und Fakten über Nahrungsmittel und deren Zusammensetzung) geprägt, die bei der Wissensbildung über gesundes Essverhalten nicht einfach außer acht gelassen werden dürfen.


title: Pediatric Otolaryngology

text: Otolaryngologic procedures are commonly performed on children. In fact, pressure equalizing tube placement (ear tubes) and adenotonsillectomy are among the most frequent surgical interventions in the pediatric population. Therefore, every anesthesiologist who manages children undergoing otolaryngologic procedures must be familiar with the special implications of sharing the pediatric airway with an otolaryngologist working in the head and neck region. In addition, it is imperative to be skilled in the challenges of compassionately yet safely managing anxious young patients and their parents from the time of preoperative assessment until discharge from the post anesthesia care unit.


Kryptokokkose


title: Alcohol and the Alveolar Epithelium

text: The distal airways are covered with a heterogeneous layer of cells known as the alveolar epithelium. Alveolar epithelial cells provide the major barrier between the airspace and fluid filled tissue compartments. As such, regulation of the alveolar epithelium is critical to maintain a healthy lung and for optimal gas exchange. In this chapter, we discuss functional roles for alveolar epithelial cells with particular emphasis on intercellular junctions and communication. As a thin layer of cells directly exposed to atmospheric oxygen, alveoli are particularly sensitive to oxidant insults. Alcohol significantly diminishes the normal antioxidant reserves of the alveolar epithelium, thereby rendering it sensitized for an exaggerated damage response to acute and chronic injuries. The effects of alcohol on alveolar epithelia are discussed along with open questions and potential therapeutic targets to prevent the pathophysiology of alcoholic lung disease.


title: Proteomic Analysis of the Plant Nucleolus

text: The nucleolus is a prominent sub-nuclear structure found in all eukaryotes. It is where the ribosomal RNA genes are transcribed and ribosomes are synthesised. However, much evidence has now accumulated that the nucleolus is involved in many other nuclear processes. Nucleoli are of moderate protein complexity, comprising a few hundred proteins, and can be isolated for proteomic analysis. In this chapter we describe the purification and analysis of plant nucleoli by proteomic methods and summarise the current results. We also discuss more specific tagging methods that have been used to analyse individual protein complexes, as well as methods for analysing post-translational modifications of nucleolar proteins. Finally we discuss the assessment of the reliability of such proteomic data, and the presentation and curation of this type of data.


title: Vlekjes

text: Mijn dochtertje (groep I) komt thuis met het bericht dat haar vriendinnetje de ‘vlekjesziekte’ heeft. Navraag bij de schoolleiding brengt mij niet veel verder. Er wordt iets geroepen van de vijfde of zesde ziekte, met daarbij de mededeling dat een aantal kinderen uit de klas hetzelfde heeft. Hoe is dit met de besmettelijkheid? Zijn er voorzorgen voor mijn tandartspraktijk nodig? Ik heb veel ouders met kinderen van school in mijn praktijk.


title: Case Studies on the Local Coverage Process

text: As providers, beneficiaries, device manufacturers, and other stakeholders strive to more fully understand the working parameters of the Medicare local coverage process, there is considerable value in presenting a more global, integrated approach. There are three major defining forces, which provide such a framework, and can be further exemplified by selected recent coverage case studies. These three forces are (1) specific regulatory mandates of the Medicare program, (2) the creation of stakeholder partnerships, and (3) the need to properly use medical evidence. Most coverage policies represent a combination of these forces. In fact, there is only the occasional local coverage scenario, which is characterized by the pure expression of any solitary element.


title: 24 Longaandoeningen

text: Longproblemen tijdens of na een verblijf in de tropen kunnen acuut (zoals Legionella-pneumonie) of chronisch van aard zijn (longtuberculose). Reizigers die longklachten hebben, zullen meestal eerst naar de huisarts gaan. Deze kan verwijzen naar een internist of longarts, een kliniek met expertise in tropische ziekten of (voor onderzoek op tuberculose) een GGD in Nederland, of een VRGT-polikliniek in Vlaanderen.


title: Nasenhöhle und Nasennebenhöhlen

text: Die Gesichtsmitte (der Bezirk zwischen Oberlippe und Stirn) entwickelt sich zwischen der 4. und 8. Schwangerschaftswoche. [ 220] Der Stirnfortsatz bildet sich währen der 4. postovulatorischen Woche, aus ihm gehen die oberen und mittleren Anteile des Gesichts hervor. Die Oberkiefer- und Nasenwülste entwickeln sich unterhalb des Stirnfortsatzes. Am Ende der 4. Woche bilden zwei oberflächliche Verdickungen der Nasenwülste die Riechplakoden, die ektodermaler Herkunft sind und aus denen der Epithelbelag der Nasenhöhle und Nasennebenhöhlen hervorgeht. Die Plakoden stülpen sich ein und bilden die Riechgruben, aus denen die vorderen Choanen (Nasenlöcher) und weniger oberflächlich die primitiven hinteren Choanen entstehen. Die medialen Nasen- und Stirnfortsätze bilden das Nasenseptum, die Stirnknochen, Nasenknochen, die Siebbeinzellen- Komplexe und die oberen Schneidezähne. Die lateralen Nasen- und Oberkieferfortsätze vereinigen sich zur Bildung des Philtrum und der Columella. Das knorpelige Nasenskelet bildet sich während der 7. und 8. postovulatorischen Woche tief unterhalb der Nasen- und Stirnbeinknochen aus dem Chondrocranium. Die Nasennebenhöhlen entwickeln sich in der 6. Fetalwoche aus den lateralen Nasenwänden, und ihr Wachstum setzt sich nach der Geburt während des gesamten Kindes- und Jugendalters fort.


title: Non-infectious Parenchymal Lung Disease

text: Acute dyspnea is a common presenting complaint in the emergency room, emergency medicine and intensive care. It may have a cardiovascular or a non-cardiovascular origin, the latter including pulmonary parenchymal diseases. Depending on the cause, it may be associated with fever, cough, hemoptysis, and/or chest pain, with a duration of symptoms that can range from hours to days. Prompt identification of the underlying cause of acute dyspnea is essential in guiding appropriate therapy and management, as patients may rapidly progress to acute respiratory failure. Evaluation with chest radiography is vital for initial assessment and may reveal diffuse parenchymal abnormalities, which may require further assessment with computed tomography (HRCT). Acute non-infectious parenchymal lung diseases are often overlooked and may be under-diagnosed. Their diagnosis requires the evaluation, along with the HRCT pattern, of the clinical and laboratory features and of the bronchoalveolar lavage. Biopsy may be necessary in more complex cases. Although the most frequent cause of diffuse non-infectious parenchymal lung involvement is acute hydrostatic pulmonary edema, there is a wide variety of diseases that may be encountered, including acute drug toxicity, hypersensitivity pneumonitis (HP), acute respiratory distress syndrome (ARDS) and diffuse alveolar hemorrhage (DAH). In trauma patients, fat embolism syndrome (FES) must be taken into account. Acute respiratory failure is an eventuality that can occur during the course of chronic lung diseases (UIP for example), which may have been unknown until then.


title: Pulmonary Collectins in Diagnosis and Prevention of Lung Diseases

text: Pulmonary surfactant is a complex mixture of lipids and proteins, and is synthesized and secreted by alveolar type II epithelial cells and bronchiolar Clara cells. It acts to keep alveoli from collapsing during the expiratory phase of the respiratory cycle. After its secretion, lung surfactant forms a lattice structure on the alveolar surface, known as tubular myelin. Surfactant proteins (SP)-A, B, C and D make up to 10% of the total surfactant. SP-B and SPC are relatively small hydrophobic proteins, and are involved in the reduction of surface-tension at the air-liquid interface. SP-A and SP-D, on the other hand, are large oligomeric, hydrophilic proteins that belong to the collagenous Ca(2+)-dependent C-type lectin family (known as “Collectins”), and play an important role in host defense and in the recycling and transport of lung surfactant (Awasthi 2010) (Fig. 43.1). In particular, there is increasing evidence that surfactant-associated proteins A and -D (SP-A and SP-D, respectively) contribute to the host defense against inhaled microorganisms (see 10.1007/978-3-7091-1065_24 and 10.1007/978-3-7091-1065_25). Based on their ability to recognize pathogens and to regulate the host defense, SP-A and SP-D have been recently categorized as “Secretory Pathogen Recognition Receptors”. While SP-A and SP-D were first identified in the lung; the expression of these proteins has also been observed at other mucosal surfaces, such as lacrimal glands, gastrointestinal mucosa, genitourinary epithelium and periodontal surfaces. SP-A is the most prominent among four proteins in the pulmonary surfactant-system. The expression of SP-A is complexly regulated on the transcriptional and the chromosomal level. SP-A is a major player in the pulmonary cytokine-network and moreover has been described to act in the pulmonary host defense. This chapter gives an overview on the understanding of role of SP-A and SP-D in for human pulmonary disorders and points out the importance for pathology-orientated research to further elucidate the role of these molecules in adult lung diseases. As an outlook, it will become an issue of pulmonary pathology which might provide promising perspectives for applications in research, diagnosis and therapy (Awasthi 2010).


title: Introduction: The World of Bats

text: Bats are unique flying mammalians that occur worldwide feeding either on insects, fruits or even on blood depending on the species. Since they are active during the night, many myths have been launched during the last 500 years. All these facets are shortly considered here and prepare for a hopefully intense look into their hidden life.


title: Point-of-Care Diagnostics

text: Rapid tests that are low-cost and portable are the first line of defence in healthcare systems. Dipstick and lateral-flow are the two universal assay formats as they are lightweight and compact, and provide qualitative results without external instrumentation. However, existing formats have limitations in the quantification of analyte concentrations. Hence, the demand for sample preparation, improved sensitivity and user-interface has challenged the commercial products. Recently, capabilities, sensors and readout devices were expanded to multiplexable assays platforms, which might transcend the capabilities of existing design format of diagnostic tests. This chapter outlines the evolution of diagnostic devices and current trends in the development of qualitative and quantitative sensing devices for applications in healthcare, veterinary medicine, environmental monitoring and food safety. The chapter also discusses design parameters for diagnostics, their functionalisation to increase the capabilities and the performance, emerging sensing platforms and readout technologies. The factors which limit the emerging rapid diagnostics to become commercial products are also discussed.


title: Health and Human Security

text: This chapter focuses on health and how it can be reimagined through the lens of human security. It builds on Chap. 10.1007/978-3-319-72068-5_5’s exploration of human security, including of health, beyond borders. It delves more deeply into the nuts and bolts of delivering the right to health by reallocating the responsibility for it across State border as well as between States and NSAs. Antecedent to its analysis is the acknowledgment of the tension between the morality of a universal human right to health and the claim to health care conferred by citizenship, focusing on the continued (r)evolution of the human right to health as part and parcel of human security, and of its practical feasibility beyond State borders.


title: Limiting the Neighborhood: De-Small-World Network for Outbreak Prevention

text: In this work, we study a basic and practically important strategy to help prevent and/or delay an outbreak in the context of network: limiting the contact between individuals. In this paper, we introduce the average neighborhood size as a new measure for the degree of being small-world and utilize it to formally define the de-small-world network problem. We also prove the NP-hardness of the general reachable pair cut problem and propose a greedy edge betweenness based approach as the benchmark in selecting the candidate edges for solving our problem. Furthermore, we transform the de-small-world network problem as an OR-AND Boolean function maximization problem, which is also an NP-hardness problem. In addition, we develop a numerical relaxation approach to solve the Boolean function maximization and the de-small-world problem. Also, we introduce the short-betweenness, which measures the edge importance in terms of all short paths with distance no greater than a certain threshold, and utilize it to speed up our numerical relaxation approach. The experimental evaluation demonstrates the effectiveness and efficiency of our approaches.


title: Infections in Hematology Patients

text: Infections are major causes of morbidity and mortality in hematology patients especially those having undergone allogeneic hematopoietic stem cell transplantation. The management relies on early diagnosis and rapid introduction of appropriate antimicrobial drugs frequently before the infectious agent has been identified. The use of broad-spectrum antibacterial drugs has reduced the mortality in febrile neutropenia. However, the increase of multiresistant strains has in several countries become a major threat, and the development of new antibacterial drugs is urgently needed. Infection control strategies are also very important to limit the spread of multiresistant bacteria. Early diagnosis with imaging and tests for antigen or DNA is important for the management of fungal infections. High-risk patients should also receive prophylaxis. Viral infections are important causes of severe disease in patients having undergone allogeneic stem cell transplantation but do occur also in non-transplanted patients. Early diagnosis usually with tests for viral nucleic acids is the key for appropriate management. Prevention and treatment with antiviral drugs are available for some viruses especially herpesviruses.


title: The Human Lung Microbiome

text: The human lower respiratory tract is considered sterile in normal healthy individuals (Flanagan et al., 2007; Speert, 2006) despite the fact that every day we breathe in multiple microorganisms present in the air and aspirate thousands of organisms from the mouth and nasopharynx. This apparent sterility is maintained by numerous interrelated components of the lung physical structures such as the mucociliary elevator and components of the innate and adaptive immune systems (discussed below) (reviewed in (Diamond et al., 2000; Gerritsen, 2000)). However, it is possible that the observed sterility might be a result of the laboratory practices applied to study the flora of the lungs. Historically, researchers faced with a set of diseases characterized by a changing and largely cryptic lung microbiome have lacked tools to study lung ecology as a whole and have concentrated on familiar, cultivatable candidate pathogens.


title: Selecting and Screening Donors

text: Oocyte donation was originally established in 1983 as a treatment option for younger women with premature ovarian failure and for women with severe pelvic disease whose ovaries, as a result, were surgically inaccessible. The indications for donor oocyte in vitro fertilization (IVF) have now expanded to include not only women with hypergonadotropic hypogonadism but also those with advanced reproductive age, diminished ovarian reserve, significant genetic disease risk, poor oocyte or embryo quality, or multiple failures in prior attempts to conceive using conventional assisted reproductive technology (ART). Oocyte donation has also been recently used as an important source of material to promote the study of stem cell research. In these first cases of donation, gametes were obtained primarily from women already undergoing IVF who had excess oocytes at the time of retrieval. Today, most egg donors are not currently pursing infertility treatment themselves but are willing to donate their gametes for altruistic or commercial reasons. Since its initiation, oocyte donation services have spread throughout the USA and to many areas of the world. In the USA, 9,000–10,000 donor oocyte cycles occur annually. Though donor oocyte IVF is available throughout the USA, globally the practice of oocyte donation varies due to legal restrictions in many countries (Chap. 30).


title: BioDIFF: An Effective Fast Change Detection Algorithm for Biological Annotations

text: Warehousing heterogeneous, dynamic biological data is a key technique for biological data integration as it greatly improves performance. However, it requires complex maintenance procedures to update the warehouse in light of the changes to the sources. Consequently, a key issue to address is how to detect changes to the underlying biological data sources. In this paper, we present an algorithm called BioDiff for detecting exact changes to biological annotations. In our approach we transform heterogeneous biological data to XML format and then detect changes between two versions of XML representation of biological data. Our algorithm extends X-Diff, a published XML change detection algorithm. X-Diff, being designed for any type of XML data, does not exploit the semantics of biological data to reduce the data set of bipartite mapping. We have implemented BioDiff in Java. We have conducted an extensive performance study using data from EMBL, GenBank, SwissProt and PDB. Our experimental results show that BioDiff runs 1.5 to 6 times faster than X-Diff.


title: The Role of Infections in BOS

text: Background: Infectious agents, particularly cytomegalovirus (CMV), have long been considered to be potential triggers for BOS, although the exact magnitude of the role of infections and the mechanisms thereof remain an area of active research. Methods: This chapter will review previous literature and newer results concerning the possible roles of CMV, other herpesviruses, community-acquired respiratory viruses, bacteria (including Pseudomonas, other gram-negative, gram-positive, and atypical organisms), and fungi, including colonization as well as invasive infection. Results: The text reviews and evaluates the body of literature supporting a role for these infectious agents as risk factors for BOS and time to BOS. Changing patterns of infection over time are taken into account, and studies that have shown an association between BOS (or lack thereof) and CMV are reviewed. Strategies for prevention or early treatment of infections are discussed as potential means of preserving allograft function long term. Immunizations, stringent infection-control practices, and antimicrobial treatment including newer therapies will be discussed. Conclusion: In addition to the classic literature that has focused on CMV, an expanding spectrum of infectious organisms has been implicated as possible risk factors for BOS. Increasing knowledge of the impact of long-term antiviral suppression, prophylaxis, and outcomes of early therapy will help guide future recipient management.


title: Personal Protective Equipment

text: Mindfulness may not be a term usually associated with personal protective equipment (PPE), but it is a useful concept for the discussion of putting together, layer by layer, the protective barriers that allow the safe provision of care for patients with highly hazardous communicable diseases. Each piece of the full PPE ensemble will have limitations that must be understood by the wearer. Close and careful attention to behaviors in the patient care environment becomes good PPE etiquette. Donning, or putting on PPE, carefully and fully before attending to a patient’s needs is fundamental but not intuitive. Removing PPE is a high-risk procedure that can be performed safely with practice, coaching, and observation. Mitigating risk depends on awareness to all areas of potential contamination and a mindful approach to delivering safe patient care.


Inhibitors of respiratory viruses


title: Kupffer Cells in Health and Disease

text: Kupffer cells (KC), the resident macrophages of the liver, represent the largest population of mononuclear phagocytes in the body. Phenotypic, developmental, and functional aspects of these cells in steady state and in different diseases are the focus of this review. Recently it has become evident that KC precursors seed the liver already early in fetal development, and the population can be maintained independently from circulating monocytes. However, inflammatory conditions allow rapid differentiation of monocytes into mature cells that are indistinguishable from genuine KC. KC are located in the lumen of sinusoids that receive blood both from the portal vein, carrying nutrients and microbial products from the gut, and from the hepatic artery. This positions KC ideally for their prime function, namely surveillance and clearance of the circulation. As such, they are important in iron recycling by phagocytosing effete erythrocytes, for instance. The immunophenotype of KC, characterized by a wide variety of endocytic receptors, is indicative of this scavenger function. In maintaining homeostasis, KC have an ambivalent response to exogenous triggers. On the one hand, their surveillance function requires alert responses to potentially hazardous substances. On the other hand, continuous exposure of the cells to the trigger-rich content of blood originating from the gut dampens their responsiveness to further stimuli. This ambivalence is also reflected in their diverse roles in disease pathogenesis. For the latter, we sketch the contribution of KC by giving examples of their role in metabolic disease, infections, and liver injury.


title: Saponin Synthesis and Function

text: Saponins are one of the most numerous and diverse groups of plant natural products. They serve a range of ecological roles including plant defence against disease and herbivores and possibly as allelopathic agents in competitive interactions between plants. Some saponins are also important pharmaceuticals, and the underexplored biodiversity of plant saponins is likely to prove to be a vital resource for future drug discovery. The biological activity of saponins is normally attributed to the amphipathic properties of these molecules, which consist of a hydrophobic triterpene or sterol backbone and a hydrophilic carbohydrate chain, although some saponins are known to have potent biological activities that are dependent on other aspects of their structure. This chapter will focus on the biological activity and the synthesis of some of the best-studied examples of plant saponins and on recent developments in the identification of the genes and enzymes responsible for saponin synthesis.


title: Neutropenic Fever in the Intensive Care Unit

text: Neutropenic fever is a common and potentially life-threatening condition in patients treated for cancer. Rapid initiation of appropriate antimicrobial therapy is necessary to decrease the risk of mortality. Most infections are due to gram-positive organisms, but the mortality rate is higher for gram-negative infections. Multidrug-resistant organisms are an emerging threat to neutropenic patients. Increasing data suggest that the pathophysiology of neutropenic fever and neutropenic sepsis is substantially different from non-neutropenic fever and sepsis. Additional research is needed to both further elucidate the pathogenesis of neutropenic fever and to develop additional effective antimicrobials.


Acute Hepatic Failure


Diagnosis and Management of Acute Rhinosinusitis


title: A Review of Microblogging Marketing Based on the Complex Network Theory

text: Microblogging marketing which is based on the online social network with both small-world and scale-free properties can be explained by the complex network theory. Through systematically looking back at the complex network theory in different development stages, this chapter reviews literature from the microblogging marketing angle, then, extracts the analytical method and operational guide of microblogging marketing, finds the differences between microblog and other social network, and points out what the complex network theory cannot explain. In short, it provides a theoretical basis to effectively analyze microblogging marketing by the complex network theory.


title: Akute Gastroenteritis und postenteritisches Syndrom

text: Definition und Häufigkeit. Die akute Gastroenteritis ist im Säuglings und Kleinkindesalter häufig. Die überwiegende Anzahl der Kinder, die an einem Brechdurchfall erkranken, ist jünger als 1 Jahr. Durch den schweren Wasser und Elektrolytverlust kommt es zur Dehydratation. Bei 70% der Patienten tritt eine isotone, bei 10% eine hyponatriämische und bei 20% eine hypertone (hypernatriämische) Dehydratation auf. Der Typ der Dehydratation ist unabhängig vom Erreger. Der Flüssigkeitsverlust kann das 2- bis 3-Fache des zirkulierenden Blutvolumens betragen, nämlich 150–250 ml/kgKG/Tag. Um das Blutvolumen konstant zu halten, entzieht der Körper dem Intrazellularraum Flüssigkeit. Dies führt zur Exsikkose. Das Ausmaß des Flüssigkeitsverlustes wird klinisch beurteilt und nach der WHO in drei Schweregrade eingeteilt (Tab. 106.1).


title: 14-jähriger Junge mit Atemnot und Halsschmerzen

text: Ein 14-jähriger Junge wird mit Verdacht auf Sepsis von einem peripheren Krankenhaus zuverlegt. Der Junge war im Ferienlager in Nordspanien gewesen und dort an einem fieberhaften Atemwegsinfekt erkrankt. Schon vor Abreise ins Ferienlager hatte er über Halsschmerzen geklagt. Im weiteren Verlauf entwickelte er Fieber und Dysphagie. Von einem Arzt vor Ort war unter der Annahme einer Angina tonsillaris ein Makrolid verschrieben worden. Doch als es dem Jungen immer schlechter ging, organisierten die Veranstalter die Rückreise. Bei Aufnahme zeigt sich der Patient tachydyspnoeisch mit Sauerstoffbedarf und kreislaufzentralisiert. Bei pathologischem Röntgenbefund und erhöhten Entzündungszeichen erfolgt die stationäre Aufnahme. Es folgt eine extensive Diagnostik inklusive Bildgebung und Mikrobiologie. Trotz der zügigen Therapie muss der Patient wegen weiterer Verschlechterung auf die Intensivstation verlegt werden.


title: Sociology and Health

text: Many people (including students of sociology) often wonder about the relevance of social sciences (especially sociology) to health issues. In general, it is often a challenge to discuss the nexus between social science and health. Why medical sociology? What does sociology have to do with medicine or health? This chapter aims to answer these questions. It starts with the meaning of sociology and its links to health studies—a definition and brief history of medical sociology and topic description of the discipline. All health problems are conceived as social problems, which are the core focus of sociological studies. This chapter explains the characteristics of social problems with regard to health issues. Health problems are viewed as parts of social pathologies by advancing the sociological dimensions of health problems. The chapter then attempts to re-explain the topical description of medical sociology (first advanced by David Mechanic in 1968) and includes some current issues. The topical descriptions specifically include social aetiology of disease, cultural beliefs and social response to illness, sociology of medical care and hospitals, sociology of psychiatry, social transition and health care, traditional medicine (alternative medicine), sociology of bioethics, health policy and politics, social epidemiology, sociology of dying and death, and medical education.


title: Hightech im Dienste der Infektiologie

text: Jeden Tag sterben weltweit etwa 13 Millionen Menschen an den Folgen viraler, bakterieller oder parasitärer Erkrankungen.