First measurement of beta decay half-lives in neutron-rich Tl and Bi isotopes

Neutron-rich isotopes around lead, beyond N = 126, have been studied exploiting the fragmentation of an uranium primary beam at the FRS-RISING setup at GSI. For the first time beta-decay half-lives of Bi-219 and Tl-211,Tl-212,Tl-213 isotopes have been derived. The half-lives have been extracted using a numerical simulation developed for experiments in high-background conditions. Comparison with state of the art models used in r-process calculations is given, showing a systematic underestimation of the experimental values, at variance from close-lying nuclei. (c) 2012 Elsevier B.V. All rights reserved.

Pollen-placement and pollen-portioning in diverse Salvia-species

This dissertation addresses the staminal lever mechanism of the genus Salvia. Various hypotheses referring to its purpose and function are tested and elucidated. The first hypothesis maintains that the lever is a mechanical selection mechanism which excludes weak pollinators from the flower. This hypothesis is refuted and the respective results of force measurements and morphological investigations are presented, statistically evaluated and discussed. The force measurements and morphological investigations were conducted on the staminal levers and flowers of 8 bee pollinated (melittophilous) and 6 bird pollinated (ornithophilous) species. For comparison a ninth melittophilous species that lacks the staminal lever was investigated. In this species the force measurements were conducted on floral structures that were suspected to hinder a flower visitor. The hypotheses, which state that the staminal lever is a tool for pollen portioning and reduces the risk of pollen loss as well as hybridisation due to its ability to perform a repeatable, accurate and species-specific pollen placement on a wide range of diverse pollinators, are confirmed. Investigations with respect to pollen portioning were carried out on 13 sages. The lever mechanism can be released several times in a row, while the pollen sacs leave a dosed pollen portion on a well defined spot on the pollinator‘s body. Pollen placement was investigated for 12 sages. In sympatric sages, lever length and the area of pollen placement are of particular interest. A shared pollinator bears species-specific areas of pollen placement for different sages. The accurate pollen placement ensures an efficient pollination. However, the question of the functionality of the lever mechanism can not be answered with absolute certainty. The lever‘s backswing is not caused by the adaxial lever arm; the adaxial lever arm is too light and too short to be an adequate counterweight to the abaxial lever arm. Therefore, the adaxial lever arm can not pull the abaxial lever arm to return it to its neutral position. But there are indications of a cellular mainspring in the filament. According to the current state of knowledge, this is the most plausible explanation for the lever's backswing, but further histological investigations on the joint of the lever mechanism are necessary to confirm this assumption.

Soil biogenic emissions of nitric oxide from arid and semi-arid ecosystems

The biogenic production of NO in the soil accounts for between 10% and 40% of the global total. A large degree of the uncertainty in the estimation of the biogenic emissions stems from a shortage of measurements in arid regions, which comprise 40% of the earth’s land surface area. This study examined the emission of NO from three ecosystems in southern Africa which cover an aridity gradient from semi-arid savannas in South Africa to the hyper-arid Namib Desert in Namibia. A laboratory method was used to determine the release of NO as a function of the soil moisture and the soil temperature. Various methods were used to up-scale the net potential NO emissions determined in the laboratory to the vegetation patch, landscape or regional level. The importance of landscape, vegetation and climatic characteristics is emphasized. The first study occurred in a semi-arid savanna region in South Africa, where soils were sampled from 4 landscape positions in the Kruger National Park. The maximum NO emission occurred at soil moisture contents of 10%-20% water filled pore space (WFPS). The highest net potential NO emissions came from the low lying landscape positions, which have the largest nitrogen (N) stocks and the largest input of N. Net potential NO fluxes obtained in the laboratory were converted in field fluxes for the period 2003-2005, for the four landscape positions, using soil moisture and temperature data obtained in situ at the Kruger National Park Flux Tower Site. The NO emissions ranged from 1.5-8.5 kg ha-1 a-1. The field fluxes were up-scaled to a regional basis using geographic information system (GIS) based techniques, this indicated that the highest NO emissions occurred from the Midslope positions due to their large geographical extent in the research area. Total emissions ranged from 20x103 kg in 2004 to 34x103 kg in 2003 for the 56000 ha Skukuza land type. The second study occurred in an arid savanna ecosystem in the Kalahari, Botswana. In this study I collected soils from four differing vegetation patch types including: Pan, Annual Grassland, Perennial Grassland and Bush Encroached patches. The maximum net potential NO fluxes ranged from 0.27 ng m-2 s-1 in the Pan patches to 2.95 ng m-2 s-1 in the Perennial Grassland patches. The net potential NO emissions were up-scaled for the year December 2005-November 2006. This was done using 1) the net potential NO emissions determined in the laboratory, 2) the vegetation patch distribution obtained from LANDSAT NDVI measurements 3) estimated soil moisture contents obtained from ENVISAT ASAR measurements and 4) soil surface temperature measurements using MODIS 8 day land surface temperature measurements. This up-scaling procedure gave NO fluxes which ranged from 1.8 g ha-1 month-1 in the winter months (June and July) to 323 g ha-1 month-1 in the summer months (January-March). Differences occurred between the vegetation patches where the highest NO fluxes occurred in the Perennial Grassland patches and the lowest in the Pan patches. Over the course of the year the mean up-scaled NO emission for the studied region was 0.54 kg ha-1 a-1 and accounts for a loss of approximately 7.4% of the estimated N input to the region. The third study occurred in the hyper-arid Namib Desert in Namibia. Soils were sampled from three ecosystems; Dunes, Gravel Plains and the Riparian zone of the Kuiseb River. The net potential NO flux measured in the laboratory was used to estimate the NO flux for the Namib Desert for 2006 using modelled soil moisture and temperature data from the European Centre for Medium Range Weather Forecasts (ECMWF) operational model on a 36km x 35km spatial resolution. The maximum net potential NO production occurred at low soil moisture contents (<10%WFPS) and the optimal temperature was 25°C in the Dune and Riparian ecosystems and 35°C in the Gravel Plain Ecosystems. The maximum net potential NO fluxes ranged from 3.0 ng m-2 s-1 in the Riparian ecosystem to 6.2 ng m-2 s-1 in the Gravel Plains ecosystem. Up-scaling the net potential NO flux gave NO fluxes of up to 0.062 kg ha-1 a-1 in the Dune ecosystem and 0.544 kg h-1 a-1 in the Gravel Plain ecosystem. From these studies it is shown that NO is emitted ubiquitously from terrestrial ecosystems, as such the NO emission potential from deserts and scrublands should be taken into account in the global NO models. The emission of NO is influenced by various factors such as landscape, vegetation and climate. This study looks at the potential emissions from certain arid and semi-arid environments in southern Africa and other parts of the world and discusses some of the important factors controlling the emission of NO from the soil.

Serumfreie Collagen-Monolayer- und Sandwich-Kulturen primärer Hepatozyten als ein wertvolles Modell zur Detektion von Toxizität und Arzneimittelwechselwirkungen in vitro

In dieser Arbeit wurden Zellkulturen primärer Hepatozyten von Ratte und Mensch hinsichtlich ihrer Eignung untersucht Speziesunterschiede der toxischen Wirkung und des Metabolismus von Substanzen darzustellen und inwieweit die in vitro-Ergebnisse in vivo vergleichbar bzw. übertragbar sind. Des Weiteren wurde ein Zellkulturmodell entwickelt, das eine Kultivierung von primären Hepatozyten aus Ratte, Mensch und Maus über einen Zeitraum von mindestens einer bis zwei Wochen erlaubt.rnrnDie Zellkulturen primärer Hepatozyten von Ratte und Mensch zeigten deutliche Unterschiede in der substanzinduzierten Veränderung der Genexpression nach Behandlung mit den, vor allem für den Menschen, lebertoxischen Substanzen Diclofenac und Troglitazon. Diese Unterschiede traten hauptsächlich in der Induktion fremdstoffmetabolisierender Enzyme sowie deren transkriptionsregulierenden Kernrezeptoren in den humanen Hepatozyten auf. Ebenso war eine verstärkte Stressantwort zu beobachten.rnDeutliche Speziesunterschiede konnten ebenso in der Wirkung der Arzneimittelentwicklungssubstanz EMD 392949 auf die Aktivität bzw. Genexpression von Cytochrom P450 Enzymen sowie deren Regulatoren nachgewiesen werden. Des Weiteren konnte hier eine sehr gute Übereinstimmung der Ergebnisse aus den Zellkulturen primärer Ratten- bzw. Humanhepatozyten mit jenen aus in vivo-Experimenten mit Ratten bzw. Affen (Macaca fascicularis) beobachtet werden, was die Aussagekraft der Primärkulturen verdeutlichte.rnDie große Übereinstimmung zwischen Enzymaktivität und Genexpression in der Induktion fremdstoffmetabolisierender Enzyme konnte durch die Behandlung mit einer Reihe speziesspezifischer Induktoren in Zellkulturen primärer Ratten- bzw. Humanhepatozyten bestätigt werden; vor allem nach dem von der amerikanischen Arzneimittelzulassungsbehörde (FDA, Food and Drug Administartion) vorgeschlagenen Bewertungsschema zur Untersuchung der CYP-Induktion.rnrnDie Lebensdauer sowie der Differenzierungsgrad von primären Hepatozyten in Kultur sind stark abhängig von den Zellkulturbedingungen. Durch diese Arbeit konnte gezeigt werden, dass spezifische Eigenschaften von Rattenleberzellen durch Kultivierung in einem Sandwich aus zwei hydratisierten Collagengelschichten und unter serumfreien Bedingungen für einen Zeitraum von mindestens zwei Wochen aufrechterhalten werden können. Dieses Kulturmodel konnte auf Primärhepatozyten von Mensch und Maus übertragen werden und erweitert die möglichen Anwendungen hin zu einer Behandlung über einen längeren Zeitraum und der Untersuchung von subchronischen Effekten.rn

Mineral dust mobilisation, transport, and deposition in different climate epochs

Mineral dust is an important component of the Earth's climate system and provides essential nutrientsrnto oceans and rain forests. During atmospheric transport, dust particles directly and indirectly influencernweather and climate. The strength of dust sources and characteristics of the transport, in turn, mightrnbe subject to climatic changes. Earth system models help for a better understanding of these complexrnmechanisms.rnrnThis thesis applies the global climate model ECHAM5/MESSy Atmospheric Chemistry (EMAC) for simulationsrnof the mineral dust cycle under different climatic conditions. The prerequisite for suitable modelrnresults is the determination of the model setup reproducing the most realistic dust cycle in the recentrnclimate. Simulations with this setup are used to gain new insights into properties of the transatlanticrndust transport from Africa to the Americas and adaptations of the model's climate forcing factors allowrnfor investigations of the impact of climatic changes on the dust cycle.rnrnIn the first part, the most appropriate model setup is determined through a number of sensitivity experiments.rnIt uses the dust emission parametrisation from Tegen et al. 2002 and a spectral resolutionrnof T85, corresponding to a horizontal grid spacing of about 155 km. Coarser resolutions are not able tornaccurately reproduce emissions from important source regions such as the Bodele Depression in Chad orrnthe Taklamakan Desert in Central Asia. Furthermore, the representation of ageing and wet deposition ofrndust particles in the model requires a basic sulphur chemical mechanism. This setup is recommended forrnfuture simulations with EMAC focusing on mineral dust.rnrnOne major branch of the global dust cycle is the long-range transport from the world's largest dustrnsource, the Sahara, across the Atlantic Ocean. Seasonal variations of the main transport pathways to thernAmazon Basin in boreal winter and to the Caribbean during summer are well known and understood,rnand corroborated in this thesis. Both Eulerian and Lagrangian methods give estimates on the typicalrntransport times from the source regions to the deposition on the order of nine to ten days. Previously, arnhuge proportion of the dust transported across the Atlantic Ocean has been attributed to emissions fromrnthe Bodele Depression. However, the contribution of this hot spot to the total transport is very low inrnthe present results, although the overall emissions from this region are comparable. Both model resultsrnand data sets analysed earlier, such as satellite products, involve uncertainties and this controversy aboutrndust transport from the Bodele Depression calls for future investigations and clarification.rnrnAforementioned characteristics of the transatlantic dust transport just slightly change in simulationsrnrepresenting climatic conditions of the Little Ice Age in the middle of the last millennium with meanrnnear-surface cooling of 0.5 to 1 K. However, intensification of the West African summer monsoon duringrnthe Little Ice Age is associated with higher dust emissions from North African source regions and wetterrnconditions in the Sahel. Furthermore, the Indian Monsoon and dust emissions from the Arabian Peninsula,rnwhich are affected by this circulation, are intensified during the Little Ice Age, whereas the annual globalrndust budget is similar in both climate epochs. Simulated dust emission fluxes are particularly influencedrnby the surface parameters. Modifications of the model do not affect those in this thesis, to be able tornascribe all differences in the results to changed forcing factors, such as greenhouse gas concentrations.rnDue to meagre comparison data sets, the verification of results presented here is problematic. Deeperrnknowledge about the dust cycle during the Little Ice Age can be obtained by future simulations, based onrnthis work, and additionally using improved reconstructions of surface parameters. Better evaluation ofrnsuch simulations would be possible by refining the temporal resolution of reconstructed dust depositionrnfluxes from existing ice and marine sediment cores.

CD137-selektierte leukämiereaktive T-Zellen gesunder Spender zur adoptiven Immuntherapie stammzelltransplantierter Leukämiepatienten = CD137-selected leukaemia-reactive T Cells from healthy donors for adoptive immunotherapy in stem-cell-transplanted leukaemia-patients

Bei stammzelltransplantierten Patienten, die ein Rezidiv ihrer Leukämie erleiden, kann eine Donor-Lymphozyten-Infusion (DLI) dauerhafte vollständige Leukämieremissionen induzieren. T-Zellen in der DLI vermitteln sowohl den potentiell kurativen Graft-versus-Leukaemia (GVL) Effekt, als auch die potentiell lebensbedrohliche Graft-versus-Host Disease (GVHD). Hingegen könnte die Infusion von leukämiereaktiven T-Zellen einen selektiven GVL Effekt und einen Langzeitschutz vor Rezidiven durch eine spezifisch gegen die Leukämie gerichtete Immunantwort und Immunität vermitteln. Unsere Arbeitsgruppe hat Protokolle zur in vitro Generierung leukämiereaktiver T-Zellen entwickelt, die hohe zytotoxische Aktivität gegen akute myeloische Leukämie-Blasten (AML) bei minimaler Reaktion auf mögliche GVHD Zielstrukturen zeigen. Für die klinische Anwendung sind diese Protokolle jedoch zu aufwändig, wobei vor allem eine erhebliche Verkürzung der Kulturzeit auf wenige Wochen erforderlich ist. Diese Verkürzung der in vitro Kulturzeit könnte das Wachstum von T-Zellen vom central memory oder frühen effector memory Phänotyp fördern, für die eine bessere in vivo Effektorfunktion und längere Persistenz im Rezipienten verglichen mit T-Zellen aus Langzeitkultur gezeigt werden konnte. Der Aktivierungsmarker und Kostimulations-Rezeptor CD137 kann zur Erkennung und Isolation antigenspezifischer T-Zellen genutzt werden, ohne dass dafür das von den T-Zellen erkannte Peptidepitop bekannt sein muss. Eine CD137-vermittelte Anreicherung mit Hilfe von clinical grade Materialien könnte verwendet werden, um DLI-Produkte mit leukämiespezifischen T-Zellen herzustellen, die sich sowohl durch eine effizientere T-Zell Generierung durch in vitro Selektion und Kostimulation, als auch durch eine verbesserte Spezifität des T-Zell-Produkts auszeichnen. Lymphozyten-Leukämie Cokulturen (mixed lymphocyte leukaemia cultures) wurden mit CD8 T-Zellen gesunder Spender und HLA-identischen oder einzel-HLA-mismatch AML-Blasten angesetzt und wöchentlich restimuliert. Nach zwei Wochen wurden die T-Zellen 12 Stunden nach Restimulation über den Marker CD137 positiv isoliert und anschließend separat weiterkultiviert. Die isolierten Fraktionen und unseparierten Kontrollen wurden im ELISPOT-Assay und im Chrom-Freisetzungstest an Tag 5 nach der Restimulation getestet. Es wurden keine konsistent nachweisbaren Vorteile im Hinblick auf Wachstum und Funktion der isolierten CD137-positiv Fraktion im Vergleich zur unseparierten Kontrolle gefunden. Verschiedene Isolationsmethoden, Patient-Spender-Systeme, Methoden zur Restimulation, Temperaturbedingungen, Zytokinkombinationen und Methoden der Zytokinzugabe sowie zusätzliche Feeder-Zellen oder AML-Blasten konnten Wachstum, funktionelle Daten und die deutlichen Zellverluste während der Isolation nicht entscheidend beeinflussen. Vitalfärbungen zeigten, dass aktivierungsinduzierter Zelltod CD137-positiver Zellen zu diesen Ergebnissen beitragen könnte. Im Gegensatz zur Stimulation mit AML-Blasten wurden erfolgreiche CD137-Anreicherungen für peptidstimulierte T-Zellen publiziert. Unterschiedliche CD137-Expressionskinetiken, aktivierungsinduzierter Zelltod und regulatorische T-Zellen sind mögliche Faktoren aufgrund derer die CD137-Anreicherung in diesem spezifischen Kontext ungeeinet sein könnte. Der stimulatorische Effekt eines CD137-Signals auf AML-reaktive CD8 T-Zellen wurde mit Hilfe von CD3/CD28 und CD3/CD28/CD137 Antikörper-beschichteten magnetischen beads untersucht. Für Nierenzellkarzinom-reaktive T-Zellen war die Stimulation mit CD3/CD28/CD137 beads genauso effektiv wie mit Tumorzellen und effektiver als mit CD3/CD28 beads. Beide Arten von beads waren für eine Stimulation während der ersten Wochen der Zellkultur geeignet, sodass ein zusätzliches CD137-Signal für die länger anhaltende Expansion tumorreaktiver T-Zellen zur klinischen Anwendung nützlich sein könnte. Die bead-Expansion veränderte die IFN-Sekretion im ELISPOT nicht, aber verursachte eine mäßige Verschlechterung der Zytotoxizität im Chrom-Freisetzungstest. Im Gegensatz dazu zeigten bei AML-reaktiven T-Zellen beide Arten von beads einen nicht apoptosevermittelten, dosisabhängigen zellschädigenden Effekt, der zu einer raschen Abnahme der Zellzahl in Kulturen mit beads führte. Unerwünschte Effekte auf die T-Zell-Funktionalität durch bead-Stimulation sind in der Literatur beschrieben, dennoch gibt es aktuell keine Veröffentlichungen, die eine fundierte Erklärung für den Effekt auf AML-reaktive T-Zellen bieten könnten. Abgesehen von Literaturdaten, die darauf hindeuten, dass CD137 ein vielversprechendes Kandidatenmolekül für die Anreicherung und Expansion von AML-reaktiven T-Zellen sein könnte, zeigen die eigenen Daten sowohl zur CD137-Isolation als auch zur bead-Stimulation, dass für diese spezielle Anwendung CD137 ein ungeeigneter Aktivierungsmarker und Kostimulations-Ligand ist.

Acute coronary syndromes in young patients: Presentation, treatment and outcome

Background: Acute coronary syndromes (ACS) in very young patients have been poorly described. We therefore evaluate ACS in patients aged 35 years and younger. Methods: In this prospective cohort study, 76 hospitals treating ACS in Switzerland enrolled 28,778 patients with ACS between January 1, 1997, and October 1, 2008. ACS definition included ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). Results: 195 patients (0.7%) were 35 years old or younger. Compared to patients N35 years, these patients were more likely to present with chest pain (91.6% vs. 83.7%; P=0.003) and less likely to have heart failure (Killip class II to IV in 5.2% vs. 23.0%; Pb0.001). STEMI was more prevalent in younger than in older patients (73.1% vs. 58.3%; Pb0.001). Smoking, family history of CAD, and/or dyslipidemia were important cardiovascular risk factors in young patients (prevalence 77.2%, 55.0%, and 44.0%). The prevalence of overweight among young patients with ACS was high (57.8%). Cocaine abuse was associated with ACS in some young patients. Compared to older patients, young patients were more likely to receive early percutaneous coronary interventions and had better outcome with fewer major adverse cardiac events. Conclusions: Young patients with ACS differed from older patients in that the younger often presented with STEMI, received early aggressive treatment, and had favourable outcomes. Primary prevention of smoking, dyslipidemia and overweight should be more aggressively promoted in adolescence.

Intraocular pressure during a very high altitude climb

Reports on intraocular pressure (IOP) changes at high altitudes have provided inconsistent and even conflicting

Chickenpox is not always benign: postvaricella purpura fulminans requires prompt and aggressive treatment

We present 2 patients, who were admitted owing to rapidly progressing purpuric lesions due to postvaricella purpura fulminans, a coagulopathy leading to life- or limb-threatening thrombosis caused by a severe transient autoimmune protein S deficiency. Laboratory results were being consistent with disseminated intravascular coagulation secondary to protein S deficiency; treatment with fresh frozen plasma, intravenous immunoglobulins, and prednisone was started. In our experience, a prompt therapy may limit the course and the extent of the disease. We present a review of the topic with supporting literature for the therapeutic options. Therefore, we should be reminded that purpura fulminans is a rare but severe complication of chickenpox, which demands quick action.

Efficacy of rituximab and cladribine in patients with chronic lymphocytic leukemia and feasibility of stem cell mobilization: a prospective multicenter phase II trial (protocol SAKK 34/02)

This phase II trial investigated rituximab and cladribine in chronic lymphocytic leukemia. Four induction cycles, comprising cladribine (0.1 mg/kg/day days 1-5, cycles 1-4) and rituximab (375 mg/m(2) day 1, cycles 2-4), were given every 28 days. Stem cell mobilization (rituximab 375 mg/m(2) days 1 and 8; cyclophosphamide 4 g/m(2) day 2; and granulocyte colony-stimulating factor 10 microg/kg/day, from day 4) was performed in responders. Of 42 patients, nine achieved complete remission (CR), 15 very good partial remission, and two nodular partial remission (overall response rate 62%). Stem cell mobilization and harvesting (> or = 2 x 10(6) stem cells/kg body weight) were successful in 12 of 20 patients. Rituximab infusion-related adverse events were moderate. The main grade 3/4 adverse events during induction were neutropenia and lymphocytopenia. Rituximab plus cladribine was effective; however, the CR rate was modest and stem cell harvest was impaired in a large number of responding patients.

Integrating novel agents into multiple myeloma treatment - current status in Switzerland and treatment recommendations

The treatment of multiple myeloma has undergone significant changes in the recent past. The arrival of novel agents, especially thalidomide, bortezomib and lenalidomide, has expanded treatment options and patient outcomes are improving significantly. This article summarises the discussions of an expert meeting which was held to debate current treatment practices for multiple myeloma in Switzerland concerning the role of the novel agents and to provide recommendations for their use in different treatment stages based on currently available clinical data. Novel agent combinations for the treatment of newly diagnosed, as well as relapsed multiple myeloma are examined. In addition, the role of novel agents in patients with cytogenetic abnormalities and renal impairment, as well as the management of the most frequent side effects of the novel agents are discussed. The aim of this article is to assist in treatment decisions in daily clinical practice to achieve the best possible outcome for patients with multiple myeloma.

Gemtuzumab ozogamicin as postremission treatment in AML at 60 years of age or more: results of a multicenter phase 3 study

In older patients with acute myeloid leukemia (AML), the prevention of relapse has remained one of the major therapeutic challenges, with more than 75% relapses after complete remission. The anti-CD33 immunotoxin conjugate gemtuzumab ozogamicin (GO) has shown antileukemic remission induction activity in patients with relapsed AML. Patients with AML or refractory anemia with excess blasts in first complete remission attained after intensive induction chemotherapy were randomized between 3 cycles of GO (6 mg/m(2) every 4 weeks) or no postremission therapy (control) to assess whether GO would improve outcome. The 2 treatment groups (113 patients receiving GO vs 119 control patients) were comparable with regard to age (60-78 years, median 67 years), performance status, and cytogenetics. A total of 110 of 113 received at least 1 cycle of GO, and 65 of 113 patients completed the 3 cycles. Premature discontinuation was mainly attributable to incomplete hematologic recovery or intercurrent relapse. Median time to recovery of platelets 50 x 10(9)/L and neutrophils 0.5 x 10(9)/L after GO was 14 days and 20 days. Nonhematologic toxicities were mild overall, but there was 1 toxic death caused by liver failure. There were no significant differences between both treatment groups with regard to relapse probabilities, nonrelapse mortality, overall survival, or disease-free survival (17% vs 16% at 5 years). Postremission treatment with GO in older AML patients does not provide benefits regarding any clinical end points. The HOVON-43 study is registered at The Netherlands Trial Registry (number NTR212) and at http://www.controlled-trials.com as ISRCTN77039377.

Metallic copper as an antimicrobial surface

Bacteria, yeasts, and viruses are rapidly killed on metallic copper surfaces, and the term "contact killing" has been coined for this process. While the phenomenon was already known in ancient times, it is currently receiving renewed attention. This is due to the potential use of copper as an antibacterial material in health care settings. Contact killing was observed to take place at a rate of at least 7 to 8 logs per hour, and no live microorganisms were generally recovered from copper surfaces after prolonged incubation. The antimicrobial activity of copper and copper alloys is now well established, and copper has recently been registered at the U.S. Environmental Protection Agency as the first solid antimicrobial material. In several clinical studies, copper has been evaluated for use on touch surfaces, such as door handles, bathroom fixtures, or bed rails, in attempts to curb nosocomial infections. In connection to these new applications of copper, it is important to understand the mechanism of contact killing since it may bear on central issues, such as the possibility of the emergence and spread of resistant organisms, cleaning procedures, and questions of material and object engineering. Recent work has shed light on mechanistic aspects of contact killing. These findings will be reviewed here and juxtaposed with the toxicity mechanisms of ionic copper. The merit of copper as a hygienic material in hospitals and related settings will also be discussed.

Gender differences in clinical presentation and surgical outcome of aortic stenosis

Little is known about the gender differences of patients undergoing aortic valve replacement (AVR) for isolated severe aortic stenosis.