Development of analytical methodologies for iodine species in gaseous and particulate phases of the coastal atmosphere

It has been demonstrated that iodine does have an important influence on atmospheric chemistry, especially the formation of new particles and the enrichment of iodine in marine aerosols. It was pointed out that the most probable chemical species involved in the production or growth of these particles are iodine oxides, produced photochemically from biogenic halocarbon emissions and/or iodine emission from the sea surface. However, the iodine chemistry from gaseous to particulate phase in the coastal atmosphere and the chemical nature of the condensing iodine species are still not understood. A Tenax / Carbotrap adsorption sampling technique and a thermo-desorption / cryo-trap / GC-MS system has been further developed and improved for the volatile organic iodine species in the gas phase. Several iodo-hydrocarbons such as CH3I, C2H5I, CH2ICl, CH2IBr and CH2I2 etc., have been measured in samples from a calibration test gas source (standards), real air samples and samples from seaweeds / macro-algae emission experiments. A denuder sampling technique has been developed to characterise potential precursor compounds of coastal particle formation processes, such as molecular iodine in the gas phase. Starch, TMAH (TetraMethylAmmonium Hydroxide) and TBAH (TetraButylAmmonium Hydroxide) coated denuders were tested for their efficiencies to collect I2 at the inner surface, followed by a TMAH extraction and ICP/MS determination, adding tellurium as an internal standard. The developed method has been proved to be an effective, accurate and suitable process for I2 measurement in the field, with the estimated detection limit of ~0.10 ng∙L-1 for a sampling volume of 15 L. An H2O/TMAH-Extraction-ICP/MS method has been developed for the accurate and sensitive determination of iodine species in tropospheric aerosol particles. The particle samples were collected on cellulose-nitrate filters using conventional filter holders or on cellulose nitrate/tedlar-foils using a 5-stage Berner impactor for size-segregated particle analysis. The water soluble species as IO3- and I- were separated by anion exchanging process after water extraction. Non-water soluble species including iodine oxide and organic iodine were digested and extracted by TMAH. Afterwards the triple samples were analysed by ICP/MS. The detection limit for particulate iodine was determined to be 0.10~0.20 ng•m-3 for sampling volumes of 40~100 m3. The developed methods have been used in two field measurements in May 2002 and September 2003, at and around the Mace Head Atmospheric Research Station (MHARS) located at the west coast of Ireland. Elemental iodine as a precursor of the iodine chemistry in the coastal atmosphere, was determined in the gas phase at a seaweed hot-spot around the MHARS, showing I2 concentrations were in the range of 0~1.6 ng∙L-1 and indicating a positive correlation with the ozone concentration. A seaweed-chamber experiment performed at the field measurement station showed that the I2 emission rate from macro-algae was in the range of 0.019~0.022 ng•min-1•kg-1. During these experiments, nanometer-particle concentrations were obtained from the Scanning Mobility Particle Sizer (SMPS) measurements. Particle number concentrations were found to have a linear correlation with elemental iodine in the gas phase of the seaweeds chamber, showing that gaseous I2 is one of the important precursors of the new particle formation in the coastal atmosphere. Iodine contents in the particle phase were measured in both field campaigns at and around the field measurement station. Total iodine concentrations were found to be in the range of 1.0 ~ 21.0 ng∙m-3 in the PM2.5 samples. A significant correlation between the total iodine concentrations and the nanometer-particle number concentrations was observed. The particulate iodine species analysis indicated that iodide contents are usually higher than those of iodate in all samples, with ratios in the range of 2~5:1. It is possible that those water soluble iodine species are transferred through the sea-air interface into the particle phase. The ratio of water soluble (iodate + iodide) and non-water soluble species (probably iodine oxide and organic iodine compounds) was observed to be in the range of 1:1 to 1:2. It appears that higher concentrated non-water soluble species, as the products of the photolysis from the gas phase into the particle phase, can be obtained in those samples while the nucleation events occur. That supports the idea that iodine chemistry in the coastal boundary layer is linked with new particle formation events. Furthermore, artificial aerosol particles were formed from gaseous iodine sources (e.g. CH2I2) using a laboratory reaction-chamber experiment, in which the reaction constant of the CH2I2 photolysis was calculated to be based upon the first order reaction kinetic. The end products of iodine chemistry in the particle phase were identified and quantified.

Influence of nitrogen and soil physical characteristics on belowground carbon flux dynamics of woody plants

At ecosystem level soil respiration (Rs) represents the largest carbon (C) flux after gross primary productivity, being mainly generated by root respiration (autotrophic respiration, Ra) and soil microbial respiration (heterotrophic respiration, Rh). In the case of terrestrial ecosystems, soils contain the largest C-pool, storing twice the amount of C contained in plant biomass. Soil organic matter (SOM), representing the main C storage in soil, is decomposed by soil microbial community. This process produces CO2 which is mainly released as Rh. It is thus relevant to understand how microbial activity is influenced by environmental factors like soil temperature, soil moisture and nutrient availability, since part of the CO2 produced by Rh, directly increases atmospheric CO2 concentration and therefore affects the phenomenon of climate change. Among terrestrial ecosystems, agricultural fields have traditionally been considered as sources of atmospheric CO2. In agricultural ecosystems, in particular apple orchards, I identified the role of root density, soil temperature, soil moisture and nitrogen (N) availability on Rs and on its two components, Ra and Rh. To do so I applied different techniques to separate Rs in its two components, the ”regression technique” and the “trenching technique”. I also studied the response of Ra to different levels of N availability, distributed either in a uniform or localized way, in the case of Populus tremuloides trees. The results showed that Rs is mainly driven by soil temperature, to which it is positively correlated, that high levels of soil moisture have inhibiting effects, and that N has a negligible influence on total Rs, as well as on Ra. Further I found a negative response of Rh to high N availability, suggesting that microbial decomposition processes in the soil are inhibited by the presence of N. The contribution of Ra to Rs was of 37% on average.

Immunohistochemical and Molecular Prognostic/Predictive Markers in Neoplastic Diseases

Traditional morphological examinations are not anymore sufficient for a complete evaluation of tumoral tissue and the use of neoplastic markers is of utmost importance. Neoplastic markers can be classified in: diagnostic, prognostic and predictive markers. Three markers were analyzed. 1) Insulin-like growth factor binding protein 2 (IGFBP2) was immunohistochemically examined in prostatic tissues: 40 radical prostatectomies from hormonally untreated patients with their preoperative biopsies, 10 radical prostatectomies from patients under complete androgen ablation before surgery and 10 simple prostatectomies from patients with bladder outlet obstruction. Results were compared with α-methylacyl-CoA racemase (AMACR). IGFBP2 was expressed in the cytoplasm of untreated adenocarcinomas and, to a lesser extent, in HG-PIN; the expression was markedly lower in patients after complete androgen ablation. AMACR was similarly expressed in both adenocarcinoma and HG-PIN, the level being similar in both lesions; the expression was slightly lower in patients after complete androgen ablation. IGFBP2 may be used a diagnostic marker of prostatic adenocarcinomas. 2) Heparan surface proteoglycan immunohistochemical expression was examined in 150 oral squamous cell carcinomas. Follow up information was available in 93 patients (range: 6-34 months, mean: 19±7). After surgery, chemotherapy was performed in 8 patients and radiotherapy in 61 patients. Multivariate and univariate overall survival analyses showed that high expression of syndecan-1 (SYN-1) was associated with a poor prognosis. In patients treated with radiotherapy, such association was higher. SYN-1 is a prognostic marker in oral squamous cell carcinomas; it may also represent a predictive factor for responsiveness to radiotherapy. 3) EGFR was studied in 33 pulmonary adenocarcinomas with traditional DNA sequencing methods and with two mutation-specific antibodies. Overall, the two antibodies had 61.1% sensitivity and 100% specificity in detecting EGFR mutations. EGFR mutation-specific antibodies may represent a predictive marker to identify patients candidate to tyrosine kinase inhibitors therapy.

Stone architecture in Carso plateau. Settlement patterns and construction techniques of historic buildings

The use of stone and its types of processing have been very important in the vernacular architecture of the cross-border Carso. In Carso this represents an important legacy of centuries and has a uniform typological characteristic to a great extent. The stone was the main constituent of the local architecture, setting and shaping the human environment, incorporating the history of places through their specific symbolic and constructive language. The primary aim of this research is the recognition of the constructive rules and the values embedded in the Carso rural architecture by use and processing of stone. Central to this investigation is the typological reading, aimed to analyze the constructive language expressed by this legacy, through the analysis of the relationship between type, technique and material.

Fiber-Optic Technologies for Wireline and Wireless In-building Networks

This doctoral dissertation aims to establish fiber-optic technologies overcoming the limiting issues of data communications in indoor environments. Specific applications are broadband mobile distribution in different in-building scenarios and high-speed digital transmission over short-range wired optical systems. Two key enabling technologies are considered: Radio over Fiber (RoF) techniques over standard silica fibers for distributed antenna systems (DAS) and plastic optical fibers (POFs) for short-range communications. Hence, the objectives and achievements of this thesis are related to the application of RoF and POF technologies in different in-building scenarios. On one hand, a theoretical and experimental analysis combined with demonstration activities has been performed on cost-effective RoF systems. An extensive modeling on modal noise impact both on linear and non-linear characteristics of RoF link over silica multimode fiber has been performed to achieve link design rules for an optimum choice of the transmitter, receiver and launching technique. A successful transmission of Long Term Evolution (LTE) mobile signals on the resulting optimized RoF system over silica multimode fiber employing a Fabry-Perot LD, central launch technique and a photodiode with a built-in ball lens was demonstrated up to 525m with performances well compliant with standard requirements. On the other hand, digital signal processing techniques to overcome the bandwidth limitation of POF have been investigated. An uncoded net bit-rate of 5.15Gbit/s was obtained on a 50m long POF link employing an eye-safe transmitter, a silicon photodiode, and DMT modulation with bit and power loading algorithm. With the insertion of 3x2N quadrature amplitude modulation constellation formats, an uncoded net-bit-rate of 5.4Gbit/s was obtained on a 50 m long POF link employing an eye-safe transmitter and a silicon avalanche photodiode. Moreover, simultaneous transmission of baseband 2Gbit/s with DMT and 200Mbit/s with an ultra-wideband radio signal has been validated over a 50m long POF link.

Numerical analysis of Dielectric Barrier Discharge

A numerical investigation of dielectric barrier discharge aimed to simulate the electro hydro dynamic interaction is presented. A discharge drift diffusive model according to the Townsend avalanche is described and used to duplicate the plasma kinetics of a DBD actuator. The discharge characteristics dependence upon dielectric material and applied voltage are simulated and the EHD force field according to a simplified approach is presented and discussed. The coupling of DBD results with a fluid dynamic code is also shown. Finally, a new non invasive diagnostic technique for EHD interaction based on Schlieren imaging is computationally validated.

Corporate Governance and Dividend Policy in European Banking

This dissertation investigates corporate governance and dividend policy in banking. This topic has recently attracted the attention of numerous scholars all over the world and currently remains one of the most discussed topics in Banking. The core of the dissertation is constituted by three papers. The first paper generalizes the main achievements in the field of relevant study using the approach of meta-analysis. The second paper provides an empirical analysis of the effect of banking corporate governance on dividend payout. Finally, the third paper investigates empirically the effect of government bailout during 2007-2010 on corporate governance and dividend policy of banks. The dissertation uses a new hand-collected data set with information on corporate governance, ownership structure and compensation structure for a sample of listed banks from 15 European countries for the period 2005-2010. The empirical papers employ such econometric approaches as Within-Group model, difference-in-difference technique, and propensity score matching method based on the Nearest Neighbor Matching estimator. The main empirical results may be summarized as follows. First, we provide evidence that CEO power and connection to government are associated with lower dividend payout ratios. This result supports the view that banking regulators are prevalently concerned about the safety of the bank, and powerful bank CEOs can afford to distribute low payout ratios, at the expense of minority shareholders. Next, we find that government bailout during 2007-2010 changes the banks’ ownership structure and helps to keep lending by bailed bank at the pre-crisis level. Finally, we provide robust evidence for increased control over the banks that receive government money. These findings show the important role of government when overcoming the consequences of the banking crisis, and high quality of governance of public bailouts in European countries.

Untersuchungen über ADAMTS13 in Gerinnungsfaktorpräparaten

Zusammenfassung rnIn der vorliegenden Arbeit wurden sechs VWF/FVIII Gerinnungsfaktorkonzentrate unterschiedlicher Chargen auf ihre ADAMTS13 Aktivität, Antigen und VWF Multimere untersucht. Grund dafür ist die Annahme, dass bei der Aufkonzentrierung des VWFs möglicherweise auch erhöhte Mengen an ADAMTS13 vorhanden sind. Wäre dies nachweisbar, könnten die entsprechenden Konzentrate auch Anwendung bei TTP Patienten finden. Neben den Gerinnungsfaktorkonzentraten wurden ebenfalls die zur Plasmapherese verwendeten Therapeutika FFP und s/d Plasma analysiert. Es soll getestet werden, ob Unterschiede hinsichtlich der Qualität zwischen den Präparaten bestehen und inwiefern die Blutgruppen eine Auswirkung auf die ADAMTS13 Aktivität/Antigen haben. Überdies wurde die Bedeutung von ADAMTS13 als wichtiges diagnostisches Merkmal im Rahmen der Gegenüberstellung von Patienten mit thrombotischen Mikroangiopathien erörtert. Alle angewandten Methoden wurden zudem kritisch miteinander verglichen und auf ihre Eignung für die klinische Diagnostik getestet. Zur Untersuchung der ADAMTS13 Aktivität kamen drei unterschiedliche Methoden zur Anwendung, die BCS-Methode nach Böhm und zwei FRET Kits (Technozym®ADAMTS13/ActifluorTMADAMTS13). Für die Bestimmung des ADAMTS13 Antigen wurde das Technozym®ADAMTS13 Kit verwendete als auch der Imubind®ELISA angewendet. Mittels der SDS-Gelelektrophorese konnten die VWF Multimere dargestellt werden. Die Untersuchungen konnten zeigen, dass nur in Haemate®P, deutlich höhere ADAMTS13 Aktivitäten (12,3% bzw. 470ng/ml) sowie ein physiologische Antigenwerte vorlagen. Die anderen Faktorkonzentrate wiesen entweder nur sehr geringe bzw. keine Aktivitäten auf. Das Antigen lag bei allen Konzentraten im nachweisbaren Bereich. Folglich ist ein Einsatz von Haemate®P bei der Therapie der TTP, insbesondere bei hereditären Formen sowie bei Kindern, die durch eine Plasmapherese stark belastet werden, und bei Schwangeren, könnten, in Erwägung zu ziehen und innerhalb der Klinik zu testen. Die Plasmapräparate FFP und Octaplas® wiesen in allen Untersuchungen ADAMTS13 Aktivitäten und Antigen im mittleren bis hohen physiologischen Bereich auf. Insbesondere bei Blutgruppe 0 ließ sich beiden Präparaten eine höhere ADAMTS13 Aktivität und Antigen gegenüber den drei anderen Blutgruppen darstellen. Insgesamt waren die interindividuellen Schwankungen bei FFP deutlich höher als bei Octaplas®, was sich in der unterschiedlichen Herstellung der Präparate begründen lässt. Octaplas® ist also genauso geeignet zur Plasmapherese bei der TTP wie FFP, kann jedoch aufgrund seiner intensiveren Virusinaktivierung eine größere Sicherheit aufweisen und stellt sich auch in der Klinik als nebenwirkungsärmer dar. Bei der Gegenüberstellung der thrombotischen Mikroangiopathien konnte gezeigt werden, dass eine verminderte ADAMTS13 Aktivität ein wichtiges Unterscheidungsmerkmal ist und auch während der Remission schon diagnostizierbar werden kann. Auf der Grundlage der labordiagnostischen Werte und dem klinischen Erscheinungsbild im akuten Schub und in der Remission konnte ein diagnostischer Algorithmus für den klinischen Alltag erstellt werden. In der Methodenvalidierung erwies sich der ActifluorTMADAMTS13 Kit als der beste Kit, da er innerhalb kürzester Zeit zuverlässige Werte in Standardeinheiten liefert. Nach neuesten Erkenntnissen, bei der eine Unterscheidung von ADAMTS13 Aktivitäten über und unter 5 % von großer prognostischer Bedeutung sind, ist die BCS-Methode nach Böhm mit einer unteren Nachweisgrenze von 6,2% zu ungenau und auch hinsichtlich ihres Zeitaufwandes eher ungünstig.rn

Molecular genetics of inherited cystic kidney diseases: new diagnostic approaches

Background. Hhereditary cystic kidney diseases are a heterogeneous spectrum of disorders leading to renal failure. Clinical features and family history can help to distinguish the recessive from dominant diseases but the differential diagnosis is difficult due the phenotypic overlap. The molecular diagnosis is often the only way to characterize the different forms. A conventional molecular screening is suitable for small genes but is expensive and time-consuming for large size genes. Next Generation Sequencing (NGS) technologies enables massively parallel sequencing of nucleic acid fragments. Purpose. The first purpose was to validate a diagnostic algorithm useful to drive the genetic screening. The second aim was to validate a NGS protocol of PKHD1 gene. Methods. DNAs from 50 patients were submitted to conventional screening of NPHP1, NPHP5, UMOD, REN and HNF1B genes. 5 patients with known mutations in PKHD1 were submitted to NGS to validate the new method and a not genotyped proband with his parents were analyzed for a diagnostic application. Results. The conventional molecular screening detected 8 mutations: 1) the novel p.E48K of REN in a patient with cystic nephropathy, hyperuricemia, hyperkalemia and anemia; 2) p.R489X of NPHP5 in a patient with Senior Loken Syndrome; 3) pR295C of HNF1B in a patient with renal failure and diabetes.; 4) the NPHP1 deletion in 3 patients with medullar cysts; 5) the HNF1B deletion in a patient with medullar cysts and renal hypoplasia and in a diabetic patient with liver disease. The NGS of PKHD1 detected all known mutations and two additional variants during the validation. The diagnostic NGS analysis identified the patient’s compound heterozygosity with a maternal frameshift mutation and a paternal missense mutation besides a not transmitted paternal missense mutation. Conclusions. The results confirm the validity of our diagnostic algorithm and suggest the possibility to introduce this NGS protocol to clinical practice.

Key issues in diagnosing and treating acute aortic syndromes: results from the metropolitan area of Bologna network

Background: Survival of patients with Acute Aortic Syndrome (AAS) may relate to the speed of diagnosis. Diagnostic delay is exacerbated by non classical presentations such as myocardial ischemia or acute heart failure (AHF). However little is known about clinical implications and pathophysiological mechanisms of Troponin T elevation and AHF in AAS. Methods and Results: Data were collected from a prospective metropolitan AAS registry (398 patients diagnosed between 2000 and 2013). Troponin T values (either standard or high sensitivity assay, HS) were available in 248 patients (60%) of the registry population; the overall frequency of troponin positivity was 28% (ranging from 16% to 54%, using standard or HS assay respectively, p = 0.001). Troponin positivity was associated with a twofold increased risk of long in-hospital diagnostic time (OR 1.92, 95% CI 1.05-3.52, p = 0.03), but not with in-hospital mortality. The combination of positive troponin and ACS-like ECG abnormalities resulted in a significantly increased risk of inappropriate therapy due to a misdiagnosis of ACS (OR 2.48, 95% CI 1.12-5.54, p = 0.02). Patients with AHF were identified by the presence of dyspnea as presentation symptom or radiological signs of pulmonary congestion or cardiogenic shock. The overall frequency of AHF was 28 % (32% type A vs. 20% type B AAS, p = 0.01). AHF was due to a variety of pathophysiological mechanisms including cardiac tamponade (26%), aortic regurgitation (25%), myocardial ischemia (17%), hypertensive crisis (10%). AHF was associated with increased surgical delay and with increased risk of in-hospital death (adjusted OR 1.97 95% CI1.13-3.37,p=0.01). Conclusions: Troponin positivity (particularly HS) was a frequent finding in AAS. Abnormal troponin values were strongly associated with ACS-like ECG findings, in-hospital diagnostic delay, and inappropriate therapy. AHF was associated with increased surgical delay and was an independent predictor of in-hospital mortality.

La diagnostica molecolare nel laboratorio di patologia clinica veterinaria

La prima parte del nostro studio riguarda la tecnica LAMP (Loop-mediated isothermal amplification), una tecnica di amplificazione isotermica recentemente inventata (Notomi et al., 2000). Essa presenta notevoli vantaggi rispetto alle tradizionali PCR: non necessita di strumentazioni sofisticate come i termociclatori, può essere eseguita da personale non specializzato, è una tecnica altamente sensibile e specifica ed è molto tollerante agli inibitori. Tutte queste caratteristiche fanno sì che essa possa essere utilizzata al di fuori dei laboratori diagnostici, come POCT (Point of care testing), con il vantaggio di non dover gestire la spedizione del campione e di avere in tempi molto brevi risultati paragonabili a quelli ottenuti con la tradizionale PCR. Sono state prese in considerazione malattie infettive sostenute da batteri che richiedono tempi molto lunghi per la coltivazione o che non sono addirittura coltivabili. Sono stati disegnati dei saggi per la diagnosi di patologie virali che necessitano di diagnosi tempestiva. Altri test messi a punto riguardano malattie genetiche del cane e due batteri d’interesse agro-alimentare. Tutte le prove sono state condotte con tecnica real-time per diminuire il rischio di cross-contaminazione pur riuscendo a comprendere in maniera approfondita l’andamento delle reazioni. Infine è stato messo a punto un metodo di visualizzazione colorimetrico utilizzabile con tutti i saggi messi a punto, che svincola completamente la reazione LAMP dall’esecuzione in un laboratorio specializzato. Il secondo capitolo riguarda lo studio dal punto di vista molecolare di un soggetto che presenza totale assenza di attività mieloperossidasica all’analisi di citochimica automatica (ADVIA® 2120 Hematology System). Lo studio è stato condotto attraverso amplificazione e confronto dei prodotti di PCR ottenuti sul soggetto patologico e su due soggetti con fenotipo wild-type. Si è poi provveduto al sequenziamento dei prodotti di PCR su sequenziatore automatico al fine di ricercare la mutazione responsabile della carenza di MPO nel soggetto indicato.

Biomedical and industrial applications of atmospheric pressure non-equilibrium plasmas

This dissertation will be focused on the characterization of an atmospheric pressure plasma jet source with an application oriented diagnostic approach and the description of processes supported by this plasma source. The plasma source investigated is a single electrode plasma jet. Schlieren images, optical emission spectra, temperature and heat flux profiles are analyzed to deeply investigate the fluid dynamic, the chemical composition and the thermal output of the plasma generated with a nanosecond-pulsed high voltage generator. The maximum temperature measured is about 45 °C and values close to the room temperature are reached 10 mm down the source outlet, ensuring the possibility to use the plasma jet for the treatment of thermosensitive materials, such as, for example, biological substrate or polymers. Electrospinning of polymeric solution allows the production of nanofibrous non-woven mats and the plasma pre-treatment of the solutions leads to the realization of defect free nanofibers. The use of the plasma jet allows the electrospinnability of a non-spinnable poly(L-lactic acid) (PLLA) solution, suitable for the production of biological scaffold for the wound dressing.

Organic lasing: correlation between molecular structure, optical and optoelectronic properties

In this thesis mainly two alternating indenofluorene-phenanthrene copolymers were investigated with a variety of spectroscopic and optoelectronic experiments. The different experimental techniques allowed to retrieve deeper insights into their unique optical as well as optoelectronic properties. The motivation of the research presented in this work was to correlate their photophysical properties with respect to their application in electrically pumped lasing. This thesis begins with the description of optical properties studied by classical absorption and emission spectroscopy and successively describes an overall picture regarding their excited state dynamics occurring after photoexcitation studied by time-resolved spectroscopy. The different spectroscopic methods do not only allow to elucidate the different optical transitions occurring in this class of materials, but also contribute to a better understanding of exciton dynamics and exciton interaction with respect to the molecular structure as well as aggregation and photooxidation of the polymers. Furthermore, the stimulated emission properties were analyzed by amplified spontaneous emission (ASE) experiments. Especially one of the investigated materials, called BLUE-1, showed outstanding optical properties including a high optical gain, a low threshold for ASE and low optical losses. Apart from the optical experiments, the charge carrier mobility was measured with the time-of-flight technique and a comparably high hole mobility on the order of 1 x 10-² cm²/(Vs) was determined for BLUE-1 which makes this material promising for organic lasing. The impact of the high charge carrier mobility in this material class was further analyzed in different optoelectronic devices such as organic LEDs (OLEDs) and organic solar cells.

Endocarditis due to Tropheryma whipplei: rapid detection, limited genetic diversity, and long-term clinical outcome in a local experience

The characteristic features of Whipple's disease include abdominal pain, diarrhoea, wasting, and arthralgias, with the causative agent, Tropheryma whipplei, being detected mainly in intestinal biopsies. PCR technology has led to the identification of T. whipplei in specimens from various other locations, including the central nervous system and the heart. T. whipplei is now recognized as one of the causes of culture-negative endocarditis, and endocarditis can be the only manifestation of the infection with T. whipplei. Although it is considered a rare disease, the true incidence of endocarditis due to T. whipplei is not clearly established. With the increasing use of molecular methods, it is likely that T. whipplei will be more frequently identified. Questions also remain about the genetic variability of T. whipplei strains, optimal diagnostic procedures and therapeutic options. In the present study, we provide clinical data on four new patients with documented endocarditis due to T. whipplei in the context of the available published literature. There was no clinical involvement of the gastrointestinal tract. Genetic analysis of the T. whipplei strains with DNA isolated from the excised heart valves revealed little to no genetic variability. In a selected case, we describe acridine orange staining for early detection of the disease, prompting early adaptation of the antibiotic therapy. We provide long-term follow-up data on the patients. In our hands, an initial 2-week course of intravenous antibiotics followed by cotrimoxazole for at least 1 year was a suitable treatment option for T. whipplei endocarditis.

Pros and cons of post-mortem CT imaging on aspiration diagnosis

Recently, the field of forensics has experienced a rapid increase in the use of modern cross-sectional imaging in forensic investigations. We examined the value of post-mortem computed tomography (CT) imaging relative to autopsy for distinguishing aspiration into the lungs from airways, from lung alterations due to other causes, and for identifying the aspirated material. We selected 54 bodies submitted to whole-body CT scanning prior to autopsy. All cases had autopsy findings of blood (31 cases), fresh water (12 cases), or gastric content (11 cases) aspiration. The radiological images were retrospectively analyzed for airway and lung aspiration. In all cases, CT imaging detected pulmonary abnormalities suggestive of aspiration. Nevertheless, analysis of the CT images alone was not able to identify the aspirated material or to distinguish pulmonary findings of aspiration from lung changes due to other causes, except for a few cases of hemo-aspiration. However, due to its ability to visualize the entire parenchyma, CT imaging was superior to autopsy in providing additional data about the distribution and severity of the aspiration as well as in detecting small abnormalities. Post-mortem CT imaging should be considered as a superior tool for forensic investigations of aspiration due to its ability to document diagnostic conclusions and to guide the forensic pathologist during lung tissue examination.