Precarious adolescence: Adolescent rickets and anterior sacral angulation in two Dutch skeletal collections from the 18th-19th centuries

OBJECTIVE

This project aims to provide an objective approach to suggesting cases of adolescent rickets using the presence of anterior sacral angulation and interglobular dentine.

MATERIALS

Sacra from 49 individuals from Hattem and 150 individuals from Middenbeemster, and second and third molars from five individuals from Hattem were analyzed. Both sites date to the 17th to 19th centuries.

METHODS

The sacra were visually assessed for sacral angulation and measured to quantify anterior sacral angulation. The sampled molars were thin sectioned to look for the presence of interglobular dentine.

RESULTS

Metric analysis determined that seven individuals had significantly anteriorly angled sacra. Three of the five individuals with sampled molars had interglobular dentine formed during adolescence.

CONCLUSIONS

Adolescent rickets may be associated with anterior sacral angulation.

SIGNIFICANCE

Anterior sacral angulation may help identify possible cases of adolescent rickets in archaeological human remains.

LIMITATIONS

The small sample size for the molars prevented the identification of more individuals with interglobular dentine present during adolescence. Several individuals with visibly angled sacra were unmeasurable due to post-mortem damage and lacked molars.

SUGGESTIONS FOR FURTHER RESEARCH

Research on a larger sample would allow us to understand better the association between anterior sacral angulation and adolescent rickets.

Keratin films for ocular surface reconstruction: Wound healing in an in-vivo model

The most commonly used tissue substitute for ocular surface reconstruction is human amniotic membrane (AM). Because of its low biomechanical strength and intransparency there is a need to search for alternatives of consistent quality. This study, further explored the biocompatibility of Keratin Film (KF) and its ability to sustain corneal epithelial wound healing. In three equal groups of 5 New Zeeland white rabbits a 4 mm superficial keratectomy was created in the right eye. Five eyes received a KF, five a human AM graft and the remaining five no implant. All eyes were treated with ofloxacin and dexamethasone eye drops and followed up for 10 days. Corneal fluorescein staining, vascularization, and transparency were assessed using slit lamp biomicroscopy according to a standardized grading score during and at the end of follow-up. The corneal-scleral-button was excised and processed for histology. After 10 days all eyes which had received a KF showed complete epithelial healing and no signs of neovascularization. In the AM group 1 eye showed a persistent epithelial defect at day 10 and 2 eyes showed neovascularization at day 7 resolving at day 10. Transparency improved progressively both in the KF group as well as in the AM group towards the end of the follow. Histology showed a multilayer epithelium firmly adherent to the KF with no evidence of keratocyte migration or inflammatory reaction in the corneal stroma. In this study on rabbit eyes KF better supported corneal epithelial wound healing than amniotic membrane.

DMEK after penetrating keratoplasty: cohort with DMEK grafts and descemetorhexis larger than full-thickness graft

PURPOSE

The study aims to evaluate visual outcome, central corneal thickness, and rebubbling rate in a cohort with oversized DMEK grafts after failed penetrating keratoplasty (PK). The unique feature of the study is a descemetorhexis diameter larger than the full-thickness graft, i.e., peripheral to the PK interface.

METHODS

A monocentric, retrospective evaluation of all patients with endothelial graft failure after PK treated with an oversized DMEK graft and descemetorhexis outside of the PK interface (i.e., in host tissue) between January 2015 and July 2019 at the Department of Ophthalmology at the University of Düsseldorf (Germany) was performed.

RESULTS

Eleven eyes of 10 patients were identified. Mean age was 69 years. On average (arithmetic mean ± standard deviation), 1.7 ± 1.0 previous PKs have been performed per eye in this cohort. The mean time between last PK and DMEK was 10.1 ± 7.3 years (range 2 to 23 years). In all cases, the graft diameter exceeded the diameter of the previous PK and descemetorhexis was performed in host tissue, that is, peripheral to the graft-host interface. Rebubbling was performed in 18.2% of the patients (n = 2 eyes) because of central graft detachment. Mean central corneal thickness showed a statistically significant improvement at 5.3 ± 3.5 months after surgery from 688.23 ± 151.01 to 527.75 ± 88 µm (p = 0.002). Visual acuity increased significantly by 5 lines from 1.24 ± 0.5 logMAR (range from 0.5 to 2) to 0.73 ± 0.76 logMAR (range from 0.1 to 2) within 3 months (p = 0.006). Excluding patients without visual potential and transplant failure, visual acuity improved significantly by 8 lines (p < 0.001), and stayed stable until the last follow-up at 15.1 ± 11.4 months (range 6 to 39 months, p < 0.001, n = 8) after surgery.

CONCLUSION

DMEK can be successfully used to treat endothelial cell failure after PK, and can provide good postoperative results with regards to visual acuity. This study shows that stripping of Descemet's membrane (DM) peripheral to the PK interface is surgically feasible. Overlapping, larger DMEK grafts with more endothelial cells can be used without increasing rebubbling rates and may potentially improve long-term graft survival.

A novel method for calibrating head models to account for variability in conductivity and its evaluation in a sphere model

The accuracy in electroencephalography (EEG) and combined EEG and magnetoencephalography (MEG) source reconstructions as well as in optimized transcranial electric stimulation (TES) depends on the conductive properties assigned to the head model, and most importantly on individual skull conductivity. In this study, we present an automatic pipeline to calibrate head models with respect to skull conductivity based on the reconstruction of the P20/N20 response using somatosensory evoked potentials and fields. In order to validate in a well-controlled setup without interplay with numerical errors, we evaluate the accuracy of this algorithm in a 4-layer spherical head model using realistic noise levels as well as dipole sources at different eccentricities with strengths and orientations related to somatosensory experiments. Our results show that the reference skull conductivity can be reliably reconstructed for sources resembling the generator of the P20/N20 response. In case of erroneous assumptions on scalp conductivity, the resulting skull conductivity parameter counterbalances this effect, so that EEG source reconstructions using the fitted skull conductivity parameter result in lower errors than when using the standard value. We propose an automatized procedure to calibrate head models which only relies on non-invasive modalities that are available in a standard MEG laboratory, measures under in vivo conditions and in the low frequency range of interest. Calibrated head modeling can improve EEG and combined EEG/MEG source analysis as well as optimized TES.

[Descemetectomy : An alternative to transplantation?]

Due to rising demand worldwide it is becoming increasingly more difficult to satisfy the needs for human corneal transplants. At this point transplantation is the only possible cure for endothelial diseases, such as Fuchs endothelial dystrophy. In this article we present descemetectomy, a circumscribed removal of Descemet's membrane (DMx) without subsequent transplantation, as new possible treatment option on the basis of a clinical case.

Medium-grade tubular proteinuria is common in HIV-positive patients and specifically associated with exposure to tenofovir disoproxil Fumarate

OBJECTIVES

The aim of this cross-sectional study was to evaluate the prevalence and risk factors of medium-grade proteinuria (100-500 mg/g creatinine) among HIV-positive adults.

METHODS

Spot urine samples of HIV-positive adults without known renal disease were analyzed quantitatively between January 2009 and February 2011. Demographic and medical data were collected. Multivariate regression models for different patterns of proteinuria were constructed.

RESULTS

Among 411 patients, 18 (4.4 %) presented albuminuria >300 mg/g creatinine and/or proteinuria >500 mg/g creatinine and were excluded from further analyses. Among the study population of 393 patients, 181 (46.1 %) had no significant proteinuria or albuminuria (<100 and <30 mg/g creatinine, respectively), 60 (15.3 %) had moderate albuminuria, while 152 (38.7 %) had proteinuria without albuminuria, suggesting tubular proteinuria. Independent predictors for medium-grade tubular proteinuria in multivariate analysis were exposure to tenofovir (DF), a CD4 nadir <500/µl, older age, and anti-HCV-antibodies. There was no association with classic renal risk factors like diabetes mellitus and arterial hypertension, or with estimated glomerular filtration rate (eGFR).

CONCLUSIONS

We detected significant proteinuria in 230 (56.0 %) of 411 HIV-positive patients. Among this group, 152 (66.1 %) had medium-grade proteinuria without albuminuria, which was significantly associated with exposure to tenofovir, older age, a lower CD4 nadir and Hepatitis C. Nephrologic or HIV treatment guidelines fail to detect most of these patients but rather identify patients with high cardiovascular risk. In the absence of an association with eGFR the role of medium-grade tubular proteinuria as a potential early marker of chronic kidney disease remains unclear. Prospective studies are needed.

Diagnostik von Binde- und Hornhauterkrankungen

Zytologische und histologische Methoden sind vergleichsweise selten eingesetzte, aber wichtige Hilfsmittel bei der Diagnostik von Erkrankungen der Bindehaut und Hornhaut. Die Impressionszytologie bzw. mit Bürsten gewonnene zytologische Abstriche der Konjunktiva sind einfach durchzuführen, kostengünstig und effizient. Als nicht invasive Verfahren stellen sie nur geringe Anforderungen an die Patientencompliance und das manuelle Geschick des Untersuchers. Sie können rasch in Tropfanästhesie durchgeführt und bei Bedarf problemlos wiederholt werden. Ein weiteres Mittel stellt die histologische Untersuchung dar, die im Regelfall zwar eine lokale Betäubung und Exzision erfordert, aber auch eine höhere diagnostische Aussagekraft besitzt.

[Factors influencing the measurement of tear film lipid layer thickness with interferometry]

INTRODUCTION

The quantitative measurement of the tear film lipid layer thickness is a relatively new and promising method. However, so far it has not been investigated whether there is a diurnal or a day to day variability and whether certain factors are confounding the measurement of the lipid layer thickness.

MATERIALS AND METHODS

In three different experimental settings, 10 subjects without known sicca syndrome were examined at three different time points on one day, on three different days and before and after therapeutic expression of the Meibomian glands. As a comparison, the parameters tear film break-up time, tear meniscus height, diagnostic expression of the Meibomian glands and subjective symptoms, determined using the OSDI (ocular surface disease index) questionnaire, were measured.

RESULTS

The results of the study showed a smaller variation of the lipid layer thickness measurements during the day and from day to day compared to the tear film break-up time. The expression of the Meibomian glands significantly increased the lipid layer thickness. There was a correlation between the baseline values of tear film break-up time and the lipid layer thickness.

DISCUSSION

Our data showed that the lipid layer thickness as measured with the Lipiview® interferometer appears to be a relatively constant parameter over time. In addition, the expression of the Meibomian glands could be identified as a potential confounding factor. In this study we included only healthy subjects without known sicca syndrome. For the future our findings need to be validated in dry eye patients.

Illuminating the Nubian 'Dark Age': a bioarchaeological analysis of dental non-metric traits during the Napatan Period

The origins of one of the most powerful sociopolitical entities of the Nile Valley, the Napatan State (850-650BCE), are debated. Some scholars have suggested local development of this influential Nubian State, while others propose foreign involvement. This study uses a bioarchaeological approach to examine the biological affinity of these Ancient Nubians. The focal site of this research, Tombos, is one of few non-central Napatan Period sites that have been excavated and can, therefore, shed light on the broader Napatan populace. Dental non-metric trait frequencies were examined in the Tombos sample as well as in 12 comparative samples to elucidate the biological affinities of these populations. Analyses indicate that Tombos dental non-metric trait frequencies were not significantly different from the majority of Egyptian and Nubian samples examined here. Therefore, we propose that gene flow, encouraged by long-term coexistence and intermarriage in Nubia, created an Egyptian/Nubian transcultural environment. These findings suggest the Napatan population at Tombos included descendants of Egyptians and Nubians. The Napatan Tombos sample was found to significantly differ from the latter Kushite and Meroitic samples; however, these samples are so temporally removed from the Napatan Period, we suspect subsequent episodes of population movement may have contributed to this variation.

Thoracal, abdominal and thoracoabdominal aortic aneurysm

AIM

Aortic aneurysm is a complex disease affecting males and females in a different way. We analysed gender specific differences in the abdominal (AAA), thoracal (TAA) and thoraco-abdominal (TA-AA) aortic aneurysm in patients hospitalized for aortic aneurysm (AAA) in Germany.

METHODS

Detailed lists for all patients suffering from AAA, TAA or TA-AA documented in the DRG-System as principal diagnosis in the years 2010 were provided by the Federal Statistical Office.

RESULTS

The total number of cases in males was 17,731. It was more than three time higher than in females with 4657. AAA were 6.2 time more frequent in males than in females, TAA and TA-AA only 1.6 and 1.5 times, respectively. The rates of ruptured aneurysms show a steep increase in the 9th and 10th decade which is more pronounced in females. In males there is an age dependent increase in the rate of endovascular treatment of TAA and AAA. There is no such trend in females. The rate for AAA even decreases with age. The same could be shown for more complex fenestrated or branched endoprotheses. In around 20% of all male cases with TA-AA such a design is used in the 7th to the 9th decade of life. In females such a rate is only reached in the 7th decade. In older females the rate stepwise decreased.

CONCLUSION

There are gender specific differences in the rate of rupture and endovascular treatment of AAA, TAA and TA-AA in males and females in Germany. The reasons for these differences should be elucidated in order to prove whether these differences are due to actual gender specific requirements, or simply a lack of compatibility in awareness and devices.

Wnt signalling in an in vitro niche model for conjunctival progenitor cells

Mimicking an environment in vitro that is more similar to the stem cell niche in vivo, by co-culture of mitotically active conjunctival fibroblasts (HCF) with human conjunctival epithelial cells (HCECs), improves the maintenance of epithelial cells with progenitor cell characteristics during in vitro expansion. However, little is known about the pathways controlling the fate of the epithelial progenitor cells during in vitro culture. In this study, differences in gene expression between this in vitro 'niche' model and standard culture conditions, in which growth-arrested 3 T3 feeder cells and fetal calf serum are used, were explored using a genome level microarray platform, quantitative (q)RT-PCR and western blot. The microarray analysis revealed significant alterations of biological processes involved in cell proliferation, differentiation and cell death. The analysis of stem cell-related pathways indicated changes in expression of genes involved in the Wnt signalling pathway, and further investigation by qPCR revealed significant downregulation of the Wnt ligands Wnt3, Wnt4, Wnt7B and Wnt10A, Wnt receptor proteins FZD1, LRP5, LRP6, ß-catenin and TCF7L1 and important Wnt target genes, such as CCND1, also confirmed by western blot and immunocytochemistry. The results indicate that epithelial cell expansion in the HCEC-HCF co-culture system is accompanied by significant changes in expression of genes involved in the Wnt signalling pathway. This altered pathway activation might be involved in the enhanced maintenance of epithelial progenitor cells in this in vitro 'niche' model.

[Anatomic and subjective success of structured surgical treatment strategy in the management of chronic epiphora - a postoperative analysis of contentment]

BACKGROUND

Epiphora is the result of hypersecretion or reduced tear outflow because of relative or absolute obstruction of the lacrimal system. For the treatment a specific surgical procedure is usually required. Herein we present the subjective and objective findings of 243 consecutive patients with non-irritative induced epiphora, who underwent an operation in a standardised therapy scheme, which is used at the eye departments of the Universities of Lübeck and Würzburg.

PATIENTS AND METHODS

In a retrospective cohort study 243 patients were included who underwent lateral tarsal strip (n = 72), external dacryocystorhinostomy (DCR) in the case of an absolute nasolacrimal duct obstruction (NLDO) (n = 116) and relative NLDO (n = 25), DCR with canalicular surgery (n = 18) and simple canalicular surgery (n = 12) with a follow-up of at least 6 month. Common patient and cosmetical satisfaction, intensity of symptoms and further symptoms of 168 patients were evaluated by sending a questionnaire with subsequent telephone survey. Objective findings were recorded from hospital charts.

RESULTS

59.5% of the patients were free of complaints, 19.6% had an absolute decrease of symptoms (epiphora outside and in windy weather) and 20.8 % persistent epiphora (symptoms both in- and outside persisted). 81% of patients with absolute NLDO and 57% with relative NLDO were graded as being free of symptoms, 7% (24%) as a relative decrease and 12% (19%) as a persistence of symptoms. There was a significant difference in success between these indications (p = 0.018). Patency of the lacrimal system assessed by irrigation was found in 95% (absolute NLDO). Commonly, 73.8% were satisfied, 7.7% indifferent and 18.4 % not satisfied. 4 patients were cosmetically not satisfied.

CONCLUSIONS

Use of a standardised therapy scheme reduces the symptoms in 79.1% of the patients. In patients with absolute NLDO external DCR achieves an anatomic success rate of 95% and a subjective improvement in 88% with excellent cosmetic results. In comparison with absolute NLDO the success rate of relative NLDO is lower, but still with a subjective improvement in 81%. Our results show that postoperative success depends on the preoperative cause of the epiphora.