Diurnal expression of hetR and diazocyte development in the filamentous non-heterocystous cyanobacterium Trichodesmium erythraeum

The marine non-heterocystous cyanobacterium Trichodesmium fixes atmospheric N(2) aerobically in light. In situ immunolocalization/light microscopy of NifH revealed that lighter, non-granulated cell regions observed correspond to the nitrogenase-containing diazocyte clusters in Trichodesmium IMS101. The number of diazocyte clusters per trichome varied from 0 to 4 depending on trichome length. The constant percentage of diazocytes (approx. 15 %) in cultured strains and five natural populations suggests a developmentally regulated differentiation process. Real-time RT-PCR showed that ntcA, encoding the global nitrogen regulator in cyanobacteria, and hetR, the key regulatory gene in heterocyst differentiation, are both constitutively expressed during a 12 h/12 h light/dark cycle. hetR in addition showed a distinct peak in the dark (close to midnight) while nifH expression commenced 6-8 h later. The expression of all three genes was negatively affected by addition of ammonia. Some early heterocyst differentiation genes were also identified in the genome of Trichodesmium. The data suggest that hetR and ntcA may be required for development and function of diazocytes in Trichodesmium.

Claudins in the tight junctions of stria vascularis marginal cells

In the mammalian cochlea, tight junctional strands are visible on freeze fracture images of marginal cells and other inner ear epithelia. The molecular composition of the strial tight junctions is, however, largely unknown. We investigated the expression of integral tight junction-proteins, claudin-1 to -4, and occludin, in stria vascularis of the guinea-pig cochlea, as compared to kidney. Western blot analysis revealed a strong expression of claudin-4 and occludin in strial tissue, and confocal immunofluorescence microscopy demonstrated their presence in the tight junctions of the marginal cells. In addition, a moderate level of claudin-3 and claudin-1 was detected and both were located in the marginal tight junctions. Claudins-1, -3, and -4 are characteristic of epithelia with low paracellular permeability and claudin-4 is known to restrict the passage of cations through epithelial tight junctions. In the marginal cells, these claudins appear to be responsible for the separation of the potassium-rich endolymph from the sodium-rich intrastrial fluid. In contrast, Western blot analysis and confocal microscopy demonstrated that the marginal cell epithelium does not contain claudin-2, which forms a cation-selective pore in tight junctions. Its absence indicates a cation-tight paracellular pathway in the marginal cells.

Differences between trunk sway characteristics on a foam support surface and on the Equitest ankle-sway-referenced support surface

Clinicians have sought ways to increase trunk sway so that it is easily observed and a balance deficit more easily identified. One technique often used for this purpose is to reduce the efficacy of ankle proprioceptive inputs on sway. To achieve this reduction either a foam mat is used as an unstable support surface or the subject stands on a surface made unstable with servo-driven ankle-sway-referencing. The purpose of the current study was to investigate differences in trunk pitch and roll sway characteristics using these techniques. Trunk sway while standing quietly on two legs was measured in 25 normal subjects in the age range 20-35 years for three support-surface conditions. Each condition was tested twice for 20 s, once with eyes open and once with eyes closed. The three conditions were standing on a foam support surface, standing on a support surface with pitch (fore-aft) ankle-sway-referencing as used for the standard Sensory Organization Test (SOT) of the Neurocom Equitest System (SOT 4 and 5), and standing with roll (lateral) ankle-sway-referencing. The latter was achieved by having the subjects stand turned 90 degrees to the standard SOT position. Two angular velocity sensors mounted on a belt measured trunk sway in the pitch and roll directions. Trunk roll angle and angular velocity amplitudes for pitch sway-referencing were reduced compared to either the foam or roll sway-referencing conditions, but trunk pitch angle and angular velocities amplitudes were greater. For roll sway-referencing, the trunk roll angle was greater than for the other stimulus conditions. Analyses of the trunk sway velocity in the frequency domain indicated that ankle-sway-referencing in the pitch direction increased trunk pitch sway at 1 Hz and decreased trunk roll sway between 2 and 5 Hz compared to foam support frequency spectra. Roll ankle-sway-referencing decreased trunk roll between 2 and 4 Hz only. These results indicate that using a foam support surface provides multidirectional trunk sway with velocity content across all frequencies in the range 0.8-5.2 Hz. Roll ankle-sway-referencing, but not pitch ankle-sway-referencing, yields trunk sway with similar characteristics to those with foam. Pitch ankle-sway-referencing forces pitch trunk resonance to be around 1 Hz and yields very different trunk sway from that obtained with a foam support surface. Roll sway-referencing is an alternative means to test multidirectional control of sway. Clinically though, foam is simpler to use and provides a more difficult balance task for the patient.

Endobronchial ultrasound-guided transbronchial lung biopsy in solitary pulmonary nodules and peripheral lesions

Transbronchial biopsy (TBBX) for peripheral lung lesions is usually performed with the help of fluoroscopy, but the yield varies widely. This feasibility study aimed to assess the ability of endobronchial ultrasound (EBUS) to provide imaging guidance for TBBX. In a prospective study, 50 consecutive patients referred for TBBX for peripheral lesions underwent fluoroscopy-guided and EBUS-guided TBBX in random order. Diagnostic yields were compared for both modalities and feasibility was assessed for EBUS. Diagnostic material was obtained in 80% of patients with EBUS and 76% of patients with fluoroscopy. There was a nonsignificant trend for EBUS to be better than fluoroscopy for lesions <3 cm in diameter. Four lesions could not be visualised with EBUS. There were no significant complications associated with the use of EBUS. Endobronchial ultrasound-guided transbronchial biopsy is feasible. It appears to be at least equivalent to fluoroscopy without the accompanying radiation exposure. Further large-scale studies are indicated to assess the possible role of endobronchial ultrasound as a potential imaging method of choice for the biopsy of peripheral lung lesions.

Endobronchial ultrasound in therapeutic bronchoscopy

Endobronchial ultrasound (EBUS) has been introduced as an adjunct to diagnostic bronchoscopy as it allows evaluation of the submucosal and parabronchial structures. Its use in therapeutic bronchoscopy has not been assessed. A large observational study of the value of EBUS in therapeutic bronchoscopy is presented here. From January 1998-January 2001 all patients undergoing therapeutic bronchoscopy and EBUS were evaluated prospectively. Patient demographics, indication for bronchoscopy, interventional treatments used and changes in therapy as influenced by the use of EBUS were documented. A total 2,446 therapeutic bronchoscopies were performed. In 1,174 cases EBUS was used (29% mechanical tumour debridement, 20% airway stenting, 13% Neodymium:yttrium aluminium garnet (Nd:YAG) laser use, 23% argon plasma coagulation, 11% brachytherapy, 2% foreign body removal and 2% endoscopic abscess drainage). EBUS guided or changed therapy significantly in 43% of cases. Changes included adjustment of stent dimensions, termination of tumour debridement when nearing vessels, and referral for surgical interventions rather than endoscopic treatment. Complications associated with EBUS use were minimal. No patient undergoing EBUS guided tumour destruction experienced severe bleeding or fistula formation. In summary, endobronchial ultrasound was easily performed and changed or guided therapeutic decisions during therapeutic bronchoscopic procedures in a substantial number of cases. As this may result in better outcomes, it has become a standard adjunct in the authors practice.

[Tracheal ruptures in endotracheal intubation. Diagnosis and therapy]

BACKGROUND

Tracheal ruptures are most frequently the result of a blunt trauma to the thorax or of forced intubation. They represent a rare, but life-threatening complication that requires immediate help.

METHODS

The resulting pneumothorax and the skin/mediastinal emphysema are the most prominent clinical signs. Injuries of the tracheobronchial tract should be diagnosed endoscopically and treated surgically immediately after the trauma.

RESULTS

The present paper reports on three cases of tracheal ruptures after forced intubation which could be successfully managed by tracheostomy and subsequent reconstruction of the defects. The postoperative care of the patients is critically discussed.

Long-term outcome and lung cancer incidence in patients with hemoptysis of unknown origin

STUDY OBJECTIVE

To provide current data on the long-term outcome and incidence of lung cancer in a large cohort of patients with hemoptysis of unknown origin.

DESIGN

A retrospective chart review followed by a telephone interview for follow-up.

SETTING

A university-affiliated tertiary referral center for pulmonary diseases.

PATIENTS

Seven hundred twenty-two patients who presented with hemoptysis from January 1990 to December 1993. One hundred thirty-five patients were identified as having hemoptysis of unknown origin.

RESULTS

One hundred thirty-five patients (19%) had hemoptysis of unknown origin; follow-up data were obtained in 115 patients, of whom 100 were still alive. The mean time of observation was 6.6 years after initial presentation. Lung cancer developed in 7 of 115 patients (6%) and was unresectable once detected; all of these patients were smokers > 40 years old, and malignancy developed within 3 years after first presentation.

CONCLUSIONS

Hemoptysis of unknown origin is present in a minority of patients presenting with hemoptysis if evaluated at a referral center for pulmonary diseases. Lung cancer seems to be increasing in these patients compared to previous studies, and closer follow-up or additional testing may be indicated in the defined population at risk.

[Mesenchymal chondrosarcomas of the facial skull]

A 13-year-old girl suffered from a mesenchymal chondrosarcoma of the left maxilla. The therapeutic options and the prognosis for this disease are described with respect to the currently known 72 cases in the literature. Mesenchymal chondrosarcomas are rare tumors of the bone and soft tissue. The first clinical symptom is a painless swelling of the facial skull. They occur largely in the 2nd and 3rd decades of life, preferentially in males. Radiological criteria for the identification of this type of tumor include focal ossification areas which are accompanied by non-calcified regions. Complete surgical removal of the tumor is the therapy of choice. Pre- and postoperative chemotherapy can have a beneficial effect. The final outcome of the disease is difficult to evaluate since late complications (e.g., reoccurrence and/or metastases) appear even after 20 years and only a small number of cases have been reported. At present, the 5-year survival rate is reported to be 54-82% and the 10-year rate 28-56%.

Documentation in bronchology

With the performance of more endoscopic procedures and newly developed diagnostic and therapeutic modalities, a wealth of information around the actual procedure is created. To date, accepted guidelines for standardized documentation are lacking. The authors present recommendations for minimal guidelines that may help to facilitate good documentation and also address future developments that will be possible with the help of computer-assisted approaches.

Successful bronchoscopic placement of tracheobronchial stents without fluoroscopy

BACKGROUND

Tracheobronchial stenting is performed increasingly often. Fluoroscopic control, which leads to significant radiation exposure for patients and staff, is recommended for the placement of metal stents.

METHODS

All consecutive patients referred to two airway centers in need of airway stenting who received stents (Ultraflex; Boston Scientific, Natick, MA) underwent placement using endoscopic guidance only. All data were collected in an ongoing continuous database.

RESULTS

One hundred stents were placed in 96 patients for central airway obstruction, and the data were reviewed. Stents were placed in all locations within the central airways for a variety of indications but mainly for malignant obstruction. No complications occurred, and all stents were placed satisfactorily.

CONCLUSION

At centers with dedicated airway teams, Ultraflex stents can be quickly and safely inserted without the need for fluoroscopy. This saves radiation exposure to patients and to staff and may lead to a more cost-effective procedure.

Hydrogen peroxide inhibits gap junctional coupling and modulates intracellular free calcium in cochlear Hensen cells

The double whole-cell patch-clamp configuration was applied to analyze gap junctional conductance (Gj) of isolated pairs of cochlear supporting Hensen cells of guinea pig under control conditions and in the presence of hydrogen peroxide (H2O2). Under control conditions, the dependence of Gj on transjunctional voltage (Vj) appeared to vary between different cell pairs with a maximum value of about 40 nS at Vj close to 0 mV. The voltage dependence and the maximum amplitude of Gj stayed constant for at least 2 hr. Addition of H2O2 to the bath at concentrations above 0.08 mm caused a significant decrease of Gj, but the membrane potential of about -30 mV was not affected. In parallel, intracellular free calcium ([Ca2+]i) was followed using fura-2. At 0.8 mm H2O2, a sustained increase of [Ca2+]i was observed, while 0.08 mm H2O2 evoked an oscillating-like behavior of [Ca2+]i. We propose that the H2O2-evoked inhibition of gap junctional coupling of Hensen cells is closely related to pathophysiological conditions such as noise- induced hearing loss, aminoglycoside-related ototoxicity and presbycusis, which are known to be associated with production of free radicals.

Fine structure of E. coli RNA polymerase-promoter interactions: alpha subunit binding to the UP element minor groove

The alpha subunit of E. coli RNAP plays an important role in the recognition of many promoters by binding to the A+T-rich UP element, a DNA sequence located upstream of the recognition elements for the sigma subunit, the -35 and -10 hexamers. We examined DNA-RNAP interactions using high resolution interference and protection footprinting methods and using the minor groove-binding drug distamycin. Our results suggest that alpha interacts with bases in the DNA minor groove and with the DNA backbone along the minor groove, but that UP element major groove surfaces do not make a significant contribution to alpha binding. On the basis of these and previous results, we propose a model in which alpha contacts UP element DNA through amino acid residues located in a pair of helix-hairpin-helix motifs. Furthermore, our experiments extend existing information about recognition of the core promoter by sigma(70) by identifying functional groups in the major grooves of the -35 and -10 hexamers in which modifications interfere with RNAP binding. These studies greatly improve the resolution of our picture of the promoter-RNAP interaction.

CT fluoroscopy guidance for transbronchial needle aspiration: an experience in 35 patients

OBJECTIVE

To demonstrate the usefulness of real-time guidance with CT fluoroscopy to improve the yield of transbronchial needle aspiration (TBNA).

DESIGN

Prospective, observational.

SETTING

A tertiary-care, university-affiliated medical center.

METHODS

From December 1998 to April 2000, 35 patients underwent CT fluoroscopy-guided TBNA. Patients with subcarinal and precarinal lymph nodes were only included if a previous attempt was nondiagnostic, as the initial yield in this setting with conventional TBNA is high. TBNA was performed using standard technique in a CT-scan suite. Needle location was confirmed with fluoroscopy without IV contrast being used. Specimens were evaluated on-site for adequacy.

RESULTS

The procedure had to be aborted in three patients before TBNA could be performed. Samples were obtained in 32 patients. Samples were nondiagnostic in four patients. Adequate tissue was obtained in 28 of 32 patients (87.5%). Twenty-two patients had a specific benign or malignant diagnosis made, and 6 patients had lymphocytes only on the specimen. In follow-up, only one of these six patients proved to have a malignancy. All procedures were performed within a regular interventional CT time slot of 1 h. No TBNA side effects were noted.

CONCLUSION

TBNA under CT fluoroscopic guidance is easy to perform. The yield in all accessible lymph node stations is high.

Hearing loss after spinal and general anesthesia: A comparative study

Hearing loss has been described after spinal anesthesia. We examined the hearing in patients before and after spinal and general anesthesia by pure tone audiometry (LdB: 125-1500 Hz; HdB: 2000-8000 Hz). Tympanic membrane displacement analysis was used to noninvasively monitor the intralabyrinthine and intracranial pressure. Eighteen patients received spinal anesthesia (G(SA)); 19 patients general anesthesia (G(GA)). Pure tone audiometry and TMD data were obtained preoperatively ((0)) and postoperatively on day 1 ((1)) and 2 ((2)). The mean threshold differences (Delta) in LdB(10) and LdB(20) were significantly different in G(SA) compared with G(GA) (DeltaLdB(10) + 0.15+/-3.07 dB vs. -1.34+/-3.77 dB, P = 0.05; DeltaLdB(20) -0.54+/-2.24 dB vs. -2.45+/-3.39 dB, P<0.01). However, there were no differences in DeltaHdB(10) between G(SA) and G(GA), but in DeltaHdB(20) (-1.40+/-3.95 dB vs -5.12+/- 6.35 dB, P = <0.01). We found a significant correlation between the magnitude of intraoperative intravascular volume replacement and low-frequency hearing loss. Tympanic membrane displacement values were not different pre- and postoperatively. Hearing was impaired after spinal and general anesthesia. Low-frequency hearing loss was correlated with intraoperative volume replacement. Tympanic membrane recordings did not reveal significant changes.