Biochemical mechanisms of pallidal deep brain stimulation in X-linked dystonia parkinsonism

OBJECTIVE

Invasive techniques such as in-vivo microdialysis provide the opportunity to directly assess neurotransmitter levels in subcortical brain areas.

METHODS

Five male Filipino patients (mean age 42.4, range 34-52 years) with severe X-linked dystonia-parkinsonism underwent bilateral implantation of deep brain leads into the internal part of the globus pallidus (GPi). Intraoperative microdialysis and measurement of gamma aminobutyric acid and glutamate was performed in the GPi in three patients and globus pallidus externus (GPe) in two patients at baseline for 25/30 min and during 25/30 min of high-frequency GPi stimulation.

RESULTS

While the gamma-aminobutyric acid concentration increased in the GPi during high frequency stimulation (231 ± 102% in comparison to baseline values), a decrease was observed in the GPe (22 ± 10%). Extracellular glutamate levels largely remained unchanged.

CONCLUSIONS

Pallidal microdialysis is a promising intraoperative monitoring tool to better understand pathophysiological implications in movement disorders and therapeutic mechanisms of high frequency stimulation. The increased inhibitory tone of GPi neurons and the subsequent thalamic inhibition could be one of the key mechanisms of GPi deep brain stimulation in dystonia. Such a mechanism may explain how competing (dystonic) movements can be suppressed in GPi/thalamic circuits in favour of desired motor programs.

Unfolded Protein Response in Cancer: IRE1α Inhibition by Selective Kinase Ligands Does Not Impair Tumor Cell Viability

The kinase/endonuclease inositol requiring enzyme 1 (IRE1α), one of the sensors of unfolded protein accumulation in the endoplasmic reticulum that triggers the unfolded protein response (UPR), has been investigated as an anticancer target. We identified potent allosteric inhibitors of IRE1α endonuclease activity that bound to the kinase site on the enzyme. Structure-activity relationship (SAR) studies led to 16 and 18, which were selective in kinase screens and were potent against recombinant IRE1α endonuclease as well as cellular IRE1α. The first X-ray crystal structure of a kinase inhibitor (16) bound to hIRE1α was obtained. Screening of native tumor cell lines (>300) against selective IRE1α inhibitors failed to demonstrate any effect on cellular viability. These results suggest that IRE1α activity is not essential for viability in most tumor cell lines, in vitro, and that interfering with the survival functions of the UPR may not be an effective strategy to block tumorigenesis.

The discovery of novel 3-(pyrazin-2-yl)-1H-indazoles as potent pan-Pim kinase inhibitors

The three Pim kinases are a small family of serine/threonine kinases regulating several signaling pathways that are fundamental to tumorigenesis. As such, the Pim kinases are a very attractive target for pharmacological inhibition in cancer therapy. Herein, we describe our efforts toward the development of a potent, pan-Pim inhibitor. The synthesis and hit-to-lead SAR development from a 3-(pyrazin-2-yl)-1H-indazole derived hit 2 to the identification of a series of potent, pan-Pim inhibitors such as 13o are described.

Orbital tumors: operative and therapeutic strategies

The term "orbital tumors" includes diverse benign or malignant space-occupying lesions of the orbit, often leading to dystopia of the eyeball, motility disturbances, diplopia, visual field defects, and sometimes a complete loss of vision. Removing these tumors in a limited surgical field is challenging. Therefore, the preservation of function is a primary concern. We retrospectively reviewed 671 patients with orbital tumors from October 1999 to June 2014. Diagnosis on referral, presenting symptoms, radiological records, histology of the primary tumor or orbital metastasis, and treatment choice were analyzed. Among the 671 orbital tumors, 40% were accessed anteriorly, 36% via an orbitotomy with temporary osteotomy, and 23.9% underwent an orbital exenteration. As an illustration of the operative strategies with subsequent reconstructions, a distinction was made among the main indication groups: (1) function-preserving therapy for retrobulbar tumors, (2) malignant tumors of the conjunctiva and the eyelids, (3) exenteration of the orbit and subsequent reconstruction, and (4) operative and therapeutic strategy for orbital metastases. Adequate preoperative use of modern imaging techniques and thorough planning of the operation are crucial. Accurate histopathological diagnosis is crucial for planning appropriate therapeutic and surgical interventions. New innovative treatment concepts and surgical techniques arise from the close cooperation of related disciplines such as ophthalmology and neurosurgery. Although an orbital exenteration in patients with eyelid and conjunctival carcinomas can now often be avoided, eye-preserving treatment for locally advanced carcinomas of the conjunctiva and eyelid must be attempted. For extensive orbital malignancies, orbital exenteration is curative. In this context, primary closure of the orbit can improve the patient's quality of life and avoid subsequent complications. Concerning orbital metastasis, early diagnosis can preserve function and fulfil the esthetic demands of the patients. In palliative tumor disease, operative procedures such as orbital decompression or tumor debulking can reduce patient complaints and contribute to improved quality of life.

OptiType: precision HLA typing from next-generation sequencing data

Motivation: The human leukocyte antigen (HLA) gene cluster plays a crucial role in adaptive immunity and is thus relevant in many biomedical applications. While next-generation sequencing data are often available for a patient, deducing the HLA genotype is difficult because of substantial sequence similarity within the cluster and exceptionally high variability of the loci. Established approaches, therefore, rely on specific HLA enrichment and sequencing techniques, coming at an additional cost and extra turnaround time.

Result: We present OptiType, a novel HLA genotyping algorithm based on integer linear programming, capable of producing accurate predictions from NGS data not specifically enriched for the HLA cluster. We also present a comprehensive benchmark dataset consisting of RNA, exome and whole-genome sequencing data. OptiType significantly outperformed previously published in silico approaches with an overall accuracy of 97% enabling its use in a broad range of applications.

Contact:szolek@informatik.uni-tuebingen.de

Supplementary information:Supplementary data are available at Bioinformatics online.

Tracheal intubation in patients with odentogenous abscesses and reduced mouth opening

BACKGROUND

Odentogenous abscesses with involvement of the facial or cervical spaces can be life-threatening and often have to be drained under general anaesthesia. Trismus and swelling can make intubation with a Macintosh laryngoscope difficult or even impossible. However, indirect laryngoscopy has been successful when conventional direct laryngoscopy has failed. Therefore, we evaluated the efficacy of the Glidescope laryngoscope in patients with odentogenous abscesses and the improvement in mouth opening after neuromuscular block.

METHODS

After approval of the ethics committee, 100 patients with odentogenous abscesses were randomized to undergo tracheal intubation with the Glidescope or Macintosh laryngoscope. Success rate, visualization of the glottis, intubation duration, and need for supporting manoeuvres were evaluated.

RESULTS

Intubation with the Glidescope was always successful, while conventional intubation failed in 17 out of 50 patients (P<0.0001). In all patients in whom conventional tracheal intubation failed, a subsequent attempt with the Glidescope was successful. The view at the glottis (according to Cormack and Lehane; P<0.0001), intubation duration [34 s (CI 27-41) vs 67 s (CI 52-82), mean (95% confidence interval); P=0.0001], and need for supporting manoeuvres (P<0.0001) were significantly different. The inter-incisor distance improved overall with induction of anaesthesia from 2.0 cm (CI 1.8-2.2) to 2.6 cm (CI 2.3-2.9; P<0.0001) and was correlated with the duration of symptoms.

CONCLUSIONS

In patients with odentogenous abscesses, the use of a Glidescope laryngoscope was associated with significantly faster tracheal intubation, with a better view, fewer supporting manoeuvres, and a higher success rate than with a conventional laryngoscope. Improvement of the inter-incisor distance after induction of anaesthesia correlated with the duration of symptoms.

Carrier envelope offset frequency of a doubly resonant, nondegenerate, mid-infrared GaAs optical parametric oscillator

We measure the carrier envelope offset (CEO) frequency of the mid-infrared frequency comb (wavelength tunable between 3 and 6 μm) from a doubly resonant nondegenerate synchronously pumped optical parametric oscillator (SPOPO) as a function of the CEO frequency of the Tm-fiber pump laser. We show that the CEO frequency of the SPOPO signal wave is a linear function of the CEO frequency of the pump laser, with a slope determined by the signal to pump center-frequency ratio.

Nasotracheal intubation with three indirect laryngoscopes assisted by standard or modified Magill forceps

We assessed the effect of modifying standard Magill forceps on the laryngeal introduction of an Eschmann stylet during nasotracheal intubations with three indirect laryngoscopes (Airtraq™, C-MAC(®) or GlideScope(®)) in patients with predicted difficult intubation. We allocated 50 participants to each laryngoscope. The stylet was advanced by one forceps followed by the other (standard or modified), with each sequence allocated to 25/50 for each laryngoscope. There were no differences in rates of failed tracheal intubation with the allocated laryngoscopes: 6/50, 5/50 and 5/50, respectively. An Eschmann stylet was advanced into the trachea less often with the standard forceps (65% vs 93%, p < 0.0001). Mean (SD) time for stylet advancement was longer with the standard forceps, 38 (30) vs 19 (19) s, p < 0.0001. In conclusion, the modified Magill forceps facilitated nasotracheal intubation, independent of the type of indirect laryngoscope.

Frequency comb stabilization with bandwidth beyond the limit of gain lifetime by an intracavity graphene electro-optic modulator

Intracavity loss modulation enables offset-frequency control with bandwidths beyond what is possible by pump power modulation. To demonstrate this new method, we use a subwavelength thick graphene electro-optic modulator to stabilize the offset frequency in a Tm:fiber frequency comb at 1.95 μm wavelength. Record-low residual phase noise of 144 mrads was achieved with this new locking scheme.

Widely tunable midinfrared difference frequency generation in orientation-patterned GaAs pumped with a femtosecond Tm-fiber system

We demonstrate a midinfrared source tunable from 6.7 to 12.7 μm via difference frequency generation (DFG) in orientation-patterned GaAs, with 1.3 mW average output power. The input pulses are generated via Raman self-frequency shift of a femtosecond Tm-doped-fiber laser system in a fluoride fiber. We numerically model the DFG process and show good agreement between simulations and experiments. We use this numerical model to show an improved design using longer pump pulses.

Biomass burning contributions to urban aerosols in a coastal Mediterranean city

Mean annual biomass burning contributions to the bulk particulate matter (PM(X)) load were quantified in a southern-European urban environment (Barcelona, Spain) with special attention to typical Mediterranean winter and summer conditions. In spite of the complexity of the local air pollution cocktail and the expected low contribution of biomass burning emissions to PM levels in Southern Europe, the impact of these emissions was detected at an urban background site by means of tracers such as levoglucosan, K(+) and organic carbon (OC). The significant correlation between levoglucosan and OC (r(2)=0.77) and K(+) (r(2)=0.65), as well as a marked day/night variability of the levoglucosan levels and levoglucosan/OC ratios was indicative of the contribution from regional scale biomass burning emissions during night-time transported by land breezes. In addition, on specific days (21-22 March), the contribution from long-range transported biomass burning aerosols was detected. Quantification of the contribution of biomass burning aerosols to PM levels on an annual basis was possible by means of the Multilinear Engine (ME). Biomass burning emissions accounted for 3% of PM(10) and PM(2.5) (annual mean), while this percentage increased up to 5% of PM(1). During the winter period, regional-scale biomass burning emissions (agricultural waste burning) were estimated to contribute with 7±4% of PM(2.5) aerosols during night-time (period when emissions were clearly detected). Long-range transported biomass burning aerosols (possibly from forest fires and/or agricultural waste burning) accounted for 5±2% of PM(2.5) during specific episodes. Annually, biomass burning emissions accounted for 19%-21% of OC levels in PM(10), PM(2.5) and PM(1). The contribution of this source to K(+) ranged between 48% for PM(10) and 97% for PM(1) (annual mean). Results for K(+) from biomass burning evidenced that this tracer is mostly emitted in the fine fraction, and thus coarse K(+) could not be taken as an appropriate tracer of biomass burning.

Easy and difficult nasal intubation--a randomised comparison of Macintosh vs Airtraq® laryngoscopes

A new Airtraq(®) laryngoscope has been developed for nasal intubation. We prospectively compared tracheal intubation efficiency of the Airtraq for nasotracheal intubation vs that of the Macintosh laryngoscope in 200 patients. Depending on pre-operative airway evaluation, the patients were allocated to expected easy (n = 100) or difficult (n = 100) intubation groups, on the basis of mouth opening ≤ 2.5 cm, modified Mallampati score of 4, history of difficult intubation, obvious tumour or swelling. Patients were randomly allocated to the Macintosh or nasotracheal Airtraq technique. All easy intubations were successfully performed with the respective technique. In the expected difficult intubation group, the success rate was higher (47/50 vs 33/50; p < 0.01), the glottis view was better (Cormack and Lehane 1/2/3/4 grades: 29/17/1/3 vs 5/11/18/16, p < 0.01), mean (SD) intubation time was shorter (45(46) s vs 77(47)s, p < 0.01) and the number of optimising manoeuvres was reduced with the nasotracheal Airtraq compared with the Macintosh, respectively. For difficult nasal intubations, the nasotracheal Airtraq is more effective than the Macintosh laryngoscope.

Inter-rater reliability of the Developmental Behaviour Checklist for Adults in community accommodation settings

BACKGROUND

With the publication of the Developmental Behaviour Checklist for Adults (DBC-A), people of all ages with intellectual disability (ID) can now be assessed using a carer-completed screening checklist of emotional and behavioural disturbance. This provides a broad assessment framework across the life span, assists the process of clinical assessment, diagnosis and management, and, through efficient screening, helps ensure that people with ID and high levels of disturbed behaviour are more likely to receive the often scarce and costly behavioural and mental health services that are available. Earlier studies have reported acceptable results of test-retest reliability studies with family members and paid carers in community settings and the results of an inter-rater reliability study completed with family members. This study reports on another aspect of DBC-A reliability, inter-rater reliability with paid carers, in two small community-based accommodation settings.

METHOD

Participants were 38 pairs of paid carers employed by two non-government agencies providing residential services in small group homes to 38 adults with ID in the community.

RESULTS

An intraclass correlation coefficient (ICC) of 0.69 (n = 38, 95% CI 0.54-0.86) was found between pairs of paid carers employed in small group homes.

DISCUSSION

  Pairs of paid carers working with adults with ID in small group homes reliably completed DBC-A checklists. An ICC result of 0.69 compares favourably with the results of an earlier inter-rater study completed with the family members of people with ID living in the community. Inter-rater reliability on the six DBC-A sub-scales was also computed and the results were satisfactory.

CONCLUSIONS

The carer-completed DBC-A provides a broad and comprehensive survey of the emotional and behavioural problems of adults with ID. It has satisfactory psychometric properties, which have been further extended. The DBC-A can be used in clinical, research and service settings to assess psychopathology across the adult life span in people with ID.

Passiflora incarnata L. (Passionflower) extracts elicit GABA currents in hippocampal neurons in vitro, and show anxiogenic and anticonvulsant effects in vivo, varying with extraction method

Potential mechanisms of Passiflora incarnata extracts and the effect of extraction methods on ingredients and biological effects were explored. Using the same batch of plant material, total flavonoid yields as measured by high-performance liquid chromatography coupled to diode array detection (HPLC-DAD) increased substantially with hot versus cold extraction methods. Whole Passiflora extract induced prominent, dose-dependent direct GABA(A) currents in hippocampal slices, but the expected modulation of synaptic GABA(A) currents was not seen. GABA was found to be a prominent ingredient of Passiflora extract, and GABA currents were absent when amino acids were removed from the extract. Five different extracts, prepared from a single batch of Passiflora incarnata, were administered to CF-1 mice for 1 week in their drinking water prior to evaluation of their behavioral effects. Anticonvulsant effects against PTZ-induced seizures were seen in mice that received 2 of the 5 Passiflora extracts. Instead of the anxiolytic effects described by others, anxiogenic effects in the elevated plus maze were seen in mice receiving any of the 5 Passiflora extracts.

miR-145-dependent targeting of junctional adhesion molecule A and modulation of fascin expression are associated with reduced breast cancer cell motility and invasiveness

Micro RNAs are small non-coding RNAs, which regulate fundamental cellular and developmental processes at the transcriptional and translational level. In breast cancer, miR-145 expression is downregulated compared with healthy control tissue. As several predicted targets of miR-145 potentially regulate cell motility, we aimed at investigating a potential role for miR-145 in breast cancer cell motility and invasiveness. Assisted by Affymetrix array technology, we demonstrate that overexpression of miR-145 in MDA-MB-231, MCF-7, MDA-MB-468 and SK-BR-3 breast cancer cells and in Ishikawa endometrial carcinoma cells leads to a downregulation of the cell-cell adhesion protein JAM-A and of the actin bundling protein fascin. Moreover, podocalyxin and Serpin E1 mRNA levels were downregulated, and gamma-actin, transgelin and MYL9 were upregulated upon miR-145 overexpression. These miR-145-dependent expression changes drastically decreased cancer cell motility, as revealed by time-lapse video microscopy, scratch wound closure assays and matrigel invasion assays. Immunofluorescence microscopy demonstrated restructuring of the actin cytoskeleton and a change in cell morphology by miR-145 overexpression, resulting in a more cortical actin distribution, and reduced actin stress fiber and filopodia formation. Nuclear rotation was observed in 10% of the pre-miR-145 transfected MDA-MB-231 cells, accompanied by a reduction of perinuclear actin. Luciferase activation assays confirmed direct miR-145-dependent regulation of the 3'UTR of JAM-A, whereas siRNA-mediated knockdown of JAM-A expression resulted in decreased motility and invasiveness of MDA-MB-231 and MCF-7 breast cancer cells. Our data identify JAM-A and fascin as novel targets of miR-145, firmly establishing a role for miR-145 in modulating breast cancer cell motility. Our data provide a rationale for future miR-145-targeted approaches of antimetastatic cancer therapy.

Course of pattern-reversed visual evoked cortical potentials in 30 eyes after bony orbital decompression in dysthyroid optic neuropathy

AIM

To investigate optic nerve function using the pattern-reversed visual evoked cortical potentials (VECP) before and after bony orbital decompression in dysthyroid optic neuropathy (DON) due to Graves' disease.

METHODS

A total of 30 eyes of 15 patients (n=14 female) were observed over 30 ± 13 months after bony three-wall orbital decompression. We examined visual acuity (VA), VECP P100 amplitudes and latencies, as well as proptosis using Hertel's exophthalmometry.

RESULTS

Mean logarithm of the minimum angle of resolution (logMAR) VA increased, statistically significantly, by 2.4 lines during 30 ± 13 months (from 0.38 ± 0.25 before surgery to 0.14 ± 0.1 at the end of observation, p=0.0001). All eyes maintained or improved vision by at least one line. Mean postoperative reduction of proptosis was 6.4 ± 3 mm. While VECP P100 amplitudes improved significantly, P100 latencies remained abnormal in 18 eyes (60%) during follow-up of 10 ± 7 months. Nine eyes (30%) with previous latency defects improved in at least one check test, five of which normalised completely. Worsening was evident in seven eyes (23%), and three previously normal eyes developed new pathological latencies. P100 latencies in 14 eyes (47%) remained unchanged.

CONCLUSION

After decompression surgery, DON remission was observed in all patients regarding vision and VECP amplitudes. New or persistent P100 latency defects were seen in 60% of eyes after surgery. DON is considered to be caused by compressive ischaemic damage, which further underlines the importance of early decompression surgery.

Vesicular GABA release delays the onset of the Purkinje cell terminal depolarization without affecting tissue swelling in cerebellar slices during simulated ischemia

Neurosteroids that can enhance GABA(A) receptor sensitivity protect cerebellar Purkinje cells against transient episodes of global brain ischemia, but little is known about how ischemia affects GABAergic transmission onto Purkinje cells. Here we use patch-clamp recording from Purkinje cells in acutely prepared slices of rat cerebellum to determine how ischemia affects GABAergic signaling to Purkinje cells. In voltage-clamped Purkinje cells, exposing slices to solutions designed to simulate brain ischemia caused an early, partial suppression of the frequency of spontaneous inhibitory post synaptic currents (sIPSCs), but after 5-8 min GABA accumulated in the extracellular space around Purkinje cells, generating a large (approximately 17 nS), sustained GABA(A) receptor-mediated conductance. The sustained GABA(A) conductance occurred in parallel with an even larger (approximately 117 nS) glutamate receptor-mediated conductance, but blocking GABA(A) receptors did not affect the timing or magnitude of the glutamate conductance, and blocking glutamate receptors did not affect the timing or magnitude of the GABA(A) conductance. Despite the lack of interaction between GABA and glutamate, blocking GABA(A) receptors significantly accelerated the onset of the Purkinje cell "ischemic" depolarization (ID), as assessed with current-clamp recordings from Purkinje cells or field potential recordings in the dendritic field of the Purkinje cells. The Purkinje cell ID occurred approximately 2 min prior to the sustained glutamate release under control conditions and a further 1-2 min earlier when GABA(A) receptors were blocked. Tissue swelling, as assessed by monitoring light transmittance through the slice, peaked just after the ID, prior to the sustained glutamate release, but was not affected by blocking GABA(A) receptors. These data indicate that ischemia induces the Purkinje cell ID and tissue swelling prior to the sustained glutamate release, and that blocking GABA(A) receptors accelerates the onset of the ID without affecting tissue swelling. Taken together these data may explain why Purkinje cells are one of the most ischemia sensitive neurons in the brain despite lacking NMDA receptors, and why neurosteroids that enhance GABA(A) receptor function protect Purkinje cells against transient episodes of global brain ischemia.

Chemically-resolved volatility measurements of organic aerosol fom different sources

A newly modified fast temperature-stepping thermodenuder (TD) was coupled to a High Resolution Time-of-Flight Aerosol Mass Spectrometer for rapid determination of chemically resolved volatility of organic aerosols (OA) emitted from individual sources. The TD-AMS system was used to characterize primary OA (POA) from biomass burning, trash burning surrogates (paper and plastic), and meat cooking as well as chamber-generated secondary OA (SOA) from alpha-pinene and gasoline vapor. Almost all atmospheric models represent POA as nonvolatile, with no allowance for evaporation upon heating or dilution, or condensation upon cooling. Our results indicate that all OAs observed show semivolatile behavior and that most POAs characterized here were at least as volatile as SOA measured in urban environments. Biomass-burning OA (BBOA) exhibited a wide range of volatilities, but more often showed volatility similar to urban OA. Paper-burning resembles some types of BBOA because of its relatively high volatility and intermediate atomic oxygen-to-carbon (O/C) ratio, while meat-cooking OAs (MCOA) have consistently lower volatility than ambient OA. Chamber-generated SOA under the relatively high concentrations used intraditional experiments was significantly more volatile than urban SOA, challenging extrapolation of traditional laboratory volatility measurements to the atmosphere. Most OAs sampled show increasing O/C ratio and decreasing H/C (hydrogen-to-carbon) ratio with temperature, further indicating that more oxygenated OA components are typically less volatile. Future experiments should systematically explore a wider range of mass concentrations to more fully characterize the volatility distributions of these OAs.

Reconstructive oral and maxillofacial surgery

BACKGROUND

The incidence of malignancies in the head and neck region is rising. Head and neck tumors are the eighth most frequent type of malignancy in German men, forming 3.3% of the total. As a result, the demand for functionally successful and esthetically pleasing reconstructions has increased.

METHODS

Review based on a selective analysis of the pertinent literature and the guidelines of the German Association of Oral and Maxillofacial Surgery as well as the authors' clinical and scientific experience.

RESULTS

Microsurgical flap transfer has become the most important type of reconstruction, with a more than 90% rate of success, i.e., complete integration of the transplant in the recipient site. The most frequent complications are thromboses of the vein or artery of the pedicle. For each specific defect constellation, the most appropriate donor sites have been identified. Some donor sites are used for more than one defect. The principal risk factors for flap loss are prior operations on the neck, atherosclerosis, and previous radiation treatment. New developments include the use of perforator flaps, which can be anastomosed to very small vessels in the face, and wrist-carriers, which offer complete independence from head and neck vessels.

CONCLUSION

The treatment, rehabilitation, and follow-up care of patients with tumors of the head and neck must be carried out by an interdisciplinary team. Full awareness of the available options for reconstruction helps the radiation therapist, oncologist, psychooncologist, general practitioner, and dentist to coordinate their efforts and advise their often mutilated and sometimes suicidal patients effectively.

[Epidemiology and management in emergency room patients with maxillofacial fractures]

OBJECTIVE

To minimize overall mortality and optimise reconstructive and cosmetic outcome in severely injured patients with maxillofacial injuries the interdisciplinary coordination of several surgical disciplines is required. It is still discussed controversy whether patients with maxillofacial fractures benefit from early fracture repair or if delayed operative management also yields in good results.

METHODS

Herein we analysed the data of 1252 severely injured patients between May 1998 through June 2002 in our trauma department regarding fractures of the maxillofacial region, injury severity, length of ICU stay and postoperative complications in patients with either early (within 72 hours) or delayed ( > 3 days) facial fracture repair.

RESULTS

147 patients had severe facial fractures. Average age was 39.8 years (3-87 years), mean ICU was 25 (+/- 16) and the overall mortality 12% (n = 18). The most common cause for the injuries were traffic accidents in 45%. 78 patients (53%) underwent surgical repair of the maxillofacial fractures; 18 patients had early fracture repair and 60 patients had delayed operative repair. We found 4 complications (22%) in the early repair group and 13 local complications (21%) in the group with delayed surgical repair.

CONCLUSION

Delayed repair of maxillofacial injuries in severely injured patients is feasible and yields in good results compared to early fracture repair.

The forearm flap: assessment of functional and aesthetic outcomes and quality of life

PURPOSE

Microvascular surgery frequently represents the only possibility to reach satisfactory cosmetic and functional outcomes after tumor resection in the head and neck. We present the functional and aesthetic outcomes and quality of life (QOL) of our patients who underwent a forearm flap transfer.

PATIENTS AND METHODS

Thirty-one patients who were operated on in the departments of oral and maxillofacial surgery and otorhinolaryngology of the University of Essen participated in the study. Grip power, pinch power, and range of motion at the wrist as well as that in the metacarpophalangeal joints were measured. A sensory assessment including 2-point discrimination, temperature discrimination, and documentation of numbness, paresthesia, and scar pain was performed. The changes in hemodynamics were evaluated with digital optical blood pressure measurement and digital electronic pulse oscillography. Aesthetic satisfaction was investigated with an ordinal scale. Forearm circumference and hair growth on the flap were documented. Quality of life was evaluated with the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3) and H&N35 (Head and Neck Module) after medical treatment and wound healing.

RESULTS

Strength, range of motion, and forearm circumference measurements showed no impairment in comparison with the opposite forearm. Subjective sensory disturbances were found in 31% of the patients but were all regarded as nondisturbing. On the split-thickness graft at the forearm, diminished sensory function could be proven and missing temperature discrimination was revealed in 93%. Evaluation of the hemodynamics showed clinical unremarkable vascularization changes, although slight differences were detectable in the collective. Female (64%) and male (77%) patients rated the aesthetic outcome in their forearm in most cases as good. Hair growth on the transplant could be observed, but it decreased with time and disturbed only a few patients in the oral cavity (14%). In comparison with normative data from a general German population, the QOL assessment showed that patients with tumors stated a similar QOL with regained emotional, cognitive, social, and role functioning. There were significant differences in the symptom scales and single items of the EORTC QLQ-C30 and H&N35. In comparison with a collective of patients with tumors of the oral cavity that were treated with various therapies, no difference was detectable.

CONCLUSIONS

Correct planning and elevation presupposed, there will be no clinically relevant finding in strength, motion, and hemodynamics in the forearm and hand after free forearm flap transfer. Sensory findings are present after the operation but decrease with wound healing or are nondisturbing. In this study, the patients with tumors judged the aesthetic result in their forearm in most cases as good. They stated a high QOL with regained emotional, cognitive, social, and role functioning, although they perceived symptoms caused by the tumor and therapy.

Inter-Rater Reliability of the Diagnoses of Psychosis and Depression in Individuals with Intellectual Disabilities

BACKGROUND: There is a history of over-prescription of antipsychotics to individuals with intellectual disability (ID), while antidepressants may be under-prescribed. However, appropriate treatment is best supported when the diagnosis of psychosis or depression is valid and carries good predictive validity. The present authors report a study examining one aspect of validity, namely whether skilled clinicians can agree on whether an individual with an ID is psychotic or depressed. MATERIALS AND METHODS: Pairs of clinicians assessed 52 individuals. Agreement was assessed using Cohen's kappa statistic and agreement proportion. RESULTS: Overall agreement was high for both psychosis and depression. Whether the individual had mild ID or moderate/severe ID did not have a significant impact on agreement. CONCLUSIONS: Experienced clinicians achieved a high level of agreement as to whether a person with ID was psychotic or depressed similar to that found for those without ID. The findings provide some support for treatment interventions based on diagnosis.

Discovery of ligands for Nurr1 by combined use of NMR screening with different isotopic and spin-labeling strategies

A comprehensive approach to target screening, hit validation, and binding site determination by nuclear magnetic resonance (NMR) spectroscopy is presented. NMR (19)F signal perturbation was used to screen a small compound library and identify candidate ligands to the target of interest. Ligand dissociation constants were measured using a pegylated form of the protein, which resulted in a 2-fold increase in the strength of the saturation transfer difference signal. The initial small-molecule hits were further optimized by combining a residue-specific labeling strategy, to identify the specific sites of interaction with the protein, with a second site screening approach based on relaxation enhancement using a paramagnetic probe. The advantages of this combination strategy in the identification and optimization of weak binding chemical entities early in a program are illustrated with the discovery of a low micromolar ligand (K(d) = 20 microM) for Nurr1 and identification of the binding site location through residue-specific (15)N isotope labeling and derivatization of Cys residues with 2-mercaptoethanol-1-(13)C.