Mechanisms underlying the anti-inflammatory actions of boswellic acid derivatives in experimental colitis

Recent clinical trials of the gum resin of Boswellia serrata have shown promising results in patients with ulcerative colitis. The objective of this study was to determine whether a semisynthetic form of acetyl-11-keto-beta-boswellic acid (sAKBA), the most potent anti-inflammatory component of the resin, also confers protection in experimental murine colitis induced by dextran sodium sulfate (DSS) to compare its effects with those standard medications of ulcerative colitis like steroids and to examine whether leukocyte-endothelial cell adhesion is a major target of action of sAKBA. Clinical measurements of disease activity and histology were used to assess disease progression, and intravital microscopy was employed to monitor the adhesion of leukocytes and platelets in postcapillary venules of the inflamed colon. sAKBA treatment significantly blunted disease activity as assessed both grossly and by histology. Similarly, the recruitment of adherent leukocytes and platelets into inflamed colonic venules was profoundly reduced in mice treated with sAKBA. Because previous studies in the DSS model have shown that P-selectin mediates these blood cell-endothelial cell interactions, the expression of P-selectin in the colonic microcirculation was monitored using the dual-radiolabeled antibody technique. The treatment of established colitis with sAKBA largely prevented the P-selectin upregulation normally associated with DSS colitis. All of the protective responses observed with sAKBA were comparable to that realized in mice treated with a corticosteroid. Our findings demonstrated an anti-inflammatory effect of sAKBA and indicated that P-selectin-mediated recruitment of inflammatory cells is a major site of action for this novel anti-inflammatory agent.

Health and clinical management - comparing the clinical outcome of computerized strategies. Findings from the Section on Health and Clinical Management

OBJECTIVES

To summarize current excellent research in the field of health and clinical management.

METHODS

Synopsis of the articles selected for the IMIA Yearbook 2006.

RESULTS

Current research in the field of health and clinical management analyses impact and patient outcome of both established and recently presented approaches. Usability and effects of extracting data from computerized medical records for preventive care and surveillance issues are a topic as well as strategies for detecting adverse events.

CONCLUSIONS

The best paper selection in the field of health and clinical management shows examples of excellent research on assessment, strategies and concepts for computerized health information management approaches. The articles emphasize the necessity of carefully considering health information systems regarding their outcome and compatibility with clinical routine. A concerted management of knowledge about evaluated health information management approaches will advance this trend and should lead to a more evidence-based design of the underlying systems.

Internal carotid artery stent placement without emboli protection: Results and long-term outcome

Patients with symptomatic > or = 60% (n = 134), asymptomatic > or = 80% (n = 143), and asymptomatic progressive > or = 60% (n = 25) internal carotid artery stenosis underwent stenting and were followed clinically and by Doppler-assisted duplex imaging for 27.1 +/- 15.6 months. Stroke and death from stroke occurred within 30 days after stenting in 4.7% of the symptomatic and in 3.0% of the asymptomatic patients and in the follow-up period in 2.3% of the symptomatic and in 1.2% of the asymptomatic patients.

Analysis and Specification of Telemedical Systems Using Modelling and Simulation: the MOSAIK-M Approach

BACKGROUND AND MOTIVATION

INCA (Intelligent Control Assistant for Diabetes) is a project funded by the EU with the objective to improve diabetes therapy by creating a personal control loop interacting with telemedical remote control. Development of telemedical systems generally is a complex task especially in international projects where engineering and user groups with different social and cultural background have to be included into the system development process.

OBJECTIVES

To explore if and how sophisticated information system modelling and simulation techniques can improve the development of telemedical systems.

METHODS

For system analysis and design the MOSAIK-M approach was chosen. MOSAIK-M means "Modelling, simulation, and animation of information and communication systems in medicine". It includes a generic process scheme, a meta model and a tool environment. The generic process scheme guides modelling projects to produce models of high quality in terms of correctness, completeness and validity. The meta model defines the modelling language.In INCA MOSAIK-M is used for analysis of the problem domain, specification of the telemedical system and cost/benefit-analysis.

RESULTS

The MOSAIK-M approach was used to create two models: an "As Is"-model of the problem domain and a "To Be"-model of the INCA system. The "As Is"-model of conventional insulin pump based diabetes care comprises submodels of diabetes management, ambulatory and clinical care. The "To Be"-model describes a patient's diabetes management using a smart phone that controls an insulin pump based on continuously measured interstitial glucose. It also describes telemedical care of a patient by diabetologists and a call centre. Both models can be simulated enhanced by visualisation capabilities to explore specific cases or scenarios. This feature proved valuable for the evaluation of both models through domain experts. The "To Be" model is used to guide the implementation of the system. Both models are being augmented by cost structures to support cost/benefit-analysis.

CONCLUSIONS

Even a complex telemedical system like the INCA system can be successfully specified using sophisticated modelling and simulation based approaches like MOSAIK-M. The resulting specification is a result of its own and ensures a lasting effect of the definitions and specifications produced during the project. International cooperation and evaluation of the system design prior to its implementation profit from simulation and visualisation capabilities of MOSAIK-M.

PrP Sc-like prion protein conformer in sudden infant death syndrome brain

Nothing is known about the pathophysiology of sudden infant death syndrome (SIDS). Here we show the presence of misfolded prion protein (PrP(Sc)-like) in extracts of various sections of the brains of two SIDS victims. DNA sequence information for one of these (death at 12 days) revealed two nucleotide variants in the protein coding region of the PrP gene. This may be a key finding in the understanding of SIDS pathology, and may suggest ways for identifying risk factors for SIDS in newborn infants.

Spontaneous remission in adult acute myeloid leukemia in association with systemic bacterial infection-case report and review of the literature

Spontaneous remission of acute myeloid leukemia in the adult is a rare event. We report on a 31-year-old male patient suffering from acute myeloid leukemia (AML) M5a according to the French-American-British (FAB) classification with biphenotypic features in flow cytometric examination and severe bacterial infection with group G streptococci at the time of diagnosis. Because of sepsis and stable clinical conditions, chemotherapy was delayed and antibiotics were administered intravenously. Within 6 weeks a spontaneous remission of AML occurred. Remission lasted for about 2 months. At the time of relapse, a change in phenotype of the leukemic blasts with a loss of B-lymphoid markers could be demonstrated by flow cytometry. The patient was treated with an induction therapy according to the multicentric German AMLCG 2000 schedule. To our knowledge, this is the first report of a spontaneous remission in an AML FAB M5a associated with coexpression of myeloid- and lymphoid-associated antigens on the leukemic blasts. Possible mechanisms of this phenomenon are discussed with a review of the literature.

A broader horizon of Alzheimer pathogenesis: ALZAS--an early serum biomarker?

Recently, a novel risk gene protein expressed in elderly patients with the diagnosis of Alzheimer disease (AD) was discovered on chromosome 21 within the APP (amyloid precursor protein) region. This 79 amino acid protein, ALZAS (Alzheimer Associated Protein) contains the beta-amyloid peptide 1-42 fragment, the APP transmembrane signal, and a unique 12 amino acid c-terminal which is not present in any known allele of the APP gene. Reverse transcription-PCR revealed that the transcript of ALZAS was expressed in cortical and hippocampal regions of human Alzheimer disease brain as well as in leukocytes derived from AD patients. Most specifically, an endogenous antibody was found in patients with confirmed AD, in patients with depression, and in subjects suggested to have presymptomatic AD, where it was directed against epitopes within the intron encoded amino acid c-terminal sequence.

Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery

BACKGROUND

Pain is a sensory and emotional experience that is influenced by physiologic, sensory, affective, cognitive, socio-cultural, and behavioral factors. Consistent with the perspective to improve the postoperative pain control, the present study has the purpose of assessing the effect of presurgical clinical factors, psychological and demographic characteristics as predictors for reporting moderate to intense acute postoperative pain.

METHODS

A prospective cohort study was performed with 346 inpatients undergoing abdominal elective surgery (ASA physical status I-III, age range 18-60 years). The measuring instruments were Pain Visual Analog Scale, the State-Trait Anxiety Inventory, and the Montgomery-Asberg Depression Rating Scale. Multivariate conditional regression modeling was used to determine independent predictors for moderate to intense acute postoperative pain.

RESULTS

Moderate to intense acute postoperative pain was associated with status ASA III (odds ratio (OR) = 1.99), age (OR = 4.72), preoperative moderate to intense pain (OR = 2.96), chronic pain (OR = 1.75), high trait-anxiety and depressive mood moderate to intense (OR = 1.74 and OR = 2.00, respectively). Patients undergoing surgery to treat cancer presented lower risk for reporting moderate to intense pain OR = 0.39, as well as those that received the epidural analgesia and multimodal analgesia with systemic opioid (OR = 0.09 and OR = 0.16, respectively).

CONCLUSIONS

The identification of predictive factors for intense acute postoperative pain may be useful for designing specific preventive interventions to relieve patient suffering. Especially because few of these variables are accessible for medical intervention, which would improve the clinical outcomes and quality of life of patients at risk of moderate to intense acute postoperative pain.

Alterations of the cyclin D1/pRb/p16(INK4A) pathway in multiple myeloma

The retinoblastoma protein (pRb), p16(INK4A), D-type cyclins, and their partners cyclin-dependent kinase (CDK) 4 and 6 constitute a G(1) regulatory pathway commonly targeted in tumorigenesis. Several malignancies show a reciprocal correlation between genetic alterations of single members of the pRb pathway. Therefore, we determined the frequency of Rb deletions and cyclin D1 alterations by fluorescence in situ hybridization as well as 5' CpG island hypermethylation of the p16(INK4A)gene using methylation-specific polymerase chain reaction in bone marrow mononuclear cells from 82 individuals with plasma cell disorders. Alterations in at least one of the components of the pathway were found in 75%. Cyclin D1 translocations or amplifications were detected in 14/82 (17.1%), Rb deletions at 13q14 in 23/82 (28%) of the cases, including three (3.6%) homozygous deletions. p16(INK4A) was hypermethylated in 33/57 (57.9%) of the samples. Further analysis revealed a highly significant correlation between cyclin D1 alterations and extramedullar or leukemic myeloma manifestations (P = 0.014; Fisher's test). Whereas Rb deletions seemed to occur alternatively to cyclin D1 alterations, no reciprocal correlation was found between p16(INK4A) hypermethylations and cyclin D1 or Rb locus aberrations. Cyclin D1 locus alterations and Rb deletions were associated with a significantly worse prognosis whereas p16(INK4A) hypermethylation had no impact on survival. We conclude that cyclin D1 and Rb aberrations seem to occur as alternative events in plasma cell malignancies and contribute to clinical course and prognosis. In contrast, although p16(INK4A) hypermethylation is frequent, inactivation of p16(INK4A) seems not to be involved in the pathogenesis of plasma cell disorders.

[Effects of the intensity of a post partum examination on the fertility performance of high yielding dairy cows]

Two methods for a scheduled post partum examination were compared on a commercial dairy farm. In Group 1, all cows (n = 601) were examined by rectal palpation between day 20 and 26 post partum for signs of endometritis (vaginal discharge, enlarged uterus). In Group 2, all cows (n = 652) were examined by external inspection for vaginal discharge as a sign for endometritis. In both groups all cows with endometritis were treated twice with prostaglandin F2 alpha (25 mg of dinoprost) in a 14-day interval. The proportion of cows with signs of endometritis was 33.3% and 17.2% in Group 1 and Group 2, respectively (p < 0.05). In Group 1, the conception rate (39.0% vs 49.3%) and the proportion of cows pregnant (60.5% vs 72.6%) were lower for cows with endometritis than for cows without endometritis. In Group 2, no significant differences were found in reproductive performance for cows with and without signs of endometritis. No significant differences in reproductive performance were found for cows with endometritis between the two groups. Also, for cows without endometritis no significant differences in reproductive performance were found between the groups. It is concluded that the post partum examination by rectal palpation was more sensitive in finding cows with endometritis. However, with regard to the reproductive performance the more sensitive method was not more effective than the method based on systematic external inspection.

Effect of pre-operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy

In a double blind, placebo-controlled trial, we have assessed the effects of pre-operative anxiolysis on postoperative pain scores in 112 ASA I-II women, aged 18-65 years, scheduled to undergo total abdominal hysterectomy. Subjects were randomly allocated to receive either oral diazepam 10 mg (n=56) or placebo (n=56) pre-operatively. Postoperative anxiety, pain scores, analgesic consumption, and sedation were evaluated at several time points during the first 24 h following surgery. Postoperative pain scores were found to be significantly higher in the diazepam group. Trait and state anxiety showed a significant effect on pain scores, independent of the treatment group. No difference was found between the groups in morphine consumption, but there was a significant reduction in morphine consumption with time.

Risk factors for postoperative anxiety in adults

We identified risk factors for postoperative anxiety and quantified their effect on 712 adults between 18 and 60 years of age (ASA I-III physical status) undergoing elective surgery under general anaesthesia, neural blockade or both. The measuring instruments were a structured questionnaire, a pain visual analogue scale, the McGill Pain Questionnaire, the State-Trait Anxiety Inventory, the Montgomery-Asberg Depression Rating Scale, a Self-Reporting Questionnaire-20, and a Self-Perception of Future Questionnaire. Multivariate conditional regression modelling taking into account the hierarchical relationship between risk factors revealed that postoperative anxiety was associated with ASA status III (OR = 1.48), history of smoking (1.62), moderate to intense postoperative pain (OR = 2.62) and high pain rating index (OR = 2.35), minor psychiatric disorders (OR = 1.87), pre-operative state-anxiety (OR = 2.65), and negative future perception (OR = 2.20). Neural block anaesthesia (OR = 0.72), systemic multimodal analgesia (OR = 0.62) and neuroaxial opioids with or without local anaesthesia (OR = 0.63) were found to be protective factors against postoperative anxiety.

Risk factors for preoperative anxiety in adults

BACKGROUND

Patients who undergo surgery experience acute psychological distress in the preoperative period. The objective of this study was to identify and quantify the effect of risk factors for preoperative anxiety in adults.

METHODS

A cross-sectional study was performed with 592 inpatients scheduled for elective surgery. Age ranged from 18 to 60 years (ASA physical status I-III). Demographic information was collected using a structured questionnaire. The measuring instruments were a visual analog scale, the State-Trait Anxiety Inventory; the Montgomery-Asberg Depression Rating Scale, the WHO Self-Reporting Questionnaire-20, and the future self-perception questionnaire. Multivariate conditional regression modeling was used to control confounding factors and to determine independent predictors of preoperative anxiety, taking into account the hierarchical relationship between risk factors.

RESULTS

High preoperative anxiety was associated with history of cancer (odds ratio (OR)=2.26) and smoking (OR=7.47), psychiatric disorders (OR=5.93), negative future perception (OR= 2.30), moderate to intense depressive symptoms (3.22), high trait-anxiety (3.83), moderate to intense pain (2.12), medium surgery (OR=1.52), female gender (OR=2.0), ASA category III (OR=3.41), up to 12 years of education (OR=1.36), and more than 12 years of education (OR=1.68). Previous surgery (OR= 0.61) was associated with lower risk for preoperative state-anxiety.

CONCLUSIONS

History of cancer and smoking, psychiatric disorders, negative future perception, moderate to intense depressive symptoms, high trait-anxiety, moderate to intense pain, medium surgery, female gender, ASA category III, up to 12 years of education and more than 12 years of education constituted independent risk factors for preoperative state-anxiety. Previous surgery reduced the risk for preoperative anxiety.

Alternative algorithm for the correction of preferred orientation in Rietveld analysis

Texture effects caused by preferred orientation can be corrected in Rietveld analysis by an alternative algorithm presented in this contribution. This algorithm is equivalent to models using symmetrized linear combinations of spherical harmonic functions, but it is unique to all Laue classes and to all orders. Positive definiteness of the polar-axis density is achieved by the exponential method. The outlined algorithm was tested during Rietveld refinement of selected polycrystal samples. The algorithm was proven to be numerically robust and satisfactorily described deviations from the ideal intensity ratios of the Bragg reflections caused by the texture of the samples.

Proliferating status of peripheral blood progenitor cells from patients with BCR/ABL-positive chronic myelogenous leukemia

To investigate the mechanisms behind the leukemic expansion of BCR/ABL-positive chronic myelogenous leukemia (CML), we examined the cell cycle status of hematopoietic progenitor cells from peripheral blood (PB) and bone marrow (BM) of 37 patients with newly diagnosed BCR/ABL-positive CML. We found a high proportion of 12.51 +/- 1.19% of CD34+ peripheral blood progenitor cells (PBPC) in S/G2M phase. Comparison of PB and BM from 19 cases revealed similar proliferation rates (10.74 +/- 1.41% vs 15.97 +/- 1.95%). Furthermore, even primitive CD34+/CD38- PBPC displayed high proliferation rates (17.45 +/- 2.98%) in 10 cases examined. In contrast, PBPC from 11 patients with BCR/ABL-negative myeloproliferative disorders were almost noncycling (S/G2M 1.46 +/- 0.47%). When matched pairs of PB and BM from six patients with BCR/ABL-negative myeloproliferative disorders were examined, only 0.89 +/- 0.41% of the CD34+ PBPC, but 8.29 +/- 3.13% CD34+ cells from BM were in S/G2M phase. Consistently, as compared to 19 patients with newly diagnosed BCR/ABL-positive CML, a significantly lower PB/BM ratio of CD34+ cells in S/G2M phase was found in these six patients with BCR/ABL-negative myeloprolifrative disorders. Administration of the tyrosine kinase inhibitor STI571 to 13 patients with CML in chronic phase, accelerated phase, or blast crisis lead to an inhibition of PBPC proliferation within a few days. Interestingly, CD34+ hematopoietic progenitor cells from BM remained proliferating in five cases examined, indicating that CML PBPC are more easily inhibited by STI571 as compared to CD34+ CML hematopoietic progenitor cells from BM. These data suggest that BCR/ABL leads to an enhanced cell cycle activation of CD34+ cells, which seems to be, at least in part, independent of additional factors provided by the bone marrow microenvironment.

[Survey of the negativation of bacteriologic tests in patients with active pulmonary tuberculosis: how long should the isolation be?]

The risk of contamination by contact with patients with tuberculosis is reduced by isolation of patients until negativation of direct sputum analysis for the research of tuberculosis bacilli. To evaluate the efficacy of this isolation, we compared, in 32 patients with active tuberculosis, the results of direct examination and culture of the sputum and the clinical outcome. Thirty-two successive patients hospitalized in the same internal medicine unit, received antituberculosis drugs and had 3 sputum examinations per week with direct analysis and culture until negativation of the 3 direct examinations. Then, isolation ended. At the time of direct-negativation, 14 of the 32 patients kept positive cultures. In the 18 remaining subjects, the cultures became negative, about seven days before direct-negativation. Patients with negative cultures had more frequently weight increase (83% versus 71%), were more rapidly without fever (11 days versus 19 days), had less cough and had less severe radiologic disease (50% versus 75%) compared to patients with positive cultures but these differences were not statistically significant due to the small sample size. In tuberculosis patients, 3 successive negative direct sputum examinations do not eliminate the risk of tuberculosis transmission, specially to hospitalized or immunocompromised patients. The risk of contamination in these cases, although unknown, may be weak. Terminating isolation should not be based on sputum examination alone, but also on other factors such as the clinical course (resolution of cough and fever, weight), the initial number of bacilli, and the severity of the radiological lesions.

Tryptophan-N-glucoside in fruits and fruit juices

In extracts prepared from various fruits as well as in fruit juices a single tryptophan glycoconjugate was detected by HPLC-MS analysis. Product ion spectra demonstrated the N-glycosidic linkage of a hexose moiety to the indole nitrogen. For structure elucidation, the novel tryptophan glycoside was isolated from pear juice and identified as N(1)-(beta-D-glucopyranosyl-(4)C(1))-L-tryptophan by (1)H, HH-COSY and (13)C NMR spectroscopy. Finally, we disclosed the biosynthetic origin of the novel tryptophan metabolite by demonstrating the enzymatic glycosylation of deuterium-labeled tryptophan, which was applied to pear fruit.

[The efficacy of the complex medication Phyto-Hypophyson L in female, hormone-related sterility. A randomized, placebo-controlled clinical double-blind study]

OBJECTIVE AND DESIGN

In a prospective, randomized, placebo-controlled, double-blind study, the effects of Phyto Hypophyson L (Steierl-Pharma GmbH, Herrsching, Germany), an Agnus castus-containing homeopathic preparation, were investigated in 67 women with fertility disorders.

PATIENTS AND METHODS

37 women with oligomenorrhea and 30 women with amenorrhea received 50 drops of Phyto Hypophyson L or placebo 3 times a day over 3 months or 3 cycles. OUTCOME MEASURE AND RESULTS: The outcome measure being spontaneous menstruation, improved concentration of progesterone in the luteal phase, shortening of the cycle, earlier ovulation, and pregnancy was achieved in 38 out of 67 women. It was achieved more often from women with oligomenorrhea in the Phyto Hypophyson L group compared to the placebo group (82 versus 45%, p = 0.021). However, there was no significant effect when viewing the whole group. The baby take-home rate during the therapy and 6 months after the end of the therapy showed a ratio of 6 : 2 (18.7 : 6.4%). This result was not significant. Furthermore, in the oligomenorrhea verum group we observed a significant increase of progesterone during the luteal phase compared to the oligomenorrhea placebo group. Only very few undesirable drug effects were observed.

CONCLUSION

In women with sterility and oligomenorrhea, a treatment with Phyto Hypophyson L can be recommended over a period of 3-6 months.

Synthesis and antiproliferative potency of 9-beta-D-arabinofuranosyl-2-fluoroadenine phospholipid adducts

Three novel alkylphospholipid and four novel O-alkylglycerophospholipid derivatives of fludarabine (F-ara-AMP), known as a drug for the clinical treatment of chronic lymphocytic leukemia, were synthesized. The antiproliferative activity was determined in comparison to the parent nucleoside fludarabine in an immortalized but nontumorigenic human mammary epithelial cell line (H 184 A1N4), in two human breast tumor cell lines (MaTu and MCF7), and in two leukemic cell lines (HL 60 and Daudi). Fludarabine inhibited the growth of the leucemic cell lines very effectively. The breast tumor cell lines responded with much less sensitivity. The antiproliferative potency of the new compounds strongly depended on the chemical structure of the lipid component, and derivatives with a high effectiveness against one or both of the breast tumor cell lines were described.