[Efficacy of epidural steroid injections for chronic lumbar pain syndromes without neurological deficits. A randomized, double blind study as part of a multimodal treatment concept]

BACKGROUND

Chronic lumbar pain syndromes without neurological deficits are generated by a multitude of causes. Functional, morphological and psychosocial factors are discussed. In many cases a diseased intervertebral disc is found on radiological examination but the clinical relevance of these findings is not clear. For this study it was postulated that a diseased disc results in a local inflammatory reaction therefore causing pain and impairing treatability of patients. An epidural injection of steroids can reduce inflammation and therefore improve treatability and ultimately treatment outcome.

METHODS

A double blind randomized prospective trial was carried out. Patients treated in hospital for a chronic lumbar pain syndrome without neurological deficits within a multimodal treatment program were screened for indications for an epidural steroid injection (e.g. diseased lumbar disc and intention to treat). Patients eligible for the study were randomized into two groups. The treatment group received an epidural injection of 80 mg triamcinolone and 8 ml bupivacaine 0.25 %. The control group received only an epidural injection of 8 ml bupivacaine 0.25 %.

RESULTS

In both groups pain intensity and treatability showed a statistically significant improvement after the epidural injection. The differences between the control and treatment groups were small and not clinically relevant. A small subgroup might profit from the steroid injection. In addition the treatability was dependent on psychometric values and the long-term outcome from a reduction of muscular skeletal dysfunctions.

DISCUSSION

After the epidural injection the decrease in pain and increase in treatability was statistically significant. The mechanism of the improvement is not clear and should be examined further. The epidural injection of a steroid in this subgroup of patients did not lead to a clinical improvement in the outcome.

[Athletic pubalgia and hip impingement]

Athletic pubalgia is a painful and complex syndrom encountered by athletes involved in pivoting and cutting sports such as hockey and soccer. To date, there is no real consensus on the criteria for a reliable diagnostic, the different investigations, and the appropriate therapy. Current literature underlines intrinsic and extrinsic factors contributing to athletic pubalgia. This review article reports upon two novelties related to the issue: the importance and efficience of prevention program and the association of femoro-acetabular impingement with the pubalgia.

In situ X-ray study of the structural evolution of gold nano-domains by spray deposition on thin conductive P3HT films

Gold (Au) nanoparticles are deposited from aqueous solution onto one of the most used conductive polymers, namely poly(3-hexylthiophene) (P3HT), using airbrush deposition. We report on the structure formation and packing of the Au nanoparticles after a 5 s spray cycle. In situ grazing incidence small-angle X-ray scattering (GISAXS) measurements with 20 ms time resolution allow a real-time observation of the emergence and evolution of the microstructure during a spray cycle and subsequent solvent evaporation. The results reveal multistage nanoscale ordering of the Au nanoparticles during the spray cycle. Further ex situ atomic force microscopy measurements of the sprayed films showed the formation of Au monolayer islands on top of the polymer film. Our study suggests that the solvent-substrate interaction as well as solvent evaporation kinetics are important factors that need to be taken into consideration in order to grow a compact uniform monolayer film for the fabrication of ultrathin films using airbrush deposition.

Designed multiple ligands in metabolic disease research: from concept to platform

Type 2 diabetes mellitus (T2DM) is a multifactorial disease, and drug monotherapy typically results in unsatisfactory treatment outcomes for patients. Even when used in combination, existing therapies lack efficacy in the long term. Designed multiple ligands (DMLs) are compounds developed to modulate multiple targets relevant to a disease. DMLs offer the potential to yield greater efficacy over monotherapies, either by modulating different biological pathways, or by boosting a single one. However, examples of DMLs progressing into clinical trials, or onto the market are rare; DML drug discovery is challenging, and perceived by some to be almost impossible. Nevertheless, with the judicious selection of biological targets, both from a biological and chemical perspective, it is possible to develop drug-like DMLs.

Erratum to: 4 INFLUENCE OF A MATERNAL DIABETES MELLITUS TYPE 1 ON LIPID AND CHOLESTEROL METABOLISM IN RABBIT PRE-IMPLANTATION EMBRYOS

The incidence of overweight and obesity has reached epidemic levels worldwide. Even more alarming is the increasing prevalence of metabolic diseases in younger children and adolescents. The rate of women with diabetes mellitus in child-bearing age is rising, too. According to the developmental origins of health and disease (DOHaD) paradigm, exposure to a hyperglycaemic environment in utero may programme physiology and metabolism permanently, with long-term consequences for offspring health. Experimental evidence indicates that programming of obesity does occur during early embryo development, a period where many women are unaware of pregnancy. To study effects of maternal diabetes mellitus on early embryo development, we induced a type I diabetes through alloxan treatment of female rabbits. In diabetic rabbits, the triglyceride and cholesterol concentrations were altered in serum and the cholesterol concentration in the uterine secretions was elevated. Lipid content of 6-day-old blastocysts was analysed after Oil Red staining and whole mount histochemistry or with Nile Red by fluorescence-activated cell sorting (FACS). Analysis by FACS revealed an approximately 2-fold increase in lipid droplets in blastocysts grown under diabetic conditions. The expression of genes important for lipid metabolism, such as fatty acid transport protein 4 (FATP4), fatty acid-binding protein 4 (FABP4), carnitine palmitoyltransferase 1 (CPT-1), and lipoprotein lipase (LPL), were determined by real-time PCR and showed distinct differences between diabetic and control blastocysts. Immunohistochemical staining of FABP4 was clearly increased in blastocysts grown under diabetic conditions and showed a cell lineage-specific distribution. Two transcription factors, peroxisome proliferator-activated receptor α (PPARα) and PPARγ, with key functions in lipid metabolism and adipogenic differentiation, were increased in blastocysts from diabetic rabbits. We show that maternal diabetes mellitus leads to alteration in lipid metabolism and to triglyceride accumulation in blastocysts. Its long-lasting consequences (e.g. for adipose cell differentiation) need attention and further investigation.

Erratum to: 4 INFLUENCE OF A MATERNAL DIABETES MELLITUS TYPE 1 ON LIPID AND CHOLESTEROL METABOLISM IN RABBIT PRE-IMPLANTATION EMBRYOS

The incidence of overweight and obesity has reached epidemic levels worldwide. Even more alarming is the increasing prevalence of metabolic diseases in younger children and adolescents. The rate of women with diabetes mellitus in child-bearing age is rising, too. According to the developmental origins of health and disease (DOHaD) paradigm, exposure to a hyperglycaemic environment in utero may programme physiology and metabolism permanently, with long-term consequences for offspring health. Experimental evidence indicates that programming of obesity does occur during early embryo development, a period where many women are unaware of pregnancy. To study effects of maternal diabetes mellitus on early embryo development, we induced a type I diabetes through alloxan treatment of female rabbits. In diabetic rabbits, the triglyceride and cholesterol concentrations were altered in serum and the cholesterol concentration in the uterine secretions was elevated. Lipid content of 6-day-old blastocysts was analysed after Oil Red staining and whole mount histochemistry or with Nile Red by fluorescence-activated cell sorting (FACS). Analysis by FACS revealed an approximately 2-fold increase in lipid droplets in blastocysts grown under diabetic conditions. The expression of genes important for lipid metabolism, such as fatty acid transport protein 4 (FATP4), fatty acid-binding protein 4 (FABP4), carnitine palmitoyltransferase 1 (CPT-1), and lipoprotein lipase (LPL), were determined by real-time PCR and showed distinct differences between diabetic and control blastocysts. Immunohistochemical staining of FABP4 was clearly increased in blastocysts grown under diabetic conditions and showed a cell lineage-specific distribution. Two transcription factors, peroxisome proliferator-activated receptor α (PPARα) and PPARγ, with key functions in lipid metabolism and adipogenic differentiation, were increased in blastocysts from diabetic rabbits. We show that maternal diabetes mellitus leads to alteration in lipid metabolism and to triglyceride accumulation in blastocysts. Its long-lasting consequences (e.g. for adipose cell differentiation) need attention and further investigation.

Respiratory disease in relation to outdoor air pollution in Kanpur, India

This paper examines the effect of outdoor air pollution on respiratory disease in Kanpur, India, based on data from 2006. Exposure to air pollution is represented by annual emissions of sulfur dioxide (SO(2)), particulate matter (PM), and nitrogen oxides (NO(x)) from 11 source categories, established as a geographic information system (GIS)-based emission inventory in 2 km × 2 km grid. Respiratory disease is represented by number of patients who visited specialist pulmonary hospital with symptoms of respiratory disease. The results showed that (1) the main sources of air pollution are industries, domestic fuel burning, and vehicles; (2) the emissions of PM per grid are strongly correlated to the emissions of SO(2) and NO(x); and (3) there is a strong correlation between visits to a hospital due to respiratory disease and emission strength in the area of residence. These results clearly indicate that appropriate health and environmental monitoring, actions to reduce emissions to air, and further studies that would allow assessing the development in health status are necessary.

Respiratory disease in relation to outdoor air pollution in Kanpur, India

This paper examines the effect of outdoor air pollution on respiratory disease in Kanpur, India, based on data from 2006. Exposure to air pollution is represented by annual emissions of sulfur dioxide (SO(2)), particulate matter (PM), and nitrogen oxides (NO(x)) from 11 source categories, established as a geographic information system (GIS)-based emission inventory in 2 km × 2 km grid. Respiratory disease is represented by number of patients who visited specialist pulmonary hospital with symptoms of respiratory disease. The results showed that (1) the main sources of air pollution are industries, domestic fuel burning, and vehicles; (2) the emissions of PM per grid are strongly correlated to the emissions of SO(2) and NO(x); and (3) there is a strong correlation between visits to a hospital due to respiratory disease and emission strength in the area of residence. These results clearly indicate that appropriate health and environmental monitoring, actions to reduce emissions to air, and further studies that would allow assessing the development in health status are necessary.

95 ALTERED PROTEIN AND AMINO-ACID METABOLISM IN PREIMPLANTATION EMBRYOS FROM DIABETIC RABBITS

During pregnancy the preimplantation period is a critical ontogenetic stage in embryo development. As the embryo is highly sensitive to its surrounding milieu and vulnerable to dysregulations by external stimuli, we investigated the influence of a maternal diabetes mellitus type 1 on blastocyst metabolism and protein modifications. Here we report on protein and amino acid metabolism in preimplantation embryos. A diabetes mellitus type 1 rabbit model was used to measure the protein and amino acid concentrations in blastocyst cavity fluid at Day 6 postcoitum. The protein concentration was enhanced in embryos from diabetic rabbits. The level of the various proteinogenic amino acids was unchanged except for the branched-chain amino acids (BCAAs; l-leucine, l-isoleucine, l-valine). The concentration of l-leucine [153.9 µM ± 60.14] and l-valine [231.95 µM ± 75.67] increased 2-fold and of l-isoleucine [99.85 µM ± 42.92] increased 3-fold. Due to the altered BCAA levels, we assumed a disturbed biodegradation. The expression of the BCAA oxidising enzymes (Bcat2, Bckdha, Dbt, and Dld) and BCAA transporters was determined by real-time PCR. Embryos grown in diabetic rabbits revealed a decreased expression of BCAA oxidizing enzymes and of the BCAA transporter LAT-2. The BCAA transporter LAT-2 was mainly localized in the embryoblast. The quality of proteins in blastocysts from diabetic rabbits was evaluated by analyzing protein glycation (advanced glycation end products, AGEs). Two specific AGE modifications, namely arg-pyrimidine and pentosidine, were detected in Day-6 blastocysts by Western Blot analysis. In blastocyst cavity fluid the AGE-specific fluorescence at 440ex/535em nm was significantly enhanced. Our findings show that not just the quantity of proteins but also the quality is affected in rabbit embryos grown in diabetic mothers. There is evidence to suggest that vital protein interactions and signalling pathways are misprogrammed with likely negative consequences for further life. Supported by EU FP 7 EpiHealth (N°278418).

Vaccination against seasonal flu in Switzerland: The indecision of pregnant women encouraged by healthcare professionals

BACKGROUND

The recommendation for seasonal flu immunization from the second trimester of pregnancy, adopted in summer 2010 in Switzerland, is situated within a social context characterized by reluctance toward some vaccinations, a relatively low vaccination coverage against flu in the general population, and still heated debates fuelled by vaccination campaigns organized around the A(H1N1)pdm09 flu pandemic in winter 2009 to 2010. This study examines Swiss pregnant women's representations of the risks associated with seasonal flu and its vaccination.

METHODS

Semi-structured interviews were conducted with 29 women, while in the maternity unit in March 2011, 3 to 5 days after giving birth. The interviews addressed the risks associated with flu, modes of protection, motivations for, and obstacles to vaccination.

RESULTS

The interviewees did not show major preoccupations regarding seasonal flu and they tended to distance themselves from the at-risk status. They did not directly challenge seasonal flu immunization; however, they were reluctant to do it. Their attitudes were supported by their personal experience and the experience of their social networks. Healthcare professionals, particularly medical doctors, gave very little direction, or even did not raise the issue with them.

CONCLUSIONS

Between the rather moderate positions of those who are against vaccination and those who support it, an intermediate grey zone, characterized by hesitation, was observed. Furthermore, the indecision of pregnant women is reinforced by doubts among the persons they are close to and also among the professionals they met during their pregnancy.

Anisotropic elasticity in confocal studies of colloidal crystals

We consider the theory of fluctuations of a colloidal solid observed in a confocal slice. For a cubic crystal we study the evolution of the projected elastic properties as a function of the anisotropy of the crystal using numerical methods based on the fast Fourier transform. In certain situations of high symmetry we find exact analytic results for the projected fluctuations.

NMD and microRNA expression profiling of the HPCX1 locus reveal MAGEC1 as a candidate prostate cancer predisposition gene

BACKGROUND

Several predisposition loci for hereditary prostate cancer (HPC) have been suggested, including HPCX1 at Xq27-q28, but due to the complex structure of the region, the susceptibility gene has not yet been identified.

METHODS

In this study, nonsense-mediated mRNA decay (NMD) inhibition was used for the discovery of truncating mutations. Six prostate cancer (PC) patients and their healthy brothers were selected from a group of HPCX1-linked families. Expression analyses were done using Agilent 44 K oligoarrays, and selected genes were screened for mutations by direct sequencing. In addition, microRNA expression levels in the lymphoblastic cells were analyzed to trace variants that might alter miRNA expression and explain partly an inherited genetic predisposion to PC.

RESULTS

Seventeen genes were selected for resequencing based on the NMD array, but no truncating mutations were found. The most interesting variant was MAGEC1 p.Met1?. An association was seen between the variant and unselected PC (OR = 2.35, 95% CI = 1.10-5.02) and HPC (OR = 3.38, 95% CI = 1.10-10.40). miRNA analysis revealed altogether 29 miRNAs with altered expression between the PC cases and controls. miRNA target analysis revealed that 12 of them also had possible target sites in the MAGEC1 gene. These miRNAs were selected for validation process including four miRNAs located in the X chromosome. The expressions of 14 miRNAs were validated in families that contributed to the significant signal differences in Agilent arrays.

CONCLUSIONS

Further functional studies are needed to fully understand the possible contribution of these miRNAs and MAGEC1 start codon variant to PC.

An integrated study of uranyl mineral dissolution processes: etch pit formation, effects of cations in solution, and secondary precipitation

Understanding the mechanism(s) of uranium-mineral dissolution is crucial for predictive modeling of U mobility in the subsurface. In order to understand how pH and type of cation in solution may affect dissolution, experiments were performed on mainly single crystals of curite, Pb2+ 3(H2O)2[(UO2)4O4(OH)3]2, becquerelite, Ca(H2O)8[(UO2)6O4(OH)6], billietite, Ba(H2O)7[(UO2)6O4(OH)6], fourmarierite Pb2+ 1−x(H2O)4[(UO2)4O3−2x(OH)4+2x] (x= 0.00–0.50), uranophane, Ca(H2O)5[(UO2)(SiO3OH)]2, zippeite, K3(H2O)3[(UO2)4(SO4)2O3(OH)], and Na-substituted metaschoepite, Na1−x[(UO2)4O2−x(OH)5+x] (H2O)n. Solutions included: deionized water; aqueous HCl solutions at pH 3.5 and 2; 0.5 mol L−1 Pb(II)-, Ba-, Sr-, Ca-, Mg-, HCl solutions at pH 2; 1.0 mol L−1 Na- and K-HCl solutions at pH 2; and a 0.1 mol L−1 Na2CO3 solution at pH 10.5. Uranyl mineral basal surface microtopography, micromorphology, and composition were examined prior to, and after dissolution experiments on micrometer scale specimens using atomic force microscopy, scanning electron microscopy, and X-ray photoelectron spectroscopy. Evolution of etch pit depth at different pH values and experimental durations can be explained using a stepwave dissolution model. Effects of the cation in solution on etch pit symmetry and morphology can be explained using an adsorption model involving specific surface sites. Surface precipitation of the following phases was observed: (a) a highly-hydrated uranyl-hydroxy-hydrate in ultrapure water (on all minerals), (b) a Na-uranyl-hydroxy-hydrate in Na2CO3 solution of pH 10.5 (on uranyl-hydroxy-hydrate minerals), (c) a Na-uranyl-carbonate on zippeite, (d) Ba- and Pb-uranyl-hydroxy-hydrates in Ba-HCl and Pb-HCl solutions of pH 2 (on uranophane), (e) a (SiOx(OH)4−2x) phase in solutions of pH 2 (uranophane), and (f) sulfate-bearing phases in solutions of pH 2 and 3.5 (on zippeite).

Lateral diffusion of phospholipids in the plasma membrane of soybean protoplasts: Evidence for membrane lipid domains

Fluorescent lipid and phospholipid probes were incorporated at 4 degrees C into soybean protoplasts prepared from cultured soybean (SB-1) cells. Fluorescence microscopy showed that the plasma membrane as well as the nucleus were labeled. Fluorescence redistribution after photobleaching (FRAP) analysis was performed on these cells at 18 degrees C to monitor the lateral mobility of the incorporated probes. After labeling at low concentrations (40 mug/ml) of phosphatidyl-N-(4-nitrobenzo-2-oxa-1,3-diazolyl)ethanolamine (NBD-PtdEtn), a single mobile component was observed with a diffusion coefficient (D) of approximately 3 x 10(-9) cm(2)/sec. After labeling at higher probe concentrations (>/=100 mug/ml), two diffusing species were observed, with diffusion coefficients of approximately 3 x 10(-9) cm(2)/sec ("fast") and approximately 5 x 10(-10) cm(2)/sec ("slow"). Similar results were observed with fluorescent derivatives of phosphatidylcholine and fatty acids. In contrast to these results, parallel analysis of 3T3 fibroblasts, using the same probes and conditions, yielded only a single diffusion component. These results suggest that the soybean plasma membrane may contain two distinct lipid domains in terms of lipid mobility. Consistent with this idea, experiments with soybean protoplasts yielded a single diffusion component under the following conditions: (i) labeling with NBD-PtdEtn (100 mug/ml), FRAP analysis at 37 degrees C (D = 1.1 x 10(-8) cm(2)/sec); (ii) labeling with NBD-PtdEtn (100 mug/ml), FRAP analysis at 18 degrees C in the presence of 2 mM EGTA (D = 4.2 x 10(-9) cm(2)/sec); (iii) labeling with 5-(N-dodecanoyl)aminofluorescein (a short-chain lipid probe), FRAP analysis at 18 degrees C or 37 degrees C (D = 2.5 x 10(-8) cm(2)/sec). These results suggest that the plasma membrane of soybean cells may contain stable immiscible domains of fluid and gel-like lipids.