Biological activities of a recombinant adenovirus p53 (SCH 58500) administered by hepatic arterial infusion in a Phase 1 colorectal cancer trial

The major focus of intrahepatic arterial (IHA) administration of adenoviruses (Ad) has been on safety. Currently, there is little published data on the biological responses to Ad when administered via this route. As part of a Phase I study, we evaluated biological responses to a replication-defective adenovirus encoding the p53 transgene (SCH 58500) when administered by hepatic arterial infusion to patients with primarily colorectal cancer metastatic to the liver. In analyzing biological responses to the Ad vector, we found that both total and neutralizing Ad antibodies increased weeks after SCH 58500 infusion. The fold increase in antibody titers was not dependent on SCH 58500 dosage. The proinflammatory cytokine interleukin-6 (IL-6) transiently peaked within 6 h of dosing. The cytokine sTNF-R2 showed elevation by 24 h post-treatment, and fold increases were directly related to SCH 58500 doses. Cytokines TNF-alpha, IL-1beta, and sTNF-R1 showed no increased levels over 24 h. Predose antibody levels did not appear to predict transduction, nor did serum Ad neutralizing factor (SNF). Delivery of SCH 58500 to tumor tissue occurred, though we found distribution more predominantly in liver tissues, as opposed to tumors. RT-PCR showed significantly higher expression levels (P<0.0001, ANOVA) for adenovirus type 2 and 5 receptor (CAR) in liver tissues, suggesting a correlation with transduction. Evidence of tumor-specific apoptotic activity was provided by laser scanning cytometry, which determined a coincidence of elevated nuclear p53 protein expression with apoptosis in patient tissue. IHA administration of a replication defective adenovirus is a feasible mode of delivery, allowing for exogenous transfer of the p53 gene into target tissues, with evidence of functional p53. Limited and transient inflammatory responses to the drug occurred, but pre-existing immunity to Ad did not preclude SCH 58500 delivery.

[Value of arthroscopy in the treatment of upper ankle arthritis]

OBJECTIVE

The purpose of this retrospective study was to evaluate arthroscopy in upper ankle osteoarthritis.

METHODS

In the period from 1988 to 1997, 358 arthroscopies of the upper ankle joint were performed in 178 cases due to arthritis. Of 132 accessible patients, 124 replied to our questionnaire: 90 (73%) of the responders underwent clinical examination 94 (37-152) months following the initial arthroscopy and were graded according to the score of Evanski and Waugh. All arthroscopies were performed under fluid filling using anterolateral and anteromedial approaches. In only five cases was the posterior compartment additionally investigated. Generally, neither tourniquet nor mechanical joint distraction were applied.

RESULTS

Of a total of 12 (6.7%) complications, only 3 (1.7%) hematomas needed surgical revision. One hematoma was due to an arteriovenous fistula treated by double ligation. All complications including five hypesthesias were temporary and subsided spontaneously. The 124 patients of the questionnaire group assessed the result of arthroscopic surgery as excellent in 11%, good in 46%, fair in 22%, and poor in 21%. Of all patients, 22% required further surgery of the upper ankle: in 9% further arthroscopy, in 3% arthrodesis, and in 10% microsurgical denervation. The total range of motion increased from 10/0/40 degrees (extension/flexion) preoperatively to 15/0/44 degrees at the follow-up examination. The Evanski score improved significantly (p<0.001) from 41 to 76 points.

CONCLUSION

Due to minimal invasiveness and low risk of complications, arthroscopy is recommended for the following indications of upper ankle osteoarthritis: focal arthrosis, limited range of motion caused by osteophytes, soft tissue impingement, corpora libera, and synovitis. Severity and extent of upper ankle arthritis, range of motion, pain, local bone and soft tissue quality as well as the age, physical activity and compliance of the patient concerned are decisive for the individual therapeutic protocol. Alternative surgical techniques in upper ankle osteoarthritis are assessed such as denervation, distraction arthroplasty, correction osteotomy, ankle arthrodesis and total ankle replacement.

Interactions between selenium and sulphur nutrition in Arabidopsis thaliana

Selenium (Se) is an essential plant micronutrient, but is toxic at high tissue concentrations. It is chemically similar to sulphur (S), an essential plant macronutrient. The interactions between Se and S nutrition were investigated in the model plant Arabidopsis thaliana (L.) Heynh. Arabidopsis plants were grown on agar containing a complete mineral complement and various concentrations of selenate and sulphate. The Se/S concentration ratio in the shoot ([Se](shoot)/[S](shoot)) showed a complex dependence on the ratio of selenate to sulphate concentration in the agar ([Se](agar)/[S](agar)). Increasing [S](agar) increased shoot fresh weight (FW) and [S](shoot), but decreased [Se](shoot). Increasing [Se](agar) increased both [Se](shoot) and [S](shoot), but reduced shoot FW. The reduction in shoot FW in the presence of Se was linearly related to the shoot Se/S concentration ratio. These data suggest (i) that Se and S enter Arabidopsis through multiple transport pathways with contrasting sulphate/selenate selectivities, whose activities vary between plants of contrasting nutritional status, (ii) that rhizosphere sulphate inhibits selenate uptake, (iii) that rhizosphere selenate promotes sulphate uptake, possibly by preventing the reduction in the abundance and/or activity of sulphate transporters by sulphate and/or its metabolites, and (iv) that Se toxicity occurs because Se and S compete for a biochemical process, such as assimilation into amino acids of essential proteins.

The nacre protein perlucin nucleates growth of calcium carbonate crystals

Atomic force microscopy (AFM) in aqueous solution was used to investigate native nacre of the marine snail Haliotis laevigata on the microscopic scale and the interaction of purified nacre proteins with calcium carbonate crystals on the nanoscopic scale. These investigations were controlled by scanning electron microscopy (SEM), light microscopy (LM) and biochemical methods. For investigations with AFM and SEM, nacre was cleaved parallel to the aragonite tablets in this biogenic polymer/mineral composite. Multilamellar organic sheets consisting of a core of chitin with layers of proteins attached on both sides lay between the aragonite layers consisting of confluent aragonite tablets. Cleavage appeared to occur between the aragonite tablet layer and the protein layer. AFM images revealed a honeycomb-like structure to the organic material with a diameter of the 'honeycombs' equalling that of the aragonite tablets. The walls of the structures consisted of filaments, which were suggested to be collagen. The flat regions of the honeycomb-like structures exhibited a hole with a diameter of more than 100 nm. When incubated in saturated calcium carbonate solution, aragonite needles with perfect vertical orientation grew on the proteinacous surface. After treatment with proteinase K, no growth of orientated aragonite needles was detected. Direct AFM measurements on dissolving and growing calcite crystals revealed a surface structure with straight steps the number of which decreased with crystal growth. When the purified nacre protein perlucin was added to the growth solution (a super-saturated calcium carbonate solution) new layers were nucleated and the number of steps increased. Anion exchange chromatography of the water-soluble proteins revealed a mixture of about 10 different proteins. When this mixture was dialysed against saturated calcium carbonate solution and sodium chloride, calcium carbonate crystals precipitated together with perlucin leaving the other proteins in the supernatant. Thus perlucin was shown to be a protein able to nucleate calcium carbonate layers on calcite surfaces, and in the presence of sodium chloride, is incorporated as an intracrystalline protein into calcium carbonate crystals.

Simulation of the influence of sports surfaces on vertical ground reaction forces during landing

In many biomechanical analyses, the vertical ground reaction force (GRF) is measured by force plates. However, if force plates are fixed on elastic surfaces, the force signals have low-frequency oscillations superimposed. The question arises, as to whether this oscillation results from the response of the athlete to the surface properties or from the fixation of the force plate on the elastic surface. For the simulation of the vertical GRF, a mechanical model was developed that combines three submodels representing the surface, the athlete and the force plate. The simulations were carried out for landings on concrete and wooden elastic surfaces, without and with the force plate, respectively. Comparison of the two surfaces showed that, on the elastic surface, the passive peak of the vertical GRF was lower and was reached later than on the concrete surface. Thus a lower force rate was possible during the landing on the elastic surface (concrete: 186 body weight per second; wooden: 164 body weight per second), which can reduce the risk of damaging the joint cartilage. The simulations also showed that the time course of the GRF was changed by a rippling effect when the force plate was fixed on the elastic surface. The rippling was not the result of a change in the athlete's movements, because the parameters of the athlete submodel were not changed. The rippling induced by the force plate hinders the analysis of the GRF time course involving the real peak force and the force rate.

Characterization of the enzymatic component of the ADP-ribosyltransferase toxin CDTa from Clostridium difficile

Certain strains of Clostridium difficile produce the ADP-ribosyltransferase CDT, which is a binary actin ADP-ribosylating toxin. The toxin consists of the binding component CDTb, which mediates receptor binding and cellular uptake, and the enzyme component CDTa. Here we studied the enzyme component (CDTa) of the toxin using the binding component of Clostridium perfringens iota toxin (Ib), which is interchangeable with CDTb as a transport component. Ib was used because CDTb was not expressed as a recombinant protein in Escherichia coli. Similar to iota toxin, CDTa ADP-ribosylates nonmuscle and skeletal muscle actin. The N-terminal part of CDTa (CDTa1-240) competes with full-length CDTa for binding to the iota toxin binding component. The C-terminal part (CDTa244-263) harbors the enzyme activity but was much less active than the full-length CDTa. Changes of Glu428 and Glu430 to glutamine, Ser388 to alanine, and Arg345 to lysine blocked ADP-ribosyltransferase activity. Comparison of CDTa with C. perfringens iota toxin and Clostridium botulinum C2 toxin revealed full enzyme activity of the fragment Ia208-413 but loss of activity of several N-terminally deleted C2I proteins including C2I103-431, C2I190-431, and C2I30-431. The data indicate that CDTa belongs to the iota toxin subfamily of binary actin ADP-ribosylating toxins with respect to interaction with the binding component and substrate specificity. It shares typical conserved amino acid residues with iota toxin and C2 toxin that are suggested to be involved in NAD-binding and/or catalytic activity. The enzyme components of CDT, iota toxin, and C2 toxin differ with respect to the minimal structural requirement for full enzyme activity.

HER-2/neu overexpression and in vitro chemosensitivity to CMF and FEC in primary breast cancer

Available clinical and experimental data on the effect of HER-2/neu overexpression on chemosensitivity are controversial. It was the purpose of this in vitro study to define the association between HER-2/neu overexpression and the sensitivity to the chemotherapeutic drug combinations of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) and 5-fluorouracil, epirubicin and cyclophosphamide (FEC) of breast cancer cells derived from 140 chemotherapy-naïve patients at the time of primary surgery. Both drug combinations were tested at six different concentrations ranging from 6.25-200% peak plasma concentration (PPC). Immunohistochemical detection of HER-2/neu overexpression was performed with the HER-2/neu antibodies, CB11, TAB250 and AO485, in the same tumor specimens. Immunoreactions were determined as negative (0/1+), weakly positive (2+) and strongly positive (3+). However, the antibodies varied in their degrees of sensitivity. Breast cancer samples with strong (3+) HER-2/neu overexpression demonstrated 90% growth inhibition (IC90) at significantly lower PPC values, using the CB11 (p = 0.048), TAB250 (p = 0.007) and AO485 (p < or =0.01) antibodies, and showed 50% growth inhibition (IC50) at significantly lower PPC values, using the CB11 antibody (p = 0.01) compared to their counterparts with lower levels of HER-2/neu expression. When analyzing the group of patients with intermediate and strong HER-2/neu overexpression (2+ and 3+), an association between HER-2/neu overexpression and increased chemosensitivity was seen with the TAB250 (p = 0.044) and AO485 (p = 0.032) antibodies, but not with the CB11 antibody (p =0.8) at the IC90 level. Differences in chemosensitivity between samples with strong HER-2/neu overexpression and those with lower levels were then analyzed separately for CMF and FEC. Both regimens achieved 90% tumor growth inhibition at lower PPC values in samples with strong HER-2/neu overexpression (3+) compared to their counterparts with lower expression levels (AO485 p = 0.011 for CMF, and p = 0.09 for FEC). Cumulative concentration-response plots of tumors responding in vitro with 90% tumor cell inhibition showed a stronger dose dependence for both CMF and FEC among tumor samples with strong HER-2/neu overexpression compared to those with lower levels of expression. In conclusion, the data show that HER-2/neu overexpression was not associated with in vitro drug resistance to CMF or FEC. In contrast, tumors with strong HER-2/neu overexpression demonstrated increased dose-dependent in vitro sensitivity to both the FEC and CMF regimens.

Simulating the impact during human jumping by means of a 4-degrees-of-freedom model with time-dependent properties

The authors simulated the vertical movements of a jumper and the force time courses by means of a 4-degrees-of-freedom model consisting of 4 masses, springs, and dampers. Of the motions simulated, only that of the mass imitating the trunk corresponded to the measured data. The best fit to the measured force curves were obtained in the simulation in which time-dependent model parameters were used. From the results, the authors concluded that at the beginning of the landing, a jumper behaves like a 2-mass model in which the leg segments (thighs, shanks, and feet) effectively combine into 1 mass. After approximately 60 ms, the connections between the leg segments become more compliant and the jumper behaves like a 4-mass model with a soft coupling between the leg segments. The process is equivalent to an increase of the degrees of freedom of the movements. At the end of the ground contact phase during hopping, the jumper has to contract the muscles in order to reach the envisaged jump height. In the model, that contraction could not be satisfactorily simulated.

Direct observation of different surface structures on high-resolution images of native halorhodopsin

Halorhodopsin (HR) was investigated with atomic force microscopic techniques (AFM) in aqueous solution. Two-dimensional (2D) crystals of HR were obtained by purifying an HR membrane fraction with the same buoyant density as the purple membrane (HR-PM) from the overexpressing strain Halobacterium salinarum D2. The membrane patches of HR were immobilized on mica. Images with a resolution up to 14 A were recorded. Crystals showed an orthogonal structure and the orientation of the molecules showed p42(1)2 symmetry; thus, alternate tetramers are inverted in the membrane. The crystal surface was found to display different structures depending on the imaging force used, indicating that some parts of the HR molecule are more rigid but others more compressible. From samples with single tetramers missing in the crystalline patches dimensions of the unit cell could be determined. Helix-connecting loops in single molecules of halorhodopsin were assigned. The images indicate that the large extracellular BC loop covers the whole molecule and is very flexible.

Perlustrin, a Haliotis laevigata (abalone) nacre protein, is homologous to the insulin-like growth factor binding protein N-terminal module of vertebrates

The 84-amino-acid-long sequence of perlustrin showed homology of the abalone nacre protein to the N-terminal domain of mammalian insulin-like growth factor binding proteins (IGFBPs). Despite the evolutionary distance between mollusks and mammals, the sequence identity was 40% including 12 conserved cysteines. However, the residues which were suggested recently to bind IGF-II in a complex with IGFBP-5 were conserved only partially. Nevertheless, perlustrin bound human IGFs with K(D) approximately 10(-7) M. This was the same affinity range as measured before for the interaction of isolated IGFBP-5 N-terminal domains with IGFs. Moreover, perlustrin bound bovine insulin with only approximately two- to sevenfold lower affinity than IGFs. Sequence similarity and growth factor binding identified perlustrin unequivocally as a member of the IGFBP family, the first found in an invertebrate biomineral. Nacre is known to contain proteinaceous factors which promote bone formation in vitro and in vivo. Bone contains IGFBPs which influence bone metabolism in many ways by modulating either IGF effects or IGF independently. Thus, perlustrin may provide a first clue at the molecular level to what these two phylogenetically rather distant biomineralization systems have in common.

[Effectiveness of Formica rufa and autologous blood injection in patients with ankylosing spondylitis: a double-blind randomized study]

While complementary medicine and homeopathy is becoming an increasingly prominent part of the health care practices, there is a lack of controlled studies concerning their effectiveness. In our study, we wanted to answer the question whether a combination of Formica rufa D6 and reinjection of the patient's own blood is superior to injection of placebo. 104 patients with ankylosing spondylitis entered a prospective, randomized, double-blind study. During four weeks they received twice weekly either 1 ml of Formica rufa D6 in combination with 0.5 ml of blood or 1.5 ml NaCl intramuscular. Before and after therapy, mobility, thoracic excursion and doctor's overall assessment were measured in addition to patient's health status, using a German version of the Arthritis Impact Measurement Scales, before and after therapy as well as four, twelve, and twenty-four weeks later. We were not able to detect any statistical difference between treatment and placebo group in any of the parameters measured. Therefore, the therapy under study may not be regarded effective.

The amino-acid sequence of the abalone (Haliotis laevigata) nacre protein perlucin. Detection of a functional C-type lectin domain with galactose/mannose specificity

Perlucin isolated from abalone nacre consists of 155 amino acids including a glycosylated asparagine. The sequence of the first 130 amino acids shows a high similarity to the C-type carbohydrate-recognition domains of asialoglycoprotein receptors and other members of the group of C-type lectins but also a weaker similarity to related proteins without carbohydrate-binding activity. This C-type module is followed by a short C-terminal domain containing two almost identical sequence repeats with a length of 10 amino acids. Solid phase assays show a divalent metal ion-dependent binding of perlucin to (neo)glycoproteins containing D-galactose or D-mannose/D-glucose indicating that perlucin is a functional C-type lectin with broad carbohydrate-binding specificity. Our results also indicate that it may be difficult to predict carbohydrate-binding specificity and the occurrence of alternative binding configurations by amino-acid sequence comparisons and homology modeling.

Simulating the response of a standing operator to vibration stress by means of a biomechanical model

Under vibration stress the compressive forces transmitted in the joints of a standing operator are composed of nearly static and oscillating force parts. Because these forces can hardly be measured they were assessed by means of a biomechanical model. In the model, 27 rigid bodies with 103 degrees of freedom represent the segments of the human body. 106 force elements imitate the muscles of the trunk and the legs. At first, the model parameter were varied so that for the simulated sitting posture the model fits the seat-to-head transmissibility given in the literature and in ISO/CD 5982. For the standing posture, the transfer functions between the ground acceleration and the oscillating forces in the ankle, the knee, the hip, and the motion segment L3-L4 were computed. According to the moduli of these functions the forces in the ankles are higher than those in the knees or the hips and they nearly come up to the forces in the lumbar spine. Further the results of the simulation indicate that under equal vibration stress in the standing and the sitting posture the differences between the compressive forces in the lumbar spine are small.

Bacterial turgor pressure can be measured by atomic force microscopy

We report a study of the deformability of a bacterial wall with an atomic force microscope (AFM). A theoretical expression is derived for the force exerted by the wall on the cantilever as a function of the depths of indentation generated by the AFM tip. Evidence is provided that this reaction force is a measure for the turgor pressure of the bacterium. The method was applied to magnetotactic bacteria of the species Magnetospirillum gryphiswaldense. Force curves were generated on the substrate and on the bacteria while scanning laterally. With the mechanical properties so gained we obtained the spring constant of the bacterium as a whole. Making use of our theoretical results we determined the turgor pressure to be in the range of 85 to 150 kPa.

Imaging microtubules and kinesin decorated microtubules using tapping mode atomic force microscopy in fluids

The atomic force microscope has been used to investigate microtubules and kinesin decorated microtubules in aqueous solution adsorbed onto a solid substrate. The netto negatively charged microtubules did not adsorb to negatively charged solid surfaces but to glass covalently coated with the highly positively charged silane trimethoxysilylpropyldiethylenetriamine (DETA) or a lipid bilayer of 1,2-dipalmitoyl-3-dimethylammoniumpropane. Using electron beam deposited tips for microtubules adsorbed on DETA, single protofilaments could be observed showing that the resolution is up to 5 nm. Under conditions where the silane coated surfaces are hydrophobic, microtubules opened, presumably at the seam, whose stability is lower than that of the bonds between the other protofilaments. This led to a "sheet" with a width of about 100 nm firmly attached to the surface. Microtubules decorated with a stoichiometric low amount of kinesin molecules in the presence of the non-hydrolyzable ATP-analog 5'-adenylylimidodiphosphate could also be adsorbed onto silane-coated glass. Imaging was very stable and the molecules did not show any scan-induced deformation even after hundreds of scans with a scan frequency of 100 Hz.

Description of the relation between the forces acting in the lumbar spine and whole-body vibrations by means of transfer functions

OBJECTIVE

The purpose of this study was to display the relationships between the forces transmitted in the spine and the accelerations of the vibrating seat.

BACKGROUND

Investigations reveal that exposure to whole-body vibration can induce degenerative changes in the lumbar spine. Elevated spinal forces are probably the crucial component in the pathogenesis of this disease.

DESIGN AND METHODS

The spinal forces are simulated by means of a biomechanical model, where 16 rigid bodies represent the upper body and the arms of a sitting operator. The relationships between seat accelerations and spinal forces are displayed as frequency-dependent transfer functions.

RESULTS

Spinal forces are not only elevated in the direction parallel to the vibration excitation but also in the two other orthogonal vibration directions. According to the magnitudes of the transfer functions the highest oscillating parts of the forces are reached at frequencies below 10 Hz.

CONCLUSIONS

Using the transfer functions, the time course of the spine forces can be computed and a new kind of weighting function can be derived which enables a force related weighting of the seat acceleration. RelevanceVibration induced health risks are commonly assessed by the weighted acceleration (ISO 2631-1). These weighting factors resulted from subjective magnitude sensation. It is argued that a more valid assessment will be obtained if the accelerations are weighted in relation to spinal forces. These forces cannot be measured directly under vibration. However, they can be simulated by means of biomechanical models.

In situ determination of sulfide turnover rates in a meromictic alpine lake

A push-pull method, previously used in groundwater analyses, was successfully adapted for measuring sulfide turnover rates in situ at different depths in the meromictic Lake Cadagno. In the layer of phototrophic bacteria at about 12 m in depth net sulfide consumption was observed during the day, indicating active bacterial photosynthesis. During the night the sulfide turnover rates were positive, indicating a net sulfide production from the reduction of more-oxidized sulfur compounds. Because of lack of light, no photosynthesis takes place in the monimolimnion; thus, only sulfide formation is observed both during the day and the night. Sulfide turnover rates in the oxic mixolimnion were always positive as sulfide is spontaneously oxidized by oxygen and as the rates of sulfide oxidation depend on the oxygen concentrations present. Sulfide oxidation by chemolithotrophic bacteria may occur at the oxicline, but this cannot be distinguished from spontaneous chemical oxidation.

Purification and characterization of perlucin and perlustrin, two new proteins from the shell of the mollusc Haliotis laevigata

Two new proteins, named perlucin and perlustrin, with M(r) 17,000 and 13,000, respectively, were isolated from the shell of the mollusc Halotis laevigata (abalone) by ion-exchange chromatography and reversed-phase HPLC after demineralization of the shell in 10% acetic acid. The sequence of the first 32 amino acids of perlucin indicated that this protein belonged to a heterogeneous group of proteins consisting of a single C-type lectin domain. Perlucin increased the precipitation of CaCO(3) from a saturated solution, indicating that it may promote the nucleation and/or the growth of CaCO(3) crystals. With pancreatic stone protein (lithostathine) and the eggshell protein ovocleidin 17, this is the third C-type lectin domain protein isolated from CaCO(3) biominerals. This indicates that this type of protein performs an important but at present unrecognized function in biomineralization. Perlustrin was a minor component of the protein mixture and the sequence of the first 33 amino acids indicated a certain similarity to part of the much larger nacre protein lustrin A.

Conventional ventilation versus high-frequency oscillation: hemodynamic effects in newborn babies

OBJECTIVE

We conducted a prospective study to assess the hemodynamic effects of conventional mechanical ventilation (CMV) compared with high-frequency oscillation (HFO) in newborn babies with respiratory distress syndrome.

METHODS

A total of 18 consecutive term and preterm infants were examined by two-dimensional M-mode and pulsed Doppler echocardiography.

RESULTS

Five patients had to be excluded, three of them because of increasing cardiovascular support after initiation of HFO. The remaining 13 infants (seven males, six females) had a median gestational age of 33 wks (range, 25-40) and a birth weight of 2350 g (range, 790-3600). Patients entered the study at 21 hrs (range, 5-69) of life, receiving total maintenance fluid of 90 mL/kg/day (range, 60-120). Five babies (38%) needed continuous inotropic support. HFO was used as a rescue therapy in infants who failed with CMV. In all 13 patients, HFO significantly impaired cardiac performance compared with CMV by decreasing aortic velocity-time integral: median, 10.2 cm (range, 6.0-14.6) vs. 8.3 cm (range, 5.3-12.4; p<.002); stroke volume: median, 3.8 mL (range, 1.6-6.8) vs. 3.2 mL (range, 1.3-5.9; p<.002); and cardiac index: 281 mL/min/kg of body weight (range, 177-579) vs. 200 mL/min/kg of body weight (range, 156-591; p<.002). Fractional shortening was also significantly reduced: median, 0.31% (range, 0.24-0.44) vs. 0.29% (range, 0.20-0.34; p<.01), because of a significantly smaller left ventricular diastolic diameter during HFO: median, 1.4 cm (range, 1.0-1.9) vs. 1.4 cm (range, 0.9-1.8; p<.05), with a median difference of -0.07 cm (range, -0.4-0.2). HFO also causes a significant decrease in heart rate-corrected left ventricular ejection time: median, 0.25 sec (range, 0.23-0.28) vs. 0.23 sec (range, 0.21-0.26; p < .02) and heart rate-corrected velocity of circumferential fiber shortening (Vcfc): median, 1.3 circ/sec (range, 1.0-1.6) vs. 1.2 circ/sec (range, 0.9-1.4; p<.05). Left ventricular end-systolic wall stress (LVESWS; g/cm2) remained stable. The correlation between Vcfc and LVESWS did not show any significance (CMV, r2 = .2; HFO, r2 = .09). The regression line between Vcfc and LVESWS showed a higher y-intercept and steeper slope during CMV than during HFO. Heart rate, mean arterial pressure, and left ventricular systolic diameter remained unchanged.

CONCLUSIONS

In newborn babies, HFO significantly decreased left ventricular cardiac output caused by reduced left ventricular filling and HFO decreased contractility at higher mean airway pressures than with CMV.

Effects of modification of the allocation system on ischemia duration and costs of heart transplantation. Transplantation Cooperation UNI-NRW

BACKGROUND

In order to optimize regional utilization of transplantable thoracic organs, the seven university hospitals in North-Rhine-Westfalia have formed a transplant cooperation meanwhile approved by Eurotransplant.

METHODS

Heart transplant and organ donation activities of the cooperating hospitals in the year before the foundation of the cooperation (period A, 7/95 - 6/96) and in the year thereafter (period B, 7/96 - 6/97) were retrospectively analysed.

RESULTS

In period A, a total of 39 heart transplants and 74 heart donations were performed, whereas in period B 67 heart transplantations and 78 heart donations could be achieved. The regional utilization of the donor organs increased from 4% to 30% with a significantly shorter ischemia time of regionally or locally allocated donor hearts than of nationally or internationally allocated ones.

CONCLUSIONS

A high rate of regional or local heart transplant procedures with short ischemia times clearly demonstrate the benefits of a regionalization of heart transplant medicine for medical as well as economical reasons.

Three-dimensional biomechanical model for simulating the response of the human body to vibration stress

Several investigations have revealed that long-term exposure to whole-body vibrations can induce low back pain. In analogy to materials handling, the health risk can be assessed if the forces transmitted in the spine during vibration are known. To estimate the forces a biomechanical model has been developed in which the human trunk, neck, head and arms are represented by 16 rigid bodies. An additional body simulates the vibrating seat. The bodies are connected by visco-elastic joint elements, and 56 force elements imitate the trunk and neck muscles. The motion equations are derived by means of the dynamics of systems of rigid bodies, and the motions are simulated in three directions. The frequency-response functions between the accelerations of the seat and the head satisfactorily correspond to data reported in the literature. The spine forces are composed of a static part, due to body posture, and a vibration-induced part. The relation between the oscillating parts of the forces transmitted from seat to pelvis and the spine forces are also described by frequency-response functions. To assess the health risk the simulated spine forces must be compared with the strength of the spine, bearing in mind that this is dependent on the number of load cycles.

Dominance of the BV17 element in nickel-specific human T cell receptors relates to severity of contact sensitivity

Hypersensitivity to nickel (Ni) represents the most common manifestation of contact allergy in humans. The role of metal-specific T cells in this disease is well established, but the molecular interactions involved in their activation are poorly understood. We examined the T cell receptor (TCR) repertoire in T cells activated with either NiSO4 or NiSO4-treated human serum albumin from six allergic patients. For the three most hyperreactive donors, we found a strong over-representation of the TCR BV17 element. TCR sequencing for one of these donors revealed an additional skewing for AV1 as well as a selection for an N region encoded argine at position 95 of the BV17 complementarity determining region (CDR)3. Since Arg is not known to participate in Ni complexing, we suppose that this selection is driven by contacts with peptide rather than nickel. However, the CDR1 of BV17 contains a unique combination of amino acids (HDA) that bears similarities to known motifs in Ni-binding proteins or peptides. We therefore propose that the severe hypersensitivity reactions found in BV17 over-expressors may be the result of Ni2+ ions bridging the germ-line-encoded BV17 CDR1 loop to corresponding sites in the major histocompatibility complex/peptide complex and thereby creating a superantigen-like enhancement of weak TCR-peptide contacts.

Estimation of spine forces under whole-body vibration by means of a biomechanical model and transfer functions

BACKGROUND

Several investigations reveal that long-term exposure to whole-body vibrations can induce degenerative changes in the lumbar spine. In analogy to the activities of lifting or carrying loads, an assessment of the health risk should be possible if the forces transmitted in the spine during vibration stress are known.

METHODS

To estimate the spine forces a biomechanical model was developed. In the model the human trunk, neck, and head were represented by 10 rigid bodies connected by visco-elastic elements. Some 56 force elements imitated the muscles of the body. The motion equations of the model were derived by means of the dynamics of systems of rigid bodies.

RESULTS

The transfer functions of the model accelerations in x- and z-direction satisfactorily corresponded to data reported in the literature. Transfer functions were computed between the forces transmitted from the seat to the pelvis and in the lumbar spine, respectively.

CONCLUSION

The forces between seat and pelvis were measured, then the spine forces were computed by means of the transfer functions. To assess the health risk the computed forces must be compared with the strength of the spine because the strength is dependent on the age and gender of the worker and decreases with the number of load cycles.

Protein tracking and detection of protein motion using atomic force microscopy

Height fluctuations over three different proteins, immunoglobulin G, urease, and microtubules, have been measured using an atomic force microscope (AFM) operating in fluid tapping mode. This was achieved by using a protein-tracking system, where the AFM tip was periodically repositioned above a single protein molecule (or structure) as thermal drifting occurred. Height (z-piezo signal) data were taken in 1 - or 2-s time slices with the tip over the molecule and compared to data taken on the support. The measured fluctuations were consistently higher when the tip was positioned over the protein, as opposed to the support the protein was adsorbed on. Similar measurements over patches of an amphiphile, where the noise was identical to that on the support, suggest that the noise increase is due to some intrinsic property of proteins and is not a result of different tip-sample interactions over soft samples. The orientation of the adsorbed proteins in these preliminary studies was not known; thus it was not possible to make correlations between the observed motion and specific protein structure or protein function beyond noting that the observed height fluctuations were greater for an antibody (anti-bovine IgG) and an enzyme (urease) than for microtubules.

Measuring the viscoelastic properties of human platelets with the atomic force microscope

We have measured force curves as a function of the lateral position on top of human platelets with the atomic force microscope. These force curves show the indentation of the cell as the tip loads the sample. By analyzing these force curves we were able to determine the elastic modulus of the platelet with a lateral resolution of approximately 100 nm. The elastic moduli were in a range of 1-50 kPa measured in the frequency range of 1-50 Hz. Loading forces could be controlled with a resolution of 80 pN and indentations of the platelet could be determined with a resolution of 20 nm.

Imaging soft samples with the atomic force microscope: gelatin in water and propanol

We have imaged mica coated with thin gelatin films in water, propanol, and mixtures of these two liquids by atomic force microscopy (AFM). The elastic modulus (Young's modulus) can be tuned from 20 kPa to more than 0.1 GPa depending on the ratio of propanol to water. The resolution is best in pure propanol, on the order of 20 nm, and becomes worse for the softer samples. The degradation in resolution can be understood by considering the elastic indentation of the gelatin caused by the AFM tip. This indentation becomes larger and thus the contact area becomes larger the softer the sample is. Therefore this study may be used to estimate the resolution to be expected with an AFM on other soft samples, such as cells. Nondestructive imaging was possible only by imaging at forces < 1 nN. This was difficult to achieve in contact mode because of drift in the zero load deflection of the cantilever, supposedly caused by temperature drift, but straightforward in tapping mode.

High-yield selection criteria for cranial computed tomography after acute trauma

OBJECTIVE

To develop and prospectively evaluate criteria for selecting head-injured patients requiring cranial CT.

METHODS

A two-phased prospective observational study design was implemented at a university ED. Physicians completed a form with 51 variables for 540 patients in Phase I. Ten high-yield variables were identified and prospectively tested on 273 patients in Phase II. Prediction rule performance for identification of patients with abnormal CT scans was determined.

RESULTS

The combined criteria had a sensitivity of 97% for CT-scan abnormalities in Phase I; sensitivity was 96% in Phase II. Negative predictive values were 97% and 94%, respectively. Prevalence of disease in Phase I was 17%; prevalence in Phase II was 16%. Had the Phase I criteria been implemented during Phase II, 43 of 273 patients (16%) would not have been scanned, including two patients with positive results who did not require operative intervention.

CONCLUSIONS

Fifty-one clinical variables from head-injured patients were narrowed to ten of statistical significance and consistent interpretation for prospective evaluation. Patients with none of these criteria were found to be at low risk of having sustained significant head injury.

Succession of putative peri-implant pathogens after root-form and plate-form implant placement in partially dentate adult monkeys

This report describes the succession of putative peri-implant pathogens in partially dentate monkeys after dental implantation and prosthetic reconstruction. Tooth and implant (6 root-end form, 4 blade-vent implants) sites in eight monkeys were monitored microbiologically and clinically during the pre-implant stage, abutment connection stage, bridge placement stage, and three and six months after the bridge placement stage. Tooth and implant sites were cleaned monthly post-extraction. Microbiological studies included dark field microscopy, selective and non-selective culture, and primary phenotypic characterization of culture isolates. After implant surgery, the median proportion of several putative peri-implant pathogens studied were significantly elevated. Following fixture placement, P. intermedia replaced P. melaninogenica as the predominant Black Pigmented Anaerobic Bacilli (BPAB) in the mouth. After abutment connection stage, levels of P. intermedia, A. actinomycetemcomitans, F. nucleatun, Haemophilus sp. and spirochetes were significantly elevated at implant and tooth sites. Three months after bridge installations, P. intermedia and A. actinomycetemcomitans remained significantly elevated at implant sites. At six months after bridge installation, levels of P. intermedia, F. nucleatum and A. actinomycetemcomitans declined significantly relative to levels at three months. Porphyromonas sp. and spirochetes were not significantly elevated although their levels correlated with gingival redness. P. intermedia, Porphyromonas sp. and spirochetes levels correlated significantly with probing depth. Correlation was detected between P. gingivalis and spirochetes; and between A. actinomycetemcomitans and F. nucleatum. Our studies show a transitional increase in levels of several organisms resembling putative pathogens of human peri-implant infection, associated with implant placements in partially edentulous mouths and supports early prophylactic interventions to control their levels.

[Balloon dilatation of postoperative and congenital aortic isthmus stenoses]

From July 1987 to December 1992, 52 patients underwent balloon-angioplasty of aortic coarctation at three units of pediatric cardiology in Austria (Graz = 35 patients, Innsbruck = 15 patients, and Vienna = 2 patients). 35 patients had postoperative and 17 had native coarctation. Mean age at intervention was 7 10/12 years with 2 patients under 1 year and 5 patients over 18 years old. The mean relation balloon diameter-coarctation diameter was 2.6 +/- 0.9. The blood pressure gradient between upper and lower extremities decreased from a mean of 44 +/- 16 mm Hg to 15 +/- 13 mm Hg (p < 0.0001). The diameter of the stenosed segment was increased from 5 +/- 3 mm to 8.5 +/- 3.5 mm (p < 0.0001). Native coarctation showed a significantly better result in respect to decrease of the gradient (36 +/- 12 mm Hg) than did postoperative coarctations (25 +/- 19 mm Hg) (p < 0.03). 13 patients did not respond adequately to angioplasty. 10 patients out of this group had tubular narrowings and belonged to the group of postoperative coarctations, whereas localized stenoses in native coarctations gave the best results. Localized wall irregularities were found in 4 patients with native coarctation. Balloon angioplasty of postoperative and native coarctations in childhood and adolescence is a secure and effective means of treatment and should be considered as therapy of first choice. The best results can be found in the group of the circumscript type of stenoses in native coarctation, whereas long and tubular stenoses in the group of postoperative coarctations give less satisfying results.

Direct observation of enzyme activity with the atomic force microscope

The height fluctuations on top of the protein lysozyme adsorbed on mica were measured locally with an atomic force microscope operated in tapping mode in liquid. Height fluctuations of an apparent size of 1 nanometer that lasted for about 50 milliseconds were observed over lysozyme molecules when a substrate (oligoglycoside) was present. In the presence of the inhibitor chitobiose, these height fluctuations decreased to the level without the oligoglycoside. The most straightforward interpretation of these results is that the height fluctuations correspond to the conformational changes of lysozyme during hydrolysis. It is also possible, however, that the height fluctuations are, at least in part, the result of a different height or elasticity of the transient complex of lysozyme plus the substrate.

A dominant negative mutant of PG13 suppresses transcription from a cauliflower mosaic virus 35S truncated promoter in transgenic tobacco plants

TGA1a and PG13 constitute a family of tobacco basic leucine zipper (bZIP) proteins that bind to activating sequence-1 (as-1), which is one of the multiple regulatory cis elements of the cauliflower mosaic virus (CaMV) 35S promoter. After truncation of the CaMV 35S promoter down to position -90 (CaMV 35S [-90] promoter), transcription stringently depends on the presence of as-1, which is recognized by nuclear DNA binding proteins called ASF-1. The role of the TGA1a/PG13 bZIP family in the formation of ASF-1 and in transcriptional activation of the CaMV 35S (-90) promoter has not yet been demonstrated in vivo. We constructed transgenic tobacco plants expressing a mutant of potato PG13, which lacks its wild-type DNA binding domain. This mutant acts as a trans-dominant inhibitor of ASF-1 formation and of expression from the CaMV 35S (-90) promoter, showing that PG13 can specifically interact with proteins necessary for these processes. Although we did not observe any other obvious phenotypic changes, these transgenic plants are a potentially valuable tool in identifying whether TGA1a and PG13 are involved in controlling promoters encoded in the plant genome.

[5-10-year results with the straight-shaft Müller prosthesis]

103 patients with 106 Müller straight stem prostheses could be evaluated clinically and radiologically after an average follow-up period of 6.8 years (range 5 to 10 ys.). Although until now no revision for aseptic loosening has become necessary 3 p.c. of the stems and 11 p.c. of the acetabular components showed radiological loosening. The clinical results were rated as satisfactory. After surgery 67 p.c. of the patients were completely painfree, 28 p.c. still had slight pain, 4 p.c. moderate and 1 p.c. severe pain. The investigation concentrated particularly on radiographic changes of the interface of the femur. Whereas radiolucency typically was non-progressive and located in the proximal part of the femur we found an increasing atrophy of the cortical bone on the calcar. Moreover, we found a continuous and increasing subsidence of the stem during the whole period of observation. At the time of follow up 56 p.c. of the straight stems had subsided about 2 mm and more. Calcar atrophy and radiolucency were significantly less present in femurs with a tapered medullary canal than in those with a cylindrical shape.