Comparative analysis of the sialic acid binding activity and the tropism for the respiratory epithelium of four different strains of avian infectious bronchitis virus

Avian infectious bronchitis virus (IBV) is a major pathogen in commercial poultry flocks. We recently demonstrated that sialic acid serves as a receptor determinant for IBV on the tracheal epithelium. Here we compared the IBV strains Beaudette, 4/91, Italy02, and QX for their sialic acid-binding properties. We demonstrate that sialic acid binding is important for the infection of primary chicken kidney cells and the tracheal epithelium by all four strains. There were only slight differences between the four strains, indicating the universal usage of sialic acids as receptor determinants by IBV. In addition, we analysed the primary target cells in the respiratory epithelium of the four different strains and found that all of them infected ciliated cells and goblet cells.

Evaluation of bone strength, keel bone deformity and egg quality of laying hens housed in small group housing systems and furnished cages in comparison to an aviary housing system

Abstract. The objective of the study was to assess bone breaking strength, keel bone status and egg quality parameters of Lohmann Silver (LS) and Lohmann Tradition (LT) layers housed in small group systems (SG) and furnished cages (FC) in comparison to an aviary system. At the end of the 3rd, 6th, 9th and 11th laying month, approximately 40 hens were randomly chosen from each housing system and slaughtered (478 hens in total). Humerus and tibia strengths were analysed using a three-point-bending machine. Keel bone status was evaluated on a scale from 1 (severe) to 4 (no deformity). Shell breaking strength was measured every four weeks, totalling 4,887 eggs. Statistical analyses were performed using the MIXED procedure of SAS. Humerus and tibia strengths of LS layers housed in SG were significantly higher compared to LS hens kept in FC. Bone breaking strengths of humerus and tibia in LS and LT layers were highest in the aviary system and the differences to the other housing systems were significant. No significant differences in tibia and humerus bone breaking strengths were found between SG and FC for LT hens. Keel bone status was not significantly influenced by housing system or laying strain. For both hybrids, shell breaking strength was significantly lower in SG compared to FC and aviary system. The results showed that SG systems can significantly enhance bone breaking strength for LS layers in comparison to hens kept in FC. The lower shell breaking strength of eggs in SG might slightly impair economic aspects.

[New approaches to early detection, estimation of prognosis and therapy for malignant tumours of the gastrointestinal tract]

Tumours of the gastrointestinal tract are the single largest group of malignant tumours of humans accounting for approximately 2 million new cases and over 1.2 million deaths annually. They are most commonly a disease of the elderly, and their relative and absolute frequency will rise continuously due to an ageing population. This explains why the prevalence of gastric cancer increases in spite of a decreasing incidence. Gastrointestinal tumours will remain a major clinical and health economical challenge. The prognosis is often dismal. Most of these cancers are diagnosed in an advanced stage, which prohibits curative treatment and limits treatment options. In order to circumvent these problems, we need to develop strategies that allow identification of at-risk patients and tumours at an early stage, and raise the compliance in the general population for screening programmes. There is a great need in clinics for prognostic and predictive biomarkers that are able to tailor patient treatment at different stages of the disease.

[Composting of poultry carcasses as an alternative method for disposal in case of an outbreak of an epizootic disease: first results]

Composting of poultry carcasses represents an alternative method for disposal in case of an outbreak of an epizootic disease. Two composting experiments, each with a different construction of the compost pile, were carried out in a stable. In the first experiment two layers of turkey carcasses were formed. This compost pile covered with straw was directly built on the ground. In the second experiment no layers of carcasses were formed, and it was assembled on straw bales covered with plastic foil. One part of this compost pile was covered with straw, the other one was additionally covered with plastic foil. In the first experiment in the upper layers of the compost pile temperatures of up to 54.9 degrees C were reached and the decomposition of carcasses was very advanced with no soft tissues remaining after 30 days. In contrast temperatures of only 45.2 degrees C were reached in the lower layers and decomposition was far less advanced. This difference in decomposition was most likely caused by the temperature difference observed. In the second experiment the near complete decomposition seen in the upper layers of the compost pile at the first trial, was not achieved. Decomposition was more advanced in the straw covered part of this compost pile than in the part covered with straw and plastic foil. On the other hand, higher temperatures of up to 48.4 degrees C were measured in the lower layers of this compost pile most likely as a result of the increased heat insulation in particular to the ground.

Surgical techniques for resectable pancreatic cancer

Pancreatic cancer is a highly aggressive cancer with a rising incidence in most European countries. Due to both the aggressive biology of the disease and the late diagnosis in many cases, pancreatic duct carcinoma is still a disease with a poor prognosis. Today, surgical resection of localized tumor remains the only potentially curative option available for these patients. Advances in surgical techniques and perioperative care has improved significantly in the last 20 years, causing an extension of indications for surgical intervention. However, despite new diagnostic techniques, the surgical exploration still plays the key role for the finally assessment of resectability. For evaluation of local resectability, laparoscopy alone cannot generally be recommended today and explorative laparotomy is required. Contraindications for pancreatic resection are liver metastasis, peritoneal metastasis, and tumor infiltration of visceral arteries. The surgical management of pancreatic cancer consists of two phases: first, assessment of tumor resectability and second, if resectability is given, the pancreaticoduodenectomy with consecutive reconstruction. Standard surgical strategies are the classic pancreaticoduodenectomy including a distal gastrectomy and the pylorus-preserving pancreaticoduodenectomy (PPPD) preserving antral and pyloric function, respectively. Both surgical procedures are equally effective for the treatment of pancreatic carcinoma. Delicate lymphadenectomy during pancreaticoduodenectomy is important for radical oncological enforcement. An extended lymphadenectomy showed no benefit in several trials. Despite the encouraging advances in surgical treatment, actuarial 5-year survival rates after pancreatic resection are only at about 20%.

Liver resection for metastases from renal cell carcinoma

BACKGROUND

This study was conducted to evaluate the safety and efficacy of liver resection in patients with hepatic metastases from renal cell carcinoma and to identify selection criteria for patients suitable for resection.

METHODS

Between January 1988 and March 2006, 31 patients underwent liver resection for metastases from renal cell carcinoma. Patients were identified from a prospective database and retrospectively reviewed. Patient, tumor, and operative parameters were analyzed for their influence on long-term survival.

RESULTS

The overall 1-, 3- and 5-year survival rates were 82.2%, 54.3%, and 38.9%, respectively. One patient was deceased and 4 developed complications during the postoperative course. In the univariate analysis, site of the primary tumor (P = 0.013), disease-free interval (P = 0.012), and resection margins (P = 0.008) showed significant influence on long-term survival. In the multivariate analysis, only the resection margins were identified as an independent prognostic factor after liver resection.

CONCLUSIONS

Liver resection is effective and safe in the treatment of patients with hepatic metastases from renal cell carcinoma and offers the chance of long-term survival and cure. Achieving a margin-negative resection is the most important criterion in the selection of suitable patients for liver resection. However, the number of patients in the present study was small, and investigations of larger series may provide further prognostic parameters in these patients.

Extended resections of liver metastases from colorectal cancer

BACKGROUND

Indications for resection of liver metastases from colorectal cancer and surgical strategies are still under debate.

METHODS

We have retrospectively reviewed the outcome of 660 patients after 685 liver resections for metastases of colorectal cancer in our institution from 1988 to 2004. All surviving patients have a minimum follow-up period of 1 year. The longest follow-up in these patients is 16 years. Three different time periods of 5 to 6 years each were analyzed.

RESULTS

The 30- and 60-day mortality rates were 1.5% (n = 10) and 2.2 % (n = 15), respectively. The rate of formally curative (R0) resections was 84%. Five-year survival rates in all patients and in patients after R0 resection were 37% and 42%, respectively. If only resections from 1999 to 2004 were considered, 5-year survival in patients after R0 resection was 50%. In a multivariate analysis, surgical radicality, ligamental lymph node involvement, number of liver metastases, and time period, in which the liver resection had been performed, were independent prognostic parameters.

CONCLUSIONS

Outcome after liver resection for metastases from colorectal cancer has constantly improved. A formally curative resection is the most relevant prognostic parameter. Number of liver metastases and, in the few patients concerned, lymph node infiltration of the hepatoduodenal ligament, were further prognostic parameters.

Role of multivisceral cytoreductive surgery in patients (pts) with recurrent ovarian cancer (ROC): Who will not benefit from radical tumor debulking?

16036

Background: Despite improvement in surgery and adjuvant chemotherapy most pts with ovarian cancer (OC) experience a relapse within 2 years after first diagnosis. For primary OC a standard concensus on optimal staging and surgical guidelines is established. The role of radical tumor debulking surgery in ROC is not clearly defined. Aim of this study was to analyze clinical parameters for prediction of operability and impact on overall survival in ROC. Methods: Within the framework of the international project “Tumor bank Ovarian Cancer“ (TOC) a systematic prospective surgical and histomorphological tumor documentation for ROC was performed. Results: Between september 2000 and december 2006, 307 multivisceral operations on 254 pts with ROC were performed consecutively in our department. Median age was 55 years (19–83), median follow-up 15 months (1–75). 34.8% of pts experienced first relapse of OC. Overall, 96.3% of pts received a platinum-based first-line chemotherapy, whereas 73.4% were platinum sensitive. In 55% of pts first relapse surgery was performed. In 41.4% of pts complete macroscopic tumor resection was achieved, associated with a significantly better recurrence-free (median 20.6 vs 13.2, p=0.001) and overall survival (median 42 vs 12 months, p<0.001) compared to pts with any postoperative residual tumor. In multivariate analysis, complete tumor resection was associated with the absence of tumor burden in the upper abdomen (p=0.001) and absence of ascites (p=0.05). Prognostic factors for postoperative survival were: tumor resection (0 cm vs > 0 cm, p<0.001), intraoperative volume of ascites (0 ml vs > 0 ml, p=0.006) and response to platinum-based first-line therapy (platinum sensitive vs platinum-resistant, p=0.006). Conclusions: Radical tumor debulking in patients with ROC is associated with a low postoperative morbidity and mortality. Complete mascroscopic tumor resection is correlated with a significant better long-term prognosis and influenced by tumor spread and presence of ascites. Pts with ROC will not benefit from multivisceral cytoreductive surgery in case of platinum resistance to first-line chemotherapy, presence of intraoperative ascites and postoperative residual tumor.

No significant financial relationships to disclose.

Repeat liver resection for recurrent liver metastases from colorectal cancer

AIMS

Numerous patients suffer from recurrence after resection of liver metastases from colorectal cancer. Recurrence is frequently restricted to the liver and repeat liver resection may offer a curative option in these patients. This study was conducted to clarify safety and effectiveness of this treatment and to identify prognostic factors of a favourable outcome after repeat hepatectomy.

METHODS

Between January 1988 and March 2006 in our institution 811 patients underwent 841 liver resections for metastases from colorectal cancer. Among these, 94 patients underwent a repeat hepatectomy. Patients were identified from a prospective database and retrospectively reviewed. Results of different time periods were assessed and prognostic factors for a favourable outcome were determined.

RESULTS

The perioperative morbidity and mortality was 24% (23 of 94) and 3% (3 of 94), respectively. The one-, three-, five- and ten-year survival for all patients in this series was 89%, 55%, 38% and 23%, respectively. In the univariate analysis, pT-stage of the primary, diameter of the largest metastases, surgical radicality, period of resection and distribution of metastases showed statistically significant influence on survival. The multivariate analysis revealed only pT-stage of the primary tumour, surgical radicality and period of resection as independent prognostic factors.

CONCLUSIONS

Repeat hepatectomy is a safe and effective treatment for recurrent liver metastases from colorectal cancer. Perioperative risk and long-term survival were similar when compared to the results obtained during the initial resection. Achieving a curative resection is the most relevant prognostic factor for a favourable prognosis after repeat liver resection.

Die laparoskopische Appendektomie in der Schwangerschaft

BACKGROUND

Acute appendicitis is the most common cause of an acute abdomen in pregnancy. However, due to the potential fetal risk associated with the CO2-pneumoperitoneum and various operative technical reasons there is still controversy about the role of laparoscopic appendectomy in pregnant women.

PATIENTS AND METHODS

Between January 2000 and November 2005, 283 women between 17 and 45 years with suspected appendicitis underwent laparoscopic appendectomy at our institution. Fifteen of these patients (5.3 %) were pregnant at the time of surgery (mean age, 28 years; range, 18-40 years; mean gestational age, 21.9 weeks; range, 14-34 weeks). Perioperative obstetric monitoring included fetal ultrasound, including Doppler sonography and cardiotocography. Clinical data were collected prospectively. Complete follow-up data were available in 14 patients.

RESULTS

All 15 patients underwent successful laparoscopic appendectomy. Mean operation time was 53 minutes (range, 30-100 minutes). The histologic appendicitis / appendectomy ratio was 73 %. One patient showed a postoperative pyelonephritis, another a cystitis. Average length of hospital stay was 5.5 days (range, 3-10 days). All fourteen pregnancies with complete follow-up resulted in delivery of healthy infants. The mean gestational age at delivery was 39.6 weeks (range, 35-42 weeks). Two patients (14.3 %) had a preterm delivery at 35 weeks with uncomplicated outcome. One patient underwent caesarean section at 41 weeks after chorioamnionitis.

CONCLUSIONS

Laparoscopic appendectomy is a safe and effective method to treat acute appendicitis in pregnant women regardless of the trimester. For the best outcome the operation should be performed in a center where surgeons, perinatologist, obstetricians and anesthesiologists work together as a part of an interdisciplinary team.

An unusual cause of epigastric pain: infected giant liver hemangioma

A 64-year-old woman was admitted to our surgical emergency department suffering from epigastric pain and fever persisting for a period of 5 weeks, and, upon admission, she presented with massively elevated C-reactive protein. Computed tomography (CT) demonstrated a giant hemangioma of the liver with an intralesional central mass, which was documented by diameter progression of the central mass on follow-up CT. After liver resection, the diagnosis was an abscess in a giant liver hemangioma.

Fast Tracking in Liver Transplantation: Which Patient Benefits From This Approach?

In liver transplantation, "fast tracking" means postoperative extubation in the operating theater immediately after surgery. This procedure was performed in a series of 837 adult liver transplant recipients between January 1997 and April 2005, proving to be safe and feasible in almost 80% of patients without increasing the incidence of reintubation. This patient population experienced a significantly higher survival compared to patients who were extubated in the intensive care unit. Consequently, fast tracking should become the standard procedure after orthotopic liver transplantation. However, special attention is required for recipients with acute liver failure, retransplantation, Child C status, or complicated surgery in terms of increased transfusion of red blood cells. These patients do not participate in fast-tracking protocols, as demonstrated by a uni- and multivariate logistic regression analysis. Moreover, ROC analysis revealed that only intraoperative transfusion of </=6 units of red blood cells was associated with extubation in the operating theater with highest sensitivity (78.9%) and specificity (49.5%), area under the ROC curve = 0.703 (standard error = 0.023; 95% confidence interval = 0.671-0.734).

Investigations on Infection Status with H5 and H7 Avian Influenza Virus in Short-Distance and Long-Distance Migrant Birds in 2001

The role of migrating birds as potential vectors for avian influenza virus (AIV) was investigated. We captured 543 migrating passerines during their stopover on the island of Helgoland (North Sea) in spring and autumn 2001. These birds were sampled for avian influenza A viruses (AIV), specifically the subtypes H5 and H7. For virus detection, samples were taken from 1) short-distance migrants, such as chaffinches (Fringilla coelebs; n = 131) and song thrushes (Turdus philomelos; n = 169); and 2) long-distance migrants, such as garden warblers (Sylvia borin; n = 142) and common redstarts (Phoenicurus phoenicurus; n = 101). Virus isolation assays failed to identify AIV. Therefore, regarding the actual low number of samples, we speculate that the tested four species of passerines were not infected by AIV, indicating that the passerine species examined in this study may play only a minor role as potential vectors of AIV.

Colonic metastasis of Klatskin tumor: Case report and discussion of the current literature

We report the case of a 65-year old male patient who initially presented with recurrent episodes of upper abdominal pain, lack of appetite and weight loss. Abdominal ultrasound indicated enlarged intrahepatic bile ducts, abdominal CT scan and ERC were performed and bile duct carcinoma (Klatskin Type III b) was diagnosed. The tumor was located in the segments 2,3,4 and 1 with possible invasion of the left intrahepatic portal vein. Both the segments 2 and 3 of the liver were atrophic and displayed a cholestatic bile duct system. Preoperatively an intraductal stent was placed in the left bile duct using ERC to drain the left hepatic lobe. A specimen of the ascites present preoperatively displayed no malignant cells. After evaluation of the preoperatively obtained data left hepatic resection was planned. Following laparotomy we found local peritoneal carcinosis in the ligamentum hepatoduodenale with lymphatic nodules that tested positive for cholangiocellular carcinoma in online pathological examination. In the course of further exploration of the abdomen a solid tumor was detected in the sigmoid colon. Regarding the advanced stage of the neoplasm it was decided to cancel hemihepatectomy and perform sigmoid resection only in order to guarantee uncomplicated intestinal passage. The sigmoid colon was removed by a typical resection technique with end-to-end anastomosis. Histological examination of the resected sigmoid revealed transmural manifestation of a malignant neoplastic process with both a tubular and a solid growth pattern in conformity with metastasis of a Klatskin tumor. The mucosal layer showed no neoplastic alteration. Peritoneal carcinosis is a common phenomenon in the dissemination pattern of advanced-stage Klatskin tumors, yet to our knowledge this is the first case of intramural colonic growth following peritoneal metastasis.

Keeping laying hens in furnished cages and an aviary housing system enhances their bone stability

1. Tibia and humerus breaking strength of Lohmann Silver hybrids kept in conventional cages, furnished cages and an aviary with outdoor run were examined in two production cycles. Each trial lasted a full laying period; feeding, management and healthcare were identical for all hens. In both trials bone strength was investigated at the end of laying months 6, 9 and 14. 2. The objective was to determine if bone strength increases when hens are kept in alternative housing systems, especially in furnished cages, and whether hen age affects bone stability. 3. The results indicated that housing system influenced bone breaking strength, which was consistently higher for hens in the aviary compared to hens in conventional and furnished cages. Furthermore, humerus breaking strength was higher for hens in furnished cages compared to conventional cages. No significant difference regarding tibia breaking strength was found between conventional and furnished cages. 4. Our results showed that lack of exercise contributed to the problem of weak bones more than did calcium depletion from eggshell formation. 5. Tibia breaking strength increased during the last third of the production cycle, whereas humerus breaking strength remained unaffected by hen age. 6. Genetic group affected only tibial bone breaking strength, which was lower overall in genetic group A than in group B, which in turn was lower than group C. 7. The increased bone strength in the aviary and in the furnished cages probably reduced the incidence of recently broken bones in these systems compared to the conventional cages. This increase in bone strength can be regarded as an improvement in welfare. Furnished cages, like the aviary system, might be considered an alternative housing system for laying hens, because both resulted in enhanced bone strength.

[Solid actinomycosis of the liver]

HISTORY

A 41-year -old man was admitted for resection of several liver segments, because a malignant tumor was suspected. He had two years previously sustained blunt trauma to the abdomen and chest. At that time a hematoma of the liver had been diagnosed by ultrasound and computed tomography. Follow-up imagings showed an increase in its size. On admission the patient had only slight right upper abdominal pain; laboratory tests were unremarkable.

INVESTIGATIONS

Computed tomography confirmed the suspected diagnosis of a cholangiocellular carcinoma with possible abdominal wall infiltration. Tumor markers were negative.

TREATMENT AND COURSE

An extensive partial liver resection was performed. Histological examination of the resected specimen revealed solid actinomycosis of the liver. After prolonged high dosage penicillin treatment all signs and symptoms resolved without further problems. Postoperative serology provided no evidence of active systemic actinomycosis.

CONCLUSION

This case demonstrates the difficulty of diagnosing and treating solid actinomycosis.

On the optimal opening pressure of hydrostatic valves in cases of idiopathic normal-pressure hydrocephalus: a prospective randomized study with 123 patients

Does the opening pressure of hydrostatic shunts influence the clinical outcome for patients suffering from idiopathic normal-pressure hydrocephalus (NPH)? Between September 1997 and January 2003, 123 patients with idiopathic NPH were surgically treated by implanting a hydrostatic shunt at the Departments of Neurosurgery of the Unfallkrankenhaus Berlin and the University Homburg/Saar. As part of a prospective randomized study, all patients were examined preoperatively, postoperatively, and 1 year after the intervention. Forty-three percent of the patients showed a very good outcome, 25% good outcome, 20% fair outcome, and 12% poor outcome 1 year after the shunt implantation. Patients treated with an opening pressure rating of 50 mmH2O in the low-pressure stage of the gravitational valve showed a better outcome than those with an opening pressure of 100 or 130 mmH2O. According to present knowledge, hydrostatic shunts with an opening pressure of 50 mmH2O for the low-pressure stage are the best option for patients with idiopathic NPH. Due to the prompt switching function when the patient changes posture (lying down, standing, sitting, slanting etc.), the Miethke gravity-assisted valve (GAV) is more suitable in such cases than the Miethke Dual-Switch valve (DSV).

Predictors of outcome in patients with normal-pressure hydrocephalus

From 1982 until 2000 we examined 200 patients diagnosed with normal-pressure hydrocephalus (NPH) in a prospective study. From the patients who were surgically treated by a shunt implantation we could re-examine 155 (78%) at a mean time interval of 7 months after the operation. NPH differed in severity according to the results of the intrathecal infusion test in an early state NPH (without brain atrophy) and late state NPH (with brain atrophy). In our study, we focused on the possible predictors: patient age; length of disease; clinical signs including gait ataxia, dementia, and bladder incontinence; idiopathic vs. secondary origin; implanted valve type and the resistance of the valve to cerebrospinal fluid outflow. In 80 patients without cerebral atrophy and a short course of disease (< 1 year), a slight amount of dementia and an implanted Miethke Dualswitch-Valve were significant predictors for a positive postoperative outcome. The outflow resistance measured in the intrathecal infusion test showed only minimal relevance for outcome. Seventy-five patients with cerebral atrophy had a better outcome when dementia was not present, outflow resistance was above 20 mmHg/mL/min, the CSF tap-test was positive, and a Miethke Dualswitch-Valve was implanted.

Polytraumatisierte Brandverletzte

Most polytraumatized burn injury persons aged 30-40 years who have suffered a burn or a burn-like injury are stigmatized by serious functional deficits, temporary loss of their social independence, injury-associated psychological reactions of different levels, and unusual reversible deficits in their higher cortical functions. The result is a prolonged stage of acute treatment and rehabilitation as well as very often the lifelong need for highly specialized care by physicians and other medical professionals. Accordingly, the deficits in any individual case are high and in spite of the low case rate (approximately 300-400 cases/ year) these accidents have a high impact on society as a whole, resulting in a significant financial burden for the social security system, insurance funds, and pension funds.

Lectin histochemical investigations of the distal gut of chicks with special emphasis on the follicle-associated epithelium

Carbohydrates on epithelial cell surfaces play an important role as attachment sites for different microorganisms like bacteria, viruses and protozoa. To obtain more information about the distribution of carbohydrates on the luminal surface along the intestine, lectin histochemical studies on different gut segments of chicks of different age groups were carried out using a panel of 13 lectins with specificities for Man, Glc, Gal, GalNAc, GlcNAc or GlcNAc oligosaccharides and Sia. Furthermore, we tried to find out whether previously reported specificities of certain lectins for M cells (membranous or multifold cells) in the bursa of Fabricius (BF) can be observed also on M cells of the intestine. As a result we were able to demonstrate binding of all lectins employed in these studies in all investigated gut segments. In some cases, the application of the same lectin led to varying staining intensities of the same histological structures in different age-groups (e.g. staining of the brush border with WGA, LEA, MAA or Conarva) or different gut segments (e.g. staining of goblet cells with CMA II, LEA and MPA). Hence, terminal carbohydrate residues of glycoconjugates on the intestinal epithelium vary depending on age and organ site. As glycoconjugates can act as attachment sites for microorganisms, these differences in the distribution of sugar residues may be one explanation for the site-specificity of certain pathogens. Furthermore, the binding of lectins to the follicle-associated epithelium (FAE) of the BF differs from that to the FAE of the intestine again stressing the site specificity of lectin binding. Thus, up to now no universal M-cell marker along the chicken intestine exists.

Use of an enzyme-linked immunosorbent asay to diagnose avian tuberculosis in a captive collection of wildfowl

The current study assessed the diagnostic accuracy of an enzyme-linked immunosorbent assay (ELISA) and evaluated it as a diagnostic screening aid for avian tuberculosis (TB) in a wildfowl collection at the Wildfowl and Wetlands Trust Centre at Llanelli, Wales, U.K.. Four hundred and eighteen birds of the collection, including geese, ducks, and swans, were screened for mycobacterial antibody levels. Of those birds tested, 40 died during the period of this study and gross post mortem examinations were performed. The ELISA showed a sensitivity of 76.9% and a specificity of 55.6% using post-mortem findings as the 'gold standard'. Thirteen of the examined birds showed evidence of avian TB at necropsy. In addition, liver and spleen biopsies of 19 birds were examined histopathologically. There was minimal agreement between gross post mortem and histopathological findings. PCR performed on 13 of the specimens prepared for histopathology did not identify the presence of mycobacterial DNA. The findings reveal a need for further research to improve the sensitivity and specificity of this ELISA and the accurate diagnosis of avian TB.

In pneumococcal meningitis a novel water-soluble inhibitor of matrix metalloproteinases and TNF-α converting enzyme attenuates seizures and injury of the cerebral cortex

Matrix metalloproteinases (MMPs) and TNF-alpha converting enzyme (TACE) contribute to the pathophysiology of bacterial meningitis. To date, MMP-inhibitors studied in models of meningitis were compromised by their hydrophobic nature. We investigated the pharmacokinetics and the effect of TNF484, a water-soluble hydroxamate-based inhibitor of MMP and TACE, on disease parameters and brain damage in a neonatal rat model of pneumococcal meningitis. At 1 mg/kg q6h TNF484 reduced soluble TNF-alpha and the collagen degradation product hydroxyproline in the cerebrospinal fluid. Clinically, TNF484 attenuated the incidence of seizures and was neuroprotective in the cortex. Water-soluble MMP-inhibitors may hold promise in the therapy of bacterial meningitis.

Vacuum-ultraviolet beam array generation by flat micro-optical structures

Micro-optical structures for VUV laser beam shaping and wave-front sensing were manufactured by thin-film deposition onto CaF2 and transfer by etching. Arrays of Bessel-like F2 laser beams at a wavelength of 157 nm with extremely small conical angles were generated by microaxicon lenses. Beam propagation was studied in simulations and experiments. Apodization by absorbing layers is proposed for beam cleaning.

GFP is the way to glow: bioimaging of the plant endomembrane system

It is less than a decade that the green fluorescent protein (GFP) and its spectral variants have changed the approach to studying the dynamics of the plant secretory pathway. GFP technology has in fact shed new light on secretory events by allowing bioimaging in vivo right to the heart of a plant cell. This review highlights exciting discoveries and the most recent developments in the understanding of morphology and dynamics of the plant secretory pathway achieved with the application of fluorescent proteins.

Modulation of the avian immune system: suppression versus induction of immunity

Knowledge of the potential, but also of the vulnerability of the avian immune system is not only of academic interest. The intact immune system, beginning in the embryo, is of central significance to safeguarding health and productivity in poultry flocks. Interactions between cellular and soluble constituents of the avian immune system on one hand, and the nature of immunosuppressants on the other, determine whether the avian immune system is able to cope with microbial and non-microbial challenges. Modulation of the immune response can be achieved in the classical way by specific vaccinations or possibly in the future by DNA vaccination. Cytokine inducing compounds may provide additional tools to enhance immune reactivity. The future will tell whether these approaches will be applicable in disease preventation or treatment in poultry medicine. In concert with these tools, however, strict hygiene measures from incubation until production, slaughter and processing are equally of vital significance as part of disease prevention strategies, ultimately leading to high quality food products originating from animal production.

Ultrashort-pulse wave-front autocorrelation

Combined spatially resolved collinear autocorrelation and Shack-Hartmann wave-front sensing of femtosecond laser pulses is demonstrated for the first time to our knowledge. The beam is divided into multiple nondiffracting subbeams by thin-film micro-optical arrays. With hybrid refractive-reflective silica/silver microaxicons, wave-front autocorrelation is performed in oblique-angle reflection. Simultaneous two-dimensional detection of local temporal structure and wave-front tilt of propagating few-cycle wave packets is demonstrated.

[Poultry husbandry and animal health]

Close interactions are existing between poultry husbandry and poultry health. The more housing systems and the environment of the animals can be controlled, the less the general risk of disorders in poultry flocks--especially of diseases which are caused by the introduction of microoganisms. Resulting deterimental effects will affect not only the animals themselves, but also pose a risk indirectly for humans via food originating from animals under production. Also, by keeping the risk of infections as low as possible, the use of therapeutics can be avoided. This will reduce the risk of residues in food of animal origin. In summary, with all probability open poultry husbandry systems, especially those including free range systems pose increased risks for poultry health and consequently for the quality of food originating from poultry production. At least, those systems require highest standards of biosecurity, defined as management, location, farm layout, cleaning and desinfection incl. pest control programs, immunization and specific veterinary monitoring concepts to prevent infections.

[Computed tomographic aspects of skull development in a child with cherubism]

The clinical picture of cherubism is similar to that of fibrous dysplasia. The initial clinical appearance involves the deformation of the maxillofacial area with orthodontic disorder. Usually it is found in the mandible giving the child a chubby-faced appearance, and it often occurs together with symmetric submandibular lymph node enlargement. This appearance reminds one of the cherubs seen in art. Only histological evidence for cherubism is inconclusive. The presence of multi-nucleated giant cells resembles fibrous dysplasia. A combination of clinical, radiographical and histological findings eventually leads to the correct diagnosis. An example is given of a patient displaying the typical disease process. Over a period of 12 years, we observed the progression of the disease from its initial appearance in a young child, through the full and characteristic display of a cherubic youth, and finally its regression. In conclusion, we advise restraint in planning surgical intervention. The diseases etiology is not entirely dear. The latest research points to genetic defects that lead to failure in the expression of matrix proteins.

Immunochemical localization of megalin, retinol-binding protein and Tamm-Horsfall glycoprotein in the kidneys of dogs

Megalin, retinol-binding protein (RBP) and Tamm-Horsfall glycoprotein (THP) are involved in the renal metabolism of vitamin A in canine species. The presence of megalin, RBP and THP in the kidneys of dogs was investigated using immunohistochemical methods Megalin was highly expressed in the apical membrane of the proximal convoluted and straight tubule cells. Immunoreactive RBP was detected below the apical plasma membrane, as well as in basolateral granules of the proximal convoluted tubule cells. THP immunoreactivity was seen in the epithelial cells lining the thick ascending limb of the loop of Henle. Furthermore, THP was displayed in a scattered pattern within the distal convoluted tubules. The co-localization of megalin and RBP coincides with biochemical studies that have shown megalin to be responsible for renal RBP absorption in the proximal convoluted tubules after filtration through the renal glomerulus. The presence of THP, the carrier for vitamin A in canine urine, showed that vitamin A excretion in the urine of dogs is not merely a filtration process but also seems to be a pathway located in the distal part of the nephron.

[5-year follow-up study of total knee arthroplasty by means of EMG mapping]

AIM

The objective of the present study was to evaluate the long-term functional results after implantation of a total knee arthroplasty (TKA) objectively and quantitatively.

METHOD

Functional parameters (muscular coordination, strength and range of motion) and the subjective satisfaction of the patients were measured by means of EMG mapping, isokinetics, ultrasound and a questionnaire in 21 patients with TKA 5.1 years after implantation of the TKA.

RESULTS

81 % of the investigated patients were subjectively satisfied. The isokinetic results showed a significant improvement of the extensor strength and of the relation between flexors and extensors. Patients who had been more physically active over these 5 years reached significantly better results. The results of EMG mapping showed good overall retention of the satisfactory coordination levels resulting from the initial in-patient rehabilitation. But the coordination patterns demonstrated clear changes showing highly activated areas in the region of the M. vastus medialis. The range of motion and the contraction capacity showed no further improvement compared with the results 26 weeks after implantation of the TKA.

CONCLUSION

Long-term results after implantation of a TKA showed a good muscular coordination, strength and range of motion. A higher physical activity level led to better functional results and greater overall satisfaction of TKA patients 5 years after implantation.

Neuropathotyping: a new system to classify Marek's disease virus

A statistical approach was used to establish a new classification system of Marek's disease virus (MDV) on the basis of neurologic responses. To develop the system, neurologic response data from 15x7 chickens inoculated with 30 strains of serotype 1 MDV were statistically analyzed by a cluster analysis. The goal was to identify a statistical system that would verify if three neurovirulence groups correlated with the three pathotypes previously described. The system was also validated in two additional strains of specific-pathogen-free (SPF) chickens, SPAFAS and line SC (Hy-Vac). The proposed system is based on analysis of three variables: 1) frequency of birds showing transient paralysis between 9 and 11 days postinoculation (dpi), (2) mortality before 15 dpi, and (3) frequency of birds showing persistent neurologic disease between 21 and 23 dpi. By use of this system, a MDV may be classified in one of three groups, designated neuropathotypes A, B, and C, which roughly correspond to the virulent, very virulent, and very virulent plus pathotypes, respectively. However, correlation between neuropathotype and pathotype was not absolute, and neuropathotyping is more a complement to the current pathotyping system than a replacement for it. Our results showed that neuropathotyping studies can be conducted in two types of commercial SPF chickens by the use of the same variables, although the system would first have to be standardized by the use of prototype viruses. Neuropathotypes can also be estimated with our statistical analysis with reasonable accuracy. By use of this analysis, we established that MDV strains within the very virulent pathotype may be subdivided into neuropathotypes B and C, thus establishing a previously unrecognized pathotypic classification. This finding illustrates how neuropathotyping may extend important information not identified by conventional pathotyping.

Serological status for Chlamydophila psittaci, Newcastle disease virus, avian polyoma virus, and Pacheco disease virus in scarlet macaws (Ara macao) kept in captivity in Costa Rica

From 1998 to 1999, a total of 128 blood samples were collected from scarlet macaws (Ara macao), kept in captivity in 11 different aviaries located in six provinces of Costa Rica. The sera were examined for antibodies directed against Chlamydophila psittaci, Newcastle disease virus (NDV), avian polyoma virus (APV), and Pacheco disease virus (PDV). Testing by enzyme-linked immunosorbent assay (ELISA), showed 16 (12.39%) of the samples (n = 129) exhibited antibodies directed against C. psittaci. Employing haemagglutination inhibition tests for NDV antibodies, all of the samples were found to be negative. The prevalence of antibodies specific for APV was tested with a blocking ELISA and serum neutralization tests (SNT) and 12 of 128 samples (9.37%) were found to be positive with both tests. In SNT, two out of 128 samples (1.56%) were positive for PDV. This is the first description of the serological status in scarlet macaws in captivity in Costa Rica. The study demonstrates the absence of NDV antibodies in the birds investigated on one hand, but also indicates a health hazard for numerous avian species due to the risk of infections with C. psittaci, APV or PDV.

[Combined liver and kidney transplantation: indications and long-term follow-up]

INTRODUCTION

In patients suffering from chronic liver and kidney disease combined liver-kidney transplantation is the only therapeutic option. However, in these patients, it is mandatory to distinguish between chronic and acute renal failure prior to transplantation, because acute renal failure may recover after successful liver transplantation. In this study we investigated the indications and results of this combined procedure.

PATIENTS AND METHODS

We report on 27 patients who underwent liver and kidney transplantation. The underlying diseases were viral hepatitis (n = 12), polycystic liver and kidney disease (n = 9), primary hyperoxaluria (n = 4), and cryptogenic cirrhosis (n = 2) with end-stage renal disease due to glomerulonephritis, diabetic nephropathy or renal failure caused by nephrotoxicity of immunosuppressive therapy after liver transplantation. Nine patients had lymphocytotoxic antibodies and 5/27 patients had a positive crossmatch pretransplant.

RESULTS

One patient died due to bleeding complications, two patients lost the kidney graft due to initial non-function or technical problems. The incidence of acute and steroid-resistant rejections was 60% and 20% in patients with a positive cross-match compared to 32% and 14% in negative cross-match transplants. Only two patients experienced a rejection episode of the kidney (3.7%). No hyperacute rejection of the kidney graft occurred. Long-term patients and graft survival was not impaired in the presence of a positive cross-match. The 1- and 5-year survival rates of patients who underwent combined transplantation was 97% and 93% versus 91% and 83% in patients with liver transplantation alone.

CONCLUSION

Combined liver-kidney transplantation is a safe treatment for endstage liver and kidney disease even in the face of a positive cross-match.

Small dose of exogenous surfactant combined with partial liquid ventilation in experimental acute lung injury: effects on gas exchange, haemodynamics, lung mechanics, and lung pathology

A combination of exogenous surfactant and partial liquid ventilation (PLV) with perfluorocarbons should enhance gas exchange, improve respiratory mechanics and reduce tissue damage of the lung in acute lung injury (ALI). We used a small dose of exogenous surfactant with and without PLV in an experimental model of ALI and studied the effects on gas exchange, haemodynamics, lung mechanics, and lung pathology. ALI was induced by repeated lavages (PaO2/FIO2 less than 13 kPa) in 24 anaesthesized, tracheotomized and mechanically ventilated (FIO2 1.0) juvenile pigs. They were treated randomly with either a single intratracheal dose of surfactant (50 mg kg(-1), Curosurf, Serono AG, München, Germany) (SURF-group, n=8), a single intratracheal dose of surfactant (50 mg kg(-1), Curosurf) followed by PLV with 30 ml kg(-1) of perfluorocarbon (PF 5080, 3M, Germany) (SURF-PLV-group, n=8) or no further intervention (controls, n=8). Pulmonary gas exchange, respiratory mechanics, and haemodynamics were measured hourly for a 6 h period. In the SURF-group, the intrapulmonary right-to-left shunt (QS/QT) decreased significantly from mean 51 (SEM 5)% after lavage to 12 (2)%, and PaO2 increased significantly from 8.1 (0.7) to 61.2 (4.7) kPa compared with controls and compared with the SURF-PLV-group (P<0.05). In the SURF-PLV-group, QS/QT decreased significantly from 54 (3)% after induction of ALI to 26 (3)% and PaO2 increased significantly from 7.2 (0.5) to 30.8 (5.0) kPa compared with controls (P<0.05). Static compliance of the respiratory system (C(RS)), significantly improved in the SURF-PLV-group compared with controls (P<0.05). Upon histological examination, the SURF-group revealed the lowest total injury score compared with controls and the SURF-PLV-group (P<0.05). We conclude that in this experimental model of ALI, treatment with a small dose of exogenous surfactant improves pulmonary gas exchange and reduces the lung injury more effectively than the combined treatment of a small dose of exogenous surfactant and PLV.

Human acid ceramidase: processing, glycosylation, and lysosomal targeting

The biosynthesis of human acid ceramidase (hAC) starts with the expression of a single precursor polypeptide of approximately 53-55 kDa, which is subsequently processed to the mature, heterodimeric enzyme (40 + 13 kDa) in the endosomes/lysosomes. Secretion of hAC by either fibroblasts or acid ceramidase cDNA-transfected COS cells is extraordinarily low. Both lysosomal targeting and endocytosis critically depend on a functional mannose 6-phosphate receptor as judged by the following criteria: (i) hAC-precursor secretion by NH(4)Cl-treated fibroblasts and I-cell disease fibroblasts, (ii) inhibition of the formation of mature heterodimeric hAC in NH(4)Cl-treated fibroblasts or in I-cell disease fibroblasts, and (iii) blocked endocytosis of hAC precursor by mannose 6-phosphate receptor-deficient fibroblasts or the addition of mannose 6-phosphate. The influence of the six individual potential N-glycosylation sites of human acid ceramidase on targeting, processing, and catalytic activity was determined by site-directed mutagenesis. Five glycosylation sites (sites 1-5 from the N terminus) are used. The elimination of sites 2, 4, and 6 has no influence on lysosomal processing or enzymatic activity of recombinant ceramidase. The removal of sites 1, 3, and 5 inhibits the formation of the heterodimeric enzyme form. None of the mutant ceramidases gave rise to an increased rate of secretion, suggesting that lysosomal targeting does not depend on one single carbohydrate chain.

Marek's disease virus infection in the brain: virus replication, cellular infiltration, and major histocompatibility complex antigen expression

Marek's disease virus (MDV) infection in the brain was studied chronologically after inoculating 3-week-old chickens of two genetic lines with two strains of serotype I MDV representing two pathotypes (v and vv+). Viral replication in the brain was strongly associated with the development of lesions. Three viral antigens (pp38, gB, and meq) were detected in the brain of infected chickens. Marked differences between v and vv+ pathotypes of MDV were identified for level of virus replication, time course of brain lesions, and expression of major histocompatibility complex (MHC) antigens. Two pathologic phenomena (inflammatory and proliferative) were detected in the brain of chickens inoculated with vv+MDV, but only inflammatory lesions were observed in those inoculated with vMDV. Inflammatory lesions, mainly composed of macrophages, CD4+ T cells, and CD8+ T cells, started at 6-10 days postinoculation (dpi) and were transient. Proliferative lesions, characterized by severe infiltrates of CD4+CD8- T cells (blasts), started at 19-26 dpi and persisted. Expression of MHC antigens in endothelial cells and infiltrating cells within the brain was influenced by MDV infection. Upregulation of MHC class II antigen occurred in all treatment groups, although it was more severe in those inoculated with vv+MDV. MHC class I antigen was downregulated only in those groups inoculated with vv+MDV. These results enhance our understanding of the nature and pattern of MDV infection in the brain and help to explain the neurovirulence associated with highly virulent MDV.

Performance-driven facial animation: basic research on human judgments of emotional state in facial avatars

Virtual reality is rapidly evolving into a pragmatically usable technology for mental health (MH) applications. As the underlying enabling technologies continue to evolve and allow us to design more useful and usable structural virtual environments (VEs), the next important challenge will involve populating these environments with virtual representations of humans (avatars). This will be vital to create mental health VEs that leverage the use of avatars for applications that require human-human interaction and communication. As Alessi et al.1 pointed out at the 8th Annual Medicine Meets Virtual Reality Conference (MMVR8), virtual humans have mainly appeared in MH applications to "serve the role of props, rather than humans." More believable avatars inhabiting VEs would open up possibilities for MH applications that address social interaction, communication, instruction, assessment, and rehabilitation issues. They could also serve to enhance realism that might in turn promote the experience of presence in VR. Additionally, it will soon be possible to use computer-generated avatars that serve to provide believable dynamic facial and bodily representations of individuals communicating from a distance in real time. This could support the delivery, in shared virtual environments, of more natural human interaction styles, similar to what is used in real life between people. These techniques could enhance communication and interaction by leveraging our natural sensing and perceiving capabilities and offer the potential to model human-computer-human interaction after human-human interaction. To enhance the authenticity of virtual human representations, advances in the rendering of facial and gestural behaviors that support implicit communication will be needed. In this regard, the current paper presents data from a study that compared human raters' judgments of emotional expression between actual video clips of facial expressions and identical expressions rendered on a three-dimensional avatar using a performance-driven facial animation (PDFA) system developed at the University of Southern California Integrated Media Systems Center. PDFA offers a means for creating high-fidelity visual representations of human faces and bodies. This effort explores the feasibility of sensing and reproducing a range of facial expressions with a PDFA system. In order to test concordance of human ratings of emotional expression between video and avatar facial delivery, we first had facial model subjects observe stimuli that were designed to elicit naturalistic facial expressions. The emotional stimulus induction involved presenting text-based, still image, and video clips to subjects that were previously rated to induce facial expressions for the six universals2 of facial expression (happy, sad, fear, anger, disgust, and surprise), in addition to attentiveness, puzzlement and frustration. Videotapes of these induced facial expressions that best represented prototypic examples of the above emotional states and three-dimensional avatar animations of the same facial expressions were randomly presented to 38 human raters. The raters used open-end, forced choice and seven-point Likert-type scales to rate expression in terms of identification. The forced choice and seven-point ratings provided the most usable data to determine video/animation concordance and these data are presented. To support a clear understanding of this data, a website has been set up that will allow readers to view the video and facial animation clips to illustrate the assets and limitations of these types of facial expression-rendering methods (www. USCAvatars.com/MMVR). This methodological first step in our research program has served to provide valuable human user-centered feedback to support the iterative design and development of facial avatar characteristics for expression of emotional communication.

[Objective assessment of results of special hydrotherapy in inpatient rehabilitation following knee prosthesis implantation]

AIM

Based on our own previous surface EMG investigations (EMG mapping), it has been shown that disturbances in coordination, proprioception and strength measured before and after implantation of a total knee arthroplasty (TKA) can be treated successfully with standard physical therapy during in-patient rehabilitation. The objective of the present study was to evaluate the therapeutic effect of a special type of hydrotherapy.

METHOD

25 patients with TKA were treated for 3 weeks with a standardized hydrotherapy training during in-patient rehabilitation. Several diagnostic methods (EMG mapping, Isokinetics, Ultrasound) were applied to objectify and quantify changes in muscular coordination and strength at 4, 7, and 26 weeks postoperative. These results were compared with the results of 38 TKA patients treated with a "standard rehabilitation program" and with the results of 20 healthy persons.

RESULTS

EMG mapping as well as isokinetics and ultrasound permitted an objective characterization of the results. Patients treated with the special hydrotherapy showed greater improvements in the investigated items of coordination and strength than patients treated with the "standard rehabilitation program". For example, in the hydrotherapy group a significantly better contraction capacity of the M. vastus intermedius was measured. The intensive hydrotherapy was tolerated by all patients and reached good acceptance.

CONCLUSION

The investigated hydrotherapy technique leads to better muscular coordination and strength, which can provoke a better stabilization of the knee joint. Therefore, the early and intensive application of hydrotherapy for improving coordination and strength in the rehabilitation of patients with total knee arthroplasty is advisable.

Inhibition of human chymase by 2-amino-3,1-benzoxazin-4-ones

A series of 2-sec.amino-4H-3,1-benzoxazin-4-ones was evaluated as acyl-enzyme inhibitors of human recombinant chymase. The compounds were also assayed for inhibition of human cathepsin G, bovine chymotrypsin, and human leukocyte elastase. Introduction of an aromatic moiety into the 2-substituent resulted in strong inhibition of chymase, cathepsin G, and chymotrypsin. Extension of the N(Me)CH2Ph substituent by one methylene unit was unfavourable to inhibit these proteases. Towards chymase, 2-(N-benzyl-N-methylamino)-4H-3,1-benzoxazin-4-one (32) and 2-(N-benzyl-N-methylamino)-6-methyl-4H-3,1-benzoxazin-4-one (33) were found to exhibit Ki values of 11 and 17 nM, respectively, and form stable acyl-enzymes with half-lives of 53 and 25 min, respectively. Benzoxazinone 33 also inhibited the human chymase-catalyzed formation of angiotensin 11 from angiotensin I.

Molecular analysis of acid ceramidase deficiency in patients with Farber disease

Farber disease is a rare, autosomal recessively inherited sphingolipid storage disorder due to the deficient activity of lysosomal acid ceramidase, leading to the accumulation of ceramide in cells and tissues. Here we report the identification of six novel mutations in the acid ceramidase gene causing Farber disease: three point mutations resulting in single amino acid substitutions, one intronic splice site mutation resulting in exon skipping, and two point mutations also leading to occasional or complete exon skipping. Of interest, these latter two mutations occurred in adjacent nucleotides and led to abnormal splicing of the same exon. Expression of the mutated acid ceramidase cDNAs in COS-1 cells and subsequent determination of acid ceramidase residual enzyme activity demonstrated that each of these mutations was the direct cause of the acid ceramidase deficiency in the respective patients. In contrast, two known polymorphisms had no effect on acid ceramidase activity. Metabolic labeling studies in fibroblasts of four patients showed that even though acid ceramidase precursor protein was synthesized in these individuals, rapid proteolysis of the mutated, mature acid ceramidase occurred within the lysosome.