Trainingsmethode für Regionalanästhesisten

INTRODUCTION

Optimized training facilities are the key to efficient teaching of regional anesthesia.

MATERIAL AND METHODS

A combination of Thiel's embalming method, flap dissection and pulse simulation was offered to participants in several workshops on regional anesthesia. Tutors, experienced anesthetists and anatomists, evaluated the workshop and compared Thiel's method to classic formaldehyde conservation. Additionally both embalming methods were assessed with regard to the mechanical properties according to the requirements of regional anesthesia.

RESULTS

The evaluation showed high acceptance of the method offered in the workshop. In a comparison of fixation methods Thiel's method was generally preferred as it presented more similar conditions to living patients and almost ideal conditions for regional anesthesia.

CONCLUSION

The presented method is an optimized, strongly accepted teaching and training tool for teaching regional anesthesia.

Improvement of the primary success rate of recanalization of chronic total coronary occlusions with the Safe-Cross system after failed conventional wire attempts

BACKGROUND

In view of the improved long-term patency with drug-eluting stents, the challenge with chronic total coronary occlusion (CTO) remains the low primary success rate. Improved guide wires have increased this rate, but alternative devices may be of additional value. The goal of the present study was to determine the additional benefit of a new penetration device in CTOs after an extensive conventional wire approach.

METHODS AND RESULTS

In 148 consecutive patients the recanalization of a CTO of >3 months was attempted. A conventional wire approach was used with recent dedicated recanalization wires, which was successful in 104 patients (70%). If after at least 20 min of fluoroscopic time no crossing of the wire was achieved, the Safe-Cross wire (SC) (Intralumina) was used which enables verification of the intraluminal wire position via optical reflectometry, and crossing of resistent occlusion caps by radiofrequency ablation. Due to severe dissections after the conventional approach, the SC was not used in 10 patients. In 34 patients the SC wire was applied, leading to successful lesion crossing in 14 patients (41%). Thus, the primary success rate was improved from 70.2% to 79.7%. No periprocedural major adverse events were observed with the SC wire. The successful attempts with the SC wire were predominantly in blunt occlusions. All patients with successful wire passage could be treated with one or more stents.

CONCLUSIONS

In a real world cohort of patients with CTO, the SC wire could increase the primary success rate after failed extensive conventional wire attempt. In these worst case patients the SC success rate was 41%. This new wire appears to have additional potential in failures of a conventional wire approach.

Model-free analysis of binding at lipid membranes employing micro-calorimetric measurements

Based on universal thermodynamic principles (Schwarz in Biophys Chem 86:119-129, 2000) it is shown how measured enthalpy changes can be utilized to determine the relevant binding isotherm as well as the variation of the molar enthalpy change. This is carried out in a novel way involving multiple titration experiments whose evaluation requires no beforehand assumptions or models whatever. An appropriate specific model mechanism may be discussed afterwards and developed in view of the given experimental results. The pertinent procedure is demonstrated using micro-calorimetric data obtained in the case of the local anesthetic dibucaine as it associates with POPC liposomes. Mutual interactions of the bound ligand molecules could be described in terms of repulsive enthalpic and entropic activity coefficients. Apparently these are induced by electrostatic forces and by the finite size of binding sites, respectively.

In vivo characterization of progestins with reduced non-genomic activity in vitro

Postmenopausal women that still have an uterus and suffer from hot flushes are treated with combinations of estrogens and progestins. Whereas estrogens are indispensable for treating postmenopausal symptoms, progestins are added to counteract the proliferative activity of estrogens on uterine epithelial cells. However, in the mammary gland, progestins, given together with estrogens, stimulate the proliferation of mammary epithelial cells. Therefore, progestins with reduced proliferative activity in the mammary gland would be of advantage for hormone therapy of postmenopausal women. In order to identify progestins with better tissue-selectivity, we exploited the activation of different signal transduction pathways by the classical progesterone receptor. We demonstrated that progestins with reduced non-genomic versus genomic activity in vitro show a better dissociation of uterine versus mammary gland effects in vivo than medroxyprogesterone acetate (MPA), a synthetic progestin that is widely used in hormone therapy.

Molybdenum cofactor biosynthesis and deficiency

The molybdenum cofactor (Moco) forms the active site of all molybdenum (Mo) enzymes, except nitrogenase. Mo enzymes catalyze important redox reactions in global metabolic cycles. Moco consists of Mo covalently bound to one or two dithiolates attached to a unique tricyclic pterin moiety commonly referred to as molybdopterin (MPT). Moco is synthesized by an ancient and conserved biosynthetic pathway that can be divided into four steps, according to the biosynthetic intermediates precursor Z (cyclic pyranopterin monophosphate), MPT and adenylated MPT. In a fifth step modifications such as attachment of nucleotides, sulfuration or bond formation between Mo and the protein result in different catalytic Mo centers. A defect in any of the steps of Moco biosynthesis results in the pleiotropic loss of all Mo enzyme activities. Human Moco deficiency is a hereditary metabolic disorder characterized by severe neurodegeneration resulting in early childhood death. Recently, a first substitution therapy was established.

[Bile acid-independent effect of hymecromone on bile secretion and common bile duct motility]

BACKGROUND AND OBJECTIVE

Hymecromone (4-methyl-umbiliferone) has been used for more than 20 years for the treatment of functional and obstructive spasms of the biliary tract. Its mode of action however is still largely unknown. We investigated the effect of 4-methyl-umbiliferone p. o. and i. v. on gall bladder and common bile duct motility and studied potentially indirect effects via alterations in bile acid metabolism.

PATIENTS AND METHODS

Twenty healthy volunteers, aged 25 - 37, 10 males, 10 females, were included into a Placebo-controlled, randomised, cross-over double-blind study. Subjects were treated with 800 mg hymecromone p. o.; in addition a standardized meal (Biloptin, 40 gs) was given. Gall bladder volume and common bile duct diameter were determined by ultrasound. Conjugated and unconjugated bile acids were analysed by gas chromatography. Additionally, in a third open label phase hymecromone was given i. v.

RESULTS

Common bile duct diameter was significantly larger after a standard meal with hymecromone given p. o. or i. v. than with placebo (each p < 0.01). However, alterations in gall bladder volume after a standard meal were not different between placebo and hymecromone (p. o. or i. v.). Unconjugated and conjugated bile acids rose after standard meal in all three groups without significant differences between hymecromone and placebo.

CONCLUSIONS

Hymecromone was associated with significant dilation of the common bile duct. In contrast to previous reports an effect of hymecromone on gall bladder motility could not be observed. The unchanged values of bile acids in serum after hymecromone compared to placebo, together with the dilatation of the common bile duct after hymecromone, may indicate a bile acid-independent effect of hymecromone on bile secretion.

[GCP inspections of clinical trials]

The new regulations on clinical trials with medicinal products for human use include rules for Good Clinical Practice (GCP) inspections. These rules pertain to such inspections as part of the surveillance program of the relevant state authorities, in preparation for a decision on the authorization of clinical trials by the federal authorities, and pre and post approval GCP-inspections as one tool of Good Regulatory Practice (GRP). The overall aim of such inspections is to verify compliance with the provisions on GCP and, thus, to ensure the protection of trial subjects, the credibility and reliability of clinical trial results, and the pro-active protection of patients. Since inspection results have to be acknowledged by other member states, there is an increasing importance for quality assurance and harmonization of inspection procedures. As in most cases a considerable number of sites are involved in the conduct of clinical trials in different member states, there is a need for coordination of GCP inspections between these states.

[Histological investigation of the micromorphological effects of the application of a laser needle--results of an animal experiment]

In an experimental animal study (Sus scrofa domesticus) we investigated the effects of the new technique of laser needle stimulation (wavelength: 685 nm; energy density: 4.6 kJ/cm2 per point; application duration: 20 min). The results revealed changes in microcirculatory parameters of the skin resulting in an increase in blood flow. However, the quality and intensity of the laser light did not induce micromorphological alterations in the skin.

Development and validation of a PCR-based marker assay for negative selection of the HMW glutenin allele Glu-B1-1d (Bx-6) in wheat

Polymorphisms between the coding sequences of high-molecular-weight (HMW) glutenin x-type genes at the Glu-1 locus were used to amplify Glu-1B x-type-specific PCR fragments. PCR analysis in a wheat cultivar subset carrying different Glu-1B x-type alleles resulted in PCR fragments that differed in size for Glu-B1-1d (B-x6) and non -Glu-B1-1d (B-x6) genotypes. Subsequent sequencing analysis revealed a 15-bp in-frame insertion in the coding regions of all Glu-B1-1d (B-x6) genotypes which allowed the development of a B-x6-specific PCR assay for high-throughput allele sizing by ion-pair reversed-phase high-performance liquid chromatography. The assay was validated in a set of 86 German wheat cultivars, and genotyping data unequivocally verified the presence of HMW glutenin subunits GLU-B1-1D (Bx-6) + GLU-B1-2A (By-8) by means of sodium dodecyl sulphate-polyacrylamide gel electrophoresis. These results demonstrate that the PCR assay can be applied for the detection and negative selection of the 'poor breadmaking quality' Glu-B1-1d (B-x6) alleles in wheat breeding programs.

Quantitative Bestimmung geschlechtsspezifischer thermischer Empfindungs- und Schmerzschwellen vor und nach Lasernadelstimulation / Quantification of Gender Specific Thermal Sensory and Pain Threshold Before and After Laserneedle Stimulation

Quantitative thermal sensory and pain threshold testing (QST) was performed in 29 adult healthy volunteers (mean age 24.2 +/- 2.7 years; range: 18-29 years; 20 females, 9 males) using the Thermal Sensory Analyser TSA-II (Medoc Advanced Medical Systems, Ramat Yishai, Israel, and Minneapolis, Minnesota, USA) before and after laser needle acupuncture and placebo stimulation, respectively. Significant (p < or = 0,001; t-test) gender-specific differences were seen on cold pain threshold analysis. No significant changes in parameters of thermal sensory and pain thresholds were found before and after laser needle or placebo stimulation at acupuncture points for acute pain. However, a trend towards change in the median value of cold pain sensation after laser needle stimulation (p = 0.479; paired t-test; n.s.) was seen within the group of healthy females. The influence of stimulation of acupuncture points for chronic pain on the various parameters needs to be clarified in future studies.

Identification and quantitative expression analysis of genes that are differentially expressed during conidial germination in Pyrenophora teres

Net blotch, caused by Pyrenophora teres, is a common disease of barley ( Hordeum vulgareL.). Two PCR-based differential screening techniques, cDNA-amplified fragment length polymorphism (cDNA-AFLP) and suppression subtractive hybridisation (SSH), were employed to clone cDNA copies of transcripts that are up-regulated during conidial germination. The nucleotide sequences of 35 transcripts were analysed, and the amino acid sequences of their predicted products were compared with entries in databases. Eleven of these clones showed homology to genes from other ascomycetes coding for a transcription factor, two regulatory proteins, a putative transposase, a protein required for the biogenesis of cytochrome C oxidase, a threonine synthase, a probable subunit of a phenylalanine-tRNA synthetase, a subunit of RNA polymerase I, a cation transport protein, a vacuolar ATP synthase subunit, and an RNA processing protein. One conserved hypothetical protein was found and 23 sequences could not be functionally classified. The relative expression of five transcripts at 0, 1, 2, 3, 6, 12 and 24 h after induction of germination was determined by real-time RT-PCR using 18S rRNA as the endogenous reference sequence. All transcripts showed a significant increase in expression during early stages of germination. The maximum change in expression relative to ungerminated conidia ranged between 2.6- and 6-fold. The characterisation of genes involved in biochemical processes during the germination of conidia could be useful for target-specific development of new antifungal agents.

Lamotrigine monotherapy for control of neuralgia after nerve section

BACKGROUND

We present six patients treated only with the new-generation anticonvulsant lamotrigine to define its sole effect on neuralgia after nerve section.

METHODS

Previous surgical or pharmacological attempts failed to relieve this neuropathic pain in our patients. Before initiation of lamotrigine therapy, patients reported spontaneous and touch-evoked shooting pain followed by periods of burning pain. No breakthrough medication was needed during the maintenance phase of 1-23 months. Data were acquired by a pain diary on a weekly basis.

RESULTS

With 75-300 mg of lamotrigine per day, the burning and shooting pain intensity was relieved by 33-100%. Most obviously, the attack frequency of the shooting pain was reduced by 80-100%. No adverse effects were observed.

CONCLUSION

We conclude that lamotrigine may be beneficial in the treatment of neuralgia after nerve section following the failure of previous pharmacological or surgical attempts.

A resistance gene analog useful for targeting disease resistance genes against different pathogens on group 1S chromosomes of barley, wheat and rye

Comparative sequence analysis of the resistance gene analog (RGA) marker locus aACT/CAA (originally found to be tightly linked to the multiallelic barley Mla cluster) from genomes of barley, wheat and rye revealed a high level of relatedness among one another and showed high similarity to a various number of NBS-LRR disease resistance proteins. Using the sequence-specific polymerase chain reaction (PCR), RGA marker aACT/CAA was mapped on group 1S chromosomes of the Triticeae and was associated with disease resistance loci. In barley and rye, the marker showed linkage to orthologous powdery mildew resistance genes Mla1 and Pm17, respectively, while in wheat linkage with a QTL against fusarium head blight (FHB) disease was determined. The use of RGA clones for R gene mapping and their role in the expression of qualitative and quantitative resistance is discussed.