[Tuberculous Otitis media - a rare differential diagnosis in Germany]

A 28-year-old female patient with a migrant background presented for surgery with a suspected cholesteatoma in the left ear. The patient reported having had an aural discharge for several months; otoscopic examination revealed a runny ear, and discrete granulation tissue was seen. Pure-tone audiometry showed conduction hearing loss of 30-40 dB across all frequencies in the left ear; high-resolution computed tomography of the temporal bone revealed that the mastoid and tympanic cavity were completely obscured. The intraoperative finding showed a caseous space-occupying mass that completely filled the tympanic cavity. The suspected diagnosis of tuberculosis was corroborated by pathohistological, microbiological and molecular biological tests. Tuberculostatic therapy was initiated at a different location. Although tuberculosis of the middle ear is a rare condition in Germany, it should nevertheless be considered when making a differential diagnosis, especially in high-risk patients where cholesteatoma is suspected on clinical and radiological evidence or in patients with a chronic middle ear process.

Trypanosoma brucei Polo-like kinase is essential for basal body duplication, kDNA segregation and cytokinesis

Polo-like kinases (PLKs) are conserved eukaryotic cell cycle regulators, which play multiple roles, particularly during mitosis. The function of Trypanosoma brucei PLK was investigated in procyclic and bloodstream-form parasites. In procyclic trypanosomes, RNA interference (RNAi) of PLK, or overexpression of TY1-epitope-tagged PLK (PLKty), but not overexpression of a kinase-dead variant, resulted in the accumulation of cells that had divided their nucleus but not their kinetoplast (2N1K cells). Analysis of basal bodies and flagella in these cells suggested the defect in kinetoplast division arose because of an inhibition of basal body duplication, which occurred when PLK expression levels were altered. Additionally, a defect in kDNA replication was observed in the 2N1K cells. However, the 2N1K cells obtained by each approach were not equivalent. Following PLK depletion, the single kinetoplast was predominantly located between the two divided nuclei, while in cells overexpressing PLKty, the kinetoplast was mainly found at the posterior end of the cell, suggesting a role for PLK kinase activity in basal body and kinetoplast migration. PLK RNAi in bloodstream trypanosomes also delayed kinetoplast division, and was further observed to inhibit furrow ingression during cytokinesis. Notably, no additional roles were detected for trypanosome PLK in mitosis, setting this protein kinase apart from its counterparts in other eukaryotes.

Anastomotic stenting in a porcine aortoiliac graft model

The purpose of the study was to evaluate the feasibility of anastomotic stent application in a porcine aortoiliac graft model. In a total of 10 pigs, a polytetrafluoroethylene aortobi-iliac graft was implanted through a midline abdominal incision. The lower edge of the iliac vessel was graft-inverted about 1 mm to produce irregularities at the downstream anastomosis. After transverse graft incision, six stainless-steel stents, six poly-L-lactic acid (PLLA) stents and four PLLA stents with 10% polycaprolactone (PCL) were implanted at the iliac anastomotic site using a 6 mm balloon dilatation catheter. Four anastomotic sites were left untreated. After two weeks, the patency of graft limbs was evaluated by contrast-enhanced computed tomography (CT). Both metal and polymeric stent designs provided adequate flexibility to manoeuvre across the anastomotic site for expansion in the chosen position. After deployment, the stent-arterial wall contact was complete on a macroscopic view. On CT scan, all metal and PLLA-stented graft limbs were free of stenosis, whereas all PLLA/PCL stents were occluded. The non-stented graft limbs showed a stenosis of 50-70%. In summary, this model is feasible to assess preclinically the deployment and patency rate of an anastomotic stent and to test future stent developments.

HIV-1 Nef upregulates CCL2/MCP-1 expression in astrocytes in a myristoylation- and calmodulin-dependent manner

HIV-associated dementia (HAD) correlates with infiltration of monocytes into the brain. The accessory HIV-1 negative factor (Nef) protein, which modulates several signaling pathways, is constitutively present in persistently infected astroctyes. We demonstrated that monocytes responded with chemotaxis when subjected to cell culture supernatants of nef-expressing astrocytic U251MG cells. Using a protein array, we identified CC chemokine ligand 2/monocyte chemotactic protein-1 (CCL2/MCP-1) as a potential chemotactic factor mediating this phenomenon. CCL2/MCP-1 upregulation by Nef was further confirmed by ribonuclease protection assay, RT-PCR and ELISA. By applying neutralizing antibodies against CCL2/MCP-1 and using CCR2-deficient monocytes, we confirmed CCL2/MCP-1 as the exclusive factor secreted by nef-expressing astrocytes capable of attracting monocytes. Additionally, we showed that Nef-induced CCL2/MCP-1 expression depends on the myristoylation moiety of Nef and requires functional calmodulin. In summary, we suggest that Nef-induced CCL2/MCP-1 expression in astrocytes contributes to infiltration of monocytes into the brain, and thereby to progression of HAD.

Interventional stenting for ruptured iliac aneurysm following transplant nephrectomy

Surgical removal of a failed kidney graft may lead to a variety of postoperative complications, development of an aneurysm being a relatively rare complication. We report the case of a 34-year-old man who developed an iliac aneurysm 13 years after transplant nephrectomy. Interventional stenting was performed upon the rupture of the aneurysm. Postintervention the function of the contralateral transplanted kidney was stable and the patient recovered. An endoleak was diagnosed after 1 week, which was also stented. No operative procedure was necessary. In conclusion, even in an emergency situation interventional stenting of a false iliac aneurysm after transplant nephrectomy may be a therapeutic option.

[Physical (in)activity in childhood and adolescence]

In the last two decades in Germany and other countries physical activity of children and adolescents declined while sedentary lifestyle increased. Physical inactivity in childhood and youth is related with coronary heart disease risk factors and higher prevalence of obesity. International recommendations suggest daily 60 minutes or more moderate to vigorous physical activity and less than 2 hours sedentary activity in leisure.

Die Konstruktion eines empirisch bestimmten Sozialschichtindexes mittels optimaler Skalierung am Beispiel von Deutschland

Numerous epidemiological studies have shown an association between social status and disease. In alcohol research, socio-economic status (SES) has been associated with drinking patterns, misuse and alcohol problems. SES is a construct which is usually built by using the indicators education, occupation or income separately or combined as a summary score. However, either approach involves theoretical assumptions about the explanatory value of a chosen indicator before the data have been analysed. In this study we have created a gender-specific metric social status indicator for Germany by using all three single SES-indicators (education, occupation, income). We used national representative data from a postal survey from 2000. The age range was restricted to 25 - 59 years. To construct the indicator we used optimal scaling (categorical principal components analysis). Therefore no theoretical assumptions were necessary about the hierarchical order of educational or occupational categories. The optimal-scaling approach allows variables to be scaled on different levels. We used education and occupation as the original categorical data and income (equivalent income) as continuous data. The result of the scaling is a two-dimensional solution. The first dimension explains that variance which could be described by status consistencies (corresponding levels for education, occupation and income). The second dimension of the indicator results from the low correlation between education and income for some individuals (status inconsistencies). The two-dimensional indicator yields differentiated results which would not be visible using a one-dimensional SES-indicator such as education or a summary score. With regard to drinking patterns there are clear differences between middle or low-educated women or men with higher incomes and other social groups. Middle or low-educated men or women with a high income are more likely to be heavy episodic drinkers than people in other social status groups.

Anti-nociceptive efficacy of carprofen, levomethadone and buprenorphine for pain relief in cats following major orthopaedic surgery

A placebo-controlled, randomized blind study was conducted in cats (n = 60) after fracture repair to compare the analgesic effects as well as the side-effects of carprofen, buprenorphine and levomethadone during a 5-day treatment. Cats with severe shock symptoms or increases in blood urea nitrogen (BUN) and creatinine were excluded from the study. The cats were randomly assigned to four groups (n= 15). In group 1, carprofen was administered upon extubation at an initial dose of 4 mg/kg body weight, followed by one-third of that dose three times daily on days 2 to 5. In group 2, buprenorphine was administered in a single dose of 0.01 mg/kg body weight upon extubation and subsequently every 8 h. Levomethadone (group 3) was applied according to the same scheme at a dosage of 0.3 mg/kg body weight each time. The placebo (group 4) was given at the same time intervals as the opioids. Examinations were carried out prior to anaesthesia, between 30 min and 8 h after extubation, and on the following 4 days, 1 h after administration of the analgesics or the placebo as well as 1 h before the next administration. Pain and sedation evaluation was carried out with a visual analogue system (VAS) and with the aid of a numerical estimation scale (NRS). Pain was also scored by measuring mechanical nociceptive threshold of traumatized tissue. Plasma glucose and cortisol concentration, heart rate, respiration rate, blood pressure and body temperature were measured. Furthermore, a complete blood count and clinical chemistry including BUN, creatinine, alanine aminotransferase (ALT), glutamate dehydrogenase (GLDH), arterial blood pressure (AP), total protein and electrolytes of the cats were checked on the day of admission as well as on the last day of this study (day 5). Defaecation and urination as well as wound healing were monitored. On the basis of the mechanical nociceptive threshold of the traumatized tissue, concentrations of plasma glucose and cortisol and pain assessment using NRS and VAS, carprofen was found to have better anti-nociceptive efficacy when compared with the two opioid analgesics, while the analgesic effect of levomethadone was similar to that of buprenorphine. However, the carprofen group also showed comparably high median NRS and VAS pain scores in addition to occasional broad deviations from the group mean on the first post-operative treatment day. Sedative effects were detected for buprenorphine and levomethadone; in addition, symptoms of central excitation were noted with levomethadone. There was no indication of any clinically relevant respiratory depressive or cardiovascular effects, nor of any undesired renal, gastrointestinal or hepatic effects of the analgesics applied. However, the somewhat insensitive examination methods did not permit sufficient evaluation of side-effects, particularly on the gastrointestinal tract and the kidneys. It was found that carprofen and buprenorphine were well-tolerated analgesics for a 5-day administration in the cat, whereas levomethadone caused central excitation in some cases in the dosage scheme used here. However, it was apparent that none of the tested analgesics induced sufficient analgesia in the post-operative phase. For this reason, suitable methods must be found to improve analgesia, particularly in the immediate post-operative phase.

Incidence of post-anaesthetic arrhythmias in dogs

OBJECTIVES

To assess the use of Holter monitoring for evaluating the incidence of post-anaesthetic cardiac arrhythmias and associated anaesthetic risk for two different anaesthetic protocols.

METHODS

Patients undergoing orthopaedic surgery were randomly divided into two groups with different anaesthetic regimens (group A, isoflurane n = 30; group B, propofol n = 30). Two 24-hour Holter recordings were performed for each patient: the first directly following anaesthesia and the second, as a comparison, on the fifth postoperative day.

RESULTS

Although all dogs were healthy on pre-anaesthetic cardiac evaluation, 56 dogs showed arrhythmias in the two 24-hour (Holter) electrocardiograms performed. However, the number of arrhythmias recorded was low in most cases (less than 10 supraventricular extrasystoles and less than 100 ventricular extrasystoles). One patient in group A showed 94 supraventricular extrasystoles during the second monitoring period. Three patients in each group developed more than 100 ventricular extrasystoles during both Holter recordings. There were no statistically significant differences between the two anaesthetic regimens or between the two recordings in both groups.

CLINICAL SIGNIFICANCE

The two anaesthetic protocols investigated in this study did not induce an increased incidence of severe arrhythmias in healthy dogs in the post-anaesthetic phase.

[Comparison of the influence of different anesthetic protocols in the development of post-anesthetic arrhythmia in the dog]

Post-anesthetic holter monitoring was performed in 2 patient groups in order to compare the incidence of cardiac arrhythmias as a result of different anesthetic protocols. The 2 groups differed in their anesthetic protocol. Both groups received levomethadone as pre-anesthetic. The dogs in group A (n = 30) additionally received diazepam, the dogs in group B (n = 30) received propofol instead. Anesthesia was maintained by isoflurane in group A and a propofol constant rate infusion in group B. In each patient 2 holter monitorings were performed. The first recording began directly after anesthesia. As a comparison a second recording was performed on the 5th post-operative day. The recorded number of arrhythmias was low and no statistical difference was demonstrated between the 2 patient groups.

Towards discovering structural signatures of protein folds based on logical hidden Markov models

With the growing number of determined protein structures and the availability of classification schemes, it becomes increasingly important to develop computer methods that automatically extract structural signatures for classes of proteins. In this paper, we introduce and apply a new Machine Learning technique, Logical Hidden Markov Models (LOHMMs), to the task of finding structural signatures of folds according to the classification scheme SCOP. Our results indicate that LOHMMs are applicable to this task and possess several advantages over other approaches.

Response of dogs to short-term infusions of carbohydrate- or lipid-based parenteral nutrition

Parenteral nutrition (PN) is used to support intensive care patients. The risk for adverse metabolic effects depends on the composition of infused solutions and the duration of application. The present study in dogs compares metabolic and endocrine effects of two infusion solutions, with either triglycerides or glucose being the major energy sources, administered in a comparatively short infusion period (10 h/day). PN was administered for 9 days to two groups of five adult dogs to meet energy maintenance requirements. In group PN-LIP 61% of the total energy was derived from lipids and 22% from carbohydrates, compared with 21 and 62% in group PN-GLUC. Among routine haematology and clinical chemistry the plasma levels of glucose, triglycerides, insulin, insulin-like growth factor-I (IGF-I), glucagon, 3,5,3'-triiodothyronine and thyroxin were measured in non-infused dogs and at 2, 4, 6, and 8 h after the start of infusion at days 2 and 8 of the study. Infusions protocols did not cause gross metabolic aberrations. During the actual infusions glucose, triglyceride and insulin concentrations were elevated, each depending on the infusion solution. Concentrations of IGF-I, glucagon, 3,5,3'-triiodothyronine, thyroxin and cortisol did not change significantly. In conclusion short infusion periods of 10 h per day were tolerated by healthy dogs without adverse signs, which could improve practicability of PN also in clinical cases.

A survey of the Predictive Toxicology Challenge 2000-2001

MOTIVATION

The Predictive Toxicology Challenge (PTC) was initiated to stimulate the development of advanced techniques for predictive toxicology models. The goal of this challenge was to compare different approaches for the prediction of rodent carcinogenicity, based on the experimental results of the US National Toxicology Program (NTP).

RESULTS

111 sets of predictions for 185 compounds have been evaluated on quantitative and qualitative scales to select the most predictive models and those with the highest toxicological relevance. The accuracy of the submitted predictions was between 25 and 79 %. An evaluation of the most accurate models by toxicological experts showed, that it is still hard for domain experts to interpret the submitted models and to put them into relation with toxicological knowledge.

AVAILABILITY

PTC details and data can be found at: http://www.predictive-toxicology.org/ptc/.

High in vivo production of a model monoclonal antibody on adenoviral gene transfer

The therapeutic potential of monoclonal antibodies (MAbs) for treating a variety of severe or life-threatening diseases is high. Although intravenous infusion appears to be the simplest and most obvious mode of administration, it is not applicable in many long-term treatments. It might, however, be advantageously replaced by gene/cell therapies, rendering treatments cost-effective and eliminating the short- and long-term side effects associated with injection of massive doses of antibodies. Grafting of ex vivo genetically modified cells of various types has already been used for in vivo production and systemic delivery of MAbs in mice. However, although sustained for long periods of time, serum levels of ectopic MAbs were low. We show here that in vivo administration to mice of a first-generation adenoviral vector expressing a model MAb also permits achievement of the same goal, but with 100 to 200 times better efficiency that in any other case of gene transfer described thus far. We also investigated for possible anti-idiotypic response against the ectopic MAb. None was detected in the animals expressing the lowest levels of ectopic MAb production; a response was detected among the highest producers. In the latter case, however, the response was low and could not exert any significant neutralizing activity. In conclusion, our work indicates that high levels of circulating ectopic MAb can be obtained on direct in vivo gene transfer without inducing an anti-idiotypic response sufficiently robust to exert a neutralizing effect. This observation is encouraging in the perspective of clinical applications of this technology.

[Health-related quality of life in patients with chronic pain]

AIMS

An empirical comparison of the performance characteristics of 3 generic health-related quality of life (HRQL) measures in pain patients.

METHODS

The Nottingham Health Profile (NHP), the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), and the German Life Satisfaction Scale (FLZ-M) by Henrich et al. were simultaneously employed in a multicenter survey measuring the impact of pain on quality of life. The HRQL- instruments were incorporated into the German Pain Questionnaire (pain variables, CES-D, Pain Disability Index).

RESULTS

Characteristics of 3294 pain patients of 13 pain facilities are detailed in tables 1-3. Six of the 8 SF-36- and 4 of the 6 NHP-scales show satisfactory item-total correlations, bottom- and ceiling-effects, and internal consistency. FLZ-M reliabilities are satisfactory. The item weighting procedure of the FLZ-M proves to be unnecessary. Principle component analyses result in 7 factors for the SF-36 and the NHP. Six of the SF-36-factors are fairly homogeneous. The heterogeneity of the NHP- factors is marked. Correlations of the HRQL scales with depression (CES-D), anxiety (STAI) and physical functioning (FFbH-R-18) are high in all related contents. All instruments discriminate well between headache and back pain patients, between several pain grades (v. Korff) and the 3 Mainz pain chronicity stages.

CONCLUSIONS

The SF-36 has satisfactory to good psychometric properties in pain patients, the NHP item selection has to be improved. The FLZ-M weighting can be eliminated. The shortcomings of the SF-36 can be overcome by adding short scales on role functioning and pain (modular approach).

Injury, inflammation, and remodeling in fetal sheep lung after intra-amniotic endotoxin

Chorioamnionitis is frequent in preterm labor and increases the risk of bronchopulmonary dysplasia. We hypothesized that intra-amniotic endotoxin injures the lung in utero, causing a sequence of inflammation and tissue injury similar to that which occurs in the injured adult lung. Preterm lamb lungs at 125 days gestational age were evaluated for indicators of inflammation, injury, and repair 5 h, 24 h, 72 h, and 7 days after 4 mg of intra-amniotic endotoxin injection. At 5 h, the epithelial cells in large airways expressed heat shock protein 70, and alveolar interleukin-8 was increased. Surfactant protein B (SP-B) decreased in alveolar type II cells at 5 h, and SP-B in lung tissue and alveolar lavage fluid increased by 72 h. By 24 h, neutrophils were recruited into the large airways, and cell death was the highest. Alveolar type II cells decreased by 25% at 24 h, and proliferation was highest at 72 h, consistent with tissue remodeling. Intra-amniotic endotoxin caused surfactant secretion, inflammation, cell death, and remodeling as indications of lung injury. The recovery phase was accompanied by maturational changes in the fetal lung.

Fragment generation and support vector machines for inducing SARs

We present a new approach to the induction of SARs based on the generation of structural fragments and support vector machines (SVMs). It is tailored for bio-chemical databases, where the examples are two-dimensional descriptions of chemical compounds. The fragment generator finds all fragments (i.e. linearly connected atoms) that satisfy user-specified constraints regarding their frequency and generality. In this paper, we are querying for fragments within a minimum and a maximum frequency in the dataset. After fragment generation, we propose to apply SVMs to the problem of inducing SARs from these fragments. We conjecture that the SVMs are particularly useful in this context, as they can deal with a large number of features. Experiments in the domains of carcinogenicity and mutagenicity prediction show that the minimum and the maximum frequency queries for fragments can be answered within a reasonable time, and that the predictive accuracy obtained using these fragments is satisfactory. However, further experiments will have to confirm that this is a viable approach to inducing SARs.

Physiological (antioxidant) responses of estuarine fishes to variability in dissolved oxygen

Cycles of dissolved oxygen (DO) in estuaries can range from anoxia to various levels of supersaturation (200-300%) over short time periods. Aerobic metabolism causes formation of damaging reactive oxygen species (ROS), a process exacerbated by high or low DO. Fish can generate physiological defenses (e.g. antioxidant enzymes) against ROS, however, there are little data tying this to environmental conditions. We investigated physiological defenses generated by estuarine fishes in response to high DO and various DO cycles. We hypothesized that chemical defenses and/or oxidative damage are related to patterns of DO supersaturation. Specific activities of antioxidants in fish tissues should be positively correlated with increasing levels of DO, if high DO levels are physiologically stressful. We caged common benthic fishes (longjaw mudsucker, Gillichthys mirabilis, and staghorn sculpin, Leptocottus armatus, in CA and spot, Leiostomus xanthurus and pinfish, Lagodon rhomboides, in NC) during summer 1998 in two estuarine sites in southern North Carolina and two in central California. At each site a water quality meter measured bottom DO, salinity, temperature, depth, pH and turbidity at 30 min intervals throughout the study. These sites exhibited a wide variety of dissolved oxygen patterns. After 2 weeks in the cages, fish gills and livers were analyzed for antioxidant enzymes (glutathione peroxidase, catalase and superoxide dismutase) and the metabolite glutathione. All fish exhibited antioxidant enzyme activity. There was a significant site-dependent effect on all enzyme activities at the NC sites, with the most activity at the site with the highest DO cycling and the most DO supersaturation. There was a trend towards higher enzyme activities under high DO levels at the CA sites.

The treatment of moderate to severe psoriasis with a new anti-CD11a monoclonal antibody

BACKGROUND

Anti-CD11a (hu1124) is a humanized monoclonal antibody directed against the CD11a subunit of LFA-1. This study investigated whether treatment with anti-CD11a antibody provides clinical benefit to patients with moderate to severe plaque psoriasis.

METHODS

This was a double-blind, placebo-controlled, phase II, multicenter study. In total, 145 patients with minimum Psoriasis Area and Severity Index scores of 12 and affected body surface area of 10% or more were sequentially enrolled into low-dose (0.1 mg/kg, n = 22) or high-dose (0.3 mg/kg, n = 75) groups. Within groups, patients were randomized to treatment or placebo (n = 48) in a 2:1 ratio. Drug was administered intravenously at weekly intervals for 8 weeks.

RESULTS

The percentage of subjects achieving more than 50% improvement in physician's global assessment at day 56 (1 week after final dose) was 15% and 48% for placebo and 0.3 mg/kg of drug, respectively (P =.002). A physician's global assessment of excellent (>75% improvement) was greater in the 0.3 mg/kg group versus placebo (25% vs 2%, P =.0003). Average Psoriasis Area and Severity Index scores at day 56 were 13.9 +/- 7.5 (placebo) and 10.9 +/- 8.4 (0.3 mg/kg) (P <.0001). Epidermal thickness was reduced in the 0.3 mg/kg group compared with the placebo group (37% vs 19%, P =.004). Treatment was well tolerated; mild to moderate flu-like complaints were the most common adverse events. White blood cell counts and lymphocyte counts transiently increased. Depletion of circulating lymphocytes did not occur.

CONCLUSIONS

Anti-CD11a antibody administered intravenously in 8 weekly doses of 0.3 mg/kg was well tolerated and induced clinical and histologic improvements in psoriasis.

Laser cutting: influence on morphological and physicochemical properties of polyhydroxybutyrate

Polyhydroxybutyrate (PHB) is a biocompatible and resorbable implant material. For these reasons, it has been used for the fabrication of temporary stents, bone plates, nails and screws (Peng et al. Biomaterials 1996;17:685). In some cases, the brittle mechanical properties of PHB homopolymer limit its application. A typical plasticizer, triethylcitrate (TEC), was used to overcome such limitations by making the material more pliable. In the past few years, CO2-laser cutting of PHB was used in the manufacturing of small medical devices such as stents. Embrittlement of plasticized PHB tubes has been observed, after laser machining. Consequently, the physicochemical and morphological properties of laser-processed surfaces and cut edges of plasticized polymer samples were examined to determine the extent of changes in polymer properties as a result of laser machining. These studies included determination of the depth of the laser-induced heat affected zone by polariscopy of thin polymer sections. Molecular weight changes and changes in the TEC content as a function of distance from the laser-cut edge were determined. In a preliminary test, the cellular response to the processed material was investigated by cell culture study of L929 mouse fibroblasts on laser-machined surfaces. The heat-affected zone was readily classified into four different regions with a total depth of about 60 to 100 microm (Klamp, Master Thesis, University of Rostock, 1998). These results correspond well with the chemical analysis and molecular weight measurements. Furthermore, it was found that cells grew preferentially on the laser-machined area. These findings have significant implications for the manufacture of medical implants from PHB by laser machining.

Comparison of the sensitivity of different diagnostic tests for pancreatitis in cats

The objective of this study was to compare the sensitivity of different diagnostic tests for pancreatitis in cats. Twenty-one cats with confirmed pancreatitis were evaluated at the Small Animal Clinic of the School of Veterinary Medicine in Hannover, Germany, between September 1997 and January 1999. Clinical signs of affected cats were nonspecific, with 95% of the cats showing anorexia and 86% lethargy. Also, hematologic and biochemical abnormalities of affected cats were nonspecific. Serum feline trypsin-like immunoreactivity (fTLI) in these 21 cats with pancreatitis was 127.5 +/- 109.5 microg/L (mean +/- SD; range, 24-500 microg/L). Fourteen of the 21 cats with pancreatitis had complicating conditions. Their serum fTLI was 153.9 +/- 124.3 microg/L (mean +/- SD; range, 29 500 microg/L). In this study, abdominal ultrasound showed a sensitivity for pancreatitis of 24%, and abdominal computed tomography had a sensitivity of 20%. Serum fTLI had a sensitivity between 86% when a cut-off value of 49 microg/L was used (upper limit of the control range) and 33% when a cut-off value of 100 microg/L was used. We conclude that in this group of cats with pancreatitis, measurement of serum fTLI was the most sensitive diagnostic test of those evaluated. Abdominal ultrasound, however, may be a valuable diagnostic tool in some cats with pancreatitis.

Percutaneous Retrieval of Lost or Misplaced Intravascular Objects

OBJECTIVE

We report on our experience with percutaneous interventional techniques for retrieval of intravascular foreign bodies or repositioning of misplaced endovascular prostheses.

MATERIALS AND METHODS

Over a period of 6 years, we attempted percutaneous treatment of intravascular foreign bodies in 45 patients. The 45 foreign objects consisted of 12 endovascular stents, 14 catheter fragments, 11 embolization coils, four guidewire fragments, three vena cava filters, and one cardiac valve fragment. Percutaneous extraction was performed using a combination of multipurpose catheters and nitinol snare loop or grasping forceps. Depending on their composition, misplaced or dislodged intravascular stents were either repositioned or percutaneously removed.

RESULTS

Percutaneous intervention was successful in 41 (91.1%) of 45 patients. Of 38 patients on whom we performed percutaneous removal, the procedure was successful in 34 patients (89.5%), including 13 of the 14 patients with catheter fragments, all four of the patients with guidewire fragments, 10 of the 11 patients with misplaced or dislodged embolization coils, four of the five patients with misplaced or dislodged endovascular stents, and all three of the patients with misplaced or dislodged vena cava filters. The procedure was not successful in the one patient with a cardiac valve fragment. All seven of the percutaneous repositioning procedures we performed resulted in the endovascular stent being successfully repositioned in a stable intravascular position. Most of the retrieval procedures (77.7%) were performed using the nitinol snare as the primary instrument. No late complications were registered during the follow-up period, which ranged from 9 to 68 months (mean, 42.4 months overall).

CONCLUSION

Percutaneous techniques for the extraction of intravascular foreign objects or for repositioning of dislocated endovascular stents are highly effective with a low rate of complications and should always be the primary method of choice.

Data quality in predictive toxicology: reproducibility of rodent carcinogenicity experiments

We compared 121 replicate rodent carcinogenicity assays from the two parts (National Cancer Institute/National Toxicology Program and literature) of the Carcinogenic Potency Database (CPDB) to estimate the reliability of these experiments. We estimated a concordance of 57% between the overall rodent carcinogenicity classifications from both sources. This value did not improve substantially when additional biologic information (species, sex, strain, target organs) was considered. These results indicate that rodent carcinogenicity assays are much less reproducible than previously expected, an effect that should be considered in the development of structure-activity relationship models and the risk assessment process.

Radiation oncology: contributions of the United States in the last years of the 20th century

The advancements in radiation oncology in the past 50 years in the United States were probably more dramatic than those in the first half of the 20th century. Not only were there major technical achievements, but there was also an associated increase in the overall cure rates of cancer, from 20% at 5 years 50 years ago to now nearly 60% at 5 years. The cure rates in selected tumor sites at 5 years in 1950 and in 2000, respectively, were as follows: breast, 50% and 80%; colon and rectum, 40% and 85%; lung, 5% and 15%-20%; prostate, 40% and 80%; Hodgkin disease, 50% and more than 90%; cervix, 40% and 70%-80%; uterus (endometrium), 80% and more than 90%; bladder, 30% and 50%; head and neck, 30% and 60%; and esophagus, 2% and 15%. Much of this has been due to a broader array of techniques in radiation therapy available for treatment but also because of new emphasis on combined integrated modalitities (surgery, radiation therapy, and chemotherapy). New imaging techniques have contributed substantially, allowing better selection of patients for treatment and better selections of treatment modalities.

High-performance liquid chromatographic determination of the beta2-selective adrenergic agonist fenoterol in human plasma after fluorescence derivatization

A sensitive high-performance liquid chromatographic method has been developed for the determination of the beta2-selective adrenergic agonist fenoterol in human plasma. To improve the sensitivity of the method, fenoterol was derivatized with N-(chloroformyl)-carbazole prior to HPLC analysis yielding highly fluorescent derivatives. The assay involves protein precipitation with acetonitrile, liquid-liquid-extraction of fenoterol from plasma with isobutanol under alkaline conditions followed by derivatization with N-(chloroformyl)-carbazole. Reversed-phase liquid chromatographic determination of the fenoterol derivative was performed using a column-switching system consisting of a LiChrospher 100 RP 18 and a LiChrospher RP-Select B column with acetonitrile, methanol and water as mobile phase. The limit of quantitation in human plasma was 376 pg fenoterol/ml. The method was successfully applied for the assay of fenoterol in patient plasma.

Mental illness and communication

Historical and more recent descriptions of mental illness emphasise the prominent nature of communicative difficulties in persons with these diagnoses (Sims 1995) and a large part of psychiatric intervention is verbally-mediated. Within this study, a theoretically-driven therapy programme addressed the communication needs of two persons with schizophrenia. Significant improvements were demonstrated using valid and reliable outcome measures.

Data quality in predictive toxicology: identification of chemical structures and calculation of chemical properties

Every technique for toxicity prediction and for the detection of structure-activity relationships relies on the accurate estimation and representation of chemical and toxicologic properties. In this paper we discuss the potential sources of errors associated with the identification of compounds, the representation of their structures, and the calculation of chemical descriptors. It is based on a case study where machine learning techniques were applied to data from noncongeneric compounds and a complex toxicologic end point (carcinogenicity). We propose methods applicable to the routine quality control of large chemical datasets, but our main intention is to raise awareness about this topic and to open a discussion about quality assurance in predictive toxicology. The accuracy and reproducibility of toxicity data will be reported in another paper.

Knowledge discovery and data mining in toxicology

Knowledge discovery and data mining tools are gaining increasing importance for the analysis of toxicological databases. This paper gives a survey of algorithms, capable to derive interpretable models from toxicological data, and presents the most important application areas. The majority of techniques in this area were derived from symbolic machine learning, one commercial product was developed especially for toxicological applications. The main application area is presently the detection of structure-activity relationships, very few authors have used these techniques to solve problems in epidemiological and clinical toxicology. Although the discussed algorithms are very flexible and powerful, further research is required to adopt the algorithms to the specific learning problems in this area, to develop improved representations of chemical and biological data and to enhance the interpretability of the derived models for toxicological experts.

Optimal outcome measures, research priorities, and international cooperation

The participants in the Eriksholm Workshop on "Measuring Outcomes in Audiological Rehabilitation Using Hearing Aids" debated three issues that are reported in this article. First, it was agreed that the characteristics of an optimal outcome measure vary as a function of the purpose of the measurement. Potential characteristics of outcome self-report tools for four common goals of outcome measurement are briefly presented to illustrate this point. Second, 10 important research priorities in outcome measurement were identified and ranked. They are presented with brief discussion of the top five. Third, the concept of generating a brief universally applicable outcome measure was endorsed. This brief data set is intended to supplement existing outcome measures and to promote data combination and comparison across different social, cultural, and health-care delivery systems. A set of seven core items is proposed for further study.

Analysis of local strain in aluminium interconnects by energy filtered CBED

Energy filtered convergent beam electron diffraction (CBED) was used to investigate localised strain in aluminium interconnects. The quantitative analysis of the experimental patterns is based on a multi-step evaluation procedure which is the main subject of the present paper. The improvements which were made to the analysis method aim at increasing both the automation and the accuracy. The detection of the higher order Laue zone (HOLZ) line positions is performed by means of the Hough transform. The required sub-pixel resolution can be achieved routinely and the achievable accuracy is only limited by the line width and the amount of noise in the patterns. The determination of the strain state is performed via a refinement algorithm which is based on varying the strain state in the sample coordinate system and simulating the patterns for the individual grains until a best fit with the experiment is obtained. For the simulation we have developed a new correction scheme in which the dynamical effects are treated separately for each individual HOLZ line. The results show that the main source of the observed strains is the difference in thermal expansion coefficients. The strain is substantially reduced underneath a hillock in the interconnect. Asymmetries in the strain distribution around the hillock show that the unidirectional diffusion during electromigration tests causes peak strains in areas next to the hillock which may be possible failure sites.

An improved automated immunoassay for C-reactive protein on the Dimension clinical chemistry system

Recent clinical data indicate that the measurement of the concentration of C-reactive protein (CRP) requires a higher sensitivity and wider dynamic range than most of the current methods can offer. Our goal was to develop a totally automated and highly sensitive CRP assay with an extended range on the Dimension((R)) clinical chemistry system based on particle-enhanced turbidimetric-immunoassay (PETIA) technology. The improved method was optimized and compared to the Binding Site's radial immunodiffusion assay using disease state specimens to minimize interference. Assay performance was assessed on the Dimension((R)) system in a 12-instrument inter-laboratory comparison study. A split-sample comparison (n = 622) was performed between the improved CRP method on the Dimension system and the N Latex CRP mono method on the Behring Nephelometer, using a number of reagent and calibrator lots on multiple instruments. The method was also referenced to the standard material, CRM470, provided by the International Federation of Clinical Chemistry (IFCC). The improved CRP method was linear to 265.1 mg/l with a detection limit between 0.2 and 0.5mg/l. The method detects antigen excess from the upper assay limit to 2000 mg/l, thereby allowing users to retest the sample with dilution. Calibration was stable for 60 days. The within-run reproducibility (CV) was less than 5.1% and total reproducibility ranged from 1.1 to 6.7% between 3.3 and 265.4 mg/l CRP. Linear regression analysis of the results on the improved Dimension method (DM) versus the Behring Nephelometer (BN) yielded the following equation: DM = 0.99 x BN - 0.37; r = 0.992. Minimal interference was observed from sera of patients with elevated IgM, IgG and IgA. The recovery of the IFCC standard was within 100 +/- 7 % across multiple lots of reagent and calibrator. The improved CRP method provided a sensitive, accurate and rapid approach to quantify CRP in serum and plasma on the Dimension clinical chemistry system. The ability to detect antigen excess eliminated reporting falsely low results caused by the 'prozone effect'.