[Myocardial perfusion scintigraphy 2006 in Germany. Results of the query and current status]

AIM

This second survey was to deliver further information on myocardial perfusion scintigraphy (MPS) in Germany in 2006.

METHOD

351 questionnaires were evaluated: 207 private practices (PP), 117 hospitals (HO), 27 from university hospitals (UH).

RESULTS

MPS of 106 331 patients were reported, 85% were investigated with (99m)Tc-perfusion tracers. 74% [2005 = 72%] were performed in PP, 17% [2005 = 15%] in HO and 9% [2005 = 13%] in UH. PP, which participated in 2005 and 2006, demonstrated an increase by 3,9% (HO 0%, UH - 13,0%). The type of stress was pharmacological in 27% [2005 = 22%]; 54% adenosine (of these 29% with exercise), 37% dipyridamole (of these 56% with exercise), and 9% dobutamine. Gated SPECT was performed in 42% [2005 = 36%] of all rest- and in 39% [2005 = 32%] of all stress MPS. An attenuation correction was used by 69 [2005 = 78] institutions. 40% of all MPS were performed in patients suspected to have CAD. 24% of all institutions reported changes in the use of MPS by competing methods.

CONCLUSION

There is a small increase of MPS between 2005 and 2006 despite competing methods. Gated SPECT has experienced more acceptance. Suspicion of CAD is an important indication of MPS. In order to tap the full potential of MPS a gated SPECT should be performed routinely.

Phylogeny and evolution of mating-type genes from Pyrenophora teres, the causal agent of barley "net blotch" disease

The main aim of this study was to test the patterns of sequence divergence and haplotype structure at the MAT locus of Pyrenophora teres, the causal agent of barley 'net blotch' disease. P. teres is a heterothallic ascomycete that co-occurs in two symptomatological forms, the net form (NF) and the spot form (SF). The mating-type genes MAT1-1-1 and MAT1-2-1 were sequenced from 22 NF isolates (12 MAT1-1-1 and 10 MAT1-2-1 sequences) and 17 SF isolates (10 MAT1-1-1 and seven MAT1-2-1 sequences) collected from Sardinian barley landrace populations and worldwide. On the basis of a parsimony network analysis, the two forms of P. teres are phylogenetically separated. More than 85% of the total nucleotide variation was found between formae speciales. The two forms do not share any polymorphisms. Six diagnostic nucleotide polymorphisms were found in the MAT1-1-1 intron (1) and in the MAT1-1-1 (3) and MAT1-2-1 (2) exons. Three diagnostic non-synonymous mutations were found, one in MAT1-1-1 and two in MAT1-2-1. For comparison with P. teres sequence data, the mating-type genes from Pyrenophora graminea were also isolated and sequenced. Divergence between P. graminea and P. teres is of a similar magnitude to that between NF and SF of P. teres. The MAT genes of P. graminea were closer to those of SF than to NF, with the MAT1-2-1 SF peptide not different from the MAT1-2-1 peptide of P. graminea. Overall, these data suggest long genetic isolation between the two forms of P. teres and that hybridization is rare or absent under field conditions, with each form having some particular niche specialization. This indicates that research on resistance to P. teres should consider the two forms separately, as different species.

[Myocardial perfusion scintigraphy in Germany. Results of the 2005 query and current status]

The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine (DGN), in cooperation with the working group Nuclear Cardiology of the German Cardiac Society (DGK), decided to conduct a national survey on myocardial perfusion scintigraphy (MPS).

METHOD

A questionnaire to evaluate MPS for the year 2005 was sent.

RESULTS

346 completed questionnaires had been returned (213 private practices, 99 hospitals and 33 university hospitals). MPS of 112 707 patients were reported with 110 747 stress and 95 878 rest studies. The majority (>75%) was performed with (99m)Tc-MIBI or tetrofosmin. (201)Tl stress-redistribution was used in 22 637 patients (20%). The types of stress were exercise in 78%, vasodilation with adenosine or dipyridamol in 21% and dobutamine in 1%. 99.97% of all MPS were SPECT studies. Gated SPECT was performed in 36% of the stress and in 32% of the rest studies. An attenuation correction was used in 21%. 29 institutions (8%) performed gated SPECT (stress and rest) and attenuation correction. 47% of all MPS were requested by ambulatory care cardiologists, 17% by internists, 12% by primary care physicians, 21% by hospital departments and 2% by others.

CONCLUSION

In Germany, MPS is predominantly performed with (99m)Tc-perfusion agents. The common type of stress is ergometry. Gated SPECT and attenuation correction do not yet represent standards of MPS practice in Germany, which indicates some potential of optimization.

A comprehensive view on organ-specific callose synthesis in wheat (Triticum aestivum L.): glucan synthase-like gene expression, callose synthase activity, callose quantification and deposition

Callose ((1,3)-beta-glucan) is important during basic developmental processes of plants, but only little is known about the regulation of callose biosynthesis on molecular level. Growing evidence indicates that glucan synthase-like (GSL) genes in higher plants are involved in callose synthesis. We analyzed the expression of eight GSL genes (TaGSL) as well as callose synthase activity and total callose content in the stem, leaf blade and spike of wheat (Triticum aestivum L.). Organ-specific expression of six TaGSL genes and strong differences in expression levels were detected by quantitative real-time PCR. Differences were also determined in callose synthase (EC 2.4.1.34) activity and total amount of callose in the examined organs. Aniline blue staining in tissue sections localized callose depositions. These results allow a comprehensive reflection of callose regulation, considering gene expression, enzyme activity and enzyme product quantification as well as localization. Our data suggests that callose synthesis is highly regulated by a combination of GSL genes, which are involved either in general or in organ-specific developmental processes.

Nonuniversality aspects of nonlinear k(perpendicular) factorization for hard dijets

The origin of breaking of conventional linear k(perpendicular) factorization for hard processes in a nuclear environment is by now well established. The realization of the nonlinear nuclear k(perpendicular) factorization which emerges instead was found to change from one jet observable to another. Here we demonstrate how the pattern of nonlinear k(perpendicular) factorization, and especially the role of diffractive interactions, in the production of dijets off nuclei depends on the color properties of the underlying pQCD subprocess.

Comparison of standard phenotypic assays with a PCR method to discriminate Candida albicans and C. dubliniensis

In 1995, Candida dubliniensis was described as a new species in the genus Candida. Its close relationship to C. albicans has proved problematic in the identification of C. dubliniensis in clinical specimens. The objective of this study was to determine if reproducible differentiation between both species can be obtained by phenotypic assays. Therefore, 100 strains from 86 patients with the ability to produce chlamydospores were examined with different methods including API ID 32 C, colour development on CHROMagar, chlamydospore formation on Staib agar, growth at different temperatures and germ tube formation at 39 degrees C. Additionally, polymerase chain reaction (PCR) was used as gold standard. Six of the investigated strains were C. dubliniensis. The results suggest that there is still no single phenotypic method satisfactory to distinguish between C. albicans and C. dubliniensis.

[Phantom sensations and peripheral induced neglect following implantation of total hip prosthesis]

OBJECTIVES

O. Sacks describes in his book "A leg to stand on" the inability to move his leg for along period after rupture of the tendon of m. quadriceps. He refers the history of similar cases, especially of a woman with a hip fracture. He discusses this as a result of disruption of proprioception (peripheral induced neglect). The aim of this investigation is to answer the question how frequently this symptom may be found in patients with hip fracture and/or arthrosis perioperativly after implantation of a total prosthesis.

METHODS

we examined 106 patients aged 70.35 +/- 10.01 years (36-male 67.54 +/- 9.74 years and 69 female 71.9 +/- 9.9 years) who underwent an implantation of a hip prosthesis - antero-lateral access Watson-Jones - (right side n = 61, left n = 44) because of arthrosis (n = 81) or a hip fracture (n = 18) on postoperative day 1./2. and 10. - 14. Besides exact neurologic examination, we particularly asked for changed perception of the operated leg.

RESULTS

by neurological examination we found only rarely signs of peripheral nerve lesion as a complication of implantation of hip prosthesis (1 femoral nerve lesion, 1 ischiadicus nerve lesion). 14 patients reported a changed perception at the first examination: 5 patients felt their operated leg shorter or longer, 4 patients described their leg changed in a strange manner (like a block of wood or lead), 2 patients felt their leg changed, but could not tell how. At follow-up examination there was no patient with a changed perception of the operated leg.

CONCLUSIONS

at first examination only a small number of patients report a changed perception of the operated leg. Early mobilization of the operated leg may be the cause of quick normalization of perception. The peripherally induced neglect, described by O. Sacks, was possibly caused by decrease of cortical representation because of immobilization, but not by disrupted proprioception.

Can urodynamic assessment of outflow obstruction predict outcome from watchful waiting?--A four-year follow-up study

OBJECTIVE

One of the most common "treatment" alternatives in suspected outflow obstruction due to bladder outlet obstruction (BOO) is watchful waiting (WW). The aim of this study was to see whether there were any differences in outcome between patients with slight, moderate or severe obstruction due to BOO as classified by transrectal ultrasound (TRUS) and urodynamics.

MATERIAL AND METHODS

Thirty-seven men with lower urinary tract symptoms (LUTS) and suspected BOO were included. All of the patients were investigated by a routine investigation schedule, including TRUS and urodynamics with pressure-flow measurement (pQS) at baseline. Patients with cancer in the urinary tract, prostatitis, history of detrusor hyperreflexia (peripheral or central diseases or trauma to the nervous system affecting the bladder) and serious systemic diseases were excluded. Patients were examined at baseline, then checked again after 1 year and 4 years. Patients who did not want to continue with WW were listed as treatment failures.

RESULTS

At baseline, 43.2% of the patients were urodynamically severely obstructed and 32.3% were moderately obstructed. Thirty-five per cent of the patients were found to have previously unknown detrusor hyperactivity/overactivity. The prevalence of detrusor hyperactivity/overactivity increased with BOO. After 1 year, IPSS had decreased at unchanged Qmax and postresidual volume. These findings persisted at 4 years. The failure rate increased in the more obstructed patients and was significantly higher with more severe obstruction. Complications were found in 13.5%, with no significant differences between patients with minor BOO [Detrusor Adjusted Mean PURR Factor (DAMPF) scale <42], moderate BOO (DAMPF 42-65) and severe BOO (DAMPF >65).

CONCLUSIONS

In patients with severe BOO, the LUTS and failure rate increase over time. The percentage of patients with detrusor hyperactivity/overactivity was higher in the severely obstructed group. By including full urodynamics when investigating patients with BOO, it seems possible to predict the failure rate according to the patients' obstruction grade. This gives an opportunity to treat the patient with minimal invasion, and to give the individual patient a more precise prognosis if WW is preferred.