Surgical resection of metastases to the adrenal gland: a single center experience

BACKGROUND

Only limited data exist on the treatment and outcome of adrenal metastases that derive from different primary tumor entities. Due to the lack of evidence, it is difficult to determine the indication for surgical resection.

METHODS

We assessed the outcome of 45 patients (28 men, 17 women) with adrenal metastases who underwent surgery (1990-2014). The median age at the time of adrenal surgery was 62 years (range 44-77 years). We were able to evaluate follow-up data of 41 patients.

RESULTS

Primary tumor types were liver n = 12 (hepatocellular carcinoma n = 9, cholangiocellular carcinoma n = 2, sarcoma n = 1), upper GI tract n = 5 (esophagus n = 2, stomach n = 3), lung n = 9, kidney n = 6, neuroendocrine tumors n = 3, colon n = 2, ovarial n = 2, melanoma n = 2, others n = 4. The overall median survival time was 14 months (95 % CI 8.375-19.625). The survival rates at 1, 2, 5, and 10 years were 60, 31, 21, and 11 %, respectively. There were statistically significant differences in the survival time according to the resection status (R0 vs. R1/R2) (p < 0.001) and the type of the primary tumor (p = 0.009), while the metachronous or synchronous occurrence of adrenal metastases did not affect the prognosis.

CONCLUSIONS

Resection of adrenal metastases can improve the survival if patients are carefully selected, the tumor is completely resected, and the intervention is integrated into a multidisciplinary oncologic treatment strategy.

Binocular visual performance with aberration correction as a function of light level

The extent to which monocular visual performance of subjects with normal amounts of ocular aberrations can be improved with adaptive optics (AO) depends on both the pupil diameter and the luminance for visual testing. Here, the benefit of correction of higher order aberrations for binocular visual performance was assessed over a range of luminances for natural light-adapted pupil sizes with a binocular AO visual simulator. Results show that binocular aberration correction benefits for visual acuity and contrast sensitivity increase with decreasing luminances. Also, the advantage of binocular over monocular viewing increases when visual acuity becomes worse. The findings suggest that binocular summation mitigates poor visual performance under low luminance conditions.

Phytate in pig and poultry nutrition

Phosphorus (P) is primarily stored in the form of phytates in plant seeds, thus being poorly available for monogastric livestock, such as pigs and poultry. As phytate is a polyanionic molecule, it has the capacity to chelate positively charged cations, especially calcium, iron and zinc. Furthermore, it probably compromises the utilization of other dietary nutrients, including protein, starch and lipids. Reduced efficiency of utilization implies both higher levels of supplementation and increased discharge of the undigested nutrients to the environment. The enzyme phytase catalyses the stepwise hydrolysis of phytate. In respect to livestock nutrition, there are four possible sources of this enzyme available for the animals: endogenous mucosal phytase, gut microfloral phytase, plant phytase and exogenous microbial phytase. As the endogenous mucosal phytase in monogastric organisms appears incapable of hydrolysing sufficient amounts of phytate-bound P, supplementation of exogenous microbial phytase in diets is a common method to increase mineral and nutrient absorption. Plant phytase activity varies greatly among species of plants, resulting in differing gastrointestinal phytate hydrolysis in monogastric animals. Besides the supplementation of microbial phytase, processing techniques are alternative approaches to reduce phytate contents. Thus, techniques such as germination, soaking and fermentation enable activation of naturally occurring plant phytase among others. However, further research is needed to tap the potential of these technologies. The main focus herein is to review the available literature on the role of phytate in pig and poultry nutrition, its degradation throughout the gut and opportunities to enhance the utilization of P as well as other minerals and nutrients which might be complexed by phytates.

Impact of proton pump inhibitor use on magnesium homoeostasis: a cross-sectional study in a tertiary emergency department

BACKGROUND

To date, the use of proton pump inhibitors (PPIs) has been associated with a low risk of hypomagnesaemia and associated adverse outcomes. We hypothesised that a better risk estimate could be derived from a large cohort of outpatients admitted to a tertiary emergency department (ED).

METHODS

A cross-sectional study was performed in 5118 patients who had measurements of serum magnesium taken on admission to a large tertiary care ED between January 2009 and December 2010. Hypomagnesaemia was defined as a serum magnesium concentration < 0.75 mmol/l. Demographical data, serum electrolyte values, data on medication, comorbidities and outcome with regard to length of hospital stay and mortality were analysed.

RESULTS

Serum magnesium was normally distributed where upon 1246 patients (24%) were hypomagnesaemic. These patients had a higher prevalence of out-of-hospital PPI use and diuretic use when compared with patients with magnesium levels > 0.75 mmol/l (both p < 0.0001). In multivariable regression analyses adjusted for PPIs, diuretics, renal function and the Charlson comorbidity index score, the association between use of PPIs and risk for hypomagnesaemia remained significant (OR = 2.1; 95% CI: 1.54-2.85). While mortality was not directly related to low magnesium levels (p = 0.67), the length of hospitalisation was prolonged in these patients even after adjustment for underlying comorbid conditions (p < 0.0001).

CONCLUSION

Use of PPIs predisposes patients to hypomagnesaemia and such to prolonged hospitalisation irrespective of the underlying morbidity, posing a critical concern.

Comparison of binocular through-focus visual acuity with monovision and a small aperture inlay

Corneal small aperture inlays provide extended depth of focus as a solution to presbyopia. As this procedure is becoming more popular, it is interesting to compare its performance with traditional approaches, such as monovision. Here, binocular visual acuity was measured as a function of object vergence in three subjects by using a binocular adaptive optics vision analyzer. Visual acuity was measured at two luminance levels (photopic and mesopic) under several optical conditions: 1) natural vision (4 mm pupils, best corrected distance vision), 2) pure-defocus monovision ( + 1.25 D add in the nondominant eye), 3) small aperture monovision (1.6 mm pupil in the nondominant eye), and 4) combined small aperture and defocus monovision (1.6 mm pupil and a + 0.75 D add in the nondominant eye). Visual simulations of a small aperture corneal inlay suggest that the device extends DOF as effectively as traditional monovision in photopic light, in both cases at the cost of binocular summation. However, individual factors, such as aperture centration or sensitivity to mesopic conditions should be considered to assure adequate visual outcomes.

Gender-specific effects of a phytogenic feed additive on performance, intestinal physiology and morphology in broiler chickens

To date, most studies published were carried out on broilers of the same sex, and possible gender-specific effects of phytogenic substances have not been investigated so far. A 3 × 2 factorial study was performed to examine gender-specific effects of a PFA at two dietary levels (150, 1500 ppm) on growth performance, carcass traits and gastrointestinal attributes in broiler chickens versus an untreated control group. The addition of 150 ppm of the PFA led to a downregulation of trypsinogen mRNA in pancreas compared with the control group (p < 0.05). The number of goblet cells decreased in jejunum compared with the unsupplemented group, whereby this effect was more pronounced in male birds (p < 0.05). Furthermore, higher methylamine contents compared with the control group were measured (p < 0.01). In proximal ileum, female birds, supplemented with 150 ppm PFA, had lower crypt depths than their litters in the 1500 ppm treatment (p < 0.05). In distal ileum, villus height:crypt depth ratio was higher in birds fed the PFA at 150 ppm than in the control group (p < 0.05). The 1500 ppm dosage of the PFA increased jejunal histamine concentration compared with the negative control group (p < 0.05). Jejunal histamine concentration was also affected by the interaction PFA × sex (p < 0.05). Regardless of inclusion level, total amount of biogenic amines and other microbial metabolites in digesta samples was not affected by the PFA. These results demonstrate variable, partially gender-specific effects of the tested PFA. Although the supplementation of 150 ppm showed little effect on mRNA expression level of selected marker genes for nutrient digestion, beneficial effects on gut morphology were observed. The 10-fold higher dosage of the PFA did not adversely affect growth performance as well as most investigated parameters compared with the control group.

Aged human mesenchymal stem cells: the duration of bone morphogenetic protein-2 stimulation determines induction or inhibition of osteogenic differentiation

Bone morphogenetic protein 2 (BMP-2) is a potent osteoinductive cytokine and a growing number of in vitro studies analyze its effects on human mesenchymal stem cells (hMSC) derived from aged or osteoporotic donors. In these studies the exact quantification of osteogenic differentiation capacity is of fundamental interest. Nevertheless, the experimental conditions for osteogenic differentiation of aged hMSC have not been evaluated systematically and vary to a considerable extend. Aim of the study was to assess the influence of cell density, osteogenic differentiation media (ODM) change intervals and duration of BMP-2 stimulation on osteoinduction. Furthermore, time series were carried out for osteogenic differentiation and BMP-2 concentration in ODM/BMP-2 cell culture supernatants. The experiments were performed using hMSC isolated from femoral heads of aged patients undergoing hip joint replacement. ODM change intervals of 96 hours resulted in significantly higher calcium deposition compared to shorter intervals. A cell density of 80% prior to stimulation led to stronger osteoinduction compared to higher cell densities. In ODM, aged hMSC showed a significant induction of calcium deposition after 9 days. Added to ODM, BMP-2 showed a stable concentration in the cell culture supernatants for at least 96 hours. Addition of BMP-2 to ODM for the initial 4 days led to a significantly higher induction of osteogenic differentiation compared to ODM alone. On the other hand, addition of BMP-2 for 21 days almost abrogated the osteoinductive effect of ODM. We could demonstrate that the factors investigated have a substantial impact on the extent of osteogenic differentiation of aged hMSC. Consequently, it is of upmost importance to standardize the experimental conditions in order to enable comparability between different studies. We here define standard conditions for osteogenic differentiation in regard to the specific features of aged hMSC. The finding that BMP-2 induces or inhibits osteogenic differentiation in a time dependent manner indicates an age related alteration in signal transduction of hMSC and requires further investigation.

Binocular visual acuity for the correction of spherical aberration in polychromatic and monochromatic light

Correction of spherical (SA) and longitudinal chromatic aberrations (LCA) significantly improves monocular visual acuity (VA). In this work, the visual effect of SA correction in polychromatic and monochromatic light on binocular visual performance is investigated. A liquid crystal based binocular adaptive optics visual analyzer capable of operating in polychromatic light is employed in this study. Binocular VA improves when SA is corrected and LCA effects are reduced separately and in combination, resulting in the highest value for SA correction in monochromatic light. However, the binocular summation ratio is highest for the baseline condition of uncorrected SA in polychromatic light. Although SA correction in monochromatic light has a greater impact monocularly than binocularly, bilateral correction of both SA and LCA may further improve binocular spatial visual acuity which may support the use of aspheric-achromatic ophthalmic devices, in particular, intraocular lenses (IOLs).

[Breeding management of black rhinos (Diceros bicornis michaeli) in Magdeburg Zoo]

OBJECTIVE

The African black rhino is an endangered species. In Germany there are only five zoos where this species is kept and breeding has not been successful in all of them. In Magdeburg Zoo the last birth occurred in December 2005, and during the following years, no matings could be observed. During the construction of a new enclosure to enable a more natural mating behaviour, the reproduction status of the rhino cows was evaluated and a hormonal treatment was performed.

MATERIAL AND METHODS

Since 2009, faecal samples from two rhino cows (Diceros bicornis michaeli; "Mana", 30 years old, and "Maleika", 17 years old) were collected periodically, and the pregnanediol-glucuronide (PdG) and oestradiol concentrations were determined using enzyme immunoassay and radioimmunoassay, respectively. Following evaluation of the results, both cows were treated for 12 days with Regumate® Equine, a synthetic progesterone, during the period of PdG-dominance.

RESULTS

"Mana" accepted the bull 11 days after completion of the hormonal treatment, and in December 2011 gave birth to a healthy calf. "Maleika" had her first ever oestrus 13 days after completion of the medication and also accepted the bull. Thereafter, she had two regular oestrus cycles with normal mating behaviour. Her first calf was born in July 2012.

CONCLUSION AND CLINICAL RELEVANCE

The causal treatment of both cows, following a long period of infertility, with synthetic progesterone led to their pregnancy and the birth of healthy calves. The commercial product Regumate® Equine is appropriate to stimulate the sexual cycle in temporarily infertile black rhinos. Attention should be paid to the timing of the medication and the required dose.

Mesenchymal stem cells from osteoporotic patients feature impaired signal transduction but sustained osteoinduction in response to BMP-2 stimulation

Osteoporotic fractures show reduced callus formation and delayed bone healing. Cellular sources of fracture healing are mesenchymal stem cells (MSC) that differentiate into osteoblasts by stimulation with osteoinductive cytokines, such as BMP-2. We hypothesized that impaired signal transduction and reduced osteogenic differentiation capacity in response to BMP-2 may underlie the delayed fracture healing. Therefore, MSC were isolated from femoral heads of healthy and osteoporotic patients. Grouping was carried out by bone mineral densitometry in an age-matched manner. MSC were stimulated with BMP-2. Signal transduction was assessed by western blotting of pSMAD1/5/8 and pERK1/2 as well as by quantitative RT-PCR of Runx-2, Dlx5, and Osteocalcin. Osteogenic differentiation was assessed by quantifying Alizarin Red staining. Osteoporotic MSC featured an accurate phosphorylation pattern of SMAD1/5/8 but a significantly reduced activation of ERK1/2 by BMP-2 stimulation. Furthermore, osteoporotic MSC showed significantly reduced basal expression levels of Runx-2 and Dlx5. However, Runx-2, Dlx5, and Osteocalcin expression showed adequate up-regulation due to BMP-2 stimulation. The global osteogenic differentiation in standard osteogenic differentiation media was reduced in osteoporotic MSC. Nevertheless, osteoporotic MSC were shown to feature an adequate induction of osteogenic differentiation due to BMP-2 stimulation. Taken together, we here demonstrate osteoporosis associated alterations in BMP-2 signaling but sustained specific osteogenic differentiation capacity in response to BMP-2. Therefore, BMP-2 may represent a promising therapeutic agent for the treatment of fractures in osteoporotic patients.

Bilateral pneumothorax following a blunt trachea trauma

A-13 year old boy had an accident with his bike with a blunt thorax trauma and presented shortly after with facial swelling. Due to respiratory insufficiency, intubation was done during the transport to the clinic. First, a chest radiograph was performed, which showed a unilateral pneumothorax. Later a CT scan revealed bilateral pneumothorax and pneumomediastinum. Bilateral chest tube insertions improved the respiratory situation. Bronchoscopy showed a tracheal lesion two cm posterior to the main carina. After good wound healing, the patient was dismissed after 21 days in good health. Conservative treatment can be recommended in selected patients with a tracheal lesion when having a stable respiratory situation. If the patient does not improve after 48 h or if the clinical condition worsens, surgical management should be considered.

Poloxamer-based hydrogels hardening at body core temperature as carriers for cell based therapies: in vitro and in vivo analysis

Cell-based regenerative therapies for bone defects usually employ bone precursor cells seeded on solid scaffolds. Thermosensitive hydrogels that harden at body core temperature are promising alternative cell carriers as they are applicable minimally invasively. We modified Pluronic® P123 with different chain extenders and assessed rheology and biocompatibility of the resulting hydrogels. The best candidate was tested in a rat's femoral defect model. All gels hardened above 25 °C with butane-diisocyanate-hydrogels (BDI-gels) displaying the highest storage moduli. BDI-gels showed the most favourable biocompatibility and did not affect cellular adipogenic or osteogenic differentiation in vitro. Implantation of BDI-hydrogel into femoral defects did not impede bone healing in vivo as evidenced by μCT and histological analysis. We conclude that thermosensitive BDI-gels are promising alternative cell carriers. The gels harden upon injection in vivo without interfering with bone metabolism. Further experiments will assess the gels' capacity to effectively transport living cells into bone defects.

Role of topoisomerase inhibition and DNA repair mechanisms in the genotoxicity of alternariol and altertoxin-II

Alternariol (AOH) and altertoxin-II (ALTX-II) have been demonstrated to possess genotoxic properties. However, the underlying mechanisms of action have not been fully elucidated yet. AOH has recently been shown to act as a topoisomerase I and II poison, contributing to its genotoxic properties. The topoisomerase-specific repair factor tyrosyl-DNA-phosphodiesterase-1 (TDP1) is involved in the respective repair processes of damaged DNA induced by topoisomerase II poison. In the present study, we investigated the role of DNA repair pathways for the extent of DNA damage by AOH and addressed the question whether interference with topoisomerase II might play a role in the genotoxicity of ALTX-II. Under cell-free conditions, AOH and ALTX-II suppressed the activity of topoisomerase II at a comparable concentration range. In HT29 cells, AOH enhanced the level of covalent DNA-topoisomerase II complexes, thus acting as a topoisomerase poison in DNA damaging concentrations. In contrast, ALTX-II in genotoxic concentrations did not show any effect on the stability of these complexes, indicating that interference with topoisomerases does not play a relevant role in genotoxicity. The differences in genotoxic mechanisms seem to be reflected in the activation of p53. AOH was found to increase p53 phosphorylation in HT29 cells in DNA damaging concentrations. In contrast, incubation with ALTX-II did not affect p53 phosphorylation despite substantial increase in tail intensity in the comet assay, suggesting that the DNA lesions formed by ALTX-II are not detected by the DNA-repair machinery of HT29 cells. These results are supported by differences in persistence of DNA damage, still maintained after 24 h for ALTX-II but nearly vanished already after 3 h for AOH. Furthermore, microarray and qPCR analysis did not indicate any substantial impact of AOH on the transcription of key elements of DNA repair pathways. However, siRNA-approaches indicate that, in addition to TDP1, the expression of other elements of the DNA repair machinery exemplified by the 70 kDa Ku autoantigen and the proliferating cell nuclear antigen are relevant for AOH-mediated DNA damage.

Impact on stereo-acuity of two presbyopia correction approaches: monovision and small aperture inlay

Some of the different currently applied approaches that correct presbyopia may reduce stereovision. In this work, stereo-acuity was measured for two methods: (1) monovision and (2) small aperture inlay in one eye. When performing the experiment, a prototype of a binocular adaptive optics vision analyzer was employed. The system allowed simultaneous measurement and manipulation of the optics in both eyes of a subject. The apparatus incorporated two programmable spatial light modulators: one phase-only device using liquid crystal on silicon technology for wavefront manipulation and one intensity modulator for controlling the exit pupils. The prototype was also equipped with a stimulus generator for creating retinal disparity based on two micro-displays. The three-needle test was programmed for characterizing stereo-acuity. Subjects underwent a two-alternative forced-choice test. The following cases were tested for the stimulus placed at distance: (a) natural vision; (b) 1.5 D monovision; (c) 0.75 D monovision; (d) natural vision and small pupil; (e) 0.75 D monovision and small pupil. In all cases the standard pupil diameter was 4 mm and the small pupil diameter was 1.6 mm. The use of a small aperture significantly reduced the negative impact of monovision on stereopsis. The results of the experiment suggest that combining micro-monovision with a small aperture, which is currently being implemented as a corneal inlay, can yield values of stereoacuity close to those attained under normal binocular vision.