Slit-lamp-adapted fourier-domain OCT for anterior and posterior segments: preliminary results and comparison to time-domain OCT

PURPOSE

To evaluate the diagnostic potential of a slit-lamp (SL)-adapted Fourier-domain (= spectral radar, SR) optical coherence tomography (OCT)-SL-SR-OCT-instrument as an in vivo imaging device for use in examinations of the anterior and posterior segments.

MATERIALS AND METHODS

In a pilot study, 88 eyes from 70 healthy volunteers and patients were examined using a prototype Fourier-domain SL-SR-OCT system. Results were compared to those from the following commercially available systems: the 1310-nm SL-OCT (Heidelberg Engineering, Heidelberg, Germany) for anterior segment and the Stratus OCT (Zeiss Meditec, Jena, Germany) for posterior segment imaging. Our SL-SR-OCT provides 1025 axial scans, 5000 Hz line-scan frequency, scan length of up to 8 mm, axial depth in air of 3.5 mm, and resolution of 9 mum. For posterior visualization, a hand-held 78-diopter ophthalmoscopic lens was used.

RESULTS

Our SL-SR-OCT system allowed simultaneous scanning with direct biomicroscopic and SL imaging of anterior and posterior segment structures. Anatomical structures and pathological changes were displayed with high resolution and excellent contrast. Measurements of corneal and retinal thickness were possible. In comparison to images obtained by the SL-OCT, our SL-SR-OCT boasted a higher resolution, thus providing more clinically relevant details of the corneal epithelium, internal structure of filtering blebs, etc. Complete imaging of the chamber angle was limited, however, due to the backscattering properties of the sclera at 830 nm. For posterior segment imaging, excellent delineation of the macula and optic nerve head details, with a distinct portrayal of macular pathology and retinal edema, was possible with SL-SR-OCT.

CONCLUSION

SL-SR-OCT enables detailed imaging of physiological and pathological anterior and posterior segment structures. As a multi-purpose device, it offers a wide spectrum of applications, with high-quality OCT-imaging, in a comfortable setting without the need to move the patient.

Safety and efficacy after switch to a saquinavir-containing antiretroviral regimen in protease inhibitor pretreated HIV-positive patients

Objective

The RAINBOW survey is a multinational observational study assessing the tolerability and efficacy of ritonavir-boosted saquinavir (SQV/r), using the 500 mg film-coated SQV formulation, in routine clinical practice. This analysis presents data from the German subgroup of protease inhibitor (PI)-pretreated, but SQV-naïve patients.

Methods

Multicenter, prospective, open-label, 48 week cohort study. Efficacy assessments included the proportion of patients with HIV-1 RNA < 50 and < 400 copies/mL and changes in CD4 cell count from baseline to week 48. Tolerability assessments included changes in liver enzymes and lipid levels from baseline to week 48.

Results

A total of 426 patients were included in the analysis. The proportion of patients with HIV RNA levels < 50 copies/mL at week 48 was 60.3% (compared with 31.7% at switch to SQV/r) (intent-to-treat, last observation carried forward analysis). After 48 weeks, median CD4 count increased by +61 cells/mm³ from baseline (p < 0.01) and 60.3% of patients achieved HIV-1 RNA < 50 copies/mL. Median changes in fasting triglyceride levels (stratified according to baseline level) at week 48 were: +14 mg/dL (IQR -8; 57) for patients with baseline triglyceride < 200 mg/dL; -50 mg/dL (IQR -139; 0) for baseline triglyceride 200-750 mg/dL, and -656 mg/dL (IQR 1024; 0) for baseline triglyceride > 750 mg/dL (p < 0.01 for all). Median changes in fasting total cholesterol (TC) levels (stratified according to baseline) were +16 mg/dL (IQR -3; 43) for patients with baseline TC < 200 mg/dL (p < 0.01), -3 mg/dL (IQR -25; 25) for baseline TC 200-300 mg/dL (p = 0.4), and -47 mg/dL (IQR -87; -4) for baseline TC > 300 mg/dL (p < 0.01). No significant changes in liver enzymes or bilirubin were observed. SQV treatment was discontinued in 22% of patients, 6% due to side effects.

Conclusions

These data confirm the efficacy and tolerability of SQV/r in PI-experienced, SQV-naïve patients treated in a real-life clinical setting. Of particular relevance are the improvements in triglycerides and TC levels observed in patients with baseline grade III-IV elevations.

Electroconvulsive therapy is equally effective in unipolar and bipolar depression

OBJECTIVE

To determine the relative efficacy of electroconvulsive therapy (ECT) in the treatment of bipolar (BP) and unipolar (UP) depressive illness and clarify its role in BP depression.

METHOD

Patients referred for ECT with both UP and BP depressions. [classified by Structured Clinical Interview for DSM (SCID-I) criteria for history of mania] were included in a multi-site collaborative, double-masked, randomized controlled trial of three electrode placements - right unilateral, bifrontal or bitemporal - in a permutated block randomization scheme.

RESULTS

Of 220 patients, 170 patients (77.3%) were classified as UP and 50 (22.7%) as BP depression in the intent-to-treat sample. The remission and response rates and numbers of ECT for both groups were equivalent.

CONCLUSION

Both UP and BP depressions remit with ECT. Polarity is not a factor in the response rate. In this sample ECT did not precipitate mania in depressed patients. Treatment algorithms for UP and BP depression warrant re-evaluation.

[Correction of a post-traumatic femoral length difference using an intramedullary distraction nail]

AIM

For the operative adjustment of a leg length shortening and for correcting an angular deformity, an external fixator is the most frequently used technique today. This method may, however, be complicated by painful soft tissue and muscle fixations, pin infections and psychic strain as well as by long treatment duration with the external fixator. The intramedullary skeletal kinetic distractor (ISKD) is an internal lengthening nail, which promises a postoperative course without further complications.

METHOD

We used the ISKD nail in a 28-year-old traumatised motorcyclist, in whom, after removal of a comminuted femur bone fragment, a leg length shortening of 8 cm resulted.

RESULTS

After uneventful healing of all fractures and having performed implant removal, we implanted an ISKD nail for femoral lengthening. The following distraction resulted, without considerable complications, in a complete compensation of the leg difference.

CONCLUSIONS

The ISKD nail is a suitable procedure to compensate for post-traumatic leg length differences, which exhibits, in contrast to the frequently used external fixator, a largely uncomplicated course. It cannot be used to correct a gross transverse or rotational deformity.

[Evaluation of the efficiency of the zero-dose-C-arm navigation approach]

BACKGROUND

The efficiency and success of computer-assisted fluoroscopic navigation systems mainly depend on the quality of the process of image acquisition: obtaining the correct view of anatomic structures, relative orientation of multiplanar X-ray images and the necessary amount of radiation dose. These systems may be optimised by using a system called zero-dose c-arm navigation (ZDCAN). We investigate whether the available computer-assisted systems may be used to navigate the c-arm before image acquisition to obtain X-ray images with maximised accuracy and minimal radiation exposure.

METHODS

Based on position data of an optical tracking system combined with statistical deformable bone models, ZDCAN is able to generate a real-time preview of expected X-ray images of the lower extremities without using radiation. We performed a cadaver study on six full-body specimens comparing the zero-dose approach to conventional positioning of the c-arm in order to evaluate efficiency and accuracy. Eight users acquired two perpendicular X-ray images of the hip, the knee and the femoral diaphysis.

RESULTS

The number of X-ray images required to get a satisfying picture could be reduced to seven using the zero-dose approach; the conventional approach needed 11 images. The mean time did not differ significantly. Regarding the image quality, using ZDCAN quasi-orthogonality could be reached while the conventional approach showed a large variation of the relative orientation.

CONCLUSION

Using ZDCAN, the amount of radiation can be reduced by requiring less X-ray images as well as reaching better accuracy.

Prevalence of mental disorders in acromegaly: a cross-sectional study in 81 acromegalic patients

OBJECTIVE

Emotional and behavioural alterations have been described in acromegalic patients. However, the nature and psychopathological value of these changes remained unclear. We examined whether acromegalic patients have an increased prevalence of comorbid DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Version) mental disorders in comparison to subjects with or without chronic somatic disorders.

DESIGN/PATIENTS

A cross-sectional study was conducted at the Max-Planck Institute of Psychiatry and the Ludwig-Maximilians-University Munich. Eighty-one acromegalic patients were enrolled. Control subjects with (n = 3281) and without chronic somatic (n = 430) disorders were drawn from a representative sample of the German adult general population as part of the Mental Health Supplement of the German Health Interview and Examination Survey. Lifetime and 12-month prevalences of DSM-IV mental disorders were assessed with face-to-face interviews using the standardized German computer-assisted version of the Composite International Diagnostic Interview.

RESULTS

Acromegalic patients had increased lifetime rates of affective disorders of 34.6% compared to 21.4% in the group with chronic somatic disorders (OR = 2.0, 95% CI 1.2-3.2) and to 11.1% in the group without chronic somatic disorders (OR = 4.4, 95% CI 2.3-8.7). Affective disorders that occurred significantly more often than in the control groups began during the putative period of already present GH excess. Higher rates of DSM-IV mental disorders were reported in those patients with additional treatment after surgery.

CONCLUSION

Acromegaly is associated with an increased prevalence and a specific pattern of affective disorders. Greater emphasis on diagnosing and treatment of mental disorders in acromegalic patients might improve the disease management.

Association of rheumatoid arthritis with Mdm2 SNP309 and genetic evidence for an allele-specific interaction between MDM2 and p53 P72R variants: a case control study

OBJECTIVE

This study examines two common, functional, single nucleotide polymorphisms (SNP) in the genes coding the human homolog of murine-double-minute-2 (MDM2) and p53 in patients with rheumatoid arthritis (RA) based on the hypothesis that p53 may be an important negative regulator of the pro-inflammatory transcription factor nuclear factor kappa b (NFKappaB).

METHODS

Genomic DNA was obtained from 221 patients with RA who fulfilled at least 4 ACR criteria and from 521 healthy controls. Mdm2 SNP309 and p53 P72R were genotyped by polymerase chain reaction and restriction enzyme analysis.

RESULTS

In RA patients the frequencies of the mdm2 SNP309 G allele and both G-containing genotypes were significantly reduced (G allele: OR: 0.75, 95% CI: 0.59-0.95, p=0.016; genotype TG: OR: 0.71, 95% CI: 0.50-1.00; genotype GG: OR. 0.58, 95% CI: 0.34-0.99; both: p=0.049). Concerning p53 P72R, no differences in allele or genotype frequencies were detected. A combined analysis of both polymorphisms revealed a significant interaction between them (p=0.046). In individuals carrying >1 p53 72R allele, MDM2 had a protective effect, whereas in individuals homozygous for p53 72P, MDM2 had the opposite effect.

CONCLUSION

The function of MDM2 depends on the p53 P72R genotype, resulting in either an increased or reduced risk for RA. We suggest that in most cases MDM2 stabilizes the conformation of p53, whereas in p53 PP-positive subjects MDM2 supports the degradation of p53.

FDG uptake is a surrogate marker for defining the optimal biological dose of the mTOR inhibitor everolimus in vivo

This study aimed to test whether [¹⁸F]fluoro-D-glucose (FDG) uptake of tumours measured by positron emission tomography (PET) can be used as surrogate marker to define the optimal biological dose (OBD) of mTOR inhibitors in vivo. Everolimus at 0.05, 0.5, 5 and 15 mg kg⁻¹ per day was administered to gastric cancer xenograft-bearing mice for 23 days and FDG uptake of tumours was measured using PET from day 1 to day 8. To provide standard comparators for FDG uptake, tumour volume, S6 protein phosphorylation, Ki-67 staining and everolimus blood levels were evaluated. Everolimus blood levels increased in a dose-dependent manner but antitumour activity of everolimus reached a plateau at doses ⩾5 mg kg⁻¹ per day (tumour volume treated vs control (T/C): 51% for 5 mg kg⁻¹ per day and 57% for 15 mg kg⁻¹ per day). Correspondingly, doses ⩾5 mg kg⁻¹ per day led to a significant reduction in FDG uptake of tumours. Dose escalation above 5 mg kg⁻¹ per day did not reduce FDG uptake any further (FDG uptake T/C: 49% for 5 mg kg⁻¹ per day and 52% for 15 mg kg⁻¹ per day). Differences in S6 protein phosphorylation and Ki-67 index reflected tumour volume and changes in FDG uptake but did not reach statistical significance. In conclusion, FDG uptake might serve as a surrogate marker for dose finding studies for mTOR inhibitors in (pre)clinical trials.

Macroscopic brain architecture changes and white matter pathology in acromegaly: a clinicoradiological study

Although long-term exposure of the brain to increased GH/IGF-1 likely influences cerebral functions, no in vivo studies have been directed towards changes of the brain structure in acromegaly. Here, we used high resolution magnetic resonance images to compare volumes of gray matter (GM), white matter (WM) and cerebrospinal fluid (CSF) of forty-four patients with acromegaly to an age and gender matched, healthy control group (n = 44). In addition, white matter lesions (WMLs) were quantified and graded. Patients exhibited larger GM (+3.7% compared with controls, P = 0.018) and WM volumes (+5.1%, P = 0.035) at the expense of CSF. Differences of WML counts between patients and controls were subtle, however, showing more patients in the 21-40 lesions category (P = 0.044). In conclusion, this MRI study provides first evidence that acromegalic patients exhibit disturbances of the macroscopic brain tissue architecture. Furthermore, acromegalic patients may have an increased risk of neurovascular pathology, likely due to secondary metabolic and vascular comorbidities.

Angiotensin inhibition stimulates PPARgamma and the release of visfatin

BACKGROUND

Angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) exhibit beneficial antidiabetic effects in patients with type 2 diabetes independent of their blood pressure-lowering effects. Some antidiabetic properties of ARB and ACE-I might by exerted by activation of peroxisome proliferator-activated receptor gamma (PPARgamma). However, it is not clear whether this action is drug specific.

MATERIALS AND METHODS

The binding affinity of telmisartan, valsartan, lisinopril, rosiglitazone and angiotensin II to PPARgamma was assessed in a cell-free assay system. PPARgamma signalling was studied in isolated skeletal muscle cells using Western blot analysis of phosphorylated protein kinase B (pAKT) and phosphorylated insulin like growth factor-1 receptor (pILGF-1R). Further, the ability of the drugs under study to stimulate the release of the adipocytokine visfatin was investigated in isolated human adipocytes, skeletal muscle cells, and umbilical vein endothelial cells (HUVEC).

RESULTS

The binding affinity to PPARgamma was highest for telmisartan with a half-maximal effective concentration of 463 nM, followed by lisinopril (2.9 microM) and valsartan (6.2 microM). In skeletal muscle cells phosphorylation of ILGF-1R was 2-fold increased after incubation with telmisartan or valsartan and 1.7-fold with lisinopril. pAKT expression was enhanced after incubation with telmisartan, valsartan and with lisinopril. The release of visfatin from adipocytes was 1.6-fold increased after treatment with lisinopril and about 2.0-fold increased with telmisartan and valsartan. Similar results were obtained in skeletal muscle cells and HUVEC.

CONCLUSIONS

Our data confirm agonism of telmisartan, valsartan and lisinopril on PPARgamma. Pharmacokinetic differences may explain different potencies of PPARgamma stimulation by drugs acting on the renin-angiotensin system in clinical settings.

Porous biodegradable microtubes-based scaffolds for tissue engineering, part I: production and preliminary in vitro evaluation

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PURPOSE

</b></i>we aimed at investigating spinning as a potential technology to produce porous microtubes for constructing scaffolds. Spinning is indeed a well known technique for producing polymeric fibres, also used in the biomedical field, but its applications for tissue engineering purposes has never been deeply investigated. <i><b>

METHOD

</b></i> the behaviour of a multi-phase poly-lactide-caprolactone copolymer based solution was here studied for the production under spinning condition of porous microtubes for patterning planar and three dimensional bioactive systems to be used for tissue regeneration. Obtained non-woven fabrics were tested investigating cells response with fibroblast, osteoblasts and chondrocytes. <i><b>

RESULTS

</b></i>once achieved optimal process parameters, microtubes were produced with a controlled and well diffused porosity which were then used to build two and three dimensional scaffolds. Cytocompatibility tests performed on these scaffolds showed good results on all tested cell models, both qualitatively (SEM imaging) and quantitatively. Particularly, cell proliferation assays by Alamar Blue staining indicated increasing trends with time and comparable values with controls. <i><b>

CONCLUSIONS

</b></i>results hereby described represent a proof of concept of the process developed and its applicability for obtaining microtubes with controlled porosity. Moreover, two and three dimensional scaffolds built from such fibres showed to be very promising substrates for cell adhesion and growth. Finally, the process developed can be taken into GMP qualification and thus scaffolds can be upgraded to medical devices and used for regenerative medicine into human applications.

[Valgus osteotomy of the subcapital humerus: a reconstructive procedure after post-traumatic malalignement]

AIM

Post-traumatic humerus varus can develop after an insufficient reduction technique. Reduced abduction, anteversion or rotation is seen, often associated with painful impingement. The radiographic sign is a diminished shaft-head angle less than 140 degrees with a consecutive elevation of the greater tubercule above the head rim and a subacromial narrowing. We analysed the data of the Constant score pre- and postcorrectionem.

METHODS

Between 1992 and 1999 we treated 8 patients with post-traumatic humerus varus. The follow-up time lasted for 3 years after the correction procedure. By means of the Constant score we evaluated the pre- and postoperative results. In addition, we measured the radiological changes of the humerus head-shaft angles. Furthermore, we controlled the arm length before and after the corrective osteotomy.

RESULTS

The age at the time of correction averaged 43 years (23 years to 65 years). In 6 patients a closing wedge was performed on the right shoulder and two times on the left side. 2 patients had an additional retrotorsional malalignment, which was corrected by means of derotation. In 5 cases cancellous bone was attached to the osteotomy plane. The average delay between the first and the second operation was 8 months (range from 4 weeks to 12 months). The Constant score improved from 39.5 to 75.5 points. The radiological head-shaft angle increased from 84 degrees to 130 degrees . The arm shortening decreased from 2 cm to less than 1 cm. Osseous consolidation of the osteotomy was established after 8.5 weeks. In one case we saw a pseudarthrotic osteotomy plane and treated it by plate extension and cancellous bone grafting.

CONCLUSION

The valgus osteotomy of the humeral neck is an extra-articular reconstructive procedure to correct a malpositioning between humeral head and shaft. It improves both radiological and clinical results. It is a demanding procedure regarding indication and operative technique.

First-aid sensor system: new methods for single-point detection and analysis of vital parameters such as pulse and respiration

The paper describes a first aid medical sensor system that is able to detect pulse and respiration. According to an opinion poll 79% of unexperienced first aiders were looking forward to use a system that supports them in first aid situations. Such a device has to be reliable and available in everyday use (e.g. as a keychain or in a first-aid kit). Therefore we investigated a single point sensor that is able to detect both respiration and blood flow at the same point of the body, for instance on the neck. Compared to ECG-derived methods absent pulse due to pulseless electrical activity (PEA) will be recognized as such. Tests have shown that the sensor can also be used to detect deglutition and other body motion sequences.

Insights into linear and rank correlation for material identification in laser-induced breakdown spectroscopy and other spectral techniques

The purpose of this work was to critically assess the potential and limitations of linear and rank correlation methods, not only relevant to laser-induced breakdown spectroscopy (LIBS), but to other spectroscopic techniques as well. Through computer simulations, it was demonstrated that a linear correlation is a more suitable technique for material identification than a rank correlation due to its better stability toward noise and better ability to detect small systematic variations in line intensities. The effect of noise on the results of correlation analysis has been studied. It was found that random noise causes correlation coefficients to be distributed normally, whereas flicker noise (random fluctuations in line intensities) results in a gamma distribution of correlation coefficients. Hence, the distribution of correlation coefficients can be used for detection of the type of noise that dominates correlated spectra. A potential of linear correlation analysis for plasma diagnostics has been demonstrated. It is based on a strong dependence of the linear correlation coefficient upon the line shapes of correlated spectral lines and, consequently, upon plasma parameters (plasma temperature, number densities).

[Laparoscopy in the management of endometrial cancer]

Recent advance in laparoscopy have changed the surgical approach of endometrial cancer patients. The Swissendos Center, Fribourg, in collaboration with AGO (Groupe de travail pour la gynécologie oncologique) and AGE (groupe de travail pour la gynécologie endoscopique) have established a consensus based on the available evidence for the use of laparoscopy in the management of patients with endometrial cancer The main objective was to define Swiss clinical practice guidelines appropriate to the country and consistent with the needs of the physicians.

The sheep as a knee osteoarthritis model: early cartilage changes after meniscus injury and repair

The purpose of this study was to analyse cartilage changes after traumatic meniscal lesions and to provide a detailed description of the model used with a view to reducing the number of animals used in future studies. The sheep's knee was chosen, as ovine biomechanics are similar to that of humans. In two groups of 10 animals each, a radial tear in the medial meniscus was either sutured with polydioxanone (PDS) or left untreated (sham-operated). Half of the animals in each group were sacrificed after six months, the other half after one year. The time periods to achieve weight bearing, meniscus healing, joint effusion (magnetic resonance imaging scan) and knee cartilage in the medial, lateral and patellofemoral compartments were evaluated in comparison to the opposite knee (control). Osteoarthritis (OA) was assessed by a modified Outerbridge classification and confirmed by scanning electron microscopy. Only one sutured meniscus remained completely adapted. In all other meniscus lesions, the rupture healed with a scar. In the PDS and sham-operated groups, OA was significantly higher in the medial knee compartment than in the lateral compartment and in controls (P < 0.001). In the operated groups, joint effusion was higher in the right hindlimb knee than in the normal left hindlimb knee (control) after six and 12 months (P < 0.001). Non-treated, displaced and even adapted sutured radial ovine meniscus tears produced intense OA within less than six months. Therefore, this animal model is suitable for assessment of new therapeutic regimens in meniscal surgery.

Increased brain oxygenation during intubation-related stress

BACKGROUND AND OBJECTIVES

The purpose of this study was to determine whether brain oxyhaemoglobin-deoxyhaemoglobin coupling was altered by anaesthesia or intubation-induced stress.

METHODS

This was a prospective observational study in the operating room. Thirteen patients (ASA I and II) undergoing spinal or peripheral nerve procedures were recruited. They were stabilized before surgery with mask ventilation of 100% oxygen. Anaesthesia was induced with 2 microg kg(-1) fentanyl and 3 mg kg(-1) thiopental. Laryngoscopy and intubation were performed 4 min later. After intubation, desflurane anaesthesia (FiO2=1.0) was adjusted to maintain response entropy of the electroencephalogram at 40-45 for 20 min. Prefrontal cortex oxyhaemoglobin and deoxyhaemoglobin were determined every 2 s using frequency domain near-infrared spectroscopy. Blood pressure, heart rate and response entropy were collected every 10 s.

RESULTS

Awake oxyhaemoglobin and deoxyhaemoglobin were 18.9 +/- 2.3 micromol (mean +/- SD) and 12.7 +/- 0.8 micromol, respectively, and neither changed significantly during induction. Intubation increased oxyhaemoglobin by 37% (P < 0.05) and decreased deoxyhaemoglobin by 16% (P < 0.05), and both measures returned to baseline within 20 min of desflurane anaesthesia. Blood pressure, heart rate and electroencephalogram response entropy increased during intubation, and the increase in heart rate correlated with the increase in brain oxygen saturation (r = 0.48, P < 0.05).

CONCLUSIONS

Intubation-related stress increased oxyhaemoglobin related to electroencephalogram and autonomic activation. Stress-induced brain stimulation may be monitored during anaesthesia using frequency domain near-infrared spectroscopy.

Rapid freeze-substitution preserves membranes in high-pressure frozen tissue culture cells

We describe a method for high-pressure freezing and rapid freeze-substitution of cells in tissue culture which provides excellent preservation of membrane detail with negligible ice segregation artefacts. Cells grown on sapphire discs were placed 'face to face' without removal of tissue culture medium and frozen without the protection of aluminium planchettes. This reduction in thermal load of the sample/holder combination resulted in freezing of cells without visible ice-crystal artefact. Freeze-substitution at -90 degrees C for 60 min in acetone containing 2% uranyl acetate, followed by warming to -50 degrees C and embedding in Lowicryl HM20 gave consistent and clear membrane detail even when imaged without section contrasting. Preliminary data indicates that the high intrinsic contrast of samples prepared in this way will be valuable for tomographic studies. Immunolabelling sensitivity of sections of samples prepared by this rapid substitution technique was poor; however, reducing the uranyl acetate concentration in the substitution medium to 0.2% resulted in improved labelling. Samples substituted in this lower concentration of uranyl acetate also gave good membrane detail when imaged after section contrasting.

Effects of radial shockwave therapy on the limb function of dogs with hip osteoarthritis

The objective of this study was to evaluate the effects of extracorporeal radial shock wave therapy on the hindlimb function of dogs suffering from hip osteoarthritis. Twenty-four client-owned dogs with hip osteoarthritis were investigated; 18 of them received radial shockwave therapy and six were left untreated as controls. Force plate analysis on a treadmill was used to assess the dogs' hindlimb function before treatment and four weeks after the last treatment, and the treated dogs were re-evaluated three and six months after the treatment. The parameters chosen for evaluation were peak vertical force and vertical impulse, and the calculated symmetry indices. In the treated dogs, differences between the ground reaction forces exerted by the right and left hindlegs disappeared four weeks after the treatment, whereas in the control dogs only the peak vertical force distribution changed significantly. The significant improvement in the treated dogs was confirmed by changes in the symmetry indices. Significant improvements in vertical impulse and peak vertical force were observed three months after the treatment.

Low-dose Tacrolimus/Sirolimus and Steroid Withdrawal in Heart Recipients Is Highly Efficacious

Heart transplant recipients treated with long-term calcineurin inhibitors (CNIs) experience significant nephrotoxicity and transplant vasculopathy. Signal proliferation inhibitors might prevent the development of transplant vasculopathy. In an open, prospective pilot study, 33 primary heart transplant recipients received tacrolimus (Tac) and sirolimus (rapamycin, Rapa) with steroids. To reduce both nephrotoxicity and transplant vasculopathy at the same time, both Tac and Rapa exposure was kept low (6 to 8 ng/ml). Steroids were withdrawn successfully from all patients within 6 months. Just one acute rejection occurred at 54 days post-transplant, resulting in 0.03 acute rejection episode per patient at 1-year (primary end-point) and 2-year follow-up. Transplant vasculopathy assessed by angiogram was absent at 2 years. Graft and patient survival were 100% at 1 and 2 years. Accordingly, the survival estimate for freedom from first acute rejection, transplant vasculopathy, graft loss or death was 0.97 at 1 and 2 years. The regimen was well tolerated with only 3 patients requiring a change of study medication. Mean serum creatinine increased during the first year but returned to baseline at 2 years.

Prognostic relevance of increased Rac GTPase expression in prostate carcinomas

Rac proteins of the Rho-like GTPase family, including the ubiquitous Rac1, the hematopoiesis-specific Rac2, and the least-characterized Rac3 play a major role in oncogenic transformation, tumor invasion and metastasis. However, the prognostic relevance of Rac expression in human tumors has not been investigated yet. In the present study, Rac protein expression was analyzed in benign secretory epithelium, high-grade prostatic intraepithelium neoplasia (HG-PIN), and prostate carcinomas of 60 R0-resected radical prostatectomy specimens by semiquantitative immunohistochemistry. Thus, Rac proteins were significantly strongly expressed in HG-PIN (P < 0.001) and prostate carcinomas (P < 0.001) when compared with benign secretory epithelium. Accordingly, all tumor tissues analyzed by isoform-specific real-time PCR (n = 7) exhibited significantly higher RNA expression levels of Rac (i.e. sum of Rac1 and Rac3 expression levels) than the respective benign counterparts (P = 0.018) and this appeared to result mainly from increased expression of the Rac3 isoform as verified by immunoblotting. Univariate analyses showed statistically significant associations of increased Rac protein expression in prostate cancer (P = 0.045), preoperative prostate-specific antigen levels (P = 0.044), pT stage (P = 0.002), and Gleason score (P = 0.001) with decreased disease-free survival (DFS). This prognostic effect of increased protein expression of Rac remained significant even in a multivariate analysis including all these four factors (relative risk = 3.22, 95% confidence interval = 1.04-10.00; P = 0.043). In conclusion, our data suggest that increased Rac protein expression in prostate cancer relative to the corresponding benign secretory epithelium is an independent predictor of decreased DFS and appears to result mainly from increased expression of the Rac3 isoform.

Approach to Detection in Laser-Induced Breakdown Spectroscopy

Gated detection with intensified detectors, e.g., ICCDs, is today the accepted approach for detection of plasma emission in laser-induced breakdown spectroscopy (LIBS). However, these systems are more cost-intensive and less robust than nonintensified CCDs. The objective of this paper is to compare, both theoretically and experimentally, the performance of an intensified (ICCD) and nonintensified (CCD) detectors for detection of plasma emission in LIBS. The CCD is used in combination with a mechanical chopper, which blocks the early continuum radiation from the plasma. The detectors are attached sequentially to an echelle spectrometer under the same experimental conditions. The laser plasma is induced on a series of steel samples under atmospheric conditions. Our results indicate that there is no substantial difference in the performance of the CCD and ICCD. Signal-to-noise ratios and limits of detection achieved with the CCD for Si, Ni, Cr, Mo, Cu, and V in steel are comparable or even better than those obtained with the ICCD. This result is further confirmed by simulation of the plasma emission signal and the corresponding response of the detectors in the limit of quantum (photon) noise.

Prognostic relevance of Tiam1 protein expression in prostate carcinomas

The Rac-specific guanine nucleotide exchange factor, Tiam1, plays a major role in oncogenicity, tumour invasion and metastasis but its usefulness as a prognostic marker in human cancer has not been tested yet. In the present study, Tiam1 expression was analysed in benign secretory epithelium, pre-neoplastic high-grade prostatic intraepithelium neoplasia (HG-PIN) and prostate carcinomas of 60 R0-resected radical prostatectomy specimens by semiquantitative immunohistochemistry. Tiam1 proved significantly overexpressed in both HG-PIN (P<0.001) and prostate carcinomas (P<0.001) when compared to benign secretory epithelium. Strong Tiam1 overexpression (i.e. ⩾3.5-fold) in prostate carcinomas relative to the respective benign prostatic epithelium was statistically significantly associated with disease recurrence (P=0.016), the presence of lymph vessel invasion (P=0.031) and high Gleason scores (GS) (i.e. ⩾7) (P=0.044). Univariate analysis showed a statistically significant association of strong Tiam1 overexpression with decreased disease-free survival (DFS) (P=0.03). This prognostic effect of strong Tiam1 overexpression remained significant in multivariate analysis including preoperative prostate-specific antigen levels, pT stage, and GS (relative risk= 3.75, 95% confidence interval=1.06–13.16; P=0.04). Together, our data suggest that strong Tiam1 overexpression relative to the corresponding benign epithelial cells is a new and independent predictor of decreased DFS for patients with prostate cancer.

Retropatellar chondromalacia associated with medial osteoarthritis after meniscus injury. One year of observations in sheep

BACKGROUND/AIMS

In an ovine meniscal repair model, the patellofemoral (PF) osteoarthritis due to a non-sutured tear or failed repair was investigated.

METHODS

A radial meniscus tear was either sutured with polydioxanone (PDS), with a slow degrading polylactide long-term suture(LTS) or left without treatment. Knee joint cartilage in the PF and medial compartment was evaluated compared to normal knees (healthy controls).

RESULTS

Retropatellar osteoarthritis in the non-sutured and sutured animals was intense in contrast to the control knees after 6 months in all groups (p < 0.001), and after 12 months in the PDS group (p < 0.001), LTS group and non-sutured animals (p < 0.05).

CONCLUSION

Non-sutured meniscus tears and failed repair lead fast to intense PF osteoarthritis corresponding with tibial damage of the injured compartment.

Influence of immunisation with Mycobacterium bovis bacillus Calmette-Guérin on the sensitisation to inhaled allergens after infection with respiratory syncytial virus

Respiratory syncytial virus (RSV) may play an important role in allergic diathesis by creating a Th2-type immune response. Mycobacterium bovis bacillus Calmette-Guérin (BCG) is known to induce a Th1-type immune response, but the association of BCG vaccination and the suppression of allergy development remain controversial. We investigated the influence of BCG vaccination on the immune response to RSV in a mouse model. Balb/c mice were BCG vaccinated, RSV infected and ovalbumin (OVA) challenged. Mice were sacrificed one, two and four weeks after allergen exposure. Bronchoalveolar lavage was performed. Alveolar macrophages and lymphocytes from spleens and lung-associated lymph nodes were investigated for cytokine production and cell proliferation. Serum was tested for allergen-specific immunoglobulin-E (IgE). Lung eosinophilia was diminished by BCG immunisation. OVA-specific serum IgE was increased regardless of prior BCG vaccination. Interleukin-4 secretion of spleen lymphocytes increased in BCG-vaccinated mice only one week after allergen exposure but was comparable to non-vaccinated mice at four weeks. The reactivity of spleen lymphocytes towards concanavalin-A to secrete interferon-gamma was increased in the vaccinated group at the end of the observation period. Interleukin-6 and tumour necrosis factor-alpha secretion of alveolar macrophages as well as proliferation of stimulated thoracic lymph node cells were increased and prolonged in vaccinated mice. BCG immunisation led to a local suppression of the allergic reaction within the lung. No reduction of systemic IgE production was observed. Further studies are necessary to determine a possible time dependence of BCG immunisation.