Surfactant function in children with chronic airway inflammation

Pulmonary surfactant is necessary to keep the terminal conducting airways patent. It is unknown whether mild to moderate airway inflammation may influence surfactant function and thus contribute to the pathogenesis of chronic airway inflammation in children. To answer this question, 21 children with chronic obstructive bronchitis and 19 asymptomatic children with long-term tracheostomy and increased numbers of neutrophils in their airways were compared with 15 healthy controls. Bronchoalveolar lavage fluid was separated into large surfactant aggregates (LA) and a supernatant containing inhibitory constituents. Surfactant function of LA, recombinations of LA and supernatant, and recombinations of a defined bovine surfactant and supernatant was assessed in a capillary surfactometer. Compared with controls, the function of the LA surfactant was reduced and there was no difference between children with tracheostomy and chronic obstructive bronchitis. The function of LA-supernatant recombinations was poor in all subjects. This may be explained by the well-known protein influx during the lavage procedure. The activity of bovine surfactant-supernatant reconstitutions was impaired in children with tracheostomy. In all surfactant mixtures assessed, surfactant function was inversely correlated to the number of neutrophils in the lavage fluid. Chronic lower airway inflammation with mild or no clinical symptoms is associated with impaired surfactant function. The dysfunction may contribute to airflow restrictions frequently observed in these children.

Effect of diode laser and fluoride varnish on initial surface demineralization of primary dentition enamel: an in vitro study

INTRODUCTION

Previous investigations have demonstrated improved enamel caries resistance after laser irradiation. The purpose of this in vitro study was to assess the caries-preventive potential of 809 nm diode laser treatment of the enamel of primary teeth compared to topical fluoride application.

METHODS

Eighty samples of sound primary teeth were embedded in plastic and stored in saline solution. The enamel surface of 80 samples was polished in an area of 2 x 2 mm. These tooth specimens were randomly assigned to one control and three test groups: (1) no treatment/control; (2) application of 0.1 mg of fluoride varnish (Duraphat) for 6 h; (3) diode laser application (809 nm, 140 mJ, 50 Hz, Ø 600 micro m fibre, contact mode, absorber, 1 min; ORA-LASER01 I.S.T.); and (4) combined application - laser/fluoride varnish. Caries-like lesions were created by pH-cycling. After lesion formation, longitudinal sections were taken and examined by polarized light microscopy.

RESULTS

In the control group, all samples showed lesions up to 30 micro m in depth. After laser application, lesions could be identified in 15 out of 20 samples. Topical fluoride treatment in groups 2 (varnish) and 4 (laser/varnish) completely inhibited the development of caries-like lesions in all samples.

CONCLUSION

In this in vitro investigation, topical fluoride treatment enhances the resistance of sound enamel of primary teeth more effectively than diode laser application.

Insulin Pump Therapy in Patients with Type 1 Diabetes Mellitus: Results of the Nationwide Quality Circle in Germany (ASD) 1999 - 2000

BACKGROUND AND AIMS

Only a few specialised centres in Germany initiated insulin pump therapy before 1990. Initiation of pump therapy involves the participation in a structured treatment and teaching programme (TTP). During the last decade insulin pump therapy has been widely used. The impact of this decentralisation on the quality of care is still unknown. The aim of this trial was both to evaluate the outcome of insulin pump therapy outside specialised centres and to identify features that might be associated with persistently increased HbA1 c levels.

PATIENTS AND METHODS

250 patients with type 1 diabetes mellitus (age 36.0 +/- 13.1 years; diabetes duration 16.1 +/- 9.9 years), who were on continuous subcutaneous insulin infusion (CSII) therapy during 1999 - 2000, were individually included in the study. Second examination was performed one year after participation in the in-patient TTP for insulin pump therapy. Patients were recruited from 21 member institutions of the Working Group for Structured Diabetes Therapy of the German Diabetes Association. Further details were sought by questionnaire on those patients with persistently increased HbA1c (> 1.7 fold of mean normal range.)

RESULTS

One year after participation in the TTP for CSII relative HbA1c (original value/mean normal of the local method [Müller et al., 1999]) decreased from 1.51 (0.9 - 3.2) to 1.44 (0.9 - 3.6) (p < 0.0001), severe hypoglycaemia from 0.46 to 0.12/patient/year (p < 0.001), severe ketoacidosis from 0.08 to 0.05/patients/year (p = 0.003) and hospitalisation from 5.2 to 3.1 days/patient/year (p = 0.002). In 43/207 (17%) the incidence of severe hypoglycaemia was unchanged (before 0.12 and after TTP 0.14/patients/year), there was slight increase in severe ketoacidosis (before 0.15; after TTP 0.23/patients/year) and hospitalisation days were unchanged (before 4.5; after TTP 4.4 days/patients/year). The following factors were associated with adverse outcomes: psychological problems including eating disorders and alcohol abuse (28%), lack of interest in self-management (28%) and social problems (11%). In 28% there was no follow-up treatment by diabetologists specialised in pump therapy.

CONCLUSION

The benefits of insulin pump therapy are improvement of HbA1c, reduction of hypoglycaemia, ketoacidosis and hospitalisation days as well as improved flexibility. It is possible to draw up a list of clinical criteria and service requirements, which are likely to reduce failures.

Cognitive function and quality of diabetes care in patients with Type-2-diabetes mellitus in general practitioner practice

INTRODUCTION/AIMS

The goal of the trial was the assessment of the quality of diabetes control and the cognitive function of all patients with type 2 diabetes mellitus treated in a randomly selected general practitioner practice in Thuringia, Germany. Furthermore possible interactions between patients' quality of diabetes control and their cognitive function should be analysed.

PATIENTS AND METHODS

The investigation comprised all 141 patients with type 2 diabetes mellitus (age 67.3 +/- 10.5 years, body-mass index 29.3 +/- 4.5 kg/m2, patients without insulin therapy: n = 102, with insulin therapy: n = 39) who were patients at the general practitioner practice in Wandersleben, Thuringia, Germany, between November 1999 and April 2000.

RESULTS

The mean HbA1c of all patients examined was 6.33 +/- 1.1% (normal range 3.5-6.8%). 55 patients were treated with diet (HbA1c 5.7 +/- 0.76%) and 47 patients were given oral antidiabetic drugs (HbA1c 6.5 +/- 0.76 %). 27/47 (57.4%) patients were treated with sulfonylurea, 37/47 (78,7%) with metformin, 3/47 (6,4%) with acarbose and 7/47 (14.9%) patients received glinides. 18/47 (38,3%) patients had combinations out of two or more oral antidiabetic drugs. A total of 39 patients with type 2 diabetes mellitus were treated with insulin (HbA1c 7.0 +/- 1.24%). The premorbide cognitive function of the patients was 97.9 +/- 10.0 IQ-points. It was significantly better than the actual cognitive function (91.8+/-13.5 IQ-points, p<0.001). The actual cognitive function showed a correlation with patient's age (r = -0.28, p = 0.001), educational level (r = -0.25, p = 0.006) and profession (r = -0.29, p = 0.001). Performing multivariate analysis the premorbide cognitive function (b = 0.53, p<0.001) and patient's age (b = -0.32, p<0.001) showed associations with the actual cognitive function (R-square =0.36). Associations with the HbA1c (R-square = 0.37) showed the frequency of blood glucose self monitoring (beta = 0.38, p<0.001), the blood glucose value at the time of examination (beta = 0.34, p<0.001) and the diabetes duration (beta = 0.16, p = 0.03). There were no associations between actual cognitive function and other parameters.

CONCLUSIONS

The data from this trial presents evidence which shows that treatment by general practitioners can enable patients both with and without insulin therapy to achieve a high quality of diabetes control. Hence, the results derived from ambulatory evaluations of treatment programmes can not be automatically tansferred to patients treated at hospitals. Regarding inpatient treatment, adapted structured treatment and teaching programmes are mandatory.

Effect of anti-nerve growth factor on early and late airway responses in allergic rats

BACKGROUND

The increased production of nerve growth factor (NGF) has been associated with allergen-induced airway hyperresponsiveness and enhanced airway inflammation in experimental models of asthma. The aim of this study was to investigate whether a local application of anti-NGF to the lungs may affect the allergen-specific early (EAR) and late (LAR) airway responses to ovalbumin (Ova) of Ova-sensitized brown Norway rats.

METHODS

Rats were sensitized systemically with Ova and were boosted twice intratracheally with Ova aerosol using a microsprayer. Two hours before every boost, the animals were pretreated either with aerosolized anti-NGF or with a control antibody. On day 21, all animals were challenged with inhalational Ova aerosol and pulmonary resistance was recorded in anesthetized, orotracheally intubated animals during the early and late asthmatic responses. In addition, differential cell counts from bronchoalveolar lavage and serum immunoglobulin E (IgE) levels were determined 48 h post-Ova challenge.

RESULTS

Pretreatment with anti-NGF significantly attenuated the EAR but had no significant effect on the LAR. Serum IgE levels and inflammatory cell influx into the lungs were not affected by anti-NGF pretreatment.

CONCLUSION

The data from this study suggest that NGF is directly involved in the development of the EAR without affecting the inflammatory airway response or LAR.

The possibility of detecting subgingival calculus by laser-fluorescence in vitro

The aim of the present study was to investigate laser-fluorescence effects on the root surface. The possibility of detecting subgingival calculus should be evaluated to control complete calculus removal after scaling and root planing. Twenty freshly extracted human teeth, partially covered with calculus on the root surface, were fixed on a translation stage. The specimens were irradiated by light from a laser source (diode laser, <1 mW) with a wavelength of 655 nm using the Diagnodent trade mark -system. To simulate the conditions in a periodontal pocket during the measurement procedure, the teeth were covered by a layer of physiological saline solution or blood in order to determine the influence of different inflammatory fluids. The root surface was scanned on a line of about 1 cm in steps of 0.5 mm. The start and end was marked by a notch. The results of the laser-fluorescence detection were compared to clinical and histological findings. Clinically apparent calculus on the root surface was always accompanied with a statistically significant increase of laser-fluorescence values ( p < 0.05). These values were not influenced by the different fluids ( p < 0.05). The laser-fluorescence values were reproducible ( p > 0.05). After scaling, when no debris remained at the root surface, laser-fluorescence values decreased significantly ( p < 0.05). The histological findings supported the clinical results. In conclusion, the present study indicates that laser-fluorescence values on the root surface are strongly correlated to the presence of calculus. This fluorescence effect can basically be used to develop a new detecting system for subgingival calculus in periodontal pockets.

Effect of smoking on risk factors for cardiovascular disease in patients with diabetes mellitus and renal insufficiency

BACKGROUND

Many studies have been published demonstrating a strong correlation between smoking, renal lesions and cardiovascular morbidity and mortality. Possible contributing factors are elevated blood pressure values, changes in vascular reactivity, concentrations of lipids, fibrinogen and carboxyhemoglobin, in patients with diabetes mellitus, the quality of diabetes control and insulin resistance. Other possible risk factors may include advanced glycation end (AGE)-products, total plasma homocysteine and metabolites as well as symmetrical (SDMA) and asymmetrical (ADMA) dimethylarginine. It was the goal of the present trial to investigate the serum concentrations of these >new<, possible risk factors in a selection free population of patients with type 1 and insulin-treated type 2 diabetes mellitus, in patients with chronic renal insufficiency and in renal transplant recipients. The second aim was to analyse the effect of cigarette smoking on the levels of these laboratory parameters.

PATIENTS AND METHODS

A total of 544 subjects (n = 98 patients with chronic renal insufficiency without hemodialysis, n = 84 patients with hemodialysis, n = 50 renal transplant recipients, n = 114 patients with type 1 and n = 147 patients with insulin treated type 2 diabetes mellitus, n = 51 healthy controls) participated in the trial.

RESULTS

Patients with renal insufficiency had significantly higher concentrations of the AGE-products N-epsilon-Carboxymethyllysine (CML) and pentosidine compared with both groups of patients with insulin-treated diabetes mellitus and the healthy controls. In patients with type 1 diabetes there was a positive correlation between HbA1c and the concentration of CML (r = 0.405, p = 0.017) and between the pentosidine-concentration and the serum creatinine-level (r = 0.482, p = 0.001). In type 2 diabetes there was a correlation between CML and diastolic blood pressure (r = 0.239, p = 0.039). In comparison to the healthy controls, patients with renal diseases and patients after kidney transplantation had higher concentrations of total plasma homocysteine and its metabolites. Similar results were found for SDMA and ADMA: Patients with chronic renal insufficiency both with and without hemodialysis had significantly higher values than the renal transplant recipients and healthy controls. A clear influence of cigarette smoking on the levels of the laboratory parameters measured could not be determined in any group; neither in the patients with diabetes mellitus, nor in the patients with renal diseases, nor in the healthy controls.

CONCLUSIONS

The present trial demonstrates an increase in the parameters linked to the development of cardiovascular diseases including total plasma homocysteine, its metabolites, the dimethylarginines SDMA and ADMA and advanced glycation end-products depending on the degree of renal insufficiency. Moreover, in patients with insulin-treated diabetes mellitus, the concentrations of the AGE-products CML and pentosidine seem to be strongly influenced by the quality of diabetes control and blood pressure levels. There was no influence of cigarette smoking on the levels of the laboratory parameters measured.

Electrochemical in situ reaction cell for X-ray scattering, diffraction and spectroscopy

A versatile electrochemical in situ reaction cell for long-term hard X-ray experiments on battery electrodes is described. Applications include the small-angle scattering, diffraction and absorption spectroscopy of lithium manganese oxide electrodes.

Supermode suppression to below -130 dBc/Hz in a 10 GHz harmonically mode-locked external sigma cavity semiconductor laser

We demonstrate supermode suppression to levels below -125 dBc/Hz and -132 dBc/Hz using Fabry-Perot etalons with finesse values of 180 and 650, respectively, for a 10 GHz harmonically mode-locked external sigma cavity semiconductor laser. The laser was hybridly mode-locked using direct electrical modulation in a compact package without the need for an external modulator.

[Changes of periprosthetic bone mineral density in cementless bicontact stem implantation; influence of different parameters--a prospective 4-year follow-up]

AIM

This prospective study describes the periprosthetic BMD (bone mineral density) after implantation of the cementless Bicontact stem over a period of 4 years. Additionally, the influence of several relevant parameters like age, sex, BMI (body mass index) and the influence of the stem-size on the periprosthetic BMD course were investigated.

METHOD

Measurement of the periprosthetic BMD in 36 patients (15 female, 21 male) in a prospective longitudinal study over 4 years with DEXA (dual energy X Ray absorptiometry) of the proximal Gruen zones 1 and 7.

RESULTS

We found a good precision of the method in vivo with a CV (coefficient of variation) of 1.04 %. There was a decline of the periprosthetic BMD at the whole proximal stem (ROI 0) of 20 % in the first 6 months. Afterwards there was a significant increase at the lateral stem (ROI 1) of 3.46 %, in contrast no significant change could be found medially, maybe as a result of a more lateral induction of power. The investigated parameters BMI, age and sex had no influence on the relative course of mineralisation. At stem sizes bigger than 15 the decline of BMD was significantly larger than at the stem sizes smaller than 15.

CONCLUSION

DEXA is a sufficiently precise method to investigate periprosthetic BMD. The postoperative periprosthetic course of mineralisation and the extent of BMD loss in the first 6 months after the Bicontact stem is similar to other periprosthetic BMD courses of prosthesis with a similar design. The course of mineralisation in "smaller" stems is obviously more auspicious than the course of "bigger" stems.

Endodontic and surgical treatment of a geminated maxillary incisor

AIM

A geminated maxillary incisor required complex multidisciplinary treatment to preserve health and restore aesthetics. This report describes the coordination of coronal division, root extraction, bone grafting, endodontic treatment and orthodontics in achieving treatment goals. It is the intention of this report to show how a difficult case could be managed by properly coordinated multidisciplinary care.

SUMMARY

Pulp testing of the geminated central right maxillary incisor gave a normal response. Radiographic investigation indicated a connection of the pulp chambers. Both the mesial and distal root were filled with gutta-percha. The connection between the two root canals was sealed with a flowable dentine-bonded resin. After dividing the crown with a diamond bur, the mesial part of the tooth was removed and the extraction socket was filled with beta-tricalcium phosphate ceramic (Cerasorb). Radiographs taken immediately after surgery and after 6 months showed no periodontal or periapical lesions. No signs of external resorption were identified. The diastema between the central incisors was closed by orthodontic treatment.

KEY LEARNING POINTS

Geminated teeth may present aesthetic and functional problems which require multidisciplinary care. Careful clinical and radiographic examination is essential to decide on the fate of the coronal and root halves involved. A proper coordination between endodontic and surgical treatment may result in maintaining one tooth half, even if a midroot connection between the pulp chambers becomes evident. Orthograde endodontic treatment, hemisection and orthodontics may solve the aesthetic problem of a geminated tooth.

Analysis of the two common alpha-1-antitrypsin deficiency alleles PiMS and PiMZ as modifiers of Pseudomonas aeruginosa susceptibility in cystic fibrosis

Lung disease is the direct cause of death in more than 90% of cystic fibrosis (CF) patients. Proteinase-antiproteinase imbalances are common in CF and alpha-1-antitrypsin (AAT) deficiency. We investigated the hypothesis that the AAT deficiency alleles PiS and PiZ contribute to pulmonary prognosis in CF. Two hundred and sixty-nine CF patients from Southern Germany were included in this study. The serum concentrations of AAT and C-reactive protein (CRP) were determined by nephelometry, and patients were screened by polymerase chain reaction (PCR) and restriction enzyme digest for the common AAT deficiency alleles PiS and PiZ. The onset of chronic bacterial colonization by Pseudomonas aeruginosa (Pae) was correlated with the AAT phenotypes PiMM, PiMS and PiMZ. Only three out of nine CF patients (33%) diagnosed with either PiMS or PiMZ had developed chronic Pae lung infection earlier in their lives. The remaining six patients showing a PiMS or PiMZ phenotype showed a later onset of chronic Pae lung infection. Our results indicate that PiMS and PiMZ are not associated with worse pulmonary prognosis in CF. These data need to be confirmed in studies with a much larger number of cases.

Clinical and microbiological effects of local chlorhexidine applications

AIM

To study the effects of an application of chlorhexidine varnish (40%) on dental plaque.

DESIGN

Randomised controlled clinical trial.

SUBJECTS

40 patients (50% females), aged 25-34 years after undergoing any necessary restorative treatment. Exactly one half of these individuals practiced good oral hygiene, the efforts of the others were poor.

METHOD

Test groups received a chlorhexidine varnish application, the control group received a placebo varnish. Initially and after 2 and 6 weeks, a modified Dentocult SM-test, bleeding on probing, and a plaque index (Quigley-Hein) were recorded.

RESULTS

In contrast to the control group, improvements in plaque index and bleeding on probing scores were found in patients with poor oral hygiene. The results of the Dentocult SM-tests showed a considerable reduction of streptococcus colonisation. The test group with good oral hygiene showed only slight improvement of the examined indices after chlorhexidine application. The index parameters of all patients of the placebo groups remained unchanged over the examination time period.

CONCLUSION

The application of a chlorhexidine varnish reduced the quantity of the Streptococcus mutans colonies significantly and improved clinical parameters in patients with elevated plaque accumulation.

Dynamics of tight and adherens junctions under EGTA treatment

The dynamics of tight junctions (TJs) and adherens junctions (AJs) under EGTA treatment were investigated in Madin Darby canine kidney (MDCK) cells. Detailed information about the behavior of TJ and AJ proteins during the opening and resealing of TJs and AJs is still scarce. By means of the "calcium chelation" method, the distribution and colocalization of junctional proteins were studied with confocal laser scanning microscopy using a deconvolution algorithm for high-resolution images. Colocalization was analyzed for pairs of the following proteins: ZO-1, occludin, claudin-1, E-cadherin and F-actin. Significant differences were found for the analyzed pairs in control cells compared to EGTA-treated cells with respect to the position of the colocalization maxima within the cell monolayers as well as with respect to the amount of colocalized voxels. Under EGTA treatment, colocalization for ZO-1/occludin, ZO-1/claudin-1, claudin-1/occludin, E-cadherin/occludin and E-cadherin/claudin-1 dropped below 35% of the control value. Only for the ZO-1/E-cadherin pair, the amount of colocalized voxels increased and a shift to a more basal position was observed. During the opening of TJs and AJs, ZO-1 colocalized with E-cadherin in the lateral membrane region, whereas in controls, ZO-1 colocalized with occludin and claudin-1 in the junctional complex. The combination of deconvolution with colocalization analysis of confocal data sets offers a powerful tool to investigate the spatial relationship of TJ and AJ proteins during assembly and disassembly of cell-cell contacts.

Measurement of residual phase noise and longitudinal-mode linewidth in a hybridly mode-locked external linear cavity semiconductor laser

We report measurements of the residual phase-noise knee position and longitudinal-mode linewidth of a hybridly mode-locked external linear cavity semiconductor laser as a function of laser cavity length. Excellent agreement between these measurements suggests a direct relationship between rms pulse-to-pulse timing jitter and average longitudinal-mode linewidth. This relationship leads to a fundamental limit in the timing jitter of mode-locked lasers.

Er:YAG laser scaling of diseased root surfaces

BACKGROUND

The removal of calculus and plaque is an essential component of a therapeutic approach to control periodontal disease. Er:YAG laser scaling was recently introduced as an alternative to conventional scaling procedures. In this histological study, the effects of laser instrumentation of diseased root surfaces are compared to mechanical removal of plaque and calculus with ultrasonic instruments and scalers.

METHODS

Areas of subgingival calculus were identified on 40 freshly extracted human teeth. Each of these areas was randomly divided into 2 equal parts. The control site was treated either with scaling and root planing or with an ultrasonic instrument. The test site was cleaned using an Er:YAG laser according to the manufacturer's instructions. The end point of debridement was the inability to mechanically or visibly detect any remaining calculus. After pre- and postsurgical photographs and impressions for scanning electronic microscopic investigation, a plastic embedding technique was used to cut the undecalcified roots into 15 microm thick sections.

RESULTS

Clinically and histologically, scaling resulted in complete debridement at all samples, producing a smooth root surface. At the test sites, laser scaling was accompanied by an increased removal of tissue and roughened surfaces.

CONCLUSIONS

Laser scaling results in an increased loss of cementum and dentin, which should be taken into account in clinical situations.

Ultralow noise and supermode suppression in an actively mode-locked external-cavity semiconductor diode ring laser

We report what is to our knowledge the lowest phase and amplitude noise characteristics achieved to date in a 10-GHz pulse train produced by the active harmonic mode locking of an external-cavity semiconductor diode laser. Supermode noise has also been suppressed below -140 dBc/Hz by use of a high-finesse fiber Fabry-Perot etalon as an intracavity filter. Novel noise sideband measurements that extend to the Nyquist offset frequency suggest a significant advantage in using harmonic (rather than fundamental) mode locking to produce ultralow-noise pulse trains, owing to the relationship between the noise roll-off frequency and the fundamental cavity frequency.

Population distribution of human flavin-containing monooxygenase form 3: gene polymorphisms

The N-oxygenation of amines by the human flavin-containing monooxygenase (form 3) (FMO3) represents an important means for the conversion of lipophilic nucleophilic heteroatom-containing compounds into more polar and readily excreted products. Certain mutations of the human FMO3 gene have been linked to abnormal drug or chemical metabolism. For example, abnormal N-oxygenation of trimethylamine has been shown to segregate with mutations of human FMO3. To date, however, it is not known whether there is a pharmacogenetic basis for abnormal drug metabolism by human FMO3. The objective of this study was to estimate the allele and genotype frequencies at three variable DNA sites in the FMO3 gene in male and female blood bank donors representative of non-Hispanic Caucasians, non-Hispanic African Americans, Hispanics, and Asians sampled from the United States. The common polymorphisms at variable sites 158, 257, and 308 were experimentally determined using a high-throughput chip-based genotype variation detection method combining MassEXTEND and matrix-assisted laser desorption ionization time-of-flight mass spectrometry. We also compared the genetic variation of nonhuman primate FMO3 with the human FMO3 gene. Exon sequence analysis of the monkey FMO3 gene sequence showed that it was similar to the human gene sequence but differed from the human consensus sequence at 31 fixed positions. Compared with that of human, the chimpanzee exon sequence had one polymorphism that induced an amino acid change. The evolutionary history of the FMO3 gene was inferred from the pattern of haplotype relationships across different populations and species. Statistically significant heterogeneity in the relative frequencies of single and multiple site alleles, haplotypes, and genotypes of the human FMO3 among ethnic subdivisions suggests that population differences in the susceptibility of humans to abnormal metabolism or adverse drug reactions for chemicals metabolized by human FMO3 could exist.

T cell activation in rheumatoid synovium is B cell dependent

Rheumatoid arthritis results from a T cell-driven inflammation in the synovial membrane that is frequently associated with the formation of tertiary lymphoid structures. The significance of this extranodal lymphoid neogenesis is unknown. Microdissection was used to isolate CD4 T cells residing in synovial tissue T cell/B cell follicles. CD4 T cells with identical TCR sequences were represented in independent, nonadjacent follicles, suggesting recognition of the same Ag in different germinal centers. When adoptively transferred into rheumatoid arthritis synovium-SCID mouse chimeras, these CD4 T cell clones enhanced the production of IFN-gamma, IL-1beta, and TNF-alpha. In vivo activity of adoptively transferred CD4 T cells required matching of HLA-DRB1 alleles and also the presence of T cell/B cell follicles. HLA-DRB1-matched synovial tissues that were infiltrated by T cells, macrophages, and dendritic cells, but that lacked B cells, did not support the activation of adoptively transferred CD4 T cell clones, raising the possibility that B cells provided a critical function in T cell activation or harbored the relevant Ag. Dependence of T cell activation on B cells was confirmed in B cell depletion studies. Treatment of chimeric mice with anti-CD20 mAb inhibited the production of IFN-gamma and IL-1beta, indicating that APCs other than B cells could not substitute in maintaining T cell activation. The central role of B cells in synovial inflammation identifies them as excellent targets for immunosuppressive therapy.

Quantitative mutant analysis of viral quasispecies by chip-based matrix-assisted laser desorption/ ionization time-of-flight mass spectrometry

RNA viruses exist as quasispecies, heterogeneous and dynamic mixtures of mutants having one or more consensus sequences. An adequate description of the genomic structure of such viral populations must include the consensus sequence(s) plus a quantitative assessment of sequence heterogeneities. For example, in quality control of live attenuated viral vaccines, the presence of even small quantities of mutants or revertants may indicate incomplete or unstable attenuation that may influence vaccine safety. Previously, we demonstrated the monitoring of oral poliovirus vaccine with the use of mutant analysis by PCR and restriction enzyme cleavage (MAPREC). In this report, we investigate genetic variation in live attenuated mumps virus vaccine by using both MAPREC and a platform (DNA MassArray) based on matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. Mumps vaccines prepared from the Jeryl Lynn strain typically contain at least two distinct viral substrains, JL1 and JL2, which have been characterized by full length sequencing. We report the development of assays for characterizing sequence variants in these substrains and demonstrate their use in quantitative analysis of substrains and sequence variations in mixed virus cultures and mumps vaccines. The results obtained from both the MAPREC and MALDI-TOF methods showed excellent correlation. This suggests the potential utility of MALDI-TOF for routine quality control of live viral vaccines and for assessment of genetic stability and quantitative monitoring of genetic changes in other RNA viruses of clinical interest.

Meningioma metastatic to thyroid gland

OBJECTIVE

To describe the first reported case of meningioma metastasizing to and completely infiltrating the thyroid gland.

METHODS

We present a detailed case report, including radiographic, histologic, and immunostaining findings, in a patient with an atypical meningioma who had a progressively enlarging thyroid mass that proved to be a metastatic meningioma.

RESULTS

A 49-year-old man had a meningioma in the parieto-occipital region that had spread locally to the scalp and bone by the time of surgical resection. Local recurrence during the following year prompted repeated surgical resection, tumor embolization, radiotherapy, and chemotherapy. Despite aggressive therapy, the tumor progressed. A thyroid mass was first noted 2 years after the meningioma was diagnosed. Enlargement of the mass caused airway obstruction, necessitating an emergency thyroidectomy. Histologic examination of the thyroidectomy specimen showed that the thyroid gland had been extensively replaced by metastatic meningioma.

CONCLUSION

To our knowledge, this is the first reported case of metastatic meningioma extensively infiltrating the thyroid gland. This case report expands the spectrum of tumors that metastasize to the thyroid gland.

Lymphoid neogenesis in rheumatoid synovitis

In rheumatoid arthritis (RA), tissue-infiltrating lymphocytes can be arranged in sophisticated organizations that resemble microstructures usually formed in secondary lymphoid organs. Molecular pathways and host risk factors involved in this process of lymphoid neogenesis remain to be defined. In a series of 64 synovial tissue biopsies, lymphoid follicles with germinal centers (GCs) were found in 23.4% of the patients. Follicular dendritic cells (FDCs) were exclusively present in tissues with GCs, suggesting that the recruitment or in situ maturation of FDCs is a critical factor for GC formation in the synovial membrane. Primary follicles were absent, emphasizing the role of Ag recognition in the generation of inflammation-associated lymphoid organogenesis. Multivariate logistic regression analysis of tissue cytokines and chemokines identified two parameters, in situ transcription of lymphotoxin (LT)-beta and of B lymphocyte chemoattractant (BLC; BLC/CXCL13), that were predictors for FDC recruitment and synovial GC formation. LT-beta and BLC/CXCL13 were found to be independent variables that could, in part, compensate for each other to facilitate GC formation. Prediction models incorporating in situ transcription of LT-beta and BLC/CXCL13 had high negative yet moderate positive predictive values, suggesting that LT-beta and BLC/CXCL13 are necessary but not sufficient. LT-beta protein was detected on a subset of mantle zone and GC B cells, but also on T cells in follicular structures. BLC/CXCL13 was produced by FDCs in follicular centers, but was predominantly found in endothelial cells and synovial fibroblasts, suggesting heterotypic signaling between cells of the synovial membrane and infiltrating lymphocytes in regulating extranodal lymphoid neogenesis.

Sequence and expression analyses of the UL37 and UL38 genes of Aujeszky's disease virus

Previously, we sequenced the HSV-1 Ul39-Ul40 homologue genes of Aujeszky's disease virus (ADV), also designated as pseudorabies virus (Kaliman et al., 1994a, b). Now we report the nucleotide sequence of the adjacent DNA that encodes Ul38, the 5'-region (750 bp) of Ul37, and the promoter regions between these divergently arranged two genes. The ADV Ul38 gene encodes a protein of 368 amino acids. Amino acid sequence comparison of ADV Ul38 with that of other herpesviruses revealed significant structural homology. In a transcription study using RNase protection assay and Northern blot hybridization, we found that the Ul38 gene had one initiation site, but the Ul37 gene was initiated at two transcription sites with two potential initiator AUGs, one of which was dominant. Comparison of ADV Ul37, Ul38 and ribonucleotide reductase gene expression showed that these genes belong to the same temporal class with early kinetics. Data of structural and transcriptional studies suggest that regulation of the expression of these two ADV genes could differ from that of the HSV-1 virus.

Polymorphisms in the bradykinin B2 receptor gene and childhood asthma

Bradykinin has been suggested as one of the key mediators of bronchial asthma. Polymorphisms with a potential functional relevance have been described in the B2 bradykinin receptor gene. Study of these polymorphisms in 77 children with asthma and 73 controls revealed no association. However, when comparing the asthmatics according to their age at onset (before and after age 4), the exon 1 allele BE1-2G was significantly associated with late-onset asthma (p<0.05). Since BE1-2G has previously been shown to lead to a higher transcription rate of the B2 receptor, this result warrants further investigation of the role of bradykinin in conferring susceptibility to pediatric asthma.

PET evaluation of bilingual language compensation following early childhood brain damage

We report a positron emission tomography (PET) study in a 37-year-old, right handed, bilingual (English and American Sign Language) male with left frontal lobe damage, without evidence of language or general intellectual dysfunction. A brain MRI scan demonstrated an atrophic lesion of the left dorsolateral prefrontal, orbital, and opercular cortices extending from the frontal pole to precentral gyrus and including parts of anterior cingulate cortex, due to an probable infantile encephalitis. H(2) (15)O PET scans found evidence of increased right hemisphere activity compared to normal controls during spontaneous generation of narrative in both English and ASL. Neuropsychological data were within normal limits with the exception of visuospatial function. The results suggest the possibility that plasticity, unmasking of neural pathways, and or other adaptations of language function in the right hemisphere may have occurred, and are discussed with regard to the crowding hypothesis.

The domino gene of Drosophila encodes novel members of the SWI2/SNF2 family of DNA-dependent ATPases, which contribute to the silencing of homeotic genes

The Drosophila domino gene has been isolated in a screen for mutations that cause hematopoietic disorders. Generation and analysis of loss-of-function domino alleles show that the phenotypes are typical for proliferation gene mutations. Clonal analysis demonstrates that domino is necessary for cell viability and proliferation, as well as for oogenesis. domino encodes two protein isoforms of 3202 and 2498 amino acids, which contain a common N-terminal region but divergent C termini. The common region includes a 500 amino acid DNA-dependent ATPase domain of the SWI2/SNF2 family of proteins, which function via interaction with chromatin. We show that, although domino alleles do not exhibit homeotic phenotypes by themselves, domino mutations enhance Polycomb group mutations and counteract Trithorax group effects. The Domino proteins are present in large complexes in embryo extracts, and one isoform binds to a number of discrete sites on larval polytene chromosomes. Altogether, the data lead us to propose that domino acts as a repressor by interfering with chromatin structure. This activity is likely to be performed as a subunit of a chromatin-remodeling complex.

The peroxisome proliferator-activated receptor-gamma2 Pro12A1a variant: association with type 2 diabetes and trait differences

Recent studies have identified a common proline-to-alanine substitution (Pro12Ala) in the peroxisome proliferator-activated receptor-gamma2 (PPAR-gamma2), a nuclear receptor that regulates adipocyte differentiation and possibly insulin sensitivity. The Pro12Ala variant has been associated in some studies with diabetes-related traits and/or protection against type 2 diabetes. We examined this variant in 935 Finnish subjects, including 522 subjects with type 2 diabetes, 193 nondiabetic spouses, and 220 elderly nondiabetic control subjects. The frequency of the Pro12Ala variant was significantly lower in diabetic subjects than in nondiabetic subjects (0.15 vs. 0.21; P = 0.001). We also compared diabetes-related traits between subjects with and without the Pro12Ala variant within subgroups. Among diabetic subjects, the variant was associated with greater weight gain after age 20 years (P = 0.023) and lower triglyceride levels (P = 0.033). Diastolic blood pressure was higher in grossly obese (BMI >40 kg/m2) diabetic subjects with the variant. In nondiabetic spouses, the variant was associated with higher fasting insulin (P = 0.033), systolic blood pressure (P = 0.021), and diastolic blood pressure (P = 0.045). These findings support a role for the PPAR-gamma2 Pro12Ala variant in the etiology of type 2 diabetes and the insulin resistance syndrome.

Tidal midexpiratory flow as a measure of airway hyperresponsiveness in allergic mice

A method for the noninvasive measurement of airway responsiveness was validated in allergic BALB/c mice. With head-out body plethysmography and the decrease in tidal midexpiratory flow (EF(50)) as an indicator of airway obstruction, responses to inhaled methacholine (MCh) and the allergen ovalbumin were measured in conscious mice. Allergen-sensitized and -challenged mice developed airway hyperresponsiveness as measured by EF(50) to aerosolized MCh compared with that in control animals. This response was associated with increased allergen-specific IgE and IgG1 production, increased levels of interleukin-4 and interleukin-5 in bronchoalveolar lavage fluid and eosinophilic lung inflammation. Ovalbumin aerosol challenge elicited no acute bronchoconstriction but resulted in a significant decline in EF(50) baseline values 24 h after challenge in allergic mice. The decline in EF(50) to MCh challenge correlated closely with simultaneous decreases in pulmonary conductance and dynamic compliance. The decrease in EF(50) was partly inhibited by pretreatment with the inhaled beta(2)-agonist salbutamol. We conclude that measurement of EF(50) to inhaled bronchoconstrictors by head-out body plethysmography is a valid measure of airway hyperresponsiveness in mice.

High-throughput development and characterization of a genomewide collection of gene-based single nucleotide polymorphism markers by chip-based matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

We describe here a system for the rapid identification, assay development, and characterization of gene-based single nucleotide polymorphisms (SNPs). This system couples informatics tools that mine candidate SNPs from public expressed sequence tag resources and automatically designs assay reagents with detection by a chip-based matrix-assisted laser desorption/ionization time-of-flight mass spectrometry platform. As a proof of concept of this system, a genomewide collection of reagents for 9,115 gene-based SNP genetic markers was rapidly developed and validated. These data provide preliminary insights into patterns of polymorphism in a genomewide collection of gene-based polymorphisms.

Estimation of DNA sequence diversity in bovine cytokine genes

DNA sequence variation provides the fundamental material for improving livestock through selection. In cattle, single nucleotide polymorphisms and small insertions/deletions (collectively referred to here as SNPs) have been identified in cytokine genes and scored in a reference population to determine linkage map positions. The aim of the present study was twofold: first, to estimate the SNP frequency in a reference population of beef cattle, and second, to determine cytokine haplotypes in a group of sires from commercial populations. Forty-five SNP markers in DNA segments from nine cytokine gene loci were analyzed in 26 reference parents. Comparison of all 52 haploid genomes at each PCR amplicon locus revealed an average of one SNP per 143 bp of sequence, whereas comparison of any two chromosomes identified heterozygous sites, on average, every 443 bp. The combination of these 45 SNP genotypes was sufficient to uniquely identify each of the 26 animals. The average number of haplotype alleles (4.4) per PCR amplicon (688 bp) and the percentage heterozygosity among founding parents (50%) were similar to those for microsatellite markers in the same population. For 49 sires from seven common breeds of beef cattle, SNP genotypes (1,225 total) were obtained by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) at three amplicon loci. All three of the amplicon haplotypes were correctly deduced for each sire without the use of parent or progeny genotypes. The latter allows a wide range of genetic studies in commercial populations of cattle where genotypic information from relatives may not be available.

Nerve growth factor induces airway hyperresponsiveness in mice

BACKGROUND

Previous studies indicated an upregulation of nerve growth factor (NGF) production during allergic inflammation. However, the function of NGF in the lungs is currently poorly understood. It was suggested that NGF could play an important role in the pathophysiology of airway hyperresponsiveness. The regulatory network between immunological events and altered neuronal control of airway smooth muscle contractility remains to be defined.

METHODS

NGF was delivered into the airways of mice either by nasal instillation or by genetic engineering. Airway reactivity was then measured by electrical field stimulation.

RESULTS

Treatment of mice with NGF induced airway hyperresponsiveness to a similar extent as demonstrated in allergen-sensitized mice. NGF-transgenic mice, overexpressing NGF in Clara cells, were hyperreactive in comparison to wild-type mice.

CONCLUSION

These data suggest that NGF by itself determines the induction of airway hyperresponsiveness in the absence of airway inflammation in mice.

Cellular and physiological roles of SR-BI, a lipoprotein receptor which mediates selective lipid uptake

High-density lipoproteins (HDL) play an important role in protection against atherosclerosis by mediating reverse cholesterol transport - the transport of excess cholesterol from peripheral tissues to the liver for disposal. SR-BI is a cell surface receptor for HDL and other lipoproteins (LDL and VLDL) and mediates the selective uptake of lipoprotein cholesterol by cells. Overexpression or genetic ablation of SR-BI in mice revealed that it plays an important role in HDL metabolism and reverse cholesterol transport and protects against atherosclerosis in mouse models of the disease. If it plays a similar role in humans then it may be an attractive target for therapeutic intervention. We will review some of the recent advances in the understanding of SR-BI's physiological role and cellular function in lipoprotein metabolism.

Biomarkers of genetic damage and inflammation in blood and bronchoalveolar lavage fluid among former German uranium miners: a pilot study

Former East German uranium miners who are known to have been exposed to radon are estimated to be at high risk for lung carcinogenesis. Among these miners over 200 occupationally caused lung cancer cases are expected to occur each year, resulting in a total of 7,000-24,000 excess lung cancer cases in the coming years. It is still unknown whether there is a correlation between biomarkers and the exposure of the uranium miners to ionizing radiation that might enable us to trace those miners with high lung cancer risk. The primary aim of this pilot study was to test the possibility of performing a biomarker study in this unique cohort of former uranium miners in spite of several limitations that had to be taken into consideration when comparing them with healthy controls, such as old age, age-dependent diseases and potential confounding artefacts from dissimilar smoking patterns. The second aim was to test a range of biomarkers for DNA damage and inflammation in leukocytes and bronchoalveolar fluid for their ability to detect biological effects. In this cohort of miners we found an increased frequency of chromosomal aberrations in blood lymphocytes and an increased prevalence of both fibronectin and tumour necrosis factor alpha in the bronchoalveolar fluid.

Profilin II is alternatively spliced, resulting in profilin isoforms that are differentially expressed and have distinct biochemical properties

We deduced the structure of the mouse profilin II gene. It contains five exons that can generate four different transcripts by alternative splicing. Two transcripts encode different profilin II isoforms (designated IIa and IIb) that have similar affinities for actin but different affinities for polyphosphoinositides and proline-rich sequences. Profilins IIa and IIb are also present in humans, suggesting that all mammals have three profilin isoforms. Profilin I is the major form in all tissues, except in the brain, where profilin IIa is most abundant. Profilin IIb appears to be a minor form, and its expression is restricted to a limited number of tissues, indicating that the alternative splicing is tightly regulated. Western blotting and whole-mount in situ hybridization show that, in contrast to the expression of profilin I, the expression level of profilin IIa is developmentally regulated. In situ hybridization of adult brain sections reveals overlapping expression patterns of profilins I and IIa.

Activation of the IkappaB kinase complex by TRAF6 requires a dimeric ubiquitin-conjugating enzyme complex and a unique polyubiquitin chain

TRAF6 is a signal transducer in the NF-kappaB pathway that activates IkappaB kinase (IKK) in response to proinflammatory cytokines. We have purified a heterodimeric protein complex that links TRAF6 to IKK activation. Peptide mass fingerprinting analysis reveals that this complex is composed of the ubiquitin conjugating enzyme Ubc13 and the Ubc-like protein Uev1A. We find that TRAF6, a RING domain protein, functions together with Ubc13/Uev1A to catalyze the synthesis of unique polyubiquitin chains linked through lysine-63 (K63) of ubiquitin. Blockade of this polyubiquitin chain synthesis, but not inhibition of the proteasome, prevents the activation of IKK by TRAF6. These results unveil a new regulatory function for ubiquitin, in which IKK is activated through the assembly of K63-linked polyubiquitin chains.

Cell cultures as tools in biopharmacy

A survey is given on a few selected cell culture models that are used for transport studies. They are characterised for growth, transcellular electrical resistance and cytoarchitecture. The importance of standardisation in view of their use as transport models is documented. Their potential for studies on passive permeation and P-glycoprotein-mediated transport is explored and related to published data. Transport studies are presented that were performed in a two-chamber set-up, the Costar "vertical diffusion system". A series of non-homologous compounds showed similar permeability data (P(app)) in the different cell cultures. The origin of the cell type had no remarkable influence on passive transcellular permeation. MDCK cells, an epithelial cell line of canine kidney origin, are perfectly suited to screen for passive permeation. They have low expression of transporter proteins and low metabolic activity. In general, they probably represent the best-known epithelial cell line with respect to genetics as well as lipid and protein composition. MDCK cells are easy to handle. Transport experiments can be done between 7 and 14 days after seeding, when the stationary growth phase is reached. To screen for P-glycoprotein substrates, efflux and uptake studies were performed with mdr1-transfected MDCK cells (MDR1-MDCK) in a one-chamber system in the presence or absence of verapamil or cyclosporin A as inhibitor. Evidence is presented why the transfected cells, which express large amounts of P-glycoprotein, are not suitable for two-chamber transport studies.

Replication and virulence of early protein 0 and long latency transcript deficient mutants of the Aujeszky's disease (pseudorabies) virus

Early protein 0 (EP0)-deficient recombinant Aujeszky's disease viruses, Ka-ep0lac and Ba-ep0lac derived from strains Kaplan and Bartha, respectively, were constructed to explore the impact of the mutation on replication, virulence and latency of the virus. Inactivation of the EP0 gene resulted in a mutation of long latency transcript (Cheung et al., 1991) that is located on the complementary DNA strand of EP0 and immediate early protein (IE)175 genes. In infection of immortalized porcine kidney cells, the growth rate and yield of both EP0(-) mutant strains were significantly smaller than that of wild-type virus. Ka-ep0lac was found to be highly virulent, while Ba-ep0lac showed an attenuated phenotype in mice. PCR assay and immunohistochemistry showed that the Ba-ep0lac virus was able to establish latency in the mouse trigeminal ganglia. However, latent virus was not able to reactivate in explant reactivation assays. Accordingly, latent Ba-ep0lac has the potential to be exploited as vectors for the delivery of foreign genes to the nervous system.

Nonlinear propagation of negatively chirped pulses: Maximizing the peak intensity at the output of a fiber probe

A simple phenomenological scaling behavior is found for the power dependence of the pulse width for negatively pre-chirped pulses propagating in a normally dispersive fiber; the consequences for maximizing nonlinear signals such as two-photon fluorescence excited at the fiber output are considered.

A novel frameshift mutation (141delT) in exon 1 of the 21-hydroxylase gene (CYP21) in a patient with the salt wasting form of congenital adrenal hyperplasia. Mutation in brief no. 255. Online

Congenital adrenal hyperplasia (CAH) is a common autosomal recessive disease with a wide range of clinical manifestation. In 90-95% of the cases it is caused by 21-hydroxylase deficiency (OMIM #201910) due to mutations of the CYP21 gene (GDB Accession #M12792). In most cases the CYP21-inactivating point mutations are transferred by apparent gene conversions from CYP21P to CYP21. In only a few cases point mutations have been described, which are not present in the pseudogene. Using Southern blot analysis and DNA sequencing we have identified a novel mutation (141delT) of the CYP21 gene in a patient suffering from the salt wasting form of CAH. This results in a premature termination of a truncated protein at amino acid position 51 (L51X), which is likely to result in an enzyme with no activity. This novel mutation has not been reported to occur in the CYP21P alleles and it was not found in the CYP21P alleles in this CAH family.

Therapy for patients with high grade astrocytoma using intraarterial chemotherapy and radiation therapy

BACKGROUND

High grade astrocytomas account for approximately 40% of all primary brain tumors. The median survival is approximately 8-10 months for patients with glioblastoma multiforme and 36 months for patients with anaplastic astrocytoma. The results of systemic chemotherapy in the treatment of brain tumors have been reported to be less than satisfactory, mainly because of the blood-brain barrier impermeability for chemotherapeutic drugs. Intraarterial chemotherapy has been an attractive alternative with which to overcome this problem.

METHODS

Eighty-three patients with high grade astrocytoma (glioblastoma multiforme [63 patients] and anaplastic astrocytoma--[20 patients]) were treated with intraarterial (intracarotid and/or intravertebral) chemotherapy and radiation therapy between 1987 and 1997. Patients received cisplatin, 60 mg/m2, and etoposide, 40 mg/m2. Radiation therapy was delivered either after completion of the chemotherapy or concomitantly with the chemotherapy.

RESULTS

Thirty-four of 71 evaluable patients with high grade astrocytoma (48%) responded to the chemotherapy. The median survival for patients with glioblastoma multiforme who received chemotherapy prior to radiation therapy was 20 months versus 7 months for those patients who underwent concomitant chemotherapy/radiation therapy. Patients with anaplastic astrocytoma who received chemotherapy prior to radiation therapy had a median survival of 45 months compared with 12 months for patients who received concomitant chemotherapy/ radiation therapy. The toxicity profile has been reported to be mild and well tolerated.

CONCLUSIONS

Intraarterial chemotherapy for patients with glioblastoma multiforme, delivered prior to radiation therapy, appears to result in a median survival three times longer than that achieved with concomitant chemotherapy/radiation therapy. In addition, patients appear to survive substantially longer than they do after radiation therapy with the addition of systemic chemotherapy. Side effects are reported to be acceptable.