Excess mortality in Black compared with White patients with Type 1 diabetes: an examination of underlying causes

AIMS

Excess mortality in Type 1 diabetes has previously been found among Black individuals. The aim of the present study was therefore to determine underlying causes.

METHODS

A longitudinal study of 1261 [1184 White (93.9%) and 76 Black (6.0%)] individuals diagnosed with Type 1 diabetes between 1965 and 1979, at age<17 years from the Allegheny County, Pennsylvania and Children's Hospital of Pittsburgh registries. Subjects were contacted in 1999 to determine living status and, where appropriate, cause of death. Living status was determined in 1183 participants (93.8%).

RESULTS

Of the 200 deaths overall, cause of death was determined in 157 subjects (79%); 31 dying from acute and 101 from chronic complications, and 25 from non-diabetes related causes. Seven deaths were investigated but no cause determined. Black participants had a significantly higher mortality rate compared with White participants for acute complications (hazard ratio=4.9, 95% confidence interval: 2.0, 11.6), but not for any other cause. There was a temporal decline in the 20-year mortality rates in both racial groups across the three cohorts diagnosed in 1965-69, 1970-74 and 1975-79.

CONCLUSIONS

These results show that the excess mortality in Black people was attributed to acute complications which therefore should be a focus for prevention.

Site-specific recombination in Zea mays

The elimination of marker genes after selection is recommended for the commercial use of genetically modified plants. We compared the applicability of the two site-specific recombination systems Cre/lox and Flp/FRT for marker gene elimination in maize plants. The selection marker gene pat surrounded by two identically directed lox or FRT sites was introduced into maize. Sexual crossing with plants harboring the corresponding constitutively expressed recombinase led to the precise and complete excision of the lox-flanked marker gene in the F1 progeny, whereas Flp-mediated recombination of FRT sequences occurred rarely. Further examination of site-specific integration was done by biolistic bombardment of immature embryos harboring only one lox site with a lox.uidA sequence with results indicating directed integration.

Simultaneous sodium lauryl sulphate testing improves the diagnostic validity of allergic patch tests. Results from a prospective multicentre study of the German Contact Dermatitis Research Group (Deutsche Kontaktallergie-Gruppe, DKG)

BACKGROUND

There is evidence that a higher skin susceptibility may induce nonspecific erythematous or weak positive reactions to contact allergens in patch testing.

OBJECTIVES

To evaluate whether simultaneous application of sodium lauryl sulphate (SLS) along with diagnostic patch tests with contact allergens can provide information regarding skin irritability which may help to discriminate allergic from nonspecific irritant reactions to contact allergens.

METHODS

Between July 2001 and June 2003, this prospective study collected patch test data of 5971 patients from 19 centres in Germany and Austria in the Information Network of Departments of Dermatology (IVDK). In addition to contact allergens (standard series and eight known 'problematic' allergens with a low reaction index and a high positivity ratio: 1,3-diphenylguanidine, amerchol L-101, benzalkonium chloride, benzoyl peroxide, cocamidopropyl betaine, octyl gallate, phenyl mercuric acetate and propylene glycol), patches with SLS 0.5% and 0.25% aq. were applied. Reactions to the allergens and to SLS were analysed at the IVDK data centre. The association between an erythematous or positive reaction to a certain allergen and an irritant reaction to SLS was assessed with logistic regression analysis, at the same time controlling for the influence of age and sex.

RESULTS

Of the 29 allergens of the standard series, 23 and 21 gave a higher percentage of nonspecific erythematous reactions in patients with an irritant reaction to 0.25% and 0.5% SLS, respectively, in comparison with SLS-negative patients. All eight 'problematic' allergens gave an increased percentage of nonspecific erythematous reactions. Similarly, 22 and 21 allergens of the standard series gave a higher percentage of positive allergic reactions in patients with an irritant reaction to 0.25% and 0.5% SLS, respectively, and seven of the eight 'problematic' allergens gave a higher percentage of positive allergic reactions (exception: octyl gallate). For most allergens, the markers of skin reaction (reaction index and positivity ratio) were worse in SLS-positive patients. Differences were more pronounced when testing with SLS 0.25% than with SLS 0.5%.

CONCLUSIONS

Because there is a convincing association between skin irritability (evaluated by SLS test) and the degree of skin reaction to contact allergens, the SLS test may help in deciding whether a doubtful erythematous or weakly 'positive' skin reaction should be interpreted as allergic or irritant.

Mexican physicians' knowledge and attitudes about the human papillomavirus and cervical cancer: a national survey

OBJECTIVE

To assess Mexican physicians' knowledge about the human papillomavirus (HPV) and cervical cancer and their opinions and practices related to screening, managing, and counselling women on these topics.

METHODOLOGY

In August 2002 we surveyed 1206 general practitioners (GPs) and obstetricians-gynaecologists (Ob-Gyns) working in a nationally representative sample of public and private facilities in urban Mexico. Eligible physicians completed a self administered questionnaire. We conducted a weighted analysis and used chi(2) tests to compare GPs and Ob-Gyns on outcome variables.

RESULTS

76% of recruited physicians responded to the survey. 43% of Ob-Gyns had performed a hysterectomy in the last year to treat a case of CIN I or II. With respect to HPV, while 80% of respondents identified the virus as the principal cause of cervical cancer, many lacked detailed knowledge about this association. Ob-Gyns were more likely than GPs to have heard about specific oncogenic strains of HPV (p<0.001). Nearly all respondents thought that women should be informed that HPV causes cervical cancer; nevertheless, physicians believed that positioning cervical cancer as a sexually transmitted infection (STI) could cause problems in partner relationships (60%), confusion (40%), and unnecessary anxiety among women (32%).

CONCLUSIONS

Mexican physicians support patient education on the HPV-cervical cancer link. However, findings suggest the need to present clear messages to women (emphasising, for example, that only certain types of HPV are oncogenic), to consider the conflicts such information might create for couples, and to further educate physicians about this topic and about overall cervical cancer screening and treatment protocols.

Evidenzbasierte Beurteilung der Auswirkung von Typ-IV-Allergien bei der Minderung der Erwerbsfähigkeit

Evidence-based guidelines about the distribution of type IV allergens of the European standard series in different professions and its occupational relevance are missing. Based on published data, epidemiological investigations, work related knowledge about industrial processes, and allergen specific properties, recommendations are given about the clinical impact in the working environment for the following allergens: acrylates/methacrylates, epoxy resins, dichromate, cobalt, nickel, formaldehyde, (chlor-)methylisothiazolone, p-phenylendiamine, colophony, thiurame, mercaptobenzothiazole, dithiocarbamate, n-isopropyl-n'-phenyl-p-phenylendiamine, fragrance mix, composite mix, and neomycinsulfate. These recommendations might improve the clearance rate and allergological evaluation of the occupational relevance of different delayed type sensitizations or allergens.

AtTPK4, an Arabidopsis tandem-pore K+ channel, poised to control the pollen membrane voltage in a pH- and Ca2+-dependent manner

The Arabidopsis tandem-pore K(+) (TPK) channels displaying four transmembrane domains and two pore regions share structural homologies with their animal counterparts of the KCNK family. In contrast to the Shaker-like Arabidopsis channels (six transmembrane domains/one pore region), the functional properties and the biological role of plant TPK channels have not been elucidated yet. Here, we show that AtTPK4 (KCO4) localizes to the plasma membrane and is predominantly expressed in pollen. AtTPK4 (KCO4) resembles the electrical properties of a voltage-independent K(+) channel after expression in Xenopus oocytes and yeast. Hyperpolarizing as well as depolarizing membrane voltages elicited instantaneous K(+) currents, which were blocked by extracellular calcium and cytoplasmic protons. Functional complementation assays using a K(+) transport-deficient yeast confirmed the biophysical and pharmacological properties of the AtTPK4 channel. The features of AtTPK4 point toward a role in potassium homeostasis and membrane voltage control of the growing pollen tube. Thus, AtTPK4 represents a member of plant tandem-pore-K(+) channels, resembling the characteristics of its animal counterparts as well as plant-specific features with respect to modulation of channel activity by acidosis and calcium.

Detailed morphology and distribution of gap junction protein associated with cells from the intra-articular disc of the rat temporomandibular joint

The present study details structural aspects of the cells of the rat intra-articular disc (IAD) of the temporomandibular joint. At the light and electron microscope level, the outline of the cells varied, although a number appeared oval/rounded. Ultrastructurally, the cells contained moderate amounts of the intracellular organelles associated with protein synthesis. Cell processes were not a prominent feature seen using these techniques. However, using confocal microscopy, phalloidin staining revealed the presence of numerous, actin-rich, long, thin, branching processes emanating from the cell membranes. Double staining for connexin 43 revealed that the cell processes showed dense, punctate positive staining for this gap junction protein along their whole length. These observations provide the basis for a transport mechanism for nutritive molecules from the periphery of the IAD (where blood vessels are present) to the central portions of the disc (where blood vessels are absent).

Exploring knowledge and attitudes about emergency contraceptive pills among university students in Jamaica. A qualitative approach

Emergency contraceptive pills (ECPs) are an important option for university students who may be at high risk for unplanned pregnancies. In the Caribbean, little research has been carried out on university student's knowledge and opinions of this method. This study uses qualitative methodology to explore knowledge and opinions on ECPs among university students attending The University of the West Indies (UWI) Mona campus. We conducted eight focus groups (n = 71) with female and male university students at The University of the West Indies, Kingston, Jamaica, in March 2000. The group discussions lasted approximately two hours. We tape-recorded discussions and then transcribed and analyzed them by coding responses according to themes. General knowledge of ECPs was high, but students lacked specific information about the method such as its time frame and its mechanism of action. Most students supported the method, especially after learning correct information. However, several students were concerned about its side effects and the potential for abuse or irresponsible use by young adults. Although the university students in this study lacked detailed information about ECPs, their opinion toward the method was favourable. We suggest further research to investigate the prevalence of misinformation about the method among other groups of Jamaicans.

Regulation of the ABA-sensitive Arabidopsis potassium channel gene GORK in response to water stress

The phytohormone abscisic acid (ABA) regulates many stress-related processes in plants. In this context ABA mediates the responsiveness of plants to environmental stresses such as drought, cold or salt. In response to water stress, ABA induces stomatal closure by activating Ca2+, K+ and anion channels in guard cells. To understand the signalling pathways that regulate these turgor control elements, we studied the transcriptional control of the K+ release channel gene GORK that is expressed in guard cells, roots and vascular tissue. GORK transcription was up-regulated upon onset of drought, salt stress and cold. The wilting hormone ABA that integrates responses to these stimuli induced GORK expression in seedlings in a time- and concentration-dependent manner and this induction was dependent on extracellular Ca2+. ABA-responsive expression of GORK was impaired in the ABA-insensitive mutants abi1-1 and abi2-1, indicating that these protein phosphatases are regulators of GORK expression. Application of ABA to suspension-cultured cells for 2 min followed by a 4 h chase was sufficient to manifest transcriptional activation of the K+ channel gene. As predicted for a process involved in drought adaptation, only 12-24 h after the release of the stress hormone, GORK mRNA slowly decreased. In contrast to other tissues, GORK expression as well as K+(out) channel activity in guard cells is ABA insensitive, allowing the plant to adjust stomatal movement and water status control separately.

Transforming growth factor beta1 immobilized adsorptively on Ti6Al4V and collagen type I coated Ti6Al4V maintains its biological activity

Titanium and titanium alloys are often used for orthopedic and dental implants. Osseointegration of Ti6Al4V may be improved not only by precoating of the surface with extracellular matrix proteins like collagen type I but also by additional immobilization of growth factors. In the present study, transforming growth factor beta1 (TGF-beta1) which is known as an inducer of collagen synthesis was immobilized adsorptively on uncoated and collagen type I coated Ti6Al4V surfaces. TGF-beta1 was found immobilized slightly faster to collagen type I coated than to uncoated Ti6Al4V and released slower from the collagen coated material. Immobilized TGF-beta1 is biologically active for at least 3 weeks storage at 4 degrees C. Sterilization by ethylene oxide inactivates immobilized TGF-beta1. In osteoblasts cultured on implants with adsorptively immobilized TGF-beta1, mRNA level and specific catalytic activity of alkaline phosphatase as well as accumulation of calcium and phosphate were found reduced, whereas procollagen alpha1(I) mRNA level and the rate of collagen synthesis were increased.

[Detection of liver metastases--comparison of contrast--enhanced ultrasound using first versus second generation contrast agents]

AIM

To compare detection rates for liver metastases for conventional ultrasound, US using tissue harmonic imaging (THI), echo-enhanced pulse inversion harmonic imaging using Optison and Levovist.

METHOD

In 73 patients with histologically proven gastrointestinal tumors spiral CT (S-CT), conventional US, US in the THI-mode, echo-enhanced ultrasound in the portal venous phase (ECI Optison ) and in the liver specific late phase (ECI Levovist) were performed and reviewed by blinded readers.

RESULTS

73 patients (25 female, 48 male, age 63 +/- 11) were included. S-CT detected 158 liver metastases. Conventional US detected 117, THI 119, ECI Optison 169 and ECI Levovist 166 liver metastases. Especially for small (< 2 cm) liver metastases and metastases near the diaphragm echo-enhanced ultrasound exceeded conventional US (p < 0.001). Between both echo enhancers there was no significant difference.

CONCLUSION

Using echo enhancers increases the ultrasound detection rate significantly. Examination in the portalvenous phase using a second generation enhancer (Optison) is equal to a late-phase examination using Levovist.

Radiofrequency ablation of hepatocellular carcinoma with a saline solution perfusion device: a pilot study

PURPOSE

The majority of patients with hepatocellular carcinoma (HCC) cannot be treated with surgery. This study evaluated the treatment of patients with radiofrequency ablation (RFA) with use of needle applicators perfused with isotonic saline solution.

MATERIALS AND METHODS

Twenty patients with a maximum of three HCCs as large as 60 mm and a contraindication to partial liver resection or orthotopic liver transplantation were enrolled in the study. They were treated with ultrasound-guided RFA with use of perfused needle applicators and followed with sonography and computed tomography.

RESULTS

Twenty patients (14 men, six women) with a total of 29 HCCs were treated with RFA. In total, 56 RFA treatments were performed. Mean HCC size was 31 mm (range, 10-60 mm). Two cases of self-limiting bleeding requiring transfusion of blood products took place. Complete response (CR) was achieved in 85% of patients (17 of 20). Partial response occurred in three tumors 45 mm in diameter or larger. There was a total of six local recurrences in five patients (25% of patients, 21% of tumors). Six patients (30%) exhibited distant recurrence, two of whom also showed local recurrence. In three patients, repeat treatment led to renewed CR. After a median follow-up of 445 days (range, 114-1,071 days), 12 patients (71% of the 17 patients with initial CR) still showed CR. Twelve patients (60% of all patients, 71% of those with initial CR) survived. Three of the eight patients who died were free of viable tumor at the time of death.

CONCLUSIONS

RFA with use of perfused needle applicators shows promise as an effective method for treating inoperable HCC. The most frequent complication was bleeding.

Use of pIRES vectors to express EGFP and connexin constructs in studies of the role of gap junctional communication in the early development of the chick retina and brain

Control of cell proliferation is vital for the normal development of the neural retina. Gap junctional communication has been implicated in the control of retinal cell proliferation. We have previously shown that the expression of the gap junction protein Connexin 43 closely correlates with the first wave of cell proliferation in the retina. Preventing its expression using antisense oligonucleotides in the developing eye and surrounding tissues, produces a reduction in cell number and the formation of a small eye. In order to examine this in more detail we have developed a new means of manipulating connexin expression in the developing chick embryo. We have generated pIRES vectors which use cyclomegalovirus (CMV) to promote the expression of a green fluorescent protein (EGFP) and either wild type Cx43 or a dominant negative form ofthis connexin. Following injection ofthese constructs into the ventricles ofthe stage 10-11 chick embryo they can be incorporated into one side of the chick brain or optic vesicle using an electroporation technique, leaving the other side as a control. EGFP expression can be seen on the electroporated side of the chick brain within 24 hours. Expression of the dominant negative construct in cultures of chick limb bud mesenchyme results in total block of cascade blue transfer when injected into transfected cells. Expression of both wild type and dominant negative constructs in the developing chick retina perturbs the normal development of the eye.

Do plasminogen activator inhibitor (PAI-1) or tissue plasminogen activator PAI-1 complexes predict complications in Type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications Study

AIMS

To examine the predictive power of plasminogen activator inhibitor-1 (PAI-1) and the complexes it forms with tissue plasminogen activator (tPA-PAI-1) for the two major Type 1 diabetes (T1D) complications (coronary artery disease (CAD) and overt nephropathy) in the context of standard risk factors.

METHODS

Observational prospective study of 454 participants with childhood onset (< 17 years) T1D, aged 18+ years at baseline. PAI-1 and tPA-PAI-1 were determined using ELISA methodology. Follow-up (6 years) was limited to 382 individuals for CAD and 294 individuals for overt nephropathy, after excluding baseline cases. Total, HDL and LDL-cholesterol, triglycerides, HbA1, blood pressure, body mass index (BMI), waist-hip ratio (WHR), leucocyte count, Beck depression score and fibrinogen were also examined.

RESULTS

The 56 incident cases of CAD had marginally lower PAI-1 and higher tPA-PAI-1 levels compared with those free of CAD. However, marginally higher PAI-1 and significantly higher tPA-PAI-1 (P = 0.04) levels were seen in those who developed nephropathy. After controlling for age, both PAI-1 and tPA-PAI-1 showed significant negative correlations with HDL-cholesterol, and positive correlations with triglycerides, WHR, HbA1 and fibrinogen. tPA-PAI-1 was also positively correlated with total and LDL-cholesterol. In multivariate analyses, neither PAI-1 nor tPA-PAI-1 was an independent predictor of CAD or overt nephropathy.

CONCLUSIONS

These results suggest little association between PAI-1 and later CAD in patients with T1D. However, tPA-PAI-1 complexes may be involved in the pathogenesis of overt nephropathy.

[Radio-frequency-ablation (RFA) with wet electrodes in the treatment of primary and secondary liver tumours]

INTRODUCTION

The majority of patients with primary and secondary tumours of the liver cannot be treated curatively by surgery. The treatment of these patients with radio-frequency thermoablation using perfused needle applicators (wet electrodes) was evaluated in a feasibility study.

METHOD

Patients with primary and secondary tumours of the liver and contraindications against surgery or LTX were included into the feasibility study. RFA was performed percutaneously under ultrasound guidance. The patients were followed up sonographically and by computed tomography.

RESULTS

20 patients (9 male, 11 female) with 35 lesions were treated with RFA. 12 patients (22 tumour locations) suffered from HCC and 8 patients (13 tumour masses) had liver metastases (colorectal, breast, pancreas, carcinoid). The median age was 65.6 years (36 to 83 years). The median tumour size was 33.5 mm. 59 RFTA applications (1.7 applications per tumour mass) were performed. The mean duration of RFTA per patient was 16.2 minutes. During the procedure isotonic saline was injected at a mean flow rate of 6.63 ml/min. All patients received local anaesthesia. In 33 sessions an additional analgosedation was necessary (average dose 63.8 mg Pethidine and 1.4 mg Midazolam). In 2 cases a reduction of the haemoglobin level, occurred, necessitating a blood transfusion. 3/4 of the treated metastases could be eradicated completely. Within a median follow-up of 145 days no intrahepatic local recurrence but 4 distant metastases occurred. 2/3 of the treated HCC could initially be brought into complete remission (CR). After a median follow-up of 329 days 5 of the 8 initially successfully treated patients with HCC were still in complete remission. In 3 cases an intrahepatic local recurrence developed.

CONCLUSION

RFA with wet electrodes is a safe, effective and inexpensive treatment for primary and secondary tumours of the liver, measuring less than 4 cm in diameter.

[Contrast enhanced ultrasound in the liver using low mechanical index--what is the difference?]

Echo-enhancing agents (EEA), also known as ultrasound contrast media, have improved the diagnostic potential of gastroenterologic ultrasound within the last years. Initially used to increase color-Doppler signals the potential to use harmonic waves being generated by the use of EEAs was established later. The effect was based upon the distraction of the EEA bubbles and the resulting pseudo-Doppler signal, the exam was carried out with high ultrasound energy and intermittent switching on and off of the ultrasound beam. Using this effect in real-time during continuous scanning is possible since the introduction of new EEAs with a flexible shell. This flexible shell oscillates during the scan process emitting harmonic signals. This new technology opens new possibilities for the detection of liver tumors including the possible characterisation. The detection rate for liver metastases can be increased by app. 40 % with this new technology. Correct sonographic characterisation of liver tumors can be achieved in nearly 100 % more cases.

Association between flupenthixol treatment and emergence of manic symptoms

BACKGROUND

Flupenthixol is an antipsychotic drug with known mood-elevating properties. Its propensity to induce manic symptoms has not been investigated.

METHODS AND RESULTS

We describe six patients, four with schizophrenia and two with bipolar disorder, in whom flupenthixol treatment was associated with emergence of manic symptoms.

CONCLUSIONS

Patients treated with flupenthixol should be carefully monitored for the emergence of manic symptoms.

Cellular and vascular reactions in the liver to radio-frequency thermo-ablation with wet needle applicators. Study on juvenile domestic pigs

The aim of this animal experiment was to investigate the cellular and vascular reactions in the liver of juvenile domestic pigs produced by a radio-frequency thermoablation (RFTA) applicator perfused with saline solution.

METHODS

A total of 13 coagulation necroses were produced in the liver of 3 anesthetized domestic pigs using RFTA. The pigs were dissected and the coagulations examined.

RESULTS

The mean macroscopical length and width of the coagulation zones with a hemorrhagic marginal zone after a 5-minute application time were 34.1 +/- 8 mm (22-46 mm) and 20.8 +/- 4 mm (12 +/- 28 mm) respectively. The sonographically determined diameters correlated significantly (r(length) = 0.741 and r(width) = 0.923). Three areas in the coagulation zones could be histologically distinguished: (1) central necrosis zone, (2) hemorrhagic marginal zone, (3) sublethal damage zone. Large vessels did not show any substantial changes after RFTA. Venous vessels less than 1 mm were completely thermally denatured or destroyed.

CONCLUSIONS

Tumors in close proximity to large blood vessels can be treated by RFTA with 'wet electrodes'.

When should a substance be designated as sensitizing for the skin ('Sh') or for the airways ('Sa')?

In the List of MAK and BAT Values compounds are designated with 'Sa' ('sensitizing for the airways') or 'Sh' ('sensitizing for the skin') if, according to scientific evidence, they are allergens. Mainly based on suggestions by a WHO working group and based on our own experience, extended criteria have been elaborated by the working group 'skin and allergy' of the Commission of the Deutsche Forschungsgemeinschaft for the Investigation of Health Hazards of Chemical Compounds in the Work Area, which are presented in this article. They serve as guidelines for deciding which substances have to be labelled 'Sa' and 'Sh', respectively, for the prevention of sensitization and subsequent allergic diseases in workers. Although in some special cases their strict application may not be deemed necessary or possible, the proposed new criteria should be used to make the procedure of classification of substances: 1) more rational, 2) more consistent, 3) more comprehensible, and 4) more transparent. This paper informs readers working scientifically or administratively in this field and invites a critical discussion of the issue.

[Treatment of a solitary adenoma of the parathyroid gland with ultrasound-guided percutaneous Radio-Frequency-Tissue-Ablation (RFTA)]

Radio-Frequency-Tissue-Ablation (RFTA) for the treatment of primary and secondary tumours of the liver has been used for several years, but this minimally invasive treatment is not limited to the liver. A patient suffering from symptomatic postmenopausal osteoporosis, additionally having primary hyperparathyroidism since 1995, refused a surgical resection of the adenoma of the parathyroid gland. Sonographically a 16 mm hypoechoic tumour dorsal of the right upper pole of the thyroid gland was detected. Osteodensitometry: severe osteoporosis of the lumbar spine (88 % of the norm for this age group). Blood check: Elevation of serum calcium level (3.1mmol/l) and serum parathormone level 274 pg/dl (N: 10-50). A percutaneous ultrasound guided RFTA of the adenoma of the thyroid gland was carried out. After RFTA the serum parathormone levels and the serum calcium levels dropped back to normal. The patient was followed-up for one year. For the first time a sufficient therapy for osteoporosis comprising calcium, etidronate and cholecalciferol could be carried out. The osteodensitometry carried out one year after treatment showed an increase in bone density. For the treatment of symptomatic primary hyperparathyroidism RFTA can be a therapeutic alternative for patients with contraindications for surgery.

[Hepatic transit time of an ultrasound echo enhancer indicating the presence of liver metastases - first clinical results]

AIM

This pilot study examines the question whether the transit time of an ultrasound echo enhancer, measured between the hepatic artery and the liver vein, can be used to differentiate between patients with and without liver metastases.

METHOD

The hepatic transit time of an ultrasound echo enhancer (Optison(R)) was determined using the pulse-inversion mode in patients suffering from gastrointestinal tumours. A group with histologically verified liver metastases was compared to a group without liver metastases.

RESULTS

24 patients have been included in the study so far. 7 patients had liver metastases from a still existing primary tumour (group A). Five patients showed liver metastases after removal of the primary tumour (group B). Six patients had a primary tumour, but no liver involvement (group C), and six patients had neither a primary tumour nor any liver disease. The mean hepatic transit time in group A and B came to 7.4 seconds. Group C and D had a transit time of 16 and 15.5 seconds, respectively. This shows a significant difference in hepatic transit time between patients with liver metastases (groups A and B) compared to those without (groups C and D). The presence of a primary tumour did not influence hepatic transit time.

CONCLUSION

In this first pilot study using the measurement of hepatic transit time it was possible to differentiate between patients with and without liver metastases.

The spectrum of allergic (cross-)sensitivity in clinical patch testing with 'para amino' compounds

BACKGROUND

Allergic contact sensitization to 'para amino' compounds is frequent and the spectrum of cross-reactivity between members of this chemical group is variable.

METHODS

A retrospective analysis of clinical patch test data obtained with a special test series in the centres of the Information Network of Departments of Dermatology (IVDK) between 1995 and 1999.

RESULTS

In the 638 patients tested with the above test panel positive reactions were observed most often to p-aminoazobenzene (16.2%), p-phenylenediamine (14.1%), p-toluylenediamine (10.0%), followed by 4,4'-diaminodiphenylmethane (8.5%), Disperse Orange 3 (8.4%) and p-aminophenol (3.1%). Among the 544 patients tested with p-phenylenediamine and all seven additional 'para amino' compounds, concordance between reactions varied greatly. The stronger the positive test reaction to p-phenylenediamine, p-toluylenediamine or p-aminoazobenzene, the more frequently additional positive reactions to the other compounds were observed.

CONCLUSIONS

A screening employing several 'para amino' compounds is necessary to describe the individual spectrum of allergic contact sensitization, as there is no reliable marker substance. Further research should aim at (i) establishing the mechanism of cross-reactivity to 'para amino' compounds and (ii) identifying exposures in the environment.

Proliferation and differentiation of rat calvarial osteoblasts on type I collagen-coated titanium alloy

Several attempts have been made to improve osseointegration of titanium alloy as an implant material by modification of its surface. In the present study, proliferation, differentiation, and mineralization of osteoblasts on type I collagen-coated Ti6Al4V were investigated. The activity of alkaline phosphatase and the accumulation of calcium by osteoblasts grown on titanium alloy were significantly higher compared to cells grown on polystyrene. Precoating of the implant surface with type I collagen did not extensively affect proliferation, the activity of alkaline phosphatase, collagen synthesis, calcium accumulation, or the mRNA levels for collagen I alpha1, osteopontin, osteocalcin, MMP-2, and TIMP-2. Maximum collagen synthesis by osteoblasts was observed at day 4 of culture independent of the type of implant material. The specific activity of alkaline phosphatase reached its maximum at day 18 of culture. Accumulation of calcium and elevated mRNA levels for osteocalcin were found at day 22. These results indicate that collagen-coating alone is not sufficient to accelerate differentiation of rat calvarial osteoblasts on Ti6Al4V.

Impact of surgery on survival in palliative patients with metastatic colorectal cancer after first line treatment with weekly 24-hour infusion of high-dose 5-fluorouracil and folinic acid

BACKGROUND

In palliative first-line treatment of colorectal cancer, the secondary resection of distant metastases after downstaging has constantly gained in importance. The objective of this prospective study was to examine the tumor response rate, the toxicity, the median survival time and the prognostic impact of metastatic resection after downstaging of consecutively enrolled patients with primary nonresectable colorectal cancer treated with once weekly 24-hour (24-h) infusion of high-dose 5-fluorouracil (5-FU) and folinic acid.

PATIENTS AND METHODS

Between January 1995 and July 1997, 53 consecutive patients with primary nonresectable metastases were recruited for a prospective phase II study. The patients received in out-patient care 500 mg/m2 folinic acid in the form of a 1-2-hour infusion followed by 2600 mg/m2 5-FU administered as a 24-h infusion once weekly. One treatment cycle comprised six weekly infusions followed by a two week rest. Three cycles were administered, and in the event of complete remission (CR) or partial remission (PR) and good tolerability, a fourth cycle was undertaken. Thereafter, the possibility of performing a curative metastatic resection was investigated.

RESULTS

Of the 53 patients treated, 7 showed a CR (13%), 15 patients a PR (28%), 26 patients stable disease (SD) (49%), and 5 patients progressive disease (PD) (10%). As the main symptom of toxicity, diarrhea (CTC grade 3 + 4) was observed in 11 patients (21%), followed by leucocytopenia (CTC grade 3 + 4) in 2 patients (4%), and the hand-foot syndrome in 1 patient (2%). The median survival time was 17 months with a median follow-up of 41 months (range: 28-59 months). In 9 patients (17%), a secondary metastatic resection was considered; in 6 patients (11%) curative resection was performed, and 4 patients (8%) showed no evidence of disease for at least three years.

CONCLUSION

In this phase II study, we have been able to show prospectively that, after downstaging by palliative treatment using a weekly 24-h infusion of high-dose 5-FU and folinic acid, secondary curative metastatic resection was technically feasible in 11% of the patients. For some of these patients, long-term survival is therefore possible. Secondary metastatic resection should be carried out in close interdisciplinary cooperation, and should be further investigated in prospective phase III studies.

K(+) channel profile and electrical properties of Arabidopsis root hairs

Ion channels and solute transporters in the plasma membrane of root hairs are proposed to control nutrient uptake, osmoregulation and polar growth. Here we analyzed the molecular components of potassium transport in Arabidopsis root hairs by combining K(+)-selective electrodes, reverse transcription-PCR, and patch-clamp measurements. The two inward rectifiers AKT1 and ATKC1 as well as the outward rectifier GORK dominated the root hair K(+) channel pool. Root hairs of AKT1 and ATKC1 loss-of-function plants completely lack the K(+) uptake channel or exhibited altered properties, respectively. Upon oligochitin-elicitor treatment of root hairs, transient changes in K(+) fluxes and membrane polarization were recorded in wild-type plants, while akt1-1 root hairs showed a reduced amplitude and pronounced delay in the potassium re-uptake process. This indicates that AKT1 and ATKC1 represent essential alpha-subunits of the inward rectifier. Green fluorescent protein (GFP) fluorescence following ballistic bombardment with GORK promoter-GFP constructs as well as analysis of promoter-GUS lines identified this K(+) outward rectifier as a novel ion channel expressed in root hairs. Based on the expression profile and the electrical properties of the root hair plasma membrane we conclude that AKT1-, ATKC- and GORK-mediated potassium transport is essential for osmoregulation and repolarization of the membrane potential in response to elicitors.

Beta-blockers: a new therapy in congestive heart failure

BACKGROUND

Until recently, use of beta-blockers was contraindicated in treatment of patients with congestive heart failure. However, empirical evidence suggests that adding beta-blockers to the standard therapy can slow the progression of heart failure and reduce mortality, including sudden cardiac death.

PURPOSE

To analyze the results of major, prospective, randomized controlled trials on the effects of beta-blockers in congestive heart failure and to provide recommendations for clinical practice and patients' education.

METHODS

MEDLINE (1989-2001) and biomedical databases (1995-2001) were searched for literature on the use of beta-blockers in patients with congestive heart failure. Information on major randomized controlled trials of at least 6 months' duration with mortality as a major end point were reviewed.

RESULTS

Both selective and nonselective beta-blockers significantly reduce mortality due to all causes; decrease need for hospitalization due to cardiovascular causes; and improve patients' New York Heart Association functional classification, hemodynamic status, left ventricular ejection fraction, and signs and symptoms of congestive heartfailure. However, clinical use of beta-blockers remains limited.

CONCLUSION

Strong empirical evidence supports adding beta-blockers to the standard therapy for congestive heart failure. Future efforts should be directed toward establishing the safety and efficacy of beta-blockers in patients with severe heartfailure.

Contrast-enhanced ultrasound improves hepatic vessel visualization after orthotopic liver transplantation

BACKGROUND

We investigated whether color-coded Doppler sonography combined with an ultrasound contrast medium would improve the assessment of liver-supplying vessels after orthotopic liver transplantation.

METHODS

Forty-seven patients after orthotopic liver transplantation participated. Examinations were done without and then with the ultrasound contrast medium Levovist. Visualization of the liver-supplying vessels was assessed with a scoring system.

RESULTS

Visualization of the portal vein was similar without and with contrast medium. Hepatic arteries were visualized in 39 patients without contrast medium and 46 patients with contrast medium. The remaining patient showed hepatic artery thrombosis, which was confirmed angiographically. With the use of Levovist, the examination took 3.7 min rather than the usual 6.4 min.

CONCLUSION

Imaging of hepatic arteries after liver transplantation improved significantly with the use of ultrasound contrast medium. These findings are important because the early detection of blood flow through the liver after transplantation affects prognosis.

Beta-blockers: a new therapy in congestive heart failure

BACKGROUND: Until recently, use of beta-blockers was contraindicated in treatment of patients with congestive heart failure. However, empirical evidence suggests that adding beta-blockers to the standard therapy can slow the progression of heart failure and reduce mortality, including sudden cardiac death. PURPOSE: To analyze the results of major, prospective, randomized controlled trials on the effects of beta-blockers in congestive heart failure and to provide recommendations for clinical practice and patients' education. METHODS: MEDLINE (1989-2001) and biomedical databases (1995-2001) were searched for literature on the use of beta-blockers in patients with congestive heart failure. Information on major randomized controlled trials of at least 6 months' duration with mortality as a major end point were reviewed. RESULTS: Both selective and nonselective beta-blockers significantly reduce mortality due to all causes; decrease need for hospitalization due to cardiovascular causes; and improve patients' New York Heart Association functional classification, hemodynamic status, left ventricular ejection fraction, and signs and symptoms of congestive heartfailure. However, clinical use of beta-blockers remains limited. CONCLUSION: Strong empirical evidence supports adding beta-blockers to the standard therapy for congestive heart failure. Future efforts should be directed toward establishing the safety and efficacy of beta-blockers in patients with severe heartfailure.

Identification of a novel, multifunctional beta-defensin (human beta-defensin 3) with specific antimicrobial activity. Its interaction with plasma membranes of Xenopus oocytes and the induction of macrophage chemoattraction

Previous studies have shown the implication of beta-defensins in host defense of the human body. The human beta-defensins 1 and 2 (hBD-1, hBD-2) have been isolated by biochemical methods. Here we report the identification of a third human beta-defensin, called human beta-defensin 3 (hBD-3; cDNA sequence, Genbank accession no. AF295370), based on bioinformatics and functional genomic analysis. Expression of hBD-3 is detected throughout epithelia of many organs and in non-epithelial tissues. In contrast to hBD-2, which is upregulated by microorganisms or tumor necrosis factor-alpha (TNF-alpha), hBD-3 expression is increased particularly after stimulation by interferon-gamma. Synthetic hBD-3 exhibits a strong antimicrobial activity against gram-negative and gram-positive bacteria and fungi, including Burkholderia cepacia. In addition, hBD-3 activates monocytes and elicits ion channel activity in biomembranes, specifically in oocytes of Xenopus laevis. This paper also shows that screening of genomic sequences is a valuable tool with which to identify novel regulatory peptides. Human beta-defensins represent a family of antimicrobial peptides differentially expressed in most tissues, regulated by specific mechanisms, and exerting physiological functions not only related to direct host defense.

VFK1, a Vicia faba K(+) channel involved in phloem unloading

In search of a K(+) channel involved in phloem transport we screened a Vicia faba cotyledon cDNA library taking advantage of a set of degenerated primers, flanking regions conserved among K(+) uptake channels. We cloned VFK1 (for Vicia faba K(+) channel 1) characterised by a structure known from the Shaker family of plant K(+) channels. When co-expressed with a KAT1 mutant in Xenopus oocytes, heteromers revealed the biophysical properties of a K(+) selective, proton-blocked channel. Northern blot analyses showed high levels of expression in cotyledons, flowers, stem and leaves. Using in situ PCR techniques we could localise the K(+) channel mRNA in the phloem. In the stem VFK1 expression levels were higher in the lower internodes. There channel transcripts increased in the light and thus under conditions of increased photosynthate allocation. VFK1 transcripts are elevated in sink leaves, and rise in source leaves during the experimental transition into sinks. Fructose- rather than sucrose- or glucose-feeding via the petiole induced VFK1 gene activity. We therefore monitored the fructose sensitivity of the sieve tube potential through cut aphid stylets. In response to an 1 h fructose treatment the sieve tube potential shift increased from 19 mV to 53 mV per 10-fold change in K(+) concentration. Under these conditions K(+) channels dominated the electrical properties of the plasma membrane. Based on the phloem localisation and expression patterns of VFK1 we conclude that this K(+) channel is involved in sugar unloading and K(+) retrieval.

[Effects of the physical configuration of plasmid DNA and other factors on production of fertile transgenic wheat plants]

The applicability of hyperosmotic treatment and different configurations of plasmid DNA for stable transformation of wheat mediated by particle bombardment was investigated. Hyperosmotic treatment increased the frequency of transient expression and had also a positive effect on stable transformation. Denaturation of plasmid DNA prior to bombardment led to dramatic reduction of transient expression. However, there were no marked differences between single-stranded and double-stranded DNA in stable transformation. Single-stranded plasmid DNA, double-stranded plasmid DNA in linear state and double-stranded plasmid DNA in circular state could all be used to produce transgenic wheat plants. A total of 26 independent transgenic plants of winter wheat genotype Florida and 4 independent transgenic plants of spring wheat genotype Veery were obtained. Most transgenic plants have set seeds. T2 seeds of some spring wheat transgenic plants have also been harvested.

Properties of fujicalin, a new modified anhydrous dibasic calcium phosphate for direct compression: comparison with dicalcium phosphate dihydrate

The novel, commercially available, free-flowing spherically granulated dicalcium phosphate anhydrous (SGDCPA) Fujicalin for direct tableting was compared with directly compressible dicalcium phosphate dihYdrate (DCPD), the properties of which are well known. The two excipients were investigated and compared with regard to their physical and powder properties, compressibility, and compactibility. As a consequence of the spherical shape of its particles, SGDCPA shows the same good flowability and even better compactibility. In contrast to DCPD, SGDCPA shows significant uptake of moisture when exposed to relative humidities (RHs) exceeding 70%. For both excipients, the main deformation mechanism is fragmentation, with SGDCPA yielding significantly stronger tablets.

Dynamic contrast-enhanced power Doppler sonography improves the differential diagnosis of liver lesions

The aim of this paper was to investigate the diagnostic value of dynamic contrast-enhanced power Doppler sonography in the differential diagnosis of liver lesions. We prospectively examined 85 focal liver lesions in 71 patients by real-time gray-scale sonography, power Doppler sonography, and contrast-enhanced power Doppler using two ultrasound contrast agents (Levovist, Optison). Amount and architecture of lesion vascularity and the kinetics of contrast enhancement within the lesions were analyzed. Vascularity was detected in 61% of liver lesions (52/85) by conventional power Doppler, compared to 86% (73/85) by contrast-enhanced power Doppler sonography. Dynamic contrast-enhanced power Doppler identified arterial radial hypervascularity <16 s after contrast injection in 19/22 focal nodular hyperplasias (86%). Irregular hypervascularity was seen with contrast enhancement in the arterial phase in 14/15 hepatocellular carcinomas (93%). In 14/25 hemangiomas (56%), a circular vascularization pattern was noted. Specific lesion diagnosis based on B-scan and conventional and dynamic contrast-enhanced power Doppler sonography led to correct diagnosis in 86% (73/85, 95% confidence interval 78%-94%) compared to 57% (48/85, 95% confidence interval 47%-94%) by B-scan criteria and conventional power Doppler sonography. Contrast-enhanced power Doppler sonography improves diagnostic accuracy in the differential diagnosis of focal liver lesions.