[Validation of telemedical fundus images from patients with retinopathy]

BACKGROUND

The degree of retinal microangiopathy is important foran estimation of the vascular risk and for the optimisation of therapy in hypertensive and diabetic patients. Retinal microangiopathy may be determined by examination of the retinal fundus. We examined the reliability of the ophthalmoscopic diagnosis and of the telemedical judgement of fundus images in relation to the presence and the degree of retinopathy.

PATIENTS AND METHODS

This comparative observational study included 47 inpatient hypertensive and/or diabetic subjects. The fundus was judged ophthalmoscopically and subsequently, a fundus image was generated by use of a KOWA camera. The images were sent to the Interdisciplinary Center of Ophthalmologic Preventive Medicine. The reliability of the two diagnostic methods was calculated for one of the two eyes, which was selected by a random generator.

RESULTS

The largest concordance of the two diagnosis methods was achieved, in descending order, for retinal bleeding, stage of diabetic retinopathy and the papilla findings. Additionally, there were no differences for the stage of hypertensive retinopathy und tortuosity. The reliability of arterio-venous nicking related to the right and the left eye was low or absent, respectively.

CONCLUSIONS

The teleophthalmologic diagnosis achieves good results as compared to the ophthalmoscopic judgement in relation to retinopathy assessment criteria.

432 INHERITANCE OF LENTIVIRAL PHOSPHOGLYCERATE KINASE-ENHANCED GREEN FLUORESCENT PROTEIN (PGK-eGFP) INTEGRANTS OF TRANSGENIC CATTLE

An alternative approach to classic techniques for the generation of transgenic livestock is the use of viral vectors. Using lentiviral vectors (LV) we previously generated transgenic founder cattle with integrants carrying phosphoglycerate kinase (PGK) promoter-enhanced green fluorescent protein (eGFP) expression cassettes (Hofmann et al. 2004 Biol. Reprod. 71, 405-409). The aim of this work was to investigate the transmission of LV-PGK-eGFP integrants through the female and male germ line of transgenic founder cattle in resulting embryos, fetuses, and offspring. The female founder animal was superovulated and artificially inseminated with a nontransgenic bull. Six of the 16 embryos obtained were transferred to synchronized recipient heifers, resulting in 2 pregnancies and birth of 1 healthy male transgenic calf, expressing eGFP as detected by in vivo imaging and real-time PCR. Cryopreserved semen of the founder bull and matured COC of nontransgenic cows were used for in vitro embryo production as previously described by Hiendleder et al. (2004 Biol. Reprod. 71, 217-223). The rates of cleavage and development to blastocysts in vitro corresponded to 52.3 ± 3.8% and 23.5 ± 4.6%, respectively. In vivo expression of eGFP was observed at blastocyst stage (Day 7 after IVF) and was seen in 93.8% (198/211) of all blastocysts. Twenty-four eGFP-positive embryos were transferred to 9 synchronized recipients. Analysis of 2 embryos flushed on Day 15, 2 fetuses recovered on Day 45, and a healthy male transgenic calf revealed consistent high-level expression of eGFP in all tissues investigated. These observations show for the first time transmission of lentiviral integrants through the germ line of female and male transgenic founder cattle. Although eGFP transgenic cattle have been produced before by nuclear transfer from transfected cells, lentiviral transgenesis has the advantage that only one copy of the provirus is integrated at a particular chromosomal integration site. High-fidelity expression of eGFP in embryos, fetuses, and offspring of founders provides an interesting tool for developmental studies in cattle, including interactions of gametes, embryos, and fetuses with their maternal environment.

Is it possible to minimize overdrainage complications with gravitational units in patients with idiopathic normal pressure hydrocephalus? Protocol of the randomized controlled SVASONA Trial (ISRCTN51046698)

Overdrainage is a common complication observed after shunting patients with idiopathic normal-pressure hydrocephalus (iNPH), with an estimated incidence up to 25%. Gravitational units that counterbalance intracranial pressure changes were developed to overcome this problem. We will set out to investigate whether the combination of a programmable valve and a gravitational unit (proGAV, Aesculap/Miethke, Germany) is capable of reducing the incidence of overdrainage and improving patient-centered outcomes compared to a conventional programmable valve (Medos-Codman, Johnson & Johnson, Germany). SVASONA is a pragmatic randomized controlled trial conducted at seven centers in Germany. Patients with a high probability of iNPH (based on clinical signs and symptoms, lumbar infusion and/or tap test, cranial computed tomography [CCT]) and no contraindications for surgical drainage will randomly be assigned to receive (1) a shunt assistant valve (proGAV) or (2) a conventional, programmable shunt valve (programmable Medos-Codman).We will test the primary hypothesis that the experimental device reduces the rate of overdrainage from 25% to 10%. As secondary analyses, we will measure iNPH-specific outcomes (i.e., the Black grading scale and the NPH Recovery Rate), generic quality of life (Short Form 36), and complications and serious adverse events (SAE). One planned interim analysis for safety and efficacy will be performed halfway through the study. To detect the hypothesized difference in the incidence of overdrainage with a type I error of 5% and a type II error of 20%, correcting for multiple testing and an anticipated dropout rate of 10%, 200 patients will be enrolled.The presented trial is currently recruiting patients, with the first results predicted to be available in late 2008.

Signature of checkerboard fluctuations in the phonon spectra of a possible polaronic metal La1.2Sr1.8Mn2O7

Charge carriers in low-doped semiconductors may distort the atomic lattice around them and through this interaction form so-called small polarons. High carrier concentrations on the other hand can lead to short-range ordered polarons (large polarons) and even to a long-range charge and orbital order. These ordered systems should be insulating with a large electrical resistivity. However, recently a polaronic pseudogap was found in a metallic phase of La(2-2x)Sr(1+2x)Mn(2)O(7) (ref. 7). This layered manganite is famous for colossal magnetoresistance associated with a phase transition from this low-temperature metallic phase to a high-temperature insulating phase. Broad charge-order peaks due to large polarons in the insulating phase disappear when La(2-2x)Sr(1+2x)Mn(2)O(7) becomes metallic. Investigating how polaronic features survive in the metallic phase, here we report the results of inelastic neutron scattering measurements showing that inside the metallic phase polarons remain as fluctuations that strongly broaden and soften certain phonons near the wavevectors where the charge-order peaks appeared in the insulating phase. Our findings imply that polaronic signatures in metals may generally come from a competing insulating charge-ordered phase. Our findings are highly relevant to cuprate superconductors with both a pseudogap and a similar phonon effect associated with a competing stripe order.

Enhanced influenza surveillance on Réunion Island (southern hemisphere) in the context of the emergence of influenza A(H1N1)v

With the winter season on the southern hemisphere that starts in Réunion Island in June seasonal influenza activity usually increases shortly afterwards. The new influenza A(H1N1)v virus is rapidly spreading worldwide and may reach the island during the coming winter season. We have therefore enhanced influenza surveillance to detect the introduction of influenza A(H1N1)v, monitor its spread and impact on public health and characterise potential viral changes, particularly if seasonal influenza A(H1N1), resistant to oseltamivir, co-circulates with A(H1N1)v.

Perception and suppression of thermally induced pain: a fMRI study

Two neuroimaging studies using functional magnetic resonance imaging (fMRI) and thermally induced pain are presented. Fifteen healthy right-handed subjects were imaged while they had to discern different levels of thermal stimuli in the first study and while they disengaged from the feeling of pain during constant stimulation in the second study. In the first experiment, during painful phasic stimuli, right-sided anterior insular activation as well as bilateral posterior insular activation could be shown regardless of stimulation side, as well as right-sided activation of sensory association areas in the superior parietal lobule. Also, activation of the ipsilateral sensorimotor cortex could be shown. In the second experiment, all subjects succeeded in suppressing the feeling of pain during previously painful levels of stimulation. During the early part of the tonic painful stimulation, bilateral activation of caudate head and dorsolateral prefrontal cortex (DLPFC) as well as insular cortex and dorsal anterior cingulated cortex (dACC) was observed. During the late part of the tonic painful stimulation, anterior insular activation as well as dACC and bilateral prefrontal cortical activation could be shown. Taken together, the activation of PFC and caudate nucleus hints at an important role in the initiation (caudate) and maintenance (PFC) of suppression of the feeling of pain. No ipsilateral sensorimotor activation could be shown in the second experiment. The possible import of unwanted sensorimotor activation due to the simultaneous rating process in the first experiment is discussed.

The interferon response circuit in antiviral host defense

Viruses have learned to multiply in the face of a powerful innate and adaptive immune response of the host. They have evolved multiple strategies to evade the interferon (IFN) system which would otherwise limit virus growth at an early stage of infection. IFNs induce the synthesis of a range of antiviral proteins which serve as cell-autonomous intrinsic restriction factors. For example, the dynamin-like MxA GTPase inhibits the multiplication of influenza and bunyaviruses (such as La Crosse virus, Hantaan virus, Rift Valley Fever virus, and Crimean-Congo hemorrhagic fever virus) by binding and sequestering the nucleocapsid protein into large perinuclear complexes. To overcome such intracellular restrictions, virulent viruses either inhibit IFN synthesis, bind and inactivate secreted IFN molecules, block IFN-activated signaling, or disturb the action of IFN-induced antiviral proteins. Many viruses produce specialized proteins to disarm the danger signal or express virulence genes that target members of the IFN regulatory factor family (IRFs) or components of the JAK-STAT signaling pathway. An alternative evasion strategy is based on extreme viral replication speed which out-competes the IFN response. The identification of viral proteins with IFN antagonistic functions has great implications for disease prevention and therapy. Virus mutants lacking IFN antagonistic properties represent safe yet highly immunogenic candidate vaccines. Furthermore, novel drugs intercepting viral IFN-antagonists could be used to disarm the viral intruders.

Direct observation of the superconducting gap in phonon spectra

We show that the superconducting energy gap 2Delta can be directly observed in phonon spectra, as predicted by recent theories. In addition, since each phonon probes the gap on only a small part of the Fermi surface, the gap anisotropy can be studied in detail. Our neutron scattering investigation of the anisotropic conventional superconductor YNi2B2C demonstrates this new application of phonon spectroscopy.

Photoconductive detectors with fast temporal response for laser produced plasma experiments

Processes during laser plasma experiments typically have time scales that are less than 100 ps. The measurement of these processes requires x-ray detectors with fast temporal resolution. We have measured the temporal responses and linearity of several different x-ray sensitive photoconductive detectors (PCDs). The active elements of the detectors investigated include both diamond (natural and synthetic) and GaAs crystals. The typical time responses of the GaAs PCDs are approximately 60 ps, respectively. Some characterizations using x-ray radiation from a synchrotron radiation source are presented.