Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and Morbidity in Augsburg Elderly

OBJECTIVE

To evaluate prevalence, sociodemographic characteristics, and risk factors of restless legs syndrome (RLS) in a population-based survey of the elderly, using standard diagnostic criteria.

BACKGROUND

Population-based studies of RLS are rare and have not yet used standard definition criteria.

METHODS

The Memory and Morbidity in Augsburg Elderly (MEMO) Study is a follow-up project of the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Survey-Augsburg, Germany, 1989-1990, evaluating neurologic diseases and their risk factors in a German population 65 to 83 years of age. Two RLS-trained physicians assessed the prevalence of RLS based on the four minimal standard criteria (International Restless Legs Syndrome Study Group, 1995) using standardized questions in face-to-face interviews. They also obtained information on medical history, medications, depression (Center of Epidemiologic Studies Depression Scale), and quality of life (Short Form 36) and performed a standardized neurologic examination for each participant.

RESULTS

The study population included 369 participants (173 women and 196 men). The overall prevalence of RLS was 9.8% (n = 36) and higher in women (13.9% versus 6.1%; p = 0.02). In women, the prevalence did not change with age, whereas men showed a nonsignificant inverse trend with increasing age. RLS-positive individuals took more benzodiazepines and estrogen compared with non-RLS cases, but the differences were not statistically significant. Participants with RLS had higher incidence of depression (p = 0.012) and lower self-reported mental health scores (p = 0.029) than did non-RLS cases.

CONCLUSIONS

RLS is a frequent syndrome in the elderly with considerable impact on self-perceived mental health, affecting women about twice as often as men.

The economic burden of hepatitis B in Germany

Despite the widespread distribution of Hepatitis B virus (HBV) infection and the ongoing controversy about HBV immunization, surprisingly few published studies examined in detail the economic impact of HBV infection in Europe. Therefore, we investigated a cohort of 180 patients throughout Germany to evaluate the economic burden of HBV-associated disease. In 58 patients with acute and 122 patients with chronic HBV infection, cost-consuming events including direct medical costs and work-loss costs were documented. The direct costs were DM 7702 (95% confidence interval (CI): 5473-9931) for each acute HBV infection and DM 4247 (CI: 1601-6893) per patient-year of chronic HBV infection, with marked differences between different stages of HBV disease. The derived overall costs (1997 price levels) per year were DM 10,018 (CI: 7613-12,421) and DM 4860 (CI: 2185-7536), respectively. Based on crude population-based estimates (30,000 acute and 420,000 chronic HBV cases), we calculated the total HBV-related costs in Germany to exceed DM 1200 millions in 1997 (CI: 924.2-1536.7), with the treatment of patients with chronic active HBV disease as the major cost determinant. Previously published data from Germany probably overestimated the financial impact of acute HBV infection. In summary, our results illustrate the ongoing economic importance of this potentially life-threatening, but preventable disease and support the call for more accurate HBV surveillance and control in Germany.

Light-to-moderate alcohol consumption and the risk of stroke among U.S. male physicians

BACKGROUND

Several studies have shown U- or J-shaped relations between alcohol consumption and the risk of stroke. We evaluated the effect of light-to-moderate alcohol intake on the risk of stroke, with separate analyses of ischemic stroke and hemorrhagic stroke.

METHODS

Our analyses were based on a prospective cohort study of 22,071 male physicians, 40 to 84 years old, who were participating in the Physicians' Health Study. At base line, the participants reported that they had no history of stroke, transient ischemic attack, or myocardial infarction and were free of cancer. Alcohol intake, reported by 21,870 participants at base line, ranged from none or almost none to two or more drinks per day.

RESULTS

During an average of 12.2 years of follow-up, 679 strokes were reported. As compared with participants who had less than one drink per week, those who drank more had a reduced overall risk of stroke (relative risk, 0.79; 95 percent confidence interval, 0.66 to 0.94) and a reduced risk of ischemic stroke (relative risk, 0.77; 95 percent confidence interval, 0.63 to 0.94). There was no statistically significant association between alcohol consumption and hemorrhagic stroke. The overall relative risks of stroke for the men who had one drink per week, two to four drinks per week, five or six drinks per week, or one or more drinks per day were 0.78 (95 percent confidence interval, 0.59 to 1.04), 0.75 (95 percent confidence interval, 0.58 to 0.96), 0.83 (95 percent confidence interval, 0.62 to 1.11), and 0.80 (95 percent confidence interval, 0.64 to 0.99), respectively, in an analysis in which we controlled for major risk factors for stroke.

CONCLUSIONS

Light-to-moderate alcohol consumption reduced the overall risk of stroke and the risk of ischemic stroke in men. The benefit is apparent with as little as one drink per week. Greater consumption, up to one drink per day, does not increase the observed benefit.

Cost of bacterial vaginosis in pregnancy. Decision analysis and cost evaluation of a clinical study in Germany

OBJECTIVE

To estimate the economic impact of screening for and treatment of bacterial vaginosis during early pregnancy.

STUDY DESIGN

Data from a clinical study that aligned two screening and treatment strategies and a no-screening or treatment strategy with three gynecologic practices in Berlin were used in decision tree analysis. Costs applied to the clinical outcomes were determined from standard German references and the charges from university clinics.

RESULTS

Practices A and B screened all 600 patients in the early second trimester and treated the positive cases with clindamycin 2% vaginal cream (A) or a Lactobacillus preparation (B), which incurred lower total costs, $493,159 and $497,619, as compared to practice C (total costs, $534,926), which did not screen or treat for bacterial vaginosis. Including costs of screening and treatment, the net savings of practice A as compared to practice C was estimated to be $47,316.

CONCLUSION

The presence of more preterm, premature and low-birth-weight infants added costs for practice C. The estimated cost savings lend support to the value of screening and treatment for bacterial vaginosis in early pregnancy.

Sadistic personality disorder in sex offenders: relationship to antisocial personality disorder and sexual sadism

To investigate the relationship of sadistic personality disorder (SPD), as defined in the appendix of DSM-III-R, to other personality disorders and to sexual sadism, 70 sex offenders (27 child molesters, 33 rapists, and 10 murderers) were assessed by the International Personality Disorder Examination. In 19 subjects (27.2%) from the total sample, SPD was diagnosed. The highest overlap appeared with borderline personality disorder (31.6%) and antisocial personality disorder (42.1%). However, in four cases SPD was the only personality disorder diagnosed. Factor analysis of the antisocial and sadistic criteria resulted in four major factors--one factor with high loadings on the sadistic criteria and the violent criteria of antisocial personality disorder, two factors with different forms of adult and juvenile aggression, and a fourth factor with high loadings on the antisocial criteria covering exploitative behavior. The results do not support SPD as a discrete disorder. Nevertheless, SPD may be seen as an important subdimension of antisocial personality disorder, distinct from more exploitative forms of antisocial behavior with less violence. Of those patients with SPD, 42.1% also had a DSM-III-R diagnosis of sexual sadism, which may be the most dangerous configuration.

[The reliability of stroke scales. The german version of NIHSS, ESS and Rankin scales]

Aim of the study was the translation of three frequently used stroke scales ("National Institutes of Health Stroke Scale" NIHSS, "European Stroke Scale" ESS and "Rankin Scale") into German and the analysis of the interrater reliability of the respective German versions. The translation process followed the protocol of the Medical Outcomes Trust (Boston) and included two independent forward, one backward translation and a consensus conference for the German versions. Interrater reliability was assessed using the weighted kappa statistic. For this study 43 patients with an ischemic stroke determined by computed tomography or magnetic resonance imaging were recruited from two university hospitals. Excluded were patients with an intracerebral hemorrhage or TIA. The interrater reliability of the three German versions was substantial to excellent. Mean Kappa for the NIHSS was 0.80, for the ESS 0.79 and 0.76 for the Rankin Scale using simple weights in the analysis. Additional analysis revealed the influence of preselected weights on the results of the kappa statistic. The use of German versions of frequently used stroke scales can reduce bias that is introduced by different levels of knowledge of the English language and thus improve the standardised assessment of neurological deficits in stroke.

Extracts and constituents of Hypericum perforatum inhibit the binding of various ligands to recombinant receptors expressed with the Semliki Forest virus system

Extracts, fractions and constituents of Hypericum perforatum were studied for in vitro receptor binding with various ligands to recombinant CNS receptors expressed with the Semliki Forest virus expression system. For this purpose we have prepared membranes of CHO cells with high density of several opioid, serotonin, estrogen, histamine, GABAA, neurokinin and metabotropic glutamate receptors, respectively. A lipophilic Hypericum fraction revealed relatively potent inhibition to the binding of the mu-, delta- and kappa-opioid and the 5-HT6 and 5-HT7 receptors. Moreover, Hypericum constituents such as the naphthodianthrones, hypericin and pseudohypericin, and the phloroglucinole hyperforin inhibited both binding to the opioid and serotonin receptors in the lower micromolar range. Estrogen binding was 50% inhibited by the biflavonoid I3,II8-biapigenin at micromolar concentration. The lipophilic Hypericum fraction provided a less potent inhibition of the neurokinin-1 receptor binding compared to the opioid and serotonin receptors. A total ethanolic Hypericum extract potently inhibited GABAA binding at approximately 3 micrograms/ml. This inhibition is however not specific to Hypericum, since extracts of plants like Valeriana officinalis and Passiflora incarnata showed similar inhibitions. Binding to neither histamine nor metabotropic glutamate receptors was affected by Hypericum extracts. These results support the hypothesis that several active constituents of Hypericum might in a synergistic way contribute to its antidepressant effect in the central nervous system.

Socioeconomic evaluation in medicine in Europe. Core economic concepts

In most European countries, healthcare cost-containment programmes have failed to meet their targets on a long term basis. For this reason, decision-makers sought effective and rational strategies to assist in the optimal allocation of available resources. The scholarly discipline of economics provides methods and instruments for investigating the rational use of limited resources. In the context of these efforts, socioeconomic evaluations of healthcare programmes have become increasingly important during the last decade. A socioeconomic evaluation is an analysis of all costs and consequences over a relevant time-period for a particular healthcare intervention. For example, a socioeconomic evaluation of an influenza prevention programme should consider the total costs of preventing influenza (costs of the vaccine, vaccination programme and treatment of adverse events), as well as the benefits of such a programme (costs saved as a result of cases of influenza avoided). In general, socioeconomic evaluations usually compare costs and benefits relative to alternative treatment strategies. The core concepts of socioeconomic analyses are as follows: costs and consequences, discounting, marginal and incremental costs, and externalities (spill-over effects). All these concepts are fixed components of published guidelines and should be considered when conducting a socioeconomic evaluation.

[What characterizes the problem psychiatric patient? Results of a study of patient descriptions using the Psychiatric Personnel Order]

In recent years, economic pressure on extended and repeated psychiatric hospitalisation have increased dramatically. At the same time, diagnostic approaches, e.g., the new concept of the "young adult chronic patient" have improved. The first part of this article summarises reports and experiences on the chronic mentally ill and the so-called "heavy users" of psychiatric hospitalisation. Although the number of studies evaluating this group is small, several characteristics can be identified. Subsequently, a study is presented that deals with psychiatric problem patients in a special way, namely the A2-categorisation according to the German Psychiatric Personnel Regulation (Psychiatrie-Personalverordnung [Psych-PV]). The study is based on 170 consecutive admissions to the Department of General Psychiatry of a large German state hospital, who are characterised as normal (A1) and intensive patients (A2), respectively. The study aimed at describing difficult-to-treat patients or those whose treatment demands large human resources. Medical histories, sociodemographic and psychopathological data as well as subjective health status data of these patients were analysed by standardised and validated instruments (e.g., BPRS, CGI, SF-36, GAF). Results show that the patients under study suffered mainly from schizophrenic psychosis according to ICD-9. Patients categorised into A2 showed a high degree of psychopathology and little insight into their disease. Further it can be demonstrated that they used more therapeutic help from general practitioners rather than from specialists in psychiatry prior to admission. In conclusion, it is suggested to evaluate concepts, e.g., new treatment methods in respect of motivating schizophrenic patients, new typological methods to better diagnosis and to treat psychiatric problem patients via new treatment modalities such as Case Management or inpatient settings for double diagnoses.

Exercise and risk of stroke in male physicians

BACKGROUND AND PURPOSE

From a physiological perspective, physical activity might be expected to decrease the risk of developing stroke. However, epidemiological studies of physical activity and stroke risk have yielded divergent findings. We therefore sought to examine the association between exercise and stroke risk.

METHODS

This was a prospective cohort study of 21 823 men, followed up for an average of 11.1 years. Participants were from the Physicians' Health Study, a randomized trial of low-dose aspirin and beta carotene. Men, aged 40 to 84 years at baseline, were free of self-reported myocardial infarction, stroke, transient ischemic attack, and cancer. At baseline, they reported on the frequency of exercise vigorous enough to work up a sweat. Stroke occurrence was reported by participants and confirmed after medical record review (n=533). We used Cox proportional hazards regression to analyze the data.

RESULTS

With adjustment for age, treatment assignment, smoking, alcohol intake, history of angina, and parental history of myocardial infarction, the relative risks of total stroke associated with vigorous exercise <1 time, 1 time, 2 to 4 times, and >/=5 times per week at baseline were 1.00 (referent), 0.79 (95% confidence interval [CI], 0.61 to 1. 03), 0.80 (95% CI, 0.65 to 0.99), and 0.79 (95% CI, 0.61 to 1.03), respectively; P for trend=0.04. In subgroup analyses, the inverse association appeared stronger with hemorrhagic than ischemic stroke. When we additionally adjusted for body mass index, history of hypertension, high cholesterol, and diabetes mellitus, corresponding relative risks for total stroke were 1.00 (referent), 0.81 (95% CI, 0.61 to 1.07), 0.88 (95% CI, 0.70 to 1.10), and 0.86 (95% CI, 0.65 to 1.13), respectively; P for trend=0.25.

CONCLUSIONS

Exercise vigorous enough to work up a sweat is associated with decreased stroke risk in men. In the present study, the inverse association with physical activity appeared to be mediated through beneficial effects on body weight, blood pressure, serum cholesterol, and glucose tolerance. Apart from its favorable influences on these variables, physical activity had no significant residual association with stroke incidence.

Kinins modulate the sodium-dependent autoregulation of renal medullary blood flow

OBJECTIVE

In the recent past it has become clear that the kallikrein-kinin system is closely intertwined with long-term blood pressure regulation. It was shown that a kinin B2 receptor blockade leads to a sodium-dependent rise in blood pressure. The underlying mechanisms of this phenomenon, however, remain unclear. The osmotic gradient of the renal medulla is a prerequisite for the preservation of volume and sodium by the kidney. We thus hypothesized, that a kinin dependent modulation of medullary blood flow accounts for the influence of sodium on blood pressure.

METHODS

In 39 urethane anaesthetized rats pressure dependent regulation of whole kidney blood flow and cortical and medullary blood flow were estimated via laser-Doppler flux by a stepwise reduction of renal perfusion pressure to 30 mm Hg.

RESULTS

In controls (n = 15), a reduction in renal perfusion pressure to 30 mm Hg lead to a concomitant reduction in whole kidney blood flow (25 +/- 3% of baseline) and cortical laser-Doppler flux (36 +/- 5% of baseline). In contrast, medullary laser-Doppler flux decreased only to 79 +/- 8% of the baseline level. Providing a 2% sodium chloride solution as drinking water over 5 days (n = 12), resulted in a significantly lower capability to autoregulate medullary flow (50 +/- 6% of baseline, P < 0.05). Acute subcutaneous administration of Hoe 140, a bradykinin B2 receptor antagonist (300 micrograms/kg bwt), restored autoregulation of medullary flow to almost normal levels (93 +/- 12% of baseline, P < 0.01 versus high sodium diet alone, n = 12).

CONCLUSIONS

Our results indicate that B2 receptor blockade restores the attenuated autoregulation of medullary Doppler flux during sodium enriched diet. This, suggests that the kinin dependent impact of sodium on blood pressure regulation is mediated by modulations of medullary blood flow autoregulation.

Cost-effectiveness analysis of paclitaxel and cisplatin versus cyclophosphamide and cisplatin as first-line therapy in advanced ovarian cancer. A European perspective

Paclitaxel is a new cytotoxic agent that has demonstrated significant activity in advanced ovarian cancer. The aim of this study was to determine the cost structure of advanced ovarian cancer and the cost-effectiveness of paclitaxel-cisplatin (PC) combination therapy compared with a standard cyclophosphamide-cisplatin (CC) regimen at first-line therapy. The analysis was performed separately for six European countries: Germany, Spain, France, Italy, The Netherlands and the U.K. The study was conducted from the national health service payer's perspective. The total cost of treatment per patient (six cycles of chemotherapy) in the six European countries varied between a minimum of US$4,926 in the U.K. and US$12,578 in Germany for the CC regimen and between US$13,038 and US$24,487 for the PC regimen (April 1996). Since the new regimen improved life expectancy by 1.283 years compared with CC, the incremental cost-effectiveness of PC was calculated to be between US$6,403 per 5-year saved in the U.K. and US$11,420 per life-year saved in Italy. Overall, the cost-effectiveness of PC compares favourably with other oncological interventions. The findings of this study suggest that healthcare decision makers should consider paclitaxel, in combination with cisplatin, as a cost-effective first-line therapy for patients with advanced ovarian cancer.

[Economic evaluation of various hepatitis B vaccination strategies in children and adolescents]

AIM

In this cost-effectiveness study 4 different vaccination strategies against hepatitis B in children and adolescents are evaluated and compared with the situation without immunization.

EXAMINATION

Projections are made for the population of the today's adolescents underage 15 and the newborns of the next 30 years. The number of avoided hepatitis B virus (HBV) infections and the cases of disease as well as the costs associated with treatment and vaccination are determined. The course of incidence of the hepatitis B virus is observed for different age groups.

RESULTS

Compared to the situation without any vaccination against hepatitis B, a decrease of the remaining infections of at least 18,900 up to 46,600 could be expected during the next 30 years. The treatment costs for the remaining cases of disease could be reduced by 0.4 up to 1.6 billions DM. The remaining expenditures for treatment and vaccination would be limited to 2.3 up to 3.4 billions DM. The net costs of a vaccination are determined as about 14,200 up to 63,000 DM per avoided case of infection. Considering the commonly accepted number of unreported cases of hepatitis B as to be the 5- to 10 fold of the known incidence, all of the 4 compared vaccination strategies will be cost-effective and associated with net savings of about 5,900 up to 36,400 DM per avoided case of hepatitis B virus infection during 30 years. The epidemiological situation will be positive influenced by such a mass vaccination. The minimization of incidence is shown for the different age groups.

CONCLUSION

Considering these economical arguments, first the vaccination of all adolescents between age 11 to 15 and second the vaccination of all children/adolescents between age 0 to 15 are the preferable strategies. The immunization of all children/adolescents between age 0 to 15 is the most effective strategy from an epidemiological point of view.

[Pharmacoeconomic evaluation of pravastatin in the secondary prevention of coronary heart disease in patients with average cholesterol levels. An analysis for Germany based on the CARE study]

Those people who are to decide about health care systems are increasingly forced to identify unnecessary costs and achieve savings in health care. Especially for diseases with high prevalence like illnesses of the heart and the circulatory system preventive measures are very important. This economic analysis tries to clarify whether the secondary-preventive application of the HMG-CoA reductase-inhibitor pravastatin is, apart from the clinical benefit, economically justified in patients suffering from coronary heart disease with average cholesterol levels. In the case of this study, the underlying type of economic evaluation was an incremental cost-effectiveness analysis. The outcome was defined as costs per life-year saved. This retrospective study is based on the results of the CARE (Cholesterol And Recurrent Events) study which has been published elsewhere [21]. When calculating costs we took into account the perspective of 3rd party payers (public health insurance) in Germany. The calculation of cost-effectiveness was carried out for the whole study population in CARE as well as for all patients aged 60 or more years in the CARE study. This was done because the different groups vary by the numbers of avoided myocardial infarctions, strokes and loss of life years. Netcosts for pravastatin therapy, i.e. drug costs for pravastatin minus costs for avoided events, were about 9.54 Mio DM (referring to 1,000 patients treated for a period of 5 years). Net-costs for patients aged 60 or more years were 8.18 Mio DM. The effectiveness was defined as the number of life years saved and amounted to 216 years of life saved (YOLS) in the overall study group. For patients aged 60 or more years we found that 358 years were saved. The costs per life years saved (i.e. the net-costs of pravastatin therapy divided through the number of life years saved) turned out to be 44,000 DM per person in the study group. For patients over 60 the costs were 23,000 DM. Lipid-lowering with pravastatin in the secondary prevention of coronary heart disease in Germany is cost-effective. In those patients aged 60 or more yeas the use of pravastatin is even more cost-effective than in all patients included in the CARE study.

Incidence and risk factors for stroke in an occupational cohort: the PROCAM Study. Prospective Cardiovascular Muenster Study

BACKGROUND AND PURPOSE

The purpose of this study was to assess the incidence of stroke and the magnitude of classic stroke risk factors in an occupational cohort of white-collar and blue-collar workers.

METHODS

We studied a prospective cohort of 12 866 male employees, aged 30 to 65 years, in 52 companies in northwestern Germany, with an average follow-up of 7.2 years. Participants were free of self-reported stroke, transient ischemic attack, and myocardial infarction at baseline. Physical examination, blood tests, and a face-to-face interview to assess presence of various risk factors were performed at the workplace. Follow-up was done by standardized mailed questionnaire. Main outcome measure was first stroke occurrence.

RESULTS

Overall stroke incidence was 42.4 per 100000 person-years, increasing from 10.1 per 100000 person-years in the age category 30 to 39 years to 33.6, 80.6, and 159.2 per 100000 person-years in the age categories 40 to 49, 50 to 59, and 60 years and older, respectively. After adjustment for potential confounders, the relative risks of total stroke associated with systolic blood pressure < or = 120, 121 to 140, and > or = 141 mm Hg were 1.00 (reference), 2.99 (95% confidence interval, 0.85 to 10.49), and 5.56 (1.56 to 19.88). The risks associated with smoking status of never/past, < or = 20 cigarettes per day, and >20 cigarettes per day) were 1.00 (reference), 1.65 (0.62 to 4.42), and 3.56 (1.78 to 7.15), respectively. A history of hypertension at baseline (yes versus no) was independently associated with a relative risk of 2.37 (1.20 to 4.71) for total stroke and a history of diabetes mellitus (yes versus no) with a risk of 2.21 (1.00 to 4.87). A comparison of risk factor levels with a general population study revealed only small differences.

CONCLUSIONS

This occupational cohort had a 2-fold lower stroke incidence than that observed in cohorts of the general population. In the absence of a strong healthy-worker effect, moderate differences in behavioral risk factors and a higher treatment rate for hypertension contribute to the explanation of this favorable stroke incidence.

[Late sequelae of CNS recurrence of acute lymphoblastic leukemia in childhood]

Study objective was to evaluate retrospectively central nervous system (CNS) morbidity of children with acute lymphoblastic leukemia treated with intensive chemotherapy and cranial radiotherapy for a first isolated or combined CNS relapse. Neurological (Touwen), neuropsychological (CFT 20, Wechsler scales, d2 attention test) and neuromorphological (CT, MRI) assessments were performed in 17 children (9 girls, 8 boys) aged between 7 and 14 years. Patients were off therapy for median 4 years; cranial radiotherapy for CNS relapse (12-24 Gy) was given to all patients 2 to 9 years ago (median 5.5 years). Ten patients had received preventive cranial radiotherapy during front-line treatment, previously. In this group, the cumulative radiation dose ranged between 30 and 39 Gy. Patients received 12 to 30 intrathecal methotrexate doses (median 22). Compared with normative levels for age (100 points) performance IQ (89.9) and full scale IQ (92.0), Culture Fair IQ (88.3) and attention and concentration (90.9) were significantly impaired. Verbal IQ (95.5) was not significantly different from normal expectations. Neurological investigations of 16 patients showed mild signs in 7 (44%) of them, mostly of fine-motor skills and coordination, but no major motor disability. In MRI and CT, white matter changes or ventricular enlargement were noted in 10 of 16 patients (63%). Parent-completed questionnaires indicated problem behaviors in 5 children. Cumulative doses of methotrexate correlated significantly with neuropsychological test results. Children irradiated twice as well as girls had poorer cognitive functions, not being statistically significant. Despite pathological test results, all children attended a normal school and did not exhibit obvious impairment in daily life. In conclusion, CNS relapse and attendant therapy, mostly consisting of a second course of cranial radiotherapy, caused measurable intellectual deficits and CNS morbidity, which did not result in severely impaired performance. Periodic psychological und clinical examinations are recommended for recognition of delayed morbiditiy and early intervention.

Significance of genetic and environmental aspects in the field cultivation of Hypericum perforatum

Agronomical and biochemical parameters of seven Hypericum perforatum (St. John's wort) accessions grown at three experimental sites in Switzerland were followed over a two year period (1995-1996). Significant effects of environmental (= site) and genetic factors (= accession) on flowering dates, plant length, and plant dry matter production (= plant yield) were observed in both years; rankings of sites and accessions with regard to plant yield were similar in both years despite the fact that the first year crop contributed only a minor part to the overall yield of both years together. Maximum dry matter production per year reached 159 dt/ha for the total plant and 54 dt/ha for the flowering segment (i.e. the pharmaceutically relevant, upper segment of the plants comprising the majority of flowers). HPLC analysis of the constituents covered eight secondary metabolites (amentoflavone, biapigenin, hyperforin, hypericin, hyperosid, pseudohypericin, quercetin, rutin). Generally, secondary metabolite contents were significantly lower in the first year of cultivation ranging from 12% (hyperosid) to 83% (hyperforin) of the contents measured in the 1996-crop. Significant genetic effects on the production of all tested secondary metabolites (except biapigenin) were observed in 1996 whereas environmental effects appeared to be less distinct (except for amentoflavone and pseudohypericin). In conclusion, genetic factors strongly affected plant yield as well as secondary metabolite content in H. perforatum cultivation; the availability of genetically superior plant material next to improved agrotechnological methods therefore is supposed to become a key factor for successful future field production.

Binding of enterostatin to the human neuroepithelioma cell line SK-N-MC

SK-N-MC cells were found to possess binding sites for enterostatin, a peptide with central effects on appetite and sympathetic activation of brown adipose tissue during high-fat feeding. Scatchard analyses of the binding indicated one high-affinity binding (Kd = 0.5-1.5 nM) and one low-affinity binding (Kd = 15-30 nM) for 3H-enterostatin (APGPR). 125I-YGGAPGPR showed similar binding parameters as for the low affinity binding of 3H-APGPR. Met-enkephalin and beta3-casomorphin1-5 were found to displace the binding of 3H-APGPR to the SK-N-MC cells. Affinity purification of solubilized cells revealed an APGPR-binding protein estimated to 53 kDa which may represent a distinct enterostatin receptor. Cross-linking of 125I-YGGAPGPR to intact cells labeled one major protein with the same molecular size. There was no binding of enterostatin to four other human neuroblastoma/neuroepithelioma cell lines, named IMR-92, LAN#5, NB-1 #14 and SH5-SY.

The unified biosocial model of personality in schizophrenia families and controls

This report describes the application of a unified biosocial model of personality developed by C.R. Cloninger to a sample of families identified through a proband with schizophrenia and a sample of controls. Families of schizophrenic patients were ascertained in USA and Austria. We could detect differences between females and males in their response to positive reinforcement (Reward Dependence) and differences between young and old people with respect to the response to new and/or exciting situations (Novelty Seeking). In general, results obtained for individuals from schizophrenia families and controls were similar. These results are not substantially influenced by psychiatric disorders in individuals. Psychiatric diagnosis may have an influence on the third dimension of Cloninger's model, designated Harm Avoidance. Analysis showed that patients with a diagnosis of schizophrenia or from the schizophrenia spectrum try harder to avoid punishment or aversive stimuli than family members with another psychiatric disorder or without a psychiatric diagnosis as well as controls. The results are promising and further research is needed to evaluate the structure of the proposed personality model in families and the relationship of personality to psychiatric status.

[Cost effectiveness of ACE inhibition in therapy of chronic heart failure in Switzerland: evaluation based on the SOLVD study]

BACKGROUND AND OBJECTIVES

Morbidity and mortality data in Switzerland underline the socioeconomic importance of heart failure. In the SOLVD study (Study on Left Ventricular Dysfunction), cardiovascular morbidity and mortality were reduced with the ACE inhibitor enalapril in patients with heart failure. The economic implications of this treatment were analyzed in a retrospective economic analysis from the perspective of Swiss third party payers.

PATIENTS AND METHODS

Source of the economic analysis was the SOLVD study data. This prospective study was placebo-controlled, double-blind and had a mean follow-up of 3.45 years (41.4 months), involving 2569 patients with heart failure, mainly in NYHA classes II and III. Costing data for treatment with enalapril, the per diem charges for hospitalization and the average length of hospital stay were retrieved from published national sources. The costs of in- and output were calculated and compared for the two treatment groups in a cost-efficacy analysis.

RESULTS

Additional treatment with enalapril resulted in an additional cost of 2.5 million Swiss francs. These incremental costs were, however, offset by reduced hospital costs (CHF 6.45 million savings) in the enalapril group. For the complete treatment cohort of the SOLVD study, the net savings were approximately 4.26 million Swiss francs.

CONCLUSIONS

From the clinical point of view, treatment with ACE inhibitors leads to a reduction in the progression of heart failure and reduced cardiovascular morbidity and mortality. With respect to health economics, it can be demonstrated that treatment with enalapril does not only offer clinical benefits, but that these also translate into impressive economic savings of CHF 3315 per patient.

[Economic aspects of drug therapy exemplified by pravastatin. A socioeconomic analysis of cholesterol synthase enzyme inhibition in coronary heart disease patients]

BACKGROUND

Decision makers in the field of health services are increasingly forced to identify and realise the grounds for spendings and savings. Therefore, preventive measures of cardiovascular diseases are becoming more and more scrutinized. The present analysis is answering the question: Is secondary preventive lipid-lowering therapy with a cholesterol-synthesis-enzyme-(CSE-)inhibitor in patients with manifest coronary heart disease cost-effective in comparison to other already proven medical interventions?

METHODS

The cost-effectiveness-analysis with the endpoint costs per life years saved had been chosen as a form of evaluation. The study is a retrospective analysis. The clinical data have been taken from the already published double blinded, randomised, placebo controlled PLAC-I- and -II-studies as well as from the PLAC-Meta-Analysis. The cost estimate (costs of myocardial infarction, stroke and cost therapy with pravastatin) were based on the perspective of the German statutory sick funds.

RESULTS

With the reduced probability of a fatal myocardial infarction or a stroke in the group treated with pravastatin there are cost offsets of DM 2,400. This figure is opposed to an additional expenditure of about DM 6,900, -for the CSE-inhibitor. The calculation of the effectiveness resulted in an additional life expectancy of 0.28 years in the pravastatin cohorts in comparison with the group treated with placebo over an observation period of 3 years. The costs per life year saved are approximately DM 16,000,-.

CONCLUSION

The preventive use of pravastatin in patients with coronary heart disease can be estimated as cost-effective as compared with other medical interventions.

Hypertension and borderline isolated systolic hypertension increase risks of cardiovascular disease and mortality in male physicians

BACKGROUND

The objective of this study was to examine whether definite hypertension and borderline isolated systolic hypertension predict subsequent cardiovascular disease and mortality.

METHODS AND RESULTS

This was a prospective cohort study with a mean follow-up of 11.7 years. The subjects were a group of 18,682 apparently healthy US men, aged 40 to 84 years, participating in the Physicians' Health Study, a randomized trial of low-dose aspirin and beta-carotene. The main outcome measures were total cardiovascular disease, myocardial infarction, stroke, cardiovascular death, and all-cause mortality. Hypertension was associated with substantially increased risks of total cardiovascular disease (relative risk [RR] 1.92; 95% confidence interval [CI], 1.70 to 2.18), myocardial infarction (RR,1.78; 95% CI, 1.49 to 2.13), stroke (RR, 2.19; 95% CI, 1.78 to 2.69), and cardiovascular death (RR, 2.10; 95% CI, 1.68 to 2.63). Borderline isolated systolic hypertension was associated with significantly increased risks of cardiovascular disease (RR, 1.32; 95% CI, 1.09 to 1.59), stroke (RR, 1.42; 95% CI, 1.04 to 1.93), and cardiovascular death (RR, 1.56; 95% CI, 1.13 to 2.15), as well as a possible but non-significant increased risk of myocardial infarction (RR, 1.26; 95% CI, 0.95 to 1.67). Hypertension and borderline isolated systolic hypertension were associated with significantly increased risks of 41% and 22%, respectively, for all-cause mortality.

CONCLUSIONS

Hypertension as well as borderline isolated systolic hypertension are associated with elevated risks of cardiovascular diseases, especially stroke and cardiovascular death. Hypertension is associated with an increased risk of myocardial infarction, and borderline isolated systolic hypertension predicts a possible but more modest increase in risk. These data add to the existing evidence that hypertension is a major cardiovascular risk factor and extend the findings to borderline isolated systolic hypertension.

Hepatitis C virus core and E2 protein expression in transgenic mice

Transgenic mice have been produced that express the hepatitis C virus (HCV) core protein in the liver under the transcriptional control of the mouse major urinary protein promoter. These animals express the full length core protein in cytoplasm of their hepatocytes at levels comparable to those detected in naturally infected patients, without histological or biochemical evidence of liver disease or hepatocellular carcinoma. This contrasts with recent reports that HCV core protein can transform NIH 3T3 cells and cooperates with H-ras to transform primary rat fibroblasts in vitro. Coexpression of HCV core protein in double transgenic mice that replicate the hepatitis B virus (HBV) does not inhibit hepatocellular HBV gene expression or replication, contrary to reports that it inhibits HBV replication in HuH-7 cells after transient transfection in vitro. We have also produced transgenic mice in which a C-terminally truncated (aa384-715) glycosylated HCV E2 protein is expressed in the liver under the transcriptional control of the mouse albumin promoter. Despite the high level expression of HCV E2 protein, no evidence of liver disease was detected in these animals. These results suggest that the HCV core and E2 proteins are not cytopathic for the hepatocyte in vivo, and they represent an initial step in the development of a small animal model of HCV immunopathology.

[Drug-induced rhabdomyolysis and lesions of peripheral nerves. Sequelae of local ischemia within the scope of circulatory collapse?]

We report on two patients with severe rhabdomyolysis and peripheral nerve involvement after drug intoxication. Nerve conduction studies of the paretic extremities of both patients could be performed within 12 h of the onset. Several nerves revealed evidence of conduction blocks in the paretic extremities. One of the patients who had taken heroin died and postmortem examination was performed. A drug-induced immune vasculitis could not be demonstrated. Besides striated muscle necrosis, extensive myocardial fragmentation was shown. Territorial ischemia, resulting from systemic hypotension and mechanical compression of arteries, seems to have been the cause of the myonecroses and peripheral nerve damage in the unconscious patients.

[Bleomycin-induced pneumonia]

We report on a case of a 38-year old patient with fatal bleomycin-induced pneumonitis. Clinical presentation, the impact of risk factors, therapeutic means and perioperative considerations to prevent this rare but life-threatening complication are reviewed.

[Resuscitation in multiple trauma]

We report on a case of successful outpatient cardiopulmonary resuscitation of cardiac arrest after blunt multisystem injury. The literature is discussed and prognostic indicators are described.

[Cost effectiveness of captopril after myocardial infarct; comment]

BACKGROUND

In Germany approximately 88,000 people died as a result of acute myocardial infarction and approximately 300,000 people suffered from acute myocardial infarction in 1992. These data demonstrate the socioeconomic impact of coronary disease. In the SAVE-(Survival-and-Ventricular-Enlargement) study, Pfeffer et al. demonstrated a reduction of morbidity and mortality due to therapy with captopril in patients after myocardial infarction. In a retrospective, incremental cost-effectiveness-analysis, from the perspective of German statutory insurance fund, the economic impact of captopril after myocardial infarction has been analysed.

PATIENTS AND METHOD

The basis for the economic evaluation has been the double-blind, placebo-controlled, clinical SAVE-study which included 2,231 patients having left ventricular dysfunction after acute myocardial infarction. Additional data e.g. average number of hospital days or average costs for hospitalisation per day was taken from published national statistical sources. In the cost-effectiveness-analysis, inputs (monetary units) and outputs (non-monetary units) were identified and measured. The cost-effectiveness (costs per life-year gained) demonstrates a relation between the costs of captopril-treatment, costs for myocardial infarction and costs for leftventricular insuffiency and the clinical benefit e.g. life years gained.

RESULTS

Initially costs in the captopril-group are 3.7 Mio DM higher as in the placebo-group. But these costs are partly compensated by the cost reductions in the captopril-group, compared to the placebo-group (2,162,901 DM) the reduction of myocardial infarction and DM 556,518 cost reduction due to fewer patients with left ventricular dysfunction. The clinical benefit of the captopril treatment equals 495 life years gained. The cost-effectiveness-ratio is 2,000 DM cost for life year gained.

CONCLUSION

The treatment with captopril after acute myocardial infarction is not only a clinically efficacious treatment, but also cost-effective in patients after acute myocardial infarction.

Interobserver agreement in the classification of stroke in the physicians' health study

BACKGROUND AND PURPOSE

The evaluation of cerebrovascular end points in prospective studies is often based exclusively on medical record examination and may be made by more than one observer over time. To address the issues of adequacy of medical record information and consistency in diagnosis over time, we evaluated interobserver agreement for the main items of the stroke classification system used in the Physicians' Health Study. This trial included 22,071 physicians randomly assigned in 1982 to receive either aspirin or placebo to assess the subsequent risk of cardiovascular events, including stroke.

METHODS

Stroke subtype, stroke severity, and certainty of diagnosis were first classified from medical records from the years 1982 through 1988. The 216 stroke events reported in this period were independently reclassified in 1994 and compared with the initial classification using kappa statistics.

RESULTS

Overall agreement in major stroke types (hemorrhagic, ischemic, undetermined stroke) as well as in hemorrhagic stroke subtypes was excellent (kappa = 0.81 and kappa = 0.95, respectively). A wide range of values for the ischemic stroke subtypes (kappa = 0.13 to kappa = 0.96) was obtained. Agreement was substantial in assessment of stroke severity (kappa = 0.71), and it was fair (kappa = 0.33) for certainty of diagnosis.

CONCLUSIONS

Interobserver agreement is high for major stroke types as well as for categories of hemorrhagic stroke on the basis of review of medical records and results of imaging data. The classification of ischemic stroke subtypes, however, is subject to substantial interobserver disagreement. Periodic reclassification of random samples of end points might be considered in long-term prospective studies to assess potential misclassification of events by different observers.

[Determinants of patient structure according to the psychiatry personnel decree. On the problem of comparing psychiatric clinics]

In Germany psychiatric hospitals are increasingly facing external comparisons with other psychiatric hospitals and departments. The focus of these comparisons often is the constitution of inpatients according to the "Decree of Psychiatric Personnel" (Psychiatrie-Personalverordnung). This report evaluates factors that influence patient categorisation into the treatment categories of the mentioned decree. The analysis yields three sociodemographic factors as significant predictors of a categorisation to the intense-treatment category A2: 1. compulsory admission into the hospital, 2. first ever admission, 3. urban place of residence. Major methodical problems of patient categorisation into categories of the decree are elucidated. The validity of the current approach that chooses four selected qualifying days per year as the basis of representation of the annual patient population in psychiatric hospitals and departments is questioned.

Vaccination of chimpanzees against infection by the hepatitis C virus

A high incidence of community-acquired hepatitis C virus infection that can lead to the progressive development of chronic active hepatitis, liver cirrhosis, and primary hepatocellular carcinoma occurs throughout the world. A vaccine to control the spread of this agent that represents a major cause of chronic liver disease is therefore needed. Seven chimpanzees (Pan troglodytes) have been immunized with both putative envelope glycoproteins [E1 (gp33) and E2 (gp72)] that were copurified from HeLa cells infected with a recombinant vaccinia virus expression vector. Despite the induction of a weak humoral immune response to these viral glycoproteins in experimentally infected chimpanzees, a strong humoral immune response was obtained in all vaccines. The five highest responders showed complete protection against an i.v. challenge with homologous hepatitis C virus 1. The remaining two vaccines became infected, but both infection and disease may have been ameliorated in comparison with four similarly challenged control chimpanzees, all of which developed acute hepatitis and chronic infections. These results provide considerable encouragement for the eventual control of hepatitis C virus infection by vaccination.

[Bronchogenic cyst as a rare differential diagnosis of retroperitoneal tumor]

A retroperitoneal tumor originating from a bronchogenic cyst is an extreme rarity. We report the sixth case of a retroperitoneal bronchogenic cyst in an asymptomatic 38-year-old man who was initially admitted to hospital due to elective herniotomy of a right-sided inguinal hernia. Excluding symptomatic hernia by preoperative, routine-ultrasound we detected left-sided adrenal tumor mass. Computerized tomography and inconspicuous hormone-analysis completed preoperative evaluation. A tumor with 3 cm in diameter above the left adrenal gland, partly solid, partly cystic could be removed by laparotomy incision without complications. Final pathology confirmed diagnosis of a bronchogenic, dysontogenic cyst. Although rare, these cysts should be considered in differential-diagnosis of retroperitoneal tumors.

Autoclaved and filter sterilized liquid media in maize anther culture: significance of activated charcoal

Medium sterilization techniques (autoclaving, filter sterilization and separate sterilization of medium components), combined with preculture exposure to activated charcoal (AC) were evaluated for effects on maize anther culture response. The addition of AC to filter sterilized medium had no effect on the number of embryo-like-structures (ES) produced. For autoclaved medium, pre-culture AC treatment resulted in a 3-fold increase in ES yield over medium lacking AC. When AC was included, autoclaved medium was more productive than filter sterilized medium. Autoclaved media without AC gave lower response than filter sterilized medium. Separate sterilization of sucrose or FeEDTA was beneficial for media autoclaved in the absence of AC. However, when all components were autoclaved together in the presence of AC, there was no advantage to separate sterilization. The maximum ES frequency (224.6 ES/100 anthers) was obtained with the genotype ETH-M 52 cultured in autoclaved medium which had been exposed to AC (5 g/L) for 96 h prior to culture initiation. It is supposed that the higher ES frequencies observed with AC-treated, autoclaved media were due to the availability of glucose and fructose following heat-induced hydrolysis of sucrose and the AC-mediated adsorption of inhibitory compounds produced during autoclaving.

Characterization of hepatitis C virus envelope glycoprotein complexes expressed by recombinant vaccinia viruses

We constructed recombinant vaccinia virus vectors for expression of the structural region of hepatitis C virus (HCV). Infection of mammalian cells with a vector (vv/HCV1-906) encoding C-E1-E2-NS2 generated major protein species of 22 kDa (C), 33 to 35 kDa (E1), and 70 to 72 kDa (E2), as observed previously with other mammalian expression systems. The bulk of the E1 and E2 expressed by vv/HCV1-906 was found integrated into endoplasmic reticulum membranes as core-glycosylated species, suggesting that these E1 and E2 species represent intracellular forms of the HCV envelope proteins. HCV E1 and E2 formed E1-E2 complexes which were precipitated by either anti-E1 or anti-E2 serum and which sedimented at approximately 15 S on glycerol density gradients. No evidence of intermolecular disulfide bonding between E1 and E2 was detected. E1 and E2 were copurified to approximately 90% purity by mild detergent extraction followed by chromatography on Galanthus nivalus lectin-agarose and DEAE-Fractogel. Immunization of chimpanzees with purified E1-E2 generated high titers of anti-E1 and anti-E2 antibodies. Further studies, to be reported separately, demonstrated that purified E1-E2 complexes were recognized at high frequency by HCV+ human sera (D. Y. Chien, Q.-L. Choo, R. Ralston, R. Spaete, M. Tong, M. Houghton, and G. Kuo, Lancet, in press) and generated protective immunity in chimpanzees (Q.-L. Choo, G. Kuo, R. Ralston, A. Weiner, D. Chien, G. Van Nest, J. Han, K. Berger, K. Thudium, J. Kansopon, J. McFarland, A. Tabrizi, K. Ching, B. Mass, L. B. Cummins, E. Muchmore, and M. Houghton, submitted for publication), suggesting that these purified HCV envelope proteins display native HCV epitopes.

Adolescent adjustment to chronic physical disorders--I. Comparing neurological and non-neurological conditions

Early research on child adjustment to chronic illness assumed that each condition had a unique impact. Recently researchers have suggested that all chronic conditions influence adjustment in similar ways. To compare these models, data were collected on 165 adolescents having chronic conditions with and without brain involvement, and 49 healthy controls. Adolescents with brain-based conditions had more behaviour problems, less autonomous functioning and poorer school achievement. Children with conditions having no brain involvement differed from controls only in reporting less work experience and having lower math achievement scores. These findings support a modified perspective that involves both general factors and effects specific to brain-based conditions.

Expression, identification and subcellular localization of the proteins encoded by the hepatitis C viral genome

We have expressed the full-length coding region and selected domains of the hepatitis C virus (HCV) cDNA in mammalian cells by transfection. Using HCV antibody-positive human sera and monospecific antibodies the proteins encoded by the putative structural and non-structural regions of the open reading frame of HCV were identified as core (p22), E1 (gp32-35), E2 (gp68-72), NS2 (p23), NS3 (p72), NS4a and b (p10 and p27) and NS5a and b (p56 and p70). We have also defined the subcellular localizations of the HCV proteins using indirect immunofluorescence assays.

The hepatitis C virus encodes a serine protease involved in processing of the putative nonstructural proteins from the viral polyprotein precursor

The hepatitis C virus (HCV) nonstructural protein 3 (NS3) domain has been predicted from sequence comparisons to represent a trypsin-like serine protease. By expressing wild-type and mutant HCV-1 cDNAs in transfected mammalian cells, we have identified putative nonstructural proteins 3 (72 kDa), 4 (10 kDa and 27 kDa) and 5 (58 kDa) and have shown that their processing from the viral polyprotein precursor is dependent on Ser1165 located in the proposed protease catalytic site. Data obtained from in vitro RNA translations indicate that unlike the processing of the NS2/NS3 junction, NS3/NS4 processing is dependent on Ser1165. In contrast to the situation for the related flaviviral NS3 proteases, the HCV NS3-mediated cleavage of the NS3/NS4 junction does not require the upstream NS2 domain and may not occur at dibasic sites.

Diagnosis of hepatitis C virus (HCV) infection using an immunodominant chimeric polyprotein to capture circulating antibodies: reevaluation of the role of HCV in liver disease

Structural and nonstructural regions of the HCV-encoded polyprotein have been expressed in recombinant yeast, bacteria, or insect cells and used to capture and measure reactive antibodies circulating in different individuals. The putative nucleocapsid protein (C) and nonstructural proteins 3-5 (NS3-NS5) were found to contain the most immunodominant epitopes. The NS3, NS4, and C regions were expressed in yeast in the form of a fused, chimeric polyprotein (C25) and a capture assay for reactive antibody was developed. This anti-C25 assay detects all previously identified HCV-seropositive cases and provides a substantially more sensitive diagnostic for both acute and chronic HCV infections than the current anti-C100-3 (NS4) assay. Anti-C25 was detected more frequently than anti-C100-3 in chronic, transfusion-associated non-A, non-B hepatitis patients from the United States (95% vs. 71%) and Japan (98% vs. 82%), in cryptogenic cirrhosis patients from the United States (62% vs. 28%), and in hepatitis B surface antigen-negative cases of hepatocellular carcinoma from Japan (83% vs. 63%). These data indicate that HCV has a greater role in these liver diseases than was previously thought. In volunteer United States blood donors sampled following the introduction of anti-C100-3 screening, the prevalence of anti-C25 and anti-C100-3 was 0.5% and 0.08%, respectively.

Characterization of the hepatitis C virus E2/NS1 gene product expressed in mammalian cells

Truncated and full-length versions of the hepatitis C virus protein domain encoding a presumptive envelope glycoprotein designated E2/NS1 were stably expressed in CHO cell lines. Characterization of the processing events involved in the maturation of E2/NS1 revealed that a high-mannose form resident in the endoplasmic reticulum was the most abundant form detected intracellularly. The ionophore carboxyl cyanide m-chlorophenyl-hydrazone was used to show that the E2/NS1 glycoprotein resided in the endoplasmic reticulum. The full-length form of E2/NS1 appeared to be cell-associated and could not be detected as a secreted product. C-terminal truncated molecules could be detected in the extracellular media as fully processed glycoproteins containing terminal sialic acid additions. These truncated glycoproteins are predicted to be biologically relevant targets of the host immune response and are therefore potential subunit vaccine candidates.

[Life threatening menorrhagia in thrombasthenia. (Glanzmann-Naegeli) thrombasthenia]

Glanzmann's Thrombasthenia is a rare inherited disorder of platelet aggregation with normal platelet count and humoral coagulation. It is caused by the deficiency or functional disorder of platelet membrane glycoproteins IIb und IIIa. This complex is considered to be a receptor for fibrinogen. Menorrhagia often occurs as a clinical manifestation of affected females. We report a case of severe menorrhagia in a 13-year-old girl during her third menstrual cycle. She needed several red blood cell transfusions. The bleeding could only be stopped by administration of Lynestrenol.

[Impulse cytophotometry determination of the DNA content of paraffin-fixed neuroblastoma]

The aim of the study was to develop a method to obtain a single cell suspension from paraffin fixated neuroblastoma tissue for measuring the DNA content by flow cytometry, and to detect possible correlation between the histological grading and the DNA stemline, and to relate these findings to the patients' prognosis. 51 samples of the fixated neuroblastoma tissue were measured. It was possible to determine the DNA content in 38 probes of the material. 79% of the evaluated samples showed aneuploid DNA stemlines, 21% showed euploid stemlines. Despite the small number of probes it was found, that in relation to the histological grading of neuroblastoma a lower grade of malignancy correlated with an euploid DNA content and a higher grade of malignancy correlated with an aneuploid DNA content. A correlation between DNA stemlines and the patients' prognosis was not found.

Genetic organization and diversity of the hepatitis C virus

The nucleotide sequence of the RNA genome of the human hepatitis C virus (HCV) has been determined from overlapping cDNA clones. The sequence (9379 nucleotides) has a single large open reading frame that could encode a viral polyprotein precursor of 3011 amino acids. While there as little overall amino acid and nucleotide sequence homology with other viruses, the 5' HCV nucleotide sequence upstream of this large open reading frame has substantial similarity to the 5' termini of pestiviral genomes. The polyprotein also has significant sequence similarity to helicases encoded by animal pestiviruses, plant potyviruses, and human flaviviruses, and it contains sequence motifs widely conserved among viral replicases and trypsin-like proteases. A basic, presumed nucleocapsid domain is located at the N terminus upstream of a region containing numerous potential N-linked glycosylation sites. These HCV domains are located in the same relative position as observed in the pestiviruses and flaviviruses and the hydrophobic profiles of all three viral polyproteins are similar. These combined data indicate that HCV is an unusual virus that is most related to the pestiviruses. Significant genome diversity is apparent within the putative 5' structural gene region of different HCV isolates, suggesting the presence of closely related but distinct viral genotypes.

Retrograde degeneration of nigrostriatal neurons induced by intrastriatal 6-hydroxydopamine injection in rats

Quantitative receptor autoradiography was used to assess the effects of unilateral intrastriatal injections of 6-hydroxydopamine (6-OHDA) on the distribution of D1 and D2 dopamine (DA) receptors and of DA uptake sites in the mesostriatal pathway. [3H]Mazindol-labeled DA uptake sites were reduced both in the striatum (-97%) and in the substantia nigra pars compacta (SNpc) (-88%) on the injected side. There were also significant decreases of dopamine uptake sites in the nucleus accumbens (NAc) (-73%) and in the ventral tegmental area (VTA) (-70%). Changes in [3H]mazindol binding were also found within the contralateral VTA (-30%) and SNpc (-13%) but not in the contralateral-striatum. [3H]SCH23390-labeled D1 receptors were significantly reduced in the dorsomedial (-18%) and ventromedial (-14%) aspects of the striatum ipsilateral to the side of the lesions. In contrast, the concentration of [3H]spiperone-labeled D2 receptors was not altered. There were also significant decreases in D1 (-18%) and of D2 (-27%) receptors in the SNpc and of D1 (-10%) in the SN pars reticulata (SNpr). These results suggest that oxyradical-induced damage in striatal DA terminals could lead to retrograde changes in the SNpc. In addition, the data indicate that unilateral striatal damage can result in bilateral changes in the SNpc, thus confirming the interdependence of the two nigrostriatal pathways in rats.

Glossopharyngeal neuralgia associated with an autoimmune disorder of the thyroid gland. Case report

A case of an idiopathic glossopharyngeal neuralgia associated with an autoimmunological disorder of the thyroid gland is reported here. The relationship between these two diseases is discussed. In conclusion we propose that in all cases of idiopathic glossopharyngeal neuralgia metabolic and autoimmunological disorders of the thyroid should be considered.

In vitro evaluation of a sustained-release veterinary peroral pellet preparation

In a preceding in vivo study in horses, wide interindividual variation was found in the extent of bioavailability and time to reach peak concentration after peroral administration of one specific theophylline sustained-release dosage form. The purpose of the present study was to investigate the factors of potency, the pH of dissolution medium, the enzymes in the dissolution medium, and the crushing of the pellets on in vitro performance. The results show a wide variation in potency for the individual units, an increase in release rate with increasing pH, and an increase in release rate if the pellets are crushed. The wide variation in potency explains the variation found in absolute bioavailability, and the increase in release rate when the pellets are crushed explains the differences seen in peak plasma times, since the pellets will be chewed to varying degrees by the horse.

Synthesis and pharmacological study of 5-aryl-6-methyl-4,5-dihydro-pyridazin-3(2H)ones and related 5-aryl-6-methyl-pyridazin-3(2H)ones

New 5-aryl-6-methyl-4,5-dihydropyridazin-3(2H)ones (III) and related 5-aryl-6-methyl-pyridazin-3(2H)ones (IV) were synthesized in order to evaluate their pharmacological profile in comparison with that of the known class of antihypertensive and platelet aggregation inhibitors 5-methyl-6-aryl-4,5-dihydropyridazin 3(2H)ones (I). Though none of the tested derivatives was found to possess the antihypertensive potency of the reference compounds, some of them displayed significant antithrombotic and antiulcer properties. In particular, 5(p. acetylaminophenyl)-6-methyl-pyridazin-3-one (IV c) was found highly effective (ED50 = 1.2 mg/kg) in inhibiting indomethacin-induced ulcers.