Successful treatment of fulminant hepatitis B during pregnancy

We here report the use of lamivudine 100 mg daily in a young pregnant woman (24th week of gestation) with fulminant hepatic failure due to acute HBV infection. After initiation of oral lamivudine (100 mg/d), ALT levels rapidly decreased from 5046 U/L to normal values within five weeks. HBe seroconversion occured three weeks after treatment start, followed by HBs seroconversion within less than six months. A preterm female baby was delivered at gestational week 29 (weight 1000 gr) (five weeks after start of lamivudine). The infant received simultaneous active and passive HBV immunisation within 12 hours after delivery. The neonatal check-up revealed meconium ileus which was successfully treated by surgery. At last presentation 241 days after initiation of treatment, both mother and infant showed stable HBs-seroconversion (anti-HBs 169 IU/mL and > 1000 IU/L, respectively). Therefore, lamivudine therapy was withdrawn. This case suggests that oral nucleos(t)ides may be safely used in pregnant patients with fulminant hepatitis B potentially preventing liver transplantation and interruption of pregnancy.

The German Hep-Net acute hepatitis C cohort: impact of viral and host factors on the initial presentation of acute hepatitis C virus infection

INTRODUCTION

The impacts of viral load, genotype, age, sex and BMI on the clinical course of acute hepatitis C are poorly defined. Here we studied 259 patients with acute HCV infection recruited in the German Hep-Net data base between 1998 and 2008. Antiviral treatment with interferon alpha was initiated in 171 patients (66 %) within 4 months after the diagnosis of acute hepatitis C.

RESULTS

In this cohort (i) the mode of infection was associated with age as iv-drug users were significantly younger than non-iv-drug users while the proportion of patients who acquired HCV by medical procedures increased with age; (ii) patients younger than 30 years were more often infected with genotype 3 (26 % versus 8 % for patients older than 50 years; p = 0.03); (iii) 51 % of patients were icteric and 28 % presented with a 30-fold elevation of liver enzymes, however, no fulminant hepatic failure occurred; (iv) HCV genotype was not associated with disease severity and time to onset of symptoms; (v) low HCV viremia was associated with lower serum AST levels and a longer time from exposure to onset of symptoms; (vi) disease severity was independent from the mode of infection, age, sex and body mass index (BMI).

CONCLUSIONS

In this large cohort of patients admitted for antiviral therapy, acute hepatitis C took a rather mild course of disease in the majority of patients. Disease severity was not associated with HCV genotype, viral load, age, sex and BMI.

VSV virotherapy improves chemotherapy by triggering apoptosis due to proteasomal degradation of Mcl-1

Overexpression of myeloid cell leukemia 1 protein (Mcl-1), an anti-apoptotic B-cell lymphoma 2 (Bcl-2) family member, contributes to chemotherapy resistance of tumors. The short half-life of Mcl-1 makes it an interesting target for therapeutic agents that negatively interfere with cellular protein biosynthesis, such as oncolytic viruses. Vesicular Stomatitis Virus (VSV) has been established as the oncolytic virus that efficiently disrupts de novo protein biosynthesis of infected cells. Here, we show that after VSV infection, Mcl-1 protein levels rapidly declined, whereas the expression of other members of the Bcl-2 family remained unchanged. Mcl-1 elimination was a consequence of proteasomal degradation, as overexpression of a degradation-resistant Mcl-1 mutant restored Mcl-1 levels. Mcl-1 rescue inhibited apoptosis and thereby confirmed that Mcl-1 downregulation contributes to VSV-induced apoptosis. In vitro, VSV virotherapy in combination with chemotherapy revealed an enhanced therapeutic effect compared with the single treatments, which could be reverted by Mcl-1 rescue or RNA interference (RNAi)-mediated knockdown of pro-apoptotic Bax and Bak proteins. Finally, in a tumor mouse model, combinations of doxorubicin and VSV showed a superior therapeutic efficacy compared with VSV or doxorubicin alone. In summary, our data indicate that VSV virotherapy is an attractive strategy to overcome tumor resistance against conventional chemotherapy by elimination of Mcl-1.

Helicobacter pylori vacuolating cytotoxin inhibits duodenal bicarbonate secretion by a histamine-dependent mechanism in mice

BACKGROUND

The pathogenic mechanisms involved in Helicobacter pylori-induced duodenal mucosal injury are incompletely understood. In the present study, we sought to investigate the effect of H. pylori vacuolating cytotoxin (VacA) on duodenal mucosal bicarbonate (HCO3-) secretion.

METHODS

Concentrated bacterial culture supernatants from an H. pylori wild-type strain producing VacA with s1/m1 genotypes (P12) and from an isogenic mutant lacking VacA (P12DeltavacA) were used. HCO3- secretion by murine duodenal mucosa was examined in vitro in Ussing chambers. Duodenal mucosal histamine release was measured using enzyme-linked immunosorbent assay. The expression of histamine H2 receptor was examined by immunohistochemical analysis.

RESULTS

In a dose-dependent manner, the VacA-positive supernatant P12 reduced prostaglandin E2 (PGE2)-stimulated duodenal mucosal HCO3- secretion to a maximum of 49% (P<.0001), whereas P12DeltavacA did not result in significant inhibition (P>.05). Purified VacA had a similar effect. Histamine H2 receptor antagonists attenuated the effect of P12 on PGE2-induced HCO3- secretion. P12 stimulated duodenal histamine release in a dose-dependent manner, and exogenous histamine inhibited PGE2-stimulated duodenal HCO3- secretion. H2 receptor expression was found in duodenal epithelial cells, the enteric nerve plexus, and lymphocytes in Peyer's patch.

CONCLUSIONS

H. pylori VacA inhibits PGE2-stimulated duodenal epithelial HCO3- secretion by a histamine-dependent mechanism. This effect likely contributes to the damaging effect of H. pylori in the duodenal mucosa.

2-Year GLOBE trial results: telbivudine Is superior to lamivudine in patients with chronic hepatitis B

BACKGROUND & AIMS

The GLOBE trial has compared the efficacy and safety of telbivudine versus lamivudine treatment over 2 years in patients with chronic hepatitis B.

METHODS

Hepatitis B e antigen (HBeAg)-positive (n = 921) and HBeAg-negative (n = 446) patients received telbivudine or lamivudine once daily for 104 weeks. The primary outcome, assessed in the intent-to-treat population, was therapeutic response (hepatitis B virus DNA <5 log(10) copies/mL and either HBeAg loss or normalization of alanine aminotransferase [ALT] level).

RESULTS

The therapeutic response to telbivudine was superior to that of lamivudine in HBeAg-positive (63% vs 48%; P < .001) and HBeAg-negative (78% vs 66%; P = .007) patients. HBeAg-positive patients given telbivudine also had better outcomes compared with lamivudine in terms of nondetectable viremia (< 300 copies/mL) at 55.6% versus 38.5% (P < .001), HBeAg loss at 35.2% versus 29.2% (P = .056), and viral resistance at 25.1% versus 39.5% (P < .001). Hepatitis B e antigen seroconversion was 29.6% versus 24.7% (P = .095) in all patients and 36% versus 27% (P = .022) in patients with baseline ALT level > or = 2 times normal. Telbivudine-treated HBeAg-negative patients showed higher rates of nondetectable viremia compared with lamivudine at 82.0% versus 56.7% (P < .001) and less resistance at 10.8% versus 25.9% (P < .001). Adverse events occurred with similar frequency, whereas grade 3/4 increases in creatine kinase levels were more common in patients given telbivudine (12.9% vs 4.1%, P < .001). Multivariate logistic regression analyses identified telbivudine treatment, among other variables, as an independent predictor of better week 104 outcomes.

CONCLUSIONS

Telbivudine is superior to lamivudine in treating patients with chronic hepatitis B over a 2-year period.

Consequences of different housing conditions on brain morphology in laying hens

The aim of this study was to analyze the impact of physical and social stress on the avian forebrain morphology. Therefore, we used laying hens kept in different housing systems from puberty (approximately 16 weeks old) until the age of 48 weeks: battery cages, small littered ground pen, and free range system. Cell body sizes and catecholaminergic and serotonergic innervation patterns were investigated in brain areas expected to be sensitive to differences in environmental stimulation: hippocampal substructures and the nidopallium caudolaterale (NCL), a functional analogue of the prefrontal cortex. Our analysis shows both structures differing in the affected morphological parameters. Compared to battery cage hens, hens in the free range system developed larger cells in the dorsomedial hippocampus. Only these animals exhibited an asymmetry in the tyrosine hydroxylase density with more fibres in the left dorsomedial hippocampus. We assume that the higher spatial complexity of the free range system is the driving force of these changes. In contrast, in the NCL the housing systems affected only the serotonergic innervation pattern with highest fibre densities in free range hens. Moreover hens of the free range system displayed the worst plumage condition, which most likely is caused by feather pecking causing an altered serotonergic innervation pattern. Considering the remarkable differences between the three housing conditions, their effects on hippocampal structures and the NCL were surprisingly mild. This observation suggests that the adult brain of laying hens displays limited sensitivity to differences in social and physical environment induced post-puberty, which warrants further studies.

Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B

BACKGROUND

Tenofovir disoproxil fumarate (DF) is a nucleotide analogue and a potent inhibitor of human immunodeficiency virus type 1 reverse transcriptase and hepatitis B virus (HBV) polymerase.

METHODS

In two double-blind, phase 3 studies, we randomly assigned patients with hepatitis B e antigen (HBeAg)-negative or HBeAg-positive chronic HBV infection to receive tenofovir DF or adefovir dipivoxil (ratio, 2:1) once daily for 48 weeks. The primary efficacy end point was a plasma HBV DNA level of less than 400 copies per milliliter (69 IU per milliliter) and histologic improvement (i.e., a reduction in the Knodell necroinflammation score of 2 or more points without worsening fibrosis) at week 48. Secondary end points included viral suppression (i.e., an HBV DNA level of <400 copies per milliliter), histologic improvement, serologic response, normalization of alanine aminotransferase levels, and development of resistance mutations.

RESULTS

At week 48, in both studies, a significantly higher proportion of patients receiving tenofovir DF than of those receiving adefovir dipivoxil had reached the primary end point (P<0.001). Viral suppression occurred in more HBeAg-negative patients receiving tenofovir DF than patients receiving adefovir dipivoxil (93% vs. 63%, P<0.001) and in more HBeAg-positive patients receiving tenofovir DF than patients receiving adefovir dipivoxil (76% vs. 13%, P<0.001). Significantly more HBeAg-positive patients treated with tenofovir DF than those treated with adefovir dipivoxil had normalized alanine aminotransferase levels (68% vs. 54%, P=0.03) and loss of hepatitis B surface antigen (3% vs. 0%, P=0.02). At week 48, amino acid substitutions within HBV DNA polymerase associated with phenotypic resistance to tenofovir DF or other drugs to treat HBV infection had not developed in any of the patients. Tenofovir DF produced a similar HBV DNA response in patients who had previously received lamivudine and in those who had not. The safety profile was similar for the two treatments in both studies.

CONCLUSIONS

Among patients with chronic HBV infection, tenofovir DF at a daily dose of 300 mg had superior antiviral efficacy with a similar safety profile as compared with adefovir dipivoxil at a daily dose of 10 mg through week 48. (ClinicalTrials.gov numbers, NCT00116805 and NCT00117676.)

Placebo-controlled trial of 400 mg amantadine combined with peginterferon alfa-2a and ribavirin for 48 weeks in chronic hepatitis C virus-1 infection

The impact of amantadine on virologic response rates of interferon-based treatment of chronic hepatitis C is controversial. The aim of this study was to compare virological response rates in patients with chronic hepatitis C virus (HCV)-1 infection treated with 400 mg amantadine or placebo in combination with peginterferon alfa-2a (40 kD) and ribavirin for 48 weeks. Seven hundred four previously untreated chronically HCV-1-infected patients (mean age, 46 +/- 12 years) were randomized to (A) amantadine-sulphate (400 mg/day) (n = 352) or (B) placebo (n = 352), both in combination with 180 microg peginterferon alfa-2a once weekly and ribavirin (1000-1200 mg/day) for 48 weeks. End of treatment and sustained virological response after a 24-week follow-up period were assessed by qualitative reverse transcription polymerase chain reaction (RT-PCR) (sensitivity, 50 IU/mL). Demographic and baseline virological parameters were similar in both treatment groups. In groups A and B, 231 of 352 patients (66%) and 256 of 352 patients (72%) achieved an end of treatment response, and 171 of 352 patients (49 %) and 186 of 352 patients (53 %) a sustained virological response, respectively. On-treatment dropout rate in the amantadine group was significantly higher than in the placebo group (32% versus 23%; P = 0.01). However, adverse events and laboratory abnormalities were similar between both groups. Per-protocol analysis revealed similar sustained virological response rates in both treatment groups (53% versus 55%).

CONCLUSION

In this large placebo-controlled multicenter study, amantadine even at a dose of 400 mg/day did not improve virological response rates of peginterferon alfa-2a and ribavirin in patients with chronic genotype HCV-1 infection.

Thrombocytopenia associated with chronic liver disease

Thrombocytopenia (platelet count <150,000/microL) is a common complication in patients with chronic liver disease (CLD) that has been observed in up to 76% of patients. Moderate thrombocytopenia (platelet count, 50,000/microL-75,000/microL) occurs in approximately 13% of patients with cirrhosis. Multiple factors can contribute to the development of thrombocytopenia, including splenic platelet sequestration, bone marrow suppression by chronic hepatitis C infection, and antiviral treatment with interferon-based therapy. Reductions in the level or activity of the hematopoietic growth factor thrombopoietin (TPO) may also play a role. Thrombocytopenia can impact routine care of patients with CLD, potentially postponing or interfering with diagnostic and therapeutic procedures including liver biopsy, antiviral therapy, and medically indicated or elective surgery. Therapeutic options to safely and effectively raise platelet levels could have a significant effect on care of these patients. Several promising novel agents that stimulate TPO and increase platelet levels, such as the oral platelet growth factor eltrombopag, are currently in development for the prevention and/or treatment of thrombocytopenia. The ability to increase platelet levels could significantly reduce the need for platelet transfusions and facilitate the use of interferon-based antiviral therapy and other medically indicated treatments in patients with liver disease.

Localization, trafficking, and significance for acid secretion of parietal cell Kir4.1 and KCNQ1 K+ channels

BACKGROUND & AIMS

K(+) recycling at the apical membrane of gastric parietal cells is a prerequisite for gastric acid secretion. Two K(+) channels are currently being considered for this function, namely KCNQ1 and inwardly rectifying K(+) channels (Kir). This study addresses the subcellular localization, trafficking, and potential functional significance of KCNQ1 and Kir4.1 channels during stimulated acid secretion.

METHODS

The effect of pharmacologic KCNQ1 blockade on acid secretion was studied in cultured rat and rabbit parietal cells and in isolated mouse gastric mucosa. The subcellular localization of KCNQ1 and Kir4.1 was determined in highly purified membrane fractions by Western blot analysis as well as in fixed and living cells by confocal microscopy.

RESULTS

In cultured parietal cells and in isolated gastric mucosa, a robust acid secretory response was seen after complete pharmacologic blockade of KCNQ1. Both biochemical and morphologic data demonstrate that Kir4.1 and KCNQ1 colocalize with the H(+)/K(+)-ATPase but do so in different tubulovesicular pools. All Kir4.1 translocates to the apical membrane after stimulation in contrast to only a fraction of KCNQ1, which mostly remains cytoplasmic.

CONCLUSIONS

Acid secretion can be stimulated after complete pharmacologic blockade of KCNQ1 activity, suggesting that additional apical K(+) channels regulate gastric acid secretion. The close association of Kir4.1 channels with H(+)/K(+)-ATPase in the resting and stimulated membrane suggests a possible role for Kir4.1 channels during the acid secretory cycle.

The type of arterial anastomosis influences hepatic hemodynamics and overall survival in liver graft recipients

AIM

Evaluation of the influence of arterial anastomoses on hepatic hemodynamics and overall survival in liver graft recipients using color Doppler ultrasound.

METHOD

224 patients recruited retrospectively were divided into five groups according to arterial anastomoses: (1) common hepatic (CHA)/gastro duodenal, (2) CHA/CHA, (3) aorta/celiac trunc, (4) aorta/aorta, (5) more than one anastomosis. We compared maximum portal [(P)Vmax], systolic [(A)Vmax] and end diastolic [(A)Vmin] arterial velocities, resistance indexes(RI), spleen and liver size between the groups. We analyzed further in a multivariate analysis the influence of time elapsed since orthotopic liver transplantation, age of recipient and donor on significant parameters as well as the overall survival of the patients between the groups.

RESULTS

Significant differences were found for: (A) Vmax between groups 2/4 (p<0.007) and 2/5 (p<0.010), (A) Vmin between groups 1/3 (p<0.029) and 2/3 (p<0.015) and RI between the groups 1/3 (p<0.018) and 3/4 (p<0.006). (A)Vmax and RI were only dependent on the type of arterial anastomosis (p<0.008 and p<0.014). The overall survival of the patients between the groups was significantly different (p<0.047).

CONCLUSION

In this study we report the natural course of the mean values of portal and arterial velocities in different arterial reconstructions for the first time. (A) Vmax of the hepatic artery is identified as the most promising candidate prognostic parameter for the assessment of hemodynamic alterations after liver transplantation originating in the type of arterial anastomosis performed. The group of patients with more than one anastomosis had the lowest arterial (A) Vmax and simultaneously the lowest overall survival.

[Sequelae of organ transplantation]

Transplant medicine has significantly changed the prognosis of diseases leading to terminal organ failure. It has evolved from an experimental procedure to standard therapy for liver, kidney and cardio-vascular diseases. Transplant medicine combines operative organ replacement with the management of severely ill patients before transplantation, as well as life-long follow-up of organ graft recipients. Ten year survival rates of 65% to over 90% have led to a steady increase of transplanted patients seen by general medical care providers which represents a challenge for practicing internists. Apart from organ-specific conditions, infectious, immunosuppressant-associated and metabolic consequences determine long-term survival. These include virus reactivation, graft rejection, anastomotic problems but more importantly general mortality determining factors such as diabetes, renal insufficiency and hypertension, which are often a consequence of immunosuppressant administration. They directly impact long-term survival. The awareness and treatment of these secondary conditions of organ transplantation in routine medical practice contributes significantly to secure the long term success of transplant medicine.

The CYP450 mouse model for autoimmune hepatitis: Breaking of self-tolerance in transgenic CYP2D6 and wildtype FVB-mice by viral infection (130.1)

The etiology of autoimmune hepatitis (AIH) is poorly understood although the major autoantigen, cytochrome P450 2D6 (CYP2D6), has been identified. We generated an animal model for human AIH using the natural autoantigen CYP2D6. We infected transgenic mice expressing human CYP2D6 in the liver with an Adenovirus-CYP2D6 vector (Ad-2D6) to break self-tolerance. Upon infection with Ad-2D6 not only transgenic CYP2D6 mice but also wildtype FVB mice showed persistent features of severe liver damage associated with AIH (hepatic fibrosis, fused liver lobules, cellular infiltrations, elevated serum ALT levels, confluent necrosis). Ad-2D6-infected mice (CYP2D6 and FVB) generated high titers of anti-CYP2D6 antibodies. Epitope mapping revealed that anti-CYP2D6 antibodies predominantly recognized the same immunodominant linear epitope recognized by sera of AIH patients (AQPPRD aa265-270). In contrast, mice infected with a control Adenovirus expressing green fluorescence protein did neither develop liver damage nor generated anti-CYP2D6 antibodies. The severity of liver damage as well as antibody formation was enhanced in FVB mice compared to transgenic CYP2D6 mice indicating a stronger tolerance to human CYP2D6 in CYP2D6 mice. In FVB mice, due to the homology of the mouse isoenzymes of the CYP superfamily to human CYP2D6, autoimmune liver damage by Ad-2D6-infection was possibly induced via true molecular mimicry.

NHE3 inhibition by cAMP and Ca2+ is abolished in PDZ-domain protein PDZK1-deficient murine enterocytes

The PDZ-binding protein PDZK1 (NHERF3/CAP70/PDZ-dc-1) in vitro binds to NHE3, but its role in the regulation of NHE3 activity in native enterocytes is unknown. This study was undertaken to understand the physiological role of PDZK1 in regulating NHE3 activity in native murine colonic enterocytes. NHE3 transport rates were assessed fluorometrically in BCECF-loaded colonic crypts in the NHE3-expressing cryptal openings by measuring acid-activated, Na+-dependent, Hoe 642-insensitive proton efflux rates. NHE3 mRNA expression levels and NHE3 total enterocyte and brush border membrane (BBM) protein abundance were determined by quantitative PCR and Western analysis and immunohistochemistry. In pdzk1-/- colonic surface cells, acid-activated NHE3 transport rates were strongly reduced, and the inhibitory effect of forskolin and ionomcyin was virtually abolished. Hyperosmolarity, on the other hand, still had an inhibitory effect. In addition, the NHE3-selective inhibitor S1611 inhibited acid-activated NHE3 activity in pdzk1-/- and +/+mice, suggesting that functional NHE3 is present in pdzk1-deficient colonocytes. NHE1 and NHE2 activity was not altered in pdzk1-/- colonic crypts. Immunohistochemistry revealed apical NHE3 staining in pdzk1-/- and +/+proximal colon, and Western blot analysis revealed no difference in NHE3 abundance in colonic enterocyte homogenate as well as brush border membrane. Lack of the PDZ-adaptor protein PDZK1 in murine proximal colonic enterocytes does not influence NHE3 abundance or targeting to the apical membrane, but abolishes NHE3 regulation by cAMPergic and Ca2+ -dependent pathways. It leaves NHE3 inhibition by hyperosmolarity intact, suggesting an important and selective role for PDZK1 in the agonist-mediated regulation of intestinal NHE3 activity.

Down regulation of small intestinal ion transport in PDZK1- (CAP70/NHERF3) deficient mice

The PDZ-binding protein PDZK1 (CAP70/PDZ-dc-1/NHERF3) in vitro binds to cystic fibrosis transmembrane conductance regulator (CFTR), the anion exchangers SLC26A3 and SLC26A6 and the Na(+)/H(+) exchanger NHE3, all of which are major transport proteins for intestinal anion secretion and salt absorption. This study was undertaken to search for a role of PDZK1 in regulating electrolyte transport in native murine small intestine. Short circuit current (I (SC)) and HCO-(3) secretory rate (J(HCO-)(3)) were measured to assess electrogenic anion secretion; (22)Na(+) fluxes to assess sodium absorption in isolated small intestine. NHE3, CFTR, as well as NHERF1, NHERF2, and PDZK1 messenger RNA (mRNA) expression levels, and NHE3 total enterocyte and brush border membrane (BBM) protein abundance were determined by quantitative polymerase chain reaction (PCR) and Western analysis. NHE3 localization was performed by immunohistochemistry. In pdzk1 -/- jejunal mucosa, basal net Na(+) absorption as well as the inhibition of Na(+) absorption by forskolin was significantly reduced. In pdzk1 -/- duodenal mucosa, identical basal I (SC) and (J(HCO-)(3)) but a significant, yet mild, reduction of forskolin-stimulated Delta(J(HCO-)(3)) and DeltaI (SC) was observed compared to +/+ tissue. Tissue conductance, morphological features, and the DeltaI (SC) and increase in (22)Na(+) absorption in response to luminal glucose was identical in pdzk1 +/+ and -/- small intestine, ruling out a general absorptive defect. While CFTR mRNA expression levels were unchanged, NHE3 mRNA expression levels were significantly increased in small intestinal mucosa of pdzk1 -/- mice. Total enterocyte and BBM abundance was not significantly different, suggesting an increased NHE3 turnover, possibly due to reduced NHE3 membrane retention time. Lack of the PDZ-adapter protein PDZK1 in murine small intestine causes a mild reduction in maximal CFTR activation, but a severe defect in electroneutral Na(+) absorption.

Organization of telencephalotectal projections in pigeons: Impact for lateralized top-down control

Birds display hemispheric specific modes of visual processing with a dominance of the right eye/left hemisphere for detailed visual object analysis. In pigeons, this behavioral lateralization is accompanied by morphological left-right differences in the ascending tectofugal pathway. This system is also asymmetrically modulated by descending telencephalotectal input whereby the left forebrain displays a much more pronounced physiological control over ipsilateral left and contralateral right visual thalamic processes. In the present study we aimed to answer the question if this top-down asymmetry that up to now had been demonstrated in single cell recording studies is due to anatomical asymmetries in the size of the fiber systems descending from the telencephalon to the tectum. We approached this question by means of a quantitative retrograde tracing study. Cholera toxin subunit B (CtB) was injected unilaterally into either the left or right optic tectum of adult pigeons. After immunohistochemical detection of CtB-positive cells, the number of ipsi- and contralaterally projecting neurons was estimated. Retrogradely labeled cells were located within the arcopallium, the hyperpallium apicale (HA) and the temporo-parieto-occipital area (TPO). Descending projections from HA, arcopallium, and TPO were mainly or exclusively ipsilateral with the contralateral projection being extremely small. Moreover, there was no difference between left and right hemispheric projections. These anatomical data sharply contrast with behavioral and electrophysiological ones which reveal an asymmetric and bilateral top down control. Therefore, contralateral and lateralized forebrain influences onto tectofugal processing are possibly not the direct result of asymmetrical descending axon numbers. Those influences emerge by a lateralized intra- and/or interhemispheric integration of ascending and descending input onto the rotundus.

Present status and perspectives of cell-based therapies for liver diseases

In recent years the interest in liver cell therapy has been increasing continuously, since the demand for whole liver transplantations in human beings far outweighs the supply. From the clinical point of view, transplantation of hepatocytes or hepatocyte-like cells may represent an alternative to orthotopic liver transplants in acute liver failure, for the correction of genetic disorders resulting in metabolically deficient states, and for late stage liver disease such as cirrhosis. Although the concept of cell therapy for various diseases of the liver is widely accepted, the practical approach in humans often remains difficult. An international expert panel critically discussed the recent published data on clinical and experimental hepatocyte transplantation and the possible role of stem cells in liver tissue repair. This paper aims to summarise the present status of cell based therapies for liver diseases and to identify areas of future preclinical and clinical research.

[Ultrasound education by simulator training high acceptance by ultrasound trainees of all qualification levels]

Ultrasound education improves by simulator training, however, the acceptance of ultrasound simulator training has not been investigated. Therefore we evaluated the participants response to simulator education during an ultrasound course of abdominal emergencies at an international ultrasound congress, at a regular ultrasound course and during courses at a regional hospital and an university hospital. Altogether, 62.3% of the participants judged the simulator image quality to be good. 84.3% considered the case selection to be good and 92.7% of the participants viewed the educational benefit to be good. 98.5% whished to have further ultrasound simulator courses to be developed and 95.3% of the participants opted for the integration of simulator training into the conventional ultrasound education.