The PerPAIN trial: a pilot randomized controlled trial of personalized treatment allocation for chronic musculoskeletal pain-a protocol

BACKGROUND

The therapy of chronic musculoskeletal pain (CMSP) is complex and the treatment results are often insufficient despite numerous therapeutic options. While individual patients respond very well to specific interventions, other patients show no improvement. Personalized treatment assignment offers a promising approach to improve response rates; however, there are no validated cross-disease allocation algorithms available for the treatment of chronic pain in validated personalized pain interventions. This trial aims to test the feasibility and safety of a personalized pain psychotherapy allocation with three different treatment modules and estimate initial signals of efficacy and utility of such an approach compared to non-personalized allocation.

METHODS

This is a randomized, controlled assessor-blinded pilot trial with a multifactorial parallel arm design. CMSP patients (n = 105) will be randomly assigned 1:1 to personalized or non-personalized treatment based on a cluster assignment of the West Haven-Yale Multidimensional Pain Inventory (MPI). In the personalized assignment condition, patients with high levels of distress receive an emotional distress-tailored intervention, patients with pain-related interference receive an exposure/extinction-tailored treatment intervention and patients who adapt relatively well to the pain receive a low-level smartphone-based activity diary intervention. In the control arm, patients receive one of the two non-matching interventions. Effect sizes will be calculated for change in core pain outcome domains (pain intensity, physical and emotional functioning, stress experience, participant ratings of improvement and satisfaction) after intervention and at follow-up. Feasibility and safety outcomes will assess rates of recruitment, retention, adherence and adverse events. Additional data on neurobiological and psychological characteristics of the patients are collected to improve treatment allocation in future studies.

CONCLUSION

Although the call for personalized treatment approaches is widely discussed, randomized controlled trials are lacking. As the personalization of treatment approaches is challenging, both allocation and intervention need to be dynamically coordinated. This study will test the feasibility and safety of a novel study design in order to provide a methodological framework for future multicentre RCTs for personalized pain psychotherapy.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00022792 ( https://www.drks.de ). Prospectively registered on 04/06/2021.

The impact of psychosocial factors on breastfeeding duration in the BaBi cohort study, Germany

Background

Breastfeeding is considered beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, a goal reached by only 34% of mothers in 2012. The WHO’s recommendation of exclusively breastfeeding for six months was met by 19% only. Hardly modifiable factors such as socio-economic status and migration background have been associated with duration of breastfeeding but little is known about the impact of psychosocial factors such as personality traits and social support. We hypothesise that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding.

Methods

We analyse baseline and follow-up data of the Bielefeld BaBi birth cohort (2013-16). They include detailed migration and socio-economic backgrounds, as well as three measures of psychological characteristics: the optimism scale, the Big Five inventory and the locus of control scales. We perform bivariate and multivariate analyses in order to identify psychosocial determinants of fully breastfeeding for four and six months.

Results

Out of 780 BaBi study participants, 548 fully breastfed for four months (70.3%), of which 279 continued until at least six months (35.8%). Logistic regression analyses show that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed and the attendance of antenatal class during this or previous pregnancies. Personality characteristics, social status and migration background show however no significant association with breastfeeding duration.

Conclusions

Our study results support the promotion of individuals’ breastfeeding intention and attendance to antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in maternal and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration.

Key messages

Neither psychosocial factors nor socioeconomic status were associated with breastfeeding duration. Two modifiable factors, breastfeeding intention and attending antenatal classes, were the main predictors of breastfeeding duration.

Effect of vildagliptin compared to glimepiride on postprandial proinsulin processing in the β cell of patients with type 2 diabetes mellitus

This study compared the effect of Glimepiride versus Vildagliptin on β-cell function and the release of intact proinsulin (PI) in patients with type 2 diabetes mellitus. Patients on metformin monotherapy were randomized to add on treatment with Vildagliptin or Glimepiride. A standardized test meal was given at baseline, after 12 and 24 weeks of treatment. Insulin, PI and blood glucose values were measured in the fasting state and postprandial for 300 min. Fasting PI levels significantly decreased in the Vildagliptin group. The area under the curve for the postprandial release of PI decreased during Vildagliptin and increased during Glimepiride treatment. The proinsulin to insulin ratio declined in the Vildagliptin group, whereas it did not change significantly in the Glimepiride group. Addition of Vildagliptin to ongoing Metformin treatment reconstitutes the disproportionality of the proinsulin to insulin secretion from the β cell.

Dephasing of triplet-sideband optical emission of a resonantly driven InAs/GaAs quantum dot inside a microcavity

Detailed properties of resonance fluorescence from a single quantum dot in a micropillar cavity are investigated, with particular focus on emission coherence in the dependence on optical driving field power and detuning. A power-dependent series over a wide range reveals characteristic Mollow triplet spectra with large Rabi splittings of |Ω|≤15  GHz. In particular, the effect of dephasing in terms of systematic spectral broadening ∝Ω(2) of the Mollow sidebands is observed as a strong fingerprint of excitation-induced dephasing. Our results are in excellent agreement with predictions of a recently presented model on phonon-dressed quantum dot Mollow triplet emission in the cavity-QED regime.

Observation of non-Markovian dynamics of a single quantum dot in a micropillar cavity

We measure the detuning-dependent dynamics of a quasiresonantly excited single quantum dot coupled to a micropillar cavity. The system is modeled with the dissipative Jaynes-Cummings model where all experimental parameters are determined by explicit measurements. We observe non-Markovian dynamics when the quantum dot is tuned into resonance with the cavity leading to a nonexponential decay in time. Excellent agreement between experiment and theory is observed with no free parameters providing the first quantitative description of an all-solid-state cavity QED system based on quantum dot emitters.

[Is there a link between the mercury release of amalgam fillings and the results of psychological questionnaires?]

Amalgam as a dental filling material shows excellent material property. It is fast, easy and economical to implement. Evidence for the release of mercury (Hg) from amalgam fillings was given in a number of studies. Mercury release from amalgam dental fillings is often claimed to be a possible cause of unspecific chronic symptoms such as chronic fatigue, headache and migraine. The present study explored relationships between the mercury release from amalgam fillings and the results of psychological questionnaires. The urine of 126 men and women in the age range of 16 to 76 years was examined. 45 participants did not present any amalgam restorations. The mercury released into the urine was measured by using cold-vapour AAS. The results of the study show that chronic mercury exposure, in the low concentration range, is not linked with chronic subjective symptoms.

Post-selected indistinguishable photons from the resonance fluorescence of a single quantum dot in a microcavity

Applying continuous-wave pure resonant s-shell optical excitation of individual quantum dots in a high-quality micropillar cavity, we demonstrate the generation of post-selected indistinguishable photons in resonance fluorescence. Close to ideal visibility contrast of 90% is verified by polarization-dependent Hong-Ou-Mandel two-photon interference measurements. Furthermore, a strictly resonant continuous-wave excitation together with controlling the spontaneous emission lifetime of the single quantum dots via tunable emitter-mode coupling (Purcell) is proven as a versatile scheme to generate close to Fourier transform-limited (T2/(2T1)=0.91) single photons even at 80% of the emission saturation level.

Control of the strong light-matter interaction between an elongated In_{0.3}Ga_{0.7}As quantum dot and a micropillar cavity using external magnetic fields

We have studied a strongly coupled quantum dot-micropillar cavity system subject to an external magnetic field. The large diamagnetic response of elongated In_{0.3}Ga_{0.7}As quantum dots is exploited to demonstrate magneto-optical resonance tuning in the strong coupling regime. Furthermore, the magnetic field provides an additional degree of freedom to in situ manipulate the coupling constant. A transition from strong coupling towards the critical coupling regime is attributed to a reduction of the quantum dot oscillator strength when the magnetic confinement becomes significant with regards to the exciton confinement above 3 T.

The role of optical excitation power on the emission spectra of a strongly coupled quantum dot-micropillar system

A strongly coupled quantum dot-micropillar cavity system is studied under variation of the excitation power. The characteristic double peak spectral shape of the emission with a vacuum Rabi splitting of 85 microeV at low excitation transforms gradually into a single broad emission peak when the excitation power is increased. Modelling the experimental data by a recently published formalism [Laussy et al., Phys. Rev. Lett. 101, 083601 (2008)] yields a transition from strong coupling towards weak coupling which is mainly attributed to an excitation power driven decrease of the exciton-photon coupling constant.

Single quantum dot controlled lasing effects in high-Q micropillar cavities

Lasing effects based on individual quantum dots have been investigated in optically pumped high-Q micropillar cavities. We demonstrate a lowering of the threshold pump power from a off-resonance value of 37 microW to 18 microW when an individual quantum dot exciton is on-resonance with the cavity mode. Photon correlation studies below and above the laser threshold confirm the single dot influence. At resonance we observe antibunching with g((2))(0) = 0.36 at low excitation, which increases to 1 at about 1.5 times the threshold. In the off-resonant case, g((2))(0) is about 1 below and above threshold.

Photon statistics of semiconductor microcavity lasers

We present measurements of first- and second-order coherence of quantum-dot micropillar lasers together with a semiconductor laser theory. Our results show a broad threshold region for the observed high-beta microcavities. The intensity jump is accompanied by both pronounced photon intensity fluctuations and strong coherence length changes. The investigations clearly visualize a smooth transition from spontaneous to predominantly stimulated emission which becomes harder to determine for high beta. In our theory, a microscopic approach is used to incorporate the semiconductor nature of quantum dots. The results are in agreement with the experimental intensity traces and the photon statistics measurements.

Coherent photonic coupling of semiconductor quantum dots

We report a new type of coupling between quantum dot excitons mediated by the strong single-photon field in a high-finesse micropillar cavity. Coherent exciton coupling is observed for two dots with energy differences of the order of the exciton-photon coupling. The coherent coupling mode is characterized by an anticrossing with a particularly large line splitting of 250 microeV. Because of the different dispersion relations with temperature, the simultaneous photonic coupling of quantum dot excitons can be easily distinguished from cases of sequential strong coupling of two quantum dots.

Strong coupling in a single quantum dot–semiconductor microcavity system

Cavity quantum electrodynamics, a central research field in optics and solid-state physics, addresses properties of atom-like emitters in cavities and can be divided into a weak and a strong coupling regime. For weak coupling, the spontaneous emission can be enhanced or reduced compared with its vacuum level by tuning discrete cavity modes in and out of resonance with the emitter. However, the most striking change of emission properties occurs when the conditions for strong coupling are fulfilled. In this case there is a change from the usual irreversible spontaneous emission to a reversible exchange of energy between the emitter and the cavity mode. This coherent coupling may provide a basis for future applications in quantum information processing or schemes for coherent control. Until now, strong coupling of individual two-level systems has been observed only for atoms in large cavities. Here we report the observation of strong coupling of a single two-level solid-state system with a photon, as realized by a single quantum dot in a semiconductor microcavity. The strong coupling is manifest in photoluminescence data that display anti-crossings between the quantum dot exciton and cavity-mode dispersion relations, characterized by a vacuum Rabi splitting of about 140 microeV.

Efficient elimination of chronic lymphocytic leukaemia B cells by autologous T cells with a bispecific anti-CD19/anti-CD3 single-chain antibody construct

Recently, we have shown that a novel recombinant bispecific single-chain antibody construct (bscCD19 x CD3), induces highly efficacious lymphoma-directed cytotoxicity mediated by unstimulated peripheral T lymphocytes. Functional analysis of bscCD19 x CD3 has so far been exclusively performed with human B lymphoma cell lines and T cells from healthy donors. Here we analysed the properties of bscCD19 x CD3 using primary B cells and autologous T cells from healthy volunteers or patients with B-cell chronic lymphocytic leukaemia (B-CLL). We show that bscCD19 x CD3 induces T-cell-mediated depletion of nonmalignant B cells in all four cases and depletion of primary lymphoma cells in 22 out of 25 cases. This effect could be observed at low effector-to-target (E:T) ratios and in the majority of cases without additional activation of autologous T cells by IL-2. Even in samples derived from patients heavily pretreated with different chemotherapy regimens, strong cytotoxic effects of bscCD19 x CD3 could be observed. The addition of bscCD19 x CD3 to patients' cells resulted in an upregulation of activation-specific cell surface antigens on autologous T cells and elevated levels of CD95 on lymphoma B cells. Although anti-CD95 antibody CH-11 failed to induce apoptosis in lymphoma cells, we provide evidence that B-CLL cell depletion by bscCD3 x CD3 is mediated at least in part by apoptosis via the caspase pathway.

Efficiency of root torquing auxiliaries

In an experimental typodont study simulating the third stage of Tip-Edge treatment, the effect of five torquing auxiliaries on upper four incisors was assessed using the method of laser reflection. The auxiliaries analysed were: (1) Two-Spurs 0.016", (2) Four-Spurs 0.016", (3) Reciprocal Lateral Torque 0.016", (4) Torque Bar 0.022x0.018", 20 degrees, and (5) Torque Bar 0.022x0.018, 30 degrees. When comparing the wires, the efficiency (amount and speed of root tipping) varied considerably: (1) The Two-Spurs wire was the most efficient auxiliary of the five tested and showed good torque effect on the central incisors. (2) The Four-Spurs wire acting on all four incisors was less efficient than the Two-Spurs wire. (3) The Reciprocal Lateral Torque wire exhibited good palatal root torque on the central incisors and labial root torque on the lateral incisors. (4) The Torque Bars (20 degrees and 30 degrees ) were the least efficient wires of the auxiliaries tested and showed only small torque effects on the central and lateral incisor teeth. In clinical work using the Tip-Edge technique, the Two-Spurs torquing auxiliary should be the wire of choice for an efficient palatal root torque of the upper central incisors.

A recombinant bispecific single-chain antibody, CD19 x CD3, induces rapid and high lymphoma-directed cytotoxicity by unstimulated T lymphocytes

Although bispecific antibodies directed against malignant lymphoma have been shown to be effective in vitro and in vivo, extended clinical trials so far have been hampered by the fact that conventional approaches to produce these antibodies suffer from low yields, ill-defined byproducts, or laborious purification procedures. To overcome this problem, we have generated a small, recombinant, lymphoma-directed, bispecific single-chain (bsc) antibody according to a novel technique recently described. The antibody consists of 2 different single-chain Fv fragments joined by a glycine-serine linker. One specificity is directed against the CD3 antigen of human T cells, and the other antigen-binding site engages the pan-B-cell marker CD19, uniformly expressed on the vast majority of B-cell malignancies. The construct was expressed in Chinese hamster ovary cells and purified by its C-terminal histioline tag. Specific binding to CD19 and CD3 was demonstrated by fluorescence-activated cell sorter analysis. By redirecting unstimulated primary human T cells derived from the peripheral blood against CD19-positive lymphoma cells, the bscCD19 x CD3 antibody showed significant cytotoxic activity at very low concentrations of 10 to 100 pg/mL and at effector to target cell ratios as low as 2:1. Moreover, strong lymphoma-directed cytotoxicity at low antibody concentrations was rapidly induced during 4 hours even in experiments without any T-cell prestimulation. Thus, this particular antibody proves to be much more efficacious than the bispecific antibodies described until now. Therefore, the described bscCD19 x CD3 molecule should be a suitable candidate to prove the therapeutic benefit of bispecific antibodies in the treatment of non-Hodgkin lymphoma. (Blood. 2000;95:2098-2103)

The effect of tissue expansion on the expression of collagen type I and type III mRNA in distinct areas of skin in the dog as an animal model

To evaluate the transcriptional response of skin to tissue expansion in the dog, the expression of procollagen alpha 1(I) mRNA and procollagen alpha 1(III) mRNA were analyzed by in situ hybridization. This expression was evaluated in distinct skin areas (subepidermal zone, dermis, capsular zone) after 4-85 days of expansion. Within the first 4 days of expansion expression of procollagen alpha 1(I) and alpha 1(III) mRNA was not affected in the subepidermal and dermal zone. Only a slightly elevated level of type III procollagen mRNA was demonstrated in tissue surrounding the implanted silicone expander. After 7 days of expansion an enhanced level of procollagen alpha 1(III) mRNA was observed in the dermis and capsular zone. A slightly enhanced type I collagen mRNA level occurred in all zones of the dermis that was even stronger in the capsular zone after 9 days of expansion. Concurrently, the number of transcriptionally active cells was significantly higher. Return to the basal level of procollagen alpha 1(I) mRNA was attained after 40 days. At this time a significant expression of procollagenase mRNA was observed. Procollagen III mRNA expression reached its basal level on day 85.

C-Mannosylation of human RNase 2 is an intracellular process performed by a variety of cultured cells

C2-alpha-Mannosyltryptophan was discovered in RNase 2 from human urine, representing a novel way of attaching carbohydrate to a protein. Here, we have addressed two questions related to the biosynthesis of this modification: (i) is C-mannosylation part of the normal intracellular biosynthetic route, and (ii) how general is it, i.e. which organisms perform this kind of glycosylation? To answer the first question, RNase 2, which is identical to the eosinophil-derived neurotoxin, was isolated from intracellular stores of cultured human HL-60 cells. The enzyme was C-mannosylated at Trp-7, showing that the modification occurs intracellularly, before secretion of the protein. The second question was investigated by immunological and chemical analysis of RNase 2 purified from the supernatant of transiently transformed cells from different organisms. This revealed that C-mannosylation occurs in cells from man, green monkey, pig, mouse, and hamster. The observation that pig kidney cells contain the machinery for C-mannosylation of Trp-7 of human RNase 2 but that the homologous RNase from porcine kidney is not a substrate, since it does not contain a tryptophan at position 7, strongly suggests that C-mannosylated proteins other than RNase 2 exist. Recombinant RNase 2 isolated from insect cells, plant protoplasts, and Escherichia coli was not C-mannosylated. These results not only form the basis for further studies on the biochemical aspects of C-mannosylation but also have implications for the choice of cells for production of recombinant glycoproteins.

[Spontaneous retroperitoneal hematoma in adrenal metastasis]

HISTORY AND CLINICAL FINDINGS

A 58-year-old man was hospitalized because of acute dull upper abdominal pain, radiating into the right flank and lower abdomen. The past history was unremarkable expect for thyroidectomy, performed 30 years previously for thyroid carcinoma. There was painful resistance on palpation of the right upper abdomen. The patient had not recently sustained any trauma. BIOCHEMICAL AND IMAGING INVESTIGATIONS: Erythrocyte sedimentation rate was increased to 38 mm/h, haemoglobin concentration was 11.7 g/dl but fell to 9.9 g/dl within the first 24 hours. Ultrasound and computed tomography (CT) revealed a large retroperitoneal mass (5 x 6.5 x 15 cm), its density of 64 Hounsfield units most strongly suggesting an haematoma. CT also showed enlargement of the right adrenal. Chest radiography demonstrated a space-occupying lesion in the right upper lobe.

DIAGNOSIS, TREATMENT AND COURSE

As a retroperitoneal haematoma of uncertain aetiology was suspected, a laparotomy was performed. The haematoma was evacuated and the adrenal, showing tumours changes, was excised. Histologically it was a mucocellular metastasis. The chest radiograph suggested carcinoma of the lung as the primary. The illness took a rapidly fatal course. Autopsy confirmed a poorly differentiated adenocarcinoma of the lung.

CONCLUSION

Trauma or anticoagulation should be considered first in the differential diagnosis of retroperitoneal haematoma of uncertain aetiology. However, adrenal metastasis should be thought of as a rare possibility.

The base specificities of tomato ribonuclease (RNase LE) and its Asp44 mutant enzyme expressed from yeast cells

RNase LE from cultured tomato cells is a member of the RNase T2 family. It is, however, distinguishable from RNase Rh from Rhizopus niveus, a typical RNase of the RNase T2 family, by its CD spectrum in the 200-250 nm region. In order to reinvestigate the base specificity of RNase LE and to study the role of Asn44 in RNase LE, which is considered to correspond to the base recognition site Asp51 of RNase Rh, RNase LE, and its Asp mutant at the 44th position were expressed from yeast cells with the same expression system as RNase Rh [K. Ohgi, et al., J. Biochem., 109, 776-785 (1991)]. RNase LE with four extra amino acid residues at the 2nd amino acid residue of mature RNase LE and its Asp44 mutant were secreted from yeast cells to give a yield of 10 mg/liter and 0.5 mg/liter culture broth, respectively. The expressed RNase LE (RNase RNAP LE) had the same characteristics as native RNase LE in the CD spectrum and specific activity. This is the first example of the expression of plant RNase from microbes and in sufficient amount to perform further enzymological research. The base specificity of RNase LE was guanylic acid preferential and that of N44D was changed to a more adenylic acid preference as compared to that of RNase LE. These experiments showed that Asn44 of RNase LE is crucial for base recognition as the case of Asp51 in RNASE Rh, and also suggested that the base recognition mechanism of RNase LE is very similar to that of RNase Rh.

Spectroscopic and protein chemical analyses demonstrate the presence of C-mannosylated tryptophan in intact human RNase 2 and its isoforms

Recently, the C-mannosylation of a specific tryptophan residue in RNase 2 from human urine has been reported [Hofsteenge, J., et al. (1994) Biochemistry 33, 13524-13530; de Beer, T., et al. (1995) Biochemistry 34, 11785-11789]. In those studies, identification of this unusual modification was accomplished by mass spectrometric and NMR spectroscopic analysis of peptide fragments. The evidence for the occurrence of C2-alpha-mannosyltryptophan [(C2-Man-)Trp] in the intact protein relied exclusively on the detection of the same phenylthiohydantoin derivatives during Edman degradation. In this paper, we have (1) excluded the possibility that (C2-Man-)Trp arose artificially under the acidic conditions previously employed for protein and peptide isolation and analysis, by maintaining the pH > 5 throughout these procedures, (2) demonstrated the occurrence of (C2-Man-)Trp in the intact protein, by NMR spectroscopy, (3) showed that (C2-Man-)Trp is not unique for RNase 2 from urine but that it is also present in the enzyme isolated from erythrocytes, and (4) found also that high-molecular mass isoforms of urinary RNase 2 are C-mannosylated. These observations firmly establish C-mannosylation as a novel way of post-translationally attaching carbohydrate to protein, in addition to the well-known N- and O-glycosylations. Furthermore, the NMR data, in combination with molecular dynamics calculations, indicate that in the native protein the mannopyranosyl residue is in a different conformation than in the glycopeptide or denatured protein, due to protein-carbohydrate interactions.

[Osteosynthesis in the mid-face and forehead area]

BACKGROUND

In the beginning of the development of facial osteosynthetic techniques only relatively thick plates were available. Since then various mini- and micro-plating systems were developed for the midfacial and forehead regions. As so many different systems with different sizes are available, it is important to know which systems are appropriate for which indications. Therefore, the aim of this study was to add knowledge to some aspects of the differential indications of different systems for the middle and upper facial regions.

METHODS AND PATIENTS

1. The pull-out forces of seven different mini- and microscrews were measured. 2. The thicknesses of the facial bone were measured at 11 different points in 10 skulls. 3. The clinical experiences of midfacial and upper facial osteosynthesis in 45 patients were summarised.

RESULTS

The pull-out forces increase with increasing bone- and screw-thickness and also substantially depend on the design of the screws. Although the bone thicknesses in the mid and upper facial region vary considerably, all investigated regions are suitable for osteosynthesis. In none of our patients any complication occurred that was related to the osteosynthesis.

CONCLUSIONS

Microsystems with screw diameters of 0.8 mm (Howmedica) are suited for fractures of the nasoethmoidal complex. Providing the same thickness as the microplates the Panfixsystem (Howmedica) offers a better holding strength especially when using the 1.3 mm screws, and is easier to handle. For stabilising fractures of the zygoma, which might dislocate postoperatively due to the pulling force of the masseteric muscle, we still feel that the miniplating technique with compression is the method of choice.

The hexopyranosyl residue that is C-glycosidically linked to the side chain of tryptophan-7 in human RNase Us is alpha-mannopyranose

Recently, the novel C-glycosidic linkage of a hexopyranosyl residue to the indole ring of tryptophan residue 7 of human RNase U(s) was reported [Hofsteenge, J., Müller, D. R., de Beer, T., Löffler A., Richter, W. J., & Vliegenthart, J. F. G. (1994) Biochemistry 33, 13524-13530]. Identification of this monosaccharide is a prerequisite for studies of its biosynthesis and its biological relevance. Using vicinal proton-proton coupling constants and rotating-frame nuclear Overhauser enhancements, ewe demonstrate that the C-linked substituent is alpha-mannopyranose. Furthermore, the nuclear magnetic resonance (NMR) data indicate that the mannopyranose moiety in a glycopeptide derived from RNase U(s) adopts several conformations on the NMR time scale.

Absorption and bioavailability of pentaerithrityl-tetranitrate (PETN, Dilcoran 80)

The effects of 80 mg pentaerithrityl-tetranitrate (PETN) as suspension or formulated as tablets were compared to placebo in a single blind, randomized, crossover study in 18 healthy subjects (study A), and the bioequivalence of two tablet formulations (marketed Dilcoran 80 vs a new formulation) was studied in 24 healthy subjects after administration of single oral doses of 80 mg PETN according to a placebo controlled, randomized, double blind, two-way crossover study design (study B). The perfusion of the right middle finger was measured by rheography (altitude A of the changes of resistance and of the incisure D) before and 24 h post-dose, and blood pressure and heart rate were measured in supine position at the same time. The values of area under curve (AUC) of the ratio A/D were calculated by the trapezoidal rule. In study A the mean A/D-values were reduced from about 2.0 to about 1.3 after intake of PETN (solution or tablet) with a minimum 60 to 90 min postdose (solution) and 2 h postdose (tablet). A significant reduction in this ratio was seen up to 8 (solution) or 12 h (tablet) post dose. Changes in blood pressure were not observed while the heart rate decreased in the subjects of all three groups 1 to 2 h postdose followed by an increase by 6 to 10 beats per min. After subtraction of the AUC values of placebo from the PETN-derived AUC values, mean values of 6.61 (SD 1.52, solution) and 7.25 (SD 1.48, A/D*h, tablet) were calculated (p > 0.1, study A).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clip migration in the common bile duct and consecutive calculus formation after laparoscopic cholecystectomy]

In 1991 a 64-year old woman underwent laparoscopic cholecystectomy for symptomatic gallstones. The follow-up was uneventful. Two years later a painless obstructive jaundice appeared. Endoscopic retrograde cholangio-pancreatography revealed a freely floating surgical clip within the common bile duct. It was a FILSHIE-Clip, commonly used to ligate the cystic duct. The endoscopic extraction of the foreign body was unsuccessful because the clip slipped into a small intrahepatic bile duct. Smaller gallstones that had probably crystallized around the clip could be extracted. Finally the clip itself disappeared spontaneously after endoscopic sphincterotomy through the papilla. It is discussed why movement of a surgical clip into the common bile duct appears after laparoscopic cholecystectomy.

cDNA structure and regulatory properties of a family of starvation-induced ribonucleases from tomato

In previous work we have determined the primary structure of two of the five ribonucleases which are induced by phosphate starvation in cultured tomato cells. Here, we present the isolation and characterization of the cDNAs for the extracellular ribonuclease LE and the intracellular, but extravacuolar ribonuclease LX. Structural analysis of these cDNAs together with partial protein-sequencing of vacuolar ribonucleases LV1, LV2 and LV3 revealed a family of very similar ribonucleases. From these data we assume identify between ribonucleases LE and LV3 for which the targeting mechanism has to be shown. Furthermore, RNase LV1 and RNase LV2 might be posttranslational processing products of RNase LX which travel to the vacuoles after splitting off the putative ER retention signal present at RNase LX. Additionally, we show by northern blot analysis that phosphate starvation in plant cells leads to an increase in the steady-state level of this type of enzymes revealing close similarities of the plant response to a limited supply of inorganic phosphate with the PHO regulation in bacteria and fungi.

New type of linkage between a carbohydrate and a protein: C-glycosylation of a specific tryptophan residue in human RNase Us

We report a new type of linkage between a carbohydrate and a protein, involving the rarely modified side chain of a tryptophan residue. An aldohexopyranosyl residue was found to be linked via a C-C bond to the indole ring of the tryptophan residue at position 7 of human RNase Us. Mass spectrometric analysis of peptides containing this residue showed a molecular mass 162 Da higher than that expected for tryptophan. The fragmentation pattern of the modified amino acid side chain was reminiscent of that of aromatic C-glycosides, suggesting a direct attachment of a hexose residue to a C-position of the tryptophan indole moiety. 1H and 13C NMR spectroscopic data confirmed this inference and unequivocally demonstrated the substituent to be an aldohexopyranosyl residue, C-glycosidically linked to the C2 atom of the indole. This mode of attachment differs from the ones known so far, in which carbohydrates are linked to an amino acid side chain by N- or O-glycosidic bonds.

[Data on the epidemiology of Crohn disease in the city of Cologne]

In the period between 1.7.1985 and 30.6. 1986 283 patients with Crohn's disease were recorded prospectively in the city of Cologne, which has a total of 922,552 inhabitants. This corresponds to a prevalence of 30.67 per 100,000 inhabitants (women 35.97, men 24.90). During this one-year survey period, 47 new cases of the disease occurred, i.e. the incidence is 5.1 per 100,000 (women 5.8, men 4.3). The highest total incidence is in the age group of 20 to 24 years (17.3) and the highest total prevalence is in the group of 25 to 29 years of age (90.0). There is a substantial sex difference with a female/male ratio of 173:110. Only data of patients residing primarily in Cologne were evaluated. Figures are given on the diagnostic latency, the locations, operations, complications and misdiagnoses of Crohn's disease.

Amino acid sequence of an intracellular, phosphate-starvation-induced ribonuclease from cultured tomato (Lycopersicon esculentum) cells

The primary structure of an intracellular ribonuclease (RNase LX) from cultured tomato (Lycopersicon esculentum) cells has been determined. Previous studies have shown that the protein is located inside the tomato cells but outside the vacuoles and that its synthesis is induced after depleting the cells for phosphate [Löffler, A., Abel, S., Jost, W., Beintema, J. J., Glund, K. (1992) Plant Physiol. 98, 1472-1478]. Sequence analysis was carried out by analysis of peptides isolated after enzymatic and chemical cleavage of the protein. RNase LX consists of 213 amino acids and has a molecular mass of 24300 Da and an isoelectric point of 5.33. The enzyme contains 10 half-cystines and there are no potential N-glycosylation sites detectable in the sequence. RNase LX, as compared to an extracellular tomato RNase (RNase LE), which is also phosphate regulated and the amino acid sequence of which was recently established [Jost, W., Bak, H., Glund, K., Terpstra, P. & Beintema, J. J. (1991) Eur. J. Biochem. 198, 1-6] has 60% of all amino acids identical and in identical positions, revealing a high degree of similarity between both proteins. In contrast to RNase LE, RNase LX has a C-terminal extension of nine amino acids. The C-terminal tetrapeptide HDEF may be a retention signal of the protein in the endoplasmic reticulum.

Phosphate-Regulated Induction of Intracellular Ribonucleases in Cultured Tomato (Lycopersicon esculentum) Cells

Four intracellular RNases were found to be induced in cultured tomato (Lycopersicon esculentum) cells upon phosphate starvation. Localization studies revealed three (RNases LV 1-3) in the vacuoles and one (RNase LX) outside these organelles. All of these RNases were purified to homogeneity and were shown to be type I RNases on the basis of type of splitting, substrate, and base specificity at the cleavage site, molecular weight, isoelectric point, and pH optimum. Moreover, RNase LV 3 was shown by fingerprinting of tryptic digests on reversed-phase high-performance liquid chromatography and sequencing the N terminus and two tryptic peptides to be structurally very similar to a recently characterized extracellular RNase LE which is also phosphate regulated (Nürnberger et al. [1990] Plant Physiol 92: 970-976; Jost et al. [1991] Eur J Biochem 198: 1-6). Expression of the four intracellular RNases is induced by depleting the cells of phosphate and repressed by adding phosphate. Our studies indicate that higher plants, in addition to secreting enzymes for scavanging phosphate under starvation conditions, also induce intracellularly emergency rescue systems.