Autophagy coupled to translation is required for long-term memory

An increase in protein synthesis following learning is a fundamental and evolutionarily conserved mechanism of long-term memory. To maintain homeostasis, this protein synthesis must be counterbalanced by mechanisms such as protein degradation. Recent studies reported that macroautophagy/autophagy, a major protein degradation mechanism, is required for long-term memory formation. However, how learning regulates autophagy and recruits it into long-term memory formation remains to be established. Here, we show that inhibitory avoidance in rats significantly increases the levels of autophagy and lysosomal degradation proteins, including BECN1/beclin 1, LC3-II, SQSTM1/p62 and LAMP1, as well as autophagic flux in the hippocampus. Moreover, pharmacological inhibition or targeted molecular disruption of the learning-induced autophagy impairs long-term memory, leaving short-term memory intact. The increase in autophagy proteins results from active translation of their mRNA and not from changes in their total mRNA levels. Additionally, the induction of autophagy requires the immediate early gene Arc/Arg3.1. Finally, in contrast to classical regulation of autophagy in other systems, we found that the increase in autophagy upon learning is dispensable for the increase in protein synthesis. We conclude that coupling between learning-induced translation and autophagy, rather than translation per se, is an essential mechanism of long-term memory.Abbreviations: AAV: adeno-associated virus; ARC/ARG3.1: activity regulated cytoskeletal-associated protein; ATG: autophagy related; DG: dentate gyrus; GFP: green fluorescent protein; IA: inhibitory avoidance; LAMP1: lysosomal-associated membrane protein 1; MAP1LC3B/LC3B: microtubule-associated protein 1 light chain 3 beta; ODN: oligodeoxynucleotide; qPCR: quantitative polymerase chain reaction; SBI: SBI0206965; SQSTM1/p62: sequestosome 1; SUnSET: surface sensing of translation; TRAP: translating ribosome affinity purification; ULK1: unc-51 like kinase 1.

CIM6P/IGF-2 Receptor Ligands Reverse Deficits in Angelman Syndrome Model Mice

Angelman syndrome (AS), a genetic disorder that primarily affects the nervous system, is characterized by delayed development, intellectual disability, severe speech impairment, and problems with movement and balance (ataxia). Most affected children also have recurrent seizures (epilepsy). No existing therapies are capable of comprehensively treating the deficits in AS; hence, there is an urgent need to identify new treatments. Here we show that insulin-like growth factor 2 (IGF-2) and mannose-6-phosphate (M6P), ligands of two independent binding sites of the cation-independent M6P/IGF-2 receptor (CIM6P/IGF-2R), reverse most major deficits of AS modeled in mice. Subcutaneous injection of IGF-2 or M6P in mice modeling AS restored cognitive impairments as assessed by measurements of contextual and recognition memories, motor deficits assessed by rotarod and hindlimb clasping, and working memory/flexibility measured by Y-maze. IGF-2 also corrected deficits in marble burying and significantly attenuated acoustically induced seizures. An observational battery of tests confirmed that neither ligand changed basic functions including physical characteristics, general behavioral responses, and sensory reflexes, indicating that they are relatively safe. Our data provide strong preclinical evidence that targeting CIM6P/IGF-2R is a promising approach for developing novel therapeutics for AS. LAY SUMMARY: There is no effective treatment for the neurodevelopmental disorder Angelman syndrome (AS). Using a validated AS mouse model, the Ube3am-/p+ , in this study we show that systemic administration of ligands of the cation independent mannose-6-phosphate receptor, also known as insulin-like growth factor 2 receptor (CIM6P/IGF-2R) reverses cognitive impairment, motor deficits, as well as seizures associated with AS. Thus, ligands that activate the CIM6P/IGF-2R may represent novel, potential therapeutic targets for AS.

[Surgical treatment of a perforated cornea in a zebra]

Microsurgical procedures in zoo and wildlife animals are challenging because of the reduced perioperative sterility and postoperative care. This case report describes the positive result of the surgical treatment of a perforated corneal ulceration with prolapsed iris in an 18-year-old Grévy's zebra mare. The postoperative development and the results of the histomorphological examination 3.5 years after surgery are described.

Radiation Exposure From Computed Tomography Of The Upper Limbs

To investigate exposure to radiation we identified a cohort of 312 patients who underwent standardized CT of an upper limb within a three years period. The effective dose per dose length product coefficient was used to calculate the effective doses of radiation. Mean effective doses were as follows: shoulder CT, 10.83 (SD 6.36) mSv; wrist CT, 0.15 (SD 0.07) mSv; elbow CT performed with the arm above the head, 0.21 (SD 0.11) mSv and with the arm adjacent to the torso, 13.1 (SD 10.8) mSv. The corresponding lifetime attributable risk of cancer was 0.6/1000 for males and 0.73/1000 for females for shoulder CT and 0.75/1000 for males and 0.96/1000 for females for elbow CT with the arm adjacent to torso. The effective doses for CT scans of the wrist and of the elbow performed with the arm above the head were low. For elbow CT scans, elevating the arm above the head decreases the radiation doses.

Pediatric Thyroid Cancer: Postoperative Classifications and Response to Initial Therapy as Prognostic Factors

CONTEXT

Prognostic factors for pediatric differentiated thyroid cancer (DTC) are not well established.

OBJECTIVE

The objective of the study was to retrospectively compare the postoperative risk-stratification systems: American Thyroid Association (ATA) risk categories, Schneider Children's Medical Center of Israel (SCMCI) score, and the response to initial therapy as predictors for disease outcome.

PATIENTS AND METHODS

Fifty-four DTC patients, median age at diagnosis 13.9 years (range 1.9-17 y), followed up for a median of 8.8 years (range 2.6-20.5 y) were stratified into prepubertal (n = 9), pubertal (n = 25), and postpubertal (n = 20) groups. All patients underwent total/near-total thyroidectomy; 48 received radioiodine therapy. The extent of DTC was evaluated by applying the ATA risk categories and the novel SCMCI score. Postoperative risk stratifications (low/intermediate/high) were determined using histopathological, laboratory, and imaging findings. Response to initial therapy (complete/acceptable/incomplete) was based on stimulated thyroglobulin and imaging results during the first 2 years of follow-up.

RESULTS

The risk for recurrent/persistent disease, as assessed by the postoperative ATA risk-stratification system and the SCMCI score and by the response to initial therapy, was higher in the prepubertal group (P < .001, P = .002, and P = .02, respectively). Outcome prediction by the risk-stratification systems was applicable: ATA risk categories, P = .014, R(2) = 0.247, predictive ability 80.4%; SCMCI score, P < .001, R(2) = 0.435, predictive ability 86.3%; and response to initial therapy stratification, P < .001, R(2) = 0.789, predictive ability 96.1%. The proportion of variance explained by the ATA risk categories (0.25), SCMCI score (0.44), and response to initial therapy (0.79) indicated that the latter was the most precise predictor and that the SCMCI score reflected the disease outcome better than ATA risk categories.

CONCLUSIONS

Our data confirm that the postoperative pediatric ATA stratification system and the novel SCMCI score are suitable for predicting the risk of recurrent/persistent disease in this population. The response to initial therapy classification performed 1-2 years after the initial therapy may be more appropriate for guiding surveillance recommendations.

Diagnostic odyssey in severe neurodevelopmental disorders: toward clinical whole-exome sequencing as a first-line diagnostic test

The current standard of care for diagnosis of severe intellectual disability (ID) and epileptic encephalopathy (EE) results in a diagnostic yield of ∼50%. Affected individuals nonetheless undergo multiple clinical evaluations and low-yield laboratory tests often referred to as a 'diagnostic odyssey'. This study was aimed at assessing the utility of clinical whole-exome sequencing (WES) in individuals with undiagnosed and severe forms of ID and EE, and the feasibility of its implementation in routine practice by a small regional genetic center. We performed WES in a cohort of 43 unrelated individuals with undiagnosed ID and/or EE. All individuals had undergone multiple clinical evaluations and diagnostic tests over the years, with no definitive diagnosis. Sequencing data analysis and interpretation were carried out at the local molecular genetics laboratory. The diagnostic rate of WES reached 32.5% (14 out of 43 individuals). Genetic diagnosis had a direct impact on clinical management in four families, including a prenatal diagnostic test in one family. Our data emphasize the clinical utility and feasibility of WES in individuals with undiagnosed forms of ID and EE and highlight the necessity of close collaborations between ordering physicians, molecular geneticists, bioinformaticians and researchers for accurate data interpretation.

Shared rhytidectomy continued to lateral canthoplasty in a Mastiff with excessive facial folding and macroblepharon

A 3.5-year-old male Neapolitan Mastiff was presented with an obstructed visual axis because of excessive facial skin folds, brow droop, macroblepharon, upper eyelid entropion and lower ectropion-entropion. To address these major defects a technique was performed which combines rhytidectomy with shortening of the palpebral fissure and stabilization of the lateral canthus. Postoperatively the dog showed an unobstructed visual axis with comfortable and symmetrical eyes.

All-fiber pulse shortening of passively Q-switched microchip laser pulses down to sub-200 fs

We present an all-fiber concept that generates ultrashort pulses using a passively Q-switched microchip seed laser. A proof-of-principle configuration combines nonlinear pulse compression applying a chirped fiber-Bragg-grating, dispersion-free pulse shortening by means of a fiber-integrated spectral filtering, and a final hollow-core-fiber compression to reach the sub-200-fs pulse-duration region. In a compact all-fiber pulse-shortening unit, initial 100 ps long microchip pulses at 1064 nm wavelength have been shortened to 174 fs and shifted to 1034 nm while preserving a high temporal quality.

[New AHA and ACC guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk : Statement of the D•A•CH Society for Prevention of Cardiovascular Diseases, the Austrian Atherosclerosis Society and the Working Group on Lipids and Atherosclerosis (AGLA) of the Swiss Society for Cardiology]

Guidelines for the reduction of cholesterol to prevent atherosclerotic vascular events were recently released by the American Heart Association and the American College of Cardiology. The authors claim to refer entirely to evidence from randomized controlled trials, thereby confining their guidelines to statins as the primary therapeutic option. The guidelines derived from these trials do not specify treatment goals, but refer to the percentage of cholesterol reduction by statin medication with low, moderate, and high intensity. However, these targets are just as little tested in randomized trials as are the cholesterol goals derived from clinical experience. The same applies to the guidelines of the four patient groups which are defined by vascular risk. No major statin trial has included patients on the basis of their global risk; thus the allocation criteria are also arbitrarily chosen. These would actually lead to a significant increase in the number of patients to be treated with high or maximum dosages of statins. Also, adhering to dosage regulations instead of cholesterol goals contradicts the principles of individualized patient care. The option of the new risk score to calculate lifetime risk up to the age of 80 years in addition to the 10-year risk can be appreciated. Unfortunately it is not considered in the therapeutic recommendations provided, despite evidence from population and genetic studies showing that even a moderate lifetime reduction of low-density lipoprotein (LDL) cholesterol or non-HDL cholesterol has a much stronger effect than an aggressive treatment at an advanced age. In respect to secondary prevention, the new American guidelines broadly match the European guidelines. Thus, the involved societies from Germany, Austria and Switzerland recommend continuing according to established standards, such as the EAS/ESC guidelines.

Smoothed spectra for enhanced dispersion-free pulse duration reduction of passively Q-switched microchip lasers

We present an enhanced technique for dispersion-free pulse shortening, which exploits the interplay of different third-order nonlinear effects in a waveguide structure. When exceeding a certain value of the pulse energy coupled into the waveguide, the typical oscillations of self-phase modulation (SPM)-broadened spectra vanish during pulse propagation. Such smoothed spectra ensure a high pulse quality of the spectrally filtered and, therefore, temporally shortened pulses independently of the filtering position. A reduction of the pulse duration from 138 to 24 ps has been achieved while preserving a high temporal quality. To the best of our knowledge, the nonlinear smoothing of SPM-broadened spectra is used in the context of dispersion-free pulse duration reduction for the first time.

Frequency, severity and predictors of playing-related musculoskeletal pain in professional orchestral musicians in Germany

Playing-related musculoskeletal disorders (PRMD) in professional musicians are common. Existing literature demonstrates that up to 86 % of musicians are affected. The aim of the study was to evaluate the frequency of musculoskeletal pain in professional orchestral musicians with regard to their instrument affiliation. Of special interest were pain intensity and its association with predictors such as gender, instrument group, age or stage fright. Professional orchestra players completed a self-report questionnaire to assess playing-related musculoskeletal pain and its frequency and intensity in various body regions on a numeric rating scale (NRS). Relative frequencies and prevalence ratios for different instrument groups were estimated. Out of 720 approached musicians, 408 were included in the sample (response rate 57 %); overall, 89.5 % had been affected by current or past playing-related musculoskeletal pain, 62.7 % reported pain in the previous 3 months, and 8.6 % reported current pain. Pain distribution and frequency varied between instrument groups. For all instrument groups, the neck was the most common pain region. About 43 % of musicians presented more than five pain regions, in particular violin players. Approximately 40 % of musicians indicated frequent or permanent pain. Average pain intensities increased from NRS 3.8 up to a range of 5.9 and 7.4 for frequent and permanent pain, respectively. Female gender and stage fright were proven to be predictors for musculoskeletal pain. Professional orchestral musicians are greatly affected by PRMD, often experiencing frequent or permanent pain, high pain levels and pain in various body regions. As PRMD might contribute considerably to performance disability, sick leave and the possibility of premature termination of a musicians' career, this study highlights the necessity for tailored therapeutic and preventive strategies in performing arts medicine.

Vomiting and dysphagia predict delayed gastric emptying in diabetic and nondiabetic subjects

BACKGROUND

Gastroparesis is a heterogeneous disorder most often idiopathic, diabetic, or postsurgical in nature. The demographic and clinical predictors of gastroparesis in Israeli patients are poorly defined.

METHODS

During the study period we identified all adult patients who were referred to gastric emptying scintigraphy (GES) for the evaluation of dyspeptic symptoms. Of those, 193 patients who were referred to GES from our institution were retrospectively identified (76 (39%) males, mean age 60.2 ± 15.6 years). Subjects were grouped according to gastric half-emptying times (gastric T 1/2). Demographic and clinical data were extracted from electronic medical records or by a phone interview.

KEY RESULTS

Gastric emptying half-times were normal (gastric T 1/2 0-99 min) in 101 patients, abnormal (gastric T 1/2 100-299 min) in 67 patients, and grossly abnormal (gastric T 1/2 ≥ 300 min) in 25 patients. Vomiting and dysphagia, but neither early satiety nor bloating, correlated with delayed gastric emptying. Diabetes was associated with grossly abnormal gastric T 1/2. Idiopathic gastroparesis was associated with a younger age at GES. No correlation was observed between gastric T 1/2 values and gender, smoking, H. pylori infection, HBA1C, or microvascular complication of diabetes. CONCLUSIONS INFERENCES: Vomiting and dysphagia are predictive of delayed gastric emptying in both diabetic and nondiabetic subjects. Diabetes is associated with more severe gastroparesis.

Symptoms of craniomandibular dysfunction in professional orchestra musicians

BACKGROUND

Up to 80% of professional musicians are affected by playing-related musculoskeletal disorders, but data regarding the frequency of craniomandibular dysfunction (CMD) in professional orchestra musicians is scarce.

AIMS

To evaluate the frequency of CMD and its relation to musculoskeletal pain in various body regions.

METHODS

A questionnaire-based survey approach assessing CMD symptoms and musculoskeletal pain in professional orchestra players was adopted. Relative prevalence rates and prevalence ratios for different instrument groups were estimated.

RESULTS

A total of 408 musicians completed the questionnaire (response rate 57%). Playing-related pain in the teeth or jaw was reported by 19-47% of musicians and TMJ pain by 15-34%, depending on the instrument group. Current pain in the face indicating a painful CMD was reported in 6-10% and related symptoms such as teeth grinding in 25-34%, jaw clenching in 33-42% and jaw locking in 11-18% of musicians. Females were 2.4 times (95% confidence intervals (CI) 1.49-3.84) more likely to report having had orofacial pain within the last month. Musicians reporting orofacial pain within the last month were 4.8 times (95% CI: 2.83-8.02) more likely to report pain in the neck and 2.5-3.8 times (P < 0.05) more likely to report pain in other body regions, including shoulders, right wrist, left fingers and the thoracic and lumbar spine.

CONCLUSIONS

Symptoms suggesting CMD were common in this study of professional orchestra musicians and were associated with pain in the neck, shoulder and hands. There is a need to enhance awareness of CMD to optimize early medical diagnosis and treatment.

Wavelength-tunable, sub-picosecond pulses from a passively Q-switched microchip laser system

We present a novel concept to generate sub-picosecond pulses from a passively Q-switched Nd:YVO4 microchip laser system with an adjustable wavelength shift up to a few tens of nanometers around the original emission wavelength of 1064 nm. This concept comprises two stages: one that carries out a nonlinear compression of fiber-amplified microchip pulses and a subsequent stage in which the compressed pulses are coupled into a further waveguide structure followed by a bandpass filter. In a proof-of-principle experiment, pedestal-free 0.62 ps long pulses have been demonstrated with a wavelength shift to 1045 nm.

Ist eine Höhenrekonstruktion mit vergleichsweise wenig Zement für die Radiofrequenz-Kyphoplastie über einen monopedikulären Zugang möglich?

Hintergrund: Perkutane Zementaugmentationssysteme haben sich in den letzten 10 Jahren als eine effektive Behandlungsmethode bei Kompressionsfrakturen durchgesetzt. Als Sonderform ist nun seit 2009 die Radiofrequenz-Kyphoplastie (RF) hinzugekommen, die durch applizierbare Energie die Viskosität des Zements erhöht. Ziel dieser Studie war es, herauszufinden, ob mit einer vergleichsweise geringen Zementmenge eine Wirbelkörpererhöhung für osteoporotische Wirbelkörperfrakturen bei der RF-Kyphoplastie zu erreichen ist. Material und Methode: Bei diesem minimalinvasiven Verfahren wurde das „StabiliT® Vertebral Augmentation System“ der Firma DFine verwendet. Im Rahmen einer retrospektiven Studie wurden von 2011 bis Januar 2012 insgesamt 35 Patienten mit 49 osteoporotischen Wirbelkörperfrakturen versorgt. Als Parameter wurden die Altersstruktur mit Geschlechtsverteilung sowie klinisch der Verlauf der Schmerzintensität anhand der visuellen Analogskala (VAS0–100) ausgewertet. Radiologisch wurde die Wirbelkörpererhöhung (Vorder-, Hinterkante, mittlere Wirbelkörperhöhe und Kyphosewinkel) erfasst und mit dem applizierten Zementvolumen verglichen. Ergebnisse: Alle Patienten hatten vor der Operation eine gescheiterte konservative Behandlung mit weiterhin bestehenden Schmerzen auf Höhe des frakturierten Wirbelkörpers. Bis zur operativen Versorgung vergingen durchschnittlich 3,0 ± 1,3 Wochen. Die durchschnittliche VAS reduzierte sich signifikant von 71 ± 9,2 präoperativ auf 35 ± 6,2 postoperativ (p < 0,001) und nach 3 Monaten weiter auf 30 ± 5,7 (p < 0,001). Mit einem durchschnittlichen Zementvolumen von 2,9 ± 0,7 ml (1,8–4,1) im Thoralbereich und einem durchschnittlichen Zementvolumen von 3,0 ± 0,7 ml (2,0–5,0) im Lumbalbereich wurde eine statistisch signifikante Wirbelkörperaufrichtung erreicht. Die Vorderkante und die mittlere Wirbelkörperhöhe wurden signifikant um 2,3 mm und 3,1 mm angehoben, der Kyphosewinkel reduzierte sich ebenfalls signifikant um 2,1° nach 3 Monaten. Bei 2 Wirbelkörpern (4,1 %) zeigte sich ein minimaler Zementaustritt in die angrenzende Bandscheibe ohne klinische Konsequenz. Bei 2 Patienten entwickelten sich Anschlussfrakturen im kranialen Segment, die erneut mit einer RF-Kyphoplastie behandelt wurden. Schlussfolgerung: Mit einem durchschnittlichen Zementvolumen von 3 ml konnte mit der RF-Kyphoplastie eine schnelle und kurzfristige Besserung der Schmerzsymptomatik erreicht werden. Zusätzlich konnte mit diesem geringen Zementvolumen eine signifikante Wirbelkörperaufrichtung erzeugt werden. Es zeigte sich keine Korrelation zwischen der Wirbelkörperaufrichtung und dem klinischen Ergebnis. Mit der ermittelten Zementleckagenrate von 4,1 % gehört die Radiofrequenz-Kyphoplastie zu den sicheren und effektiven minimalinvasiven perkutanen Zementaugmentationsverfahren. Unsere Daten bestätigen die in der Literatur angegebene höhere Sicherheit für die Kyphoplastie im Vergleich zur Vertebroplastie.

Playing-related musculoskeletal disorders in music students-associated musculoskeletal signs

BACKGROUND

Pain and overuse are common problems for musicians. Up to 80% of professional musicians suffer from playing-related musculoskeletal disorders (PRMD). The prevalence rate in music students is very high as well. Sufficient data on the underlying musculoskeletal dysfunctions however is scarce. Additionally, the self-assessment of health in musicians seems to differ compared to non-musicians, which might influence their attitudes concerning preventive strategies.

AIM

Evaluation of frequency of PRMD in music students, investigation of signs and symptoms in music students compared to non-music controls, comparison of self-reported health and well-being between the two groups.

DESIGN

Prospective, cross-sectional, case control, non-randomized.

SETTING

Other (University volunteers).

POPULATION

Music students in comparison to a non-music control group.

METHOD

Musculoskeletal examination and questionnaire of 36 volunteers of a music university and 19 volunteer students of an university of education were analyzed. The total number of musculoskeletal dysfunctions and differences between the student groups were examined. The personal pain and health self-rating were compared between music and non-music students.

RESULTS

Eighty one percent of musicians experienced PRMD. Musicians experienced 6.19 pain regions on average compared to 4.31 of non-musicians. Musicians experiencing PRMD reported significantly (P<0.05) more pain locations than musicians without. Music students presented with nearly the double amount (8.39 versus 4.37) of musculoskeletal dysfunctions per person compared to the non-music control group. Nevertheless, musicians significantly (P<0.05) rated their health more positively than the controls.

CONCLUSION

Musicians presented with more pain regions and a higher amount of musculoskeletal dysfunctions. Further studies evaluating the clinical relevance and their role in the development of PRMD are warranted.

CLINICAL REHABILITATION IMPACT

Screening of musicians for musculoskeletal dysfunction may identify those musicians at increased risk. Early treatment may prevent PRMD in musicians. Additional research is needed to confirm our hypothesis.

Dispersion-free pulse duration reduction of passively Q-switched microchip lasers

We present a dispersion-free method for the pulse duration reduction of passively Q-switched microchip laser (MCL) seed sources. This technique comprises two stages: one that carries out the self-phase modulation induced spectral broadening in a waveguide structure and a subsequent spectral filtering stage in order to shorten the pulses in time domain. The setup of a proof-of-principle experiment consists of a fiber-amplified passively Q-switched MCL, a passive single-mode fiber used as nonlinear element in which the spectrum is broadened, and a reflective volume-Bragg-grating acting as bandpass filter. A reduction of the pulse duration from 118 to 32 ps with high temporal quality has been achieved with this setup.

Sub-5-ps, multimegawatt peak-power pulses from a fiber-amplified and optically compressed passively Q-switched microchip laser

We report on high-energy picosecond pulse generation from a passively Q-switched and fiber-amplified microchip laser system. Initially, the utilized microchip lasers produce pulses with durations of around 100 ps at 1064 nm central wavelength. These pulses are amplified to energies exceeding 100 μJ, simultaneously chirped and spectrally broadened by self-phase modulation using a double stage amplifier based on single-mode LMA photonic crystal fibers at repetition rates of up to 1 MHz. Subsequently, the pulse duration of chirped pulses is reduced by means of nonlinear pulse compression to durations of 2.7 ps employing a conventional grating compressor and 4.7 ps using a compact compressor based on a chirped volume Bragg grating.

Assessment of response of brain metastases to radiotherapy by PET imaging of apoptosis with ¹⁸F-ML-10

PURPOSE

Early assessment of tumor response to therapy is vital for treatment optimization for the individual cancer patient. Induction of apoptosis is an early and nearly universal effect of anticancer therapies. The purpose of this study was to assess the performance of (18)F-ML-10, a novel PET radiotracer for apoptosis, as a tool for the early detection of response of brain metastases to whole-brain radiation therapy (WBRT).

MATERIALS AND METHODS

Ten patients with brain metastases treated with WBRT at 30 Gy in ten daily fractions were enrolled in this trial. Each patient underwent two (18)F-ML-10 PET scans, one prior to the radiation therapy (baseline scan), and the second after nine or ten fractions of radiotherapy (follow-up scan). MRI was performed at 6-8 weeks following completion of the radiation therapy. Early treatment-induced changes in tumor (18)F-ML-10 uptake on the PET scan were measured by voxel-based analysis, and were then evaluated by correlation analysis as predictors of the extent of later changes in tumor anatomical dimensions as seen on MRI scans 6-8 weeks after completion of therapy.

RESULTS

In all ten patients, all brain lesions were detected by both MRI and the (18)F-ML-10 PET scan. A highly significant correlation was found between early changes on the (18)F-ML-10 scan and later changes in tumor anatomical dimensions (r = 0.9).

CONCLUSION

These results support the potential of (18)F-ML-10 PET as a novel tool for the early detection of response of brain metastases to WBRT.

[Magnetic resonance imaging and ultrasonography in dogs and cats with ocular and orbital diseases. Part 1: Ocular diseases]

OBJECTIVE

This two-part study describes the clinical usefulness and value of ultrasound and magnetic resonance imaging (MRI) in dogs and cats with ocular (n=30) and orbital diseases (n=31). MRI and ultrasonography characteristics are described in single cases with ocular and orbital disease.

MATERIAL AND METHODS

Ultrasonography and MRI were performed in 15 dogs and 15 cats with intraocular neoplasia or intraocular inflammatory disease.

RESULTS

In all patients with intraocular neoplasia, sonography revealed masses with increased echogenicity and fairly uniform echotexture, thus allowing the tentative diagnosis of an intraocular tumour. In these cases, MRI often proved to be a valuable diagnostic tool in showing the complete extent of intraocular lesion. An additional benefit of MRI was seen in the tissue characterization of tumours based on MRI signal characteristics and pattern of contrast enhancement. Discreet intraocular inflammatory alterations, in particular to the anterior and posterior segment of the eyeball, were more clearly shown by ultrasound than by MRI. Neoplasia could be excluded and inflammatory disease was successfully diagnosed using MRI due to the different image sequences with or without contrast medium administration. Traumatic ruptures of the lens capsule and the globe after trauma were depicted more clearly with MRI.

CONCLUSIONS AND CLINICAL RELEVANCE

When opacity of the anterior eye segment is present, various intraocular changes can be quickly diagnosed by ultrasound with high accuracy, without requiring anaesthesia of the patient. MRI of the globe allows differentiation of diverse pathologies, gives detailed information of infiltration in orbital structures and the exact degree of ocular lesions after trauma. This additional evidence often makes it easier to predict the correct prognosis and choose the best therapy.

454 EST analysis detects genes putatively involved in ginsenoside biosynthesis in Panax ginseng

Panax ginseng C.A. Meyer is one of the most highly valued medicinal plants in the world. To analyze the transcriptome of P. ginseng and discover the genes involved in ginsenoside biosynthesis, cDNAs derived from the total RNA of 11-year-old, wood-grown P. ginseng roots were analyzed by 454 sequencing. A total of 217,529 high quality reads (expressed sequence tags, ESTs), with an average length of 409 bases, were generated from a one-quarter run to yield 31,741 unique sequences. The majority (20,198; 63.6%) of the unique sequences were annotated using BLAST similarity searches. A total of 16,810 and 16,577 unique sequences were assigned to functional classifications and biochemical pathways based on Gene Ontology analysis and the Kyoto Encyclopedia of Genes and Genomes assignment, respectively. Nine genes involved in the biosynthesis of ginsenoside skeletons and many candidate genes putatively responsible for modification of the skeletons, including 133 cytochrome P450s and 235 glycosyltransferases, were identified. From these candidates, six transcripts encoding UDP-glycosyltransferases that were most likely to be involved in ginsenoside biosynthesis were selected. These results open a new avenue by which to explore and exploit biosynthetic and biochemical properties that may lead to drug improvement. These 454 ESTs will provide the foundation for further functional genomic research into the traditional herb P. ginseng or its closely related species.

FDG PET/CT early dynamic blood flow and late standardized uptake value determination in hepatocellular carcinoma

PURPOSE

To prospectively determine whether fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) early dynamic blood flow estimates could be used to discriminate hepatocellular carcinoma (HCC) from background liver and to characterize HCC in patients with and those without angioinvasion; and to evaluate the association between blood flow measures at FDG PET/CT with metabolism in HCCs.

MATERIALS AND METHODS

Institutional review board approval and written informed consent were obtained for this prospective study. Twenty-one consecutive patients (mean age, 65 years) with 30 established HCCs (mean size, 5.5 cm; seven lesions in five patients with angioinvasion) underwent a blood flow study with an FDG dynamic scan divided into 18 sequences of 5 seconds each and a standard PET/CT scan. On the dynamic study, three independent operators obtained volumes of interest (VOIs) for which three blood flow estimates were calculated (hepatic perfusion index [HPI], time to peak [TTP], and peak intensity [PI]). On the late study, a VOI was placed on the fused scan for each HCC, and maximum standardized uptake value (SUV(max)) was obtained. By using a mixed-effects model analysis, comparison of blood flow estimates between HCC with and that without angioinvasion and background liver was performed. The association between blood flow estimates and SUV(max) was also assessed.

RESULTS

HPI and TTP showed better performance than did SUV(max) for discriminating HCC and background liver (areas under receiver operating characteristic curve: 0.96, 0.95, and 0.83, respectively; P < .05). HPI was higher in HCC in patients with angioinvasion (0.91 ± 0.15 [standard deviation]) than in those without angioinvasion (0.80 ± 0.18; P = .03). There was no difference in SUV(max) between HCC in patients with and those without angioinvasion (7.8 ± 2.9 vs 6.3 ± 3.4; P = .85). No clear association was found between HPI, PI, or TTP and SUV(max) (P = .49, .77, and .91, respectively).

CONCLUSION

Early dynamic blood flow FDG PET/CT may be used to help discriminate and characterize HCC tumors.

Blindness as a sign of proventricular dilatation disease in a grey parrot (Psittacus erithacus erithacus)

An approximately eight-year-old female grey parrot (Psittacus erithacus erithacus) was presented with a two months history of blindness. The radiographic examination showed a dilatation of the proventriculus, ventriculus and gut. Ophthalmoscopy and electroretinography revealed degeneration of the retina. A proventricular dilatation disease was suspected. The bird was euthanased because of deteriorating condition and poor prognosis. The pathological examination showed an atrophy of the ventricular muscles and lymphoplasmacytic infiltrates of the myenteric plexus of the proventriculus, ventriculus and gut as well as moderate lymphoplasmacytic infiltrates of the cerebrum with moderate neuronophagia. Lymphoplasmacytic infiltrates in the retina, indicating proventricular dilatation disease, and subsequent retinal degeneration were found. A potential common aetiology for proventricular dilatation disease and blindness is discussed.

Search for Lorentz and CPT violation effects in Muon spin precession

The spin precession frequency of muons stored in the (g-2) storage ring has been analyzed for evidence of Lorentz and CPT violation. Two Lorentz and CPT violation signatures were searched for a nonzero delta omega a(=omega a mu+ - omega a mu-) and a sidereal variation of omega a mu+/-). No significant effect is found, and the following limits on the standard-model extension parameters are obtained: bZ = -(1.0+/-1.1) x 10(-23) GeV; (m mu dZ0 + HXY)=(1.8+/-6.0) x 10(-23) GeV; and the 95% confidence level limits b perpendicular mu+ <1.4 x 10(-24) GeV and b perpendicular mu- <2.6 x 10(-24) GeV.

Das Management des Glaukoms bei Hund und Katze

Das Glaukom als akuten Notfall zu erkennen und umgehend eine drucksenkende Therapie einzuleiten, ist die Grundvoraussetzung für den Erhalt der Sehkraft des betroffenen Auges. Beim Vorliegen eines Sekundärglaukoms ist die Beseitigung der Ursache wesentlicher Bestandteil der Behandlung. Tiere mit einem Primärglaukom bleiben in der Regel nach einem initialen Druckanstieg lebenslang “Augenpatienten”, die einer regelmäßigen, frequenten Kontrolle bedürfen. Diese dient der individuellen Therapieanpassung. Die therapeutischen Möglichkeiten umfassen sowohl medikamentöse als auch chirurgische Maßnahmen. Ein aufgrund eines Glaukoms irreversibel erblindetes Auge (Buphthalmus) sollte chirurgisch entfernt werden.

Acute infantile bilateral striatal necrosis: single-photon emission computed tomography (SPECT) imaging and review

Acute infantile bilateral striatal necrosis is a rarely described acute neurological syndrome associated with radiological findings. Its etiology and pathogenic mechanisms are unknown. Clinically, the syndrome usually follows respiratory illnesses and presents with an array of neurological findings, including axial ataxia, grimacing, mutism, head nodding, and high-pitched cry. This study follows a child with acute infantile bilateral striatal necrosis both clinically and radiologically. In addition, for the first time, the authors describe the serial findings of single-photon emission computed tomography (SPECT) from onset of illness through 20 months. Their findings indicate an initial insult apparent on both magnetic resonance imaging and SPECT localized to the basal ganglia, which, although improved over time, does not fully regress. The residual lesion on SPECT was clinically associated with only mild attention deficit disorder and no motor pathology. The authors review the published literature concerning acute infantile bilateral striatal necrosis and suggest possible mechanisms of this poorly understood and probably underreported condition.

Benign hereditary chorea: clinical, neuroimaging, and genetic findings

Benign hereditary chorea is an autosomal dominant disease with an early onset of symptoms. In some families, symptoms tend to decrease in adulthood, suggesting that the disorder results from a developmental disturbance in the brain. Individuals with benign hereditary chorea, a nonprogressive disease, have normal or slightly below normal intelligence. The locus for benign hereditary chorea is on chromosome 14. Benign hereditary chorea is a result of mutations in the thyroid transcription factor 1 gene. Previous neuroimaging and pathological investigations of the brain showed no notable abnormalities in patients with this condition. In this study, 5 patients from 1 family with typical clinical features of benign hereditary chorea are presented. Clinical severity varied considerably in the family. Brain magnetic resonance imaging results were normal. Brain single photon emission computed tomography in 3 children, performed 1 hour after intravenous injection of 0.35 mCi/kg of body weight of technetium 99m ethyl cysteinate dimer, showed markedly decreased uptake in the right striatum and the right thalamus in 1 child. The oldest child had mildly reduced uptake in the right putamen and the left thalamus. Brain single photon emission computed tomographic findings in the youngest child were normal. Contrary to other reports of radionuclide brain imaging, notable brain single photon emission computed tomography changes were detected in 2 of 5 patients. Brain single photon emission computed tomography findings did not seem to correlate with the clinical status of the children.

Quantitative Lung Perfusion Following Single Lung Transplantation

BACKGROUND

Following successful lung transplantation, most of the lung perfusion, as well as ventilation, is shifted towards the transplanted lung. We investigated the changes in perfusion during exercise in lung transplant recipients.

PATIENTS AND METHODS

Twelve patients were included in the study. Six patients had emphysema and 6 patients had idiopathic pulmonary fibrosis (IPF). Patients underwent two upright lung perfusion scans: the first at rest and the second during a maximal cardiopulmonary exercise test. Lung perfusion was assessed in each lung and regionally.

RESULTS

At rest, patients with emphysema had 83.3 +/- 8 % of total perfusion to the transplanted side and 16.7 +/- 8 % to the native lung, while in the IPF patients, it was 68.7 +/- 12 and 32.7 +/- 10 %, respectively ( P = 0.028). At peak exercise, perfusion shifted from the transplanted lung to the native lung ( P = 0.0095) both in emphysema and IPF patients.

CONCLUSIONS

Following successful lung transplantation, most of the perfusion is directed towards the transplanted lung. During exercise, there was a small but significant shift towards the native lung. These findings highlighted the important role of the native lung during maximal exercise.

Treatment of neuroblastoma using the fused imaging guided radiotherapy (FIGURA) system

PURPOSE

The purpose of this study was to describe our department's experience with the fused imaging-guided radiotherapy (FIGURA) system for planning radiation treatment of high-risk neuroblastoma.

PATIENTS AND METHODS

Between 1999 and 2002, 11 patients received radiation therapy as consolidation after chemotherapy in 9 and for palliation in 2. Diagnostic metaiodobenzylguanidine (MIBG) imaging was used, which is specific for neuroblastoma, to identify the residual tumor, followed by computed tomography scanning in the radiation treatment position. The FIGURA software fused the images obtained by the 2 modalities and transferred the result to a 3-dimensional radiation treatment planning system. Radiation was delivered at a total dose of 25.2 Gy according to the FIGURA.

RESULTS

Five patients achieved complete remission and 2 partial remission; 3 were stabilized. One child with a highly rapid progressive course died of the disease.

CONCLUSION

FIGURA is a new, feasible technique for defining target volumes. By using standard hospital equipment, it is possible to treat residual disease identified by sensitive metaiodobenzylguanidine imaging and localized with the anatomic computed tomography scan. Treating a more accurate target volume spares normal tissue and organs and minimizes side effects.

Chronische Therapie des metabolischen Syndroms bei herzoperierten Diabetikern

Patients with type 2 diabetes often also exhibit additional features of the metabolic syndrome. These include specifically central obesity triggering development and maintenance of diabetes together with arterial hypertension, hypertriglyceridemia and low levels of high-density lipoprotein cholesterol. Chronic therapy of the metabolic syndrome in diabetics after coronary bypass surgery focuses on changes in lifestyle, i.e., cessation of smoking, changes in nutrition and increase in physical activity. Nutrition aims at fat reduction and modification to reduce saturated fatty acids, to allow mono- and polyunsaturated fatty acids instead, and moderate alcohol consumption. High fiber and complex carbohydrate diet complete the recommendations. Nutrition therapy connected to increases in physical activity are aimed at reducing weight in overweight and obese subjects, which should reduce their body weight by 5 to 10% within about 6 months. Normal weight subjects benefit from increases in physical activity by lipid and glucose regulation as well as by reduction in mortality.Diabetes-specific therapy aims at normoglycemia including postprandial blood glucose levels, reduces blood pressure supported by ACE inhibitors and aims at weight reduction. Reduction of LDL-cholesterol is the first line therapy, also diminishing small-dense LDL particles. Decreasing triglycerides and increasing HDL-cholesterol are further lipid-regulating aims. Specifically diabetics after coronary bypass surgery need LDL-cholesterol levels below 70 mg/d (1.8 mmol/L) and triglycerides below 150 mg/dL (1.7 mmol/L). In addition, in males HDL-cholesterol should be at least above 40 mg/dl (1 mmol/L), in females above 50 mg/dL (1.3 mmol/L).

Empfehlungen zur Statintherapie im Alter

Elderly patients are significantly less likely to receive statins than younger patients possibly because of doubts regarding compliance or concerns regarding the increased likelihood of adverse events and drug interactions. Poor compliance can be expected especially in patients suffering from dementia or depression as well as those whose stage of cardiovascular disease exhibits few symptoms. On the other hand, the clinical significance of CHD events is high in the elderly, and 80% of coronary deaths occur in patients aged over 65 years. The average statistical life expectancy of elderly and old patients is often underestimated. The HPS and PROSPER studies showed that statins reduce mortality and morbidity even in very elderly individuals with a high global cardiovascular risk and/or CAD. Patients up to the age of 79 years should be treated according to the same guidelines as younger patients. Statin therapy should only be considered for patients aged 80 years and older who are at a very high risk for cardiovascular events.