Signaling pathways in cutaneous wound healing

Wound healing is a very complex process, where variety of different pathways is activated, depending on the phase of healing. Improper or interrupted healing might result in development of chronic wounds. Therefore, novel approaches based on detailed knowledge of signalling pathways that are activated during acute or chronic cutaneous wound healing enables quicker and more effective healing. This review outlined new possibilities of cutaneous wound healing by modulation of some signalling molecules, e.g., gasotransmitters, or calcium. Special focus is given to gasotransmitters, since these bioactive signalling molecules that can freely diffuse into the cell and exert antioxidative effects. Calcium is an important booster of immune system and it can significantly contribute to healing process. Special interest is given to chronic wounds caused by diabetes mellitus and overcoming problems with the inflammation.

Evaluation of chromatographic performance of three C18 columns for avenanthramides separation

Phenolic amides contained in oats (Avenanthramides; AVNs) are biologically active substances with strong antioxidant activity. In this paper, we evaluated efficiency of three C18 chromatographic columns (Symmetry, XBridge, Cortecs) with different particle technology and particle sizes for the separation of three major avenanthramides (AVN A, AVN B, AVN C). We compared columns in terms of retention times, retention factors of AVNs and in terms of other parameters such as number of theoretical plates, height equivalent to a theoretical plate, reduced plate height, resolution and in terms of peak symmetry, respectively. Limits of detection and limits of quantification of AVNs on all columns were calculated. Retention results of AVNs on individual columns showed a significant reduction in retention times of AVNs on solid core column with a particle size 2.7 μm compared to columns with particle size 3.5 μm. Within columns with 3.5 μm particles, separation on Symmetry C18 column appeared to be more efficient than on the XBridge C18 column. In general, results achieved on Cortecs C18 column can be considered as the best in terms of both separation efficiency and retention times.

Reflecting Before, During, and After the Heat of the Moment: A Review of Four Approaches for Supporting Health Staff to Manage Stressful Events

Being a healthcare professional in both paediatric and adult hospitals will mean being exposed to human tragedies and stressful events involving conflict, misunderstanding, and moral distress. There are a number of different structured approaches to reflection and discussion designed to support healthcare professionals process and make sense of their feelings and experiences and to mitigate against direct and vicarious trauma. In this paper, we draw from our experience in a large children's hospital and more broadly from the literature to identify and analyse four established approaches to facilitated reflective discussions. Each of the four approaches seeks to acknowledge the stressful nature of health professional work and to support clinicians from all healthcare professions to develop sustainable skills so they continue to grow and thrive as health professionals. Each approach also has the potential to open up feelings of uncertainty, frustration, sorrow, anguish, and moral distress for participants. We argue, therefore, that in order to avoid unintentionally causing harm, a facilitator should have specific skills required to safely lead the discussion and be able to explain the nature, scope, safe application, and limits of each approach. With reference to a hypothetical but realistic clinical case scenario, we discuss the application and key features of each approach, including the goals, underpinning theory, and methods of facilitation.

MicroRNA and hyperaggregability of platelets in women with sticky platelet syndrome and pregnancy complications

AIMS

We aimed to characterize relationship between the expression profiles of platelet miR-96, miR-126 and miR-223 and platelet function examination in patients with sticky platelet syndrome (SPS) and in healthy controls.

BACKGROUND

MicroRNAs (miRNA, miR) are a group of small and non-coding RNAs involved in many mechanisms as regulators of post-transcriptional protein expression in platelets. SPS is defined as platelet hyperaggregability after administration of low doses of adenosine diphosphate and/or epinephrine. Clear genetic abnormality of this syndrome is not known yet.

METHODS

We examined 45 patients with SPS and 30 healthy volunteers. For functional platelet examination we used light transmission aggregometry, and qRT-PCR was used to determine the expression of the miRNAs.

RESULTS

We observed no relationship of the platelet miRNA expression with functional platelet examination in the entire cohort of patients with SPS. However, in a group of patients with SPS and pregnancy complications, we found that the expression of platelet miR-96 (p = 0.009) was up-regulated.

CONCLUSION

In spite of the multiple limitations of the study, it can be considered that the increased expression of platelet miR-96 found in a group of patients with SPS and pregnancy complications could be related to the hyperaggregability in these selected patients (Tab. 2, Ref. 31).

Hyaluronic acid application vs arthroscopy in treatment of internal temporomandibular joint disorders

AIMS

The goal of this study was to compare the treatment outcome after two different treatment modalities in cases of disc displacement of the temporomandibular joint diagnosed via magnetic resonance technique, namely surgical procedure in form of arthroscopic lysis and lavage vs. hyaluronic acid superior joint space application.

MATERIALS AND METHODS

Magnetic resonance imaging was performed before and one year after treatment. Simultaneously, pre- and post-treatment visual analogue scales and maximal mouth opening distance were documented.

RESULTS

In our study, out of the total of 145 patients who were initially diagnosed with magnetic resonance imaging to have internal derangements and treated with arthroscopic lysis and lavage or hyaluronic acid application, we observed progression of internal derangement in 27 cases (18.6 %), improvement in 37 cases (25.5 %) and stationary state in 81 patients (55.9 %). Both treatment methods significantly improved the followed maximal mouth opening distance and visual analogue scale, as confirmed upon the 12‑month follow-up examination. Maximal mouth opening was 4.7mm for hyaluronic acid application and 12.2mm for arthroscopic lysis and lavage (p<0.005). The mean visual analogue scale values decreased from 6.2 to 2.1 for hyaluronic acid application and from 6.9 to 1.2 for arthroscopic lysis and lavage (p<0.005).

CONCLUSION

Our study shows that both arthroscopic lysis and lavage and hyaluronic acid injections are effective and safe in the treatment of disc displacement in the temporomandibular joint (Tab. 3, Ref. 30).

Determination of Lipid Oxidation Level in Broiler Meat by Liquid Chromatography

An assay was conducted for the determination of malondialdehyde (MDA) levels in broiler meat. The method involves extraction of tissues with trichloroacetic acid (TCA) and reaction of the TCA extract with 2,4-dinitrophenylhydrazine (DNPH). After separation of the MDA-DNPH complex using a solid-phase extraction C18 column, samples were eluted with 1 mL acetonitrile. Aliquots of 20 μL acetonitrile were analyzed by liquid chromatography on reversed-phase C18 column (3 μm) with UV detection. The products were eluted isocratically with the mobile phase containing acetonitrile–water–acetic acid (39 + 61 + 0.2, v/v/v). The retention time was for MDA-DNPH was 6.5 min, and the detection limit was 3.5 μg/kg. Two extraction methods (cold and hot) were also used in the study. The results showed that hot extraction increased results about 55.8% and recovery from samples spiked with 116.6 μg/kg was lower (74.6%) in comparison with cold extraction (94.7%).

Phenolic compounds and biological activities of rye (Secale cereale L.) grains

The rye flour is, together with the wheat flour, the basic ingredient used in traditional bread baking. The rye grain contains many compounds with significant impacts on the consumer. Considering that, various biologically active phytochemicals were determined in extracts from mature grains of 19 rye genotypes (Secale cereale L.). The content of total phenols, flavonoids, phenolic acids and thiols, as well as antioxidant activities and inhibitory activities against trypsin, thrombin, and urokinase were analyzed by spectrophotometric methods. The vanillic acid, vanillin, p-coumaric acid, and t-ferulic acid were analyzed in particular by high performance liquid chromatography (HPLC). The observed differences in the amounts and activities between rye genotypes reflected variations in their genetic background. Rye grain is a remarkable source of specific phytochemicals. Genetic diversity in rye makes it possible to identify individual genotypes that have a unique content and biological activity of compounds deposited in mature grains. One subgroup of rye genotypes had higher values of antioxidant properties and concentrations of polyphenols. Other sub-group had higher proteinase inhibitory activities and contents of polyphenols. The third sub-group contained as though the universal genotypes, i.e. genotypes with average values in nearly all the measured parameters.

Comparison of Two Different Techniques Of Warfarin Dosing Determination - A Chemometrics Study

A high prevalence of genetic polymorphisms increases sensitivity to warfarin therapy. In this study, we investigated 47 patients with effective long-term therapy by warfarin well-controlled by monitoring of International Normalised Ratio (INR). All patients were tested for gene polymorphisms VKORC1, CYP2C9*C2, and CYP2C9*C3, which were used for a dose calculation employing a program www.WarfarinDosing.org. The main goal was to investigate whether the warfarin doses determined by INR are in accordance with the doses calculated according to the pharmacogenetic algorithm. For this purpose, several chemometric tools, namely principal component analysis, cluster analysis, correlation analysis, correspondence analysis, Passing-Bablock regression, Bland-Altman method, descriptive statistics, and ANOVA were used. We also analysed the relationship between the dose of warfarin determined by INR and several constitutional and genetic factors. Statistically significant association between clinically optimized warfarin dose and indication for the treatment, age, and warfarin sensitivity determined by VKORC1, CYP2C9 gene polymorphisms were confirmed. Finally, we confirmed a good concordance between the INR determined warfarin doses and pharmacogenetic approach.

Mild antithrombin deficiency and risk of recurrent venous thromboembolism: results from the MEGA follow-up study

Essentials Mild antithrombin deficiency may increase the risk of recurrent venous thromboembolism (VTE). In a cohort study, we stratified patients with VTE to various cut-off antithrombin levels. A 1.6-3.7-fold increased risk of recurrent VTE was observed in the lowest antithrombin categories. Mild antithrombin deficiency (activity < 5th percentile of normal) increases recurrent VTE risk.

SUMMARY

Background Mild antithrombin deficiency (previously defined as antithrombin activity below 70% or 80%) has been associated with a 2.4-3.5-fold increased risk of recurrent venous thromboembolism (VTE). This finding may have implications for duration of antithrombotic therapy in VTE patients with mild antithrombin deficiency. Objectives To externally validate whether mild antithrombin deficiency is a risk factor for recurrent VTE. Methods In a population-based cohort study, patients with a first VTE (n = 2357) were stratified according to percentile cut-off antithrombin levels (< 5th [< 87%], 5-10th [87-92%], > 10th percentile [> 92%]) and functional antithrombin levels (< 70%, 70-80%, > 80%). Results During a median follow-up of 7.4 years, 361 recurrent events occurred (incidence rate, 2.5/100 patient-years). We observed an increased risk of recurrent VTE in the lowest antithrombin activity category (< 5th percentile; < 87%) as compared with antithrombin activity that was > 10th percentile (> 92%), with an adjusted hazard ratio (HR) of 1.5 (95%CI, 1.0-2.3). When analyses were stratified to antithrombin cut-off criteria of< 70% vs. patients with antithrombin activity > 80%, the adjusted HR for venous recurrence was 3.7 (95% CI, 1.4-9.9). Mild antithrombin deficiency was able to predict recurrent VTE over at least 8 years of follow-up and the association remained present when the population was stratified to the presence or absence of thrombosis risk factors. Restriction analyses, where patients who used anticoagulation at time of blood draw and those who reported drinking ≥ 5 glasses alcohol daily were excluded, did not materially affect these outcomes. Conclusion This study confirms that mild antithrombin deficiency is a risk factor for recurrent VTE.

A Perinatal Database Management System

Obstetric services have long recognized the need for ongoing evaluation of their experiences. Manual »departmental statistics« systems sufficed, but with the advent of more sophisticated care, perinatal re-gionalization and increased research activity, the potential usefulness of computer technology became obvious. At Cleveland Metropolitan General Hospital, a laboratory computer based patient information file system was designed and implemented beginning in 1974. Over the succeeding six years, data have been collected and stored for all delivered pregnancies. There are now over 61,000 files for more than 20,000 consecutively delivered patients. The system provides over 40,000 clinical reports per year. However, the use of a file-oriented system has limited our ability to respond to specific research queries. The application of a relational database management system, INGRES, for perinatal information is reported here. Examples of its use for efficiently »answering questions« are presented, as are guidelines for the development and implementation of computer-based perinatal record systems.

Isolated orbital mucoceles in the absence of obstructive sinus disease

Orbital surgeons are quite familiar with the diagnosis and management of paranasal sinus mucoceles due their frequent involvement of the orbit. These benign masses form and expand following sinus outflow obstruction secondary to various causes including trauma, inflammation and malignancy, amongst others. The authors present two cases of isolated orbital mucoceles without associated sinus outflow obstruction. There were notably no connections between the paranasal sinuses and the lesions. The mucoceles were diagnosed following orbitotomies and excisional biopsies with confirmatory histopathology. These rare orbital lesions should be considered when evaluating cystic orbital lesions, and the orbital surgeon should be familiar with the proposed pathophysiology and treatment recommendations.

Monitoring of Hemostasis by Rotational Thrombelastometry During Normal Pregnancy and Postpartum

Background: Rotational thrombelastometry (ROTEM) is a real-time clotting test that provides insight into clotting factors, the fibrinolytic system and platelet function. We obtained the longitudinal values on ROTEM in normal pregnancy and in puerperium.

Material and Methods: After ethics committee approval and subject informed consent, citrated blood was sampled from healthy pregnants four times during pregnancy and one time postpartum. As controls we used nonpregnant women undergoing voluntary blood donation. Extem and Intem tests and basic coagulation test were carried out.

Results: We included 112 women in our study, 55 non-pregnant women (controls) and 57 healthy pregnants with 5 samplings. The values of maximum clot firmness (MCF - in EXTEM and INTEM) were significantly higher up to 34th-36th week of pregnancy than those in non-pregnant subjects. MCF in 6th-7th week after delivery was significantly higher in both tests. Clotting time (CT) in pregnant women was significantly shorter (EXTEM) compared to non-pregnant subjects. We also found a very strong correlation between MCF and platelet count in all gestational weeks.'

Conclusions: Rotation thromboelastometry clearly demonstrates the hypercoagulability in pregnancy and can reflect the higher risk of venous thromboembolism in both pregnancy and puerperium. Strong correlation between MCF and platelet count can suggest role of platelets in hypercoagulability in pregnant women. This study provides a better knowledge about physiological changes in ROTEM measurement during pregnancy and postpartum.

Activity of coagulation factor XI in patients with spontaneous miscarriage: the presence of risk alleles

The aim of this study was to compare the activity of coagulation factor XI (FXI) between patients with spontaneous miscarriage versus control group with no history of miscarriage and thrombosis, and then we evaluated the occurrence of risk alleles in the relation to miscarriage. FXI activity was determined using a coagulometer (Sysmex, CA 1500, Japan). Single nucleotide polymorphisms (SNPs) of F11 and CYP4V2 genes were evaluated. We examined 55 patients versus 31 control subjects. We found significantly higher activity of FXI (p = 0.04) in patients versus control subjects. The occurrence of two SNPs (rs2289252 and rs2036914) of the F11 gene and SNP (rs13146272) of CYP4V2 gene was not significantly different between both groups. Increased activity of FXI may be a potential risk factor for miscarriage. High activity of FXI diagnosed in women with history of miscarriage is not probably caused by the presence of studied SNPs.

Mercury and selenium concentrations in muscle tissue of different species of predatory freshwater fish and correlation between these elements

Concentrations of total mercury and selenium were determined in 49 and 42 muscle tissue samples, respectively, of six species of predatory freshwater fish, dace (Leuciscus leuciscus), pike perch (Sander lucioperca), pike (Esox lucius), European catfish (Silurus glanis), rainbow trout (Oncorhynchus mykiss) and asp (Aspius aspius). Muscle selenium concentration did not correlate with the corresponding total mercury concentration (R² < 0.198) in all examined predatory fish species. There was an inverse correlation between the ratio Se/Hg content and the total mercury content in the muscle tissues of dace, pike perch, pike, European catfish and asp. The muscle tissue of rainbow trout exhibits a linear correlation between the ratio Se/Hg content and the total mercury content. The total mercury concentration of all examined samples did not exceed the hygienic limit for Hg for predatory fish.

Endotracheal DNase for atelectasis in ventilated neonates

Management of atelectasis and lung collapse in ventilated neonates remains a common challenge in the neonatal intensive care unit. Recombinant human DNase (rhDNase) is an established treatment of atelectasis in cystic fibrosis and its use is also reported in the management of asthma, respiratory syncitial virus bronchiolitis and bronchiectasis to liquefy sputum and aid its clearance from the lungs. We report the use of rhDNase in a subgroup of ventilated neonates with severe end-stage respiratory failure and atelectasis. Three of the four patients showed clinical improvement. A previously undiagnosed lung anomaly was subsequently identified in the fourth patient. Future randomized studies could examine any potential benefits of this emerging therapy.

Estimation of the burden of pesticide residues in Slovak population

Pesticides used in the agriculture have to be applied according to the requirements of good agricultural practice and appropriate law. Pesticides leave detectable residues in agricultural crops, raw materials and ecosystem components. Pesticides reach the human population through the food chain. Information on the type and concentration of pesticide residues in food is in Slovakia collected trough the monitoring programs. Health risks associated with pesticides contaminants in human nutrition are very important and are recently studied by several expert groups. Prerequisite programs are necessary to protect public health. Risk analysis and monitoring of the population burden by pesticide contaminants have to be performed in expert level. The general strategy for assessment of toxicity of pesticides is listed by the World health Organisation. Scientific risk assessment is the basis for taking action and making the legislation at national and European community level.

Determination of lipid oxidation level in broiler meat by liquid chromatography

An assay was conducted for the determination of malondialdehyde (MDA) levels in broiler meat. The method involves extraction of tissues with trichloroacetic acid (TCA) and reaction of the TCA extract with 2,4-dinitrophenylhydrazine (DNPH). After separation of the MDA-DNPH complex using a solid-phase extraction C18 column, samples were eluted with 1 mL acetonitrile. Aliquots of 20 microL acetonitrile were analyzed by liquid chromatography on reversed-phase C18 column (3 microm) with UV detection. The products were eluted isocratically with the mobile phase containing acetonitrile-water-acetic acid (39 + 61 + 0.2, v/v/v). The retention time for MDA-DNPH was 6.5 min, and the detection limit was 3.5 microg/kg. Two extraction methods (cold and hot) were also used in the study. The results showed that hot extraction increased results about 55.8% and recovery from samples spiked with 116.6 microg/kg was lower (74.6%) in comparison with cold extraction (94.7%).

Inhaled nitric oxide for acute hypoxemic respiratory failure in children and adults

BACKGROUND

Acute hypoxemic respiratory failure affects all age groups and may result from a number of systemic diseases. It continues to be associated with high mortality and morbidity. Initial studies examining the effect of inhaled nitric oxide in respiratory failure demonstrated transient improvement in oxygenation but did not examine mortality or other significant morbidity outcomes.

OBJECTIVES

To systematically examine randomized controlled trials addressing the effect of inhaled nitric oxide, compared with placebo inhaled gas, on mortality and morbidity in patients with acute hypoxemic respiratory failure.

SEARCH STRATEGY

Randomized controlled trials were identified from electronic databases: The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2002;MEDLINE (January 1966-August 2002); EMBASE (1980-March 2001); CINAHL (1982-July 2002), as well as from bibliographies of retrieved articles. Relevant journals and conference proceedings were hand searched and authors published in this field were contacted for knowledge of unpublished ongoing trials.

SELECTION CRITERIA

Randomized controlled trials comparing inhaled nitric oxide with maximal conventional therapy and inhaled placebo, in either children or adults with acute hypoxemic respiratory failure.

DATA COLLECTION AND ANALYSIS

Qualitative assessment of each trial was made and analyses performed according to statistical methods in Review Manager MetaView 4.1. A sub-group analysis was performed to assess the impact of inhaled nitric oxide at varied doses.

MAIN RESULTS

Five randomized controlled trials were evaluated, assessing 535 patients with acute hypoxemic respiratory failure (Age range not provided). Lack of data prevented assessment of all outcomes. There was no significant difference of nitric oxide on mortality in trials without cross-over (RR 0.98, 95%CI 0.66,1.44). Published evidence from one study demonstrated nitric oxide to transiently improve oxygenation in the first 72 hours of treatment. Limited data demonstrated no significant difference in ventilator-free days between treatment and placebo groups, and no specific dose of nitric oxide was significantly advantageous over another. Other clinical indicators of effectiveness, such as duration of hospital and intensive care stay, were inconsistently reported. There were no significant complications directly attributable to this treatment.

REVIEWER'S CONCLUSIONS

Nitric oxide did not demonstrate any statistically significant effect on mortality and transiently improved oxygenation in patients with hypoxemic respiratory failure. Lack of data prevented assessment of other clinically relevant end points. If further trials comparing inhaled nitric oxide with an inhaled placebo are to proceed, they should be stratified for primary disease, assess the impact of other combined treatment modalities for respiratory failure, and must specifically evaluate clinically relevant outcomes, before any benefit of inhaled nitric oxide for respiratory failure can be excluded.

[The niches and pathways of animal pathogens]

Infectious diseases are not a relict of the past but a topical phenomenon determined by complex evolution of the currently existing and constantly changing microbial agents and their hosts. With regard to abundance of species within the microbial kingdom and rate of its changes and development, it is difficult to predict the role of the microbial factor in mortality of humans and animals. The study and generalization of sequential similarities of microbial virulence factors after the completion of genome sequencing of principal pathogens can play a positive role in this direction. At present, molecular-genetic methods allow us to study the phylogenetic relationships of microbes and categorize them according to new criteria. The efficient control of diseases caused by microbes requires knowledge on their physiological and ecological niche from which they penetrate, in various ways, into the host organisms and, under suitable conditions, induce mass diseases. This process has several stages and, in the recent period, it is increasingly affected by human activities. The knowledge on all participants in this process, i.e. the microbe and its niche, factors of virulence and pathways of their dissemination, requires a scientifically based surveillance. Abundance and variability is characteristic for both microbial kingdom and microbial niche. Some identification of pathogenic properties of microorganisms and factors affecting their movement from their niche to the recipients results in activation of old classical diseases (e.g. plague, cholera, tuberculosis etc.) or emerging of new, so far unknown infections diseases ("emerging inf. disease"--EID), caused for example by lentiviruses, oncoviruses, filiviruses, bartonella, borrelia etc. This has provided the basis for establishment of new medical trends and approaches, such as "Emergency medicine" or "Travel medicine", expressing their purpose by their names. The control of existing or proposed infectious diseases in the 21st century (in which majority of factors such as urbanization, environmental factors, evolution of the microbial kingdom, will contribute to the persistence or "emergence" of new diseases) will be affected by the input of new knowledge in the field of molecular biology, such as introduction of biosensors, genetic tests, microchips, new generation of DNA vaccines, enteric vaccines and antibodies produced by transgenic animal bioreactors or plants, "customized" vaccines assessed for individual genetic profiles, etc. (Tab. 5, Ref. 21.)

Characteristics of the myopic patient population applying for refractive surgery

PURPOSE

Assessment of the characteristics of the myopic patient population applying for refractive surgery in order to determine the potential market for myopic refractive surgery.

METHODS

Records of consecutive patients who responded to an advertisement for refractive surgery to correct myopia were evaluated retrospectively with regards to patient demographics and the amount and distribution of the refractive error. Data were compared to that available from population-based statistics for distribution of myopia in the general population. For statistical analysis, one sample Student's t-test and two tailed Student's t-test were utilized.

RESULTS

Two hundred fifty seven patients (140 women and 117 men) responded to an advertisement for refractive surgery during the six month period between January and June 1998. Mean spherical equivalent (SEQ) of the patient population was -4.59+/-2.54 D (min;-0.25 D, max;-15.75 D) right eye (OD) and -4.62+/-2.82 D (min;-0.25 D, max;-15.25 D) left eye (OS). Among the patients who had myopia with an astigmatism of at most 1.00 D (n=165), the distribution of refractive error was statistically significantly different from that obtained from population-based statistics, such that, although most of the myopic population (40%) had an SEQ of -1.00 to -2.25 D, the majority of our patients (54.8%) who applied for myopic refractive surgery had an SEQ of -2.50 to -5.00 D. Another striking difference was that, although patients with an SEQ more than -6.00 D were a minority(2%) in the population study, in our study group, they comprised 16.7% of the patients seeking refractive correction. The difference between the SEQ of the right and left eyes ranged from 0.00 D to 13.0 D (mean, 0.89+/-1.5 D), 47.1 % having a difference of at most +/-0.5 D between the two eyes. The mean cylindrical error in the patient population was 0.69+/-0.93 D (min: 0, max: -4.5) OD and 0.69+/-0.96 D (min: 0, max: -4.5) OS. There were no statistically significant differences between the distribution of SEQ or cylindrical refractive error between males and females.

CONCLUSION

Although a population-based study reported that most of the myopic population (40%) had an SEQ of -1.00 to -2.25 D, the majority of our patients (54.8%) who applied for myopic refractive surgery had an SEQ of -2.50 to -5.00 D. On the other hand, while patients with an SEQ of -6.00 D and more constituted only about 2% of the general population, they accounted for 16.7% of our study population. Therefore, the refractive characteristics of the patient population applying for myopic refractive surgery may not necessarily parallel that of general population-based statistics. In order to establish a more effective refractive surgery practice, it is feasible to perform local studies and reevaluate the requirements of your practice accordingly.

Is intraoperative topography predictive of postoperative topographical changes following refractive surgery?

PURPOSE

To evaluate the usefulness of measuring corneal topography intraoperatively by Intraoperative PAR Corneal Topography System (IOPAR CTS) to predict the postoperative topographical changes in patients undergoing refractive surgery.

METHODS

Topographical measurements of 9 eyes of 9 patients were taken by IOPAR CTS: 6 immediately after Intrastromal Corneal Ring Segments (ICRS) placement surgery and 3 immediately after Photorefractive Keratectomy (PRK) surgery. The topographical images taken by IOPAR CTS were analyzed to determine the quality of the image produced and the correlation of the keratometric data from the central 3 mm of cornea with measurements taken from an autokeratometer (Auto-Km) and the EyeSys Corneal Analysis System (CAS) for the same eyes taken three months following the procedure.

RESULTS

At the 3-month postoperative exam, the correlation coefficients for flat (K1), steep (K2), and average keratometry (AK) readings produced by the Auto-Km and the EyeSys CAS were quite high. However, the correlation coefficients for K1, K2, AK, As or steep meridian axis (Ax) readings taken intraoperatively by IOPAR CTS were quite low when compared to the readings taken by either the Auto-Km or EyeSys CAS three months postoperatively.

CONCLUSION

We found IOPAR CTS, relatively difficult to perform in the operating room during refractive surgical procedures and not useful clinically in predicting the postoperative topographical changes induced by ICRS or PRK procedure. Further studies are required to establish the efficacy and reproducibility of the instrument.

[Prionoses--neurodegenerative diseases caused by prions, offectious proteinaceous molecules]

Prionoses are a group of human and animal neurodegenerative diseases caused by prions, infectious pathogens that differ from bacteria, fungi, parasites, viroids, and viruses. Despite intensive searches over the past three decades, no nucleic acid has been found within prions and considerable experimental data argue that prions are composed exclusively of proteins (glycoproteins). Normal prion protein (PrPC) is encoded by a gene present in all nuclear cells of humans and other mammals but is constitutively expressed mainly in neurons. PrPC is protease sensitive and nonpathogenic but it can be modified to the pathological and protease resistant form designated PrPSC which is essential for infectivity. Prion diseases are manifested as infectious, genetic, or sporadic disorders and are also named as transmissible spongiform encephalopathies (TSE). TSE culminate with a progressive and fatal degeneration of the CNS. The human prionoses include Creutzfeldt-Jakob disease (CJD), kuru, Gerstman-Sträussler-Scheinker syndrome (GSS), and fatal familial insomnia (FFI). In mammals, more than 15 different species have been described to suffer from prion disorders till now. Scrapie of sheep and goats is the oldest and the most studied of the prion diseases. Bovine spongiform encephalopathy (BSE) and transmissible mink encephalopathy are thought to result from the feeding of scrapie-infected animal products, whereas BSE has been identified in transmission to mice, domestic cats, two exotic species of ruminant, and monkey. More than 20 cases of clinically and pathologically atypical form of CJD, referred to as "new variant" CJD (vCJD) have been recognized in unusually young people in the United Kingdom. There is a strong evidence that the same prion strain is involved in both BSE and vCJD. It suggest the breaking of species barrier which results by spreading of BSE to humans, putatively by dietary exposure. Understanding the function of prion proteins and their modification to the pathological form may give new insight into the etiologic and pathogenic mechanisms also other diseases caused by aberrant proteins, including Alzheimer' disease, amyotrophic lateral sclerosis, and Parkinson's disease. (Tab. 4, Fig. 3, Ref. 76.)

[Infectious diseases of animals and their prevention]

Infectious diseases of animals are the subject of continuous concern. On the one hand there are some diseases which have not yet been described and on the other hand the presence of microbial agents is proved also in diseases which have been considered non-infectious. Undoubtedly, microbes and parasites take part also in the development of malignant transformation of cells. The question of possible transfer of animal oncogenic microorganisms (retroviruses in particular) to humans remains open. The study points to the changes in the incidence of orthopoxviruses which occurred after eradication of human variola and the increasing importance of bartonelloses. Disease prevention in animals is affected to an increasing extent by DNA recombinant methods. So called "Gene farming" has developed, consisting in production of narrow-profile therapeutically important proteins via animal bioreactors. We enter a period in which the resistance of animal organism begins to affect the transfer of genes encoding non-specific and specific protective mechanisms of organisms. (Tab. 7, Ref. 39.)

ECLS in pertussis: does it have a role?

OBJECTIVES

To investigate the value of extracorporeal circulatory life support (ECLS) in paediatric patients with severe Bordetella pertussis infection.

DESIGN

Single case report and a review of the ECLS database.

SETTING

Tertiary referral hospital paediatric intensive care unit.

PATIENTS AND PARTICIPANTS

A single case report of an infant with B. pertussis infection is described. Despite receiving ECLS, this infant died from overwhelming cardiac and cerebral insults. Outcome for children receiving ECLS registered on the Extracorporeal Life Support Organization database is reviewed.

MEASUREMENTS AND RESULTS

The mortality of infants receiving ECLS for B. pertussis infection is high, with only 5 survivors reported among 22 registered cases. The majority of nonsurvivors had evidence of circulatory collapse in addition to severe respiratory failure, and these patients commonly died of hypoxic-ischaemic cerebral insult. These data suggest the existence of a subgroup of patients with respiratory failure only, who may benefit from ECLS, and a larger subgroup who suffer ischaemic cardiac and cerebral insults which are unlikely to be improved by ECLS.

CONCLUSIONS

The value of ECLS in patients with B. pertussis infection who present with major cardiac dysfunction is questionable. Such patients almost invariably have a poor outcome despite maximal therapy.

Niemann-Pick C1 disease gene: homology to mediators of cholesterol homeostasis

Niemann-Pick type C (NP-C) disease, a fatal neurovisceral disorder, is characterized by lysosomal accumulation of low density lipoprotein (LDL)-derived cholesterol. By positional cloning methods, a gene (NPC1) with insertion, deletion, and missense mutations has been identified in NP-C patients. Transfection of NP-C fibroblasts with wild-type NPC1 cDNA resulted in correction of their excessive lysosomal storage of LDL cholesterol, thereby defining the critical role of NPC1 in regulation of intracellular cholesterol trafficking. The 1278-amino acid NPC1 protein has sequence similarity to the morphogen receptor PATCHED and the putative sterol-sensing regions of SREBP cleavage-activating protein (SCAP) and 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase.

[Determination of tetracycline in bones, mechanically separated bones and meat using HPLC and microbiological plating methods]

HPLC method with solid phase extraction, and microbiological agar diffusion tests for determination of oxytetracycline (OTC), tetracycline (TC) and chlortetracycline (CTC) in bones, mechanically separated beef and bones were developed. Both mechanically separated bones and bovine flat bones showed the highest yield of tetracyclines by HPLC method. Among tetracyclines, the highest yield was determined in chlortetracycline. The strains of Bacillus subtilis (PH 6.0) and B. stearothermophilus showed the highest sensitivity to the presence of tetracyclines.

[Spongiform encephalopathies (prionoses) in animals]

Spongiform encephalopathies constitute a growing group of diseases of the central nervous system which, contrary to other neurodegenerative processes, can be transferred experimentally from one animal species to another. They can develop spontaneously on a hereditary familial basis, the conform prion protein developing in the posttranslation process having the character of in infectious agent initiating the degeneration of nerve cells. The mechanism of such as infection differs from other infectious diseases. The bovine spongiform encephalopathy agent, discovered in Great Britain in 1985 has an extensive zoonosis potential and has overcome the interspecies barriers. The key problem in spongiform encephalopathies of animals is the definitive explanation of their etiology, pathogenesis, intravital diagnosis as well as interspecies relationships. (Tab. 5, Ref. 11.)

Gender-related differences exist in cortical [3H]nisoxetine binding and are not affected by prenatal morphine exposure

The present study was designed to test the hypothesis that prenatal morphine, which differentially affects hypothalamic norepinephrine content and turnover in male and female rats, has sexually dimorphic effects on the density of hypothalamic norepinephrine uptake sites in adult offspring. The binding characteristics of norepinephrine transporters were examined in the hypothalamus, preoptic area and frontal cortex of adult male and female rats exposed to morphine (5-10 mg/kg, twice daily) or saline on gestation days 11-18. There was a gender-related difference in the density of norepinephrine uptake sites measured by [3H]nisoxetine binding in the frontal cortex of saline controls, with control males having significantly fewer binding sites than control females. Prenatal morphine administration did not reverse or eliminate this difference. Additionally, prenatal morphine exposure had no effects on either the binding capacity or the affinity of norepinephrine uptake sites in the hypothalamus, preoptic area or frontal cortex of adult progeny. Thus, alterations in hypothalamic norepinephrine content and turnover following prenatal morphine exposure are not reflected in alterations in norepinephrine uptake sites. However, recent immunocytochemical work in our laboratory correlated reductions in hypothalamic norepinephrine content and turnover rate with reductions in tyrosine hydroxylase and dopamine-beta-hydroxylase fiber density in the hypothalamus of morphine-exposed female rats. Therefore, the present results may suggest that compensatory mechanisms increase the density of norepinephrine uptake sites in hypothalamic terminal fields of morphine-exposed females.

[Oxytetracycline in the milk of dairy cows with clinical signs of mastitis during the lactation period]

The objective of this study was to determine the oxytetracycline residues in milk from cows with clinical mastitis dosed with two extra-label routes of oxytetracycline administration not only during antibiotic's treatment (5 days), but also six days after treatment by use of a liquid chromatography method of testing with a detection limit of 20 ppb. Both groups of animals were treated once daily for five milkings at 24-hour intervals following morning milkings. Composite milk samples (equal volumes of foremilk from each quarter) were collected during morning and afternoon milkings, mixed together (1:1), and stored until analyzed. Milk samples were analyzed just before the first treatment (0 hour) and ten times at 24-hour intervals. Residue studies in milk cows indicate that oxytetracycline passes into milk. Residues in milk were higher for the cows receiving oxytetracycline by intramammary route (Tab. I) than for the cows receiving oxytetracycline intramuscularly (Tab. II). The highest mean data were 195.68 mg/kg after intramammary infusion (Fig. 2) and 2.74 mg/kg after intramuscular injection (Fig. 3) on the 5th day of the treatment beginning. The analysis data showed that oxytetracycline persisted in milk for as long as two days after both treatments at the concentration 0.03 mg/kg versus 0.02 mg/kg, respectively. No residues were detected in milk of any animal from the 4th day of the cessation of the therapy (Fig. 1) as detected by the HPLC method.

Increase in iris-lens contact after laser iridotomy for pupillary block angle closure

PURPOSE

To quantitate changes in anterior ocular segment anatomy after laser iridotomy for pupillary block angle closure.

METHODS

We prospectively performed ultrasound biomicroscopy and A-scan biometry in 13 eyes of 13 consecutive untreated patients with relative pupillary block and appositional angle closure, without peripheral anterior synechiae on indentation gonioscopy. A radial, perpendicular image in the horizontal temporal meridian was obtained with ultrasound biomicroscopy before and one week after laser iridotomy in each eye.

RESULTS

Mean age of the 13 patients was 69.3 +/- 1.8 (S.E.) years, mean refractive error was +1.37 +/- 0.39 diopters, and mean axial length was 22.54 +/- 0.20 mm. In 13 eyes, before and after laser iridotomy measurements of angle-opening distance (0.11 +/- 0.02 vs. 0.18 +/- 0.02 mm) (P = .0004; paired t test), angle aperture (8.3 +/- 1.3 vs 18.6 +/- 2.8 degrees) (P = .0003) and iris-lens contact distance (0.58 +/- 0.06 vs 1.18 +/- 0.14 mm) (P = .0003) were greater postoperatively, but anterior chamber depth was unchanged (P = .7).

CONCLUSIONS

Flattening of the iris after laser iridotomy for pupillary block causes an increase in iris-lens contact. The change in angle configuration after iridotomy results more from an alteration in aqueous pressure gradients across the iris rather than from posterior lens movement.

Reduced trabecular meshwork height in juvenile primary open-angle glaucoma

OBJECTIVE

To compare trabecular meshwork height in a series of patients with juvenile primary open-angle glaucoma (JPOAG) with that in normal control patients.

METHODS

Ultrasound biomicroscopy and A-scan biometry were performed on 16 eyes with JPOAG and 24 normal eyes. A radial, perpendicular image in the horizontal temporal meridian detailing the line of Schwalbe, scleral spur, and angle anatomy was obtained for each eye by a single examiner. Trabecular meshwork height was defined as the distance from the scleral spur to the Schwalbe line.

RESULTS

Mean patient age (P = .85, t test), refractive error (P = .68), sex distribution (P = .26, Fisher exact test) and axial length (P = .39) were similar between the groups. Mean +/- SE trabecular meshwork heights were 0.36 +/- 0.03 mm (range, 0.19-0.53 mm) for JPOAG and 0.58 +/- 0.02 mm (range, 0.40-0.80 mm) for controls (P < .001). Eyes with greater axial length tended to have larger trabecular meshworks in both groups (P = .012, multivariate regression). A trabecular meshwork height-axial length ratio of 0.021 or less was associated with a significantly increased risk for JPOAG being present (odds ratio, 57; 95% confidence interval, 6.0-541).

CONCLUSIONS

The trabecular meshwork is smaller in eyes with JPOAG compared with that in normal eyes. This finding suggests a structural abnormality that may underlie the reduced outflow.

Survival of model bacterial strains and helminth eggs in the course of mesophilic anaerobic digestion of pig slurry

The effect of methanogenesis on the survival of model bacterial strains (Escherichia coli EC 5, Staphylococcus aureus SA 11, Enterococcus faecium CCM 4231) and non-embryonated helminth eggs (Ascaris suum) was investigated in pig slurry. Two pilot-plant experiments were carried out in two anaerobic digesters (800 and 1,000 litre) in a mesophilic thermal range (35-37 degrees C). The mean hydraulic retention time of the digesters was 20 days. The methanogenesis process was monitored by determining the following chemical parameters: pH, N-NH3, total dry matter (kg/day), organic matter (kg/day) production of methane by supplied and degraded organic matter (m3/kg). The results obtained allow us to state that the anaerobic stabilization of pig slurry in the mesophilic temperature range resulted in total devitalization of model bacterial strains E. coli EC 5 and Ent. faecium CCM 4231. St. aureus SA 11 cells, exposed to the above mentioned conditions, were also reduced in their number from 10.04 to 3.27 and from 8.69 to 2.77 log cfu/ml. It is assumed that the longer retention time of excrements in the digester could also result in total devitalization of St. aureus SA 11 cells. From the microbiological point of view, the above mentioned facts indicate a sufficient hygienization effect of the anaerobic fermentation on the contaminated pig excrements. The survival of A. suum eggs was little affected by the 20-day anaerobic mesophilic digestion of pig slurry. Only 17 or 18% (F1, F2) of the non-embryonated A. suum eggs were damaged after the 20-day exposure.

Location of the iris insertion in pigment dispersion syndrome

PURPOSE

To evaluate the position of the iris insertion into the ciliary body in persons with pigment dispersion syndrome (PDS) and control subjects.

METHODS

Ultrasound biomicroscopy was performed on 19 eyes with PDS and on 21 eyes of control subjects. A radial, perpendicular image in the temporal meridian detailing Schwalbe line (SL), scleral spur (SS), and iris root insertion (IR) was obtained for each eye by a single examiner. The distances between these structures then was measured.

RESULTS

There were no differences between the groups in refractive error (mean +/- standard error, -2.8 +/- 0.7 diopters for PDS eyes versus -2.2 +/- 0.6 for control subjects) (P=0.46), sex distribution (P=0.49), and trabecular meshwork height (SL to SS) (0.63 +/- 0.03 mm [PDS eyes] versus 0.59 +/- 0.03 [control eyes]; P = 0.24). The SS-to-IR distance was significantly greater in PDS eyes (0.04 +/- 0.04 mm) than in control eyes (0.28 +/- 0.04 mm) (P=0.01) as was the overall distance from SL to IR (0.98 +/- 0.04 mm versus +/- 0.04 mm) (P = 0.003).

CONCLUSION

The insertion of the iris into the ciliary body is more posterior in PDS eyes than in control eyes. This anatomic variation places the iris pigment epithelium proximal to the zonular apparatus and may increase the likelihood of iridozonular contact and zonular pigment dispersion.

Chronic influence of pyrethroid supermethrin on some reproductive features in Japanese quail (140 days long avian reproduction test)

We observed the influence of chronic effect of pyrethroid supermethrin on some reproduction features in Japanese quails. They received 3 different doses (P1 10.7 mg.kg-1.day-1; P2 21.4 mg.kg-1.day-1 and P3 35.7 mg.kg-1.day-1) of the tested substance during 20 weeks. The total health status, reproduction of Japanese quails, the damage rate (degree) of the organs and tissues as well as the determination of residue in the eggs and muscles of the experimental birds showed that pyrethroid insecticide supermethrin can be considered a safe pesticide.

Determination of tetracycline antibiotics in animal tissues of food-producing animals by high-performance liquid chromatography using solid-phase extraction

A high-performance liquid chromatographic (HPLC) method was developed for the determination of oxytetracycline (OTC), tetracycline (TC) and chlortetracycline (CTC) residues in bovine and porcine muscles. The method involved the homogenization of the sample in EDTA-McIlvaine buffer with added n-hexane and dichloromethane, centrifugation, precipitation of the supernatant using trichloroacetic acid and filtration. Preconcentration on Separcol SI C18 cartridges improved the clean-up and the recovery of tetracyclines that were separated by HPLC using the optimized mobile phase of 0.01 M oxalic acid-acetonitrile-methanol (45:35:20) on a Spherisorb ODS 2 column (250 x 4 mm I.D.). UV detection at 360 nm was applied with a detection limit of about 50 ng/g. The diode-array spectra confirmed the applicability of this method to the study of tetracycline residues in carcasses.

[The effect of bentazone manufactured in Czechoslovakia on the synthesis of bacterial proteins in the rumen of sheep]

The effect of the perorally ingested pesticide bentazone (195 mg.kg-1) of Czechoslovak origin on the amino acid composition of proteins of bacteria adhering to the ventral and dorsal ruminal wall investigated in six sheep. Proteosynthesis of adherent bacteria was studied by a modified and quantified elution method (elution of bacteria by an isotonic buffered solution at 4 degrees C). By the latter, a concentrate of undamaged bacteria a adhering to the sheep ruminal epithelium could be obtained. The yield of the method was estimated by scanning electrone microscopy and it was 93.3% (Legáth et al., 1990). The high correlation coefficient (r = 0.94, p < 0.01) suggested that in comparison with the control group of sheep, bentazone in the diet did not have a marked effect on the amount of amino acids in hydrolyzates of bacteria adhering to the dorsal and ventral ruminal epithelium. From the analysis of the single amino acids, it however follows that bentazone in the feeding ration caused significant changes in the concentrations of some amino acids in the proteins of bacteria adhering to the epithelium in the ventral and dorsal part of the rumen (p < 0.05) (Tab. I, II). In both topographico-anatomical parts of the rumen phenylalanine levels significantly increased whereas those of alanine and glycine decreased (Fig. 1). Pesticides can be one of the factors that negatively affect the biosynthetic processes in the rumen of ruminants.(ABSTRACT TRUNCATED AT 250 WORDS)