Using the da Vinci X® - System for Esophageal Surgery

Robotic esophageal surgery is becoming more widely adopted. Several publications on the feasibility, short-term outcomes and technical aspects are available. Most of these articles used either the da Vinci® SI system or in newer series the Xi System. The da Vinci® X system is generally considered less suited for multiquadrant access like in esophageal surgery, hence only limited data is available. Here we describe our initial experience with 16 Ivor-Lewis robotic assisted minimally invasive esophagectomies (RAMIE) in patients with esophageal adenocarcinoma. The da Vinci® X system was installed in our department in 2019; the robotic program comprises colorectal, pancreatic and esophageal surgery. The first two patients were operated in the presence of a proctor. An operative standard was established including fluorescence angiography (Firefly®). Technical aspects with focus on the characteristics of the da Vinci® X system, operating room setup, and short-term outcomes are discussed.

Inhibition of ADAM17 impairs endothelial cell necroptosis and blocks metastasis

Metastasis is the major cause of death in cancer patients. Circulating tumor cells need to migrate through the endothelial layer of blood vessels to escape the hostile circulation and establish metastases at distant organ sites. Here, we identified the membrane-bound metalloprotease ADAM17 on endothelial cells as a key driver of metastasis. We show that TNFR1-dependent tumor cell-induced endothelial cell death, tumor cell extravasation, and subsequent metastatic seeding is dependent on the activity of endothelial ADAM17. Moreover, we reveal that ADAM17-mediated TNFR1 ectodomain shedding and subsequent processing by the γ-secretase complex is required for the induction of TNF-induced necroptosis. Consequently, genetic ablation of ADAM17 in endothelial cells as well as short-term pharmacological inhibition of ADAM17 prevents long-term metastases formation in the lung. Thus, our data identified ADAM17 as a novel essential regulator of necroptosis and as a new promising target for antimetastatic and advanced-stage cancer therapies.

HMPAO-SPECT Can Discriminate between Patients with Subjective Cognitive Complaints with and without Cognitive Deficits and those with Mild Cognitive Impairment

BACKGROUND

Growing evidence suggests that pathological processes leading to Alzheimer's disease occurs gradually and begins to develop decades before the earliest clinical symptoms occur. The use of biomarkers has been proposed to detect evidence of preclinical Alzheimer's pathologic change in asymptomatic subjects. Subjective cognitive complaints (SCC) i.e. self-reported cognitive decline with normal cognition have been reported as an indicator of future cognitive decline, however, this condition is unspecific.

OBJECTIVE

In the present study we used the regional brain perfusion measured by HMPAO-SPECT as Biomarker of neurodegeneration to compare the regional brain perfusion of patient with subjective cognitive complaints with and without minimal cognitive dysfunction (SCC+ and SCC- respectively) in respect to patients with mild cognitive impairment (MCI).

METHODS

We retrospectively examined 736 Patients who referred to our Memory Clinic because of suspected cognitive dysfunction. After exclusion of patients with overt dementia, automated, quantitatively assessed relative cerebral blood flow of 10 forebrain regions (thalamus, parietotemporal, medial temporal, posterior temporal, posterior cingulate gyrus, each region left hemispheric and right hemispheric) and neuropsychological assessment of 64 SCC (32 SCC+; 32 SCC-) and 28 MCI subjects were analysed.

RESULTS

.The most relevant differences between groups in cognitive performance concerned verbal memory. Left hemispheric medial temporal region could significantly discriminate between all three groups, with a progressive decrease n perfusion from SCC towards MCI. Area under the curve of left medial temporal region showed a sensitivity of 0,61 and a specificity of 0,78 for discriminating MCI from SCC.

CONCLUSION

Automated analysis of HMPAO-SPECT data of MCI and SCC+ patients showed significant perfusion differences in medial temporal region and impaired verbal memory, both of which are known features of Alzheimer's disease. Perfusion patterns and verbal memory performance in SCC+ are more similar to MCI than SCC-. Thus, SPECT analysis could distinguish those subjects whose perfusion pattern resembles that of an MCI from those who do not. In our opinion, this could identify two populations with a different risk of progression to AD, with SCC+ subjects needing further diagnostic examination and repeated follow-up.

Tempo-spatial gait adaptations in stroke patients when approaching and crossing an elevated surface

BACKGROUND

In ambulatory stroke survivors, outdoor walking is important for participation, so adapting to heightened levels (e.g. curbs) is essential. This needs precise step regulation and foot positioning and has to be achieved despite impaired balance and motor regulation.

RESEARCH QUESTION

How do stroke patients approach and cross elevated surfaces?

METHODS

Gait of 12 hemiparetic stroke patients (62.8 ± 10.3 years; Functional Ambulatory Category 3-5) and 13 controls (60.0 ± 12.4 years) was compared using a sensor carpet and 3D motion capturing to collect tempo-spatial parameters and foot trajectories in two conditions: flat walking vs. approaching to and stepping onto an elevated surface (height 15 cm) in a self-selected manner (6 trials each). Tempo-spatial adaptations were normalized to flat walking while trajectory analysis focused on foot clearance and placement. Complementary assessments included the Dynamic-Gait-Index, the Berg-Balance-Test and the Falls Efficacy Scale.

RESULTS

Patients showed significantly worse Dynamic-Gait-Indices, less balance and more fear of falling. During the approach phase, patients slowed down, partly accompanied by shorter steps which controls did not. During crossing, no preference for a specific leading leg was detected. Clearance of the leading leg on average was not reduced but patients landed closer to the edge. Still clearance of the paretic leg was less than that of the non-paretic leg and the minimal clearance across all trials suggested an increased tripping risk, most evident for the trailing leg. In particular slower approaching caused difficulties to ensure sufficient leg clearance and to place the foot safely. Independent from that, better balance correlated with safer clearance.

SIGNIFICANCE

When managing elevated levels, leading with the paretic leg causes more difficulties to safely clear the legs which is considerably dependent upon speed. Therapists should consider that slow walking may not increase safety while faster gait and aspects of postural control potentially facilitate crossing a curb.

Dawning of the N=32 Shell Closure Seen through Precision Mass Measurements of Neutron-Rich Titanium Isotopes

A precision mass investigation of the neutron-rich titanium isotopes ^{51-55}Ti was performed at TRIUMF's Ion Trap for Atomic and Nuclear science (TITAN). The range of the measurements covers the N=32 shell closure, and the overall uncertainties of the ^{52-55}Ti mass values were significantly reduced. Our results conclusively establish the existence of the weak shell effect at N=32, narrowing down the abrupt onset of this shell closure. Our data were compared with state-of-the-art ab initio shell model calculations which, despite very successfully describing where the N=32 shell gap is strong, overpredict its strength and extent in titanium and heavier isotones. These measurements also represent the first scientific results of TITAN using the newly commissioned multiple-reflection time-of-flight mass spectrometer, substantiated by independent measurements from TITAN's Penning trap mass spectrometer.

A disintegrin and metalloprotease 10 (ADAM10) is a central regulator of murine liver tissue homeostasis

A Disintegrin And Metalloprotease (ADAM) 10 exerts essential roles during organ development and tissue integrity in different organs, mainly through activation of the Notch pathway. However, only little is known about its implication in liver tissue physiology. Here we show that in contrast to its role in other tissues, ADAM10 is dispensable for the Notch2-dependent biliary tree formation. However, we demonstrate that expression of bile acid transporters is dependent on ADAM10. Consequently, mice deficient for Adam10 in hepatocytes, cholangiocytes and liver progenitor cells develop spontaneous hepatocyte necrosis and concomitant liver fibrosis. We furthermore observed a strongly augmented ductular reaction in 15-week old ADAM10(Δhep/Δch) mice and demonstrate that c-Met dependent liver progenitor cell activation is enhanced. Additionally, liver progenitor cells are primed to hepatocyte differentiation in the absence of ADAM10. These findings show that ADAM10 is a novel central node controlling liver tissue homeostasis.

HIGHLIGHTS

Loss of ADAM10 in murine liver results in hepatocyte necrosis and concomitant liver fibrosis. ADAM10 directly regulates expression of bile acid transporters but is dispensable for Notch2-dependent formation of the biliary system. Activation of liver progenitor cells is enhanced through increased c-Met signalling, in the absence of ADAM10. Differentiation of liver progenitor cells to hepatocytes is augmented in the absence of ADAM10.

IL-6 trans-signaling is essential for the development of hepatocellular carcinoma in mice

Hepatocellular carcinoma (HCC) is one of the most frequent tumors worldwide with rising incidence. The inflammatory cytokine, interleukin-6 (IL-6), is a critical mediator of HCC development. It can signal through two distinct pathways: the IL-6 classic and the IL-6 trans-signaling pathway. Whereas IL-6 classic signaling is important for innate and acquired immunity, IL-6 trans-signaling has been linked to accelerated liver regeneration and several chronic inflammatory pathologies. However, its implication in liver tumorigenesis has not been addressed yet. Here, we show that IL-6 trans-signaling, but not IL-6 classic signaling, is essential to promote hepatocellular carcinogenesis by two mechanisms: First, it prevents DNA-damage-induced hepatocyte apoptosis through suppression of p53 and enhances β-catenin activation and tumor proliferation. Second, IL-6 trans-signaling directly induces endothelial cell proliferation to promote tumor angiogenesis. Consequently, soluble gp130 fused to Fc transgenic mice lacking IL-6 trans-signaling are largely protected from tumor formation in a diethylnitrosamine/3,3',5,5'-tetrachloro-1,4-bis(pyridyloxy)benzene model of HCC.

CONCLUSION

IL-6 trans-signaling, and not IL-6 classic signaling, is mandatory for development of hepatocellular carcinogenesis. Therefore, specific inhibition of IL-6 trans-signaling, rather than total inhibition of IL-6 signaling, is sufficient to blunt tumor initiation and impair tumor progression without compromising IL-6 classic signaling-driven protective immune responses. (Hepatology 2017;65:89-103).

Identification of the Female Sex Pheromone of the Leafroller Proeulia triquetra Obraztsov (Lepidoptera: Tortricidae)

Proeulia triquetra Obraztsov (Lepidoptera: Tortricidae) is an occasional pest in fruit orchards in central-southern Chile. In order to develop species-specific lures for detection and monitoring of this species, we identified the female-produced sex pheromone. (Z)-11-Tetradecenyl acetate (Z11-14:OAc), (E)-9-dodecenyl acetate (E9-12:OAc), and (E)-11-Tetradecenyl acetate (E11-14:OAc) were identified as biologically active compounds present in female pheromone glands by solvent extraction of the gland and analysis of the extracts by gas chromatography-electroantennographic detection and gas chromatography-mass spectrometry. In field tests, lures baited with synthetic Z11-14:OAc and E9-12:OAc in a 10:1 ratio were highly attractive to males of the species.

Three-dimensional fracture pattern analysis of the Obwegeser and Dal Pont bilateral sagittal split osteotomy

The Obwegeser and Dal Pont modification of the bilateral sagittal split osteotomy (BSSO) is a well-established procedure in orthognathic surgery. The purpose of this retrospective study was to analyze the actual fracture patterns achieved with BSSO by Obwegeser and Dal Pont modification using postoperative cone beam computed tomography (CBCT) datasets from 100 patients. A total of 200 split osteotomies were assessed, which could be categorized into nine different split patterns. Only one of the observed split fractures (0.5%) followed exactly the fracture line described by Obwegeser and Dal Pont, whereas 40% followed the fracture line according to the Hunsuck and Epker modification and 13.5% were seen as unfavourable splits mainly running over the buccal plate. A significant correlation was found between unfavourable buccal splits and both horizontal osteotomies reaching the buccal surface at the dorsal ramus (P=0.001) and a vertical caudal bone cut end at the corpus with a buccal position (P<0.001). These results show that a complete antero-posterior horizontal osteotomy at the mandibular ramus does not lead to the intended fracture pattern, which rebuts the argument of a greater amount of bony overlap using the Obwegeser and Dal Pont modification.

[Network for Oncological Advisory Service (NOF) - a Pilot Project for (Long-Term) Follow-Up Care of Pediatric Cancer Patients]

Background: In Germany some 2 000 children and adolescent are diagnosed with cancer every year. Curing rates are increasing and therewith also the number of survivors is growing. Survivors frequently suffer from long-term effects of the disease and its treatment, but long-term follow-up care shows deficits. Method: The Network for oncological advisory service (NOF) started in 11/2013, researching and building up a network of available support in Lower Saxony. A telephone hotline was installed in 01/2014 in order to advice survivors on their problems. At the same time, an interview study on survivors needs was conducted throughout Germany. Results: In the first 2 years, the NOF gave advice to 79 patients. Whilst enquiries of medical or psychological nature were transferred to the cooperation partner, requests on psychosocial and social legal issues are being deled by the NOF due to lack of appropriate partners. The evaluation of 25 interviews shows key issues in long-term after-care: (1) transition from acute therapy to everyday life, (2) problems due to pediatric cancer and therapy, (3) patients perception of own disposition, (4) social reactions towards survivors, (5) structure of long-term follow-up care, (6) information flow. Conclusion: Many survivors suffer from long-term effects of cancer and treatment. The lack of available contact person and being in limbo between cured and simultaneously affected by the cancer treatment and chronic diseases is perceived as being problematic. This translates to various requirements on a patient-oriented long-term care, mainly in the psychosocial field.

Tuning of spectral and angular distribution of scattering from single gold nanoparticles by subwavelength interference layers

Localized surface plasmon resonance (LSPR) as the resonant oscillation of conduction electrons in metal nanostructures upon light irradiation is widely used for sensing as well as nanoscale manipulation. The spectral resonance band position can be controlled mainly by nanoparticle composition, size, and geometry and is slightly influenced by the local refractive index of the near-field environment. Here we introduce another approach for tuning, based on interference modulation of the light scattered by the nanostructure. Thereby, the incoming electric field is wavelength-dependent modulated in strength and direction by interference due to a subwavelength spacer layer between nanoparticle and a gold film. Hence, the wavelength of the scattering maximum is tuned with respect to the original nanoparticle LSPR. The scattering wavelength can be adjusted by a metallic mirror layer located 100-200 nm away from the nanoparticle, in contrast to near-field gap mode techniques that work at distances up to 50 nm in the nanoparticle environment. Thereby we demonstrate, for the first time at the single nanoparticle level, that dependent on the interference spacer layer thickness, different distributions of the scattered signal can be observed, such as bell-shaped or doughnut-shaped point spread functions (PSF). The tuning effect by interference is furthermore applied to anisotropic particles (dimers), which exhibit more than one resonance peak, and to particles which are moved from air into the polymeric spacer layer to study the influence of the distance to the gold film in combination with a change of the surrounding refractive index.

Oncogenic deletion mutants of gp130 signal from intracellular compartments

Interleukin 6 and hence activation of the IL-6 receptor signalling subunit gp130 have been linked to inflammation and tumour formation. Recently, deletion mutations in gp130 have been identified in inflammatory hepatocellular adenoma. The mutations clustered around one IL-6 binding epitope and rendered gp130 constitutively active in a ligand-independent manner. Here we can show that gp130 deletion mutants, but not wildtype gp130 localise predominantly to intracellular compartments, notably the ER and early endosomes. One of the most frequent mutants gp130 Y186-Y190del (ΔYY) is retained in the ER quality control by its association with the chaperone calnexin. Furthermore, we can show that gp130 ΔYY induces downstream signalling from both, ER and endosomes and that both signals contribute to ligand-independent cell proliferation. We also demonstrate that endosomal localisation of gp130 ΔYY is crucial for full-fledged STAT3 activation. Therefore aberrant signalling from intracellular compartments might explain the tumourigenic potential of naturally occurring somatic mutations of gp130.

A new technique of ex vivo gene delivery of VEGF to wounds using genetically modified skin particles promotes wound angiogenesis

BACKGROUND

Transplantation of genetically modified keratinocytes has been shown to accelerate wound healing. However, this method is labor-intensive and time-consuming. We have developed a new technique of intraoperative gene delivery to wounds that involves transplantation of transfected minced skin particles (MSPs) derived from harvested partial-thickness skin.

STUDY DESIGN

MSPs measuring 0.8 × 0.8 × 0.35 mm were created from a split-thickness skin graft of a pig. In vitro transfection was carried out with adenoviral LacZ (Ad-LacZ) for qualitative and adenoviral vascular endothelial growth factor (Ad-VEGF) for quantitative analysis. Transfected MSPs were transplanted to each of 2.5 × 2.5 cm full-thickness wounds on the dorsum of the pig. Nontransfected MSPs served as controls. Wound chambers were applied and injected with saline to create a wet environment.

RESULTS

LacZ expression was detected in migrating cells originating from MSPs both in vitro and in vivo. VEGF expression in the wound fluid of Ad-VEGF-MSP-transplanted wounds on each of days 2 to 4 (mean ± SEM 6.74 ± 1.89 ng/mL, day 2; 9.88 ± 2.27 ng/mL, day 3; 9.87 ± 1.28 ng/mL, day 4) was significantly higher (p < 0.0001) compared with wounds transplanted with either untransfected MSPs, Ad-LacZ-MSPs, or untransplanted controls. In vitro VEGF expression was significantly higher (p < 0.0001) in Ad-VEGF 1 × 10(10) transfected MSPs compared with either Ad-VEGF 1 × 10(9) transfected MSPs or untransfected MSPs. Wounds transplanted with Ad-VEGF-MSPs showed significantly higher (p < 0.0001) numbers of newly formed blood vessels (12.6 ± 0.9 vessels/high power field [HPF]) compared with wounds transplanted with either Ad-LacZ-MSPs (4.4 ± 0.5 vessels/HPF) or untransfected MSPs (5.2 ± 0.7 vessels/HPF). All MSP-transplanted wounds (Ad-VEGF-MSPs, untransfected MSPs, Ad-LacZ-MSPs) showed significantly higher re-epithelialization compared with untransplanted wounds on days 10 and 14 (p < 0.0001).

CONCLUSIONS

We demonstrated successful transfection of MSPs that can be transplanted to wounds as a source of gene-expressing cells. This technique can be used to deliver growth-modulating genes in wound healing.

Virtual Reality to control active participation in a subacute stroke patient during robot-assisted gait training

Virtual Reality (VR) provides a promising medium to enrich robot assisted rehabilitation. VR applications present the opportunity to engage patients in therapy and control participation. The aim of this study was to investigate two strategies to control active participation of a stroke patient focusing on the involvement of the paretic leg in task solution. A subacute stroke patient with a severe hemiparesis performed two experiments on the driven gait orthosis Lokomat. Patient activity was quantified by weighted interaction torques measured in both legs (experiment A) and the paretic leg only (experiment B). The patient was able to successfully implement both the bilateral and unilateral control modality. Both control modes increased the motor output of the paretic leg, however the paretic leg control mode resulted in a much more differentiated regulation of the activity in the leg. Both control modes are appropriate approaches to enhance active participation and increase motor output in the paretic leg. Further research should evaluate the therapeutic benefit of patients with hemiparesis using the unilateral control mode depending on the severity of their impairment.

Bayesian approach to the Rietveld refinement of Poisson-distributed powder diffraction data

The Rietveld method is based on a weighted least-squares fit of a model diffraction pattern to the step-scan data of a complete experimental X-ray or neutron diffraction pattern. It is shown here that the weight most commonly used in Rietveld refinement of powder diffraction data leads to a biased background estimate. To overcome this bias, an alternative method for refinement of Poisson-distributed experimental data is suggested that only involves changes of the input data and the weights of least-squares refinement. Model calculations demonstrate that this novel method allows an improved refinement of the parameters describing the background and the Bragg reflections. The proposed method can be readily implemented in existing Rietveld programs.

Minced urothelium to create epithelialized subcutaneous conduits

PURPOSE

We used in vivo cell expansion to create 3-dimensional subcutaneous conduits lined with an inner layer of autologous urothelial mucosa.

MATERIALS AND METHODS

Laparotomy and excision of a fifth of the bladder were done in 5 female Yorkshire pigs (Parsons Farm, Westhampton, Massachusetts) under general anesthesia. After mechanical removal of the detrusor muscle the bladder mucosa was minced to obtain 0.2 x 0.8 x 0.8 mm particles, which were attached to the outer surface of latex tubes using a thin layer of fibrin glue. Seven to 10 tubes were placed in the abdominal wall subcutaneous tissue in each original donor pig with tubes lacking particles serving as controls. Biopsy was done 1 to 4 weeks after transplantation for histological evaluation.

RESULTS

One week after transplantation particles were still present in the granulation tissue. At 2 weeks the epithelium was differentiated with transitional uroepithelium facing the lumen, ie toward the tube. No epithelium was detected around control tubes.

CONCLUSIONS

After autologous transplantation of bladder mucosal particles organized in 3-dimensional fashion in pig subcutaneous tissue the transplanted cells proliferated, migrated and reorganized to form a continuous epithelial lining facing the lumen. This novel approach to urothelial transplantation may allow successful formation of a conduit to the bladder or of a neourethra.

Pulse stretcher with variable pulse length for excimer laser applications

Excimer laser systems are often combined with pulse stretchers, e.g., in lithography and Raman spectroscopy to reduce pulse peak intensities. We developed a pulse stretcher which is suited especially for pulse length dependent applications, e.g., in material research. This pulse stretcher is based on imaging and provides identical beam profiles and divergences at different pulse lengths in combination with the possibility of switching between four pulse lengths. Therefore, beam splitters are mounted onto motorized translation stages. These features are important for the characterization and development of improved optical materials for deep-ultraviolet applications. Here, two 193 nm single tube excimer lasers (Lambda Physik: LPX 240i, Cymer: ELS 5600) were evaluated concerning their combinability with an attached pulse stretcher. The wave-front radii of the ELS 5600 are dependent on repetition rate or pulse energy and are changing during warming-up. Without adapted pulse shaping, this can cause destruction of stretcher optics due to moving foci. We found that the LPX 240i could be combined easily with a pulse stretcher using beam shaping with only one cylindrical lens. We could demonstrate that stretched 193 nm laser pulses retard aging of CaF(2) crystals.

The effect of amnion-derived cellular cytokine solution on the epithelialization of partial-thickness donor site wounds in normal and streptozotocin-induced diabetic swine

OBJECTIVE

The purpose of this study was to determine whether amnion-derived cellular cytokine solution (ACCS) could improve the quality of epithelialization and accelerate closure of dermatome-created partial-thickness wounds in normal and streptozotocin-induced diabetic pigs.

METHODS

Dermatome-created partial-thickness wounds were sealed with wound chambers in healthy and diabetic pigs and were injected with ACCS. Wound fluid was exchanged daily for total protein concentration, and biopsies were taken on days 6, 8, 10, and 12. Epithelialization, thickness of epidermis, number of epidermal cell layers, and rete ridges were evaluated.

RESULTS

The macroscopic appearance of the wounds and speed of healing was similar in all groups at each time point. All wounds were healed by day 6. The epidermis was thicker in the ACCS-treated diabetic wounds than in the controls (140.6 microm vs 82.7 microm on day 12 in diabetic pigs). There were more cell layers (13 vs 7.7) in ACCS-treated diabetic pigs on day 12. The number of rete ridges per 2.5 mm was greater on day 12 in the ACCS-treated diabetic wounds (13 vs 8). There was also a significant increase in the number of rete ridges in ACCS-treated nondiabetic pigs but no difference in epidermal thickness or number of cell layers.

CONCLUSION

In diabetic pigs, we found a significantly thicker epidermis and more cell layers and rete ridges in the ACCS-treated wounds. Healthy pigs showed more rete ridges but no difference in thickness of epidermis or number of cell layers on day 12.

[Postpartum cerebral venous sinus thrombosis after epidural anaesthesia]

Cerebral venous sinus thrombosis during pregnancy or puerperium is not a rarity. Nevertheless, it is often misdiagnosed. With the increasing use of regional anaesthesia in obstetrics the differential diagnosis of postdural puncture headache is often difficult. The case of a patient is reported who suffered from both intracranial hypotension and cerebral venous sinus thrombosis in the postpartum period.

Cerebral perfusion (HMPAO-SPECT) in patients with depression with cognitive impairment versus those with mild cognitive impairment and dementia of Alzheimer's type: a semiquantitative and automated evaluation

PURPOSE

Comparative evaluation of regional brain perfusion measured by HMPAO-SPECT of patients with mild cognitive impairment (MCI), dementia of Alzheimer's type (DAT) and depression with cognitive impairment (DCI).

METHODS

A total of 736 patients were investigated because of suspected cognitive dysfunction. After exclusion of patients with other forms of dementia than DAT or relevant accompanying disorders, SPECT data from 149 MCI, 131 DAT and 127 DCI patients, and 123 controls without any cognitive impairment, were analysed. Relative cerebral blood flow of 34 anatomical regions was assessed with automated analysis software (BRASS).

RESULTS

Calculation of global forebrain perfusion discriminated demented from nondemented patients. Compared to controls DCI patients showed hypoperfusion of the thalamus, lentiform nucleus and medial temporal cortex. MCI patients differed significantly from controls concerning perfusion in both hemispheric temporal and parietal areas, and in the (right hemispheric) posterior part of the cingulate gyrus. MCI and DCI patients differed in the parietal, temporal superior and right hemispheric cingulate gyrus posterior cortices. Global forebrain and regional perfusion was more extensively reduced in DAT patients and discriminated them from controls, and MCI and DCI patients. Frontal perfusion disturbance was only present in DAT patients.

CONCLUSION

Automated analysis of HMPAO-SPECT data from MCI patients showed significant perfusion deficits in regions also involved in DAT patients, but ROC analysis demonstrated only moderate sensitivity and specificity for differentiating DAT patients from controls and DCI patients. Frontal hypoperfusion seems to correspond with conversion from MCI to DAT. Finally, the results in DCI patients again raise the question of depression as an early symptom of neurodegeneration.

Cell suspensions of autologous keratinocytes or autologous fibroblasts accelerate the healing of full thickness skin wounds in a diabetic porcine wound healing model

Autologous dermal fibroblasts may be useful in the treatment of diabetic skin wounds. We hypothesized that cultured fibroblasts or cultured keratinocytes would not only survive in a hyperglycemic wound environment but also enhance the rate of re-epithelialization. We previously developed a new porcine model of delayed cutaneous wound healing in the diabetic pig. Full thickness wounds were created on the dorsum and dressed with polyurethane chambers to keep the wounds wet and to allow for wound fluid monitoring. Suspensions of either autologous fibroblasts or autologous keratinocytes were injected into full thickness wounds and compared with wounds treated in a wet environment in normal saline. Serum glucose and wound fluid glucose concentrations were monitored daily. Wound contraction was monitored and biopsies taken on day 12. Transplantation of suspensions of autologous fibroblasts or autologous keratinocytes enhanced re-epithelialization of cutaneous full thickness wounds. Wounds treated with autologous fibroblasts showed a re-epithelialization rate of 86.75% and wounds treated with autologous keratinocytes showed a re-epithelialization rate of 91.3%. This is compared with a re-epithelialization rate of 56.8% seen in the normal saline treated wounds. While previous studies have shown fibroblasts suspension to have little effect in the treatment of full thickness wounds in nondiabetic wounds, this study shows a clear beneficial effect in the use of fibroblast or keratinocyte suspensions for the cutaneous healing of diabetic wounds in pigs.

Optically controlled thermal management on the nanometer length scale

The manipulation of polymers and biological molecules or the control of chemical reactions on a nanometer scale by means of laser pulses shows great promise for applications in modern nanotechnology, biotechnology, molecular medicine or chemistry. A controllable, parallel, highly efficient and very local heat conversion of the incident laser light into metal nanoparticles without ablation or fragmentation provides the means for a tool like a 'nanoreactor', a 'nanowelder', a 'nanocrystallizer' or a 'nanodesorber'. In this paper we explain theoretically and show experimentally the interaction of laser radiation with gold nanoparticles on a polymethylmethacrylate (PMMA) layer (one-photon excitation) by means of different laser pulse lengths, wavelengths and pulse repetition rates. To the best of our knowledge this is the first report showing the possibility of highly local (in a 40 nm range) regulated heat insertion into the nanoparticle and its surroundings without ablation of the gold nanoparticles. In an earlier paper we showed that near-infrared femtosecond irradiation can cut labeled DNA sequences in metaphase chromosomes below the diffraction-limited spot size. Now, we use gold as well as silver-enhanced gold nanoparticles on DNA (also within chromosomes) as energy coupling objects for femtosecond laser irradiation with single-and two-photon excitation. We show the results of highly localized destruction effects on DNA that occur only nearby the nanoparticles.

Health and Clinical Management - Impact on Clinical Outcome

To summarize current excellent research in the field of health and clinical management.

Synopsis of the articles selected for the IMIA Yearbook 2007.

Five articles from international peer reviewed journals were selected for the section on health and clinical management of the IMIA Yearbook 2007. They represent outstanding research on computerized provider order entry, computer applications in the field of translational medicine, time efficiency of electronic health records, and deliverance of telemedicine.

In the field of health and clinical management, clinical outcome of computer-supported healthcare, cost-benefit analysis, and barriers and facilitators for technology adoption are still current research topics.

Health and clinical management--impact on clinical outcome. Findings from the section on health and clinical management

OBJECTIVES

To summarize current excellent research in the field of health and clinical management.

METHOD

Synopsis of the articles selected for the IMIA Yearbook 2007.

RESULTS

Five articles from international peer reviewed journals were selected for the section on health and clinical management of the IMIA Yearbook 2007. They represent outstanding research on computerized provider order entry, computer applications in the field of translational medicine, time efficiency of electronic health records, and deliverance of telemedicine.

CONCLUSIONS

In the field of health and clinical management, clinical outcome of computer-supported healthcare, cost-benefit analysis, and barriers and facilitators for technology adoption are still current research topics.

Section 1: Health and Clinical Mangement: Health and Clinical Management – Comparing the Clinical Outcome of Computerized Strategies

To summarize current excellent research in the field of health and clinical management.

Synopsis of the articles selected for the IMIA Yearbook 2006.

Current research in the field of health and clinical management analyses impact and patient outcome of both established and recently presented approaches. Usability and effects of extracting data from computerized medical records for preventive care and surveillance issues are a topic as well as strategies for detecting adverse events.

The best paper selection in the field of health and clinical management shows examples of excellent research on assessment, strategies and concepts for computerized health information management approaches. The articles emphasize the necessity of carefully considering health information systems regarding their outcome and compatibility with clinical routine. A concerted management of knowledge about evaluated health information management approaches will advance this trend and should lead to a more evidence-based design of the underlying systems.

Mechanisms underlying the anti-inflammatory actions of boswellic acid derivatives in experimental colitis

Recent clinical trials of the gum resin of Boswellia serrata have shown promising results in patients with ulcerative colitis. The objective of this study was to determine whether a semisynthetic form of acetyl-11-keto-beta-boswellic acid (sAKBA), the most potent anti-inflammatory component of the resin, also confers protection in experimental murine colitis induced by dextran sodium sulfate (DSS) to compare its effects with those standard medications of ulcerative colitis like steroids and to examine whether leukocyte-endothelial cell adhesion is a major target of action of sAKBA. Clinical measurements of disease activity and histology were used to assess disease progression, and intravital microscopy was employed to monitor the adhesion of leukocytes and platelets in postcapillary venules of the inflamed colon. sAKBA treatment significantly blunted disease activity as assessed both grossly and by histology. Similarly, the recruitment of adherent leukocytes and platelets into inflamed colonic venules was profoundly reduced in mice treated with sAKBA. Because previous studies in the DSS model have shown that P-selectin mediates these blood cell-endothelial cell interactions, the expression of P-selectin in the colonic microcirculation was monitored using the dual-radiolabeled antibody technique. The treatment of established colitis with sAKBA largely prevented the P-selectin upregulation normally associated with DSS colitis. All of the protective responses observed with sAKBA were comparable to that realized in mice treated with a corticosteroid. Our findings demonstrated an anti-inflammatory effect of sAKBA and indicated that P-selectin-mediated recruitment of inflammatory cells is a major site of action for this novel anti-inflammatory agent.

Health and clinical management - comparing the clinical outcome of computerized strategies. Findings from the Section on Health and Clinical Management

OBJECTIVES

To summarize current excellent research in the field of health and clinical management.

METHODS

Synopsis of the articles selected for the IMIA Yearbook 2006.

RESULTS

Current research in the field of health and clinical management analyses impact and patient outcome of both established and recently presented approaches. Usability and effects of extracting data from computerized medical records for preventive care and surveillance issues are a topic as well as strategies for detecting adverse events.

CONCLUSIONS

The best paper selection in the field of health and clinical management shows examples of excellent research on assessment, strategies and concepts for computerized health information management approaches. The articles emphasize the necessity of carefully considering health information systems regarding their outcome and compatibility with clinical routine. A concerted management of knowledge about evaluated health information management approaches will advance this trend and should lead to a more evidence-based design of the underlying systems.

Internal carotid artery stent placement without emboli protection: Results and long-term outcome

Patients with symptomatic > or = 60% (n = 134), asymptomatic > or = 80% (n = 143), and asymptomatic progressive > or = 60% (n = 25) internal carotid artery stenosis underwent stenting and were followed clinically and by Doppler-assisted duplex imaging for 27.1 +/- 15.6 months. Stroke and death from stroke occurred within 30 days after stenting in 4.7% of the symptomatic and in 3.0% of the asymptomatic patients and in the follow-up period in 2.3% of the symptomatic and in 1.2% of the asymptomatic patients.

Analysis and Specification of Telemedical Systems Using Modelling and Simulation: the MOSAIK-M Approach

BACKGROUND AND MOTIVATION

INCA (Intelligent Control Assistant for Diabetes) is a project funded by the EU with the objective to improve diabetes therapy by creating a personal control loop interacting with telemedical remote control. Development of telemedical systems generally is a complex task especially in international projects where engineering and user groups with different social and cultural background have to be included into the system development process.

OBJECTIVES

To explore if and how sophisticated information system modelling and simulation techniques can improve the development of telemedical systems.

METHODS

For system analysis and design the MOSAIK-M approach was chosen. MOSAIK-M means "Modelling, simulation, and animation of information and communication systems in medicine". It includes a generic process scheme, a meta model and a tool environment. The generic process scheme guides modelling projects to produce models of high quality in terms of correctness, completeness and validity. The meta model defines the modelling language.In INCA MOSAIK-M is used for analysis of the problem domain, specification of the telemedical system and cost/benefit-analysis.

RESULTS

The MOSAIK-M approach was used to create two models: an "As Is"-model of the problem domain and a "To Be"-model of the INCA system. The "As Is"-model of conventional insulin pump based diabetes care comprises submodels of diabetes management, ambulatory and clinical care. The "To Be"-model describes a patient's diabetes management using a smart phone that controls an insulin pump based on continuously measured interstitial glucose. It also describes telemedical care of a patient by diabetologists and a call centre. Both models can be simulated enhanced by visualisation capabilities to explore specific cases or scenarios. This feature proved valuable for the evaluation of both models through domain experts. The "To Be" model is used to guide the implementation of the system. Both models are being augmented by cost structures to support cost/benefit-analysis.

CONCLUSIONS

Even a complex telemedical system like the INCA system can be successfully specified using sophisticated modelling and simulation based approaches like MOSAIK-M. The resulting specification is a result of its own and ensures a lasting effect of the definitions and specifications produced during the project. International cooperation and evaluation of the system design prior to its implementation profit from simulation and visualisation capabilities of MOSAIK-M.

PrP Sc-like prion protein conformer in sudden infant death syndrome brain

Nothing is known about the pathophysiology of sudden infant death syndrome (SIDS). Here we show the presence of misfolded prion protein (PrP(Sc)-like) in extracts of various sections of the brains of two SIDS victims. DNA sequence information for one of these (death at 12 days) revealed two nucleotide variants in the protein coding region of the PrP gene. This may be a key finding in the understanding of SIDS pathology, and may suggest ways for identifying risk factors for SIDS in newborn infants.

Spontaneous remission in adult acute myeloid leukemia in association with systemic bacterial infection-case report and review of the literature

Spontaneous remission of acute myeloid leukemia in the adult is a rare event. We report on a 31-year-old male patient suffering from acute myeloid leukemia (AML) M5a according to the French-American-British (FAB) classification with biphenotypic features in flow cytometric examination and severe bacterial infection with group G streptococci at the time of diagnosis. Because of sepsis and stable clinical conditions, chemotherapy was delayed and antibiotics were administered intravenously. Within 6 weeks a spontaneous remission of AML occurred. Remission lasted for about 2 months. At the time of relapse, a change in phenotype of the leukemic blasts with a loss of B-lymphoid markers could be demonstrated by flow cytometry. The patient was treated with an induction therapy according to the multicentric German AMLCG 2000 schedule. To our knowledge, this is the first report of a spontaneous remission in an AML FAB M5a associated with coexpression of myeloid- and lymphoid-associated antigens on the leukemic blasts. Possible mechanisms of this phenomenon are discussed with a review of the literature.

A broader horizon of Alzheimer pathogenesis: ALZAS--an early serum biomarker?

Recently, a novel risk gene protein expressed in elderly patients with the diagnosis of Alzheimer disease (AD) was discovered on chromosome 21 within the APP (amyloid precursor protein) region. This 79 amino acid protein, ALZAS (Alzheimer Associated Protein) contains the beta-amyloid peptide 1-42 fragment, the APP transmembrane signal, and a unique 12 amino acid c-terminal which is not present in any known allele of the APP gene. Reverse transcription-PCR revealed that the transcript of ALZAS was expressed in cortical and hippocampal regions of human Alzheimer disease brain as well as in leukocytes derived from AD patients. Most specifically, an endogenous antibody was found in patients with confirmed AD, in patients with depression, and in subjects suggested to have presymptomatic AD, where it was directed against epitopes within the intron encoded amino acid c-terminal sequence.

Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery

BACKGROUND

Pain is a sensory and emotional experience that is influenced by physiologic, sensory, affective, cognitive, socio-cultural, and behavioral factors. Consistent with the perspective to improve the postoperative pain control, the present study has the purpose of assessing the effect of presurgical clinical factors, psychological and demographic characteristics as predictors for reporting moderate to intense acute postoperative pain.

METHODS

A prospective cohort study was performed with 346 inpatients undergoing abdominal elective surgery (ASA physical status I-III, age range 18-60 years). The measuring instruments were Pain Visual Analog Scale, the State-Trait Anxiety Inventory, and the Montgomery-Asberg Depression Rating Scale. Multivariate conditional regression modeling was used to determine independent predictors for moderate to intense acute postoperative pain.

RESULTS

Moderate to intense acute postoperative pain was associated with status ASA III (odds ratio (OR) = 1.99), age (OR = 4.72), preoperative moderate to intense pain (OR = 2.96), chronic pain (OR = 1.75), high trait-anxiety and depressive mood moderate to intense (OR = 1.74 and OR = 2.00, respectively). Patients undergoing surgery to treat cancer presented lower risk for reporting moderate to intense pain OR = 0.39, as well as those that received the epidural analgesia and multimodal analgesia with systemic opioid (OR = 0.09 and OR = 0.16, respectively).

CONCLUSIONS

The identification of predictive factors for intense acute postoperative pain may be useful for designing specific preventive interventions to relieve patient suffering. Especially because few of these variables are accessible for medical intervention, which would improve the clinical outcomes and quality of life of patients at risk of moderate to intense acute postoperative pain.

Alterations of the cyclin D1/pRb/p16(INK4A) pathway in multiple myeloma

The retinoblastoma protein (pRb), p16(INK4A), D-type cyclins, and their partners cyclin-dependent kinase (CDK) 4 and 6 constitute a G(1) regulatory pathway commonly targeted in tumorigenesis. Several malignancies show a reciprocal correlation between genetic alterations of single members of the pRb pathway. Therefore, we determined the frequency of Rb deletions and cyclin D1 alterations by fluorescence in situ hybridization as well as 5' CpG island hypermethylation of the p16(INK4A)gene using methylation-specific polymerase chain reaction in bone marrow mononuclear cells from 82 individuals with plasma cell disorders. Alterations in at least one of the components of the pathway were found in 75%. Cyclin D1 translocations or amplifications were detected in 14/82 (17.1%), Rb deletions at 13q14 in 23/82 (28%) of the cases, including three (3.6%) homozygous deletions. p16(INK4A) was hypermethylated in 33/57 (57.9%) of the samples. Further analysis revealed a highly significant correlation between cyclin D1 alterations and extramedullar or leukemic myeloma manifestations (P = 0.014; Fisher's test). Whereas Rb deletions seemed to occur alternatively to cyclin D1 alterations, no reciprocal correlation was found between p16(INK4A) hypermethylations and cyclin D1 or Rb locus aberrations. Cyclin D1 locus alterations and Rb deletions were associated with a significantly worse prognosis whereas p16(INK4A) hypermethylation had no impact on survival. We conclude that cyclin D1 and Rb aberrations seem to occur as alternative events in plasma cell malignancies and contribute to clinical course and prognosis. In contrast, although p16(INK4A) hypermethylation is frequent, inactivation of p16(INK4A) seems not to be involved in the pathogenesis of plasma cell disorders.

[Effects of the intensity of a post partum examination on the fertility performance of high yielding dairy cows]

Two methods for a scheduled post partum examination were compared on a commercial dairy farm. In Group 1, all cows (n = 601) were examined by rectal palpation between day 20 and 26 post partum for signs of endometritis (vaginal discharge, enlarged uterus). In Group 2, all cows (n = 652) were examined by external inspection for vaginal discharge as a sign for endometritis. In both groups all cows with endometritis were treated twice with prostaglandin F2 alpha (25 mg of dinoprost) in a 14-day interval. The proportion of cows with signs of endometritis was 33.3% and 17.2% in Group 1 and Group 2, respectively (p < 0.05). In Group 1, the conception rate (39.0% vs 49.3%) and the proportion of cows pregnant (60.5% vs 72.6%) were lower for cows with endometritis than for cows without endometritis. In Group 2, no significant differences were found in reproductive performance for cows with and without signs of endometritis. No significant differences in reproductive performance were found for cows with endometritis between the two groups. Also, for cows without endometritis no significant differences in reproductive performance were found between the groups. It is concluded that the post partum examination by rectal palpation was more sensitive in finding cows with endometritis. However, with regard to the reproductive performance the more sensitive method was not more effective than the method based on systematic external inspection.