[Assessment of subjective physical well-being in heart failure : Validation of the FEW16 questionnaire]

INTRODUCTION

Improvement in the quality of life (QoL) is a major goal of therapy for heart failure (HF) patients. Physical well-being as an important component of QoL has not yet been sufficiently covered by disease-specific assessment instruments. The aim of the study was to validate the questionnaire for assessing subjective physical well-being (FEW16) in HF patients with preserved ejection fraction (HFpEF) from the exercise training in diastolic heart failure (Ex-DHF‑P) trial.

METHOD

A total of 64 HFpEF patients (65 years, 56 % female) were randomized to usual routine treatment with (n = 44) or without training (n = 20). At baseline and 3 months, patients were clinically evaluated and assessed using appropriate questionnaires on the QoL (SF36), physical well-being (FEW16) and depression (PHQ-D).

RESULTS

The FEW16 showed good values for Cronbachs' alpha coefficients (0.85-0.93). The cross-validity with SF36 and PHQ-D was highly significant but more so for psychological aspects. At baseline, the FEW16 score correlated with age, the subscale resilience with age and the 6 min walking distance test. At follow-up, the total and resilience scores had improved in the training group. In contrast to the SF36, the FEW16 did not detect differences between the groups in Ex-DHF‑P.

DISCUSSION

The FEW16 questionnaire showed good internal consistency and correlation with SF36, its total score and resilience had improved after training; however, it did not reflect different changes between the study groups. The FEW16 is therefore more suited to assess general/mental well-being than the subjective physical well-being.

Attachment of Algal Cells to Zwitterionic Self-Assembled Monolayers Comprised of Different Anionic Compounds

The influence of zwitterionic self-assembled monolayers on settlement and removal of algae was studied. The monolayers were constructed either from zwitterionic thiols or from solutions of positively and negatively charged thiols. The cationic component was composed of quaternary ammonium terminated thiols and the anionic component contained sulfate or carboxylate termination. During assembly, all surfaces showed a strong tendency for equilibration of the surface charge. Settlement and adhesion assays with zoospores of Ulva linza and the diatom Navicula incerta, and field tests of the initial surface colonization revealed the relevance of charge equilibration for the biological inertness of the prepared surfaces.

HIV encephalopathy: glial activation and hippocampal neuronal apoptosis, but limited neural repair

OBJECTIVES

HIV infection affects the central nervous system (CNS), frequently causing cognitive impairment. Hippocampal injury impedes the ability to transfer information into memory. Therefore, we aimed to examine neuronal injury and repair in the hippocampal formation in HIV encephalopathy.

METHODS

We compared neuropathological findings in 14 autopsy cases after death from systemic complications of HIV infection and in 15 age-matched HIV-negative control cases after sudden death from nonneurological causes using immunohistochemistry.

RESULTS

The density of apoptotic granule cells in the dentate gyrus was higher in HIV-infected than in control cases (P = 0.048). Proliferation of neural progenitor cells in the dentate gyrus was increased in HIV infection (P = 0.028), whereas the density of recently generated TUC-4 [TOAD (turned on after division)/Ulip/CRMP family 4]-expressing neurons in this region was not significantly elevated in HIV-infected cases (P = 0.13). HIV infection caused microglial activation and astrocytosis in the neocortex and hippocampal formation. Conversely, we were unable to detect more pronounced axonal injury in HIV-infected than in control cases.

CONCLUSIONS

As in other infections involving the CNS, apoptosis of hippocampal neurons accompanied by microglial activation and astrocytosis is a prominent feature of HIV encephalopathy. The regenerative potential, assessed using the density of young neurons in the hippocampal dentate gyrus, in HIV infection appears to be lower than in acute bacterial meningitis and septic encephalitis.

Three-dimensional musculoskeletal modelling of the seated row resistance-training exercise

Objective. To evaluate whether three-dimensional (3D) musculoskeletal modelling could be effective in assessing the safety and efficacy of exercising on a seated row resistance-training machine. The focus of the evaluation was on biomechanical and anthropometric considerations of the end user.Methods. Three anthropometric cases were created; these represented a 5th percentile female as well as a 50th and a 95th percentile male based on body mass index. Two repetitions, with a resistance equal to 50% of the functional strength of one repetition maximum (1RM) for each anthropometric case, were performed.Results. Results indicate that the default model of the LifeModeler software has important limitations that should be taken into consideration when used to evaluate exercise equipment. Adjustments had to be made to the model to solve the forward dynamics simulations; as a result, no muscle forces or contraction values were obtained. This negatively influenced the value of the results as these parameters are important when analysing an exercise. The seated row resistance-training machine’s engineered or manufactured adjustability was sufficient, as it appeared to accommodate the three anthropometric cases adequately during execution of this exercise.Conclusion. It appears that 3D musculoskeletal modelling can be used to evaluate resistance-training exercises such as the seated row; however, the limitations indicated by this study must be taken into consideration, especially when using the default LifeModeler model

Three-dimensional musculoskeletal modelling of the seated row resistance-training exercise

Objective. To evaluate whether three-dimensional (3D) musculoskeletal modelling could be effective in assessing the safety and efficacy of exercising on a seated row resistance-training machine. The focus of the evaluation was on biomechanical and anthropometric considerations of the end user.Methods. Three anthropometric cases were created; these represented a 5th percentile female as well as a 50th and a 95th percentile male based on body mass index. Two repetitions, with a resistance equal to 50% of the functional strength of one repetition maximum (1RM) for each anthropometric case, were performed.Results. Results indicate that the default model of the LifeModeler software has important limitations that should be taken into consideration when used to evaluate exercise equipment. Adjustments had to be made to the model to solve the forward dynamics simulations; as a result, no muscle forces or contraction values were obtained. This negatively influenced the value of the results as these parameters are important when analysing an exercise. The seated row resistance-training machine’s engineered or manufactured adjustability was sufficient, as it appeared to accommodate the three anthropometric cases adequately during execution of this exercise.Conclusion. It appears that 3D musculoskeletal modelling can be used to evaluate resistance-training exercises such as the seated row; however, the limitations indicated by this study must be taken into consideration, especially when using the default LifeModeler model

[Neurogenic muscular atrophy and selective fibre type atrophies : Groundbreaking findings in the biopsy diagnosis of neuromuscular disease]

Neurogenic muscular atrophy (NMA) is the most frequent diagnosis obtained from reading a muscle biopsy. It is characterized by specific histological changes which distinguish NMA from other important muscle pathologies including the primary myopathies such as the muscular dystrophies as well as the inflammatory muscle disorders. Within the group of denervation atrophies, NMAs due to motor neuron diseases are associated with particular histological patterns. The diagnosis of NMA in muscle biopsies requires special methods, mainly enzyme and immunohistochemistry, but also resin histology and in some cases electron microscopy. Analysis of a combined muscle and sural nerve biopsy provides the opportunity to compare the extent of degeneration in the motor and sensory systems, respectively. Muscle fiber typing by enzyme and immunohistochemistry also leads to the detection of selective type 1 and type 2 muscle fiber atrophies which are relevant in the differential diagnosis of neuromuscular diseases.

[Inflammatory and other myopathies and skeletal muscle vasculitis: the role of muscle and nerve biopsy]

Muscle and nerve biopsies provide valuable information contributing to the diagnosis of diseases of the peripheral nervous system and skeletal muscle. The application of modern histological, immunohistochemical, electron microscopic and molecular methods establishes a definite diagnosis in many cases and narrows the spectrum of possible entities in most of the remaining cases. Inflammatory myopathies and neuropathies are distinguished from non-inflammatory muscular and peripheral nervous conditions. The latter include muscular dystrophies and congenital myopathies, hereditary neuropathies, metabolic diseases affecting skeletal muscle and peripheral nerves as well as degenerative myopathies and neuropathies including sporadic motor neuron diseases.

Primary lymphoma of the skull base

This case demonstrates the rare finding of a primary malignant lymphoma of the frontobasis and ethmoidal cells in a patient presenting with progressive loss of vision. Computed tomography and MRI demonstrated a homogenously enhancing tumour with extensive bony destructions of the skull base. After transsphenoidal biopsy, histology revealed a highly malignant primary B-cell lymphoma. The patient was further treated with immunochemotherapy. Tissue diagnosis is, therefore, crucial before a definitive therapy is instituted.

Regional size differences in four commonly used cephalometric atlases: the Ann Arbor, Cleveland (Bolton), London (UK), and Philadelphia atlases compared

OBJECTIVE

To explore regional influence on size in roentgenocephalometric atlases.

DESIGN

Comparisons of the size of 10 linear distances in four atlases from geographically different regions, i.e. Ann Arbor Michigan, Cleveland Ohio, Philadelphia Pennsylvania and London, UK. DISTANCES COMPARED: anterior cranial base length (S-N), posterior cranial base length (S-Ba), total face height (N-Me), upper face height (N-ANS), lower face height (ANS-Me), mandibular diagonal (Ar-Gn), corpus length (Go-Pg), ramus height (Ar-Go), maxillary length (SNP-SNA), posterior face height (S-Go).

RESULTS

Correction for enlargement appeared to be a necessity before distances could be compared. After correction for enlargement, the anterior cranial base was longest in Ann Arbor, lower face height smallest in Cleveland (Bolton standards) and the maxilla was shortest in Philadelphia.

CONCLUSION

Regional size variance in cephalometric data cannot be ignored.

Comparative study analyzing effects of sirolimus-cyclosporin and sirolimus-tacrolimus combinations on bile flow in the rat

The new immunosuppressive agent sirolimus is combined in transplant patients with the cholestatic substances cyclosporin and tacrolimus. Nothing is known about possible cholestatic effects of these combinations. Therefore, we compared their effects on bile flow and on important bile parameters in an acute bile fistula model in rats. Cyclosporin reduced bile flow, biliary excretion of bile salts, cholesterol, and GSH to 20-40% of basal values. Sirolimus decreased bile flow to 50% and excretion of GSH to 30% of the initial conditions but had no effect on cholesterol and bile salt excretion. In contrast, tacrolimus increased bile flow to 120% and GSH excretion to 220% of the basal levels. Sirolimus/cyclosporin decreased bile flow and bile parameters to the same extent as cyclosporin alone. Sirolimus/tacrolimus reversed sirolimus-induced reduction of bile flow and GSH excretion and resulted in a normal bile salt and cholesterol excretion, thus it may be the better alternative in cholestatic patients.

In vitro studies of poorly absorbed drugs using porcine intestine in the ring model RIMO

Two compounds, an aminobisphosphonate (A) and a steroid (B), showing a very large difference in lipophilicity (log PC (A) = O, log PC (B) > 8) but both revealing very poorly absorption in vivo of less than 1% were tested in respect of in vitro absorption and mucoadhesion using a model with porcine intestine named RIMO (ring model). Explanations for the poor absorption of the two compounds were investigated in order to propose methods for absorption enhancement. Moreover, absorption and mucoadhesion were measured for different parts of intestine with radiolabelled substances. Last but not least the inhibiting effect of calcium ions was investigated as well as enhancement by DTT (dithiothreitol), EDTA and bile. Results showed that mucus plays an important role in oral bioavailability. The aminobisphosphonate formed a complex with calcium ions which was insoluble in the mucus and resulted in a smaller amount of substance being absorbed. The very lipophilic steroid was kept back from the mucosa by the hydrophilic mucus, but addition of the solubilizer bile increased the absorption. The results were in good agreement with in vivo bioavailability data. Therefore, simplicity of the model and easy access of porcine intestine by slaughter houses make RIMO a valuable tool for investigations concerning the role of mucus and influences of diverse additives on absorption.

In vitro absorption studies with carvedilol using a new model with porcine intestine called BM-RIMO (Boehringer-Mannheim ring model)

Carvedilol (CAS 72956-09-3, Dilatrend) is a beta-blocker with additional vasodilating, antiproliferative and antioxidative properties. It is indicated for the treatment of high tension (HT), coronary artery disease (CAD) and congestive heart failure (CHF). Carvedilol has been investigated in numerous in vivo studies and thus comparisons of in vitro results to in vivo observations are possible. In this publication the results of studies on the in vitro absorption of carvedilol in a new model called BM-RIMO (Boehringer-Mannheim ring model) using porcine intestine are reported. In particular the influence of absorption enhancers and of pH and the existence of absorption windows were examined and the relevance of the obtained data for in vivo conditions was estimated. The main route of carvedilol absorption seemed to be transcellular. In vitro as well as in vivo absorption decreased within the intestine in the following order: jejunum > ileum > colon. The highest amount of in vitro absorption of carvedilol was achieved in the jejunum at a neutral pH. Enhancers such as bile and the mucoadhesive agent chitosan had opposite effects on the absorption of the compound. The results indicate that BM-RIMO is a simple, cheap and fast tool for the investigation of the influence of absorption enhancers, pH and different parts of intestine on absorption. For carvedilol the in vitro model tends to overestimate absorption in the colon, possibly because of the lack of faeces.

Solvent vapor abuse leukoencephalopathy. Comparison to adrenoleukodystrophy

Chronic organic solvent vapor inhalation can cause permanent damage to the central nervous system. Clinical features and radiologic abnormalities are well known, but pathology has not been definitely established. This study describes the gross, microscopic and ultrastructural changes and fatty acid composition of cholesterol esters in the brain of two chronic paint sniffers as well as the electron microscopic findings from a third, all with permanent neurological impairment. The abnormalities which were the same in all cases consisted of a demyelinating process which grossly manifested itself as brain atrophy and subtle discoloration of the cerebral and cerebellar white matter. Periodic acid-Schiff-positive macrophages in the absence of foamy macrophages were the histological hallmark of this process. Electron microscopy revealed oval membrane-bound cytoplasmic bodies filled with bundles of trilaminar inclusions composed of 3 nm paired dense leaflets separated by a space 3-7 nm wide in macrophages. Biochemical analysis showed an increase of very long chain fatty acids in the white matter cholesterol esters. This study defines the morphologic substrate of solvent vapor abuse leukoencephalopathy. The novel ultrastructural observations in conjunction with biochemical findings provide a link with adrenoleukodystrophy and raise the possibility of similar mechanisms of myelin degradation in both.

A novel hantavirus associated with an outbreak of fatal respiratory disease in the southwestern United States: evolutionary relationships to known hantaviruses

Four Corners hantavirus (FCV) is the tentative name of the suspected etiologic agent of the newly identified hantavirus-associated respiratory distress syndrome (HARDS). The identification in HARDS patients of serum immunoglobulin M and immunoglobulin G antibodies that cross-reacted with Hantaan, Seoul, and Puumala virus antigens first suggested that FCV is a hantavirus. Limited nucleotide sequence data from the FCV glycoprotein-2 (G2) confirmed that FCV is a hantavirus and showed that it is most closely related to Prospect Hill and Puumala viruses. We have molecularly cloned approximately 95% of the sequences of the M and S segments of the FCV genome encoding the envelope glycoproteins and nucleocapsid protein N from the lungs of a patient with HARDS. The nucleotide sequence has been determined for 2,632 bases. The nucleotide sequence data show that FCV is a new member of the Puumala virus and Prospect Hill virus division of the hantavirus genus. Phylogenetic tree analyses indicate that the M and S segments have evolved in parallel. Therefore, the novel pathogenic activity of FCV is not likely to be the result of recent reassortment of segments from less pathogenic viruses.

Constitutional delay of growth and adolescence. Results of short-term and long-term treatment with GH

During recent years numerous reports on the favourable results of short-term trials with GH in patients with constitutional delay of growth and adolescence (CDGA) have been published, but it has been unclear whether such treatment affects final height. In the present study, the results of long-term therapy with GH in replacement doses have been evaluated in 15 patients who were treated with GH for several years (three years on average). At the start of treatment, 10 of the children were prepubertal and 5 were in puberty. All patients were followed up until final height was reached. Mean final height of the 13 male patients was 170.0 +/- 4.4 cm, i.e. -1.58 SDS. In the two female patients, final height was 150.0 cm (-3.5 SDS) and 164.0 cm (-0.8 SDS), respectively. Adult height of the patients lagged behind target height by 5.4 +/- 3.2 cm (mean +/- SD). Measured adult height corresponded to adult height as predicted prior to treatment. In conclusion, GH treatment of patients with CDGA did not increase final height.

[Pulmonary artery loop and dysplastic tracheal stenosis. Case report with pre- and postoperative spirometry and discussion of the value of diagnostic signs]

Since his second week of life a boy, with pulmonary artery sling now 8 3/4 years old suffered from mainly expiratory stridor during exercise and dyspnoe during bronchopulmonary infections, twice in a life-threatening manner. The indirect diagnostic signs were all negative, bronchoscopy revealed a narrow distal trachea and a pulsating stenosis of high degree at the bifurcation. Bronchographic findings were characteristic. Angiocardiographically the retrotracheal run of the left pulmonary artery could only be proved by marking the trachea with a catheter. After operation at the age of 8 1/4 years, the boy had no relevant subjective complaints during a follow-up of 6 months. Spirometric lung function tests before and after corrective operation revealed a considerable obstruction of central intrathoracic airways that persisted after operation, only peak flow improved significantly. According to the bronchological findings the reason therefore is a dysplastic tracheobronchial stenosis, which is seen often in combination with PAS.

[Bilateral middle ear tuberculosis and morphologically unusual lung tuberculosis in an 11-year-old boy]

A 11 year old boy presented with chronic otorrhea and hearing impairment. After repeated tympanorevision macroscopic findings suggested the presence of middle ear tuberculosis. Chest X-ray revealed unusual abnormalities which in conjunction with normal pulmonary function and overall well-being did not support concurrent pulmonary tuberculosis. However, microbiological investigations verified this diagnosis in both sites, and proper tuberculostatic treatment proved successful.

The Kenny syndrome, a rare type of growth deficiency with tubular stenosis, transient hypoparathyroidism and anomalies of refraction

One family (3 cases) with the Kenny syndrome and a second family (3 cases) with features of Kenny syndrome but lacking medullary stenosis are reported. The main symptoms in both families are proportionate dwarfism, cortical thickening of tubular bones, variable anomalies of the calvaria, anemia, transient hypoparathyroidism and variable ocular anomalies. The latter include microphthalmia, and moderate-to-severe myopia or hyperopia. In the first family there was medullary stenosis of most tubular bones. In the second family two cases exhibited mild-to-moderate cortical thickening of tubular bones, but absent or mild medullary stenosis. Possible variability of the Kenny syndrome is discussed. Endocrine studies failed to demonstrate any permanent disturbance of parathormone or calcitonin metabolism, or GH deficiency. Pathogenesis remains unclear. Autosomal dominant inheritance seems to be likely.

[Malignant lymphoma of the bone in children (author's transl)]

Two children with primary malignant lymphoma of the bone and the progress of the disease are presented. There was a delayed diagnosis in both children. The tumors were first misinterpreted as being benign (epipiphysiolysis capitis femoris atheroma) and later on as being malignant (Ewing's sarcoma neuroblastoma). The course of the disease in one child (leukemia transformation) confirmed finally the diagnosis of malignant lymphoma.

[Mediastinal complications following retropleural operation for oesophageal atresias (author's transl)]

Serious acute complications can occur in relation to anastomotic insufficiency or re-opening of the fistula in patients with tracheo-oesophageal fistula and atresia, even if the repair has been carried out extra-pleurally. For this reason the patient should not be nursed flat and the important life-threatening signs to watch for are increasing tachypnoea and dyspnoea with respiratory acidosis and a central air shadow in the mediastinum.

Malignant intracranial chordoma and sarcoma of the clivus in infancy

Neuroradiological and clinical findings suggesting chordoma of the clivus are described in three children. They presented with torticollis as the primary and predominant symptom. Progressive deterioration with development of slurred speech, signs of intracranial pressure and further cranial nerve involvement led to more extensive neuroradiological investigation. The clinical and neuroradiological findings in these three children were similar; the prognosis was unfavourable for two of the children. The histological diagnosis in two cases was malignant chordoma; in the third case it was undifferentiated sarcoma of the clivus.

Pneumopericardium as a complication of foreign body aspiration

A case of pneumopericardium in an infant complicating aspiration of a foreign body is reported. In addition to X-ray studies echocardiography is valuable for the control of the disease. The pathogenesis and the treatment are discussed and a short review of the literature is given.

Hypophosphatasia. Review of 24 cases

Radiographic analysis of 24 cases of hypophosphatasia (H) from 9 Paediatric Centres was performed. 3 cases were of neonatal (lethal), 18 cases of infantile (severe) and 3 cases of late (benign) type. Some of the patients were in reality borderline cases between these groups. In the authors' material all the patients showed radiographic signs of the disease. These were divided into diagnostic, characteristic and suggestive features. All of the patients had in common generalised (usually irregular) osteoporosis, generalised (usually irregular) metaphyseal changes, craniostenosis (13 of 18 infantile cases) or widened cranial sutures and ofter bowing of the long bones. Besides the well know radiographic features of hypophosphatasia some less well known, rare or 'new' ones such as, 1. spurs of the long bones (Bowdler sign), 2. distal femoral central metaphyseal defects and epiphyseal defects, 3. S-like deformities of the tibiae, 4. abnormal shape of the distal phalanges of the fingers, 5. multiple rib fractures and slender bones, 6. wedging of the lower thoracic and upper lumbar vertebrae, 7. partial premature fusion of the epiphyses, 8. nephrocalcinosis, 9. loss of lamina dura around the teeth, 10. variation in radiographic appearances of a pair of siblings with lethal form, and, 11. rapid changes in roentgen appearances. are discussed. In two of our patients (siblings) phosphoethanolamine was undetectable in the urine. The authors doubt if a normal skeletal survey may be present at any stage in any of the three major types of hypophosphatasia.

[Radiological diagnosis (and differential diagnosis) of lethal type (congenital type) of hypophosphatasia (author's transl)]

Diagnosis of Hypophosphatasia can be proved by typical radiological findings. The paper presents a case report of a newborn living only a few hours. Diagnosis according to clinical aspect was "Osteogenesis imperfecta" although a postmortal x-ray-babygram was available but which had not been shown to a radiologist. Anatomical diagnosis with the histological findings was then altered to "Metaphyseal chondrodysplasia, Jansen-type". Finally the diagnosis could be corrected to congenital, lethal type of Hypophosphatasia after the babygram had been shown to a radiologist. The typical radiological features of congenital Hypophosphatasia are described subsequently and differential diagnosis of Congenital Osteochondrodysplasias is discussed. The importance of early or postmortal diagnosis for genetic counselling is stressed as well as a close cooperation between obstetricians and pediatric radiologists. Typical biochemical findings are mentioned.

[The so-called chondrodystrophia of the newborn (author's transl)]

Chondrodystrophia (now: Achondroplasia) formerly believed to be a uniform disease rather is an entity comprising up till now at least ten radiologically differing types. Definite diagnosis of these types can only be made radiologically although certain clinical features are of additional help. For practical purpose a schematic representation of these types is given, based upon the classification of congenital osteochondrodysplasias by the ESPR (European Society of Pediatric Radiology, Rome, 1969). It emphasizes the characteristic radiological signs and describes the typical changes in body proportions. In a second part the single diseases are discussed according to the scheme with their radiological differential diagnosis and their prominent changes in the skeletal system. Some examples are given for possibly associated malformations and final prognosis.

[Acute adrenal hemorrhage in newborn infants: the importance of early diagnosis (author's transl)]

Two case reports demonstrate the importance of an early diagnosis for the therapy of adrenal hemorrhage. In the first case with unilateral hemorrhage, the hemorrhage as such was of importance. In the second case with bilateral hemorrhage, the course was dominated by acute adrenal insufficiency with circulatory collapse and major salt loss. The diagnosis was supported by the typical changes in electrolyte levels as well as by radiography, and endocrinological results. With early therapy (in the first instance by surgery, and in the latter by substitution of corticosteroids), both children safely passed the critical period. In the second child ACTH administration did not, in the first phase of the disease, result in a significant rise of plasma cortisol. However, two months later there was a normal rise of the cortisol level following ACTH administration. From this observation we conclude that a favourable regeneration of the adrenal glands has resulted.