Local control and patient reported outcomes after online MR guided stereotactic body radiotherapy of liver metastases

Introduction

Stereotactic body radiotherapy (SBRT) is used to treat liver metastases with the intention of ablation. High local control rates were shown. Magnetic resonance imaging guided radiotherapy (MRgRT) provides the opportunity of a marker-less liver SBRT treatment due to the high soft tissue contrast. We report herein on one of the largest cohorts of patients treated with online MRgRT of liver metastases focusing on oncological outcome, toxicity, patient reported outcome measures (PROMs), quality of life.

Material and methods

Patients treated for liver metastases with online MR-guided SBRT at a 1,5 T MR-Linac (Unity, Elekta, Crawley, UK) between March 2019 and December 2021 were included in this prospective study. UK SABR guidelines were used for organs at risk constraints. Oncological endpoints such as survival parameters (overall survival, progression-free survival) and local control as well as patient reported acceptance and quality of life data (EORTC QLQ-C30 questionnaire) were assessed. For toxicity scoring the Common Toxicity Criteria Version 5 were used.

Results

A total of 51 patients with 74 metastases were treated with a median of five fractions. The median applied BED GTV D98 was 84,1 Gy. Median follow-up was 15 months. Local control of the irradiated liver metastasis after 12 months was 89,6%, local control of the liver was 40,3%. Overall survival (OS) after 12 months was 85.1%. Progression free survival (PFS) after 12 months was 22,4%. Local control of the irradiated liver lesion was 100% after three years when a BED ≥100 Gy was reached. The number of treated lesions did not impact local control neither of the treated or of the hepatic control. Patient acceptance of online MRgSBRT was high. There were no acute grade ≥ 3 toxicities. Quality of life data showed no significant difference comparing baseline and follow-up data.

Conclusion

Online MR guided radiotherapy is a noninvasive, well-tolerated and effective treatment for liver metastases. Further prospective trials with the goal to define patients who actually benefit most from an online adaptive workflow are currently ongoing.

Genome-wide association analysis of coffee drinking suggests association with CYP1A1/CYP1A2 and NRCAM

Coffee consumption is a model for addictive behavior. We performed a meta-analysis of genome-wide association studies (GWASs) on coffee intake from 8 Caucasian cohorts (N=18 176) and sought replication of our top findings in a further 7929 individuals. We also performed a gene expression analysis treating different cell lines with caffeine. Genome-wide significant association was observed for two single-nucleotide polymorphisms (SNPs) in the 15q24 region. The two SNPs rs2470893 and rs2472297 (P-values=1.6 × 10(-11) and 2.7 × 10(-11)), which were also in strong linkage disequilibrium (r(2)=0.7) with each other, lie in the 23-kb long commonly shared 5' flanking region between CYP1A1 and CYP1A2 genes. CYP1A1 was found to be downregulated in lymphoblastoid cell lines treated with caffeine. CYP1A1 is known to metabolize polycyclic aromatic hydrocarbons, which are important constituents of coffee, whereas CYP1A2 is involved in the primary metabolism of caffeine. Significant evidence of association was also detected at rs382140 (P-value=3.9 × 10(-09)) near NRCAM-a gene implicated in vulnerability to addiction, and at another independent hit rs6495122 (P-value=7.1 × 10(-09))-an SNP associated with blood pressure-in the 15q24 region near the gene ULK3, in the meta-analysis of discovery and replication cohorts. Our results from GWASs and expression analysis also strongly implicate CAB39L in coffee drinking. Pathway analysis of differentially expressed genes revealed significantly enriched ubiquitin proteasome (P-value=2.2 × 10(-05)) and Parkinson's disease pathways (P-value=3.6 × 10(-05)).

Weichteildefekt und exponiertes Osteosynthesematerial — Metallerhalt oder Entfernung?

BACKGROUND

In the event of exposed hardware from reconstructive surgery, it must be decided whether to retain or remove it prior to plastic surgical soft-tissue reconstruction to ensure long-term freedom from infection and stable wound closure.

MATERIAL AND METHODS

Treatment options and results in the literature are reviewed. A treatment algorithm is proposed under consideration of our personal experience.

RESULTS AND CONCLUSION

Hardware used in spine surgery is commonly left in situ until bony consolidation has been achieved. The indications for hardware removal depend on length of exposure or infection, implant failure, and location. Osteosynthetic devices in the extremities may be removed and replaced by external fixators or immobilisation. Removal of prostheses requires complex second-stage reimplantation or arthrodesis. A treatment algorithm is suggested that might ease the decision whether exposed hardware can remain or requires removal before reconstruction of soft-tissue defects.

Mikrochirurgische Rekonstruktion der oberen Extremität nach Brandverletzungen

BACKGROUND

Free tissue transplantation is a rarely indicated procedure in burn reconstruction. As the versatility and variability of free flaps have significantly increased during recent years, so too have the indications for these procedures expanded.

MATERIAL AND METHODS

We retrospectively report the results of 42 free flaps for upper extremity reconstruction in 35 severely burned patients using 13 different free flaps. This experience has enabled us to establish reconstructive principles pertinent to the type of injury (burn versus high voltage injuries) and the timing of reconstruction procedures.

RESULTS

In high voltage injuries (n = 17) early free flap coverage (< 21 days after trauma) with muscular flaps was the most frequently used type of reconstruction. Reconstruction site was predominately the forearm. In burn injuries (flame, contact, fluid), free flap coverage was performed during a later stage of the treatment course (3 to 6 weeks after trauma), or as a secondary procedure. Reconstruction with cutaneous or fascial flaps was the preferred method. The elbow and the dorsum of the hand underwent defect coverage in most circumstances. For the reconstruction of complex or large defects (n = 6) combined "chimeric" flaps, preexpansion of free flaps, or the combination of a free and local flap were used. Overall, the flap failure rate was 12 % (n = 5). Interestingly, there was a relationship between flap failure rate and timing of the procedure. Four out of five flap failures occurred within 5 to 21 days after trauma, all five flap failures occurred between five days and six weeks. No flap failure was seen during secondary reconstruction.

CONCLUSION

Our data demonstrate that burn and high voltage injuries are distinct entities, each requiring custom-tailored reconstructive solutions for limb salvage. Even if our flap failures all occurred during the first six weeks it should not be forgotten that this type of coverage is the only alternative to amputation in selective cases.

Funktionelle Ergebnisse nach Entfernung der proximalen Handwurzelreihe bei SNAC- und SLAC-Wrist Stadium II

The proximal row carpectomy (PRC) is a motion preserving procedure which creates a new joint without arthrosis. It is a frequently used procedure in stage II of a posttraumatic degenerative arthrosis of the wrist after scaphoid nonunion or scapholunate ligament instability (SNAC-/SLAC-wrist). In this retrospective analysis the functional postoperative results of this operation are compared in light of a homogenous indication (SNAC-/SLAC-wrist stage II). In 38 patients PRC was performed for a stage II SNAC- (n = 29) or SLAC-wrist (n = 9) between June 1994 and March 2002. Postoperative examination included range of motion and grip strength. Pain was assessed using a visual analogue scale (VAS 0 - 100). The DASH questionnaire (disability of the arm, shoulder and hand) was used to evaluate the disabilities in activities of daily living (ADL). Thirty patients (79 %) with a mean age of 39 years (23 - 59) were evaluated with a mean follow-up of 27 months (6 - 100). Mean extension and flexion of the wrist reached 75 degree which was 57 % of the contralateral hand. Mean radial and ulnar deviation was 33 degree corresponding with 52 % of the contralateral hand. The average grip strength was 50 % of the unaffected side. The postoperative DASH score was 27.4. Pain with strenuous activity was reduced by 40 %, resting pain by 77 %. Three patients showed radiological signs of a radiocapitate arthrosis, one patient needed conversion into a complete wrist arthrodesis. Our results are in concordance with the literature. However, our follow-up time is relatively short and we cannot make any conclusion about the long-term outcome. PRC is a technically straightforward procedure for treatment of carpal collapse. For stage II of the SNAC-/SLAC-wrist we consider the resection of the proximal carpal row an alternative procedure to the midcarpal arthrodesis particularly in patients who require less grip strength and when a shorter postoperative immobilization is reasonable.

Principles of microvascular reconstruction in burn and electrical burn injuries

Free tissue transplantation is a rarely indicated procedure in burn reconstruction. As the versatility and variability of free flaps have significantly developed during recent years, so have the indications for this procedure expanded. This study reports retrospectively the results of 75 free flaps in 60 severely burned patients using 20 different free flaps. This experience enabled us to establish reconstructive principles pertinent to the type of injury (burn versus high voltage injuries) and the timing of reconstruction procedures. In high voltage injuries (n = 26) early free flap coverage (<21 days after trauma) with muscular flaps was the most frequently used type of reconstruction. Reconstruction site was predominantly the upper extremity and forearm. In burn injuries (flame, contact, fluid), free flap coverage was performed during a later stage of the treatment course (3-6 weeks after trauma), or as a secondary procedure. Reconstruction with cutaneous flaps was the preferred method. In contrast to high voltage injuries, the trunk and the face were also recipient sites. In the upper extremity, the elbow and dorsum of the hand were the most frequent sites of reconstruction. Overall, the flap failure rate was 13% (n = 10). We were able to show a relationship between flap failure rate and timing of the procedure. Eight out of 10 flap failures occurred within 5-21 days after trauma, all 10-flap failures occurred between 5 days and 6 weeks. No flap failure occurred during secondary reconstruction. For the reconstruction of complex or large defects (n = 14), we recommended combined 'chimeric' flaps, pre-expansion of free flaps, or the combination of a free and local flap. Our data demonstrate that burn and high voltage injuries are distinct entities, each requiring custom tailored reconstructive solution.

[Reconstruction of burned extremities by free flap transplantation]

Free tissue transplantation in burn reconstruction presents a major challenge to reconstructive surgeons. The results of a retrospective analysis of 68 free flaps in 55 patients are reported. This experience facilitated the establishment of reconstructive principles and a decision-making algorithm for primary and secondary reconstruction of burned extremities. Fourty-two free flaps were used for primary reconstruction. The indications were predominantly extremity salvage.The safety of the microsurgical procedures is correlated with the timing of the reconstruction. The failure rate of the free flaps was 24% in primary reconstruction. Due to an increased post-traumatic thrombogenicity, the period between 5 and 21 days had the highest risk of flap failure (40%).Twenty-six flaps were used for secondary reconstruction, with a success rate of 100%. Due to their elasticity, adipo- and fasciocutaneous flaps provide a useful option for the release of contractures. The large variability demonstrated by the use of 19 different types of free flaps showed that the reconstruction of burned extremities requires a reconstructive concept individualized to each patient as well as sophisticated microsurgical techniques. This clearly demonstrates the importance of a close link between primary burn treatment and reconstructive plastic surgery.

Stellenwert der Plastischen Chirurgie im interdisziplinären Therapiekonzept diabetischer Ulzera am Fuß

BACKGROUND AND OBJECTIVE

Diabetes mellitus and its sequelae such as the "diabetic foot" are increasing in incidence and pose a challenging medical and financial problem. Interdisciplinary teams have been formed to prevent and treat these problems, consisting of diabetic nurses and physicians, nutritionists, podiatrists, specialist shoemakers, general, orthopaedic and vascular surgeons. However, hardly mentioned in the literature are the surgical options offered by plastic and reconstructive surgeons. The aim of this study was to analyse the outcome of plastic surgical treatment for soft tissue defect coverage of the diabetic foot ulcer and to define the role of plastic and reconstructive surgery within an interdisciplinary treatment concept.

PATIENTS AND METHODS

In a retrospective cohort study the charts of 38 diabetic patients (female n = 14/male n = 24) with an average age of 68.6 years and with 45 defects on the foot or ankle were analysed regarding the patient profile, defect etiology and size, operative procedures, complications and outcome results.

RESULTS

Defect coverage was performed using 20 split skin grafts, 19 local flaps and 6 free flaps as well as 27 amputations. At the time of discharge 25 of 45 defects were closed (56 %), 15 patients had an amputation and in 3 cases a small defect remained. The success rate of defect coverage decreased with increasing comorbidity. Whereas 71 % of the defects were covered in ASA stage 2 patients, only 50 % of the defects could be covered in ASA stage 3 patients and only 33 % in ASA stage 4 patients.

CONCLUSIONS

Despite a high complication rate, plastic surgical techniques in many cases prevented an amputation in this negatively preselected patient group. These results provide justification for plastic and reconstructive surgery being in any case part of an interdisciplinary treatment approach of the diabetic ulcer.

Soft tissue coverage of the extremely traumatized foot and ankle

The development of microsurgery and the expansion of plastic surgery techniques have led to a significant increase of surgical options for the salvage of the lower extremity. The traditional methods still have a role, but many authors have demonstrated a superiority of free and sophisticated regional flaps. This article gives an overview of treatment algorithms and surgical options. A therapeutic goal for the surgeon is to select the appropriate procedure with respect to the patient's medical condition and rehabilitation potential, the defect, and the surgeon's technical skills to achieve durable, permanent, pain-free, and functionally and aesthetically satisfying defect coverage.

[Therapeutic strategies for covering traumatic defects of the heel area]

Tissue defects of the heel region are a challenging problem. Various reconstructive techniques were performed in 44 patients with 59 defects around the heel region, who were treated between 1994 and 1999 following a traffic accident in 27%, a burn injury in 25%, and other traumatic causes in 48%. Free flap coverage was performed in 20 defects (36%), local flaps were used in 15 patients (27%) and autologous skin transplantation in 21 patients (36%). The overall complication rate was 18% with the highest rate after local flap procedures. A therapeutic strategy was developed, which is based mostly on the localization and extension of the defect area.

[Use of a cannulated 3.0 mm AO screw with an intraosseous support washer in osteosynthesis of the scaphoid: results and analysis of problems in 28 cases]

The cannulated 3.0 mm AO/ASIF screw with threaded washer is a new implant for scaphoid osteosynthesis. After insertion into the distal scaphoid pole, the washer serves as an intraosseous support for the head of the cannulated lag screw. From June 1997 to March 1998 the new implant was used in 28 male patients between 14 and 50 years of age. In fourteen patients, acute scaphoid fractures were operated on, including five transscaphoid perilunate fracture dislocations (Herbert type B2 and B4, respectively). Fourteen patients had scaphoid pseudarthroses, among those two re-pseudarthroses after prior surgery elsewhere. Using a palmar approach, the scaphoid was reduced. In pseudarthroses an iliac cortico-cancellous bone block was inserted, and the implants were inserted in a distal-to-proximal manner. In the fourteen acute fractures, follow-up assessment at a mean of 11 months revealed one pseudarthrosis (7%) and four screw removals (29%) for screw back-out after bony consolidation. In the fourteen pseudarthroses, follow-up assessment at a mean of ten months revealed one re-pseudarthrosis (7%) after a technical fault. It was treated by re-operation using the same implant, and healing was now uneventful. One screw removal became necessary after bony consolidation in another patient (7%). In conclusion, our preliminary results suggest that the new implant is suitable for stabilization of scaphoid pseudarthroses after insertion of an iliac crest bone graft. The complication rate in the treatment of acute fractures was inacceptably high.

Phosphocholine-containing, zwitterionic glycosphingolipids of adult Onchocerca volvulus as highly conserved antigenic structures of parasitic nematodes

Human Onchocerca volvulus infection sera were found to recognize zwitterionic glycolipids of O. volvulus and to cross-react with those of other parasitic nematodes (Ascaris suum, Setaria digitata and Litomosoides sigmodontis). By the use of an epitope-specific monoclonal antibody, zwitterionic glycolipids of all these nematode species were observed to contain the antigenic determinant phosphocholine. A hyperimmune serum specific for arthro-series glycolipid structures reacted with the various neutral glycolipids of all these nematodes, which demonstrated that their oligosaccharide moieties belonged to the arthro-series of protostomial glycolipids. These results indicated that arthro-series glycosphingolipids carrying, in part, phosphocholine substituents, represent highly conserved, antigenic glycolipid markers of parasitic nematodes. Three glycolipid components of the O. volvulus zwitterionic fraction were structurally characterized by matrix-assisted laser-desorption/ionization time-of-flight MS, methylation analysis and exoglycosidase treatment. Their chemical structures were elucidated to be phosphocholine-6GlcNAc(beta1-3)Man(beta1-4)Glc(1-1)ceramide, GalNAc(beta1-4)[phosphocholine-6]GlcNAc(beta1-3)Man(beta1-4)Glc(1-1) ceramide and Gal(alpha1-3)GalNAc(beta1-4)[phosphocholine-6]GlcNAc(beta1-3)Man(beta 1-4)Glc(1-1)ceramide for the zwitterionic ceramide tri-, tetra- and penta-hexosides respectively. The ceramide composition was found to be dominated by 2-hydroxylated docosanoic (C(22h:0)), tricosanoic (C(23h:0)) and tetracosanoic (C(24h:0)) acids, and C(17) sphingosine (C(d17:1)) (where (h) is hydroxylated and (d) is dihydroxylated).

[Therapeutic options in treatment of heel defects. Presentation of an algorithm for therapeutic strategy]

INTRODUCTION

The treatment of soft tissue defects of the foot and ankle region remains a challenge, because special anatomical and physiological properties have to be considered.

PATIENTS AND METHODS

The data of 52 patients, who were treated between 1994 and 1998, were analyzed. 48% were posttraumatic defects and were located in the weight bearing zone in 37%.

RESULTS

Fifty-nine procedures were used, including skin transplantation in 16 patients, local flaps in 3 cases, regional flaps in 14 cases, and microvascular procedures in 17 cases. Amputation was required in 4 patients. The overall success rate was 92%. Complications occurred in 18 patients.

CONCLUSIONS

Using these data and evaluation of the actual literature lead to the development of an algorithm for the treatment of defects in this area. The modern armamentarium of plastic surgery offers the possible different treatment modalities.

Reconstitution of protein transport across the vacuolar membrane in Plasmodium falciparum-infected permeabilized erythrocytes

The parasite Plasmodium falciparum induces morphological and biochemical alterations of its host erythrocyte. Some of these changes are mediated by parasite proteins that are transported to specific destinations within the erythrocyte or to the erythrocyte plasma membrane. The pathways underlying this transport are still unknown. We anticipate that at least some aspects of these pathways may be biologically unique and therefore potential targets for chemotherapeutic intervention. We have utilized bacterial pore-forming proteins to establish an experimental system that allows selective permeabilization of the erythrocyte plasma membrane, without affecting the integrity of the vacuolar membrane and the parasite plasma membrane, in order to study protein transport from the parasite into the host erythrocyte. Physiological properties of the parasite within permeabilized erythrocytes, such as the ability to synthesize proteins, will be described. The permeabilization of infected erythrocytes has allowed the dissection of individual steps in protein transport from the parasite surface across the vacuolar membrane. Possible pathways involved in the trafficking of parasite proteins within the erythrocyte cytosol, i.e. in a cell that normally has no need to transport proteins, will be discussed.

Characterization and cloning of the gene encoding the vacuolar membrane protein EXP-2 from Plasmodium falciparum

As a contribution to the characterization of the parasitophorous vacuolar membrane from Plasmodium falciparum we have begun the identification of vacuolar membrane proteins. Exported protein-2 (EXP-2) is a vacuolar membrane protein exposed into the vacuolar space. To further characterize EXP-2, it was purified, and the 45 N-terminal amino acids were determined by micro-sequencing. Based on this information, partial cDNA and genomic fragments were amplified by PCR and used as probes for the isolation of complete cDNA and genomic DNA clones. The single copy gene is located on chromosome 14, and is transcribed during the ring stage of parasite development. The open reading frame encodes an N-terminal signal sequence which is cleaved from the mature protein. The amino acid composition of EXP-2 is characterized by charged amino acids, with a high abundance of aspartate residues in the C-terminal portion of the protein. In contrast to EXP-1, an integral protein of the vacuolar membrane, EXP-2 lacks a typical hydrophobic transmembrane domain. We suggest that EXP-2 may associate with the vacuolar membrane via an amphipathic helix located in the N-terminal half of the protein.

[Nematode and trematode fauna of the muskrat (Ondatra zibethicus LINK, 1795) in Lower Saxony]

From January 1995 to December 1995, 991 muskrats were examined for the occurrence and the regional prevalence of nematodes and trematodes. The muskrats were trapped in all parts of Lower Saxony. 77.2% of the studied population were less than one year old, 22.8% were older. The male to female ratio was 54.5% to 45.5%. One genus of nematodes, Trichuris spp., was found in the colon in 1.9% of the animals in the south of the investigated area. A species differentiation was not possible, as exclusively female parasites had been found. Additionally, two genera of trematodes (Echinostoma spp. and Quinqueserialis quinqueserialis) belonging to two different families were detected in 2.5% of the muskrats. In the north of the investigated area the prevalence was significantly higher than in the south. As to the echinostomatides, no species-differentiation was made because, according to KANEV (1985), many echinostomatides have not been described correctly in the past. Some echinostomatides cannot be differentiated until today. There was no statistically significant correlation between parasite infections and sex of the animals. Concerning Echinostoma spp. and Quinqueserialis quinqueserialis, a highly significant correlation was found between the age of the muskrats and the trematode-infections. Young animals were infected more often than older animals, none of the younger animals was infected with Trichuris spp.

[Prevalence of Echinococcus multilocularis and other metacestodes and cestodes in the muskrat (Ondatra zibethicus LINK 1795) in Lower Saxony]

Aim of the study was to examine the prevalence and regional distribution of Echinococcus multilocularis and other metacestodes and cestodes in muskrats in Lower Saxony, Germany. A total of 991 muskrats with similar numbers from all districts of the country were examined between January and December 1995. E. multilocularis metacestodes were found in 4.1% of the muskrats in the liver and other organs of the abdominal cavity. The majority of the E. multilocularis positive animals came from the south of Lower Saxony, where E. multilocularis is endemic, and single animals from the middle or the northern part of the country. All metacestodes found were fertile. Additionally, metacestodes from T. taeniaeformis were found in the livers of 42.3% of the muskrats, metacestodes from T. crassiceps were present in the abdominal cavity of 2.7%, T. polyacantha in 0.4% and T. martis in 3.4% of the animals. Adult cestodes of the family of the Anoplocephalidae were found in the small intestine of 1.5% of the muskrats. Due to autolysis a species differentiation of the latter was not possible.

Neutral glycolipids of Schistosoma mansoni as feasible antigens in the detection of schistosomiasis

The neutral glycolipid fraction from mouse-propagated, Schistosoma mansoni adult worms has been investigated as to its chromatographic and antigenic properties, and whether it fulfills the serodiagnostic antigen requirements of sensitivity and specificity in the detection of schistosomiasis. Serological analyses were performed by thin-layer chromatography immunostaining and ELISA. In the acute-phase form of mouse schistosomiasis, the kinetics of development of neutral glycolipid-specific antibody levels was correlated with the intensity of the initial infection and the response was dominated by IgG, as represented by the subclass IgG1. With the experimental animal helminthiases screened, glycolipid antigenicity fulfilled the fundamental traits for a serodiagnostic reagent. In the chronic-phase form of human schistosomiasis mansoni, neutral glycolipid-specific antibody levels were not correlated with the intensity of infection, as estimated from the faecal content of parasite eggs, whilst the isotypic response was dominated by IgM and IgG, the latter represented primarily by IgG1 and secondarily by IgG3. With other human helminthiases, glycolipid antigenicity was incomplete, in that, the specificity was only partially fulfilled. The reason for this incomplete specificity has been clarified, in part, by the detection of cryptic schistosomiasis infections in the cohorts of African patient sera examined.

Initiation of chemical studies on the immunoreactive glycolipids of adult Ascaris suum

There is a general lack of basic information concerning one class of glycoconjugate, the glycolipids, from parasitic nematodes. As the prototype, the neutral glycolipid fraction derived from adult males of Ascaris suum was investigated as to its chromatographic, differential chemical staining, antigenic and chemical properties. The thin-layer chromatography-resolved neutral fraction glycolipids could be classified into components of fast and slow migrating band groups. Immunoreactivity was restricted to the latter as detected by IgG and IgM anti-neutral fraction glycolipid antibody levels in serial infection sera of mice. Similarities of chromatography, antigenicity and serological cross-reactivity have been extended to the neutral glycolipid fractions of other parasitic nematodes: Litomosoides carinii and Nippostrongylus brasiliensis. Chemical, differential chemical staining and enzymatic analyses identified the Ascaris suum antigenic, slow migrating band group of components as amphoteric glycosphingolipids, and not the originally hypothesized glycoglycerolipids or glycosylphosphatidylinositols, that contained typical neutral monosaccharide constituents and a zwitterionic phosphodiester linkage, most probably phosphocholine. Glycosphingolipid-immunoreactivity is eliminated on cleavage of the zwitterionic phosphodiester linkage by hydrofluoric acid treatment.

Bovine cysticercosis: demonstration in experimentally infected calves of serum IgG antibodies reactive with neutral glycolipids of Taenia saginata and T. crassiceps metacestodes

The immunoreactivity of Taenia saginata and T. crassiceps metacestode neutral glyco(sphingo)lipids towards IgG antibodies derived from the sera of calves with experimental cysticercosis has been established. The glyco(sphingo)lipids are separable by normal-phase HPTLC (high-performance thin-layer chromatography) into groups of increasing sugar-chain length (lipid/ceramide mono-, di-, tri-, tetra- and > tetrasaccharides), with those corresponding to three and four hexoses being the main immunoreactive components (HPTLC immunostaining). In ELISA (enzyme-linked immunosorbent assay), reverse-phase HPTLC-isolated T. crassiceps metacestode glyco(sphingo)lipids equivalent to tri- and tetrahexoside allowed a discrimination between non-infected and infected calves (at least 80 metacestodes recovered). The formation of IgG antibodies was correlated with the infection, not with other non-specific inducing factors, as seen by the differential humoral response detected in experimentally infected (T. saginata) calves before and after Praziquantel treatment (HPTLC immunostaining and ELISA).

Litomosoides carinii: macrofilariae-derived glycolipids--chromatography, serology and potential in the evaluation of anthelminthic efficacy

A preliminary characterization of the glycolipids of Litomosoides carinii macrofilariae, resolved according to their chromatographic, chemical and serological properties, has been performed. Emphasis has been placed on the neutral fraction glycolipids. These are separable on thinlayer chromatography into two groups of fast and slow migrating band components, that differ in their migration, differential chemical staining and serological traits, respectively. Serological analyses have been accomplished by thin-layer chromatography immunostaining and ELISA. Only components of the slow migrating band group react with infection serum from Litomosoides carinii-infected Mastomys coucha. Cross-reactivity experiments with homologous and heterologous infection sera of various helminthiases indicate that, epitopes bound to the neutral glycolipid fraction show structural similarity within the Nematoda, but not to the Cestoda or Trematoda. The dynamic development of specific Ig-, IgG- and IgM-anti-neutral glycolipid fraction antibody levels were correlated with the different progression of L. carinii and Brugia malayi infections in the multimammate rat, Mastomys coucha. The reduction in the dynamics of IgG- and IgM-antibody levels on chemotherapeutic treatment with the filaricides flubendazole and CGP 20376 has been related to their macrofilaricide-activity.

Chromatographic and antigenic properties of Echinococcus granulosus hydatid cyst-derived glycolipids

The neutral and acidic fraction glycolipids of Echinococcus granulosus metacestode tissue compartments were isolated, defined by their chromatographic and antigenic properties, and assessed as to their efficacy as antigens in the serodiagnosis of human hepatic cystic and alveolar echinococcosis, and other helminthiases. Analyses were accomplished by thin-layer chromatography immunostaining and ELISA. The neutral glycolipid fraction's major carbohydrate epitope was the same as or very similar to that of Taenia crassiceps neutral glyco(sphingo)lipids, as represented by the 'neogala'-series core structure. The blood group-active, carbohydrate epitope P1 was expressed by a number of neutral fraction glycolipid component bands. The reverse-phase, thin-layer chromatography-isolated neutral fraction glycolipid component, designated Ag1, was efficient in the serological discrimination of cystic echinococcosis medium to high-titred sera. Ag1 did not specifically discriminate low-titred sera, i.e., other human helminthiases. The detected sialic acid residues of the acidic fraction glycolipids, on enzymatic cleavage, were identified as N-acylneuraminic acid and terminal. The acidic fraction glycolipids exhibited the paradox of only chemically minor components being antigenic towards cystic and alveolar echinococcosis infection sera. The combined acidic fraction glycolipid components Ra and Rx were capable of serological discrimination between cystic echinococcosis, alveolar echinococcosis and other helminthiases.

Glycosphingolipids in cestodes. Chemical structures of ceramide monosaccharide, disaccharide, trisaccharide and tetrasaccharide from metacestodes of the fox tapeworm, Taenia crassiceps (Cestoda: Cyclophyllidea)

The presence of glycosphingolipids in the metacestodes of the fox tapeworm, Taenia crassiceps, has been established. The normal-phase TLC pattern of the neutral-fraction glycolipids revealed groups of bands corresponding to homologous components of increasing sugar chain length. The three simplest glycolipid components have been isolated and their chemical constitution determined as being of the neogala series: Gal beta 1Cer, Gal beta 6Gal beta 1Cer and Gal beta 6Gal beta 6Gal beta 1Cer. The ceramide tetrasaccharide fraction has been found to consist of a mixture of neogalatetraosylceramide, as an elongation of the neogala series, Gal beta 6Gal beta 6Gal beta 6Gal beta 1Cer and the component Gal alpha 4Gal beta 6Gal beta 6Gal beta 1Cer (both occurring in approximately equimolar proportions). The long-chain bases of the ceramide monogalactoside, digalactoside, trigalactoside and tetragalactosides contain, as well as small amounts of sphingosine, predominantly dihydrosphingosine/phytosphingosine in the approximate ratios 1.7:1, 1.4:1, 1:1 and 2.3:1, respectively. The major ceramide fatty acids have particularly long chains, with hexacosanoic and octacosanoic acids predominating. Upon reverse-phase TCL, the glycolipid components ceramide monogalactoside, digalactoside and trigalactoside were each separable into five component bands. Parent glycolipid components therefore show component band distributions comparable to one another in being governed by similar ceramide constitutions.

Comparative serological reactivity of Taenia crassiceps, Taenia solium and Taenia saginata metacestode neutral glycolipids to infection serum from Taenia crassiceps-infected mice

A comparative survey was undertaken of the neutral fraction glycolipids from the metacestodes of 3 taeniid species, Taenia crassiceps, Taenia solium and Taenia saginata, to determine their chemical and serological staining patterns on separation by thin-layer chromatography. The orcinol-positive patterns of T. solium and T. saginata metacestodes exhibited a closer superficial resemblance to each other than to T. crassiceps or T. saginata adults. A comparison of component migration properties against standards of known structure indicated the main oligosaccharide chains to be mono-, di-, tri- and tetrasaccharides; however, in T. solium this was extended to at least a heptasaccharide. The multiple banding characteristic of each component is a consequence of lipid moiety heterogeneity. Serologically, the patterns of the 3 taeniid species neutral fraction glycolipids showed virtually the same immunological reactivity towards mouse normal serum, infection serum and a monospecific, polyclonal antibody directed against the trisaccharide component of T. crassiceps. The latter antibody was isolated from mouse infection serum by affinity chromatography on a column of glycolipid-bound octyl-Sepharose CL-4B. Immunochemically, the major common epitope expressed by the neutral fraction glycolipids of the 3 taeniid species is the same or very similar to the glycosphingolipid, neogalatriaosyl ceramide derived from the marine mollusc Turbo cornutus (Gal(beta 1-6) Gal(beta 1-6) Gal(beta 1-1)Cer). Host tissue neutral fraction glycolipids, porcine muscle and bovine muscle, as well as human spleen, were not immunoreactive.

Immunological recognition of larval Taenia crassiceps glycolipids by sera from parasite-infected mice

The isolation and purification of a neutral glycolipid fraction from Taenia crassiceps metacestodes (KBS strain), harvested from both male and female NMRI mice at 70-80 days following intraperitoneal infection, revealed 24 thin-layer chromatography-designated glycolipid bands. The glycolipids were defined as ceramide mono- (n = 3), di- (n = 3), tri- (n = 4), tetra- (n = 5), and greater than tetrasaccharides (n = 9) according to their running properties as defined by thin-layer chromatography against standards of known structure. The defined glycolipids were tested for immunoreactivity with sera from noninfected and T. crassiceps-infected NMRI mice (intraperitoneal injection or implantation of 15 larvae/animal) using the enzyme-linked immunosorbent assay (ELISA) until day 33 p.i. (IgM and IgG reaction) and high-performance thin-layer chromatography (HPTLC) combined with immunostaining (IgG reaction) until day 7 p.i. ELISA-determined IgM and IgG titres were significantly elevated from day 5 p.i. Immunostaining revealed early reactivity for certain ceramide tetra- and greater than tetrasaccharides (n = 6) on day 3 p.i. From day 5 p.i. onwards, nearly all glycolipids, including ceramide mono- and disaccharides, were recognized by the sera from metacestode-challenged mice. On day 7 p.i., a total of 22 bands were serologically active; of these, a considerable number (n = 10) showed increased staining intensity. Remarkably, in many cases (10 of 20), 3 glycolipids (tetra- and greater than tetrasaccharides) were weakly recognized by mouse sera taken before infection.

[Malignant tumors of the nasal cavity and paranasal sinuses (author's transl)]

Therapeutic results from 134 cases with malignant tumors of the nasal cavity and paranasal sinuses are reported. Retrospective classification based on clinical and roentgenological findings was possible in 121 cases. 49 patients underwent primary radiation treatment by 60Co-teletherapy, 46 were exposed to postoperative irradiation. The mean 2-year survival rate considering all stages and all kinds of malignant tumors amounts to 52%, the 5-year survival rate to ca. 32%. The 5-year survival rate obtained by means of curative tumor doses was 59%. Recurrences of the tumor appeared in 58 cases (43%), most of them in the course of a year. The therapeutic control of local tumor disease and the possibilities of an early detection of recurrences, improved with the help of new diagnostic methods, must therefore be regarded as the essential problems. No generally approved clinical classification of tumors of the nasal cavity and paranasal sinuses is available as yet, and the comparison of therapeutic results from different authors thus is difficult.

[Results of therapy in cases of tumors of the nasal cavity and paranasal sinuses in relation to different tumor classifications (author's transl)]

The primary findings in 128 patients with malignancies of the nasal cavity and the paranasal sinuses were classified by 4 tumor classifications. The survival times and the rates of recurrences in relation to the stage of tumor were compared. Mostly cancers of advanced stages T3 and T4 with bad prognosis were treated: only 35% of the examined patients survived longer than 5 years. There was no obvious difference in the results of therapy in tumor cases T3 and T4 in relation to the different tumor classifications.