Language and executive functioning in young adults with Down syndrome

BACKGROUND

This study examined the association between executive functioning and language in young adults with Down syndrome (DS).

METHOD

Nineteen young adults with DS (aged 19-24 years) completed standardised measures of overall cognition, vocabulary, verbal fluency and executive function skills.

RESULTS

Friedman's analysis of variance (χ² (3) = 28.15, P < .001) and post hoc comparisons indicated that, on average, participants had a significantly lower overall non-verbal than verbal cognitive age equivalent and lower expressive than receptive vocabulary skills. Using Spearman correlations, performance on a verbal measure of cognition inhibition was significantly negatively related to receptive vocabulary (ρ = -.529, adjusted P = .036) and verbal fluency (ρ = -.608, adjusted P = .022). Attention was significantly positively correlated with receptive (ρ = .698, adjusted-p = .005) and expressive (ρ = .542, adjusted P = .027) vocabulary. Verbal working memory was significantly positively associated with receptive vocabulary (ρ = .585, adjusted P = .022) and verbal fluency (ρ = .737, adjusted P = .003). Finally, visuospatial working memory was significantly associated with receptive vocabulary (ρ = .562, adjusted P = .027).

CONCLUSIONS

Verbal and non-verbal measures of executive functioning skills had important associations with language ability in young adults with DS. Future translational research is needed to investigate causal pathways underlying these relationships. Research should explore if interventions aimed at increasing executive functioning skills (e.g. attention, inhibition and working memory) have the potential to lead to increases in language for young adults with DS.

Nuclear ELAC2 overexpression is associated with increased hazard for relapse after radical prostatectomy

ELAC2 is a ubiquitously expressed enzyme potentially involved in tRNA processing and cell signaling pathways. Mutations of the ELAC2 gene have been found to confer increased prostate cancer susceptibility in families. ELAC2 protein expression was analyzed by immunohistochemistry in 9,262 patients and Kaplan-Meier curves of PSA recurrence-free survival were calculated in 8,513 patients treated with radical prostatectomy. Nuclear ELAC2 staining was observed in 60.8% of prostate cancers. It was weak in 26.3%, moderate in 26.6% and strong in 7.9%. Strong nuclear ELAC2 expression was associated with advanced tumor stage, nodal metastasis, higher Gleason grade, presence of TMPRSS2:ERG fusion, higher Ki67-labeling index and PTEN deletion. The difference in 1-, 5- and 10-year recurrence-free survival between strong and weak nuclear ELAC2 intensity is 7.2/13.8/17.6% in all cancers, 7.4/16.1/26.5% in the ERG negative subset, and 3.1/5.7/9.8% in the ERG positive subset. Regarding the univariate hazard ratio, PSA recurrence-free survival after prostatectomy for strong nuclear ELAC2 expression is 1.89 (1.64–2.10, p < 0.0001). It is independent of preoperative PSA-level, Gleason grade, pathological stage, surgical margin stage, and lymph node stage (multivariate hazard ratio 1.29 (1.11–1.49, p = 0.001). We conclude that nuclear ELAC2 expression is an independent prognostic marker for PSA recurrence-free survival after radical prostatectomy with a weak to moderate increase of the hazard ratio for biochemical relapse.

The independent prognostic impact of the GATA2 pioneering factor is restricted to ERG-negative prostate cancer

GATA2 is a pioneering transcription factor governing androgen receptor expression and signaling in prostate cells. To understand the prognostic potential of GATA2 assessment in prostate cancer, we analyzed nuclear GATA2 expression on an annotated tissue microarray with 12,427 prostate cancer samples. Normal prostate glands were negative to weakly positive. GATA2 staining was found in almost all prostate cancers (95%). Strong GATA2 staining was linked to advanced tumor stage, high classical and quantitative Gleason grade (p < 0.0001 each), positive nodal stage (p = 0.0116), and early biochemical recurrence (p < 0.0001). GATA2 was linked to ERG-fusion-type cancers, with strong GATA2 staining in 29% of ERG-negative and 53% of ERG-positive cancers (p < 0.0001). Separate calculations in 3854 cancers with and 4768 cancers without TMPRSS2:ERG fusion revealed that these associations with tumor phenotype and patient outcome were largely driven by the subset of ERG-negative tumors. GATA2 expression was further linked to androgen receptor expression: Only 8% of androgen receptor-negative, but 56% of strongly androgen receptor expressing cancers had strong GATA2 expression (p < 0.0001). In conclusion, the results of our study demonstrate that increasing GATA2 levels are linked to prostate cancer progression and aggressiveness. The prognostic value of GATA2 is remarkable in ERG-negative cancers. However, the upregulation of GATA2 in ERG-positive cancers makes it unsuitable as a prognostic marker in this patient subset.

SNW1 is a prognostic biomarker in prostate cancer

Background

SNW1 is a nuclear receptor co-activator involved in splicing and transcription control, including androgen receptor signaling. Overexpression of SNW1 has been linked to adverse prognosis in different cancer types, but studies on the role of SNW1 in prostate cancer are lacking.

Methods

Using immunohistochemistry, we analyzed SNW1 expression in 10,310 prostate cancers in a tissue microarray (TMA) with attached clinical and molecular data.

Results

The comparison with normal prostate tissue revealed an up regulation of SNW1 in a subset of cancer samples. SNW1 staining was considered weak in 31.5%, moderate in 37.7% and strong in 14% of cancers. Strong SNW1 expression was markedly more frequent in prostate cancers harboring the TMPRSS2:ERG fusion (24%) than in ERG negative cancers (7%, p < 0.0001). Significant associations with Gleason grade, stage, nodal status and early biochemical recurrence were observed in the ERG negative and positive subset. Multivariable modeling revealed that the prognostic value of SNW1 up regulation was independent from the established preoperative histopathological and clinical parameters.

Conclusion

These results demonstrate that SNW1 overexpression is an independent prognostic marker in prostate cancer with potential clinical utility.

Electronic supplementary material

The online version of this article (10.1186/s13000-019-0810-8) contains supplementary material, which is available to authorized users.

Upregulation of centromere protein F is linked to aggressive prostate cancers

Background

Centromere protein F (CENPF) is a key component of the kinetochore complex and plays a crucial role in chromosome segregation and cell cycle progression. Recent work suggests that CENPF upregulation is linked to aggressive tumor features in a variety of malignancies including prostate cancer.

Materials and methods

Using a highly annotated tissue microarray, we analyzed CENPF protein expression from a cohort of 8,298 prostatectomized patients by immunohistochemistry to study its effect on prostate-specific antigen recurrence-free survival.

Results

CENPF overexpression was found in 53% of cancers, and was linked to higher Gleason grade, advanced pathological tumor stage, accelerated cell proliferation, and lymph node metastasis (p<0.0001, each). A comparison with other key molecular features accessible through the microarray revealed strong associations between CENPF overexpression and presence of erythroblast transformation-specific (ETS)-related gene (ERG) fusion as well as phosphatase and tensin homolog deletion (p<0.0001, each). CENPF overexpression was linked to early biochemical recurrence. A subset analysis revealed that this was driven by the ERG-negative subset (p<0.0001). This was independent of established preoperative and postoperative prognostic parameters in multivariate analyses.

Conclusion

The results of our study identify CENPF overexpression as an important mechanism and a potential biomarker for prostate cancer aggressiveness.

High expression of class III β-tubulin in upper gastrointestinal cancer types

Class III β-tubulin (TUBB3) is a component of microtubules of neuronal cells that is upregulated in various cancer entities. To better understand the role of TUBB3 in upper gastrointestinal tract cancer types, the present study assessed TUBB3 expression in tissue microarrays including 189 gastric and 428 esophageal cancer. TUBB3 expression was detected in 62.4% of gastric cancer, 73.8% of esophageal adenocarcinoma and 88.7% of esophageal squamous cell cancer, while control samples of normal esophageal and gastric epithelium were TUBB3-negative. TUBB3 positivity was not associated with the International Union Against Cancer classification, World Health Organization grading, lymph node involvement or distant metastasis in any entity. Of note, TUBB3 expression was associated with tumor localization and prognosis in gastric cancer, with the tumor stage in esophageal adenocarcinoma, and with the resection margin in esophageal squamous cell cancer. In conclusion, the substantial rate of positivity for TUBB3 already in early stages of gastric cancer in combination with the lack of a further increase in frequency with tumor stage, may suggest, that TUBB3 upregulation is rather relevant for cancer development than for cancer progression. TUBB3 might be a suitable prognostic biomarker in gastric cancer types.

13q deletion is linked to an adverse phenotype and poor prognosis in prostate cancer

Deletions of chromosome arm 13q belong to the most frequent molecular alterations in prostate cancer. To better understand the role of 13q deletion in prostate cancer we took advantage of our large prostate cancer tissue microarray comprising more than 12 000 cancer samples with full pathological and clinical follow-up data. Fluorescence in situ hybridization with probes for ENOX1 (13q14.11) and the retinoblastoma gene (RB1, 13q14.2) was employed. A 13q deletion was found in 21% of 7375 analyzable cancers. Deletions were always heterozygous and associated with high Gleason grade (P < .0001), advanced tumor stage (P < .0001), high preoperative prostate-specific antigen (PSA) levels (P = .0125), lymph node metastasis (P = .0377), positive resection margin (P = .0064), and early biochemical recurrence (P < .0001). 13q deletions were marginally more frequent in prostate cancers with negative ERG status (22.9%) than in ERG-positive tumors (18.7%; P < .0001). Loss of 13q predicted patient prognosis independently from established prognostic parameters that are available at the time of biopsy (P = .0004), including preoperative PSA level, clinical tumor stage, and biopsy Gleason grade. In summary, the results of our study identify 13q deletion as a frequent event in prostate cancer, which is linked to an adverse phenotype and poor prognosis in this disease.

Up regulation of the steroid hormone synthesis regulator HSD3B2 is linked to early PSA recurrence in prostate cancer

HSD3B2 plays a crucial role in steroid hormone biosynthesis and is thus of particular interest in hormone dependent tumors such as prostate cancer. To clarify the clinical relevance of HSD3B2 expression in prostate cancer, we analyzed HSD3B2 protein expression by immunohistochemistry on our preexisting tissue microarray with 12.247 annotated cancers. Compared with normal tissue cytoplasmic HSD3B2 staining was stronger in prostate cancers. In 9371 interpretable cancers, HSD3B2 expression was found in 95.5% of cancers and was considered weak in 29.9%, moderate in 40.7% and strong in 24.9%. HSD3B2 up regulation was linked to advanced pathological tumor stage (pT), high Gleason grade, elevated preoperative PSA levels (p < 0.0001 each), lymph node metastasis (p = 0.0019), accelerated cell proliferation (p < 0.0001), androgen receptor (AR) expression (p < 0.0001), and early biochemical recurrence (p < 0.0001). HSD3B2 up regulation was only marginally more frequent in ERG positive (98%) than in ERG negative cancers (94%; p < 0.0001) and was strongly linked to deletions of 5q and 6q (p < 0.0001 each). Multivariate analyses showed that the prognostic impact of HSD3B2 expression was independent of established preoperative, but not of postoperative prognostic parameters. In summary, the results of our study demonstrate that HSD3B2 is strongly up regulated in a fraction of prostate cancers that are characterized by increased AR signaling, adverse tumor phenotype and early biochemical recurrence.

[Effect of oxytocin on human pain perception]

BACKGROUND

Over the years the effect of the neuropeptide oxytocin and its possible utilization for pain management has been increasingly more investigated and discussed. Initial results emphasized the effects of oxytocin with respect to labor and breastfeeding. Diverse animals studies were also able to demonstrate the effectiveness of the peptide in attachment behavior and pain perception; however, it is still unclear how oxytocin affects pain perception in humans. The potential therapeutic effectiveness of oxytocin could be particularly important for primary and secondary treatment of pain patients because chronification of pain can occur more frequently in this area.

METHODS

For this review the databases PubMed, Medline und PsycINFO were searched using the terms oxytocin, pain, human and analgesic. The search resulted in a total of 89 original articles after excluding articles regarding labor pain, breastfeeding and animal studies. Only those studies were included which were carried out between 1994 and 2015. A total of 17 articles remained for inclusion in this review and included 13 studies on the exogenous application of oxytocin and 4 on measurement of oxytocin levels in plasma.

CONCLUSION

This review article gives a summary of the current state of research on oxytocin and its direct and indirect association with human pain perception and emphasizes its relevance for the multimodal management of pain.

[Impact of attachment behavior on chronic and somatoform pain]

In addition to being a risk factor for the course of chronic pain, the personality characteristics of the individual attachment style are also predictors for the success of medical and psychosocial interventions and aspects of the physician-patient relationship. Insecurely attached patients seem to be less able to sustain the positive effects of pain therapy. These results are especially relevant as insecure attachment patterns are overrepresented among chronic pain patients. As a result the attachment style can be seen as a psychosocial vulnerability factor for the chronification of acute pain.

Dosimetic quality and evolution of edema after prostate brachytherapy for small prostates: Implications for the use of newer isotopes

232

Background: Prostate brachytherapy is often avoided in men with small prostate volumes (PV) due to concerns about suboptimal dosimetry. We characterized prostate swelling and dosimetry in patients with small PVs compared with large PVs. Methods: We studied twenty-five patients with PV <25 cc (range 15.1-24.8) and sixty-five patients with PV >=25 cc (range 25.0-66.2) who underwent brachytherapy. Gland size was based on the contoured volume on a 3D transrectal ultrasound before the procedure. Ultrasound-guided brachytherapy was performed under intra-operative planning with loose Iodine-125 seeds to a prescription dose of 145 Gy. Patients underwent CT and MRI scans on post-implant Days 1 and 30 for dosimetric study. MRI was used to contour the prostate and then fused with the CT for dosimetry. Results: Small PVs had greater Day 1 post-implant swelling than patients with large PVs (32.5% increase in volume vs. 23.7%, p=0.04) but Day 30 swelling was minimal and not significantly different (4.4% increase in volume vs. 1.6%, p=0.44) for small and large PVs respectively. Small PVs had greater seed and needle density at implant (p<0.001). Small PV patients had larger Day 1 hot spots in the prostate at (V150 = 59.6% vs. 53.0, p=0 .022) which resolved by Day 30 (V150 = 70.9% vs. 67.1, p=0.20). Rectal and urethral doses were nearly identical by Day 30 (Small PV RV100 = 0.32 cc, Large PV RV100 = 0.33 cc, p=0.99; small PV UV150 = 0.20, large PV UV150 = 0.20, p=0.91). Day 1 swelling created cold areas (rate D90>140 Gy = 88.0% and 90.6% for the small and large PV groups respectively, p=0.71), but day 30 dosimetry was excellent (rate D90>140 Gy = 100% for both groups). Conclusions: While smaller prostates have more immediate post-operative swelling, good Day 30 dosimetry can be achieved in small prostates, which makes them excellent candidates for treatment with I-125 seeds (t½ = 60 days). Due to the increased short-term swelling, small prostates may be suboptimal candidates for implants done with shorter half-life sources such as cesium-131 (t½ = 9.7 days), where the majority of the dose may be delivered to an edematous gland.

[Chronic knee pain and specific heat phobia. A case report]

This case report presents the medical history of a patient suffering from chronic knee pain with specific heat phobia who had a long history of sick certificates. Using multimodal pain therapy and biofeedback therapy the acquired anxiety disorder could be solved. Long-term working ability could be achieved.

Characterisation of sputter deposited niobium and boron interlayer in the copper-diamond system

In most metal matrix composites (MMCs) interfaces are decisive but hard to manipulate. Especially copper-carbon composites can exhibit excellent mechanical and thermal properties only if the Cu/C interface is modified by an optimised interlayer. Due to the excellent thermal conductivity and mechanical stability of diamond this form of carbon is preferred as reinforcement in heat sink materials (copper-diamond composite) which are often subjected to severe thermal and mechanical loads. In the present case niobium and boron interlayers of various thicknesses were deposited on diamond and vitreous carbon substrates by magnetron sputter deposition. After the coverage of all samples by a copper film, a part of the samples was subjected to heat treatment for 30 min at 800 °C under high vacuum (HV) to simulate the thermal conditions during the production of the composite material by uniaxial hot pressing. De-wetting during heat treatment leads to the formation of holes or humps in the Cu coating. This effect was investigated by scanning electron microscopy (SEM) and atomic force microscopy (AFM). A comparison of time-of-flight secondary ion mass spectroscopy (TOF SIMS) profiles of heat treated samples with those of as deposited ones showed the influence of interdiffusion during the heating process. Diffusion behaviour and chemical composition of the interface were also studied by cross sectional transmission electron microscopy (X-TEM) investigations using focused ion beam (FIB) cut samples. The thermal contact resistance (TCR) of the interface was calculated from results obtained from modulated infrared radiometry (IR). Thin interlayers suppressed de-wetting most effectively and consequently the TCR at the Cu-diamond interface was found to decrease. Therefore they are promising candidates for optimising the Cu-diamond interface.

Assessment of shoulder position variation and its impact on IMRT and VMAT doses for head and neck cancer

Background

For radiotherapy of the head and neck, 5-point mask immobilization is used to stabilize the shoulders. Still, the daily position of the shoulders during treatment may be different from the position in the treatment plan despite correct isocenter setup. The purpose of this study was to determine the interfractional displacement of the shoulders relative to isocenter over the course of treatment and the associated dosimetric effect of this displacement.

Methods

The extent of shoulder displacements relative to isocenter was assessed for 10 patients in 5-point thermoplastic masks using image registration and daily CT-on-rails scans. Dosimetric effects on IMRT and VMAT plans were evaluated in Pinnacle based on simulation CTs modified to represent shoulder shifts between 3 and 15 mm in the superior-inferior, anterior-posterior, and right-left directions. The impact of clinically observed shoulder shifts on the low-neck dose distributions was examined.

Results

Shoulder motion was 2-5 mm in each direction on average but reached 20 mm. Superior shifts resulted in coverage loss, whereas inferior shifts increased the dose to the brachial plexus. These findings were generally consistent for both IMRT and VMAT plans. Over a course of observed shifts, the dose to 99% of the CTV decreased by up to 101 cGy, and the brachial plexus dose increased by up to 72 cGy.

Conclusions

he position of the shoulder affects target coverage and critical structure dose, and may therefore be a concern during the setup of head and neck patients, particularly those with low neck primary disease.

Characterization of the mechanical and thermal interface of copper films on carbon substrates modified by boron based interlayers

The manipulation of mechanical and thermal interfaces is essential for the design of modern composites. Amongst these are copper carbon composites which can exhibit excellent heat conductivities if the Cu/C interface is affected by a suitable interlayer to minimize the Thermal Contact Resistance (TCR) and to maximize the adhesion strength between Cu and C.In this paper we report on the effect of boron based interlayers on wetting, mechanical adhesion and on the TCR of Cu coatings deposited on glassy carbon substrates by magnetron sputtering. The interlayers were 5 nm thick and consisted of pure B and B with additions of the carbide forming metals Mo, Ti and Cr in the range of 5 at.% relative to B. The interlayers were deposited by RF magnetron sputtering from either a pure B target or from a composite target. The interlayer composition was checked by Auger Electron Spectroscopy and found to be homogenous within the whole film.The system C-substrate/interlayer/Cu coating was characterized in as deposited samples and samples heat treated for 30 min at 800 °C under High Vacuum (HV), which mimics typical hot pressing parameters during composite formation. Material transport during heat treatment was investigated by Secondary Ion Mass Spectroscopy (SIMS). The de-wetting and hole formation in the Cu coating upon heat treatment were studied by Scanning Electron Microscopy (SEM) and Atomic Force Microscopy (AFM). The adhesion of the Cu coating was evaluated by mechanical pull-off testing. The TCR was assessed by infrared photothermal radiometry (PTR). A correlation between the adhesion strength and the value of the TCR which was measured by PTR was determined for as deposited as well as for heat treated samples.

Characterization of connective tissue growth factor expression in primary cultures of human tubular epithelial cells: modulation by hypoxia

Tubular epithelial cells secrete connective tissue growth factor (CTGF, CCN2), which contributes to tubulointerstitial fibrosis. However, the molecular regulation of CTGF in human primary tubular epithelial cells (hPTECs) is not well defined. Therefore, CTGF expression was characterized in hPTECs isolated from healthy parts of tumor nephrectomies, with special emphasis on the regulation by transforming growth factor-β (TGF-β) and hypoxia, essential factors in the development of fibrosis. CTGF synthesis was strongly dependent on cell density. High CTGF levels were detected in sparse cells, whereas CTGF expression was reduced in confluent cells. Concomitantly, stimulation of CTGF by TGF-β or the histone deacetylase inhibitor trichostatin was prevented in dense cells. Exposure of hPTECs to low oxygen tension (1% O2) or the hypoxia mimetic dimethyl-oxalylglycine for 24 h reduced CTGF gene expression in most of the 17 preparations analyzed. Preincubation of the cells under hypoxic conditions significantly reduced TGF-β-mediated upregulation of CTGF. In line with these data, CTGF mRNA was only induced in interstitial cells, but not in tubular cells in kidneys of mice exposed to hypoxia. Longer exposure to hypoxia or TGF-β (up to 72 h) did not induce hPTECs to adopt a mesenchymal phenotype characterized by upregulation of α-smooth muscle actin, downregulation of E-cadherin, or increased sensitivity of the cells in terms of CTGF expression. Sensitivity was restored by inhibition of DNA methylation. Taken together, our data provide evidence that exposure to hypoxia decreased CTGF gene expression. Furthermore, hypoxia per se was not sufficient to induce a mesenchymal phenotype in primary tubular epithelial cells.

[Therapy of patients with chronic back pain. Prescriptions--contentment--outcome]

Chronic back pain is a frequent complaint in out-patient orthopaedic practice. National (DEGAM; German Society of General Medicine and Family Medicine) and international guidelines provide recommendations for diagnostic and therapeutic procedures. Regulation of the behaviour of treating orthopaedists in the context of the therapy is so far little known.In this survey it was investigated which treatments are prescribed, whether there is a link between regulations and stage of chronification and whether the subjective effects correspond to objective results. Questionnaires relating to patient anamnesis were sent to 235 orthopaedic practices and a second questionnaire was sent to all patients who took part in the survey 6 months later. A total of 630 data sets could be evaluated.It was shown that primarily passive therapies (physiotherapy, drug therapy, injections and tablets) are mostly prescribed (physiotherapy, medications, injections) and that more therapies are used with increasing stages of chronification. The prescribed therapy achieved a high subjective patient satisfaction but an objective success could not be recognized.

Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients

OBJECTIVES

This prospective longitudinal clinical study analyses the therapy outcome of 365 patients with either chronic neck (n = 134) or low back (n = 231) pain treated with a multidisciplinary biopsychosocial therapy approach.

METHODS

Patients with chronic neck pain (NP) or low back pain (LBP) for 3 months or longer, corresponding sick leave for longer than 6 weeks, and clearly defined inclusion and exclusion criteria underwent a 3-week standardized inpatient multidisciplinary biopsychosocial therapy. Baseline sociodemographic, occupational, functional, and psychological data at entry into the study (T0) were comparable in both groups. At the 6-month follow-up (T1), five different therapy outcomes were analysed in both groups: back-to-work status, generic health status (the 36-item Short Form Health Survey, SF-36), pain intensity (visual analogue scale), functional capacity (Hannover back capacity score), and satisfaction with the therapy.

RESULTS

Both treatment groups improved significantly in all outcome criteria between T0 and T1. In the total group, the back-to-work rate was 67.4%. At the final follow-up there were no significant differences between the group with chronic NP and the group with chronic LBP in the outcome criteria back-to-work status, improvement of health status and functional capacity, satisfaction with therapy, and reduction of pain.

CONCLUSION

Evaluation of the main results of this study suggests that patients with chronic NP also derive significant benefit from a multidisciplinary treatment strategy, demonstrated in the literature so far mainly for patients with chronic LBP.

Hypoxia interferes with connective tissue growth factor (CTGF) gene expression in human proximal tubular cell lines

BACKGROUND

Hypoxia plays an important role in kidney injury. By the stabilization of the transcription factor HIF-1, hypoxia affects gene expression also in tubular epithelial cells. Increased expression of connective tissue growth factor (CTGF) is observed in different kidney diseases and is associated with deteriorating renal function. Therefore, we hypothesized that the expression of CTGF might be modulated under hypoxic conditions.

METHODS

The human proximal tubular epithelial cell lines HK-2 and HKC-8 were treated with reduced oxygen tension (1% O(2)) or the hypoxia mimetic dimethyloxalyl glycine (DMOG). CTGF was analysed by Western blotting, real-time RT-PCR and luciferase gene expression assays.

RESULTS

Exposure of HK-2 or HKC-8 cells to hypoxia or treatment with DMOG for up to 24 h reduced cellular as well as secreted CTGF protein synthesis. Downregulation was also detectable at the mRNA level and was confirmed by reporter gene assays. Hypoxic repression of CTGF synthesis was dependent on HIF-1, as shown by HIF-1alpha knockdown by siRNA. Furthermore, exposure to hypoxia reduced CTGF synthesis in response to TGF-beta. A negative correlation between HIF-1alpha accumulation and CTGF synthesis was also observed in renal cell carcinoma cells (RCC4 and RCC10). Reexpression of von Hippel-Lindau protein reduced HIF-1alpha and increased CTGF synthesis.

CONCLUSIONS

We provide evidence that hypoxia inhibits CTGF synthesis in human proximal tubular epithelial cells, involving HIF-1alpha. Under hypoxic conditions, induction of CTGF by TGF-beta was repressed. The reduced synthesis of the profibrotic factor CTGF may contribute to a potential protective effect of hypoxic preconditioning in acute renal injury.

[Comorbidity in patients with chronic low back pain]

BACKGROUND

Studies concerning comorbidity in patients with chronic low back pain and its correlation to the stage of chronification are rare.

METHODS

This case-control study (matched-pair analysis) examines the number and specificity of comorbidity as well as the extent of disability due to comorbidity in 51 patients with chronic low back pain compared to age- and sex-matched control persons. Moreover, the correlation of comorbidity and the stage of chronification was analysed in these patients.

RESULTS

Patients with chronic low back pain had significantly more comorbidities and a higher disability due to comorbidity compared to the control persons. The higher the stage of chronification according to the Mainz Pain Staging System (MPSS) the higher was the number of comorbidities.

CONCLUSION

Comorbidity should be given due consideration when evaluating diagnosis, therapy, prognosis and therapy outcome in patients with chronic low back pain.

Gutes Therapieergebnis nach Behandlung chronischer Rückenschmerzen

AIM

The aim of this study was to evaluate how much change in pain intensity is necessary to discriminate between good, bad or no treatment outcome from the patient's point of view after therapy for chronic back pain.

METHODS

A total of 153 patients with chronic back pain were admitted to a 3 week multimodal treatment program including functional restoration and cognitive behavioral support (outpatient). Pain intensity was measured at the beginning of treatment and 6 months after discharge using a visual analogue scale (VAS). At this time, patients had to evaluate their back pain compared to the beginning of treatment as of better, equal or worse (global self-assessment).

RESULTS

Six months after therapy, 48% of the patients assessed their back pain as better, 28% reported no change and 14% stated that their pain was worse. Mean pain reduction among the patients who assessed themselves as better was 25 points, while those who stated that their pain was worse had an average of 9 points more (VAS).

CONCLUSION

Patients' global self-assessment is a valid parameter to determine the outcome after treatment of chronic back pain. A clinically meaningful pain reduction can be assumed if there is at least a 25/100 point reduction (VAS), while a worsening of pain is already found to be important when there is a rise of 9/100 points.

Multimodale Therapie bei chronischem HWS- und LWS-Schmerz

BACKGROUND

Multimodal therapy has been established for patients with chronic low back pain, but studies reporting results in patients with chronic neck pain are rare.

METHODS

This prospective clinical study compared the results in 97 patients with chronic cervical pain and 231 patients with chronic lumbar pain after three weeks of multimodal therapy. The following factors were analyzed in both groups at the beginning and after 6 months: ability to work, pain intensity and functional back capacity.

RESULTS

Both groups had improved significantly after 6 months in all outcome parameters. Functional back capacity and ability to work at 6 months were not different between the two groups, but pain intensity was significantly lower in patients with low back pain compared to patients with neck pain.

CONCLUSION

Multimodal therapy is also an efficient treatment strategy for patients with chronic cervical pain as has already been shown for patients with chronic lumbar pain.

[What questions are appropriate for predicting the risk of chronic disease in patients suffering from acute low back pain?]

AIM

The objective of the study was to develop a brief questionnaire to determine the risk of chronification for patients suffering from lumbar (low) back pain who are consulting a physician for the first or second time.

METHOD

At the outset, and again after six months, a questionnaire with 167 valid items for chronification was distributed to patients in orthopedic offices. After six months, patients were contacted by mail to inquire whether they were still suffering from back pain. Based on outcome (persistence of back pain/absence of back pain) and by means of logistic regression analysis, those variables were determined that could predict actual chronification.

RESULTS

The following items were predictive: "How strong was your back pain during the last week when it was most tolerable?" and "How much residual pain would you be willing to tolerate while still considering the therapy successful?" (Acceptance value, beta = 0.61), patient's educational level (beta = - 0.44), massage is experienced as bringing relief (beta = 0.44), 5 items of the Zung scale for depression (beta = 0.42), items of the scale for catastrophizing thoughts (beta = 0.41) and items of the scale for feelings of helplessness (beta = - 0.39) of the Kiel pain inventory; duration of the back pain for longer than 1 week (beta = 0.38), pain in other parts of the body (beta = 0.37); and female gender (beta = 0.25)

CONCLUSION

Based on these questions, it was possible to predict the chronification of back pain with a probability of 78.05 %. A corresponding questionnaire and an evaluative table were developed.

Characterisation of the interface of sputter-deposited copper coatings on nitrogen plasma-treated carbon substrates

The adhesion of copper coatings to carbon substrates is very poor, because of lack of diffusion or reaction between the constituents. Because there is technological interest in enhancing the adhesion and improving the interface between copper and carbon, plasma treatment of the carbon substrate was employed in this study. For modification of the carbon surface a nitrogen plasma was used. It was confirmed by pull-off tests that the strength of adhesion of the copper coating can be improved by a factor of more than 10 by plasma pretreatment, even after treatment for a very short time (1 min). To obtain more information about the mechanisms of the processes occurring at the interface SIMS investigations were performed on samples which had been treated for different times (between 1 and 60 min). These measurements confirmed that nitrogen is located on the interface. With increasing pretreatment time the amount of nitrogen detected on the interface increased. Besides characterisation of as-deposited samples, another focus was to study the mechanisms of diffusion of nitrogen if the samples are heat treated at 500 degrees C.

Effect of intermittent high altitude hypoxia on gene expression in rat heart and lung

Hypoxia has been identified as an important stimulus for gene expression during embryogenesis and in various pathological situations. Its influence under physiological conditions, however, has only been studied occasionally. We therefore investigated the effect of intermittent high altitude hypoxia on the mRNA expression of different cytokines and protooncogenes, but also of other genes described to be regulated by hypoxia, in the left ventricle (LV), the right ventricle (RV), atria and the lung of adult rats after simulation of hypoxia in a barochamber (5000 m, 4 hours to 10 days). Heme oxygenase-1 as well as transforming growth factor-beta1 showed an increased expression in all regions of the heart and the lung at different periods of hypoxia. For lactate dehydrogenase-A, we found a significant up-regulation in the RV and the lung, for lactate dehydrogenase-B up-regulation in the RV, but down-regulation in the LV and the atria. Vascular endothelial growth factor was up-regulated in the RV, the LV and the lung, but down-regulated in the atria. Its receptor Flk-1 mRNA was significantly increased in the atria and RV only. Expression of c-fos was found in the LV and RV only after 4 hours of hypoxia. The level of c-jun was significantly increased in the LV but decreased in the atria. Our data clearly demonstrate that intermittent hypoxia is a modulator of gene expression under physiological conditions. It differently regulates the expression of distinct genes not only in individual organs but even within one organ, i.e. in the heart.

Receptor-independent role of the urokinase-type plasminogen activator during arteriogenesis

To define the role of the plasminogen activators (PAs) urokinase PA (uPA) and tissue PA (tPA) as well as the uPA receptor (uPAR) in arteriogenesis, we investigated their impact in a rabbit and mouse model of adaptive collateral artery growth. Collateral artery growth was induced by occlusion of the femoral artery in rabbit and wild-type (WT) mice and in mice with targeted inactivation of uPA (uPA-/-), tPA (tPA-/-), or uPAR (uPAR-/-). Northern blot results revealed a significant up-regulation of uPA but not uPAR or tPA in the early phase of arteriogenesis in rabbit and WT mice. This up-regulation on RNA level was followed by an increased protein level and enzymatic activity. Impaired perfusion recovery upon femoral artery ligation was observed by laser Doppler analysis in vivo in uPA-deficient mice but not in uPAR or tPA deficiency compared with WT mice. Immunohistochemical studies revealed an association of leukocyte infiltration with arteriogenesis in WT mice that was strongly reduced in uPA-/- but not in uPAR- or tPA-deficient mice. We conclude that arteriogenesis is promoted by an uPA-mediated infiltration of leukocytes that is not dependent on uPAR.

Head-to-head comparison of N-terminal pro-brain natriuretic peptide, brain natriuretic peptide and N-terminal pro-atrial natriuretic peptide in diagnosing left ventricular dysfunction

Brain natriuretic peptide (BNP), NT-proBNP and NT-pro-atrial natriuretic peptide (NT-proANP) were measured in blood samples from 57 patients using immunoassays and immunoradiometric assays to evaluate the usefulness as diagnostic markers for the detection of heart failure. For the detection of impaired left ventricular ejection fraction (LVEF), receiver operating characteristic curves showed that BNP had the best diagnostic performance with an area under curve (AUC) of 0.75+/-0.06. However, NT-proBNP (AUC: 0.67+/-0.07) and NT-proANP (AUC: 0.69+/-0.08) showed no significant difference to BNP. In a further analysis for the detection of resting LVEF <40%, BNP again was the best marker with an AUC of 0.83+/-0.06. NT-proBNP showed only a slightly smaller AUC (0.79+/-0.07). The AUC for NT-proANP was significantly smaller (0.65+/-0.08) compared to BNP. Additionally, BNP and NT-proBNP correlated negatively with the resting LVEF (BNP: -0.472, p<0.001; NT-proBNP: -0.306, p=0.026), whereas NT-proANP showed no significant correlation. In summary, BNP was the best marker to detect patients with impaired LVEF compared to NT-proBNP and NT-proANP. However, NT-proBNP showed no significant differences to BNP and it is therefore a new promising alternative marker for the detection of left ventricular dysfunction.

Bone mineral content after renal transplantation. Placebo-controlled prospective study with 1,25-dihydroxy vitamin D3

Forearm bone mineral content (BMC), as evaluated by photonabsorption densitometry, was measured in 28 cadaver kidney donor recipients who entered the study 8 weeks postoperatively and were followed up for 18 months. BMC decreased significantly (p less than 0.05) but marginally in placebo-treated patients (n = 14) (initial BMC 1.09 +/- 0.25 g/cm; final BMC 1.05 +/- 0.24). Fourteen patients were prophylactically given 1,25(OH)2 vitamin D3 in a dose which avoided hypercalcemia and hypercalciuria (approximately 0.25 microgram/day); under 1,25(OH)2 vitamin D3 prophylaxis a significant decrease of forearm BMC was observed no longer (initial BMC 0.94 +/- 0.21 g/cm; final BMC 0.95 +/- 0.21), but the difference between placebo and 1,25(OH)2 vitamin D3 narrowly missed statistical significance (p = 0.066). It is concluded that the decrease of forearm BMC is negligible in transplant recipients with low steroid regimens. The data suggest a trend for prophylaxis with 1,25(OH)2 vitamin D3 to slightly ameliorate forearm (cortical) BMC loss.