C-X-C Motif Chemokine Receptor 4 Blockade Promotes Tissue Repair After Myocardial Infarction by Enhancing Regulatory T Cell Mobilization and Immune-Regulatory Function

BACKGROUND

Acute myocardial infarction (MI) elicits an inflammatory response that drives tissue repair and adverse cardiac remodeling. Inflammatory cell trafficking after MI is controlled by C-X-C motif chemokine ligand 12 (CXCL12) and its receptor, C-X-C motif chemokine receptor 4 (CXCR4). CXCR4 antagonists mobilize inflammatory cells and promote infarct repair, but the cellular mechanisms are unclear.

METHODS

We investigated the therapeutic potential and mode of action of the peptidic macrocycle CXCR4 antagonist POL5551 in mice with reperfused MI. We applied cell depletion and adoptive transfer strategies using lymphocyte-deficient Rag1 knockout mice; DEREG mice, which express a diphtheria toxin receptor-enhanced green fluorescent protein fusion protein under the control of the promoter/enhancer region of the regulatory T (T_reg) cell-restricted Foxp3 transcription factor; and dendritic cell-depleted CD11c-Cre iDTR mice. Translational potential was explored in a porcine model of reperfused MI using serial contrast-enhanced magnetic resonance imaging.

RESULTS

Intraperitoneal POL5551 injections in wild-type mice (8 mg/kg at 2, 4, 6, and 8 days) enhanced angiogenesis in the infarct border zone, reduced scar size, and attenuated left ventricular remodeling and contractile dysfunction at 28 days. Treatment effects were absent in splenectomized wild-type mice, Rag1 knockout mice, and T_reg cell-depleted DEREG mice. Conversely, treatment effects could be transferred into infarcted splenectomized wild-type mice by transplanting splenic T_reg cells from POL5551-treated infarcted DEREG mice. Instructive cues provided by infarct-primed dendritic cells were required for POL5551 treatment effects. POL5551 injections mobilized T_reg cells into the peripheral blood, followed by enhanced T_reg cell accumulation in the infarcted region. Neutrophils, monocytes, and lymphocytes displayed similar mobilization kinetics, but their cardiac recruitment was not affected. POL5551, however, attenuated inflammatory gene expression in monocytes and macrophages in the infarcted region via T_reg cells. Intravenous infusion of the clinical-stage POL5551 analogue POL6326 (3 mg/kg at 4, 6, 8, and 10 days) decreased infarct volume and improved left ventricular ejection fraction in pigs.

CONCLUSIONS

These data confirm CXCR4 blockade as a promising treatment strategy after MI. We identify dendritic cell-primed splenic T_reg cells as the central arbiters of these therapeutic effects and thereby delineate a pharmacological strategy to promote infarct repair by augmenting T_reg cell function in vivo.

Morphological, chemical, and antigenic organization of mammalian C-type viruses

New features in the architecture of mammalian type C viruses, in particular knoblike surface projections and hexagonally arranged subunits on the core shell could be demonstrated by electron microscopy, taking advantage of newly developed preparation techniques. As examples, murine leukemia viruses (MuLVs) and newly isolated porcine and bovine C viruses are presented. The major proteins of a MuLV were isolated and partially characterized in chemical terms and with respect to their serological and other biological activities, such as interfering and hemagglutinating (HA) capacity. Most of the characterized proteins could be localized in particular substructures of the virion either by selective removal or isolation of electron microscopically identifiable constituents. The information obtained allowed the design of a more detailed model of mammalian C viruses. Special attention was devoted to the further characterization of interspecies antigens of mammalian C viruses. Different antigenic determinants were revealed. Their distribution allows further subgrouping of mammalian C viruses.

Zur Vielfachstreuung und Rückdiffusion schneller Elektronen nach Durchgang durch dicke Schichten

Es wird über die Winkel- und Energieverteilung der an Metallfolien (Al, Cu, Pb) gestreuten Elektronen berichtet, indem Beispiele für die verschiedenen in der Praxis interessierenden Fälle zusammengestellt werden. Dabei trafen monoenergetische Elektronen mit einer kinetischen Energie von 1,75 MeV unter verschiedenen Einfallswinkeln auf Folien, deren Dicke einen Halbwertswinkel von mindestens 20° ergab und bis zur praktischen Reichweite variiert wurde. Die Messungen erstreckten sich bis zum Ablenkungswinkel Θ=170°.

In Vorwärtsrichtung wurde bei senkrechtem Einschuß insbesondere der Fall der „vollständigen Diffusion“ untersucht, bei schrägem Einschuß der Übergang zur Symmetrie um die Foliennormale mit wachsender Foliendicke.

Für die rückgestreuten Elektronen wurde vor allem der Einfluß der Folienstellung auf Energie- und Winkelverteilung untersucht. Dreht man die Folie, so nimmt die Rückstreuintensität in der Nähe des Reflexionswinkels für alle Z in gleichem Maße zu und man erhält schließlich bei sehr schrägem Einschuß im Reflexionswinkel eine von Z unabhängige Rückstreuintensität. Die Rückstreukoeffizienten für senkrechten Einschuß und sättigungsdicke Schicht sind Pb: 36%, Cu: 18% und Al: 5%. Sie sind kleiner als die bei kleinen Energien bekannten Werte. Den Änderungen in der Winkelverteilung entsprechen beträchtliche Änderungen der Energieverteilung mit der Beobachtungsgeometrie. Die mittleren Energieverluste sind im vorliegenden Energiebereich größer als bei kleinen Primärenergien. Der Einfluß der Primärenergie wird an einigen Beispielen diskutiert. Dabei bestätigt sich eine Abschätzung für die Rückstreuung, nach der die Energieverteilung und der Rückstreukoeffizient für E0 > 1 MeV vom Parameter Z/E0 abhängen sollten.

Quantitative Bausteinanalyse der Stützmembran in der Zellwand von Escherichia coli B

The three concentric layers of the cell wall of E. coli B (the outer lipoprotein layer, the intermediate lipopolysaccharide layer and the inner protein- and mucopolymer containing rigid layer) contribute 60%, 12% and 21%, respectively, to the total weight of the cell wall. — Treatment of the rigid layer with proteolytic enzymes removes the bulk of its protein components but leaves it otherwise intact: still rigid and cell-shaped, it is found to contain glucose, lipid and the mucopeptide constituents muramic acid, glucosamine, diaminopimelic acid, glutamic acid and alanine in molar ratios corresponding to the chemical compositions of known enzymatic mucopolymer split-products from E. coli-walls. Quantitative balance sheets of these components are made up and their implications on the structural concept of the rigid layer are discussed.

High resolution modelling of wind fields for optimization of empirical storm flood predictions

Abstract. High resolution wind fields are necessary to predict the occurrence of storm flood events and their magnitude. Deutscher Wetterdienst (DWD) created a catalogue of detailed wind fields of 39 historical storms at the German North Sea coast from the years 1962 to 2011. The catalogue is used by the Niedersächsisches Landesamt für Wasser-, Küsten- und Naturschutz (NLWKN) coastal research center to improve their flood alert service. The computation of wind fields and other meteorological parameters is based on the model chain of the DWD going from the global model GME via the limited-area model COSMO with 7 km mesh size down to a COSMO model with 2.2 km. To obtain an improved analysis COSMO runs are nudged against observations for the historical storms. The global model GME is initialised from the ERA reanalysis data of the European Centre for Medium-Range Weather Forecasts (ECMWF). As expected, we got better congruency with observations of the model for the nudging runs than the normal forecast runs for most storms. We also found during the verification process that different land use data sets could influence the results considerably.

[A rare cause of edema: sporadic lymphangioleiomyomatosis]

HISTORY AND CLINICAL FINDINGS

A 45-year-old woman presented with marked edema of both lower extremities over 6 weeks for a nephrological work-up; she had gained 8 kg of body weight. Voiding was asymptomatic and she had a stable diuresis. The patient took oestrogens for contraception over 10 years. Blood pressure was normotensive. Serum-creatinine was 0.8 mg/dl; a slight microalbuminuria was noted. Left and right ventricular systolic function were normal. DIAGNOSTIC FINDINGS, TREATMENT AND CLINICAL COURSE: Computed tomography of the abdomen revealed a hemodynamically relevant obstruction of the venous blood flow or the lymphatic vessels as cause for the edema of both legs. Masses of lymphangioleiomyomas located around the v. cava inferior were documented. Biopsy of the masses proved a massive proliferation of smooth muscle cells and epitheloid cells with an immunohistochemically typical staining. Furthermore, CT revealed multiple pulmonary cysts in both lungs, results which are pathognomic for lymphangioleiomyomatosis (LAM). In our patient, the structural impairment of the lungs was not substantiated clinically, i. e. she had only slight dyspnoe during exertion. By mild diuretic treatment with HCT and fluid control, a moderate regression of the edema was achieved. At present, the mTOR inhibitor rapamycin as antiproliferative treatment is considered to reduce the retroperitoneal LAM-related masses on an individual basis.

CONCLUSION

LAM is a rare genetically determined progressive disease occurring frequently in women in childbearing age. LAM is characterized by a proliferation of smooth muscle cells, lymphangioma, renal angiomyolipoma, pulmonary cysts and progressive destruction of lung parenchyma. Refractory edema can result from an obstruction of the venous blood and lymphatic flow by lymphangioma masses located paracaval, which was the impressive and first clinical feature of LAM in our case report.

[Phlebology in German departments of dermatology. An analysis on behalf of the German Society of Phlebology]

BACKGROUND

Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP).

METHODS

To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012.

RESULTS

In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments.

CONCLUSIONS

Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.

Quantification of the herpesvirus content in various tissues and organs, and associated post mortem lesions of psittacine birds which died during an epornithic of pacheco's parrot disease (PPD)

This paper reports on the viral content of up to 52 tissue and organ samples of 18 individual large psittacines which died during an epornithic of Pacheco's parrot disease (PPD) caused by psittacid herpesvirus 1 (PsHV1). Associated clinical signs and pathological lesions are described. The large spectrum of samples found to be positive for PsHVl suggests that birds succumb to PPD during viraemia. Tissues and organs from which the virus could be isolated included the integument and associated structures, the muscular, respiratory and circulatory system, bone marrow, the nervous system, thyroid and adrenal glands, spleen and liver, the urogenital tract and the gastro-intestinal tract. Nevertheless, individual and organ (but not species)-specific variation does occur. Virus isolation appears to be most promising from the respiratory, vascular and nervous system and the liver. Highest titres were obtained from heart blood and liver (up to 7.6 log(10)/g tissue), airsac, Nervus vagus and pulp and quill of pin feathers. Pin feathers may therefore be suitable for in-vivo diagnosis. In contrast, HV could not be isolated from any of the feather vanes examined. For the most part, post mortem lesions do not reflect the organ pattern found to be most permissive for virus replication as judged by the success of virus isolation and virus titres. A closer quantitative correlation is indicated for the lungs, spleen and liver, only. Corresponding findings as to frequency of gross pathological lesions and virus quantification appear to be restricted to the liver. In accordance with clinical observations and experimental findings, tissue virus content indicates that horizontal spread of herpesviruses is mediated by cloacal contents or secretions from the respiratory system.

Prospective randomized phase III trial of triplet chemotherapy with paclitaxel + gemcitabine + cisplatin compared to standard doublet chemotherapy with vinorelbine + cisplatin in advanced non-small cell lung cancer

8034

Background: Paclitaxel + gemcitabine + cisplatin showed promising results in phase II with 59% response rate and 48 weeks median survival. Hence, it was compared to a standard doublet regimen to examine for superiority. Methods: Histologically verified inoperable NSCLC patients (pts) aged 18–75 years, performance status 0–2 and normal organ function were randomized to regimen A (paclitaxel 180 mg/m2 and cisplatin 100 mg/m2 day 1 with gemcitabine 1000 mg/m2 day 1 and 8 every 3 weeks) or regimen B (cisplatin 100 mg/m2 day 1 and weekly i.v. vinorelbine every 4 weeks) for maximum 6 cycles. Totally 428 pts were needed to detect a 30% median survival increase with 80% power and two-sided type 1-error of 5%. Results: 221 pts.received reg. A and 222 reg. B. Overall, median age was 62 years (range 38–75 yrs), 58% were males, 11% had performance status 2, 62% stage IV disease, 46% adenocarcinoma, and 28% squamous cell carcinoma (SCC), equally distributed between the regimens. Median no. of treatment courses were 4 in both regimens. Frequencies of CTC grade 4 leucocytopenia, thrombocytopenia, or grade 3+4 nausea, neurotoxicity, or nephrotoxicity were 15%, 17%, 19%, 8%, and 8% in reg. A, and 18%, 5% (p=0.001), 17%, 11%(p=0.014), and 7% in reg. B, respectively. Febrile leucopenia episodes were 14% and 10% in reg. A and B, while thrombocytopenic bleedings occurred in 12% and 4% of pts (p=0.008), respectively, with two toxic deaths due to bleeding in reg. A and none in reg. B. Response rates were 52% and 49% in reg. A and reg. B, median response durations were 263 and 217 days (not significant), median times to progressions (TTP) 6.7 and 5.8 months (p=0.453), and median survival times 11.4 and 10.8 months (p=0.415), respectively. In SCC subtype, TTP was higher in reg. A than reg. B (medians 7.0 mths vs. 4.1 mths, p=0.001) and survival was increased (medians 13.5 mths vs 9.7 mths, p=0.020). Conclusions: The triplet regimen A had significantly higher activity in SCC, both with respect to TTP and to survival with median survival in excess of one year and may be preferred in this histologic subtype.

[Table: see text]

Cisplatin and vinorelbine first-line chemotherapy in non-resectable malignant pleural mesothelioma

The aim was to evaluate the activity of cisplatin and vinorelbine in previously untreated, inoperable patients having histologically verified malignant pleural mesothelioma (MPM), normal organ function, and performance status 0-2. Treatment was vinorelbine 25 mg m(-2) i.v. weekly and cisplatin 100 mg m(-2) i.v. every 4 weeks with hydration and standard prophylactic antiemetic treatment. Patients gave written informed consent. Characteristics of 54 consecutive patients were: males 85%, epithelial subtype 74%, IMIG stages III and IV 35 and 46%, performance status 0, 1, and 2, 26, 69, and 6%, and median age 63 years (31-78 years). CTC grade 3 or 4 toxicity occurred with respect to leukocytopenia (48% of patients, grade 4 in 13%), nausea (13%), neurotoxicity (11%), nephrotoxicity (4%), and other toxicities (9%). There were no toxic deaths. The median number of cycles was four. The fraction of patients alive at 1-, 2-, and 3-years were 61, 31, and 4%, respectively, and median survival and median time to progression were 16.8 months (0.5 to 46.4 +months) and 7.2 months (1.6 to 40.6 + months). There were two CRs and 14 PRs (response rate 29.6%). Cisplatin and intravenous vinorelbine is a highly active regimen in MPM with a response rate and survival comparable to the most active regimens so far reported.

Bcl-2 Gene Silencing in Pediatric Epithelial Liver Tumors

BACKGROUND

Proteins of the Bcl-2 family prevent cells of various tumor types from undergoing apoptosis and thus contribute to their chemotherapy resistance. The phenotype of multidrug resistance is a major factor for poor treatment results of advanced epithelial liver tumors in children. The role of Bcl-2 proteins in these tumors is yet unclear. The purpose of this study was to analyze the influence of Bcl-2 on the chemotherapy resistance of hepatoblastoma (HB) and pediatric hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

Bcl-2 expression was analyzed in the HB cell lines HUH6 and HepT1 as well as in the HCC cell line HepG2 before and after treatment with cisplatin, doxorubicin, taxol, and etoposid. Silencing of the Bcl-2 gene was performed via RNA interference using specific siRNA. Treatment efficiencies of cytotoxic agents were assessed against original and Bcl-2 siRNA transfected tumor cells.

RESULTS

The mixed HB cell line HUH6 showed a relevant amount of Bcl-2 expression, which increased after chemotherapy. In these cells Bcl-2 appeared within the nuclei and the cytosol. Treatment with all cytotoxic agents was significantly improved through Bcl-2 siRNA (P < 0.001-0.0054) in this cell line. There was no effect of Bcl-2 siRNA in HepT1 and HepG2 cells.

CONCLUSIONS

Bcl-2 seems to play a role in antiapoptotic mechanisms of some HB subtypes. Thus, this gene might serve as target for a gene-directed adjuvant therapy. Further studies seem necessary to clear the susceptibility of pediatric epithelial liver tumors toward the described approach.

[Comparative in vitro analysis of vacuum plasma-sprayed titanium implants--evaluation of OPG, Osteokalzin and AP expression]

INTRODUCTION

The purpose of this study was to evaluate the influence of different surface topographies on the expression of bone cell-associated proteins, such as osteoprotegerin (OPG), osteocalcin and alkaline phosphatase (AP), and the production of the extracellular matrix (ECM) in vitro. Another aspect was the question as to whether a hydroxyapatite (HA) coating offers additional advantages. Vacuum plasma-sprayed (VPS) pure titanium was used to generate different surface topographies.

MATERIALS AND METHODS

The in vitro response of human bone marrow cells to VPS implants (porosity ranging from 25 to 50%, pore size ranging from 50 to 200 microm and roughness ranging from 0.191 to 0.547 mm) and cancellous structured titanium (cs-Ti) as a reference material (55% porosity, pore size of 500 microm, roughness 0.836 mm) were compared. The expression of bone cell-associated proteins, such as OPG, osteocalcin and alkaline phosphatase (AP), was evaluated. Scanning electron microscopy (SEM) was used to judge the production of ECM.

RESULTS

All implant materials induced the release of OPG, osteocalcin and AP. Significant differences were evident between the cs-Ti and the different VPS-Ti surface structures. There was no difference in the response between the VPS-Ti surfaces. SEM showed a dense and increased production of ECM on the VPS-Ti surfaces. An additional HA coating caused a faster production of ECM and higher levels of OPG.

CONCLUSIONS

The in vitro data presented here demonstrate the superiority of VPS-Ti surfaces over cs-Ti, which is already in clinical use. Differences between the VPS-Ti surfaces were not evident. Presumably, VPS-Ti surfaces offer good prerequisites for a successful integration of the implant in the surrounding tissue. An additional HA coating could influence these events positively.

In vitro gene targeting in human hepatoblastoma

Poor treatment results in advanced hepatoblastoma (HB) made alternative treatment approaches desirable. Gene-directed tumor therapy is increasingly investigated in different malignancies. The aim of this study was to analyze possible alternatives of gene transfer into HB cells and to study therapeutic applications based on different strategies. Liposomal transfection of HB cells was assessed using liver-specific promoters, and adenovirus and Sendai virus transductions were performed in vitro. Transfer efficiencies were measured via flow cytometry determining expression of vector-encoded marker gene green fluorescent protein. Gene silencing of the anti-apoptotic bcl-2 gene in HUH6 cells was performed using lipofection of small interfering RNA (siRNA). Additionally, suicide gene therapy was carried out through a yeast-derived cytosine deaminase (YCD)-combined yeast uracil phosphoribosyltransferase (YUPRT)-based adenovirus-mediated gene transfer, leading to a potent intracellular prodrug transformation of 5-fluorocytosine into 5-fluorouracil. Treatment efficiencies were monitored via MTT viability assay. Highest gene transfer rates (86%) were observed using adenovirus transduction. We furthermore observed a significant therapeutic effect of adenovirus-mediated YCD::YUPRT suicide gene transfer. Liposomal-mediated anti-bcl-2 siRNA transfer led to a significant improvement of cisplatin treatment in HUH6 cells. Liver-specific promoters were found to be strongly active in HUH6 cells (mixed HB-derived), but less active in HepT1 cells (embryonal HB-derived). Liposomal transfection and viral transduction are effective approaches to genetically manipulate HB cells in vitro. For the first time, we demonstrate a positive effect of siRNA gene silencing in this malignancy. Additionally, we successfully investigated a model of adenovirus-based suicide gene therapy in HB cell cultures. Our data strongly encourage further studies assessing these alternative treatment approaches.

Quantification of phytochelatins in plants by reversed-phase HPLC–ESI–MS–MS

An on-line HPLC-ESI-MS-MS method has been developed for determination of glutathione and phytochelatins (PC) in plant tissues. For sample pretreatment, dithiothreitol (DTT) must be added at the very beginning, as an anti-oxidant. Optimization of instrumental conditions i.e. composition of HPLC mobile phase, ionization efficiency of the electrospray interface, and MS-MS detection in the multiple ion-monitoring mode, are the central aspects of this work. A polystyrene-packed column was found to be superior to a standard silica-packed reversed-phase column. A concave quadratic gradient of ammonium formate buffer and acetonitrile was found to be optimum. The limits of quantitation were 0.2 micromol kg(-1) plant tissue for glutathione and PC. The method has been applied to analysis of tissue samples from Vicia faba grown in Cd-containing nutrient solutions.

Histomorphometrische Evaluation poröser Titanprobenkörper anhand eines computergestützten Bildanalysesystems / Histomorphometric evaluation of bone ingrowth of porous titanium by a computer-assisted analyzing system

The objective of this study was to evaluate the bone ingrowth of a new vacuum plasma sprayed titanium surface (vps-ti) in comparison to cs-titanium implants in a göttinger minipig model. Fifteen göttinger minipigs each received the two implants, vacuum plasma sprayed titanium with a porosity of 50% and a pore size of 200 microm (vps-ti) and an implant with a similar porosity but a different pore size 500 microm (cs-ti), at the proximal femur metaphysis by press-fit technique. The pigs were euthanized at three different postsurgical periods: 4, 8 and 12 weeks. Each femur was harvested and qualitative (macroscopic and microscopic) and quantitative (histomorphometric) histological analysis was done on histological slides. The results indicated that there was a difference in bone ingrowth between the two implants, whereas the bone ingrowth of vps-ti was superior to cs-ti after 4 and 8 weeks healing time. 12 weeks post implantationem no statistiscal difference was evident. The pore size of 200 microm seemed superior to a pore size of 500 microm. Whether or not these effects lead to a better mechanical stability remains unanswered.

Pregnancy-induced sympathetic overactivity: a precursor of preeclampsia

BACKGROUND

Preeclampsia has been shown to constitute a state of sympathetic overactivity. However, it remains unclear if the sympathetic activity precedes preeclampsia or represents only a secondary phenomenon. To further investigate this issue, we performed a prospective study in pregnant women considered to be at increased risk for preeclampsia owing to preeclampsia during a preceding pregnancy.

MATERIALS AND METHODS

Twenty-two women with a history of preeclampsia were longitudinally studied on three occasions: twice during pregnancy (M1: 22 +/- 4, M2: 33 +/- 5 weeks) and once postpartum (M3: 26 +/- 6 weeks postpartum). We measured muscle sympathetic nerve activity (MSNA), forearm blood flow, and blood pressure at rest and during reactive hyperaemia after forearm occlusion.

RESULTS

At M1 and M2, none of the subjects was hypertensive, however, muscle sympathetic nerve activity levels were significantly augmented, compared with their postpartum values (M1: 21 +/- 9, M2: 29 +/- 14, M3: 9 +/- 5 bursts min(-1); P < 0.05). Forearm vascular resistance did not significantly change from M1 through M3 (M1: 16 +/- 9, M2: 15 +/- 7, M3: 16 +/- 7 U; P = NS). Gestational muscle sympathetic nerve activity values did not differ significantly among the subjects with subsequent preeclampsia compared with those who remained normotensive [with preeclampsia (n = 6): M1: 21 +/- 5, M2: 27 +/- 6, M3: 7 +/- 4 bursts min(-1); without preeclampsia (n = 16): M1: 21 +/- 11, M2: 30 +/- 16, M3: 9 +/- 6 bursts min(-1); P = NS].

CONCLUSION

Invariably, all women at risk for preeclampisa showed a pregnancy-induced increase in MSNA (pregnancy-induced sympathetic overactivity, PISO), which normalized after delivery. Most importantly, PISO is not necessarily associated with peripheral vasoconstriction and hypertension. Furthermore, only a subset of patients developed preeclampsia later on. Therefore, we hypothesize that PISO constitutes a precursor of preeclampsia which is physiologically compensated for by vasodilating mechanisms, leading to preeclampsia only when they fail.

Isolated anti-HBV core phenotype in anti-HCV-positive patients is associated with hepatitis C virus replication

Recovery from hepatitis B virus (HBV) infection is associated with the presence of antibodies against HBV surface (HBs) antigen and HBV core (HBc) antigen. However, anti-HBs antibodies are lost in many cases, and only anti-HBc antibodies persist. A higher frequency of the anti-HBc-alone pattern has been demonstrated for anti-hepatitis C virus (HCV)-positive patients. In this report, 1126 anti-HCV-positive/anti-HBc-positive patients were studied, and the role of HCV replication in influencing the presence or absence of anti-HBs antibodies was investigated. The anti-HBc-alone phenotype was significantly more frequent in HCV-viraemic than in HCV-recovered patients. This finding represents new information regarding the immunopathogenesis of chronic HCV infection and supports previous data indicating impaired humoral immune responses in HCV infection.

Simultaneous hemodialysis during coronary angiography fails to prevent radiocontrast-induced nephropathy in chronic renal failure

BACKGROUND

Radiocontrast medium- (RM) associated nephrotoxicity continues to be a common cause of acute renal failure and may lead in patients with pre-existing chronic renal insufficiency even to end-stage renal failure requiring chronic dialysis. Since extracorporeal removal of RM after RM administration has been shown to be effective but does not prevent radiocontrast-induced nephropathy, the effect of a simultaneous dialysis during RM administration on renal function is not clear.

METHODS

In a prospective, randomized and controlled trial, we studied the effect of a 4-hour online dialysis during RM (iomeprol) application in patients with advanced chronic renal failure (serum creatinine > or = 3 mg/dl) undergoing coronary angiography. All patients received hydration with saline before and after standardized coronary angiography and were randomized to receive a simultaneous high-flux hemodialysis (7 patients, HD group) or to control group (10 patients). 24-hour creatinine clearance (CrCl) was measured in all patients before, 1 week and 8 weeks after coronary angiography. The clinical follow-up comprised 8 weeks after RM application. RM plasma levels were measured in both groups 15, 30, 60 minutes, 2, 4, 12, 24, 48 and 72 hours after application by high-pressure liquid chromatography.

RESULTS

At baseline, CrCl (19 +/- 10 vs 17 +/- 7 ml/min), percentage of diabetics (57 vs 70%) and dose of RM (77 +/- 27 vs 86 +/- 21 ml) were similar in both groups. Pharmacokinetics: Total clearance of iomeprol was significantly higher (54 +/- 15 vs 20 +/- 12 ml/min, p < 0.001) and the area under curve (AUC) was significantly lower (23 +/- 10 g x h/l vs 94 +/- 57 g x h/l, p < 0.001) in the HD group compared to control group. RM peak plasma levels 15 min after application were not different in both groups (3.0 +/- 1.1 vs 4.2 +/- 1.7 mmol/l, NS), however, significantly lower 60 min (1.6 +/- 0.4 vs 3.7 +/- 1.5 mmol/l, p < 0.01) and 240 min (0.7 +/- 0.3 vs 2.3 +/- 0.7 p < 0.001) after angiography.

CLINICAL RESULTS

CrCl showed no difference 1 week (24 +/- 11 vs 19 +/- 9 ml/min, ns) and 8 weeks (24 +/- 5 vs 20 +/- 9 ml/min, NS) after angiography from baseline or between the groups. In each group, 2 patients developed end-stage renal disease and requested permanent dialysis during the 8-week follow-up.

CONCLUSION

Simultaneous dialysis reduces AUC of iomeprol significantly, however, does not influence plasma peak concentration after angiography. Renal function and incidence of end-stage renal failure were not influenced by online-dialysis.

Cardiovascular effects of beta-blockers with and without intrinsic sympathomimetic activity. A comparison between celiprolol and metoprolol

BACKGROUND

Celiprolol, a newer beta-blocking agent, has been reported to have vasodilatory capacity which may be due to partial beta-2-receptor agonistic activity or to alpha-receptor antagonistic or central sympathoinhibitory effects.

METHODS

To more critically assess the physiologic effects of celiprolol, we measured sympathetic nerve activity to muscle (MSNA), forearm blood flow (FBF), blood pressure (BP), central venous pressure, and heart rate (HR) in 10 normal volunteers at rest, during unloading of cardiopulmonary baroreceptors with lower body negative pressure (LBNP), and during a cold pressor test (CPT). Responses were compared with those seen with metoprolol and with placebo, i.e. each subject was studied three times.

RESULTS

Celiprolol did not alter resting levels of hemodynamics, FBF, and MSNA nor did it alter responses to LBNP or the CPT. In contrast, metoprolol produced significant decreases of FBF and HR, and increases of forearm vascular resistance and BP, but had also no effect on responses to the applied stress tests.

CONCLUSIONS

The lack of peripheral vasoconstriction seen after acute administration of celiprolol is most likely due to its partial beta-2-receptor agonistic effect and does not seem to be due to a central or reflex action or to an alpha-blocking effect. Both beta-blockers do not impair fundamental neural mechanisms involved in circulatory homeostasis.

Long-term results after microvascular decompression in essential hypertension

BACKGROUND AND PURPOSE

In 1998, 8 patients with severe, intractable arterial hypertension and MR tomography-demonstrated neurovascular contact of a looping artery at the root entry zone of cranial nerves IX and X, causing neurovascular compression, underwent neurosurgical decompression. The short-term results showed a normalization of blood pressure with a markedly reduced antihypertensive drug regimen in 7 patients. To determine the longer-term outcome concerning blood pressure and secondary organ damage after neurovascular decompression, we studied these 8 operated patients prospectively for a mean follow-up of 3.5 years after surgical intervention.

METHODS

Eight hypertensive patients who had undergone microsurgical decompression were monitored every 6 months after surgery to assess blood pressure (by 24-hour ambulatory pressure readings) and the need for antihypertensive medication. To evaluate secondary organ damage, echocardiographic assessment of left ventricular hypertrophy, fundoscopic assessment of hypertensive lesions, and analysis of renal function and proteinuria were done.

RESULTS

Three of the 8 operated patients remained normotensive in the long-term period with decreased antihypertensive medication. Two patients required gradual increases of antihypertensive medication after the first postoperative year, after which arterial blood pressure levels were 10% to 15% lower than preoperative levels. Three patients suffered serious cardiovascular and renal complications, with the incidence of lethal intracerebral hemorrhage in 1 patient and end-stage renal disease in 2 patients, of whom 1 experienced sudden cardiac death.

CONCLUSIONS

The long-term results verify that microsurgical decompression is a successful alternative therapy in a certain subgroup of patients with arterial hypertension due to neurovascular compression. However, the relevance of the looping artery in the other cases, who did not improve, is not clear. Prospective studies to elucidate the pathophysiological role of neurovascular abnormalities and arterial hypertension are needed.

Afterload reduction in severe aortic regurgitation

This study was designed to assess the effects of afterload reduction in asymptomatic patients with severe aortic regurgitation (AR) and maintained LV function by cine-MRI. We studied 13 patients at baseline and after 0.2 mg/kg Hydralazine (I.V.). Patients were stratified according to the volumetric LV response to acute afterload reduction: Group I comprised patients with improved LV response; Group II comprised patients with unchanged or deteriorated LV response. Baseline LV function and severity of AR were not significantly different between groups. However, regurgitant fraction decreased (50 +/- 12 vs. 36 +/- 9%; P < 0.03) and cardiac output increased (4.9 +/- 1.4 vs. 7.1 +/- 1.6l/minute; P < 0,001) in Group I and remained unchanged in Group II (54 +/- 10 vs. 55 +/- 10%, P = n.s. and 5.5 +/- 1.4 vs. 6.6 +/- 0.9l/minute; P = n.s.) during maximal vasodilation. Beat-to-beat analysis revealed a decrease of left ventricular endsystolic volume index in group I (48 +/- 13 vs. 37 +/- 9 ml/beat; P < 0.05) and no change in group II (61 +/- 20 vs. 62 +/- 20 ml/beat; P = n.s.). In the natural history of chronic AR, the absence of improved LV performance during acute vasodilation using beat-to-beat analysis by MRI may identify patients with more advanced cardiac adaptation to chronic volume overload.

Developmental inhibitory gate controls the relay of activity to the superficial layers of the visual cortex

A developmental reduction in the radial transmission of synaptic activity has been proposed to underlie the end of the critical period for experience-dependent modification in layers II/III of the visual cortex. Using paired-pulse stimulation, we investigated in visual cortical slices how the propagation of synaptic activity to the superficial layers changes during development and how this process is affected by sensory experience. The results can be summarized as follows. (1) Layers II/III responses to repetitive stimulation of the white matter become increasingly depressed between the third and sixth week of postnatal development, a time course that parallels the end of the critical period. (2) Paired-pulse depression is reduced after dark rearing and also by blocking inhibitory synaptic transmission. (3) Paired-pulse depression and its regulation by age and sensory experience is more pronounced when stimulation is applied to the white matter than when applied to layer IV. Together, these results are consistent with the idea that the maturation of intracortical inhibition reduces the capability of the cortex to relay incoming high-frequency patterns of activity to the supragranular layers.

Capillary electrophoresis with on-chip four-electrode capacitively coupled conductivity detection for application in bioanalysis

Microchip capillary electrophoresis (CE) with integrated four-electrode capacitively coupled conductivity detection is presented. Conductivity detection is a universal detection technique that is relatively independent on the detection pathlength and, especially important for chip-based analysis, is compatible with miniaturization and on-chip integration. The glass microchip structure consists of a 6 cm etched channel (20 microm x 70 microm cross section) with silicon nitride covered walls. In the channel, a 30 nm thick silicon carbide layer covers the electrodes to enable capacitive coupling with the liquid inside the channel as well as to prevent interference of the applied separation field. The detector response was found to be linear over the concentration range from 20 microM up to 2 mM. Detection limits were at the low microM level. Separation of two short peptides with a pI of respectively 5.38 and 4.87 at the 1 mM level demonstrates the applicability for biochemical analysis. At a relatively low separation field strength (50 V/cm) plate numbers in the order of 3500 were achieved. Results obtained with the microdevice compared well with those obtained in a bench scale CE instrument using UV detection under similar conditions.

The effects of ACE inhibitor therapy on left ventricular myocardial mass and diastolic filling in previously untreated hypertensive patients: a cine MRI study

Cardiac remodeling in case of hypertension induces hypertrophy of myocytes and elevated collagen content and, subsequently, impaired diastolic filling of the left ventricle. The purpose of this prospective study was to evaluate changes of left ventricular (LV) myocardial mass, as well as diastolic filling properties, in hypertensive patients treated with the ACE inhibitor fosinopril. Sixteen hypertensive patients with echocardiographically documented LV hypertrophy and diastolic dysfunction received fosinopril (10-20 mg daily). Measurements of LV myocardial mass and properties of diastolic filling (peak filling fraction (PFF); peak filling rate (PFR)) were performed prior to medication, as well as after 3 and 6 months of therapy using cine magnetic resonance imaging (MRI). Ten healthy subjects served as a control group. LV myocardial mass (g/m2) decreased continuously within 3-6 months of follow-up by 32% (148 +/- 40 vs. 120 +/- 26 vs. 101 +/- 22 g/m2; P < 0.0001/0.005). The extent of regression correlated to the severity of LV hypertrophy at baseline (r = 0.77; P < 0.004). Early diastolic filling increased significantly within 6 months of therapy (PFF (%): 36 +/- 6 vs. 61 +/- 7, P < 0.0001; PFR (mL/second): 211 +/- 48 vs. 282 +/- 48, P < 0.001). Cine MRI can be used to assess the time course of pharmacological effects on cardiac remodeling in the course of hypertension. ACE inhibitor therapy results in a significant reduction of LV mass within 3 months and is accompanied by a normalization of diastolic filling that is completed after 6 months.

Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany

The goals of this study were to describe demographic variables, drinking history, and the 6-month prevalence of Axis I comorbidity among alcohol-dependent subjects in GERMANY: The variables: amount of alcohol consumption, age at onset of the first alcohol consumed, age at onset of daily alcohol consumption, age at onset of withdrawal symptoms and number of detoxifications were related to the different comorbid disorders and gender. In this study, 556 patients from 25 alcohol treatment centres were enrolled between 1 January 1999 and 30 April 1999. After a minimum of 10 days of sobriety patients who fulfilled ICD-10 and DSM-IV criteria of alcohol dependence were interviewed for data collection using the Mini-DIPS (German version of the Anxiety Disorders Interview Schedule) and a standardized psychosocial interview. The 6-month prevalence of comorbid Axis I disorders was 53.1%. Among the patients with comorbidity, affective and anxiety disorders were most frequent. Comorbid stress disorder was associated with an early start of drinking, an early beginning of withdrawal symptoms, highest number of detoxifications, and the highest amount of alcohol consumed. Female patients with anxiety disorder consumed more alcohol and started earlier than females without this comorbid disorder. The data do not answer the question of the pathogenesis of comorbid disorders and alcoholism, but indicate that stress disorders in alcoholic patients and anxiety disorders in female alcoholics influence the course and severity of alcoholism.

Haloacetates in fog and rain

Atmospheric haloacetates can arise from photochemical degradation of halogenated hydrocarbons and from direct anthropogenic emissions. Furthermore, there is also evidence of natural sources although these are quantitatively uncertain. As haloacetates are highly soluble in water, hydrometeors are most significant for their deposition. Fogwater (96 samples) and rainwater samples (over 100 samples) were collected from July 1998 to March 1999 at an ecological research site in northeastern Bavaria, Germany. They were analyzed for monofluoroacetate (MFA), difluoroacetate (DFA), trifluoroacetate (TFA), monochloroacetate (MCA), dichloroacetate (DCA), trichloroacetate (TCA), monobromoacetate (MBA), and dibromoacetate (DBA). The major inorganic ions were also determined. High concentrations of up to 11 microg/L MCA, 5 microg/L DCA, 2 microg/L TCA, and 2 microg/L TFA were found in fogwater associated with westerly winds. Backward trajectories were calculated to determine the origin of the air masses. MBA and DBA have highest concentrations in fogwater advected with air originating from the Atlantic, suggesting the marine origin of these two compounds. All analyzed substances show higher average concentrations in fog than in rain. Estimates of the deposition of haloacetates suggest that the contribution of fog may be more important than rain for the total burden of a forest ecosystem.

Comparative study of composite resin placement: centripetal buildup versus incremental technique

An in vitro study was performed to evaluate the effect of two different proximal restoration techniques with different matrix systems on the marginal seal and microhardness of Class II composite restorations. Results indicated that the lowest, however, not significantly different, microleakage was achieved in totally bonded deep Class II restorations prepared with margins surrounded by enamel when using transparent matrices and reflective wedges in combination with the centripetal buildup technique. Highest surface hardness of composite resin was related to transparent matrices and reflecting wedges.

[Sensitive and rapid analysis of nitrophenols and herbicides by capillary zone electrophoresis (CZE)]

11 Nitrophenols and some acidic herbicides have been separated by modified CZE. Good separation of such compounds can be achieved in less than 10 min by simply modifying the run buffer with organic solvents such as methanol, acetonitrile in a concentration of 40% (V/V). The limits of detection (LODs) for nitrophenols by UV-absorption at 215 nm were 0.5 mg/L-1.1 mg/L. Solid phase extraction was used to preconcentrate nitrophenols and some herbicides to reach an LOD at microgram/L levels. Typical samples have been analyzed.

Induction of autoantibodies to the adrenal cortex and pancreatic islet cells by interferon alpha therapy for chronic hepatitis C

BACKGROUND/AIMS

Interferon alpha (IFN-alpha) therapy for chronic hepatitis C may trigger induction of autoimmunity against several organs. Immune reactions against distinct adrenocortical protein antigens involved in adrenal autoimmune disease have not been reported to date. Therefore, we investigated the development of highly sensitive and specific adrenal autoantibodies in patients with chronic hepatitis C in response to IFN-alpha treatment. In addition, we studied induction of pancreatic islet and thyroid autoantibodies.

PATIENTS/METHODS

Sera of 75 patients (42 males, 33 females; mean age 47 (13) years) were analysed before, during, and after IFN-alpha therapy (9-18x10(6) IE/week; mean duration 8.3 (3.5) months). Autoantibodies (Abs) to adrenal 21-hydroxylase (21OH-Abs), and to islet glutamic acid decarboxylase (GAD65-Abs) and protein tyrosine phosphatase (IA2-Abs) were determined by a radiobinding assay using (35)S labelled protein generated by an in vitro translation system. Thyroid antibodies were measured by a commercially available ELISA.

RESULTS

Thirteen of 75 patients were initially positive for some of the autoantibodies. During or after IFN-alpha therapy, 3/62 initially negative patients (4.8%) developed 21OH-Abs. GAD65-Abs or IA2-Abs appeared in 5/62 and 1/62 patients, respectively (9.7% in total). In 12/62 patients (19.4%), thyroid specific antibodies appeared. In none of the 21OH-Ab positive subjects was adrenal dysfunction observed, and no patient with islet autoantibodies developed diabetes mellitus or impaired glucose tolerance.

CONCLUSIONS

IFN-alpha induces 21OH-Abs in some cases, while islet and thyroid specific autoantibodies are more frequently found. However, our results indicate for the first time that the adrenal cortex also has to be considered as a potential target of IFN-alpha related autoimmunity.