Magnetic resonance classification of lumbar intervertebral disc degeneration

STUDY DESIGN

A reliability study was conducted.

OBJECTIVES

To develop a classification system for lumbar disc degeneration based on routine magnetic resonance imaging, to investigate the applicability of a simple algorithm, and to assess the reliability of this classification system.

SUMMARY OF BACKGROUND DATA

A standardized nomenclature in the assessment of disc abnormalities is a prerequisite for a comparison of data from different investigations. The reliability of the assessment has a crucial influence on the validity of the data. Grading systems of disc degeneration based on state of the art magnetic resonance imaging and corresponding reproducibility studies currently are sparse.

METHODS

A grading system for lumbar disc degeneration was developed on the basis of the literature. An algorithm to assess the grading was developed and optimized by reviewing lumbar magnetic resonance examinations. The reliability of the algorithm in depicting intervertebral disc alterations was tested on the magnetic resonance images of 300 lumbar intervertebral discs in 60 patients (33 men and 27 women) with a mean age of 40 years (range, 10-83 years). All scans were analyzed independently by three observers. Intra- and interobserver reliabilities were assessed by calculating kappa statistics.

RESULTS

There were 14 Grade I, 82 Grade II, 72 Grade III, 68 Grade IV, and 64 Grade V discs. The kappa coefficients for intra- and interobserver agreement were substantial to excellent: intraobserver (kappa range, 0.84-0.90) and interobserver (kappa range, 0.69-0.81). Complete agreement was obtained, on the average, in 83.8% of all the discs. A difference of one grade occurred in 15.9% and a difference of two or more grades in 1.3% of all the cases.

CONCLUSION

Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation.

Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging

Forty-one patients scheduled for shoulder surgery underwent computed tomography (CT) and magnetic resonance imaging (MRI) examination of their affected shoulder to verify whether fatty degeneration of the rotator cuff muscles could reproducibly be assessed by CT or by MRI and whether the grading with the 2 methods was comparable. In addition, rotator cuff muscle cross-sectional areas were measured on parasagittal MRI scans to establish a possible correlation between rotator cuff muscle atrophy and fatty degeneration. Interobserver reproducibility for grading fatty degeneration was good to excellent for CT and for MRI. The correlation between MRI and CT was fair to moderate and remained unsatisfactory, even if the classification system was simplified with only a 3- rather than a 5-grade scale as originally proposed. The degree of fatty degeneration was significantly related to the amount of atrophy of the respective muscles.

Cathelicidins: a novel protein family with a common proregion and a variable C-terminal antimicrobial domain

A novel protein family, showing a conserved proregion and a variable C-terminal antimicrobial domain, and named cathelicidin, has been identified in mammalian myeloid cells. The conserved proregion shows sequence similarity to members of the cystatin superfamily of cysteine proteinase inhibitors. Cathelicidins are stored in the cytoplasmic granules of neutrophil leukocytes and release the antimicrobial peptides upon leukocyte activation. Some of these peptides can assume an alpha-helical conformation, others contain one or two disulfide bonds, still others are Pro- and Arg-rich, or Trp-rich. In addition to bacterial killing, some of these peptides exert additional functions related to host defense such as LPS-neutralization and promotion of wound healing.

Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis

BACKGROUND

Hepatocellular carcinoma (HCC) is a major cause of death in cirrhotic patients. This neoplasm is associated with liver cirrhosis (LC) in more than 90% of cases. Early diagnosis and treatment of HCC are expected to improve survival of patients.

AIMS

To assess the cost effectiveness of a surveillance programme of patients with LC for the early diagnosis and treatment of HCC.

PATIENTS

A cohort of 313 Italian patients with LC were enrolled in the surveillance programme between March 1989 and November 1991. In the same period, 104 consecutive patients with incidentally detected HCC were referred to our centre and served as a control group.

METHODS

Surveillance was based on ultrasonography (US) and alpha fetoprotein (AFP) determinations repeated at six month intervals. Risk factors for HCC were assessed by multivariate analysis (Cox model). Outcome measures analysed were: (1) number and size of tumours; (2) eligibility for treatment; and (3) survival of patients. Economic issues were: (1) overall cost of surveillance programme; (2) cost per treatable HCC; and (3) cost per year of life saved (if any). Costs were assessed according to charges for procedures at our university hospital.

RESULTS

Surveillance lasted a mean of 56 (31) months (range 6-100). During the follow up, 61 patients (19.5%) developed HCC (unifocal at US in 49 cases), with an incidence of 4.1% per year of follow up. AFP, Child-Pugh classes B and C, and male sex were detected as independent risk factors for developing HCC. Only 42 (68.9%) of 61 liver tumours were treated by surgical resection, orthotopic liver transplantation, or local therapy. The cumulative survival rate of the 61 patients with liver tumours detected in the surveillance programme was significantly longer than that of controls (p=0.02) and multivariate analysis showed an association between surveillance and survival. The overall cost of the surveillance programme was US$753 226, the cost per treatable HCC was US$17 934, and the cost for year of life saved was US$112 993.

CONCLUSION

Our surveillance policy of patients with LC requires a large number of resources and offers little benefit in terms of patient survival. The decision whether to adopt a surveillance policy towards HCC should rely on the prevalence of the disease in the population and on the resources of a particular country.

Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings

PURPOSE

To correlate magnetic resonance (MR) images of a bone marrow edema pattern with histologic findings in osteoarthritic knees.

MATERIALS AND METHODS

Sixteen consecutive patients (age range, 43-79 years; mean, 67 years) referred for total knee replacement were examined with sagittal short inversion time inversion-recovery (STIR) and T1- and T2-weighted turbo spin-echo MR imaging 1-4 days before surgery. Tibial plateau abnormalities on MR images were compared quantitatively with those on histologic maps.

RESULTS

The bone marrow edema pattern zone (ill-defined and hyperintense on STIR images and hypointense on T1-weighted MR images) mainly consisted of normal tissue (53% of the area was fatty marrow, 16% was intact trabeculae, and 2% was blood vessels) and a smaller proportion of several abnormalities (bone marrow necrosis [11% of area], abnormal [necrotic or remodeled] trabeculae [8%], bone marrow fibrosis [4%], bone marrow edema [4%], and bone marrow bleeding [2%]). The bone marrow edema pattern zone and the zone with a normal MR imaging appearance differed significantly in the presence of bone marrow necrosis (P =.021), bone marrow fibrosis (P =.014), and abnormal trabeculae (P =.011) but not in the prevalence of bone marrow edema (P =.069). Bone marrow edema also was found in zones with an unremarkable MR appearance (perifocal zone, 5% edema; control zone, 2% edema).

CONCLUSION

A bone marrow edema pattern in osteoarthritic knees represents a number of noncharacteristic histologic abnormalities. Edema is not a major constituent of MR imaging signal intensity abnormalities in such knees.

Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging

RATIONALE AND OBJECTIVES

The purpose of this study was to establish a magnetic resonance (MR) imaging standard for quantification of the muscles of the rotator cuff.

METHODS

Parasagittal T1-weighted turbo spin-echo images of the shoulder were obtained in 70 asymptomatic subjects (35 women, 35 men; age range: 21-70 years, mean: 45 years). Standardized cross-sectional areas (rotator cuff muscle areas divided by the area of the supraspinatus fossa) and standardized signal intensities (related to signal intensities of the teres major muscle) were measured and compared with 30 patients with different stages of rotator cuff tears and 10 patients with glenohumeral instability. In addition, a so-called tangent sign was evaluated with the hypothesis that a healthy supraspinatus muscle crosses a line (tangent) drawn through the superior borders of the scapular spine and the superior margin of the coracoid.

RESULTS

Cross-sectional areas of the muscles of the rotator cuff were variable in asymptomatic subjects. Cross-sectional areas (but not signal intensities) did discriminate patients with different stages of rotator cuff tears from asymptomatic subjects. The tangent sign was negative in all asymptomatic subjects but positive in four and nine of 10 patients with medium and large rotator cuff tears, respectively.

CONCLUSIONS

A method for quantification of the muscles of the rotator cuff using MR imaging is presented. Cross-sectional areas can be used for quantification of the muscles of the rotator cuff. The tangent sign is a useful MR sign for atrophy of the supraspinatus muscle.

MR imaging and CT in osteoarthritis of the lumbar facet joints

OBJECTIVE

To test the agreement between MR imaging and CT in the assessment of osteoarthritis of the lumbar facet joints, and thus to provide data about the need for an additional CT scan in the presence of an MR examination.

DESIGN AND PATIENTS

Using a four-point scale, two musculoskeletal radiologists independently graded the severity of osteoarthritis of 308 lumbar facet joints on axial T2-weighted and on sagittal T1- and T2-weighted turbo-spin-echo images and separately on the corresponding axial CT scans. Kappa statistics and percentage agreement were calculated.

RESULTS

The weighted kappa coefficients for MR imaging versus CT were 0.61 and 0.49 for readers 1 and 2, respectively. The weighted kappa coefficients for interobserver agreement were 0.41 for MR imaging and 0.60 for CT, respectively. There was agreement within one grade between MR and CT images in 95% of cases for reader 1, and in 97% of cases for reader 2.

CONCLUSION

With regard to osteoarthritis of the lumbar facet joints there is moderate to good agreement between MR imaging and CT. When differences of one grade are disregarded agreement is even excellent. Therefore, in the presence of an MR examination CT is not required for the assessment of facet joint degeneration.

Identification of CRAMP, a cathelin-related antimicrobial peptide expressed in the embryonic and adult mouse

Cathelicidins are the precursors of potent antimicrobial peptides that have been identified in several mammalian species. Prior work has suggested that members of this gene family can participate in host defense through their antimicrobial effects and activate mesenchymal cells during wound repair. To permit further study of these proteins a reverse transcriptase-polymerase chain reaction approach was used to identify potential mouse homologs. A full-length 562-base pair cDNA clone was obtained encoding an NH2-terminal prepro domain homologous to other cathelicidins and a unique COOH-terminal peptide. This gene, named Cramp for cathelin-related antimicrobial peptide, was mapped to chromosome 9 at a region of conserved synteny to which genes for cathelicidins have been mapped in pig and man. Northern blot analysis detected a 1-kilobase transcript that was expressed in adult bone marrow and during embryogenesis as early as E12, the earliest stage of blood development. Reverse transcriptase-polymerase chain reaction also detected CRAMP expression in adult testis, spleen, stomach, and intestine but not in brain, liver, heart, or skeletal muscle. To evaluate further the expression and function of CRAMP, a peptide corresponding to the predicted COOH-terminal region was synthesized. CD spectral analysis showed that CRAMP will form an amphipathic alpha-helix similar to other antimicrobial peptides. Functional studies showed CRAMP to be a potent antibiotic against Gram-negative bacteria by inhibiting growth of a variety of bacterial strains (minimum inhibitory concentrations 0.5-8.0 microM) and by permeabilizing the inner membrane of Escherichia coli directly at 1 microM. Antiserum against CRAMP revealed abundant expression in myeloid precursors and neutrophils. Thus, CRAMP represents the first antibiotic peptide found in cells of myeloid lineage in the mouse. These data suggest that inflammatory cells in the mouse can use a nonoxidative mechanism for microbial killing and permit use of the mouse to study the role such peptides play in host defense and wound repair.

MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers

PURPOSE

To identify the magnetic resonance (MR) abnormalities of the lumbar spine that have a low prevalence in asymptomatic patients and thus determine the findings that are predictive of low back pain in symptomatic patients.

MATERIALS AND METHODS

Sagittal T1-weighted and sagittal and axial T2-weighted MR images were obtained in 60 asymptomatic volunteers aged 20-50 years. The MR images were evaluated with regard to intervertebral disk abnormalities, end plate abnormalities, and osteoarthritis of the facet joints by two musculoskeletal radiologists independently.

RESULTS

Disk bulging or disk protrusion was found in 42 (14%) and 48 (16%) of the intervertebral spaces in 37 (62%) and 40 (67%) subjects, respectively. High-signal-intensity zones were found commonly (in 23 [7.7%] and 25 [8.3%] of the intervertebral spaces in 19 (32%) and 20 (33%) subjects, respectively). Disk extrusions were less common (in 11 [3.7%] and 11 [3.7%] of the intervertebral spaces in 11 (18%) and 11 (18%) subjects, respectively). There were no disk sequestrations. A nerve root compression in a single intervertebral space was diagnosed by one reader. End plate abnormalities were found in two (0.7%) and six (1.9%) of the intervertebral spaces in two (3%) and six (10%) subjects, respectively. No severe osteoarthritis was diagnosed by either reader.

CONCLUSION

In patients younger than 50 years, disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints are rare and, therefore, may be predictive of low back pain in symptomatic patients.

Femoral trochlear dysplasia: MR findings

PURPOSE

To establish quantitative and qualitative magnetic resonance (MR) criteria for the diagnosis of trochlear dysplasia.

MATERIALS AND METHODS

MR images were analyzed in 16 consecutive patients with and 23 without trochlear dysplasia. The standard of reference was a true lateral radiograph of the knee. Quantitative and qualitative MR criteria were assessed.

RESULTS

In patients with trochlear dysplasia, the trochlear groove was significantly less deep than that in control subjects. The most accurate measurement was 3 cm above the femorotibial joint space (P: <.001), where a trochlear depth of 3 mm or less had a sensitivity of 100% and a specificity of 96%. The ventral trochlear prominence between the supratrochlear femoral cortex and the most ventral point of the trochlear floor (midsagittal section) was always larger than 6.9 mm in dysplastic trochleae. A facet ratio of less than 2:5 (medial to lateral) 3 cm above joint space level had a sensitivity of 100% and a specificity of 96%. A nipplelike anterior prominence at the superior end of the femoral trochlea on midsagittal images was a specific (91%) qualitative criterion.

CONCLUSION

Dysplasia of the femoral trochlea can be diagnosed reliably by using quantitative or qualitative criteria on midsagittal or transverse MR images obtained 3 cm above the femorotibial joint space.

Collagen VI deficiency induces early onset myopathy in the mouse: an animal model for Bethlem myopathy

To gain insight into the function of type VI collagen, the col6a1 gene was inactivated by targeted gene disruption in the mouse. The homozygous mutants lacked collagen VI in the tissues and showed histological features of myopathy such as fiber necrosis and phagocytosis and a pronounced variation in the fiber diameter. Muscles also showed signs of stimulated regeneration of fibers. Necrotic fibers were particularly frequent in the diaphragm at all ages examined. Similar, although milder, alterations were detected in heterozygous mutant mice, indicating haploinsufficiency of the col6a1 gene function. The data led us to conclude that collagen VI is necessary for maintenance of the integrity of muscle fibers and that the col6a1 -deficient mouse can be considered an animal model of Bethlem myopathy.

Structural features and biological activities of the cathelicidin-derived antimicrobial peptides

Cathelicidins are a numerous group of mammalian proteins that carry diverse antimicrobial peptides at the C-terminus of a highly conserved preproregion. These peptides, which become active when released from the proregion, display a remarkable variety of sizes, sequences, and structures, and in fact comprise representatives of all the structural groups in which the known antimicrobial peptides have been classified. Most of the cathelicidin-derived peptides exert a broad spectrum and potent antimicrobial activity and also bind to lipopolysaccharide and neutralize its effects. In addition, some of them have recently been shown to exert other activities and might participate in host defense also by virtue of their ability to induce expression of molecules involved in a variety of biological processes. This review is aimed at providing a general overview of the cathelicidins and of the peptides derived therefrom, with emphasis on aspects such as structure, biological activities in vitro and in vivo, and structure/activity relationship studies.

Painful Lumbar Disk Derangement: Relevance of Endplate Abnormalities at MR Imaging

PURPOSE

To investigate the predictive value of magnetic resonance (MR) imaging of abnormalities of the lumbar intervertebral disks, particularly with adjacent endplate changes, to predict symptomatic disk derangement, with discography as the standard.

MATERIALS AND METHODS

Fifty patients aged 28-50 years with chronic low back pain and without radicular leg pain underwent prospective clinical examination and sagittal T1- and T2-weighted and transverse T2-weighted MR imaging. Subsequently, patients underwent lumbar discography with a pain provocation test (116 disks). MR images were evaluated for disk degeneration, a high-signal-intensity zone, and endplate abnormalities. Results of pain provocation at discography were rated independently of the image findings as concordant or as nonconcordant or painless. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the clinical relevance of MR abnormalities.

RESULTS

Normal disks on MR images were generally not painful at provocative discography (NPV, 98%). Disk degeneration (sensitivity, 98%; specificity, 59%; PPV, 63%) and a high-signal-intensity zone (sensitivity, 27%; specificity, 85%; PPV, 56%) were not helpful in the identification of symptomatic disk derangement. When only moderate and severe type I and type II endplate abnormalities were considered abnormal, all injected disks caused concordant pain with provocation (sensitivity, 38%; specificity, 100%; PPV, 100%).

CONCLUSION

Moderate and severe endplate abnormalities appear be useful in the prediction of painful disk derangement in patients with symptomatic low back pain.

Biological characterization of two novel cathelicidin-derived peptides and identification of structural requirements for their antimicrobial and cell lytic activities

Cathelicidins are a family of myeloid antimicrobial peptide precursors that have been identified in several mammalian species (Zanetti, M., Gennaro, R., and Romeo, D. (1995) FEBS Lett. 374, 1-5). Two novel bovine congeners have been deduced from cDNA. Their C-terminal sequences of 27 and 28 residues correspond to putative antimicrobial peptides with a cationic N-terminal region predicted to assume an amphipathic alpha-helical conformation followed by a hydrophobic C-terminal tail. Peptides corresponding to these sequences have been chemically synthesized and shown to exert a potent antimicrobial activity against Gram-negative and Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus, and fungi. Both peptides are also cytotoxic to human erythrocytes and neutrophils, although at higher than microbicidal concentrations. The target selectivity has been improved by synthesizing truncated analogues, comprising only the 18 N-terminal residues, which show a great reduction in cytotoxic, but not in antimicrobial activity. The involvement of the C-terminal hydrophobic tail in the cytotoxic activity has been further demonstrated by inducing a major loss of activity in an analogue after replacing highly hydrophobic residues with more hydrophilic ones.

The cathelicidins--structure, function and evolution

The cathelicidin family of host defense peptides includes a group of cationic and usually amphipathic peptides that display a variety of activities related to host defense functions, among which the most acknowledged is a direct antimicrobial activity against various microbial pathogens. All members of this family are synthesized as precursors characterized by an N-terminal cathelin-like domain which is relatively well conserved also in evolutionary distant vertebrates. By contrast, the C-terminal region, which carries the active peptide, appears to be a focus for genetic mechanisms that have selectively generated a considerable sequence diversity. This process is particularly striking in Cetartiodactyls, where repeated gene duplication events and subsequent divergence have produced an array of distinct family members. The corresponding mature cathelicidin peptides are considerably diverse in length, amino acid sequence and structure, variously adopting alpha-helical, elongated or beta-hairpin conformations. The diverse nature of these peptides may account for distinct functions and for a diverse spectrum of activity and/or antimicrobial potency.

Cytotoxic T cell immunity against telomerase reverse transcriptase in humans

Telomerase is a ribonucleoprotein enzyme which has been linked to malignant transformation in human cells. Telomerase activity is increased in the vast majority of human tumors, making its gene product the first molecule common to all human tumors. The generation of endogenously processed telomerase peptides bound to Class I MHC molecules could therefore target cytotoxic T lymphocytes (CTL) to tumors of different origins. This could advance vaccine therapy against cancer provided that precursor CTL recognizing telomerase peptides in normal adults and cancer patients can be expanded through immunization. We demonstrate here that the majority of normal individuals and patients with prostate cancer immunized in vitro against two HLA-A2.1 restricted peptides from telomerase reverse transcriptase (hTRT) develop hTRT-specific CTL. This suggests the existence of precursor CTL for hTRT in the repertoire of normal individuals and in cancer patients. Most importantly, the CTL of cancer patients specifically lysed a variety of HLA-A2(+) cancer cell lines, demonstrating immunological recognition of endogenously processed hTRT peptides. Moreover, in vivo immunization of HLA-A2.1 transgenic mice generated a specific CTL response against both hTRT peptides. Based on the induction of CTL responses in vitro and in vivo, and the susceptibility to lysis of tumor cells of various origins by hTRT CTL, we suggest that hTRT could serve as a universal cancer vaccine for humans.

Subscapularis tendon tears: detection and grading at MR arthrography

PURPOSE

To assess diagnostic accuracy in the detection and grading of subscapularis tendon lesions at magnetic resonance (MR) arthrography.

MATERIALS AND METHODS

MR arthrograms in 50 consecutive patients (29 with normal subscapularis tendons, 11 with a lesion in the cranial quarter, seven with a major tear but not complete detachment, three with complete detachment) with arthroscopic or surgical confirmation were evaluated independently by two radiologists. Diagnosis was established on findings from transverse and/or parasagittal images.

RESULTS

With transverse images alone, sensitivity was 95%/100% (reader 1/reader 2); specificity was 55%/62%. With parasagittal images alone, sensitivity was 91%/91%; specificity was 76%/90%. With combined images, sensitivity was 91%/91%; specificity was 86%/79%. Interobserver agreement was substantial (kappa = 0.67). Forty-one of 50 (82%) grades for subscapularis abnormalities matched at MR imaging and surgery; nine mismatches differed by only one degree. Several signs were specific (90%-100%) but insensitive (29%-62%); these included leakage of contrast material onto the lesser tuberosity, fatty degeneration of the subscapularis muscle, and abnormality in the course of the long biceps tendon (luxation, subluxation).

CONCLUSION

MR arthrography is accurate in the detection and grading of subscapularis tendon lesions. Specificity of findings on transverse images for this diagnosis can be improved by including indirect signs and findings on parasagittal images.

SMAP-29: a potent antibacterial and antifungal peptide from sheep leukocytes

SMAP-29 is a cathelicidin-derived peptide deduced from sheep myeloid mRNA. The C-terminally amidated form of this peptide was chemically synthesized and shown to exert a potent antimicrobial activity. Antibiotic-resistant clinical isolates highly susceptible to this peptide include MRSA and VREF isolates, that are a major worldwide problem, and mucoid Pseudomonas aeruginosa associated with chronic respiratory inflammation in CF patients. In addition, SMAP-29 is also active against fungi, including Cryptococcus neoformans isolated from immunocompromised patients. SMAP-29 causes significant morphological alterations of the bacterial surfaces, as shown by scanning electron microscopy, and is also hemolytic against human, but not sheep erythrocytes. Its potent antimicrobial activity suggests that this peptide is an excellent candidate as a lead compound for the development of novel antiinfective agents.

Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging: predictors of low back pain-related medical consultation and work incapacity

STUDY DESIGN

Prospective study on individuals with asymptomatic lumbar disc abnormalities detected in magnetic resonance imaging.

OBJECTIVES

To determine the natural history of asymptomatic disc abnormalities in magnetic resonance imaging and to identify predictors of future low back pain-related medical consultation and work incapacity.

SUMMARY OF BACKGROUND DATA

The natural history of individuals with asymptomatic disc herniations has not been well established, but the high rate of lumbar disc alterations recently detected in asymptomatic individuals by magnetic resonance imaging demands reconsideration of a pathomorphology-based explanation of low back pain and sciatica.

METHODS

Forty-six asymptomatic individuals who had a high rate of disc herniations (73%) were observed for an average of 5 years (range, 54-72 months). Four classes of variables (medical data including magnetic resonance imaging-identified disc abnormalities, general psychological factors, physical job characteristics, and psychosocial aspects of work) were assessed at baseline and follow-up.

RESULTS

Disc herniations and neural compromise did not significantly worsen at follow-up, whereas disc degeneration progressed in 17 individuals (41.5%). Minor episodes of low back pain occurred in 19 individuals (41.3%), 6 of whom had to seek medical treatment and 5 of whom had to stop work temporarily. The requirement for low back pain-related medical consultation was predicted with high accuracy by listlessness, job satisfaction, and working in shifts (P < 0.001). Work incapacity was best predicted by physical job characteristics, job disaffection, and working in shifts (P < 0.01).

CONCLUSION

Physical job characteristics and psychological aspects of work were more powerful than magnetic resonance imaging-identified disc abnormalities in predicting the need for low back pain-related medical consultation and the resultant work incapacity. However,the conclusions are still preliminary, and replication of the findings in larger and more representative study samples is needed.

Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography

PURPOSE

To compare measurements of the sagittal diameter of the lumbar dural sac obtained at positional magnetic resonance (MR) imaging and at functional myelography and to assess the influence of various body positions on the dural sac and the intervertebral foramina.

MATERIALS AND METHODS

Thirty consecutive patients referred for lumbar myelography were examined with an open 0.5-T MR imager, Sagittal T2-weighted fast spin-echo images were acquired with patients in the supine, upright flexion, and upright extension positions. The midsagittal diameter of the dural sac was measured at the level of the disks on MR images and myelograms. Foraminal sizes on the MR images were scored independently by two observers.

RESULTS

Correlation between MR imaging and myelographic measurements was high (r = .81-.97). A small but statistically significant positional dependence of the dural sac diameter was found in the lower lumbar spine. Position-dependent differences in foraminal scores were uncommon.

CONCLUSION

Quantitative assessment of sagittal dural sac diameters is comparable between lumbar myelography and positional MR imaging. In a selected patient population, only small changes in the sagittal diameter of the dural sac and foraminal size can be expected between various body positions, and the information gained in addition to that from standard MR imaging is limited [corrected].

Two subpopulations of differentiated chondrocytes identified with a monoclonal antibody to keratan sulfate

We have prepared a monoclonal antibody, named MZ15, that specifically binds keratan sulfate. Immunofluorescence studies showed that the distribution of keratan sulfate in articular cartilage was not uniform: the amount of keratan sulfate increased with distance from the articular surface. Two subpopulations of chondrocytes could be distinguished after isolation from cartilage by the presence or absence of cell surface keratan sulfate. Keratan sulfate-negative chondrocytes were shown to come from the upper cartilage layers. There was therefore a direct correlation between biochemical heterogeneity of cartilage matrix and heterogeneity within the chondrocyte population. During growth in monolayer culture, superficial chondrocytes began to synthesize keratan sulfate, but the cells could still be distinguished from cultures of deep or unfractionated chondrocytes by their reduced substrate adhesiveness and tendency to remain rounded.

Event generator tunes obtained from underlying event and multiparton scattering measurements

New sets of parameters ("tunes") for the underlying-event (UE) modelling of the pythia8, pythia6 and herwig++ Monte Carlo event generators are constructed using different parton distribution functions. Combined fits to CMS UE proton-proton ([Formula: see text]) data at [Formula: see text] and to UE proton-antiproton ([Formula: see text]) data from the CDF experiment at lower [Formula: see text], are used to study the UE models and constrain their parameters, providing thereby improved predictions for proton-proton collisions at 13[Formula: see text]. In addition, it is investigated whether the values of the parameters obtained from fits to UE observables are consistent with the values determined from fitting observables sensitive to double-parton scattering processes. Finally, comparisons are presented of the UE tunes to "minimum bias" (MB) events, multijet, and Drell-Yan ([Formula: see text] lepton-antilepton+jets) observables at 7 and 8[Formula: see text], as well as predictions for MB and UE observables at 13[Formula: see text].

Bactenecins, defense polypeptides of bovine neutrophils, are generated from precursor molecules stored in the large granules

Bactenecins are highly cationic polypeptides of bovine neutrophil granules and exert in vitro a potent antimicrobial activity. We have previously purified two bactenecins, designated in an abbreviated form Bac7 and Bac5 from their approximate molecular masses of 7 and 5 kD (Gennaro, R., B. Skerlavaj, and D. Romeo. 1989. Infect. Immun. 57:3142-3146). Here we have studied the biosynthesis, processing, and localization of precursors of Bac7 and Bac5 in bovine bone marrow cells of the myeloid lineage. In vitro translation directed by mRNA isolated from these cells has shown that the primary translation products are preprobactenecins of 23.5 and 21 kD, and are processed to polypeptides of 20 and 15.8 kD, respectively. The 20-kD polypeptide is the granule storage form of Bac7, or proBac7, as also demonstrated by Western blot analysis of lysates of peripheral neutrophils. Between 15 and 50 min from the beginning of its biosynthesis the 15.8-kD polypeptide is converted into the 15-kD granule storage form of Bac5, or proBac5. As shown by immunogold EM, proBac7 and proBac5 are sorted and targeted to the matrix of the so called large granules, which are the predominant organelles in the cytoplasm of bovine neutrophils and are the exclusive store of the nonoxidative antimicrobial system of these cells. Solubilization of granules with Triton X-100 with concomitant unmasking of proteases leads to cleavage of the proforms to Bac7 and Bac5. Experiments performed with protease inhibitors suggest that the proteolytic cleavage is catalyzed in detergent-solubilized neutrophils by neutral serine protease(s), very likely derived from the azurophil granules.