Correlation of local impedance, global impedance and contact force with resulting lesion size in RF ablation

Funding Acknowledgements

Type of funding sources: None.

Background

During clinical application of RF-energy, several parameters are constantly observed, e.g. RF time, power, global impedance and temperature. The new parameter "local impedance" is gaining importance and might be a possible real-time marker for predicting long-lasting RF-lesions and increasing safety. The aim of this study was to investigate the correlation between local and global impedance as well as RF power and contact force.

Methods

RF-lesions were created using an ex vivo model with porcine cardiac preparations. These were put in a saline-filled container with a dispersive electrode. Global impedance was held at 120 Ohm by adjusting saline and water. Additionally, a heated thermostat and a circulation pump were installed to imitate blood flow. RF-lesions were produced with different settings of energy and contact force (20, 30, 40 and 50 watts; contact force of 0-5g, 10-15g and 20-25g). While creating the lesions, global and local impedance, temperature, energy and RF time were documented, as well as the current lesion width and depth. Local and global impedance drops were calculated as the difference between baseline impedance and current impedance.

Results

In total, 1223 measurements were made during application of RF-energy. 6 steam pops occurred. Contact force, local and global impedance changes showed highly significant correlations with lesion depth and diameter. Amongst analyzed values, local impedance drop showed highest correlation with lesion diameter and depth (r = 0,391 and 0,613; p<0,001). Visualized in Figure 1 and 2, global and local impedance correlate with lesion diameter and depth.

Discussion

Local impedance was found to be a suitable real-time marker for lesion size, showing significantly higher correlations with RF lesion size than contact force and global impedance. Further investigation is necessary to find a cut off for a safe but long-lasting RF-lesion.

Electrode tissue coupling is a new main determinant of RF lesion creation, experience from a cardiac animal model

Funding Acknowledgements

Type of funding sources: None.

Background

Radiofrequency (RF) current is a classic ablation technology used in the EP lab. By now it is assumed that RF lesion size is mainly determined by RF power, duration and contact force. This ex vivo animal model study shows that a new parameter - "electrode tissue coupling" (ETC) - plays an additional major role in RF lesion creation. The ETC level describes the amount of electric contact between the RF electrode and cardiac tissue: In minor ETC levels, only the distal electrode connects to tissue. In full ETC levels, the whole RF electrode is embedded in cardiac tissue.

Methods

RF-lesions were created using an ex vivo porcine cardiac model. The experimental setup consisted of a saline-filled container, a dispersive electrode, a heated thermostat and a circulation pump to imitate in vivo conditions. Global impedance was kept at 120 Ohm as well as the temperature at 37°C. RF-lesions were created using identic values of RF duration and contact force. A RF power of 20W, 30W, 40W, and 50W was used. The ETC levels were systematically varied between minor and full coupling. All parameters (power, temperature, global and local impedance, contact force, ETC, lesion size) were measured constantly during application of RF-current, enabling real-time correlation of RF parameters and lesion size.

Results

In total, 1923 measurements during application of RF-current were analyzed. In ETC III (full tissue coupling), lesions became significantly wider and deeper. In 20W ablations, lesion diameters were significantly (1.68 fold) larger when applying ETC III instead of ETC I. This relation was found in variations of RF parameters (Table 1).

Interestingly, baseline local impedance and local impedance drop showed a high correlation with selected ETC levels. The average baseline local impedance in ETC I was 207.2 Ohm, compared to 267.3 Ohm in ETC III (p < 0.01).

Discussion

In addition to by now known parameters (power, duration, contact force), electrode tissue coupling is a main determinant of lesion size. Higher ETC levels result in higher amounts of RF current going into adjacent tissue instead of current dissipation into the blood pool. In clinical practice, the ETC level can be predicted by baseline local and global impedance. Observation of these parameters should become clinical practice during RF ablation.

Safety of high power and short duration ablation (70 watts over 5–7 seconds) in patients with persistent atrial fibrillation undergoing pulmonary vein isolation and additional substrate modification

Background

In paroxysmal atrial fibrillation (AF), pulmonary vein isolation using HPSD has shown a promising success rate compared to ablation using conventional power settings, as well as a significant reduction in procedural and ablation time. In persistent atrial fibrillation, left atrial substrate modification seems to be a promising additional ablation approach besides pulmonary vein isolation (PVI). However, results after additional substrate ablation are not consistently positive, which may be related to non-transmural lesions and tissue oedema. An extended time of the procedure may also influence safety. Recent publications showed that HPSD ablation provides more sufficient lesions due to acute cell necrosis instead of cell oedema.

Purpose

The aim of this study is to evaluate the safety of HPSD ablation in patients undergoing ablation of persistent atrial fibrillation with PVI and additional substrate modification.

Methods

We studied and compared n=300 patients from our register undergoing the first ablation of persistent atrial fibrillation with HPSD settings (n=150) between May 2018 and January 2019 and standard settings (n=150) between July 2017 and January 2018. Patients were followed up for three months to report procedure-related adverse events. In all patients, a modified stepwise approach using PVI followed by electrogram-guided substrate modification and linear-ablation, if necessary, was performed. A HPSD ablation was performed with 70 watts with a maximum duration of 5–7 seconds. Catheter irrigation was set to 20 ml/min using the Flexability™ ablation catheter and the Ampere™ generator. The patients were compared with a historical cohort that underwent PVI using a conventional power protocol with 30–40 watts over 20–40 seconds, using the same ablation catheter. A transthoracic echocardiogram was performed in all patients after the ablation-procedure and on the following day. Duplex sonography or clinical control were performed to assess groin complications.

Results

Baseline characteristics and procedural data are shown in table 1. No significant difference in the complication rates in both groups was observed by a significant procedure-time reduction in HPSD-Group (2:13h vs 2:31h p<0,001) and overall low risk of the procedure. No deaths, thromboembolic complications or atrioesophageal fistula were registered. Complication rates with statistical relevancy are shown in table 2.

Conclusion

Complex ablation using PVI and additional substrate modification in persistent atrial fibrillation using HPSD seems to be equally as safe regarding procedure-related outcomes as standard power settings ablation and can significantly reduce the time of the overall procedure.

Funding Acknowledgement

Type of funding sources: None.

Risk factors for mortality among patients with Pseudomonas aeruginosa bacteraemia: a retrospective multicentre study

This study aimed to evaluate risk factors for 30-day mortality among hospitalised patients with Pseudomonas aeruginosa bacteraemia, a highly fatal condition. A retrospective study was conducted between 1 January 2009 and 31 October 2015 in 25 centres (9 countries) including 2396 patients. Univariable and multivariable analyses of risk factors were conducted for the entire cohort and for patients surviving ≥48 h. A propensity score for predictors of appropriate empirical therapy was introduced into the analysis. Of the 2396 patients, 636 (26.5%) died within 30 days. Significant predictors (odds ratio and 95% confidence interval) of mortality in the multivariable analysis included patient-related factors: age (1.02, 1.01-1.03); female sex (1.34, 1.03-1.77); bedridden functional capacity (1.99, 1.24-3.21); recent hospitalisation (1.43, 1.07-1.92); concomitant corticosteroids (1.33, 1.02-1.73); and Charlson comorbidity index (1.05, 1.01-1.93). Infection-related factors were multidrug-resistant Pseudomonas (1.52, 1.15-2.1), non-urinary source (2.44, 1.54-3.85) and Sequential Organ Failure Assessment (SOFA) score (1.27, 1.18-1.36). Inappropriate empirical therapy was not associated with increased mortality (0.81, 0.49-1.33). Among 2135 patients surviving ≥48 h, hospital-acquired infection (1.59, 1.21-2.09), baseline endotracheal tube (1.63, 1.13-2.36) and ICU admission (1.53, 1.02-2.28) were additional risk factors. Risk factors for mortality among patients with P. aeruginosa were mostly irreversible. Early appropriate empirical therapy was not associated with reduced mortality. Further research should be conducted to explore subgroups that may not benefit from broad-spectrum antipseudomonal empirical therapy. Efforts should focus on prevention of infection, mainly hospital-acquired infection and multidrug-resistant pseudomonal infection.

Urethroplasty performed with an autologous urothelium-vegetated collagen fleece to treat urethral stricture in the minipig model

INTRODUCTION AND OBJECTIVE

Tissue-engineered materials in urethral reconstructive surgeries are a promising field for innovative therapy. Collagen matrices increase stability of cell-based implants and can promote viability and proliferation of urothelial cells. In this study, a collagen type I-based cell carrier (CCC) with stratified multi-layer autologous urothelium was used for urethroplasty after induction of urethral stricture in eight minipigs.

MATERIALS AND METHODS

Minipigs underwent surgical procedures to induce urethral stricture by thermocoagulation. Simultaneously, bladder tissue was harvested. Urothelial cells were expanded, labeled with PKH26 and seeded onto CCC in high density. 3 weeks after strictures were induced and verified by urethrography, minipigs underwent urethroplasty using the seeded CCC. Two animals were euthanized after 1, 2, 4, and 24 weeks. Urethras were histologically examined for integration and survival of seeded CCC. In vivo phenotype of multi-layered urothelium matrix constructs was characterized via immunofluorescence staining with pancytokeratin, CK20, p63, E-cadherin and ZO-1.

RESULTS

Seeded CCCs showed excellent stability and suturability after manipulation and application. Transplanted cells were detected using positive PKH26 fluorescence up to 6 months after labeling. Urothelium matrix implants integrated well into the host tissue without sign of inflammation. Animals showed no sign of rejection or stricture recurrence (urethrography) at any time during experimental period. Immunofluorescence analysis confirmed epithelial phenotype, junction formation and differentiation after 2 weeks.

CONCLUSION

CCC can be suitable for urologic reconstructive surgeries and represents a promising option for clinical application. Longer follow-up results are required to exclude re-occurrence of stricture reformation.

THE STRUCTURE AND DIFFERENTIATION OF THE SPECIFIC CELLULAR ELEMENTS OF THE PARS INTERMEDIA OF THE HYPOPHYSIS OF THE DOMESTIC PIG

The bearing of these results on the Herring-Cushing theory of pituitary secretion is apparent. For the first time a true secretion antecedent has been demonstrated in the cells of the pars intermedia, an antecedent which appears in the cells at the same period of development at which active pressor effects may be obtained from the gland extracts. The route of export of this material from the gland to its point of utilization, however, is unknown; it may go by way of the blood or, as required by the Herring theory, by the transneural route to the third ventricle. The objections to the latter conclusion have been amply expanded in the introduction to this paper, but here may be emphasized the fact that the fetal pig hypophysis contains no hyaline bodies. Indeed they are rare in the adult, though there may be seen in the cells of the pars nervosa in the processes of its intrinsic cells, granular deposits which we believe to be the antecedents of the hyaline bodies but which in the pig rarely are discharged and aggregated into discrete masses as in other mammals. The fact that some observers have obtained positive pressor effects from the nervous part of the posterior lobe, exclusive of the pars intermedia, need not weigh very heavily in attempting to trace the course of the secretion, when we reflect that the difficulties of making such a mechanical separation are almost insuperable, and that the chemical product of the pars intermedia is so soluble and vanishes from the cells so rapidly that it may well be diffusible through the thin membranes which intervene and penetrate post mortem into adjacent parts. We are inclined, therefore, to the view that the secretion leaves the gland by the vascular route rather than by way of the interfibrillar spaces of the pars nervosa.

„Tissue engineering“ und Stammzellforschung in der Urologie für den rekonstruktiven bzw. regenerativen Therapieansatz

With the involvement of clinical reconstructive urology in the field of tissue engineering, outstanding results have been achieved in basic research as well as in some clinics. Stem cell research has even opened up possibilities for regenerative aspects. In close cooperation with various disciplines, the Department of Urology at the University of Tübingen investigates different clinical aspects with regard to reconstructive and regenerative urology. The regeneration of the external urethral sphincter requires functionally integrated muscle cells. In addition stricture reconstruction with multilayer urothelium should become less invasive and the re-stricture rate reduced. After the application of differentiating stem cells was proven, the clinical setting needed to be set for legal issues. In addition to the specification of culture media and verification in the animal model, the possibility to harvest omnipotent stem cells out of human testis and to differentiate those into the three germ layers was demonstrated. With the reduced invasiveness of harvesting the urothelium cells by a bladder wash using specific culture fluids, the cell culture was significantly improved enabling successful creation of urothelium by stratification. In addition urothelial cells in a matrix are further improved for endoscopic application. The close cooperation of different disciplines shortens the time to develop therapeutic approaches with a close clinical relationship in reconstructive and regenerative urology.

In vitro stratifiziertes Urothelium und seine Bedeutung für die rekonstruktive Urologie

There are two main objectives regarding tissue engineering in reconstructive urology: (1) to provide the surgeon with autologous tissue for urogenital reconstructive purposes and (2) to create the framework for experimental investigations to better understand the structure and function of the tissues involved. In the last years urothelial cell culture has become a routine laboratory technique. There is sufficient cellular output after isolation and propagation to seed cells as single cell suspensions on biodegradable matrices for the construction of cell-matrix implants. In recent publications attention was directed toward using established primary cell cultures for in vitro stratification of multilayered urothelial sheets. Urothelial sheets have been used quite successfully for covering acellular matrices for bladder augmentation in dog and minipig models. However, up to now there has been no clinical application in humans of urothelial sheets generated in vitro. Here we review facts about the different strategies for generating multilayered urothelial sheets.

The effect of alendronate (Fosamax) and implant surface on bone integration and remodeling in a canine model

Patients at high risk for osteoporosis and its associated morbidity, including postmenopausal women, are being pharmacologically managed to stabilize and improve bone mass. Alendronate sodium (Fosamax) is a commonly used antiresorptive agent effective in osteopenic women for reducing bone resorption, increasing bone density, and decreasing fracture incidence. With the increased incidence of alendronate-treated women who are undergoing hip replacement or fracture repair by prosthesis placement, data are needed to predict how alendronate affects host bone integration with uncemented surfaces. The aim of this study was to determine the effect of alendronate on new bone formation and attachment to implant surfaces in a normal and simulated estrogen-deficient, calcium-deficient canine model, using an implantable bone growth chamber. Alendronate did not affect host bone integration to surfaces commonly used in uncemented total joint arthroplasty, but there were significant differences dependent solely on the type of surface.

Improved measurement of (3)J(H(alpha)(i),N(i+1)) coupling constants in H(2)O dissolved proteins

A modification to the recently proposed alpha/beta-HN(CO)CA-J TROSY pulse sequence (P. Permi et al., J. Magn. Reson. 146, 255-259 (2000)) makes it possible to determine (3)J(H(alpha)(i), N(i+1)) coupling constants from a single E.COSY-type cross-peak pattern rather than from two (1)H(alpha) spin-state-edited subspectra. Advantages are increased (15)N resolution, critical to extracting accurate (1)H(alpha)-(15)N coupling constants, and minimized differential relaxation due to nested (13)C(alpha) and (15)N evolution periods. Application of the improved pulse sequence to Desulfovibrio vulgaris flavodoxin results in (3)J(H(alpha)(i), N(i+1)) values being systematically larger than those obtained with the original scheme. Parametrization of the coupling dependence on the protein backbone torsion angle psi yields the Karplus relation (3)J(H(alpha)(i), N(i+1))=-1.00 cos(2)(psi-120 degrees )+0.65 cos(psi-120 degrees )-0.15 Hz, with a residual root-mean-square difference of 0.13 Hz between measured and back-calculated coupling constants. The curve compares with data derived from ubiquitin (A. C. Wang and A. Bax, J. Am. Chem. Soc. 117, 1810-1813 (1995)), although spanning a slightly larger range of J values in flavodoxin. The orientation of the Ala39/Ser40 peptide link, forming a type-II beta-turn in flavodoxin, is twisted against X-ray-derived torsions by approximately 10 degrees in the NMR structure as evident from the analysis of straight phi- and psi-related (3)J coupling constants. The remaining deviation of some experimental values from the prediction is likely to be due to strong hydrogen bonding, substituent effects, or the additional dependence on the adjacent torsions straight phi.

Use of a serially layered, double connective tissue graft approach to enhance maxillary anterior esthetics

The demands of current periodontal practice require that clinicians use varied approaches to resolve poor esthetic appearances. In particular, patients are becoming less and less accepting of exposed roots and lost interdental papillae, especially in the maxillary anterior sextant. This report describes a surgical technique that combines the advantages of a root-coverage procedure using subepithelial connective tissue grafts and an incision design that preserves interdental papillae, coupled with the use of enamel matrix derivative (Emdogain) to maximize the regenerative potential.

Width of keratinized tissue after gingivoplasty of healed subepithelial connective tissue grafts

BACKGROUND

The subepithelial connective tissue graft has markedly broadened clinicians' abilities to treat gingival recession. Frequently, however, bulky soft tissue contours are sequelae of this procedure, and post-healing gingivoplasty is often performed to improve esthetics of the grafted site. As a secondary benefit, it is believed that the zone of keratinized tissue is additionally increased after gingivoplasty.

METHODS

To further investigate this clinical impression, 16 bilateral pairs of sites with recession in 6 consecutive patients (mean age = 38 +/- 9 years) were studied. At the time of initial grafting, one site in each pair was randomly assigned to receive either gingivoplasty 2 months later (GP+) or no further treatment (GP-). Clinical measurement of recession and keratinized tissue width was standardized using customized acrylic stents and Schiller iodine solution, which stains epithelia; values were recorded at baseline (day of graft) and at 2, 3, and 5 months after grafting. Mean clinical gingival widths over time between GP+ and GP- sites, as well as within GP+ sites, were analyzed by t test.

RESULTS

At 5 months, both the GP+ and GP- sites demonstrated a mean root coverage of 87.4% and increased keratinized tissue width (1.2 mm) when compared to their respective baseline measures. No differences in recession depth and width of keratinized tissue were seen at 5 months between the GP+ and GP- groups. In addition, no differences in recession or gingival width were found between 2- and 5-month observations for either the GP+ or GP- groups.

CONCLUSIONS

These data suggest that the observed clinical improvements are the outcome of the initial graft surgery and that the gingivoplasty procedure does not result in additional (or "rebound") increases in keratinized tissue width.

Overexpression of PHGPx inhibits hydroperoxide-induced oxidation, NFkappaB activation and apoptosis and affects oxLDL-mediated proliferation of rabbit aortic smooth muscle cells

Rabbit abdominal aortic smooth muscle cells (SMC) were stably transfected with the cDNA of porcine phospholipid hydroperoxide glutathione peroxidase (PHGPx) by means of a retroviral gene transfer technique, to create a model for studying cellular processes relevant to atherogenesis. The transfected cells (SMC/PHGPx) had approximately 4-fold higher PHGPx activity when cultured in the presence of selenite whereas the parental cells did not show any significant increase in PHGPx or total GPx activity upon selenium supplementation. In situ functionality of PHGPx was validated by inhibition of linoleic acid hydroperoxide-induced toxicity, dihydrorhodamine oxidation, NFkappaB activation and apoptosis. SMC grown in 1% FCS responded to oxidized LDL (oxLDL) with a marked proliferation, as measured by [3H]thymidine incorporation, irrespective of selenium supplementation. In SMC/PHGPx grown with or without selenite under control conditions or exposed to native LDL, thymidine incorporation was generally depressed. Also, oxLDL-induced proliferation was lower in SMC/PHGPx compared to untransfected SMC up to 24 h of incubation. After 40 h, however, selenite supplementation restored maximum proliferation response to oxLDL in SMC/PHGPx. The results suggest a proliferative effect of endogenous hydroperoxides in SMC. They further reveal that hydroperoxy lipids of oxLDL contribute to the induction of proliferation, but also suggest involvement of hydroxy lipids in the response to oxLDL.

Visible and microscopic injury in leaves of five deciduous tree species related to current critical ozone levels

Because the current critical level of ozone (O(3)) for forest trees is based only on one species, the responses of five deciduous tree species were differentiated in a climate chamber experiment. The number of symptomatic leaves per tree was significantly increased, and stomatal conductance was decreased under 50% ambient+30 nl l(-1) O(3) as compared to 'normal' senescence at 50% ambient [O(3)]. Species with a high stomatal conductance did not show earlier or more leaf injury symptoms. The additional 30 nl l(-1) O(3) induced specific pectinaceous cell wall protrusions, phenolic cell wall incrustations, tonoplast vesicles, and inhomogeneous, condensed/precipitated phenolic material in the vacuoles. Due to added O(3), cell senescence was accelerated with increased electron-density of the cytoplasm, and initial chloroplast degeneration. The slow degeneration process started in mesophyll cells, and expanded into epidermal and finally guard cells. Because of the large variance in biomass between individuals and species, the current critical level is supported by the assessment of visible leaf symptoms rather than growth reduction.

Postpartum curettage in patients with HELLP-syndrome does not result in accelerated recovery

OBJECTIVE

Our purpose was to examine the impact of immediate postpartum curettage on the recovery of patients with HELLP-syndrome (hemolysis, elevated liver enzymes, and low platelets).

SUBJECTS

Between January 1994 and July 1997 all patients who presented with HELLP-syndrome in our institution underwent immediate postpartum curettage (n=24). Their outcome was compared with the recovery of women with HELLP-syndrome who were delivered without postpartum curettage between 1987 and 1993 (n=20). Clinical and laboratory data were analyzed.

RESULTS

No significant difference could be found between both groups in terms of normalization of serum glutamic-oxaloacetic transaminase (GOT), serum glutamic-pyruvic transaminase (GPT), lactic dehydrogenase (LDH), and quantitative platelet count. Postpartum hospitalization time was identical in both groups.

CONCLUSION

In our retrospective study no benefit is achieved by immediate postpartum curettage in patients with HELLP-syndrome. In order to eliminate the possible bias of retrospective analysis, we now plan a randomized study to further investigate the impact of immediate postpartum curettage.

Cytoprotection against lipid hydroperoxides correlates with increased glutathione peroxidase activities, but not selenium uptake from different selenocompounds

Cells cultivated under standard conditions were highly deficient in tocopherol, selenium, and glutathione peroxidase (GPx) activities. We investigated whether and to what extent the addition of different selenocompounds to growth media would alter biochemical, physiological, and pathophysiological parameters of cultured liver cells. Cellular uptake of selenium, GPx activities, and cytoprotection were measured and compared in human hepatoma cells (HepG2). Selenite and selenocystine were Se donors of high bioavailability (i.e., with these culture supplements, the increased Se uptake, induction of GPx isoenzymes, and protection of treated cells from lipid hydroperoxides were well correlated). In contrast, selenium from selenomethionine was incorporated into cellular proteins but had no effect on GPx activities or cytoprotection. The data show that not all selenium donors provide selenium, which is bioactivated to act as antioxidant. Thus, cellular selenium content, in general, did not correlate with cytoprotective activity of this trace element. However, cellular GPx activities at different times, with different concentrations, and with different Se donors always correlated with protection from lipid hydroperoxides and may, thus, represent a more reliable parameter to define adequate Se supply.

[Value of electrotherapy within the scope of conservative treatment of anorectal incontinence]

The following study reports on transanal electric stimulation as a conservative method of treatment in anal incontinence. In the centre of interest are clinical examinations on 45 patients that underwent a combined treatment with the IT-system 100 from Reha-Medi and pelvic floor training. A collective of 29 patients only treated with pelvic floor training was used as a control group. The results were based on a thorough medical history ascertainment and the corresponding clinical examinations at the beginning and end of the treatment. Our findings were classified according to the modified score of incontinence of Holschneider [16]. After therapy 42.2% of patients with electric stimulation therapy and 27.6% of the control group showed continence. 40 respectively 62.1% were non responder without relevant benefit. In the electric stimulation group the median score before and after therapy amounted to 6.57 versus 9.24 points. The control group achieved 6.72 respectively 8.58 points. The differences are statistically significant (p < 0.05, Student t-test). Concerning the results in relation to the cause of the incontinence, no significant differences between idiopathic and traumatic origin of the insufficiency of the sphincter mechanism are found in both groups. Therefore all variations of anorectal incontinence are seen as indication for treatment. The international literature as well as our own results confirm that electric stimulation is effective and may be in special cases a major factor in the conservative treatment of anorectal incontinence.

Attempt to differentiate between individual glutathione peroxidases in biological samples

Routine determinations of glutathione peroxidases (GPx) still suffer from poor standardization and usually from lack of specification. The different types of glutathione peroxidases present in cellular homogenates may be differentially estimated by their distinct substrate specificities. Complex lipid hydroperoxides required for this approach, however, are not generally available nor easily standardized due to their molecular heterogeneity and tendency to form micelles. We therefore developed a simple procedure for the differential estimation of the major cellular types of GPx, the cytosolic GPx (cGPx) and the phospholipid hydroperoxide glutathione peroxidase (PHGPx) taking advantage of the peculiar susceptibility of PHGPx to deoxycholate. It proved to reliably determine the activities of both purified cGPx and PHGPx, in mixtures thereof, and in homogenates of tissue samples (e.g., testes), and some (e.g. ECV 304) but not all (e.g. THP-1) cultured cell lines. The method allows the differential estimation of cGPx and PHGPx, if the samples do not contain further types of GPx.

Interleukin-1-induced nuclear factor kappa B activation is inhibited by overexpression of phospholipid hydroperoxide glutathione peroxidase in a human endothelial cell line

Oxygen radicals are commonly accepted mediators in the tumour necrosis factor-mediated nuclear factor kappa B (NF kappa B) signalling cascade, but evidence for their role during interleukin-1 (IL-1) signalling is lacking. To test the involvement of hydroperoxides we investigated whether IL-1-induced NF kappa B activation could be influenced by glutathione peroxidases (GPx). These enzymes remove hydroperoxides with various specificities for the hydroperoxide substrate. By overexpressing phospholipid hydroperoxide glutathione peroxidase (PHGPx), which characteristically reacts with lipophilic hydroperoxides, the roles of H2O2 and lipid hydroperoxides were assessed. A human umbilical endothelial cell line, ECV 304, was stably transfected with the genes for both PHGPx and selenophosphate synthetase (selD), which provides selenophosphate for selenoprotein biosynthesis. When grown in selenium-deficient culture medium, the double-transfected clone (ECVPHGPx+SelD+) expressed 5-fold higher (P<0.005) PHGPx activity (measured by phosphatidylcholine hydroperoxide removal) than controls. The rate of H2O2 removal was also significantly (P<0.01) higher in this clone. When grown with high levels of extracellular selenium (up to 100 nM selenite), PHGPx activity and H2O2 removal were enhanced substantially in control cells and transfected cells. Under these conditions, PHGPx activity was 1.7-fold (P<0.005) higher in ECVPHGPx+SelD+, but H2O2 removal was the same as in controls. IL-1-induced NF kappa B activation was inhibited by selenium supplementation in control cells. In ECVPHGPx+SelD+ under conditions of selenium restriction, IL-1 induced NF kappa B activation only to a similar extent as under conditions of selenium supplementation in controls, and activation was abolished with 50 nM sodium selenite. These results show that overexpressed PHGPx is sufficient to inhibit NF kappa B activation, and suggests that NF kappa B activation by IL-1 is mediated by a preferential substrate of PHGPx, such as a fatty acid hydroperoxide, rather than by H2O2, the preferred substrate of the more abundant cytosolic GPx.

Effect of fertilization on ozone-induced changes in the metabolism of birch (Betula pendula) leaves

Cloned cuttings of Betula pendula Roth were grown in field fumigation chambers at Birmensdorf throughout one growing season in filtered air with either < 3 (control) or 90/40 nl l^-1 O₃ (day/night; ozone generated from pure oxygen). Each ozone regime was split into high and low soil nutrient regimes by watering plants with either a 0.05 % or a 0.005% solution of a fertilizer which contained macronutrients and micronutrients. Fertilization had a strong effect on plant growth, enzyme activities and the expression of ozone-induced effects at the biochemical level. The activities of PEPC and Rubisco were enhanced about threefold in the plants with high fertilization (HF). Significant effects of ozone were in most cases found only in the older leaves of the plants with low fertilization (LF), There, sucrose, glucose and fructose levels were enhanced. In both fertilization treatments, the number of starch granules along the minor veins was increased. These ozone effects point to a decreased or inhibited phloem loading. The increased PEPC activity and the enhanced malate levels in the ozone-exposed plants might be the result of a redirection of carbon flow from sucrose synthesis and translocation towards anapleurotic processes, which can feed detoxification and repair of ozone injury as indicated by enhanced respiration. These findings agree well with the observed effects of ozone in lowering the root: shoot biomass ratio. Although there was a marked reduction in the O₃ /LF plants, O₃ /HF plants showed no significant response. Inositol was decreased under ozone exposure in both fertilizer treatments, contrasting with the pattern for carbohydrates. These results demonstrate the role of fertilization as an important modifier of ozone-induced effects at the plant biochemical level. Well fertilized plants appear to cope better with the impact of ozone on metabolism.

Determinants of PHGPx expression in a cultured endothelial cell line

Selenoprotein biosynthesis may not only be affected by the availability of selenium and the transcription rate of pertinent genes but also by the activity of components of the selenocysteine incorporation complex, SelA, B, C, or D. Incorporation of selenocysteine into selenoproteins requires a complex co-translational mechanism guaranteeing the correct recoding of the termination codon TGA as selenocysteine codon. A particular tRNA(Ser)(Sec) is enzymatically transformed by selenophosphate into tRNA(Sec) which recognizes the UGA codon by means of a specific elongation factor (SelB) and a peculiar mRNA secondary structure. Selenophosphate is formed from selenide and ATP by the SelD gene product, selenophosphate synthase (SelD). To further elucidate the biological role of phospholipid hydroperoxide GPx (PHG-Px), we transformed cells with a heterologous (pig) PHGPx gene and/or an additional (human) SelD gene and studied the behaviour of these cells under selenium depletion and repletion. Transfection of the endothelial cell line ECV 304 with either PHGPx cDNA or SelD cDNA did not result in a substantial increase of PHGPx activities, independent of selenium supply. However, cells co-transfected with both, PHGPx and SelD cDNA, expressed significantly higher PHGPx activity. This effect was much more pronounced under selenium limiting conditions. The enhanced PHGPx activity correlated with two functional parameters, increased capability to reduce hydroperoxides and less sensitivity against H2O2-induced cytotoxicity. Thus, the ECV cells, stably transfected with PHGPx and SelD cDNA, provide a model to specifically investigate the role of PHGPx in endothelial cell function.

Optimized differential diagnosis of breast lesions by combined B-mode and color Doppler sonography

To optimize the sensitivity and specificity of gray-scale imaging and color Doppler in breast tumor diagnosis, alone and in combination, 89 women with palpable breast masses were scanned preoperatively and standard parameters were determined in both modes. Parameters significant for differentiation of benign and malignant tumors identified using univariate analysis were combined and weighted using multivariate analysis (multiple logistic regression). Histologically 59 tumors were malignant and 30 benign. Gray-scale sonography alone achieved a sensitivity of 88% and a specificity of 96% using the parameters of wall structure and posterior acoustic attenuation. Color Doppler achieved a sensitivity of 85% and a specificity of 79% using resistance index and pulsatility index as parameters. Combination of both methods yielded an accurate diagnosis in 84/87 patients (sonographic lesion correlates were absent in two cases), equivalent to a sensitivity of 97% and a specificity of 96%. Thus the individual diagnostic performance of gray-scale imaging and color Doppler sonography in palpable breast disease is further enhanced using multiple logistic regression to combine independently significant parameters.

Differentiation between MHC-restricted and non-MHC-restricted porcine cytolytic T lymphocytes

The immune system of swine is unique in that the expression of CD4 and CD8 antigens defines four subpopulations of resting extrathymic T lymphocytes. Beyond phenotypic differences to other species, porcine T lymphocytes, particularly when derived from infected animals, are known to show high non-specific cytolytic in vitro activity. Here we describe the putative porcine CD6 antigen (workshop CD6; wCD6) which enables a phenotypic separation of T lymphocytes responsible for major histocompatibility complex (MHC)-restricted and non-MHC-restricted cytotoxicity. The putative porcine CD6 analogue, wCD6, a protein with a molecular mass of 110,000, shows high specificity for T lymphocytes and is neither expressed on B lymphocytes nor on cells of the myeloid lineage. In the extrathymic T-lymphocyte compartment wCD6 characterizes two T-lymphocyte fractions: wCD6+ T lymphocytes including both CD4+ T-helper cell subpopulations (CD4+CD8- and CD4+CD8+) and within the CD4-CD8+ fraction cells with high CD8 antigen density. In contrast the CD4-CD8- gamma/delta T-cell receptor (TCR) subset and CD4-CD8+ cells with low CD8 antigen density are included in the wCD6- T-lymphocyte fraction. Functional studies with separated wCD6 fractions revealed that the wCD6- cells can be characterized by spontaneous and non-MHC restricted cytolytic activity, whereas the wCD6+ T lymphocytes are responsible for MHC-restricted T-cell functions. Thus, the porcine wCD6 is an important antigen to discriminate between MHC-restricted and non-MHC-restricted cytotoxicity.

Conventional cell culture media do not adequately supply cells with antioxidants and thus facilitate peroxide-induced genotoxicity

Commercially available calf serum did not supply the cultured murine fibroblast cell line L929 with amounts of selenium and alpha-tocopherol sufficient to protect against peroxide damage. Supplementation of the culture medium with 30 microM alpha-tocopherol or 50 nM sodium selenite led to a substantial increase of cellular alpha-tocopherol concentrations from 18 +/- 3.0 to 3179 +/- 93.0 pmol/10(6) cells or cellular selenium concentrations from 0.17 +/- 0.02 to 1.75 +/- 0.16 ng/10(6) cells, respectively. L929 fibroblasts grown in selenite-containing medium also had markedly raised activities of both cytosolic glutathione peroxidase (from 11 +/- 0.9 to 67.2 +/- 4.2 mU/10(7) cells) and phospholipid hydroperoxide glutathione peroxidase (from 0.2 to 9.5 +/- 0.9 mU/10(7)cells). Supplementation with alpha-tocopherol inhibited single-strand breaks induced by low concentrations of H2O2 only, whereas an adequate selenium supply almost completely inhibited single-strand breaks induced by up to 30 microM H2O2 and also significantly reduced H2O2-induced cell death. An inadequate selenium supply and corresponding increase of GPx activity upon selenite supplementation was also observed with other cell lines, for instance, D10N, ECV-304, HepG2, and THP-1. Our data strengthen the relevance of standardized and adequate supplementation of tissue culture media with antioxidants to improve viability and genetic stability of cultured cells in general and in particular, if they are oxidatively challenged.

Nighttime exposure to ozone reduces whole-plant production in Betula pendula

For 20 weeks during the growing season, cuttings of one birch clone (Betula pendula Roth.) were exposed in the Birmensdorf fumigation chambers to O(3)-free air (control) or 75 nl O(3) l(-1). Ozone was supplied either from 1900 until 0700 h (nighttime regime), from 0700 until 1900 h (daylight regime), or all day (24-h regime). By autumn, reductions in whole-plant biomass production, root/shoot biomass and stem weight/length ratios were evident in all three O(3) regimes. The reductions in cuttings receiving the 24-h O(3) treatment were about twofold larger than in cuttings receiving the daylight O(3) treatment. Stomata were open at night, and stomatal conductance was about 50% of its maximum daytime value. We calculated that the rate of O(3) uptake into leaves in the dark approached 4 nmol m(-2) s(-1). Whole-plant production and carbon allocation were more sensitive to O(3) during the night than during the day; however, O(3) exposure caused similar visible leaf injury in both of the 12-h regimes, although the leaves exposed to O(3) at night exhibited delayed O(3)-induced shedding. Overall, changes in production and carbon allocation were determined by the external O(3) dose rather than by the kind of O(3) exposure, indicating that, at the seasonal scale, the internal dose of ozone that was physiologically effective was a constant fraction of the external O(3) dose. We conclude that nighttime O(3) exposures should be included in the daily time period for determining critical concentrations of O(3) causing injury in trees.