New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study.

OBJECTIVES: Orthostatic hypotension (OH) is a key feature of multiple system atrophy (MSA), a fatal progressive neurodegenerative disorder associated with autonomic failure, parkinsonism and ataxia. This study aims (1) to determine the clinical spectrum of OH in a large European cohort of patients with MSA and (2) to investigate whether a prolonged postural challenge increases the sensitivity to detect OH in MSA. METHODS: Assessment of OH during a 10 min orthostatic test in 349 patients with MSA from seven centres of the European MSA-Study Group (age: 63.6 ± 8.8 years; disease duration: 4.2 ± 2.6 years). Assessment of a possible relationship between OH and MSA subtype (P with predominant parkinsonism or C with predominant cerebellar ataxia), Unified MSA Rating Scale (UMSARS) scores and drug intake. RESULTS: 187 patients (54%) had moderate (> 20 mm Hg (systolic blood pressure (SBP)) and/or > 10 mm Hg (diastolic blood pressure (DBP)) or severe OH (> 30 mm Hg (SBP) and/or > 15 mm Hg (DBP)) within 3 min and 250 patients (72%) within 10 min. OH magnitude was significantly associated with disease severity (UMSARS I, II and IV), orthostatic symptoms (UMSARS I) and supine hypertension. OH severity was not associated with MSA subtype. Drug intake did not differ according to OH magnitude except for antihypertensive drugs being less frequently, and antihypotensive drugs more frequently, prescribed in severe OH. CONCLUSIONS: This is the largest study of OH in patients with MSA. Our data suggest that the sensitivity to pick up OH increases substantially by a prolonged 10 min orthostatic challenge. These results will help to improve OH management and the design of future clinical trials.

[MSA-QoL: disease-specific questionnaire to assess health-related quality of life in multiple system atrophy: validation of the German translation]. / MSA-QoL: spezifisches Bewertungsinstrument zur Erfassung der Lebensqualität bei Multisystematrophie : Validierung der deutschsprachigen Übersetzung.

BACKGROUND: Multiple system atrophy (MSA) is a rapidly progressive neurodegenerative disorder which causes early sustained disability and quality of life impairment. Recently, a self-reported questionnaire focusing on MSA-specific symptoms (Multiple System Atrophy Quality of Life questionnaire, MSA-QoL) was developed in the English language. This article reports the validation of the German translation of the MSA-QoL. METHODS: Translation of the MSA-QoL was implemented in a 3-tiered approach including a forward translation, a back translation and an independent review. For the validation study 38 consecutive patients with MSA according to the consensus criteria were recruited by the participating centers in a German-Austrian cohort. Data were analyzed using standard psychometric procedures. RESULTS: As determined by the independent review, the German translation of the MSA-QoL was classified as fully equivalent to the English version. The validation study confirmed good psychometric properties of the rating scale. CONCLUSION: The German translation of the MSA-QoL was shown to be a reliable patient-reported rating scale to determine health-related quality of life in MSA patients.

A cross-sectional multicenter study of cognitive and behavioural features in multiple system atrophy patients of the parkinsonian and cerebellar type.

Imaging and neuropathology studies have demonstrated significant abnormalities not only in subcortical, but also in cortical regions of patients with multiple system atrophy (MSA). This raises the possibility that cognitive dysfunction may contribute to the clinical spectrum of this disorder to a greater extent than it is currently not widely appreciated. In this cross-sectional multicenter study from the European multiple system atrophy study group ( http://www.emsa-sg.org ), we applied an extensive neuropsychological test battery in a series of 61 clinically diagnosed probable MSA patients. The results demonstrated that general cognitive decline as assessed by MMSE was uncommon (2 out of 61 patients <24). In contrast, frontal lobe-related functions (as measured by FAB) were impaired in 41 % of patients, with abstract reasoning and sustained attention less compromised. This pattern was similar to our control group of 20 patients with Parkinson's disease (matched for disease duration and age at onset). There was no difference in cognitive performance between MSA patients with the parkinsonian versus the cerebellar variant. Behaviourally, MSA patients had greater depression than PD and in the case of MSA of the cerebellar variant significantly lower anxiety. Our data show that cognitive abnormalities are relatively frequent in multiple system atrophy and this involves primarily frontal-executive functions. Their contribution to clinical disability and disease progression needs to be addressed in larger prospective studies.

[Atypical Parkinson syndromes--recent advances in diagnosis and therapy]. / Atypische Parkinson-Syndrome - Aktuelles aus Diagnostik und Therapie.

The term "atypical Parkinson syndromes" usually encompasses the following diseases: multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). The differential diagnosis is still a challenge even for a movement disorders specialist, not least because of the distinct therapeutic approaches and disease prognosis. The aim of this review is to provide an overview of current diagnostic criteria and therapeutic approaches and to cite recent findings from clinical and experimental studies.

Study of microbial contamination and dosing accuracy of oral dispensers.

BACKGROUND AND OBJECTIVE: The optimal administration of liquid medications requires accurate dose delivery. This is particularly important in the treatment of infants and children, as well as elderly people, who are more sensitive to dosage errors. Previous studies revealed significant dosage inaccuracies with measuring spoons. Oral syringes are therefore generally recommended instead. There is no data on the efficacy of standard cleaning techniques, and consequently on the degree of microbial contamination associated with the repeated use of oral syringes. This study aimed to investigate the level and types of microorganisms found in oral dispensers subjected to simulated in-use conditions. In addition, the dosing accuracy of the oral dispensers is compared with that of measuring spoons supplied and designed for use with specific medications. METHODS: Exadoral 5 mL oral dispensers from B. Braun Melsungen AG (Melsungen, Germany) were subjected to simulated in-use conditions and microbial assay. Six different liquid medications representing different substance classes were included. The test lasted 4-15 days with two to four doses withdrawn according to dosage recommendations. Dosing accuracy was assessed using six representative amoxicillin suspensions available on the German market after withdrawing 1.25, 2.5 and 5 mL that correspond to », ½ and full measuring spoons. RESULTS AND DISCUSSION: Low counts of Micrococcus luteus, Micrococcus lylae, Staphylococcus epidermidis, Staphylococcus chromogenes as well as Bacillus species and Candida lusitaniae may contaminate the interior surface of the oral dispenser, but the microbial count was below the accepted limit of microbial counts permissible for drinking water over the whole test period. Hence, oral dispensers may be considered safe, provided that cleaning procedures are followed exactly. Moreover, oral dispensers, although not specifically designed for the tested medication, showed much higher dosing accuracy in comparison with the specifically designed measuring spoons. CONCLUSION: The present study revealed that oral dispensers are accurate measuring devices for the safe administration of liquid medication. Pharmacists and physicians should encourage their patients to use oral dispensers routinely in practice.

Hosts as ecological traps for the vector of Lyme disease.

Vectors of infectious diseases are generally thought to be regulated by abiotic conditions such as climate or the availability of specific hosts or habitats. In this study we tested whether blacklegged ticks, the vectors of Lyme disease, granulocytic anaplasmosis and babesiosis can be regulated by the species of vertebrate hosts on which they obligately feed. By subjecting field-caught hosts to parasitism by larval blacklegged ticks, we found that some host species (e.g. opossums, squirrels) that are abundantly parasitized in nature kill 83-96% of the ticks that attempt to attach and feed, while other species are more permissive of tick feeding. Given natural tick burdens we document on these hosts, we show that some hosts can kill thousands of ticks per hectare. These results indicate that the abundance of tick vectors can be regulated by the identity of the hosts upon which these vectors feed. By simulating the removal of hosts from intact communities using empirical models, we show that the loss of biodiversity may exacerbate disease risk by increasing both vector numbers and vector infection rates with a zoonotic pathogen.

MMP-2/gelatinase A is a gene product of human adult articular chondrocytes and is increased in osteoarthritic cartilage.

OBJECTIVE: Collagen fibril degeneration involves initially the cleavage within the triple helix by the collagenases (1 and 3), but then mainly involves also the gelatinases, of which gelatinase A (MMP-2) appears to play a central role in many tissues. The objective of this study was to determine the quantitative expression levels as well as the distribution in normal and osteoarthritic cartilage of gelatinase A and in cultured articular chondrocytes with and without stimulation by Il-1beta. METHODS: Conventional and online PCR technology and immunohistochemistry were used to determine MMP-2 expression levels on the mRNA and protein level. RESULTS: Conventional PCR analysis could demonstrate the presence of MMP-2 mRNA in normal and osteoarthritic chondrocytes. Online quantitative PCR confirmed the presence of MMP-2 mRNA expression in normal articular chondrocytes in vivo (and in vitro). An increase of 5x (p < 0.001) was observed in osteoarthritic cartilage in vivo. Of note, no significant up-regulation of gelatinase A was observed by Il-1beta in vitro. Immunostaining for gelatinase A confirmed the presence of MMP-2 with mono- and polyclonal antibodies in normal and osteoarthritic chondrocytes with somewhat higher levels observed in the latter. CONCLUSIONS: The presented results confirm the increased expression of gelatinase A by osteoarthritic articular chondrocytes as previously described. Of note, also normal adult articular chondrocytes expressed significant amounts of gelatinase A in vivo and in vitro suggesting gelatinase A as being also involved in physiological collagen turnover in human adult articular cartilage.

MMP-8 is only a minor gene product of human adult articular chondrocytes of the knee.

OBJECTIVE: The initial degradation of collagen fibrils during osteoarthritic cartilage destruction depends on the cleavage at the collagenase site, for which there exist three major candidate enzymes: collagenase 1 (MMP-1), collagenase 2 (MMP-8), and collagense 3 (MMP-13). The objective of this study was to determine the quantitative expression as well as distribution levels in normal and osteoarthritic cartilage and synovium and in cultured articular chondrocytes with and without stimulation by Il-1 beta. METHODS: Conventional and online PCR technology and immunohistochemistry were used to determine MMP-8 expression levels on the mRNA and protein level. RESULTS: Whereas conventional PCR analysis could demonstrate the presence of MMP-8 mRNA in normal and osteoarthritic chondrocytes, online quantitative PCR showed that only very minor amounts of MMP-8 mRNA expression is found in articular chondrocytes in vivo (and in vitro) and that there is no significant upregulation in osteoarthritic cartilage in vivo nor by Il-1 beta in vitro. The in vivo results were confirmed by the absence of significant protein staining with monoclonal antibodies for MMP-8 in normal and osteoarthritic chondrocytes. CONCLUSIONS: The presented results confirm the presence of a very minor MMP-8 expression by articular chondrocytes, but clearly question the hypothesis that MMP-8 is a major cartilage matrix degrading protease and is involved in enhanced cartilage matrix breakdown in osteoarthritic cartilage degeneration or by Il-1 beta stimulation in vitro.

sportsmedicine forum.

A Forum For Our Readers Sportsmedicine Forum is intended to provide a sounding board for our readers. Perhaps you have a special way to treat a common medical problem, or you may want to air your views on a controversial topic. You may object to an article that we have published, or you may want to support one. You may have a new trend to report, identified through an interesting case or a series of patients. Whatever your ideas, we invite you to send them to us. Illustrative figures are welcomed. Address correspondence to Sportsmedicine Forum, The Physician And Sportsmedicine, 4530 W 77th St, Minneapolis. MN 55435.

Chromosome replication in an Escherichia coli dnaA mutant integratively suppressed by prophage P2.

Escherichia coli CRT4624-P2sig5 is a dnaA mutant in which integration of the prophage P2sig5 has occurred at the attP2II site (min 85). This strain was integratively suppressed, and when cells were shifted to 42 degrees C replication was initiated at a site in or near the P2 prophage. Initially, this replication occurred primarily in the direction that corresponds to the clockwise direction on the genetic map. Replication also occurred in the counterclockwise direction, but the initiation of replication in this direction occurred approximately 40 min later than the initiation of replication in the other direction. Because of this delay, the replication forks that traveled in the clockwise direction were the first to arrive in the region of the replication terminus. These replication forks ceased replication near the aroD locus (min 37), and it is proposed that the replication terminus is between the aroD and rac loci (min 31). A model is proposed for the cycle of chromosome replication in this strain at 42 degrees C.

Terminus region of the chromosome in Escherichia coli inhibits replication forks.

Induction of prophage P2sig5 at 42 degrees caused replication of the bacterial chromosome in a dnaA mutant of Escherichia coli. The P2sig5 is integrated in this strain near the metG locus, which is at min 47 on the genetic map. The regions of the chromosome replicated after prophage induction have been determined by means of DNA-DNA hybridization with various DNAs obtained from Proteus mirabilis/E. coli F' merogenotes and from lambda specialized transducing phage. The replication was initiated at the prophage site and was bidirectional. Most of the replication occurred in a counterclockwise direction on the genetic map, and the replication quickly proceeded to the aroD locus (min 37). The replication forks were retarded between aroD and rac (min 31) loci, although the rac locus was finally replicated. A more severe inhibition of replication occurred between the rac and trp (min 27) loci. It is proposed that the replication terminus is near the rac locus and that the terminus inhibits replication forks.

Gunshot wound of the abdomen with cerebral embolization.

A distinctly rare case of a bullet embolus to the internal carotid artery following an abdominal gunshot wound is reported. Unusual aspects of the case are discussed with references to the literature. Pathways the bullet may have traversed to reach its final location are proposed.