[Standards in the use of fiberoptic endoscopic evaluation of swallowing in Germany : A questionnaire survey]. / Standards bei der Anwendung der fiberendoskopischen Schluckuntersuchung in Deutschland : Eine Fragebogenerhebung.

BACKGROUND: The fiberoptic endoscopic evaluation of swallowing (FEES) is considered to be an indispensable instrumental procedure in the management of patients with dysphagia. The aim of the implemented training curriculum is to raise the quality standards and to contribute to an upgrading of the procedure. OBJECTIVE: The study evaluated to what extent a standardized implementation, evaluation and documentation of FEES takes place in Germany after the introduction of the curriculum. MATERIAL AND METHODS: In this study 603 neurological and geriatric hospitals in Germany were interviewed by the use of an online questionnaire regarding structural features and the course of the investigation. RESULTS: A total of 190 institutions completed the survey. Of the institutions 43.31% had only implemented FEES since the publication of the curriculum. The practical application is increasingly carried out by physicians (59%), the clinical reports and cost recommendations are carried out by speech therapists (62% and 83%, respectively). The practical application by speech therapists increases with increasing level of training. Despite orientation towards the standard protocol according to Langmore, there are differences in the implementation of the anatomical physiological examination, the consistencies and foods administered and the scoring of swallowing-relevant parameters. DISCUSSION: The introduction of the curriculum has led to an upgrading of the FEES and to a strengthening of speech therapy as the implementing professional group. At the current state of the art there is a homogeneous course of the examination in essential aspects but it shows a need for further uniformity. The FEES curriculum could be used as a guiding instrument for further standardization.

Association between ACTH stimulation test results and clinical signs in dogs with hyperadrenocorticism treated with trilostane.

Trilostane is the recommended medical treatment for dogs with hyperadrenocorticicm (HAC). The objective of this study was to investigate the association between ACTH stimulation test (ACTHST) results, and relevant clinical signs, in dogs treated with trilostane. A disease-specific questionnaire was developed, which included the owner's assessment of polydipsia, polyuria, polyphagia, panting, and satisfaction with the treatment, based on a 5-response category rating scale. Forty-nine dogs with HAC were prospectively enrolled. Dogs were grouped according to their recheck appointment (first recheck, 710 days after commencement of treatment or change of trilostane dose; second recheck, 4 weeks after the first recheck; third recheck, performed at 3-6 months intervals once the dog was well controlled). At the recheck appointment, the owner's questionnaire responses were recorded, and an ACTHST was performed, along with urine specific gravity measurement. Linear mixed effects models were used to assess differences among the three recheck time points and to test possible associations between ACTHST results and clinical signs. Significant differences between rechecks were present for stimulated cortisol (first to third recheck, P < 0.001; second to third recheck, P < 0.01), polydipsia (first to second recheck, P = 0.001), polyuria (first to second recheck, P < 0.001; first to third recheck, P = 0.001), and owner satisfaction (first to second recheck, P < 0.001; first to third recheck, P < 0.001). Backward stepwise variable elimination did not identify any significant associations between ACTHST results and clinical signs. Therefore, clinical signs of HAC were not predicted based on the ACTHST results.

Associations between proteinuria, systemic hypertension and glomerular filtration rate in dogs with renal and non-renal diseases.

Proteinuria and systemic hypertension are well recognised risk factors in chronic renal failure (CRF). They are consequences of renal disease but also lead to a further loss of functional kidney tissue. The objectives of this study were to investigate the associations between proteinuria, systemic hypertension and glomerular filtration rate (GFR) in dogs with naturally occurring renal and non-renal diseases, and to determine whether proteinuria and hypertension were associated with shorter survival times in dogs with CRF. Measurements of exogenous creatinine plasma clearance (ECPC), urine protein:creatinine ratio (UPC), and Doppler sonographic measurements of systolic blood pressure (SBP) were made in 60 dogs with various diseases. There was a weak but significant inverse correlation between UPC and ECPC, a significant inverse correlation between SBP and ECPC and a weak but significant positive correlation between UPC and SBP. Some of the dogs with CRF were proteinuric and almost all were hypertensive. Neoplasia was commonly associated with proteinuria in the dogs with a normal ECPC. CRF was the most common cause leading to hypertension. In the dogs with CRF, hypertension and marked proteinuria were associated with significantly shorter survival times.

Serotonergic pre-treatments block in vitro serotonergic phase shifts of the mouse suprachiasmatic nucleus circadian clock.

The suprachiasmatic nucleus (SCN) contains a circadian clock that maintains its time-generating and phase-modulating capacities in vitro. Previous studies report clear differences in the ability of serotonergic stimuli to phase-shift the SCN clock when applied directly to the SCN either in vivo or in vitro: while mice and rat circadian clocks are readily phase-shifted by serotonin (5-HT) or 5-HT agonists applied in vitro, hamster and mice circadian clocks respond inconsistently to 5-HT agonists injected directly into the SCN in vivo. Here we have investigated one possible explanation for these differences: that the SCN isolated in vitro experiences reduced endogenous 5-HT signaling, which increases clock sensitivity to subsequent 5-HT stimulation. For these experiments we treated mouse SCN brain slices with low concentrations of compounds that increase serotonin signaling: 5-HT, a 5-HT agonist (8-OH-DPAT), the 5-HT precursor, l-tryptophan, or the 5-HT re-uptake inhibitor, fluoxetine. Pretreatment with each of these substances completely blocked subsequent phase-shifts induced by mid-subjective day treatment with either 5-HT or 8-OH-DPAT, while they did not block phase-shifts induced by the adenylate cyclase activator, forskolin. Time-course data on l-tryptophan-induced inhibition are consistent with this treatment inducing receptor internalization, while timing of the recovery from inhibition is consistent with receptor reinsertion. Together these data support the hypothesis that SCN clock sensitivity to serotonergic phase modulation is affected by the amount of prior serotonin signaling present in the SCN, and that this signaling alters the density of surface 5-HT receptors on SCN clock neurons.

Effects of diethylnitrosamine and cigarette smoke on hamsters.

One hundred two 2-month-old male Syrian hamsters received 12 weekly sc injections of 0.25 mg diethylnitrosamine (DEN). Half the animals were also exposed for 10 minutes to cigarette smoke in Hamburg II-type smoking machines, three times per day, 5 days per week, for their life-span. The other half received sham exposure. Two additional groups of 51 hamsters each, serving as controls, received either only smoke or sham smoke exposures. The DEN treatment resulted in a significant increase (P less than 0.01) in epithelial lesions of the larynx, including laryngeal papillomas. Cigarette smoke inhalation had a significant (P less than 0.01) potentiating effect on the incidence of these lesions. We did not observe the high incidence of tumors of the nasal cavity, trachea, and the lower respiratory tract, or a significant development of malignant tumors, reported by several other investigators. The life-spans of the animals were unaffected by DEN and significantly increased (P less than 0.01) by exposure to smoke. The smoke-exposed groups had significantly lower mean body weights than their sham smoke-exposed cohorts.

The p75 neurotrophin receptor augments survival signaling in the striatum of pre-symptomatic Q175(WT/HD) mice.

Huntington's disease (HD) is a dominantly inherited neurodegenerative disorder characterized by a constellation of motor, cognitive, and psychiatric features. Striatal medium spiny neurons, one of the most affected populations, are dependent on brain-derived neurotrophic factor (BDNF) anterogradely transported from the cortex for proper function and survival. Recent studies suggest both receptors for BDNF, TrkB and p75 neurotrophin receptor (p75), are improperly regulated in the striata of HD patients and mouse models of HD. While BDNF-TrkB signaling almost exclusively promotes survival and metabolic function, p75 signaling is able to induce survival or apoptosis depending on the available ligand and associated co-receptor. We investigated the role of p75 in the Q175 knock-in mouse model of HD by examining the levels and activation of downstream signaling molecules, and subsequently examining Hdh(+/Q175);p75(-/-) mice to determine if p75 represents a promising therapeutic target. In Hdh(+/Q175);p75(+/+) mice, we observed enhanced survival signaling as evidenced by an increase in phosphorylation and activation of Akt and the p65 subunit of NFκB in the striatum at 5 months of age and an increase in XIAP expression compared to Hdh(+/+);p75(+/+) mice; this increase was lost in Hdh(+/Q175);p75(-/-) mice. Hdh(+/Q175);p75(-/-) mice also showed a decrease in Bcl-XL expression by immunoblotting compared to Hdh(+/Q175);p75(+/+) and Hdh(+/+);p75(+/+) littermates. Consistent with diminished survival signaling, DARPP-32 expression decreased both by immunoblotting and by immunohistochemistry in Hdh(+/Q175);p75(-/-) mice compared to Hdh(+/+);p75(+/+), Hdh(+/Q175);p75(+/+), and Hdh(+/+);p75(-/-) littermates. Additionally, striatal volume declined to a greater extent in Hdh(+/Q175);p75(-/-) when compared to Hdh(+/Q175);p75(+/+) littermates at 12 months, indicating a more aggressive onset of degeneration. These data suggest that p75 signaling plays an early role in augmenting pro-survival signaling in the striatum and that disruption of p75 signaling at a pre-symptomatic age may exacerbate pathologic changes in Hdh(+/Q175) mice.

[Photodynamic therapy with verteporfin for recurrent choroidal neovascularisation (CNV) following prior argon laser coagulation]. / Photodynamische Therapie mit Verteporfin bei Rezidiven choroidaler Neovaskularisationen (CNV) nach primärer Argonlaserkoagulation.

BACKGROUND: Photodynamic therapy (PDT) with verteporfin has been successfully introduced to treat choroidal neovascularisations (CNV) that have more than 50% classic CNV components due to exudative age-dependent macular degeneration (AMD) and other diagnoses. However, what is still unclear is if patients with recurrent subfoveal CNV who have had prior laser coagulation can also profit from PDT for CNV. METHODS: The course of visual acuity (ETDRS) and the fluorescein angiographic findings were retrospectively analysed after standard PDT of recurrent subfoveal CNV after prior argon laser coagulation of an extrafoveal or juxtafoveal CNV in AMD or other diagnoses. RESULTS: A total of 20 consecutive eyes from 19 AMD patients were evaluated. After 12 months in 14 of the 20 eyes (70%) deterioration in visual acuity of 3 or more ETDRS lines could be avoided and likewise in 7 of 16 eyes (44%) after 24 months. After the 1st year, 5 of the 7 eyes (71%) with recurrent subfoveal CNV after laser coagulation of a myopic, postinflammatory or idiopathic CNV had deterioration of visual acuity of less than three lines or an improvement in visual acuity. CONCLUSIONS: Despite the low number of patients examined, we could see an indication for PDT in recurrent subfoveal CNV after prior argon laser coagulation of extrafoveal or juxtafoveal CNV. When the patient presented with a CNV cause other than AMD, a better prognosis for visual acuity was achieved.

A catalytic role for threonine-12 of E. coli asparaginase II as established by site-directed mutagenesis.

A threonine-12 to alanine mutant of E. coli asparaginase II (EC 3.5.1.1) has less than 0.01% of the activity of wild-type enzyme. Both tertiary and quaternary structure of the enzyme are essentially unaffected by the mutation; thus the activity loss seems to be the result of a direct impairment of catalytic function. As aspartate is still bound by the mutant enzyme, Thr-12 appears not be involved in substrate binding.

Biological effects of cosmetic talc.

A review of the literature reveals two primary issues: (1) a weak, but not causal, association of hygienic use of cosmetic talc and ovarian cancer; (2) lung changes in animals exposed to talc aerosol concentrations that resulted in lung overload. The evidentiary weight of the most significant of the epidemiological and laboratory studies and their biological significance for human risk assessment are briefly discussed. Publications describing granulomatous lesions attributed to talc on surgical gloves, and consequences of accidental inhalation of baby powder by infants are also reviewed. The literature reviewed does not provide any convincing evidence that pure cosmetic talc, when used as intended, presents a health risk to the human consumer.

On talc translocation from the vagina to the oviducts and beyond.

The objective of this study was to investigate whether multiple vaginal depositions of neutron-activated talc in the cynomolgus monkey result in the translocation of this material to the uterus and beyond. Within a 45-day period, six monkeys received 30 applications of 125 mg neutron-activated talc, suspended in 0.3 ml physiological saline solution containing 1% carboxymethyl cellulose as a suspending agent. The suspension was deposited in the posterior vaginal fornix of the sedated monkeys. Two days after the final talc application, the animals were anaesthetized. Abdominal lavage was performed and the lavage fluid collected for gamma-ray analysis. Also collected for gamma-ray analysis were the following tissues/organs: ovaries, oviducts, uterus, and vagina with cervix. Six untreated control monkeys underwent the same procedures. The radioisotopes 46Sc, 60Co, 59Fe and 51Cr in the activated talc served as tracers. Only the samples containing vagina and cervix from the dosed monkeys contained varying quantities of talc. This demonstrates that no measurable quantities of talc, deposited by multiple applications in the vaginal fornix of the cynomolgus monkey, translocated to the uterus or beyond.

Do particles translocate from the vagina to the oviducts and beyond?

To investigate whether particles deposited in the vagina translocate to the oviducts, 0.3 ml of a 4% bone black suspension was deposited in the posterior vaginal fornix of each of five cynomolgus monkeys (Macaca fascicularis) during their mid-menstrual cycle. Simultaneously, each animal received 10 units of oxytocin by intramuscular injection. The oviducts of three animals were removed 1 hr after administration of the bone black, while those of the remaining two animals were removed 72 hr after dosing. The removed oviducts were flushed with Hank's solution and then with collagenase solution. The solutions were collected in clean vials and filtered. The filters were examined for bone black particles by light microscopy, as were filters through which solution blanks (negative controls) had been passed. Particles resembling bone black were found on all filters. There were no appreciable differences in the number or shape of these particles between the solution-blank filters and the oviduct-flush filters. The particles on both the solution-blank filters and on the oviduct-flush filters probably originated from environmental contamination by ubiquitous carbon particles. While these results suggested that no translocation took place, translocation could not be ruled out with certainty in the absence of quantitative analyses. A more definitive pilot study was then conducted with two dosed monkeys and one control, using talc labelled by neutron activation to circumvent the problem of environmental contamination. Gamma-Ray analysis of tissue and peritoneal lavage samples for the radionuclides 46Sc, 59Fe and 60Co indicated that no measurable quantities (i.e. greater than 0.5 micrograms) of talc translocated from the deposition site in the vagina to the uterine cavity and beyond.

[Photodynamic treatment with verteporfin for patients with idiopathic choroidal neovascularization. Two-year results]. / Photodynamische Therapie mit Verteporfin bei Patienten mit idiopathischer chorioidaler Neovaskularisation. 2-Jahres-Ergebnisse.

BACKGROUND: The aim of this study was the evaluation of safety and effectiveness of photodynamic therapy (PDT) as a treatment option for idiopathic choroidal neovascularization (CNV). METHODS: We performed a retrospective analysis of 11 eyes of 9 patients who were treated with standard PDT. The follow-up period was at least 1 year and included regular standardized ETDRS visual acuity measurement and fluorescein angiography. RESULTS: Eight sub- and three juxtafoveal CNV were treated. The mean follow-up was 23.2 months (12-41 months), the mean change in visual acuity was +2.1 lines (+3 for juxtafoveal and +1.9 for subfoveal localization), and a mean of 1.9 (1-3) treatments were performed. Visual acuity improved > or =2 lines in 6 of 11 eyes (54.5%) and 5 eyes (45.5%) remained stable (+/-1 lines). Alterations of the retinal pigmented epithelium (RPE) with window defects in fluorescein angiography occurred in 7 of 11 eyes (63.6%) but did not alter visual acuity. In 4 of 11 cases (36.4%), we saw recurrences after initially successful therapy, which were retreated successfully with PDT. CONCLUSION: Stabilization or even an improvement of visual acuity in idiopathic CNV is possible with PDT treatment. Side effects such as RPE changes and recurrences are possible, but do not seem to influence visual acuity.

Increased life span and decreased weight in hamsters exposed to cigarette smoke.

Five groups of fifty-one 2-month-old male Syrian golden hamsters received three 10-minute exposures to cigarette smoke per day, 5 days per week, for the duration of their lives. Three of the groups were also chronically exposed to aerosols of chrysotile asbestos, cobalt oxide, and nickel oxides, respectively. The fourth group received twelve weekly injections of 0.25 mg of diethylnitrosamine. The smoke-exposed groups lived significantly (P less than .01) longer than their sham-exposed cohorts and untreated controls. Their mean body weights were significantly (P less than .01) lower than in the sham-exposed groups. The hypothesis is proposed that delayed onset of amyloidosis and lower body weight in the smoke-exposed hamsters may have been responsible for their increased life spans. It is hypothesized that cigarette smoke affected the immune system of the animals, resulting in retardation of amyloidosis, a frequent cause of death in hamsters.

Tobacco smoke inhalation studies: a dosimetric comparison of different cigarette types.

As part of a long-term inhalation bioassay study of cigarette smoke in rats, a detailed dosimetric comparison of three groups of rats exposed to smoke from different cigarette types was performed. Groups of 20 female F-344 rats were exposed, in Maddox-ORNL smoking machines, to 14C-dotriacontane-labeled smoke from three types of research cigarettes: high tar-low nicotine, low tar-high nicotine, and high tar-high nicotine. Analyses of lung tissues revealed similar deposition amounts and patterns of particulate matter for all three cigarette types even though the chamber smoke concentrations varied substantially. These results suggested that for rats exposed to different types of cigarette smoke, the amount of particulate material deposited may not be a function of concentration only. The authors conclude that when comparing cigarette smoke inhalation studies of different cigarette types, exposure parameters and smoke composition may both influence the amount of smoke inhaled and deposited in the lung and other organs.

[Acute haemorrhagic diarrhoea as a presenting sign in a dog with primary hypoadrenocorticism]. / Akuter blutiger Durchfall als Vorstellungsgrund bei einem Hund mit primärem Hypoadrenokortizismus.

A 7-year-old male castrated mixed breed dog was presented because of acute haemorrhagic vomiting and watery haemorrhagic diarrhoea. According to clinical signs, nonspecific clinicopathological abnormalities, normal electrolytes and a rapid improvement with fluid therapy, haemorrhagic gastroenteritis (HGE) was suspected. One month later the dog was represented with weakness and electrolyte changes characteristic for typical hypoadrenocorticism (hyperkalaemia and hyponatraemia) were found. The tentative diagnosis was confirmed using an ACTH stimulation test. This case report highlights that dogs with hypoadrenocorticism may be presented with acute haemorrhagic diarrhoea. Electrolyte changes characteristic for hypoadrenocorticism may not be present in case of gastrointestinal potassium loss because of vomiting and diarrhoea. To rule out hypoadrenocorticism, a basal cortisol measurement should be performed in every dog with acute haemorrhagic diarrhoea of unknown cause.

Comparison of auricular and rectal temperature measurement in normothermic, hypothermic, and hyperthermic dogs.

OBJECTIVE: Measurement of rectal temperature is the most common method and considered gold standard for obtaining body temperature in dogs. So far, no study has been performed comparing agreement between rectal and auricular measurements in a large case series. The purpose of the study was to assess agreement between rectal and auricular temperature measurement in normothermic, hypothermic, and hyperthermic dogs with consideration of different environmental conditions and ear conformations. MATERIALS AND METHODS: Reference values for both methods were established using 62 healthy dogs. Three hundred dogs with various diseases (220 normothermic, 32 hypothermic, 48 hyperthermic) were enrolled in this prospective study. Rectal temperature was compared to auricular temperature and differences in agreement with regard to environmental temperature, relative humidity, and different ear conformations (pendulous versus prick ears) were evaluated using Pearson's correlation coefficient and Bland-Altman analysis. RESULTS: Correlation between rec- tal and auricular temperature was significant (r: 0.892; p  <  0.01). However, Bland-Altman plots showed an inacceptable variation of values (bias: 0.300 °C; limits of agreement: -0.606 to 1.206 °C). This variation was above a maximal clinical tolerance of 0.3 °C, which was established by experts' opinion (n = 16). Relative humidity had a significant influence (p   =   0.001), whereas environmental temperature did not. CONCLUSION: Variation between the two methods of measuring body temperature was clinically unacceptable. CLINICAL RELEVANCE: Although measurement of auricular temperature is fast, simple, and well tolerated, this method provides a clinically unacceptable difference to the rectal measurement.

[Disseminated intravascular coagulopathy in a dog with Angiostrongylus vasorum infection]. / Disseminierte intravasale Koagulopathie bei einem Hund mit Angiostrongylus-vasorum-Infektion.

A 2-year-old female spayed Epagneul-Breton dog was presented with ecchymoses, but an undisturbed general condition. Clinical examination additionally revealed petechia and a haematoma. Travel history included Italy and Denmark. Laboratory abnormalities were moderate thrombocytopenia, prolonged PT, aPTT and TT, and elevated d-dimers. Initial therapy consisted of plasma transfusions, fluids, doxycycline and famotidine administration. Babesiosis, ehrlichiosis, leishmaniosis, dirofilariosis or anaplasmosis could not be confirmed. Abdominal ultrasound was unremarkable, while thoracic radiographs showed a bronchointerstitial pattern. Faecal samples collected over 3 days were positive for Angiostrongylus vasorum after examination using the Baermann lungworm test. The A. vasorum infection was successfully treated with fenbendazole, whereupon thrombocytopenia and prolonged coagulation times were resolved. In regions of low prevalence, an infection with A. vasorum should also be considered as a differential diagnosis in dogs with coagulation abnormalities. Respiratory signs can be absent with this disease. The patient may have acquired the infection abroad or in Germany.