Changes of the subchondral bone microchannel network in early osteoarthritis.

OBJECTIVE: We have identified a 3D network of subchondral microchannels that connects the deep zone of cartilage to the bone marrow (i.e., cartilage-bone marrow microchannel connectors; CMMC). However, the pathological significance of CMMC is largely unknown. Here, we quantitatively evaluated how the CMMC microarchitecture is related to cartilage condition, as well as regional differences in early idiopathic osteoarthritis (OA). METHODS: Two groups of cadaveric female human femoral heads (intact cartilage vs early cartilage lesions) were identified, and a biopsy-based high-resolution micro-CT imaging was employed. Subchondral bone (SB) thickness, CMMC number, maximum and minimum CMMC size, and the CMMC morphology were quantified and compared between the two groups. The effect of joint's region and cartilage condition was examined on each dependent variable. RESULTS: The CMMC number and morphology were affected by region of the joint, but not by cartilage condition. On the other hand, the minimum and maximum CMMC size was changed by both the location on the joint, as well as the cartilage condition. The smallest CMMC were consistently detected at the load-bearing region (LBR) of the joint. Compared to non-pathological subjects, the size of the microchannels was enlarged in early OA, most noticeably at the non-load-bearing region (NLBR) and the peripheral rim (PR) of the femoral head. Furthermore, subchondral bone thinning was observed in early OA as a localized occurrence linked with areas of partial chondral defect. CONCLUSION: Our data point to an enlargement of the SB microchannel network, and a collective structural deterioration of SB in early idiopathic OA.

Physical distress and relationship problems: exploring the psychosocial and intrapsychic world of suicidal geriatric patients.

BACKGROUND: Suicide is a serious mental health problem in old age. Suicide ideation and life weariness are important psychopathological issues in geriatric medicine, although suicide ideation does not primarily depend on the severity of any physical disease. Despite these facts, insight into the internal psychological state of suicidal geriatric patients is still limited. MATERIAL AND METHODS: This study examines intrapsychic and psychosocial issues in suicidal geriatric inpatients. A semistructured interview concerning suicide ideation in old age was used to interview 20 randomly chosen, acutely suicidal clinically geriatric inpatients aged 60 years and older. The control group comprised 20 nonsuicidal patients. RESULTS: Hamilton Depression Scale 21 scores (HAMD 21; patient mean 17.3, control mean 6.1), suicidal ideation and psychiatric treatments differed significantly between the groups. In contrast to lifetime suicidal ideation, the discovery of a physical disease was the primary trigger for current suicidal ideation, followed by interactional conflicts. Patients would rather speak with family or friends than professionals about their suicidal ideation. CONCLUSION: Suicidal ideation should be recognised as an important psychological problem in geriatric patients with interpersonal conflicts. Specific help and training for relatives is recommended.

[Ideal types of interaction patterns of psychosomatic patients in geriatric inpatient treatment]. / Idealtypische Interaktionsmuster psychosomatischer Patienten in stationär-geriatrischer Behandlung.

BACKGROUND: Cooperation between psychosomatic and geriatric medicine is still sporadic and rarely institutionally integrated. At the same time, however, nearly half of geriatric inpatients suffer from psychopathological symptoms of clinical relevance. The patterns of interactions between patients and professionals of the geriatric team prior to a psychosomatic intervention that lead to a specific consultation are still rarely known. The aim of this paper was to identify these relational patterns, which can again occur during interaction with the psychosomatic patient. MATERIAL AND METHODS: Protocols from the consultation sessions of 76 geriatric in-patients, treated over a period of 1 year, were used as the basis data for the development of interactional patterns with the systematic, qualitative method of forming ideal types by understanding. RESULTS: Three groups with a total of 11 interactional patterns were formed: (1) "conflictuous interaction" with patients who re-enact their inner conflicts (e.g., autonomy or conflicts on power and subjugation), (2) "the problem can not be dealt with" with patients who forget or deny and repress their mental problems in other ways, and (3) "avoiding contact" with patients who have different forms of psychosocial withdrawal. CONCLUSION: Extension of the geriatric functional diagnostic approach on interactional-psychodynamic aspects is possible and fosters a differentiated view on the psychosomatic situation of geriatric patients.

Enhanced resolution of microscopic objects by image inversion interferometry.

We demonstrate in experiment that the resolution of a conventional light microscope can be enhanced by 26% with the help of an image inverting interferometer. In order to prove this statement, we measured the point spread function of the system as well as the resolution of two-point objects. Additionally, the contrast transmission function of the interferometric setup was measured and compared to the results gained with a conventional wide-field microscope. Using the interferometric system, the spatial frequencies near the cutoff-frequency were far better transmitted than by the conventional microscope. Finally, we demonstrate the improved resolution with the help of images of two-dimensional structures.

Stable expression of HIV-1 Nef induces changes in growth properties and activation state of human astrocytes.

OBJECTIVE: Nef was shown to be the predominant viral protein expressed in HIV-1-infected astrocytes in vivo and in vitro suggesting a distinct role of Nef in this cell type. Nef-induced activation of T cells is well described, whereas the functional activities of Nef in astrocytes are unknown. Our aim was to examine the effect of Nef on growth properties and activation of astrocytes. DESIGN: Human Nef-expressing astrocytic cell lines were established by stable transfection with different wild-type and mutant nef genes derived from laboratory isolates and brain tissue. METHODS: Nef-expressing astrocytes were characterized in terms of growth properties (proliferation, growth in soft agar, focus formation) and morphology. Apoptotic cell death and expression of activation markers were determined by fluorescent antibody cell sorting. RESULTS: Astrocytic cell lines revealed persistent Nef expression--detectable at the levels of mRNA and protein--and showed altered growth properties and morphology. Elevated expression of activation markers such as glial fibrillary acidic protein and CD88 (complement receptor C5a) was observed; these are regarded as markers for inflammatory processes in the brain. This effect was independent of the nef type or the expression level of the Nef protein. In contrast with previous reports no evidence for increased apoptotic cell death was found in astrocytes expressing Nef stably. CONCLUSIONS: Our findings suggest that Nef changes the cellular properties of astrocytes, thus contributing to astrocyte activation and induction of astrogliosis in the central nervous system of individuals with AIDS.

Long-term evaluation of 0.25% levobunolol and timolol for therapy for elevated intraocular pressure.

In a one-year, double-masked, randomized study, the ocular hypotensive efficacy of twice-daily treatment with 0.25% levobunolol hydrochloride or timolol maleate was evaluated in 78 patients with glaucoma or ocular hypertension (phase 1). If intraocular pressure (IOP) was not well controlled during the study, the concentration of medication was increased to 0.5%, and the patient was followed up for an additional three months (phase 2). During phase 1, the mean IOP was reduced by 4.6 mm Hg in the timolol treatment group and by 5.1 mm Hg in the levobunolol treatment group. Seventy-one percent (29/41) of the patients in the timolol treatment group and 70% (26/37) of the patients in the levobunolol treatment group successfully completed phase 1. Of those patients who required the higher concentration of medication, 89% (8/11) in the timolol treatment group and 75% (3/4) in the levobunolol treatment group successfully completed phase 2. Higher concentration, however, did not produce greater IOP reduction. No statistically or clinically significant differences between the groups were noted in any of the efficacy or safety variables evaluated.

Levobunolol compared with timolol for the long-term control of elevated intraocular pressure.

Levobunolol hydrochloride (0.5% and 1%) and timolol maleate (0.5%) are being compared in an ongoing, double-masked, randomized study of 141 patients with ocular hypertension or chronic open-angle glaucoma. Baseline intraocular pressure (IOP) in the three treatment groups ranged from 26 to 27 mm Hg. During the first 15 months of the study, the two drugs have not proved to be significantly different in ocular hypotensive efficacy, with overall mean IOP decreases of 6.8 to 7.6 mm Hg. In addition, the two concentrations of levobunolol have been equally effective in controlling IOP. Neither drug has been associated with any significant ocular side effects. Both drugs have produced significant decreases (five to ten beats per minute) in mean heart rate. The effect on mean blood pressure has been less pronounced: overall decreases have been less than 4 mm Hg for both systolic and diastolic blood pressure. The results of this ongoing study suggest that levobunolol is as effective and as safe as timolol for the long-term control of IOP.

[Disease, physician-patient contacts and work disability in a general practice]. / Krankheit, Arzt-Patient-Kontakte und Arbeitsunfähigkeit in einer Allgemeinpraxis

The frequency of Coronary Heart Disease symptoms (questionnaire from G. Rose) and some risk factors were recorded for 314 men in a general practice as part of a preventive screening programme. Simultaneously the number of physician-patient contacts and the total days of work disability were registered. The patients were divided into four social classes. There was a significant increase of symptoms of autonomic nervous disorder and hyperuricemia (p less than 0,025) as well as the number of smokers (p less than 0,001) with descending social class. The same trend was found with the frequency of physician-patient contacts and the total days of work disability (p less than 0,1). Patients with vegetative symptoms showed a mean of 7,2 physician-patient contacts and a work disability of 37,4 days per year. For patients with abnormal ECG findings the rates were 5,6 contacts and 33,4 days of disability per year. There was a significant difference in these rates compared to a control group.

Phagocytosis of opsonized fluorescent microspheres by equine polymorphonuclear leukocytes.

Equine blood polymorphonuclear leukocytes (PMN) were isolated by buffy coat and hypotonic lysis of residual erythrocytes. A highly reproducible method is described for measuring the uptake of opsonized latex microspheres by equine PMN using flowcytometry. The use of cytochalasin D allowed for differentiation of ingested from attached particles. The kinetics of phagocytosis in vitro is shown for different experimental conditions. We developed an assay for evaluation of phagocytic capacity of PMN which allows the assessment of drugs for their influence on phagocytosis in vivo as well as in vitro.

In vitro studies on the metabolism of aflatoxin B1 and aldrin in testes of genetically different strains of Drosophila melanogaster.

As Drosophila melanogaster occupies an important position within the test battery for mutagens and carcinogens, it is of interest to study the xenobiotics metabolism of this insect. Likewise, the genetic control of these important enzyme systems falls within this interest. Our attempt was to get new strains, which show changes in their xenobiotics metabolism. This was done by a mutagenization and selection procedure for the second chromosome. The 44 fertile homozygous inbred strains produced by this selection were first tested for DDT resistance. Some of them showed LT50 values which were remarkably higher than that of the original strain Berlin K. Aflatoxin B1 metabolism in two of the new strains (H349 and H362), Berlin K, and Hikone-R was compared, whilst aldrin epoxidase activity was compared in strains H349, H362, Berlin K, vestigial, and Karsnäs-R. The metabolism studies were carried out in vitro with testes tissue of the different strains. The metabolism in testes is of specific interest because this tissue is most often used in mutagenicity testing. In the AFB1 assays of the up to 12 observed metabolites three could be identified as AFB2a, AFM1, and AFR0. Hikone-R produced mostly AFR0 (3.43% of the initial AFB1 concentration) and small amounts of AFM1 (0.59% AF and AFB2a (0.36% AF). The strain Berlin K showed only a low production of AFB2a (0.48% AF), while the strain H349 formed AFR0 (6.02% AF) and AFM1 (0.75% AF). The AFM1 appeared in even higher amounts than with Hikone-R. On the other hand, H362 showed the lowest activity in AFB1 metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prophylaxis in general practice. Aspects of the problems (author's transl)]. / Modell einer Vorsorge in der Allgemeinpraxis. Aspekte ihrer Problematik

For four and a half years prophylactic examinations were carried out quarterly in addition to the statutory early recognition investigations in a general practice. The participation being 42.5% was above the participation rate at the statutory early recognition investigations and showed a marked correlation to age and social stratum, but not to sex. The therapeutic effect, measured by the lowering of the cholesterol level, was compared with data from the literature, our results being below those of the other authors. Then the therapeutic effect was considered from various points of view such as sex, age, social stratum and frequency of participation. The most important result appeared to be that similar investigations are probably necessary once a year at the most on medical grounds, to detect and treat risk factors, which would be of great economic importance.