A new circle method for measuring humeral torsion on MRI-scans less sensitive to Hill-Sachs lesions.

Objectives: The literature on humeral torsion angles (retrotorsion) reveals great inconsistencies between methodology and values. Decreased retrotorsion was suspected to correlate with instability, but evidence is contradictory. The measurement according to the gold standard method of Bernageau and Godefroy (B&G) can be challenging especially in the presence of Hill-Sachs-lesions. Therefore, we have developed and evaluated a new measurement method for the humeral torsion angle on MRI-scans. Materials and Methods: Three investigators have measured 67 patients (35 with shoulder instability, 32 healthy) on axial MRIs with 603 measurements used for reliability calculation. The new Circle-method determines the retrotorsion by overlaying two circles on the transversal section of the humeral head. The first circle is adjusted congruent with the margin of the humeral head, whereas the second circle is adjusted to the greater tubercle. The line bisecting the centres of these circles is defined as the humeral head axis. This method was compared to B&G. Results: The mean retrotorsion angle of all patients was 25°± 25° (mean ± SD) with B&G, and 24° ± 27° with the Circle-method. Neither method revealed a significant difference between stable and unstable shoulders (p = 0.47). Of the 35 patients with unstable shoulders 21 (60%) presented Hill-Sachs lesions. No significant differences between patients with or without Hill-Sachs lesions (Circle-method: p = 0.61; B&G: p = 0.67). The reliability parameters for both methods were similar. Conclusions: The new Circle-method is as precise as the method of B&G. It may yield more consistent values in cases with substantial Hill-Sachs-lesions. Our data do not suggest retrotorsion as a predictor of instability.

Activation of Human Pancreatic Proteolytic Enzymes: The Role of Enteropeptidase and Trypsin.

The role of enteropeptidase and trypsin in the process by which pancreatic proteolytic zymogens are converted into active enzymes has been investigated in the past, using purified enzymes and proenzymes of animal origin. In the present study, we wanted to study this process under conditions which come near to the physiological situation, which prevails in the human duodenum and upper small intestine. Patients and Methods: Duodenal contents were collected from 2 patients with intestinal enteropeptidase deficiency. The samples expressed no tryptic activity and were used as the source of zymogens. Enteropeptidase or trypsin was added to these samples and the process of zymogen activation was followed by measuring trypsin and chymotrypsin activities. Results: When exogenous trypsin was added to the duodenal contents of patients with enteropeptidase deficiency, having no tryptic activity, activation of intrinsic trypsinogen was not observed. When purified porcine or human enteropeptidase was added to the same samples of duodenal contents, this resulted in a rapid, dose-dependent activation of trypsinogen followed by the activation of chymotrypsinogen. Conclusion: The study underlines the key role of enteropeptidase in the cascade process, which leads to the presence of active proteolytic enzymes in the human small intestine. The results also explain why patients with congenital deficiency of enteropeptidase are unable to activate trypsinogen by alternative pathways and therefore suffer from a severe disturbance of protein digestion with failure to thrive at young age, hypoproteinemia, and anemia.

Seven-year course of asymptomatic acromioclavicular osteoarthritis diagnosed by MRI.

BACKGROUND: Asymptomatic acromioclavicular osteoarthritis (AC-OA) is a frequent finding in shoulder magnetic resonance imaging (MRI). Its natural course is unknown. Therefore, the question arises whether a resection should be performed simultaneously with shoulder surgery for another reason to prevent future pain and reoperation. The purpose of this study was to investigate the mid-term course of asymptomatic AC-OA. METHODS: Overall, 114 asymptomatic AC-OA diagnosed on MRI were followed for 7 years between 2011 and 2018. At baseline, MRI signal enhancement in the clavicle and acromion, OA grade, physical demand as well as the parameters (1) Constant Score Visual Analogue Scale, (2) pain on AC-joint compression, and (3) cross-body adduction test were measured. All patients were followed up after 7 years by interview, and in case of symptoms by clinical examination. The endpoint "deterioration" was reached if 2 of the 3 parameters turned worse. RESULTS: Asymptomatic AC-OA remained asymptomatic in 83% of cases, 7% turned better, 10% turned worse. Physical demand and osteoarthritis grade increased the risk of deterioration, whereas MRI signal enhancement in the clavicle or acromion had no influence on outcome. During follow-up, the frequency of pain on AC-joint compression increased from 11% to 16% (P = .24), the frequency of a positive cross-body adduction test increased from 6% to 20% (P = .017), and the mean Constant Score Visual Analogue Scale increased from 10 to 13 points (P < .001) indicating less pain. CONCLUSIONS: Asymptomatic AC-OA remained asymptomatic in 90% over 7 years. A simultaneous resection of an asymptomatic AC-OA during shoulder surgery for another reason is not indicated in every patient.

Intralymphatic Immunotherapy: Update and Unmet Needs.

Allergen-specific immunotherapy (AIT) is the only allergy treatment that confers long-term symptom amelioration for patients suffering from allergy. The most frequently used allergen application route is subcutaneous injection (SCIT), commonly taken as the gold standard, followed by sublingual (SLIT) or oral (OIT) application of allergen preparations. This is an up-to-date review of the clinical evidence for a novel route of allergen application, i.e., directly into lymph nodes - intralymphatic immunotherapy (ILIT). The major advantages of ILIT over the current AIT approaches are its short duration and the low allergen doses administered. The whole treatment consists of merely 3 ultrasound-guided injections into inguinal lymph nodes 1 month apart. While the number of patients included in randomised controlled trials is still limited, the clinical results for ILIT are encouraging, but more clinical trials are needed, as well as more preclinical work for optimising formulations.

Epicutaneous/transcutaneous allergen-specific immunotherapy: rationale and clinical trials.

PURPOSE OF REVIEW: IgE-mediated allergies, such as allergic rhinoconjunctivitis and asthma, have become highly prevalent, today affecting up to 35% of the population in industrialized countries. Allergen immunotherapy (also called hyposensitization therapy, desensitization or allergen-specific immunotherapy), the administration of gradually increasing amounts of an allergen, either subcutaneously or via the sublingual or oral route is effective. However, only few allergy patients (<5%) choose immunotherapy, as treatment duration is over years and because allergen administrations are associated with local and in some cases even systemic allergic side effects due to allergen accidentally reaching the circulation. Therefore, ideally the allergen should be administered to a site that contains high numbers of potent antigen-presenting cells in order to enhance efficacy and shorten treatment duration, and ideally that site should also be nonvascularized in order to prevent both systemic distribution of the allergen and systemic allergic side effects. The epidermis, a nonvascularized multilayer epithelium that contains high numbers of potent antigen-presenting Langerhans cells, could therefore be an interesting administration route. RECENT FINDINGS: We have recently reintroduced transcutaneous or epicutaneous allergen-specific immunotherapy (EPIT) as treatment option for IgE-mediated allergies. This method was found efficacious and safe. Few applications of allergens using skin patches with a treatment duration of a few weeks were sufficient to achieve lasting relief. SUMMARY: This review gives an overview on the history, the rationale, and the mechanisms of transcutaneous/epicutaneous immunotherapy.

Influenza vaccination coverage rates in Austria in 2006/07 - a representative cross-sectional telephone survey.

The objective of the study was to evaluate influenza vaccination coverage in Austria in the season of 2006/07 and to understand motivations and barriers. Two-thousand telephone interviews with individuals over 15 years of age were conducted. The overall influenza vaccination coverage rate was 17.8%. In the elderly (>65 years) the rate was 32.1%, and the adjusted odds ratio of being vaccinated, compared to those not belonging to a high-risk group, was 3.8. Chronically ill persons and health care workers had adjusted odds ratios of 2.6 and 1.5, respectively, while chronically ill elderly persons had an odds ratio of vaccination of 7.0. Minimizing the risk of contracting influenza was the most frequent reason for getting vaccinated (35.2%), and a recommendation by the family doctor was perceived as the major encouraging factor for vaccination (46.4%). The main reason for not getting vaccinated was indifference (>50%). Vaccination coverage in Austria in 2006/07 was low and far behind WHO objectives.

Trends in influenza vaccination coverage rates in Germany over six seasons from 2001/02 to 2006/07.

BACKGROUND AND PURPOSE: Influenza is a considerable health problem all over the world. Vaccination is the most important measure for preventing influenza and reducing morbidity and mortality. The aims of this study were to assess influenza vaccination coverage from 2001 to 2007 in Germany, to understand motivations and barriers to vaccination, and to identify vaccination intentions for season 2007/08. METHODS: In representative household surveys, 12,039 telephone interviews with individuals aged >or= 14 years were conducted between 2001 and 2007. Essentially the same questionnaire was used in all seasons. RESULTS: In season 2006/07, the overall influenza vaccination coverage rate dropped from 32.5% in the previous season to 27.4%. In the elderly (>or= 60 years), the rate decreased from 51.6% to 44.7% and the odds ratio of being vaccinated, compared to those not belonging to a high-risk group, remained < 5. Chronically ill elderly persons had an odds ratio of vaccination of 7, while younger chronically ill persons and health-care workers had odds ratios of about 2. Perceiving influenza as a serious illness was the most frequent reason for getting vaccinated. 14% of those vaccinated in 2006/07 indicated the threat of avian flu as a reason. The main reason for not getting vaccinated was thinking not to be likely to catch the flu. A recommendation by the family doctor/nurse was perceived as the major encouraging factor for vaccination. A total of 44.7% of the respondents intended to get vaccinated against influenza in 2007/08. CONCLUSION: A trend of increasing vaccination rates was observed from 2001 to 2006 in Germany, but the rates dipped by almost a sixth after 2005/06. The loss of media interest in the threat of avian influenza after February 2006 and stalling reimbursement programs may have contributed to the recent drop in vaccination rates.