Propofol sedation in Drug Induced Sedation Endoscopy without an anaesthesiologist â€" a study of safety and feasibility.

BACKGROUND: Propofol sedation in Drug Induced Sedation Endoscopy (DISE) of the upper airway of patients with obstructive sleep apnea (OSA) without the presence of anesthesiologist has not been done before. Propofol sedation is normally administered by an anesthesiologist. This is the first study of this new method. METHODOLOGY: Based on the positive experience with Nurse-administered Propofol Sedation (NAPS) for endoscopic procedures in the departments of gastroenterology we wanted to test the set-up as method of propofol sedation for DISE procedures in our Otorhinolaryngology (ORL) department. The ORL specialists and staff nurses that carry out DISE procedures all underwent a formalized education in Nurse-administered Propofol Sedation before the study. We included 200 patients with severe snoring and / or obstructive sleep apnea. They were referred for DISE examination prior to possible targeted surgery based on the findings. RESULTS: In our study the aforementioned ORL team successfully cared out propofol sedation without the presence of an anesthesiologist. All examinations were carried out according to plan. There were no adverse events during the procedures or in the following observational period. CONCLUSIONS: The NAPS method of sedation for DISE seems safe and feasible when performed by trained staff in a hospital setting.

Face and emotion expression processing and the serotonin transporter polymorphism 5-HTTLPR/rs22531.

Face cognition, including face identity and facial expression processing, is a crucial component of socio-emotional abilities, characterizing humans as highest developed social beings. However, for these trait domains molecular genetic studies investigating gene-behavior associations based on well-founded phenotype definitions are still rare. We examined the relationship between 5-HTTLPR/rs25531 polymorphisms - related to serotonin-reuptake - and the ability to perceive and recognize faces and emotional expressions in human faces. For this aim we conducted structural equation modeling on data from 230 young adults, obtained by using a comprehensive, multivariate task battery with maximal effort tasks. By additionally modeling fluid intelligence and immediate and delayed memory factors, we aimed to address the discriminant relationships of the 5-HTTLPR/rs25531 polymorphisms with socio-emotional abilities. We found a robust association between the 5-HTTLPR/rs25531 polymorphism and facial emotion perception. Carriers of two long (L) alleles outperformed carriers of one or two S alleles. Weaker associations were present for face identity perception and memory for emotional facial expressions. There was no association between the 5-HTTLPR/rs25531 polymorphism and non-social abilities, demonstrating discriminant validity of the relationships. We discuss the implications and possible neural mechanisms underlying these novel findings.

[Uveitis in multiple sclerosis : Overview and perspectives]. / Uveitis bei multipler Sklerose : Übersicht und Ausblick.

The association of uveitis and multiple sclerosis (MS) is less well known than the association between optic neuritis and MS even though MS patients suffer ten times more often from uveitis than the normal population. In this group of patients, intermediate uveitis presenting with periphlebitis and "snowbanks" or "snowballs", as well as granulomatous anterior uveitis play an important role. Simultaneous occurrence of MS and uveitis could be due to the fact that both neural and ocular tissues have the same embryological origin or could be the consequence of an immunological reaction following an Epstein-Barr virus infection. The aim is to find a drug for these patients that treats both MS and uveitis. Currently various studies with different drugs already used successfully in MS patients are under investigation for use in the treatment of uveitis. There is some evidence that interferon beta is effective in macular edema associated with uveitis. Other substances, such as daclizumab, natalizumab and fingolimod also seem to be promising.

[Human babesiosis - a rare but potentially dangerous zoonosis]. / Humane Babesiose - eine seltene, aber potenziell gefährliche Zoonose.

Human babesiosis is caused by the intraerythrocytic parasite of the genus Babesia (phylum Apicomplexa). Humans are commonly infected by the bite of Ixodid ticks. Rarely, transmission does occur perinatal or via contaminated blood transfusion. There is only insufficient data available on the clinical relevance in Europe, whereas there are known endemic states in the United States with an increasing importance of the disease in transfusion medicine. The following article gives an overview of the situation in Germany. Human babesiosis is a zoonotic disease with a worldwide increasing importance according to the increasing number of immunocompromised patients. Clinical symptoms have a wide range from asymptomatic to severe and letal cases. So far, the detection of the parasites in ticks and seroepidemiological data in Europe identified 3 humanpathogenic species: B. microti, B. divergens und B. venatorum (EU1-3). The relative small number of approximately 50 documented human cases is probably due to the lack of knowledge of the disease and the availability of diagnostic tools. Comprehensive systematic investigations of the prevalence in ticks, seroepidemiological data and improved diagnostic tests are urgently needed to evaluate the importance of the parasite.

Human babesiosis in Europe: what clinicians need to know.

Although best known as an animal disease, human babesiosis is attracting increasing attention as a worldwide emerging zoonosis. Humans are commonly infected by the bite of ixodid ticks. Rare ways of transmission are transplacental, perinatal and transfusion-associated. Infection of the human host can cause a very severe host-mediated pathology including fever, and hemolysis leading to anemia, hyperbilirubinuria, hemoglobinuria and possible organ failure. In recent years, apparently owing to increased medical awareness and better diagnostic methods, the number of reported cases in humans is rising steadily worldwide. Hitherto unknown zoonotic Babesia spp. are now being reported from geographic areas where babesiosis was not previously known to occur and the growing numbers of travelers and immunocompromised individuals suggest that the frequency of cases in Europe will also continue to rise. Our review is intended to provide clinicians with practical information on the clinical management of this rare, but potentially life-threatening zoonotic disease. It covers epidemiology, phylogeny, diagnostics and treatment of human babesiosis and the potential risk of transfusion-transmitted disease with a special focus on the European situation.

On the genetic basis of face cognition and its relation to fluid cognitive abilities.

The oxytocin and the dopaminergic systems have turned out to be highly relevant for social abilities and cognition. Therefore, we examined the association between two functional gene polymorphisms and face cognition (FC) in a multivariate study (N = 250) by applying structural equation modeling. The catechol-O-methyltransferase (COMT) val158met polymorphism influences the enzyme activity of COMT, which affects the prefrontal dopamine concentration. The rs226849 is a single-nucleotide polymorphism located in the promoter region of the oxytocin receptor (OXTR) gene, modulating the mRNA expression. By modeling a general fluid ability factor (defined by working memory and reasoning) and nested FC factors, we tested genetic contributions to FC, after controlling for variance in FC that was also associated with fluid abilities. In line with several previous studies, we found a significant association between the COMT genotype and fluid abilities (Gf) but not with FC. The association between the oxytocin polymorphism and Gf was opposite in direction for men and women. Women with the C(+) genotype performed better on Gf tasks than those with the C(-) genotype. Conversely, men with the C(-) genotype performed better than those with the C(+) genotype. There was no significant association between OXTR and the nested FC factor. Therefore, the relationship between the oxytocin polymorphism and FC can be fully accounted for by Gf. The sex specificity of this relationship is a novel finding and warrants a mechanistic explanation.

The hormone melatonin stimulates renoprotective effects of "early outgrowth" endothelial progenitor cells in acute ischemic kidney injury.

Endothelial progenitor cells (EPCs) protect the kidney from acute ischemic injury. The aim of this study was to analyze whether pretreatment of murine "early outgrowth" EPCs (eEPCs) with the hormone melatonin increases the cells' renoprotective effects in the setting of murine acute ischemic renal failure. Male (8-12 wk old) C57Bl/6N mice were subjected to unilateral ischemia-reperfusion injury postuninephrectomy (40 min). Postischemic animals were injected with either 0.5×10(6) untreated syngeneic murine eEPCs or with cells, pretreated with melatonin for 1 h. Injections were performed shortly after reperfusion of the kidney. While animals injected with untreated cells developed acute renal failure, eEPC pretreatment with melatonin dramatically improved renoprotective actions of the cells. These effects were completely reversed after cell pretreatment with melatonin and the MT-1/-2 antagonist luzindole. In vitro analysis revealed that melatonin reduced the amount of tumor growth factor-ß-induced eEPC apoptosis/necrosis. Secretion of vascular endothelial growth factor by the cells was markedly stimulated by the hormone. In addition, migratory activity of eEPCs was enhanced by melatonin and supernatant from melatonin-treated eEPCs stimulated migration of cultured mature endothelial cells. In summary, melatonin was identified as a new agonist of eEPCs in acute ischemic kidney injury.

[Precision of a new device for biometric measurements in pseudophakic eyes]. / Präzision eines neuen Biometriegeräts zur Messung pseudophaker Augen.

BACKGROUND: Biometric measurements and the knowledge of interrelationships of structures within the eye are especially mandatory for cataract and refractive surgery. As the number of pseudophakic patients steadily increases because cataract surgery becomes more easily available all over the world, exact biometry of eyes with crystalline lenses as well as pseudophakic eyes is gaining interest. In the present study we compared biometric measurements in pseudophakic eyes using a new optical low-coherence reflectometry (OLCR) device with results measured by the IOLMaster. PATIENTS AND METHODS: In this prospective study 140 pseudophakic eyes from 123 adult volunteers following uneventful cataract surgery and IOL implantation were examined at the International Vision Correction Research Centre (IVCRC) at the University of Heidelberg, Germany. The aim of this study was to evaluate a functional prototype of the new LENSTAR LS 900 (Haag-Streit)/ALLEGRO BioGraph (Wavelight) biometer and the IOLMaster V.5 (Carl Zeiss Meditec) and to compare axial length (AL) and keratometry measurements with those obtained by the IOLMaster. Additionally we investigated whether the LENSTAR/BioGraph can detect anterior chamber depth (ACD) and the effective lens position (ELP) of IOLs by OLCR in pseudophakic eyes. Patients with corneal or intraocular pathology and patients who had undergone other surgery in the investigated eye or whose cataract surgery dated back less than 4 weeks were not included in the study. Measurements were repeated with both devices as recommended by the manufacturers. Results were compared using Bland-Altman plots, Passing Bablok regression analysis and Pearson correlation calculations (MedCalc version 7.3.0.1). RESULTS: Valid axial length measurements were available in 137 eyes. The mean values were 23.75 mm for both devices (SD±2.08 with the IOLMaster, ±1.7 with the LENSTAR/BioGraph). The mean corneal radius (R) was 7.7±0.27 mm (IOLMaster) vs. 7.74±0.29 mm (LENSTAR/BioGraph). Valid ACD measurements with the LENSTAR/BioGraph were achieved in 30% of all cases. In 98.6% of the eyes in which ACD was analyzed manually a mean ACD of 4.73±0.53 mm was found. CONCLUSIONS: Both devices tested in this study showed a high correlation for AL and keratometry measurements. ACD measurements performed with the LENSTAR/BioGraph showed a measurable signal but the prototype calculated a value only in the minority (30%) of cases. This study showed that on the one hand the LENSTAR/BioGraph has the potential to be a reliable and useful machine for clinical everyday routine: This space and time-saving device includes several features which make it a patient and user friendly tool for diagnostics as well as screening. On the other hand we found that the software used in the prototype could be improved especially in order to identify IOLs and to measure reliable ACD values in pseudophakic patients. IOL surfaces did not generate sufficient interference signals in the LENSTAR/BioGraph and although the light reflected by the IOL surfaces was recognized by the device the software version used in this study did not generate numerical results for ACD.

Established and emerging pathogens in Ixodes ricinus ticks collected from birds on a conservation island in the Baltic Sea.

Tick-borne pathogens such as Lyme borreliosis spirochaetes, Anaplasma phagocytophilum, Rickettsia spp. and Babesia spp. cause a great variety of diseases in animals and humans. Although their importance with respect to emerging human diseases is increasing, many issues about their ecology are still unclear. In spring 2007, 191 Ixodes ricinus (Acari: Ixodidae) ticks were collected from 99 birds of 11 species on a bird conservation island in the Baltic Sea in order to test them for Borrelia spp., A. phagocytophilum, Rickettsia spp. and Babesia spp. infections. Identification of the pathogens was performed by polymerase chain reaction (PCR), restriction fragment length polymorphism and sequence analysis. The majority of birds with ticks testing positive were European robins and thrushes. Borrelia DNA was detected in 14.1%, A. phagocytophilum in 2.6%, rickettsiae in 7.3% and Babesia spp. in 4.7% of the ticks. Co-infections with different pathogens occurred in six ticks (3.1%). The fact that 11 ticks (five larvae, six nymphs) were infected with Borrelia afzelii suggests that birds may, contrary to current opinion, serve as reservoir hosts for this species. Among rickettsial infections, we identified Rickettsia monacensis and Rickettsia helvetica. As we detected five Rickettsia spp. positive larvae and two birds carried more than one infected tick, transmission of those pathogens from birds to ticks appears possible. Further characterization of Babesia infections revealed Babesia divergens and Babesia microti. The occurrence of Babesia spp. in a total of five larvae suggests that birds may be able to infect ticks, at least with Ba. microti, a species considered not to be transmitted transovarially in ticks.

[Development of disease-specific patient groups within Pro Retina]. / Entwicklung diagnosespezifischer Gruppen in der Pro Retina.

The formation, development and external impact of the following eight disease-specific patient groups with rare forms of retinal degeneration (RRD) within the patient organization Pro Retina are described: Gyrate Atrophy, Bardet-Biedl Syndrome (BBS), Adult Refsum's Disease, Usher Syndrome, Rod-Cone Dystrophy, Leber's Congenital Amaurosis, Choroideremia and Stargardt Disease/juvenile macular degeneration. Within the project sponsored by the German Ministry of Health (BMG) approaches of patient self-help for an adequate organization and interaction with the professional medical care system were supported, analyzed and documented. In syndromic RRD a relatively high proportion of patients are organized in patient groups (Refsum's disease 25%, BBS 14%, Usher Syndrome 8%). Patients with syndromic RRD are more highly motivated to contribute to self-help work than patients with non-syndromic RRD. At the same time, these patients are more dependent on the support from their relatives and on technical aids. The following tendencies in the development of RRD groups were observed: increasing focus on one patient organization (PRO RETINA Deutschland, Self-Help Organisation of People with Retinal Degenerations) all RRD groups in Pro Retina grew; RRD groups became increasingly independent within Pro Retina; external activities of the groups showed considerable increase. Stable work relationships with scientific and medical care institutions have been established. The example of RRD demonstrates how rare and isolated patients receive basic coping support by self-help groups, how they deal with resources in a collective way and how they can interact with the medical care system.

Reentrant condensation of proteins in solution induced by multivalent counterions.

Negatively charged globular proteins in solution undergo a condensation upon adding trivalent counterions between two critical concentrations C and C, C

Nitric oxide reduces organ injury and enhances regeneration of reduced-size livers by increasing hepatic arterial flow.

BACKGROUND: Reduced-size livers suffer from portal hyperperfusion, diminished arterial blood flow and the risk of postoperative liver injury. The aim of this experimental study was to unravel the role of nitric oxide in this setting. METHODS: Rats underwent 85 per cent partial hepatectomy and either substitution of nitric oxide with molsidomine or inhibition of nitric oxide synthase (NOS) with N(G)-nitro-L-arginine methyl ester. Untreated hepatectomized animals served as controls and unresected animals as the sham group. RESULTS: Ultrasonic flowmetry following partial hepatectomy revealed a marked increase in portal venous inflow with a concomitant decrease in hepatic arterial inflow. Nitric oxide substitution counteracted the decline in hepatic arterial inflow and caused a significantly greater increase in cell proliferation after partial hepatectomy compared with control or NOS-inhibited animals. Hepatectomized animals further profited from nitric oxide substitution, as indicated by reduced aminotransferase release and improved liver function. CONCLUSION: Nitric oxide improves the postoperative course of rats with reduced-size livers by modulating hepatic macrohaemodynamics and mediating regeneration and cytoprotection, but not by reducing hepatic hyperperfusion and the accompanying sinusoidal shear stress.

Babesiosis: recent insights into an ancient disease.

Ever since the discovery of parasitic inclusions in erythrocytes of cattle in Romania by Victor Babes at the end of the 19th century, newly recognised babesial pathogens continue to emerge around the world and the substantial public health impact of babesiosis on livestock and man is ongoing. Babesia are transmitted by ixodid ticks and infection of the host causes a host-mediated pathology and erythrocyte lysis, resulting in anemia, hyperbilirubinuria, hemoglobinuria, and possibly organ failure. Recently obtained molecular data, particularly for the 18S rRNA gene, has contributed significantly to a better understanding of the sometimes puzzling phylogenetic situation of the genus Babesia and new information has been added to help determine the taxonomic position of many species. Moreover, it seems that owing to higher medical awareness the number of reported cases in humans is rising steadily. Hitherto unknown zoonotic babesias are now being reported from geographical areas where babesiosis was not known to occur and the growing numbers of immunocompromised individuals suggest that the frequency of cases will continue to rise. This review covers recent insights into human babesiosis with regard to phylogeny, diagnostics and treatment in order to provide new information on well known as well as recently discovered parasites with zoonotic potential.

[Patient participation in medical care, taking rare retinal degenerations as examples]. / Patientenselbsthilfe und seltene Erkrankungen. Mitgestaltung der Versorgungsrealität am Beispiel seltener Netzhautdegenerationen.

Eight rare retinal degenerations were chosen to exemplify self-organisation and involvement of patient self-help groups in medical care. They were studied and supported in their development on the following levels: disease-specific groups (level 1), patient organisations (level 2), umbrella organisation (level 3). Databases of defined needs and concerns ("Themenspeicher") of disease-specific patient groups and of patient organisations with respect to care, research and patient networking were established. Priority concerns were implemented in the following areas: specialised medical care; quality assurance; quality management; expert panel with international dialogue of patients and physicians (including consensus statement on treatment recommendations); glossary internet portal; criteria for patient-oriented disease descriptions; structured documentation of patient experiences; patient management of health care records (paper bound and electronic health records). Apart from disease- specific approaches, interdisciplinary disease approaches were also applied, e.g. by contributing to the establishment of the German Alliance for Rare Diseases (ACHSE). This umbrella organisation has substantially improved chances for cooperation and patient advocacy. Patient participation was promoted by a federal regulation in 2004 ("Patientenbeteiligungsverordnung"). The example of rare retinal degenerations demonstrates the advantage of strong patient and umbrella organisations. Further development of qualified self-help resources is required for patient participation in rare diseases.

First confirmed autochthonous case of human Babesia microti infection in Europe.

A 42-year-old female patient with acute myeloid leukemia presented with fever and heavy chest pain after her first cycle of specific chemotherapy. Acute myocardial infarction was excluded, but surprisingly, parasitic inclusions in erythrocytes became obvious in Pappenheim and Giemsa-stained peripheral blood smears. The patient did not remember a tick bite but acknowledged having received several blood transfusions in her recent medical history. Suspicion of malaria was ruled out by use of a dip-stick test. The diagnosis of Babesia microti infection was finally established by specific polymerase chain reaction (PCR). Six weeks after initiation of specific treatment, PCR turned negative and a positive immunoflourescence assay (IFA) with an IgG titer of 1:128 indicated seroconversion. Subsequent screening of donors involved in the transfusion of blood products to the patient demonstrated borderline reactivity for Babesia microti (IgG-titer 1:32) in 1 out of 44 individuals. Neither the patient nor the positively tested blood donor had travelled to North America or Asia. Therefore, this is the first confirmed autochthonous human infection in Europe.

Optical immunosensor for fast and sensitive detection of DDT and related compounds in river water samples.

A surface plasmon resonance (SPR) based immunosensor has been developed for the monitoring of environmentally persistent pollutants like DDT, its metabolites and analogues in real water samples. A reusable immunosurface is provided via the covalent attachment of the analyte derivative to a self-assembled alkanethiol monolayer formed onto the SPR gold-thin layer. The regeneration of the sensor surface allowed the performance of 270 assay cycles within an analysis time of 20 min for each assay cycle. Immunoassays based on a binding inhibition format were performed by using two monoclonal antibodies (MAbs) with different selectivity. Low limits of detection (LODs), in the sub-nanogram per litre range, were attained for DDT-selective (15 ng L-1) and DDT group-selective immunoassays (31 ng L-1). Both assays were carried out in spiked river water samples without significant effect of the matrix. SPR measurements were validated using gas-chromatography-mass spectrometry. The comparison between methods was in good agreement showing an excellent correlation coefficient (r2=0.995). The SPR analysis of DDT proved to be three times more sensitive than colorimetric ELISAs without the need of labelling and a much lower time of response. Our SPR biosensor portable platform (beta-SPR) is already commercialised by the company SENSIA, S.L. (Spain).

Public knowledge and attitudes on organ donation do not differ in Germany and Spain.

BACKGROUND: The background of this study was the inadequate supply of donor organs in Germany. In Spain, by contrast, a strong increase of organ donors over the past years has created a satisfactory supply situation. Because both countries have similar legal situations, the causes for the drastic differences in organ donation rates remain unclear. The main issue of our study was to investigate the intellectual attitudes toward various aspects of postmortem donations in the populations of both countries as a causative factor for the observed differences. METHODS: We studied 726 persons by questionnaire. Probands, matched for age and gender, were recruited among medical students, in a public library and in a general medical practice in both Germany and Spain. RESULTS: We found no differences in the attitudes toward postmortem organ donation between the two countries. Differences among the social groups within the countries were apparent in the expected direction. CONCLUSION: A higher level of knowledge or a difference in attitudes toward organ donation is probably not the reason for the higher donation rate in Spain. The cause appears to be rather at the organizational level.

Determination of carbaryl in natural water samples by a surface plasmon resonance flow-through immunosensor.

The analysis of carbaryl in natural water samples was accomplished using a portable immunosensor based on surface plasmon resonance (SPR) technology. The assay was based on a binding inhibition immunoassay format with the analyte derivative covalently immobilized on the sensor surface. An alkanethiol self-assembled monolayer (SAM) was formed onto the gold-coated sensor surface to allow the reusability of the same sensing surface during 220 regeneration cycles. Reproducibility was evaluated by performing three independent assays in triplicate on 3 different days. The batch-assay variability was also calculated using three different gold-coated sensor surfaces. The intra- and inter-day relative standard deviation were 8.6 and 15.3%, respectively, whilst a variation of 7.4% in assay sensitivity was obtained by employing different sensor chips. The lowest detection limit, calculated as the concentration providing a 10% decrease of the blank signal, was of 1.38 microg L(-1). Matrix effects were also evaluated in different water types, showing I50 values (carbaryl concentrations that produced a 50% decrease of the blank signal) within the range of carbaryl standard curves in distilled water (2.78-3.55 microg L(-1)). The carbaryl immunoassay performance was validated with respect to conventional high-performance liquid chromatography-mass spectrometry (HPLC-MS). The correlation between methods was in good agreement (r2 = 0.998, 0.999 and 0.999) for the three types of natural water samples tested. A complete assay cycle, including regeneration, is accomplished in 20 min. All measurements were carried out with the SPR sensor system (beta-SPR) commercialised by the company SENSIA, SL (Spain). The small size and low-time of response of the beta-SPR platform would allow its utilization in real contaminated locations.

A novel transcriptome subtraction method for the detection of differentially expressed genes in highly complex eukaryotes.

We have designed a novel transcriptome subtraction method for the genome-scale analysis of differential gene expression in highly complex eukaryotes, in which suppression subtractive hybridization (SSH) is performed first to enrich the target and, after exchange of adapters, negative subtraction chain (NSC) is then used to eliminate the remaining background. NSC evolved from differential subtraction chain (DSC). We designed novel adapters which make the subtraction system more robust. SSH and NSC were then combined to successfully detect differentially expressed genes in Solanum. The combined technique improves qualitatively upon SSH, the only commercially available transcriptome subtraction system, by detecting target genes in the middle abundance class, to which most differentially expressed genes in highly complex eukaryotes are expected to belong. The main advantage of the combined technique with SSH/NSC is its ability to isolate differentially expressed genes quickly and cost-efficiently from non-standard models, for those microarrays are unavailable.

Novel formulation of nonlocal electrostatics.

The accurate modeling of the dielectric properties of water is crucial for many applications in physics, computational chemistry, and molecular biology. This becomes possible in the framework of nonlocal electrostatics, for which we propose a novel formulation allowing for numerical solutions for the nontrivial molecular geometries arising in the applications mentioned before. Our approach is based on the introduction of a secondary field psi, which acts as the potential for the rotation free part of the dielectric displacement field D. For many relevant models, the dielectric function of the medium can be expressed as the Green's function of a local differential operator. In this case, the resulting coupled Poisson (-Boltzmann) equations for psi and the electrostatic potential phi reduce to a system of coupled partial differential equations. The approach is illustrated by its application to simple geometries.