Lipoprotein apheresis influences monocyte subpopulations.

BACKGROUND: Monocytes can be differentiated into subpopulations depending on their expression profile of CD14 and CD16. CD16-positive monocytes are associated with coronary artery disease. Up to now, no data exist about the effect of lipoprotein apheresis (LA) on the distribution of monocyte subpopulations. METHODS: 80 patients who underwent LA at the University Hospital Dresden were included in the study. 8 out of the 80 LA patients received LA for the first time at the time point of blood analysis. Six different methods of LA were used (H.E.L.P. n = 8; Liposorber D n = 10; LF n = 14; DALI n = 17; MONET n = 11; Therasorb® LDL n = 12). Blood samples were taken immediately before and after LA and analyzed for CD14 and CD16 expression on monocytes. A total of 42 patients with cardiovascular risk factors but no indication for LA served as control group. RESULTS: The composition of monocyte-population was analyzed in regard to the 3 subpopulations. After LA, an increase in classical monocytes (CD14++CD16-) (93.3% vs. 93.9%, p < 0.01) and a decrease in non-classical monocytes (CD14+CD16+) (1.5% vs 1.0%; p < 0.001) were observed. LA did not change the amount of intermediate monocytes (CD14++CD16+) (5.3% vs. 5.1%). Two methods (MONET and Therasorb® LDL) did not influence the distribution of monocyte subpopulations. Interestingly, patients with LDL-C above 2.5 mmol/l prior LA showed increased amounts of intermediate monocytes. CONCLUSION: The distribution of monocyte populations is influenced by LA but depends on the distinct method of LA. Influences of LA were mainly observed in the content of classical and non-classical monocytes, whereas the intermediate monocyte population remained unaltered by LA.

A prospective, cohort evaluation of major and minor airway management complications during routine anaesthetic care at an academic medical centre.

The aim of this study was to develop an audit tool to identify prospectively all peri-operative adverse events during airway management in a cost-effective and reproducible way. All patients at VU University Medical Center who required general anaesthesia for elective and emergency surgical procedures were included during a period of 8 weeks. Daily questionnaires and interviews were taken from anaesthesia trainees and anaesthetic department staff members. A total of 2803 patients underwent general anaesthesia, 1384 men and 1419 women, including 2232 elective patients and 571 emergency procedures, 697 paediatric and 2106 adult surgical procedures. A total of 168 airway-related events were reported. The incidence of severe airway management-related events was 24/2803 (0.86%). There were 12 (0.42%) unanticipated ICU admissions, two patients (0.07%) required a surgical airway. There was one (0.04%) death, one cannot intubate cannot oxygenate (0.04%), one aspiration (0.04%) and eight (0.29%) severe desaturations < Sp O2 50%. We suggest that our method to determine and investigate airway management-related adverse events could be adopted by other hospitals.

Muscle growth in young horses: Effects of age, cytokines, and growth factors.

Success as equine athletes requires proper muscle growth in young horses. Muscle hypertrophy occurs through protein synthesis and the contribution of muscle satellite cells, which can be stimulated or inhibited by cytokines and growth factors present during exercise and growth. The hypotheses of this study were that 1) the LM area in young horses would increase over 1 yr, and 2) specific cytokines and growth factors (IL-1ß, IL-6, tumor necrosis factor [TNF]-α, IGF-I, and fibroblast growth factor [FGF]-2) would alter proliferation and differentiation of satellite cells isolated from young horses. Fourteen horses were divided into 3 age groups: weanlings ( = 5), yearlings to 2 yr olds ( = 4), and 3 to 4 yr olds ( = 5). The area, height, and subcutaneous fat depth of the LM were measured using ultrasonography, and BW and BCS were taken in October (Fall1), April (Spring), and October of the following year (Fall2). Satellite cells obtained from 10-d-old foals ( = 4) were cultured in the presence of IL-6, IL-1ß, TNF-α, IGF-I, or FGF-2 before evaluation of proliferation and differentiation. Data were analyzed using PROC MIXED in SAS. Body weight increased from Fall1 to Spring in weanlings ( < 0.001) and increased in all horses from Spring to Fall2 ( ≤ 0.02). Area and height of the LM increased over time ( < 0.001) and with increasing age group of horse ( ≤ 0.03), although there was no interaction of time and age ( > 0.61). There was a significant increase in LM area in all animals from Spring to Fall2 ( < 0.001) but not from Fall1 to Spring. Interleukin-6 and TNF-α decreased satellite cell proliferation by 14.9 and 11.5%, respectively ( ≤ 0.01). Interleukin-6 increased fusion 6.2%, whereas TNF-α decreased fusion 8.7% compared with control cells ( ≤ 0.001). Interleukin-1ß had no effect on proliferation ( = 0.32) but tended to decrease fusion ( = 0.06). Satellite cell proliferation was increased 28.8 and 73.0% by IGF-I and FGF-2, respectively ( < 0.0001). Differentiation was decreased 13.1% in the presence of FGF-2 but increased 3.5% in the presence of IGF-I ( ≤ 0.01). In summary, the LM area increases over the course of a year in young horses with the most growth occurring in summer. By stimulating or inhibiting proliferation and differentiation of satellite cells, IL-6, TNF-α, IL-1ß, IGF-I, and FGF-2 may alter muscle growth in young horses, thereby impacting athletic potential.

HORSE SPECIES SYMPOSIUM: The aging horse: Effects of inflammation on muscle satellite cells.

With improvements in care, the equine population is living longer, remaining active, and competing at increasingly older ages. Both advancing age and exercise result in increased concentrations of circulating and local cytokines, including IL-1ß, IL-6, and tumor necrosis factor-α. Athletic endeavors in the aged horse may further increase the proinflammatory environment in muscle, decreasing the ability to react appropriately to exercise. Poor response to exercise limits the athletic ability of geriatric horses, thus reducing their useful life span and potentially increasing the risk of injury. Satellite cells are muscle stem cells that reside adjacent to muscle fibers in skeletal muscle and are at least partially responsible for maintenance of muscle mass and muscle hypertrophy. In the adult animal, these cells normally exist in a quiescent state, becoming active, proliferating, and differentiating in response to specific stimuli. Growth factors and cytokines present during hypertrophy and following exercise affect satellite cell activity. Whereas the specific effects of cytokines on equine satellite cells are not well established, cytokines can influence satellite cell and myoblast proliferation and differentiation both positively and negatively. Understanding the effects of cytokines on equine satellite cell function will provide insight into the mechanisms responsible for the poor response to exercise in the aged horse. The proinflammatory environment in aged horses may inhibit exercise induced satellite cell activity, thereby diminishing exercise-induced hypertrophy. As more horses are surviving and competing into their 20s, more research is required to understand the response of these animals to exercise during normal aging.

Metabolic parameters and their relationship to energy balance in multiparous Simmental, Brown Swiss and Holstein cows in the periparturient period as influenced by energy supply pre- and post-calving.

A study was conducted to evaluate the effects of three energy supply (E) levels [low (L), medium (M), high (H)], both pre-partum (PRE) and post-partum (POST), and their interactions on metabolic parameters and energy balance (EB) in dairy cows of three breeds. In both phases, E levels applied to a total of 81 multiparous cows of breeds Simmental (SI), Brown Swiss (BS) and Holstein-Friesian (HF; n = 27 for each breed) were 75%, 100% and 125% of recommendations of the German Society of Nutrition Physiology, using a 3 × 3 factorial arrangement of treatments. During the pre-calving period, serum concentrations of non-esterified fatty acids (NEFA) were higher for L(PRE) cows, and glucose concentrations were elevated for H(PRE) cows. During the lactation period, NEFA concentrations were greatest for treatment L(POST). Mean concentrations of ß-hydroxybutyrate (BHB) were highest for cows of the L(POST) treatment, intermediate for M(POST) and lowest for H(POST). Glucose concentrations were lower for L(POST) cows. SI cows had lower BHB concentrations both pre- and post-calving and higher glucose concentrations during early lactation than the other breeds. BHB concentration POST was highest for BS cows. Restricted feeding PRE resulted in a better energy status of cows fed above energy requirements POST (E(PRE) × E(POST) interaction). HF cows had a higher EB pre-calving, whereas SI cows had a less negative EB during early lactation, compared with the other breeds respectively. Correlations of serum NEFA, BHB and glucose concentrations with EB were strongest during the transition period. Results suggest that controlling energy intake during the dry period might be advantageous for the energy status of dairy cows after calving, whereas energy restriction in early lactation leads to metabolic stress. Evidence is provided of a clear relationship between EB and the blood metabolites NEFA and BHB, especially in the transition period.

Influence of energy and nutrient supply pre and post partum on performance of multiparous Simmental, Brown Swiss and Holstein cows in early lactation.

A study was conducted to evaluate the effects of pre partum (PRE) and post partum (POST) dietary energy and nutrient supply (E) and their interactions on feed intake, performance and energy status in dairy cows of three breeds. In this experiment, the effects of three energy and nutrient supply levels (low (L), medium (M), high (H)), both pre-calving and post-calving, were investigated, using a 3×3 factorial arrangement of treatments. In both phases (84 days pre- and 105 days post-calving) E levels applied to a total of 81 multiparous cows of breeds Simmental (SI), Brown Swiss (BS) and Holstein-Friesian (HF; n=27 for each breed), were 75%, 100% and 125% of recommendations of the German Society of Nutrition Physiology (GfE). Dry matter intake (DMI) was restricted, if energy intake exceeded target values. Pre partum DMI and energy intake were different as designed, liveweight and body condition score (BCS) of SI cows were higher, but EB was lower, compared to BS and HF cows. Milk yield and composition were influenced by all three main experimental factors (EPRE, EPOST, breed). Energy-corrected milk yield was 25.6, 28.6 and 30.1 kg/day for LPRE, MPRE and HPRE as well as 21.5, 30.1 and 32.6 kg/day for LPOST, MPOST and HPOST, respectively. Numerically, only for milk protein content the interactions EPRE×EPOST and EPRE×breed reached significance. Impact of energy supply pre-calving was more pronounced when cows had lower energy supply post-calving and vice versa. On the other hand, milk yield response of cows to energy supply above requirements was greater for cows that were fed on a low energy level pre partum. Impact of energy level pre partum was higher for HF cows, showing that their milk production relies to a greater extent on mobilization of body reserves. Increasing energy supply pre partum led to a more negative energy balance post partum, mainly by increasing milk yield and content, whereas feed intake was slightly reduced. Increasing energy supply post partum enhanced milk yield as well as milk protein and lactose content. Calculated energy balance corresponded well with liveweight and BCS change. Response of milk yield to increasing energy supply followed the principle of diminishing returns, since energy was increasingly partitioned to body retention. Increasing energy supply pre partum enhances milk yield and content post partum, but exacerbates negative energy balance and its consequences.

Tracheal intubation with a camera embedded in the tube tip (Vivasight(™) ).

We studied tracheal intubation in manikins and patients with a camera embedded in the tip of the tracheal tube (Vivasight(™) ). Four people in two teams and two individuals attempted intubation of a manikin through an i-gel(™) 10 times each. The tracheas of 12 patients with a Mallampati grade of 1 were intubated with a Vivasight tracheal tube through a Berman airway, passed over a Frova(™) introducer. All 60 manikin intubations were successful, taking a mean (SD) time of 1.4 (0.5) s. The fastest intubation was performed in 0.5 s. All 12 participants' tracheas were successfully intubated in a median (IQR [range]) time of 90 (70-120 [50-210]) s. Seven participants complained of a sore throat, comparable with earlier findings for standard laryngoscopy and intubation: five mild; one moderate; and one severe. Tracheal intubation with the Vivasight through the i-gel or Berman airway is an alternative to existing techniques, against which it should be compared in randomised controlled trials in human participants. It has potential as a fast airway rescue technique.

International investigation of breast MRI: results of a multicentre study (11 sites) concerning diagnostic parameters for contrast-enhanced MRI based on 519 histopathologically correlated lesions.

A multicentre study was undertaken to provide fundamentals for improved standardization and optimized interpretation guidelines of dynamic contrast-enhanced MRI. Only patients scheduled for biopsy of a clinical or imaging abnormality were included. They underwent standardized dynamic MRI on Siemens 1.0 (163 valid lesions > or = 5 mm) or 1.5 T (395 valid lesions > or = 5 mm) using 3D fast low-angle shot (FLASH; 87 s) before and five times after standardized bolus of 0.2 mmol Gd-DTPA/kg. One-Tesla and 1.5 T data were analysed separately using a discriminant analysis. Only histologically correlated lesions entered the statistical evaluation. Histopathology and imaging were correlated in retrospect and in open. The best results were achieved by combining up to five wash-in or wash-out parameters. Different weighting of false-negative vs false-positive calls allowed formulation of a statistically based interpretation scheme yielding optimized rules for the highest possible sensitivity (specificity 30%), for moderate (50%) or high (64-71%) specificity. The sensitivities obtained at the above specificity levels were better at 1.0 T (98, 97, or 96%) than at 1.5 T (96, 93, 86%). Using a widely available standardized MR technique definition of statistically founded interpretation rules is possible. Choice of an optimum interpretation rule may vary with the clinical question. Prospective testing remains necessary. Differences of 1.0 and 1.5 T are not statistically significant but may be due to pulse sequences.

Detection of serum autoantibodies to tumor suppressor gene p53 with a new enzyme-linked immunosorbent assay in patients with ovarian cancer.

Sera from 99 ovarian cancer patients were assayed for serum autoantibodies to p53 using a newly developed enzyme-linked immunosorbent assay (ELISA). Results were compared to the investigation using the former ELISA. The incidence of autoantibodies (25%) was lower using the newly developed ELISA as compared to the previous results (41%). The results were consistent in 79% of patients (P < .001). The incidence of autoantibodies was lower in patients with complete remission (19%) as compared to that of patients with recurrence (30%) and before primary surgery (26%). No statistically significant correlation was found among p53 serum autoantibody status and tumor stage, degree of malignancy, histologic subtype, and residual tumor after primary surgery. Use of the newly developed ELISA resulted in a higher consensus between immunohistochemically negative and autoantibody negative cases. Owing to further purifying of the prepared human recombinant p53. the newly developed ELISA seems to be of higher specificity as compared to the former ELISA.

Partial cambial mortality in high-elevation Pinus aristata (Pinaceae).

Partial cambial mortality is a growth form that is characteristic of Pinus aristata trees. To better elucidate their cambial death pattern, tree size and aspect of cambial death data were gathered from three Pinus aristata forests in central Colorado, USA. Stripping frequency tended to be higher for larger diameter classes. Partial cambial mortality exhibits significant directionality within each stand. Furthermore, cambial death was measured to be most frequent on the wind-exposed side of stripped trees in two of the three study sites and appeared to be at the third. Data presented here support the hypothesis that wind plays a role in the occurrence of partial cambial mortality in Pinus aristata. The mechanisms by which wind causes cambial mortality remain unclear.

[Psychological disorders and environmental pollution]. / Seelische Störungen und Umweltbelastung.

In the past years Environmental Medicine has established itself in the departments of community medicine. The clients of these health offices as well as those attending other Environmental Outpatient Departments and who suffer from anxiety in connection with environmental pollution show increasingly psychomatic and even psychiatric disturbances. This paper demonstrates, from the psychiatrists as well as the environmental physicians point of view, the relationship between psychological disturbances and environmental pollution in a typical case-history. The differentiation between possibly toxically induced symptoms and psychologically caused symptoms will be made clear. The aim of this interdisciplinary paper is to contribute towards reducing contact anxiety between Psychiatry und Environmental Medicine also to reduce the clients' fears of psychiatrisation and thus to facilitate therapeutic intervention.

Helicobacter pylori-induced hyperproliferation: relevance for gastric cancer development in connection with mutagenic factors.

AIMS: Current data on Helicobacter pylori induced regenerative hyperproliferation of the antral gastric mucosa and significance in cancer development are still under discussion and investigation. An improved method for evaluation of the regeneratory process in antral mucosa is introduced and compared with the conventional method used for determination of proliferating cells in perpendicular sections of the gastric mucosa. METHODS: Using a combination of immunohistochemistry and PAS-staining the expression of Ki-67 (MiB1)-proliferation associated antigen was analyzed in 50 Helicobacter pylori (Hp) positive and 35 negative biopsies of the gastric antrum. PAS-staining was performed to identify the proliferative zone of the antral gastric glands. The degree of inflammation was evaluated by grades on routinely H & E-stained slides. RESULTS: Proliferative activity is significantly increased in Hp-positive cases (p = 0.00095) compared to negative ones. By using the conventionally applied proliferation index, every nucleus has to be counted and the proliferation zone is identified by at least one positive stained nucleus. The method presented here seems to be easier because the proliferative zone is clearly identified by PAS staining of neutral glycoproteins characteristic for the proliferation zone of antral glands. The density of labeled nuclei is determined and is expressed as a proliferation factor. This factor gives more distinct values, is easier to evaluate and shows a better correlation with the helicobacter status and the degree of inflammation. These results are discussed in relation to the data from the literature and with a view to other relevant factors in the course of carcinogenesis, such as growth factors, mainly EGF, p53 mutation and role of apoptosis, genetic instability and local production of oxidants. CONCLUSION: Helicobacter pylori induces an increase of regenerative proliferation activity. Under these conditions the chance of mutation is increased and time for DNA repair reduced. This could be at least a part of multiple step carcinogenesis. The newly introduced combination of staining procedures (PAS/MiBI) allows a more differentiated evaluation of the proliferation zone and its widening. This method can be more easily handled in follow-up studies than the method using perpendicular sections because in this method heavy irregularities of gland pattern induced by accompanying inflammatory processes considerably hinder evaluation.

Differential binding activities of lectins and neoglycoproteins in human testicular tumors.

Testicular germ-cell tumors, a morphologically and clinically diverse group of malignancies provide an ideal model for investigating the biology of glycoconjugates because the biosynthesis of oligosaccharide chains of glycoproteins monitored by plant/invertebrate lectins often changes during tumorigenesis, tumor progression, and metastasis. To investigate such changes in germ-cell tumors, we analyzed 67 surgical specimens from 31 seminomas, 32 embryonic carcinomas, and four choriocarcinomas using glyco- and immunohistochemistry that involved five plant/invertebrate lectins, 16 neoglycoproteins, and galectin-1 antibody. The results showed that some of these markers, such as melibiose-, lactose-, and beta-N-acetylgalactosamine-BSA-biotin were clearly differentially expressed amongst these tumors and between primary and metastatic embryonic carcinomas. The differences in staining for positivity, intensity, and heterogeneity indicate that the differential display of glycoconjugates in tumor cells may be important in tumor growth, metastasis, or prognosis because subtypes of these tumors behave quite differently from one another. Furthermore, we also found identical staining for positivity between most neoglycoproteins and their corresponding lectins, though the staining intensity of neoglycoproteins was weaker. This suggests that neoglycoproteins may be useful markers to replace their plant lectins.

Analysis of the DNA mismatch repair proteins expression in malignant melanomas.

The importance of properly functioning DNA mismatch repair has been shown in several tumour types both hereditary and sporadic, but not yet in malignant melanomas. The aim of this study was to examine the expression of DNA mismatch repair genes (MLH1, MSH2, PMS1 and PMS2) in primary melanomas and to define their possible prognostic impact in 106 primary melanomas. MLH1 was found in 64 and MSH2 in 61 out of 106 melanomas. PMS1 and PMS2 proteins were present in 69 and 67 tumours, respectively. Loss of the expression of DNA mismatch repair proteins correlated with the increase of Clark levels. Cox regression analysis demonstrated some prognostic significance for PMS1 (forward p = 0.0018 and backward selections p = 0.0277), MLH1 (only forward selection p = 0.0081) and MSH2 (only backward selection p = 0.0115).