[Severe blunt thoracic trauma caused by ski collision]. / Schweres stumpfes Thoraxtrauma nach Skikollision.

An approximately 25-year-old skier collided in a ski-run intersection. At high speed, he first hit another skier and then smashed into a snow cannon. He died from his injuries a short time later in hospital. A whole-body CT scan was conducted under resuscitation conditions, which was followed by an autopsy. The investigation revealed a severe blunt thoracic trauma as cause of death. The detailed analysis was the result of the combination of the two methods of investigation, CT scan and autopsy. The methods complemented each other effectively and allowed for a detailed presentation of the injury pattern. In conjunction with the additional analytical accident report, this combination of CT scan and autopsy contributes towards a reconstruction of accidents and the development of prevention measures and related protective systems.

Postmortem computed tomography (PMCT) and autopsy in deadly gunshot wounds--a comparative study.

INTRODUCTION: Postmortem computed tomography (PMCT) data in gunshot-related death were evaluated by two reader groups and compared to the gold standard autopsy for the determination of forensic pathology criteria. MATERIALS AND METHODS: Reader group I consisted of two board-certified radiologists whereas one board-certified radiologist and one board-certified forensic pathologist formed group II. PMCT data of 51 gunshot-related deaths were evaluated for the forensic pathology criteria number of gun shots, localization of gunshot injury, caliber, and direction of the gunshot differentiating between entry and exit wound as well as associated injury to surrounding tissue. The results of both reader groups were compared to the each other and to autopsy findings considered as gold standard. RESULTS: Reader groups I and II and as gold standard the autopsy evaluation showed in general a good correlation between all results. The overall discrepancy rate was 12/51 (23.4%) cases for group I and 8/51 (15.6%) for group II. DISCUSSION: Ultimately, the designated reader is able to draw the following conclusion from the presented data. At first, physical autopsy is better than PMCT regarding the localization of most gunshot injuries. Second, PMCT presents with better results than physical autopsy in locating fragmented bullets/fragment clouds, and finally, PMCT results of two radiologists were equivalent to the results of one evaluating radiologist and one pathologist with the exception of caliber assessment. However, referring to the pure numbers, the slight but not significant difference in the overall discrepancy rate of both reader groups might indicate the advantage of combining expertise in evaluating imaging in cases of gunshot-related death.

[Legal considerations regarding radiological examinations of bodypackers ordered by police officers]. / Röntgenuntersuchungen von Bodypackern auf Anordnung durch Polizeibeamte.

A 28-year-old woman was arrested for body packing. One pack was removed from her vagina by the forensic pathologist. She was referred by the police to an emergency surgical department to obtain a radiological examination of the abdomen in order to rule out the presence of further packs in the intestines. In the case of a negative result it would not be necessary to be kept under arrest. For this reason the woman agrees to the examination. The surgeon in the emergency department refused to perform an examination involving radiation exposure to a young woman without any medical indications according to the German X-Ray Ordinance § 23 subsection I. Generally a physician can refuse to perform examinations ordered by state authorities; however, the provision of expert testimony in legal proceedings by a judge, a state attorney or a high ranking police officer makes collaboration mandatory in accordance with § 75 of the German penal code of procedures. However, any relevant harm caused by the examination must be excluded with a very high degree of certainty.

[Diffusion-weighted MRI of the prostate]. / Diffusionsgewichtete MRT der Prostata.

Diffusion-weighted magnetic resonance imaging (DWI) can complement MRI of the prostate in the detection and localization of prostate cancer, particularly after previous negative biopsy. A total of 13 original reports and 2 reviews published in 2010 demonstrate that prostate cancer can be detected by DWI due to its increased cell density and decreased diffusiveness, either qualitatively in DWI images or quantitatively by means of the apparent diffusion coefficient (ADC). In the prostate, the ADC is influenced by the strength of diffusion weighting, localization (peripheral or transitional zone), presence of prostatitis or hemorrhage and density and differentiation of prostate cancer cells. Mean differences between healthy tissue of the peripheral zone and prostate cancer appear to be smaller for ADC than for the (choline + creatine)/citrate ratio in MR spectroscopy. Test quality parameters vary greatly between different studies but appear to be slightly better for combined MRI and DWI than for MRI of the prostate alone. Clinical validation of DWI of the prostate requires both increased technical conformity and increased numbers of patients in clinical studies.

[Multi-detector computed tomography in non-traumatic urologic emergencies]. / Multidetektor-CT bei nichttraumatischen urologischen Notfällen.

Today's modern multi-detector computer tomography (MDCT) with its fast gantry rotation enables scanning of large body volumes with high temporal and spatial resolution. The fast acquisition of data and subsequent data reconstruction enables multiphase protocols with short time gaps between consecutive scan series so that large numbers of scans within one respiratory pause are possible and even in cases of non-cooperative patients acceptable quality of image data is provided. The acquired thin-slice raw data with isotropic submillimeter voxels can be visualized with different reconstruction algorithms. The advantages of imaging for diagnostics in urologic emergencies are the excellent visualization of acute arterial and venous pathologies, detailed assessment of renal parenchyma and the precise depiction of the urinary tract. In non-trauma settings this enables detailed visualization of inflammatory diseases and differentiation of obstructive or post-therapeutic pathologies along the upper and lower urinary tract. Based on these MDCT findings adequate therapy planning and planning of interventional or surgical procedures can be carried out.

[Psychiatric effects and side effects of the alpha-2-antagonist yohimbine: a review of literature and case report]. / Yohimbin, ein Alpha-2-Antagonist: Literaturübersicht zu psychiatrisch relevanten Wirkungen und Nebenwirkungen mit aktuellem Fallbericht.

We describe a 21-year old female patient who had taken the alpha-2-antagonist yohimbine for weight-loss. The patient reported alterations in alcohol- and cocaine-seeking along with changes in defensive behaviour, including suicidal tendencies. Pre-clinical and clinical studies are discussed, which support the hypothesis of a causal relationship. We added an overview of relevant psychiatric effects and side effects of yohimbine.

[The relationship between emotional distress, cognitive performance and health - related quality of life in patients with hepatitis C prior to antiviral treatment]. / Der Zusammenhang zwischen emotionalen Befindlichkeitsstörungen, kognitiver Leistungsfähigkeit und gesundheitsbezogener Lebensqualität bei mit dem Hepatitis-C-Virus infizierten Patienten vor einer antiviralen Therapie.

Recent epidemiologic studies suggest that more than 175 million individuals are infected with hepatitis C virus (HCV) worldwide. In the past few years, outcome studies in chronic HCV patients are no longer focusing solely on traditional end points such as mortality rates but on psychosocial well-being such as health-related quality of life (HRQoL), emotional states, and neuropsychological functioning. The purpose of our exploratory study was to assess cross sectionally the frequency of depression, posttraumatic stress symptoms, cognitive deficits, and impairments in HRQoL in chronic HCV patients prior to antiviral treatment, and to investigate how cognitive impairments and emotional distress were related to quality of life. We recruited 34 chronic HCV patients who had presented for initial assessment of the need for antiviral therapy. Psychometric observer-rating and self-rating scales were administered to evaluate posttraumatic stress symptoms (PTSS-10), depressive symptoms (BDI), HRQoL (SF-36 Health Status Questionnaire), and cognitive functioning (SKT). 32.4 % (n = 11) of the sample suffered from clinical depression, and 8.8 % (n = 3) had a posttraumatic stress syndrome. 8.8 % (n = 3) of the sample showed cognitive impairments. Significant impairments in HRQoL were found in the health-related domains vitality, role-emotional, and role-physical. The severity of emotional distress as measured on the BDI and PTSS-10 was associated with decrements in HRQoL. However, lower cognitive function scores on the SKT were not associated with lower HRQoL SF-36 values. Chronic HCV patients seem to face a major risk of depression, posttraumatic stress symptoms, and cognitive dysfunction, and the presence of emotional distress is associated with impairments in quality of life. We therefore underscore the need for early and comprehensive bio-psycho-social diagnosis and therapy of chronic HCV patients in order to treat emotional distress and enhance patients; quality of life at an early stage before initiating antiviral therapy, as well as to expand the pool of patients eligible to receive antiviral therapy.

FMIP controls the adipocyte lineage commitment of C2C12 cells by downmodulation of C/EBP alpha.

Fms interacting protein (FMIP) is a substrate for Fms tyrosine kinase, and a nuclear/cytoplasm shuttling protein with a leucine zipper. As the phosphorylation of FMIP is observed in insulin-stimulated preadipocytes, we examined the role of FMIP in adipocyte differentiation, using the mesenchymal multipotent stem cells, C2C12 cells, that can differentiate into adipocytes, muscle cells and osteoblasts. Ectopic expression of FMIP in C2C12 impairs the adipocyte differentiation induced by treatment with insulin, dexamethasone and 3-isobutyl-1-methylxanthine. These cells exhibit muscle phenotype with multinuclear morphology. Furthermore, knockdown of endogenous FMIP expression by small interfering RNA improves adipocytic lineage commitment of C2C12 cells, while impairing muscle differentiation. Upon stimulation with insulin, CCAAT/enhancer binding protein (C/EBP)beta, but not C/EBPalpha, is upregulated in cells expressing ectopic FMIP, whereas in FMIP knockdown cells, C/EBPalpha is constitutively expressed. Ectopic expression of C/EBPalpha counteracts the effects of FMIP, whereas C/EBPalpha knockdown partially mimics the effects of FMIP in this system. Northern blot analysis and reverse transcriptase-polymerase chain reaction study reveal that ectopic FMIP-expressing cells do not contain the polyadenylated C/EBPalpha mRNA, but contain the C/EBPalpha pre-mRNA, suggesting that FMIP plays a role in RNA processing and/or export. Indeed, a member of the THO complex that plays a role in mRNA export, THOC1, is co-precipitated with FMIP. The data we have acquired on FMIP suggest that it is a target for tyrosine kinase receptors that potentiate mRNA export.

Visualization of bronchial lesions using multidetector CT and endobronchial ultrasound (EBUS).

OBJECTIVE: Staging of bronchial carcinoma presents a diagnostic challenge. In addition to CT scans, endobronchial ultrasound is used. The aim of this study was to compare the diagnostic accuracy of high-resolution multidetector CT (MSCT) with that of endobronchial ultrasound with respect of detection and extension of the bronchial lesions. METHODS: 24 patients with lesions in the central bronchial area were examined using both EBUS and MSCT. Multiplanar reconstructions (MPR) as well as virtual endoscopy (VE) were used as adjuncts in this investigation of the comparative diagnostic accuracy of MSCT and EBUS in the imaging of bronchial lesions. RESULTS: No significant difference could be established between EBUS and MSCT in detecting and extension of bronchial lesions. With both procedures, the use of supplementary techniques may be advantageous and helpful in individual cases. CONCLUSIONS: When compared with EBUS, MSCT with post-processing has equally high sensitivity with regard to the visualization of malign endobronchial lesions.

[Imaging procedures to diagnose prostate cancer]. / Bildgebende Verfahren bei der Diagnose des Prostatakarzinoms.

Prostate cancer is one of the most frequent malignant diseases in men. Despite constant progress achieved in imaging procedures, prostate biopsy is the gold standard for diagnosing prostate cancer. For the assessment of lymph node status, only staging lymphadenectomy provides valid information. The aim of this work is to analyze the imaging procedures available in Germany and their value in primary and lymph node staging as well as biochemical recurrence.

HLXB9 activates IL6 in Hodgkin lymphoma cell lines and is regulated by PI3K signalling involving E2F3.

Multiple cytokines are secreted by Hodgkin lymphoma (HL) cells, notably interleukin-6 (IL6), which is believed to play a significant pathobiological role in this and certain other tumors. Previous work on prostate carcinoma cells has shown that IL6 expression is activated therein by the homeodomain protein GBX2, which we found to be absent in HL cells. Instead, we observed expression of a closely related gene, HLXB9, albeit restricted to HL cells coexpressing IL6. Treatment of HL cell lines with antisense-oligonucleotides directed against HLXB9, forced expression of recombinant HLXB9, and analysis of reporter gene constructs containing IL6 promoter sequences all confirmed the potential of HLXB9 to drive expression of IL6. Chromosomal rearrangements of the HLXB9 locus at 7q36 were not detected in HL cells unlike AML subsets expressing HLXB9. However, inhibition of certain signal transduction pathways revealed that the phosphatidylinositol 3 kinase (PI3K) pathway contributes to HLXB9 expression. AKT/phospho-AKT analysis revealed constitutively active PI3K signalling in HL cell lines. Downstream analysis of PI3K revealed that E2F3 may mediate activation of HLXB9. Taken together, our data show that the PI3K signalling pathway in HL cells is constitutively activated and promotes HLXB9 expression, probably via E2F3, thereby enhancing malignant expression of IL6.

RNA accessibility prediction: a theoretical approach is consistent with experimental studies in cell extracts.

The use of antisense oligodeoxyribonucleotides (ODN) or ribozymes to specifically suppress gene expression is simple in concept and relies on efficient binding of the antisense strand to the target RNA. Although the identification of target sites accessible to base pairing is gradually being overcome by different techniques, it remains a major problem in the antisense and ribozyme approaches. In this study we have investigated the potential of a recent experimental and theoretical approach to predict the local accessibility of murine DNA-methyltransferase (MTase) mRNA in a comparative way. The accessibility of the native target RNA was probed with antisense ODN in cellular extracts. The results strongly correlated with the theoretically predicted target accessibility. This work suggests an effective two-step procedure for predicting RNA accessibility: first, computer-aided selection of ODN binding sites defined by an accessibility score followed by a more detailed experimental procedure to derive information about target accessibility at the single nucleotide level.

MRI of the Prostate in Germany: Online Survey among Radiologists.

PURPOSE: To assess structural, technical, and communicative aspects of dedicated MR examinations of the prostate (MRP) offered by radiologists in Germany. MATERIALS AND METHODS: We conducted an eight-item online survey among members of the German Radiology Society (DRG). Radiological institutions were asked about their structure, i.e., either hospital department (HD) or private practice (PP), number of board-certified radiologists, postal regions, number of MRPs in 2011, MR technology and MR sequences applied, ways to communicate results, and feedback from referring physicians on results of subsequent tests and procedures. Submissions were cleared of redundancies and anonymized. Differences in the number of positive replies to each item were statistically significant at p < 0.05 for two-tailed testing in 2 x 2 tables. RESULTS: The survey represented board-certified radiologists in 128 institutions (63 HDs and 65 PPs) in 67/95 German postal regions (71%). Almost two-thirds of institutions performed 11 to 50 MRPs in 2011, more often at 1.5 T (116/128, 91%) than at 3.0 T (36/128, 28%), and most frequently with surface coils (1.5 T, 88/116, 76%; 3.0 T, 34/36, 94%; chi-square, 1.9736, 0.1 < p < 0.25). About two-thirds of 1.5 T users and 90% of 3.0 T users applied at least one functional MR modality (diffusion-weighted imaging, dynamic contrast-enhanced imaging, or MR spectroscopy) for MRP. Reports including graphic representations of the prostate were applied by 21/128 institutions (16%). Clinical feedback after MRP to radiologists other than upon their own request was infrequent (HDs, 32-45%, PPs, 18-32%). CONCLUSION: MRP was a widely available, small-volume examination among radiologists in Germany in 2011. The technology mainstay was a 1.5 T surface coil examination including at least one functional MR modality. Dedicated reporting and feedback mechanisms for quality control were underdeveloped. KEY POINTS: MRI of the prostate was available in at least 67 of 95 German postal regions (71%) in 2011. MRI of the prostate was most often performed at 1.5 T without an endorectal coil in Germany in 2011. At least two thirds of MRI-examinations of the prostate included both T2WI and at least one functional MR test (mostly DWI, less frequently MRS or DCE) in Germany in 2011. Structured reporting including graphic elements was offered by less than 20% of participating radiological institutions. Feedback to radiologists from referring physicians on subsequent test results in patients with MRI of the prostate most frequently came only upon special request by the radiologist.

Quantitative determination of lentiviral vector particle numbers by real-time PCR.

Here, we describe a quantitative, DNA-based, real-time PCR approach to determine the number of lentivirus particles that are present in vector preparations. In this approach, the minus strong-stop cDNA fragment that is present in viral capsids serves as template for PCR. Using this technology, we found that only 0.1%-1% of the virus particles that are present in vector preparations are infectious. The approach described here is rapid, reliable, and simple in concept and can be used to estimate both vector particles in supernatants and the number of infectious particles. Also, this approach can easily be adapted to a high-throughput system by using 96-well plates and a 2-h running time.

Nocturnal oxygen saturation in normal and asthmatic children.

At sea level, it appears that oxygen desaturation does not occur in normal children at night and that the desaturation that occurs in moderately severe asthmatic children with therapeutic levels of theophylline does not approach dangerously low levels.

Coloradocin, an antibiotic from a new Actinoplanes. II. Identity with luminamicin and elucidation of structure.

Coloradocin was isolated from a fermentation broth by adsorption onto Amberlite XAD-2. The activity was eluted in MeOH and purified by gel filtration on Shephadex LH-20, followed by liquid-liquid chromatography on diol-bonded silica gel. The last two steps in the purification of this antibiotic included reverse-phase chromatography on C18-bonded silica gel and countercurrent chromatography on an Ito Coil Planet Centrifuge to give material of 90% purity. Analytically pure material was obtained by preparative HPLC. As a result of extensive homo and heteronuclear two-dimensional NMR studies, a structure was proposed for coloradocin. The structure consists of a decalin ring system fused to a 10-membered macrolactone which in turn is fused to a 14-membered macrolactone possessing an enol ether in conjugation with an unsaturated cyclic anhydride functionality. Coloradocin is related to a small class of antibiotics which include nodusmicin and nargenicin and was shown to be identical to luminamicin for which no structure has been reported.

Aselacins, novel compounds that inhibit binding of endothelin to its receptor. II. Isolation and elucidation of structures.

Three novel compounds, named the aselacins, which inhibit the binding of endothelin to its receptor have been isolated from two related Acremonium species of fungi grown in stationary culture. These compounds are cyclic pentapeptolides with a ring formed by cyclo[Gly-D-Ser-D-Trp-beta-Ala-L-Thr] and an additional exocyclic D-Gln to which is attached a functionalized long chain fatty acid. The aselacins differ in the functionalization of this acid. The structures of the aselacins were determined by amino acid analysis, mass spectrometry and evaluation of 1-D and 2-D homonuclear and heteronuclear 1H, 13C and 15N NMR spectra in protic and aprotic solvents. The stereochemistry of the amino acids present was elucidated by chiral HPLC of hydrolyzed compound.

Benzanthrins A and B, a new class of quinone antibiotics. II. Isolation, elucidation of structure and potential antitumor activity.

The benzanthrins, which were produced by Nocardia lurida, were extracted from the fermentation broth with CH2Cl2. Subsequent purification on Sephadex LH-20 and diolbonded silica gel, followed by countercurrent chromatography, afforded analytically pure benzanthrins A and B. FAB-MS revealed that benzanthrins A and B were isomeric. It was demonstrated through degradative and spectroscopic studies that the benzanthrins were di-glycosides of a trihydroxy benz[a]anthraquinone chromophore where one of the sugars was linked through carbon and the other through oxygen. Benzanthrins A and B differed in the stereochemistry of the O-glycosidic sugar. Both compounds inhibited the growth of Gram-positive bacteria and 9KB, 9PS and 9ASK tumor cells in tissue culture.

5-N-acetylardeemin, a novel heterocyclic compound which reverses multiple drug resistance in tumor cells. I. Taxonomy and fermentation of the producing organism and biological activity.

The ardeemins are a new family of secondary metabolites produced by submerged fermentation of a fungus which was isolated from a soil sample collected in Brazil. Based on taxonomic studies, the producing culture was identified as Aspergillus fischeri var. brasiliensis strain AB 1826M-35. 5-N-Acetylardeemin potentiated the cytotoxicity of the anticancer agent vinblastine in multidrug resistant human tumor cells.