Identification and validation of a gene involved in anchorage-independent cell growth control using a library of randomized hairpin ribozymes

We have developed a library of hairpin ribozyme genes that can be delivered and expressed in mammalian cells with the purpose of identifying genes involved in a specific phenotype. By applying the appropriate phenotypic selection criteria in tissue culture, we can enrich for ribozymes that knock down expression of an unknown gene or genes in a particular pathway. Once specific ribozymes are selected, their target binding sequence is used to identify and clone the target gene. We have applied this technology to identify a putative tumor suppressor gene that has been activated in HF cells, a nontransformed revertant of HeLa cells. Using soft agar growth as the selection criteria for gain of transformation, we have isolated ribozymes capable of triggering anchorage-independent growth. Isolation of one of these ribozymes, Rz 568, led to the identification and cloning of the human homologue of the Drosophila gene ppan, a gene involved in DNA replication, cell proliferation, and larval development. This novel human gene, PPAN, was verified as the biologically relevant target of Rz 568 by creating five additional "target validation" ribozymes directed against additional sites in the PPAN mRNA. Rz 568 and all of the target validation ribozymes reduced the level of PPAN mRNA in cells and promoted anchorage-independent growth. Exogenous expression of PPAN in HeLa and A549 tumor cells reduced their ability to grow in soft agar, underscoring its role in regulating anchorage-dependent growth. This study describes a novel method for gene discovery where the intracellular application of hairpin ribozyme libraries was used to identify a novel gene based solely on a phenotype.

Comparison of On-X and SJM HP bileaflet aortic valves

BACKGROUND AND AIM OF THE STUDY

The study aim was to evaluate the hemodynamic function after aortic valve replacement (AVR) using the On-X valve, in comparison with St. Jude Medical (SJM) HP bileaflet valves.

METHODS

Patients received either the On-X (n = 20) or SJM HP prosthesis (n = 20) for AVR. The control (SJM HP) group was computer-matched with the On-X group for age, gender, aortic stenosis as underlying disease, body surface area, NYHA functional class, left ventricular size, mass and function, transvalvular pressure gradients and cardiac index. Mean implanted valve size was 23.5 mm (three 21 mm, ten 23 mm, six 25 mm, one 27 mm) in both groups. All patients underwent postoperative, and six- and 12-month follow up echocardiography.

RESULTS

The intra- and postoperative course was uneventful in all patients. There were no significant differences in cross-clamp and cardiopulmonary bypass times, intensive care unit stay, in-hospital stay and postoperative NYHA functional class. Two patients (both On-X) had paravalvular leakage postoperatively and at follow up. Five patients in the control group had additional myocardial revascularization. Transvalvular flow velocities were 2.38 +/- 0.3 versus 2.38 +/- 0.4 m/s (p = NS) postoperatively, and 2.08 +/- 0.2 versus 2.22 +/- 0.3 m/s (p = NS) at one year follow up for On-X and SJM HP valves, respectively. Maximum pressure gradients were 16.9 +/- 6.0 versus 18.5 +/- 8.0 mmHg (p = NS) postoperatively and 14.0 +/- 3.7 versus 16.5 +/- 5.7 mmHg (p = NS) at one year for the two valve types, respectively. A relatively pronounced transvalvular reflux was diagnosed for On-X valves.

CONCLUSION

At one year after implantation, the On-X bileaflet prosthesis is equally suited for AVR in comparison with the 'standard' therapy (SJM HP). Exact sizing requires some experience. There were no significant differences between the two prostheses with regard to hemodynamic parameters either postoperatively or at one-year follow up. Long-term prospective randomized studies yet have to be carried out.

Complementarity as a biodiversity indicator strategy

Richness, rarity, endemism and complementarity of indicator taxon species are often used to select conservation areas, which are then assumed to represent most regional biodiversity. Assessments of the degree to which these indicator conservation areas coincide across different taxa have been conducted on a variety of vertebrate, invertebrate and plant groups at a national scale in Britain, Canada, USA and South Africa and at a regional scale in Cameroon, Uganda and the USA. A low degree of spatial overlap among and within these selected indicator conservation areas has been demonstrated. These results tend to suggest that indicator conservation areas display little congruence across different taxa. However, some of these studies demonstrate that many conservation areas for indicator taxa capture a high proportion of non-target species. Thus it appears that indicator conservation areas might sample overall biodiversity efficiently. These indicator conservation areas may, however, exclude species essential for effective conservation, e.g. rare, endemic or endangered species. The present study investigated the value of indicator taxa as biodiversity surrogates using spatial congruence and representativeness of different indicator priority conservation areas. The conservation status of species excluded by the indicator approaches is also assessed. Indicator priority conservation areas demonstrate high land area requirements in order to fully represent non-target species. These results suggest that efficient priority area selection techniques must reach a compromise between maximizing non-target species gains and minimizing land-use requirements. Reserve selection procedures using indicator-based complementarity appear to be approaches which best satisfy this trade-off.

Possible association of the short allele of the serotonin transporter promoter gene polymorphism (5-HTTLPR) with violent suicide

There is abundant evidence that the serotonin (5-HT) system is modulating mood and several behavioural traits and that disturbances in the regulation of this system can be associated with severe behavioural malfunctions, as aggressive implusive and suicidal behaviour.1 Recently a functional polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) was identified2 and the presence of one or two short alleles was associated with anxiety-related personality traits3 and several psychiatric disturbances, such as affective disorder4 or severe alcohol dependence.5 With respect to the importance of the 5-HT transporter in serotonergic transmission, we have genotyped the DNA of 58 Caucasian suicide victims (with unknown psychiatric diagnoses) and 110 healthy controls for the biallelic functional polymorphism in the 5-HTTLPR. We found a highly significant increased frequency of suicide victims being carriers of one or two short alleles (Fisher's Exact Test, two sided, P = 0.0003), which suggests that a genetically altered protein function within the serotonergic pathway might be involved in suicidality, independently from the clinical diagnosis.

Purification and characterization of an aminopeptidase from the chloroplast stroma of barley leaves by chromatographic and electrophoretic methods

Aminopeptidases catalyze the cleavage of amino acids from the amino terminus of protein or peptide substrates. Although some aminopeptidase activities have been found in plant chloroplasts, the identity of these proteins remains unclear. In this work, we report the purification to apparent homogeneity of a soluble aminopeptidase from isolated barley chloroplasts which preferentially degraded alanyl-p-nitroanilide (Ala-pNA). After organelle isolation in a density gradient and precipitation of soluble proteins with ammonium sulfate, the proteins were purified in three consecutive steps including hydrophobic interaction, gel permeation and ion-exchange chromatographies. The purified enzyme appeared as a single band with a Mr of approximately 84000 in sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis. The Mr of the native enzyme was estimated to be approximately 93000 by gel permeation chromatography, suggesting that the protein is a monomer. Mass spectrometry analysis of tryptic digests indicates that the primary structure of the protein has not been reported previously. The enzyme was characterized as a metalloprotease as it could be totally inhibited by 1,10-phenanthroline. Strong inhibition could also be observed using the specific aminopeptidase inhibitors amastatin and bestatin. Besides Ala-pNA, the purified protein could also cleave with decreasing activity glycyl-pNA, leucyl-pNA, lysyl-pNA, methionyl-pNA and arginyl-pNA. The possible physiological role of this enzyme in the chloroplast stroma is discussed.

The Leipzig experience with robotic valve surgery

OBJECTIVES

The study describes the single-center experience using robot-assisted videoscopic mitral valve surgery and the early results with a remote telemanipulator-assisted approach for mitral valve repair.

MATERIAL AND METHODS

Out of a series of 230 patients who underwent minimally invasive mitral valve surgery, in 167 patients surgery was performed with the use of robotic assistance. A voice-controlled robotic arm was used for videoscopic guidance in 152 cases. Most recently, a computer-enhanced telemanipulator was used in 15 patients to perform the operation remotely.

RESULTS

The mitral valve was repaired in 117 and replaced in all other patients. The voice-controlled robotic arm (AESOP 3000) facilitated videoscopic-assisted mitral valve surgery. The procedure was completed without the need for an additional assistant as "solo surgery." Additional procedures like radiofrequency ablation and tricuspid valve repair were performed in 21 and 4 patients, respectively. Duration of bypass and clamp time was comparable to conventional procedures (107 A 34 and 50 A 16 min, respectively). Hospital mortality was 1.2%. Using the da Vinci telemanipulation system, remote mitral valve repair was successfully performed in 13 of 15 patients.

CONCLUSION

Robotic-assisted less invasive mitral valve surgery has evolved to a reliable technique with reproducible results for primary operations and for reoperations. Robotic assistance has enabled a solo surgery approach. The combination with radiofrequency ablation (Mini Maze) in patients with chronic atrial fibrillation has proven to be beneficial. The use of telemanipulation systems for remote mitral valve surgery is promising, but a number of problems have to be solved before the introduction of a closed chest mitral valve procedure.

Effects of disintegration on anaerobic degradation of sewage excess sludge in downflow stationary fixed film digesters

The effects of mechanical disintegration on anaerobic digestibility of sewage excess sludge in downflow stationary fixed film (DSFF) digesters were investigated on laboratory scale. Mechanical pretreatment using a high pressure homogenizer led to significantly enhanced concentrations of soluble proteins and carbohydrates in the feed sludge. Using DSFF digesters with two different tubular plastic media as support material it was shown that a stable digestion process could be achieved at hydraulic retention times (HRT) down to 5 days. Compared to conventional digesters at 10 d and 15 d HRT respectively, the degradation of volatile solids was enhanced up to 25%, also resulting in a higher specific biogas production. Further investigations on degradation of soluble proteins and carbohydrates showed that a slowly degradable fraction of carbohydrates was released via disintegration. Using the distribution of chain length and the concentrations of volatile fatty acids as process parameters, the dependability on the HRT and the degree of disintegration (the release of soluble COD) predominated the effects of specific surface area of the support media.

Quadrileaflet stentless mitral valve replacement

BACKGROUND

The study evaluates clinical results and hemodynamic parameters one year after implantation of a stentless quadrileaflet mitral valve (QMV).

METHODS

Since August 1997 28 patients received the QMV, patient age was 69 +/- 8 years; 13 had predominant mitral stenosis and 15 incompetence, preoperative NYHA functional class was III or IV and cardiac index 1.8 +/- 0.6 L/min/m2.

RESULTS

Surgery was performed using a conventional (25) or a minimally invasive approach (3). 20 patients received a medium and 8 a large-size prosthesis, crossclamp time was 58 +/- 19 min. Additional procedures were myocardial revascularization in four, tricuspid repair in two, and left-atrial radiofrequency ablation to restore sinus rhythm in six patients. Perioperative mortality (1) was not valve-related. All other patients were discharged on time. At postoperative, 6-, and 12-months follow-up mean transvalvular pressure gradients were 4.2 +/- 1.5 / 4 +/- 0.9/ 3.8 +/- 1.4 mmHg and mitral valve orifice area index was 1.5 +/- 0.3 / 1.6 +/- 0.3 / 1.6 +/- 0.4, NYHA class was I or II.

CONCLUSIONS

The QMV is well suited for mitral valve replacement. The anulo-ventricular continuity is preserved and the QMV function resembles native mitral valve function. If its performance is maintained in the long term the QMV may be the mitral prosthesis of choice.

Prospectively randomized evaluation of stentless versus conventional biological aortic valves: impact on early regression of left ventricular hypertrophy

BACKGROUND

The aim of this prospectively randomized study was to evaluate left ventricular hypertrophy and its regression after stentless versus conventional biological aortic valve replacement.

METHODS AND RESULTS

From March 1996 through April 1998, 180 patients were prospectively selected; 106 patients received a stentless aortic valve (SAV), and 74 received a conventional stented bioprosthesis (CSB). Of these patients, 95% and 96%, respectively, had aortic stenosis. Their mean age was 72.3 and 74.8 years, and there were no significant differences in left ventricular function, preoperative pressure gradients, and NYHA functional status. Aortic annulus diameter indexes were comparable at 13.46 (SAV) versus 13.55 (CSB) mm (P=NS). Larger SAVs were implanted because of the oversizing technique. In-hospital mortality (n=3 and 1 for SAV and CSB) was not valve related. At follow-up, all patients were in NYHA class 1 or 2. Baseline end-diastolic left ventricular posterior wall thickness was 15.6 (SAV) and 14.8(CSB) mm (P=NS) and decreased to 11. 8 (SAV) and 13.2 (CSB) mm (P<0.05) at 6 months. Left ventricular mass index was 213 and 202 g/m(2) at baseline (P=NS), whereas after 6 months, it was 141 (SAV) and 170 (CSB) g/m(2) (P<0.05).

CONCLUSIONS

Regression of left ventricular hypertrophy occurs in all patients after aortic valve replacement but is significantly enhanced after SAV implantation. This possibly is due to improved transvalvular hemodynamics.

Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region

OBJECTIVE

To analyze the genotypes of the promoter region of the serotonin transporter gene (5-HTT) in patients with fibromyalgia (FM).

METHODS

Genomic DNA from 62 patients meeting the American College of Rheumatology 1990 criteria for FM and 110 healthy controls was analyzed by polymerase chain reaction. Additionally, the psychopathologic state of 52 of the FM patients was evaluated using the Beck Depression Inventory (BDI) and the Symptom Checklist-90-Revised (SCL-90-R).

RESULTS

The 5-HTTLPR genotypes in FM patients versus controls were distributed as follows: L/L 27% versus 34%, L/S 42% versus 50%, and S/S 31% versus 16%. FM patients with the S/S genotype had higher mean scores on the BDI and the SCL-90-R compared with those in the L/L and L/S groups.

CONCLUSION

A higher frequency of the S/S genotype of 5-HTT was found in FM patients compared with healthy controls. The S/S subgroup exhibited higher mean levels of depression and psychological distress. These results support the notion of altered serotonin metabolism in at least a subgroup of patients with FM.

Stentless mitral valve replacement using the quattro valve

This study analyzed early clinical results after stentless mitral valve (Quadrileaflet Mitral Valve (QMV)/Quattro) implantation. A total of 28 patients have received a Quattro valve since August 1997. Patient age was 69+/-8 years; the underlying disease was mitral incompetence (14) and stenosis (13). Preoperative New York Heart Association functional class was 3.2+/-0.4 and cardiac index was 1.8+/-0.6. Mean cross-clamp duration was 58+/-19 minutes. Twenty patients received a 28-mm prosthesis, and eight patients received a 30-mm prosthesis. Four patients had myocardial revascularization, two had tricuspid valve repair, and six had radiofrequency ablation therapy to restore sinus rhythm. Mortality (1) was nonvalve related. Reoperation was necessary in two patients for posterior paravalvular leakage (1) and for functional stenosis (1). Echocardiography showed satisfactory hemodynamic function. By stentless mitral valve implantation the annuloventricular continuity is preserved to stabilize left ventricular function. The Quattro valve resembles native mitral valve function and is well suited for mitral valve replacement.

Transforming growth factor-beta1 stimulates the synthesis of basement membrane proteins laminin, collagen type IV and entactin in rat liver sinusoidal endothelial cells

BACKGROUND/AIMS

It is suggested that during fibrogenesis as well as during carcinogenesis of the liver, the hepatic microvascular phenotype is transformed from sinusoids - which lack a basement membrane--into continuous capillaries which rest on a basement membrane. As transforming growth factor (TGF)-beta1 seems to be the most effective mediator in the stimulation of matrix protein synthesis, we were interested in the modulation of basement membrane proteins collagen type IV, laminin, and entactin expression by TGF-beta1 in liver sinusoidal endothelial cells (SECs), especially since a stimulation of the synthesis of collagen type IV but not of entactin and laminin by TGF-beta1 has been demonstrated in a fibrosarcoma cell line.

METHODS

The synthesis of the basement membrane (BM) proteins entactin, laminin, and collagen type IV and of the extracellular matrix (ECM) proteins tenascin and fibronectin with or without TGF-beta1--stimulation was analyzed by immunostaining, immunoprecipitation of endogenously labeled proteins and Northern blot analysis of total RNA extracted from freshly isolated or cultured SECs from rat or guinea pig livers. Furthermore, SECs were isolated from acutely and chronically CCl4-damaged rat livers and were analyzed for matrix protein expression.

RESULTS

SECs were adherent 24 h after isolation and formed confluent monolayers on day 4 of primary culture. Specific immunoprecipitates and specific transcripts for the BM proteins entactin, laminin, and collagen type IV and for ECM proteins tenascin and fibronectin were detectable in freshly isolated or cultured SECs. The synthesis of all tested BM proteins and ECM proteins was stimulated at least 3-fold by TGF-beta1. In SECs isolated after CCl4-induced acute and chronic liver damage, increased levels of matrix protein transcripts were detectable.

CONCLUSIONS

The stimulation of the synthesis of all BM-proteins by TGF-beta1 in vitro and the accumulation of ECM transcripts in SECs isolated from CCl4-treated livers, suggests that SECs are involved in the formation of a basement membrane during the "capillarization" of the sinusoids during liver disease.

Regression of left ventricular hypertrophy after stentless versus conventional aortic valve replacement

The goal of this study was to analyze regression of left ventricular hypertrophy after randomization to conventional biological versus stentless aortic valve replacement. Stentless (Freestyle, Toronto, n = 106) or conventional biological aortic valves (Carpentier-Edwards, n = 74) were evaluated prospectively. Preoperatively there were no differences with regard to aortic valve pathology, left ventricular function, and pressure gradients between the two patient groups. The patient annulus index (13.55 vs. 13.46 mm; NS) measured intraoperatively was used as baseline for further comparison. Postoperatively, left ventricular mass index was 213+/-77 g/m2 (stentless) compared with 202+/-72 (conventional group) g/m2 (NS), whereas after 6 months it was 141+/-41 g/m2 in the stentless and 170+/-43 g/m2 in the conventional group (P<.05). Regression of left ventricular hypertrophy occurs in all patients after aortic valve replacement. Nevertheless, the use of stentless bioprostheses leads to a significant enhancement, which may result in a reduction of the cardiac risk profile for the patient.

The T102C polymorphism of the 5-HT2A-receptor gene in fibromyalgia

Based on a possible involvement of serotonergic dysfunction in the pathophysiology of fibromyalgia (FM) and on preliminary reports of a possible genetically driven vulnerability for this disorder we investigated the silent T102C polymorphism of the 5-HT2A-receptor gene in 168 FM patients and 115 healthy controls. Our results showed a significantly different genotype distribution in FM patients with a decrease in T/T and an increase in both T/C and C/C genotypes as compared to the control population (Fisher's Exact test, two-sided, P = 0.008). However, the increase in allele-C102 frequency felt short of significance (P = 0.07). Correlation of genotypes to clinical parameters revealed no influences on age of onset, duration of disease or psychopathological symptoms, measured with the Beck Depression Inventory and the symptom checklist SCL-90-R. In contrast to that the pain score, being a self reported information on pain severity, was significantly higher in patients of the T/T genotype (Mann-Whitney U test, P = 0.028). This suggests that the T102-allele might be involved in the complex circuits of nociception. However, the T102C polymorphism is not directly involved in the aetiology of FM but might be in linkage dysequilibrium with the true functional variant, which has to be unravelled.

[Interventional occlusion of persistent ductus arteriosus Botalli with Gianturco spirals]

Interventional duct occlusion is increasingly performed with detachable coils. In a series of 33 patients (34 procedures), we consistently used Gianturco-coils which were the initially employed coils. They are not securable but can be implanted in a simple manner. The rate of embolization was high (28%) in the first 14 procedures; however, it declined to 5% in the last 20 patients. We modified the technique by partially blocking the duct, when necessary, with a catheter which was advanced from the pulmonary artery and by implanting up to three coils. There was only one embolization and one small residual shunt in the last 20 patients. The mean fluoroscopy time in these patients was 11.0 +/- 5.8 minutes and decreased to 7.0 +/- 3.2 minutes in the last 10 patients with successful closure. Considering our experience, we continue to recommend the use of Gianturco-coils especially in the small duct which can be closed quickly at low cost.

[Investigations on the behavior of C-reactive protein, cell count, lactose content as well as electric conductivity in quarter milk samples of subclinically diseased quarters of the udders in relation to bacteriologic results]

Inflammations of the udder influence the amount of somatic cells and lactose as well as electrical conductivity in milk. They are often caused by bacterial agents. Similar reactions are to be seen in relation to C-reactive protein (CRP). The amount of CRP in milk depends on concentration and characteristics of the agents and the phase of inflammation. We found a significant increase of CRP in milk samples with Streptococcus (Sc.) uberis. There was no significant difference in CRP concentrations in samples with coagulase positive Staphylococcus spp. (CPS) and bacteriological negative samples and such with Corynebacterium (C.) bovis, Micrococcus spp. and Staphylococcus (S.) epidermidis. We only found high correlations to the amount of somatic sells and lactose as well as electrical conductivity in samples with Sc. uberis. The results of our investigations show that CRP may be a parameter for better understanding subclinical inflammations of udder.

[Effect of lactation state (1st-20th week of lactation) on dynamics of C-reactive protein (CRP) in initial quarter milk samples in relation to somatic cell count, lactose content and blood serum CRP levels]

The concentration of C-reactive protein (CRP) in milk and blood serum varies during the first half of lactation. Somatic cell count and lactose content also depend on the stage of lactation. CRP blood serum levels show a distinct tendency to increase from the 2nd to the 20th week of lactation. In contrary the milk CRP content decreases from the 1st week to the end of the 2nd month post partum and increases again from the 8th to the 20th week post partum. Somatic cells and CRP-concentrations in milk increase parallelly but the lactose content shows a contrary pattern in the first five months of lactation.

[Thoracic surgery relevant indications for adjuvant and/or palliative measures in breast carcinoma]

Metastatic lesions of breast cancer represent rare indications for operation in thoracic surgery. Only in case of persistent malignant pleural effusions or in case of tumour progress despite all other available therapy modalities thoracic surgery can be indicated. Over a period of 5 years between 1993 and 1997 53 patients with metastatic breast cancer were treated in our institution. 36 pts. suffered from persistent pleural effusions, 13 pts. had pulmonary metastases and 4 pts. had metastases involving the chest wall. In all these patients the disease could not be controlled by conservative measures. Our experiences are the following: Thoracoscopy is the diagnostic method of choice for pleural effusions in patients with malignant tumors. If a malignant pleural effusion is confirmed, a talc poudrage represents the most reliable treatment to palliate the dyspnea. The resection of a single solitary pulmonary metastasis can be indicated to confirm the histologic type of the nodule. Resections for centrally localized lesions causing hemoptysis or atelectasis represent rare occasions. Metastatic lesions of breast cancer involving the ribs or the sternum are resected in order to confirm the histologic diagnosis. According to the literature these procedures, with a 5-year survival rate of 50% and without perioperative mortality, can be beneficial.

[Examination of systemic tumor necrosis factor activity under physiologic and pathophysiologic conditions]

Tumor necrosis factor (TNF) activity in the circulation of several animal species was determined by a bioassay, using the murine cell line L929. In healthy adult cattle, horses, pigs and dogs, species specific differences of systemic TNF activity were visible. In cattle, TNF activity in the circulation increased during growing up from calf to adult animal. In cattle suffering from various diseases, unchanged, elevated, but also reduced systemic TNF activity have proved to possess clinical relevance. Low systemic TNF activity frequently occurs during lethal inflammatory diseases and may be an indicator of generalized monozyte paralysis.

[Miliary tuberculosis and adult respiratory distress syndrome in an infant]

We report on a 7 months old infant, who was admitted to our hospital with the tentative diagnosis of interstitial pneumonia. The infant was treated with erythromycin because of a positive mycoplasma antigen test in the nasopharyngeal mucus and the radiological findings. A tension pneumothorax led to rapid respiratory deterioration and a severe ARDS developed. A sustained respiratory stabilization could not be achieved. The diagnosis miliary tuberculosis was detected on autopsy. A parenchymal focus was found subpleurally in the left lung with a massive hematogenous spread and a tuberculous meningitis. The source of infection could not be identified in the family or in persons known to have had contact to the infant. The tuberculin skin test (PPD) was negative. Clinical, radiological and pathological findings are demonstrated.

Poisoning with tilidine and naloxone: toxicokinetic and clinical observations

The opioid analgesic tilidine and its metabolites were detected by high performance liquid chromatography (HPLC) with UV-detection in serum from a 28 year-old woman who ingested 100 ml Valoron (o)N containing 6.94 g of tilidine and about 0.56 g of naloxone with suicidal intention. Data on the toxicokinetics of tilidine in severe poisonings are missing. Therefore we followed serum concentrations of tilidine and metabolites for 48 or 96 h and for the first time calculated basic kinetic parameters in a massive life threatening poisoning. Serum concentration of tilidine 3 h after ingestion was 38.1 mg/l which is about 70 times of the upper therapeutic level in man and about ninefold above toxic concentrations known so far. The concentration of nortilidine, the primary active metabolite at this time was 18.8 mg/l. The terminal elimination half life's of tilidine and nortilidine were explicit, prolonged with 23.9 and 13.9 h respectively. The competitive opiate antagonist naloxone, which is added as a part of the industrially produced preparation Valoron N solution to minimise oral abuse is not able to prevent ventilatory depression in massive overdoses.

[Determination of C-reactive protein and neopterin in serum of diseased and bacterially infected swine]

The parameters C-reactive protein (CRP) and neopterin, which are associated with immunological reactions, were investigated in serum of healthy, diseased and with Haemophilus parasuis infected pigs. When comparing diseased young pigs with healthy young pigs significant increases of the CRP- and neopterin concentrations can be seen. The increase of the CRP-concentration was most remarkable. After the infection of SPF-piglets with Haemophilus parasuis, significantly decreased neopterin concentrations and increased CRP concentrations were determined in comparison with non-infected animals. The animals with the symptoms of arthritis and disorders of the central nervous system showed the lowest neopterin concentrations and the highest concentrations of CRP. It seems that CRP and neopterin are interesting serum parameters in pigs with regard to the recognition of immunological reactions after illness or infection.

Postoperative complications after bronchoplastic procedures in the treatment of bronchial malignancies

OBJECTIVE

The purpose of this study was to determine the frequency of postoperative complications after bronchoplastic procedures in the treatment of pulmonary malignant tumors and to analyze the factors influencing the complication rate.

METHODS

During a 5-year-period (1992-1996) 79 patients (68 male, 11 female, mean age 57 years) underwent reconstructive operations for bronchial malignancies. We performed 58 bronchoplastic procedures and 21 combined broncho- and angioplastic procedures. Among the bronchoplastic procedures the number of sleeve resections (n = 44) and wedge resections (n = 35) were comparable.

RESULTS

Fifty-nine patients (74,7%) showed a regular postoperative course; 12 patients (15,2%) had severe postoperative complications (death, re-operation). Concerning the primary operation the operative 30-day mortality was 5.1% (n = 4) and including the two deaths after re-operation it was 7.6% (n = 6). After subdividing the patients into three groups (severe, less severe and no complications) we tried to determine predictors for occurrence of postoperative complications. There was a higher rate of severe complications in the age group 61-70 years (6/25 = 24%) as compared with younger patients between 51 and 60 years (4/38 = 10,5%; P < 0,05). Concerning the location, the outcome was better after sleeve- or wedge lobectomies of the upper lobes (four complications/51 patients = 7.8%) compared with procedures of the lower lobes (3/14 = 21.4%). The data could not prove a lower frequency of severe postoperative complications or specific morbidity after pleural coverage following bronchial sleeve resection. The complication rate was higher when sleeve resection of the bronchus was performed (10/44 = 22.7%) as compared with wedge resections (2/35 = 5.7%; P = 0,011) and after resection of T3/T4 tumors (6/28 = 21,4%) compared with T1/T2 tumors (4/37 = 10.8%; P < 0,05).

CONCLUSIONS

Bronchoplastic procedures represent a fairly safe therapy opportunity in patients with centrally localized bronchial carcinoma and compromised or uncompromised pulmonary function. In this study the complication rate was higher after sleeve resection of the bronchus as compared with wedge resection. Pleural coverage of the anastomosis was not effective to prevent major complications due to dehiscence of the bronchial anastomosis. A pedicled muscle flap could be a valuable alternative.

[Effect of transport stress on the content of endotoxin in blood of slaughter pigs]

Stress during transportation of slaughter pigs could lead to an increased level of translocation of endotoxin from the gut. In particular, during longtime transportation increased concentrations of endotoxin in blood are likely. Since nonlethal doses of endotoxin could trigger translocation of bacteria from the gut to systemic organs an endogenous contamination of the carcasses also with human pathogens may occur. Therefore, it is necessary to evaluate transportation regimes of slaughter animals also with regard to food-borne infections and intoxications.

[Generation and characterization of avian vitelline antibodies against lipopolysaccharide and lipid A. 1. Induction and preparation of specific egg yolk antibodies (IgY) against endotoxins]

The immunisation of mammals with LPS- and lipid A-antigens leads to the production of specific antibodies. In the present study, we describe the generation and preparation of antibodies from egg yolks of immunized chickens. Egg yolk antibodies were raised by immunizing laying hens with five LPS- and three lipid A-preparations from various gram-negative bacteria species in different immunisation protocols. Antibodies from collected egg yolks were extracted and purified by means of several standard methods. The purity of antibody-preparations was measured and compared by SDS-PAGE. Specific antibodies were assayed by two different EIA procedures. It could be shown that the immunisation of hens with LPS- and lipid A-Antigens resulted in the production of specific egg yolk antibodies, regardless of immunisation-scheme and amount of antigen.

[An unusual course of fetal gastroschisis]

We report on prenatal diagnosis of gastroschisis at 20th gestational week. In addition to gastroschisis intraabdominal intestinal stenosis was detected. As a consequence cesarean section was planned close to term. Control examinations in the last trimester didn't confirm initial diagnosis so that the recommended mode of delivery was changed. However postpartum diagnosis again confirmed the early diagnosis of gastroschisis including spontaneous necrosis of dislocated intraamniotic intestinal parts. The course demonstrates that even at unambiguous prenatal diagnosis control examinations are recommended as dynamic changes may occur in the second and third trimester. Thus mode of delivery may have to be adapted close to term to reduce maternal risk.

Integrity of a Zn finger-like domain in SamB is crucial for morphogenesis in ascomycetous fungi

Genetic features determine the site of polarized growth in filamentous fungi and lead to hyphal tip extension or subapical branching. We have isolated the samB gene (suppressor of anucleate metulae) of Aspergillus nidulans which encodes a 66 kDa protein carrying an atypical Cys4 and an additional Cys2/His/Cys Zn finger motif at the carboxy-terminus. Such novel Zn finger-like domains have recently been found in several other developmental regulators in organisms ranging from yeast to man. Deletion of this domain at the carboxy-terminus of SamB led to premature hyphal ramification, mislocalization of septa and suppression of the asporogenous phenotype of the developmental mutant aps (anucleate primary sterigmata). A DeltasamB deletion strain displayed an identical phenotype. A homologous gene in Saccharomyces cerevisiae was also characterized whose deletion resulted in a multi-budding phenotype; thus it was named MUB1. An underlying common mechanism for both genes in determination of the onset of polarized growth and its links to other cellular developmental processes is discussed.

Synaptopodin: an actin-associated protein in telencephalic dendrites and renal podocytes

Synaptopodin is an actin-associated protein of differentiated podocytes that also occurs as part of the actin cytoskeleton of postsynaptic densities (PSD) and associated dendritic spines in a subpopulation of exclusively telencephalic synapses. Amino acid sequences determined in purified rat kidney and forebrain synaptopodin and derived from human and mouse brain cDNA clones show no significant homology to any known protein. In particular, synaptopodin does not contain functional domains found in receptor-clustering PSD proteins. The open reading frame of synaptopodin encodes a polypeptide with a calculated Mr of 73.7 kD (human)/74.0 kD (mouse) and an isoelectric point of 9.38 (human)/9. 27 (mouse). Synaptopodin contains a high amount of proline ( approximately 20%) equally distributed along the protein, thus virtually excluding the formation of any globular domain. Sequence comparison between human and mouse synaptopodin revealed 84% identity at the protein level. In both brain and kidney, in vivo and in vitro, synaptopodin gene expression is differentiation dependent. During postnatal maturation of rat brain, synaptopodin is first detected by Western blot analysis at day 15 and reaches maximum expression in the adult animal. The exclusive synaptopodin synthesis in the telencephalon has been confirmed by in situ hybridization, where synaptopodin mRNA is only found in perikarya of the olfactory bulb, cerebral cortex, striatum, and hippocampus, i.e., the expression is restricted to areas of high synaptic plasticity. From these results and experiments with cultured cells we conclude that synaptopodin represents a novel kind of proline-rich, actin-associated protein that may play a role in modulating actin-based shape and motility of dendritic spines and podocyte foot processes.

Inhibition of CREB- and cAMP response element-mediated gene transcription by the immunosuppressive drugs cyclosporin A and FK506 in T cells

The clinically important immunosuppressant drugs cyclosporin A and FK506 (tacrolimus) inhibit in T-cells calcineurin phosphatase activity and nuclear translocation of the cytosolic component of the transcription factor nuclear factor of activated T-cells (NF-ATc) that is involved in the induction of early genes during T-cell activation. This effect has been proposed to explain at least part of the immunosuppressive effect of these drugs. Previous studies in pancreatic islet cell lines have shown that cyclosporin A and FK506 through inhibition of calcineurin interfere also with the function of the transcription factor cAMP response element binding protein (CREB) that is activated by cAMP and calcium signals and binds to cAMP/calcium response elements (CRE). By transient expression of CRE-reporter genes or GAL4-CREB fusion proteins, the present study shows that inhibition of CREB/CRE-directed transcription by cyclosporin A and FK506 occurs in a great variety of cell types including in cell lines derived from tissues in which adverse effects of the immunosuppressants develop. CREB activity and CRE-mediated transcription was blocked by these drugs also in Jurkat T-cells. When taken together with recent evidence for an essential role of CREB in T-cell activation and proliferation, the present results suggest that inhibition of CREB/CRE-directed transcription may be a molecular mechanism of the immunosuppressive effect of cyclosporin A and FK506.

[Liver transplantation in familial amyloid polyneuropathy. Case report and review of the literature]

A 59-year old male of German origin noticed exercise-independent cardiac arrhythmia two years before admission. An alanine 47 transthyretin variant of Familial Amyloid Polyneuropathy with hypertrophic cardiomyopathy, peripheral sensory-motor polyneuropathy, I, degree AV heart block was diagnosed. To diminish production and deposition of mutant transthyretin and to prevent disease progression orthotopic liver transplantation was performed. Prior to transplant the patient complained of inappetence. Postoperatively, he received a chemically defined enteral nutrition regime that was discontinued after 30 months until return of appetite and weight gain indicated marked improvement. However, a duodenal biopsy still demonstrated amyloid deposits 24 months after transplantation. Echocardiographic findings remained unchanged. Neurologic examination showed an improvement of sensory-motor polyneuropathy with regression of electromyographic changes. Only traces of variant transthyretin were detectable in plasma samples taken 12 months after the operation. During the 3 year follow-up, no additional symptoms have occurred and progression of amyloidosis was prevented. Currently, orthotopic liver transplantation is the only specific treatment to prevent progression of familial amyloid polyneuropathy.

[A new Bordetella species in sheep?]

Occasionally the occurrence of isolates of the genus Bordetella has been reported, with unclear assignment to one of the known species in sheep from New Zealand and Great Britain. In this study we describe the isolation of strains belonging to the genus Bordetella in a flock of sheep from Germany. These isolates were characterized biochemically by serological tests and whole cell fatty acid analysis. Our isolates could be divided into three subgroups by their differential growth on MacConcey- and Tyrosine agar. A clear assignment to one of the known Bordetella species was not possible.

Differentiation of Pasteurella multocida subspecies multocida isolates from the respiratory system of pigs by using polymerase chain reaction fingerprinting technique

PCR fingerprinting technique was applied to subtype 44 Pasteurella multocida subspecies multocida (P.m.sp.m.) isolates from the respiratory system of pigs. Two single primers were tested for their abilities to generate individual fingerprints by using PCR. Primer 1 (core sequence of the M13 phage) grouped the 44 P.m.sp.m. strains into five distinct fingerprinting profiles, while primer 2 ((GACA)4) grouped them into seven profiles. The results suggest that PCR fingerprinting is an efficient technique to detect DNA polymorphism in the species P.m.sp.m. This technique could be used to differentiate P.m.sp.m. strains of the same capsular serotype.

Eröffnung von Verschlüssen der Arteria femoralis nach Herzkatheterisierung

Die Thrombosierung der Arteria femoralis nach retrograder Katheterunter-suchung stellt im Kindesalter die häufigste Indikation für den Einsatz einer syste-mischen Lysetherapie dar. Hierbei kommen heute Urokinase oder rt-PA zum Einsatz. Wir untersuchten retrospektiv alle Patienten mit Thrombose der Femo-ralarterie nach Katheteruntersuchung in den letzten 42 Monaten, um die Sicherheit und Effektivität des verwendeten Schemas einer Urokinaselyse (Bolus 10000 E/kg, Dauerinfusion 2500 E/kg, parallel Heparininfusion) zu überprüfen. In 42 Monaten wurden 82 Patienten unter 15 kg Körpergewicht arteriell femoral punktiert. Bei sieben Patienten (8,5%) wurde eine systemische Lyse durchge-führt. Bei allen Patienten kam es nach 23-132 h zur Wiedereröffnung des Ge-fäßes. Bei drei dieser Patienten kam es zum deutlichen Hämoglobinabfall aufgrund einer lokalen Nachblutung, die durch Kompression gut beherrschbar war. Andere Blutungskomplikationen fanden sich nicht. In keinem Fall war eine Bluttransfusion notwendig. Während die Lysetherapie mit rt-PA auch im Kindesalter wegen der thrombinspezifischeren Wirksamkeit zunehmende Verbreitung findet, zeigen unsere Ergebnisse bei den sieben Patienten eine gute und sichere Wirksamkeit der Urokinasetherapie.

Isolation of two apsA suppressor strains in Aspergillus nidulans

Aspergillus nidulans reproduces asexually with single nucleated conidia. In apsA (anucleate primary sterigmata) strains, nuclear positioning is affected and conidiation is greatly reduced. To get further insights into the cellular functions of apsA, aconidial apsA strains were mutagenized and conidiating suppressor strains were isolated. The suppressors fell into two complementation groups, samA and samB (suppressor of anucleate metulae), samA mapped on linkage group 1 close to pyrG. The mutant allele was dominant in diploids homozygous for apsA. Viability of conidia of samA suppressor strains (samA-; apsA-) was reduced to 50% in comparison to wild-type conidia. Eighty percent of viable spores produced small size colonies that were temperature and benomyl-sensitive. samB mapped to chromosome VIII and was recessive. Viability of conidia from samB suppressor strains (apsA-; samB) was also affected but no small size colonies were observed. Both suppressors produced partial defects in sexual reproduction and both suppressed an apsA deletion mutation. In wild-type background the mutant loci affected hyphal growth rate (samA) or changed the colony morphology (samB) and inhibited sexual spore formation (samA and samB). Only subtle effects on conidiation were found. We conclude that both suppressor genes bypass the apsA function and are involved in microtubule-dependent processes.

Postexercise albuminuria in children with different duration of type-1 diabetes mellitus

About 30% of diabetic patients develop progressive renal failure. We studied albumin, IgG, and transferrin excretion during exercise in diabetic children without signs of nephropathy to investigate proteinuria under these conditions: 39 patients with insulin-dependent diabetes mellitus and 21 healthy children undertook a bicycle exercise test. Albuminuria measured by nephelometry was calculated as the albumin excretion rate (AER) and albumin-to-creatinine ratio before and after exercise. The diabetic group was divided into three subgroups according to disease duration (DI < 5 years, DII 5-10 years, DIII > 10 years). No significant difference in metabolic control (hemoglobin A1c was detected between the diabetic groups (median hemoglobin A1c: DI 7.2%, DII 7.6%, DIII 8.6%). There was no increase in AER in the healthy children after exercise. Before exercise the diabetic groups had an AER similar to controls. No significant increase in albuminuria after exercise was seen in group DI. Both groups with a disease duration of more than 5 years had a significant increase in albuminuria [median before/after: DII 7.8/16.7 (P < 0.05), DIII 0/57.9 (P < 0.05) micrograms/min per 1.73 m2). Of these patients, 43% also had a measurable urinary excretion of IgG and transferrin, indicating structural glomerular damage. There was no correlation of albuminuria and parameters of metabolic control or renal function. We conclude that in diabetic children an exercise test unveils albuminuria in certain patients, while their AER may be normal at rest.

Famciclovir treatment of hepatitis B virus recurrence after liver transplantation: a pilot study

Despite hepatitis B immunoprophylaxis hepatitis B virus (HBV) recurrence is a frequent and often fatal complication after orthotopic liver transplantation (OLT). The purine nucleoside analogues penciclovir and its oral form famciclovir (FCV) proved to be well tolerated and effective against herpes simplex and zoster virus infections. In addition, an effective reduction of duck and human HBV replication was observed. Therefore, we conducted an uncontrolled pilot study of famciclovir in patients with HBV recurrence after OLT. Twelve patients have received famciclovir for at least 3 months in an open compassionate-use protocol. FCV was administered orally 500 mg three times a day for all patients (except one patient who was started on 750 mg three times a day for the first 2 weeks). Immediately after starting famciclovir, serum HBV DNA levels declined in 9 of 12 patients (75%) with a mean reduction from baseline levels of 80% after 3 months, 90% after 6 months, and > 95% after 12 months of treatment. With continued treatment, 5 of these 9 patients became negative by conventional hybridization assay, and in one of these HBV DNA became undetectable by polymerase chain reaction (PCR) 28 weeks after the start of treatment. Three patients showed no (sustained) reduction in HBV DNA after at least 3 months of treatment; therefore, FCV was stopped. Latest serum alanine aminotransferase (ALT) levels decreased in 6 of 12 patients (50%) with a median decrease of 80% (range, 40%-95%) in comparison to pretreatment ALT values. ALT levels normalized in 4 patients (33%). One patient died due to sepsis and peritonitis in week 13 of treatment. This event was not related to FCV. No clinically significant side effects were noticed in any patient. The oral nucleoside analog famciclovir reduces HBV replication and transaminase levels in patients with HBV recurrence after liver transplantation. Because long-term FCV treatment is well tolerated, famciclovir appears to be a promising antiviral strategy in the treatment of HBV in immunocompromised patients.