Influence of breed and genotype on the onset and distribution of infectivity and disease-associated prion protein in sheep following oral infection with the bovine spongiform encephalopathy agent

The onset and distribution of infectivity and disease-specific prion protein (PrP(d)) accumulation was studied in Romney and Suffolk sheep of the ARQ/ARQ, ARQ/ARR and ARR/ARR prion protein gene (Prnp) genotypes (where A stands for alanine, R for arginine and Q for glutamine at codons 136, 154 and 171 of PrP), following experimental oral infection with cattle-derived bovine spongiform encephalopathy (BSE) agent. Groups of sheep were killed at regular intervals and a wide range of tissues taken for mouse bioassay or immunohistochemistry (IHC), or both. Bioassay results for infectivity were mostly coincident with those of PrP(d) detection by IHC both in terms of tissues and time post infection. Neither PrP(d) nor infectivity was detected in any tissues of BSE-dosed ARQ/ARR or ARR/ARR sheep or of undosed controls. Moreover, four ARQ/ARQ Suffolk sheep, which were methionine (M)/threonine heterozygous at codon 112 of the Prnp gene, did not show any biological or immunohistochemical evidence of infection, while those homozygous for methionine (MARQ/MARQ) did. In MARQ/MARQ sheep of both breeds, initial PrP(d) accumulation was identified in lymphoreticular system (LRS) tissues followed by the central nervous system (CNS) and enteric nervous system (ENS) and finally by the autonomic nervous system and peripheral nervous system and other organs. Detection of infectivity closely mimicked this sequence. No PrP(d) was observed in the ENS prior to its accumulation in the CNS, suggesting that ENS involvement occurred simultaneously to that of, or followed centrifugal spread from, the CNS. The distribution of PrP(d) within the ENS further suggested a progressive spread from the ileal plexus to other ENS segments via neuronal connections of the gut wall. Differences between the two breeds were noted in terms of involvement of LRS and ENS tissues, with Romney sheep showing a more delayed and less consistent PrP(d) accumulation than Suffolk sheep in such tissues. Whether this accounted for the slight delay (∼5 months) in the appearance of clinical signs in Romney sheep is debatable since by the last scheduled kill before animals reached clinical end point, both breeds showed widespread accumulation and similar magnitudes of PrP(d) accumulation in the brain.

Loss of giant obscurins from breast epithelium promotes epithelial-to-mesenchymal transition, tumorigenicity and metastasis

Obscurins, encoded by the single OBSCN gene, are giant cytoskeletal proteins with structural and regulatory roles. The OBSCN gene is highly mutated in different types of cancers. Loss of giant obscurins from breast epithelial cells confers them with a survival and growth advantage, following exposure to DNA-damaging agents. Here we demonstrate that the expression levels and subcellular distribution of giant obscurins are altered in human breast cancer biopsies compared with matched normal samples. Stable clones of non-tumorigenic MCF10A cells lacking giant obscurins fail to form adhesion junctions, undergo epithelial-to-mesenchymal transition and generate >100-μm mammospheres bearing markers of cancer-initiating cells. Obscurin-knockdown MCF10A cells display markedly increased motility as a sheet in 2-dimensional (2D) substrata and individually in confined spaces and invasion in 3D matrices. In line with these observations, actin filaments redistribute to extending filopodia where they exhibit increased dynamics. MCF10A cells that stably express the K-Ras oncogene and obscurin short hairpin RNA (shRNA), but not scramble control shRNA, exhibit increased primary tumor formation and lung colonization after subcutaneous and tail vein injections, respectively. Collectively, our findings reveal that loss of giant obscurins from breast epithelium results in disruption of the cell-cell contacts and acquisition of a mesenchymal phenotype that leads to enhanced tumorigenesis, migration and invasiveness in vitro and in vivo.

Neuropeptide Y receptor Y5 as an inducible pro-survival factor in neuroblastoma: implications for tumor chemoresistance

Neuroblastoma (NB) is a pediatric tumor of neural crest origin with heterogeneous phenotypes. While low stage tumors carry a favorable prognosis, over 50% of high risk NB relapses after treatment with a fatal outcome. Thus, developing therapies targeting refractory NB remains an unsolved clinical problem. Brain-derived neurotrophic factor (BDNF) and its TrkB receptor are known to protect NB cells from chemotherapy-induced cell death, while neuropeptide Y (NPY), acting via its Y2 receptor (Y2R), is an autocrine proliferative and angiogenic factor crucial for maintaining NB tumor growth. Here, we show that in NB cells, BDNF stimulates the synthesis of NPY and induces expression of another one of its receptors, Y5R. In human NB tissues, the expression of NPY and Y5R positively correlated with the expression of BDNF and TrkB. Functionally, BDNF triggered Y5R internalization in NB cells, while Y5R antagonist inhibited BDNF-induced p44/42-MAPK activation and its pro-survival activity. These observations suggested TrkB-Y5R transactivation that resulted in cross-talk between their signaling pathways. Additionally, NPY and Y5R were up-regulated in a BDNF-independent manner in NB cells under pro-apoptotic conditions, such as serum deprivation and chemotherapy, as well as in cell lines and tissues derived from post-treatment NB tumors. Blocking Y5R in chemoresistant NB cells rich in this receptor sensitized them to chemotherapy-induced apoptosis and inhibited their growth in vivo by augmenting cell death. In summary, the NPY/Y5R axis is an inducible survival pathway activated in NB by BDNF or cellular stress. Upon such activation, Y5R augments the pro-survival effect of BDNF via its interactions with TrkB receptor and exerts an additional BDNF-independent anti-apoptotic effect, both of which contribute to NB chemoresistance. Therefore, the NPY/Y5R pathway may become a novel therapeutic target for patients with refractory NB, thus far an incurable form of this disease.

Sorption of phthalic acid at goethite surfaces under flow-through conditions

The objectives of this investigation were to improve our understanding of organic acid transport in porous media by focusing on a model system involving phthalic acid and goethite-coated sand (GCS). This was specifically made by first recalibrating a molecularly sound phthalate surface complexation model to GCS and then applying this model to describe breakthrough curves (BTC) in a GCS packed column. ATR-FTIR spectra of phthalic acid adsorbed at goethite surfaces at pH 3.0 and 6.0 and at loadings from 2.0 to 40.8 μmol/m(2) confirmed the coexistence of metal-bonded (MB) and hydrogen-bonded (HB) complexes at low pH and the predominance of HB complexes at high pH. This concept was incorporated into a surface complexation model used to describe BTC at influent pH (pH(in)) values of 3.0, 6.0, and 7.8. The BTC revealed strongly pH-dependent behaviors. At pH(in) 3.0, the BTC revealed one front/plateau behavior while at pH(in) 6.0 two fronts/plateaus occurred. The existence of a second front/plateau led to an overestimation of the sorbed amount compared to that observed in the batch and caused a failure in the prediction of BTC. Additional column investigations suggested that surface loadings of nonspecifically adsorbed complexes could vary with pH and ionic strength and that the two-step breakthrough behavior may have emerged as a result of the formation of surface species of different natures than those during the first step, with the latter even serving as attachment sites corresponding to the second step. These findings call for refinements in current day modeling approaches used in reactive transport studies.

Die Reaktionen 30Si(d, p)31Si und 30Si(3He, d)31P

Es wurden die Reaktionen 30Si(d, p)31Si bei Ed = 10 MeV und 30Si(3He, d)31P bei E3He = 15 MeV mit einem Breitbandmagnetspektrographen untersucht. Für 31Si wurden Winkelverteilungen für 20 Niveaus von 5° bis 120° gemessen und mit einer DWBA Analyse wurden l-Werte und spektroskopische Faktoren bestimmt. Auf Grund der Targetzusammensetzung wurden zugleich mit dem 31Si 23 Niveaus im 29Si gemessen, deren spektroskopische Faktoren mit früheren Messungen 1 übereinstimmen. Die l = 2 Winkelverteilungen sind strukturiert oder flach je nach dem dem Spin 3/2+ oder 5/2+ des Endzustandes, so daß sich durch Vergleich auch die Spins der Niveaus im 31Si bestimmen ließen. Im 31P wurden die l-Werte und relativen spektroskopischen Faktoren aus 4 Spektren bei 4 ausgewählten Winkeln bestimmt. Eine Interpretation der Niveaustruktur und der spektroskopischen Faktoren von 31Si und 31P nach den Schalenmodellrechnungen von GLAUDEMANS et al. 2 schlägt fehl, vor allem da in den Rechnungen die d5/2 Schale als abgeschlossen betrachtet wird. Die versuchsweise Anwendung des NILssoN-Models führt auf kleine Deformationen | η | < 2, ohne die Niveauleiter indessen exakt erklären zu können.

Stacking fault energy in austenitic steels determined by usingin situX-ray diffraction during bending

A method is presented which determines the stacking fault energy in face-centred cubic materials from the critical stress that is inducedviasample bending in the early stages of plastic deformation. The critical stress is gauged byin situX-ray diffraction. This method utilizes the results of Byun's consideration of the stress dependence of the partial dislocation separation [Byun (2003).Acta Mater.51, 3063–3071]. Byun showed that the separation distance of the partial dislocations increases rapidly when the critical stress is reached and that the critical stress needed for the rapid separation of the partial dislocations is directly proportional to the stacking fault energy. In the approach presented here, the partial dislocation separation and the corresponding triggering stress are monitored by usingin situX-ray diffraction during sample bending. Furthermore, thein situX-ray diffraction measurement checks the possible interactions between stacking faults present on equivalent lattice planes and the interactions of the stacking faults with other microstructure defects. The capability of the proposed method was tested on highly alloyed austenitic steels containing chromium (∼16 wt%), manganese (∼7 wt%) and nickel as the main alloying elements. For the steels containing 5.9 and 3.7 wt% Ni, stacking fault energies of 17.5 ± 1.4 and 8.1 ± 0.9 mJ m−2were obtained, respectively.

[The emergency department: an appropriate place for identifying troubled teens]

OBJECTIVES

The main objective of this study was to estimate the prevalence of psychological distress among adolescents seen in emergency departments, and the secondary objective was to highlight their main reasons for consulting.

METHODS

Cross-sectional study in three multicenter emergency departments receiving adolescents in Île-de-France conducted in 2010. All adolescents completed a questionnaire including the ADRS (Adolescent Depression Rating Scale, a screening questionnaire for depression) and a series of questions relating to somatization and risk behaviors.

RESULTS

The study included 346 adolescents, 320 of which were fully analyzed. The ADRS score was considered normal (score < 3) for 70.6% of the sample (n = 226), 19.4% of adolescents (n = 62) had moderate depressive symptoms (3 ≤ score < 6), and 10.0% severe depressive symptoms (score ≥ 6) (n = 32). The majority of patients consulted for trauma and less than 10% for acute psychiatric problems; 17% of adolescents who came to the emergency department for a nonpsychiatric reason had an ADRS ≥ 3, i.e., with mental distress.

CONCLUSION

The routine use of a self-administered questionnaire in the emergency services could identify adolescents with moderate to severe depressive symptoms.

Laparoscopic sleeve gastrectomy improves reproductive hormone levels in morbidly obese males -- a series of 28 cases

BACKGROUND

Obese males frequently present with low androgen levels that may improve after weight loss achieved by bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) has been used often in the last decade as treatment for morbid obesity. The aim of this study was to evaluate modifications in the male reproductive hormone profile after LSG.

PATIENTS AND METHODS

The prospective study included 28 males with body mass index (BMI) 35 kg m2 who underwent LSG.Total Testosterone (TT), Sex Hormone Binding Globulin(SHBG) and Luteinizing hormone (LH), together with biochemical and anthropometric data, were evaluated at baseline and after LSG.

RESULTS

Baseline patients had a mean BMI of 50.10 (+-11.19)kg m2, SHBG 23.37 (+-17.47) nmol L, LH 3.83 (+-1.76)mUI ml and TT 8.31 (+-3.24) nmol L. After LSG, patients showed a mean BMI of 35.87 (+-7.02) kg m2 (p 0.001),SHBG 37.81 (+-18.95) nmol L (p 0.05), LH 4.76 (+-2.49)mUI ml (p 0.05), whereas mean TT was 12.7 (Â+-3.8) nmol L(p 0.001). The percentage of excess body weight loss (%EBL)was 43.07 (+-9.56) and metabolic syndrome prevalence decreased significantly from 75% to 25% (p 0.001).

CONCLUSIONS

Beyond BMI loss, LSG significantly improved reproductive hormone levels in morbidly obese males.

Danger signalling during cancer cell death: origins, plasticity and regulation

Accumulating data indicates that following anti-cancer treatments, cancer cell death can be perceived as immunogenic or tolerogenic by the immune system. The former is made possible due to the ability of certain anti-cancer modalities to induce immunogenic cell death (ICD) that is associated with the emission of damage-associated molecular patterns (DAMPs), which assist in unlocking a sequence of events leading to the development of anti-tumour immunity. In response to ICD inducers, activation of endoplasmic reticulum (ER) stress has been identified to be indispensable to confer the immunogenic character of cancer cell death, due to its ability to coordinate the danger signalling pathways responsible for the trafficking of vital DAMPs and subsequent anti-cancer immune responses. However, in recent times, certain processes apart from ER stress have emerged (e.g., autophagy and possibly viral response-like signature), which have the ability to influence danger signalling. In this review, we discuss the molecular nature, emerging plasticity in the danger signalling mechanisms and immunological impact of known DAMPs in the context of immunogenic cancer cell death. We also discuss key effector mechanisms modulating the interface between dying cancer cells and the immune cells, which we believe are crucial for the therapeutic relevance of ICD in the context of human cancers, and also discuss the influence of experimental conditions and animal models on these.

Short-term effects of airborne ragweed pollen on clinical symptoms of hay fever in a panel of 30 patients

OBJECTIVES

Ragweed, Ambrosia artemisiifolia, is a highly allergenic annual herbaceous plant that is spreading quickly across the globe. Few studies have investigated the relationship between ragweed pollen counts and hay fever symptoms. We investigate the dose-response relationship between ragweed exposure in patients sensitized to ragweed and daily hay fever symptoms.

METHOD

A panel study was conducted among 31 adult patients sensitized to A artemisiifolia in France and Switzerland. Rhinitis, conjunctivitis, and bronchial symptoms were recorded daily, as well as daily pollen counts of ragweed, air pollutants, and meteorological data over 2 successive years. Data were analyzed with generalized estimating equation models to quantify effects of ragweed pollen whilst controlling for confounders.

RESULTS

The relationship between ragweed pollen and the percentage of patients with nasal, ocular, and bronchial symptoms was linear. For every increase of 10 grains/m3, the odds ratio (OR) (95% confidence interval) for nasal symptoms was, in 2009, 1.18 [1.04-1.35] on weekdays and 1.43 [1.16-1.75] at weekends, and in 2010, 1.04 [1.00-1.07] on weekdays and 1.25 [1.06-1.46] at weekends.The OR for ocular symptoms was 1.32 [1.16-1.56] in 2009 and 1.05 [1.02-1.07] in 2010. Finally, the OR for bronchial symptoms was 1.14 [1.03-1.25] in 2009 and 1.03 [0.97-1.08] in 2010.

CONCLUSION

There is a statistically significant linear relationship between ragweed pollen counts and hay fever symptoms. Our study shows that nasal symptoms differ on weekdays and at weekends.

[Health impact of exposure to pollens: A review of epidemiological studies]

The aim of this review is to describe the health impact of exposure to pollen based on recently published epidemiological studies. The methodology chapter, describes a review of the literature and outlines important elements of these studies: measurement of exposure to pollens, study types used, study populations and the health indicators related to pollen exposure. In this review, two types of studies have been used to assess the epidemiological evidence of short-term links between pollen exposure and hay fever or asthma. Ecological time-series studies use daily indicators of asthma exacerbations (emergency room admissions or hospitalizations), consultations for rhinitis or conjunctivitis, or anti-allergic drug consumption within general population. Panel studies relate measurements of pollen grain concentrations to nasal, ocular and bronchial symptom severity in a group of subjects sensitized to a specific pollen, monitored during the pollen season. In both cases, the studies show a relationship on a day-to-day basis between health indicators and daily rates of atmospheric pollen collected by a pollen trap. These studies take into account confounding factors, such as air pollution, weather factors and sometimes exposure to outdoor molds. Unlike earlier studies, more and more studies focus on the shape of the dose-response relationship and the lag between pollen exposure and symptoms. Only rarely, individual susceptibility factors, the clinical phenomenon of priming and polysensitization are reported. Thus, ecological time-series studies and panel studies assess respectively the impact of pollen exposure in the general population and in groups of sensitized patients. Using appropriate statistical tools, these studies provide insight into the shape of the dose-response relationship, with a potential threshold below which symptoms are absent, then a linear relationship for nasal, ocular and bronchial symptoms and a plateau where the symptoms do not increase despite the continued increase in pollen.

Association of serum adiponectin and insulin-like growth factor I levels with parameters of cardiac remodeling in severely obese patients

BACKGROUND

Obesity is associated with various changes in cardiac geometry and this process involves both hemodynamic and non-hemodynamic factors, among which adipocitokines and growth factors may play an important role. The aim of this study was to identify the extent and pattern of cardiac remodeling in a group of severely obese patients and analyze the relationship between adiponectin, IGFI and cardiac parameters reflecting obesity-associated structural changes.

SUBJECTS AND METHODS

Our study included 344 patients (104 men) with severe obesity [mean body mass index (BMI)= 45.7 ± 8.5 kg/m(2)], extensively evaluated clinically and biologically (complete metabolic tests, serum adiponectin, and IGF-I measurements). Left ventricular (LV) mass index (LVMI), left atrium (LA) size, and LV geometry were determined by means of cardiac ultrasound.

RESULTS

The most prevalent pattern of LV geometry was eccentric hypertrophy (28.7% of patients). In a gender-, age-, BMI-, diabetes- and hypertension-adjusted general linear model, patients with concentric or eccentric hypertrophy had significantly lower values of adiponectin than those with normal geometry (6.75 ± 0.41, 6.96 ± 0.53, vs 9.04 ± 0.42 mg/l, p<0.05). In multivariate analysis, independent determinants for LVMI were BMI (β=0.364, p<0.001), systolic blood pressure (BP) (β=0.187, p=0.004), age (β=0.246, p<0.001), adiponectin (β=-0.151, p=0.012), and IGF-I z-score (β=0.134, p=0.025) while factors independently related to LA size were systolic BP (β=0.218, p<0.001), BMI (β=0.194, p<0.001), age (β=0.273, p<0.001), gender (β=-0.195, p<0.001), and adiponectin (β=-0.180, p=0.005).

CONCLUSIONS

In patients with severe obesity, IGF-I z score and adiponectin correlate with parameters of cardiac remodeling independently of anthropometric, hemodynamic or metabolic factors.

Comparing the sustainability of different action policy possibilities: application to the issue of both household survival and forest preservation in the corridor of Fianarantsoa

A sustainability issue for the rain forest in the corridor of Fianarantsoa (Madagascar) is to preserve the forest while ensuring the development of the local population. The aim of this paper is to determine whether the current situation is sustainable or not according to different action policy possibilities. We propose a general procedure based on viability analysis: Translation of sustainability issues into constraints on the system state; elaboration of a mathematical model of system evolution rules in the form of controlled dynamical system; computations of the viability kernels according to different action policy possibilities. Among control variables, we focus on monetary transfer. Without monetary transfer, we show that the current situation of the rain forest corridor is not sustainable in our mathematical modeling framework. We then estimate the minimal maximal amount per year necessary to make the current situation sustainable.

Meal replacement reduces insulin requirement, HbA1c and weight long-term in type 2 diabetes patients with >100 U insulin per day

BACKGROUND

Despite high insulin doses, good glycaemic control is often lacking in type 2 diabetes patients and new therapeutic options are needed.

METHODS

In a proof of principle study, an energy-restricted, protein-rich meal replacement (PRMR) was examined as a means of reducing insulin requirement, HbA1C and body weight. Obese type 2 diabetes patients (n = 22) with >100 U insulin per day replaced, in week 1, the three main meals with 50 g of PRMR (Almased-Vitalkost) each (= 4903 kJ day(-1) ). In weeks 2-4, breakfast and dinner were replaced, and, in weeks 5-12, only dinner was replaced. Clinical parameters were determined at baseline, and after 4, 8 and 12 weeks, as well as after 1.5 years of follow-up. The Wilcoxon signed-rank test was used for the intention-to-treat analysis and the Mann-Whitney U-test for subgroup analyses.

RESULTS

The 12-week-programme was completed by 15 participants (68%). After 1 week, the mean insulin dose was reduced from 147 (75) U to 91 (55) U day(-1) (P = 0.0001), and to 65 (32) U (P < 0.0001) after 12 weeks of study. Over a period of 12 weeks, HbA1c decreased from 8.8% (1.4%) to 8.1% (1.6%) (P = 0.048) and weight decreased from 118.0 (19.7) kg to 107.4 (19.2) kg (P < 0.0001). Moreover, body mass index, waist and hip circumference, fasting blood glucose, triglycerides and high-density lipoprotein cholesterol improved significantly. After 1.5 years, insulin requirement and weight remained significantly lower than baseline. Participants who continued PRMR further reduced their HbA1c, weight and insulin dose. Two patients were able to stop insulin therapy altogether.

CONCLUSIONS

Energy-restricted PRMR was effective in reducing insulin requirement of type 2 diabetes patients with intensified insulin therapy accompanied by a reduction of HbA1c, weight and other cardiometabolic risk factors. With the continuous use of PRMR, glycaemic control might be improved in the long term.

Demonstration of coherent imaging through a phased array of single-mode optical fibers

We demonstrate coherent imaging through a phased array of single-mode optical fibers. Specifically, we show that two laboratory point sources located within the individual-fiber single-mode acceptance angle can be resolved. Such techniques could eventually enable direct imaging with arrays of small collecting telescopes.

ES cells-derived ectomesenchymal cells for tooth engineering

Recent progresses in stem cell biology and tissue engineering allow considering the possible development of new therapies for compensating the dental tissue losses associated with traumas, pathologies or ageing. The possibility of generating a tooth by mimicking development through reassociations between dental epithelial cells and ectomesenchymal cells derived from the neural crest (NC) has been demonstrated in the mouse. In the search of cell sources to be used for a human transfer, pluripotent stem cells could represent a good alternative. Our study thus focuses on obtaining, ectomesenchymal cells from pluripotent ES cells, capable of promoting tooth histomorphogenesis, when reassociated with a competent dental epithelium. To this end, two ES differentiation protocols, using cyclopamine or a combination of FGF2 and BMP4, have been developed and tested for their capacity to generate such cells. The differentiated ES cells were characterized by quantitative RT-PCR. Both protocols led the cells to acquire in 10 days a mesenchymal-like cell morphology. Rapidly after induction, the cells loose their expression of pluripotent genes while sequentially activating typical NC specifiers. However, the kinetics of gene activation differed between the 2 protocols. Interestingly, Twist, a gene whose expression in the NC is associated with a commitment towards an ectomesenchymal fate, is only activated under the influence of FGF2 and BMP4. Reassociation experiments with a competent epithelium will allow testing the odontogenic potential of the differentiated ES cells. These experiments performed in the mouse system should allow defining a strategy for obtaining odontogenic competent human cells.

Inducing apoptosis of cancer cells using small-molecule plant compounds that bind to GRP78

Background:

Glucose regulated protein 78 (GRP78) functions as a sensor of endoplasmic reticulum (ER) stress. The aim of this study was to test the hypothesis that molecules that bind to GRP78 induce the unfolded protein response (UPR) and enhance cell death in combination with ER stress inducers.

Methods:

Differential scanning calorimetry (DSC), measurement of cell death by flow cytometry and the induction of ER stress markers using western blotting.

Results:

Epigallocatechin gallate (EGCG), a flavonoid component of Green Tea Camellia sinensis, and honokiol (HNK), a Magnolia grandiflora derivative, bind to unfolded conformations of the GRP78 ATPase domain. Epigallocatechin gallate and HNK induced death in six neuroectodermal tumour cell lines tested. Levels of death to HNK were twice that for EGCG; half-maximal effective doses were similar but EGCG sensitivity varied more widely between cell types. Honokiol induced ER stress and UPR as predicted from its ability to interact with GRP78, but EGCG was less effective. With respect to cell death, HNK had synergistic effects on melanoma and glioblastoma cells with the ER stress inducers fenretinide or bortezomib, but only additive (fenretinide) or inhibitory (bortezomib) effects on neuroblastoma cells.

Conclusion:

Honokiol induces apoptosis due to ER stress from an interaction with GRP78. The data are consistent with DSC results that suggest that HNK binds to GRP78 more effectively than EGCG. Therefore, HNK may warrant development as an antitumour drug.

[Diagnostic accuracy of a standardized carbohydrate-rich breakfast compared to an oral glucose tolerance test in occupational medicine]

BACKGROUND

Increasing prevalence of type 2 diabetes mellitus is not only a problem for the health care system but also impairs working environment. In order to reduce costs by illness and early retirement and the development of diabetic complications occupational medicine is important for early diabetes detection. However, the diagnostic gold standard, oral glucose tolerance test (oGTT), is rarely accepted. Aim of our investigation was to evaluate diagnostic accuracy of a standardizable and cost-effective test-breakfast in comparison to oGTT which might be accepted in workplace.

METHODS

During a workplace health promotion program diagnostic accuracy (sensitivity and specificity) of a test-breakfast (index test) was analyzed in a random-cross-over-design with healthy volunteers in comparison to an oGTT (reference test).

RESULTS

278 subjects participated and rated the health promotion program to be useful (99%). 74% stated that they preferred the test-breakfast in contrast to the oGTT. Both screening methods showed comparable plasma glucose and insulin curves. The plasma glucose levels measured capillary and venously during test-breakfast and oGTT were very consistent. Differences were only seen for the 2 h plasma glucose values in the fully adjusted model. The test-breakfast demonstrated high sensitivity and specificity for diabetes diagnosis compared to the reference test with highly comparable results, i. e. 8 persons (2,9%) newly diagnosed with diabetes by the test-breakfast vs. 7 (2,5%) by oGTT.

CONCLUSION

A test-breakfast seems to be a useful first screening instrument to increase the compliance of occupational health promotions and might improve early diabetes diagnosis.

Proboscis lateralis

INTRODUCTION

Proboscis lateralis is a rare congenitally acquired facial abnormality characterized by a soft-tissue tube- or trunk-like appendage projecting from the surface of the face, most frequently rooted in the medial canthal region. Proboscis lateralis is generally associated with a wide range of concomitant craniofacial anomalies, giving rise to multiple theories describing the embryological pathogenesis and various classification systems to account for the pathological associations.

RESULTS/CONCLUSION

This paper provides a literature review of the rare manifestations of proboscis lateralis and represents a summary of current literature related to embryological pathogenesis, definitive diagnosis, and surgical management approaches.