[Nail diseases in routine practice]

BACKGROUND

Nail problems are common reasons for patients presenting to dermatological and general practitioners practices.

PROBLEM

Which nail diseases should be known and recognized in routine daily practice?

MATERIAL AND METHODS

This article presents the most common nail alterations experienced by the authors from clinics and routine practices with guidelines on the diagnostics, therapy and additional literature.

RESULTS

Nail alterations can be designated as inflammatory nail dermatoses or neoplasms. Depending on the local nail findings, clinical investigations, patient history, histology if necessary and additional procedures, concrete indications can be derived for the correct diagnosis and therapy.

CONCLUSION

Knowledge of the most commonly occurring nail diseases allows a targeted classification and additional diagnostics which can help to alleviate pain, improve aesthetics and adequately treat malignant alterations.

Microvascular retinal abnormalities in acute intracerebral haemorrhage and lacunar infarction

BACKGROUND

Retinal microvascular changes have been previously associated with cerebral MRI markers of small vessel disease (SVD). Whether retinal changes differ between patient with intracerebral haemorrhage (ICH) and patients with lacunar infarction (LI) caused by small vessel disease has been poorly investigated.

OBJECTIVE

The study aims to compare the frequency of retinal changes between patients with LI and patients with ICH at the acute stage of stroke-related SVD.

METHODS

Microvascular wall signs (arteriolar occlusion, arteriovenous nicking, focal arterial narrowing) and retinopathy lesions (microanevrysms, cotton wool spots, retinal haemorrhages, hard exudates) were assessed by retinography up to three months after stroke onset.

RESULTS

Forty-eight non-diabetic patients with acute stroke-related to SVD (26 LI, 22 ICH) were recruited prospectively in the study. Retinal wall signs (arteriovenous nicking, and focal arterial narrowing) were found in more than three quarters of subjects and most often bilaterally in both groups. Retinopathy lesions (cotton wool spots, retinal haemorrhages) were found more frequently in ICH patients than in LI patients (22.2% vs. 15.4%, 50% vs. 34% respectively, P>0.005). The frequency of bilateral cotton wool spots and of bilateral retinal haemorrhages was significantly higher in ICH patients than in LI patients (12.5% vs. 0%, P=0.012, 41.2% vs. 7.7%, P=0.029 respectively).

CONCLUSION

These results confirm the high frequency of microvascular alterations in patients with hypertension-related SVD leading to LI or ICH and suggest that retinal tissue alterations are more frequent in ICH than in LI. Further investigations are needed to investigate the mechanisms underlying this difference.

Investigation of the male pattern baldness major genetic susceptibility loci AR/EDA2R and 20p11 in female pattern hair loss

BACKGROUND

The aetiology of female pattern hair loss (FPHL) is largely unknown. However, it is hypothesized that FPHL and male pattern baldness (AGA) share common susceptibility alleles. The two major susceptibility loci for AGA are the androgen receptor (AR)/ectodysplasin A2 receptor (EDA2R) locus on the X-chromosome, and a locus on chromosome 20p11, for which no candidate gene has yet been identified.

OBJECTIVES

To examine the role of the AR/EDA2R and 20p11 loci in the development of FPHL using 145 U.K. and 85 German patients with FPHL, 179 U.K. supercontrols and 150 German blood donors.

METHODS

Patients and controls were genotyped for 25 single nucleotide polymorphisms (SNPs) at the AR/EDA2R locus and five SNPs at the 20p11 locus.

RESULTS

Analysis of the AR/EDA2R locus revealed no significant association in the German sample. However, a nominally significant association for a single SNP (rs1397631) was found in the U.K. sample. Subgroup analysis of the U.K. patients revealed significant association for seven markers in patients with an early onset (P = 0·047 after adjustment for the testing of multiple SNPs by Monte Carlo simulation). No significant association was obtained for the five 20p11 variants, either in the overall samples or in the analysis of subgroups.

CONCLUSIONS

The observed association suggests that the AR/EDA2R locus confers susceptibility to early-onset FHPL. Our results do not implicate the 20p11 locus in the aetiology of FPHL.

Measurement of the ZZ production cross section and limits on anomalous neutral triple gauge couplings in proton-proton collisions at sqrt[s] = 7 TeV with the ATLAS detector

A measurement of the ZZ production cross section in proton-proton collisions at sqrt[s] = 7 TeV using data corresponding to an integrated luminosity of 1.02 fb(-1) recorded by the ATLAS experiment at the LHC is presented. Twelve events containing two Z boson candidates decaying to electrons and/or muons are observed, with an expected background of 0.3 ± 0.3(stat)(-0.3)(+0.4)(syst) events. The cross section measured in a phase-space region with good detector acceptance and for dilepton masses within the range 66 to 116 GeV is σ(ZZ → ℓ+ ℓ- ℓ+ ℓ-)(fid) = 19.4(-5.2)(+6.3)(stat)(-0.7)(+0.9)(syst) ± 0.7(lumi) fb. The resulting total cross section for on-shell ZZ production, σ(ZZ)(tot) = 8.5(-2.3)(+2.7)(stat)(-0.3)(+0.4)(syst) ± 0.3(lumi) pb, is consistent with the standard model expectation of 6.5(-0.2)(+0.3) pb calculated at the next-to-leading order in QCD. Limits on anomalous neutral triple gauge boson couplings are derived.

Search for sub-eV mass solar axions by the CERN Axion Solar Telescope with 3He buffer gas

The CERN Axion Solar Telescope (CAST) has extended its search for solar axions by using (3)He as a buffer gas. At T=1.8 K this allows for larger pressure settings and hence sensitivity to higher axion masses than our previous measurements with (4)He. With about 1 h of data taking at each of 252 different pressure settings we have scanned the axion mass range 0.39 eV≲m(a)≲0.64 eV. From the absence of excess x rays when the magnet was pointing to the Sun we set a typical upper limit on the axion-photon coupling of g(aγ)≲2.3×10(-10) GeV(-1) at 95% C.L., the exact value depending on the pressure setting. Kim-Shifman-Vainshtein-Zakharov axions are excluded at the upper end of our mass range, the first time ever for any solar axion search. In the future we will extend our search to m(a)≲1.15 eV, comfortably overlapping with cosmological hot dark matter bounds.

[Relevance and barriers of physician empathy in daily practice - current state of research and qualitative survey of physicians]

AIMS OF THE STUDY

The aim of this study was to investigate the relevance and the barriers of physician empathy in medical rehabilitation by conducting a narrative literature review and a qualitative survey in physicians.

METHODS

First, we described the current state of research of physician empathy in medical rehabilitation based on a narrative (non-systematic) review of the literature. Additionally, the questions of relevance and barriers of physician empathy were examined in a qualitative short survey with physicians from Rehabilitation Medicine, Internal Medicine, Pediatric and Family Medicine. The qualitative data were analyzed according to the summarizing content analysis of Mayring.

RESULTS

Only n=13 studies of physician empathy were conducted in Rehabilitation Medicine; of those, just a few were from Germany and a small number investigated the influence of empathy on patient health outcomes. The qualitative survey's results regarding the definition, patient outcomes and barriers of physician empathy are similar to other theoretical and empirical studies on those issues. Moreover, they show many new, practical aspects, particularly in the field of barriers of physician empathy.

CONCLUSION

Although physician empathy has been shown to be an outcome-relevant factor in acute health care, less attention has been paid to it in Rehabilitation research. Physicians from Rehabilitation Medicine, Internal Medicine, Pediatric and Family Medicine perceive empathic behavior also as an outcome-relevant ability, which is particularly hindered by time pressure and stress but also by personal and patient-specific factors.

[Effect of written patient information on knowledge and function of patients with acute uncomplicated back pain (PIK Study)]

BACKGROUND

If patients return early in the course of acute, uncomplicated back pain to their normal activities, their symptoms improve more quickly. Written detailed patient information can have a positive effect on knowledge and can increase physical activity. In this study the effect of a short evidence-based back pain leaflet on knowledge, function and patients' beliefs was investigated.

METHODS

A randomised controlled trial was carried out in 12 primary care practices. Patients with acute, uncomplicated back pain received either the back-pain specific information (intervention) or a leaflet without content regarding back pain (control). Participants' data were inquired before consultation of the general practitioner, as well as 1 week and 3 months later. Outcome measures were SF-36, FABQ-D, FFbH-R, knowledge concerning back pain, frequency of use of the leaflet, usefulness of the information and change of behaviour.

RESULTS

The included patients totaled 174. The response rates were 74.7% (1 week) and 67% (3 months). Patients receiving the intervention leaflet showed better knowledge at 1 week and greater improvement in function scores at 3 months. There was no effect on patients' beliefs. Patients of the intervention group reported more activity in everyday life.

CONCLUSION

Short written information may have small, in total possibly positive effects on knowledge, support of activity and function in patients with acute, uncomplicated back pain.

The TRAF1/C5 locus confers risk for familial and severe alopecia areata

BACKGROUND

Alopecia areata (AA) is a common hair loss disorder with a complex mode of inheritance. Autoimmune mechanisms are presumed to be crucial aetiologically. It is plausible that a number of autoimmune disorders may share a common genetic background. This phenomenon has been demonstrated in previous studies, which have shown an overlap of susceptibility alleles between AA and other autoimmune disorders. Recent studies have shown that genetic variants on the TRAF1/C5 (tumor necrosis factor receptor-associated factor 1, complement component 5) locus confer susceptibility to rheumatoid arthritis (RA).

OBJECTIVES

To examine the role of the TRAF1/C5 locus in the development of AA using a large sample of 1,195 patients with AA and 1280 controls.

METHODS

We genotyped the two most significant single nucleotide polymorphisms (SNPs) (rs10818488, rs2416808) from a former RA candidate gene study. After having obtained evidence for association, we performed a fine-mapping study and genotyped the locus with an additional 27 SNPs.

RESULTS

While no significant result was obtained for the overall sample, rs2416808 showed significant associations in the analysis of the subgroups with severe AA and with a positive family history. The most significant P-value for rs2416808 was in familial cases (P = 0.004, P(corr) = 0.026). The fine mapping revealed significant associations for four additional SNPs in the analysis of subgroups, with rs2416808 remaining the most significant marker.

CONCLUSIONS

Our results point to the involvement of the TRAF1/C5 locus in the aetiology of familial and severe AA, and provide further support for a shared aetiology between AA and other autoimmune disorders.

The R620W polymorphism in PTPN22 confers general susceptibility for the development of alopecia areata

BACKGROUND

The functional R620W (c.1858C>T) variant of the protein tyrosine phosphatase nonreceptor 22 gene (PTPN22) has been associated with a variety of autoimmune disorders. A recent study has suggested that R620W also contributes to the severe form of alopecia areata (AA).

OBJECTIVES

We sought to replicate the finding of an association between PTPN22 and severe AA. In addition, we wanted to study the effect of PTPN22 on the general risk to develop AA and on other subtypes of AA (mild AA, early/late age at onset, positive/negative family history).

METHODS

The R620W variant was genotyped in a large case-control sample of Belgian-German origin with 435 patients and 628 controls.

RESULTS

Significant results were obtained for the overall collective of patients with AA (P=0.007). Subdividing the sample according to severity of AA, family history and age at onset, we detected lowest P-values for patients with the severe form of AA (Pcorr=0.036), with a positive family history (Pcorr=0.042) and with an age at onset<or=20 years (Pcorr=0.048).

CONCLUSIONS

Our results suggest the R620W variant of PTPN22 as a general risk factor in AA with the strongest effect observed among patients with a severe type of AA, a positive family history or an early onset of disease.

Silicon drift and pixel devices for X-ray imaging and spectroscopy

Starting from the basic photon detection process in semiconductors, the function, principles and properties of sophisticated silicon detectors are discussed. These detectors are based on, or inspired by, the semiconductor drift detector. They have already shown their potential in X-ray astronomy (pn-CCD) and in X-ray spectroscopy (silicon drift diode), and further detector types (DEPFET pixel detector and macro-pixel detector) are under development for several other future experiments. The detectors seem to be very well suited for synchrotron radiation experiments.

First results from the CERN axion solar telescope

Hypothetical axionlike particles with a two-photon interaction would be produced in the sun by the Primakoff process. In a laboratory magnetic field ("axion helioscope"), they would be transformed into x-rays with energies of a few keV. Using a decommissioned Large Hadron Collider test magnet, the CERN Axion Solar Telescope ran for about 6 months during 2003. The first results from the analysis of these data are presented here. No signal above background was observed, implying an upper limit to the axion-photon coupling g(agamma)<1.16x10(-10) GeV-1 at 95% C.L. for m(a) less, similar 0.02 eV. This limit, assumption-free, is comparable to the limit from stellar energy-loss arguments and considerably more restrictive than any previous experiment over a broad range of axion masses.

Efficacy and tolerability of acetazolamide in migraine prophylaxis: a randomised placebo-controlled trial

BACKGROUND

Familial hemiplegic migraine and episodic ataxia type 2 (EA2) are allelic disorders with distinct types of mutations in the CACNA1A gene. EA2 attacks are remarkably sensitive to acetazolamide, a carbonic anhydrase inhibitor. The effectiveness of acetazolamide in migraine prophylaxis is unknown.

OBJECTIVES

To evaluate the efficacy and the tolerability of acetazolamide in migraine prophylaxis.

METHODS

We compared daily oral 500 mg acetazolamide and placebo in patients with migraine in a multicentre, double-blind, randomised trial of 12 weeks duration after a run-in period of 4 weeks without treatment. Frequency of attacks at the last trial period of 4 weeks was the primary efficacy criterion. Secondary efficacy criteria were the frequency of attacks per 4 weeks, the severity and duration of attacks, the number of hours with migraine as well as the number of responders with more than 50% reduction in attack frequency.

RESULTS

53 patients had been enrolled when the study was prematurely stopped because of a high number of withdrawals (34%), primarily linked to acetazolamide related side effects. Considering the primary and secondary efficacy criteria, among the 53 included patients (27 in the placebo group and 26 in the acetazolamide group), no difference between the 2 study groups could be demonstrated. The most frequent adverse events related to acetazolamide were paresthesias and asthenia.

CONCLUSIONS

In this trial, migraine sufferers poorly tolerated acetazolamide given in an oral dose of 500 mg daily. No obvious prophylactic beneficial effect of acetazolamide appeared on migraine attacks.

Rad54 protein stimulates heteroduplex DNA formation in the synaptic phase of DNA strand exchange via specific interactions with the presynaptic Rad51 nucleoprotein filament

RAD54 is an important member of the RAD52 group of genes that carry out recombinational repair of DNA damage in the yeast Saccharomyces cerevisiae. Rad54 protein is a member of the Snf2/Swi2 protein family of DNA-dependent/stimulated ATPases, and its ATPase activity is crucial for Rad54 protein function. Rad54 protein and Rad54-K341R, a mutant protein defective in the Walker A box ATP-binding fold, were fused to glutathione-S-transferase (GST) and purified to near homogeneity. In vivo, GST-Rad54 protein carried out the functions required for methyl methanesulfonate sulfate (MMS), UV, and DSB repair. In vitro, GST-Rad54 protein exhibited dsDNA-specific ATPase activity. Rad54 protein stimulated Rad51/Rpa-mediated DNA strand exchange by specifically increasing the kinetics of joint molecule formation. This stimulation was accompanied by a concurrent increase in the formation of heteroduplex DNA. Our results suggest that Rad54 protein interacts specifically with established Rad51 nucleoprotein filaments before homology search on the duplex DNA and heteroduplex DNA formation. Rad54 protein did not stimulate DNA strand exchange by increasing presynaptic complex formation. We conclude that Rad54 protein acts during the synaptic phase of DNA strand exchange and after the formation of presynaptic Rad51 protein-ssDNA filaments.

Transient global amnesia, migraine, thalamic infarct, dihydroergotamine, and sumatriptan

This case report describes an episode of transient global amnesia that occurred during a migraine attack, which had been treated with vasoconstrictors. Magnetic resonance imaging showed a small lesion with an ischemic appearance in the right thalamus.

Psychiatric comorbidity is related to headache induced by chronic substance use in migraineurs

Headache centers have to deal with patients suffering from headache induced by chronic substance use which is a well-recognized complication of migraine treatment. The objective of this study was to compare psychiatric comorbidity between migraineurs with and without chronic substance use: 34 migrainous inpatients with chronic substance use were compared with 34 sex-matched noncomplicated migraineurs in a case-control study. The results showed a significantly higher prevalence of major depressive disorder, panic disorder, and social phobia in the patients with a history of chronic substance use. Consistently, anxious and depressive dimensions were significantly higher in these patients. Therefore, psychiatric morbidity may be linked to chronic substance use in migraineurs. This stresses the importance of psychiatric assessment and the need for appropriate treatment in such patients.

Dissociation of affect recognition and mood state from blunting in patients with schizophrenia

The present study was designed to investigate the relationships between expression, perception, and experience of emotion in schizophrenic patients with and without affective blunting. Cognitive processing speed, emotional perception, and emotional experience were assessed in 25 schizophrenic patients grouped according to scores on a measure of overt emotional expression (Rating Scale for Emotional Blunting). Results showed dissociation of emotional expression from emotional perception and emotional experience. Blunted schizophrenic patients were no more impaired in the perception of emotion (Profile of Nonverbal Sensitivity) than non-blunted schizophrenic patients. In addition, groups did not differ in intensity of emotional experience as quantified on the self-report of arousal state (Positive and Negative Affect Scales). Accuracy of perception and reported experience of emotion did not differ between groups as a function of emotional valence. Cognitive processing speed (Symbol Digit Modalities Test; SDMT) was related to blunting score and to perception accuracy, although the SDMT did not differ between groups. Results are discussed in terms of a neuropathological basis for impairment of emotional expression.

High-Resolution High-Count-Rate X-ray Spectroscopy with State-of-the-Art Silicon Detectors

For the European X-ray multi-mirror (XMM) satellite mission and the German X-ray satellite ABRIXAS, fully depleted pn-CCDs have been fabricated, enabling high-speed low-noise position-resolving X-ray spectroscopy. The detector was designed and fabricated with a homogeneously sensitive area of 36 cm(2). At 150 K it has a noise of 4 e(-) r.m.s., with a readout time of the total focal plane array of 4 ms. The maximum count rate for single-photon counting was 10(5) counts s(-1) under flat-field conditions. In the integration mode more than 10(9) counts s(-1) can be detected at 6 keV. Its position resolution is of the order of 100 micro m. The quantum efficiency is higher than 90% from carbon K X-rays (277 eV) up to 10 keV. New cylindrical silicon drift detectors have been designed, fabricated and tested. They comprise an integrated on-chip amplifier system with continuous reset, on-chip voltage divider, electron accumulation layer stabilizer, large area, homogeneous radiation entrance window and a drain for surface-generated leakage current. At count rates as high as 2 x 10(6) counts cm(-2) s(-1), they still show excellent spectroscopic behaviour at room-temperature operation in single-photon detection mode. The energy resolution at room temperature is 220 eV at 6 keV X-ray energy and 140 eV at 253 K, being achieved with Peltier coolers. These systems were operated at synchrotron light sources (ESRF, HASYLAB and NLS) as X-ray fluorescence spectrometers in scanning electron microscopes and as ultra low noise photodiodes. The operation of a multi-channel silicon drift detector system is already foreseen at synchrotron light sources for X-ray holography experiments. All systems are fabricated in planar technology having the detector and amplifiers monolithically integrated on high-resistivity silicon.

Angiotropic large-cell lymphoma with peripheral nerve and skeletal muscle involvement: early diagnosis and treatment

Angiotropic large-cell lymphoma is a disorder characterized by an intravascular proliferation of malignant lymphoid cells. We present a patient with polyradiculoneuropathy, myelopathy, and myopathy diagnosed by peripheral nerve and muscle biopsy, who was treated and remains in stable neurologic condition.

Antipsoriatic effect of fumaric acid derivatives. Results of a multicenter double-blind study in 100 patients

BACKGROUND

Psoriasis vulgaris may benefit from treatment with fumaric acid and/or its derivatives; however, because different preparations have been used, results have been contradictory and difficult to interpret.

OBJECTIVE

The purpose of this clinical trial was to evaluate the therapeutic value of fumaric acid derivatives.

METHODS

A randomized double-blind study was carried out in patients with psoriasis, comparing a well-characterized formulation of fumaric acid derivatives with placebo.

RESULTS

The results indicated statistically significant superiority of the fumaric acid derivatives over placebo. Adverse events (flush, gastrointestinal disturbances) were initially relatively frequent, but decreased thereafter.

CONCLUSION

Fumaric acid derivatives were found to be effective and safe in the treatment of psoriasis.

Effects of cyclosporin A on hair

Cyclosporin A (CSA) is an immunosuppressive agent that has provided new approaches in transplantation medicine and in the treatment of autoimmune diseases. One of the most common dermatological side effects of oral CSA is dose-dependent hypertrichosis. This stimulating effect on hair growth encouraged a number of investigators to use CSA not only in the treatment of alopecia areata (AA), but also in male pattern alopecia (MPA). While oral application proved successful, the beneficial effect of topical application was very limited in both AA and MPA.

Highly purified omega-3-polyunsaturated fatty acids for topical treatment of psoriasis. Results of a double-blind, placebo-controlled multicentre study

We report the results of a multicentre, double-blind, placebo-controlled study of topical therapy with omega-3-polyunsaturated fatty acids (omega-3-PUFA) in 52 patients suffering from moderate plaque-type psoriasis. In each patient, two similar stable psoriatic plaques served as indicator lesions for the study. One indicator lesion was randomly assigned to treatment with topical preparations of highly purified omega-3-PUFA in one of two concentrations (1 or 10%), and the other was treated with placebo. Efficacy assessment was based on changes in local psoriasis severity index, area involved, erythema, desquamation, induration and pruritus. After 8 weeks of treatment, all indicator lesions had improved significantly, compared with baseline. However, no statistically or clinically relevant differences between the omega-3-PUFA-treated and the placebo-treated lesions were found. Therapy was well tolerated and, apart from one patient who developed perilesional eczema, no clinically relevant adverse events occurred. In conclusion, topical omega-3-PUFA were not effective in a randomized, placebo-controlled, double-blind setting. Results of non-blind trials should be (re-)considered with caution.

Headache following carotid endarterectomy: a prospective study

The occurrence of headache in the 28 days following surgery was studied in 50 consecutive patients (14F and 36M, mean aged 70 years) who underwent carotid endarterectomy for atheromatous carotid stenosis. Thirty-one patients (62%) reported headache. Headache occurred in the first five days after surgery in 87% of cases. Its characteristics and temporal profile were highly variable but it was mostly bilateral (74%), mild or moderate (78%), requiring no treatment (77%). No correlation was found between the occurrence of headache and degree of stenosis, intraoperative characteristics and past history of headache. In none of our patients was severe ipsilateral headache, cerebral hyperperfusion syndrome, or cluster-like hemicrania encountered and only five patients met the IHS criteria for post-endarterectomy headache. Post-endarterectomy headache is frequent when specifically looked for and is therefore not a single entity. The present IHS criteria are unsatisfactory and should be modified accordingly.

The influence of temperature on muscle function in the fast swimming scup. I. Shortening velocity and muscle recruitment during swimming

In this study, electromyography showed that scup can swim to a maximum speed of 80 cm s-1 with their red muscle whereas previous results showed that carp can swim to only 45 cm s-1. Our aim was to evaluate the adaptations that enable scup to swim nearly twice as fast as carp. Although we anticipated that, at their respective maximum speeds, the red muscle of scup would be shortening at twice the velocity (V) of carp muscle, we found that the values of V were the same (2.04 muscle lengths s-1). At any given swimming speed, V was higher in carp than in scup because carp had a larger sarcomere length excursion and higher tail-beat frequency. The smaller sarcomere excursion in scup is primarily associated with using a less undulatory style of swimming (i.e. with a smaller backbone curvature). This less undulatory style of swimming may be an important adaptation that not only reduces V but may also reduce drag. At their respective maximum speeds, however, the 28% lower sarcomere length excursion in scup is balanced by a 26% higher tail-beat frequency, giving an equal V to that of carp. Although the scup in this study were somewhat longer than the carp in the previous one (19.7 vs 13.4 cm), we believe that many of the observed differences are species-related rather than size-related. We also found that scup swam in a kinematically similar fashion at 10 degrees C and 20 degrees C. However, at 10 degrees C, the scup could swim to only 54 cm s-1 before recruiting their white muscle whereas, at 20 degrees C, they could swim to 80 cm s-1. The difference in speed of initial white muscle recruitment, as well as information on muscle mechanics, suggests that the scup compress their recruitment order into a narrow speed range at low temperatures, thereby recruiting more muscle fibres. Quantitative analysis of red muscle electromyograms in this paper supports this hypothesis.

[Selective changes in lymphocytic differentiation antigens in the peripheral blood of patients with alopecia areata treated with oral zinc]

Recent research has shown that the regrowth of hair in alopecia areata (AA) is associated with the normalization of the CD4+/CD8+ ratio, which is usually in an unbalanced state. This dysbalance is represented by an increased level of CD4+ and a decrease of CD8+ cells and found not only in the bulbar region but also in the peripheral blood. Since zinc generally acts as a polyclonal T-cell activator and has been proved a useful oral therapeutic in AA, we additionally controlled the levels of CD4+ and CD8+ cells as well as other lymphocyte subpopulations in the peripheral blood of AA patients before and during oral treatment with zinc. Our data revealed a significant raise of CD3+, CD8+, CD19+, HLA-DQ+, HLA-DR+, and Leu 2a+8+ cells during oral therapy with zinc. We conclude that the successful treatment of AA with zinc may be due to immunomodulation, especially through the increase of CD8+ cells.

[The value of serologic inflammatory parameters in the diagnosis of alopecia areata]

Even recently, focal processes or inflammatory diseases have repeatedly been discussed as the possible causes of alopecia areata (AA) and corresponding diagnostic measures are still recommended. Therefore, we initially attempted to find definite indications of processes like these in AA patients by means of serologic parameters of inflammation and ESR as well as supplementary clinical focal diagnostics. The data obtained revealed increased titers of antistreptolysin in 2.9% and antistreptococcal DNase B in 25.7%, positive C-reactive protein in 8.6%, positive rheumatoid factor in 4.3%, and elevated ESR in 11.7% of the cases. After these data had carefully been compared to those in healthy persons, only the titer of antistreptococcal DNase B and the ESR were found to be increased. In the majority of the cases, these elevations correlated with concomitant bacterial infections detected by clinical focal diagnostics. Antistreptococcal DNase B titer and ESR seem to be the most appropriate of all our test parameters to provide some indications of a focal process or concomitant inflammatory diseases. The remaining parameters are not indicated in AA.

[Treatment of alopecia areata of the eyebrow with diphenylcyclopropenone and its possible risks]

The treatment of alopecia areata (AA) with diphencyprone is well established and acknowledged. Up to now, diphencyprone has only been applied in case of AA of the capillitium. Thus, for the first time, we used this substance in the treatment of AA of the eyebrows. In consideration of the possible risks, we discuss the necessary precautions regarding the patient, as well as possible side effects.

[Epidermal reticular CD1 pattern]

183 biopsies taken from various skin diseases as well as normal skin were studied in cryostat sections by means of the avidin-biotin complex immunoperoxidase technique, using monoclonal antibody anti-Leu 6, which is directed against the Langerhans cell antigen CD1. In 47 cases, we observed a reticular, pemphigus-like intercellular pattern. This pattern was neither correlated to individual skin diseases, nor to the quality or quantity of corial or epidermotropic infiltrates, nor to the HLA-DR expression of keratinocytes, nor to the count of Langerhans cells. There was, however, a correlation to the presence of Langerhans cells: This pattern was never observed in the aerosyringia or deep infundibula. We conclude, therefore, that the stained antigen has to be regarded as free CD1 derived from the Langerhans cell and diffusing into the keratinocytic intercellular spaces.

[The significance of lymphocytic differentiation antigens in the diagnosis and therapy of alopecia areata]

In an earlier study, a significant reduction of the CD8+, CD16+, CD19+, CD8+Leu8+ and HLA-DQ+ cells was found in the peripheral blood of patients with alopecia areata (AA). On the basis of these findings, typing was repeated after 6 months at the earliest in a total of 44 patients who had meanwhile received different therapies, to detect any shifts in these lymphocyte subgroups with cure or persistence of AA. Any external or internal treatment had been discontinued 4 weeks before typing, in order to preclude short-term influences of the therapy. An increase, i.e., normalization, in CD8+ cells together with a significant decrease in CD4+ cells was shown in the group with complete remission, in contrast to the patients in whom AA had not yielded to treatment. The remaining lymphocyte dysbalances persisted unchanged in both groups. This shows that healing of AA is associated with an increase in CD8+ and a decrease in CD4+ cells.

Two-color flow cytometry analysis in alopecia areata

Since previous studies have shown that circulating T cytotoxic/suppressor cells and natural killer cells are reduced in alopecia areata (AA), we attempted to find further imbalances in mononuclear cells by double labeling with these and additional monoclonal antibodies. In all, the blood of 35 patients and 44 controls was examined using the combinations anti-Leu 3a/8, Leu 2a/8, Leu 2a/15, Leu 7/15 and Leu 7/11a. We found a highly significant reduction of the subpopulation Leu 2a+8+ (p less than 0.008). The results show that patients with AA have additional abnormalities of the circulating mononuclear cells, whereby the reduced Leu 2a+8+ subpopulation represents a new additional marker.

Differential expression of major histocompatibility complex class II antigens on human keratinocytes

Skin biopsies from 136 patients with 30 different dermatoses and eight biopsies of normal skin were investigated with the avidin-biotin-peroxidase complex method with regard to the expression of major histocompatibility complex class II antigens human leukocyte antigen (HLA) HLA-DR, HLA-DQ, HLA-DP on keratinocytes. In normal skin the expression of these antigens was restricted to acrosyringia and Langerhans cells. In the dermatoses investigated HLA-DR was found in 51.5% (70 of 136), HLA-DQ in 24.3% (33 of 136), and HLA-DP in 20.5% (8 of 39). In 37 cases (27.2%) only HLA-DR could be detected, whereas in 33 cases (24.3%) HLA-DR was expressed jointly with HLA-DQ. Coexpression of HLA-DR and HLA-DQ was found especially often in cutaneous T cell lymphomas, skin tumors, and inflammatory dermatoses.

Why animals have different muscle fibre types

Animals have different muscle fibre types: slow fibres with a low maximum velocity of shortening (Vmax) and fast fibres with a high Vmax. An advantage conferred by the use of different fibre types during locomotion has been proposed solely on the basis of their in vitro properties. Isolated muscle experiments show that force generation, mechanical power production and efficiency are all functions of V/Vmax, where V is the velocity of muscle shortening. But it is not known whether animals actually use the different fibres at shortening velocities that are optimal for mechanical power production and efficiency. Here we compare the V of muscle fibres during locomotion with their Vmax. This comparison shows that during slow locomotion, the slow fibres shorten at a velocity that gives peak mechanical power and efficiency and the fast fibres shorten at their optimal velocity when powering maximal movements. Our results also show that maximal movements are impossible without fast fibres because the slow ones cannot shorten rapidly enough.