New Constraint on the Local Relic Neutrino Background Overdensity with the First KATRIN Data Runs

We report on the direct search for cosmic relic neutrinos using data acquired during the first two science campaigns of the KATRIN experiment in 2019. Beta-decay electrons from a high-purity molecular tritium gas source are analyzed by a high-resolution MAC-E filter around the end point at 18.57 keV. The analysis is sensitive to a local relic neutrino overdensity ratio of η<9.7×10^{10}/α (1.1×10^{11}/α) at a 90% (95%) confidence level with α=1 (0.5) for Majorana (Dirac) neutrinos. A fit of the integrated electron spectrum over a narrow interval around the end point accounting for relic neutrino captures in the tritium source reveals no significant overdensity. This work improves the results obtained by the previous neutrino mass experiments at Los Alamos and Troitsk. We furthermore update the projected final sensitivity of the KATRIN experiment to η<1×10^{10}/α at 90% confidence level, by relying on updated operational conditions.

A Pilot Clinical Study to Investigate the Hypomethylating Properties of Freeze-dried Black Raspberries in Patients with Myelodysplastic Syndrome or Myeloproliferative Neoplasm

Myelodysplastic syndromes (MDS) and myelodysplastic/myeloproliferative neoplasms (MDS/MPN) are bone marrow disorders characterized by cytopenias and progression to acute myeloid leukemia. Hypomethylating agents (HMAs) are Food and Drug Administration-approved therapies for MDS and MDS/MPN patients. HMAs have improved patients' survival and quality of life when compared with other therapies. Although HMAs are effective in MDS and MDS/MPN patients, they are associated with significant toxicities that place a large burden on patients. Our goal is to develop a safer and more effective HMA from natural products. We previously reported that black raspberries (BRBs) have hypomethylating effects in the colon, blood, spleen, and bone marrow of mice. In addition, BRBs exert hypomethylating effects in patients with colorectal cancer and familial adenomatous polyposis. In the current study, we conducted a pilot clinical trial to evaluate the hypomethylating effects of BRBs in patients with low-risk MDS or MDS/MPN. Peripheral blood mononuclear cells (PBMCs) were isolated before and after three months of BRB intervention. CD45+ cells were isolated from PBMCs for methylation analysis using a reduced-representation bisulfite sequencing assay. Each patient served as their own matched control, with their measurements assessed before intervention providing a baseline for post-intervention results. Clinically, our data showed that BRBs were well-tolerated with no side effects. When methylation data was combined, BRBs significantly affected methylation levels of 477 promoter regions. Pathway analysis suggests that BRB-induced intragenic hypomethylation drives leukocyte differentiation. A randomized, placebo-controlled clinical trial of BRB use in low-risk MDS or MDS/MPN patients is warranted.

Bound on 3+1 Active-Sterile Neutrino Mixing from the First Four-Week Science Run of KATRIN

We report on the light sterile neutrino search from the first four-week science run of the KATRIN experiment in 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are analyzed by a high-resolution MAC-E filter down to 40 eV below the endpoint at 18.57 keV. We consider the framework with three active neutrinos and one sterile neutrino. The analysis is sensitive to the mass, m_{4}, of the fourth mass state for m_{4}^{2}≲1000  eV^{2} and to active-to-sterile neutrino mixing down to |U_{e4}|^{2}≳2×10^{-2}. No significant spectral distortion is observed and exclusion bounds on the sterile mass and mixing are reported. These new limits supersede the Mainz results for m_{4}^{2}≲1000  eV^{2} and improve the Troitsk bound for m_{4}^{2}<30  eV^{2}. The reactor and gallium anomalies are constrained for 100<Δm_{41}^{2}<1000  eV^{2}.

Improved Upper Limit on the Neutrino Mass from a Direct Kinematic Method by KATRIN

We report on the neutrino mass measurement result from the first four-week science run of the Karlsruhe Tritium Neutrino experiment KATRIN in spring 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are energy analyzed by a high-resolution MAC-E filter. A fit of the integrated electron spectrum over a narrow interval around the kinematic end point at 18.57 keV gives an effective neutrino mass square value of (-1.0_{-1.1}^{+0.9})  eV^{2}. From this, we derive an upper limit of 1.1 eV (90% confidence level) on the absolute mass scale of neutrinos. This value coincides with the KATRIN sensitivity. It improves upon previous mass limits from kinematic measurements by almost a factor of 2 and provides model-independent input to cosmological studies of structure formation.

Comparison of EEG and MEG in source localization of induced human gamma-band oscillations during visual stimulus

High frequency gamma oscillations are indications of information processing in cortical neuronal networks. Recently, non-invasive detection of these oscillations have become one of the main research areas in magnetoencephalography (MEG) and electroencephalography (EEG) studies. The aim of this study, which is a continuation of our previous MEG study, is to compare the capability of the two modalities (EEG and MEG) in localizing the source of the induced gamma activity due to a visual stimulus, using a spatial filtering technique known as dynamic imaging of coherent sources (DICS). To do this, the brain activity was recorded using simultaneous MEG and EEG measurement and the data were analyzed with respect to time, frequency, and location of the strongest response. The spherical head modeling technique, such as, the three-shell concentric spheres and an overlapping sphere (local sphere) have been used as a forward model to calculate the external electromagnetic potentials and fields recorded by the EEG and MEG, respectively. Our results from the time-frequency analysis, at the sensor level, revealed that the parieto-occipital electrodes and sensors from both modalities showed a clear and sustained gamma-band activity throughout the post-stimulus duration and that both modalities showed similar strongest gamma-band peaks. It was difficult to interpret the spatial pattern of the gamma-band oscillatory response on the scalp, at the sensor level, for both modalities. However, the source analysis result revealed that MEG3 sensor type, which measure the derivative along the longitude, showed the source more focally and close to the visual cortex (cuneus) as compared to that of the EEG.

Comparison of imaging modalities and source-localization algorithms in locating the induced activity during deep brain stimulation of the STN

One of the most commonly used therapy to treat patients with Parkinson's disease (PD) is deep brain stimulation (DBS) of the subthalamic nucleus (STN). Identifying the most optimal target area for the placement of the DBS electrodes have become one of the intensive research area. In this study, the first aim is to investigate the capabilities of different source-analysis techniques in detecting deep sources located at the sub-cortical level and validating it using the a-priori information about the location of the source, that is, the STN. Secondly, we aim at an investigation of whether EEG or MEG is best suited in mapping the DBS-induced brain activity. To do this, simultaneous EEG and MEG measurement were used to record the DBS-induced electromagnetic potentials and fields. The boundary-element method (BEM) have been used to solve the forward problem. The position of the DBS electrodes was then estimated using the dipole (moving, rotating, and fixed MUSIC), and current-density-reconstruction (CDR) (minimum-norm and sLORETA) approaches. The source-localization results from the dipole approaches demonstrated that the fixed MUSIC algorithm best localizes deep focal sources, whereas the moving dipole detects not only the region of interest but also neighboring regions that are affected by stimulating the STN. The results from the CDR approaches validated the capability of sLORETA in detecting the STN compared to minimum-norm. Moreover, the source-localization results using the EEG modality outperformed that of the MEG by locating the DBS-induced activity in the STN.

Impact of head modeling and sensor types in localizing human gamma-band oscillations

An effective mechanism in neuronal communication is oscillatory neuronal synchronization. The neuronal gamma-band (30-100 Hz) synchronization is associated with attention which is induced by a certain visual stimuli. Numerous studies have shown that the gamma-band activity is observed in the visual cortex. However, impact of different head modeling techniques and sensor types to localize gamma-band activity have not yet been reported. To do this, the brain activity was recorded using 306 magnetoencephalography (MEG) sensors, consisting of 102 magnetometers and 102 pairs of planar gradiometers (one measuring the derivative of the magnetic field along the latitude and the other along the longitude), and the data were analyzed with respect to time, frequency, and location of the strongest response. The spherical head models with a single-shell and overlapping spheres (local sphere) have been used as a forward model for calculating the external magnetic fields generated from the gamma-band activity. For each sensor type, the subject-specific frequency range of the gamma-band activity was obtained from the spectral analysis. The identified frequency range of interest with the highest gamma-band activity is then localized using a spatial-filtering technique known as dynamic imaging of coherent sources (DICS). The source analysis for all the subjects revealed that the gradiometer sensors which measure the derivative along the longitude, showed sources close to the visual cortex (cuneus) as compared to the other gradiometer sensors which measure the derivative along the latitude. However, using the magnetometer sensors, it was not possible to localize the sources in the region of interest. When comparing the two head models, the local-sphere model helps in localizing the source more focally as compared to the single-shell head model.

Coherent source and connectivity analysis on simultaneously measured EEG and MEG data during isometric contraction

The most well-known non-invasive electric and magnetic field measurement modalities are the electroencephalography (EEG) and magnetoencephalography (MEG). The first aim of the study was to implement the recently developed realistic head model which uses an integrative approach for both the modalities. The second aim of this study was to find the network of coherent sources and the modes of interactions within this network during isometric contraction (ISC) at (15-30 Hz) in healthy subjects. The third aim was to test the effective connectivity revealed by both the modalities analyzing them separately and combined. The Welch periodogram method was used to estimate the coherence spectrum between the EEG and the electromyography (EMG) signals followed by the realistic head modelling and source analysis method dynamic imaging of coherent sources (DICS) to find the network of coherent sources at the individual peak frequency within the beta band in healthy subjects. The last step was to identify the effective connectivity between the identified sources using the renormalized partial directed coherence method. The cortical and sub-cortical network comprised of the primary sensory motor cortex (PSMC), secondary motor area (SMA), and the cerebellum (C). The cortical and sub-cortical network responsible for the isometric contraction was similar in both the modalities when analysing them separately and combined. The SNR was not significantly different between the two modalities separately and combined. However, the coherence values were significantly higher in the combined modality in comparison to each of the modality separately. The effective connectivity analysis revealed plausible additional connections in the combined modality analysis.

The Molecular Zeeman Effect of Imines. I. Methanimine, its Molecular g-Tensor, its Magnetic Susceptibility Anisotropies, its Molecular Electric Quadrupole Moment, its Electric Field Gradient at the Nitrogen Nucleus, and its Nitrogen Spin-Rotation Coupling

The rotational Zeeman effect has been observed in methanimine which was produced from ethylenediamine by flash pyrolysis. The observed vibronic ground state expectation values of the molecular g-values, the magnetic susceptibility anisotropies and the molecular electric quadrupole moments are: gaa = -1.27099(22), gbb= -0.18975(7), gcc= -0.03440(8), 2ξaa-ξbb-ξcc = 12.49(19) · 10-6 ergG-2mol-1, 2ξbb-ξcc-ξaa = 5.22(11) · 10-6 ergG-2 mol-1 Qaa = 0.43(17) · 10-26esu cm2, Qbb= 1.08(10) · 10-26 esu cm2, and Qcc= -1.51 (26) . 10-26 esu cm2. With the TZVP ab initio value for the out-off plane electronic second moment as additional input, reliable values can be given also for the individual components of the magnetic susceptibility tensor and for the bulk susceptibility:

ξ = (ξaa + ξbb + ξcc)/3=-13.13(88) · 10-6 erg G -2 mol-1.

From low-J a-and b-type zero field transitions the spin-rotation coupling constants and the 14N nuclear quadrupole coupling constants could be redetermined with improved accuracy. These data are compared with our new theoretical results.

Anterior compartment mesh: a descriptive study of mesh anchoring failure

OBJECTIVES

To define types of support failure after anterior compartment mesh placement and to investigate any association with predictors of recurrence.

METHODS

This was a retrospective study on patients ≥ 3 months after anterior mesh placement. All patients underwent a standardized interview, clinical examination using the International Continence Society Pelvic Organ Prolapse Quantification system (ICS POP-Q) and three-dimensional/four-dimensional (3D/4D) translabial ultrasound. Mesh failure was defined as recurrence of anterior/central compartment prolapse seen on ultrasound. Failures were classified as anterior, global and apical. Their association with hiatal area on Valsalva maneuver and levator avulsion was tested.

RESULTS

Three hundred and one patients were seen initially, of whom five were excluded because of missing data, leaving 296. Mean follow-up was 1.8 (range, 0.3-5.6) years. Mean age was 65 (range, 32-88) years. One hundred and thirty-nine (47%) women were fitted with a Perigee mesh, 66 (22%) with an Anterior Prolift mesh and 91 (31%) with an Anterior Elevate mesh. Recurrent symptoms (lump/drag) were reported in 65 (22%), a recurrent cystocele was noted in 128 clinically (43%) and in 105 on ultrasound (35%). Avulsion was diagnosed in 117 patients (40%). Mean hiatal area on Valsalva was 33.3 (range, 14.1-60.0) cm2. Mesh failure was diagnosed in 112 patients (38%), comprising global failure in 81 (27%), apical failure in 23 (8%) and anterior failure in eight (3%). Apical and global failures were significantly associated with hiatal area, associations that remained after controlling for potential confounders.

CONCLUSIONS

Mesh failure, i.e. anterior or central compartment recurrent prolapse, was noted in 38% of patients on average 1.8 years after placement of anterior compartment mesh. Global and apical failures together constituted 93% of all mesh failures, both types of failure being significantly associated with hiatal area on Valsalva maneuver.

[Alterations of vertebrocerebral arterial branches in children and adolescents - current aspects of epidemiology, diagnostics, treatment, outcome and follow-up including a representative case report]

INTRODUCTION

Vascular alterations such as arterial lesions themselves or caused by injuries (external site) occur only rarely in children and adolescents. By means of a narrative review including our own clinical experience and a representative case report, vascular alterations in children and adolescents are discussed. Complex Patient- & clinical Finding-associated Aspects: - Dissections of vertebrocerebral arterial branches: usually, the aetiopathogenesis reveals external factors or primary alterations of the vascular wall. The therapeutic approach comprises anticoagulation or surgical, sometimes endovascular intervention in cases of recurrent ischaemic symptoms. - Aneurysm of the carotid artery: the therapeutic approach is characterised by surgical and interventional treatment according to the individual case-specific finding, alternatives in vascular reconstruction can be derived from the classification by de Jong et al. Representative Case Report: An 11 year old boy was diagnosed with intracranial dissection of the left vertebral artery initially treated with anticoagulation (6 months) and a consecutive neurosurgical approach (trepanation and coverage of the dissecting aneurysm) and, subsequently (within the 16th year of age), he underwent interventional treatment (coil embolisation) because of an expansion of the aneurysm. In addition, an aneurysm of the right internal carotid artery was found, which was approached surgically with interposition of a vena-saphena-magna segment.

CONCLUSION

Vascular alterations such as dissections and aneurysms of vertebrocerebral arterial branches in children and adolescents are challenging. Dissections should be treated with anticoagulation. In the case of recurrent ischaemic symptoms or in cases of pressure phenomenon including neurological alterations, interventional or surgical treatment is indicated. In the case of an aneurysm of the carotid artery, there is an indication for surgical treatment: In children and teenagers, venous segments for interposition and single-stitch sutures are usually used. Competent decision-making for treatment and periinterventional management require appropriate interdisciplinary expertise.

Dipole source analysis for readiness potential and field using simultaneously measured EEG and MEG signals

Various source localization techniques have indicated the generators of each identifiable component of movement-related cortical potentials, since the discovery of the surface negative potential prior to self-paced movement by Kornhuber and Decke. Readiness potentials and fields preceding self-paced finger movements were recorded simultaneously using multichannel electroencephalography (EEG) and magnetoencephalography (MEG) from five healthy subjects. The cortical areas involved in this paradigm are the supplementary motor area (SMA) (bilateral), pre-SMA (bilateral), and contralateral motor area of the moving finger. This hypothesis is tested in this paper using the dipole source analysis independently for only EEG, only MEG, and both combined. To localize the sources, the forward problem is first solved by using the boundary-element method for realistic head models and by using a locally-fitted-sphere approach for spherical head models consisting of a set of connected volumes, typically representing the scalp, skull, and brain. In the source reconstruction it is to be expected that EEG predominantly localizes radially oriented sources while MEG localizes tangential sources at the desired region of the cortex. The effect of MEG on EEG is also observed when analyzing both combined data. When comparing the two head models, the spherical and the realistic head models showed similar results. The significant points for this study are comparing the source analysis between the two modalities (EEG and MEG) so as to assure that EEG is sensitive to mostly radially orientated sources while MEG is only sensitive to only tangential sources, and comparing the spherical and individual head models.

Source analysis of median nerve stimulated somatosensory evoked potentials and fields using simultaneously measured EEG and MEG signals

The sources of somatosensory evoked potentials (SEPs) and fields (SEFs), which is a standard paradigm, is investigated using multichannel EEG and MEG simultaneous recordings. The hypothesis that SEP & SEF sources are generated in the posterior bank of the central sulcus is tested, and analyses are compared based on EEG only, MEG only, bandpass filtered MEG, and both combined. To locate the sources, the forward problem is first solved by using the boundary-element method for realistic head models and by using a locally-fitted-sphere approach for averaged head models consisting of a set of connected volumes, typically representing the skull, scalp, and brain. The location of each dipole is then estimated using fixed MUSIC and current-density-reconstruction (CDR) algorithms. For both analyses, the results demonstrate that the band-pass filtered MEG can localize the sources accurately at the desired region as compared to only EEG and unfiltered MEG. For CDR analysis, it looks like MEG affects EEG during the combined analyses. The MUSIC algorithm gives better results than CDR, and when comparing the two head models, the averaged and the realistic head models showed the same result.

Is levator avulsion a predictor of cystocele recurrence following anterior vaginal mesh placement?

OBJECTIVE

Levator avulsion has been shown to be a predictor of cystocele recurrence following anterior colporrhaphy. The aim of this study was to determine if levator avulsion is a risk factor for prolapse recurrence following anterior colporrhaphy with mesh.

METHODS

This was a retrospective analysis of data obtained from three surgical audits for subjective and objective outcomes following anterior colporrhaphy with mesh. Recurrence was defined as cystocele ≥ Stage 2 on the prolapse quantification system of the International Continence Society; symptoms of vaginal lump/bulge; or cystocele on ultrasound, defined as maximum bladder descent to ≥ 10 mm below the symphysis pubis. Levator avulsion was diagnosed using tomographic ultrasound imaging.

RESULTS

Two hundred and nine patients were followed up at a mean of 2.2 years (range, 3 months to 5.6 years) after anterior vaginal mesh placement. 24% (51/209) had recurrent prolapse symptoms, 33% (68/209) clinical cystocele recurrence ≥ Stage 2, and 26% (54/209) a recurrent cystocele on ultrasound. Twenty-eight out of 80 (35%) women with levator avulsion had significant sonographic cystocele recurrence (odds ratio (OR), 2.24 (95% confidence interval (CI), 1.13-4.43)). This finding was confirmed after adjusting for potential predictors of prolapse recurrence on multivariate logistic regression (OR, 2.13 (95% CI, 1.04-4.39); P = 0.04).

CONCLUSION

Levator avulsion doubles the risk of cystocele recurrence after anterior colporrhaphy with transobturator mesh.

[Acute scrotum in childhood]

BACKGROUND

Due to the variety of differential diagnoses causing acute scrotum and their possible consequences, this finding is a challenge for diagnostic and therapeutic management in the daily clinical practice of paediatric medicine.

PATIENTS AND METHODS

Through a defined time period, all consecutive paediatric patients of a tertiary surgical centre aged up to 16 years who were diagnosed with and treated for primary acute scrotum were prospectively registered and retrospectively evaluated for patient, finding and treatment (intervention) associated specifics in this systematic unicentric observational study (design: case series) to reflect daily clinical practice.

RESULTS

A total of 141 cases with acute scrotum were enrolled in the study during the 10-year period from January 2000 to December 2009. Eight percent of cases (n = 11) showed bilateral findings. There were two age peaks: newborns and puberty. The most common diagnoses were epididymitis and orchitis (26 %), torsion of the testicular appendix (22 %) and testicular torsion (21 %). Trauma, hydrocele, inguinal hernia, idiopathic scrotal oedema and tumours were rather rare differential diagnoses as possible causes for an acute scrotum. The mean period of discomfort, complaints and symptoms up to presenting in the outpatient clinic was 24 hours. For sixty percent (n = 84, i.e., all patients treated conservatively and 43 % of the operated patients) an imaging study was obtained with ultrasound or Doppler ultrasonography, respectively. Two thirds of the patients underwent an operative exploration. The orchiectomy rate in testicular torsion amounted to 40 %. In one newborn, a bilateral orchiectomy was necessary. In patients with unilateral orchiectomy, a prophylactic fixation of the contralateral testis was performed preferentially at 4-8 weeks after the initial intervention even though a simultaneous procedure is being increasingly used.

CONCLUSIONS

In approximately one fifth of registered patients, a testicular torsion is present causing the acute scrotum, and leading to an obligatory surgical intervention. Various causative differential diagnoses can be clarified by precise medical history and exact physical examination. Imaging procedures can be helpful in decision-finding. Finally, the clinical finding is crucial and decisive. If a testicular torsion cannot reliably be excluded by clinical investigation or imaging, an immediate surgical exploration of the testis has to be performed.

Wild-type p53 is not involved in reversion of the tumorigenic phenotype of breast-cancer cells after transfer of normal chromosome-17

A number of different candidate tumor suppressor genes involved in human breast cancer are presumed to be located on chromosome 17. To verify the relevance of chromosome 17 abnormalities in breast cancer cells, a normal human chromosome 17 was transferred by microcell fusion to R30 tumor cells derived from an infiltrating ductal mammary carcinoma. The tumorigenicity of the microcell hybrids in nude mice was examined. The tumor volume obtained with different clones was reduced by up to 94% of the value corresponding to the parental tumor cells. This effect was accompanied by a reduction of anchorage-independent growth, as well as cell growth rates on plastic plates. These effects were independent of the continued presence of a transferred 17q arm and could not be attributed to the action of the normal p53 gene. The results support the assumption that in addition to p53 a further tumor suppressor gene is located on 17p which is involved in breast cancer.

[Bilateral intrauterine testicular torsion in a newborn]

Bilateral intrauterine testicular torsion is a rare condition associated with a low salvage rate of the testes. Due to variable symptoms it is difficult to rapidly find the correct diagnosis. Here, we report on a newborn with bilateral livid swelling of the scrotum for which a bilateral orchiectomy was carried out. Histological investigation of the specimens confirmed bilateral hemorrhagic infarction. The management of bilateral intrauterine testicular torsion is still controversial. Immediate surgical intervention is still considered to be the treatment approach of choice to salvage the testes.

[What must the (abdominal) surgeon know about paediatric surgery - paediatric surgical aspects in general (abdominal) surgery]

Due to the advances in neonatal intensive care medicine, prenatal ultrasound-guided diagnostic measures and paediatric surgical options, conditions have been established to achieve long-term survival in newborns with severe diseases. In addition, this means that the "non-paediatric" physician can be increasingly confronted with patients who would not have survived childhood some decades ago. Therefore, the article summarises concisely selected diseases of premature infants and newborns, e. g., congenital abdominal wall defects, and outlines possible long-term consequences based on the surgical interventions and their basic diseases, respectively, which need to be adequately cared for in the case of a surgical disease of the former patient of paediatric surgery. The overview cannot be considered as a complete revision course; however, it might constitute a basic outline for thought-provoking impulses for personal professional skills and expertise in managing such patients in later age from a surgical perspective.

[Therapeutic options for haemangiomas of infancy]

The necessity of haemangioma treatment in infants has been controversially discussed for years. One reason is the favoured clinical observation of a potential spontaneous involution without any therapeutic approach or medical treatment, thus avoiding their specific risks. On the other hand, there are several reports on serious cases with -rapidly growing haemangiomas including severe consequences. There are potential complications such as loss of visus in cases of periorbital manifestation. A basic problem is the lack of a unique systematic classification, on the basis of which -diagnostic measures, therapeutic indications and modes could be compared. Such a classification would be much more competent including a sufficient comparison of treatment results. The basic aim in management is to achieve control of the haemangioma growth and induction of its sub-sequent involution back to only a cosmetic detraction. Each threatening functional loss can be classified as an urgent indication for treatment. There is a need to consider the treatment options and their values; in particular, cryotherapy or laser therapy in localised manifestations are mostly -favoured because of the convincing evidence from available data. In the case of a more disseminated haemangioma manifestation, the initiation of propranol medication is possible, a novel drug for this indication. However, there are no follow-up data on the mid-term or long-term outcome available at this time. Further studies on the subject are therefore required.

Motor impairment in liver cirrhosis without and with minimal hepatic encephalopathy

AIM

Manifest hepatic encephalopathy (HE) goes along with motor symptoms such as ataxia, mini-asterixis, and asterixis. The relevance of motor impairments in cirrhotics without and with minimal HE (mHE) is still a matter of debate.

PATIENTS AND METHODS

We tested three different groups of patients with liver cirrhosis: no signs of HE (HE 0), mHE, and manifest HE grade 1 according to the West Haven criteria (HE 1). All patients (n = 24) and 11 healthy control subjects were neuropsychometrically tested including critical flicker frequency (CFF), a reliable measure for HE. Motor abilities were assessed using Fahn Tremor Scale and International Ataxia Rating Scale. Fastest alternating index finger movements were analyzed for frequency and amplitude.

RESULTS

Statistical analyses showed an effect of HE grade on tremor and ataxia (P < 0.01). Additionally, both ratings yielded strong negative correlation with CFF (P < 0.01, R = -0.5). Analysis of finger movements revealed an effect of HE grade on movement frequency (P < 0.03). Moreover, decreasing movement frequency and increasing movement amplitude parallel decreasing CFF (P < 0.01, R = 0.6).

CONCLUSION

Our results indicate that ataxia, tremor, and slowing of finger movements are early markers for cerebral dysfunction in HE patients even prior to neuropsychometric alterations becoming detectable.

[Congenital abdominal wall defects--an analysis of prevalence and operative management by means of gastroschisis and omphalocele]

The management of congenital abdominal wall defects is one of the main characteristics of quality for a department of paediatric surgery. The results of treatment in the early years were the reason for a continuous improvement of procedures, operation strategies and the kinds of -material that had been used. During the last years there has been a great discussion about the presumed increase in the incidence of gastroschisis and the preterm delivery of such cases. On the basis of our own first results (2006-2009) and details from the literature, we survey these two topics.

[Incidental finding of an acute appendicitis in a premature newborn with haematochezia]

In newborns, acute appendicitis is a very rare condition associated with significant lethality. Due to mostly non-specific symptoms, it is difficult to find the correct diagnosis preoperatively. Interestingly, rectal bleeding as a clinical sign in neonatal appendicitis is very uncommon. Here, we report on a 4-day-old premature female newborn with rectal bleeding who, therefore, underwent laparotomy because of a suspected volvulus. Except for an acutely inflamed appendix, no other pathological findings were found intraoperatively, leading to appendectomy. Histological investigation of the specimen confirmed acute ulcero-phlegmonous appendicitis. Thus, the rectal bleeding can be attributed to erosions as part of the inflammatory changes in clinically apparent appendicitis. The postoperative course of the patient was unremarkable, in perticular, no further rectal bleeding episode was observed. In spite of the low incidence of neonatal appendicitis, it has to be included in the spectrum of differential diagnoses if unclear abdominal discomfort occurs and whenever non-specific clinical signs are found in newborns. Early surgical intervention is considered the curative treatment approach of choice and can, thus, contribute to a reduction of the potential complications.

[Colon triplication associated with ileum atresia in laparoschisis]

The present paper reports the unusual and rare case of a colon triplication associated with other findings never reported before, including the diagnostic and therapeutic management with consideration of the relevant, but rare scientific references in the medical literature. In the basic finding of an ileum atresia with laparoschisis, a colon triplication was incidentally found. The surgical procedure performed after the primarily planned Caesarean section within the 34(th) week of gravidity consisted of a bowel-preserving resection of the triplication including the ileum atresia and a subsequent Santulli anastomosis followed by a later excision of the ileostoma. Interestingly, this is the 9(th) reported case in the accessible English medical literature but, however, the first and only one with an associated ileum atresia and laparoschisis, which was successfully treated with a surgical intervention.

Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial

OBJECTIVE

To compare vaginal repair augmented by mesh with traditional colporrhaphy for the treatment of pelvic organ prolapse.

DESIGN

Prospective randomised controlled trial.

SETTING

Tertiary teaching hospital.

POPULATION

One hundred and thirty-nine women with stage >or=2 prolapse according to the pelvic organ prolapse quantification (POP-Q) system requiring both anterior and posterior compartment repair.

METHODS

Subjects were randomised to anterior and posterior vaginal repair with mesh augmentation (mesh group, n = 69) or traditional anterior and posterior colporrhaphy (no mesh group, n = 70).

MAIN OUTCOME MEASURES

The primary outcome was the absence of POP-Q stage >or=2 prolapse at 12 months. Secondary outcomes were symptoms, quality-of-life outcomes and satisfaction with surgery. Complications were also reported.

RESULTS

For subjects attending the 12-month review, success in the mesh group was 81.0% (51 of 63 subjects) compared with 65.6% (40/61) in the no mesh group and was not significantly different (P-value = 0.07). A high level of satisfaction with surgery and improvements in symptoms and quality-of-life data were observed at 12 months compared to baseline in both groups, but there was no significant difference in these outcomes between the two groups. Vaginal mesh exposure occurred in four women in the mesh group (5.6%). De novo dyspareunia was reported by five of 30 (16.7%) sexually active women in the mesh group and five of 33 (15.2%) in the no mesh group at 12 months.

CONCLUSION

In this study, vaginal surgery augmented by mesh did not result in significantly less recurrent prolapse than traditional colporrhaphy 12 months following surgery.

Expression parameters of the polycomb group proteins BMI1, SUZ12, RING1 and CBX7 in urothelial carcinoma of the bladder and their prognostic relevance

BACKGROUND

The polycomb group (PCG) proteins are epigenetic transcriptional repressors involved in the control of cellular proliferation and oncogenesis. This study aimed at examining whether mRNA tumor levels of the PCG family members BMI1, SUZ12, RING1, and CBX7 relate to histopathological parameters in urothelial carcinomas of the bladder and whether they may provide prognostic information following tumor resection.

METHODS

The relative gene expression of BMI1, SUZ12, RING1, and CBX7 was analyzed by real-time RT-PCR in tumor tissue obtained from 93 patients with urothelial carcinoma of the bladder undergoing surgical treatment. Expression data was correlated with pathological variables and outcome.

RESULTS

PCG family members BMI1, SUZ12, RING1, and CBX7 are commonly expressed in urothelial carcinomas of the bladder. The relative CBX7 mRNA expression levels gradually decreased from superficial (pTa) to invasive (pT1) and finally to muscle-invasive (> or =pT2) tumors (p = 0.008). Furthermore, CBX7 expression was statistically significantly correlated with tumor grade (p = 0.04). No correlation of mRNA levels with histopathological tumor features or tumor recurrence was observed for the other PCG components investigated.

CONCLUSION

Expression levels of CBX7 inversely correlate with the progression of tumor stage and grade in urothelial carcinomas of the bladder, suggesting that downregulation of CBX7 indicates aggressive urothelial carcinoma phenotype.

[Expression levels of the IAP antagonists XAF1, Smac/DIABLO and HtrA2 in testicular germ cell tumours]

PURPOSE

Down-regulation of the IAP antagonistis XAF1, Smac/DIABLO and HtrA2, has been related to the onset and progression of various malignancies. We examined the mRNA-expression of these pro-apoptotic parameters in testicular germ cell tumors (TGCT) and normal testicular tissue and correlated their expression levels to clinicopathological tumour features.

MATERIAL AND METHODS

Real-time RT-PCR was used to quantify the mRNA-expression of XAF1, Smac/DIABLO and HtrA2 in normal testicular tissue (n = 18), carcinoma in situ (n = 4), seminomas (n = 64), and non-seminomatous germ cell tumors (n = 35).

RESULTS

Compared to normal testicular tissue, the expression levels of XAF1 were increased in TGCT (p < 0.001), whereas those of Smac/DIABLO and HtrA2 were decreased (p < 0.001 and p < 0.001). Smac/DIABLO expression levels showed a significant trend towards a gradual decrease from normal testicular tissue to CIS and seminomas and finally to NSGCT (p < 0.001). Moreover, XAF1 and HtrA2 expression levels gradually increased with progression of clinical tumour stage in seminoma patients (p = 0.001 and p = 0.018), their expression levels being strongly intercorrelated (Spearman rho correlation coefficient: 0.674; p < 0.001).

CONCLUSION

These data suggest that a down-regulation of Smac/DIABLO and HtrA2 is implicated in the development and progression of TGCT, whereas overexpression of XAF1 in TGCT might contribute to their extraordinary sensitivity to chemotherapy. Regarding the additional correlation of XAF1 and HtrA2 expression with clinical tumour stage in seminoma patients, it appears reasonable to further evaluate these three IAP antagonists as molecular parameters for the prediction of treatment response and prognosis of TGCT patients.

[New polymorphisms in the PSA promoter in patients with prostate carcinoma]

INTRODUCTION

PSA is still the most important parameter in the diagnosis and follow-up of prostate cancer. We searched for single nucleotide polymorphisms (SNP) in four different parts of the PSA promoter, which harbour binding sites for major transcriptional regulators using PCR-based combined SSCP and sequence analysis.

MATERIALS AND METHODS

Lymphocyte DNA samples from 279 prostate cancer patients and 55 age-matched controls were subjected to SSCP analysis after PCR amplification of four approximately 200-bp fragments selected to contain the known AREs I-III or the transcriptional start site, respectively. Conspicuous PCR fragments with variant SSCP patterns were subsequently cloned and sequenced. Computer-assisted comparison with published sequences of the promoter region was performed to reveal polymorphic sites.

RESULTS

In 66.6 % of the carcinoma cases DNA displayed polymorphisms in ARE I-, whereas the benign cases showed this SNP only in 14.5 %. This difference was highly significant (p < 0.0001). In addition, we found novel SNPs with lower frequency at positions - 179, - 230, - 233 (ARE I) and - 356 (ARE II).

CONCLUSION

The present study confirmed that the otherwise already described polymorphism in the position - 158 is highly significantly more frequent in prostate cancer patients than in the control group. There is no significant correlation to the clinical stage of the disease. Furthermore we described for the first time four rare, previously unknown polymorphisms.

Frequent epigenetic inactivation of p53 target genes in seminomatous and nonseminomatous germ cell tumors

Hypermethylation of tumor-suppressor genes has been implicated in the pathogenesis of human cancers. This study was designed to examine the methylation profiles of a selected group of p53 target genes (APAF-1, CASP-8, DAPK-1, IGFBP-3) and to correlate the findings with the histopathological characterization of testicular germ cell tumors (TGCT). Promoter methylation status was analysed by highly sensitive real-time methylation-specific PCR in 46 primary TGCTs (26 seminomas and 20 nonseminomas) and 15 normal testicular tissue samples. APAF-1 methylation was detected in all of the seminomatous and nonseminomatous TGCTs as well as in 60% of normal testicular tissue. Methylation of DAPK-1 was frequent in seminomas (50%) and nonseminomas (20%), but not in normal testicular tissue (6%). The degree of DAPK-1 methylation correlated with the clinical stage of the disease (P=0.05) and was useful in differentiating seminomatous from nonseminomatous, and malignant from nonmalignant testicular tissue (P=0.04 and 0.02, respectively). The APAF-1 methylation index achieved a highly significant differentiation between seminomatous or nonseminomatous tissue and nonmalignant testicular tissue (P=0.0001). In testicular tumorigenesis, promoter methylation of specific p53 target genes occurs at early stage but to varying degrees. Methylation also occurs in normal testicular tissue, which is in contrast to findings in other urogenital malignancies. Further studies will be necessary to determine whether the methylation level may be used as marker for risk estimation, especially in clinical stage I disease.

Bone formation using human demineralised bone matrix (Grafton) for the treatment of bone cysts in children

Bone cysts, in particular solitary bone cysts, are the most frequent cause of pathological fractures in children. However, there is still a great variety of regimens used to treat these lesions. Since demineralised bone matrix (DBM) is commercially available, we aimed to use this material for the consolidation of bones diagnosed as fragile because of cyst formation. Each of the 7 bone cysts as well as one enchondroma filled with DBM showed a continuous decrease in bone transparency over a period of two years (mean 8 months). A significant decrease in bone transparency and simultaneous cortical remodelling was radiographically detected in these cases as the specific hallmark of an initiated graft incorporation after 3 to 4 months. It was demonstrated that it is possible to heal children within an acceptable period of time using DBM to fill the cystic lesion. DBM appears to be a reasonable and beneficial alternative for the treatment of bone cysts offering both osteoinduction and osteoconductive features.