DNA dynamics in complex coacervate droplets and micelles

Single stranded DNA (ssDNA), or another polyanion, can be mixed with polycations to form liquid-like complex coacervates. When the polycations are replaced by cationic-neutral diblock copolymers, complex coacervate core micelles (C3Ms) can be formed instead. In both complex coacervates and C3Ms, dynamics plays an important role. Yet, to date, the effect of chain length on the dynamics effect is still not fully understood. The DNA complexes provide a versatile platform to further elucidate these chain length effects because the DNA is monodisperse and its length can be easily adapted. Therefore, we study in this paper the dynamics of fluorescently labelled ssDNA in both complex coacervate droplets and micelles. The DNA dynamics in the complex coacervate droplets is probed by fluorescence recovery after photobleaching (FRAP). We observe that the DNA diffusion coefficient depends more strongly on the DNA length than predicted by the sticky Rouse model and we show that this can be partly explained by changes in complex coacervate density, but that also other factors might play a role. We measure the molecular exchange of C3Ms by making use of Förster resonance energy transfer (FRET) and complement these measurements with Langevin dynamics simulations. We conclude that chain length polydispersity is the main cause of a broad distribution of exchange rates. We hypothesise that the different exchange rates that we observe for the monodisperse DNA are mainly caused by differences in dye interactions and show that the dye can indeed have a large effect on the C3M exchange. In addition, we show that a new description of the C3M molecular exchange is required that accounts among others for the effect of the length of the oppositely charged core species. Together our findings can help to better understand the dynamics in both specific DNA systems and in complex coacervate droplets and micelles in general.

Evaluation of the association between the introduction of data-driven tools to support calf rearing and reduced calf mortality in dairy herds in the Netherlands

Between 2009 and 2017, calf mortality in the Dutch dairy sector showed a slight but steady increase. The Dutch dairy industry decided to act and supported the development of several data-driven tools that were implemented from 2018 on. The tools informed farmers about their calf mortality rates and stimulated them to improve. The Trend Analysis Surveillance Component of the Dutch cattle Health Surveillance System provided the possibility to evaluate the calf mortality in Dutch dairy herds before and after implementation of these tools. The aim of this study was to evaluate the association between calf mortality and i) all actions that were taken by the Dutch dairy industry to improve the quality of calf rearing and ii) other potential management or environmental factors associated with calf mortality in Dutch dairy herds. Census data from approximately 98 % of all Dutch dairy herds were available from July 2014 until June 2019. Four different calf mortality indicators were defined: perinatal calf mortality risk (i.e., mortality before, during, or shortly after the moment of birth up to the moment of ear-tagging), postnatal calf mortality risk (ear-tagging till 14 d), preweaned calf mortality rate (15 d-55 d) and weaned calf mortality rate (56 d-1 yr.). All data were aggregated to herd and monthly level and were analysed using Population-Averaged Generalized Estimating Equations (PA GEE models) with a Poisson distribution and log link function. When the period before implementation of the tools (2016-2017) was compared to the period thereafter (2018-2019), all four calf mortality indicators decreased. The relative decrease varied from 3 % (postnatal calves) and 10 % (perinatal calves) up to 18 % and 30 % in preweaned and weaned calves, respectively. Registrations of veterinary treatments such as antimicrobial use, vaccinations (calf or cow) and antiparasitic treatments were associated with calf mortality. Additionally, herds with a higher level of metabolic problems in transition cows had a higher calf mortality and also extreme outside temperatures were associated with higher calf mortality. Given that the different tools were implemented nation-wide and a control group was lacking, we could not prove that implementing the different tools caused the reduction in calf mortality. We do however, believe that all the actions and communication towards improvement of calf rearing in dairy herds led to an increased awareness among farmers towards the importance of calf rearing management and therefore a reduction in calf mortality on national level.

FRET-Based Determination of the Exchange Dynamics of Complex Coacervate Core Micelles

Complex coacervate core micelles (C3Ms) are nanoscopic structures formed by charge interactions between oppositely charged macroions and used to encapsulate a wide variety of charged (bio)molecules. In most cases, C3Ms are in a dynamic equilibrium with their surroundings. Understanding the dynamics of molecular exchange reactions is essential as this determines the rate at which their cargo is exposed to the environment. Here, we study the molecular exchange in C3Ms by making use of Förster resonance energy transfer (FRET) and derive an analytical model to relate the experimentally observed increase in FRET efficiency to the underlying macromolecular exchange rates. We show that equilibrated C3Ms have a broad distribution of exchange rates. The overall exchange rate can be strongly increased by increasing the salt concentration. In contrast, changing the unlabeled homopolymer length does not affect the exchange of the labeled homopolymers and an increase in the micelle concentration only affects the FRET increase rate at low micelle concentrations. Together, these results suggest that the exchange of these equilibrated C3Ms occurs mainly by expulsion and insertion, where the rate-limiting step is the breaking of ionic bonds to expel the chains from the core. These are important insights to further improve the encapsulation efficiency of C3Ms.

Chemical Feedback in Templated Reaction-Assembly Networks

Chemical feedback between building block synthesis and their subsequent supramolecular self-assembly into nanostructures has profound effects on assembly pathways. Nature harnesses feedback in reaction-assembly networks in a variety of scenarios including virion formation and protein folding. Also in nanomaterial synthesis, reaction-assembly networks have emerged as a promising control strategy to regulate assembly processes. Yet, how chemical feedback affects the fundamental pathways of structure formation remains unclear. Here, we unravel the pathways of a templated reaction-assembly network that couples a covalent polymerization to an electrostatic coassembly process. We show how the supramolecular staging of building blocks at a macromolecular template can accelerate the polymerization reaction and prevent the formation of kinetically trapped structures inherent to the process in the absence of feedback. Finally, we establish a predictive kinetic reaction model that quantitatively describes the pathways underlying these reaction-assembly networks. Our results shed light on the fundamental mechanisms by which chemical feedback can steer self-assembly reactions and can be used to rationally design new nanostructures.

Langevin Dynamics Simulations of the Exchange of Complex Coacervate Core Micelles: The Role of Nonelectrostatic Attraction and Polyelectrolyte Length

Complex coacervate core micelles (C3Ms) are promising encapsulators for a wide variety of (bio)molecules. To protect and stabilize their cargo, it is essential to control their exchange dynamics. Yet, to date, little is known about the kinetic stability of C3Ms and the dynamic equilibrium of molecular building blocks with micellar species. Here we study the C3M exchange during the initial micellization by using Langevin dynamics simulations. In this way, we show that charge neutral heterocomplexes consisting of multiple building blocks are the primary mediator for exchange. In addition, we show that the kinetic stability of the C3Ms can be tuned not only by the electrostatic interaction but also by the nonelectrostatic attraction between the polyelectrolytes, the polyelectrolyte length ratio, and the overall polyelectrolyte length. These insights offer new rational design guides to aid the development of new C3M encapsulation strategies.

Two-dimensional crystals of star polymers: a tale of tails

The formation of non-hexagonal crystalline structures by the organisation of colloidal nanoparticles often involves the use of complex particles with anisotropic shape or interactions or the imposition of non-uniform external fields. Here we explore how unusual symmetries can be created using experimentally realistic particles that interact through isotropic and purely repulsive potentials. In particular, we use simulations to explore the phase behavior of two-dimensional systems of star polymers. We uncover how the tail of the pair potential has a large role in dictating the phase behavior. Star polymers interacting in the far field with a Gaussian potential only form hexagonal phases, while an exponential tail gives rise to stable primitive oblique and honeycomb lattices. We identify the ratio in strength between long and short range interactions and the nature of the transition between these regimes as crucial parameters to predict when non-hexagonal crystals of star polymers can be stable. This leads to experimental design rules for creating star polymers which should exhibit unusual lattice formation.

Design of binary polymer brushes with tuneable functionality

Using coarse grained molecular dynamics simulations, we study how functionalized binary brushes may be used to create surfaces whose functionality can be tuned. Our model brushes consist of a mixture of nonresponsive polymers with functionalized responsive polymers. The functional groups switch from an exposed to a hidden state when the conformations of the responsive polymers change from extended to collapsed. We investigate quantitatively which sets of brush parameters result in optimal switching in functionality, by analyzing to which extent the brush conformation allows an external object to interact with the functional groups. It is demonstrated that brushes with species of comparable polymer lengths, or with longer responsive polymers than nonresponsive polymers, can show significant differences in their functionality. In the latter case, either the fraction of responsive polymers or the total grafting density has to be reduced. Among these possibilities, a reduction of the fraction of responsive polymers is shown to be most effective.

Multiple LHCII antennae can transfer energy efficiently to a single Photosystem I

Photosystems I and II (PSI and PSII) work in series to drive oxygenic photosynthesis. The two photosystems have different absorption spectra, therefore changes in light quality can lead to imbalanced excitation of the photosystems and a loss in photosynthetic efficiency. In a short-term adaptation response termed state transitions, excitation energy is directed to the light-limited photosystem. In higher plants a special pool of LHCII antennae, which can be associated with either PSI or PSII, participates in these state transitions. It is known that one LHCII antenna can associate with the PsaH site of PSI. However, membrane fractions were recently isolated in which multiple LHCII antennae appear to transfer energy to PSI. We have used time-resolved fluorescence-streak camera measurements to investigate the energy transfer rates and efficiency in these membrane fractions. Our data show that energy transfer from LHCII to PSI is relatively slow. Nevertheless, the trapping efficiency in supercomplexes of PSI with ~2.4 LHCIIs attached is 94%. The absorption cross section of PSI can thus be increased with ~65% without having significant loss in quantum efficiency. Comparison of the fluorescence dynamics of PSI-LHCII complexes, isolated in a detergent or located in their native membrane environment, indicates that the environment influences the excitation energy transfer rates in these complexes. This demonstrates the importance of studying membrane protein complexes in their natural environment.

Brain-derived neurotrophic factor as a driving force behind neuroplasticity in neuropathic and central sensitization pain: a new therapeutic target?

INTRODUCTION

Central sensitization is a form of maladaptive neuroplasticity underlying many chronic pain disorders, including neuropathic pain, fibromyalgia, whiplash, headache, chronic pelvic pain syndrome and some forms of osteoarthritis, low back pain, epicondylitis, shoulder pain and cancer pain. Brain-derived neurotrophic factor (BDNF) is a driving force behind neuroplasticity, and it is therefore crucial for neural maintenance and repair. However, BDNF also contributes to sensitization of pain pathways, making it an interesting novel therapeutic target.

AREAS COVERED

An overview of BDNF's sensitizing capacity at every level of the pain pathways is presented, including the peripheral nociceptors, dorsal root ganglia, spinal dorsal horn neurons, and brain descending inhibitory and facilitatory pathways. This is followed by the presentation of several potential therapeutic options, ranging from indirect influencing of BDNF levels (using exercise therapy, anti-inflammatory drugs, melatonin, repetitive transcranial magnetic stimulation) to more specific targeting of BDNF's receptors and signaling pathways (blocking the proteinase-activated receptors 2-NK-κβ signaling pathway, administration of phencyclidine for antagonizing NMDA receptors, or blockade of the adenosine A2A receptor).

EXPERT OPINION

This section focuses on combining pharmacotherapy with multimodal rehabilitation for balancing the deleterious and therapeutic effects of BNDF treatment in chronic pain patients, as well as accounting for the complex and biopsychosocial nature of chronic pain.

Differentiation and histogenesis of syringomatous tumour of the nipple and low-grade adenosquamous carcinoma: evidence for a common origin

AIMS

Syringomatous tumour of the nipple and low-grade adenosquamous carcinoma (LGAdSC) of the breast are regarded as distinct entities. To clarify the nature of these two lesions, we compared the expression of different lineage/differentiation markers in 12 syringomatous tumours of the nipple, nine LGAdSCs, and normal breast epithelium.

METHODS AND RESULTS

Using triple immunofluorescence labelling and quantitative RT-PCR for keratins, p63, and smooth muscle actin, we demonstrated that syringomatous tumour and LGAdSC contain p63+/K5/14+ tumour cells, K10+ squamous cells, and K8/18+ glandular cells, with intermediary cells being found in both lineages. Identical p63+/K5/14+ cells were also found in the normal breast duct epithelium.

CONCLUSIONS

Our data provide evidence that syringomatous tumour of the nipple and LGAdSC are identical or nearly identical lesions. They contain p63+/K5/14+ cells as the key cells from which the K10+ squamous lineage and the K8/18+ glandular lineage arise. On the basis of our findings in normal breast tissue and associated benign lesions, we suggest that p63+/K5/14+ cells of the normal breast duct epithelium or early related cells might play a key role in the neoplastic transformation of both syringomatous tumour and LGAdSC. We propose that the differentiation patterns found in both lesions reflect the early ontogenetic stages of the normal breast epithelium.

Removal of collagen nerve conduits (NeuraGen) after unsuccessful implantation: focus on histological findings

Nerve conduits are nonneural, hollow tubular structures designed to bridge the gap of a sectioned nerve, to protect the nerve from scar formation, and to guide the regenerating fibers into the distal nerve stump. In the 8-year experience of our department, four patients aged 14 to 50 years had an unsuccessful implantation of a nerve conduit (NeuraGen, Integra, Plainsboro, NJ). In these four patients, the collagen tubes were replaced by an autogenous nerve graft. The histological specimens showed characteristic histological findings of a scar neuroma without any signs of foreign body reaction in three cases and with minimal foreign body reaction in one case. The collagen nerve tube was completely resorbed in all cases after a time period of 6 to 17 months and could not be detected marco- or microscopically.To our knowledge, this is the first report in the English and German literature describing the histological characteristics of explanted collagen nerve tubes in humans.

Validation of the ICF core set for neuromuscular diseases

BACKGROUND

Understanding of the consequences of a neuromuscular disease (NMD) can improve when a valid sample of disease-specific categories based on the International Classification of Functioning, Disabilities, and Health (ICF) is available.

OBJECTIVE

To examine the content validity of the initial ICF Core Set for neuromuscular diseases (NMDs). The initial ICF Core Set was developed for three chronic neurological diseases.

DESIGN

A qualitative method.

METHODS

To examine the content validity of the initial ICF Core Set for NMD, concepts in established disease-specific health-related Quality of Life Questionnaires (HRQOL) were compared with ICF categories. Next, the selected ICF categories were linked to the ICF categories in the initial ICF Core Set.

RESULTS

All concepts in the HRQOL questionnaires, except one body function concept, were covered by the initial ICF Core Set. However, the NMD Core Set reflects a broader scope concerning health problems than the concepts in the HRQOL questionnaires do, especially concerning the "Participation" and "Environmental Factors" components.

CONCLUSION

The NMD Core Set, as well as a measurement based on this Core Set, can contribute to a better understanding of the consequences of NMDs and can also serve as a basis for clinical practice, research, social security systems, and educational programs.

CLINICAL REHABILITATION IMPACT

The newly developed NMD Core Set can be a basis for enhancing the development of rehabilitation interventions and improving overall health care for patients with a NMD.

Negative effects of ultrafine particle exposure during forced exercise on the expression of Brain-Derived Neurotrophic Factor in the hippocampus of rats

Exercise improves cognitive function, and Brain-Derived Neurotrophic Factor (BDNF) plays a key role in this process. We recently reported that particulate matter (PM) exposure negatively contributed to the exercise-induced increase in human serum BDNF concentration. Furthermore, PM exposure is associated with neuroinflammation and cognitive decline. The aim of this study was to investigate the effect of exposure to ultrafine particles (UFP) during a single bout of forced exercise on the expression of inflammatory (IL1α, IL1β, TNF, IL6, NOS2, NOS3) and oxidative stress (NFE2L2)-related genes, as well as BDNF in the brain of rats. Four groups (n=6/group) of Wistar rats were exposed for 90 min to one of the following exposure regimes: UFP+exercise, UFP+rest, ambient air+exercise, ambient air+rest (control). Hippocampus, olfactory bulb and prefrontal cortex were collected 24h after exposure. Gene expression changes were analyzed with real-time PCR. In the condition ambient air+exercise, hippocampal expression of BDNF and NFE2L2 was up-regulated, while the expression of IL1α and NOS3 in the prefrontal cortex and IL1α in the olfactory bulb was down-regulated compared to the control. In contrast, gene expression in the condition UFP+exercise did not differ from the control. In the condition UFP+rest, hippocampal expression of NFE2L2 was down-regulated and there was a trend toward down-regulation of BDNF expression compared to the control. This study shows a negative effect of UFP exposure on the exercise-induced up-regulation of BDNF gene expression in the hippocampus of rats.

Acute running stimulates hippocampal dopaminergic neurotransmission in rats, but has no influence on brain-derived neurotrophic factor

Hippocampal brain-derived neurotrophic factor (BDNF) protein is increased with exercise in rats. Monoamines seem to play a role in the regulation of BDNF, and monoamine neurotransmission is known to increase with exercise. The purpose of this study was to examine the influence of acute exercise on monoaminergic neurotransmission and BDNF protein concentrations. Hippocampal microdialysis was performed in rats that were subjected to 60 min of treadmill running at 20 m/min or rest. Two hours postexercise, the rats were killed, and the hippocampus was dissected. In experiments without microdialysis, hippocampus and serum samples were collected immediately after exercise. Exercise induced a twofold increase in hippocampal dopamine release. Noradrenaline and serotonin release were not affected. Hippocampal BDNF levels were not influenced, whether they were measured immediately or 2 h after the exercise protocol. Serum BDNF levels did not change either, but serum BDNF was negatively correlated to peripheral corticosterone concentrations, indicating a possible inhibitory reaction to the stress of running. Sixty minutes of exercise enhances dopamine release in the hippocampus of the rat in vivo. However, this increase is not associated with changes in BDNF protein levels immediately nor 2 h after the acute exercise bout. An increased corticosterone level might be the contributing factor for the absence of changes in BDNF.

No exercise-induced increase in serum BDNF after cycling near a major traffic road

Commuting by bike has a clear health enhancing effect. Moreover, regular exercise is known to improve brain plasticity, which results in enhanced cognition and memory performance. Animal research has clearly shown that exercise upregulates brain-derived neurotrophic factor (BDNF - a neurotrophine) enhancing brain plasticity. Studies in humans found an increase in serum BDNF concentration in response to an acute exercise bout. Recently, more evidence is emerging suggesting that exposure to air pollution (such as particulate matter (PM)) is higher in commuter cyclists compared to car drivers. Furthermore, exposure to PM is linked to negative neurological effects, such as neuroinflammation and cognitive decline. We carried-out a cross-over experiment to examine the acute effect of exercise on serum BDNF, and the potential effect-modification by exposure to traffic-related air pollution. Thirty eight physically fit, non-asthmatic volunteers (mean age: 43, 26% women) performed two cycling trials, one near a major traffic road (Antwerp Ring, R1, up to 260,000 vehicles per day) and one in an air-filtered room. The air-filtered room was created by reducing fine particles as well as ultrafine particles (UFP). PM10, PM2.5 and UFP were measured. The duration (∼20min) and intensity of cycling were kept the same for each volunteer for both cycling trials. Serum BDNF concentrations were measured before and 30min after each cycling trial. Average concentrations of PM10 and PM2.5 were 64.9μg/m(3) and 24.6μg/m(3) in cycling near a major ring way, in contrast to 7.7μg/m(3) and 2.0μg/m(3) in the air-filtered room. Average concentrations of UFP were 28,180 particles/cm(3) along the road in contrast to 496 particles/cm(3) in the air-filtered room. As expected, exercise significantly increased serum BDNF concentration after cycling in the air-filtered room (+14.4%; p=0.02). In contrast, serum BDNF concentrations did not increase after cycling near the major traffic route (+0.5%; p=0.42). Although active commuting is considered to be beneficial for health, this health enhancing effect could be negatively influenced by exercising in an environment with high concentrations of PM. Whether this effect is also present with chronic exercise and chronic exposure must be further elucidated.

[Histopathologic diagnosis of infectious loosening of joint prostheses]

To optimize the reliability of histopathological criteria for periprosthetic infection, 110 tissue specimens from joint prostheses were analyzed with quantification of the inflammatory cells and immunohistochemical typing of lymphocytes and plasma cells. As reported in the literature the density of granulocytic infiltration was the most sensitive marker of periprosthetic infection with an accuracy of 84%, a sensitivity of 91%, a specificity of 81%, a positive predictive value of 67%, and a negative predictive value of 95%, using the mostly favored limit value of 5 granulocytes per HPF. T lymphocytes were also found to a high degree in cases of aseptic loosening. In contrast, B lymphocytes were predominantly seen in cases with periprosthetic infection. For B lymphocytes an accuracy of 80% and a sensitivity of 79% were calculated and for plasma cells an accuracy of 75% and a sensitivity of 79%. Our data suggest that the quantification of granulocyte, B-cell, and plasma cell infiltrates is an important parameter for verifying the diagnosis of periprosthetic infection.

[A rare cause of facial asymmetry: nasoalveolar cyst: a clinical report]

Nasoalveolar cysts are rare nonodontogenic cysts that develop from the soft tissue in the mucobuccal area of the nasal ala. Their origin is a residuum of the nasolacrimal canal.

CLINICAL CASE

A 45-year-old woman had been aware of a painless tumor at the base of the nose and in the region of the left nasal ala for several months. We diagnosed a nasolabial cyst, which was extirpated in toto through a combined transvestibular-transnasal approach.

Influence of different intravenous lipid emulsions on hepatobiliary dysfunction in a rabbit model

OBJECTIVES

Long-term total parenteral nutrition (TPN) in children is often complicated by the development of cholestasis, liver fibrosis, and liver failure. High doses of intravenous lipids may be involved in the pathogenesis of hepatobiliary dysfunction. The purpose of this study was to determine whether the use of 2 newly developed lipid emulsions could reduce liver damage.

MATERIALS AND METHODS

Three groups of prepubescent rabbits received TPN including a lipid emulsion either based on soybean oil, olive oil, or soybean oil with n-3 fatty acids added. Enterally fed animals served as controls. After 21 d the animals were killed. Serum samples were obtained at the beginning and end of the study period. Specimens were processed for histological evaluation using a specific score to assess the severity of liver damage.

RESULTS

Biochemical parameters did not predict the extent of liver damage. Hydropic degeneration as an indicator of toxic liver injury was the predominant histological alteration regardless of the type of lipids infused. The extent of fibrosis did not significantly differ among treatment groups except for animals infused with n-3 fatty acids exhibiting increased fibrotic transformation as compared with controls.

CONCLUSION

In our animal model, the use of a lipid emulsion with a reduced amount of polyunsaturated fatty acids was not superior to a lipid emulsion based on soybean oil. Long-term application of n-3 fatty acids was associated with more extensive fibrosis. Therefore, intravenous n-3 fatty acids containing lipid preparations (fish oil) should not be used in patients for long-term TPN.

Proposal for a histopathological consensus classification of the periprosthetic interface membrane

AIMS

The introduction of clearly defined histopathological criteria for a standardised evaluation of the periprosthetic membrane, which can appear in cases of total joint arthroplasty revision surgery.

METHODS

Based on histomorphological criteria, four types of periprosthetic membrane were defined: wear particle induced type (detection of foreign body particles; macrophages and multinucleated giant cells occupy at least 20% of the area; type I); infectious type (granulation tissue with neutrophilic granulocytes, plasma cells and few, if any, wear particles; type II); combined type (aspects of type I and type II occur simultaneously; type III); and indeterminate type (neither criteria for type I nor type II are fulfilled; type IV). The periprosthetic membranes of 370 patients (217 women, 153 men; mean age 67.6 years, mean period until revision surgery 7.4 years) were analysed according to the defined criteria.

RESULTS

Frequency of histopathological membrane types was: type I 54.3%, type II 19.7%, type III 5.4%, type IV 15.4%, and not assessable 5.1%. The mean period between primary arthroplasty and revision surgery was 10.1 years for type I, 3.2 years for type II, 4.5 years for type III and 5.4 years for type IV. The correlation between histopathological and microbiological diagnosis was high (89.7%), and the inter-observer reproducibility sufficient (85%).

CONCLUSION

The classification proposed enables standardised typing of periprosthetic membranes and may serve as a tool for further research on the pathogenesis of the loosening of total joint replacement. The study highlights the importance of non-infectious, non-particle induced loosening of prosthetic devices in orthopaedic surgery (membrane type IV), which was observed in 15.4% of patients.

[Cutaneous form of sarcoidosis at the auricle]

Sarkoidosis is a disease of so far unknown etiology that can affect potentially every organ. Sarcoidosis of the lung is the most common form, nevertheless in more than one third of the cases the head and neck area is affected. Manifestations of the disease can be present in lymph nodes of the neck, the middle ear, the pars petrosa of the temporal bone and in the paranasal sinuses as well as in the larynx and pharynx. We would like to present two rare manifestations of sarkoidosis of the ear lobe. The cutaneous form of sarcoidosis is characterized by a spectrum of skin changes. Aside from the physical presentation and observation of the disease progress the diagnosis is confirmed histologically. A multidisciplinary care of the affected patients is needed to diagnose the systemic extend of the disease on one side and to provide the patient with an effective therapeutic regimen that includes surgical and conservative measures on the other.

Histopathologic Findings in a Novel Decellularized Pulmonary Homograft: An Autopsy Study

Innovative valved conduits for reconstruction of the right ventricular outflow tract are desirable to overcome the risk of valve deterioration of conventional homografts. This study describes the histopathology of a novel decellularized pulmonary homograft (SynerGraft) implanted in the right ventricular outflow tract of a 60-year-old man 5 weeks before death. The histomorphology of this decellularized homograft showed integrity of its extracellular matrix and a gradual cellular infiltrate consisting predominantly of macrophages, resembling an early nonspecific inflammatory phase of recellularization without any signs of a specific immunologic interference 5 weeks after implantation. Whether this morphologic appearance precedes the desired repopulation with autologous fibroblasts remains to be established.

[Proposal for the classification of the periprosthetic membrane from loosened hip and knee endoprostheses]

After 10 years, loosening of total joint endoprostheses occurs in about 3 to 10 percent of all patients, requiring elaborate revision surgery. A periprosthetic membrane is routinely found between bone and loosened prosthesis. Further histomorphological examination allows determination of the etiology of the loosening process. Aim of this study is the introduction of clearly defined histopathological criteria for a standardized evaluation of the periprosthetic membrane. Based on histomorphological criteria and polarized light microscopy, four types of the periprosthetic membrane were defined: periprosthetic membrane of wear particle type (type I), periprosthetic membrane of infectious type (type II), periprosthetic membrane of combined type (type III), periprosthetic membrane of indifferent type (type IV). Periprosthetic membranes of 268 patients were analyzed according to the defined criteria. The correlation between histopathological and microbiological diagnosis was high (89%, p<0,001), the inter-observer reproducibility was sufficient (95%). This classification system enables a standardized diagnostic procedure and therefore is a basis for further studies concerning the etiology of and pathogenesis of prosthesis loosening.

[Lymphadenoma of the parotid gland without sebaceous differentiation. Immunohistochemical investigations]

An encapsulated tumor measuring 8 cm was removed from the parotid gland in a 42-year-old man. The tumor had grown for about 5 years. The histopathological and immunohistochemical evaluation revealed a lymphadenoma without sebaceous differentiation of the epithelial component. The tumor consisted of exclusively solid epithelial islands and a lymphoid stroma with rare lymph follicles and abundant predominantly IgG plasma cells. The histogenesis of lymphadenomas is discussed in consideration of the differential diagnosis from Warthin's tumor and the data in the literature.

[Transmission electron microscopy image of wear particles of joint endoprostheses and ultrastructural cell changes]

Wear particles from joint endoprostheses vary considerably in size, and may be detectable in tissue only by electron microscopy. Wear debris plays a central role in the non-infectious late loosening of prostheses, and it has been estimated that the submicron particles induce increased liberation of mediators of osteolysis by activated macrophages. From the types of prostheses currently in use, bone cement and polyethylene particles greatly predominate over metallic and ceramic particles. Since it had formerly not been possible to reliably identify wear particles in the transmission electron microscopy, and descriptions of them in the literature varied considerably, we analysed ultrathin sections obtained from periprosthetic tissue containing wear particles previously identified by laser microprobe mass analysis. Using this method, it proved possible to classify almost all the wear particles detected in the electron microscope, to determine their size range and to represent the cellular alterations caused by them.

[Tissue reactions around loosened hip joint endoprostheses. A histological study of secondary capsules and interface membranes]

Pseudocapsules and interface membranes from 142 consecutive revision surgeries of hip prostheses were histomorphologically analyzed including a semiquantitative grading of the wear particles from the prostheses and bone cement as well as the cell infiltrates. The implant duration varied between 3 months and 19.5 years. In 37% of the cases up to 6 months in situ, inflammatory cell infiltrates characteristic for early infection were seen. In 22% of the cases with longer implant duration, signs of late infection were found. In the tissues of the predominantly cemented prostheses, bone cement wear prevailed, which could be regularly detected after about 1 year. Polyethylene wear appeared to be the second most common foreign material. Metallic wear was found in only 18% of the cases. Ceramic wear was only seen in tissues around loosened prostheses with ceramic ceramic couples. Due to the material abrasion, a foreign body reaction rich in macrophages developed with minimal lymphocytic infiltration. The degree of these tissue alterations and the amount of wear particles showed a statistically significant increase with increasing implant duration. In contrast, fibrin exudates, hemorrhages, and metaplastic ossifications were not dependent on the length of time in situ. Differences in respect to the amount of wear particles were found between prostheses with ceramic and metallic heads. Prostheses with metal-polyethylene combinations generated approximately twice as many polyethylene wear particles as prostheses with ceramic heads. Among the metal-polyethylene couples, the bipolar prostheses showed a markedly increased polyethylene wear, some of them with extensive osteolyses. Deposits of calcium pyrophosphate were twice as common in pseudocapsules as in capsules from joints with degenerative arthrosis. Because of the increasing frequency of revision surgery, knowledge of the histologic changes around joint prostheses seems to be important as these changes may indicate complications and give information in respect to the biocompatibility of implant materials.

[Identification of wear particles of joint prostheses in tissues using laser microprobe mass analysis (LAMMA)]

The definite identification of wear particles from joint prostheses is of great importance for the development of joint replacement, as the type and quantity of different wear particles gives information on the wear resistance of implant materials. From the types of prostheses nowadays in use polyethylene wear of the sockets, bone cement wear, metallic and ceramic wear can be generated. Whereas polyethylene wear can be easily identified by its bright luminescence in polarized light and its characteristic configuration, the distinction of the small granular wear particles of the bone cement, metal and ceramic by light microscope is difficult. The laser microprobe mass analysis (LAMMA) is a method, which allows the analysis of single light microscopically detectable wear particles in tissues. Not only contrast medium particles of the bone cements (zirconium oxide or barium sulfate) but also metallic and aluminum oxide particles could be definitely identified within the pseudocapsules as well as in regional lymph nodes by LAMMA-analysis, whereby the bone cement wear predominated. In addition, the distinction between organic substances (as blood degradation products), which may appear similar to wear particles in configuration and colour, and the foreign material is also possible with this method.

Morphologic characteristics of periprosthetic tissues from hip prostheses with ceramic-ceramic couples: a comparative histologic investigation of 18 revision and 30 autopsy cases

Pseudocapsules and interface membranes from 18 revision cases having hip prostheses with ceramic-ceramic couples and 30 autopsy specimens (6 with ceramic-ceramic couples, 7 with ceramic-polyethylene combinations and 17 with metal-polyethylene combinations) were histomorphologically analyzed, including a semiquantitative grading of the wear particles and histologic changes. Unlike the revision cases, which usually showed ceramic wear particles in the adjacent tissues, only half of the autopsy cases revealed ceramic wear. As compared to the ceramic-polyethylene and metal-polyethylene couples, the alumina on alumina combinations showed a thinner synovial layer with reduced villous transformation and smaller infiltrates of macrophages and necroses, which can be explained by the absence of polyethylene wear. Metal-polyethylene couplings produced more than twice as many polyethylene wear particles with correspondingly more marked foreign body reaction than the ceramic-polyethylene couplings.

In vitro interaction of C1-inhibitor with thrombin

Previous observations of increased generation of thrombin during acute attacks of angioedema in plasma of patients with C1-inhibitor (C1-INH) deficiency prompted us to evaluate the interaction of C1-INH with thrombin in both purified systems and human plasma. For this purpose, we used several methods: (1) sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting analysis; (2) enzyme-linked immunosorbent assays to measure complexes between C1-INH and thrombin and inactivated C1-INH; and (3) kinetic studies using a chromogenic assay. We found that the interaction of purified C1-INH with thrombin is associated with the formation of bimolecular complexes of molecular weight (Mr) 130 000 and 120 000 as well as with the appearance of a cleaved form of C1-INH of Mr 97 000. The kinetic studies of inhibition of thrombin by C1-INH showed an average second-order rate constant of 19/s per mol/l, which was significantly increased in the presence of heparin. The addition of thrombin to human plasma was not associated with detectable C1-INH-thrombin complex formation or with cleavage of C1-INH. In conclusion, our data demonstrate that C1-INH upon interaction with thrombin, in part, forms enzyme-inhibitor complexes and, in part, is cleaved. The low second-order rate constant and the lack of a significant interaction in plasma suggest that the inhibition of thrombin by C1-INH has a minor role in circulating blood; however, its role might be important at the endothelial surface, where high concentrations of glycosaminoglycans occur.

Mapping of 41 chemotaxis, flagellar and motility genes to a single region of the Sinorhizobium meliloti chromosome

Three previously identified gene clusters that contain chemotaxis (che), flagellar (fla) and motility (mot) genes of Sinorhizobium meliloti (formerly Rhizobium meliloti) were mapped to a contiguous 45-kb region of the S. meliloti RU11/001 genome by pulsed-field gel electrophoresis (PFGE) in combination with Southern hybridization. The entire region was cloned and sequenced. The map combines 32 che, fla (flg, flh, fli) and mot genes and nine new open reading frames that probably encode taxis-related functions as well. It is concluded that between 80 and 90% of the genes responsible for chemotaxis and motility are located in a single region of the S. meliloti chromosome near the his-39 marker.

[Pseudohyperthyroxinemia in endemic sprue--reversibility with a gluten-free diet]

HISTORY

An increased concentration of free T3 (fT3) with normal TSH was repeatedly measured in a 58-year-old man with diarrhoea. Hyperthyroidism was diagnosed and he was treated with thyrostatic drugs.

INVESTIGATIONS

Referred to our clinic, fT4 concentration, determined by routine ELISA, was found to be raised to 33.9 pmol/l, while fT3 and TSH levels were within normal limits. But the equilibrium-dialysis method gave a normal serum level also for fT4. Gastroscopy suggested coeliac disease, confirmed histologically.

TREATMENT AND COURSE

The symptoms quickly improved on a gluten-free diet and the fT4 level returned to normal values even on routine measurement.

CONCLUSION

The raised fT4 level with non-suppressed TSH was only revealed as a false finding by special non-routine laboratory methods. The reversibility and the close time relationship of the reported laboratory data with the clinical manifestations of the concomitant coeliac disease strongly suggested that changes in serum in the course of the latter disease played a role in these misleading laboratory results. An interference of coeliac disease with some laboratory tests has been previously described.

Tissue reactions to cemented hip sockets. Histologic and morphometric autopsy study of 25 acetabula

To gain an insight into the tissue reactions leading to noninfectious loosening, 25 autopsy specimens of acetabula with well-fixed cemented sockets were analyzed histomorphologically and morphometrically. The mean duration of the implant was 7 (0.2-16) years. With the exception of some focal direct bone-cement contacts, bone and cement were separated by a soft tissue membrane which increased in thickness with increasing duration of the implant. Necroses in the membrane were also commoner with advancing implant time. The soft tissue membranes developed increasingly dense infiltrates of histiocytes, mainly containing wear particles of the bone cement and--though less abundant--polyethylene. The cancellous bone adjacent to the soft tissue membrane showed an increasing histiocytic infiltration with an increasing duration of the implant. The trabecular bone showed remodeling with formation of a neocortical layer parallel to the border of the cement mantle.

[Differences in polyethylene wear in hip joint prostheses with ceramic- and with metal-polyethylene combination of the articulation surfaces--a study of surgical and of autopsy materials]

Pseudocapsules of artificial hip joints with ceramic- and metal on polyethylene combination of the articulating surfaces from 126 revision arthroplasties and 41 autopsies were studied histologically with semiquantitative evaluation of the polyethylene wear. The results were compared with reports of laboratory tests in the literature. We found in the autopsy specimens as well as in the biopsies from revision arthroplasties of prostheses implanted for 4 to 8 years three times less polyethylene wear particles released from the ceramic on polyethylene prostheses. The newly established synovium surrounding prostheses with ceramic heads appeared 20% reduced in thickness with minor villous transformation. Different types of metal on polyethylene prostheses revealed no differences in wear behaviour with the exception of the bipolar prostheses which showed a markedly increased polyethylene wear.

Comparative investigations of regional lymph nodes and pseudocapsules after implantation of joint endoprostheses

Morphological alterations of pseudocapsules and regional lymph nodes were studied by light and electron microscopy and by Laser Microprobe Mass Analysis (LAMMA). The tissue specimens originated from 32 autopsies of patients with hip joint endoprostheses (time in situ: 3 weeks - 15 years, average: 6 years) and two cases with knee joint endoprostheses. Characteristic changes of the lymph nodes as well as of the pseudocapsules consisted in an infiltration by monocytic histiocytes with various intracytoplasmatic wear particles. The foreign material consisted mainly of the components of bone cement: polymethylmethacrylate (PMMA) and zirconium oxide, to a lesser degree of polyethylene from the articulating surfaces. In two cases with special types of prostheses ceramic or metallic wear particles could be detected too. Most of the wear particles were found in the ipsilateral parailiac lymph nodes and in the paraaortic lymph nodes bilaterally. In the cases with mostly stable prostheses small amounts of wear particles were found in the lymph nodes as soon as 1.5 years after insertion and their number increased in all groups of lymph nodes after longer duration of the implant. The phagocytosing histiocytes showed degenerative changes. At present it is not clear, if the cell damage is caused by the amount of phagocytosed wear particles alone or if specific toxic effects of certain substances are of importance.

[The cause of loosening in cemented hip joint prostheses. Light and electron microscopy study and laser microprobe mass analysis]

Aseptic loosening of joint prostheses is a quantitatively increasing problem. For evaluation of the pathogenesis of prosthesis loosening joint capsules and tissue membranes taken from the femoral and acetabular bone-cement-interface of 23 hips revised for aseptic loosening were examined. In all cases we found an excessive inflammatory histiocytic reaction with intracytoplasmatic incorporation of a small granular foreign material. This could be identified to be zirconium oxide by LAMMA-analysis. Zirconium oxide and polymethylmethacrylate (PMMA) wear particles could be shown in the cytoplasm of histiocytes by transmission electron microscopy. By quantitative grading of the histiocytic reaction and the intracellular granular wear particles we found that both were evenly distributed around the loosened prosthesis. Chronic inflammation due to bone cement abrasion is regarded as a leading cause of aseptic prosthesis loosening.

Morphologic alterations in the long Q-T syndrome. Light and electron microscopic observations in the conduction system and in sympathetic trunks

Post-mortem examinations of 2 patients with long Q-T syndrome revealed marked focal fibrosis and lipomatosis of the conduction system as well as focal round cell ganglionitis of both sympathetic trunks. The patients, young women of different nationality displaying syncopal attacks and a long Q-T interval in the ECG died suddenly of ventricular arrhythmias. A family study of one of them revealed Q-T prolongation in 4 generations. The ultrastructure of the conductive tissue and the ventricular myocardium showed no specific alterations indicative of a primary metabolic defect. Ganglionitis of the sympathetic trunks has not yet been reported in the long Q-T syndrome. Although the etiology of the inflammatory changes is uncertain a chronic viral infection, noninfectious toxic alterations or an autoimmunopathy are among the plausible causes discussed.

Influence of peroral charcoal on pharmacokinetics and intestinal toxicity of intravenously given methotrexate

Intestinal toxicity is an often reported side effect of methotrexate (MTX) in man. We found in rats that the large MTX amount occurring in the intestinal lumen (31.6% of dose) after intravenous injection does not contribute to the intestinal toxicity of MTX (31 mg/kg) because adsorption of MTX to charcoal within the intestinal lumen did not alter the reduced mitotic count and the villus height induced by MTX injection. Binding of intraluminal MTX to charcoal in vivo did not markedly alter MTX pharmacokinetics in plasma.

[Sympathetic ganglionitis in the hereditary syndrome of QT prolongation (Romano-Ward syndrome); intracardiac registration of after-potentials (author's transl)]

A 20-year-old woman, admitted to an intensive care unit in ventricular fibrillation, had marked QT prolongation in the ECG after successful defibrillation. Family study revealed ECG signs of QT prolongation, as seen in the Romano-Ward syndrome, in four generations. Syncopal attacks only occurred in the third generation, affecting four siblings. In the described patient the intraventricular ECG revealed additional depolarizations (after-potentials) during and following repolarization (ST-T) in the surface ECG. The patient died later as a result of irreversible hypoxic cerebral damage. Invasive ECG studies in the mother also revealed after-potentials. In the patient, morbid-anatomical examination revealed, in addition to fibrosis and lipomatosis around the sinus and AV nodes, focal round-cell ganglionitis in both sympathetic trunks, but predominantly on the right. These infiltrations have not previously been described in this disease and could be of significance in the pathogenesis of the prolonged QT syndrome.