A scoring system for grading corkscrew claws in dairy cattle

Corkscrew claw (CC) in dairy cattle is increasingly reported in dairy herds. CC is a progressive deformity of the claw capsule with uncertain aetiology and pathogenesis. Genetics and specific environmental factors are suspected of contributing to the development of this irreversible condition. CC has been found in lame cows; however, the cause and effect has not been established. To perform analysis of risk factors, treatment and pathogenesis, a definition of severity scores is called for. The aim of this study was to measure and analyse CC characteristics from photos of cows' feet to describe and evaluate a scoring system for CC. Width of the visible part of the axial wall, degree of contact between the toe and the floor and angle of the distal part of the abaxial wall as a proxy for the deviation of the abaxial wall was measured from 393 pictures of CC. Based on the measurements on the claws, the parameter "width of the axial wall" was chosen to define the scores. The parameter was divided into three intervals to define either mild CC 0.3-2.0 cm, moderate CC 2.1-3.5 cm or severe CC>3.5 cm and correlation between the parameters; level of contact between the toe and the floor and the angle of the distal abaxial wall was evaluated. There was a significant positive linear correlation between width of the axial wall and angle of the distal part of the abaxial wall (r=0.91), the wider the axial wall, the more the abaxial wall deviated in the distal part. As the width of the axial wall increased the toe increasingly lost contact with the floor, this association was significant for mild CC and moderate CC but not for severe CC. The Interobserver agreement of the CC Scoring system was tested by 30 claw trimmers each scoring 32 cadaver feet and by 2 trained observers on 28 photos of feet using Cohen´s weighted kappa and showed substantial to almost perfect agreement between untrained and trained observers, respectively.

Primary S100 Negative Amelanotic Spindle Vaginal Melanoma

Introduction/Objective

Vaginal melanoma is a rare malignancy composed of cells showing melanocytic differentiation and represents less than 3% of malignant vaginal tumors. It occurs in older women, typically in the distal third of the vagina. Outcomes are poor and median survival is less than 2 years. Macroscopically, 90% of these lesions are pigmented, polypoid and ulcerated. Microscopically they demonstrate diffuse, nested, trabecular, and/or fascicular patterns and are comprised of epithelioid cells with or without a spindle cell component. They are typically pigmented and S100 positive.

Methods/Case Report

Here we present a rare case of purely spindled amelanotic S100 negative vaginal melanoma. The patient is a 75 year old woman who presented with a 6 month history of vaginal discharge, and a one month history of new foul odor and vaginal bleeding, constipation, and unintentional weight loss. A large vaginal mass was palpated on physical exam. Subsequent computed tomography demonstrated a 8.2 x 8.2 x 9.4 cm mass occupying the vaginal vault with abutment of the urinary bladder anteriorly and the rectal and anal walls posteriorly. A biopsy was performed and a 3.8 x 2.2 x 1.2 cm aggregate of pink tan friable tissuse was obtained. Histopathologic examination showed a malignant neoplasm composed purely of spindled cells in a fasicular pattern. Tumor cells showed marked nuclear pleomorphism with inconspicuous nucleoli. Tumor necrosis was present. No pigment was seen. By immunohistochemistry, tumor was positive for SOX10, HMB45, and Melan A, and negative for S100, AE1/3, EMA, myogenin, desmin, smooth muscle actin, synaptophysin, chromogranin, Pax8, and GATA3. BRAF mutation analysis showed no mutations. Patient received radiation therapy with a good clinical reponse.

Results (if a Case Study enter NA)

NA.

Conclusion

Amelanotic S100 negative spindled vaginal melanoma is an unusual presenation of a rare tumor and should be considered in the workup of malignant vaginal tumors with a spindle cell morphology.

Rhabdoid Melanoma Solitary Metastasis to Kidney with Renal Vein Invasion Mimicking Renal Cell Carcinoma

Introduction/Objective

83 percent of malignant melanoma cases present as localized skin lesions. However, a small percentage of patients present with concurrent metastatic disease or experience late metastasis. Metastatic melanoma has highly variable presentation and morphology, frequently mimicking other tumors. The most common metastatic sites in order of frequency are skin and subcutaneous tissue, lungs, liver, bones, and brain. While rare, metastasis to the kidney can occur and typically takes the form of multiple micrometastases.

Methods/Case Report

Here we present an unusual case of a late, purely rhabdoid large solitary renal metastatic melanoma with renal vein invasion, mimicking rhabdoid renal cell carcinoma. The patient is an 84 year old male with a remote history (30 years) of cutaneous malignant melanoma who was referred with a CT scan demonstrating 7.9 x 5.7 x 5.7 mass in the lower pole of the left kidney with a tumor thrombus in the renal vein hhighly suspicious radiographically for renal cell carcinoma. The patient underwent a radical nephrectomy. Macroscopically there was a solitary 7.7 x 6.3 x 5.5 cm tan-grey mass in the lower pole with gross invasion into the renal sinus fat and renal vein resembling the macroscopic appearance of a renal cell carcinoma. Microscopic examination demonstrated pleomorphic tumor cells with pure rhabdoid morphology, extensive necrosis and Lymphovascular invasion. No pigment was identified. No classic clear cell areas were identified. Immunohistochemical stains were positive for S100, SOX10 Melan-A, HMB45 and vimentin and negative for AE1/3, CK7, CAIX, PAX8, P63, CD117 and AMACR. Multiple resected lymph nodes were negative for metastasis

Results (if a Case Study enter NA)

NA.

Conclusion

This case is a rare and unusual presentation of melanoma, and it’s important to keep this diagnosis in consideration in the setting of unusual morphology of renal tumors.

Changes in the soft-tissue thickness of the claw sole in Holstein heifers around calving

Claw horn disruption lesions are a common cause of lameness in dairy cattle. It is commonly agreed that they develop due to excessive pressure from the distal phalanx on the horn-producing tissue in the sole. The distal phalanx is supported by the suspensory apparatus, a large proportion of which is made up of connective tissue. It has been hypothesized that increased laxity of the connective tissue due to hormonal changes around calving may lead to decreased support of the distal phalanx, resulting in a sinking of the bone and increased pressure on the horn-producing tissue. In this longitudinal study, our first objective was to determine whether the thickness of the soft tissue related to the claw sole (the combined depth of the digital cushion and corium; soft-tissue thickness, STT) in the weight-bearing hind claws of live heifers changed around calving (the period from approximately 3 wk before calving to 2 wk after calving). Our second objective was to evaluate the relationship between the body condition score (BCS) of recruited heifers and the STT estimates we obtained. We measured STT (defined as the distance between the distal phalanx and the sole horn) in the apex and the posterior part of the sole of the hind claws of 34 Holstein heifers 4 times over 3 to 4 wk around calving. We determined STT by ultrasonographic measurements through the sole horn on weight-bearing claws. The overall mean STT at site 1 was 3.3 mm [minimum-maximum (min-max): 1.8 to 5.2 mm], and the mean at site 2 was 3.7 mm (min-max: 2.2 to 5.8). The overall mean STT was thickest in the first examination before calving [site 1: 3.4 mm (min-max: 1.9 to 4.7); site 2: 4.1 mm (min-max: 2.7 to 5.8)] and thinnest at site 1 in the second examination after calving (3.2 mm, min-max: 1.8 to 5.2) and at site 2 at the first examination after calving (3.5 mm, min-max: 2.2 to 5.0). We observed an average reduction in STT of -0.2 mm (min-max: 0.8 to -0.9 mm) at site 1 during the study period, but we did not observe this reduction in all animals. At site 2, we found an average reduction in STT of -0.6 mm (min-max: 0.8 to -1.3 mm) from 10 d before calving to 5 d after calving, corresponding to a decrease of approximately 15% (min-max: 0 to 31%). We suggest that this reduction was caused by a rotation of the distal phalanx toward the posterior part of the sole horn in the weeks around calving. During the same period, heifer BCS decreased between 0.25 and 0.5 increments in the BCS scale, but we found no correlation between BCS and STT. However, the heifers experienced many changes related to management, feeding, and time budget during the study period, and the rotation of the distal phalanx and reduction of the STT might be explained not only by calving but also by other factors that affect heifers and their claws during the transition period.

Indicators of iron status are correlated with adiponectin expression in adipose tissue of patients with morbid obesity

AIM

The aim of this study was to assess interactions between glucose and iron homoeostasis in the adipose tissue (AT) of obese subjects.

METHODS

A total of 46 obese patients eligible for bariatric surgery were recruited into the study. Anthropometric and biochemical characteristics were assessed, and biopsies of subcutaneous (SCAT) and visceral adipose tissue (VAT) performed. The mRNA levels of genes involved in iron and glucose homoeostasis were measured in their AT and compared with a pool of control samples.

RESULTS

Gene expression of hepcidin (HAMP) was significantly increased in the SCAT and VAT of obese patients, while transferrin receptor (TFRC) expression was reduced, compared with non-obese controls, suggesting a higher iron load in obese patients. Also, mRNA levels of adiponectin (ADIPOQ) were decreased in both SCAT and VAT in obese patients, and correlated negatively with hepcidin expression, while adiponectin expression was positively correlated with TFRC expression in both SCAT and VAT. Interestingly, TFRC expression in VAT correlated negatively with several metabolic parameters, such as fasting blood glucose and LDL cholesterol.

CONCLUSION

Iron content appears to be increased in the SCAT and VAT of obese patients, and negatively correlated with adiponectin expression, which could be contributing to insulin resistance and the metabolic complications of obesity.

Altered Calreticulin expression in human colon cancer: maintenance of Calreticulin expression is associated with mucinous differentiation

Calreticulin is an endoplasmic reticulum luminal calcium-binding chaperone involved in various cellular functions and is a ligand for the scavenger receptor CD91. Recent studies, based on proteomic approaches on whole tissue samples containing both neoplastic and non-neoplastic cells, have shown alterations of Calreticulin expression in colon carcinomas, albeit with divergent results. The aims of this study were: 1) to assess the expression of Calreticulin and its receptor CD91 in 58 human colon adenocarcinomas, compared with paired normal mucosa, using a semi-quantitative immunohistochemical analysis, and 2) to examine associations between the tumour phenotypic features, and Calreticulin and/or CD91 expressions. Calreticulin expression was down-regulated in 51.7% human colon adenocarcinomas. Accordingly, quantitative immunoblot analysis showed that Calreticulin expression was significantly lower in human colonic cancer cell lines than in preparations of isolated human normal colonic epithelial cells. CD91 was co-expressed with Calreticulin in both normal colonic epithelial cells and pericryptic myofibroblasts. Calreticulin and CD91, that characterize the 'amateur phagocyte' function of epithelial cells, were both down-regulated in 48% of adenocarcinomas. Finally, Calreticulin expression was significantly associated with the mucinous differentiation of the tumour. Collectively, these results show that Calreticulin is likely to play a pivotal role in the differentiation of human colonic adenocarcinomas.

Ostomy bag management: comparative study of a new one-piece closed bag

The aim of this study was to compare the performance of a new one-piece closed ostomy bag, SenSura, to an already established bag with a focus on minimizing problems related to use of stoma bags for individuals with a colostomy. There were 68 Danish participants with a colostomy who tested each bag for 1 week in a randomized, open, comparative, crossover study. The SenSura bag was perceived more secure than the reference bag (p=0.0006). Crucial performance and safety parameters were rated significantly better for SenSura than for the reference bag. The high preference for SenSura (85%) reflected these results (p<0.0001). Individuals with a colostomy can expect a higher sense of security with the SenSura bag than with the reference bag. This may relate to good adhesion, tack, flexibility and effective filter performance. Future studies should examine the long-term effects of SenSura on peristomal skin conditions. To our knowledge, this is the first published comparative study of one-piece closed ostomy bags.

[Gynecological outpatient management in HNPCC]

OBJECTIVE

Female patients with diagnosis of endometrial or ovarian cancer before the age of 45 are suspicious of hereditary non-polyposis colorectal cancer (HNPCC). In the daily routine it is difficult to distinguish between HNPCC and sporadic cancer, however, the consequences are severe. A standardised interview was conducted to evaluate the management of HNPCC-patients in medical practice. COHORT AND METHODS: 36 gynecologists working in medical practice were interviewed, statistical analyses were performed with SPSS 12.0.

RESULTS

Most of the gynecologists refer to a hereditary tumor syndrome in consideration of family history, diagnosis at early age and synchronous or metachronous cancer. Patients with endometrial or ovarian cancer before the age of 45 years were rated as high risk patients. 72 % of the gynecologists take care of female patients suspicious of HNPCC according to the Bethesda criteria, even though half of these do not consider that diagnosis. Gynecological surveillance examinations are not fully taken into account. The interdisciplinary surveillance concept is rarely initiated.

CONCLUSION

The current surveillance recommendation for patients suspicious of HNPCC should be applied more often in the daily routine of gynecological outpatient management. Sponsored by Deutsche Krebshilfe.

[Evaluation of outpatient management in HNPCC]

The differential diagnostic assignment of patients with hereditary non-polyposis colorectal cancer among patients with non-familial colorectal carcinoma is difficult but essential to provide early sufficient cancer screening. In order to analyze the actual situation of outpatients, 36 gastroenterologists in private practice have been interviewed with respect to their experience concerning outpatients. The interview data revealed that care for patients with colorectal cancer is a fundamental component of their work. A third of the gastroenterologists deal with patients suffering from colorectal cancer before 45 years of age. Yet these gastroenterologists did not report a single HNPCC patient. Especially gastroenterologists with long lasting experience in private practice did not mention HNPCC patients at all. These results may indicate that identifying the cases at risk for HNPCC is difficult in daily routine work. The possibility of genetic diagnostics (and counselling) should be taken into consideration in individual cases. In consequence comprehensive screening programs can be initiated for patients and their families.

Effects of academic stress on oral hygiene - a potential link between stress and plaque-associated disease?

BACKGROUND

While there seems to be a common belief that psychosocial stress affects oral hygiene behavior, this assumption has rarely been proved. The present study thus aims to analyse stress effects on oral hygiene.

MATERIAL AND METHODS

16 matched pairs of medical students each consisting of 1 student participating in a major academic exam and 1 control without current academic stress, were formed on the basis of baseline plaque levels. At baseline, a professional tooth cleaning was performed. On the last day of exams, students answered questionnaires about oral hygiene during the exams and were afterwards asked to attend for a 2nd dental examination, of which they had no prior knowledge.

RESULTS

On the last day of exams, approximately 6 weeks after professional tooth cleaning, 20.9+/-18.3% of control students' sites but only 10.5+/-9.3% of exam students' sites were found to be free of any plaque (p=0.022). Differences were most obvious at oral, as compared to vestibular, sites. Exam students reported a reduction in thoroughness (p=0.019) but not of frequency of oral hygiene behavior.

CONCLUSION

The study strongly supports the assumption that psychosocial stress may induce neglect of oral hygiene and increase of plaque accumulation.

Biological activity of RE-1 silencing transcription factor (REST) towards distinct transcriptional activators

The zinc finger protein RE-1 silencing transcription factor (REST) is a transcriptional repressor that represses neuronal genes in non-neuronal tissues. We have analyzed the ability of REST and the REST mutants, RESTDeltaN and RESTDeltaC lacking either the N-terminal or C-terminal repression domains of REST, to inhibit transcription mediated by distinct transcriptional activator proteins. For this purpose we have designed an activator specific assay where transcription is activated as a result of only one distinct activation domain. In addition, binding sites for REST were inserted in the 5'-untranslated region or at a distant position downstream of the polyadenylation signal. The results show that REST or the REST mutants containing only one repression domain were able to block transcriptional activation mediated by the transcriptional activation domains derived from p53, AP2, Egr-1, and GAL4. Moreover, REST, as well as the REST mutants, blocked the activity of the phosphorylation-dependent activation domain of Elk1. However, the activity of the activation domain derived from cAMP response element binding protein 2 (CREB2), was not inhibited by REST, RESTDeltaN or RESTDeltaC, suggesting that REST is able to distinguish between distinct transcriptional activation domains. Additionally, the activator specific assay, together with a positive-dominant mutant of REST that activated instead of repressed transcription, was used in titration experiments to show that REST has transcriptional repression and no transcriptional activation properties when bound to the 5'-untranslated region of a gene.

The extracellular signal-regulated protein kinases Erk1/Erk2 stimulate expression and biological activity of the transcriptional regulator Egr-1

The zinc finger protein early growth response 1 (Egr-1) is a transcriptional activator involved in the regulation of growth and differentiation. We show here that a constitutive active mutant of mitogen-activated kinase kinase-1 (MAPKK-1) strongly stimulates the activity of the Egr-1 promoter, thus explaining the effects of mitogens upon Egr-1 mRNA and protein levels. Moreover, we show that a constitutive active MAPKK-1 leads to an increase in the biological activity of Egr-1 to activate transcription. We conclude that the signaling pathway involving mitogen-activated protein kinase/extracellular signal-regulated protein kinase has a dual impact on the biology of Egr-1 by controlling the transcription of the Egr-1 gene and the transcriptional activity of the Egr-1 protein.

Biological activity of mammalian transcriptional repressors

Research on the regulation of transcription in mammals has focused in recent years mainly on the mechanism of transcriptional activation. However, transcriptional repression mediated by repressor proteins is a common regulatory mechanism in mammals and might play an important role in many biological processes. To understand the molecular mechanism of transcriptional repression, the activity of eight mammalian repressors or repressor domains was investigated using a set of model promoters in combination with two different transcriptional detection methods. The repressors studied were: REST, the thyroid hormone receptors alpha and beta, the zinc finger protein NK10 containing a 'krüppel-associated box' (KRAB), repressor domains derived from the proteins Egr-1, Oct2A and Dr1 and the repressor/activator protein YY1. Here we show that the repressor domains of REST, Egr-1, the thyroid hormone receptors alpha< and beta and NK10 were transferable to a heterologous DNA-binding domain and repressed transcription from proximal and distal positions. Moreover, these repressor domains also blocked the activity of a strong viral enhancer in a 'remote position'. Thus, these domains are 'general' transcriptional repressor domains. The 'krüppel-associated box' was the most powerful repressor domain tested. In contrast, the repressor domains derived from Oct2A and Dr1 were inactive when fused to a heterologous DNA-binding domain. The repressor domain of YY1 exhibited transcriptional repression activity only in one of the transcriptional assay systems. The recruitment of histone deacetylases to the proximity of the basal transcriptional apparatus was recently discussed as a mechanism for some mammalian transcriptional repressor proteins. Here we show here that histone deacetylase 2, targeted to the reporter gene via DNA-protein interaction, functions as a transcriptional repressor protein regardless of the location of its binding site within the transcription unit.

The human transcriptional repressor protein NAB1: expression and biological activity

The zinc finger protein early growth response 1 (Egr-1) is a transcriptional activator involved in the regulation of growth and differentiation. Egr-1 has a large activating domain and three zinc finger motifs that function as a DNA binding region. We show here that a third functional domain of the Egr-1 protein, localized between the extended activation domain and the zinc finger DNA binding region, acts as a transcriptional repressor domain when fused to a heterologous DNA binding domain (DBD). Through protein-protein interaction this inhibitory domain of Egr-1 brings the transcriptional corepressor NAB1 in close proximity to the transcription unit. NAB1 is expressed ubiquitously in human cell lines as shown by RNase protection mapping. Overexpression studies revealed that NAB1 is able to completely block transcription mediated by Egr-1. In addition, the transcriptional repression activity of a fusion protein containing the inhibitory domain of Egr-1 and the DBD of the yeast transcription factor GAL4 was increased by overexpression of NAB1. A fusion protein consisting of the DBD of GAL4 and the coding region of human NAB1 repressed transcription from model promoters with engineered upstream GAL4 binding sites. The GAL4-NAB1 fusion protein functioned from proximal and distal positions indicating that NAB1 displays transcriptional repressor activity at any position within the transcription unit. Thus, the biological function of the inhibitory domain of Egr-1 is solely to provide a docking site for NAB1 via protein-protein interaction.

Three different mask physiotherapy regimens for prevention of post-operative pulmonary complications after heart and pulmonary surgery

OBJECTIVE

An investigation into the incidence of post-operative complications after thoracic surgery with 3 different physiotherapy masks.

DESIGN

A prospective, consecutive, randomized comparison.

SETTING

Department of Thoracic and Heart Surgery at a University Hospital. The treatments were performed by experienced and specially trained physiotherapists.

PATIENTS

160 patients were evaluated. 60 patients undergoing heart surgery, 59 patients having pulmonary resection, and 41 patients with exploratory thoracotomy.

INTERVENTIONS

In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy. These were either continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), or inspiratory resistance - positive expiratory pressure (IR-PEP).

MEASUREMENTS AND RESULTS

Post-operative pulmonary complications were assessed by forced vital capacity (FVC), arterial oxygen tension (PaO2), and chest X-ray examination, all measured pre-operatively and on the fourth and ninth post-operative day. The patients filled in a questionnaire expressing their opinion about their mask treatment. There was an equal decrease in FVC, FVC%, and PaO2, and equal frequency of atelectasis in the 3 mask treatments. More patients with the PEP mask favoured their system than did those with the other 2 systems.

CONCLUSION

There was no statistically significant difference between the treatments: continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), and inspiratory resistance - positive expiratory pressure (IR-PEP) on post-operative complications. Any of the three treatments may be used as supplement to standard chest physiotherapy.

[The clinical significance of pseudouridine determination of the urine in children and adolescents]

A HPLC-method is described to determine the Pseudouridine/creatinine ratio in spontaneous urine samples in infancy and childhood. The urines of 74 healthy children between 1 and 18 years of age and of 231 children with different diseases were examined for this ratio, making 1097 measurements. 157 children suffered from a malignant disease, 66 of them having an acute leukemia. Those patients, who remain in remission of the leukemia showed normal values, whereas the others had elevated ratios, reflecting the activity of the leukemia, when they were followed up by multiple determinations. Perhaps it is also possible to detect preclinical stages of leukemia by measuring the pseudouridine/creatinine ratio routinously over a long period of time. Today no strict correlation between the prognosis of leukemia and the level of this ratio can be drawn. Similar behaviour of the pseudouridine/creatinine ratio is seen in other malignant diseases with exception of brain tumors. The difference to leukemias is, that all other malignant tumors show more often normal values in patients with a remaining tumor. A pathological value of pseudouridine may also be seen in others than malignant diseases.

New diagnostic and therapeutic aspects of 2,8-dihydroxyadenine lithiasis. Another case of complete adenine phosphoribosyltransferase deficiency

2,8-Dihydroxyadenine lithiasis is rare. One case, the methods to establish the diagnosis by high performance liquid chromatography and the treatment are described.

[Structural and functional conception of in-patient and ambulatory psychiatric care in Leipzig]

The present paper reports a model designed to optimize treatment of mental disorders. This model has as its basic principle the division into sections of the region to be cared for in addition to the restructuring of existing mental hospitals. The advantages of this model of sectionalisation are discussed in detail.