Trajectories of illness perceptions in paediatric cancer patients and their parents and associations with health-related quality of life: Results of a prospective-longitudinal study

OBJECTIVE

In paediatric oncology, little is known about trajectories of illness perceptions and their longitudinal associations with health-related quality of life (HRQoL). Therefore, the aim of this study was to investigate changes in illness perceptions in children and parents over a one-year-period and to investigate predictive value of child's and parent's illness perceptions during acute treatment for child's HRQoL 1 year later.

METHODS

N = 65 child-parent-dyads participated in a longitudinal study (retention rate: 80.2%). Children were 4-18 years of age and underwent acute cancer treatment at baseline. Children and parents reported on their own illness perceptions (Illness-Perception-Questionnaire-Revised), as well as on the child's HRQoL (KINDL-R) at baseline and one-year-follow-up. Paired-samples t-tests were calculated to investigate changes over time. A hierarchical multiple regression analysis was performed to investigate predictive value of child's and parent's illness perceptions for child's HRQoL.

RESULTS

Child's HRQoL t(63) = -6.73, p < 0.001, their perceptions of coherence (i.e. understanding; t(54) = -2.36, p = 0.022) and consequences of their illness (t(54) = 2.86, p = 0.006), and parent's perception of cyclical trajectory (t(61) = 2.06, p = 0.044) improved from baseline to 1-year-follow-up. All other illness perceptions remained stable. Exploratory post-hoc analyses showed differences in the pattern of change in age-, gender-, and diagnosis-specific subgroups. After controlling for baseline levels of HRQoL, child's perceptions of symptoms and consequences were independent predictors of their HRQoL 1 year later (R2 = 0.396, F(2,52) = 10.782, p < 0.001), whereas no parent's illness perceptions added predictive value.

CONCLUSION

In paediatrics, child's and parent's illness perceptions should be assessed. Our findings highlight the importance of illness perceptions as potential modifiable variables in interventions to improve child's HRQoL.

The puppet interview to measure illness perceptions in paediatric oncology: development and psychometric properties in acute treatment and follow-up care

BACKGROUND

Illness perceptions comprise assumptions about symptoms, timeline, consequences, controllability, and emotional responses to an illness. Recent evidence shows that illness perceptions are associated with coping and well-being. So far, assessment in paediatric care was based on parental report only, since no instrument for the direct assessment of young children was available. We aim to describe the development (incl. indication and contraindication) of an innovative puppet interview to assess illness perceptions in children with cancer from the age of four years. Moreover, we investigate longitudinal trajectories and examine psychometric properties.

METHODS

The puppet interview was developed based on the Illness-Perception-Questionnaire-Revised and the Berkeley-Puppet-Interview. Longitudinal trajectories and psychometric properties were examined in a sample of patient-parent dyads (N = 75) in a prospective longitudinal study in acute treatment with a 1-year follow-up (study 1: nT1 = 41, nT2 = 27) and in a cross-sectional study in follow-up care (study 2, n = 34).

RESULTS

The puppet interview is comprehensible and well-received by children in acute treatment and follow-up care. There were significant differences in perceptions of a chronic timeline (U = 301.00, p = .008), consequences (U = 251.00, p = .008), and emotional representations (U = 244.50, p = .020) between children in acute treatment and children in follow-up care. Over the course of one year, children in acute treatment perceived more symptoms as part of their illness (MT1 = 3.6, SDT1 = 2.9, MT2 = 4.5, SDT2 = 3.1, n = 27, Z = -2.603, p = .009). We found expected intercorrelations between illness perception dimensions, e.g. between perception of consequences and emotional representations (rτ = .27, p = .033), and between perception of a chronic timeline and consequences (rτ = .38, p = .001). Moreover, we found confirming results regarding construct validity, as child's perceptions of symptoms correlated with their self-rated HRQoL (rτ = -.32, padj. = .014). Also parent-rated subscale on illness-specific aspects of child's HRQoL correlated with child's perception of symptoms (rτ = -.26, padj. = .016), cyclicity (rτ = -.28, padj. = .016), and consequences (rτ = -.34, padj. = .014). Acceptable internal consistency was shown for the dimensions timeline-acute/chronic and personal control.

CONCLUSIONS

Parental report can now be complemented by a self-report of illness perceptions in children aged four years and older. This will allow for the further adaptation of medical and psychosocial care during and after acute cancer treatment.

TRIAL REGISTRATION

The study has been pre-registered at the German Clinical Trials Register (registered 30/06/2020; DRK-S00022034) and at the Open Science Foundation ( https://osf.io/7xr6z ).

The oracle of D-A-Ch - Results of a Delphi Survey for the development of the evidence- and consensus-based tool "My Logbook"

OBJECTIVE

The present report describes the results of four delphi surveys conducted within the quality improvement project "My Logbook" which aims to translate evidence-based standards for psychosocial care in pediatric oncology into a practical consensus-based tool.

METHODS

In four consecutive delphi surveys a total of n=153 international, multi-disciplinary experts rated the content, method, and design of the different booklets of "My Logbook" which a local expert group had conceptualized. After each survey, the feedback was incorporated, and the changes were evaluated in a final consensus vote by the quality assurance panel of the PSAPOH.

RESULTS

While some surveys led to a review on a page level, most booklets as a whole reached the consensus-level of approval. Over the course of the surveys, any revisions and comments were incorporated in the booklets, and approval rates increased steadily.

DISCUSSION

The delphi surveys ensured the integration of multi-disciplinary, international expertise, uncovering issues such as language barriers and the need for a user manual that would not have been evident in first line . The incorporation of the input led to a continuous improvement of the tool, reflected in steadily increasing acceptance rates in the consecutive survey rounds.

CONCLUSION

The incorporation of the expert input as well as the additional development of a user manual resulted in a final version of the "My Logbook" apt for the interdisciplinary application in pediatric oncology in the entire DACH-region.

[How good are teachers at recognising mental health issues and assistance needs in adolescents? A vignette-based study]

INTRODUCTION

Teachers can help identify mental health issues in adolescents and act as gateway-providers by referring adolescents at risk to a mental health professional. Studies have so far investigated awareness concerning mental health issues among primary school teachers in the USA. The present study uses case vignettes to examine whether secondary school teachers in Germany can detect and assess the presence and severity of mental disorders in adolescents, and which factors predict referral to professional support services.

METHODS

N=136 secondary school teachers completed an online questionnaire with case vignettes depicting students with moderate or severe internalizing and externalizing disorders. We assessed the ability to recognize mental health issues and evaluate the level of severity, worry and perceived prevalence of the problem as well as the helping behaviour among teachers.

RESULTS

66 and 75% of the teachers were able to identify mental health issues in case vignettes of externalizing and internalizing disorders, respectively. 60% and 61%, respectively, designated the mental disorder correctly as externalizing or internalizing, and the true positive rates did not differ between externalizing vs. internalizing disorders. However, moderate and externalizing disorders were identified with less precision, and recommendations to seek professional mental help were more seldom made for these disorders.

DISCUSSION

The results indicate that teachers can validly and probably intuitively identify (at least severe cases of) mental disorders in their students. Given the uncertainty expressed and the substantial interest of teachers, further education and training on mental health conditions disorders in adolescents is recommended.

[Screening to Assess Psychosocial Follow-up Needs in Pediatric Oncology (NPO-11) for Self- and Parent-Report]

BACKGROUND

Children diagnosed with cancer are at increased risk for the development of psychosocial problems. Currently, no qualitative and quantitative tests are available to measure their need for psychosocial follow-up care. The NPO-11 screening was developed to tackle this issue.

PATIENTS AND METHODS

11 dichotomous items were generated to measure self- and parent-reported fear of progression, sadness, avolition, self-esteem problems, school and vocational problems, somatic complaints, emotional withdrawal, social disintegration, pseudo-maturity, parent-child conflicts, and parental conflicts. Data from N=101 parent-child dyads were obtained to validate the NPO-11.

RESULTS

Self- and parent-reported items showed few missing values and response frequencies without floor or ceiling effects. Inter-rater reliability was fair to moderate. Factor analysis confirmed a single-factor model and therefore an overall NPO-11 sum score. Self- and parent-reported sum scores had sufficient to good reliability and large correlations with health-related quality of life.

CONCLUSION

The NPO-11 is a screening for psychosocial needs in pediatric follow-up care with good psychometric properties. It may help to plan diagnostics and interventions for patients transitioning from in-patient to out-patient treatment.

Illness perceptions, fear of progression and health-related quality of life during acute treatment and follow-up care in paediatric cancer patients and their parents: a cross-sectional study

BACKGROUND

This study examines the role of illness perceptions and fear of progression (FoP) in paediatric cancer patients and their parents for patient's health-related quality of life (HRQoL), controlling for sociodemographic and medical variables. 4-18-year-old patients in acute treatment or follow-up care and one parent were examined.

METHODS

N = 46 patient-parent dyads in acute treatment and n = 84 dyads in follow-up care completed measures on illness perceptions (Illness-Perceptions-Questionnaire for 12-18-year-old patients and parents or as age-adapted puppet interview for 4-11-year-old patients) and FoP (Fear-of-Progression-Questionnaire for 7-18-year-old patients and parents). Patients also completed the KINDL-R to measure HRQoL. Hierarchical multiple regression analyses were calculated.

RESULTS

In acute treatment, patient's perceptions of symptoms and cyclicity of their illness explained variation in their HRQoL in addition to sociodemographic and medical variables. In follow-up care, patient's FoP and parent's perception of consequences explained additional variation in patient's HRQoL. Overall, sociodemographic and medical variables explained less variation in HRQoL in follow-up care than in acute treatment.

CONCLUSIONS

Our results stress the importance of psychological factors for the well-being of paediatric cancer patients, particularly in follow-up care, where sociodemographic and medical variables play a lesser role. We recommend screening for illness perceptions and FoP during and after acute treatment to support patients and parents. Furthermore, standardized interventions focussed on changing maladaptive illness perceptions should be developed and evaluated. As parents' perceptions, thoughts, and feelings may also play an important role for the well-being of the patients, interventions should be family-focussed and include parents. Trial registration The study has been pre-registered at the German Clinical Trials Register (registered 30/06/2020; DRKS00022034) and at the Open Science Framework ( https://osf.io/3uwrx ).

Dos and Don'ts in Designing School-Based Awareness Programs for Suicide Prevention

Abstract.Background: Despite the promising evidence for the effectiveness of school-based awareness programs in decreasing the rates of suicidal thoughts and suicide attempts in young people, no guidelines on the targets and methods of safe and effective awareness programs exist. Aims: This study intends to distill recommendations for school-based suicide awareness and prevention programs from experts. Method: A three-stage Delphi survey was administered to an expert panel between November 2018 and March 2019. A total of 214 items obtained from open-ended questions and the literature were rated in two rounds. Consensus and stability were used as assessment criteria. Results: The panel consisted of 19 participants in the first and 13 in the third stage. Recommended targets included the reduction of suicide attempts, the enhancement of help-seeking and peer support, as well as the promotion of mental health literacy and life skills. Program evaluation, facilitating access to healthcare, and long-term action plans across multiple levels were among the best strategies for the prevention of adverse effects. Limitations: The study is based on opinions of a rather small number of experts. Conclusion: The promotion of help-seeking and peer support as well as facilitating access to mental health-care utilities appear pivotal for the success of school-based awareness programs.

Effects of intravenous infusion of E. coli lipopolysaccharide in early pregnant cows

The objective was to characterize effects of Escherichia coli LPS (given i.v.) on corpus luteum (CL) and embryonic viability in early pregnant cattle. Eight non-lactating German Holstein cows were given 0.5 µg/kg LPS on 35 ± 3 day (mean ± s.e.m.) of pregnancy, whereas seven heifers, 41 ± 6 day pregnant, were given 10 mL saline (control group). Transrectal B-mode examinations of the CL were done at -1, 3, 6, 12, 24, 48, 72 and 96 h relative to treatment. Blood samples were collected at -1, 0.5, 1, 2, 3, 4, 6, 9, 12, 24, 48, 72 and 96 h. At 12 and 48 h, the CL was biopsied. None of the cows still in the experiment 10 day after LPS (n = 7) had embryonic loss. In LPS-treated cows, luteal area decreased (from 4.1 to 3.1 cm2; P ≤ 0.05) within 6 h and until 48 h. Luteal blood flow decreased by 39% (P ≤ 0.05) within the first 6 h after LPS, but returned to pre-treatment values by 48 h. Plasma P4 decreased by 62% (P ≤ 0.05), reached a nadir (2.7 ± 0.6 ng/mL) at 12 h after LPS and was not restored to pre-treatment (P ≤ 0.05). In luteal tissue, mRNAs for STAR and for FGF1 were lower (P ≤ 0.05) in LPS than in saline-treated cattle at 12 h, with no difference between groups at 48 h. Levels of mRNAs for CASP3 and FGF2 were not different between groups (P > 0.05) at 12 or 48 h after treatment. In conclusion, LPS transiently suppressed CL function, but did not induce embryonic mortality.

Pregnancy outcome is influenced by luteal area during diestrus before successful insemination but not by milk production level

The objective was to compare luteal area (LA), luteal blood flow (LBF), and progesterone (P4) concentration before and after artificial insemination (AI) in pregnant and open cows in the diestrus preceding insemination and during the first 21 d after insemination. A number of 119 multiparous German Holstein cows were examined using B-mode and color Doppler sonography in diestrus (15-5 d before AI) and on days 7, 14, and 21 post insemination (pi). Blood samples for determination of P4 concentration were collected at each examination. In pregnant cows, P4 was measured in the diestrus before AI and on days 7, 14, and 21 of pregnancy, and in open cows, in the diestrus preceding the first AI and 7, 14, and 21 d later. Cows were retrospectively allocated into two groups according to the mean daily milk yield in the first 42 d (high milk yield [HMY], ≥39 kg/d; low milk yield [LMY], <39 kg/d). Pregnant cows had larger LA than open cows during diestrus before insemination (5.69 ± 1.85 vs. 4.94 ± 1.66 cm², P < 0.05), on days 7 (5.34 ± 1.83 vs. 4.52 ± 1.93 cm², P < 0.05) and 21 pi (5.92 ± 1.60 vs. 4.97 ± 1.44 cm², P < 0.05). On day 14 there was a tendency towards larger LA in pregnant cows (P = 0.09). Luteal blood flow (1.72 ± 0.74 vs. 1.22 ± 0.67 cm²) and P4 concentration (8.97 ± 4.37 vs. 6.49 ± 4.32 ng/mL) were higher in pregnant cows than in open cows on day 21 (P < 0.05). At day 150, 69% of the LMY cows and 56% of the HMY cows were pregnant (P > 0.05). Pregnant HMY cows had larger LA during diestrus before insemination and on days 7 and 21 pi than open HMY cows (P < 0.05) and tended to result in larger CLs on day 14 (P = 0.06). Pregnant HMY cows had higher LBF on days 14 and 21 (P < 0.05) and higher P4 concentration on day 21 than open HMY cows (P < 0.05). The main finding of this study was a larger LA during diestrus in cows that conceived in the ensuing estrous cycle compared to cows that did not conceive. Luteal area, LBF, and P4 concentration were greater in pregnant cows compared to open cows, and further studies should be conducted on the usefulness of these variables to detect open cows as early as possible after breeding. High-yielding cows appear to require larger LA, LBF, and higher P4 concentration than low-yielding cows to maintain pregnancy. In conclusion, larger LAs were established in pregnant cows in the diestrus before successful insemination regardless of their milk yield. Further studies are needed to verify whether LA in the diestrus before insemination might be used to predict probabilities in reproductive performance.

LPS-mediated effects and spatio-temporal expression of TLR2 and TLR4 in the bovine corpus luteum

When given intravenously (iv), lipopolysaccharide (LPS) transiently suppresses the structure and function of the bovine corpus luteum (CL). This is associated with increased release of prostaglandin (PG) F2α metabolite. The underlying regulatory mechanisms of this process remain, however, obscure. Therefore, the aims of this study were: i) to investigate the expression of the LPS receptor toll-like receptor 4 (TLR4) and 2 (TLR2) in the bovine CL during early, mid- and late luteal phases; and ii) to further dissect the mechanisms of LPS-mediated suppression of luteal function. As revealed by semi-quantitative qPCR and immunohistochemistry, both receptors were detectable throughout the luteal lifespan. Their mRNA levels increased from the early toward the mid-luteal phase; no further changes were observed thereafter. The TLR4 protein seemed more highly represented than TLR2. The cellular localization of TLRs was in blood vessels; weaker signals were observed in luteal cells. Additionally, cows were treated either with LPS (iv, 0.5 μg/kg BW) or with saline on Day 10 after ovulation. Samples were collected 1200 h after treatment and on Day 10 of the respective subsequent (untreated) cycle. The mRNA expression of several possible regulatory factors was investigated, revealing the suppression of PGF2α receptor (PTGFR), STAR protein and 3β-hydroxysteroid dehydrogenase, compared with controls and subsequent cycles. The expression of TLR2 and TLR4, interleukin 1α (IL1A) and 1β (IL1B) and of PGF2α and PGE2 synthases (HSD20A and mPTGES respectively) was increased. The results demonstrate the presence of TLR2 and TLR4 in the bovine CL, and implicate their possible involvement in the deleterious effects of LPS on its function.

Knowledge, attitudes and barriers regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: a survey of family medicine and internal medicine physicians in the United States

BACKGROUND

Although vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for all patients with chronic hepatitis C virus (HCV) infection, physician vaccination practices are suboptimal. Since training for family medicine (FM) and internal medicine (IM) physicians differ, we hypothesised that there are differences in knowledge, attitudes and barriers regarding vaccination against HAV and HBV in patients with chronic HCV between these two groups.

METHODS

A two-page questionnaire was mailed to 3000 primary care (FM and IM) physicians randomly selected from the AMA Physician Masterfile in 2005. The survey included questions about physician demographics, knowledge and attitudes regarding vaccination.

RESULTS

Among the 3000 physicians surveyed, 1209 (42.2%) returned completed surveys. There were no differences between respondents and non-respondents with regard to age, gender, geographic location or specialty. More FM than IM physicians stated that HCV+ patients should not be vaccinated against HAV (23.7% vs. 11.8%, p < 0.001) or HBV (21.9% vs. 10.6%, p < 0.001). FM physicians were also less likely than IM physicians to usually/always test HCV+ patients for immunity against HAV (33.9% vs. 48.6%, p < 0.001) or against HBV (50.8% vs. 68.0%, p < 0.001). There were numerous barriers to HAV and HBV vaccination identified. The median number of barriers was 3 for FM physicians and 2 for IM physicians (p < 0.001).

CONCLUSIONS

Despite recommendations to vaccinate against HAV and HBV in patients with chronic HCV infection, physicians often do not test or vaccinate susceptible individuals. Interventions are needed to overcome the barriers identified and improve vaccination rates.

Escherichia coli lipopolysaccharide administration transiently suppresses luteal structure and function in diestrous cows

The objective was to characterize the effects of Escherichia coli lipopolysaccharide (LPS) endotoxin (given i.v.) on luteal structure and function. Seven nonlactating German Holstein cows, 5.1 ± 0.8 years old (mean ± s.e.m.), were given 10  ml saline on day 10 (ovulation=day 1) of a control estrous cycle. On day 10 of a subsequent cycle, they were given 0.5 μg/kg LPS. Luteal size decreased (from 5.2 to 3.8 cm², P≤0.05) within 24 h after LPS treatment and remained smaller throughout the remainder of the cycle. Luteal blood flow decreased by 34% (P≤0.05) within 3 h after LPS and remained lower for 72 h. Plasma progesterone (P₄) concentrations increased (P≤0.05) within the first 3 h after LPS but subsequently declined. Following LPS treatment, plasma prostaglandin (PG) F metabolites concentrations were approximately tenfold higher in LPS-treated compared with control cows (9.2 vs 0.8 ng/ml, P≤0.05) within 30 min, whereas plasma PGE concentrations were nearly double (P≤0.05) at 1 h after LPS. At 12 h after treatment, levels of mRNA encoding Caspase-3 in biopsies of the corpus luteum (CL) were increased (P≤0.05), whereas those encoding StAR were decreased (P≤0.05) in cattle given LPS vs saline. The CASP3 protein was localized in the cytoplasm and/or nuclei of luteal cells, whereas StAR was detected in the cytosol of luteal cells. In the estrous cycle following treatment with either saline or LPS, there were no significant differences between groups on luteal size, plasma P₄ concentrations, or gene expression. In conclusion, LPS treatment of diestrus cows transiently suppressed both the structure and function of the CL.

Multizystischer Granulosazelltumor bei einer Milchkuh

Gegenstand und Ziel: Diagnostik und therapeutisches Vorgehen bei einer Milchkuh mit einem Granulosazelltumor. Material und Methoden: Bei einer Kuh (Deutsche Holstein, schwarzbunt; 3 Jahre, 630 kg KM) wurde nach einer klinischen und sonographischen Untersuchung der inneren Geschlechtsorgane eine Laparotomie mit Ovarektomie über die rechte Flanke durchgeführt. Ergebnisse: Aufgrund der klinischen Befunde ergab sich die Verdachtsdiagnose eines Ovartumors. Mithilfe der histologischen Untersuchung des entnommenen Gewebes konnte der Verdacht bestätigt und ein multizystischer Granulosazelltumor diagnostiziert werden. Das Tier überstand den operativen Eingriff komplikationslos. Nach der Tumorentfernung zeigte die Kuh eine regelrechte Zyklusaktivität. Da zwei Besamungen erfolglos blieben und eine Mastitis auftrat, wurde das Tier geschlachtet. Schlussfolgerung und klinische Relevanz: Klinische und sonographische Befunde liefern zwar wichtige Hinweise auf pathologische Veränderungen am Ovar, doch ist zur Bestätigung der Verdachtsdiagnose eine Ovarektomie mit anschließender histologischer Untersuchung zwingend erforderlich. Eine weitere züchterische und/oder wirtschaftliche Nutzung des Tieres nach Entfernung eines Eierstocks ist grundsätzlich möglich.

Effects of Abdominal Surgery on Thiobarbituric acid Reactive Substances and Plasma Anti-oxidative Capacity in Dairy Cows

The present investigation was undertaken to study the effects of surgical stress on thiobarbituric acid reactive substances (TBARS) and ferric reducing ability of plasma (FRAP) in dairy cows. Ten Holstein-Friesian dairy cows, mean age 5.26 years, admitted for treatment of left abomasal displacement (omentopexy), were used in our study. Blood samples were collected from the jugular vein prior to surgery, immediately and then 15, 30, 60, 90 min, and 2, 5, 10, and 24 h after reposition of abomasum. Surgical stress resulted in a significant increase in plasma cortisol concentrations (P < 0.001) with the highest mean levels 15 min after surgery (32.4 +/- 18.1 microg/l) as well as in serum levels of glucose (P < 0.001) and non-esterified fatty acids (P < 0.001). Similarly, surgery transiently enhanced the plasma levels of TBARS (P < 0.001). The highest TBARS plasma levels (0.91 +/- 0.18 micromol/l) were recognized 60 min after reposition of abomasums. There were no significant differences in FRAP in dairy cows before and after reposition of abomasum. In conclusion, these data indicate that stress reaction caused by surgical correction of left displacement of abomasum can be associated with higher production of TBARS.

Application of Doppler Ultrasonography in Cattle Reproduction

The development of Doppler processing extended the scope of sonographic imaging from an anatomical to a physiological basis. This technique became established as a clinical tool in human gynaecology. For example, it has been discussed that the implantation of an embryo is influenced by the uterine blood flow. In cows, this uterine blood flow was investigated, using surgically implanted Doppler ultrasonic or electromagnetic blood flow probes prior to the introduction of colour Doppler sonography in bovine medicine. Therefore, the aims of our studies were to use transrectal Doppler sonography for the non-invasive measurement of uterine and ovarian blood flow in cows and to determine changes in genital perfusion during the oestrous cycle, pregnancy and puerperium, respectively. The results of our studies show that transrectal flow imaging can be used to obtain blood flow velocity waveforms from the uterine arteries at any time during the oestrous cycle, pregnancy and puerperium. During all these phases, characteristic changes in the uterine blood flow could be observed. This uterine blood flow was low during diestrus and high during proestrus and oestrus. During pregnancy, an exponential rise in uterine blood supply could be detected. There was a positive relationship between the uterine blood flow volume (BFV) at the end of gestation and the birth weight of calves. During puerperium, the uterine BFV declined tremendously, especially during the first week after birth. In cows, with pathological disturbances of the pueperium a delayed decrease in the uterine BFV was observed. Characteristic alterations occurred also in the luteal blood flow during the oestrous cycle, which were highly related to those of the progesterone levels. Furthermore, it has been detected by the colour Doppler technique that there is no decrease, but an increase of the luteal blood flow at the beginning of luteolysis in cows. Another group has found that there are close relationships between the LH-surge and the follicular blood flow before ovulation. In conclusion, these studies show that transrectal colour Doppler sonography is a useful technique for the investigation of the genital blood flow and provides new information about physiological changes of the genital organs during, all reproductive phases. The influence of the genital blood flow on fertility in cows needs to be examined further in future studies.

Eitrig-nekrotisierende Zystitis mit konsekutiver Hydronephrose beim Rind – Diagnostik und Therapie anhand von zwei Fallbeispielen

Gegenstand und Ziel: Diagnostik und Therapie einer Harnblasenentzündung mit konsekutiver Hydronephrose werden anhand von zwei Fallbeispielen aus dem Patientengut der Klinik für Rinder der Stiftung Tierärztliche Hochschule Hannover dargestellt. Material und Methoden: Bei zwei erkrankten Rindern (Angus- Erstkalbin, 380 kg KM; Alter: 19 Monate; Deutsche Holstein Färse, 450 kg KM; Alter: 12 Monate) erfolgte neben einer klinischen, labordiagnostischen, sonographischen und endoskopischen Untersuchung des Harnapparates eine bakteriologische Untersuchung des Harns. Ergebnisse: Durch die Kombination der Untersuchungsmethoden konnte bei beiden Tieren die Diagnose einer eitrig-nekrotisierenden Zystitis mit konsekutiver Hydronephrose gestellt werden. Das erste Tier wurde aufgrund der aussichtslosen Prognose euthanasiert. Das zweite Tier wurde nach erfolgreicher Behandlung (Antibiose, Antiphlogese, orale Flüssigkeitszufuhr) nach Hause entlassen. Schlussfolgerung und klinische Relevanz: Bei Erkrankungen des Harnapparats liefert die Sonographie als nicht invasives Diagnostikum zusätzlich zur klinischen Untersuchung Befunde, die Aussagen über Ausdehnung und Grad der Veränderungen ermöglichen. Sie erlaubt so eine frühzeitige Erkennung und Behandlung. Mithilfe der Zystoskopie können die lokalen Veränderungen direkt visualisiert und die Schleimhautoberfläche sowie Blaseninhalt beurteilt werden. Die Therapie der eitirg-nekrotisierenden Zystitis basiert neben Antiphlogese und Anregung der Diurese auf einer dem Resistogramm entsprechenden Antibiose.

The glycosylation of pregnancy-associated glycoproteins and prolactin-related protein-I in bovine binucleate trophoblast giant cells changes before parturition

Binucleate trophoblast giant cells (BNC) in the bovine placenta produce glycoproteins, which are delivered into the mother after fusion of BNC with uterine epithelial cells. During most time of pregnancy, BNC produce pregnancy-associated glycoproteins (PAGs) and prolactin-related protein-I (PRP-I) with asparagine-linked lactosamine-type glycans terminating withN-acetyl-galactosamine. We show by lectin histochemistry that terminalN-acetyl-galactosamine (detected byDolichos biflorusagglutinin, DBA) in placentomal BNC is greatly reduced prior to parturition, while lactosamine-typeN-glycans (detected byPhaseolus vulgarisleucoagglutinin, PHA-L) remain unaltered. The change in DBA-staining showed no statistically significant differences between placentomes of cows with and without retention of fetal membranes. Western blots revealed that, at parturition the apparent molecular mass of PAGs and PRP-I is 1–2 kDa lower than in late pregnancy. These changes are due to alterations of asparagine-linked glycans, since the molecular weight of the peptide backbones after enzymatical release of asparagine-linked glycans is identical at late pregnancy and parturition. Lectin western blots showed a reduction of terminalN-acetyl-galactosamine on PAGs at parturition. A lectin sandwich-ELISAwas used to differentiate DBA- and PHA-L-binding PAGs in sera of pregnant and non-pregnant cows. The values for DBA-binding PAGs at parturition were not significantly different from non-pregnancy, while the values for PHA-L-binding PAGs were significantly higher at parturition. The peripartal changes of PAG- and PRP-I-glycosylation could alter functional properties of these proteins and might therefore be considered for functional studies. The differentiation of PAG glycoforms in maternal serum could be valuable for a further optimization of PAG-based pregnancy diagnosis in cattle.

Reduction of behavioural disturbances in elderly dogs supplemented with a standardised Ginkgo leaf extract

In this open clinical trial conducted in 10 veterinary practices, Ginkgo leaf extract was administered as a dietary supplement to 42 elderly dogs (mean age 11.4 years) at a daily dose of 40 mg/ 10 kg body weight for 8 weeks. The "severity of the geriatric condition" in dogs with a history of geriatric behavioural disturbances (mean duration 12 months), was significantly reduced after 8 weeks of treatment (P = 0.0002). The positive effect was already apparent after 4 weeks. Thirty-six % of the dogs were completely free of clinical signs at study end. Overall efficacy of treatment as judged by the investigator was good or very good in 79% of the dogs. Five of six clinical sign scores (disorientation, sleep/activity changes, behavioural changes, general behaviour and general physical condition/vitality) also showed a significant decrease over the treatment period. In conclusion, these findings provide promising results that could increase the quality of life in the elderly dog and, as a consequence, that of the pet owner. The Ginkgo leaf extract appears to be an efficacious agent that provides a safe dietary supplement for the elderly dog with age-related behavioural disturbances.

Post surgical development of inflammatory adhesions and reticular function in cows suffering from traumatic reticuloperitonitis

Inflammatory adhesions between reticulum and ventral abdomen in patients suffering traumatic reticuloperitonitis (TRP) may induce a massive inhibition of reticular contractions and thereby an impairment of the separation process of particles in the reticulorumen. However, a substantial disturbance of digesta passage (Hoflund-syndrome) is found only in a few TRP-cows. We hypothesized that this is due to a retrieval of reticular motility due to rebuilding and degradation of adhesions within months after the removal of the foreign body as the primary inflammatory stimulus. Accordingly, it was the objective of this study (a) to assess the extent and structure of inflammatory adhesions in cows with TRP over a period of six months following surgery and (b) to persecute reticular function by characterizing the sequence of reticular contractions sonographically and by assessment of particle size distribution in the faeces of patients by means of wet-sieving. Twenty-six cows suffering from TRP were studied on the day of rumenotomy (day 1) and on day 6, day 12 and 6 months post operationem. Additionally, six healthy control cows were investigated once. All cows were on a hay and concentrate diet. On day 1, the reticular floor and the reticular wall were affected by adhesions in varying extent in all cows; the contraction distance and contraction velocity of the reticulum were markedly reduced and the portion of large particles in the faces increased compared to healthy cows. On day 12, the portion of large particles did not vary any more from that of control cows; a tendency towards an increased contraction distance compared to day 1 was found. Sonographically, only marginal differences were detected in respect to extent and consistency of adhesions. Six months after rumenotomy, in 9 of 16 re-investigated cows sonography revealed no adhesions at the reticulum at all, in other cases the extent of adhesions shrunk considerably. Contraction distance and contraction velocity and particle size distribution in the faeces were found to be nearly comparable to that of control cows. It is concluded that inflammatory adhesions disappear in the majority of the TRP-patients, as a consequence reticular function normalizes. A serious disturbance of digesta passage seems to develop exclusively in those patients with the most extensive adhesions and may be also in such cows, where the primary adhesions cause the development of extensive abscesses.

Antibodies against recombinant heat shock protein 65 of Tropheryma whipplei in patients with and without Whipple's disease

Tropheryma whipplei is the causative agent of Whipple's disease (WD), a chronic, life-threatening infection. Laboratory diagnosis is mainly based on PCR and histopathological analysis in duodenal biopsies and other specimens requiring invasive procedures. We have examined the presence of antibodies to recombinant heat shock protein (Hsp65) of T. whipplei in patients with Whipple's disease as well as in control subjects by Western blot and enzyme-linked immunosorbent assay (ELISA). A recombinant plasmid carrying the entire T. whipplei hsp65 gene was constructed, and the expression yielded a 65-kDa histidine-tagged protein. Among four patients with Whipple's disease, two showed an IgG- and one an IgA-response, respectively, when analyzed by Western blotting, whereas from 10 patients without Whipple's disease, only two patients showed a positive IgG-response. The differences between the sera from patients and controls were thus not significant. Successful purification of the protein was achieved by Ni-NTA affinity chromatography. Quantitative analysis of serum antibodies by ELISA demonstrated that antibody levels in the sera of 14 patients were not significantly higher than in those of 89 control subjects. The established ELISA test is not useful to clinical diagnostics.

Internet-assisted exercises in structural analysis

In this report we describe our experience in the analytical chemistry curriculum of teaching spectrometer principles and preparing spectroscopy laboratory exercises by means of virtual instruments. The benefits of the intensified preparation of laboratory exercises by virtual instruments will be evaluated with respect to the subsequent handling of real instruments. The utilization of in-house electronic media with Internet resources for elucidation and verification of a structural assignment will also be considered.

[Manifestation of a highly malignant B-cell lymphoma simulating osteomyelitis of the mandible]

A case of precursor B-cell lymphoma of unusual location in the mandible is presented. Clinical features as well as technical examinations led to the misdiagnosis of chronic osteomyelitis. Only immunohistological examination of intraoperatively taken biopsies was able to reveal the true diagnosis. High-dose chemotherapy was started and full remission could be achieved.

Experience with the osteocutaneous fibula flap: an analysis of 24 consecutive reconstructions of composite mandibular defects

Based on findings from anatomical dissections of the skin of the peroneal artery, we used the osteocutaneous fibula flap for combined replacement of the mandible and floor of the mouth in 24 patients, form November 1993 to December 1995. There were 22 primary and 2 secondary reconstructions; the mean age of the patients (2 women and 22 men) was 64 years. The length of the fibula segments ranged between 5.5 and 18 cm, the size of the skin component between 3 x 5 and 6 x 15 cm. Corresponding to the results of our anatomical studies, the skin island was exclusively raised form the distal third of the lower leg, and the donor sites were generally covered with split thickness skin grafts. The average length of the dissected vascular pedicle was 11 cm, so that a vein graft was only required in one case. Flap raising and tumour resection were always carried out simultaneously. Fibula osteosynthesis was done with titanium miniplates; the insertion of endosseous implants followed secondarily. The success rate was 95.8% with one transplant loss and pseudarthrosis in one case. Despite the limited width of the fibula, the shape of the mandible was satisfactorily reconstructed in all patients, and the thin, pliable component enabled intraoral coverage with only negligible surplus volume. Chronic wound-healing disturbances at the donor site of the skin island occurred in two cases; impairment of walking ability was not detected. According to our experience, the use of the osteocutaneous fibula flap is a valuable method for the reconstruction of composite mandibular defects.

Gallbladder adenocarcinoma and acalculous chronic lymphoplasmacytic cholecystitis associated with ulcerative colitis [corrected]

Patients with ulcerative colitis, particularly long-standing ulcerative pancolitis, have an increased risk of developing carcinoma of the hepatobiliary tract. However, only 14 cases of carcinomas localized to the gallbladder have been associated with ulcerative colitis. Of 57 cases of gallbladder carcinomas seen at this institution, we found 3 cases in patients with ulcerative colitis, all of whom had undergone total proctocolectomy. All three patients had pancolitis, two with high-grade dysplasia, and one with low-grade dysplasia. All three gallbladders harbored an invasive adenocarcinoma. The nonneoplastic gallbladder mucosa showed a background of acalculous chronic lymphoplasmacytic cholecystitis in two cases. One of these patients also had a liver biopsy which showed changes of primary sclerosing cholangitis. Because cholecystectomy adds little to the operative morbidity and mortality of total proctocolectomy, it might be advisable to perform both operations when the latter is indicated for high-grade dysplasia in ulcerative colitis.

Detection of multiple boron sites in glasses by 11B satellite transition nuclear magnetic resonance spectroscopy

The magic-angle spinning sidebands of the satellite transition (ST, m = +/- 3/2 <==> +/- 1/2) for 11B nuclear magnetic resonance (11B ST spectroscopy) have been used to detect multiple boron sites in Na2O-B2O3-SiO2 glasses. The experimental details and data analysis are described, how multiple BO4 and BO3 units can be distinguished using standard magic-angle spinning. For a 16Na2O-30B2O3-53.9SiO2 glass (0.1 MnO) two BO4 units with chemical shifts of -2.5 and 0 ppm were found which differ considerably in their quadrupole interaction. Besides this we found three different BO3 units with approximate chemical shifts of 17, 15, and 19 ppm. The results are compared with earlier measurements.

Structure of hydrated layers on silicate electrode glasses

The structural changes of the silicate framework in hydrated layers of silicate electrode glasses compared with untreated glasses as well as the quality and quantity of water and its ionic species stored in the layer have been investigated by high-resolution solid-state nuclear magnetic resonance (NMR) techniques [29Si magic-angle spinning (MAS), 29Si cross-polarization (CP) MAS, 1H high-speed MAS, 1H CRAMPS and 1H Echo NMR]. To support the results, infrared (IR) spectroscopy, thermal analysis and sodium ion concentration analyses were used. It was found that at least two different water species exist in the hydrated layer: SiOH groups and not very mobile hydrogen-bonded molecular water. Concerning the framework modified, Q3 groups [(SiO)3SiOH] were formed in the hydrated glass. During the swelling process a condensation of silanol groups formed took place to a great extent.

CT and MR evaluation of intracranial involvement in pediatric HIV infection: a clinical-imaging correlation

PURPOSE

To review the cranial CT and MR examinations of 29 children with perinatally transmitted HIV infection and correlate the imaging findings with clinical and pathologic data.

METHODS

28 children were examined with CT, four with MR.

RESULTS

CT abnormalities were seen in 25 children studied (89%), including cerebral atrophy (25 children), basal ganglia calcification (10 children), periventricular frontal white matter calcification (four children), cerebellar calcification (one child), white matter low attenuation areas (two children), intracranial hemorrhage (three children) and cerebral infarction (one child). Intracranial calcifications were only seen in association with cerebral atrophy and were never seen prior to 1 year of age. Calcifications in the periventricular white matter or cerebellum were always associated with basal ganglia calcifications. MR abnormalities were seen in all four children studied; cerebral atrophy (four children), areas of high signal intensity in white matter (four children), loss of normal posterior pituitary high signal intensity (one child). Cerebral atrophy appeared to be a nonspecific finding that was seen in some children in the absence of neurologic signs and symptoms. All children with intracranial calcifications had developmental delay. Intracranial hemorrhage was seen in children with severe thrombocytopenia. Focal intracranial infections were unusual and neoplastic lesions were not found.

CONCLUSIONS

Cerebral atrophy, basal ganglia calcifications, and focal white matter lesions were the most common abnormalities seen neuroradiologically in our series of HIV-infected children; cerebral atrophy was a nonspecific finding.

[Diagnostic value of aspartate aminotransferase in the cerebrospinal fluid]

As datum, the range of aspartate aminotransferase in the cerebrospinal fluid of adults was determined on the basis of 153 fluid samples and compared with the values obtained from 356 neurological patients. A significant increase in enzyme activity was established in respect of CVI, polyneuropathy, acute encephalitis, and SAB. It was possible to eliminate any dependence of the aspartate aminotransferase activity on serum activity, total protein, and cell count. The increase in activity of aspartate aminotransferase in the cerebrospinal fluid is thus identified as an independent pathological fact, and thus it can be incorporated in diagnostic routine more particularly in the diagnosis of CVI disorders.

Mature placenta simulating fetus papyraceus on ultrasonic examination

A case of a heavily calcified, mature placenta simulating the appearance of a fetus papyraceus is presented. Calcification surrounding the more sonolucent cotyledons simulated the body and limbs of a dead fetus. Awareness of the morphologic alterations which occur as the placenta matures should prevent confusion of normal placental changes with a pathologic entity.