[Clinical and sonographic examination findings in patients with carotid-cavernous sinus fistulas]

BACKGROUND

Symptoms and clinical findings in patients with carotid-cavernous fistulas are specific. Nevertheless, they can be very mildly expressed. This study aims to point out the potential diagnostic value of ultrasound of the orbit.

METHODS

A total of 25 patients with a reliable angiographic diagnosis of a fistula were reviewed retrospectively. We analyzed the symptoms, clinical findings and demonstrability in ultrasound of the orbit.

RESULTS

The most common clinical findings were nerve palsy, dilation of episcleral vessels and exophthalmos. If an ultrasound had been part of the examination a dilation of the superior ophthalmic vein could be demonstrated in all cases.

CONCLUSION

The expeditious ultrasound investigation provides valuable information for the diagnosis of red eyes which are resistant to treatment. The examiner has to consider a fistula and perform an ultrasound especially when diplopia has newly occurred. Finally, the expedient neuroimaging can be arranged.

A Non-linear Relationship Between Selective Attention and Associated ERP Markers Across the Lifespan

The ability to selectively attend to task-relevant information increases throughout childhood and decreases in older age. Here, we intended to investigate these opposing developmental trajectories, to assess whether gains and losses early and late in life are associated with similar or different electrophysiological changes, and to get a better understanding about the development in middle-adulthood. We (re-)analyzed behavioral and electrophysiological data of 211 participants, who performed a colored Flanker task while their Electroencephalography (EEG) was recorded. Participants were subdivided into six groups depending on their age, ranging from 8 to 83 years. We analyzed response speed and accuracy as well as the event replated potential (ERP) components P1 and N1, associated with visual processing and attention, N2 as marker of interference suppression and cognitive control, and P3 as a marker of cognitive updating and stimulus categorization. Response speed and accuracy were low early and later in life, with peak performance in young adults. Similarly, ERP latencies of all components and P1 and N1 amplitudes followed a u-shape pattern with shortest latencies and smallest amplitudes occurring in middle-age. N2 amplitudes were larger in children, and for incongruent stimuli in adults middle-aged and older. P3 amplitudes showed a parietal-to-frontal shift with age. Further, group-wise regression analyses suggested that children’s performance depended on cognitive processing speed, while older adults’ performance depended on cognitive resources. Together these results imply that different mechanisms restrict performance early and late in life and suggest a non-linear relationship between electrophysiological markers and performance in the Flanker task across the lifespan.

Acute Exercise as an Intervention to Trigger Motor Performance and EEG Beta Activity in Older Adults

Acute bouts of exercise have been shown to improve fine motor control performance and to facilitate motor memory consolidation processes in young adults. Exercise effects might be reflected in EEG task-related power (TRPow) decreases in the beta band (13-30 Hz) as an indicator of active motor processing. This study aimed to investigate those effects in healthy older adults. Thirty-eight participants (65-74 years of age) were assigned to an experimental (EG, acute exercise) or a control group (CG, rest). Fine motor control was assessed using a precision grip force modulation (FM) task. FM performance and EEG were measured at (1) baseline (immediately before acute exercise/rest), (2) during practice sessions immediately after, (3) 30 minutes, and (4) 24 hours (FM only) after exercise/rest. A marginal significant effect indicated that EG revealed more improvement in fine motor performance immediately after exercise than CG after resting. EG showed enhanced consolidation of short-term and long-term motor memory, whereas CG revealed only a tendency for short-term motor memory consolidation. Stronger TRPow decreases were revealed immediately after exercise in the contralateral frontal brain area as compared to the control condition. This finding indicates that acute exercise might enhance cortical activation and thus, improves fine motor control by enabling healthy older adults to better utilize existing frontal brain capacities during fine motor control tasks after exercise. Furthermore, acute exercise can act as a possible intervention to enhance motor memory consolidation in older adults.

Does physical activity benefit motor performance and learning of upper extremity tasks in older adults? - A systematic review

Upper extremity motor performance declines with increasing age. However, older adults need to maintain, learn new and relearn known motor tasks. Research with young adults indicated that regular and acute physical activity might facilitate motor performance and motor learning processes. Therefore, this review aimed to examine the association between chronic physical activity and acute bouts of exercise on motor performance and motor learning in upper extremity motor tasks in older adults. Literature was searched via Cochrane library, PubMED, PsycINFO and Scopus and 27 studies met all inclusion criteria. All studies dealt with the influence of chronic physical activity on motor performance or motor learning, no appropriate study examining the influence of an acute bout of exercise in older adults was found. Results concerning the association of chronic physical activity and motor performance are mixed and seem to be influenced by the study design, kind of exercise, motor task, and exercise intensity. Regarding motor learning, a high physical activity or cardiovascular fitness level seems to boost the initial phase of motor learning; results differ with respect to motor retention. Overall, (motor-coordinative) intervention studies seem to be more promising than cross-sectional studies.

[Self-Medication, Health and Online Orders: An Online Survey]

Background: The intensive use of Internet as health guide is proved by a current representative survey. Online orders of OTC pharmaceuticals and prescription medicine represent a special way of utillisation. Intention: The aim of the following study is to investigate motives and backgrounds of self-medication in coherency of health and ordering of OTC pharmaceuticals via Internet. Method: With an online questionnaire developed in particular for this thesis N=104 internet users (mean age M=32,7; SD=11,1 consisting of 73 female and 31 male participants) were questioned concerning the relevant topics. Furthermore, the subjects were interviewed with regard to identification of their quality of life (with the German version of the EUROHIS-QOL 8 item index), their well-being (by using the German version of the WHO-5 well-being index, version II). Results: The wish for (especially temporal) independence from a physicians treatment and the idea of a faster convalescence or prevention of worse ailment could be identified as motives for self-medication. The most frequently selected advantages of ordering drugs via internet were the lower price, organisational aspects such as direct home delivery or saving time without a consultation. In contrast, the lack of advice was often mentioned as a possible disadvantage, just like the risk of undetected and undiagnosed diseases. Compared to participants who did not do any Internet orders, participants who ordered their non-prescription drugs on the Internet were less aware of possible risks and they also used painkillers available without prescription more frequently. However, there were no differences in the total amount of applied OTC medications, which made a drug abuse less likely. Overall, self-medication of the users of Internet forums interviewed within this thesis seemed to be quantitatively and qualitatively appropriate. Conclusion: Self-medication by Internet users in this study seems to be reasonable in a quantitative and qualitative way.

Altered NK cell function in obese healthy humans

Background

Obesity is associated with an elevated risk for several types of cancer and thus a major health hazard. However, the mechanism between overweight and cancer susceptibility is still elusive. Leptin, mainly produced by adipocytes links food intake and energy expenditure. In addition, recent studies have shown an immunomodulatory impact of leptin on NK cells. The purpose of the present study was to investigate whether leptin stimulation of NK cells from obese humans leads to altered functions as compared to NK cells from lean subjects. On the basis of body mass index 20 healthy individuals were classified in two groups: normal weight (<25 kg/m²) and obese (>30 kg/m²). Peripheral blood mononuclear cells (PBMC) were isolated from blood samples. We used flow cytometry to assess differences in phenotype and activity markers (CD107a, CD178 and TRAIL) of PBMCs between both groups. Furthermore, we determined after short-term in vitro leptin stimulation the phosphorylation of JAK2, downstream target of the intracellular signaling cascade of the leptin receptor, by Western Blotting and numbers of NK-cell-tumor-cell-conjugates as well as Granzyme⁺ and IFN-γ⁺ NK cells by flow cytometry. Finally, the proliferative capacity of control and long-term (7 days) leptin-stimulated NK cells was examined.

Results

As opposed to similar NK cell counts, the number of CD3⁺CD56⁺ cells was significantly lower in obese compared to lean subjects. Human NK cells express the leptin receptor (Ob-R). For further determination of Ob-R, intracellular target proteins of PBMCs were investigated by Western Blotting. Phosphorylation of JAK2 was lower in obese as compared to normal weight subjects. Furthermore, significantly lower levels of TNF-related apoptosis-inducing ligand (TRAIL) as an NK cell functional marker in obese subjects were found. In vitro leptin stimulation resulted in a higher production of interferon-γ in NK cells of normal weight subjects. Interestingly, long-term leptin stimulation had no significant influence on numbers of proliferating NK cells.

Conclusions

NK cells from obese healthy humans show functional deficits and altered responses after in vitro leptin challenge.

Vergleich zwischen der Svedberg-, der Maximalgradienten- und der Drei-Punkte-Methode zur Auswertung der mit Philpot-Svensson-Optik gewonnenen Kurven der Ultrazentrifuge

Rinderplasma-Albumin wurde bei seinem isoelektrischen Punkt gelöst und in einer Unterschichtungszelle ultrazentrifugiert. Die mit Philpot-Svensson- Optik und Phasenplatte gewonnenen Sedimentationskurven wurden nach der SvEdbERG-Methode 1 (Sv.M.), nach der Maximalgradienten-Methode 2 (Mg.M.) und nach der Drei-Punkte-Methode 2 (D.P.M.) ausgewertet.

Die klassische Svedberg - Methode liefert die Sedimentationskonstante s; mit den beiden neuen Methoden kann man auf einfache Weise unmittelbar den Quotienten s/D sowie gleichzeitig und aus denselben Meßgrößen die Sedimentationskonstante s und die Diffusionskonstante D erhalten. (Die Bestimmung des zweiten Momentes der Sedimentationskurve, wie bei der ARCAIBALD-Methode 3 ist dabei nicht erforderlich.)

Nach Sv.M. und Mg.M. ergab sich der gleiche Wert für die Sedimentationskonstante. Nach der D.P.M. wurde eine um etwa 11% größere Sedimentationskonstante erhalten. Diese Abweichung beruht vermutlich auf einem bei der D.P.M. leicht unterlaufenden systematischen Meßfehler.

Der mittlere Fehler der nach Svedberg bestimmten Sedimentationskonstante betrug ± 2,7%. Etwa sechsmal größer war der mittlere Fehler von s und s/D bei der Mg.M., nämlich ± 17%, trotz annähernd gleicher Meßgenauigkeit bei Sv.M. und Mg.M.

Es scheint, daß die neuen Methoden schärfere und eindeutigere Sedimentations-Kurven erfordern als sie mit dem Philpot-Svensson- System bisher im allgemeinen erhalten werden können.

Eine Aussnahme macht dabei die nach der Mg.M. bestimmte Diffusionskonstante D, deren mittlerer Fehler hier 1,2% betrug.

Short-term and long-term leptin exposure differentially affect human natural killer cell immune functions

Epidemiological studies have indicated that obesity is associated with a higher risk for certain cancers caused by elevated levels of adipocyte-derived hormones. Leptin, one such hormone produced by adipocytes, is a major regulator of metabolism and has also been shown to modulate immunity. However, its role in regulating human natural killer (NK) cell functions is largely unknown. Here, we show that the leptin receptor (Ob-R) is expressed on 5% of NK cells isolated from blood donors, as measured with flow cytometry, and expression of the signal-transducing long form of the leptin receptor Ob-Rb was confirmed with quantitative PCR. The Ob-R+ subpopulation displayed a lower expression of CD16, a cell surface receptor mediating antibody-dependent activation. Short-term stimulation with leptin increased IFNγ secretion, CD69 activation marker expression, and cytotoxic lysis of tumor cells; this was mediated by an improved conjugate forming between NK cells and tumor cells as well as higher expression of tumor necrosis factor-related apoptosis-inducing ligand. On the contrary, long-term incubation with leptin significantly impaired these NK cell immune functions and decreased cell proliferation. In addition, phosphorylation of Jak-2 after leptin stimulation was reduced in peripheral mononuclear blood cells from obese humans compared with normal-weight controls. NK cells represent an immune cell population that is crucial for an effective antitumor response. Here, we show that long-term exposure to leptin, similarly to the situation in obese individuals with elevated serum leptin levels, significantly impairs integral parts of NK cell immune functions, possibly linking leptin to increased cancer susceptibility in obesity.

Species-specific assessment of Mycobacterium leprae in skin biopsies by in situ hybridization and polymerase chain reaction

Conventional histopathologic diagnosis of mycobacterial infections are limited to the determination of "acid-fast bacilli". A species-specific diagnosis is thus far impossible. In addition, routine microbiologic assessments of mycobacteria suffer from the major drawback that a species-specific diagnosis is extremely time-consuming and in several cases even impossible. As Mycobacterium leprae cannot be cultured in vitro, we tried to specifically target this obligate intracellular parasite by in situ hybridization and polymerase chain reaction (PCR) techniques. For this purpose we used a 22 mer oligonucleotide probe recognizing a species-specific sequence of the 16S rRNA of Mycobacterium leprae. Using an immunoenzymatic detection method for in situ hybridization we were able to specifically assess Mycobacterium leprae (a) in long-term cultured macrophages in vitro infected with different mycobacteria species and (b) in frozen sections of skin biopsies obtained from patients suffering from lepromatous leprosy. These results could be confirmed and extended by PCR experiments in which we used conserved oligonucleotide primers for 16S rRNA to amplify bacterial DNA isolated from different eubacterial species and from fresh-frozen as well as from formalin-fixed, paraffin-embedded and routinely processed mycobacteria-infected tissues. Upon Southern blot analysis, the Mycobacterium leprae-specific oligonucleotide probe exclusively hybridized with PCR products obtained from Mycobacterium leprae-containing samples (including paraffin sections), but not with PCR products obtained from samples containing other mycobacterial species. As species-specific oligonucleotide probes targeted at rRNA are described for a variety of mycobacterial species, these methods may be generally applied for a rapid species-specific assessment of mycobacteria in histologic material.

Enhancement of monocyte antimycobacterial activity by diethyldithiocarbamate (DTC)

Diethyldithiocarbamate (DTC) has been recently reported to significantly reduce the incidence of opportunistic infections in HIV-infected patients. The present study addresses the question whether DTC is capable of stimulating antimycobacterial activity of mononuclear phagocytes. We found that peripheral blood mononuclear cells (PBMC) of healthy subjects preincubated in vitro with 100-1000 ng/ml of DTC and thereafter infected with Mycobacterium tuberculosis H37Rv or Mycobacterium avium-intracellulare complex exhibited an enhanced antimycobacterial activity compared with control-incubated cells as assessed by the determination of mycobacterial colony-forming units. In subsequent experiments monocytes from healthy volunteers injected with 5 mg/kg body weight of DTC were tested ex vivo for antimycobacterial activity at various periods of time after injection. Injection of DTC resulted in a significant enhancement of antimycobacterial activity which was most evident 24 h after DTC injection. We conclude that DTC stimulates the antimicrobial function of mononuclear phagocytes both in vitro and in vivo. These results may explain the favourable clinical course observed in HIV-infected patients treated with DTC and may serve as a basis for treatment with DTC in patients with drug-resistant atypical mycobacteriosis.

Chemical characterization of macrophage cytotoxicity factor, macrophage migration inhibitory factor, T-helper cell-replacing factor and colony-stimulating factor from culture supernatants of concanavalin A-stimulated murine spleen cells

Supernatants from Concanavalin A-stimulated murine spleen cells were subjected to hydrophobic interaction chromatography on phenyl-Sepharose. Macrophage cytotoxicity factor (MCF), macrophage migration inhibitory factor (MIF), T-helper cell-replacing factor (TRF) and colony-stimulating factor (CSF) were bound at high ionic strength and were released stepwise at low ionic strength. CSF thus could be separated from MCF, MIF and TRF and the bulk of other proteins. Chromatograhy of pools containing MCF, MIF and TRF on Sephadex did not lead to a separation of the three activities which were all found in a molecular weight range of 25.000-55.000. Isoelectric focusing of these pools in pH range from 4 to 9 gave two peaks for MCF in a single sharp peak at pH 5.3. The results demonstrate that the four biological activities can be distinguished on a chemical basis and are accessible for purification and chemical characterization.