ComplexEye: a multi-lens array microscope for high-throughput embedded immune cell migration analysis

Autonomous migration is essential for the function of immune cells such as neutrophils and plays an important role in numerous diseases. The ability to routinely measure or target it would offer a wealth of clinical applications. Video microscopy of live cells is ideal for migration analysis, but cannot be performed at sufficiently high-throughput (HT). Here we introduce ComplexEye, an array microscope with 16 independent aberration-corrected glass lenses spaced at the pitch of a 96-well plate to produce high-resolution movies of migrating cells. With the system, we enable HT migration analysis of immune cells in 96- and 384-well plates with very energy-efficient performance. We demonstrate that the system can measure multiple clinical samples simultaneously. Furthermore, we screen 1000 compounds and identify 17 modifiers of migration in human neutrophils in just 4 days, a task that requires 60-times longer with a conventional video microscope. ComplexEye thus opens the field of phenotypic HT migration screens and enables routine migration analysis for the clinical setting.

Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care

OBJECTIVE

The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis.

METHODS

We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded.

RESULTS

We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers.

CONCLUSION

In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

BACKGROUND

Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.

METHODS

We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.

RESULTS

We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).

CONCLUSION

While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

Magnetic anisotropy of endohedral lanthanide ions: paramagnetic NMR study of MSc2N@C80-Ih with M running through the whole 4f row

Paramagnetic and variable temperature 13C and 45Sc nuclear magnetic resonance studies are performed for nitride clusterfullerenes MSc2N@C80 with icosahedral Ih(7) carbon cage, where M runs through all lanthanides forming nitride clusters. The influence of the endohedral lanthanide ions on the NMR spectral pattern is carefully followed, and dramatic differences are found in peak positions and line widths. Thus, 13C lines broaden from 0.01-0.02 ppm in diamagnetic MSc2N@C80 molecules (M = La, Y, Lu) to several ppm in TbSc2N@C80 and DySc2N@C80. Direction of the paramagnetic shift depends on the shape of the 4f electron density in corresponding lanthanide ions. In TmSc2N@C80 and ErSc2N@C80 with prolate 4f-density of lanthanide ions, 13C signals are shifted down-field, whereas 45Sc peaks are shifted up-field versus diamagnetic values. In all other MSc2N@C80 molecules lanthanide ions have oblate-shaped 4f electron density, and the lanthanide-induced shift is negative for 13C and positive for 45Sc peaks. Analysis of the pseudocontact and contact contributions to chemical shifts revealed that the pseudocontact term dominates both in 13C and 45Sc NMR spectra, although contact shifts for 13C signals are also considerable. Point charge computations of the ligand field splitting are performed to explain experimental results, and showed reasonable agreement with experimental pseudocontact shifts. Nitrogen atom bearing large negative charge and located close to the lanthanide ion results in large magnetic anisotropy of lanthanide ions in nitride clusterfullerenes with quasi-uniaxial ligand field.

Cluster-size dependent internal dynamics and magnetic anisotropy of Ho ions in HoM2N@C80 and Ho2MN@C80 families (M = Sc, Lu, Y)

The paramagnetic NMR study of HoM2N@C80-Ih and Ho2MN@C80-Ih nitride cluster fullerenes (M = Sc, Lu, Y) reveals strong dependence of Ho-induced paramagnetic shifts (δ(para)) in (13)C NMR spectra on the size of the diamagnetic metal in the cluster. In particular, the δ(para) value in HoY2N@C80 is almost doubled in comparison to that in HoSc2N@C80. X-ray magnetic circular dichroism studies show that all Ho-nitride cluster fullerenes have the same magnetic ground state of Ho(3+). Point-charge ligand-field splitting calculations show that the increase of the M(3+) radius in going from Sc to Y results in a considerable increase of the energy splitting between different Jz states. This leads to a 19% higher magnetic anisotropy of Ho(3+) in HoY2N@C80 than in HoSc2N@C80 at 300 K. Variations of the molecular geometry and cluster dynamics with the size of the cluster are found to have even greater influence on δ(para) values. This work shows that the magnetic properties of the species confined inside the fullerene cages can be tuned using the geometrical factors such as the cluster and the cage size.

Biogenic volatile emissions from the soil

Volatile compounds are usually associated with an appearance/presence in the atmosphere. Recent advances, however, indicated that the soil is a huge reservoir and source of biogenic volatile organic compounds (bVOCs), which are formed from decomposing litter and dead organic material or are synthesized by underground living organism or organs and tissues of plants. This review summarizes the scarce available data on the exchange of VOCs between soil and atmosphere and the features of the soil and particle structure allowing diffusion of volatiles in the soil, which is the prerequisite for biological VOC-based interactions. In fact, soil may function either as a sink or as a source of bVOCs. Soil VOC emissions to the atmosphere are often 1-2 (0-3) orders of magnitude lower than those from aboveground vegetation. Microorganisms and the plant root system are the major sources for bVOCs. The current methodology to detect belowground volatiles is described as well as the metabolic capabilities resulting in the wealth of microbial and root VOC emissions. Furthermore, VOC profiles are discussed as non-destructive fingerprints for the detection of organisms. In the last chapter, belowground volatile-based bi- and multi-trophic interactions between microorganisms, plants and invertebrates in the soil are discussed.

Isoprene function in two contrasting poplars under salt and sunflecks

In the present study, biogenic volatile organic compound (BVOC) emissions and photosynthetic gas exchange of salt-sensitive (Populus x canescens (Aiton) Sm.) and salt-tolerant (Populus euphratica Oliv.) isoprene-emitting and non-isoprene-emitting poplars were examined under controlled high-salinity and high-temperature and -light episode ('sunfleck') treatments. Combined treatment with salt and sunflecks led to an increased isoprene emission capacity in both poplar species, although the photosynthetic performance of P. × canescens was reduced. Indeed, different allocations of isoprene precursors between the cytosol and the chloroplast in the two species were uncovered by means of (13)CO2 labeling. Populus × canescens leaves, moreover, increased their use of 'alternative' carbon (C) sources in comparison with recently fixed C for isoprene biosynthesis under salinity. Our studies show, however, that isoprene itself does not have a function in poplar survival under salt stress: the non-isoprene-emitting leaves showed only a slightly decreased photosynthetic performance compared with wild type under salt treatment. Lipid composition analysis revealed differences in the double bond index between the isoprene-emitting and non-isoprene-emitting poplars. Four clear metabolomics patterns were recognized, reflecting systemic changes in flavonoids, sterols and C fixation metabolites due to the lack/presence of isoprene and the absence/presence of salt stress. The studies were complemented by long-term temperature stress experiments, which revealed the thermotolerance role of isoprene as the non-isoprene-emitting leaves collapsed under high temperature, releasing a burst of BVOCs. Engineered plants with a low isoprene emission potential might therefore not be capable of resisting high-temperature episodes.

New ischemic brain lesions after carotid artery stenting

Carotid artery stenting is associated with the risk of periprocedural stroke. Moreover, modern magnetic resonance (MR) imaging techniques have found high rates of clinically silent ischemic brain lesions on post-treatment diffusion-weighted MR imaging (DWI) scans. The clinical significance of procedure-related DWI lesions, however, is still a matter of debate. This review article considers the frequency, location and pathophysiology of new DWI lesions on post-treatment MR images and summarizes available data on their clinical significance.

Acute Cerebrovascular Disease in the Young

Background and Purpose—

Strokes have especially devastating implications if they occur early in life; however, only limited information exists on the characteristics of acute cerebrovascular disease in young adults. Although risk factors and manifestation of atherosclerosis are commonly associated with stroke in the elderly, recent data suggests different causes for stroke in the young. We initiated the prospective, multinational European study Stroke in Young Fabry Patients (sifap) to characterize a cohort of young stroke patients.

Methods—

Overall, 5023 patients aged 18 to 55 years with the diagnosis of ischemic stroke (3396), hemorrhagic stroke (271), transient ischemic attack (1071) were enrolled in 15 European countries and 47 centers between April 2007 and January 2010 undergoing a detailed, standardized, clinical, laboratory, and radiological protocol.

Results—

Median age in the overall cohort was 46 years. Definite Fabry disease was diagnosed in 0.5% (95% confidence interval, 0.4%–0.8%; n=27) of all patients; and probable Fabry disease in additional 18 patients. Males dominated the study population (2962/59%) whereas females outnumbered men (65.3%) among the youngest patients (18–24 years). About 80.5% of the patients had a first stroke. Silent infarcts on magnetic resonance imaging were seen in 20% of patients with a first-ever stroke, and in 11.4% of patients with transient ischemic attack and no history of a previous cerebrovascular event. The most common causes of ischemic stroke were large artery atherosclerosis (18.6%) and dissection (9.9%).

Conclusions—

Definite Fabry disease occurs in 0.5% and probable Fabry disease in further 0.4% of young stroke patients. Silent infarcts, white matter intensities, and classical risk factors were highly prevalent, emphasizing the need for new early preventive strategies.

Clinical Trial Registration Information—

URL: http://www.clinicaltrials.gov .Unique identifier: NCT00414583

Impact of protein content on proton diffusibility in intracranial cysts

PURPOSE

The physical background of diffusion phenomena in intracranial cysts is unclear in some cases. To evaluate a potential dependency of proton diffusion on the concentration of proteins in cystic lesions we investigated the correlation of diffusion weighted imaging (DWI) and magnetization transfer ratio imaging (MTR) in intracranial cystic pathologies in vivo and in vitro with protein solutions.

MATERIALS AND METHODS

21 patients (14 male/7 female) with intracranial cystic lesions underwent preoperative MRI (1.5T) including MTR and DWI sequences. For comparison a series of samples with declining concentration of albumin was investigated in vitro with a 7T animal scanner.

RESULTS

In the patients examination mean ADC values were 1.93×10-3mm2/sec and mean MTR values were 0.2. Mean ADC value of the albumin solutions was 0.22× 0-3mm2/sec and mean MTR was 0.12. ADC and MTR values showed a strong negative correlation in the patients (Spearman's rank correlation rs=-0.80, p<0.01) and a very strong negative correlation in the in vitro examinations (rs=-1.0, p<0.01).

CONCLUSION

The strong negative correlation of ADC and MTR values suggest a strong influence of proteins on proton diffusion in intracranial cysts. The phenomena can be explained by macromolecules that bind nearby protons in their vicinity.

Thrombolysis targeting MRI defined tissue at risk in minor stroke

BACKGROUND

Treatment with intravenous tissue plasminogen activator (IV-tPA) is usually not recommended in patients with minor stroke. Clinical and imaging outcome were studied after IV-tPA treatment based on MRI criteria in patients with minor stroke.

METHODS

Data were analysed retrospectively of acute ischaemic stroke patients with minor stroke (National Institutes of Health Stroke Scale (NIHSS) score <4). All patients were studied by stroke MRI including perfusion and diffusion weighted imaging (PWI and DWI) and treated with IV-tPA for < or =6 h. Final infarct volume was delineated on follow-up MRI. Clinical outcome was assessed after 90 days using the modified Rankin Scale (mRS).

RESULTS

Six patients with a median NIHSS on admission of 2 (range 0-3) were treated with IV-tPA based on MRI criteria. In all patients, occlusion of the middle cerebral artery (MCA) was detected (MCA branch n = 2, MCA trunk n = 3, MCA trifurcation n = 1), and the PWI lesion (41, 25-60 ml) exceeded the DWI lesion (4, 1-23 ml). Final infarct volume was 9 (2-29) ml. Favourable outcome (mRS 0-1) was seen in 5/6 patients and independent outcome (mRS = 2) in one patient. No intracerebral haemorrhages occurred.

CONCLUSION

Treatment with IV-tPA based on MRI criteria was safe and appeared to be effective in this small series of patients with minor stroke.

[Long-term outcome after endovascular treatment of high-risk patients with recurrently symptomatic intracranial stenoses of the posterior circulation]

PURPOSE

We present long-term clinical and duplex data from high-risk patients with severe, recurrent symptomatic stenoses of the vertebrobasilar circulation. We hypothesized that despite the greater risk of periprocedural complications in this patient group, interventional treatment would reduce the risk of recurrent strokes relative to the expected natural risk. We also predicted that the long-term treatment outcome would be positively influenced by the use of stents and by the periprocedural technical success rate.

MATERIALS AND METHODS

An analysis of our patient data base yielded 45 cases of stenosis of the vertebrobasilar circulation treated endovascularly in 42 patients between 1998 and 2006. Clinical and vascular diagnostic tests, both periinterventionally and during follow-up, were performed independently by experienced neurologists.

RESULTS

The technical success rate was 93%. Stents were used in 67% of the procedures. After 30 days, 24% of the patients showed post-procedural clinical deterioration. After an average period of 26.3 months, 17.8 % of the patients had deteriorated. 11.1% of the patients suffered severe permanent damage as a result of the procedure (mRs 3 - 6). Restenosis was found in 9.5% of the cases. There were no instances of a recurrent stroke during follow-up.

CONCLUSION

For this population of high-risk patients with recurrently symptomatic intracranial stenoses of the vertebrobasilar axis, endovascular treatment reduced the risk of stroke and death relative to the expected natural risk. The use of stents had no significant effect on the long-term results.

Transcranial grey-scale sonography of subdural haematoma in adults

AIM

Transcranial high-resolution grey-scale sonography reliably allows diagnosis and monitoring of subdural haematoma (SDH) and extra-cerebral intracranial fluid collections in infants but has not been evaluated thoroughly in adults up to now. Because of rapid development of ultrasound systems, the depiction of intracerebral haemorrhage (ICH) has now become feasible. The presented study evaluated the sonographic appearance of SDH in adults.

METHOD

We performed transcranial grey-scale sonography (TGS) in 25 consecutive patients with SDH confirmed by cranial computed tomography (CCT) or MRI. According to paediatric TGS, the dural border of the arachnoid was depicted as a highly echogenic membrane, and the distance between the skull and the echogenic membrane was measured. SDH was measured by CCT/MRI and by TGS in corresponding axial planes. The rate of identification of SDH in TGS was evaluated, and the extent of SDH as assessed by CCT/MRI and TGS was compared.

RESULTS

TGS reliably detected SDH in 22 of the 25 patients with confirmed SDH (88 %). In the remaining 3 patients, the temporal bone window was insufficient for TGS investigation. Extent of SDH measured by CCT and TGS correlated linearly (r= 0.849).

CONCLUSION

TGS allows imaging of SDH in patients with CCT/MRI confirmed SDH, and the extent of SDH correlates significantly between TGS and CCT/MRI. Therefore, TGS may be a possible alternative to serial CCT imaging in monitoring SDH, since in contrast to CCT, TGS is a non-invasive bedside method. So far, TGS is not suitable for the diagnosis of SDH.

The amount of solid cerebral microemboli during carotid stenting does not relate to the frequency of silent ischemic lesions

BACKGROUND AND PURPOSE

Carotid artery stent placement (CAS) may be associated with clinically silent cerebral lesions. We prospectively evaluated the association of the number of solid cerebral microemboli during unprotected CAS with the frequency of silent cerebral lesions as detected by diffusion-weighted MR imaging (DWI).

METHODS

We performed multifrequency transcranial Doppler detection of solid microemboli in the ipsilateral middle cerebral artery (MCA) during CAS in 27 consecutive patients with symptomatic high-grade carotid stenoses. No embolus protection was used in any of the cases. DWI before and 24 +/- 2 hours after CAS was used to detect new ischemic lesions.

RESULTS

We detected 484 solid microemboli in 17 patients (63%). On MR imaging 24 +/- 2 hours after CAS, 6 patients (22%) had developed 13 new clinically silent DWI lesions within the ipsilateral MCA territory. In patients with Doppler evidence of solid emboli during CAS, the incidence of new DWI lesions was higher (29%) than in patients without Doppler evidence of solid emboli during the procedure (10%); this difference was not statistically significant (P = .25). The number of solid microemboli during CAS in patients with new ipsilateral DWI lesions was not significantly different from that in patients without new ipsilateral DWI lesions.

CONCLUSIONS

Solid microembolism is a common event during unprotected CAS; however, the frequency of procedure-related silent cerebral lesions appears to be independent of the number of solid cerebral microemboli during the procedure.

Plasma amino acids in ecstasy users

Recreational use of the illegal drug "ecstasy" has increased dramatically in recent years. We have measured 33 different plasma amino acids in ecstasy users and controls. Significant differences were found for phosphoserine, glutamate, citrulline, methionine, tyrosine and histidine. Resembling changes in the plasma amino acids have been described in acute transient polymorphous psychosis. Thus, alterations in plasma - methionine and phosphoserine or other amino acids could be involved in the psychical symptoms produced by MDMA.

Plasma concentrations of 5-HT, 5-HIAA, norepinephrine, epinephrine and dopamine in ecstasy users

Recreational use of the synthetic methamphetamine derivative MDMA (3,4-methylenedioxymethamphetamine), the main constituent of the illegal drug "ecstasy", has increased dramatically in recent years. The reasons for ecstasy-associated cardiovascular complications like tachycardia, arrhythmias and hypertensive crises and psychiatric symptoms like psychotic episodes are not well understood. We have measured the plasma concentrations of 5-HIAA, 5-HT, norepinephrine, epinephrine and dopamine in 159 ecstasy users and controls. Ecstasy users showed elevated resting sympathetic activity, reflected in increased norepinephrine, epinephrine and dopamine levels. The levels of these catecholamines correlated positively with the cumulative dose and also with consumption during the last 30 days and 12 months. Although it is known that significant changes in 5-HT and 5-HIAA appear in the cerebrospinal fluid in ecstasy users, we could not detect alterations in serotonergic neurotransmitters in plasma in this large sample of subjects. Thus, in the drug-free interval, ecstasy users show lowered central serotonergic activity (lowered 5-HT and 5-HIAA concentrations in CSF) along with unchanged central noradrenergic and dopaminergic activity (HVA and MHPG unchanged in CSF) and elevated peripheral noradrenergic, dopaminergic and adrenergic activity along with unchanged peripheral serotonergic activity (plasma levels). We conclude, that the data presented here could argue for a noradrenergic hyperreactivity in the drug-free interval in ecstasy users resulting from previous ecstasy consumption. Also for an association with psychotic episodes and cardiovascular complications like tachycardia, arrhythmias.

[A comparative study of cytological and histological studies of the thyroid gland]

We compare the results of fine-needle aspiration cytology of the thyroid gland with postoperative histological findings in 533 patients with thyroidectomy operated on between 1987 and 1994. The classification of the cytological preparations followed the proposal of Weiss and Pilz [35] with the groups 0-IV. In group 0 the most frequent findings were cystic changes in multinodular goitre or malpuncture, respectively. The groups I and II contained cases with multinodular goitre, thyroiditis and follicular adenomas, but 4 carcinomas too. The group III comprised particularly follicular adenomas and carcinomas (8 cases). Both cases in group IV were carcinomas. In group III (cytologic group with suspicious findings) there were 65 cases with false positive results of the cytologic investigation resulting in a specificity of 86.4%. 4 out of 14 thyroid carcinomas could not be detected by cytologic preparations corresponding to a sensitivity of 71.4% for carcinomas. The false negative rate for thyroid carcinomas in group II was caused by regression areas in the center of the tumors (3 cases) as well as one microcarcinoma. Preoperative fine-needle aspiration cytology of the thyroid gland reduces the number of patients operated on for multinodular goitre or cold nodules especially in cases suspicious of carcinoma.

Intercellular communication, tumor promotion and non-genotoxic carcinogenesis: relationships based upon structural considerations

An SAR model for inhibition of metabolic cooperation (iMC) was developed. The structural and physicochemical features associated with the ability to cause iMC are primarily lipophilic moieties consistent with the possibility that they represent receptor-binding ligands. There are also significant parallels between the structural descriptors associated with iMC and those associated with tumor promotion and with carcinogenesis in rodents. Overall, the present study provides structural evidence that iMC is a feature associated with the carcinogenic process.

[Immune activity and serum interleukin-2-receptor concentration in autoimmune thyroid diseases]

Serum interleukin-2 receptor (IL-2R) concentrations were compared in 55 patients with thyrotoxicosis (14 men, 41 women, mean age 43.5 +/- 17 years), 18 patients with Hashimoto's thyroiditis (5 men, 13 women, mean age 47 +/- 15 years) and 28 healthy subjects (12 men, 16 women, mean age 30 +/- 10 years). The patients with thyrotoxicosis were divided into three groups depending on the activity or stage of the disease: 17 patients with florid untreated hyperthyroidism, 23 euthyroid patients receiving treatment with antithyroid drugs and 15 patients with thyrotoxicosis in remission after completing one year's antithyroid treatment. The patients with untreated thyrotoxicosis had significantly higher IL-2R values than the euthyroid patients receiving treatment or those in remission (207 +/- 112 vs 139 +/- 66 and 91 +/- 26 U/ml, P < 0.05 and P < 0.01). The IL-2R values of patients with thyrotoxicosis in remission were, however, significantly lower than those of the 28 healthy subjects (126 +/- 34 U/l; P < 0.01) or the euthyroid patients receiving treatment (P < 0.05). The 18 patients with Hashimoto's thyroiditis had significantly lower serum IL-2R values (70 +/- 39 U/ml) than the healthy controls. These data show that the serum IL-2R level depends on the state of thyroid metabolism and on the activity phase of the thyrotoxicosis. The low serum levels of IL-2R in patients with Hashimoto's thyroiditis could signify a genetically determined decrease in IL-2R production or might be linked with the destruction of thyroid tissue by the chronic autoimmune process.

Increased serum neopterin levels in patients with Graves' disease

Neopterin (NPT) a marker of activation of the T-lymphocyte/monocyte axis has been measured in serum of 89 patients with autoimmune thyroid disease (72 patients with Graves' disease and 17 patients with autoimmune thyroiditis) and compared to a group of 24 normal controls and 24 patients with nontoxic goitre. There was a significant correlation between NPT levels and age in the patients with nontoxic goitre (r = 0.447, p < 0.001) but not in patients with autoimmune thyroid disease. Significantly higher NPT levels were found in all patients with Graves' disease (GD) compared to age and sex matched healthy controls, and patients with nontoxic goitre (5.7 +/- 2.4 vs 4.1 +/- 1.7, and 4.0 +/- 1.5, p < 0.01). However, there was no difference in NPT levels between each group of patients with GD when subdivided in: hyperthyroid newly diagnosed GD, treated GD, GD in remission and relapse. Patients with autoimmune thyroiditis did not have abnormal NPT levels compared to age and sex matched normal controls. Neopterin serum levels were not influenced by hyperthyroidism as no significant differences in NPT levels could be found in 24 patients with hyperthyroid Graves' disease and 13 patients with toxic goitre or toxic adenoma when compared to age and sex matched euthyroid patients with Graves' disease or normal controls. Moreover, there was no significant difference in mean NPT levels 1. before and after restoration of euthyroidism in 10 patients with hyperthyroid Graves' disease and 2. before and under T3 supplementation in 18 patients with Graves' disease in remission who underwent a T3 thyroid suppression test.(ABSTRACT TRUNCATED AT 250 WORDS)

External ventricular drainage for treatment of rapidly progressive posthemorrhagic hydrocephalus

Twenty-seven newborn infants (birth weight, 1503 +/- 776 g; gestational age, 31 +/- 3 wk) (mean +/- standard deviation) with rapidly progressive posthemorrhagic hydrocephalus and increased intracranial pressure were treated by external ventricular drainage. The progression of hydrocephalus was arrested during the drainage period in each patient. The drainage was kept in place for 23 +/- 9 days, the longest drainage period being 48 days. In 16 of 23 surviving patients, progressive ventricular dilation recurred after removal of the drainage, requiring a definitive shunt implantation (nine ventriculoatrial, seven ventriculoperitoneal). For the remaining seven infants, no further therapy was necessary. Implantation of the permanent shunt was done days 28 to 88 (body weight, 2400 +/- 950 g). Bacterial cultures from cerebrospinal fluid and/or the tip of the ventriculostomy catheter were negative in 175 instances and positive in 11 instances (7 patients). No clinical or biochemical evidence of ventriculitis was noted. Four of the 27 patients died of causes unrelated to external ventricular drainage. Twenty-three infants survived. Seventeen of 23 survivors suffered from intraventricular hemorrhage Grade 3; in 7, neurological and developmental outcomes were classified as normal; 9 patients experienced mild to moderate paresis and/or mild to moderate developmental delay; and only 1 patient was severely retarded. Six patients with parenchymal lesions had severe motor and/or developmental handicaps. We consider external ventricular drainage an effective and safe therapy in newborn infants with rapidly progressive posthemorrhagic hydrocephalus and increased intracranial pressure. The ultimate outcome, however, depends mainly on the mode and the extent of the primary brain lesion.

[The value of placental histology for the detection of genetically-induced abortions]

The majority of early spontaneous abortions is caused by genetic disorders. Chromosomal aberrations do not only imply characteristical morphologic alterations in embryo/fetus, but also in chorionic villi. Its possible to draw conclusions through the combination of a small amount of histological findings on chorionic villi to explain the kind of aneuploidy. Among 968 early spontaneous abortions 18.3% were defined as genetically caused by histological examination. 87.6% are probably trisomies, 7.3% polyploidies. 5.1% were diagnosed as complete hydatidiform moles with a diploid, androgenetic chromosome set. The value of histological examination of early spontaneous abortion tissue are discussed and it is pointed out to remaining problems. In a different percentage it is possible to establish the type of aneuploid by microscopic examination alone. Frequently there are sings to allow the conclusion there is a developmental disorder like genetic aberration.

[External ventricle drainage in newborn infants with rapidly growing posthemorrhagic hydrocephalus]

14 newborn infants (birth weight: 1830 +/- 930 gms, gestational age 33 +/- 4 wks) (mean +/- SD) with rapidly progressive posthaemorrhagic hydrocephalus and increased intracranial pressure were treated by means of external ventricular drainage. Progression of hydrocephalus was arrested during the drainage period in each patient. The drainage was kept in place for 20 +/- 12 days, the longest drainage period being 48 days. 8 of 10 surviving patients showed recurrence of progressive ventricular dilatation, 5 required a ventriculoatrial and 3 a ventriculoperitoneal shunt. The other 2 infants required no further therapy. Implantation of a permanent shunt was performed at day 28 to 88 after delivery, at the time of implantation the weight of the infants was 2400 +/- 950 gms (lowest weight 1650 gms). Bacterial cultures of ventricular liquor were negative in 66 and positive in 7 instances. Clinical and biochemical evidence of ventriculitis was absent in all patients. 4 of the 14 patients died of causes unrelated to external ventricular drainage. 10 infants survived. 7 out of 10 survivors suffered from IVH 3; 6 subsequently showed normal neurological development and one was retarded. 3 patients with parenchymal lesions (2 patients: IVH 4, 1 patient: primarily intraparenchymal haemorrhage) had neurological handicaps. We consider external ventricular drainage to be an effective form of therapy in newborn infants with rapidly progressive posthaemorrhagic hydrocephalus and increased intracranial pressure because this treatment achieves prompt and sustained decrease in intraventricular pressure without complications.

[The effect of D-penicillamine on experimental allergic arthritis in rabbits]

The effect of D-penicillamine on experimental allergic arthritis in rabbits (16 with arthritis and 15 controls) was investigated. After 40 days of treatment with D-penicillamine (intravenous) the arthritis had receded to a large extent. At the same time a maturation inhibition of the hematopoietic marrow had occurred in all the treated arthritic and control animals. The results suggest that D-penicillamine affects fast proliferating cells, to which the precursors of immunologically active cells in the synovial membrane also belong.