Cranial form differences in goats by breed and domestic status

Domestic goats (Capra hircus) are globally represented by over 300 breeds, making them a useful model for investigating patterns of morphological change related to domestication. However, they have been little studied, likely due to their poor representation in museum collections and the difficulty in obtaining truly wild goat (Capra aegagrus, the bezoar) samples. Similar studies on other species reveal that domestication correlates with craniofacial alterations in domestics, which are non-uniform and often species-specific. Here, we use three-dimensional geometric morphometric methods (3DGMM) to describe and quantify cranial shape variation in wild (n = 21) versus domestic (n = 54) goats. We find that mean cranial shapes differ significantly between wild and domestic goats as well as between certain breeds. The detected differences are lower in magnitude than those reported for other domestic groups, possibly explained by the fewer directions of artificial selection in goat breeding, and their low global genetic diversity compared to other livestock. We also find tooth-row length reduction in the domestics, suggestive of rostral shortening-a prediction of the "domestication syndrome" (DS). The goat model thus expands the array-and combinations of-morphological changes observed under domestication, notably detecting alterations to the calvarium form which could be related to the ~ 15% brain size reduction previously reported for domestic compared to wild goats. The global success of domestic goats is due more to their ability to survive in a variety of harsh environments than to systematized human management. Nonetheless, their domestication has resulted in a clear disruption from the wild cranial form, suggesting that even low-intensity selection can lead to significant morphological changes under domestication.

Clinical utility of repeat fetal echocardiography in congenital heart disease

OBJECTIVES

To investigate the utility of repeat fetal echocardiography (FE) following a diagnosis of structural congenital heart disease (CHD) on the initial FE. We evaluated how often changes in management and counseling occurred based on subsequent FE findings and sought to determine which types of CHD were more likely to have changes in management and/or counseling based on repeat FE.

METHODS

This was a retrospective review of all patients who presented to our center between January 2012 and January 2019 and who had more than one FE performed for structural CHD. We reviewed consultation notes to determine whether management or counseling had changed based on FE findings at follow-up visits. Management variables included a change in location or mode of delivery, plan for atrial septostomy, initiation of prostaglandin infusion, umbilical line placement and planned admission location (nursery vs neonatal intensive care unit). We defined a counseling change as any of the above changes in management as well as any meaningful refinements in the cardiac diagnosis that led to a change in the overall prognosis or future management. Initial diagnoses were grouped into anatomically/hemodynamically relevant subgroups. Fisher's exact test was used to assess the relationship between the initial diagnosis and changes in management. Post-hoc pairwise comparisons were performed using Dunnett's test.

RESULTS

Between January 2012 and January 2019, 267 patients underwent 534 follow-up FE assessments performed for structural CHD. Management change based on repeat FE occurred in 41/267 (15.4%) cases. A change in management was associated with the diagnosis made at the initial visit (P < 0.001). The proportion of cases with a management change was highest among those with an initial diagnosis of pulmonary valve abnormality/non-critical pulmonary stenosis (4/11 (36.4%)), followed by balanced atrioventricular canal (AVC) defect (5/17 (29.4%)) and left ventricular outflow tract obstruction/aortic valve abnormality or coarctation/interrupted aortic arch (19/68 (27.9%)). No management change occurred in fetuses diagnosed with isolated ventricular septal defect (VSD), truncus arteriosus, pulmonary vein anomaly or isolated arch sidedness/branching abnormality. Compared to those with a VSD, management was significantly more likely to be changed in fetuses with a balanced AVC defect (P = 0.025) and left heart lesions (P = 0.002). Right heart lesions showed a trend towards an increased incidence of management change (P = 0.05). A counseling change based on repeat FE occurred in 108/267 (40.4%) cases. The proportion of cases with a counseling change was highest among those with an initial diagnosis of pulmonary valve abnormality/non-critical pulmonary stenosis (8/11 (72.7%)) and hypoplastic left heart syndrome/critical aortic stenosis (5/9 (55.6%)).

CONCLUSIONS

The clinical utility of follow-up FE is associated with the type of CHD diagnosed. Follow-up FE led to changes in management in several types of CHD, most commonly in cases with an initial diagnosis of right and left outflow obstructive lesions and balanced AVC defect. When developing programmatic protocols for the frequency of FE assessments, the type of CHD should be a major determinant, but additional studies are required to reach a consensus on how often serial FE should be performed for each type of CHD. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Bispecific antibodies redirect synthetic agonistic receptor modified T cells against melanoma

BACKGROUND

Melanoma is an immune sensitive disease, as demonstrated by the activity of immune check point blockade (ICB), but many patients will either not respond or relapse. More recently, tumor infiltrating lymphocyte (TIL) therapy has shown promising efficacy in melanoma treatment after ICB failure, indicating the potential of cellular therapies. However, TIL treatment comes with manufacturing limitations, product heterogeneity, as well as toxicity problems, due to the transfer of a large number of phenotypically diverse T cells. To overcome said limitations, we propose a controlled adoptive cell therapy approach, where T cells are armed with synthetic agonistic receptors (SAR) that are selectively activated by bispecific antibodies (BiAb) targeting SAR and melanoma-associated antigens.

METHODS

Human as well as murine SAR constructs were generated and transduced into primary T cells. The approach was validated in murine, human and patient-derived cancer models expressing the melanoma-associated target antigens tyrosinase-related protein 1 (TYRP1) and melanoma-associated chondroitin sulfate proteoglycan (MCSP) (CSPG4). SAR T cells were functionally characterized by assessing their specific stimulation and proliferation, as well as their tumor-directed cytotoxicity, in vitro and in vivo.

RESULTS

MCSP and TYRP1 expression was conserved in samples of patients with treated as well as untreated melanoma, supporting their use as melanoma-target antigens. The presence of target cells and anti-TYRP1 × anti-SAR or anti-MCSP × anti-SAR BiAb induced conditional antigen-dependent activation, proliferation of SAR T cells and targeted tumor cell lysis in all tested models. In vivo, antitumoral activity and long-term survival was mediated by the co-administration of SAR T cells and BiAb in a syngeneic tumor model and was further validated in several xenograft models, including a patient-derived xenograft model.

CONCLUSION

The SAR T cell-BiAb approach delivers specific and conditional T cell activation as well as targeted tumor cell lysis in melanoma models. Modularity is a key feature for targeting melanoma and is fundamental towards personalized immunotherapies encompassing cancer heterogeneity. Because antigen expression may vary in primary melanoma tissues, we propose that a dual approach targeting two tumor-associated antigens, either simultaneously or sequentially, could avoid issues of antigen heterogeneity and deliver therapeutic benefit to patients.

The mammalian brain under domestication: Discovering patterns after a century of old and new analyses

Comparisons of wild and domestic populations have established brain reduction as one of the most consistent patterns correlated with domestication. Over a century of scholarly work has been devoted to this subject, and yet, new data continue to foster its debate. Current arguments, both for and against the validity of brain reduction occurring in domestic taxa, have repeatedly cited a small set of reviews on this subject. The original works, their sampling, methodological details, and nuances of results that would be key to establishing validity, particularly in light of new data, have not been investigated. To facilitate and encourage a more informed discussion, we present a comprehensive review of original brain reduction literature for four mammalian clades: Artiodactyla, Perissodactyla, Carnivora, and Glires. Among these are studies that generated the most cited brain reduction values in modern domestication literature. In doing so, we provide a fairer stage for the critique of traits associated with domestication. We conclude that while brain reduction magnitudes may contain error, empirical data collectively support the reduction in brain size and cranial capacity for domestic forms.

Interferon-β Decreases the Hypermetabolic State of Red Blood Cells from Patients with Multiple Sclerosis

Multiple sclerosis (MS) is an inflammatory disease characterized by damage to the myelin sheath surrounding axons in the central nervous system. While the exact mechanism of this destruction is unknown, excess nitric oxide (NO) and adenosine triphosphate (ATP) have been measured in tissues and fluids obtained from people with MS. Here, incubation of interferon-beta (IFN-β), an MS drug with an unknown mechanism of action, with red blood cells (RBCs) obtained from people with MS provide evidence of a potential hypermetabolic state in the MS RBC that is decreased with IFN-β intervention. Specifically, binding of all three components of an albumin/C-peptide/Zn²⁺ complex to MS RBCs was significantly increased in comparison to control RBCs. For example, the binding of C-peptide to MS RBCs was significantly increased (3.4 ± 0.1 nM) compared to control RBCs (1.6 ± 0.2 nM). However, C-peptide binding to MS RBCs was reduced to a value (1.6 ± 0.3 nM) statistically equal to that of control RBCs in the presence of 2 nM IFN-β. Similar trends were measured for albumin and Zn²⁺ binding to RBCs when in the presence of IFN-β. RBC function was also affected by incubation of cells with IFN-β. Specifically, RBC-derived ATP and measurable membrane GLUT1 were both significantly decreased (56 and 24%, respectively) in the presence of IFN-β. Collectively, our results suggest that IFN-β inhibits albumin binding to the RBC, thereby reducing its ability to deliver ligands such as C-peptide and Zn²⁺ to the cell and normalizing the basal hypermetabolic state.

Comparison of the socio-economic value and welfare of working donkeys in rural and urban Ethiopia

Donkeys (Equus asinus) are widely used throughout Ethiopia and play essential roles in a variety of everyday and income-generating tasks for the people that use them. The challenges faced by people and their working equids vary across communities and geographic locations. This may have implications for how donkeys are perceived by the people they work for, the roles they fulfil and ultimately their welfare. Two complementary methodological approaches were used in this study to explore the socio-economic value of donkeys for their owners and the welfare of the donkeys in rural and urban Ethiopia. Using a questionnaire, donkey owners were asked about their donkeys, their attitudes and beliefs related to donkey use and ownership, and the role donkeys played in their lives. Animal-based welfare assessments were also conducted on a sample of donkeys from different locations, with the overarching aim of the study to investigate differences in use, beliefs, and donkey welfare between rural and urban locations. In both rural and urban locations, working donkeys are critical for their owners' income-generating activity and therefore their livelihoods. The work they undertake differs substantially between locations, as does their welfare. Work in each setting presents its own challenges and these are reflected in the behaviour and physical health of the donkeys. Rural donkeys showed more apathetic behaviour, a higher ectoparasite burden and greater evidence of tethering/hobbling. Urban donkeys were more alert and had a wider range of body condition scores. The findings highlight marked differences in the role and welfare of donkeys between different areas within the same country, demonstrating the importance of understanding the context, both from the perspective of humans and working equids, prior to staging interventions intended to benefit either party.

Exceptional Changes in Skeletal Anatomy under Domestication: The Case of Brachycephaly

"Brachycephaly" is generally considered a phenotype in which the facial part of the head is pronouncedly shortened. While brachycephaly is characteristic for some domestic varieties and breeds (e.g., Bulldog, Persian cat, Niata cattle, Anglo-Nubian goat, Middle White pig), this phenotype can also be considered pathological. Despite the superficially similar appearance of "brachycephaly" in such varieties and breeds, closer examination reveals that "brachycephaly" includes a variety of different cranial modifications with likely different genetic and developmental underpinnings and related with specific breed histories. We review the various definitions and characteristics associated with brachycephaly in different domesticated species. We discern different types of brachycephaly ("bulldog-type," "katantognathic," and "allometric" brachycephaly) and discuss morphological conditions related to brachycephaly, including diseases (e.g., brachycephalic airway obstructive syndrome). Further, we examine the complex underlying genetic and developmental processes and the culturally and developmentally related reasons why brachycephalic varieties may or may not be prevalent in certain domesticated species. Knowledge on patterns and mechanisms associated with brachycephaly is relevant for domestication research, veterinary and human medicine, as well as evolutionary biology, and highlights the profound influence of artificial selection by humans on animal morphology, evolution, and welfare.

Human immunocompetent Organ-on-Chip platforms allow safety profiling of tumor-targeted T-cell bispecific antibodies

Traditional drug safety assessment often fails to predict complications in humans, especially when the drug targets the immune system. Here, we show the unprecedented capability of two human Organs-on-Chips to evaluate the safety profile of T-cell bispecific antibodies (TCBs) targeting tumor antigens. Although promising for cancer immunotherapy, TCBs are associated with an on-target, off-tumor risk due to low levels of expression of tumor antigens in healthy tissues. We leveraged in vivo target expression and toxicity data of TCBs targeting folate receptor 1 (FOLR1) or carcinoembryonic antigen (CEA) to design and validate human immunocompetent Organs-on-Chips safety platforms. We discovered that the Lung-Chip and Intestine-Chip could reproduce and predict target-dependent TCB safety liabilities, based on sensitivity to key determinants thereof, such as target expression and antibody affinity. These novel tools broaden the research options available for mechanistic understandings of engineered therapeutic antibodies and assessing safety in tissues susceptible to adverse events.

Protease-activation using anti-idiotypic masks enables tumor specificity of a folate receptor 1-T cell bispecific antibody

T-cell bispecific antibodies (TCBs) crosslink tumor and T-cells to induce tumor cell killing. While TCBs are very potent, on-target off-tumor toxicity remains a challenge when selecting targets. Here, we describe a protease-activated anti-folate receptor 1 TCB (Prot-FOLR1-TCB) equipped with an anti-idiotypic anti-CD3 mask connected to the anti-CD3 Fab through a tumor protease-cleavable linker. The potency of this Prot- FOLR1-TCB is recovered following protease-cleavage of the linker releasing the anti-idiotypic anti-CD3 scFv. In vivo, the Prot-FOLR1-TCB mediates antitumor efficacy comparable to the parental FOLR1-TCB whereas a noncleavable control Prot-FOLR1-TCB is inactive. In contrast, killing of bronchial epithelial and renal cortical cells with low FOLR1 expression is prevented compared to the parental FOLR1-TCB. The findings are confirmed for mesothelin as alternative tumor antigen. Thus, masking the anti-CD3 Fab fragment with an anti-idiotypic mask and cleavage of the mask by tumor-specific proteases can be applied to enhance specificity and safety of TCBs.

Acute effects of bi-hemispheric transcranial direct current stimulation on the neuromuscular function of patients with chronic stroke: A randomized controlled study

BACKGROUND

Muscle weakness in patients with chronic stroke is due to neuromuscular disorders such as muscle atrophy, loss of voluntary activation or weak muscle contractile properties which are majored by the imbalance of interhemispheric inhibition following stroke. In patients with chronic stroke, unilateral transcranial direct current stimulation improved the maximal isometric strength of paretic knee extensors, but bilateral transcranial direct current stimulation failed to improve concentric strength. This study aimed to assess if a bilateral current stimulation improves isometric maximal strength, voluntary activation and contractile properties of knee extensors in patients with chronic stroke.

METHODS

Thirteen patients with chronic stroke and eight young healthy individuals participated in this randomized, simple-blinded, crossover study that included two experimental sessions: one with sham bilateral transcranial direct current stimulation and another with effective bilateral transcranial direct current stimulation (20 min, 2 mA). In the stroke patients, the anode was placed over the primary motor cortex of the affected hemisphere and the cathode over the contralateral primary motor cortex. In healthy participants, the brain side targeted by the anode and the cathode was randomly assigned. In each session, participants performed three assessments of strength, voluntary activation and contractile properties: before, during and after effective/sham bilateral transcranial direct current stimulation.

FINDINGS

Bilateral transcranial direct current stimulation had no effect on any neuromuscular assessments in both groups (All P values > 0.05, partial eta-squares varied from 0.02 to 0.06).

INTERPRETATION

A single session of bilateral transcranial direct current stimulation did not compensate muscular weakness of knee extensors in patients with chronic stroke.

Psychological factors outmatched morphological markers in predicting limitations in activities of daily living and participation in patients with lumbar stenosis

BACKGROUND

Recent demographic changes have led to a large population of older adults, many of whom experience degenerative disc diseases. Degenerative lumbar spinal stenosis (DLSS) is associated with considerable discomfort and limitations in activities of daily living (ADL). Symptomatic DLSS is one of the most frequent indications for spinal surgery. The aim of this study was to identify sociodemographic variables, morphological markers, depression as well as fear of movement that predict ADL performance and participation in social life in patients with DLSS.

METHODS

Sixty-seven patients with DLSS (mean age 62.5 years [11.7], 50.7% females) participated in the study. Predictor variables were age, gender, duration of disease, three morphological markers (severity of the lumbar stenosis, the number of affected segments and presence of spondylolisthesis) as well as self-reported depression and fear of movement. Dependent variables were pain interference with the performance of ADLs, ADLs and participation in social life. Correlations between predictor and dependent variables were calculated before stepwise, linear regression analyses. Only significant correlations were included in the linear regression analyses.

RESULTS

Variance explained by the predictor variables ranged between 12% (R2 = .12; pain interference-physical) and 40% (R2 = .40; ADL requiring lower extremity functioning; participation). Depression and fear of movement were the most powerful predictors for all dependent variables. Among the morphological markers only stenosis severity contributed to the prediction of ADLs requiring lower extremity functioning.

CONCLUSION

Depression and fear of movement were more important predictors of the execution of ADLs and participation in social life compared to morphological markers. Elevated depressive symptoms and fear of movement might indicate limited adaptation and coping regarding the disease and its consequences. Early monitoring of these predictors should therefore be conducted in every spine centre. Future studies should investigate whether psychological screening or a preoperative psychological consultation helps to avoid operations and enables better patient outcomes.

Bispecific Antibodies Enable Synthetic Agonistic Receptor-Transduced T Cells for Tumor Immunotherapy

PURPOSE

Genetically engineered T cells are powerful anticancer treatments but are limited by safety and specificity issues. We herein describe an MHC-unrestricted modular platform combining autologous T cells, transduced with a targetable synthetic agonistic receptor (SAR), with bispecific antibodies (BiAb) that specifically recruit and activate T cells for tumor killing.

EXPERIMENTAL DESIGN

BiAbs of different formats were generated by recombinant expression. T cells were retrovirally transduced with SARs. T-cell activation, proliferation, differentiation, and T-cell-induced lysis were characterized in three murine and human tumor models in vitro and in vivo.

RESULTS

Murine T cells transduced with SAR composed of an extracellular domain EGFRvIII fused to CD28 and CD3ζ signaling domains could be specifically recruited toward murine tumor cells expressing EpCAM by anti-EGFRvIII × anti-EpCAM BiAb. BiAb induced selective antigen-dependent activation, proliferation of SAR T cells, and redirected tumor cell lysis. Selectivity was dependent on the monovalency of the antibody for EGFRvIII. We identified FAS ligand as a major mediator of killing utilized by the T cells. Similarly, human SAR T cells could be specifically redirected toward mesothelin-expressing human pancreatic cancer cells. In vivo, treatment with SAR T cells and BiAb mediated antitumoral activity in three human pancreatic cancer cell xenograft models. Importantly, SAR activity, unlike CAR activity, was reversible in vitro and in vivo.

CONCLUSIONS

We describe a novel ACT platform with antitumor activity in murine and human tumor models with a distinct mode of action that combines adoptive T-cell therapy with bispecific antibodies.

Differentiation of the Factor VII Complex

A factor recently described and for which the designation Stuart-Prower Factor is proposed, was investigated. It is detected by the usual Factor VII assay but differs from this factor (Matching experiments with plasma and serum of Owren’s Factor VII deficient patient). Stuart-Prower factor is necessary for the conversion prothrombin-thrombin with tissue thromboplastin as well as for the formation of blood thromboplastin. Therefore lack of Stuart-Prower factor produces abnormal Quick’s prothrombin time (not normalized with Russell’s viper venom [Stypven]), and also abnormal prothrombin consumption, abnormal recalcification time and abnormal thromboplastin generation with serum. Matching experiments with plasma and serum of the patients of Graham and Hougie, Telfer Denson and Wright, and Beaumont and Bernard show that we are dealing with the same defect. Physiological and physico-chemical properties are indicated. The possible relationship between Stuart-Prower factor and Factor X is discussed. A critical review with 59 cases of the so-called Factor VII deficiency is given. Investigation of the family of our patient Delia B. indicates that the mode of inheritance is an intermediate autosomal one.

The effect of transcranial direct current stimulation (tDCS) on locomotion and balance in patients with chronic stroke: study protocol for a randomised controlled trial

BACKGROUND

Following stroke, patients are often left with hemiparesis that reduces balance and gait capacity. A recent, non-invasive technique, transcranial direct current stimulation, can be used to modify cortical excitability when used in an anodal configuration. It also increases the excitability of spinal neuronal circuits involved in movement in healthy subjects. Many studies in patients with stroke have shown that this technique can improve motor, sensory and cognitive function. For example, anodal tDCS has been shown to improve motor performance of the lower limbs in patients with stroke, such as voluntary quadriceps strength, toe-pinch force and reaction time. Nevertheless, studies of motor function have been limited to simple tasks. Surprisingly, the effects of tDCS on the locomotion and balance of patients with chronic stroke have never been evaluated. In this study, we hypothesise that anodal tDCS will improve balance and gait parameters in patients with chronic stroke-related hemiparesis through its effects at cortical and spinal level.

METHODS/DESIGN

This is a prospective, randomised, placebo-controlled, double-blinded, single-centre, cross-over study over 36 months. Forty patients with chronic stroke will be included. Each patient will participate in three visits: an inclusion visit, and two visits during which they will all undergo either one 30-min session of transcranial direct current stimulation or one 30-min session of placebo stimulation in a randomised order. Evaluations will be carried out before, during and twice after stimulation. The primary outcome is the variability of the displacement of the centre of mass during gait and a static-balance task. Secondary outcomes include clinical and functional measures before and after stimulation. A three-dimensional gait analysis, and evaluation of static balance on a force platform will be also conducted before, during and after stimulation.

DISCUSSION

These results should constitute a useful database to determine the aspects of complex motor function that are the most improved by transcranial direct current stimulation in patients with hemiparesis. It is the first essential step towards validating this technique as a treatment, coupled with task-oriented training.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT02134158 . First received on 18 December 2013; last updated on 14 September 2016. Other study ID numbers: P120135 / AOM12126, 2013-A00952-43.

Microangiopathy in Chronic Venous Insufficiency before and after Sclerotherapy and Compression Treatment: Results of a One-Year Follow-up Study

Objective:

To characterize microangiopathy in patients with chronic venous insufficiency (CVI) of a moderate to severe stage and to evaluate improvement of the microcirculatory parameters after sclerotherapy of incompetent perforators and compression therapy.

Design:

Fluorescence videomicroscopy (Na-fluore-scein), laser Doppler fluxmetry and tc Po2 measurements (43°C) at the medial ankle in healthy controls and patients. Laser Doppler flux and tc Po2 were recorded in supine and sitting position in order to evaluate postural vasoconstriction. The measurements were repeated 6 and 12 months after sclerotherapy of incompetent perforators (Polidocanol 40 mg/ml) and compression therapy by below-knee class II or III stockings (Sigvaris®).

Setting:

Department of Internal Medicine, Angiology Division, University Hospital, Zurich, Switzerland.

Patients, participants:

15 healthy subjects (15 legs, mean age 53.3 years) and 15 patients with CVI of a moderate to severe stage (17 legs, mean age 56.8 years).

Results:

Microangiopathy in CVI is characterized by significantly enlarged, elongated and dilated capillaries with increased diameters of the pericapillary spaces (‘halos’). Single capillaries may be thrombosed. Laser Doppler flux is increased and tc Po2 is decreased. After therapy, there was a trend to decreased laser Doppler flux and an increase in tc Po2, but the differences were not statistically significant. Capillary thromboses were no longer detected. Mean halo diameters tended to decrease, but this difference was not statistically significant.

Conclusions:

Microangiopathy in CVI is characterized by morphological and functional changes. Beneficial changes induced by therapy develop slowly and emphasize the importance of long-lasting treatment.

Relationship between hip flexion and ankle dorsiflexion during swing phase in chronic stroke patients

BACKGROUND

During the clinical examination of stroke patients, it is common to observe that involuntary hip flexion occurs during voluntary ankle dorsiflexion (synkinesia). This suggests that there is a relationship between these two joints. We hypothesized that there may be a relationship between hip and ankle flexion during swing phase of the gait cycle. The objective of this study was to determine if there is a biomechanical relationship between peak hip flexion and peak ankle dorsiflexion during the swing phase of the gait cycle following stroke.

METHOD

The paretic lower limbs of 60 patients with stroke were evaluated using clinical tests and 3D-gait analysis. The clinical assessment included muscle strength, spasticity and passive range of ankle motion. The gait analysis focused on sagittal frontal and transverse kinematic gait parameters during swing.

FINDINGS

A stepwise-linear-regression indicated that peak hip flexion and gait speed were the only 2 parameters which accounted for peak ankle dorsiflexion. There was also a significant negative correlation between peak hip flexion and peak ankle dorsiflexion during swing, and a significant positive correlation between hip flexor and ankle dorsiflexor muscle strength.

INTERPRETATION

These results suggest that the biomechanical behaviour of hip and ankle joints during the swing phase of the gait cycle is linked in patients with stroke. They also suggest that two strategies exist: if sufficient ankle dorsiflexion is present, less hip flexion is required (distal-strategy) whereas if dorsiflexion is reduced, it is compensated for by an increase in peak hip flexion (proximal-strategy).

Is there already a place for endovascular treatment of the common femoral artery?

Surgical endarterectomy has been considered the prefered technique for treating the common femoral artery (CFA). Although favorable endovascular treatment results of the CFA have recently become available, losing the groin area as an important acess site is still the major concern for this technique to become the golden standart. Nevertheless, the endovascular approach has shown, through several studies, including our experience, the capacity to establish itself as a complementery treatment for the modern vascular surgeon.

[Concept of an interdisciplinary emergency department at the Schwarzwald-Baar Hospital]

BACKGROUND

Numerous hospitals were combined years ago into a new Central Hospital for cost reasons in the Schwarzwald-Baar region. This also suggested the idea of a large central emergency department. The concept of a central emergency department is an organizational challenge, since they are directly engaged in the organizational structure of all medical departments that are involved in emergency treatment. Such a concept can only be enforced if it is supported by hospital management and all parties are willing to accept interdisciplinary and interprofessional work.

OBJECTIVE

In this paper, the concept of a central emergency department in a tertiary care hospital which was rebuilt as an organizationally independent unit is described. Collaborations with various departments, emergency services, and local physicians are highlighted. The processes of a central emergency department with an integrated admission department and personnel structures are described.

CONCLUSION

The analysis of the concept after almost a year has shown that the integration into the clinic has been successful, the central emergency department has proven itself as a central hub and has been accepted as a unit within the hospital.

Cytotoxicity and mycotoxin production of shellfish-derived Penicillium spp., a risk for shellfish consumers

In order to assess the putative toxigenic risk associated with the presence of fungal strains in shellfish-farming areas, Penicillium strains were isolated from bivalve molluscs and from the surrounding environment, and the influence of the sample origin on the cytotoxicity of the extracts was evaluated. Extracts obtained from shellfish-derived Penicillia exhibited higher cytotoxicity than the others. Ten of these strains were grown on various media including a medium based on mussel extract (Mytilus edulis), mussel flesh-based medium (MES), to study the influence of the mussel flesh on the production of cytotoxic compounds. The MES host-derived medium was created substituting the yeast extract of YES medium by an aqueous extract of mussel tissues, with other constituent identical to YES medium. When shellfish-derived strains of fungi were grown on MES medium, extracts were found to be more cytotoxic than on the YES medium for some of the strains. HPLC-UV/DAD-MS/MS dereplication of extracts from Penicillium marinum and P. restrictum strains grown on MES medium showed the enhancement of the production of some cytotoxic compounds. The mycotoxin patulin was detected in some P. antarcticum extracts, and its presence seemed to be related to their cytotoxicity. Thus, the enhancement of the toxicity of extracts obtained from shellfish-derived Penicillium strains grown on a host-derived medium, and the production of metabolites such as patulin suggests that a survey of mycotoxins in edible shellfish should be considered.

Digital macro-photogrammetry in orthodontic tooth movement: case report

Digital macro-photogrammetry (DMP) method was used to assess the 3-dimensional (3D) movement of the canine during retraction with a Hybrid Retractor (HR) spring (Forestadent, Pforzheim, Germany) following extraction of first premolars. Computer images of the canine were generated from multiple synchronous digital photos of a patient taken during clinical follow-ups. Time intervals were recorded from the begining of the treatment before the insertion of the spring (T0), to the last follow-up session of canine retraction (T8). All movements of the canine were calculated from the generated three dimensional co-ordinates (X,Y, & Z). The results indicated that the canine was distalized about 6,78 mm over a period of 258 days. The maximum velocity of the canine movement was found to be approximately 1 mm/month. In conclusion, it was found that DMP can be applied in clinical orthodontics to monitor orthodontic tooth movement. This technique is cost-effective and measurements can be made on site as the use of computers and digital photographs have been incorporated in the majority of orthodontic practices.

Effect of coronary heart disease (CHD) risk factors and medications on invasive breast cancer risk in the Raloxifene Use for The Heart (RUTH) trial

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Background: RUTH enrolled 10,101 postmenopausal women at increased risk for major coronary events. Women were not enrolled based on their risk for breast cancer. The incidence of invasive breast cancer in the placebo group was low for this older population of women (mean age 67.5 years). The aim of this analysis was to determine whether CHD risk factors and selected cardiac medications were protective against invasive breast cancer in this population at increased risk for coronary events. Methods: Covariates assessed were baseline factors that are known CHD risk factors and selected medications ( Table ). Univariate analyses were performed for all covariates using placebo data. Results: The effect of baseline CHD risk factors and selected cardiac medications on the incidence of invasive breast cancer in women receiving placebo in RUTH (N=5057) Conclusions: In these postmenopausal women at increased risk for major coronary events, baseline CHD risk factors and selected cardiac medications assessed individually did not protect against invasive breast cancer. The low incidence of invasive breast cancer in the RUTH population does not appear to be due to the presence of CHD risk factors or use of cardiac medications.

[Table: see text]

[Table: see text]

Improving comprehension for HIV vaccine trial information among adolescents at risk of HIV

A simplified version of the HIVNET prototype HIV vaccine process was developed for adolescents at risk of HIV by:(1) reducing reading level; (2) reorganizing; (3) adding illustrations; and (4) obtaining focus group feedback. Then adolescents (N = 187) in three cities were randomly assigned to the standard or simplified version. Adolescents receiving the simplified version had significantly higher comprehension scores (80% correct vs. 72% correct), with 37% of items significantly more likely to be answered correctly. They were also significantly more likely to recall study benefits and procedures. Overall, adolescents were less willing to participate in a potential HIV vaccine trial after presentation than prior to presentation. The present study indicates that it would be feasible for adolescents to participate in a vaccine trial, as simplification of vaccine information, combined with illustrations to depict key concepts, resulted in improved scores for adolescents on the comprehension and recall test.

Prevalence of Fungal Foot Infections in Patients with Diabetes Mellitus Type 1 - Underestimation of Moccasin-Type Tinea

In diabetic patients, mycotic infections may increase the risk of developing diabetic foot syndrome. However, few data are available on the prevalence of fungal foot infections in patients with diabetes. During a conference attended by patients with long-term diabetes, 95 individuals with type 1 diabetes mellitus (52 men, 43 women, mean disease duration 35.8 years) were examined for fungal infections of the feet. As well as frequency of infection and risk profiles, the level of patient awareness and preventive measures taken were assessed by means of a questionnaire. Clinically, 78 patients (82.1 %) showed probable pedal fungal infections, of which 84.6 % (66/78) were mycologically confirmed by direct microscopy and/or culture. Skin mycoses were found in 9 patients (toe webs 5, soles 4), onychomycosis in 29 patients and simultaneous infection of nails and skin in 28 patients (toe webs 8, soles 20). Thirty-seven (47.4 %) of these patients had positive cultures, particularly for the dermatophyte Trichophyton rubrum (69.2 % of isolates). A significant correlation was found between infection and gender (men more frequently affected) and the age of the patients. The actual frequency of mycoses was underestimated by the patients. This correlated with the assessment of their own knowledge level concerning fungal infections: 83.2 % of patients with skin mycoses and 88.4 % of those with onychomycosis of the feet felt that they needed more information about their disease. Marked mycoses on the soles were often considered to be dry skin by the patients. The high number of infections detected is especially remarkable in that this group of patients were highly motivated. It therefore appears that diabetics require more diagnostic, therapeutic and preventive care in terms of mycotic diseases than has been previously thought.

Quasi-automatic 3D finite element model generation for individual single-rooted teeth and periodontal ligament

The paper demonstrates how to generate an individual 3D volume model of a human single-rooted tooth using an automatic workflow. It can be implemented into finite element simulation. In several computational steps, computed tomography data of patients are used to obtain the global coordinates of the tooth's surface. First, the large number of geometric data is processed with several self-developed algorithms for a significant reduction. The most important task is to keep geometrical information of the real tooth. The second main part includes the creation of the volume model for tooth and periodontal ligament (PDL). This is realized with a continuous free form surface of the tooth based on the remaining points. Generating such irregular objects for numerical use in biomechanical research normally requires enormous manual effort and time. The finite element mesh of the tooth, consisting of hexahedral elements, is composed of different materials: dentin, PDL and surrounding alveolar bone. It is capable of simulating tooth movement in a finite element analysis and may give valuable information for a clinical approach without the restrictions of tetrahedral elements. The mesh generator of FE software ANSYS executed the mesh process for hexahedral elements successfully.

Collagen sponges for bone regeneration with rhBMP-2

In the US alone, approximately 500,000 patients annually undergo surgical procedures to treat bone fractures, alleviate severe back pain through spinal fusion procedures, or promote healing of non-unions. Many of these procedures involve the use of bone graft substitutes. An alternative to bone grafts are the bone morphogenetic proteins (BMPs), which have been shown to induce bone formation. For optimal effect, BMPs must be combined with an adequate matrix, which serves to prolong the residence time of the protein and, in some instances, as support for the invading osteoprogenitor cells. Several factors involved in the preparation of adequate matrices, specifically collagen sponges, were investigated in order to test the performance in a new role as an implant providing local delivery of an osteoinductive differentiation factor. Another focus of this review is the current system consisting of a combination of recombinant human BMP-2 (rhBMP-2) and an absorbable collagen sponge (ACS). The efficacy and safety of the combination has been clearly proven in both animal and human trials.