Regional outcome disparities in German head and neck cancer patients: Shorter survival in Eastern Germany

INTRODUCTION

Demographics are important prognostic factors in malignant diseases. A nationwide analysis concerning the prognostic impact of demographics in head and neck cancer (HNC) patients (HNCP) has not been performed previously.

METHODS

A retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) and the Federal Statistical Office (Destatis) between 2002 and 2017 was performed. A total of 212'920 HNCP were included. Incidence, tumor stage, age development, sex distribution, age-, residence-, and diagnosis-time-specific survival were examined.

RESULTS

Mean age of HNCP increased more rapidly than in the general population (slope coefficient: 0.29 vs. 0.20; p < 0.0001). Higher age and male sex were associated with a worse prognosis. Whereas overall survival (OS) increased from the early to the later observation period for HNCP <70 years, no OS improvement for HNCP >70 years was found. Furthermore, an OS disadvantage was observed for East Germany compared to West Germany (median 47 vs. 60 months; p < 0.0001). This disparity was associated with a disproportionately high ratio of men in East Germany (men/women: 4.4 vs. 3.1; p < 0.0001) and a lower mean age (61 vs. 63 years; p < 0.0001). In addition to stage, age and sex, residence in East Germany were confirmed as an independent factor for OS in a multivariate analysis.

CONCLUSION

Finally, three decades after the German reunion, a survival disadvantage for patients in East Germany still exists. This discrepancy may be a result of socioeconomic disparities.

Demographics and access to head and neck cancer care in rural areas compared to urban areas in Germany

BACKGROUND

Demographic development in rural and urban areas differs substantially. Demographics and access to specialized head and neck cancer centers may affect head and neck cancer patients' (HNCP) outcomes. Here, we compare epidemiological indicators and outcomes of HNCP in rural and urban Germany.

PATIENTS AND METHODS

In a retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) between 2002 and 2017, 212,920 HNCP were included. Incidence, demographics, travel distance to specialized centers, and ground values were compared between rural and urban areas with a focus on their association with patient outcomes.

RESULTS

The mean age of HNCP was significantly higher in urban areas (mean difference = 1.4 years; p < 0.0001), but increased at a comparable rate (p = 0.26) in rural and urban areas during the observation period. Gender imbalance was higher in rural areas (mean ratio of men/women: 4.1 vs. 3.1; p < 0.0001), but showed a comparable trend toward equilibration in both, rural and urban districts (p = 0.46). The portion of HNCP of the entire HNCP population living in urban areas increased from 55.9% in the year 2002 to 76.4% in the year 2017. There was no significant difference or change in the ratio of advanced to low UICC stage during the observation period (p = 0.26). However, travel distances to medical centers were higher in rural areas, especially (p < 0.0001) in East Germany. Median survival of HNCP in rural areas was significantly lower than in urban areas (42 months [SEM = 0.7; CI: 40.5-43.5] vs. 54 months [SEM = 1.2; CI: 51.7-56.3]; p < 0.0001) in East Germany, whereas in West Germany no significant difference was observed (59 months [SEM = 0.8; CI: 57.4-60.6] vs. 60 months [SEM = 0.5; CI: 59.0-61.0]; p = 0.15).

CONCLUSIONS

Place of residence contributes to survival outcome of HNCP. Access to specialized care and socioeconomic factors could be improved in East Germany.

Structure variations within RSi2 and R2Si3 silicides. Part II. Structure driving factors

To gain an overview of the various structure reports on RSi₂ and R₂TSi₃ compounds (R is a member of the Sc group, an alkaline earth, lanthanide or actinide metal, T is a transition metal), compositions, lattice parameters a and c, ratios c/a, formula units per unit cell, and structure types are summarized in extensive tables and the variations of these properties when varying the R or T elements are analyzed. Following the structural systematization given in Part I, Part II focuses on revealing the driving factors for certain structure types, in particular, the electronic structure. Here, concepts of different complexity are presented, including molecular orbital theory, the principle of hard and soft acids and bases, and a Bader analysis based on Density Functional Theory calculations for representatives of the reported structure types. The potential Si/T ordering in different structures is discussed. Additionally, the influences from intrinsic and extrinsic properties (e.g. elemental size and electronics as well as lattice parameters and structure type) are investigated on each other using correlation plots. Thermal treatment is identified as an important factor for the ordering of Si/T atoms.

Structure variations within RSi2 and R2TSi3 silicides. Part I. Structure overview

Here, structural parameters of various structure reports on RSi2 and R2TSi3 compounds [where R is an alkaline earth metal, a rare earth metal (i.e. an element of the Sc group or a lathanide), or an actinide and T is a transition metal] are summarized. The parameters comprising composition, lattice parameters a and c, ratio c/a, formula unit per unit cell and structure type are tabulated. The relationships between the underlying structure types are presented within a group-subgroup scheme (Bärnighausen diagram). Additionally, unexpectedly missing compounds within the R2TSi3 compounds were examined with density functional theory and compounds that are promising candidates for synthesis are listed. Furthermore, a correlation was detected between the orthorhombic AlB2-like lattices of, for example, Ca2AgSi3 and the divalence of R and the monovalence of T. Finally, a potential tetragonal structure with ordered Si/T sites is proposed.

odMLtables: A User-Friendly Approach for Managing Metadata of Neurophysiological Experiments

An essential aspect of scientific reproducibility is a coherent and complete acquisition of metadata along with the actual data of an experiment. The high degree of complexity and heterogeneity of neuroscience experiments requires a rigorous management of the associated metadata. The odML framework represents a solution to organize and store complex metadata digitally in a hierarchical format that is both human and machine readable. However, this hierarchical representation of metadata is difficult to handle when metadata entries need to be collected and edited manually during the daily routines of a laboratory. With odMLtables, we present an open-source software solution that enables users to collect, manipulate, visualize, and store metadata in tabular representations (in xls or csv format) by providing functionality to convert these tabular collections to the hierarchically structured metadata format odML, and to either extract or merge subsets of a complex metadata collection. With this, odMLtables bridges the gap between handling metadata in an intuitive way that integrates well with daily lab routines and commonly used software products on the one hand, and the implementation of a complete, well-defined metadata collection for the experiment in a standardized format on the other hand. We demonstrate usage scenarios of the odMLtables tools in common lab routines in the context of metadata acquisition and management, and show how the tool can assist in exploring published datasets that provide metadata in the odML format.

Regulation of two motor patterns enables the gradual adjustment of locomotion strategy in Caenorhabditis elegans

In animal locomotion a tradeoff exists between stereotypy and flexibility: fast long-distance travelling (LDT) requires coherent regular motions, while local sampling and area-restricted search (ARS) rely on flexible movements. We report here on a posture control system in C. elegans that coordinates these needs. Using quantitative posture analysis we explain worm locomotion as a composite of two modes: regular undulations versus flexible turning. Graded reciprocal regulation of both modes allows animals to flexibly adapt their locomotion strategy under sensory stimulation along a spectrum ranging from LDT to ARS. Using genetics and functional imaging of neural activity we characterize the counteracting interneurons AVK and DVA that utilize FLP-1 and NLP-12 neuropeptides to control both motor modes. Gradual regulation of behaviors via this system is required for spatial navigation during chemotaxis. This work shows how a nervous system controls simple elementary features of posture to generate complex movements for goal-directed locomotion strategies.

DOI:http://dx.doi.org/10.7554/eLife.14116.001

Animals navigate through their environment using different strategies according to their current needs. For example, when the goal is to travel long distances, they move quickly and in an efficient way by employing regular, repetitive movements. However, when the aim is to explore the nearby area – to search for food, for example – animals move slowly and make more flexible movements. These different types of movement mostly use the same groups of muscles, and so animals must be able to alter how they control their muscles to yield these different strategies.

These movement strategies have been observed in many animal species, from worms to grazing cows, and researchers have mostly classified them into distinct behavioral states that the animals switch between. To date, the patterns of movements that underlie these strategies have not been described in detail.

The wavelike movement of the roundworm Caenorhabditis elegans has the advantage of being relatively easy to measure. By analyzing precise recordings of how the worms change posture as they move, Hums et al. now show that two main patterns of motion underlie worm movement. Regular whole-body waves (undulations) efficiently drive long-distance travel, while more complex turning motions allow the animals to flexibly change direction and so explore the local environment. Furthermore, the worms can fine-tune their movement strategy by gradually transitioning between the two patterns. This finding is opposed to the standard view, where animals switch between distinct behavioral states.

Hums et al. then studied how neuronal regulation in the C. elegans nervous system enables the worms to transition between the different movement strategies. In these experiments, neurons were manipulated and their activity was recorded. The results suggest that two classes of so called interneurons enable the worms to fine-tune their movements. Each class of these interneurons produces a signaling molecule (or neuropeptide) that counteracts the activity of the other signal; together both neuropeptides regulate the patterns of movements.

Further work is now needed to identify and investigate the downstream neurons that work together to represent the different patterns of movements in the roundworm. Future studies could also analyze whether other animals – such as swimming animals and limbed animals – use similar principles to change between distinct forms of movement and thus enact a range of behavioral strategies.

DOI:http://dx.doi.org/10.7554/eLife.14116.002

The responsiveness of the EQ-5D and time trade-off scores in schizophrenia, affective disorders, and alcohol addiction

OBJECTIVE

To compare the responsiveness of the EQ-5D index (German and British tariff), the EQ-5D visual analogue scale (EQ VAS), and time trade-off (TTO) scores in schizophrenia, affective disorders, and alcohol addiction.

METHODS

We used a sample of 502 patients and examined the measures at baseline and after 14 months. We used the generic "WHO Quality of Life BREF" (WHOQOL) and the disorder-specific "Global Severity Index" (GSI) as anchors for a relevant improvement in a patient's health status. In a complete case analysis, we assessed the responsiveness, which is the ability to detect a change given a relevant change on the anchor. We computed the effect sizes (ESs) and standardised response means (SRMs).

RESULTS

In patients with schizophrenia, the ESs and SRMs were large (ES/SRM > 0.8) for the British EQ-5D index (ESGSI: 0.93; SRMGSI: 0.89; SRMWHOQOL: 0.82). In patients with affective disorders, we found large ESs and SRMs for the EQ VAS (ESGSI: 1.79; ESWHOQOL: 0.90; SRMGSI: 1.52; SRMWHOQOL: 0.93) and a large ES for the British EQ-5D index (ESGSI: 0.88). In patients with alcohol addiction, the ESs and SRMs were large for the EQ VAS (ESGSI: 1.40; ESWHOQOL: 0.94; SRMGSI: 1.04; SRMWHOQOL: 0.83). The ESs and SRMs of the German EQ-5D index were consistently lower than those of the British EQ-5D index. Regarding TTO score, ESs and SRMs were generally less than 0.5.

CONCLUSIONS

No preference-based instrument was consistently more responsive than others across all mental disorders. While the EQ VAS was the most responsive instrument in patients with affective disorders or alcohol addiction, the British EQ-5D index was reasonably responsive in patients with schizophrenia.

Reliability, validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with social phobia

Objective

The aim of the study was to analyse the psychometric properties of the EQ-5D in patients with social phobia.

Methods

We used a sample of 445 patients with social phobia with five measurement points over a 30 month period. The discriminative ability of the EQ-5D was analysed by comparing the patients’ responses with the general population and between different disease severity levels. For test-retest reliability we assessed the level of agreement in patients’ responses over time, when there was no change in the Liebowitz Social Anxiety Scale (LSAS). Construct validity was analysed by identifying correlations of the EQ-5D with more specific instruments. For responsiveness we compared the means of EQ VAS/EQ-5D index anchored on improved (deteriorated) health status and computed effect sizes as well as a receiver operating characteristic (ROC) curve.

Results

Compared to the general population, patients with social phobia reported more problems in the dimensions “usual activities”, “pain/discomfort”, and “anxiety/depression” and less problems in “mobility” and “self-care”. The EQ-5D was able to distinguish between different disease severity levels. The test-retest reliability was moderate (intraclass correlation coefficient > 0.6). Correlations between the EQ-5D and other instruments were mostly small except for correlations with Beck Depression Inventory. The EQ-5D index seemed to be more responsive than the EQ VAS, but with only medium effect sizes (0.5 < effect size < 0.8) in the British EQ-5D index and only significant in patients with improved health status. The ROC analysis revealed no significant results.

Conclusions

The EQ-5D was moderately reliable and responsive in patients with improved health status. Construct validity was limited.

Trial registration

Current controlled trials ISRCTN53517394

Reliability, validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with social phobia

OBJECTIVE

The aim of the study was to analyse the psychometric properties of the EQ-5D in patients with social phobia.

METHODS

We used a sample of 445 patients with social phobia with five measurement points over a 30 month period. The discriminative ability of the EQ-5D was analysed by comparing the patients' responses with the general population and between different disease severity levels. For test-retest reliability we assessed the level of agreement in patients' responses over time, when there was no change in the Liebowitz Social Anxiety Scale (LSAS). Construct validity was analysed by identifying correlations of the EQ-5D with more specific instruments. For responsiveness we compared the means of EQ VAS/EQ-5D index anchored on improved (deteriorated) health status and computed effect sizes as well as a receiver operating characteristic (ROC) curve.

RESULTS

Compared to the general population, patients with social phobia reported more problems in the dimensions "usual activities", "pain/discomfort", and "anxiety/depression" and less problems in "mobility" and "self-care". The EQ-5D was able to distinguish between different disease severity levels. The test-retest reliability was moderate (intraclass correlation coefficient > 0.6). Correlations between the EQ-5D and other instruments were mostly small except for correlations with Beck Depression Inventory. The EQ-5D index seemed to be more responsive than the EQ VAS, but with only medium effect sizes (0.5 < effect size < 0.8) in the British EQ-5D index and only significant in patients with improved health status. The ROC analysis revealed no significant results.

CONCLUSIONS

The EQ-5D was moderately reliable and responsive in patients with improved health status. Construct validity was limited.

TRIAL REGISTRATION

Current controlled trials ISRCTN53517394.

The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review

OBJECTIVE

To systematically review approaches and instruments used to derive utility weights in cost-utility analyses (CUAs) within the field of mental disorders and to identify factors that may have influenced the choice of the approach.

METHODS

We searched the databases DARE (Database of Abstracts of Reviews of Effects), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment), and PubMed for CUAs. Studies were included if they were full economic evaluations and reported quality-adjusted life-years as the health outcome. Study characteristics and instruments used to estimate utility weights were described and a logistic regression analysis was conducted to identify factors associated with the choice of either the direct (e.g. standard gamble) or the preference-based measure (PBM) approach (e.g. EQ-5D).

RESULTS

We identified 227 CUAs with a maximum in 2009, 2010, and 2012. Most CUAs were conducted in depression, dementia, or psychosis, and came from the US or the UK, with the EQ-5D being the most frequently used instrument. The application of the direct approach was significantly associated with depression, psychosis, and model-based studies. The PBM approach was more likely to be used in recent studies, dementia, Europe, and empirical studies. Utility weights used in model-based studies were derived from only a small number of studies.

LIMITATIONS

We only searched four databases and did not evaluate the quality of the included studies.

CONCLUSIONS

Direct instruments and PBMs are used to elicit utility weights in CUAs with different frequencies regarding study type, mental disorder, and country.

Unique features of extracellular matrix in the mouse medial nucleus of trapezoid body--implications for physiological functions

The medial nucleus of the trapezoid body (MNTB) is a vital structure of sound localization circuits in the auditory brainstem. Each principal cell of MNTB is contacted by a very large presynaptic glutamatergic terminal, the calyx of Held. The MNTB principal cells themselves are surrounded by extracellular matrix components forming prominent perineuronal nets (PNs). Throughout the CNS, PNs, which form lattice-like structures around the somata and proximal dendrites, are associated with distinct types of neurons. PNs are highly enriched in hyaluronan and chondroitin sulfate proteoglycans therefore providing a charged surface structure surrounding the cell body and proximal neurites of these neurons. The localization and composition of PNs have lead investigators to a number of hypotheses about their functions including: creating a specific extracellular ionic milieu around these neurons, stabilizing synapses, and influencing the outgrowth of axons. However, presently the precise functions of PNs are still quite unclear primarily due to the lack of an ideal experimental model system that is highly enriched in PNs and in which the synaptic transmission properties can be precisely measured. The MNTB principal cells could offer such a model, since they have been extensively characterized electrophysiologically. However, extracellular matrix (ECM) in these neurons has not yet been precisely detailed. The present study gives a detailed examination of the ECM organization and structural differences in PNs of the mouse MNTB. The different PN components and their distribution pattern are scrutinized throughout the MNTB. The data are complemented by electron microscopic investigations of the unique ultrastructural localization of PN-components and their interrelation with distinct pre- and postsynaptic MNTB cell structures. Therefore, we believe this work identifies the MNTB as an ideal system for studying PN function.

New adenovirus in bats, Germany

We tested 55 deceased vespertilionid bats of 12 species from southern Germany for virus infections. A new adenovirus was isolated from tissue samples of 2 Pipistrellus pipistrellus bats, which represents the only chiropteran virus isolate found in Europe besides lyssavirus (rabies virus). Evidence was found for adenovirus transmission between bats.

[Ulcus terebrans. Therapy options and their limits]

Basal cell carcinoma (BCC) is the most common tumor in humans and is defined as a slow-growing, locally invasive, epithelial skin tumor which rarely metastasizes. The first line treatment is surgical excision with histologic examination of the tumor margins, but numerous alternative therapies are available. A 75-year old patient with the most destructive form of BCC, ulcus terebrans, involving the scalp and invading the frontal bone. We discuss the problems and therapeutic limitations for this unusual BCC variant.

Upregulation of epidermal surface molecule expression in primary and ultraviolet-induced lesions of lupus erythematosus tumidus

BACKGROUND

Lupus erythematosus tumidus (LET), a photosensitive skin disorder with characteristic clinical and histological features, has not been generally accepted as a subset of cutaneous lupus erythematosus (CLE).

OBJECTIVES

To analyse the expression of epidermal surface molecules in skin biopsy specimens from patients with LET and to relate the results to other variants of CLE, such as discoid lupus erythematosus (DLE) and subacute CLE (SCLE).

METHODS

In total, 45 patients with different subtypes of CLE were included in the study, and cryostat sections from primary and ultraviolet (UV) A- and UVB-induced skin lesions were investigated using immunohistochemical methods.

RESULTS

In contrast to healthy controls, skin lesions of LET showed upregulation of intercellular adhesion molecule-1 (ICAM-1) and histocompatibility class II molecules (HLA-DR), with an expression pattern resembling that seen in DLE and SCLE. Furthermore, staining with a monoclonal antibody against 27E10, a distinct marker for cell activation and differentiation, revealed intense focal or band-like labelling of all epidermal layers independent of the type of lesion.

CONCLUSIONS

Expression of epidermal surface molecules such as ICAM-1, HLA-DR and 27E10 is equally upregulated in primary and UV-induced lesions of patients with LET, DLE and SCLE. These results support our recent clinical findings that LET represents a distinct subset of CLE with a similar immunopathomechanism rather than a different disease.

Phototesting in lupus erythematosus: a 15-year experience

It has long been observed that sun exposure can induce or exacerbate skin lesions in patients with certain forms of lupus erythematosus. Despite the frequency of photosensitivity in these patients, the mechanism by which ultraviolet radiation alters the pathogenic course of this disease remains poorly understood. After development of standardized test methods, our group demonstrated in 1986 that skin lesions in patients with lupus erythematosus can be experimentally reproduced by UVA and UVB irradiation. In the following years, phototesting has received much attention as a valid model to study photosensitivity of different forms of lupus erythematosus and the pathogenetic mechanism of this disease. Further investigations have also made it possible to find genetic and immunologic factors associated with photosensitivity and have helped to identify the pathophysiologic steps involved in the induction of such skin lesions. We present phototesting results and clinical correlations of more than 400 patients with different forms of lupus erythematosus and discuss the recent advances in provocative phototesting.

Phototesting in Lupus Erythematosus Tumidus—Review of 60 Patients¶

Photosensitivity is an important characteristic feature of several forms of lupus erythematosus (LE), and induction of skin lesions by UV-A and UV-B irradiation has been proved to be an optimal model for evaluating light sensitivity in patients with this disease. Because lupus erythematosus tumidus (LET) has rarely been documented in the literature and is often difficult to differentiate from other photodermatoses such as polymorphous light eruption, we performed photoprovocation tests in 60 patients with LET according to a standardized protocol. Areas of uninvolved skin on the upper back were irradiated with single doses of UV-A (100 J/cm2) and/or UV-B (1.5 minimal erythema dose) daily for three consecutive days. Interestingly, patients with LET are more photosensitive than those with subacute cutaneous lupus erythematosus, and in our study experimental phototesting revealed characteristic skin lesions in 43 patients (72%). Because of the latency period in developing positive phototest reactions, it might be difficult for these patients to link sun exposure with their skin lesions. Furthermore, our data revealed a positive correlation of antinuclear antibodies and positive provocative phototest reactions in these patients as seen for other forms of LE. In conclusion, the high incidence of positive phototest reactions in correlation with the clinical findings, history of photosensitivity and antinuclear antibodies enable the classification of LET as the most photosensitive type of LE.

[Posterolateral retroperitoneal approach and exclusion technique in therapy of infrarenal aortic aneurysm: initial experiences]

Although the infrarenal aorta is a retroperitoneal structure, the surgical access has been transperitoneal especially when dealing with infrarenal aneurysms. After the opening of the sack a tube-or bifurcated graft is implanted. With the posterolateral retroperitoneal (RP) approach described by G.M. Williams in 1980 access to the aorta can be gained without opening the peritoneal cavity. With the non resective exclusion technique the intraoperative blood loss is minimized. This method is routinely used in Albany N.Y. for the treatment of infrarenal aneurysms. We describe here our first experiences with 44 RP excluded aortic aneurysms. Despite the small number of cases we can confirm the advantages described in the larger series of Sicard et al. and Leather and Shah: the RP approach and the exclusion technique can be routinely used for infrarenal aneurysms. It is associated with a smoother and shorter postoperative period (8 to 10 days).

Intracranial microembolic signals in 500 patients with potential cardiac or carotid embolic source and in normal controls

BACKGROUND AND PURPOSE

We undertook this study to evaluate the prevalence and clinical correlations of Doppler microembolic signals (MES) in stroke-prone patients.

METHODS

Patients with potential cardiac (n = 300) or carotid (n = 100) embolic source and control subjects (n = 100) were monitored with transcranial Doppler sonography for MES. Transthoracic (n = 192) and/or transesophageal (n = 134) echocardiography and carotid studies (continuous-wave Doppler, n = 181; color-coded duplex, n = 47) were performed in all patients with potential native cardioembolic source. Carotid disease was evaluated by means of continuous-wave Doppler (n = 87), color-coded duplex (n = 70), or intra-arterial angiography (n = 24) in patients with potential carotid embolic source.

RESULTS

Overall MES prevalence was 23% in patients with potential native cardioembolic source (infective endocarditis [n = 7] 43%, left ventricular aneurysm [n = 38] 34%, intracardiac thrombus [n = 23] 26%, dilative cardiomyopathy [n = 39] 26%, nonvalvular atrial fibrillation [n = 24] 21%, valvular disease [n = 80] 15%), 55% in patients with prosthetic cardiac valves (mechanical [n = 77] 58%, porcine [n = 7] 43%, homografts [n = 5] 20%), 28% in patients with carotid disease (symptomatic [n = 46] 52%, asymptomatic [n = 54] 7%; P < .01), and 5% in control subjects. No relationship between MES counts and patients' age, sex, or actual medication was noted. The sensitivity and specificity of MES detection in identifying patients with potential embolic sources were 31% and 95%, respectively.

CONCLUSIONS

Our study confirmed the reported clinical significance of MES in patients with carotid disease and the high specificity of this technique. The demonstrated low sensitivity of MES detection could be due to short monitoring duration or application of antihemostatic treatment. Prospective large-scale studies are needed to determine the definitive value of MES detection as a diagnostic method in patients with potential cardioembolic source.

Minimal effects of nitric oxide on spatial blood flow heterogeneity of the dog heart

Eleven Beagle dogs were studied to elucidate the possible role of L-arginine-derived nitric oxide on local blood flow distribution in left and right ventricular myocardium. Local blood flow was determined in 256 samples from the left and 64 samples from the right ventricle per heart using the tracer microsphere technique (mean sample mass 319 +/- 131 mg). Nitric oxide production was effectively inhibited by intravenous infusion of 20 mg/kg nitro-L-arginine methylester (L-NAME) as evidenced by a shift of the dose/response curve for the effect of intracoronary administration of bradykinin (0.004-4.0 nmol/min) on coronary blood flow. L-NAME enhanced left and right ventricular systolic pressures from 132 +/- 18 to 155 +/- 15 mm Hg and from 26 +/- 3 to 29 +/- 3 mm Hg respectively (both P = 0.043). Mean left ventricular blood flow was 1.14 +/- 0.38 before and 0.99 +/- 0.28 ml min-1 g-1 after L-NAME (P = 0.068), while right ventricular blood flow fell from 0.72 +/- 0.28 to 0.53 +/- 0.20 ml min-1 g-1 (P = 0.043). Coronary conductance of left and right ventricular myocardium fell by 31 and 43% respectively (both P = 0.043). The coefficient of variation of left ventricular blood flow was 0.26 +/- 0.07 before and 0.29 +/- 0.07 after L-NAME (P = 0.068), that of right ventricular blood flow was 0.27 before and after L-NAME. Skewness (0.51) and kurtosis (4.23) of left ventricular blood flow distribution were unchanged after L-NAME, while in the right ventricle skewness decreased from 0.54 to 0.09 (P = 0.043) and kurtosis (3.68) tended to decrease after L-NAME (P = 0.080). The fractal dimension (D = 1.20-1.27) and the corresponding nearest-neighbor correlation coefficient (rn = 0.37-0.53) of left and right ventricular myocardium remained unchanged after infusion of L-NAME. From these results it is concluded that firstly, local nitric oxide release does not explain the higher perfusion of physiological high flow samples and secondly, that spatial myocardial blood flow coordination is not dependent on nitric oxide.

[Dermatitis bullosa striata pratensis caused by Dictamnus albus L. (burning bush)]

We report two patients with bullous phototoxic contact dermatitis caused by Dictamnus albus L. (gas plant) which belongs to the Rutaceae family. In both cases long lasting postinflammatory hyper-pigmentations were observed as a result of the phototoxic contact dermatitis. The phototoxic components of Dictamnus albus L. are the furocoumarins 5-methoxypsoralen (bergapten) and 8-methoxypsoralen, and the alkaloid dictamnin whose phototoxic properties were recently discovered. Even though reactions to the gas plant have been infrequently reported, it is becoming more popular with gardenus and should be considered in the differential diagnosis of phototoxic contact dermatitis.

Spatial heterogeneity of blood flow in the dog heart. I. Glucose uptake, free adenosine and oxidative/glycolytic enzyme activity

The spatial heterogeneity of myocardial perfusion and metabolism was studied in 11 anaesthetized dogs under resting conditions. In each heart local myocardial blood flow was assessed using the tracer microsphere technique in 256 samples (mean mass: 83.1 mg) taken from the left anterior ventricular wall. In the same samples, the following biochemical parameters were determined: accumulation of [3H]-deoxyglucose (a measure of glucose uptake), free cytosolic adenosine (S-adenosylhomocysteine accumulation technique, a measure of tissue oxygenation and a possible mediator of blood flow regulation), and the specific activities of oxidative (citrate synthase, cytochrome-c-oxidase) and glycolytic (hexokinase, phosphoglycerate kinase) enzymes. Capillary density and mitochondrial and myofibril volume densities were determined by morphometry. Myocardial perfusion in each sample (average 0.77 ml min-1 g-1) varied between 0.1 and 2.5 times the mean (coefficient of variation 0.30+/-0.02). [3H]-deoxyglucose was deposited locally in proportion to perfusion. Samples showing low flow (<0.2 ml min-1 g-1) did not exhibit increased levels of cytosolic adenosine. The specific activities of the oxidative and glycolytic enzymes, however, were uniformly distributed between low and high flow areas. Furthermore, capillary density and mitochondrial and myofibril densities were similar in high and low flow regions. The results show firstly that local glucose metabolism in the heart occurs in proportion to local blood flow, suggesting that high flow regions have a higher than average metabolic rate. Secondly, regions of low flow are not compromized by critical oxygenation and most likely have a lower than average oxygen demand and finally, the homogeneous distribution of oxidative and glycolytic enzymes, as well as the homogeneous myocardial ultrastructure, suggest that areas with high and low blood flow under resting conditions may increase their metabolic rate to similar levels when required.

Spatial heterogeneity of blood flow in the dog heart. II. Temporal stability in response to adrenergic stimulation

The effects of adrenergic stimulation on local myocardial blood flow in the left ventricle were studied in 13 anaesthetized Beagle dogs using the tracer microsphere technique. Adrenergic stimulation was induced by intravenous infusion of orciprenaline (1-2 microg kg-1 min-1) over 15 min or by electrical stimulation of the left ansa subclavia (10 Hz, 1 ms, 4-8 V) over 5 min. Local myocardial blood flow was analysed in 256 samples with an average (+/-SD) mass of 318+/-49 mg from the left ventricular myocardium using a standardized dissection procedure. Orciprenaline increased the average myocardial blood flow from 0.85+/-0.18 to 1.73+/-0.27 ml min-1 g-1, while oxygen consumption and the pressure-rate product increased by 129 and 119% respectively. The coefficients of variation of local myocardial blood flow, a measure of spatial blood flow heterogeneity, were 0.21 and 0.18 under control and orciprenaline respectively. Except for a slight transmural gradient (endomyocardium/epimyocardium flow ratio 1.19) myocardial blood flow did not exhibit significant spatial gradients. Stimulation with orciprenaline increased the average blood flow in all regions of the left ventricle by comparable extents. However, local blood flow during orciprenaline was significantly lower in samples from regions which had a lower blood flow under resting control conditions. A significant positive relationship was obtained between local myocardial blood flow under resting conditions and orciprenaline (r=0.45+/-0.18). Moreover, after recovery from orciprenaline stimulation (i.e. 40-112 min after the end of orciprenaline infusion) local myocardial blood flow exhibited a high degree of correlation with local flow before orciprenaline (r=0.71+/-0.08). Comparable results were obtained with electrical stimulation of the left ansa subclavia. For the comparison stimulation vs. control, the correlation coefficient of local blood flow was 0.52+/-0.04 and for recovery vs. control 0.77+/-0.06. From these results it is concluded firstly that local myocardial blood flow under resting conditions is an important determinant of local flow during adrenergic stimulation. Secondly, the anatomical region does not have any predictive value for the blood flow change during adrenergic stimulation and finally, the close relationship between local blood flow before and after cardiac stimulation indicates that the spatial blood flow heterogeneity is temporally stable over hours.

[Effect of arginine-dependent nitric oxide synthesis on regional perfusion of the eye in the anesthesized dog]

The changes of the retinal and uveal perfusion after inhibition of the arginine-dependent nitric oxide (NO) synthesis by systemic administration of NG-nitro-L-arginine methyl ester (L-NAME; 20 mg/kg bw i.v.) were studied in four anesthetized dogs using the tracer microsphere technique. The regional perfusion rates (ml.min-1.g-1) under steady-state control conditions were: retina 0.13 +/- 0.05, choroid 8.26 +/- 1.85, iris 0.24 +/- 0.05 and ciliary body 1.11 +/- 0.26. Infusion of L-NAME over 10 min reduced the perfusion of the retina on the average by 23% (P > 0.05). The perfusion of choroid, iris and ciliary body fell by 54 +/- 8%, 58 +/- 7% and 53 +/- 8%, respectively (P < or = 0.05 for all). In five additional experiments the local activity of NO-producing enzymes (NO synthases) was determined by measuring the production rate of citrullin in tissue extracts of the different eye regions. Total NO synthase activities (pmol citrullin.min-1.g-1) were: retina 31.0 +/- 5.5, choroid 3.1 +/- 2.8, iris 7.1 +/- 2.1 and ciliary body 1.3 +/- 1.3. Differences of the total NO synthase activities of retina, iris and cilary body were statistically significant (P < or = 0.02). The results show that the uvea perfusion is largely influenced by the steady-state production of NO. The homogeneous flow reduction in the uvea after inhibition of NO synthase is contrasted by the heterogeneous NO synthase activities of the different uvea regions.(ABSTRACT TRUNCATED AT 250 WORDS)

L-arginine-derived nitric oxide: a major determinant of uveal blood flow

The effect of inhibition of the L-arginine-nitric oxide pathway on regional ocular blood flow was studied in anaesthetized Beagle dogs. Under control conditions (mean arterial blood pressure 105 +/- 6 mmHg) trapping of 11 and 15-microns-diameter tracer microspheres revealed the following regional blood flows (ml min-1 g-1): retina 0.065 +/- 0.016, choroid 5.72 +/- 0.32, ciliary body 0.77 +/- 0.11, iris 0.18 +/- 0.04. After i.v. infusion of nitro-L-arginine methylester (20 mg kg-1), a potent inhibitor of nitric oxide production from L-arginine, mean arterial blood pressure increased from 105 +/- 6 mmHg by 19% to a new steady-state level of 125 +/- 7 mmHg. This increase of arterial blood pressure extended over 3 hr and was reversible after i.v. infusion of L-arginine (100 mg kg-1 over 10 min). Despite the increase in blood pressure following infusion of nitro-L-arginine methylester blood flow of choroid, ciliary body, and iris were significantly decreased by 40, 40 and 48%, respectively. Retinal blood flow did not change significantly (-12%). These results suggest that the L-arginine-nitric oxide pathway is of major importance for the adjustment of uveal blood flow under resting physiological conditions.

Role of nitric oxide in local blood flow control in the anaesthetized dog

Intravenous infusion of NG-nitro-L-arginine methyl ester (L-NAME), a potent inhibitor of nitric oxide (NO) formation from L-arginine, provokes marked rises in arterial blood pressure by increasing peripheral resistance. In order to further evaluate the contribution of basal NO-formation to control of organ blood flow, regional blood flow distribution within the myocardium, kidney and brain areas was assessed using the tracer-microsphere technique in anaesthetized dogs. After L-NAME (20 mg kg-1 i.v.) kidney perfusion was homogeneously reduced by 55% in the entire cortex and the outer medulla. Within the left ventricular myocardium regional blood flow significantly decreased only in subepicardial layers (-12%), whereas within the entire right ventricle regional blood flow was reduced by 19-24%. A close inverse relationship was found between all changes in regional myocardial blood flows observed after L-NAME and the respective control values. No significant changes in regional blood flow in different areas of the brain were detectable after L-NAME. It is concluded that the contribution of basal NO formation varies greatly between different organs and exhibits significant regional differences within the heart. It is possible that local metabolic mechanisms may compensate functionally for the inhibition of NO synthesis.

Neuropeptides within the nucleus tractus solitarii modulate the central cardiovascular control process

Local administration of small amounts of vasopressin, angiotensin or endothelin into the nucleus tractus solitarii elicits similar decreases in blood pressure and heart rate. These central effects oppose the peripheral action of these hormones on the cardiovascular system. The baroreceptor-heart-reflex, however, is influenced differentially: vasopressin and angiotensin II enhances the sensitivity of the reflex but angiotensin III impairs it. In this way the cardiovascular system may be adjusted to different demands including those related to electrolyte and fluid homeostasis.

Cardiovascular effects of vasopressin micro-injections into the nucleus tractus solitarii in normotensive and hypertensive rats

In anesthetized, normotensive Wistar rats, Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR), 100 pg [Arg8]-vasopressin was micro-injected bilaterally into the nucleus tractus solitarii (NTS). Blood pressure and the interbeat heart interval were measured. In both Wistar rats and WKY the interbeat interval was prolonged and blood pressure was decreased, while in SHR only the interbeat interval was prolonged. Thus, within a very low dose range, the influence of [Arg8]-vasopressin within the NTS on mechanisms of cardiovascular regulation seems to differ between normotensive rats and SHR.

[Treatment of progressive axial deformities in children by surgical measures of the growth plate]

Report of the results of 4 surgically treated epiphyseal injuries with progressing deformities in the lower extremities (3 injuries type V, 1 epiphyseal fracture type IV according to Salter and Harris). Our Surgical procedure consisted in a resection of the posttraumatic transphyseal bony bridge with a following interposition of a silastic block to prevent again transphyseal blocking. The indications for such a surgical procedure is explained possibilities leading to failures are discussed. The results of our experimental studies being the basis for such operations are reported.

Entry of quinidine into cerebrospinal fluid

Some of the unwanted effects of quinidine commonly occurring in clinical practice involve the central nervous system. We therefore assessed the rate and extent of quinidine passage into cerebrospinal fluid (CSF) in humans and dogs. In eight human subjects receiving oral quinidine therapy, lumbar CSF quinidine concentrations averaged 16% of unbound serum concentrations (range: 4% to 37%). The findings were confirmed when simultaneous serum (total and unbound) and CSF quinidine concentrations were followed for up to 8 hours after a single intravenous dose of quinidine in anesthetized dogs. Quinidine appeared promptly in CSF of all animals, but CSF concentrations averaged only 37% to 46% of unbound serum levels. The in vitro octanol:water partition coefficient for quinidine at physiologic pH was greater than 100, indicating that unbound quinidine should readily traverse the blood-brain barrier. Thus, passage of quinidine into CSF appears not to be governed by passive diffusion alone. Quinidine may participate in an active transport system such as that which removes certain other basic substances from CSF.

[Results of treatment of leg paraspasm cases following longitudinal frontal myelotomy]

Follow-up examinations of 14 patients on whom longitudinal frontal myelotomy had been performed because of extreme leg spasms, showed consistently good results as far as spasm removal was concerned. Effective rehabilitation is possible only if the basic condition is stationary, if the operation is made at an early stage and followed by a comprehensive rehabilitation programme. For patients with an advancing condition the operation can alleviate the subjective discomfort felt, and it can make care easier.