Simple, low-cost, and well-performing method, the outgrowth technique, for the isolation of cells from nasal polyps

BACKGROUND

Epithelial cells are an important part of the pathomechanism in chronic rhinosinusitis with nasal polyps. It is therefore essential to establish a robust method for the isolation and culture of epithelial cells from nasal polyps to enable further research. In this study, the feasibility of the outgrowth technique for the isolation of the epithelial cells from the nasal polyps was evaluated.

RESULTS

Using the outgrowth technique, epithelial cells could be isolated from all tissue samples. Isolated epithelial cells showed a proliferation rate of approximately 7- to 23-fold every 6 days up to the 3rd passage. Over 97% of isolated cells were shown to be cytokeratin- and p63-positive, and over 86% of them were Ki-67-positive in flow cytometry. Interleukin-33 and periostin were detectable in the supernatant.

CONCLUSIONS

We introduce a simple, low-cost, and well-performing method for isolating epithelial cells from nasal polyps with the outgrowth technique.

Long-Term Cryopreservation of Nasal Polyp Tissue in a Biobank for the Isolation and Culture of Primary Epithelial Cells

Epithelial cells may play an important role in the pathologic process of chronic rhinosinusitis with nasal polyps. Therefore, providing epithelial cells from a biobank could greatly contribute to further research. In the present work, the isolation of epithelial cells from long-term cryopreserved tissue is demonstrated. Polyp tissues were cryopreserved in a commercially available freezing medium with dimethyl sulfoxide and stored in liquid nitrogen. The outgrowth and proliferation of epithelial cells from cryopreserved tissue were evaluated and compared to that of fresh tissue. Flow cytometric analysis with anti-cytokeratin, anti-p63, and anti-Ki-67 was performed to identify epithelial cells and determine differentiation and proliferation. A functionality test was performed by determining type 2–relevant proteins, representatively thymic stromal lymphopoietin (TSLP) and periostin, using ELISA. Primary epithelial cells could be isolated from cryopreserved tissues. Cells from cryopreserved tissues showed comparable outgrowth and proliferation to that of fresh tissue. Isolated epithelial cells showed high cytokeratin, p63, and Ki-67 expression and secreted TSLP and periostin. In the present study, a method for long-term cryopreservation of polyp tissue was established, thereby enabling the isolation and cell culture of primary cell culture at a later time. Epithelial cell availability should be greatly improved by including this method in a biobank.

[Syphilis infection in the ENT area]

The number of reported cases of syphilis has been increasing for years. The sexually transmitted disease is caused by the spirochete Treponema pallidum subspecies pallidum and progresses in different stages. Symptoms in the ENT area can occur in all stages. This means that a syphilis infection should always be considered by the ENT doctor as a differential diagnosis if the symptoms are suitable. Thus, with increasing oral sexual intercourse, the primary effect/hard chancre is more often observed in the oral cavity. In addition, symptoms can occur not only in the oral cavity, but also in the ear, nose, larynx, cervical and facial regions. The diagnosis is confirmed by direct pathogen detection or by serological detection. The spirochete cannot be cultivated. The therapeutic gold standard is the administration of benzathine penicillin G or procaine penicillin G. Doxycycline, macrolides or ceftriaxone are available as alternatives. In case of inner ear or cranial nerve involvement, the additional administration of a glucocorticoid is recommended. Before antibiotic therapy is administered, the patient must be informed about the possibility of a Jarisch-Herxheimer reaction. In cases of a syphilis infection, a collegial cooperation with the venereologists is always recommended so that an effective and comprehensive diagnosis and therapy can be carried out.

Distinct epitope structures of defensin-like proteins linked to proline-rich regions give rise to differences in their allergenic activity

Background

Art v 1, Amb a 4, and Par h 1 are allergenic defensin‐polyproline–linked proteins present in mugwort, ragweed, and feverfew pollen, respectively. We aimed to investigate the physicochemical and immunological features underlying the different allergenic capacities of those allergens.

Methods

Recombinant defensin‐polyproline–linked proteins were expressed in E. coli and physicochemically characterized in detail regarding identity, secondary structure, and aggregation status. Allergenic activity was assessed by mediator releases assay, serum IgE reactivity, and IgE inhibition ELISA using sera of patients from Austria, Canada, and Korea. Endolysosomal protein degradation and T‐cell cross‐reactivity were studied in vitro.

Results

Despite variations in the proline‐rich region, similar secondary structure elements were observed in the defensin‐like domains. Seventy‐four percent and 52% of the Austrian and Canadian patients reacted to all three allergens, while Korean patients were almost exclusively sensitized to Art v 1. This was reflected by IgE inhibition assays demonstrating high cross‐reactivity for Austrian, medium for Canadian, and low for Korean sera. In a subgroup of patients, IgE reactivity toward structurally altered Amb a 4 and Par h 1 was not changed suggesting involvement of linear epitopes. Immunologically relevant endolysosomal stability of the defensin‐like domain was limited to Art v 1 and no T‐cell cross‐reactivity with Art v 1_25‐36 was observed.

Conclusions

Despite structural similarity, different IgE‐binding profiles and proteolytic processing impacted the allergenic capacity of defensin‐polyproline–linked molecules. Based on the fact that Amb a 4 demonstrated distinct IgE‐binding epitopes, we suggest inclusion in molecule‐based allergy diagnosis.

Corpuls cpr resuscitation device generates superior emulated flows and pressures than LUCAS II in a mechanical thorax model

The provision of sufficient chest compression is among the most important factors influencing patient survival during cardiopulmonary resuscitation (CPR). One approach to optimize the quality of chest compressions is to use mechanical-resuscitation devices. The aim of this study was to compare a new device for chest compression (corpuls cpr) with an established device (LUCAS II). We used a mechanical thorax model consisting of a chest with variable stiffness and an integrated heart chamber which generated blood flow dependent on the compression depth and waveform. The method of blood-flow generation could be changed between direct cardiac-compression mode and thoracic-pump mode. Different chest-stiffness settings and compression modes were tested to generate various blood-flow profiles. Additionally, an endurance test at high stiffness was performed to measure overall performance and compression consistency. Both resuscitation machines were able to compress the model thorax with a frequency of 100/min and a depth of 5 cm, independent of the chosen chest stiffness. Both devices passed the endurance test without difficulty. The corpuls cpr device was able to generate about 10-40% more blood flow than the LUCAS II device, depending on the model settings. In most scenarios, the corpuls cpr device also generated a higher blood pressure than the LUCAS II. The peak compression forces during CPR were about 30% higher using the corpuls cpr device than with the LUCAS II. In this study, the corpuls cpr device had improved blood flow and pressure outcomes than the LUCAS II device. Further examination in an animal model is required to prove the findings of this preliminary study.

[Detection of hearing loss in dementia patients : pilot study and literature survey]

There is a higher incidence of dementia among people with hearing loss, although the complex interrelation is not yet understood. The potential influence of hearing rehabilitation is also unclear. A previously published retrospective study on this topic throws doubt on the ability of dementia patients to accomplish audiometric tests. Therefore, we conducted a pilot study to analyse the feasibility of applying conventional speech and pure tone audiometry in patients with dementia. In contrast to previously published data, we were able to achieve reproducible results in almost all patients. The difficulty associated with audiometric testing in dementia patients does thus not seem to lie in the application of pure tone and speech audiometry. On the basis of evidence indicating the importance of central hearing loss in the elderly, these tests alone do not appear sufficient. It is of greater interest to ascertain whether central hearing loss is relevant in patients suffering from dementia and whether corresponding audiometric tests are feasible.

[Structural and process quality in outpatient psychosocial cancer counselling centres. evaluating a major funding programme of the "Deutsche Krebshilfe e.V."]

BACKGROUND

In 2007, the German Cancer Aid ("Deutsche Krebshilfe e.V.") initiated and funded a programme in 28 selected cancer counselling centres in Germany attempting to both promote and strengthen quality assured psychosocial cancer counselling as well as to ensure long-term financing. The accompanying evaluation programme aims to collect structural data of the institutions and to evaluate processes of quality assurance within the sample of cancer counselling centres.

METHODS

On the basis of structured research within scientific databases and internet, as well as with the support of experts, characteristics of structural quality of cancer counselling centres were identified. Structural data were collected using a self-developed questionnaire and a semi-structured interview during the on-site visitations of the institutions.

RESULTS

The results show homogeneity in some fields of structural quality such as individual psycho-oncological and social counselling, human resources, room facilities, quality assurance, diagnostics, documentation and public relations. Structural quality of the investigated centres appears more heterogeneous with regard to aspects such as availability and accessibility, barrier-free access, group support offers (counselling, sports, arts, etc.) as well as cooperation, financing and written mission statements.

CONCLUSION

The investigated cancer counselling centres ensure mainly good minimum standards according to structural quality of cancer counselling. There is potential for further optimisation including cooperation, quality assurance, room facilities and being differentiated in terms of conceptual content and working concepts. Further achievements on quality assured cancer counselling can use the presented data as a basis for describing minimum standards and obligatory quality criteria.

Generation and characterization of a human acellular meniscus scaffold for tissue engineering

Meniscus tears are frequent indications for arthroscopic evaluation which can result in partial or total meniscectomy. Allografts or synthetic meniscus scaffolds have been used with varying success to prevent early degenerative joint disease in these cases. Problems related to reduced initial and long-term stability, as well as immunological reactions prevent widespread clinical use so far. Therefore, the aim of this study was to develop a new construct for tissue engineering of the human meniscus based on an acellular meniscus allograft. Human menisci (n = 16) were collected and acellularized using the detergent sodium dodecyl sulfate as the main ingredient or left untreated as control group. These acellularized menisci were characterized biomechanically using a repetitive ball indentation test (Stiffness N/mm, residual force N, relative compression force N) and by histological (hematoxylin-eosin, phase-contrast) as well as immunohistochemical (collagen I, II, VI) investigation. The processed menisci histologically appeared cell-free and had biomechanical properties similar to the intact meniscus samples (p > 0.05). The collagen fiber arrangement was not altered, according to phase-contrast microscopy and immunohistochemical labeling. The removal of the immunogenic cell components combined with the preservation of the mechanically relevant parts of the extracellular matrix could make these scaffolds ideal implants for future tissue engineering of the meniscus.

Quantitative ultrasound biomicroscopy for the analysis of healthy and repair cartilage tissue

The increasing spectrum of different cartilage repair strategies requires the introduction of adequate non-destructive methods to analyse their outcome in-vivo, i.e. arthroscopically. The validity of non-destructive quantitative ultrasound biomicroscopy (UBM) was investigated in knee joints of five miniature pigs. After 12 weeks, six 5-mm defects, treated with different cartilage repair approaches, provided tissues with different structural qualities. Healthy articular cartilage from each contralateral unoperated knee joint served as a control. The reflected and backscattered ultrasound signals were processed to estimate the integrated reflection coefficient (IRC) and apparent integrated backscatter (AIB) parameters. The cartilage repair tissues were additionally assessed biomechanically by cyclic indentation, histomorphologically and immunohistochemically. UBM allowed high-resolution visualisation of the structure of the joint surface and subchondral bone plate, as well as determination of the cartilage thickness and demonstrated distinct differences between healthy cartilage and the different repair cartilage tissues with significant higher IRC values and a steeper negative slope of the depth-dependent backscatter amplitude AIBslope for healthy cartilage. Multimodal analyses revealed associations between IRC and the indentation stiffness. Furthermore, AIBslope and AIB at the cartilage-bone boundary (AIBdC) were associated with the quality of the repair matrices and the subchondral bone plate, respectively. This ex-vivo pilot study confirms that UBM can provide detailed imaging of articular cartilage and the subchondral bone interface also in repaired cartilage defects, and furthermore, contributes in certain aspects to a basal functional characterization of various forms of cartilage repair tissues. UBM could be further established to be applied arthroscopically in-vivo.

Design of a fuzzy controller for the automation of an extracorporeal support system with the use of a simulation environment

The automation of a portable extracorporeal support system may greatly help people who suffer from cardiogenic shock by providing them with an optimal oxygen perfusion and avoid mult-organ failure while being transported to a hospital. This however requires the creation of tools that help in the design of the ideal controller. In this paper a simulation environment is described were a cardiovascular model from the ISR Physiome database was used together with a model of a portable extracorporeal support system. Additionally a model of an oxygenator/blender model is introduced to allow the simulation of oxygen perfusion. Fuzzy controlling was used for automation since it allows a straightforward implementation of expert knowledge. Through the simulation environment different scenarios may be created where intensive testing is possible and constant repetition for control optimization. Initial simulation results are given of the fuzzy controller adjusting the extracorporeal flow rate and oxygen administration for a case of low cardiac output.

Biomechanical and histomorphometric comparison between zirconia implants with varying surface textures and a titanium implant in the maxilla of miniature pigs

BACKGROUND

Mechanical properties and biocompatibility make zirconia ceramics suitable implant material. The characteristics of tooth-color like, the ability to be machined and the low plaque affinity make zirconia especially suitable as a dental implant material. The influence of surface modification on the osseointegration of this material has not been extensively investigated.

PURPOSE

Long-term investigations with titanium implants have shown superior biomechanical results with the sandblasted acid-etched (SLA) surface, demonstrating a high bone-implant interaction. The objective of this study was to compare two different zirconia surface topographies biomechanically and histologically with the well-documented titanium SLA surface.

MATERIAL AND METHODS

Zirconia implants with either a machined (ZrO2m) or a sandblasted (rough, ZrO2r) surface were manufactured with the exact same cylindrical shape with a standard ITI thread configuration as the SLA titanium implants. The incisors 2 and 3 were removed from both sides of the maxillae of 13 adult miniature pigs and the tissues left to heal for 6 months. After this time period the animals received a total of 78 implants using a randomized scheme, with the titanium SLA implant used as an only individual reference. After healing periods of 4, 8, and 12 weeks 20, 24, and 25 implants, respectively, were subjected to removal torque tests (RTQ) as the main biomechanical analysis of the of the study. A fewer number was resected on bloc, embedded in methylmethacrylat and analyzed for their direct bone apposition under a light microscope.

RESULTS

Surface analysis revealed the highest surface roughness for the SLA-implant, followed by ZrO2r and ZrO2m. The turned ZrO2m implants showed statistically significant lower RTQ values than the other two implants types after 8 and 12 weeks, while the SLA implant showed significantly higher RTQs values than ZrO2r surface after 8 weeks. Differences in the bone apposition were observed in the histomorphometric analysis using light microscopy for all surfaces at any time point.

CONCLUSION

The findings suggest that ZrO2r implants can achieve a higher stability in bone than ZrO2m implants. Roughening the turned zirconia implants enhances bone apposition and has a beneficial effect on the interfacial shear strength.

[Expression and localization profile of tenascin in squamous cell carcinomas of the head and neck]

Tenascin is a glycoprotein of the extracellular matrix and is mainly expressed in association with a high proliferative and migratory activity. This characteristic has made it a successfully used target molecule in the treatment of glioblastoma. An application of anti-tenascin therapy concept in squamous cell carcinomas of the head and neck (HNSCC) mainly depends on the expression pattern of tenascin in a tumor type. In the present study, we analyzed the messenger (m) RNA and protein expression of tenascin in HNSCC tumors when compared to normal mucosa and determined its cellular localization and correlation with various clinical parameters, including tumor staging. In native tissue tenascin protein was localized in the entire extracellular matrix surrounding the tumor. Normal mucosa showed only a weak and interrupted basement membrane staining. In situ hybridization revealed a very faint tenascin mRNA signal in basal cells of normal mucosa and a strong signal in tumor cells. This tumor cell-specific expression of tenascin was confirmed at the protein level in HNSCC cultures. However, there was no correlation of tenascin expression with tumor staging or tumor cell proliferation. Our data clearly show that tenascin is selectively expressed in HNSCC and therefore could be useful for a therapeutic intervention in these tumors.

Association of prognosis in surgically treated lung cancer patients with cytometric, histometric and ligand histochemical properties: with an emphasis on structural entropy

OBJECTIVE

To explore new tumor features for refined category formation that permits the tailoring of individualized treatment schemes in lung cancer.

STUDY DESIGN

Survival data on patients from six independent studies on cases with surgically treated lung cancer, primary lung carcinoids or metastasizing breast carcinoma (including data on primary breast carcinoma) were analyzed by nonhierarchic multivariant discriminant analysis with respect to a set of cytometric/histometric and immunohistochemical/ligand histochemical parameters. The number of stem lines, S-phase-related tumor cell fraction and the extent of structural entropy and its current were measured. In addition, the expression of binding capacities for histo-blood group trisacharides, galectins, the alpha/beta-interferon antagonist sarcolectin, the lymphokine macrophage migration inhibitory factor and a monoclonal antibody to the Le(y) epitope was monitored for insight into aspects of immunologic and biologic behavior.

RESULTS

In all studies, a correlation between tumor parameters, according to TNM stage and survival, was seen. In order to refine this category formation, at least certain selected features should provide an even more stringent association than TNM stages. Indeed, statistical correlation of the cytometric and histometric parameters as well as the expression of receptors for the two histo-blood group trisaccharides, ligands for the galectins (CL-16, CL-14) and macrophage migration inhibitory factor was stronger than that of TNM stage. A large amount of the current of structural entropy was especially highly significantly associated with poor survival. This observation could be verified in each of the different studies.

CONCLUSION

The obtained data strongly support the notion that thermodynamic evaluation of tumor growth focusing on the "entropy distance" of the tumor from its environment is a promising perspective warranting extended studies. Additionally, glycohistochemical features, including binding capacities for histo-blood group trisaccharides, have the potential to aid in establishment of a biologic marker set for tumor staging.

Application of attributed graphs in diagnostic pathology

OBJECTIVE

To compute attributed graphs based upon calculation of the minimum spanning tree (MST) for various applications in diagnostic lung pathology.

STUDY DESIGN

The study design included assistance in histologic diagnosis, confirmation of the diagnosis in single cases, measurement of texture alterations after induction chemotherapy, estimation of prognosis of operated-on lung cancer patients and analysis of lung cancer cells in association with differentiation markers. The histologic slides were Feulgen stained, and features of the integrated optical density (IOD) were associated with the nodes of the MST. The same procedure was applied to immunohistochemically and ligand histochemically stained slides by calculation of the mean staining intensity of the cytoplasm of tumor cells. A measure for structural entropy was introduced by computing the relative differences in distance and IOD between neighboring tumor cells in a 1/r2 field of force. In addition, the current of entropy was computed.

RESULTS

Structural entropy reflects alterations in regular textures; the current of entropy is an especially good prognostic parameter in lung cancer. In immunochemistry and ligand histochemistry, construction of the attributed MST permits detailed insight into locally different staining behavior of tumor cells and immunocompetent cells.

CONCLUSION

Attributed graphs contain important information that can be used for the estimation of survival or for confirmation of diagnostic entities, such as tumor cell types.

Expression of lectin, interleukin-2 and histopathologic blood group binding sites in prostate cancer and its correlation with integrated optical density and syntactic structure analysis

The binding of several biotinylated biologic probes was determined in sections of 20 surgical specimens of prostate cancer and of 21 biopsy specimens of hyperplastic prostate. Whereas neither the immunomodulatory, galactoside-specific lectin from Viscum album nor the human beta-galactoside-specific lectin (M(r) 14 kd) or its specific antibody discerned any remarkable differences, the lectin from Urtica dioica (UDA) and interleukin-2, the in vitro production of which is enhanced by this lectin, exhibited obvious preference for hyperplastic cells. In addition, the presence of binding sites for chemically synthesized blood group determinants was tested. Carcinoma cases revealed a higher percentage of binding of synthetic blood group trisaccharide H than hyperplasia cases. Due to these differences, diverse parameters, derived from measurement of integrated optical density (IOD) and from syntactic structure analysis, were correlated with the extent of binding of these biologic probes for the tumor cases. Primarily, parameters that are related to computation of a minimum spanning tree were significantly different in positive and negative cases for both UDA and interleukin-2. For the binding of blood group trisaccharide H the 5C exceeding rate, the 2CV deviation index and the distance of neighboring tumor cells with an IOD > 5 were clearly dissimilar. Our results thus suggest an extension of the panel of biologic probes for prostate cancer and substantiate the usefulness of correlations of binding of selected biologic probes to features derived from the assessment of IOD and syntactic structure analysis.

The consumer survey review process: a pathway to quality

This paper describes the consumer survey review process (CSRP), a vehicle for continuous improvement of patient care quality at The Mount Sinai Hospital in New York City. Following a historical sketch of the events which led to its establishment at Mount Sinai, we then describe the instrument used to elicit patients' rating of service delivery, the Consumer Survey, and show how it meets the changing requirements of those who use it. Next, we explain the role and functioning of the management group that most directly translates the patient satisfaction data into action, the Consumer Survey Review Group. Finally, we discuss implications of Mount Sinai's consumer survey review process for managing quality in health care.

Hospital employee-patient relations: a program for enhancing patient well-being

Hospital service employees are often untrained for the human relations aspects of their jobs. Yet, workers who clean patient rooms, deliver meals, provide escort services, make room repairs, and the like can make a critical difference in the quality of patients' hospital experiences. The Patient Service Ethic Program helps such employees identify typical patient concerns during the course of hospitalization and guides them in ways to respond appropriately to those concerns. At a large teaching hospital where this program has been implemented, employees have responded positively to the caregiver role, and managers have used the program as a catalyst for constructive change.

Abnormal seasonality of schizophrenic births. A specific finding?

The unusual finding of an abnormal seasonal distribution of schizophrenic births, showing an excess of 10% in the winter or spring months and an equal deficit in the summer or autumn months, cannot be explained by artefacts. It has not yet been established whether the finding is specific to schizophrenia. We observed an excess of schizophrenic births of some 10% in March to May, significant at the 5% level, and a deficit of approximately the same size in June to August on the birth data of first-admission patients with the clinical diagnosis of schizophrenia. The data, obtained from the Mannheim Psychiatric Case Register, were compared with those of the Mannheim population and a control group matched by birth year and sex. The total population of mentally retarded children aged 7 to 16 years from the Mannheim population showed an excess of some 20% in April to June and an equal deficit in the last two quarters of the year, compared with the Mannheim population of the same birth years. The finding was not significant, but allowance must be made for the low case number of 415. We also compared 3409 first-admission patients with depressive syndromes (ICD 296 and 300.4) and 5615 first-admission patients with the diagnosis of "neurosis and personality disorders" (ICD 300-302, except 300.4, and 305-309) from the Mannheim Case Register with a control population and a parallel control group. Depressed males showed an excess of births in March to May, which was significant at the 1% level; the birth peak for females was smaller and not significant. The same findings were obtained for the category of neurosis and personality disorders, i.e. an excess of about 10% in March to May for males, significant at the 1% level, and a non-significant excess for females. Our findings are awaiting replication. Causal explanations will be discussed with great reservation. The procreational hypothesis, assuming those factors that lead to an equidirectional seasonal pattern of births with a slight deviation from the average of a year in the general population, to be reinforced in the disease categories mentioned, is regarded as the most simple and plausible explanation. It is based on the assumption that some of the parents of individuals suffering from schizophrenia, mental retardation or probably also some other mental disorders running from generation to generation, have a higher threshold in partner-seeking behaviour, which is overcome more easily in the summer months with the consequence of increased pregnancies.