P18.06.B ETS-Transcription Factor inhibitors are effective inTERT promoter mutated meningioma cells in vitro

Background

TERT promoter mutations in meningiomas were recently found to be strongly prognostic and associated with malignant progression and risk of recurrence. As result, the mutation in the TERT promoter generates a binding site for E twenty-six (ETS) transcription factors. Consequently, ETS-transcription factor inhibition might represent a novel strategy to impede meningioma growth. In a prior study we could demonstrate effectiveness of the ETS-transcription factor inhibitor YK-4-279 in TERT promoter mutant meningiomas. Recently, TK216 the clinical derivative of YK-4-279 was developed. Therefore, we aimed to clarify whether TK216 might have an increased effect as compared to YK-4-279 in TERT promoter mutated meningioma cells in vitro.

Methods

A meningioma-derived cell line (BTL695) generated from a TERT promoter mutated (C228T) anaplastic meningioma served as cell model for the experiments. BTL695 was characterized by high telomerase activity and TERT mRNA expression as analysed by the TRAP assay and RT-PCR, respectively. Genomic aberrations were verified using Ion Torrent Oncomine Comprehensive Assay v3-based next-generation sequencing (NGS). The sensitivity of BTL695 to YK-4-279 and TK216 was determined using an MTT-based viability assay (EZ4U). To elucidate the effectiveness of TK216 on cell cycle and apoptosis, cells were stained with PI and annexin V, respectively, and measured by flow cytometry. The effect of TK216 on the protein expression of the cleaved poly(ADP-ribose) polymerase-1 (PARP-1), indicative for apoptosis, was investigated by western blot. Additionally, a TK216-resistant cell model (BTL695res) was generated and analysed by NGS.

Results

BTL695 was significantly more sensitive to TK216 as compared to YK-4-279 (p<0.0001) characterized by the distinctly lower IC50 value of TK216 exposed cells (0.7 µM TK216; 1.6 µM YK-4-279). Flow cytometry analysis revealed a TK216 induced G2M cell cycle arrest and increased apoptosis rate, which was additionally verified by the expression of cleaved PARP-1 expression using western blot. Genomic aberrations were found in 18 genes including NF2, CDKN2A/B, ARID1A and PTEN. Interestingly, although the majority of genomic alterations was persistent in the TK216 resistant cell model, a p53 mutation was newly acquired as compared to the parental cell line.

Conclusion

In summary, our results indicate that ETS transcription factor inhibition by TK216 exerts antitumour activity in our TERT promoter mutant meningioma cell model. Additionally, the sensitivity against TK216 is superior to YK-4-279 and therefore TK216 may represent a promising new therapeutic option for patients with aggressive, TERT promoter mutated meningioma.

P10.08.A Lipogenesis inhibition by fatostatin shows effectiveness in glioblastoma models highly expressing fatty acid synthase (FASN)

Background

Glioblastoma (GBM) is the most common and most aggressive primary brain tumour in adults. Despite intensive treatment, the medium overall survival of GBM patients remains below 20 months after diagnosis. Therefore, new tumour specific targets allowing successful therapeutic treatment are needed to distinctly enhance GBM patient overall survival. Reprogramming of lipid metabolism leading to highly upregulated anabolic pathways, like phosphatidylinositol-3-kinase (PI3K)/AKT pathway and subsequently lipogenesis, is a hallmark of cancer cells including glioblastomas to meet increased energy demands for proliferation and cell growth. Accordingly, lipogenesis inhibition might be a promising strategy to impede GBM cell growth. Therefore, it was aim of our study to analyse the effect of the lipogenesis inhibitor fatostatin on downstream targets e.g. fatty acid synthase (FASN) and its impact on cell growth in GBM cells in vitro.

Material and Methods

In a cohort of 52 GBM-derived cell lines, FASN mRNA was investigated by qRT-PCR. The impact of fatostatin on cell viability (IC50) was analysed in selected cell lines using cell viability assays (Cell Titer Glo®). To elucidate whether fatostatin exposure affects cell migration, wound healing assays were performed. The effect of fatostatin on cell cycle and apoptosis was analysed by flow cytometry. Additionally, expression of FASN and level of phosphorylated AKT, the active form of AKT serine/threonine kinase, were examined before and after fatostatin treatment with qRT-PCR (mRNA) and Western blot (protein), respectively.

Results

FASN mRNA was found to be expressed at varying levels in our GBM-derived cell line cohort (n=52). Compared to normal astrocytes, FASN mRNA expression was significantly upregulated in GBM cells (p=0.0127). Furthermore, high FASN mRNA expression was significantly associated with higher sensitivity against fatostatin (p=0.0352). Regarding corresponding recurrences, the response to the inhibitor was shown to be persistent. Accordingly, the effectiveness of fatostatin treatment resulted in substantial downregulation of AKT phosphorylation and consequently in the induction of apoptosis and G2/M arrest of the cell cycle. In addition, a significant inhibition of the migration potential by fatostatin treatment was observed.

Conclusion

In summary, FASN expression represents a promising biomarker and therapy target within the lipid metabolism indicated by a significant sensitivity to fatostatin in FASN overexpressing GBM cell lines. Consequently, lipogenesis inhibition by fatostatin might be a promising novel therapeutic option in glioblastoma.

OS08.4.A Retrospective analysis of in vivo 1H-magnetic resonance spectroscopy based on a machine learning approach enables reliable prediction of IDH mutation in patients with glioma

BACKGROUND

Mutation of isocitrate dehydrogenase (IDH) is not only an important landmark in the development of low-grade gliomas, but also has prognostic significance and is a potential therapeutic target. There is a high need to determinate IDH mutation status at diagnosis and during the course of therapy in a non-invasive and reliable manner. We established a machine learning approach based on a support vector machine to detect IDH mutation status in in vivo standard 1H-magnetic resonance spectroscopy (1H-MRS) at 3T with an accuracy of 88.2%, a sensitivity of 95.5% (95% CI, 77.2–99.9%), and a specificity of 75% (95% CI, 42.85–94.5%) in a prospective monocentric clinical trial. Here, the same method is applied in a retrospective cohort at 1.5T and tested for transferability.

MATERIAL AND METHODS

Validation cohort. The validation cohort comprised 100 patients with glioma for which standard in vivo 1H-MRS spectra had been acquired between 2002 and 2007. Standard single voxel spectroscopy had been measured at 1.5T using a PRESS sequence with a TR of 1500ms and a TE of 30ms. One sample had to be excluded due to non-malignant histology and for 15 samples the IDH mutation status was not available. Therefore, the validation cohort comprised 84 samples, of which 35 were bearing an IDH mutation in immunohistochemistry (sequencing for confirmation is outstanding). Machine learning. To transfer our method to an independent validation cohort our previously established machine learning approach was first trained on all samples of the 3T group. The trained algorithm was then applied to the data of the validation cohort. Here, among other factors the different field strengths, with which the spectra were acquired (3T vs. 1.5T) had to be considered.

RESULTS

27 samples of the validation cohort had to be excluded due to poor spectra quality. Our approach correctly detected IDH mutation status in 47 of 62 patients (75.8%), although the technical conditions were significantly different from our published prospective cohort. 17 of 30 patients bearing an IDH mutation were correctly identified, while 30 of 32 wild type patients were determined successfully.

CONCLUSION

Our approach to detect IDH mutation status has promising application in an unselected retrospective cohort, demonstrating transferability across different technical conditions. Further investigations to improve our technique and an advanced neuropathological processing of the samples are planned.

Mobility and fate of ligand stabilized semiconductor nanoparticles in landfill leachates

Semiconductor quantum dots (QDs) are nanocrystals used in diverse optoelectronics. At the end of their useful life they are likely to end up in landfills, where they could be mobilzed by infiltrating rain water. In this work, spectroscopic and light scattering techniques were employed to investigate the environmental fate of QDs exposed to leachates from Austrian landfill sites containing municipal solid and bulky wastes. Brij-58-coated CdSe QDs, a model for surfactant stabilized hydrophobic nanoparticles, primarily sedimented before being degraded on a slower timescale in the course of 6 months. In contrast, N-acetyl-l-cystein-coated CdTe QDs, which represent electrostatically stabilized nanoparticles with a small covalently linked stabilizing molecule, mainly underwent a degradation mechanism that was accelerated by temperature. 71-95 % of this QD type was still dispersed in all leachates after 6 months at low temperature. Leachate temperature and composition, such as the DOC, as well as the used particle coating determined the mechanistic route of clearance of sedimentation versus degradation. Our study shows, that mechanistic investigations are necessary to determine the persistence of nanoparticles depending on their coatings in waste matrices which can be further used to assess hazardous risks of such nanowastes.

Updating genome annotation for the microbial cell factory Aspergillus niger using gene co-expression networks

A significant challenge in our understanding of biological systems is the high number of genes with unknown function in many genomes. The fungal genus Aspergillus contains important pathogens of humans, model organisms, and microbial cell factories. Aspergillus niger is used to produce organic acids, proteins, and is a promising source of new bioactive secondary metabolites. Out of the 14,165 open reading frames predicted in the A. niger genome only 2% have been experimentally verified and over 6,000 are hypothetical. Here, we show that gene co-expression network analysis can be used to overcome this limitation. A meta-analysis of 155 transcriptomics experiments generated co-expression networks for 9,579 genes (∼65%) of the A. niger genome. By populating this dataset with over 1,200 gene functional experiments from the genus Aspergillus and performing gene ontology enrichment, we could infer biological processes for 9,263 of A. niger genes, including 2,970 hypothetical genes. Experimental validation of selected co-expression sub-networks uncovered four transcription factors involved in secondary metabolite synthesis, which were used to activate production of multiple natural products. This study constitutes a significant step towards systems-level understanding of A. niger, and the datasets can be used to fuel discoveries of model systems, fungal pathogens, and biotechnology.

Prevalence of WNT10A gene mutations in non-syndromic oligodontia

OBJECTIVES

Non-syndromic oligodontia is an infrequent clinical condition whose etiology is not yet completely understood being a wide spectrum of gene mutations described in concomitance with this severe form of tooth agenesis. Recently, multiple observations have linked up to 50% of cases with isolated hypodontia to mutations in the WNT10A gene. Here, we hypothesized that mutations in the WNT10A gene could also be present in families affected by non-syndromic oligodontia.

MATERIAL AND METHODS

All available patients with non-syndromic oligodontia (n = 20) treated at the Department of Orthodontics, University of Giessen, Germany between 1986 and 2013 as well as their family members were analyzed for mutations in the WNT10A gene.

RESULTS

Mutation screening was positive in 50% of the 20 patients. The analysis revealed that the mutations 2:219755011(c.682T>TA)(p.F228I), 2:219754822(c.493G>GA)(p.G165R), 2:219754816(c.487C>CT)(p.R163W), and 2:219747090(c.321C>CA)(p.C107*), the novel missense mutation 2:219757676(c.937G/GT)(p.G313C), and the novel synonym variant 2:219754854(c.525C>CT)(p.H175H) were present.

CONCLUSION

Multiple phenotypes are found in individuals presenting mutations in the WNT10A gene. Among them, the stop codon p.C107* as well as the biallelic p.F228I variants correlate with the most severe oligodontia phenotypes. In addition, we diagnosed the monoallelic mutations p.F228I, p.G165R, and p.G313C in healthy relatives with normal dentitions.

CLINICAL RELEVANCE

A correct diagnosis of non-syndromic oligodontia is fundamental to discard a possible underlying pathology in which multiple tooth agenesis could be the most evidential clinical sign. Due to the wide spectrum of pathologies that are associated to mutations in the WNT10A gene, an extended genetic analysis of these individuals' relatives is also essential.

Quantitative prediction of nuclear-spin-diffusion-limited coherence times of molecular quantum bits based on copper(ii)

We have investigated the electron spin dynamics in a series of copper(ii) β-diketonate complexes both in frozen solutions and doped solids. We simulate the coherence decay quantitatively without fit parameters.

Determination of leachate compounds relevant for landfill aftercare using FT-IR spectroscopy

Controlling and monitoring of emissions from municipal solid waste (MSW) landfills is important to reduce environmental damage and health risks. Therefore, simple and meaningful monitoring tools are required. This paper presents how Fourier Transform Infrared (FT-IR) Spectroscopy can be used to monitor leachate from various landfill sites. The composition of percolated leachate provides information about reactivity or stability of organic matter in landfills. Chemical compounds of investigated leachate are depicted by distinct spectral pattern. Partial least squares regression (PLS-R) models, a multivariate analysis tool, were developed based on infrared spectra to determine simultaneously conventional parameters such as ammonium, nitrate, sulfate, and dissolved organic carbon. The developed models are appropriate for application in waste management practice with respect to their excellent coefficients of determination, namely R(2)=0.99, 0.99, 0.98, and 0.98, their low errors of cross-validation and their high ratios of performance to deviation (RPD=9.3, 12.5, 6.5, 7.3). Thus, FT-IR spectroscopy turned out to be a reliable, time-saving tool to determine four parameters relevant for landfill aftercare monitoring by one single easy adaptable measurement.

Pilot scale evaluation of the BABIU process--upgrading of landfill gas or biogas with the use of MSWI bottom ash

Biogas or landfill gas can be converted to a high-grade gas rich in methane with the use of municipal solid waste incineration bottom ash as a reactant for fixation of CO2 and H2S. In order to verify results previously obtained at a laboratory scale with 65-90 kg of bottom ash (BA), several test runs were performed at a pilot scale, using 500-1000 kg of bottom ash and up to 9.2 Nm(3)/h real landfill gas from a landfill in the Tuscany region (Italy). The input flow rate was altered. The best process performance was observed at a input flow rate of 3.7 Nm(3)/(htBA). At this flow rate, the removal efficiencies for H2S were approximately 99.5-99%.

Pilot scale evaluation of the BABIU process--upgrading of landfill gas or biogas with the use of MSWI bottom ash

Biogas or landfill gas can be converted to a high-grade gas rich in methane with the use of municipal solid waste incineration bottom ash as a reactant for fixation of CO2 and H2S. In order to verify results previously obtained at a laboratory scale with 65-90 kg of bottom ash (BA), several test runs were performed at a pilot scale, using 500-1000 kg of bottom ash and up to 9.2 Nm(3)/h real landfill gas from a landfill in the Tuscany region (Italy). The input flow rate was altered. The best process performance was observed at a input flow rate of 3.7 Nm(3)/(htBA). At this flow rate, the removal efficiencies for H2S were approximately 99.5-99%.

Ultrasound-guided radiofrequency ablation of symptomatic uterine fibroids: short-term evaluation of effect of treatment on quality of life and symptom severity

OBJECTIVE

To evaluate the feasibility of ultrasound-guided radiofrequency ablation (USgRFA) for the treatment of women with symptomatic uterine fibroids in relation to volume of fibroid.

METHODS

Forty-three women with symptomatic fibroids underwent USgRFA for treatment of uterine fibroids. Improvements in fibroid symptoms and quality of life were measured by the Uterine Fibroid Symptom and Quality of Life questionnaire scores at baseline and 3, 6 and 9 months after the intervention, and analyzed in relation to baseline fibroid volume. Volume reduction of fibroids was measured and the frequency of adverse events and re-interventions was recorded.

RESULTS

Following USgRFA, mean Symptom Severity Scores (SSS) decreased from 60.7 ± 17.8 to 31.2 ± 19.5, corresponding to an improvement of 48.6%. The total Health-Related Quality of Life (HRQOL) score improved by 46.4% from 55.6 ± 20.9 to 81.4 ± 16.6. There was no correlation between fibroid volume at baseline and improvement in SSS and HRQOL scores. Fibroid volume was reduced in all patients, by a mean of 69.7 ± 19.4%. Two (4.7%) patients underwent hysterectomy. No adverse events occurred.

CONCLUSION

USgRFA reduces fibroid symptom and size even in patients with larger fibroids. USgRFA is a promising new treatment for fibroids in gynecological settings and should be further investigated.

Breast ultrasound in office gynecology--ten years of experience

PURPOSE

Mammography in screening or on indication is regarded as the gold standard for breast examination to detect breast cancer. The present study was performed to evaluate breast ultrasound examination (BU) as a supplement to physical breast examination in a gynecological office setting.

MATERIALS AND METHODS

BU was performed concomitantly with all physical breast examinations in a gynecological clinic. The results of all BUs during a 10-year period using the patients' personal numbers were crossed with the Danish Cancer Registry and the Danish Pathology Data Bank. All new breast malignancies registered from the date of BU and 12 months later were included.

RESULTS

A total of 3030 BUs of both breasts was performed in 1428 women. Twenty-eight new breast malignancies were registered in 27 patients. Physical examination did not reveal any tumors not detected by ultrasound. Sixteen of the 28 malignancies were non-palpable (57 %). BU detected 25 of these malignancies, thus yielding a sensitivity of 89 %. Mammography performed within 12 months of the diagnosis was negative in 11 patients resulting in a rate of 44 % of malignancies with a negative mammography result. The tumors measured an average of 11 mm (range 4 - 30 mm) using the largest diameter.

CONCLUSION

BU offers substantial help for the detection of breast cancer. The sensitivity is high, and in a gynecological setting where ultrasound is used for almost every consultation, it is natural to use the scanner for the breast examination. Larger studies with evaluation of interobserver variability for tumor detection by ultrasound are needed.

[Long-term liver damage due to trauma]

Severe trauma has a major influence on the visceral organs, especially on the liver. Splanchnic hypotension leads to necrosis of the bile duct cells as well as to damage to hepatocytes. Furthermore, the liver is a very immunologically active organ so that damage to the liver can increase the amount of proinflammatory cytokines. The major complication of post-traumatic damage to the liver is secondary sclerosing cholangitis (SCC) a highly progressive disease for which there is no sufficient therapy except liver transplantation. Therefore it is very important to put all efforts into avoiding posttraumatic liver damage from the very beginning. A sophisticated resuscitation therapy is the most important aspect. Direct peritoneal volume resuscitation is a promising possibility to improve perfusion of the visceral organs. Other possibilities are substitution with 17beta-estradiol as a strongly vasoactive hormone with a positive effect on liver perfusion and interleukin-10 as modulator of the immune reaction caused by the liver.

Limited humoral immunoglobulin E memory influences serum immunoglobulin E levels in blood

The switch of B cells expressing membrane-bound Igs, which serve as antigen receptors, to antibody-secreting plasmablasts and finally to non-dividing, long-lived plasma cells (PCs) lacking an antigen receptor, marks the terminal differentiation of a B cell. Antibody-secreting PCs represent the key cell type for the maintenance of a proactive humoral immunological memory. Although some populations of long-lived PCs persist in the spleen, most of them return to their 'place of birth' and travel to the bone marrow or invade inflamed tissues, where they survive up to several months in survival niches as resident, immobile cells. Existing data strongly support the notion that isotype-specific receptor signalling influences the migration behaviour of plasmablasts to the bone marrow. The recent observation in the murine system that the immigration of plasmablasts and the final differentiation to long-lived PCs in the bone marrow is dependent on the expressed B-cell isotype and the related expression of chemokine receptors leads to the conclusion that during a T-helper type 2 (Th2)-mediated immune response in wild type mice, IgE plasmablasts do not have the same chance to contribute to long-lived PC memory as IgG1 plasmablasts. The overall limited humoral IgE memory additionally restricts the quantity of IgE Igs in the serum.

Mswi bottom ash for upgrading of biogas and landfill gas

A new upgrading process for biogas and landfill gas (LFG) has been designed recently by the authors' institute. The process uses the alkalinity of the fine fraction of bottom ash from municipal solid waste incineration (MSWI) for sorbing CO2 and H2S. Results from process development and optimisation are presented in this paper. It is expected that nearly pure CH4 can be produced for substitution of fossil fuels. Simultaneously, the leachability of MSWI bottom ash is clearly reduced.

[What to do if incompressible bleeding from a stab wound occurs in EMS and ER? Temporary control with a Foley catheter]

Exsanguination plays a key role in avoidable prehospital deaths. As some bleedings from deep stab wounds cannot be stopped with direct compression, the insertion of a Foley catheter can prevent ongoing bleedings. A case report of bleeding from a stab wound in the supraclavicular region is given. The simple measure of careful insertion and blocking of a Foley catheter proved to be a key resuscitative procedure which can be done under any suitable circumstances.

[Procedures of temporary wall closure in abdominal trauma and sepsis]

Temporary abdominal closure methods differ mainly between vacuum-assisted and conventional approaches. Each method has its indications. Vacuum-assisted methods seem to be superior especially for trauma indications--in terms of lethality, the possibility of secondary closure during primary hospital stay, and frequency of enterocutaneous fistulas. Skin-only closure might be used as a short-term application (e.g. when damage control closure is needed), and the Bogota bag silo gives space to protruding bowels in pending or manifest abdominal compartment syndrome. Temporary fascial mesh closure enables repetitive laparotomies through the mesh, thus sparing the fascia. For that reason it is to be preferred, especially for its good practicability in clinical situations and on mission abroad.

Detection of gene expression and enzyme activity of Cytochrom P450 arom (aromatase) in preantral and early antral bovine follicles depending on culture conditions in vitro

Abstract. This study reveals that cultivation of preantral and early antral (< 500 μm) follicles in culture medium containing FCS results in an expression of cytochrome P450 arom. (aromatase). The enzymatic activity of aromatase, measured in terms of the estradiol synthesis, was proved to be present in follicles greater than 100 μm, could further be stimulated by FSH in follicles greater than 300 μm diameter. The enzyme protein and the gene expression were studied by means of western blot and immunohistochemistry as well as by means of realtime PCR. Neither the protein nor the corresponding mRNA could be found in uncultivated follicles and in FCS-free cultivated follicles. Estradiol synthesis could not be determined under FCS-free conditions. The expression of the FCS effect was dependent on the follicle size.

[Penetrating injuries to the pelvis]

As criminality and weapon use increase, general and military surgeons are increasingly confronted with penetrating pelvic injuries both at home and on peacekeeping missions. Penetrating injuries to the iliac vascular axis are associated with considerable mortality, and thus the majority of these emergency patients arrive in a state of deep hypovolemic shock. Concomitant bowel injuries are present in one of five cases, resulting in contamination of the damaged area. Surgical options are simple lateral repair, ligation of the veins, temporary shunt insertion, and prosthetic graft interposition in the injured artery. In extremis ligation of the common or external iliac artery may be the only option to save the patient's life. Surgeons must be aware that damage control surgery and related methods may be needed early on to enable patient survival.

[German education for treatment of penetrating gut traumata in army service]

On military missions abroad, surgical care for penetrating abdominal injuries differentiates from that given at home. The different conditions in the field usually include a single general surgeon with no further specialists or hospitals to rely upon. Thus a mismatch between treatment capacity and needs can be experienced in mass casualty situations. Therefore the focus is on damage control surgery, getting patients fit for evacuation, and transport home under intensive care if needed. Knowledge of ballistics and explosive devices are adjunct fields of interest, as they improve the understanding and treatment of military injuries. Although these aspects add up to additional training requirements to be met by our surgeons, we are convinced that the new German education standards will allow successful training of future military surgeons.

Cloning and characterisation of chlorophyll synthase from Avena sativa

The chlorophyll synthase gene from oat (Avena sativa) was cloned and expressed in Escherichia coli. The deduced amino acid sequence consists of 378 amino acids including a presequence of 46 amino acids. Deletion mutants show that a core protein comprising amino acid residues 88 to 377 is enzymatically active. The sequence of the mature protein shows 85% identity with the chlorophyll synthase of Arabidopsis thaliana and 62% identity with the chlorophyll synthase of Synechocystis PCC 6803. The gene is constitutively expressed as the same transcript level is found in dark-grown and in light-grown seedlings. The enzyme requires magnesium ions for activity; manganese ions can reconstitute only part of the activity. Diacetyl and N-phenylmaleimide (NPM) inhibit the enzyme activity. Site-directed mutagenesis reveals that, out of the 4 Arg residues present in the active core protein, Arg-91 and Arg-161 are essential for the activity. Five cysteine residues are present in the core protein, of which only Cys-109 is essential for the enzyme activity. Since the wild-type and all other Cys-mutants with the exception of the mutant C304A are inhibited by N-phenylmaleimide, we conclude that the inhibitor binds to a non-essential Cys residue to abolish activity. The role of the various Arg and Cys residues is discussed.

Coccygeal muscle injury in English Pointers (limber tail)

A condition colloquially referred to as "limber tail" and "cold tail" is familiar to people working with hunting dogs, primarily Pointers and Labrador Retrievers. The typical case consists of an adult dog that suddenly develops a flaccid tail. The tail either hangs down from the tail base or is held out horizontally for several inches from the tail base and then hangs straight down or at some degree below horizontal. Initially, the hair on the dorsal aspect of the proximal tail may be raised and dogs may resent palpation of the area 3-4 inches (8-10 cm) from the tail base. Most dogs recover spontaneously within a few days to weeks. Anecdotal reports suggest that anti-inflammatory drugs administered within 24 hours after onset hasten recovery. Less than one half of affected dogs experience a recurrence. Affected Pointers almost always have a history of prolonged cage transport, a hard workout the previous day, or exposure to cold or wet weather Most owners and trainers familiar with the condition do not seek veterinary assistance. In cases where people are not familiar with this disease, other conditions such as a fracture, spinal cord disease, impacted anal glands, or prostatic disease have been incorrectly diagnosed. We examined 4 affected Pointers and found evidence of coccygeal muscle damage, which included mild elevation of creatine kinase early after onset of clinical signs, needle electromyographic examination showing abnormal spontaneous discharges restricted to the coccygeal muscles several days after onset, and histopathologic evidence of muscle fiber damage. Specific muscle groups, namely the laterally positioned intertransversarius ventralis caudalis muscles, were affected most severely. Abnormal findings on thermography and scintigraphy further supported the diagnosis.

[Prevention of infection in war wounds]

Medical treatment of injured patients by international missions of non-governmental organisations in crisis areas and out-of-area operations by troops, and also national disasters require special trauma management. Deviations from peacetime surgical guidelines are obligatory because of long-distance medical evacuation, the possibility of gaps in supply and the typical pattern of war injuries. Massive contamination combined with the high risk of infection is one typical attribute of wounds inflicted during a war or a disaster. In contrast to peacetime surgical guidelines, aggressive wound débridement is often needed. Timely and prophylactically prescription of a broad-spectrum antibiotic with a long half-life has great importance in the treatment of these wounds. Suitable antibiotics for these indications are: piperacillin/tazobactam and ceftriazon. Nevertheless the use of antimicrobial agents will only be effective with early surgical débridement.

A Danish national cohort of 730 infants born after intracytoplasmic sperm injection (ICSI) 1994-1997

This national cohort study included all clinical pregnancies obtained after intracytoplasmic sperm injection (ICSI) registered in Denmark between January 1994 and July 1997 at five public and eight private fertility clinics. Laboratory and clinical data were obtained from the fertility clinics. The couples answered a questionnaire regarding the pregnancy and the health of the child (response rate 94%). Data validation was carried out through discharge charts. The mean age of the women was 32.1 years. In 84.2% of couples, male factor was the main reason for performing ICSI, and in 4.8% epididymal spermatozoa were used. The mean number of embryos replaced was 2.3 (range 1-3) and in 95% of cases fresh embryos were transferred. Only 183 women (28.5%) underwent prenatal diagnosis, resulting in 209 karyotypes with seven (3.3%) chromosome aberrations. Six major chromosomal abnormalities (2.9%) and one inherited structural chromosome aberration (0.5%) were found, but no sex chromosome aberrations. The frequency of multiple birth, Caesarean section rate, gestational age, preterm birth, and birth weight were comparable with previous studies. The perinatal mortality rate was 13.7 per 1000 children born with a gestational age of 24 weeks or more. In 2.2% (n = 16) of the liveborn infants, and in 2.7% (n = 20) of all infants, major birth defects were reported by the parents. Minor birth defects were found in nine liveborn infants (1.2%). In conclusion, the results of this study on outcome of ICSI pregnancies are in line with earlier reports, except that no sex chromosome abnormalities were found.

IL-12 administered during Chlamydia psittaci lung infection in mice confers immediate and long-term protection and reduces macrophage inflammatory protein-2 level and neutrophil infiltration in lung tissue

Protection against infections with the intracellular bacterium Chlamydia spp. requires Th1-polarized CD4+ T cell immunity. In BALB/c mouse lung infections, immediate innate and nascent Chlamydia-specific immune responses following intranasal inoculation of Chlamydia psittaci strain B577 were modulated by 7-day i.p. administration of murine rIL-12, the initiation cytokine for Th1 immunity. Treatment with IL-12 reduced the severity of chlamydial pneumonia, abolished mortality (37.5% in untreated mice), and significantly reduced numbers of chlamydial organisms in lungs. On day 4 after inoculation, the neutrophil:macrophage ratio in bronchointerstitial pneumonias was 1.96 in untreated mice and 0.51 in IL-12-treated mice. This immediate, IL-12-mediated shift in innate inflammatory phenotype was correlated with a significant reduction of lung concentrations of the neutrophil chemoattractant macrophage inflammatory protein (MIP)-2 (putative murine homologue of human IL-8), monocyte chemotactic protein-1, and TNF-alpha; and a reduction in MIP-1alpha and IFN-gamma, at high-dose infection only, and IL-12-independent IL-10 levels. Chlamydia-specific Ab titers and Ig isotype ratios indicated an IL-12-dependent Th1 shift. Recall responses of IL-12-primed mice to secondary chlamydial lung infection eliminated chlamydiae more effectively and generated a lung cytokine profile conducive to perpetuation of the Th1 memory population. These data support the hypothesis that genetic differences in endogenous IL-12 production and response pathways could determine disease outcomes characterized by poor chlamydial clearance and a purulent inflammatory infiltrate vs effective elimination of chlamydiae in a macrophage-dominated response.

[Validity of telephone ECG multichannel transmission]

Transtelephonic ECG transmission is an established monitoring system for cardiac patients in many countries around the world with the exception of Germany. This study reports first experiences with a multichannel ECG system using nine leads. This system allows to analyze ECG for ischemic events in addition to cardiac arrhythmias. In this study the reliability of a modified lead registration procedure of the telephonic ECG system David 9 (MAP, München) was compared to conventional 12-lead ECG recording (Mingograph 7, Siemens) in 225 consecutive patients. Comparison was performed using the arm electrodes of the telephonic ECG system (Tel. ECG) within the armpit (group I) or at the wrists (group II). Placing the electrodes at the wrists improved sensitivity and specificity of electrocardiograpic abnormalities to conventional 12 lead ECG (Conv. ECG). Specificity for detection of anterior myocardial infarction was 0.95 (Tel. ECG vs. Conv. ECG), specificity was 1.0. For infero-posterior infarction these relations were 0.94 and 1.0 respectively. ST-segment changes have been detected in the Tel. ECG with 0.93 and 0.89 for specificity and sensitivity. The numbers of arrhythmia analysis were 1.0 and 0.7 for all rhythm disturbances. Detection of atrial fibrillation was less reliable due to short recording time and low amplitude of the transmitted signal. Specificity and sensitivity for detection of ventricular arrhythmias were 1.0 and 0.89. Optimizing the placement of arm electrodes to the wrist instead of armpits as done up to now improved the reliability of the telephonic transmitted ECG. This telephonic ECG system then enables a reliable registration of ischemic and arrhythmic events.

Abnormal ultrasonic pattern in contralateral testes in patients with unilateral testicular cancer

Ultrasound examination and biopsy of the nonaffected testis was performed in 78 men with a unilateral testicular cancer. Each testis was measured in three planes and the volume was calculated using the formula of an ellipsoid. The ultrasonic texture of each testis was given a score ranging from 1 to 5 as follows: 1, very regular; 2, slightly irregular; 3, irregular with small echogenic points; 4, very irregular or with coarse echogenic points; and 5, irregular with demarcated areas raising suspicion of tumor. Biopsies were examined for the presence of tubules with carcinoma in situ (CIS), germinative epithelium, Sertoli cell only, and obliterations; the thickness of tubular membranes and the amount of Leydig cells were registered. The mean ultrasonic testicular volume was 12.88 ml (range 3-24 ml), which was smaller than that previously reported for normal men and larger than that previously reported for infertile men. The ultrasonic testicular volume was inversely correlated to the score. Score 4 was given to 46% of the testes (median score, 4), and the score distribution was different from that reported in normal men (median, 2) and in infertile men (median, 3). In all, 9 testes contained CIS tubules, and 8 of these were given score 4; 1 testis with CIS in only 5% of the tubules was given score 3. The predictive value of score 4 for the testis to contain CIS was 22.2%, and the predictive value of a score different from 4 that the testis would not contain CIS was 97.6%. We conclude that a large percentage of contralateral testes in men with unilateral testicular cancer have an abnormal echotexture and that CIS is most likely found in testes given score 4 by ultrasound.

Pharmacological characterization of heterodimeric NMDA receptors composed of NR 1a and 2B subunits: differences with receptors formed from NR 1a and 2A

Pharmacological and molecular biological evidence indicates the existence of multiple types of NMDA receptors within the CNS. We have characterized pharmacological properties of receptors assembled from the combination of NR 1a and NR 2B subunits (NR 1a/2B) expressed in transfected cells using both 125I-MK-801 binding assays and electrophysiological measures. Binding of 125I-MK-801 to cells transfected with NR 1a/2B is saturable with a KD of 440 pM. The binding is potently inhibited by ketamine, dextromethorphan, phencyclidine, and MK-801 and is stimulated by low concentrations of magnesium. These properties resemble those of native receptors and receptors produced by NR 1a/2A. However, 125I-MK-801 binding to membranes from cells transfected with NR 1a/2B is inhibited with high affinity by ifenprodil and is stimulated by spermidine, unlike receptors assembled from NR 1a/2A. NMDA-induced currents measured in cells transfected with either NR 1a/2A or NR 1a/2B have pharmacological properties that correlate well with the binding studies. Currents in cells transfected with NR 1a/2B are potentiated by spermidine and blocked with high affinity by ifenprodil, whereas currents in cells transfected with NR 1a/2A are not enhanced by spermidine and are weakly inhibited by ifenprodil. These data suggest that pharmacological heterogeneity in native NMDA receptors may be explained by combinations of different subunits.

An investigation of the role of Fusarium moniliforme in duodenitis/proximal jejunitis of horses

Duodenitis/proximal jejunitis syndrome (DPJ) is a small intestinal disease of horses that is associated with depression and copious gastric reflux. Since an infectious cause for DPJ remains unsubstantiated, these studies were designed to investigate the possible role of Fusarium moniliforme toxins in this disease. Fusarium moniliforme was isolated by culturing 2 samples of feed that had been fed to horses with clinical signs of DPJ. These isolates (AU 2/3) were subsequently grown concurrently on autoclaved corn and their toxicity evaluated in a feeding trial utilizing horses. Isolates of F moniliforme known to be low and high producers (RRC 415 and MRC 826, respectively) of fumonisin B1 (FB1) were cultured individually on corn and each fed separately to other groups of horses. Control horses were fed autoclaved corn that was not inoculated with fungus. Production of FB1 by isolates RRC 415, MRC 826 and AU 2/3 were 19, 4360 and 1455 ppm, respectively. Each group contained 2 horses and the test diets were prepared by diluting culture material with sweet feed and clean corn. The test diets consisted of control corn that contained < 1 ppm FB1, RRC 415 diluted to < 1 ppm FB1, MRC 826 diluted to 200 ppm FB1, and AU 2/3 culture material diluted to contain 65 ppm FB1 on days 1-10 and 130 ppm on days 11-27. Horses fed either MRC 826 or AU 2/3 had elevated serum gamma-glutamyltransferase after 7 to 21 d exposure and elevated serum L-iditol dehydrogenase activity after 7 to 19 d exposure to test diets.(ABSTRACT TRUNCATED AT 250 WORDS)

GABA-ergic interneurons of the striatum express the Shaw-like potassium channel Kv3.1

In addition to numerous GABA-ergic efferent neurons, the striatum contains a subpopulation of fast-firing GABA-ergic interneurons characterized by the presence of immunoreactivity for the calcium-binding protein, parvalbumin. Double-label in situ hybridization with digoxigenin- and radiolabelled cRNA probes was performed on striatal sections of adult rats to identify mRNAs expressed by striatal GABA-ergic interneurons. In the dorsolateral striatum, only parvalbumin mRNA-positive neurons expressed the mRNA encoding the potassium channel Kv3.1, a member of the Shaw family of potassium channels with rapid activation and inactivation kinetics, usually found in fast-firing neurons such as the basket cells of the hippocampus. Colocalization of the parvalbumin and Kv3.1 proteins was confirmed by double-label immunohistochemistry. Parvalbumin mRNA-positive neurons expressed very high levels of the mRNA encoding glutamic acid decarboxylase (Mr 67,000: GAD67) in the dorsolateral striatum. A smaller proportion of double-labelled neurons was found in the ventrolateral striatum. A small number of densely labelled neurons for GAD67 mRNA also expressed the mRNA encoding the dopamine D2 receptor, but none expressed detectable levels of the dopamine D1 receptor mRNA. This indicates major differences in the expression of dopamine receptor mRNA in a majority of GABA-ergic interneurons vs. GABA-ergic efferent neurons of the striatum. The results suggest that distinct molecular characteristics are associated with the distinct electrophysiological properties of striatal GABA-ergic neurons.

The economic considerations in laparoscopic surgery

There has been increasing concern in the medical, business, and insurance communities and government agencies about the rising cost of health care. Since 1980 the cost of medical care has increased from $280 billion dollars per year to $670 billion dollars in 1990, and was estimated at $900 billion in 1993. Several factors have contributed to this increase, including the high cost of hospitalization and new expensive technology, such as laparoscopic cholecystectomy. This present cost analysis was undertaken to determine the cost variables in laparoscopic cholecystectomy to see if changes in physician, nursing, and administration work activities could decrease the cost of hospitalization. Fifty-four patients who had an uncomplicated elective cholecystectomy during a five-month period in 1993 were assessed in terms of cost components of hospitalization, including nursing unit labor costs, surgery personnel labor costs, supply/instrument cost, and ancillary costs. Nine general surgeons participated in this study, four of whom accounted for 71% of the annual volume of cases. This analysis was performed with the help of Baxter Corporate Consulting, a Division of Baxter Healthcare Corporation. From this study, it was found that the average cost for uncomplicated laparoscopic cholecystectomy patients was $1589 +/- $223. The operating room and supply/instrument component costs were the two largest expenses, accounting for 42% of the total cost. Reimbursement from various insurance agencies were also evaluated, and it was determined that a contract made with a local HMO caused the hospital to lose an average of $443.00 per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonic texture and volume of testicles in infertile men

Ultrasound scanning of the testes and surgical biopsy were performed in 95 infertile men to evaluate the use of ultrasound in male infertility. Ultrasonic testicular volume was calculated using three measurements and the formula of an ellipsoid, and the ultrasonic texture was evaluated and given a score from 1 to 5, indicating increasing degrees of irregularity. The median score was 3 (range 1-5), which was higher than previously found in normal men (median score 2; range 1-5; P < 0.0001). The ultrasonic texture score was lower in testes with a uniform pattern of 100% spermatogenic tubules compared with the rest, both for the right (P < 0.001) and for the left (P < 0.0005) testis. Texture score was correlated with the number of obliterated tubules for both testes (P < 0.001). The mean ultrasonic testicular volume of the right testis was 10.30 ml, and that of the left 10.26 ml. Both were smaller compared with the findings in normal men (P < 0.0001). Ultrasonic testicular volume was negatively correlated with texture score (P < 0.001). A positive correlation between ultrasonic volume and sperm count was seen (P < 0.001). Sperm count was negatively correlated with texture score if calculated together with data from 119 men from the general population (P < 0.001). The study shows that ultrasonic volume and texture are valuable parameters in the evaluation of infertile men.

Benchmarking: finding ways to improve

BACKGROUND

This article provides health care organizations with a benchmarking methodology to use in comparing practices and processes to identify and actualize opportunities for improvement. The 15-step model can be used to guide internal and external benchmarking activities in a variety of health care settings.

EXAMPLES

Two internal benchmarking case studies are illustrated: (1) one hospital used the Baxter model to evaluate its laparoscopic cholecystectomy services, and (2) another prepared for expansion of cardiac catheterization services.

CONCLUSIONS

Two key factors of a successful benchmarking initiative are highlighted: management commitment and involvement, and the need to understand internal practices and processes before benchmarking.

Resolution, absolute stereochemistry, and pharmacology of the S-(+)- and R-(-)-isomers of the apparent partial AMPA receptor agonist (R,S)-2-amino-3-(3-hydroxy-5-phenylisoxazol-4-yl)propionic acid [(R,S)-APPA]

(R,S)-2-Amino-3-(3-hydroxy-5-phenylisoxazol-4-yl)propionic acid ((R,S)-APPA) is the only partial agonist at the (R,S)-2-amino-3-(3-hydroxy-5-methylisoxazol-4-yl)propionic acid (AMPA) subtype of excitatory amino acid receptors so far described. In light of the pharmacological interest in partial agonists, we have now accomplished the resolution of (R,S)-APPA. (S)-(+)-APPA (5) and (R)-(-)-APPA (6) were obtained in high enantiomeric purity using (R)-(+)- and (S)-(-)-1-phenylethylamine, respectively, as resolving agents. The absolute stereochemistry of 6 was established by X-ray analysis of 6.HCl.0.25H2O. Compounds 5 and 6 were tested electropharmacologically using the rat cortical wedge preparation and in receptor-binding assays using [3H]-AMPA, [3H]kainic acid, and the N-methyl-D-aspartic acid (NMDA) receptor ligands [3H]CPP, [3H]MK-801, and [3H]glycine. Whereas 6 did not significantly affect the binding of any of these ligands (IC50 > 100 microM), compound 5 revealed affinity for only the [3H]AMPA-binding site (IC50 = 6 microM). In electropharmacological tests, 5 showed full AMPA receptor agonism (EC50 = 230 microM). This effect of 5 was insensitive to the NMDA antagonist CPP but was inhibited competitively by the non-NMDA antagonist NBQX (pKi = 6.30). Compound 6, on the other hand, turned out to be a non-NMDA receptor antagonist, inhibiting competitively depolarizations induced by AMPA (pKi = 3.54), kainic acid (pKi = 3.07), and 5 (pKi = 3.57).

Ultrasonic testicular texture and size in 444 men from the general population: correlation to semen quality

Scrotal ultrasonography was performed in 888 testes of 444 randomly selected men appearing before the medical board prior to military service (Mili group, 287 men, median age 18.8 years), and in employees from an industrial company (Empl group, 157 men, median age 35.6 years). The ultrasonic volume of each testis was calculated from 3 perpendicular measurements. The ultrasonic texture on sectional planes was scored using a scale from 1 to 5, 1 being very regular, 2 slightly irregular, 3 moderately irregular, 4 very irregular or with bright echogenic points, and 5 with demarcated tumor suspicious areas. Orchidometer measurements were performed in 258 men in Mili group, and semen samples were obtained from 121 men in Empl group. The ultrasonic volume of the right testis (median 14.1 ml, range 3.0-31.4 ml) was bigger than that of the left testis (median 13.0 ml, range 3.5-35.2). The volume was dependent on age for men under 20 years, but not for men aged 20 years or more. The subgroup of men with a history of cryptorchidism had a smaller average testicular volume (median 10.5 ml) compared with men with normal descent (median 14.1 ml). Ultrasonic volume was positively correlated to the total sperm count in the ejaculate, to sperm penetration in egg white, and to normal sperm morphology. The echo score distribution showed slightly higher scores in Empl for both the right and the left testis. Men in Empl group were older, and it could not be precluded that this difference was due to age.(ABSTRACT TRUNCATED AT 250 WORDS)