Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel

Chronic pain causes significant suffering, limitation of daily activities and reduced quality of life. Infection from COVID-19 is responsible for an ongoing pandemic that causes severe acute respiratory syndrome, leading to systemic complications and death. Led by the World Health Organization, healthcare systems across the world are engaged in limiting the spread of infection. As a result, all elective surgical procedures, outpatient procedures and patient visits, including pain management services, have been postponed or cancelled. This has affected the care of chronic pain patients. Most are elderly with multiple comorbidities, which puts them at risk of COVID-19 infection. Important considerations that need to be recognised during this pandemic for chronic pain patients include: ensuring continuity of care and pain medications, especially opioids; use of telemedicine; maintaining biopsychosocial management; use of anti-inflammatory drugs; use of steroids; and prioritising necessary procedural visits. There are no guidelines to inform physicians and healthcare providers engaged in caring for patients with pain during this period of crisis. We assembled an expert panel of pain physicians, psychologists and researchers from North America and Europe to formulate recommendations to guide practice. As the COVID-19 situation continues to evolve rapidly, these recommendations are based on the best available evidence and expert opinion at this present time and may need adapting to local workplace policies.

An Australian study on the benefits of pastoral care to aged care residents in Christian affiliated homes

This study aimed to understand the experience of pastoral care (PC), that is, the provision of support, comfort and spiritual counselling, from the perspective of Australian aged care residents. A survey research design captured feedback on participants' PC experience. Outcomes were reported by 575 residents (aged 53-102) across 41 sites. The majority perceived that they received a high quality of care (92%) and benefited from their meeting with the pastoral practitioner (80%), 'often' or 'all of the time'. A few significant differences were found based on participants' gender, spirituality (i.e. connection and meaning), religiosity (i.e. faith beliefs and religious practices) and well-being. Females and participants who identified as both religious and spiritual were more likely to feel that their faiths/beliefs were valued. Those with greater psychological well-being, as defined by the World Health Organisation (1998), were more likely to report receiving a high quality of care and greater benefits from receiving PC than those with poorer well-being. Three overarching themes and eight subthemes were identified from the open-ended responses: 1) personal qualities of the pastoral practitioner; caring, supportive, understanding and empathetic; 2) pastoral practitioner met specific needs; spiritual and religious, friendship and company and assistance, advice and help; and 3) positive impact on the participant; feeling listened to, peaceful and valued, accepted and respected. The qualitative findings resonate with Maslow's Hierarchy of Needs, to feel safe, belong and have self-esteem. There was a synergy between what participants desire in the care they receive, as expressed in the open-ended questions, and what the pastoral practitioners provide, as indicated in the quantitative findings. A study strength was its mixed-method, multi-site and cross-organisational context, enabling PC to be explored across a diverse sample. Future research should consider a pre- and post-test survey to more comprehensively capture the impact and benefits of PC.

Increasing the throughput of label-free cell assays to study the activation of G-protein-coupled receptors by using a serial agonist exposure protocol

Label-free, holistic assays, monitoring, for example, the impedance of cells on electrodes, are gaining increasing popularity in the evaluation of G-protein-coupled receptor (GPCR) ligands. It is the strength of these approaches to provide the integrated cellular response non-invasively, highly automated and with a device-dependent time resolution down to several milliseconds. With an increasing number of samples to be studied in parallel, the available time resolution is, however, reduced and the cost for the disposable sensor arrays may become limiting. Inspired by protocols from organ pharmacology, we investigated a simple serial agonist addition assay that circumvents these limitations in impedance-based cellular assays. Using a serial addition of increasing concentrations of a GPCR agonist while continuously monitoring the sample's impedance, we were able to establish a full concentration-response curve for the endogenous agonist histamine on a single layer of U-373 MG cells endogenously expressing the histamine 1 receptor (H1R). This approach is validated with respect to conventional, parallel agonist addition protocols and studies using H1R antagonists such as mepyramine. Applicability of the serial agonist addition assay was shown for other GPCRs known for their signaling via one of the canonical G-protein pathways, Gq, Gi/0 or Gs as well. The serial agonist addition protocol has the potential to further strengthen the output of label-free analysis of GPCR activation.

Label-free versus conventional cellular assays: Functional investigations on the human histamine H1 receptor

A set of histamine H₁ receptor (H₁R) agonists and antagonists was characterized in functional assays, using dynamic mass redistribution (DMR), electric cell-substrate impedance sensing (ECIS) and various signaling pathway specific readouts (Fura-2 and aequorin calcium assays, arrestin recruitment (luciferase fragment complementation) assay, luciferase gene reporter assay). Data were gained from genetically engineered HEK293T cells and compared with reference data from GTPase assays and radioligand binding. Histamine and the other H₁R agonists gave different assay-related pEC₅₀ values, however, the order of potency was maintained. In the luciferase fragment complementation assay, the H₁R preferred β-arrestin2 over β-arrestin1. The calcium and the impedimetric assay depended on G_q coupling of the H₁R, as demonstrated by complete inhibition of the histamine-induced signals in the presence of the G_q inhibitor FR900359 (UBO-QIC). Whereas partial inhibition by FR900359 was observed in DMR and the gene reporter assay, pertussis toxin substantially decreased the response in DMR, but increased the luciferase signal, reflecting the contribution of both, G_q and G_i, to signaling in these assays. For antagonists, the results from DMR were essentially compatible with those from conventional readouts, whereas the impedance-based data revealed a trend towards higher pK_b values. ECIS and calcium assays apparently only reflect G_q signaling, whereas DMR and gene reporter assays appear to integrate both, G_q and G_i mediated signaling. The results confirm the value of the label-free methods, DMR and ECIS, for the characterization of H₁R ligands. Both noninvasive techniques are complementary to each other, but cannot fully replace reductionist signaling pathway focused assays.

Pathogenesis of varroosis at the level of the honey bee (Apis mellifera) colony

The parasitic mite Varroa destructor, in interaction with different viruses, is the main cause of honey bee colony mortality in most parts of the world. Here we studied how effects of individual-level parasitization are reflected by the bee colony as a whole. We measured disease progression in an apiary of 24 hives with differing degree of mite infestation, and investigated its relationship to 28 biometrical, physiological and biochemical indicators. In early summer, when the most heavily infested colonies already showed reduced growth, an elevated ratio of brood to bees, as well as a strong presence of phenoloxidase/prophenoloxidase in hive bees were found to be predictors of the time of colony collapse. One month later, the learning performance of worker bees as well as the activity of glucose oxidase measured from head extracts were significantly linked to the timing of colony collapse. Colonies at the brink of collapse were characterized by reduced weight of winter bees and a strong increase in their relative body water content. Our data confirm the importance of the immune system, known from studies of individually-infested bees, for the pathogenesis of varroosis at colony level. However, they also show that single-bee effects cannot always be extrapolated to the colony as a whole. This fact, together with the prominent role of colony-level factors like the ratio between brood and bees for disease progression, stress the importance of the superorganismal dimension of Varroa research.

Proton conductivity in doped aluminum phosphonate sponges

Proton-conducting networks (NETs) were prepared successfully by the insertion of phosphonated nanochannels into organic-inorganic hybrid materials that contain Al(3+) as the connector and hexakis(p-phosphonatophenyl)benzene (HPB) as the linker. Noncomplexed phosphonic acid groups remain in the framework, which depends on the ratio of both compounds, to yield a proton conductivity in the region of 10(-3) S cm(-1). This conductivity can be further improved and values as high as Nafion, a benchmark proton-exchange membrane for fuel cell applications, can be obtained by filling the network pores with intrinsic proton conductors. As a result of their sponge-like morphology, aluminum phosphonates adsorb conductive small molecules such as phosphonic acids, which results in a very high proton conductivity of approximately 5 × 10(-2) S cm(-1) at 120 °C and 50 % relative humidity (RH). Contrary to Nafion, the doped networks show a remarkably low temperature dependence of proton conductivity from external humidification. This effect indicates a transport mechanism that is different to the water vehicle mechanism. Furthermore, the materials exhibit an activation energy of 40 kJ mol(-1) at 15 % RH that starts to diminish to 10 kJ mol(-1) at 80 % RH, which is even smaller than the corresponding values obtained for Nafion 117.

Real-time label-free monitoring of the cellular response to osmotic stress using conventional and long-range surface plasmons

Cell volume and its regulation are key factors for cellular integrity and also serve as indicators of various cell pathologies. SPR sensors represent an efficient tool for real-time and label-free observations of changes in cell volume and shape. Here, we extend this concept by employing the use of long-range surface plasmons (LRSP). Due to the enhanced penetration depth of LRSP (~1μm, compared to ~0.4μm of a conventional surface plasmon), the observation of refractive index changes occurring deeper inside the cells is possible. In this work, the responses of a confluent normal rat kidney (NRK) epithelial cell layer to osmotic stress are studied by both conventional and long-range surface plasmons. Experiments are conducted in parallel using cell layers grown and stimulated under the same conditions to enable direct comparison of the results and discrimination of the osmotic stress-induced effects in different parts of the cell.

Toxicity of cryoprotectants to honey bee semen and queens

Given the threats to the intraspecific biodiversity of Apis mellifera and the pressure on bee breeding to come up with disease-tolerant lines, techniques to cryopreserve drone semen are of great interest. Freeze-thawed drone semen of high viability and/or motility has repeatedly been obtained, but fertility of such semen, when it was measured, was always low. The cryoprotective agent (CPA) most frequently used with drone semen is dimethyl sulfoxide (DMSO), although this substance has been suspected of causing genetic damage in sperm. No form of sperm washing is currently performed. Using a membrane permeability assay, we measured the short-term toxicity of four possible replacements for DMSO, 1,3-propane diol, 2,3-butane diol, ethylene glycol, and dimethyl formamide. We also tested whether the practice of inseminating queens with CPA-containing semen affects sperm numbers in the storage organs of queens, or sperm fertility. Finally, we tested whether CPA-toxicity in vivo can be reduced by using mixtures of two CPAs, DMSO, and ethylene glycol. Our results show that, although short-term toxicity of all CPAs tested was low, the presence of single CPAs in insemination mixtures at concentrations required for slow freezing greatly reduced the number of sperm reaching the spermatheca. Contrary to earlier reports, this was also true for DMSO. Ethylene glycol was additionally shown to reduce the viability of spermatozoa reaching the storage organ. Mixtures of DMSO and EthGly performed better than either substance used singly at the same concentration. We conclude that the toxicity of CPAs, including DMSO, on honey bee semen and/or queens has been underestimated in the past. This could partly explain the discrepancy between in vitro and in vivo quality of cryopreserved drone semen, described by others. Combinations of several CPAs and techniques to partly remove CPAs after thawing could help to solve this problem.

Functional rehabilitation of mandibular continuity defects using autologous bone and dental implants - prognostic value of bone origin, radiation therapy and implant dimensions

AIM

The aim of this retrospective study was to investigate prognostic parameters for the rehabilitation of mandibular continuity defects with free autologous bone and dental implants for patients after intraoral squamous cell carcinoma.

METHODS

Following potential prognostic factors for implant survival were analyzed: bony bed (local bone versus augmented iliac crest bone), radiation dose (no radiation, <50 Gy, >or=50 Gy) and implant dimensions. Kaplan-Meier survival estimates of the inserted implants were performed.

RESULTS

After 5 years, the cumulative survival rate of all investigated implants was 82.6%. Dental implantation into augmented bone resulted in a significantly lower survival rate (78.4%), compared to original local bone (92.8%). Modifications of implant dimensions as well as radiation therapy showed no significant impact on implant survival.

CONCLUSION

For the investigated compromised collective, our results reveal a satisfactory long-term survival rate of dental implants even in augmented bone and underline the value of dental implantation for the functional rehabilitation of cancer patients.

Analysis of calcium channels by conditional mutagenesis

Ca2+ influx through various ion channels is an important determinant of the cytosolic Ca2+ concentration, which plays a pivotal role in countless cellular processes. The cardiac L-type Ca2+ channel, Ca(v)1.2, represents a major pathway for Ca2+ entry and is in many cells expressed together with other high- and low-voltage-activated Ca2+ channels. This article will focus on the use of conditional transgenic mouse models to clarify the roles of Ca2+ channels in several biological systems. The phenotypes of conditional Ca2+ channel transgenic mice have provided novel, and often unexpected, insights into the in vivo function of L-type and T-type Ca2+ channels as mediators of signaling between cell membrane and intracellular processes in blood pressure regulation, smooth muscle contractility, insulin secretion, cardiac function, sleep, learning, and memory.

Bradykinin shifts endothelial fluid passage from para- to transcellular routes

The signalling peptide bradykinin (BK) is implicated in inflammation and angiogenesis. It promotes fluid transport from blood vessels to interstitial space, and thus facilitates oedema formation. To clarify whether paracellular or transcellular pathways mediate this effect, we investigated the BK-stimulated fluid transport across endothelial monolayers in vitro by comparison of electrical and fluorescence methods. Electrical cell impedance sensing monitored a biphasic response of cell layers to BK with high time resolution: a short decrease (18%, 1 min) was followed by a more sustained increase in paracellular resistance (30%, 10 min). The two phases can be assigned to second messengers of the BK-signalling pathway: Ca(2+) for the decrease and cyclic adenosine monophosphate for the rise of resistance, respectively. Despite tightening of the intercellular clefts, BK increased the fluid permeability by 39%, indicating transcellular fluid transport. Additionally, BK stimulated both in- and outwardly directed membrane trafficking as assessed by vesicular fluid uptake (by 49%) and secretion of von Willebrandt factor (by 85%). In conclusion, the combination of electrical and fluorescence data suggests that BK induces a shift from para- to transcellular fluid transport across endothelium.

Critical soft tissue parameters of the zygomatic implant

AIM

Zygomatic implants have been introduced for the rehabilitation of patients with severe bone defects of the maxilla. The soft tissue aspects of the palatal emergence situation have not been described yet. The aim of this study was to evaluate the incidence and clinical impact of possible periimplant alterations of zygomatic implants.

MATERIALS AND METHODS

From 1998 to 2001 all patients with zygomatic implants were included into this study (24 patients, 37 zygomatic implants). One implant was lost in the loading phase giving a survival rate of 97%. Fourteen patients with 20 zygomatic implants fulfilled the inclusion criteria and were all available for the recall examination. Thirteen zygomatic implants were inserted in cases of severe maxillary atrophy, seven in cases of tumour-resection of the maxilla. Clinical examination and microbial analysis using a DNA probe was performed. The implants had a mean time in situ of 598 days (min: 326, max: 914).

RESULTS

Colonisation with periodontal pathogens was found at four of the 20 implants. A positive microbiologic result of the periimplant pocket and the maximum pocket probing depth were not statistically related. Nine of the 20 implants showed bleeding on probing, four of these had positive microbiologic results. At sites without bleeding on probing only negative microbiologic samples were found (p=0.026). The mean palatal and mesial probing depth was 1 mm deeper than at the vestibular and distal aspect. Thus at nine out of the 20 implants both, bleeding on probing and pocket probing depth >/=5 mm indicated soft tissue problems resulting in a success rate of only 55%. The patient's history (tumor versus atrophy) or smoking habits seemed not to have influence the situation.

CONCLUSION

These soft tissue problems should be taken into account if zygomatic implants are considered as an alternative therapy option in the maxilla.

[Patient satisfaction with dental implants]

BACKGROUND

Almost all implant systems available today achieve success rates of over 90%. The subjective satisfaction of patients with dental implants is only rarely considered in the definition of implant success and there are only limited data on the satisfaction of patients with dental implants in the literature. Therefore, a satisfaction analysis was carried out in a retrospective study.

DESIGN OF STUDY

In addition to a clinical investigation, 330 patients with 1,273 implants (Astra, Frialit-2, IMZ TwinPlus and ITI) were asked to answer a standardized questionnaire to rate their personal opinion on the implant success. A total of 199 questionnaires (803 implants, 63%) were returned and could be analyzed.

RESULTS

Of the patients, 67% participated in regular follow-up after implantation and 15% indicated postoperative discomfort. Patient satisfaction with the implants (rated on a scale of 1-6) was good or excellent (2 and 1, respectively) in 88% of cases. Satisfaction with the prosthetic treatment was 80%. The whole treatment was considered good or very comfortable by 86% of patients. If necessary, 91% of patients who underwent the procedure would do so again, and 94% would recommend the procedure to someone else. The Spearman correlation analysis did not reveal any statistically significant correlations between the clinical parameters and patient satisfaction scores.

DISCUSSION

Despite the high number of patients involved ( n=330), the expected influence of objective clinical parameters on patient satisfaction could not be statistically evaluated. Nevertheless, in addition to the clinical parameters, subjective patient satisfaction should be included in the evaluation of implant success.

The quartz crystal microbalance as a novel means to study cell-substrate interactions in situ

The quartz crystal microbalance (QCM) was first introduced as a mass sensor in gas phase and in vacuum. Since oscillator circuits capable of exciting shear vibrations of quartz resonators under liquid loading have been developed, the QCM became accepted as a new, powerful technique to follow adsorption processes at solid-liquid interfaces in chemical and biological research. Lately, the QCM technique has attracted considerable interest as a novel means to monitor cell-substrate interactions of mammalian cells in vitro. Because the establishment and modulation of cell-substrate contacts is important for many physiological processes, and potent techniques to measure these interactions noninvasively are rare, the present review highlights applications of the QCM technique in this field. The suitability of the QCM device to monitor attachment and spreading of mammalian cells in real time has been well established. The QCM response is dependent on the individual cell type that is examined. In order to identify the sources for these cell-type-specific results of QCM readings, and to understand the information content of the signal, attempts have been made to decompose the overall QCM response into subcellular contributions. The aforementioned subjects, together with a condensed introduction into the QCM technology, are included in this article.

Five-year prospective follow-up report of the Astra tech standard dental implant in clinical treatment

Between 1994 and 1999, 515 Astra standard implants were placed and documented prospectively in 107 patients. Of these implants, 364 were placed in original jawbone, 38 in areas augmented with local osteoplasty, and 113 in bone grafts from the iliac crest. The main indications for implantation were an atrophic edentulous alveolar crest (n = 361) and a shortened dental arch (n = 113). Single-tooth implants were excluded. In a special clinical examination, 56 patients with 258 implants were investigated. The average in situ time of the implants was 34.2 months. Failing osseointegration (n = 10), peri-implantitis (n = 10), and implant fracture (n = 1) in 15 patients resulted in the failure of 21 implants (4.1%). Three patients with 8 implants died from malignant tumor. Currently, 27 implants have been lost to follow-up, and 488 implants remain in situ (95.9%). Under analyses with different implant success criteria, the success rate decreased to 85%. Based on the results in this patient population, this implant was found to be a useful alternative to established implant systems for the indications analyzed.

Porcine Choroid plexus epithelial cells in culture: regulation of barrier properties and transport processes

The epithelial cells of the choroid plexus are the structural basis of the blood-cerebrospinal fluid (CSF)-barrier. Here we summarise our recent efforts to culture those cells mainly on permeable supports in vitro. Isolated from porcine brains, we report a simple protocol for the primary culture using cytosine arabinoside as an additive that is cytotoxic for other cells except the plexus epithelial cells. Enhanced barrier properties are obtained by withdrawal of serum from the culture medium after confluency is reached. Cells improve their polarity, permeability for hydrophilic substrates is lowered, electrical resistance is increased tenfold, and a pH-gradient is built up across the cell monolayer. Polarised secretion of proteins and most importantly fluid secretion into the apical filter compartment was attained and proven to be dependent on the Na(+),K(+)-ATPase activity. Active transport processes (penicillin G, riboflavin, myo-inositol, ascorbic acid) were studied and clearly showed the involvement of the organic anion transporter. The permeability of the barrier was found to be regulated by cyclic adenosine monophosphate (cAMP). Moreover, we report that cell proliferation and differentiation is controlled by components of the extracellular matrix. The present culture model could now be used as an in vitro system to quantify drug transport across the blood-CSF-barrier.

Electric cell-substrate impedance sensing (ECIS) as a noninvasive means to monitor the kinetics of cell spreading to artificial surfaces

This article describes the optimization of an experimental technique referred to as electric cell-substrate impedance sensing (ECIS) to monitor attachment and spreading of mammalian cells quantitatively and in real time. The method is based on measuring changes in AC impedance of small gold-film electrodes deposited on a culture dish and used as growth substrate. Based on experimental data and theoretical considerations we demonstrate that high-frequency capacitance measurements (f = 40 kHz) are most suited to follow the increasing surface coverage of the electrode due to cell spreading. The excellent time resolution of the method allowed an in-depth analysis of cell spreading kinetics under various experimental conditions. Using ECIS we studied the attachment and spreading of epithelial MDCK cells (strain II) on different protein coatings, and investigated the influence of divalent cations on spreading kinetics. We quantified the inhibitory effect of soluble peptides that mimic the recognition sequence of fibronectin and other extracellular matrix proteins (RGDS). We also applied the ECIS technique to monitor the detachment of confluent fibroblastic cell layers (WI38/VA-13) by means of these peptides.

Analysis of the composite response of shear wave resonators to the attachment of mammalian cells

The suitability of the quartz crystal microbalance (QCM) technique for monitoring the attachment and spreading of mammalian cells has recently been established. Different cell species were shown to generate an individual response of the QCM when they make contact with the resonator surface. Little is known, however, about the underlying mechanisms that determine the QCM signal for a particular cell type. Here we describe our results for different experimental approaches designed to probe the particular contributions of various subcellular compartments to the overall QCM signal. Using AC impedance analysis in a frequency range that closely embraces the resonators' fundamental frequency, we have explored the signal contribution of the extracellular matrix, the actin cytoskeleton, the medium that overlays the cell layer, as well as the liquid compartment that is known to exist between the basal plasma membrane and the culture substrate. Results indicate that the QCM technique is only sensitive to those parts of the cellular body that are involved in cell substrate adhesion and are therefore close to the resonator surface. Because of its noninvasive nature, sensitivity, and time resolution, the QCM is a powerful means of quantitatively studying various aspects of cell-substrate interactions.

Barrier function of porcine choroid plexus epithelial cells is modulated by cAMP-dependent pathways in vitro

In the present paper, we demonstrate that the barrier properties of primary cultured epithelial cells isolated from porcine choroid plexus are regulated by cAMP-dependent signal transduction pathways in vitro. Triggering cAMP-connected cascades in cell layers grown on permeable filters with cAMP-analogues or forskolin led to a significant increase of transepithelial electrical resistances and a pronounced reduction in the permeation rate of a 4 kDa-dextran probe. In dose-response experiments using the cAMP-analogue 8-(4-chlorophenylthio)-cAMP transepithelial electrical resistances were observed to increase above a threshold concentration ranging between 10(-5.5) and 10(-5) M. Additional impedance studies performed with confluent cell layers grown on gold-film electrodes revealed that the observed changes in transepithelial resistances and presumably also in macromolecular permeation rates were not entirely caused by a reinforcement of intercellular junctions but also contained contributions from changes in the cell-substrate adhesion pattern. These inherent contributions to the electrical resistance and macromolecular permeability are caused by a restricted diffusion pathway between basal plasma membrane and culture substrate that have to be considered in data analysis, especially when leaky cell layers on filter substrates with low pore densities are used.

[The maxilla--a poor implant site?]

In the maxilla, it is sometimes necessary to use implants to achieve a good prosthetic result. However, an increased failure rate of maxillary implants seems to be a common clinical experience. This experience was investigated in a retrospective statistical analysis. In a retrospective study of 665 patients between 1987 and 1997, 2484 implants were examined. The implants in the upper jaw were compared to those in the lower jaw. Implants with and without autogenous bone grafts and fixtures in patients with alveolar ridge atrophy, tumor, or trauma were explored. In particular, the data obtained from the orthopantomograms after completion of the prosthetic superstructures were controlled for peri-implantary bone loss evaluation. A total of 40% of the fixtures were placed in the maxilla, and 30% of these implants were combined with a local or an iliac bone graft. Out of 2484 implants, 207 were lost, largely during the healing period. The failure rates in the groups of patients with alveolar ridge atrophy, tumor, and trauma were between 6 and 27.5%, and the differences between these groups were higher than the difference between the upper and the lower jaw. Especially in the maxilla and after osteoplasty, horizontal peri-implantary bone loss was increased, with some cases of dramatic bone loss and decrease of the osseous integration of the fixtures. There was no statistic evidence of a significantly higher failure rate in the upper jaw than in the lower jaw. However, besides the rate of implant loss, additional markers should also be considered for adequate evaluation of implant prognosis in the maxilla.

[Prognosis and prognostic factors of endosseous implants in the irradiated jaw]

In comparison to tumor patients not receiving radiotherapy, the rehabilitation of masticatory function after head and neck irradiation is limited due to radiation-induced caries, radioxerostomia, and the risk of osteoradionecrosis. This study focused on implants in the irradiated jaw and on the evaluation of the prognosis and the effect of potential factors on the prognosis. The retrospective study covered 197 implants (47 patients) from 1988 to 1997. The implant prognosis was determined by implant survival statistics (Kaplan-Meier). Losses not related to the implants were censored. In addition, groups were formed according to factors potentially affecting the prognosis. The significance of differences in the groups relative to survival were tested using the log-rank test. Twelve (6.1%) implants from a total of 197 were lost due to peri-implantitis, and eight (4.1%) due to possible biomechanical stress. A total of 52 losses (26.4%) due to death of patients and two (1.0%) due to resection of the jaw were censored; 111 (56.3%) implants remained at recall and the average interval was 33 months. The rates of implant survival (Kaplan-Meier) after 1 and 2 years were 95%, after 3 and 4 years 92%, and after 5 and 6 years 72%. The univariate analysis of group comparisons showed a significantly lower rate of loss after perimplant flap reconstruction (p = 0.036). There was no effect due to the doses of irradiation (p = 0.16), chemotherapy (p = 0.90), or peri-implant osteoplasty (p = 0.84). Although none of the implants inserted before radiotherapy had to be explanted, the implant survival difference in the very heterogeneous groups was not significant (preirradiation, n = 29; postirradiation: n = 156; p = 0.13). According to the literature, the rate of survival of teeth which were sound before radiotherapy (1 year, 75%; 5 years, 45%) was distinctly lower than the survival of enossal implants (1 year, 95%; 5 years, 72%). The high-quality rehabilitation of masticatory function with implant-based protheses is the preferred method of treatment for irradiated tumor patients. In addition, contraindications for enossal implants were ruled out for all studied factors affecting prognosis.

Use of electrochemical impedance measurements to monitor beta-adrenergic stimulation of bovine aortic endothelial cells

Due to the high permeability of endothelial cell layers derived from macrovascular vessels, precise determination of their barrier function towards ion movement requires refined experimental techniques. We thus cultured bovine aortic endothelial cells (BAEC) directly on thin gold-film electrodes and measured the electrochemical impedance to study their passive electrical properties in general and during beta-adrenergic stimulation. Impedance spectra (10-2.10(6) Hz) of confluent cell monolayers revealed that the electrical characteristics of the cells can be modelled by a simple resistor-capacitor parallel network. Under control conditions the overall resistance of confluent BAEC monolayers was 3.6+/-0.6 Omega.cm2 (n=30) and the capacitance was 0. 6+/-0.1 microF/cm2. Both quantities are discussed with respect to morphological characteristics of these cells. Stimulation of BAECs with the synthetic beta-adrenoceptor agonist isoproterenol leads to a concentration-dependent, highly specific increase of the cell layer resistance characterized by a concentration for half-maximal response (EC50) of 0.3+/-0.1 microM. The cell layer capacitance, however, remained unaffected. Using impedance measurements at a single frequency, we analysed the response of BAECs to treatment with isoproterenol in comparison with several chemically unrelated compounds known to stimulate the adenosine 3',5'-cyclic monophosphate (cAMP)-dependent signal transduction cascade. These studies confirmed that the enhancement of the cell layer resistance after beta-adrenergic stimulation is mediated by an increase in intracellular cAMP.

Cell adhesion monitoring using a quartz crystal microbalance: comparative analysis of different mammalian cell lines

The quartz crystal microbalance (QCM) has been widely accepted as a sensitive technique to follow adsorption processes in gas as well as in liquid environments. However, there are only a few reports about the use of this technique to monitor the attachment and spreading of mammalian cells onto a solid support in culture. Using a QCM-setup we investigated the time course of cell attachment and spreading as a function of seeding density for three widespread and frequently used cell lines (MDCK strains I and II and Swiss 3T3-fibroblasts). Results were found to be in good agreement with the geometrical properties of the individual cell types. The shifts of the resonance frequency associated with confluent cell layers on top of the quartz resonators were found to be dependent on the cell species [MDCK-I: (320 +/- 20) Hz; MDCK-II: (530 +/- 25) Hz; 3T3: (240 +/- 15) Hz] reflecting their individual influence on the shear oscillation of the resonator. These findings are discussed with respect to the basic models of materials in contact with an oscillating quartz resonator. We furthermore showed by inhibition-assays using soluble RGD-related peptides, that only specific, integrin mediated cell adhesion is detected using this QCM approach, whereas the sole presence of the cellular body in close vicinity to the resonator surface is barely detectable.

Acting without asking: an ethical analysis of the Food and Drug Administration waiver of informed consent for emergency research

This article summarizes the current requirements for a waiver of informed consent for emergency research and analyzes ethical issues that are involved. Researchers who intend to apply for a waiver of informed consent for emergency research must understand that they are asking for the major protector of human subjects, the informed consent process, to be removed. In its absence, other protections are required. These include communication with the community, family members, and others close to the patient. It is unlikely that even these additional protections can equal that afforded by an adequate consent process. With this understanding, investigators' actions must be in accordance with the highest ethical standards. It is therefore necessary for investigators to know the ethical implications of conducting controlled research without the subjects' consent.

Analysis and occurrence of estrogenic hormones and their glucuronides in surface water and waste water in The Netherlands

An analytical procedure was developed that enables routine analysis of four estrogenic hormones in concentrations below 1 ng/l in surface water and waste water. The recovery was 88-98% with a limit of detection of 0.1-2.4 ng/l depending on the compound and the matrix measured. This method was used to determine the occurrence of 17 beta-estradiol, 17 alpha-estradiol, estrone and 17 alpha-ethinylestradiol in the aquatic environment in The Netherlands. The data show that estrogenic hormones can be detected at low concentrations (up to 6 ng/l) at some locations in surface water. In selected effluents of waste water treatment plants estrone and 17 beta-estradiol were detected in concentrations in the ng/l range. Concentrations of 17 alpha-estradiol and the contraceptive 17 alpha-ethinylestradiol were in most of these samples below the limit of detection. Hormone glucuronides were not detected in most surface water and effluents.

The polarity of choroid plexus epithelial cells in vitro is improved in serum-free medium

The influence of culture conditions on the development of normal characteristics of the choroid plexus epithelium has been investigated in vitro with respect to polarity, barrier properties, transport, and secretory activity. Withdrawal of serum supplement in the culture medium of cells grown on filters caused morphologically visible changes by an increased trimming of microvilli at the apical membrane side, which is accompanied by an increased expression of the Na+,K+-ATPase. Moreover cells under serum-free conditions exhibit structural changes in tight junctional zonula occludens protein-1 (ZO-1) organization, a reduced permeability, and a drastically increased electrical resistance from 150 ohms x cm2 in the presence of serum to 1,500 ohms x cm2 after serum withdrawal. Under these conditions, cell monolayers are able to build up a transcellular proton gradient and to secrete fluid into the upper (apical) filter compartment, which is accompanied by a polarized secretion of proteins like transthyretin. Active transport of the dyes fluorescein and phenol red by the organic anion transporter is found to be driven by the Na+,K+-ATPase. We come to the conclusion that removal of serum favors the differentiation process of the plexus epithelium in vitro, which brings the cell culture model closer to the physiological situation in vivo. We present preliminary evidence that epidermal growth factor may be one component in serum preventing the proper in vitro differentiation.

Hydrocortisone reinforces the blood-brain properties in a serum free cell culture system

The increasing number of newly developed drugs demands for functional in vitro models of the blood-brain barrier to determine their brain uptake. Cultured cerebral capillary endothelial cells are considered to be such a model, however in serum containing media they exhibit low electrical resistances and high permeabilities compared to the in vivo situation. Here we report the establishment of a serum-free cell culture model. Withdrawal of serum already caused a twofold increase of transendothelial resistance (TER), which in presence of serum is about 100-150 Omega x cm2. We tested several supplements and found that hydrocortisone is a potent stimulator for the formation of barrier properties. TERs up to 1000 Omega x cm2 were measured in the presence of physiological relevant hydrocortisone concentrations. In correspondence to the TER increase hydrocortisone decreased cell monolayer permeability for sucrose down to 5x10(-7) cm/s, which is close to the in vivo value of 1.2x10(-7) cm/s and by a factor of five lower compared to cultures without hydrocortisone and in presence of serum.

Hydrocortisone reinforces the blood-brain barrier properties in a serum free cell culture system

The increasing number of newly developed drugs demands for functional in vitro models of the blood-brain barrier to determine their brain uptake. Cultured cerebral capillary endothelial cells are considered to be such a model, however in serum containing media they exhibit low electrical resistances and high permeabilities compared to the in vivo situation. Here we report the establishment of a serum-free cell culture model. Withdrawal of serum already caused a twofold increase of transendothelial resistance (TER), which in presence of serum is about 100-150 omega.cm2. We tested several supplements and found that hydrocortisone is a potent stimulator for the formation of barrier properties. TERs up to 1000 omega.cm2 were measured in the presence of physiological relevant hydrocortisone concentrations. In correspondence to the TER increase hydrocortisone decreased cell monolayer permeability for sucrose down to 5 x 10(-7) cm/s, which is close to the in vivo value of 1.2 x 10(-7) cm/s and by a factor of five lower compared to cultures without hydrocortisone and in presence of serum.

Impedance and shear wave resonance analysis of ligand-receptor interactions at functionalized surfaces and of cell monolayers

The present paper scrutinizes the application of impedance spectroscopy and quartz-crystal microbalance (QCM) measurements in the analysis of composite layers of receptor containing lipid bilayers, and their interaction with external ligands or pore-forming peptides. The formation of supramolecular structures and their analysis will be discussed. Impedance measurement allows one to follow the adsorption of proteins on artificial membranes. This method is even more suitable for quantifying changes in membrane conductivity induced by channel peptides incorporated into the lipid membrane. The QCM is another sophisticated method for analyzing ganglioside-lectin and ganglioside-toxin interactions. A critical comparison between both methods will be given. Moreover, we will demonstrate that the QCM method, especially in combination with impedance analysis, is a completely new approach for determining electrical and viscoelastic properties of epithelial and endothelial cell monolayers that form controlled barriers in vivo.

Porcine choroid plexus cells in culture: expression of polarized phenotype, maintenance of barrier properties and apical secretion of CSF-components

We have successfully cultured choroid plexus epithelial cells from porcine brain in pure form by the addition of cytosine arabinoside to the culture medium which prevented growth of other contaminating cells. We characterized the cells in culture by the presence of desmoplakin, fibronectin, thrombospondin, and the zonula occludens protein ZO-1 in comparison to frozen fractions of the isolated choroid plexus tissue. The cells in culture express those marker proteins and moreover exhibit a polarized phenotype which was expected from the presence of tight junction strands that correlate to an electrical resistance of 120 Ohm.cm2 measured across the cell monolayer on a permeable support. Permeability studies with fluorescein-labeled dextrans also indicate a biochemical tightness. The polarity of the cells is demonstrated by the presence of microvilli and cilia on the surface of the cultured cells as well as by the laser scanning microscopic determination of the apical localization of the ZO-1-protein and the Na+K(+)-ATPase. Thrombospondin and fibronectin were found to be localized at the basolateral membrane side. The cells in culture secrete medium containing prealbumin predominantly into the apical compartment which demonstrates that they are able to release medium containing CSF-proteins and therefore verifies the usefulness of this in vitro model.

Impedance analysis of epithelial and endothelial cell monolayers cultured on gold surfaces

The present study describes a new method to determine transepithelial and transendothelial electrical resistances (TER) of cultured cell monolayers which is based on impedance analysis. To obtain impedance data of the epithelia or endothelia under investigation, we developed special measuring chambers that allow to culture the cells on gold surfaces that are used as measuring electrodes. Impedance analysis is carried out in the frequency range from 1 to 10(5) s-1 under normal culture conditions using a self-developed continuous wave impedance spectrometer. Evaluation of impedance data is achieved by fitting (NLSQ) the parameters of appropriate equivalent circuits to the experimental data. We investigated cell monolayers of primary cultured endothelial cells isolated from porcine brain microvessels, epithelial cells from porcine choroid plexus as well as those of the epithelial cell line MDCK. Transepithelial resistances were found to be in good agreement with published data. The main advantages of the new technique are the ability (i) to use multi-electrode arrays that allow to determine TERs at different locations of a given cell monolayer; (ii) to carry out impedance analysis under normal culture conditions; and (iii) to obtain TER values of cell monolayers grown on impermeable supports, which means that conditions cells are normally exposed to in ordinary culture dishes are maintained.

Applications of impedance spectroscopy in biochemistry and biophysics

The present study is intended to demonstrate the application of impedance spectroscopy to two very different fields of biophysical research. The core component of our measuring setup is a self-constructed continuous wave impedance spectrometer together with special measuring chambers which are individually designed for the systems under investigation. We directed our attention towards: i) the investigation of solid supported lipid bilayers in general, especially systems which are suitable for protein reconstitution such as dimethyldioctadecylammonium bromide (DODAB) immobilized onto a gold electrode, precovered with a negatively charged monolayer of 3-mercaptopropionic acid. Impedance spectroscopy allows to study the stability, the thickness and the electrode coverage of those artificial membranes as well as the observation of ion transport mediated by ionophores like gramicidin D incorporated into a DODAB-bilayer. ii) The characterization of the passive electrical properties of epithelial and endothelial cell monolayers in general and especially the determination of their transepithelial (transendothelial) electrical resistances as a measure for epithelial barrier function. From impedance spectra, as reported here, we are able to follow the formation and modulation of cell layer permeability to small ions.

Economic evaluation of allogeneic bone marrow transplantation: a rudimentary model to generate estimates for the timely formulation of clinical policy

PURPOSE

To provide an evidence-based approach to the formulation of clinical policy with respect to allogeneic bone marrow transplantation (BMT) that involves perceived trade offs between two major factors: costs and consequences. The report also highlights key informational deficiencies.

PATIENTS AND METHODS

Adults with acute myeloid leukemia (AML) in second complete remission (2CR) and those with acute lymphoblastic leukemia (ALL) in first complete remission (1CR) were assigned to BMT or control groups solely on the availability of a suitable donor. All hospital-borne costs were estimated, based on services used according to manual chart review, in four categories: diagnostic and therapeutic costs, professional fees, drug costs, and ward costs. Incremental costs and incremental life-years were calculated, and the quotient determined a cost per life-year gained by BMT for AML (2CR) and ALL (1CR).

RESULTS

The incremental cost (in 1992 Canadian dollars) per life-year gained by BMT (cost-effectiveness) for AML (2CR) was $29,200; and for ALL (1CR) it was minus $29,200.

CONCLUSION

For AML (2CR), allogeneic BMT creates better outcomes than standard treatment, but is more costly. For ALL (1CR), both the costs and outcomes are similar for BMT and standard therapy. Quality adjustments made to life-years gained did not change these conclusions.

Double-mode impedance analysis of epithelial cell monolayers cultured on shear wave resonators

The viscoelastic behavior of epithelial cells (MDCK-I and MDCK-II) grown on AT-cut quartz crystals with a fundamental resonance at 5 MHz was investigated by impedance spectroscopy. Using the electromechanical model recently derived by Martin et al. [(1991) Anal Chem 63: 2272-2281] for Newtonian liquids in contact with shear wave resonators we quantified the viscous damping arising from the adherent cells by fitting the impedance data with a modified Butterworth-Van Dyke circuit in the region of the resonance frequency. Impedance spectroscopy was additionally performed in the frequency range from 1 Hz to 1 MHz to scrutinize the passive electrical properties of the epithelial cell layers using an additional platinum electrode. These data allow one to document the cell layers' integrity as well as the electrode coverage. We were able to confirm that the presence of a cell-layer mainly increases damping of the shear wave and does not exhibit a pure mass-load behavior. These findings were supported by the discovery that the inductance L in the electromechanical model was less influenced by the cell-layer than the resistance R. The apparent cell-viscosities determined by our method are 0.097 poise for MDCK-I and 0.142 poise for MDCK-II cell-layers. These low apparent viscosities may be explained in terms of a considerable spacing between the cells immobilized via their focal contacts and the quartz surface.

Notes on technical progress in veterinary public health

Scientific and technical progress in the field of veterinary public health (VPH) over the last one hundred years has contributed to the protection of consumer health and the environment. This report presents examples of the success achieved in the control of epizootics of tuberculosis, brucellosis, rabies and trichinellosis, which are also zoonotic diseases. The discussion also considers hygiene measures in relation to Listeria in food as well as certain challenges resulting from the spread of latent infections among farm animals. The increasing incidence of Salmonella infections among humans is also considered. Other important VPH tasks include the control of chemical residues of varying origin and of toxic biological substances in foods. Examples are also presented of measures taken and problems which arise in connexion with ensuring that meat is produced under hygienic conditions (meat inspection). The principles involved in efficient controls of establishments and products are outlined. Technical progress in consumer protection is exemplified by the processes of pasteurisation, cooling and freezing, and the limitation of additives. Other important tasks arise in the disposal of animal carcasses and wastes, and in the fields of animal welfare and genetic engineering. Future activities in VPH will depend upon proper education, onward and postgraduate training for veterinarians, and suitable infrastructures for research, examination and surveillance.

The role of the marabou stork (Leptoptilos crumeniferus (Lesson)) in Kenya in the spread of echinococcosis from the abattoir

In experiments, adult marabou storks were fed with hydatid fluid of viable Echinococcus cysts obtained from sheep and goats. On microscopic examination of the birds' faeces no scolices were found, the only remaining undigested parts of the parasites fed being the chitinous hooks of the rostellum. The feeding trials have shown that the marabou does not play a role in the spread of echinococcosis from the abattoir.