Critical role of lateral habenula circuits in the control of stress-induced palatable food consumption

Chronic stress fuels the consumption of palatable food and can enhance obesity development. While stress- and feeding-controlling pathways have been identified, how stress-induced feeding is orchestrated remains unknown. Here, we identify lateral habenula (LHb) Npy1r-expressing neurons as the critical node for promoting hedonic feeding under stress, since lack of Npy1r in these neurons alleviates the obesifying effects caused by combined stress and high fat feeding (HFDS) in mice. Mechanistically, this is due to a circuit originating from central amygdala NPY neurons, with the upregulation of NPY induced by HFDS initiating a dual inhibitory effect via Npy1r signaling onto LHb and lateral hypothalamus neurons, thereby reducing the homeostatic satiety effect through action on the downstream ventral tegmental area. Together, these results identify LHb-Npy1r neurons as a critical node to adapt the response to chronic stress by driving palatable food intake in an attempt to overcome the negative valence of stress.

Acellular Dermal Matrix in Plastic and Reconstructive Surgery

Despite significant advances in medical research, plastic surgeons still face a shortage of suitable patient tissues, and soft tissue reconstruction is no exception. In recent years, there has been a rapid boom in the use of acellular dermal matrix (ADM) in reconstructive and aesthetic surgery. ADM is incorporated into the surrounding tissue and gradually replaced by the host's collagen, thus promoting and supporting the healing process and reducing the formation of scar tissue. The main goal of this article is to provide a brief review of the current literature assessing the clinical applications of ADM across a broad spectrum of applications in plastic and reconstructive surgery.

NPFF signalling is critical for thermosensory and dietary regulation of thermogenesis

Thermogenesis is a centrally regulated physiological process integral for thermoregulation and energy homeostasis. However, the mechanisms and pathways involved remain poorly understood. Importantly, in this study we uncovered that in an environment of 28 °C that is within the mouse thermoneutral zone, lack of NPFF signalling leads to significant increases in energy expenditure, resting metabolic rate and brown adipose tissue (BAT) thermogenesis, which is associated with decreased body weight gain and lean tissue mass. Interestingly, when exposed to a high-fat diet (HFD) at 28 °C, Npff^-/- mice lost the high energy expenditure phenotype observed under chow condition and exhibited an impaired diet-induced thermogenesis. On the other hand, under conditions of increasing levels of thermal demands, Npff^-/- mice exhibited an elevated BAT thermogenesis at mild cold condition (22 °C), but initiated comparable BAT thermogenic responses as WT mice when thermal demand increased, such as an exposure to 4 °C. Together, these results reveal NPFF signalling as a novel and critical player in the control of thermogenesis, where it regulates thermosensory thermogenesis at warm condition and adjusts thermoregulation under positive energy balance to regulate diet-induced thermogenesis.

Central NPFF signalling is critical in the regulation of glucose homeostasis

OBJECTIVE

Neuropeptide FF (NPFF) group peptides belong to the evolutionary conserved RF-amide peptide family. While they have been assigned a role as pain modulators, their roles in other aspects of physiology have received much less attention. NPFF peptides and their receptor NPFFR2 have strong and localized expression within the dorsal vagal complex that has emerged as the key centre for regulating glucose homeostasis. Therefore, we investigated the role of the NPFF system in the control of glucose metabolism and the histochemical and molecular identities of NPFF and NPFFR2 neurons.

METHODS

We examined glucose metabolism in Npff^-/- and wild type (WT) mice using intraperitoneal (i.p.) glucose tolerance and insulin tolerance tests. Body composition and glucose tolerance was further examined in mice after 1-week and 3-week of high-fat diet (HFD). Using RNAScope double ISH, we investigated the neurochemical identity of NPFF and NPFFR2 neurons in the caudal brainstem, and the expression of receptors for peripheral factors in NPFF neurons.

RESULTS

Lack of NPFF signalling in mice leads to improved glucose tolerance without significant impact on insulin excursion after the i.p. glucose challenge. In response to an i.p. bolus of insulin, Npff^-/- mice have lower glucose excursions than WT mice, indicating an enhanced insulin action. Moreover, while HFD has rapid and potent detrimental effects on glucose tolerance, this diet-induced glucose intolerance is ameliorated in mice lacking NPFF signalling. This occurs in the absence of any significant impact of NPFF deletion on lean or fat masses, suggesting a direct effect of NPFF signalling on glucose metabolism. We further reveal that NPFF neurons in the subpostrema area (SubP) co-express receptors for peripheral factors involved in glucose homeostasis regulation such as insulin and GLP1. Furthermore, Npffr2 is expressed in the glutamatergic NPFF neurons in the SubP, and in cholinergic neurons of the dorsal motor nucleus of the vagus (DMV), indicating that central NPFF signalling is likely modulating vagal output to innervated peripheral tissues including those important for glucose metabolic control.

CONCLUSIONS

NPFF signalling plays an important role in the regulation of glucose metabolism. NPFF neurons in the SubP are likely to receive peripheral signals and mediate the control of whole-body glucose homeostasis via centrally vagal pathways. Targeting NPFF and NPFFR2 signalling may provide a new avenue for treating type 2 diabetes and obesity.

The distribution of Neuropeptide FF and Neuropeptide VF in central and peripheral tissues and their role in energy homeostasis control

Neuropeptide FF (NPFF) and Neuropeptide VF (NPVF) are part of the extended RFamide peptide family characterized by their common arginine (R) and amidated phenylalanine (F)-motif at the carboxyl terminus. Both peptides signal through their respective high affinity G-protein coupled receptors, NPFFR2 and NPFFR1, but also show binding affinity for the other receptor due to their sequence similarity. NPFF and NPVF are highly conserved throughout evolution and can be found across the whole animal kingdom. Both have been implicated in a variety of biological mechanisms, including nociception, locomotion, reproduction, and response to pain and stress. However, more recently a new major functional role in the control of energy homeostasis has been discovered. In this article we will summarise the current knowledge on the distribution of NPFF, NPVF, and their receptors in central and peripheral tissues, as well as how this relates to the regulation of food intake and energy balance, which will help to better understand their role in these processes and thus might help finding treatments for impaired energy homeostasis disorders, such as obesity or anorexia.

Lack of neuropeptide FF signalling in mice leads to reduced repetitive behavior, altered drinking behavior, and fuel type selection

Although best known for their involvement in modulating nociception, Neuropeptide FF (NPFF) group peptides have been suggested to fulfil a variety of biological functions such as feeding, anxiety behaviors and thermogenesis. However, evidence supporting these functions of NPFF is mostly pharmacological, leaving the physiological relevance unaddressed. Here we examined the physiological impact of lack of NPFF signalling in both genders using a Npff^-/- mouse model. NPFF expression in the mouse is restricted to the spinal cord and brainstem while its cognate receptor NPFFR2 has wider distribution throughout the brain. Both male and female Npff^-/- mice showed reduced repetitive behaviors evidenced in the marble burying test and self-grooming test. A decrease in anxiety-related behaviors in the Npff^-/- mice was also observe in the open field test and to a lesser degree in an elevated plus maze test. Moreover, both male and female Npff^-/- mice exhibited increased water intake resulting from increases in drinking size, rather than number of drinking events. During a fasting-refeeding challenge, Npff^-/- mice of both genders displayed alterations in reparatory exchange ratio that reflect a greater fuel type flexibility. Npff^-/- mice were otherwise wild-type-like regarding body weight, body composition, feeding behaviors, locomotion or energy expenditure. Together, these findings reveal the important physiological roles of NPFF signalling in the regulation of anxiety-related and repetitive behaviors, fluid homeostasis and oxidative fuel selection, highlighting the therapeutical potential of the NPFF system in a number of behavioral and metabolic disorders.

Somatostatin receptor 2 expression in nasopharyngeal cancer is induced by Epstein Barr virus infection: impact on prognosis, imaging and therapy

Nasopharyngeal cancer (NPC), endemic in Southeast Asia, lacks effective diagnostic and therapeutic strategies. Even in high-income countries the 5-year survival rate for stage IV NPC is less than 40%. Here we report high somatostatin receptor 2 (SSTR2) expression in multiple clinical cohorts comprising 402 primary, locally recurrent and metastatic NPCs. We show that SSTR2 expression is induced by the Epstein-Barr virus (EBV) latent membrane protein 1 (LMP1) via the NF-κB pathway. Using cell-based and preclinical rodent models, we demonstrate the therapeutic potential of SSTR2 targeting using a cytotoxic drug conjugate, PEN-221, which is found to be superior to FDA-approved SSTR2-binding cytostatic agents. Furthermore, we reveal significant correlation of SSTR expression with increased rates of survival and report in vivo uptake of the SSTR2-binding 68Ga-DOTA-peptide radioconjugate in PET-CT scanning in a clinical trial of NPC patients (NCT03670342). These findings reveal a key role in EBV-associated NPC for SSTR2 in infection, imaging, targeted therapy and survival.

Preparation and processing of human allogenic dermal matrix for utilization in reconstructive surgical procedures

AIM

This article presents the development of a novel preparation and processing method as well as indication for clinical applications of human allogeneic acellular dermal matrix, which was developed originally in the Central Tissue Bank (CTB) for use in burn medicine and reconstructive surgery.

METHODS

Acellular dermal matrix (ADM) is a biological material assigned for utilization in several surgical procedures due to its unique structure and advantageous properties. The article focuses on a novel preparation and processing method developed by CTB, which differs in its impact on the structure, biological and biomechanical properties of the final ADM compared to the wide range of commercially available ADM products and currently available ADM products of other tissue banks.

RESULTS

The ubiquitous acellular allogeneic dermal collagen matrix is the main substance participating in advantageous properties facilitating the use of ADM in numerous indications from dermal replacement and soft tissue augmentation to more extensive surgical reconstructive procedures. Dermal substitutes play an essential role in the reconstruction of full-thickness skin defects, both in acute and chronic wounds, defects of fasciae, peritoneum, etc., and there is a strong evidence that they can improve the final scar quality as well. Differences in preparation methods of ADMs are recently causing concerns among surgeons utilizing the ADMs. We present three different cases with favourable outcomes by using human acellular ADM grafts.

CONCLUSIONS

Although ADMs did not fulfil all of the requirements for an ideal dermal substitute, their applications have been advanced for diverse indications in soft tissue reconstructions and augmentations. Early revascularization of the allografts reduces bacterial contamination. Research and development of new generation of acellular dermal matrices with incorporated autologous in vitro cultured cells will likely yield new products and give new hope for continued improve-ments in functional and cosmetic outcomes (Fig. 9, Ref. 60).

Adipose derived mesenchymal stem cells harvesting

BACKGROUND

The lipografting is increasingly used in the field of plastic surgery. Widely used harvesting technique of fatderived stem-cells is lipoaspiration. There exist two big streams of fat harvesting for lipografting: mechanical liposuction and manual liposuction.

METHODS

Two harvested specimens were compared in this prospective blind study in the means of stem-cells viability and their ability to grow in cell-cultures. Techniques to compare were: manual lipoaspiration with 50 ml syringe and WAL (water-jet assisted liposuction).

RESULTS

Twenty specimens from ten patients were investigated in the tissue bank. There were no differences in the amount of live stem-cells between two groups. Also no differences were found between both harvesting techniques in the mean of cell ability to grow in cell-cultures.

CONCLUSION

It can be concluded that there are no statistically significant differences in the number, vitality and viability of stem cells when comparing two ways of mesenchymal stem cell collection, both manual and machine sampling (WAL). When cultured in vitro, both samples collected from each patient also appeared to be able to multiply with no statistical differences (Tab. 2, Fig. 2, Ref. 18).

Anterograde Amnesia as a Manifestation of Acute Type A Aortic Dissection

Objectives  Memory impairment has been only rarely reported in association with acute aortic dissection type A. We report a patient with pure anterograde amnesia and memory impairment of contents occurring after the event, accompanying acute aortic dissection type A. Case Report  A previously healthy 53-year-old Caucasian male was admitted because of sudden chest pain after having lifted a heavy object. Clinical examination and electrocardiogram showed no abnormalities. Since blood tests showed leukocytosis, anemia, and elevated D-dimer level, either pulmonary embolism or aortic dissection was suspected; therefore, computed tomography was suggested. The patient seemed disoriented to time, and neurologic investigation confirmed that the patient was disoriented to time; short time memory was severely impaired and concentration was reduced. An amnestic episode with anterograde amnesia was diagnosed. Computed tomography showed type A aortic dissection. A supracoronary replacement of the ascending aorta was performed. The patient was discharged on the 7th postoperative day. Three months postoperatively, the patient is clinically stable; however, amnesia for the interval between pain onset and cardiac surgery persists. Conclusions  Transient amnesia, usually considered a benign syndrome, may be more common than generally recognized in aortic dissection. The suspicion for aortic dissection or other cardiovascular emergencies is substantiated when amnesia is associated with sudden onset of chest pain, leukocytosis, and elevated D-dimer levels. Computed tomography of the aorta with contrast medium is the imaging method of choice to confirm or exclude the diagnosis.

Amygdala NPY Circuits Promote the Development of Accelerated Obesity under Chronic Stress Conditions

Neuropeptide Y (NPY) exerts a powerful orexigenic effect in the hypothalamus. However, extra-hypothalamic nuclei also produce NPY, but its influence on energy homeostasis is unclear. Here we uncover a previously unknown feeding stimulatory pathway that is activated under conditions of stress in combination with calorie-dense food; NPY neurons in the central amygdala are responsible for an exacerbated response to a combined stress and high-fat-diet intervention. Central amygdala NPY neuron-specific Npy overexpression mimics the obese phenotype seen in a combined stress and high-fat-diet model, which is prevented by the selective ablation of Npy. Using food intake and energy expenditure as readouts, we demonstrate that selective activation of central amygdala NPY neurons results in increased food intake and decreased energy expenditure. Mechanistically, it is the diminished insulin signaling capacity on central amygdala NPY neurons under combined stress and high-fat-diet conditions that leads to the exaggerated development of obesity.

Patient-derived cell line models revealed therapeutic targets and molecular mechanisms underlying disease progression of high grade serous ovarian cancer

High grade serous ovarian cancer (HGSOC) is the most frequent type of ovarian cancer. Most patients have primary response to platinum-based chemotherapy but frequently relapse, which leads to patient death. A lack of well documented and characterized patient-derived HGSOC cell lines is so far a major barrier to define tumor specific therapeutic targets and to study the molecular mechanisms underlying disease progression. We established 34 patient-derived HGSOC cell lines and characterized them at cellular and molecular level. Particularly, we demonstrated that a cancer-testis antigen PRAME and Estrogen Receptor could serve as therapeutic targets. Notably, data from the cell lines did not demonstrate acquired resistance due to tumor recurrence that matched with clinical observations. Finally, we presented that all HGSOC had no or very low CDKN1A (p21) expression due to loss of wild-type TP53, suggesting that loss of cell cycle control is the determinant for tumorigenesis and progression. In conclusion, patient-derived cell lines reveal that PRAME is a potential tumor specific therapeutic target in HGSOC and counteracting the down-regulation of p21 caused by loss of wild-type TP53 might be the key to impede disease progression.

Toxic epidermal necrolysis data from the CELESTE multinational registry. Part I: Epidemiology and general microbiological characteristics

INTRODUCTION

Toxic epidermal necrolysis (TEN) is a rare, life-threatening autoimmune disease predominantly manifested in the skin and mucous membranes. Today, infectious complications have the dominant share in mortality of TEN patients. Due to the nature of the therapy and administration of immunosuppressive medications, a wide range of potentially pathogenic microorganisms, which cause infectious complications in different compartments in these patients, is not surprising.

MATERIAL AND METHODOLOGY

This is a multicentric study, which included all patients with TEN hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area was over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the registry CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation), when specific parameters relating to epidemiological indicators and infectious complications in patients with TEN were evaluated in the form of a retrospective analysis.

RESULTS

In total, 39 patients with TEN were included in the study (12 patients died, mortality was 31%), who were hospitalized in the monitored period. The median age of patients in the group was 63 years (the range was 4-83 years, the mean was 51 years), the median of the exfoliated area was 70% TBSA (total body surface area) (range 30-100%, mean 67%). SCORTEN was calculated for 38 patients on the day of admission. Its median in all patients was 3 (range 1-6; mean 3). Any kind of infectious complication in the study group was recorded in 33 patients in total (85%). In total, 30 patients (77%) were infected with gram-positive cocci, 27 patients (69%) with gram-negative rods, and yeast cells or fibrous sponge were cultivated in 12 patients (31%). A total of 32 patients (82%) were found to have infectious complications in the exfoliated area, 15 patients (39%) had lower respiratory tract infections, 18 patients (46%) urinary tract infections and 15 patients (39%) an infection in the bloodstream. The most common potentially pathogenic microorganism isolated in our study group was coagulase neg. Staphylococcus, which caused infectious complications in 24 patients. Enterococcus faecalis/faecium (19 patients), Pseudomonas aeruginosa (17 patients), Staphylococcus aureus (11 patients) and Escherichia coli (11 patients) were other most frequently isolated micro-organisms.

CONCLUSION

The published data were obtained from the unique registry of TEN patients in Central Europe. In the first part, we have succeeded in defining the basic epidemiological indicators in the group of patients anonymously included in this registry. The study clearly confirms that infectious complications currently play an essential role in TEN patients, often limiting the chances of survival. The study also shows a high prevalence of these complications in the period after 15days from the start of hospitalization, when most patients already have completely regenerated skin cover.

Detection of melanoma metastases With Tc-99m-tetrofosmin

Aim: The aim of this study was to evaluate Tc-99mtetrofosmin whole-body imaging in the detection of metastases in patients with malignant melanoma. Methods: In 30 patients with suspected melanoma metastases we performed whole body imaging. After administration of about 600 MBq Tc-99m-tetrofosmin dynamic images up to 10 min were performed in 7 patients (1 image per 10 sec) to evaluate the optimal tracer uptake in the metastases. In all patients whole-body images were performed 5-10 min p. i. using an acquisition time of 5 min per image. The final diagnosis was confirmed by surgical histology in 30 lesions, by computertomogaphy and clinical course in the remaining lesions. Results: Out of 64 melanoma metastases 49 were detected using Tc-99m-tetrofosmin scintigraphy (49 rp., 15 fn.). The overall sensitivity for the detection of malignant lesions was 77%. Referring only to the lymph node metastases, the sensitivity was 87% (26 rp.; 4 fn.). The maximal tracer uptake was reached 1 min after injection, with a slow decrease in the following 10 minutes. The size of the lesions ranged between 0.5 and 7.0 cm and the T/B ratios between 1.3 and 3.0 (mean 1.88). Conclusions: Tc-99m-tetrofosmin whole body imaging is a simple and side-effectless method for the detection of melanoma metastases especially of lymph node metastases. The results are comparable to Tc-99m-sestamibi and TI-201 scintigraphy.

A Complex Network of Tumor Microenvironment in Human High-Grade Serous Ovarian Cancer

Purpose: Most high-grade serous ovarian cancer (HGSOC) patients develop recurrent disease after first-line treatment, frequently with fatal outcome. This work aims at studying the molecular biology of both primary and recurrent HGSOC.Experimental Design: Gene expression profiles of matched primary and recurrent fresh-frozen tumor tissues from 66 HGSOC patients were obtained by RNA sequencing. Clustering analyses and pairwise comparison of the profiles between matched samples and subsequent functional alignment were used for the identification of molecular characteristics of HGSOC.Results: Both primary and recurrent HGSOC samples presented predominant gene expression differences in their microenvironment, determined by a panel of genes covering all major pathways of immune activation together with a number of genes involved in the remodeling of extracellular matrix and adipose tissues. Stratifying tumor tissues into immune active and silent groups, we further discovered that although some recurrent tumors shared the same immune status as their primary counterparts, others switched the immune status, either from silent to active or active to silent. Interestingly, genes belonging to the B7-CD28 immune checkpoint family, known for their major role as negative regulators of the immune response, were overexpressed in the immune active tumors. Searching for potential tumor antigens, CEACAM21, a member of the carcinoembryonic antigen family, was found to be significantly overexpressed in immune active tissues in comparison with the silent ones.Conclusions: The results illustrate the complexity of the tumor microenvironment in HGSOC and reveal the molecular relationship between primary and recurrent tumors, which have multiple therapeutic implications. Clin Cancer Res; 23(24); 7621-32. ©2017 AACR.

Global skin colour prediction from DNA

Human skin colour is highly heritable and externally visible with relevance in medical, forensic, and anthropological genetics. Although eye and hair colour can already be predicted with high accuracies from small sets of carefully selected DNA markers, knowledge about the genetic predictability of skin colour is limited. Here, we investigate the skin colour predictive value of 77 single-nucleotide polymorphisms (SNPs) from 37 genetic loci previously associated with human pigmentation using 2025 individuals from 31 global populations. We identified a minimal set of 36 highly informative skin colour predictive SNPs and developed a statistical prediction model capable of skin colour prediction on a global scale. Average cross-validated prediction accuracies expressed as area under the receiver-operating characteristic curve (AUC) ± standard deviation were 0.97 ± 0.02 for Light, 0.83 ± 0.11 for Dark, and 0.96 ± 0.03 for Dark-Black. When using a 5-category, this resulted in 0.74 ± 0.05 for Very Pale, 0.72 ± 0.03 for Pale, 0.73 ± 0.03 for Intermediate, 0.87±0.1 for Dark, and 0.97 ± 0.03 for Dark-Black. A comparative analysis in 194 independent samples from 17 populations demonstrated that our model outperformed a previously proposed 10-SNP-classifier approach with AUCs rising from 0.79 to 0.82 for White, comparable at the intermediate level of 0.63 and 0.62, respectively, and a large increase from 0.64 to 0.92 for Black. Overall, this study demonstrates that the chosen DNA markers and prediction model, particularly the 5-category level; allow skin colour predictions within and between continental regions for the first time, which will serve as a valuable resource for future applications in forensic and anthropologic genetics.

COMPLICATIONS OF LOWER EXTREMITY HEMATOMAS IN PATIENTS WITH PRE-INJURY WARFARINE USE

INTRODUCTION

The aim of this paper is to ascertain the number of patients with pre-injury warfarin use who developed lower extremity hematomas treated in our facility, to analyse the data, used treatment methods and outcomes in these patients.

PATIENTS AND METHODS

We performed a retrospective review, identifying all the patients with pre-injury Warfarin use admitted with hematoma or full-thickness skin loss in the ten years period from January 2006 to December 2015.

RESULTS

Overall 9 women and 2 men with mean age of 72 years were identified. All the injuries were sustained in a domestic setting. Except of one female patient primarily admitted to our department, all patients had been hospitalized primarily in local/regional hospitals for an average period of 32.6 days. All the patients transferred to our department required surgical wound closure. The mean wound surface area was 136.3cm² (range 45-525). The duration of hospital stay was 15 days in average.

DISCUSSION

The data obtained were compared with the results and findings of similar studies and were discussed.

CONCLUSION

The results achieved in the present study showed the beneficial effect of used treatment methods based on the surgical wound closure techniques during hospital stay of the patients. Clinicians, first contact physicians, and also patients alone need to be aware of the vulnerability of this group of patients. The consequences of even minor lower extremity trauma can be serious, with development of a very complex chronic wound that is difficult to manage.

[AMNIOTIC MEMBRANE APPLICATIONS - OUR EXPERIENCE]

INTRODUCTION

Amniotic membrane is the innermost part of the fetal and packaging for its exceptional qualities likes to be used in treating many ocular pathologies. Amniotic membrane has improved the ability to treat ocular surface disease. It has unique features like support conjunctival and corneal epithelialization.

MATERIAL AND METHODS

Retrospective analysis of group patients who underwent amniotic membrane transplantation at the Department of Ophthalmology Faculty of Medicine and UN Bratislava in 2013-2015. We evaluated indications amniotic membrane transplantation, the percentage, the number of transplants and the number of failures and retransplantation of the membrane.

RESULTS

In group of 71 patients (amniotic membrane covering defects of conjunctiva and cornea) male patients formed a slight predominance of males in the number of patients a slightly larger preponderance in 38 women (53.5 %) - 52 surgeries (59.09 %) and 33 male (46.5 %) in 36 interventions (40.91 %). The left eye was affected in 40 interventions (45.45 %), 48 interventions were on the right eye (54.54 %). The most common cause application of 30.68 % in 27 eyes was corneal ulcer, bullous keratopathy followed by the 11.36 % in 10 eyes, and the ulcer herpetic keratitis in 9.10 % in 8 eyes. Injury or vulnus penetrans 6.82 % in 6 eyes, ulcers caused by paresis n. facialis 6.82 % in 6 eyes and sicca syndrome 5.68 % in 5 eyes.In 2015 we applied amniotic membrane covering the defect of eyelids after trauma in one patient.

CONCLUSION

Amniotic membrane is the appropriate treatment in a number of diseases of ocular surface when conservative methods of treatment fail. In corneal application can prevent the execution of more aggressive treatment, such as keratoplasty, or to soothe inflammation and keratoplasty is not performed as emergent, but elective.Key words: amniotic membrane transplantation, eye diseases.

Minimally invasive burn care: a review of seven clinical studies of rapid and selective debridement using a bromelain-based debriding enzyme (Nexobrid®)

Current surgical and non-surgical eschar removal-debridement techniques are invasive or ineffective. A bromelainbased rapid and selective enzymatic debriding agent was developed to overcome these disadvantages and compared with the standard of care (SOC). The safety and efficacy of a novel Debriding Gel Dressing (DGD) was determined in patients with deep partial and full thickness burns covering up to 67% total body surface area (TBSA). This review summarizes data from seven studies, four of which were randomized clinical trials that included a SOC or control vehicle. DGD eschar debridement efficacy was >90% in all studies, comparable to the SOC and significantly greater than the control vehicle. The total area excised was less in patients treated with DGD compared with the control vehicle (22.9% vs. 73.2%, P<0.001) or the surgical/non-surgical SOC (50.5%, P=0.006). The incidence of surgical debridement in patients treated with DGD was lower than the SOC (40/163 [24.5%] vs. 119/170 [70.0%], P0.001). Less autografting was used in all studies. Long-term scar quality and function were similar in DGD- and SOCtreated. DGD is a safe and effective method of burn debridement that offers an alternative to surgical and non-surgical SOC.

Ferromagnetic State of a Model Chain System

Ferromagnetic states of two linear chains are determined. The comparison with the solution of the restricted Hartree-Fock method shows that such states are energetically very unlikely

LCAO Approach to SCF-Xα Method

An LCAO approach to the Slater SCF-Xα method is described. The equilibrium distances and Hellman-Feynman forces are determined.

Some ab Initio Calculations on Indole, Isoindole, Benzofuran, and Isobenzofuran

Ab initio calculations in the framework of the methodology of Pople et al. have been performed on indole, isoindole, benzofuran. and isobenzofuran. Several molecular properties (dipole moments, n. m. r. chemical shifts, stabilities, and reactivities) correlate well with calculated indices (charge densities, HOMO-LUMO separation). The calculations failed to give magnitudes of first ionization potentials, although the correct trends are reproduced, i. e. giving higher values to more stable isomers. Some of the obtained results (charge densities, dipole moments) parallel CNDO/2 values.

Epileptics and burns

BACKGROUND

The aim of this paper is to ascertain the number of patients with a burn injury sustained during an epileptic seizure treated in our facility, to identify the characteristics of these types of injuries and to suggest preventive measures, which could reduce the frequency and morbidity of such injuries.

PATIENTS AND METHODS

We performed a retrospective study, identifying all patients admitted with burns sustained during an epileptic seizure within a period of six years.

RESULTS

Totally 7 women with an average age of 45 years were enrolled in this retrospective study. Mean BSAB was 2.4% (range 0.5-6). All burns occurred in a domestic setting during household activities (cooking, ironing). Thermal injury included contact burn (6 patients with deep burns), followed by scald (one patient with superficial burns). 6 of 7 patients (85%) required excision of deep burns and skin grafting procedure. The average duration of hospital stay was 13 days. Collected data were compared with the results and findings of similar studies and analysed. A list of preventive measures is included.

CONCLUSION

Patients with epilepsy should be informed about all potential threats at the time of neurological diagnosis including also the risk of serious burn injury, which should be emphasised.

Abstract 2171: Human FLCN delays cell cycle progression through late S and G2/M-phases: Effect of phosphorylation and tumor-associated mutations

The Birt-Hogg-Dube (BHD) autosomal dominantly inherited syndrome has clinical features that include the development of skin fibrofolliculomas, lung cysts, and renal neoplasia. Renal tumors occur in approximately one third of individuals with BHD. The gene responsible for BHD syndrome is Folliculin (FLCN), which encodes a 68kD phosphoprotein (FLCN). One allele of the FLCN gene is mutated in the germline of &gt;90% of BHD patients and somatic mutations or loss of the wild type FLCN allele are observed in the renal tumors of patients with BHD, suggesting that FLCN acts as a tumor suppressor protein. The human renal cell carcinoma cell line UOK257, derived from a patient with a germline mutation in the FLCN gene, harbors a truncated version of the FLCN protein. Reconstitution of the wild type FLCN protein into the FLCN-deficient UOK257 cells decreased their proliferation rate. Here we tested whether this difference in cell proliferation rate may be partly attributed to the effect of FLCN on cell cycle progression. We synchronized FLCN-deficient UOK257 cells and their isogenic, wild type or mutant FLCN counterparts, by double thymidine block and followed cell cycle progression after release. UOK257 cells expressing wild type FLCN exhibited a slower progression through the late S and G2/M-phases of the cell cycle compared to the vector only controls (FLCN-deficient). The reintroduction of tumor-associated FLCN mutants failed to delay cell cycle progression in UOK257 cells, indicating that the effect of wild type FLCN on cell cycle progression may contribute to its tumor suppressor function. FLCN phosphorylation on serines S62 and S73 fluctuates throughout the cell cycle and peaks in cells arrested at the G2/M boundary following treatment with nocodazole. In keeping with this observation, the reintroduction of a FLCN S62/73 phosphomimetic mutant into the UOK257 cell line resulted in faster progression through the cell cycle compared to those expressing the wild type FLCN protein. These findings suggest that orderly changes in FLCN phosphorylation during the cell cycle are linked to and may be required for its effect on cell cycle progression and possibly its activity as a tumor suppressor protein. We expect that these studies will provide insight into the role of FLCN in kidney tumorigenesis and will identify putative new targets for therapeutic intervention.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2171. doi:1538-7445.AM2012-2171

Clinical trial of the temporary biosynthetic dermal skin substitute based on a collagen and hyaluronic acid named Coladerm H/HM, first part

BACKGROUND

This paper presents the results of the first part of the clinical study of temporary biosynthetic dermal skin substitute based a on collagen and hyaluronic acid, named Coladerm H/HM. The aim of this study was to evaluate safety and effects of Coladerm H/HM in covering the split-thickness skin graft donor sites in humans. This membrane was applied to a part of the split-thickness skin graft donor site; its effects and properties were compared to standard dressing used for covering the split-thickness skin graft donor sites at the Department of Burns and Reconstructive Surgery, University Hospital Bratislava, Slovakia, Dermazin® (Lek) + Acidum Aceticum 1% (magistraliter), which were applied together to the rest of the donor site.

MATERIAL AND METHODS

Twenty patients were randomly selected with the following criteria: age of 18-65 years, no severe accompanying diseases such as diabetes, renal failure, immune disorders, severe arteriosclerosis, severe allergic conditions. Evaluation was done according to the evaluation protocol.

RESULTS

Primary assessment showed that Coladerm H/HM does not influence the rate of epithelization from a long term point of view, but the initial faster epithelization contributes to the reduction of the risk of complications, which may arise from a long term open wounds. Secondary assessment showed the effect of Coladerm H/HM to the secretion of the wounds in the second inspection interval when the wound was dry in the whole group. Next, Coladerm H/HM contributed to the temporarily statistically significant positive effect to the color of donor area in the third inspection interval. Positive bacteriological finding occurred in one patient secondary. Analgetic effect of Coladerm H/HM assessed by a doctor was expressed as good in 70%. 95% of patients reported only mild pain after application of Coladerm H/HM. There were no significant side effects recorded, only 1 patient stated itching, which disappeared spontaneously. Application of Coladerm H/HM has positive properties for treating the split-thickness skin graft donor sites in humans.

CONCLUSION

Coladerm H/HM showed positive results covering the split-thickness skin graft donor sites in the first part of the clinical trial. Production of the Coladerm H/HM and its introduction into the clinical practice is planned after successful completion of all the parts of clinical trial.

Cultured keratinocytes and their possible applications

Skin is the largest organ, providing an outer layer of the body and thus creating a barrier against the surrounding environment. It possesses many important functions and can be damaged by various mechanisms. The substitution of damaged skin, mainly in the treatment of deep extensive burns, represents a key challenge. Damaged skin can be replaced permanently by skin autografts, cultured autogenous and allogenic keratinocytes or by the combination of skin substitutes with in vitro cultured autologous keratinocytes. In this article the preparation method and the possible applications of cultured autologous and allogeneic keratinocytes are described; we have long experience of this issue at the Department of Burns and Reconstructive Surgery in the University Hospital Bratislava.

Temperature monitored on the cuff surface of an endotracheal tube reflects body temperature

OBJECTIVE

When treating patients with cardiac arrest with mild therapeutic hypothermia, a reliable and easy-to-use temperature probe is desirable. This study was conducted to investigate the accuracy and safety of tracheal temperature as a measurement of body temperature.

DESIGN

Observational cohort study.

SETTING

Emergency department of a tertiary care university hospital.

PATIENTS

Patients successfully resuscitated from cardiac arrest intended for mild hypothermia therapy.

INTERVENTIONS

Intubation was performed with a newly developed endotracheal tube that contains a temperature sensor inside the cuff surface. During the cooling, mild hypothermia maintenance, and rewarming phases, the temperature was recorded minute by minute. These data were compared with the temperature assessed by esophageal and blood temperature probes. Thereafter, tracheoscopy was performed to evaluate the condition of the tracheal mucosa.

MEASUREMENTS AND MAIN RESULTS

Approximately 2000 measurements per temperature sensor per patient were recorded in 21 patients. The mean bias between the blood temperature and the tracheal temperature was -0.16 degrees C (limits of agreement: -0.36 degrees C to 0.04 degrees C). The mean bias between the esophageal and tracheal temperatures was -0.22 degrees C (limits of agreement: -0.49 degrees C to 0.07 degrees C). Agreement between temperature probes investigated by the Bland-Altman method showed a mean bias of less than -(1/4) degrees C, and time lags assessed graphically by hysteresis plots were negligible. No clinically relevant injury to the tracheal mucosa was detected.

CONCLUSION

Temperature monitoring at the cuff surface of an endotracheal tube is safe and provides accurate and reliable data in all phases of therapeutically induced mild hypothermia after cardiac arrest.

Nosocomial Staphylococcal scalded skin syndrome caused by intra-articular injection

BACKGROUND

The pathogenic role of nasal carriage as a source for cutaneous and soft-tissue Staphylococcus aureus (SA) infections, and Staphylococcal scalded skin syndrome (SSSS) in particular, is unclear.

OBSERVATION

We herein describe a nosocomial outbreak of SSSS in three orthopaedic patients who received intra-articular injections by a single orthopaedic surgeon. Bacteriological samples from the index patients and medical personnel involved in their care were assessed by phage typing, polymerase chain reaction for exfoliative toxin genes, SmaI macro-restriction analysis and molecular spa-typing. These studies first revealed SA cultural growth in synovial fluid of all three patients as well as nasal mucosa of one medical assistant. Moreover, all SA isolates had the same phage typing and antibiotic susceptibilities and were positive for exfoliative toxin ETa by polymerase chain reaction. SmaI macro-restriction and spa-typing further confirmed all proband isolates to be identical.

CONCLUSION

These findings provide evidence that SA nasal colonization of otherwise healthy carriers is a risk factor for SA infections, including SSSS, in predisposed individuals.

Estimates and relationships between aboveground and belowground resource exchange surface areas in a Sitka spruce managed forest

Our knowledge of the nature of belowground competition for moisture and nutrients is limited. In this study, we used an earth impedance method to determine the root absorbing area of Sitka spruce (Picea sitchensis (Bong.) Carr.) trees, making measurements in stands of differing density (2-, 4- and 6-m inter-tree spacing). We compared absorbing root area index (RAI(absorbing); based on the impedance measure) with fine root area index (RAI(fine); based on estimates of total surface area of fine roots) and related these results to investment in conductive roots. Root absorbing area was a near-linear function of tree stem diameter at 1.3 m height. At the stand level, RAI(absorbing), which is analogous to and scaled with transpiring leaf area index (maximum stomatal pore area per unit ground area; LAI(transpiring)), increased proportionally with basal area across the three stands. In contrast, RAI(fine) was inversely propotional to basal area. The ratio of RAI(absorbing) to LAI(transpiring) ranged from 7.7 to 17.1, giving an estimate of the relative aboveground versus belowground resource exchange areas. RAI(absorbing) provides a way of characterizing ecosystem functioning as a physiologically meaningful index of belowground absorbing area.

European quality system for tissue banking

AIM

The aims of this project were to analyze the factors that influence quality and safety of tissues for transplantation and to develop the method to ensure standards of quality and safety in relation to tissue banking as demanded by European Directive 2004/23/EC and its technical annexes. It is organized in 4 Working Groups, the objectives of each one being focused in a specific area.

STANDARDS

The Guide of Recommendations for Tissue Banking is structured into 4 parts: (1) quality systems that apply to tissue banking and general quality system requirements, (2) regulatory framework in Europe, (3) standards available, and (4) recommendations of the fundamental quality and safety keypoints.

REGISTRY

This Working Group handled design of a multinational musculoskeletal tissue registry prototype.

TRAINING

This Working Group handled design and validation of a specialized training model structured into online and face-to-face courses. The model was improved with suggestions from students, and 100% certification was obtained.

AUDIT

The Guide for Auditing Tissue Establishments provides guidance for auditors, a self-assessment questionnaire, and an audit report form. The effectiveness and sustainability of the outputs were assessed. Both guides are useful for experienced tissue establishments and auditors and also for professionals that are starting in the field. The registry prototype proves it is possible to exchange tissues between establishments throughout Europe. The training model has been effective in educating staff and means having professionals with excellent expertise. Member states could adapt/adopt it. The guides should be updated periodically and perhaps a European organization should take responsibility for this and even create a body of auditors.

Treatment of partial-thickness scalds by skin xenografts--a retrospective study of 109 cases in a three-year period

BACKGROUND

The purpose of the present study was to confirm the clinical expediency of using a particular type of biological skin substitute--porcine skin xenograft--in the treatment of partial-thickness scald burns.

MATERIAL AND METHODS

Over a period of three years (from the beginning of the 2005 to the end of the 2007) 109 admitted patients with partial-thickness scald burns were treated with skin xenografts. The mean age of the patients was 7.6 years (S.D.: 15.3), while mean TBSA was 13% (S.D.: 8.2).

RESULTS

The number of patients healed by the 14th day postburn or sooner and their mean healing time, the mean healing time for all 109 patients, mean hospital stay and number of patients undergoing surgery were all evaluated. Of the 109 patients, 78 (71%) healed within 14 days with a mean time of 9.6 days (S.D.: 3.2). One sample t-test which compared mean healing times achieved within 14 days with the value of 14 days established a significant difference (p = 0.0001). For all 109 cases the mean healing time was 15.1 days (S.D.: 11.6), with no significant difference between mean healing times and the value of 14 days (p = 0.3). The mean hospital stay was up to 10 days (S.D.: 6.7). Four patients (3.6%) received split thickness skin grafts with an average extent of 4.5% TBSA. The data obtained were compared with similar studies and other treatment options for this indication and were discussed.

CONCLUSION

This retrospective study proves the clinical efficiency of using skin xenografts for the treatment of partial-thickness scald burns. Skin xenografts showed good adherence on the wound surfaces, decreased the amount of exudate and reduced pain. In addition, the risk of hypertrophic scar formation was lower when wound healing was achieved within 14 days.

Quality-of-life (QoL) impairment in melanoma patients receiving high-dose interferon alpha 2b (IFNa2b)

e20011

Background: High-dose interferon (HDI) for patients with malignant melanoma (MM) has consistently demonstrated benefits as an adjuvant treatment. Side effects and impairment of QoL have played a major role in patients motivation to continue treatment. The adjuvant, randomized, controlled phase III DeCOG MM-ADJ-5 trial evaluates QoL and tolerability of pulsed high-dose intravenous (iv) IFNα2b compared to standard HDI regimen. In the pulsed arm, 3 courses of IFNα2b, 20 Mio IU/m2 iv 5 days a wk for 4 wks, repeated every 4 months was administered, whereas the subcutaneous (sc) treatment was 10 Mio IU/m2 3 times a wk for 11 months, after 4 wks of iv therapy. As a secondary endpoint, health related QoL was evaluated during iv and sc treatment and during treatment free intervals. Methods: 631 patients have been recruited for an expected 300 events (distant metastasis) during 4 years of follow-up. A planned interim analysis was performed after a third of the expected events occurred. The EORTC QLQ-C30 questionnaire modified for typical IFN side effects, was administered to pts before therapy, at 4, 16, 24, and 40 wks of treatment. Global QoL questions were completed by pts weekly by a visual analogue scale over the entire year of treatment. Results: Out of 377 patients having completed treatment, 300 were evaluable for QoL analysis. The iv HDI treatment led to a globally decreased QoL score in 84% of patients. During the 4 wk course of iv IFN, impairment of QoL was mainly due to physical symptoms. During the sc treatment phase, global QoL remained reduced by an average of 24%, despite dose adjustments in a majority of patients. Analysis of particular dimensions of decreased QoL revealed that fatigue was the most important determinant, especially during continuous treatment. In contrast, depression only played a minor role, being less important than physical and cognitive impairment. Conclusions: QoL impairment caused by long term sc HDI is mostly mediated by chronic fatigue, and more likely to interfere with treatment adherence than short term iv HDI treatment.

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Enzymatic necrolysis of acute deep burns--report of preliminary results with 22 patients

Enzymatic debridement by the use of a proteolytic enzyme complex derived, isolated and purified from pineapple stems proves to be an innovative, rapid, effective, selective and safe method of postburn necrotic skin removal. The major advantages of the procedure include minimal invasivity, rapidity, effectiveness, possibility to perform the debridement at the bedside, minimal or no loss of blood and minimal interference with natural wound healing processes. Our preliminary experience with this treatment method showed that in most of the cases treated the debridement was excellent, safe and rapid. The average duration of the debridement was less than 4 hours. The debridement was accompanied by minor to moderate pain which could be treated by analgetic medications. No serious adverse events or reactions have been observed during the study. The time for healing was comparable with the standard of care methods. The second randomized multicenter study is still in progress and has not yet been finished.