Impact of Holocene environmental change on the evolutionary ecology of an Arctic top predator

The Arctic is among the most climatically sensitive environments on Earth, and the disappearance of multiyear sea ice in the Arctic Ocean is predicted within decades. As apex predators, polar bears are sentinel species for addressing the impact of environmental variability on Arctic marine ecosystems. By integrating genomics, isotopic analysis, morphometrics, and ecological modeling, we investigate how Holocene environmental changes affected polar bears around Greenland. We uncover reductions in effective population size coinciding with increases in annual mean sea surface temperature, reduction in sea ice cover, declines in suitable habitat, and shifts in suitable habitat northward. Furthermore, we show that west and east Greenlandic polar bears are morphologically, and ecologically distinct, putatively driven by regional biotic and genetic differences. Together, we provide insights into the vulnerability of polar bears to environmental change and how the Arctic marine ecosystem plays a vital role in shaping the evolutionary and ecological trajectories of its inhabitants.

[Update on collaborative autopsy-based research in German pathology, neuropathology, and forensic medicine]

BACKGROUND

Autopsies are a valuable tool for understanding disease, including COVID-19.

MATERIALS AND METHODS

The German Registry of COVID-19 Autopsies (DeRegCOVID), established in April 2020, serves as the electronic backbone of the National Autopsy Network (NATON), launched in early 2022 following DEFEAT PANDEMIcs.

RESULTS

The NATON consortium's interconnected, collaborative autopsy research is enabled by an unprecedented collaboration of 138 individuals at more than 35 German university and non-university autopsy centers through which pathology, neuropathology, and forensic medicine autopsy data including data on biomaterials are collected in DeRegCOVID and tissue-based research and methods development are conducted. More than 145 publications have now emerged from participating autopsy centers, highlighting various basic science and clinical aspects of COVID-19, such as thromboembolic events, organ tropism, SARS-CoV‑2 detection methods, and infectivity of SARS-CoV-2 at autopsy.

CONCLUSIONS

Participating centers have demonstrated the high value of autopsy and autopsy-derived data and biomaterials to modern medicine. The planned long-term continuation and further development of the registry and network, as well as the open and participatory design, will allow the involvement of all interested partners.

Heritable epigenetic diversity for conservation and utilization of epigenetic germplasm resources of clonal East African Highland banana (EAHB) accessions

KEY MESSAGE

Genetically identical East African Highland banana (EAHB) clones are epigenetically diverse with heritable epialleles that can contribute to morphological diversity. Heritable epigenetic variation can contribute to agronomic traits in crops and should be considered in germplasm conservation. Despite the genetic uniformity arising from a genetic bottleneck of one ancestral clone, followed by subsequent vegetative propagation, East African Highland bananas (EAHBs) display significant phenotypic diversity potentially arising from somatic mutations, heritable epialleles and/or genotype-by-environment interactions. Here, we use DNA methylation profiling across EAHB accessions representing most of the primary EAHB genepool to demonstrate that the genetically uniform EAHB genepool harbours significant epigenetic diversity. By analysing 724 polymorphic DNA methylation sites by methylation-sensitive AFLP across 90 EAHB cultivars, we could differentiate the EAHB varieties according to their regions (Kenya and Uganda). In contrast, there was minimal association of DNA methylation variation with the five morphological groups that are used to classify EAHBs. We further analysed DNA methylation patterns in parent-offspring cohort, which were maintained in offspring generated by sexual (seed) and asexual (vegetative) propagation, with higher levels of altered DNA methylation observed in vegetatively generated offspring. Our results indicate that the phenotypic diversity of near-isogenic EAHBs is mirrored by considerable DNA methylation variation, which is transmitted between generations by both vegetative reproduction and seed reproduction. Genetically uniform vegetatively propagated crops such as EAHBs harbour considerable heritable epigenetic variation, where heritable epialleles could arise in offspring and contribute to functional traits. This study provides a basis for developing strategies for conservation of epigenetic resources and for integration of epimarkers into crop breeding programmes.

[Merkel cell carcinoma in chronic lymphocytic leukemia : Successful treatment with PD-L 1 inhibition, avelumab and chlorambucil]

We report the case of an 85-year-old chronic lymphocytic leukemia patient with a local metastatic MCVPyV-negative Merkel cell carcinoma at initial diagnosis. Therapy comprised surgical excision and radiotherapy but without lymphadenectomy. Six months after the primary diagnosis, liver metastases were detected. They responded to the PD-L1 inhibitor avelumab for more than 15 months. Thus, we postulate a synergistic effect of combined therapy with chlorambucil and avelumab through a mutual improvement of immune function, from which both diseases benefit.

Der Röntgenthorax: Routineindikation in der Nachsorge des differenzierten Schilddrüsenkarzinoms?

Ziel: Anhand einer retrospektiven Untersuchung wurde überprüft, inwieweit der routinemäßige Einsatz des Röntgenthorax auch bei Low-risk-Patienten trotz der hohen Sensitivität des Tumormarkers Thyreoglobulin sinnvoll ist. Methode: Es wurden die Krankengeschichten von 609 Patienten mit einem differenzierten Schilddrüsenkarzinom ausgewertet. Bei 50 Patienten wurde eine pulmonale Metastasierung diagnostiziert. Der Thyreoglobulinwert zum Zeitpunkt der Diagnosestellung der pulmonalen Metastasierung wurde mit dem Befund des Röntgenthorax und der vorhandenen weiteren Diagnostik, wie der lod-131-Ganzkörperszintigraphie und CT des Thorax, soweit vorhanden, verglichen. Ergebnisse: Die gefundene Sensitivität des Röntgenthorax im Nachweis von Lungenmetastasen lag mit 52% unterhalb der Sensitivität der 131 -lod-Ganzkörperszintigraphie (64%), der Thorax-CT (82%) und der Sensitivität des Thyreoglobulins unter Suppressionsbedingungen (86%). Bei Patienten mit papillärem Schilddrüsenkarzinom der Tumorstadien I und II entwickelte nur ein Patient im Verlauf eine Lungenmetastasierung. Der Nachweis von Lungenfiliae nur mit Hilfe des Röntgenthorax bei einem Thyreoglobulinwert unter der Nachweisgrenze ist in einer solchen Low-risk-Gruppe sehr selten (berechnete Wahrscheinlichkeit: 1:4000) und mit erheblichen Kosten verbunden. Schlußfolgerung: Der routinemäßige, lebenslange Einsatz des Röntgenthorax ohne Rezidivverdacht (z. B. Thyreoglobulin positiv) ist für Low-risk-Patienten zu überdenken.

Onko-PET: Bildanalyse mittels Monitor versus standardisierter Filmdokumentation

Ziel: Die Wertigkeit einer standardisierten Filmdokumentation in der Beurteilung von 2-[18F]Fluor-2-deoxy-D-Glukose (F-18-FDG) Onko-PET-Untersuchungen sollte untersucht werden. Methoden: 100 Onko-PET-Untersuchungen (ohne Schwächungskorrektur) wurden in Hinblick auf Zahl und Lokalisation malignitätsverdächtiger Läsionen ausgewertet: zum einen mittels standardisierter Filmvorlagen und zum anderen unter zusätzlicher Analyse am Monitor. Die Filmdokumentation beinhaltet erstens transversale Schnitte des Gehirns, zweitens koronale Schnitte und Maximum-intensity-projections (MIPs) sowohl des Kopf-/Halsbereiches als auch drittens des Körperstammes und viertens MIPs der Beine. Bei der Monitorauswertung wurden sämtliche Körperabschnitte in koronaler, transversaler und sagittaler Schnittführung analysiert. Ergebnisse: Insgesamt wurden 315 Läsionen bei 100 Patienten detektiert. Bei 96/100 Untersuchungen fand sich eine Übereinstimmung beider Auswertemethoden in Anzahl und Lokalisation der Läsionen. In der Filmauswertung wurden bei drei Patienten insgesamt sieben Herde in den Beinen übersehen. 9/315 Läsionen in 2/100 Patienten erfuhren durch die zusätzliche Monitorauswertung eine Lokalisationsänderung. Hiervon befanden sich acht der neun Läsionen in den Beinen. Erst nach zusätzlicher Dokumentation der Beine in koronaler Schnittführung wurden sämtliche, in den MIPs übersehene Läsionen detektiert und die topographisch falsch zugeordneten Läsionen konnten konkordant zur Monitorauswertung lokalisiert werden. Bei dieser so ergänzten Filmdokumentation führte die zusätzliche Monitorauswertung zu keiner Detektion weiterer Herde und zu einer klinisch nicht relevanten Lokalisationsänderung von lediglich 1/322 Läsionen. Schlußfolgerung: Die beschriebene, standardisierte Filmdokumentation erlaubt eine Befundung unter nur noch gezieltem Einsatz der Analyse am Monitor. Darüber hinaus entspricht der hier vorgestellte Ansatz den Intentionen der nuklearmedizinischen Arbeitsgemeinschaft Standardisierung, daß auswärtige Voruntersuchungen problemlos in eine Verlaufsbeurteilung einbezogen werden können.

Granulationsgewebe: Pitfall in der Therapiekontrolle mit F-18-FDG-PET nach Chemotherapie

FDG-Speicherung in Entzündungsherden als Ursache für falsch positive Befunde bei der FDG-PET in der primären Tumor- und Metastasendiagnostik ist in der Literatur belegt. Der vorliegende Fall zeigt, daß die vermehrte Speicherung von FDG in aktivierten neutrophilen Granulozyten und Makrophagen auch in der Therapieverlaufskontrolle unter Chemotherapie zu berücksichtigen ist. Bei einem 52jährigem Patienten wurde eine FDG-PET nach Abschluß der Chemotherapie eines Non-Hodgin-Lymphoms des Abdomens mit der Frage nach verbliebener Tumorvitalität durchgeführt. In der FDG-PET fand sich im Randbereich des persistierenden Restbefundes ein erhöhter Glukosestoffwechsel. Histologisch war dieser Befund auf umgebendes Granulationsgewebe mit zentralen nekrotischen Tumoranteilen zurückzuführen.

Abstract P3-05-09: Interlaboratory variability of Ki67 labeling index in breast cancer tissue microarrays

Objective: Assessment of tumor proliferation using the Ki67 labeling index (Ki67-LI) is increasingly recommended for prognostication and adjuvant chemotherapy decisions in breast cancer. Our aim was to investigate interlaboratory variance of Ki67-LI results using TMA and centralised assessment to exclude preanalytic influences and postanalytic variance, respectively.

Methods: Nine pathology laboratories (8 German and 1 Dutch) performed Ki67 staining of a TMA slide according to their routine in house protocol (including internal and external quality assurance). 40 samples per lab were centrally analyzed. The Ki67-LI was calculated after counting first all tumor cells and subsequently all Ki67 positive tumor cells of each sample regardless of staining intensity. For each tissue sample we evaluated the range of Ki67-LIs between different labs. Further 20 labs of the German Breast Screening Pathology Initiative will participate in 2013.

Results: The range of Ki67-LIs between the labs was: 1-5% in 4 (10%), 6-10% in 6 (15%), 11-15% in 7 (17,5%), 16-20% in 2 (5%), 21-25% in 7 (17%), 26-30% in 4 (10%), 31-35% in 1 (1%), 36-40% in 4 (10%), 41-45% in 2 (5%), 46-50 in 0 (0%) and >50% in 3 samples (7%), respectively. Thus, in 35% of results of the 9 labs (26 of the 40 TMA specimens) the Ki67-LI differed by more than 25%. The analysis of variance (ANOVA) came out with F = 4.24 which is much larger than the critical F value of 1.97 for these study results (p = 7.74902E-05). This means that the observed interlaboratory variance of 4.24 is systematic and not due to sampling error. The respective standard deviation is 33.4%.

Conclusion: In a setting strictly standardised in terms of preanalytic influences by using TMA and postanalytic variance by centralised quantification, Ki67-LI seems to be heavily influenced by laboratory-specific analytic variables. Taking this into consideration, there may be a risk of prognostic or predictive misclassification in some breast cancer patients in daily practice.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-05-09.

[Heterotopic sebaceous glands in the esophagus: case report with review of the literature]

Heterotopia of sebaceous glands is a very rare endoscopically indistinct benign finding in the esophagus. To date only 30 cases have been reported in the literature. The lesions exhibit a considerable variation in number and size. No malignant transformation has yet been reported. From the pathologists' point of view an inflammatory or neoplastic process has to be excluded as the cause of the non-distinctive endoscopic findings.

Second Opinion Assessment in Diagnostic Mammography at a Breast Cancer Centre

Purpose: The aim of this retrospective study was to evaluate the importance of second opinion assessment for diagnostic mammography and sonography in a breast cancer centre. Material and Method: We analysed a total of 374 diagnostic mammographies and sonographies. All patients had previously undergone mammography and sonography examination in different external clinics, and the findings had been classified according to the BI-RADS system. All patients underwent additional sonography investigation in the outpatient department of our university clinic with additional mammography where necessary. The final diagnosis (histological clarification in 316 cases, follow-up in 58 cases) was compared with the BI-RADS classification made by the external clinics and by the university clinic, and the correlation between their findings and the final diagnosis was analysed. Results: The final diagnosis yielded 146 benign lesions and 228 cancers. In 74 % of cases (277/374), the BI-RADS classification of the first assessment corresponded to that of the second assessment. 26/55 lesions (47 %) were upgraded at the second assessment from BI-RADS 3 to BI-RADS 4, and 71/186 findings (38 %) were downgraded at the second assessment from BI-RADS 4 to BI-RADS 3. The correlation between the initial diagnosis made in the external facilities and the final diagnosis was low (kappa: 0.263), but the correlation between the second opinion assessment and the final diagnosis was significantly (p < 0.001) higher (kappa: 0.765). The second assessment increased the sensitivity from 91 % (208/228) to 99 % (225/228) and the specificity from 32 % (46/146) to 74 % (108/146). 20 additional malignant lesions were only detected at the second assessment; however the second assessment also resulted in 3 additional false-negative findings. Surgical biopsy was prevented in 49 women after the second assessment. Conclusion: An independent second diagnostic evaluation can significantly improve the correlation between BI-RADS classification and the final diagnosis, resulting in a benefit for the patient.

The effect of milk proteins on appetite regulation and diet-induced thermogenesis

BACKGROUND/OBJECTIVES

There is increasing evidence to support that a high-protein diet may promote weight loss and prevent weight (re)gain better than a low-protein diet, and that the effect is due to higher diet-induced thermogenesis (DIT) and increased satiety. However, data on the effect of different types of protein are limited. In the present study we compare the effect of whey, casein and milk on DIT and satiety.

SUBJECTS/METHODS

Seventeen slightly overweight (29 ± 4 kg/m(2)) male subjects completed the study. The study had a randomized, crossover design, where the effect on 4 h postprandial energy expenditure (EE), substrate oxidation and subjective appetite sensation of three isocaloric test meals containing either a whey drink, a casein drink or skim milk was examined. Energy intake (EI) at a subsequent ad libitum lunch was also measured.

RESULTS

There was no significant effect on subjective appetite sensation, but EI at lunch was lower after the milk test meal than after the casein (9%; P=0.0260) and the whey (9%; P=0.0258) test meals. Postprandial lipid oxidation was significantly higher after the casein test meal compared with the whey test meal (P=0.0147) when adjusted for baseline values. There was no significant difference in effect on EE, protein oxidation or carbohydrate oxidation.

CONCLUSIONS

Milk reduced subsequent EI more than isocaloric drinks containing only whey or casein. A small but significant increase in lipid oxidation was seen after casein compared with whey.

Linkage analysis of a rare alkaloid present in a tetraploid potato with Solanum chacoense background

The potato genotype ND4382-19 has Solanum chacoense Bitt. in its genetic background. Foliar alkaloid analysis of it and its progeny ND5873 (ND4382-19 × Chipeta) by gas chromatography-mass spectrometry (GC-MS) showed that, in addition to the expected alkaloids (solanidine, leptinidine, and acetyl-leptinidine), there was an aglycone of another rare alkaloid. Its molecular mass and some of the m/z fragment ions were similar to leptinidine, but the major fragment ion was the m/z 150 peak of solanidine. This fragmentation pattern suggested that this alkaloid is a solanidine-based compound with mass equal to leptinidine. Leptinidine differs from solanidine by an extra -OH group, but the GC-MS fragmentation pattern of the rare compound indicated hydroxylation at a different position than the C-23 of leptinidine. The exact chemical structure is still unknown, and further analysis, such as NMR will be necessary to determine the structure. Segregation analysis of ND5873 (ND4382-19 × Chipeta) showed that presence of this rare compound segregated in a 1:1 ratio, indicating that a single gene controlled its synthesis and/or accumulation in foliar tissue. Analysis with AFLP and microsatellite markers indicated that the locus-controlling presence of this alkaloid resided on potato chromosome I, with the nearest flanking AFLP markers 0.6 and 9.4 cM apart. This rare alkaloid was present in the foliage and not detected in potato tubers. Its presence in leaves did not affect resistance/susceptibility to Colorado potato beetle.

[Systematic review about eccentric training in chronic achilles tendinopathy]

BACKGROUND

Throughout the recent decade, eccentric training has become a widely accepted therapy option in the conservative treatment of chronic Achilles tendinopathy. Nevertheless, current recommendations are missing regarding dosage and duration of eccentric training as well as standardized training protocols.

OBJECTIVES

Is eccentric training as a conservative treatment in chronic Achilles tendinopathy of beneficial effect versus other conservative treatments? According to the current scientific data, is it possible to recommend dosages and duration of training time of eccentric training?

STUDY DESIGN

Systematic review of the current scientific literature on eccentric training as a conservative treatment in chronic Achilles tendinopathy according to the PRISMA-guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

DATA SOURCE

National library of Medicine (NLM) between the years 1950 and 2010.

STUDY ELIGIBILITY CRITERIA

Prospective randomised controlled trials (RCT).

PARTICIPANTS

8 RCTs included 416 subjects with a median number of 42 subjects and a range of 17 to 116 subjects per trial. Median follow-up duration was 12 weeks with a range from 12 to 54 weeks.

RESULTS

124 papers met the eligibility criteria in the NLM, whereas only eight randomised controlled trials were included in this review after screening titles, abstracts and full texts. All included trials demonstrated an improvement in pain after performing equivalent training protocols of eccentric training in chronic Achilles tendinopathy.

LIMITATIONS

A pooled statistical evaluation of the included trials could not be performed due to different study designs as well as limited documentation of subjects' compliance.

CONCLUSION

In spite of different compliance, effects of eccentric training in conservative treatment of chronic mid-portion-Achilles tendinopathy are promising. Because of the heterogeneous outcome variables (ordinal scale, VAS, FAOS, AOFAS, VISA-A) and the methodological limitations of the trials, no definite recommendation can be published concerning dosage and duration of eccentric training in chronic Achilles tendinopathy.

[Gangliocytic paraganglioma--a rare cause of an upper gastrointestinal bleeding]

INTRODUCTION

Gangliocytic paraganglioma is a rare tumour, occurring nearly exclusively in the descending part of the duodenum. It is regarded as a mostly benign tumour but of unknown malignant potential, which rarely metastasises to local lymph nodes or distantly.

CASE REPORT

Here we report on a 62-year-old female patient with a marked microcytic anaemia with a haemoglobin concentration of 3.4 mg/dL. Oesophagogastroduodenoscopy showed an ulcerous periampullary tumour in the duodenum with a diameter of approximately 5 cm. Endoscopic ultrasonography showed no evidence of tumour infiltration of the tunica muscularis and of locoregional lymph node metastasis. Therefore, complete endoscopic resection of the tumour was achieved after ligating the tumour base by an endoloop using a dual channel endoscope. In a second step, the tumour base was resected by endoscopic submucosal dissection (ESD) and revealed no residual tumour. The histological evaluation showed a gangliocytic paranganglioma consisting of three specific cell types: epithelioid cells arranged in typical carcinoid-like patterns, spindle cells wrapped around nests of epithelioid cells and ganglion cells. All cell types expressed neuron-specific enolase (NSE) as a neuroendocrine marker. Synaptophysine was expressed mainly by the epithelioid and ganglion cells while the protein S 100 was expressed mainly by the spindle cells, which surround the epithelioid cell nests as a sustentacular network. The proliferation rate determined by Ki67 staining was only < 5 %.

CONCLUSION

Gangliocytic gangliocytomas of the duodenum can be safely removed by endoscopic submucosal dissection as long as there is no evidence of infiltration of the tunica muscularis or of local lymph node metastasis. Because of the unknown malignant potential, these patients have to be controlled by regular ultrasonographic and endosonographic procedures.

A QTL that confers resistance to Colorado potato beetle (Leptinotarsa decemlineata [Say]) in tetraploid potato populations segregating for leptine

Genetic resistance to Colorado potato beetle (Leptinotarsa decemlineata [Say]) from Solanum chacoense has been incorporated in the tetraploid potato selection, ND4382-19, which is highly resistant and contains moderate level of foliar leptines. We recently reported using ND4382-19 progeny, population ND5873 (ND4382-19 x Chipeta), to map two genes that segregated as complementary epistatic genes that allow accumulation of leptinidine (Lep) and acetyl-leptinidine (AL) on chromosomes 2 and 8, respectively. We describe here the characterization of a second half-sib population NDG116 (ND4382-19 x N142-72). In this population, solasodine from parent N142-72, which has Solanum berthaultii in its background, was predominant over solanidine-based alkaloids. Concentrations of solanidine, leptinidine, and acetyl-leptinidine were 15-, 5-, and 14-fold lower than in the ND5873 population. Nevertheless, Lep and AL mapped to the same locations on chromosomes 2 and 8 of parent ND4382-19, respectively. The two populations were evaluated for resistance to Leptinotarsa in field assays, and by detached leaf assay for population NDG116. In both families, QTL analysis identified a major QTL from ND4382-19 on the distal end of chromosome 2, close to the Lep locus. The contribution of this QTL to resistance ranged from 11 to 34% for ND5873 at four field sites. Contribution to resistance from the linkage group that contains the gene AL for the accumulation of leptine was not detected. In family NDG116, the same chromosome 2 QTL was detected for field and detached leaf assays, explaining 26 and 12% of the variance for defoliation and larval development, respectively. These data may indicate another resistance mechanism besides leptine in the Leptinotarsa resistance observed in these populations.

Heart and muscle involvement by extra-medullary myeloid leukemia: A case report and review of the literature

Extra-medullary myeloid tumours (EMT) have been described after curative treatment for acute myeloid leukaemia (AML) in increasing numbers after allogeneic stem cell transplantation. The sites of manifestations are ubiquitous and the discovery is most frequently guided by symptoms reported by the patient or by findings on clinical examination. This study reports a case of EMT in muscles and the heart 1.5 years after allogeneic transplantation for an AML with t(8;21)(q22;23) who achieved a complete remission by use of an idarubicine-based combination chemotherapy. Pathological and imaging findings are presented and treatment options are discussed.

[Certified quality management according to DIN ISO 9001 in a radiology department at a university hospital: measurable changes in academic quality indicators?]

PURPOSE

To evaluate the changes in academic quality indicators after implementation of a quality management system according to DIN ISO 9001:2000.

MATERIALS AND METHODS

After implementation and certification of a quality management system, the actual state based on quality indicators from the fields of student teaching, research, continuing education and the satisfaction of referring physician was determined. After implementation of an action plan for the individual areas, the temporal changes in the ratios were documented in the follow-up.

RESULTS

The evaluation of teaching performance obtained by questionnaire among the students of the radiology course showed a steady increase in satisfaction (mean value 2003: 2.7; 2007: 3.9). In the field of research an increase in scientific output was achieved based on the number of an internal publication score (2002: 99 points; 2006: 509). Repeated opinion surveys among our referring physicians found improvements in indicators for the appointment of investigations, consulting service and waiting times for the investigation, while the waiting times for internal transport service did not improve. Exemplary measurements of the success of the advanced training of the staff demonstrated the need for continuing education for quality improvement.

CONCLUSION

The evaluation of quality indicators showed over time a measurable positive impact on processes of a radiological University Hospital after implementation of a QM system according to DIN ISO 9001:2000.

Relationship between matrix metalloproteinases MMP-2, MMP-9, tissue inhibitor of matrix metalloproteinases-1 and IL-5, IL-8 in nasal polyps

BACKGROUND

Nasal polyps (NP), a subgroup of chronic rhinosinusitis, are characterized by interleukin 5 (IL-5) mediated infiltration of eosinophils in sinus mucosa, leading to pseudostratified ciliated columnar epithelium, thickening of the epithelial basement membrane and tissue edema. Matrix metalloproteinases (MMP) constitute a large group of Zn2+ dependent endopeptidases with the ability to degrade extracellular matrix and are possibly responsible for the development of tissue edema in chronic sinusitis.

OBJECTIVE

The aim of this study was to determine the expression of MMP-2, MMP-9 and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) mRNA and to locate the distribution of MMP-2, MMP-9 and TIMP-1 by immunohistochemistry in ethmoid sinus mucosa in NP. Furthermore the correlation between IL-5 or IL-8 and MMP-2, MMP-9 or TIMP-1 is examined.

METHODS

Nasal polyps of 33 patients and 18 specimens of inferior turbinate mucosa were examined by real time RT-PCR for MMP-2, MMP-9, TIMP-1, IL-5 and IL-8 mRNA expression. Immunohistochemical labeling for MMP-2, MMP-9 and TIMP-1 was performed.

RESULTS

Differences between both locations were detectable for MMP-9 (P < 0.001) and IL-5 (P=0.003) but not for MMP-2 (P=0.278), TIMP-1 (P=0.515) and IL-8 (P=0.386). Correlation was detected only between TIMP-1 and IL-5 (r=0.422, P =0.014). Cytoplasmic staining of MMP-2 was present in the apical part of the ciliated cells, submucosal glands and in smooth muscle cells. Matrix metalloproteinase-9 was expressed in surface epithelium, in seromucous glands and in polymorphonuclear cells.

CONCLUSIONS

Expression of MMP-9 and IL-5 mRNA are associated with NP. The correlation between IL-5 and TIMP-1 indicates the role of TIMP-1 in maintaining the homeostasis in NP.

Mapping of genes associated with leptine content of tetraploid potato

High content of leptine glycoalkaloids present in Solanum chacoense has been associated with genetic resistance to Colorado potato beetle (Leptinotarsa decemlineata [Say]). From an unrecorded accession of S. chacoense, the North Dakota State University breeding program has developed a tetraploid genotype, ND4382-19, that contains foliar leptines. In this study, using a segregating population, ND5873 (ND4382-19 x Chipeta), and GC-MS to analyze foliar content of alkaloids, two loci, involved in the synthesis of leptines were identified. They segregated as two complementary epistatic genes that allowed the synthesis of leptinidine (Lep) and acetyl-leptinidine (AL), respectively. Partial AFLP maps for both parents were developed using 97 individuals from population ND5873. The total lengths mapped for ND4382-19 and Chipeta were 1,883 and 1,021 cM, respectively. The marker for Lep was located at the distal end of simplex-coupling linkage group R37. Expansion of the initial mapping population and analysis of Lep-containing individuals allowed us to identify the linkage group (R35) that enabled synthesis of AL. By the use of simple sequence repeat markers, linkage group R37 (Lep) and linkage group R35 (AL) have been identified as homologs of chromosomes II and VIII, respectively.

Subnormal energy expenditure: a putative causal factor in the weight gain induced by treatment of hyperthyroidism

AIMS

To examine the causes of weight gain occurring as an adverse effect of treatment of hyperthyroidism.

METHODS

We measured 24-h energy expenditure (EE), body composition and spontaneous physical activity (SPA) in eight patients before and 1 year after treatment of hyperthyroidism was initiated, and eight controls.

RESULTS

One year after initiation of treatment thyrotropin was normalized, thyroid hormones had fallen to the lower end of the reference range and fat mass had increased by 3.5 kg (p < 0.001). Twenty-four hour EE adjusted for fat-free mass (FFM) was 15% higher in hyperthyroid patients before treatment than in controls (p = 0.003), and treatment decreased 24-h EE by 1.9 MJ/day (p = 0.001). After treatment, 24-h EE, adjusted for FFM, was similar to the controls. Multiple regression analyses showed that the suppressed EE could partly be attributed to an iatrogenic suppression of thyroid hormones, resulting in lower sleeping EE. Twenty-four hour SPA was normal in the hyperthyroid state, but decreased after treatment by 21% (p = 0.045), to a level not significantly different, but still below that of the controls.

CONCLUSIONS

The study suggests that weight gain during treatment of hyperthyroidism might be due to subnormal levels of EE and SPA caused by a suppression of the thyroid hormone to a level in the lower end of the normal range.

Wirtschaftliche Evaluation angiographischer Interventionen einschließlich einer radiologischen stationären und ambulanten Patientenbetreuung

PURPOSE

To determine the economic efficiency of a whole-radiology in- and outpatient treatment with angiographic interventions performed as the main or sole therapy.

MATERIALS AND METHODS

The calculations represent the data of a university radiology department, including the following angiographic interventions (neuroradiology not considered): Vascular intervention (PTA, stent implantation) of kidneys and extremities, recanalization of hemodialysis access, chemoembolization, diagnostic arterioportal liver CT, port implantation, varicocele embolization, PTCD, percutaneous implantation of biliary stent. First, the different angiographic interventions are categorized with reference to the German DRG system 2005. Considering the example of a university hospital, the individual cost of each intervention is calculated and correlated with reimbursements by G-DRG2005 and so-called "ambulant operation" (EBM200plus). With these data, profits and losses are calculated for both in- and outpatient care.

RESULTS

Radiologic interventions of inpatients yield a profit in the majority of cases. With a base rate of 2900 euros, the profits in our university hospital range between - 872 euros and + 3411 euros (mean: + 1348 euros). On the other hand, those angiographic interventions suitable for "ambulant operation" generate average profits of + 372 euros, if only direct costs are considered. The data of outpatient radiological interventions average between 381 euros up to 1612 euros lower than compared with profits obtained from in patient care.

CONCLUSION

Once an angiographic intervention represents the major or sole therapy, German radiologists are advised to operate out- and inpatient care by themselves. In Germany, the G-DRG-system and EBM enable radiology departments to generate considerable proceeds for their hospitals and, secondly, to yield a valuable add-on profit for their own department budget, which then is partly detached from the inflexible conventional reimbursement of radiological services.

[Clinical relevance of multislice CT of the spine after osteosynthesis]

PURPOSE

To examine the clinical relevance of multislice CT (MSCT) scans in postoperative checks of the spine after osteosynthesis.

MATERIAL AND METHODS

The results of x-rays (apical lateral) in 30 patients having spinal surgery involving osteosynthesis (5 x metastasis, 20 x fractures, 3 x spondylolisthesis, 2 x scoliosis) were correlated to those of MSCT (140 kV, 200 mAs, collimation 4 x 1 mm, pitch 0.75; VolumeZoom, Siemens, Erlangen, Germany) with multiplanar reconstruction. Two radiologists independently checked the conventional x-ray and multislice CT scans for anatomical positioning, damage of osteosynthetic material, and intraspinal dislocation of bone fragments.

RESULTS

By correlating conventional spinal x-rays with MSCT, additional diagnostic information was gained. In 9 of 30 patients MSCT revealed the extraosseal location of a screw tip (x-ray, 5/30), in 8/30 patients a narrowing of the spinal canal by osteosynthetic material was detected in MSCT (x-ray, 4/30), in 2/30 patients osteal fragments were detected in the vertebral canal by MSCT (x-ray, 0/30). In MSCT and in conventional x-ray a fracture of the osteosynthesis was correctly diagnosed in 3 patients. One patient underwent corrective surgery for dislocated osteosynthetic material, which was solely diagnosed with MSCT.

CONCLUSION

Due to the high degree of additional diagnostic information MSCT seems to be the method of choice for postoperative spinal surgery involving osteosynthesis.

Mapping and characterization of new EST-derived microsatellites for potato (Solanum tuberosum L.)

Microsatellites, or simple sequence repeats (SSRs) are very useful molecular markers for a number of plant species. They are commonly used in cultivar identification, plant variety protection, as anchor markers in genetic mapping, and in marker-assisted breeding. Early development of SSRs was hampered by the high cost of library screening and clone sequencing. Currently, large public SSR datasets exist for many crop species, but the number of publicly available, mapped SSRs for potato is relatively low (approximately 100). We have utilized a database mining approach to identify SSR-containing sequences in The Institute For Genomic Research Potato Gene Index database (http://www.tigr.org), focusing on sequences with size polymorphisms present in this dataset. Ninety-four primer pairs flanking SSR sequences were synthesized and used to amplify potato DNA. This study rendered 61 useful SSRs that were located in pre-existing genetic maps, fingerprinted in a set of 30 cultivars from South America, North America, and Europe or a combination thereof. The high proportion of success (65%) of expressed sequence tag-derived SSRs obtained in this work validates the use of transcribed sequences as a source of markers. These markers will be useful for genetic mapping, taxonomic studies, marker-assisted selection, and cultivar identification.

Imaging anisotropic and viscous properties of breast tissue by magnetic resonance-elastography

MR-elastography is a new technique for assessing the viscoelastic properties of tissue. One current focus of elastography is the provision of new physical parameters for improving the specificity in breast cancer diagnosis. This analysis describes a technique to extend the reconstruction to anisotropic elastic properties in terms of a so-called transversely isotropic model. Viscosity is treated as being isotropic. The particular model chosen for the anisotropy is appealing because it is capable of describing elastic shear anisotropy of parallel fibers. The dependence of the reconstruction on the particular choice of Poisson's ratio is eliminated by extracting the compressional displacement contribution using the Helmholtz-Hodge decomposition. Results are presented for simulations, a polyvinyl alcohol breast phantom, excised beef muscle, and measurements in two patients with breast lesions (invasive ductal carcinoma and fibroadenoma). The results show enhanced anisotropic and viscous properties inside the lesions and an indication for preferred fiber orientation.

[Dose optimization for multislice computed tomography protocols of the midface]

PURPOSE

To optimize multislice computed tomography (MSCT) protocols of the midface for dose reduction and adequate image quality.

MATERIALS AND METHODS

MSCT (Somatom Volume Zoom, Siemens) of the midface was performed on 3 cadavers within 24 hours of death with successive reduction of the tube current, applying 150, 100, 70 and 30 mAs at 120 kV as well as 40 and 21 mAs at 80 kV. At 120 kV, a pitch of 0.875 and collimation of 4x1 mm were used, and at 80 kV, a pitch of 0.7 and collimation of 2x0.5 mm. Images were reconstructed in transverse and coronal orientation. Qualitative image analysis was separately performed by two radiologists using a five-point scale (1 = excellent; 5 = poor) applying the following parameters: image quality, demarcation and sharpness of lamellar bone, overall image quality, and image noise (1 = minor; 5 = strong). The effective body dose [mSv] and organ dose [mSv] of the ocular lens (using the dosimetry system "WINdose") were calculated, and the interobserver agreement (kappa coefficient) was determined.

RESULTS

For the evaluation of the lamellar bone, adequate sharpness, demarcation and image quality was demonstrated at 120 kV/30 mAs, and for the overall image quality and noise, 120 kV/40 mAs was acceptable. With regard to image quality, the effective body dose could be reduced from 1.89 mSv to 0.34 mSv and the organ dose of the ocular lens from 27.2 mSv to 4.8 mSv. Interobserver agreement was moderate (kappa = 0.39).

CONCLUSION

Adequate image quality was achieved for MSCT protocols of the midface with 30 mAs at 120 kV, resulting in a dose reduction of 70 % in comparison to standard protocols.

Diagnostische Mammographie und Sonographie: Korrelation von diagnostischer BI-RADS-Einstufung mit dem histologischen und klinischen Endbefund

PURPOSE

The purpose of the study was to assess the final clinical outcome of BI-RADS Categories for diagnostic mammography and sonography.

MATERIAL AND METHODS

We analysed 632 mammography and sonography examinations from women with diagnostic indications (age: 23 - 100, mean 58) performed during 2001 and 2003. All patients received mammography and sonography examinations at different outside facilities and all patients received an additional sonography examination at the university radiology department and if necessary supplemental mammographic views. Final clinical outcome (Histology: 554; follow-up: 78) was ascertained in each case and concordance of BI-RADS-categories for mammography and sonography and final diagnosis were analysed.

RESULTS

Final diagnosis yielded 230 benign lesions (36 %) and 402 cancers (64 %). Concordance of BI-RADS Assessment and final outcome was documented in 542 cases (86 %). There were 11 correct category 1 and 2 assessments (2 %). 142 lesions were classified with BI-RADS 3 (22 %) with 5 false negative ratings. There were 264 category 4 lesions (42 %) with a PPV for a malignant lesion of 71 % (187/264) and finally 215 BI-RADS 5 lesions with a PPV of 98 % (210/215). Overall sensitivity of mammography was 92 % with specificity of 75 % and for sonography 86 % and 76 %. Mammography had a significantly higher detection rate for malignant lesions than sonography. The highest correlation between BI-RADS category and final outcome was documented for the diagnostic combination of mammography and sonography with a kappa-value of 0.817 (p < 0.001), followed by mammography (kappa: 0.684) and sonography (kappa: 0.631). The overall correlation was 0.681 (p < 0.001).

CONCLUSION

BI-RADS assessments of diagnostic mammography and sonography yields in a high cancer detection rate with a justifiable part of false positive ratings.

MR elastography of the prostate: initial in-vivo application

PURPOSE

To analyze the initial assessment of the technical feasibility of in-vivo MR elastography (MRE) of the prostate gland in healthy volunteers.

MATERIALS AND METHODS

Dynamic sinusoidal MR elastography was performed in 7 healthy volunteers in prone position. The mechanical wave was induced via an external oscillator attached to the pubic bone. A 1.5 Tesla MR system (Philips Medical Systems, Netherland) was used with 4 combined surface coils for signal reception. MRE data acquisition was performed with a motion-sensitive spin-echo MR sequence that was phase-locked to the mechanical oscillation. Subsequently, these images were used to reconstruct the local distribution of elasticity inside the prostate gland. The applied reconstruction algorithm was tested by means of phantom measurements.

RESULTS

Sufficient penetration of the mechanical wave into the prostate gland was achieved in all volunteers, allowing the acquisition of utilizable image data sets. The reconstructed distribution of elasticity (shear-modulus) inside the healthy prostate gland correlated with the zonal anatomy of the gland. The elasticity of the central portion (2.2 +/- 0.3 kPa) appeared to be lower than the peripheral prostatic portion (3.3 +/- 0.5 kPa).

CONCLUSION

In-vivo MRE of the prostate gland is technically feasible. The proposed experimental set-up allows the efficient insertion of the mechanical wave into the prostate gland and provides a successful MR data acquisition.

[Diagnosis of an initial infratentorial central nervous system B-cell lymphoma during prolonged cortisone medication]

We present a patient with primary central nervous system B-cell lymphoma. He had suffered from slowly developing weight loss and presented to us with disorientation, seizures, and a supranuclear gaze disturbance. The patient was dismissed with the primary diagnosis of autoimmune encephalitis of the brainstem and put on oral corticosteroids. Four months later, his health status had deteriorated, and at that time diagnostic methods pointed to a cerebral lymphoma. Stereotactic biopsy with subsequent immunohistochemistry and polymerase chain reaction analysis revealed a highly malignant B-cell lymphoma of the CNS, despite prolonged corticosteroid treatment. The patient was treated with whole brain radiotherapy.

Korrelation von lumbogenem Schmerz und vermehrter Vaskularisation in den Wirbelkörperendplatten

AIM OF THE STUDY

Degenerative changes of the motion segments are accompanied by an increased vascularization of the endplates. Nerve elements have been demonstrated in the environment of the endplate vessels, which might play a role in pressure related pain sensation. In order to investigate this theory we compared and correlated the extent of memory pain as determined by discography with the amount of vascularization in the endplates on histological examination.

METHOD

Discography was performed in 32 Patients (21 female, 11 male), who underwent spinal fusion. The extent of pain sensation was determined on a self reported visual analogue scale ranging from 0-10 Points. Bone chips from the anterior vertebral endplates were obtained during surgery. Decalcified paraffin-embedded samples were then immunostained with the vascular endothelial marker CD 34. The quantification of endothelium as part of the whole cross section area was performed by means of a computerized optical method.

RESULTS

The extent of the pain sensation during discography ranged from 0-9 points on the VAS (average: 5.3 points, SD 3.1). On the histological quantification the total endothelial area per observed field varied from 0.04 to 7.39 % (average: 2.19 %, SD 1.62). The comparison of the pain extent on discography and the vascularization of the endplate resulted in a correlation coefficient after Spearman of rho = + 0.64 (p=0.0006).

CONCLUSION

The extent of vascularization in the degenerated endplates of a motion segment shows a moderate correlation with the self reported VAS scores after discography. Further investigations will have to clarify, whether neurogenic structures originating from vascular endothelium yield a better correlation to discogenic pain.

Acute myeloid leukaemia with t(8;21) associated with "occult" mastocytosis. Report of an unusual case and review of the literature

Approximately 20% of patients with systemic mastocytosis (SM) have an associated haematological, clonal, non-mast cell lineage disease, and most exhibit an associated myelogenous neoplasm. This report describes a 48 year old man with acute myeloid leukaemia (AML) and a type t(8;21) cytogenetic abnormality. Associated bone marrow mastocytosis (a defined subtype of SM) was only detected after successful polychemotherapy in the state of bone marrow aplasia, and persisted after complete remission of AML. The diagnosis of mastocytosis was based on the demonstration of a multifocal dense mastocytic infiltrate. The atypical mast cells showed prominent spindling and an aberrant immunophenotype, with coexpression of tryptase, chymase, KIT, and CD25-which is expressed only on neoplastic (not normal) mast cells. In addition, the transforming somatic mutation D816V of the c-kit gene was detected. Re-examination of the pretherapeutic (initial) bone marrow revealed a slight diffuse increase in partially spindle shaped mast cells also exhibiting an abnormal immunophenotype, with CD25 expression, although compact mastocytic infiltrates were not detected. Because the D816V mutation was detected in the initial bone marrow specimen, strict application of three minor diagnostic criteria (spindling, CD25, D816V) enabled a diagnosis of SM-AML to be confirmed retrospectively in the initial bone marrow tissue.

[Multislice CT of the pelvis: dose reduction with regard to image quality]

PURPOSE

To optimize the examination protocols of multislice CT (MSCT) of the pelvis for dose reduction with regard to image quality.

MATERIALS AND METHODS

MSCT of the pelvis was performed on 5 cadaver specimens with stepwise reduction of the tube current at 140 kV (250, 200, 150, 100, 75, 50, 35, 25 mAs) and 120 kV (50, 27 mAs). The remaining scan parameters like collimation (4 x 1 mm) and table speed of 4 mm per rotation remained unchanged. Axial sections and coronal reconstructions were used to evaluate cortex, trabecular structures, subjective image quality, image noise and detail detectability (pelvis and SI joint), with evaluation performed independently by four blinded experienced radiologists on a 5-point scale. Kappa coefficient, accuracy of the observers to sort the films with regard to dose reduction and mean scores of image evaluation were determined for statistical analysis.

RESULTS

The deterioration of the image quality was most pronounced for all criteria between 75 mAs and 50 mAs at 140 kV. Good results with adequate image quality were obtained for detail detectability at 50 mAs and 140 kV (effective dose [E]: 3.3 mSv) and for the remaining four criteria at 75 mAs (E: 4.9 mSv). There was a moderate agreement between the four observers (kappa coefficient: 0.27). All observers were excellent in arranging the images according to the increasing dose reduction.

CONCLUSIONS

Image quality of MSCT of the pelvis appears to be acceptable at 75 mAs and 140 kV with the dose reduced to 46% of the average value of the nation-wide survey of the German Roentgen Society in 1999 for this type of examination.

MIC mitigation in a 100 MW district heating peak load unit

During inspection of AISI316 stainless steel plate heat exchangers in a district heating peak load unit, localised corrosion attacks along with indications of microbiological activity were found on the boiler side beneath patches of sturdy black deposits. Bacteria and sulphide were detected within black deposits. Thorough investigation of the boiler system revealed several incidents of localised corrosion on low alloy steel along with deposits of organic matter and bacteria primarily in places with stagnant water or places operating at a low flow rate. A relatively large amount of bacteria was detected within the system, primarily in deposits and around corrosion sites. The observations suggested the combination of deposits and bacterial activity, being the major reason for the observed corrosion. Prior to the investigation, the boiler system had operated with cat-/anion-exchanged, de-aerated water for 3 years, during which the water fulfilled strict chemical limits set to minimise corrosion. Based on these findings, the system has been modified in order to minimise the risk of microbiologically influenced corrosion and a monitoring program for fouling and corrosion has been established.