Myocardial injury in patients with acute ischemic stroke detected by cardiovascular magnetic resonance imaging

BACKGROUND

Patients with acute ischemic stroke (AIS) are at high risk of adverse cardiovascular events. Until now, the burden of myocardial injury derived from cardiovascular magnetic resonance imaging (CMR) has not been established in this population.

METHODS

Patients with AIS underwent CMR at 3 Tesla within 120 h after the index stroke as part of a prospective, single-center study. Patients with persistent atrial fibrillation were excluded. Morphology and function of both cardiac chambers and atria were assessed applying SSFP cine. Myocardial tissue differentiation was based on native and contrast-enhanced imaging including late gadolinium enhancement (LGE) after 0.15 mmol/kg gadobutrol for focal fibrosis and parametric T2- and T1-mapping for diffuse findings. To detect myocardial deformation global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain was measured applying feature tracking. Cardiac troponin was measured using a high-sensitivity assay (99th percentile upper reference limit 14 ng/L). T2 mapping values were compared with 20 healthy volunteers.

RESULTS

CMR with contrast media was successfully performed in 92 of 115 patients (mean age 74 years, 40% female, known myocardial infarction 6%). Focal myocardial fibrosis (LGE) was detected in 31 of 92 patients (34%) of whom 23/31 (74%) showed an ischemic pattern. Patients with LGE were more likely to have diabetes, prior myocardial infarction, prior ischemic stroke, and to have elevated troponin levels compared to those without. Presence of LGE was accompanied by diffuse fibrosis (increased T1 native values) even in remote cardiac areas as well as reduced global radial, circumferential and longitudinal strain values. In 14/31 (45%) of all patients with LGE increased T2-mapping values were detectable.

CONCLUSIONS

More than one-third of patients with AIS have evidence of focal myocardial fibrosis on CMR. Nearly half of these changes may have acute or subacute onset. These findings are accompanied by diffuse myocardial changes and reduced myocardial deformation. Further studies, ideally with serial CMR measurements during follow-up, are required to establish the impact of these findings on long-term prognosis after AIS.

Depressive Störungen bei Tumorpatienten

Leitlinien zur Diagnostik und Therapie depressiver Störungen in der Onkologie und Palliativmedizin sind ein zentraler Bestandteil der verbesserten Versorgung von Tumorpatienten. Komorbide depressive Erkrankungen verschlechtern die Lebensqualität und die Compliance, erhöhen vielleicht die Mortalität der Patienten und haben erheblichen Einfluss auf Kosten des Gesundheitssystems. Jüngste Entwicklungen in den bildgebenden Verfahren und molekularbiologischen Techniken ermöglichen ein neues Verständnis der Pathophysiologie von Depressionen bei onkologischen Prozessen. Neben ihren bekannten Wirkungen auf Depression und Angst sind Antidepressiva wirksam gegen neuropathischen Schmerz, Hitzewallungen, Fatigue, Anorexie und Kachexie. Psychosoziale Interventionen scheinen einen Effekt auf Wohlbefinden, Lebensqualität und depressives Syndrom zu haben, verbessern jedoch die Überlebensdauer nicht. Der vorliegende Artikel gibt einen Überblick über die pharmakologische Behandlung depressiver Störungen bei Krebserkrankungen und beschreibt neue neuroimmunologische Forschungsergebnisse, die das auffällig häufige Auftreten komorbider affektiver Erkrankungen bei onkologischen Patienten erklären könnten.

Transcranial sonography and [18F]fluorodeoxyglucose positron emission tomography for the differential diagnosis of parkinsonism: a head-to-head comparison

BACKGROUND AND PURPOSE

Brain imaging with positron emission tomography using [(18) F]fluorodeoxyglucose (FDG-PET) and transcranial B-mode sonography (TCS) improves the differential diagnosis of parkinsonism. The diagnostic merits of these approaches in identifying and differentiating atypical parkinsonian syndromes (APS) are compared.

METHODS

Data were included from 36 patients with clinically suspected APS who underwent PET and TCS. FDG-PET scans were analyzed by visual assessment (including voxel-based statistical maps) of a priori defined disease-specific metabolic patterns. Sonographers achieved diagnoses according to pre-defined criteria for echogenicities of the substantia nigra and lenticular nucleus, and third ventricle diameter. Patients with APS were identified and allocated to the subgroups multiple system atrophy (MSA), progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD).

RESULTS

After a median follow-up period of 9 months, the final clinical diagnoses (reference standard) were Parkinson's disease, n = 15; MSA, n = 9; PSP, n = 7; and CBD, n = 5 (n = 21 APS in total). Six patients (4 APS) showed an insufficient bone window for TCS. In the remaining 30 patients, sensitivity/specificity for diagnosing APS were 82%/100% and 82%/85% for FDG-PET and TCS, respectively. Diagnostic accuracies did not differ between FDG-PET (90%) and TCS (83%; P = 0.69). Likewise, overall accuracy of subgroup classification (non-APS, MSA, PSP and CBD) did not differ between modalities (FDG-PET 87% and TCS 83%; P = 1.00).

CONCLUSIONS

FDG-PET and TCS show comparable accuracies for differential diagnosis of neurodegenerative parkinsonism. This preliminary study supports the use of TCS and warrants further prospective validation.

Optimal nitrogen supply as a key to increased and sustained production of a monoclonal full-size antibody in BY-2 suspension culture

Plant cell cultures have been used as expression hosts for recombinant proteins for over two decades. The quality of plant cell culture-produced proteins such as full-size monoclonal antibodies has been shown to be excellent in terms of protein folding and binding activity, but the productivity and yield fell short of what was achieved using mammalian cell culture, in which the key to gram-per-liter expression levels was strain selection and medium/process optimization. We carried out an extensive media analysis and optimization for the production of the full-size human anti-HIV antibody 2G12 in N. tabacum cv. BY-2. Nitrogen source and availability was found to be one key factor for the volumetric productivity of plant cell cultures. Increased amounts of nitrate in the culture medium had a dramatic impact on protein yields, resulting in a 10-20-fold increase in product accumulation through a combination of enhanced secretion and higher stability. The results were scalable from shake flasks to stirred-tank bioreactors, where the maximum yield per cultivation volume was 8 mg L(-1) over 7 days. During the stationary phase, antibody levels were 150-fold higher in nitrogen-enriched medium compared to standard medium. The enhanced medium appeared not to affect antibody quality and activity, as determined by Western blots, surface plasmon resonance binding assays and N-glycan analysis.

A UVB fingerprint mutation on the p53 tumor suppressor gene decreases in vitro

The culture of tissue-derived human cells is an important aspect of tissue engineering. Prior to transplantation, the quality of the cultured cells/tissue should be routinely tested so that any enrichment of procarcinogenic cells can be excluded. On this account, a UVB-induced p53 fingerprint mutation would be a valuable quality control marker for skin cells cultured for use in tissue engineering. We developed an allele-specific real-time polymerase chain reaction assay based on SYBR Green which can quantitatively detect CC-TT transitions in the tumor suppressor gene p53. To analyze the transition 281/282, we used DNA from HaCaT cells, a keratinocyte cell line containing the investigated mutation, as a standard to determine the mutation frequency in cultured cutaneous cells. We analyzed a variety of skin cells grown in culture and found a notable decrease in the UVB fingerprint mutation in fibroblasts during proliferation. Furthermore, we quantified the total amount of mutated DNA in different cutaneous cells and detected a significantly higher level in melanocytes. These results are consistent with findings obtained in our laboratory concerning the common deletion, the most frequently reported mutation in the mitochondrial genome, which suggest a positive influence of prolonged in vitro cell proliferation on the quality of genomic DNA.

The topography of the scalp-recorded visual N700

OBJECTIVE

To describe the topography of the N700 component of the scalp-recorded visual event-related potential (ERP) and to provide fundamental knowledge of the conditions under which it occurs.

METHODS

We examined the time-course of visual ERP in response to the short (100ms) and prolonged (7s) presentation of simple salient visual stimuli separated by long interstimulus intervals employing high-resolution 64-channel DC-EEG. Current source density (CSD) mapping and spatio-temporal dipole source analysis were performed.

RESULTS

CSD analysis revealed highly significant bilateral current sinks over occipito-temporal areas from about 450ms up to 1s after stimulus offset (visual N700). CSD topography and dipole source analysis suggested late prolonged activation of extrastriate visual areas which did not depend merely upon a stimulus offset response, afterimages or blinking, as confirmed by control conditions.

CONCLUSIONS

Our findings provide basic knowledge about the time-course of sensory activation. We found that passive watching of rare salient short stimuli automatically evoked sustained activity in the extrastriate visual cortex up to 1s after stimulus offset.

SIGNIFICANCE

Visual N700 provides a promising tool for important insights into the cortical mechanisms of stimulus post-processing. Its role in associative learning of temporally non-overlapping stimuli (automatic ultra-short-term sensory memory) should be explored.

Differences in pairing and cluster formation of T cell receptor α- and β-chains in T cell clones and fusion hybridomas

The questions of T cell receptor (TCR) clustering and preferential pairing of TCR alpha- and beta-chains are discussed controversially. We here describe the rare case of a non-pairing TCR alpha-TCR beta combination detected in the murine T cell hybridoma Hy-E6. Of its two TCR alpha-chains (Valpha3.2, Vbeta17) and one Vbeta16-chain only the Valpha17/Vbeta16 TCR is exposed on the surface, despite intracellular expression of Valpha3.2 protein. The lack of Valpha3.2/Vbeta16 pairing was confirmed by TCR transfections. Surprisingly, however, the parental T cell clone CTL-E6 expressed both alpha-chains on its plasma membrane. Different size distribution of TCR clusters in CTL-E6 versus Hy-E6 and transfectants as determined by Blue-Native gel electrophoresis indicated differences in the supra-molecular TCR assembly as one possible reason for this phenomenon. Our data further reveal that the nominal specificity of CTL-E6 for the fully agonistic trinitrophenyl (TNP) modified peptide M4L-TNP was specifically mediated by the trimeric Valpha3.2/Valpha17/Vbeta16 TCR of CTL-E6. In contrast, the Valpha17/Vbeta16 combination in Hy-E6 only conferred specificity for the cross-reactive partial agonist O4-TNP. Both specificities are H-2Kb-restricted and, hence, appear to be positively selected. The differences in TCR clustering in CTL and hybridoma might indicate differences in the reception and transmission of TCR-signals between these two cell types.

Analysis of single-chain antibody production in Pichia pastoris using on-line methanol control in fed-batch and mixed-feed fermentations

In the last few years the Pichia pastoris expression system has been gaining more and more interest for the expression of recombinant proteins. Many groups have employed fermentation technology in their investigations because the system is fairly easy to scale up and suitable for the production in the milligram to gram range. A large number of heterologous proteins from different sources has been expressed, but the fermentation process technology has been investigated to a lesser extent. A large number of fermentations are carried out in standard bioreactors that may be insufficiently equipped to meet the demands of high-cell-density fermentations of methylotrophic yeasts. In particular, the lack of on-line methanol analysis leads to fermentation protocols that may impair the optimal expression of the desired products. We have used a commercially available methanol sensor to investigate in detail the effects of supplementary glycerol feeding while maintaining a constant methanol concentration during the induction of a Mut(+) strain of Pichia pastoris. Specific glycerol feed rates in the range of 38-4.2 mg. g(-1). h(-1) (mg glycerol per gram fresh weight per hour) were investigated. Expression of the recombinant scFv antibody fragment was only observed at specific feed rates below 6 mg. g(-1). h(-1). At low specific feed rates, growth was even lower than with methanol as the sole carbon source and the harvest expression level of the scFv was only half of that found in the control fermentation. These results show that glycerol inhibits expression driven by the AOX1 promoter even at extremely limited availability and demonstrate the benefits of on-line methanol control in Pichia fermentation research.

Clonal anergy induced in a CD8+ hapten-specific cytotoxic T-cell clone by an altered hapten-peptide ligand

Clonal T-cell anergy has been proposed as a mechanism to ensure peripheral tolerance in vivo. Anergy has been reported to result from T cell activation with inappropriate antigen-presenting cells (APC) or, in the case of CD4+ T cells, also by altered peptide ligands. This study reveals that altered hapten ligands can also induce anergy in CD8+ T cells. The Kb-restricted, trinitrophenyl (TNP) specific cytotoxic T lymphocyte (CTL) clone E6 was found to lyse target cells presenting the TNP-modified peptides M4L-TNP (derived from mouse serum albumin) or O4TNP (derived from chicken ovalbumin), but not the corresponding dinitrophenol (DNP)-modified peptides. However, whereas M4L-DNP was found totally unreactive, O4DNP antagonistically inhibited M4L-TNP-mediated kill if expressed on the same target cell. Moreover, when presented alone on APC, O4DNP, but not M4L-DNP, induced anergy in clone E6 by preventing its subsequent proliferative response to M4L-TNP. The anergic state did not affect agonist-specific cytolysis or T-cell receptor (TCR) down-modulation by the anergized CTL, and proliferative responses were regained upon addition of interleukin (IL)-2 or IL-12 plus IL-18. These findings substantiate the similarity between hapten-and peptide-recognition by T cells. The induction as well as the reversal of anergy in CD8+ CTL may thus be of relevance not only in autoimmunity or tumour rejection, but also in contact hypersensitivity reactions to haptens.

[Multiple mantleomas in Birt-Hogg-Dubé syndrome: successful therapy with CO2 laser]

Birt-Hogg-Dubé-syndrome, first described 20 years ago, is an autosomal dominant inherited disease, characterized by the occurrence of multiple cutaneous hamartomas with adnexal differentiation. An association with intestinal neoplasms has been mentioned repeatedly. Recently, the cutaneous lesions in this syndrome have been interpreted as different developmental stages of one single hamartoma with sebaceous differentiation, called mantleoma. Numerous dermatohistopathologic studies contribute to the certain diagnosis of Birt-Hogg-Dubé-syndrome. In contrast, little information is available on the therapy of the multiple skin lesions. A father and his daughter with Birt-Hogg-Dubé-syndrome were treated with the CO2 laser, producing satisfactory results.

Treatment of a nonresponding port-wine stain with a new pulsed light source (PhotoDerm VL)

BACKGROUND AND OBJECTIVE

The pulsed dye laser is effective and safe in the treatment of port-wine stains. It is the laser of choice for port-wine stains and initial superficial hemangiomas in children. For the treatment of darker port-wine stains in adults that have not responded to pulsed dye laser treatment, excellent results can be achieved using the PhotoDerm VL, a new technology based upon the emission of wide band, noncoherent intense pulsed light.

STUDY DESIGN/PATIENT AND METHODS

Our report presents a patient with a facial port-wine stain that hardly responded to previous pulsed dye laser therapy. After the first ineffective treatment trial, the patient refused further dye laser applications. An intense pulsed light source (Photoderm VL) was applied instead.

RESULTS

The lesion responded well after the first treatment session and was completely resolved after four treatments with the PhotoDerm VL.

CONCLUSIONS

The new intense pulsed light source Photoderm VL seems to be a promising treatment alternative for the therapy of otherwise nonresponding port-wine stains due to its special technical features.

Cutaneous lupus erythematosus-treatment with pulsed dye laser

Because of its vascular selectivity, the flashlamp-pumped pulsed dye laser (585 nm) is efficacious in the treatment of vascular lesions and is successfully used for the treatment of port-wine stains and haemangiomas in children. Based on the encouraging results with these cutaneous vascular disorders, the cutaneous lesions of patients with lupus erythematosus (LE) have now also been treated with the pulsed dye laser. Cutaneous lesions in lupus erythematosus are often difficult to treat with readily available local therapeutic methods. We report here on a group of 12 patients whose LE lesions were treated with the pulsed dye laser. In 10 patients, the LE was limited to the skin, while two patients had systemic LE (SLE). Even in the two patients with SLE, a significant improvement of skin lesions was achieved. After a mean number of 51 laser sessions, a median clearance rate of 70% was attained for nine patients. In one case, the laser treatment failed to clear the lesions. Two patients did not show any visible improvement of the lesions, but pain and itching were significantly reduced. There were few side-effects. No prolonged laser-induced scarring occurred and in only two patients was hyperpigmentation seen, which had resolved completely after 4 and 5 months, respectively. During a median follow-up of 7 months (range: 3-32 months), only one patient (after a complete clearance of the skin lesions) had a small relapse. In summary, the pulsed dye laser is an effective therapy for the treatment of superficial skin lesions in LE.

Production of carcinoembryonic antigen (CEA) N-A3 domain in Pichia pastoris by fermentation

Carcinoembryonic antigen (CEA) is a 180-kDa glycoprotein found on the surface of normal colon and malignant human adenocarcinomas. Recently, a fusion protein containing two of the seven Ig-like domains present in CEA (N and A3) has been constructed and expressed in Pichia pastoris [You, Hefta, Yazaki, Wu and Shively (1998) Anticancer Res. 18, 3193-3201]. Here, we report the generation and selection of a multi-copy clone expressing this fusion protein, the optimization of the shake-flask expression protocol and the upscaled production of CEA N-A3 using fermentation technology. P. pastoris transformants secreting the CEA N-A3 domain were generated by electrotransformation of the GS115 host strain with the pPIC9K vector containing the CEA N-A3 cDNA [You, Hefta, Yazaki, Wu and Shively (1998) Anticancer Res. 18, 3193-3201] then screened for CEA N-A3 expression and G418 resistance. The recombinant CEA N-A3 domain was detected in the culture supernatant using the monoclonal anti-CEA antibody T84.66. Optimization of methanol-induction conditions resulted in a high-methanol shake-flask expression protocol yielding significantly increased CEA N-A3 levels. Fermentation and culture conditions were optimized for 5-l working-volume fermentations and CEA N-A3 was affinity purified using Ni-IDA (imino di-acetic acid) affinity chromatography from the clarified fermentation supernatant. Peptide N-glycosidase F treatment revealed that the recombinant protein was heavily glycosylated but expressed as a single polypeptide of 28 kDa with no evidence of proteolytic degradation. Our results demonstrate that functional CEA N-A3 domain can be produced in sufficient quantities in P. pastoris for structural analysis or diagnostic applications. To our knowledge, this article represents the first report on the production of a human tumour antigen through fermentation.

Towards molecular farming in the future: pichia pastoris-based production of single-chain antibody fragments

This review article focuses on the use of the methylotrophic yeast Pichia pastoris as a recombinant protein-expression system. P. pastoris is a useful system for the expression of milligram-to-gram quantities of a protein, which can be scaled up to fermentation to meet greater demands. Compared with mammalian cells, Pichia do not require a complex growth medium or culture conditions, they are as easy to manipulate genetically as Escherichia coli and have a eukaryotic protein-synthesis pathway. They seem suited to laboratory-scale production of recombinant proteins for in-house use or, in some cases, molecular farming of recombinant products. This review article focuses on the use of P. pastoris, describes a fermentation production run of a single-chain antibody fragment and includes a discussion of fermentation as a production strategy.

Towards molecular farming in the future: using plant-cell-suspension cultures as bioreactors

Plant-suspension cells are an in vitro system that can be used for recombinant protein production under carefully controlled certified conditions. Plant-suspension cells can be grown in shake flasks or fermenters to produce secondary metabolites, like vincristine and vinblastine, and to produce recombinant proteins after transformation. This review article focuses on discussing the generation of transformed suspension-cell lines expressing recombinant proteins, like antibodies, and recombinant-protein downstream processing and purification.

Towards molecular farming in the future: using plant-cell-suspension cultures as bioreactors

Plant-suspension cells are an in vitro system that can be used for recombinant protein production under carefully controlled certified conditions. Plant-suspension cells can be grown in shake flasks or fermenters to produce secondary metabolites, like vincristine and vinblastine, and to produce recombinant proteins after transformation. This review article focuses on discussing the generation of transformed suspension-cell lines expressing recombinant proteins, like antibodies, and recombinant-protein downstream processing and purification.

[Pulsed laser in scar treatment]

Pulsed laser systems such as pulsed CO2, Q-switched Er:YAG, ruby and alexandrite lasers provide good therapeutic options in therapy of scars and keloids. The use of these laser systems is compared to non-surgical and surgical methods.

[Current status of laser therapy in dermatology]

Indications for dermatological laser therapy have been enlarged during the last few years. In this article the physics and biophysics of laser therapy and the common laser systems in dermatology are described. Modern pulsed laser systems are combined with little side effects. Nevertheless, successfully used alternative methods should not be neglected.

[Persistence and variability of yeasts isolated from hospitalized patients: a comparison of results from Rostock and Dresden]

We investigated the yeast colonizations of hospitalized patients at time of the admission to hospital (< or = 3d; 1161 patients) and during stay in hospital (> 3d-several months; 568 patients). At admission to hospital 58% of patients had yeasts in one of the investigated specimens. During stay in hospital the part of patients with yeasts increased up to 81.7%. We established remarkable differences in proof of yeasts in patients of different area of risk. The spectrum of yeasts of the patients in Rostock and Dresden shows a similar shift in frequency of the different Candida species. C. albicans was the predominant yeast. But during hospitalization we saw an elevation of patients with C. glabrata infection from 7.4 to 22.5% and C. krusei infection from 2.8% to 11.8%. There were a remarkable correlation to the area of risk. In 30.8% of the patients we observed a change in yeast spectrum: from negative cultures to positive specimens or from one Candida species to another one.

[The pulsed dye laser--possibilities and limits]

The pulsed dye laser (wavelength 585 nm, pulse duration 0.3-0.45 ms) is very effective in the treatment of port-wine stains, beginning hemangiomas, telangiectasias, spider nevi, xanthelasma and red hypertrophic scarring. It is the laser of choice in the therapy of young patients with port-wine stains. The pulsed dye laser is limited by its relatively superficial penetration into the skin with a maximum of 1.5 mm.

Constitutive secretion of beta-trace protein by cultivated porcine choroid plexus epithelial cells: elucidation of its complete amino acid and cDNA sequences

Primary porcine choroid plexus epithelial cells cultivated in chemically defined medium maintain their epithelial characteristics and form confluent monolayers. They produce a fluid the composition of which resembles cerebrospinal fluid. The present study demonstrates constitutive secretion of large amounts of beta-trace protein. This intrathecally synthesized protein is a prominent polypeptide constituent of natural cerebrospinal fluid. According to the identity of amino acid sequences it has previously been tentatively identified as a prostaglandin-D synthase and as a member of the lipocalin protein family. beta-Trace was purified from cell culture supernatants and was subjected to tryptic digestion and amino acid sequencing of the resulting peptides. The complete primary structure of the protein was obtained by additional isolation of the cDNA from cultured epithelial cells. The porcine 163-amino acid polypeptide showed 69% identity with the human beta-trace and contained two N-glycosylation sites occupied by complex-type oligosaccharides as is the case for the human protein. The amino acid sequences around the N-glycosylation sites of mammalian beta-trace proteins (porcine, human, murine, and rat) were highly conserved. The nucleotide sequence was found to be less conserved; the porcine cDNA had a strikingly high GC-content (67%). The constitutive secretion of beta-trace protein from the in vitro cultivated porcine choroid plexus epithelial cells demonstrates that the cells have retained their major in vivo physiological properties: secretion of cerebrospinal fluid proteins. Therefore, this in vitro culture system may be used as a versatile tool for studying the regulation of the formation of cerebrospinal fluid.

[Accidental dirt tattooing. Removal with Q-switched ruby laser]

The Q-switched ruby laser (wave length 694 nm; pulse durations 25 ns or 40 ns) cause selective damage to natural and artificial skin pigments. Treatable lesions include benign pigmented growths (benign, lentigo, ephelides, caféau-lait spots and Becker's nevi), as well as amateur and professional tattoos. The Q-switched ruby laser is also very effective in the treatment of traumatic tattoos. We report our experiences with two patients whose traumatic tattoos resolved completely without any scarring after ruby laser therapy. Our findings show that Q-switched ruby laser treatment may represent the therapy of choice for these tattoos.

[Removal of wrinkles and acne scars with the ultra-pulse CO2 laser]

The introduction of the UltraPulse Co2 laser has made it possible to remove wrinkles without scarring, especially in the perioral and periorbital area. Often only a single treatment session is required. The very short impulse duration of the laser is less than the thermal relaxation time of the skin, so that thermal damage and scanning of adjacent skin is almost non-existent. We report on a patient with perioral wrinkles who was treated by UltraPulse CO2 laser in a single sitting with a cosmetically excellent result. Another patient with acne scarring, and a third patient with wrinkles and acne scarring were also treated successfully in a single session.

Bilirubin glucuronidation by intact Gunn rat fibroblasts expressing bilirubin UDP-glucuronosyltransferase

Crigler-Najjar (CN) disease is an inherited disorder of bilirubin metabolism. The disease is caused by a deficiency of the hepatic enzyme bilirubin UDP-glucuronosyltransferase (B-UGT). Patients with CN disease have high serum levels of the toxic compound, unconjugated bilirubin. The only defect in bilirubin metabolism of CN patients is the absence of B-UGT activity. The transplantation of cells able to glucuronidate bilirubin should therefore lower serum bilirubin levels. The Gunn rat is the animal model of CN disease. Primary Gunn rat fibroblasts (GURF) were transduced with a recombinant retrovirus, capable of transferring B-UGT cDNA. A cell line was obtained expressing B-UGT at a level comparable to hepatocytes. Bilirubin added to the culture medium of these cells was glucuronidated and excreted. The B-UGT activities of transduced GURF and freshly isolated Wistar hepatocytes were compared at different bilirubin concentrations. The specific B-UGT activities of these two cell types were comparable when physiological bilirubin concentrations (5-10 microM) were present in the culture media. At higher bilirubin concentrations (20-80 microM) the hepatocytes were more active than the transduced GURF. We conclude that with the addition of only one enzyme (B-UGT) fibroblasts can perform the complete set of reactions necessary for bilirubin glucuronidation. The difference in B-UGT activity between transduced GURF and hepatocytes at 20-80 microM bilirubin can be explained by lower UDP-glucuronic acid and glutathione S-transferase levels in GURF. Our findings also indicate that these cells could be used to develop extrahepatic gene therapy for CN disease.

[Lentigo benigna. Removal with the Q-switched ruby laser]

The Q-switched ruby laser (wave-length 694 nm, pulse duration 25 ns or 40 ns) causes selective damage to natural or artificial pigment. This laser has produced very good results in the treatment of amateur, professional and traumatic tattoos and of a number of benign pigmented lesions. We report on two patients with lentigines treated effectively with a Q-switched ruby laser.

[Removal of amateur and dirt tattooing with the Q-switched ruby laser]

The Q-switched ruby laser with a wavelength of 694 nm and a pulse duration of 25 ns causes selective damage to skin pigment. This laser has produced good to excellent results in the treatment of amateur professional and traumatical tattoos, and also of benign pigmented lesions such as lentigines, ephelides, café-au-lait spots and Becker nevi. We report on three patients with amateur and traumatic tattoos, which were removed by Q-switched ruby laser treatment without leaving scars.

[Treatment of vascular malformations and pigment disorders of the face and neck by pulsed dye laser, Photoderm VL and Q-switched ruby laser]

BACKGROUND

Two new types of lasers, the pulsed dye laser and the Q-switched ruby laser, have shown good to excellent results in the treatment of vascular malformations and benign pigmented lesions of the skin. A new and very effective alternative to pulsed dye laser is the recently introduced Photoderm VL. This device is based on the use of a wide-band non-coherent intense pulsed light source which emits a continuous spectrum in the range of 515 nm to 1200 nm.

PATIENTS AND METHODS

More than a 1000 patients with a variety of lesions of the skin were treated by these new laser systems and the Photoderm VL. The Q-switched ruby laser (wavelength 694 nm, pulse duration 25 ns) is suitable for the treatment of benign lentigines, café-au-lait macules, seborrhoic ceratosis, tattoos, and traumatic tattoos. The pulsed dye laser (585 nm, 0,3-0,45 ms) treats nevi flammei, capillary hemangiomas, telangiectasias, xanthelasma, hypertrophic scarring, and adenoma sebaceum. In addition we present the facilities of the new Photoderm VL (515 nm-1200 nm, 0,5-20 ms) for the treatment of nevi flammei, benign hemangiomatous malformations, telangiectasias, erythrosis interfollicularis colli, hypertrophic scarring, and hypertrichosis.

RESULTS AND CONCLUSIONS

the Q-switched ruby laser, the pulsed dye laser, and the Photoderm VL show excellent results in the treatment of lesions of the skin, which otherwise would have been difficult to treat of untreatable. The efficiency of the laser types presented is based on the theory of selective photothermolysis. Scarring is almost never seen and hypo- or hyperpigmentation is in most cases transient.

Induction of the blood/brain-barrier-associated enzyme alkaline phosphatase in endothelial cells from cerebral capillaries is mediated via cAMP

The mammalian blood/brain barrier is located at the endothelial cells of the cerebral capillaries. Alkaline phosphatase is associated to a very large extent with these cells and has been established as a marker enzyme for a differentiated blood/brain barrier phenotype in vivo and in vitro. Nevertheless cultured brain capillary endothelial cells (BCEC) lose this marker enzyme because of a cessation of de novo synthesis. Since astrocytes have been shown to possess the capability to re-induce the enzymic activity of alkaline phosphatase in BCEC in vitro we were interested in the second messengers involved in the signal-transduction mechanism of this induction in BCEC. For this reason we treated cultured porcine BCEC with a water-soluble and membrane-permeable analogue of cAMP, 8-(4-chlorophenylthio)-cAMP (C1PhS-cAMP) in the absence of astrocytes. By means of enzymic activity assays we were able to show that within three days the activity of alkaline phosphatase increased up to sixfold compared with the controls. The total activity of alkaline phosphatase in C1PhS-cAMP-treated BCEC was comparable to that of freshly isolated cells. Addition of cycloheximide inhibited the alkaline phosphatase activity increase. We conclude that cAMP is one of the second messengers involved in the induction of alkaline phosphatase activity in BCEC in vitro.