Light scattering on the structural characterization of DMPG vesicles along the bilayer anomalous phase transition

Highly charged vesicles of the saturated anionic lipid dimyristoyl phosphatidylglycerol (DMPG) in low ionic strength medium exhibit a very peculiar thermo-structural behavior. Along a wide gel-fluid transition region, DMPG dispersions display several anomalous characteristics, like low turbidity, high electrical conductivity and viscosity. Here, static and dynamic light scattering (SLS and DLS) were used to characterize DMPG vesicles at different temperatures. Similar experiments were performed with the largely studied zwitterionic lipid dimyristoyl phosphatidylcholine (DMPC). SLS and DLS data yielded similar dimensions for DMPC vesicles at all studied temperatures. However, for DMPG, along the gel-fluid transition region, SLS indicated a threefold increase in the vesicle radius of gyration, whereas the hydrodynamic radius, as obtained from DLS, increased 30% only. Despite the anomalous increase in the radius of gyration, DMPG lipid vesicles maintain isotropy, since no light depolarization was detected. Hence, SLS data are interpreted regarding the presence of isotropic vesicles within the DMPG anomalous transition, but highly perforated vesicles, with large holes. DLS/SLS discrepancy along the DMPG transition region is discussed in terms of the interpretation of the Einstein-Stokes relation for porous vesicles. Therefore, SLS data are shown to be much more appropriate for measuring porous vesicle dimensions than the vesicle diffusion coefficient. The underlying nanoscopic process which leads to the opening of pores in charged DMPG bilayer is very intriguing and deserves further investigation. One could envisage biotechnological applications, with vesicles being produced to enlarge and perforate in a chosen temperature and/or pH value. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Tomographic, Histological, and Immunohistochemical Evidences on the Use of N-Butyl-2-Cyanoacrilate for Onlay Graft Fixation in Rabbits

Background: The bone tissue responses to Cyanoacrylate have been described in the literature, but none used N-butyl-2-cyanoacrilate (NB-Cn) for bone graft fixation. Purpose: The aims of the study were: (a) to analyze the bone grafts volume maintenance fixed either with NB-Cn or titanium screw; (b) to assess the incorporation of onlay grafts on perforated recipient bed; and (c) the differences of expression level of tartrate-resistant acid phosphatase (TRAP) protein involved in bone resorption. Materials and Methods: Eighteen New Zealand White rabbits were submitted to calvaria onlay grafting on both sides of the mandible. On one side, the graft was fixed with NB-Cn, while on the other hand the bone graft was secured with an osteosynthesis screw. The computed tomography (CT) was performed just after surgery and at animals sacrifice, after 1 (n = 9) and 6 weeks (n = 9), in order to estimate the bone grafts volume along the experiments. Histological sections of the grafted areas were prepared to evaluate the healing of bone grafts and to assess the expression of TRAP protein. Results: The CT scan showed better volume maintenance of bone grafts fixed with NB-Cn (p = 0.05) compared with those fixed with screws, in both experimental times (analysis of variance). The immunohistochemical evaluation showed that the TRAP expression in a 6-week period was significantly higher compared with the 1-week period, without showing significant difference between the groups (Wilcoxon and MannWhitney). Histological analysis revealed that the NB-Cn caused periosteum damage, but provided bone graft stabilization and incorporation similar to the control group. Conclusion: The perforation provided by screw insertion into the graft during fixation may have triggered early revascularization and remodeling to render increased volume loss compared with the experimental group. These results indicate that the NB-Cn possesses equivalent properties to titanium screw to be used as bone fixation material in osteosynthesis.

On the cellular stress response to Staphylococcus aureus alpha-toxin

Staphylococcus aureus alpha-hemolysin was the first bacterial toxin recognized to form pores in the plasma membrane of eukaryotic cells. It is secreted as a water-soluble monomer that upon contact with target membranes forms an amphiphatic heptameric beta-barrel which perforates the bilayer. As a consequence, red cells undergo colloidosmotic lyses, while some nucleated cells may succumb to necrosis or programmed cell death. However, most cells are capable of repairing a limited number of membrane lesions, and then respond with productive transcriptional activation of NF-kB. In the present study, by using microarray and semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR), data from a previously performed serial analysis of gene expression (SAGE) were extended and verified, revealing that immediate early genes (IEGs) such as c-fos, c-jun and egr-1 are strongly induced at 2-8 h after transient toxin treatment. Activating protein 1 (AP-1: c-Fos, c-Jun) binding activity was increased accordingly. As IEGs are activated by growth factors, these findings led to the discovery that -toxin promotes cell cycle progression of perforated cells in an EGFR-dependent fashion. Although the amount of c-fos mRNA rose rapidly after toxin treatment, c-Fos protein expression was observed only after a lag of about 3 h. Since translation consumes much ATP, which transiently drops after transient membrane perforation, the suspicion arised that membrane-perforation caused global, but temporary downregulation of translation. In fact, eIF2α became heavily phosphorylated minutes after cells had been confronted with the toxin, resulting in shutdown of protein synthesis before cellular ATP levels reached the nadir. GCN2 emerged as a candidate eIF2α kinase, since its expression rapidly increased in toxin-treated cells. Two hours after toxin treatment, GADD34 transcripts, encoding a protein that targets the catalytic subunit of protein phosphatase 1 (PP1) to the endoplasmic reticulum, were overexpressed. This was followed by dephosphorylation of eIF2α and resumption of protein synthesis. Addition of tautomycetin, a specific inhibitor of PP1, led to marked hyperphosphorylation of eIF2α and significantly reduced the drop of ATP-levels in toxin-treated cells. A novel link between two major stress-induced signalling pathways emerged when it was found that both translational arrest and restart were under the control of stress-activated protein kinase (SAPK) p38. The data provide an explanation for the indispensible role of p38 for defence against the archetypal threat of membrane perforation by agents that produce small transmembrane-pores.

Mechanismen und funktionelle Konsequenzen der Chlorid-Homöostase in unreifen Neuronen des Neocortex

GABA, der wichtigste inhibitorische Neurotransmitter im adulten Gehirn, bewirkt im unreifen Nervensystem eine Membrandepolarisation, vermutlich aufgrund der erhöhten intrazellulären Chloridkonzentration ([Cl-]i) in unreifen Nervenzellen. GABAerge Membrandepolarisationen sind essentiell für die korrekte Entwicklung des zentralen Nervensystems und die Entstehung kortikaler Netzwerkaktivität. Im Rahmen der vorliegenden Arbeit wurde mit Hilfe elektrophysiologischer und immunohistochemischer Methoden die Regulation der Chlorid-Homöostase in unreifen Neuronen des Neokortex untersucht. Die Experimente wurden an Cajal-Retzius (CR) Zellen, einem transienten Zelltyp der Marginalzone, in akuten Hirnschnittpräparaten neonataler Ratten (P0-P3) durchgeführt. Es konnte gezeigt werden, dass CR Zellen eine hohe native [Cl-]i von ~30 mM aufweisen. Die hohe [Cl-]i wurde ausschließlich durch Bumetanid sensitiven und Na+-abhängigen aktiven Cl--Transport aufrechterhalten, was auf eine Cl--Akkumulation durch den Kationen-Chlorid-Cotransporter NKCC1 schließen lässt. Diese pharmakologischen Hinweise konnten durch den Nachweis der Expression von NKCC1 in der gesamten Marginalzone, speziell in CR Zellen, bestätigt werden. Die Transportgeschwindigkeit der NKCC1-abhängigen Cl--Akkumulation war gering, was auf eine limitierte Transportkapazität schließen lässt. In Übereinstimmung mit diesem Befund konnte gezeigt werden, dass die Cl--Leitfähigkeit in CR Zellen äußerst klein ist, so dass die NKCC1-abhängige Cl--Akkumulation ausreichend war, um unter Ruhebedingungen eine hohe [Cl-]i zu gewährleisten. Aufgrund dieser hohen [Cl-]i waren GABAA-Rezeptor vermittelte Antworten in CR Zellen exzitatorisch. Die Kapazität des NKCC1-vermittelten Cl--Transportes in CR Zellen konnte durch höherfrequente Stimulation überschritten werden, was dazu führte, dass die [Cl-]i abnahm und GABAerge Antworten unter diesen Bedingungen inhibitorisch wurden. Die inhibitorische Wirkung von GABA in CR Zellen wurde überwiegend durch die Reduktion des Eingangswiderstandes der Zelle vermittelt und beruhte nicht auf einer Verschiebung der Aktionspotentialschwelle.

Das Paläolithikum der Magdalenahöhle bei Gerolstein

Die vorliegende Arbeit hat das von 1969 – 1972 ergrabene Inventar der Magdalenahöhle bei Gerolstein unter kritischer Berücksichtigung der Originaldokumentation sowie der stratigraphischen und sedimentologischen Beschreibungen erneut untersucht und v.a. hinsichtlich zweier Arbeitshypothesen überprüft. Daneben fanden jedoch auch die Schmuckobjekte und in kursorischer Weise die Tierknochen Betrachtung. Die Elfenbeinobjekte setzen sich aus elf Fragmenten zusammen, die bereits in zerbrochenem Zustand in die Höhle gelangt sein müssen. Sie sind mit mehreren Linienbündeln verziert, die teilweise aus v- oder zickzack-förmigen Motiven bestehen. Auch gestanzte Punktreihen treten auf. In ihrer Größe und Form sind die Elfenbeinobjekte einzigartig. Lediglich aus der Csákvár-Höhle in Ungarn gibt es vergleichbare Stücke, deren genaue Altersstellung jedoch unklar ist. Daneben kommen in der Magdalenahöhle zwei vollständige durchlochte Hirschgrandeln sowie die Fragmente einer durchlochten Grandel sowie eines durchlochten Wolfzahns vor. Diese tragen teilweise Spuren einer Aufhängung bzw. Befestigung. Der Grund für ihre Niederlegung vor Ort ist indes nicht endgültig zu klären. Die überlieferten Tierknochen besitzen verschiedene Grade von Verfärbung und Erhaltung, lassen sich dadurch jedoch nicht verschiedenen Schichten zuordnen. Neben Modifikationen von Carnivoren, darunter v.a. durch Verdauungsprozesse, sind auch an einigen Exemplaren Schnittspuren festgestellt worden. Eine Bärenphalange aus der Fundschicht b1 eröffnet so die Perspektive, die menschliche Belegung erneut mit der Radiokohlenstoffmethode direkt zu datieren. Der Untere paläolithische Fundhorizont besteht aus relativ unspezifischen Quarzartefakten, die von einer opportunistischen Abschlags- und Werkzeugsgewinnung aus lokalen Schottern zeugen. Für den Oberen paläolithischen Fundhorizont zeigt die Steinartefaktanalyse, dass die Abschläge als Herstellungsreste dünner bifazieller Geräte angesprochen werden können. Während dieser Befund alleine auch im Zusammenhang mit den spätmittelpaläolithischen Blattspitzengruppen gesehen werden kann, sprechen die bereits erwähnten vergesellschafteten Schmuckobjekte, der Nachweis eines Klingenabbaus sowie die fast ausschließliche Verwendung exogenen Rohmaterials für einen jungpaläolithischen Kontext, d.h. für eine Affinität zum Solutréen. Die Steinartefakte der Magdalenahöhle zeugen gleichzeitig von einer sehr mobilen Lebensweise, da lediglich eine Phase des Herstellungsprozesses des bifaziellen Geräts vor Ort stattgefunden hat. Gleichzeitig wurden früher an anderem Ort gewonnene Abschläge mitgebracht und als Werkzeug verwendet. Ebenso wie der Kern selbst wurden Abschläge auch wieder abtransportiert. Insgesamt kann daher eine Rohmaterial konservierende Strategie rekonstruiert werden, in der neben dem Kern als Gerät selbst auch die Abschläge Verwendung finden. Da die Magdalenahöhle als östlicher Niederschlag des Solutréen und als Beleg für das maximale Verbreitungsgebiet dieses Technokomplexes gewertet werden muss, reiht sie sich in eine Reihe von Fundstellen und Argumenten ein, wonach das zentrale Mitteleuropa während des LGM s.l. nicht menschenleer war, sondern in sporadischen Exkursionen begangen wurde. Obwohl sich daran noch keine dauerhafte Wiederbesiedlung anschloss, muss vom Bild einer absoluten Siedlungsleere Abstand genommen werden. Weitere Fundstellen und absolutchronologische Datierungen, u.a. der Magdalenahöhle, könnten in Zukunft zu einem noch besseren Verständnis der menschlichen Anpassungsstragien an kaltzeitliche Umwelten beitragen.

Negative appendicectomy and perforation rates in patients undergoing laparoscopic surgery for suspected appendicitis

Despite widespread use of imaging technologies including ultrasonography and computed tomography, rates of negative appendicectomy and perforated appendicitis remain high. This trend analysis examined whether rates of negative appendicectomy and perforated appendicitis have decreased over time, and sought to evaluate clinical predictors associated with negative appendicectomy and perforated appendicitis.

Relative Contributions of Osteogenic Tissues to New Bone Formation in Periosteal Distraction Osteogenesis: Histological and Histomorphometrical Evaluation in a Rat Calvaria

Background: The relative contributions of different, potential factors to new bone formation in periosteal distraction osteogenesis are unknown. Purpose: The aim of the present study was to assess the influence of original bone and periosteum on bone formation during periosteal distraction osteogenesis in a rat calvarial model by means of histology and histomorphometry. Methods: A total of 48 rats were used for the experiment. The contribution of the periosteum was assessed by either intact or incised periosteum or an occlusive versus a perforated distraction plate. The cortical bone was either left intact or perforated. Animals were divided in eight experimental groups considering the three possible treatment modalities. All animals were subjected to a 7-day latency period, a 10-day distraction period and a 7-day consolidation period. The newly formed bone was analyzed histologically and histomorphometrically. Results: New, mainly woven bone was found in all groups. Differences in the maximum height of new bone were observed and depended on location. Under the distraction plate, statistically significant differences in maximum bone height were found between the group with perforations in both cortical bone and distraction plate and the group without such perforations. Conclusions: If the marrow cavities were not opened, the contribution to new bone formation was dominant from the periosteum. If the bone perforations opened the marrow cavities, a significant contribution to new bone formation originated from the native bone.

An anatomical investigation of the cervicothoracic ganglion

Anatomical variability within the autonomic nervous system has long been accepted. This study evaluated the anatomical variability of the cervicothoracic ganglion (CTG) according to its form and, in addition, provided precise measurements between the CTG and the anterior tubercle of the transverse process of the sixth cervical vertebra (C6TP), the first costovertebral articulation, and the vertebral artery. Forty-two adult cadavers were dissected, 22 male and 20 females. Five main forms of CTG were documented; spindle (31.9%), dumbbell (23.2%), truncated (21.7%), perforated (14.5%), and inverted-L (8.7%). The means for length, width, and thickness of the CTG were 18.5 mm, 8.2 mm, and 4.5 mm, respectively. The dimensions were found to be slightly larger in the males than females and on the left sides as compared to the right. The mean shortest distance between the CTGs and the vertebral artery was found to be 2.8 mm, whilst the mean shortest distances to C6TP was 25.7 mm and to the first costovertebral articulation was 1.7 mm. There is great variability in the morphology of the CTG with five common forms consistently seen. The relation to the vertebral artery may influence the form of the ganglion. Two previously undocumented forms are recorded; the truncated which describes the important juxtaposition of the CTG and the vertebral artery and the perforated which describes the piercing of the ganglion itself by the artery. The findings are considered to be of clinical importance to anesthetists, surgeons, neurosurgeons, and anatomists.

Behavioral Economics and Physician Behavior

This study seeks to answer whether the availability heuristic leads physicians to utilize more medical care than is economically efficient. Do rare, salient events alter physicians' perceptions about the probability of patient harm? Do these events lead physicians to overutilize certain medical procedures? This study uses Pennsylvania inpatient hospital admissions data from 2009 aggregated at the physician level to investigate these questions. The data come from the 2009 Pennsylvania Health Care Cost Containment Council (PHC4). The study is divided into two parts. In Part I, we examine whether bad outcomes during childbirth (defined as maternal mortality, an obstetric fistula or a uterine rupture) lead physicians to utilize more cesarean sections on future patients. In Part II, we examine whether bad outcomes associated with appendicitis (defined as patient death, a perforated or ruptured appendix or sepsis) lead physicians to perform more negative appendectomies (appendectomies performed when the patient did not have appendicitis) on future patients. Overall the study does not find evidence to support the claim that the availability heuristic leads physicians to overutilize medical care on future patients. However, the study does find evidence that variations in health care utilization are strongly correlated with individual physician practice patterns. The results of the study also imply that physicians' financial incentives may be a source of variation in health care utilization.

[A young child with acute abdomen and iron deficiency anemia]

The case of a 20 month-old girl that was admitted to the emergency ward because of worsening of her general condition in the setting of acute non-bloody gastroenteritis is reported. The clinical examination revealed signs of severe dehydration and a prominent tender abdomen. Laboratory evaluation showed leucocytosis, elevated C-reactive protein and severe hypochromic microcytic anemia. Abdominal X-ray revealed diffuse meteorism. The child underwent laparascopic evaluation. A perforated Meckel's diverticulum was found. Perforation and anemia due to occult bleeding are unusual presentations of Meckel's diverticulum. The differential diagnosis of children presenting with an acute abdomen with special focus on Meckel's diverticulum is discussed.

Osseointegration of hollow cylinder based spinal implants in normal and osteoporotic vertebrae: a sheep study

INTRODUCTION: Osteoporosis is not only responsible for an increased number of metaphyseal and spinal fractures but it also complicates their treatment. To prevent the initial loosening, we developed a new implant with an enlarged implant/bone interface based on the concept of perforated, hollow cylinders. We evaluated whether osseointegration of a hollow cylinder based implant takes place in normal or osteoporotic bone of sheep under functional loading conditions during anterior stabilization of the lumbar spine. MATERIALS AND METHODS: Osseointegration of the cylinders and status of the fused segments (ventral corpectomy, replacement with iliac strut, and fixation with testing implant) were investigated in six osteoporotic (age 6.9 +/- 0.8 years, mean body weight 61.1 +/- 5.2 kg) and seven control sheep (age 6.1 +/- 0.2 years, mean body weight 64.9 +/- 5.7 kg). Osteoporosis was introduced using a combination protocol of ovariectomy, high-dose prednisone, calcium and phosphor reduced diet and movement restriction. Osseointegration was quantified using fluorescence and conventional histology; fusion status was determined using biomechanical testing of the stabilized segment in a six-degree-of-freedom loading device as well as with radiological and histological staging. RESULTS: Intact bone trabeculae were found in 70% of all perforations without differences between the two groups (P = 0.26). Inside the cylinders, bone volume/total volume was significantly higher than in the control vertebra (50 +/- 16 vs. 28 +/- 13%) of the same animal (P<0.01), but significantly less (P<0.01) than in the near surrounding (60 +/- 21%). After biomechanical testing as described in Sect. "Materials and methods", seven spines (three healthy and four osteoporotic) were classified as completely fused and six (four healthy and two osteoporotic) as not fused after a 4-month observation time. All endplates were bridged with intact trabeculae in the histological slices. CONCLUSIONS: The high number of perforations, filled with intact trabeculae, indicates an adequate fixation; bridging trabeculae between adjacent endplates and tricortical iliac struts in all vertebrae indicates that the anchorage is adequate to promote fusion in this animal model, even in the osteoporotic sheep.

Perforation of the pulmonary artery by a bronchial wall stent

Implantation of stents into the bronchial walls is a newly developed method to treat lung emphysema, which is now being tested clinically. During this procedure, a bronchoscope carrying a Doppler ultrasonography head is placed into a segmental bronchus and the blood vessels running in parallel to the bronchus are localized. Once a safe location without blood vessels is found, the bronchial wall is perforated and a stent is placed within the wall to improve the expiratory volume of these "bypasses" to the adjacent lung parenchyma. We observed a fatal complication with this method in a 60-year-old man. The bronchial wall and the pulmonary artery were perforated by one of the stents inducing massive bleeding, which could not be stopped. The patient died due to aspiration of blood in combination with massive loss of blood. The general risk to perforate the pulmonary artery during this procedure cannot be estimated from this single observation but should be considered regarding the legal and clinical aspects.

Ultrasound-guided paravertebral puncture and placement of catheters in human cadavers: an imaging study

BACKGROUND: During paravertebral block, the anterolateral limit of the paravertebral space, which consists of the pleura, should preferably not be perforated. Also it is possible that, during the block, the constant superior costotransverse ligament can be missed in the loss-of-resistance technique. We therefore aimed to develop a new technique for an ultrasound-guided puncture of the paravertebral space. METHODS: We performed 20 punctures and catheter placements in 10 human cadavers. A sonographic view showing the pleura and the superior costotransverse ligament was obtained with a slightly oblique scan using a curved array transducer. After inline approach, injection of 10 ml normal saline confirmed the correct position of the needle tip, distended the space, and enabled catheter insertion. The spread of contrast dye injected through the catheters was assessed by CT scans. RESULTS: The superior costotransverse ligament and the paravertebral space were easy to identify. The needle tip reached the paravertebral space without problems under visualization. In contrast, the introduction of the catheter was difficult. The CT scan revealed a correct paravertebral spread of contrast in 11 cases. Out of the remaining, one catheter was found in the pleural space, in six cases there was an epidural, and in two cases there was a prevertebral spread of contrast dye. CONCLUSIONS: We successfully developed a technique for an accurate ultrasound-guided puncture of the paravertebral space. We also showed that when a catheter is introduced through the needle with the tip lying in the paravertebral space, there is a high probability of catheter misplacement into the epidural, mediastinal, or pleural spaces.

Perforation of the median nerve with an acupuncture needle guided by ultrasound

In an experiment on one of the authors, we used ultrasound to visualise an acupuncture needle completely perforating the median nerve at the acupuncture point PC6. During this procedure only a slight sensation occurred, and no pain. We conclude that, in individual cases, the median nerve might be perforated without causing pain or neurological problems.

Injuring potential of drinking glasses

At a party of a sports club, an argument started between two groups of young men, in the course of which one of the persons involved threw a beer glass hitting a young man of the other group, who collapsed with a profusely bleeding wound. Although resuscitation measures were initiated immediately, the victim died at the scene due to exsanguination from the completely severed left external carotid artery in combination with the aspiration of blood. Tests with drinking glasses thrown at a skull-neck model suggested that an undamaged beer glass thrown at the head of the victim could not cause the fatal injuries on the neck because of its splintering behaviour. In fact, it seemed that the beer glass had been damaged prior to throwing it and that its sharp edges perforated the skin on hitting the neck.