Expression der pronozizeptiven Vanilloidrezeptoren TRPV1 und TRPV2 und des antinozizeptiven Cannabinoidrezeptors CB1 in Spinalganglienneuronen der Ratte

Nozizeptive Spinalganglienneurone detektieren mit einer Vielzahl liganden- und spannungsgesteuerter Ionenkanäle noxische Reize, d.h. Reize, die eine Gewebeschädigung bewirken können, wandeln sie in Aktionspotenzialentladungen um und leiten sie über das Rückenmark zum Gehirn weiter, wo eine Schmerzempfindung ausgelöst wird. Die pronozizeptiven transienten Rezeptor-Potenzial-Kanäle der Vanilloidrezeptorfamilie, TRPV1 und TRPV2, sind die klassischen Transduktionsmoleküle für noxische Hitzereize in den Spinalganglien und werden von Reiztemperaturen über 43°C bzw. 52°C aktiviert. Daneben finden sich auch antinozizeptive Membranproteine, wie z.B. der metabotrope Cannabinoidrezeptor CB1. Er koppelt an spannungsgesteuerte Kaliumkanäle, die neben Natrium- und Kalziumkanälen ebenfalls an der neuronalen Erregbarkeit beteiligt sind. Von den spannungsgesteuerten Kaliumkanälen könnte der Kv1.4, der einen schnell inaktivierenden A-Strom vermittelt, an antinozizeptiven Signalwegen beteiligt sein. Um die molekulare Physiologie der Regulation von Nozizeption und Antinozizeption zu charakterisieren, wurde die Expression bzw. Ko-Expression dieser Membranproteine auf der einen als auch die funktionelle Charakterisierung von TRPV1 auf der anderen Seite im Soma der Spinalganglienneurone und im heterologen Expressionssystem untersucht. TRPV1 wurde in je einem Drittel und TRPV2 in je einem Zehntel aller Spinalganglienneurone nachgewiesen. Das Expressionsmuster veränderte sich nicht zwischen verschiedenen Präparationsmethoden, die zur Aufarbeitung der Zellen für unterschiedliche experimentelle Ansätze notwendig sind. Somit können die aus Expressionsanalysen und funktionellen Untersuchungen gewonnenen Ergebnisse miteinander verglichen werden. Obwohl TRPV1 und TRPV2 in unterschiedlich großen Zellen exprimiert werden, überlappen dennoch ihre Größenverteilungen. Durch Ko-Expressionsanalysen konnten hier erstmalig TRPV1-TRPV2-ko-exprimierende Neurone detektiert werden. Mit dem neu entwickelten N-terminalen Antikörper gegen TRPV1 (3C11) konnte gezeigt werden, dass für TRPV1 verschiedene Splice-Varianten existieren. Neben den bereits bekannten Splice-Varianten wurde hier die neue Variante Vr.3’sv isoliert. Diese besitzt zwischen Exon 15 und 16 eine Insertion aus 104 Basen und exprimiert daher einen veränderten C-Terminus. Trotz dieser Veränderung bildeten sich im heterologen Expressionssystem funktionelle Kanäle aus, die im Gegensatz zu den anderen Varianten immer noch durch Capsaicin aktivierbar waren. Vr.3’sv könnte als Homo- oder Heterotetramer die Eigenschaften TRPV1-positiver Neurone beeinflussen. Bei der Bestimmung der Häufigkeit von TRPV1 in einem Gewebe ist somit die Wahl des Antikörpers von entscheidender Bedeutung. Für TRPV2 dagegen gibt es hier keine Hinweise auf Splice-Varianten. TRPV1 wird durch das Vanilloid Capsaicin aktiviert, wobei diese Substanz neurotoxisch ist und eine Degeneration von Neuronen und epidermalen Nervenfasern bewirkt. Hier wurde nun gezeigt, dass unabhängig von den Splice-Varianten nicht alle TRPV1-positiven Neurone bei langer Inkubationszeit absterben. Funktionelle Untersuchungen belegten, dass auch Capsaicin-sensitive Zellen unter dem Einfluss des Agonisten überleben können. Dieser Schutzmechanismus wird möglicherweise von den verschiedenen Splice-Varianten vermittelt. Ko-Expressionsanalysen zeigten, dass der spannungsgesteuerte Kaliumkanal Kv1.4 in nahezu allen TRPV1- aber nicht TRPV2-positiven Neuronen exprimiert wird. Desweiteren ko-exprimierten nahezu alle TRPV1-positiven Neurone auch den Cannabinoidrezeptor CB1. Diese fast vollständige Ko-Lokalisation von CB1 und Kv1.4 in nozizeptiven Spinalganglienneuronen spricht für eine funktionell synergistische Aktivität. Der Kaliumkanal kann unter der regulativen Kontrolle von CB1 als Vermittler von A-Typ-Kaliumströmen an der Kontrolle der repetitiven Entladungen in der Peripherie und der Transmitterausschüttung zentral beteiligt sein. Es ergeben sich daraus Ansatzpunkte für die Entwicklung neuer Medikamente. Mit Kv1.4-Aktivatoren und/oder peripher wirkenden Cannabinoiden könnten die Nebenwirkungen der Cannabinoide im zentralen Nervensystem umgangen werden.

Coordinazione situata: integrazione di Arduino in un middleware basato su tuple

Il concetto di situatedness applicato ad un sistema multi-agente distribuito può essere riformulato come problema di coordinazione fra i componenti del sistema e le risorse ambientali. Per poter garantire e governare la coordinazione delle parti, viene esteso il modello di coordinazione TuCSoN arricchendo il linguaggio di coordinazione e l'architettura per la comunicazione verso l'ambiente introducendo il concetto di artefatto d'ambiente. In questo elaborato viene definita l'estensione Situated ReSpecT, la nuova componente Transducer e la sua interazione con le Probe, tramite un analisi teorica che si conclude con una verifica pratica su piattaforma Arduino.

Topological aspects of the human protein interaction network

It is currently widely accepted that the understanding of complex cell functions depends on an integrated network theoretical approach and not on an isolated view of the different molecular agents. Aim of this thesis was the examination of topological properties that mirror known biological aspects by depicting the human protein network with methods from graph- and network theory. The presented network is a partial human interactome of 9222 proteins and 36324 interactions, consisting of single interactions reliably extracted from peer-reviewed scientific publications. In general, one can focus on intra- or intermodular characteristics, where a functional module is defined as "a discrete entity whose function is separable from those of other modules". It is found that the presented human network is also scale-free and hierarchically organised, as shown for yeast networks before. The interactome also exhibits proteins with high betweenness and low connectivity which are biologically analyzed and interpreted here as shuttling proteins between organelles (e.g. ER to Golgi, internal ER protein translocation, peroxisomal import, nuclear pores import/export) for the first time. As an optimisation for finding proteins that connect modules, a new method is developed here based on proteins located between highly clustered regions, rather than regarding highly connected regions. As a proof of principle, the Mediator complex is found in first place, the prime example for a connector complex. Focusing on intramodular aspects, the measurement of k-clique communities discriminates overlapping modules very well. Twenty of the largest identified modules are analysed in detail and annotated to known biological structures (e.g. proteasome, the NFκB-, TGF-β complex). Additionally, two large and highly interconnected modules for signal transducer and transcription factor proteins are revealed, separated by known shuttling proteins. These proteins yield also the highest number of redundant shortcuts (by calculating the skeleton), exhibit the highest numbers of interactions and might constitute highly interconnected but spatially separated rich-clubs either for signal transduction or for transcription factors. This design principle allows manifold regulatory events for signal transduction and enables a high diversity of transcription events in the nucleus by a limited set of proteins. Altogether, biological aspects are mirrored by pure topological features, leading to a new view and to new methods that assist the annotation of proteins to biological functions, structures and subcellular localisations. As the human protein network is one of the most complex networks at all, these results will be fruitful for other fields of network theory and will help understanding complex network functions in general.

Il ruolo dell’ecografia prenatale nella diagnosi precoce delle anomalie fetali della fossa cranica posteriore

Obiettivo: Valutare il ruolo brainstem-vermis angle (BV angle) a 16-18 settimane per la diagnosi precoce delle anomalie cistiche della fossa cranica posteriore. Metodi: Uno studio prospettico, multicentrico, osservazionale. Volumi ecografici tridimensionali della testa fetale sono stati acquisiti in feti a 16-18 settimane. Tre operatori di simile esperienza hanno misurato il BV angle nel piano sagittale come precedentemente descritto1,2 e hanno annotato se il quarto ventricolo era aperto sul piano assiale. Un follow-up dettagliato è stato ottenuto in tutti i casi. Risultati: Tra novembre 2009 e marzo 2011, 150 volumi sono stati acquisiti ad un’epoca gestazionale media di 16 settimane. A causa di una scarsa qualità delle immaginai, 49 volumi sono stati esclusi, con una popolazione finale di 101 casi. Di questi, 6 hanno ricevuto successivamente una diagnosi di malformazione di Dandy-Walker (DWM) e 2 di cisti della tasca di Blake (BPC), gli altri erano normali. In tutti i feti con anomalie cistiche della fossa cranica posteriore, il BV angle è risultato significativamente più ampio rispetto ai controlli (57.3+23.0° vs 9.4+7.7°, U-Mann Whitney test p<0.000005). Nel 90.3% dei feti normali, il BV angle era <20° e il quarto ventricolo era chiuso sul piano assiale. In 9 feti normali e nei casi con BPC, l’angolo era >20° ma <45° (25.8+5.6°) e il quarto ventricolo era aperto posteriormente sul piano assiale, ma solo utilizzando una scansione non convenzionale. In tutti i feti con DWM, il BV angle era >45° (67.9+13.9°) e il quarto ventricolo era aperto anche sul piano assiale standard. Conclusioni: Fino ad ora la diagnosi di anomalie cistiche della fossa cranica posteriore è stata consideratea difficile o impossibile prima di 20 settimane, a causa del presunto sviluppo tardivo del verme cerebellare. La nostra esperienza suggerisce che la misurazione del BV angle consente un’identificazione precisa di queste condizioni già a 16 settimane.

Self-Assembled Monolayers (SAMs) in Organic Field-Effect Transistors

Organic printed electronics is attracting an ever-growing interest in the last decades because of its impressive breakthroughs concerning the chemical design of π-conjugated materials and their processing. This has an impact on novel applications, such as flexible-large-area displays, low- cost printable circuits, plastic solar cells and lab-on-a-chip devices. The organic field-effect transistor (OFET) relies on a thin film of organic semiconductor that bridges source and drain electrodes. Since its first discovery in the 80s, intensive research activities were deployed in order to control the chemico-physical properties of these electronic devices and consequently their charge. Self-assembled monolayers (SAMs) are a versatile tool for tuning the properties of metallic, semi-conducting, and insulating surfaces. Within this context, OFETs represent reliable instruments for measuring the electrical properties of the SAMs in a Metal/SAM/OS junction. Our experimental approach, named Charge Injection Organic-Gauge (CIOG), uses OTFT in a charge-injection controlled regime. The CIOG sensitivity has been extensively demonstrated on different homologous self-assembling molecules that differ in either chain length or in anchor/terminal group. One of the latest applications of organic electronics is the so-called “bio-electronics” that makes use of electronic devices to encompass interests of the medical science, such as biosensors, biotransducers etc… As a result, thee second part of this thesis deals with the realization of an electronic transducer based on an Organic Field-Effect Transistor operating in aqueous media. Here, the conventional bottom gate/bottom contact configuration is replaced by top gate architecture with the electrolyte that ensures electrical contact between the top gold electrode and the semiconductor layer. This configuration is named Electrolyte-Gated Field-Effect Transistor (EGOFET). The functionalization of the top electrode is the sensing core of the device allowing the detection of dopamine as well as of protein biomarkers with ultra-low sensitivity.

Ricerca di nuove strategie differenziative: Analisi degli effetti di stimoli fisici e molecolari su cellule mesenchimali umane isolate da tessuto adiposo

Introduzione. Le cellule mesenchimali derivate dal tessuto adiposo (hASC) rappresentano un importante strumento per la terapia cellulare, in quanto derivano da un tessuto adulto abbondante e facilmente reperibile. Con il dispositivo medico Lipogems l’isolamento di tali cellule è eseguito esclusivamente mediante sollecitazioni meccaniche. Il prodotto ottenuto è quindi minimamente manipolato e subito utilizzabile. Ad oggi, il condizionamento pro-differenziativo delle staminali è per lo più attuato mediante molecole di sintesi. Tuttavia, altri fattori possono modulare la fisiologia cellulare, come gli stimoli fisici e molecole naturali. Onde elettromagnetiche hanno indotto in modelli cellulari staminali l’espressione di alcuni marcatori di differenziamento e, in cellule adulte, una riprogrammazione, mentre estratti embrionali di Zebrafish sono risultati antiproliferativi sia in vitro che in vivo. Metodi. La ricerca di nuove strategie differenziative sia di natura fisica che molecolare, nel particolare onde acustiche ed estratti embrionali di Zebrafish, è stata condotta utilizzando come modello cellulare le hASC isolate con Lipogems. Onde acustiche sono state somministrate mediante l’utilizzo di due apparati di trasduzione, un generatore di onde meccaniche e il Cell Exciter . I trattamenti con gli estratti embrionali sono stati effettuati utilizzando diverse concentrazioni e diversi tempi sperimentali. Gli effetti sull’espressione dei marcatori di staminalità e differenziamento relativi ai trattamenti sono stati saggiati in RT-PCR quantitativa relativa e/o in qPCR. Per i trattamenti di tipo molecolare è stata valutata anche la proliferazione. Risultati e conclusioni. La meta-analisi dei dati delle colture di controllo mostra la stabilità d’espressione genica del modello. I trattamenti con i suoni inducono variazioni dell’espressione genica, suggerendo un ruolo regolatorio di tali stimoli, in particolare del processo di commitment cardiovascolare. Due degli estratti embrionali di Zebrafish testati inibiscono la proliferazione alle 72 ore dalla somministrazione. L’analisi d’espressione associata ai trattamenti antiproliferativi suggerisce che tale effetto abbia basi molecolari simili ai processi di differenziamento.

Antigen-dependent induction of a CD40 signal in peripheral B cells

Monoclonal antibodies have emerged as one of the most promising therapeutics in oncology over the last decades. The generation of fully human tumorantigen-specific antibodies suitable for anti-tumor therapy is laborious and difficult to achieve. Autoreactive B cells expressing those antibodies are detectable in cancer patients and represent a suitable source for human antibodies. However, the isolation and cultivation of this cell type is challenging. A novel method was established to identify antigen-specific B cells. The method is based on the conversion of the antigen independent CD40 signal into an antigen-specific one. For that, the artificial fusion proteins ABCos1 and ABCos2 (Antigen-specific B cell co-stimulator) were generated, which consist of an extracellular association-domain derived from the constant region of the human immunoglobulin (Ig) G1, a transmembrane fragment and an intracellular signal transducer domain derived of the cytoplasmic domain of the human CD40 receptor. By the association with endogenous Ig molecules the heterodimeric complex allows the antigen-specific stimulation of both the BCR and CD40. In this work the ability of the ABCos constructs to associate with endogenous IgG molecules was shown. Moreover, crosslinking of ABCos stimulates the activation of NF-κB in HEK293-lucNifty and induces proliferation in B cells. The stimulation of ABCos in transfected B cells results in an activation pattern different from that induced by the conventional CD40 signal. ABCos activated B cells show a mainly IgG isotype specific activation of memory B cells and are characterized by high proliferation and the differentiation into plasma cells. To validate the approach a model system was conducted: B cells were transfected with IVT-RNA encoding for anti-Plac1 B cell receptor (antigen-specific BCR), ABCos or both. The stimulation with the BCR specific Plac1 peptide induces proliferation only in the cotransfected B cell population. Moreover, we tested the method in human IgG+ memory B cells from CMV infected blood donors, in which the stimulation of ABCos transfected B cells with a CMV peptide induces antigen-specific expansion. These findings show that challenging ABCos transfected B cells with a specific antigen results in the activation and expansion of antigen-specific B cells and not only allows the identification but also cultivation of these B cells. The described method will help to identify antigen-specific B cells and can be used to characterize (tumor) autoantigen-specific B cells and allows the generation of fully human antibodies that can be used as diagnostic tool as well as in cancer therapy.

A simple and novel method to monitor breathing and heart rate in awake and urethane-anesthetized newborn rodents

Rodents are most useful models to study physiological and pathophysiological processes in early development, because they are born in a relatively immature state. However, only few techniques are available to monitor non-invasively heart frequency and respiratory rate in neonatal rodents without restraining or hindering access to the animal. Here we describe experimental procedures that allow monitoring of heart frequency by electrocardiography (ECG) and breathing rate with a piezoelectric transducer (PZT) element without hindering access to the animal. These techniques can be easily installed and are used in the present study in unrestrained awake and anesthetized neonatal C57/Bl6 mice and Wistar rats between postnatal day 0 and 7. In line with previous reports from awake rodents we demonstrate that heart rate in rats and mice increases during the first postnatal week. Respiratory frequency did not differ between both species, but heart rate was significantly higher in mice than in rats. Further our data indicate that urethane, an agent that is widely used for anesthesia, induces a hypoventilation in neonates whilst heart rate remains unaffected at a dose of 1 g per kg body weight. Of note, hypoventilation induced by urethane was not detected in rats at postnatal 0/1. To verify the detected hypoventilation we performed blood gas analyses. We detected a respiratory acidosis reflected by a lower pH and elevated level in CO2 tension (pCO2) in both species upon urethane treatment. Furthermore we found that metabolism of urethane is different in P0/1 mice and rats and between P0/1 and P6/7 in both species. Our findings underline the usefulness of monitoring basic cardio-respiratory parameters in neonates during anesthesia. In addition our study gives information on developmental changes in heart and breathing frequency in newborn mice and rats and the effects of urethane in both species during the first postnatal week.

Coordinazione situata per la domotica: Butlers in TuCSoN

Siamo ormai abituati a vivere in un mondo pieno di dispositivi intelligenti ed un sistema domotico deve essere facilmente integrato con essi. L'obbiettivo di questa tesi è di estendere con il concetto di transducer il prototipo di Home Manager, applicazione per la gestione di una casa intelligente che sfrutta la tecnologia TuCSoN. I vantaggi di questa scelta sono molteplici: permettendo al media di coordinazione di gestire le interazioni fra gli agenti e l'ambiente, si separano i problemi implementativi da quelli coordinativi, guadagnando anche un sistema più facilmente ispezionabile, con componenti sostituibili e manutenibili. Dopo un'introduzione alla domotica, all'architettura Butlers e all'infrastruttura TuCSoN, pilastri su cui è basato Home Manager, si passerà ad una fase di analisi dello stato attuale del prototipo, per comprendere dove e perché andare a introdurre il concetto di transducer. Seguiranno poi le fasi di progettazione e, infine, di implementazione di questa tecnologia in Home Manager.

Growth hormone (GH) deficiency type II: a novel GH-1 gene mutation (GH-R178H) affecting secretion and action

Context and Objective: Main features of the autosomal dominant form of GH deficiency (IGHD II) include markedly reduced secretion of GH combined with low concentrations of IGF-I leading to short stature. Design, Setting, and Patients: A female patient presented with short stature (height -6.0 sd score) and a delayed bone age of 2 yr at the chronological age of 5 yr. Later, at the age of 9 yr, GHD was confirmed by standard GH provocation test, which revealed subnormal concentrations of GH and a very low IGF-I. Genetic analysis of the GH-1 gene revealed the presence of a heterozygous R178H mutation. Interventions and Results: AtT-20 cells coexpressing both wt-GH and GH-R178H showed a reduced GH secretion after forskolin stimulation compared with the cells expressing only wt-GH, supporting the diagnosis of IGHD II. Because reduced GH concentrations found in the circulation of our untreated patient could not totally explain her severe short stature, functional characterization of the GH-R178H performed by studies of GH receptor binding and activation of the Janus kinase-2/signal transducer and activator of transcription-5 pathway revealed a reduced binding affinity of GH-R178H for GH receptor and signaling compared with the wt-GH. Conclusion: This is the first report of a patient suffering from short stature caused by a GH-1 gene alteration affecting not only GH secretion (IGHD II) but also GH binding and signaling, highlighting the necessity of functional analysis of any GH variant, even in the alleged situation of IGHD II.

INVESTIGATION OF INTRAOCULAR PRESSURE AS A PREDICTOR OF TRAUMATIC EYE INJURIES

Eye injuries are a large societal problem in both the military and civilian sectors. Eye injury rates are increasing in recent military conflicts, and there are over 1.9 million eye injuries in the United States civilian sector annually. In order to develop a better understanding of eye injury risk, several previous studies have developed eye injury criteria based on projectile characteristics. While these injury criteria have been used to estimate eye injury potential of impact scenarios, they require that the mass, size and velocity of the projectile are known. It is desirable to develop a method to assess the severity of an eye impact in environments where it would be difficult or impossible to determine these projectile characteristics. The current study presents a measurement technique for monitoring intraocular pressure of the eye under impactloading. Through experimental tests with a custom pressure chamber, a subminiature pressure transducer was validated to be thermally stable and suitable for testing in an impact environment.Once validated, the transducer was utilized intraocularly, inserted through the optic nerve, to measure the pressure of the eye during blunt-projectile impacts. A total of 150 impact tests were performed using projectiles ranging from 3.2 mm to 17.5 mm in diameter. Investigation of the relationship between projectile energy and intraocular pressure lead to the identification of at least two distinct trends. Intraocular pressure and normalized energy measurements indicated a different response for penetrating-type globe rupture injuries with smaller diameter (d < 1 cm)projectiles, and blunt-type globe rupture injuries with larger diameter (d > 1 cm) projectiles. Furthermore, regression analysis indicates that relationships exist between intraocular pressureand projectile energy that may allow quantification of eye injury risk based on pressure data, and also that intraocular pressure measurements of impact may lead to a better understanding of thetransition between penetrating and blunt globe rupture injury mechanisms.

Real-time ultrasound-guided spinal anaesthesia: a prospective observational study of a new approach

Identification of the subarachnoid space has traditionally been achieved by either a blind landmark-guided approach or using prepuncture ultrasound assistance. To assess the feasibility of performing spinal anaesthesia under real-time ultrasound guidance in routine clinical practice we conducted a single center prospective observational study among patients undergoing lower limb orthopaedic surgery. A spinal needle was inserted unassisted within the ultrasound transducer imaging plane using a paramedian approach (i.e., the operator held the transducer in one hand and the spinal needle in the other). The primary outcome measure was the success rate of CSF acquisition under real-time ultrasound guidance with CSF being located in 97 out of 100 consecutive patients within median three needle passes (IQR 1-6). CSF was not acquired in three patients. Subsequent attempts combining landmark palpation and pre-puncture ultrasound scanning resulted in successful spinal anaesthesia in two of these patients with the third patient requiring general anaesthesia. Median time from spinal needle insertion until intrathecal injection completion was 1.2 minutes (IQR 0.83-4.1) demonstrating the feasibility of this technique in routine clinical practice.

[Guidance of interventions in subintimal recanalization and fenestration of dissection membranes using a novel dual-lumen intravascular ultrasound catheter]

PURPOSE: To evaluate the feasibility and effectiveness of IVUS-guided puncture for gaining controlled target lumen reentry in subintimal recanalization of chronic iliac/femoral artery occlusions and in fenestration of aortic dissections. MATERIALS AND METHODS: Between 5/2004 and 12/2005 12 consecutive patients (7 male, 5 female; mean age 64.6 +/- 12.0 years) with chronic critical limb ischemia and ischemic complications of aortic dissection were treated using the Pioneer catheter. This 6.2-F dual-lumen catheter combines a 20-MHz IVUS transducer with a pre-shaped extendable, hollow 24-gauge nitinol needle. This coaxial needle allows real-time IVUS-guided puncture of the target lumen and after successful reentry a 0.014" guidewire may be advanced through the needle into the target lumen. 7 patients were treated for aortic dissection and 5 patients (with failed previous attempts at subintimal recanalization) for chronic arterial occlusion. Patients with aortic dissection (5 type A dissections, 2 type B dissections) had developed renal ischemia (n = 2), renal and mesenteric ischemia (n = 2), or low extremity ischemia (n = 3). Patients with chronic arterial occlusions (2 common iliac artery occlusions, 3 superficial femoral artery occlusions) experienced ischemic rest pain (n = 4), and a non-healing foot ulcer (n = 1). RESULTS: The technical success rate using the Pioneer catheter was 100%. The recanalization/fenestration time was 37 +/- 12 min. Procedure-related complications did not occur. In 10 cases a significant improvement of clinical symptoms was evident. One patient with aortic dissection and ischemic paraplegia required subsequent surgical intervention. One patient had persistent ischemic rest pain despite successful recanalization of a superficial femoral artery occlusion. CONCLUSION: The Pioneer catheter is a reliable device which may be helpful for achieving target lumen reentry in subintimal recanalization of chronic occlusions and in fenestration of aortic dissections.

Sonographic visualization and ultrasound-guided block of the third occipital nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain

BACKGROUND: Chronic neck pain after whiplash injury is caused by cervical zygapophysial joints in 50% of patients. Diagnostic blocks of nerves supplying the joints are performed using fluoroscopy. The authors' hypothesis was that the third occipital nerve can be visualized and blocked with use of an ultrasound-guided technique. METHODS: In 14 volunteers, the authors placed a needle ultrasound-guided to the third occipital nerve on both sides of the neck. They punctured caudal and perpendicular to the 14-MHz transducer. In 11 volunteers, 0.9 ml of either local anesthetic or normal saline was applied in a randomized, double-blind, crossover manner. Anesthesia was controlled in the corresponding skin area by pinprick and cold testing. The position of the needle was controlled by fluoroscopy. RESULTS: The third occipital nerve could be visualized in all subjects and showed a median diameter of 2.0 mm. Anesthesia was missing after local anesthetic in only one case. There was neither anesthesia nor hyposensitivity after any of the saline injections. The C2-C3 joint, in a transversal plane visualized as a convex density, was identified correctly by ultrasound in 27 of 28 cases, and 23 needles were placed correctly into the target zone. CONCLUSIONS: The third occipital nerve can be visualized and blocked with use of an ultrasound-guided technique. The needles were positioned accurately in 82% of cases as confirmed by fluoroscopy; the nerve was blocked in 90% of cases. Because ultrasound is the only available technique today to visualize this nerve, it seems to be a promising new method for block guidance instead of fluoroscopy.

Practical sources of error in measuring pulmonary artery occlusion pressure: a study in participants of a special intensivist training program of The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI)

BACKGROUND: Physiological data obtained with the pulmonary artery catheter (PAC) are susceptible to errors in measurement and interpretation. Little attention has been paid to the relevance of errors in hemodynamic measurements performed in the intensive care unit (ICU). The aim of this study was to assess the errors related to the technical aspects (zeroing and reference level) and actual measurement (curve interpretation) of the pulmonary artery occlusion pressure (PAOP). METHODS: Forty-seven participants in a special ICU training program and 22 ICU nurses were tested without pre-announcement. All participants had previously been exposed to the clinical use of the method. The first task was to set up a pressure measurement system for PAC (zeroing and reference level) and the second to measure the PAOP. RESULTS: The median difference from the reference mid-axillary zero level was - 3 cm (-8 to + 9 cm) for physicians and -1 cm (-5 to + 1 cm) for nurses. The median difference from the reference PAOP was 0 mmHg (-3 to 5 mmHg) for physicians and 1 mmHg (-1 to 15 mmHg) for nurses. When PAOP values were adjusted for the differences from the reference transducer level, the median differences from the reference PAOP values were 2 mmHg (-6 to 9 mmHg) for physicians and 2 mmHg (-6 to 16 mmHg) for nurses. CONCLUSIONS: Measurement of the PAOP is susceptible to substantial error as a result of practical mistakes. Comparison of results between ICUs or practitioners is therefore not possible.