Identificazione delle Lamine di tipo A come nuovi substrati della protein chinasi Akt/PKB

Akt (also called PKB) is a 63 kDa serine/threonine kinase involved in promotion of cell survival, proliferation a nd metabolic responses downstream the phosphoinositide-3-kinase (PI 3-kinase) signaling pathway. In resting cells, Akt is a predominantly cytosolic enzyme; however generation of PI 3-kinase lipid products recruits Akt to the plasma membrane, resulting in a conformational change which confers full enzymatic activity through the phosphorylation of the membrane-bound protein at two residues, Thr308, and Ser473. Activated Akt redistributes to cytoplasm and nucleus, where phosphorylation of specific substrates occurs. Both the presence and the activity of Akt in the nucleus have been described. An interesting mechanism that mediates nuclear translocation of Akt has been described in human mature T-cell leukemia: the product of TCL1 gene, Tcl1, interacts with the PH domain of phosphorylated Akt, thus driving Akt to the nucleus. In this context, Tcl1 may act as a direct transporter of Akt or may contribute to the formation of a complex that promotes the transport of active Akt to the nucleus, where it can phosphorylate nuclear substrates. A well described nuclear substrate if Foxo. IGF-1 triggers phosphorylation of Foxo by Akt inside the nucleus, where phospho-Foxo associates to 14.3.3 proteins that, in turn, promote its export to the cytoplasm where it is sequestered. Remarkably, Foxo phosphorylation by Akt has been shown to be a crucial event in Akt-dependent myogenesis. However, most Akt nuclear substrates have so far remained elusive, as well as nuclear Akt functions. This lack of information prompted us to undertake a search of substrates of Akt in the nucleus, by the combined use of 2D-separation/mass spectrometry and anti-Akt-phosphosubstrate antibody. This study presents evidence of A-type lamins as novel nuclear substrates of Akt. Lamins are type V intermediate filaments proteins found in the nucleus of higher eukaryotes where, together with lamin-binding proteins, they form the lamina at the nuclear envelope, providing mechanical stability for the nuclear membrane. By coimmunoprecipitation, it is demonstrated here that endogenous lamin A and Akt interact, and that A-type lamins are phosphorylated by Akt both in vitro and in vivo. Moreover, by phosphoaminoacid analysis and mutagenesis, it is further demonstrated that Akt phosphorylates lamin A at Ser404, and, more importantly, that while lamin A/C phosphorylation is stable throughout the cell cycle, phosphorylation of the precursor prelamin A becomes detectable as cells enter the G2 phase, picking at G2/M. This study also shows that lamin phosphorylation by Akt creates a binding site for 14.3.3 adaptors which, in turn, promote prelamin A degradation. While this mechanism is in agreement with a general role of Akt in the regulation of a subset of its substrates, opposite to what has been described, degradation is not mediated through a ubiquitination and proteasomal mechanism but through a lysosomal pathway, as indicated by the reverting action of the lysosomal inhibitor cloroquine. Phosphorylation is a key event in the mitotic breakdown of the nuclear lamina. However, the kinases and the precise sites of phosphorylation are scarcely known. Therefore, these results represent an important breakthrough in this very significant but understudied area. The phosphorylation of the precursor protein prelamin A and its subsequent degradation at G2/M, when both the nuclear envelop and the nuclear lamina disassemble, can be view as part of a mechanism to dispose off the precursor that is not needed in this precise context. The recently reported finding that patients affected by Emery-Dreifuss muscular dystrophy carry a mutation at Arg 401, in the Akt phosphorylation motif, open new perspective that warrant further investigation in this very important field.

Riabilitazione protesica ed implanto-protesica di pazienti in età evolutiva affetti da Displasia Ectodermica

Introduction. Ectodermal Dysplasias are a heterogeneous group of inherited disorders characterized by dysplasia of tissues of ectodermal origin (hair, nails, teeth, skins and glands). Clinically, it may be divided into two broad categories: the X-linked hypoidrotic form and the hidrotic form. Hypohidrotic Ectodermal Dysplasia (H.E.D) is characterized by the triad oligo-anodontia, hypotricosis, hypo-anhydrosis (Christ-Siemens-Tourane syndrome). The incidence of HED is about 1/100,000. Mutation in the actodysplasin-A (EDA) and ectodysplasin-A receptor (EDAR) genes are responsible for X-linked and autosomal HED. The clinical features include sparse, fine hair, missing or conical-shaped teeth, decreased sweat and mucous glands, hypoplastic skin, and heat intolerance with exercise or increased ambient temperature. Complete or partial anodontia and malformation of teeth are the most frequent dental findings. Incisors and canines are often conical-shaped while primarily second molars, if present, are mostly affected by taurodontism. Treatment is supportive and includes protection from heat exposure, early prosthetic rehabilitation, skin, hair ear, nose and nail care, and genetic counseling for family planning. The diagnosis of HED in the neonatal and early infancy period may be difficult since sparse hair and absent teeth are normal finding at this age. In childhood the diagnosis is more easily made on the basis of history and clinical examination. Dental abnormalities are the most common complaint. Prosthetic rehabilitation has been recommended as an essential part of the management of HED because is important from functional, esthetic, and psychological standpoint. A team approach that includes input from a pediatric dentist, an orthodontist, a prosthodontist, and an oral and maxillofacial surgeon is necessary for a successful outcome. Conventional prosthodontic rehabilitation in young patient is often difficult because of the anatomical abnormalities of existing teeth and alveolar ridges. The conical shaped teeth and “knife-edge” alveolar ridges result in poor retention and instability of dentures. Moreover, denture must permit jaws expansion and a correct pattern of growth. Materials and Methods. Complete removable dentures were provided to allow for normal physiological development and a corrected masticatory function. Initial maxillary and mandibular impressions were made with smallest stock trays and irreversible hydrocolloid and then final impressions ware made with light-bodied polysulfide rubber base impression material. A base of autopolymerizing resin was constructed and a wax rim was added to the base. The patient’s vertical dimension of occlusion was established by assessing phonetic and esthetic criteria. Preliminary occlusal relations were recorded, and the mandibular cast was mounted on the articulator. Acrylic resin teeth specific for children dentures were selected and mounted. The dentures were tried in and, after proper adjustments, were inserted. The patients were monitored clinically every month to fit prostheses. Cephalometric radiographs were taken every 6 month with the prostheses in place in order to evaluate correct pattern of growth. Cephalometric measurements were realized and used to evaluate the effect of rehabilitation on craniofacial growth. Cephalometric measurements of sound patients were compared with ED patients. After two month expander screws (three-way screw in the upper denture and two-way the lower one)were inserted in each denture in order to permit the expansion of the denture and the jaws growth. Where conical teeth were present, composite crown were realized and luted to improve the esthetic and phonesis. In order to improve retention the placement of endosseous implants was carried out. TC 3D Accuitomo was performed and a resin model of mandibular bone of the patient was realized. At the age of 11 years two implants were inserted into anterior mandible in a child with anodontia. Despite a remarkable multi-dimensional atrophy of the mandibular alveolar process, the insertion of two tapered screw implants (SAMO Smiler, diameter 3.8, length 10 mm). After a submerged healing period of two-three month, the implants were exposed. Implants were connected with an expansion guide that permits mandibular growth and prosthetic retention. The amount of mandibular growth was also evaluate dusing the expansion guide. Results. Early oral rehabilitation improve oral function, phonesis and esthetic, reducing social impairment. Treated patients showed normal cephalometric measurement. Early rehabilitation is able to prevent the prognatissm of the mandibula . The number of teeth was significantly related to several changes in craniofacial morphology. Discussion. In the present study the 5,3% of ED patients showed hypodontia, the l’89,4% di oligodontia, and the 5,3% di anodontia. The cephalometric analysis supports that ED patients showed midface hypoplasia. ED groups showed an increased pogonion to nasion measurement than sound patients, indicative of class III tendency. The present study demonstrated that number of teeth was significantly correlated with deviation of cephalometric measurements from normality. Oligoanodontia is responsible for changing of cephalometric measuraments also on sagittal plane with a class III tendency. Maxillary jaw showed a retrused position related to the presence of hypodontia.

Analyse der Einweisungsdiagnose in einer universitären Schmerzambulanz unter dem besonderen Aspekt des Anteils therapiebedürftiger psychischer Störungen bei Patienten mit Rückenschmerzen, Morbus Sudeck, Phantomschmerzen sowie

Es wurde eine retrograde Analyse von Patientenakten der Schmerzambulanzder Klinik für Anästhesiologie der Universitätsklinik Mainz durchgeführt, indie alle Patienten mit bestimmten Einschlußkriterien derBehandlungsjahrgänge1996 und 1997 aufgenommen wurden.Dies waren die vier Diagnosegruppen multilokuläre Schmerzen,Rückenschmerzen, Phantomschmerz und Morbus Sudeck (SRD). Das Ziel dervorliegenden Arbeit war die Frage nach der Häufigkeit von Psychotherapie alsergänzende Therapieempfehlung seitens der Schmerzambulanz herauszuarbeiten.Psychotherapie (ambulant, stationär, Bestandteil vonRehabilitationsaufenthalten) in vielgestaltiger Weise wurde häufigerempfohlen, 1. je länger die Schmerzerkrankung bestand,2. je jünger die Patienten waren,3. je länger sie arbeitsunfähig waren,4. wenn belastende biographische Ereignisse festgestellt werden konnten5. je höher das Chronifizierungsstadium nach Gerbershagen war. Im Einzelnenspielten die zeitlichen Aspekte der Erkrankung, Lokalisationseinflüsse sowieAspekte vorheriger Behandlungen und schmerzbedingter Krankenhausaufenthalteeine besondere Rolle.6. wenn Patienten nicht berentet waren.

Funktionelle Analyse von Dystroglycan in der sich entwickelnden Hühnerretina durch in-ovo-Elektroporation

Alpha- und Beta-Dystroglycan, die zentralen Komponenten eines multimeren Dystrophin-assoziierten Proteinkomplexes wurden bislang im Wesentlichen in der Skelettmuskulatur charakterisiert. Dort stellt der DAG eine molekulare Verbindung zwischen dem Aktin-Zytoskelett der Muskelfaser und einer Basalmembran her, die die einzelne Muskelfaser umhüllt. Dystroglycan vermittelt auf diese Weise die mechanische Festigkeit der Muskelfasern während der Kontraktion. Außerdem dient der DAG als Gerüst für die Anlagerung von Proteinen. Mutationen in den strukturgebenden oder signaltransduzierenden Proteinen des DAG verursachen Muskeldystrophie. Besonders schwere Muskeldystrophien werden durch Mutationen hervorgerufen, die eine veränderte Glykosylierung von Dystroglycan und damit eine verminderte Bindung von alpha-Dystroglycan an Matrixproteine verursachen. Dies führt zu einer Beeinträchtigung der Basalmembranbiosynthese sowie sich daraus ergebende Störungen in der Migration, Schichtung und Differenzierung von Nervenzellen im ZNS. Welche Rolle Dystroglycan im sich entwickelnden ZNS spielt, sollte in dieser Arbeit an der Hühnerretina untersucht werden. Durch Anwendung der in ovo Elektroporation wurden zwei modifizierte Dystroglycankonstrukte in Neuroepithelzellen transfiziert. Die Überexpression eines verkürtzten Dystroglycanproteins, verursachte eine Abrundung der Neuroepithelzellen. Dies führte zur Hyperproliferation der Zellen deren Folge die Bildung von Verdickungen in der Retina war sowie eine verstärkte Bildung postmitotischer Neurone. Die Elektroporation eines nicht-spaltbaren Dystroglycans, führte im Gegensatz dazu zu einer Abnahme der Anzahl proliferierender und differenzierender Nervenzellen. Als Konsequenz veränderte sich die Orientierung der Axone von retinalen Ganglienzellen. Nach der Überexpression des verkürzten Dystroglycans verloren die Axone ihre zentripetale Orientierung auf den optischen Nerv, während die Elektroporation von Wt-Dystroglycan und nicht-spaltbarem Dystroglycan nur einen gelegentlichen Richtungswechsel der Axone verursachte. Die Daten zeigen, dass Dystroglycan einen entscheidenden Einfluss auf die Proliferation, Differenzierung und Polarität der Neuroepithelzellen ausübt. Dies geschieht vermutlich durch die Vermittlung der Adhäsion des Endfußes von Neuroepithelzellen an die Basalmembran. Die Veränderungen nach der Überexpression der modifizierten Dystroglycankonstrukte liefern möglicherweise eine Erklärung für den ZNS-Phänotyp der sich bei verschiedenen Formen von Muskeldystrophie zeigt.

Strategies to identify and further characterize novel and known genes involved in regulation of skeletogenesis

372 osteochondrodysplasias and genetically determined dysostoses were reported in 2007 [Superti-Furga and Unger, 2007]. For 215 of these conditions, an association with one or more genes can be stated, while the molecular changes for the remaining syndromes remain illusive to date. Thus, the present dissertation aims at the identification of novel genes involved in processes regarding cartilage/ bone formation, growth, differentiation and homeostasis, which may serve as candidate genes for the above mentioned conditions. Two different approaches were undertaken. Firstly, a high throughput EST sequencing project from a human fetal cartilage library was performed to identify novel genes in early skeletal development (20th week of gestation until 2nd year of life) that could be investigated as potential candidate genes. 5000 EST sequences were generated and analyzed representing 1573 individual transcripts, corresponding to known (1400) and to novel, yet uncharacterized genes (173). About 7% of the proteins were already described in cartilage/ bone development or homeostasis, showing that the generated library is tissue specific. The remaining profile of this library was compared to previously published libraries from different time points (8th–12th, 18th–20th week and adult human cartilage) that also showed a similar distribution, reflecting the quality of the presented library analyzed. Furthermore, three potential candidate genes (LRRC59, CRELD2, ZNF577) were further investigated and their potential involvement in skeletogenesis was discussed. Secondly, a disease-orientated approach was undertaken to identify downstream targets of LMX1B, the gene causing Nail-Patella syndrome (NPS), and to investigate similar conditions. Like NPS, Genitopatellar syndrome (GPS) is characterized by aplasia or hypoplasia of the patella and renal anomalies. Therefore, six GPS patients were enrolled in a study to investigate the molecular changes responsible for this relatively rare disease. A 3.07 Mb deletion including LMX1B and NR5A1 (SF1) was found in one female patient that showed features of both NPS and GPS and investigations revealed a 46,XY karyotype and ovotestes indicating true hermaphroditism. The microdeletion was not seen in any of the five other patients with GPS features only, but a potential regulatory element between the two genes cannot be ruled out yet. Since Lmx1b is expressed in the dorsal limb bud and in podocytes, proteomic approaches and expression profiling were performed with murine material of the limbs and the kidneys to identify its downstream targets. After 2D-gel electrophoresis with protein extracts from E13.5 fore limb buds and newborn kidneys of Lmx1b wild type and knock-out mice and mass spectrometry analysis, only two proteins, agrin and carbonic anhydrase 2, remained of interest, but further analysis of the two genes did not show a transcriptional down regulation by Lmx1b. The focus was switched to expression profiles and RNA from newborn Lmx1b wild type and knock-out kidneys was compared by microarray analysis. Potential Lmx1b targets were almost impossible to study, because of the early death of Lmx1b deficient mice, when the glomeruli, containing podocytes, are still immature. Because Lmx1b is also expressed during limb development, RNA from wild type and knock-out Lmx1b E11.5 fore limb buds was investigated by microarray, revealing four potential Lmx1b downstream targets: neuropilin 2, single-stranded DNA binding protein 2, peroxisome proliferative activated receptor, gamma, co-activator 1 alpha, and short stature homeobox 2. Whole mount in situ hybridization strengthened a potential down regulation of neuropilin 2 by Lmx1b, but further investigations including in situ hybridization and protein-protein interaction studies will be needed.

Valutazione della psoriasi ungueale come fattore di rischio per lo sviluppo di artropatia psoriasica - studio pilota

Scopo della tesi è verificare se i pazienti affetti da psoriasi puramente ungueale sviluppano psoriasi artropatica e se esistono parametri clinici che possano permettere di predire lo sviluppo del danno articolare. Viene inoltre valutato l'impatto che la psoriasi ungueale, associata alla psoriasi artropatica, determina sulla qualità di vita dei nostri pazienti. L'artrite psoriasica è spesso associata a psoriasi ungueale, che è più frequente nei pazienti con artrite psoriasica rispetto ai pazienti con psoriasi cutanea. Vi è una stretta relazione funzionale tra l'unghia e l'articolazione interfalangea distale, i tendini e i legamenti: lo sviluppo di entesite della falange distale è infatti associato ad una infiammazione dell'apparato ungueale. Riportiamo i dati preliminari emersi dal nostro studio pilota, che conferma come siano necessari e doverosi ulteriori studi su popolazioni più ampie per determinare la relazione che sussiste fra psoriasi ungueale e psoriasi artropatica

Musculoskeletal tissue regeneration by human non-embryonic stem cells

The aim of this thesis was to investigate the regenerative potential of alternative sources of stem cells, derived from human dental pulp (hDPSCs) and amniotic fluid (hAFSCs) and, specifically, to evaluate their capability to be committed towards osteogenic and myogenic lineages, for the eventual applicability of these stem cells to translational strategies in regenerative medicine of bone and skeletal muscle tissues. The in vitro bone production by stem cells may represent a radical breakthrough in the treatment of pathologies and traumas characterized by critical bone mass defects, with no medical or surgical solution. Human DPSCs and AFSCs were seeded and pre-differentiated on different scaffolds to test their capability to subsequently reach the osteogenic differentiation in vivo, in order to recover critical size bone defects. Fibroin scaffold resulted to be the best scaffold promoting mature bone formation and defect correction when combined to both hDPSCs and hAFSCs. This study also described a culture condition that might allow human DPSCs to be used for human cell therapy in compliance with good manufacturing practices (GMPs): the use of human serum (HS) promoted the expansion and the osteogenic differentiation of hDPSCs in vitro and, furthermore, allowed pre-differentiated hDPSCs to regenerate critical size bone defects in vivo. This thesis also showed that hDPSCs and hAFSCs can be differentiated towards the myogenic lineage in vitro, either when co-cultured with murine myoblasts and when differentiated alone after DNA demethylation treatment. Interestingly, when injected into dystrophic muscles of SCID/mdx mice - animal model of Duchenne Muscular Dystrophy (DMD) - hDPSCs and hAFSCs pre-differentiated after demethylating treatment were able to regenerate the skeletal muscle tissue and, particularly, to restore dystrophin expression. These observations suggest that human DPSCs and AFSCs might be eventually applied to translational strategies, in order to enhance the repair of injured skeletal muscles in DMD patients.

Studio delle citochine nella distrofia muscolare di Emery-Dreifuss: Possibili marker patogenetici e bersagli di cura della malattia

La distrofia muscolare di Emery-Dreifuss (EDMD) è una miopatia degenerativa ereditaria caratterizzata da debolezza e atrofia dei muscoli senza coinvolgimento del sistema nervoso. Individui EDMD presentano, inoltre, cardiomiopatia con difetto di conduzione che provoca rischio di morte improvvisa. Diversi studi evidenziano un coinvolgimento di citochine in diverse distrofie muscolari causanti infiammazione cronica, riassorbimento osseo, necrosi cellulare. Abbiamo effettuato una valutazione simultanea della concentrazione di citochine, chemochine, fattori di crescita, presenti nel siero di un gruppo di 25 pazienti EDMD. L’analisi effettuata ha evidenziato un aumento di citochine quali IL-17, TGFβ2, INF-γ e del TGFβ1. Inoltre, una riduzione del fattore di crescita VEGF e della chemochina RANTES è stata rilevata nel siero dei pazienti EDMD rispetto ai pazienti controllo. Ulteriori analisi effettuate tramite saggio ELISA hanno evidenziato un aumento dei livelli di TGFβ2 e IL-6 nel terreno di coltura di fibroblasti EDMD2. Per testare l’effetto nei muscoli, di citochine alterate, abbiamo utilizzato terreno condizionante di fibroblasti EDMD per differenziare mioblasti murini C2C12. Una riduzione del grado di differenziamento è stata osservata nei mioblasti condizionati con terreno EDMD. Trattando queste cellule con anticorpi neutralizzanti contro TGFβ2 e IL-6 si è avuto un miglioramento del grado di differenziamento. In C2C12 che esprimevano la mutazione H222P del gene Lmna,non sono state osservate alterazioni di citochine e benefici di anticorpi neutralizzanti. I dati mostrano un effetto patogenetico delle citochine alterate come osservato in fibroblasti e siero di pazienti, suggerendo un effetto sul tessuto fibrotico di muscoli EDMD. Un effetto intrinseco alla mutazione della lamina A è stato rilevato sul espressione di caveolina 3 in mioblasti differenziati EDMD. I risultati si aggiungono a dati forniti sulla patogenesi dell' EDMD confermando che fattori intrinseci ed estrinseci contribuiscono alla malattia. Utilizzo di anticorpi neutralizzanti specifici contro fattori estrinseci potrebbe rappresentare un approccio terapeutico come mostrato in questo studio.

Minimalinvasive Osteosynthese der distalen extraartikulären Radiusfraktur : XSCREW und DorsalNailPlate im biomechanischen Vergleich

Gegenstand der Arbeit: Die distale Radiusfraktur ist der häufigste Bruch des Menschen. Neben etablierten Verfahren wie der dorsalen und palmaren Plattenosteosynthese gibt es seit Kurzem neuartige minimalinvasive Osteosynthesesysteme. Gegenstand der vorliegenden Arbeit ist die Untersuchung der biomechanischen Stabilität von zwei neuartigen Implantaten für die distale extraartikuläre Radiusfraktur. rnMethodik: Es handelt sich einerseits um das System XSCREW (Zimmer, Freiburg i. Br., Deutschland), eine kanülierte Schraube, die über den Processus styloideus eingeführt wird und mit bis zu neun Bohrdrähten im Knochen fixiert werden kann. Das Vergleichsimplantat DorsalNailPlate (HandInnovations, Miami, Florida, USA) ist ein Hybrid aus einer dorsalen Platte und einem Marknagel. Beide Systeme wurden an 8 paarigen frischen unfixierten Leichenradii unter Axialbelastung bis 100 N und Torsionsbelastung bis 1,5 Nm getestet. Die A3-Fraktur wurde durch eine standardisierte Keilosteotomie simuliert. Das Biomaterial wurde prä- und postinterventionell sowie nach einem Dauerbelastungstest unter 1000 Zyklen in Rotation mit 0,5 Hz untersucht. Ein Versagenstest mit steigendem Drehmoment beendete das Experiment. rnErgebnisse: Die XSCREW erreichte eine Axialsteifigkeit von 136 N/mm und eine Torsionssteifigkeit von 0,16 Nm/°. Die DNP erzielte hingegen axial 70 N/mm und torsional 0,06 Nm/°. Der Unterschied zwischen beiden Verfahren war nur für die Torsion eindeutig statistisch auffällig (p=0,012), jedoch nicht für die Axialsteifigkeit (p=0,054). Die ursprüngliche Axial- und Torsionssteifigkeit wurde durch die XSCREW signifikant besser wiederhergestellt als durch die DNP (p=0,012). Beide Verfahren erzielten nach der Intervention signifikant niedrigere Steifigkeiten als die intakten Knochen (p=0,012). Ein Präparat der DNP-Gruppe und vier Präparate der XSCREW-Gruppe überstanden den Dauerbelastungstest. Das Drehmoment bei Versagen war mit der XSCREW höher als mit der DNP, der Unterschied zwischen den Verfahren war signifikant (p=0,043). Die Schwachstellen beider Systeme lagen vorwiegend in der proximalen Verankerung im Knochen. Kirschner-Drähte bzw. Verriegelungsschrauben führten unter andauernder Belastung zu einer Spaltung der Kortikalis im Schaftbereich. Bedingt durch die Ausrichtung der distalen Verriegelungen können mit beiden Implantaten Schäden an der radiocarpalen bzw. radioulnaren Gelenkfläche entstehen. rnZusammenfassung: Die XSCREW ermöglicht insgesamt eine höhere mechanische Stabilität als die DNP. Beide Verfahren sind jedoch einer winkelstabilen palmaren Plattenosteosynthese insbesondere unter rotatorischer Dauerbelastung unterlegen und erreichen nicht die Stabilität eines anderen neuartigen minimalinvasiven Systems.

Strength development of single beech wood veneers considering different climate conditions

La tesi di laurea è stata svolta presso l’Università di Scienze Applicate di Rosenheim, in Germania; il progetto di ricerca si basa sulla tecnica di rinforzo conosciuta come “Soil Nailing”, che consiste nella costruzione di un’opera di sostegno nella realizzazione di pareti di scavo o nel consolidamento di versanti instabili. L’obiettivo principale dell’elaborato sarà quello di valutare la fattibilità dell’impiego di tubi fabbricati con legno di faggio, in sostituzione dei chiodi d’acciaio comunemente utilizzati; la scelta di questo tipo di legno è dettata dalla larga disponibilità presente in Germania. La sollecitazione principale su tali tubi sarà di trazione parallela alla fibratura, tramite test sperimentali è stato possibile valutare tale resistenza nelle diverse condizioni in cui si verrà a trovare il tubo dopo l’installazione nel terreno. A tal proposito è necessario specificare che, l’indagine per risalire all’influenza che le condizioni ambientali esercitano sull’elemento, verrà condotta su provini costituiti da un singolo strato di legno; in tal modo si può apprezzare l’influenza direttamente sull’elemento base e poi risalire al comportamento globale. I dati ottenuti dall’indagine sperimentale sono stati elaborati tramite la teoria di Weibull, largamente utilizzata in tecnologia dei materiali per quanto riguarda materiali fragili come il legno; tali distribuzioni hanno permesso la determinazione della resistenza caratteristica dei provini per ogni condizione ambientale d’interesse. Per quanto riguarda la valutazione della fattibilità dell’uso di tubi in legno in questa tecnica di consolidamento, è stato eseguito il dimensionamento del tubo, utilizzando i dati a disposizione ottenuti dall’indagine sperimentale eseguita; ed infine sono state eseguite le verifiche di stabilità dell’intervento.

[Examination reports on survived strangulation cases]

Clinical-forensic examination of strangulation victims is an increasing part of the routine of many forensic pathology institutes. The cases examined between 2004 and 2008 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analysed. In total, the study material comprised 218 victims (175 females and 43 males). In 80.7 %, the clinical-forensic examination was performed within 24 hours after the incident. In the overwhelming number of cases, the alleged perpetrator was no stranger. 128 victims (58.7 %) had strangulation marks, 32 victims (14.7 %) ligature marks and 65 victims (29.8 %) nail marks. Four victims showed injuries of the laryngeal and pharyngeal structures (reddening, hematomas, swelling and in one case a fracture of the cricoid cartilage on both sides). Extensive petechiae were predominantly seen in the conjunctivae, the buccal mucosa and the skin of the face in cases where the victims suffered a loss of consciousness. 87 cases (39.9% were classified as potentially life-threatening and 30 cases (13.8 %) as acute life-threatening events. This classification is of legal relevance for the penalty. In addition, 60 victims experienced sexual violence. These results suggest that early clinical-forensic examination is crucial for documenting forensic evidence in support of police investigations and may deliver significant details relevant in court.

Definition of treatment goals for moderate to severe psoriasis: a European consensus

Patients with moderate to severe psoriasis are undertreated. To solve this persistent problem, the consensus programme was performed to define goals for treatment of plaque psoriasis with systemic therapy and to improve patient care. An expert consensus meeting and a collaborative Delphi procedure were carried out. Nineteen dermatologists from different European countries met for a face-to-face discussion and defined items through a four-round Delphi process. Severity of plaque psoriasis was graded into mild and moderate to severe disease. Mild disease was defined as body surface area (BSA) ≤10 and psoriasis area and severity index (PASI) ≤10 and dermatology life quality index (DLQI) ≤10 and moderate to severe psoriasis as (BSA > 10 or PASI > 10) and DLQI > 10. Special clinical situations may change mild psoriasis to moderate to severe including involvement of visible areas or severe nail involvement. For systemic therapy of plaque psoriasis two treatment phases were defined: (1) induction phase as the treatment period until week 16; however, depending on the type of drug and dose regimen used, this phase may be extended until week 24 and (2) maintenance phase for all drugs was defined as the treatment period after the induction phase. For the definition of treatment goals in plaque psoriasis, the change of PASI from baseline until the time of evaluation (ΔPASI) and the absolute DLQI were used. After induction and during maintenance therapy, treatment can be continued if reduction in PASI is ≥75%. The treatment regimen should be modified if improvement of PASI is <50%. In a situation where the therapeutic response improved ≥50% but <75%, as assessed by PASI, therapy should be modified if the DLQI is >5 but can be continued if the DLQI is ≤5. This programme defines the severity of plaque psoriasis for the first time using a formal consensus of 19 European experts. In addition, treatment goals for moderate to severe disease were established. Implementation of treatment goals in the daily management of psoriasis will improve patient care and mitigate the problem of undertreatment. It is planned to evaluate the implementation of these treatment goals in a subsequent programme involving patients and physicians.

A search for activation of C nociceptors by sympathetic fibers in complex regional pain syndrome

Although the term 'reflex sympathetic dystrophy' has been replaced by 'complex regional pain syndrome' (CRPS) type I, there remains a widespread presumption that the sympathetic nervous system is actively involved in mediating chronic neuropathic pain ["sympathetically maintained pain" (SMP)], even in the absence of detectable neuropathophysiology.

Regulation of the cardiac sodium channel Nav1.5 by utrophin in dystrophin-deficient mice

Duchenne muscular dystrophy (DMD) is a severe striated muscle disease due to the absence of dystrophin. Dystrophin deficiency results in dysfunctional sodium channels and conduction abnormalities in hearts of mdx mice. Disease progression in the mdx mouse only modestly reflects that of DMD patients, possibly due to utrophin up-regulation. Here, we investigated mice deficient in both dystrophin and utrophin [double knockout (DKO)] to assess the role of utrophin in the regulation of the cardiac sodium channel (Na(v)1.5) in mdx mice.