Synthese, Tritierung, 99m Tc-Markierung und Evaluierung von Benzamid-Derivaten zur Visualisierung der D 2, D 3-Rezeptoren

Die Diagnose und Therapie von neurodegenerativen Krankheiten, wie beispielsweise Morbus Parkinson besitzt in der heutigen Gesellschaft eine immer größere Bedeutung. Über moderne, bild¬gebende nuklear¬medizinische Verfahren wie SPECT und PET ist es mit geeigneten Radioliganden möglich, Morbus Parkinson vor dem Auftreten von Symptomen zu diagnostizieren. Ein wichtiger Ansatzpunkt zur Diagnose von Morbus Parkinson ist die Visualisierung der postsynaptischen Dopamin-Rezeptoren über radioaktiv (11C, 18F, 123I) markierte Benz¬amid-Derivate. Auf Grundlage der (S)-Pyrolidin-2,3-dimethoxy-Benzamid-Struktur des 18F-Liganden Fallypride wurden verschiedene 99mTc-markierte Benzamid-Derivate als potentielle Radio¬liganden zur Parkinson-Diagnostik entwickelt. Um das Potential von Metall-konjugierten Benzamiden abschätzen zu können, wurden zunächst einfache Vergleichssubstanzen entwickelt. Diese sollten die Einführung eines Chelators simulieren und wurden hierfür hinsichtlich ihrer in vitro-Bindungsaffinitäten zu den Dopamin-, Serotonin- und adrenergen Rezeptoren evaluiert. Die zunächst entwickelten Derivate mit unterschiedlichen Kettenlängen zur Kopplung des Chelators zeigten für die Propylkette Affinitäten im nanomolaren Bereich. Im Anschluss sollten basierend auf diesen Ergebnissen vier verschiedene Chelatoren (Carbony-Cyclopentadienyl, Amido-Cyclopentadienyl, 2-Pyridyl-Imin und N2S2) über eine Propylkette an die 5-Position der Benzamidgrundstruktur gekoppelt werden. Die geplante Synthese des Carbonyl-Cyclopentadienyl-Derivates gelang jedoch nicht. Für die weiteren Chelatoren (Amido-Cyclopentadieny, 2-Pyridyl-Imin und N2S2) konnten die jeweiligen Markierungs¬vorläufer und Rhenium-Komplexe dargestellt werden, die ebenfalls hinsichtlich ihrer Bindungs¬affinitäten evaluiert wurden. Die erzielten Affinitäten zeigten, dass eine Über¬tragung der Affinitäten der einfachen Vergleichssubstanzen auf die komplexeren Metall-Benzamide nicht möglich war. Insbesondere der N2S2-Rhenium-Komplex besitzt nur noch geringe Affinität (490 - 900 nM) zu den D2- und D3-Rezeptoren. Die mittel-affinen 2-Pyridyl-Imin- und Amdio¬cyclopentadien-Komplexe wurden mit 99mTc markiert und die Markierungsausbeute hinsichtlich Reaktionstemperatur, Markierungs-vorläuferkonzentration und Heizmethoden optimiert. Dabei konnte der Imin-Komplex quantitativ mittels fac-[99mTc(CO)3(H2O)3]+ in 30 Minuten bei 45°C markiert werden. Der Amido-Cyclopentadien-Komplex konnte über die Umsetzung des Ferrocen-Markierungsvorläufer mit Mn(CO)5Br und [99mTcO4]- in Ausbeuten von bis zu 60 % markiert werden. Im Anschluss an die Markierungen wurden die 99mTc-Komplexe über HPLC isoliert und in in vitro-Auto¬radiographien von Rattenhirnschnitten weiter evaluiert. Die erhaltenen Ergebnisse bestätigten die für die Rhenium-Komplexe erzielten Affinitäten und zeigten keine spezifische Anreicherung in bestimmten Hirnarealen. Aus diesen Ergebnissen kann ge¬schlossen werden, dass die dargestellten 99mTc-Benzamide aufgrund mangelnder Affinitäten und einer hohen unspezifischen Bindung keine geeigneten Liganden zur Darstellung der D2- und D3- Rezeptoren sind. Um die dargestellten 99mTc-Benzamide mit [18F]Fallypride vergleichen zu können, wurde zusätzlich [3H]Fallypride dargestellt. Hierfür wurde zunächst der Nor-Markierungsvor¬läufer synthetisiert und die Markierungsausbeute optimiert. Die finale Umsetzung mit [3H]Methylnosylat ergab nach HPLC-Aufreinigung 15 mCi [3H]Fallypride mit einer radio¬chemischen Reinheit von >99,5 %. Erste Autoradiographien zeigten eine hohe Anreicherung des Liganden im Striatum, verbunden mit einer sehr niedrigen unspezifischen Bindung.

Nuclear charge radii of light isotopes based on frequency comb measurements

Optical frequency comb technology has been used in this work for the first time to investigate the nuclear structure of light radioactive isotopes. Therefore, three laser systems were stabilized with different techniques to accurately known optical frequencies and used in two specialized experiments. Absolute transition frequency measurements of lithium and beryllium isotopes were performed with accuracy on the order of 10^(−10). Such a high accuracy is required for the light elements since the nuclear volume effect has only a 10^(−9) contribution to the total transition frequency. For beryllium, the isotope shift was determined with an accuracy that is sufficient to extract information about the proton distribution inside the nucleus. A Doppler-free two-photon spectroscopy on the stable lithium isotopes (6,7)^Li was performed in order to determine the absolute frequency of the 2S → 3S transition. The achieved relative accuracy of 2×10^(−10) is improved by one order of magnitude compared to previous measurements. The results provide an opportunity to determine the nuclear charge radius of the stable and short-lived isotopes in a pure optical way but this requires an improvement of the theoretical calculations by two orders of magnitude. The second experiment presented here was performed at ISOLDE/CERN, where the absolute transition frequencies of the D1 and D2 lines in beryllium ions for the isotopes (7,9,10,11)^Be were measured with an accuracy of about 1 MHz. Therefore, an advanced collinear laser spectroscopy technique involving two counter-propagating frequency-stabilized laser beams with a known absolute frequency was developed. The extracted isotope shifts were combined with recent accurate mass shift calculations and the root-mean square nuclear charge radii of (7,10)^Be and the one-neutron halo nucleus 11^Be were determined. Obtained charge radii are decreasing from 7^Be to 10^Be and increasing again for 11^Be. While the monotone decrease can be explained by a nucleon clustering inside the nucleus, the pronounced increase between 10^Be and 11^Be can be interpreted as a combination of two contributions: the center-of-mass motion of the 10^Be core and a change of intrinsic structure of the core. To disentangle these two contributions, the results from nuclear reaction measurements were used and indicate that the center-of-mass motion is the dominant effect. Additionally, the splitting isotope shift, i.e. the difference in the isotope shifts between the D1 and D2 fine structure transitions, was determined. This shows a good consistency with the theoretical calculations and provides a valuable check of the beryllium experiment.

Mode-coupling theory: generalizations, high dimensions and microscopic dynamics

This work contains several applications of the mode-coupling theory (MCT) and is separated into three parts. In the first part we investigate the liquid-glass transition of hard spheres for dimensions d→∞ analytically and numerically up to d=800 in the framework of MCT. We find that the critical packing fraction ϕc(d) scales as d²2^(-d), which is larger than the Kauzmann packing fraction ϕK(d) found by a small-cage expansion by Parisi and Zamponi [J. Stat. Mech.: Theory Exp. 2006, P03017 (2006)]. The scaling of the critical packing fraction is different from the relation ϕc(d)∼d2^(-d) found earlier by Kirkpatrick and Wolynes [Phys. Rev. A 35, 3072 (1987)]. This is due to the fact that the k dependence of the critical collective and self nonergodicity parameters fc(k;d) and fcs(k;d) was assumed to be Gaussian in the previous theories. We show that in MCT this is not the case. Instead fc(k;d) and fcs(k;d), which become identical in the limit d→∞, converge to a non-Gaussian master function on the scale k∼d^(3/2). We find that the numerically determined value for the exponent parameter λ and therefore also the critical exponents a and b depend on the dimension d, even at the largest evaluated dimension d=800. In the second part we compare the results of a molecular-dynamics simulation of liquid Lennard-Jones argon far away from the glass transition [D. Levesque, L. Verlet, and J. Kurkijärvi, Phys. Rev. A 7, 1690 (1973)] with MCT. We show that the agreement between theory and computer simulation can be improved by taking binary collisions into account [L. Sjögren, Phys. Rev. A 22, 2866 (1980)]. We find that an empiric prefactor of the memory function of the original MCT equations leads to similar results. In the third part we derive the equations for a mode-coupling theory for the spherical components of the stress tensor. Unfortunately it turns out that they are too complex to be solved numerically.

Synthese und Evaluierung von [18 F]-Fluormethyltosylat als prosthetische Gruppe für die 18 F-Fluormethylierung von ZNS-Liganden für die PET

Die 11C-Methylierung von Radioliganden ist eine weit verbreitete Markierungsstrategie für PET-Liganden. Aber die kurze Halbwertszeit des Kohlenstoff-11 von 20,3 Minuten limitiert seinen Nutzen. Daher ist die 18F-Fluoralkylierung eine Möglichkeit, Fluor-18, das eine Halbwertszeit von 109,8 Minuten hat, in Target-Moleküle einzuführen. Während die 18F-Fluorethylierung eine weitverbreitete Markierungsstrategie ist, wird die 18F-Fluormethylierung bisher nur selten angewendet. Eine Ursache dafür ist die geringe Stabilität der 18F-Fluormethylgruppe in vivo. Durch Substitution des Wasserstoffs in der 18F-Fluormethylgruppe durch Deuterium kann deren Stabilität jedoch deutlich erhöht werden. Dadurch kann die 18F-Fluormethylierung eine wichtige Synthesestrategie für ZNS-Liganden sein, bei denen große strukturelle Varianz zum Einführen des Fluor-18 nicht möglich ist. rnAls prosthetische Gruppen zur 18F-Fluormethylierung wurden [18F]Fluormethyltosylat und [18F]Fluor-[d2]methyltosylat mit radiochemischen Ausbeuten bis zu 50% synthetisiert. Die Reaktionsbedingungen der 18F-Fluormethylierung mit d2-[18F]FMT und die Abtrennung der Radioliganden wurden an einer Modellverbindungen und den drei Zielstrukturen [18F]Fluor-[d2]methylharmol, [18F]Fluor-[d2]methyl-MH.MZ und [18F]Fluor-[d2]methylflumazenil optimiert. Es konnten radiochemischen Ausbeuten zwischen 25 und 60% erzielt werden. rnMit allen drei ZNS-Liganden wurden Kleintier-PET-Studien durchgeführt. Das d2-[18F]FMH zeigte eine schnelle und 1,5fach höhere Anreicherung im Hirn innerhalb der ersten fünf Minuten als die Vergleichssubstanz [18F]FEH. Für d2-[18F]FM-MH.MZ wurde in vivo eine höhere spezifische Anreicherung des Radiotracers im frontalen Cortex beobachtet als bei der 18F-fluorethylierten Vergleichssubstanz. Für das [18F]Fluor-[d2]methylflumazenil konnte keine Aufnahme ins Hirn festgestellt werden, sondern es kam zur vollständigen Zersetzung des Radioliganden durch Defluorierung. d2-[18F]FMH und d2-[18F]FM-MH.MZ waren bei physiologischen Bedingungen zu mehr als 90% stabil.rn

In vitro modulation of epileptiform activity in the hippocampal formation of immature rodents by GABAergic antagonists, dopamine and methylxanthines

Während des frühen Lebens stellen epileptische Anfälle schwere neurologische Zustände dar, weil sie ein großer Risikofaktor für die Manifestation der Epilepsie sind und eine hohe pharmakologische Resistenz zeigen. In meiner Doktorarbeit konzentrierte ich mich auf die Frage, wie verschiedene Neurotransmitter-Systeme und klinisch verwendete Medikamente epileptiforme Entladungen im perinatalen Hippocampus beeinflussen. rnIm ersten Teil meines Projektes untersuchte ich die Wirkung von GABA-Antagonisten und Modulatoren, die zwischen phasischen und tonischen GABAergen Strömen differenzieren, auf Feldpotentialaktivität in Hippocampusschnitten. Diese Experimente zeigten, dass im unreifen Hippocampus synaptische GABAerge Aktivität benötigt wird, um die Erregbarkeit zu begrenzen, während tonische GABAerge Ströme die Erregbarkeit verstärken können. Dies könnte darauf hinweisen, dass Antiepileptika mit einer höheren Spezifität für synaptische GABAA-Rezeptoren wirksamer zur Behandlung von epileptischen Anfällen bei Neugeborenen sein können. rnUm den Einfluss von Dopamin auf die Erregbarkeit des unreifen Hippocampus herauszufinden, untersuchte ich im zweiten Teil meiner Arbeit die Wirkung von verschiedenen Dopaminkonzentrationen und spezifische Agonisten und Antagonisten der Dopamin-Rezeptor-Subtypen auf epileptiforme Entladungen. Diese Experimente zeigten, dass niedrige Dopamin Konzentrationen eine antikonvulsive Wirkung haben, welche vom D2-ähnliche-Rezeptor-Agonisten Quinpirol nachgeahmt werden kann, während höhere Dopamin-Konzentrationen eine prokonvulsive Wirkung über Aktivierung von D1-ähnlichen Rezeptoren hervorrufen. Obwohl unsere Untersuchungen eine mögliche Verwendung von D2-ähnlichen Rezeptor-Agonisten zur Kontrolle epileptischer Anfälle in Neugeborenen nahelegen, müssen mögliche negative Auswirkungen von DAergen Agonisten und Antagonisten auf die neuronale Entwicklung berücksichtigt werden.rnIm dritten Teil meiner Arbeit untersuchte ich welche Konzentrationen von Methylxanthinen epileptische Anfälle in Hippocampuspreparationen auslösen die synaptische Übertragungen verändern können. Diese Experimente zeigten, dass sowohl Theophyllin als auch Koffein in höheren Konzentrationen die basale synaptische Übertragungen in der CA1-Region des Hippocampus modifizieren und epileptiforme Entladungen provozieren. Die Auswirkungen auf die postsynaptischen Antworten und spontanen epileptiformen Entladungen durch Koffein waren weniger ausgeprägt, was darauf hindeutet, dass diese Substanz potentiell vorteilhafter für therapeutische Anwendungen bei Frühgeborenen sein kann. rnZusammenfassend bereichern die Ergebnisse meiner Studie erheblich unser Wissen über die zugrunde liegenden Mechanismen epileptiformer Aktivität im unreifen Hippocampus und den therapeutischen Einsatz von Methylxanthinen und Pharmaka, die auf das GABAerge und DArge System einwirken.rnrn

Thermal excitations of optical nanofibers measured with a fiber-integrated Fabry-Pérot cavity

Efficient coupling of light to quantum emitters, such as atoms, molecules or quantum dots, is one of the great challenges in current research. The interaction can be strongly enhanced by coupling the emitter to the eva-nescent field of subwavelength dielectric waveguides that offer strong lateral confinement of the guided light. In this context subwavelength diameter optical nanofibers as part of a tapered optical fiber (TOF) have proven to be powerful tool which also provide an efficient transfer of the light from the interaction region to an optical bus, that is to say, from the nanofiber to an optical fiber. rnAnother approach towards enhancing light–matter interaction is to employ an optical resonator in which the light is circulating and thus passes the emitters many times. Here, both approaches are combined by experi-mentally realizing a microresonator with an integrated nanofiber waist. This is achieved by building a fiber-integrated Fabry-Pérot type resonator from two fiber Bragg grating mirrors with a stop-band near the cesium D2-line wavelength. The characteristics of this resonator fulfill the requirements of nonlinear optics, optical sensing, and cavity quantum electrodynamics in the strong-coupling regime. Together with its advantageous features, such as a constant high coupling strength over a large volume, tunability, high transmission outside the mirror stop band, and a monolithic design, this resonator is a promising tool for experiments with nanofiber-coupled atomic ensembles in the strong-coupling regime. rnThe resonator's high sensitivity to the optical properties of the nanofiber provides a probe for changes of phys-ical parameters that affect the guided optical mode, e.g., the temperature via the thermo-optic effect of silica. Utilizing this detection scheme, the thermalization dynamics due to far-field heat radiation of a nanofiber is studied over a large temperature range. This investigation provides, for the first time, a measurement of the total radiated power of an object with a diameter smaller than all absorption lengths in the thermal spectrum at the level of a single object of deterministic shape and material. The results show excellent agreement with an ab initio thermodynamic model that considers heat radiation as a volumetric effect and that takes the emitter shape and size relative to the emission wavelength into account. Modeling and investigating the thermalization of microscopic objects with arbitrary shape from first principles is of fundamental interest and has important applications, such as heat management in nano-devices or radiative forcing of aerosols in Earth's climate system. rnUsing a similar method, the effect of the TOF's mechanical modes on the polarization and phase of the fiber-guided light is studied. The measurement results show that in typical TOFs these quantities exhibit high-frequency thermal fluctuations. They originate from high-Q torsional oscillations that couple to the nanofiber-guided light via the strain-optic effect. An ab-initio opto-mechanical model of the TOF is developed that provides an accurate quantitative prediction for the mode spectrum and the mechanically induced polarization and phase fluctuations. These high-frequency fluctuations may limit the ultimate ideality of fiber-coupling into photonic structures. Furthermore, first estimations show that they may currently limit the storage time of nanofiber-based atom traps. The model, on the other hand, provides a method to design TOFs with tailored mechanical properties in order to meet experimental requirements. rn

Synaptic circuitry of ganglion cells in the mammalian retina

Before signals of the visual environment are transferred to higher brain areas via the optic nerve, they are processed and filtered in parallel pathways within the retina. In the past a plethora of functionally distinct ganglion cell types responding to certain aspects of the environment, such as direction of movement, contrast and colour have been described. Aim of this thesis was the anatomical investigation of the selectivity in retinal circuits underlying this diversity. For this purpose, mouse and macaque retinae were analysed. OFF-ganglion cells in the mouse retina received their excitatory drive unselectively from all bipolar cell types stratifying within the area of their dendritic trees. Only the input to direction-selective C6 ganglion cells and bistratified D2 ganglion cells appeared to be weighted. In primates the highly specialised midget-system forms a 1:1 connection from red- and green-sensitive cones onto midget bipolar- and ganglion cells, building the substrate for red/green colour vision. Here it was demonstrated that blue-sensitive (S-) cones also contact OFF-midget bipolars and are, thus, potential candidates to transfer blue-OFF signals to M1 intrinsically photosensitive ganglion cells (ipRGCs). M1 cells received glycinergic input from A8 amacrine cells and express GABAA receptors containing subunit alpha 3. M2 cells, in contrast, received less inhibitory input.

Role of somatostatins in gastroenteropancreatic neuroendocrine tumor development and therapy

The incidence and prevalence of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have increased in the past 20 years. GEP-NETs are heterogeneous tumors, in terms of clinical and biological features, that originate from the pancreas or the intestinal tract. Some GEP-NETs grow very slowly, some grow rapidly and do not cause symptoms, and others cause hormone hypersecretion and associated symptoms. Most GEP-NETs overexpress receptors for somatostatins. Somatostatins inhibit the release of many hormones and other secretory proteins; their effects are mediated by G protein-coupled receptors that are expressed in a tissue-specific manner. Most GEP-NETs overexpress the somatostatin receptor SSTR2; somatostatin analogues are the best therapeutic option for functional neuroendocrine tumors because they reduce hormone-related symptoms and also have antitumor effects. Long-acting formulations of somatostatin analogues stabilize tumor growth over long periods. The development of radioactive analogues for imaging and peptide receptor radiotherapy has improved the management of GEP-NETs. Peptide receptor radiotherapy has significant antitumor effects, increasing overall survival times of patients with tumors that express a high density of SSTRs, particularly SSTR2 and SSTR5. The multi-receptor somatostatin analogue SOM230 (pasireotide) and chimeric molecules that bind SSTR2 and the dopamine receptor D2 are also being developed to treat patients with GEP-NETs. Combinations of radioactive labeled and unlabeled somatostatin analogues and therapeutics that inhibit other signaling pathways, such as mammalian target of rapamycin (mTOR) and vascular endothelial growth factor, might be the most effective therapeutics for GEP-NETs.

Selective REM sleep deprivation in narcolepsy

Narcolepsy is characterized by excessive daytime sleepiness and rapid eye movement (REM) sleep abnormalities, including cataplexy. The aim of this study was to assess REM sleep pressure and homeostasis in narcolepsy. Six patients with narcolepsy and six healthy controls underwent a REM sleep deprivation protocol, including one habituation, one baseline, two deprivation nights (D1, D2) and one recovery night. Multiple sleep latency tests (MSLTs) were performed during the day after baseline and after D2. During D1 and D2 REM sleep was prevented by awakening the subjects at the first polysomnographic signs of REM sleep for 2 min. Mean sleep latency and number of sleep-onset REM periods (SOREMs) were determined on all MSLT. More interventions were required to prevent REM sleep in narcoleptics compared with control subjects during D1 (57 ± 16 versus 24 ± 10) and D2 (87 ± 22 versus 35 ± 8, P = 0.004). Interventions increased from D1 to D2 by 46% in controls and by 53% in narcoleptics (P < 0.03). Selective REM sleep deprivation was successful in both controls (mean reduction of REM to 6% of baseline) and narcoleptics (11%). Both groups had a reduction of total sleep time during the deprivation nights (P = 0.03). Neither group had REM sleep rebound in the recovery night. Narcoleptics had, however, an increase in the number of SOREMs on MSLT (P = 0.005). There was no increase in the number of cataplexies after selective REM sleep deprivation. We conclude that: (i) REM sleep pressure is higher in narcoleptics; (ii) REM sleep homeostasis is similar in narcoleptics and controls; (iii) in narcoleptics selective REM sleep deprivation may have an effect on sleep propensity but not on cataplexy.

Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy

Objective: To compare clinical outcomes after laparoscopic cholecystectomy (LC) for acute cholecystitis performed at various time-points after hospital admission. Background: Symptomatic gallstones represent an important public health problem with LC the treatment of choice. LC is increasingly offered for acute cholecystitis, however, the optimal time-point for LC in this setting remains a matter of debate. Methods: Analysis was based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery and included patients undergoing emergency LC for acute cholecystitis between 1995 and 2006, grouped according to the time-points of LC since hospital admission (admission day (d0), d1, d2, d3, d4/5, d ≥6). Linear and generalized linear regression models assessed the effect of timing of LC on intra- or postoperative complications, conversion and reoperation rates and length of postoperative hospital stay. Results: Of 4113 patients, 52.8% were female, median age was 59.8 years. Delaying LC resulted in significantly higher conversion rates (from 11.9% at d0 to 27.9% at d ≥6 days after admission, P < 0.001), surgical postoperative complications (5.7% to 13%, P < 0.001) and re-operation rates (0.9% to 3%, P = 0.007), with a significantly longer postoperative hospital stay (P < 0.001). Conclusions: Delaying LC for acute cholecystitis has no advantages, resulting in significantly increased conversion/re-operation rate, postoperative complications and longer postoperative hospital stay. This investigation—one of the largest in the literature—provides compelling evidence that acute cholecystitis merits surgery within 48 hours of hospital admission if impact on the patient and health care system is to be minimized.

Structural Analysis of alpha-Fetoprotein (AFP)-like Peptides with Anti-Breast-Cancer Properties

The abundance of alpha-fetoprotein (AFP), a natural protein produced by the fetal yolk sac during pregnancy, correlates with lower incidence of estrogen receptor positive (ER+) breast cancer. The pharmacophore region of AFP has been narrowed down to a four amino acid (AA) region in the third domain of the 591 AA peptide. Our computational study focuses on a 4-mer segment consisting of the amino acids threonine-proline-valine-asparagine (TPVN). We have run replica exchange molecular dynamics (REMD) simulations and used 120 configurational snapshots from the total trajectory as starting configurations for quantum chemical calculations. We optimized structures using semiempirical (PM3, PM6, PM6-D2, PM6-H2, PM6-DH+, PM6-DH2) and density functional methods (TPSS, PBE0, M06-2X). By comparing the accuracy of these methods against RI-MP2 benchmarks, we devised a protocol for calculating the lowest energy conformers of these peptides accurately and efficiently. This protocol screens out high-energy conformers using lower levels of theory and outlines a general method for predicting small peptide structures.

Oral prednisolone induced acute generalized exanthematous pustulosis due to corticosteroids of group A confirmed by epicutaneous testing and lymphocyte transformation tests

BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous eruption which is often provoked by drugs. CASE REPORT: We report 2 cases of AGEP which showed rapidly spreading pustular eruptions accompanied by malaise, fever and neutrophilia after the administration of systemic prednisolone (corticosteroid of group A, hydrocortisone type). The histological examination showing neutrophilic subcorneal spongiform pustules was consistent with the diagnosis of AGEP. In both cases the rash cleared within a week upon treatment with topical steroids (corticosteroid of group D1, betamethasonedipropionate type and corticosteroid of group D2, hydrocortisone-17-butyrate type). Three months after recovery, the sensitization to corticosteroids of group A was confirmed by epicutaneous testing and positive lymphocyte transformation tests. CONCLUSION: These cases show that systemic corticosteroids can induce AGEP and demonstrate that epicutaneous testing and lymphocyte transformation tests may be helpful in identifying the causative drug. Our data support previous reports indicating an important role for drug-specific T cells in inducing neutrophil inflammation in this disease.

Penetration ability and microleakage of a fissure sealant applied on artificial and natural enamel fissure caries

OBJECTIVES AND METHODS: This study investigated the sealing ability of a current available unfilled fissure sealant applied over sound (n=80), artificially created (n=80) and naturally carious fissures (n=80) under different humidity conditions (90+/-2 and 45+/-2% relative humidity) and etching times (40 and 60s). All samples were submitted to 5000 thermal cycles and examined by light microscopy after sectioning. Microleakage, penetration ability, fissure type, fissure entrance angle, sealant occlusal length, caries location and caries depth were assessed. RESULTS: The significantly longer sealant occlusal length and larger entrance angle exhibited by shallow fissures, contributed to their higher microleakage and smaller amounts of unfilled areas compared to deep fissures. Sealant microleakage was significantly influenced by the condition of the enamel (sound, artificial and natural caries) and the caries location in the fissures, but not by enamel caries depth (D1 and D2), etching time, or humidity condition. Natural caries exhibited significantly higher microleakage than sound or artificially created carious fissures. CONCLUSIONS: Based on the results of this study, it can be concluded that location of caries in the fissure rather than its depth should be taken into account when applying a fissure sealant. When the borders of the fissure sealant are on carious enamel, a significantly higher microleakage must be expected. The artificial caries model was not a suitable method to assess the behavior of natural fissure caries.

Detection of approximal caries with a new laser fluorescence device

The laser device DIAGNOdent developed for the detection of occlusal caries has limited value on approximal surfaces. The aim of this study was to develop and to test a new laser fluorescence (LF) device for the detection of approximal caries. Light with a wavelength of 655 nm was transported to the approximal surface using two different sapphire fibre tips. Seventy-five teeth were selected from a pool of extracted permanent human molars, frozen at -20 degrees C until use. Before being measured, they were defrosted, cleaned and calculus was removed with a scaler. The molars were set in blocks simulating the contact area of adults. Bitewing radiographs were obtained using Kodak Insight films. After two independent assessments with the new LF device, the teeth were histologically prepared, and assessed for caries extension. Using the laser, specificity values for D1 threshold (outer half of enamel), D2 threshold (inner half of enamel), D3 threshold (dentine) ranged between 0.81 and 0.93, sensitivity between 0.84 and 0.92 with no difference between the two tips. Bitewing radiography showed an inferior performance compared to LF (p<0.05). Intraex aminer reproducibility was high (kappa>.74). The new LF system might be a useful additional tool in detecting approximal caries. Because of its good reproducibility, it could be used to monitor caries regression or progression on approximal surfaces.

Psychosocial and neurocognitive performance after spontaneous nonaneurysmal subarachnoid hemorrhage related to the APOE-epsilon4 genotype: a prospective 5-year follow-up study

OBJECT: In this study, the authors prospectively evaluated long-term psychosocial and neurocognitive performance in patients suffering from nonaneurysmal, nontraumatic subarachnoid hemorrhage (SAH) and investigated the association between the APOE-epsilon4 genotype and outcome in these patients. METHODS: All patients admitted to the authors' institution between January 2001 and January 2003 with spontaneous nonaneurysmal SAH were prospectively examined (mean follow-up 59.8 months). The APOE genotype was determined in all patients by polymerase chain reaction from a blood sample. Of the 30 patients included in this study, 11 were carriers of the epsilon4 allele. RESULTS: All patients showed a good recovery and regained full independence with no persisting neurological deficits. The patients with the epsilon4 allele, however, scored significantly higher on the Beck Depression Inventory (22.1 +/- 6.3 vs 14.1 +/- 5.1). At follow-up, depression was more persistent in the group with the epsilon4 allele compared with the group that lacked the allele. This finding reached statistical significance (p < 0.05). Selective attention was impaired in all patients during the first year of follow-up, with an earlier recovery noted in the patients without the epsilon4 allele. Moreover, there was a tendency toward a linear relationship between the Beck Depression Inventory and the d2 Test of Attention. Two patients who carried the epsilon4 allele did not return to their employment even after 5 years. CONCLUSIONS: The findings in this study suggest that the APOE genotypes may be associated with the psychosocial and neurocognitive performance after spontaneous nonaneurysmal SAH, even in the absence of neurological impairment. Physicians should consider patient genotype in assessing the long-term consequences of nonaneurysmal SAH.