Revisione critica dei risultati e nuovi algoritmi decisionali sulla chirurgia dell'OSAS

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is the periodic reduction or cessation of airflow during sleep. The syndrome is associated whit loud snoring, disrupted sleep and observed apnoeas. Surgery aims to alleviate symptoms of daytime sleepiness, improve quality of life and reduce the signs of sleep apnoea recordered by polysomnography. Surgical intervention for snoring and OSAHS includes several procedures, each designed to increase the patency of the upper airway. Procedures addressing nasal obstruction include septoplasty, turbinectomy, and radiofrequency ablation (RF) of the turbinates. Surgical procedures to reduce soft palate redundancy include uvulopalatopharyngoplasty with or without tonsillectomy, uvulopalatal flap, laser-assisted uvulopalatoplasty, and RF of the soft palate. More significant, however, particularly in cases of severe OSA, is hypopharyngeal or retrolingual obstruction related to an enlarged tongue, or more commonly due to maxillomandibular deficiency. Surgeries in these cases are aimed at reducing the bulk of the tongue base or providing more space for the tongue in the oropharynx so as to limit posterior collapse during sleep. These procedures include tongue-base suspension, genioglossal advancement, hyoid suspension, lingualplasty, and maxillomandibular advancement. We reviewed 269 patients undergoing to osas surgery at the ENT Department of Forlì Hospital in the last decade. Surgery was considered a success if the postoperative apnea/hypopnea index (AHI) was less than 20/h. According to the results, we have developed surgical decisional algorithms with the aims to optimize the success of these procedures by identifying proper candidates for surgery and the most appropriate surgical techniques. Although not without risks and not as predictable as positive airway pressure therapy, surgery remains an important treatment option for patients with obstructive sleep apnea (OSA), particularly for those who have failed or cannot tolerate positive airway pressure therapy. Successful surgery depends on proper patient selection, proper procedure selection, and experience of the surgeon. The intended purpose of medical algorithms is to improve and standardize decisions made in the delivery of medical care, assist in standardizing selection and application of treatment regimens, to reduce potential introduction of errors. Nasal Continuous Positive Airway Pressure (nCPAP) is the recommended therapy for patients with moderate to severe OSAS. Unfortunately this treatment is not accepted by some patient, appears to be poorly tolerated in a not neglible number of subjects, and the compliance may be critical, especially in the long term if correctly evaluated with interview as well with CPAP smart cards analysis. Among the alternative options in Literature, surgery is a long time honoured solution. However until now no clear scientific evidence exists that surgery can be considered a really effective option in OSAHS management. We have design a randomized prospective study comparing MMA and a ventilatory device (Autotitrating Positive Airways Pressure – APAP) in order to understand the real effectiveness of surgery in the management of moderate to severe OSAS. Fifty consecutive previously full informed patients suffering from severe OSAHS were enrolled and randomised into a conservative (APAP) or surgical (MMA) arm. Demographic, biometric, PSG and ESS profiles of the two group were statistically not significantly different. One year after surgery or continuous APAP treatment both groups showed a remarkable improvement of mean AHI and ESS; the degree of improvement was not statistically different. Provided the relatively small sample of studied subjects and the relatively short time of follow up, MMA proved to be in our adult and severe OSAHS patients group a valuable alternative therapeutical tool with a success rate not inferior to APAP.

Influence of processing conditions on quality aspects of potato-based fresh pasta

Gnocchi is a typical Italian potato-based fresh pasta that can be either homemade or industrially manufactured. The homemade traditional product is consumed fresh on the day it is produced, whereas the industrially manufactured one is vacuum-packed in polyethylene and usually stored at refrigerated conditions. At industrial level, most kinds of gnocchi are usually produced by using some potato derivatives (i.e. flakes, dehydrated products or flour) to which soft wheat flour, salt, some emulsifiers and aromas are added. Recently, a novel type of gnocchi emerged on the Italian pasta market, since it would be as much similar as possible to the traditional homemade one. It is industrially produced from fresh potatoes as main ingredient and soft wheat flour, pasteurized liquid eggs and salt, moreover this product undergoes steam cooking and mashing industrial treatments. Neither preservatives nor emulsifiers are included in the recipe. The main aim of this work was to get inside the industrial manufacture of gnocchi, in order to improve the quality characteristics of the final product, by the study of the main steps of the production, starting from the raw and steam cooked tubers, through the semi-finished materials, such as the potato puree and the formulated dough. For this purpose the investigation of the enzymatic activity of the raw and steam cooked potatoes, the main characteristics of the puree (colour, texture and starch), the interaction among ingredients of differently formulated doughs and the basic quality aspects of the final product have been performed. Results obtained in this work indicated that steam cooking influenced the analysed enzymes (Pectin methylesterase and α- and β-amylases) in different tissues of the tuber. PME resulted still active in the cortex, it therefore may affect the texture of cooked potatoes to be used as main ingredient in the production of gnocchi. Starch degrading enzymes (α- and β-amylases) were inactivated both in the cortex and in the pith of the tuber. The study performed on the potato puree showed that, between the two analysed samples, the product which employed dual lower pressure treatments seemed to be the most suitable to the production of gnocchi, in terms of its better physicochemical and textural properties. It did not evidence aggregation phenomena responsible of hard lumps, which may occur in this kind of semi-finished product. The textural properties of gnocchi doughs were not influenced by the different formulation as expected. Among the ingredients involved in the preparation of the different samples, soft wheat flour seemed to be the most crucial in affecting the quality features of gnocchi doughs. As a consequence of the interactive effect of the ingredients on the physicochemical and textural characteristics of the different doughs, a uniform and well-defined split-up among samples was not obtained. In the comparison of different kinds of gnocchi, the optimal physicochemical and textural properties were detected in the sample made with fresh tubers. This was probably caused not only by the use of fresh steam cooked potatoes, but also by the pasteurized liquid eggs and by the absence of any kind of emulsifier, additive or preserving substance.

Effetto di un packaging innovativo sulla qualità di nettarine

L’imballaggio alimentare si può definire come un sistema coordinato per disporre i beni per il trasporto, la distribuzione, la conservazione, la vendita e l’utilizzo. Uno dei materiali maggiormente impiegati, nell’industria alimentare, per la produzione di imballaggi sono le materie plastiche. Esse sono sostanze organiche derivanti da petrolio greggio, sono composti solidi allo stato finito, ma possono essere modellate allo stato fluido. Un imballaggio alimentare deve svolgere determinate funzioni tra cui: - contenimento del prodotto - protezione del prodotto da agenti esterni - logistica - comunicativa - funzionale - ecologica L'ultimo punto sopracitato è il principale problema delle materie plastiche derivanti dal petrolio greggio. Questi materiali sono difficilmente riciclabili perché spesso un imballaggio è composto da più materiali stratificati o perché si trova a diretto contatto con gli alimenti. Inoltre questi materiali hanno un lungo tempo di degradazione (da 100 a 1000 anni) che ne rendono difficile e costoso lo smaltimento. Per questo nell’ultimo decennio è cominciata la ricerca di un materiale plastico, flessibile alle esigenze industriali e nel contempo biodegradabile. Una prima idea è stata quella di “imitare la natura” cercando di replicare macromolecole già esistenti (derivate da amido e zuccheri) per ottenere una sostanza plastico-simile utilizzabile per gli stessi scopi, ma biodegradabile in circa sei mesi. Queste bioplastiche non hanno preso piede per l’alto costo di produzione e perché risulta impossibile riconvertire impianti di produzione in tutto il mondo in tempi brevi. Una seconda corrente di pensiero ha indirizzato i propri sforzi verso l’utilizzo di speciali additivi aggiunti in minima misura (1%) ai classici materiali plastici e che ne permettono la biodegradazione in un tempo inferiore ai tre anni. Un esempio di questo tipo di additivi è l’ECM Masterbatch Pellets che è un copolimero di EVA (etilene vinil acetato) che aggiunto alle plastiche tradizionali rende il prodotto finale completamente biodegradabile pur mantenendo le proprie caratteristiche. Scopo di questo lavoro di tesi è stato determinare le modificazioni di alcuni parametri qualitativi di nettarine di Romagna(cv.-Alexa®) confezionate-con-film-plastici-tradizionali-e-innovativi. I campioni di nettarine sono stati confezionati in cestini in plastica da 1 kg (sigillati con un film flow-pack macroforato) di tipo tradizionale in polipropilene (campione denominato TRA) o vaschette in polipropilene additivato (campione denominato BIO) e conservati a 4°C e UR 90-95% per 7 giorni per simulare un trasporto refrigerato successivamente i campioni sono stati posti in una camera a 20°C e U.R. 50% per 4 giorni al fine di simulare una conservazione al punto vendita. Al tempo 0 e dopo 4, 7, 9 e 11 giorni sono state effettuate le seguenti analisi: - coefficiente di respirazione è stato misurata la quantità di CO2 prodotta - indice di maturazione espresso come rapporto tra contenuto in solidi solubili e l’acidità titolabile - analisi di immagine computerizzata - consistenza della polpa del frutto è stata misurata attraverso un dinamometro Texture Analyser - contenuto in solidi totali ottenuto mediante gravimetria essiccando i campioni in stufa sottovuoto - caratteristiche sensoriali (Test Accettabilità) Conclusioni In base ai risultati ottenuti i due campioni non hanno fatto registrare dei punteggi significativamente differenti durante tutta la conservazione, specialmente per quanto riguarda i punteggi sensoriali, quindi si conclude che le vaschette biodegradabili additivate non influenzano la conservazione delle nettarine durante la commercializzazione del prodotto limitatamente ai parametri analizzati. Si ritiene opportuno verificare se il processo di degradazione del polimero additivato si inneschi già durante la commercializzazione della frutta e soprattutto verificare se durante tale processo vengano rilasciati dei gas che possono accelerare la maturazione dei frutti (p.e. etilene), in quanto questo spiegherebbe il maggiore tasso di respirazione e la più elevata velocità di maturazione dei frutti conservati in tali vaschette. Alimentary packaging may be defined as a coordinate system to dispose goods for transport, distribution, storage, sale and use. Among materials most used in the alimentary industry, for the production of packaging there are plastics materials. They are organic substances deriving from crude oil, solid compounds in the ended state, but can be moulded in the fluid state. Alimentary packaging has to develop determinated functions such as: - Product conteniment - Product protection from fieleders agents - logistic - communicative - functional - ecologic This last term is the main problem of plastic materials deriving from crude oil. These materials are hardly recyclable because a packaging is often composed by more stratified materials or because it is in direct contact with aliments. Beside these materials have a long degradation time(from 100 to 1000 years) that make disposal difficult and expensive. For this reason in the last decade the research for a new plastic material is begin, to make industrial demands more flexible and, at the same time, to make this material biodegradable: At first, the idea to “imitate the nature” has been thought, trying to reply macromolecules already existents (derived from amid and sugars) to obtain a similar-plastic substance that can be used for the same purposes, but it has to be biodegradable in about six months. These bioplastics haven’t more success bacause of the high production cost and because reconvert production facilities of all over the wolrd results impossible in short times. At second, the idea to use specials addictives has been thought. These addictives has been added in minim measure (1%) to classics plastics materials and that allow the biodegradation in a period of time under three years. An example of this kind of addictives is ECM Masterbatch Pellets which is a coplymer of EVA (Ethylene vinyl acetate) that, once it is added to tradizional plastics, make final product completely biodegradable however maintaining their own attributes. The objective of this thesis work has been to determinate modifications of some Romagna’s Nectarines’ (cv. Alexa®) qualitatives parameters which have been packaged-with traditional and innovative-plastic film. Nectarines’ samples have been packaged in plastic cages of 1 kg (sealed with a macro-drilled flow-pack film) of traditional type in polypropylene (sample named TRA) or trays in polypropylene with addictives (sample named BIO) and conservated at 4°C and UR 90-95% for 7 days to simulate a refrigerated transport. After that, samples have been put in a camera at 20°C and U.R. 50% for 4 days to simulate the conservation in the market point. At the time 0 and after 4, 7, 9 and 11 days have been done the following analaysis: - Respiration coefficient wherewith the amount CO2 producted has been misurated - Maturation index which is expressed as the ratio between solid soluble content and the titratable acidity - Analysis of computing images - Consistence of pulp of the fruit that has been measured through Texture Analyser Dynanometer - Content in total solids gotten throught gravimetry by the drying of samples in vacuum incubator - Sensorial characteristic (Panel Test) Consequences From the gotten results, the two samples have registrated no significative different scores during all the conservation, expecially about the sensorial scores, so it’s possible to conclude that addictived biodegradable trays don’t influence the Nectarines’ conservation during the commercialization of the product qualifiedly to analized parameters. It’s advised to verify if the degradation process of the addicted polymer may begin already during the commercialization of the fruit and in particular to verify if during this process some gases could be released which can accelerate the maturation of fruits (p.e. etylene), because all this will explain the great respiration rate and the high speed of the maturation of fruits conservated in these trays.

Therapeutic strategies for modulation of the vaginal microbiota

The vaginal microbiota of healthy women consists of a wide variety of anaerobic and aerobic bacteria, dominated by the genus Lactobacillus. The activity of lactobacilli is essential to protect women from genital infections and to maintain the natural healthy balance of the vaginal ecosystem. This role is particularly important during pregnancy because vaginal infection is one of the most important mechanisms for preterm birth. The most common vaginal disorder is bacterial vaginosis (BV). BV is a polymicrobial disorder, characterized by a depletion of lactobacilli and an increase in the concentration of other bacteria, including Gardnerella vaginalis, anaerobic Gram-negative rods, anaerobic Gram-positive cocci, Mycoplasma hominis, and Mobiluncus spp. An integrated molecular approach based on real-time PCR and PCR-DGGE was used to investigate the effects of two different therapeutic approaches on the vaginal microbiota composition. (i) The impact of a dietary supplementation with the probiotic VSL#3, a mixture of Lactobacillus, Bifidobacterium and Streptococcus strains, on the vaginal microbial ecology and immunological profiles of healthy women during late pregnancy was investigated. The intake was associated to a slight modulation of the vaginal microbiota and cytokine secretion, with potential implications in preventing preterm birth. (ii) The efficacy of different doses of the antibiotic rifaximin (100 mg/day for 5 days, 25 mg/day for 5 days, 100 mg/day for 2 days) on the vaginal microbiota of patients with BV enrolled in a multicentre, double-blind, randomised, placebo-controlled study was also evaluated. The molecular analyses demonstrated the ability of rifaximin 25 mg/day for 5 days to induce an increase of lactobacilli and a decrease of the BV-associated bacteria after antibiotic treatment, and a reduction of the complexity of the vaginal microbial communities. Thus, confirming clinical results, it represents the most effective treatment to be used in future pivotal studies for the treatment of BV.

Untersuchungen zu Migration, Homing und Effektor-Funktionen humaner T-Lymphozyten in NOD.Cg-Prkdc scid Il2r gtm1Wjl, SzJ-Mäusen im Rahmen der allogenen hämatopoetischen Stammzelltransplantation

Die akute myeloische Leukämie (AML) zählt zu den aggressivsten neoplastischen Erkrankungenrnder Hämatopoese. Die Mehrheit der Patienten mit AML erreicht nach Induktions-rnChemotherapie den Zustand der kompletten Remission, jedoch erleiden mehr als die Hälfterndieser Patienten anschließend einen Rückfall und versterben an den Folgen der Erkrankungrn[1]. Die allogene hämatopoetische Stammzelltransplantation (engl.: hematopoietic stem cellrntransplantation, HSCT) stellt die einzig putativ kurative Behandlungsform für rezidierendernPatienten und solche mit schlechter Prognose dar. Jedoch birgt diese Form der Therapiernauch eine Vielzahl an Risiken. Insbesondere das Auftreten einer akuten Transplantat-gegen-rnWirt-Erkrankung (engl.: graft-versus-host disease, GvHD) stellt die Hauptursache für transplantationsassoziierternMortalität und Morbidität dar [2]. Die Depletion von alloreaktiven zytotoxischenrnT Lymphozyten (CTL) aus dem Transplantat ermöglicht zwar die Prävention derrnEntstehung einer GvH-Erkrankung, jedoch häufig unter gleichzeitigem Verlust des förderlichen,rnanti-leukämischen Transplantat-gegen-Leukämie-Effekts (engl.: graft-versus-leukemia,rnGvL) [3]. Um den GvL-Effekt unter Vermeidung einer GvH-Erkrankung zu erhalten, bietetrnsich der gezielte adoptive Transfer von Leukämie-spezifischen, nicht alloreaktiven CTL alsrnattraktive Strategie der Immuntherapie für AML-Patienten nach allogener HSCT an. In derrnvorliegenden Arbeit konnte erfolgreich ein prä-klinisches murines AML-Modell unter Einsatzrndes stark immundefizienten NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ- (NSG-) Mausstamms und primärenrnAML-Blasten durch die Optimierung bereits publizierter Protokolle etabliert werden.rnBei zehn von 17 transplantierten primären AML-Proben konnte ein erfolgreiches Engraftmentrnder humanen Zellen und eine Rekonstitution der humanen Neoplasie in den NSG-Mäusenrnerzielt werden. Die Engraftment-Rate betrug somit 58,82% und lag etwas unter dem aus derrnLiteratur bekannten Wert von 65-70% [4, 5]. Es ließen sich gut, intermediär und schlecht anwachsendernAML-Proben anhand der Engraftment-Stärke und -Reproduzierbarkeit voneinanderrnunterscheiden. Anhand der Analyse von für das Engraftment kritischer Parameter konnternein Zusammenhang zwischen Engraftment-Rate in der Maus und Flt3-Mutationsstatus sowiernFAB-Klassifikation des Patienten hergestellt und somit Angaben aus der Literatur bestätigtrnwerden. Für zwei Patienten-spezifische AML-Modelle, MZ580 und MZ308, konnten in vitrornerfolgreich AML-reaktive, über einzelne bzw. duale HLA-Diskrepanzen restringierte CTLPopulationenrngeneriert und über einen Zeitraum von bis zu 70 Tagen expandiert werden.rnDeren adoptiver Transfer in zuvor mit humanen AML-Blasten inokulierte NSG-Mäuse führternzu einer nahezu vollständigen Eradikation der AML-Blasten und Remission der Versuchstiere.rnAnhand unterschiedlich langer in vitro Kultur-Zeiträume konnte ein für die in vivo ausgeübtenrnEffektor-Funktionen optimaler Reifungszustand der CTL-Populationen von maximalrn28 Tagen bestimmt werden. Die kinetische Analyse der lytischen Aktivität in vivo deutete auf eine relativ schnelle Ausübung der Effektor-Funktionen durch die CTL-Populationen innerhalbrnvon zwei bis 24 Stunden nach adoptivem Transfer hin. Durch die Verwendung von inrnvitro generierten EBV-reaktiven CTL aus einem irrelevanten Spender konnte zudem die Spezifitätrnder in vivo ausgeübten Effektor-Funktionen nachgewiesen werden. Die ex vivo Re-rnIsolation adoptiv transferierter CTL und deren in vitro Analyse in einem IFNγ ELISpot wiesrneine konstante Reaktivität der Zellen ohne Induktion einer Xeno-Reaktivität nach. Die zurrnVerbesserung der Persistenz humaner CTL-Populationen eingesetzten autologen CD4+ TrnZellen zeigten nur im AML MZ308-System eine positive Wirkung. Generell konnte die Persistenzrnin vivo jedoch trotz initialer Substitution mit den Zytokinen IL-2 und IL-7 nicht über einenrnZeitraum von sieben Tagen hinaus aufrechterhalten werden.rnZur Untersuchung des Extravasations-Mechanismus humaner T Zellen über murines Endothelrnwurden sowohl Flusskammer- als auch Transwell-Studien durchgeführt, um die molekularenrnGrundlagen des Adhäsions- und Transmigrationsprozesses aufzuklären. Durch denrnparallelen Einsatz humaner und muriner T Zellen auf murinen Endothelzellen unter Zusatzrnfunktionsblockierender monoklonaler Antikörper konnte gezeigt werden, dass derrnExtravasations-Mechanismus beider Spezies auf Interaktionen homologer Adhäsionsmolekül-rnPaare, nämlich VLA-4–VCAM-1 und LFA-1–ICAM-1, beruht. Für einzelne Moleküle konntenrnin Abhängigkeit der eingesetzten Endothelzellen Unterschiede in der Funktionalität zwischenrnden Spezies identifiziert werden. Der Adhäsionsprozess war durch die Blockade derrnVLA-4–VCAM-1-Interaktion stärker inhibierbar als durch die Blockade von LFA-1–ICAM-1.rnDie Transmigration hingegen war durch die Blockade beider Adhäsionsmolekül-Paare vergleichbarrnstark inhibierbar.

Antifibrotic effects of tocotrienols on human Tenon's fibroblasts

Antifibrotic effects of α- (40, 60, 80, 100, and 120 μM), γ- (10, 20, 30, and 40 μM) and δ-tocotrienol (10, 20, 30, and 40 μM) on hTf cultures were evaluated by performing proliferation, migration and collagen synthesis assays. Whereas for vitamin E the exposure time was set to 7 days to mimic subconjunctival application, cultures were exposed only 5 min to mitomycin C 100 μg/ml to mimic intraoperative administration. Cell morphology (phase contrast microscopy) as an assessment for cytotoxicity and cell density by measuring DNA content in a fluorometric assay to determine proliferation inhibition was performed on day 0, 4, and 7. Migration ability and collagen synthesis of fibroblasts were measured. Results All tested tocotrienol isoforms were able to significantly inhibit hTf proliferation in a dose-dependent manner (maximal inhibitory effect without relevant morphological changes at day 4 for α-tocotrienol 80 μM with 36.7% and at day 7 for α-tocotrienol 80 μM with 42.6% compared to control). Degenerative cell changes were observed in cultures with concentrations above 80 μM for α- and above 30 μM for γ- and δ-tocotrienol. The highest collagen synthesis inhibition has been found with 80 µM α-tocotrienol (62.4%) and no significant inhibition for mitomycin C (2.5%). Migration ability was significantly reduced in cultures exposed to 80 µM α- and 30 µM γ-tocotrienol (inhibition of 82.2% and 79.5%, respectively, compared to control) and also after mitomycin C treatment (60.0%). Complete growth inhibition without significant degenerative cell changes could only be achieved with mitomycin C. Conclusion In vitro, all tested tocotrienol isoforms were able to inhibit proliferation, migration and collagen synthesis of human Tenon’s fibroblasts and therefore may have the potential as an anti-scarring agent in filtrating glaucoma surger

Is hypoxia training good for muscles and exercise performance?

Altitude training has become very popular among athletes as a means to further increase exercise performance at sea level or to acclimatize to competition at altitude. Several approaches have evolved during the last few decades, with "live high-train low" and "live low-train high" being the most popular. This review focuses on functional, muscular, and practical aspects derived from extensive research on the "live low-train high" approach. According to this, subjects train in hypoxia but remain under normoxia for the rest of the time. It has been reasoned that exercising in hypoxia could increase the training stimulus. Hypoxia training studies published in the past have varied considerably in altitude (2300-5700 m) and training duration (10 days to 8 weeks) and the fitness of the subjects. The evidence from muscle structural, biochemical, and molecular findings point to a specific role of hypoxia in endurance training. However, based on the available performance capacity data such as maximal oxygen uptake (Vo(2)max) and (maximal) power output, hypoxia as a supplement to training is not consistently found to be advantageous for performance at sea level. Stronger evidence exists for benefits of hypoxic training on performance at altitude. "Live low-train high" may thus be considered when altitude acclimatization is not an option. In addition, the complex pattern of gene expression adaptations induced by supplemental training in hypoxia, but not normoxia, suggest that muscle tissue specifically responds to hypoxia. Whether and to what degree these gene expression changes translate into significant changes in protein concentrations that are ultimately responsible for observable structural or functional phenotypes remains open. It is conceivable that the global functional markers such as Vo(2)max and (maximal) power output are too coarse to detect more subtle changes that might still be functionally relevant, at least to high-level athletes.

Segmentation of brain tumor images based on atlas-registration combined with a Markov-Random-Field lesion growth model

We present an automatic method to segment brain tissues from volumetric MRI brain tumor images. The method is based on non-rigid registration of an average atlas in combination with a biomechanically justified tumor growth model to simulate soft-tissue deformations caused by the tumor mass-effect. The tumor growth model, which is formulated as a mesh-free Markov Random Field energy minimization problem, ensures correspondence between the atlas and the patient image, prior to the registration step. The method is non-parametric, simple and fast compared to other approaches while maintaining similar accuracy. It has been evaluated qualitatively and quantitatively with promising results on eight datasets comprising simulated images and real patient data.

Correlation of fat embolism severity and subcutaneous fatty tissue crushing and bone fractures

Pulmonary fat embolism (PFE) is frequently encountered in blunt trauma. The clinical manifestation ranges from no impairment in light cases to death due to right-sided heart failure or hypoxaemia in severe cases. Occasionally, pulmonary fat embolism can give rise to a fat embolism syndrome (FES), which is marked by multiorgan failure, respiratory disorders, petechiae and often death. It is well known that fractures of long bones can lead to PFE. Several authors have argued that PFE can arise due to mere soft tissue injury in the absence of fractures, a claim other authors disagree upon. In this study, we retrospectively examined 50 victims of blunt trauma with regard to grade and extent of fractures and crushing of subcutaneous fatty tissue and presence and severity of PFE. Our results indicate that PFE can arise due to mere crushing of subcutaneous fat and that the fracture grade correlated well with PFE severity (p = 0.011). The correlation between PFE and the fracture severity (body regions affected by fractures and fracture grade) showed a lesser significant correlation (p = 0.170). The survival time (p = 0.567), the amount of body regions affected by fat crushing (p = 0.336) and the fat crush grade (p = 0.485) did not correlate with the PFE grade, nor did the amount of body regions affected by fractures. These results may have clinical implications for the assessment of a possible FES development, as, if the risk of a PFE is known, preventive steps can be taken.

Was durch einen Visusverlust ans Licht kommt

We report a case of a 36-year old patient who suffered from a unilateral painless loss of vision. Ophthalmological examination in the context of a highly reactive syphilis serology revealed an acute syphilitic posterior placoide chorioretinitis (ASPPC). Additional clinical findings were a mucosal lesion on the upper lip, consistent with a plaque opaline and an alopecia specifica as manifestation of secondary syphilis. Treatment consisted in 6x 4 Mio. IE Penicillin G for 14 days and 50 mg Prednison for five days to prevent a Jarisch Herxheimer reaction. The diagnostic measures, therapy and follow up of syphilis, focusing on ocular involvement, are described.

Preference for structured environment in zebrafish (Danio rerio) and checker barbs (Puntius oligolepis)

Information about the welfare and husbandry of pet and laboratory fish is scarce although millions of fish are sold in pet shops and used in laboratory research every year. Inadequate housing conditions can cause behavioural problems also in fish since they are complex animals with sophisticated behaviour. In this study, we investigated the influence of environmental complexity on compartment preference and behaviour in zebrafish (Danio rerio) and checker barbs (Puntius oligolepis). For the preference test, large aquaria were divided by two semi-transparent walls of Plexiglas into an empty compartment, a structured compartment enriched with plants and clay pots, and a smaller compartment in-between, where food was provided. For observation, the empty and structured compartments were divided into six zones of similar size by defining three vertical layers and two horizontal areas (back vs. front area). Seven groups of six to nine zebrafish and seven groups of seven or eight checker barbs were observed on four days each (within a time period of ten days) to assess compartment use and activity, and to assess behavioural diversity and use of zones within compartments. Both zebrafish and checker barbs showed a significant preference for the structured compartment. Nevertheless, in neither species did behavioural diversity differ between the empty and structured compartment. Zebrafish used all zones in both compartments to the same extent. Checker barbs, however, used the structured compartment more evenly than the empty compartment, where they mainly used the lower and middle zones. These results suggest that zebrafish and checker barbs have a preference for complex environments. Furthermore, they indicate that the behavioural and ecological needs of fish may vary depending on species, and recommendations for husbandry should be specified at species level. (C) 2011 Elsevier B.V. All rights reserved.

Multiple meningiomas: clinical, radiological, surgical, and pathological findings with outcome in four cats

The present report describes the clinical signs, magnetic resonance imaging (MRI) findings, surgical procedure, pathological findings and follow-up in four cats with multiple meningiomas; three castrated male and one spayed female domestic shorthair indoor cats, ranging in age from 11 to 14 years. In three of four cats, clinical signs at presentation were suggestive of a focal lesion. Three cats had two meningiomas and one had four meningiomas. Most of the tumours were supratentorial, one arose from the tentorium and one was infratentorial. The duration of presenting signs before surgery ranged from 10 days to 11 months. Postoperative MRI revealed complete gross tumour removal in three cases. In one cat with two cranial fossa meningiomas, subtotal excision with a small basal remnant (2 x 2 mm) of the ventral part of one meningioma lying on the floor of the skull, was observed. Based on histopathological architecture, six tumours revealed features of a transitional subtype meningioma, and four of a meningotheliomatous meningioma. In each cat, the multiple meningiomas were all assigned to the same histopathological group. The preoperative presenting signs had resolved by the follow-up examinations 4 weeks after surgery in two cats. Long-term follow-up evaluation revealed that surgically-induced or exacerbated neurological deficits in two cats had completely or almost completely resolved within 8 weeks of surgery. All patients are still alive 12 to 21 months after surgery and no clinical signs of recurrence could be detected at that time.

Cartilage tissue engineering by expanded goat articular chondrocytes

In this study we investigated whether expanded goat chondrocytes have the capacity to generate cartilaginous tissues with biochemical and biomechanical properties improving with time in culture. Goat chondrocytes were expanded in monolayer with or without combinations of FGF-2, TGF-beta1, and PDGFbb, and the postexpansion chondrogenic capacity assessed in pellet cultures. Expanded chondrocytes were also cultured for up to 6 weeks in HYAFF-M nonwoven meshes or Polyactive foams, and the resulting cartilaginous tissues were assessed histologically, biochemically, and biomechanically. Supplementation of the expansion medium with FGF-2 increased the proliferation rate of goat chondrocytes and enhanced their postexpansion chondrogenic capacity. FGF-2-expanded chondrocytes seeded in HYAFF-M or Polyactive scaffolds formed cartilaginous tissues with wet weight, glycosaminoglycan, and collagen content, increasing from 2 days to 6 weeks culture (up to respectively 2-, 8-, and 41-fold). Equilibrium and dynamic stiffness measured in HYAFF M-based constructs also increased with time, up to, respectively, 1.3- and 16-fold. This study demonstrates the feasibility to engineer goat cartilaginous tissues at different stages of development by varying culture time, and thus opens the possibility to test the effect of maturation stage of engineered cartilage on the outcome of cartilage repair in orthotopic goat models.

The effect of rhBMP-2 around endosseous implants with and without membranes in the canine model

BACKGROUND: Bone morphogenetic protein (BMP) is a potent differentiating agent for cells of the osteoblastic lineage. It has been used in the oral cavity under a variety of indications and with different carriers. However, the optimal carrier for each indication is not known. This study examined a synthetic bioabsorbable carrier for BMP used in osseous defects around dental implants in the canine mandible. METHODS: Twelve canines had their mandibular four premolars and first molar teeth extracted bilaterally. After 5 months, four implants were placed with standardized circumferential defects around the coronal 4 mm of each implant. One-half of the defects received a polylactide/glycolide (PLGA) polymer carrier with or without recombinant human BMP-2 (rhBMP-2), and the other half received a collagen carrier with or without rhBMP-2. Additionally, one-half of the implants were covered with a non-resorbable (expanded polytetrafluoroethylene [ePTFE]) membrane to exclude soft tissues. Animals were sacrificed either 4 or 12 weeks later. Histomorphometric analysis included the percentage of new bone contact with the implant, the area of new bone, and the percentage of defect fill. This article describes results with the PLGA carrier. RESULTS: All implants demonstrated clinical and radiographic success with the amount of new bone formed dependent on the time and presence/absence of rhBMP-2 and presence/absence of a membrane. The percentage of bone-to-implant contact was greater with rhBMP-2, and after 12 weeks of healing, there was approximately one-third of the implant contacting bone in the defect site. After 4 weeks, the presence of a membrane appeared to slow new bone area formation. The percentage of fill in membrane-treated sites with rhBMP-2 rose from 24% fill to 42% after 4 and 12 weeks, respectively. Without rhBMP-2, the percentage of fill was 14% rising to 36% fill, respectively. CONCLUSIONS: After 4 weeks, the rhBMP-2-treated sites had a significantly higher percentage of contact, more new bone area, and higher percentage of defect fill than the sites without rhBMP-2. After 12 weeks, there was no significant difference in sites with or without rhBMP-2 regarding percentage of contact, new bone area, or percentage of defect fill. In regard to these three outcomes, comparing the results with this carrier to the results reported earlier with a collagen carrier in this study, only the area of new bone was significantly different with the collagen carrier resulting in greater bone than the PLGA carrier. Thus, the PLGA carrier for rhBMP-2 significantly stimulated bone formation around dental implants in this model after 1 month but not after 3 months of healing. The use of this growth factor and carrier combination appears to stimulate early bone healing events around the implants but not quite to the same degree as a collagen carrier.

Statistical evaluation of time-dependent metabolite concentrations: estimation of post-mortem intervals based on in situ 1H-MRS of the brain

Knowledge of the time interval from death (post-mortem interval, PMI) has an enormous legal, criminological and psychological impact. Aiming to find an objective method for the determination of PMIs in forensic medicine, 1H-MR spectroscopy (1H-MRS) was used in a sheep head model to follow changes in brain metabolite concentrations after death. Following the characterization of newly observed metabolites (Ith et al., Magn. Reson. Med. 2002; 5: 915-920), the full set of acquired spectra was analyzed statistically to provide a quantitative estimation of PMIs with their respective confidence limits. In a first step, analytical mathematical functions are proposed to describe the time courses of 10 metabolites in the decomposing brain up to 3 weeks post-mortem. Subsequently, the inverted functions are used to predict PMIs based on the measured metabolite concentrations. Individual PMIs calculated from five different metabolites are then pooled, being weighted by their inverse variances. The predicted PMIs from all individual examinations in the sheep model are compared with known true times. In addition, four human cases with forensically estimated PMIs are compared with predictions based on single in situ MRS measurements. Interpretation of the individual sheep examinations gave a good correlation up to 250 h post-mortem, demonstrating that the predicted PMIs are consistent with the data used to generate the model. Comparison of the estimated PMIs with the forensically determined PMIs in the four human cases shows an adequate correlation. Current PMI estimations based on forensic methods typically suffer from uncertainties in the order of days to weeks without mathematically defined confidence information. In turn, a single 1H-MRS measurement of brain tissue in situ results in PMIs with defined and favorable confidence intervals in the range of hours, thus offering a quantitative and objective method for the determination of PMIs.