Effects of MK-801 and amphetamine treatments on allergic lung inflammatory response in mice

Glutamate acts as a neurotransmitter within the Central Nervous System (CNS) and modifies immune cell activity. In lymphocytes, NMDA glutamate receptors regulate intracellular calcium, the production of reactive oxygen species and cytokine synthesis. MK-801, a NMDA receptor open-channel blocker, inhibits calcium entry into mast cells, thereby preventing mast cell degranulation. Several lines of evidence have shown the involvement of NMDA glutamate receptors in amphetamine (AMPH)-induced effects. AMPH treatment has been reported to modify allergic lung inflammation. This study evaluated the effects of MK-801 (0.25mg/kg) and AMPH (2.0mg/kg), given alone or in combination, on allergic lung inflammation in mice and the possible involvement of NMDA receptors in this process. In OVA-sensitized and challenged mice, AMPH and MK-801 given alone decreased cellular migration into the lung, reduced IL-13 and IL10 levels in BAL supernatant, reduced ICAM-1 and L-selectin expression in granulocytes in the BAL and decreased mast cell degranulation. AMPH treatment also decreased IL-5 levels. When both drugs were administered, treatment with MK-801 reversed the decrease in the number of eosinophils and neutrophils induced by AMPH in the BAL of OVA-sensitized and challenged mice as well as the effects on the expression of L-selectin and ICAM-1 in granulocytes, the IL-10, IL-5 and IL-13 levels in BAL supernatants and increased mast cell degranulation. At the same time, treatment with MK-801, AMPH or with MK-801+AMPH increased corticosterone serum levels in allergic mice. These results are discussed in light of possible indirect effects of AMPH and MK-801 via endocrine outflow from the CNS (i.e., HPA-axis activity) to the periphery and/or as a consequence of the direct action of these drugs on immune cell activity, with emphasis given to mast cell participation in the allergic lung response of mice.

Terapia hormonal para criptorquidia com hormônio gonadotrofina coriônica humana (HCG): ensaio clínico randomizado duplo-cego placebo controlado

Objetivo: O objetivo deste estudo foi comparar o efeito do tratamento hormonal do hormônio Gonadotrofina Coriônica Humana (HCG), em dois esquemas posológicos diferentes, ao placebo quanto sua efetividade e segurança no tratamento da Criptorquidia. Métodos: Este estudo é um ensaio clínico randomizado, duplo-cego, placebo-controlado de 14 semanas. A amostra de 92 pacientes que foram randomizados para o grupo-HCG dias alternados, denominados de Grupo G1 (N = 29), para o grupo HCG a cada quatro dias, denominados Grupo G4 (N= 33) e o grupo-placebo, denominados como Grupo O(N = 30). 2. Os desfechos clínicos primários para este estudo foram 1) Cura, 2) Melhora, 3) Não Cura. Os desfechos complementares foram: 4) Efeitos adversos, 5) Níveis séricos hormonais. Resultados: Não existiram diferenças entre os grupos HCG dias alternados, HCG a cada quatro dias e placebo para as medidas dos desfechos primários. 1) Cura: G1: 3/29(3,3%), G4: 4/33(4,3%) e O: 3/30(3,3%) 2) Melhora: G1:3/29(3,3%), G4: 1/33(1,1%) e O: 3/30(3,3%). 3) Não Cura: G1: 23/29(25%), G4: 28/33(30,4%) e O: 24/30(26,1%) p=0,815. 4) Os efeitos adversos mais freqüentes em nossa amostra foram: Aumento do numero de ereções: não foi possível avaliar. 5) Níveis séricos hormonais: Testosterona sérica: G1: de 34,15 ± 5,8ng/ml; G4: 49,6± 5,6 ng/ml e O: 7,5± 3,5ng/ml. Hormônio Luteinizante (LH): G1: 0,22± 0,2 , G4: 0,07±0,1 e O: 0,08±0,02 Hormônio Folículo Estimulante (FSH): G1: 0,88±0,16, G4: 0,3±0,1 e O 1,15±0,6. Conclusão: Não foi encontrada nenhuma diferença estatística no tratamento com HCG, independente da posologia adotada, e placebo. Os autores concluem a hormonioterapia com HCG não demonstrou superioridade na eficácia e ou segurança no tratamento da criptorquidia ao placebo.

Mercury-induced autoimmunity : Genetics and immunoregulation

The existence of immune self-tolerance allows the immune system to mount responses against infectious agents, but not against self-molecular constitutes. Although self-tolerance is a robust phenomenon, in some individuals as well as in experimental models, the self-tolerance breaks down and as a result, a self-destructive autoimmune disease emerges. The underlying mechanisms for the development of autoimmune diseases are not known, but genetic, environmental and immunological factors are suggested to be involved. In this thesis, we used murine mercury-induced autoimmunity to test this suggestion. In susceptible mice mercuric chloride induces a systemic autoimmune disease characterized by increased serum levels of IgG1 and IgE, production of anti-nucleolar autoantibodies (ANolA) and formation of renal IgG deposits. In contrast, in resistant DBA/2 (H-2d) mice, none of these characteristics develop after exposure to mercury. By crossing and backcrossing mercury-resistant DBA/2 mice to mercury susceptible strains, we found that the resistance was inherited as a dominant trait in F1 hybrids and that one gene or a cluster of genes located in the H-2 loci determined the resistance to ANolA production, whereas resistance to the other characteristics was found to be controlled by two or three non-H-2 genes. We further put forward the “cryptic peptide hypothesis” to investigate whether mercury and another xenobiotic metal use similar pathway(s) to induce the H-2 linked production of ANolA. We found that while mercury stimulated ANolA synthesis in all H-2 susceptible (H-2s, H-2q and H-2f) mouse strains, silver induced only ANolA responses in H-2s and H-2q mice, but not in H-2f mice. Further studies showed that the resistance to silver-induced ANolA production in H-2f mice was inherited as a dominant trait. We next tested the proposition that mercury induces more adverse immunological effects in mouse strains, which are genetically prone to develop autoimmune diseases, using tight-skin 1 mice, an animal model for human Scleroderma. It was found that in this strain, mercury induced a strong immune activation with autoimmune characteristics, but did not accelerate the development of dermal fibrosis, a characteristic in Tsk/1 mice. Finally we addressed the Th1/Th2 cross-regulation paradigm by examining if a Th1-type of response could interact with a Th2-type of response if simultaneous induced in susceptible mice. Our findings demonstrated that mercury-induced autoimmunity (Th2-type) and collagen-induced arthritis (CIA) (Th1-type) can interact in a synergistic, antagonistic or additive fashion, depending on at which stage of CIA mercury is administered.

The role of interleuchin 6 (IL-6) in the promotion of an aggressive and stem cell-like phenotype in human breast cancer cells and in stem/progenitor cells expanded in vitro as mammospheres

High serum levels of Interleukin-6 (IL-6) correlate with poor outcome in breast cancer patients. However no data are available on the relationship between IL-6 and stem/progenitor cells which may fuel the genesis of breast cancer in vivo. Herein, we address this issue in mammospheres (MS), multi-cellular structures enriched in stem/progenitor cells of the mammary gland, and also in MCF-7 breast cancer cells. We show that MS from node invasive breast carcinoma tissues express IL-6 mRNA at higher levels than MS from matched non-neoplastic mammary glands. We find that IL-6 mRNA is detectable only in basal-like breast carcinoma tissues, an aggressive variant showing stem cell features. Our results reveal that IL-6 triggers a Notch-3-dependent up-regulation of the Notch ligand Jagged-1, whose interaction with Notch-3 promotes the growth of MS and MCF-7 derived spheroids. Moreover, IL-6 induces a Notch-3-dependent up-regulation of the carbonic anhydrase IX gene, which promotes a hypoxia-resistant/invasive phenotype in MCF-7 cells and MS. Finally, an autocrine IL-6 loop relies upon Notch-3 activity to sustain the aggressive features of MCF-7-derived hypoxia-selected cells. In conclusion, our data support the hypothesis that IL-6 induces malignant features in Notch-3 expressing, stem/progenitor cells from human ductal breast carcinoma and normal mammary gland.

Identificazione e dosaggio di marcatori molecolari dell'endometriosi nel sangue periferico

Purpose: to quantify the mRNA levels of MMP-3, MMP-9, VEGF and Survivin in peripheral blood and the serum levels of CA-125, Ca19-9 in women with and without endometriosis and to investigate the performance of these markers to differentiate between deep and ovarian endometriosis. Methods: a case controls study enrolled a series of 60 patients. Twenty controls have been matched with 20 cases of ovarian and 20 cases of deep endometriosis. Univariable and multivariable performance of serum CA125 and CA19-9, mRNA for Survivin, MMP9, MMP3 and VEGF genes have been evaluated by means of ROC curves and logistic regression respectively. Results: No difference in markers concentration were detected between ovarian and deep endometriosis. In comparison with controls serum CA19 and CA125 yielded the better sensitivity followed by mRNA for Survivin gene (81.5%, 51.9% and 7.5% at 10% false positive rate respectively). Multivariable estimated odds of endometriosis yielded a sensitivity of 87% at the same false positive rate. Conclusions: A combination of serum and molecular markers could allow a better diagnosis of endometriosis.

Valutazione dei disturbi cognitivi nei pazienti sottoposti a Rivascolarizzazione Carotidea (Endoarterectomia vs Stenting) mediante dosaggio di marker di danno neuronale, Mini Mental State Examination e Risonanza Magnetica

Scopo del nostro studio è quello di valutare i disturbi cognitivi in relazione al tasso di microembolia cerebrale in due gruppi di pazienti trattati per lesione carotidea asintomatica con endoarterectomia (CEA) o stenting (CAS). Comparando le due metodiche mediante l’utilizzo di risonanza magnetica in diffusione (DW-MRI), neuromarkers (NSE e S100β) e test neuropsicometrici. MATERIALE E METODI: 60 pazienti sono stati sottoposti a rivascolarizzazione carotidea (CEA n=32 e CAS n=28). Sono stati tutti valutati con DW-MRI e Mini-Mental State Examination (MMSE) test nel preoperatorio, a 24 ore, a 6 ed a 12 mesi dall’intervento. In tutti sono stati dosati i livelli sierici di NSE e S100β mediante 5 prelievi seriati nel tempo, quello basale nel preoperatorio, l’ultimo a 24 ore. L’ananlisi statistica è stata effettuata con test t di Student per confronti multipli per valori continui e con test χ2 quadro e Fisher per le variabili categoriche. Significatività P <0,05. RISULTATI: Non vi è stato alcun decesso. Un paziente del gruppo CAS ha presentato un ictus ischemico. In 6 pazienti CAS ed in 1 paziente CEA si sono osservate nuove lesioni subcliniche alla RMN-DWI post-operatoria (21,4% vs 3% p=0,03). Nel gruppo CAS le nuove lesioni presenti alla RMN sono risultate significativamente associate ad un declino del punteggio del MMSE (p=0,001). L’analisi dei livelli di NSE e S100β ha mostrato un significativo aumento a 24 ore nei pazienti CAS (P = .02). A 12 mesi i pazienti che avevano presentato nuove lesioni ischemiche nel post-operatorio hanno mostrato minor punteggio al MMSE, non statisticamente significativo. CONCLUSIONI: I neuromarkers in combinazione con MMSE e RMN-DWI possono essere utilizzati nella valutazione del declino cognitivo correlato a lesioni silenti nell’immediato postoperatorio di rivascolarizzazione carotidea. Quest’ultime dovrebbero essere valutate quindi non solo rispetto al tasso di mortalità e ictus, ma anche rispetto al tasso di microembolia.

Funktionelle Bedeutung von P-Glykoprotein für Wirkungen und Nebenwirkungen von Antipsychotika

Therapeutisches Drug Monitoring (TDM) ist eine Maßnahme, bei der durch Messung der Medikamentenspiegel im Blut die Dosis ermittelt wird, bei der mit höchster Wahrscheinlichkeit mit Therapieansprechen gerechnet werden kann. Dabei wird angenommen, dass die Konzentrationen im Blut mit denen im Wirkkompartiment korrelieren. Für Antipsychotika wurde gezeigt, dass die Konzentrationen im Blut direkt mit denen im Gehirn korrelieren, die Verteilung zwischen den beiden Kompartimenten ist jedoch für die verschiedenen Antipsychotika sehr unterschiedlich. Die Distribution von Arzneistoffen zwischen Blut und Gehirn wird durch Effluxtransporter in der Blut-Hirn-Schranke kontrolliert. Welche Rolle dabei P-Glykoprotein (P-gp) für die Verteilung von atypischen Antipsychotika spielt und wie die Pharmakokinetik und –dynamik durch diesen Transporter beeinflusst werden, sollte in dieser Arbeit untersucht werden. Für die Messung des neu eingeführten Antipsychotikums Aripiprazol, sowie für seinen aktiven Metaboliten Dehydroaripiprazol, wurde eine hochleistungsflüssigchromatographische (HPLC) Methode mit Säulenschaltung und spektrophotometrischer Detektion etabliert. Die Methode wurde für die Messung von Serumproben schizophrener Patienten eingesetzt, um einen therapeutischen Bereich für Aripiprazol zu ermitteln. Aus der Analyse von 523 Patientenproben wurde herausgefunden, dass Aripiprazol-Serumkonzentrationen von 150 bis 300 ng/ml mit gutem klinischen Ansprechen und einem geringen Risiko für Nebenwirkungen einhergingen. Weiterhin wurde festgestellt, dass die Serumspiegel bei gleichzeitiger Gabe von Inhibitoren und Induktoren der Cytochrom P450 (CYP) Isoenzyme CYP2D6 und CYP3A4 erhöht bzw. gesenkt wurden. Am Modell der P-gp Knockout Maus im Vergleich zu FVB Wildtyp Mäusen wurden Konzentrationsverläufe von Antipsychotika nach i.p. Gabe von Amisulprid, Aripiprazol, Dehydroaripiprazol, Clozapin, Desmethylclozapin, Haloperidol, Olanzapin, Quetiapin, Risperidon und 9-Hydroxyrisperidon sowie der Kontrollsubstanz Domperidon im Gehirn und Blut über 24 Stunden mittels HPLC-Methoden gemessen. Welchen Einfluss eine verminderte Expression von P-gp auf die Pharmakodynamik hat, wurde in zwei Verhaltenstests untersucht. Mit Hilfe des Rotarods wurden motorische Effekte der Arzneistoffe erfasst und mittels Radial Arm Water Maze kognitive Fähigkeiten. Risperidon und sein aktiver Metabolit 9-Hydroxyrisperidon waren die stärksten Substrate von P-gp. 10-fach höhere Konzentrationen im Gehirn der P-gp Knockout Mäuse führten zu 10-fach stärkeren Beeinträchtigungen in den pharmakodynamischen Untersuchungen im Vergleich zu Wildtyp Tieren. Amisulprid, Aripiprazol, Dehydroaripiprazol, Desmethylclozapin und Quetiapin konnten ebenfalls als Substrate von P-gp identifiziert werden. Olanzapin, Haloperidol und Clozapin wurden durch P-gp wenig bzw. nicht in ihrer Pharmakokinetik und –dynamik beeinflusst. Da P-gp von Nagern und Menschen nach derzeitiger Kenntnis in ihren Substrateigenschaften weitgehend übereinstimmen, muss bei einer Behandlung von schizophrenen Patienten mit Antipsychotika, die als Substrate von P-gp identifiziert wurden, davon ausgegangen werden, dass eine Veränderung der Expression oder Aktivität von P-gp, genetisch verursacht oder durch Medikamente bedingt, für das Therapieansprechen oder das Auftreten von Nebenwirkungen bedeutsam sind.

Optimierung der Pharmakotherapie schizophrener Patienten durch objektive Symptomerfassung und Therapeutisches Drug Monitoring

Der Erfolg einer Schizophrenie-Behandlung ist zum größten Teil abhängig vom Ansprechen des Patienten auf seine antipsychotische Medikation. Welches Medikament und welche Dosis bei einem individuellen Patienten wirksam sind, kann derzeit erst nach mehrwöchiger Behandlung beurteilt werden. Ein Grund für variierendes Therapieansprechen sind variable Plasmakonzentrationen der Antipsychotika. Ziel dieser Arbeit war es, zu untersuchen, in wieweit der Therapieerfolg zu einem frühen Zeitpunkt der Behandlung durch objektive Symptomerfassung vorhersagbar ist und welche Faktoren die hohe Variabilität der Antipsychotikaspiegel im Blut beeinflussen. rnEine 18-monatige naturalistische klinische Studie an schizophrenen Patienten wurde durchgeführt, um folgende Fragen zu beantworten: Kann man das Therapieansprechen prädizieren und welche Instrumente sind dafür geeignet? Die Psychopathologie wurde anhand zweier Messskalen (Brief Psychiatric Rating Scale, BPRS und Clinical Global Impressions, CGI) wöchentlich ermittelt, um die Besserung der Krankheitssymptome im Verlauf von 8 Wochen zu bewerten. Therapiebegleitend wurden noch die Serum-Konzentrationen der Antipsychotika gemessen. Objektive Symptomerfassung durch BPRS oder CGI waren als Messinstrumente geeignet, Therapieansprechen vorherzusagen. Bezogen auf den Behandlungsbeginn war eine Verminderung der Symptome hoch prädiktiv für späteres Therapieversagen oder -ansprechen. Eine Verminderung um mehr als 36,5% auf der BPRS Skala in Woche 2 wurde als signifikanter Schwellenwert für Nichtansprechen ermittelt. Patienten, deren Symptombesserung unterhalb des Schwellenwertes lag, hatten eine 11,2-fach höhere Wahrscheinlichkeit, am Ende der Studie nicht auf ihre medikamentöse Therapie anzusprechen als die Patienten, die sich um mindestens 36,5% verbesserten. Andere Faktoren, wie Alter, Geschlecht, Dauer der Erkrankung oder Anzahl der stationären Aufenthalte hatten keinen Einfluss auf die Prädiktion des Therapieansprechens. Therapeutische Antipsychotika-Spiegel übten einen positiven Einfluss auf die Ansprechrate aus. Bei Patienten mit therapeutischen Spiegeln war das Ansprechen rascher und die Ansprechrate größer als unter denjenigen deren Spiegel außerhalb der therapeutisch üblichen Bereiche lag. rnEine wichtige Voraussetzung für den Einsatz von TDM ist das Vorhandensein einer präzisen, reproduzierbaren, zeit- und kostensparenden analytischen Methode zur quantitativen Bestimmung der untersuchten Substanzen. Die Entwicklung und Validierung einer solchen geeigneten Methode wurde für den Nachweis von Haloperidol vorgenommen. Eine HPLC-Methode mit Säulenschaltung erwies sich für TDM geeignet. rnBasierend auf den Ergebnissen der eigenen klinischen Studie zur Response Prädiktion wurde untersucht, welche Faktoren die Variabilität der Pharmakokinetik von Antipsychotika beeinflussen. Die Variabilität der Pharmakokinetik ist ein Grund für fehlendes oder unzureichendes Ansprechen. Es wurde zum einen der Einfluss der galenischen Formulierung auf die Freisetzung und zum anderen der Einfluss von entzündlichen Prozessen auf die Metabolisierung eines Antipsychotikums untersucht. Dazu wurden Patientendaten retrospektiv ausgewertet.rnDie Analyse von 247 Serumspiegeln von Patienten, die mit Paliperidon in OROS®Formulierung, einer neu eingeführten Retardform, behandelt wurden, zeigte, dass die intraindividuelle Variabilität der Talspiegel (Vk) von Paliperidon 35% betrug. Er war damit vergleichbar wie für nicht retardiertes Risperidon 32% (p=n.s.). Die Retardierung hatte demnach keinen Varianz mindernden Effekt auf die Talspiegel des Antipsychotikums. Der Wirkstoff-Konzentrations-Bereich lag bei 21-55 ng/ml und entsprach ebenfalls nahezu dem therapeutischen Bereich von Risperidon (20-60 ng/ml). rnEntzündliche Prozesse können die Metabolisierung von Medikamenten verändern. Dies wurde bisher für Medikamente nachgewiesen, die über CYP1A2 abgebaut werden. Durch die eigene Analyse von 84 Patienten-Serumspiegeln konnte festgestellt werden, dass die Metabolisierung von Quetiapin während eines entzündlichen Prozesses beeinträchtigt war, wahrscheinlich durch Hemmung von CYP3A4. Dies sprach dafür, dass auch Wirkstoffe, die über CYP3A4 abgebaut werden, während eines entzündlichen Prozesses im Körper in ihrer Pharmakokinetik beeinträchtigt sein können. Aus diesem Grund sollte während einer Infektion unter der Therapie mit Quetiapin besonders auf die Nebenwirkungen geachtet werden und der Serumspiegel sollte in dieser Zeit überwacht werden, um den Patienten vor eventuellen Nebenwirkungen oder sogar Intoxikationen zu schützen. rnDie Befunde dieser Arbeit zeigen, dass bei einer Behandlung schizophrener Patienten mit Antipsychotika die Messung der Psychopathologie zur Vorhersage des Therapieansprechens und die Messung der Blutspiegel zur Identifizierung von Faktoren, die die pharmakokinetische Variabilität bedingen, geeignet sind. Objektive Symptomerfassung und Therapeutisches Drug Monitoring sind demnach Instrumente, die für die Steuerung der antipsychotischen Pharmakotherapie genutzt werden sollten.rn

Expression, regulation and clinical significance of soluble and membrane CD14 receptors in pediatric inflammatory lung diseases

BACKGROUND: Inflammatory lung diseases are a major morbidity factor in children. Therefore, novel strategies for early detection of inflammatory lung diseases are of high interest. Bacterial lipopolysaccharide (LPS) is recognized via Toll-like receptors and CD14. CD14 exists as a soluble (sCD14) and membrane-associated (mCD14) protein, present on the surface of leukocytes. Previous studies suggest sCD14 as potential marker for inflammatory diseases, but their potential role in pediatric lung diseases remained elusive. Therefore, we examined the expression, regulation and significance of sCD14 and mCD14 in pediatric lung diseases. METHODS: sCD14 levels were quantified in serum and bronchoalveolar lavage fluid (BALF) of children with infective (pneumonia, cystic fibrosis, CF) and non-infective (asthma) inflammatory lung diseases and healthy control subjects by ELISA. Membrane CD14 expression levels on monocytes in peripheral blood and on alveolar macrophages in BALF were quantified by flow cytometry. In vitro studies were performed to investigate which factors regulate sCD14 release and mCD14 expression. RESULTS: sCD14 serum levels were specifically increased in serum of children with pneumonia compared to CF, asthma and control subjects. In vitro, CpG induced the release of sCD14 levels in a protease-independent manner, whereas LPS-mediated mCD14 shedding was prevented by serine protease inhibition. CONCLUSIONS: This study demonstrates for the first time the expression, regulation and clinical significance of soluble and membrane CD14 receptors in pediatric inflammatory lung diseases and suggests sCD14 as potential marker for pneumonia in children.

Periodontitis: a future risk of acute coronary syndrome? A follow-up study over 3 years

BACKGROUND: Periodontitis has been associated with cardiovascular disease. We assess if the recurrence of acute coronary syndrome (ACS) could be predicted by preceding medical and periodontal conditions. METHODS: A total of 165 consecutive subjects with ACS and 159 medically healthy, matched control subjects were examined and followed for 3 years. Periodontitis was defined by alveolar bone loss. Subgingival microbial samples were studied by the checkerboard DNA-DNA hybridization method. RESULTS: The recurrence of ACS was found in 66 of 165 (40.0%) subjects, and a first ACS event was found in seven of 159 (4.4%) subjects among baseline control subjects. Subjects who later had a second ACS event were older (P <0.001). Significantly higher serum levels of high-density lipoprotein (P <0.05), creatinine (P <0.01), and white blood cell (WBC) counts (P <0.001) were found in subjects with future ACS. Periodontitis was associated with a first event of ACS (crude odds ratio [OR]: 10.3:1; 95% confidence interval [CI]: 6.1 to 17.4; P <0.001) and the recurrence of ACS (crude OR: 3.6:1; 95% CI: 2.0 to 6.6; P <0.001). General linear modeling multivariate analysis, controlling for age and the prediction of a future ACS event, identified that WBC counts (F = 20.6; P <0.001), periodontitis (F = 17.6; P <0.001), and serum creatinine counts (F = 4.5; P <0.05) were explanatory of a future ACS event. CONCLUSIONS: The results of this study indicate that recurrent ACS events are predicted by serum WBC counts, serum creatinine levels, and a diagnosis of periodontitis. Significantly higher counts of putative pathogens are found in subjects with ACS, but these counts do not predict future ACS events.

Attention-deficit hyperactivity disorder (ADHD) and glial integrity: an exploration of associations of cytokines and kynurenine metabolites with symptoms and attention

In contrast to studies of depression and psychosis, the first part of this study showed no major differences in serum levels of cytokines and tryptophan metabolites between healthy children and those with attention-deficit/hyperactivity disorder of the combined type (ADHD). Yet, small decreases of potentially toxic kynurenine metabolites and increases of cytokines were evident in subgroups. Therefore we examined predictions of biochemical associations with the major symptom clusters, measures of attention and response variability.

Can molecular markers stratify the diagnostic value of high-grade prostatic intraepithelial neoplasia?

The diagnostic performance of isolated high-grade prostatic intraepithelial neoplasia in prostatic biopsies has recently been questioned, and molecular analysis of high-grade prostatic intraepithelial neoplasia has been proposed for improved prediction of prostate cancer. Here, we retrospectively studied the value of isolated high-grade prostatic intraepithelial neoplasia and the immunohistochemical markers ?-methylacyl coenzyme A racemase, Bcl-2, annexin II, and Ki-67 for better risk stratification of high-grade prostatic intraepithelial neoplasia in our local Swiss population. From an initial 165 diagnoses of isolated high-grade prostatic intraepithelial neoplasia, we refuted 61 (37%) after consensus expert review. We used 30 reviewed high-grade prostatic intraepithelial neoplasia cases with simultaneous biopsy prostate cancer as positive controls. Rebiopsies were performed in 66 patients with isolated high-grade prostatic intraepithelial neoplasia, and the median time interval between initial and repeat biopsy was 3 months. Twenty (30%) of the rebiopsies were positive for prostate cancer, and 10 (15%) showed persistent isolated high-grade prostatic intraepithelial neoplasia. Another 2 (3%) of the 66 patients were diagnosed with prostate cancer in a second rebiopsy. Mean prostate-specific antigen serum levels did not significantly differ between the 22 patients with prostate cancer and the 44 without prostate cancer in rebiopsies, and the 30 positive control patients, respectively (median values, 8.1, 7.7, and 8.8 ng/mL). None of the immunohistochemical markers, including ?-methylacyl coenzyme A racemase, Bcl-2, annexin II, and Ki-67, revealed a statistically significant association with the risk of prostate cancer in repeat biopsies. Taken together, the 33% risk of being diagnosed with prostate cancer after a diagnosis of high-grade prostatic intraepithelial neoplasia justifies rebiopsy, at least in our not systematically prostate-specific antigen-screened population. There is not enough evidence that immunohistochemical markers can reproducibly stratify the risk of prostate cancer after a diagnosis of isolated high-grade prostatic intraepithelial neoplasia.

[Analgesia for pediatric patients. Standards and special aspects]

In this paper we describe the assessment and medical treatment of pain in children according to the concept of the Centre of Pediatrics and Adolescent Medicine at the university of Freiburg, Germany. Opiate therapy in children as well as novel data about the association of paracetamol (acetaminophen) and wheezing/asthma bronchiale in children are discussed. Special aspects of analgesia for painful procedures and a nitrous oxide/oxygen mixture which has been recently introduced in Germany are described. The second part of the paper presents results of our prospective study about continuous infusion of fentanyl and midazolam in a fixed combination in 19 critically ill patients with a median age of 46 months, 40% of these patients had an ARDS. The mortality rate was 21%. A median dose of fentanyl of 3.9 microg/kg/h (midazolam 0.26 mg/kg/h) was infused. The fentanyl serum level (median 4.2 ng/ml, range 1.7-17.8 ng/ml) correlated significantly with the administered dose while the midazolam serum levels (median 911 ng/ml, range 234-4 651 ng/ml) correlated neither with the administered dose nor with any of the analysed parameters. Conclusion: A standard protocol for the assessment and treatment of pain should be established in every pediatric hospital. The data about the association of asthma bronchiale and paracetamol cannot be interpreted conclusively, but show that even for well known substances clinical trials may lead to new awareness. The study data about continuous infusion of fentanyl and midazolam show a good correlation of the fentanyl application to serum levels, while midazolam appears to be not the optimal substance for continuous sedation in this setting.

Mice overexpressing BAFF develop a commensal flora-dependent, IgA-associated nephropathy

B cell activation factor of the TNF family (BAFF) is a potent B cell survival factor. BAFF overexpressing transgenic mice (BAFF-Tg mice) exhibit features of autoimmune disease, including B cell hyperplasia and hypergammaglobulinemia, and develop fatal nephritis with age. However, basal serum IgA levels are also elevated, suggesting that the pathology in these mice may be more complex than initially appreciated. Consistent with this, we demonstrate here that BAFF-Tg mice have mesangial deposits of IgA along with high circulating levels of polymeric IgA that is aberrantly glycosylated. Renal disease in BAFF-Tg mice was associated with IgA, because serum IgA was highly elevated in nephritic mice and BAFF-Tg mice with genetic deletion of IgA exhibited less renal pathology. The presence of commensal flora was essential for the elevated serum IgA phenotype, and, unexpectedly, commensal bacteria-reactive IgA antibodies were found in the blood. These data illustrate how excess B cell survival signaling perturbs the normal balance with the microbiota, leading to a breach in the normal mucosal-peripheral compartmentalization. Such breaches may predispose the nonmucosal system to certain immune diseases. Indeed, we found that a subset of patients with IgA nephropathy had elevated serum levels of a proliferation inducing ligand (APRIL), a cytokine related to BAFF. These parallels between BAFF-Tg mice and human IgA nephropathy may provide a new framework to explore connections between mucosal environments and renal pathology.

Elevated systemic monocyte chemoattractrant protein-1 in hepatic steatosis without significant hepatic inflammation

Non-alcoholic fatty liver disease (NAFLD) is strongly associated with obesity and the metabolic syndrome. It encompasses a clinico-pathologic spectrum of conditions ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). The latter develops upon pro-inflammatory cell infiltration and is widely considered as the first relevant pathophysiological step in NAFLD-progression. The chemokine monocyte chemoattractant protein 1 (MCP-1) plays an important role in the progression of hepatic inflammation and fibrosis, and both increased hepatic expression and circulating serum levels have been described in NASH. Here, we aimed to investigate MCP-1 expression in simple hepatic steatosis. Upon feeding a high-fat diet mice developed hepatic steatosis in the absence of significant hepatic inflammation, but elevated hepatic MCP-1 expression compared to control mice fed a standard chow. Interestingly, high-fat diet fed mice had significantly higher MCP-1 serum levels, and MCP-1 mRNA expression was significantly increased in visceral adipose tissue. Furthermore, MCP-1 serum levels were also elevated in patients with ultrasound-diagnosed NAFLD and correlated with the body-mass index and fasting glucose. In conclusion, our data indicate both the liver and adipose tissue as cellular sources of elevated circulating MCP-1 levels already in the early phase of hepatic steatosis. Since MCP-1 derived from visceral adipose tissue reaches the liver via portal circulation at high concentrations it may significantly contribute to the progression of simple steatosis to NASH.