Calpains, also called calcium activated neutral proteases (CANP), are expressed ubiquitously. They are intracellular, non-lysosomal cytoplasmic cysteine endopeptidases. Calcium is required for their activation. Their endogenous specific inhibitor is calpastatin, which is expressed ubiquitously and coexists within cells besides calpain. When calcium is present, calpastatin and calpain attach to each other inhibiting the protease. The calpain system plays an important role in many processes including apoptosis, necrosis, ischemia formation and exocytosis. So far, many reports exist on studies about the influence of calpains in different tumors (skin, breast, renal cell and prostate cancers). The role of calpains in pathogenesis or further tumor progression has always been proved in related studies, but their exact function could not be demonstrated. So far, no studies on calpains being involved in the pathogenesis of ovarian cancer have been published. In our study we focused on the expression of the enzymes calpain 1, calpain 2 and their inhibitor calpastatin in normal and malign ovarian tissue. Therefore, we performed immunohistochemical stainings of paraffin slices and evaluated staining intensity (SI), percentage of positive cells (PP) and immunoreactive score (IRS). We evaluated the correlation between enzyme expression in malign and benign ovarian tissues. In malignant ovarian tissue, we found decreased expression, staining intensity and immunoreactive score of calpastatin. With higher grading of the ovarian carcinoma, staining intensity and immunoreactive score of calpain 1 decreased. Staining intensity of calpain 2 in ovarian carcinoma decreased with increasing lymph node status. We clearly demonstrated differences between enzyme expressions in malign and benign tissue. This study could not find any specific function of calpains. Only few studies in the literature have been found that deal with calpain evaluation of ovarian cancer. Additional studies including more patients are required to elucidate the functional role and impact of calpain in tumors in detail.

OBJECTIVE The purpose of this biomechanical in-vitro-study was to compare two different PLIF-techniques with two types of implants on human lumbar spine: PLIF with threaded cages, (Bagby and Kuslich, Spinetech, Minneapolis, USA) and PLIF with the Moss-Miami-implants, (DePuy International Limited, Leeds, Great Britain). METHODS Six cadaveric human lumbar spine segments L2-5 were explanted, frozen at -20 degrees C and thawed before preparation. They were cut in two parts by discectomie and arthrotomie L3/4, so six specimen L2/3 and six specimen L4/5 were obtained and used in a crossover-trial. Analysis included testing in a tension-torsion-machine under axial compression with 600 N, rotation (left-right) with 25 Nm and shearing forces with 250 N without preload. This was first done in the intact and then in the fused specimen. RESULTS Stiffness before treatment was comparable in both groups irrespective of location. Posttreatment stiffness was higher with MOSS-MIAMI-implants as compared to PLIF with BAK-cages. Average relative superiority (and 95%-confidence intervall) were 1.98 (1.01-3.69) for compression, 2.30 (0.85-6.24) for rotation and 1.73 (0.78-3.84) for shearing. Statistical comparison of log posttreatment stiffness was significant for compression but not for rotation and shearing (2-sided independent crossover t-test). CONCLUSION This biomechanical in-vitro-study demonstrates the higher initial stability of PLIF with titanium surgical mesh and posterior instrumentation when compared to PLIF with threaded cages alone.

PURPOSE: Numerous new all inside meniscus repair techniques using biodegradable fixation devices have become available in the last years. Few studies have dealt with the biomechanical properties of these implants so far. The aim of this study was to analyze meniscus repairs under cyclic loading conditions for different fixation devices (Meniscus Arrow, Clearfix Meniscal Screw, Meniscal Dart, BioStinger) and to compare them to standard suture techniques. MATERIAL AND METHODS: Eighty meniscus repairs on 27 medial porcine menisci were performed. For biomechanical testing loosening, number of failures, failure modes and failure loads were evaluated under cyclic and maximum loading conditions. Testing was performed on a materials testing machine. RESULTS: During cyclic loading 10 out of 40 (25%) fixation devices failed. A gap appeared between the 2 parts of the meniscus within the first loading cycles. The failure strengths obtained with the 4 meniscus fixation devices did not differ significantly (Meniscus Arrow: 44 N; Clearfix Meniscal Screw: 35 N; Meniscal Dart: 33 N; BioStinger: 54 N). Besides for the BioStinger, the values of the sutures were significantly higher. The use of a stronger suture material (PDS 0) increased the failure load significantly. During maximum loading the fixation devices failed by both pull-out of the head or the tip of the device, except for the BioStinger showing only pull-out of the head. All sutures failed by breakage, except for the PDS 0 horizontal sutures in which 50% of complete tissue failures could be noted. CONCLUSION: This study shows that meniscal fixation devices may fail under repetitive loading conditions. A gap appeared between the meniscal margins within the first loading cycles irrespective of the suture type and fixation device used. Both gapping and failure modes of the fixation devices may be design-specific. The maximum failure loads differed significantly between the bioabsorbable devices and the sutures. Stronger suture materials increased the failure loads significantly. To allow a complete evaluation of new meniscus fixation devices not only biomechanical, but also biological and clinical parameters need to be analyzed in forthcoming studies.

CONTEXT:Bone disease after kidney transplantation is a common problem. The serum levels of the active vitamin D metabolite 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D] have been studied extensively. In contrast, there has not been much concern about the serum levels of 25-hydroxyvitamin D(3) [25(OH)D]. However, it is well recognized that serum levels of 1,25(OH)(2)D are often normal in vitamin D-deficient patients. Moreover, inadequate serum 25(OH)D may limit the extrarenal production of 1,25(OH)(2)D that could lead to increased risk of many chronic diseases.OBJECTIVE:We analyzed whether renal transplant patients were at a higher risk of 25(OH)D deficiency because of the consequence of their need to protect themselves from sun exposure.DESIGN, SETTING, AND PATIENTS:We hypothesized that renal transplant recipients are at high risk to develop 25(OH)D deficiency. Serum 25(OH)D levels were analyzed in renal transplant patients with adequate renal function and in an age- and gender-matched control group (n = 31) at the end of winter. All renal transplant patients practiced solar UV-protection after transplantation. 25(OH)D levels were compared using a nonparametrical test (Wilcoxon rank sum test).RESULTS:Serum 25(OH)D levels were significantly lower in renal transplant patients compared with controls (P = 0.007). Geometric mean (with 95% confidence interval) in renal transplant patients was 10.9 ng/ml (8.2-14.3) compared with 20.0 ng/ml (15.7-25.5) in the control group.CONCLUSIONS:Renal transplant recipients are at high risk to develop 25(OH)D deficiency. Treatment with vitamin D is recommended to correct their vitamin D deficiency, which may help protect them from serious vitamin D deficiency-related health problems that include an increased risk for internal malignancies.

BACKGROUND:N-terminal brain natriuretic peptide (NT-proBNP) is a neurohormonal substance secreted mainly by the cardiac myocytes of the left ventricle and to a less degree of the left atrium. The releasing mechanism is induced by an increased wall stress on the base of volume or pressure load of the ventricle. The physiologic actions of BNP are prohibition of the sympathetic activity, vasodilatation, natriuresis, diureses and inhibition of the renin-angiotensin system. Because of its high sensitivity and specifity in relation to the left ventricular incompetence, BNP as well as NTproBNP are well accepted markers of ventricular dysfunction. It was the aim of the study to establish reference values of NT-proBNP serum concentrations throughout childhood, in particular in the newborn age group.METHODS:In a cross sectional study, serum NT-proBNP concentrations were measured by an ElectroChemiLuminescenceImmunoAssay ("ECLIA" Roche) in the umbilical cord blood of 62 healthy full-term neonates and in 222 healthy probands from birth up to the age of 18 years.RESULTS:The concentration of NT-proBNP in the cord blood samples ranged from 281 to 2595 pg/ml (mean: 818 pg/ml). There was a significant increase in the first days of life followed by a rapid decrease during the first year and a further gradual decrease throughout infancy; beyond the 10(th) year of age normal adult values were approached.CONCLUSIONS:The knowledge of the normal range of plasma NT-proBNP levels in healthy subjects during childhood serves as a non-invasive marker for differentiation of pathologic conditions such as acute myocarditis, hypertrophic or dilated cardiomyopathy, tachyarrhythmias and pulmonary hypertension.

OBJECTIVE:Higher risks of infertility have been found in overweight women. The purpose of the present study was to explore whether protein metabolism profiles related to body mass index (BMI) and to find out whether these parameters should affect IVF/ICSI outcome. PATIENTS AND METHODS:52 patients were enrolled in this study. All patients underwent an ovarian stimulation either with recombinant follicle stimulating hormone (Gonal-F) or human menopausal gonadotropin (Menogon) after pituitary down-regulation with Goserelin (Zoladex) or Triptorelin (Decapeptyl Gyn). Five blood samples were taken: before treatment, at the beginning of ovarian stimulation, on the day of HCG injection for the ovulation induction, on the day of follicle aspiration and 14 days after embryo transfer. The blood samples were analysed with regard to the serum concentrations of total protein, albumin, total bilirubin and urea. According to the BMI values the patients were divided into two groups: BMI < 25 kg/m (2) (GI, n = 28) and BMI > 25 kg/m (2) (GII, n = 24). The results of IVF/ICSI outcome were compared in both groups. RESULTS:In both groups, the serum concentrations of total protein, albumin, total bilirubin and urea decreased during ovarian stimulation. In GII, albumin concentration decreased significantly on the day of follicle aspiration (46.0 +/- 2.3 g/l versus 43.5 +/- 2.5 g/l, p < 0.001) and 14 days after embryo transfer (46.8 +/- 2.5 g/l versus 44.7 +/- 2.3 g/l, p < 0.002), whereas the concentration of total bilirubin was not significantly decreased on the day of HCG injection (0.57 +/- 0.29 mg/dl versus 0.49 +/- 0.26 mg/dl, p = 0.11). Furthermore, pregnancy rate in women with BMI < 25 kg/m (2) was 46.4 % and in women with BMI > 25 kg/m (2) 33.1 % (p = 0.34). CONCLUSIONS:Serum concentrations of albumin and total bilirubin are influenced by BMI. Excess weight defined as BMI > 25 kg/m (2) has a negative impact on IVF outcome leading to decreased chances of pregnancy.

Intensive front-line protocols have improved survival in children with malignancies; however, intensive multimodal therapy of paediatric malignancies can be associated with a significant risk of serious adverse events. Common risk scores (PRISM, PRISM III, APACHE-II) fail to predict mortality in these patients. A retrospective chart analysis of 32 paediatric cancer patients admitted to the Paediatric Intensive Care Unit (PICU) at the University Hospital of Saarland between January 2001 and December 2003 for life-threatening complications was performed. The aim of this study was to assess risk factors for short-term outcome (survival vs. non-survival when leaving the PICU) and to develop a risk score to estimate outcome in these patients. Overall survival was good (25 of 32 patients). Mortality rate was significantly related to leukaemia/lymphoma ( P =0.029), to the number of organ failures ( P <0.0001), neutropenia ( P =0.001), septic shock ( P =0.025), mechanical ventilation ( P =0.01) and inotropic support ( P =0.01). Employing multiple logistic regression, the strongest predictor for poor outcome was the number of organ failures ( P <0.05). A risk score (cut-off value: >3 points for non-survival) which included the following risk factors (non-solid tumour, number of organ failures ( n >2), neutropenia, septic shock, mechanical ventilation, and inotropic medication) yielded a sensitivity of 7/7 (95% CI: 4.56–7.00), a specificity of 23/25 (95% CI: 18.49–24.75), a positive predictive value of 23/23 (95% CI: 19.80–23.00), and a negative predictive value of 7/9 (95% CI: 3.60–8.74) for the time of admission to the PICU. Conclusion:Although our risk of mortality score is of prognostic value in assessing short-term outcome in these patients, prospective validation in a larger study cohort is mandatory. Furthermore, it must be emphasised that this risk score must not be used for decision-making in an individual patient.

The aim of this controlled, parallel design clinical study was to compare the effectiveness of an Er:YAG laser (ERL) to that of mechanical debridement using plastic curettes and antiseptic therapy for nonsurgical treatment of peri-implantitis. Twenty patients with moderate to advanced peri-implantitis lesions were randomly treated with either (1) an ERL using a cone-shaped glass fiber tip at an energy setting of 100 mJ/pulse and 10 pps (ERL), or (2) mechanical debridement using plastic curettes and antiseptic therapy with chlorhexidine digluconate (0.2%) (C). The following clinical parameters were measured at baseline, 3 and 6 months after treatment by one blinded and calibrated examiner: Plaque index (PI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR) and clinical attachment level (CAL). At the baseline examination, there were no statistically significant differences in any of the investigated parameters. Mean value of BOP decreased in the ERL group from 83% at baseline to 31% after 6 months (P < 0.001) and in the C group from 80% at baseline to 58% after 6 months (P < 0.001). The difference between the two groups was statistically significant (P < 0.001, respectively). The sites treated with ERL demonstrated a mean CAL change from 5.8 +/- 1 mm at baseline to 5.1 +/- 1.1 mm (P < 0.01) after 6 months. The C sites demonstrated a mean CAL change from 6.2 +/- 1.5 mm at baseline to 5.6 +/- 1.6 mm (P < 0.001) after 6 months. After 6 months, the difference between the two groups was statistically not significant (P > 0.05). Within the limits of the present study, it was concluded that (i) at 6 months following treatment both therapies led to significant improvements of the investigated clinical parameters, and (ii) ERL resulted in a statistically significant higher reduction of BOP than C.

Chronic heart failure (CHF) is a major public health problem causing considerable morbidity and mortality (1)(2)(3). Prevention of CHF by identifying risk factors is therefore a major issue. Previous studies found that hypertension, smoking, diabetes mellitus, obesity, and advancing age are the most important risk factors for CHF (4). Recently, plasma homocysteine (Hcy) has been suggested as a newly recognized risk factor (5)(6). However, there are no data regarding the association between Hcy and various objective as well as subjective measures of CHF. The demonstration of such relationships would help to clarify the role of hyperhomocysteinemia in CHF. We hypothesized that plasma Hcy is associated with clinical and echocardiographic signs of CHF as well as with N-terminal pro-brain natriuretic peptide (NT-proBNP), suggesting a relationship between Hcy and the severity of CHF. Accordingly, we investigated the relationships of plasma Hcy with serum NT-proBNP and clinical and echocardiographic indices of CHF in patients and in controls. For this study, 95 patients with systolic CHF and 12 healthy persons without cardiac diseases were interviewed and examined by the same 2 experienced cardiologists, who were blinded to the study. All participants had a medical history, physical examination, venous blood sampling, 6-min walking test (6-MWT), electrocardiography, and echocardiography. Eighty-two patients underwent a cardiac catheterization according to the American Heart Association guidelines (7). Additionally, 37 patients performed a symptom-limited bicycle exercise test (Ergoline cardio-systems) with gas-exchange analysis (MedGraphics CPX/D spiroergometry system; Medical Graphics Corporation) to determine maximum oxygen uptake ( V o2max). Informed consent was obtained from all participants, and the study protocol was approved by the Institutional Review Board. Nonfasting venous blood samples (plasma and serum) were drawn during the office visits and centrifuged within 45 min. …

The objective of the study was to investigate the influence of bone cement, length of burr hole and bone density on pullout force and insertional screw torque of cervical spine facet screws. Both facets of 24 human cervical vertebrae were scanned for bone mineral density (BMD) and assigned to two groups for measuring of insertional screw torque and pullout strength. Maximal insertional screw torque was measured and removal of the screws was performed in displacement control (0.25 mm/s) without bone cement (PMMA), with 0.1 ml of PMMA and with the burr hole completely filled with PMMA. Screw torque was 59.1 N cm (±25.7 N cm), pullout force was 382.8 N (±140.5 N) without PMMA. Injection of 0.1 ml PMMA did not change significantly both screw torque (p=0.73) and pullout (p=0.129). Filling of the burr holes with PMMA increased significantly both screw torque (p<0.0001) and pullout force (p=0.028) when compared with injection of 0.1 ml of PMMA. A positive, moderate correlation was seen between BMD and screw torque before (r=0.501; p=0.097) and after filling with PMMA (r=0.514; p=0.088), BMD and pullout force before (r=0.441; p=0.152) and after complete filling with PMMA (r=0.673; p=0.047). The PMMA does increase both screw torque (p<0.0001) and pullout force (p=0.028) of facet screws significantly if the burr hole is filled with PMMA completely when compared with injection of 0.1 ml PMMA. Bone mineral density of the cervical facets moderately correlates with peak insertional torque and pullout force. This is true for a facet without PMMA and for a facet filled with PMMA. The length of the burr hole seems to be less important.

In the present study, 32 ambulant patients with psychoses and depressive disorders were tested on a voluntary basis. They had an average age of 41.6 ± 11.3 years and included 15 females and 17 males. They received outpatient therapy on a constant basis consisting either of one medicament or a combination of several psychoactive substances. Leading drugs were neuroleptics (n=22) or antidepressants (n=10). The test persons had to pass a computer-assisted traffic psychology test battery (Vienna test system with 8 single tests) examining psychophysical parameters such as capacity, reaction time and alertness. Pupillographic sleepiness testing (PST) for the objective evaluation of daytime sleepiness was performed twice, before and after the test battery. There was a considerable interindividual variability concerning the measurable trafficrelevant capability. The total test group of patients with psychoactive drugs showed significant results below average of normal persons (p<0.05) in all of the test procedures including numerous single parameters found in the German decree on driving licence (e.g. reactive capacity under conditions of stress, visual structuring ability, concentration, attention and reaction time). The main pupillographic sleepiness parameter, pupillary unrest index (PUI), was on the average within the normal range. It developed only slightly worse in the second test after psychomotor evaluation. In comparison with patients under neuroleptics suffering from psychoses, persons with less severe disorders and antidepressant treatment exhibited less impairments concerning their psychophysical performance. Sleepiness testing was not significantly different in these two subgroups. On the whole, the tested persons with non-acute mental disorders and chronic treatment with psychoactive substances showed significant deficits in numerous traffic-relevant parameters. Especially the impairments in complex reaction tests and under conditions of stress may cause critical situations in traffic. The results were only slightly dependent on the sedating potency of substances. Thus, the primary (non-acute) mental disorder and the individual personality may have an essential effect on the outcome in psychological testing and traffic behaviour. The assessment of driving ability should be done after careful additional tests in each single case. Background and Introduction Psychoactive drugs possess sedating and centrally modulating effects. Thus, it is common opinion, that they play a role in traffic medicine (1-4). Driving ability is usually not given during acute phases of psychosis or in the beginning of a new therapy with psychoactive drugs. This is in accordance with the German guidelines for the assessment of driving ability (4). However, this question can be judged in a different way in the frame of an outpatient treatment of non-acute illness with long-term doses of psychochemicals such as neuroleptics and antidepressants (4). In continuation of former investigations on opioid patients (5), we used a new approach in the evaluation of the psychophysical capability of such ambulant patients with mental disorders and under permanent therapy with psychoactive drugs by means of a computerassisted version of the so called Wiener (Vienna) test system. Moreover, the degree of the daytime sleepiness was measured by the objective pupillographic sleepiness test (PST). This test is based on recording of the spontaneous and involuntary pupil movement in the dark; an increased sleepiness here due to the potentially sedating effect of psychochemicals leads to typical pupil diameter changes (slow oscillations, fatigue waves) (6-9). Objectives Aim of this study was the evaluation of daytime sleepiness and psychophysical capability of patients suffering from mental disorders who were permanently treated with neuroleptics and antidepressants. Methodology In the present study, 32 ambulant patients with psychoses and depressive disorders were tested on a voluntary basis. They had an average age of 41.6 ± 11.3 years and included 15 females and 17 males. They received outpatient therapy on a constant basis consisting either of one medicament or a combination of several psychoactive substances. Leading drugs were neuroleptics (n=22) such as phenothiazines, butyrophenones and dibenzazepines, or antidepressants (n=10), mainly tricyclic antidepressants and serotonin re-uptake inhibitors. All substances were given for at least two weeks in therapeutic dosages and in a stable long-term way. The intake of the prescribed drugs could be confirmed by toxicological analyses in urine and/or serum. The test persons had to pass a computer-assisted traffic psychology test battery according to the Wiener (Vienna) test system examining psychophysical parameters such as capacity, reaction time and alertness (10). The test program was created by the manufacturer (Schuhfried, Moedling/Vienna) for an examination according to the German guidelines for the assessment of driving ability (4). In detail, it comprised the following 6 test groups and 8 single tests (German abbreviations and tested parameters in parenthesis): 1. Determination test (DT; complex multiple-stimulus multiple-choice reaction experiment, reactive capacity under conditions of stress). 2. Visual pursuit test (LVT; orientation, visual structuring ability). 3. Tachistoscopic traffic perception test (TAVT; procedure for the checking of optical perception performance and attention). 4. Cognitrone (COG; general performance test for the registration of attention and concentration). 5. Two-hand coordination (2-HAND; checking of visual-motor coordination, sensory-motor ability and concentration). 6. Reaction tests (RT) in 3 variants (measurement of total reaction time for optic and acoustic stimuli consisting of reaction time and motor time): RT1 (simple reaction yellow), RT5 (choice reaction yellow/tone, yellow/red), RT6 (simple reaction white under monotony). For each single test several parameters were automatically registered by the software. They were compared with internal, age-correlated norm values resulting in percent ranges. Pupillographic sleepiness testing (PST, AMTech, Weinheim/Germany) for the objective and quantitative evaluation of daytime sleepiness was performed twice, before and after the Vienna test battery (= permanent performance of the test person). In the dark the subject had to wear black goggles (transparent for infrared light) and had to fixate a dimly visible infrared illumination over a period of 11 minutes. The spontaneous and involuntary pupillary oscillations were recorded by computer aid. Main parameters was the pupillary unrest index (PUI, normal values: 5.1 ± 2.8 mm/min, according to Wilhelm et al, Tuebingen/Germany). The normal values are independent of age and sex (8). Using PUI values and the necessity of waking measures, sleepiness was furthermore graduated as inapparent, elevated or pathological (8). These objective values were compared with subjective assessments of test persons according to the Stanford sleepiness scale. The total test procedure including PST and Vienna test battery took between 1.5 and 2 hours and was carried out in the morning. The statistical evaluation (SPSS) was done by t-test, chi-square test, correlation analyses according to Pearson and Spearman, analysis of variance and regression analysis. Results and Analysis Psychophysical capability in the Vienna test battery There was a considerable interindividual variability concerning the measurable trafficrelevant capability. Figures 1 and 2 show the most important results of measurable capability as a synopsis. Various parameters for each single test are depicted with means and standard deviations. The comparison was drawn with age-correlated norm values, the p-values are given for parameters being significantly above or below the average (percentile 50). The total test group of patients with psychoactive drugs showed significant results below average of normal persons (p<0.05) in all of the test procedures including numerous single parameters found in the German decree on driving licence (e.g. reactive capacity under conditions of stress, visual structuring ability, concentration, attention and reaction time). The relatively good results in the two-hand coordination are due to the fact that only some patients were able to finish the test successfully. Noticeable were normal results in both the reaction time and the motor time in the simple reaction test RT1, whereas the same parameters were significantly below the average in the more complex reaction test RT5 and the monotony test RT6. Separate evaluation of the subgroup with leading intake of neuroleptics showed very similar test results. Conversely, patients under antidepressants exhibited significantly better results. Problems appeared in the determination test, the visual pursuit test and the reaction time under monotony (results below average, p<0.05). Fig. 1: Psychophysical capability I, total test group: determination test (DT), visual pursuit test (LVT), tachistoscopic traffic perception test (TAVT), Cognitrone (COG). Fig. 2: Psychophysical capability II, total test group: two-hand coordination (2-HAND), reaction tests (RT) in 3 variants. Daytime sleepiness The essential results for the main pupillographic parameter, pupillary unrest index (PUI), are depicted in Fig. 3. On an average, it was within the normal range. Sleepiness testing was not significantly different in our two subgroups concerning patients under neuroleptics suffering from psychoses on the one hand, and persons with less severe disorders and antidepressant treatment on the other hand. The medians were within the normal range for both PUI 1 and PUI 2. It was remarkable, that the level of sleepiness developed only slightly worse in the second test after psychomotor evaluation. However, there were a few drop-outs with very high daytime sleepiness belonging to the

Autonomic nervous system dysfunction is a common complication of ischemic stroke. Clinical and experimental data indicate hemispheric lateralization in the control of autonomic activity. The insular cortex has also been shown to play a crucial role in the central autonomic network. The aim of this study was to assess cardioautonomic dysfunction in patients with ischemic insular versus non-insular cortex infarction, and to demonstrate a possible lateralization in autonomic activity mediated by the insular cortex. Sympathetic function was prospectively assessed by determining plasma norepinephrine and epinephrine in 15 patients with left-hemisphere (LH; four insular infarction), and 14 with right-hemisphere (RH) middle cerebral artery (MCA) stroke (five insular infarction). Systolic and diastolic blood pressure and heart rate were recorded during the first 5 days after stroke. Sympathetic activity was significantly higher in insular than in non-insular infarction (p<0.05) with concomitantly elevated cardiovascular parameters in insular stroke patients. The pathological activation of the sympathetic nervous system was most excessive in RH-stroke involving the insular cortex (p<0.05). Our data indicate a hemispheric lateralization in autonomic activity which is mediated by the right-sided insular cortex. Patients with RH stroke involving the insular cortex are most susceptible to develop cardioautonomic dysfunction.

Careful normalization is essential for the accurate quantitation of mRNA levels in biopsy-sized tissue samples. Commonly, normalization of the target gene with an endogenous standard, mainly housekeeping genes (HKGs), is applied. However, differences in the expression levels of endogenous reference genes have been reported between different tissues and pathological states. Therefore, we were challenged to identify a set of endogenous reference genes whose mRNA expression levels would not change significantly between normal and cancerous tissues. Quantitative real-time PCR (Q-RT-PCR) analysis was applied to evaluate the variability in gene expression among 21 classical housekeeping genes in colorectal, pancreatic, esophageal and gastric cancer as well as in liver metastases in comparison to the corresponding normal tissue. Our results indicated that some housekeeping genes were candidates with relatively stable gene expression in several of the investigated tissues but for most of the HKGs under investigation our data have revealed distinct differences in the extent of variability in gene expression between the different tissues and pathological states. However, for each of the five tissues investigated we found a group of genes that were expressed at a constant level thus representing a panel of candidates that we can recommend as housekeeping genes in the respective tissue types. In summary, our results can be used as guidance for other scientists studying various carcinomas for tissue-specific selection of the optimal housekeeping gene (HKG) to be used in normalizing target gene expression.

Referenzwerte für Blutflussgeschwindigkeiten während der Vorhofkontraktion (a-Welle), der Systole (S-Welle) und der Diastole (D-Welle) sowie kalkulierte Hüllkurvenindizes [(S-A/D), (S-A/Vmean), (S-A(S), S/A, S/D[ im Ductus Venosus in einem Niedrig-Risiko-Kollektiv zu erstellen.

Our objective was to establish reference values for ductus venosus flow velocities during ventricular systole (S wave) and diastole (D wave), the lowest forward velocity during atrial contraction (A wave) and different calculated indices [(S-A)/D), (S-A)/Vmean, (S-A)/S, S/A, S/D)].

Structural imaging studies of bipolar affective disorder or major depression have shown a spectrum of abnormal findings. However, a characteristic pattern of abnormality for either disease has not yet emerged. While the majority of studies focused on brain atrophy and the volumes of supratentorial cerebral structures, little attention has been paid to infratentorial structures. This MRI study focused on the pontomesencephalic area including the region of the raphe nuclei. The raphe nuclei are of special interest in affective disorders as they are the origin of the major serotonergic projections in this region. MRI scans of 10 bipolar I patients, 10 patients with major depression and 10 age-matched healthy control subjects were studied. The brain stem and the fourth ventricle areas as well as T2-relaxation times in the area of the raphe nuclei were evaluated. A difference between patients with major depression and control subjects for T2-relaxation times was found in a region of interest located along the midline of the pons. No difference was found between patients with bipolar disorder and control subjects. This finding needs to be replicated in a larger sample with more elaborated MRI techniques (multi-echo sequences) for the determination of T2-relaxation times.

The purpose of the study was to investigate possible variation of thickness of the cervical spine endplate with respect to endplate orientation (superior or inferior endplate) and level distribution (C4–C7). Six human cervical spine segments C4–C7 were used to create six specimen of C4, C5, C6, and C7, respectively. The bony endplates of each vertebra were cleaned carefully from disc tissue without damaging the endplates. Six endplates with severe degenerative changes were excluded from the study. The posterior elements were removed, and a midaxial cut using a bone saw was performed through each vertebral body, thus producing a superior and inferior half. Each half-vertebra was then glued onto a piece of wood with the endplate oriented upwards and horizontally. For each specimen, four computed tomography scans were taken and thickness of the endplate was measured at five points on each scan perpendicular to the midaxial cut. Factorial analysis of variance (ANOVA) and Scheffe-test were used to detect significant differences. All peripheral regions were significantly thicker than the central point of the endplate if all measuring points were considered for statistical analysis, regardless of scan, endplate orientation or level (Scheffe-test, P<0.001). In both superior and inferior endplates, peripheral areas were thicker than the central region (Scheffe-test, P<0.001). For all levels, the endplate within the peripheral regions was thicker than within the central region and the difference reached significance for the superior and inferior endplate of C4, C5, and C6 and the inferior endplate of C7 (Scheffe-test, P<0.05). The peripheral regions of the cervical spine endplate are usually thicker than its central region, regardless of endplate orientation and level (C4, C5, C6, C7) distribution.

OBJECTIVE:Our objective was to establish reference values for ductus venosus, inferior vena cava and hepatic vein flow velocities during ventricular systole (S-wave) and diastole (D-wave), the lowest forward velocity during atrial contraction (a-wave), the intensity-weighted mean flow velocity (Vmean) and different calculated indices.METHODS:Venous flow velocity waveforms were obtained from 329 singleton pregnancies at 20-42 weeks of gestation by pulsed-wave color Doppler. Reference values were constructed by means of a quadratic regression model after logarithmic transformation of original data.RESULTS:With advancing gestational age the peak velocity index for the vein (PVIV) and pulsatility index for the vein (PIV) decreased whereas blood flow velocities increased. Blood flow velocities were highest in the ductus venosus and lowest in the right hepatic vein. Values for PVIV and PIV were highest in the hepatic vein and lowest in the ductus venosus. During atrial contraction there was a blood flow towards the fetal heart in the ductus venosus, whereas in the inferior vena cava and in the hepatic vein blood flow was either in the opposite from the fetal heart (reverse flow), or there was absent flow (zero flow) or flow was towards the fetal heart (positive flow).CONCLUSIONS:The reference ranges and calculated velocities established in this study may be utilized in studies dealing with the role of ductus venosus and inferior vena cava blood flow in fetuses with chromosomal abnormalities or congenital heart disease as well as hypoxic conditions. We speculate, that the reduction in PVIV and PIV with advancing gestational age may reflect a decrease in cardiac afterload as a result of maturation of diastolic ventricular function.

OBJECTIVES The aim of the present study was to compare the combination therapy of deep intrabony periodontal defects using an Er:YAG laser (ERL) and enamel matrix protein derivative (EMD) to scaling and root planing+ ethylenediaminetetraacetic acid (EDTA)+EMD. MATERIAL AND METHODS Twenty-two patients with chronic periodontitis, each of whom displayed 1 intrabony defect, were randomly treated with access flap surgery and defect debridement with an Er:YAG (160 mJ/pulse, 10 Hz) plus EMD (test) or with access flap surgery followed by scaling and root planing (SRP) with hand instruments plus EDTA and EMD (control). The following clinical parameters were recorded at baseline and at 6 months: plaque index, gingival index, bleeding on probing (BOP), probing depth (PD), gingival recession, and clinical attachment level (CAL). No differences in any of the investigated parameters were observed at baseline between the two groups. RESULTS Healing was uneventful in all patients. At 6 months after therapy, the sites treated with ERL and EMD showed a reduction in mean PD from 8.6 +/- 1.2 mm to 4.6 +/- 0.8 mm and a change in mean CAL from 10.7 +/- 1.3 mm to 7.5 +/- 1.4 mm (p < 0.001). In the group treated with SRP+EDTA+EMD, the mean PD was reduced from 8.1 +/- 0.8 mm to 4.0 +/- 0.5 mm and the mean CAL changed from 10.4 +/- 1.1 mm to 7.1 +/- 1.2 mm (p < 0.001). No statistically significant differences in any of the investigated parameters were observed between the test and control group. CONCLUSION Within the limits of the present study, it may be concluded that both therapies led to short-term improvements of the investigated clinical parameters, and the combination of ERL and EMD does not seem to improve the clinical outcome of the therapy additionally compared to SRP+EDTA+EMD.