Empfehlungen zu Ernährung und Bewegung von Kleinkindern

Monatsschrift Kinderheilkunde -     

Effect of intravenous nitroglycerin on lipid peroxidation after thrombolytic therapy for acute myocardial infarction

Free oxygen radicals are produced after coronary artery occlusion and reperfusion. Polyunsaturated fatty acids are oxidized by free radicals to lipid peroxides. Measurements of plasma malondialdehyde (MDA) formed by the breakdown of lipid peroxides are often used as markers of lipid peroxidation. The effect of intravenous nitroglycerin on plasma MDA levels was studied in 43 patients who received thrombolytic therapy for acute myocardial infarction. Plasma MDA levels in patients were elevated on admission to the hospital compared with healthy controls, and normalized within 48 hours. A greater increase in plasma MDA concentrations after thrombolysis was found in patients with noninvasive signs of reperfusion than in patients judged to have a persistent occlusion. In the 23 patients receiving immediate intravenous nitroglycerin infusion, plasma MDA levels did not change from baseline to 90 minutes (0.92 ± 0.22 and 0.92 ± 0.23 μmol/L, p = 0.99), whereas a significant increase was found in the 20 control patients who did not receive nitroglycerin (from 0.83 ± 0.22 to 1.01 ± 0.30 μmol/L, p = 0.0004) (p = 0.036 for the difference between groups). Successful reperfusion after thrombolytic therapy entails increased lipid peroxidation. Intravenous nitroglycerin reduces lipid peroxidation during myocardial ischemia and reperfusion.     

Multicentre study for diagnostic evaluation of an assay for simultaneous detection of antibodies to HIV-1, HIV-2 and HIV-1 subtype 0 (HIV-0)

Summary The aim of the study was to evaluate a new ELISA for detection of HIV-1, HIV-2 and HIV-1 subtype 0 (HIV-0) antibodies. The assay format is based on the antigen sandwich principle. To enable specific detection of HIV-0 antibodies, in addition to HIV-1 and HIV-2 antigens HIV-0 antigen is used for coating the solid phase and for the conjugate. The results show that all 12 HIV-0 samples tested were detected with a high degree of reactivity, as were all the 1,144 anti-HIV-1 and 424 anti-HIV-2 positive samples. The capacity of the test to enable early detection of seroconversions is equivalent to that of other sandwich ELISAs. The specificity of the assay was determined to be 99.89/99.94% (initial/after retest) using 58,366 samples, which is superior to the other ELISAs used for comparison. Even with difficult samples (i.e. samples of African origin, samples known to cause false-positive reactivity in different ELISAs, or samples containing potential interference factors) there were very few false-positive reactions. Therefore, the new assay is well suited for screening blood donations as well as for evaluating samples from patients of different geographic origin.

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Multizenterstudie zur Bewertung eines Testsystems für den gleichzeitigen Nachweis von Antikörpern gegen HIV-1, HIV-2 und HIV-1 Subtyp 0 (HIV-0)

Zusammenfassung Ziel der Studie war die Bewertung eines neuen ELISA zum Nachweis von Antikörpern gegen HIV-1, HIV-2 und dem HIV-1 Subtyp 0 (HIV-0). Der Test beruht auf dem Antigen-Sandwich-Prinzip. Für den spezifischen Nachweis von Antikörpern gegen HIV-0 wird HIV-0-Antigen zusammen mit HIV-1 und HIV-2-Antigen zur Beschichtung der festen Phase und für das Konjugat verwandt. Die Ergebnisse zeigten, daß alle 12 getesteten HIV-0-Proben mit hoher Reaktivität nachweisbar waren sowie alle 1 144 anti-HIV-1- und 424 anti-HIV-2-positiven Proben. Die Fähigkeit des Testsystems zum frühen Nachweis einer Serokonversion entspricht derjenigen anderer Sandwich-ELISAs. Die Spezifität des Tests wurde an 58 366 Proben mit 99,89/99,94% (initial/Wiederholungstestung) ermittelt und liegt über derjenigen von anderen zum Vergleich herangezogenen ELISAs. Auch bei schwierigen Proben (zum Beispiel Proben aus Afrika, Proben, bei denen falsch-positive Reaktivität in verschiedenen ELISAs beobachtet worden war oder Proben, die mögliche Interferenzfaktoren enthalten) fanden sich nur sehr wenige falsch positive Reaktionen. Der neue Test eignet sich daher gut für das Screening von Blutspenden und für die Beurteilung von Proben von Patienten unterschiedlicher geographischer Herkunft.

     

Heterogeneous localization of connexin40 in the renal vasculature

The renal circulation, which treats 25% of the cardiac output, is organized and regulated in unique patterns. Gap junction channels may contribute to the control of vascular tone by transmitting intracellular signals rapidly between cells of the blood vessel. We investigated the distribution patterns of the major vascular gap junction proteins in the murine kidney by immunofluorescence staining of frozen sections, and connexin40 (Cx40) was the most prominent connexin detected. The endothelial cells of large vessels within the kidney consistently showed abundant Cx40 immunoreactivity, but small vessels showed unique distributions of Cx40 along their courses within the kidney. Cx40 immunoreactivity between endothelial cells was abundant in the interlobular arteries and the proximal portion of the afferent arterioles, but was significantly decreased when arterioles approached the glomerulus. No Cx40 immunoreactivity was detected in the region of the glomerular isthmus where the afferent and efferent arterioles join the glomeruli, although glomeruli showed very intense patchy staining for Cx40. Intense patchy staining for Cx40 was also found in the modified smooth muscle cells of the juxtaglomerular apparatus, but none was detected in smooth muscle cells elsewhere in the vasculature. Taken together, these data suggest that the abundance of Cx40-containing gap junctions may be important for coordinating function of cells within individual blood vessels, while their absence in juxtaglomerular regions of the arterioles may prevent conduction of signals between the glomerulus and afferent or efferent arterioles.     

What German dentists choose for their teeth: A Web-based survey of molar restorations and their longevity

Statement of problemWhich restorative material is best suited for treating the posterior molar region is unclear. As dentists presumably choose the most appropriate restoration, German dentists were asked how their own molars were treated.PurposeThe purpose of this survey study was to examine molar restorations and their durability in German dentists.Material and methodsIn the official journal of the Federal Dental Association, German dentists were asked to participate in an online survey that gathered demographic data and information on the type and durability of their molar restorations. To reduce selection bias, the data were weighted for region, sex, and age of the dentist.ResultsThe data set consisted of 1719 molars from 288 dentists. Restorations included gold inlays (25%), composite resin (24.3%), amalgam (11.8%), ceramic inlays (5.4%), glass ionomer cement or compomer (0.8%), gold crowns (21.8%), ceramic crowns (6.6%), and metal-ceramic crowns (4.3%). Notable differences were identified based on the sex, age, and region of the dentist. Women selected increased esthetic options, as did young dentists. Restorations made of gold, amalgam, and base metal had the highest longevity, at more than 20 yearsConclusionsAmong German dentists, restorations with metallic materials dominated in molars, with gold accounting for the largest share. In recent years, the proportion of tooth-colored restorations has increased, and in particular, young dentists use composite resin and ceramics.     

Adverse effects of irreversible electroporation of malignant liver tumors under CT fluoroscopic guidance: a single-center experience

PURPOSE

We aimed to describe the frequency of adverse events after computed tomography (CT) fluoroscopy-guided irreversible electroporation (IRE) of malignant hepatic tumors and their risk factors.

METHODS

We retrospectively analyzed 85 IRE ablation procedures of 114 malignant liver tumors (52 primary and 62 secondary) not suitable for resection or thermal ablation in 56 patients (42 men and 14 women; median age, 61 years) with regard to mortality and treatment-related complications. Complications were evaluated according to the standardized grading system of the Society of Interventional Radiology. Factors influencing the occurrence of major and minor complications were investigated.

RESULTS

No IRE-related death occurred. Major complications occurred in 7.1% of IRE procedures (6/85), while minor complications occurred in 18.8% (16/85). The most frequent major complication was postablative abscess (4.7%, 4/85) which affected patients with bilioenteric anastomosis significantly more often than patients without this condition (43% vs. 1.3%, P = 0.010). Bilioenteric anastomosis was additionally identified as a risk factor for major complications in general (P = 0.002). Minor complications mainly consisted of hemorrhage and portal vein branch thrombosis.

CONCLUSION

The current study suggests that CT fluoroscopy-guided IRE ablation of malignant liver tumors may be a relatively low-risk procedure. However, patients with bilioenteric anastomosis seem to have an increased risk of postablative abscess formation.About 70% of hepatic metastases are nonresectable because of their anatomic location, the presence of comorbidities, or limited hepatic functional reserve (1). In these patients and in case of nonresectable primary liver tumors, percutaneous thermal ablation procedures, such as radiofrequency (RF) and microwave ablation, have become effective tools for treating hepatic malignancies (2–4). However, the effectiveness of RF and microwave treatment may be limited, either because of thermal damage to temperature-sensitive structures located in close proximity to the target tissue (5) or because of incomplete ablation of tumors adjacent to major hepatic vessels due to a phenomenon commonly termed “heat-sink effect” (6–10) which describes the loss of the applied thermal energy through the blood flow in those major vessels, whereby the effective energy application remains inadequate to ablate the target lesion.Irreversible electroporation (IRE) is a theoretically nonthermal ablation technique that delivers a series of high-voltage millisecond electrical pulses to the surrounding tissue, thus leading to irreversible disruption of the integrity of cell membranes and subsequent cell death by apoptosis (11–14). IRE may overcome the problems raised with thermal ablation: previous animal studies reported that bile ducts, blood vessels, nerves, and connective tissues are affected by IRE; however, regeneration is possible to some extent due to preservation of the tissue architecture (12, 13, 15–19). Moreover the feasibility of inducing cell death up to a vessel wall without any perivascular sparing was shown with IRE (12, 13, 18). The safety of IRE in the treatment of humans has been described (20). First reports have described potential complications after IRE, such as hemorrhage requiring blood transfusion (1.2%, two of 167 ablation procedures), portal vein thrombosis (3.2%, one of 31 ablation procedures), injury to bile ducts (1.8%, three of 167 ablation procedures), and infection (3.6%, six of 167 ablation procedures) (21, 22). However, few data are available for evaluating the potential risk factors associated with the occurrence of post-IRE complications.The purpose of this study was to review the frequency of mortality and morbidity after computed tomography (CT) fluoroscopy-guided liver IRE conducted at a single center and assess the factors influencing the occurrence of major complications.