Deficient IgA and IgG2 anti-pneumococcal antibody levels and response to vaccination in otitis prone children

OBJECTIVE: To evaluate the isotype and IgG subclass distribution of anti-pneumococcal antibodies and response to polysaccharide vaccination in otitis prone children. METHODS: IgG1, IgG2 and IgA antibodies to pneumococcal serotypes 3, 4, 6B, 9V, 14, 19F and 23F were determined in otitis prone children and in an age-matched healthy control population. Patients were immunized with a 23-valent pneumococcal polysaccharide vaccine. The antibody response was measured 4 weeks later. RESULTS: Geometric mean IgA and IgG2 antibody levels for all seven pneumococcal serotypes tested were significantly lower in otitis prone children than in the control population. After immunization, there was no significant increase in geometric mean IgG2 anti-serotype 6B, 19F and 23F pneumococcal polysaccharide (weak immunogenic), but also no increase for IgG2 anti-serotype 4 and 14. Post immunization IgG2 antibody titers for serotypes 6B, 9V and 19F even remained below titers of non-vaccinated controls. Nine out of 29 otitis prone children were colonized nasopharyngeally with Streptococcus pneumoniae during the time of vaccination; these children had an even more severely impaired systemic antibody response. CONCLUSIONS: Otitis prone children, while having normal IgG1 antibody levels, have low IgG2 and IgA anti-polysaccharide antibody levels and fail to respond in these subclasses upon vaccination with pneumococcal polysaccharide vaccine.     

Peri-implant alveolar bone loss with respect to bone quality after use of the osteotome technique: results of a retrospective study

Knife-edge configurations or non space-maintaining defects of the alveolar ridge limit the indications for implant-prosthetic rehabilitation. If ridge expansion is required, bone splitting and bone spreading techniques may be applied. Summers introduced a modified approach for ridge expansion by osteotome technique. The principles of this nonablative implant bed preparation technique are lateral and apical bone relocation and condensation. The peri-implant alveolar bone loss after use of the osteotome technique was evaluated radiographically with respect to the bone quality in 22 patients with 22 implants. Differences between the alveolar crest and the implant shoulder in radiographs obtained immediately after implant insertion, after the end of unloaded healing period and after different periods of functional loading were calculated. The osteotome technique was used in bone quality classes 2 and 3, respectively, according to the Lekholm and Zarb classification. Two implants failed. Significant differences were found between the bone levels after implant insertion and at the end of the healing period as well as after functional loading (P = 0.028). The bone quality was significantly correlated (r = - 0.505; P = 0.023) with the change of the peri-implant marginal bone height level 6 months after the implant installation. The present data indicate the importance of bone quality evaluation before application of the osteotome technique.     

Arteriolar and venular patterning in retinas of mice selectively expressing VEGF isoforms

The murine VEGF gene is alternatively transcribed to yield the VEGF(120), VEGF(164), and VEGF(188) isoforms, which differ in their potential to bind to heparan sulfate and neuropilin-1 and to stimulate endothelial growth. Here, their role in retinal vascular development was studied in mice selectively expressing single isoforms. VEGF(164/164) mice were normal, healthy, and had normal retinal angiogenesis. In contrast, VEGF(120/120) mice exhibited severe defects in vascular outgrowth and patterning, whereas VEGF(188/188) mice displayed normal venular outgrowth but impaired arterial development. It is noteworthy that neuropilin-1, a receptor for VEGF(164), was predominantly expressed in retinal arterioles. These findings reveal distinct roles of the various VEGF isoforms in vascular patterning and arterial development in the retina.     

Trypan blue not toxic for retinal pigment epithelium in vitro

PURPOSE: To investigate whether trypan blue has a toxic effect on cultured retinal pigment epithelial (retinal pigment epithelium) cells. DESIGN: Experimental study with a direct live/dead cell staining technique using fluorescent dyes. METHODS: Cultured human retinal pigment epithelium cells were exposed for 5 minutes to various concentrations of trypan blue (0.06%, 0.15%, 0.30%), and cell viability was confocally measured. RESULTS: No increased cell death was found in cultures incubated in any of the trypan blue concentrations used. CONCLUSION: These findings indicate that a short exposure of trypan blue does not have a toxic effect on cultured retinal pigment epithelium cells.     

Postnatal increase in insulin-sensitive glucose transporter expression is associated with improved recovery of postischemic myocardial function

OBJECTIVE: Glucose is an important substrate for energy production in the developing heart. Increased glucose uptake rate and metabolism during ischemia and reperfusion are closely linked to postischemic myocardial recovery. The initial rate-limiting step for glycolysis is the transport of glucose across the plasma membrane by glucose transporters (GLUT-1 and GLUT-4). We hypothesized that changes in GLUT-1 and GLUT-4 expression in developing hearts lead to age-dependent adaptive changes in glucose uptake capacity and influence tolerance to ischemia. METHODS: Western-immunoblotting was performed to determine GLUT-1 and GLUT-4 expression in myocardial tissue from 1, 2, and 3-week-old and adult rabbits. Glucose uptake rate was measured with (31)P-nuclear magnetic resonance spectroscopy using 2-deoxyglucose as substrate in isolated perfused hearts. Hearts from same age rabbits were perfused in the Langendorff mode with crystalloid buffer or buffer plus a GLUT-4 specific antibody in order to determine GLUT-4 mediated effects on myocardial protection. The hearts were subjected to 30 minutes of normothermic ischemia followed by reperfusion. Cardiac contractile function measurements were obtained pre- and postischemia. Tissue lactate accumulation was measured in all groups at end-ischemia CONCLUSIONS: Insulin-regulated glucose transporter (GLUT-4) expression in the heart increased gradually after birth reaching nearly adult levels by 3 weeks of age. Corresponding with the higher amount of GLUT-4 protein, improved recovery of postischemic contractile function was seen in older hearts in association with increased anaerobic glycolytic capacity. Interventions to accelerate postnatal GLUT-4 expression may improve ischemic tolerance in the neonatal heart.     

Ultrasound guidance for ulnar nerve block in the forearm

OBJECTIVE: The objective of this study was to establish the feasibility of ulnar nerve block under direct imaging. CASE REPORTS: Two patients undergoing surgery on the fifth digit or medial hand received ulnar nerve blocks in the mid-forearm (approximately 15 cm proximal to the styloid process of the ulna). Ultrasound imaging was used to identify the ulnar nerve in the forearm and guide local anesthetic infiltration. Both patients had successful blocks, including sensory anesthesia of the dorsomedial hand. CONCLUSIONS: Ultrasound guidance for ulnar nerve block in the forearm is a promising technique that includes block of the dorsal cutaneous branch. Anatomic and sonographic considerations are discussed.     

Preoperative attitudes, fears and expectations of non-small cell lung cancer patients

Knowing preoperative fears in cancer patients should help us to overcome perioperative psychological problems. One hundred and three patients underwent a semistructured interview addressing the effect of preoperative information on disease and forthcoming operation, attitude towards operation, expectations for the postoperative time and family support. Evaluation was performed by three psychologists by qualitative structured content analysis according to Mayring. Interrater reliability was 85%. Only 42 patients (40.8%) were informed in detail about their diagnosis. Eighty-three patients (80.6%) considered the information given on their disease and the forthcoming operation as understandable, 57 patient (55.3%) experienced reduction of fear. Eighty-three patients (80.6%) showed a positive attitude to the operation, 21 (20.4%) expected an impairment of later life after operation although becoming healthy again. Diffuse fears were named in 47 cases (45.6%), 19 (18.4%) patients were afraid of metastases, 11 (10.7%) of postoperative death, 19 (18.4%) of pain, 11 (10.7%) of mutilation and 17 (16.5%) of surgical complications. Seventy-three patients (70.9%) had good family support, seven (6.8%) not. Of the support group 32 patients (31%) considered their relatives' empathy as onerous. Problems, that are self-evident to the attending staff may be insurmountable for the patients. If we succeed to overcome their most simple fears they can focus their energy on mastering the postoperative course.