Adhäsionsmoleküle in der Dermatoonkologie

Zusammenfassung Adh?sionsmoleküle sind Zell-Oberfl?chen-Proteine, welche verantwortlich sind für die Zell-Zell- und Zell-Matrix-Interaktionen. Sie sind in der Lage eine gro?e Zahl von Stimuli zu erkennen und darauf entsprechend zu reagieren. Sie bilden somit eine Basis für manchen physiologischen und pathologischen Prozess insbesonders des „Homing“-Verhaltens, der Homeostase der Immunantwort, der Wundheilung, der Entzündungen und der Tumormetastasierung. In der Dermatologie wurde das Interesse vor allem durch die Entdeckung des CLA (cutaneous lymphocyte antigen) geweckt, welches der spezifische „Homing“-Rezeptor für Memory-T-Zellen darstellt. So konnte gezeigt werden, da? die Zellen in kutanen Lymphomen CLA-positive T-Zellen sind, im Gegensatz zu prim?r nodalen Non-Hodgkin Lymphomen, wo die T-Zellen CLA negativ sind. Neuere Arbeiten haben gezeigt, da? die Adh?sionsmoleküle wie CD44v6 bei kutanen Lymphomen, welche eine systemische Ausbreitung zeigen, auf den Tumorzellen exprimiert werden und somit eine entscheidende Rolle in der Metastasierung dieser Tumoren darstellen. Eingegangen am 27. November 1995 Angenommen am 22. Dezember 1995     

Vers des indicateurs de continuité des soins : suivi à deux ans de patients hospitalisés en 1999

The paper presents a two-year follow-up of the patients admitted in 1999 in three catchment areas (sectors). By comparing the group of patients who were new in 1999 (N = 321) to the group of those who were already treated (N = 498), the paper describes the type of care received by the patients in 1999, 2000 and 2001 according to age, gender, diagnosis, and type of care. The paper describes the probability of follow up according to the above data. The paper shows the value of a knowledge of the actual pathways of the patients within the psychiatric care organization.     

Platelet additive solutions: A future perspective

Platelet additive solutions (PASs) were first developed in the 1980s, and continued to be improved over the following years. The use of PASs as replacement for plasma has a number of benefits, both for the quality of the platelet concentrates and for the patients. However, some PASs have been associated with a lower platelet yield in the PCs, a shorter storage time, and a lower increment in the patient when compared to PCs in plasma. A number of reformulations of the PASs have taken place to counteract these disadvantages. Most PASs use acetate as nutrient for the platelets, which has the benefit of generating bicarbonate when oxidized by the platelets, thus supplying its own buffering capacity. Alternatively, glucose is used, but may cause deterioration of pH in the stored PCs due to the formation of lactic acid. Addition of other buffering substances, such as phosphate, can be added to ensure maintenance of neutral pH. An important finding was the inhibiting effect of potassium and magnesium on platelet activation. The initially developed PASs lacked these two ingredients and showed reduced storage times of the PCs in PAS when compared to those stored in plasma. However, when these constituents are included in the PAS, storage time is similar and even exceeds those seen for PCs in plasma. Considerable research is done in further formulating the optimal PAS. Bicarbonate is being considered as buffer for these PASs. Also, L-carnitine appears to have a favorable effect on stored platelets, including a reduction of platelet metabolism, and inhibition of apoptosis. Another area of optimization is lowering of plasma content needed for maintaining platelet quality. Where current PASs still need at least 30% residual plasma, there is a trend towards lowering the plasma content to less than 5% with the newer PASs. Preservation of purinergic platelet receptor functionality by ADP-degrading activities in plasma appears to play an important role in this respect. Development of PASs are usually based on in vitro studies alone. It is important to realize that only clinical studies can give definitive answers about the quality of platelets stored in PASs. Sofar, only limited clinical evaluations have been published that either studied the effectiveness of platelets in initially-developed PASs, or were specifically done in combination with pathogen reduction technologies. Thus, PASs seem to be an excellent replacement for (part of) the plasma when producing PCs, and allow extended storage with maintenance of quality, but more clinical studies are needed to substantiate in vitro results.     

Identification of neutrophil chemotactie factors in bronchoalveolar lavage fluid of asthmatic patients

Background Although neutrophils have been implicated in bronchial asthma, the mechanism(s) which bring these cells into the airways is poorly understood. Objective To investigate the presence and identity of neutrophil chemotactic factors in bronchoalveolar lavage (BAL) fluid from atopic asthmatic subjects. Method BAL fluid was obtained from 13 subjects (seven asthmatics and six normals). aged 19 to 60 yr, at bronchoscopy. Separation of neutrophil chemotactic activity (NCA) was achieved by FPLC cation exchange chromatography. Fractions were collected and assayed for chemotaxis multiwell micro-chemotaxes chambers using polycarbonate filters, for the complement peptide C5a/C5a des Arg by radioimmunoassay (RIA) and for interleukin-8 (IL-8) by ELISA. Results NCA was found in FPLC fractions of BAL samples in four out of seven asthmatics and each of these subjects had at least three similar peaks of NCA. The major peak of NCA was found to contain immunoreactive C5a/C5a des Arg and chemotaxis. In response to this NCA could be blocked by desensitization of the neutrophils with recombinant C5a. Purified serum derived C5a/C5a des Arg was found to have altered chromatographic properties when added to BAL fluid; this suggested that BAL fluid contained proteins which interacted with the C5a/C5a des Arg. Immunoreactive IL-8 (iIL-8) was also detected but its concentration or chemical form was insufficient to induce neutropbil chemotaxis. Conclusion This study demonstrates that bronchial asthmatic lavage fluid contains C5a/C5a des/Arg and iL-8, together with other as yet unidentified factors which may contribute to neutropbil recruitment in this disease.     

Inhibitory effects of rat alpha2 macroferoprotein (alphaMFP), an acute phase globulin, on galactosamine hepatitis.

Refractoriness to Gal N toxicity occurs especially in fetal rats, newborn rats, and in rats after partial hepatectomy. An injury however (laparotomy, incision on the back or ip BaSO₄ suspension), prior to Gal N administration, also inhibits Gal N toxicity. In all these circumstances high levels of rat α₂-macrofetoprotein (α_MFP) occur. This protein is an acute phase reactant and is identical to rat α₂-macroglobulin. α_MFP isolated from the serum of injured rats and then administered to normal rats strongly inhibits Gal N toxicity. When time interval between the preceding injury, provoking α_MFP production and Gal N administration shortens, the inhibiting effects are less and α_MFP production remains low.During resistance to Gal N, the primary and secondary biochemical lesions of Gal N persist and the protecting effect of α_MFP must be due to another mechanism, operating in later phases of cell injury. Very probably this is attributable to the stabilizing effect on membranes of hepatocytic organelles and the plasma membranes. As α_MFP is an acute phase reactant the importance of these proteins to the course of hepatitis must be considered.     

Methods of leaks detection under therapy with continuous positive airway pressure

To assess the performance of continuous positive airway pressure devices in treatment of sleep breathing disorders during polysomnographic studies, analysis are based essentially on the patient airflow signal measured by a pneumotachograph and the mask pressure. These signals used either by the softwares or the physicians provide powerful information on respiratory events occurring during the night. However, sometimes signals are artifacted by airflow leaks at the mask or the mouth. These artifacts are causes of information loss and then of possible wrong interpretations. We studied the relationship between airflow and mask pressure at the occurrence of leaks. We used analogy with electrical models and Kirchoff laws to estimate mask leaks and to detect mouth breathing. A Starling model connected to a flow generator simulated respiratory movements. A positive pressure was maintained in the model and artificial leaks comparable to mask leaks were provoked. Then, we replaced the Starling model and the flow generator by two healthy volunteers. We computed mask leaks in both conditions and found no contradiction between the simulated model and the subjects. Equations of the analog circuit were helpful to assess mask leaks and to detect mouth breathing. Such equations could be included in polysomnographs or in pressure generator algorithms either for detecting leaks or adjusting airway pressure.     

Differential distribution of growth associated protein (GAP-43) in the motor nuclei of the adult rat conus medullaris

GAP-43 is normally produced by neurons during developmental growth and axonal regeneration, but it is also expressed in specific regions of the normal adult nervous system. We studied the protein expression of GAP-43 within the conus medullaris portion of the spinal cord in adult male rats. Immunohistochemistry for choline acetyltransferase (ChAT) was first performed to identify specific efferent autonomic and motor nuclei in lumbosacral segments of the spinal cord. Adjacent sections were then processed for GAP-43 immunoreactivity (IR). We show GAP-43 IR in the superficial portion of the dorsal horn, the intermediolateral nucleus, and the dorsal commissural tract. We also demonstrate a differential distribution of GAP-43 IR between different motor nuclei of the conus medullaris. Using densitometry, the most prominent GAP-43 IR was detected in the dorsolateral and dorsomedial motor nuclei, which represent the human Onufs nucleus homologue. Confocal microscopy of double immunofluorescent labeling for ChAT and GAP-43 demonstrate GAP-43 IR in the neuropil of the autonomic and motor nuclei, and many of the GAP-43 IR arbors are in close apposition with the efferent cholinergic neurons. We note that the efferent neurons of both the autonomic and somatic nuclei, which are ultimately responsible for the integrated normal control of the lower urinary tract, bowel and sexual functions, are heavily innervated by GAP-43 enriched projections. We speculate that these functionally related neurons retain a physiological GAP-43-associated synaptic plasticity throughout adult life.     

Système de télésurveillance sonore pour la détection de situations de détresse

The telemedicine and medical remote monitoring in particular, today represents an effective solution to the health professional shortcomings facing to the increasing older population. In addition to the comfort of being at home, this system decreases the cost of long hospitalization. The proposed system achieves the home medical telesurveillance by means of microphones and medical sensors to detect a distress situation. This system is designed for elderly people at home or for the patient with chronic illness. The experimental apartment is equipped with medical sensors (tensiometer, oxymeter, balance, etc.), infrared position sensors, and acoustic sensors (1 microphone/room). The originality of the system comes from the replacement of the video surveillance with a sound surveillance. The sound analysis system is divided in two stages: firstly, the detection/extraction of the sounds is operated and secondly, a classification of these sounds in known classes takes place. A wavelet-based algorithm with good performance when applied in noisy environments is proposed. The acoustical classification step uses a Gaussian Mixture Models to classify the sounds according to the 7 predefined classes. The detection algorithm allows an equal error rate of 0% for the signal to noise ratio superior or equal to 10 dB and 4% for the 0 dB. The proposed system coupled with a classical medical telesurveillance system will bring extra information needed for the reliability of the global system.     

Association between chronic hepatitis C infection and metabolic syndrome: A meta-analysis

BackgroundHepatitis C virus (HCV) infected patients have been found to be more susceptible to metabolic syndrome (MetS), but the results remain unclear and lack of a meta-analysis.MethodsDatabases including PubMed, Web of Science, EMBASE and the Cochrane Library were searched to identify all studies concerning HCV and MetS. Funnel plots combined with Begg's tests and Egger's tests were used to analysis the possible publication bias. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to access the effect of HCV infection on the risk of MetS.ResultsEight articles, involving a total of 57387 HCV patients were included. HCV infection was significantly associated with an increased incidence of MetS (OR = 1.73; 95% CI, 1.19–2.52). After adjustment according to the sensitivity analysis, one included article was removed to decrease the publication bias and high heterogeneity, of which the results showed that HCV infection was still associated with an increased incidence of MetS (OR = 1.93; 95% CI, 1.39–2.68).ConclusionsHCV patients tend to have a significant increased risk for MetS, but more large-scale studies are needed to confirm this and explore the exact mechanism.