Biomechanische Eigenschaften bei Achillessehnen-Tendinopathien und deren Korrelation mit der elastosonografisch bestimmten Sehnenqualität

BackgroundThe aim of this study was to assess the correlation of the (reduced) quality of tendons in Achilles tendinopathy and the efficiency of the muscle-tendon system. Thereby the biomechanical variables of the isokinetic strength as well as the gait analysis in patients with Achilles tendinopathy were correlated to the strain scores of the TDI elastosonography.Materials and MethodsThe tendon quality in Achilles tendinopathies was determined using the TDI elastosonography in 25 athletes (Æ 48±10.2 years). Additionally, a plantar pressure analysis (FDM-T, zebris Medical GmbH) as well as an isokinetic strength test (Humac®NormTM, CSMI) was conducted with the subjects.ResultsThere were moderate correlations between the strength of the plantar flexors and the amount of the strain scores (tendon quality) with r=0.473 (absolut) und r=0.554 (normalized KG). Additionally, there was a significant correlation between the strength deficit of the plantar flexors on the injured side and the amount of the strain scores with r=0.794.ConclusionsNext to the anamnesis and clinical finding the elastosonography as well as the biomechanical examination can be used in a comprehensive assessment of Achilles pathology to provide additional information for a differentiated and cause related choice of therapy.Level of Evidence: III     

改良型甲苯二异氰酸酯哮喘小鼠模型的建立

目的采用气管滴注方式进行甲苯二异氰酸酯(toluene-diisocyanate,TDI)激发给药,改进TDI哮喘小鼠模型建立方法,并对模型的建立进行评价。方法将20只SPF级健康雌性BALB/c小鼠随机分为TDI组和溶剂对照组,每组10只。TDI组小鼠第1、8天于耳背分别涂抹20μl 0.3%TDI致敏,第15天采用气管滴注法给予20μl 0.01%TDI进行激发,溶剂对照组给予等量溶剂(丙酮与橄榄油混合物)。激发结束后,观察各组小鼠的行为学改变。致敏实验后每组取6只小鼠收集支气管肺泡灌洗液(BALF)并进行炎细胞计数分类,以ELISA法检测BALF上清中白细胞介素-4(IL-4)、γ-干扰素(IFN-γ)含量;以HE染色观察小鼠肺组织病理变化。结果激发结束后,TDI组小鼠均出现呼吸急促、点头呼吸、弓背、前肢缩抬等行为学改变,溶剂对照组未出现上述症状。TDI组小鼠BALF中白细胞总数、嗜中性粒细胞、淋巴细胞、单核细胞、嗜酸性粒细胞、嗜碱性粒细胞数目均高于溶剂对照组,且嗜中性粒细胞、嗜酸性粒细胞百分比高于溶剂对照组,BALF中细胞因子IL-4、IFN-γ含量高于溶剂对照组,差异均有统计学意义(P0.05)。HE染色可见TDI组小鼠肺组织内支气管管壁破坏明显,管腔增厚,支气管管腔内及肺泡腔内有大量的炎细胞浸润,而溶剂对照组未见明显病理变化。结论采用气管滴注方式进行TDI激发给药,可成功建立TDI哮喘小鼠模型。     

Persistence,Up to 18 Months of Follow‐Up,of Epirubicin‐Induced Myocardial Dysfunction Detected Early by Serial Tissue Doppler Echocardiography: Correlation with Inflammatory and Oxidative Stress Markers

A phase II, open, nonrandomized trial was carried out in a group of epirubicin‐treated cancer patients with the aim of detecting early preclinical changes that are predictive of the risk for heart failure. Thirty‐one patients (male/female ratio, 8/23; mean age ± standard deviation, 59 ± 14 years) with tumors at different sites and scheduled to be treated with an epirubicin‐based chemotherapy regimen, were enrolled. We prospectively evaluated the acute (1 week after) and late (3, 6, 12, and 18 months of follow‐up) effects of epirubicin administration. A significant impairment in systolic left ventricular (LV) function was observed at a cumulative epirubicin dose of 200 mg/m². This was shown by a reduction in the strain rate (SR) peak in comparison with baseline and persisted throughout the treatment and follow‐up, up to 18 months; strain (Σ) remained unchanged. The Sm wave showed a progressive reduction that became significant only at the 18‐month follow‐up. On TDI the E_m/A_m ratio declined at the 200‐mg/m² cumulative epirubicin dose versus baseline and persisted throughout the treatment and up to the 18‐month follow‐up. On conventional echocardiography the E/A ratio declined significantly only at the 300‐mg/m² cumulative epirubicin dose. Interleukin (IL)‐6, soluble IL‐6 receptor, and reactive oxygen species (ROS) increased significantly at the 200‐mg/m² dose, and IL‐6 was persistently high at the 300‐ and 400‐mg/m² doses, returning to within baseline values during follow‐up. ROS, after the peak reached at the 200‐mg/m² dose, returned to within baseline values. A significant inverse correlation between ΔSR and the increase in both IL‐6 and ROS was observed. A multiple regression analysis showed that both the IL‐6 and ROS variables were independent and strongly predictive of ΔSR. The clinical meaningfulness of our findings warrants further investigations on a larger number of patients for a longer period of follow‐up.     

Prognostic factors for toluene diisocyanate-induced occupational asthma after removal from exposure

Background The outcome of isocyanatc-induced occupational asthma remains to be further defined. There have been few studies on the role of specific antibodies in prognosis of toluene diisocyanate (TDI) induced occupational asthma. Moreover, to the best of our knowledge, there have been no studies on the improvement pattern of airway hyper-responsiveness (AH). We analysed the prognostic factors that affected the outcome of 35 toluene diisocyanate-induced occupational asthma. Objectives To define clinical and laboratory parameters predicting favourable prognosis for TDI-induced occupational asthma. Methods and results After confirmation of bronchial sensitivity by TDI hronchoprovocation test (BPT), 35 patients were recommended to avoid exposure to TDI; they were also given anti-asthmatic medications including inhaled steroids and monitored for 2 years. Seventeen (49%) recovered completely with disappearance of airway hyperresponsiveness (AH) to methacholine during the follow-up period (mean duration: 12 months, range of 3–30 months). Eleven (31%) showed a significant improvement in AH for first year, which improvement stabihzed in the next year with mild symptoms. Seven (20%) patients did not show any evidence of improvement in AH and had persistent symptoms. Favourable prognosis was associated with a short duration of asthmatic symptoms before diagnosis (P < 0.05), immediate cessation of exposure after diagnosis (P < 0.05), milder degree of AH at diagnosis (P < 0.05), and the presence of specific IgE antibodies to TDI-human serum albumin conjugate (0.05 < P < 0.1). No association was found with atopic and smoking status, age, exposure duration, or length of latent period (P > 0.05). Conclusion These data suggest that early detection of TDI-induced asthma and immediate cessation of exposure are important factors for a favourable prognosis.     

Human biomonitoring pilot study DEMOCOPHES in Germany: Contribution to a harmonized European approach

Human biomonitoring (HBM) is an effective tool to assess human exposure to environmental pollutants, but comparable HBM data in Europe are lacking. In order to expedite harmonization of HBM studies on a European scale, the twin projects COPHES (Consortium to Perform Human Biomonitoring on a European Scale) and DEMOCOPHES (Demonstration of a study to Coordinate and Perform Human Biomonitoring on a European Scale) were formed, comprising 35 partners from 27 European countries.In COPHES a research scheme and guidelines were developed to exemplarily measure in a pilot study mercury in hair, cadmium, cotinine and several phthalate metabolites in urine of 6–11 year old children and their mothers in an urban and a rural region. Seventeen European countries simultaneously conducted this cross-sectional DEMOCOPHES feasibility study.The German study population was taken in the city of Bochum and in the Higher Sauerland District, comprising 120 mother-child pairs. In the present paper features of the study implementation are presented. German exposure concentrations of the pollutants are reported and compared with European average concentrations from DEMOCOPHES and with those measured in the representative German Environmental Survey (GerES IV).German DEMOCOPHES concentrations for mercury and cotinine were lower than the European average. However, 47% of the children were still exposed to environmental tobacco smoke (ETS) outside their home, which gives further potential for enhancing protection of children from ETS.Compared with samples from the other European countries German participating children had lower concentrations of the phthalate metabolites MEP and of the sum of 3 DEHP-metabolites (MEHP, 5OH-MEHP and 5oxo-MEHP), about the same concentrations of the phthalate metabolites MBzP and MiBP and higher concentrations of the phthalate metabolite MnBP. 2.5% of the German children had concentrations of the sum of 4 DEHP-metabolites and 4.2% had concentrations of MnBP that exceeded health based guidance values, indicating reasons for concern.Continuous HBM is necessary to track changes of pollutant exposure over time. Therefore Germany will continue to cooperate on the harmonisation of European human biomonitoring to support the chemicals regulation with the best possible exposure data to protect Europe’s people against environmental health risks.     

Isocyanates and respiratory disease: current status

This paper reviews the known respiratory effects of isocyanates. There is good evidence to indicate that isocyanates: cause chemical bronchitis/pneumonitis; are potent pulmonary sensitizers capable of causing "isocyanate asthma"; cause nonspecific airways disease, including chronic bronchitis; can induce a general asthmatic state; and can cause hypersensitivity pneumonitis. Similar dose-response relationships are seen for both acute and chronic effects. There are plants operating in which exposures are well controlled and in which no respiratory effects can be detected. Suggestions are provided for preplacement assessment and periodic surveillance for workers exposed to these compounds.     

Detection of Early Cardiac Dysfunction in Patients with Beta Thalassemia by Tissue Doppler Echocardiography

Backgrounds: In this study we tried to evaluate the prognostic significance of several echocardiographic parameters on the occurrence of heart failure or arrhythmias in patients with beta thalassemia. Methods: We investigated possible differences in myocardial function between a population of 37 asymptomatic patients with beta thalassemia and 25 age‐matched healthy controls, all of whom underwent an echocardiographic study, including tissue Doppler imaging (TDI), moreover plasmatic levels of N‐terminal pro‐BNP (NT‐pro BNP) were measured in all patients. We followed the patients for 22 ± 8 months to evaluate adverse cardiac events. Results: Conventional echocardiographic parameters of left ventricle were comparable in both groups. Whereas TDI peak systolic velocity (Sm) and diastolic parameter (E/Em ratio) were significantly abnormal in patients with thalassemia. Moreover eleven adverse cardiac events were observed during follow‐up. Baseline systolic velocity (Sm) <7.9 cm/s was significantly associated with cardiac complications (P < 0.05). We also demonstrated that systolic velocity is inversely related to NT‐proBNP plasmatic levels (P < 0.001). Conclusions: Our study suggests that mitral annular systolic velocity <7.9 cm/s is associated to the onset of adverse cardiac events. (Echocardiography 2011;28:175‐180)     

Left Atrial Structure and Function,and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review

Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.     

New insights into the human metabolism of the Fusarium mycotoxins deoxynivalenol and zearalenone

This study reports on the detailed investigation of human deoxynivalenol (DON) and zearalenone (ZEN) in vivo metabolism through the analysis of urine samples obtained from one volunteer following a naturally contaminated diet containing 138 μg DON and 10 μg ZEN over a period of four days. Based on the mycotoxin intake and the concentrations of mycotoxin conjugates in urine, a mass balance was established. The average rates of DON excretion and glucuronidation were determined to be 68 and 76%, respectively. The investigation of formed glucuronides revealed DON-15-glucuronide as main conjugation product besides DON-3-glucuronide. Furthermore, for the first time in human urine a third DON-glucuronide was detected and the fate of ingested masked DON forms (3-acetyl-DON and DON-3-glucoside) was preliminary assessed. The mean excretion rate of ZEN was determined to be 9.4%. ZEN was mainly present in its glucuronide form and in some samples ZEN-14-glucuronide was directly determined 3–10 h after exposure. For the first time concrete figures have become available for the excretion pattern of DON and ZEN-glucuronides throughout a day, the comparison of total DON in 24 h and first morning urine samples and the urinary excretion rate of total ZEN in humans following exposure through naturally contaminated food. Therefore, valuable preliminary information has been obtained through the chosen experimental approach although the study involved only one single individual and needs to be confirmed in larger monitoring studies. The presented experiment contributes to a better understanding of human DON and ZEN in vivo metabolism and thereby supports advanced exposure and risk assessment to increase food safety and examine the relationship between these mycotoxins and potentially associated chronic diseases in the future.