Interaktion von HWS mit Kau- und Kieferapparat

Both the cervical spine and the masticatory organs and jaws can cause local and generalised symptoms. Depending on the patient’s age, there is a close interaction between the two regions. While during early development the influence of the cervical spine in pathology of cervicomandibular function is greater, in the course of adolescence the significance of the jaw and the teeth increases more and more. In adulthood, finally, the pathomorphological impairment potential of the jaw region is dominant. Differentiation between the acute findings (e.g. between cervical spine and jaw region as the main problem area) is offset by analysis of the time axis (what type of patient do we have before us?). If the KiSS (Kopfgelenkinduzierte Symmetrie-Störung [impairment of symmetry attributable to the atlanto-axial and atlanto-occipital joints]) symptom complex offers a diagnostic/anamnestic concept for assessment of the ontogenetic relevance of vertebrogenic problems and can make it easier to decide on where the emphasis of treatment should be. Functional irritations that have originated in the cervical spine can thus be recognised earlier, and in children it can be possible to avoid malformations in the orofacial region. This approach also allows better understanding of the complex interaction between manual medicine and dentistry.     

Normal morphology of sacroiliac joints in children: magnetic resonance studies related to age and sex

Objective. To determine in a prospective study the normal MRI morphology of the sacroiliac joints (SIJs) in relation to age and sex during adolescence. Design and patients. A total of 98 children (63 boys, mean age 12.7±2.8 years; 35 girls, mean age 13.7±2.3 years), ranging in age from 8 to 17 years, with juvenile chronic arthritis (JCA) but without signs of sacroiliitis fulfilled the study prerequisites (no back pain and no pathologic changes of the SIJs on physical examination before MRI in a 1.5-year follow-up). An additional eight HLA-B27-negative boys and eight HLA-B27-negative girls without arthritis served as controls. The MRI protocol comprised a T1-weighted SE sequence, an opposed-phase T2*-weighted GE sequence, and a dynamic contrast-enhanced study in single-section technique. Results. Noncontrast MRI permitted differentiation of “open” from ossified segmental and lateral apophyses of the sacral wings, with a significant difference in age (P <0.05) between children with open and ossified apophyses. Ossification of the apophyses of the sacral wings was seen significantly earlier (P <0.05) in girls than in boys. Girls also had a significantly higher incidence of transitional lumbosacral vertebrae, pelvic asymmetries, and accessory joints. In the contrast-enhanced opposed-phase MRI study, normal cartilage of the SIJs showed no contrast enhancement whereas the joint capsule showed a moderate enhancement. Conclusion. There are significant age- and sex-related differences in the normal MRI morphology of juvenile SIJs. Our findings might serve as a standard of comparison for the evaluation of pathologic changes – in particular for the early identification of juvenile sacroiliitis.     

A PCR Specific for Escherichia coli O157 Based on the rfb Locus Encoding O157 Lipopolysaccharide

A PCR was developed for the detection of Escherichia coli O157 based on the rfbE O-antigen synthesis genes. A 479-bp PCR product was amplified specifically from E. coli O157 in cell lysates containing 200 or 2 CFU following crude DNA extraction. The PCR detected <1 CFU of E. coli O157 per ml in raw milk following enrichment.     

Homologues of insecticidal toxin complex genes in Yersinia enterocolitica biotype 1A and their contribution to virulence

Yersinia enterocolitica is an enteric pathogen that consists of six biotypes: 1A, 1B, 2, 3, 4, and 5. Strains of the latter five biotypes can carry a virulence plasmid, known as pYV, and several well-characterized chromosomally encoded virulence determinants. Y. enterocolitica strains of biotype 1A lack the virulence-associated markers of pYV-bearing strains and were once considered to be avirulent. There is growing epidemiological, clinical, and experimental evidence, however, to suggest that some biotype 1A strains are virulent and can cause gastrointestinal disease. To identify potential virulence genes of pathogenic strains of Y. enterocolitica biotype 1A, we used genomic subtractive hybridization to determine genetic differences between two biotype 1A strains: an environmental isolate, Y. enterocolitica IP2222, and a clinical isolate, Y. enterocolitica T83. Among the Y. enterocolitica T83-specific genes we identified were three, tcbA, tcaC, and tccC, that showed homology to the insecticidal toxin complex (TC) genes first discovered in Photorhabdus luminescens. The Y. enterocolitica T83 TC gene homologues were expressed by Y. enterocolitica T83 and were significantly more prevalent among clinical biotype 1A strains than other Yersinia isolates. Inactivation of the TC genes in Y. enterocolitica T83 resulted in mutants which were attenuated in the ability to colonize the gastrointestinal tracts of perorally infected mice. These results indicate that products of the TC gene complex contribute to the virulence of some strains of Y. enterocolitica biotype 1A, possibly by facilitating their persistence in vivo.     

Surface EMG-recordings using a miniaturised matrix electrode: a new technique for small animals

A new method for multichannel surface-EMG measurements in small animals is presented. The underlying scientific aim is the characterisation of the spreading and the co-ordination of skeletal muscle activation between different muscles or muscle parts, depending on various motor tasks. The myoelectrical signals were recorded monopolarly by a 16-channel matrix electrode on the muscle surface directly under the skin on the fascia of the investigated muscle, without damaging the muscle. Surface-EMG's were recorded for at least 5 days after surgery without electrical interferences. During defined motor tasks, the projection of the myoelectrical activation of the different parts of the M. triceps brachii of rats (Rattus norvegicus), pikas (Ochotona rufescens) and cuis (Galea musteloides) or the M. anconeus of toads (Bufo marinus) on the muscle surface was mapped. The locomotion of the investigated animals was monitored by a three-dimensional kinematic analysis (video and/or high-speed cineradiography). There was no perceptible influence from application of EMG matrix electrode. The miniaturised matrix electrode seemed practicable in gaining insight into changes in myoelectrical activation patterns (EMG mapping). This allows a characterisation of the intramuscular co-ordination processes corresponding to the actual morphofunctional state of the investigated animals.     

Niere,Blase

Ohne Zusammenfassung     

Clinical effects of antiplatelet drugs and statins on D‐dimer levels

Background

Acute pulmonary embolism may be ruled out by combining nonhigh clinical probability and a normal D‐dimer level. Both antiplatelet drugs and HMG‐CoA reductase inhibitors (statins) have been associated with effects on thrombus formation, potentially influencing D‐dimer levels in this setting, leading to a higher rate of false‐negative tests. Therefore, we determined whether D‐dimer levels in patients with suspected pulmonary embolism are affected by concomitant use of antiplatelet drugs and/or statins and evaluated whether the effect of antiplatelet drugs or statins might affect diagnostic accuracy.

Materials and methods

We performed a posthoc analysis in the YEARS diagnostic study, comparing age‐ and sex‐adjusted D‐dimer levels among users of antiplatelet drugs, statins and nonusers. We then reclassified patients within the YEARS algorithm by developing a model in which we adjusted D‐dimer cut‐offs for statin use and evaluated diagnostic accuracy.

Results

We included 156 statins users, 147 antiplatelet drugs users and 726 nonusers of either drugs, all with suspected pulmonary embolism . Use of antiplatelet drugs did not have a significant effect, whereas statin use was associated with 15% decrease in D‐dimer levels (95% CI, ?28% to ?0.6%). An algorithm with lower D‐dimer thresholds in statin users yielded lower specificity (0.42 compared to 0.33) with no difference in false‐negative tests.

Conclusions

We conclude that use of statins but not of antiplatelet agents is associated with a modest decrease in D‐dimer levels. Adjusting D‐dimer cut‐offs for statin use did, however, not result in a safer diagnostic strategy in our cohort.