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Background: Hepatocellular adenoma is a rare benign liver tumor. Typically, hepatocellular adenomas are solitary and are found in young women who use estrogen-containing contraceptives. The occurrence of multiple hepatocellular adenoma has been linked to higher body mass index, and as the prevalence of overweight increases, multiple hepatocellular adenomas are seen more often. An hepatocellular adenoma does not always necessitate treatment, as they can regress under conservative strategies. In incidental cases, an adenoma presents owing to bleeding, which is mostly self-limiting. If it is not, embolization of hepatic involved vessels is indicated., Case Presentation: In this case report, we discuss a 42-year old Caucasian woman with multiple hepatocellular bleeds, treated by multiple endovascular procedures. After the first embolization of an adenoma in the right liver lobe, a second bleed occurred in the left lobe, necessitating additional endovascular intervention. During admittance, treatment was complicated by pulmonary embolism and a pneumonia. During follow-up, our patient was diagnosed with antiphospholipid syndrome., Conclusion: Hepatocellular adenoma is a rare diagnosis that requires centralized expertise. This particular case illustrates the complexity of treatment strategies for associated intra-abdominal bleeding and possible complications. Although liver adenoma is often an incidental finding, it can also result in significant morbidity. Centralization of treatment leads to expertise in managing complex treatment strategies., (© 2024. The Author(s).)

The role of aichivirus A1 (AiV-A1) in acute gastroenteritis remains controversial and in vitro data illustrating its pathogenesis in suitable human models are scarce. Here, we demonstrate that AiV-A1 isolate A846/88 replicates in ApoA1- (absorptive) and Ki-67-positive (proliferative) enterocytes in stem cell-derived human small intestinal epithelium (HIE) as well as in patient biopsy samples, but not in any of the tested human cell lines. The infection did not result in tissue damage and did not trigger type I and type III interferon (IFN) signalling, whereas the control, human coxsackievirus B3 (strain Nancy), triggered both IFNs. To investigate the tissue tropism, we infected a human tracheal/bronchial epithelium model (HTBE) with AiV-A1 isolates A846/88 and kvgh99012632/2010 and, as a control, with rhinovirus A2 (RV-A2). AiV-A1 isolate kvgh99012632/2010, but not isolate A846/88, replicated in HTBE and induced type III IFN and ISGs signalling. By using various pharmacological inhibitors, we elaborated that cellular entry of AiV-A1 depends on clathrin, dynamin, and lipid rafts and is strongly reliant on endosome acidification. Viral particles co-localised with Rab5a-positive endosomes and promoted leakage of endosomal content. Our data shed light on the early events of AiV-A1 infection and reveal that different isolates exhibit distinct tissue tropism. This supports its clinical importance as a human pathogen with the potential to evolve toward broader tissue specificity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Imaging and image processing is the fundamental pillar of interventional oncology in which diagnostic, procedure planning, treatment and follow-up are sustained. Knowing all the possibilities that the different image modalities can offer is capital to select the most appropriate and accurate guidance for interventional procedures. Despite there is a wide variability in physicians preferences and availability of the different image modalities to guide interventional procedures, it is important to recognize the advantages and limitations for each of them. In this review, we aim to provide an overview of the most frequently used image guidance modalities for interventional procedures and its typical and future applications including angiography, computed tomography (CT) and spectral CT, magnetic resonance imaging, Ultrasound and the use of hybrid systems. Finally, we resume the possible role of artificial intelligence related to image in patient selection, treatment and follow-up., (© 2023 Royal Australian and New Zealand College of Radiologists.)

Vimentin is highly expressed in metastatic cancers, and its expression correlates with poor patient prognoses. However, no causal in vivo studies linking vimentin and non-small cell lung cancer (NSCLC) progression existed until now. We use three complementary in vivo models to show that vimentin is required for the progression of NSCLC. First, we crossed LSL-Kras G12D ; Tp53 fl/fl mice (KPV +/+ ) with vimentin knockout mice (KPV -/- ) to demonstrate that KPV -/- mice have attenuated tumor growth and improved survival compared with KPV +/+ mice. Next, we therapeutically treated KPV +/+ mice with withaferin A (WFA), an agent that disrupts vimentin intermediate filaments (IFs). We show that WFA suppresses tumor growth and reduces tumor burden in the lung. Finally, luciferase-expressing KPV +/+ , KPV -/- , or KPV Y117L cells were implanted into the flanks of athymic mice to track cancer metastasis to the lung. In KPV Y117L cells, vimentin forms oligomers called unit-length filaments but cannot assemble into mature vimentin IFs. KPV -/- and KPV Y117L cells fail to metastasize, suggesting that cell-autonomous metastasis requires mature vimentin IFs. Integrative metabolomic and transcriptomic analysis reveals that KPV -/- cells upregulate genes associated with ferroptosis, an iron-dependent form of regulated cell death. KPV -/- cells have reduced glutathione peroxidase 4 (GPX4) levels, resulting in the accumulation of toxic lipid peroxides and increased ferroptosis. Together, our results demonstrate that vimentin is required for rapid tumor growth, metastasis, and protection from ferroptosis in NSCLC., (© 2023. The Author(s).)

The index of refraction and the extinction coefficient for thin films of boron carbide were determined by angle-dependent reflectance measurements in the vacuum-ultraviolet spectral range. The numerical approximation was done using transfer-matrix formalism in combination with particle swarm optimization for the fitting algorithm. By this, not only for the reflectance measurement but also for the numerical approximation, a profound uncertainty budget was developed. This includes possible effects due to contamination and intermediate layers. Thus it was possible to establish a method for determination of n and k with reliable and highly traceable uncertainties, and to significantly improve the consistency of existing data required for current developments in optical technology.

We provide the first quantitative comparison between Barkhausen noise experiments and recent predictions from the theory of avalanches for pinned interfaces, both in and beyond mean field. We study different classes of soft magnetic materials, including polycrystals and amorphous samples-which are characterized by long-range and short-range elasticity, respectively-both for thick and thin samples, i.e., with and without eddy currents. The temporal avalanche shape at fixed size as well as observables related to the joint distribution of sizes and durations are analyzed in detail. Both long-range and short-range samples with no eddy currents are fitted extremely well by the theoretical predictions. In particular, the short-range samples provide the first reliable test of the theory beyond mean field. The thick samples show systematic deviations from the scaling theory, providing unambiguous signatures for the presence of eddy currents.

Background: Incorporating transplantation into undergraduate medical curricula can improve organ procurement rates. Intricacies related to the assessment of donor suitability, the clinical diagnosis of brain death, and relevant legal processes are key challenges for the newly qualified doctor. The aim of this study was to describe and analyze knowledge of medical students regarding the various aspects dealing with the diagnosis of brain death, with a view to designing an undergraduate training module., Methods: A previously validated, self-administered, 26-item questionnaire was distributed to all medical students at the University of Cape Town. General data included age, sex, year of study, and career interests. Knowledge-specific questions explored the suitability of potential organ donors (8 items), the clinical diagnosis of brain death (7 items), and legal factors (11 items) thereof. Descriptive statistical methods were then used to analyze the data., Results: There were 346 participants; 217 (63%) were pre-clinical students and 29 (8%) carried an organ donor card. The mean and median scores for the 26 items were both 12 (range, 0-25). Mean scores increased steadily with years of medical education: from 8 in the first year of study, 10 in the second year, and 17 in the final year. Demographics, year of study, organ donor status, and an interest in a surgical career did not influence knowledge levels (P > .05)., Conclusions: Medical students have limited knowledge about brain death and identification of potential organ donors. This confirms the need for an educational intervention early in the medical curriculum., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Secondary uveitic glaucoma in children can only be controlled in many cases by surgery. The aim of this study was to evaluate the outcome of trabeculectomy (TE) with administration of mitomycin C in children with secondary uveitis associated with juvenile idiopathic arthritis (JIA)., Materials and Methods: This study was a retrospective chart review of 21 children with uveitic glaucoma who underwent TE with administration of mitomycin C including analysis of complications, further interventions, additional surgical procedures to control intraocular pressure (IOP) and of the success rates after a mean follow-up of 5 years., Results: Defining success as an IOP ≤ 15 mmHg, the surgical success rate after TE was 55 % after 1 year and 38 % after 5 years but 43 % of the children required further IOP controlling operations in the long-term follow-up. An IOP ≤ 15 mmHg was observed in 70 % of the children after 1 year and in 62 % after 5 years. In regard to the overall success (with topical antiglaucomatous medication) the success rate increased to 71.4 % after 5 years., Conclusions: The results show that TE is a suitable surgical procedure to control IOP in secondary uveitic glaucoma of JIA patients. In the long-term follow up additional postoperative adjustments are necessary to control the IOP.

Background: The octamer-binding transcription factor 4 (Oct4) was originally described as a marker of embryonic stem cells. Recently, the role of Oct4 as a key regulator in pluripotency was shown by its ability to reprogram somatic cells in vitro, either alone or in concert with other factors. While artificial induction of pluripotency using transcription factors is possible in mammalian cell culture, it remains unknown whether a potential natural transfer mechanism might be of functional relevance in vivo. The stem cell based regeneration of deer antlers is a unique model for rapid and complete tissue regeneration in mammals and therefore most suitable to study such mechanisms. Here, the transfer of pluripotency factors from resident stem cell niche cells to differentiated cells could recruit more stem cells and start rapid tissue regeneration., Methodology/principal Findings: We report on the ability of STRO-1(+) deer antlerogenic mesenchymal stem cells (DaMSCs) to transport Oct4 via direct cell-to-cell connections. Upon cultivation in stem cell expansion medium, we observed nuclear Oct4 expression in nearly all cells. A number of these cells exhibit Oct4 expression not only in the nucleus, but also with perinuclear localisation and within far-ranging intercellular connections. Furthermore, many cells showed intercellular connections containing both F-actin and α-tubulin and through which transport could be observed. To proof that intercellular Oct4-transfer has functional consequences in recipient cells we used a co-culture approach with STRO-1(+) DaMSCs and a murine embryonic fibroblast indicator cell line (Oct4-GFP MEF). In this cell line a reporter gene (GFP) under the control of an Oct4 responsive element is only expressed in the presence of Oct4. GFP expression in Oct4-GFP cells started after 24 hours of co-culture providing evidence of Oct4 transfer from STRO-1(+) DaMSCs to Oct4-GFP MEF target cells., Conclusions: Our findings indicate a possible mechanism for the expansion of a resident stem cell niche by induction of pluripotency in surrounding non-niche cells via transfer of transcription factors through intercellular connections. This provides a new approach to explain the rapid annual antler regrowth.

The behaviour of planktonic animals remains poorly understood due to the difficulty of observing them in situ without influencing their behaviour. Here we review experiments on the behavioural responses of Northern krill, Meganyctiphanes norvegica (and related organisms), in isolation in laboratory-based aquaria. The value of this approach lies in the close observation that is possible; the downside is the uncertainty as to how well the observed behaviour relates to the natural behaviour of the subject animal. We discuss studies of swimming and swarming, and the responses of krill to light. We consider techniques involving automatic recordings that avoid, to some extent, making subjective decisions on behaviour. The effects of isolation of such a gregarious animal and of exposure to unnaturally high light levels are also considered. We conclude that such experiments can be of great value as long as these limiting factors are addressed., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: There is increasing interest in testing surfactant preparations for asthma therapy. Previously, Curosurf was demonstrated to increase inflammation in allergic asthmatics. So far, little is known about the immunomodulatory effects of therapeutic surfactants, in particular concerning the interaction of surfactant components with eosinophils as key effector cells of the allergic airway inflammation. The aim of the present study was to determine the effect of different therapeutic surfactants on cellular functions of eosinophils., Methods: Eosinophils were isolated from peripheral blood of atopic volunteers and incubated with the natural animal-derived surfactants Curosurf or Alveofact or the synthetic recombinant human surfactant Venticute at different concentrations for up to 42 h., Results: Curosurf and Venticute modulated the viability of eosinophils. While incubation with Curosurf increased the number of necrotic eosinophils after 1, 20 and 42 h, Venticute increased the number of apoptotic and necrotic cells after 1 h, but there were no differences compared with control cells at later time points. All surfactant preparations increased the levels of eosinophil cationic protein after 20 h and, in addition, Curosurf enhanced eosinophil cationic protein release after 42 h. The supernatant of eosinophils induced chemotaxis against autologous eosinophils, and the presence of Curosurf, but not Alveofact or Venticute, augmented the chemotactic effect. Chemotaxis was partly blocked by inhibition of eotaxin but not by inhibition of leukotrienes or platelet-activating factor., Conclusions: Therapeutic surfactants differ in their effects on eosinophil viability and the accompanying release of inflammatory mediators and chemotactic signals. Proinflammatory effects were most pronounced for the natural surfactant Curosurf., (Copyright (C) 2009 S. Karger AG, Basel.)

The annual regeneration of deer antlers is a unique developmental event in mammals, which as a rule possess only a very limited capacity to regenerate lost appendages. Studying antler regeneration can therefore provide a deeper insight into the mechanisms that prevent limb regeneration in humans and other mammals, and, with regard to medical treatments, may possibly even show ways how to overcome these limitations. Traditionally, antler regeneration has been characterized as a process involving the formation of a blastema from de-differentiated cells. More recently it has, however, been hypothesized that antler regeneration is a stem cell-based process. Thus far, direct evidence for the presence of stem cells in primary or regenerating antlers was lacking. Here we demonstrate the presence of cells positive for the mesenchymal stem cell marker STRO-1 in the chondrogenic growth zone and the perivascular tissue of the cartilaginous zone in primary and regenerating antlers as well as in the pedicle of fallow deer (Dama dama). In addition, cells positive for the stem cell/progenitor cell markers STRO-1, CD133 and CD271 (LNGFR) were isolated from the growth zones of regenerating fallow deer antlers as well as the pedicle periosteum and cultivated for extended periods of time. We found evidence that STRO-1(+) cells isolated from the different locations are able to differentiate in vitro along the osteogenic and adipogenic lineages. Our results support the view that the annual process of antler regeneration might depend on the periodic activation of mesenchymal progenitor cells located in the pedicle periosteum. The findings of the present study indicate that not only limited tissue regeneration, but also extensive appendage regeneration in a postnatal mammal can occur as a stem cell-based process.

This paper presents two in-depth studies on RnaPredict, an evolutionary algorithm for RNA secondary structure prediction. The first study is an analysis of the performance of two thermodynamic models, Individual Nearest Neighbor (INN) and Individual Nearest Neighbor Hydrogen Bond (INN-HB). The correlation between the free energy of predicted structures and the sensitivity is analyzed for 19 RNA sequences. Although some variance is shown, there is a clear trend between a lower free energy and an increase in true positive base pairs. With increasing sequence length, this correlation generally decreases. In the second experiment, the accuracy of the predicted structures for these 19 sequences are compared against the accuracy of the structures generated by the mfold dynamic programming algorithm (DPA) and also to known structures. RnaPredict is shown to outperform the minimum free energy structures produced by mfold and has comparable performance when compared to sub-optimal structures produced by mfold.

This retrospective study included 148 patients who were evaluated for postoperative long-term results after osteosynthesis of isolated zygoma fractures. The influence of open reposition of the zygomaticoalveolar crest to middle face symmetry was evaluated quantitatively with a zygometer. In dependence on operative management patients were divided into two groups: In group I zygomaticofrontal suture (1-point-fixation) and infra-orbital rim were exposed (2-point-fixation), followed by osteosynthesis. In group II additional exposure of zygomaticoalveolar crest was performed and if required osteosynthesis was performed (3-point-fixation). For osteosynthetic reconstruction of isolated zygoma fractures the only 2-point-fixation is usually enough to achieve lateral middle face symmetry. In all cases zygomaticofrontal suture and alternatively infra-orbital rim or respectively zygomaticoalveolar crest should be supplied osteosynthetically. A further 3-point-fixation is indicated only in exceptional cases--for example comminuted fractures of lateral middle face columns. For an exact anatomical reposition of zygoma fractures the exposition and possible osteosynthesis of zygomaticoalveolar crest is recommended.

Introduction: Fractures of the wrist and forearm are the most frequent injuries in Inline-Skating. Clinical experience has shown that these injuries can be prevented the use of wrist protectors. But various authors have shown that fractures can also occur despite the use of wrist protectors. Aim of this study was to examine different wrist protectors in a biomechanical set up., Method: A standardized trauma was simulated using an artificial hand with a certain weight. The forces with or without protective devices have been recorded by a force moment sensor. The results of different protectors have been compared., Results: A mean force of 956 N was measured without the use of a protective device. With the application of a wrist protector these forces were reduced between 4 and 20 %. The best values have been reached with models with a strong base plate., Conclusions: The results of the present study may explain the clinical observation that wrist and forearm fractures can occur despite the use of a wrist guard. The protective effect of a wrist protector depends highly on the model that is used.

Problem: The aim of this study was to determine which technique--B-scan sonography, 3D sonography, X-ray, or endoscopy--is the most effective for diagnosis in changes of the maxillary sinus after sinus lift and simultaneous augmentation., Material and Methods: In 33 patients the maxillary sinus was examined before sinus lift, 1 week and 6 months postoperatively with a 7.5-MHz linear scanner and 3D sonography. At the same time, the sonographic results were compared with the X-ray as well as the endoscopic results. Endoscopy of the maxillary sinus was only applied during the sinus lift operation and the abutment operation after 6 months., Results: A total of 56 operations of sinus lift and simultaneous augmentation with autogenous bone were carried out. Preoperatively, there where no pathological findings detectable in the maxillary sinus. One week postoperatively, the X-rays as well as the sonographic images revealed thickening of the mucosa in 40 maxillary sinuses. After the healing period of 6 months, polyposa was still detected in three cases sonographically, in the radiographic follow-up as well as endoscopically. The sonographic 3D imaging of the maxillary sinus improved the spatial visualization of postoperative changes in the maxillary sinus and the reliability of the diagnosis., Conclusion: Due to the lack of radiation, the cost effectiveness, and its reproducibility, sonography is suitable as a primary screening technique in recall. In cases of normal sonographic findings but clinical symptoms, CT, MRT, and endoscopy should be performed to exclude pathological processes of the posterior maxillary sinus.

Although widely used, the radial forearm flap has been criticized for the poor quality of its donor site. Attempts to avoid donor-site problems have concentrated on the elaboration of the split-thickness and full-thickness skin graft methods of reconstruction. Skin grafts frequently fail over the flexor carpi radialis tendon, leading to chronic skin breakdown or, at best, tendon adhesion. Tissue expansion appears to be a good alternative that allows the use of local tissues to ultimately improve the forearm donor-site appearance. To avoid the disadvantages of traditional silicone balloon expanders (such as pressure peaks, infection, the valve at a distance from the expander, postoperative fillings), an osmotically active system was used. In an 18-month prospective study, 10 osmotically active hydrogel tissue expanders were placed on the forearms of 10 patients. The radial forearm flap was performed for intraoral reconstruction after surgical resection of oral cavity malignancies. The study showed that, in nine out of 10 patients, the expanded skin achieved was sufficient to cover the donor site after raising the forearm flap. Additionally, the expansion-related swelling pressure was well tolerated by the patients, the cosmetic results were very satisfactory, and the incidence of complications was very low. By using osmotically active hydrogel tissue expanders, there is no postoperative filling and no risk of complications arising from defective balloon expanders, filling valves, or missing ports.

We study the field theories for pinned elastic systems at equilibrium and at depinning. Their beta functions differ to two loops by novel "anomalous" terms. At equilibrium we find a roughness zeta = 0.208 298 04 epsilon + 0.006 858 epsilon(2) (random bond), zeta = epsilon/3 (random field). At depinning we prove two-loop renormalizability and that random field attracts shorter range disorder. We find zeta = epsilon/3(1 + 0.143 31 epsilon), epsilon = 4 - d, in violation of the conjecture zeta = epsilon/3, solving the discrepancy with simulations. For long range elasticity zeta = epsilon/3(1 + 0.397 35 epsilon), epsilon = 2 - d, much closer to the experimental value (approximately 0.5 both for liquid helium contact line depinning and slow crack fronts) than the standard prediction 1/3.

The aim of this study was to investigate the swelling properties and the biocompatibility of a novel tissue expander material. The self-inflating material is a hydrogel consisting of a modified copolymer of methylmethacrylate and N-vinyl-2-pyrrolidone, which takes up water by osmosis. To increase the swelling volume, the primarily neutral gel material was modified by converting it into an ionized gel. To study the swelling and pressure behavior of the material, the anhydrous gel cylinders were equilibrated in distilled water, saline, and sugar solutions. The biocompatibility was investigated in cell culture. We tested the hydrogel eluate after swelling for cytotoxicity and mutagenicity using the cell lines MRC-5 and P3X63 Ag8 653 (Ag8). Furthermore, particles of the material were added to cell cultures to induce foreign body reactions and to verify its influence on monocyte differentiation. The material has a swelling capacity (Q = maximum swelling volume/anhydrous volume) of 5 to 50 depending on the degree of ionization of the polymer network. In this study, two polymer modifications with a swelling equilibrium of Q = 11.1 and 30 in water were tested. The swelling ratio also depends on concentration and ion content of the equilibration medium. The highest swelling capacity was found in water, the lowest in Ringer's solution. The swelling of the anhydrous material with the swelling capacity of Q = 11.1 fits best the average purpose of material properties for tissue expansion and generates a maximal hydrostatic pressure of approximately 235 mmHg. Effects on cell proliferation were detected only at the highest eluate concentration tested (i.e., eluate: culture medium = 1:1), which was far beyond physiological values, whereas mutagenicity was absent. Monocytes neither migrated nor tightly attached to the hydrogel. They neither phagocytose the material nor did they show any sign of a foreign body reaction, e.g., formation of multinucleated giant cells or monocyte proliferation. In the presence of hydrogel material, the differentiation processes of monocytes to macrophages or dendritic cells, respectively, were found to be undisturbed. From these results, we conclude that there is a high biocompatibility of the expander material, which may be a favorable and interesting candidate for further clinical applications., (Copyright 2000 John Wiley & Sons, Inc.)

Objective: The goal of this study was to clarify whether patients with chronic pain selectively attend to syndrome-specific (i.e., pain-related) information and, if so, to determine whether this occurs at the conscious (i.e., strategic) or unconscious (i.e., automatic) level., Setting: This study was conducted at a tertiary care rehabilitation center., Patients: Thirty-three patients with chronic back and/or neck pain and 33 healthy volunteers matched for age, sex, and education participated in this study., Outcome Measures: A computerized version of a modified Stroop color-naming task, with unmasked and masked conditions, was used to assess strategic and automatic information processing of words related to sensory pain, affect pain, physical threat, social threat, and neutral themes., Results: A repeated-measures ANOVA indicated that patients with chronic pain but not healthy volunteers had delayed color-naming latencies to both sensory and affect pain words in the unmasked condition. Color-naming latency differences were not evident for other word types in the unmasked condition or for any word types in the masked condition. Correlational and regression analyses indicated that the delayed color-naming latencies to pain words in the unmasked condition observed for the chronic pain patients were, in part, associated with high pain-specific cognitive anxiety and interference and lower levels of anxiety sensitivity., Conclusions: Individuals with chronic pain selectively process pain-related cues at the strategic level but not at the automatic level. Implications of the findings and future research directions are discussed.

Human monocytes (Mo) in culture can be differentiated into macrophages (M phi), dendritic cells (DC) and osteoclasts. In addition, we have established a Mo-derived in vitro granuloma model which here was compared with ex-vivo isolated foreign body granuloma cells. In these models overlapping phenotypes developed between monocyte-derived dendritic cells (MoDC), osteoclasts, M phi, and osteoblasts. In Mo cultures granulomas were induced by immobilized particulate material. AP activity (osteoblast marker) was found to be co-expressed with cytoplasmic tartrate resistant acid phosphatase (TRAP) as a marker of osteoclasts. While proliferating, the number of AP+ cells decreased, being replaced by cells co-expressing the osteoclast markers vitronectin receptor (VNR) and TRAP. Coexpression of the Mo/M phi marker CD68 with AP or VNR confirmed the monocytic origin of the cells. When Mo were treated with interleukin-4 (IL-4), the number of AP+ cells markedly increased and remained stably expressed over 12 days. In explants from ex vivo granulomas obtained from endoprosthetic revisions the major cell type was the AP+ cell co-expressing CD68. The bone-specific alkaline phosphatase (BAP) as a marker of osteoblasts was detected by FACS analysis in the ex vivo granuloma cells. By RT-PCR the mRNA for osteocalcin, which is a highly specific marker for osteoblasts, was detected. From our results we conclude an ontogenetic relationship between macrophages, DC and osteoclasts. Furthermore, the data suggest a transdifferentiation between Mo and osteoblasts.

Background: Clinical anophthalmia is characterized by the absence of an eyeball within the orbit and can result in overall growth retardation of the facial skeleton. The goal of treatment consists of fitting a serial prosthesis following rapid expansion of the contracted socket as soon as possible to achieve cosmetically acceptable eyelid and orbital symmetry., Methods: Four children, aged 3-11 months, were treated by implantation of an anhydrous, highly hydrophilic tissue expander into the rudimentary conjunctival sac. With hydration of up to 98% in 72 h, the copolymer of methylmethacrylate and vinylpyrrolidone acts like an osmotically self-inducing socket expander., Results: In the course of 2 months the previous contracted socket was enlarged, the horizontal lid length increased and the hydrated expander could be exchanged for a custom-made glass prosthesis., Conclusion: Preliminary results suggest that this new device can be used to avoid early plastic surgery of the eyelid. In addition, it also may enlarge the volume of the bony orbit.

We report the case of an unresected, metastatic gastric cancer, which was treated with a very short course of the oral 5-fluorouracil (5-FU) prodrug S-1. The patient had to discontinue chemotherapy during the first treatment cycle due to severe toxicity, but achieved a pathologically confirmed, long-term complete response of her primary tumour, a diffuse-type poorly differentiated adenocarcinoma.

In 26 patients with abscesses in the maxillofacial area, the electrolyte concentrations, pH and osmotic and hydrostatic pressures of the pus fluid were measured and calculated. The main cations identified were sodium (134 +/- 38 mmol/l) and potassium (37 +/- 16 mmol/l) and as anions chloride (183 +/- 46 mmol/l) and bicarbonate (10 +/- 4 mmol/l). The pH value of the pus liquid was 6.164 +/- 0.233. The calculated mean osmotic pressure of the pus liquid was 7910 +/- 1455 mm Hg, whereas the measured physical pressure inside the abscess was 49 +/- 13 mm Hg. Both pressure types show time-dependent pressure curves. With time, the real pressure inside the abscess cavity increases, whereas the osmotic pressure decreases. There was no relationship between the two pressure types and the different species of microorganisms responsible for the inflammation. The results of the study reveal that abscesses can be regarded as osmotically active systems, and the mechanism by which the abscess is formed might be as follows. After penetration of virulent microorganisms into the tissue space, the area of acute inflammation is walled off by the collection of inflammatory cells. Destruction of tissue by products of the polymorphonuclear leucozytes takes place and results in liquefactive necrosis and a hypertonic abscess cavity. The inwards-directed flow of tissue fluids into the cavity via the abscess membrane causes volume expansion and generates pressure, two facts that can explain the swelling dynamics and typical symptoms of abscesses in the maxillofacial area.

A possible complication of fossa canina infections is reactive thrombosis of the vena angularis, which can lead to cavernous sinus phlebothrombosis. According to the literature there are different opinions about the treatment protocol of fossa canina abscesses. Therefore a multicentre study was undertaken in which 55 departments of oral surgery were interviewed using a standardized questionnaire about their procedures. The basis of diagnosis consists of clinical examination (100%), antibiogram (77.1%) and radiography (97.1%). A total of 28.6% use additional imaging procedures. Sonography is used by 20.0% and is found to be helpful in the diagnosis of vena angularis thrombosis. The painful palpation of the medial angle of the eye is of major diagnostic importance (100%) although anatomic variations of the vena angularis have to be considered. Extraoral incisions are not used in most cases (25.7% in exceptional cases) as well as ligations of the vena angularis in case of thrombosis (8.6% in exceptional cases). There is an agreement in the use of antibiotics (elective administration in 14.3%, obligatory administration in 85.7%); 77.1% don't use heparin to treat thrombosis of the vena angularis. In heparin therapy risks such as bleeding complications and thrombocytopenia have to be considered.

Congenital anophthalmos is a rare malformation in which the optic vesicle fails to develop. This leads to a small bony orbit, a constricted mucosal socket, short eyelids, reduced palpebral fissure and malar hypoplasia. The treatment includes both aesthetic and functional aspects. Therefore, a two-step procedure is described using a new self-inflating hydrogel expander. A lens-shaped expander with a diameter of 8 mm expands the lids and the mucosal socket to allow insertion of an eye prosthesis. As a second step, orbital expansion is performed with a spherical device. The expanders absorb lacrimal fluid from the mucosal socket or tissue fluid and start swelling when implanted in the orbital tissue. The insertion of an expander into the orbit as well as into the conjunctival pocket including its fixation by a single suture took only a few minutes and was an easy procedure. The expansion of the small conjunctival sockets was successfully completed in all cases within a period of 2-4 weeks. The weight (= volume in ml) of devices increased from 0.15-1.5 g (lens-shaped expander; weight in grams = volume in ml) respectively, 0.3-3.5 g (spherical device). The expanders inserted in orbital tissue increased from 0.4-4.4 g. This is equivalent to a 10 to 11 fold increase in their water-free volumes. Orbital expansion with spherical devices in combination with the inserted eye prosthesis enlarges the lid and palpebral fissures also. In contrast to conventional silicon balloon expanders, the procedure using self-inflating hydrogel expanders is simple and highly efficient.

Ultrasound contrast agent is used in color Doppler flow imaging for signal enhancement in perfused vessels. We present our experience with its use in the head and neck area and the results obtained. Up until now, 30 patients with carcinomas of the oral cavity or the maxillary sinus, tumors of the mandible and metastatic or inflammatory lymph nodes have been examined. Conventional B-scan sonography was supplemented by non-contrast color Doppler flow imaging. Depending on the indication, 2.5 g Levovist in bolus or 4 g fractionated was injected intravenously in a concentration of 300 or 400 mg/ml. The administration of the contrast agent was tolerated by all patients without any side effects and in all cases led to a remarkable enhancement of the Doppler signals. About 15 to 30 s after injection, an enhancement in perfused vessels was detected. The fractioned injection of 4 g led to a lengthening of signal enhancement up to more than 10 min and to the possibility of examining more parts with a single application of contrast agent. In 64% of the lymph nodes, vessels could only be identified with the administration of Levovist. The general vessel topography could be better evaluated in 83% of the cases. The lymph-node-supplying vessels were identified in 8 of 11 patients after the injection of contrast media. Additional information, which was gained in 17 patients, increased the certainty of diagnosis or of the therapeutic concept. In three cases, the examinations with the signal enhancer resulted in a change in therapy. By applying signal enhancer in color Doppler sonography the fields of examination in the head and neck areas can be expanded.

Ultrasound contrast agent is used in color Doppler flow imaging for signal enhancement in perfused vessels. We present our experience with its use in the head and neck area and the results obtained. Up until now, 30 patients with carcinomas of the oral cavity or the maxillary sinus, tumors of the mandible and metastatic or inflammatory lymph nodes have been examined. Conventional B-scan sonography was supplemented by non-contrast color Doppler flow imaging. Depending on the indication, 2.5 g Levovist in bolus or 4 g fractionated was injected intravenously in a concentration of 300 or 400 mg/ml. The administration of the contrast agent was tolerated by all patients without any side effects and in all cases led to a remarkable enhancement of the Doppler signals. About 15 to 30 s after injection, an enhancement in perfused vessels was detected. The fractioned injection of 4 g led to a lengthening of signal enhancement up to more than 10 min and to the possibility of examining more parts with a single application of contrast agent. In 64% of the lymph nodes, vessels could only be identified with the administration of Levovist. The general vessel topography could be better evaluated in 83% of the cases. The lymph-node-supplying vessels were identified in 8 of 11 patients after the injection of contrast media. Additional information, which was gained in 17 patients, increased the certainty of diagnosis or of the therapeutic concept. In three cases, the examinations with the signal enhancer resulted in a change in therapy. By applying signal enhancer in color Doppler sonography the fields of examination in the head and neck areas can be expanded.

Background: Neutrophils are of great importance for the host's defense against invading organisms. Granulocyte colony-stimulating factor (G-CSF) has been used to augment both the neutrophil number and function, and its prophylactic administration has proved beneficial in animal models of sepsis. However, pretreatment with G-CSF is not practical under clinical conditions. We therefore investigated the effect of recombinant human (rh)G-CSF, administered only after infection, on the survival rate as well as the hemodynamic and cytokine response of the animals., Methods: Chronically catheterized conscious pigs were challenged with Pseudomonas aeruginosa (8 x 10(7) colony-forming units kg(-1) x h(-1) for 120 h (control group, n = 10). Animals in the G-CSF group (n = 7) also received rhG-CSF (5 microg kg(-1) x day(-1)), the first dose being given 3 h after beginning bacterial infusion., Results: The mortality rate was 50% (5/10) and 29% (2/7) in the control and G-CSF groups, respectively (p = NS, control vs. G-CSF group). Fever, severe pulmonary hypertension, and a hyperdynamic response were recorded in all of the animals. In spite of a prompt and significant recovery from the initial leukopenia (p < .05 vs. control group), the animals of the G-CSF group showed no significant differences in the parameters investigated from those of the controls. Compared with the survivors, the interleukin-1 receptor antagonist was markedly elevated in all nonsurvivors after 6 h of sepsis (p < .05)., Conclusions: These data suggest that treatment with rhG-CSF after the onset of bacterial sepsis might not significantly improve the chances of survival for non-neutropenic patients.

The synaptic contacts between the auditory sensory cells and identified auditory interneurons ON1 and AN2 have been examined at the ultrastructural level by selective electron-dense labeling of two interneurons or of one interneuron and the sensory fibers in the same preparation. The experiments have provided the following information. The auditory afferent fibers have a monosynaptic connection with the lateral inhibitors ON1 and the ascending interneuron AN2, allowing direct activation of these interneurons. Furthermore, our work proves that the paired, lateral, inhibitor ON1 neurons have direct output synapses onto each other. The results also show that the auditory afferent axons, themselves, receive synaptic inputs just before entering the central auditory neuropil. The effects of current injection into the ON1 neuron during auditory processing indicate that these synaptic inputs onto the afferents originate, in part, from the lateral branches of the ipsilateral ON1 neuron and that they have inhibitory function. The significance of these results for auditory processing and a future perspective for electron microscopic analysis of neuropil are discussed.

Chin correction is an important procedure in orthognathic and facial plastic surgery. Whereas simple genioplasty can be easily performed by sliding or jumping osteotomies, extreme chin advancement, i.e., an advancement greater than 10 mm, requires the use of the double-step sliding technique. Independent of the fixation technique chosen these bony segments tend towards instability when being pedicled on the periosteum and the posterior muscle attachments. The traction force of the geniohyoid, genioglossus and digastric muscles is responsible for the instability of the advanced segments. To compensate for this muscle force a special double-step osteotomy was developed that combines the sliding and jumping osteotomy and allows the positioning of the pedicled basal chin segment in front of the mandible. Using this new tandem genioplasty, six cases of retrogenia with an advancement of 16 to 20 mm were corrected. The only complications in one case was mild wound dehiscence of the mucous membrane of the mandible's frontal vestibulum.

Background: Over the past 20 years, considerable progress has been made in the early detection and treatment of cancer. Despite these advances, cancer incidence and mortality rates among Native Americans have not kept pace. Cancer centers are in a unique position to offer technical assistance, resources, and a long term commitment that can help address these concerns within tribal communities., Methods: The University of Wisconsin Comprehensive Cancer Center developed a proactive plan to build collaborative partnerships with Wisconsin Native Americans. This began with an outreach plan that prioritized intervention strategies. A Native American health professional was hired to serve as liaison and advocate. Resources were committed, and staff was assigned to work with the community to develop intervention strategies that would be culturally competent and able to address the concerns of community members., Results: Various collaborative activities resulted from these efforts. These included participation in Native American cancer work groups, conferences, and seminars. Most importantly, these efforts resulted in a partnership with the Native American community that is based on honor and mutual respect., Conclusions: Careful planning, prioritization, allocation of resources, and a commitment to Native Americans can result in partnerships with the community and interventions that address their cancer control needs. Building and sustaining these partnerships takes time and thoughtful exploration of issues and concerns to develop mutual trust and respect. Both cancer centers and tribal communities can benefit by recognizing that shared power, as a reciprocal value, can benefit the whole.

Conventional fractionated radiation therapy was used in 15 patients to treat arteriovenous malformations (AVMs) of the brain deemed inoperable or incompletely obliterated using endovascular or surgical techniques. The AVMs measured from 0.8 to 85 cm3 (mean 28.2 cm3; median 24 cm3). Angiography in 12 patients 1-21 years following radiation therapy demonstrated no significant change in 7, slight reduction in 2, near complete obliteration in 1, and complete obliteration in 2. Magnetic resonance imaging further demonstrated apparent obliteration in one other case. Three irradiated AVMs were available for pathological examination following fatal recurrent hemorrhage after 21 years in case 1 and following surgery after 5 years in cases 2 and 3. Doses of 20 and 45 Gy were delivered to the area of the AVM in 10 and 15 fractions with a 6-MV linear accelerator in case 1 and in cases 2 and 3, respectively. A blinded histopathological comparison was made of the latter cases and three AVMs removed at surgery that were not previously irradiated and that were comparable in size, number of arterial feeders, and location within the brain. Segmental hyalinization of some blood vessels was seen in both irradiated and nonirradiated cases. The single postmortem specimen showed extensive thrombosis but a patent nidus. The findings are in keeping with the clinical impression that conventional fractionated radiation therapy fails to alter the natural history of cerebral AVMs. The favorable outcome of radiosurgery on small- to medium-sized AVMs appears attributable to the shorter duration of therapy using relatively high-dose prescriptions to the nidus.

Electrolyte concentrations, osmotic and hydrostatic pressures of 26 abscesses in the head and neck area were measured. As the main cations Sodium (138 +/- 38 mmol/l) and Potassium (37 +/- 16 mmol/l and as anions Chloride (183 +/- 46 mmol/l) and Bicarbonate (10 +/- 4 mmol/l) were identified. The pH-value of the pus liquid decreased to 6.164 +/- 0.233. The calculated mean osmotic pressure of the pus liquid was 7910 +/- 1455 mm Hg whereas the measured physical pressure inside the abscess was 49 +/- 13 mm Hg. As a consequence of being an osmotically active system the inactivity of antibiotics in abscesses may be explained by a lack of diffusion through the abscess membrane, due to electrochemical charges or the size of the molecule, or by lack or reduction of the capillary perfusion and ultrafiltration rate due to physical pressure of the abscesses on perifocal blood vessels.

A new measuring instrument called "zygometer" is introduced. This device provides a simple technique for measuring the position of the zygomatic bone and arch allowing for lateral comparison. Standard measurements of the midface were collected from 250 uninjured test subjects. In 80% of the cases a symmetry of up to 2 mm was determined. The research results are presented and discussed with reference to clinical application.

The role of the periosteum in the osteointegration of hydroxyapatite (HA) granules was studied in the skull and tibial bone of eight adult Göttingen minipigs. Calcein and tetracycline were used as labeling stains to determine new bone formation. Depending on the condition of the periosteum, three different patterns of osteointegration of HA were found.

The possibility of using an osmotically-driven system for effective tissue expansion has been verified. As a biocompatible and efficient system, a copolymer of methylmethacrylate and vinylpyrrolidone is used in animal research (rats). This hydrogel was able to generate, in vitro, a physical swelling pressure of approximately 235 mm Hg. The range of possible volume expansion in solutions of differing concentrations was 3 to 30 times its water-free gel form. In animal experiments a high biocompatibility and efficiency in tissue expansion can be observed.

The effect of lidocaine on the growth rate of human squamous cell carcinoma of the head and neck area was investigated in tissue culture. As growth parameters, the mean cell area, the total cell area, the field area and the total number of cells have been measured by digital image analysis. The carcinoma's two cell types--round and spindle--were recorded separately to verify different patterns of alteration. All parameters did not decrease significantly when lidocaine was given as a single dose prior to the culture. A significant decrease (p < 0.05) at day 6, 9 and 12 in culture was found when lidocaine (7 micrograms ml-1) was added to the culture medium.

Conventional radiation therapy has been used in the treatment of arteriovenous malformations (AVM's) for many years, but there are limited data pertaining to specific treatment parameters, long-term results, and complications. Between 1955 and 1985, 15 patients with AVM's deemed inoperable or incompletely obliterated using surgical or endovascular techniques were treated at the University of Western Ontario. There were nine males and six females, aged 15 to 48 years (mean 29 years). Presenting symptoms included hemorrhage in nine patients, seizures in four, and focal neurological deficits in two. There were three infratentorial and 12 supratentorial AVM's, ranging in size from 1.5 to 6.5 cm. Therapy prior to irradiation consisted of incomplete surgical removal in four cases and subtotal embolization in four. One patient received 2000 cGy of irradiation, while 4000 to 5000 cGy were delivered in the remaining patients to fields ranging in size from 4 x 4 to 14 x 14 cm in 15 to 28 fractions. The 15 patients have been followed for 1 1/2 to 21 years since undergoing radiotherapy (mean 8.1 years). Angiography in 12 patients at 1 to 21 years following irradiation demonstrated no significant change in seven patients, a slight reduction in AVM size in two, near-complete obliteration in one, and complete obliteration in two. One patient with an AVM measuring 6.5 cm refused angiography but underwent magnetic resonance imaging at 5 years which showed no evidence of residual AVM. There were four hemorrhages in 122 patient-years of follow-up study, indicating a hemorrhage rate of 3.3% per year. The authors conclude that conventional irradiation is successful in obliterating AVM's in only about 20% of cases.

The pre- and intraoperative determination of the midface symmetry during the management of trauma or reconstructive surgery cases may be difficult due to swelling of the covering tissue. To handle these problems, a new apparatus, called "Zygometer", is introduced. This instrument is able to measure the position of the midface bones and enables a comparison with the controlateral side. The results of a study with 250 persons to get standard measurements for symmetry and asymmetry are presented and discussed. Indications and clinical application of the zygometer are demonstrated.

The omega neurons of crickets are connected with each other by reciprocal inhibition. This inhibition could be mimicked by bath-applied histamine and blocked by histamine H1-antagonists. Histamine, like ON1, also influenced the ascending interneuron AN2, so that its response pattern more closely reflected the temporal structure of the calling song. This evidence strongly suggests that histamine is the inhibitory transmitter of the ON1s.

The incidence and morphology of thyroid neoplasms in different strains and stocks of rats are reported. The frequency of thyroid tumours varied to a great extent between different strains of rats. Low incidences were observed in DA/Han (0.85 per cent) and BDII/Han rats (1.25 per cent), while somewhat higher incidences occurred in Han:WIST rats (7.3 per cent). The highest number of thyroid tumour-bearing rats was found in the Han:SPRD stock (55.5 per cent). Thyroid neoplasms were classified histologically as polymorphofollicular adenomas, papillary adenomas, cystadenomas, polymorphofollicular carcinomas, papillary carcinomas, C-cell adenomas and C-cell carcinomas (medullary carcinomas). C-cell neoplasms were predominant in Han:SPRD rats (93.0 per cent), while the majority of tumour-bearing Han:WIST rats (61.4 per cent) had follicular tumours.

The chorionic plate of the human placenta at term consists of amniotic epithelium, amniotic connective tissue, intermediate layer, chorionic connective tissue, cytotrophoblast, and syncytiotrophoblast. - The connective tissue layers are divided into unorientated (situated just below the amniotic epithelium and in direct contact with the trophoblast) and orientated layers (between the two unorientated connective tissue layers). Besides an accelular border below the amniotic epithelium the connective tissue includes fibrocytes, fibroblasts, histiocytes, and old Hofbauer cells in the intermediate layer. - From the edge of the chorionic plate to its centre, the number of well preserved cytotrophoblasts decreases; instead of them especially intercellular substances (subchorial fibrinoid) but also degenerating cells predominate. In the trophoblast layer rests of chorionic villi are localized. Among the intact cytotrophoblasts 4 types can be distinguished (less differentiated, well differentiated, spongiotrophoblast-like, and glycogen-rich cytotrophoblastic cells). They are interpreted as different developmental stages of one and the same cell population. - The syncytiotrophoblast is inter rupted at many places; only fragments can be observed. Then cytotrophoblastic cells or intercellular substances may form the border to the intervillous space.