Ileal transposition: A non-restrictive bariatric surgical procedure that reduces body fat and increases ingestion-related energy expenditure.

BACKGROUND: Ileal Transposition (IT) was developed as a model to study body weight reduction without the restrictive or malabsorptive aspects of other bariatric surgeries, but the exact mechanisms of the alterations in body weight after IT are not completely understood. OBJECTIVE: To provide a detailed description of the surgical procedure of IT, and describe its effect on energy balance parameters. METHODS: Adult male Lewis rats underwent either IT (IT+) or sham (IT-) surgery. Following surgery body weight and energy intake were monitored. After attaining weight stability (> 30 days), energy expenditure and its components were assessed using indirect calorimetry at a day of fasting, limited intake, and ad libitum intake. At the end of the study body composition analysis was performed. RESULTS: IT+ resulted in transiently reduced energy intake, increased ingestion-related energy expenditure (IEE) and decreased body and adipose tissue weight when compared to IT-. At weight stability, neither energy budget (i.e., energy intake - energy expenditure), nor energy efficiency was different in IT+ rats compared to IT-. CONCLUSION: Our data show that the primary cause of weight reduction following IT+ is a transient reduction in energy intake. If the increased IEE is related to a higher level of satiety, compensatory feeding to bridge body weight difference between IT+ and IT- rats is less likely to occur.

Exploitation of Langerhans cells for in vivo DNA vaccine delivery into the lymph nodes.

There is no clinically available cancer immunotherapy that exploits Langerhans cells (LCs), the epidermal precursors of dendritic cells (DCs) that are the natural agent of antigen delivery. We developed a DNA formulation with a polymer and obtained synthetic 'pathogen-like' nanoparticles that preferentially targeted LCs in epidermal cultures. These nanoparticles applied topically under a patch-elicited robust immune responses in human subjects. To demonstrate the mechanism of action of this novel vaccination strategy in live animals, we assembled a high-resolution two-photon laser scanning-microscope. Nanoparticles applied on the native skin poorly penetrated and poorly induced LC motility. The combination of nanoparticle administration and skin treatment was essential both for efficient loading the vaccine into the epidermis and for potent activation of the LCs to migrate into the lymph nodes. LCs in the epidermis picked up nanoparticles and accumulated them in the nuclear region demonstrating an effective nuclear DNA delivery in vivo. Tissue distribution studies revealed that the majority of the DNA was targeted to the lymph nodes. Preclinical toxicity of the LC-targeting DNA vaccine was limited to mild and transient local erythema caused by the skin treatment. This novel, clinically proven LC-targeting DNA vaccine platform technology broadens the options on DC-targeting vaccines to generate therapeutic immunity against cancer.

Rat enamel contains RP59: a new context for a protein from osteogenic and haematopoietic precursor cells.

We have recently identified a protein, RP59, in bone marrow cells and young osteoblasts, in cells involved in bone repair and in young erythroblasts and megakaryocytes. Here, we report immunohistochemical data at the light- and electron-microscope level indicating that RP59 is also present in newly secreted tooth enamel of the rat and in ameloblasts, the formative cells. In enamel matrix, RP59 was located proximal to secretory ameloblasts only, i.e. in newly secreted material. Distal enamel and enamel in association with maturation stage ameloblasts were unlabelled. Secretory ameloblasts contained RP59 in the matrix-proximal region including Tomes' processes, post-secretory ameloblasts in the cell-matrix interface. Western blotting of proteins from tooth germs identified RP59 as a band at 90 kD, co-migrating with RP59 from bone marrow and spleen. Antisera versus a chemically synthesised RP59 peptide and versus a bacteria-synthesised protein fragment reacted in the same manner. In situ hybridisation of tooth tissue revealed RP59 RNA specifically in ameloblasts. The reverse transcription/polymerase chain reaction method identified tooth RNA coding for RP59. Sequence analysis indicated that RP59 RNA from tooth and marrow had the same sequence. An internal sequence motif was found in rat RP59 resembling a signal implicated in secretion of the chicken "engrailed" gene product. The findings indicate that RP59 is a genuine product of ameloblasts and that it is secreted in the course of enamel formation together with other matrix components.

Nucleobindin--a Ca2+-binding protein present in the cells and mineralized tissues of the tooth.

Nucleobindin, a Ca2+-binding protein, has been previously identified within the nucleus and endoplasmic reticulum, and in association with the Golgi membrane. In addition, nucleobindin has been shown to be a minor constituent of bone extracellular matrix and has been postulated to play a role in mineralization. In the current investigation, we report the expression and localization of nucleobindin within odontoblasts and the dentin matrix. Nucleobindin mRNA transcripts were detected in the tooth, and in situ hybridization analysis substantiated the findings, showing nucleobindin expression within mature odontoblasts and within the cells of surrounding developing alveolar bone. Western blot analysis of tooth protein extracts demonstrated the presence of a 63 kDa protein, which showed immunologic affinity for a rat nucleobindin peptide antibody. The distribution of the protein was shown in mature odontoblasts by using immunohistochemistry. Moreover, immunogold labeling of nucleobindin and subsequent ultrastructural analysis demonstrated a similar pattern of distribution. Nucleobindin was identified within odontoblast cellular compartments: the nucleus, endoplasmic reticulum, and mitochondria. Of interest, nucleobindin localization was observed within the surrounding dentin extracellular matrix, and immunogold labeling was shown to accumulate with tissue development toward the cusp. The study clearly demonstrated the presence of nucleobindin within dental tissues. In consideration of the known functional properties of nucleobindin, it may be postulated that nucleobindin may contribute to the accumulation and transport of Ca2+ ions to the mineralization front prior to hydroxyapatite deposition.

Quantitative assessment of apoptotic and proliferative gingival keratinocytes in oral and sulcular epithelium in patients with gingivitis and periodontitis.

BACKGROUND: Periodontal disease is caused by a chronic infection inducing an inflammatory reaction that leads to a breakdown of tooth-supporting tissue. The maintenance of an equilibrium between the host defence and microorganisms in the sulcus is essential to preserve health. All multicellular organisms have mechanisms for killing their own cells, and use physiological cell death for defence, development, homeostasis and ageing. Apoptosis and proliferation are very important phenomena in regulating this and a disturbance is often associated with disease e.g. cancer, AIDS, Alzheimer's disease, rheumatoid arthritis. OBJECTIVE: The aim of this study was to determine whether the number of apoptotic and proliferative gingival keratinocytes differed between patients with gingivitis and those with periodontitis. MATERIAL AND METHODS: The distribution of neutrophil elastase, PCNA/cyclin, DNA fragmentation (apoptosis) and p53 was determined with immunocytochemical techniques. We used paraffin-embedded sections from gingival biopsies and did quantitative analyses. RESULTS AND CONCLUSION: These showed that 5-12% of the keratinocytes in the basal layers of the epithelium proliferated in the two groups. Fewer apoptotic cells were seen in the oral epithelium than in the sulcus in all subjects in both groups. Only in the most apical part of the sulcus, close to the junctional epithelium, did the number of apoptotic keratinocytes exceed the proliferative ones in patients with periodontitis.

Family- and school-related stresses in depressed Hungarian children.

The aim of the study was 1) to identify recent and past life stresses as having a significant differential risk of childhood depression versus other childhood psychiatric illnesses, and 2) to establish if life stresses shared with other family members had a greater impact on the depression of the child than events of only personal relevance. Using a recently developed semi-structured interview (Diagnostic Evaluation Schedule for Children and Adolescents - Hungarian version, DESCA-H ), 68 life events of a total sample of 526 children were investigated. Two hundred and fifteen depressed preadolescents (mean age 12.73 years, SD 2.58) were compared with identical variables of 311 nondepressed mixed clinical controls (mean age: 10.91 years, SD 2.46) referred to child psychiatry care with other psychiatric symptomatology than depression. The life event questionnaire part of the DESCA-H was administered separately by means of lists of recent (within 1 year) and past stresses (events prior to 1 year before the assessment). With the two series of life stresses, two separate logistic regression analyses were performed. Of past stressors, physical punishment of the child by teachers, serious financial problems of the family and mental health problems of family members were found to be significant predictors of depression. From the series of recent stresses, moving to a new school, somatic illness, death of relatives and mental health disorders of family members were proved to be independent risk factors of depression for the children. The findings suggest that significant stresses of the child shared with other family members dominate in demarcating depressed children from nondepressed ones. School-related stresses are critically discussed.

[Cantilever bridges--a cross-sectional study]. / A disztálisan szabadvégú rögzített fogpótlások néhány jellemzóje szúróvizsgálat alapján.

Life expectancy and functional performance of the cantilever bridges is determined by the length of the cantilever pontic(s) and by the number and localisation of the abutment teeth. No overall epidemiological survey covering this topic was found in the literature. 529 distally cantilevered bridges were evaluated by the authors. There were 310 upper and lower cases. The following parameters were recorded: length of the cantilever part (number of units), the relationship of the cantilevered pontics and the bridge, and the position of the fixed restoration in the dental arch. Previously the cantilevered bridge design was not accepted in Hungary but in spite of this fact a large number of distally cantilevered bridges were made in the country. Most of the examined cantilever bridges are properly designed: two abutments are supporting one pontic (342 cases, 65.56%). However some of the solutions are too risky: one abutment, one cantilevered pontic (110 cases, 20.45%), or two abutments, two cantilevered pontics (53 cases, 9.85%).

[The dental status of elderly people in Hungary--based on mass screening]. / Az idóskorúak fogazati állapotának jellemzói Magyarországon, szúróvizsgálat alapján.

Twenty-three % of the Hungarian population was older than 60 years at the time of this epidemiological survey. This ratio increases gradually. So it is important to know the dental status of this population both from a professional and national health service point of view. The authors have evaluated the data of the dental health state of 2466 persons who were older than 60 years. The data were collected between 1986 and 1989. 1.8% of them kept all their teeth, 38.5% had no teeth at all. The average number of teeth was 3.49 on the upper and 4.57 on the lower jaw. 4-5% of the remaining teeth had caries. The ratio of filled teeth was 3.7% (male) and 6.8% (female). Periodontal problems were diagnosed in 34.2% (male) and 26.1% (female) of the patients. In 57.5% (male) and 73.0% (female) of the missing teeth were replaced. The cases where a large number of teeth were missing (class 2A, 2B, Fábián and Fejérdy classification) were quite often only partially treated.

[Prosthodontic treatment of missing molars (distal edentulous state class 1B); practice in Hungary based on mass screening]. / A molarisokkal rövidült fogívek (protetikai 1B osztályú distalis foghiányok) pótlásának hazai gyakorlata szürövizsgálat alapján.

Between the years of 1985 and 1989 we examined 9991 people. From the examined patients those people were selected, who lost their molars on one or both side, but they had no greater continuous edentate area in their dental arch than four teeth. The recorded data were evaluated separately by arches. 486 upper and 1568 lower arches filled the requirements of us. Patients wore in the upper jaw in 216 cases (46%) fixed prostheses with posterior cantilever pontic, in 26 cases (5%) combined prostheses (fixed + removable partial denture), in 18 cases (4%) removable partial dentures. 208 (45%) cases were untreated. In the lower arch in 417 cases (27%) fixed prostheses with a posterior cantilever pontic, in 97 cases (6%) combined prostheses (fixed + removable partial denture), in 57 cases (3%) removable partial dentures were constructed. 997 cases were (63%) were untreated. The results of this study indicate, that the treatment of distal edenate arches in the everyday practice is also verifying our prosthetic planning guidelines.

[Dynamics of tooth loss In the adult population in Hungary]. / A felnött lakosság fogelvesztésének dinamikája Magyarországon.

The authors examined the dental status of 9991 hungarian adult people and they drawn the conclusion of the tooth-loss dynamics of the '80-es. It has been found, that in comparison with international data the number of lost teeth was shaping unfavourable. Nevertheless the rate of completely edentate patients in all age-groups shows a favourable tendency.

[Distribution of the position of the last remaining tooth in otherwise edentulous mouth, based on mass screening]. / Az utolsónak maradó fog elhelyezkedésének megoszlása, szürövizsgálat alapján.

The authors examined the frequency of the last remaining tooth's positions in both arches and they found the canine in the lower arch in 63% and the second molar in 13% of the second molar. In single remaining tooth situations the rate of wearing denture is 73%. The cariological status of these teeth is negligible in relation to the bad periodontal health conditions, which are not influenced essentially by crowns or wearing dentures.

[Evaluation of the dental status from he viewpoint of denture requirements in the adult population of Hungary]. / Magyarország felnött lakossága fogazatának értékelése a fogpótlás szempontjából.

Authors found a rather high number of missing teeth of the Hungarian population, whereas the claim of the patients to dentures is less than the capacity of the dental professionals. The percentage of the patients wearing fixed and/or removable dentures is only around 50% (mean value), in the aesthetically not disadvantageous cases (i.e.: classes 1/a; 2/a; Fábián-Fejérdy) only 30-40%, but in the aesthetically disadvantageous cases 70-80% (i.e.: classes 1/b; 2/a/1; 3; Fábián-Fejérdy). The percentage of the men wearing dentures is higher than the percentage of the men (61.9% and 44.9% respectively). Authors concluded that, the most important expectations of the patients to dentures are aesthetic. The injurious effects of not reconstructed missing teeth have minor effects on the patients motivation.

[Evaluation of iatrogenic accessory nerve injury in forensic medical practice]. / Az iatrogen accessorius idegsérülés igazságügyi orvosszakértöi megítélése.

The authors give a survey of the clinical and medical-legal characteristics of the accessory nerve injury. In the past two decades the conception of the successfulness of the surgical treatment of the accessory nerve injury became prevailing. About the medical-legal aspects of the iatrogenic injury of the nerve reported in connection of the reconstructive surgery chiefly also departments of neurosurgery, orthopedics and traumatology. In the case of the authors a 70 year old patient suffered 10 years ago a iatrogenic accessory nerve injury. The mild trapezius palsy recovered spontaneously practically with cosmetic disadvantage. In connection with the development of extreme dorso-lumbal scoliosis associated with torsion the trapezius atrophy worsened. Physical therapy was partly successful. But the patient became unfit for manual work. Their observations sustain the data of authors who established that in the case of accessory nerve injury not only the surgical but also conservative treatment is usually successful. In opposite to certain data of the literature the authors establish that the iatrogenic injuries of the accessory nerve may lead to significant lifelong disability. The diagnosis is not always made in time with consequent delay in repair. This may be regarded as an unfavorable issue during medical-legal discussions. The authors recommend in interest to prevent nerve injury in the posterior triangle of the neck to perform operation in special department.

[Evaluation of syncope in medicolegal expertise]. / A syncope megítélése az orvosszakértöi gyakorlatban.

The authors summarise the clinical characteristics of the syncope and neurological signs respectively caused by basilar vertebral artery insufficiency as well as carotid sinus hypersensitivity. Several authors have seen an increased number of patients with neurological symptoms caused by ischaemia in the region of the basilar artery occurring while driving and causing a traffic accident. Carotid sinus hypersensitivity as cause of driving accidents has much less importance. In the case of the authors on a 51 years old man after turning his head to the right a sudden transient loss of consciousness without signs of convulsion developed while driving a car. The attack resulted in a serious traffic accident. Vertebrobasilar insufficiency was presumed as the cause of the signs. Despite the rare incidence of isolated syncope caused by ischaemia in the region of basilar artery, after observation of one and half a year, chiefly supported by the pathological otoneurological findings, the definitive diagnosis could be established. The recurrence of the syncope could not be excluded. An inability to drive was established. The new hungarian legal regulation of 1992, of driving ability emphasises the extraordinary hazards in the traffic posed by processes the sinus of which occur associated with sudden loss of consciousness with great probability, perhaps rarely, but at any time.

Drugs and medical ethics.

Naturopathy has received considerable interest all over the world recently. The use of its methods and its consequences have raised legal and ethical problems. This article reports on the use of two 'oncolytic' drugs. Neither of them was produced by cancer researchers and neither passed the analytic examination required in pharmaceutical research. During their use--they were prescribed and applied by physicians--conventional treatment was withdrawn. The ethical responsibility of doctors using fringe medicine drugs is dealt with. Naturopathy may, however, have a role in official medicine in certain cases.

Dynamics of creatine kinase shuttle enzymes in the human heart.

Myocardial cytoplasmic creatine kinase subunits M and B, mitochondrial CK (CKMIT), and citrate synthase (CS) were determined in 10 locations of the normal human heart (n = 8) and in papillary muscles of patients operated on for mitral regurgitation (n = 6). Compared to atrial biopsies, septal and left ventricular biopsies showed higher activities for CS (P less than 0.0001), total CK (P less than 0.05) and CKMIT (P less than 0.0001). CKM was evenly distributed. CKB activity in the right septum and left ventricular locations were 0.5-1% of total CK and 4-5 times lower than those of the atria and the right ventricular free wall. Activities of CS, CKB and CKMIT in right septal biopsies did not differ from those in left ventricular locations. The activities of CS, total CK, and CKM in papillary muscle from patients operated on for mitral regurgitation did not differ from that of healthy papillary muscle. CKMIT was about 40% lower (P less than 0.02), whereas CKB was 15-20 times higher (P less than 0.0001) than in the healthy heart. In conclusion, adaptations within the creatine kinase system occur in the human heart in health and disease. Small amounts of CKB in the normal left ventricle, as opposed to the right ventricular free wall, might be related to differences in myocardial perfusion during the cardiac cycle. In disease, a decreased CKMIT and dramatically increased CKB may indicate a stressed intracellular energy transfer. CK enzyme activities in right septal biopsy specimens may be used as an indication of metabolic stress on the myocardium of the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

[Why should teeth, used for anchoring partial prostheses, also be used as their support?]. / Miért kell a részleges lemezes fogpótlások elhorgonyzására igénybe vett fogakat azok megtámasztásába is bevonni?

It is proved by means of static models that, as regards the load of the periodontium, the teeth employed for the dental supporting and anchoring of partial dentures are in a much more favourable situation than the teeth employed but for anchorage. Viz. while the resultant of the axially and laterally directed forces resulting from supporting and anchoring does not become eccentric, the direction of the but anchorage force points out of the structure and entails an unfavourable torque on the tooth.

[Restoration of unilateral borderline edentulousness (Fábián-Fejérdy prosthetic class 2A-2B)]. / Az unilaterális (Fábián és Fejérdy protetikai 2A., 2B. osztályú) foghiányok határeseteinek pótlása.

A frequent case of unilateral row and edentulousness is when, on one side, all three molars are missing and, thus, the second promolar is the last tooth. To solve such edentulousness a removable denture or a combined fix plus removable plate denture is suggested. By employing the principles of the prosthetical classification (Fábián-Fejérdy) the justification of the distally free end bridge is proved.

Myoglobin content and citrate synthase activity in different parts of the normal human heart.

Myoglobin (Mb) content and citrate synthase (CS) activity were determined in myocardial samples from nine human brain-dead organ donors with normal hearts. Six regions of each heart were analyzed: right and left atria, right ventricle, left ventricular subepicardium, subendocardium, and anterior papillary muscle. The Mb content was similar, whereas the CS activity was higher in the left than in the right heart at both atrial and ventricular levels. Mb content and CS activity were higher in ventricles than in atria. The subendocardial layer and papillary muscle of the left ventricle had a higher Mb content than the subepicardial layer, whereas CS activity was similar in these three locations. The results suggested a closer relationship between CS activity (oxidative potential) and work load than between Mb content and work load. Mb content may, instead, be related to intramuscular oxygen tension (PO2) on the basis of a comparison between our Mb data and those of others on regional variations in myocardial PO2.

Immunofluorescence demonstration of digoxin in human myocardial tissue and isolated rat cardiac myocytes with monoclonal antibodies.

The aim of the present investigation was to identify the morphological correlates of digoxin binding sites in human heart muscle tissue and isolated viable rat heart myocytes. Cardiac glycoside linked to myocardial cells was demonstrated by monoclonal digoxin specific antibody and by FITC-conjugated anti-mouse immunoglobin serum. This versatile immunofluorescence method can be used in diagnostic and experimental studies of cardiac glycoside binding.