[Results of a structural diagnosis of patients with chronic dyspnoea recruited from two cardiological practices]. / Ergebnisse einer strukturierten Diagnostik bei Patienten mit chronischer Dyspnoe in zwei kardiologischen Facharztpraxen.

While well validated algorithms exist for the diagnosis of patients with acute dyspnoea, such generally valid procedural instructions are lacking for patients with chronic dyspnoea. The diagnostic approach presented here is based on investigations of 246 patients with chronic dyspnoea recruited from two cardiological practices using a self-developed multi-level procedure. Besides anamnestic and clinical examinations, different diagnostic procedures, available in the ambulant range, are included. The results suggest that in over 50 % of the cases the cause of chronic dyspnoea can be determined from anamnestic and clinical examinations as well as from electrocardiogram and echocardiography. Additional inclusion of lung function and capillary blood gas analysis permitted a sufficient clarification in over 80 % of the cases. In a further step, cardiopulmonary exercise testing clarified the reasons for chronic dyspnoea in approximately 10 % of the remaining patients. Threshold values of lung function parameters as used for the differentiation of acute dyspnoea, do not seem suitable for the diagnosis of patients with chronic dyspnoea. By means of a simple step-wise diagnostic algorithm, applicable under ambulant conditions, the cause of chronic dyspnoea could sufficiently be clarified in more than 95 % of the cases.

[Number of patients with chronic dyspnea in three German specialist practices]. / Häufigkeit von Patienten mit chronischer Dyspnoe in drei deutschen Facharztpraxen.

In the second quarter 2011 the incidence of the symptoms "chronic dyspnea" among the patients in three specialist practices was determined by means of a self-developed questionnaire. 1286 anonymised questionnaires with full information could be evaluated. The proportion of the patients with a chronic dyspnea (inclusive "dyspnea and weakness feeling") in the practices amounted to between 15.3 and 57.7 %. An exclusive assessment of chronic dyspnea could be assigned to 10.4 to 31.4 % of the patients evaluated. From the view point of the treating physicians, the cause of the chronic dyspnea was sufficiently explained by the available information.

High resolution BrainPET combined with simultaneous MRI.

UNLABELLED: After the successful clinical introduction of PET/CT, a novel hybrid imaging technology combining PET with the versatile attributes of MRI is emerging. At the Forschungszentrum Jülich, one of four prototypes available worldwide combining a commercial 3T MRI with a newly developed BrainPET insert has been installed, allowing simultaneous data acquisition with PET and MRI. The BrainPET is equipped with LSO crystals of 2.5 mm width and Avalanche photodiodes (APD) as readout electronics. Here we report on some performance characteristics obtained by phantom studies and also on the initial BrainPET studies on various patients as compared with a conventional HR+ PET-only scanner. MATERIAL, METHODS: The radiotracers [18F]-fluoro-ethyl-tyrosine (FET), [11C]-flumazenil and [18F]-FP-CIT were applied. RESULTS: Comparing the PET data obtained with the BrainPET to those of the HR+ scanner demonstrated the high image quality and the superior resolution capability of the BrainPET. Furthermore, it is shown that various MR images of excellent quality could be acquired simultaneously with BrainPET scans without any relevant artefacts. DISCUSSION, CONCLUSION: Initial experiences with the hybrid MRI/BrainPET indicate a promising basis for further developments of this unique technique allowing simultaneous PET imaging combined with both anatomical and functional MRI.

[A comparison of the Proseal laryngeal mask to the standard laryngeal mask on anesthesized, non-relaxed patients]. / Ein Vergleich der Larynxmaske (LMA) vom Typ Proseal gegen die Standard-LMA bei anästhesierten, nicht relaxierten Patienten. Ergebnisse einer deutschen Multizenterstudie.

It was our goal to compare the Proseal-laryngeal mask airway (PLMA) with the classical laryngeal mask airway (LMA) in a german multicenter trial. Handling of the instruments and application criteria were to be tested. 7 anaesthesia departments were able to take part in this study. 280 patients could be investigated after approval of the ethics committee of the medical faculty of the university of Goettingen. 145 patients received the PLMA and 135 the LMA. The surgical interventions were small to moderate procedures with a duration of at least 20 minutes in the sections general surgery, trauma/orthopedic surgery, urology, vascular surgery, gynecology, ENT-surgery and ophthalmology. There was equivalence of the two instruments PLMA and LMA concerning duration and ease of insertion, endoscopic position check, observations on emergence, potential for injury and some postoperative complaints. This equivalence could be confirmed statistically. Laryngospasm was observed in three, Bronchospasm in two patients with the PLMA, in no one with the LMA. In one case of laryngospasm and another of bronchospasm a mechanism of supraglottic laryngeal stenosis has been involved which may occur in rare instances with the PLMA. This mechanism is due to the double cuff of the PLMA with the instruments proximity to the laryngeal inlet. The seal pressure in both groups differs significantly (p = 0.001). The mean value for the seal pressure was 29,3 +/- 0,21 mbar for the PLMA and 20,9 +/- 0,21 mbar for the LMA. In the PLMA the gastric tube could be positioned with the first attempt in 118 patients, with the second attempt in 17 cases. In 10 patients the gastric tube could not be placed. Contrary to the LMA the tip of the PLMA cuff may be bent in some cases with loss of airway safety and positioning of the gastric tube. The symptoms sore throat and painful swallowing on the first postoperative day were more frequent with LMA application. These differences could be confirmed statistically (sore throat p = 0.01, painful swallowing p = 0.04). They may be explained by the more rigid LMA compared to the PLMA and by the fact that the LMA in this study was older than the PLMA, loosing plasticizer. The drainage tube within the PLMA offers safety from aspiration in patients with no primary aspiration risk, additional reassurance for a correct position and a better stability of the airway. Our data may support a wider indication range for the PLMA compared with the LMA. The PLMA may be applied in laparoscopies and lower abdominal surgical interventions. Careful clinical observation will show, if the minimal invasiveness of the PLMA offers an advantage for these patients. The PLMA should not be applied in patients with increased aspiration risk.

Transcriptional activation domains of human heat shock factor 1 recruit human SWI/SNF.

Chromatin remodeling complexes such as SWI/SNF use the energy of ATP hydrolysis to remodel nucleosomal DNA and increase transcription of nucleosomal templates. Human heat shock factor one (hHSF1) is a tightly regulated activator that stimulates transcriptional initiation and elongation using different portions of its activation domains. Here we demonstrate that hHSF1 associates with BRG1, the ATPase subunit of human SWI/SNF (hSWI/SNF) at endogenous protein concentrations. We also show that hHSF1 activation domains recruit hSWI/SNF to a chromatin template in a purified system. Mutation of hHSF1 residues responsible for activation of transcriptional elongation has the most severe effect on recruitment of SWI/SNF and association of hHSF1 with BRG1, suggesting that recruitment of chromatin remodeling activity might play a role in stimulation of elongation.

Transcriptional activation domains stimulate initiation and elongation at different times and via different residues.

Transcriptional activators can stimulate multiple steps in the transcription process. We have used GAL4 fusion proteins to characterize the ability of different transcriptional activation domains to stimulate transcriptional elongation on the hsp70 gene in vitro. Stimulation of elongation apparently occurs via a mechanistic pathway different from that of stimulation of initiation: the herpes simplex virus VP16, heat shock factor 1 (HSF1) and amphipathic helix (AH) activation domains all stimulate initiation, but only VP16 and HSF1 stimulate elongation; and mutations in hydrophobic residues of the HSF1 activation domains impair stimulation of elongation but not of initiation, while mutations in adjacent acidic residues impair stimulation of initiation more than of elongation. Experiments in which activators were exchanged between initiation and elongation demonstrate that the elongation function of HSF1 will stimulate RNA polymerase that has initiated and is transcriptionally engaged. Transcriptional activators thus appear to have at least two distinct functions that reside in the same domain, and that act at different times to stimulate initiation and elongation.

Sedimentation coefficients of self-associating species. II. Tests with a simulated example and with beta-lactoglobulin A.

If sedimentation equilibrium and sedimentation velocity experiments are performed on a self-associating solute under the same solution conditions, it is possible to evaluate the sedimentation coefficients (si) of the self-associating species and the usual concentration dependence parameter (g or gs). We have tested some of these methods with simulated examples. A more critical test is to use real data. Sedimentation equilibrium experiments with beta-lactoglobulin A at 20 degrees C in 0.2 M glycine buffer (pH 2.46) indicated that a nonideal monomer-dimer association was present. Sedimentation velocity experiments were performed on beta-lactoglobulin A under the same conditions. Using data from both sets of experiments we were able to evaluate s1, s2, g and gs using two different models for swa, the apparent weight average sedimentation coefficient. The empirical model for swa developed by Weirich et al. [1] gave better variance than did the model for swa developed by Gilbert and his co-workers [2-5]. Using a simulated monomer-dimer association mimicking a system having higher sedimentation coefficients than beta-lactoglobulin A did, we were able to show that one could not obtain s2 from tangents to the plot of 1/swa vs. c in the high concentration region. The methods developed here for sedimentation coefficients can be applied to other experiments in which a weight average property (or its apparent value) of a self-associating solute is measured, provided the appropriate thermodynamic experiments are done under the same solution conditions.