ForMAX - a beamline for multiscale and multimodal structural characterization of hierarchical materials.

The ForMAX beamline at the MAX IV Laboratory provides multiscale and multimodal structural characterization of hierarchical materials in the nanometre to millimetre range by combining small- and wide-angle X-ray scattering with full-field microtomography. The modular design of the beamline is optimized for easy switching between different experimental modalities. The beamline has a special focus on the development of novel fibrous materials from forest resources, but it is also well suited for studies within, for example, food science and biomedical research.

[Mechanomyography for the assessment of contractive ability of muscles].

Results of mechanomyographic study of long radial hand extensor in 32 patients with radial nerve neuropathy were analyzed. The novel way of secure early diagnostics of reinnervation was presented. The method uses the quality characteristics of muscular contractility. The small sized device with the body mount were worked out. The main mechanomyographic changes of de- and reinnervation process were registered and explained. The contractility index, allowing assess the treatment efficacy, was defined.

[The ultrasound assessment of neuro-muscular apparatus by the radial nerve injuries].

The use of ultrasound (US) scanning to assess the muscular function during the reinnervation is a new concept in medicine. The US signs of muscle denervation were thoroughly described in the article. The US muscle monitoring was performed by the complete and partial radial nerve injury in various follow-up periods. Absolute and relative indications for surgery were determined. The comparative characteristics of structural muscular changes, together with the US test for the assessment of the treatment efficacy and nerval and muscular recovery were suggested.

[The electroneuromyography in diagnostics of the radial nerve injuries].

Basic difficulties of the adequate and precise electrophysiological examination of radial nerve injuries are traditionally conditioned by the impossibility to separate the muscle, isolated from the muscles, innervated by the ulnar or medial nerves. The phenomenon of flexor motor units potentials propagation by the stimulating electroneuromyography and M-flow registration from extensor muscles has been described in literature. To prevent the false interpretation of the examination results, 98 patients with radial nerve injuries were examined using the original program of separate assessment of motor and sensor fibers.

[The optimal treatment algorithm of radial nerve injuries].

The results of rehabilitation of 52 patients with radial nerve injuries were comparatively analyzed: the traditional rehabilitation complex (massage, training, etc.) was compared with the method of functional biomanagement. The technical characteristics of the designed functional cast were thoroughly described. The study demonstrated that reinnervation and functional recovery of the denervated muscles without segmental influence were significantly slower.

[Miniinvasive technologies in treatment of intraarticular splittered fractures of the proximal shoulder].

The algorithm of diagnostics, miniinvasive ostheosynthesis and postoperative rehabilitation of patients with the splittered fractures of caput femori was worked out. Treatment results of 24 patients were analyzed. All patients were treated with the use of the original apparatus of the external osteal fixation. The method allows early functional treatment and limb function restoration in cases, when classic immersinal ostheosynthesis is contraindicated.

Vascular disease and apathy in old age. The Leiden 85-Plus Study.

BACKGROUND: Apathy is defined as an important loss of motivation in all domains of daily functioning. Especially in old age, apathy might be a specific neuropsychiatric syndrome separate from depression. There are indications that apathy in elderly subjects is related to vascular disease. OBJECTIVE: To assess the relation between vascular disease and apathy in subjects aged 85 years and older. METHODS: The Leiden 85-plus Study is a prospective, population-based study of 500 elderly subjects. Vascular disease including myocardial infarction, angina pectoris or myocardial ischemia, claudicatio intermittens, and arterial surgery was determined at baseline. Symptoms of apathy were assessed annually from age 85 through 90 years using the apathy questions of the 15-item Geriatric Depression Rating Scale (GDS). Diagnostic accuracy of the apathy questions was validated using the Apathy Scale at age 90 years. The association between vascular disease and apathy was estimated both at baseline and longitudinally. RESULTS: The apathy items of the GDS showed a sensitivity of 69% and a specificity of 85%. At baseline, 69 subjects with apathy but free of depression had significantly more cardiovascular pathologies compared to 287 subjects without apathy. In the 287 subjects who were free of apathy and depression, increase of apathy but not depression during follow-up was significantly higher for each additional cardiovascular pathology at baseline. CONCLUSION: In community dwelling elderly, those with vascular disease were at higher risk of developing apathy but not depression. This suggests that apathy and depression in old age have different etiologies.

Dopamine receptors in hypertension.

There is increased awareness of the role of dopamine in cardiovascular function, renal function and systemic blood pressure regulation. Growing evidence indicates that each of the five dopamine receptor subtypes participates in the regulation of blood pressure by mechanisms distinct for that particular subtype. Some dopamine receptors regulate blood pressure by influencing the central and peripheral nervous system, while others influence renal function and release of renin, aldosterone and vasopressin. This review summarizes the physiology and pathophysiology of the peripheral dopaminergic system and our current understanding of the role of individual dopamine receptors in the pathophysiology of human essential hypertension.

Differential expression of adenylyl cyclases in the rat nephron.

BACKGROUND: Adenylyl cyclases (ACs) are a family of enzymes that catalyze the formation of the second-messenger cyclic adenosine 3',5'-monophosphate (cAMP). At least nine isoforms of AC have been cloned. These isoforms differ in their tissue distribution and basal activity. AC isoforms also differ in their capacity to be stimulated or inhibited by G protein alpha(i), alpha(s) and beta/gamma subunits, protein kinase C, and intracellular calcium. The distribution of ACs in the kidney is only partially known, although it is known that ACs play important roles in kidney signal transduction. Several receptors are known to couple to AC, but their linkage to individual AC isoforms in the kidney is not known. METHODS: This study investigated the tissue distribution of AC isoforms along the nephron of Wistar-Kyoto rats using reverse transcription-polymerase chain reaction (RT-PCR), immunohistochemistry, and immunoblotting. RESULTS: While AC VI and IX mRNA were found in all nephron segments, there was no expression of AC VIII mRNA. ACs II through V and VII mRNA were variably found in specific nephron segments. mRNA for AC isoforms II, III, VI, VII, and IX were expressed in renal proximal tubules. All of the AC isoforms studied, except VIII, were found in glomeruli. Immunoblotting and immunohistochemistry confirmed the mRNA results. AC isoforms II, III, IV, and IX were expressed in luminal rather than in basolateral membranes. However, immunohistochemical studies were not feasible for the other isoforms that could be expressed in basolateral membranes. CONCLUSION: Knowledge of the distribution of ACs may help establish the linkage between receptors and specific AC isoforms and define their functions.

Adrenergic and endothelin B receptor-dependent hypertension in dopamine receptor type-2 knockout mice.

Polymorphism of the dopamine receptor type-2 (D(2)) gene is associated with essential hypertension. To assess whether D(2) receptors participate in regulation of blood pressure (BP), we studied mice in which the D(2) receptor was disrupted. In anesthetized mice, systolic and diastolic BPs (in millimeters of mercury) were higher in D(2) homozygous and heterozygous mutant mice than in D(2)+/+ littermates. BP after alpha-adrenergic blockade decreased to a greater extent in D(2)-/- mice than in D(2)+/+ mice. Epinephrine excretion was greater in D(2)-/- mice than in D(2)+/+ mice, and acute adrenalectomy decreased BP to a similar level in D(2)-/- and D(2)+/+ mice. An endothelin B (ET[B]) receptor blocker for both ET(B1) and ET(B2) receptors decreased, whereas a selective ET(B1) blocker increased, BP in D(2)-/- mice but not D(2)+/+ mice. ET(B) receptor expression was greater in D(2)-/- mice than in D(2)+/+ mice. In contrast, blockade of ET(A) and V(1) vasopressin receptors had no effect on BP in either D(2)-/- or D(2)+/+ mice. The hypotensive effect of an AT(1) antagonist was also similar in D(2)-/- and D(2)+/+ mice. Basal Na(+),K(+)-ATPase activities in renal cortex and medulla were higher in D(2)+/+ mice than in D(2)-/- mice. Urine flow and sodium excretion were higher in D(2)-/- mice than in D(2)+/+ mice before and after acute saline loading. Thus, complete loss of the D(2) receptor results in hypertension that is not due to impairment of sodium excretion. Instead, enhanced vascular reactivity in the D(2) mutant mice may be caused by increased sympathetic and ET(B) receptor activities.

Ultrafiltration profiling and measurement of relative blood volume as strategies to reduce hemodialysis-related side effects.

Hemodialysis (HD) side effects, such as hypotension and muscle cramps, may be related to excessive ultrafiltration (UF) in relation to refilling of fluids from the extravascular space, resulting in hemoconcentration and reduction of relative blood volume (RBV). This study examines the suitability of RBV measurements and UF modeling to reduce the incidence of dialysis side effects. We followed up 188 dialysis sessions in 53 patients. RBV and incidence of side effects were evaluated. Six treatment regimens were examined: UF profile 0, with a constant UF rate; UF profile 1, with a linear decreasing UF rate; UF profile 2, with a stepwise decreasing UF rate; and UF profiles 3 through 5, with intermittent high UF rates interrupted by UF pauses. During dialyses with a constant UF rate (UF profile 0), 10.6% of the treatments were associated with symptomatic hypotension. UF profiles 2 through 5, intermittently using high UF rates, caused a marked increase in hypotensive episodes (18.4%). In contrast, UF profile 1, providing a continuously decreasing UF rate, showed a reduced incidence of hypotension at only 5.7%. Symptomatic hypotension occurred in 13 of 53 patients during one or more dialysis sessions. With the help of RBV measurements, a subgroup of 8 patients with hypovolemia-induced hypotension could be identified. In these patients, an individual threshold of RBV could be defined, below which 92.3% of all hypotensive episodes occurred. In the remaining 5 hypotension-prone patients, there was no correlation between the occurrence of symptomatic hypotension and low RBV during HD treatments. In conclusion, UF profiles intermittently using high UF pulses cannot be recommended. RBV measurements help define a subgroup of patients at risk for hypovolemia-induced hypotension. Only these patients may benefit from blood volume-controlled UF. The incidence of symptomatic hypotension can likely be reduced if an individual threshold of RBV is avoided during HD treatments, eg, using lower UF rates in these patients.

Characterization of prostanoid receptors in podocytes.

Prostaglandins participate in the regulation of important glomerular functions and are involved in the pathogenesis of glomerular diseases. This study investigates the influence of prostaglandins on membrane voltage, ion conductances, cAMP accumulation, and cytosolic calcium activity ([Ca2+]i) in differentiated podocytes. Prostaglandin E2 (PGE2) caused a concentration-dependent depolarization and an increase of the whole cell conductance in podocytes (EC50 approximately 50 nM). Compared with PGE2, the EP2/EP3/EP4 receptor agonist 11-deoxy-PGE1 caused an equipotent depolarization, whereas the DP receptor agonist BW 245 C, the EP1/EP3 receptor agonist sulprostone, and the IP receptor agonist iloprost were at least 100 to 1000 times less potent than PGE2. The EP2 receptor agonist butaprost did not change membrane voltage of podocytes. The depolarizing effect of PGE2 was increased in an extracellular solution with a reduced Cl- concentration (from 145 to 32 mM). PGE2 and the prostaglandin agonists, but not the IP receptor agonist iloprost and the EP2 receptor agonist butaprost, induced a time- and concentration-dependent cAMP accumulation in podocytes. In fura-2 fluorescence experiments, PGE2, sulprostone, PGF2alpha, fluprostenol (a potent FP agonist), and U-46619 (a selective thromboxane A2 agonist) induced a biphasic increase of [Ca2+]i in 60 to 80% of podocytes. In reverse transcription-PCR studies, podocyte mRNA for the EP1, EP4, FP, and TP receptor could be amplified. These data indicate that in podocytes, PGE2 regulates distinct cellular functions via the EP1 and EP4 receptor, thereby increasing [Ca2+]i and cAMP, respectively. Furthermore, PGF1alpha and U-46619 increase [Ca2+]i via their specific receptors.

Transmission of tuberculosis from a seven-year-old child in a Sydney school.

OBJECTIVES: To determine whether a 7-year-old child with extrapulmonary and pulmonary tuberculosis (TB) and direct smear positive sputum for acid-fast bacilli was infectious to home and school contacts, and to ascertain potential adult sources of infection for these contacts. METHODS: Contact tracing by Mantoux testing was conducted on 220 children at a primary school and after-school care facility, and 59 selected adults considered potential sources of infection. RESULTS: The participation rate for the children was 98% and 92% for the adults. Mantoux positivity (induration >/= 10 mm, or >/= 15 mm with previous BCG) among children was 13% at the school (anticipated rate 2-3%), 26% among school staff, and 7% among children at the after-school care centre where the index case attended. One exposed adult hospital staff member converted from Mantoux negative to positive. No other cases of TB disease were detected among children or adults tested. CONCLUSION: Although spread of TB from children to others is rare, the findings of this investigation indicate that transmission of TB from a young child to other children and an adult may have occurred, and that sputum testing and contact tracing for sputum smear positive children should be considered.

Dopamine depolarizes podocytes via a D1-like receptor.

BACKGROUND: Dopamine influences glomerular haemodynamics and dopamine receptors have been demonstrated in the glomerulus, but little is known about the cellular effects of dopamine in glomerular cells. The aim of this study was to investigate the influence of dopamine on the cellular functions of podocytes. METHODS: The effect of dopamine on membrane voltage was investigated in differentiated mouse podocytes. The membrane voltage was measured using the patch clamp technique. Reverse transcribed-polymerase chain reaction (RT-PCR) studies were performed to investigate the expression of dopamine receptor mRNA in mouse glomeruli and podocytes. RESULTS: The addition of dopamine (100 nM-1000 microM) caused a concentration-dependent depolarization of podocytes (EC50 is approximate to 10 microM). Like dopamine, the selective agonist of the D1-like receptor, SKF 82958, depolarized podocytes in a concentration-dependent manner. (EC50 is approximate to 50 microM). SKF 82958 stimulated a time-and concentration-dependent accumulation of cyclic adenosine 3',5'-monophosphate (cAMP) in podocytes (EC50 is approximate to microM). RT-PCR studies with primers derived from mouse sequences amplified mouse mRNA for the D1-like and the D2-like receptor in glomeruli, which were obtained by the sieve technique, whereas only mRNA for the D1-like receptor was detected in cultured mouse podocytes. CONCLUSION: The data indicate that dopamine induces a cAMP-dependent depolarization via a D1-like receptor in podocytes.

Infection control and contaminated waste disposal practices in Southern Sydney Area Health Service Dental Clinics.

The sterilization and contaminated waste disposal practices in all 14 dental clinics operated by the Southern Sydney Area Health Service were surveyed. All of the clinics used autoclaves for sterilization. All hand instruments, handpieces and triplex syringes were autoclaved between patients. Chemical disinfection solutions were used in 12 of the 14 dental clinics, mainly for surface decontamination. Five dental clinics had separate storage areas for contaminated waste which compiled with contaminated waste separation and disposal guidelines. The practice of recapping needles with fingers and some inadequate washing facilities are areas that require particular attention.

Recurrent ulcerations on both legs since early childhood due to a factor V gene mutation.

We describe the case of a young man who suffered from recurrent ulcerations on both legs since his early childhood as a result of two coagulation factor abnormalities: factor V gene mutation causing microthrombotic occlusions and subsequently ulcerations and an intermittent factor XIII deficiency responsible for retarded wound healing.

Horizontal transmission of hepatitis B in a children's day-care centre: a preventable event.

Using molecular finger-printing, we provided evidence that, in a children's day-care centre, a known hepatitis B virus (HBV) hepatitis B e antigen (HBeAg) carrier transmitted HBV to another child (the index case). The chronic HBV carrier had an exudative skin lesion and a history of biting. We sought to identify other at-risk children and prevent further transmission. Blood samples were collected and tested serologically for HBV. Of the 90 other children, 78 (87 per cent) were tested and none had serological evidence of HBV infection; 73 (81 per cent) were of Caucasian background; 38 (49 per cent) had a history of HBV immunisation with serological confirmation. Therefore, 1 (2.4 per cent, 95 per cent confidence interval 1.0 to 12.8 per cent) of the 41 known susceptible contacts became infected. The risk of horizontal HBV transmission in a children's day-care centre is low but not negligible. Staff and children should be vaccinated when a child in a day-care centre is a known HBV carrier.

[Weil's disease and necrotizing herpes pneumonia as the cause of death of a 39-year-old sewage drain worker]. / Weil'sche Erkrankung und nekrotisierende Herpespneumonie als Todesursache bei einem 39 Jahre alt gewordenen Kanalarbeiter.

Acute leptospirosis in Europe (Weil's disease) is a rare and in more than 90% of the cases undiagnosed febrile, self-limited disease. We report the case of a 39-year-old sewerage worker, who was admitted to our hospital with fever, jaundice, pain in his calves and acute renal failure. Serology revealed elevated antibody titers against Leptospira canicola, L. icterhaemorrhagica and L. sejroe. The patient developed disseminated intravascular coagulation (DIC) with diffuse gastrointestinal bleeding due to thrombocytopenia. The ECG showed atrial fibrillation with irregularly irregular rhythm. Cardiac arrest developed, most likely due to hypoxia, with a drop in the blood pressure. Despite immediate resuscitation efforts the patient developed severe hypoxic brain damage and died a few days later. Autopsy disclosed histologic signs of a generalized leptospiral infection, signs of shock and within the lungs a necrotizing herpes simplex virus pneumonia causing the death of the patient. The virus pneumonia most probably was caused by retrograde canalicular dissemination of oral secretions since herpetic tracheitis and esophagitis were found and herpetic lesions were readily identified on the lips and tongue. A medical opinion asked for by the professional association having liability for occupational safety and insurance was given, the disease being recognized as an occupational disease.

"On the spot' vaccination: does it work?

OBJECTIVE: To trial and evaluate a system of "on the spot' vaccination for children up to the age of 15 years in the Early Childhood Centres of the Central Sydney Area Health Service, at the Royal Alexandra Hospital for Children and in a number of general practices in the area. METHODOLOGY: A brief questionnaire was used to collect data from parents and health care professionals about the child's vaccination status and vaccines given "on the spot'. RESULTS: Over an 8 week period in August-September 1993, 5162 questionnaires were completed; 71% of children were up to date with their vaccination. If Haemophilus influenzae type b vaccine, which had been introduced only 2 months before commencement of the study, was excluded, 84% of the children were up to date. A total of 441 children were given 663 vaccinations "on the spot'. Very few children were too ill to be vaccinated (6%). However, only 30% of those who needed vaccination "on the spot' actually received it (441 of 1480), and only 41% (24 of 58) of a subset of those who were not vaccinated were known to have complied 1 month later. Children attending Early Childhood Centres were younger than children attending general practices or the hospital. CONCLUSIONS: A high proportion of children who attended for routine or acute health care had vaccinations overdue (30%). If this scheme could be continued and expanded it would have an important impact on vaccination coverage, and hence on the incidence of vaccine-preventable diseases.