Medizin - Open Access LMU - Teil 20/22 Archiv

Background and Aims: Exclusive enteral nutrition (EEN) induces remissionin patients with Crohn’s disease (CD). We investigated the short-termimpact of EEN on bone quality and muscle mass in children with CD.Methods: Ten newly diagnosed CD patients (7 male, 10.6-17.7 years ofage) were assessed by peripheral quantitative computed tomography (pQCT)at the forearm before starting an 8-weeks treatment with EEN, and after12 and 52 weeks. No steroids or biologicals were applied. Trabecular andcortical bone mineral density, total bone, and muscle cross-sectionalarea (CSA) were measured by pQCT and expressed as age- and sex-specificz-scores; size-dependent CSAs were corrected for low height for age.Wilcoxon rank sum test was applied. Results: Remission at week 12 wasachieved in 8 patients; 2 still had mild disease.

In the present study, we examined the distribution of 6 groups ofintermediate filaments (IFs; cytokeratins, CKs, vimentin, synemin,desmin, glial fibrillary acidic protein and lamins) in oocytes andfollicular walls of the Japanese quail (Coturnix japonica) during theirdevelopment using immunohistochemical and ultrastructural techniques. Adistinctly vimentin- and synemin-positive Balbiani body, which is atransient accumulation of organelles (mitochondria, Golgi complex andendoplasnnic reticulum) that occurs in the oocytes of all vertebratesincluding birds, could be detected in the oocytes of primordial andearly pre-vitellogenic follicles. In larger pre-vitellogenic follicles,the Balbiani body has dispersed and the positivity of the granulosacells appeared to concentrate in the basal portion of their cytoplasm.Our ultrastructural data demonstrated that the matrix of the Balbianibody consists of fine IFs, which may play a role in the formation anddispersion of the Balbiani body. Of the CKs studied (panCK, CK5, CK7,CK8, CK14, CK15, CK18 and CK19), only CK5 showed a slight positivestaining in both the theca externa and the Balbiani bodies ofpre-vitellogenic oocytes. In conclusion, our data, which describe thechanges in avian IF protein expression during folliculogenesis, suggestthat the functions of the IFs (vimentin and synemin) of oocytes andfollicular walls are not primarily mechanical but may be involved in thetransient tethering of mitochondria in the area of the Balbiani body andin the gain of endocrine competence during the differentiation ofgranulosa cells.

Background: Paraneoplastic hypoglycemia is a rare syndrome amoungtumorous diseases. It is often associated with a paraneoplasticsecretion of ‘big’ insulin-like growth factor-II. Methods: We describethis syndrome in a 60-year-old patient with advanced breast cancer 8years after primary diagnosis. Results and Conclusion: This non-isletcell tumor-induced hypoglycemia may be the only evidence for anotherwise clinically occult disease progression. Fast diagnosis andappropriate acute and causal treatment concepts should be part ofoncological management.

Background/Aims: It has been hypothesized that the intrauterineenvironment is an independent factor in obesity development. If so, thematernal effect is likely to be a stronger influencing factor (’fetalovernutrition hypothesis’). We aimed to systematically evaluate theassociations of offspring body mass index (BMI, or adiposity) withpre-pregnancy BMI (or adiposity) of the mother and the father. Methods:The Medline, Embase and Cochrane Library databases were searched inMarch 2012. Results: Seven cohort studies were eligible for theanalysis. Among these, 2 groups of trials presented different data fromthe same parent-offspring cohorts (the Avon Longitudinal Study ofParents and Children, ALSPAC, and the Mater-University Study ofPregnancy, MUSP). In total, 3 large birth cohorts and 1 additional smallstudy were identified. Three studies provided a direct comparison ofparent-offspring associations, with a statistically stronger maternalinfluence found only in the MUSP cohort. Equivocal results were obtainedfrom all studies describing the ALSPAC cohort. The parental effect(indirectly estimated based on the presented odds ratio) was similar inthe Finnish cohort. In 1 additional small study, maternal BMI was foundto be a strong predictor of childhood obesity. Conclusions: There isonly limited evidence to support the ‘fetal overnutrition hypothesis’.

Background: During acellular replacement of an acute blood loss,hyperoxic ventilation (HV) increases the amount of O-2 physicallydissolved in the plasma and thereby improves O-2 supply to the tissues.While this effect could be demonstrated for HV with inspiratory O-2fraction (FiO(2)) 0.6, it was unclear whether HV with pure oxygen(FiO(2) 1.0) would have an additional effect on the physiological limitof acute normovolemic anemia. Methods: Seven anesthetized domestic pigswere ventilated with FiO(2) 1.0 and subjected to an isovolemichemodilution protocol. Blood was drawn and replaced by a 6%hydroxyethyl starch (HES) solution (130/0.4) until a sudden decrease oftotal body O-2 consumption (VO2) indicated the onset of O-2 supplydependency (primary endpoint). The corresponding hemoglobin (Hb)concentration was defined as ‘ critical Hb’ (Hb crit). Secondaryendpoints were parameters of myocardial function, central hemodynamics,O-2 transport and tissue oxygenation. Results: HV with FiO(2) 1.0enabled a large blood-for-HES exchange (156 +/- 28% of the circulatingblood volume) until Hb crit was met at 1.3 +/- 0.3 g/dl. Aftertermination of the hemodilution protocol, the contribution of O 2physically dissolved in the plasma to O-2 delivery and VO2 hadsignificantly increased from 11.7 +/- 2 to 44.2 +/- 9.7% and from 29.1+/- 4.2 to 66.2 +/- 11.7%, respectively. However, at Hb crit,cardiovascular performance was found to have severely deteriorated.Conclusion: HV with FiO(2) 1.0 maintains O-2 supply to tissues duringextensive blood-for-HES exchange. In acute situations, where profoundanemia must be tolerated (e.g. bridging an acute blood loss until redblood cells become available for transfusion), O-2 physically dissolvedin the plasma becomes an essential source of oxygen. However,compromised cardiovascular performance might require additionaltreatment.

Background: In patients with chronic lung diseases, the work rate forendurance training is calculated by the maximal work rate (W-max).Because the assessment bears side effects, a prediction by easieraccessible tests would be of practical use. Objective: We addressed thereliability of predicting W-max on the basis of the 6-min walk distance(6MWD) test and a set of further parameters in patients with differentlung diseases. Methods: Baseline data of a longitudinal study including6MWD, W max, peripheral muscle force, lung function, fat-free mass anddyspnea (Modified Medical Research Council score) of 255 men withoccupational lung diseases (104 asthma, 69 asbestosis, 42 silicosis, 40 chronic obstructive pulmonary disease) were evaluated.

Background: A high percentage of patients with vestibular migraine (VM)were reported to have central ocular motor dysfunctions (COMD) in thesymptom-free interval. Since VM is a chronic disorder, it is of interestif COMD worsen over time. Methods: Thirty VM patients and 11 controlpatients participated in an 8-year-long observational study withfollow-up. All patients underwent standardized neuro-ophthalmologicaland neuro-otological examinations at the initial presentation and atfollow-up. The primary outcome measure was change in COMD at follow-up.Results: In general, COMD in the symptom-free interval were subtle,consisting of a saccadic horizontal and/or vertical pursuit.

Detection of acute kidney injury is undergoing a dynamic revolution ofbiomarker technology allowing greater, earlier, and more accuratedetermination of diagnosis, prognosis, and with powerful implication formanagement. Biomarkers can be broadly considered as any measurablebiologic entity or process that allows differentiation between normalfunction and injury or disease. The ADQI (Acute Dialysis QualityInitiative) had its Ninth Consensus Conference dedicated to synthesisand formulation of the existing literature on biomarkers for thedetection of acute kidney injury in a variety of settings. In the papersthat accompany this summary, ADQI workgroups fully develop key conceptsfrom a summary of the literature in the domains of early diagnosis,differential diagnosis, prognosis and management, and concurrentphysiologic and imaging measures.

Purpose: To analyze the correlation between morphological and functionalresults 12 months after epiretinal membrane (ERM) surgery. Methods: 31eyes from 31 consecutive patients with nnetamorphopsia and bestcorrected visual acuity (BCVA) below 20/32 underwent a transconjunctival23-gauge vitrectomy with ERM and internal limiting membrane peeling. Preoperatively and 3, 6 and 12 months postoperatively, we assessed BCVA,microperimetry (MP-1) and spectral domain optical coherence tomography(SD-OCT). Photoreceptor inner and outer segment (IS/OS) was graded onSD-OCT images and correlated with microperimetry measurements in thefovea and parafoveal region. Results: The postoperative BCVA wassignificantly better in eyes with an intact IS/OS junction (p < 0.01).In addition, the mean defect depth was postoperatively decreased in thefoveal and parafoveal area in eyes with an intact IS/OS junction. Acorrelation of SD-OCT IS/OS images and microperinnetry in eyes withimprovement in BCVA of at least 2 lines revealed a statisticallysignificant result for the parafoveal quadrants (p < 0.011 for SD-OCTand p < 0.005 for microperimetry) but not for the foveal area alone.Conclusions: The IS/OS regeneration in the parafoveal quadrantscontributes significantly to the recovery of BCVA following ERM surgery.Consequently, functional and morphological tests of the macular areashould not be limited to the fovea but should be extended to theparafoveal region.