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Biomedical subjects

G Wolf

Publications and source records attributed to G Wolf.

At least 19 recordsLinked to original sources

Interleukin-1 signaling modulates stress-induced analgesia.

Exposure to stressful stimuli is often accompanied by reduced pain sensitivity, termed "stress-induced analgesia" (SIA). In the present study, the hypothesis that interleukin-1 (IL-1) may play a modulatory role in SIA was examined. Two genetic mouse models impaired in IL-1-signaling and their wild-type (WT) controls were employed. Another group of C57 mice was acutely administered with IL-1 receptor antagonist (IL-1ra). Mice were exposed to 2min swim stress at one of three water temperatures: 32 degrees C (mild stress), 20-23 degrees C (moderate stress), or 15 degrees C (severe stress); and then tested for pain sensitivity using the hot-plate test. Corticosterone levels were assessed in separate groups of WT and mutant mice following exposure to the three types of stress. Mild stress induced significant analgesia in the two WT strains and saline-treated mice, but not in the mutant strains or the IL-1ra-treated mice. Similarly, mild stress induced significantly elevated corticosterone levels in WT mice, and blunted corticosterone response in mutant mice. In contrast, both WT and mutant strains, as well as IL-1ra-treated mice, displayed analgesic and corticosterone responses following moderate and severe stress. Interestingly, the analgesic response to moderate stress was markedly potentiated in the mutant strains, as compared with their WT controls. The present results support our previous findings that in the absence of IL-1, stress response to mild stress is noticeably diminished. However, the analgesic response to moderate stress is markedly potentiated in mice with impaired IL-1 signaling, corroborating the anti-analgesic role of IL-1 in several pain modulatory conditions, including SIA.

Analgesia↗

Neural nitric oxide gene inactivation affects the release profile of oxytocin into the blood in response to forced swimming.

This study was undertaken to examine the importance of nitric oxide (NO) generated by the neural isoform of the nitric oxide synthase (nNOS) on the activity of the hypothalamic neurohypophyseal system in neural nitric oxide synthase knock-out (KO) and wild-type (WT) mice under basal conditions and in response to forced swimming. The intensity of the hybridisation signal for vasopressin (AVP) in the hypothalamic supraoptic nucleus (SON) was significantly higher in KO mice when compared with WT, whereas oxytocin (OXT) basal mRNA levels were similar in both groups. Although the basal peripheral release of AVP and OXT was equivalent in both genotypes, we observed in KO mice a significant drop of AVP and OXT plasma values 15 min after stressor onset and a robust increase in the OXT plasma concentration at 60 min. These findings suggest that in the male mouse, NO inhibits AVP gene transcription in magnocellular neurones of the SON and collaborates in maintaining constant AVP and OXT plasma levels following acute stressor exposure, exerting a bimodal regulatory action on OXT secretion. We conclude that NO is involved in the regulation of magnocellular neurones of the SON, and it is preferentially implicated in the attenuation of the peripheral release of OXT induced by acute stressor exposure.

Animals↗

DNA fragmentation in chronic glomerulonephritis: an immunohistological analysis.

BACKGROUND: Experimental data suggest that apoptosis plays an important pathophysiological role in glomerulonephritis by restoring tissue structure after proliferation of intrinsic renal cells and infiltration of leukocytes. Relatively little is known of apoptosis in human glomerulonephritis, particularly in predicting renal function during follow-up. METHODS: In order to colocalize different markers for cell damage in renal tissue from patients with different forms of glomerulonephritis (GN), a series of semithin sections from 34 kidney biopsies were studied retrospectively. Normal kidney from a nephrectomy specimen with a small renal adenocarcinoma served as a control. DNA fragmentation, expression of tissue transglutaminase II, BAX and BCL-2 were visualized immunohistochemically. In some renal biopsies, immunohistochemical staining for activated caspase 3 was performed. Proinflammatory markers (C-reactive protein, leukocytes), serum creatinine, creatinine clearance, total proteinuria, albuminuria, alpha(1)-microglobulin and IgG excretion were determined at the time of biopsy. Serum creatinine and total proteinuria were assessed 6 and 12 months after renal biopsy. RESULTS: Nuclei with different degrees of DNA fragmentation were mainly found in epithelial cells of tubules, but also in glomerular cells, regardless of the form of GN studied. Transglutaminase II expression was found only in cells with a strong staining for DNA fragmentation. DNA fragmentation localized to glomerular cells was more pronounced in proliferative than in non-proliferative forms of GN, being most abundant in patients with rapid progressive GN. Staining for activated caspase 3 in selected biopsies confirmed the presence of apoptosis. BAX and BCL-2 staining was detected within the same cells, but exhibited a different intracellular distribution. In proliferative GN, the extent of DNA damage in tubular epithelial cells significantly corresponds with the concentration of serum creatinine (p < 0.04) and with urinary excretion of alpha(1)-microglobulin (p < 0.01) at the time of biopsy. A significant correlation (p < 0.01) was seen between glomerular DNA fragmentation and follow-up total proteinuria 12 months after biopsy for proliferative forms of GN. The damaged glomerular area (e.g. mesangial sclerosis) significantly correlated with DNA fragmentation in proliferative, but not in nonproliferative GN at the time of biopsy. Furthermore, glomerular damaged showed a significant correlation with tubular DNA damage in proliferative GN. CONCLUSION: In glomerular cells, apoptosis may be important for the clearance of proliferating cells whereas in tubules, cell damage showed dependence on the degree of tubular injury mediated by inflammation and/or proteinuria. Although the degree of apoptosis in tubular cells correlates with serum creatinine in proliferative GN at the time of biopsy, it is of limited use to predict future renal function.

Adult↗

Renal injury due to renin-angiotensin-aldosterone system activation of the transforming growth factor-beta pathway.

Glomerulosclerosis, interstitial fibrosis, and tubular atrophy occur with end-stage kidney failure, irrespective of the primary etiology. The transforming growth factor-beta (TGF-beta) is a key factor in these alterations either directly, by stimulating synthesis of extracellular matrix components and reducing collagenase production, or indirectly through other profibrogenic factors such as connective tissue growth factor (CTGF). TGF-beta is important for the proliferation of intrarenal fibroblasts and the epithelial-mesenchymal transition through which tubular cells become fibroblasts. Although several factors induce TGF-beta expression in the kidney, one very interesting aspect is the link between the renin-angiotensin-aldosterone (Aldo) system (RAAS) and TGF-beta. Angiotensin II (ANG II) stimulates TGF-beta expression in the kidney by various mechanisms and upregulates receptors for TGF-beta. ANG II can directly phosphorylate Smads without inducing TGF-beta. Recent data provide compelling evidence that other components of the RAAS including ANG III, renin, and Aldo also activate the TGF-beta system. As direct modulation of the TGF-beta system is not yet feasible in humans, angiotensin-converting enzyme (ACE) inhibitors and angiotensin type 1 (AT1)-receptor blockers are currently the most potential drugs to interfere with this ANG II-mediated TGF-beta expression. This review highlights some current aspects of the interaction between the RAAS and the TGF-beta axis.

Angiotensin II↗

Multi-site quantitative ultrasound compared to dual energy X-ray absorptiometry in rheumatoid arthritis: effects of body mass index and inflamed soft tissue on reproducibility.

The objective of the study is to evaluate multi-site quantitative ultrasound (QUS) in comparison to dual energy X-ray absorptiometry (DXA) considering the effects of body mass index (BMI) and disease activity on measurements in patients suffering from rheumatoid arthritis (RA). Sixty-eight patients underwent a cross-sectional analysis of bone mineral density measured by DXA (lumbar spine, total femur) and speed of sound estimated by QUS (phalanx III, distal radius). The short-term precision of QUS was investigated with regard to BMI of healthy individuals and with regard to the level of disease activity in patients suffering from RA. The patients with RA were divided into two BMI groups as well as into low and advanced disease activity groups. The short-term precision of QUS-SOS ranged from 0.90 to 2.55% (healthy controls) and from 0.64 to 1.89% (patients with RA). The association between DXA and QUS parameters were limited in the case of advanced disease activity and pronounced BMI. Low QUS-SOS was observed for advanced disease activity group (QUS-SOS phalanx: -2.5%; QUS-SOS distal radius: -2.1%) in comparison to low disease activity group, whereas only a slight change of DXA parameters was observed. DXA-BMD and QUS parameters revealed higher values with pronounced BMI. The system shows only a short-term precision with limitations in healthy controls with accentuated BMI, as well as in patients with active RA. The application of multi-site QUS seems to be restricted for patients with active inflammation based on soft tissue alteration in RA and for healthy individuals with pronounced body mass.

Absorptiometry, Photon↗

Asymmetrical (ADMA) and symmetrical dimethylarginine (SDMA) as potential risk factors for cardiovascular and renal outcome in chronic kidney disease - possible candidates for paradoxical epidemiology?

BACKGROUND: Asymmetrical dimethylarginine (ADMA) is an inhibitor of nitric-oxide synthase. It has been linked to atherosclerotic risk in the general population as well as in end-stage renal disease patients (ESRD), whereas symmetrical dimethylarginine (SDMA) is thought to be biological inactive. Prospective data concerning the role of both dimethylarginines are rare in patients with chronic kidney disease. METHODS: 200 Patients with chronic kidney disease (mean age 57.6 +/- 13.0 years, 69 female, 131 male); 82 with chronic renal failure (CRF), 81 on maintenance haemodialysis (HD) and 37 renal transplant recipients (RTR) were prospectively followed for 24 months. ADMA and SDMA were measured by HPLC. The relation of plasma levels of ADMA and SDMA together with conventional risk factors for the cardiovascular and renal outcome was investigated with Cox proportional hazards model. RESULTS: Mean serum levels of SDMA were significantly increased in all groups compared to the control group (P <or= 0.0005), ADMA was increased only in HD and RTR (P <or= 0.004). Forty-seven cardiovascular events (CVE) occurred during follow-up, 35 patients died, and 39 patients reached ESRD. Multivariate analysis showed diabetes (RR 3.072, P = 0.01), ESRD (RR 11.915, P < 0.0005), elevated CRP levels (RR 3.916, P < 0.0005) and surprisingly a lower ADMA level (RR 0.271, P = 0.008) as independent risk factors for CVE. Serum creatinine (RR 11.378, P = 0.001), haemoglobin (RR 0.710, P = 0.038 for an increment of 1 mmol/l), and SDMA levels (RR 1.633, P = 0.006, per 1 micromol/l increment) were predictors for the progression to ESRD. CONCLUSIONS: Data from a heterogeneous group of patients with chronic kidney disease provide evidence that conventional risk factors seem to play a more important role than elevated serum levels of ADMA or SDMA for cardiovascular events. Increasing serum SDMA concentration seems to play an additive role for the renal outcome besides serum creatinine and haemoglobin levels. Whether ADMA might possibly be a candidate for the phenomenon of "paradoxical epidemiology" in chronic kidney disease needs further investigation.

Adult↗

[Histopathology after implantation of lid weights].

BACKGROUND: Various implants are used to treat lagophthalmos in facial paralysis. The implantation of gold or platinum eyelid weights (lid loading) is being used increasingly. Histological changes have not yet been systematically examined in the implant capsule during explantation of the eyelid weight. MATERIAL AND METHODS: Of 26 explanted implants, 18 implants in 17 patients were followed-up using light microscopy from 1997 to 2004. We semi-quantitatively evaluated the density of the inflammatory infiltrate and recorded the occurrence of foreign bodies in the tissue. The inflammatory infiltrate was also immunohistochemically examined to characterize cellular composition. RESULTS: In the semi-quantitative examination of inflammatory infiltration density, 60% of the gold implants showed a moderately dense or dense inflammatory infiltrate, while there was moderately dense infiltration in only 12.5% of the platinum implants. The immunohistochemical examination revealed a mixed lymphocytic inflammatory infiltrate which tended to a preponderance of B lymphocytes (humoral response). This is typical of unspecific chronic inflammation. CONCLUSIONS: Both gold and platinum are suitable for treating lagophthalmos, however, platinum has a higher density and better biocompatibility than gold.

Equipment Failure Analysis↗

[Acute myopia and progressive acute renal failure in a 28-year old active horsewoman].

A 28-year old active sportswoman was admitted to hospital suffering from fever, menigeal irritation, acute myopia and progressive acute renal failure. Showing signs of polyserositis in combination with pulmonary granulomatous changes a collagenosis as well as an atypical pneumonia was excluded first. Due to the renal loss of function a renal biopsy was taken with the typical histological result of a hantavirus infection. This could be confirmed serologically in the following. With symptomatic treatment the patient had an uneventful complete recovery during the next four weeks.

Acute Disease↗

[The osteoporosis patient with renal insufficiency: what has to be taken into account in the selection and administration of antiosteoporosis medication?].

The incidence of osteoporosis and renal insufficiency increases with age, the use of antiosteoporotic drugs approved for long-term administration in patients with inadequate renal function is therefore a cause for concern. In the dose approved for the treatment of osteoporosis oral bisphosphonates and i.v. ibandronate (3 mg every 12 weeks) have a secure antifracture efficacy, and their use is considered safe in patients with glomerular filtration rate (GFR) > 30 mI/min. Treatment with strontium ranelate and the osteoanabolic substance teriparatide is not altered by impaired renal function until GFR falls below 30 ml/min. Efficiancy of the selective estrogen receptor modulator (SERM) raloxifene is not altered by renal function.

Administration, Oral↗

Realization of the sixth modification of guidelines for organ placement in renal transplantation-a single-center experience.

Because of the recommendation of the standing commission on organ transplantation, the Board of Bundesärztekammer agreed to a modification of the guidelines for organ transplantation under section 16 of the transplantation law regarding organs from extended donors who have grave diseases. In our case all patients on our waiting list were contacted to be informed about the guideline changes. Only 6 of 322 patients (1.9%) on our waiting list who were transplantable agreed to allow organ placement from a donor with extended criteria.

Germany↗

Prevalence of impaired glucose tolerance 6 years after gestational diabetes.

AIM: Prevalence of glucose metabolism disorders in women six years after gestational diabetes in the index pregnancy (GDM). METHOD: 227 Caucasian women who developed GDM between 1995 and 1996 were investigated; 173 women (BMI 27.5+/-6.0 kg/m2) received 75 g oGGT on average 5.8+/-2.0 years after delivery. RESULTS: Impaired glucose metabolism was found in 31.2%, IGT or IFG 19.1%, diabetes mellitus type 2 (DM2) 9.2%, diabetes mellitus type 1 (DM1) 2.3%, second GDM 0.6%. 27.2% (BMI 25-29.9 kg/m2) were overweight, 23.1% suffered from obesity (BMI 30-39.9 kg/m2) and 5.2% morbid obesity (BMI>or=40 kg/m2). In comparison to a healthy control group, women with DM2 at re-examination were: older in age (32.1+/-5.9 vs. 29.1+/-4.8 years, p<0.05), had higher BMI (29.4+/-6.9 vs. 24.6+/-4.8 kg/m2, p<0.05), higher fasting blood glucose (6.5+/-1.9 vs. 5.2+/-0.9 mmol/l, p<0.05), earlier diagnosis of GDM (25+/-8 vs. 29+/-5 SSW, p<0.05), more frequent insulin therapy during pregnancy (75 vs. 24%) and had significantly higher insulin- and C-peptide for all measures of the oGTT, whereas HbA1c was not different (4.9+/-0.5 vs. 4.8+/-0.3%, n. s.). CONCLUSION: In an average of 5.8 years after the diagnosis of GDM, the majority of women still have chronic insulin resistance. One third has either IGT, IFG or diabetes mellitus. Therefore, a long term follow-up is strongly recommended for women diagnosed with GDM.

Adult↗

Portrayal of negative qualities in a doctor as a potential teaching tool in medical ethics and humanism: Journey to the End of Night by Louis-Ferdinand Celine.

Fictional stories about physicians and patients are increasingly used as a powerful teaching resource for medical students. Very often, but not exclusively, stories of physicians as positive role models are selected to teach students virtues and ethical values. Negative role models are rarely used and if so, physicians are rather described as medical quacks in such fiction then exhibiting primarily a corrupted character. I suggest that a fictional story that presents exclusively a negative role model of a physician could also be a valuable, admittedly difficult, teaching resource to demonstrate the consequences of absolute loss of ethical standards and virtues in physicians. A not widely known example of this genre is Louis-Ferdinand Céline's (1894-1961) novel Voyage au bout de la nuit (Journey to the End of the Night), published in 1932. Having a strong autobiographical background, the novel described the adventures of the medicine student, Ferdinand Bardamu, during the first world war, in the African colonies as a trader, in the United States of America as factory worker, and later after finishing his education, as a doctor for the poor. Unfortunately, Dr Bardamu develops an unprofessional, even criminal behaviour, and may serve as a negative role model for the virtues of physicians. This article will familiarise the reader with the novel and its physician author.

Education, Medical, Undergraduate↗

The use of PEG-Hirudin in chronic hemodialysis monitored by the Ecarin Clotting Time: influence on clotting of the extracorporeal system and hemostatic parameters.

AIM: The aim of our study was to investigate the use of polyethylene glycol (PEG)-Hirudin (PEG-H) as an anticoagulant in hemodialysis including drug monitoring with the Ecarin Clotting Time (ECT) in whole blood and to compare this regimen with standard anticoagulant unfractionated heparin (UFH) for influence on hemostatic parameters and clot frequency of the extracorporeal system. PATIENTS AND METHODS: The application of PEG-H as an anticoagulant in patients on chronic HD was studied in 20 patients (12 males, 8 females) from a single center in an exploratory, open-label, controlled, single-blind, dose-finding study. The patients were divided in 2 groups with 10 patients each (Group I and II); both received 3 dialyses with UFH, thereafter Group I received 5 dialyses with PEG-H and Group II 10 dialyses with PEG-H. Starting dose of PEG-H in the first dialysis was a bolus of 0.08 mg/kg bwt, the mean dose of the following HD was 0.041 mg/kg bwt (range 0.026 0.065 mg/kg bwt). PEG-H was applied as an intravenous bolus-dose followed by a 0.9% saline as a placebo-infusion. HD was performed regularly 3 times a week. All dialysis treatments were performed exclusively with a hollow fiber dialyzer type. Fibrinogen, antithrombin III, prothrombin fragments, thrombin-antithrombin and soluble fibrin were measured with commercial tests. ECT was determined in a mechanical coagulometer. A semiquantitative score was given for the presence of clots in the extracorporeal system after each dialysis. RESULTS: PEG-H was effectively used as an anticoagulant in 150 chronic dialysis treatments using ECT as a simple monitoring method. The optimal whole blood concentration for PEG-H is 600-1000 ng/ml. Clotting in the whole extracorporeal system was decreased by 45% (p = 0.059) with PEG-H anticoagulated HD in comparison to UFH. Fibrinogen, prothrombin fragments (F1+2-fragments) and thrombin-antithrombin-complex showed no significant change in comparison with UFH, antithrombin III (AT III) increased to normal concentrations. Highly sensitive coagulation markers such as a soluble fibrin showed a significant decrease (p < 0.001) before and after HD with PEG-H compared with UFH. CONCLUSION: PEG-H can be used effectively as an alternative anticoagulant in patients on chronic HD using ECT as a simple drug monitoring method. The lower frequency of clots in the extracorporeal system, the stronger and more efficient inhibition of coagulation during HD as indicated by soluble fibrin, may have a positive influence on the disturbed blood coagulation of these patients.

Adult↗

A versatile flow cytometry-based immunofluorescence inhibition assay for the detection of bovine viral diarrhea virus-specific antibodies.

A fast, sensitive and reliable flow cytometry-based (FACS = fluorescence activated cell sorting) immunofluorescence inhibition assay (FACS-IFI) for the detection of virus-specific antibodies in sera is described. The method was evaluated using sera from cattle experimentally infected with bovine viral diarrhea virus (BVDV). Virus-infected cells, which were fixed and permeabilized, were incubated with diluted sera from immunized or control animals. Monoclonal antibodies (mabs) against different viral proteins were added, and detected with ALEXA488-conjugated goat-antimouse antibodies. The fluorescence signals were detected by flow cytometry and determined as mean channel values. Results were expressed as percent fluorescence inhibition compared to standardized negative sera. The FACS-IFI test with sera from experimentally infected animals was highly sensitive and specific. Comparison of the FACS-IFI results with a commercially available blocking ELISA, an indirect ELISA and the standard serum neutralization test showed a strong correlation. Furthermore, the detection of protein-specific antibodies was possible using the FACS-IFI test.

Animals↗

[Detection of Haemophilus parasuis and Mycoplasma hyorhinis in swine and association of those pathogens with clinical and pathological-anatomic findings].

In routine diagnostic it is difficult to detect a Haemophilus parasuis infection causing a polyserositis. In the presented study, a detection method by means of PCR, from collective swabs of the serosal surfaces from animals, with and without fibrinous serositis, was investigated. A significant association was detected between post mortal findings of fibrinous serositis and molecular biological detection of Haemophilus parasuis and Mycoplasma hyorhinis. However, no significant association existed between cultural detection of Haemophilus parasuis in bronchoalveolar lavage fluid and pathological-anatomical ascertainable fibrinous serositis. A significant association between Haemophilus parasuis and Mycoplasma hyorhinis could be determined in the animals that were included in this study.

Animals↗

Radiofrequency tissue volume reduction of the soft palate and UPPP in the treatment of snoring.

The purpose of this study was to evaluate the efficiency of radiofrequency tissue volume reduction (RFTVR) and uvulopalatopharyngoplasty (UPPP) in the treatment of snoring in a prospective clinical trial of 79 patients consecutively undergoing surgery for snoring. Seventy-nine patients with primary snoring or mild OSAS (obstructive sleep apnea syndrome) were enrolled in this clinical trial (66 males and 13 females). According to the anatomical findings (the size of the tonsils and uvula), the patients underwent UPPP/TE of the RFTVR of the soft palate. Forty-seven patients had UPPP/TE (age 45.81+/-12.11 years; median AHI: 8; range 1-29). Thirty-two patients were treated with RFTVR of the soft palate (age 48.10+/-10.92; median AHI: 5.0; range 0-26). The average number of treatments was 2.2. All patients underwent preoperative polysomnography to exclude severe OSAS. Pre- and postoperative snoring scores were evaluated from the patients with bed partners. Postoperative follow-up data were collected at a median of 4 months after treatment; 85.1% of the UPPP group and 53.1% of the RFTVR group underwent postoperative polysomnography. Subjective snoring scores of all study participants were evaluated. Preoperatively, there was no statistically significant difference of subjective symptoms, age and BMI between the two groups. The snoring scores improved statistically significantly in both groups (P <0.001 in the UPPP group; P =0.001 in the RFTVR group). After UPPP/TE snoring improved in 37 patients (78.7%), and 29 (61.7%) thereof were free of bothersome snoring; no change was found in 9 patients (19.2%), and 1 (2.1%) worsened. In the RFTVR group, snoring improved in 15 (46.9%), and 9 (28.1%) thereof were free of bothersome snoring; no change was found in 13 patients (50%), and 1 worsened (3.1%). Preoperative AHI was statistically higher (P =0.016) and mean minimal oxygen saturation significantly lower (P =0.002) in the UPPP group. In the UPPP group AHI and HI showed statistically significant improvement postoperatively (P =0.025 and P =0.034, respectively). After RFTVR, no statistically significant change of AHI, HI or oxygen saturation was found. Besides limited mucosal erosions (15%) after RFTVR and foreign body sensations (<10%) after UPPP/TE, no side effects were observed. The success rate of RFTVR of the soft palate is lower compared to the more invasive technique of UPPP. Due to its minimally invasive character, RFTVR is suitable as first-step treatment for snoring, but patients should be counseled about possible success rates and different treatment options.

Catheter Ablation↗