The Use of Polydimethylsiloxane for Injection Laryngoplasty

Background: Injuries of the recurrent laryngeal nerve with consecutive vocal cord paralysis is a typical complication in chest, esophageal, thyroideal, and neck surgery. Glottic insufficiency secondary to such a lesion can be treated by endolaryngeal vocal cord augmentation (injection laryngoplasty). Many different substances have been used, often showing complications or disadvantages. This study reports on the use of injectable polydimethylsiloxane (PDMS), with special regard to the long-term results. Methods: In this prospective study, 21 patients with unilateral vocal cord paralysis underwent injection laryngoplasty using PDMS at a volume of 0.5-1.0ml. Preoperatively, 6 weeks and 12 months after the injection the following parameters concerning patients' voice were evaluated: Glottic closure by videolaryngostroboscopy, maximum phonation time, voice range, voice dynamic, jitter, shimmer, noise-to-harmonic-ratio, and roughness, breathiness, and hoarseness (RBH). In addition, patients were asked to give their own evaluation of how satisfied they felt with their voice and of the handicaps it caused them. Results: Postoperatively an improvement was evident in all the parameters that were investigated, and this significant improvement was still in evidence for most of the parameters more than one year after the injection. In our study no complications were observed more than one year after injection. Conclusion: PDMS is a safe substance for injection laryngoplasty in unilateral vocal cord paresis. Objective and subjective parameters confirm its effectiveness. It is suitable for obtaining satisfying results in the reestablishment of the patient's voice and communication abilit

Intravascular tissue factor initiates coagulation via circulating microvesicles and platelets

Although tissue factor (TF), the principial initiator of physiological coagulation and pathological thrombosis, has recently been proposed to be present in human blood, the functional significance and location of the intravascular TF is unknown. In the plasma portion of blood, we found TF to be mainly associated with circulating microvesicles. By cell sorting with the specific marker CD42b, platelet-derived microvesicles were identified as a major location of the plasma TF. This was confirmed by the presence of full-length TF in microvesicles acutely shedded from the activated platelets. TF was observed to be stored in the α-granules and the open canalicular system of resting platelets and to be exposed on the cell surface after platelet activation. Functional competence of the blood-based TF was enabled when the microvesicles and platelets adhered to neutrophils, as mediated by P-selectin and neutrophil counterreceptor (PSGL-1, CD18 integrins) interactions. Moreover, neutrophil-secreted oxygen radical species supported the intravascular TF activity. The pools of platelet and microvesicle TF contributed additively and to a comparable extent to the overall blood TF activity, indicating a substantial participation of the microvesicle TF. Our results introduce a new concept of TF-mediated coagulation crucially dependent on TF associated with microvesicles and activated platelets, which principally enables the entire coagulation system to proceed on a restricted cell surface

Finite-Elemente-Modellierung des Risswachstums an 3-Punktbiegeproben

Das Verhalten einer 3-Punkt-Biegeprobe mit Anriss unter Belastung kann mittels eines Finite-Element-Modells nachgebildet werden. Das Modell ermöglicht die Berücksichtigung von elastisch-plastischem Materialverhalten entsprechend der jeweiligen materialspezifischen Spannungs-Dehnungs-Kurve, welche mit dem Ansatz der multilinearen kinematischen Verfestigung (MKIN) umgesetzt wird. Weiterhin gestattet das Modell die Einbeziehung der realen Rollenkinematik beim Biegevorgang. Für die Beschreibung des Bruchkriteriums wird ein spezielles Damage-Modell verwendet, mit dem man in der Lage ist, das Risswachstums in geeigneter Weise wiederzugeben. Mit diesem Modell lässt sich auch das Teilentlastungs-Compliance-Verfahren nachbilden. Diese Simulation ermöglicht die Einschätzung von Korrekturansätzen zur experimentellen Risslängenbestimmung über die Compliance-Methode

Spectroscopic studies of the chlorophyll d containing photosystem I from the cyanobacterium, Acaryochloris marina

AbstractAbsorbance difference spectroscopy and redox titrations have been applied to investigate the properties of photosystem I from the chlorophyll d containing cyanobacterium Acaryochloris marina. At room temperature, the (P740+−P740) and (FA/B−−FA/B) absorbance difference spectra were recorded in the range between 300 and 1000 nm while at cryogenic temperatures, (P740+A1−−P740A1) and (3P740−P740) absorbance difference spectra have been measured. Spectroscopic and kinetic evidence is presented that the cofactors involved in the electron transfer from the reduced secondary electron acceptor, phylloquinone (A1−), to the terminal electron acceptor and their structural arrangement are virtually identical to those of chlorophyll a containing photosystem I. The oxidation potential of the primary electron donor P740 of photosystem I has been reinvestigated. We find a midpoint potential of 450±10 mV in photosystem I-enriched membrane fractions as well as in thylakoids which is very similar to that found for P700 in chlorophyll a dominated organisms. In addition, the extinction difference coefficient for the oxidation of the primary donor has been determined and a value of 45,000±4000 M−1 cm−1 at 740 nm was obtained. Based on this value the ratio of P740 to chlorophyll is calculated to be 1:~200 chlorophyll d in thylakoid membranes. The consequences of our findings for the energetics in photosystem I of A. marina are discussed as well as the pigment stoichiometry and spectral characteristics of P740

Myocardial extracellular volume quantification with computed tomography-current status and future outlook

Non-invasive quantification of the extracellular volume (ECV) is a method for the evaluation of focal and diffuse myocardial fibrosis, potentially obviating the need for invasive endomyocardial biopsy. While ECV quantification with cardiac magnetic resonance imaging (ECV$_{MRI}$) is already an established method, ECV quantification with CT (ECV$_{CT}$) is an attractive alternative to ECV$_{MRI}$, similarly using the properties of extracellular contrast media for ECV calculation. In contrast to ECV$_{MRI}$, ECV$_{CT}$ provides a more widely available, cheaper and faster tool for ECV quantification and allows for ECV calculation also in patients with contraindications for MRI. Many studies have already shown a high correlation between ECV$_{CT}$ and ECV$_{MRI}$ and accumulating evidence suggests a prognostic value of ECV$_{CT}$ quantification in various cardiovascular diseases. Adding a late enhancement scan (for dual energy acquisitions) or a non-enhanced and late enhancement scan (for single-energy acquisitions) to a conventional coronary CT angiography scan improves risk stratification, requiring only minor adaptations of the contrast media and data acquisition protocols and adding only little radiation dose to the entire scan. Critical relevance statement: This article summarizes the technical principles of myocardial extracellular volume (ECV) quantification with CT, reviews the literature comparing ECV$_{CT}$ with ECV$_{MRI}$ and histopathology, and reviews the prognostic value of myocardial ECV quantification for various cardiovascular disease. Key points: • Non-invasive quantification of myocardial fibrosis can be performed with CT. • Myocardial ECV quantification with CT is an alternative in patients non-eligible for MRI. • Myocardial ECV quantification with CT strongly correlates with ECV quantification using MRI. • Myocardial ECV quantification provides incremental prognostic information for various pathologies affecting the heart (e.g., cardiac amyloidosis)

First in-human quantitative plaque characterization with ultra-high resolution coronary photon-counting CT angiography

Purpose: To assess the effect of ultra-high-resolution coronary CT angiography (CCTA) with photon-counting detector (PCD) CT on quantitative coronary plaque characterization. Materials and methods: In this IRB-approved study, 22 plaques of 20 patients (7 women; mean age 77 ± 8 years, mean body mass index 26.1 ± 3.6 kg/m2) undergoing electrocardiography (ECG)-gated ultra-high-resolution CCTA with PCD-CT were included. Images were reconstructed with a smooth (Bv40) and a sharp (Bv64) vascular kernel, with quantum iterative reconstruction (strength level 4), and using a slice thickness of 0.6, 0.4, and 0.2 mm, respectively (field-of-view 200 mm × 200 mm, matrix size 512 × 512 pixels). Reconstructions with the Bv40 kernel and slice thickness of 0.6 mm served as the reference standard. After identification of a plaque in coronary arteries with a vessel diameter ≥2 mm, plaque composition was determined using a dedicated, semi-automated plaque quantification software. Total plaque, calcified, fibrotic, and lipid-rich plaque components were quantified in all datasets. Results: Median plaque volume was highest (23.5 mm3, interquartiles 17.9-34.3 mm3) for reconstructions with the reference standard and lowest for ultra-high-resolution reconstructions with a slice thickness of 0.2 mm and the Bv64 kernel (18.1 mm3, interquartiles 14.1-25.8 mm3, p < 0.001). Reconstructions with the reference standard showed largest calcified (85.1%, interquartiles 76.4-91.1%) and smallest lipid-rich plaque components (0.5%, interquartiles 0.0-1.5%). Smallest calcified plaque components (75.2%, interquartiles 69.9-80.8%) and largest lipid-rich components (6.7%, interquartiles 5.1-8.4%) were found for ultra-high-resolution reconstructions with a slice thickness of 0.2 mm and the Bv64 kernel. At an identical slice thickness, volume of calcified components was always lower, and volume of lipid-rich components was always higher for reconstructions with the Bv64 kernel compared with reconstructions with the Bv40 kernel (all, p < 0.001). Conclusion: This patient study indicates significant differences of ultra-high-resolution scanning with PCD-CT on quantitative coronary plaque characterization. Reduced blooming artifacts may allow improved visualization of fibrotic and lipid-rich plaque components with the ultra-high-resolution mode of PCD-CT. Keywords: coronary artery disease; coronary computed tomographic angiography (CCTA); high risk plaque; photon-counting detector CT (PCD-CT); ultra-high-resolution C

Gene expression and activity of specific opioid-degrading enzymes in different brain regions of the AA and ANA lines of rats

AbstractThere is increasing evidence that alcoholism runs in families suggesting that genetic factors may play a role. In support of this hypothesis, the alcohol-preferring (AA) and the alcohol-avoiding (ANA) rat lines have been developed through selective outbreeding. Numerous studies indicate that the endogenous opioid system may be involved in controlling ethanol consumption. Changes in opioid peptides and opioid receptors have been described after ethanol intake. But, the influence of ethanol on peptidolytic degradation of opioid peptides has been largely ignored, although the peptidase-mediated metabolism of neuropeptides is known as an important regulatory site of peptidergic transmission. Neutral endopeptidase 24.11 (NEP) and angiotensin-converting enzyme (ACE) degrade neuropeptides, including enkephalin and are expressed in the brain. Furthermore, a good correspondence between the regional distribution of NEP and opioid receptors in rat brain has already been reported pointing to a possible role of NEP in regulating opioid peptides. For both enzymes studied, the gene expression pattern was found to be in good agreement with the corresponding enzyme activities in the brain regions investigated, showing the highest levels for both specific mRNAs and enzyme activities in the striatum. Differences in both measured parameters were detected in distinct brain regions of AA and ANA rats. Furthermore, in some brain regions discrepancies between ACE and NEP mRNA levels and the corresponding enzyme activities were observed. For example, in olfactory bulb and striatum such discrepancies were found for both enzymes studied. In tegmentum/colliculi a higher NEP gene expression in AA rats was associated with a higher NEP enzyme activity compared to the amounts found in ANA rats