Importance of and Satisfaction with Domains of Health-Related Quality of Life in Cancer Rehabilitation

Instruments for measuring health-related quality of life (HRQoL) generally do not consider the subjective importance of the dimensions they comprise. The aims of this study were to analyze the subjectively perceived importance of the dimension of HRQoL and to investigate their relationship to the satisfaction ratings with these dimensions. A total of 1108 participants enrolled in a cancer rehabilitation program were surveyed. Patients rated eight dimensions of HRQoL (physical functioning, autonomy, emotional stability, cognitive functioning, social relationships, vitality, absence of pain, and sleep quality), as well as global health in terms of how important those dimensions are to them, and how satisfied they are with them. The dimensions with the highest importance ratings were autonomy and social relationships. There were only small sex differences in the importance ratings, but younger patients rated health as being more important than older patients did. The correlations between the importance ratings and the satisfaction ratings of the specific HRQoL dimensions ranged from 0.06 to 0.40, and the correlation between importance and satisfaction for global health was 0.01. Importance ratings provide relevant information for health care professionals in addition to the HRQoL assessments in the context of cancer rehabilitation

Genetic and physical interaction of Meis2, Pax3 and Pax7 during dorsal midbrain development

<p>Abstract</p> <p>Background</p> <p>During early stages of brain development, secreted molecules, components of intracellular signaling pathways and transcriptional regulators act in positive and negative feed-back or feed-forward loops at the mid-hindbrain boundary. These genetic interactions are of central importance for the specification and subsequent development of the adjacent mid- and hindbrain. Much less, however, is known about the regulatory relationship and functional interaction of molecules that are expressed in the tectal anlage after tectal fate specification has taken place and tectal development has commenced.</p> <p>Results</p> <p>Here, we provide experimental evidence for reciprocal regulation and subsequent cooperation of the paired-type transcription factors <it>Pax3, Pax7 </it>and the TALE-homeodomain protein <it>Meis2 </it>in the tectal anlage. Using in ovo electroporation of the mesencephalic vesicle of chick embryos we show that (i) <it>Pax3 </it>and <it>Pax7 </it>mutually regulate each other's expression in the mesencephalic vesicle, (ii) <it>Meis2 </it>acts downstream of <it>Pax3/7 </it>and requires balanced expression levels of both proteins, and (iii) Meis2 physically interacts with Pax3 and Pax7. These results extend our previous observation that <it>Meis2 </it>cooperates with <it>Otx2 </it>in tectal development to include Pax3 and Pax7 as Meis2 interacting proteins in the tectal anlage.</p> <p>Conclusion</p> <p>The results described here suggest a model in which interdependent regulatory loops involving <it>Pax3 </it>and <it>Pax7 </it>in the dorsal mesencephalic vesicle modulate <it>Meis2 </it>expression. Physical interaction with Meis2 may then confer tectal specificity to a wide range of otherwise broadly expressed transcriptional regulators, including Otx2, Pax3 and Pax7.</p

Effects of percutaneous transluminal angioplasty on muscle BOLD-MRI in patients with peripheral arterial occlusive disease: preliminary results

The purpose was to evaluate the effect of percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) on the blood oxygenation level-dependent (BOLD) signal change in the calf musculature of patients with intermittent claudication. Ten patients (mean age, 63.4 ± 11.6years) with symptomatic peripheral arterial occlusive disease (PAOD) caused by SFA stenoses were investigated before and after PTA. Patients underwent BOLD-MRI 1 day before and 6 weeks after PTA. A T2*-weighted single-shot multi-echo echo-planar MR-imaging technique was applied. The BOLD measurements were acquired at mid-calf level during reactive hyperaemia at 1.5 T. This transient hyperperfusion of the muscle tissue was provoked by suprasystolic cuff compression. Key parameters describing the BOLD signal curve included maximum T2* (T2*max), time-to-peak to reach T2*max (TTP) and T2* end value (EV) after 600 s of hyperemia. Paired t-tests were applied for statistic comparison. Between baseline and post-PTA, T2*max increased from 11.1 ± 3.6% to 12.3 ± 3.8% (p = 0.51), TTP decreased from 48.5 ± 20.8 s to 35.3 ± 11.6s (p = 0.11) and EV decreased from 6.1 ± 6.4% to 5.0 ± 4.2% (p = 0.69). In conclusion, BOLD-MRI reveals changes of the key parameters T2*max, TTP, and EV after successful PTA of the calf muscles during reactive hyperaemi

ECG-triggered non-enhanced MR angiography of peripheral arteries in comparison to DSA in patients with peripheral artery occlusive disease

Object: The purpose of this study was to evaluate peripheral non-enhanced-MRA (NE-MRA) acquired with a 3D Turbo Spin Echo sequence with electrocardiographt (ECG) triggering in comparison to Digital Subtraction Angiography (DSA) as the gold standard in symptomatic peripheral artery occlusive disease (PAOD) patients. Materials and methods: This IRB approved prospective study included 23 PAOD patients from whom three patients had to be excluded. The remaining 20 subjects were included in the analysis (15 male; mean age 62.4±15.3years). The patients first underwent DSA followed by NE-MRA on a 1.5-T whole body scanner within 24h after the DSA study. A NATIVE (Non-contrast Angiography of the Arteries and Veins) SPACE (Sampling Perfection with Application Optimized Contrast by using different flip angle Evolution) sequence at four levels (pelvis, upper leg, knee region and lower leg) was acquired. For evaluation purposes, subtracted standardized MIP (maximum intensity projection) images were generated from the NE-MRA data sets. Qualitative assessment of NE-MRA images in reference to the corresponding DSA images, as well as blinded stenosis grading of preselected segments in NE-MRA images were performed by two experienced readers. Image quality in 95 corresponding arterial segments was rated from 1 (good) to 4 (inadequate) directly comparing the NE-MRA with the corresponding DSA segment as the gold standard. Blinded stenosis grading consisted of 66 preselected stenoses rated from 1 (90%) in NE-MRA which were compared to the grade in the corresponding DSA. Results: The mean image quality of NE-MRA in comparison to DSA was 2.7±1.1 (reader 1) and 3.0±1.0 (reader 2). The kappa value indicating interobserver agreement was 0.34; readers 1 and 2 rated the image quality as good in 21% and 3%, sufficient in 19% and 41%, limited in 29% and 14% and inadequate in 31% and 42%, respectively. Stenosis graduation revealed significantly higher grades in NE-MRA (reader 1: 3.0±0.7, p<0.001 and reader 2: 3.1+0.8, p<0.001) compared to DSA (mean value DSA 2.7±0.8). The kappa value indicating interobserver agreement concerning stenosis grading was 0.59. Conclusion: NE-MRA revealed a relatively high number of inadequate quality segments. This is in line with recently published comparable studies of the similar SPACE NE-MRA techniques. Further advance of NE-MRA techniques remains desirable for patients with PAO

A Novel Seeding and Conditioning Bioreactor for Vascular Tissue Engineering

Multiple efforts have been made to develop small-diameter tissue engineered vascular grafts using a great variety of bioreactor systems at different steps of processing. Nevertheless, there is still an extensive need for a compact all-in-one system providing multiple and simultaneous processing. The aim of this project was to develop a new device to fulfill the major requirements of an ideal system that allows simultaneous seeding, conditioning, and perfusion. The newly developed system can be actuated in a common incubator and consists of six components: a rotating cylinder, a pump, a pulse generator, a control unit, a mixer, and a reservoir. Components that are in direct contact with cell media, cells, and/or tissue allow sterile processing. Proof-of-concept experiments were performed with polyurethane tubes and collagen tubes. The scaffolds were seeded with fibroblasts and endothelial cells that were isolated from human saphenous vein segments. Scanning electron microscopy and immunohistochemistry showed better seeding success of polyurethane scaffolds in comparison to collagen. Conditioning of polyurethane tubes with 100 dyn/cm2 resulted in cell detachments, whereas a moderate conditioning program with stepwise increase of shear stress from 10 to 40 dyn/cm2 induced a stable and confluent cell layer. The new bioreactor is a powerful tool for quick and easy testing of various scaffold materials for the development of tissue engineered vascular grafts. The combination of this bioreactor with native tissue allows testing of medical devices and medicinal substances under physiological conditions that is a good step towards reduction of animal testing. In the long run, the bioreactor could turn out to produce tissue engineered vascular grafts for human applications “at the bedside”