Apoptosis and oncosis in acute coronary syndromes: Assessment and implications

The rational design of therapeutic interventions for protection of ischemic myocardium from ultimate death requires an understanding of the mechanistic basis of cardiomyocyte (CM) cell death, its timing and the tools for its quantification. Until recently, CM cell death following ischemia and/or reperfusion was considered to involve necrosis or accidental cell death from very early on. Collective evidence over the past decade indicates that early CM cell death after myocardial ischemia and post-ischemic reperfusion involves apoptosis with cell shrinkage and drop-out, and/or oncosis with cell swelling followed by necrosis. This paradigm shift suggests that different approaches for cardioprotection are required. Oncologists, pathologists, anatomists and basic scientists who have studied apoptosis over the last three decades separated physiological apoptosis from inappropriate apoptosis in pathological states. Until recently, cardiologists resisted the concepts of CM apoptosis and regeneration. Cumulative evidence indicating that apoptosis in the heart may occur in different cell types, spread from one cell type to another, and occur in bursts, may have profound implications for therapies aimed at protection of ischemic myocardium by targeting CM apoptosis in acute coronary syndromes. This review focuses on a critique of the methods used for the assessment of CM apoptosis and the implications of CM apoptosis in acute coronary syndromes. (Mol Cell Biochem 270: 177–200, 2005)     

Variability of the hepatitis B surface protein in HBV-infected liver transplant recipients

Variations in the major surface proteins (HBsAg) of hepatitis B virus (HBV) have been implicated in the high rate of reinfection in HBV-infected recipients of orthotopic liver transplantations (OLT). Sera from 6 OLT patients positive for HBsAg and from 3 recipients negative for it prior to transplantation were analyzed over several years, and 39 HBsAg sequences were compared. Despite anti-HBs immunoprophylaxis resulting in the disappearance of HBsAg, HBV DNA was detectable by a sensitive nested PCR in almost all sera. In 1 patient, a significant temporary shift in HBV subtypes was observed, indicating a mixed infection or the presence of multiple HBV populations in this patient; this was also true for other patients. Amino acid substitutions compared to wild-type HBV subtypes in 7 patients and variations within patients in 5 patients were detectable over time; the escape mutation at amino acid position 145 was detected in 2 patients. Our data suggest that the high rate of reinfection in OLT recipients seems not to be associated with specific sequence variations in the major HBs gene, but shows a remarkable inter- and intraindividual variability. Obviously, no correlation between heterogeneity in this gene and clinical outcome was present.The following investigators and institutions were members of the Liver Transplantation Group: U. Beuers, M. Bilzer, W. Caselmann, A. Gerbes, R. Hoffmann, C. Jung, G.R. Pape (Medical Department II), J. Briegel, J. Groh, M. Haller (Institute of Anesthesiology), H.J. Krämling, H. Rauh and M. Stangl (Department of Surgery).     

A multidisciplinary approach to understanding the recent and historical occurrence of the freshwater plant, Littorella uniflora

1. The vulnerability of softwater, oligotrophic lakes to eutrophication has caused the disappearance of many, if not most, of the unique isoetid plant communities. We tested whether the presence or disappearance of the isoetid Littorella uniflora (L.) could be predicted from environmental parameters, soil types and land use in the catchment area, and atmospheric nitrogen deposition. 2. We found that the topographic catchment area of a lake was an irrelevant unit to study effects of soil type and land use. Instead, using a GIS‐generated buffer zone around the lakes it proved feasible to classify 472 lakes into historical (if L. uniflora had disappeared) or recent (if L. uniflora was still present) Littorella lakes, based on soil type and land use. Our analysis showed that aeolian sand deposits and heath in the buffer zone favoured the presence of L. uniflora, whereas moraine clay and agriculture were strongly linked to the disappearance of L. uniflora. 3. However, in order to understand fully the presence or disappearance of L. uniflora, environmental data were needed in addition to soil types, land use and nitrogen deposition, and the use of discriminant analysis allowed us to classify 96% of the investigated lakes correctly into recent or historical sites. Alkalinity, total phosphorus, total nitrogen, aeolian sand deposits and heath were the most important parameters explaining the presence or disappearance of L. uniflora. Our analysis also indicated that eutrophication, rather than acidification, has likely caused the disappearance of L. uniflora from 218 of the 472 lakes investigated. 4. Our findings have widespread implications for the conservation or restoration of isoetid habitats and we recommend applying a wide buffer zone around lakes, with restrictions on farming and traditional forestry activities. In addition, our buffering concept may prove a useful tool for aquatic ecologists to investigate relationships between catchment features and organisms (plants, insects and amphibians) with aquatic as well as terrestrial life forms.     

EMG muscle scanning: Stability of hand-held surface electrodes

Electromyographic (EMG) muscle scanning measures 2-second samples of integrated muscle action potentials from individual neck and back muscles using a hand-held scanner with post-style surface electrodes separated by a fixed distance. This scanning technique is widely used to expeditiously assess muscle activity in the diagnosis of musculoskeletal disorders. In order to determine if the 2-second sample is sufficiently representative of electrical activity at a specific muscle site, the stability of the signal received by the hand-held scanner was measured bilaterally at six neck and back muscle sites over 40 seconds (20 2-second integration periods) in five seated subjects. Taking the overall average EMG activity as the true value, the mean number of 2-second integration periods required to achieve <5% standard error was calculated to be 1.47 for the 60 muscles tested. Only three sites required more than five integration periods. The validity of EMG scanning as a diagnostic tool is enhanced by longer integration periods     

Mycotic infection and the pediatric surgeon

The incidence of major fungal infection in recent years has paralleled increasing use of immunosuppressive drugs, broad spectrum antibiotics and implantable catheters and prostheses. The pediatric surgeon encounters fungi as agents of perioperative infection and anatomic disease requiring surgical intervention. Clinical mycology is increasingly challenged by a wide spectrum of unfamiliar fungi, fungal infections and antimycotic drugs. An overview of the expanding role of surgical mycosis in children is presented.