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OBJECTIVE: Retrograde aortic type A dissection (RTAD) is a known complication in patients with aortic type B dissection. The purpose of this computational fluid dynamics (CFD) study was to identify haemodynamic risk factors for the occurrence of RTAD. METHODS: Computed tomographic angiography (CTA) images of 10 patients with type B dissections, who subsequently developed a RTAD, were retrospectively analysed together with patients constituting a control group (n = 10) where no further vascular events after the initial type B dissection occurred. CFD simulations were conducted based on 3D surface models of the aortic lumen derived from CTA datasets. For both groups, pressures, velocity magnitudes and wall shear stress (WSS) were compared at the site of the future RTAD entry tear and the surrounding aortic wall. RESULTS: WSS at the site of the future entry tear was significantly elevated compared with the surrounding wall (15.10 Pa vs. 5.15 Pa, p < .001) and was significantly higher in the RTAD group than in the control group (6.05 Pa, p < .002). Pressures and velocity magnitudes were not significantly elevated at the entry tear (3825.8 Pa, 0.63 m/s) compared with the aortic arch (3549.8 Pa, 0.50 m/s) or control group (3501.7 Pa, 0.62 m/s). CONCLUSIONS: Increased WSS accompanies the occurrence of RTAD. The results merit the design for a prospective study to confirm whether WSS is a risk factor for the occurrence of RTAD.

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MnGe has been grown as a thin film on Si(111) substrates by molecular beam epitaxy. A 10 Å layer of MnSi was used as the seed layer in order to establish the B20 crystal structure. Films of a thickness between 45 and 135 Å have been prepared and structurally characterized using reflection high-energy electron diffraction, atomic force microscopy and x-ray diffraction. These studies provided evidence that MnGe forms in the cubic B20 crystal structure as islands exhibit a very smooth surface. The islands become larger with increasing film thickness. A magnetic characterization reveals that the ordering temperature of MnGe thin films is enhanced compared to that for bulk material. The properties of the helical magnetic structure obtained from magnetization and magnetoresistivity measurements are compared with those of films of the related compound MnSi. The much stronger Dzyaloshinskii-Moriya interaction in MnGe results in a higher rigidity of the spin helix.

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CONTEXT: Whether ergocalciferol (D(2)) and cholecalciferol (D(3)) are equally effective to increase and maintain serum 25-hydroxyvitamin D [25(OH)D] concentration is controversial. OBJECTIVE: The aim of the study was to evaluate the effect of daily and once monthly dosing of D(2) or D(3) on circulating 25(OH)D and serum and urinary calcium. DESIGN, SETTING AND PARTICIPANTS: In a university clinical research setting, 64 community dwelling adults age 65+ were randomly assigned to receive daily (1,600 IU) or once-monthly (50,000 IU) D(2) or D(3) for 1 yr. MAIN OUTCOME MEASURES: Serum 25(OH)D, serum calcium, and 24-h urinary calcium were measured at months 0, 1, 2, 3, 6, 9, and 12. Serum PTH, bone-specific alkaline phosphatase, and N-telopeptide were measured at months 0, 3, 6, and 12. RESULTS: Serum 25(OH)D was less than 30 ng/ml in 40% of subjects at baseline; after 12 months of vitamin D dosing, levels in 19% of subjects (n = 12, seven receiving daily doses and five monthly doses) remained low, despite compliance of more than 91%. D(2) dosing increased 25(OH)D(2) but produced a decline (P < 0.0001) in 25(OH)D(3). Substantial between-individual variation in 25(OH)D response was observed for both D(2) and D(3). The highest 25(OH)D observed was 72.5 ng/ml. Vitamin D administration did not alter serum calcium, PTH, bone-specific alkaline phosphatase, N-telopeptide, or 24-h urine calcium. CONCLUSIONS: Overall, D(3) is slightly, but significantly, more effective than D(2) to increase serum 25(OH)D. One year of D(2) or D(3) dosing (1,600 IU daily or 50,000 IU monthly) does not produce toxicity, and 25(OH)D levels of less than 30 ng/ml persist in approximately 20% of individuals. Substantial between-individual response to administered vitamin D(2) or D(3) is observed.

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UNLABELLED: This prospective study finds that ergocalciferol 50,000 IU three times weekly for four weeks effectively and safely corrects vitamin D inadequacy in nursing home residents. INTRODUCTION: Low vitamin D status is common among nursing home residents and contributes to bone loss, falls and fractures. The objective of this study was to evaluate the efficacy and safety of short course, high dose, oral vitamin D(2) (ergocalciferol) treatment. METHODS: This prospective study included 63 nursing home residents. The 25 with low vitamin D status (serum 25(OH)D < or = 25 ng/ml) received oral ergocalciferol 50,000 IU three times weekly for four weeks; the others received no change to their routine care. Serum total 25(OH)D, 25(OH)D(2), 25(OH)D(3), calcium, parathyroid hormone (PTH), bone turnover markers and neuro-cognitive assessments were obtained at baseline and four weeks. RESULTS: Mean total 25(OH)D concentration increased (p < 0.0001) from 17.3 to 63.8 ng/ml in the treated group and remained unchanged in the comparison group. Serum 25(OH)D(3) remained stable in the comparison group, but declined (p < 0.0001) with D(2) treatment from 15.4 to 9.1 ng/ml. Serum PTH trended down in the treatment group (p = 0.06). No treatment-induced improvement in ambulation, cognition or behavior was observed. No hypercalcemia or other adverse effects were observed with ergocalciferol treatment. CONCLUSION: Four weeks of oral vitamin D(2) supplementation effectively and safely normalizes serum 25(OH)D in nursing home residents.

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BACKGROUND: There have been remarkable developments in Cochlear Implants in the past years. Technical improvements lead to more reliable and durable devices. In cases of traumatic and atraumatic device failure a reimplantation of the Cochlear Implant is necessary. METHODS: In a retrospective study we examined 15 patients with 17 Cochlear reimplantation procedures after a traumatic or atraumatic device failure between 1996 and 2002. The reasons leading to the revision, the intraoperative findings, the perioperative complications and the postoperative audiological results as well as the personal evaluation of the revision procedure were analyzed. RESULTS: In our study there were 11 children and 4 adults. In 10 cases a traumatic and in 7 cases an atraumatic device failure lead to the reimplantation. In 13 of the 15 patients the revision surgery took place within 1 month after the date of device failure. The electrode array could be reinserted safely without any perioperative complications. The postoperative results showed a continuous development of speech perception in all patients. The personal evaluation of the reimplantation procedure was positive in all cases. CONCLUSIONS: Cochlear reimplantation in cases of traumatic or atraumatic device failure is a safe procedure without any serious perioperative complications. The timely reimplantation leads to a continuous development of speech perception.

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INTRODUCTION: During the last years, an increasing number of papers is presented dealing with diseases and diagnostic procedures of the macula function. On the other hand, there are just a few distinct test setups for this purpose. In clinical routine, this kind of test system has to be efficient and effective to diagnostic and therapeutic findings. METHODS: The presented test setup includes examination of the semicircular canals by means of harmonic acceleration pendular rotation test and the bilateral, bithermal test as well as otolith function tests i. e. off vertical axis rotation (OVAR) and eccentric rotation. From March 1999 to May 2000 522 patients with dizziness were examined. RESULTS: Otolith tests results could be assessed in a range between 87 % to 95 % of the cases. The quality failure rate was significantly higher than in findings of semicircular canals examination procedures. The major caused technical problem were artifacts. Looking for the diagnostic relevance of the method, 37 % of the patients. Suffering from dizziness and who have normal findings in cupula VOR testing procedures revealed isolated macular dysfunctions. DISCUSSION: The relevance for diagnostic is demonstrated. Otolith function tests can be applied in clinical routine and give relevant information for diagnosis and treatment. Macula test procedures are still sophisticated. Technical development of VOG-recording is necessary for their general application in otology.

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Estrogen-depletion bone-loss studies often use ovariectomized (ovx) rats and measure bone mineral density in vivo or ex vivo using DXA. Recently, a portable densitometer (PIXImus) was developed for mouse research; however, its use in rats is unclear. This study compared the ability of PIXImus and a standard densitometer (DPXL) to detect ovx-induced bone loss in rats both in vivo and ex vivo. Additionally, instrument accuracy was assessed by comparing measured bone mass with ash weight. Finally, the use of two distal femur regions of interest (ROI) to detect ovx-induced bone loss was evaluated. Twenty-three 6-month-old nulliparous female Sprague-Dawley rats were randomly assigned to sham or ovx groups. Distal femur bone mineral density was assessed at baseline and at 1 and 2 months postoperatively, using a PIXImus and DPXL densitometer. At 3 months postoperatively, all animals were killed, and ex vivo femur scans obtained. Distal femur bone loss was demonstrable by 1 month post-ovx using either densitometer. With the PIXImus, a 4-mm ROI demonstrated greater bone loss (p < 0.05) than an 8-mm ROI. Using the 4-mm ROI, similar amounts of bone loss were detected by the PIXImus and DPXL: 22.2% and 22.4%, respectively, at 2 months post-ovx. Total femur bone mineral content was overestimated by the PIXImus but highly correlated with the DPXL measurement (r = 0.988) and ash weight (r = 0.998). Given its comparability to standard DXA plus its rapid scan speed and portability, the PIXImus is useful in evaluating ovx-induced osteopenia in rats.

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Vitamin K may be important in bone metabolism. Notably, high-dose menaquinone-4 (menatetrenone, MK4) has been reported to reduce ovariectomy (ovx)-induced bone loss in rats and to decrease osteoporotic fracture in postmenopausal women. However, it is unclear whether these beneficial effects reflect a physiologic effect of vitamin K, or indicate direct pharmacologic activity of MK4. To further evaluate this, 60 6-month-old nulliparous Sprague-Dawley rats were randomized by distal femur bone mineral density (BMD) in a 3:1 ratio to ovx or sham groups. The sham and one ovx group's diet contained 1% calcium and 1300 microg/kg of vitamin K1, phylloquinone. Diets of the other two ovx groups were supplemented with 882 mg phylloquinone or MK4 per kilogram chow. Distal femur bone mineral density (DFBMD) in an 8 mm region of interest was measured at baseline, 1 and 3 months postoperatively, utilizing dual-energy X-ray absorptiometry (DXA). All animals were killed at 3 months, their right femurs excised, ex vivo BMD measured by DXA, and biomechanical testing performed. No effect of phylloquinone or MK4 supplementation on ovx-induced bone loss was observed. Specifically, DFBMD declined 10.5%, 9.2%, and 11.2% at 1 month and 14.4%, 10.6%, and 13.9% at 3 months in the ovx control, high phylloquinone, and high MK4 groups, respectively. In addition, serum osteocalcin was elevated by ovx; this was not altered by phylloquinone or MK4. Finally, femoral biomechanical properties were not affected by phylloquinone or MK4. To conclude, in this study, neither high-dose phylloquinone nor MK4 reduced the ovx-associated increase in bone turnover or decline in DFBMD.

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BACKGROUND: Progress in surgical techniques in the temporal bone has lead to the demand of exact delineation of this complex anatomical region for preoperative planning. The aim of this study was to assess the potential of a three-dimensional T2 weighted turbo-spin-echo-sequence to depict anatomical details and pathological changes of the inner ear. METHODS: Twenty-five patients presenting with sensori-neural hearing loss and/or vertigo were included in this study. A T2 weighted turbo-spin-echo-sequence was carried out on a 1.5 T imager, employing a surface coil with a diameter of 8 cm. The scan parameters were set as follows: TR 2000, TE 500, scan matrix 128 x 128, field of view 90 mm, slice thickness 0.66 mm, NSA 4. In addition, 3D maximum-intensity-projections (MIP) were created, using these data as source images. RESULTS: Image quality was excellent in all 25 cases. The 2.5 cochlear windings, modiolus, vestibule with saccule and utricle all three semicircular canals, crus commune and the facial nerve and vestibulocochlear nerve in the inner auditory canal were clearly delineated in all patients. The cochlear aqueduct was seen in 32% (8 cases), while the vestibular aqueduct was delineated in 16% (4 cases) in this series. In MIP, the entire labyrinth was shown in a single view. In 22 patients regular morphology was found, while in three cases pathological changes were detected (an enlarged vestibular aqueduct and saccus in one patient, partial fibrous obliteration of the labyrinth in two patients). CONCLUSIONS: The introduced TSE sequence can be used to delineate the anatomy of the inner ear as well as pathological changes. The technique appears to be useful for preoperative planning.

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BACKGROUND: Subclinical vitamin K insufficiency, manifested by under-gamma-carboxylation of the bone matrix protein osteocalcin, may be common. OBJECTIVE: Our objective was to delineate the prevalence of submaximal gamma-carboxylation as assessed by response to phylloquinone supplementation and to evaluate the effect of this intervention on skeletal turnover in healthy North American adults. DESIGN: Healthy subjects (n = 219), approximately equally distributed by sex and age (18-30 y and >/=65 y), received daily phylloquinone (1000 microg) or placebo for 2 wk. Serum undercarboxylated osteocalcin (ucOC) and total osteocalcin, N:-telopeptides of type I collagen (NTx), bone-specific alkaline phosphatase (BSAP), and phylloquinone concentrations were measured at baseline and after weeks 1 and 2. RESULTS: At baseline, the mean serum phylloquinone concentration was lower in the young than in the old group; there was no effect of sex. Concomitantly, baseline %ucOC was highest in the young and lowest in the old men (P: < 0.0001) but did not differ significantly by age in women. After supplementation, serum phylloquinone concentration increased approximately 10-fold (P: < 0.0001) at week 1 (from 0.93 +/- 0.08 to 8.86 +/- 0.70 nmol/L, x+/- SEM); this was sustained through week 2. Among all supplemented groups, mean %ucOC decreased from 7.6% to 3. 4% without significant differences by age or sex; 102 of 112 subjects had a >1% decrease. Phylloquinone supplementation reduced serum osteocalcin but did not alter NTx or BSAP concentration. CONCLUSIONS: Usual dietary practices in this population did not provide adequate vitamin K for maximal osteocalcin carboxylation. Phylloquinone supplementation reduced serum osteocalcin concentration but did not alter other markers of serum bone turnover.

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To further characterize the skeletal role of vitamin K (K), markers of bone turnover, density, and strength were evaluated in rats with diet- or warfarin (W)-induced K insufficiency. One hundred two, 7-week-old, female rats were randomly assigned to low K (phylloquinone [K1], 20 microg/kg diet), control K (K1, 1300 microg/kg diet), low-dose W (W, 1.5 mg/kg control diet), or high-dose W plus K (W/K1, 10/100 mg/kg diet). Femur bone mineral content (BMC) and bone mineral density (BMD), plasma prothrombin time (PT) and prothrombin concentration (PC), and serum total alkaline phosphatase (ALP) and skeletal alkaline phosphatase (sALP) were measured at baseline and days 20, 40, 60, and 80. Serum total osteocalcin (OC) and undercarboxylated osteocalcin (ucOC) and femur length (FL) were measured at baseline and day 80. Left femur OC was measured and biomechanical testing of the right femur and third lumbar vertebral body was performed at day 80. Low dietary K elevated circulating ucOC (17% higher than control; p < 0.0001) at day 80. Furthermore, in both W groups, essentially all circulating OC was undercarboxylated and femur OC was lower than control (p < 0.0001). However, there was no change in femur percent ucOC, suggesting deposition of less newly synthesized OC. No between group differences were observed in PT, ALP, sALP, FL, BMC, BMD, or bone strength. In conclusion, skeletal K insufficiency can be induced by W or diet manipulation. This does not hinder peak bone mass attainment in female rats; however, W causes less newly synthesized OC to be deposited in bone.

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BACKGROUND: Basaloid squamous cell carcinoma is a variant of squamous cell carcinoma which is located predominantly in the upper aerodigestive tract. The cardinal histopathologic feature is a biphasic cellular pattern of basaloid and squamous components in a close relationship. Major differential diagnoses include adenoid cystic, adeno, squamous, adenosquamous, and basal cell carcinomas. This entity may commonly pose diagnostic difficulties, especially on small biopsy material, if only the basaloid component of the tumor is included. CASE REPORT: A tumor of the oropharynx (T2) was detected in a 61-year-old man. After endoscopic biopsy, this tumor was histologically identified as an adenocarcinoma. A very rapid tumor growth became obvious during the patient's staging. After pharyngectomy and neck dissection, the histopathological diagnosis was corrected to a basaloid squamous cell carcinoma. The definite diagnosis was not made on biopsy material, because only the basaloid component of the tumor was included. DISCUSSION: Basaloid squamous carcinoma is a biologically aggressive tumor with high proliferative activity and a propensity to destructive local growth and early regional and distant metastasis. Literature predominantly indicates that basaloid squamous cell carcinoma is an aggressive variant of squamous cell carcinoma and is prognostically worse than the regular squamous cell carcinoma. CONCLUSION: Because of the aggressive biological behavior of basaloid squamous cell carcinoma, radical surgery combined with radiation and chemotherapy is the treatment of choice.

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In contrast to CT and MRI, conventional B-scan echography is quick and easy to perform, cheap, and without side effects. The disadvantage is the limited field of view. This may result in a loss of information between the dynamic examination and the documentation. With SieScape a new technology was developed to address these problems. It allows one to obtain any imaging slices from the head and the neck. This technique is the first to allow a topographical orientation based on B-scan images. This study presents the application of SieScape, and demonstrates normal and abnormal findings. Initial experience with the new technology indicates that SieScape is an alternative to other methods such as CT and MRI.

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BACKGROUND: Vascularization is a characteristic of malignant tumor growth. It is possible to distinguish between benign and malignant tumors and lymph nodes of the head and the neck by their pattern of blood vessels which can be detected by color image ultrasonography. Unfortunately this detection is often unsuccessful because the vessels are too small. METHOD: Four cases (lymph node metastasis, chronic lymph node inflammation, Morbus Hodgkin, cancer of the floor of the mouth) are demonstrated. The vascularization of the masses was detected before and after the injection of Levovist, a contrast agent which is known to amplify the duplex signal up to 25 dB. RESULTS: In all of the demonstrated cases, a similar pattern of intranodal vessels was detected before the application of Levovist. After the injection an enhancement of the duplex signal could always be detected within the first minute and differences of the intratumoral pattern of the blood vessels between the cases could be identified. DISCUSSION: Levovist results in an increased detection of intratumoral blood vessels detected by color image ultrasonography. Further studies are necessary to check whether its application results in an increase of the specificity of the examination.

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Two- and three-dimensional heteronuclear NMR experiments have been performed to identify internally bound water molecules in the solution structure of bovine heart fatty-acid-binding protein (heart FABP). NOE and rotating-frame NOE (ROE) cross peaks between protein protons and protons of bound water molecules were observed in two-dimensional H2O-ROE/NOE-1H,15N-heteronuclear single quantum coherence spectra recorded from a uniformly 13C/15N-enriched sample of bovine heart FABP. Contacts between water protons and 23 NH protons of the protein backbone were identified. The protein structure consists of 10 antiparallel beta-strands (betaA-betaJ), forming two nearly orthogonal beta-sheets, and a short helix-turn-helix motif connecting beta-strands A and B. The spatial folding resembles a beta-barrel. Most of the water molecules are localized in the gap between beta-strands D and E, and near the two alpha-helices. In the delipidated heart FABP additional contacts between water molecules and NH protons could be observed using a three-dimensional rotating frame Overhauser 1H,15N heteronuclear single quantum coherence experiment obtained with a 15N-labeled sample of apo-heart FABP.

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The ability of male rats to accumulate menaquinone-4 (MK-4) in tissues when fed a vitamin K-deficient diet supplemented with intraperitoneal phylloquinone (K) as the sole source of vitamin K for 14 d was assessed. In both conventionally housed controls and gnotobiotic rats, supplementation with the equivalent of 1500 microg vitamin K/kg diet increased (P < 0.001) tissue MK-4 concentrations above those of controls fed a vitamin K-deficient diet. MK-4 concentrations were approximately 5 ng/g (11 pmol/g) in liver, 14 ng/g in heart, 17 ng/g in kidney, 50 ng/g in brain and 250 ng/g in mandibular salivary glands of gnotobiotic rats. MK-4 concentrations in conventionally housed rats were higher than in gnotobiotic rats in heart (P < 0.01), brain (P < 0.01) and kidney (P < 0.05) but lower in salivary gland (P < 0.05). Cultures of a kidney-derived cell line (293) converted K to the expoxide of MK-4 in a manner that was dependent on both time of incubation and concentration of vitamin K in the media. A liver-derived cell line (H-35) was less active in carrying out this conversion. These data offer conclusive proof that the tissue-specific formation of MK-4 from K is a metabolic transformation that does not require bacterial transformation to menadione as an intermediate in the process.

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The dynamics of amino acid side chains of uniformly 13C/15N-enriched ribonuclease T1 (RNase T1) have been investigated. Heteronuclear longitudinal relaxation rates, 1H/13C NOEs, and transverse cross-correlated cross-relaxation rates between the Sx and the SxIz1Iz2 operators (SIIS cross relaxation) [Ernst and Ernst (1994) J. Magn. Reson., A110, 202-213] have been determined in this study. New pulse sequences for measuring the longitudinal relaxation time and the heteronuclear NOE of aliphatic side chain carbon nuclei were developed using the CCONH type of magnetization transfer and 1HN detection. In addition, an improved pulse sequence for the determination of the SIIS cross relaxation is presented. For the analysis of the relaxation rates, the model of restricted rotational diffusion around the chi1 dihedral angle has been applied [London and Avitabile (1978) J. Am. Chem. Soc., 100, 7159-7165]. These techniques were used in order to describe the side chain dynamics of the small globular protein RNase T1 (104 amino acids, MW about 11 kDa). Qualitative values of microdynamical parameters were obtained for 73 out of 85 amino acid side chains (glycine and alanine residues excepted) whereas more quantitative values were derived for 67 beta-CH and beta-CH2 groups.

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The backbone dynamics of uniformly 13C/15N-enriched ribonuclease T1 have beeninvestigated using carbonyl carbon relaxation times recorded at three different spectrometerfrequencies. Pulse sequences for the determination of the longitudinal (T1) and transverse (T2)relaxation times are presented. The relaxation behaviour was analysed in terms of a multispinsystem. Although the chemical shift anisotropy relaxation mechanism dominates at highmagnetic field strength, the contributions of the dipole-dipole interactions and thecross-correlation between these two relaxation mechanisms have also been considered.Information about internal motions has been extracted from the relaxation data using themodel-free approach of Lipari and Szabo in order to determine order parameters (S2) andeffective internal correlation times (taui). Using a relatively simple relation between themeasured relaxation rates and the spectral density function, an analytical expression for themicrodynamical parameters in dependence of T1 and T2 has been derived. The spectraldensity mapping technique has been applied in order to study the behaviour of the carbonylcarbon resonances in more detail.

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The established role of vitamin K in nutrition is as a cofactor in the post-translational conversion of specific glutamyl to gamma-carboxyglutamyl (Gla) residues in a limited number of proteins. Administration of the vitamin K antagonist warfarin has previously been shown to decrease brain sulfatide concentrations and decrease brain galactocerebroside sulfotransferase (GST) activity in young mice. A dietary deficiency of vitamin K has now been shown to decrease (P < 0.01) brain sulfatide concentrations of 30-d-old mice significantly (by 21%). Male 21-d-old rats fed an excess of vitamin K for 7 or 14 d had 26 and 31% (P < 0.05) greater GST activity and 15 and 18% (P < 0.05) greater brain sulfatide concentrations, respectively, than controls fed a vitamin K-deficient diet. Male 21-d-old rats fed a diet containing 500 mg of phylloquinone/kg diet had an intermediate response and were vitamin K sufficient by normal criteria. The vitamin K response was observed when either phylloquinone or menaquinone-4 was fed as a source of the vitamin. These data suggest that in addition to its recognized role in Gla synthesis, vitamin K status is important in the maintenance of normal complex lipid sulfatide metabolism in young rats and mice.

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