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BACKGROUND: Depressive symptoms are prominent psychopathological features of Huntington's disease (HD), making a negative impact on social functioning and well-being. METHOD: We compared the frequencies of a history of depression, previous suicide attempts and current subthreshold depression between 61 early-stage HD participants and 40 matched controls. The HD group was then split based on the overall HD group's median Hospital Anxiety and Depression Scale-depression score into a group of 30 non-depressed participants (mean 0.8, s.d. = 0.7) and a group of 31 participants with subthreshold depressive symptoms (mean 7.3, s.d. = 3.5) to explore the neuroanatomy underlying subthreshold depressive symptoms in HD using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI). RESULTS: Frequencies of history of depression, previous suicide attempts or current subthreshold depressive symptoms were higher in HD than in controls. The severity of current depressive symptoms was also higher in HD, but not associated with the severity of HD motor signs or disease burden. Compared with the non-depressed HD group DTI revealed lower fractional anisotropy (FA) values in the frontal cortex, anterior cingulate cortex, insula and cerebellum of the HD group with subthreshold depressive symptoms. In contrast, VBM measures were similar in both HD groups. A history of depression, the severity of HD motor signs or disease burden did not correlate with FA values of these regions. CONCLUSIONS: Current subthreshold depressive symptoms in early HD are associated with microstructural changes - without concomitant brain volume loss - in brain regions known to be involved in major depressive disorder, but not those typically associated with HD pathology.

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We reported the successful administration of infliximab for late-onset OKT3-resistant rejection in two patients, who presented persistent ulcerative inflammation of the ileal graft after intestinal transplantation (ITX). Based on this experience, the present study demonstrated our long-term experience with infliximab for different types of rejection-related and inflammatory allograft alterations. Infliximab administration (5 mg/kg body weight (BW)) was initiated at a mean of 18.2 ± 14.1 months after transplantation. The number of administrations per patient averaged 8.4 ± 6.7. Repeat dosing was timed according to clinical signs and graft histology in addition to serum-levels of tumor necrosis factor alpha (TNFα), lipopolysaccharide binding protein (LBP) and C-reactive protein (CRP). Infliximab was successful in the following patients: patients with late-onset OKT3- and steroid-refractory rejection who presented persistent ulcerative alterations of the ileal graft (n = 5), patients with ulcerative ileitis/anastomositis, who did not show typical histological rejection signs (n = 2), and one patient with early-onset OKT3-resistant rejection. Infliximab was not successful in one patient with early-onset OKT3-resistant rejection that was accompanied by treatment-refractory humoral rejection. In conclusion, infliximab can expand therapeutic options for late-onset OKT3- and steroid-refractory rejection and chronic inflammatory graft alterations in intestinal allograft recipients.

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BACKGROUND AND PURPOSE: Ultrasound is a useful non-invasive instrument in visualizing physiological and pathological morphology in skeletal muscle. Here, we evaluate the possibility that quantitative muscle ultrasound using the parameters 'intensity', 'entropy', and 'fractal dimension' is a feasible method to distinguish between dystrophic myopathies (DM), inflammatory myopathies (IM), and motor neuron disorders. METHODS: Seven patients with IM, 12 patients with DM, nine patients with motor neuron diseases, and 24 healthy subjects underwent an identical ultrasound examination protocol, applied on gastrocnemius and tibialis anterior muscle. Analysis parameters were applied on grey scale images as well as on gradient images. RESULTS: Statistical evaluation revealed no significant differences in the evaluated parameters for differentiation of the distinct disease groups. Compared with healthy controls however we found statistically significant differences between almost of all the investigated parameters, even in disease cases with clinically unaffected distal musculature. CONCLUSION: The parameters are able to distinguish between healthy and affected musculature but not between distinct disease entities. Studies are needed to establish whether or not the parameters are helpful to monitor muscle involvement and disease progression in neuromuscular diseases.

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Developmental dyslexia is one of the most common neuropsychological disorders in children and adults. Only few data are available on the pathomechanisms of this specific dysfunction, assuming--among others--that dyslexia might be a disconnection syndrome of anterior and posterior brain regions involved in phonological and orthographic aspects of the reading process, as well as in the integration of phonemes and graphemes. Therefore, diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) were used to verify the hypothesis of altered white and gray matter structure in German dyslexic adults. DTI revealed decreased fractional anisotropy (FA) in bilateral fronto-temporal and left temporo-parietal white matter regions (inferior and superior longitudinal fasciculus). Significant correlations between white matter anisotropy and speed of pseudoword reading were found. In dyslexics, gray matter volumes (as measured by VBM) were reduced in the superior temporal gyrus of both hemispheres. So far, our results, based on a combined analysis of white and gray matter abnormalities, provide exceedingly strong evidence for a disconnection syndrome or dysfunction of cortical areas relevant for reading and spelling. Thus, we suggest that this imbalance of neuronal communication between the respective brain areas might be the crucial point for the development of dyslexia.

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White matter connectivity in the human brain can be mapped by diffusion tensor magnetic resonance imaging (DTI). After reconstruction, the diffusion tensors, the diffusion amplitude and the diffusion direction can be displayed on a morphological background. Consequently, diffusion tensor fibre tracking can be applied as a non-invasive in vivo technique for the delineation and quantification of specific white matter pathways. The aim of this study was to show that normalization to the Montreal Neurological Institute (MNI) stereotaxic standard space preserves specific diffusion features. Therefore, techniques for tensor imaging and fibre tracking were applied to the normalized brains as well as to the group averaged brain data. A normalization step of individual data was included by registration to a scanner- and sequence-specific DTI template data set which was created from a normal database transformed to MNI space. The algorithms were tested and validated for a group of 13 healthy controls.

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In the routine recording of magnetocardiograms (MCGs), it is necessary to underline the problem of noise cancellation. Source separation has often been suggested to solve this problem. In this paper, blind source separation (BSS), by means of singular value decomposition (SVD) and independent component analysis (ICA), was used for noise reduction in MCG data to improve the signal to noise ratio. Special techniques, based on statistical parameters, for identifying noise and disturbances, have been introduced to automatically eliminate noise-related and disturbance-related components before reconstructing cleaned data sets. The results show that ICA and SVD can detect and remove a variety of noise and artefact sources from MCG data, as well as from stress MCG.

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In 1992, Brockmeier et al. showed that there is a strong difference in magnetocardiography (MCG)-detected field distribution generated by the heart at rest and under stress. To study the possible clinical applications of this finding, it is convenient to avoid pharmacological stress and to perform stress MCG (SMCG) using conventional physical stress with an ergometer. When using a non-magnetic ergometer, the MCG recordings under physical stress are more noisy due to the unavoidable movement artefacts from the patient and from the residual artefacts of the ergometer. To remove these artefacts a denoising was performed using independent component analysis (ICA) in a new implementation. This work shows that with ICA in this special implementation it is becoming feasible to extract heart signals from SMCG data recorded during ergometer exercise.

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Performing signal averaging in an efficient and correct way is indispensable since it is a prerequisite for a broad variety of magnetocardiographic (MCG) analysis methods. One of the most common procedures for performing the signal averaging to increase the signal-to-noise ratio (SNR) in magnetocardiography, as well as in electrocardiography (ECG), is done by means of spatial or temporal techniques. In this paper, an improvement of the temporal averaging method is presented. In order to obtain an accurate signal detection, temporal alignment methods and objective classification criteria are developed. The processing technique based on hierarchical clustering is introduced to take into account the non-stationarity of the noise and, to some extent, the biological variability of the signals reaching the optimum SNR. The method implemented is especially designed to run fast and does not require any interaction from the operator. The averaging procedure described in this work is applied to the averaging of MCG data as an example, but with its intrinsic properties it can also be applied to the averaging of ECG recording, averaging of body-surface-potential mapping (BSPM) and averaging of magnetoencephalographic (MEG) or electroencephalographic (EEG) signals.

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Modelling the electromagnetic properties of the thorax in magnetocardiographic (MCG) studies is usually performed by the Boundary Element Method (BEM). Magnetic Resonance Imaging (MRI) scans are generally used as the basis for extracting the coordinates for BEM. As MRI is a (time) expensive technique and scanners have a high use demand, in this work a strategy is presented that reduces the costs and the need for additional MRI images. This strategy is based on the use of low resolution and incomplete MRI image sets of the thorax.

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OBJECTIVE: To test the feasibility of using gingival crevice blood (GCB) collected during routine periodontal examination to estimate blood glucose levels using a novel and very sensitive self-monitoring device (FreeStyle). SUBJECTS AND METHODS: Forty-six patients (20 male, 26 female; age range 12-56 years, mean age 36 +/- 11 years) seeking dental treatment took part in the study. Three and 4 patients reported diabetes mellitus type 1 and 2, respectively; 24 had gingivitis, of which 22 were moderate or advanced periodontitis. Periodontal probing depth (PD) and clinical attachment loss was measured at 6 sites of every tooth present, and bleeding on probing (BOP) was recorded. A site with profuse BOP was chosen for glucose determination. Measurements in GCB were compared with those of conventional capillary fingerstick blood (CFB). RESULTS: Sufficiently large GCB volumes provided glucometer readings in 32 cases (range 1.17-10.00 mmol/l). The CFB readings ranged between 1.39 and 11.50 mmol/l. If low amounts of crevice blood prohibited a glucometer reading, significantly lower mean numbers of sites with BOP (26 vs. 67, p <0.001) and elevated PD > or =4 mm (2 vs. 21, p <0.05) were seen. Agreement between the two measurements was low, the mean difference was -1.22, and limits of agreement (1.96 times the standard deviation of differences) were +/-2.89 mmol/l. CONCLUSION: The present study failed to provide any evidence for the usefulness of GCB for testing blood glucose during routine periodontal examination.

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BACKGROUND: Ileocolonoscopy represents the diagnostic standard in the work-up of patients with inflammatory bowel diseases (IBD). Patients are often reluctant to be colonoscoped because of the invasiveness and pain sensation during colonoscopy. AIMS: To compare the usefulness oftransabdominal ultrasound (US) and magnetic resonance imaging (MRI) in assessing disease extension and activity in patients with IBD restricted to the terminal ileum and large bowel. PATIENTS AND METHODS: 61 patients with IBD [37 Crohn's disease (CD) and 24 ulcerative colitis (UC)] were prospectively studied. All patients underwent clinical and laboratory assessment, ileocolonoscopy, transabdominal sonography, and MRI within 5 days. Involved bowel segments were defined as those with bowel wall thickness >3 mm and increased Doppler signal on US or contrast enhancement of the bowel wall on MRI. To compare disease activity endoscopic, MRI and US findings were graded with newly developed scores. RESULTS: The segment-by-segment analysis revealed an overall accuracy of 89% for US and 73% for MRI in identifying active IBD. The accuracy was better in patients with UC than in patients with CD for both US and MRI. The endoscopic activity index (EAI) correlated stronger with the US activity index (r = 0.884) than with the MRI activity index (r = 0.344). The correlation of US and MRI activity indices with EAI was better in patients with UC compared with patients with CD. All three imaging methods showed a significant correlation with clinical disease activity in patients with UC but not in patients with CD. CONCLUSION: This study provides strong evidence that US should be considered as a first-choice method for follow-up of patients with IBD of the terminal ileum and large bowel.

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OBJECTIVE: Over the last few years, a number of studies have shown that fetal magnetocardiography (fMCG) is useful in describing fetal cardiac activity. A 55-channel MCG system in Ulm was used to record fetal cardiac activity in 12 pregnant women (with normal fetal heart activity in echocardiography) and in 5 pregnant women in whom the echocardiography showed fetal arrhythmias. METHOD: The recorded MCG data were treated in order to eliminate the maternal signal and three MCG channels with the best signals were used to emulate a standard electrocardiogram (ECG) recording so that standard MCG analysis could be performed. RESULTS: The results in assessing fetal electrophysiology, demonstrating its potential, are presented here for two fetuses with recorded supraventricular extrasystoles (SVES) and for one with ventricular extrasystoles (VES). Concerning the SVES, the analysis software OMEGA was able to separate three different beat morphologies. The VES could be detected exactly and have been confirmed by postnatal ECG. CONCLUSION: The beat morphology and the beat-to-beat variations allow new insights into the electrophysiology of the fetal heart.

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Parameterization of the ST-segment is used as a tool for risk stratification for patients to suffer from ventricular tachycardia. This parameterization is performed in terms of Principal Component Analysis (PCA) applied on multichannel magnetocardiographic (MCG) recordings. 55-channel MCG was recorded from 14 normal persons, 10 patients with CHD, 14 patients with MI, and six patients with VT. We found a significantly (p < 0.05) lower PCA-score in patients with MI compared to normals. The lowest PCA-score was found in VT patients. Significant differences can be found between VT patients and normals and also between VT patients and CHD patients.

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The MEG system Argos 500, recently installed at the University of Ulm, is designed for clinical application and routine use, to allow investigation of a large number of patients per day. To reach this goal, the system design meets the requirements of reliability, high field sensitivity, minimal set-up overhead before each measurement and an easy-to-handle user interface. The sensor system consists of a 163 vector-magnetometer array oriented and located in a suitable way to cover the whole head of the patient. Four additional triplets are available as references to build software gradiometers. To use this system at a high performance level, it must be properly calibrated, with these goals: to determine the actual geometry of the sensors array, which can deviate from the design specifications, and to determine the actual sensitivity of each sensor. The calibrating source consists of 31 coils placed at the corners of a head-size dodecahedron. Various details of the calibration system and process are presented here.

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We here describe the MEG system recently installed at the University of Ulm; it is specifically designed for clinical application and routine use, to allow investigation of a large number of patients per day. To reach this goal, the system design meets the requirements of reliability, high field sensitivity, minimal set-up time before each measurement and an easy-to-handle user interface. The sensor system consists of a 163 vector-magnetometers array oriented and located in a suitable way to cover the whole head of the patient. Four additional triplets are available as references to arrange software gradiometers. The helmet shaped sensor system is positioned to accommodate the patient in a supine position. Simultaneously to the MEG, there are 64 EEG channels. Other relevant patient information can be recorded up to a total number of 660 acquisition channels. Noise level of a single magnetometer is about 5 fT/square root of Hz. Maximum sampling rate is 4200 Hz.

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High resolution electrocardiography (HRECG) recordings have already shown an increased beat-to-beat microvariability of the QRS duration of the terminal QRS in patients with a history of ventricular tachycardia (VT). The purpose of this study is to detect QRS-duration microvariability with magnetocardiographic (MCG) recordings in normals, patients with coronary heart disease (CHD), patients with a history of myocardial infarction (MI), and VT patients. QRS microvariability is calculated as the variance of time-shifts of single beats respectively to the average of all beats. The average over all channels of the MCG is performed. QRS microvariability was evaluated from 55-channel MCG in 15 normal persons, in 12 patients with CHD, in 13 patients with MI, and in 10 patients with VT. We found a significantly higher microvariability in patients with MI compared to normals. The highest microvariability was found in VT patients.

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BACKGROUND/AIMS: Periodontal infections with Actinobacillus actinomycetemcomitans seem to be refractory to conventional therapy. The aim of the present study was to test the in vitro susceptibilities of A. actinomycetemcomitans strains to a panel of seven orally administrable antibiotics. METHODS: A total of 60 isolates of A. actinomycetemcomitans recovered from 43 individuals with gingivitis or periodontitis were tested. In addition, laboratory strains UP-6 and JP2 were analysed. The E-test was employed in order to determine minimal inhibitory concentrations (MIC) of antibiotics ampicillin/sulbactam, roxithromycin, azithromycin, doxycycline, metronidazole, ciprofloxacin, and moxifloxacin. RESULTS: A. actinomycetemcomitans was highly susceptible to both fluoro-quinolones (MIC90 of 0.006 microgram/mL of ciprofloxacin and 0.032 microgram/mL of moxifloxacin). Good susceptibilities were found for ampicillin/sulbactam and doxycycline (MIC90 of 0.75 microgram/mL and 1 microgram/mL, respectively), and moderate susceptibilities for azithromycin (MIC90 of 3 microgram/mL). Most strains were resistant to metronidazole and roxithromycin. Cluster analysis revealed two larger clusters of A. actinomycetemcomitans strains with the smaller cluster assembling isolates with significantly higher MICs of most antibiotics. CONCLUSIONS: Due to reported favourable pharmacokinetics, the fluoro-quinolone moxifloxacin appeared to be a promising candidate for adjunctive systemic antibiotic therapy in periodontal infections with A. actinomycetemcomitans.

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