Sonographic assessment of median nerve swelling and vascularity allows for a reliable diagnosis of CTS. Determination of CSA at its maximal shape offers an easily reproducible tool for CTS classification in daily clinical practice.

Recurrent disease following high-dose chemotherapy is a major problem in patients with acute myeloid leukemia (AML). To identify its characteristics, we performed expression profiling in blasts from untreated AML and relapse, using a specific cDNA microarray comprising 4128 genes generated by cDNA subtraction supplemented with cancer-associated genes. Expression analysis of 18 AML bone marrow specimens showed that recurrent AML is commonly associated with the mRNA expression changes in a set of 58 genes. Increased cellular proliferation was indicated by the overexpression of the transferrin receptor, proliferating cell nuclear antigen, and G1 cyclins. An immunohistochemical study for Ki-67-positive blasts in 18 paired bone marrow biopsy samples confirmed a highly significant (Po0.0001) increase in the proliferation fraction at relapse. In addition, we found enhanced activation of the RAF/MEK/ERK cascade as mRNAs of MKP-1, c-jun, c-fos, and egr-1 were significantly increased at relapse. Immunohistochemistry and immunoblotting analyses for biphosphorylated ERK1/2 protein provide additional evidence for enhanced activation of the RAF/MEK/ERK pathway. The degree of increase is significantly correlated with the increased proliferation. Furthermore, the genes identified provide a rationale for further studies on predictive diagnosis and therapeutic intervention.

ObjectivesTo investigate the prognostic value of B-mode and Power Doppler (PD) ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS).MethodsProspective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months) and long-term (15–36 months) follow-up. At baseline, the cross-sectional area (CSA) of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0–3). Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ) and the DASH Questionnaire, as well as visual analogue scales for the patient’s assessment of pain (painVAS) and physician’s global assessment (physVAS). The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models.ResultsShort-term and long-term follow-up data were available for 111 (82.2%) and 105 (77.8%) patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists). Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05), but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes.ConclusionsUltrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings.

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Zusammenfassung. Grundlagen: Das Pringle-Manöver ist eine bewährte Methode, um große Blutverluste bei Leberteilresektionen zu vermeiden. Diese Methode führt jedoch zu einem Ischämie-Reperfusionsschaden der Leber. Der Ischämie-Reperfusionsschaden ist mit der Expression von Hitzeschock-Proteinen assoziiert.Methodik: Sechzehn Patienten nahmen an der Studie teil. Es wurden drei Leberproben von jedem Patienten entnommen, die erste vor dem Pringle-Manöver, die zweite etwa 30 Minuten nach Beginn des Manövers und die dritte Probe während Reperfusion. Die Proben wurden quantitativ mittels Echtzeit-Polymerase-Kettenreaktion auf die Expressionsdaten von HSP70-mRNA untersucht. GAP-DH wurde als Referenzgen verwendet.Ergebnisse: Die Expression von HSP70-mRNA war signifikant (P = 0.001) höher in Probe drei verglichen mit Probe eins mit Ausnahme zweier Patienten. Die Erhöhung der HSP70-mRNA-Werte korrelierte mit der Entnahmezeit der Reperfusionsprobe und den postoperativen Serum-Transaminase-Werten (P = 0.039). Bezugnehmend auf jene zwei Patienten ohne Erhöhung waren deren klinische Daten vergleichbar mit denen der anderen Patienten, jedoch zeigte einer der beiden präexistent höhere HSP70-mRNA-Werte.Schlussfolgerungen: HSP70 kann als Biomarker für den Ischämie-Reperfusionsschaden bei Leberteilresektionen dienen. Dieser Marker kann zur Entwicklung neuer Strategien in der Leberchirurgie beitragen.Schlüsselwörter: Hitzeschock-Protein 70, Leber, Ischämie-Reperfusionsschaden, Leberteilresektion, Präkonditionierung, Pringle-Manöver. Summary. Background:The Pringle maneuver is a common method to avoid blood loss during liver resection. This method, however, leads to an ischemic-reperfusion injury of the liver. The ischemic-reperfusion injury is associated with expression of heat shock proteins.Methods: Sixteen patients entered this study. Three liver tissue samples were taken from each patient, the first sample prior to Pringle maneuver, the second approximately 30 minutes after the beginning of the maneuver, and the third sample during reperfusion. The samples were quantitatively analyzed by real-time polymerase chain reaction for mRNA levels of HSP70. GAP-DH was used as a reference gene.Results: HSP70 mRNA levels were significantly (P = 0.001) higher in sample three compared to sample one, except in two patients. The elevation of HSP70 mRNA levels correlated with the time point of achieving the sample in reperfusion and with serum transaminase levels found after surgery (P = 0.039). Referring to those two patients without elevation, their clinical data were comparable to the others; however, one of them had a preexisting higher mRNA level of HSP70.Conclusions: HSP70 can be used as a biomarker for ischemic-reperfusion injury following liver resection. This marker can help to design new strategies in liver surgery.

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Background Sialoscintigraphy (Szinti) is used to investigate salivary gland function in patients with primary Sjögren’s syndrome (pSS). Real-time sonoelastography (SElasto) indicates tissue rigidity of salivary glands and correlates with an impaired saliva production. Objectives To investigate the value of SElasto and B-mode sonography to identify pSS patients with dysfunctional salivary glands. Methods Prospective study on 37 pSS patients fulfilling the American-European consensus group criteria [mean age 59 years; 92% female; median disease duration 3.1 years]. Szinti was conducted according to a routine protocol and semiquantitative scoring was performed (1): each gland was graded into 3= severe dysfunction, 2= moderate dysfunction, 1= mild dysfunction or 0= normal function. B-mode sonography and SElasto of parotid and submandibular glands was performed using a GE Logiq E9 ultrasound device. Parenchymal homogenicity, echogenicity, hypoechogenic areals, hyperechoic reflections and clearness of glandular borders were also semiquantitatively scored (total score 0-48) (2). SElasto was used to examine the elasticity of glandular parenchyma and a semiquantitative rating was performed with 0=no, 1=up to 25%, 2=up to 50%, 3=up to 75% and 4=more than 75% hardened areas within the salivary gland (total score 0-16). Interobserver variability of sonography and Szinti were tested in 30% of pSS patients. Results The mean Szinti score of pSS patients was 6.0 (±4.3). Loss function of 1,2 or 4 salivary glands was present in 5.3%, 17.5% and 19.3% of patients, respectively. B-mode (corrcoeff 0.65, p<0.001) as well as SElasto scores (corrcoeff 0.39, p=0.02) correlated with the Szinti score. Patients with at least one dysfunctional salivary gland had higher B-mode [median 27.5 (range 10.0-44.0) vs. 12.0 (2.0-6.9) p<0.001] and SElasto scores [median 7.0 (range 3.0-12.0) vs. 6.0 (2.0-7.0) p=0.032] than patients with normal salivary gland function. In ROC curve analysis we found an area under the curve (AUC) of 0.91 (95%CI 0.8-1.0, p<0.001) and 0.73 (0.56-0.89, p=0.03) for B-mode sonography and SElasto, respectively, to detect patients with salivary gland dysfunction. A good reproducibility of B-mode and SElasto results was found as indicated by an ICC of 0.926 (95%CI 0.565-0.983) and 0.934 (0.787-0.981), respectively. Reproducibility of Szinti results was also good (kappa 0.871). Conclusions Structural changes and increased rigidity of major salivary glands as demonstrated by B-mode sonography and SElasto, respectively correlates closely withsalivary gland dysfunction in patients with pSS. References Shizukuishi K, Nagaoka S, Kinno Y, Saito M, Takahashi N, Kawamoto M et al. Scoring analysis of salivary gland scintigraphy in patients with Sjögren’s syndrome. Ann Nucl Med 2003;17:627-31. Shizukuishi K, Nagaoka S, Kinno Y, Saito M, Takahashi N, Kawamoto M et al. Ultrasonographic changes of major salivary glands in primary Sjogren’s syndrome. Diagnostic value of a novel scoring system. Rheumatology 2005;44:768-72 Disclosure of In...