One known problem within laryngoscopy is the spatially limited view onto the hypopharynx and the larynx through the endoscope. To examine the complete larynx and hypopharynx, the laryngoscope can be rotated about its main axis, and hence the physician obtains a complete view. If such examinations are captured using endoscopic video, the examination can be reviewed in detail at a later time. Nevertheless, in order to document the examination with a single representative image, a panorama image can be computed for archiving and enhanced documentation. Twenty patients with various clinical findings were examined with a 70 rigid laryngoscope, and the video sequences were digitally stored. The image sequence for each patient was then post-processed using an image stitching tool based on SIFT features, the RANSAC approach and blending. As a result, endoscopic panorama images of the larynx and pharynx were obtained for each video sequence. The proposed approach of image stitching for laryngoscopic video sequences offers a new tool for enhanced visual examination and documentation of morphologic characteristics of the larynx and the hypopharynx.

Objective: The distribution of ventilation within the lung is inhomogeneous. We hypothesized that the degree of inhomogeneity in patients with cystic fibrosis (CF) differs from that in healthy subjects. Method: Three adult patients with cystic fibrosis (CF) and two healthy subjects were recruited for this preliminary study. Subjects were asked to breathe in as deep and exhale as hard as possible three times. Electrical impedance tomography (EIT) measurements were performed during spirometry tests. The global inhomogeneity index(GI) was applied to assess the degree of ventilation homogeneity at 25%, 50%, 75% and 100% of maximum inspiratory volume. Results: Airway obstruction was detected in CF patients but not in healthy volunteers during spirometry tests. GI decreased as inspiratory volume increased in CF patients (0.59+/-0.20 at 25% and 0.39+/-0.09 at 100%, p<0.01, mean+/-SD) while GI remained unchanged in healthy subjects (0.40+/-0.05 at 25% and 0.37+/-0.03 at 100%, p=0.31). Conclusion: Degree of ventilation homogeneity appears to vary during forced respiration in CF patients, but not in healthy volunteers. EIT is a practical method to measure the inhomogeneity of ventilation distribution.

Over the past 6 years, next generation sequencing (NGS) has been established as a valuable high-throughput method for research in molecular genetics and has successfully been employed in the identification of rare and common genetic variations. All major NGS technology companies providing commercially available instruments (Roche 454, Illumina, Life Technologies) have recently marketed bench top sequencing instruments with lower throughput and shorter run times, thereby broadening the applications of NGS and opening the technology to the potential use for clinical diagnostics. Although the high expectations regarding the discovery of new diagnostic targets and an overall reduction of cost have been achieved, technological challenges in instrument handling, robustness of the chemistry and data analysis need to be overcome. To facilitate the implementation of NGS as a routine method in molecular diagnostics, consistent quality standards need to be developed. Here the authors give an overview of the current standards in protocols and workflows and discuss possible approaches to define quality criteria for NGS in molecular genetic diagnostics.

alpha-Tocopherol transfer protein (alpha-TTP) has been identified as the major intracellular transport protein for the antioxidant vitamin E (alpha-Tocopherol). Expression of alpha-TTP on the reproductive system has been described both in mouse uterus and lately in the human placenta. The aim of this study was to clarify if placental expression of alpha-TTP can be modified by substances causing oxidative reactions. The human choriocarcinoma cell line BeWo was, therefore, treated with two known pro-oxidants. alpha-TTP expression was determined with immunocytochemistry and evaluated by applying a semiquantitative score. The presence of pro-oxidants in BeWo cells induced alpha-TTP expression. We thus hypothesize that stimulation of alpha-TTP expression by oxidative stress, as this was induced by pro-oxidants, could be part of an antioxidant process occurring in the placenta in the aim of enhancing the supply of alpha-Tocopherol. This process could occur both in normal pregnancies, as well as in pregnancy disorders presented with intensified oxidative stress. In that view, this model is proposed for further oxidative stress studies on trophoblast and placenta, on the grounds of clarifying the role of alpha-Tocopherol in pregnancy physiology and pathophysiology.

The primary stability of cementless total hip endoprosthesis is of vital importance for proximate, long-term osteointegration. The extent of micromotions between implant and acetabulum is an indicator of primary stability. Based on this hypothesis, different cementless hip joint endoprosthesis were studied with regard to their micromotions. The primary stability of nine different cementless threaded acetabular cups was studied in an experimental setup with blocks of rigid foam. The micromotions between implant and implant bearing were therefore evaluated under cyclic, sinusoidal exposure. The blocks of polymer foam were prepared according to the Paprosky defect classifications. The micromotions increased with the increasing degree of the defect with all acetabuli tested. Occasionally coefficients of over 200 mu m were measured. From a defect degree of 3b according to Paprosky, the implants could no longer be appropriately placed. The exterior form of the spherical implants tended to exhibit better coefficients than the conical/parabolic implants.

Systemic autoimmune diseases are characterized by the presence of antinuclear autoantibodies (ANAs). Diluted patient sera are typically used to screen for the presence of ANAs by immunofluorescence microscopy with fixed HEp-2 cells. Despite high quality test kits, reports of different laboratories frequently present controversial results. This study presents a recommendation for a unified processing and interpretation of HEp-2 based screening for autoantibodies. We provide suggestions for selection of high quality test kits, optimized processing, and diagnostic procedures. For good laboratory practice, in addition to a relevant clinical diagnosis and an experienced laboratory specialist, the following procedure is highly recommended: initial HEp-2 based screening by indirect immunofluorescence, starting with a 1:80 serum dilution and evaluation in a bright fluorescence microscope, pathological values from a titer of 1:160, internal quality checks, and unified interpretation. We aim to improve diagnostics and care for patients with autoimmune diseases as a central focus of the European Autoimmunity Standardization Initiative (EASI).

The symptoms of growth hormone deficiency and growth hormone excess manifest themselves clinically in different ways, before and after the completion of longitudinal growth. Always, however, biochemical diagnostics is based on the measurement of circulating concentrations of growth hormone and insulin-like growth factor I (IGF-I). Immunoassays are practical, sensitive, and mostly specific methods for measuring either hormone. Still, there are serious discrepancies between the measured results of different assays. These discrepancies are mainly due to differences in the isoform specificity of assays, the use of different standard preparations, as well as the interference of binding proteins. The method-related differences in measured results make the general application of published diagnostic decision limits more difficult. At an interdisciplinary consensus conference, with the participation of the Growth Hormone Research Society, the IGF Society, and the International Federal of Clinical Chemistry and Laboratory Medicine (IFCC), the existing problems were analyzed and possible strategies were highlighted to improve the comparability of the measured results of different GH and IFG-I assays. Currently, however, the use of method-specific reference ranges obtained from well-characterized cohorts continues to be essential in clinical practice.

The mechanical complications of osteosyntheses after hip fractures are previously investigated by mostly static or dynamic uniaxial loading test systems. However, the physiologic loading of the hip joint during a normal gait is a multiplanar, dynamic movement. Therefore, we constructed a system to test osteosyntheses for hip fractures under physiologic multiplanar loading representative of normal gait. To evaluate the testing system, 12 femora pairs were tested under 25,000 cycles with two standard osteosyntheses (Proximal Femoral Nail Antirotation/Gamma3 Nail). For angular movement, the varus collapse to cut out (proportional to(CO)) (proportional to(CO) = 4.8 degrees +/- 2.1 degrees for blade and proportional to(CO) = 7.8 degrees +/- 3.8 degrees for screw) was the dominant failure mode, and only slight rotational angle shifts (proportional to(Rot)) (proportional to(Rot) = 1.7 degrees +/- 0.4 degrees for blade and proportional to(Rot) = 2.4 degrees +/- 0.3 degrees for screw) of the femoral head around the implant axis were observed. Angular displacements in varus direction and rotation were higher in specimens reinforced with screws. Hence, the cut out model and the migration directions showed a distinction between helical blade and hip screw. However, there were no significant differences between the different implants. The new setup is able to create clinical failures and allows to give evidence about the anchorage stability of different implant types under dynamic gait motion pattern.

The extent of porous coating of cementless total hip stems is held responsible for radiological periprosthetic changes, the rate of thigh pain, and even its long-term success. However, there is only sparse knowledge on how the biomechanical loading conditions of the femur are influenced by the extent of porous coating in the early phase after implantation of a cementless hip stem. Aiming to evaluate the effect of surface structuring on the strain pattern of the femur, we implanted three anatomic hip stems with different extents of porous coating (full, two-thirds proximal, and penguin type) in second-generation composite femora coated with a photoelastic layer. A cortical strain mapping was conducted before and after insertion of the implants under standardized loading conditions considering relevant muscle forces. The results of the statistical analysis of three different implantation sequences proved that composite femora are suitable for repeated measurements within the applied experimental setup. Cortical strain changes including stress-shielding effects medially (-60%) and laterally (-50%) were validated with a cadaver femur. The extent of porous coating had no significant influence on the surface strain pattern for an immediate postoperative situation.

Background: Extensive sets of data are required to investigate the potential use of a therapeutic drug monitoring with individualization of dosage of the antimycotic compound caspofungin. The goal was to develop an improved liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for this aim. Methods: Following protein precipitation, on-line solid phase extraction was performed for sample preparation. As the internal standard compound the veterinary drug tylosin was used. A standard validation protocol was applied. Results: Good reproducibility and accuracy of the method were observed. On-line solid phase extraction resulted in a convenient work-flow and good robustness of the method. Conclusions: This improved LC-MS/MS method was found reliable and convenient. It can be suggested for further work on the clinical pharmacology of caspofungin in the setting of clinical research laboratories.