Volker Neumeister

Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty.

Background All metal implants—and metal-on-metal bearings in particular—corrode and cause a release of metal ions. Because cobalt and chromium have been shown to be carcinogenic and mutagenic in human and animal models, systemic toxicity and cancer risk are considered to be possible disadvantages of the metal-on-metal articulation. This study was designed to investigate the serum concentration profiles of chromium, cobalt and molybdenum after implantation of a Birmingham hip resurfacing arthroplasty (BHR) and a cementless total hip replacement with a 28-mm Metasul articulation (MTHR), over the first 2 years after implantation. Methods We analyzed profiles of metal ion serum levels in 111 patients implanted with a BHR, in 74 patients implanted with an MTHR, and in 130 implant-free probands control subjects using atomic absorption spectrophotometry. Results Chromium and cobalt concentrations (in μg/L) of all BHR and MTHR patients differed significantly from those of control subjects (chromium: < 0.25; cobalt: 0.25). The median chromium and cobalt concentrations in BHR patients had increased to 5.1 and 4.3 μg/ L 2 years after surgery. Concentrations in BHR patient exceeded those in the unilateral MTHR patients. Molybdenum serum concentrations hardly changed over time in either group and were not significantly different from the concentrations seen in the control subjects. Interpretation During the first 2 years after surgery, the Birmingham hip resurfacing arthroplasty leads to a significantly greater increase in serum chromium and cobalt levels than the 28-mm metal-on-metal MTHR. Observation of patients over a longer period will be necessary in order to evaluate any chronic adverse effects to the system due to elevated chromium and cobalt serum concentrations.

Determination of cholesterol in atherosclerotic plaques using near infrared diffuse reflection spectroscopy

The aim of this investigation was to examine whether near infrared diffuse reflection spectroscopy is an acceptable tool for the determination of cholesterol content in atherosclerotic plaques. Using an FT-spectrophotometer (lambda=1000-2500 nm) and fiberoptic systems (d=4 mm), the cholesterol content could be determined in mixtures of the primary compounds of the aortic wall with acceptable precision. Considering the inhomogeneous distribution of cholesterol and cholesterol esters in atherosclerotic plaques the determination of total cholesterol using this method is of acceptable efficacy, even though the calibration procedure did not reflect the composition correctly. Using an energy dose of less than 100 mW/cm(2) to avoid damage to endothelial cells, arterial tissue of about 170-200 microm thickness attenuates the reflected NIRS signal by up to 50%. Cholesterol levels could be determined accurately in atherosclerotic lesions in human aortic specimens obtained by autopsy. The correlation coefficient between the NIRS results and those of HPLC analysis calculated in the investigation of 82 different areas of 18 human aortic specimens was 0.926 (y=0.869x+0. 771, external validation). Acceptable results were also achieved by means of a coronary-catheterlike fiberoptic strand (d=l mm), despite the worsened signal/noise ratio. The results show that the development of a coronary catheter using NIRS appears to be possible in principle.

Determination of the cholesterol–collagen ratio of arterial atherosclerotic plaques using near infrared spectroscopy as a possible measure of plaque stability

Particular danger associated with an arteriosclerotic plaque consists in the possible rupture of its cap, dependent on the thickness of the cap covering the lipid core, its composition and different inflammatory changes. The purpose of this study was to compare the total cholesterol and collagen contents of arterial walls, both measured by near infrared spectroscopy (NIRS), and to test whether the ratios of cholesterol to collagen correlate with histochemical parameters possibly being indicators for plaque stability. NIR spectra of 118 sections from 36 human aortas were measured at 1000-2500 nm. Evaluation was performed by the partial least squares method (PLS), the chemical reference analysis by HPLC. Acceptable results were achieved for calibrations. With these calibrations 38 further aortic sections taken at autopsy were NIR-spectroscopically analysed and ordered in relation to histological findings of fatty deposits, cap thickness over the lipid core, and the ratio of fatty deposits to cap thickness. Correlations were found to exist between the spectroscopically determined total cholesterol concentrations and the histologically estimated fatty deposits (r=0.887), between the spectroscopically determined collagen concentrations and the cap thickness over the lipid core (r=0.441), and between the ratios total cholesterol to collagen and the ratios fatty deposits to cap thickness (r=0.575).

Simultaneous Determination of Fecal Fat, Nitrogen, and Water by Near-infrared Reflectance Spectroscopy

BACKGROUND Determinations of fecal fat and nitrogen reveal evidence of malabsorption and assist in estimating the efficacy of pancreatic enzyme treatment. Seventy-two-hour stool collection, with chemical analysis of fecal fat, and Kjeldahls method for measurement of fecal nitrogen are generally accepted as standard methods for making these determinations. However, these traditional methods are expensive, time-consuming, and cumbersome. This study evaluated the efficiency and validity of an alternative method, using near-infrared reflectance spectroscopy (NIRS) and compared results with those of the standard methods. METHODS Near-infrared reflectance spectroscopy is a secondary method: The instrument first has to be calibrated with samples analyzed by the standard method. Sixty-three stool samples with known fat content (range 4.79-292.5 mg/g), 24 samples with known nitrogen content (range 5.36-19.38 mg/g), and 24 samples with known water concentration (range 60.1-82.22%) served for calibration. A further 69 samples were analyzed to validate the procedure. RESULTS There was a satisfactory correlation between the measurements produced by near-infrared reflectance spectroscopy and those produced by standard methods: fat r = 0.97; nitrogen r = 0.94; water r = 0.96. CONCLUSIONS Near-infrared reflectance spectroscopy appears to be a reliable, simple, and rapid method of measuring different fecal components-as precise and accurate as the standard methods. Stool samples should be analyzed immediately after collecting or stored only a few days before analyzing.

Serum levels of secreted group IIA phospholipase A(2) in benign prostatic hyperplasia and prostate cancer: a biomarker for inflammation or neoplasia?

Secreted group IIA phospholipase A2 (sPLA2-IIA) is markedly up-regulated in human prostate cancer (PCa) specimens and in some PCa-derived cell lines, indicating an important role of this enzyme in tumourigenesis. In this study, we measured levels of sPLA2-IIA, C-reactive protein (CRP), and prostate-specific antigen (PSA) in serum samples obtained from patients with benign prostatic hyperplasia (BPH) and with PCa of different stages. We found that serum levels of sPLA2-IIA and CRP in BPH and PCa patients were significantly elevated compared to those of healthy individuals, but the concentrations of these inflammatory biomarkers did not differ between patients with BPH or PCa. Furthermore, serum levels of sPLA2-IIA correlated with concentrations of CRP, but not with PSA, Gleason grade or tumour stage. In conclusion, these findings suggest that cancer-related changes are not exclusive factors contributing to elevated serum sPLA2-IIA levels and emphasize the utility of sPLA2-IIA as a circulating marker of inflammation in patients with BPH and PCa.

Exocrine pancreatic insufficiency and its consequences on physical development and metabolism in children and adolescents with type 1 diabetes mellitus

The aim of this study was to investigate exocrine pancreatic function and its consequences on physical development and metabolism in children and adolescents with type 1 diabetes mellitus. A total of 94 children and adolescents (44 girls and 50 boys; mean age 14.5 years, range 2.7–25.5 years) with type 1 diabetes mellitus were included. None received pancreatic enzymes at the time of the study. Coeliac disease and cystic fibrosis were excluded. We studied three groups of parameters: (1) exocrine pancreatic function, (2) diabetes status and (3) physical development. First all patients had a single determination of faecal elastase 1 (E1) (ScheBo Biotech AG, Giessen, Germany) [5, 6]. If the first E1 value was less than 200 lg E1/g stool, three further E1 determinations were conducted using three consecutive stool samples. If these control tests also showed reduced E1 values, a quantitative fat determination was carried out. Fat excretion £ 7 g in 24 h was classified as normal and values >7 g as pathological. We defined three groups of exocrine pancreatic function:

Simultaneous determination of fecal fat, nitrogen and water by Fourier transform near infrared reflectance spectroscopy through a polyethylene/polyaminde film

The determination of fecal fat, nitrogen and water is important to get evidence for malassimilation and for estimating the efficacy of treatment with pancreatic enzymes. Standard methods for the determination of these parameters (van-de-Kamer method for fat determination, Kjeldahl method for nitrogen determination) are expensive, time-consuming and cumbersome for laboratory assistants. Near infrared (NIR) reflectance spectroscopy was evaluated as a potentially attractive alternative method, especially because the simultaneous measurement of fat, nitrogen and water content is possible. After homogenisation parts of stool samples were packed and thermowelded in a bag of polyethylene/polyamide (PE/PA) film to optimize the handling in the laboratory. Two optical systems were tested: 1. Fiber optic, In-Ga-As-detector, weavelength range 1000–2500 nm, area of measurement diameter 4–mm; 2. Integrating sphere, Ge-detector, wavelength range 1000–1800 nm, area of measurement diameter 10 mm. Forty stool samples were used for calibration, another 20 for validation from both healthy children and patients with cystic fibrosis in an age range from 5 to 18 years. The concentrations of fecal compounds were calculated using the chemometric Partial Least Square (PLS) method with the NIR reflectance spectroscopy measurement data. The calibration were carried out based on results of chemical analysis with standard methods. The regression equations of the external NIR reflectance spectroscopy validations were as follows: 1. for the fiber optic system: fat determination y = 0.9737x + 5.7261r = 0.989, nitrogen determination y = 1.0092x+0.0731 r = 0.933, water determination y = 0.9699x+2.0703 r = 0.993; 2. for the integrating sphere system: fat determination y = 1.0308x–1.6797 r = 0.998, nitrogen determination y = 0.9529x+0.5302 r = 0.959, water y = 1.0301x–1.8193 r = 0.993. The NIR reflectance spectroscopy method is a precise and alternative method for the determination of fecal fat, nitrogen and water. Moreover, handling is simple, time of analysis is short (4 minutes on average) and all calibrated constituents can be analyzed simultaneously. Therefore, we conclude that NIR reflectance spectroscopy is a reliable and useful method for analysis of fecal components in laboratory medicine.