Background: Churg-Strauss syndrome (CSS) is a rare systemic vasculitis. Case series with a focus on neurologic involvement are not common. With this study, we intended to evaluate the frequency and types of neurologic manifestations and complications at time of diagnosis and during follow-up of patients with CSS. Methods: In this monocentric study, consecutive patients of our hospital with first diagnosis of CSS based on the criteria of the American College of Rheumatology were included between 2001 and 2007. Each patient underwent a periodic follow-up with clinical and electrophysiologic examination. Data were obtained prospectively. Results: Fourteen patients were included. All patients had a hypereosinophilia and a history of asthma. Twelve of 14 patients had a neurologic involvement, mainly as an acute or subacute multiplex mononeuropathy (eight patients) or an axonal polyneuropathy (three patients). Three patients suffered from a neuropathy of cranial nerves, and two patients had a cerebral infarct. Mean follow-up period was 31 months. With immunosuppressive therapy, 13 patients had no additional neurologic complications, one patient suffered from a cerebral infarct. Initial neurologic symptoms as a result of peripheral neuropathy improved, but sequelae of axonal damage were persistently detectable. Conclusions: Even at time of diagnosis of a CSS, neurologic manifestations are common, especially as a multiplex mononeuropathy. With a consequent immunosuppressive therapy, new neurologic complications can be avoided for the most part.

BACKGROUND: Joint hypermobility syndrome is defined by abnormal laxity in multiple joints in association with symptomatic joint pain. Previous studies in small populations suggest a predominance of female gender and nonwhite race among those diagnosed with hypermobility syndrome. QUESTIONS/PURPOSES: We investigated the epidemiology of joint hypermobility in a large military population, presuming this syndrome would be less prevalent in this specialized population but that demographic analysis would reveal risk factors for this rare condition. METHODS: We queried the Defense Medical Epidemiology Database by race, gender, military service, and age for the years 1998 to 2007 using the International Classification of Diseases, 9th Revision code 728.5 (hypermobility syndrome). RESULTS: We identified 790 individuals coded for joint hypermobility syndrome among a population at risk of 13,779,234 person-years for a raw incidence rate of 0.06 per 1000 person-years. Females had a higher incidence rate for joint hypermobility syndrome compared with males. Racial stratification showed service members of white race had higher rates of joint hypermobility syndrome compared with service members categorized as black and "other." CONCLUSIONS: In a large, established military database it appears joint hypermobility syndrome is a rare condition within the young, active population we studied and female gender is the most important risk factor. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

PURPOSE: An intravenous (IV) erlotinib formulation has not been characterized in cancer patients but may be useful in those with gastrointestinal abnormalities that impact on the ability to take oral medication. This study sought to determine the maximum tolerated dose (MTD) of erlotinib administered as a single 30-min infusion in patients with advanced solid tumors and absolute bioavailability of erlotinib tablets at matched doses. METHODS: This was a two-center, open label, Phase I, dose-escalation and bioavailability study of single dose IV and oral erlotinib. RESULTS: The highest escalated IV erlotinib dose achieved was 100 mg, with only mild adverse events reported. The MTD for IV erlotinib was not reached as a predetermined erlotinib plasma concentration cap of 4 mug/mL was exceeded in 3/6 patients. No dose-limiting toxicity was observed. Median bioavailability of erlotinib tablets was 76%. CONCLUSIONS: A 100 mg single IV dose of erlotinib, given as a 30-min infusion, was well tolerated with only minor adverse events and the high level of bioavailability of oral erlotinib was confirmed.

Novel sequential combination therapy for induction may improve the quality of response and therefore prolong survival in newly diagnosed multiple myeloma (MM) patients. We report results from a phase 2 study of two sequential three-drug combinations. Forty-four previously untreated, symptomatic MM patients received: bortezomib 1.3 mg/m(2)(days 1, 4, 8, 11), cyclophosphamide 300 mg/m(2)(days 1, 8), plus dexamethasone 40 mg (day of and day after bortezomib) for three 21-day cycles, followed by bortezomib 1.0 mg/m(2), dexamethasone 40 mg and thalidomide 100 mg daily for three cycles. Overall response rate for 42 evaluable patients was 95%, including 19% stringent complete response (sCR), 26% CR, and 57%>/= very good partial response. Twenty-two patients have undergone stem-cell transplantation. After a median follow-up of 20.9 months, five patients have died; none was induction therapy-related. Median event-free survival (EFS) and overall survival (OS) have not been reached; estimated 1-year EFS and OS rates were 81% and 91% respectively. Both three-drug combinations were well tolerated; 82% of patients completed all six cycles. Toxicities were predictable and manageable; the most-commonly reported grade 3/4 toxicity was neuropathy (11%). This novel sequential three-drug combination therapy is effective and well-tolerated in previously untreated MM patients.

A bio-economic model including a computer program was developed where a large number of parameters can be modified to describe a great variety of production systems. Economic values for up to 27 traits can be calculated. Seasonal feeding is considered and protein requirement in addition to net energy may be taken into account when calculating feed requirement. Furthermore, the model allows for the evaluation of individual parts of the growth curve. The model was applied to the Czech Suffolk breed used in pure-breeding. An extensive pasture system with spring lambing and sale of surplus progeny for slaughter after weaning or after a finishing period was assumed. The economic values (in Euro cent per ewe, per year and per genetic standard deviation of the trait) were as follows: 9.9 for birth weight,-72.6 for mature weight, 142, 32.1 and 16.9 for growth rates till weaning, in rearing of breeding animals and in fattening, respectively, 19.9 and 101 for conception rate of female lambs and ewes, respectively, 690 for litter size per ewe lambing, 172 for productive lifetime of ewes, 402 and 503 for survival rate of lambs at lambing and till weaning, respectively, and 16.5 for fleece weight.

Glycolytic oscillations occur in many cell types and have been intensively studied in yeast. Recent experimental and theoretical research has been focussed on the oscillatory dynamics and the synchronisation mechanism in stirred yeast cell suspensions. Here we are interested in the spatio-temporal organisation of glycolysis in cell layers. To this end we study a grid of a few thousand compartments each containing a cell. The intracellular dynamics is described by a core model of glycolysis. The compartments can exchange metabolites via diffusion. The conditions for oscillatory dynamics in a single compartment are investigated by bifurcation analysis. The spatio-temporal behaviour of the cell layer is studied by simulations. The model predicts the propagation of repetitive wave fronts induced by a substrate gradient. The formation of these waves crucially depends on the diffusive exchange of the reaction product between cells. Depending on the kinetic parameters complex spatio-temporal behaviour such as periodic termination of waves can arise. In these cases the cellular oscillation characteristics depend on the location of the cell in the array.

In order to improve tissue integration, the neck region of dental implants was coated with the biodegradable polymer poly (L-lactide) incorporating tetracycline, ibuprofen and the combination of both drugs using a solvent dip-coating process. Metallographic analysis, light microscopy and electron microscopy were used to detect the thickness range and the surface characteristics of the coatings. Cytotoxicity was evaluated using the tetrazolium colorimetric method with the fibroblast cell line L929. The in vitro drug release was measured in isotonic sodium chloride solution by UV spectroscopy. To explore if drug release is concentration-dependent, the total amount of drug was varied in the coating (20% wt, 30% wt and 40% wt). The results showed a continuous release of the embedded drugs in relevant dosage over a period of 6 months. In contrast to high tetracycline concentrations, high ibuprofen concentrations resulted in a decreased metabolic activity of the L929 fibroblasts.

OBJECTIVE: To confirm that smoking increases the risk for ulnar neuropathy at the elbow and to investigate potential mechanisms for that increased risk. DESIGN: Prospective case-control study featuring the recruitment of 100 subjects with upper-limb neurologic symptoms: 50 meeting (cases) and not meeting (controls) electrodiagnostic criteria for ulnar neuropathy at the elbow. Known risk factors for ulnar neuropathy at the elbow, preferred smoking hand, and upper-limb joint angles during preferred smoking posture were recorded. RESULTS: Subjects with ulnar neuropathy at the elbow reported increased smoking when compared with the control group, but there was no agreement between ulnar neuropathy at the elbow side and preferred smoking hand or group differences in joint angles during preferred smoking posture. Ulnar neuropathy at the elbow occurred more frequently on the left regardless of hand dominance (P = 0.007). Independent risk factors included age, male sex, and smoking (in pack-years), demonstrating odds ratios (95% confidence intervals) of 1.054 (1.015-1.095), 4.41 (1.75-11.16), and 1.035 (1.001-1.070), respectively. Smoking also correlated negatively with above-elbow ulnar compound muscle action potential, across-elbow conduction velocity, and conduction block. CONCLUSIONS: Smoking is associated with increased risk for ulnar neuropathy at the elbow, and the dose-response effect between smoking and electrophysiologic ulnar measures associated with ulnar neuropathy at the elbow severity increases the likelihood that the relationship is one of cause and effect. However, the data do not suggest that a mechanical explanation related to repetitive elbow flexion is likely.