A dietary intervention for postmenopausal hot flashes: A potential role of gut microbiome. An exploratory analysis

OBJECTIVE

This study examined the role of gut microbiome changes in mediating the effects of a dietary intervention on the frequency and severity of postmenopausal vasomotor symptoms METHODS: Postmenopausal women (n = 84) reporting ≥2 moderate-to-severe hot flashes daily were randomly assigned, in 2 successive cohorts, to an intervention including a low-fat, vegan diet and cooked soybeans (½ cup [86 g] daily) or to stay on their usual diet. Over a 12-week period, frequency and severity of hot flashes were recorded with a mobile application. In a subset of 11 women, gut microbiome was analyzed at baseline and after 12 weeks of the dietary intervention (low-fat vegan diet with soybeans), using deep shotgun metagenomic sequencing. Differences in the microbiome between baseline and 12 weeks were assessed by comparing alpha diversity with Wilcoxon signed rank tests, beta diversity with permanovaFL, and taxon abundance with Wilcoxon signed rank tests. Pearson correlations were used to assess the association between changes in hot flashes and gut bacteria.

RESULTS

In the subset for which microbiome testing was done, total hot flashes decreased by 95 % during the dietary intervention (p = 0.007); severe hot flashes disappeared (from 0.6 to 0.0/day; p = 0.06); and moderate-to-severe hot flashes decreased by 96 % (p = 0.01). Daytime and nighttime hot flashes were reduced by 96 % (p = 0.01) and 94 % (p = 0.004), respectively. Alpha and beta diversity did not significantly differ in the intervention group between baseline and 12 weeks. Two families (Enterobacteriaceae and Veillonellaceae), 5 genera (Erysipelatoclostridium, Fusicatenibacter, Holdemanella, Intestinimonas, and Porphyromonas), and 6 species (Clostridium asparagiforme, Clostridium innocuum, Bacteroides thetaiotaomicron, Fusicatenibacter saccharivorans, Intestinimonas butyriciproducens, Prevotella corporis, and Streptococcus sp.) were differentially abundant, but after correction for multiple comparisons, these differences were no longer significant. Changes in the relative abundance of Porphyromonas and Prevotella corporis were associated with the reduction in severe day hot flashes both unadjusted (r = 0.61; p = 0.047; and r = 0.69; p = 0.02), respectively), and after adjustment for changes in body mass index (r = 0.63; p = 0.049; and r = 0.73; p = 0.02), respectively). Changes in relative abundance of Clostridium asparagiforme were associated with the reduction in total severe hot flashes (r = 0.69; p = 0.019) and severe night hot flashes (r = 0.82; p = 0.002) and the latter association remained significant after adjustment for changes in body mass index (r = 0.75; p = 0.01).

CONCLUSIONS

This exploratory analysis revealed potential associations between changes in vasomotor symptoms in response to a diet change and changes in the gut microbiome. Larger randomized clinical trials are needed to investigate these findings.

To reduce cytotoxicity when testing the virucidal activity of chemical disinfectants and biocides: The "T-25 method" as an alternative to "large-volume-plating"

When testing the virucidal activity of biocides, the non-inactivated residual virus is titrated on cell cultures by the end point dilution method on 96-well tissue culture plates. However, residues of the biocide to be tested also come into contact with the cell cultures in varying concentrations and thus can lead to cytotoxic effects even at high levels of dilution. In the European standards for testing biocides, in particular disinfectants, methods such as Large-Volume-Plating (LVP) method and, in some guidelines, gel filtration procedures are described for reducing cytotoxic effects in the case of highly cytotoxic products, if the classical dilution method proves to be impractical. In order to enable the testing of highly cytotoxic biocides for their activity against viruses, an alternative method for reducing cytotoxicity is introduced, which is based on a procedure of isolating infectious viruses from cytotoxic patients' materials such as stool and can be applied when the other methods fail.

Dietary advanced glycation end-products and postmenopausal hot flashes: A post-hoc analysis of a 12-week randomized clinical trial

OBJECTIVE

Postmenopausal hot flashes are associated with an increased risk of cardiovascular disease and diabetes. Because dietary advanced glycation end-products (AGEs) may act as endocrine disruptors, this study examined the potential association of modifications to the intake of dietary AGEs with the frequency and severity of postmenopausal hot flashes.

METHODS

Postmenopausal women (n = 84) reporting ≥2 moderate-to-severe hot flashes daily were randomly assigned to either the intervention group or the control group. The former were asked to follow a low-fat, vegan diet, including cooked soybeans (1/2 cup [86 g]/day) for 12 weeks, and the latter continued their usual diets for 12 weeks. Frequency and severity of hot flashes were recorded with a mobile application. Three-day diet records were analyzed using the Nutrition Data System for Research software and dietary AGEs were estimated, using a database. Seventy-one participants completed the whole study and 63 provided complete hot flash and dietary data for the AGEs analysis (n = 31 in the intervention and n = 24 in the control group). Pearson correlations were used to assess the association between changes in hot flashes and dietary AGEs.

RESULTS

Dietary AGEs decreased in the intervention group by 73 %, that is by 5509 ku/day on average (95 % -7009 to -4009; p < 0.001), compared with the control group (+458; 95 % CI -835 to +1751; p = 0.47; treatment effect -5968 ku/day [95 % CI -7945 to -3991]; Gxt, p < 0.001). Severe hot flashes decreased by 92 % (p < 0.001) and moderate-to-severe hot flashes decreased by 88 % in the intervention group (p < 0.001). Changes in dietary AGEs correlated with changes in severe (r = +0.39; p = 0.002) and moderate hot flashes (r = +0.34; p = 0.009) and remained significant after adjustment for changes in energy intake (r = +0.45; p < 0.001; and r = +0.37; p = 0.004, respectively) and changes in body mass index (r = +0.37; p = 0.004; and r = +0.27; p = 0.04, respectively). The reduction in dietary AGEs required to achieve a predicted reduction in hot flashes by 1/day was 6933 ku/day for severe and 4366 ku/day for moderate-to-severe hot flashes.

CONCLUSIONS

The reduction in dietary AGEs with a low-fat plant-based diet was associated with a significant reduction in the frequency of severe and moderate-to-severe postmenopausal hot flashes, independent of changes in energy intake and weight loss. Plant-based diets could be used not only to alleviate vasomotor symptoms in postmenopausal women, but also to reduce other health risks associated with AGEs.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04587154.

Nutrition in the prevention and treatment of endometriosis: A review

Endometriosis is characterized by the presence of endometrial tissues outside the uterine lining, typically on the external surface of the uterus, the ovaries, fallopian tubes, abdominal wall, or intestines. The prevalence of endometriosis in North America, Australia, and Europe is ~1-5% in women of reproductive age. Treatment options for endometriosis are limited. While over-the-counter medications may be used to reduce acute pain, hormonal treatments are common and may interfere with fertility. In more severe cases, laparoscopic excision procedures and even hysterectomies are used to treat the pain associated with endometriosis. Nutritional interventions may be helpful in the prevention and treatment of endometriosis and associated pain. Reducing dietary fat and increasing dietary fiber have been shown to reduce circulating estrogen concentrations, suggesting a potential benefit for individuals with endometriosis, as it is an estrogen-dependent disease. Meat consumption is associated with greater risk of developing endometriosis. Anti-inflammatory properties of plant-based diets may benefit women with endometriosis. Additionally, seaweed holds estrogen-modulating properties that have benefitted postmenopausal women and offers potential to reduce estradiol concentrations in pre-menopausal women. Furthermore, consumption of vitamin D has been shown to reduce endometrial pain via increased antioxidant capacity and supplementation with vitamins C and E significantly reduced endometriosis symptoms, compared with placebo. More randomized clinical trials are needed to elucidate the role of diet in endometriosis.

P13.03.A Radiomics for the non-invasive assessment of the PDL-1 expression in patients with non-small cell lung cancer brain metastases

BACKGROUND

The expression level of programmed cell death ligand 1 (PDL-1) might be an indicator for response to immunotherapy using checkpoint inhibitors in patients with non-small cell lung cancer (NSCLC). As intra-tumoral differences and discrepancies between the PDL-1 expression in the primary tumor and the brain metastases may occur, a method for a reliable non-invasive assessment of the intracranial PDL-1 expression would be of clinical value. We evaluated the potential of MRI radiomics for a non-invasive assessment of the PDL-1 expression in patients with NSCLC brain metastases.

PATIENTS AND METHODS

Fifty-three patients with brain metastases from NSCLC from two university brain tumor centers (group 1, 36 patients; group 2, 17 patients) underwent tumor resection with subsequent immunohistochemical assessment of the PDL-1 expression. Brain metastases were manually segmented on preoperative T1-weighted contrast-enhanced MRI. Group 1 was used for model training and validation, group 2 for model testing. After image pre-processing and radiomics feature extraction from T1-weighted contrast-enhanced MRI, a test-retest analysis was performed to identify robust features prior to feature selection. The radiomics model was trained and validated using five-fold cross validation. Finally, the best performing radiomics model was applied to the test data. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analyses.

RESULTS

An intracranial PDL-1 expression was found by immunohistochemistry in 18 of 36 patients (50%) in group 1, and 7 of 17 patients (41%) in group 2. Univariate analysis identified tumor volume as a significant clinical feature for PDL-1 expression (area under the ROC curve (AUC), 0.77). A random forest classifier using a four-parameter radiomics signature including tumor volume yielded an AUC of 0.83 ± 0.18 in the training data (group 1). Finally, the classifier achieved an AUC of 0.84 in the external test data (group 2).

CONCLUSION

The developed radiomics classifiers allows a non-invasive assessment of the intracranial PD-L1 expression in patients with NSCLC brain metastases with a high diagnostic performance.

Coping strategies during legally enforced quarantine and their association to psychological distress level: a cross-sectional study

OBJECTIVES

The non-pharmacological measures to contain the COVID-19 pandemic may lead to considerable psychological distress. The aim of the CoCo-Fakt study was to investigate possible coping strategies and their effects on psychological distress during legally enforced quarantine of infected persons (IPs) and their close contacts (CPs).

STUDY DESIGN

This was a cross-sectional cohort study.

METHODS

From 12 December 2020 to 6 January 2021, all IPs and their CPs (n = 8232) registered by the public health department (Cologne, Germany) were surveyed online. Psychosocial distress and coping were measured using sum scores; free-text answers related to specific strategies were subsequently categorised.

RESULTS

Psychosocial distress was higher in IPs than in CPs (P < .001). Although the mean coping score did not differ between both groups, it was influenced by the reason for quarantine (IP vs CP) besides gender, age, socio-economic status, living situation, psychological distress, resilience, physical activity and eating behaviour. This final regression model explained 25.9% of the variance. Most participants used active coping strategies, such as contact with the social environment, a positive attitude and hobbies.

CONCLUSIONS

Although psychological distress was higher in IPs than in CPs during the quarantine period, the mean coping score did not differ. The strategies most frequently used by IPs and CPs were activating social networks, a healthy lifestyle and professional support systems, such as the health department helpline. Appropriate advice should be implemented to prevent long-term psychological consequences when supporting affected people.

P13.14 Inhibition of extracellular carbonic anhydrases reduces glioblastoma cell invasion

BACKGROUND

Malignant gliomas metabolize glucose preferably by glycolysis which is in accordance with the Warburg effect. This induces a high demand of glucose combined with a significant lactic acid load. The hypoxia-inducible carbonic anhydrase (CA) IX has been shown to moderate the extrusion of hydrogen ions into the extracellular space. Since the acidification of the extracellular environment contributes to host tissue invasion due to activation of proteolytic enzymes, we hypothesized that CA IX plays an important role in malignant glioma Recently, specific small molecule inhibitors of this enzyme have been developed and may provide an innovative strategy for anti - invasive treatment.

MATERIAL AND METHODS

Two established and 4 primary GBM cell lines (2 with mesenchymal and 2 with proneural transcriptional profile) were exposed to the CAIX inhibitor U104 under normoxic and hypoxic conditions. Cell toxicity was measured by ATP and crystal violet assay. For invasion assessment, a matrigel invasion chamber system with 8 µm pore size polycarbonate filter was used. CAIX expression was analyzed by quantitative RTPCR and Western Blot.

RESULTS

Hypoxia significantly induced CAIX expression in all cell lines. Invasiveness increased significantly under hypoxic conditions in the mesenchymal cells (p &lt; 0.01). Regardless of oxygenation status, the mesenchymal group displayed significantly higher invasiveness compared to the proneural group (p = 0.006). Looking at all cell lines, invasion is significantly inhibited by U104, both under normoxic and hypoxic conditions (p &lt; 0.01). However, while the mesenchymal group showed the highest susceptibility to CAIX inhibition followed by the proneurally differentiated group, the established cell lines were entirely refractory to CAIX inhibition.

CONCLUSION

Our data demonstrate that CAIX inhibition can effectively inhibit invasion in malignant glioma cells independent from oxygenation status, however the effects are significantly influenced by cell type specific biological features.

Physical activity promotion of elderly people as a complex intervention: supportive toolbox

Issue

In EU countries, almost 20% of the population is aged 65 or older. This longer life expectancy offers many opportunities but health risks as well. Health promotion measures like physical activity are of central importance but only a small proportion of the elderly meets the minimum level of physical activity recommended by the WHO. The project “Ageing in balance” investigates how a complex intervention to promote physical activity in older people can be implemented and facilitated by making practical tools centrally available.

Description of the problem

A complex intervention following the steps of an ideal-typical process and combining behavioural and structural preventive approaches is implemented in several model regions in Germany over three years (2019-2021). As a service at the federal level, a toolbox comprising tools for needs assessment, interventions and information on physical activity, project management, legal issues and financing is built up to support the work of local decision-makers. It's evaluated how setting approaches to promote physical activity for elderly people can be successful, which supporting and impeding factors exist and how the process can be supported by a flexible toolbox provided at federal level.

Results

Socioeconomically deprived model regions (rural, town, city) were recruited and started to raise awareness and to perform needs assessment. Building of local steering committees and implementing interventions are the next steps. Currently the toolbox contains systematically identified instruments for needs assessment, an intervention database with a newly developed evidence ranking system and several information modules.

Lessons

Facilitating promotion of physical activity in the elderly is important as prioritization and resources at local level are often limited. Making the implementation of setting approaches successful and providing the potentially most promising support from federal level is still pioneering work.

Key messages

The effort is to build up a flexible support system for local stakeholders to promote physical activity in elderly people. It is evaluated how a complex behavioural and structural prevention effort for elderly people can be implemented.

Cost-effectiveness of a family-based multicomponent outpatient intervention program for children with obesity in Germany

OBJECTIVES

Facing an epidemic of childhood obesity and budget constraints, public health administrations are showing an urgent interest in interventions that are both health effective and cost-effective. Thus, this study intends to analyze the return on investment of these existing programs.

STUDY DESIGN

All analyses are based on a comprehensive data set from 249 children with obesity and overweight children who participated in the Children's Health InterventionaL Trial (CHILT), an 11-month outpatient multidisciplinary family-based program.

METHODS

Cost-effectiveness was assessed by comparing estimated savings associated with a reduction in weight and improvement of obesity-related health parameters with intervention costs. Projected future savings in health care expenditures were modeled on existing research, using estimates of health care costs associated with juvenile obesity and remission thresholds of obesity-related disease.

RESULTS

On average, participants achieved a 0.19-unit reduction in the body mass index standard deviation score, showed reduction in their blood pressure values (systolic = -1.76 mmHg, diastolic = -2.82 mmHg), and showed improvement in their high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol values (HDL = +1.31 mg/dL, LDL = -4.82 mg/dL). The intervention costs were 1799€ per participant, and the benefits of avoided future health care costs varied by individual. On an aggregated level, future savings amounted to between 1859€ and 1926€ per person, translating into a return on investment of 3.3-7.0%.

CONCLUSIONS

This study shows that a multicomponent obesity intervention, such as the CHILT, not only results in weight loss and improves important health parameters but also is cost-effective.

Investigating the role of interleukin 10 on Eimeria intestinal pathogenesis in broiler chickens

Eimeria species are intestinal protozoan parasites that cause lack of production, malabsorption and mortality in floor raised chickens. Administering an oral antibody to interleukin 10 (aIL-10) reduces the symptoms of coccidiosis in broilers, indicating interleukin 10 (IL-10) is key to Eimeria pathology. IL-10 is an anti-inflammatory cytokine and acts as a stand down signal to reduce inflammation and host pathology during disease. Related protozoan parasites exploit IL-10 to reduce pathogen-damaging host inflammatory responses. We hypothesize that IL-10 is increased during Eimeria infection through an unknown host-pathogen interaction, and by feeding aIL-10 to neutralize excess IL-10 the bird is allowed to mount an effective immune response to Eimeria. To determine the effects of aIL-10 during the intestinal immune response, intestinal pathology and the relationship between IL-10, interferon gamma (IFNγ) and Eimeria infection were evaluated in this study. In both experiments, broilers were administered either a 10x dose of Advent® Eimeria vaccine or saline. Duodenum, jejunum and cecum samples were collected, processed, stained and examined under a microscope. Evaluation of intestinal histomorphology during aIL-10 administration showed minimal differences in birds fed aIL-10 during infection compared to animals fed a control antibody during Eimeria infection. To further evaluate aIL-10's positive effect during infection, immunofluorescent histochemistry was performed on chicken intestines days 3-7 post Eimeria infection for IL-10 and IFNγ presence in intestinal mucosa in control and infected birds, in regions with and without visible Eimeria burden. IL-10 and IFNγ had significant changes between days 4.5-7 post-infection in birds fed aIL-10 compared to animals fed a control antibody. Overall we found that the duodenum had increased IL-10 presence and increased IFNγ presence, and the jejunum and cecum had decreased IL-10 presence and decreased IFNγ presence. These differences in spatial regulation of IL-10 and IFNγ may indicate Eimeria species induce slightly different cytokine responses.

T cell metabolism in chronic viral infection

T cells are a fundamental component of the adaptive immune response in the context of both acute and chronic viral infection. Tight control over the metabolic processes within T cells provides an additional level of immune regulation that is interlinked with nutrient sensing and the continued balancing of co-stimulatory and co-inhibitory signals. Underpinning T cell responsiveness for viral control are a number of phenotypic and functional adaptations ensuring adequate nutrient uptake and their utilization. T cells responding to persistent viral infections often exhibit a profile associated with immune cell exhaustion and a dysregulated metabolic profile, driven by a combination of chronic antigenic stimulation and signals from the local microenvironment. Understanding alterations in these metabolic processes provides an important basis for immunotherapeutic strategies to treat persistent infections.

Spatial orientation and postural control in patients with Parkinson's disease

Postural instability is one of the most disabling and risky symptoms of advanced Parkinson's disease (PD). The purpose of this study was to investigate whether and how this is mediated by a centrally impaired spatial orientation. Therefore, we performed a spatial orientation study in 21 PD patients (mean age 68years, SD 8.5 years, 9 women) in a medically on condition and 21 healthy controls (mean age 68.9years, SD 5.5years, 14 women). We compared their spatial responses to the horizontal axis (Sakashita's visual target cancellation task), the vertical axis (bucket-test), the sagittal axis (tilt table test) and postural stability using the Fullerton Advanced Balance Scale (FAB). We found larger deviations on the vertical axis in PD patients, although the direct comparisons of performance in PD patients and healthy controls did not reveal significant differences. While the total scores of the FAB Scale were significantly worse in PD (25.9 points, SD 7.2 points) compared to controls (35.1 points, SD 2.3 points, p<0.01), the results from the spatialorientation task did not correlate with the FAB Scale. In summary, our results argue against a relation between perceptional deficits of spatial information and postural control in PD. These results are in favor of a deficit in higher order integration of spatial stimuli in PD that might influence balance control.

Excisions of severe cervical dysplasia: Are there mandatory diameters of the cone that need to be considered?

Objective:

To achieve optimal depth for negative margin cones after loop electrosurgical excision procedures (LEEP) for cervical dysplasia.

Material and Methods:

Retrospective cohort analysis of LEEP cones of 201 patients with cervical dysplasia during a four-year period. Analysed cones were divided into two different groups: cones with negative margins without dysplasia, and cones with margins positive for dysplasia. In order to determine the cut-off value of the depth of the resected cones, receiver operating characteristic (ROC) analysis was performed.

Results:

Negative margins were found in 71.0% (n=49) of all cones, whereas positive margins were reported in 29.0% (n=20). Negative margin cones were achieved in 100% with a cone depth of ≥20 mm. A resection depth between 10-19.9 mm led to 73.0% negative margin cones. Calculation of cone volume shows for 2.0 cm3, a sensitivity of 79% and a specificity of 64%. Statistical analysis using an ROC model showed p=0.002.

Conclusion:

Forth greatest safety of patients, cone depths from LEEPs for cervical dysplasia should be ≥20 mm to achieve negative margins.

Biodegradation of pharmaceuticals and endocrine disruptors with oxygen, nitrate, manganese (IV), iron (III) and sulfate as electron acceptors

Biodegradation of pharmaceuticals and endocrine disrupting compounds was examined in long term batch experiments for a period of two and a half years to obtain more insight into the effects of redox conditions. A mix including lipid lowering agents (e.g. clofibric acid, gemfibrozil), analgesics (e.g. diclofenac, naproxen), beta blockers (e.g. atenolol, propranolol), X-ray contrast media (e.g. diatrizoic acid, iomeprol) as well as the antiepileptic carbamazepine and endocrine disruptors (e.g. bisphenol A, 17α-ethinylestradiol) was analyzed in batch tests in the presence of oxygen, nitrate, manganese (IV), iron (III), and sulfate. Out of the 23 selected substances, 14 showed a degradation of >50% of their initial concentrations under aerobic conditions. The beta blockers propranolol and atenolol and the analgesics pentoxifylline and naproxen showed a removal of >50% under anaerobic conditions. In particular naproxen proved to be degradable with oxygen and under most anaerobic conditions, i.e. with manganese (IV), iron (III), or sulfate. The natural estrogens estriol, estrone and 17β-estradiol showed complete biodegradation under aerobic and nitrate-reducing conditions, with a temporary increase of estrone during transformation of estriol and 17β-estradiol. Transformation of 17β-estradiol under Fe(III)-reducing conditions resulted in an increase of estriol as well. Concentrations of clofibric acid, carbamazepine, iopamidol and diatrizoic acid, known for their recalcitrance in the environment, remained unchanged.

Mandatory colposcopic findings of severe cervical dysplasia. Are there key-signs that need our special attention?

INTRODUCTION

To test for colposcopic differences between CIN2+ and non CIN2+ lesions of the "major changes" of the RIO 2011 nomenclature of the International Federation of Cervical Pathology (IFCPC).

MATERIAL AND METHODS

Retrospective cohort analysis of colposcopic examinations of patients with histologically confirmed CIN2+ (n=99) and non CIN2+ (n=102) lesions during a four years period.

MAIN OUTCOME MEASURES

leukoplakia, coarse mosaic and punctuation, dense acetowhitening, sharp boarders, ridge sign, atypical vessels.

RESULTS

Only coarse punctuation (P≤0.001; OR 9.64; 95% CI 2.15-43.13), coarse mosaic (P≤0.001; OR 4.00; 95% CI 1.83-8.73) and dense acetowhitening (P≤0.05; OR 1.86; 95% CI 1.06-3.26) occurred more frequently in CIN2+ lesions which were confirmed as predictors by a regression analysis.

CONCLUSIONS

Only coarse punctuation and coarse mosaic followed by dense acetowhitening as part of the "major changes" of the IFCPC Rio 2011 nomenclature achieve predictive values for CIN2+ lesions and should be therefore emphasized in colposcopy.

Perspectives of immunotherapy in hepatocellular carcinoma (HCC)

Immunotherapy is considered a new treatment option for many tumor entities, as decades of research into cancer immunotherapy have recently yielded promising results. Indeed, impressive clinical results of checkpoint blockade inhibitors in malignant melanoma and non-small cell lung cancer indicate the therapeutic potential of tumor-specific immune restoration. Over the years, different immunotherapeutic approaches have been evaluated for the treatment of hepatocellular carcinoma (HCC) with some respectable results. In this review article, we will summarize the key studies of the past 30 years and will elucidate in which direction the dynamic field of HCC immunotherapy is currently moving.

Verbal memory declines more in female patients with Parkinson's disease: the importance of gender-corrected normative data

BACKGROUND

Data on gender-specific profiles of cognitive functions in patients with Parkinson's disease (PD) are rare and inconsistent, and possible disease-confounding factors have been insufficiently considered.

METHOD

The LANDSCAPE study on cognition in PD enrolled 656 PD patients (267 without cognitive impairment, 66% male; 292 with mild cognitive impairment, 69% male; 97 with PD dementia, 69% male). Raw values and age-, education-, and gender-corrected Z scores of a neuropsychological test battery (CERAD-Plus) were compared between genders. Motor symptoms, disease duration, l-dopa equivalent daily dose, depression - and additionally age and education for the raw value analysis - were taken as covariates.

RESULTS

Raw-score analysis replicated results of previous studies in that female PD patients were superior in verbal memory (word list learning, p = 0.02; recall, p = 0.03), while men outperformed women in visuoconstruction (p = 0.002) and figural memory (p = 0.005). In contrast, gender-corrected Z scores showed that men were superior in verbal memory (word list learning, p = 0.02; recall, p = 0.02; recognition, p = 0.04), while no difference was found for visuospatial tests. This picture could be observed both in the overall analysis of PD patients as well as in a differentiated group analysis.

CONCLUSIONS

Normative data corrected for gender and other sociodemographic variables are relevant, since they may elucidate a markedly different cognitive profile compared to raw scores. Our study also suggests that verbal memory decline is stronger in women than in men with PD. Future studies are needed to replicate these findings, examine the progression of gender-specific cognitive decline in PD and define different underlying mechanisms of this dysfunction.

Dynamic weight bearing as a non-reflexive method for the measurement of abdominal pain in mice

BACKGROUND

Chronic pelvic pain (CPP) is a high burden for patients and society. It affects 15-24% of women in reproductive age and is an area of high unmet medical need. CPP can be caused by a wide range of visceral diseases such as abdominal infections, gastrointestinal or gynaecological diseases like endometriosis. Despite the high medical need for this condition, pharmacological approaches are hampered by the limited number of available methods for the behavioural evaluation of pain in inflammation-driven animal models of pelvic pain.

METHODS

The dynamic weight bearing (DWB) system was used for the evaluation of spontaneous behaviour changes in the zymosan-induced peritonitis mouse model. Inflammatory mediator levels were evaluated in peritoneal lavage and their correlation with the behavioural endpoints was assessed. We evaluated the effect on behavioural endpoints of the selective cyclooxygenase-2 (COX-2) inhibitor celecoxib and the Nav 1.8 blocker A-803467.

RESULTS

The presence of a relief posture, characterized by a significantly increased weight distribution towards the front paws, was observed following intraperitoneal injection of zymosan. A positive correlation was detected between PGE2 levels in the peritoneal lavage and DWB endpoints. In addition, zymosan-induced weight bearing changes were reverted by celecoxib and A-803467.

CONCLUSIONS

This study described for the first time the use of DWB as a non-subjective and non-reflexive method for the evaluation of inflammatory-driven abdominal pain in a mouse model.

Measuring information transfer in a soft robotic arm

Soft robots can exhibit diverse behaviors with simple types of actuation by partially outsourcing control to the morphological and material properties of their soft bodies, which is made possible by the tight coupling between control, body, and environment. In this paper, we present a method that will quantitatively characterize these diverse spatiotemporal dynamics of a soft body based on the information-theoretic approach. In particular, soft bodies have the ability to propagate the effect of actuation through the entire body, with a certain time delay, due to their elasticity. Our goal is to capture this delayed interaction in a quantitative manner based on a measure called momentary information transfer. We extend this measure to soft robotic applications and demonstrate its power using a physical soft robotic platform inspired by the octopus. Our approach is illustrated in two ways. First, we statistically characterize the delayed actuation propagation through the body as a strength of information transfer. Second, we capture this information propagation directly as local information dynamics. As a result, we show that our approach can successfully characterize the spatiotemporal dynamics of the soft robotic platform, explicitly visualizing how information transfers through the entire body with delays. Further extension scenarios of our approach are discussed for soft robotic applications in general.

The olfactory bulb volume in patients with idiopathic Parkinson's disease

BACKGROUND AND PURPOSE

This study addresses the question of whether the neuropathological findings on the olfactory bulb (OB) in idiopathic Parkinson's disease (IPD) correspond to a detectable change in volume of the OB. Additionally, the relationship between OB volume and residual olfactory function, clinical disease characteristics and age are investigated.

METHODS

Fifty-two IPD patients were investigated and compared to 31 healthy age-matched controls. All participants were scanned using a 3 T magnetic resonance imaging MRI scanner including a T2 DRIVE sequence in coronal slices through the OB. The OB volumes were measured via manual segmentation of the OB. Olfactory testing was carried out using the Sniffin' Sticks test battery.

RESULTS

The OB volume in the IPD group was 42.1 mm³ (SD ± 11.6) for the right and 41.5 mm³ (SD ± 11.7) for the left OB and showed no difference from the controls. Additionally, there were no significant correlations between OB volume and disease characteristics such as disease duration or Unified Parkinson's Disease Rating Scale motor score. Likewise, patients' residual smell function did not correlate with their OB volume. In contrast, controls indicated a correlation between smell function and OB volume.

CONCLUSION

The study shows that high resolution MRI does not show a detectable volume loss of the OB in PD patients. It is concluded that OB measurement using in vivo high resolution MRI at 3 T is not helpful to identify IPD.

Sources and processes affecting the spatio-temporal distribution of pharmaceuticals and X-ray contrast media in the water resources of the Lower Jordan Valley, Jordan

The closed basin of the Lower Jordan Valley with the Dead Sea as final sink features high evapotranspiration rates and almost complete reuse of treated wastewater for irrigation farming. This study focuses on the water transfer schemes and the presence, spreading, and potential accumulation of pharmaceutical residues in the local water resources based on findings of a five-year monitoring program. Overall 16 pharmaceuticals and 9 iodinated X-ray contrast media were monitored in groundwater, surface water, and treated wastewater. A total of 95 samples were taken to cover all geographical settings and flow paths from origin (wastewater) to target (groundwater). Nine substances were detected in groundwater, with concentrations ranging between 11 ng/L and 33,000 ng/L. Sometimes, detection rates were higher than in comparable studies: Diatrizoic acid 75%, iopamidol 42%, iopromide 19%, iomeprol 11%, carbamazepine and iohexol 8%, ibuprofen 6%, and fenofibrate and iothalamic acid 3%. Concentrations in groundwater generally increase from north to south depending on the application of treated wastewater for irrigation. Almost all substances occurred most frequently and with highest concentrations in treated wastewater, followed by surface water and groundwater. As exception, diatrizoic acid was found more frequently in groundwater than in treated wastewater, with concentrations being similar. This indicates the persistence of diatrizoic acid with long residence times in local groundwater systems, but may also reflect changing prescription patterns, which would be in accordance with increasing iopamidol findings and surveys at local hospitals. Trend analyses confirm this finding and indicate a high probability of increasing iopamidol concentrations, while other substances did not reveal any trends. However, no proof of evaporative enrichment could be found. The high spatial and temporal variability of the concentrations measured calls for further systematic studies to assess the long-term evolution of organic trace substances in this reuse setting.

[Difficult course of rhabdomyolysis in influenza A/H1N1]

HISTORY AND ADMISSION FINDINGS

A 37-year-old man complained about a lack of strength, an unproductive cough and myalgia predominantly thigh-focused with subfebrile temperatures for days.

INVESTIGATIONS

Laboratory investigations indicated rhabdomyolysis with acute kidney injury (AKI). Drug misuse was denied. Exertion and trauma could be excluded as well as rheumatologic or other infectious causes often responsible for rhabdomyolysis. PCR of a nasopharyngeal swab was positive for influenza A virus subtype H1N1.

TREATMENT AND COURSE

Because of a progressive course of AKI haemodialysis was initiated. Levels of creatine kinase declined and urinary excretion rised. Hypocalcaemia due to secondary hyperparathyreoidism was substituted. During hospitalisation two seizures appeared. After performing a magnetic resonance imaging (MRI) the seizures could be attributed to a posterior reversible encephalopathy syndrome (PRES) secondary to influenza infection. A medication with valproic acid was initiated.

CONCLUSION

Extrapulmonary manifestations of an influenza A (H1N1) virus infection are rare but have to be considered after exclusion of differential diagnosis in younger patients in particular. In addition to a therapy with neuraminidase inhibitors a symptomatic treatment is of paramount significance.

Persistence with bisphosphonates in patients with metastatic breast cancer: a retrospective database analysis

BACKGROUND

In women with breast cancer and bone metastasis, compliance to antiresorptive treatment is of upmost importance to ensure maximum effectiveness in clinical practice. The aim of our study was to investigate persistence with oral and intravenous bisphosphonates (BIS) in a large group of women with metastatic breast cancer and to identify the determinants of non-persistence.

PATIENTS AND METHODS

We used data from the Disease Analyzer database (IMS Health, Germany), which includes 2,067 general practices and 397 gynaecological practices. From a dataset of 20 million patients, we identified 1,045 patients diagnosed between January 2001 and December 2010 with bone metastasis (ICD 10: C795) following breast cancer (ICD 10: C50) with first-time cancer-related bisphosphonate prescriptions (ATC: M03B4). Of these, 763 patients received intravenous treatment, and 280 patients received oral BIS treatment.

RESULTS

After 1 year, 35.3 % of patients treated with intravenous, and 45.6 % of patients treated with oral bisphosphonates discontinued their therapy (p = 0.002). Multivariate Cox Regression analyses showed a significant increased risk of treatment discontinuation in patients using intravenous BIS (HR: 0.82) compared with oral BIS. Patients younger than 50 (HR: 1.52) were most likely to discontinue treatment compared with the reference group of women over 70. The use of other treatments, such as chemotherapy or hormone therapy, was associated with a decreased risk of treatment discontinuation. Moreover, treatment discontinuation was higher in West Germany compared with East Germany (HR: 1.65) and in patients covered under private health insurance (HR: 1.33).

CONCLUSIONS

Persistence with all bisphosphonate treatments in women with breast cancer and bone metastasis is low and needs to be significantly increased to improved outcomes in clinical practice. Further research is required to understand this complex issue.

[Perspectives on immunotherapy for hepatocellular carcinoma]

Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide with a high mortality. Available therapeutical options are limited, thus the development of new, innovative therapeutic strategies is crucial. Based on the immune system's antitumoral effect, immunotherapy is a promising new treatment option. Specific antitumoral T-cell responses can be detected in patients with HCC, however, their impact on tumor control seems to be rather weak. Various different immunosuppressive mechanisms seem to contribute to the failure of tumor-specific T-cell responses. Thus, the aim of immunotherapeutic strategies is to address these mechanisms of T-cell failure and to induce new or to boost existing antitumoral immune responses.

Persistence in patients with breast cancer treated with tamoxifen or aromatase inhibitors: a retrospective database analysis

Compliance and persistence are often underestimated in breast cancer (BC) treatment. The aim of our study was to analyze the persistence with tamoxifen (TAM) and aromatase inhibitors (AI) in postmenopausal women with hormone-receptor-positive BC and to identify determinants of non-persistence. We used data of the Disease Analyzer database (IMS HEALTH, Germany) including 2,067 general practices and 397 gynecological practices. Out of a dataset of 15 million patients, we identified BC patients with a first-time TAM or AI prescriptions from October 2001 to December 2010. For persistence analyses, 12,412 women on tamoxifen, 2,796 on anastrozole, 647 on exemestane, and 1,657 on letrozole met the inclusion/exclusion criteria. Within 3 years of follow-up, the discontinuation rates increased to 52.2 % for tamoxifen, 47 % for anastrozole, 55.1 % for exemestane, and 44.3 % for letrozole treated women. A minor proportion of patients switched to a different endocrine treatment; 33 % tamoxifen, 20 % anastrozole, 22.9 % exemestane, and 23 % letrozole. The multivariate hazard ratios of the cox regression models showed that patients younger than 50 were most likely to discontinue initial therapy when compared with the reference group of women over 70 (p < 0.001). In contrast, patients treated in gynecologist practice had significantly longer persistence than patients who obtained their prescriptions in general practitioner practice (p < 0.001). In addition, the presence of the co morbidities like diabetes (p < 0.001) or depression (p < 0.002) was also associated with decreased risk of treatment discontinuation. Persistence with all endocrine treatments in women with hormone-receptor-positive BC is low and needs to be significantly increased to improved outcome in clinical practice. Further research is required to understand this complex issue.