[Diagnosis and Treatment in frontobasal fractures]

Traumatic brain injury can result in frontobasal fractures (FBF). The goals of treatment for FBF are to eliminate primary morbidity and/or prevent secondary morbidity. Of particular importance in this regard is the proximity of important sensory organs for hearing, vision, smell, and taste, as well as their supplying nervous structures. Medical history, clinical findings, or CT scan are necessary and should lead to an individual evaluation. Depending on the severity of the fractures, the following disciplines may be involved in the treatment of FBF: neurosurgery, plastic surgery, oral and maxillofacial surgery, and/or otorhinolaryngology. Particularly less invasive endoscopic endonasal therapy is a specialty of otorhinolaryngologic surgeons and has not been widely established in other disciplines. The present work provides an overview of the current state of the art in terms of the following aspects, taking into account the current literature: anatomic principles, classification of fractures, diagnostics (in particular clinical examination, imaging, and laboratory chemistry tests), clinical symptoms, and treatment.

Effectiveness of the lateral pedicled endonasal flap for prevention of restenosis in frontal sinus drillouts

BACKGROUND

Frontal sinus median drainage according to Draf is an established procedure for achieving maximum drainage of the frontal sinus. Despite great efforts and several modifications, restenosis of the neo-ostium is still a persistent problem. This study presents an approach by implementing local mucosal flaps to prevent restenosis and compares it with the conventional technique without using the flap.

METHODS

Description of endonasal, lateral pedicle mucosal flap. A Draf III procedure was performed on 156 patients between 2012 and 2021. Data for 123 of the included patients were retrospectively analyzed in terms of surgical indication, technique, postoperative aftercare and patency of the drainage pathway. The follow-up observation period was between 3 and 24 months.

RESULTS

Treatment with the pedicle mucosal flap took place in 86 cases. 37 patients were treated as a control group without this flap. The analysis showed a significant association to the event "total closure of the drainage pathway" for surgical technique, as well as in the case of the presence of an allergy and the existence of Samter's triad. Furthermore, there was a significant association between the onset of "near total closure of the frontal sinus ostium" and Samter's triad, CRS and revision surgery was involved.

CONCLUSIONS

Use of an endonasal lateral pedicle flap for reconstruction of mucosal defects in frontal sinus surgery improves the long-term chances of a patent drainage pathway. Bone exposed by drilling was covered with a local mucosal flap for a faster epithelialization, healing and less scarring.

Characterization of the circumferential cevel of the pulmonary vein isolation area using pulsed-field catheter ablation: Spatial distribution and extent of insufficient and excessive isolation areas

Funding Acknowledgements

Type of funding sources: None.

Introduction

The cornerstone of pulmonary vein isolation (PVI) is a wide area circumferential ablation (WACA) resulting in an isolation area encompassing the PV antrum. Pulsed field ablation (PFA) is a new non-thermal "single-shot" PVI device with promising success rates. However, the circumferential level of its PV isolation area is still unknown.

Objective

To characterize the circumferential acute PV isolation area by assessing the spatial distribution (qualitative analysis) and extent (quantitative analysis) of insufficient PV antral and excessive LA isolation areas.

Methods

In this study, patients with paroxysmal or persistent atrial fibrillation (AF) underwent PVI with a pentaspline PFA catheter. Before and immediately after PVI, ultra-high-density (UHD) voltage maps using a 20-polar circular mapping catheter were created. The insufficient isolations areas per antral PV segment (10-segment model) and excessive isolation areas per LA region (8-region model) were quantified.

Results

Between November – December 2021, in forty consecutive patients (age 62 ± 6 years, 28/40 [70%] male, LA 41 ± 4 mm) acute PVI using PFA was achieved and pre (5469 ± 1822 points) and post mapping (6809 ± 2769 points) was performed. The anterior antral PV segments of the left PVs were the most frequent locations of insufficient isolation areas (Table 1, Figure 1). The largest extent of insufficient isolation areas at the PV antral level was located again on the anterior parts of both left PVs (Figure 2A), but also in the anterior lower segment of the right inferior PV (Figure 2B). The posterior wall and roof region of both LA sides were the most frequent locations of excessive isolation areas (Figure 4). The extent of this excessive isolation at the roof and the posterior wall on both LA sides even resulted in a connection of the both-sided low voltage areas in 18% and 8%, respectively.

Conclusion

When using PFA to achieve a circumferential antral PVI, efforts should be made to enhance anterior antral PV segment and prevent excessive posterior wall and roof ablation. For further optimizing the procedure, full integration of PFA catheter visualization into 3D-mapping systems is needed.

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log₁₀ increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

Establishing an objective biomarker for corneal cystinosis using a threshold-based Spectral domain optical coherence tomography imaging algorithm

PURPOSE

The purpose of the present study was to establish a semi-automated threshold-based image segmentation algorithm to detect and objectively quantify corneal cystine crystal deposition in ocular cystinosis with anterior segment optical coherence tomography (AS-OCT).

METHODS

This prospective, observational, comparative study included 88 eyes of 45 patients from the German Cystinosis Registry Study as well as 68 eyes of 35 healthy control subjects. All eyes were imaged with AS-OCT (Cirrus HD-OCT 5000, Carl Zeiss Meditec AG, Jena, Germany). As an initial step, B-scan images were subjectively analysed for typical changes in morphology in comparison to healthy controls. Based on the experience gained, an objective semi-automated B-scan image segmentation algorithm was developed using a grey scale value-based threshold method to automatically quantify corneal crystals.

RESULTS

On AS-OCT B-scans, corneal crystals appeared as hyperreflective deposits within the corneal stroma. The crystals were distributed either in all stromal layers (43 eyes, 49%) or confined to the anterior (23 eyes, 26%) or posterior stroma (22 eyes, 25%), respectively. The novel automatic B-scan image segmentation algorithm was most efficient in delineating corneal crystals at higher grey scale thresholds (e.g. 226 of a maximum of 255). Significant differences in suprathreshold grey scale pixels were observable between cystinosis patients and healthy controls (p < 0.001). In addition, the algorithm was able to detect an age-dependent depth distribution profile of crystal deposition.

CONCLUSION

Objective quantification of corneal cystine crystal deposition is feasible with AS-OCT and can serve as a novel biomarker for ocular disease control and topical treatment monitoring.

Stroke care during the COVID-19 pandemic: experience from three large European countries

In order to cope with the exponentially increasing number of patients infected with SARS-CoV-2, European countries made enormous efforts to reorganize medical assistance and several diseases, including stroke, were particularly impacted. We report the experience of stroke neurologists from three European countries (Italy, France and Germany) that faced the pandemic at diverse time points and with different approaches, depending on their resources and healthcare system organization. Pre-hospital and in-hospital acute stroke pathways were reorganized to prioritize COVID-19 management and, in severely affected regions of Italy and France, stroke care was centralized to a limited number of centers, whereas the remaining stroke units were dedicated to patients with COVID-19. Access to acute stroke diagnostics and time-dependent therapies was limited or delayed because of reduced capacities of emergency services due to the burden of patients with COVID-19. A marked reduction in the number of patients presenting with transient ischaemic attack and stroke was noted in the emergency departments of all three countries. Although we only have preliminary data, these conditions may have affected stroke outcome. These indirect effects of the COVID-19 pandemic could negate the efforts of stroke neurologists over the last few years to improve outcome and reduce mortality of stroke patients. Although the SARS-CoV-2 infection rate is slowing down in Europe, the effects of ending lockdown in the next months are unpredictable. It is important for the European and world stroke community to share what has been learned so far to be plan strategies to ensure stroke care in the future and upcoming challenging times.

[Autopneumonectomie. A Forgotten Disease]

HISTORY

 An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis.

INVESTIGATIONS AND DIAGNOSIS

 The ECG showed 2nd degree Mobitz atrio-ventricular block. The chest x-ray and computerized tomography identified a shift of the mediastinum and the heart to the left. The left lung was completely destroyed whilst the right lung was enlarged and crossed the midline. Pulmonary function tests revealed a moderate restrictive ventilation disorder. The diagnosis of autopneumonectomy was based on patient history together with radiological findings.

TREATMENT AND COURSE

 A pacemaker was implanted with two stimulation electrodes via a left cephalic venous cutdown. A carotid endarterectomy was also performed without any complication.

CONCLUSION

 After autopneumonectomy, postpneumonectomy like syndrome may occur in very rare cases, whereupon operative treatment is mandatory. Any respiratory infections should be treated with antibiotics. Pacemaker electrode placement via the subclavian vein is contraindicated due to the risk of a catastrophic pneumothorax.

55Non-invasive ECG-imaging for identification of atrial arrhythmogenic low voltage substrate in patients with persistent atrial fibrillation

Background/Introduction

Left atrial (LA) fibrosis is associated with increased arrhythmia recurrence rates after pulmonary vein isolation (PVI) and increased stroke risk in patients with atrial fibrillation (AF). So far, detection and quantification of LA fibrosis is only feasible by invasive electrophysiological mapping of low-voltage-substrate (LVS) or delayed enhancement areas in MRI.

Purpose

The aim of this study was to assess the distribution and extent of atrial fibrosis by non-invasive ECG-Imaging (ECGI) in patients with persistent AF prior to PVI.

Methods

Thirty-seven consecutive patients (66 ± 9 years, 84% male) presenting for their first PVI were included. Patients with AF were cardioverted into sinus rhythm (SR). One day prior to AF ablation procedure, patients underwent ECGI in SR using the 252-electrode-array (CardioInsight) and a low-X-ray-dose, non-injected cardiac CT-scan to assess the relationship between ECGI-electrodes and cardiac epicardial structures. Prior to PVI, high-density biatrial voltage and activation maps were acquired in SR (CARTO-3). Localization and extent of atrial LVS (relevant fibrosis: LA-LVS: ≥5cm2 at &lt;0.5mV threshold) and biatrial activation times depicted by CARTO were compared with atrial activation/conduction times assessed by non-invasive ECGI.  Presence of LA-LVS was classified according to its extent into 3 stages and compared to the inter- and intraatrial conduction delay in ECGI.

Results

Relevant atrial fibrosis was found in 17/37(46%) patients. Presence of biatrial LVS resulted in a linear increase of the biatrial activation time in CARTO-SR-maps (146 ± 18ms in patients without LVS vs 184 ± 27ms in patients with LVS, p &lt; 0.001) and in non-invasive ECGI (133 ± 11ms vs 170 ± 20ms, p &lt; 0.001).

Both the extent of biatrial LVS and invasively measured total activation time correlated well with non-invasive total atrial conduction time (TACT) in ECGI (r = 0.91 and r = 0.82, respectively, figure). Moreover, the extent of LA-LVS showed an excellent correlation to TACT in ECGI (r = 0.89).

A combination of inter-atrial (RA-LA) conduction delay and TACT in ECGI allowed to quantify the extent of LA-LVS and to distinguish between three stages of LA-LVS: Stage 1 (minimal LA-LVS: 1 ± 2cm2): ECGI revealed rapid RA&LA activation with short TACT 132 ± 9ms; Stage 2 (moderate LA-LVS: 14 ± 8cm2 involving the anteroseptal LA) was associated with delayed LA activation and prolonged TACT measuring 161 ± 7ms; Stage 3 (extensive LA-LVS involving the anteroseptal and posterior LA: 26 ± 17cm2) was characterized by a significantly delayed LA activation with a TACT of 178 ± 24ms in ECGI.

Conclusion

Analysis of interatrial conduction delay and total atrial conduction time (TACT) in non-invasive ECGI allows accurate staging of patients with arrhythmogenic atrial LVS who present an increased risk for arrhythmia recurrences and stroke.

Abstract Figure.

Changes in Renal Function After Switching From TDF to TAF in HIV-Infected Individuals: A Prospective Cohort Study

Background

Replacing tenofovir disoproxil fumarate (TDF) with tenofovir alafenamide (TAF) improves renal tubular markers in HIV-infected individuals but the impact on estimated glomerular filtration rate (eGFR) remains unclear.

Methods

In all participants from the Swiss HIV Cohort Study who switched from TDF to TAF-containing antiretroviral regimen or continued TDF, we estimated changes in eGFR and urine protein-to-creatinine ratio (UPCR) after 18 months using mixed-effect models.

Results

Of 3520 participants (26.6% women, median age 50 years), 2404 (68.5%) switched to TAF. Overall, 1664 (47.3%) had an eGFR &lt;90 mL/min and 1087 (30.9%) an UPCR ≥15 mg/mmol. In patients with baseline eGFR ≥90 mL/min, eGFR decreased with the use of TDF and TAF (−1.7 mL/min). Switching to TAF was associated with increases in eGFR of 1.5 mL/min (95% confidence interval [CI], .5–2.5) if the baseline eGFR was 60–89 mL/min, and 4.1 mL/min (95% CI, 1.6–6.6) if &lt;60 mL/min. In contrast, eGFR decreased by 5.8 mL/min (95% CI, 2.3–9.3) with continued use of TDF in individuals with baseline eGFR &lt;60 mL/min. UPCR decreased after replacing TDF by TAF, independent of baseline eGFR.

Conclusions

Switching from TDF to TAF improves eGFR and proteinuria in patients with renal dysfunction.

Short-Range Disorder in TeO2 Melt and Glass

High-resolution X-ray pair distribution functions for molten and glassy TeO₂ reveal coordination numbers n_TeO ≈ 4. However, distinct from the known α-, β-, and γ-TeO₂ polymorphs, there is considerable short-range disorder such that no clear cutoff distance between bonded and nonbonded interactions exists. We suggest that this is similar to disorder in δ-TeO₂ and arises from a broad distribution of asymmetric Te-O-Te bridges, something that we observe becomes increasingly asymmetric with increasing liquid temperature. Such behavior is qualitatively consistent with existing interpretations of Raman scattering spectra, and equivalent to temperature-induced coordination number reduction, for sufficiently large cutoff radii. Therefore, TeO₂ contains a distribution of local environments that are, furthermore, temperature dependent, making it distinct from the canonical single-oxide glass formers. Our results are in good agreement with high-level ab initio cluster calculations.

Anthropogenic control over wintertime oxidation of atmospheric pollutants

During winter in the mid-latitudes, photochemical oxidation is significantly slower than in summer and the main radical oxidants driving formation of secondary pollutants, such as fine particulate matter and ozone, remain uncertain, owing to a lack of observations in this season. Using airborne observations, we quantify the contribution of various oxidants on a regional basis during winter, enabling improved chemical descriptions of wintertime air pollution transformations. We show that 25-60% of NO_x is converted to N₂O₅ via multiphase reactions between gas-phase nitrogen oxide reservoirs and aerosol particles, with ~93% reacting in the marine boundary layer to form >2.5 ppbv ClNO₂. This results in >70% of the oxidizing capacity of polluted air during winter being controlled, not by typical photochemical reactions, but from these multiphase reactions and emissions of volatile organic compounds, such as HCHO, highlighting the control local anthropogenic emissions have on the oxidizing capacity of the polluted wintertime atmosphere.

Determination of Deoxynivalenol in Cereals and Cereal Products by Immunoaffinity Column Cleanup with Liquid Chromatography: Interlaboratory Study

An interlaboratory study was performed on behalf of the UK Food Standards Agency to evaluate the effectiveness of an immunoaffinity column cleanup liquid chromatographic (LC) method for the determination of deoxynivalenol in a variety of cereals and cereal products at proposed European regulatory limits. The test portion was extracted with water. The sample extract was filtered and applied to an immunoaffinity column. After being washed with water, the deoxynivalenol was eluted with acetonitrile or methanol. Deoxynivalenol was quantitated by reversed-phase LC with UV determination. Samples of artificially contaminated wheat-flour, rice flour, oat flour, polenta, and a wheat based breakfast cereal, naturally contaminated wheat flour, and blank (very low level) samples of each matrix were sent to 13 collaborators in 7 European countries. Participants were asked to spike test portions of all samples at a range of deoxynivalenol concentrations equivalent to 200–2000 ng/g deoxynivalenol. Average recoveries ranged from 78 to 87%. Based on results for 6 artificially contaminated samples (blind duplicates), the relative standard deviation for repeatability (RSDr) ranged from 3.1 to 14.1%, and the relative standard deviation for reproducibility (RSDR) ranged from 11.5 to 26.3%. The method showed acceptable within-laboratory and between-laboratory precision for all 5 matrixes, as evidenced by HorRat values &lt;1.3.

Assessment of pops contaminated sites and the need for stringent soil standards for food safety for the protection of human health

Persistent organic pollutants (POPs) including PCDD/Fs, PCBs and organochlorine pesticides (OCPs) are among the most important and hazardous pollutants of soil. Food producing animals such as chicken, beef, sheep and goats can take up soil while grazing or living outdoors (free-range) and this can result in contamination. In recent decades, large quantities of brominated flame retardants such as polybrominated diphenyl ethers (PBDEs), short-chain chlorinated paraffins (SCCPs) and per- and polyfluorinated alkylated substances (PFAS) have been produced and released into the environment and this has resulted in widespread contamination of soils and other environmental matrices. These POPs also bioaccumulate and can contaminate food of animal origin resulting in indirect exposure of humans. Recent assessments of chicken and beef have shown that surprisingly low concentrations of PCBs and PCDD/Fs in soil can result in exceedances of regulatory limits in food. Soil contamination limits have been established in a number of countries for PCDD/Fs but it has been shown that the contamination levels which result in regulatory limits in food (the maximum levels in the European Union) being exceeded, are below all the existing soil regulatory limits. 'Safe' soil levels are exceeded in many areas around emission sources of PCDD/Fs and PCBs. On the other hand, PCDD/F and dioxin-like PCB levels in soil in rural areas, without a contamination source, are normally safe for food producing animals housed outdoors resulting in healthy food (e.g. meat, eggs, milk). For the majority of POPs (e.g. PBDEs, PFOS, PFOA, SCCP) no regulatory limits in soils exist. There is, therefore, an urgent need to develop appropriate and protective soil standards minimising human exposure from food producing animals housed outdoors. Furthermore, there is an urgent need to eliminate POPs pollution sources for soils and to control, secure and remediate contaminated sites and reservoirs, in order to reduce exposure and guarantee food safety.

Molten barium titanate: a high-pressure liquid silicate analogue

The structure of molten BaTiO₃ has been measured using laser heating, aerodynamic levitation and a combination of neutron diffraction with Ti isotope substitution, x-ray diffraction and spectroscopy. All measurements indicate a Ti-O coordination of n _TiO  =  4.4(2), far lower than the perovskite or hexagonal crystalline forms. However, n _TiO  >  4 suggests structural analogy with molten silicates at high pressures. We introduce methodology for ascertaining such analogies and demonstrate similarity with molten CaSiO₃ at upper mantle pressures circa 5 GPa. Although some topological differences exist, we propose that planetary melt analogues provide rich insight into important processes relevant to hot exoplanets and Earth's early history.

Why do sub-Saharan Africans present late for HIV care in Switzerland?

OBJECTIVES

Late presentation (LP) to HIV care disproportionally affects individuals from sub-Saharan Africa (SSA). We explored the reasons for late presentation to care among this group of patients in the Swiss HIV Cohort Study.

METHODS

The prevalence of LP was compared between patients from Western Europe (WE) and those from SSA enrolled between 2009 and 2012. Patients were asked about HIV testing, including access to testing and reasons for deferring it, during face-to-face interviews.

RESULTS

The proportion of LP was 45.8% (435/950) among patients from WE, and 64.6% (126/195) among those from SSA (P < 0.001). Women from WE were slightly more likely to present late than men (52.6% versus 44.5%, respectively; P = 0.06), whereas there was no sex difference in patients from SSA (65.6% versus 63.2%, respectively; P = 0.73). Compared with late presenters from WE, those from SSA were more likely to be diagnosed during pregnancy (9.1% versus 0%, respectively; P < 0.001), but less likely to be tested by general practitioners (25.0% versus 44.6%, respectively; P = 0.001). Late presenters from SSA more frequently reported 'not knowing about anonymous testing possibilities' (46.4% versus 27.3%, respectively; P = 0.04) and 'fear about negative reaction in relatives' (39.3% versus 21.7%, respectively; P = 0.05) as reasons for late testing. Fear of being expelled from Switzerland was reported by 26.1% of late presenters from SSA.

CONCLUSIONS

The majority of patients from SSA were late presenters, independent of sex or education level. Difficulties in accessing testing facilities, lack of knowledge about HIV testing and fear-related issues are important drivers for LP in this population.

Inventory and substance flow analysis of polybrominated diphenyl ethers in the Nigerian transport sector-end-of-life vehicles policy and management

Recently, certain polybrominated diphenyl ethers (PBDEs) have been listed as persistent organic pollutants (POPs) in the Stockholm Convention. In this study, a preliminary material and substance flow analysis of commercial pentabromodiphenyl ether (c-PentaBDE) was conducted for motor vehicles-a major use sector for POP-PBDE in polyurethane (PUR) foam-for Nigeria. The methodology of the Stockholm Convention PBDE inventory guidance was used for the calculation of c-PentaBDE. Material/substance flow analysis was conducted applying the STAN software. The time frame for this analysis was 1980-2010, considering that this was the period when POP-PBDE-containing vehicles were largely imported into Nigeria.It is estimated that the approximately 19 million passenger cars imported from 1980 to 2010 contained ca. 270 t of POP-PBDEs in ca. 401,000 t of PUR foam. A major share of cars from the USA and only a small share of cars from Europe and Asia were impacted. This simplified material and substance flow of PUR foams and POP-PBDEs in motor vehicles demonstrated the potential for environmental/human contamination and pollution of recycling/reuse for Nigeria and other developing countries.The study developed the first preliminary inventory of end-of-life vehicles for Nigeria, following which the environment ministry has taken up the important issue of end-of-life vehicles management. Considering that a range of other pollutants are contained in vehicles (e.g. heavy metals, flame retardants, PCBs, chlorofluorocarbons, hydrofluorocarbons and waste oil), this initiated activity should finally lead to an integrated management of pollutants and resources from the transport sector.

AIDA – Experiences in Compensating the Mutual Weaknesses of Knowledge-based and Object-oriented Development in a Complex Dental Planning Domain

Objectives: Dentistry is a discipline with two properties that pose a serious challenge to knowledge based decision support: (1) It has to integrate six sub-disciplines ranging from conservative measures to invasive disciplines, such as implantology; (2) A plan may have to cover a complex treatment often lasting one year or more. It is the aim of the AIDA-project1 to set up a planning strategy that is suited to incorporate all dental peculiarities in one methodology.

Methods: Generic tasks, that can be assigned to individual persons involved in dental treatment, have been designed with the help of KADS. They have been integrated into a planning super-structure for the planning of all dental solution alternatives, that can principally be applied on the basis of the given patient status.

Results: Besides an evaluation of the implemented planning system itself, it has been evaluated how well the development is supported by (1) knowledge-engineering methods and (2) object-oriented methods.

Conclusion: Common knowledge-based tools are not powerful enough for the planning of complex dental constructions. Therefore, a solution combining object-oriented and knowledge-based methods is proposed.

Medical Informatics Education Needs Information System Practicums in Health Care Settings

Objectives: To report about the themes and about experiences with practicums in the management of information systems in health care settings (health information management) for medical informatics students.

Methods: We first summarize the topics of the health information management practicums/projects that the authors organized between 1990 and 2003 for the medical informatics programs at Heidelberg/ Heilbronn, Germany, UMIT, Austria, as well as for the informatics program at the University of Leipzig, Germany. Experiences and lessons learned, obtained from the faculty that organized the practicums in the past 14 years, are reported.

Results: Thirty (of 32) health information management practicums focused on the analysis of health information systems. These took place inside university medical centers. Although the practicums were time-intensive and required intensively tutoring students with regard to health information management and project management, feedback from the students and graduates was mainly positive.

Discussion: It is clearly recommended that students specializing in medical informatics need to be confronted with real-world problems of health information systems during their studies.

Therapieakzeptanz und Therapiebeziehung in der frühen Phase der Verhaltenstherapie bei Negativsymptomatik der Schizophrenie

Gegenstand und Ziel: Die Studie überprüfte die Durchführbarkeit und Akzeptanz einer ambulanten kognitiven Verhaltenstherapie bei Negativsymptomatik der Schizophrenie. Ein zusätzlicher Fokus lag auf der Analyse der therapeutischen Beziehung (TB) und deren Vorhersage aus klinisch- psychopathologischen Merkmalen. Material und Methoden: 49 Patienten mit Schizophrenie wurden randomisiert entweder einer kognitiven Verhaltenstherapie (KVT; Experimentalgruppe) oder einer kognitiven Remediation (KR; Kontrollgruppe) zugewiesen. Die Sitzungen wurden anhand von Stundenprotokollen und Patienten- bzw. Therapeutenstundenbögen dokumentiert. Analysiert wurde die frühe Therapiephase. Ergebnisse: Die Stundenprotokolle zeigten, dass die Therapeuten die KVT manualgetreu durchführen konnten. Die Analysen der Stundenbögen erbrachten, dass die Patienten die TB in der KVT als positiv und besser als in der KR beurteilten. Patienten- und Therapeuteneinschätzungen der TB zeigten keine Korrelation. Eine mildere Positivsymptomatik war mit einer besseren Beurteilung der TB durch den Patienten assoziiert. Eine stärkere Negativsymptomatik prädizierte eine ungünstigere Beurteilung der TB durch den Therapeuten. Schlussfolgerungen und klinische Relevanz: Die Studie ist ein erster Indikator für die Durchführbarkeit und Akzeptanz der KVT bei Negativsymptomatik. Positiv- und Negativsymptomatik bergen Implikationen für die Entwicklung der TB.

Antiplatelet agents in stroke prevention

In primary prevention, aspirin reduces the risk of stroke but not of myocardial infarction in women while in men only the risk of myocardial infarction but not stroke could be significantly reduced. Only aspirin has been shown to be safe and effective in large randomized trials in the first 48 hours after ischemic stroke. Aspirin/dipyridamole and clopidogrel both reduce the risk of a combined cardiovascular outcome in long-term secondary prevention compared to aspirin alone. More potent antiplatelet drugs or combination of aspirin and clopidogrel prevent more ischemic events, but also lead to more bleeding complications. No benefit of oral anticoagulants could be shown in patients with non-cardioembolic stroke. In patients with atrial fibrillation oral anticoagulation is more effective than aspirin in stroke prevention. The choice between oral anticoagulants and aspirin in these patients depends on age and the individual risk factor profile. Patients with symptomatic intracranial stenosis have a higher risk of intracerebral bleeding with oral anticoagulation compared to high dose aspirin. Aspirin is the recommended treatment in stroke patients with a patent foramen ovale.

Association of WNT Pathway Genes With Nonsyndromic Cleft Lip With or Without Cleft Palate

OBJECTIVE

Nonsyndromic cleft lip with or without cleft palate (NSCL±P) is a common craniofacial anomaly with multifactorial etiology. Evidence suggests that variations in WNT pathway genes contribute to an increased susceptibility to NSCL±P. The aim of this study was to investigate the association of AXIN1, APC, CTNNB1, DVL2, and GSK3β gene variants with NSCL±P in a case-control data set from Brazil.

PATIENTS

471 individuals with NSCL±P and 504 unrelated control individuals of Caucasian ethnicity.

DESIGN

Twenty single-nucleotide polymorphisms (SNPs) in/nearby AXIN1, APC, CTNNB1, DVL2, and GSK3B genes were genotyped using Taqman chemistry in a Viia7 sequence detection instrument. Genotype, allele, and haplotype frequencies were compared among NSCL±P patients and controls using Fisher exact test, implemented in PLINK software. The level of significance was established at P ≤.002 under Bonferroni correction. In silico analysis of SNP function was assessed using MirSNP database.

RESULTS

Significant association was found between GSK3B rs13314595 genotypes and NSCL±P ( P = .0006). Additionally, nominal associations were found between DVL2 (rs35594616) and APC (rs448475) with NSCL±P ( P = .02 and P = .03, respectively). SNP haplotypes for GSK3B and APC genes showed nominal associations with NSCL±P ( P < .05). In silico analysis predicted that APC rs448475 harbors a binding site for the microRNA miR-617 and that the switch from a G allele to C allele enhances binding, whereas DVL2 rs35594616 did not appear to harbor microRNA-binding sites.

CONCLUSION

This study shows for the first time the association between GSK3B and NSCL±P and confirms the role of additional WNT pathway genes as candidates for NSCL±P.

Saline irrigations following sinus surgery - a controlled, single blinded, randomized trial

BACKGROUND

Chronic rhinosinusitis (CRS) is a common health problem. If medical treatment fails, endonasal sinus surgery is a valuable treatment option. A thorough postsurgical treatment is needed including, among others, nasal saline irrigations (NSI). In this prospective, controlled, single blinded, randomized trial, we aimed to evaluate efficacy of nasal saline irrigations following endonasal sinus surgery in CRS-patients with nasal polyps.

METHODOLOGY

We examined patient's nasal symptoms, general quality of life and postoperative condition of the mucosa. We also investigated whether or not NSI reduced the number of missed workdays after surgery (MWD). Patients were randomized into an irrigation and non-irrigation arm.

RESULTS

Following treatment, mean nasal sum-score in the irrigation arm was 4.4 and in the non-irrigation arm it was 6.3. Accordingly, mean general sum-score in the irrigation arm was 2.5 and in the non-irrigation arm 4.8. Thus, nasal irrigation led to a more pronounced improvement of nasal and general symptoms than in the non-irrigation arm. No differences were observed in postoperative condition of mucosa or number of MWD.

CONCLUSIONS

Nasal irrigation improves symptoms score after ESS in patients with CRSwNP.

EAACI Molecular Allergology User's Guide

The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.

Emergence of Acquired HIV-1 Drug Resistance Almost Stopped in Switzerland: A 15-Year Prospective Cohort Analysis

BACKGROUND

Drug resistance is a major barrier to successful antiretroviral treatment (ART). Therefore, it is important to monitor time trends at a population level.

METHODS

We included 11 084 ART-experienced patients from the Swiss HIV Cohort Study (SHCS) between 1999 and 2013. The SHCS is highly representative and includes 72% of patients receiving ART in Switzerland. Drug resistance was defined as the presence of ≥1 major mutation in a genotypic resistance test. To estimate the prevalence of drug resistance, data for patients with no resistance test was imputed based on the patient's risk of harboring drug-resistant viruses.

RESULTS

The emergence of new drug resistance mutations declined dramatically from 401 to 23 patients between 1999 and 2013. The upper estimated prevalence limit of drug resistance among ART-experienced patients decreased from 57.0% in 1999 to 37.1% in 2013. The prevalence of 3-class resistance decreased from 9.0% to 4.4% and was always <0.4% for patients who initiated ART after 2006. Most patients actively participating in the SHCS in 2013 with drug-resistant viruses initiated ART before 1999 (59.8%). Nevertheless, in 2013, 94.5% of patients who initiated ART before 1999 had good remaining treatment options based on Stanford algorithm.

CONCLUSIONS

Human immunodeficiency virus type 1 drug resistance among ART-experienced patients in Switzerland is a well-controlled relic from the era before combination ART. Emergence of drug resistance can be virtually stopped with new potent therapies and close monitoring.

Violence-related content in video game may lead to functional connectivity changes in brain networks as revealed by fMRI-ICA in young men

In violent video games, players engage in virtual aggressive behaviors. Exposure to virtual aggressive behavior induces short-term changes in players' behavior. In a previous study, a violence-related version of the racing game "Carmageddon TDR2000" increased aggressive affects, cognitions, and behaviors compared to its non-violence-related version. This study investigates the differences in neural network activity during the playing of both versions of the video game. Functional magnetic resonance imaging (fMRI) recorded ongoing brain activity of 18 young men playing the violence-related and the non-violence-related version of the video game Carmageddon. Image time series were decomposed into functional connectivity (FC) patterns using independent component analysis (ICA) and template-matching yielded a mapping to established functional brain networks. The FC patterns revealed a decrease in connectivity within 6 brain networks during the violence-related compared to the non-violence-related condition: three sensory-motor networks, the reward network, the default mode network (DMN), and the right-lateralized frontoparietal network. Playing violent racing games may change functional brain connectivity, in particular and even after controlling for event frequency, in the reward network and the DMN. These changes may underlie the short-term increase of aggressive affects, cognitions, and behaviors as observed after playing violent video games.