Cognitive Rehabilitation in Alzheimer's Disease - A Conceptual and Methodological Review

Within the last 20 years, several standardized cognitive trainings have been developed aiming at the delay of cognitive decline in older people who are at risk of Alzheimer's Disease (AD) or in mild stages of dementia. The transfer of cognitive training effects into activities of daily living was very limited in most previous studies. Therefore, multimodal Cognitive Rehabilitation approaches have been designed that aim to improve the activities of daily living. These approaches also attempt to integrate the patient's psychopathological and behavioral status as well as social relationships into the treatment plan. Contrary to other approaches, CR mainly focuses on compensation rather than restoration of impaired functionality. In this review, we define CR conceptually, and derive specific criteria to evaluate current CR approaches for individuals with mild cognitive impairment (MCI) and AD dementia. In addition, we perform a critical, methodical analysis of available CR studies, reviewing their short- and long-term treatment effects. Findings suggest that CR approaches improve memory performance and competence of activity of daily living (ADL) in mildly cognitively impaired subjects (MCI), when compensatory, integrative, as well as interactive elements and domain specificity are taken into account. Interactive and individual aspects also appear to be relevant to sustain long-term effects. In AD dementia, similar results emerged, although with smaller effect sizes. The efficacy of individualized CR approaches was comparable with theory-based, manual-guided concepts as long as promoting interaction was part of the treatment. So far, only few randomized controlled studies of sufficient sample size are available. Future systematic efficacy studies need to consider precisely defined outcome variables. This is necessary before one can draw conclusions of how CR can be used for secondary prevention of AD dementia as well as AD treatment.

800-fs, 330-μJ pulses from a 100-W regenerative Yb:YAG thin-disk amplifier at 300 kHz and THz generation in LiNbO₃

Yb:YAG thin-disk lasers offer extraordinary output power, but systems delivering femtosecond pulses at a repetition rate of hundreds of kilohertz are scarce, even though this regime is ideal for ultrafast electron diffraction, coincidence imaging, attosecond science, and terahertz (THz) spectroscopy. Here we describe a regenerative Yb:YAG amplifier based on thin-disk technology, producing 800-fs pulses at a repetition rate adjustable between 50 and 400 kHz. The key design elements are a short regenerative cavity and fast-switching Pockels cell. The average output power is 130 W before the compressor and 100 W after compression, which at 300 kHz corresponds to pulse energies of 430 and 330 μJ, respectively. This is sufficient for a wide range of nonlinear conversions and broadening/compression schemes. As a first application, we use optical rectification in LiNbO₃ to produce 30-nJ single-cycle THz pulses with 6 W pump power. The electric field exceeds 10  kV/cm at a central frequency of 0.3 THz, suitable for driving structural dynamics or controlling electron beams.

[Memorandum 'Development of health services research in Bavaria from the perspective of the Bavarian State Working Group 'Health Services Research (LAGeV)': status quo - potential - strategies']

The aim of the memorandum on the development of health services research (HSR) in Bavaria is to operationalise the global objectives of the State Working Group "Health Services Research" (LAGeV) and to collectively define future topics, specific implementation steps, methods as well as ways of working for the future course of the LAGeV. The LAGeV is an expert committee that integrates and links the competencies of different actors from science, politics and health care regarding HSR and facilitates their cooperation. The memorandum is based on an explorative survey among the LAGeV members, which identified the status quo of health services research in Bavaria, potential for development, important constraints, promoting factors, specific recommendations as well as future topics for the further development of HSR in Bavaria. From the perspective of the LAGeV members, the 12 most important future topics are: 1) Interface and networking research, 2) Innovative health care concepts, 3) Health care for multimorbid patients, 4)Health care for chronically ill patients, 5) Evaluation of innovations, processes and technologies, 6) Patient orientation and user focus, 7) Social and regional inequalities in health care, 8) Health care for mentally ill patients, 9) Indicators of health care quality, 10) Regional needs planning, 11) Practical effectiveness of HSR and 12) Scientific use of routine data. Potential for development of HSR in Bavaria lies a) in the promotion of networking and sustainable structures, b) the establishment of an HSR information platform that bundles information and results in regard to current topics and aims to facilitate cooperation as well as c) in the initiation of measures and projects. The latter ought to pinpoint health care challenges and make recommendations regarding the improvement of health care and its quality. The cooperation and networking structures that were established with the LAGeV should be continuously expanded and be used to work on priority topics in order to achieve the global objectives of the LAGeV.

Status of the diagnostics development for the first operation phase of the stellarator Wendelstein 7-X

An overview of the diagnostics which are essential for the first operational phase of Wendelstein 7-X and the set of diagnostics expected to be ready for operation at this time are presented. The ongoing investigations of how to cope with high levels of stray Electron Cyclotron Resonance Heating (ECRH) radiation in the ultraviolet (UV)/visible/infrared (IR) optical diagnostics are described.

Monitoring of the neutron production at the Wendelstein 7-X stellarator

The stellarator Wendelstein 7-X (W7-X), presently under construction at the Max-Planck-Institute for Plasma Physics in Greifswald, will be equipped with a set of neutron monitors to measure the total annual neutron emission for official documentation and to provide information for plasma diagnostics purposes. The authors performed MCNP calculations to design and optimise the moderator geometry of the monitors to exhibit a nearly energy-independent response as well as particular angular responses for one central and two peripheral monitors. The monitors were designed with up to five neutron detector tubes with different sensitivity to thermal neutrons to cover the expected neutron emission rates of W7-X from 10(11) s(-1) to 10(16) s(-1). A prerequisite for the determination of the neutron emission produced by a D-D plasma is an in-situ calibration of the neutron monitors. Such a procedure requires a MCNP simulation of the entire geometry of the W7-X stellarator. In a first benchmark experiment during the assembly phase of W7-X, the validity of the W7-X MCNP model was tested.

[Specialised out-patient palliative care (SAPV) in Bavaria: efficiency, structural and process-related effects and rural care]

Empirical indications show that specialised out-patient palliative care (SAPV), introduced in Germany in 2007, allows critically ill and dying patients to pass away within their own home even under complex symptoms. SAPV avoids emergency and hospital interferences, and the patient's wish to stay at home until the very end can be respected in most cases. The performance of SAPV is not solely focused on medical and patient-care aspects. It includes consulting and coordination work and also psycho-social support both of patients and family members. Within this framework, different active factors could be identified that are essential for high-quality care. Furthermore, the results show that the general ambulant care commodities on site determine the need, the extent and even the efficiency of SAPV. At the same time, SAPV changes also the respective care environment: it changes the roles of previous care providers and offers new resources, though not all existing resources (e. g., hospice services) are taken into account.

Binding and Uptake of 125Iodine-Labelled, Oxidized Low Density Lipoprotein by Macrophages: Comparism of the Effects of a-Tocopherol, Probucol, Pyridoxal-5'-phosphate and Magnesium-pyridoxal-5'-phosphate-glutamate

Specific and unspecific binding and uptake (internalization) by macrophages of 125iodine -labelled, copper-oxidized human low density lipoprotein is differently influenced by the anti­ oxidants α-tocopherol (α-Toc), probucol (Prob), pyridoxal-5'-phosphate (PP) and the magnesium-pyridoxal-5'-phosphate glutamate complex (MPPG). Binding as well as internalization, mediated by the so-called "scavenger receptor" is lower in the presence of MPPG whereas both specific binding and internalization are enhanced. The comparison of the effects in vitro allows a rating of the potentially anti-atherogenic and thus protective effects of the tested substances as follows: MPPG > PP > α-Toc > Prob.

Manganorganische Verbindungen

Es wird über die Umsetzung von Mangansalzen mit organischen Lithium- und Grignard-Verbindungen berichtet.

Diagnostics development for quasi-steady-state operation of the Wendelstein 7-X stellarator (invited)

The critical issues in the development of diagnostics, which need to work robust and reliable under quasi-steady state conditions for the discharge durations of 30 min and which cannot be maintained throughout the one week duration of each operation phase of the Wendelstein 7-X stellarator, are being discussed.

[Is high resolution ultrasound of the median nerve helpful before reintervention after failed carpal tunnel surgery?]

A common reason for persisting or new complaints after carpal tunnel surgery is an incomplete release of the retinaculum flexorum. Traction neuropathy, a real recurrent carpal tunnel syndrome and iatrogenic nerve lesions occur less frequently. In the case of an incomplete release of the flexor retinaculum the clinical symptoms in most of the patients can be resolved with revision surgery. Electrodiagnostic testing can only support the indication for a reoperation if a preoperative examination exists but is not able to demonstrate the exact cause of a failed carpal tunnel surgery. The 4 cases presented here show that high resolution ultrasound provides valuable information in addition to electrodiagnostic testing before a reintervention.

An isolated hand tumour as primary manifestation of sarcoidosis

BACKGROUND

Sarcoidosis is a systemic disorder with unknown etiology, characterized by non-caseating granulomas in numerous organs and tissues. In 90% of patients lung and lymph nodes are involved. The incidence of sarcoidal granulomas in the upper extremities is low. Here we present the case of a primary hand manifestation of sarcoidosis without clinical systemic involvement.

OBJECTIVES

A young woman presented with a painful swelling in her right hand. There were no signs of inflammation. Normal perfusion, mobility and sensibility were found. Magnetic resonance imaging (MRI) revealed a tumour infiltrating the muscles and flexor tendons of the third digit around the metacarpal bone and with pathological signal enhancement after administration of contrast medium.

RESULTS

Intraoperatively, nodular masses and fat tissue were seen. Histological examination after radical tumour resection showed sarcoidal granulomas. Postoperative staging diagnostics with computed tomography (CT) demonstrated multiple thoracic lymph node swellings in the mediastinum and bilateral hill. Follow-up after one year we saw normal scars in the palmar hand. There was no sign of local recurrence. The pulmological care is still going on.

CONCLUSIONS

Sarcoidosis is a rare, often asymptomatic disease. Patients present with dyspnoe and cough caused by the inflammation of the lung. The first clinical manifestation of sarcoidosis as a tumor in the palmar hand is unusual. Extrapulmonary systemic or progressive sarcoidosis is regarded as an indication for therapy with glucocorticosteroids. This case demonstrates that surgical excision enabled complete local cure without necessity of systemic and/or local treatment with steroids.