Synthetic Mirnov diagnostic for the validation of experimental observations

A synthetic Mirnov diagnostic has been developed to investigate the capabilities and limitations of an arrangement of Mirnov coils in terms of a mode analysis. Eight test cases have been developed, with different coil arrangements and magnetic field configurations. Three of those cases are experimental configurations of the stellarator Wendelstein 7-X. It is observed that, for a high triangularity of the flux surfaces, the arrangement of the coils plays a significant role in the exact determination of the poloidal mode number. For the mode analysis, torus and magnetic coordinates have been used. In most cases, the reconstruction of the poloidal mode number of a prescribed mode was found to be more accurate in magnetic coordinates. As an application, the signal of an Alfvén eigenmode, which has been calculated with a three-dimensional magnetohydrodynamics code, is compared to experimental observations at Wendelstein 7-X. For the chosen example, the calculated and measured mode spectra agree very well and additional information on the toroidal mode number and localization of the mode has been inferred.

The role of the atrium in the development of the Takotsubo Syndrome – investigation of a patient-specific atrial stem cell model

Background and aims

The Takotsubo syndrome (TTS) is characterised by an acute left ventricular dysfunction without exhibiting signs of stenosis. TTS affects mainly the left ventricle, however, its pathophysiology comprises transient impairments in left atrium functions with a prevalence of atrial fibrillation (AF) of around 18% correlating with higher ventricular heart rhythm disorders. In this study, we aimed to prove the hypothesis that molecular and cellular arrhythmic events contribute to the development of TTS under catecholamine stress and to test if the currently clinically used β-blockers (Metoprolol) or the PDE4 activator MR-L2 are suitable for Takotsubo cardiomyopathy in vitro.

Methods and results

We generated induced pluripotent stem cell-derived atrial cardiomyocytes (TTS-iPSC-aCMs) from TTS patients, confirmed atrial marker expression (MLC2a, PItX2, NR2F2), and treated them with catecholamines (Iso) to mimic TTS-phenotype. Using a cytosolic Förster resonance energy transfer (FRET) based cAMP sensor, we tested the activity of phosphodiesterases (PDEs) in TTS-iPSC-aCMs and observed that after β-AR stimulation, the strong effects of the PDE4 family in the cytosol of atrial control cells were significantly decreased in aCMs of the TTS patients. This effect was rescued after application of PDE4 activator MR-L2 and is in line with the previously described downregulation of PDE4 in human atrial myocardium of AF patients. In functional studies, Iso-induced increase in systolic Ca2+ transient amplitude was more pronounced in TTS iPSC-aCM compared to controls. These effects were rescued by both, the clinically approved β-blocker Metoprolol and by MR-L2. To analyse arrhythmic events in atrial TTS CMs, we performed confocal microscope Ca2+ measurements and demonstrated that the diastolic sarcoplasmic reticulum Ca2+ leak was increased in iPSC aCMs of TTS patients compared to control under basal conditions and after Iso-treatment. In addition, TTS patients displayed faster Ca2+ kinetics compared to control cells, already under basal conditions. These results were underlined on a molecular level by increased phospholamban phosphorylation in TTS iPSC-aCM. Subsequent treatment with Metoprolol rescued the Ca2+ kinetic parameters and the increased calcium sparks in all cell lines.

Conclusion

In conclusion, we were able to draw a comprehensive picture on the role of the atrium in the development of arrhythmias in TTS. We found TTS-patient-specific differences with reduced PDE4 activity, elevated arrhythmic events and enhanced reactions to catecholamines, which could be rescued by the clinically approved drug Metoprolol and partly by the PDE4 activator MR-L2. Therefore, Metoprolol has proven to be an effective treatment option for TTS and preliminary data of MR-L2 demonstrate promising effects as a new patient-specific therapeutic target for TTS under catecholamine-stress.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German centre for cardiovascular research

Motion compensation for non-periodic dynamic tracer distributions in multi-patch magnetic particle imaging

Objective. While the spatial and temporal resolution of magnetic particle imaging is very high, the size of the field of view is limited due to physiological constraints. Multi-patch scans allow for covering larger areas by sequentially scanning smaller subvolumes, so-called patches. The visualization of tracer dynamics with a high temporal resolution are of particular interest in many applications, e.g. cardiovascular interventions or blood flow measurements. The reconstruction of non-periodic dynamic tracer distributions is currently realized by the reconstruction of a time-series of frames under the assumption of nearly static behavior during the scan of each frame. While this approach is feasible for limited velocities, it results in data gaps in multi-patch scans leading thus to artifacts for strong dynamics. In this article, we are aiming for the reconstruction of dynamic tracer concentrations with high velocities and the compensation of motion and multi-patch artifacts. Approach. We present a reconstruction method for dynamic tracer distributions using a dynamic forward model and representing the concentration within each voxel by a spline curve. The method is evaluated with simulated single- and multi-patch data. Main results. The dynamic model enables for the reconstruction of fast tracer dynamics from few frames and the spline approach approximates the missing data which reduces multi-patch artifacts. Significance. The presented method allows to compensate motion and multi-patch artifacts and to reconstruct fast dynamic tracer distributions with arbitrary motion patterns.

Splints and immobilisation approaches used for second to fifth metacarpal fractures: a systematic review

BACKGROUND: The second to fifth metacarpal fractures are immobilised with splints, plaster of Paris (POP) or buddy strapping for a period of time. However, no recent evidence-based splinting and immobilisation programme exists for the management thereof, leaving a gap in the literature to inform clinical practice. This review aimed to review, appraise and collate the literature on splints and immobilisation approaches used for second to fifth metacarpal fractures after surgical and conservative management in adults aged 20 to 59 years. METHODS: The review included experimental study designs, quasi-experimental studies, cohort studies and case-control studies from January 2008 to September 2018. Two reviewers independently screened, selected, appraised and extracted data from the included studies. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) guided the reporting. Joanna Briggs Institute (jBl) critical appraisal tools were used to assess the risk of bias for each included study. RESULTS: Database searches generated 1 005 articles with ten additional articles found on Google Scholar. Ten articles were included: two randomised controlled trials (RCTs), one quasi-RCT, four prospective studies, one retrospective record review, one retrospective study and one comparative study with descriptive reporting of the results. CONCLUSION: High level 1b evidence suggests that no reduction, a soft wrap and buddy strapping for three weeks with early active finger and wrist mobilisation are effective for individuals who sustained boxer's fractures with < 70° angulation. To guide clinical practice, high-level research is needed to determine the immobilisation of second to fifth metacarpal fracture types. Level of evidence: Level 2

Injury prevention knowledge, beliefs, and practices among women's football teams in South Africa

Background

Numerous factors account for injury prevention or lack thereof in any team setting. With the increasing burden of injuries in women's football, and limited human resources accessible in sub-Saharan Africa, it is important to investigate the ways in which standardised injury prevention practices can be achieved.

Objectives

The study aimed to evaluate injury prevention knowledge, beliefs, and practices in women's football teams in the University Sport South Africa (USSA) Football League in Gauteng Province, South Africa.

Methods

A cross-sectional self-administered survey was conducted among women's football teams registered to participate in the USSA Football League in South Africa's Gauteng Province.

Results

A total of 107 respondents participated in the study, which included both players (n=98; 92%) and their support staff (n=9; 9%). The median (interquartile range) age of the participants was 22 (20-25) years. In the population sampled, 36% of the participants perceived that they had adequate knowledge of injury prevention practices in football, while others felt they had limited knowledge of the basic injury prevention programmes (IPPs). The results also indicated that the injury prevention practices of coaches (93%) and their beliefs in this regard (70%) are sufficient for achieving the basic injury prevention goals. Most of the respondents (89%) indicated that a medical support system is important in attaining the goals of injury prevention.

Conclusion

Members of women's teams in the USSA Football League have recognised limited knowledge about the basic IPPs, while they do employ some of the basic injury prevention practices in football. These practices could be influenced by the beliefs of the coaches and the players, and most of them believe that IPPs are important. It is essential as key stakeholders that coaches' and players' education and knowledge of injury prevention strategies should be considered as an integral part of the process to succeed. It should be strongly highlighted and implemented, thus augmenting the credibility, trust and compliance for IPPs in the sport.

ECCD operations in the second experimental campaign at W7-X

In the Wendelstein 7-X stellarator, up to 7MW of power are delivered to the plasma by an electron cyclotron resonance heating system consisting of ten 140 GHz gyrotrons [1].

Due to the flexible front steering mirror of each beam line, the power deposition can be varied over the whole plasma radius and is optionally combinable with additional current drive. This flexibility, together with small toroidal currents in the stellarator, makes W7-X a perfect testbed for electron cyclotron current drive (ECCD) experiments, which have been successfully accomplished during the first two experimental campaigns OP1.1 and OP1.2a.

Long discharges (lasting up to 30s) have been performed in OP1.2a, thus allowing the study of the current drive time evolution and the possibility to compensate the bootstrap current.

ECCD efficiency has been studied using different power deposition profiles combined with a variation of the injection angles in relation to the magnetic field.

During ECCD experiments, saw-tooth-like oscillations have been observed. Depending on the driven current density, ECCD can significantly modify the rotational transform (iota) profile, which can locally reach low order rational, thus triggering plasma instabilities.

Different current density profiles have been tested, in order to try to understand the main trigger parameter for the instabilities. In particular, effects caused by current density gradient have been investigated producing both co- and counter-current drive at different radial positions: the total current drive is negligible, but a strong current gradient arises by driving currents in opposite directions.

In this work an overview of ECCD operations in OP1.2a is given and first results, comparing different diagnostics, are presented. An initial 1-D model, coupled with the ray tracer TRAVIS, is developed, in order to have an estimation of current diffusion times and the radial position where a low order rational crosses the disturbed iota profile.

Respiratory sound analysis in the era of evidence-based medicine and the world of medicine 2.0

OBJECTIVE

This paper describes the state of the art, scientific publications, and ongoing research related to the methods of analysis of respiratory sounds.

METHODS AND MATERIAL

Narrative review of the current medical and technological literature using Pubmed and personal experience.

RESULTS

We outline the various techniques that are currently being used to collect auscultation sounds and provide a physical description of known pathological sounds for which automatic detection tools have been developed. Modern tools are based on artificial intelligence and techniques such as artificial neural networks, fuzzy systems, and genetic algorithms.

CONCLUSION

The next step will consist of finding new markers to increase the efficiency of decision-aiding algorithms and tools.

Concussion knowledge and attitudes among amateur South African rugby players

Background: The South African Rugby Union’s BokSmart programme currently educates coaches and referees on concussion. Rugby players are often more familiar with their teammates than the coach or referee. Therefore they are well-positioned to play a pivotal role in rugby safety if they have adequate knowledge to identify subtle signs and abnormal behaviour displayed by a concussed teammate. However, no programme focuses on concussion education among South African rugby players and there is a dearth of literature on concussion education programmes among rugby players which could lead to safer return to play (RTP) habits.Objectives: To evaluate South African rugby players’ concussion knowledge and attitudes/behaviours regarding RTP following a concussion.Methods: A descriptive, cross-sectional study was used. Participants (n=294) were divided into junior amateur high school (JAHS) (n=216) and senior amateur club (SAC) (n=78) players. The modified RoCKAS-ST questionnaire was used to evaluate their concussion knowledge index (CKI) and concussion attitudes/behaviours index (CAI) regarding RTP.Results: On average, 62% (JAHS) and 60% (SAC) of the CKI questions were answered correctly. JAHS participants correctly identified 66% of concussion symptoms, similarly to the SAC participants (63%), rendering similar (p=0.37) overall CKI scores when comparing the two groups. The CAI questions yielded similar (p=0.98) results between the groups, reporting safe responses in 66% (JAHS) and 67% (SAC) of the items.Discussion and conclusion: Junior and senior South African amateur rugby players lacked approximately one-third of essential concussion knowledge, which may lead to a display of unsafe attitudes/behaviours to concussion and RTP. Further research is warranted to inform educational programmes on concussion among rugby players.

Concussion knowledge and attitudes among amateur South African rugby players

Background: The South African Rugby Union’s BokSmart programme currently educates coaches and referees on concussion. Rugby players are often more familiar with their teammates than the coach or referee. Therefore they are well-positioned to play a pivotal role in rugby safety if they have adequate knowledge to identify subtle signs and abnormal behaviour displayed by a concussed teammate. However, no programme focuses on concussion education among South African rugby players and there is a dearth of literature on concussion education programmes among rugby players which could lead to safer return to play (RTP) habits.Objectives: To evaluate South African rugby players’ concussion knowledge and attitudes/behaviours regarding RTP following a concussion.Methods: A descriptive, cross-sectional study was used. Participants (n=294) were divided into junior amateur high school (JAHS) (n=216) and senior amateur club (SAC) (n=78) players. The modified RoCKAS-ST questionnaire was used to evaluate their concussion knowledge index (CKI) and concussion attitudes/behaviours index (CAI) regarding RTP.Results: On average, 62% (JAHS) and 60% (SAC) of the CKI questions were answered correctly. JAHS participants correctly identified 66% of concussion symptoms, similarly to the SAC participants (63%), rendering similar (p=0.37) overall CKI scores when comparing the two groups. The CAI questions yielded similar (p=0.98) results between the groups, reporting safe responses in 66% (JAHS) and 67% (SAC) of the items.Discussion and conclusion: Junior and senior South African amateur rugby players lacked approximately one-third of essential concussion knowledge, which may lead to a display of unsafe attitudes/behaviours to concussion and RTP. Further research is warranted to inform educational programmes on concussion among rugby players.

Clinical classification of adult patients with chronic intestinal failure due to benign disease: An international multicenter cross-sectional survey

BACKGROUND & AIMS

The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements.

METHODS

ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need.

RESULTS

Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume.

CONCLUSIONS

Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.

Phosphorylation of a constrained azacyclic FTY720 analog enhances anti-leukemic activity without inducing S1P receptor activation

The frequency of poor outcomes in relapsed leukemia patients underscores the need for novel therapeutic approaches. The FDA-approved immunosuppressant FTY720 limits leukemia progression by activating protein phosphatase 2A and restricting nutrient access. Unfortunately, FTY720 cannot be re-purposed for use in cancer patients due to on-target toxicity associated with S1P receptor activation at the elevated, anti-neoplastic dose. Here we show that the constrained azacyclic FTY720 analog SH-RF-177 lacks S1P receptor activity but maintains anti-leukemic activity in vitro and in vivo. SH-RF-177 was not only more potent than FTY720, but killed via a distinct mechanism. Phosphorylation is dispensable for FTY720’s anti-leukemic actions. However, chemical biology and genetic approaches demonstrated that the sphingosine kinase 2- (SPHK2) mediated phosphorylation of SH-RF-177 led to engagement of a pro-apoptotic target and increased potency. The cytotoxicity of membrane-permeant FTY720 phosphonate esters suggests that the enhanced potency of SH-RF-177 stems from its more efficient phosphorylation. The tight inverse correlation between SH-RF-177 IC₅₀ and SPHK2 mRNA expression suggests a useful biomarker for SH-RF-177 sensitivity. In summary, these studies indicate that FTY720 analogs that are efficiently phosphorylated but fail to activate S1P receptors may be superior anti-leukemic agents compared to compounds that avoid cardiotoxicity by eliminating phosphorylation.

Reduction of Surgical Site Infection Rates Associated With Active Surveillance

Objective.

To evaluate whether surgical site infection (SSI) rates decrease in surgical departments as a result of performing active SSI surveillance.

Design.

Retrospective multiple logistic regression analyses.

Setting.

A group of 130 surgical departments of German hospitals participating in the Krankenhaus Infektions Surveillance System (KISS).

Methods.

Data for 19 categories of operative procedures performed between January 1997 and June 2004 were included (119,114 operations). Active SSI surveillance was performed according to National Nosocomial Infections Surveillance system (NNIS) methods and definitions. Departments' SSI rates were calculated individually for each year of surveillance and for each operative procedure category, taking into account when the individual departments had begun their surveillance activities. Multiple logistic regression analyses on a single operation basis were carried out with stepwise variable selection to predict outcomes for patients with SSI. The variables included were as follows: the department's year of participation, NNIS risk index variables, patients' age and sex, and the hospitals' structural characteristics, such as yearly operation frequency, number of beds, and academic status.

Results.

For 14 of 19 operative procedure categories analyzed, there was a tendency toward lower SSI rates that was associated with increasing duration of SSI surveillance. In multiple logistic regression analyses of pooled data for all operative procedures, the departments' participation in the surveillance system was a significant independent protective factor. Compared with the surveillance year 1, the SSI risk decreased in year 2 (odds ratio, 0.84; 95% confidence interval, 0.77-0.93) and in year 3 (odds ratio, 0.75; 95% confidence interval, 0.68-0.82), and there was no change in year 4.

Conclusion.

The SSI incidence was reduced by one quarter as a result of the surveillance-induced infection control efforts, which indicates the usefulness of a voluntary surveillance system.

Pregnant women in vehicles: Driving habits, position and risk of injury

This study proposed to broadly examine vehicle use by pregnant women in order to improve realism of accident simulations involving these particular occupants. Three research pathways were developed: the first consisted in a questionnaire survey examining the driving habits of 135 pregnant women, the second obtained measurements of 15 pregnant women driving position in their own vehicle from the 6th to the 9th month of pregnancy by measuring distances between body parts and vehicle parts, and the third examined car accidents involving pregnant occupants. Results obtained indicate that between 90% and 100% of pregnant women wore their seat belts whatever their stage of pregnancy, although nearly one third of subjects considered the seat belt was dangerous for their unborn child. The measurements obtained also showed that the position of the pregnant woman in her vehicle, in relation to the various elements of the passenger compartment, changed significantly during pregnancy. In the studied accidents, no correlation was found between the conditions of the accident and the resulting fetal injury. Results reveal that pregnant women do not modify significantly the seat setting as a function of pregnancy stage. Only the distance between maternal abdomen and steering wheel change significantly, from 16 cm to 12 cm at 6 and 9 month respectively. Pregnant women are mainly drivers before 8 months of pregnancy, passengers after that. Car use frequency falls down rapidly from 6 to 9 months of pregnancy. Real crashes investigations indicate a low rate of casualties, i.e. 342 car accidents involving pregnant women for a period of 9 years in an approximately 1.7 million inhabitants area. No specific injury was found as a function of stage of pregnancy.

Increase in migraine diagnoses and guideline-concordant treatment in veterans, 2004-2012

Background and aim Health administrators, policy makers, and educators have attempted to increase guideline adherence of migraine medications while reducing inappropriate use of opioid- and barbiturate-containing medications. We evaluated the burden of migraine and proportion of guideline-concordant care in a large, national health care system over time. Methods We conducted a time-series study using data from the Veterans Health Administration (VHA) electronic health record. Veterans with migraines were identified by ICD-9 code (346.X). Prescriptions and comorbid conditions were evaluated before and after migraine diagnosis. Chi-square tests and logistic regression were performed. Results A total of 57,064 veterans were diagnosed with migraine headache (5.3%), with women significantly more likely diagnosed (11.6% vs. 4.4%, p < 0.0001). The number of veterans diagnosed with migraine has significantly increased over the years. By 2012, triptans were prescribed to 43% of people with migraine, with no difference by gender. However, triptan prescriptions increased from 2004 to 2012 in men, but not women, veterans. Preventive medicines showed a significant increase with the year of migraine diagnosis, after controlling for age, sex, race, and for comorbidities treated with medications used for migraine prevention. Conclusions The burden of migraines is increasing within the VHA, with a corresponding increase in the delivery of guideline-concordant acute and prophylactic migraine-specific medication.

The relevance of neuropsychiatric symptoms and cognitive problems in new-onset epilepsy - Current knowledge and understanding

Neurobehavioral and cognition problems are highly prevalent in epilepsy, but most research studies to date have not adequately addressed the precise nature of the relationship between these comorbidities and seizures. To address this complex issue and to facilitate collaborative, innovative research in the rising field of neurobehavioral comorbidities and cognition disturbances in new-onset epilepsy, international epilepsy experts met at the 3rd Halifax International Epilepsy Conference & Retreat at White Point, South Shore, Nova Scotia, Canada from September 18 to 20, 2014. This Conference Proceedings provides a summary of the conference proceedings. Specifically, the following topics are discussed: (i) role of comorbidities in epilepsy diagnosis and management, (ii) role of antiepileptic medications in understanding the relationship between epilepsy and neurobehavioral and cognition problems, and (iii) animal data and diagnostic approaches. Evidence to date, though limited, strongly suggests a bidirectional relationship between epilepsy and cognitive and psychiatric comorbidities. In fact, it is likely that seizures and neurobehavioral problems represent different symptoms of a common etiology or network-wide disturbance. As a reflection of this shared network, psychiatric comorbidities and/or cognition problems may actually precede the seizure occurrence and likely get often missed if not screened.

Epilepsy in the elderly: restrictions, fears, and quality of life

OBJECTIVES

Due to demographic change and high incidence of epilepsy in elderly, the number of elderly with epilepsies is increasing. However, only few studies investigated the impact of epilepsy on quality of life (QoL). We investigated how epilepsy affects different aspects of QoL dependent on the age of the patients and the age of onset of epilepsy.

MATERIALS AND METHODS

In a multicenter, cross-sectional study, three patient groups were recruited from five centers: Group A1: 45 elderly (≥65 years.) with late onset of epilepsy (≥65 years), group A2: 51 elderly (≥65 years.) with early-onset, long-lasting epilepsy (≤50 years), group B: 41 young adults (≤50 years) with epilepsy. Statistical analysis of differences between groups was performed using generalized linear models.

RESULTS

Elderly with late-onset epilepsy (group A1) had a significantly lower seizure frequency, were treated with less anti-epileptic drugs (AEDs), and reported a better tolerability of AED treatment, but had more comorbidities compared with groups A2 and B. After adjusting for seizure frequency, tolerability of AEDs and comorbidity, young adults (group B) reported the highest overall QoL, whereas patients of group A1 and A2 did not differ significantly. Epilepsy-related fears, especially fears of stigmatization, were significantly higher in elderly with long-lasting epilepsy compared with groups A1 and B.

CONCLUSION

Seizure-related variables, tolerability of AEDs and comorbidity have a stronger impact on QoL and on restrictions due to epilepsy than age, age at onset of epilepsy or duration of epilepsy. However, some results indicate group-specific patterns of impairment and epilepsy-related fears.

Spatiotemporal splitting of global eigenmodes due to cross-field coupling via vortex dynamics in drift wave turbulence

Spatiotemporal splitting events of drift wave (DW) eigenmodes due to nonlinear coupling are investigated in a cylindrical helicon plasma device. DW eigenmodes in the radial-azimuthal cross section have been experimentally observed to split at radial locations and recombine into the global eigenmode with a time shorter than the typical DW period (t≪fDW(-1)). The number of splits correlates with the increase of turbulence. The observed dynamics can be theoretically reproduced by a Kuramoto-type model of a network of radially coupled azimuthal eigenmodes. Coupling by E×B-vortex convection cell dynamics and ion gyro radii motion leads to cross-field synchronization and occasional mode splitting events.

Simultaneous use of camera and probe diagnostics to unambiguously identify and study the dynamics of multiple underlying instabilities during the route to plasma turbulence

We use multiple-tip Langmuir probes and fast imaging to unambiguously identify and study the dynamics of underlying instabilities during the controlled route to fully-developed plasma turbulence in a linear magnetized helicon plasma device. Langmuir probes measure radial profiles of electron temperature, plasma density and potential; from which we compute linear growth rates of instabilities, cross-phase between density and potential fluctuations, Reynold's stress, particle flux, vorticity, time-delay estimated velocity, etc. Fast imaging complements the 1D probe measurements by providing temporally and spatially resolved 2D details of plasma structures associated with the instabilities. We find that three radially separated plasma instabilities exist simultaneously. Density gradient driven resistive drift waves propagating in the electron diamagnetic drift direction separate the plasma into an edge region dominated by strong, velocity shear driven Kelvin-Helmholtz instabilities and a central core region which shows coherent Rayleigh-Taylor modes propagating in the ion diamagnetic drift direction. The simultaneous, complementary use of both probes and camera was crucial to identify the instabilities and understand the details of the very rich plasma dynamics.

Epilepsy in the elderly: comparing clinical characteristics with younger patients

The prevalence and incidence of epilepsies in elderly is high. Due to demographic development, the portion of elderly patients with epilepsy will continue to rise over the next decades. In this study, we aimed to investigate seizure semiology, etiology, comorbidity, and therapy in elderly patients dependent on onset of epilepsy and in comparison with younger patients. In a prospective multicentre study, 202 epilepsy patients were included in a consecutive manner and subdivided into three groups (group A1: >65 years, onset of epilepsy after the age of 65 years; group A2: >65 years with early onset epilepsy, seizure onset before the age of 50 years; and group B: <50 years with epilepsy). Clinical data with respect to epilepsy, seizures, comorbidity, etiology, and anti-epileptic drug (AED) therapy were assessed using a questionnaire developed especially for these patient groups and filled out by the physicians. The clinical profile with regard to etiology, postictal conditions, and comorbidities clearly depends on the age of the patients and age of onset of epilepsy. Patients with an epilepsy onset after 65 years need lower doses of AEDs, gain better seizure control and have more concomitant diseases than younger patients or elderly epilepsy patients with early-onset epilepsy.

Leben mit chronischer spinaler Muskelatrophie

Eines der höchsten Ziele der individuellen menschlichen Entwicklung ist es, erwachsen zu werden, sein Leben selbstständig und eigenverantwortlich in die Hand zu nehmen und vielleicht sogar seinen Beitrag für die Gemeinschaft zu leisten. Dies kann aufgrund einer schweren Körperbehinderung, z. B. wenn wegen einer Muskelerkrankung nicht einmal die Gabel zum Essen gehalten werden kann, als praktisch schwierig und für nicht umsetzbar angesehen werden. Ins Erwachsenenalter zu kommen und auch Erwachsen zu sein, d. h. eigenverantwortlich und selbstbestimmt zu leben, ist aber durchaus möglich, auch wenn die rein körperliche Kraft dazu fehlt.

Wir berichten über unser Leben mit einer spinalen Muskelatrophie (SMA) vom Typ II, 3 Survival-motor-neuron-2(SMN2)-Genkopien, ein Leben voller Herausforderungen und Abhängigkeiten und doch ein ganz normales Leben.

Experimental investigation of modern and established carotid stents

PURPOSE

The design and material determine the mechanical properties of stents. In vitro parameters such as radial force, flexibility and wall adaptation of different stents were investigated in order to obtain evidence for clinical use.

MATERIALS AND METHODS

A total of 8 stents, including 2 hybrid stents with a combination of closed/open-cell design (Sinus Carotid RX, Cristallo Ideale), 3 closed-cell stents (Adapt, Carotid Wallstent, Xact Carotid) and 3 open-cell stents (Vivexx Carotid, Protégé Rx and Precise) with a diameter of 8 mm and a length of 40 mm, were investigated. The radial force, the bending stiffness of the stent system and of the stent, and the collapse pressure were measured. The wall adjustment of the stents was documented by fluoroscopy and assessed in a step and curve model.

RESULTS

The bending stiffness of the stent systems declined significantly in the expanded state, whereby the Xact Carotid stent showed the highest value (291.1 N/mm2) in contrast to 31.6-39.4 N/mm2 for the Sinus Carotid and Cristallo Ideale. The radial force on expansion of the stents to 7 mm was lowest for the Adapt (0.009 N/mm) and highest for the Precise (0.068 N/mm). The collapse pressure was highest for the Carotid Wallstent (0.48 bar), compared with the other stents (0.1 - 0.2 bar). The best wall adjustment in the curve model was shown by the Precise, the Sinus Carotid Rx and the Vivexx Carotid Stent. The diameter change from 5 to 7 mm was smoothly adapted by the Cristallo Ideale and the Carotid Wallstent. The Adapt showed poor vessel wall adaptation in both step and curved vessels.

CONCLUSION

As a result of their design, the Sinus Carotid Rx and the Cristallo Ideale show the best wall adjustment, with comparable radial force and high flexibility, whereby the Cristallo Ideale has the advantage that it has a closed-cell design in the middle third of the stent. The other stents should be taken into consideration with their specifications in individual cases.

KEY POINTS

The investigation of carotid stents provides an objective comparison of mechanical properties. Conclusions about the respective optimum uses of stents can be drawn from this. The hybrid stents show a good balance of properties for wide applicability. Citation Format: • Wissgott C, Schmidt W, Behrens P et al. Experimental Investigation of Modern and Established Carotid Stents. Fortschr Röntgenstr 2014; 186: 157 - 165.

Spatial relaxation of selective laser perturbations in a glow discharge plasma

An effect of a nonlocal plasma response caused by local laser radiation exciting atoms in resonant and metastable states is observed in a dc neon glow discharge. Starting at the perturbed position, spatially damped oscillations in the direction of the anode effecting all plasma quantities are created. Depending on the excitation of resonant or metastable atoms, the oscillations are phase-shifted by π. If the laser excites in particular a cycling transition, no nonlocal plasma response is observed. The relaxation of the plasma is investigated by means of visible light measurements using a line camera in the vicinity of the axial perturbation position. The effect is modeled in terms of nonlocal electron kinetics by solving the spatially inhomogeneous electron Boltzmann equation.

[MRSA/MDRO in rehabilitation--recommendation of the MDRO-Network Rhein-Main]

The German national guideline to prevent the spread of MRSA in acute care hospitals demands isolation of patients with MRSA, whereas a guideline for management of MRSA/MRDO-patients in rehabilitation is pending. Many rehabilitation clinics believe they should isolate these patients and therefore deny rehabilitation of this patient group arguing that rehabilitation and isolation are incompatible. In order to improve the rehabilitation of MDRO-patients the MDRO network Rhein-Main has developed a recommendation for rehabilitation clinics.Based on literature data on the prevalence of MRSA/MDRO in rehabilitation clinics, the data on transmission of MDRO in such clinics and on existing recommendations, a new recommendation was established by experts in hygiene and by management of rehabilitation clinics in the region.Current studies in Germany as well as in France exhibit the same prevalence of MDRO patients in rehabilitation units as well as in acute care clinics. Transmission occurs mainly via hand contact during patient care or medical therapy in critically ill patients with high maintenance. However, the risk of transmissions in patients with great mobility is not increased. Hence, good standard hygiene, especially good hand hygiene both in staff and patients, is the key method to prevent transmission. Isolation or other restriction of mobility does not seem necessary. These data formed the basis of the newly established recommendation, which sets out in a clearly laid-out and tabular manner the standard hygiene procedures necessary for safe rehabilitation of all patients and the additional measures necessary for rehabilitation of MDRO-patients. The recommendation provides guidance and thus will enable a better rehabilitation of MDRO-patients.

IL-6 regulates exercise and training-induced adaptations in subcutaneous adipose tissue in mice

AIM

The aim of this study was to test the hypothesis that IL-6 regulates exercise-induced gene responses in subcutaneous adipose tissue in mice.

METHODS

Four-month-old male IL-6 whole body knockout (KO) mice and C57B wild-type (WT) mice performed 1 h of treadmill exercise, where subcutaneous adipose tissue (AT) was removed either immediately after, 4 h or 10 h after exercise as well as from mice not running acutely. Moreover, AT was sampled at resting conditions after 5 weeks of exercise training.

RESULTS

AT leptin mRNA decreased immediately after a single running exercise bout in both genotypes and returned to baseline within 10 h of recovery in IL-6 KO mice, but not WT mice. Leptin mRNA content decreased in WT and increased in IL-6 KO mice with training, but without significant alterations in leptin protein. Acute exercise induced a decrease in the AT TNFα mRNA content in WT, but not in IL-6-KO mice, while training lowered resting levels of TNFα mRNA in both genotypes. In addition, an exercise-induced decline in AT PPARγ mRNA content was absent in IL-6 KO mice and in line training increased PPARγ mRNA only in IL-6 KO mice.

CONCLUSION

The present findings indicate a role of IL-6 in regulating exercise- and training-induced leptin and PPARγ expression in adipose tissue. In addition, while IL-6 is required for TNF-α mRNA reduction in response to acute exercise, IL-6 does not appear to be mandatory for anti-inflammatory effects of exercise training in adipose tissue.

Immunoglobulin G subclass levels and antibody responses to the 2009 influenza A (H1N1) monovalent vaccine among human immunodeficiency virus (HIV)-infected and HIV-uninfected adults

Immunoglobulin (Ig)G levels are important for antibody vaccine responses and IgG subclass deficiencies have been associated with severe 2009 influenza A (H1N1) infections. Studies have demonstrated variations in immune responses to the H1N1 vaccine, but the aetiology of this is unknown. We determined the associations between pre-vaccination overall and influenza-specific IgG subclass levels and 2009 H1N1-specific antibody responses post-vaccination (robust versus poor at day 28) stratified by human immunodeficiency virus (HIV) status. Logistic regression models were utilized to evaluate whether pre-vaccination IgG subclass levels were associated with the antibody response generated post-vaccination. We evaluated 48 participants as part of a clinical study who were stratified by robust versus poor post-vaccination immune responses. Participants had a median age of 35 years; 92% were male and 44% were Caucasian. HIV-infected adults had a median CD4 count of 669 cells/mm(3) , and 79% were receiving highly active anti-retroviral therapy. HIV-infected participants were more likely to have IgG2 deficiency (<240 mg/dl) than HIV-uninfected individuals (62% versus 4%, P < 0·001). No association of pre-vaccination IgG subclass levels (total or influenza-specific) and the antibody response generated by HIN1 vaccination in either group was found. In summary, pre-vaccination IgG subclass levels did not correlate with the ability to develop robust antibody responses to the 2009 influenza A (H1N1) monovalent vaccine. IgG2 deficiencies were common among HIV-infected individuals but did not correlate with poor influenza vaccine responses. Further investigations into the aetiology of disparate vaccine responses are needed.

Fatty liver disease is associated with underlying cardiovascular disease in HIV-infected persons(*)

BACKGROUND

Cardiovascular disease is an increasing concern among HIV-infected persons and their providers. We determined if fatty liver disease is a marker for underlying coronary atherosclerosis among HIV-infected persons.

METHODS

We performed a cross-sectional study in HIV-infected adults to evaluate the prevalence of and factors, including fatty liver disease, associated with subclinical coronary atherosclerosis. All participants underwent computed tomography for determination of coronary artery calcium (CAC; positive defined as a score >0) and fatty liver disease (defined as a liver-to-spleen ratio <1.0). Factors associated with CAC were determined using multivariate logistic regression models.

RESULTS

We included in the study 223 HIV-infected adults with a median age of 43 years [interquartile range (IQR) 36-50 years]; 96% were male and 49% were Caucasian. The median CD4 count was 586 cells/μL and 83% were receiving antiretroviral medications. Seventy-five (34%) had a positive CAC score and 29 (13%) subjects had fatty liver disease. Among those with CAC scores of 0, 1-100 and >100, the percentage with concurrent fatty liver disease was 8, 18 and 41%, respectively (P=0.001). In the multivariate model, CAC was associated with increasing age [odds ratio (OR) 4.3 per 10 years; P<0.01], hypertension (OR 2.6; P<0.01) and fatty liver disease (OR 3.8; P<0.01).

CONCLUSIONS

Coronary atherosclerosis as detected using CAC is prevalent among young HIV-infected persons. The detection of fatty liver disease among HIV-infected adults should prompt consideration of assessment for underlying cardiovascular disease and risk factor reduction.

Hippocampal dysgenesis and variable neuropsychiatric phenotypes in patients with Bardet-Biedl syndrome underline complex CNS impact of primary cilia

The Bardet-Biedl syndrome (BBS) is a rare ciliopathy clinically defined by the association of retinitis pigmentosa, polydactyly, obesity, kidney disease and cognitive impairment. The cognitive functioning, behavioral phenotype, prevalence of psychiatric diseases and memory performances of a cohort of 34 patients with BBS were evaluated and a systemic brain magnetic resonance imaging (MRI) was performed. The patients' cognitive functioning was of marked variable efficiency ranging from normal to disabling performances. Neuropsychological disorders such as slow thought process, attention difficulties and obsessive-compulsive traits were observed. Our main finding was hippocampal dysgenesis, diagnosed by MRI, found in 42.31% of the patients in this cohort. Moreover, we show that BBS proteins are expressed in the human hippocampus and in the human brain in the normal subject. Recent literature in the murine model shows that hippocampal neurogenesis, in particular in the adult mouse, requires an intact primary cilia. These results encourage us to further investigate the possible role of BBS proteins in the hippocampus and related central nervous system structures.