Chronic Acute Hepatitis

The current literature concerning chronic acute hepatitis is reviewed. The clinical picture, morphology, laboratory data and etiology are discussed. It is pointed out that much work is still to be done toward fully understanding this disease. A program of treatment is suggested

Sphaera terrae - das mittelalterliche Bild der Erde und die kosmographische Revolution

Die Arbeit stellt erstmals die komplexen antiken und mittelalterlichen Konzeptionen von Erd- und Wassersphäre dar und untersucht mit der Analyse ausgewählter Quellen deren Veränderung im Verlauf der überseeischen Entdeckungen bis zu Beginn des 16. Jahrhunderts. Noch am Ende des 15. Jahrhunderts vertraten gut informierte, umfassend gebildete Naturphilosophen mit guten Argumenten die Auffassung, die kleinere Erdsphäre sei von einer deutlich größeren Wassersphäre umgeben. Die tiefgreifende Veränderung solcher spätmittelalterlichen Konzeptionen von der Erdgestalt und der Durchbruch des Bildes vom modernen Globus um 1500 wird als ''kosmographische Revolution'' beschrieben. Nach einem Forschungsüberblick über ''Antike und mittelalterliche Vorstellungen von der Erdgestalt'' (Kapitel 1) werden unter der Überschrift ''Antike Grundlagen'' in Kapitel 2 mit Texten von Aristoteles, Cicero, Plinius, Martianus Capella, Macrobius und anderen diejenigen antiken Quellen näher untersucht, die für den Fortgang der mittelalterlichen gelehrten Diskussion über die Gestalt der Erde von besonderer Bedeutung waren. Kapitel 3 ''Sphaera terrae. Konzeptionen der Erdgestalt bis zum Ende des 14. Jahrhunderts'' zeigt an Quellen aus dem arabischen und lateinischen Sprachbereich, wie im Rahmen des kosmischen Sphärenmodells eine Vielfalt komplexer räumlicher Modelle der Relation von Erd- und Wassersphäre begründet und entwicklet wurde. Besonders bemerkenswert ist das vom Pariser Naturphilosophen Johannes Buridan (1300 - ca. 1360) mit physikalischen Argumenten umfassend begründete Modell einer gegenüber der umgebenden Wassersphäre exzentrisch versetzten Erdsphäre, die durch e! inen versetzten Erdschwerpunkt im Mittelpunkt des Kosmos gehalten werde -eine Konzeption, die die naturphilsophische Lehre von der Erdgestalt bis zum Ende des 15. Jahrhundert dominierte. Kapitel 4 ''Sphärische Kosmographie und der Beginn der europäischen Expansion nach Übersee'' zeigt, wie weitgehende exzentrische Modelle der Relation von Erd- und Wasserspäre im 15. Jahrhundert verbreitet waren. Dies wird anhand der Untersuchung weit verbreiteter Texte, etwa des geographsichen Kommentars von Pierre d'Ailly, und bedeutender kartographischer Zeugnisse wie der Weltkarte des Fra Mauro (1460) nachgewiesen. Erst mit der Rezeption der überseeischen Entdeckungen um 1500 setzte sich die moderne Konzeption des Erd-Wasser-Globus durch. Dies wird in Kapitel 5 unter der Überschrift ''Die kosmographische Revolution'' anhand von Texten von Christoph Kolumbus, Zacharias Lilius (1496), Gregor Reisch (1496/1501), Antonius Galateus (1501) und Amerigo Vespucci (1503) beschrieben. Der Epilog ''Die Rückseite der Erde'' zeigt, wie die Erkenntnis einer ''kosmographischen Revolution'', die von Autoren des 19. Jahrhunderts wie Alexander von Humboldt im Grundsatz bereits erkannt worden war, durch den Verlauf der zunehmenden fachwissenschaftlichen Spezialiserung in Vergessenheit geriet. Erst die Verknüpfung von Geographie-, Physik- und Astronomiegeschichte und deren Verbindung mit der Geschichte der überseeischen Entdeckungen im 15. und frühen 16. Jahrhundert ermöglicht die Erkenntnis des historischen Prozesses der ''kosmographischen Revolution'' um 1500. Daß am Ende des Mittelalters eine umfassende Horizonterweiterung, die mit der Zuhname neuer, komplexer Erfahrungsmöglichkeiten verbunden war, eine grundlegende Vereinfachung des Bildes von Erde und einen Verlust an kosmologisch-kosmographischer Komplexität bewirkte - dieses Paradox leite die beginnende Moderne ein

The Endoscopic Approach to the Diagnosis of Upper Gastrointestinal Bleeding

Fifty-nine consecutive patients who were bleeding from the upper gastrointestinal tract were examined endoscopically with fiberoptic instruments. The site and nature of the bleeding were identified in 84% of the patients without significant morbidity or mortality. Endoscopic examination of the esophagus, stomach and duodenum in the bleeding patient should be done within 12 to 24 hours after hospital admission and before barium study of the upper gastrointestinal tract

Revealing Hidden Potentials of the q-Space Signal in Breast Cancer

Mammography screening for early detection of breast lesions currently suffers from high amounts of false positive findings, which result in unnecessary invasive biopsies. Diffusion-weighted MR images (DWI) can help to reduce many of these false-positive findings prior to biopsy. Current approaches estimate tissue properties by means of quantitative parameters taken from generative, biophysical models fit to the q-space encoded signal under certain assumptions regarding noise and spatial homogeneity. This process is prone to fitting instability and partial information loss due to model simplicity. We reveal unexplored potentials of the signal by integrating all data processing components into a convolutional neural network (CNN) architecture that is designed to propagate clinical target information down to the raw input images. This approach enables simultaneous and target-specific optimization of image normalization, signal exploitation, global representation learning and classification. Using a multicentric data set of 222 patients, we demonstrate that our approach significantly improves clinical decision making with respect to the current state of the art.Comment: Accepted conference paper at MICCAI 201

Effects of methylphenidate on memory functions of adults with ADHD

Neuropsychological research on adults with attention deficit hyperactivity disorder (ADHD) revealed considerable impairments in memory functions related to executive control. However, only limited evidence exists supporting the effects of pharmacological treatment using methylphenidate (MPH) on memory functions. The aim of the present study was, therefore, to explore the impact of MPH on various memory functions of adults with ADHD. Thirty-one adults with ADHD treated with MPH, 36 adults with ADHD not-treated with MPH, and 36 healthy individuals were assessed on several aspects of memory, including short-term memory, working memory, retrospective memory, prospective memory, and source memory. Multivariate statistical analyses were applied to compare memory functions between groups. Nonmedicated adults with ADHD showed considerable impairments in memory functions related to executive control. Adults with ADHD treated with MPH showed improved memory functions when compared to nonmedicated patients, but were still impaired when compared to healthy controls. The present study emphasized the severity of memory impairments of adults with ADHD. A pharmacological treatment with MPH appeared to improve memory, but does not normalize functioning. Additional treatment intervention (e.g., cognitive-behavioral therapy) is therefore necessary

Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD:A systematic literature review

As attention-deficit/hyperactivity disorder (ADHD) is one of the most frequently diagnosed developmental disorders in childhood, effective yet safe treatment options are highly important. Recent research introduced physical exercise as a potential treatment option, particularly for children with ADHD. The aim of this review was to systematically analyze potential acute and chronic effects of cardio and non-cardio exercise on a broad range of functions in children with ADHD and to explore this in adults as well. Literature on physical exercise in patients with ADHD was systematically reviewed based on categorizations for exercise type (cardio versus non-cardio), effect type (acute versus chronic), and outcome measure (cognitive, behavioral/socio-emotional, and physical/(neuro)physiological). Furthermore, the methodological quality of the reviewed papers was addressed. Cardio exercise seems acutely beneficial regarding various executive functions (e.g., impulsivity), response time and several physical measures. Beneficial chronic effects of cardio exercise were found on various functions as well, including executive functions, attention and behavior. The acute and chronic effects of non-cardio exercise remain more questionable but seem predominantly positive too. Research provides evidence that physical exercise represents a promising alternative or additional treatment option for patients with ADHD. Acute and chronic beneficial effects of especially cardio exercise were reported with regard to several cognitive, behavioral, and socio-emotional functions. Although physical exercise may therefore represent an effective treatment option that could be combined with other treatment approaches of ADHD, more well-controlled studies on this topic, in both children and adults, are needed

The Development of an Embedded Figures Test for the Detection of Feigned Attention Deficit Hyperactivity Disorder in Adulthood

ObjectivesIt has been shown that an increasing number of adults deliberately feign attention deficit hyperactivity disorder (ADHD), which demonstrates the need for new tests designed to detect feigned ADHD.MethodsAn Embedded Figures Test ( EFT) was developed for the detection of feigned ADHD in adulthood. EFT performance of 51 adults with ADHD was compared to the performance of 52 matched healthy individuals, as well as to 268 undergraduate students who were randomly allocated in a simulation design to one of four experimental conditions, i.e. a control group, a naive simulation group, a symptom-coached simulation group or a test-coached simulation group. Furthermore, an independent sample of 11 adults with ADHD as well as a sample of 17 clinicians experienced in the work with adults with ADHD were assessed for further validation of the EFT.ResultsThe EFT was relatively easy to perform for both patients with ADHD and healthy comparisons as shown by low error rates and non-significant group differences. However, simulation groups differed from patients with ADHD by significant and large effects. An EFT index for the prediction of feigned ADHD was derived based on logistic regression coefficients. Receiver Operating Characteristics (ROC) demonstrated good classification accuracy of feigned ADHD relative to ADHD (AUC = 94.8%), i.e. high sensitivity (88%) and specificity (90%).ConclusionsThis study supports the utility of the EFT for the detection of feigned adult ADHD.</p

Epistatic interactions between mutations of TACI (TNFRSF13B) and TCF3 result in a severe primary immunodeficiency disorder and systemic lupus erythematosus

Common variable immunodeficiency disorders (CVID) are a group of primary immunodeficiencies where monogenetic causes account for only a fraction of cases. On this evidence, CVID is potentially polygenic and epistatic although there are, as yet, no examples to support this hypothesis. We have identified a non-consanguineous family, who carry the C104R (c.310T>C) mutation of the Transmembrane Activator Calcium-modulator and cyclophilin ligand Interactor (TACI, TNFRSF13B) gene. Variants in TNFRSF13B/TACI are identified in up to 10% of CVID patients, and are associated with, but not solely causative of CVID. The proband is heterozygous for the TNFRSF13B/TACI C104R mutation and meets the Ameratunga et al. diagnostic criteria for CVID and the American College of Rheumatology criteria for systemic lupus erythematosus (SLE). Her son has type 1 diabetes, arthritis, reduced IgG levels and IgA deficiency, but has not inherited the TNFRSF13B/TACI mutation. Her brother, homozygous for the TNFRSF13B/TACI mutation, is in good health despite profound hypogammaglobulinemia and mild cytopenias. We hypothesised that a second unidentified mutation contributed to the symptomatic phenotype of the proband and her son. Whole-exome sequencing of the family revealed a de novo nonsense mutation (T168fsX191) in the Transcription Factor 3 (TCF3) gene encoding the E2A transcription factors, present only in the proband and her son. We demonstrate mutations of TNFRSF13B/TACI impair immunoglobulin isotype switching and antibody production predominantly via T-cell-independent signalling, while mutations of TCF3 impair both T-cell-dependent and -independent pathways of B-cell activation and differentiation. We conclude that epistatic interactions between mutations of the TNFRSF13B/TACI and TCF3 signalling networks lead to the severe CVID-like disorder and SLE in the proband.We thank AMRF, A+ Trust, IDFNZ, ASCIA and the Australian National Health and Medical Research Council (NHMRC, Program Grant 1054925, Project Grant 1127198 and Independent Research Institutes Infrastructure Support Scheme Grant 361646) for grant support. We also received support from Bloody Long Way (BLW) the Victorian State Government Operational Infrastructure scheme and Walter and Eliza Hall Institute (WEHI) Innovation Grant. CAS is supported by NHMRC postgraduate scholarship 1075666

Stigmatization in teachers towards adults with attention deficit hyperactivity disorder

OBJECTIVES: Attention deficit hyperactivity disorder (ADHD) is understood as a developmental disorder which shares common characteristics between childhood, adolescence and adulthood. However, ADHD is widely associated with misconceptions and misbeliefs which can lead to stigmatization. Teachers have an important role for the individual development as they accompany students for a long period of time. The aim of the present study was to explore stigmatizing attitudes in teachers towards adults with ADHD, thereby focusing on the developmental trajectory of the condition. Furthermore, it was aimed to identify factors contributing to prevention and intervention of stigmatization in ADHD. METHODS: Stigma responses of 170 teachers and 170 comparison participants were measured and compared with a recently developed tool for the assessment of stigmatization towards adults with ADHD. Furthermore, the contribution of knowledge about ADHD and the frequency of contact with adults with ADHD to stigmatization were explored. RESULTS: Teachers showed significantly less stigmatizing attitudes than comparison participants in various dimensions, including Reliability and Social Functioning, Malingering and Misuse of Medication and the total scale. With regard to teachers, frequency of contact with adults with ADHD was not related to stigma. However, knowledge about the disorder was negatively correlated with stigma in teachers, indicating lower expressed stigma with increasing knowledge about adult ADHD. CONCLUSIONS: Teachers demonstrated more sensitized attitudes towards stigma in adults with ADHD than comparison participants. Since the present results indicate that knowledge about ADHD increase the sensitivity towards the disorder, special education programs for the community may have the potential to reduce stigmatization towards adults with ADHD. Possibilities for intervention strategies of stigmatization in educational settings were discussed