Anteriore zervikale Diskektomie und Fusion. Eine Langzeituntersuchung von bis zu 45 Jahren an der Neurochirurgischen Klinik des Universitätsklinikums des Saarlandes

1.1 Abstract Objectives: Anterior cervical discectomy and fusion (ACDF) with an autologous iliac crest is an accepted and safe surgical procedure for treatment of degenerative cervical disc disease. Studies with a follow-up of more than 20 years are rare. The aim of this study was the evaluation of the long-term clinical outcome after ACDF with an autologous iliac crest with and without plate stabilization. Special focus was given to pain, functional outcome and repeat procedure for symptomatic adjacent segment disease (ASD). Methods: Hospital records were used to obtain information about diagnosis, surgery and postoperative process. Inclusion criteria were patients who underwent surgery for degenerative cervical disc disease with detailed documentation of the preoperative neurological status, of the procedure, of the postoperative process during hospitalization, of the postoperative neurological status at hospital discharge and of full contact detail information. Patients were reviewed with a standardized questionnaire including the current neurological status, neck disability index (NDI), EuroQol-5 dimensions (EQ-5D), patient satisfaction index (PSI), hospital anxiety and depression score (HADS), Odom`s criteria, complications at the iliac crest donor side and limitations in quality of life. Results: A total of 366 patients fulfilled inclusion criteria. Among those 160 patients participated at the study. One-hundred-six (66.3%) out of 160 patients attended a personal optional follow-up at our institution. The mean follow-up time was 25 years and mean age at the initial surgery was 43 years. Sixty-five (40.6%) out of 160 patients had ACDF with plate stabilization (ACDF+PS). Preoperative, 152 (95.0%) patients had neck and/or arm pain with an intensity of 8 on the numeric pain rating scale (NPRS). Postoperative, 118 (73.8%) patients reported a decrease of neck and/or arm pain with a mean of 2 on the NPRS and remained pain free without second surgery. Thirteen (8.1%) out of 160 patients had repeat procedure due to symptomatic ASD. The mean time period with donor side pain was 2 month, and the mean postoperative donor site pain was 2 on the NPRS. The mean NDI was 7 and mean score for EQ-5D was 6. According to Odom`s criteria 85.0% of patients report excellent and good functional recovery, 98.0% of patients were very satisfied or satisfied after procedure. All 160 (100.0%) patients would decide to undergo surgery as therapy again. Conclusion: ACDF with an autologous iliac crest is a safe procedure that yields good clinical results. ACDF and ACDF+PS yield significant a decrease in neck and arm pain, an improvement in functional outcome and excellent patient satisfaction. Overall prevalence for symptomatic ASD is 8.1%. ACDF+PS had a lower rate of repeat procedures due to symptomatic ASD in a long-term follow-up (ACDF: 11.6% versus ACDF+PS: 3.1%).1.2 Zusammenfassung Hintergrund: Die anteriore zervikale Diskektomie und Fusion (ACDF) mit einem autologen Beckenkammspan ist ein anerkanntes Verfahren in der Therapie des degenerativen zervikalen Bandscheibenleidens. Studien mit einem Beobachtungszeitraum von mehr als 20 Jahren sind selten. Das Ziel dieser Untersuchung ist die Bewertung der langfristigen klinischen Ergebnisse nach ACDF mit autologem Beckenkammspan mit und ohne Casparplatte (CP) mit besonderem Fokus auf die neurologische Erholung, Schmerzen und symptomatische Anschlussdegeneration. Methoden: Krankenhausakten von Patienten mit degenerativen Erkrankungen der Halswirbelsäule wurden nach Informationen zur Diagnose, zur Operationstechnik und zum postoperativen Verlauf rezensiert. Einschlusskriterien waren Patienten mit einer Operation aufgrund einer degenerativen Erkrankung der Halswirbelsäule (HWS), Dokumentation über den präoperativen neurologischen Status, ein ausführlicher Operationsbericht, Informationen über den postoperativen Verlauf während des Krankenhausaufenthalts, ein neurologische Status zum Entlassungszeitpunkt und vollständige Kontaktdaten. Alle partizipierenden Patienten wurden mit einem standardisierten Fragebogen befragt, welcher neben den Fragen zum aktuellen neurologischen Status auch den neck disability index (NDI), die Euroqol-5 dimensions (EQ-5D), den patient satisfaction index (PSI), den hospital anxiety and depression score (HADS), die Odom`s Kriterien, Fragen zu Komplikationen an der Beckenkammspanentnahmestelle und zu Einschränkungen der Lebensqualität enthielt. Ergebnisse: 366 Patienten erfüllten die Einschlusskriterien. Von diesen Patienten nahmen 160 an der Untersuchung teil. 106 (66.3%) der 160 Patienten stellten sich zu einer persönlichen Nachuntersuchung in unserer Klinik vor. Die mittlere Nachbeobachtungszeit betrug 25 Jahre und das Durchschnittsalter bei der ersten Operation war 43 Jahre. 65 (40.6%) von 160 Patienten hatten eine ACDF mit Stabilisierung durch eine CP (ACDF+CP). Präoperativ hatten 152 (95.0%) Patienten Nacken- und/oder Armschmerzen mit einem mittleren Wert von 8 auf der NPRS. Postoperativ berichteten 118 (73.8%) Patienten von einer Abnahme der Nacken- und/oder Armschmerzen mit einem mittleren Wert von 2 auf der NPRS und blieben schmerzfrei und ohne zweite Operation. Dreizehn (8.1%) der 160 Patienten benötigten eine weitere Operation in einem angrenzenden Segment. Die mittlere Zeitdauer der Schmerzen an der Spanentnahmestelle war zwei Monate und der mittlere Wert auf der NPRS aufgrund von Schmerzen am Beckenkamm war 2. Der mittlere NDI war 7, und der mittlere Wert beim EQ-5D Fragebogen war 6 Punkte. Entsprechend der Odom`s Kriterien haben 85.0% der Patienten eine exzellente oder gute funktionelle Erholung, 98.0% der Patienten waren sehr zufrieden oder zufrieden nach der Operation. Alle 160 (100.0%) Patienten würden sich wieder einer operativen Therapie unterziehen. Schlussfolgerung: Die ACDF mit einem autologen Beckenkammspan ist ein sicheres Verfahren, das gute klinische Ergebnisse liefert. ACDF und ACDF+CP führt zu einem signifikanten Rückgang von Nacken- und Armschmerzen, zu einer Steigerung der Funktion und zu hervorragenden Ergebnissen der Patientenzufriedenheit. Die Rate der Operationen aufgrund einer symptomatischen Anschlussdegeneration liegt bei 8.1%. Die ACDF+CP führt in einem langfristigen Nachbeobachtungszeitraum zu weniger Operationen aufgrund von symptomatischer Anschlussdegeneration (ACDF: 11.6%, ACDF+CP: 3.1%)

Stem rot and wilt on Euonymus

Im August 2008 trat an Euonymus japonica eine Stammfäule mit Welke unbekannter Ursache auf. Aus der Triebbasis wurde ein Pilz der Gattung Calonectria (Anamorphe: Cylindrocladium) isoliert (Isolat JKI 2140). Das Isolat wies morphologisch große Ähnlichkeit mit Ca. colhounii, Ca. fujianensis sowie Ca. pseudocolhounii auf, allerdings waren die Konidien im Durchschnitt größer als für diese drei Arten beschrieben. Die Sequenzanalysen ergaben hohe Übereinstimmungen mit Ca. colhounii, Ca. eucalypti, Ca. fujianensis und Ca. pseudocolhounii. Der taxonomische Status des Pilzisolates aus E. japonica ist noch nicht eindeutig geklärt. Es gehört zum Arten­komplex Ca. colhounii, eine sichere Zuordnung zu oder Abtrennung von einer der bekannten Arten aus diesem Komplex lässt sich aber anhand eines einzigen Isolates nicht treffen. Der Pilz wird vorläufig als Calonectria colhounii compl. bezeichnet.Die Pathogenität des Pilzes wurde an E. japonica und an E. fortunei geprüft. Die ursprünglich an E. japonica beobachteten Symptome ließen sich reproduzieren, der Pilz reisolieren. Die Pathogenität von Isolat JKI 2140 an beiden Euonymus-Arten ist damit nachgewiesen. Seit dem Erstauftreten dieses Pilzes gab es keine weiteren Meldungen über eine Stammgrundfäule mit Welkeerscheinungen an Euonymus in Deutschland. Die Bedeutung dieses Erregers an Euonymus ist deshalb als gering einzustufen. DOI: 10.5073/JfK.2015.10.01, https://doi.org/10.5073/JfK.2015.10.01In August 2008, stem rot and wilt symptoms of unknown origin were observed on Euonymus japonica. From the symptomatic stem base a fungus belonging to the genus Calonectria (anamorph: Cylindrocladium) was isolated (isolate JKI 2140). The isolate was morphologically very similar to Calonectria colhounii as well as to Ca. fujianensis and Ca. pseudocolhounii, except for the larger conidia. Sequence analysis of genes (ITS, BT, TEF-1α, HIS3) showed high similarity to Ca. colhounii, Ca. eucalypti, Ca. fujianensis and Ca. pseudocolhounii. The taxonomic status of the fungal isolate from E. japonica is not yet clear. It belongs to the complex Ca. colhounii but a definitive allocation to or separation from a known Calonectria species is not possible on the basis of a single isolate. The fungus is provisionally named Calonectria colhounii compl.The pathogenicity of the fungus was tested on E. japonica and E. fortunei. The disease symptoms originally observed on field plants of E. japonica were reproduced and the fungus was re-isolated. Thus the pathogenicity of isolate JKI 2140 on both Euonymus species is proved. Since the first occurrence of this infestation there were no further notifications of stem canker and wilt on Euonymus spp. in Germany. Therefore the importance of this pathogen on Euonymus is considered to be low. DOI: 10.5073/JfK.2015.10.01, https://doi.org/10.5073/JfK.2015.10.0

Screening of Impatiens walleriana cultivars for susceptibility to Plasmopara obducens

Befall mit dem Falschen Mehltaupilz Plasmopara obducens stellt ein zunehmendes Problem an Impatiens walleriana dar. Trotz Einsatzes von Fungiziden in der Produktion nahmen die Ausfälle im Freiland in den letzten Jahren deutlich zu. Der Anbau widerstandsfähiger Sorten wäre eine gute Lösung. In Klimakammerversuchen wurden I. wal­leriana-Sämlinge auf ihre Anfälligkeit für P. obducens getestet. Sie wurden mit einer Sporangiensuspension inokuliert, nach zwei Wochen erfolgte die Auswertung. Der Anteil an Pflanzen mit Sporangienbildung wurde ermittelt. 52 Sorten aus neun Serien des aktuellen I. walleriana-Sortiments wurden getestet. In zwei Versuchswiederholungen erwiesen sich alle geprüften Sorten als hoch anfällig für P. obducens.    The infestation of Impatiens walleriana with the downy mildew fungus Plasmopara obducens has become a serious problem. Inspite of fungicide use during production, losses in the field increased significantly during the last years. The growing of resistant cultivars would be a good solution to face this problem. Seedlings of I. walleriana were tested for their susceptibility to P. obducens in growth chambers. They were inoculated with a sporangia suspension and assessed for infestation two weeks later. The percentage of plants which showed development of sporangia was determined. 52 cultivars out of nine series of the current I. walleriana assortment were tested. In two replicates all cultivars proved to be highly susceptible to P. obducens.   &nbsp

Impact of cannabis use on brain metabolism using 31P and 1H magnetic resonance spectroscopy

Purpose This prospective cross-sectional study investigated the infuence of regular cannabis use on brain metabolism in young cannabis users by using combined proton and phosphorus magnetic resonance spectroscopy. Methods The study was performed in 45 young cannabis users aged 18–30, who had been using cannabis on a regular basis over a period of at least 2 years and in 47 age-matched controls. We acquired 31P MRS data in diferent brain regions at 3T with a double-resonant 1H/31P head coil, anatomic images, and 1H MRS data with a standard 20-channel 1H head coil. Absolute concentration values of proton metabolites were obtained via calibration from tissue water as an internal reference, whereas a standard solution of 75 mmol/l KH2PO4 was used as an external reference for the calibration of phosphorus signals. Results We found an overall but not statistically signifcant lower concentration level of several proton and phosphorus metabolites in cannabis users compared to non-users. In particular, energy-related phosphates such as adenosine triphosphate (ATP) and inorganic phosphate (Pi) were reduced in all regions under investigation. Phosphocreatine (PCr) showed lowered values mainly in the left basal ganglia and the left frontal white matter. Conclusion The results suggest that the increased risk of functional brain disorders observed in long-term cannabis users could be caused by an impairment of the energy metabolism of the brain, but this needs to be verifed in future studies

Cylindrocladiella parva as a causal agent of dieback on Euonymus fortunei

Im August 2011 traten an Euonymus fortunei Absterbe­erscheinungen unbekannter Ursache auf. Aus befallenen Trieben wurde ein Cylindrocladium-ähnlicher Pilz isoliert. Anhand seiner morphologischen Merkmale wurde der Pilz als Cylindrocladiella parva (P.J. Anderson) Boesewinkel identifiziert. Eine anschließende Sequenzanalyse der ITS-Region sowie des β-Tubulin-Gens bestätigte das Ergebnis. Die Pathogenität des Pilzes an E. fortunei 'Emerald’n Gold' wurde in mehreren Versuchsansätzen geprüft. Nach Inokulation an den Nodien nach leichter Verletzung entwickelten sich bei hoher Luftfeuchte innerhalb von sieben Wochen an zweijährigen Pflanzen deut­liche Krankheitssymptome. Cylindrocladiella parva ließ sich aus befallenen Trieben reisolieren. Die Pathogenität dieses Erregers an E. fortunei ist damit nachgewiesen. Es ist das erste bekannt gewordene Auftreten von Cylindro­cladiella parva an E. fortunei in Deutschland. DOI: 10.5073/JfK.2014.01.01, https://doi.org/10.5073/JfK.2014.01.01In August 2011 a shoot dieback of unknown cause was observed on Euonymus fortunei. From the affected shoots a fungus similar to Cylindrocladium was isolated. According to its morphological characteristics this fungus could be identified as Cylindrocladiella parva (P.J. Anderson) Boesewinkel. The subsequent sequence analysis of the ITS regions as well as the β-tubulin-gene confirmed this result. Pathogenicity of this fungus was tested in several trials on E. fortunei 'Emerald’n Gold'. After inoculation of wounded nodes with the fungus and incubation with high humidity two year old plants developed disease symptoms within seven weeks. Cylindrocladiella parva could be reisolated from infected shoots. This is the first occurrence of Cylindrocladiella parva on E. fortunei in Germany according to our knowledge. DOI: 10.5073/JfK.2014.01.01, https://doi.org/10.5073/JfK.2014.01.0

Age-dependent effects of low-dose nicotine treatment on cocaine-induced behavioral plasticity in rats

Epidemiological evidence of early adolescent tobacco use, prior to that of marijuana and other illicit drugs, has led to the hypothesis that nicotine is a “gateway” drug that sensitizes reward pathways to the addictive effects of other psychostimulants. To test this hypothesis, we have compared the effect of a brief, low-dose nicotine pretreatment of adolescent and adult rats on subsequent locomotor response to acute and chronic cocaine. Adolescents, aged postnatal day (P) 28, and adults, aged P86, were given four daily injections of saline or nicotine (0.06 mg/kg, i.v.). At P32 and P90, rats were given acute injections of cocaine (0, 0.4 or 1.0 mg/kg, i.v.) and monitored for locomotor activity in either a habituated or novel test environment. To examine cocaine sensitization, rats were treated for 3 days with saline or cocaine (0.4 mg/kg, i.v.), and, after 1 day of withdrawal, were given a challenge dose of cocaine (0.4 mg/kg, i.v.). Nicotine pretreatment did not affect acute, drug-induced locomotor activity at either age. However, age differences in cocaine response were observed, with adolescent animals showing enhanced locomotor activity in the novel environment. Adolescent controls did not exhibit cocaine-induced locomotor sensitization, whereas adults did. Nicotine pretreatment during adolescence promoted the development and expression of a sensitized response to repeated cocaine exposure similar to that observed in saline-pretreated adult controls. These findings show that brief pretreatment with nicotine, in a low dose comparable to that inhaled in 2–4 cigarettes, enhances cocaine-induced behavioral plasticity in adolescent rats

Localization of Mineralocorticoid Receptors at Mammalian Synapses

In the brain, membrane associated nongenomic steroid receptors can induce fast-acting responses to ion conductance and second messenger systems of neurons. Emerging data suggest that membrane associated glucocorticoid and mineralocorticoid receptors may directly regulate synaptic excitability during times of stress when adrenal hormones are elevated. As the key neuron signaling interface, the synapse is involved in learning and memory, including traumatic memories during times of stress. The lateral amygdala is a key site for synaptic plasticity underlying conditioned fear, which can both trigger and be coincident with the stress response. A large body of electrophysiological data shows rapid regulation of neuronal excitability by steroid hormone receptors. Despite the importance of these receptors, to date, only the glucocorticoid receptor has been anatomically localized to the membrane. We investigated the subcellular sites of mineralocorticoid receptors in the lateral amygdala of the Sprague-Dawley rat. Immunoblot analysis revealed the presence of mineralocorticoid receptors in the amygdala. Using electron microscopy, we found mineralocorticoid receptors expressed at both nuclear including: glutamatergic and GABAergic neurons and extra nuclear sites including: presynaptic terminals, neuronal dendrites, and dendritic spines. Importantly we also observed mineralocorticoid receptors at postsynaptic membrane densities of excitatory synapses. These data provide direct anatomical evidence supporting the concept that, at some synapses, synaptic transmission is regulated by mineralocorticoid receptors. Thus part of the stress signaling response in the brain is a direct modulation of the synapse itself by adrenal steroids

Consensus Paper: Cerebellum and Social Cognition.

The traditional view on the cerebellum is that it controls motor behavior. Although recent work has revealed that the cerebellum supports also nonmotor functions such as cognition and affect, only during the last 5 years it has become evident that the cerebellum also plays an important social role. This role is evident in social cognition based on interpreting goal-directed actions through the movements of individuals (social "mirroring") which is very close to its original role in motor learning, as well as in social understanding of other individuals' mental state, such as their intentions, beliefs, past behaviors, future aspirations, and personality traits (social "mentalizing"). Most of this mentalizing role is supported by the posterior cerebellum (e.g., Crus I and II). The most dominant hypothesis is that the cerebellum assists in learning and understanding social action sequences, and so facilitates social cognition by supporting optimal predictions about imminent or future social interaction and cooperation. This consensus paper brings together experts from different fields to discuss recent efforts in understanding the role of the cerebellum in social cognition, and the understanding of social behaviors and mental states by others, its effect on clinical impairments such as cerebellar ataxia and autism spectrum disorder, and how the cerebellum can become a potential target for noninvasive brain stimulation as a therapeutic intervention. We report on the most recent empirical findings and techniques for understanding and manipulating cerebellar circuits in humans. Cerebellar circuitry appears now as a key structure to elucidate social interactions