Neurotoxische Enzephalopathie unter Neuroleptika und Lithium

Zusammenfassung: Überlappende neuroleptische Medikationen sind in psychiatrischen Behandlungen gelegentlich unumgänglich. Wir berichten über eine unter schizoaffektiver Störung leidende 60-jährige Frau, welche vorübergehend 3 Neuroleptika und Lithium erhielt. Hierunter entwickelte sie eine neurotoxische Enzephalopathie mit Symptomen eines malignen neuroleptischen Syndroms. Gegenwärtig ist unklar, ob irreversible Hirnschäden zurückbleiben werden. Wir empfehlen engmaschige EEG-Kontrollen zur Früherkennung von Neurotoxizitä

Advances in the genetics of endometriosis

Endometriosis is a gynecological disease characterized by implantation of endometrial tissue outside of the uterus. Early familial aggregation and twin studies noted a higher risk of endometriosis among relatives. Studies on the roles of the environment, genetics and aberrant regulation in the endometrium and endometriotic lesions of women with endometriosis suggest that endometriosis arises from the interplay between genetic variants and environmental factors. Elucidating the hereditary component has proven difficult because multiple genes seem to produce a susceptibility to developing endometriosis. Molecular techniques, including linkage and genome-wide analysis, have identified candidate genes located near known loci related to development and regulation of the female reproductive tract. As new candidate genes are discovered and hereditary pathways identified using technologies such as genome-wide analysis, the possibility of prevention and treatment becomes more tangible for millions of women affected by endometriosis. Here, we discuss the advances of genetic research in endometriosis and describe technologies that have contributed to the current understanding of the genetic variability in endometriosis, variability that includes regulatory polymorphisms in key genes

Stabilization of the ζ-Cu10Sn3 Phase by Ni at Soldering-Relevant Temperatures

A current issue in electrical engineering is the enhancement of the quality of solder joints. This is mainly associated with the ongoing electrification of transportation as well as the miniaturization of (power) electronics. For the reliability of solder joints, intermetallic phases in the microstructure of the solder are of great importance. The formation of the intermetallic phases in the Cu-Sn solder system was investigated for different annealing temperatures between 472 K and 623 K using pure Cu as well as Cu-1at.%Ni and Cu-3at.%Ni substrate materials. These are relevant for lead frame materials in electronic components. The Cu and Cu-Ni alloys were in contact to galvanic plated Sn. This work is focused on the unexpected formation of the hexagonal ζ-(Cu,Ni)10Sn3 phase at annealing temperatures of 523–623 K, which is far below the eutectoid decomposition temperature of binary ζ-Cu10Sn3 of about 855 K. By using scanning electron microscopy, energy dispersive X-ray spectroscopy, electron backscatter diffraction and X-ray diffraction the presence of the ζ phase was confirmed and its structural properties were analyzed

Evolution of the ion environment of comet 67P during the Rosetta mission as seen by RPC-ICA

Rosetta has followed comet 67P from low activity at more than 3.6 au heliocentric distance to high activity at perihelion (1.24 au) and then out again. We provide a general overview of the evolution of the dynamic ion environment using data from the RPC-ICA ion spectrometer. We discuss where Rosetta was located within the evolving comet magnetosphere. For the initial observations, the solar wind permeated all of the coma. In 2015 mid-April, the solar wind started to disappear from the observation region, to re-appear again in 2015 December. Low-energy cometary ions were seen at first when Rosetta was about 100 km from the nucleus at 3.6 au, and soon after consistently throughout the mission except during the excursions to farther distances from the comet. The observed flux of low-energy ions was relatively constant due to Rosetta's orbit changing with comet activity. Accelerated cometary ions, moving mainly in the antisunward direction gradually became more common as comet activity increased. These accelerated cometary ions kept being observed also after the solar wind disappeared from the location of Rosetta, with somewhat higher fluxes further away from the nucleus. Around perihelion, when Rosetta was relatively deep within the comet magnetosphere, the fluxes of accelerated cometary ions decreased, as did their maximum energy. The disappearance of more energetic cometary ions at close distance during high activity is suggested to be due to a flow pattern where these ions flow around the obstacle of the denser coma or due to charge exchange losses

Investigating short-time-scale variations in cometary ions around comet 67P

The highly varying plasma environment around comet 67P/Churyumov–Gerasimenko inspired an upgrade of the ion mass spectrometer (Rosetta Plasma Consortium Ion Composition Analyzer) with new operation modes, to enable high time resolution measurements of cometary ions. Two modes were implemented, one having a 4 s time resolution in the energy range 0.3–82 eV/q and the other featuring a 1 s time resolution in the energy range 13–50 eV/q. Comparing measurements made with the two modes, it was concluded that 4 s time resolution is enough to capture most of the fast changes of the cometary ion environment. The 1462 h of observations done with the 4 s mode were divided into hour-long sequences. It is possible to sort 84 per cent of these sequences into one of five categories, depending on their appearance in an energy–time spectrogram. The ion environment is generally highly dynamic, and variations in ion fluxes and energies are seen on time-scales of 10 s to several minutes

Development of a cometosheath at comet 67P/Churuyumov-Gerasimenko: A case study comparison of Rosetta observations

Context: The ionosphere of a comet is known to deflect the solar wind through mass loading, but the interaction is dependent on cometary activity. We investigate the details of this process at comet 67P using the Rosetta Ion Composition Analyzer. Aims: This study aims to compare the interaction of the solar wind and cometary ions during two different time periods in the Rosetta mission. Methods: We compared both the integrated ion moments (density, velocity, and momentum flux) and the velocity distribution functions for two days, four months apart. The velocity distribution functions were projected into a coordinate system dependent on the magnetic field direction and averaged over three hours. Results: The first case shows highly scattered H+ in both ion moments and velocity distribution function. The He2+ ions are somewhat scattered, but less so, and appear more like those of H2O+ pickup ions. The second case shows characteristic evidence of mass-loading, where the solar wind species are deflected, but the velocity distribution function is not significantly changed. Conclusions: The distributions of H+ in the first case, when compared to He2+ and H2O+ pickup ions, are indicative of a narrow cometosheath on the scale of the H+ gyroradius. Thus, He2+ and H2O+, with larger gyroradii, are largely able to pass through this cometosheath. An examination of the momentum flux tensor suggests that all species in the first case have a significant non-gyrotropic momentum flux component that is higher than that of the second mass-loaded case. Mass loading is not a sufficient explanation for the distribution functions and momentum flux tensor in the first case, and so we assume this is evidence of bow shock formation.Comment: 14 pages, 9 figures, 3 tables, 2 video

Non-operatively managed small to medium-sized subscapularis tendon tears: MRI evaluation with a minimum of 5 years follow-up

Background Isolated or combined subscapularis (SSC) tendon tears are frequently found in patients with shoulder pain. The purpose of this study was to evaluate the structural changes associated with SSC tear in a consecutive series of patients with nonoperatively treated small size to midsize SSC tendon tears using magnetic resonance imaging (MRI). Methods In this retrospective case series, all patients with an isolated or combined SSC tendon tear treated nonoperatively between 1999 and 2019 were identified from our MRI and clinical databases. Twenty-one patients with a mean age of 52.6 years (range 26.6-64.8, standard deviation 9.3) with a second MRI scan at a minimum of 5 years of follow-up were enrolled. The mean follow-up was 8.6 years (range 5.6-12.6, standard deviation 1.8). Initial and last follow-up MRI scans were used to determine concomitant cuff lesions, size of the SSC tear, fatty infiltration of the SSC muscle, and biceps pathology. Results Five patients had an isolated SSC lesion; 7 patients had a concomitant tear of the supraspinatus, and 9 patients had a supraspinatus and anterior infraspinatus tendon tear. At diagnosis, 14 patients had a type 1 SSC lesion as classified by Lafosse et al, 4 patients had type 2, and 3 patients had type 3 lesions. Nineteen patients (90%) were found to have an SSC tear progression of at least one Lafosse grade (P < .001); however, no tear had progressed to an irreparable type lesion (defined as Lafosse type 5). In addition, the size of SSC tendon tears increased significantly from 75 mm2 to 228 mm2 (P < .001). At the final MRI scan, the grading of fatty infiltration increased by 1 grade in 4 cases and by 2 grades in 4 cases (P = .042). At the final follow-up, in eight patients, the condition of the long head of biceps tendon was unchanged from the initial MRI; in nine patients, there was a newly subluxated biceps tendon, and in 6 patients, there was a newly ruptured long head of biceps tendon (P < .001). Conclusion After a mean of 8.6 years, almost all nonoperatively treated SSC tendon tears had increased in size, but only one-third showed additional progression of muscle fatty degeneration on MRI scan. None of the SSC lesions became irreparable during the observation period

Economic evaluation of oral versus parenteral iron therapy for iron deficiency without anemia

The Swiss Federal Office of Public Health (SFOPH) commissioned a Health Technology Assessment (HTA) regarding iron therapy in symptomatic patients with iron deficiency without anemia (iron deficiency no anemia, IDNA) to the Basel Institute for Clinical Epidemiology and Biostatistics (CEB) and the Winterthur Institute of Health Economics (WIG). The scope, which describes the background of the HTA and elucidates the general approach, has been published on the SFOPH homepage. This HTA followed a step-wise approach. The aim of the first step was to assess the clinical effectiveness of iron therapy in symptomatic patients with IDNA, and to identify symptomatic populations that benefit from the therapy. In this first step, the clinical effectiveness of iron therapy was assessed in comparison to any other non-iron treatment or placebo, irrespective of the route of iron administration. This step was conducted by CEB, and the results are summarized in chapter 2 of this document. In the second step, which will be conducted by WIG, the economic evaluation shall compare parenteral versus oral iron therapy for those populations, for which a significant treatment effect of iron therapy (parenteral or oral) versus control could be identified during the first step. Based on the effectiveness results, the scope of the economic evaluation is outlined in chapter 4. Section 4.1 defines the objective of the economic evaluation. Section 4.2 defines the population, the intervention, the comparator, and the outcome (PICO) which will be evaluated. A screening of health economic literature and publicly available HTAs for economic studies comparing parenteral with oral iron therapy is presented in section 4.3, and section 4.4 concludes with the outline of the research methodology of the economic evaluation