Laparoscopic partial adrenalectomy for bilateral pheochromocytomas in a boy with von Hippel-Lindau disease

Objectives: In adults, increasing numbers of adrenalectomies for pheochromocytomas are performed laparoscopically. We report for the first time laparoscopic bilateral subtotal adrenalectomy for pheochromocytomas in an 8-year-old boy with von Hippel-Lindau disease. Methods, In July 1998, an 8-year-old boy with von Hippel-Lindau disease underwent laparoscopic adrenal-sparing surgery for bilateral pheochromocytomas. The boy presented with severe hypertension and two pheochromocytomas on both sides. Results: The child could be solely treated with laparoscopic adrenal-sparing surgery. The procedure was completed as planned. There were absolutely no intraoperative or postoperative complications. Postoperatively, catecholamine levels and hypertension went back to normal. At follow-up no residual tumor could be detected and no steroid replacement therapy was necessary. Conclusions: In experienced hands, laparoscopic adrenal-sparing surgery for pheochromocytomas is feasible and safe. Moreover, this minimal invasive approach represents an exceptional improvement in life quality, especially in children with von Hippel-Lindau disease since surgery will probably be necessary again and again in their future life. Copyright (C) 2000 S. Karger AG, Basel

Cryo-printed microfluidics enable rapid prototyping for optical-cell analysis

This paper highlights an innovative, low-cost rapid-prototyping method for generating microfluidic chips with extraordinary short fabrication times of only a few minutes. Microchannels and inlet/outlet ports are created by controlled deposition of aqueous microdroplets on a cooled surface resulting in printed ice microstructures, which are in turn coated with a UV-curable acrylic cover layer. Thawing leaves an inverse imprint as a microchannel structure. For an exemplary case, we applied this technology for creating a microfluidic chip for cell-customized optical-cell analysis. The chip design includes containers for cell cultivation and analysis. Container shape, length, position, and angle relative to the main channel were iteratively optimized to cultivate and analyze different cell types. With the chip, we performed physiological analyses of morphologically distinct prokaryotic Corynebacterium glutamicum DM1919, eukaryotic Hansenula polymorpha RB11 MOX-GFP, and phototrophic Synechocystis sp. PCC 6803 cells via quantitative time-lapse fluorescence microscopy. The technology is not limited to rapid prototyping of complex biocompatible microfluidics. Further exploration may include printing with different materials other than water, printing on other substrates in-situ biofunctionalization, the inclusion of electrodes and many other applications

Age-related efficiency loss of household refrigeration appliances: Development of an approach to measure the degradation of insulation properties

Despite the omnipresence of household refrigeration appliances, there is still a lack of knowledge about their age-related efficiency loss over time. Past studies provide basic evidence for increasing electricity consumption of cooling appliances with ageing but fail to investigate the associated technical wear. Concentrating on the degradation of the thermal insulation, we first determined the ageing process of sealed samples of polyurethane rigid foam by investigating changes in cell gas composition and thermal conductivity over time. Simultaneously, the main challenge was to develop an approach that investigates the age-related efficiency loss of the insulation without its destruction. This testing procedure is referred to as the Bonn method. The non-destructive Bonn method was applied to varying refrigerator models in a series of successive experiments to evaluate the insulation degradation over time. Subsequently, the physical relationship between the test value of the Bonn method and the heat transfer through the multi-layered compartment walls of domestic refrigeration appliances was established, ultimately characterising the degrading insulation in terms of increasing heat transfer. Our results give substantiated evidence that the efficiency loss of cooling appliances is greatly influenced by insulation degradation over time. The ageing of sealed samples of polyurethane rigid foam indicates a large initial increase of thermal conductivity by 15% within the first year, corresponding to a change in cell gas composition. These results are in line with those of the Bonn method, emphasising an increasing heat flow through the multi-layered compartment walls of domestic refrigerators with ageing. Therewith, the present study is of significance to a wide range of stakeholders and forms the basis for future research.BMWi, 03ET1544, ALGE: Alterungsmechanismen von Haushaltskältegeräte

Centralized modeling of the communication space for spectral awareness in cognitive radio networks

The communication space is five dimensional: its degrees of freedom are frequency, time and space. The use of the electromagnetic spectrum depends on these parameters. With future applications such as opportunistic overlay access or distributed spectrum monitoring in mind, it is important to estimate the state of the communication space on the basis of incomplete or imprecise information. A promising approach are technology centric Cognitive Radio networks. In these networks, nodes cooperate to infer information on spectral occupancy. This conceptual paper proposes a novel approach for centralized modeling of the communication space with emphasis on spatial dependencies through the use of a regression model. The modeling approach is verified with practical measurements

Quarterly vs. yearly clinical follow-up of remotely monitored recipients of prophylactic implantable cardioverter-defibrillators: results of the REFORM trial

Aims The rapidly increasing number of patients with implantable cardioverter-defibrillators (ICD) places a large burden on follow-up providers. This study investigated the possibility of longer in-office follow-up intervals in primary prevention ICD patients under remote monitoring with automatic daily data transmissions from the implant memory. Methods and results Conducted in 155 ICD recipients with MADIT II indications, the study compared the burden of scheduled and unscheduled ICD follow-up visits, quality of life (SF-36), and clinical outcomes in patients randomized to either 3- or 12-month follow-up intervals in the period between 3 and 27 months after implantation. Remote monitoring (Biotronik Home Monitoring) was used equally in all patients. In contrast to previous clinical studies, no calendar-based remote data checks were performed between scheduled in-office visits. Compared with the 3-month follow-up interval, the 12-month interval resulted in a minor increase in the number of unscheduled follow-ups (0.64 vs. 0.27 per patient-year; P = 0.03) and in a major reduction in the total number of in-office ICD follow-ups (1.60 vs. 3.85 per patient-year; P < 0.001). No significant difference was found in mortality, hospitalization rate, or hospitalization length during the 2-year observation period, but more patients were lost to follow-up in the 12-month group (10 vs. 3; P = 0.04). The SF-36 scores favoured the 12-month intervals in the domains ‘social functioning' and ‘mental health'. Conclusion In prophylactic ICD recipients under automatic daily remote monitoring, the extension of the 3-month in-office follow-up interval to 12 months appeared to safely reduce the ICD follow-up burden during 27 months after implantation. ClinicalTrials.gov Identifier NCT00401466 (http://www.clinicaltrials.gov/ct2/show/NCT00401466

Enhanced removal and toxicity decline of diclofenac by combining UVA treatment and adsorption of photoproducts to polyvinylidene difluoride

The occurrence of micropollutants in the environment is an emerging issue. Diclofenac, a non-steroidal anti-inflammatory drug, is one of the most frequently detected pharmaceuticals in the environment worldwide. Diclofenac is transformed by UVA light into different products with higher toxicity. The absorbance of the transformation products overlaps with the absorbance of diclofenac itself and inhibits the ongoing photoreaction. By adding polyvinylidene difluoride (PVDF), the products adsorb to the surface of PVDF. Therefore, phototransformation of diclofenac and total organic carbon (TOC) removal is enhanced and the toxicity decreased. At 15 min and 18 h of UVA treatment, removal of diclofenac and TOC increases from 56% to 65% and 18% to 54%, respectively, when PVDF is present. The toxicity of a UVA treated (18 h) diclofenac solution doubles (from 5 to 10, expressed in toxicity units, TU), while no toxicity was detectable when PVDF is present during UVA treatment (TU = 0). PVDF does not need to be irradiated itself but must be present during photoreaction. The adsorbent can be reused by washing with water or ethanol. Diclofenac (25 mg L−1) UVA light irradiation was monitored with high performance liquid chromatography (HPLC), UV-Vis spectroscopy and by analysing the decrease of TOC. The toxicity towards Vibrio fischeri was examined according to DIN EN ISO 11348-1: 2009-05. Density functional theory (DFT) was used to simulate the phototransformation products known in literature as well as further products identified via gas chromatography–mass spectrometry (GC-MS). The absorption spectra, reaction enthalpies (ΔH) and Gibbs free energy of reactions (ΔG) were calculated. The combination of UVA irradiation of diclofenac with adsorption of photoproducts to PVDF is unique and opens up new possibilities to enhance removal of pollutants from water

Error-related activity of the sensorimotor network contributes to the prediction of response to cognitive-behavioral therapy in obsessive–compulsive disorder

Background Although cognitive behavioral therapy is a highly effective treatment for obsessive–compulsive disorder (OCD), yielding large symptom reductions on the group level, individual treatment response varies considerably. Identification of treatment response predictors may provide important information for maximizing individual treatment response and thus achieving efficient treatment resource allocation. Here, we investigated the predictive value of previously identified biomarkers of OCD, namely the error-related activity of the supplementary motor area (SMA) and the sensorimotor network (SMN, postcentral gyrus/precuneus). Methods Seventy-two participants with a primary diagnosis of OCD underwent functional magnetic resonance imaging (fMRI) scanning while performing a flanker task prior to receiving routine-care CBT. Results Error-related BOLD response of the SMN significantly contributed to the prediction of treatment response beyond the variance accounted for by clinical and sociodemographic variables. Stronger error-related SMN activity at baseline was associated with a higher likelihood of treatment response. Conclusions The present results illustrate that the inclusion of error-related SMN activity can significantly increase treatment response prediction quality in OCD. Stronger error-related activity of the SMN may reflect the ability to activate symptom-relevant processing networks and may thus facilitate response to exposure-based CBT interventions

Itching in patients with chronic hand eczema: Data from the CARPE registry

BACKGROUND Itching is a leading symptom of chronic hand eczema (CHE) having a great impact on patients. The determinants of itching in CHE are unclear. OBJECTIVE We performed a cross-sectional analysis investigating factors associated with the presence and severity of itch in CHE patients from the CARPE registry. METHODS We present baseline data on itch in relationship with sociodemographic factors, severity of CHE, atopy, contact allergy, treatment and patient- reported outcomes including health-related quality of life (HRQoL). RESULTS Of 1,051 patients with CHE, 78.1% reported itching. Significant positive associations with itching were observed for younger age groups (17-25 and 26-45 years), for moderate, severe and very severe CHE and for small/moderate impairment in HRQoL. Atopic skin diathesis, hardly being able to realize treatment recommendations and very or extremely large impairments in HRQoL were associated with itch severity. CONCLUSION Taking the identified variables into account may help identify vulnerable groups most affected by (severe) itch

Heart rate and heart rate variability in obsessive-compulsive disorder: Evidence from patients and unaffected first-degree relatives

Altered heart rate (HR) and heart rate variability (HRV) are common observations in psychiatric disorders. Yet, few studies have examined these cardiac measures in obsessive-compulsive disorder (OCD). The current study aimed to investigate HR and HRV, indexed by the root mean square of successive differences (RMSSD) and further time domain indices, as putative biological characteristics of OCD. Electrocardiogram was recorded during a five-minute resting state. Group differences between patients with OCD (n = 96), healthy participants (n = 112), and unaffected first-degree relatives of patients with OCD (n = 47) were analyzed. As potential moderators of group differences, we examined the influence of age and medication, respectively. As results indicated, patients with OCD showed higher HR and lower HRV compared to healthy participants. These group differences were not moderated by age. Importantly, subgroup analyses showed that only medicated patients displayed lower HRV compared to healthy individuals, while HR alterations were evident in unmedicated patients. Regarding unaffected first-degree relatives, group differences in HRV remained at trend level. Further, an age-moderated group differentiation showed that higher HRV distinguished relatives from healthy individuals in young adulthood, whereas at higher age lower HRV was indicative of relatives. Both the role of familial risk and medication in HRV alterations need further elucidation. Pending future studies, alterations in HR and potentially HRV might serve as useful indices to characterize the pathophysiology of OCD

Induction of a hardening phenomenon by repeated application of SLS: analysis of lipid changes in the stratum corneum

Adaptation of the skin to repeated influence of exogenous irritants is called the hardening phenomenon. We investigated the stratum corneum lipid composition before and after induction of a hardening phenomenon. Irritant contact dermatitis was induced in 23 non-atopic volunteers by repeated occlusive application of 0.5% sodium lauryl sulfate (SLS) over 3 weeks. At 3, 6 and 9 weeks after irritation, the SLS responses of pre-irritated skin and normal skin were compared. The horny layer lipid composition (ceramides 1–7, cholesterol and free fatty acids) was assessed before irritation and 3, 6 and 9 weeks after irritation. During the first 2 weeks of irritation the transepidermal water loss increased continuously and seemed to decrease during the third week (effect of adaptation). The barrier function of pre-irritated sites was more stable to SLS challenge. Three weeks after irritation, there was a significant increase of ceramide 1 (pv0. 001). The only volunteer without hardening phenomenon showed no increase of ceramide 1. Ceramide 1 seems to play a key role as a protection mechanism against repeated irritation. Key words: hardening phenomenon; irritant contact dermatitis; stratum corneum lipids; ceramides; transepidermal water loss