What went wrong? The flawed concept of cerebrospinal venous insufficiency

In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency ('CCSVI'). The diagnosis of 'CCSVI' is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of 'CCSVI' could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the 'CCSVI' concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the 'CCSVI' concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat 'CCSVI' in the care of MS patients, outside of the setting of scientific research

Atomic Transport in Dense, Multi-Component Metallic Liquids

Pd43Ni10Cu27P0 has been investigated in its equilibrium liquid state with incoherent, inelastic neutron scattering. As compared to simple liquids, liquid PdNiCuP is characterized by a dense packing with a packing fraction above 0.5. The intermediate scattering function exhibits a fast relaxation process that precedes structural relaxation. Structural relaxation obeys a time-temperature superposition that extends over a temperature range of 540K. The mode-coupling theory of the liquid to glass transition (MCT) gives a consistent description of the dynamics which governs the mass transport in liquid PdNiCuP alloys. MCT scaling laws extrapolate to a critical temperature Tc at about 20% below the liquidus temperature. Diffusivities derived from the mean relaxation times compare well with Co diffusivities from recent tracer diffusion measurements and diffsuivities calculated from viscosity via the Stokes-Einstein relation. In contrast to simple metallic liquids, the atomic transport in dense, liquid PdNiCuP is characterized by a drastical slowing down of dynamics on cooling, a q^{-2} dependence of the mean relaxation times at intermediate q and a vanishing isotope effect as a result of a highly collective transport mechanism. At temperatures as high as 2Tc diffusion in liquid PdNiCuP is as fast as in simple liquids at the melting point. However, the difference in the underlying atomic transport mechanism indicates that the diffusion mechanism in liquids is not controlled by the value of the diffusivity but rather by that of the packing fraction

Mechanisms, functions and ecology of colour vision in the honeybee.

notes: PMCID: PMC4035557types: Journal Article© The Author(s) 2014.This is an open access article that is freely available in ORE or from Springerlink.com. Please cite the published version available at: http://link.springer.com/article/10.1007%2Fs00359-014-0915-1Research in the honeybee has laid the foundations for our understanding of insect colour vision. The trichromatic colour vision of honeybees shares fundamental properties with primate and human colour perception, such as colour constancy, colour opponency, segregation of colour and brightness coding. Laborious efforts to reconstruct the colour vision pathway in the honeybee have provided detailed descriptions of neural connectivity and the properties of photoreceptors and interneurons in the optic lobes of the bee brain. The modelling of colour perception advanced with the establishment of colour discrimination models that were based on experimental data, the Colour-Opponent Coding and Receptor Noise-Limited models, which are important tools for the quantitative assessment of bee colour vision and colour-guided behaviours. Major insights into the visual ecology of bees have been gained combining behavioural experiments and quantitative modelling, and asking how bee vision has influenced the evolution of flower colours and patterns. Recently research has focussed on the discrimination and categorisation of coloured patterns, colourful scenes and various other groupings of coloured stimuli, highlighting the bees' behavioural flexibility. The identification of perceptual mechanisms remains of fundamental importance for the interpretation of their learning strategies and performance in diverse experimental tasks.Biotechnology and Biological Sciences Research Council (BBSRC

Differenzierte Diagnostik und multimodale Therapie neuropathischer Schmerzen

Whereas acute pain acts as a warning sign, neuropathic pain loses this protective attribute and develops a self–sustaining chronic course. Almost 33 % of the general population report chronic pain and at least 3,3 % neuropathic pain, in Germany ≤ 5 million people. The prevalence is higher in women and increases with age. Neuropathic pain is defined as a direct consequence of a lesion or disease affecting the somatosensory system either at peripheral or central level. Spontaneously occurring dysesthesias, particularly burning pain and repetitive stimulus–triggered neuralgias such as classical trigeminal neuralgia are typical clinical features. Neuropathic pain is frequently found in patients with radiculopathy, nerve compression syndrome and polyneuropathy. The complex regional pain syndrome (CRPS) is associated with abnormal sudomotor, vasomotor and trophic findings as well as psychosomatic symptoms. Frequent reasons for neuropathic pain of CNS origin are cerebral ischemia and traumatic injuries of the spinal cord with phantom pain. Clinical examination, including accurate sensory examination and Quantitative sensory testing (QST), is the basis of pain diagnosis and therapy. It is important to distinguish neuropathic pain from other chronic pain syndromes: Multimodal therapy differs from treatment of nociceptive pain (for example, in most cases of arthropathy), when the nervous system is intact. Drugs of choice are antidepressants and antiepileptics with analgesic properties

Dichter, Ärzte und Rebellen – psychosomatische Aspekte ihres Wirkens

Early traces of Psychosomatics in fiction and particularly in drama can be found in pathbreaking texts by Friedrich Schiller, Georg Büchner, and Arthur Schnitzler. These medical doctors pay close attention to the mind-body problem. They transfer their observations into poetry, creating world literature. As sons of doctors, they rebelled against their fathers as well as some of the dominant concepts of medicine and society. Friedrich Schiller. It were the plays about freedom: „Die Räuber“ (1782) „Don Carlos“ (1787) and „Wilhelm Tell“ (1804) which established Friedrich Schiller’s fame; Schiller, son of a surgeon (Wundarzt), studied medicine at the military academy in Stuttgart. Before the successful premiere of „Die Räuber” in Mannheim, the budding regimental doctor has drawn up three academic studies dealing with philosophic, physiologic, and psychosomatic issues. Georg Büchner. The playwriter and private lecturer Georg Büchner can be considered a precursor of Psychosomatics within scientific medicine. His father was a surgeon and the district doctor of Darmstadt. Georg Büchner’s fierce debates about the issue of the Biedermeier-attitude led him to become a revolutionary. His most important plays are „Dantons Tod“ (1835) and „Woyzeck“ (1836). Arthur Schnitzler. Towards the end of the 19th century, the doctor, dramatist, and storyteller Arthur Schnitzler who was the son of a laryngologist in Vienna linked Literature and Psychoanalysis to represent processes of the inner life. These efforts were based on his works about hypnotic and suggestive therapies of functional (psychogenic) disorders. He developed with Lieutenant Gustl (1900) und Fräulein Else (1924) the narrative form of the „internal monologue” for the German language. The article introduces 33 poets, doctors, rebels, for example, Francois de Rabelais and Johann Christian Günther, John Keats and Justinus Kerner, or Alfred Döblin and Rainald Götz. In the 20th century, poets and doctors like Harriet Straub, Charlotte Wolff and Hertha Nathorff, who were engaged in the women’s movement, joined them. These writers have a unique sensorium to perceive what might be significant for them as doctors and poets, what art and medicine are about, and what effects their lives because it affects them. Whichever observations and adventures they transform into literature: it is the medical work that provides experiences about life and pain

Risk of recurrence of cerebral venous and sinus thrombosis during subsequent pregnancy and puerperium

Methods: The authors retrospectively studied the relapse rate of CVST and the incidence of extracerebral venous thrombosis during subsequent pregnancies in 39 women (from 125 patients with CVST) who suffered a CVST at childbearing age. Results: Mean follow up was 10.25 years (range 1 to 20). Twenty two pregnancies and 19 births were observed in 14 women without evidence of either recurrence of CVST or extracerebral venous thrombosis. One pregnancy occurred during oral anticoagulation and was interrupted and two pregnancies ended with spontaneous abortions. Low dose heparin had been given during five pregnancies. Conclusions: The risk of recurrence for CVST during pregnancy seems to be low and these data do not justify a negative advice on pregnancy in women with previous CVST. Further studies are needed to evaluate the need for a prophylactic anticoagulation during pregnancy and puerperium