German-austrian recommendations for HIV1-therapy in pregnancy and in HIV1-exposed newborn - update 2008

German-Austrian recommendations for HIV1-therapy in pregnancy - Update 2008 Bernd Buchholz (University Medical Centre Mannheim, Pediatric Clinic), Matthias Beichert (Mannheim, Gynecology and Obstetrics Practice), Ulrich Marcus (Robert Koch Institute, Berlin), Thomas Grubert, Andrea Gingelmaier (Gynecology Clinic of the Ludwig Maximilians University of Munich), Dr. med. Annette Haberl (HIV-Department, J. W. Goethe-University Hospital, Frankfurt), Dr. med. Brigitte Schmied (Otto-Wagner Spital, Wien)

Supernova remnants and candidates detected in the XMM-Newton M31 large survey

We present the analysis of supernova remnants (SNRs) and candidates in M31 identified in the XMM-Newton large programme survey of M31. SNRs are among the bright X-ray sources in a galaxy. They are good indicators of recent star formation activities of a galaxy and of the interstellar environment in which they evolve. By combining the X-ray data of sources in M31 with optical data as well as with optical and radio catalogues, we aim to compile a complete, revised list of SNRs emitting X-rays in M31 detected with XMM-Newton, study their luminosity and spatial distribution, and understand the X-ray spectrum of the brightest SNRs. We analysed the X-ray spectra of the twelve brightest SNRs and candidates using XMM-Newton data. The four brightest sources allowed us to perform a more detailed spectral analysis and the comparison of different models to describe their spectrum. For all M31 large programme sources we searched for optical counterparts on the Ha, [Sii], and [Oiii] images of the Local Group Galaxy Survey. We confirm 21 X-ray sources as counterparts of known SNRs. In addition, we identify five new X-ray sources as X-ray and optically emitting SNRs. Seventeen sources are no longer considered as SNR candidates. We have thus created a list of 26 X-ray SNRs and 20 candidates in M31 based on their X-ray, optical, and radio emission, which is the most recent complete list of X-ray SNRs in M31. The brightest SNRs have X-ray luminosities of up to 8 x 10^36 erg/s in the 0.35 - 2.0 keV band.Comment: Accepted by AandA. 15 pages. Appendices will be published electronically onl

XMM-Newton timing mode observations of Mrk 421

We present the results of a detailed temporal analysis of the bright BL Lac object Mrk 421 using the three available long timing mode observations by the EPIC PN camera. This detector mode is characterized by its long life time and is largely free of photon pile-up problems. The source was found in different intensity and variability states differing by up to more than a factor of three in count rate. A time resolved cross correlation analysis between the soft and hard energy bands revealed that the characteristics of the correlated emission, with lags of both signs, change on time scales of a few thousand seconds. Individual spectra, resolved on time scales of a few hundread seconds, can be quite well fitted by a broken power law. We find significant spectral variations on time scales as short as 500-1000 sec. Both the hard and the soft band spectral indices show a non-linear correlation with the source flux. A comparison of the observed light curves with numerical results from relativistic hydrodynamic computer simulations of the currently favored shock-in-jet models indicates that any determination of the jet's physical parameters from `simple' emission models must be regarded with caution: at any time we are seeing the emission from several emission regions distinct in space and time, which are connected by the complex hydrodynamic evolution of the non-uniform jet.Comment: 16 pages, 16 figures. Accepted for publication in A&

Motor and functional outcome of selective dorsal rhizotomy in children with spastic diplegia at 12 and 24 months of follow-up

Background: Selective dorsal rhizotomy (SDR) in ambulatory children affected by cerebral palsy (CP) is a surgical treatment option to lower spasticity and thereby improve gait and ambulation. The aim of the current study is to investigate the outcome of children with respect to spasticity, muscle strength, and overall function after SDR. Methods: All children who underwent SDR via a single-level laminotomy in the time period from January 2007 to April 2015 at our center were enrolled in this study. Within a standardized evaluation process, the following was assessed routinely pre-operatively and 12 and 24 months following surgery: extent of spasticity at hip adductors and hamstrings as characterized by the Modified Ashworth Scale (MAS), maximal muscle strength as characterized by the Medical Council Research Scale (MRC), overall function regarding ambulation as characterized by the Gross Motors Function Classification System (GFMCS), and overall function as characterized by the Gross Motor Function Measure (GMFM-88). Results: Matching sets of pre- and post-operative assessments of the chosen outcome parameters were available for 109 of the 150 children who underwent SDR within the observation period. After 24 months, the MAS scores of hip adductors (n = 59) improved in 71% and 76% of children on the right and left side, respectively. In 20% and 19%, it remained unchanged and worsened in 9% and 5% of children on the right and left side, respectively (p < 0.00625). For hamstrings, the rates for the right and left sides were 81% and 79% improvement, 16% and 16% unchanged, and 4% and 5% worsened, respectively (p < 0.00625). Muscle strength of ankle dorsiflexion and knee extension significantly improved after 24 months. Overall function assessed by GMFM-88 improved significantly by 4% after 12 months (n = 77) and by 7% after 24 months (n = 56, p < 0.0001). Conclusions: The presented data underlines the benefit of SDR in a pediatric patient collective with bilateral spastic CP. The procedure resulted in an effective and permanent reduction of spasticity and improved overall function without causing relevant weakness of the lower extremities

Frequency distribution in intraoperative stimulation-evoked EMG responses during selective dorsal rhizotomy in children with cerebral palsy—part 1: clinical setting and neurophysiological procedure

Introduction: Selective dorsal rhizotomy (SDR) consists of microsurgical partial deafferentation of sensory nerve roots (L1-S2). It is primarily used today in decreasing spasticity in young cerebral palsy (CP) patients. Intraoperative monitoring (IOM) is an essential part of the surgical decision-making process, aimed at improving functional results. The role played by SDR-IOM is examined, while realizing that connections between complex EMG responses to nerve-root stimulation and a patient's individual motor ability remain to be clarified. Methods: We conducted this retrospective study, analyzing EMG responses in 146 patients evoked by dorsal-root and rootlet stimulation, applying an objective response-classification system, and investigating the prevalence and distribution of the assessed grades. Part1 describes the clinical setting and SDR procedure, reintroduced in Germany by the senior author in 2007. Results: Stimulation-evoked EMG response patterns revealed significant differences along the segmental levels. More specifically, a comparison of grade 3+4 prevalence showed that higher-graded rootlets were more noticeable at lower nerve root levels (L5, S1), resulting in a typical rostro-caudal anatomical distribution. Conclusions: In view of its prophylactic potential, SDR should be carried out at an early stage in all CP patients suffering from severe spasticity. It is particularly effective when used as an integral part of a coordinated, comprehensive spasticity program in which a team of experts pool their information. The IOM findings pertaining to the anatomical grouping of grades could be of potential importance in adjusting the SDR-IOM intervention to suit the specific individual constellation, pending further validation. Trial registration: ClinicalTrials.gov ID: NCT03079362

Frequency distribution in intraoperative stimulation-evoked EMG responses during selective dorsal rhizotomy in children with cerebral palsy—part 2: gender differences and left-biased asymmetry

Introduction: Spinal reflexes reorganize in cerebral palsy (CP), producing hyperreflexia and spasticity. CP is more common among male infants, and gender might also influence brain and spinal-cord reorganization. This retrospective study investigated the frequency of higher-graded EMG responses elicited by electrical nerve-root stimulation during selective dorsal rhizotomy (SDR), prior to partial nerve- root deafferentation, considering not only segmental level and body side, but also gender. Methods: Intraoperative neuromonitoring (IOM) was used in SDR to pinpoint the rootlets most responsible for exacerbated stimulation-evoked EMG patterns recorded from lower-limb muscle groups. Responses were graded according to an objective response-classification system, ranging from no abnormalities (grade 0) to highly abnormal (grade 4+), based on ipsilateral spread and contralateral involvement. Non-parametric analysis of data with repeated measures was primarily used in investigating the frequency distribution of these various EMG response grades. Over 7000 rootlets were stimulated, and the results for 65 girls and 81 boys were evaluated, taking changes in the composition of patient groups into account when considering GMFCS levels. Results: The distribution of graded EMG responses varied according to gender, laterality, and level. Higher-graded EMG responses were markedly more frequent in the boys and at lower segmental levels (L5, S1). Left-biased asymmetry in higher-graded rootlets was also more noticeable in the boys and in patients with GMFCS level I. A close link was observed between higher-grade assessments and left-biased asymmetry. Conclusions: Detailed insight into the patient's initial spinal-neurofunctional state prior to deafferentation suggests that differences in asymmetrical spinal reorganization might be attributable to a hemispheric imbalance

Improving XMM-Newton EPIC pn data at low energies: method and application to the Vela SNR

High quantum efficiency over a broad spectral range is one of the main properties of the EPIC pn camera on-board XMM-Newton. The quantum efficiency rises from ~75% at 0.2 keV to ~100% at 1 keV, stays close to 100% until 8 keV, and is still ~90% at 10 keV. The EPIC pn camera is attached to an X-ray telescope which has the highest collecting area currently available, in particular at low energies (more than 1400 cm2 between 0.1 and 2.0 keV). Thus, this instrument is very sensitive to the low-energy X-ray emission. However, X-ray data at energies below ~0.2 keV are considerably affected by detector effects, which become more and more important towards the lowest transmitted energies. In addition to that, pixels which have received incorrect offsets during the calculation of the offset map at the beginning of each observation, show up as bright patches in low-energy images. Here we describe a method which is not only capable of suppressing the contaminations found at low energies, but which also improves the data quality throughout the whole EPIC pn spectral range. This method is then applied to data from the Vela supernova remnant.Comment: Proc. SPIE Vol. 5488: Astronomical Telescopes and Instrumentation, UV - Gamma-Ray Space Telescope Systems, Eds. Guenther Hasinger and Martin J. Turner, 22-24 June 2004, Glasgow, Scotland United Kingdo