Veränderungen kognitiver und psychischer Merkmale nach Exstirpation erstmaliger intrakranieller niedriggradiger Meningeome unter Berücksichtigung des Screening-Verfahrens MoCA® im klinischen Alltag

In der vorliegenden Arbeit wurden kognitive und psychische Veränderungen im Rahmen neurochirurgischer Interventionen bei Patienten mit erstmaligen intrakraniellen Meningeomen unter Berücksichtigung des Screening-Verfahrens MoCA® untersucht. Die prospektiv angelegte Studie wurde an einer anfallenden Patientenstichprobe (n=14) im Erhebungszeitraum 2013 – 2015 durchgeführt. Hierbei wurde umfangreich das präoperative kognitive Niveau mit zahlreichen standardisierten neuropsychologischen Testverfahren sowie auch das psychische Befinden mittels geeigneter Fragebögen untersucht. Die Ergebnisse wurden mit alters- und bildungsadäquaten gesunden Kontrollen (n=14) verglichen. Im Fokus der Studie stand die Evaluation des MoCA®, eines inzwischen weithin etablierten Screenings. Die Ergebnisse zeigten neben signifikant schlechteren Leistungen der Patienten im präoperativen MoCA® und zumindest tendenziell höherer Lernleistung, schnelleren Detektions- und Umstellzeiten, kürzeren Bearbeitungszeiten und höheren Produktionsmaßen bei den Gesunden in die gleiche Richtung einer eher globalen präoperativen Leistungsminderung. In Bezug auf das psychische Befinden zeigten Patienten vor der Operation gegenüber Gesunden eine deutlich höhere Angst, und zumindest nominal eine höhere Depressivität, die jedoch statistisch ebenfalls nicht bedeutsam war. Das psychische Befinden hatte statistisch keinen bedeutsamen Einfluss auf die präoperativen Testergebnisse im MoCA®. Symptomdauer, Tumorgröße oder Lateralität des Tumors zeigten keinen statistisch relevanten Einfluss auf die präoperativen Testergebnisse im MoCA® oder auf das präoperative psychische Befinden. Der Vergleich der prä- und postoperativen Ergebnisse der Patienten ergab für den MoCA® keine statistisch bedeutsame Änderung. Das psychische Befinden der Patienten änderte sich im Verlauf des postoperativen Jahres dagegen nicht, weder in Bezug auf die Ängstlichkeit noch hinsichtlich der Depressivität. Schließlich konnte für die operationsspezifischen Variablen (Schnitt-Naht-Zeit, Resektionsausmaß) kein relevanter Einfluss auf die postoperativen kognitiven Leistungen im MoCA® bzw. auf das postoperative psychische Befinden nachgewiesen werden. Die vorliegenden Ergebnisse weisen insgesamt darauf hin, dass Patienten mit erstmaligen intrakraniellen Meningeomen im präoperativen Leistungsbild durchaus schlechtere Ergebnisse erzielen als Gesunde und dass sich diese Leistungen im postoperativen Verlauf mehrheitlich zu erholen scheinen. Dies deckt sich mit den bisherigen Erkenntnissen. Schließlich bestätigt die bereits präoperativ erhöhte Schließlich bestätigt die bereits präoperativ erhöhte psychische Belastung der Patienten die bisherigen Erkenntnisse einer höheren Prävalenz von Stress, Depression, Angststörungen bzw. einer Kombination. Auch zeigt sich, dass das psychischen Befinden keinen nachweisbaren Einfluss auf das postoperative Leistungsbild zu haben scheint.:1 EINLEITUNG 2 THEORETISCHER HINTERGRUND 2.1 Hirntumoren – Ätiologie, Arten, WHO-Gradierung, Epidemiologie und Klinik 2.2 Meningeome – Ätiologie, Arten, WHO-Gradierung, Epidemiologie und Klinik 2.3 Meningeome - Diagnostik und Therapie 2.4 Allgemeine Aspekte kognitiver Diagnostik - Entwicklungen und Standards 2.5 Der MoCA® als kognitives Screening zur Verlaufskontrolle 2.6 Erkenntnisse kognitiver Diagnostik bei Hirntumoren im Allgemeinen 2.7 Erkenntnisse kognitiver Diagnostik bei Meningeomen im Speziellen 2.8 Psychisches Befinden und Lebensqualität bei Patienten mit Meningeomen 2.9 Zusammenfassung 2.10 Fragestellungen 2.10.1 Kognitive Leistungen vor und nach der Exstirpation 2.10.2 Psychisches Befinden vor und nach der Exstirpation 2.10.3 Einflussfaktoren auf die präoperative Situation 2.10.4 Einflussfaktoren auf die postoperative Situation 3 METHODEN 3.1 Zur Vorbereitung der Studie 3.2 Untersuchungsdesign 3.3 Fallzahlschätzung 3.4 Ein- und Ausschlusskriterien 3.5 Organisation und Rekrutierung 3.6 Stichprobe 3.7 Eingesetzte neuropsychologische Testverfahren 3.8 Eingesetzte klinisch-psychologische Fragebögen 3.9 Ablauf der Untersuchungen 3.10 Reduktion der Variablenanzahl für die Analyse 3.11 Statistische Analyse 4 ERGEBNISSE 4.1 Kognitive Leistungen vor und nach der Exstirpation 4.2 Psychisches Befinden vor und nach der Exstirpation 4.3 Einflussfaktoren auf die präoperative Situation 4.4 Einflussfaktoren auf die postoperative Situation 5 DISKUSSION 5.1 Kognitive Leistungen vor und nach der Exstirpation eines Meningeoms 5.2 Psychisches Befinden vor und nach der Exstirpation eines Meningeoms 5.3 Methodologische Würdigung 6 SCHLUSSFOLGERUNGEN UND AUSBLICK 7 ZUSAMMENFASSUNG 7.1 Theoretischer Hintergrund 7.2 Methoden 7.3 Ergebnisse 7.4 Schlussfolgerunge

Olfactory dysfunction after autoimmune encephalitis depending on the antibody type and limbic MRI pathologies

Objective: Patients’ olfactory function after autoimmune encephalitis (AE) involving limbic structures may be impaired. This study aimed to characterize olfactory function in patients after autoimmune encephalitides. Methods: A case–control study was performed including 11 AE patients with antibodies against NMDAR (n = 4), GAD (n = 3), VGKC (n = 3) and antibody-negative AE (n = 1) and a control group of 12 patients with pneumococcal meningo-encephalitis (PC). In subgroup analyses, AE patients with and without NMDAR-antibodies were compared. Olfactory function was assessed using the Sniffin Sticks test and the resulting TDI-score (threshold, discrimination, identification). Involvement of limbic structures was evaluated on imaging data (MRI). Statistical analyses were performed to test for correlations of TDI-score and MRI results. Results: The overall olfactory function of the AE-group and the PC-group was comparable (mean TDI 32.0 [CI 27.3–36.7], 32.3 [CI 28.5–36.0)]. The proportions of hyposmic patients were similar compared to the general population. However, AE patients of the non-NMDAR group had significantly lower TDI-scores (28.9 ± 6,8) than NMDAR patients (37.4 ± 3.5) (p = 0.046) and a significantly lower discrimination capability than the NMDAR patients (9.9 ± 2.0 vs. 14.5 ± 0.6) (p = 0.002). The non-NMDAR patients had significantly more limbic MRI pathologies (6/7) compared to the NMDAR patients (0/4) (p = 0.015). Furthermore, a correlation between limbic MRI pathologies and worse capability of smelling discrimination was found (p = 0.016, r = −0.704, n = 11). Conclusion: Our results indicate that patients with NMDAR autoimmune encephalitis have normal long term olfactory function. However, patients with non-NMDAR autoimmune encephalitis appear to have a persistently impaired olfactory function, probably mediated by encephalitic damage to limbic structures

Concept For Databased Sales And Resource Planning For Re-Assembly In The Automotive Industry

In linear economy, the growing wealth in the world is linked to a growing resource consumption and greenhouse gas emission. This results in a shortage of primary resources, environmental destruction through resource extraction, and global warming. A high productivity of the manufacturing industry, overcapacities and a decrease in the value of existing products intensify this situation. Circular economy offers resource-efficient value addition by multiple utilization of resources. One challenge in this form of value creation is the duration of reconditioning processes and the lack of product innovation in reconditioned products. To bring products back to the market as quickly as possible, the method of Re-Assembly is introduced and focused in this paper. Re-Assembly can be defined as reconditioning old products into new or higher-valued products, by assembling new or remanufactured parts and components after disassembly. However, manufacturing companies face difficulties in industrialization of such methods. In practice, one of the biggest challenges is the mid- and long term planning of the reconditioning process. Due to uncertainties in the quality and quantity of the returning end-of-life products the resulting reconditioning process is challenging to predict in terms of process time and production costs. To encounter this, this paper presents a concept for sales and resource planning in the context of Re-Assembly. In the first step the uncertainties for the long term production planning and the resulting data requirements are identified. Based on this, a concept for sales and resource planning is presented. The approach is based on the Internet of Production reference framework and includes data from the whole product lifecycle. As the area of application, the automotive industry is chosen as it is the largest manufacturing industry in Germany and already leading in the recording of usage data of their products

Hillock formation of Pt thin films on Yttria stabilized Zirconia single crystals

The stability of a metal thin films on a dielectric substrate is conditioned by the magnitude of the interactive forces at the interface. In the case of a non-reactive interface and weak adhesion, the minimization of free surface energy gives rise to an instability of the thin film. In order to study these effects, Pt thin films with a thickness of 50 nm were deposited via ion-beam sputtering on yttria stabilized zirconia single crystals. All Pt films were subjected to heat treatments up to 973 K for 2 h. The morphological evolution of Pt thin films has been investigated by means of scanning electron microscopy (SEM), atomic force microscopy (AFM) and standard image analysis techniques. Three main observations have been made: i) the deposition method has a direct impact on the morphological evolution of the film during annealing. Instead of hole formation, that is typically observed as response to a thermal treatment, anisotropic pyramidal shaped hillocks are formed on top of the film. ii) It is shown by comparing the hillocks' aspect ratio with finite element method (FEM) simulations that the hillock formation can be assigned to a stress relaxation process inside the thin film. iii) By measuring the equilibrium shapes and the shape fluctuations of the formed Pt hillocks the anisotropy of the step free energy and its stiffness have been derived in addition to the anisotropic kink energy of the hillock's edges.Comment: 8 pages, 7 figure

Sex specific abdominal activation strategies during landing

Control of the trunk segment in landing has been implicated as a contributing factor to the higher incidence of anterior cruciate ligament injuries in females than in males. Investigating the sex-specific abdominal activation strategies during landing lends insight into mechanisms contributing to control of the trunk segment. To examine the abdominal activation strategies used by males and females during a landing task. Mixed-model (between-subjects and within-subjects) design. Laboratory. Healthy, recreationally active males (n = 20, age = 23 ± 4.8 years, height = 1.8 ± 0.1 m, mass = 79.6 ± 9.9 kg, body mass index = 24.8 ± 2.7 kg/ m^sup 2^) and females (n = 22, age = 20.8 ± 4.8 years, height = 1.7 ± 0.1 m, mass = 64.1 ± 9.2 kg, body mass index = 22.9 ± 2.6 kg/m^sup 2^). Subjects performed 5 double-leg landings from a box height of 60 cm. Male and female activation amplitudes for the rectus abdominis (RA), external oblique (EO), and transversus abdominis and lower fibers of the internal oblique (TrA-IO) muscles during preactivation (150-millisecond interval just before landing) and after impact (150-millisecond interval immediately after ground contact). Males had greater TrA-IO activation than females (P < .05). Males preferentially activated the TrA-IO muscles relative to the RA and EO, whereas females demonstrated no significant muscle differences. Males and females also differed by phase, with males having more TrA-IO activation than females during the preactivation landing phase (P < .05) but not during the postimpact phase. The TrA-IO was the only muscle to significantly differ by landing phase, decreasing from preactivation to postimpact (P < .05). Males used different abdominal muscle activation strategies than females in landing. The efficacy of these muscle activation strategies to control the trunk should be assessed through trunk kinematic and kinetic measures in future studies

Holisms of communication: The early history of audio-visual sequence analysis

A central pillar of contemporary communication research is the analysis of filmed interactions between people. The techniques employed in such analysis first took on a recognizably modern form in the 1970s, but their roots go back to the earliest days of motion picture technology in the late nineteenth century. This book presents original essays accompanied by written responses which together create a dialogue exploring early efforts at audio-visual sequence analysis and their common goal to capture the "whole" of the communicative situation. The first three chapters of this volume look at the film-based research of Gestalt psychologists in Berlin as well as psychologists in the orbit of Karl and Charlotte Bühler in Vienna in the first decades of the twentieth century. Most of these figures – along with many other Central European scholars of this era – were driven into exile in the United States after the rise of National Socialism in the 1930s. This scientific migration led to the cross-pollination of communication studies in America, an outcome visible in the leading project in interaction research of the mid-twentieth century, the Natural History of an Interview. The following two chapters examine this project in its historical context. The volume closes with a critical edition of a treasure from the archives: the transcript of a speech delivered by Ray Birdwhistell, a key participant in the Natural History of an Interview project and founder of kinesics

Holisms of communication: The early history of audio-visual sequence analysis

A central pillar of contemporary communication research is the analysis of filmed interactions between people. The techniques employed in such analysis first took on a recognizably modern form in the 1970s, but their roots go back to the earliest days of motion picture technology in the late nineteenth century. This book presents original essays accompanied by written responses which together create a dialogue exploring early efforts at audio-visual sequence analysis and their common goal to capture the "whole" of the communicative situation. The first three chapters of this volume look at the film-based research of Gestalt psychologists in Berlin as well as psychologists in the orbit of Karl and Charlotte Bühler in Vienna in the first decades of the twentieth century. Most of these figures – along with many other Central European scholars of this era – were driven into exile in the United States after the rise of National Socialism in the 1930s. This scientific migration led to the cross-pollination of communication studies in America, an outcome visible in the leading project in interaction research of the mid-twentieth century, the Natural History of an Interview. The following two chapters examine this project in its historical context. The volume closes with a critical edition of a treasure from the archives: the transcript of a speech delivered by Ray Birdwhistell, a key participant in the Natural History of an Interview project and founder of kinesics